Facial nerve palsy following parotid gland surgery: A machine learning prediction outcome approach.

Introduction: Machine learning (ML)-based facial nerve injury (FNI) forecasting grounded on multicentric data has not been released up to now. Three distinct ML models, random forest (RF), K-nearest neighbor, and artificial neural network (ANN), for the prediction of FNI were evaluated in this mode. Methods: A retrospective, longitudinal, multicentric study was performed, including patients who went through parotid gland surgery for benign tumors at three different university hospitals. Results: Seven hundred and thirty-six patients were included. The most compelling aspects related to risk escalation of FNI were as follows: (1) location, in the mid-portion of the gland, near to or above the main trunk of the facial nerve and at the top part, over the frontal or the orbital branch of the facial nerve; (2) tumor volume in the anteroposterior axis; (3) the necessity to simultaneously dissect more than one level; and (4) the requirement of an extended resection compared to a lesser extended resection. By contrast, in accordance with the ML analysis, the size of the tumor (>3 cm), as well as gender and age did not result in a determining favor in relation to the risk of FNI. Discussion: The findings of this research conclude that ML models such as RF and ANN may serve evidence-based predictions from multicentric data regarding the risk of FNI. Conclusion: Along with the advent of ML technology, an improvement of the information regarding the potential risks of FNI associated with patients before each procedure may be achieved with the implementation of clinical, radiological, histological, and/or cytological data.

Coexistence of Rosai-Dorfman disease and Hodgkin's lymphoma in a patient with cervical lymphadenopathy.

A man in his 40s, with no tobacco or alcohol habit, was referred to the otorhinolaryngology department presenting with a 2-month history of enlarged left cervical lymphadenopathy with no other signs or symptoms. The ear, nose and throat examination showed no abnormalities apart from the described lymphadenopathy. An ultrasound scan suggested these nodes to be part of either an inflammatory or a malignant process. Subsequent positron emission tomography-CT proved those lymph nodes to be metabolically active, as well as others within the thorax. Cervicotomy was performed and the histopathological analysis showed dilated sinuses and histiocytes with emperipolesis. Suspecting Rosai-Dorfman disease (RDD), high-dose steroid therapy was started; but given no improvement was observed, a second cervicotomy was performed, with the histopathological diagnosis of the latter of Hodgkin's lymphoma. The present article aims to emphasise the need to exclude haematological disorders whenever RDD histology is observed, given their possible coexistence, and a worse outcome and clinical and histopathological semblance.

Valor pronóstico de la parathormona postoperatoria de 24 horas en el manejo de la hipocalcemia tras tiroidectomía total en un hospital de Valencia durante 2012-2019

Introducción: La hipocalcemia por hipoparatiroidismo es la complicación más frecuente tras tiroidectomía total. Un factor predictor importante de hipocalcemia es la parathormona postoperatoria, pero el momento en el que otorga mejores resultados predictivos aún se discute. Objetivo: El objetivo es analizar el valor pronóstico de la parathormona postoperatoria a las 24 horas como indicador de hipocalcemia, en comparación con la seriación de los niveles de calcio. Metodología: Estudio observacional retrospectivo y descriptivo de 297 pacientes intervenidos de tiroidectomía total durante ocho años. Los pacientes fueron clasificados en tres grupos de riesgo según la parathormona postoperatoria (alto, medio y bajo riesgo). Para comparar la parathormona frente al calcio postoperatorio como predictor de hipocalcemia, se obtuvieron curvas ROC y áreas debajo de la curva. Resultados: El riesgo relativo de tener hipocalcemia con parathormona ≤15 pg/mL es de 353,4 (p = 0,00). La prueba de parathormona postoperatoria (≤15 pg/mL a las 24 h) obtuvo una sensibilidad del 96,25 % para la detección de hipocalcemia, especificidad del 94,06 % y precisión global del 95,03 %. El grupo de alto riesgo (parathormona ≤15 pg/mL) concentra la mayoría de los pacientes con hipocalcemia, y abarca la totalidad de los casos permanentes. Conclusiones: La parathormona postoperatoria a las 24 horas de la tiroidectomía total es un test con un valor pronóstico considerable, capaz de predecir el riesgo de hipocalcemia postquirúrgica. Se encontró que los pacientes con parathormona >15 pg/mL pueden ser dados de alta de manera segura.

