Documento de consenso de la Sociedad Española de Medicina Intensiva, Crítica, y Unidades Coronarias (SEMICYUC), la Sociedad Española de Otorrinolaringología y Cirugía de Cabeza y Cuello (SEORL-CCC) y la Sociedad Española de Anestesiología y Reanimación (SEDAR) sobre la traqueotomía en pacientes con COVID-19 / Consensus Document of the Spanish Society of Intensive and Critical Care Medicine and Coronary Units (SEMICYUC), the Spanish Society of Otorhinolaryngology and Head and Neck Surgery (SEORL-CCC) and the Spanish Society of Anesthesiology and Resuscitation (SEDAR) on Tracheotomy in Patients with COVID-19 Infection

La alta incidencia de insuficiencia respiratoria aguda en el contexto de la pandemia por COVID-19 ha conllevado el uso de ventilación mecánica hasta en un 15%. Dado que la traqueotomía es un procedimiento quirúrgico frecuente, este documento de consenso, elaborado por 3 Sociedades Científicas, la SEMICYUC, la SEDAR y la SEORL-CCC, tiene como objetivo ofrecer una revisión de las indicaciones y contraindicaciones de traqueotomía, ya sea por punción o abierta, esclarecer las posibles ventajas y exponer las condiciones ideales en que deben realizarse, y los pasos que considerar en su ejecución. Se abordan situaciones regladas y urgentes, así como los cuidados postoperatorios

The current COVID-19 pandemic has rendered up to 15% of patients under mechanical ventilation. Because the subsequent tracheotomy is a frequent procedure, the three societies mostly involved (SEMICYUC, SEDAR and SEORL-CCC) have setup a consensus paper that offers an overview about indications and contraindications of tracheotomy, be it by puncture or open, clarifying its respective advantages and enumerating the ideal conditions under which they should be performed, as well as the necessary steps. Regular and emergency situations are displayed together with the postoperative measures

Consensus Document of the Spanish Society of Intensive and Critical Care Medicine and Coronary Units (SEMICYUC), the Spanish Society of Otorhinolaryngology and Head and Neck Surgery (SEORL-CCC) and the Spanish Society of Anesthesiology and Resuscitation (SEDAR) on Tracheotomy in Patients with COVID-19 Infection. / Documento de consenso de la Sociedad Española de Medicina Intensiva, Crítica, y Unidades Coronarias (SEMICYUC), la Sociedad Española de Otorrinolaringología y Cirugía de Cabeza y Cuello (SEORL-CCC) y la Sociedad Española de Anestesiología y Reanimación (SEDAR) sobre la traqueotomía en pacientes con COVID-19.

The current COVID-19 pandemic has rendered up to 15% of patients under mechanical ventilation. Because the subsequent tracheotomy is a frequent procedure, the three societies mostly involved (SEMICYUC, SEDAR and SEORL-CCC) have setup a consensus paper that offers an overview about indications and contraindications of tracheotomy, be it by puncture or open, clarifying its respective advantages and enumerating the ideal conditions under which they should be performed, as well as the necessary steps. Regular and emergency situations are displayed together with the postoperative measures.

[Consensus document of the Spanish Society of Intensive and Critical Care Medicine and Coronary Units (SEMICYUC), the Spanish Society of Otorhinolaryngology and Head and Neck Surgery (SEORL-CCC) and the Spanish Society of Anesthesiology and Resuscitation (SEDAR) on tracheotomy in patients with COVID-19 infection]. / Documento de consenso de la Sociedad Española de Medicina Intensiva, Crítica y Unidades Coronarias (SEMICYUC), la Sociedad Española de Otorrinolaringología y Cirugía de Cabeza y Cuello (SEORL-CCC) y la Sociedad Española de Anestesiología y Reanimación (SEDAR) sobre la traqueotomía en pacientes con COVID-19.

