Elaboración de una escala de puntuación predictiva de infección periamigdalina basada en signos y síntomas / Design of a predictive score table for peritonsillar infection based on signs and symptoms

Introducción La infección periamigdalina (IPA) supone un motivo de consulta urgente entre las molestias de garganta. Un diagnóstico diferido o incorrecto puede comprometer la vía aerodigestiva alta y resultar mortal en su evolución. Nuestro objetivo fue desarrollar un modelo predictivo de presencia de IPA que ayude en su rápida detección. Pacientes y métodos Un estudio observacional retrospectivo de 66 meses desde 2017 fue desarrollado en un hospital comarcal y su centro terciario de referencia, recogiendo datos de todos los pacientes diagnosticados de IPA y un volumen proporcional de sujetos con sintomatología faríngea sin IPA. Recopilación de datos clínicos, exploratorios y demográficos entre participantes. Su mayor riesgo relativo de presencia de IPA los etiquetó como variables a testar. Elaboración de una escala de puntuación de probabilidad de padecerla y análisis de regresión logística, con obtención de la curva ROC que ofreciera mejor correlación diagnóstica. Validación interna y cálculo de los valores predictivos de este modelo. Resultados Sobre 348 casos de IPA, la escala de valoración puntuó la presencia de 6 variables: trismus (3), disfagia-odinofagia unilateral (2), abombamiento velar (2), otalgia refleja (1), faringolalia (1) y edad de 16-46 años (1). Con un rango de 0 a 10, un cut-off≥6 ofreció una sensibilidad del 96,1%, una especificidad del 93,9% y una eficienca del 94,9%. El área bajo la curva ROC fue de 0,979. Conclusiones La validación interna de este modelo basado en signos y síntomas la faculta como herramienta muy útil para detectar precozmente IPA en otorrinolaringología y atención primaria (AU)

Background Peritonsillar infection (PTI) is a reason for urgent consultation due to intense throat discomfort. A delayed or inaccurate diagnosis can jeopardize the upper aerodigestive tract and be fatal in its evolution. Our objective was to develop a predictive model for the presence of IPA helping in its rapid detection. Patients and methods A 66-month retrospective observational study from 2017 was carried out in a county and tertiary referral hospitals, registering data from all patients diagnosed with PTI and a proportional volume of subjects with pharyngeal symptoms without PTI. Collection of clinical, exploratory and demographic data among participants. Their higher relative risk of PTI presence allowed them to be considered as variables to be tested. Development of a scoring scale for the probability of suffering from it and logistic regression analysis, obtaining the ROC curve with the best diagnostic correlation. Internal validation and estimation of the predictive values of the model. Results On 348 cases of PTI, the assessment scale scored the presence of six variables: trismus (3), unilateral dysphagia-odynophagia (2), velar bulging (2), reflex otalgia (1), pharyngolalia (1) and age between 16 and 46 years (1). With a range of 0-10, a cut-off ≥6 offered a sensitivity of 96.1%, a specificity of 93.9%, and an efficiency of 94.9%. The area under the ROC curve was 0.979. Conclusions The internal validation of this model based on signs and symptoms makes it a very useful tool for early detection of PTI in otorhinolaryngology and primary care (AU)

[Design of a predictive score table for peritonsillar infection based on signs and symptoms]. / Elaboración de una escala de puntuación predictiva de infección periamigdalina basada en signos y síntomas.