Introduction: Hypocalcemia due to hypoparathyroidism is the most frequent complication after total thyroidectomy. An important predictive factor of hypocalcaemia is postoperative parathormone (PTH), but the optimal time for testing PTH levels is under discussion. Objectives: The objective is to analyze the prognostic value of postoperative PTH at 24 hours as an indicator of hypocalcaemia, compared to serum calcium levels. Methodology: Descriptive retrospective observational study of 297 patients who underwent total thyroidectomy over an 8-year period. The patients were classified into 3 risk groups according to postoperative parathormone (high, medium and low risk). To compare parathormone versus postoperative calcium as a predictor of hypocalcemia, ROC curves and areas under the curve (AUC) were obtained. Results: The relative risk of having hypocalcemia with parathormone ≤ 15 pg/mL is 353.4 (p = 0.00). The postoperative parathormone test (≤ 15 pg / mL at 24h) obtained a sensitivity of 96.25% for the detection of hypocalcemia, specificity of 94.06% and global precision of 95.03%. The high-risk group (parathormone ≤ 15 pg/mL) accounts for the vast majority of patients with hypocalcemia and covers all permanent cases. Conclusions: Postoperative levels 24 hours after total thyroidectomy is a test with considerable prognostic value, capable of predicting the risk of postsurgical hypocalcemia. Patients with levels over > 15 pg/mL can be safely discharged.

Odynophagia as the first manifestation of toxic epidermal necrolysis.

Stevens-Johnson syndrome (SJS) and toxic epidermal necrolysis (TEN) are infrequent mucocutaneous diseases, rapidly progressive and life-threatening. The clinical aspects and the management of TEN are exposed following a case.A man in his 40s presented to the emergency department with severe odynophagia, poor general condition and fever. His medical history was significant for HIV stage AIDS, and the treatment was discontinued 5 years before the present diagnosis. He was admitted for cerebral toxoplasmosis and discharged the previous 14 days with sulfadiazine. Erythematous-bullous lesions in the oral cavity, diffuse erythematous maculopapular rashes over his neck and chest, acute bilateral conjunctivitis and purulent urethritis was observed. The diagnostic suspicion was SJS/TEN due to sulfadiazine in immunosuppressed patients.This entity is infrequent but is a life-threatening dermatological emergency that requires immediate medical attention. Its diagnosis is mainly clinical, with a new drug history, prodromal symptoms and characteristic cutaneous-mucous lesions. Early diagnosis and rapid withdrawal of the drug improve the prognosis.

The Effects of Barbed Repositioning Pharyngoplasty in Positional and Non-Positional OSA Patients: A Retrospective Analysis.

PURPOSE: The aim of our retrospective study is evaluating the effectiveness of barbed repositioning pharyngoplasty (BRP) in a consecutive cohort of patients and assessing its impact on positional indexes in order to potentially identify specific obstructive sleep apnea (OSA) phenotypes for patients who might benefit more significantly from this intervention. METHODS: A single-center retrospective study with baseline and follow-up type III sleep tests evaluating the Apnea Hypopnea Index (AHI), supine AHI, non-supine AHI, oxygen desaturation index (ODI), mean SaO2, percentage of time spent at SaO2 below 90% (CT90), and lowest oxygen saturation (LOS) were performed. The patients were then divided into groups according to Sher's criteria and Amsterdam Positional OSA Classification (APOC). Parametric and non-parametric tests and univariate and multivariate analyses were conducted. RESULTS: The study finally included 47 patients. The statistical analysis showed significant improvement in AHI, supine AHI, non-supine AHI, and ODI after surgery. The linear regression showed that high values of baseline AHI, AHI supine, and AHI non supine predict more significant postoperative reductions in AHI, AHI supine, and AHI non supine, respectively. Therapeutic success was achieved in 22 patients out of 47. The logistic regression did not find any independent risk factors for success. The most significant reduction in AHI, supine AHI, and non-supine AHI was observed in the APOC 3 group while the APOC 1 patients experience a substantially lower improvement. CONCLUSIONS: BRP appears to be an effective surgical procedure for the treatment of OSA. The non-positional patients might benefit more from BRP in comparison with positional patients. Moreover, OSA severity should not be considered an absolute contra-indication for this surgical procedure.

