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Publisher: Elsevier   (Total: 3155 journals)

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Showing 1 - 200 of 3155 Journals sorted alphabetically
A Practical Logic of Cognitive Systems     Full-text available via subscription   (Followers: 9)
AASRI Procedia     Open Access   (Followers: 15)
Academic Pediatrics     Hybrid Journal   (Followers: 34, SJR: 1.655, CiteScore: 2)
Academic Radiology     Hybrid Journal   (Followers: 23, SJR: 1.015, CiteScore: 2)
Accident Analysis & Prevention     Partially Free   (Followers: 96, SJR: 1.462, CiteScore: 3)
Accounting Forum     Hybrid Journal   (Followers: 27, SJR: 0.932, CiteScore: 2)
Accounting, Organizations and Society     Hybrid Journal   (Followers: 38, SJR: 1.771, CiteScore: 3)
Achievements in the Life Sciences     Open Access   (Followers: 5)
Acta Anaesthesiologica Taiwanica     Open Access   (Followers: 7)
Acta Astronautica     Hybrid Journal   (Followers: 411, SJR: 0.758, CiteScore: 2)
Acta Automatica Sinica     Full-text available via subscription   (Followers: 2)
Acta Biomaterialia     Hybrid Journal   (Followers: 27, SJR: 1.967, CiteScore: 7)
Acta Colombiana de Cuidado Intensivo     Full-text available via subscription   (Followers: 2)
Acta de Investigación Psicológica     Open Access   (Followers: 3)
Acta Ecologica Sinica     Open Access   (Followers: 10, SJR: 0.18, CiteScore: 1)
Acta Haematologica Polonica     Free   (Followers: 1, SJR: 0.128, CiteScore: 0)
Acta Histochemica     Hybrid Journal   (Followers: 3, SJR: 0.661, CiteScore: 2)
Acta Materialia     Hybrid Journal   (Followers: 258, SJR: 3.263, CiteScore: 6)
Acta Mathematica Scientia     Full-text available via subscription   (Followers: 5, SJR: 0.504, CiteScore: 1)
Acta Mechanica Solida Sinica     Full-text available via subscription   (Followers: 9, SJR: 0.542, CiteScore: 1)
Acta Oecologica     Hybrid Journal   (Followers: 12, SJR: 0.834, CiteScore: 2)
Acta Otorrinolaringologica (English Edition)     Full-text available via subscription  
Acta Otorrinolaringológica Española     Full-text available via subscription   (Followers: 3, SJR: 0.307, CiteScore: 0)
Acta Pharmaceutica Sinica B     Open Access   (Followers: 1, SJR: 1.793, CiteScore: 6)
Acta Poética     Open Access   (Followers: 4, SJR: 0.101, CiteScore: 0)
Acta Psychologica     Hybrid Journal   (Followers: 28, SJR: 1.331, CiteScore: 2)
Acta Sociológica     Open Access   (Followers: 1)
Acta Tropica     Hybrid Journal   (Followers: 6, SJR: 1.052, CiteScore: 2)
Acta Urológica Portuguesa     Open Access  
Actas Dermo-Sifiliograficas     Full-text available via subscription   (Followers: 3, SJR: 0.374, CiteScore: 1)
Actas Dermo-Sifiliográficas (English Edition)     Full-text available via subscription   (Followers: 2)
Actas Urológicas Españolas     Full-text available via subscription   (Followers: 3, SJR: 0.344, CiteScore: 1)
Actas Urológicas Españolas (English Edition)     Full-text available via subscription   (Followers: 1)
Actualites Pharmaceutiques     Full-text available via subscription   (Followers: 6, SJR: 0.19, CiteScore: 0)
Actualites Pharmaceutiques Hospitalieres     Full-text available via subscription   (Followers: 3)
Acupuncture and Related Therapies     Hybrid Journal   (Followers: 6)
Acute Pain     Full-text available via subscription   (Followers: 14, SJR: 2.671, CiteScore: 5)
Ad Hoc Networks     Hybrid Journal   (Followers: 11, SJR: 0.53, CiteScore: 4)
Addictive Behaviors     Hybrid Journal   (Followers: 17, SJR: 1.29, CiteScore: 3)
Addictive Behaviors Reports     Open Access   (Followers: 8, SJR: 0.755, CiteScore: 2)
Additive Manufacturing     Hybrid Journal   (Followers: 10, SJR: 2.611, CiteScore: 8)
Additives for Polymers     Full-text available via subscription   (Followers: 22)
Advanced Drug Delivery Reviews     Hybrid Journal   (Followers: 154, SJR: 4.09, CiteScore: 13)
Advanced Engineering Informatics     Hybrid Journal   (Followers: 11, SJR: 1.167, CiteScore: 4)
Advanced Powder Technology     Hybrid Journal   (Followers: 17, SJR: 0.694, CiteScore: 3)
Advances in Accounting     Hybrid Journal   (Followers: 8, SJR: 0.277, CiteScore: 1)
Advances in Agronomy     Full-text available via subscription   (Followers: 14, SJR: 2.384, CiteScore: 5)
Advances in Anesthesia     Full-text available via subscription   (Followers: 28, SJR: 0.126, CiteScore: 0)
Advances in Antiviral Drug Design     Full-text available via subscription   (Followers: 2)
Advances in Applied Mathematics     Full-text available via subscription   (Followers: 10, SJR: 0.992, CiteScore: 1)
Advances in Applied Mechanics     Full-text available via subscription   (Followers: 11, SJR: 1.551, CiteScore: 4)
Advances in Applied Microbiology     Full-text available via subscription   (Followers: 24, SJR: 2.089, CiteScore: 5)
Advances In Atomic, Molecular, and Optical Physics     Full-text available via subscription   (Followers: 14, SJR: 0.572, CiteScore: 2)
Advances in Biological Regulation     Hybrid Journal   (Followers: 4, SJR: 2.61, CiteScore: 7)
Advances in Botanical Research     Full-text available via subscription   (Followers: 2, SJR: 0.686, CiteScore: 2)
Advances in Cancer Research     Full-text available via subscription   (Followers: 33, SJR: 3.043, CiteScore: 6)
Advances in Carbohydrate Chemistry and Biochemistry     Full-text available via subscription   (Followers: 9, SJR: 1.453, CiteScore: 2)
Advances in Catalysis     Full-text available via subscription   (Followers: 5, SJR: 1.992, CiteScore: 5)
Advances in Cell Aging and Gerontology     Full-text available via subscription   (Followers: 4)
Advances in Cellular and Molecular Biology of Membranes and Organelles     Full-text available via subscription   (Followers: 12)
Advances in Chemical Engineering     Full-text available via subscription   (Followers: 27, SJR: 0.156, CiteScore: 1)
Advances in Child Development and Behavior     Full-text available via subscription   (Followers: 10, SJR: 0.713, CiteScore: 1)
Advances in Chronic Kidney Disease     Full-text available via subscription   (Followers: 10, SJR: 1.316, CiteScore: 2)
Advances in Clinical Chemistry     Full-text available via subscription   (Followers: 29, SJR: 1.562, CiteScore: 3)
Advances in Colloid and Interface Science     Full-text available via subscription   (Followers: 19, SJR: 1.977, CiteScore: 8)
Advances in Computers     Full-text available via subscription   (Followers: 14, SJR: 0.205, CiteScore: 1)
Advances in Dermatology     Full-text available via subscription   (Followers: 14)
Advances in Developmental Biology     Full-text available via subscription   (Followers: 12)
Advances in Digestive Medicine     Open Access   (Followers: 9)
Advances in DNA Sequence-Specific Agents     Full-text available via subscription   (Followers: 5)
Advances in Drug Research     Full-text available via subscription   (Followers: 25)
Advances in Ecological Research     Full-text available via subscription   (Followers: 44, SJR: 2.524, CiteScore: 4)
Advances in Engineering Software     Hybrid Journal   (Followers: 28, SJR: 1.159, CiteScore: 4)
Advances in Experimental Biology     Full-text available via subscription   (Followers: 8)
Advances in Experimental Social Psychology     Full-text available via subscription   (Followers: 46, SJR: 5.39, CiteScore: 8)
Advances in Exploration Geophysics     Full-text available via subscription   (Followers: 1)
Advances in Fluorine Science     Full-text available via subscription   (Followers: 9)
Advances in Food and Nutrition Research     Full-text available via subscription   (Followers: 58, SJR: 0.591, CiteScore: 2)
Advances in Fuel Cells     Full-text available via subscription   (Followers: 16)
Advances in Genetics     Full-text available via subscription   (Followers: 16, SJR: 1.354, CiteScore: 4)
Advances in Genome Biology     Full-text available via subscription   (Followers: 8, SJR: 12.74, CiteScore: 13)
Advances in Geophysics     Full-text available via subscription   (Followers: 6, SJR: 1.193, CiteScore: 3)
Advances in Heat Transfer     Full-text available via subscription   (Followers: 23, SJR: 0.368, CiteScore: 1)
Advances in Heterocyclic Chemistry     Full-text available via subscription   (Followers: 12, SJR: 0.749, CiteScore: 3)
Advances in Human Factors/Ergonomics     Full-text available via subscription   (Followers: 22)
Advances in Imaging and Electron Physics     Full-text available via subscription   (Followers: 2, SJR: 0.193, CiteScore: 0)
Advances in Immunology     Full-text available via subscription   (Followers: 35, SJR: 4.433, CiteScore: 6)
Advances in Inorganic Chemistry     Full-text available via subscription   (Followers: 8, SJR: 1.163, CiteScore: 2)
Advances in Insect Physiology     Full-text available via subscription   (Followers: 2, SJR: 1.938, CiteScore: 3)
Advances in Integrative Medicine     Hybrid Journal   (Followers: 7, SJR: 0.176, CiteScore: 0)
Advances in Intl. Accounting     Full-text available via subscription   (Followers: 3)
Advances in Life Course Research     Hybrid Journal   (Followers: 8, SJR: 0.682, CiteScore: 2)
Advances in Lipobiology     Full-text available via subscription   (Followers: 1)
Advances in Magnetic and Optical Resonance     Full-text available via subscription   (Followers: 8)
Advances in Marine Biology     Full-text available via subscription   (Followers: 18, SJR: 0.88, CiteScore: 2)
Advances in Mathematics     Full-text available via subscription   (Followers: 11, SJR: 3.027, CiteScore: 2)
Advances in Medical Sciences     Hybrid Journal   (Followers: 6, SJR: 0.694, CiteScore: 2)
Advances in Medicinal Chemistry     Full-text available via subscription   (Followers: 5)
Advances in Microbial Physiology     Full-text available via subscription   (Followers: 4, SJR: 1.158, CiteScore: 3)
Advances in Molecular and Cell Biology     Full-text available via subscription   (Followers: 23)
Advances in Molecular and Cellular Endocrinology     Full-text available via subscription   (Followers: 8)
Advances in Molecular Toxicology     Full-text available via subscription   (Followers: 7, SJR: 0.182, CiteScore: 0)
Advances in Nanoporous Materials     Full-text available via subscription   (Followers: 3)
Advances in Oncobiology     Full-text available via subscription   (Followers: 1)
Advances in Organ Biology     Full-text available via subscription   (Followers: 1)
Advances in Organometallic Chemistry     Full-text available via subscription   (Followers: 17, SJR: 1.875, CiteScore: 4)
Advances in Parallel Computing     Full-text available via subscription   (Followers: 7, SJR: 0.174, CiteScore: 0)
Advances in Parasitology     Full-text available via subscription   (Followers: 5, SJR: 1.579, CiteScore: 4)
Advances in Pediatrics     Full-text available via subscription   (Followers: 24, SJR: 0.461, CiteScore: 1)
Advances in Pharmaceutical Sciences     Full-text available via subscription   (Followers: 12)
Advances in Pharmacology     Full-text available via subscription   (Followers: 16, SJR: 1.536, CiteScore: 3)
Advances in Physical Organic Chemistry     Full-text available via subscription   (Followers: 8, SJR: 0.574, CiteScore: 1)
Advances in Phytomedicine     Full-text available via subscription  
Advances in Planar Lipid Bilayers and Liposomes     Full-text available via subscription   (Followers: 3, SJR: 0.109, CiteScore: 1)
Advances in Plant Biochemistry and Molecular Biology     Full-text available via subscription   (Followers: 10)
Advances in Plant Pathology     Full-text available via subscription   (Followers: 5)
Advances in Porous Media     Full-text available via subscription   (Followers: 5)
Advances in Protein Chemistry     Full-text available via subscription   (Followers: 18)
Advances in Protein Chemistry and Structural Biology     Full-text available via subscription   (Followers: 20, SJR: 0.791, CiteScore: 2)
Advances in Psychology     Full-text available via subscription   (Followers: 64)
Advances in Quantum Chemistry     Full-text available via subscription   (Followers: 6, SJR: 0.371, CiteScore: 1)
Advances in Radiation Oncology     Open Access   (SJR: 0.263, CiteScore: 1)
Advances in Small Animal Medicine and Surgery     Hybrid Journal   (Followers: 3, SJR: 0.101, CiteScore: 0)
Advances in Space Biology and Medicine     Full-text available via subscription   (Followers: 6)
Advances in Space Research     Full-text available via subscription   (Followers: 399, SJR: 0.569, CiteScore: 2)
Advances in Structural Biology     Full-text available via subscription   (Followers: 5)
Advances in Surgery     Full-text available via subscription   (Followers: 11, SJR: 0.555, CiteScore: 2)
Advances in the Study of Behavior     Full-text available via subscription   (Followers: 34, SJR: 2.208, CiteScore: 4)
Advances in Veterinary Medicine     Full-text available via subscription   (Followers: 17)
Advances in Veterinary Science and Comparative Medicine     Full-text available via subscription   (Followers: 13)
Advances in Virus Research     Full-text available via subscription   (Followers: 5, SJR: 2.262, CiteScore: 5)
Advances in Water Resources     Hybrid Journal   (Followers: 46, SJR: 1.551, CiteScore: 3)
Aeolian Research     Hybrid Journal   (Followers: 6, SJR: 1.117, CiteScore: 3)
Aerospace Science and Technology     Hybrid Journal   (Followers: 345, SJR: 0.796, CiteScore: 3)
AEU - Intl. J. of Electronics and Communications     Hybrid Journal   (Followers: 8, SJR: 0.42, CiteScore: 2)
African J. of Emergency Medicine     Open Access   (Followers: 6, SJR: 0.296, CiteScore: 0)
Ageing Research Reviews     Hybrid Journal   (Followers: 11, SJR: 3.671, CiteScore: 9)
Aggression and Violent Behavior     Hybrid Journal   (Followers: 456, SJR: 1.238, CiteScore: 3)
Agri Gene     Hybrid Journal   (Followers: 1, SJR: 0.13, CiteScore: 0)
Agricultural and Forest Meteorology     Hybrid Journal   (Followers: 17, SJR: 1.818, CiteScore: 5)
Agricultural Systems     Hybrid Journal   (Followers: 31, SJR: 1.156, CiteScore: 4)
Agricultural Water Management     Hybrid Journal   (Followers: 41, SJR: 1.272, CiteScore: 3)
Agriculture and Agricultural Science Procedia     Open Access   (Followers: 3)
Agriculture and Natural Resources     Open Access   (Followers: 3)
Agriculture, Ecosystems & Environment     Hybrid Journal   (Followers: 57, SJR: 1.747, CiteScore: 4)
Ain Shams Engineering J.     Open Access   (Followers: 5, SJR: 0.589, CiteScore: 3)
Air Medical J.     Hybrid Journal   (Followers: 6, SJR: 0.26, CiteScore: 0)
AKCE Intl. J. of Graphs and Combinatorics     Open Access   (SJR: 0.19, CiteScore: 0)
Alcohol     Hybrid Journal   (Followers: 11, SJR: 1.153, CiteScore: 3)
Alcoholism and Drug Addiction     Open Access   (Followers: 10)
Alergologia Polska : Polish J. of Allergology     Full-text available via subscription   (Followers: 1)
Alexandria Engineering J.     Open Access   (Followers: 1, SJR: 0.604, CiteScore: 3)
Alexandria J. of Medicine     Open Access   (Followers: 1, SJR: 0.191, CiteScore: 1)
Algal Research     Partially Free   (Followers: 11, SJR: 1.142, CiteScore: 4)
Alkaloids: Chemical and Biological Perspectives     Full-text available via subscription   (Followers: 2)
Allergologia et Immunopathologia     Full-text available via subscription   (Followers: 1, SJR: 0.504, CiteScore: 1)
Allergology Intl.     Open Access   (Followers: 5, SJR: 1.148, CiteScore: 2)
Alpha Omegan     Full-text available via subscription   (SJR: 3.521, CiteScore: 6)
ALTER - European J. of Disability Research / Revue Européenne de Recherche sur le Handicap     Full-text available via subscription   (Followers: 9, SJR: 0.201, CiteScore: 1)
Alzheimer's & Dementia     Hybrid Journal   (Followers: 51, SJR: 4.66, CiteScore: 10)
Alzheimer's & Dementia: Diagnosis, Assessment & Disease Monitoring     Open Access   (Followers: 4, SJR: 1.796, CiteScore: 4)
Alzheimer's & Dementia: Translational Research & Clinical Interventions     Open Access   (Followers: 4, SJR: 1.108, CiteScore: 3)
Ambulatory Pediatrics     Hybrid Journal   (Followers: 6)
American Heart J.     Hybrid Journal   (Followers: 50, SJR: 3.267, CiteScore: 4)
American J. of Cardiology     Hybrid Journal   (Followers: 54, SJR: 1.93, CiteScore: 3)
American J. of Emergency Medicine     Hybrid Journal   (Followers: 45, SJR: 0.604, CiteScore: 1)
American J. of Geriatric Pharmacotherapy     Full-text available via subscription   (Followers: 10)
American J. of Geriatric Psychiatry     Hybrid Journal   (Followers: 14, SJR: 1.524, CiteScore: 3)
American J. of Human Genetics     Hybrid Journal   (Followers: 34, SJR: 7.45, CiteScore: 8)
American J. of Infection Control     Hybrid Journal   (Followers: 28, SJR: 1.062, CiteScore: 2)
American J. of Kidney Diseases     Hybrid Journal   (Followers: 35, SJR: 2.973, CiteScore: 4)
American J. of Medicine     Hybrid Journal   (Followers: 47)
American J. of Medicine Supplements     Full-text available via subscription   (Followers: 3, SJR: 1.967, CiteScore: 2)
American J. of Obstetrics and Gynecology     Hybrid Journal   (Followers: 215, SJR: 2.7, CiteScore: 4)
American J. of Ophthalmology     Hybrid Journal   (Followers: 66, SJR: 3.184, CiteScore: 4)
American J. of Ophthalmology Case Reports     Open Access   (Followers: 5, SJR: 0.265, CiteScore: 0)
American J. of Orthodontics and Dentofacial Orthopedics     Full-text available via subscription   (Followers: 6, SJR: 1.289, CiteScore: 1)
American J. of Otolaryngology     Hybrid Journal   (Followers: 25, SJR: 0.59, CiteScore: 1)
American J. of Pathology     Hybrid Journal   (Followers: 28, SJR: 2.139, CiteScore: 4)
American J. of Preventive Medicine     Hybrid Journal   (Followers: 28, SJR: 2.164, CiteScore: 4)
American J. of Surgery     Hybrid Journal   (Followers: 38, SJR: 1.141, CiteScore: 2)
American J. of the Medical Sciences     Hybrid Journal   (Followers: 12, SJR: 0.767, CiteScore: 1)
Ampersand : An Intl. J. of General and Applied Linguistics     Open Access   (Followers: 7)
Anaerobe     Hybrid Journal   (Followers: 4, SJR: 1.144, CiteScore: 3)
Anaesthesia & Intensive Care Medicine     Full-text available via subscription   (Followers: 62, SJR: 0.138, CiteScore: 0)
Anaesthesia Critical Care & Pain Medicine     Full-text available via subscription   (Followers: 17, SJR: 0.411, CiteScore: 1)
Anales de Cirugia Vascular     Full-text available via subscription  
Anales de Pediatría     Full-text available via subscription   (Followers: 3, SJR: 0.277, CiteScore: 0)
Anales de Pediatría (English Edition)     Full-text available via subscription  
Anales de Pediatría Continuada     Full-text available via subscription  
Analytic Methods in Accident Research     Hybrid Journal   (Followers: 5, SJR: 4.849, CiteScore: 10)
Analytica Chimica Acta     Hybrid Journal   (Followers: 42, SJR: 1.512, CiteScore: 5)
Analytical Biochemistry     Hybrid Journal   (Followers: 180, SJR: 0.633, CiteScore: 2)
Analytical Chemistry Research     Open Access   (Followers: 12, SJR: 0.411, CiteScore: 2)
Analytical Spectroscopy Library     Full-text available via subscription   (Followers: 11)
Anesthésie & Réanimation     Full-text available via subscription   (Followers: 2)
Anesthesiology Clinics     Full-text available via subscription   (Followers: 23, SJR: 0.683, CiteScore: 2)
Angiología     Full-text available via subscription   (SJR: 0.121, CiteScore: 0)
Angiologia e Cirurgia Vascular     Open Access   (Followers: 1, SJR: 0.111, CiteScore: 0)
Animal Behaviour     Hybrid Journal   (Followers: 201, SJR: 1.58, CiteScore: 3)

