La depresión de la investigación en otorrinolaringología en España tiene solución / The downturn in ENT research in Spain has a solution

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Análisis de la producción científica en otorrinolaringología en España durante el periodo 2011-2015 / Analysis of scientific production in otolaryngology in Spain in the period 2011-2015

INTRODUCCIÓN: La publicación de artículos científicos es un indicador de calidad del hospital y se ha convertido en un criterio de excelencia entre los indicadores clínicos que acreditan a un profesional o a una institución. Se evaluaron las publicaciones científicas realizadas en los servicios de otorrinolaringología españoles durante el período 2011-2015 comparándolas con el periodo 1998-2002. MATERIAL Y MÉTODOS: Se extrajeron los artículos de Pubmed publicados por los servicios de ORL de España en el periodo 2011-2015, clasificándose según el tipo de revista (Acta Otorrinolaringológica Española o internacional) y el área de conocimiento: otología, audiología y otoneurología, cirugía de cabeza y cuello incluyendo oncología, rinología y ORL pediátrica. Se estableció un ranking de hospitales considerando el número total de originales, el factor de impacto acumulado y el número total de publicaciones. RESULTADOS: En el periodo 2011-2015 se han identificado 49.342 publicaciones, de las cuales el 1,44% proceden de España, mientras que entre 1998-2002 el 3,80% proceden de España. De los 712 artículos hay 389 publicados en Acta Otorrinolaringológica Española y 323 internacionales. De estas últimas el 20,7% pertenecen a la sección de otología, el 19,2% a audiología-otoneurología, el 30,6% a cirugía de cabeza y cuello, el 15,2% a rinología y el 3,4% ORL pediátrica. Cinco centros hospitalarios publicaron al menos 10 artículos originales en el período estudiado. CONCLUSIONES: La producción científica de la ORL española a nivel internacional ha descendido en los últimos 12 años. Se observa un fenómeno de concentración en determinados centros, asociado a un incremento considerable del factor de impacto acumulado

INTRODUCTION: Publishing in scientific journals is an indicator of hospital quality and has become a standard of excellence for medical doctors and institutions. The aim of the study is to identify the scientific publications performed by Otolaryngology Departments in Spain within the period 2011-2015 and to compare them to a previous period between 1998-2002. MATERIAL AND METHODS: Original papers published by Otolaryngology Departments in Spain in PubMed within 2011-2015 were retrieved. They were classified according to the type of journal published (international or Acta ORL Española) and the following subspecialty areas: Otology, Audiology and Neuro-Otology, Head and Neck Surgery (including Oncology), Rhinology and Paediatric ENT. Hospitals were ranked according to: number of original papers, accumulated impact factor and total number of publications. RESULTS: Between 2011 and 2015, 49342 publications were included in PubMed, 1.44% from Otolaryngology Departments in Spain. Between 1998 and 2002, 3.80% publications were from Spanish ENT departments. Of the 712 papers published within the period 2011-2015, 389 were published in Acta ORL Española and 323 in international journals. From the latter, 20.7% belong to the Otology area, 19.2% to Audiology-Neuro-otology, 30.6% to Head and Neck Surgery, 15.2% to Rhinology and 3.4% to Paediatric ENT. Five tertiary centres published at least 10 original papers in the same period. CONCLUSIONS: Spanish otolaryngology's contribution to international journals has decreased in the last 12 years. A few institutions are responsible for the majority of publications and they have notably increased the cumulative impact factor

Analysis of scientific production in otolaryngology in Spain in the period 2011-2015. / Análisis de la producción científica en otorrinolaringología en España durante el periodo 2011-2015.

