Infecciones periamigdalinas en el área de salud de León los años previos a la pandemia, durante la misma y posterior a ella. Estudio de un periodo de 6 años / Trend of peritonsillar infections in the León Health Area in the years before, during and after the pandemic. Study of a 6-year period

Introducción y objetivo: La COVID-19 ha tenido diversas consecuencias para el sistema sanitario de salud. Centrándonos en nuestro Servicio de Otorrinolaringología, hemos observado un descenso en la aparición de infecciones periamigdalinas (IPA). El objetivo de este estudio es evaluar aspectos epidemiológicos de las IPA a lo largo de un período de 6 años. Método: Estudio descriptivo retrospectivo y longitudinal con datos obtenidos del registro hospitalario informatizado de León durante un período de 6 años. Resultados: Un total de 327 pacientes fueron incluidos, prepandemia 201 (61.47%), en pandemia 64 (19.54%) y postpandemia 62 (18.96%), con una disminución de 48.58% en la incidencia de IPA. Discusión: Encontramos resultados similares a los analizados en otras series sobre la incidencia de los abscesos periamigdalinos durante la pandemia, sin embargo, tenemos una mayor estancia media hospitalaria en los ingresos por dicha patología. Conclusiones: La pandemia ha repercutido y cambiado la forma de atender ciertas patologías. En nuestro caso, en lo referente a los abscesos periamigdalinos observamos un claro descenso. (AU)

Introduction and objective: COVID-19 has had various consequences for the health care system. Focusing on our ENT Service, we have observed a decrease in the occurrence of peritonsillar infections (PTI). The aim of this study is to evaluate epidemiological aspects of PTIs over a 6-year period. Method: Retrospective and longitudinal descriptive study with data obtained from the computerized hospital registry of León over a 6-year period. Results: A total of 327 patients were included, pre-pandemic 201 (61.47%), pandemic 64 (19.54%) and post-pandemic 62 (18.96%), with a decrease of 48.58% in the incidence of IPA. Discussion: We found similar results to those analyzed in other series about the incidence of peritonsillar abscesses during the pandemic, however, we have a longer mean hospital stay in admissions for this pathology. Conclusions: The pandemic has affected and changed the way we look at certain conditions. In our case, when looking at peritonsillar abscesses we have observed a clear decrease. (AU)

Revisión de la cirugía endoscópica nasosinusal en la era de los tratamientos biológicos en una cohorte de 388 pacientes / Review of endoscopic sinus surgery in the era of biologic treatments in a cohort of 388 patients

Introducción y objetivo: Estudiar retrospectivamente la tasa de revisión quirúrgica nasosinusal en un hospital de tercer nivel a fin de aplicar las mejores estrategias terapéuticas. Método: Se realizó una revisión retrospectiva de pacientes intervenidos entre 2016 y 2020. Los factores evaluados incluyeron datos epidemiológicos, quirúrgicos, radiológicos e histopatológicos. En los casos de recidiva de patología nasosinsual se realizó una tomografía computerizada siguiendo la clasificación de Lund-Mackay y el recuento de eosinófilos. Se estudió también la tasa de revisión quirúrgica. Resultados: Se realizaron 506 cirugías endoscópicas nasosinusales (CENS) en 388 pacientes en 5 años. El 78% eran rinosinusitis crónicas (RSC), de las cuales el 18 % requirió cirugía de revisión. El índice de revisión fue mayor en pacientes con RSC con pólipos y asma (34%) o enfermedades respiratorias exacerbadas por AAS-EREA (42%). La mayor tasa de recurrencia se objetivó en el complejo osteomeatal (73%). Los pacientes con recuento elevado de eosinófilos en tejido polipoideo presentaban una tasa de cirugía de revisión del 34,2% y una OR de 3,2 (IC95 % 1,2-8,2). La terapia biológica se administró en 7 pacientes con asma grave. Discusión y conclusiones: La tasa de cirugía de revisión por RSC fue del 18%. Las recurrencias son frecuentes en el complejo osteomeatal. Es importante considerar los factores específicos que influyen en la tasa de cirugía de revisión, tales como el recuento elevado de eosinófilos, a fin de aplicar el mejor tratamiento. (AU)

