Persistent Tracheostomy after Organ Preservation Protocol in Patients Treated for Larynx and Hypopharynx Cancer.

Introduction Squamous cell carcinoma of the larynx is currently the second most common malignancy of the airway after lung cancer, and hypopharyngeal cancer accounts for fewer than 5% of head and neck cancers. The nonsurgical options for patients with this disease are related to significant long-term toxicities and the need for persistent tracheostomy, which adversely affects the quality of life of these patients. Objective To evaluate the need for tracheostomy, and the influence of this in the overall and specific survival rates of patients diagnosed with all stages of laryngeal carcinoma treated by chemoradiotherapy. Methods A retrospective study of patients diagnosed with laryngeal carcinoma was performed according to the criteria of the Union for International Cancer Control (UICC) and the American Joint Committee on Cancer (AJCC) 7th edition, in a tertiary hospital. Results A total of 21 patients were evaluated, 8 patients required a tracheotomy (31%) during the treatment protocol, 7 (35%) men and 1 (100%) women. According to subsite 4/4 patient with glottis cancer (p ≤ 0.001), 2/10 patients with supra glottis cancer and 2/7 patients with hypopharyngeal cancer. During follow up, just in 1 patient was possible to close the tracheostomy. Conclusion Persistent tracheostomy dependence after primary chemoradiation increases significantly the morbidity, and decreases the quality of life of those patients. Patients with glottis cancer are prone to need a tracheostomy, but no statistical difference regarding the oncological stage and the need for a tracheostomy were detected. A more thorough selection of the patients is needed to improve the quality of life and reduce permanent tracheostomy dependence.

Tuberculosis de cabeza y cuello: estudio retrospectivo de 6 años / Head and neck tuberculosis: 6-year retrospective study

Introducción: En el 80% de los casos de infección por Mycobacterium tuberculosis existe afectación pulmonar, sin embargo hasta en un 20% de casos puede haber compromiso extrapulmonar. En el área otorrinolaringológica la localización más frecuente es la linfadenitis cervical, que afecta aproximadamente al 95% de los casos. Materiales y métodos: Estudio retrospectivo en pacientes que acudieron a consulta de ORL en un hospital terciario por sintomatología en cabeza y cuello y que fueron diagnosticados de tuberculosis, entre diciembre del año 2007 y diciembre del año 2013. Resultados: Un total de 73 pacientes fueron incluidos, 41 (56,2%) hombres y 32 (43,8%) mujeres (ratio H/M = 1,28), con una edad promedio de 39,4 años (±26,5 años; mín: 1/máx 88). Un total de 53 (72,6%) casos correspondieron a linfadenopatía cervical, 11 (15%) a tuberculosis laríngea, 3 (4,1%) a tuberculosis hipofaríngea, y los restantes 6 en otras localizaciones. Del total, 14 (19,2%) pacientes eran VIH positivo y 10 (13,7%) tenían antecedentes de contacto con familiares que habían sufrido tuberculosis pulmonar. En 51 (69,8%) de los casos se realizó una PCR como medida de confirmación, siendo positiva en 47 de estos (92,1%). Conclusión: La similitud de la tuberculosis con enfermedades de mal pronóstico y la dificultad que entraña su diagnóstico hacen necesario tener en cuenta la tuberculosis a la hora de explorar a pacientes con lesiones granulomatosas o ulcerativas del área ORL. Al analizar nuestros resultados, la incidencia de tuberculosis según su localización en el área ORL es similar a la reportada en la literatura. Es importante hacer mención especial del uso de la PCR en nuestro estudio y las ventajas que su aplicación significa para el diagnóstico (AU)

Introduction: Pulmonary involvement exists in 80% of cases of infection with Mycobacterium tuberculosis; however, in up to 20% of cases there may be extra-pulmonary involvement. In the ENT area, the most common site is cervical lymphadenitis, affecting approximately 95% of cases. Materials and methods: This was a retrospective study of patients attending an ENT department in a tertiary hospital for head and neck symptoms that were diagnosed with tuberculosis (TB), between December 2007 and December 2013. Results: The study included 73 patients, 41 (56.2%) males and 32 (43.8%) females (M/F ratio = 1.28), with a mean age of 39.4 years (±26.5 years; Min 1, Max 88). There were 53 (72.6%) cases of cervical lymphadenopathy, 11 (15%) of laryngeal tuberculosis 3 (4.1%) of hypopharyngeal tuberculosis, and six cases in other locations. Of the total, 14 (19.2%) patients were HIV positive and 10 (13.7%) had a history of contact with relatives who had suffered pulmonary tuberculosis. PCR was performed in 51 (69.8%) cases to confirm being positive, of which 47 (92.1%) cases were. Conclusion: The similarity of tuberculosis to diseases of poor prognosis and the difficulty of its diagnosis make considering tuberculosis necessary when exploring patients with ulcerative or granulomatous ENT lesions. Analysing our results, the incidence of TB according to its ENT area location is similar to that reported in the literature. It is important to make special mention of the use of PCR in our study and the benefits that its implementation means for diagnosis (AU)

Head and neck tuberculosis: 6-year retrospective study.

