[Undiagnosed (corrected) cases of obstructive sleep apnoea syndrome: a new reason for involvement of otorhinolaryngologists]. / Casos no diagnosticados de síndrome de apnea obstructiva del sueño: un nuevo motivo de implicación para el otorrinolaringólogo.

INTRODUCTION: In Spain there are around 2 million people with obstructive sleep apnoea syndrome who should be treated. However, less than 10 % have been diagnosed and treated. Untreated patients are associated with a higher risk of cardiovascular and neurological complications, higher accident rates, reduced quality of life and greater health-care consumption. It is necessary, therefore, to reduce these consequences through early diagnosis and treatment. OBJECTIVE: To demonstrate the usefulness of a simple series of questions and examination as a mechanism to detect patients with undiagnosed obstructive sleep apnoea syndrome, in a consultation with a general otorhinolaryngologist. MATERIAL AND METHOD: Five hundred two consecutive patients coming to an otorhinolaryngological consultation for reasons other than sleep pathology were submitted to a series of questions and an examination of upper aerodigestive tract, to search for indications of suspected sleep apnoea. For the different clinical and anatomical comparisons, a control group of 178 consecutive already-diagnosed patients was used. RESULTS: Of the 502 cases, 74 (14.7%) fulfilled the requirements for suspicion and 35 of them agreed to take a polysomnograph test (47.29%). Of this group, an apnoea/ hypopnoea index greater than 5 was found in 24 of the 35 cases (4.78%). CONCLUSIONS: The prevalence of obstructive sleep apnoea in the group of patients studied is greater than that of the general population. With a simple interview and physical examination, a high rate of success can be obtained in the detection of undiagnosed sleep apnoea cases.

[Gastroesophageal reflux and obstructive sleep apnea syndrome]. / Reflujo gastroesofágico proximal y sindrome de la apnea obstructiva del sueño. Datos preliminares de un estudio prospectivo.

INTRODUCTION: Patients with mild or moderate Sleep Apnea Syndrome (SAS) need wider therapeutic scope options according to their disease severity. AIM: To consider including proton pump inhibitors (PPI) to the therapeutical alternatives of these patients. MATERIAL AND METHODS: A prospective study was designed, among patients with SAS. Nocturnal polysomnography and double channel pHmetry were performed simultaneously. RESULTS: From the 18 patients included in this preliminary phase, in three (16.7%) nocturnal proximal ph monitoring was positive. These 3 patients were treated with PPI during at least 3 months with a very satisfactory outcome in two of them. CONCLUSIONS: Treatment with PPI may be a useful therapeutical alternative in patients with mild to moderate SAS.

Prognostic factors in laryngotracheal injury following intubation and/or tracheotomy in ICU patients.

The aim of this study was to determine the incidence of laryngotracheal injuries following intubation and/or tracheotomy in intensive care unit (ICU) patients and to analyze their prognostic factors. This prospective study includes the clinical data and endoscopic exploration of 654 ICU patients who underwent oro-tracheal intubation between September 1992 and February 1999. The prognostic factors for upper airway injuries were analyzed using a multivariate statistical study. Endoscopic exploration of the upper airway 6 to 12 months after extubation revealed laryngotracheal injuries in 30 of the 280 patients examined (11%). The most important factors influencing the development of laryngotracheal lesions were the duration of the oro-tracheal intubation and the length of time in the ICU. Patients at high risk of developing injuries were those with pathological background, a non-neurological or non-surgical (medical) admission or upper-airway injuries at an early stage. The length of oro-tracheal intubation is the most important factor in the development of laryngotracheal injuries. Consequently, it is essential to establish a time limit to perform tracheotomy in ICU patients. Such timing should be adapted to each patient and pathology.

[Adverse effects of continuous positive airway pressure therapy and its relation to the nose]. / Efectos adversos derivados del tratamiento con nCPAP y su relación con la nariz.

