Pediatric vagal nerve stimulator explantation: A comprehensive literature review and tertiary care experience.

OBJECTIVE: Patients with medically-refractory epilepsy who undergo vagal nerve stimulator (VNS) implantation to reduce seizure burden sometimes require device removal. Complete explantation refers to the removal of both the generator and vagal nerve leads, and is uncommonly performed by otolaryngologists due to the perceived risk associated with lead removal. This comprehensive literature review and case series studies safety outcomes among pediatric patients undergoing complete VNS explantation. STUDY DESIGN/SETTING: Literature review and tertiary care case series. METHODS: PubMed, Embase, Web of Science, and Google Scholar were searched to identify all articles involving VNS explantation prior to January 2023. A retrospective review of pediatric patients undergoing complete VNS explantation from 2009 to 2023 at our tertiary center was also conducted. RESULTS: After screening, 36 articles were retained involving 399 patients (139 confirmed children) who underwent complete VNS explantation. 26 patients (6.5%) experienced 1+ peri/post-operative complications. These included temporary VF paresis or dysphonia (n = 14; 3.6%), permanent vocal fold (VF) paralysis/paresis (n = 6; 1.5%), internal jugular vein injury (n = 4; 1.0%), temporary dysphagia (n = 2; 0.50%), and cable-bowstring phenomenon (n = 1; 0.25%). Data from our tertiary care center revealed eight patients (6 M: 2 F) with a mean age of 11.4 ± 6.2 years. Devices were removed for clinical ineffectiveness (n = 2), infection (n = 2), lead failures (n = 2), and increased lead impedance (n = 2). Mean total length of implantation was 44.4 ± 40.3 months. Mean follow-up was 44.8 ± 35.2 months. No complications were identified. CONCLUSIONS: Complete VNS device removal in pediatric patients is technically feasible with low reported complications. Working alongside neurosurgery, otolaryngologists offer unique expertise in dissection along the vagus nerve and may thus add value to the practice of VNS surgery.

Cardiovascular Risk Factors in Patients With Sudden Sensorineural Hearing Loss: A Systematic Review and Meta-analysis.

OBJECTIVE: The interruption of vascular supply to the inner ear is one of several proposed etiologies of sudden sensorineural hearing loss (SSNHL). The increased presence of cardiovascular risk factors may predispose patients to SSNHL through this pathway. This systematic review and meta-analysis studies the presence of cardiovascular risk factors in patients diagnosed with SSNHL. DATA SOURCES: Databases included PubMed/Medline, OVID, EMBASE, Cochrane, and Web of Science. REVIEW METHODS: Inclusion criteria included studies featuring SSNHL patients presenting with 1+ cardiovascular risk factors. Exclusion criteria included case reports and studies without outcome measures. Two investigators independently reviewed all manuscripts and performed quality assessments using validated tools. RESULTS: Of 532 identified abstracts, 27 studies met inclusion criteria (19 case-control, 4 cohorts, 4 case series). Of these, 24 underwent meta-analysis encompassing a total of 77,566 patients (22,620 SSNHL patients, 54,946 matched controls). The mean age was 50.43 years. SSNHL patients were more likely to have concomitant diabetes (odds ratio [OR] 1.61 [95% confidence interval [CI]: 1.31, 1.99; p < .00001]) and hypertension (OR 1.5 [95% CI: 1.16, 1.94; p = .002]). An increased standard mean difference of total cholesterol of 11.09 mg/dL (95% CI; 3.51, 18.67; p = .004) was noted in the SSNHL group compared with the controls. No significant differences in smoking, high-density lipoprotein, triglycerides, or body mass index were detected. CONCLUSION: Patients presenting with SSNHL have a significantly higher risk of concomitant diabetes, hypertension, and higher total cholesterol in comparison to matched controls. This may indicate a higher cardiovascular risk profile in this population. More prospective and matched cohort studies are needed to understand the role of cardiovascular risk factors in SSNHL.

Complication Rates in Osteotome and Drill Techniques in External Auditory Canal Exostoses: A Systematic Review and Meta-Analysis.