INTRODUCTION: Publishing in scientific journals is an indicator of hospital quality and has become a standard of excellence for medical doctors and institutions. The aim of the study is to identify the scientific publications performed by Otolaryngology Departments in Spain within the period 2011-2015 and to compare them to a previous period between 1998-2002. MATERIAL AND METHODS: Original papers published by Otolaryngology Departments in Spain in PubMed within 2011-2015 were retrieved. They were classified according to the type of journal published (international or Acta ORL Española) and the following subspecialty areas: Otology, Audiology and Neuro-Otology, Head and Neck Surgery (including Oncology), Rhinology and Paediatric ENT. Hospitals were ranked according to: number of original papers, accumulated impact factor and total number of publications. RESULTS: Between 2011 and 2015, 49342 publications were included in PubMed, 1.44% from Otolaryngology Departments in Spain. Between 1998 and 2002, 3.80% publications were from Spanish ENT departments. Of the 712 papers published within the period 2011-2015, 389 were published in Acta ORL Española and 323 in international journals. From the latter, 20.7% belong to the Otology area, 19.2% to Audiology-Neuro-otology, 30.6% to Head and Neck Surgery, 15.2% to Rhinology and 3.4% to Paediatric ENT. Five tertiary centres published at least 10 original papers in the same period. CONCLUSIONS: Spanish otolaryngology's contribution to international journals has decreased in the last 12 years. A few institutions are responsible for the majority of publications and they have notably increased the cumulative impact factor.

Clinical Subgroups in Bilateral Meniere Disease.

Meniere disease (MD) is a heterogeneous clinical condition characterized by sensorineural hearing loss, episodic vestibular symptoms, and tinnitus associated with several comorbidities, such as migraine or autoimmune disorders (AD). The frequency of bilateral involvement may range from 5 to 50%, and it depends on the duration of the disease. We have performed a two-step cluster analysis in 398 patients with bilateral MD (BMD) to identify the best predictors to define clinical subgroups with a potential different etiology to improve the phenotyping of BMD and to develop new treatments. We have defined five clinical variants in BMD. Group 1 is the most frequently found, includes 46% of patients, and is defined by metachronic hearing loss without migraine and without AD. Group 2 is found in 17% of patients, and it is defined by synchronic hearing loss without migraine or AD. Group 3, with 13% of patients, is characterized by familial MD, while group 4, that includes 12% of patients, is associated by the presence of migraine in all cases. Group 5 is found in 11% of patients and is defined by AD. This approach can be helpful in selecting patients for genetic and clinical research. However, further studies will be required to improve the phenotyping in these clinical variants for a better understanding of the diverse etiological factors contributing to BMD.

Intronic variants in the NFKB1 gene may influence hearing forecast in patients with unilateral sensorineural hearing loss in Meniere's disease.

Meniere's disease is an episodic vestibular syndrome associated with sensorineural hearing loss (SNHL) and tinnitus. Patients with MD have an elevated prevalence of several autoimmune diseases (rheumatoid arthritis, systemic lupus erythematosus, ankylosing spondylitis and psoriasis), which suggests a shared autoimmune background. Functional variants of several genes involved in the NF-κB pathway, such as REL, TNFAIP3, NFKB1 and TNIP1, have been associated with two or more immune-mediated diseases and allelic variations in the TLR10 gene may influence bilateral affectation and clinical course in MD. We have genotyped 716 cases of MD and 1628 controls by using the ImmunoChip, a high-density genotyping array containing 186 autoimmune loci, to explore the association of immune system related-loci with sporadic MD. Although no single nucleotide polymorphism (SNP) reached a genome-wide significant association (p<10(-8)), we selected allelic variants in the NF-kB pathway for further analyses to evaluate the impact of these SNPs in the clinical outcome of MD in our cohort. None of the selected SNPs increased susceptibility for MD in patients with uni or bilateral SNHL. However, two potential regulatory variants in the NFKB1 gene (rs3774937 and rs4648011) were associated with a faster hearing loss progression in patients with unilateral SNHL. So, individuals with unilateral MD carrying the C allele in rs3774937 or G allele in rs4648011 had a shorter mean time to reach hearing stage 3 (>40 dB HL) (log-rank test, corrected p values were p = 0.009 for rs3774937 and p = 0.003 for rs4648011, respectively). No variants influenced hearing in bilateral MD. Our data support that the allelic variants rs3774937 and rs4648011 can modify hearing outcome in patients with MD and unilateral SNHL.

