Improvement in Nasal Obstruction and Quality of Life after Nasal Septoplasty with Turbinoplasty: A Pre- and Post-study

Abstract Introduction Septoplasty and turbinoplasty are common surgical interventions used to relieve nasal obstructive symptoms. Since it is difficult to measure the degree of nasal blockage, current literature wonders about the frequent performance of these procedures. Objective To evaluate the perceived change in the nasal obstruction and the quality of life (QoL) of patients that underwent a septoplasty along with a turbinoplasty by applying subjective scales, to describe the correlation between those scales, and to study the impact of clinical factors in the postoperative outcomes. Methods Prospective observational study. The Nasal Obstruction Symptom Evaluation (NOSE), the Visual Analog Scale (VAS), and the Glasgow Benefit Inventory (GBI) were assessed. The paired sample Wilcoxon test was used to evaluate the difference between the pre- and postoperative surveys. The correlation coefficient between the subjective scales was calculated. A quantile regression was performed to evaluate the effect of surgery on the results adjusted for clinical and demographic variables. Results A total of 115 patients were interviewed. Postoperative NOSE scores were 45 points lower (95% confidence interval [CI]: - 53.53-- 35.46; p < 0.001) in comparison with the NOSE preoperative scores. Obesity was the only statistically significant factor associated with worse outcomes. Additionally, we found a high correlation between the NOSE and VAS scores and a negative correlation between the GBI and postoperative VAS scores. Conclusion Nasal septoplasty, when paired with a turbinoplasty, decreases nasal obstruction and improves QoL. Obesity was associated with worse results. There was a strong correlation between the NOSE and the VAS results and between the GBI and postoperative VAS results.

Improvement in Nasal Obstruction and Quality of Life after Nasal Septoplasty with Turbinoplasty: A Pre- and Post-study.

Introduction Septoplasty and turbinoplasty are common surgical interventions used to relieve nasal obstructive symptoms. Since it is difficult to measure the degree of nasal blockage, current literature wonders about the frequent performance of these procedures. Objective To evaluate the perceived change in the nasal obstruction and the quality of life (QoL) of patients that underwent a septoplasty along with a turbinoplasty by applying subjective scales, to describe the correlation between those scales, and to study the impact of clinical factors in the postoperative outcomes. Methods Prospective observational study. The Nasal Obstruction Symptom Evaluation (NOSE), the Visual Analog Scale (VAS), and the Glasgow Benefit Inventory (GBI) were assessed. The paired sample Wilcoxon test was used to evaluate the difference between the pre- and postoperative surveys. The correlation coefficient between the subjective scales was calculated. A quantile regression was performed to evaluate the effect of surgery on the results adjusted for clinical and demographic variables. Results A total of 115 patients were interviewed. Postoperative NOSE scores were 45 points lower (95% confidence interval [CI]: - 53.53-- 35.46; p < 0.001) in comparison with the NOSE preoperative scores. Obesity was the only statistically significant factor associated with worse outcomes. Additionally, we found a high correlation between the NOSE and VAS scores and a negative correlation between the GBI and postoperative VAS scores. Conclusion Nasal septoplasty, when paired with a turbinoplasty, decreases nasal obstruction and improves QoL. Obesity was associated with worse results. There was a strong correlation between the NOSE and the VAS results and between the GBI and postoperative VAS results.

Analysis of tinnitus severity and associated factors in patients with chronic otitis media in a low- to middle-income country.

OBJECTIVE: This study aimed to describe the tinnitus severity in patients with chronic otitis media (COM) and describe the sociodemographic and clinical variables associated with tinnitus severity. DESIGN: Cross-sectional study. Two otology-referral centers in Bogotá (Colombia) were included. Sociodemographic, clinical associated factors and quality of life questionnaires were applied. Otoscopic evaluation and audiometric data were collected. STUDY SAMPLE: About 231 adults with COM. RESULTS: Up to 51.5% of the patients reported severe tinnitus discomfort, 21.7% moderate discomfort, and 26.8% minor discomfort. Factor associated with increased tinnitus severity in patients with COM were older age (aOR: 1.02; 95% CI: 1.01-1.05), higher education (aOR: 2.24; 95% CI: 1.03-4.87), ear discharge during childhood (aOR: 1.88; 95% CI: 1.02-3.45), cholesteatoma in one ear (aOR: 2.26; 95% CI: 1.05-4.88), and pure-tone air average over 15 dB (aOR: 2.08; 95% CI: 1.28-3.36). Differences of 10-points in symptoms severity and 15-points in the total score of the "Chronic Suppurative Otitis Media Questionnaire-12" were found between the tinnitus severity groups. CONCLUSIONS: Our results highlight the need for further research on the associated factors of tinnitus severity on COM patients. COM patients with higher tinnitus severity presented worse audiometric results and worse quality of life outcomes.

