Relationship between short lingual frenulum and malocclusion. A multicentre study

Objective: Ankyloglossia is characterized by an abnormally short lingual frenulum, which impairs tongue movement. Ankyloglossia has been related to craniofacial growth disturbances and dental malocclusion. But even though there is a clear biological plausibility for this hypothesis, available evidence is scarce. Methods: A case–control design was followed. Patients between 4 and 14 years old were routinely screened for short lingual frenulum and recruited from the pediatric Otolaryngology consultation of 3 Spanish tertiary referral hospitals. Lingual frenulum was assessed with the Marchesan system. A cohort of cases with short lingual frenulum and a cohort of healthy controls matched for sex and age were included. Both cases and controls had pictures of occlusion. Occlusion was evaluated by an expert in orthodontics, blinded for the frenulum assessment. Results: A total of 100 participants were included, 70 males and 30 females. The proportion of malocclusion in the short lingual frenulum group was 48%, while it was 24% in the normal frenulum group. The odds ratio of malocclusion for the short lingual frenulum patients was 2.92 (CI 95% 1.15–7.56). The difference was statistically significant (p=.012). This difference was significant for patients with class III occlusion (p=.029). There was no difference for patients with class II (p=.317). Conclusions: This work supports the hypothesis that relates class III malocclusion with a short lingual frenulum.(AU)

Objetivo: La anquiloglosia se caracteriza por un frenillo lingual anormalmente corto que dificulta la movilidad de la lengua. La anquiloglosia ha sido relacionada con alteraciones del desarrollo facial y maloclusión dentaria. Sin embargo, a pesar de una clara plausibilidad biológica para esta hipótesis, la evidencia disponible es escasa. Métodos: Siguiendo un diseño de casos y controles se incluyeron pacientes entre 4-14 años atendidos en las consultas de otorrinolaringología pediátrica de 3 hospitales de tercer nivel en España. El frenillo lingual se evaluó mediante el sistema de Marchesan. Se incluyó una cohorte de casos con frenillo lingual corto, y una cohorte de controles sanos apareados por sexo y edad. A todos los participantes se les tomó fotografía dentaria en oclusión. La oclusión se evaluó mediante un odontólogo experto en ortodoncia, ciego a la evaluación del frenillo lingual. Resultados: Se incluyeron un total de 100 participantes, 70 hombres y 30 mujeres. La proporción de maloclusión en la cohorte con frenillo lingual corto fue del 48% y del 24% en la cohorte de controles. La odds ratio de maloclusión fue 2,92 (IC 95%: 1,15-7,56). La diferencia entre grupos fue estadísticamente significativa (p=0,012). Por subgrupos, la diferencia fue estadísticamente significativa para los pacientes con maloclusión clase iii (p=0,029), pero no para aquellos con maloclusión clase ii (p=0,317). Conclusiones: Este trabajo apoya la hipótesis que relaciona la maloclusión de clase iii con el frenillo lingual corto.(AU)

The Listening Network and Cochlear Implant Benefits in Hearing-Impaired Adults.

Older adults with mild or no hearing loss make more errors and expend more effort listening to speech. Cochlear implants (CI) restore hearing to deaf patients but with limited fidelity. We hypothesized that patient-reported hearing and health-related quality of life in CI patients may similarly vary according to age. Speech Spatial Qualities (SSQ) of hearing scale and Health Utilities Index Mark III (HUI) questionnaires were administered to 543 unilaterally implanted adults across Europe, South Africa, and South America. Data were acquired before surgery and at 1, 2, and 3 years post-surgery. Data were analyzed using linear mixed models with visit, age group (18-34, 35-44, 45-54, 55-64, and 65+), and side of implant as main factors and adjusted for other covariates. Tinnitus and dizziness prevalence did not vary with age, but older groups had more preoperative hearing. Preoperatively and postoperatively, SSQ scores were significantly higher (Δ0.75-0.82) for those aged <45 compared with those 55+. However, gains in SSQ scores were equivalent across age groups, although postoperative SSQ scores were higher in right-ear implanted subjects. All age groups benefited equally in terms of HUI gain (0.18), with no decrease in scores with age. Overall, younger adults appeared to cope better with a degraded hearing before and after CI, leading to better subjective hearing performance.