BACKGROUND: Peritonsillar infection (PTI) is a reason for urgent consultation due to intense throat discomfort. A delayed or inaccurate diagnosis can jeopardize the upper aerodigestive tract and be fatal in its evolution. Our objective was to develop a predictive model for the presence of IPA helping in its rapid detection. PATIENTS AND METHODS: A 66-month retrospective observational study from 2017 was carried out in a county and tertiary referral hospitals, registering data from all patients diagnosed with PTI and a proportional volume of subjects with pharyngeal symptoms without PTI. Collection of clinical, exploratory and demographic data among participants. Their higher relative risk of PTI presence allowed them to be considered as variables to be tested. Development of a scoring scale for the probability of suffering from it and logistic regression analysis, obtaining the ROC curve with the best diagnostic correlation. Internal validation and estimation of the predictive values of the model. RESULTS: On 348 cases of PTI, the assessment scale scored the presence of six variables: trismus (3), unilateral dysphagia-odynophagia (2), velar bulging (2), reflex otalgia (1), pharyngolalia (1) and age between 16 and 46 years (1). With a range of 0-10, a cut-off ≥6 offered a sensitivity of 96.1%, a specificity of 93.9%, and an efficiency of 94.9%. The area under the ROC curve was 0.979. CONCLUSIONS: The internal validation of this model based on signs and symptoms makes it a very useful tool for early detection of PTI in otorhinolaryngology and primary care.

Complicación por inyección de silicona en estética facial: migración a tejido adenoideo / Silicone injection complication in facial aesthetics: Migration to adenoids

No disponible

False positive for ß2-transferrin in rhinorrhoea. Ocular trauma. / Un falso positivo para ß2-transferrina en rinorrea. Traumatismo ocular.

Ocular perforations require an action depending on the findings observed. Additionally, the closeness of the orbit to the nasal cavity and the anterior cranial fossa requires any collateral damage in these spaces to be ruled out. The presence of a penetrating ocular injury associated with ipsilateral rhinorrhoea in which the presence of ß2-transferrin -a highly specific and sensitive marker to identify cerebrospinal fluid- is detected, obliges to suspect and locate any possible leakage. A case is presented in which this unbound protein is detected in post-traumatic rhinorrhoea with an origin in the eyeball, making the diagnosis of a CSF leak into a false positive.

Evolución de la otosclerosis hacia la implantación coclear / Evolution of otosclerosis to cochlear implantation

Introducción: La otosclerosis es una osteodistrofia de la cápsula laberíntica que produce hipoacusia de conducción. Si el proceso invade la cóclea, aparece una hipoacusia neurosensorial, siendo el implante coclear una buena alternativa en estos pacientes. Objetivo: Conocer el comportamiento de la otosclerosis en la implantación coclear. Material y métodos: Se revisó una base de datos de 250 pacientes intervenidos de implante coclear realizando un estudio retrospectivo sobre 13 pacientes con criterios clínicos, audiológicos y/o de imagen de otosclerosis bilateral. Se estudian los 26 oídos analizando la historia natural, cirugías previas, evolución hacia hipoacusia profunda, hallazgos en imagen mediante tomografía computarizada, complicaciones y resultados funcionales. Resultados: El 46% fueron mujeres y el 54% hombres con una edad media de 26 años al inicio de la hipoacusia conductiva. La cirugía del estribo fue llevada a cabo en 19 oídos (73%) a una edad media de 29 años y de estos en el 53% se realizó posteriormente un implante coclear. Los resultados de la tomografía computarizada muestran que en el 54% de los oídos existen signos de afectación radiológica en diferente grado. Se registraron un total de 3 complicaciones (23%): un fallo de implante coclear, una estimulación del nervio facial y un acúfeno bilateral. Al año de la implantación obtenemos un porcentaje promedio de aciertos en bisílabos del 80% y del 85% en frases en contexto abierto. Conclusiones: Pacientes que presentan una hipoacusia neurosensorial profunda bilateral secundaria a una otosclerosis se benefician extraordinariamente de la implantación coclear(AU)