OBJECTIVES: To assess and compare complication rates of symptomatic external auditory canal (EAC) exostoses treated with drill versus osteotome canalplasty. DATABASES REVIEWED: PubMed/Medline, OVID, EMBASE, Web of Science, Google Scholar. METHODS: A systematic review and meta-analysis in accordance with PRISMA guidelines and standardized bias assessment using the JBI critical appraisal checklist was performed. Studies containing original outcome data on drill and osteotome canalplasty were included. The primary study outcome was complication rates. RESULTS: Fifteen studies were included, encompassing 1399 total patients (1788 ears) with 530 and 1258 ears in the osteotome and drill groups, respectively. Ten studies used a drill, 2 used an osteotome, and 3 used both. The most frequently reported complications were tympanic membrane (TM) perforation (osteotome group: 5.3% [95% CI: 1.7%-10.9%]; drill group: 3.8% [1.5%-7.1%]), sensorineural hearing loss (SNHL) (0.69% [0.07%-1.9%]; 4.3% [2.2%-7.0%]), and postoperative stenosis (1.1% [0.0005%-4.3%]; 4.1% [1.9%-7.0%]). Use of the osteotome was associated with a lower rate of SNHL (P < .05) and stenosis (P < .05), and a higher rate of TM perforation (P < .05). Heterogeneity of the studies included in the analyzed complications ranged from moderate to high. Level of evidence in the included studies ranged from 2b to 4 and all studies had an overall low risk of bias. CONCLUSION: While an osteotome technique may increase the risk of TM perforation, drill canaloplasty may increase the risk of SNHL and postoperative stenosis in EAC exostectomy. The exact quantity of hearing loss could not be definitively evaluated. Additional research with participant randomization is needed to assess clinical efficacy. LEVEL OF EVIDENCE: Level 8.

Racial Disparities in Tympanoplasty Surgery: A 30-Day Morbidity and Mortality National Cohort Study.

OBJECTIVES: To assess the impact of race and ethnicity on 30-day complications after tympanoplasty surgery. METHODS: The National Surgical Quality Improvement Program database was queried for tympanoplasty procedures from 2005 to 2019. Demographic, comorbidity, and postoperative complication data were compared according to race using univariate and binary logistic regression analyses. RESULTS: A total of 11,701 patients were included, consisting of 80.3% White, 3.0% Black, 7.7% Asian, 5.7% Hispanic, 2.5% American Indian/Alaska Native, and 0.8% other. Binary logistic regression model indicated that Black patients had increased odds of unplanned readmittance (p = 0.033; odds ratio [OR], 3.110) and deep surgical site infections (p = 0.008; OR, 6.292). American Indian/Alaska Native patients had increased odds of reoperation (p = 0.022; OR, 6.343), superficial surgical site infections (p < 0.001; OR, 5.503), urinary tract infections (p < 0.001; OR, 18.559), surgical complications (p < 0.001; OR, 3.820), medical complications (p = 0.001; OR, 10.126), and overall complications (p < 0.001; OR, 4.545). CONCLUSION: Although Black and American Indian/Alaskan Native patients were more likely to have complications after tympanoplasty surgery after adjusting for comorbidities, age, and sex, these results are tempered by an overall low rate of complications. Future studies should be devoted to understanding the drivers of these health inequities in access to otologic care and surgical treatment to improve outcomes and achieve equitable care.

Electronic Cigarettes: A Narrative Review and Cohort Study of Electronic Cigarette Users in the Otolaryngology Clinic.

Electronic nicotine delivery systems (ENDSs) are growing in popularity, particularly in young adults. While in vitro and murine models have demonstrated potentially harmful health effects of ENDSs, long-term health effects and clinical outcomes are generally unknown. Use as a smoking cessation aid is propagated by studies of potential harm reduction compared to conventional cigarette smoking. We present a review of the current controversies of ENDS use and present a novel cohort of patients visiting the otolaryngology clinic with known ENDS use to understand their clinical and demographic characteristics and the prevalence of otolaryngologic inflammatory diagnoses. Eighty-eight patients had 105 diagnoses. Forty-three (48.9%) ENDS users had at least 1 inflammatory diagnosis. ENDS use was more common in White, male patients between the ages of 18 and 35 years. The most common inflammatory diagnoses were chronic otitis media (17.4%) and allergic rhinitis (13.0%). While the rate of inflammatory disease was significantly higher in male than in female patients (60.7% vs 28.1% p = 0.003), no significant association was seen between inflammatory disease and age, race/ethnicity, or length of ENDS use. The identification and description of patients with ENDS use will help clinicians' better risk-stratify otolaryngologic diagnoses associated with this novel health behavior. Additionally, further clinical research is necessary to elucidate long-term health outcomes of ENDS use.