Análisis de la marcha y el equilibrio mediante el uso de sensores inerciales: estudio prospectivo, longitudinal, no aleatorio / Gait and balance analysis through the use of inertial sensors. Prospective, longitudinal, non-randomized study

Antecedentes: la población mundial envejece de manera acelerada. Una tercera parte de los mayores de 65 años se cae por lo menos una vez al año, y esta prevalencia se incrementan a la mitad cuando se superan los 69 años. Objetivo: establecer la sensibilidad del uso de sensores inerciales para determinar la marcha y las rotaciones del tronco en un grupo de individuos sanos. Materiales: utilizamos tres sensores inerciales de nueve ejes, junto a un mismo número de microcontroladores, los cuales enviaron la información vía bluetooth al ordenador, el procesamiento de los datos fue realizado mediante un programa de análisis desarrollado en MATLAB. Para analizar la sensibilidad de los sensores utilizamos el protocolo de Akram et al.,5 modificado, el cual consta de cinco actividades. Resultados: en nuestro estudio participaron seis voluntarios, con una media de edad de 29 años, con un rango de edad de 25 a 33 años. Los sensores fueron capaces de detectar múltiples variables, entre ellas la elevación máxima y mínima de las piernas, número de pasos, el grado de inclinación del tronco, giro, velocidad y cadencia. Conclusión: los resultados hasta ahora obtenidos son prometedores y consideramos que el uso de múltiples sensores inerciales para valorar la marcha y el equilibrio podrían resultar en una nueva herramienta para el diagnóstico y seguimiento de personas con trastorno de la marcha y equilibrio

Introduction: The world population is aging rapidly. A third of those over 65 years of age falls at least once a year, and this prevalence increases by half when they exceed 69 years. Objective: To determine the sensitivity of the use of inertial sensors to determine the gait and rotations of the trunk in a group of healthy individuals. Materials: We use 3 inertial sensors of 9-axis together with the same number of microcontrollers, that sent the information via bluetooth to the computer, the data processing was carried out through an analysis program developed in MATLAB. To analyze the sensitivity of the sensors we use the protocol of Akram et al,5 modified, which consists of 5 activities. Results: In our study 6 volunteers participated, with an average age of 29 years, with an age range 25 to 33 years. The sensors were able to detect multiple variables, including the maximum and minimum elevation of the legs, number of steps, the degree of inclination of the trunk, rotation, speed and cadence. Conclusion: The results obtained are promising and we believe that the use of multiple inertial sensors to assess gait and balance could result in a new tool for the diagnosis and monitoring of people with gait and balance disorder.

Carcinoma sarcomatoide de laringe. ¿Un reto histológico? / Sarcomatoid carcinoma of larynx. A histological challenge?

Introducción. El carcinoma sarcomatoide puede aparecer en cualquier parte del cuerpo, siendo las glándulas salivales mayores su principal localización en cabeza y cuello, pero en la laringe representa aproximadamente un 1%. Cuenta con componentes epiteliales y mesenquimales, lo que ha llevado a plantear múltiples teorías acerca de su origen. Por esto su diagnóstico anatomopatológico puede ser un reto. Caso clínico. Presentamos un caso clínico de un varón de 76años fumador que consulta por disfonía. Se observa una lesión en cuerdas vocales sin adenopatías ni metástasis. Se le realiza microcirugía laríngea con escisión completa de la lesión, y el diagnóstico anatomopatológico es de carcinosarcoma, mostrando positividad intensa y difusa para vimentina y focal para AE1-AE3, CK5 y p63. El paciente recibe tratamiento complementario con radioterapia. Discusión. El carcinoma sarcomatoide tiende a manifestarse con síntomas obstructivos como la disfonía. Su pronóstico depende del estadio y de si hay o no metástasis. Suelen ser positivos los marcadores epiteliales citoqueratina (AE1-AE3), antígenos de membrana epitelial (EMA), Ki 67 y marcadores mesenquimales como vimentina, desmina y S-100. En cuanto al tratamiento, se recomienda de entrada una biopsia por escisión seguida o no de radioterapia complementaria, aunque la radioterapia sola también ha tenido éxito (T2-T1). En estadios T3-T4 pueden ser tratados con resección local, laringectomía parcial, total con o sin vaciamiento, seguida de radioquimioterapia concomitante (AU)

