Manifestaciones otorrinolaringológicas en la viruela del mono / Otorhinolaryngological manifestations in monkeypox

Antecedentes y objetivo En la actual emergencia sanitaria declarada por la Organización Mundial de la Salud (OMS) por viruela del mono se han detallado pocos datos sobre las manifestaciones otorrinolaringológicas (ORL) de dicha enfermedad. El propósito del estudio pretende describir las características clínicas de las manifestaciones ORL de la viruela del mono. Material y métodos Análisis descriptivo de 11 pacientes consecutivos con odinodisfagia o lesiones de la cavidad oral derivados al área de urgencias de ORL de un hospital terciario con factores de riesgo epidemiológicos que pudieran sugerir infección por viruela del mono. Se describen los hallazgos clínicos, diagnósticos y de tratamiento. Resultados El 90,9% de los pacientes habían tenido contacto sexual de riesgo previo. El cuadro de presentación predominante incluía fiebre de más de 38°C con odinodisfagia intensa. El examen físico mostraba úlceras y lesiones exudativas de presentación variable en la vía aerodigestiva superior. El frotis de las lesiones confirmó positividad en la reacción en cadena de la polimerasa (PCR) para viruela del mono en todos los pacientes. Conclusiones La infección por virus de viruela del mono puede presentarse en el área ORL con múltiples manifestaciones que precisan de un grado de sospecha epidemiológico alto y la confirmación con PCR para llegar a un diagnóstico de certeza. (AU)

Background and objective In the current health emergency declared by the World Health Organization (WHO) for monkeypox, few data on the otorhinolaryngological (ENT) manifestations of the disease have been detailed. The purpose of this study is to describe the clinical features of the ENT manifestations in monkeypox. Material and methods Descriptive analysis of 11 consecutive patients with odynodysphagia or oral cavity lesions referred to the ENT emergency department of a tertiary hospital with epidemiological risk factors suggestive of monkeypox infection. Clinical, diagnostic, and treatment findings are described. Results 90.9% of the patients had previous unsafe sexual contact. The predominant presenting features included fever over 38°C with severe odynodysphagia. Physical examination showed ulcers and exudative lesions of variable presentation in the upper respiratory tract. Smear of the lesions confirmed polymerase chain reaction (PCR) positivity for monkeypox in all patients. Conclusions Monkeypox virus infection can occur in the ENT area with multiple manifestations that require a high degree of epidemiological suspicion and confirmation with PCR to reach a diagnosis of certainty. (AU)

Otorhinolaryngological manifestations in monkeypox.

BACKGROUND AND OBJECTIVE: In the current health emergency declared by the World Health Organization (WHO) for monkeypox, few data on the otorhinolaryngological (ENT) manifestations of the disease have been detailed. The purpose of this study is to describe the clinical features of the ENT manifestations in monkeypox. MATERIALS AND METHODS: Descriptive analysis of 11 consecutive patients with odynodysphagia or oral cavity lesions referred to the ENT emergency department of a tertiary hospital with epidemiological risk factors suggestive of monkeypox infection. Clinical, diagnostic and treatment findings are described. RESULTS: 90.9% of the patients had previous unsafe sexual contact. The predominant presenting features included fever over 38 °C with severe odynodysphagia. Physical examination showed ulcers and exudative lesions of variable presentation in the upper respiratory tract. Smear of the lesions confirmed polymerase chain reaction (PCR) positivity for monkeypox in all patients. CONCLUSIONS: Monkeypox virus infection can occur in the ENT area with multiple manifestations that require a high degree of epidemiological suspicion and confirmation with PCR to reach a diagnosis of certainty.

[Otorhinolaryngological manifestations in monkeypox]. / Manifestaciones otorrinolaringológicas en la viruela del mono.