Sport and Recreational Causes of Nasal Bone Fractures.

OBJECTIVE: Nasal bone fractures are the most common facial bone fractures. However, there is limited literature on the etiology of these fractures, particularly distribution across sports and other recreational activities. METHODS: The Nationwide Electronic Injury Surveillance System (NEISS) national injury database was queried for emergency department visits involving the diagnosis of nasal or nose fractures associated with sports and recreation activities over the most recent 10 year span available. Demographic, disposition, and weighted incidence were analyzed. RESULTS: Total incidence of nasal fractures across 10 years was 158 979. The mean age of nasal bone fractures was 20.4 years old. Nasal fractures were more common in males (74.6%) and white patients (54.1%). National estimated incidence of nasal fractures decreased from 21 028 in 2009 to 11 108 in 2018, a reduction of 47.2%. The most common causes among all patients were basketball (23.2%), baseball (17.1%), softball (9.8%), soccer (7.4%), and football (7%). In pediatric patients, the most common cause was baseball (25.1%). The majority (98.1%) of patients were discharged from the emergency department, while 0.9% of patients were admitted. CONCLUSION: The most common recreational causes of nasal fractures are sports, with the most common being non-contact sports like basketball and baseball. However, the incidence of nasal bone fractures due to recreational causes nationwide has decreased significantly over the past 10 years. This may reflect improved safety protocols among athletes.

Postoperative Pain After Endoscopic vs Microscopic Otologic Surgery: A Systematic Review and Meta-analysis.

OBJECTIVE: Equivalent outcomes, such as procedural safety and audiometry, have been reported between endoscopic ear surgery (EES) and microscopic ear surgery (MES). This study aims to determine if EES leads to decreased postoperative pain when compared with MES. DATA SOURCES: PubMed, OVID MEDLINE, Scopus, Web of Science, and Cochrane Central from 2000 to 2020. REVIEW METHODS: A systematic review in accordance with the PRISMA guidelines and standardized bias assessment was performed. Studies containing original data on postoperative pain following EES and MES were included. RESULTS: Fourteen studies fulfilled eligibility: 7 retrospective studies, 6 randomized controlled trials, and 1 case series. Studies included surgery for cholesteatoma (n = 3), tympanoplasty/myringoplasty (n = 6), and stapedotomy (n = 5), pooling data from 974 patients. Postoperative pain was quantitatively described through a variety of numeric pain scores. Meta-analysis was performed on 11 studies. Among the 7 studies utilizing the numeric rating scale or visual analog scale, postoperative pain in the EES cohort was significantly lower than that of the MES cohort (standardized mean difference = -1.45 [95% CI, -2.05 to -0.85], P < .001). Similarly, pain scores were lower in the EES cohort among the 4 studies utilizing the Three Grades Pain Scale (odds ratio = 0.2 [95% CI, 0.09-0.45], P < .001). Additional qualitative strengths identified in EES included significant improvements in visualization, operative time, postoperative complications, and decreased need for canalplasty. Quality assessment indicated low to moderate risk of bias for all studies. CONCLUSION: Meta-analysis confirms that EES results in significantly less postoperative pain when compared with MES. This surgical approach should be considered in the armamentarium of otologic surgeons, allowing for improved outcomes.

Pediatric foreign bodies of the ear: A 10-year national analysis.

OBJECTIVES: To estimate the incidence of emergency department visits for pediatric ear foreign bodies. To identify the most common items and their trends. METHODS: The Nationwide Electronic Injury Surveillance System (NEISS) was queried for emergency department visits involving the diagnosis of foreign bodies in the ear including pinna and canal in children over the most recent 10-year span available. National incidence estimates and demographic data were extracted from the same database. RESULTS: Ear foreign bodies in children made up an estimated total 446,819 ED visits nationwide over the past 10 years. The mean age was 7.2 ± 4.3 years old. The majority (55.6%, n = 248,531) of cases were female. The most common class of objects found was jewelry, primarily embedded earrings and beads, accounting for 55.5% visits, followed by paper products at 7.1%, pens and pencils at 4.1%, desk supplies (erasers) at 3.7%, BBs or pellets at 3.5%, and earplugs and earphones at 3%. Females were significantly more likely to have jewelry foreign bodies, and males were significantly more likely to have foreign bodies from all other categories other than first-aid supplies. CONCLUSION: Foreign bodies of the ear are a common reason for emergency department visits in children, primarily jewelry, paper products, and desk supplies. Recognition of commonly encountered objects can aid in both speedier recognition of unknown objects, as well as guide patient counseling.

