Translation and Validation of the Facial Clinimetric Evaluation Scale to Spanish.

OBJECTIVE: Peripheral facial palsy is a disabling condition; thus, assessing its impact on quality of life is one of the greatest challenges within this discipline. The Facial Clinimetric Evaluation (FaCE) Scale has been validated for this purpose. The aim of this study is to translate and validate the Spanish version of the FaCE Scale. STUDY DESIGN: We performed a forward-backward translation of the original English FaCE Scale. A pilot test and a posterior prospective validation study were performed. SETTING: A pilot test and a posterior prospective validation study were conducted in a specialized facial palsy unit in a tertiary hospital. METHODS: A validation study was carried out in 85 patients to calculate the scale's internal consistency and validity and to compare outcomes with the Sunnybrook Facial Grading System and the Facial Disability Index (FDI). RESULTS: Internal consistency was evaluated by Cronbach's α coefficient, which showed a value of 0.841 (95% CI, 0.786-0.886). The total FaCE Scale score correlates well with the Sunnybrook, FDI physical function, and FDI social/well-being function scores: r = 0.773, r = 0.883, and r = 0.523, respectively. The FDI social/well-being function has the highest correlation with the FaCE Scale social function domain (r = 0.595). CONCLUSION: The Spanish version of the FaCE Scale demonstrated a high psychometric property that allows it to be used for clinical practice to assess the quality of life of Spanish-speaking patients with peripheral facial palsy.

Translation and validation of the Parotidectomy Outcome Inventory 8 (POI-8) to Spanish.

INTRODUCTION: There are >400 million of native Spanish speakers around the world, being the second most spoken language in regard to the number of native speakers. For this reason, a valid questionnaire to access the quality of our patients after parotidectomy is necessary. MATERIAL AND METHODS: Validation and cross-cultural adaptation of the POI-8 questionnaire to the Spanish language. Internal consistency of Sp-POI 8 measured with Cronbach α. RESULTS: 35 patients met the inclusion criteria during the mentioned period. Mean age was 59 ±â€¯15,37 (Min: 18/Max: 87). 20 patients (57,1%) were male and 15 (42,9%) were female. Internal consistency with Cronbach α was 0.868. The intraclass correlation coefficient was 0.830 [CI] (95%: 0,791-925). Hypoesthesia was the most severely weighted problem (0,91) and xerostomia was the second (0,89). However, the high score was for fear of revision surgery (1,26). CONCLUSION: The Spanish Language is the second most spoken language with regard to the number of native speakers and the Sp-POI 8 translation represents a valid option for the Spanish-speaking medical community, from which a large number of patients can benefit.

Complications after cochlear implantation in adult patients. 10-Year retrospective analysis of a tertiary academic centre.

OBJECTIVE: Cochlear implants (CI) are electronic devices that enable the auditory rehabilitation and the management of individuals with severe to profound bilateral hearing loss, and nowadays, advanced age is not considered a contraindication for cochlear implantation and several studies have shown that older adults do benefit from CI, with improvements in hearing abilities and quality of life. METHODS: Retrospective analysis of patients older than 18 years who underwent cochlear implant surgery in a tertiary academic centre. RESULTS: 57 patients met the inclusion criteria: 25 (43.9%) male and 32 (56.1%) female. Total percentage of minor complication was 24.6% and major complication was 17.5%. The most common minor complication in our series was vestibular disorder, and the most common major complication was device failure. No correlation was found among age, previous meningitis, anatomical variables or comorbidities with the appearance of complications. CONCLUSION: Cochlear implantation is a safe surgical technique for rehabilitation of severe to profound sensorineural hearing loss. According to our results, neither the age over 65 years nor the presence of comorbidities does have a direct impact over the complication rates in our patients.

