ENT emergencies during the first wave of COVID-19 pandemic in Spain: Our experience.

OBJECTIVES: To analyze the characteristics of the visits attended to in an ENT Emergency Department (ENT-ED) during the first wave of COVID-19, comparing them with the emergencies attended to during the same period of time in 2019. METHODS: Descriptive and analytical observational retrospective study of all emergency consultations between March 1, 2020, and May 21, 2020, carried out by the Otorhinolaryngology-Head and Neck Surgery Department of a tertiary university hospital. The adequacy of consultations was assessed with the Hospital Emergency Suitability Protocol (HESP). The correlation between the emergencies and the SARS-CoV-2 confirmed cases was assessed with a generalized linear model. RESULTS: Although there was a decrease of almost 50% in ENT-ED visits during the first wave of COVID-19, the pattern of most cases remained similar to the pre-COVID-19 era: non-urgent consultations, not previously assessed by Primary Care (PC), being considered inadequate by the HESP. The three main reasons for consultation were otalgia, odynophagia, and epistaxis. The number of ENT-ED visits and the total number of confirmed cases of SARS-CoV-2 in the health area were correlated. CONCLUSIONS: SARS-CoV-2 pandemic was a challenge for the Spanish health system. The critical epidemiological situation experienced during March, April, and May explains the reduction in the number of visits to the ENT-ED. However, this condition did not affect the predominant pattern of visits with respect to the pre-COVID-19 era, which were mostly inadequate. A strengthening of PC and an improvement in the population's health education is essential.

T1b Glottic Tumor and Anterior Commissure Involvement: Is the Transoral CO2 Laser Microsurgery a Safe Option?

OBJECTIVES: Transoral CO2 laser therapy represents the treatment of choice for early-stage laryngeal tumors. The anterior commissure involvement (ACI) is related to a worse local control and a lower rates of organ preservation. The objective of this study is to analyze the differences in survival, local control, and organ preservation in T1b glottic patients according to the presence of ACI. METHODS: Observational prospective study in pT1b treated with transoral CO2 laser between 2009 and 2014. RESULTS: Forty patients (37 male and 3 female) with a mean age of 66.43 ± 8.16 years were recruited. Anterior commissure involvement was present in 70% of the patients. The 5-year specific cause survival was 91.66%, with 32.50% of local recurrences. Laryngeal preservation was 80%, being lower in the group with local recurrence (P < .000). The involvement of the anterior commissure does not influence the organ preservation (P = .548), the appearance of local recurrences (P = .391), or the survival (P = .33). CONCLUSIONS: Transoral CO2 laser therapy is an effective and reproducible treatment for early-stage laryngeal tumors. The results obtained are similar to previous studies, although they present discrepancies in relation to the role of the ACI. Prospective randomized trials are required focusing also on the patients' quality of life and functional outcome in order to clarify the role of the ACI and the need to implement changes in its evaluation, staging, and evolution.

Obstructive ectopic intratracheal thyroid / Tiroides ectópico intratraqueal obstructivo

No disponible

Hemangioma capilar de oído medio / Capillary hemangioma of the middle ear: a case report

Los hemangiomas capilares se consideran tumores vasculares benignos. Aproximadamente dos tercios de los mismos se localizan en cabeza y cuello. Su origen en oído medio procede del aporte vascular del ganglio geniculado. Se encuentran infradiagnosticados debido a la gran variedad de patologías con similares manifestaciones clínicas y radiológicas, siendo definitivo, el examen histológico para su diagnóstico(AU)

Capillary hemangiomas are considered benign vascular tumours. Two-thirds of hemangiomas occur in the head and neck region. They commonly originate from the vascular networks around the geniculate ganglion. They are underdiagnosed because there are a great many diseases with similar clinical and radiologic signs. Therefore, the histological exam is definitive for diagnosis(AU)

[Capillary hemangioma of the middle ear: a case report]. / Hemangioma capilar de oído medio.

