Procedimientos para la integración de una Unidad de Voz en el funcionamiento de un Servicio/Área de ORL y sus resultados / Procedures for Integrating a Voice Unit in an ENT area/service and its results

Objetivos(I): Servir de modelo para aquellos Servicios de ORL que se encuentren en proceso de creación de una Unidad de Voz. (II) Exponer los resultados que hemos obtenido en nuestra Unidad de Voz a lo largo de los últimos 12 meses. Material y método: Se desarrollan los apartados: Funciones de la Unidad de Voz; Organización de la Unidad de Voz y Procedimientos de la Unidad de Voz. Se han estudiado 122 pacientes: valoración de autopercepción mediante el Índice de Incapacidad Vocal, categoría diagnóstica, diagnóstico de la Unidad, tratamientos previos y tratamientos propuestos por la Unidad. Resultados: Entre los resultados destacamos: tendencia en las puntuaciones del Voice Handicap Index a valoración leve y moderada; el grupo patológico más frecuente son las lesiones exudativas del espacio de Reinke; la existencia de más de un 50% de discrepancias diagnósticas entre las Consultas de ORL Generales y la Unidad de Voz; la terapia más habitual es el tratamiento logopédico (45%) seguido de la fonocirugía con un 28%. Conclusiones: El objetivo principal de la Unidad de Voz será obtener la máxima efectividad y calidad en sus diferentes funciones. Un diagnóstico y tratamiento correcto aumenta la efectividad y permite un mejor aprovechamiento de los recursos. Para alcanzarlo se requiere un equipamiento mínimo e imprescindible: laringoestroboscopio, protocolo multidimensional y trabajo interdisciplinar (AU)

Objectives(I): To serve as a model for ENT services in the process of creating a Voice Unit and (II) to show the results obtained in our Voice Unit over the past 12 months. Methods: Sections on Voice Unit Functions, Organisation, and Procedures are presented, as well as the study of 122 patients: an assessment of patient self-perception using the Voice Handicap Index, diagnostic category, Voice Unit diagnosis, previous treatments, and treatments proposed by the Unit. Results: The results highlight that Voice Handicap Index scores tend towards mild and moderate evaluations; that the most frequent pathological group are exudative lesions affecting Reinke's space; that there are diagnostic discrepancies of more than 50% between the general ENT consultations and the Voice Unit; and that the most common treatment is speech and language therapy (45%), followed by phonosurgery (28%). Conclusions: The main aim of the Voice Unit is to achieve maximum effectiveness and quality in its various functions. Correct diagnosis and treatment increase effectiveness and allow better use of resources; achieving this requires a minimal, essential setup: laryngostroboscope, a multidimensional protocol and interdisciplinary work (AU)

[Procedures for integrating a voice unit in an ENT area/service and its results]. / Procedimientos para la integración de una Unidad de Voz en el funcionamiento de un Servicio/Área de ORL y sus resultados.

OBJECTIVES: (I) To serve as a model for ENT services in the process of creating a voice unit and (II) to show the results obtained in our Voice Unit over the past 12 months. METHODS: Sections on Voice Unit Functions, Organisation and Procedures are presented, as well as the study of 122 patients: an assessment of patient self-perception using the Voice Handicap Index, diagnostic category, Voice Unit diagnosis, previous treatments and treatments proposed by the Unit. RESULTS: The results highlight that Voice Handicap Index scores tend towards mild and moderate evaluations; that the most frequent pathological group are exudative lesions affecting Reinke's space; that there are diagnostic discrepancies of more than 50% between the general ENT consultations and the Voice Unit; and that the most common treatment is speech and language therapy (45%), followed by phonosurgery (28%). CONCLUSIONS: The main aim of the Voice Unit is to achieve maximum effectiveness and quality in its various functions. Correct diagnosis and treatment increases effectiveness and allows better use of resources; achieving this requires a minimal, essential setup: laryngostroboscope, a multidimensional protocol and interdisciplinary work.

