Cross-cultural adaptation and validation of the Spanish version of the Paediatric Throat Disorders Outcome Test (T-14).

OBJECTIVES: The Paediatric Throat Disorders Outcome Test (T-14) is a disease-specific questionnaire that parents are requested to complete; it aimed to assess the quality of life related to tonsil and adenoid disease or its treatment in children with throat disorders. The aim of this study was to validate the Spanish adaptation of the T-14, thus allowing comparison across studies and facilitating international multicentre projects. DESIGN, SETTING AND PARTICIPANTS: This was a multicentre prospective instrument validation study. Guidelines for the cross-cultural adaptation process from the original English-language scale into a Spanish-language version were followed. The psychometric properties (reproducibility, reliability, validity, responsiveness) of the Spanish version ("T-14-s" for "T-14-Spanish") were assessed in 50 consecutive children undergoing adeno/tonsillectomy (both before and 6 months after surgery) and in a separate cohort of 50 unaffected children in a comparable age range. MAIN OUTCOME MEASURES AND RESULTS: Test-retest reliability (γ = 0.83) and internal consistency reliability (α = 0.94) were adequate. The T-14-s demonstrated satisfactory construct validity (r > 0.40). The instrument showed excellent between-group discrimination (P < .0001) and a high responsiveness to change (effect size = 2.09). CONCLUSIONS: The Spanish version of the T-14 (T-14-s) is a valid tool for measuring the subjective severity of throat disorders, and its use is recommended.

Salvage surgery after locoregional failure in head and neck carcinoma patients treated with chemoradiotherapy.

With the increasing use of concomitant chemoradiotherapy (CCRT) in the treatment of advanced head and neck carcinoma, surgery has lost ground as the first therapy and is reserved as a salvage treatment in cases of locoregional failure. The objective of our study was to review our experience in patients who had a local or regional recurrence after treatment with CCRT. Thirty-two patients underwent salvage surgery after CCRT: 24 were treated with a local or locoregional resection and 8 patients with a neck dissection only. In patients who had surgery involving the primary location of the tumor, some kind of reconstruction was required in 83% of cases. One or more postoperative complications occurred in nine patients. The median hospital stay was 18.5 days. There was a significant difference in hospital stay in relation to the appearance of surgical complications. Five-year adjusted survival after salvage surgery was 34.2% (CI 95% 13.2-55.2%). Adjusted survival was related to the status of the resection margins and appearance of neck nodes with extracapsular spread in the neck dissection. In conclusion, salvage surgery after CCRT involves extensive resections, requiring reconstruction techniques with regional or microanastomosed free flaps in most cases, achieving acceptable outcomes.

Outcome of drug-induced sleep endoscopy-directed surgery for persistent obstructive sleep apnea after adenotonsillar surgery.

PURPOSE: Drug-induced sleep endoscopy (DISE) is suitable for evaluating persistent obstructive sleep apnea syndrome (OSAS) after adenotonsillar surgery as a means to guide surgical intervention, yet few studies demonstrate its usefulness in resolving the syndrome. We describe our experience of DISE-directed surgery in children with persistent OSAS by analysing objective and subjective outcomes of this treatment. METHODS: Prospective study of 20 otherwise healthy 2-12 year-old children with OSAS persisting after adenotonsillar surgery. All patients underwent DISE-directed surgery and were followed up clinically and with a polysomnogram at 12 ±â€¯3 months. RESULTS: All 20 children had an apnea-hypopnea index (AHI) score ≥1 (mean: 6.1 ±â€¯4.9) and 75% had AHI>3 before surgery. We performed a total of 14 total tonsillectomies (70%), 7 with associated pharyngoplasties; 5 radiofrequency turbinate reductions (25%); 7 radiofrequency lingual tonsil reductions (35%); and 10 revision adenoidectomies (50%). No surgery-related complications were observed. AHI scores at follow-up were significantly lower than AHI scores before surgery (1.895 ±â€¯1.11 vs 6.143 ±â€¯4.88; p < 0.05) and, in 85% (n = 17) of patients, AHI was below 3. There was a significant reduction in the number of children with AHI>3 in follow-up at 12 ±â€¯3 months (15%; n = 3) compared to before surgery (75%; n = 15) (p < 0.005). CONCLUSION: DISE-directed surgery for otherwise healthy children with persistent OSAS is a useful and safe technique to decide a therapeutic strategy and to obtain good objective and subjective results regarding resolution of the syndrome.

