Guillermo Plaza

Balloon dilation of the frontal recess: a randomized clinical trial.

Objectives: We sought to evaluate the effectiveness and safety of balloon dilation of the frontal recess in the management of chronic rhinosinusitis of the frontal sinus. Methods: We designed a double-blind randomized clinical trial of functional endoscopic sinus surgery assisted by balloon dilation versus conventional functional endoscopic sinus surgery in the treatment of chronic rhinosinusitis of the frontal sinus. We enrolled a total of 40 patients in whom medical therapy had failed. The patients were randomly allocated to balloon dilation or to conventional frontal sinus drainage with a Draf I procedure. The main outcome measures were resolution of frontal sinus disease confirmed by computed tomographic scan, and permeability of the frontal recess seen on endoscopy, both at 12 months. Results: Of the 40 patients enrolled, 32 concluded the trial. In both groups, we obtained a statistically significant reduction in the Lund-Mackay stage. Resolution of frontal sinus disease confirmed by computed tomographic scan seemed to be more common after balloon dilation, although this finding was not statistically significant. Permeability of the frontal recess was seen on endoscopy statistically more frequently after balloon treatment (73% versus 62.5%). Only 4 patients needed revision surgery. No major complications were observed. Conclusions: Balloon dilation of the frontal recess is a relatively safe and effective tool in the management of chronic frontal rhinosinusitis after intensive medical treatment has failed.

Consenso sobre el diagnóstico y tratamiento de la sordera subita

Idiopathic sudden sensorineural hearing loss is an unexplained unilateral hearing loss with onset over a period of less than 72 hours, without other known otological diseases. We present a consensus on the diagnosis, treatment and follow-up of this disease, designed by AMORL, after a systematic review of the literature from 1966 to June 2010. Diagnosis of sudden sensorineural hearing loss is based on mandatory otoscopy, acoumetry, tonal audiometry, speech audiometry, and tympanometry. After clinical diagnosis is settled, and before treatment is started, a full analysis should be done and an MRI should be requested later. Treatment is based on systemic corticosteroids (orally in most cases), helped by intratympanic doses as rescue after treatment failures. Follow-up should be done at day 7, with tonal and speech audiometries, and regularly at 15, 30, and 90 days after start of therapy, and after 12 months. By consensus, results after treatment should be reported as absolute dBs recovered in pure tonal audiometry, as improvement in the recovery rate in unilateral cases, and as improvement in speech audiometry.

Auditory discrimination therapy (ADT) for tinnitus managment: preliminary results

Conclusion. This clinical assay has demonstrated the efficacy of auditory discrimination therapy (ADT) in tinnitus management compared with a waiting-list group. In all, 43% of the ADT patients improved their tinnitus, and its intensity together with its handicap were statistically decreased (EMB rating: B-2). Objective. To describe the effect of sound discrimination training on tinnitus. ADT designs a procedure to increase the cortical representation of trained frequencies (damaged cochlear areas with a secondary reduction of cortical stimulation) and to shrink the neighbouring over-represented ones (corresponding to tinnitus pitch). Study design. This prospective descriptive study included 14 patients with high frequency matched tinnitus. Tinnitus severity was measured according to a visual analogue scale (VAS) and the Tinnitus Handicap Inventory (THI). Patients performed a 10-min auditory discrimination task twice a day for 1 month. Discontinuous 8 kHz pure tones were randomly mixed with 500 ms ‘white noise’ sounds through a MP3 system. ADT group results were compared with a waiting-list group (n=21). Results. In all, 43% of our patients had improvement in their tinnitus. A significant improvement in VAS (p=0.004) and THI mean scores was achieved (p=0.038). Statistical differences between ADT and the waiting-list group have been proved, considering patients’ self-evaluations (p=0.043) and VAS scores (p=0.004). A non-significant reduction of THI was achieved (p=0.113).

Intratympanic drug delivery for the treatment of inner ear diseases

INTRODUCTION: Intratympanic drug delivery for labyrinth diseases is a non-aggressive outpatient procedure where drugs reach high concentrations in the cochlea and minimum systemic diffusion. The aim of this review is to update the delivery techniques and report on the results obtained with different substances in cochleovestibular disorders. New perspectives in drug development and gene therapy are discussed. MATERIAL AND METHOD: We have analyzed the literature published to date using the MEDLINE and EMBASE databases. The categories chosen for the review where the delivery techniques, the results using corticosteroids and aminoglucosides (gentamicin) and isolated papers related with new drugs or pathways to introduce the substance in the inner ear. RESULTS: Intratympanic steroid therapy has been shown to be effective for cochleovestibular symptoms after failure of systemic steroids for sudden deafness and for control of Menieres disease. Intratympanic gentamicin using a titration method showed vertigo control in 80% of the patients with a 0-25% risk of hearing impairment in Menieres disease. CONCLUSIONS: Intratympanic delivery is an effective procedure for the control of cochleovestibular disorders such as sudden deafness and Menieres disease. Future perspectives could increase the indications for steroid and gentamicin treatment and open the door to new drugs and gene therapy.

Aumento de expresión y actividad de MMP-9 en rinosinusitis crónica con poliposis nasal

Introduccion Las metaloproteinasas de matriz (MMP) son un conjunto de endopeptidasas implicadas en la degradacion de la matriz extracelular, que podrian explicar los cambios histologicos caracteristicos de la poliposis nasal. El objetivo de este estudio consiste en determinar la implicacion de MMP-2 y MMP-9 en la rinosinusitis cronica con poliposis nasal. Material y metodo Para ello, se tomaron muestras de 15 pacientes afectados de poliposis nasal y muestras de 15 controles intervenidos de turbinoplastia. Las muestras se procesaron para analisis de la expresion de ambas MMP mediante Western blot, y para determinacion de su actividad enzimatica mediante cimografia. Resultados Los resultados mostraron un incremento de la actividad y de la expresion de MMP-9, pero no de MMP-2, en las muestras procedentes de pacientes afectados de poliposis nasal en comparacion con los controles. Conclusiones Estos resultados apoyarian la implicacion de la MMP-9 en la remodelacion tisular caracteristica de esta enfermedad.