Capillary hemangiomas are considered benign vascular tumours. Two-thirds of hemangiomas occur in the head and neck region. They commonly originate from the vascular networks around the geniculate ganglion. They are underdiagnosed because there are a great many diseases with similar clinical and radiologic signs. Therefore, the histological exam is definitive for diagnosis.

Linfoma no Hodgkin primario de la glándula parótida: revisión de 8 casos / Primary Non-Hodgkin Lymphoma of the parotid gland: Revision of 8 cases

La manifestación de un linfoma no Hodgkin como tumor primario de la parótida representa el 5% de los tumores en esta localización. Se presentan 8 pacientes diagnosticados y tratados de linfoma no Hodgkin parotídeo en nuestro hospital entre 1996–2003. El 62% eran mujeres que presentaban una masa indurada de 4 meses de evolución. En todos los casos se realizó una punción aspiración con aguja fina y una tomografía computerizada siendo el estudio inmunohistoquímico esencial en el diagnóstico definitivo. Para ello, se realizó en todos los casos una biopsia. El tratamiento fue con quimioterapia en el 75% de los casos y en el 25% quirúrgico. El objetivo es analizar los patrones clínicos y patológicos, así como las distintas modalidades terapéuticas y pronósticas, que caracterizan a este tipo de patología basándonos en el análisis de nuestros pacientes y comparándolos con los reflejados en la literatura (AU)

The manifestation of non-Hodgkin lymphoma as a primary parotid tumour account for 5% of all tumours at this location. We present 8 patients diagnosed and treated for parotid non-Hodgkin lymphoma in our hospital between 1996 and 2003. Of the cases, 62% were women who had an indurated mass for almost 4 months. A fine needle aspiration and computed tomography were performed on all patients. The immunohistochemical study provided us with the definitive diagnosis. Biopsy was done in all cases. The treatment was chemotherapy in 75% cases and surgery in 25%.The objective was to analyse the clinical and pathological patterns, plus the different treatment modalities and prognoses, which characterise this type of pathology based on the analysis of our patients and compared with those reported in the literature (AU)

Tratamiento quirúrgico de las estenosis subglóticas / Surgical treatment of subglottic stenosis

Introducción: Las estenosis de localización subglótica son poco frecuentes, siendo su principal mecanismo etiopatogénico la intubación orotraqueal. El objetivo es analizar la experiencia en el tratamiento, revisando el tipo de terapéutica, porcentaje de decanulación, evolución sintomática postratamiento y número de procedimientos por paciente. Material y método: Dieciséis pacientes diagnosticados y tratados de estenosis subglótica entre 1995–2007. Se recogieron datos clinicopatológicos que incluyen: edad, sexo, etiología, clínica, grado de severidad (clasificación de Cotton), métodos diagnósticos, tipo de tratamiento, evolución sintomática, decanulación y número de procedimientos. Analizamos nuestros resultados comparándolos con otros estudios para conocer la evolución, morbilidad y porcentaje de éxitos con las terapéuticas propuestas. Resultados: El 75% eran mujeres con edad media de 60 años. El 75% presentaban antecedente de intubación prolongada. El síntoma de presentación fue disnea (94%) y el 69% precisó traqueotomía de urgencia. Se trataron quirúrgicamente 10 pacientes: 7/10 láser CO2, 2/10 dilataciones y 1/10 cirugía abierta. La decanulación tras la cirugía fue posible en el 60% del total. El número de procedimientos por paciente fue 1,37. Discusión: El tratamiento de las estenosis subglóticas debe individualizarse según las características del paciente, el tipo de estenosis y la severidad de la misma. El uso de técnicas láser proporciona buenos resultados en grados leves-moderados, asociando baja morbilidad. La cirugía abierta estaría reservada para los grados más severos de estenosis y tras el fracaso del láser CO2 (AU)