Parálisis unilateral de cuerda vocal de causa extralaríngea: etiología y pronóstico / Extralaryngeal causes of unilateral vocal cord paralysis: aetiology and prognosis

Introducción y metodología: La parálisis unilateral de cuerda vocal sin lesión laríngea asociada es una entidad relativamente frecuente. Puede ser la manifestación de numerosas enfermedades con origen en tórax, cuello, cráneo o sistémicas. El objetivo es estudiar la etiología extralaríngea de la parálisis unilateral de cuerda vocal, su pronóstico y la relación de ambas con distintas variables clínicas. Estudio retrospectivo de 116 pacientes con parálisis unilateral completa de cuerda vocal sin lesión laríngea asociada. Los pacientes fueron sometidos a tomografía computarizada (TC) cérvico-torácico +/– valoración por Servicio de Neurología con resonancia magnética (RM) cerebral para establecer la etiología y seguimiento de al menos 1 año.ResultadosLa causa extralaríngea más común de parálisis de cuerda vocal fue la yatrogénica tras cirugía cervical (46,5%), seguida de la tumoral (24,1%). Las parálisis idiopáticas resultaron el 15,5%. Se obtuvo relación entre el sexo y la etiología (p < 0,01), los varones en relación con la patología maligna y las mujeres con la yatrogénica. En los pacientes de edades avanzadas predomina la etiología cardiovascular, cerebrovascular, tumoral e idiopática; mientras que en los pacientes más jóvenes la quirúrgica (p < 0,01). El 18,1% recuperaron la movilidad de la cuerda vocal. El sexo femenino se relacionó con su recuperación (p < 0,01). El tabaco y la etiología maligna se relacionó con su persistencia (p < 0,01).ConclusionesLa primera causa extralaríngea de parálisis unilateral de CV es la quirúrgica seguido de las neoplasias de pulmón y tiroides. Existe gran diversidad de lesiones que pueden ocasionarla, en muchos casos supone el diagnóstico de tumores malignos. Su recuperación es más frecuente entre pacientes de sexo femenino, no fumadores y con patología de etiología benigna. (AU)

Introduction and methodology: Unilateral vocal cord paralysis without laryngeal lesions is a relatively frequent entity. It can be the manifestation of numerous diseases from the thorax, neck, skull or systemic. The objective is to study the extralaryngeal etiology of unilateral vocal cord paralysis, its prognosis and the relationship of both with different clinical variables. Retrospective study of 116 patients with complete unilateral vocal cord paralysis without laryngeal lesions. The patients underwent cervical-thoracic CT +/– evaluation by Neurology with brain MRI to establish the etiology and follow-up for at least 1 year.ResultsThe most common extralaryngeal cause of vocal cord paralysis was cervical surgery (46.5%), followed by tumor (24.1%). Idiopathic paralysis were 15.5%. An association was obtained between sex and etiology (p <0.01), men in relation to malignant pathology and women to iatrogenic disease. Cardiovascular, cerebrovascular, tumor and idiopathic etiology predominate in elderly patients; while in younger patients the surgical one (p <0.01). 18.1% recovered vocal cord mobility. The female sex was related to its recovery (p <0.01). Tobacco and malignant etiology were related to its persistence (p <0.01).ConclusionsThe first extralaryngeal cause of unilateral CV paralysis is surgical followed by lung and thyroid neoplasms. There is a great diversity of lesions that can cause it, in many cases it involves the diagnosis of malignant tumors. Its recovery is more frequent in female patients, non-smokers and with benign pathology. (AU)

Extralaryngeal causes of unilateral vocal cord paralysis: Aetiology and prognosis.

INTRODUCTION AND METHODOLOGY: Unilateral vocal cord paralysis without laryngeal lesions is a relatively frequent entity. It can be the manifestation of numerous diseases of the thorax, neck, skull, or systemic disease. The objective is to study the extralaryngeal aetiology of unilateral vocal cord paralysis, its prognosis, and the relationship of both with different clinical variables. Retrospective study of 116 patients with complete unilateral vocal cord paralysis without laryngeal lesions. The patients underwent cervical-thoracic CT ±â€¯evaluation by Neurology with brain MRI to establish the aetiology and were followed-up for at least 1 year. RESULTS: The most common extralaryngeal cause of vocal cord paralysis was cervical surgery (46.5%), followed by tumour (24.1%). Idiopathic paralysis was the cause in 15.5%. An association was obtained between sex and aetiology (P < .01), men in relation to malignant pathology and women to iatrogenic disease. Cardiovascular, cerebrovascular, tumour and idiopathic aetiology predominated in elderly patients; while surgical aetiology predominated in younger patients (P < .01). A total of 18.1% recovered vocal cord mobility. The female sex was related to recovery (P < .01). Tobacco and malignant aetiology were related to persistence (P < .01). CONCLUSIONS: The first extralaryngeal cause of unilateral CV paralysis is surgical followed by lung and thyroid neoplasms. There is a great diversity of lesions that can cause the condition, in many cases involving a diagnosis of malignant tumours. Recovery is more frequent in female patients, non-smokers and with benign pathology.

