Disminución de hemorragia post adenoamigdalectomía mediante la utilzación de subgalato de bismuto / Decrease of post adenoamigdalectomy hemorrhage through the use of bismutal subgalate / Diminuição da hemorragem pós adenotonsilectomia através do uso do subgalato de bismuto

Introducción: la cirugía de amígdalas y adenoides es la más frecuentemente realizada en otorrinolaringología. La incidencia de complicaciones es baja, siendo la hemorragia la más frecuente y seria. Se estima que la incidencia de hemorragia post adenoamigdalectomia es entre 0,1 y 8,1%. Dentro de las técnicas hemostáticas se utilizan suturas, electrocauterio, radiofrecuencia, presión con packs, vasoconstrictores u otras sustancias hemostáticas. Entre estas últimas el subgalato de bismuto (activa el factor XII de la coagulación) ha sido empleado durante décadas para hemostasia de diferentes sitios quirúrgicos. El objetivo de este trabajo es determinar la eficacia de la pasta de subgalato de bismuto en la disminución de hemorragias post adenoamigdalectomías. Material y método: Trabajo retrospectivo con pacientes adultos y pediátricos intervenidos quirúrgicamente de amigdalectomía/ adenoidectomía mediante técnica de Daniels y cureta de Beckmann, a los que se dividió en dos grupos: Uno, sin la utilización de subgalato de bismuto y otro utilizando la pasta hemostática intraoperatoria. Posteriormente se comparó la incidencia de hemorragia postquirúrgica entre ambos grupos. Resultados: El primer grupo incluyó a 2.125 pacientes operados y el porcentaje de hemorragias post quirúrgicas sin la utilización del subgalato de bismuto fue de 4,56% (N=97). El otro grupo se conformó con 1.647 pacientes a los que se les aplicó la pasta de subgalato de bismuto en el lecho sangrante y el porcentaje de hemorragias post quirúrgicas descendió a 1,33% (N=22). La diferencia entre ambos grupos fue estadísticamente significativa p=0,001. Conclusiones: La pasta de subgalato de bismuto disminuye la incidencia de hemorragia post amigdalectomía.

Backgruond: tonsils and adenoid surgery are the most frequently performed in otorhinolaryngology. The incidence of complications is low, being the hemorrhage the most frequent and serious one (estimated between 0.1% and 8.1%). The hemostatic techniques used during surgery are sutures, electrocautery, radio frequency, pressure with packs, vasoconstrictors and other haemostatic substances. Between these last substances, Bismuth Subgalate (activates factor XII of coagulation) has been used during decades for hemostasis in different surgical sites. The objective is to determine the efficacy of Bismuth Subgalate paste in the reduction of postadenotonsillectomy hemorrhage. Material and method: Retrospective study including adult and pediatric patients who underwent tonsilectomy / adenoidectomy using the Daniels technique and Beckmann’s curette, which were divided into two groups: one without the use of bismuth subgalate and another using the intraoperative hemostatic paste. Subsequently, the incidence of postoperative hemorrhage between the two groups was compared. Results: The first group included 2,125 patients operated. The percentage of postoperative hemorrhages without the use of the bismuth subgalate was 4.56% (N = 97). The other group consisted of 1,647 patients in whom the Bismuth Subgalate paste was used as a hemostatic agent during surgery. The percentage of postoperative hemorrhage fell to 1.33% (N = 22). The difference between both groups was statistically significant p = 0.001. Conclutions: Bismuth subgalate paste decreases the incidence of post adenotonsillectomy hemorrhage.

