A new score for airway assessment using clinical and ultrasound parameters.

Background: Over the last few years, ultrasonography has been introduced as the fifth pillar to patient's bedside physical examination. Clinical assessments aim to screen and look for airway difficulties to predict difficult intubations, but none have demonstrated a significant predictive capacity. Recent systematic reviews have established a correlation between ultrasound imaging and difficult direct laryngoscopy. The primary objective of this study was to determine whether the utilization of ultrasonography to examine the upper airway could accurately predict difficult direct laryngoscopy. Methods: This is a prospective observational study including 102 adult patients that required general anesthesia for elective surgery. Preoperatively, clinical airway assessments were performed. Data such as Mallampati-Samsoon grade (MS), upper lip bite test (ULBT), thyromental (TMD) and sternomental distance (SMD), cervical circumference (CC) and the Arné risk index were collected. Ultrasound evaluation was taken at five different levels in two planes, parasagittal and transverse. Therefore, the following measurements were registered: distance from skin to hyoid bone (DSHB), distance from skin to thyrohyoid membrane (DSTHM), distance from skin to epiglottis (DSE), distance from skin to thyroid cartilage (DSTC) and distance from hyoid bone and thyroid cartilage (DHBTC). Patients were divided into two groups based on the difficulty to perform direct laryngoscopy, according to Cormack-Lehane (C-L) classification. Grades I and II were classified as easy laryngoscopy and grades III or IV as difficult. Logistic regression models and the Receiver Operating Characteristic (ROC) curve was employed to determine the diagnostic precision of ultrasound measurements to distinguish difficult laryngoscopy (DL). Results: The following risk score for DL was obtained, DSTHM ≥ 1.60 cm (2 points), DSTC ≥ 0.78 cm (3 points) and gender (2 points for males). The score can range from 0 to 7 points, and showed and AUC (95% CI) of 0.84 (0.74-0.95). A score of 5 points or higher indicates a 34-fold increase in the risk of finding DL (p = 0.0010), sensitivity of 91.67, specificity of 75.56, positive predictive value of 33.33, and negative predictive value of 98.55. Conclusion: The use of ultrasonography combined with classic clinical screening tests are useful tools to predict difficult direct laryngoscopy.

Análisis de la producción científica en otorrinolaringología en España durante el periodo 2011-2015. Acta Otorrinolaringol Esp. 2018; 69: 275-282 / Analysis of scientific production in otolaryngology in Spain in the period 2011-2015. Acta Otorrinolaringol Esp. 2018; 69: 275-282

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Morphological and morphometric study on human Scarpa ganglion development.

CONCLUSION: In Scarpa neurons the cell and nuclear area increases and nuclear/cytoplasm ratio decreases with fetal age (p < 0.0001). There are statistically significant differences in cell area between all fetal groups, except for the interval 45-74 mm crown-rump-length (CRL). Displacement of a neuron within the internal auditory meatus (IAM) occurs from 9 weeks in the fetus until the neonate. METHODS: A light microscopic histomorphometric study of the Scarpa ganglion in human fetuses from spontaneous abortions measuring 45, 74, 90, 134, 145 and 270 mm CRL and a from a 1-day-old neonate (360 mm) was carried out. Cell and nuclear area, ganglion area and distances from the Scarpa ganglion neurons to the endocranial porus of the IAM were measured. RESULTS: In the 45, 74, 90 and 134 mm CRL human fetuses the cartilaginous labyrinthine capsule appears divided by the facial nerve and the Scarpa ganglion into two compartments: rostral and dorsal. Ovoidal Scarpa ganglion in the 45 mm CRL lies within the IAM near its endocranial porus (15 µm). In the otic capsule of the 145 mm CRL fetus an endochondral ossification appears in the IAM base, where Scarpa ganglion neurons are displayed in two groups: superior and inferior divided by a vascular-connective septum. This anatomy remains from this specimen until the neonate specimen.

Principles of cranial base ossification in humans and rats.