Introduction. Sarcomatoid carcinoma can occur in any part of the body; in the head and neck it occurs most frequently in the major salivary glands, with only about 1% of cases found in the larynx. As it has both epithelial and mesenchymal components, there are many theories concerning its origin and it can prove a diagnostic challenge. Case report. A 76 year old male smoker presented with dysphonia. Vocal cord injury was found on examination but no lymphadenopathy or metastases were present. Laryngeal microsurgery was performed with complete excision of the lesion. Histopathology showed it to be a carcinosarcoma which showed intense and diffuse positivity for vimentin and focal positivity for AE1-AE3, CK5 and p63. The patient underwent radiotherapy as complementary treatment. Discussion. Sarcomatoid carcinoma usually presents with obstructive symptoms such as dysphonia. Prognosis depends on the stage and the presence or not of metastases. Both epithelial markers EMA, cytokeratin (AE1-AE3), epithelial membrane antigen, Ki 67 and mesenchymal markers such as vimentin, desmin, S-100 may be positive in these tumours. Recommended treatment for T2-T1 stages is an excisional biopsy which can be followed by adjuvant radiotherapy; radiotherapy alone has also been successful. T3-T4 stages can be treated with local excision, partial laryngectomy or total laryngectomy with subsequent ganglion emptying and concomitant radio and chemotherapy (AU)

[Sarcomatoid carcinoma of larynx. A histological challenge?] / Carcinoma sarcomatoide de laringe. ¿Un reto histológico?

INTRODUCTION: Sarcomatoid carcinoma can occur in any part of the body; in the head and neck it occurs most frequently in the major salivary glands, with only about 1% of cases found in the larynx. As it has both epithelial and mesenchymal components, there are many theories concerning its origin and it can prove a diagnostic challenge. CASE REPORT: A 76 year old male smoker presented with dysphonia. Vocal cord injury was found on examination but no lymphadenopathy or metastases were present. Laryngeal microsurgery was performed with complete excision of the lesion. Histopathology showed it to be a carcinosarcoma which showed intense and diffuse positivity for vimentin and focal positivity for AE1-AE3, CK5 and p63. The patient underwent radiotherapy as complementary treatment. DISCUSSION: Sarcomatoid carcinoma usually presents with obstructive symptoms such as dysphonia. Prognosis depends on the stage and the presence or not of metastases. Both epithelial markers EMA, cytokeratin (AE1-AE3), epithelial membrane antigen, Ki 67 and mesenchymal markers such as vimentin, desmin, S-100 may be positive in these tumours. Recommended treatment for T2-T1 stages is an excisional biopsy which can be followed by adjuvant radiotherapy; radiotherapy alone has also been successful. T3-T4 stages can be treated with local excision, partial laryngectomy or total laryngectomy with subsequent ganglion emptying and concomitant radio and chemotherapy.

Persistent Tracheostomy after Organ Preservation Protocol in Patients Treated for Larynx and Hypopharynx Cancer.

Introduction Squamous cell carcinoma of the larynx is currently the second most common malignancy of the airway after lung cancer, and hypopharyngeal cancer accounts for fewer than 5% of head and neck cancers. The nonsurgical options for patients with this disease are related to significant long-term toxicities and the need for persistent tracheostomy, which adversely affects the quality of life of these patients. Objective To evaluate the need for tracheostomy, and the influence of this in the overall and specific survival rates of patients diagnosed with all stages of laryngeal carcinoma treated by chemoradiotherapy. Methods A retrospective study of patients diagnosed with laryngeal carcinoma was performed according to the criteria of the Union for International Cancer Control (UICC) and the American Joint Committee on Cancer (AJCC) 7th edition, in a tertiary hospital. Results A total of 21 patients were evaluated, 8 patients required a tracheotomy (31%) during the treatment protocol, 7 (35%) men and 1 (100%) women. According to subsite 4/4 patient with glottis cancer (p ≤ 0.001), 2/10 patients with supra glottis cancer and 2/7 patients with hypopharyngeal cancer. During follow up, just in 1 patient was possible to close the tracheostomy. Conclusion Persistent tracheostomy dependence after primary chemoradiation increases significantly the morbidity, and decreases the quality of life of those patients. Patients with glottis cancer are prone to need a tracheostomy, but no statistical difference regarding the oncological stage and the need for a tracheostomy were detected. A more thorough selection of the patients is needed to improve the quality of life and reduce permanent tracheostomy dependence.