The current COVID-19 pandemic has rendered up to 15% of patients under mechanical ventilation. Because the subsequent tracheotomy is a frequent procedure, the three societies mostly involved (SEMICYUC, SEDAR and SEORL-CCC) have setup a consensus paper that offers an overview about indications and contraindications of tracheotomy, be it by puncture or open, clarifying its respective advantages and enumerating the ideal conditions under which they should be performed, as well as the necessary steps. Regular and emergency situations are displayed together with the postoperative measures.

Carcinoma de Merkel nasal con biopsia del ganglio centinela y reconstrucción con colgajo frontal / Merkel cell carcinoma of the nose with sentinel lymph node biopsy and reconstruction with frontal flap

El carcinoma de células de Merkel (CM) es una neoplasia neuroendocrina agresiva, en la que está indicada la biopsia del ganglio centinela (BGC) para una correcta estadificación ganglionar regional. El tratamiento habitual del CM es la resección quirúrgica amplia con radioterapia adyuvante, reservandola quimioterapia para casos recurrentes o diseminados. Presentamos el caso de un varón de 83 años con un CM nasal, al que se realizó una BGC, una resección nasal subtotal y reconstrucción con colgajo frontal para mediano (AU)

Merkel cell carcinoma (MCC) is an aggressive neuroendocrine neoplasm in which sentinel lymph node biopsy (SLNB) is indicated to perform the correctregional staging. The usual treatment is surgery with wide margins and adjuvant radiation therapy, while systemic chemotherapy is reserved for recurrentor disseminated disease. We present the case of an 83 year old man with a MCC of the nose, in which a SLNB, subtotal excision of the nose and reconstruction with a paramedian forehead flap was done (AU)

[Delayed vertigo after stapedotomy with good hearing results]. / Vértigo diferido tras estapedotomía con buen resultado auditivo.

Stapedial surgery is able to obtain excellent hearing results in the long-term in most otosclerotic patients. Nevertheless, some cases have vertigo and/or tinnitus after surgery, that may lead them to revision surgery. Out of a consecutive series on 115 patients, we present three cases (2,6%) with persistent vertigo after stapedotomy. These patients had residual unsteadiness despite good hearing after surgery, with a minimum follow-up of 12 months. Videonystagmography showed spontaneous nystagmus towards the contralateral ear in one case, whereas the other two had a canalicular paresis in the operated side, signs of vestibular hypofunction. After vestibular rehabilitation, unsteadiness resolved in all cases, with good spontaneous compensation, without any further surgery.

Vértigo diferido tras estapedotomía con buen resultado auditivo / Delayed vertigo after stapedotomy with good hearing results

La cirugía del estribo consigue Buenos resultados auditivos a largo plazo en la mayoría de los pacientes con otosclerosis. Sin embargo, existen pacientes que sufren debutan cono tros síntomas como vértigo o acúfenos tras la cirugía, que pueden ser la causa de revisión. De una serie de 115 pacientes, presentamos tres casos (2,6%) de vértigo persistente en pacientes intervenidos de estapedotomía. Se trata de pacientes que padecen inestabilidad residual tras estapedotomía con buena ganancia auditiva, tras un seguimiento mínimo de doce meses. En uno de ellos, la videonistagmografía evidenciaba la presencia de nistagmo espontáneo hacia el oido no operado, mientras que en los otros dos demostraba una paresia canalicular del lado operado, todo ellos signos de hipofunción vestibular. Tras seguimiento y rehabilitación vestibular, la inestabilidad se resolvió en todos los casos, con buena compensación espontánea, sin necesidad de revisión quirúrgica. Realizamos una revisión de la fisiopatología del vértigo posoperatorio en la cirugía del estribo, especialmente en aquellos casos en los que existe ganancia auditiva

Stapedial surgery is able to obtain excellent hearing results in the long term in most otosclerotic patients. Neverthless, some cases have vertigo and/or tinnitus after surgery, that may lead them to revision surgery. Out of a consecutive series on 115 patients, we present three cases (2,6%) with persistent vertigo after stapedotomy. These patients had residual unsteadiness despite good hearing after surgery, with a minimum follow-up of 12 months. Videonystagmography showed spontaneous nystagmus towards the contralateral ear in one case, whereas the other two had a canalicular paresis in the operated side, signs of vestibular hypofunction. After vestibular rehabilitation, unsteadiness resolved in all cases, with good spontaneous compensation, without any further surgery. We review the physiopathology of postoperative vertigo alter stapedial surgery, especially in those cases with good hearing recovery

[Neuro-otological manifestations as presentacion of type I Chiari malformation]. / Manifestaciones otoneurológicas como presentación de la malformación de Chiari tipo I.

