Egresos hospitalarios por enfermedades otorrinolaringológicas, Chile 2018 / Hospital discharges for otorhinolaryngological diseases, Chile 2018

Resumen Introducción: Las enfermedades otorrinolaringológicas presentan una alta prevalencia en la población, lo que obliga continuamente a estudiar sus características epidemiológicas. Una forma de estimarlo a nivel país es a través de los egresos hospitalarios. Objetivo: Describir las principales causas de egresos hospitalarios por enfermedades otorrinolaringológicas a nivel nacional durante el año 2018. Material y Método: Estudio transversal donde se describen las distintas frecuencias de las principales causas de egresos hospitalarios por causa otorrinolaringológica en todo Chile durante el año 2018. Datos obtenidos del Departamento de Estadísticas e Información en Salud (DEIS). Resultados: Se incluyeron 64.715 egresos con una mediana de edad de 22 años. Las patologías con mayor cantidad de egresos fueron la enfermedad crónica de amígdalas y adenoides (28,4%), patología rinosinusal (23,3%), neoplasias de cabeza y cuello (15,2%) y oído (7,8%). Conclusión: La enfermedad crónica de amígdalas y adenoides persiste como la patología con más egresos. Emergen en importancia enfermedades neoplásicas y diagnósticos relacionados con mejora de calidad de vida. Existen errores de codificación de diagnósticos que requieren discusión dentro de la especialidad para mejorar la calidad del registro.

Abstract Introduction: Otolaryngological diseases have a high prevalence in the population, creating the need to continuously study their epidemiological characteristics. One way to estimate prevalence at the country level, is to check hospital discharges. Aim: To describe the main causes of hospital discharges due to otolaryngological diseases at the Chilean level during 2018. Material and Method: Cross-sectional study describing the different frequencies of the main causes of hospital discharge due to otolaryngological diseases throughout Chile during 2018. Data obtained from the Department of Health Statistics and Information (DEIS). Results: 64,715 discharges were included with a median age of 22 years. The pathologies with the highest number of discharges were chronic tonsil and adenoids Disease (28.4%), rhinosinusal (23.3%), head and neck neoplasms (15.2%) and ear (7.8%). Conclusion: Chronic tonsil and adenoids disease persists as the pathology with the most discharges. Neoplastic diseases and diagnoses related to improvement of quality of life emerge in importance. There are errors in the coding of diagnoses that require discussion within the specialty to improve the quality of the registry.

Utilidad de la evaluación por otorrinolaringología en atención primaria de salud: Evaluación piloto / Usefulness of otolaryngology evaluation in primary health care: Pilot evaluation

Introducción: En Atención Primaria de Salud (APS), las consultas por causas otorrinolaringológicas alcanzan hasta el 40%-50%. De éstos, muchos son enviados para evaluación al nivel secundario de salud. Objetivo: Evaluar la utilidad de una atención de otorrinolaringología en APS para tamizar el número de interconsultas al especialista. Explorar estrategias que permitan replicar la experiencia. Material y método: Se consideran las consultas de otorrinolaringología realizadas en dos escenarios diferentes, donde se evaluaron pacientes que se encontraban a la espera de atención formal por el nivel secundario. Resultados: Se evaluaron 201 pacientes. El 60,9% fueron de sexo femenino y el 39,1% masculino. La mediana de tiempo de espera para la derivación fue de 20 meses, con un rango intercuartil de 8-29 meses. El tiempo máximo de espera de interconsulta fue de 6 años (73 meses). Del total de interconsultas, 71,7% fueron dadas de alta con tratamiento según la causa, mientras que sólo en el restante 28,3% de las interconsultas se consideró necesario mantener la interconsulta al nivel secundario. Conclusión: Los resultados de la presente evaluación permiten plantear la utilidad de una evaluación otorrinolaringológica en APS. Esto permitiría reducir el flujo de derivaciones y listas de espera hacia el sector secundario, descongestionar el sistema, priorizar las derivaciones más pertinentes, crear canales de comunicación expeditos entre los niveles de atención, contribuir a la capacitación continua en ambos equipos y niveles.

Introduction: In primary health care, medical appointments for otorhinolaryngological causes reach up to 40%-50%. Of these cases, many are referred for the evaluation of the tertiary level of health. Aim: Assess the usefulness of an otorhinolaryngology evaluation at the primary health care level to screen the number of referrals to specialist. Explore strategies to replicate the experience. Material and method: Attention by otorhinolaryngologist is considered in two different scenarios, where patients who were waiting for formal care by the secondary level were evaluated. Results: 201 patients were evaluated. 60.9% of the patients were females and 39.1% were males. The median waiting time for referral was 20 months, with an interquartile range of 8 - 29 months. The maximum waiting time for consultation was 6 years (73 months). Of the total number of consultations, 71.7% were discharged with treatment according to the cause, while only the remaining 28.3% of the consultations were considered necessary to maintain consultation at the tertiary level. Conclusion: The results of this evaluation allow us to propose the usefulness of an otorhinolaryngological evaluation in primary health care. This would reduce the flow of referrals and waiting lists to the secondary sector, decongest the system, prioritize the most relevant referrals, create expedited channels of communication between levels of care, contribute to continuous training in both teams and levels.

