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1.
Head Neck ; 43(5): 1415-1420, 2021 05.
Artigo em Inglês | MEDLINE | ID: mdl-33433950

RESUMO

BACKGROUND: To describe the low morbidity of middle turbinate mucosal flap (MTMF) to repair anterior skull base defects. METHODS: Skull base endonasal endoscopic surgeries performed at a tertiary hospital between 2015 and 2018 were analyzed. Patients were divided into two groups according the existence or not of a significant intraoperative cerebrospinal fluid (CSF) leak. In Group 1 (n = 28), gasket seal and a pedicled endonasal flap were used to repair the defect: 13 nasoseptal flaps (NSF), 8 inferolateral wall flaps (ILF), and 7 MTMF. In Group 2 only an endonasal flap was used: 9 NSF, 4 ILF, and 18 MTMF. Surgical and recovery time were analyzed (Student's t test). Our favorite surgical technique is described. RESULTS: Fifty-nine patients were included. Average surgical time was 27.7, 41.6, and 11.3 min for NSF, ILF, and MTMF, respectively. MTMF showed a faster recovery. CONCLUSION: MTMF is a safe reconstructive option for anterior skull base defects.


Assuntos
Procedimentos de Cirurgia Plástica , Conchas Nasais , Vazamento de Líquido Cefalorraquidiano , Endoscopia , Humanos , Morbidade , Base do Crânio/cirurgia , Retalhos Cirúrgicos , Conchas Nasais/cirurgia
2.
Clin Mol Allergy ; 17: 8, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31068762

RESUMO

BACKGROUND: Component-resolved diagnosis (CRD) allows to identify single molecular allergen components, and constitutes a routine practice in many allergy units. However, skin prick test (SPT) remains the technique of choice in many otorhinolaryngology departments, thus increasing the risk of using inadequate immunotherapies in patients with respiratory allergies. This study aimed to compare sensitization profiles determined by SPT and CRD in patients with respiratory allergy, and to explore the relationship between sensitization and type and severity of the respiratory disease. METHODS: Cross-sectional, multicenter study of patients admitted to the Otorhinolaryngology Department due to symptoms of respiratory allergy. Extracts from various house dust mites, pollens, and molds were tested by SPT, whereas IgE against the corresponding antigens were measured by CRD. RESULTS: The analysis included 101 patients. The sensitization profile obtained by SPT had low agreement with that of CRD, particularly to dust mite allergens (Dermatophagoides sp.) and pollens (Plantago lanceolata, Olea europaea, and Cupressus sempervirens). While SPT did not show any significant relationship between sensitization and type/severity of the respiratory disease, CRD allowed to associate Der p 1, Der f 1 and Lep d 2 sensitizations with asthma, and Der p 2, Der f 2 and Lep d 2 sensitizations with more severe symptoms of allergic rhinitis. CONCLUSIONS: Compared with SPT, CRD enables to describe a more accurate sensitization profile and to identify associations between symptoms and specific antigens. The routine use of CRD in an otorhinolaryngology setting may benefit the management of patients with respiratory allergy.Trial registration IB 3108/15 (Retrospectively registered).

3.
Int Arch Otorhinolaryngol ; 23(2): 165-171, 2019 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-30956700

RESUMO

Introduction Granulomatosis with Polyangiitis (GPA) is a small vessel vasculitis characterized by a necrositing granulomatous inflammation of the upper and lower respiratory tracts and focal/proliferative glomerulonephritis. In more than 70% of the cases, the presenting symptoms are head and neck manifestations that are often misdiagnosed as infectious or allergic in etiology. Objective The present study provides an analysis of head and neck manifestations in a series of patients diagnosed with GPA. It also evaluates their medical and surgical treatment and provides a review of the relevant literature. Methods A retrospective analysis of 19 patients diagnosed with GPA at a public tertiary care hospital between 2006 and 2017 was performed. Results A total of 19 patients were included in the present study, and 16 of them presented head and neck manifestations. Sinonasal symptoms were the most common, affecting 56% of the patients, followed by laryngotracheal (31.25%) and ear (25%) symptoms. In 7 patients, sinonasal symptoms were the first manifestation of the disease (43.75%). Four patients underwent surgery at some stage of the disease. Conclusions Head and neck involvement is common in GPA and may stand for the first or the only manifestation of the disease. The otolaryngologists play a central role in the diagnosis and long-term treatment of these patients, and they have to keep this pathology in mind when treating patients with ENT symptoms that do not respond as expected to the treatment.

