Cirugía como tratamiento de la apnea obstructiva del sueño

Nasal continuous positive airway pressure (CPAP) is considered an ideal treatment for treating Obstructive Sleep Apnea Syndrome (OSAS), due to its being conservative and reversible; however, there is a poor rate of adherence in its long-term use. Surgery can significantly complement those cases where CPAP is not tolerated. Surgery for OSAS must be carried out taking into account the degree of obstructive apnea, the place of greatest obstruction and the experience of the medical team. The more severe the OSAS, the more aggressive the surgical therapy can be. The place of obstruction must not be considered in a simplistic way, in which only one place of obstruction is defined, but as a general alteration of the airway where the surgeon must act in order to carry out an effective remodelling. This paper describes different types of surgery and their efficacy in OSAS according to the anatomical area involved (nose, adenoidal surgery, tonsils, soft palate, base of the tongue, hypopharynx and bimaxillary protrusion). The scientific evidence shows that at present reconstructive surgery of the airway competes effectively with medical treatmen

Sialoendoscopia: una nueva alternativa en el tratamiento de la patología salival. Nuestra experiencia

Objectives: Sialoendoscopy is a procedure used to visualize the salivary ducts and their pathology. It can be used either as a diagnostic method to rule out inflammatory processes in the parotid and submandibular glands (diagnostic sialoendoscopy) or to treat pathological areas (stenosis, extract foreign bodies or sialolithiasis) through the use of appropriate instruments (interventionist sialoendoscopy). We attempt to prove a declining rate of salivary gland excision. Patients and method: Sialoendoscopy was performed in 8 patients. Results: Of these, 50 % of patients were diagnosed as having sialolithiasis and the other 50 % had chronic sialoadenitis. In patients with sialolithiasis, sialoendoscopy allowed the extraction of the calculus in two patients (50 %). In the remainder, sialoendoscopy provided confirmation of the diagnosis in all cases. Conclusions: Sialoendoscopy is a new technique for use in the diagnosis, treatment and post-operative management of sialolithiasis, sialoadenitis and other salivary gland pathologies

Lacrimal Diversion Devices (Sinopsys Lacrimal Stent): Sharing our Experience with Patients with Chronic Rhinosinusitis without Polyposis

Introduction: Chronic rhinosinusitis (CRS) is a highly prevalent pathology in our society. Due to the prevalence of this condition and to the persisting symptoms despite an appropriate medical treatment, surgical techniques are often required. Lately, minimal invasive techniques have been described, such as lacrimal diversion devices (LDDs). This technique offers a fast and convenient choice for delivery of sinus irrigation and topical medication. Objective: We aimed to describe our experience with LDDs and evaluate the safety and effectiveness of the procedure in patients with moderate to severe CRS without nasal polyposis (CRSsNP) and persistent symptomatology despite medical therapy. Methods: A total of 7 patients underwent bilateral lacrimal stents placement in the operating room. A retrospective observational study was conducted. The Sino-Nasal Outcome Test-20 (SNOT-20) survey was performed and the score obtained was compared before and 1 month after the procedure. Results: The LDDs were used for an average of 80 days. During the follow-up, only three patients had a mild complication with the device (granuloma in the punctum, obstruction, and early extrusion). The mean baseline SNOT-20 score dropped significantly (p ¼ 0.015) from 25.85 to 11.57 (mean: - 14.29) 1 month after the procedure. Conclusion: According to our experience and results, the use of LDD is a novel, feasible, and less invasive technique to treat refractory CRS. It reduces the risk of mucosal stripping, provides short-term outcomes, and the surgical procedure does not require advanced training in endoscopic sinus surgery. Moreover, it can be performed in-office under local anesthesia or sedation

Nasal delivery devices: A comparative study on cadaver model

Nasal nebulization is a more effective method of delivering topical medication than nasal spray. The purpose of this study was to assess the deposition patterns of nebulization in delivering topical agents to the nasal cavities in the human cadaveric model using a color-based method. We have compared these following nasal devices: single-dose vial irrigation, syringe-irrigation, common nasal spray, Spray-sol, MAD nasal, and Rinowash nasal douche. Endoscopic images were recorded at six anatomical regions prior to and following each nasal device application and four reviewers evaluated the amount of surface area staining. At the nasal vestibule, the blue dye distribution achieved with Spray-sol was more extensive than nasal sprays. At inferior turbinate and nasal cavity floor, single dose vial, syringe, MAD nasal, Spray-sol, and Rinowash demonstrated a greater extent of dye distribution than nasal spray. At the middle turbinate, the average score of both Spray-sol and MAD nasal was significantly higher than other nasal investigated devices. At the nasopharynx, Spray-sol nebulization covers a surface significantly greater than other devices. Compared to traditional sprays, Spray-sol and MAD nasal provided a more effective method of delivering topical agents to the deeper and higher portions of the nasal cavities

Floppy closing door epiglottis treated successfully with an mhealth application based on myofunctional therapy: a case report

We introduce the first case reported to date of a floppy closing door epiglottis in an OSA (obstructive sleep apnea) patient treated successfully with an Mhealth smartphone application based on myofunctional therapy

COVID-19 infection and its influence in otorhinolaryngology-head and neck surgery