Profils épidémiologiques et cliniques des urgences ORL infantiles à l'Hôpital National Ignace Deen (CHU de Conakry)

Introduction : Les urgences ORL de l'enfant constituent une entité relativement fréquente. Elles exigent un diagnostic et une prise en charge précoce. En Guinée, la fréquence de ces affections est mal connue. Le but de cette étude était de décrire le profil épidémiologique et clinique des urgences ORL infantiles dans le Service ORL de l'hôpital national Ignace Deen du CHU (Centre Hospitalier Universitaire) de Conakry. Patients et méthodes : Il s'est agi d'une étude prospective de type descriptif d'une durée de 6 mois. Les données sociodémographiques et cliniques de 159 enfants ont été recueillies à l'aide d'un questionnaire anonyme, structuré et analysées à l'aide du logiciel Stata Version 13, StataCorp, College, Texas. Résultats : Les urgences ORL de l'enfant représentaient 17,3% des admissions du service ORL. L'âge moyen des enfants était de 6 ans avec une prédominance masculine (52,2%). 54,1% étaient reçus plus de 72 heures après le début des symptômes. Les principaux motifs de consultation étaient l'otalgie (85,5%) et la fièvre (74,8%). Le diagnostic était dominé par les urgences relatives (87,4%) contre 11,9% d'urgences absolues. Les principales circonstances de survenue des urgences absolues étaient les accidents de la voie publique (47,4%), les accidents de jeux (26,3%). Les urgences relatives, étaient découvertes de façon fortuite dans 85,6% des cas. Les pathologies infectieuses, les corps étrangers étaient les principaux diagnostics observés.Conclusion : Les urgences ORL infantiles sont relativement fréquentes dans notre contexte. Elles sont dominées par les urgences relatives qui regroupent les pathologies infectieuses et les corps étrangers. Elles surviennent de façon fortuite ou suite à un accident domestique

Estudio epidemiológico descriptivo de pacientes hospitalizados en el Servicio de ORL del Hospital Clínico de la Universidad de Chile entre los años 2007 y 2014 / Descriptive epidemiological study of patients hospitalized in the ENT Department of the Hospital Clínico de la Universidad de Chile between the years 2007 and 2014

Introducción: Las enfermedades de origen otorrinolaringológico (ORL) tienen una elevada prevalencia en atención primaria de salud, sin embargo, la información epidemiológica en pacientes hospitalizados es bastante escasa. Objetivo: Obtener características demográficas y prevalencia de enfermedades en los pacientes hospitalizados del Servicio de ORL del Hospital Clínico de la Universidad de Chile (HCUCh). Material y método: Estudio de tipo descriptivo y retrospectivo, llevado a cabo en el Servicio de ORL del HCUCh, donde se revisaron los registros electrónicos, existentes de grupos relacionados a diagnóstico (GRD) de egresos, entre los años 2007 y 2014. Resultados: Se incluyeron 7.353 egresos, con un promedio de edad de los pacientes de 28,24 años. La causa de hospitalización más frecuente fue la patología de faringe. Del total de los egresos 87,88% presentaron una intervención quirúrgica donde la amigdalectomía con adenoidectomía alcanzó el 15,7% de las cirugías realizadas. Conclusión: Este estudio nos entrega información epidemiológica sobre los pacientes hospitalizados en un servicio de ORL de un hospital de referencia a nivel nacional.

Introduction: Diseases ofotolaryngology (ENT) origin have a high prevalence in primary health care, however, the epidemiological information on hospitalized patients is almost null. Aim: To obtain demographic and disease prevalence information in hospitalized patients of the ENT Department at the Hospital Clínico de la Universidad de Chile (HCUCh). Material and method: A descriptive and retrospective study, was carried out at the ENT department of the HCUCh, reviewing existing records of diagnostic related groups (GRD) for discharges between 2007 and 2014. Results: We review a total of 7353 discharges, with an average age of patients of 28.24 years. The most frequent cause of hospitalization was pharynx pathology. An 87.88% of discharges had surgery performed, where tonsillectomy with adenoidectomy reached 15,7% of the total. Conclusion: This study provides us with epidemiological information on patients hospitalized in an ENT department in a nationwide referral hospital.