Introduction: Otosclerosis is an osteodystrophy of the labyrinthine capsule producing conductive hearing loss. If the process invades the cochlea, a sensorineural hearing loss usually takes place. The cochlear implant is a good alternative in these patients. Objective: To ascertain the behaviour of cochlear implantation in otosclerosis. Material and methods: We reviewed a database of 250 patients that underwent cochlear implantation, performing a retrospective study of 13 patients with clinical, audiological and/or imaging findings of bilateral otosclerosis. The 26 ears were studied as to their natural history, previous surgeries, evolution to profound hearing loss, computed tomography images, complications and functional results. Results: Of the cases studied, 46% were female and 54% were men, with a mean age of 26 years at the onset of conductive hearing loss. Stapes surgery was performed in 19 ears (73%), with a mean patient age of 29 years, and 53% of them underwent cochlear implantation. Computed tomography results showed that there were signs of different degrees of radiological affectation in 54% of the ears. A total of 3 complications took place (23%): implant failure, overstimulation of the facial nerve and bilateral tinnitus were found. One year after implantation, the average percentages of correct 2-syllable words were 80% and 85% in open sentences. Conclusions: Patients having profound bilateral sensorineural hearing loss secondary to otosclerosis obtain great benefit from cochlear implantation(AU)

Evolution of otosclerosis to cochlear implantation.

INTRODUCTION: Otosclerosis is an osteodystrophy of the labyrinthine capsule producing conductive hearing loss. If the process invades the cochlea, a sensorineural hearing loss usually takes place. The cochlear implant is a good alternative in these patients. OBJECTIVE: To ascertain the behaviour of cochlear implantation in otosclerosis. MATERIAL AND METHODS: We reviewed a database of 250 patients that underwent cochlear implantation, performing a retrospective study of 13 patients with clinical, audiological and/or imaging findings of bilateral otosclerosis. The 26 ears were studied as to their natural history, previous surgeries, evolution to profound hearing loss, computed tomography images, complications and functional results. RESULTS: Of the cases studied, 46% were female and 54% were men, with a mean age of 26 years at the onset of conductive hearing loss. Stapes surgery was performed in 19 ears (73%), with a mean patient age of 29 years, and 53% of them underwent cochlear implantation. Computed tomography results showed that there were signs of different degrees of radiological affectation in 54% of the ears. A total of 3 complications took place (23%): implant failure, overstimulation of the facial nerve and bilateral tinnitus were found. One year after implantation, the average percentages of correct 2-syllable words were 80% and 85% in open sentences. CONCLUSIONS: Patients having profound bilateral sensorineural hearing loss secondary to otosclerosis obtain great benefit from cochlear implantation.

Amigdalitis por Yersinia enterocolitica / Yersinia enterocolitica tonsillitis

Presentamos los casos de cinco pacientes con infección amigdalar debida a Yersinia enterocolitica. Fue común la ausencia de respuesta a antibióticos de empleo habitual y el contacto habitual con suidos. El diagnóstico definitivo se estableció por aislamientos microbiológicos de muestras histológicas amigdalares (AU)

We present five cases of tonsillitis secondary to Yersinia enterocolitica. No response to commonly-used antibiotics and continuous professional contact with pigs were common. The definitive diagnosis was established by bacteriological isolation on tonsil tissue samples (AU)

[Yersinia enterocolitica tonsillitis]. / Amigdalitis por Yersinia enterocolitica.

We present five cases of tonsillitis secondary to Yersinia enterocolitica. No response to commonly-used antibiotics and continuous professional contact with pigs were common. The definitive diagnosis was established by bacteriological isolation on tonsil tissue samples.

Taponamiento nasal en la epistaxis posterior. Comparación de dos métodos / Nasal packing in posterior epistaxis. Comparison of two methods