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Journal Cover
Acta Otorrinolaringológica Española
Journal Prestige (SJR): 0.307
Number of Followers: 3  
 
  Full-text available via subscription Subscription journal
ISSN (Print) 0001-6519
Published by Elsevier Homepage  [3155 journals]
  • Cirugía virtual para pacientes con obstrucción nasal: empleo de un
           software basado en dinámica de fluidos (MeComLand®, Digbody® &
           Noseland®) para documentar parámetros objetivos de flujo y optimizar
           resultados quirúrgicos
    • Authors: Manuel A. Burgos; Maria Agustina Sevilla García; Enrique Sanmiguel Rojas; Carlos Del Pino; Carlos Fernández Velez; Francisco Piqueras; Francisco Esteban Ortega
      Pages: 125 - 133
      Abstract: Publication date: May–June 2018
      Source:Acta Otorrinolaringológica Española, Volume 69, Issue 3
      Author(s): Manuel A. Burgos, Maria Agustina Sevilla García, Enrique Sanmiguel Rojas, Carlos Del Pino, Carlos Fernández Velez, Francisco Piqueras, Francisco Esteban Ortega
      Introducción La dinámica de fluidos computacional (CFD) es una herramienta matemática que permite analizar el flujo aéreo. Presentamos un software innovador basado en CFD para mejorar los resultados de la cirugía nasal. Métodos Mediante colaboración de ingenieros especialistas en mecánica de fluidos y otorrinolaringólogos se ha desarrollado un software de fácil uso denominado MeComLand®, que utilizando los cortes de tomografía computarizada de un paciente permite obtener gran cantidad de información como flujo, presiones, temperatura, velocidad o fricción sobre la pared de las fosas nasales. El programa DigBody® permite modificar en 3D la anatomía del modelo y realizar cirugías virtuales para simular resultados antes de la cirugía real. Por último, NoseLand® permite viajar virtualmente por el interior de la fosa nasal, mostrando todo tipo de magnitudes termo-fluido mecánicas. Objetivo Presentar un programa innovador para mejorar los resultados de la cirugía nasal. Emplear este software sobre cortes tomográficos de un paciente con desviación septal para planificar distintas opciones quirúrgicas (septoplastia, turbinectomía, spreader-grafts, colgajo en J y combinaciones) a fin de conseguir la mejor alternativa con la menor morbilidad. Resultados La combinación de todos los procedimientos considerados no produce los mejores resultados en cuanto a flujo nasal. Estos se consiguen asociando septoplastia y turbinectomía. La turbinectomía aislada obtuvo resultados muy similares a la septoplastia. Conclusiones La técnica computacional CFD proporciona una información complementaria valiosa en el diagnóstico del paciente con obstrucción nasal y sobre los resultados de distintas alternativas quirúrgicas respecto al flujo nasal, contribuyendo a un mejor manejo del enfermo. El software MeComLand® con sus respectivos módulos DigBody® y NoseLand® suponen una alternativa barata y no invasiva al estudio funcional del paciente con obstrucción nasal. Introduction Computational fluid dynamics (CFD) is a mathematical tool to analyse airflow. We present a novel CFD software package to improve results following nasal surgery for obstruction. Methods A group of engineers in collaboration with otolaryngologists have developed a very intuitive CFD software package called MeComLand®, which uses the patient's cross-sectional (tomographic) images, thus showing in detail results originated by CFD such as airflow distributions, velocity profiles, pressure, or wall shear stress. NOSELAND® helps medical evaluation with dynamic reports by using a 3D endoscopic view. Using this CFD-based software a patient underwent virtual surgery (septoplasty, turbinoplasty, spreader grafts, lateral crural J-flap and combinations) to choose the best improvement in nasal flow. Objective To present a novel software package to improve nasal surgery results. To apply the software on CT slices from a patient affected by septal deviation. To evaluate several surgical procedures (septoplasty, turbinectomy, spre...
      PubDate: 2018-06-01T10:40:33Z
      DOI: 10.1016/j.otorri.2017.05.005
       