Infecciones por micobacterias en otorrinolaringología: revisión de la literatura / Mycobacterial infections in otolaryngology: review

Las micobacterias constituyen un grupo de bacilos aeróbicos no capsulados y no móviles, algunos de los cuales son patógenos causantes de graves enfermedades en los mamíferos incluyendo tuberculosis y lepra. Chile, a pesar de pertenecer al grupo de países de baja prevalencia de tuberculosis en América, presentó un enlentecimiento en la curva de descenso de incidencia. Así mismo, se ha visto un aumento de micobacterias atípicas tanto en muestras pulmonares como extrapulmonares respecto a décadas anteriores. Por otra parte, las infecciones por micobacterias adquieren importancia en otorrinolaringología dado que la tuberculosis de cabeza y cuello representa alrededor del 10% a 35% de los casos de tuberculosis, siendo su localización más frecuente los ganglios linfáticos. La siguiente revisión abarcará los cuadros de infecciones por micobacterias en otorrinolaringología, sus manifestaciones clínicas, diagnóstico y tratamiento.

Mycobacteriums are a group of aerobic non-capsuled and non-mobile bacillus some of which can cause diseases in mammals such as tuberculosis and leprosy. Chile, despite belonging to the group of countries with low prevalence of tuberculosis in America, presented a slowing in the decline in incidence curve. At the same time there has been an increase in atypical mycobacterium in pulmonary and extrapulmonary samples, comparedto past decades. On the other hand infections by mycobacterium become important because the head and neck tuberculosis accounts for about 10%-35% of cases of tuberculosis, the most common site being the lymph nodes. The following review will cover mycobacterial infections in otolaryngology clinical manifestations, diagnosis and treatment.

Perfil de morbilidad otorrinolaringológica en niños con síndrome de Down / Ear, nose and throat disease profile in children with Down syndrome

Introducción: Los niños con síndrome de Down (SD) tienen mayor riesgo de desarrollar enfermedad otorrinolaringológica (ORL). Recomendaciones internacionales sugieren realizar tamizaje auditivo precoz y control periódico por especialista. Nuestro objetivo fue caracterizar la enfermedad ORL en niños con SD y proponer una recomendación adaptada a nuestra realidad. Pacientes y método: Estudio transversal, descriptivo, en niños de 6 meses a 15 años con SD. Los datos se obtuvieron por medio de entrevista a los padres y revisión de fichas clínicas. Resultados: Se analizaron 134 pacientes, con una edad promedio de 44,5 meses. El 78,8% de ellos presentaba enfermedad ORL, siendo la más frecuente la rinitis alérgica y otitis con efusión. El tamizaje auditivo estaba alterado en un 25% de ellos, el 50% de los mayores de 3 años con estudio de sueño tenían apnea obstructiva del sueño. Los niños de mayor edad tuvieron estadísticamente mayor frecuencia de enfermedad ORL. Conclusiones: Esta serie muestra una alta frecuencia de enfermedad ORL en niños con SD, lo que refuerza la necesidad de realizar tamizaje auditivo, sospechar e identificar las apneas obstructivas del sueño y derivación rutinaria al especialista para optimización de las condiciones auditivas que permitan el mejor desarrollo del niño con SD.

Introduction: The children with Down syndrome (DS) are at increased risk of ear-nose-throat (ENT) disorders. International recommendations suggest early hearing screening and periodic specialist evaluation. Our goal was to characterize ENT disorders in children with DS, and propose recommendations for the Chilean population. Patients and method: Cross-sectional, descriptive study, of children with DS, between 6 months and 15 years of age. The data was obtained by a health interview to the parents and review of medical records. Results: We analyzed 134 patients with an average age of 44.5 months. The 78.8% had ENT disorders, the most frequent ENT disorders was allergic rhinitis and otitis media with effusion. Hearing screening was abnormal in a quarter of the patients, 50% of children over 3 years of age had obstructive sleep apnea diagnosed by polysomnogram. Older children had a statistically higher frequency of ENT disorders. Conclusions: This series shows a high rate of ENT disorders in children with DS, which supports recommendations for hearing screening, high suspicion of obstructive sleep apnea and routine referral to an ENT specialist for prevention and aggressive therapy in order to reduce hearing loss and improve development of the child with DS.

Síndrome de Down en otorrinolaringología / Down Syndrome in Otolaryngology

El síndrome de Down es la cromosomopatía más frecuente en Chile. Los pacientes portadores de este síndrome presentan una serie de dismorfias y malformaciones congénitas. Muchas patologías secundarias a estos trastornos son de la esfera otorrinolaringológica. Existen alteraciones otológicas, rinosinusitis crónica, apnea obstructiva del sueño, obstrucción de la vía aérea, inestabilidad atlantoaxial, etc. Se realiza una revisión bibliográfica y se describen las patologías más relevantes y su enfrentamiento.

Down syndrome is the most common chromosomal abnormality in Chile. The patients with this syndrome have a number of dysmorphic features and congenital malformations. Many secondary pathologies of these disorders are ENT sphere. There otologic disorders, chronic rhinosinusitis, obstructive sleep apnea, airway obstruction, atlantoaxial instability, etc. A literature review is performed and the most relevant diseases and confrontation are described.