CONCLUSIONS: 1. The principle of bilateral symmetry depends on the chordal cartilage that is the keystone in cranial base ossification in rats and humans, due to its anatomical situation and for the production of the chordin protein that regulates the bone morphogenetic protein BMP-7. 2. In humans and in rats, foramen lacerum closure follows a line of intramembranous ossification that depends on BMP-7, regulated by the first branchial pouch. 3. The cranial base ossification patterns and centres are similar in humans and in rats, except in the otic capsule, palate and the lateral pterygoid plate. 4. The neural crest may induce cranial ossification through the cranial nerves. OBJECTIVES: To study the patterns of cranial base ossification in humans and in rats, considering the chordal cartilage, and the otic, nasal and orbit capsules, as well as the participation of the branchial arches and pouches. METHODS: This was a light microscopy study of human fetal specimens obtained from spontaneous abortions with the following crown-rump-lengths (crl) 45, 74, 90, 134, 145 and 270 mm, and a 1-day-old neonate (360 mm crl), who had died of sudden death syndrome. We also examined Webster albino rat embryos of 16, 18 and 20 days of gestation and a postnatal series of rats 8 h and 1, 3, 4, 6, 7, 10 and 13 days old, as well as adult animals. RESULTS: In the 45 mm human fetus, the chordal cartilage with the nasal, otic and orbit capsules initiates cranial base ossification. Foramen lacerum closure begins in the 16-day-old rat embryo, following a line of membranous ossification between the external pterygoid process and the lateral alisphenoidal wing at ovalis foramen level. This is not a timing symmetrical process, which may persist until the 10th postnatal day in the rat. In the human fetus of 74 mm, the foramen lacerum space is closed by a membranous fusion ossification between the chordal cartilage and otic capsule, finishing at the 270 mm specimen. Endochondral ossification of the human otic capsule first appeared in the 145 mm (18 weeks) fetal specimen with four ossifying centres. The rat otic cartilaginous capsule showed rapid endochondral ossification, in the third and fourth postnatal day specimens.

Inflammatory myofibroblastic tumor of the temporal bone: a histologically nonmalignant lesion with fatal outcome.

INTRODUCTION: Inflammatory myofibroblastic tumor (IMFT) of the temporal bone is an unusual but distinct clinicopathologic entity. CASE REPORT: We report the case of a 75-year-old patient with an IMFT located in the temporal bone. Symptoms included VI, X, XI, and XII cranial nerves palsies. Computed tomography and magnetic resonance images are described. The lesion was locally aggressive and outcome was fatal. IMFT was identified by analysis of postmortem specimen with histopathologic and immunohistochemical confirmation. DISCUSSION: IMFT can be locally destructive lesions. Involvement of the skull base and cervical spine is indistinguishable from an aggressive infection or a malignant tumor and can be fatal as in our case report. The difficulties in establishing clinicopathologic diagnosis, radiological imaging characteristics, and treatment are discussed.

Evaluation of the frequency selectivity of contralateral acoustic stimulation on the active mechanisms of the organ of corti by analyzing the changes in the amplitude of transitory evoked otoacoustic emissions and distortion products.

INTRODUCTION: The central nervous system can regulate the input of acoustic information to the cochlea by means of the olivocochlear efferent system's action on the organ of Corti. The aim of this study was to determine whether the suppressor effect of contralateral acoustic stimulation shows frequency selectivity in active cochlear mechanisms by recording transient evoked otoacoustic emissions (TEOAEs) and distortion product otoacoustic emissions (DPOAEs). MATERIAL AND METHOD: We conducted a prospective study of 56 subjects with normal-hearing ears aged 20 to 22 years (mean 5 20.9 years); 50% were male and 50% were female. We studied the amplitude of each TEOAE and DPOAE frequency band before and after contralateral acoustic stimulation with broadband white noise, 0 to 20,000 Hz frequency range, and pure tones of 700, 1000, 1500, 2000, 3000, 4000, 5000, and 6000 Hz, at an intensity of 60 dB HL. RESULTS: TEOAE recording amplitudes decreased 84% after contralateral acoustic stimulation. White noise and pure tones of 1000, 1500, and 2000 Hz had the greatest suppressor effects on the TEOAEs. The suppressor effect was higher in 1000 to 4000 Hz frequency bands, with a statistically significant decrease in amplitudes of 0.5 to 2.5 dB. Distortion product amplitude decreased 75%. Stimulation with white noise and pure-tone contralateral stimulation at 1000 and 1500 Hz showed the highest decrease in DPOAE amplitude. Suppression was concentrated in DPOAEs obtained with F2 of 1500 and 2000 Hz. CONCLUSION: Contralateral acoustic stimulation causes selective frequency modulation of the cochlear micromechanisms, which can be assessed by recording TEOAEs and DPOAEs.