  • Análisis cepstral de la voz normal y patológica en adultos españoles.
           Medida de la prominencia del pico cepstral suavizado en vocales sostenidas
           versus habla conectada
    • Authors: Jonathan Delgado-Hernández; Nieves M. León-Gómez; Laura M. Izquierdo-Arteaga; Yanira Llanos-Fumero
      Pages: 134 - 140
      Abstract: Publication date: May–June 2018
      Source:Acta Otorrinolaringológica Española, Volume 69, Issue 3
      Author(s): Jonathan Delgado-Hernández, Nieves M. León-Gómez, Laura M. Izquierdo-Arteaga, Yanira Llanos-Fumero
      Introducción y objetivos En los últimos años se ha incrementado el uso de medidas cepstrales para la evaluación acústica de la voz. Uno de los parámetros más investigados es la prominencia del pico cepstral suavizado (CPPs). Los objetivos de este trabajo son conocer la utilidad de esta medida acústica en la evaluación objetiva de las alteraciones de la voz en español y determinar qué tipo de muestra de voz (vocales sostenidas o habla conectada) es la más sensible para evaluar la severidad de la disfonía. Método En este estudio participaron 40 sujetos, 20 normofónicos y 20 con disfonía. Se grabaron 2 muestras de voz para cada sujeto (una/a/sostenida y 4 frases fonéticamente balanceadas) y se calculó la CPPs con el programa Praat. Tres expertos valoraron perceptivamente la voz de la muestra con el parámetro grado de la escala GRABS. Resultados Se encontraron valores significativamente menores en las voces disfónicas, tanto para la/a/(t[38] =4,85, p<0,000) como para las frases (t[38] =5,75, p<0,000). En relación con el tipo de muestra de voz más indicado para evaluar la severidad de las alteraciones de la voz se encontró una fuerte correlación con la escala acústico-perceptiva de la CPPs calculada a partir del habla conectada (rs = –0,73) y moderada con la calculada a partir de la vocal sostenida (rs =–0,56). Conclusión Los resultados de este estudio preliminar apuntan a que la CPPs es una buena medida para detectar la disfonía y para evaluar objetivamente el grado de severidad de las alteraciones en la voz. Introduction and objectives In recent years, the use of cepstral measures for acoustic evaluation of voice has increased. One of the most investigated parameters is smoothed cepstral peak prominence (CPPs). The objectives of this paper are to establish the usefulness of this acoustic measure in the objective evaluation of alterations of the voice in Spanish and to determine what type of voice sample (sustained vowels or connected speech) is the most sensitive in evaluating the severity of dysphonia. Method Forty subjects participated in this study 40, 20 controls and 20 with dysphonia. Two voice samples were recorded for each subject (one sustained vowel/a/and four phonetically balanced sentences) and the CPPs was calculated using the Praat programme. Three raters perceptually evaluated the voice sample with the Grade parameter of GRABS scale. Results Significantly lower values were found in the dysphonic voices, both for/a/(t[38]= 4.85, P<.000) and for phrases (t[38] = 5,75, P<.000). In relation to the type of voice sample most suitable for evaluating the severity of voice alterations, a strong correlation was found with the acoustic-perceptual scale of CPPs calculated from connected speech (rs = –0.73) and moderate correlation with that calculated from the sustained vowel (rs = –0,56). Conclusion The results of this preliminary st...
      PubDate: 2018-06-01T10:40:33Z
      DOI: 10.1016/j.otorri.2017.05.006
       
  • oVEMP as an objective indicator of successful repositioning maneuver
    • Authors: Samir Asal; Osama Sobhy; Amany Balbaa
      Pages: 141 - 148
      Abstract: Publication date: May–June 2018
      Source:Acta Otorrinolaringológica Española, Volume 69, Issue 3
      Author(s): Samir Asal, Osama Sobhy, Amany Balbaa
      Background and objective Benign paroxysmal positioning vertigo (BPPV) is the most common peripheral vestibular disorder. Canalolithiasis in the posterior semi-circular canal is the most common underlying pathology that can be treated effectively by repositioning maneuvers. Our hypothesis suggested that successful maneuvers can lead to repositioning of dislodged otoconia to the utricle. Materials and methods Air conducted oVEMP, which is thought to originate from the contra-lateral utricular organ was measured in twenty patients with unilateral BPPV and we compared n1–p1 peak to peak amplitude of the affected ears in 3 separate intervals: on pre-treatment when typical nystagmus was confirmed, immediately after, and 1 week after repositioning maneuvers to assess change, if any, in amplitude. Results This study showed significant increase of oVEMP amplitude in the affected ears after successful repositioning maneuver that was more significant after 1 week. Conclusions oVEMP can be used as a reliable objective test for ensuring a successful maneuver rather than subjective dependence on the patient's symptoms, which may be misleading due to a remission.

      PubDate: 2018-06-01T10:40:33Z
      DOI: 10.1016/j.otorri.2017.06.004
       
  • Cierre endoscópico de las perforaciones septales
    • Authors: Isam Alobid
      Pages: 165 - 174
      Abstract: Publication date: May–June 2018
      Source:Acta Otorrinolaringológica Española, Volume 69, Issue 3
      Author(s): Isam Alobid
      Introducción El cierre quirúrgico de las perforaciones septales sintomáticas a menudo conduce a resultados no satisfactorios. El conocimiento de la irrigación vascular es de suma importancia para el éxito. Objetivo El manejo de las perforaciones septales constituye un reto para el cirujano. Hay descritas una gran variedad de técnicas quirúrgicas, con distintas vías de abordaje. No existen pruebas científicas que avalen un abordaje en concreto. El objetivo de esta revisión es presentar una guía práctica sobre la técnica de elección para cada caso de perforación septal. Discusión La inspección de la mucosa nasal, el tamaño de la perforación, la localización y, sobre todo, el soporte osteocartilaginoso son los pilares para lograr el éxito de la cirugía. Para los colgajos de deslizamiento o rotación de la mucosa del tabique es fundamental haber estudiado previamente si es posible la elevación del mucopericondrio o mucoperiosteo del septum, de lo contrario, el uso de estos colgajos no estaría indicado. Los colgajos de la pared lateral o del suelo nasal son la alternativa. El colgajo pericraneal podría estar indicado en perforaciones totales o casi totales. Conclusión El remanente del septum nasal y el estado del soporte osteocartilaginoso son los factores determinantes en el manejo de las perforaciones septales. Cada caso debe valorarse individualmente y la elección del abordaje se realiza según el tamaño y la localización de la perforación, la calidad de la mucosa, los antecedentes personales, la cirugía previa y la experiencia del cirujano. Objective The management of septal perforations is a challenge for the surgeon. A wide variety of surgical techniques have been described, with different approaches. There is no scientific evidence to support a particular approach. The objective of this review is to present a practical guide on the technique of choice for each case of septal perforation. Discussion Inspection of the nasal mucosa, the size of the perforation, the location and especially the osteo-cartilaginous support, are the pillars of a successful surgery. For the sliding or rotating flaps of the mucosa of the septum it is essential to know in advance if the elevation of the mucopericondrio or mucoperiosteo of the septum is possible, otherwise the use of these flaps would not be indicated. The flaps of the lateral wall or nasal floor are the alternative. The pericranial flap may be indicated in total or near total perforations. Conclusion The remnant of the nasal septum and status of osteo-cartilaginous support are the determining factors in the management of septal perforations. Each case should be evaluated individually and the approach chosen according to the size and location of the perforation, mucosal quality, personal history, previous surgery and the experience of the surgeon.

      PubDate: 2018-06-01T10:40:33Z
      DOI: 10.1016/j.otorri.2017.02.001
       
  • Seudotumor inflamatorio subglótico en un niño de 3 años
    • Authors: Javier Cervera Escario; Sara Sirvent Cerdá; Saturnino Santos Santos; Adolfo Sequeiros González
      Pages: 175 - 177
      Abstract: Publication date: May–June 2018
      Source:Acta Otorrinolaringológica Española, Volume 69, Issue 3
      Author(s): Javier Cervera Escario, Sara Sirvent Cerdá, Saturnino Santos Santos, Adolfo Sequeiros González


      PubDate: 2018-06-01T10:40:33Z
      DOI: 10.1016/j.otorri.2017.04.007
       
  • Lesión del conducto torácico a nivel cervical de forma espontánea: a
           propósito de un caso
    • Authors: Natalia Rodriguez; Maria Luisa Navarrete; Cesar Ortiz; Shelagh Dyer
      Pages: 178 - 180
      Abstract: Publication date: May–June 2018
      Source:Acta Otorrinolaringológica Española, Volume 69, Issue 3
      Author(s): Natalia Rodriguez, Maria Luisa Navarrete, Cesar Ortiz, Shelagh Dyer


      PubDate: 2018-06-01T10:40:33Z
      DOI: 10.1016/j.otorri.2017.05.002
       
  • Lipoma of the pre-epiglottic space: A common pathology in an uncommon
           place
    • Authors: Nuno Ribeiro Costa; Delfim Duarte; Miguel Viana
      Pages: 181 - 182
      Abstract: Publication date: May–June 2018
      Source:Acta Otorrinolaringológica Española, Volume 69, Issue 3
      Author(s): Nuno Ribeiro Costa, Delfim Duarte, Miguel Viana


      PubDate: 2018-06-01T10:40:33Z
      DOI: 10.1016/j.otorri.2017.01.001
       
  • Osteocondroma del seno maxilar, una localización infrecuente
    • Authors: Ana Belén Gil Guerra; Esther Gómez San Martín; María Isabel Jiménez Cuenca
      Pages: 183 - 184
      Abstract: Publication date: May–June 2018
      Source:Acta Otorrinolaringológica Española, Volume 69, Issue 3
      Author(s): Ana Belén Gil Guerra, Esther Gómez San Martín, María Isabel Jiménez Cuenca


      PubDate: 2018-06-01T10:40:33Z
      DOI: 10.1016/j.otorri.2017.04.003
       
  • Maxillary hydatid cyst
    • Authors: Satvinder Singh Bakshi; Roopa Urs
      Pages: 185 - 186
      Abstract: Publication date: May–June 2018
      Source:Acta Otorrinolaringológica Española, Volume 69, Issue 3
      Author(s): Satvinder Singh Bakshi, Roopa Urs


      PubDate: 2018-06-01T10:40:33Z
      DOI: 10.1016/j.otoeng.2018.05.001
       
  • Discrepancy between clinical and pathological neck staging in oral cavity
           carcinomas
    • Authors: Vânia Henriques; Eduardo Breda; Eurico Monteiro
      Pages: 67 - 73
      Abstract: Publication date: March–April 2018
      Source:Acta Otorrinolaringológica Española, Volume 69, Issue 2
      Author(s): Vânia Henriques, Eduardo Breda, Eurico Monteiro
      Introduction The presence of cervical lymph node metastases in patients with oral cavity squamous cell carcinoma reduces survival by up to 50%. Objective The aims of this study are to assess the accuracy of clinical N staging versus pathological N staging and its impact on survival in order to identify predictive factors associated with the presence of occult neck metastases. Methods Outcomes of 105 patients with oral cavity squamous cell carcinoma who underwent surgical treatment of the primary tumor and neck were retrospectively evaluated. Results For pN0 and pN+ patients 5-year overall survival was respectively 53% and 27%; disease specific survival was 66% for pN0 and 33% for pN+. Patients with clinical negative lymph nodes were pathologically upstaged in 62% of cases. Disease specific survival according to staging discrepancy had statistically significant impact on survival (p =0.009). Conclusion Clinical staging usually underestimates the presence of nodal disease. Neck dissection should be performed in cN0 oral cavity squamous cell carcinoma.

      PubDate: 2018-03-17T11:38:13Z
      DOI: 10.1016/j.otorri.2017.02.008
       
  • Impacto de la laringectomía total en la situación laboral
    • Authors: Jose Miguel Costa; Montserrat López; Jacinto García; Xavier León; Miquel Quer
      Pages: 74 - 79
      Abstract: Publication date: March–April 2018
      Source:Acta Otorrinolaringológica Española, Volume 69, Issue 2
      Author(s): Jose Miguel Costa, Montserrat López, Jacinto García, Xavier León, Miquel Quer
      Introducción La laringectomía total es una de las cirugías oncológicas más mutilantes. No existen estudios específicos que evalúen el retorno laboral después de la misma. Pacientes y métodos Se realizó un estudio transversal de una muestra de 116 pacientes laringectomizados que se hallaban libres de enfermedad y con un seguimiento mínimo de 2 años desde la laringectomía total. Se les realizó una encuesta dirigida a conocer la situación laboral, tanto previa como posterior. En el momento de la cirugía 62 (53%) estaban activos laboralmente, 40 (35%) estaban jubilados y 14 (12%) tenían una situación de invalidez. Resultados El 60% tenía profesiones con bajo grado de cualificación, siendo el grupo más numeroso los trabajadores de la construcción. De los 62 pacientes laboralmente activos en el momento de la laringectomía total 29 pasaron a inactivos y 33 (53%) mantuvieron la actividad laboral. Los factores más importantes para mantener la actividad laboral fueron el nivel de cualificación profesional y el método de rehabilitación vocal. El 80% de los pacientes con cualificación alta-intermedia mantuvieron su trabajo, frente al 35% en los de cualificación profesional baja (p<0,001). El 70% de los pacientes con prótesis fonatoria mantuvo la actividad laboral, frente a un 31% de los pacientes rehabilitados con erigmofonía (p=0,004). La regresión logística confirmó estas variables como independientes para seguir trabajando. Conclusiones Este es el primer estudio que analiza el impacto de la laringectomía total en la situación laboral. Los factores más importantes para volver a trabajar fueron tener un trabajo cualificado alto-intermedio y la utilización de prótesis fonatoria como método de rehabilitación vocal. Introduction Total laryngectomy is one of the most mutilating oncological operations. There are no specific studies evaluating return to work after this surgery. Patients and methods A cross-sectional study was performed on a sample of 116 laryngectomized patients who were disease- free and had a minimum follow-up of 2 years from total laryngectomy. A survey was conducted to find out their employment situation before and after surgery. At the time of surgery, 62 (53%) were working, 40 (35%) were retired and 14 (12%) were in a disability situation. Results 60% had professions with low qualification requirements, the largest group being construction workers. Of the 62 patients active at the time of total laryngectomy, 29 became inactive and 33 (53%) maintained their work activity. The most important factors in maintaining work activity were the level of professional qualification and the method of vocal rehabilitation. Eighty percent of the patients with high-intermediate qualification maintained their jobs, compared to 35% of those with low professional qualifications (P <.001). Seventy percent of the patients with voice prostheses maintained their work activity, compared to 31% of the patients rehabilitated with oesophageal voice (P =.004). Logistic regression confirmed these as independent variables for continuing to work. Conclusions
      PubDate: 2018-03-17T11:38:13Z
      DOI: 10.1016/j.otorri.2017.02.006
       
