Unidad de Atención al Paciente Traqueostomizado. Una solución innovadora desde Otorrinolaringología con carácter transversal para el hospital / Tracheostomy Patient Care Unit. An innovative Otorhinolaryngology solution of a transversal nature for the hospital

Antecedentes y objetivo: Los cuidados de los pacientes traqueostomizados son habilidades de alto riesgo y baja incidencia. Las estrategias de mejora de la atención sanitaria en plantas hospitalarias y en especialidades distintas a la Otorrinolaringología (ORL) basadas únicamente en la formación no han sido capaces de ofrecer una solución adecuada. Se presenta un modelo de Unidad de Atención al Paciente Traqueostomizado dirigida por el Servicio de Otorrinolaringología para atender a todos los pacientes traqueostomizados de un hospital en todas las especialidades. Material y métodos Ámbito: hospital universitario público de tercer nivel con 876 camas de hospitalización y 30 camas de UCI para 481.296 habitantes. Modelo de Unidad: unidad transversal para el hospital proporcionando atención a todos los pacientes traqueostomizados, adultos y niños, de todas las especialidades, con dedicación del 50% de una enfermera de ORL de hospitalización que se desplaza hasta la cama de hospitalización de la especialidad de cada paciente y el 50% de otra enfermera de ORL de consultas externas para los pacientes ambulatorios, con la consultoría de un especialista en ORL y coordinación de la supervisora de ORL. Resultados Se atendió en la unidad a 572 pacientes entre 2016 y 2021, el 80% varones, con una media de edad de 63±14 años. Se atendieron 14,7±2 pacientes traqueostomizados diarios y 96±4 consultas por complicaciones anuales, elevándose hasta 19 pacientes traqueostomizados diarios en 2020 y 141±8,4 consultas por complicaciones en los años 2020 y 2021, durante la pandemia por COVID-19. Se redujo la estancia media de las especialidades no ORL en 13 días a lo largo de los 6 años del estudio, aumentando la satisfacción de los profesionales de ORL y de no ORL, y la satisfacción de los usuarios.... (AU)

Background and objective: The care of tracheostomized patients are high risk skills and low incidence. Strategies for improvement of health care in hospital wards and specialties other than otolaryngology based solely on training have not been able to offer an adequate solution. A tracheostomized patient unit is presented directed by the otolaryngology service to attend all tracheostomized hospitalized patients of all specialties. Material and methods Background: Third level public hospital with 876 hospitalization beds and 30 ICU beds for 481,296 inhabitants. Unit model: Transversal unit for the hospital providing attention to all tracheostomized patients, adults, and children, of all specialties, with dedication of 50% of a ENT nurse of hospitalization that moves to the hospitalization bed of the specialty of each patient and 50% of another office ENT nurse for ambulatory patients care, with the consultancy of an ENT specialist and coordinated by the ENT supervisor. Results 572 patients between 2016 and 2021, 80% men, aged 63±14 years, were attended in the unit. 14.7±2 tracheostomized patients daily and 96±4 complication annual consultations were attended, rising up to 19 tracheostomized patients daily by 2020 and 141±8.4 consultations by complications in 2020 and 2021, during the COVID-19 pandemic. The mean stay of the non-ENT specialties was reduced in 13 days, increasing the satisfaction of the ENT and non-ENT professionals and the satisfaction of the users. ... (AU)

Research and application progress in deep learning in otology. / æ·±åº¦å­¦ä¹ åœ¨è€³ç§‘å­¦ä¸­çš„ç ”ç©¶ä¸Žåº”ç”¨è¿›å±•.

With the optimization of deep learning algorithms and the accumulation of medical big data, deep learning technology has been widely applied in research in various fields of otology in recent years. At present, research on deep learning in otology is combined with a variety of data such as endoscopy, temporal bone images, audiograms, and intraoperative images, which involves diagnosis of otologic diseases (including auricular malformations, external auditory canal diseases, middle ear diseases, and inner ear diseases), treatment (guiding medication and surgical planning), and prognosis prediction (involving hearing regression and speech learning). According to the type of data and the purpose of the study (disease diagnosis, treatment and prognosis), the different neural network models can be used to take advantage of their algorithms, and the deep learning can be a good aid in treating otologic diseases. The deep learning has a good applicable prospect in the clinical diagnosis and treatment of otologic diseases, which can play a certain role in promoting the development of deep learning combined with intelligent medicine.

[Residency is a fundamental stage of professional training of an otorhinolaryngologist]. / Ordinatura ­ osnovopolagayushchii etap professional'noi podgotovki otorinolaringologa.