Perfil dos atendimentos em pronto-socorro de Otorrinolaringologia em um hospital público de alta complexidade / Profile of Otorhinolaryngology emergency unit care in a high complexity public hospital

As urgências/emergências em Otorrinolaringologia são desordens comuns e de baixa morbimortalidade, em sua maioria. Existem poucos estudos que abordam a epidemiologia desses atendimentos. OBJETIVO: Avaliar as características epidemiológicas dos atendimentos em pronto-socorro de Otorrinolaringologia em um hospital de alta complexidade no período de 12 meses. MÉTODO: Estudo epidemiológico, tipo corte transversal, retrospectivo com coleta de dados realizada a partir das fichas de atendimento do pronto-socorro de Otorrinolaringologia de um hospital de alta complexidade do estado de São Paulo, pelo período de 12 meses. Foram levantados os dados: idade, sexo, diagnóstico clínico e conduta. Os atendimentos foram divididos em subespecialidades: otologia, rinologia, faringolaringoestomatologia e cirurgia de cabeça e pescoço. Nível de urgência/emergência, etiologia e distribuição mensal dos atendimentos foram avaliados. RESULTADOS: Obtidas 17.503 fichas de atendimento, foram excluídas 1.863. Das 15.640 fichas incluídas, a média de idade foi 36,3 anos. 9.818 (62,77%) corresponderam a atendimentos considerados como urgência/emergência. Entre os atendimentos urgência/emergência, 6.422 (65,41%) foram por diagnósticos em otologia e entre os 10 diagnósticos mais prevalentes, sete foram da subespecialidade de otologia. CONCLUSÃO: Dentre os atendimentos em pronto-socorro de Otorrinolaringologia avaliados, 62,77% correspondem a casos de urgência/emergência, com predomínio na subespecialidade de otologia.

Urgent and emergency care are common happenings in ENT practice and most carry low morbidity and mortality. There are but few studies that address the epidemiology of these situations. OBJECTIVE: To evaluate the epidemiological characteristics of care in the emergency department of otorhinolaryngology at a high complexity hospital. METHOD: Epidemiological, cross-sectional study, retrospective with data collection carried out from medical records from the emergency department of otorhinolaryngology of a high complexity hospital in São Paulo, for a period of 12 months. Data collected: age, gender, clinical diagnosis and management. The cases were divided by subspecialty: otology, rhinology, pharyngolaryngeal-stomatology and head and neck surgery. We evaluated the level of urgency/emergency, etiology and monthly distribution of visits. RESULTS: 17,503 medical records were obtained; 1,863 were excluded. Of the 15,640 cases included, the average age was 36.3 years. 9,818 (62.77%) corresponded to cases considered as emergency/urgency. Among the urgency/emergency cases, 6,422 (65.41%) were diagnosed in the ear and among the 10 most prevalent diagnostics, 7 were in the subspecialty of otology. CONCLUSION: Among the patients seen in the emergency department of otolaryngology evaluated in this study, 62.77% corresponded to cases of urgency/emergency, predominantly in the otology subspecialty.

Prevalence of otorhinolaryngologic diagnoses in the pediatric emergency room

Introduction: Fever and pain, which are very common in ear, nose, and throat pathologies, are among the most frequent complaints recorded during emergency room pediatric patient treatment. Most of time, the pediatricians are called on to evaluate otorhinolaryngology disorders that requires specialist assessment. Aim: To determine the prevalence of otorhinolaryngologic diagnoses in a pediatric population in a reference hospital in the city of Itatiba, São Paulo. Methods: We evaluated 2,054 pediatric patients (age range, 0-12 years, 11 months) in this descriptive, transversal observational (survey) study. Data collection was performed by a single observer during 103 night shifts (07:00 p.m. to 07:00 a.m.) between January and December 2011, and included documentation of the main diagnosis, and patient age and sex. The ethics committee and research institution approved study. Patients were divided into 2 groups based on diagnosis: Group A otorhinolaryngology disease and Group B included diagnoses not contained in Group A. Results: Of the total enrolled patients, 52.2% corresponded to Group A and 47.8% to Group B; 51.9% were male and 48.1% were female. The average age was 4.5 years (Group A, 3.93 years; Group B, 5.03 years). We compared the prevalence of the diagnostic hypotheses of the 2 groups. Conclusion: A large number of patients sought treatment at pediatric emergency rooms for otorhinolaryngologic diagnoses...