  • Test de pepsina en saliva: prueba útil y sencilla para el diagnóstico
           del reflujo faringo-laríngeo
    • Authors: Luz Barona-Lleó; Claudia Duval; Rafael Barona-de Guzmán
      Pages: 80 - 85
      Abstract: Publication date: March–April 2018
      Source:Acta Otorrinolaringológica Española, Volume 69, Issue 2
      Author(s): Luz Barona-Lleó, Claudia Duval, Rafael Barona-de Guzmán
      Introducción y objetivos El reflujo faringo-laríngeo (RFL) es una enfermedad caracterizada por la presencia de síntomas, signos y alteraciones tisulares, consecuencia del movimiento retrógrado del contenido gastrointestinal hacia el tracto aerodigestivo superior. Representa hasta el 10% de las consultas en otorrinolaringología. El objetivo de nuestro trabajo es describir los hallazgos obtenidos al aplicar el test de determinación de pepsina en saliva (PEP-test) en una muestra de pacientes con signos clínicos sugestivos de RFL. Material y métodos En nuestro estudio clínico descriptivo se han incluido 142 sujetos con síntomas sugestivos de RFL que obtuvieron puntuaciones por encima de 13 en la escala RSI. A todos ellos se les realizó una endoscopia laríngea para descartar otras enfermedades que pudieran justificar los síntomas y el PEP-test. Ésta se realizó en ayunas a todos los sujetos, y en aquellos con resultados negativos se realizó una segunda determinación una hora después de comer. Resultados Los resultados obtenidos en las pruebas realizadas en los 142 sujetos incluidos fueron los siguientes: 105 pacientes (73,94%) presentaron resultados positivos en alguna de las determinaciones de pepsina en saliva y en 37 sujetos (26,06%) los resultados de ambas determinaciones fueron negativos. Conclusión El PEP-test es un método sencillo, económico, no invasivo y fácilmente repetible que podría minimizar el uso de tratamientos empíricos y pruebas invasivas para el diagnóstico del RFL, si bien son necesarias más investigaciones para la validación del mismo. Introduction and objectives Laryngopharyngeal Reflux (LPR) is a disease characterized by the presence of symptoms, signs and tissue damage caused by retrograde flow of gastric contents to the upper aerodigestive tract. It represents up to 10% of otolaryngology consultations. The aim of the study is to describe the findings obtained by applying the salivary pepsin test (PEP-test) in a sample of patients with the clinical suspicion of LPR. Material and methods Our descriptive clinical study included 142 subjects with symptoms suggestive of LPR and a score above 13 on the RSI scale. The subjects underwent laryngeal endoscopy to rule out other pathologies that could justify the symptoms and the salivary pepsin test (PEP-test). The latter was carried out on fasting subjects and a second test one hour after eating, only on those with negative results. Results The results obtained in the tests performed on the 142 patients included in the study were: 105 (73.94%) presented positive results in some of the salivary pepsin tests and the results of both tests were negative in 37 subjects (26.06%). Conclusion The salivary pepsin test is a simple, low-cost, non-invasive and easily repeatable tool which could minimize empirical treatments and invasive tests for LPR diagnosis, although further research is needed for its validation.

      PubDate: 2018-03-17T11:38:13Z
      DOI: 10.1016/j.otorri.2017.03.001
       
  • Cirugía radioguiada en el hiperparatiroidismo primario: resultados y
           correlación con el diagnóstico anatomopatológico intraoperatorio
    • Authors: Juan P. Suárez; María L. Domínguez; Francisco J. de Santos; José M. González; Nuria Fernández; Fidel J. Enciso
      Pages: 86 - 94
      Abstract: Publication date: March–April 2018
      Source:Acta Otorrinolaringológica Española, Volume 69, Issue 2
      Author(s): Juan P. Suárez, María L. Domínguez, Francisco J. de Santos, José M. González, Nuria Fernández, Fidel J. Enciso
      Introducción y objetivos La cirugía radioguiada es una técnica de tratamiento quirúrgico mínimamente invasivo del hiperparatiroidismo primario. Los objetivos de este estudio fueron estudiar el porcentaje de éxito de esta técnica y realizar una comparación de la misma con el estudio histológico intraoperatorio. Métodos Estudiamos retrospectivamente a 84 pacientes con hiperparatirodismo primario con gammagrafía paratiroidea positiva. Se administró una dosis de Tc-99m sestamibi previa a la cirugía y se utilizó una sonda gammadetectora intraoperatoria para detectar el tejido paratiroideo anómalo, siguiendo la «regla del 20%». En todos los casos se realizó estudio anatomopatológico intraoperatorio y seguimiento clínico y analítico durante al menos 6 meses. Asimismo, se comparó el valor predictivo positivo de la ecografía cervical respecto a la gammagrafía paratiroidea. Resultados El porcentaje de éxito de la cirugía radioguiada fue 99%. La sonda gammadetectora intraoperatoria tuvo una sensibilidad, especificidad, valores predictivos positivo y negativo respecto al estudio histológico intraoperatorio de 99, 73, 97 y 89%, respectivamente. La calcemia se normalizó en 83 de 84 pacientes (99%) y la paratohormona se normalizó en 77 de los 84 pacientes (92%). La ecografía mostró un bajo valor predictivo positivo (41%) comparada con la gammagrafía. Conclusiones La cirugía radioguiada es una técnica con excelentes resultados en el tratamiento quirúrgico mínimamente invasivo del hiperparatiroidismo primario y podría sustituir tanto al estudio anatomopatológico intraoperatorio como a la determinación intraoperatoria de paratohormona. Esta última posibilidad debe ser demostrada en futuros estudios. Introduction and objectives Radioguided surgery is a minimally invasive surgical technique for the treatment of primary hyperparathyroidism. The goals of our study were to evaluate the rate of success and compare the results with intraoperative histological analysis. Methods We retrospectively studied 84 patients with primary parathyroidism who had undergone radioguided surgery. All the patients had a positive parathyroid scintigraphy prior to surgery. An intravenous injection of Tc-99m sestamibi was administered before surgery, and radioguided location of the pathologic parathyroid tissue was performed using an intraoperative gamma probe, applying the “20% rule”. All resected specimens underwent intraoperative histologic analysis. All patients were followed up for at least 6 months. Positive predictive values of both parathyroid scintigraphy and cervical ultrasonography were also compared. Results Radioguided surgery success rate was 99%. Sensitivity, specificity, positive and negative predictive values for gamma probe were 99, 73, 97 and 89%, respectively. After surgery, 83 of 84 patients were eucalcaemic (99%) and parathyroid hormone normalised in 77 of 84 patients (92%). Ultrasonography showed low positive predictive value (41%) when compared with scintigraphy. Conclusions Radioguided surgery is a minimally invasive surgical technique with excellent results for the treatment of primary hyperparathyroidism and ...
      PubDate: 2018-03-17T11:38:13Z
      DOI: 10.1016/j.otorri.2017.04.005
       
  • Correlación entre medidas de evaluación perceptual GRB y
           cociente de contacto
    • Authors: Rodrigo Maximiliano Jerez
      Pages: 95 - 98
      Abstract: Publication date: March–April 2018
      Source:Acta Otorrinolaringológica Española, Volume 69, Issue 2
      Author(s): Rodrigo Maximiliano Jerez
      Objetivo El objetivo del presente trabajo es correlacionar los parámetros perceptuales de grade, roughness y breathiness de la escala GRBAS con el cociente de contacto (CQ) obtenido por medio de electroglotografía. Material y método Se analizaron 70 muestras de voces normales y patológicas por medio de análisis auditivo-perceptual y electroglotografía. El análisis perceptual fue llevado a cabo por dos jueces expertos en función de los parámetros grade, roughness y breathiness. Los valores de CQ fueron obtenidos por medio del sistema VoceVista Versión 3.3.7. Resultados Los resultados demuestran correlación fuerte entre CQ y soplo (r = -0,869), mientras que, entre grado de disfonía y CQ (r = -0,567), y aspereza y CQ (r = 0,643) la correlación es media. Conclusiones Es posible establecer relaciones entre el comportamiento vibratorio de los pliegues vocales y el fenómeno resultante que percibimos auditivamente. El parámetro más relevante al respecto fue breathiness. La correlación entre grade, roughness y CQ fue más débil. Objective The aim of the present workis to correlate the perceptual parameters grade, roughness and breathiness of the GRB scale with the contact quotient (CQ) obtained by electroglotography. Material and method 70 samples of normal and pathological voices were analyzed by means of auditory-perceptual analysis and electroglotography. The perceptual analysis was carried out by two expert judges depending on the parameters grade, roughness and breathiness. The CQ values were obtained through the VoceVista System Version 3.3.7. Results The results show a strong correlation between CQ and breathiness (r = -0.869), whereas between grade of dysphonia and CQ (r = -0.567), and roughness and CQ (r = 0.643) the correlation is average. Conclusions It is possible to establish relationships between the vibrational behavior of the vocal folds and the resulting phenomenon that we perceive auditively. The most relevant parameter in this respect was breathiness. The correlation between grade, roughness and CQ was weaker.

      PubDate: 2018-03-17T11:38:13Z
      DOI: 10.1016/j.otorri.2017.04.002
       
  • Efectividad del colgajo de músculo pectoral mayor miofascial en la
           reducción de fístulas salivares tras laringectomía total de rescate
    • Authors: Carlos Miguel Chiesa Estomba; Jose Angel González García; Jon Alexander Sistiaga Suarez; Izaskun Thomas Arrizabalaga; Ekhiñe Larruscain Sarasola; Xabier Altuna Mariezcurrena
      Pages: 99 - 104
      Abstract: Publication date: March–April 2018
      Source:Acta Otorrinolaringológica Española, Volume 69, Issue 2
      Author(s): Carlos Miguel Chiesa Estomba, Jose Angel González García, Jon Alexander Sistiaga Suarez, Izaskun Thomas Arrizabalaga, Ekhiñe Larruscain Sarasola, Xabier Altuna Mariezcurrena
      Introducción La fístula faringocutánea es la más frecuente de las complicaciones poslaringectomía total. Su incidencia varía entre un 9-25% en pacientes poslaringectomía total primaria, hasta un 14-57% en laringectomía de rescate posradioterapia o posquimioterapia+radioterapia. El colgajo de músculo pectoral mayor miofascial (PMMF) se postula como una herramienta útil para disminuir la incidencia de esta complicación. Material y método Análisis retrospectivo de pacientes tratados mediante laringectomía total de rescate, asociada o no a refuerzo de sutura faríngea con colgajo de PMMF. Resultados Veinte pacientes fueron incluidos, 18 hombres (90%) y 2 mujeres (10%), en 10 de los cuales se utilizó colgajo de PMMF. La edad promedio fue de 66,65 años. Diecisiete (85%) presentaron un tumor laríngeo y 3 (15%) un tumor de hipofaringe. Ocho (80%) pacientes del grupo sin PMMF presentaron fístula en el postoperatorio, mientras que tan solo 2 (20%) pacientes del grupo de PMMF presentaron fístula durante el postoperatorio (p=0,005). El tiempo promedio para el cierre de la fístula fue significativamente menor en los casos en que se empleó el PMMF (16±11 vs. 76,8±67 días, p=0,001), así como la estancia hospitalaria (19,6±18 vs. 83,9±77 días, p0,001). Conclusión El uso del PMMF se asocia a una menor tasa de fístulas poslaringectomía total de rescate en pacientes tratados de forma primaria mediante protocolo de conservación de órgano por cáncer de laringe/hipofaringe, y favorece la cicatrización local disminuyendo el tiempo promedio de cierre de fístulas y la estancia media hospitalaria. Introduction Pharyngocutaneous fistula is the most frequent complication after total laryngectomy. Its incidence varies between 9%-25% in post primary total laryngectomy patients, to 14%-57% in salvage laryngectomy post radiotherapy or post chemotherapy + radiotherapy. The pectoralis major myofascial flap (PMMF)is postulated as a useful tool to decrease the incidence of this complication. Materials and method Retrospective analysis of a group of patients treated by salvage laryngectomy, associated or not with pharyngeal closure reinforcement with PMMF. Results Twenty patients were included, 18 males (90%) and 2 females (10%), in 10 of whom the PMMF was used. The average age was 66.65 years. Seventeen (85%) had a laryngeal tumour and 3 (15%) had a hypopharyngeal tumour. Eight (80%) patients in the non-PMMF group had postoperative fistula, whereas only 2 (20%) patients in the PMMF group had a fistula during the postoperative period (P =.005). The mean time for fistula closure was significantly shorter in the cases where PMMF flap was used (16±11 days vs. 76.8±67 days, P =.001), as was hospital stay (19. 6±18 days vs. 83.9±77 days, P =.001).
      PubDate: 2018-03-17T11:38:13Z
      DOI: 10.1016/j.otorri.2017.06.003
       