4.
Int Arch Otorhinolaryngol ; 23(2): 196-202, 2019 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-30956705

RESUMO

Introduction Benign paroxysmal positional vertigo (BPPV) is the most common form of peripheral vertigo, and, in most cases, it presents a favorable prognosis. The treatment is based on a series of specific canalicular repositioning maneuvers that offer an efficacy close to 100%. Despite this, there are cases that are refractory to treatment, with the persistence of the vertigo symptoms. Objectives The objective of the present paper is to analyze the factors associated with an increased risk of refractory BPPV and the importance of nuclear magnetic resonance in the study of these patients. Methods We retrospectively reviewed the cases of 176 patients diagnosed with BPPV in our center. We divided them into two groups: responders and non-responders to the treatment, and analyzed the possible risk factors associated with a higher risk of refractory vertigo. Fischer exact test was used. Results We found 11 cases refractory to treatment; all of them underwent magnetic resonance imaging (MRI) with gadolinium according to our protocol. Of these, four had an otoneurologic background or pathology, and two other patients presented a multicanal involvement. The difference between the two groups was statistically significant ( p < 0.05). Conclusion Otoneurologic background and multicanal involvement were associated with a higher risk of refractory BPPV. When dealing with a BPPV with persistent symptomatology/nystagmus or with early relapse after an initial improvement, other entities that enter into the differential diagnosis must always be considered. We consider it essential to perform an MRI with gadolinium to rule out cases of BPPV that have a central cause.

5.
Acta otorrinolaringol. esp ; 70(2): 80-87, mar.-abr. 2019. graf, tab, ilus
Artigo em Espanhol | IBECS | ID: ibc-178518

RESUMO

Objetivo: El implante activo de conducción ósea transcutáneo Bonebridge(R) está indicado en pacientes con hipoacusia conductiva/mixta bilateral o en casos de hipoacusia neurosensorial unilateral, mostrando resultados auditivos similares a otros dispositivos percutáneos de conducción ósea pero con menor tasa de complicaciones. El objetivo del siguiente trabajo ha sido analizar los resultados auditivos en una serie de 26 pacientes con hipoacusia conductiva/mixta tratados con Bonebridge(R). Métodos: Veintiséis de un total de 30 pacientes implantados con Bonebridge(R) entre octubre 2012 y mayo 2017 fueron incluidos en el estudio. Se compararon los umbrales de vía aérea a las frecuencias 500, 1.000, 2.000, 3.000 y 4.000 Hz, umbral de reconocimiento verbal 50% y el porcentaje de aciertos a 50 dB sin y con el implante. Resultados: El umbral tonal medio en campo libre con el dispositivo en funcionamiento fue de 34,91 dB, obteniendo unas ganancias medias de 33,46 dB. La SRT 50% media con el implante fue de 34,33 dB mientras que sin él nadie alcanzaba el 50% de aciertos a una intensidad de hasta 50 dB. Con respecto al porcentaje de aciertos a 50 dB, mejoró desde un 11% sin implante a un 85% con el mismo. Entre las complicaciones solo se observó un caso de extrusión del dispositivo en una paciente con antecedentes de 2 ritidoplastias previas. Conclusiones: Los resultados audiológicos obtenidos en nuestro estudio son similares a los publicados en la literatura. Bonebridge(R) representa una excelente alternativa en el tratamiento de la hipoacusia conductiva/mixta, pero con una tasa menor de complicaciones


Objective: The active transcutaneous bone conduction implant Bonebridge®, is indicated for patients affected by bilateral conductive/mixed hearing loss or unilateral sensorineural hearing loss, showing hearing outcomes similar to other percutaneous bone conduction implants, but with a lower rate of complications. The aim of this study was to analyze the hearing outcomes in a series of 26 patients affected by conductive or mixed hearing loss and treated with Bonebridge(R). Methods: 26 of 30 patients implanted with Bonebridge(R) between October 2012 and May 2017, were included in the study. We compared the air conduction thresholds at the frequencies 500, 1000, 2000, 3000, 4000Hz, the SRT50% and the percentage of correct answers at an intensity of 50dB with and without the implant. Results: "Pure tone average" with the implant was 34.91 dB showing an average gain of 33.46 dB. Average SRT 50% with the implant was 34.33 dB, whereas before the surgery no patient achieved 50% of correct answers at a sound intensity of 50dB. The percentage of correct answers at 50dB changed from 11% without the implant to 85% with it. We only observed one complication consisting of an extrusion of the implant in a patient with a history of 2 previous rhytidectomies. Conclusions: The hearing outcomes obtained in our study are similar to those published in the literature. Bonebridge(R) represents an excellent alternative in the treatment of conductive or mixed hearing loss, and with a lower rate of complications


Assuntos
Humanos , Masculino , Feminino , Adulto Jovem , Adulto , Pessoa de Meia-Idade , Idoso , Condução Óssea , Perda Auditiva Condutiva/cirurgia , Perda Auditiva Neurossensorial/cirurgia , Implantes Cocleares , Retalhos Cirúrgicos , Audiometria/métodos , Estudos Retrospectivos , Audiologia/métodos , Colesteatoma/complicações
6.
Artigo em Inglês, Espanhol | MEDLINE | ID: mdl-29784242