Evaluation of the influence of visual stimulation in the active mechanisms of the organ of Corti by analyzing the changes in the amplitude of distortion products.

INTRODUCTION: The central nervous system can regulate the input of information to the cochlea by means of the activity of the olivocochlear efferent system on the active micromechanisms of the organ of Corti. This article discusses a quantitative study of the inhibitory phenomenon that visual tasks exert on active cochlear micromechanisms. MATERIAL AND METHOD: We studied prospectively the characteristics of distortion products (DPs) in 80 normal ears, with and without visual stimulation. RESULTS: The results showed a decrease in the amplitude of DPs (2F1-F2), which was significant in frequencies between 1500 and 6000 Hz. CONCLUSION: Visual stimulation causes a modulation of the cochlear micromechanisms from the central nervous system from the medial olivocochlear bundle of the efferent auditory pathway.

Evaluation of cochlear function in normal-hearing young adults exposed to MP3 player noise by analyzing transient evoked otoacoustic emissions and distortion products.

OBJECTIVE: Exposure to recreational noise may cause injuries to the inner ear, and transient evoked (TEOAEs) and distortion product otoacoustic emissions (DPOAEs) may identify these cochlear alterations. The goal of this study was to evaluate TEOAEs and DPOAEs as a method to diagnose early cochlear alterations in young adults exposed to MP3 player noise. MATERIAL AND METHODS: We performed a prospective study of the cochlear function in normal-hearing MP3 player users by analyzing TEOAE and DPOAE incidence, amplitude, and spectral content. We gathered a sample of 40 ears from patients between 19 and 29 years old (mean age 24.09 years, SD 3.9 years). We compared the results with those of a control group of 232 ears not exposed to MP3 noise from patients aged 18 to 32 years (mean age 23.35 years, SD 2.7 years). Fifty percent of ears were from females and 50% were from males. RESULTS: Subjects who had used MP3 players for most years and for more hours each week exhibited a reduction in TEOAE and DPOAE incidence and amplitudes and an increase in DPOAE thresholds. TEOAEs showed a statistically significant lower incidence and amplitudes for normal-hearing subjects using MP3 players at frequencies of 2000, 3000, and 4000 Hz. DPOAE incidence was lower at 700, 1000, 1500, and 2000 Hz; the amplitudes were lower at frequencies between 1500 and 6000 Hz; and the thresholds were higher for all frequency bands, statistically significant at frequencies from 1500 to 6000 Hz, p < .05. CONCLUSIONS: Cochlear impairment caused by MP3 player noise exposure may be detectable by analyzing TEOAEs and DPOAEs before the impairment becomes clinically apparent.

[Analysis of the anthropometric, epidemiological, and clinical parameters in patients with snoring and obstructive sleep apnoea]. / Análisis de los parámetros antropométricos, epidemiológicos y clínicos en los pacientes con roncopatía y síndrome obstructivo de apnea-hipopnea del sueño.

OBJECTIVES: The existence of snoring, apnoeas and diurnal somnolence constitutes obstructive sleep apnoea (OSA), a disease of high prevalence that can cause serious complications. We have made a descriptive study of the epidemiological and clinical characteristics of patients with suspected OSA, with the main target of knowing the value of some of these characteristics in the evaluation of these patients. PATIENTS AND METHOD: We have had access to a retrospective sample of 433 patients (361 men and 72 women) with an average age of 47 (11.1) years (range, 18-75), referred due to suspected OSA. The variables and examinations studied were: age, gender, electrocardiogram, spirometry, blood pressure, smoking, neck perimeter, body mass index (BMI), daytime drowsiness (Epworth Sleepiness Scale), nasal and pharyngeal examination, Müller's manoeuvre, and Respiratory Disturbance Index (RDI). RESULTS: Patients with OSA included in this study are older and more obese, and they have a greater neck perimeter. In addition, they present greater daytime sleepiness and a greater frequency of pharyngeal collapse in Müller's mano-euvre than mere snorers. Clinical and epidemiological parameters were seen to correlate better with the existence of OSA in clearly obese individuals (BMI >30) than in individuals with normal BMI scores (<24) or even overweight (25-29). As far as age was concerned, the clinical and epidemiological parameters showed more statistically significant differences between patients with OSA and simple snorers among the youngest individuals in our sample (<43 years of age). CONCLUSIONS: Physical examination and the clinical and epidemiological data are useful to complete the diagnostic assessment of these patients.

