Cambios olfatorios en pacientes con rinosinusitis crónica polipoidea tratados mediante cirugía endoscópica nasosinusal (CENS) / Olfactory changes in patients with chronic polypoid rhinosinusitis treated with functional endoscopic sinus surgery (FESS) / Mudanças olfativas em pacientes com rinossinusite crônicapolipóide tratados mediante cirurgia endoscópica nasosinusal (Cens)

Introducción y objetivos: La poliposis nasal se encuentra presente en el 4% de la población general y entre el 25-30% de aquellos con rinosinusitis crónica. La presencia de pólipos nasales es un importante factor de riesgo para alteraciones en el olfato. Objetivo: establecer si existe mejoría del olfato en pacientes con poliposis nasal luego de ser intervenidos quirúrgicamente con cirugía endoscópica nasosinusal. Métodos: Se tomó una muestra de 20 pacientes con rinosinusitis crónica polipoidea tratados mediante cirugía oscópica nasosinusal por un mismo cirujano, con follow up a 30 días en los que se examinó el nivel de olfato pre y postoperatorio mediante el método del Connecticut Chemosensory Clinical Research Center. Se evaluó prequirúrgicamente el grado de poliposis mediante el score tomográfico de Lund McKay. Resultados: Aumento del puntaje de olfato en pacientes con poliposis nasal luego de la polipectomía con cirugía endoscópica nasosinusal (p<0,0001). Relación lineal entre el score tomográfico preoperatorio y el grado de mejoría del olfato (p<0,05). Conclusiones: Existe mejoría del olfato en paciente con rinosinusitis crónica polipoidea luego del tratamiento de esta patología con cirugía endoscópica nasosinusal. Se observó, también, que a mayor grado de poliposis preoperatoria, mayor es la mejoría del olfato postoperatorio.

Introduction and objectives: nasal polyposis affects 4% of the general population and 25% - 30% of pa tients with chronic rhinosinusitis. The presence of nasal polyps poses a significant risk of developing olfaction disorders. The aim of this study is to determine whether patients with nasal polyps show any olfactory improvement after treatment with functional endoscopic sinus surgery. Methods: 20 patients were examined. All of them suffered from chronic rhinosinusitis with polyps and were treated with functional endoscopic sinus surgery by the same surgeon. A 30-day follow-up was conducted, studying the patients’ pre-and-post-operative/ surgery olfaction levels through the method of the Connecticut Chemosensory Clinical Research Center. Polyposis was staged preoperatively, using the Tomographic Lund McKay scale with scores ranging from 0 to 24, depending on the occupation of the paranasal sinuses and the osteomeatal complex. We excluded patients under 15 years old, patients having chronic rhinosinusitis without polyps, patients who had undergone repeated surgery due to relapse and patients with comorbidities, including mucoviscidosis, brain degenerative diseases and cilium diseases. Results: There was an improvement of the olfactory level after the Functional Endoscopic Sinus Surgery patients suffering from chronic rhinosinusitis with nasal polyps. We concluded that the higher the tomographic Lund-McKay score, the better the olfaction after the surgery.

Introdução e objetivos: A polipose nasal está presente em 4% da população geral e entre 25%-30% das pessoas com rinossinusite crônica. A presença de pólipos nasais é um importante fator de risco para alterações no olfato. Objetivo: estabelecer se existe melhora do olfato em pacientes com polipose nasal após intervenção cirúrgica com endoscopia nasossinusal. Métodos: Considerou-se uma amostra de 20 pacientes com rinossinusite crônica polipóide tratados mediante cirurgia endoscópica nasossinusal pelo mesmo cirurgião, com acompanhamento 30 dias após a cirurgia, nos quais foi examinado o nível de olfato antes e depois da operação com o método do Connecticut Chemosensory Clinical Research Center. Avaliou-se antes da cirurgia o grau de polipose com um score tomográfico de Lund McKay. Resultados: Aumento da pontuação de olfato em pacientes com polipose nasal após a polipectomia com cirurgia endoscópica nasossinusal (p<0,0001) . Relação linear entre o score tomográfico pré-operatório e o grau de melhora do olfato (p<0,05). Conclusões: Existe uma melhora de olfato em pacientes com rinossinusite crônica polipoide após o tratamento desta patologia com cirurgia endoscópica nasossinusal. Observou-se também que quanto maior o grau de polipose pré-operatória, maior é a melhora do olfato pós-operatório.

[Mucormycosis. Clinical cases and update]. / Mucormicosis revisión de casos y actualización.

Mucormycosis is an emerging mycotic infection with high mortality. We described the clinical presentation, evolution and treatment of 5 patients with diagnosis of mucormycosis.