The type I Chiari malformation consists of an caudal descent of the cerebellar tonsils through the foramen magno towards the spinal cervical channel. The usual clinical presentation are occipital headaches and cervical pain, as well as some otoneurological symptoms. Among them are common dizziness and crisis of central positional vertigo in which down beating nystagmus can be observed. We present our experience with three cases presenting with neurotological manifestations in which MRI showed a type I Chiari malformation. Case 1: a patient of 24 years that had frequent instability, and common crisis ofpositional vertigo. It was possible to see the presence of positional down-beating nystagmus, of central characteristics, that improved after neurosurgical treatment. Case 2: patient of 11 years who suffered from occasional headaches, dizziness and positional vertigo, without severe handicap, and did not need surgery. Case 3: lady of 63 years who had common episodes of vertigo with head tilt, and unsteadiness during walks. Due to the coexistence of hydrocephalus and syringomyelia, surgery was indicated. A revision is done on otoneurological presentation of type I Chiari malformation, especially as differential diagnosis on central positional vertigo.

Manifestaciones otoneurológicas como presentación de la malformación de Chiari tipo I / Neurotological manifestation as presentation of type 1 Chiari malformation

La malformación de Chiari tipo I consiste en un desplazamiento caudal de las amígdalas cerebelosas a través del foramen magno hacia el canal cervical espinal. La presentación clínica habitual de esta anomalía son las cefaleas y dolores cervicales, así como algunos síntomas otoneurológicos. Entre ellos son comunes los cuadros de inestabilidad y episodios de vértigo posicional central en los que se objetiva nistagmo vertical hacia abajo. Presentamos nuestra experiencia en tres casos con alteraciones otoneurológicas en los que la resonancia magnética craneal demostró el diagnóstico de malformación de Chiari tipo I. En primer lugar, una paciente de 24 años que consultó por un cuadro de inestabilidad habitual y frecuentes episodios de vértigo posicional, en los que presentaba nistagmo posicional hacia abajo, que mejoraron tras tratamiento neuroquirúrgico. En segundo lugar, un paciente de 11 años que presentó episodios esporádicos de cefalea, asociada a inestabilidad y vértigo posicional, sin incapacidad evidente, por lo que no se derivó para tratamiento quirúrgico. En tercer lugar, una paciente de 63 años que padecía crisis de vértigo con los movimientos cefálicos, así como inestabilidad en la marcha. Ante la coexistencia de hidrocefalia y siringomielia, se derivó a la paciente para tratamiento neuroquirúrgico. Realizamos una revisión de las alteraciones otoneurológicas con las que puede presentarse la malformación de Chiari tipo 1, especialmente como diagnóstico diferencial dentro de los cuadros de vértigo posicional central

The type I Chiari malformation consists of an caudal descent of the cerebellar tonsils through the foramen magno towards the spinal cervical channel. The usual clinical presentation are occipital headaches and cervical pain, as well as some otoneurological symptoms. Among them are common dizziness and crisis of central positional vertigo in which down beating nystagmus can be observed. We present our experience with three cases presenting with neurotological manifestations in which MRI showed a type I Chiari malformation. Case 1: a patient of 24 years that had frequent instability, and common crisis of positional vertigo. It was possible to see the presence of positional down-beating nystagmus, of central characteristics, that improved after neurosurgical treatment. Case 2: patient of 11 years who suffered from occasional headaches, dizziness and positional vertigo, without severe handicap, and did not need surgery. Case 3: lady of 63 years who had common episodes of vertigo with head tilt, and unsteadiness during walks. Due to the coexistence of hydrocephalus and syringomyelia, surgery was indicated. A revision is done on otoneurological presentation oftype I Chiari malformation, especially as differential diagnosis on central positional vertigo

[Pseudohypertrophy of the ventricular bands due to deformation of the thyroid cartilage]. / Pseudohipertrofia de bandas ventriculares por deformación del cartílago tiroides.