Análisis de los parámetros antropométricos, epidemiológicos y clínicos en los pacientes con roncopatía y síndrome obstructivo de apnea-hipopnea del sueño / Analysis of the anthropometric, epidemiological, and clinical parameters in patients with snoring and obstructive sleep apnoea

Objetivos: Los ronquidos, las apneas y la somnolencia diurna constituyen el síndrome de apnea-hipopnea obstructiva del sueño (SAHOS), enfermedad de elevada prevalencia que puede causar graves complicaciones. Hemos realizado un estudio descriptivo de las características epidemiológicas y clínicas de los pacientes con sospecha de SAHOS, con el objetivo principal de conocer el valor de algunas de esas características en la evaluación de los pacientes. Pacientes y método: Hemos dispuesto de una muestra retrospectiva de 433 pacientes, 361 varones y 72 mujeres, con una media ± desviación estándar de edad de 47 ± 11,1 (intervalo, 18-75) años, remitidos por sospecha de SAHOS. Las variables y exploraciones estudiadas fueron edad, sexo, electrocardiograma, espirometría, presión arterial, tabaquismo, perímetro del cuello, índice de masa corporal (IMC), test de somnolencia diurna (Epworth Sleepiness Scale), exploración nasal y faríngea, maniobra de Müller e índice de apnea-hipopnea (IAH). Resultados: Los pacientes con SAHOS incluidos en este estudio tienen más edad, son más obesos y tienen mayor perímetro cervical. Además, presentan más somnolencia diurna y mayor frecuencia de colapso faríngeo en la maniobra de Müller que los roncadores simples. Por otra parte, se observó que los parámetros clínicos y epidemiológicos se correlacionan mejor con el diagnóstico de SAHOS en los individuos con obesidad franca (IMC > 30) que en los individuos con IMC normal (< 24) e incluso con sobrepeso (IMC 25-29). En cuanto a la edad, los parámetros clínicos y epidemiológicos mostraron más diferencias estadísticamente significativas entre los pacientes con SAHOS y los roncadores simples en los individuos más jóvenes de nuestra muestra (menores de 43 años). Conclusiones: La exploración física y los datos epidemiológicos y clínicos son útiles para completar la evaluación diagnóstica de estos pacientes

Objectives: The existence of snoring, apnoeas and diurnal somnolence constitutes obstructive sleep apnoea (OSA), a disease of high prevalence that can cause serious complications. We have made a descriptive study of the epidemiological and clinical characteristics of patients with suspected OSA, with the main target of knowing the value of some of these characteristics in the evaluation of these patients. Patients and method: We have had access to a retrospective sample of 433 patients (361 men and 72 women) with an average age of 47 (11.1) years (range, 18-75), referred due to suspected OSA. The variables and examinations studied were: age, gender, electrocardiogram, spirometry, blood pressure, smoking, neck perimeter, body mass index (BMI), daytime drowsiness (Epworth Sleepiness Scale), nasal and pharyngeal examination, Müller’s manoeuvre, and Respiratory Disturbance Index (RDI). Results: Patients with OSA included in this study are older and more obese, and they have a greater neck perimeter. In addition, they present greater daytime sleepiness and a greater frequency of pharyngeal collapse in Müller’s mano-euvre than mere snorers. Clinical and epidemiological parameters were seen to correlate better with the existence of OSA in clearly obese individuals (BMI >30) than in individuals with normal BMI scores (<24) or even overweight (25-29). As far as age was concerned, the clinical and epidemiological parameters showed more statistically significant differences between patients with OSA and simple snorers among the youngest individuals in our sample (<43 years of age). Conclusions: Physical examination and the clinical and epidemiological data are useful to complete the diagnostic assessment of these patients

Evaluation of cochlear function in patients with tinnitus using spontaneous and transitory evoked otoacoustic emissions.