Lingual Tonsillectomy for Pediatric Persistent Obstructive Sleep Apnea: A Systematic Review and Meta-analysis.

Objective To determine the role of lingual tonsillectomy (LT) in pediatric patients with persistent obstructive sleep apnea (OSA) after tonsillectomy and adenoidectomy (T&A). Data Sources PubMed, OVID-MEDLINE, and Cochrane Central from 2006 to 2017. Review Methods Inclusion criteria included English-language studies containing original data on LT in pediatric patients with persistent OSA. Exclusion criteria included case reports and studies without outcome measures. Two investigators independently reviewed all manuscripts and performed quality assessment using validated tools. Meta-analysis was performed. Results Of the 866 abstracts identified, 5 studies met inclusion criteria. All studies were case series (level of evidence 4). Outcome measures included apnea-hypopnea index (AHI), minimum oxygen saturation (minSaO2), comorbidity status, and adverse events. Qualitatively, all studies demonstrated reduction in AHI and increase in minSaO2 after LT. Comorbidities may not affect the success of LT for lingual tonsil hypertrophy (LTH). LT had similar adverse event rates as T&A. Meta-analysis was performed on 4 studies. LT showed a mean change in reduction of AHI and increase of minSaO2 of -6.64 (95% CI, -8.63 to -4.65) and 4.17 (95% CI, 1.25-7.08), respectively. The overall success rate, defined as postoperative AHI <5, was 52%. Conclusion LT for LTH can be a safe and effective adjunct surgery for persistent OSA in patients after T&A. LT may reduce AHI and increase minSaO2, though complete resolution of OSA is rare. Given the limited number of patients studied, no formal recommendations can be made for the routine use of LT for LTH in persistent pediatric OSA.

Anti-IgE and Anti-IL5 Biologic Therapy in the Treatment of Nasal Polyposis: A Systematic Review and Meta-analysis.

OBJECTIVE: To determine the role of biologic therapy on sinonasal symptoms and objective outcomes in chronic rhinosinusitis with nasal polyposis (CRSwNP). METHODS: PubMed, OVID MEDLINE, and Cochrane Central were reviewed from 2000 to 2015. Inclusion criteria included English-language studies containing original data on biologic therapy in CRSwNP patients with reported outcome measures. Two investigators independently reviewed all manuscripts and performed quality assessment and quantitative meta-analysis using validated tools. RESULTS: Of 495 abstracts identified, 7 studies fulfilled eligibility: 4 randomized control trials (RCT), 1 case-control, and 2 case series. Outcome measures included nasal polyp score (NPS,6), computer tomography score (5), and symptom scores (5). Meta-analysis was performed on 5 studies: Anti-IL5 therapy (mepolizumab/reslizumab) and anti-IgE therapy (omalizumab) demonstrated a standard mean difference of NPS improvement of -0.66 (95% CI, -1.24 to -0.08) and -0.75 (95% CI, -1.93 to 0.44), respectively, between biologic therapy and placebo. Quality assessment indicated a low to moderate risk of bias for the RCTs. CONCLUSION: Biologic therapies may prove beneficial in the treatment of recalcitrant nasal polyposis in select populations. In meta-analysis, anti-IL5 therapy demonstrates a reduction in nasal polyp score. Anti-IgE therapy reduces nasal polyp score in patients with severe comorbid asthma. Additional high-level evidence is needed to assess clinical efficacy.

Bilateral Basaloid Squamous Cell Carcinoma of the Parotid Gland: A Case Report and Review of the Literature.

INTRODUCTION: We describe the first known case of bilateral basaloid squamous cell carcinoma of the parotid gland, and we review existing literature. CASE PRESENTATION: A previously healthy, 70-year-old white man presented with a 2-cm enlarging mass in the tail of the right parotid gland. Magnetic resonance imaging and computed tomography showed ipsilateral pathologic adenopathy. Results of fine-needle aspiration revealed a high-grade malignancy with squamous features. The patient underwent a right total parotidectomy and modified radical neck dissection. Final pathologic findings revealed a basaloid squamous cell carcinoma. Four years after the initial resection, the patient presented with an enlarging left parotid mass. Findings of fine-needle aspiration and imaging were similar to those 4 years earlier. The patient received a left total parotidectomy and modified radical neck dissection. Postoperative radiation therapy was performed after each surgical intervention. He remains disease free at 4-year follow-up after the second mass was resected. DISCUSSION: Squamous cell carcinoma with basaloid features is a rare and aggressive type of squamous cell carcinoma. To our knowledge, this is the first case report of bilateral parotid basaloid squamous cell carcinoma.

