Resultados de aplicar un protocolo de seguridad al paciente traqueotomizado procedente de una unidad de cuidados críticos / Results of applying a safety protocol of the patient with tracheotomy from a critical care unit

Introducción y objetivo: El incremento de traqueotomías en las unidades de cuidados críticos aumenta notablemente la morbimortalidad en la sala general. Para revertirlo, hemos implementado un programa de seguimiento multidisciplinar basado en la formación, la estandarización de los cuidados y la adopción de nuevas estrategias. Metodología: Estudio de cohorte prospectivo y observacional del seguimiento de 150 pacientes en un hospital universitario de tercer nivel, que carece de unidad de cuidados intermedios. Registramos y analizamos las variables clínicas, epidemiológicas y la evolución tras la aplicación del programa. Resultados: La edad media de los pacientes fue de 61 años, 67% varones y el 42% neurocríticos. 71% con traqueotomía percutánea. La mortalidad general fue del 17% y la de los pacientes con accidente cerebrovascular del 6,3%. Hubo un 8% de reingresos en la unidad de críticos. Detectamos un 23% de complicaciones de escasa gravedad. Se decanuló durante el ingreso a un 43% de pacientes y el 38% volvió a su domicilio, siendo dados de alta un 55% con alimentación oral. El tiempo medio de estancia en la unidad de críticos fue de 34 días y de 70 días la media de ingreso hospitalario. Conclusiones: Este trabajo describe los resultados obtenidos tras aplicar un protocolo de seguimiento multidisciplinar en la sala de hospitalización, del paciente traqueotomizado que procede de las UCC. La finalidad de este seguimiento es mejorar la seguridad de estos pacientes, a fin de disminuir su morbimortalidad. Las aplicación de nuevas estrategias permitirá su evaluación en relación con los datos obtenidos de este estudio. (AU)

Introduction and objective: Increasing the number of tracheostomies in critical care units significantly increases morbimortality in the wards. To reverse this, we have implemented a multidis-ciplinary follow-up program based on training, standardization of care and the adoption of new strategies. Methodology: Prospective and observational cohort study of the follow-up of 150 patients in a third-level university hospital that does not have a step-down unit. We record and analyze the clinical and epide-miological variables and the evolution after the application of the program. Results: The average age was 61 years old, 67 % male, and 41 % neurocritical care patients. Percutaneous tracheostomy in 71 % of all tracheostomies. Global mortality was 17 % and that of patients with stroke was 6.3 %. Readmission to critical care units was 8 %. Low-severity complications were detected in 23 % of patients. The decannulation process was completed during admission in 43 % of patients, 38 % in all discharged from hospital, 55 % of them with oral feeding now of discharge. Average stay in critical care unit was 34 days and hospital length of stay was 70 days. Conclusions: This work describes the results obtained after applying a multidisciplinary follow-up protocol in the wards, of the tracheotomized patient who comes from the critical care units. The purpose of this follow-up is to improve the safety of these patients, to reduce their morbimortality. The application of new strategies will allow their evaluation in relation to the data obtained from this study. (AU)

Colesteatoma de conducto auditivo externo: estudio de una serie de casos / Cholesteatoma of the external auditory canal: case series study

INTRODUCCIÓN Y OBJETIVOS: El colesteatoma de conducto auditivo externo (CCAE) es un proceso patológico poco frecuente, caracterizado por la invasión de tejido escamoso en un área del canal auditivo, que progresa hasta la destrucción ósea. Debido a la escasez de casos publicados hemos considerado de utilidad esta revisión. MATERIAL Y MÉTODOS: Estudio prospectivo y observacional desde el año 2000, de 18 pacientes diagnosticados clínicamente de CCAE en nuestro servicio de ORL. RESULTADOS: El porcentaje de hombres y mujeres es similar, con una edad media de diagnóstico de 60 años. La localización más frecuente es póstero-inferior y en la mayor parte de casos el origen es primario. La otalgia, la otorrea y la hipoacusia fueron los síntomas principales, siendo menos habitual el prurito y excepcional la debilidad facial. En general el tratamiento es conservador, pero resultó necesario el abordaje quirúrgico en un tercio de pacientes mediante canaloplastia, siguiendo el esquema expuesto, o la mastoidectomía, en función de la extensión de las lesiones. CONCLUSIONES: Aunque desconocemos los mecanismos patogénicos responsables de la formación y desarrollo del CCAE, la inclusión de queratina entre el epitelio y el hueso, con la participación del periostio, parecen ser los desencadenantes del proceso. El diagnóstico es clínico y su extensión determina el empleo de un tratamiento local o quirúrgico, que suele ser resolutivo