Nasal Obstruction and Quality of Life Assessment After Septoplasty With Turbinoplasty: Correlation Between Subjective Scales.

BACKGROUND: Assessment of nasal obstruction is imprecise due to a low correlation between findings on the physical examination and objective measures with the severity of symptoms reported by the patient even after septoplasty with turbinoplasty is performed. The aim of this study is to evaluate the use of subjective scales, and the correlation between them for the evaluation of nasal obstruction after surgery. OBJECTIVE: To assess the impact of undergoing septoplasty with turbinoplasty to relieve nasal obstructive symptoms and the quality of life in a mid-term period by using the Visual Analogue Scale (VAS), Nasal Obstruction Symptom Evaluation (NOSE), and Glasgow Benefit Inventory (GBI). METHODS: A retrospective study was conducted of patients who underwent a septoplasty with turbinoplasty due to nasal septodeviation and secondary nasal obstructive symptoms at the Hospital Universitario Fundación Santa Fe de Bogotá. Three scales were used to measure the outcomes one year after surgery: VAS (0-10), NOSE (0-100), and GBI (-100 to 100). RESULTS: Data from 56 patients (21 females, mean age 37.5 years of age, SD 12.13) was collected. The results showed that 75% of the patients had a post-surgical NOSE score below 50 and a VAS score below 6. Regarding the GBI scale, 75% of the patients improved in their quality of life. An inverse proportional correlation was found between the NOSE and GBI scales (rho = -0.3682) (95% CI -0.579 to -0.111), and there was a directly proportional correlation between the NOSE and VAS scales (rho = 0.7440) (95% CI 0.595 to 0.844). CONCLUSION: Subjective measures suggest there was an improvement in nasal obstructive symptoms and quality of life after surgery. Non-anatomical causes such as rhinitis can be confounding factors to consider in subsequent studies. VAS stands out as a possible interchangeable scale with NOSE to measure nasal obstruction in these patients.

¿Es necesaria la prueba confirmatoria para COVID-19 prequirúrgica? Experiencia preliminar de un departamento de otorrinolaringología / ¿Is there a really a need for preoperative PCR testing for COVID-19? Preliminary experience of an ENT Department

Introducción: la enfermedad por el nuevo coronavirus de 2019 (COVID-19) ha cambiado la practica quirúrgica. Su aparición en nuestro país ha provocado el aplazamiento masivo de las cirugías electivas. La evidencia actual sobre los desenlaces de las cirugías electivas de otorrinolaringología durante la pandemia de COVID-19 es limitada. Objetivo: describir la experiencia quirúrgica durante la pandemia de COVID-19 en un departamento de otorrinolaringología en Bogotá, Colombia. Métodos: estudio retrospectivo que incluyó las historias clínicas y las descripciones quirúrgicas de los pacientes que fueron llevados a cirugía de otorrinolaringología durante la pandemia de COVID-19 en dos hospitales, entre el 5 de mayo y el 15 de agosto de 2020 en Bogotá, Colombia. Resultados: Se incluyeron 199 pacientes (122 hombres con una mediana de edad de 28 años). Ningún paciente falleció o requirió del ingreso a una unidad de cuidados intensivos (UCI). El 97,5 % de las cirugías fueron electivas. 19,5 % pacientes desarrollaron síntomas relacionados con COVID-19 en el posoperatorio; de los pacientes evaluados, solo uno obtuvo un resultado positivo posquirúrgico para COVID-19 y no desarrolló ninguna complicación. Seis pacientes desarrollaron complicaciones después de la cirugía y uno tuvo neumonía con resultado negativo en la prueba de reacción en cadena de la polimerasa nasofaríngeo (PCR) para COVID-19. Conclusiones: a pesar de la alta exposición a aerosoles durante las cirugías de otorrinolaringología y la alta transmisibilidad del virus, los resultados sugieren que estas cirugías, con el uso apropiado del equipo de protección personal (EPP), y la adecuada selección de los pacientes son seguras para el paciente y para el otorrinolaringólogo.