Allelic variants in TLR10 gene may influence bilateral affectation and clinical course of Meniere's disease.

Toll-like receptors trigger the innate immune response by activating various cell types such us macrophages and lymphocytes. We genotyped SNV of TLR3, TRL7, TLR8 and TLR10 in 863 Spanish and 150 Italian patients with Meniere's disease (MD) and 1,013 controls by using Taqman assays. Real-Time qPCR was used to measure the expression level of TLR10 in peripheral blood leukocytes. The overall dataset showed that the C allele and the CC genotype of rs11096955 in TLR10 gene were more commonly observed in controls than patients (corrected p = 1 × 10(-3), OR = 0.68 [95 % confidence interval, 0.54-0.84] for CC genotype; corrected p = 1.5 × 10(-5), OR = 0.75 [0.66-0.85] for allele C). Moreover, the CC genotype was more frequent in patients with uni- (19 %) than bilateral sensorineural hearing loss (SNHL) (13 %). Logistic regression demonstrated that the time since the onset of MD, Tumarkin crises, hearing stage and rs11096955 were independent factors influencing the risk of bilateral SNHL. In addition, rs11096955 influenced hearing loss progression in patients with bilateral MD. No change in expression of TLR10 was observed according to CC, CA or AA genotypes. Our data suggest that allelic variants of TLR10 gene may influence the susceptibility and time-course of hearing loss of MD in the European population.

High prevalence of systemic autoimmune diseases in patients with Menière's disease.

BACKGROUND: Autoimmunity appears to be associated with the pathophysiology of Meniere's disease (MD), an inner ear disorder characterized by episodes of vertigo associated with hearing loss and tinnitus. However, the prevalence of autoimmune diseases (AD) in patients with MD has not been studied in individuals with uni or bilateral sensorineural hearing loss (SNHL). METHODS AND FINDINGS: We estimated the prevalence of AD in 690 outpatients with MD with uni or bilateral SNHL from otoneurology clinics at six tertiary referral hospitals by using clinica criteria and an immune panel (lymphocyte populations, antinuclear antibodies, C3, C4 and proinflammatory cytokines TNFα, INFγ). The observed prevalence of rheumatoid arthritis (RA), systemic lupus erythematosus (SLE) and ankylosing spondylitis (AS) was higher than expected for the general population (1.39 for RA, 0.87 for SLE and 0.70 for AS, respectively). Systemic AD were more frequently observed in patients with MD and diagnostic criteria for migraine than cases with MD and tension-type headache (p = 0.007). There were clinical differences between patients with uni or bilateral SNHL, but no differences were found in the immune profile. Multiple linear regression showed that changes in lymphocytes subpopulations were associated with hearing loss and persistence of vertigo, suggesting a role for the immune response in MD. CONCLUSIONS: Despite some limitations, MD displays an elevated prevalence of systemic AD such as RA, SLE and AS. This finding, which suggests an autoimmune background in a subset of patients with MD, has important implications for the treatment of MD.

Angiomiolipoma: a propósito de un caso / Angiomyolipoma of the hypopharynx: a case report

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Parotiditis supurada aguda bilateral recidivante por St. Pneumoniae / Bilateral acute suppurative and recurrent parotitis by St. Penumoniae

Presentamos el caso clínico de una mujer de 31 años con parotitidis supurada aguda bilateral de repetición severa que requirió ingreso, tratamiento antibiótico intravenoso, corticoides y drenaje periódico de ambas parótidas mediante punción-aspiración con salida dematerial purulento. El estudio microbiológico más antibiograma puso de manifiesto un Streptococcus pneumoniae como germen responsable del cuadro clínico. Realizamos una breve revisión de la literatura al respecto de las sialoadenitis bacterianas agudas, crónicas y de repetición

We report the clinical case of a 31 years old female with bilateral and severe recurrent suppurative parotitis which required admission, endovenous antibiotic treatment, corticoids and periodic drainage on both parotid glands by punction-aspiration with collection of purulent material. The microbiologic exam and antibiogram showed Streptococcus pneumoniae as the germen which caused the symptoms. We perform a short review of the literature at respect of acute, recurrent and chronic bacterial sialoadenitis