Elective neck dissection during salvage surgery after radiotherapy in patients with head and neck squamous cell carcinoma.

SUMMARY: Elective neck dissection in patients with recurrent head and neck squamous cell carcinoma (HNSCC) without evidence of neck disease (crN0) is poorly defined. A retrospective review was carried out on 165 crN0 patients treated with salvage surgery and elective neck dissection. Multivariate Cox analysis and recursive partitioning analysis were used to evaluate prognostic factors. The frequency of occult neck node metastases in the neck dissection (rpN+) was 16.4%. The risk of occult metastases for glottic rpT1-T2 recurrences was 5.9%, for glottic rpT3-T4 recurrences 13.2%, for non-glottic rpT1-T2 recurrences 16.1% and for locally advanced (rpT3-T4) non-glottic recurrences 31.1%. Patients with occult neck node metastases (rpN+) had a 5-year adjusted survival rate of 38.1%, while patients without nodal disease (rpN0) had a 5-year adjusted survival rate of 71.1% (p = 0.0001). Elective neck dissection can be omitted in crN0 patients with rT1-T2 glottic recurrence. We consider it advisable to perform elective neck dissection in all other situations.

Obstructive sleep apnea syndrome and growth failure.

Obstructive sleep apnea syndrome is a common problem among children and is recognized as a cause of significant medical morbidity. Since the 1980s, it has been suggested that obstructive sleep apnea syndrome is a risk factor for growth failure in children. In many cases, it has been shown that growth failure is reversible once the obstructive sleep apnea syndrome is resolved. The objectives of this study were to analyze and compare growth failure prevalence in a Mediterranean population of children with obstructive sleep apnea syndrome and healthy children matched in age and sex, and to assess the effectiveness of tonsillectomy and adenoidectomy in resolving growth retardation. We compared 172 children with obstructive sleep apnea syndrome (apnea-hypopnea index ≥ 3) who had undergone tonsillectomy and adenoidectomy with 172 healthy controls in terms of key anthropometric parameters. Most of the criteria used for growth failure were higher to a statistically significant degree in the study group vs the control group: height-for-age ≤ 3rd percentile (7.56% vs 2.91%; p = 0.044), weight-for-age ≤ 5th percentile (9.30% vs 2.33%; p = 0.005), weight-for-age ≤ 3rd percentile (8.14% vs 2.33%; p = 0.013) and height and/or weight for-age ≤ 5th percentile (13.95% vs 5.81%; p = 0.009). The height-for-age ≤ 5th percentile was almost at the limit of statistical significance (8.72% for the study group vs 4.65% for the control group; p = 0.097). At one-year post-surgery follow-up, 10 of 15 children with height-for-age ≤ 5th percentile had achieved catch-up growth (66.6%), and 14 of 24 children with height- and/or weight-for-age ≤ 5th percentile had normalized growth (58.33%). For children with failure to thrive or who have growth failure, physicians should consider the possibility of obstructive sleep apnea. A significant number of children with obstructive sleep apnea concurrent with growth failure could benefit from tonsillectomy and adenoidectomy to recover and normalize their growth rate.

[Gastroesophageal reflux and obstructive sleep apnea syndrome]. / Reflujo gastroesofágico proximal y sindrome de la apnea obstructiva del sueño. Datos preliminares de un estudio prospectivo.

INTRODUCTION: Patients with mild or moderate Sleep Apnea Syndrome (SAS) need wider therapeutic scope options according to their disease severity. AIM: To consider including proton pump inhibitors (PPI) to the therapeutical alternatives of these patients. MATERIAL AND METHODS: A prospective study was designed, among patients with SAS. Nocturnal polysomnography and double channel pHmetry were performed simultaneously. RESULTS: From the 18 patients included in this preliminary phase, in three (16.7%) nocturnal proximal ph monitoring was positive. These 3 patients were treated with PPI during at least 3 months with a very satisfactory outcome in two of them. CONCLUSIONS: Treatment with PPI may be a useful therapeutical alternative in patients with mild to moderate SAS.

