Evaluación pretrasplante en otorrinolaringología / Pretransplant evaluation in otolaryngology

Resumen Los pacientes trasplantados presentan mayor vulnerabilidad a complicaciones infecciosas, no solo debido al uso de drogas inmunosupresoras, sino que también, a las enfermedades subyacentes que presentan y a la falla de órganos primarios. A pesar de que las infecciones otorrinolaringológicas no son frecuentes en estos pacientes, es importante establecer un adecuado estudio y tratamiento de ellas. A través del siguiente artículo se aportan directrices en el estudio pretrasplante desde un enfoque otorrinolaringológico, generando recomendaciones de acuerdo a la patología del paciente y el órgano a trasplantar. Si bien, las recomendaciones se realizan según evaluación rinosinusal, otológica y faringoamigdalina, una adecuada anamnesis y examen físico son los pilares de la evaluación pretrasplante en otorrinolaringología, reservándose el estudio con imágenes para aquellos pacientes con alteraciones sospechosas.

Abstract Transplanted patients have higher frequency of infectious complications, not only due to the use of immunosuppressive drugs, but also the underlying diseases that present and the failure of primary organs. Although ear, nose and throat (ENT) infections are not frequent in these patients, it is important to establish an adequate study and treatment of them. Through the following article, guidelines are provided in the pretransplant study from an ENT approach, generating recommendations according to the pathology of the patient and the organ to be transplanted. Although, the recommendations are made according to rhinosinusal, otological and pharyngotonsiline evaluation, adequate anamnesis and physical examination are the pillars of the pretransplant evaluation in otolaryngology, reserving the study with images for patients with suspicious alterations.

Head and neck manifestations of granulomatosis with polyangiitis: a retrospective analysis of 19 patients and review of the literature

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

Do Otolaryngology Patients Show Gender Preference When Choosing a Surgeon? — A Quantitative and Qualitative Analysis

Abstract Introduction Otorhinolaryngology has always been considered a gender-neutral specialty, whereas in several other specialties, such as obstetrics, gynecology and urology, gender preference has been consistently shown by patients when choosing their treating surgeon. To date, no study has been performed to analyze whether this practice of gender preference is prevalent in otorhinolaryngology patients too. Objectives To identify if gender preference exists in the field of otorhinolaryngology, specifically in its four subspecialties, namely otology, pediatric otolaryngology, laryngology and head and neck surgery. Methods Patients attending our outpatient department were asked to complete a preformed proforma. The pro forma consisted of two parts, demographic details of the subjects and gender preference in the following subspecialties: otology, pediatric otolaryngology, laryngology and head and neck oncosurgery. Results A total of 1,112 subjects took part in the study, out of which 1,089 subjects were included in the final analysis. Female gender preference was highest in the field of pediatric otolaryngology, while male preference was highest for head and neck oncosurgery. Conclusion Though otorhinolaryngology and head and neck surgery has been considered a gender-neutral field, subspecialties of this field show considerable gender preference.

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.

Predictive value of preoperative tests in estimating difficult intubation in patients who underwent direct laryngoscopy in ear, nose, and throat surgery / Valor preditivo dos testes pré-operatórios para estimar a intubação difícil em pacientes submetidos à laringoscopia direta para cirurgia de ouvido, nariz e garganta / Valor predictivo de los test preoperatorios para estimar la intubación difícil en pacientes sometidos a la laringoscopia directa para la cirugía de oído, nariz y garganta

BACKGROUND AND OBJECTIVES: Predictive value of preoperative tests in estimating difficult intubation may differ in the laryngeal pathologies. Patients who had undergone direct laryngoscopy (DL) were reviewed, and predictive value of preoperative tests in estimating difficult intubation was investigated. METHODS: Preoperative, and intraoperative anesthesia record forms, and computerized system of the hospital were screened. RESULTS: A total of 2611 patients were assessed. In 7.4% of the patients, difficult intubations were detected. Difficult intubations were encountered in some of the patients with Mallampati scoring (MS) system Class 4 (50%), Cormack-Lehane classification (CLS) Grade 4 (95.7%), previous knowledge of difficult airway (86.2%), restricted neck movements (cervical ROM) (75.8%), short thyromental distance (TMD) (81.6%), vocal cord mass (49.5%) as indicated in parentheses (p < 0.0001). MS had a low sensitivity, while restricted cervical ROM, presence of a vocal cord mass, short thyromental distance, and MS each had a relatively higher positive predictive value. Incidence of difficult intubations increased 6.159 and 1.736-fold with each level of increase in CLS grade and MS class, respectively. When all tests were considered in combination difficult intubation could be classified accurately in 96.3% of the cases. CONCLUSION: Test results predicting difficult intubations in cases with DL had observedly overlapped with the results provided in the literature for the patient populations in general. Differences in some test results when compared with those of the general population might stem from the concomitant underlying laryngeal pathological conditions in patient populations with difficult intubation. .