Systematic analysis of various indicators of the educational process becomes important to assess the effectiveness of the training of residents. One of the most common tools for monitoring the effectiveness of the educational process is a questionnaire of students. OBJECTIVE: To analyze the results of the assessment of the quality of training in the residency of the Sverzhevky Research Clinical Institute of Otorhinolaryngology according to the survey of residents. MATERIAL AND METHODS: The study includes the results of an anonymous questionnaire survey of a sample group of residents of the residency of the Sverzhevky Research Clinical Institute of Otorhinolaryngology of the second year of study. RESULTS: The data obtained allow us to judge the satisfaction with the quality of training of the absolute majority of the interviewed residents, their active use of specialized electronic search engines, a high assessment of the level of lectures, the desire to improve their surgical training. The importance for the professional development of residents of participation in weekly scientific and clinical conferences of the Sverzhevky Research Clinical Institute of Otorhinolaryngology, meetings of the Moscow Scientific Society of Otorhinolaryngologists, traditional annual scientific and practical conferences of otorhinolaryngologists of Moscow, as well as in the activities of the Youth Council of the Institute is noted. CONCLUSION: The results of the survey create prerequisites for improving the educational process, the formation of professional competencies and readiness for independent work among residents.

Otolaryngologic Manifestations of Trisomy 13 and Trisomy 18 in Pediatric Patients.

OBJECTIVE: The survival rate of patients with trisomy 13 and trisomy 18 has increased dramatically over the past two decades. We sought to comprehensively describe the otolaryngologic clinical characteristics and procedures required for these patients at our institution. METHODS: We performed algorithmic identification of patients with a diagnosis of trisomy 13 and trisomy 18 for whom the otolaryngology service provided inpatient or outpatient care at our institution between the dates of February 1997 and March 2021. RESULTS: Of the 47 patients studied, 18 patients had a diagnosis of trisomy 13, and 29 had a diagnosis of trisomy 18. Complete trisomy was present in 44% (8/18) of trisomy 13 patients and 55% (16/29) of trisomy 18 patients. 81% of patients were living at the time of the study. About 94% (44/47) of patients required consultation with another specialty in addition to Otolaryngology. Overall, the most common diagnoses among this cohort were gastroesophageal reflux disease (47%), dysphagia (40%), otitis media (38%), and obstructive sleep apnea (34%). Nearly three-quarters (74%) of patients studied required an otolaryngologic procedure. The most common surgical procedure was tonsillectomy and/or adenoidectomy. Patients with trisomy 18 were significantly more likely to have external auditory canal stenosis and obstructive sleep apnea whereas patients with trisomy 13 were more likely to have cleft lip and palate. CONCLUSIONS: Patients with a diagnosis of trisomy 13 or 18 often require multidisciplinary management and the range of required care spans the breadth of otolaryngology. LEVEL OF EVIDENCE: 4 Laryngoscope, 133:1501-1506, 2023.

Acute otolaryngological presentations in Northland, New Zealand: analysed with respect to geography and rurality.

AIM: Otorhinolaryngology, head and neck surgery (ORL) diagnoses and treats disorders of the ear, nose, throat, head and neck which can be commonly seen across a range of medical specialities. Rural patients experience a burden of ORL diseases and face greater barriers to healthcare than their urban counterparts. We aim to provide information on the diagnoses of rural patients presenting with ORL symptomatology to provide data that may be useful in targeting resources and training towards rural patients. METHODS: A 6-year retrospective study was performed between 1 January 2015 to 31 December 2020. The Northland District Health Board (NDHB) data warehouse was searched using ICD-10 codes relevant to ORL. The study included any patient acutely presenting to an NDHB hospital with an ORL diagnosis. Patients with a diagnosis that was not related to ORL, a non-acute presentation, or a diagnosis not usually managed by hospital ORL services were excluded. RESULTS: Five thousand, five hundred and thirty-four presentations in 4,671 individual patients were included in the study. The mean age of patients was 35.1 years (SD 26.58). Two thousand, three hundred and twenty-six (49.8%) patients were female and 2,345 (50.2%) were male. One thousand, nine hundred and sixty-five (42.1%) were Maori and 2,699 (57.8%) were non-Maori. Median decile was 8 (4 IQR). Two thousand and seventy-seven (44.5%) patients were classified as rural and 2,594 (55.5%) as urban. The most common presentation was epistaxis with 16.8% (n=927/5534) of total presentations. The four next most common presentations were otological. There was a total of 224 complications including post-operative bleed, post-operative infection, and other post-operative complications. There was a significant difference in the rate of discharge with 1,819/2,430 (74.9%) rural patients and 2,518/3,104 (81.1%) urban patients being discharged directly from the emergency department (ED) (p <0.001). CONCLUSION: This retrospective study provides a picture of acute ORL presentations in Northland patients, analysed with respect to geography and rurality. It highlights the large volume of ORL patients who are seen and managed by rural and ED physicians, and the importance of rural provision of care in Northland. These findings support the need for targeting resources and training to centres treating rural patients for the management and treatment of ORL conditions.

