Current Opinion in Allergy and Clinical Immunology, Apr 1, 2009
Rhinosinusitis is a common condition in children. The association between rhinosinusitis and asth... more Rhinosinusitis is a common condition in children. The association between rhinosinusitis and asthma is supported by strong epidemiological and pathogenic evidence. Moreover, a close relationship between sinusitis and asthma severity has also been reported. This study shows the new findings in this strong relationship. The profile of inflammatory cells and inflammatory mediators seen in both conditions bears considerable similarity, especially in both diseases with a relevant role played by eosinophils. Summary Severe asthma is uncommon in childhood, but there is compelling evidence showing that the most severe asthma is closely associated to upper respiratory illness, especially rhinosinusitis. Treatment of chronic rhinosinusitis, medical or surgical or both, benefits concomitant asthma and has been shown to reduce the severity of asthma.
Los biofilms son estructuras de microorganismos altamente organizadas que crecen unidas irreversi... more Los biofilms son estructuras de microorganismos altamente organizadas que crecen unidas irreversiblemente a una superficie cubiertas por una matriz extracelular polisacárida que ellas mismas secretan. Actualmente los biofilms son considerados factores de virulencia que constituyen un modo de crecimiento protegido, que permite la supervivencia en un medio hostil, facilitando la unión de las bacterias a distintas superficies, ayudando al mantenimiento de las bacterias y protegiéndolas de distintos factores, como los cambios en las condiciones ambientales, la posibilidad de ser fagocitadas por células macrofágicas del huésped o por el efecto de los agentes antimicrobianos. Los cuadros clínicos crónicos de la vía aérea superior, pueden tener relación directa con la presencia de microorganismos en forma de biofilms. Las bacterias, protegidas de las defensas del huésped, en forma de biofilms, continúan con su metabolismo y la producción de exotoxinas locales, lo que favorecería la cronicidad de la respuesta inflamatoria evidenciable por los cambios en la mucosa respiratoria y la persistencia de infecciones que no responden a los tratamientos antibióticos.Fil: Zernotti, M. E.. Universidad Católica de Córdoba; ArgentinaFil: Paraje, Maria Gabriela. Consejo Nacional de Investigaciones Científicas y Técnicas. Centro Científico Tecnológico Córdoba. Instituto Multidisciplinario de Biología Vegetal (p); ArgentinaFil: Baena Cagnani, C. E.. Universidad Católica de Córdoba; Argentin
Objectives. To measure the prevalence of and identify the clinical characteristics associated wit... more Objectives. To measure the prevalence of and identify the clinical characteristics associated with olfactory decline in patients with chronic rhinosinusitis. Methods and Materials. There is analytical, prospective, and observational study in adult patients with a diagnosis of chronic rhinosinusitis. The olfactory test used was the Connecticut Chemosensory Clinical Research Center (CCCRC). Results. They are 33 patients total. Within the group of patients aged 18 to 39, 9% had normosmia, 73% hyposmia, and 18% anosmia (P < 0.001). Between 40 and 64 years old, there was no patient with normosmia, 63% hyposmia, and 37% anosmia (P < 0.001). Of patients older than 65 years old, 33% showed mild hyposmia, 34% severe hyposmia, and 33% anosmia (P < 0.001). 52% were females, and 48% were males. Conclusion. Nasal polyposis, asthma, septal deviation, turbinate hypertrophy, tobacco, and allergic rhinitis are predicting factors of olfactory dysfunction. Antecedents of previous endoscopic surgeries, age, and gender would not be associated with olfactory loss.
Acta Otorrinolaringologica (english Edition), Mar 1, 2013
Chronic rhinosinusitis (CRS) is the inflammation of the nasal and paranasal sinus mucosa persisti... more Chronic rhinosinusitis (CRS) is the inflammation of the nasal and paranasal sinus mucosa persisting for at least 12 weeks. The success of endoscopic sinus surgery (ESS) depends on minimising oedema and intraoperative bleeding. For this purpose, some surgeons advocate the use of preoperative systemic steroids (SS). Our aim was to assess if the administration of preoperative SS in patients with CRS with or without nasal polyps (NP) facilitates the surgical procedure. Non-randomized clinical trial in CRS patients with or without NP. Patients in the ESS group received oral meprednisone preoperatively, whereas the control group did not. The visibility of the surgical field, intraoperative bleeding and surgery duration were recorded. Each group (SS group and control group) included 27 patients. The administration of SS reduced the values of all the parameters in patients without NP, with no significant differences. In patients with NP, only operative bleeding was reduced significantly. Even though all the parameters decreased with the preoperative administration of SS, only operative bleeding was significantly reduced in patients with CRS with NP.