  • Reconstrucción de defectos orofaríngeos tras cirugía transoral
           robótica. Revisión y recomendaciones de la Comisión de Cirugía de
           Cabeza y Cuello de la Sociedad Española de Otorrinolaringología y
           Cirugía de Cabeza y Cuello
    • Authors: José Ángel González García; Carlos Pollán Guisasola; Carlos Miguel Chiesa Estomba; Constanza Viña Soria; David Virós Porcuna
      Abstract: Publication date: Available online 30 May 2018
      Source:Acta Otorrinolaringológica Española
      Author(s): José Ángel González García, Carlos Pollán Guisasola, Carlos Miguel Chiesa Estomba, Constanza Viña Soria, David Virós Porcuna
      La cirugía transoral de la orofaringe ha presentado una importante evolución en los últimos años, al ampliarse las opciones quirúrgicas disponibles (TORS, TOUSS, TOLS), la capacidad de resecar lesiones cada vez más extensas y el número de pacientes que se beneficia de ellas. Este hecho ha provocado una evolución en la reconstrucción de los defectos quirúrgicos tras cirugía transoral. Este artículo tiene como objetivo la revisión de las posibles técnicas reconstructivas, las indicaciones y factores que tener en cuenta previamente a la cirugía, además de proponer un protocolo para valorar la necesidad de reconstrucción transoral sobre la base de la profundidad del defecto, la estadificación y el tratamiento previamente recibido. Transoral surgery of the oropharynx has seen an important evolution in recent years, expanding the surgical options available (TORS, TOUSS, TOLS). The capacity to resect increasingly extensive lesions and the number of patients who benefit from them. This fact has led to an evolution in the reconstruction of surgical defects after transoral surgery. This article aims to review the possible reconstructive techniques, indications and factors to be taken into account prior to surgery, proposing a protocol to assess the need for transoral reconstruction based on the depth of the defect, the staging, and previous treatment.

      PubDate: 2018-06-01T10:40:33Z
      DOI: 10.1016/j.otorri.2018.04.004
       
  • Dehiscencia de la lámina papirácea del etmoides
    • Authors: Gabriel Huguet Llull; Marta Mesalles Ruiz; Xavier González Compta
      Abstract: Publication date: Available online 30 May 2018
      Source:Acta Otorrinolaringológica Española
      Author(s): Gabriel Huguet Llull, Marta Mesalles Ruiz, Xavier González Compta


      PubDate: 2018-06-01T10:40:33Z
      DOI: 10.1016/j.otorri.2018.03.001
       
  • Hyperostotic esthesioneuroblastoma as a fibrous dysplasia mimicker
    • Authors: Christian Calvo-Henríquez; Gabriel Martínez-Capoccioni; Aldo Rosario-Ortiz
      Abstract: Publication date: Available online 19 May 2018
      Source:Acta Otorrinolaringológica Española
      Author(s): Christian Calvo-Henríquez, Gabriel Martínez-Capoccioni, Aldo Rosario-Ortiz


      PubDate: 2018-06-01T10:40:33Z
      DOI: 10.1016/j.otorri.2018.02.001
       
  • Rehabilitación del paciente laringectomizado. Recomendaciones de la
           
    • Authors: Pedro Díaz de Cerio Canduela; Ismael Arán González; Rafael Barberá Durban; Alexander Sistiaga Suárez; Marc Tobed Secall; Pablo L. Parente Arias
      Abstract: Publication date: Available online 18 May 2018
      Source:Acta Otorrinolaringológica Española
      Author(s): Pedro Díaz de Cerio Canduela, Ismael Arán González, Rafael Barberá Durban, Alexander Sistiaga Suárez, Marc Tobed Secall, Pablo L. Parente Arias
      La laringectomía total permanece como tratamiento fundamental para el carcinoma de laringe localmente avanzado asociándose a una mayor supervivencia. Sin embargo, supone para el paciente una serie de cambios, como la incapacidad de comunicarse verbalmente, la respiración o el cambio estético, que inciden en su calidad de vida y obligan a su rehabilitación integral. El presente documento ha sido elaborado por el grupo de trabajo de rehabilitación del paciente laringectomizado de la Comisión de Cabeza y Cuello y Base de Cráneo de la Sociedad Española de Otorrinolaringología y Cirugía de Cabeza y Cuello con el objeto de unificar las recomendaciones sobre materiales, técnicas y medidas que aúnen la rehabilitación integral del paciente sometido a una laringectomía total para la mejora de su calidad de vida y está destinado a especialistas en otorrinolaringología, a profesionales relacionados con el cuidado del paciente laringectomizado total y también a los propios pacientes. Las recomendaciones del documento tienen como objetivo mejorar la atención del paciente al cual se le ha realizado una laringectomía total teniendo en cuenta las necesidades de personal y material, las consideraciones sobre los procedimientos necesarios antes de la cirugía, durante el propio acto quirúrgico y tras el alta hospitalaria del paciente. Se dan también recomendaciones específicas sobre los tipos de rehabilitación y seguimiento de la misma, así como la necesidad de llevar un registro de dichas actividades. Las recomendaciones expuestas pretenden ayudar a los profesionales sanitarios relacionados con el tratamiento de los pacientes laringectomizados totales a llevar a cabo la tarea de hacer que la vida de estos pacientes sea lo más parecida posible a la vida que llevaban antes de realizarse una laringectomía total. Total laryngectomy remains essential treatment for locally advanced laryngeal carcinoma, related to better survival rates. However, it involves changes for the patient, such as the inability to communicate verbally, breathing or aesthetic changes, which affect their quality of life and require comprehensive rehabilitation. This paper was written by the total laryngectomy rehabilitation workgroup of the National Head and Neck and Skull Base working committee of the Spanish Society of Otolaryngology and Head and Neck Surgery. The purpose of the article is to combine materials, surgical procedures and means towards the comprehensive rehabilitation of total laryngectomy patients, so that they can achieve a good quality of life. This paper is aimed at all health care professionals caring for total laryngectomy patients. It is also aimed at the patients themselves, as well as ENT surgeons. We have considered staffing and material needs, all procedures before, during and after surgery and after hospital discharge. There are also detailed recommendations about types of rehabilitation and follow-up, and the need for recording these events. The comprehensive rehabilitation total laryngectomy patients is very important if we want to improve their quality of life. The recommendations we mention aim to help the healthcare professionals involved in the treatment of total laryngectomy patients to help them achieve a good quality of life, as similar as possible to the life they led before surgery.

      PubDate: 2018-06-01T10:40:33Z
      DOI: 10.1016/j.otorri.2018.01.003
       
  • Frank's Sign
    • Authors: Satvinder Singh Bakshi
      Abstract: Publication date: Available online 9 May 2018
      Source:Acta Otorrinolaringológica Española
      Author(s): Satvinder Singh Bakshi


      PubDate: 2018-06-01T10:40:33Z
      DOI: 10.1016/j.otorri.2018.01.002
       
  • Hematoma cervical por sangrado espontáneo de adenoma paratiroideo
    • Authors: Alberto Martínez-Martínez; Jade García-Espinosa
      Abstract: Publication date: Available online 8 May 2018
      Source:Acta Otorrinolaringológica Española
      Author(s): Alberto Martínez-Martínez, Jade García-Espinosa


      PubDate: 2018-06-01T10:40:33Z
      DOI: 10.1016/j.otorri.2018.01.001
       
  • Macrostomia: The defining feature of the oculo-auriculo-vertebral spectrum
    • Authors: Mainak Dutta; Indranil Chatterjee
      Abstract: Publication date: Available online 1 May 2018
      Source:Acta Otorrinolaringológica Española
      Author(s): Mainak Dutta, Indranil Chatterjee


      PubDate: 2018-06-01T10:40:33Z
      DOI: 10.1016/j.otorri.2017.11.005
       
  • Multi-disciplinary clinical protocol for the diagnosis of bulbar
           amyotrophic lateral sclerosis
    • Authors: Rita Chiaramonte; Carmela Di Luciano; Ignazio Chiaramonte; Agostino Serra; Marco Bonfiglio
      Abstract: Publication date: Available online 23 April 2018
      Source:Acta Otorrinolaringológica Española
      Author(s): Rita Chiaramonte, Carmela Di Luciano, Ignazio Chiaramonte, Agostino Serra, Marco Bonfiglio
      Introduction and objectives The objective of this study was to examine the role of different specialists in the diagnosis of amyotrophic lateral sclerosis (ALS), to understand changes in verbal expression and phonation, respiratory dynamics and swallowing that occurred rapidly over a short period of time. Materials and methods 22 patients with bulbar ALS were submitted for voice assessment, ENT evaluation, Multi-Dimensional Voice Program (MDVP), spectrogram, electroglottography, fiberoptic endoscopic evaluation of swallowing. Results In the early stage of the disease, the oral tract and velopharyngeal port were involved. Three months after the initial symptoms, most of the patients presented hoarseness, breathy voice, dysarthria, pitch modulation problems and difficulties in pronunciation of explosive, velar and lingual consonants. Values of MDVP were altered. Spectrogram showed an additional formant, due to nasal resonance. Electroglottography showed periodic oscillation of the vocal folds only during short vocal cycle. Swallowing was characterized by weakness and incoordination of oro-pharyngeal muscles with penetration or aspiration. Conclusions A specific multidisciplinary clinical protocol was designed to report vocal parameters and swallowing disorders that changed more quickly in bulbar ALS patients. Furthermore, the patients were stratified according to involvement of pharyngeal structures, and severity index.

      PubDate: 2018-06-01T10:40:33Z
      DOI: 10.1016/j.otorri.2017.12.002
       
  • Guía clínica sobre implantes de conducción de vía
           ósea
    • Authors: María José Lavilla Martín de Valmaseda; Laura Cavalle Garrido; Alicia Huarte Irujo; Faustino Núñez Batalla; Manuel Manrique Rodriguez; Ángel Ramos Macías; Carlos de Paula Vernetta; Elisa Gil-Carcedo Sañudo; Luis Lassaleta; Isabel Sánchez-Cuadrado; Juan Manuel Espinosa Sánchez; Ángel Batuecas Caletrio; Carlos Cenjor Español
      Abstract: Publication date: Available online 13 April 2018
      Source:Acta Otorrinolaringológica Española
      Author(s): María José Lavilla Martín de Valmaseda, Laura Cavalle Garrido, Alicia Huarte Irujo, Faustino Núñez Batalla, Manuel Manrique Rodriguez, Ángel Ramos Macías, Carlos de Paula Vernetta, Elisa Gil-Carcedo Sañudo, Luis Lassaleta, Isabel Sánchez-Cuadrado, Juan Manuel Espinosa Sánchez, Ángel Batuecas Caletrio, Carlos Cenjor Español
      Introducción y objetivos En la última década se han producido numerosos y relevantes avances en el tratamiento de la hipoacusia transmisiva y mixta que han desembocado en una ampliación de las indicaciones de los implantes de conducción de vía ósea y la aparición de nuevos dispositivos. La Comisión Científica de Audiología de la Sociedad Española de Otorrinolaringología y Cirugía de Cabeza y Cuello (SEORL-CCC), junto con las comisiones de Otología y Otoneurología, ha llevado a cabo una revisión del estado actual de los implantes de vía ósea con la finalidad de ofrecer a los especialistas de Otorrinolaringología, a los profesionales de la sanidad, a las autoridades sanitarias y a la sociedad en general una guía clínica sobre implantes de conducción de vía ósea. Métodos Esta guía clínica sobre implantes de conducción ósea contiene información sobre los siguientes temas: 1) definición y descripción de los implantes auditivos de vía ósea; 2) indicaciones actuales y emergentes de los implantes de vía ósea; compatibilidad y resonancia magnética, y 3) requisitos organizativos para un programa de implantes de vía ósea. Resultado y conclusiones La finalidad de esta guía es describir los diferentes sistemas de conducción ósea, sus particularidades e indicaciones, con el objeto de aportar unas coordenadas que ayuden a todos estos agentes en las tomas de decisiones que deban asumir en los diferentes ámbitos de responsabilidad en los que están enmarcados en sus áreas de trabajo. Introduction and goals During the last decade there have been multiple and relevant advances in conduction and mixed hearing loss treatment. These advances and the appearance of new devices have extended the indications for bone-conduction implants. The Scientific Committee of Audiology of the Sociedad Española de Otorrinolaringología y Cirugía de Cabeza y Cuello SEORL-CCC (Spanish Society of Otolaryngology and Head and Neck Surgery), together with the Otology and Otoneurology Committees, have undertaken a review of the current state of bone-conduction devices with updated information, to provide a clinical guideline on bone-conduction implants for otorhinolaryngology specialists, health professionals, health authorities and society in general. Methods This clinical guideline on bone-conduction implants contains information on the following: 1) Definition and description of bone-conduction devices; 2) Current and upcoming indications for bone conduction devices: Magnetic resonance compatibility; 3) Organization requirements for a bone-conduction implant programme. Results and conclusions The purpose of this guideline is to describe the different bone-conduction implants, their characteristics and their indications, and to provide coordinated instructions for all the above-mentioned agents for decision making within their specific work areas.