Introdução: amígdalas e adenóides cirurgia é a mais realizada na otorrinolaringologia. A incidência de complicações é baixa, sendo o sangramento mais frequentes e graves. Estima-se que a incidência de hemorragia pós-adenotonsilectomia é entre 0,1 e 8,1%. Entre as técnicas hemostáticos, electrocauterização, suturas, radiofrecuecia, pacotes de pressão vasoconstritores ou outras substâncias hemostáticos são utilizados. O subgalato de bismuto ( ativa o fator de coagulação XII) tem sido usada há décadas para hemostasia de diferentes locais cirúrgicos. O objectivo é determinar a eficiência de pasta de subgalato de bismuto na redução de hemorragias pós-adenoamigdalectomia. Material e método: Estudo retrospectivo com pacientes adultos e pediátricos submetidos á cirurgia de adenoidectomia/ amigdalectomia pela técnica Daniels e cureta Beckmann, que foi dividido em dois grupos: um sem o uso de subgalato de bismuto e a outra usando pasta hemostática intraoperatória subsequentemente na incidência de hemorragia pós-cirúrgica entre os dois grupos foi comparado. Resultados: O primeiro grupo incluiu 2125 pacientes operados e a porcentagem de hemorragias pós-cirúrgico, sem o uso de subgalato de bismuto foi 4,56% (97n) o outro grupo foi formada com 1647 pacientes o qual foi aplicada uma pasta de subgalato de bismuto e a percentagem de hemorragia pós-cirurgia caiu para 1,33% (22n), a diferença entre ambos grupos foi estatisticamente significativa (p:0,001). Conclusões: a pasta de subgalato de bismuto diminui a incidencia de hemorragia pós-adenoamigdalectomia.

[Severe laryngitis associated to gastroesophageal reflux]. / Laringitis graves asociadas a reflujo gastroesofágico.

There is a strong association between gastroesophageal reflux and pharyngolaryngeal reflux as factors leading to respiratory disease, manifested as dysphonia, wheezing, coughing, recurrent laryngitis, bronchial obstruction, laryngospasm and apparent life-threatening events (ALTEs). These manifestations can be mild or severe and may sometimes put the patient's life at risk. We present two cases of patients with severe laryngitis who required endotracheal intubation, one of which underwent tracheostomy. The diagnostic methods and their limitations and the patients outcomes are described.

Laringitis graves asociadas a reflujo gastroesofágico / Severe laryngitis associated to gastroesophageal reflux

Está demostrado que hay una fuerte asociación entre el reflujo gastroesofágico y el reflujo faringolaríngeo como causantes de enfermedad respiratoria, que puede manifestarse como disfonía, estridor, tos, laringitis recurrente, obstrucción bronquial, laringoespasmo y eventos de aparente amenaza para la vida (ALTE). Estas manifestaciones pueden ser leves o graves y potencialmente mortales. Se presentan los casos de dos pacientes con laringitis grave que requirieron intubación endotraqueal, a uno de los cuales se le realizó una traqueotomía. Se describen los métodos diagnósticos, sus limitaciones y la evolución presentada por los pacientes

There is a strong association between gastroesophageal reflux and pharyngolaryngeal reflux as factors leading to respiratory disease, manifested as dysphonia, wheezing, coughing, recurrent laryngitis, bronchial obstruction, laryngospasm and apparent life-threatening events (ALTEs). These manifestations can be mild or severe and may sometimes put the patient’s life at risk. We present two cases of patients with severe laryngitis who required endotracheal intubation, one of which underwent tracheostomy. The diagnostic methods and their limitations and the patients outcomes are described.

Laringitis graves asociadas a reflujo gastroesofágico. / [Severe laryngitis associated to gastroesophageal reflux].

There is a strong association between gastroesophageal reflux and pharyngolaryngeal reflux as factors leading to respiratory disease, manifested as dysphonia, wheezing, coughing, recurrent laryngitis, bronchial obstruction, laryngospasm and apparent life-threatening events (ALTEs). These manifestations can be mild or severe and may sometimes put the patients life at risk. We present two cases of patients with severe laryngitis who required endotracheal intubation, one of which underwent tracheostomy. The diagnostic methods and their limitations and the patients outcomes are described.

[Intratympanic dexamethasone as therapeutic option in sudden sensorineural hearing loss]. / Dexametasona intratimpánica como opción terapéutica en hipoacusia neurosensorial súbita.