Patología otorrinolaringológica ambulatoria en el Hospital Clínico de la Universidad de Chile durante el año 2008: reporte de 9.157 pacientes / Otolaryngology outpatient pathology at Clinical Hospital of the University of Chile in 2008: report of 9.157 patients

Introducción: En atención primaria las consultas por patología de nariz, oído y faringe son muy frecuentes, representando el 40 por ciento del total. Objetivo: Describir la patología ambulatoria atendida en el Policlínico de Otorrinolaringología del Hospital Clínico de la Universidad de Chile (HCUCH) durante el año 2008. Material y método: Estudio retrospectivo descriptivo de las atenciones en el Policlínico de Otorrinolaringología del HCUCH durante el año 2008. Se analizan datos demográficos, diagnósticos y distribución según localización. Resultados: Se analizan 9.157 pacientes, con promedio de edad de 34,9 años. El 55 por ciento del total correspondió al sexo femenino. El 62 por ciento del total estuvo en el grupo entre 15 y 64 años. Se observó un aumento de las consultas en primavera y verano, representando un tercio. El 38 por ciento correspondió a patología otológica, 27 por ciento nasosinusal, 10 por ciento faríngea y 10 por ciento laríngea. Predominó la hipoacusia (10 por ciento), rinitis alérgica (10 por ciento), patología adenoamigdalina (7 por ciento), otitis media crónica (6 por ciento) y rinosinutis (5 por ciento). Discusión: Los diagnósticos y su frecuencia encontrados en nuestro centro concuerdan con la literatura internacional. Conclusión: El conocimiento sobre las patologías más frecuentes y su distribución etaria permiten organizar más eficazmente las atenciones y recursos de nuestro servicio.

Introduction: In primary care the consultations about nouse, ear and pharynx's pathology are very frequent, representing the 40 percent of the total. Aim: Describe the outpatient pathology seen at the polyclinic of the Clinical Hospital of the University of Chile in 2008. Material and method: Retrospective, descriptive study of the Otolaryngology polyclinic consultations during the 2008's year. Demographic datas, diagnosis and distribution by localization were analyzed. Results: 9.157 patients were analized, with a mean age of 34,9 years. 55 percent was female, and the 62 percent of the total was in the group between 15 and 64 years. There was a increase of consultations in spring and summer. The 38 percent was otologic pathology, 27 percent sinonasal and 10 percent pharyngeal. It predominated the hearing loss (10 percent), allergic rhinitis (10 percent), adenotonsillar pathology (7 percent), the chronic ear's disease (6 percent) and rhinosinusitis (5 percent). Discussion: The diagnoses and their frequencies founded in our center are consistent with international literature. Conclusions: The knowledge about the most common diseases and age distribution allows to organize more effectively the attentions and resources of our service.

Clinic-epidemiological analysis of an otorhinolaryngology emergency unit care in a tertiary hospital / Análise clínico-epidemiológica do atendimento de pronto-socorro de otorrinolaringologia de um hospital terciário

Emergencies are common in our Otorhinolaringology specialty. However, the clinical and epidemiological features are not very well known. OBJECTIVES: To evaluate the clinical and epidemiological profiles of otorhinolaryngological disorders in an emergency unit of a tertiary hospital, and to determine the appropriateness of the level of health care for a tertiary hospital. MATERIALS AND METHODS: An analytical study using data records of an otorhinolaryngological emergency unit at a tertiary hospital in the Federal District for a year, full time, and no screening. The age, sex, arrival time and clinical diagnosis were evaluated. The entities were separated into cases of pharingolaryngoesthomatology, otology, rhinology, and head and neck surgery. These were evaluated according to the urgency level, the required care, and the arrival time. RESULTS: 26,584 data records were selected, of which 2,001 were excluded. The group comprised 54. 48 percent women, and 45. 51 percent men. Otological complaints (62. 27 percent) prevailed. 61. 26 percent of cases were considered emergencies. Only 9. 7 percent of those required medium or high complex resources for resolution. CONCLUSIONS: The study showed that 61. 26 percent of the otorhinolaryngological cases are emergencies, and only 9. 7 percent required medium or high complexity resources.

Pronto-atendimento em Otorrinolaringologia é uma prática constante da especialidade. Entretanto, as características clínico-epidemiológicas são pouco conhecidas. OBJETIVOS: Avaliar fatores clínico-epidemiológicos referentes às doenças otorrinolaringológicas de pacientes atendidos no pronto-socorro de um hospital terciário e avaliar a adequação do nível de atenção em saúde em relação ao atendimento prestado em um hospital terciário. MATERIAIS E MÉTODOS: Estudo analítico, transversal a partir dos dados de guias de atendimentos do pronto socorro de otorrinolaringologia de um hospital terciário do Distrito Federal durante 01 ano, em horário integral, sem triagem. Foram avaliados: idade, sexo, horário de chegada e diagnóstico clínico. Os eventos foram divididos em otologia, rinologia, faringolaringoestomatologia e cirurgia de cabeça e pescoço. Os eventos foram avaliados segundo o grau de urgência, nível de assistência necessário e o horário de chegada. RESULTADOS: Foram colhidas 26. 584 guias de atendimentos, sendo excluídas 2001. 54,48 por cento eram mulheres e (45,51 por cento) homens. Queixas otológicas foram as mais prevalentes (62,27 por cento). Foram consideradas urgências 61,26 por cento dos atendimentos; apenas 9,7 por cento atendimentos necessitaram de recursos de média ou alta complexidade. CONCLUSÃO: O estudo mostrou que 61,26 por cento das doenças otorrinolaringológicas atendidas no pronto-socorro são urgências e que apenas 9,7 por cento necessitam de recursos de média ou alta complexidade.