Introduction: Subglottic stenosis is rare, its primary pathogenic mechanism being tracheal intubation. Its incidence has declined in recent decades due to improved material and reduced intubation time. The objective of this study was to analyse the experience in treating this disease, emphasising the type of treatment used, the rate of decannulation obtained, symptomatic changes after treatment, and the total number of procedures performed per patient. Materials and methods: The study included 16 patients diagnosed and treated for subglottic stenosis in our department from 1995 to 2007. Clinicopathologic data were collected including: age, sex, etiology and severity (the Cotton classification), diagnostic methods used, type of treatment, progression of symptoms, decannulation and number of procedures performed per patient. To identify changes, morbidity and success rate with the proposed treatment, we analysed our results, comparing them with those collected in other studies. Results: Of the cases analysed, 75% were women, with a mean age of 60 years; 75% of the total cases had a history of prolonged intubation. The presenting symptom was dyspnea (94%), and 69% required an emergency tracheotomy. Ten patients were treated surgically: 7/10 CO2 laser, 2/10 dilation and 1/10 open surgery. Decannulation after surgery was possible in 60% of the total. The number of procedures per patient was 1.37. Conclusions: Subglottic stenosis treatment must be individualised based on patient characteristics, type of stenosis and severity. The use of endoscopic laser provides the best results in mild to moderate degrees with low morbidity. Open surgery was reserved for severe degrees, and after the failure of the CO2 laser (AU)

[Surgical treatment of subglottic stenosis]. / Tratamiento quirúrgico de las estenosis subglóticas.

INTRODUCTION: Subglottic stenosis is rare, its primary pathogenic mechanism being tracheal intubation. Its incidence has declined in recent decades due to improved material and reduced intubation time. The objective of this study was to analyse the experience in treating this disease, emphasising the type of treatment used, the rate of decannulation obtained, symptomatic changes after treatment, and the total number of procedures performed per patient. MATERIALS AND METHODS: The study included 16 patients diagnosed and treated for subglottic stenosis in our department from 1995 to 2007. Clinicopathologic data were collected including: age, sex, etiology and severity (the Cotton classification), diagnostic methods used, type of treatment, progression of symptoms, decannulation and number of procedures performed per patient. To identify changes, morbidity and success rate with the proposed treatment, we analysed our results, comparing them with those collected in other studies. RESULTS: Of the cases analysed, 75% were women, with a mean age of 60 years; 75% of the total cases had a history of prolonged intubation. The presenting symptom was dyspnea (94%), and 69% required an emergency tracheotomy. Ten patients were treated surgically: 7/10 CO(2) laser, 2/10 dilation and 1/10 open surgery. Decannulation after surgery was possible in 60% of the total. The number of procedures per patient was 1.37. CONCLUSIONS: Subglottic stenosis treatment must be individualised based on patient characteristics, type of stenosis and severity. The use of endoscopic laser provides the best results in mild to moderate degrees with low morbidity. Open surgery was reserved for severe degrees, and after the failure of the CO(2) laser.

[Primary non-Hodgkin lymphoma of the parotid gland: Revision of 8 cases]. / Linfoma no Hodgkin primario de la glándula parótida: revisión de 8 casos.

The manifestation of non-Hodgkin lymphoma as a primary parotid tumour account for 5% of all tumours at this location. We present 8 patients diagnosed and treated for parotid non-Hodgkin lymphoma in our hospital between 1996 and 2003. Of the cases, 62% were women who had an indurated mass for almost 4 months. A fine needle aspiration and computed tomography were performed on all patients. The immunohistochemical study provided us with the definitive diagnosis. Biopsy was done in all cases. The treatment was chemotherapy in 75% cases and surgery in 25%. The objective was to analyse the clinical and pathological patterns, plus the different treatment modalities and prognoses, which characterise this type of pathology based on the analysis of our patients and compared with those reported in the literature.

[Otic myiasis. Case report]. / Miasis ótica. A propósito de un caso.