Gender representation in leadership & research: a 13-year review of the Annual Canadian Society of Otolaryngology Meetings.

BACKGROUND: The gender disparity in surgical disciplines, specifically in speakers across North American medical and surgical specialty conferences, has been highlighted in recent literature. Improving gender diversity at society meetings and panels may provide many benefits. Our aim was to determine the state of gender diversity amongst presenters and speakers at the annual Canadian Society of Otolaryngology-Head and Neck Surgery (CSO) meetings. METHODS: Scientific programs for the CSO annual meetings from 2008 to 2020 were obtained from the national society website. Participant name, role, gender, location, and subspecialty topic were recorded for all roles other than poster presenter. Gender (male or female) was determined using an online search. The total number of opportunity spots and proportion of women was then calculated. Gender differences were analyzed using chi-square test and logistic regression with odds ratios. Four categories were analyzed: Society Leadership, Invited Speaker Opportunities, Workshop Composition (male-only panels or "manels", female-only panels, or with at least one female speaker), and Oral Paper Presenters (first authors). RESULTS: There were 1874 leadership opportunity spots from 2008 to 2020, of which 18.6% were filled by women. Among elected leadership positions in the society, only 92 unique women filled 738 leadership opportunity spots. 13.2% of workshop chairs, 20.8% of panelists and 22.7% of paper session chairs were female. There was an overall increase in the proportion of leadership positions held by women, from 13.9% of leadership spots in 2008 to 30.1% in 2020. Of the 368 workshops, 61.1% were led by men only, 36.4% by at least 1 female surgeon, and 2.5% by women only. "Manels" have comprised at least 37.5% of workshops each year. CONCLUSIONS: The proportion of women in speaking roles at the annual CSO meetings has generally increased over time, particularly among panelists, leading to fewer male-only speaking panels. However, there has been a slower rate of growth in the proportion of unique women in speaker roles. There remains an opportunity to increase gender/sex diversity at the major Canadian otolaryngology meeting.

Tracheostomy Patient Care Unit. An innovative Otorhinolaryngology solution of a transversal nature for the hospital.

BACKGROUND AND OBJECTIVE: The care of tracheostomized patients are high risk skills and low incidence. Strategies for improvement of health care in hospital wards and specialties other than otolaryngology based solely on training have not been able to offer an adequate solution. A tracheostomized patient unit is presented directed by the otolaryngology service to attend all tracheostomized hospitalised patients of all specialties. MATERIAL AND METHODS: Background: Third level public hospital with 876 hospitalisation beds and 30 ICU beds for 481,296 inhabitants. Unit model: Transversal unit for the hospital providing attention to all tracheostomized patients, adults, and children, of all specialties, with dedication of 50% of a ENT nurse of hospitalisation that moves to the hospitalisation bed of the specialty of each patient and 50% of another office ENT nurse for ambulatory patients care, with the consultancy of an ENT specialist and coordinated by the ENT supervisor. RESULTS: 572 patients between 2016 and 2021, 80% men, aged 63 ± 14 years, were attended in the Unit. 14.7 ± 2 tracheostomized patients daily and 96 ± 4 complication annual consultations were attended, rising up to 19 tracheostomized patients daily by 2020 and 141 ± 8.4 consultations by complications in 2020 and 2021, during the COVID-19 pandemic. The mean stay of the non-ENT specialties was reduced in 13 days, increasing the satisfaction of the ENT and non-ENT professionals and the satisfaction of the users. CONCLUSIONS: A Tracheostomized Patient Care Unit proactively directed from the Otorhinolaryngology Service to transversally care for all tracheostomized patients improves the quality of health care by reducing stay, complications, and emergencies. Improves the satisfaction of non-otolaryngological professionals by reducing the anxiety of facing care of patients who lack knowledge and experience and that of ENT specialists and nurses by reducing unplanned extemporaneous demands for care. Improves user satisfaction by perceiving adequate continuity of care. The Otorhinolaryngology Services provide their experience in the management of laryngectomized and tracheostomized patients and in teamwork with other specialists and professionals without the need to create new structures outside Otorhinolaryngology.

Study protocol for a randomised controlled trial to determine the effectiveness of a mHealth application as a family supportive tool in paediatric otolaryngology perioperative process (TONAPP).