INTRODUCTION: Pulmonary involvement exists in 80% of cases of infection with Mycobacterium tuberculosis; however, in up to 20% of cases there may be extra-pulmonary involvement. In the ENT area, the most common site is cervical lymphadenitis, affecting approximately 95% of cases. MATERIALS AND METHODS: This was a retrospective study of patients attending an ENT department in a tertiary hospital for head and neck symptoms that were diagnosed with tuberculosis (TB), between December 2007 and December 2013. RESULTS: The study included 73 patients, 41 (56.2%) males and 32 (43.8%) females (M/F ratio=1.28), with a mean age of 39.4 years (± 26.5 years; Min 1, Max 88). There were 53 (72.6%) cases of cervical lymphadenopathy, 11 (15%) of laryngeal tuberculosis 3 (4.1%) of hypopharyngeal tuberculosis, and six cases in other locations. Of the total, 14 (19.2%) patients were HIV positive and 10 (13.7%) had a history of contact with relatives who had suffered pulmonary tuberculosis. PCR was performed in 51 (69.8%) cases to confirm being positive, of which 47 (92.1%) cases were. CONCLUSION: The similarity of tuberculosis to diseases of poor prognosis and the difficulty of its diagnosis make considering tuberculosis necessary when exploring patients with ulcerative or granulomatous ENT lesions. Analysing our results, the incidence of TB according to its ENT area location is similar to that reported in the literature. It is important to make special mention of the use of PCR in our study and the benefits that its implementation means for diagnosis.

The risk of venous thromboembolism in ENT and head & neck surgery.

OBJECTIVES: Venous thromboembolic disease (VTD) includes deep vein thrombosis (DVT) and pulmonary embolism (PE), thus is one of the most feared postoperative complications developed by patients at any surgical department, because of high morbidity and mortality associated with it. MATERIALS AND METHODS: We performed a retrospective study including all patients operated on at the Otolaryngology Head and Neck Department (tertiary hospital) between January 2009 and December 2013. RESULTS: A total of 9007 surgical procedures were performed, including 7150 elective surgeries under general anesthesia, with 2127 on children and 5023 on adults. A total of 1989 patients had oncological head and neck surgery, eight cases had VTE complications, which represents 0.08% of patients. All of those complicated cases had head and neck cancer (8/1989 = 0.4%) and belonged to the group of scheduled surgeries under general anesthesia (8/7150 = 0.1%). CONCLUSION: The incidence of DVT and PE in ENT and head and neck surgery appears to be lower than in other surgical specialties. Oncological surgery of the head and neck, usually associated with other risk factors, appears to increase the risk of VTD.

Compensatory hypertrophy of the contralateral inferior turbinate in patients with unilateral nasal septal deviation. A computed tomography study.

INTRODUCTION: The compensatory hypertrophy of the inferior turbinate in patients with septal deviation to one of the nostrils is considered to protect the airways from the excess of air that could enter through the nostril and its potential negative effects such as dryness, alteration of air filtration, mucociliary flow, or lung involvement. MATERIALS AND METHODS: A prospective, longitudinal, non-randomized study. Patients were divided in two groups: 10 consecutive patients, with nasal septal deviation and compensatory hypertrophy of the inferior turbinate in the contralateral nasal cavity (10 non-hypertrophied turbinates as control and 10 contralateral hypertrophied turbinates as study cases), and the second group with 5 patients without any nasal pathology (10 turbinates without any obvious pathology). In both groups CT scans of the nasal region were performed. A comparison of patients with nasal septal deviation with compensatory hypertrophy of the inferior turbinate in the contralateral nasal cavity and with non-pathological inferior turbinate was carried out. RESULTS: When analyzing the groups of patients with septal deviation, the contralateral hypertrophied turbinate and the non-hypertrophied turbinate side, we found a significant hypertrophy in the anterior portion of the inferior turbinate, at the level of the medial mucosa (P = 0.002) and bone (P = 0.001) in the group of patients with contralateral hypertrophied turbinate. However, when we compared the contralateral hypertrophic turbinate with the turbinate of patients without septal deviation, we found a significant difference in all volumes of the medial and lateral mucosa and the bone portion (P = 0.001, P = 0.005). CONCLUSION: Surgical correction of the nasal septum and lateralization or reduction of the volume of the inferior turbinate (which may include the medial mucosa, head or part of the bone) is necessary in order to improve air passage into the nasal valve.