Objetivo: Evaluar la tolerancia y eficacia de 2 sistemas de taponamiento nasal para epistaxis posteriores refractarias. Pacientes y métodos: Estudio comparativo longitudinal y prospectivo de 5 años en pacientes que acudieron a Urgencias por epistaxis y precisaron taponamiento posterior. Se consideraron 2 grupos: uno atendido con un sistema de hinchado neumático bicameral (n=105); otro en el que se efectuó oclusión posterior con gasa accediendo por boca y refuerzo anterior (n=47). La tolerancia se midió mediante escala analógica de intensidad dolorosa durante la colocación y mantenimiento del tapón, así como por necesidad de analgesia. La eficacia se valoró por índices de resangrado, necesidad de medidas concomitantes, transfusión de hemoderivados y efectos secundarios. Resultados: En los pacientes con taponamiento hinchable la colocación fue significativamente más rápida (36±19s vs. 228±102s; p<0,001) y menos dolorosa (6,7±1,7 vs. 8,3±1,5; p<0,001), precisando menos analgesia hasta su retirada. El taponamiento de gasa presentó menor porcentaje de resangrados (17% Vs. 26%; p<0,001), menos necesidades de transfusión de hemoderivados (15% vs. 18%; p<0,001) o de otros procedimientos (4% vs. 11%; p<0,001). El gasto sanitario con este último fue menor (1327±202€ vs. 1648±318€; p<0,001) y generó menos complicaciones a corto y largo plazo. Conclusiones: El taponamiento posterior clásico con gasa resulta menos cómodo y rápido de adaptar, pero asegura un mayor porcentaje de éxitos en control de epistaxis, genera menos lesiones locales y reduce costes sanitarios con respecto al neumotaponamiento (AU)

Objective: To evaluate tolerance and efficiency of two nasal blocking systems for posterior refractory epistaxis. Patients and methods: A five year comparative and longitudinal prospective study was developed in patients with epistaxis who attended our Emergency Unit and who required posterior nasal packing. Two groups were considered: one group was treated with a bi-chamber pneumatic inflation system (n=105). In other one, posterior occlusion was carried out with gauze, accessing through the mouth and using nasal reinforcement (n=47). The tolerance was measured by means of an analogue scale of pain intensity during the placement and maintenance of the packing, as well as for the need of analgesia. The efficiency was evaluated by episodes of re-bleeding, need for other concomitant measures, blood transfusion and side effects. Results: In patients with inflatable nasal packing its placement was significantly faster (36±19s vs. 228±102s; p<0.001) and less painful (6.7±1.7 vs. 8.3±1.5; p<0.001), requiring less analgesia until its removal. Patients with pack of gauze showed a lower average incidence of re-bleeding (17% vs. 26 %; p<0.001), fewer cases of blood transfusion (15% vs. 18%; p<0.001) or of other procedures (4% vs. 11 %; p<0.001). The sanitary cost of the latter was also lower (1327±202€ vs. 1648±318€; p<0.001) and it generated less short and long-term complications. Conclusions: The classical posterior packing with gauze is less rapid and comfortable to adapt, but it ensures a higher success rate in the control of epistaxis, produces fewer local injuries and reduces sanitary costs in comparison with inflatable balloon packing (AU)

[Nasal packing in posterior epistaxis. Comparison of two methods]. / Taponamiento nasal en la epistaxis posterior. Comparación de dos métodos.

OBJECTIVE: To evaluate tolerance and efficiency of two nasal blocking systems for posterior refractory epistaxis. PATIENTS AND METHODS: A five year comparative and longitudinal prospective study was developed in patients with epistaxis who attended our Emergency Unit and who required posterior nasal packing. Two groups were considered: one group was treated with a bi-chamber pneumatic inflation system (n=105). In other one, posterior occlusion was carried out with gauze, accessing through the mouth and using nasal reinforcement (n=47). The tolerance was measured by means of an analogue scale of pain intensity during the placement and maintenance of the packing, as well as for the need of analgesia. The efficiency was evaluated by episodes of re-bleeding, need for other concomitant measures, blood transfusion and side effects. RESULTS: In patients with inflatable nasal packing its placement was significantly faster (36+/-19s vs. 228+/-102 s; p<0.001) and less painful (6.7+/-1.7 vs. 8.3+/-1.5; p<0.001), requiring less analgesia until its removal. Patients with pack of gauze showed a lower average incidence of re-bleeding (17% vs. 26 %; p<0.001), fewer cases of blood transfusion (15% vs. 18%; p<0.001) or of other procedures (4% vs. 11 %; p<0.001). The sanitary cost of the latter was also lower (1327+/-202 euro vs. 1648+/-318 euro; p<0.001) and it generated less short and long-term complications CONCLUSIONS: The classical posterior packing with gauze is less rapid and comfortable to adapt, but it ensures a higher success rate in the control of epistaxis, produces fewer local injuries and reduces sanitary costs in comparison with inflatable balloon packing.