Background and objective: In the current health emergency declared by the World Health Organization (WHO) for monkeypox, few data on the otorhinolaryngological (ENT) manifestations of the disease have been detailed. The purpose of this study is to describe the clinical features of the ENT manifestations in monkeypox. Material and methods: Descriptive analysis of 11 consecutive patients with odynodysphagia or oral cavity lesions referred to the ENT emergency department of a tertiary hospital with epidemiological risk factors suggestive of monkeypox infection. Clinical, diagnostic, and treatment findings are described. Results: 90.9% of the patients had previous unsafe sexual contact. The predominant presenting features included fever over 38 °C with severe odynodysphagia. Physical examination showed ulcers and exudative lesions of variable presentation in the upper respiratory tract. Smear of the lesions confirmed polymerase chain reaction (PCR) positivity for monkeypox in all patients. Conclusions: Monkeypox virus infection can occur in the ENT area with multiple manifestations that require a high degree of epidemiological suspicion and confirmation with PCR to reach a diagnosis of certainty.

CO2-TOLMS for laryngeal cancer in the elderly, pushing the boundaries of partial laryngectomy.

INTRODUCTION: CO2 transoral laser microsurgery (CO2-TOLMS) has pushed the indications of partial surgery of the larynx regardless the age of the patient. OBJECTIVE: To evaluate the complications and the oncologic and functional outcomes of CO2-TOLMS in patients older and younger than 70 years. METHODS: Retrospective analysis of 1244 consecutive laryngeal carcinomas treated with CO2-TOLMS. Complications, length of hospitalization, functional and survival outcomes were evaluated. RESULTS: The mean age was 64.2 ±â€¯11.1 years (20-96). Four hundred and sixteen patients were older than 70 years and 104 older than 80 years. The main location was the glottis (912), followed by the supraglottis (332). There were no differences in pT classification between the age groups. No differences were observed in voice outcomes. A higher rate of signs of aspiration at the glottic location was observed for those older than 70 years (2.1 % vs 5 %, p = 0.027). The need for definitive gastrostomy in supraglottic tumours was higher in those older than 70 years (0 % vs 6.5 %, p: 0.001). In the glottis, no differences in tracheostomy or gastrostomy rates were observed. Five-year overall survival was lower in the older than 70 years. No differences in disease-specific survival were observed in early stages for both locations, but a lower survival was observed in stage III glottic cancer for the older than 70 years. CONCLUSIONS: CO2-TOLMS is a valid treatment for laryngeal carcinomas in the elderly, with a reduced number of complications and good functional and oncologic outcomes.

Loss of smell in patients with traumatic brain injury is associated with neuropsychiatric behavioral alterations.

OBJECTIVE: We sought to identify and correlate the severity of traumatic brain injuries (TBIs) associated with olfactory dysfunction with cognitive and behavioral profiles. PARTICIPANTS AND SETTING: Patients with TBI undergoing treatment in a specialized neuro-rehabilitation hospital. DESIGN: Prospective study. MAIN MEASURES: Glasgow Coma Scale (GCS) at the time of injury and during posttraumatic amnesia. Motor functions were assessed with the Functional Instrument Measure and Disability Rating Scales. The Wechsler Adult Intelligence test was used for neuropsychologic assessment and the Neuropsychiatric Inventory was used to assess behavioral changes. The Barcelona Smell Test-24 was used to study subjective smell loss. RESULTS: A total of 111 patients with TBI were enrolled (33 females; mean age 32.86 years); 38.73% exhibited smell loss. Patients with no olfactory impairment (OI) had worse TBIs than those with OI (GCS scores 5.65 and 7.74, respectively); no significant differences in cognitive behaviors, such as attention memory, visuoperception, and visuoconstruction, were observed. However, patients with TBI and olfactory dysfunction showed statistically significant alterations in neuropsychiatric behavioral performances such as feeding when compared with patients with TBI without smell loss. CONCLUSION: Olfactory dysfunction in patients with a TBI correlates with altered neuropsychiatric behavioral performances such as feeding, sleeping, and motor behavior.

Transoral laser microsurgery in locally advanced laryngeal cancer: Prognostic impact of anterior versus posterior compartments.