JUSTIFICATIVA E OBJETIVOS: O valor preditivo dos testes pré-operatórios para estimar a intubação difícil pode diferir em patologias laríngeas. Foram feitas uma revisão dos prontuários de pacientes submetidos à laringoscopia direta (LD) e uma investigação do valor preditivo de exames pré-operatórios para estimar a intubação difícil. MÉTODOS: Triagem de prontuários dos períodos pré-operatório e intraoperatório e do sistema informatizado do hospital. RESULTADOS: Foram avaliados 2.611 pacientes. Em 7,4%, intubações difíceis foram detectadas. Intubações difíceis foram constatadas em pacientes com escore de Mallampati (EM), classe 4 (50%); classificação de Cormack-Lehane (CCL), grau 4 (95,7%); conhecimento prévio de via aérea difícil (86,2%); restrição da amplitude de movimentos (ADM) do pescoço (ADM cervical) (75,8%); distância tireomentoniana (DTM) curta (81,6%); e massa nas pregas vocais (849,5%) (p < 0,0001). O EM apresentou uma sensibilidade baixa, enquanto ADM cervical, presença de massa nas pregas vocais, DTM curta e EM apresentaram um valor preditivo positivo relativamente maior. A incidência de intubações difíceis aumentou 6.159 e 1.736 vezes com cada nível de aumento dos graus da CCL e da classe do EM, respectivamente. Quando todos os testes foram considerados em conjunto, a intubação difícil pôde ser classificada com precisão em 96,3% dos casos. CONCLUSÃO: Os resultados dos testes que preveem intubações difíceis em casos com LD coincidiram claramente com os resultados previstos na literatura para as populações de pacientes em geral. As diferenças em alguns resultados dos testes, quando comparados com os da população em geral, podem ser por causa das condições patológicas subjacentes da laringe em populações de pacientes com intubação difícil. .

JUSTIFICACIÓN Y OBJETIVOS: El valor predictivo de los test preoperatorios para estimar la intubación difícil puede ser diferente en afecciones laríngeas. Se hizo una revisión de las historias clínicas de los pacientes sometidos a laringoscopia directa y una investigación del valor predictivo de los exámenes preoperatorios para estimar la intubación difícil. MÉTODOS: Selección de historias clínicas de los períodos preoperatorio e intraoperatorio y del sistema informatizado del hospital. RESULTADOS: Se evaluaron 2.611 pacientes. En un 7,4% se detectaron intubaciones difíciles. Las intubaciones difíciles fueron constatadas en pacientes con una puntuación de Mallampati (escala de Mallampati [EM]) clase 4 (50%); clasificación de Cormack-Lehane grado 4 (95,7%); conocimiento previo de la vía aérea difícil (86,2%); restricción de la amplitud de movimientos del cuello (amplitud de movimientos cervical) (75,8%); distancia tiromentoniana corta (81,6%); y masa en las cuerdas vocales (849,5%) (p < 0,0001). La EM tuvo una sensibilidad baja, mientras que la amplitud de movimientos cervical, tuvo la presencia de masa en las cuerdas vocales, distancia tiromentoniana corta y EM con un valor predictivo positivo relativamente mayor. La incidencia de intubaciones difíciles se incrementó 6.159 y 1.736 veces en cada nivel de aumento de los grados de la clasificación de Cormack-Lehane y de la clase de la EM, respectivamente. Cuando todos los test fueron considerados en su conjunto, la intubación difícil pudo ser clasificada con exactitud en un 96,3% de los casos. CONCLUSIÓN: Los resultados de los test que prevén intubaciones difíciles en casos con laringoscopia directa coincidieron claramente con los resultados previstos en la literatura para las poblaciones de pacientes en general. Las diferencias en algunos resultados de los test, cuando se les comparó con los de la población en general, pueden ser debidas a las condiciones patológicas subyacentes de la ...