Acta otorrinolaringológica española, Mar 1, 2013
Corticosteroides sistémicos; Sangrado intraoperatorio; Campo quirúrgico; Cirugía endoscópica naso... more Corticosteroides sistémicos; Sangrado intraoperatorio; Campo quirúrgico; Cirugía endoscópica nasosinusal Resumen Introducción: La rinosinusitis crónica (RSC) es la inflamación de la mucosa nasal y senos paranasales de más de 12 semanas de evolución. El éxito de la cirugía endoscópica nasosinusal (CENS) para su tratamiento depende de la correcta orientación anatómica en la región, para lo cual es vital la minimización del edema y sangrado intraoperatorio. Con este fin algunos cirujanos consideran el uso de corticosteroides sistémicos (CS) preoperatorios. El objetivo de este trabajo es determinar si el uso de CS administrados preoperatorios en pacientes con RSC con o sin poliposis nasal (PN) mejora las condiciones operatorias. Material y métodos: Ensayo clínico controlado, no aleatorizado, en pacientes con RSC con o sin PN sometidos a CENS. Al primer grupo (CS) se le administró meprednisona por vía oral antes de la CENS. Los pacientes del grupo control no recibieron CS. Se analizaron campo quirúrgico, volumen total de sangre aspirada y duración total de la cirugía. Resultados: Se incluyeron 27 pacientes en cada grupo. En pacientes con RSC sin PN la administración de corticoides disminuyó los valores de todos los parámetros en estudio, sin encontrar diferencia significativa para ninguno de ellos. En el grupo con PN solo fue estadísticamente significativa la diferencia entre el sangrado intraoperatorio. Conclusión: Si bien los valores de todos los parámetros estudiados se encuentran disminuidos en alguna medida con la administración de glucocorticoides preoperatorios, solo existe una diferencia significativa con relación al sangrado intraoperatorio de pacientes con RSC con PN.
examined the adequacy of different drugs for primal therapy on each type of pollinosis. Methods: ... more examined the adequacy of different drugs for primal therapy on each type of pollinosis. Methods: Patients with pollinosis attending 11 otorhinolaryngology clinics in Tokyo during part of pollen season (February 18-26) were enrolled and assigned to either an anti-leukotriene agent (pranlukast) or an antihistamine based on their symptoms in the previous year. During 3 months of treatment, symptoms and quality of life (QOL) were investigated by a mail questionnaire at 7 time points (at the start of treatment, and between March 1 and May 15). Results: Of 150 patients with pollinosis who were registered, analysis was conducted on 144 patients (62 receiving anti-leukotriene therapy and 82 receiving antihistamine therapy), excluding those with incomplete questionnaires. In both groups, scores for symptoms of pollinosis and QOL were low, suggesting that both drugs were effective considering the high pollen levels season (5-9 times higher than the previous year). After defining types of pollinosis by the severity of symptoms (sneezing, rhinorrhea, or nasal blockage), stratified analysis was conducted. This showed that antihistamine therapy was effective for the sneezing/rhinorrhea type and anti-leukotriene therapy was effective for the nasal blockage type, with no difference between the 2 drugs the combined type. For the nasal blockage type, symptoms and QOL improved faster with anti-leukotriene than antihistamine therapy from the peak to the end of the pollen season. No adverse effects were observed. Conclusions: When either an anti-leukotriene (pranlukast) or an antihistamine was used for primal therapy of pollinosis, both drugs improved pollinosis symptoms and QOL. Stratified analysis showed that the antihistamine was more effective for the sneezing/rhinorrhea type and the antileukotriene was more effective for the nasal blockage type, with no difference in effectiveness for the combined type. Therefore, appropriate drugs for the type of pollinosis should be selected for primal therapy.
Acta Otorrinolaringologica (english Edition), May 1, 2012
Introduction: Muscle tension dysphonia (MTD) is a voice disorder in the absence of current organi... more Introduction: Muscle tension dysphonia (MTD) is a voice disorder in the absence of current organic laryngeal pathology, without obvious psychogenic or neurological aetiology. The laryngeal features of MTD include a posterior glottal gap and supraglottic hyperfunctional activities; however, it remains unclear if these features are specific to MTD. This report aims to compare the laryngeal features in telemarketer patients with MTD versus non-dysphonic control subjects. Methods: We reported on an observational, analytic, and transversal study. Fiberoptic nasal endoscopy was performed on 57 patients (28 telemarketers with MTD and 29 control subjects). These random-sequence videotapes were independently rated by an expert laryngologist according to the modified Morrison and Rammage classification. In addition, a questionnaire about vocal symptoms and other details was completed. Results: The posterior glottal gap was the most common feature in telemarketers with MTD, while incomplete glottal gap was observed more frequently in non-dysphonic patients. More than 70% of the videotapes were rated as pathologic. There was no statistical difference in the prevalence of normal features or bowing glottal gap between patients and control subjects. Anterior---posterior supraglottic contraction was more frequent in the control group. The major symptoms found were: voice gets tired quickly, increased vocal effort and neck tension. Conclusions: The heterogeneity in the laryngeal features in telemarketers with MTD seen under fibroscopy and their presence among the non-dysphonic population suggest that they cannot determine by themselves the diagnosis of MTD.