      PubDate: 2018-04-15T20:10:09Z
      DOI: 10.1016/j.otorri.2017.12.001
       
  • Fenómeno de vacío intervertebral: una causa de abombamiento de
           la pared faríngea
    • Authors: Luis Gorospe; Rosa María Gómez-García; Juan Martínez San Millán
      Abstract: Publication date: Available online 4 April 2018
      Source:Acta Otorrinolaringológica Española
      Author(s): Luis Gorospe, Rosa María Gómez-García, Juan Martínez San Millán


      PubDate: 2018-04-15T20:10:09Z
      DOI: 10.1016/j.otorri.2017.11.001
       
  • Esclerosis múltiple: ventaja izquierda para la lateralidad auditiva en
           pruebas dicóticas de procesamiento auditivo central y relación de
           pruebas psicoacústicas con examen de discapacidad-EDEM
    • Authors: Yolanda Rebeca Peñaloza López; Xóchitl Daisy Orozco Peña; Santiago Jesús Pérez Ruiz
      Abstract: Publication date: Available online 3 April 2018
      Source:Acta Otorrinolaringológica Española
      Author(s): Yolanda Rebeca Peñaloza López, Xóchitl Daisy Orozco Peña, Santiago Jesús Pérez Ruiz
      Objetivo Evaluar los trastornos en procesos centrales de la audición, en pacientes con esclerosis múltiple, enfatizando en lateralidad auditiva mediante la aplicación de pruebas psicoacústicas e identificar la relación de estas con funciones de la Escala de Discapacidad en Esclerosis Múltiple(EDEM). Método En 26 individuos con esclerosis múltiple y 26 controles se aplicaron escala de depresión (HADS), EDEM y 9 pruebas psicoacústicas para estudiar trastornos en los procesos centrales de la audición. Se efectuaron pruebas de correlación entre EDEM y pruebas psicoacústicas. Resultados Siete de 9 pruebas psicoacústicas fueron diferentes significativamente (p<0,05); derecha o izquierda (14/19 exploraciones) respecto al grupo control. En dígitos dicóticos la izquierda mostró ventaja de aciertos respecto al predominio usual de dígitos dicóticos en la derecha. Hubo correlación significativa en 5 pruebas psicoacústicas y funciones específicas de la Escala de Discapacidad en Esclerosis Múltiple. Conclusión Conviene investigar la ventaja del oído izquierdo detectada como expresión de influencias deficientes del cuerpo calloso y de atención en esclerosis múltiple. Hay correlación entre pruebas psicoacústicas con funciones específicas de EDEM. Objective To evaluate the central auditory processing disorders in patients with multiple sclerosis, emphasizing auditory laterality by applying psychoacoustic tests and to identify their relationship with the Multiple Sclerosis Disability Scale (EDSS) functions. Method Depression scales (HADS), EDSS, and 9 psychoacoustic tests to study CAPD were applied to 26 individuals with multiple sclerosis and 26 controls. Correlation tests were performed between the EDSS and psychoacoustic tests. Results Seven out of 9 psychoacoustic tests were significantly different (P <.05); right or left (14/19 explorations) with respect to control. In dichotic digits there was a left-ear advantage compared to the usual predominance of RDD. There was significant correlation in five psychoacoustic tests and the specific functions of EDSS. Conclusion The left-ear advantage detected and interpreted as an expression of deficient influences of the corpus callosum and attention in multiple sclerosis should be investigated. There was a correlation between psychoacoustic tests and specific EDSS functions.

      PubDate: 2018-04-15T20:10:09Z
      DOI: 10.1016/j.otorri.2017.11.003
       
  • Cirugía de rescate en las recidivas locales del carcinoma de
           nasofaringe
    • Authors: María Cecilia Salom; Fernando López; Esteban Pacheco; Gabriela Muñoz; Patricia García-Cabo; Laura Fernández; Vanessa Suárez; José Luis Llorente
      Abstract: Publication date: Available online 3 April 2018
      Source:Acta Otorrinolaringológica Española
      Author(s): María Cecilia Salom, Fernando López, Esteban Pacheco, Gabriela Muñoz, Patricia García-Cabo, Laura Fernández, Vanessa Suárez, José Luis Llorente
      Introducción y objetivos La quimiorradioterapia es el tratamiento de elección del carcinoma de nasofaringe. Las recurrencias locales son una de las principales causas de mortalidad en estos pacientes: el rescate quirúrgico o la reirradiación son el tratamiento de elección, según la disponibilidad. El objetivo fue evaluar y comparar los resultados de la cirugía de rescate en el tratamiento de las recidivas locales de los carcinomas nasofaríngeos mediante abordajes abiertos vs. endoscópicos. Métodos Veinte pacientes con recidivas locales de carcinomas nasofaríngeos fueron intervenidos quirúrgicamente: 12 pacientes fueron intervenidos mediante cirugía abierta y 8 mediante un abordaje endoscópico endonasal transpterigoideo. Un paciente fue estadiado como rT1; 3 como rT2; 2 como rT3 y 6 como rT4 en el grupo de abordajes abiertos; en la serie endoscópica, 2 pacientes fueron rT1, 5 fueron rT2 y uno fue rT3. Resultados En 3 de los pacientes (25%) intervenidos mediante cirugía abierta (un rT4, un rT3 y un rT2) no se logró una resección macroscópica completa). En el grupo endoscópico la resección fue completa en todos los pacientes. La tasa de complicaciones en el grupo intervenido mediante abordajes abiertos fue del 92% (5 complicaciones leves, 5 complicaciones moderadas y una complicación grave) y en el grupo intervenido mediante endoscopia fue del 100% (7 sufrieron complicaciones leves y un paciente una complicación grave). La supervivencia a los 3 y 5 años fue del 53 y del 42% en el abordaje abierto y del 100 y del 75% en el abordaje endoscópico, respectivamente. Conclusiones Los abordajes endoscópicos disminuyen la morbilidad asociada a los abordajes abiertos y permiten obtener un control oncológico favorable. Introduction and objectives Chemoradiotherapy is the treatment of choice for nasopharyngeal carcinoma. Local recurrences are one of the leading causes of death in these patients, and surgical salvage the treatment of choice. Our goal was to evaluate and compare the results of salvage surgery in the treatment of local recurrence of nasopharyngeal carcinomas comparing endoscopic to open approaches. Methods Twenty patients with local recurrence of nasopharyngeal carcinomas underwent surgery: 12 patients underwent open surgery and 8 endoscopic endonasal transpterygoid nasopharyngectomy. One patient was classified as rT1; 3 as rT2;2 as rT3; and 6 as rT4 in the group of open approaches; in the endoscopic series, 2 patients were rT1, 5 rT2 and one rT3. Results In 3 patients (25%) operated by an open approach (one rT4, one rT3 and one rT2) a complete gross resection was not achieved. Gross total resection was achieved in patients operated by endoscopic surgery. The complication rate in the group operated by an open approach was 92% (5 minor complications, 5 moderate complications, and one serious complication) and in the group that underwent endoscopic surgery all patients had some complication (7 had minor complications and one patient developed a severe complication). Survival at 3 and 5 years was 53% and 42% with the open approach and 100% and 50% with the endoscopic approach, respectively. Conclusions Endoscopic approaches decrease the morbidity associated with open approa...
      PubDate: 2018-04-15T20:10:09Z
      DOI: 10.1016/j.otorri.2017.11.006
       
  • Guía clínica sobre implantes cocleares
    • Authors: Manuel Manrique; Ángel Ramos; Carlos de Paula Vernetta; Elisa Gil-Carcedo; Luis Lassaleta; Isabel Sanchez-Cuadrado; Juan Manuel Espinosa; Ángel Batuecas; Carlos Cenjor; María José Lavilla; Faustino Núñez; Laura Cavalle; Alicia Huarte
      Abstract: Publication date: Available online 26 March 2018
      Source:Acta Otorrinolaringológica Española
      Author(s): Manuel Manrique, Ángel Ramos, Carlos de Paula Vernetta, Elisa Gil-Carcedo, Luis Lassaleta, Isabel Sanchez-Cuadrado, Juan Manuel Espinosa, Ángel Batuecas, Carlos Cenjor, María José Lavilla, Faustino Núñez, Laura Cavalle, Alicia Huarte
      Introducción En la última década son numerosos los hospitales que han iniciado su actividad en pacientes candidatos a un implante coclear (IC), y se han producido numerosos y relevantes avances para el tratamiento de la hipoacusia neurosensorial que han desembocado en una ampliación de las indicaciones de los IC. Objetivos Ofrecer a los especialistas de otorrinolaringología, de otras especialidades médicas, autoridades sanitarias y a la sociedad en general una guía clínica sobre implantes cocleares. Métodos Las comisiones científicas de otología, otoneurología y audiología de la Sociedad Española de Otorrinolaringología y Cirugía de Cabeza y Cuello (SEORL-CCC), de manera coordinada y consensuada, han llevado a cabo una revisión del estado actual de los IC basándose en las reglamentaciones existentes y en las publicaciones científicas que se referencian en la bibliografía del documento elaborado. Resultados La guía clínica sobre implantes cocleares aporta información sobre: a) definición y descripción sobre IC; b) indicaciones de los IC; y c) requisitos organizativos para un programa de IC. Conclusiones Se ha elaborado por un comité de expertos de la SEORL-CCC una Guía clínica sobre implantes cocleares que aporta coordenadas de actuación para todos aquellos agentes de la sanidad en la toma de decisiones en el ámbito de los IC como forma de tratamiento de la discapacidad auditiva. Introduction In the last decade numerous hospitals have started to work with patients who are candidates for a cochlear implant (CI) and there have been numerous and relevant advances in the treatment of sensorineural hearing loss that extended the indications for cochlear implants. Objectives To provide a guideline on cochlear implants to specialists in otorhinolaryngology, other medical specialities, health authorities and society in general. Methods The Scientific Committees of Otology, Otoneurology and Audiology from the Spanish Society of Otolaryngology and Head and Neck Surgery (SEORL-CCC), in a coordinated and agreed way, performed a review of the current state of CI based on the existing regulations and in the scientific publications referenced in the bibliography of the document drafted. Results The clinical guideline on cochlear implants provides information on: a) Definition and description of Cochlear Implant; b) Indications for cochlear implants; c) Organizational requirements for a cochlear implant programme. Conclusions A clinical guideline on cochlear implants has been developed by a Committee ...
      PubDate: 2018-04-15T20:10:09Z
      DOI: 10.1016/j.otorri.2017.10.007
       