Metástasis cervical de germinoma con primario desconocido / Cervical metastasis of germinoma with unknown primary

Presentamos el caso clínico muy poco común de un varónde 43 años con una metástasis cervical de germinomay primario desconocido tras realizar un estudio de extensióncompleto, incluído urológico, que fue normal. Procedimosa realizar un vaciamiento ganglionar radicalizquierdo remitiendo la pieza a Anatomía Patológica (AP)cuyo resultado era compatible con un tumormesenquimal. Tras pruebas específicas fue informadocomo tumor de células germinales y en la evoluciónpostoperatoria apareció cierta disfagia en el paciente.Después de 5 años de seguimiento por ORL y Oncologíase encuentra libre de enfermedad o recidiva

We are reporting the very uncommon clinical case of a 43years male with a cervical metastasis of germinoma andunknown primary tumour after performing a completeextension study, including urologic one, that was normal.He was operated by left radical neck emptying procedureand sending the piece to Pathologic Anatomy (PA) withcompatible result of a mesenchimal tumour. After specifictests it was informed as germinal cells tumour and thepostsurgical evolution showed some of dysphagia in thepatient. The follow-up for him was 5 years by ORL andOncology being free of illness

Papiloma nasal invertido. 3 casos clínicos y revisión de la literatura / No disponible

Los papilomas invertidos son lesiones nasosinusaleshistológicamente benignas pero que poseen un comportamientoagresivo con degeneración maligna en un 10%de los casos aproximadamente. En este trabajo presentamostres pacientes (2 mujeres y 1 varón) con este diagnósticoy edades de 40, 51 y 69 años respectivamente.Analizamos la clínica, localización del tumor, pruebasde imagen y tratamiento quirúrgico utilizado en cada caso.Destacamos la importancia de la extirpación completapara intentar evitar recurrencias y del estudio finalanatomopatológico (AP).Se trata de tumores poco frecuentes en la literatura comocomprobamos al realizar una revisión bibliográfica deltema

Inverted papillomas are nasosinusal lesions of benignhistopathology with an aggressive behaviour and malignancyabout in 10% of the cases. This article reportsthree patients (2 females, 1 male) with such diagnosisand ages of 40, 51, 69 years, respectively. We have analysedthe symptoms, location of tumor, imaging tests andsurgical treatment used in every case. The importance ofa radical resection is emphasized in order to try to avoidrecurrences just like the final anathomopathologic study.They are uncommon tumors in the literature as we haveproved by making a literature review about this theme

Mucoceles de los senos paranasales. Presentación de 10 casos y revisión de la literatura / No disponible

Los mucoceles tienen su origen en una obstrucción de los conductos de drenaje de los senos paranasales con retención de exudado mucinoso, en ocasiones purulento, y adelgazamiento progresivo más destrucción gradual de las paredes óseas. Presentamos una revisión propia de 10pacientes con este diagnóstico, 6 varones y 4 mujeres, con una edad media de 51 años. En 6 casos el mucocele se localizaba a nivel fronto-etmoidal; en 3, a nivel maxilar y un paciente fue diagnosticado de mucocele esfenoidal. Las manifestaciones clínicas oculares (diplopía, exoftalmos y desplazamiento del globo ocular) fueron las más frecuentes junto con la cefalea. El tipo de cirugía ,realizada en 9 ocasiones, varió en función de la localización de la lesión(C.E.N.F. con marsupialización, etmoidectomía externa,Caldwell-Luc). Realizamos un seguimiento clínico-evolutivo de los pacientes y una revisión de la literatura al respecto