Factors associated with diagnosis delay in head and neck cancer.

INTRODUCTION AND OBJECTIVES: Tumour stage is an important prognostic factor in head and neck tumours. Many tumours are diagnosed in advanced stages despite almost universal healthcare and their being symptomatic. This paper seeks to determine the diagnostic delay in head and neck tumours in our health department, to analyse factors associated with delay and if it is associated with diagnosis in advanced stages. METHODS: Retrospective study of 137 patients with head and neck cancer diagnosed from 2016-2018. Patient delay, delay in primary health care, delay in secondary health care, diagnostic delay and possible associated factors (smoking, location, stage, …) were evaluated. RESULTS: Many patients (44.5%) were diagnosed in advanced stages. The median patient delay was 30 days. The median referral to otorhinolaryngology was 3.5 days. If the referral was made by another specialist (p = .008), the patients were under previous treatment (P=.000) and the tumours were in initial stages (P=.038) this delay was greater. The median from the first visit to otorhinolaryngology was 15 days, higher in regular referrals (43%) (P=.000). The median diagnostic delay was 12 days, higher in surgical biopsies (P=.000). The median professional delay was 58.5 days and total delay was 118.5 days. CONCLUSIONS: Many head and neck tumours are diagnosed in advanced stages. A relationship was not found between diagnosis in advanced stages and diagnostic delay. However, steps must be taken to reduce these excessive delays.

Factores asociados a la demora diagnóstica en tumores de cabeza y cuello / Factors associated with diagnosis delay in head and neck cancer

Introducción y objetivos: El estadio tumoral al diagnóstico es clave en el pronóstico del cáncer de cabeza y cuello. Pese a un sistema sanitario casi universal y ser tumores generalmente sintomáticos, una gran proporción de tumores son diagnosticados en estadios avanzados. El objetivo es conocer el tiempo que se tarda en diagnosticar los tumores de cabeza y cuello en nuestro departamento de salud, analizar si existen factores asociados a su retraso y si este se asocia al diagnóstico en estadios avanzados. Métodos: Estudio retrospectivo de 137 pacientes con cáncer de cabeza y cuello diagnosticados de 2016-2018. Se evaluó la demora del paciente en la búsqueda de atención médica, en la prestación de la atención y en la obtención del diagnóstico, así como la existencia de factores asociados (tabaquismo, localización, estadio, etc.). Resultados: El 44,5% de los pacientes se diagnosticaron en estadios avanzados. Los pacientes tardaron en consultar una mediana de 30 días desde el inicio de los síntomas. Se tardó en derivar a Otorrinolaringología una mediana de 3,5 días. Se evidenció mayor retraso cuando la derivación la hacía otro especialista (p=0,008), si recibieron tratamiento previo (antibiótico, antiinflamatorios no esteroideos, etc.) (p=0,000) y en tumores en estadios iniciales (p=0,038). En la consulta de Otorrinolaringología fueron valorados 15 días después de la derivación. Este tiempo fue mayor en el 43% de los tumores que fueron remitidos de forma ordinaria (p=0,000). Se obtuvo el diagnóstico en 12 días desde la primera visita a Otorrinolaringología, mayor cuando se tomó la biopsia en quirófano (p=0,000). La mediana de retraso médico fue de 58,5 días y el retraso total 118,5 días. Conclusiones: Muchos tumores de cabeza y cuello siguen diagnosticándose en estadios avanzados. No se ha encontrado relación entre el diagnóstico en estadios avanzados y la demora en el diagnóstico. Aun así, es necesario adoptar medidas para disminuir estas excesivas demoras. (AU)

Introduction and objectives: Tumour stage is an important prognostic factor in head and neck tumours. Many tumours are diagnosed in advanced stages despite almost universal healthcare and their being symptomatic. This paper seeks to determine the diagnostic delay in head and neck tumours in our health department, to analyse factors associated with delay and if it is associated with diagnosis in advanced stages. Methods: Retrospective study of 137 patients with head and neck cancer diagnosed from 2016-2018. Patient delay, delay in primary health care, delay in secondary health care, diagnostic delay and possible associated factors (smoking, location, stage, …) were evaluated. Results: Many patients (44.5%) were diagnosed in advanced stages. The median patient delay was 30 days. The median referral to otorhinolaryngology was 3.5 days. If the referral was made by another specialist (p=.008), the patients were under previous treatment (P=.000) and the tumours were in initial stages (P=.038) this delay was greater. The median from the first visit to otorhinolaryngology was 15 days, higher in regular referrals (43%) (P=.000). The median diagnostic delay was 12 days, higher in surgical biopsies (P=.000). The median professional delay was 58.5 days and total delay was 118.5 days. Conclusions: Many head and neck tumours are diagnosed in advanced stages. A relationship was not found between diagnosis in advanced stages and diagnostic delay. However, steps must be taken to reduce these excessive delays. (AU)

Long-term stability of results following surgery for obstructive sleep apnea (OSA).