Epidemiología de la patología otorrinolaringológica ambulatoria y quirúrgica en población mayor de 65 años en el Hospital Clínico de la Universidad de Chile / Epidemiology otorhinolaryngological pathology ambulatory and surgery in population over 65 years at the Hospital Clínico de la Universidad de Chile

Introduction: The otolaryngology (ear, nose and throat (ENT)) pathology is a common ambulatory cause of consultation in an elderly country as Chile. Aims: Characterize the ENT diagnosis in ambulatory elderly population more than 65 years old consultant on ENT clinic of HCUCH (Hospital Clínico Universidad de Chile) during 2009. Patients and Methods: descriptive transversal retrospective study. ENT diagnosis was rescued of clinical archives. Anatomical functional groups, specific diagnosis and sex were tabulated. A patient could have more than one diagnosis. STATA statistical analysis was performed. Results: 148 elderly (204 diagnosis) consulted during 2009, average age 74,08+/-6,87 years old, 65,54 percent women. The most frecuent groups were the vestibular-auditive (n=133; 65,20 percent), naso-sinusal (n=36; 17,64 percent) and pharingo-laryngeal (n=17; 8,33 percent). The most frecuent specific diagnosis were prebycusis(n=43; 21,08 percent), earwax (n=28; 13,73 percent), allergic rhinitis (n=17; 8,33 percent) and unspecified vertigo (n=13; 6,37 percent). There were not significant differences between gender in any specific diagnosis. Discussion: The diagnostic profile is consistent to age group. Results agree with the high frequency of presbycusis, but differ in the high presence of earwax and allergic rhinitis above other expected diagnostics. Conclusion: new Chilean epidemiologic information of ambulatory and surgical ENT pathology was provided.

Ocorrência da síndrome da apneia obstrutiva do sono (SAOS) em crianças respiradoras orais / Obstructive sleep apnea syndrome (OSAS) in mouth breathing children

É bem estabelecido que a respiração oral em crianças está relacionada à hipertrofia adenoamigdaliana, que é a principal causa de apneia do sono nesta população. Apesar da importância deste tema, há poucos estudos que comprovam a relação entre SAOS e respiração oral. OBJETIVO: Determinar a prevalência de distúrbios respiratórios do sono em crianças respiradoras orais e sua correlação com achados otorrinolaringológicos. MATERIAL E MÉTODO: Foram avaliados retrospectivamente 248 prontuários de crianças respiradoras orais do serviço de Otorrinolaringologia Pediátrica de uma grande instituição entre 2000 e 2006, analisando os achados otorrinolaringológicos, polissonografia, nasofibroscopia e/ou radiografia em perfil do Cavum. O principal dado polissonográfico utilizado foi o índice de apneia (IA). Classificou-se como ronco primário aqueles com IA< 1 e como SAOS, os com IA >1. Desenho Científico: Coorte retrospectivo. RESULTADOS: Dos 248 pacientes incluídos, 144 (58 por cento) apresentavam ronco primário e 104 (42 por cento) apresentavam SAOS. Os achados otorrinolaringológicos mais frequentes foram Hipertrofia adenoamigdaliana (n=152; 61,2 por cento), Hipertrofia de tonsila palatina (n=17; 6,8 por cento) Hipertrofia da tonsila faríngea (n=37; 14,9 por cento), Rinite Alérgica (n=155; 62,5 por cento) e Otite Secretora (36; 14,5 por cento). CONCLUSÕES: Ronco Primário e SAOS são frequentes em crianças respiradoras orais. A afecção otorrinolaringológica mais encontrada em crianças com SAOS é a hipertrofia adenoamigdaliana acompanhada ou não de rinite alérgica.

It is well known that mouth breathing is associated with adenotonsillar hypertrophy - which is the main cause of obstructive sleep apnea among children. Despite the importance of this matter, there are only a handful of studies showing the relationship between OSAS and mouth breathing. AIM: to determine the prevalence of obstructive sleep disorders in mouth breathing children and study its correlation with otorhinolaryngological findings. STUDY DESIGN: Retrospective cohort study. METHOD: Data analysis from 248 medical charts of mouth breathing children seen at the Pediatric Otolaryngologic Division of a large medical institution between the years of 2000 and 2006. All patients had nasofibroscopy and or Cavum radiographs and polysomnographic exams. According to the Apnea index, patients were classified as primary snorers (AI<1); and as OSAS (>1). RESULTS: From 248 patients included in the study, 144 (58 percent) were primary snorers and 104 (42 percent) had OSAS. The most prevalent otorhinolaryngological findings were adenotonsillar hypertrophy (n=152; 61.2 percent), tonsilar hypertrophy (n=17; 6.8 percent), adenoid hypertrophy (n=37; 14.9 percent), rhinitis (n=155; 62.5 percent) and secretory otitis (n=36; 14.5 percent). CONCLUSIONS: primary snoring and OSAS are frequent findings in mouth breathing children. The most frequent otorhinolaryngological disorder in children with OSAS is adenotonsillar hypertrophy with or without rhinitis.

