Estudio comparativo entre sondajes lacrimonasales de primera intención con y sin control endoscópico / Comparative study of primary intention lacrimal probing with and without nasal endoscopy

Objetivo: Comparar los resultados de dos series de sondajes de primera intención, sin y con endoscopia nasal, acompañados en este segundo caso de luxación de cornete inferior y corrección de enfermedad del meato inferior si la hubiera, en casos de obstrucción nasolagrimal congénita. Métodos: Se practica un estudio de cohortes retrospectivos con 36 sondajes simples (grupo 1) frente a 36 sondajes con endoscopia (grupo 2), entre enero de 2011 y enero de 2013, en 2 grupos de población parecidos sin intervenciones previas. El rango de edad fue entre 8 y 27 meses en el grupo 1 y entre 7 y 30 meses en el grupo 2. Resultados: El 50% de cirugías lagrimales fueron realizadas con éxito en el grupo de los sondajes sin endoscopia, frente al 97,22% en el grupo guiado por endoscopia. En el grupo 2 se diagnosticó y corrigió intraoperatoriamente un 16,67% de vías lagrimales con aposición del cornete inferior en su porción distal y un 11,11% de falsas vías o trayectos submucosos. En un 30,56% de los sondajes practicados con endoscopia se observó más de una anomalía nasolagrimal, tanto a nivel del canal como en el meato inferior, que influía negativamente en su funcionamiento. Conclusión: Aunque clásicamente se ha reservado la endoscopia para fracasos quirúrgicos en reintervenciones, su utilización de primera intención mejora significativamente los éxitos. En nuestra serie un 97,22% tuvieron resolución completa de los síntomas, evitando un segundo paso por quirófano y la utilización de materiales y técnicas más costosas. Nos ayuda a la visualización y compresión de esta enfermedad y es el único método para confirmar directamente un correcto sondaje en tiempo real (AU)

Objective: Our objective was to compare the results of probing with and without endoscopy in cases of congenital nasolacrimal duct obstruction without prior probing. Methods: This was a retrospective analysis on 2 non-randomized cohorts, 36 simple soundings (group 1) and 36 soundings with endoscope (group 2), between January 2011 and January 2013. Both groups were similar in age and had no previous surgery. The age of the patients studied ranged between 8 and 27 months in the first group and between 7 and 30 months in the second group. Results: The procedure was successful in 50% of the conventional probing group and in 97.22% in the endoscopy probing group. In this group 16.67% of patients with tight inferior turbinate and 11.11% of those where the probe passed into the submucosal space were diagnosed and corrected intraoperatively. Some anomaly was observed in 30.56% of patients undergoing endoscopy. Conclusion: Although nasal endoscopy is classically reserved for unsuccessful probing, its use in primary intention increases the success rate of the procedure. In our study, 97.22% of eyes had complete resolution of symptoms, avoiding a second surgery and the use of more expensive materials and techniques. Nasal endoscopy helps intraoperative visualisation, understanding and management of congenital nasolacrimal duct obstruction and is the only method that confirms the correct anatomic position of the catheterisation in real time (AU)

Comparative study of primary intention lacrimal probing with and without nasal endoscopy.

OBJECTIVE: Our objective was to compare the results of probing with and without endoscopy in cases of congenital nasolacrimal duct obstruction without prior probing. METHODS: This was a retrospective analysis on 2 non-randomized cohorts, 36 simple soundings (group 1) and 36 soundings with endoscope (group 2), between January 2011 and January 2013. Both groups were similar in age and had no previous surgery. The age of the patients studied ranged between 8 and 27 months in the first group and between 7 and 30 months in the second group. RESULTS: The procedure was successful in 50% of the conventional probing group and in 97.22% in the endoscopy probing group. In this group 16.67% of patients with tight inferior turbinate and 11.11% of those where the probe passed into the submucosal space were diagnosed and corrected intraoperatively. Some anomaly was observed in 30.56% of patients undergoing endoscopy. CONCLUSION: Although nasal endoscopy is classically reserved for unsuccessful probing, its use in primary intention increases the success rate of the procedure. In our study, 97.22% of eyes had complete resolution of symptoms, avoiding a second surgery and the use of more expensive materials and techniques. Nasal endoscopy helps intraoperative visualisation, understanding and management of congenital nasolacrimal duct obstruction and is the only method that confirms the correct anatomic position of the catheterisation in real time.