Pharmacists are trusted health care professionals. Many patients use over‐the‐counter (OTC) medic... more Pharmacists are trusted health care professionals. Many patients use over‐the‐counter (OTC) medications and are seen by pharmacists who are the initial point of contact for allergic rhinitis management in most countries. The role of pharmacists in integrated care pathways (ICPs) for allergic diseases is important. This paper builds on existing studies and provides tools intended to help pharmacists provide optimal advice/interventions/strategies to patients with rhinitis. The Allergic Rhinitis and its Impact on Asthma (ARIA)‐pharmacy ICP includes a diagnostic questionnaire specifically focusing attention on key symptoms and markers of the disease, a systematic Diagnosis Guide (including differential diagnoses), and a simple flowchart with proposed treatment for rhinitis and asthma multimorbidity. Key prompts for referral within the ICP are included. The use of technology is critical to enhance the management of allergic rhinitis. However, the ARIA‐pharmacy ICP should be adapted to l...
Evidence that enables us to identify, assess, and access the small airways in asthma and chronic ... more Evidence that enables us to identify, assess, and access the small airways in asthma and chronic obstructive pulmonary disease (COPD) has led INTERASMA (Global Asthma Association) and WAO to take a position on the role of the small airways in these diseases. Starting from an extensive literature review, both organizations developed, discussed, and approved the manifesto, which was subsequently approved and endorsed by the chairs of ARIA and GA(2)LEN. The manifesto describes the evidence gathered to date and defines and proposes issues on small airway involvement and management in asthma and COPD with the aim of challenging assumptions, fostering commitment, and bringing about change. The small airways (defined as those with an internal diameter <2 mm) are involved in the pathogenesis of asthma and COPD and are the major determinant of airflow obstruction in these diseases. Various tests are available for the assessment of the small airways, and their results must be integrated to...
Background: Spirometry is essential for pulmonologist to diagnose and monitor treatment. Its refe... more Background: Spirometry is essential for pulmonologist to diagnose and monitor treatment. Its reference values vary with ethnicity. Objective: To establish an update predicted reference values, and derive summary equations of spirometric parameters specifically for 6-18 years Thai children in Bangkok. A cross sectional study of spirometry measured with Jaeger spirometer (Jaeger, model: 97342 Hoechberg, Germany) was carried out in 1,104 healthy non-smoker Bangkok Thai children, aged 6-18 years (476 boys and 628 girls from 5 schools). Prior to pulmonary function testing the parents was asked to complete the questionnaire for detailed medical history. Various regression models treating two sexes separately were applied to spirometric parameters including FVC, FEV1, FEF 25-75 and PEF. Results: 395 children were excluded due to presence of respiratory illnesses within 4 weeks before testing (n = 156), inability to achieve ATS criteria for reproducibility and acceptability (n = 199), chronic illnesses (n = 39), Caucasians (n = 1). Results from the remaining 709 (292 boys and 417 girls) were analyzed. The correlation of FVC and FEV1 were highest with height followed by weight and age in both sexes. FEF 25-75 and PEF were also significantly correlated with height, weight and age respectively. Boys had greater FVC and FEV1 than girls in all separate height. Regression equations to predict normal spirometry were derived for boys and girls in Bangkok. Our measurements were similar to those reported for children in Singapore and lower than those reported for Caucasians. Our predicted values of spirometry can be used for Thai Bangkok children aged 6-18 years. The results of the study will improve clinical diagnosis, treatment outcomes monitoring and future epidemiological research of respiratory diseases in Thai children.
Congenital aural atresia (CAA) poses significant challenges to surgical remediation. Both bone an... more Congenital aural atresia (CAA) poses significant challenges to surgical remediation. Both bone anchored hearing aids (BAHA) and the Vibrant Soundbridge (VSB) have been considered as alternatives or adjuncts to conventional atresiaplasty. A consensus statement on VSB implantation in children and adolescents recommended against implantation when the Jahrsdoerfer score was less than 8. More recent publications suggest that patients with Jahrsdoerfer scores between three and seven may benefit from VSB implantation. The purpose of this study was to further investigate the outcomes of VSB implantation in CAA. The study was a multi-center, retrospective review. A retrospective review of data (patient's demographic, clinical, implant and audiological information) from four collaborating centers that have performed VSB implantation in CAA was performed. Outcomes based on severity of the atresia using the Jahrsdoerfer and Yellon-Branstetter scoring systems were also evaluated. Data from 28 patients from the four centers revealed no iatrogenic facial nerve injuries or change in bone thresholds. Post-operative speech threshold and speech recognition was, respectively, 39 dB and 94 %. Jahrsdoerfer and Yellon scores ranged from 4 to 9 and 4 to 12, respectively. The scores did not correlate to or predict outcomes. Three individual elements of the scores did correlate to initial, but not long-term outcomes. Atresiaplasty and BAHA in the management of CAA are not complete solutions. VSB may offer an alternative in these surgically complex patients for achieving amplification, though better metrics for patient selection need to be developed. Level of evidence IV.