PURPOSE: Although upper airway surgery in selected patients with obstructive sleep apnea (OSA) has been shown to be beneficial, its long-term effects have been questioned. The main objective was to evaluate whether results following surgery remain stable over time, both in objective and subjective terms. As a secondary aim, such stability was also measured in relation with the type of surgery performed. METHODS: This work constitutes a retrospective study of OSA adult patients subjected to the following surgical procedures: different types of pharyngoplasties, tongue-base surgery, partial epiglottectomy or hyoid suspension. Those who exclusively underwent tonsillectomy or nasal surgery were excluded. Before surgery, a sleep study, and an assessment of the patients' sleepiness and quality of life were performed, which were repeated at 8, 34, and 48 months after surgery. A total of 153 patients was included. RESULTS: Following surgery, the apnea-hypopnea index decreased from 34.84/h to 14.54/h and did not vary more than one point in subsequent controls (p = 0.01). The oxygen desaturation index changed from 31.02/h to 14.0/h and remained stable in the second (15.34/h) and third (11.43/h) controls (p = 0.01). Parameters measuring sleepiness and well-being demonstrated the maintenance of long-term benefits. New pharyngoplasties were observed to be more stable than classic pharyngoplasties in the long term (p = 0.04). Single-level surgeries were found to be more stable than multilevel surgeries, although a statistically significant difference was not observed (p = 0.07). CONCLUSION: The benefits obtained remained stable in the long term. In our sample, modern pharyngoplasty techniques showed superiority over the classic ones regarding long-term stability.

Faringoplastia de reposición modificada para el tratamiento del SAHS: cómo lo hacemos y nuestros resultados / Modified reposition pharyngoplasty for OSAS treatment: How we do it and our results

Introducción y objetivos: En los últimos 20años se ha descrito la relevancia de las paredes laterales faríngeas en el colapso de la vía aérea superior de pacientes con síndrome de apneas e hipopneas del sueño (SAHS). De ahí que hayan ido apareciendo nuevas técnicas quirúrgicas para mejorar este colapso. Nuestro objetivo es describir la técnica quirúrgica de la faringoplastia que realizamos y mostrar nuestros resultados iniciales.Material y métodosSe trata de un estudio retrospectivo en el que incluimos pacientes diagnosticados de SAHS que no toleran (o en los que no está indicado) el uso de CPAP. Los pacientes rellenaron un cuestionario previo a la cirugía en relación con sus hábitos de vida y con su roncopatía. Tras una exploración física completa tanto despierto como bajo somnoscopia, se procedió a esta intervención cuando observamos un colapso retropalatal y de paredes laterales faríngeas. En todos los pacientes se realizó un estudio de sueño preoperatorio así como entre los 3 y los 6meses tras la intervención, rellenando el mismo cuestionario en el postoperatorio a los 6meses. Calculamos la tasa de éxito según los criterios de Sher y, de una forma más restrictiva, según el criterio de índice de apnea-hipopnea (IAH) <10/h.ResultadosIncluimos un total de 26 pacientes, obteniendo un descenso significativo en el IAH de 29,1±18,3 a 12,3±12, sin cambios significativos en el IMC. Según criterios de Sher, en el 65,4% de los pacientes hubo un descenso del IAH a la mitad y <20/h, y el 42,3% del total consiguió un IAH <10/h. Obtuvimos resultados estadísticamente significativos en el resto de parámetros estudiados. La complicación más frecuente fue la extrusión parcial de la sutura.ConclusionesEsta cirugía obtiene resultados estadísticamente significativos tanto en los parámetros objetivos como subjetivos estudiados, sin complicaciones mayores asociadas. (AU)