Otic myiasis is rare in developed countries and is related to environmental conditions and poor hygiene. We present the case of a 65-year-old woman with pain and tinnitus in the left ear lasting for one week. Physical examination in the emergency room showed numerous dipteran larvae totally occupying the external auditory canal. After the diagnosis of otic myiasis, the larvae were removed and the patient was discharged after 24 hours of medical observation. The diagnosis of otic myiasis is by means of direct visualization of the larvae in the ear cavities and treatment includes the removal of larvae from the ear. Prognosis is generally good.

Miasis ótica. A propósito de un caso / Otic miasis. Case report

La miasis ótica es una enfermedad que se relaciona con condiciones ambientales e higiénicas deficientes y es muy poco frecuente en los países desarrollados. Presentamos el caso de una mujer de 65 años de edad que acude al servicio de urgencias del hospital por presentar otalgia y acufenos en el oído izquierdo de una semana de evolución. La exploración mostró ocupación total del conducto auditivo externo por larvas de dípteros. Tras el diagnóstico de miasis ótica, se procedió a la extracción de las larvas y se sometió a observación durante 24 h antes del alta definitiva. El diagnóstico de la miasis ótica consiste en la visualización directa de las larvas en las cavidades óticas, y su tratamiento incluye la extirpación de las larvas de las cavidades del oído; generalmente el pronóstico es favorable (AU)

Otic myiasis is rare in developed countries and is related to environmental conditions and poor hygiene. We present the case of a 65-year-old woman with pain and tinnitus in the left ear lasting for one week. Physical examination in the emergency room showed numerous dipteran larvae totally occupying the external auditory canal. After the diagnosis of otic myiasis, the larvae were removed and the patient was discharged after 24 hours of medical observation. The diagnosis of otic myiasis is by means of direct visualization of the larvae in the ear cavities and treatment includes the removal of larvae from the ear. Prognosis is generally good (AU)

[Resection with end-to-end anastomosis for postintubation tracheal stenosis]. / Resección con anastomosis término-terminal en la estenosis traqueal tras intubación.

OBJECTIVE: To study results of resection and end-to-end anastomosis in tracheal stenosis (TS). PATIENTS AND METHOD: Retrospective review of 14 patients with previous long-term intubation and residual tracheal stenosis, all operated on with resection and end-to-end anastomosis. We studied the percentage of surgical success, decannulation index, use of Montgomery T tube, and complications. RESULTS: We performed a total of 42 interventions (mean, 2.93) and 19 T-Montgomery tubes were used. We achieved surgical success in 85.12 % of patients, with a decannulation index of 71.42 %. Two patients developed granulomas in the suture field that required treatment with endoscopic laser and cryotherapy. One patient died intraoperatively. CONCLUSIONS: Surgical resection with end-to-end anastomosis and insertion of a T-Montgomery tube is a useful technique in post-intubation tracheal stenosis despite involving multiple interventions in a large percentage of patients.

[Phonation fistulas today]. / Fístulas fonatorias hoy.

OBJECTIVE: To describe our experience with the use of trachea-oesophageal puncture (TEP) after total laryngectomy. MATERIAL AND METHOD: We have studied retrospectively 96 patients who received a voice prosthesis through tracheoesophageal puncture between October 2000 and December 2005. RESULTS: The punctures effected were 86 primary (89.6 %) and 10 secondary (10.4 %); of the prostheses, 81 (84.4 %) were Provox(R) type and 74 % of patients used it as their normal means of communication. Reasons for withdrawal included insufficiency and aspiration in 66.7 % (14/21), lack of use in 23.8 % (2/21), granulation tissue, and inflammation in 4.7 % (1/21). CONCLUSIONS: Voice rehabilitation by TEP and prosthesis was successful in 74 % of our patients with acceptable complications and better results than those obtained by tracheaoesophageal speech. We recommend the use of TEP in those patients who have the motivation and a good oncological and physical assessment.