RESUMO

OBJECTIVE: The active transcutaneous bone conduction implant Bonebridge®, is indicated for patients affected by bilateral conductive/mixed hearing loss or unilateral sensorineural hearing loss, showing hearing outcomes similar to other percutaneous bone conduction implants, but with a lower rate of complications. The aim of this study was to analyze the hearing outcomes in a series of 26 patients affected by conductive or mixed hearing loss and treated with Bonebridge®. METHODS: 26 of 30 patients implanted with Bonebridge® between October 2012 and May 2017, were included in the study. We compared the air conduction thresholds at the frequencies 500, 1000, 2000, 3000, 4000Hz, the SRT50% and the percentage of correct answers at an intensity of 50dB with and without the implant. RESULTS: "Pure tone average" with the implant was 34.91dB showing an average gain of 33.46dB. Average SRT 50% with the implant was 34.33dB, whereas before the surgery no patient achieved 50% of correct answers at a sound intensity of 50dB. The percentage of correct answers at 50dB changed from 11% without the implant to 85% with it. We only observed one complication consisting of an extrusion of the implant in a patient with a history of 2 previous rhytidectomies. CONCLUSIONS: The hearing outcomes obtained in our study are similar to those published in the literature. Bonebridge® represents an excellent alternative in the treatment of conductive or mixed hearing loss, and with a lower rate of complications.


Assuntos
Condução Óssea , Prótese Ancorada no Osso , Perda Auditiva Bilateral/reabilitação , Perda Auditiva Condutiva-Neurossensorial Mista/reabilitação , Adulto , Idoso , Audiometria de Tons Puros , Limiar Auditivo , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Desenho de Prótese , Implantação de Prótese/métodos , Estudos Retrospectivos , Testes de Discriminação da Fala , Resultado do Tratamento , Adulto Jovem
7.
Laryngoscope ; 129(4): 1001-1004, 2019 04.
Artigo em Inglês | MEDLINE | ID: mdl-30588638

RESUMO

Recurrent respiratory papillomatosis can be a devastating condition for a child, with severe consequences. Currently, there is no proven successful medical treatment. We describe the use of systemic bevacizumab to treat two children affected by aggressive recurrent respiratory papillomatosis. Respiratory symptoms and quality of life improved dramatically in both patients, without observing any toxicity. The only complication was mild proteinuria. Systemic bevacizumab is a promising adjuvant treatment in aggressive recurrent respiratory papillomatosis in children. It is effective and well tolerated. Further studies are needed to establish the optimal dosing frequency and duration of therapy. Laryngoscope, 129:1001-1004, 2019.


Assuntos
Inibidores da Angiogênese/uso terapêutico , Bevacizumab/uso terapêutico , Infecções por Papillomavirus/tratamento farmacológico , Infecções Respiratórias/tratamento farmacológico , Inibidores da Angiogênese/efeitos adversos , Bevacizumab/efeitos adversos , Criança , Feminino , Humanos , Masculino
8.
Int. arch. otorhinolaryngol. (Impr.) ; 23(2): 165-171, 2019. ilus
Artigo em Inglês | LILACS | ID: biblio-1015114

RESUMO

Introduction: Granulomatosis with Polyangiitis (GPA) is a small vessel vasculitis characterized by a necrositing granulomatous inflammation of the upper and lower respiratory tracts and focal/proliferative glomerulonephritis. In more than 70% of the cases, the presenting symptoms are head and neck manifestations that are often misdiagnosed as infectious or allergic in etiology. Objective: The present study provides an analysis of head and neckmanifestations in a series of patients diagnosed with GPA. It also evaluates their medical and surgical treatment and provides a review of the relevant literature. Methods: A retrospective analysis of 19 patients diagnosed with GPA at a public tertiary care hospital between 2006 and 2017 was performed. Results: A total of 19 patients were included in the present study, and 16 of them presented head and neck manifestations. Sinonasal symptoms were the most common, affecting 56% of the patients, followed by laryngotracheal (31.25%) and ear (25%) symptoms. In 7 patients, sinonasal symptoms were the first manifestation of the disease (43.75%). Four patients underwent surgery at some stage of the disease. Conclusions: Head and neck involvement is common in GPA and may stand for the first or the onlymanifestation of the disease. The otolaryngologists play a central role in the diagnosis and long-term treatment of these patients, and they have to keep this pathology in mind when treating patients with ENT symptoms that do not respond as expected to the treatment (AU)


Assuntos
Humanos , Masculino , Feminino , Adulto , Pessoa de Meia-Idade , Idoso , Otorrinolaringopatias/fisiopatologia , Granulomatose com Poliangiite/fisiopatologia , Otorrinolaringopatias/cirurgia , Otorrinolaringopatias/diagnóstico por imagem , Espanha , Vasculite , Granulomatose com Poliangiite/cirurgia , Granulomatose com Poliangiite/diagnóstico por imagem , Estudos Retrospectivos , Anticorpos Anticitoplasma de Neutrófilos , Endoscopia
9.
Acta otorrinolaringol. esp ; 69(4): 201-207, jul.-ago. 2018. tab, graf, ilus
Artigo em Espanhol | IBECS | ID: ibc-180484