Introduction and purposes: The relevance of the lateral pharyngeal walls in the collapse of the upper airway in obstructive sleep apnea patients has been revealed in the last 20years. New surgical techniques that address this collapse have been published. The aim of this study is to show the technique that we are currently using to treat the collapse and its results.Materials and methodsThis is a retrospective study of surgically treated OSAS patients who did not tolerate conventional positive airway pressure (CPAP) or for whom it was not indicated. After a complete physical examination either awake or under drug-induced sleep endoscopy, tonsillectomy with reposition pharyngoplasty was performed using barbed bidirectional suture and removing the supratonsillar fat. Three to 6months after surgery the subjective parameters were evaluated and a sleep study was performed.ResultsTwenty-six patients were enrolled with a significative decrease in the AHI and also significative improvement in all the rest parameters studied. In 65.4% of the patients the AHI decreased 50% and was lower than 20/h, in 42.3% postoperative AHI was lower than 10/h. The most frequent complication was the partial extrusion of the suture.ConclusionsThis surgical procedure obtains statistically significant results in objective and subjective parameters of sleep apnoea without major associated complications. (AU)

Daytime Neuromuscular Electrical Therapy of Tongue Muscles in Improving Snoring in Individuals with Primary Snoring and Mild Obstructive Sleep Apnea.

Study Objectives: Evaluating daytime neuromuscular electrical training (NMES) of tongue muscles in individuals with Primary Snoring and Mild Obstructive Sleep Apnea (OSA). Methods: A multicenter prospective study was undertaken in patients with primary snoring and mild sleep apnea where daytime NMES (eXciteOSA® Signifier Medical Technologies Ltd., London W6 0LG, UK) was used for 20 min once daily for 6 weeks. Change in percentage time spent snoring was analyzed using a two-night sleep study before and after therapy. Participants and their bed partners completed sleep quality questionnaires: Epworth Sleepiness Scale (ESS) and Pittsburgh Sleep Quality Index (PSQI), and the bed partners reported on the nighttime snoring using a Visual Analogue Scale (VAS). Results: Of 125 patients recruited, 115 patients completed the trial. Ninety percent of the study population had some reduction in objective snoring with the mean reduction in the study population of 41% (p < 0.001). Bed partner-reported snoring reduced significantly by 39% (p < 0.001). ESS and total PSQI scores reduced significantly (p < 0.001) as well as bed partner PSQI (p = 0.017). No serious adverse events were reported. Conclusions: Daytime NMES (eXciteOSA®) is demonstrated to be effective at reducing objective and subjective snoring. It is associated with effective improvement in patient and bed partner sleep quality and patient daytime somnolence. Both objective and subjective measures demonstrated a consistent improvement. Daytime NMES was well tolerated and had minimal transient side effects.

Factors associated with diagnosis delay in head and neck cancer. / Factores asociados a la demora diagnóstica en tumores de cabeza y cuello.

INTRODUCTION AND OBJECTIVES: Tumour stage is an important prognostic factor in head and neck tumours. Many tumours are diagnosed in advanced stages despite almost universal healthcare and their being symptomatic. This paper seeks to determine the diagnostic delay in head and neck tumours in our health department, to analyse factors associated with delay and if it is associated with diagnosis in advanced stages. METHODS: Retrospective study of 137 patients with head and neck cancer diagnosed from 2016-2018. Patient delay, delay in primary health care, delay in secondary health care, diagnostic delay and possible associated factors (smoking, location, stage, …) were evaluated. RESULTS: Many patients (44.5%) were diagnosed in advanced stages. The median patient delay was 30 days. The median referral to otorhinolaryngology was 3.5 days. If the referral was made by another specialist (p=.008), the patients were under previous treatment (P=.000) and the tumours were in initial stages (P=.038) this delay was greater. The median from the first visit to otorhinolaryngology was 15 days, higher in regular referrals (43%) (P=.000). The median diagnostic delay was 12 days, higher in surgical biopsies (P=.000). The median professional delay was 58.5 days and total delay was 118.5 days. CONCLUSIONS: Many head and neck tumours are diagnosed in advanced stages. A relationship was not found between diagnosis in advanced stages and diagnostic delay. However, steps must be taken to reduce these excessive delays.

Subjective evaluation of smell and taste dysfunction in patients with mild COVID-19 in Spain.

BACKGROUND: Has been described the loss of smell and taste as onset symptoms in SARS-CoV-2. The objective of this study was to investigate the prevalence in Spain. METHODS: Prospective study of COVID-19 confirmed patients through RT-PCR in Spain. Patients completed olfactory and gustatory questionnaires. RESULTS: A total of 1043 patients with mild COVID-19 disease. The mean age was 39 ±â€¯12 years. 826 patients (79.2%) described smell disorder, 662 (63.4%) as a total loss and 164 (15.7%) partial. 718 patients (68.8%) noticed some grade of taste dysfunction. There was a significant association between both disorders (p < 0.001). The olfactory dysfunction was the first symptom in 17.1%. The sQOD-NS scores were significantly lower in patients with a total loss compare to normosmic or hyposmic individuals (p = 0.001). Female were significantly more affected by olfactory and gustatory dysfunctions (p < 0.001). The early olfactory recover in 462 clinically cured patients was 315 (68.2%), during the first 4 weeks. CONCLUSION: The sudden onset smell and/or taste dysfunction should be considered highly suspicious for COVID-19 infection.