BACKGROUND: To evaluate the importance of larynx compartments in the prognosis of T3-T4a laryngeal cancer treated with transoral laser microsurgery. METHODS: Two hundred and two consecutive pT3-T4a larynx carcinomas. Pre-epiglottic space involvement, anterior and posterior paraglottic space (PGS) involvement, vocal cord, and arytenoid mobility were determined. Local control with laser (LC), overall survival (OS), disease-specific survival (DSS), and laryngectomy-free survival (LFS) were evaluated. RESULTS: The lowest LC was found in tumors with fixed arytenoid. In the multivariate analysis, positive margins (hazard ratio [HR] = 0.289 [0.085-0.979]) and anterior (HR = 0.278 [0.128-0.605]) and posterior (HR = 0.269 [0.115-0.630]) PGS invasion were independent factors of a reduced LC. Anterior (HR = 3.613 [1.537-8.495]) and posterior (HR = 5.195 [2.167-12.455]) PGS involvement were independent factors of total laryngectomy. Five-year OS, DSS, and LFS rates were 63.9%, 77.5%, and 77.5%, respectively. Patients with posterior PGS presented a reduced 5-year LFS. CONCLUSIONS: Tumor classification according to laryngeal compartmentalization depicts strong correlation with LC and LFS.

Intra and interobserver agreement of narrow band imaging for the detection of head and neck tumors.

BACKGROUND: Narrow band imaging (NBI) in combination with white light endoscopy (WLE) has improved the accuracy for the diagnosis and follow-up of head and neck carcinomas by identifying changes in the vascular patterns of the mucosa. However, NBI evaluation is explorer-dependent and may be influenced by the learning curve. The aim of this study is to assess the intra and interobserver agreement of NBI and WLE at the office, under local anaesthesia, by either experienced or non-experienced observers. METHODS: Eighty-seven images of head and neck lesions were routinely collected under WLE and NBI. A group of three experienced otolaryngologists and three medical students assessed the images after a brief training. No additional patient information was provided. The same protocol was repeated after three weeks. Intra and interobserver agreement were calculated with the kappa index. RESULTS: NBI intraobserver agreement was substantial (κ = 0.62) and better than with WLE alone, which was moderate (κ = 0.57) in both groups. Interobserver agreement was moderate with WLE (κ = 0.58) and substantial with NBI (κ = 0.63). Both groups improved intraobserver and interobserver agreement with the implementation of NBI. CONCLUSIONS: Intra and interobserver agreement with NBI for the evaluation of head and neck lesions are substantial, and improve the results of WLE alone in both, professionals and trainees.

Olfactory Training in Post-Traumatic Smell Impairment: Mild Improvement in Threshold Performances: Results from a Randomized Controlled Trial.

Traumatic Brain Injury (TBI) can be associated with partial or total smell loss. Recent studies have suggested that olfactory outcome can be positively modulated after olfactory training (OT). This study's aim was to investigate OT's potential role in smell recovery after TBI-induced olfactory loss. A prospective, randomized, and controlled study was developed. Patients with TBI-induced olfactory dysfunction (n = 42) were randomized into an experimental group with OT and a control group without (nOT). OT was performed twice daily with a six odor training set during 12 weeks. Olfactory loss was assessed using subjective olfactometry (Barcelona Smell Test [BAST] 24), a visual analogue scale (VAS), and n-butanol threshold (n-BTt) at baseline at 4, 12, and 24 weeks. Additionally, patients underwent MRI of the olfactory brain and olfactory bulbs (OB). Based on the MRI results, an overall score (0-16) was developed to associate the structural neurological damage with olfactory outcomes. The primary outcome was the change in olfactory measurements (VAS and BAST-24) between baseline and 12 weeks. The secondary outcome was the association of the MRI score with olfactory outcomes at baseline, and the impact on quality of life (QoL). After 12 weeks of training, OT patients showed a significant improvement in n-BTt (0.6 ± 1.7 OT vs. -0.6 ± 1.8 nOT, p < 0.05), but not in the smell VAS and BAST-24 scores. Olfactory outcomes (VAS, BAST-24, and n-BTt) were significantly associated with MRI structural findings (p < 0.001), but not with the OB volume or olfactory sulcus length. The present study suggests that 12 weeks of OT mildly improves the olfactory threshold in TBI, whereas the overall MRI score may be used as an imaging marker of olfactory dysfunction and disease severity in TBI patients.