INTRODUCTION AND OBJECTIVES: The administration of systemic corticosteroids has demonstrated effectiveness on the treatment of idiopathic sudden sensorineural hearing loss. However, its systemic toxicity and subsequent difficulty for its justification in some patients have led to it being applied intratympanically. The main aim of this study is to determine the effectiveness of intratympanic dexamethasone in these patients. In addition we evaluate the relationship between the prognosis of this condition and the magnitude of initial hearing loss, the presence of vertigo or delay in the beginning of therapy. METHODS: We performed a retrospective case study of 18 patients. All of them were treated with intratympanic dexamethasone (4 mg/ml), administered weekly for 3 weeks. The follow-up was 1 month at least. The therapeutic success was arbitrarily defined to be a mean improvement of 25 dB or greater. RESULTS: 72.2% of the population recovered hearing successfully. The mean auditory threshold prior to treatment was 91+/-25 dB versus 51+/-35 dB after the end of it (p<0.0005). In addition, we observed that the initial severity of the hearing loss, the presence of vertigo and the delay in starting therapy cannot be considered as indicators of poor auditory prognosis. CONCLUSIONS: Intratympanic dexamethasone appears to be an effective therapeutic option for patients with sudden onset sensorineural hearing loss who, for whatever reason, cannot be treated with systemic steroids. Nonetheless, randomized controlled trials should be instituted to improve levels of scientific evidence.

Dexametasona intratimpánica como opción terapéutica en hipoacusia neurosensorial súbita / Intratympanic dexamethasone as therapeutic option in sudden sensorineural hearing loss

Introducción y objetivos: La administración de corticosteroides sistémicos tiene efectividad comprobada en el manejo de pacientes con hipoacusia neurosensorial súbita idiopática. Sin embargo, su toxicidad sistémica y, en consecuencia, la dificultad para utilizarlos en algunos pacientes, ha llevado a su aplicación por vía intratimpánica. El objetivo principal de este estudio es determinar la efectividad de la dexametasona intratimpánica en estos pacientes. Como objetivo secundario, intentamos establecer la relación entre la magnitud inicial de la hipoacusia, la presencia de vértigo y la demora en el inicio del tratamiento con el pronóstico de esta afección. Métodos: Se estudió, de forma retrospectiva, a 18 pacientes tratados con dexametasona intratimpanica (4 mg/ml), en dosis de 1 ml semanal, durante 3 semanas consecutivas. Se realizó un seguimiento de, al menos, 1 mes. El suceso terapéutico fue definido en forma arbitraria, ante una recuperación auditiva promedio de, al menos, 25 dB. Resultados: El 72,2 % de los pacientes recuperó la audición exitosamente. El umbral auditivo promedio previo al inicio del tratamiento fue de 91 ± 25 dB, mientras que el posterior fue de 51 ± 35 dB (p < 0,0005). Además, observamos que la magnitud inicial de la hipoacusia, la presencia de vértigo y la demora en el inicio del tratamiento no pueden considerarse como indicadores de mal pronóstico auditivo. Conclusiones: La dexametasona intratimpánica puede ser una un opción efectiva en pacientes con hipoacusia neurosensorial súbita que no pueden ser tratados con esteroides sistémicos, aunque se necesitarán ensayos clínicos controlados y aleatorizados para obtener mayor evidencia al respecto(AU)

Introduction and objectives: The administration of systemic corticosteroids has demonstrated effectiveness on the treatment of idiopathic sudden sensorineural hearing loss. However, its systemic toxicity and subsequent difficulty for its justification in some patients have led to it being applied intratympanically. The main aim of this study is to determine the effectiveness of intratympanic dexamethasone in these patients. In addition we evaluate the relationship between the prognosis of this condition and the magnitude of initial hearing loss, the presence of vertigo or delay in the beginning of therapy. Methods: We performed a retrospective case study of 18 patients. All of them were treated with intratympanic dexamethasone (4 mg/ml), administered weekly for 3 weeks. The follow-up was 1 month at least. The therapeutic success was arbitrarily defined to be a mean improvement of 25 dB or greater. Results: 72.2 % of the population recovered hearing successfully. The mean auditory threshold prior to treatment was 91 ± 25 dB versus 51 ± 35 dB after the end of it (p < 0.0005). In addition, we observed that the initial severity of the hearing loss, the presence of vertigo and the delay in starting therapy cannot be considered as indicators of poor auditory prognosis. Conclusions: Intratympanic dexamethasone appears to be an effective therapeutic option for patients with sudden onset sensorineural hearing loss who, for whatever reason, cannot be treated with systemic steroids. Nonetheless, randomized controlled trials should be instituted to improve levels of scientific evidence (AU)