ANTECEDENTES Y OBJETIVO: En la infección por SARS-CoV-2 la pérdida repentina del olfato y/o gusto han sido descritas como síntomas iniciales. El objetivo principal de este estudio es conocer la prevalencia de estos síntomas en España. MATERIALES Y MÉTODOS: Estudio prospectivo de pacientes con COVID-19 confirmado mediante RT-PCR en España. Se utilizaron los cuestionarios traducidos y validados. RESULTADOS: Un total de 1043 pacientes COVID-19 leve. Edad media de 39 ±â€¯12 años. 826 pacientes (79,2%) refirieron algún grado de alteración del olfato, 662 (63,4%) pérdida total y 164 (15,7%) parcial. 718 pacientes (68,8%) notaron alteración del gusto. Hubo una asociación significativa entre ambos trastornos (p < 0,001). La disfunción olfatoria fue el síntoma inicial en el 17,1%. Las puntuaciones del sQOD-NS fueron significativamente menores en pacientes con una alteración total. Ambas alteraciones fueron proporcionalmente mayores en las mujeres (p < 0,001). De 462 pacientes clínicamente curados 315 (68,2%) recuperaron el olfato dentro de las primeras 4 semanas. CONCLUSIONES: La alteración repentina del olfato y el gusto debería ser reconocida como un síntoma de alarma de posible infección por COVID-19.

Evaluación subjetiva de las alteraciones del olfato y del gusto en pacientes con afectación leve por COVID-19 en España / Subjective evaluation of smell and taste dysfunction in patients with mild COVID-19 in Spain

Antecedentes y objetivo: En la infección por SARS-CoV-2 la pérdida repentina del olfato y/o gusto han sido descritas como síntomas iniciales. El objetivo principal de este estudio es conocer la prevalencia de estos síntomas en España.Materiales y métodosEstudio prospectivo de pacientes con COVID-19 confirmado mediante RT-PCR en España. Se utilizaron los cuestionarios traducidos y validados.ResultadosUn total de 1043 pacientes con COVID-19 leve. Edad media de 39±12 años. De ellos 826 pacientes (79,2%) refirieron algún grado de alteración del olfato, 662 (63,4%) pérdida total y 164 (15,7%) parcial. Por otra parte 718 pacientes (68,8%) notaron alteración del gusto. Hubo una asociación significativa entre ambos trastornos (p<0,001). La disfunción olfatoria fue el síntoma inicial en el 17,1%. Las puntuaciones del sQOD-NS fueron significativamente menores en pacientes con una alteración total. Ambas alteraciones fueron proporcionalmente mayores en las mujeres (p<0,001). De 462 pacientes clínicamente curados 315 (68,2%) recuperaron el olfato dentro de las primeras 4 semanas.ConclusionesLa alteración repentina del olfato y el gusto debería ser reconocida como un síntoma de alarma de posible infección por COVID-19. (AU)

Background: Has been described the loss of smell and taste as onset symptoms in SARS-CoV-2. The objective of this study was to investigate the prevalence in Spain.MethodsProspective study of COVID-19 confirmed patients through RT-PCR in Spain. Patients completed olfactory and gustatory questionnaires.ResultsA total of 1043 patients with mild COVID-19 disease. The mean age was 39±12 years. 826 patients (79.2%) described smell disorder, 662 (63.4%) as a total loss and 164 (15.7%) partial. 718 patients (68.8%) noticed some grade of taste dysfunction. There was a significant association between both disorders (p<.001). The olfactory dysfunction was the first symptom in 17.1%. The sQOD-NS scores were significantly lower in patients with a total loss compare to normosmic or hyposmic individuals (p=.001). Female were significantly more affected by olfactory and gustatory dysfunctions (p<.001). The early olfactory recover in 462 clinically cured patients was 315 (68.2%), during the first 4 weeks.ConclusionThe sudden onset smell and/or taste dysfunction should be considered highly suspicious for COVID-19 infection. (AU)

Modified reposition pharyngoplasty for OSAS treatment: How we do it and our results. / Faringoplastia de reposición modificada para el tratamiento del SAHS: cómo lo hacemos y nuestros resultados.