Introduction and objective: To retrospectively review the revision surgical rate in a cohort cohort of a tertiary level hospital to select better strategies for recurrent patients. Method: A retrospective review of patients operated between 2016 and 2020 was carried out. The factors evaluated included epidemiological, surgical, radiological and histopathological data. In recurrences, Lund-Mackay CT score and eosinophil count was performed. Surgical revision rate was investigated. Results: We performed 506 Functional Endoscopic Sinus Surgery (FESS) on 388 patients for five years. Out of them, 78% were chronic rhinosinusitis (CRS). Globally, 18% required revision surgery, highest if they had CRS with polyps and asthma (34%), or aspirin-intolerance (42%). The highest rate of recurrence was on the osteometal complex (73%). Patients with elevate eosinophil count in nasal tissues present a revision surgical rate of 34.2% and an OR of 3.2 (IC95 % 1.2-8.2). Biologic therapy is administrated in 7 patients with severe asthma. Discussion and conclusions: The revision surgery rate for CRS was 18%. Recurrences are frequent in anterior meatal complex. It is important to consider patient-specific factors that affect revision surgery rates such as elevate eosinophil count to find better treatments for these worse patients. (AU)

Risk of contagion of SARS-CoV-2 among otorhinolaryngologists in Spain during the "Two waves".

INTRODUCTION: The aim of our study was to obtain data about the contagion rate among Otolaryngologists in Spanish ENT Departments and about the clinical outcomes in positive otolaryngologists. As a secondary objective, we aim to assess the rate of contagion in the first and the second Covid-19 wave in Spain among Otorhinolaryngologists and the regional distribution by ENT-Departments. METHODS: Study design and population: This is a prospective observational study in a cohort of 975 Otolaryngologists from 87 ENT Departments conducted from March 25 to November 17 in our collaborative group, COVID ORL ESP. COVID-19 polymerase chain reaction (PCR) was the diagnostic standard. Hospitalization and/or intensive care admission and mortality was recorded as non-identified data. RESULTS: Data collected from 975 otolaryngologist from 87 Departments resulted in 157 (16.5%) otolaryngologists testing positive for SARS-CoV-19 by RT-PCR. Important geographic differences in contagion are reported. A total of 136 (86.6%) otolaryngologists were tested positive during the first wave and 21 (13.3%) during the second wave. At the last cut-off point of the study only 30/87 ENT Departments (34.5%) remained COVID19-free and 5 Departments reported more than 50% staff members testing positive. The majority of positive tested otolaryngologists (126/157; 80.2%) had only mild or no symptoms, 17 developed moderate symptoms (10.8%) and 3 had pneumonia not requiring hospitalization (2%). Five colleagues were admitted at hospital, 4 required ICU (2.5%) and 2 colleges died from COVID-19. CONCLUSIONS: During the first wave of the SARS-CoV-19 pandemic otolaryngologists in Spain have been overall the group suffering the highest rate of contagion, particularly during the first month. Subsequently, the Spanish Ministry of Health should include otorhinolaryngologists as a high-risk group in airborne pandemics.

Outcome of 1890 tracheostomies for critical COVID-19 patients: a national cohort study in Spain.

BACKGROUND: The question of an optimal strategy and outcomes in COVID-19 tracheostomy has not been answered yet. The critical focus in our case study is to evaluate the outcomes of tracheostomy on intubated COVID-19 patients. METHODS: A multicentric prospective observational study of 1890 COVID-19 patients undergoing tracheostomy across 120 hospitals was conducted over 7 weeks in Spain (March 28 to May 15, 2020). Data were collected with an innovative approach: instant messaging via WhatsApp. OUTCOME MEASUREMENTS: complications, achieved weaning and decannulation and survival. RESULTS: We performed 1,461 surgical (81.3%) and 429 percutaneous tracheostomies. Median timing of tracheostomy was 12 days (4-42 days) since orotracheal intubation. A close follow-up of 1616/1890 (85.5%) patients at the cut-off time of 1-month follow-up showed that in 842 (52.1%) patients, weaning was achieved, while 391 (24.2%) were still under mechanical ventilation and 383 (23.7%) patients had died from COVID-19. Decannulation among those in whom weaning was successful (n = 842) was achieved in 683 (81%) patients. CONCLUSION: To the best of our knowledge, this is the largest cohort of COVID-19 patients undergoing tracheostomy. The critical focus is the unprecedented amount of tracheostomies: 1890 in 7 weeks. Weaning could be achieved in over half of the patients with follow-up. Almost one out of four tracheotomized patients died from COVID-19.