RESUMO

INTRODUCCIÓN Y OBJETIVOS: El vértigo posicional paroxístico benigno es la entidad más frecuente dentro de los vértigos de origen periférico. El objetivo del siguiente trabajo es revisar los resultados obtenidos con las diferentes maniobras de reposicionamiento canalicular específicas para cada tipo de canal semicircular afectado, evaluando posibles factores de riesgo relacionados con un peor pronóstico. MÉTODOS: Se han revisado retrospectivamente 176 pacientes diagnosticados de vértigo posicional paroxístico benigno en nuestro centro, de los cuales 150 tenían vértigo del canal semicircular posterior, 20 del horizontal, 3 del superior y 3 multicanal. Se ha usado la maniobra de Epley para el tratamiento del canal posterior y del superior y la maniobra de Lempert para el tratamiento del horizontal. En los casos refractarios se ha realizado siempre un estudio de imagen cerebral con resonancia. RESULTADOS: La maniobra de Epley ha mostrado una eficacia al primer intento del 74,6% para el canal posterior y del 100% para el superior. La eficacia de la maniobra de Lempert para el canal horizontal ha sido del 72,72% en los casos de canalolitiasis y del 58,33% en los de cupulolitiasis. Más complicado ha sido el tratamiento de los pacientes con más de un canal afectado y con antecedente quirúrgico en el mes previo. CONCLUSIONES: Las maniobras de reposicionamiento canalicular permiten alcanzar una tasa de éxito muy alta, obteniendo mejores resultados en el tratamiento del canal posterior. Hacen falta más estudios para confirmar la sospecha de que la cirugía previa pueda ser un factor de peor pronóstico


INTRODUCTION AND OBJECTIVES: Benign paroxysmal positional vertigo is the most common peripheral vertigo disease. The aim of this paper is to review the results obtained with the different specific particle repositioning manoeuvres, evaluating the possible risk factors linked to a poorer prognosis. METHODS: One hundred and seventy-six patients with a diagnosis of benign paroxysmal positional vertigo were reviewed retrospectively, of whom 150 had vertigo of the posterior canal, 20 had vertigo of the horizontal canal, 3 had vertigo of the superior canal, and 3 had a double vertigo. The Epley manoeuvre was used to treat the posterior and superior canals, and Lempert manoeuvre was used to treat the horizontal canal. An imaging study by nuclear magnetic resonance with gadolin was always used in refractory cases. RESULTS: The Epley manoeuvre showed an efficacy of 74.6 and 100% at first attempt for posterior and superior canals respectively. The efficacy of the Lempert manoeuvre for the horizontal canal was 72.72% in the patients with canalolithiasis, and 58.33% in the patients with cupulolithiasis. The treatment of patients with more than one affected canal and a history of surgery in the previous month was more difficult. CONCLUSIONS: Particle repositioning manoeuvres show a very high success rate, allowing better results in the treatment of the posterior canal. We need more studies to confirm the suspicion that surgery may be a factor of poorer prognosis


Assuntos
Humanos , Masculino , Feminino , Pessoa de Meia-Idade , Manipulações Musculoesqueléticas/métodos , Resultado do Tratamento , Estudos Retrospectivos , Canais Semicirculares , Atenção Terciária à Saúde , Centros de Atenção Terciária
10.
Artigo em Inglês, Espanhol | MEDLINE | ID: mdl-28965618

RESUMO

INTRODUCTION AND OBJECTIVES: Benign paroxysmal positional vertigo is the most common peripheral vertigo disease. The aim of this paper is to review the results obtained with the different specific particle repositioning manoeuvres, evaluating the possible risk factors linked to a poorer prognosis. METHODS: One hundred and seventy-six patients with a diagnosis of benign paroxysmal positional vertigo were reviewed retrospectively, of whom 150 had vertigo of the posterior canal, 20 had vertigo of the horizontal canal, 3 had vertigo of the superior canal, and 3 had a double vertigo. The Epley manoeuvre was used to treat the posterior and superior canals, and Lempert manoeuvre was used to treat the horizontal canal. An imaging study by nuclear magnetic resonance with gadolin was always used in refractory cases. RESULTS: The Epley manoeuvre showed an efficacy of 74.6 and 100% at first attempt for posterior and superior canals respectively. The efficacy of the Lempert manoeuvre for the horizontal canal was 72.72% in the patients with canalolithiasis, and 58.33% in the patients with cupulolithiasis. The treatment of patients with more than one affected canal and a history of surgery in the previous month was more difficult. CONCLUSIONS: Particle repositioning manoeuvres show a very high success rate, allowing better results in the treatment of the posterior canal. We need more studies to confirm the suspicion that surgery may be a factor of poorer prognosis.