  • Patrón olfativo en lesiones cerebrales no psiquiátricas ni
           traumáticas
    • Authors: Josep de Haro-Licer; Adela González-Fernández; Albert Planas-Comes; Josep Antón González-Ares
      Abstract: Publication date: Available online 23 March 2018
      Source:Acta Otorrinolaringológica Española
      Author(s): Josep de Haro-Licer, Adela González-Fernández, Albert Planas-Comes, Josep Antón González-Ares
      Introducción Las etiologías más frecuente de las patologías olfativas dentro de la otorrinolaringología suelen ser las producidas por resfriados, inflamaciones nasosinusales, alergias y traumatismos craneo-faciales, fuera de estas etiologías tenemos, con menor frecuencia, las enfermedades neurológicas, psiquiátricas, metabólicas. Nuestro servicio ha podido atender a pacientes con alteraciones neurológicas que presentan patologías olfativas. Objetivo Este trabajo tiene por finalidad verificar qué tipo de alteraciones olfativas se hallan en las personas que padecen lesiones del sistema nervioso central excluidos los traumatismos craneales, las enfermedades psiquiátricas, las epilepsias, las enfermedades de Parkinson y Alzheimer y las sinestesias. Material metodos Se trata de un estudio descriptivo basado en un grupo de 61 pacientes diagnosticados de diversas lesiones neurológicas y de un grupo control. Ambos grupos fueron valorados por medio del olfatómetro BAST-24. Se comparan los resultados con un grupo control de 120 personas. Resultados Los resultados muestran que las personas con estos tipos de lesiones neurológicas tienen una capacidad de percibir olores que oscila entre el 60 y el 77% mientras que el grupo control se sitúa entre el 98 y el 100%. Respecto a la capacidad de reconocer correctamente los olores, los paciente neurológicos no superan el 32% de aciertos, mientras que el grupo control se sitúa entre el 59 y el 75% de aciertos, siendo las diferencias olor a olor presentado estadísticamente significativas (p<0,05) tanto para la detección como para el acierto. Conclusiones a) Las alteraciones neurológicas no causadas por traumatismos craneales ni por alteraciones psiquiátricas pueden presentar una pérdida olfativa que oscila entre el 68 y el 89%. b) En este tipo de lesiones debe tenerse en cuenta la presencia de alteraciones olfativas. c) Hay alteraciones olfativas por afectación de otras áreas cerebrales distintas a las clásicas olfativas. d) Debe establecerse una colaboración entre los servicios de ORL y Neurología para poder atender dichas alteraciones. Introduction The most common cause of olfactory ENT disorders are colds and flu, chronic sinusitis, allergies and traumatic brain injury. Rarer aetiologies include certain neurological, psychiatric and metabolic injuries. Target The aim of this paper was to check the sort of olfactory disorders found in people who have suffered a brain injury, excluding: cranial traumas, psychiatric diseases, epilepsy, Parkinson's and Alzheimer's disease, and synaesthesia. Material and methods A descriptive study based on 61 patients with diagnoses of various neurological injuries, which were tested by BAST-24 olfactometer. The results were compared with those of a control group (n= 120). Results The results show major impairment in these patients’ olfactory sense. The neurological injury patients were able to detect from 60-77% of the odours, while the control group were able to detect...
      PubDate: 2018-04-15T20:10:09Z
      DOI: 10.1016/j.otorri.2017.10.002
       
  • Island cartilage vs temporalis fascia in type 1 tympanoplasty: A
           prospective study
    • Authors: Avani Jain; Sunil Samdani; Man Prakash Sharma; Vinod Meena
      Abstract: Publication date: Available online 22 March 2018
      Source:Acta Otorrinolaringológica Española
      Author(s): Avani Jain, Sunil Samdani, Man Prakash Sharma, Vinod Meena
      Objective (1) To compare the results of graft take-up and audiological outcome of temporalis fascia versus island cartilage graft in type 1 tympanoplasty. (2) To compare the rate of postoperative retraction of neotympanum in both. Methods A prospective study was conducted on 70 patients of ages ranging from 11 to 50 years with dry subtotal perforation. 35 underwent island cartilage tympanoplasty and 35 underwent type 1 tympanoplasty using temporalis fascia graft. Graft acceptance rates and post-operative audiograms were compared. Results At one year follow up, the graft take-up rate for temporalis fascia and island cartilage graft were found to be 82.9% and 97.1% respectively, which was found to be statistically significant (p <0.05). In the temporalis fascia group, two out of 35 patients (5.7%) had retraction of the neo tympanum. There was no incidence of retraction using island cartilage graft. There was no significant difference in the postoperative air-bone gap gain between temporalis fascia graft and island cartilage graft. Conclusion Island cartilage tympanoplasty shows a high degree of reliability in high risk cases. It has a higher graft take-up rate with no incidence of retraction of neotympanum. Moreover, it provided significant hearing improvement in our patients.

      PubDate: 2018-04-15T20:10:09Z
      DOI: 10.1016/j.otorri.2017.10.004
       
  • Valor pronóstico de la ruta de EGFR-PI3K-pAKT-mTOR-pS6 en los carcinomas
           epidermoides nasosinusales
    • Authors: María Gabriela Muñoz-Cordero; Fernando López; Cristina García-Inclán; Alejandro López-Hernández; Sira Potes-Ares; Laura Fernández-Vañes; José Luis Llorente; Mario Hermsen
      Abstract: Publication date: Available online 21 March 2018
      Source:Acta Otorrinolaringológica Española
      Author(s): María Gabriela Muñoz-Cordero, Fernando López, Cristina García-Inclán, Alejandro López-Hernández, Sira Potes-Ares, Laura Fernández-Vañes, José Luis Llorente, Mario Hermsen
      Antecedentes y objetivos En estudios previos hemos indicado que EGFR tiene un papel en la carcinogénesis en un subgrupo de carcinomas epidermoides nasosinusales (CENS). Además, EGFR activa a 2 de las más importantes vías de señalización intracelular como son la PI3K/pAKT/mTOR/pS6 y la vía MAP-cinasas. El objetivo de este estudio fue evaluar la participación de la ruta de EGFR/PI3K/pAKT/mTOR/pS6 y su relación con parámetros clínico-patológicos y de seguimiento de los CENS. Material y métodos La expresión proteica de PTEN, pAKT, mTOR y pS6 fue analizada mediante inmunohistoquímica en 54 CENS. Los resultados fueron relacionados con diversos parámetros clínico-patológicos y la supervivencia. Resultados La pérdida de expresión de PTEN se observó en 33/54 casos (61%) y la sobreexpresión de pAKT, mTOR y pS6 se observó en 19/54 casos (35%), 8/54 casos (15%) y 47/54 casos (87%), respectivamente. La pérdida de expresión de PTEN se relacionó con la invasión intracraneal y el desarrollo de metástasis regionales (p = 0,005). La ausencia de sobreexpresión de pS6 se relacionó con una supervivencia específica (p = 0,008) y global (p = 0,007) más favorables y la ausencia de recidivas locales (p = 0,055). No se observaron relaciones significativas entre la expresión de pAKT y mTOR y los parámetros clínico-patológicos estudiados. Conclusiones Las alteraciones en la expresión de los componentes de la vía EGFR/PI3K/pAKT/mTOR/pS6 son frecuentes en un subgrupo de CENS. Este estudio revela que la ausencia de sobreexpresión de pS6 se relaciona con mejores resultados clínicos, por lo que la expresión pS6 podría considerarse como un marcador pronóstico. Background and objectives We have previously indicated that EGFR has a role in carcinogenesis in a subgroup of sinonasal squamous cell carcinomas (SNSCC). In addition, EGFR activates 2 of the most important intracellular signalling pathways: PI3K/pAKT/mTOR/pS6 and MAP pathway kinases. The objective of this study was to evaluate the involvement of the EGFR/PI3K/pAKT/mTOR/pS6 pathway and its relationship with clinical-pathological parameters and follow-up of sinonasal squamous cell carcinoma. Material and methods The immunohistochemical expression of different components of the PI3K/AKT/mTOR/pS6 pathway and its relationship with various clinical-pathological parameters was studied in a series of 54 patients with SNSCC. Results Loss of PTEN expression was observed in 33/54 cases (61%) and pAKT, mTOR and pS6 pre-expression was observed in 19/54 cases (35%), 8/54 cases (15%), and 47/54 cases (87%), respectively. Loss of PTEN expression was related to intracranial invasion and development of regional metastases (p=0.005). Overexpression of pS6 was associated with a decrease in survival (p=0.008), presence of local recurrences (p=0.055), and worsening of overall prognosis (p=0.007). No significant relationships were observed between pAKT and mTOR expression and the clinicopathological parameters studied. Conclusions Alterations in the expression of EGFR/PI3K/pAKT/mTOR/p...
      PubDate: 2018-04-15T20:10:09Z
      DOI: 10.1016/j.otorri.2017.10.005
       
  • Congenital Aural Atresia prevalence in the Argentinian population
    • Authors: Mario Emilio Zernotti; Carlos A. Curet; Susana Cortasa; Mario Chiaraviglio; Maria Fernanda Di Gregorio
      Abstract: Publication date: Available online 20 March 2018
      Source:Acta Otorrinolaringológica Española
      Author(s): Mario Emilio Zernotti, Carlos A. Curet, Susana Cortasa, Mario Chiaraviglio, Maria Fernanda Di Gregorio
      Introduction Congenital Aural Atresia (CAA) or microtia is a malformation that results in esthetic and functional problems. There is little information on prevalence, considering that Latin American is the most affected region in the world. Objective To determine the prevalence of microtia, considering the different ethnical structure of the population. Methods A retrospective analysis was performed of the clinical reports of newborn infants (public hospitals) in three different regions. Results The incidence of CAA in Argentina was 1 case per 7500 new births (i.e. 1.3/10,000). Marked differences were found per geographical area. The means were calculated per year by bilateral parametric estimation, according to the ethnical origins of the population. In the Caucasoid area: 02.47/10,000 (±1.2), in the Mestizo area: 03.99/10,000 (±0.0) and finally in the Amerindian area: 20.93/10,000 (±0.1). Conclusion This study shows different incidences according to the demographic features of the population from 1.90/10,000 to 20.9/10,000. This data indicates that CAA is associated with a genetic problem (ethnic differences).

      PubDate: 2018-04-15T20:10:09Z
      DOI: 10.1016/j.otorri.2017.10.006
       
  • Auditory steady-state response in cochlear implant patients
    • Authors: Alejandro Torres-Fortuny; Isabel Arnaiz-Marquez; Heivet Hernández-Pérez; Eduardo Eimil-Suárez
      Abstract: Publication date: Available online 19 March 2018
      Source:Acta Otorrinolaringológica Española
      Author(s): Alejandro Torres-Fortuny, Isabel Arnaiz-Marquez, Heivet Hernández-Pérez, Eduardo Eimil-Suárez
      Introduction and objective Auditory steady state responses to continuous amplitude modulated tones at rates between 70 and 110Hz, have been proposed as a feasible alternative to objective frequency specific audiometry in cochlear implant subjects. The aim of the present study is to obtain physiological thresholds by means of auditory steady-state response in cochlear implant patients (Clarion HiRes 90K), with acoustic stimulation, on free field conditions and to verify its biological origin. Methods 11 subjects comprised the sample. Four amplitude modulated tones of 500, 1000, 2000 and 4000Hz were used as stimuli, using the multiple frequency technique. The recording of auditory steady-state response was also recorded at 0dB HL of intensity, non-specific stimulus and using a masking technique. Results The study enabled the electrophysiological thresholds to be obtained for each subject of the explored sample. There were no auditory steady-state responses at either 0dB or non-specific stimulus recordings. It was possible to obtain the masking thresholds. A difference was identified between behavioral and electrophysiological thresholds of −6±16, −2±13, 0±22 and −8±18dB at frequencies of 500, 1000, 2000 and 4000Hz respectively. Conclusions The auditory steady state response seems to be a suitable technique to evaluate the hearing threshold in cochlear implant subjects.

      PubDate: 2018-04-15T20:10:09Z
      DOI: 10.1016/j.otorri.2017.08.007
       
  • Implantes activos de oído medio
    • Authors: Luis Lassaletta; Isabel Sánchez-Cuadrado; Juan Manuel Espinosa; Ángel Batuecas; Carlos Cenjor; María José Lavilla; Laura Cavallé; Alicia Huarte; Faustino Nuñez; Manuel Manrique; Ángel Ramos; Carlos de Paula; Elisa Gil-Carcedo
      Abstract: Publication date: Available online 17 March 2018
      Source:Acta Otorrinolaringológica Española
      Author(s): Luis Lassaletta, Isabel Sánchez-Cuadrado, Juan Manuel Espinosa, Ángel Batuecas, Carlos Cenjor, María José Lavilla, Laura Cavallé, Alicia Huarte, Faustino Nuñez, Manuel Manrique, Ángel Ramos, Carlos de Paula, Elisa Gil-Carcedo
      Los implantes activos de oído medio son prótesis implantadas quirúrgicamente, que estimulan la cadena osicular o los fluidos del oído interno a través de la ventana oval o redonda. Estos implantes pueden ser útiles para el tratamiento de determinados pacientes con pérdida auditiva neurosensorial, así como para pérdida auditiva conductiva o mixta. Esta guía clínica pretende resumir los conocimientos actuales sobre las características básicas y las indicaciones de los implantes de oído medio más utilizados, como Vibrant Soundbrige (Med-el, Innsbruck), Carina (Cochlear, Australia) y CodacsTM. (Cochlear, Australia). Active middle ear implants are surgically implanted prosthesis, which intend to stimulate the ossicular chain or the inner ear fluids through the oval or round windows. These implants may be useful for the treatment of certain patients with sensorineural hearing loss as well as for conductive or mixed hearing loss. This clinical guide attempts to summarize the current knowledge concerning the basic characteristics and indications of the most commonly used middle ear implants, including Vibrant Soundbrige (Med-el, Innsbruck), Carina (Cochlear, Australia), and CodacsTM. (Cochlear, Australia).