La mucormicosis es una micosis emergente, de elevada mortalidad. El objetivo del estudio es presentar las características clínicas y evolución de los casos asistidos en el Sanatorio Allende, de la Ciudad de Córdoba República Argentina y hacer una actualización bibliografíca. Se presentan 5 pacientes con mucormicosis con diferentes formas clínicas de presentación. El diagnóstico clínico se confirmó por histopatología y/o cultivo de los tejidos. Concluimos que en la actualidad la sospecha clínica basada en la forma de presentación y los factores de riesgo siguen siendo claves para establecer la sospecha clínica y realizar el diagnóstico temprano. En cuanto al tratamiento se basa fundamentalmente en el desbridamiento quirúrgico para eliminación del tejido necrótico y Anfotericina liposomal como antifúngico de elección. El posaconazol nuevo triazol tendría un rol importante en la consolidación del tratamiento una vez que el paciente logra la estabilización clínica o como tratamiento de rescate.

Influencia de la premedicación con esteroides sistémicos en el sangrado y visualización del campo quirúrgico durante la cirugía endoscópica nasosinusal / Effect of premedication with systemic steroids on surgical field bleeding and visibility during nasosinusal endoscopic surgery

Introducción: La rinosinusitis crónica (RSC) es la inflamación de la mucosa nasal y senos paranasales de más de 12 semanas de evolución. El éxito de la cirugía endoscópica nasosinusal (CENS) para su tratamiento depende de la correcta orientación anatómica en la región, para lo cual es vital la minimización del edema y sangrado intraoperatorio. Con este fin algunos cirujanos consideran el uso de corticosteroides sistémicos (CS) preoperatorios.El objetivo de este trabajo es determinar si el uso de CS administrados preoperatorios en pacientes con RSC con o sin poliposis nasal (PN) mejora las condiciones operatorias. Material y métodos: Ensayo clínico controlado, no aleatorizado, en pacientes con RSC con o sin PN sometidos a CENS. Al primer grupo (CS) se le administró meprednisona por vía oral antes de la CENS. Los pacientes del grupo control no recibieron CS. Se analizaron campo quirúrgico, volumen total de sangre aspirada y duración total de la cirugía. Resultados: Se incluyeron 27 pacientes en cada grupo. En pacientes con RSC sin PN la administración de corticoides disminuyó los valores de todos los parámetros en estudio, sin encontrar diferencia significativa para ninguno de ellos. En el grupo con PN solo fue estadísticamente significativa la diferencia entre el sangrado intraoperatorio. Conclusión: Si bien los valores de todos los parámetros estudiados se encuentran disminuidos en alguna medida con la administración de glucocorticoides preoperatorios, solo existe una diferencia significativa con relación al sangrado intraoperatorio de pacientes con RSC con PN (AU)

Introduction: Chronic rhinosinusitis (CRS) is the inflammation of the nasal and paranasal sinus mucosa persisting for at least 12 weeks. The success of endoscopic sinus surgery (ESS) depends on minimising oedema and intraoperative bleeding. For this purpose, some surgeons advocate the use of preoperative systemic steroids (SS).Our aim was to assess if the administration of preoperative SS in patients with CRS with or without nasal polyps (NP) facilitates the surgical procedure. Methods: Non-randomized clinical trial in CRS patients with or without NP. Patients in the ESS group received oral meprednisone preoperatively, whereas the control group did not. The visibility of the surgical field, intraoperative bleeding and surgery duration were recorded. Results: Each group (SS group and control group) included 27 patients. The administration of SS reduced the values of all the parameters in patients without NP, with no significant differences. In patients with NP, only operative bleeding was reduced significantly. Conclusions: Even though all the parameters decreased with the preoperative administration of SS, only operative bleeding was significantly reduced in patients with CRS with NP (AU)

Effect of premedication with systemic steroids on surgical field bleeding and visibility during nasosinusal endoscopic surgery.

INTRODUCTION: Chronic rhinosinusitis (CRS) is the inflammation of the nasal and paranasal sinus mucosa persisting for at least 12 weeks. The success of endoscopic sinus surgery (ESS) depends on minimising oedema and intraoperative bleeding. For this purpose, some surgeons advocate the use of preoperative systemic steroids (SS). Our aim was to assess if the administration of preoperative SS in patients with CRS with or without nasal polyps (NP) facilitates the surgical procedure. METHODS: Non-randomized clinical trial in CRS patients with or without NP. Patients in the ESS group received oral meprednisone preoperatively, whereas the control group did not. The visibility of the surgical field, intraoperative bleeding and surgery duration were recorded. RESULTS: Each group (SS group and control group) included 27 patients. The administration of SS reduced the values of all the parameters in patients without NP, with no significant differences. In patients with NP, only operative bleeding was reduced significantly. CONCLUSIONS: Even though all the parameters decreased with the preoperative administration of SS, only operative bleeding was significantly reduced in patients with CRS with NP.