European Archives of Oto-rhino-laryngology, Mar 11, 2016
The objective of the study was to evaluate postoperative pain following a transcutaneous active c... more The objective of the study was to evaluate postoperative pain following a transcutaneous active conductive hearing implant. 27 patients undergoing Bonebridge (BB) bone conduction implantation were evaluated with two pain-related questionnaires. The Headache Impact Test (HIT-6) was used to measure the degree of disability including none or little impact (≤49), mild (50-55), moderate (56-59), and severe (≥60). The Brief Pain Inventory (BPI) was used to assess pain severity score and function interference (0 = no pain to 10 = worst pain); meaningful pain was considered to be ≥3. The impact of surgical factors on postoperative pain was analyzed. Postoperative BB pain results were compared with 11 Vibrant Soundbridge™ (VSB) and 103 cochlear implant (CI) users. The mean pre- and postoperative HIT-6 scores for BB implantation were 42.6 and 41.8, respectively and the mean preoperative BPI pain severity score changed from 0.6 to 0.9 postoperatively, whereas the preoperative interference score changed from 0.1 to 0.3. None of the mean postoperative values revealed significant pain. The retrosigmoid approach, the need for dural or sinus compression, and the use of bone conduction implant lifts had no significant impact on pain scores. The mean postoperative HIT-6 pain scores for patients with BB, VSB, and CI were 41.8, 46.4, and 42.8, respectively, with the differences not being significant. BB implantation causes no significant postoperative pain irrespective of sinus or dura compression. Pain scores were similar to those experienced by patients with other transcutaneous auditory implants such as middle ear or CIs.
International Archives of Otorhinolaryngology, Sep 24, 2020
BCHA (Bonebridge, Vibrant MED EL, Innsbruck, Austria) was approved for commercialization in 2012.... more BCHA (Bonebridge, Vibrant MED EL, Innsbruck, Austria) was approved for commercialization in 2012. Its main indication is the treatment of conductive or mixed hearing loss and single sided deafness (SSD). In our experience, and due to the high prevalence of congenital aural atresia (CAA) in our country, 2 the Keywords ► conductive hearing loss ► aural atresia ► bone conductive hearing implant
Introduction: Complications are very sensitive indicators of the usefulness of a surgical techniq... more Introduction: Complications are very sensitive indicators of the usefulness of a surgical technique. In cochlear implant surgery, there are 3 principal approaches: the classic approach uses the facial recess (FR), the suprameatal approach (SMA) does not require mastoidectomy and uses the creation of a tunnel over the facial nerve to enter the middle ear, and the endomeatal approach (EMA) is based on the completion of a groove in the posterior wall of external auditory canal. Material and methods: A multicentre review of 208 patients with cochlear implants was performed for comparing the different techniques. The complications were classified into major and minor. Results: Among the 208 implanted patients, 10.5% (22 of 208) had complications. Of these, 2.88% (6 of 208) were major complications and 7.69% (16 of 208) were minor complications. Comparing the results obtained by the different approaches, the FR technique had the lowest rate of major complications (1.1%), followed by the EMA technique with 2.38% and SMA with 3.75%. As for minor complications, operations in the SMA group had the lowest rate (6.25%), followed by the EMA group (7.14%) and the group operated on using the FR technique presented the highest (10%). Conclusions: The 3 techniques described show very similar rates of complications. Consequently, we can conclude that they are safe and are alternatives.
Conclusion Bonebridge (BB) and Sophono (SP) devices improved hearing; with the BB implant showing... more Conclusion Bonebridge (BB) and Sophono (SP) devices improved hearing; with the BB implant showing a better performance at medium and high frequencies. Furthermore, the BB, as an active implant, showed higher functional gain and increased time of use, when compared to the SP, a passive system. Objectives This study aims to compare surgical and audiological outcomes of SP and BB devices in order to assess and further differentiate the indication criteria. Methods Fourteen patients with conductive and mixed hearing loss were evaluated pre- and post-operatively (BB or SP) (period 2013-2014). Age, gender, surgical history, cause and type of hearing loss, implant use per day, levels of bone and air conduction, and functional gain were recorded. Data was analysed by Wilcoxon singed-rank and Wilcoxon rank-sum tests. Results Fourteen patients (BB; n = 10 and SP; n = 4) with an average age = 25.42 years (CI95 = 12.41-38.43) were evaluated. The gender relation was equal (1:1), with pre-implantation osseous thresholds of 20.42 dB (CI95 = 11.15-29.69), and pre-implantation aerial thresholds of 70.83 dB (CI95 = 62.52-79.14). The SP wearing time was significantly lower than that of the BB (SP = 7-10 h/day, BB = 8-12 h/day; p = 0.0323). The functional gain did not differ significantly between the two devices (BB = 40.00 ± 13.19 dB, SP = 34.06 ± 15.63 dB; p = 0.3434), but a significant improvement from pre- to post-implantation was observed (p &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt; 0.05). BB and SP decreased auditory thresholds at 1 and 2 kHz (&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt; 0.01), respectively. The BB even significantly decreased thresholds at 0.5 kHz (p = 0.0140) and 4 kHz (p &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt; 0.0001). No relevant surgical complications were found.