[Considerations on acute otitis externa for its optimized treatment]. / Consideraciones sobre la otitis externa aguda para un tratamiento optimizado.

INTRODUCTION AND OBJECTIVES: To evaluate the optimal treatment for diffuse acute otitis externa (DAOE) by means of a new staging system based on clinical and otoscopic findings. METHODS: Monitoring of otitis cases diagnosed at our Centre over the last 21 months (n=1,026), taking into account those who returned for a second visit, either via the emergency service or with a prior appointment. Staging of otitis externa by degree of obstruction of the external auditory canal (EAC): under 25% (type I, n=174); between 25% and 75% (type II; n=277); over 75% (type III; n=359); total obstruction due to organized oedema (type IV; n=216). RESULTS: In most cases at an advanced stage, the canal was cleared by aspiration and placement of gauze or cellulose sponges. Ototopical drops were chosen in more than 95% of cases in every group, but anti-inflammatory and systemic antibiotic agents were administered in significantly larger amounts to patients in stages III and IV. Stage IV showed a statistically significant increase in the percentage of second visits. These manoeuvres improved pain, fullness and otorrhea significantly faster in stages I and II. CONCLUSIONS: Staging of otitis allows comparisons of the level of involvement and treatment recommendations: aspiration is advisable in stages II, III and IV; placement of a wick inside the canal is necessary in stages III and IV. Ototopical drops seem to be needed in every case and systemic antibiotics almost only in stage IV. Acidifying agents and topic glycerine vehicles access the canal better than aqueous solutions and would be the first choice in advanced stages.

Consideraciones sobre la otitis externa aguda para un tratamiento optimizado / Considerations on acute otitis externa for its optimized treatment

Introducción y objetivo: Evaluar el tratamiento idóneo de la otitis externa aguda difusa mediante un nuevo sistema de estadiaje basado en hallazgos clínicos y otoscopia. Métodos: Seguimiento de los casos de otitis diagnosticados en nuestro centro durante los últimos 21 meses (n=1.026). Recuento del número de pacientes que acudieron a una segunda visita urgente o programada. Estadiaje de la otitis externa si la obstrucción del conducto auditivo externo presentaba obstrucción inferior al 25% (tipo I, n=174), entre el 25/75% (tipo II, n=277), mayor del 75% (tipo III, n=359), u obstrucción completa con edema organizado (tipo IV, n=216). Resultados: La aspiración y el mechado del conducto se colocaron en mayor número de casos con estadios avanzados. Las gotas óticas se colocaron en más del 95% en todos los grupos pero los antiinflamatorios y antibióticos sistémicos se administraron significativamente en mayor cantidad a pacientes de estadios III y IV. El estadio IV presentó de forma estadísticamente significativa un mayor porcentaje de segundas visitas. Con estas maniobras, el dolor, el taponamiento y la otorrea cedieron significativamente más rápido en los estadios I y II. Conclusiones: El estadiaje de la otitis externa permite equiparar grados de afectación y recomendar tratamientos: aspiración aconsejable en estadios II, III y IV, mechado siempre en estadios III y IV. Las gotas óticas parecen necesarias en todos los casos y los antibióticos sistémicos casi únicamente en el estadio IV. Los agentes acidificantes y las formas tópicas glicerinadas acceden mejor al conducto que las acuosas y serían de elección en estadios avanzados (AU)