Análisis epidemiológico de la patología otorrinolaringológica ambulatoria en el Hospital San Juan de Dios / Epidemiological analysis of otolaryngology outpatient pathology at San Juan de Dios's Hospital

Introducción: La patología otorrinolaringológica presenta una alta incidencia. Objetivo: Conocerla frecuencia de consultas permite crear programas de formación continua adecuados. Material y método: Estudio retrospectivo. Análisis de las hojas de atención de policlínico ambulatorio durante el año 2006 en el Hospital San Juan de Dios. Resultados: La patología más frecuente es la otológica, que corresponde a 50 por ciento de las consultas. Individualmente, la patología más común es la otitis media crónica, seguida de la patología adenoamigdalina y la rinitis. Conclusiones: Ha habido un desplazamiento de la patología infecciosa hacia la patología crónica inflamatoria.

Introduction: The otolaryngology pathology has a high incident. Aim: To know the outpatient pathology frequency that allows the creation of suitable permanent training programs. Methods: Retrospective study. Analysis of outpatient daily attention sheets during 2006 at San Juan de Dios's Hospital. Results: The most frequent pathology is the otologic, which represents 50 percent of the consultations. Individually, the most common pathology is chronic otitis media, followed tonsilar and adenoid pathology and rhinitis. Conclusions: There has been a displacement of the infectious pathology towards the chronic inflammatory pathology.

Prevalência dos principais sintomas ORL numa população geriátrica ambulatorial / The prevalence of the major ENT symptoms in an ambulatorial geriatric population

O aumento da expectativa de vida da população e o declínio das taxas de nascimento vêm acarretando mudanças na prática médica. O segmento de idosos da população é o que mais cresce e continuará assim por décadas...

The increase on life and reduction on birth rates have been causing changes in medical practices. The geriatric population has already become the fastest-growing segment of our society, and it will continue to be so for decades to come...

Otorrinolaringologia pediátrica no Sistema Público de Saúde de Belo Horizonte / Pediatric (Otolaryngology) at the Public Health System of a city in Southeastern Brazil

OBJETIVO: Analisar a adequação dos encaminhamentos da atenção primária para a secundária em otorrinolaringologia pediátrica. MÉTODOS: Estudo realizado em Belo Horizonte, estado de Minas Gerais, de março de 2004 a maio de 2005. Foram avaliadas 408 crianças pré-escolares encaminhadas da atenção primária para a secundária do setor de otorrinolaringologia com otite, faringoamigdalite, rinossinusite, rinite alérgica e hipertrofia de amígdala/adenóide. As variáveis analisadas foram: concordância dos diagnósticos na atenção primária e secundária, tempo de espera pela consulta, acompanhamento e especialista (médico de família ou pediatra) que examinou a criança na atenção primária. A concordância dos diagnósticos foi avaliada pela análise estatística de kappa. RESULTADOS: Os pacientes tinham em média cinco anos de idade, dos quais 214 (52,5 por cento) eram meninos, o tempo médio de espera pela consulta foi de 3,7 meses. Os diagnósticos na atenção primária e secundária foram, respectivamente: otite (44 por cento, 49 por cento), hipertrofia de amígdala/adenóide (22 por cento, 33 por cento), faringoamigdalite (18 por cento, 23 por cento), rinossunusite (13 por cento, 21 por cento), rinite alérgica (3 por cento, 33 por cento). Análise de concordância kappa foi 0,15 para otite com efusão, 0,35 para otite recorrente, 0,04 para hipertrofia de amígdala/adenóide, 0,43 para faringoamigdalite, 0,05 para rinite alérgica; 0,2 para rinossinusite. Os diagnósticos na atenção primária para encaminhamento à secundária, definidos pelo médico de família ou pelo pediatra que avaliou a criança foram concordantes. CONCLUSÕES: A inadequação dos encaminhamentos da atenção primária para a secundária em otorrinolaringologia foi expressa pelo longo tempo de espera pela consulta e pela baixa concordância de diagnósticos firmados entre os níveis de atenção para os mesmos pacientes avaliados. A atenção primária poderia se tornar mais eficiente se os profissionais fossem mais...