Current Opinion in Allergy and Clinical Immunology, Apr 1, 2009
Rhinosinusitis is a common condition in children. The association between rhinosinusitis and asth... more Rhinosinusitis is a common condition in children. The association between rhinosinusitis and asthma is supported by strong epidemiological and pathogenic evidence. Moreover, a close relationship between sinusitis and asthma severity has also been reported. This study shows the new findings in this strong relationship. The profile of inflammatory cells and inflammatory mediators seen in both conditions bears considerable similarity, especially in both diseases with a relevant role played by eosinophils. Summary Severe asthma is uncommon in childhood, but there is compelling evidence showing that the most severe asthma is closely associated to upper respiratory illness, especially rhinosinusitis. Treatment of chronic rhinosinusitis, medical or surgical or both, benefits concomitant asthma and has been shown to reduce the severity of asthma.
Los biofilms son estructuras de microorganismos altamente organizadas que crecen unidas irreversi... more Los biofilms son estructuras de microorganismos altamente organizadas que crecen unidas irreversiblemente a una superficie cubiertas por una matriz extracelular polisacárida que ellas mismas secretan. Actualmente los biofilms son considerados factores de virulencia que constituyen un modo de crecimiento protegido, que permite la supervivencia en un medio hostil, facilitando la unión de las bacterias a distintas superficies, ayudando al mantenimiento de las bacterias y protegiéndolas de distintos factores, como los cambios en las condiciones ambientales, la posibilidad de ser fagocitadas por células macrofágicas del huésped o por el efecto de los agentes antimicrobianos. Los cuadros clínicos crónicos de la vía aérea superior, pueden tener relación directa con la presencia de microorganismos en forma de biofilms. Las bacterias, protegidas de las defensas del huésped, en forma de biofilms, continúan con su metabolismo y la producción de exotoxinas locales, lo que favorecería la cronicidad de la respuesta inflamatoria evidenciable por los cambios en la mucosa respiratoria y la persistencia de infecciones que no responden a los tratamientos antibióticos.Fil: Zernotti, M. E.. Universidad Católica de Córdoba; ArgentinaFil: Paraje, Maria Gabriela. Consejo Nacional de Investigaciones Científicas y Técnicas. Centro Científico Tecnológico Córdoba. Instituto Multidisciplinario de Biología Vegetal (p); ArgentinaFil: Baena Cagnani, C. E.. Universidad Católica de Córdoba; Argentin
Objectives. To measure the prevalence of and identify the clinical characteristics associated wit... more Objectives. To measure the prevalence of and identify the clinical characteristics associated with olfactory decline in patients with chronic rhinosinusitis. Methods and Materials. There is analytical, prospective, and observational study in adult patients with a diagnosis of chronic rhinosinusitis. The olfactory test used was the Connecticut Chemosensory Clinical Research Center (CCCRC). Results. They are 33 patients total. Within the group of patients aged 18 to 39, 9% had normosmia, 73% hyposmia, and 18% anosmia (P < 0.001). Between 40 and 64 years old, there was no patient with normosmia, 63% hyposmia, and 37% anosmia (P < 0.001). Of patients older than 65 years old, 33% showed mild hyposmia, 34% severe hyposmia, and 33% anosmia (P < 0.001). 52% were females, and 48% were males. Conclusion. Nasal polyposis, asthma, septal deviation, turbinate hypertrophy, tobacco, and allergic rhinitis are predicting factors of olfactory dysfunction. Antecedents of previous endoscopic surgeries, age, and gender would not be associated with olfactory loss.
Acta Otorrinolaringologica (english Edition), Mar 1, 2013
Chronic rhinosinusitis (CRS) is the inflammation of the nasal and paranasal sinus mucosa persisti... more Chronic rhinosinusitis (CRS) is the inflammation of the nasal and paranasal sinus mucosa persisting for at least 12 weeks. The success of endoscopic sinus surgery (ESS) depends on minimising oedema and intraoperative bleeding. For this purpose, some surgeons advocate the use of preoperative systemic steroids (SS). Our aim was to assess if the administration of preoperative SS in patients with CRS with or without nasal polyps (NP) facilitates the surgical procedure. Non-randomized clinical trial in CRS patients with or without NP. Patients in the ESS group received oral meprednisone preoperatively, whereas the control group did not. The visibility of the surgical field, intraoperative bleeding and surgery duration were recorded. Each group (SS group and control group) included 27 patients. The administration of SS reduced the values of all the parameters in patients without NP, with no significant differences. In patients with NP, only operative bleeding was reduced significantly. Even though all the parameters decreased with the preoperative administration of SS, only operative bleeding was significantly reduced in patients with CRS with NP.