Hoarseness due to phonation by the false cords (dysphonia plicae ventricularis) is a common cause of functional dysphonia, in relation to excessive muscular tension in the larynx area. Nevertheless, a mechanic cause can be observed in some cases with dysphonia plicae ventricularis, which is usually due to deformation of the thyroid cartilage. We report a case with hypertrophy of the ventricular bands which was treated by vocal rehabilitation followed by suspension laryngoscopy with partial removal of the ventricular bands, without further improvement. This failure was related to a pseudohypertrophy of the ventricular bands, due to deformation of the thyroid cartilage, which was confirmed by computed tomography.

Otalgia como presentación de tuberculosis primaria de nasofaringe / Otalgia as presentation of primary nasopharinx tuberculosis

Presentamos una paciente de 63 años que padecía otalgia izquierda de más de seis meses de evolución. A la exploración, la otoscopia era normal, mientras que la fibroscopia nasal demostró una asimetría en la nasofaringe. La TC confirmó la presencia de una masa nasofaríngea izquierda. Se realizó una exéresis endoscópica de la lesión nasofaríngea. La anatomía patológica demostró una granulomatosis necrotizante, aunque no fue posible hallar bacilos ácido-alcohol resistentes. Se consideró el diagnóstico de tuberculosis nasofaríngea. Tras 36 meses de seguimiento, la endoscopia nasal y la TC no demuestran signos de recidiva. La discusión se centra en la inclusión de la patología nasofaríngea en el diagnóstico diferencial de las otalgias, el diagnóstico histopatológico de los granulomas y la indicación de tratamiento antituberculoso en casos limitados de tuberculosis extrapulmonar

We report a case of a 63 year-old woman who presented with left otalgia during more than six months. On examination, otoscopy was normal, whereas flexible nasopharyngoscopy revealed an asymmetry in the nasopharynx. CT scans confirmed the presence of a left nasopharyngeal mass. A transnasal endoscopic removal of the nasopharyngeal lesion was performed. Necrotizing granulomatosis was found. Tuberculosis of the nasopharynx was considered the final diagnosis, but oral treatment was not started. After 36 months of follow-up, nasal endoscopy and CT images show no sign of recurrence. Discussion is focused on the inclusion of nasopharyngeal diseases in otalgia differential diagnosis, histopathological diagnosis of granulomas and the need of any further treatment for these limited cases of extrapulmonary tuberculosis

Pseudohipertrofia de bandas ventriculares por deformación del cartílago tiroides / Pseudohypertrophy of the ventricular bands due to deformation of the thyroid cartilage

La disfonía por hipertrofia de las bandas ventriculares (disfonia plicae ventricularis) es una causa frecuente de disfonía funcional, relacionada con una tensión muscular excesiva en la región laríngea. Sin embargo, en algunos pacientes puede objetivarse una causa mecánica para dicha disfonía funcional por hipertrofia de bandas, que suele tratarse de una deformidad del cartílago tiroides. Presentamos un caso de hipertrofia de bandas ventriculares que fue tratado mediante foniatría, seguida de laringoscopia directa y microcirugía endolaríngea, con exéresis parcial de las mismas, sin mejoría. Dicho fracaso estaba en relación con una pseudohipertrofia de bandas por deformidad del cartílago tiroides, que fue confirmada en tomografia computarizada

Hoarseness due to phonation by the false cords (dysphonia plicae ventricularis) is a common cause of functional dysphonia, in relation to excessive muscular tension in the larynx area. Nevertheless, a mechanic cause can be observed in some cases with dysphonia plicae ventricularis, which is usually due to deformation of the thyroid cartilage. We report a case with hypertrophy ofthe ventricular bands which was treated by vocal rehabilitation followed by suspension laryngoscopy with parti al removal of the ventricular bands, without further improvement. This failure was related to a pseudohypertrophy ofthe ventricular bands, due to deformation of the thyroid cartilage, which was confirmed by computed tomography

[Otalgia as presentation of primary nasopharynx tuberculosis]. / Otalgia como presentación de tuberculosis primaria de nasofaringe.