Resultado funcional de las miringoplastias / Functional results in myringoplasties

Objetivo: Determinar la mejoría de los umbrales auditivos tras la realización de una miringoplastia. Material y métodos: Utilizamos un estudio restrospectivo con un total de 119 casos intervenidos de miringoplastia en nuestro servicio analizando los umbrales aéreos pre- y posquirúrgicos a los 6 meses de la intervención. Se realiza un análisis de varianzas para las distintas variables y un contraste de hipótesis utilizando una T-Student. Resultados: Se obtuvo una mejoría en umbrales aéreos en todas las frecuencias, excepto en 8.000Hz, en los que la cirugía empeora la audición sensiblemente. La ganancia auditiva es mayor cuanto más baja es la frecuencia, con lo que se obtuvo el resultado máximo en 250Hz, donde la mejoría auditiva media llegó hasta los 13,49dB. Conclusiones: La miringoplastia es una técnica eficaz en la recuperación de umbrales auditivos secundarios a un defecto de la membrana timpánica (AU)

Goal: The aim of this study was to assess hearing improvement after myringoplasty. Material and methods: We present a retrospective study with a total of 119 cases undergoing myringoplasty at our Department analyzing the air conduction thresholds before and 6 months after surgery. We conducted an analysis of variance for the different variables and contrasted hypotheses using Student's T-test. Results: We obtained a hearing improvement at all frequencies, except at 8.000Hz, at which surgery noticeably worsens hearing. The lower the frequency, the higher the hearing improvement, with the best results at 250Hz, where the mean hearing improvement reached 13.49dB. Conclusions: Myringoplasty is an effective technique in the recovery of hearing thresholds secondary to a tympanic membrane perforation (AU)

[Functional results in myringoplasties]. / Resultado funcional de las miringoplastias.

GOAL: The aim of this study was to assess hearing improvement after myringoplasty. MATERIAL AND METHODS: We present a retrospective study with a total of 119 cases undergoing myringoplasty at our Department analyzing the air conduction thresholds before and 6 months after surgery. We conducted an analysis of variance for the different variables and contrasted hypotheses using Student's T-test. RESULTS: We obtained a hearing improvement at all frequencies, except at 8.000 Hz, at which surgery noticeably worsens hearing. The lower the frequency, the higher the hearing improvement, with the best results at 250 Hz, where the mean hearing improvement reached 13.49 dB. CONCLUSIONS: Myringoplasty is an effective technique in the recovery of hearing thresholds secondary to a tympanic membrane perforation.

Evaluación del uso apropiado de procedimientos sanitarios mediante el método RAND: revisión de su aplicación en la literatura biomédica (1999-2004) / Review of the utilization of the RAND appropriateness method in the biomedical literature (1999-2004)

Objetivos: Identificar y describir los estudios de evaluación del uso apropiado de procedimientos sanitarios en los cuales se haya empleado el método RAND/UCLA. Se trata de una técnica de consenso con varias fases para el desarrollo de criterios de uso apropiado. Métodos: La búsqueda bibliográfica se realizó en 2005, consultando las bases de datos OVID-Medline, ISI Web of Knowledge, Índice Médico Español y Highwire. Se seleccionaron los artículos publicados entre 1999 y 2004 que tuviesen las palabras clave «appropriateness», «utilization review» y «physician practice patterns». Se incluyeron los estudios en que se hubiese aplicado el método RAND y se excluyeron aquellos cuya metodología no estuviese suficientemente explicada. De cada artículo se extrajo información sobre el procedimiento estudiado, el lugar y el año de publicación, y las características de la revista. Resultados y discusión: Se identificaron 5.092 referencias y se seleccionaron 205. Algo más de la mitad analizaban procedimientos quirúrgicos o médicos, mientras que el 16,5% se centraba en la evaluación de la calidad asistencial. Más del 50% fueron trabajos publicados en revistas de salud pública, medicina general, y gastroenterología y hepatología. La media del factor de impacto era de 4,07. El 25,4% de los artículos habían sido publicados en 1999. Conclusiones y perspectivas: El método RAND se sigue utilizando ampliamente. Los criterios de uso apropiado pueden emplearse para la revisión de la utilización de procedimientos, como base para elaborar guías o como apoyo para la toma de decisiones. Estas herramientas han de ser sometidas a revisiones para obtener resultados cada vez más válidos y fiables (AU)