OBJECTIVE: To assess the suitability of referral from primary to secondary care in pediatric Otolaryngology. METHODS: The study was performed in the city of Belo Horizonte, in the state of Minas Gerais, from March 2004 to May 2005. A total of 408 pre-school children referred from primary care to secondary care in the department of Otolaryngology presenting with otitis, tonsillitis, sinusitis, allergic rhinitis, and tonsillar/adenoidal hypertrophy was assessed. The studied variables were: agreement between diagnoses in primary and secondary care; waiting time for doctor's appointment; follow-up, and professional (pediatrician or family physician) that examined children in primary care. Agreement of diagnoses was assessed using kappa statistics. RESULTS: Patients were five years old on average, 214 (52.5 percent) were boys, mean waiting time for appointment was 3.7 months. Diagnoses in primary and secondary care were respectively: otitis (44 percent, 49 percent), tonsillar/adenoidal hypertrophy (22 percent, 33 percent), tonsillitis (18 percent, 23 percent), sinusitis (13 percent, 21 percent), allergic rhinitis (3 percent, 33 percent). Agreement analysis of kappa was 0.15 for otitis with effusion, 0.35 for recurrent otitis, 0.04 for tonsillar/adenoidal hypertrophy, 0.43 for tonsillitis, 0.05 for allergic rhinitis, and 0.2 for sinusitis. Diagnoses in primary care referred to secondary care were in agreement when given either by pediatrician or family physician. CONCLUSIONS: Unsuitability of referrals from primary to secondary care in otolaryngology was expressed by the long time waiting for appointments and by the low agreement between diagnoses in different level of care for the same patients. Primary health care could be more efficient if professionals were better qualified in Otolaryngology.

[Epidemiologic profile and management pediatric medical emergencies consultants of Tunisian child's hospital]

Background: the pediatric medical emergencie's of Tunisian child's hospital service manages all children fifteen years old. It received 45 000 children in year in average

The aims: establish an epidemiologic profile of consultants and study the encountred morbidity

Methods: we made a transversal describing study of the pediatric emergencie's activity during three successive months in 2004 [February, March, April]. We described the characteristics of the population consulting this service, study the severity and immediate behaviours in emergencies

Results: The number of all consultants is 10560 children during these three months. 54.9% of cases are between one month old and two years old, 54.7% of them are boys

The recruitment mode is direct in 92.9% of cases. The maximum of consultants is in the week-ends with an average of 129 patients per day

In the other days of the week, the average number is 115 +/- 27 patients per day ant the extrems are 75 and 225 patients per day. In the morning, a third of the daily activity is made the morbidity is dominated by the pulmonary pathologies in 39.9% of cases, otorhinolarygologic affections in 31.8% of cases, gastroenterologic pathologies in 6.72% of cases and brain system's pathology in 3.43% of cases. The neonatal affection represents 2.74% of total consultants. At the end of the consultations, 38.7% of patients go back home with medical prescriptions. 45.6% of them receive nebulisations and 21.3% are hospitalized. The bulk is the first dysfunction of the emergencies service. The second dysfunction is the inappropriate use of this service which works like a first structure. Some affections such as febrile seizures, pyelonephritis are excessively hospitalized in 97.5% and 100% respectively

Conclusion: The dysfunction of pediatric medical emergencies's service can be improved by sanitary education of the parents about the role of emergencie's service and the formation of the doctors in the management of patients suffering from usual emergencies

Jubilación por enfermedad ORL de acuerdo al DL 3500 / Retirement caused by ORL disease according to the decree-law 3500

El DL 3500 establece que tendrán derecho a pensión de invalidez los afiliados a una AFP que sin tener los requisitos para obtener pensión de vejez, y a consecuencia de enfermedad o debilitamiento de sus fuerzas físicas o intelectuales, pierdan a lo menos dos tercios de su capacidad de trabajo. El mismo texto indica que la invalidez debe ser calificada por una Comisión Médica designada por la Superintendencia de Administradoras de Fondos de Pensiones. A su vez, estas comisiones para mejor resolver se hacen asesorar por médicos especialistas quienes son los que realizan el peritaje correspondiente. Los autores de este trabajo realizan la labor de peritos asesores de las Comisiones Médicas Metropolitana y Central. Se realiza análisis estadístico retrospectivo de los pacientes de la Especialidad vistos por los autores desde 1990 hasta mayo de 2000. Dichos pacientes invocaron como causal primaria o accesoria, para acceder a jubilación, una patología ORL. Como criterio de exclusión se utiliza las reevaluaciones a que obliga la ley. Se analiza los diagnósticos más frecuentes involucrados como causa de jubilación, los problemas más difíciles de evaluar y los resultados que dichos peritajes arrojaron. Todo lo anterior enmarcado en las normas legales que reglamentan este decreto. Allí se establece los grados de impedimento médico en porcentajes de pérdida del órgano afectado y del impedimento global que aquel provoca sobre el individuo, o ambos, dependiendo de las tablas a que se haga referencia. Se discute, finalmente, los problemas prácticos a los que se ven enfrentados los autores lo que es extrapolable a los especialistas ORL que realizan idéntica labor en el resto del país