BACKGROUND: Otorhinolaryngology (ORL) surgery is common in children, but hospitalisation, surgery, and home care after discharge are stressful experiences for young patients and their family caregivers. Findings from literature highlight a lack of time in hospitals to support ORL surgery children and their caregivers through the perioperative process, along with the risks of caregivers' autonomous web or social media resources investigation. Therefore, this study aims to evaluate the effectiveness of a mobile health application with content to support ORL patients and their caregivers in the perioperative period to reduce caregiver anxiety and child distress compared to standard care. METHODS: An open-label, two-arm randomised control trial design is being adopted. The intervention consists of a mobile health application with content to support ORL patients and their caregivers during the perioperative period. One hundred eighty participants will be enrolled and randomly assigned to the experimental group using the mHealth application or the control group. The control group receives standard information and education about the ORL perioperative period from healthcare providers orally or through brochures. The primary outcome is the difference between the intervention and control groups in preoperative caregiver state anxiety. Secondary outcome measures include children's distress before surgery and family preparation for hospitalisation. DISCUSSION: The results of this study will be critical to the implementation of a new and safe model for the management of care and education in paediatrics. This model can achieve positive organisational and health outcomes by supporting continuity of care and empowering citizens to have informed participation and satisfaction in paediatric health promotion and management. TRIAL REGISTRATION: Trial identifier: NCT05460689 registry name: ClinicalTrials.gov. Date of registration: July 15, 2022. Last update posted: February 23, 2023.

Canadian women in otolaryngology: head and neck surgery part 2-challenges in family planning, fertility, and lactation.

BACKGROUND: Previous literature demonstrates that female surgeons face difficulties in family planning, meeting breastfeeding goals, leadership and advancement opportunities. These issues have received limited attention in Canadian surgeons despite different maternity leave patterns compared to the general Canadian population. We sought to describe the experience of otolaryngologist-head and neck surgeons in family planning, fertility, and lactation and to identify the role of gender and career stage in these experiences. METHODS: A RedCAP® survey was disseminated to Canadian otolaryngology-head and neck surgeons and residents from March to May of 2021 through social media and the national listserv. This survey examined fertility, pregnancy losses, and infant feeding. Major independent variables include gender and career stage (faculty and resident). Dependent variables include respondent experiences with fertility, number of children, and length of parental leave. Responses were tabulated and presented descriptively to communicate the experience of Canadian otolaryngologists. Further, statistical comparisons such as chi-square and t-tests were employed to identify relationships between these variables. Thematic analysis was conducted for narrative comments. RESULTS: We received 183 completed surveys (22% response rate). 54% of females versus 13% of males agreed that career influenced their ability to have children (p = 0.002). 74% of female respondents without children have concerns about future fertility compared to 4% of men (p < 0.001). Furthermore, 80% of women versus 20% of men have concerns about future family planning (p < 0.001). The average maternity leave was 11.5 weeks for residents, and 22.2 weeks for staff. Additionally, significantly more women than men stated that maternity leave impacted advancement opportunities (32% vs. 7%) and salary/remuneration (71% vs. 24%) (p < 0.001). Over 60% of those choosing to pump breastmilk at work reported having inadequate time, space, and breastmilk storage. In total, 62% of breastfed infants were receiving breastmilk at 1 year. CONCLUSION: Canadian female otolaryngologists-head and neck surgeons face challenges in family planning, ability to conceive, and breastfeeding. Focused effort is required to provide an inclusive environment that helps all otolaryngologists-head and neck surgeons achieve both their career and family goals, regardless of gender or career stage.

Assessing the competitiveness of medical humanities research on psychiatry, otolaryngology, and ophthalmology residency program applications.

Medical humanities research is an increasing area of interest for students as medical schools become more aware of the benefits of humanities and the arts on patient care. However, medical students may feel dissuaded from pursuing medical humanities work for fear of how it will be perceived on their residency applications. In this study, residency program directors (PDs) in New York state in psychiatry, ophthalmology, and otolaryngology were surveyed about their opinions on the competitiveness of students doing medical humanities research applying to their programs. Of the 64 PDs contacted, twenty submitted responses (31.3%). When asked if a residency applicant who only had medical humanities research experience would be seriously considered for their program, 95% of PDs said yes. Furthermore, 65% of PDs said that having medical humanities research experience in addition to clinical research increased a student's chance of being accepted to their program. Thirty percent of PDs indicated that the medical humanities were an important selection criteria for their program. Qualitative responses emphasized that non-traditional projects, such as personal essays, were as valid as published journal articles when conducted with academic rigor. Many PDs also believed that the medical humanities increased compassion, empathy, and communication skills in their residents. Considering these results, medical students should feel empowered to pursue medical humanities research, even if they are applying into a competitive surgical specialty. It should not diminish their chances of being seriously considered for a program, and may even confer an advantage over their clinical research peers.

Canadian Women in Otolaryngology-Head and Neck Surgery part 1: the relationship of gender identity to career trajectory and experiences of harassment.