[Myringoplasty. A prospective study of 238 cases]. / Miringoplastia. Estudio prospectivo de 238 casos.

It has been made a review of 238 myringoplasties done in the last three years (1988-90) at the Santa Creu i Sant Pau Hospital. In this work are only contemplated the plain myringoplasties. Tympanoplasties because cholesteatoma and ossiculoplasties are excluded. Some characteristics are studied: age, sex, ear state, kind of perforation, ossicular chain state and others. Anatomical and functional results are analyzed as also the relationship between the type of perforation with the audiometric loose and anatomic success.

[Adenolymphoma or Warthin's tumor: review of 30 cases]. / Adenolinfoma o tumor de Warthin: revisión de 30 casos.

Perusal of Warthin's tumors treated during the past 20 years (1969-1989) in our Hospital department. As a whole 229 tumors of salivary glands were operated upon, 30 of them being adenolymphomata. The parameters of our series were confronted with those given by the cases of the literature. In the paper are also reminded the several theories concerning the origin of this tumor.

[The treatment of carcinoma of the pyriform sinus at Santa Creu I Sant Pau Hospital of Barcelona. The role of surgery]. / Tratamiento del carcinoma del seno piriforme en el Hospital de la Santa Creu I Sant Pau de Barcelona: papel de la cirugía.

The paper deals with the retrospective review done by the AA. about the treatments used for squamous carcinomata of the pyriform sinus at Santa Creu i Sant Pau Hospital, Barcelona, between the years 1984-1990. In this term 76 sinus pyriform carcinomata were diagnosed, 12 of which (16%) were managed palliatively. In the other 64 cases radical treatment was advised and followed: 5 cases underwent radical cobalt-therapy; polychemotherapy followed by radiotherapy in 27; surgery plus radiotherapy in 7; and polychemotherapy completed with surgery and radiotherapy in the remaining 25 cases. Considerations on the realized pharyngectomies and their reconstructive steps and complications are commented. Inventory and end results in each group are reported. The beneficial local influence was evident when surgery was employed (100% with surgery plus radiotherapy and 92% with polychemotherapy, surgery and radiotherapy). Local control was inferior if surgery was discarded (20% in radiotherapy and 37% by polychemotherapy followed by radiotherapy). Actuarial survival for the lump sum amounted for the 40 percent after 5 years follow-up. It must be emphasized that these groups are not comparable because the choice treatment in each case was indicated in view of the initial stage.

[Efficacy and safety of dotarizine vs. cinnarizine in the symptomatic treatment of acute balance disorders (common vertigo)]. / Eficacia y seguridad de dotarizina frente a cinarizina en el tratamiento sintomático de los trastornos agudos del equilibrio (vértigo común).

One hundred and ten adult patients suffering from peripheral vertigo were treated in a multifactorial double-blind randomized clinical trial with dotarizine (50 mg b.i.d.) or cinnarizine (75 mg b.i.d.). There was a 60 days clinical follow-up. Results showed that dotarizine was significantly active against the vertigo attacks and its associated symptoms (mainly neurovegetative). The global superiority of dotarizine was confirmed by statistically significant differences between treatments in the improvement of the severity of vertigo, hearing loss in audiometries, global relief of symptoms, disability produced by crises and global assessment by the investigators themselves. No clinically significant unwanted effects were seen in either group on blood pressure, heart rate or analytical parameters. No serious adverse effects to dotarizine were reported. This study confirms the value of dotarizine in the treatment of peripheral vertigo.

[Adverse effects of continuous positive airway pressure therapy and its relation to the nose]. / Efectos adversos derivados del tratamiento con nCPAP y su relación con la nariz.