Utilidad de fibrolaringoscopía en la disfonía por tensión muscular en teleoperadores / The use of fibrolaryngoscopy in muscle tension dysphonia in telemarketersla

Introducción: La disfonía por tensión muscular (DTM) es una alteración de la voz en ausencia de patología laríngea orgánica, y sin alteraciones neurológicas o psicológicas evidentes. El hiatus posterior y la actividad supraglótica hipertónica son considerados como las manifestaciones fibrolaringoscópicas típicas de DTM, sin embargo, todavía permanece poco claro si estos patrones son específicos de esta patología. El objetivo principal de este estudio fue comparar los hallazgos fibrolaringoscópicos entre pacientes teleoperadores con DTM versus individuos sin síntomas vocales. Como objetivo secundario se persiguió describir las características personales, laborales y clínicas del grupo de teleoperadores. Métodos: Estudio observacional, analítico y transversal. Se reclutaron 57 pacientes (28 de DTM y 29 del grupo control) a los cuales se les realizó una fibrolaringoscopia, catalogados a ciegas por un laringólogo experto en función de la clasificación de Morrison y Rammage modificada. Además se llevó a cabo un cuestionario a ambos grupos acerca de antecedentes personales y laborales. Resultados: El hiatus posterior fue más prevalente en teleoperadores con DTM, mientras que en el grupo control lo fue el hiatus longitudinal. Más del 70% de las fibroscopias del grupo control fueron informadas como patológicas. La contracción supraglótica antero-posterior fue más frecuente en pacientes sanos. Los síntomas más relatados fueron fonastenia, tensión en musculatura del cuello y esfuerzo vocal aumentado. Conclusión: La heterogeneidad en los patrones fibroscópicos laríngeos en teleoperadores con DTM, así como su presencia en personas sanas, sugiere que los mismos en forma aislada no pueden establecer el diagnóstico de DTM(AU)

Introduction: Muscle tension dysphonia (MTD) is a voice disorder in the absence of current organic laryngeal pathology, without obvious psychogenic or neurological aetiology. The laryngeal features of MTD include a posterior glottal gap and supraglottic hyperfunctional activities; however, it remains unclear if these features are specific to MTD. This report aims to compare the laryngeal features in telemarketer patients with MTD versus non-dysphonic control subjects. Methods: We reported on an observational, analytic and transversal study. Fiberoptic nasal endoscopy was performed on 57 patients (28 telemarketers with MTD and 29 control subjects). These random-sequence videotapes were independently rated by an expert laryngologist according to the modified Morrison and Rammage classification. In addition, a questionnaire about vocal symptoms and other details was completed. Results: The posterior glottal gap was the most common feature in telemarketers with MTD, while incomplete glottal gap was observed more frequently in non-dysphonic patients. More than 70% of the videotapes were rated as pathologic. There was no statistical difference in the prevalence of normal features or bowing glottal gap between patients and control subjects. Anterior-posterior supraglottic contraction was more frequent in the control group. The major symptoms found were: voice gets tired quickly, increased vocal effort and neck tension. Conclusions: The heterogeneity in the laryngeal features in telemarketers with MTD seen under fibroscopy and their presence among the non-dysphonic population suggest that they cannot determine by themselves the diagnosis of MTD(AU)

[The use of fibrolaryngoscopy in muscle tension dysphonia in telemarketers]. / Utilidad de la fibrolaringoscopía en la disfonía por tensión muscular en teleoperadores.

INTRODUCTION: Muscle tension dysphonia (MTD) is a voice disorder in the absence of current organic laryngeal pathology, without obvious psychogenic or neurological aetiology. The laryngeal features of MTD include a posterior glottal gap and supraglottic hyperfunctional activities; however, it remains unclear if these features are specific to MTD. This report aims to compare the laryngeal features in telemarketer patients with MTD versus non-dysphonic control subjects. METHODS: We reported on an observational, analytic and transversal study. Fiberoptic nasal endoscopy was performed on 57 patients (28 telemarketers with MTD and 29 control subjects). These random-sequence videotapes were independently rated by an expert laryngologist according to the modified Morrison and Rammage classification. In addition, a questionnaire about vocal symptoms and other details was completed. RESULTS: The posterior glottal gap was the most common feature in telemarketers with MTD, while incomplete glottal gap was observed more frequently in non-dysphonic patients. More than 70% of the videotapes were rated as pathologic. There was no statistical difference in the prevalence of normal features or bowing glottal gap between patients and control subjects. Anterior-posterior supraglottic contraction was more frequent in the control group. The major symptoms found were: voice gets tired quickly, increased vocal effort and neck tension. CONCLUSIONS: The heterogeneity in the laryngeal features in telemarketers with MTD seen under fibroscopy and their presence among the non-dysphonic population suggest that they cannot determine by themselves the diagnosis of MTD.