Cofosis unilateral asociada a un neurinoma del glosofaríngeo / Unilateral deafness associated with a glossopharyngeal neurinoma

No disponible

Complications after cochlear implantation in adult patients. 10-Year retrospective analysis of a tertiary academic centre.

OBJECTIVE: Cochlear implants (CI) are electronic devices that enable the auditory rehabilitation and the management of individuals with severe to profound bilateral hearing loss, and nowadays, advanced age is not considered a contraindication for cochlear implantation and several studies have shown that older adults do benefit from CI, with improvements in hearing abilities and quality of life. METHODS: Retrospective analysis of patients older than 18 years who underwent cochlear implant surgery in a tertiary academic centre. RESULTS: 57 patients met the inclusion criteria: 25 (43.9%) male and 32 (56.1%) female. Total percentage of minor complication was 24.6% and major complication was 17.5%. The most common minor complication in our series was vestibular disorder, and the most common major complication was device failure. No correlation was found among age, previous meningitis, anatomical variables or comorbidities with the appearance of complications. CONCLUSION: Cochlear implantation is a safe surgical technique for rehabilitation of severe to profound sensorineural hearing loss. According to our results, neither the age over 65 years nor the presence of comorbidities does have a direct impact over the complication rates in our patients.

Carotid blowout syndrome in patients treated by larynx cancer.

INTRODUCTION: Carotid blowout syndrome is an uncommon complication for patient treated by head and neck tumors, and related to a high mortality rate. OBJECTIVE: The aim of this study was to study the risk of carotid blowout in a large cohort of patients treated only by larynx cancer. METHODS: Retrospective analysis of patients older than 18 years, treated by larynx cancer who developed a carotid blowout syndrome in a tertiary academic centre. RESULTS: 197 patients met the inclusion criteria, 192 (98.4%) were male and 5 (1.6%) were female. 6 (3%) patients developed a carotid blowout syndrome, 4 patients had a carotid blowout syndrome located in the internal carotid artery and 2 in the common carotid artery. According to the type of rupture, 3 patients suffer a type I, 2 patients a type III and 1 patient a type II. Five of those patients had previously undergone radiotherapy and all patients underwent total laryngectomy. We found a statistical correlation between open surgical procedures (p=0.004) and radiotherapy (p=0.023) and the development of a carotid blowout syndrome. CONCLUSION: Carotid blowout syndrome is an uncommon complication in patients treated by larynx tumours. According to our results, patient underwent radiotherapy and patients treated with open surgical procedures with pharyngeal opening have a major risk to develop this kind of complication.

Enfisema periorbitario tras sonarse la nariz / Orbital emphysema after blowing the nose

No disponible

Tuberculosis de cabeza y cuello: estudio retrospectivo de 6 años / Head and neck tuberculosis: 6-year retrospective study

Introducción: En el 80% de los casos de infección por Mycobacterium tuberculosis existe afectación pulmonar, sin embargo hasta en un 20% de casos puede haber compromiso extrapulmonar. En el área otorrinolaringológica la localización más frecuente es la linfadenitis cervical, que afecta aproximadamente al 95% de los casos. Materiales y métodos: Estudio retrospectivo en pacientes que acudieron a consulta de ORL en un hospital terciario por sintomatología en cabeza y cuello y que fueron diagnosticados de tuberculosis, entre diciembre del año 2007 y diciembre del año 2013. Resultados: Un total de 73 pacientes fueron incluidos, 41 (56,2%) hombres y 32 (43,8%) mujeres (ratio H/M = 1,28), con una edad promedio de 39,4 años (±26,5 años; mín: 1/máx 88). Un total de 53 (72,6%) casos correspondieron a linfadenopatía cervical, 11 (15%) a tuberculosis laríngea, 3 (4,1%) a tuberculosis hipofaríngea, y los restantes 6 en otras localizaciones. Del total, 14 (19,2%) pacientes eran VIH positivo y 10 (13,7%) tenían antecedentes de contacto con familiares que habían sufrido tuberculosis pulmonar. En 51 (69,8%) de los casos se realizó una PCR como medida de confirmación, siendo positiva en 47 de estos (92,1%). Conclusión: La similitud de la tuberculosis con enfermedades de mal pronóstico y la dificultad que entraña su diagnóstico hacen necesario tener en cuenta la tuberculosis a la hora de explorar a pacientes con lesiones granulomatosas o ulcerativas del área ORL. Al analizar nuestros resultados, la incidencia de tuberculosis según su localización en el área ORL es similar a la reportada en la literatura. Es importante hacer mención especial del uso de la PCR en nuestro estudio y las ventajas que su aplicación significa para el diagnóstico (AU)