Introduction and objectives: To evaluate the optimal treatment for diffuse acute otitis externa (DAOE) by means of a new staging system based on clinical and otoscopic findings. Methods: Monitoring of otitis cases diagnosed at our Centre over the last 21 months (n=1,026), taking into account those who returned for a second visit, either via the emergency service or with a prior appointment. Staging of otitis externa by degree of obstruction of the external auditory canal (EAC): under 25% (type I, n=174); between 25% and 75% (type II; n=277); over 75% (type III; n=359); total obstruction due to organized oedema (type IV; n=216). Results: In most cases at an advanced stage, the canal was cleared by aspiration and placement of gauze or cellulose sponges. Ototopical drops were chosen in more than 95% of cases in every group, but anti-inflammatory and systemic antibiotic agents were administered in significantly larger amounts to patients in stages III and IV. Stage IV showed a statistically significant increase in the percentage of second visits. These manoeuvres improved pain, fullness and otorrhea significantly faster in stages I and II. Conclusions: Staging of otitis allows comparisons of the level of involvement and treatment recommendations: aspiration is advisable in stages II, III and IV; placement of a wick inside the canal is necessary in stages III and IV. Ototopical drops seem to be needed in every case and systemic antibiotics almost only in stage IV. Acidifying agents and topic glycerine vehicles access the canal better than aqueous solutions and would be the first choice in advanced stages (AU)

[Use of imaging criteria to identify cervical metastases using CT scans in head and neck tumours]. / Empleo de patrones de imagen en la identificación de metástasis cervical mediante tomografía computarizada en tumores de cabeza y cuello.

OBJECTIVE: To assess the diagnostic certainty of CT images to identify regional spread of head and neck tumours. PATIENTS AND METHOD: A CT study was performed on 86 patients with neoplasms in the larynx and/or pharynx. After this, surgical dissection was performed for 142 neck sides. In the imaging study the following parameters were considered for all patients before suspecting malignant nodes: size of adenopathy bigger than 10-11 mm, irregular borders, central necrosis, spherical shape, capsular enhancement and presence of groups with three or more lymphadenopathies. RESULTS: 48.5 % of dissections were N+. Sensitivity and specificity for physical examination were 59 % and 82 %, respectively, against 73 % and 86 % for CT. Lymph node necrosis was the pattern with the greatest sensitivity and specificity (35.8 % and 100 %, respectively) and its accuracy was 69.7 %. Accuracy was 60.5 % for spherical shape, 59.8 % for node size, and between 54 % and 58 % for the other three criteria. In the histopathological findings, 25 % of neck dissections were N+ when only one pattern had been detected on CT, whereas those neck sides in which four patterns were identified simultaneously showed regional spread in 100 %. CONCLUSIONS: The presence of specific morphological imaging criteria for head and neck tumours in cervical lymph nodes and their concomitance increase the accuracy of imaging to predict regional spread.

Empleo de patrones de imagen en la identificación de metástasis cervical mediante tomografía computarizada en tumores de cabeza y cuello / Use of imaging criteria to identify cervical metastases using CT scans in head and neck tumours

Objetivo: Evaluar la seguridad diagnóstica que proporcionan las imágenes de tomografía computarizada (TC) para identificar la extensión regional de tumores de cabeza y cuello (CC). Pacientes y método: Se efectuó TC a 86 pacientes diagnosticados de neoplasia de faringe y/o laringe que después fueron intervenidos, con un total de 142 vaciamientos ganglionares. En el estudio de imagen se consideraron los siguientes parámetros radiológicos para sospechar afección ganglionar: tamaño de la adenopatía > 10-11 mm, márgenes mal definidos, necrosis central, forma esférica, realce capsular y agrupación de tres o más adenopatías. Resultados: El 48,5 % de los vaciamientos resultaron N+. La sensibilidad y la especificidad de la palpación fueron del 59 y el 82 %, respectivamente, y para la TC, del 73 y el 86 %. La necrosis central fue el patrón de imagen con mayor sensibilidad y especificidad, el 35,8 y el 100 % respectivamente, con una eficiencia diagnóstica del 69,7 %. Esta eficiencia fue del 60,5 % para la forma esférica, del 59,8 % para el tamaño, y entre el 54 y el 58 % para los otros tres criterios de imagen. El 25 % de los vaciamientos resultó N+ en el estudio histopatológico cuando en la TC se había hallado sólamente uno de los patrones radiológicos descritos, pero las vertientes cervicales con cuatro patrones identificados simultáneamente presentaron extensión regional en el 100 %. Conclusiones: La presencia de patrones morfológicos específicos en los ganglios cervicales en la TC de tumores de CC y su concomitancia optimizan la eficiencia diagnóstica en esta prueba para predecir la extensión regional