Objectives: To identify and describe studies using the RAND/UCLA method to evaluate the appropriateness of health procedures. This method is a consensus technique that involves several phases to develop appropriateness criteria. Methods: We performed a literature search in 2005. OVIDMedline, ISI Web of Knowledge, IME and Highwire were consulted. Articles published between 1999 and 2004 and using the key words «appropriateness», «utilization review» and «physician practice patterns» were selected. Studies using the RAND method were included and those that did not explain the methodology in sufficient detail were excluded. Information on the procedure studied, the place and year of publication, and the characteristics of the journal were extracted from each article. Results and discussion: A total of 5092 articles were identified and 205 were selected. Slightly more than half analyzed surgical or medical procedures, while 16.5% evaluated healthcare quality. More than 50% were published in journals of public health, general medicine, and gastroenterology and hepatology. The mean impact factor was 4.07. A quarter (25.4%) of the articles was published in 1999. Conclusions and perspective: The RAND method is still widely used. Appropriateness criteria can be used to review utilization of procedures, to design guidelines, or to support for decision making. These tools should be reviewed to obtain evermore valid and reliable results (AU)

[Review of the utilization of the RAND appropriateness method in the biomedical literature (1999-2004)]. / Evaluación del uso apropiado de procedimientos sanitarios mediante el método RAND: revisión de su aplicación en la literatura biomédica (1999-2004).

OBJECTIVES: To identify and describe studies using the RAND/UCLA method to evaluate the appropriateness of health procedures. This method is a consensus technique that involves several phases to develop appropriateness criteria. METHODS: We performed a literature search in 2005. OVIDMedline, ISI Web of Knowledge, IME and Highwire were consulted. Articles published between 1999 and 2004 and using the key words "appropriateness", "utilization review" and "physician practice patterns" were selected. Studies using the RAND method were included and those that did not explain the methodology in sufficient detail were excluded. Information on the procedure studied, the place and year of publication, and the characteristics of the journal were extracted from each article. RESULTS AND DISCUSSION: A total of 5092 articles were identified and 205 were selected. Slightly more than half analyzed surgical or medical procedures, while 16.5% evaluated healthcare quality. More than 50% were published in journals of public health, general medicine, and gastroenterology and hepatology. The mean impact factor was 4.07. A quarter (25.4%) of the articles was published in 1999. CONCLUSIONS AND PERSPECTIVE: The RAND method is still widely used. Appropriateness criteria can be used to review utilization of procedures, to design guidelines, or to support for decision making. These tools should be reviewed to obtain evermore valid and reliable results.

[Endonasal versus trans-canalicular endoscopic dacriocystorhinostomy using diode laser. Surgical techniques and outcomes]. / Dacriocistorrinostomía endoscópica endonasal frente a transcanalicular con láser diodo. Técnicas quirúrgicas y resultados.

OBJECTIVE: To evaluate the benefits and disadvantages of the endoscopic endonasal versus transcanalicular approaches using diode laser, and to compare their clinical outcomes. PATIENTS AND METHOD: A total of 127 patients were operated on, 80 of them with the endonasal approach (Group I) and 47 with the transcanalicular technique (Group II). OUTCOMES: Epiphora improved completely in 67 patients in Group I (83.7 %) while the other 13 (16.2 %) continued to present the same symptoms. In Group II, a successful result was achieved in 39 patients (82.9 %) and 8 (17 %) of them had to be re-operated because of the persistence of epiphora. CONCLUSIONS: The surgical outcomes are similar with both laser techniques. The main advantages of using diode laser are that it does not require general anaesthesia, the lower intra- and peri-operative morbidity, the lack of nasal packing and the greater ease of performing additional interventions if it fails. The only real disadvantage of laser procedures is the high cost.

Dacriocistorrinostomía endoscópica endonasal frente a transcanalicular con láser diodo. Técnicas quirúrgicas y resultados / Endonasal versus trans-canalicular endoscopic dacriocystorhinostomy using diode laser. Surgical techniques and outcomes

Objetivo: Valorar las ventajas y los inconvenientes de la vía endoscópica endonasal frente a las transcanalicular con láser diodo, así como comparar los resultados clínicos obtenidos. Material y método: Se intervino a un total de 127 enfermos, 80 por vía endonasal (grupo I) y 47 por vía transcanalicular (grupo II). Resultados: En el grupo I obtuvimos una desaparición completa de la epífora en 67 (83,7 %) casos, mientras que los 13 (16,2 %) restantes mantuvieron la sintomatología. En el grupo II, en 39 (82,9 %) se obtuvo un resultado positivo, y fue necesario reintervenir a los 8 (17 %) restantes por persistencia de epífora. Conclusiones: Los resultados obtenidos son equiparables con ambas técnicas quirúrgicas. Entre las ventajas del uso del láser se encuentran que no es necesario emplear anestesia general, la baja morbilidad peroperatoria y perioperatoria, la ausencia de taponamiento nasal y la mayor facilidad de realizar cirugía de rescate. El único inconveniente real del láser es su coste económico