INTRODUCTION: External auditory canal cholesteatoma (EACC) is a rare entity characterized by the invasion of squamous tissue in the auditory canal, that progresses to bone destruction. Due to the scarcity of published cases of EACC, we have deemed useful this review. MATERIAL AND METHODS: Prospective and observational study from the year 2000 to the present in 18 patients clinically diagnosed with EACC in our ORL service. RESULTS: The percentage of men and women is similar, with a mean age at diagnosis of 60 years. The most frequently location was postero-inferior, and in most cases, the origin is primary. Otalgia, otorrhea and subjective hearing loss were the main symptoms, being less common the pruritus and exceptional facial weakness. Overall, the treatment is conservative, but it was necessary surgical treatment on one-third of the patients, performing canaloplasty or mastoidectomy, according to the extent of injuries. CONCLUSIONS: Although we do not know the genesis and pathogenic mechanisms responsible of EACC formation and development, the inclusion of keratin between the epithelium and bone, with the participation of the periosteum, seems to be the trigger of this process. The diagnosis is clinical, and its extension determines the use of a local or surgical treatment, which is usually resolutive

Timpanometría de alta frecuencia (1.000 Hz) en lactantes y su comparación con otoemisiones acústicas, otomicroscopia y timpanometría de 226 Hz / High frequency tympanometry (1000 Hz) in young infants and its comparison with otoacoustic emissions, otomicroscopy and 226 Hz tympanometry

Introducción y objetivo: La timpanometría de baja frecuencia (226 Hz) se considera un procedimiento ineficaz para el diagnóstico de la otitis media serosa en los primeros 6 meses de la vida. Con la implantación del cribado auditivo universal, se recomienda la utilización de la timpanometría de alta frecuencia de 1.000 Hz. A fin de optimizar el diagnóstico de la hipoacusia neonatal presentamos este trabajo donde comparamos, desde el punto de vista clínico, los resultados timpanométricos de 226 Hz y de 1 kHz. Material y método: Estudio prospectivo de 100 niños menores de 9 meses procedentes del cribado auditivo. Comparamos el resultado de la timpanometría con la otomicroscopia y con las otoemisiones acústicas transitorias. Resultados: La aplicación de las otoemisiones acústicas transitorias, la otomicroscopia y la timpanometría de 226 Hz y de 1 kHz ha mostrado su utilidad en el manejo de la otitis media serosa del lactante, con una validez similar entre las 4 pruebas. Conclusión: El uso conjunto de la otomicroscopia, las otoemisiones acústicas transitorias y la timpanometría de 226 Hz y de 1 kHz nos ha permitido diagnosticar la otitis media serosa del lactante con mayor precisión que si aplicáramos estas pruebas de forma aislada. Se aconseja utilizar inicialmente la timpanometría de 1 kHz, al menos en niños menores de 7 meses, pero en presencia de hipoacusia o de un resultado confuso, la timpanometría de 226 Hz es un buen complemento diagnóstico (AU)

Introduction and objective: In the first 6 months of life, 226 Hz tympanometry is considered an ineffective procedure for the diagnosis of otitis media with effusion. With the introduction of universal hearing screening, the use of high frequency 1000 Hz (1 kHz) tympanometry has been recommended. To optimise the diagnosis of neonatal hearing loss, we present this comparison, from the clinical point of view, of the results of 226 Hz and 1 kHz tympanometry in infants. Materials and methods: We designed a prospective study of 100 children under 9 months of age proceeding from our hearing screening program. We compare the result of tympanometry with binocular microscopy and transient evoked otoacoustic emissions. Results: The application of transient otoacoustic emissions, otomicroscopy and 226 Hz and 1 kHz tympanometry has shown its usefulness in the management of otitis media with effusion of young infants, with a similar effectiveness between the 4 tests. Conclusion: The joint use of otomicroscopy, transient otoacoustic emissions and 226 Hz and 1 kHz tympanometry, has allowed us to diagnose otitis media with effusion in young infants more accurately than each test separately. We recommend initial use of 1 kHz tympanometry, at least in children younger than 7 months, but in the presence of hearing loss or an unclear result, 226 Hz tympanometry is a good diagnostic complement (AU)

Palinacusia secundaria a daño cerebral por metotrexato / Palinacousis secondary to brain damage from methotrexate

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High frequency tympanometry (1000Hz) in young infants and its comparison with otoacoustic emissions, otomicroscopy and 226Hz tympanometry. / Timpanometría de alta frecuencia (1.000Hz) en lactantes y su comparación con otoemisiones acústicas, otomicroscopia y timpanometría de 226Hz.