INTRODUCTION: Women in surgical specialties face different challenges than their male peers. However, there is a paucity of literature exploring these challenges and their effects on a Canadian surgeon's career. METHODS: A REDCap® survey was distributed to Canadian Otolaryngology-Head and Neck Surgery (OHNS) staff and residents in March 2021 using the national society listserv and social media. Questions examined practice patterns, leadership positions, advancement, and experiences of harassment. Gender differences in survey responses were explored. RESULTS: 183 completed surveys were obtained, representing 21.8% of the Canadian society membership [838 members with 205 (24.4%) women]. 83 respondents self-identified as female (40% response rate) and 100 as male (16% response rate). Female respondents reported significantly fewer residency peers and colleagues identifying as their gender (p < .001). Female respondents were significantly less likely to agree with the statement "My department had the same expectations of residents regardless of gender" (p < .001). Similar results were observed in questions about fair evaluation, equal treatment, and leadership opportunities (all p < .001). Male respondents held the majority of department chair (p = .028), site chief (p = .011), and division chief positions (p = .005). Women reported experiencing significantly more verbal sexual harassment during residency (p < .001), and more verbal non-sexual harassment as staff (p = .03) than their male colleagues. In both female residents and staff, this was more likely to originate from patients or family members (p < .03). DISCUSSION: There is a gender difference in the experience and treatment of OHNS residents and staff. By shedding light on this topic, as a specialty we can and must move towards greater diversity and equality.

Therapeutic management of allergic rhinitis: a survey of otolaryngology and allergology specialists.

PURPOSE: To describe the current management of allergic rhinitis (AR) in Spain's specialized care according to the next-generation ARIA guidelines. METHODS: An ad hoc online survey was distributed to AR specialists to appraise their perceptions of pathology management, knowledge of next-generation ARIA guidelines (including four case clinics), and their views on the principal barriers and the actions to proper AR management. RESULTS: one hundred nine specialists (38.5% allergists and 61.5% otolaryngologists) completed the study survey. Most respondents (87.2%) had read all or part of the Next-Generation ARIA Guidelines, and 81.6% stated that they considered the patient's treatment choice preferences. However, only 20.2% of specialists answered according to the recommendations in at least three of the four case clinics. Most participants failed to fulfill the treatment duration according to the guidelines. They regarded the lack of multidisciplinary teams (21.7%) and the lack of patients' AR treatment adherence (30.6%) as the most critical healthcare system- and patient-related barriers to the correct management of AR, respectively. Promoting patients' education was considered the most crucial action to improve it. CONCLUSION: Despite specialists' awareness, there is a gap between the evidence-based guidelines' recommendations and their implementation in clinical practice.

New Year's Eve in otorhinolaryngology: a 16-year retrospective evaluation.

PURPOSE: Pyrotechnics are a long-standing tradition at the turn of the year. There are little data available on New Year's Eve-associated ORL injuries. Due to restrictions during the Corona pandemic, the handling of fireworks and meetings on New Year's Eve 2020-2022 had been significantly changed. Our aim was to analyze first data about New Year's Eve-associated ORL injuries. METHODS: A retrospective analysis of 16 turns of the year (2006-2022) at a University ORL department was performed. The 2 recent years were influenced by the changes and restrictions of the COVID-19 pandemic. RESULTS: Of 343 emergency presentations, 69 presented with New Year's Eve-associated reasons (20%). 72% were male, 15.9% were underage. 74% presented for fireworks-related injuries, 19% due to violent altercations. Noise trauma was present in 71%. The average number of New Year's Eve-associated emergency patients per year and the average total number of patients were reduced by more than half under COVID-19 pandemic conditions. CONCLUSIONS: New Year's Eve-associated ORL injuries range from inner ear trauma to midface fractures. Long-term damage may include hearing loss and tinnitus. These results shall support the responsible use of fireworks even after the end of the special regulations of the COVID-19 pandemic.

[Study on the time-point distribution characteristics of the occurrence of laryngopharyngeal reflux].

Objective: To investigate the characteristics of the time-point distribution of the occurrence of laryngopharyngeal reflux (LPR) by 24-hour multichannel intraluminal impedance-pH monitoring (24 h MII-pH) and to provide guidance for the development of individualized anti-reflux strategies for LPR patients. Methods: We conducted a retrospective analysis of 24 h MII-pH data from 408 patients [339 males and 69 females, aged 23-84 (55.08±11.08) years] attending the Department of Otorhinolaryngology Head and Neck Surgery at the Sixth Medical Center of the PLA General Hospital from January 2013 to March 2020. The number of gas acid/weak-acid reflux, mixed gas-liquid acid/weak-acid reflux, liquid acid/weak-acid reflux and alkaline reflux events at different time points were recorded and statistically analyzed through SPSS 26.0 software. Results: A total of 408 patients were included. Based on the 24 h MII-pH, the total positive rate of LPR was 77.45% (316/408). The type of positive gaseous weak-acid reflux was significantly higher than the remaining types of LPR (χ2=297.12,P<0.001). Except the gaseous weak-acid reflux, the occurrence of the remaining types of LPR showed a tendency to increase after meals, especially after dinner. Liquid acid reflux events occurred mainly between after dinner and the following morning, and 47.11% (57/121) of them occurred within 3 h after dinner. There was a significant positive association between Reflux Symptom Index scores and gaseous weak-acid reflux(r=0.127,P<0.01), liquid acid reflux(r=0.205,P<0.01) and liquid weak-acid reflux(r=0.103,P<0.05)events. Conclusions: With the exception of gaseous weak-acid reflux events, the occurrence of the remaining types of LPR events has a tendency to increase after meals, especially after dinner. Gaseous weak-acid reflux events accounts for the largest proportion of all types of LPR events, but the pathogenic mechanisms of gaseous weak-acid reflux are needed to further investigate.