Introduction: Pulmonary involvement exists in 80% of cases of infection with Mycobacterium tuberculosis; however, in up to 20% of cases there may be extra-pulmonary involvement. In the ENT area, the most common site is cervical lymphadenitis, affecting approximately 95% of cases. Materials and methods: This was a retrospective study of patients attending an ENT department in a tertiary hospital for head and neck symptoms that were diagnosed with tuberculosis (TB), between December 2007 and December 2013. Results: The study included 73 patients, 41 (56.2%) males and 32 (43.8%) females (M/F ratio = 1.28), with a mean age of 39.4 years (±26.5 years; Min 1, Max 88). There were 53 (72.6%) cases of cervical lymphadenopathy, 11 (15%) of laryngeal tuberculosis 3 (4.1%) of hypopharyngeal tuberculosis, and six cases in other locations. Of the total, 14 (19.2%) patients were HIV positive and 10 (13.7%) had a history of contact with relatives who had suffered pulmonary tuberculosis. PCR was performed in 51 (69.8%) cases to confirm being positive, of which 47 (92.1%) cases were. Conclusion: The similarity of tuberculosis to diseases of poor prognosis and the difficulty of its diagnosis make considering tuberculosis necessary when exploring patients with ulcerative or granulomatous ENT lesions. Analysing our results, the incidence of TB according to its ENT area location is similar to that reported in the literature. It is important to make special mention of the use of PCR in our study and the benefits that its implementation means for diagnosis (AU)

Head and neck tuberculosis: 6-year retrospective study.

INTRODUCTION: Pulmonary involvement exists in 80% of cases of infection with Mycobacterium tuberculosis; however, in up to 20% of cases there may be extra-pulmonary involvement. In the ENT area, the most common site is cervical lymphadenitis, affecting approximately 95% of cases. MATERIALS AND METHODS: This was a retrospective study of patients attending an ENT department in a tertiary hospital for head and neck symptoms that were diagnosed with tuberculosis (TB), between December 2007 and December 2013. RESULTS: The study included 73 patients, 41 (56.2%) males and 32 (43.8%) females (M/F ratio=1.28), with a mean age of 39.4 years (± 26.5 years; Min 1, Max 88). There were 53 (72.6%) cases of cervical lymphadenopathy, 11 (15%) of laryngeal tuberculosis 3 (4.1%) of hypopharyngeal tuberculosis, and six cases in other locations. Of the total, 14 (19.2%) patients were HIV positive and 10 (13.7%) had a history of contact with relatives who had suffered pulmonary tuberculosis. PCR was performed in 51 (69.8%) cases to confirm being positive, of which 47 (92.1%) cases were. CONCLUSION: The similarity of tuberculosis to diseases of poor prognosis and the difficulty of its diagnosis make considering tuberculosis necessary when exploring patients with ulcerative or granulomatous ENT lesions. Analysing our results, the incidence of TB according to its ENT area location is similar to that reported in the literature. It is important to make special mention of the use of PCR in our study and the benefits that its implementation means for diagnosis.

The risk of venous thromboembolism in ENT and head & neck surgery.

OBJECTIVES: Venous thromboembolic disease (VTD) includes deep vein thrombosis (DVT) and pulmonary embolism (PE), thus is one of the most feared postoperative complications developed by patients at any surgical department, because of high morbidity and mortality associated with it. MATERIALS AND METHODS: We performed a retrospective study including all patients operated on at the Otolaryngology Head and Neck Department (tertiary hospital) between January 2009 and December 2013. RESULTS: A total of 9007 surgical procedures were performed, including 7150 elective surgeries under general anesthesia, with 2127 on children and 5023 on adults. A total of 1989 patients had oncological head and neck surgery, eight cases had VTE complications, which represents 0.08% of patients. All of those complicated cases had head and neck cancer (8/1989 = 0.4%) and belonged to the group of scheduled surgeries under general anesthesia (8/7150 = 0.1%). CONCLUSION: The incidence of DVT and PE in ENT and head and neck surgery appears to be lower than in other surgical specialties. Oncological surgery of the head and neck, usually associated with other risk factors, appears to increase the risk of VTD.