We report a case of a 63-year-old woman who presented with left otalgia during more than six months. On examination, otoscopy was normal, whereas flexible nasopharyngoscopy revealed an asymmetry in the nasopharynx. CT scans confirmed the presence of a left nasopharyngeal mass. A transnasal endoscopic removal of the nasopharyngeal lesion was performed. Necrotizing granulomatosis was found. Tuberculosis of the nasopharynx was considered the final diagnosis, but oral treatment was not started. After 36 months of follow-up, nasal endoscopy and CT images show no sign of recurrence. Discussion is focused on the inclusion of nasopharyngeal diseases in otalgia differential diagnosis, histopathological diagnosis of granulomas and the need of any further treatment for these limited cases of extrapulmonary tuberculosis.

[The use of magnetic resonance in the study of sensorineural hearing loss in children]. / Utilidad de la rm en el estudio de la hipoacusia neurosensorial unilateral infantil.

Although newborn screening of congenital hearing loss through otoacustic emissions allow prompt recognition, imaging techniques, such as CT and MRI are needed to get a morphological diagnosis. Furthermore they can be very useful in unilateral cases, whose clinical presentation is belated and more insidious. Our aim is to show the utility of MRI in the study of inner ear congenital anomalies, whose presentation is belated. Thus from a series of 88 consecutive patients in which a MRI was performed as screening of assymetric sensorineural hearing loss, we selected 6 cases aged between 6 and 20. Four of them showed an inner ear anomaly on MRI. We present these anomalies commenting the findings on CT and MRI. Imaging techniques are required to start hearing rehabilitation programs early on patients with bilateral inner ear anomalies. But also they are very useful in the evaluation of unilateral assymetric sensorineural hearing loss, in young patients, even if only some frequencies are damned, to determine the nature of hearing loss.

Alteraciones del olfato en la consulta ORL general / Olfaction disturbances in general ORL practice

Revisión de las alteraciones olfatorias de los pacientes de una consulta de ORL en un hospital general cuando éste es el motivo fundamental de consulta. Es un estudio retrospectivo y descriptivo. Incluimos en el estudio todos los pacientes con alteraciones del olfato como principal motivo de consulta. La muestra recogida fueron 38 pacientes. Definimos las etiologías de las alteraciones del olfato: viral, idiopática, postraumática, tóxica, medicamentosa e inflamatoria. Los estudios realizados en cada paciente fueron: anamnesis, endoscopia nasal y exploración de imagen. Las alteraciones del olfato son más frecuentes en mujeres (2:1), a partir de los 55 años y la causa más frecuente es la viral (55,3 per cent). La endoscopia nasal fue normal en la mayoría de los casos (68,4 per cent). El estudio de imagen más utilizado en nuestra consulta es la TC (68,4 per cent). La recuperación es mayor en pacientes jóvenes y en aquellas lesiones reversibles (AU)

Analysis of smell disturbances in the ENT outpatients department of in a General Hospital. A retrospective and descriptive study. We include all patients with olfactory alterations as the main reason for consultation. The sample was 38 patients. Viral, postraumatic, toxic, drug-induced and inflammatory. We performed anamnesis, nasal endoscopic and scan images on all patients. Olfactory disturbances were more frequent in women older than 55 (2:1). The viral cause was the most frequent aethiology (55.3%). Nasal endoscopic exploration was normal in 68.4% patients. The CT scan was the main imaging study used (68.4%). The younger patients recovered better than the older ones. Smell disorders provoked by virus, toxic and medical drugs do have a better (AU)

[Pediatric temporal bone fractures]. / Fracturas del hueso temporal en la infancia.