Tuberculosis de la glándula parótida / Tuberculosis of parotid gland

Hoy en día la tuberculosis es una de las más importantes infecciones reemergentes en el mundo. Hasta un 20% de las formas de presentación son extratorácicas. Sin embargo, la presencia de tuberculosis a nivel parotídeo es infrecuente incluso en países subdesarrollados, donde la incidencia de esta enfermedad es mayor. Presentamos un paciente de 83 años que acude por tumoración en región parotídea de 4 semanas de evolución sin antecedentes personales. La exploración clínica revela una masa en cola de parótida izquierda de aproximadamente 3 × 2 cm, no dolorosa a la palpación y sin evidencia de adenopatías a nivel cervical. Tras el estudio radiológico y punción con aguja fina, no se obtienen datos concluyentes, por lo que se procede a realizar exéresis. Se envía muestra para estudio de PCR, se confirma diagnóstico de tuberculosis parotídea. Tras recibir quimioterapia antituberculosa complementaria, el paciente es dado de alta por remisión de la enfermedad (AU)

Tuberculosis is currently one of the most important re-emerging infections worldwide. Up to 20% of cases are extra-thoracic. However, the presence of parotid tuberculosis is uncommon even in developing countries where the incidence of this disease is higher. The case of an 83 year-old patient is presented who had a tumour in the parotid region of 4 weeks onset, and with no previous personal history. Clinical examination revealed a mass of approximately 3 × 2 cm in the left parotid. It was not painful on palpation and there was no evidence of cervical lymph node involvement. After inconclusive radiological examination and fine needle aspiration, an excision of the lesion was performed, and the specimen sent for a PCR study. This confirmed the diagnosis of parotid tuberculosis, and after receiving additional tuberculosis treatment the patient was discharged due to remission of the disease (AU)

Tuberculosis de cabeza y cuello: estudio retrospectivo de 6 años / Head and neck tuberculosis: 6-year retrospective study

Introducción: En el 80% de los casos de infección por Mycobacterium tuberculosis existe afectación pulmonar, sin embargo hasta en un 20% de casos puede haber compromiso extrapulmonar. En el área otorrinolaringológica la localización más frecuente es la linfadenitis cervical, que afecta aproximadamente al 95% de los casos. Materiales y métodos: Estudio retrospectivo en pacientes que acudieron a consulta de ORL en un hospital terciario por sintomatología en cabeza y cuello y que fueron diagnosticados de tuberculosis, entre diciembre del año 2007 y diciembre del año 2013. Resultados: Un total de 73 pacientes fueron incluidos, 41 (56,2%) hombres y 32 (43,8%) mujeres (ratio H/M = 1,28), con una edad promedio de 39,4 años (±26,5 años; mín: 1/máx 88). Un total de 53 (72,6%) casos correspondieron a linfadenopatía cervical, 11 (15%) a tuberculosis laríngea, 3 (4,1%) a tuberculosis hipofaríngea, y los restantes 6 en otras localizaciones. Del total, 14 (19,2%) pacientes eran VIH positivo y 10 (13,7%) tenían antecedentes de contacto con familiares que habían sufrido tuberculosis pulmonar. En 51 (69,8%) de los casos se realizó una PCR como medida de confirmación, siendo positiva en 47 de estos (92,1%). Conclusión: La similitud de la tuberculosis con enfermedades de mal pronóstico y la dificultad que entraña su diagnóstico hacen necesario tener en cuenta la tuberculosis a la hora de explorar a pacientes con lesiones granulomatosas o ulcerativas del área ORL. Al analizar nuestros resultados, la incidencia de tuberculosis según su localización en el área ORL es similar a la reportada en la literatura. Es importante hacer mención especial del uso de la PCR en nuestro estudio y las ventajas que su aplicación significa para el diagnóstico (AU)

Introduction: Pulmonary involvement exists in 80% of cases of infection with Mycobacterium tuberculosis; however, in up to 20% of cases there may be extra-pulmonary involvement. In the ENT area, the most common site is cervical lymphadenitis, affecting approximately 95% of cases. Materials and methods: This was a retrospective study of patients attending an ENT department in a tertiary hospital for head and neck symptoms that were diagnosed with tuberculosis (TB), between December 2007 and December 2013. Results: The study included 73 patients, 41 (56.2%) males and 32 (43.8%) females (M/F ratio = 1.28), with a mean age of 39.4 years (±26.5 years; Min 1, Max 88). There were 53 (72.6%) cases of cervical lymphadenopathy, 11 (15%) of laryngeal tuberculosis 3 (4.1%) of hypopharyngeal tuberculosis, and six cases in other locations. Of the total, 14 (19.2%) patients were HIV positive and 10 (13.7%) had a history of contact with relatives who had suffered pulmonary tuberculosis. PCR was performed in 51 (69.8%) cases to confirm being positive, of which 47 (92.1%) cases were. Conclusion: The similarity of tuberculosis to diseases of poor prognosis and the difficulty of its diagnosis make considering tuberculosis necessary when exploring patients with ulcerative or granulomatous ENT lesions. Analysing our results, the incidence of TB according to its ENT area location is similar to that reported in the literature. It is important to make special mention of the use of PCR in our study and the benefits that its implementation means for diagnosis (AU)

Head and neck tuberculosis: 6-year retrospective study.