Cartilage invasion patterns in laryngeal cancer.

The cartilaginous invasion determines the T and is one of the most common sources of mistake in tumor staging. Also it is of great importance when planning any therapeutic alternative. In the latest revision of the TNM classification a clear distinction is made between infiltration of cartilage without going through it, considered a T3 recently and that would be a T4 according to the previous classification, and those going through the cartilage, classified as T4a. While this classification makes the difference in depth of infiltration, it does not emphasize the extent of invasion. This paper provides a detailed description of the laryngeal cartilage tumor infiltration by whole organ serial section in which the invasion is considered both horizontal (transcartilaginous) and vertical (extent of invasion) and establishing patterns of three-dimensional infiltration of the cartilage. This is a cross-sectional study of prevalence. 275 records of patients treated for laryngeal squamous cell carcinoma between 1995 and 2000 were reviewed. The pathological processing of laryngectomy surgical specimens was performed following the method of whole organ serial section described by G. F. Tucker. The following patterns of cartilaginous infiltration were defined: (1) transcartilaginous infiltration; (2a) partial focal infiltration of the cartilage: infiltration not going through the cartilage but occupying one third or less of its extent; (2b) partial extensive infiltration of the cartilage: infiltration occupying two thirds or more of its length and (3) no cartilage infiltration: tumor in contact with the cartilage (paraglottic space) but without affecting it. 161 patients met the inclusion criteria. The most frequent tumor location was supraglottic (58 cases) followed by glottic (47). 109 patients (67.7 %) were treated with total laryngectomy. Partial surgical techniques were performed in the remaining cases. TNM tumor staging was performed according to the results of pathological study (pTNM). 72.06 % (116) were classified as advanced laryngeal tumors (pT3 and pT4). 46 % of patients showed some extent of laryngeal cartilage infiltration (thyroid, cricoid, arytenoids, epiglottis). The cartilage most frequently infiltrated was the thyroid in 48 patients (29.8 %) and when it is affected, in most cases (66.7 %), the infiltration is transcartilaginous. The next most common pattern is partial focal infiltration (27 %). In the cricoid cartilage, the most common pattern of infiltration is focal partial infiltration (52.6 %). Of the 19 cases with infiltration of the cricoid, there are 12 cases with extra laryngeal invasion through a cricothyroid membrane perforation. The study of laryngeal cancer by laryngeal whole serial section has been proved to be very useful in offering a high precision pTNM staging and a detailed description of the infiltration of cartilage. We have seen that when the thyroid cartilage is infiltrated the tumor often passes through the cartilage. However, there are cases where the tumor is extremely aggressive, being very widespread in cartilage thickness without actually crossing it. The isolated infiltration of the cricoid cartilage is exceptional.

Electrophysiological monitoring of hearing function during cochlear perilymphatic perfusions.

CONCLUSION: The cochlear perilymphatic perfusion produces, by itself, significant effects in the cochlear physiology that could be associated with the surgical procedure. These effects need to be well characterized to allow a reliable quantification of the effects of the experimental agent being tested. OBJECTIVES: The study focused on the accurate description of the electrophysiological effects on the cochlear potential recordings of perilymphatic perfusions. METHODS: Two successive cochlear perilymphatic perfusions were carried out. The first used artificial perilymph. The second used artificial perilymph alone or a kainic acid (KA) solution in artificial perilymph. The compound action potential of the auditory nerve (CAP-AN) was recorded: (1) before the first perfusion, (2) after the first perfusion and (3) after the second perfusion, and compared between groups. RESULTS: The first intracochlear perfusion with artificial perilymph produced significant effects in the CAP-AN that could be related to the surgical procedure. These effects were analysed separately from the effects produced by the KA. In particular, the KA administered intracochlearly produced a significant increase in the latency and a decrease in the amplitude of the CAP-AN N1 wave compared with the controls that were perfused twice with artificial perilymph.