Temporal bone trauma are more common nowadays related to sports. We report 2 cases with temporal bone fractures in patients younger than 14 years. They were two male, 9 and 12-year-old respectively, that presented traumatism after accidental falls from lowe height. The first case had a longitudinal temporal bone fracture without hypoacusia or vertigo, whereas the second one had an oblique fracture involving the otic capsule, provoking permanent neurosensorial hearing loss, as well as vertigo and unsteadiness that resolved later, related to a vestibular hyporreflexia. Neither case had facial paresia or paralysis. CT scanning was essential to determine the importance of the trauma. Despite the otic capsule rupture, hearing loss in the second case was only significant over 2 KHz, suggesting a selective cochlear trauma. We present clinical and imaging findings, as well as correlation of audiological and vestibular alterations, reviewing the clinical presentation of temporal bone trauma in children.

[The neck cysts and infectious mononucleosis due to cytomegalovirus]. / Masa cervical y mononucleosis infecciosa por citomegalovirus.

Infectious mononucleosis is usually produced as primoinfection by Epstein-Barr virus, but the second most common cause is cytomegalovirus. Clinical presentation of infectious mononucleosis is a pharyngitis and tonsillitis, associated to neck nodes, fever and general malaise, as well as haematological features such as an absolute lymphomonocytosis. Occasionally it is the neck node that is more severe, even without initial lymphomonocytosis. We report a deep neck abscess within a neck node as subacute presentation of infectious mononucleosis by cytomegalovirus. We review the clinical presentation of infectious mononucleosis, specially due to cytomegalovirus, as well as the importance that this disease could have while dealing with diagnosis and management of neck masses.

[Olfaction disturbances in general ORL practice]. / Alteraciones del olfato en la consulta ORL general.

Analysis of smell disturbances in the ENT outpatients department of in a General Hospital. A retrospective and descriptive study. We include all patients with olfactory alterations as the main reason for consultation. The sample was 38 patients. Viral, postraumatic, toxic, drug-induced and inflammatory. We performed anamnesis, nasal endoscopic and scan images on all patients. Olfactory disturbances were more frequent in women older than 55 (2:1). The viral cause was the most frequent aethiology (55.3%). Nasal endoscopic exploration was normal in 68.4% patients. The CT scan was the main imaging study used (68.4%). The younger patients recovered better than the older ones. Smell disorders provoked by virus, toxic and medical drugs do have a better.

[Torticollis after unnoticed pharyngeal perforation: suspected retropharyngeal abscess]. / Tortícolis tras perforación faríngea inadvertida: sospecha de absceso retrofaríngeo.

Pharyngeal perforations due to foreign bodies are severe when retropharyngeal space infection develops into an abscess. Although the common clinical presentation is sore throat and fever, when the perforation remains occult, torticollis can be a significant symptom. Palatopharyngeal lesions, caused by rigid objects' impactation through the mouth, are common in childhood. Most are not important, but all have the potential hazard of pharyngeal perforation with development of a retropharyngeal abscess. It must be suspected specially when air is shown in the retropharyngeal space on a lateral radiography of the neck, which should always be done. We report a 9-years old boy who had cervical stiffness and torticollis and elevation of the right shoulder, without previous known trauma. Air was shown in the retropharyngeal space on a lateral radiography of the neck in relation to a possible pharyngeal perforation which was later confirmed by a CT scan. We review the literature about diagnosis and treatment of retropharyngeal abscess in childhood.

[Congenital anomalies of the first branchial cleft. Retrospective study]. / Anomalías congénitas de primera hendidura branquial: estudio retrospectivo.

Anomalies of the first branchial cleft are occasional problems putting up diagnostic and therapeutic difficulties, because the imperfect settlement of reminders of this cleft, which can appear as cysts or branchial fistula, among patients of any age. Though there are several recommended classifications in order to achieve a precious diagnosis and a total surgical removal, sometimes is laborious to correlate the clinical and the histological findings. We report a sequence of congenital periauricular anomalies operated in our Department during a ten-years-term and compare our findings of those quoted after the literature series.