INTRODUCTION: Pulmonary involvement exists in 80% of cases of infection with Mycobacterium tuberculosis; however, in up to 20% of cases there may be extra-pulmonary involvement. In the ENT area, the most common site is cervical lymphadenitis, affecting approximately 95% of cases. MATERIALS AND METHODS: This was a retrospective study of patients attending an ENT department in a tertiary hospital for head and neck symptoms that were diagnosed with tuberculosis (TB), between December 2007 and December 2013. RESULTS: The study included 73 patients, 41 (56.2%) males and 32 (43.8%) females (M/F ratio=1.28), with a mean age of 39.4 years (± 26.5 years; Min 1, Max 88). There were 53 (72.6%) cases of cervical lymphadenopathy, 11 (15%) of laryngeal tuberculosis 3 (4.1%) of hypopharyngeal tuberculosis, and six cases in other locations. Of the total, 14 (19.2%) patients were HIV positive and 10 (13.7%) had a history of contact with relatives who had suffered pulmonary tuberculosis. PCR was performed in 51 (69.8%) cases to confirm being positive, of which 47 (92.1%) cases were. CONCLUSION: The similarity of tuberculosis to diseases of poor prognosis and the difficulty of its diagnosis make considering tuberculosis necessary when exploring patients with ulcerative or granulomatous ENT lesions. Analysing our results, the incidence of TB according to its ENT area location is similar to that reported in the literature. It is important to make special mention of the use of PCR in our study and the benefits that its implementation means for diagnosis.

The risk of venous thromboembolism in ENT and head & neck surgery.

OBJECTIVES: Venous thromboembolic disease (VTD) includes deep vein thrombosis (DVT) and pulmonary embolism (PE), thus is one of the most feared postoperative complications developed by patients at any surgical department, because of high morbidity and mortality associated with it. MATERIALS AND METHODS: We performed a retrospective study including all patients operated on at the Otolaryngology Head and Neck Department (tertiary hospital) between January 2009 and December 2013. RESULTS: A total of 9007 surgical procedures were performed, including 7150 elective surgeries under general anesthesia, with 2127 on children and 5023 on adults. A total of 1989 patients had oncological head and neck surgery, eight cases had VTE complications, which represents 0.08% of patients. All of those complicated cases had head and neck cancer (8/1989 = 0.4%) and belonged to the group of scheduled surgeries under general anesthesia (8/7150 = 0.1%). CONCLUSION: The incidence of DVT and PE in ENT and head and neck surgery appears to be lower than in other surgical specialties. Oncological surgery of the head and neck, usually associated with other risk factors, appears to increase the risk of VTD.

Compensatory hypertrophy of the contralateral inferior turbinate in patients with unilateral nasal septal deviation. A computed tomography study.

INTRODUCTION: The compensatory hypertrophy of the inferior turbinate in patients with septal deviation to one of the nostrils is considered to protect the airways from the excess of air that could enter through the nostril and its potential negative effects such as dryness, alteration of air filtration, mucociliary flow, or lung involvement. MATERIALS AND METHODS: A prospective, longitudinal, non-randomized study. Patients were divided in two groups: 10 consecutive patients, with nasal septal deviation and compensatory hypertrophy of the inferior turbinate in the contralateral nasal cavity (10 non-hypertrophied turbinates as control and 10 contralateral hypertrophied turbinates as study cases), and the second group with 5 patients without any nasal pathology (10 turbinates without any obvious pathology). In both groups CT scans of the nasal region were performed. A comparison of patients with nasal septal deviation with compensatory hypertrophy of the inferior turbinate in the contralateral nasal cavity and with non-pathological inferior turbinate was carried out. RESULTS: When analyzing the groups of patients with septal deviation, the contralateral hypertrophied turbinate and the non-hypertrophied turbinate side, we found a significant hypertrophy in the anterior portion of the inferior turbinate, at the level of the medial mucosa (P = 0.002) and bone (P = 0.001) in the group of patients with contralateral hypertrophied turbinate. However, when we compared the contralateral hypertrophic turbinate with the turbinate of patients without septal deviation, we found a significant difference in all volumes of the medial and lateral mucosa and the bone portion (P = 0.001, P = 0.005). CONCLUSION: Surgical correction of the nasal septum and lateralization or reduction of the volume of the inferior turbinate (which may include the medial mucosa, head or part of the bone) is necessary in order to improve air passage into the nasal valve.