Acta otorrinolaringológica española, Mar 1, 2013
Corticosteroides sistémicos; Sangrado intraoperatorio; Campo quirúrgico; Cirugía endoscópica naso... more Corticosteroides sistémicos; Sangrado intraoperatorio; Campo quirúrgico; Cirugía endoscópica nasosinusal Resumen Introducción: La rinosinusitis crónica (RSC) es la inflamación de la mucosa nasal y senos paranasales de más de 12 semanas de evolución. El éxito de la cirugía endoscópica nasosinusal (CENS) para su tratamiento depende de la correcta orientación anatómica en la región, para lo cual es vital la minimización del edema y sangrado intraoperatorio. Con este fin algunos cirujanos consideran el uso de corticosteroides sistémicos (CS) preoperatorios. El objetivo de este trabajo es determinar si el uso de CS administrados preoperatorios en pacientes con RSC con o sin poliposis nasal (PN) mejora las condiciones operatorias. Material y métodos: Ensayo clínico controlado, no aleatorizado, en pacientes con RSC con o sin PN sometidos a CENS. Al primer grupo (CS) se le administró meprednisona por vía oral antes de la CENS. Los pacientes del grupo control no recibieron CS. Se analizaron campo quirúrgico, volumen total de sangre aspirada y duración total de la cirugía. Resultados: Se incluyeron 27 pacientes en cada grupo. En pacientes con RSC sin PN la administración de corticoides disminuyó los valores de todos los parámetros en estudio, sin encontrar diferencia significativa para ninguno de ellos. En el grupo con PN solo fue estadísticamente significativa la diferencia entre el sangrado intraoperatorio. Conclusión: Si bien los valores de todos los parámetros estudiados se encuentran disminuidos en alguna medida con la administración de glucocorticoides preoperatorios, solo existe una diferencia significativa con relación al sangrado intraoperatorio de pacientes con RSC con PN.
examined the adequacy of different drugs for primal therapy on each type of pollinosis. Methods: ... more examined the adequacy of different drugs for primal therapy on each type of pollinosis. Methods: Patients with pollinosis attending 11 otorhinolaryngology clinics in Tokyo during part of pollen season (February 18-26) were enrolled and assigned to either an anti-leukotriene agent (pranlukast) or an antihistamine based on their symptoms in the previous year. During 3 months of treatment, symptoms and quality of life (QOL) were investigated by a mail questionnaire at 7 time points (at the start of treatment, and between March 1 and May 15). Results: Of 150 patients with pollinosis who were registered, analysis was conducted on 144 patients (62 receiving anti-leukotriene therapy and 82 receiving antihistamine therapy), excluding those with incomplete questionnaires. In both groups, scores for symptoms of pollinosis and QOL were low, suggesting that both drugs were effective considering the high pollen levels season (5-9 times higher than the previous year). After defining types of pollinosis by the severity of symptoms (sneezing, rhinorrhea, or nasal blockage), stratified analysis was conducted. This showed that antihistamine therapy was effective for the sneezing/rhinorrhea type and anti-leukotriene therapy was effective for the nasal blockage type, with no difference between the 2 drugs the combined type. For the nasal blockage type, symptoms and QOL improved faster with anti-leukotriene than antihistamine therapy from the peak to the end of the pollen season. No adverse effects were observed. Conclusions: When either an anti-leukotriene (pranlukast) or an antihistamine was used for primal therapy of pollinosis, both drugs improved pollinosis symptoms and QOL. Stratified analysis showed that the antihistamine was more effective for the sneezing/rhinorrhea type and the antileukotriene was more effective for the nasal blockage type, with no difference in effectiveness for the combined type. Therefore, appropriate drugs for the type of pollinosis should be selected for primal therapy.
Acta Otorrinolaringologica (english Edition), May 1, 2012
Introduction: Muscle tension dysphonia (MTD) is a voice disorder in the absence of current organi... more Introduction: Muscle tension dysphonia (MTD) is a voice disorder in the absence of current organic laryngeal pathology, without obvious psychogenic or neurological aetiology. The laryngeal features of MTD include a posterior glottal gap and supraglottic hyperfunctional activities; however, it remains unclear if these features are specific to MTD. This report aims to compare the laryngeal features in telemarketer patients with MTD versus non-dysphonic control subjects. Methods: We reported on an observational, analytic, and transversal study. Fiberoptic nasal endoscopy was performed on 57 patients (28 telemarketers with MTD and 29 control subjects). These random-sequence videotapes were independently rated by an expert laryngologist according to the modified Morrison and Rammage classification. In addition, a questionnaire about vocal symptoms and other details was completed. Results: The posterior glottal gap was the most common feature in telemarketers with MTD, while incomplete glottal gap was observed more frequently in non-dysphonic patients. More than 70% of the videotapes were rated as pathologic. There was no statistical difference in the prevalence of normal features or bowing glottal gap between patients and control subjects. Anterior---posterior supraglottic contraction was more frequent in the control group. The major symptoms found were: voice gets tired quickly, increased vocal effort and neck tension. Conclusions: The heterogeneity in the laryngeal features in telemarketers with MTD seen under fibroscopy and their presence among the non-dysphonic population suggest that they cannot determine by themselves the diagnosis of MTD.