Olfactory function in an excitotoxic model for secondary neuronal degeneration: Role of dopaminergic interneurons.

Secondary neuronal degeneration (SND) occurring in Traumatic brain injury (TBI) consists in downstream destructive events affecting cells that were not or only marginally affected by the initial wound, further increasing the effects of the primary injury. Glutamate excitotoxicity is hypothesized to play an important role in SND. TBI is a common cause of olfactory dysfunction that may be spontaneous and partially recovered. The role of the glutamate excitotoxicity in the TBI-induced olfactory dysfunction is still unknown. We investigated the effects of excitotoxicity induced by bilateral N-Methyl-D-Aspartate (NMDA) OB administration in the olfactory function, OB volumes, and subventricular zone (SVZ) and OB neurogenesis in rats. NMDA OB administration induced a decrease in the number of correct choices in the olfactory discrimination tests one week after lesions (p<0.01), and a spontaneous recovery of the olfactory deficit two weeks after lesions (p<0.05). A lack of correlation between OB volumes and olfactory function was observed. An increase in SVZ neurogenesis (Ki67+ cells, PSANCAM+ cells (p<0.01) associated with an increase in OB glomerular dopaminergic immunostaining (p<0.05) were related to olfactory function recovery. The present results show that changes in OB volumes cannot explain the recovery of the olfactory function and suggest a relevant role for dopaminergic OB interneurons in the pathophysiology of recovery of loss of smell in TBI.

Usefulness of office examination with narrow band imaging for the diagnosis of head and neck squamous cell carcinoma and follow-up of premalignant lesions.

BACKGROUND: The purpose of this study was to evaluate the value of narrow band imaging (NBI) examination in the office for the diagnosis and follow-up of upper airway premalignant and malignant lesions. METHODS: Four hundred eighty lesions were evaluated with white light endoscopy (WLE) and NBI before a biopsy/excision. Additionally, 151 premalignant lesions were followed up without proven biopsy. Carcinoma-free survival was calculated. The learning curve was analyzed. RESULTS: Overall, the accuracy improved from 74.1% with WLE to 88.9% with NBI, being relevant in all anatomic subsites. The accuracy of NBI increased significantly with increasing experience (area under the curve [AUC] >0.9). After a follow-up of 25 months, 14 of 151 lesions (9.3%) converted into carcinoma. The 4-year carcinoma-free survival rate was 86.4%. The 4-year carcinoma-free survival rate differed significantly between lesions classified as benign/mild dysplasia versus those presenting as moderate/severe dysplasia (88.9% vs 73.5%; P = .018). CONCLUSION: The NBI provided a greater accuracy than WLE and showed promising usefulness for the follow-up of premalignant lesions.

Prognostic factors of quality of life after transoral laser microsurgery for laryngeal cancer.

We aimed to evaluate factors influencing quality of life (QOL) after transoral laser microsurgery (TLM) of laryngeal cancer. Four hundred and one consecutive disease-free patients were evaluated 1 year after treatment using the University of Washington-QOL v4, the SF-12 (short form of SF-36), and a questionnaire about self-rated health status. The importance of age, gender, tumor location, tumor size, tumor stage, neck dissection and adjuvant treatment were evaluated. One year after TLM patients had a good QOL, with only 6 % of patients reporting a worsening in their health status. Radiation therapy (p = 0.000) and neck dissection (p = 0.000) were negative factors for disease-specific QOL, whereas age ≥ 70 (p = 0.01) was a positive independent factor for mental score of SF-12. Speech was negatively influenced by tumor size (p = 0.001) as was swallowing by age (p = 0.001) and postoperative radiation (p = 0.000). Patients treated with TLM present a good QOL 1 year after surgery. Radiation and neck dissection negatively impact QOL. Elderly patients cope better with their disabilities.