Sinonasal small cell neuroendocrine carcinoma: a systematic review of 80 patients.

BACKGROUND: The objective of this study was to review the published literature related to sinonasal small cell neuroendocrine carcinomas (SCNECs). Clinical presentation, demographics, treatment, and outcomes of this uncommon disease are reported. METHODS: A systematic review of studies for sinonasal SCNECs in PubMed and Ovid databases from 1970 to 2014 was conducted. Bibliographies of selected articles were also examined. Articles were examined for patient data that reported disease outcome. RESULTS: Thirty-four articles were included in this analysis, comprising a total of 80 cases. The mean age of presentation was 53.0 years. Nasal obstruction (53.8%) and epistaxis (48.8%) were the most common presenting symptoms. The nasal cavity and septum (32.5%) was the most common site of involvement. Seventy percent of patients presented with American Joint Committee on Cancer (AJCC) stage IV disease. Combination chemotherapy and radiation therapy was the most common treatment modality, used in 21 cases (26.3%). The second and third most common treatment modalities was combination surgery and chemoradiation therapy (21.3%), and surgery alone (18.8%), respectively. A total of 37 patients (46.3%) were alive after a mean follow-up of 30.8 months (median 15.5 months), independent of treatment modality. Of the treatment modalities, multimodality therapy remained the most common therapy. CONCLUSION: This review contains the largest pool of sinonasal SCNEC patients to date. Sinonasal SCNEC is a rare and aggressive neoplasm, and there is currently no standard of care for treatment. Various treatment modalities have been employed. Our systematic review suggests that multimodality therapy remains the most common treatment of sinonasal SCNEC.

Rhinoscleroma presenting as a nasal-palatal mass with airway obstruction.

We report a case of a 45-year-old male with severe rhinoscleroma. The patient presented to the emergency room with dyspnea from a long-standing nasal-palatal mass. A tracheostomy was required for airway control. While dyspnea in the presence of an upper airway mass is typical of malignancy, consideration of non-oncological etiologies is important. We review the epidemiology, pathology, diagnosis, and treatment of rhinoscleroma.

Comportamiento de la cirugía mayor aplicada a pacientes ambulatorios / Behaviour of major surgery applied to outpatients

Se realizó una investigación observacional-descriptiva para conocer el comportamiento de la cirugía mayor aplicada a pacientes ambulatorios del Servicio de Cirugía General del Hospital General Provincial Docente Capitán Roberto Rodríguez Fernández, de Morón, durante el período comprendido entre el 1ro. de enero de 1996 y el 30 de junio de 1998. La mayor proporción de casos de uno y otro sexos, pertenecía a los grupos de edad de 15 a 44 años. La hernia inguinal fue la afección más frecuente y por ende la intervención quirúrgica más realizada. El 10,5 porciento de los operados presentaba enfermedades asociadas. La anestesia espinal se utilizó en el 61,8 porciento de los intervenidos. El 2,2 porciento de los intervenidos tuvo complicaciones; sólo el 0,4 porciento de los pacientes necesitó hospitalización. El 100,0 porciento de los pacientes fue seguido por consulta especializada de cirugía y el médico de la familia. El método tuvo buena aceptación en el 99,6 porciento de los investigados(AU)

An observational descriptive research was made in order to know the behavior of major surgery applied to outpatients from the Service of General Surgery of the "Capitán Roberto Rodriguez Fernández" General Teaching Hospital, in Morón, from January 1st, 1996, to June 30th, 1998. Most of the cases of both sexes were 15-44 years old. Inguinal hernia was the most frequent affection and, therefore, the most performed operation. 10.5 percent of the operated on individuals had associated diseases. Spinal anesthesia was used in 61.8 percent of those who underwent surgery. 2.2 percent had complications and just 0.4 percent needed hospitalization. 100 percent of the patients were followed up by the specialized surgery department and the family physician. The method had good acceptation in 99.6 percent of the investigated patients(AU)