[Early management of presbycusis: recommendations from the French Society of Otorhinolaryngology and Head and Neck Surgery, the French Society of Audiology, and the French Society of Geriatrics and Gerontology]. / Recommandations de la Société française d'otorhinolaryngologie et de chirurgie de la face et du cou, la Société française d'audiologie et la Société française de gériatrie et gérontologie pour la prise en charge précoce de la presbyacousie.

INTRODUCTION: Presbycusis is the physiological decrease in hearing due to advancing age and begins well before the sixth decade. These recommendations recall the principles of early diagnosis of presbycusis and the means of optimal rehabilitation as soon as the first symptoms appear. MATERIAL AND METHODS: The recommendations are based on a systematic analysis of the literature carried out by a multidisciplinary group of doctors and audioprosthetists from all over France. They are graded A, B, C or expert opinion according to decreasing level of scientific evidence. RESULTS: The diagnosis of presbycusis is more difficult at the beginning of its evolution but a certain number of tools are available for its early diagnosis and its management in face-to-face or even distance learning. CONCLUSION: In case of a clinical profile suggestive of presbycusis in a young subject, especially if there are several family cases, it is recommended to propose a genetic investigation. It is recommended to perform free-field speech audiometry in noise to measure intelligibility in an environment as close as possible to reality. Questionnaires can be used in addition to audiometry to best assess the patient's disability. It is recommended that hearing rehabilitation with a hearing aid or cochlear implant may slow or prevent cognitive decline. Combined auditory and cognitive rehabilitation should be offered regardless of the time elapsed since the fitting. It is recommended to integrate programs accessible via smartphones, tablets or the Internet, integrating different training domains in addition to face-to-face sessions.

Benefits of medially based perichondrio-adipo-dermal flap in cartilage sparing prominent ear surgery / Ventajas del colgajo pericondrial-adipo-dérmico con base medial en la cirugía de remodelación del cartílago de oreja prominente

Background: Cartilage-cutting and cartilage-sparing techniques are the two types of otoplasty procedures. Because of the significant risk of haematoma, skin necrosis, and ear deformity, cartilage-cutting techniques have been questioned. As a result; suture-based cartilage-sparing procedures such as Mustarde and Furnas suture procedures have grown in popularity. However, these techniques have a tendency for deformity recurrence due to cartilage memory and suture fatigue, as well as the possibility of suture extrusion and pinpricking sensation of the sutures.MethodsIn this study, we used a medially based adipo-dermal flap including perichondrium which is elevated from the back of the auricle to cover and support a cartilage-sparing otoplasty, thirty-four patients (14 female and 20 male) were operated using this technique. The medially based perichondrio-adipo-dermal flap is advanced anteriorly and fixed to the helical rim under cover of the distal skin flap. This procedure sought to cover the suture line preventing suture extrusion and support in the repair of the deformity preventing its recurrence.ResultsThe average operative time was 80min, ranging from 65 to 110min. The patients passed the early postoperative period uneventfully except for 2 patients; one patient (2.9%) developed haematoma, and the other patient developed a small area of necrosis on the new antihelical fold. In late the postoperative period recurrence of the deformity developed in one patient. No patients developed suture extrusion or granuloma.ConclusionThe treatment to repair prominent ears is easy and safe, with benefits such as a natural-looking antihelical fold and minimal tissue stress. The medially or proximally based adipo-dermal flap may help to lower recurrence rates and suture extrusion. (AU)