The treatment of snoring by radiofrequency-assisted uvulopalatoplasty and results after one-session protocol: a prospective, longitudinal, non-randomized study.

Snoring is usually caused by the vibration of walls of the soft palate at the pharyngeal level. Its worldwide prevalence is estimated to range between 2 and 85% depending on age, gender or population group. The aim of this study is to determine the degree of improvement that can be subjectively evident in patients treated by snoring with radiofrequency-assisted uvulopalatoplasty based on a one-session protocol. This is a prospective, longitudinal, non-randomized study. Patients of both sexes, aged 18 years, who attended to the ENT consultation in a tertiary hospital with snoring during the period of July 2012-July 2013 were included. Age, body mass index, Epworth sleepiness scale were calculated. The volume of snoring of each subject was assessed using a visual analog scale. A total of 27 patients were included in the study; the average age of the sample was 49 years (±8.7; min 36/max 74); of these 22 (81.5%) were male and 5 (18.5%) females. The average BMI was 27.07 ± 2.5 (min 23.15/max 29.39) before the test and after 1 year was 26.75 ± 2.32 (min 23.11/max 29.56) with no statistically significant differences in BMI before and after surgery (p = 0.407). Preoperative snoring intensity was 8.10 ± 0.93 according to VAS. We found a statistically significant difference in the post-operative intensity at 3 months of 3.93 ± 0.88 (p ≤ 0.05) at 6 months of 4.41 ± 1.08 (p ≤ 0.05), and after 1 year 4.90 ± 0.77 (p ≤ 0.05). The average rate of ESS was significantly higher preoperatively than post-operative, being 8.76 ± 3.1 preoperative and 6.93 ± 1.68 post-operative (p ≤ 0.05). We conclude that the use of radiofrequency in simple snorers with an apnea/hypopnea index <15 events per hour and a BMI < 30 kg/m(2) in whom clinically proven that the source of snoring is the soft palate, can be treated by one-session protocol, being possible to obtain an improvement of snoring up to 70% of cases by a short follow-up period.

Anestesia tópica en la nasofibrolaringoscopia flexible / Topical anesthesia in flexible nasofibrolaryngoscopy

Introducción: El desarrollo de la otorrinolaringología en las últimas décadas se ha visto favorecido por la aparición de la nasofibrolaringoscopia flexible, la cual se ha convertido en una herramienta diagnóstica esencial para el otorrinolaringólogo. Sin embargo su uso no está exento de molestias para el paciente, razón por la cual diversas opciones de anestesia tópica se han propuesto durante el desarrollo de la técnica. Materiales y métodos: Estudio prospectivo, doble ciego, cruzado, realizado en pacientes sin antecedentes de patología nasal a través del cual comparamos el uso de anestésico tópico (lidocaína) + epinefrina, oximetazolina y placebo. Mediante escala visual analógica se valoró el grado de molestias durante cada exploración. Resultados: Fueron evaluados 18 pacientes, 10 mujeres (55,6%) y 8 hombres (44,4%), con una edad promedio de 28 años ± 4. El grado de molestia generado por la exploración con la aplicación de lidocaína más epinefrina fue de 1,94; oximetazolina 3,78; y placebo 4,61. Al comparar la mezcla lidocaína-epinefrina con oximetazolina obtuvimos significación estadística a favor de la lidocaína-epinefrina (p < 0,05); al comparar el uso de lidocaína-epinefrina con placebo el resultado también fue estadísticamente significativo en favor de la lidocaína-epinefrina (p < 0,05). Conclusiones: En este estudio demostramos que el uso de la asociación de lido (AU)