Mucoceles have been origined by blockage of the paranasal sinuses ostium with mucinous retention in side, sometimes purulent, and progressive slimming more gradual destruction on the bone walls. We report an own review of 10 patients with that diagnosis, 6 males and 4females, 51-years average. The mucocele was located infrontal ethmoidal level in 6 cases; 3 for maxillary sinus and one patient was diagnosed as sphenoidal mucocele.The oftalmologic clinical symptoms (diplopia, exoftalmosand the eyeball movement) were the most frequent jointlyto cefalea. The kind of surgery that we have performed, in9 times, was variable according to the lesional location (F. E. S. with marsupialization, extern ethmoidectomy, Caldwell-Luc approach). A clinical and evolutive followuphas been made besides a literature review at this respect

Cuerpos extraños esofágicos en adultos. Análisis de 308 pacientes / Esophageal foreign bodies in adults. Analysis of 308 patients

Hemos realizado un estudio retrospectivo sobre 308 pacientes adultos que acudieron al servicio de urgencias con sospecha de cuerpo extraño esofágico. Analizamos las siguientes variables: edad, sexo, antecedentes personales, sintomatología clínica inicial, tipo de cuerpo extraño referido, localización, tratamiento realizado y evolución hospitalaria. 49 casos se resolvieron espontáneamente o mediante tratamiento médico. 203 cuerpos extraños (65,9 por ciento) fueron extraídos mediante endoscopia digestiva mientras que 56 pacientes (18,2 por ciento) fueron ingresados y precisaron esofagoscopia rígida por nuestro servicio. En el postoperatorio constatamos 5 casos de perforación esofágica de los que 3 se resolvieron con tratamiento médico conservador, 1 precisó reintervención y otro más se complicó con mediastinitis. El resto evolucionaron bien (AU)

Carcinoma medular de tiroides. A propósito de 6 casos

Presentamos 6 casos de Carcinoma Medular de Tiroides estudiados en un período de 9 años. Analizamos las siguientes variables: Sexo, edad, antecedentes familiares y personales, exploración ORL, pruebas de imagen, tratamiento realizado y evolución. Tuvimos 3 hipocalcemias postoperatorias (dos transitorias y una definitiva) y un caso de paresia recurrencial transitoria. Actualmente los 6 pacientes permanecen vivos y libres de enfermedad excepto una paciente, portadora de traqueotomía, que presenta un carcinoma medular recidivado y que rechazó el tratamiento propuesto. Los carcinomas medulares tiroideos son tumores poco frecuentes, de peor pronóstico que los diferenciados, y que requieren un diagnóstico y tratamiento quirúrgico precoces para mejorar su supervivencia global. Realizamos una revisión bibliográfica al respecto (AU)

Otitis externa aguda por Citrobacter Freundii. A propósito de un caso clínico

Citrobacter Freundii es una Enterobacteria oportunista que se aisla rara vez de procesos patológicos, fundamentalmente infecciones urinarias y respiratorias. Presentamos el caso de una mujer de 67 años diagnosticada de una otitis externa aguda derecha, sin antecedentes personales de interés, y en cuyo frotis ótico el Laboratorio de Microbiología aisló este germen. Se trata de una asociación extremadamente rara con pocas referencias en la literatura. La paciente fue tratada con netilmicina (4 días) y metilprednisolona IM (3 días), continuando posteriormente con tratamiento tópico una semana más. La evolución fue satisfactoria con remisión completa de la sintomatología (AU)

Hiperparatiroidismo terciario. A propósito de 3 casos / Tertiary hyperparathyroidism. About three cases

Presentamos tres casos de hiperparatiroidismo terciario recogidos estadísticamente durante 10 años. Analizamos el estado clínico pre y postquirúrgico de los tres pacientes que fueron sometidos por nuestro Servicio a distintos tipos de cirugía con objeto de mejorar su enfermedad de base. En todos los casos desapareció la hipercalcemia con mejoría significativa de las manifestaciones osteoarticulares avanzadas que sufrían antes de la intervención quirúrgica. La anatomía patológica (AP) reveló la presencia de hiperplasia de paratiroides en dos casos y constató un adenoma en el tercero. Realizamos una revisión de la literatura sobre esta patología poco frecuente pero que repercute claramente sobre la calidad de vida de los pacientes (AU)