OBJECTIVE: The aim of this paper has been to investigate the cochlear function and the basic properties of otoacoustic emissions (OAEs) in patients with tinnitus using Spontaneous Otoacoustic Emissions (SOAEs) and Transitory Evoked Otoacoustic Emissions (TEOAEs). MATERIALS AND METHODS: We have analyzed the incidence, amplitude and spectral content of hearing thresholds, SOAEs and TEOAEs in a sample of 44 ears. We have measured incidence, intensity, frequency, number of peaks and amplitude of emission and their variability across frequency range from 500 to 5000 Hz. A correlation was determined between the OAEs results and the results obtained using hearing thresholds. RESULTS: We have not found statistically significant differences at 500, 1000, 2000, 4000 and 8000 Hz frequencies neither at mean hearing thresholds between the sample of ears with tinnitus and the sample of ears without tinnitus. SOAEs were only present in 1 of the 44 ears tested (2.27%) and it was a 17 dB SPL amplitude peak at 2770 Hz frequency. TEOAEs, however, were displayed in some frequency in all the ears. We have compared TEOAEs parameters between the sample of ears with tinnitus and the sample of ears without tinnitus in 500, 1000, 2000, 4000 and 5000 Hz frequencies, and we have only found statistically significant differences at 4000 Hz, p = 0.02. Comparison of TEOAEs parameters between ears with tinnitus and ears without tinnitus in the same patient have only found statistically significant differences at 4000 Hz frequency, p = 0.011. In both cases there were not statistically significant differences at 500, 1000, 2000 and 5000 Hz frequencies nor at mean TEOAEs amplitudes for every group. CONCLUSIONS: We have not found significant relations between tinnitus and OAEs registration.

The predictive value of clinical and epidemiological parameters in the identification of patients with obstructive sleep apnoea (OSA): a clinical prediction algorithm in the evaluation of OSA.

We sought to analyze the predictive value of anthropometric, clinical and epidemiological parameters in the identification of patients with suspected OSA, and their relationship with apnoea/hypopnoea respiratory events during sleep. We studied retrospectively 433 patients with OSA, 361 men (83.37%) and 72 women (16.63%), with an average age of +/-47, standard deviation +/-11.10 years (range 18-75 years). The study variables for all of the patients were age, sex, spirometry, neck circumference, body mass index (BMI), Epworth sleepiness scale, nasal examination, pharyngeal examination, collapsibility of the pharynx (Müller Manoeuvre), and apnoea-hypopnoea index (AHI). Age, neck circumference, BMI, Epworth sleepiness scale, pharyngeal examination and pharyngeal collapse were the significant variables. Of the patients, 78% were correctly classified, with a sensitivity of 74.6% and a specificity of 66.3%. We found a direct relationship between the variables analysed and AHI. Based on these results, we obtained the following algorithm to calculate the prediction of AHI for a new patient: AHI = -12.04 + 0.36 neck circumference +2.2286 pharyngeal collapses (MM) + 0.1761 Epworth + 0.0017 BMI x age + 1.1949 pharyngeal examinations. The ratio variance in the number of respiratory events explained by the model was 33% (r2 = 0.33). The variables given in the algorithm are the best ones for predicting the number of respiratory events during sleep in patients studied for suspected OSA. The algorithm proposed may be a good screening method to the identification of patients with OSA.

Tumor desmoide del espacio retroestiloideo / Desmoid tumor of the retrostiloid space

En este artículo describimos el caso clínico de un paciente 74 años de edad, que acudió a nuestra consulta por presentar una tumoración cervical derecha de 6 meses de evolución. La T.A.C., R.M.N., y arteriografía realizadas informaban de la existencia de un tumor no capsulado, avascular, que se extendía por los espacios carotideo, retrofaríngeo y prevertebral. El informe anatomopatológico de la pieza quirúrgica nos informó de la existencia de un tumor desmoide: una fibromatosis profunda de tipo extrabdominal de muy escasa incidencia en su localización en el cuello; y que aunque carece de capacidad maligna o metastatizante, tiene un carácter localmente invasivo y con tendencia a la recurrencia (AU)