Pharmacists are trusted health care professionals. Many patients use over‐the‐counter (OTC) medic... more Pharmacists are trusted health care professionals. Many patients use over‐the‐counter (OTC) medications and are seen by pharmacists who are the initial point of contact for allergic rhinitis management in most countries. The role of pharmacists in integrated care pathways (ICPs) for allergic diseases is important. This paper builds on existing studies and provides tools intended to help pharmacists provide optimal advice/interventions/strategies to patients with rhinitis. The Allergic Rhinitis and its Impact on Asthma (ARIA)‐pharmacy ICP includes a diagnostic questionnaire specifically focusing attention on key symptoms and markers of the disease, a systematic Diagnosis Guide (including differential diagnoses), and a simple flowchart with proposed treatment for rhinitis and asthma multimorbidity. Key prompts for referral within the ICP are included. The use of technology is critical to enhance the management of allergic rhinitis. However, the ARIA‐pharmacy ICP should be adapted to l...
Evidence that enables us to identify, assess, and access the small airways in asthma and chronic ... more Evidence that enables us to identify, assess, and access the small airways in asthma and chronic obstructive pulmonary disease (COPD) has led INTERASMA (Global Asthma Association) and WAO to take a position on the role of the small airways in these diseases. Starting from an extensive literature review, both organizations developed, discussed, and approved the manifesto, which was subsequently approved and endorsed by the chairs of ARIA and GA(2)LEN. The manifesto describes the evidence gathered to date and defines and proposes issues on small airway involvement and management in asthma and COPD with the aim of challenging assumptions, fostering commitment, and bringing about change. The small airways (defined as those with an internal diameter <2 mm) are involved in the pathogenesis of asthma and COPD and are the major determinant of airflow obstruction in these diseases. Various tests are available for the assessment of the small airways, and their results must be integrated to...
Background: Spirometry is essential for pulmonologist to diagnose and monitor treatment. Its refe... more Background: Spirometry is essential for pulmonologist to diagnose and monitor treatment. Its reference values vary with ethnicity. Objective: To establish an update predicted reference values, and derive summary equations of spirometric parameters specifically for 6-18 years Thai children in Bangkok. A cross sectional study of spirometry measured with Jaeger spirometer (Jaeger, model: 97342 Hoechberg, Germany) was carried out in 1,104 healthy non-smoker Bangkok Thai children, aged 6-18 years (476 boys and 628 girls from 5 schools). Prior to pulmonary function testing the parents was asked to complete the questionnaire for detailed medical history. Various regression models treating two sexes separately were applied to spirometric parameters including FVC, FEV1, FEF 25-75 and PEF. Results: 395 children were excluded due to presence of respiratory illnesses within 4 weeks before testing (n = 156), inability to achieve ATS criteria for reproducibility and acceptability (n = 199), chronic illnesses (n = 39), Caucasians (n = 1). Results from the remaining 709 (292 boys and 417 girls) were analyzed. The correlation of FVC and FEV1 were highest with height followed by weight and age in both sexes. FEF 25-75 and PEF were also significantly correlated with height, weight and age respectively. Boys had greater FVC and FEV1 than girls in all separate height. Regression equations to predict normal spirometry were derived for boys and girls in Bangkok. Our measurements were similar to those reported for children in Singapore and lower than those reported for Caucasians. Our predicted values of spirometry can be used for Thai Bangkok children aged 6-18 years. The results of the study will improve clinical diagnosis, treatment outcomes monitoring and future epidemiological research of respiratory diseases in Thai children.
Congenital aural atresia (CAA) poses significant challenges to surgical remediation. Both bone an... more Congenital aural atresia (CAA) poses significant challenges to surgical remediation. Both bone anchored hearing aids (BAHA) and the Vibrant Soundbridge (VSB) have been considered as alternatives or adjuncts to conventional atresiaplasty. A consensus statement on VSB implantation in children and adolescents recommended against implantation when the Jahrsdoerfer score was less than 8. More recent publications suggest that patients with Jahrsdoerfer scores between three and seven may benefit from VSB implantation. The purpose of this study was to further investigate the outcomes of VSB implantation in CAA. The study was a multi-center, retrospective review. A retrospective review of data (patient's demographic, clinical, implant and audiological information) from four collaborating centers that have performed VSB implantation in CAA was performed. Outcomes based on severity of the atresia using the Jahrsdoerfer and Yellon-Branstetter scoring systems were also evaluated. Data from 28 patients from the four centers revealed no iatrogenic facial nerve injuries or change in bone thresholds. Post-operative speech threshold and speech recognition was, respectively, 39 dB and 94 %. Jahrsdoerfer and Yellon scores ranged from 4 to 9 and 4 to 12, respectively. The scores did not correlate to or predict outcomes. Three individual elements of the scores did correlate to initial, but not long-term outcomes. Atresiaplasty and BAHA in the management of CAA are not complete solutions. VSB may offer an alternative in these surgically complex patients for achieving amplification, though better metrics for patient selection need to be developed. Level of evidence IV.