Quality of life assessment using the World Health Organization quality questionnaire pre- and post-otolaryngological surgery among patients in western Saudi Arabia

To evaluate the health-related quality of life [HRQoL] of patients' pre- and post-otolaryngological surgery. We conducted a cross-sectional study of patients who underwent otolaryngological surgery in the western region of Saudi Arabia between March and October 2013. We administered the Arabic version of the World Health Organization Quality of Life assessment instrument to all patients before surgery and 2-4 weeks after surgery. The demographic details such as age, gender, level of education, marital status, patients' incomes, otolaryngology diagnosis, and type of otolaryngology surgery were analyzed. A total of 99 patients [43 males and 52 females], ranging from 1-75 years of age [mean: 21.6 years], were included in this study. The most frequently diagnosed conditions were chronic tonsillitis and obstructive sleep apnea due to adenoid enlargement. Adenotonsillectomy was the most frequently performed surgery, followed by septoplasty and myringotomy with grommet tube insertion. For all domains, patients had significantly higher scores post-surgery. The highest score was obtained for the social relationship domain and the lowest for the physical health domain. However, the highest differences between the pre- and post-surgery scores were for physical health [7.9], psychological [5.1], environmental [2.5], and social health [2.3] domains. The HRQoL of patients improved significantly after otolaryngology surgery

Infecciones por Streptococcus anginosusen otorrinolaringología: revisión de 9 casos clínicos / Infections caused by Streptococcus anginosusin otolaryngology: review of 9 clinical cases

Introducción: El Streptococcus anginosus (SA) es un habitante común de la cavidad oral y tracto gastrointestinal, y puede ser un patógeno agresivo causante de abscesos en varios sitios del cuerpo. Aparentemente, su rol en infecciones de cabeza y cuello está adquiriendo cierta notoriedad y no está claramente reportado en la literatura. Objetivo: El objetivo del presente estudio fue evaluar las implicancias clínicas de estas infecciones en otorrinolaringología. Material y método: Estudio retrospectivo de todos los pacientes diagnosticados microbiológicamente con infecciones causadas por Streptococcus anginosus, tratados en el Servicio de Otorrinolaringología del Hospital Barros Luco-Trudeau entre los años 2007 a 2012. Se describen las características clínicas, microbiológicas y el manejo de los pacientes. Resultados: La muestra estuvo constituida por 9 casos, 3 hombres y 6 mujeres, con una mediana de edad de 52 años (rango 6-70). Los sitios de infección fueron: absceso periamigdalino (2 casos), un absceso peritraqueostoma, un absceso submandibular, un absceso submentoniano, un absceso parafaríngeo con extensión retrofaríngea y mediastino, un caso de absceso cerebral frontal secundario a sinusitis frontal complicada, un caso de otitis media crónica activa, y un caso de sinusitis maxilar crónica. Discusión: El SA ha sido reportado como un agente causal de infecciones potencialmente graves en cabeza y cuello. Su identificación requiere de consideraciones especiales para el cultivo, y al ser un microorganismo común puede ser confundido e informado como S viridans o Streptococcus anaeróbico. Es importante reconocer al SA como un patógeno a considerar en infecciones de cabeza y cuello.

Introduction: Streptococcus anginosus (SA) is a common inhabitant of the oral cavity and gastrointestinal tract, and can be an aggressive pathogen causing abscesses in various body sites. Apparently, its role in head and neck infections is gaining some notoriety that it is not clearly reported in the literature. Aim: The aim of this study was to evaluate the clinical implications of this infections in otolaryngology. Material and method: A retrospective case series study of all patients diagnosed microbiologically with Streptococcus anginosus infections treated at the Department of Otolaryngology, HospitalBarros Luco-Trudeau from 2007 to 2012. We describe the clinical and microbiological features, and treatment of each patient. Results: The sample consisted of 9 patients, 3 men and 6 women, with a median age of 52 years (range 6-70). The sites of infection were: peritonsillar abscess (2 cases), peritracheostomy abscess, submandibular abscess, submental abscess, parapharyngeal abscess with retropharyngeal and mediastinal extension, a case of frontal brain abscess secondary to frontal sinusitis, a case of otitis chronic active half, and one case of chronic maxillary sinusitis. Discussion: SA has been reported as a causative agent ofpotentially serious infections in the head and neck region. Their identification requires special considerations for growing, and because of being a common microorganism may be confused and informed as Streptococcus viridans or anaerobic streptococcus. It is important to recognize SA as a relevant pathogen in head and neck infections.

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.