Tratamiento de la obstrucción congénita de la vía lagrimal mediante balón catéter, intubación monocanalicular y control endoscópico / Treatment of the congenital obstruction of the lachrymal route, by means of ball catheter, intubation monocanalicular and endoscopic control

Introducción y objetivo: La obstrucción lagrimal congénita constituye un motivo frecuente de consulta, siendo el control endoscópico de la fosa nasal a nivel del meato inferior el que permite llevar a cabo procedimientos quirúrgicos controlados. El objetivo de nuestro estudio es analizar el resultado obtenido en el tratamiento de la obstrucción congénita de la vía lagrimal mediante dilatación del conducto nasolagrimal con balón catéter e intubación monocanalicular con Monoka y control endoscópico en niños en los que habían fallado dos sondajes como tratamiento previo. Material y métodos: Entre octubre de 2004 y septiembre de 2008 se practica esta técnica en un estudio prospectivo en 36 pacientes con una edad entre 12 y 66 meses (media de 36,2 meses) con obstrucción nasolagrimal congénita en los que ha fallado el sondaje en dos ocasiones. Se incluye cuestionario con test de Munk y examen oftalmológico, incluyendo el test de desaparición de colorante a los 5min, efectuados en los controles a las 6 semanas, 3 meses, 6 meses y 12 meses en todos los casos. Se define éxito cuando se normalizaron todos los síntomas y signos (Munk 0) y en el test de desaparición de colorante hay ausencia de tinción residual (grado 0). Resultados: En el 91,66 % de los pacientes se obtuvieron buenos resultados y en el 8,33%, aceptables. Todos los casos (100%) mejoraron con respecto a los síntomas previos. No se precisó repetir el proceso ni practicar una dacriocistorrinostomía en ningún caso. Conclusiones: El tratamiento de la obstrucción congénita de la vía lagrimal mediante balón catéter, intubación monocanalicular y control endoscópico es una técnica quirúrgica segura, efectiva y poco agresiva para el tratamiento de la obstrucción lagrimal congénita con fracasos de 2 sondajes previos (AU)

Introduction and goals: Congenital lachrymal obstruction is a frequent motive of consultation. Endoscopic control in the inferior meatus of the nostril allows to realize surgical controlled procedures. The aim of the study is to analyze the result obtained in the treatment of congenital obstruction of the lachrymal duct by monocanalicular intubation with Monoka and endoscopic control in children who had failed two lachrymal system probings. Methods: Between October 2004 and September 2008 this technique was performed in a prospective study on 36 patients with congenital nasolacrimal obstruction who had failed two lachrymal system probings. The mean age was 36.2 months (range 12–66 months).Patients were followed at 6 weeks, 3 months and 6 months, with clinical evaluation by Munk's score and ophthalmologic exam using dye disappearance test. Success was defined as complete resolution of signs and symptoms (Munk 0) and no fluorescein remaining in dye disappearance test (grade 0). Results: The procedure was successful in 91.66% of the cases and acceptable in 8.33%.We have not found any complication or side effects, and not further procedures have been needed on any patient. Conclusions: Balloon dachryoplasty with monocanalicular intubation under endoscopic control is a safe, easy to perform and effective surgical technique for the treatment of congenital lachrymal obstruction with two previous failed lachrymal system probing (AU)

[Treatment of the congenital obstruction of the lachrymal duct, by means of balloon catheter, monocanalicular intubation, and endoscopic control]. / Tratamiento de la obstrucción congénita de la vía lagrimal mediante balón catéter, intubación monocanalicular y control endoscópico.

INTRODUCTION AND GOALS: Congenital lachrymal obstruction is a frequent motive of consultation. Endoscopic control in the inferior meatus of the nostril allows to realize surgical controlled procedures. The aim of the study is to analyze the result obtained in the treatment of congenital obstruction of the lachrymal duct by monocanalicular intubation with Monoka and endoscopic control in children who had failed two lachrymal system probings. METHODS: Between October 2004 and September 2008 this technique was performed in a prospective study on 36 patients with congenital nasolacrimal obstruction who had failed two lachrymal system probings. The mean age was 36.2 months (range 12-66 months). Patients were followed at 6 weeks, 3 months and 6 months, with clinical evaluation by Munk's score and ophthalmologic exam using dye disappearance test. Success was defined as complete resolution of signs and symptoms (Munk 0) and no fluorescein remaining in dye disappearance test (grade 0). RESULTS: The procedure was successful in 91.66% of the cases and acceptable in 8.33%. We have not found any complication or side effects, and not further procedures have been needed on any patient. CONCLUSIONS: Balloon dachryoplasty with monocanalicular intubation under endoscopic control is a safe, easy to perform and effective surgical technique for the treatment of congenital lachrymal obstruction with two previous failed lachrymal system probings.

[Conjunctivodacryocystorhinostomy with the assistance of diode laser. Endoscopic placement of Jones lacrimal tubes]. / Conjuntivodacriocistorrinostomía con láser diodo. Inserción endoscópica de tubos de Jones.