Assuntos
Vertigem Posicional Paroxística Benigna/terapia , Manipulações Musculoesqueléticas/métodos , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Canais Semicirculares , Centros de Atenção Terciária , Resultado do Tratamento
11.
Acta Neurochir (Wien) ; 158(3): 445-9, 2016 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-26748503

RESUMO

BACKGROUND: Intraoperative magnetic resonance imaging (iMRI) is an effective and proven tool in transsphenoidal endoscopic surgery. However, image interpretation is not always easy and can be hindered by the presence of blood, tumor remains or the displacement of surrounding structures. In this article we present a novel technique based on using intrasellar ballons to reduce these difficulties and facilitate the surgeon's intraoperative assessment by iMRI. METHODS: Eighteen patients with pituitary macroadenomas underwent transsphenoidal surgery during 2013-2014 under low-field iMRI control (PoleStar N20, 0.15 T). Intrasellar balloons were used in all of them to assess the presence of tumoral remnants. We compared the findings in iMRI and postoperative high-field MRI control scans and also analyzed the number of intermediate imaging controls needed during surgery using this technique. RESULTS: In total, of the 18 patients, 14 underwent a complete resection. In the remaining four patients, a safe maximal resection was performed, leaving a remnant because of cavernous sinus invasion. In all cases, the balloons were a major help in distinguishing the anatomical structures from the tumoral remnants. Fewer imaging controls were required, and there were no false-positives or negative intraoperative findings. No complications related to the technique were registered. CONCLUSION: The "intrasellar balloon technique" is a useful tool that facilitates surgeons' intraoperative decision making. It is an important contribution to overcome the limitations of low-field iMRI as it provides a precise delineation of the resection margins, reduces false-positives and -negatives, and decreases the number of intermediate imaging controls required.


Assuntos
Adenoma/cirurgia , Endoscopia/métodos , Imageamento por Ressonância Magnética/métodos , Neoplasias Hipofisárias/cirurgia , Cirurgia Assistida por Computador/métodos , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Feminino , Humanos , Masculino , Pessoa de Meia-Idade
12.
Acta otorrinolaringol. esp ; 65(1): 43-46, ene.-feb. 2014. ilus
Artigo em Espanhol | IBECS | ID: ibc-124180

RESUMO

Los encefaloceles espontáneos son aquellos en los que no se puede determinar un origen. El objetivo del trabajo consiste en describir el tratamiento quirúrgico empleado. Presentamos los 3 últimos casos tratados mediante abordaje combinado transmastoideo y minicraneotomía, y cierre con cartílago y pericondrio conchal. En todos los casos se pudo acometer una correcta localización del encefalocele con un adecuado sellado del defecto óseo. No existieron complicaciones postoperatorias. No existieron recidivas en el periodo de seguimiento. El abordaje transmastoideo tiene la ventaja de permitir la localización del defecto en la base del cráneo sin provocar morbilidad neurológica. Sin embargo, y sobre todo en defectos amplios o de localización más anterior no permite un correcto sellado del defecto óseo y/o un control de todo el volumen de tejido herniado. Debido a estas limitaciones creemos una buena indicación combinar el abordaje transmastoideo con la realización de una minicraneotomía temporal (AU)


Spontaneous encephaloceles are defined as brain herniations with no apparent cause. The aim of this paper is to describe the surgical technique performed in our department. We reviewed the last 3 cases treated with combined approach (transmastoid plus minicraniotomy) with 2-layer closure. In all cases the bone defects were located and successfully sealed. We had no postoperative complications. There were no relapses in our follow-up period. The transmastoid approach has the advantage over the open approach with middle fossa craniotomy in that it locates the bone defect with no brain retraction. Nevertheless, it is not useful in large-sized, multiple or anterior defects. Due to those drawbacks, we think that the combined approach with temporal minicraniotomy is the best choice for this entity (AU)


Assuntos
Humanos , Feminino , Pessoa de Meia-Idade , Idoso , Encefalocele/cirurgia , Processo Mastoide/cirurgia , Craniotomia/métodos , Otorreia de Líquido Cefalorraquidiano/cirurgia , Fatores de Risco , Diagnóstico por Imagem/métodos
13.
Acta Otorrinolaringol Esp ; 65(1): 43-6, 2014.
Artigo em Espanhol | MEDLINE | ID: mdl-23953829

RESUMO

Spontaneous encephaloceles are defined as brain herniations with no apparent cause. The aim of this paper is to describe the surgical technique performed in our department. We reviewed the last 3 cases treated with combined approach (transmastoid plus minicraniotomy) with 2-layer closure. In all cases the bone defects were located and successfully sealed. We had no postoperative complications. There were no relapses in our follow-up period. The transmastoid approach has the advantage over the open approach with middle fossa craniotomy in that it locates the bone defect with no brain retraction. Nevertheless, it is not useful in large-sized, multiple or anterior defects. Due to those drawbacks, we think that the combined approach with temporal minicraniotomy is the best choice for this entity.