INTRODUCTION AND PURPOSES: The relevance of the lateral pharyngeal walls in the collapse of the upper airway in obstructive sleep apnea patients has been revealed in the last 20years. New surgical techniques that address this collapse have been published. The aim of this study is to show the technique that we are currently using to treat the collapse and its results. MATERIALS AND METHODS: This is a retrospective study of surgically treated OSAS patients who did not tolerate conventional positive airway pressure (CPAP) or for whom it was not indicated. After a complete physical examination either awake or under drug-induced sleep endoscopy, tonsillectomy with reposition pharyngoplasty was performed using barbed bidirectional suture and removing the supratonsillar fat. Three to 6months after surgery the subjective parameters were evaluated and a sleep study was performed. RESULTS: Twenty-six patients were enrolled with a significative decrease in the AHI and also significative improvement in all the rest parameters studied. In 65.4% of the patients the AHI decreased 50% and was lower than 20/h, in 42.3% postoperative AHI was lower than 10/h. The most frequent complication was the partial extrusion of the suture. CONCLUSIONS: This surgical procedure obtains statistically significant results in objective and subjective parameters of sleep apnoea without major associated complications.

[Subjective evaluation of smell and taste dysfunction in patients with mild COVID-19 in Spain]. / Evaluación subjetiva de las alteraciones del olfato y del gusto en pacientes con afectación leve por COVID-19 en España.

BACKGROUND: Has been described the loss of smell and taste as onset symptoms in SARS-CoV-2. The objective of this study was to investigate the prevalence in Spain. METHODS: Prospective study of COVID-19 confirmed patients through RT-PCR in Spain. Patients completed olfactory and gustatory questionnaires. RESULTS: A total of 1043 patients with mild COVID-19 disease. The mean age was 39±12 years. 826 patients (79.2%) described smell disorder, 662 (63.4%) as a total loss and 164 (15.7%) partial. 718 patients (68.8%) noticed some grade of taste dysfunction. There was a significant association between both disorders (p<.001). The olfactory dysfunction was the first symptom in 17.1%. The sQOD-NS scores were significantly lower in patients with a total loss compare to normosmic or hyposmic individuals (p=.001). Female were significantly more affected by olfactory and gustatory dysfunctions (p<.001). The early olfactory recover in 462 clinically cured patients was 315 (68.2%), during the first 4 weeks. CONCLUSION: The sudden onset smell and/or taste dysfunction should be considered highly suspicious for COVID-19 infection.

La endoscopia del sueño inducido / Drug-induced sleep endoscopy

Este documento pretende dar a conocer la endoscopia de sueño inducido entre los distintos especialistas que tratan a los pacientes con trastornos respiratorios del sueño y ser una guía para los especialistas que vayan a realizarla de modo que pueda ser reproducible

This document introduces drug-induced sleep endoscopy to the specialist treating sleep breathing disorders and is intended as a guide for those willing to perform the procedure so that it can be reproducible

Surgical versus non-surgical treatment in the Obstructive Sleep Apnea-Hypopnea Syndrome.

INTRODUCTION: The treatment of choice for pediatric OSAHS is surgical. However, its etiopathogenesis is multifactorial and surgery does not always solve it. Therefore, other modalities of treatment are used. The main objective of this study is to shed light on the efficacy of surgery compared to other treatments. METHODS AND MATERIALS: Prospective cohort study with 317 children ages 1-13 years and apnea-hypopnea index (AHI) ≥3/h with no previous treatment. The treatment was organised into 3 categories: surgical (n = 201), medical (n = 75) and observation (n = 41). Quality of life and sleep was assessed by two validated questionnaires (PSQ & Esteller et al.) The upper airway was explored, and nocturnal polysomnography (PSG) performed in every patient. After 12 ± 3 months of treatment was completed, a new PSG and questionnaires were evaluated. RESULTS: The surgical group improved significantly both subjectively and objectively. Mean AHI decreased from 7.95/h to 2.57/h and T 90 (time spent with arterial oxygen saturation <90%) from 0.49 to 0. AHI of the medical group decreased only from 5.09/h to 4.9/h. Subjective parameters improved less than in the surgical group. Persistence after surgery was 31%, 50% following medical treatment, and after observation 75%. There were no differences in age and BMI between groups. Age or obesity showed no relationship with treatment success or failure. CONCLUSIONS: The best results were achieved in surgically treated children. However, 31% of those operated had OSAHS persistence, which means a combination of treatments may be the most appropriate strategy.