Objective: To assess the diagnostic certainty of CT images to identify regional spread of head and neck tumours. Patients and method: A CT study was performed on 86 patients with neoplasms in the larynx and/or pharynx. After this, surgical dissection was performed for 142 neck sides. In the imaging study the following parameters were considered for all patients before suspecting malignant nodes: size of adenopathy bigger than 10-11 mm, irregular borders, central necrosis, spherical shape, capsular enhancement and presence of groups with three or more lymphadenopathies. Results: 48.5 % of dissections were N+. Sensitivity and specificity for physical examination were 59 % and 82 %, respectively, against 73 % and 86 % for CT. Lymph node necrosis was the pattern with the greatest sensitivity and specificity (35.8 % and 100 %, respectively) and its accuracy was 69.7 %. Accuracy was 60.5 % for spherical shape, 59.8 % for node size, and between 54 % and 58 % for the other three criteria. In the histopathological findings, 25 % of neck dissections were N+ when only one pattern had been detected on CT, whereas those neck sides in which four patterns were identified simultaneously showed regional spread in 100 %. Conclusions: The presence of specific morphological imaging criteria for head and neck tumours in cervical lymph nodes and their concomitance increase the accuracy of imaging to predict regional spread

[Effect of smoking withdrawal on hearing loss induced by occupational exposure to noise. A preliminary study]. / Efecto de la supresión del tabaco en la hipoacusia inducida por ruido laboral. Estudio preliminar.

Smoking and occupational exposure to noise are factors with independent predisposition to sensorineural hearing loss. This is a sinergistic and additive effect. Nevertheless, we have observed that withdrawal of smoking stops the progression on hearing loss in occupational groups with an acoustic exposition lesser than 80 dB SPL. Actually, there is not an unique ethiologic hypothesis.

[Utility of vasopressin in cardiopulmonary resuscitation]. / Utilidad de la vasopresina en la resucitación cardiopulmonar.

Many vasopressants have been studied in cardiopulmonary resuscitation (CPR) to increase cerebral and coronary perfusion. Although there is a debate on the utility of epinephrine, this is the one that has been used historically, above all after verifying that other agents such as norepinephrine, metoxamine or phenylephrine, have not been shown to be more effective. Currently, due to the good experimental results, the use of vasopressin (ADH) in CPR is being evaluated. However there is little (only three studies) and debated evidence based on randomized clinical trials (norepinephrine or ADH) in humans. Once these are reviewed, it can be concluded: The results of the three randomized studies in humans obtain different results regarding the utility of ADH in cardiorespiratory arrest (CRA) secondary to ventricular fibrillation, electro-mechanical dissociation or asystole. More prospective studies are needed to know the role of ADH in prolonged CRA and in asystole, that may be the subgroups that can benefit the most from this drug. The neurological repercussion of a drug in the context of CRA should be evaluated before its inclusion in the CPR guides.

Efecto de la supresión del tabaco en la hipoacusia inducida por ruido laboral. Estudio preliminar / Effect of smoking withdrawal on hearing loss induced by occupational exposure to noise. A preliminary study

El consumo de tabaco y la exposición laboral a ruido son factores que independientemente predisponen a la hipoacusia neurosensorial. Este efecto es sinérgico y aditivo. Sin embargo, hemos observado que la supresión del tabaquismo condiciona la anulación en la progresión de la hipoacusia en grupos laborales en los que la exposición acústica no supera los 80 dB SPL, sin que en la actualidad pueda proponerse una única hipótesis causal

Smoking and occupational exposure to noise are factors with independent predisposition to sensorineural hearing loss. This is a sinergistic and additive effect. Nevertheless, we have observed that withdrawal of smoking stops the progression on hearing loss in occupational groups with an acoustic exposition lesser than 80 dB SPL. Actually, there is not an unique ethiologic hypothesis