Assuntos
Craniotomia/métodos , Encefalocele/cirurgia , Osso Temporal/cirurgia , Idoso , Feminino , Humanos , Processo Mastoide , Pessoa de Meia-Idade
14.
Rev. otorrinolaringol. cir. cabeza cuello ; 74(2): 115-122, 2014. ilus, graf, tab
Artigo em Espanhol | LILACS | ID: lil-726161

RESUMO

Introducción: El órgano vomeronasal (OVN) descrito por Jacobson en mamíferos distintos al ser humano, es una incógnita tanto en lo que se refiere a su localización así como a su función en la raza humana. Se considera como un vestigio del olfato, que en los animales mamíferos parece influir en los hábitos sexuales (feromonas) y sociales. Hasta la fecha han sido escasos los estudios concluyentes al respecto en humanos. Objetivo: Conocer la prevalencia del órgano vomeronasal en nuestras consultas. Material y método: Presentamos un estudio prospectivo de prevalencia de la frecuencia de aparición de dicho órgano en 150 sujetos distribuidos por edad y sexo, explorados por endoscopia nasosinusal rígida. Por otro lado, analizamos la influencia sobre la libido (normal-disminuida-aumentada) en el posoperatorio de 35 septoplastías, a los 15 días tras retirada de taponamiento nasal y a los 30 días y lo comparamos con un grupo de 40 pacientes intervenidos timpanoplastías. Resultados: Estudiados 150 sujetos, encontramos la presencia del órgano vomeronasal en el 39,33% (59), de los cuales el 72,88% (43) fue unilateral (23 derecha y 20 izquierda) y el 27,12% (16) bilateral. En 91 (60,67%) no hallamos dicha estructura. La libido de los 35 pacientes intervenidos de septoplastía estaba disminuida, a los 15 días, en el 77,14% (27) frente al 40% (16) de las timpanoplastías, normal en el 17,14% (6) frente al 50% (20) de las cirugías otológicas, y en 2 (5,7%) poseptoplastía había aumentado, frente al 10% (4) del otro grupo. A los 30 días, en el 77,14% (27) de las septoplastías se había normalizado frente al 90% (36) del grupo otológico, en 2 (5,71%) de la cirugía nasal continuaba disminuida frente al 10% (4) del grupo de las timpanoplastías y en 6 (17,14%) tras septoplastía había aumentado. A todos los pacientes se les aplicó el mismo test no normalizado. Conclusión: El órgano vomeronasal de Jacobson continúa siendo un gran desconocido. Es una estructura que, al parecer, no es constante, al menos a la exploración endoscópica nasosinusal. Es difícil valorar si la cirugía en sí misma o el trauma psicológico posquirúrgico son los que afectan la libido de los pacientes tras la cirugía.


Introduction: The vomeronasal organ (OVN) described by Jacobson in mammals other than humans is unknown both in terms of its location and its role in the human race. It is viewed as a vestige of smell, that mammals in the animal seems to influence the sexual habits (pheromone) and social. To date, few studies have been inconclusive on this in humans. Aim: To determine the prevalence of vomeronasal organ in our medical consultations. Materials and methods: We report a prospective prevalence study of the occurrence of such a body in 150 subjects distributed by age and sex explored by endoscopic sinus rigid. On the other hand, we analyze the effect on the libido (normally less-plus) in the postoperative 35 septoplasty, 15 days after the withdrawal of nasal pack and 30 days and compared with a group of 40 tympanoplasty surgery. Results: Studied 150 subjects, we found the presence of the vomeronasal organ in 39.33% (59), of which 72.88% (43) had unilateral (23 right and 20 left) and 27.12% (16) bilaterally. In 91 (60.67%) did not find such a structure. The libido of the 35 patients who underwent septoplasty was decreased at 15 days, at 77.14% (27) versus 40% (16) of tympanoplasty, normal in 17.14% (6) compared to 50% (20) of otologic surgery, and in 2 (5.7%) postseptoplasty had increased, compared to 10% (4) the other group. At 30 days, in 77.14% (27) of the septoplasty group the libido was normalized against 90% (36) in the otologic group. In 2 cases (5.71%) of nasal surgery group was still decreased versus 10% (4) of cases of the tympanoplasty group, and in 6 (17.14%) postseptoplasty was increased. All patients were administered the same test is not standardized. Conclusion: The vomeronasal organ of Jacobson remains the great unknown. It is a structure that apparently is not constant, at least in the endoscopic sinus exploration. With regard to their role, it is difficult to assess whether the psychological trauma after surgery or the surgery by itself is responsible of the libido changes.