OBJECTIVE: To describe and assess a surgical technique for cases of complete bicanalicular lachrymal destruction by means of the endoscopic insertion use of the Jones tube with a diode laser to study functionality and complications. PATIENTS AND METHOD: A descriptive study of a case series with 24 consecutive patients with complete bicanalicular obstruction who underwent conjunctivodacryocystorhinostomy with diode laser. The surgery time, intra-operative and post-operative complications, long-term patency, and need for secondary revision were evaluated. RESULTS: Twenty-four consecutive patients were included in the study. All surgical procedures were successfully performed without significant complications. Average operating time was 15 minutes. The length of the tubes used ranged from 17 to 26 mm. Patients were evaluated at 24 hours, 3 weeks, 3 months, and 6 months and then every 6 months. The most frequent post-surgical complication was the downward migration of the tube towards the nasal fossa (37.5%). Secondary intervention was performed in 6 patients. Success was demonstrated using the fluoresceinic staining test under endoscopic monitoring and represented 37.5% after the initial surgery and 50% including revision surgery. CONCLUSIONS: Laser-guided endoscopic intubation is a speedy and accurate surgical procedure that is well-tolerated during the operation and leaves no scar on the skin surface. However, it is associated with a considerable number of post-surgical complications.

Conjuntivodacriocistorrinostomía con láser diodo. Inserción endoscópica de tubos de Jones / Conjunctivodacryocystorhinostomy with the assistance of diode laser. Endoscopic placement of jones lacrimal tubes

Objetivo: Describir y evaluar la cirugía en los casos de destrucción canalicular total, mediante la inserción endoscópica con láser diodo del tubo de Jones para estudiar la funcionalidad y las complicaciones. Pacientes y método: Se realiza un estudio descriptivo de una serie de casos consecutivos en 24 pacientes con obstrucción bicanalicular completa, a los que se practica una conjuntivodacriocistorrinostomía con láser diodo. Se valoró los tiempos quirúrgicos, las complicaciones operatorias y postoperatorias, la permeabilidad y la necesidad de reintervenciones. Resultados: Se incluyó a 24 pacientes en el estudio. La cirugía se llevo a cabo en todos los pacientes sin complicaciones. El tiempo quirúrgico medio fue de 15 min. Los tamaños de los tubos usados fueron de 17-26 mm. Se efectuaron controles a las 24 h, a las 3 semanas y a los 3 y 6 meses, seguidos de revisiones cada 6 meses. La complicación posquirúrgica más frecuente fue el desplazamiento inferior del tubo hacia la fosa nasal (37,5 %). Se precisó reintervención en 6 casos. Los éxitos demostrados mediante el test de tinción fluoresceínica con control endoscópico fueron un 37,5 % tras una primera intervención y un 50 % si se incluye una segunda reintervención. Conclusiones: La intubación endoscópica guiada con láser es una cirugía precisa, rápida, bien tolerada intraoperatoriamente y sin cicatriz cutánea, si bien va asociada a un importante número de complicaciones posquirúrgicas

Objective: To describe and assess a surgical technique for cases of complete bicanalicular lachrymal destruction by means of the endoscopic insertion use of the Junes tube with a diode laser to study functionality and complications. Patients and method: A descriptive study of a case series with 24 consecutive patients with complete bicanalicular obstruction who underwent conjunctivodacryocystorhinostomy with diode laser. The surgery time, intra-operative and post-operative complications, long-term patency, and need for secondary revision were evaluated. Results: Twenty-four consecutive patients were included in the study. All surgical procedures were successfully performed without significant complications. Average operating time was 15 minutes. The length of the tubes used ranged from 17 to 26 mm. Patients were evaluated at 24 hours, 3 weeks, 3 months, and 6 months and then every 6 months. The most frequent post-surgical complication was the downward migration of the tube towards the nasal fossa (37.5 %). Secondary intervention was performed in 6 patients. Success was demonstrated using the fluoresceinic staining test under endoscopic monitoring and represented 37.5 % after the initial surgery and 50 % including revision surgery. Conclusions: Laser-guided endoscopic intubation is a speedy and accurate surgical procedure that is well-tolerated during the operation and leaves no scar on the skin surface. However, it is associated with a considerable number of post-surgical complications

Estudio comparativo entre potenciales evocados auditivos de estado estable, potenciales evocados auditivos de tronco cerebral y audiometría tonal liminar / Comparative Study Between Auditory Steady-State Responses, Auditory brain-stem responses and liminar tonal audiometry