Cirugía mayor ambulatoria en otorrinolaringología: experiencia de 6 años / Major ambulatory surgery in otorhinolaryngology: a six-year experience

Las evidencias indican que la cirugía mayor ambulatoria es muy segura y, por sus bondades, es aceptada y solicitada por la población. El objetivo del presente trabajo fue conocer el comportamiento de los resultados obtenidos con la aplicación de esta cirugía. Se realizó un estudio descriptivo-prospectivo, cuya muestra estuvo integrada por 482 casos de cirugía mayor ambulatoria programada, operados entre enero del 2001 y diciembre del 2006 en el Servicio de Otorrinolaringología del Hospital Universitario Manuel Fajardo. La selección de los pacientes se realizó tras la valoración de: asimilación del procedimiento, edad, factores socioeconómicos, medios propios de transportación, cercanía del domicilio al hospital. La cirugía mayor ambulatoria programada representó el 72,9 por ciento. Predominó el sexo masculino (54,9 por ciento) y la mayor incidencia se registró en el grupo etario entre 15 y 46 años. La técnica anestésica más empleada fue la local, tópica e infiltrativa, con sedación (81,7 por ciento). Las técnicas quirúrgicas utilizadas, en orden decreciente, fueron: laringoscopia directa (26,9 por ciento); amigdalectomía (19,7 por ciento) y septoplastia (17,8 por ciento). Sólo se presentaron 2,07 por ciento de complicaciones (1,65 por ciento durante el acto quirúrgico). No ocurrieron infecciones nosocomiales. La cirugía mayor ambulatoria programada en otorrinolaringología resultó segura y eficaz, y posibilitó al familiar y al paciente la incorporación a la comodidad del hogar, exento de infecciones. Además de reportar ventajas económicas, hace posible el trabajo quirúrgico a pesar de que existan dificultades derivadas de remodelaciones o reconstrucciones de los hospitales(AU)

Evidences show that major ambulatory surgery is very safe and that due to its benefits, it is accepted and requested by the population. The objective of this paper is to know the behavior of the results obtained on applying this surgery. A descriptive and prospective study was conducted. The sample was composed of 482 cases of major ambulatory scheduled surgery that were operated on between January 2001 and December 2006 at the Otorhinolaryngology Service of Manuel Fajardo University Hospital. Patients were selected after assessing the assimilation of the procedure, age, socioeconomic factors, own means of transportation, and distance from home to hospital. Major ambulatory elective surgery accounted for 72,9 percent. Males prevailed (54,9 percent) and the highest incidence was registered in the age group 15-46. The most used anesthetic technique was the local, topical and infiltrative, with sedation (81,7 percent). The surgical procedures used in a decreasing order were: direct laryngoscopy (26,9 percnet), tonsillectomy (19,7 percent) and septoplasty (17,8 percent). There were only 2,07 percent of complications (1,65 percent during surgery). No nosocomial infections were reported. Major ambulatory elective surgery in otorhinolaryngology proved to be safe and efficient and allowed the relative and the patient to enjoy home comfort, without infections. In addition to its economic advantages, it makes surgery possible, in spite of the dificulties existing in the hospitals as a result of the reconstruction work(AU)

Láser en otorrinolaringología: [revisión] / Laser in otorhinolaryngology: [review]

Esta revisión bibliográfica analiza los diferentes tipos de láser usados en otorrinolaringología, destacando las propiedades de cada uno. Posteriormente describe las características de una sesión con anestesia y uso de láser y las patologías con indicaciones de cirugía láser. Estas se clasifican en cinco rubros. Patología laringotraqueal, patología faringobucal, patología sinusal, otología y dermatología cérvico facial. En la primera se analizan: lesiones fonoquirúrgico, papilomatosis laríngea, parálisis laríngeas, laringomalacia, angioma subglótico, estenosis y displasia laríngea, cáncer laríngeo. En patología faríngea y bucal se analiza su uso en atresia coanal, amígdalas palatinas linguales, roncopatías, divertículo de Zenker. En fosas nasales se describen los usos en cirugía endoscópica (FEELS). En patología otológica se analiza su uso en CAE y oído medio, para concluir con las lesiones cervicofaciales.