Algunos aspectos clinicoquirúrgicos del neumotórax espontáneo / Some clinical and surgical aspects of spontaneous pneumothorax

Se realizó una investigación observacional-descriptiva para conocer el comportamiento de algunos aspectos clinicoquirúrgicos del neumotórax espontáneo, el que fue diagnosticado en 180 pacientes atendidos en el Servicio de Cirugía General del Hospital General Provincial Docente Capitán Roberto Rodríguez Fernández, de Morón, desde 1985 hasta 1999, ambos inclusive. La mayor proporción de enfermos pertenecía al sexo masculino y a los grupos de edad de 15 a 44 años. El 83,3 porciento de los pacientes era fumador. No existieron antecedentes patológicos demostrables en el 45,6 porciento de los enfermos. El dolor y la disnea fueron los síntomas predominantes. El 50,6 porciento de los investigados tenía un neumotórax mayor del 50 porciento. La pleurostomía mínima alta y la punción pleural con aspiración fueron los procederes mayoritarios, esta última curativa en el 70,9 porciento de los neumotórax entre 26 y 50 porciento. La complicación principal fue la inexpansibilidad pulmonar. La mortalidad fue de 2,8 porciento(AU)

An observational descriptive research was made to know the behaviour of some clinicosurgical aspects of the spontaneous pneumothorax, which was diagnosed in 180 patients attended at the Service of General Surgery of the "Capitán Roberto Rodriguez Fernández" Provincial General Hospital, in Morón, from 1985 to 1999, including both. Most of the patients were males and age groups were 15-44. 83.3 percent of the patients were smokers. 45.6 percent of the patients had no pathological history. Pain and dyspnoea were the predominant symptoms. 50.6 percent of the studied individuals had a pneumothorax over 50 percent. Minimum high pleurostomy and pleural puncture with aspiration were the most used procedures. The latter proved to be curative in 70.9 percent of the pneumothoraxes between 26 and 50 percent. Pulmonary inexpansibility was the main complication. There was 2.8 percent of mortality(AU)

Comportamiento de la cirugía mayor aplicada a pacientes ambulatorios / Behaviour of major surgery applied to outpatients

Se realizó una investigación observacional-descriptiva para conocer el comportamiento de la cirugía mayor aplicada a pacientes ambulatorios del Servicio de Cirugía General del Hospital General Provincial Docente ®Capitán Roberto Rodríguez Fernández¼, de Morón, durante el período comprendido entre el 1ro. de enero de 1996 y el 30 de junio de 1998. La mayor proporción de casos de uno y otro sexos, pertenecía a los grupos de edad de 15 a 44 años. La hernia inguinal fue la afección más frecuente y por ende la intervención quirúrgica más realizada. El 10,5 porciento de los operados presentaba enfermedades asociadas. La anestesia espinal se utilizó en el 61,8 porciento de los intervenidos. El 2,2 porciento de los intervenidos tuvo complicaciones; sólo el 0,4 porciento de los pacientes necesitó hospitalización. El 100,0 porciento de los pacientes fue seguido por consulta especializada de cirugía y el médico de la familia. El método tuvo buena aceptación en el 99,6 porciento de los investigados (AU)

Algunos aspectos clinicoquirúrgicos del neumotórax espontáneo / Some clinical and surgical aspects of spontaneous pneumothorax

Se realizó una investigación observacional-descriptiva para conocer el comportamiento de algunos aspectos clinicoquirúrgicos del neumotórax espontáneo, el que fue diagnosticado en 180 pacientes atendidos en el Servicio de Cirugía General del Hospital General Provincial Docente ®Capitán Roberto Rodríguez Fernández¼, de Morón, desde 1985 hasta 1999, ambos inclusive. La mayor proporción de enfermos pertenecía al sexo masculino y a los grupos de edad de 15 a 44 años. El 83,3 porciento de los pacientes era fumador. No existieron antecedentes patológicos demostrables en el 45,6 porciento de los enfermos. El dolor y la disnea fueron los síntomas predominantes. El 50,6 porciento de los investigados tenía un neumotórax mayor del 50 porciento. La pleurostomía mínima alta y la punción pleural con aspiración fueron los procederes mayoritarios, esta última curativa en el 70,9 porciento de los neumotórax entre 26 y 50 porciento. La complicación principal fue la inexpansibilidad pulmonar. La mortalidad fue de 2,8 porciento (AU)