INTRODUCTION AND OBJECTIVE: In the first 6 months of life, 226Hz tympanometry is considered an ineffective procedure for the diagnosis of otitis media with effusion. With the introduction of universal hearing screening, the use of high frequency 1000Hz (1kHz) tympanometry has been recommended. To optimise the diagnosis of neonatal hearing loss, we present this comparison, from the clinical point of view, of the results of 226Hz and 1kHz tympanometry in infants. MATERIALS AND METHODS: We designed a prospective study of 100 children under 9 months of age proceeding from our hearing screening program. We compare the result of tympanometry with binocular microscopy and transient evoked otoacoustic emissions. RESULTS: The application of transient otoacoustic emissions, otomicroscopy and 226Hz and 1kHz tympanometry has shown its usefulness in the management of otitis media with effusion of young infants, with a similar effectiveness between the 4 tests. CONCLUSION: The joint use of otomicroscopy, transient otoacoustic emissions and 226Hz and 1kHz tympanometry, has allowed us to diagnose otitis media with effusion in young infants more accurately than each test separately. We recommend initial use of 1kHz tympanometry, at least in children younger than 7 months, but in the presence of hearing loss or an unclear result, 226Hz tympanometry is a good diagnostic complement.

Conducto petromastoideo / Petromastoid canal

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Schwannoma múltiple del nervio facial intraparotídeo / Intraparotid multiple facial nerve schwannoma

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La gestión enfermera del estudio genético de la hipoacusia / The nurse played by the nurse in the genetic testing of hypoacusia

Durante el año 2001, a raíz del inicio en el Hospital Clínico Universitario de Valladolid de un programa de cribado auditivo universal de la hipoacusia congénita, se incluyó el diagnóstico genético como parte del protocolo de estudio etiológico. La citación y realización de las pruebas audiológicas a los pacientes guía y a sus familiares, la tramitación de solicitudes, el registro de datos y el intercambio de información con las unidades de genética, complicaban de tal manera la realización de este estudio diagnóstico que ponían en peligro su viabilidad. A partir del año 2008 el proceso se centralizó en una consulta gestionada por un profesional de Enfermería y especializada en técnicas audiológicas, que cuenta con el apoyo de un médico especialista en otorrinolaringología(ORL).En este trabajo se presenta el procedimiento que se lleva a cabo para el diagnóstico genético de la hipoacusia y los resultados obtenidos desde su inicio, que muestran la importancia de realizar este estudio, por la frecuencia y posibilidades terapéuticas que pueden derivarse y de disponer de una consulta de este tipo que lo facilite (AU)

In 2001, following the initiation at the Valladolid University Hospital of a universal hearing screening program for congenital hearing loss, genetic diagnosis was included as part of the etiologic study protocol. The shcedulling and implementation of audiological tests for patients and their families, the processing of applications, data recording and exchange of information with the genetic units, complicated so much the conductance of this diagnostic study that it endangered its viability. Since 2008 the process was centralized in a consultation visit managed by a nursing professional specialized in audiological techniques, under the support of a specialist in ENT. This paper presents the procedure that is carried out for genetic diagnosis of hearing loss and the results obtained since its initiation, which show the importance of this study, due to the frequency and therapeutic possibilities that arise from the availability of having such consultation office (AU)

Lipoma laríngeo asociado a enfermedad de Madelung: a propósito de un caso / Laryngeal lipoma associated with Madelung’s disease: a case report

La lipomatosis cervical múltiple es una alteración del depósito graso cervical, parte alta de tórax y extremidades superiores que genera un problema estético y eventualmente cuadros obstructivos de la vía respiratoria en aquellos casos de infiltración grasa de la laringe. Presentamos el caso de un hombre con enfermedad de Madelung y cuadro disneico agudo por infiltración grasa laríngea y lipoma obstructivo (AU)

Multiple symmetric lipomatosis is an alteration in the neck, upper trunk and upper extremities fat deposits. It produces an aesthetic problem and sometimes upper airway obstruction when the larynx is infiltrated by the mass. We report the case of a male with Madelung's disease, which began with acute dyspnea caused by laryngeal fat deposits and obstructive lipoma (AU)

Laryngeal lipoma associated with Madelung's disease: a case report.

Multiple symmetric lipomatosis is an alteration in the neck, upper trunk and upper extremities fat deposits. It produces an aesthetic problem and sometimes upper airway obstruction when the larynx is infiltrated by the mass. We report the case of a male with Madelung's disease, which began with acute dyspnea caused by laryngeal fat deposits and obstructive lipoma.