Perfil de internamento por morbidade otorrinolaringológica com tratamento cirúrgico. Brasil, 2003 / Profile of hospitalizations due to otorhinolaryngologic morbidity requiring surgical treatment. Brazil, 2003

Objetivo: Analisar o perfil dos procedimentos cirúrgicos relacionados à otorrinolaringologia no Brasil no ano de 2003. Forma de Estudo: Trata-se de um estudo observacional, descritivo, transversal do tipo seccional. Métodos: Analisamos 80.030 procedimentos cirúrgicos nos 27 estados do Brasil no período compreendido entre janeiro e dezembro de 2003. Os dados foram obtidos do Sistema de Informação Hospitalar do Ministério da Saúde. O fator de inclusão se deu pela variável procedimento cirúrgico em otorrinolaringologia. Todos os arquivos foram processados pelo software TABWIN. Resultados: No ano 2003, no Brasil, foram realizados 80.030 procedimentos cirúrgicos relacionados à ORL. A Região Sudeste é a região com maior número de procedimentos (53,08%), seguida pela Região Sul e Nordeste com 19,6% e 15,6% respectivamente. Quanto ao grupo de procedimento as cirurgias da faringe representam 45% dos procedimentos em ORL. Os procedimentos de alta complexidade foram realizados em maior número no grupo de cirurgia de ouvido. Quanto à distribuição segundo tipo de prestador, observamos que existe uma maior concentração dos procedimentos cirúrgicos realizados nos hospitais filantrópicos, seguido dos públicos estaduais e universitários. A Tabela adotada pelo SUS para pagamento de procedimentos cirúrgicos em ORL não se encontra atualizada para os procedimentos hoje realizados, repercutindo na notificação inapropriada de alguns tipos de cirurgias. Conclusão: Com o conhecimento do perfil dos internamentos cirúrgicos em ORL no Brasil, podem ser identificadas particularidades na distribuição quanto às diferentes regiões que podem auxiliar gestores de saúde à tomada de decisões no sentido de garantir os princípios preconizados pelo SUS no acesso aos serviços de saúde.

Aim: To analyze the profile of the surgical procedures related to otorhinolaryngology in Brazil in the year 2003. Study Design: This was an observational, descriptive, cross-sectional study. Methods: We analyzed 80,030 surgical procedures performed in 27 Brazilian States during the period from January to December 2003. The data were obtained from the Hospital Information System of the Ministry of Health. The inclusion factor was a surgical procedure in otorhinolaryngology (ORL). All files were processed with the TABWIN software. Results: In 2003, 80,030 ORL-related surgical procedures were performed in Brazil. The Southeast region had the largest number of procedures (53.08%), followed by the South and Northeast regions (19.6% and 15.6%, respectively). Regarding the group of procedures, surgeries of the pharynx represented 45% of ORL procedures. Procedures of high complexity were more numerous in the ear surgery group. Regarding the distribution of the type of attending institution, the highest concentration of surgical procedures occurred in philanthropic hospitals, followed by state and university public hospitals. The table adopted by SUS for payment of ORL surgical procedures has not been updated for the procedures currently performed, with the consequent inappropriate notification of some types of surgery. Conclusion: Knowledge about the profile of surgical hospitalizations related to ORL permits the identification of the peculiarities of the different regions that can help health-managing authorities to make decisions in order to guarantee the principles recommended by SUS regarding access to health services.

Maniobras de EPLEY en el tratamiento de vertigo postural paroxístico benigno Hospital Escuela Antonio Lenin Fonseca octubre 2003- enero 2004 / Maneuvers of EPLEY in the treatment of vertigo postural paroxístico benign Hospital School Antonio Lenin Fonseca October 2003 - January 2004

Se realizó un estudio de una cohorte, en el Hospital Escuela Antonio Lenin Fonseca, en pacientes con diagnóstico de Vértigo Postural Paroxístico Benigno, en el período comprendido entre Octubre 2003 y Enero 2004.El universo lo constituyeron todos los pacientes que asistieron a la consulta de Otorrinolaringología con sintomatología de Vértigo Postural Paroxístico Benigno en el período mencionado. El tamaño de la muestra se obtuvo mediante muestreo Probabilístico por conveniencia correspondiendo a 18 pacientes que cumplieron con criterios de inclusión.Se planteo como objetivo general conocer la Experiencia obtenida por el Servicio de Otorrinolaringología con el uso de las Maniobras de Epley en el tratamiento del Vértigo Postural Paroxístico Benigno, considerándose necesario valorar edad y sexo, antecedentes personales patológicos relacionados con este tipo de vértigo, signos y síntomas presentes previos a la maniobra de Epley, canal semicircular afectado y respuesta clínica a la terapéutica con dichas maniobras, para ello se utilizó una ficho de recolección de datos elaborada a partir del marco teórico. El Vértigo Postural Paroxístico Benigno, predominó en el sexo femenino correspondiendo 61.1 porciento de casos, siendo más frecuente en el grupo de 41- 60 años, en el cual e1 33.33 porciento fueron pacientes femeninas y 27.78 porcientomasculinos. En el 88.9 porciento de pacientes no se identificó ningún antecedente personal patológico que pudiera estar relacionado con vértigo. El canal semicircular posterior derecho fue el más afectado en 55.56 porciento de casos y al izquierdo 33.33 porciento. La mayoría de pacientes presentó como síntomas la sensación de movimiento rotatorio y lateropulsión siempre más asociado a la afectación del canal semicircular posterior; representado por 88.2 porciento y 88.9 porciento respectivamente