Management of chronic rhinosinusitis in asthma patients: is there still a debate?

The united airway concept in which upper and lower respiratory conditions are present in one patient requires special consideration. There is some evidence linking chronic rhinosinusitis and asthma, but a good understanding of the pathophysiology and combined management is still lacking, a fact that leads to discussion. Bronchial asthma is more prevalent in patients who suffer chronic rhinosinusitis. On the other hand, patients with asthma have a greater prevalence of rhinosinusitis than patients without asthma. The effect of chronic rhinosinusitis in patients with or without nasal polyps on asthma treatment, whether medical or surgical, is controversial. Some studies show worsening, other trials improvement, and others no effect. Direct comparisons between surgical and medical treatments are few. Most of the current literature available about this intriguing combination does not provide a good level of evidence. Thus, randomized clinical trials should be performed to better understand the management when asthma and CRS occur together. This review aims to summarize the current state of this association regarding the effects of different types of treatment.

The optimal evaluation and management of patients with a gradual onset of olfactory loss.

PURPOSE OF REVIEW: The aim of this review is to provide an overview of the causes of olfactory dysfunction, their evaluation and management, with a main focus on the gradual/progressive loss of smell. RECENT FINDINGS: As the sense of smell gives us essential information about our environment, its loss can cause nutritional and social problems while threatening an individual's safety. Recent surveys have shown quite a substantial prevalence of hyposmia (one out of four people) and anosmia (one out of 200 people) in a variety of populations. SUMMARY: Nasal inflammatory diseases such as allergic rhinitis and predominantly chronic rhinosinusitis account for the major and common causes of gradual/progressive loss of smell. However, they are also among the most successfully treated forms of olfactory dysfunction. The management of gradual/progressive smell deficit must always address its etiological causes. In most cases, a detailed medical history and nasal examination, smell testing, and imaging will help to establish an appropriate diagnosis. In addition to anti-inflammatory therapy, mainly nasal and systemic corticosteroids, recent investigations on smell training suggest that the controlled exposure to selected odors may increase olfactory performance. VIDEO ABSTRACT AVAILABLE: See the Video Supplementary Digital Content 1 (http://links.lww.com/COOH/A8).

Quality of life after transoral laser microresection of laryngeal cancer: a longitudinal study.

BACKGROUND AND METHODS: In the treatment of early to moderate laryngeal carcinoma, both, transoral laser surgery and radiation-based protocols have demonstrated good survival and preservation rates. In this scenario, quality of life (QOL) may become an important tool for treatment planning. We aimed to evaluate QOL changes after transoral laser microsurgery (TLM). Prospective longitudinal study. Ninety-three consecutive disease-free patients were evaluated using UW-QOL v4 and SF-12, before and 12 months after treatment. Changes over time were assessed according to age, gender, location, tumor size, and adjuvant treatment. RESULTS: UW-QOL improved from 1,051.5 ± 133.7 to 1,121.7 ± 92.1 (P = 0.000), suggesting that the impact of the treatment was favorable in most of the patients. Voice quality significantly improved after TLM, but speech was still the most important variable for 46% of the patients. Tumor location (P = 0.002) was an independent factor for preoperative total score of UW-QOL, whereas adjuvant radiation (P = 0.03) and neck dissection (P = 0.02), were the only postoperative negative factors. CONCLUSION: One year after TLM patients present a very good QOL. Relevant voice impairment is detected especially in locally advanced tumors, reinforcing the necessity of preoperative counseling and postoperative rehabilitation. Adjuvant radiotherapy and neck dissection negatively influenced disease-specific QOL.