European Archives of Oto-rhino-laryngology, Mar 11, 2016
The objective of the study was to evaluate postoperative pain following a transcutaneous active c... more The objective of the study was to evaluate postoperative pain following a transcutaneous active conductive hearing implant. 27 patients undergoing Bonebridge (BB) bone conduction implantation were evaluated with two pain-related questionnaires. The Headache Impact Test (HIT-6) was used to measure the degree of disability including none or little impact (≤49), mild (50-55), moderate (56-59), and severe (≥60). The Brief Pain Inventory (BPI) was used to assess pain severity score and function interference (0 = no pain to 10 = worst pain); meaningful pain was considered to be ≥3. The impact of surgical factors on postoperative pain was analyzed. Postoperative BB pain results were compared with 11 Vibrant Soundbridge™ (VSB) and 103 cochlear implant (CI) users. The mean pre- and postoperative HIT-6 scores for BB implantation were 42.6 and 41.8, respectively and the mean preoperative BPI pain severity score changed from 0.6 to 0.9 postoperatively, whereas the preoperative interference score changed from 0.1 to 0.3. None of the mean postoperative values revealed significant pain. The retrosigmoid approach, the need for dural or sinus compression, and the use of bone conduction implant lifts had no significant impact on pain scores. The mean postoperative HIT-6 pain scores for patients with BB, VSB, and CI were 41.8, 46.4, and 42.8, respectively, with the differences not being significant. BB implantation causes no significant postoperative pain irrespective of sinus or dura compression. Pain scores were similar to those experienced by patients with other transcutaneous auditory implants such as middle ear or CIs.
International Archives of Otorhinolaryngology, Sep 24, 2020
BCHA (Bonebridge, Vibrant MED EL, Innsbruck, Austria) was approved for commercialization in 2012.... more BCHA (Bonebridge, Vibrant MED EL, Innsbruck, Austria) was approved for commercialization in 2012. Its main indication is the treatment of conductive or mixed hearing loss and single sided deafness (SSD). In our experience, and due to the high prevalence of congenital aural atresia (CAA) in our country, 2 the Keywords ► conductive hearing loss ► aural atresia ► bone conductive hearing implant
Introduction: Complications are very sensitive indicators of the usefulness of a surgical techniq... more Introduction: Complications are very sensitive indicators of the usefulness of a surgical technique. In cochlear implant surgery, there are 3 principal approaches: the classic approach uses the facial recess (FR), the suprameatal approach (SMA) does not require mastoidectomy and uses the creation of a tunnel over the facial nerve to enter the middle ear, and the endomeatal approach (EMA) is based on the completion of a groove in the posterior wall of external auditory canal. Material and methods: A multicentre review of 208 patients with cochlear implants was performed for comparing the different techniques. The complications were classified into major and minor. Results: Among the 208 implanted patients, 10.5% (22 of 208) had complications. Of these, 2.88% (6 of 208) were major complications and 7.69% (16 of 208) were minor complications. Comparing the results obtained by the different approaches, the FR technique had the lowest rate of major complications (1.1%), followed by the EMA technique with 2.38% and SMA with 3.75%. As for minor complications, operations in the SMA group had the lowest rate (6.25%), followed by the EMA group (7.14%) and the group operated on using the FR technique presented the highest (10%). Conclusions: The 3 techniques described show very similar rates of complications. Consequently, we can conclude that they are safe and are alternatives.
Conclusion Bonebridge (BB) and Sophono (SP) devices improved hearing; with the BB implant showing... more Conclusion Bonebridge (BB) and Sophono (SP) devices improved hearing; with the BB implant showing a better performance at medium and high frequencies. Furthermore, the BB, as an active implant, showed higher functional gain and increased time of use, when compared to the SP, a passive system. Objectives This study aims to compare surgical and audiological outcomes of SP and BB devices in order to assess and further differentiate the indication criteria. Methods Fourteen patients with conductive and mixed hearing loss were evaluated pre- and post-operatively (BB or SP) (period 2013-2014). Age, gender, surgical history, cause and type of hearing loss, implant use per day, levels of bone and air conduction, and functional gain were recorded. Data was analysed by Wilcoxon singed-rank and Wilcoxon rank-sum tests. Results Fourteen patients (BB; n = 10 and SP; n = 4) with an average age = 25.42 years (CI95 = 12.41-38.43) were evaluated. The gender relation was equal (1:1), with pre-implantation osseous thresholds of 20.42 dB (CI95 = 11.15-29.69), and pre-implantation aerial thresholds of 70.83 dB (CI95 = 62.52-79.14). The SP wearing time was significantly lower than that of the BB (SP = 7-10 h/day, BB = 8-12 h/day; p = 0.0323). The functional gain did not differ significantly between the two devices (BB = 40.00 ± 13.19 dB, SP = 34.06 ± 15.63 dB; p = 0.3434), but a significant improvement from pre- to post-implantation was observed (p &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt; 0.05). BB and SP decreased auditory thresholds at 1 and 2 kHz (&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt; 0.01), respectively. The BB even significantly decreased thresholds at 0.5 kHz (p = 0.0140) and 4 kHz (p &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt; 0.0001). No relevant surgical complications were found.
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