Alda Cardesín

The effect of topical amphotericin B on inflammatory markers in patients with chronic rhinosinusitis: A multicenter randomized controlled study

It has been suggested that an exaggerated immune response to fungi is crucial in the pathogenesis of chronic rhinosinusitis (CRS). Based on this rationale, the use of topical antifungals (amphotericin B) has been advocated. Studies on its clinical effectiveness are, however, contradictory.

A randomised double blind clinical trial to compare surgical field bleeding during endoscopic sinus surgery with clonidine-based or remifentanil-based hypotensive anaesthesia.

BACKGROUND Significant bleeding during functional endoscopic naso-sinusal surgery (FESS) impairs recognition of anatomical references and may negatively affect surgical outcome. Anaesthesia including clonidine as an adjuntive hypotensive agent may reduce intraoperative bleeding. METHODS A randomised comparison of clonidine-based vs remifentanil-based hypotensive anaesthetic regimen was conducted in patients undergoing FESS. The main assessment was the proportion of subjects with Boezaart scores of surgical field bleeding, as blindly assessed from video recordings by a third surgeon not involved in patient care. RESULTS A total of 47 subjects underwent FESS and were randomised to clonidine or remifentanil. A significantly lower proportion of patients in the clonidine arm had blindly-assessed Boezaart scores higher than 2, with significantly lower mean blind Boezaart scores at 60 minutes and at 120 minutes. Similar findings were reported by the operating surgeon, and when Wormald and VAS scores were used. Objective estimates of bleeding and the duration of surgery and anaesthesia did not differ between groups. CONCLUSION The use of clonidine- based controlled hypotensive anaesthesia achieves lower surgical field bleeding during FESS.

Síndrome del seno silente: abordaje endoscópico y reconstrucción orbitaria en un solo tiempo

Silent sinus syndrome (SSS) is an uncommon disease characterised by enophthalmos, caused by ipsilateral maxillary sinus atelectasis. The diagnosis is clinical with radiological confirmation. The treatment has two objectives: to regulate the aeration of the maxillary sinus through achieving normal nasal cavity drainage and to restore the orbital architecture. A case of SSS treated in our hospital in a single surgical intervention is reported.

Amigdalectomía mediante electrodisección y mascarilla laríngea

INTRODUCTION The Colorado® microdissection needle has been used for 30 years as an alternative to cold dissection. Alexander was the first to publish the results of laryngeal mask in otorhinolaryngology and maxillofacial surgery. Later on it was introduced as a standard anaesthetic technique in our speciality. Objective The objective of this study was to compare the results of using laryngeal mask combined with Colorado® microdissection needle in tonsillectomies. The benefits of each of these 2 techniques are already known. Methods We present a prospective observational study of 107 paediatric tonsillectomies associated or not to adenoidectomy. Variables analysed are pain (Brodman scale), analgesia, bleeding, uvula oedema and days up to the restoration of diet and normal life. Surgical, anaesthetic and total surgery room times are also discussed. Results The Colorado® electrodissection technique minimised intraoperative bleeding and the need for haemostasis. However, uvula oedema and local pain increased compared with cold dissection. There were no clinical variations in the recovery of normal life. Combining the Colorado® microdissection needle and laryngeal mask reduced intraoperative, anaesthetic and total surgery room times. Conclusions The combination of these two techniques is a secure, quick and effective method that derives benefits from the advantages of both of them, without increasing surgical or anaesthetic risks.

Colocación de tubos de ventilación transtimpánicos en niños con otitis seromucosa: análisis de resultados y complicaciones

Introduccion y objetivos: La colocacion de tubos de ventilacion transtimpanicos (TVT) es una de las cirugias mas habituales de la otorrinolaringologia pediatrica. Esta cirugia no esta exenta de complicaciones que, a veces, dependen de la propia enfermedad y, otras, de su tratamiento. El objetivo de este estudio es conocer los resultados que hemos obtenido con la colocacion de tubos de ventilacion transtimpanicos y sus complicaciones. Material y metodos: Estudio retrospectivo de todos los ninos intervenidos con colocacion de TVT, en un periodo de 18 meses, y un seguimiento minimo de 7 anos, 143 oidos intervenidos por primera vez. Las variables objeto del estudio son: edad, sexo, aspecto inicial del oido, contenido del oido, tipo de TVT colocado, duracion del TVT, complicaciones aparecidas y no necesitar controles hospitalarios tras extrusion del TVT. Resultados: El 46 % de los casos presentaron algun tipo de complicacion. El TVT que mas complicaciones nos ha producido es el tipo Donaldson de 1,27 mm de diametro interno. Aparecen mas complicaciones en los oidos que estaban peor en la otoscopia independientemente del TVT colocado. Conclusiones: La alta incidencia de complicaciones y/o secuelas tras la colocacion de TVT hace necesario el seguimiento de los pacientes durante un largo periodo. Los resultados obtenidos orientan a utilizar TVT de diametro interno mas pequeno.