Assuntos
Humanos , Masculino , Feminino , Adolescente , Adulto , Pessoa de Meia-Idade , Idoso , Órgão Vomeronasal/anatomia & histologia , Órgão Vomeronasal/fisiologia , Feromônios/fisiologia , Fatores de Tempo , Prevalência , Estudos Prospectivos , Órgão Vomeronasal/cirurgia , Distribuição por Idade e Sexo , Libido/fisiologia , Septo Nasal/anatomia & histologia , Septo Nasal/cirurgia
15.
Int J Pediatr Otorhinolaryngol ; 77(8): 1237-43, 2013 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-23759335

RESUMO

OBJECTIVE: Few studies exist on children with common cavity, fewer still on their long-term audiological development after having received a cochlear implant. Our goal was to observe and report the long-term audiological progress of children with common cavity who were implanted with a custom-made electrode. METHODS: In this longitudinal, multi-center study, 19 children were implanted with a MED-EL custom-made electrode via either single slit cochleostomy or double posterior labyrinthotomy. We observed their audiological development with a test battery consisting of Categories of Auditory Performance (CAP), Speech Intelligibility Rating (SIR), and Ling 6-Sounds tests. We tested the children 1 month prior to the surgery; at first fitting; at 1, 3, 6, 12, and 18 months post first-fitting; at 2 years after first-fitting; and, whenever possible, at 3, 4, and 5 years after first-fitting. RESULTS: Children with common cavity tend to steadily and significantly improve their audiological skills over time. This development may, however, be highly individual; probably in part due to relatively high levels of additional needs. Parents should be counseled to establish realistic post-implantation expectations. Surgically, contrary to our expectations, we cannot confirm that double posterior labyrinthotomy reduces intracochlear electrode movement or that the MED-EL custom electrode leads to fewer incidences of intra- or post-implantation complications. CONCLUSIONS: Cochlear implantation is a safe and effective treatment option in children with common cavity. The majority of children with CC derive significant audiological benefit from implantation. Intra- and post-surgical complications, while serious, and be dealt with effectively in most cases.


Assuntos
Implantes Cocleares , Surdez/terapia , Orelha Interna/anormalidades , Eletrodos Implantados , Inteligibilidade da Fala/fisiologia , Percepção da Fala/fisiologia , Adolescente , Limiar Auditivo/fisiologia , Criança , Pré-Escolar , Implante Coclear , Surdez/diagnóstico , Surdez/etiologia , Feminino , Humanos , Lactente , Estudos Longitudinais , Masculino , Fatores de Tempo , Resultado do Tratamento
16.
Acta Otorrinolaringol Esp ; 60 Suppl 1: 119-29, 2009 Feb.
Artigo em Espanhol | MEDLINE | ID: mdl-19245782

RESUMO

The most common sequelae in the treatment of head and neck chemodectomas are cranial nerve lesions; of these, the most frequently affected are the trigeminal, facial, glossopharyngeal, vagus and hypoglossus nerves. The lesions of the lower cranial nerves (IX, X, XI and XII) affect the oral and pharyngeal phases of swallowing and frequently lead to aspiration. The frequency with which these nerves are affected varies according to several factors, being 30% in glomus vagale tumors and 20% in carotid tumors. If the V and VII cranial nerves are affected, defects in oral preparation, bolus transport and drooling may occur. Lesions of the XI and X cranial nerves are associated with delayed initiation of the pharyngeal phase, nasal reflux, dysphonia, retained secretions in the piriform sinus, and aspiration. Lesions of the XII cranial nerves affect the oral phase of swallowing. Treatment of dysphagia and aspiration will often be managed with maneuvers to aid swallowing, and changes in food bolus consistency and/or volumes. The remaining complications that can be produced are facial palsy, cerebrospinal fluid fistula, and vascular complications. Facial palsy can be produced by two mechanisms: on the one hand, by central involvement, as a complication of preoperative embolization, and on the other, by direct involvement during surgery or during occasional treatment with radiotherapy. Treatment, whether functional or cosmetic, can be provided either during surgery or subsequently to treat the sequelae of facial palsy.


Assuntos
Neoplasias de Cabeça e Pescoço/cirurgia , Paraganglioma/cirurgia , Complicações Pós-Operatórias/etiologia , Complicações Pós-Operatórias/terapia , Neoplasias da Base do Crânio/cirurgia , Transtornos de Deglutição/diagnóstico , Transtornos de Deglutição/etiologia , Transtornos de Deglutição/terapia , Doenças do Nervo Facial/etiologia , Doenças do Nervo Facial/terapia , Humanos
17.
Curr Opin Otolaryngol Head Neck Surg ; 16(6): 507-10, 2008 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-19005321

RESUMO

PURPOSE OF REVIEW: This article reviews literature on the diagnosis and management of globus. The maneuver of pulling the tongue forward is important in the diagnosis. RECENT FINDINGS: In some patients, physical examination will reveal findings that could be a possible cause of globus. The more frequent findings are tongue base hypertrophy and uvula hypertrophy. In these selected patients, surgical treatment such as partial epiglottectomy or uvulectomia can be offered. Treatment with a proton-pump inhibitor will be useful in some patients with globus. SUMMARY: The diagnosis of globus must be carried out by exclusion with an exhaustive clinical exploration of some anatomical factors that could result in surgical treatment.