Introduction: The 2019 novel coronavirus disease (COVID-19) has changed global surgical activity causing massive elective surgery postponement. Current evidence surrounding surgical outcomes after otorhinolaryngological surgical procedures during COVID-19 pandemic is limited. Objective: To describe our surgical experience during COVID-19 outbreak in an otolaryngology department in Bogotá, Colombia. Methods: This retrospective study analysed the records and surgical information of adults and children's patients who underwent an elective or emergency ENT surgery during COVID-19 outbreak at two hospitals between May 5 to August 15, 2020 in Bogotá, Colombia. Results: A total of 199 patients were enrolled (122 males, median age of 28 years). No patients died or required intensive unit care (ICU). Elective surgery represented the 97.5% surgeries. 19.5% patients had COVID-19 related symptoms in the postoperative period, from the tested patients only one obtained a positive COVID-19 polymerase chain reaction (PCR) test result and did not develop any associated respiratory complication. Six patients developed complications after surgery, and one had pneumonia with a negative COVID-19 PCR nasopharyngeal swab result. Conclusions: This study shows that despite the high exposure to droplets during otorhinolaryngologic surgeries and the inherent high transmissibility from the virus, the surgical procedures with correct patient selection and appropriate use of PPE can be safe for both the patient and the otolaryngologist.

Consideraciones perioperatorias para cirugía otológica en época de COVID-19 / Perioperative aspects in otologic surgery during COVID-19 era

La cirugía electiva en otología se ha visto afectada por la pandemia del COVID-19. No sabemos cuánto tiempo pasará hasta que veamos un descenso en el número de casos nuevos y podamos volver al ejercicio médico que conocíamos. Mientras tanto, debemos adaptarnos rápidamente a la nueva forma de funcionamiento de los servicios quirúrgicos en otología, siguiendo los protocolos que están surgiendo para la reactivación gradual y segura de esta clase de actividad. El objetivo de este artículo es realizar una revisión narrativa de la literatura sobre las nuevas recomendaciones para la reactivación de los servicios quirúrgicos otológicos durante esta pandemia, estableciendo pautas seguras en el manejo perioperatorio. Una de las metas más importantes es brindar una guía sobre la forma de comportarse dentro del ambiente de los quirófanos, sus cambios operacionales, el correcto uso de elementos de protección personal y dar a conocer métodos que busquen disminuir la exposición del equipo quirúrgico a la aerosolización, describiendo una técnica novedosa de vestido del microscopio de doble cubrimiento con extensión cefálica para el cirujano.

Otologic surgical procedures have been affected by the COVID-19 pandemic. Is not known how long it will be until we see a decrease in the number of new cases and when we will be able to return to our usual medical practice. Meanwhile, we must adapt quickly to a new surgical practice in the COVID era. This article discuses recommendations for reactivating otological surgical services during the pandemic, establishing safe guidelines for ear surgery and for postoperative patient follow-up. One of the most important goals is to provide recommendations on how to behave in the operating room, how to use personal protection elements and to present new methods that seek to reduce the exposure of the surgical team to aerosolization. Here we describe a novel technique using the already described double draping technique and adding an extension for the surgeon´s protection.

COVID-19: generalidades, comportamiento epidemiológico y medidas adoptadas en medio de la pandemia en Colombia / COVID-19: Generalities, epidemiological behavior and measures adopted in the middle of the pandemic in Colombia

En diciembre de 2019 se reportó a la oficina de la Organización Mundial de la Salud (OMS) los primeros casos de neumonía de etiología desconocida en Wuhan, Provincia Hubei, China. Posteriormente, se identificó como agente causal un nuevo virus de la familia coronavirus (CoV). La enfermedad fue nombrada por la OMS como enfermedad coronavirus 2019 (COVID-19, por su sigla en inglés). Por su rápida expansión global y alta infectividad, se declaró la enfermedad como una emergencia sanitaria mundial. La mortalidad se ha visto que varía dependiendo de la región. Múltiples países, incluyendo Colombia, han logrado desarrollar medidas de contención fundamentadas en el aislamiento social con un gran impacto socioeconómico secundario. El siguiente artículo describe el cuadro clínico del virus, su comportamiento epidemiológico en Colombia y qué medidas públicas se han adoptado en Colombia y otros países latinoamericanos frente a la pandemia.