Tympanostomy tube emplacement in children with secretory otitis media: analysis of effects and complications

INTRODUCTION AND OBJECTIVES Tympanostomy tube emplacement is a common surgical procedure in paediatric otolaryngological surgery. This surgery has complications that sometimes depend on the disease and at other times on the treatment. The objective of this study is to know the results obtained with tympanostomy tube emplacement and its complications. MATERIAL AND METHODS Retrospective study of all the children operated on for tympanostomy tube emplacement over a period of 18 months and with follow-up for at least seven years; this amounted to 143 ears operated on for the first time. The study variables were age, gender, initial appearance of the ear, inner ear contents, type of grommet inserted, duration of grommet and the lack of any hospital monitoring needed after extrusion. RESULTS One complication or another arose in 46% of the ears. The Donaldson type of grommet with a diameter of 1.27 mm is the one that produced most complications. There were more complications in ears that were worse in the otoscopic examination regardless of the grommet inserted. CONCLUSIONS The high prevalence of complications and after-effects after grommet emplacement needs long-term follow-up in patients. The results obtained suggest the use of grommets with a smaller internal diameter.

Adaptation and validation of the Spanish version of the Tonsil and Adenoid Health Status Instrument

The Tonsil and Adenoid Health Status Instrument (TAHSI) is a disease‐specific questionnaire, intended for completion by parents, for assessing quality of life related to tonsil and adenoid disease or its treatment in children with throat disorders. The aim of this study was to validate the Spanish adaptation of the TAHSI, thus allowing comparison across studies and international multicenter projects.

Use of α 2 -Adrenergic Agonists to Improve Surgical Field Visibility in Endoscopy Sinus Surgery: A Systematic Review of Randomised Controlled Trials

PURPOSE We assessed the evidence for the use of α2-adrenergic agonists (A2AAs) in bleeding control and field quality in endoscopic sinus surgery. METHODS We systematically reviewed randomized clinical trials (RCTs) assessing A2AAs in endoscopic sinus surgery. Abstracts were reviewed by 2 investigators for eligibility, and selected articles were fully reviewed. Data on study design, population, A2AA drug and control groups, bleeding and surgical field quality outcomes, and adverse effects were extracted and synthesized. FINDINGS A total of 13 RCTs that included 896 individuals (7 double-blind trials, 5 single-blind trials, and 1 open-label trial) were selected that assessed the efficacy of clonidine (6 RCTs, 407 patients), dexmedetomidine (6 RCT, 423 patients), or both (1 RCT, 66 patients). Clonidine was compared with placebo (3 RCTs), midazolam (1 RCT), and remifentanil (2 RCTs). Dexmedetomidine was compared with esmolol (2 RCTs), remifentanil (2 RCTs), nitroglycerin and esmolol (1 RCT), and magnesium sulfate (1 RCT). Clonidine and dexmedetomidine were compared in 1 RCT. Clonidine reduced the proportion of individuals with an impaired surgical field by 23% vs placebo (number needed to treat = 4). Clonidine was better than midazolam and remifentanil in 2 trials, and dexmedetomidine was better than magnesium sulfate and esmolol in 2 trials but was not superior to esmolol, remifentanil, or nitroglycerin in 4 trials. Dexmedetomidine produced significantly better differences in bleeding outcomes versus clonidine. Adverse events were infrequent and mainly caused by hypotension or bradycardia. IMPLICATIONS RCTs consistently report that A2AAs reduce bleeding and improve surgical field quality during endoscopic sinus surgery. Adverse event reporting was often omitted in RCTs. Well-designed RCTs with appropriate sample sizes are desirable to identify the best A2AAs and confirm their potential effects on clinical outcomes.

Aberrant internal carotid artery in the middle ear: a cause of aural fullness

An aberrant internal carotid artery in the middle ear is rare. We present a new case with a red mass behind the eardrum. The diagnosis must be established by radiology and angiography. The consequences of injury and surgical intervention are serious. The purpose of this paper is to review the literature on the subject of vascular anomalies of the middle ear and to discuss the diagnosis and management of this lesion.