Objetivos: Los potenciales evocados auditivos de estado estable (PEAee) con frecuencias de modulación de 70-110 Hz son una nueva técnica para explorar la audición. Nos proponemos valorar su aportación al diagnóstico audiológico. Material y método: Se estudió las diferentes aportaciones al diagnóstico del umbral auditivo de los PEAee y los potenciales evocados auditivos de tronco cerebral (PEATC) en respuesta al clic. Además se estudió las diferencias entre estos umbrales y los de la audiometría tonal liminar (ATL). Se analiza los coeficientes de correlación entre los umbrales obtenidos en PEAee y los de la ATL. Resultados: Los PEAee permitieron detectar restos de audición que no eran detectados mediante PEATC transitorios. Se encontraron diferencias de ­13,750 dB HL (­22,291 a ­5,209) y de ­13,250 dB HL (­19,163 a ­7,337) entre los valores registrados mediante PEAee para las frecuencias de 500 y 1.000 Hz y los umbrales de la ATL para esas mismas frecuencias. Se encontraron diferencias de 1,625 dB HL (­6,967 a 10,217) y de ­2,875 dB HL (­7,446 a 1,696) entre los valores estimados en los PEAee y los umbrales de la ATL para las frecuencias de 500 y 1.000 Hz. Los coeficientes de correlación fueron estadísticamente muy significativos (p = 0,01) entre los umbrales registrados y los estimados en los PEAee para las portadoras de 500 y 1.000 Hz y los de la ATL para las mismas frecuencias. Conclusiones: Los PEAee con frecuencias de modulación entre 70 y 110 Hz constituyen una nueva técnica de exploración de la audición que es más específica en frecuencia que los PEATC en respuesta al clic. La respuesta obtenida no se modificará por el estado de conciencia y además es una técnica doblemente objetiva. Los umbrales obtenidos en los PEAee permiten realizar una estimación del umbral de audición

Objetives: Auditory steady-state responses (ASSR) using frequencies of modulation between 70-110 Hz are a new auditive exploration technique. The aim of the study was to evaluate the contribution of the ASSR to diagnostic of the audition. Material and method: Different aportations of auditory steady-states responses (ASSR) and auditory brain-stem responses (ABR) to diagnostic of threshold of audition were studied Differences between these thresholds and thresholds obtained by liminar tonal audiometry (LTA) were studied too. Correlations between thresholds obtained by ASSR and LTA were studied. Results: ASSR detected rest of audition that transients ABR did not detect. Differences about ­13.750 dB HL (­5.209 to ­22.291) and ­13.250 dB HL (­7.337 to ­19.163) were found between registered values for carriers of 500 and 1000 Hz and the thresholds by LTA for these carriers. Differences about 1.625 dB HL (­6.967 to 10.217) and ­2.875 dB HL (­7.446 to 1.696) were found between estimations for the carries of 500 and 1000 Hz and thresholds by TLA. Stadistically very signifficant (P=.01) coefficients of correlation were found between registered and estimated thresholds by ASSR for carrier of 500 and 1000 Hz and threshold by TLA for these frecuencies. Conclusions: Auditory steady-state responses (ASSR) using frequencies of modulation between 70-110 Hz are a new auditive technique of exploration. This stimulus is more frecuency-specific than clicks for auditory brain-stem responses (ABR). Response is not modificated by steady of consciousness. The technique is doublely objetive. Thresholds obtained by ASSR permits to estimation of the audition threshold

[Comparative study between auditory steady-state responses, auditory brain-stem responses and liminar tonal audiometry]. / Estudio comparativo entre potenciales evocados auditivos de estado estable, potenciales evocados auditivos de tronco cerebral y audiometría tonal liminar.

OBJECTIVES: Auditory steady-state responses (ASSR) using frequencies of modulation between 70-110 Hz are a new auditive exploration technique. The aim of the study was to evaluate the contribution of the ASSR to diagnostic of the audition. MATERIAL AND METHOD: Different aportations of auditory steady-states responses (ASSR) and auditory brain-stem responses (ABR) to diagnostic of threshold of audition were studied Differences between these thresholds and thresholds obtained by liminar tonal audiometry (LTA) were studied too. Correlations between thresholds obtained by ASSR and LTA were studied. RESULTS: ASSR detected rest of audition that transients ABR did not detect. Differences about -13.750 dB HL (-5.209 to -22.291) and -13.250 dB HL (-7.337 to -19.163) were found between registered values for carriers of 500 and 1000 Hz and the thresholds by LTA for these carriers. Differences about 1.625 dB HL (-6.967 to 10.217) and -2.875 dB HL (-7.446 to 1.696) were found between estimations for the carries of 500 and 1000 Hz and thresholds by TLA. Statistically very significant (P=.01) coefficients of correlation were found between registered and estimated thresholds by ASSR for carrier of 500 and 1000 Hz and threshold by TLA for these frequencies. CONCLUSIONS: Auditory steady-state responses (ASSR) using frequencies of modulation between 70-110 Hz are a new auditive technique of exploration. This stimulus is more frequency-specific than clicks for auditory brain-stem responses (ABR). Response is not modificated by steady of consciousness. The technique is doublely objective. Thresholds obtained by ASSR permits to estimation of the audition threshold.