Antecedentes: El recorte y la remodelación del cartílago son los dos tipos de técnicas en los procedimientos de otoplastia. Debido al riesgo considerable de hematoma, necrosis cutánea y deformidad de la oreja, las técnicas de recorte del cartílago han sido cuestionadas. Como resultado, los procedimientos de remodelación del cartílago basados en sutura, tales como las técnicas de Mustarde y de Furnas, han ganado popularidad. Sin embargo, dichas técnicas tienden a recidivar la deformidad debido a la memoria del cartílago y a la fatiga de la sutura, así como hay la posibilidad de extrusión y de la sensación de pinchazo en ellas.MétodosEn el presente estudio utilizamos un colgajo pericondrial-adipo-dérmico con base medial que se eleva desde el dorso auricular para cubrir y soportar la otoplastia de remodelación del cartílago, habiendo operado a 34 pacientes con esta técnica (14 mujeres y 20 varones). El colgajo pericondrial-adipo-dérmico con base medial se avanza anteriormente y se fija al borde helical inferior para cubrir el colgajo cutáneo distal. El objetivo de este procedimiento fue cubrir la línea de la sutura, impidiendo la extrusión de la misma, y soportar la reparación de la deformidad previniendo su recidiva.ResultadosEl tiempo quirúrgico medio fue de 80min, fluctuando de 65 a 110min, transcurriendo el periodo postoperatorio temprano de los pacientes con normalidad, excepto en dos pacientes: uno de ellos (2,9%) desarrolló hematoma y el otro desarrolló una zona pequeña de necrosis en el nuevo pliegue antihelical. En el periodo postoperatorio posterior un paciente desarrolló recidiva de la deformidad. Ningún paciente desarrolló extrusión de la sutura ni granuloma. (AU)

Prevalence of hearing protection use and subjective auditory symptoms among Spanish classical orchestral musicians / Prevalencia del uso de protección auditiva y síntomas auditivos subjetivos entre los intérpretes de orquesta de música clásica españoles

Introduction: Sensorineural hearing loss caused by exposure to noise is one of the most frequent causes of deafness. Professional musicians have significant occupational exposure to high levels of noise. Use of hearing protection among musicians could substantially prevent hearing damage, though the rate of use is quite low.Methods and materialA questionnaire on the use of protective hearing devices, hearing care, and subjective judgments of hearing difficulties was completed by a group of classical musicians from Spain. We analysed the frequency of device use by instrument based on contingency tables analysed by χ2 tests.ResultsOne hundred and ninety-four Spanish classical orchestral musicians voluntarily completed the questionnaire. The percentage of musicians who reported using hearing protection in our survey was very low and varied with the type of instrument played. However, we found a high prevalence of subjective auditory disorders within this group.ConclusionFew Spanish musicians use hearing protection. Training on hearing-loss prevention in this field and better protective devices could increase device use and improve the auditory health of this group. (AU)

Introducción: La hipoacusia neurosensorial motivada por la exposición al ruido es una de las causas más frecuentes de sordera. Los músicos profesionales tienen una exposición ocupacional significativa a los altos niveles de ruido. El uso de protección auditiva entre los músicos podría prevenir sustancialmente el daño auditivo, aunque su tasa de utilización es bastante baja.Métodos y materialUn grupo de intérpretes de orquesta de música clásica españoles completó un cuestionario sobre el uso de dispositivos de protección auditiva, cuidados auditivos, y opiniones subjetivas sobre las dificultades auditivas. Analizamos la frecuencia del uso de dispositivos por instrumento basada en tablas de contingencia analizadas mediante pruebas χ2.ResultadosCiento noventa y cuatro intérpretes de orquesta de música clásica españoles completaron el cuestionario voluntariamente. El porcentaje de músicos que reportaron el uso de protección auditiva en nuestra encuesta fue muy bajo, y variable dependiendo del tipo de instrumento interpretado. Sin embargo, encontramos una alta prevalencia de trastornos auditivos subjetivos dentro de este grupo.ConclusiónPocos músicos españoles utilizan protección auditiva. La formación sobre prevención de hipoacusia en este campo y la mejora de los dispositivos protectores podría incrementar el uso y mejorar la salud auditiva de este colectivo. (AU)

Skin and soft tissue complications of bone-anchored hearing aids: Introducing a new classification system / Complicaciones de la piel y los tejidos blandos de los audífonos osteointegrados: introducción de un nuevo sistema de clasificación

Objectives: There have been significant surgical and technological advances in bone-anchored hearing aid (BAHA) design, function, and implantation technique, but peri-implant skin complications remain the most frequent complication. The most important aspect in dealing with cutaneous complications is to identify the type of cutaneous lesion.Although Holger's Classification has been an extremely useful clinical tool, this grading system has been shown to be unsuitable for some cases. We therefore propose a new consistent and easy assessment classification of cutaneous complications associated with BAHA.MethodsA retrospective clinical study was carried out at a tertiary centre, between January 2008 and December 2014. All patients under 18 years old with a unilateral BAHA were included in the study.ResultsA total of 53 children, with a BAHA, were included in the study. Post-operative skin complications were observed in 49.1% of the patients. Of the children, 28.3% presented with soft tissue hypertrophy, the most frequently reported skin complication, and grading according to the Holger's classification was not considered feasible.To overcome the difficulties we face in clinical practice, a new classification was developed and presented.ConclusionThe new proposed classification – Coutinho Classification – aims to fill the gaps in the one used currently by introducing new clinical features, most importantly the presence/absence of tissue overgrowth, and by providing a better description of what each category encompasses. This is an inclusive and objective new classification system, maintaining applicability, and useful in guiding the treatment. (AU)