The role of partial parotidectomy for benign parotid tumors: A case-control study

Abstract Objective: To evaluate the results and complications after partial parotidectomy vs superficial parotidectomy, as primary treatment of benign parotid tumors. Study design: Case-control study. Setting: University hospital. Subjects and methods: A case-control study is presented on parotidectomy, comparing a group of 25 patients treated by partial parotidectomy vs a similar group of 25 patients treated by superficial parotidectomy. All patients had primary benign parotid tumors, were matched by sex and age, and had a minimum follow-up of 4 years. Independent variables included sex, age, medical history, intra-operative variables (surgical time, estimated blood loss, type of drainage, use of collagen), fine-needle aspiration cytology, computed tomography findings, and final histopathological diagnosis. Outcome measures were early and late complications, such as facial nerve paralysis, seroma, sialocele, Frey syndrome, and recurrence. Results: Partial parotidectomy resulted in less early and late complications than superficial parotidectomy, with similar recurrence rates. Temporal facial paresis was found in 4% of partial surgeries, vs 12% of superficial parotidectomies, a significant difference. Three months after surgery, only one patient has a persistent marginal nerve paresis. In contrast, sialocele was more common after partial parotidectomy (28% vs 16%), a significant difference. Conclusions: Partial parotidectomy achieves less early and late complications than superficial parotidectomy, with similar recurrence rates.

Consensus on diagnosis and treatment of sudden hearing loss

Abstract Idiopathic sudden sensorineural hearing loss is an unexplained unilateral hearing loss with onset over a period of less than 72 hours, without other known otological diseases. We present a consensus on the diagnosis, treatment and follow-up of this disease, designed by AMORL, after a systematic review of the literature from 1966 to June 2010. Diagnosis of sudden sensorineural hearing loss is based on mandatory otoscopy, acoumetry, tonal audiometry, speech audiometry, and tympanometry. After clinical diagnosis is settled, and before treatment is started, a full analysis should be done and an MRI should be requested later. Treatment is based on systemic corticosteroids (orally in most cases), helped by intratympanic doses as rescue after treatment failures. Follow-up should be done at day 7, with tonal and speech audiometries, and regularly at 15, 30, and 90 days after start of therapy, and after 12 months. By consensus, results after treatment should be reported as absolute dBs recovered in pure tonal audiometry, as improvement in the recovery rate in unilateral cases, and as improvement in speech audiometry.

Cirugía endoscópica nasosinusal como cirugía mayor ambulatoria

Introduccion La cirugia endoscopica nasosinusal (CENS) es una tecnica quirurgica muy extendida que permite el tratamiento de multiples enfermedades del area nasosinusal. Por otro lado, aunque muchas intervenciones otorrinolaringologicas se realizan ambulatoriamente, la CENS todavia se aplica con al menos un dia de ingreso en la mayoria de los hospitales. Objetivos Evaluar nuestra experiencia en CENS como cirugia mayor ambulatoria, analizar las causas que causaron el ingreso inesperado e identificar algun factor de riesgo para no cumplir con el alta precoz. Material y metodo Se estudia a 145 pacientes intervenidos ambulatoriamente mediante CENS por rinosinusitis cronica, polipos antrocoanales y dacriocistorrinostomias desde agosto de 2004 a junio de 2007. Se analizaron las variables: sexo, edad, antecedentes personales (hipertension arterial, asma, sindrome de Widal), enfermedad intervenida, septoplastia asociada, extension de la cirugia y cirugia de revision. Resultados El indice de sustitucion fue del 13,1 %; las causas mas frecuentes fueron las hemorragias (31,6 %), de las que mas de la mitad solo precisaron observacion sin recambio de taponamiento, y mareo/debilidad tras cirugia (36,8 %). De todas las variables estudiadas, solo la cirugia de revision se asocio a un incremento en la tasa de reingreso ( odds ratio =3,5; intervalo de confianza del 95 %, 1,2-10,1). Conclusiones Nuestra experiencia en CENS como cirugia mayor ambulatoria muestra un indice de sustitucion del 13,1 %, si bien la mayoria de los casos correspondieron a pacientes con complicaciones leves. La cirugia de revision supuso en nuestra serie un factor que aumento la tasa de ingreso.

Wildervanck's syndrome with severe inner ear dysplasia and agenesis of the right internal carotid artery

We describe a case with Wildervanck syndrome (cervico-oculo-acoustic syndrome) comprising Klippel-Feil anomaly, retractio bulbi (Duane syndrome), and congenital sensorineural deafness. An 18-month male baby had a severe inner ear dysplasia, and MRI also showed a complex vascular carotid malformation associated.

Office-based laryngeal injection of botulinum toxin for paradoxical vocal fold motion in a child

We describe the case of a 13-year-old girl with paradoxical vocal fold motion (PVFM) who failed to improve with repeated medical treatment, speech therapy and psychotherapy, but was successfully treated with botulinum toxin A (BTX-A) injection to the vocal folds. For delivering the BTX-A we used a channeled fiber-optic laryngoscope under local anesthesia, in an office setting. The patient remained asymptomatic of PVFM for 5 months, was successfully treated again with the same method, and had no important side effects.