The main problem in the treatment of obstructive sleep apnea syndrome (OSAS) with nasal continuous airway pressure (nCPAP) is the lack of compliance. One of the most important reasons for no compliance is the adverse effects of this treatment. We analyse, prospectively, 182 patients treated with nCPAP in order to show the relationship between previous nasal problems and adverse effects of nCPAP. Sixty percent of the population developed one o more side effects. Of this group, 69% showed nasal septum deviation at first examination in front of 31% that did not showed this problem (p = 0.001). In the group of patients with nasal side effects we observed an increase of compliance in 80% of patients treated medically and in 89% of those treated by a septoplasty. We demonstrate that the adverse effects of nCPAP are related to previous nasal problems and, also, that treatment of those problems can achieve an increase in compliance to nCPAP therapy.

[Adenocarcinoma of the nose and paranasal sinuses. Presentation of 3 cases]. / Adenocarcinoma de nariz y senos paranasales. Presentación de tres casos.

Three cases of intestinal type adenocarcinomas of the nose and sinuses are described. In two of them the tumors were associated with an extended exposure to wood dust, while no association with any known exposure factor was detected in the third. Clinical history, pathology, treatment and follow-up of each case are reviewed.

[A retropharyngeal synovial sarcoma]. / Sarcoma sinovial retrofaríngeo.

The synovial sarcomas constitute the 7-10% of the soft tissue malign tumors, with a preferred location in the limbs. In the head and neck a 5% of the totality are placed. We present one case of retropharyngeal synovial sarcoma and the accomplished treatment, together with a revision of the bibliography.

[Neurocognitive and behavioral disturbances after adenotonsillectomy in obstructive sleep apnea syndrome]. / Alteraciones cognitivas y conductuales tras adenoamigdalectomía en el síndrome de apnea del sueño.

INTRODUCTION: Adenotonsillectomy is an effective treatment for sleep-disordered breathing in children, but its ability to resolve neurocognitive issues, is not clear. OBJECTIVE: To analyze the outcomes of cognitive and behavioral disorders after one year of adenotonsillectomy. METHOD: We studied the behavioral and cognitive abnormalities in 45 children with obstructive sleep apnea and 30 healthy controls, aged 3 to 13 years. Psychological tests were performed in both groups at baseline and at 12 months. RESULTS: Preoperatively, all cognitive and behavioral disturbances were higher in the study group than in the control group: attention in 46.7% of cases in the study group versus 20% in the control group (P=.016), anxiety 60.9% versus 40.9% (not significant); memory 55.6% versus 36.7% (P=.019), spatial structuring 64.4% versus 36.7% (P=.017), hyperactivity 42.9% versus 12.5% (P=.016), and attention deficit 46.4% versus 8.3% (P=.003). After one year we observed more disturbances in all variables in the study group. However, significant differences remained only in spatial structure (31.3% versus 3.3%, P=.017), and attention deficit (40.5% versus 16.7%, P=.031). The percentages of patients that improved in one year were not significantly different between both groups. CONCLUSION: Behavioral and cognitive disturbances in children with sleep apnea were partially resolved following adenotonsillectomy. Improvements in the cognitive and behavioral variables did not differ significantly from those the normal evolution of the individual, and were independent of the resolution of respiratory disorders.

Delayed carotid blow-out syndrome: a new complication of chemoradiotherapy treatment in pharyngolaryngeal carcinoma.

BACKGROUND: Carotid blow-out syndrome is one of the most devastating complications of head and neck carcinoma. It usually occurs as a post-operative complication or when the tumour compromises the vascular axis. METHODS AND RESULTS: We report two patients who suffered carotid blow-out syndrome but who did not have the usual predisposing factors. Both patients had a pharyngolaryngeal carcinoma that was treated with chemoradiotherapy. Residual non-tumoural ulceration was seen along the lateral wall of the hypopharynx in both cases. This ulceration eventually reached the vascular axis, precipitating carotid rupture and death. CONCLUSION: Residual non-tumoural ulceration of the lateral wall of the hypopharynx after chemoradiotherapy should be considered with the utmost caution. Once persistence of the tumour is excluded, surgery is indicated to protect the vascular axis, in order to prevent carotid blow-out syndrome.