Utilidad de la vasopresina en la resucitación cardiopulmonar / Utility of vasopressin in cardiopulmonaryresuscitation

Muchos son los vasopresores estudiados en resucitación cardiopulmonar (RCP) para aumentar la presión de perfusión cerebral y coronaria. A pesar de que existe controversia sobre la utilidad de la adrenalina, ésta es la que históricamente se ha utilizado, sobre todo tras la comprobación de que otros agentes como la noradrenalina, metoxamina o fenilefrina no han demostrado ser más efectivos. Actualmente, debido a los buenos resultados experimentales, se está valorando la utilidad de la vasopresina (ADH) en la RCP. Sin embargo existe poca (sólo tres estudios) y controvertida evidencia basada en ensayos clínicos aleatorizados (adrenalina o ADH) en seres humanos. Una vez revisados éstos, se puede concluir lo siguiente: Los resultados de los tres estudios aleatorizados en seres humanos obtienen resultados distintos respecto a la utilidad de la ADH en la parada cardiorrespiratoria (PCR) secundaria a fibrilación ventricular, disociación electromecánica o asistolia. Son necesarios más estudios prospectivos para conocer el papel de la ADH en la PCR prolongada y en la asistolia, que tal vez sean los subgrupos que más se puedan beneficiar de este fármaco. La repercusión neurológica de un fármaco en el contexto de la PCR debe evaluarse antes de su inclusión en las guías de la RCP

Many vasopressants have been studied in cardiopulmonary resuscitation (CPR) to increase cerebral and coronary perfusion. Although there is a debate on the utility of epinephrine, this is the one that has been used historically, above all after verifying that other agents such as norepinephrine, metoxamine or phenylephrine, have not been shown to be more effective. Currently, due to the good experimental results, the use of vasopressin (ADH) in CPR is being evaluated. However there is little (only three studies) and debated evidence based on randomized clinical trials (norepinephrine or ADH) in humans. Once these are reviewed, it can be concluded: The results of the three randomized studies in humans obtain different results regarding the utility of ADH in cardiorespiratory arrest (CRA) secondary to ventricular fibrillation, electro-mechanical dissociation or asystole. More prospective studies are needed to know the role of ADH in prolonged CRA and in asystole, that may be the subgroups that can benefit the most from this drug. The neurological repercussion of a drug in the context of CRA should be evaluated before its inclusion in the CPR guides

[Management of peritonsillar infections]. / Tratamiento de la infección periamigdalina.

OBJECTIVE: To evaluate the clinical and epidemiologic characteristics in children with peritonsillar infections. PATIENTS AND METHODS: A longitudinal retrospective study was performed through a review of the clinical histories of patients attending the emergency unit in the previous 6 years. The variables gathered were age, sex, recurrent tonsillitis, previous upper airway infection, antibiotic administration, and therapeutic approach. RESULTS: Twenty-nine children were admitted, with a mean age of 7.4 +/- 1.6 years (boys 1.6:1). Twenty-seven percent had recurrent tonsillitis. At the visit, 57.8 % had an upper respiratory infection and 65 % were taking antibiotic treatment, especially macrolides. The treatment selected at our center consisted of the association of penicillin or amoxicillin-clavulanate acid with clindamycin, including corticosteroids. Ten children underwent computed tomography and nine underwent fine-needle aspiration. Drainage was performed in 20.6 % of confirmed abscesses. The mean length of hospital stay was 5.6 +/- 1.6 days. Delayed tonsillectomy was performed in 31 %, except in one patient who developed a parapharyngeal abscess. Currently, 18.9 % of all peritonsillar infections occur in the pediatric population. CONCLUSIONS: The increase in these infections is probably related to inappropriate use of antibiotics in respiratory diseases. Diagnosis is clinical, and infections are often resolved by intravenous administration of beta-lactams with clindamycin and an expectant attitude. When an abscess is suspected or there is no clinical improvement, fine-needle aspiration or computed tomography is warranted and drainage should be performed if an abscess is confirmed. Tonsillectomy, usually delayed, is only indicated in patients with recurrent tonsillitis.