Pólipo hamartomatoso de la hipofaringe / Hamartomatous polyp of the hypopharynx

Presentamos el caso clínico de una mujer de mediana edad a la que se le descubre de forma casual, practicándole una endoscopia digestiva, una formación polipoide en hipofaringe. La extirpación tumoral por vía endoscópica reveló el diagnóstico histológico de hamartoma. Revisamos los procedimientos diagnósticos y terapéuticos utilizados en esta rara entidad (AU)

We present the clinical case of a polyp in the hypopharynx discovered incidentally while performing an upper digestive endoscopy in a middle aged woman. Endoscopic resection was performed, and the histological result was a hamartomatous polyp. We review the diagnosis and treatment of this rare entity (AU)

[Hamartomatous polyp of the hypopharynx]. / Pólipo hamartomatoso de la hipofaringe.

We present the clinical case of a polyp in the hypopharynx discovered incidentally while performing an upper digestive endoscopy in a middle aged woman. Endoscopic resection was performed, and the histological result was a hamartomatous polyp. We review the diagnosis and treatment of this rare entity.

Síndrome de sonda nasogástrica: a propósito de un caso / Nasogastric tube syndrome: a case report

El síndrome de la sonda nasogástrica (NTS) es una complicación infrecuente del sondaje nasogástrico que por ulceración e infección postcricoidea provoca una disfunción en la abducción de las cuerdas vocales que puede comprometer la vía aérea. Debemos pensar en esta patología en todo paciente con sondaje nasogástrico prolongado que comience con dolor faríngeo de moderada intensidad. Presentamos el caso de una mujer de 70 años ingresada en el Servicio de Neurología de nuestro hospital por un accidente isquémico cerebral que, tras un sondaje nasogástrico prolongado, presenta un cuadro agudo de disnea que requirió traqueotomía de urgencia (AU)

Nasogastric tube syndrome (NTS) is an uncommon complication of an indwelling nasogastric tube. Ulceration and infection in the posterior cricoid region causes dysfunction in the abduction of the vocal cords and may seriously compromise patients’ airway. This pathology should be considered in patients with prolonged nasogastric intubation who start with moderate pharyngeal pain. We report a case of a 70 year-old woman, admitted to the Neurology department of our centre due to an ischaemic cerebral accident who presented acute dyspnoea requiring emergency tracheotomy following prolonged nasogastric intubation (AU)

Nasogastric tube syndrome: a case report.

Nasogastric tube syndrome (NTS) is an uncommon complication of an indwelling nasogastric tube. Ulceration and infection in the posterior cricoid region causes dysfunction in the abduction of the vocal cords and may seriously compromise patients' airway. This pathology should be considered in patients with prolonged nasogastric intubation who start with moderate pharyngeal pain. We report a case of a 70 year-old woman, admitted to the Neurology department of our centre due to an ischaemic cerebral accident who presented acute dyspnoea requiring emergency tracheotomy following prolonged nasogastric intubation.

Calcificación de la epiglotis / Calcification of the epiglottis

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[Results of applying a universal protocol for early detection of hypoacusia in newborn infants for 42 months]. / Resultados de aplicar durante 42 meses un protocolo universal de detección e intervención precoz de la hipoacusia en neonatos.

INTRODUCTION AND OBJECTIVES: We present the results from applying over a period of three and a half years a universal newborn hearing screening programme aimed at the early detection of hearing loss. Our goal has been to diagnose and treat all unilateral or bilateral permanent hearing losses > or =40 dB nHL. METHODS: The detection strategy consists of two screening phases with transient evoked otoacoustic emissions (TEOAE) and one diagnostic phase with auditory brainstem responses (ABR). ABR tests were performed on newborns "not passing" the TEOAE screening, as well as those with risk factors for hearing loss. RESULTS: Of 4568 live newborns (NB), we evaluated 97.6 %. Of these, 3.7 % presented risk factors for hearing loss. The first TEOAE was "passed" in both ears by 91.7 % of the newborns; after the second TEOAE, only 1.3 % of cases were referred to the diagnostic phase. We detected 2.7/1000 cases of severe/profound bilateral hearing loss. CONCLUSIONS: This programme was designed for early application of appropriate treatment. Although it is possible to reach the objectives of screening and diagnosis of newborn hearing loss, the intervention stage is much more complicated. This is because intervention depends on different disciplines that must act in co-ordination, as well as multiple environmental and family factors that are difficult to control. Therapeutic effectiveness still remains our challenge and a motive for discussion in fully justifying early congenital hearing loss screening programmes.