Anestesia tópica en la nasofibrolaringoscopia flexible / Topical anesthesia in flexible nasofibrolaryngoscopy

Introducción: El desarrollo de la otorrinolaringología en las últimas décadas se ha visto favorecido por la aparición de la nasofibrolaringoscopia flexible, la cual se ha convertido en una herramienta diagnóstica esencial para el otorrinolaringólogo. Sin embargo su uso no está exento de molestias para el paciente, razón por la cual diversas opciones de anestesia tópica se han propuesto durante el desarrollo de la técnica. Materiales y métodos: Estudio prospectivo, doble ciego, cruzado, realizado en pacientes sin antecedentes de patología nasal a través del cual comparamos el uso de anestésico tópico (lidocaína) + epinefrina, oximetazolina y placebo. Mediante escala visual analógica se valoró el grado de molestias durante cada exploración. Resultados: Fueron evaluados 18 pacientes, 10 mujeres (55,6%) y 8 hombres (44,4%), con una edad promedio de 28 años ± 4. El grado de molestia generado por la exploración con la aplicación de lidocaína más epinefrina fue de 1,94; oximetazolina 3,78; y placebo 4,61. Al comparar la mezcla lidocaína-epinefrina con oximetazolina obtuvimos significación estadística a favor de la lidocaína-epinefrina (p < 0,05); al comparar el uso de lidocaína-epinefrina con placebo el resultado también fue estadísticamente significativo en favor de la lidocaína-epinefrina (p < 0,05). Conclusiones: En este estudio demostramos que el uso de la asociación de lido (AU)

Introduction: The emergence of flexible nasofibrolaryngoscopy in recent decades has facilitated the development of Otolaryngology and the nasofibrolaryngoscope has become an essential diagnostic tool for the otolaryngologist. However, its use is not without discomfort for the patient, which is why various options for topical anaesthesia have been proposed during the development of the technique. Material and methods: This was a prospective, double blind, crossover study in patients with no history of nasal disease, through which we compared the use of topical anaesthetic (Lidocaine) + epinephrine, oxymetazoline and placebo. Using a visual analogue scale, the degree of discomfort was assessed during each scan. Results: We evaluated 18 patients, 10 women (55.6%) and 8 men (44.4%), with a mean age of 28±4 years. The degree of disturbance generated by the scan with the application of lidocaine-epinephrine was 1.94; with oxymetazoline it was 3.78, and with placebo, 4.61. When the lidocaine-epinephrine solution was compared with oxymetazoline, there was a statistical significance in favour of lidocaine-epinephrine (P<0.05). When we compared the use of lidocaine-epinephrine with the placebo, the result was also statistically significant in favour of lidocaine-epinephrine (P<0.05). Conclusions: In this study we demonstrated that using lidocaine associated with epinephrine as a topical anaesthetic prior to flexible nasofibrolaryngoscopy decreases pain and feeling of discomfort for the patient. Consequently, we can recommend the use of topical nasal anaesthesia when performing this exploratio (AU)

Síndrome de Eagle / Eagle syndrome

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[Topical anesthesia in flexible nasofibrolaryngoscopy]. / Anestesia tópica en la nasofibrolaringoscopia flexible.

INTRODUCTION: The emergence of flexible nasofibrolaryngoscopy in recent decades has facilitated the development of Otolaryngology and the nasofibrolaryngoscope has become an essential diagnostic tool for the otolaryngologist. However, its use is not without discomfort for the patient, which is why various options for topical anaesthesia have been proposed during the development of the technique. MATERIAL AND METHODS: This was a prospective, double blind, crossover study in patients with no history of nasal disease, through which we compared the use of topical anaesthetic (Lidocaine) + epinephrine, oxymetazoline and placebo. Using a visual analogue scale, the degree of discomfort was assessed during each scan. RESULTS: We evaluated 18 patients, 10 women (55.6%) and 8 men (44.4%), with a mean age of 28±4 years. The degree of disturbance generated by the scan with the application of lidocaine-epinephrine was 1.94; with oxymetazoline it was 3.78, and with placebo, 4.61. When the lidocaine-epinephrine solution was compared with oxymetazoline, there was a statistical significance in favour of lidocaine-epinephrine (P<0.05). When we compared the use of lidocaine-epinephrine with the placebo, the result was also statistically significant in favour of lidocaine-epinephrine (P<0.05). CONCLUSIONS: In this study we demonstrated that using lidocaine associated with epinephrine as a topical anaesthetic prior to flexible nasofibrolaryngoscopy decreases pain and feeling of discomfort for the patient. Consequently, we can recommend the use of topical nasal anaesthesia when performing this exploration.