Objective: To evaluate the benefits and disadvantages of the endoscopic endonasal versus transcanalicular approaches using diode laser, and to compare their clinical outcomes. Patients and method: A total of 127 patients were operated on, 80 of them with the endonasal approach (Group I) and 47 with the transcanalicular technique (Group II). Outcomes: Epiphora improved completely in 67 patients in Group I (83.7 %) while the other 13 (16.2 %) continued to present the same symptoms. In Group II, a successful result was achieved in 39 patients (82.9 %) and 8 (17 %) of them had to be re-operated because of the persistence of epiphora. Conclusions: The surgical outcomes are similar with both laser techniques. The main advantages of using diode laser are that it does not require general anaesthesia, the lower intra- and peri-operative morbidity, the lack of nasal packing and the greater ease of performing additional interventions if it fails. The only real disadvantage of laser procedures is the high cost

[Variability in hospital care. Nasosinus surgery in Spain]. / Variabilidad en la asistencia hospitalaria. El caso de la cirugía nasosinusal en España.

OBJECTIVES: To describe variations in the management of nasosinus disorders among the Autonomous Communities and hospitals of Spain. METHODS: We analyzed the Minimum Basic Data Set of the public health system from 1998-2000 for the diagnoses of nasosinus polyps and chronic sinusitis. We studied the distribution by regions of the rate of hospitalizations and of 4 indicators of quality of care and efficiency: mean length of stay, percentage of discharges without surgery, percentage of functional endoscopic sinus surgery and surgical complications. A cluster analysis was performed to classify hospitals according to the values of these indicators. RESULTS: We analyzed 13061 discharges from 263 hospitals. Marked differences were found in age-adjusted hospitalization rates by regions. Cluster analysis classified the centers with more than 10 annual discharges in 3 categories: a) 32 hospitals in which the 4 quality indicators were above average; b) 35 hospitals in which 3 of the indicators were below average, and c) 74 hospitals in which 2 indicators were above average and 2 indicators were below average. CONCLUSIONS: Marked interregional variations were found in hospitalization rates, as well as in the characteristics of management of nasosinus disorders in Spanish hospitals. The centers examined could be grouped into three clearly defined patterns according to indicators of quality of care and efficiency.

Variabilidad en la asistencia hospitalaria. El caso de la cirugía nasosinusal en España / Variability in hospital care. Nasosinus surgery in Spain

Objetivo: Describir las variaciones en la asistencia de las enfermedades nasosinusales entre comunidades autónomas (CCAA) y hospitales españoles. Métodos: Se analizó el Conjunto Mínimo Básico de Datos del Sistema Nacional de Salud de los años 1998-2000 para los diagnósticos de pólipos nasosinusales y sinusitis crónica. Se estudió la distribución por CCAA de la tasa de hospitalización y de 4 indicadores de calidad asistencial y eficiencia: estancia media, porcentajes de altas sin intervención, técnicas de cirugía endoscópica nasosinusal y complicaciones posquirúrgicas. Se realizó un análisis de conglomerados para clasificar los hospitales según los valores de dichos indicadores. Resultados: Se analizaron 13.061 altas de 263 hospitales. Se (..) (AU)

Objectives: To describe variations in the management of nasosinus disorders among the Autonomous Communities and hospitals of Spain. Methods: We analyzed the Minimum Basic Data Set of the public health system from 1998-2000 for the diagnoses of nasosinus polyps and chronic sinusitis. We studied the distribution by regions of the rate of hospitalizations and of 4 indicators of quality of care and efficiency: mean length of stay, percentage of discharges without surgery, percentage of functional endoscopic sinus surgery and surgical complications. A cluster analysis was performed to classify hospitals according to the values of these indicators. Results: We analyzed 13061 discharges from 263 hospitals. Marked differences were found in age-adjusted hospitalization rates by regions. Cluster analysis classified the centers with (..) (AU)