Fístulas fonatorias hoy / Phonation fistulas today

Objetivo: Analizar nuestra experiencia con el uso de prótesis fonatorias (PF) tras la realización de laringectomía total. Material y método: Estudio retrospectivo de 96 pacientes a quienes se colocó una PF mediante punción traqueoesofágica entre octubre de 2000 y diciembre de 2005. Resultados: Se realizaron 86 (89,6 %) punciones primarias y 10 (10,4 %) secundarias; el 84,4 % (81/96) de las prótesis eran del tipo Provox® y el 74 % de los pacientes la utilizaban como medio habitual de comunicación. Las causas de retirada fueron: insuficiencia y aspiración, 66 % (14/21); no emplearla, 23,8 % (2/21), y granulaciones e inflamación, 4,7 % (1/21). Conclusiones: El empleo de PF mediante punción traqueoesofágica ha sido útil en el 74 % de nuestros pacientes, con una tasa de complicaciones asumible y resultados fonatorios superiores a los obtenidos mediante erigmofonía, por lo que recomendamos su uso en pacientes que, por motivación y valoración física y oncológica, sean candidatos

Objective: To describe our experience with the use of trachea-oesophageal puncture (TEP) after total laryngectomy. Material and method: We have studied retrospectively 96 patients who received a voice prosthesis through tracheoesophageal puncture between October 2000 and December 2005. Results: The punctures effected were 86 primary (89.6 %) and 10 secondary (10.4 %); of the prostheses, 81 (84.4 %) were Provox® type and 74 % of patients used it as their normal means of communication. Reasons for withdrawal included insufficiency and aspiration in 66.7 % (14/21), lack of use in 23.8 % (2/21), granulation tissue, and inflammation in 4.7 % (1/21). Conclusions: Voice rehabilitation by TEP and prosthesis was successful in 74 % of our patients with acceptable complications and better results than those obtained by tracheaoesophageal speech. We recommend the use of TEP in those patients who have the motivation and a good oncological and physical assessment

Resección con anastomosis término-terminal en la estenosis traqueal tras intubación / Resection with end-to-end anasthomosis for postintubation tracheal stenosis

Objetivo: Evaluar los resultados de la cirugía de resección con anastomosis término-terminal en la estenosis traqueal (ET). Pacientes y método: Estudio retrospectivo de 14 pacientes con antecedentes de intubación prolongada y ET, operados mediante resección y anastomosis término-terminal. Se estudia los porcentajes de resolución de la estenosis, decanulación, utilización del tubo en T de Montgomery y complicaciones. Resultados: Se realizó un total de 42 (media, 2,93) intervenciones y se colocaron 19 tubos en T de Montgomery. En el 85,12 % de los pacientes se resolvió la estenosis, con decanulación en el 71,42 %. Dos pacientes desarrollaron granulomas en la zona de sutura, que requirieron exéresis mediante broncoláser y crioterapia. Una paciente falleció durante la operación. Conclusiones: La cirugía resectiva con anastomosis término-terminal y colocación de tubo en T de Montgomery es una técnica útil para la resolución de la ET tras intubación, aunque en un alto porcentaje de pacientes requiera múltiples intervenciones

Objective: To study results of resection and end-to-end anastomosis in tracheal stenosis (TS). Patients and method: Retrospective review of 14 patients with previous long-term intubation and residual tracheal stenosis, all operated on with resection and end-to-end anastomosis. We studied the percentage of surgical success, decannulation index, use of Montgomery T tube, and complications. Results: We performed a total of 42 interventions (mean, 2.93) and 19 T-Montgomery tubes were used. We achieved surgical success in 85.12 % of patients, with a decannulation index of 71.42 %. Two patients developed granulomas in the suture field that required treatment with endoscopic laser and cryotherapy. One patient died intraoperatively. Conclusions: Surgical resection with end-to-end anastomosis and insertion of a T-Montgomery tube is a useful technique in post-intubation tracheal stenosis despite involving multiple interventions in a large percentage of patients