Abordagem transmastóidea de fístulas liquóricas em tegmem timpânico / Transmastoid approach for the tegmen tympani cerebrospinal fluid leaks

AS fístulas liquóricas otológicas podem resultar de causas adquiridas ou congênitas e freqüentemente necessitam de abordagem cirúrgica.

CO2 laser surgery in otorhinolaryngology-site and complications: a 10-year experience at Ramathibodi Hospital.

OBJECTIVE: To present data on ten years' experience in CO2 laser surgery and associated complications among otorhinolayngologic patients. MATERIAL AND METHOD: The study involved examining records of otorhinolaryngologic patients who underwent CO2 laser operations during a 10-year period (July 1, 1986-June 30, 1996). The sample consisted of 733 patients: 370 male and 363 female patients. CO2 laser surgery in otorhinolaryngology was first used in Ramathibodi Hospital on July 10, 1986. RESULTS: These patients were aged 2 months to 93 years with the mean age of 24.3 years (median = 16 years). Among 1,725 operations, 1,570 operations (91%) were performed under general anesthesia and 155 operations (9%) were performed under local anesthesia. In our series, the most frequent sites for laser surgery were as follows: larynx (77.22%), oral cavity and oropharynx (12.64%), skin (5.04%) and nose and paranasal sinuses (3.31%). Intraoperative complications occurred in 18 out of 1,725 (intra-operative complication rate of 1%). Laser-related complications were found in 13 out of 1,725 operations (0.75%) and non laser-related complications were found in 5 out of 1,725 operations (0.25%). There was no mortality. CONCLUSION: CO2 laser is a useful modality of treatment in otorhinolaryngologic surgery especially in the larynx. Our experience demonstrates the relative low incidence of complications (1%) and no mortality in otorhinolaryngology head and neck surgery.

Cuidados perioperatórios dos pacientes com anemia falciforme em cirurgias otorrinolaringológicas / Perioperative Management of Sickle Cell Patients in Otolaryngologic Surgery

O objetivo deste trabalho foi o de padronizar um protocolo perioperatório para o manejo de pacientes homozigotos para anemia falciforme em cirurgias otorrinolaringológicas. Material e método: Foi realizado um regime de transfusões pré-operatórias para se obter níveis de hemoglobina S menor do que 15% e de hemoglobina total maior do que 10 mg/dL. As cirurgias foram realizadas sob anestesia geral e hiperhidratação. A temperatura corporal e a saturação de oxigênio foram monitoradas, com precaução com relação à hipóxia, acidose e hipotermia. A técnica cirúrgica de tonsilectomia foi modificada, com total fechamento da loja amigdaliana. Conclusão: Usando este guia em cinco pacientes otorrinolaringológicos não foram observadas complicações na instituição.

The purpose of this study was to standardize a medical and surgical perioperative protocol to management of homozygous sickle cell disease in otolaryngologic surgery. Material and Method: The judicious use of peroperative transfusion regimens to have S haemoglobin level fewer than 15% and a haemoglobin level greater than 10 mg/dL. The surgical procedures were under general anesthesia and hyperhydartation. The body temperature and oxygen saturation were monitorized, with avoidance of hypoxia, acidoses and cold. The operative technique for tonsillectomy was modified, and a total close of the tonsil's place was performed. Conclusion: Using this guidelines in five otolaryngologic cases, no complications was observed at the institution.

Análisis de la atención intrahospitalaria del servicio de otorrinolaringología del Hospital Guillermo Grant Benavente de Concepción 1993-1997 / Analysis of intrahospitalary care at the otolaryngology departament of Guillermo Grant Benavente hospital, Concepción 1993-1997

Presentamos una análisis estadístico de los egresos e intervenciones quirúrgicas realizadas en el servicio de otorrinolaringología del Hospital Guillermo Grant Benavente de Concepción en el período 1993-1997. Se estudia un total de 8.275 egresos y 9.607 cirugías y/o procedimientos, analizando las características de los pacientes, patologías e intervenciones más frecuentes