Assuntos
Transtornos de Deglutição/etiologia , Transtornos de Deglutição/diagnóstico , Transtornos de Deglutição/terapia , Feminino , Humanos , Masculino , Espanha
18.
Acta otorrinolaringol. esp ; 58(supl.2): 57-59, dic. 2007. ilus
Artigo em Espanhol | IBECS | ID: ibc-136220

RESUMO

Distintas intervenciones del ámbito de la otorrinolaringología, especialmente sobre el oído y los senos paranasales, pueden dar lugar a dudas sobre la posibilidad de seguir realizando actividades expuestas a cambios de presión, especialmente, el buceo y los vuelos. La que más interés ha conllevado ha sido la estapedectomía, que en la actualidad sabemos que no debe resultar afectada por los cambios de presión, al menos, tras haber trascurrido unos días. Sobre las timpanoplastias, hay dudas en pacientes que han experimentado una reconstrucción de la cadena osicular con prótesis tipo TORP. En cualquiera de los casos, es importante valorar la función tubárica. Los pacientes de cirugía sobre los senos paranasales, y siempre que el resultado obtenido con la cirugía sea el adecuado y transcurrido un tiempo no inferior a 3 meses, también podrían bucear. En el caso de los implantes cocleares, no existe ninguna contraindicación. En pacientes intervenidos de cáncer de laringe puede haber limitaciones o dificultades muy marcadas en el caso de las técnicas totales y menores en las parciales (AU)


Various surgical otorhinolaryngological interventions, especially those performed in the ear and paranasal sinuses, may curtail the possibility of performing activities exposing the individual to pressure changes, especially diving or flying. The procedure that has generated the greatest interest is stapedectomy. Currently there is positive evidence on the possibility of flying and diving after stapedectomy, at least several days after the procedure. In tympanoplasty, there are still doubts, mainly in patients who have undergone ossicular chain reconstruction with a TORP. Evaluation of Eustachian tube function is of prime importance. Patients who have undergone paranasal sinus surgery are fit to dive after at least 3 months of rest, as long as a favorable outcome has been obtained. Cochlear implants are not a contraindication to diving. Patients who have undergone total laryngectomy for laryngeal cancer will experience marked limitations, while those who have undergone partial endoscopic or open resections should experience fewer problems (AU)


Assuntos
Humanos , Masculino , Feminino , Procedimentos Cirúrgicos Otorrinolaringológicos/métodos , Procedimentos Cirúrgicos Otorrinolaringológicos , Mergulho , Medicina Aeroespacial , Cirurgia do Estribo/instrumentação , Cirurgia do Estribo , Cirurgia do Estribo/métodos , Timpanoplastia/métodos , Endoscopia/métodos , Seios Paranasais/cirurgia , Seios Paranasais , Doenças dos Seios Paranasais/cirurgia , Vertigem/terapia
19.
Rhinology ; 43(4): 277-81, 2005 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-16405272

RESUMO

INTRODUCTION: Endoscopic surgery of the anterior skull base has become the standard procedure for the repair of cerebrospinal fluid (CSF) leaks of various origins. Closure of the leaks is believed to prevent ascending meningitis, although no report has specifically shown this. MATERIAL AND METHODS: Retrospective chart study of 39 patients who underwent endoscopic skull base surgery from 1/1993 to 11/2002. SETTING: Tertiary University Hospitals. OUTCOME MEASUREMENT: Incidence of ascending meningitis after endoscopic skull base repair in patients with anterior skull base defects associated or not with meningitis and CSF leak. RESULTS: Forty-one endoscopic repairs of anterior skull base defects of various origins were performed in 39 patients. Fifteen (36.5%) had suffered bacterial meningitis before surgery. Mean follow-up was 65 months (range 22-120). The defect was repaired using an "underlay" technique with lyophilized dura (n=11) or fascia lata (n=30), and covered with free mucosal grafts from either the middle or the inferior turbinates. Closure was achieved in 40/41 cases at first attempt. No recurrence of ascending bacterial meningitis was observed during follow-up in any of the fifteen patients who had previously presented with a CSF leak or skull base defect with meningitis. Also, no new bacterial meningitis occurred in all other patients. One case of meningoencephalocele of the lateral sphenoid wall developed a recurrent CSF fistula associated with bacterial meningitis two years after endoscopic repair, requiring endoscopic revision surgery. No patient received vaccination in this series. DISCUSSION: Closure of active CSF leaks and reconstruction of skull base defects without CSF-leak in patients with prior ascending bacterial meningitis seem to provide excellent long-term results with neither recurrence of ascending meningitis nor incidence of meningitis in the other patients, unless a CSF leak re-appears. Conservative treatment of CSF leaks may lead to bacterial meningitis, therefore surgical closure of leaks or defects at the skull base should be considered treatment of choice to prevent ascending meningitis.


Assuntos
Rinorreia de Líquido Cefalorraquidiano/cirurgia , Endoscopia , Meningites Bacterianas/prevenção & controle , Base do Crânio/cirurgia , Adulto , Idoso , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Base do Crânio/microbiologia , Resultado do Tratamento
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