Compensatory hypertrophy of the contralateral inferior turbinate in patients with unilateral nasal septal deviation. A computed tomography study.

INTRODUCTION: The compensatory hypertrophy of the inferior turbinate in patients with septal deviation to one of the nostrils is considered to protect the airways from the excess of air that could enter through the nostril and its potential negative effects such as dryness, alteration of air filtration, mucociliary flow, or lung involvement. MATERIALS AND METHODS: A prospective, longitudinal, non-randomized study. Patients were divided in two groups: 10 consecutive patients, with nasal septal deviation and compensatory hypertrophy of the inferior turbinate in the contralateral nasal cavity (10 non-hypertrophied turbinates as control and 10 contralateral hypertrophied turbinates as study cases), and the second group with 5 patients without any nasal pathology (10 turbinates without any obvious pathology). In both groups CT scans of the nasal region were performed. A comparison of patients with nasal septal deviation with compensatory hypertrophy of the inferior turbinate in the contralateral nasal cavity and with non-pathological inferior turbinate was carried out. RESULTS: When analyzing the groups of patients with septal deviation, the contralateral hypertrophied turbinate and the non-hypertrophied turbinate side, we found a significant hypertrophy in the anterior portion of the inferior turbinate, at the level of the medial mucosa (P = 0.002) and bone (P = 0.001) in the group of patients with contralateral hypertrophied turbinate. However, when we compared the contralateral hypertrophic turbinate with the turbinate of patients without septal deviation, we found a significant difference in all volumes of the medial and lateral mucosa and the bone portion (P = 0.001, P = 0.005). CONCLUSION: Surgical correction of the nasal septum and lateralization or reduction of the volume of the inferior turbinate (which may include the medial mucosa, head or part of the bone) is necessary in order to improve air passage into the nasal valve.

The treatment of snoring by radiofrequency-assisted uvulopalatoplasty and results after one-session protocol: a prospective, longitudinal, non-randomized study.

Snoring is usually caused by the vibration of walls of the soft palate at the pharyngeal level. Its worldwide prevalence is estimated to range between 2 and 85% depending on age, gender or population group. The aim of this study is to determine the degree of improvement that can be subjectively evident in patients treated by snoring with radiofrequency-assisted uvulopalatoplasty based on a one-session protocol. This is a prospective, longitudinal, non-randomized study. Patients of both sexes, aged 18 years, who attended to the ENT consultation in a tertiary hospital with snoring during the period of July 2012-July 2013 were included. Age, body mass index, Epworth sleepiness scale were calculated. The volume of snoring of each subject was assessed using a visual analog scale. A total of 27 patients were included in the study; the average age of the sample was 49 years (±8.7; min 36/max 74); of these 22 (81.5%) were male and 5 (18.5%) females. The average BMI was 27.07 ± 2.5 (min 23.15/max 29.39) before the test and after 1 year was 26.75 ± 2.32 (min 23.11/max 29.56) with no statistically significant differences in BMI before and after surgery (p = 0.407). Preoperative snoring intensity was 8.10 ± 0.93 according to VAS. We found a statistically significant difference in the post-operative intensity at 3 months of 3.93 ± 0.88 (p ≤ 0.05) at 6 months of 4.41 ± 1.08 (p ≤ 0.05), and after 1 year 4.90 ± 0.77 (p ≤ 0.05). The average rate of ESS was significantly higher preoperatively than post-operative, being 8.76 ± 3.1 preoperative and 6.93 ± 1.68 post-operative (p ≤ 0.05). We conclude that the use of radiofrequency in simple snorers with an apnea/hypopnea index <15 events per hour and a BMI < 30 kg/m(2) in whom clinically proven that the source of snoring is the soft palate, can be treated by one-session protocol, being possible to obtain an improvement of snoring up to 70% of cases by a short follow-up period.

Síndrome de Eagle / Eagle syndrome

No disponible