      PubDate: 2018-04-15T20:10:09Z
      DOI: 10.1016/j.otorri.2017.10.001
       
  • Predictors of locoregional recurrence in early stage buccal cancer with
           pathologically clear surgical margins and negative neck
    • Authors: Shakeel Uz Zaman; Shakil Aqil; Mohammad Ahsan Sulaiman
      Abstract: Publication date: Available online 16 March 2018
      Source:Acta Otorrinolaringológica Española
      Author(s): Shakeel Uz Zaman, Shakil Aqil, Mohammad Ahsan Sulaiman
      Objective To identify the significant predictors of locoregional recurrence in early stage squamous cell carcinoma (SCC) of buccal mucosa with pathologically clear surgical margins and negative neck. Method Seventy-three patients who underwent per oral wide excision and supraomohyoid neck dissection for early stage buccal SCC with clear surgical margins (>5mm margins each) and negative neck (N0) were included. None of the patients received postoperative radiotherapy or chemotherapy. Univariate and multivariate analyses were used to identify independent predictors of locoregional recurrence. Results Recurrence was observed in 22 of 73 (30%) cases. Twelve had local, seven had regional and three developed locoregional recurrences. Both univariate and multivariate analyses demonstrated that lymphovascular invasion (LVI) and non-T4 muscular invasion (non-T4MI) were independent predictors affecting locoregional control. Conclusion Lymphovascular invasion (LVI) and non-T4 muscular invasion (non-T4MI) significantly increased the locoregional recurrence rate in early stage buccal SCC with clear surgical margins and negative nodal status. Adjuvant treatment with either radiation or chemoradiation should be considered when one or both of these factors present.

      PubDate: 2018-03-17T11:38:13Z
      DOI: 10.1016/j.otorri.2017.09.003
       
  • Doble conducto auditivo interno
    • Authors: María Fernanda Vargas Gamarra; Carlos de Paula Vernetta; Miguel Mazón Momparler
      Abstract: Publication date: Available online 15 March 2018
      Source:Acta Otorrinolaringológica Española
      Author(s): María Fernanda Vargas Gamarra, Carlos de Paula Vernetta, Miguel Mazón Momparler


      PubDate: 2018-03-17T11:38:13Z
      DOI: 10.1016/j.otorri.2017.10.008
       
  • Valoración de la reacción emocional provocada por la prueba vestibular
           calórica mediante monitorización de variables fisiológicas
    • Authors: Rafael Barona-de-Guzmán; Claudio Krstulovic-Roa; Elena Donderis-Malea; Luz Barona-Lleó
      Abstract: Publication date: Available online 8 March 2018
      Source:Acta Otorrinolaringológica Española
      Author(s): Rafael Barona-de-Guzmán, Claudio Krstulovic-Roa, Elena Donderis-Malea, Luz Barona-Lleó
      Introducción y objetivos La valoración emocional que provoca el vértigo se realiza mediante la historia clínica y diversos cuestionarios subjetivos. El objetivo del presente trabajo es valorar la respuesta emocional de forma objetiva, en sujetos normales, durante la crisis de vértigo inducida. Material y método Se realizó la prueba vestibular calórica con agua fría en 30 sujetos sanos. Durante los 60s previos a la estimulación y los 60s posteriores a la misma se monitorizaron las siguientes variables fisiológicas: Conductabilidad cutánea, Volumen de pulso periférico, Temperatura corporal, Contracción muscular, Frecuencia cardiaca y Frecuencia respiratoria. Se valoró la velocidad angular máxima de la fase lenta del nistagmo provocado en cada estimulación. Resultados Durante las crisis de vértigo, la conductabilidad cutánea presentó un aumento estadísticamente significativo con relación al periodo previo a las mismas, mientras que el volumen de pulso periférico presentó una disminución estadísticamente significativa. No hubo relación entre la velocidad angular de la fase lenta del nistagmo provocado y los cambios de la conductabilidad y el volumen de pulso periférico. La disminución provocada en el volumen de pulso periférico fue significativamente mayor en la segunda crisis de vértigo. Conclusiones La conductabilidad cutánea y el volumen de pulso periférico cambiaron de forma significativa durante las crisis de vértigo. No Hubo relación entre la intensidad de la crisis vertiginosa provocada y los cambios producidos en estas variables. El estrés generado por la estimulación calórica es mayor en la segunda crisis, cuando el sujeto tiene experiencia del vértigo que provoca la estimulación. Introduction and objectives The emotional evaluation of the causes of vertigo is made using the clinical records and several subjective questionnaires. The aim of the present study is to evaluate the emotional response objectively, in normal subjects, during an induced vertigo crisis. Material and method A caloric vestibular test with cold water was performed on 30 healthy subjects. The following physiological parameters were monitored during the 60seconds prior to and the 60seconds after the stimulation: Skin Conductivity, Peripheral Pulse Volume, Body Temperature, Muscle Contraction, Heart Rate, and Respiratory Rate. The maximum angular speed of the nystagmus slow phase at each stimulation was assessed. Results Skin conductance presented a statistically significant increase during the vertigo crisis in relation to the prior period while the peripheral pulse volume presented a statistically significant decrease. There was no relationship between the slow phase of the provoked nystagmus angular speed and skin conductance and peripheral pulse volume changes. The decrease in peripheral pulse volume was significantly higher in the second vertigo crisis. Conclusions Skin conductance and peripheral pulse volume changed significantly during a vertigo crisis. There was no relation between the provoked vertiginous crisis intensity and the changes produced in those variables. The stress generated by the caloric stimulation is higher in the second crisis, when...
      PubDate: 2018-03-17T11:38:13Z
      DOI: 10.1016/j.otorri.2017.09.002
       
  • Immune-Mediated Inner Ear Disease: Diagnostic and therapeutic approaches
    • Authors: José Ferreira Penêda; Nuno Barros Lima; Francisco Monteiro; Joana Vilela Silva; Rita Gama; Artur Condé
      Abstract: Publication date: Available online 7 March 2018
      Source:Acta Otorrinolaringológica Española
      Author(s): José Ferreira Penêda, Nuno Barros Lima, Francisco Monteiro, Joana Vilela Silva, Rita Gama, Artur Condé
      Introduction Immune Mediated Inner Ear Disease (IMIED) is a rare form of sensorineural bilateral hearing loss, usually progressing in weeks to months and responsive to immunosuppressive treatment. Despite recent advances, there is no consensus on diagnosis and optimal treatment. Methods A review of articles on IMIED from the last 10 years was conducted using PubMed® database. Results IMIED is a rare disease, mostly affecting middle aged women. It may be a primary ear disease or secondary to autoimmune systemic disease. A dual immune response (both cellular and humoral) seems to be involved. Cochlin may be the inner ear protein targeted in this disease. Distinction from other (core common) forms of neurosensory hearing loss is a challenge. Physical examination is mandatory for exclusion of other causes of hearing loss; audiometry identifies characteristic hearing curves. Laboratory and imaging studies are controversial since no diagnostic marker is available. Conclusion Despite recent research, IMIED diagnosis remains exclusive. Steroids are the mainstay treatment; other therapies need further investigation. For refractory cases, cochlear implantation is an option and with good relative outcome.

      PubDate: 2018-03-17T11:38:13Z
      DOI: 10.1016/j.otorri.2017.08.008
       
  • Otoemisiones en los niños tratados con gentamicina de un hospital
           comarcal
    • Authors: Jose Miguel Sequi Canet; Carlos Miguel Angelats Romero; Jose Miguel Sequi Sabater; Ana Miralles Torres; Miguel Boronat Garcia; Marta Gomez Delgado
      Abstract: Publication date: Available online 5 March 2018
      Source:Acta Otorrinolaringológica Española
      Author(s): Jose Miguel Sequi Canet, Carlos Miguel Angelats Romero, Jose Miguel Sequi Sabater, Ana Miralles Torres, Miguel Boronat Garcia, Marta Gomez Delgado
      Introducción Las recomendaciones de la Comisión Nacional para la Detección Precoz de la Hipoacusia (CODEPEH) aconsejan re-valorar la audición de aquellos niños que hayan sufrido algún evento potencialmente dañino para la audición como es la utilización de antibióticos ototóxicos como la gentamicina. Las otoemisiones evocadas son un buen método de evaluación de la integridad de la función coclear. Material y método Se presenta un estudio prospectivo que incluye a 92 niños, sin otros factores de riesgo auditivo, en los que se pautó tratamiento con gentamicina intravenosa por riesgo séptico/sepsis o infección urinaria y en los que se realizaron otoemisiones seriadas: al ingreso, al finalizar el tratamiento y al mes del alta (si estaban alteradas). Resultados Ningún sujeto presentó otoemisiones alteradas al final del seguimiento. Conclusión La gentamicina parece un antibiótico seguro en tratamientos con una duración <10días y a las dosis descritas. Las otoemisiones son un método barato, rápido, incruento y fiable para comprobar la posible ototoxicidad por gentamicina. Su realización podría ahorrar la determinación de niveles del fármaco. Introduction The National Commission for the Early Detection of Hearing Loss (CODEPEH) recommends the re-evaluation of hearing in children who have suffered any potentially harmful event, such as the prescription of ototoxic antibiotics such as gentamicin. The evoked otoacoustic emissions (EOAE) are a good method for assessing the integrity of cochlear functionality. Material and method A prospective study is presented, including 92 children who were treated with intravenous gentamicin for septic risk/sepsis or urinary tract infection. The children underwent serial EOAE: on admission, at the end of treatment and one month later (if altered on discharge). Results In the end, none of the subjects were affected by the treatment. Conclusion Gentamicin appears to be a safe antibiotic in treatments lasting <10days and at the doses described. EOAE are an inexpensive, fast, non-invasive and reliable method to check for gentamicin ototoxicity. This could save in the determination of drug levels.

      PubDate: 2018-03-06T09:03:29Z
      DOI: 10.1016/j.otorri.2017.09.001
       
  • La azatioprina reduce el riesgo de recaída audiométrica en
           hipoacusia inmunomediada
    • Authors: Nieves Mata-Castro; Javier Gavilanes-Plasencia; Rafael Ramírez-Camacho; Alfredo García-Fernández; José Ramón García-Berrocal
      Abstract: Publication date: Available online 2 March 2018
      Source:Acta Otorrinolaringológica Española
      Author(s): Nieves Mata-Castro, Javier Gavilanes-Plasencia, Rafael Ramírez-Camacho, Alfredo García-Fernández, José Ramón García-Berrocal
      Introducción Los esquemas actuales de tratamiento de la hipoacusia inmunomediada con corticoides, a dosis baja y pauta corta, son insuficientes. Métodos Para determinar el papel de la azatioprina en el control del deterioro auditivo se ha llevado a cabo un estudio observacional descriptivo longitudinal con 20 pacientes tratados con azatioprina por vía oral (1,5-2,5mg/kg/día en dos dosis) durante 1año. Se consideró recaída la pérdida de 10dB en dos frecuencias consecutivas o de 15dB en una frecuencia aislada. Resultados La edad media de los pacientes fue de 52,50años (IC95%: 46,91-58,17), y la mitad fueron mujeres. La afectación bilateral fue del 65%. Un 75% presentaban enfermedad organoespecífica y un 25%, enfermedad autoinmune sistémica. La diferencia entre la PTA basal (46,49 dB; DE18,90) y la PTA a los 12meses (45,47dB; DE18,88) no alcanzó significación estadística (p=0,799). Existía una correlación positiva moderada entre sexo femenino y presencia de enfermedad sistémica (R=0,577). Aplicando t de Student para datos apareados se obtuvo una diferencia significativa (p=0,042) entre el descenso de la PTA en frecuencias hasta 1.000Hz (PTA125-1.000Hz). La tasa relativa de incidencia de recaída por año fue de 0,52 recaídas/año (IC95%: 0,19-1,14). El tiempo medio de supervivencia libre de recaída audiométrica fue de 9,70meses (DE1,03). Conclusiones La azatioprina mantiene el umbral de audición, disminuye el riesgo de recaída y frena la velocidad con la que los pacientes recaen, alterando el curso de la enfermedad inmunomediada del oído interno. Introduction Current schemes for treatment of immune-mediated hearing loss with sporadic short-course, low-dose corticosteroids, are insufficient. Methods To determine the role of azathioprine in the control of auditory impairment, a longitudinal, observational, descriptive study was performed with 20 patients treated with azathioprine (1.5-2.5mg/kg/day into two doses) for 1year. The loss of 10dB on two consecutive frequencies or 15dB on an isolated frequency was considered as relapse. Results The mean age of the patients was 52.50years (95%CI: 46.91-58.17), half were women. Bilateral affectation was 65%. 75% had organ specific disease and 25% had systemic autoimmune disease. The difference between baseline PTA (46.49dB; DS18.90) and PTA at 12months (45.47dB; DS18.88) did not reach statistical significance (P =.799). There was a moderate positive correlation between female sex and the presence of systemic disease (R =.577). By applying Student's t for paired data, a significant difference (P =.042) was obtained between the PTA in frequencies up to 1000 Hz (PTA125-1000Hz). The relative incidence rate of relapse per year was .52 relapses/year (95%CI: .19-1.14]). The median time to audiometric relapse-free was 9.70months (DS
      PubDate: 2018-03-06T09:03:29Z
      DOI: 10.1016/j.otorri.2017.08.006
       
 
 
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