In December 2019, the first cases of pneumonia of unknown etiology were reported to the World Health Organization (WHO) office in Wuhan, Hubei Province, China. Subsequently, a new coronavirus family virus (CoV) was identified as the causal agent. The disease was named by the WHO as Coronavirus Disease 2019 (COVID-19). Due to its rapid global expansión and high infectivity, the disease was declared a global health emergency. Mortality has been seen to vary depending on the region. Multiple countries, including Colombia, have managed to develop containment strategies based on social isolation with an important secondary socioeconomic impact. The following article describes the virus clinical features, its epidemiology in Colombia and public health measures taken in Colombia and other countries in latin america in response to the pandemic.

Lista de chequeo preoperatorio para la cirugía endoscópica de hipófisis / Preoperative checklist for endoscopic pituitary surgery

Introducción: las listas de chequeo son herramientas que buscan evitar errores y complicaciones al momento de realizar un procedimiento. El adenoma hipofisiario es la primera causa de cirugía endoscópica transnasal de la región selar, y se estima que ocurren hasta un 20 % de complicaciones derivadas de esta cirugía. Objetivo: desarrollar una lista de chequeo preoperatoria que sirva como una guía para la evaluación prequirúrgica de los pacientes a quienes se les realicen cirugías de la región selar. Metodología: se realizó una revisión de la literatura para desarrollar una lista de chequeo preliminar y una serie de declaraciones que resumían los puntos importantes de la lista. Se construyó un comité de expertos en cirugía endoscópica de la base de cráneo conformado por neurocirujanos y otorrinolaringólogos de hospitales de Bogotá. Utilizando la metodología Delphi modificada, se llegó a un consenso para la realización de la lista de chequeo final. Resultados: se describieron 15 declaraciones; de estas, hubo una discrepancia en 6 declaraciones. Por esta razón, se realizaron modificaciones en 5 declaraciones, y se llegó a un consenso entre los expertos participantes. La lista de chequeo final aprobada está compuesta por 4 ítems. Discusión/conclusiones: la cirugía para el manejo de la patología de la región selar es compleja y requiere de un equipo quirúrgico entrenado y disciplinado para lograr los mejores desenlaces posibles. Consideramos que nuestra lista de chequeo es una herramienta que permitirá a los equipos que realizan estas cirugías en Colombia tener una visión más completa del paciente y, eventualmente, ayudar a evitar errores y posibles complicaciones.

Introduction: checklists that seek to avoid errors are very useful tools for any surgical practice. Pituitary adenomas are the leading indication to perform a transnasal endoscopic surgery in the sellar region and up to 20 % complications have been reported related to this procedure. Objetive: develop a preoperative checklist, based on an expert consensus, to serve as a guide for the skull base teams to consistently evaluate preoperatively all patients with pathologies in the sellar region. Methods: a literature review was conducted to develop a preliminary checklist and a series of statements summarizing the most important items on the list. A committee of experts in endoscopic skull base surgery was summoned, made up of neurosurgeons and otolaryngologists from hospitals in Bogotá. Using the modified Delphi methodology, a consensus was reached for the completion of the final checklist. Results: fifteen statements were developed. A discrepancy was seen in six statements. Modifications were made for five statements, thus reaching a consensus among the participating experts. The final approved checklist is made up of 4 items. Conclusion: surgery for treating different pathologies in the sellar region is complex and requires a welltrained and disciplined surgical team to achieve the best possible outcomes. We consider that our preoperative checklist is a valuable resource for skull base surgical teams performing transnasal endoscopic surgery of the sellar region. This tool will allow skull base surgical teams in Colombia to have a more comprehensive view of the patient and eventually help to avoid errors and possible complications.