Introduction: The emergence of flexible nasofibrolaryngoscopy in recent decades has facilitated the development of Otolaryngology and the nasofibrolaryngoscope has become an essential diagnostic tool for the otolaryngologist. However, its use is not without discomfort for the patient, which is why various options for topical anaesthesia have been proposed during the development of the technique. Material and methods: This was a prospective, double blind, crossover study in patients with no history of nasal disease, through which we compared the use of topical anaesthetic (Lidocaine) + epinephrine, oxymetazoline and placebo. Using a visual analogue scale, the degree of discomfort was assessed during each scan. Results: We evaluated 18 patients, 10 women (55.6%) and 8 men (44.4%), with a mean age of 28±4 years. The degree of disturbance generated by the scan with the application of lidocaine-epinephrine was 1.94; with oxymetazoline it was 3.78, and with placebo, 4.61. When the lidocaine-epinephrine solution was compared with oxymetazoline, there was a statistical significance in favour of lidocaine-epinephrine (P<0.05). When we compared the use of lidocaine-epinephrine with the placebo, the result was also statistically significant in favour of lidocaine-epinephrine (P<0.05). Conclusions: In this study we demonstrated that using lidocaine associated with epinephrine as a topical anaesthetic prior to flexible nasofibrolaryngoscopy decreases pain and feeling of discomfort for the patient. Consequently, we can recommend the use of topical nasal anaesthesia when performing this exploratio (AU)

Síndrome de Eagle / Eagle syndrome

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[Topical anesthesia in flexible nasofibrolaryngoscopy]. / Anestesia tópica en la nasofibrolaringoscopia flexible.

INTRODUCTION: The emergence of flexible nasofibrolaryngoscopy in recent decades has facilitated the development of Otolaryngology and the nasofibrolaryngoscope has become an essential diagnostic tool for the otolaryngologist. However, its use is not without discomfort for the patient, which is why various options for topical anaesthesia have been proposed during the development of the technique. MATERIAL AND METHODS: This was a prospective, double blind, crossover study in patients with no history of nasal disease, through which we compared the use of topical anaesthetic (Lidocaine) + epinephrine, oxymetazoline and placebo. Using a visual analogue scale, the degree of discomfort was assessed during each scan. RESULTS: We evaluated 18 patients, 10 women (55.6%) and 8 men (44.4%), with a mean age of 28±4 years. The degree of disturbance generated by the scan with the application of lidocaine-epinephrine was 1.94; with oxymetazoline it was 3.78, and with placebo, 4.61. When the lidocaine-epinephrine solution was compared with oxymetazoline, there was a statistical significance in favour of lidocaine-epinephrine (P<0.05). When we compared the use of lidocaine-epinephrine with the placebo, the result was also statistically significant in favour of lidocaine-epinephrine (P<0.05). CONCLUSIONS: In this study we demonstrated that using lidocaine associated with epinephrine as a topical anaesthetic prior to flexible nasofibrolaryngoscopy decreases pain and feeling of discomfort for the patient. Consequently, we can recommend the use of topical nasal anaesthesia when performing this exploration.

Temporal bone dissection practice using a chicken egg.

HYPOTHESIS: Temporal bone drilling practice constitutes an essential stage in training for the surgical approach to this complex anatomic structure. To facilitate adaptation and surgical skills in otologic surgery, we recall the easy cost-effective practice of drilling a chicken egg. BACKGROUND: The resident in training must master the use of the surgical microscope, the burr, and fine drilling instruments used in dissection. Animal models, plastic temporal bones, prototyped temporal bones, and virtual reality temporal bones have all been used. METHODS: This article describes a method of training residents' otologic skills by drilling a chicken egg. We used basic support materials found in a typical temporal bone dissection laboratory, with a surgical microscope, a desk, and a drilling system. Practice includes drilling and dissection of the eggshell, preserving the natural eggshell membrane. RESULTS: Learning temporal bone drilling on an egg, using basic materials, allows the surgeon to simulate surgery on a physical model using the same instrumentation that is used in surgery, obviating the need for laboratory conditions required for cadaveric dissection. CONCLUSION: Simulation is emerging as a mandatory component of surgical training. The egg is an excellent cost-effective model for drilling and dissection training and helps in improving surgical skills, enables learning of fine motor skills, and allows repeated practice. Although this method of training does help one control a drill and manual instrumentation, it does not help with temporal bone anatomy knowledge.