The main problem in the treatment of obstructive sleep apnea syndrome (OSAS) with nasal continuous airway pressure (nCPAP) is the lack of compliance. One of the most important reasons for no compliance is the adverse effects of this treatment. We analyse, prospectively, 182 patients treated with nCPAP in order to show the relationship between previous nasal problems and adverse effects of nCPAP. Sixty percent of the population developed one o more side effects. Of this group, 69% showed nasal septum deviation at first examination in front of 31% that did not showed this problem (p = 0.001). In the group of patients with nasal side effects we observed an increase of compliance in 80% of patients treated medically and in 89% of those treated by a septoplasty. We demonstrate that the adverse effects of nCPAP are related to previous nasal problems and, also, that treatment of those problems can achieve an increase in compliance to nCPAP therapy.

Endoscopic sinus surgery in sinusitis.

In terms of functional treatment of sinonasal pathologies, endoscopic surgery represents a spectacular advance, offering excellent illumination, views of areas previously impossible to monitor, and the ability to view the main reference points in the surgical field. Over a five-year period (1988-1993), the authors have performed 278 paranasal sinus operations, using endoscopic techniques. The results obtained in 250 patients, with a minimum follow-up period of one year, have been analyzed. The criteria of assessment used include: self-assessment by the patient and the surgeon's assessment, made on basis of the endoscopic data. The best results were obtained in cases of antrochoanal polyps, polyposis not associated with asthma or acetylsalicylic acid (ASA) sensitivity, circumscribed chronic sinusitis, and aspergillomas. The worst results, with a high rate of recurrence, have been obtained with ASA sensitivity and chronic suppurative pan-sinusitis. It is essential to reach a consensus on the staging of polyposis so that treatment can be monitored adequately, even though, in itself, the pathology is difficult to classify as it can vary in a single patient for no apparent reason. On the other hand, there is a difference between the subjective and objective assessment of the condition, and this makes it even harder to explain the results obtained.

[The middle turbinate as the cause of sinusal pathology]. / El cornete medio como causa de patología sinusal.

The middle turbinate and its anatomical variations (concha bullosa and paradoxically bent middle turbinate) may be the site of different pathologies due to the alteration of the sinus function at the key area of the osteomeatal complex. In the present work we study 4 cases of concha bullosa and 4 cases of paradoxically bent middle turbinates, associated to recurrent sinusitis and/or headaches, which underwent endoscopic surgery. Improvement was achieved in all recurrent circumscribed sinusitis. One of the patients with bilateral paradoxically bent middle turbinate had an associated pansinusitis, and he only improved in his right side. An aspergilloma was found inside one of the conchae bullosae. Headaches improved in all the cases analyzed. Anatomic variations may be the cause of recurrent sinusal pathology or isolated headaches and it should be noted that, in correctly selected groups, a dramatic improvement can be achieved with a minor surgical procedure on the middle turbinate or ethmoidal infundibulum.

[Endoscopic naso-sinusal surgery. Experience with 150 cases]. / Cirugía endoscópica nasosinusal. Experiencia en 150 casos.

The AA. expose their experience drawn out from 150 cases of naso-sinusal pathology, treated through endoscopic surgery after the Messerklinger-Stammberger technique. They emphasize either the advantages of the procedure, in comparison with the classic methods, and the postoperative pitfalls. This procedure call for an exact knowledge of the endoscopic anatomy of the ethmoidal area, which can be gained only through corpses training.

[Laryngeal reinnervation in the dog]. / Reinervación laríngea en el perro.

In a group of 7 operated dogs, atrophy of the laryngeal musculature begins 3-4 weeks after recurrent nerve division. The atrophy increases progressively as time runs out, so that at the ninth week (last control done) the degree of atrophy of the posterior cricoarytenoid muscle is well marked as compared with that of the initial stage (4-5 weeks). In another set of 8 dogs reinnervation of this muscle was successful in 5 animals. In some of them up to 36 months elapsed after the cutting of the recurrent nerve and 14 weeks after application of a neuromuscular graft (composed of the hypoglossal ansa and a sheet of sternothyroid muscle). Histologic recuperation was good in all cases, but in only 2 of them the motility of the vocal cord at stimulation of the branch of the nerve was effective. The conclusion drawn is that histologic regeneration does now always parallel the functional one. Nevertheless, it seems possible that the elapsing of more time should be necessary in order to restore motility. This point demands new and broader experience before a positive answer can be given.