Objetivos: La técnica de implantación de los audífonos osteointegrados (bone-anchored hearing aid [BAHA]) ha experimentado avances tecnológicos y quirúrgicos significativos en el diseño y en la función, aunque las complicaciones cutáneas periimplantarias son frecuentes. El aspecto más importante del tratamiento de las complicaciones cutáneas es identificar el tipo de lesión cutánea.Aunque la clasificación de Holger ha sido una instrumento clínico extremadamente útil, este sistema de clasificación ha demostrado ser inadecuado en algunos casos. Por lo tanto, proponemos una nueva clasificación, consistente y fácil, de las complicaciones cutáneas asociadas con BAHA.MétodosSe realizó un estudio clínico retrospectivo en un centro de tercer nivel, entre enero de 2008 y diciembre de 2014. Se incluyeron en el estudio todos los pacientes menores de 18 años a los que se colocó BAHA unilateral.ResultadosUn total de 53 niños a los que se colocaron BAHA fueron incluidos en el estudio. Se observaron complicaciones cutáneas postoperatorias en el 49,1% de los pacientes. El 28,3% de los niños presentaron hipertrofia de tejidos blandos, la complicación cutánea más frecuentemente reportada, y la clasificación de Holger no se consideró adecuada.Para superar las dificultades con que nos enfrentamos en la práctica clínica, se desarrolló y se presentó una nueva clasificación. (AU)

Turbinate surgery in pediatric patients: A worldwide survey / Cirugía de cornetes en población pediátrica: una encuesta global

Objective: Impaired nasal breathing is a common condition among pediatric patients, being rhinitis the most common cause. In recent years, turbinate surgery, mainly turbinate radiofrequency ablation (TRA), has increased in popularity amongst pediatric otolaryngologists and rhinologists as a safe and useful technique to address turbinate hypertrophy in pediatric patients. The present paper is designed with the aim of assessing the current worldwide clinical practice regarding turbinate surgery in pediatric patients.MethodsThe questionnaire was developed based on previous researches, by a group of 12 experts from the rhinology and pediatric otolaryngology research group belonging to the Young Otolaryngologists of the International Federation of Otorhinolaryngological societies (YO-IFOS). The survey was then translated to 7 languages and sent to 25 scientific otolaryngologic societies around the globe.Results15 scientific societies agreed to distribute the survey to their members. There were 678 responses from 51 countries. From them, 65% reported to usually perform turbinate surgery in pediatric patients. There was a statistically significant increased likelihood of performing turbinate surgery for those practicing rhinology, sleep medicine, and/or pediatric otolaryngology compared to other subspecialties. The main indication to perform turbinate surgery was nasal obstruction (93.20%); followed by sleep disordered breathing (53.28%), chronic rhinosinusitis (28.70%) and facial growth alterations (22.30%). (AU)

Objetivo: La obstrucción nasal es una enfermedad habitual en pacientes pediátricos, siendo la rinitis la causa más frecuente. En los últimos años la cirugía de cornetes, especialmente la radiofrecuencia (RF), ha aumentado su popularidad entre los otorrinolaringólogos pediátricos y los rinólogos como una técnica segura y eficaz para tratar esta enfermedad en población pediátrica. Este artículo se diseña con el objetivo de evaluar la práctica clínica habitual a este respecto a nivel global.MétodosEl cuestionario fue diseñado basado en trabajos previos por un grupo de 12 expertos del Grupo de Investigación en Rinología y en Otorrinolaringología Pediátrica de la Young Otolaryngologists of the International Federation of Otorhinolaryngological societies (YO-IFOS). La encuesta fue traducida a 7 idiomas y enviada a 25 sociedades científicas.ResultadosQuince sociedades científicas aceptaron distribuir la encuesta entre sus miembros. Hubo 678 respuestas de 51 países. De ellos, el 65% comunicó realizar de manera habitual cirugía de cornetes en población pediátrica. Se observó una mayor probabilidad de realizar la intervención entre especialistas en Rinología, Medicina del sueño u Otorrinolaringología pediátrica comparado con el resto de las subespecialidades. La indicación más habitual para realizar la cirugía fue obstrucción nasal (93,20%), seguida por trastorno respiratorio del sueño (53,28%), rinosinusitis crónica (28,70%) y alteraciones del desarrollo facial (22,30%). (AU)