Introduction The novel coronavirus disease 2019 pandemic has rapidly spread worldwide, challenging healthcare resources and communities to an unprecedent degree. Simultaneously, the amount of clinical and scientific information released has overwhelmed journal platforms. Objectives This review aims to summarize the available diagnostic tools and current guidelines to safely assist patients while limiting the exposure of otolaryngologists during this pandemic. Data Synthesis Key articles were retrieved from the following databases: PubMed, Lancet, Springer Nature, BioMed Central, JAMA network and MEDLINE, as well as updated documents from the Spanish Ministry of Health, World Health Organization, Centers for Disease Control and Prevention, Spanish Association of Surgeons, ENT-UK, American College of Surgeons, and American Academy of Otolaryngology-Head and Neck Surgery. The terms used for the search were: COVID-19, Test COVID, Surgery in COVID, 2019-nCoV, ‘coronavirus’, and SARS-CoV-2. A total of 10,245 papers were retrieved. The inclusion criteria for the review included: COVID-19 testing (n ¼ 531), society guidelines for otolaryngologyhead and neck surgery patient care in the outpatient clinic (n ¼ 10) and surgical (n ¼ 18) settings. Studies not related to COVID-19 diagnosis were excluded. Conclusion Healthcare institutions around the world are outlining their own protocols regarding laboratory testing and personnel protective equipment usage based upon medical societies recommendations during the COVID-19 pandemic. We have summarized the available laboratory tests and their respective sensitivity and specificity. Moreover, clinical guidelines from different societies were reviewed and summarized to facilitate guidance for otolaryngologists in the operating room and in the clinical settings

Does nasal surgery improve multilevel surgical outcome in obstructive sleep apnea:A multicenter study on 735 patients

Objective Does nasal surgery affect multilevel surgical success outcome. Methods Prospective eight country nonrandomized trial of 735 obstructive sleep apnea (OSA) patients, who had multilevel palate and/or tongue surgery, divided into two groups, with or without nose surgery. Results There were 575 patients in nose group, 160 patients in no nose group. The mean age for nose group 44.6 ± 11.4, no nose group 44.2 ± 11.8. Mean preoperative BMI for nose group 27.5 ± 3.6, no nose group 27.5 ± 4.1, mean postoperative BMI nose group 26.3 ± 3.7, no nose group 27.1 ± 3.8 (P = .006). Mean preoperative AHI nose group 32.7 ± 19.4, no nose group 34.3 ± 25.0 (P = .377); and mean postoperative AHI nose group 13.5 ± 10.2, no nose group 17.1 ± 16.0 (P = .001). Mean preoperative ESS nose group was 11.3 ± 4.7, no nose group was 10.4 ± 5.4 (P = .051); and mean postoperative ESS nose group was 5.3 ± 3.2, no nose group was 6.7 ± 2.8 (P = .001). The nose group had higher percentage change (adjusted for age, gender, BMI) in AHI (33.7%, 95% CI 14% to 53.5%) compared to the no nose group (P = .001); the nose group also had more percentage change in ESS (37%, 95% CI 23.6% to 50.3%) compared to the no nose group (P < .001). Change in BMI did not affect AHI nor ESS change (Cohen effect 0.03 and 0.14, respectively). AHI change in both groups were also statistically significant in the mild OSA (P = .008) and the severe OSA (P = .01). Success rate of surgery for the nose group 68.2%, while the no nose group 55.0% (P = .002). Conclusion Combining nose surgery in multilevel surgery improves surgical success. Level of evidence IIC

Cirugía como tratamiento de la apnea obstructiva del sueño

Nasal continuous positive airway pressure (CPAP) is considered an ideal treatment for treating Obstructive Sleep Apnea Syndrome (OSAS), due to its being conservative and reversible; however, there is a poor rate of adherence in its long-term use. Surgery can significantly complement those cases where CPAP is not tolerated. Surgery for OSAS must be carried out taking into account the degree of obstructive apnea, the place of greatest obstruction and the experience of the medical team. The more severe the OSAS, the more aggressive the surgical therapy can be. The place of obstruction must not be considered in a simplistic way, in which only one place of obstruction is defined, but as a general alteration of the airway where the surgeon must act in order to carry out an effective remodelling. This paper describes different types of surgery and their efficacy in OSAS according to the anatomical area involved (nose, adenoidal surgery, tonsils, soft palate, base of the tongue, hypopharynx and bimaxillary protrusion). The scientific evidence shows that at present reconstructive surgery of the airway competes effectively with medical treatmen

Hypoglossal nerve stimulation in the treatment of obstructive sleep apnea: patient selection and new perspectives

Hypoglossal nerve stimulation (HNS) is an increasingly widespread OSA treatment. It is a non-anatomical modifying surgery able to achieve an adequate objective and subjective result with a reasonable complication rate. HNS exploits the neurostimulation to reduce upper airway collapsibility providing a multilevel upper airway improvement within a single procedure. Proper patient selection has a fundamental role in determining an adequate long-term clinical outcome. All patient candidates for HNS undergo a standard comprehensive sleep medicine assessment and upper airway surgical examination. Several features should be assessed preoperatively in order to predict patients' response to HNS treatment. In particular, the assessment of OSA severity, BMI > 32 Kg/m2 , collapse pattern during drug-induced sleep endoscopy (DISE), and many other parameters, is central for a good patient selection and customization of OSA treatment. HNS is indeed one of the most promising tools in the widespread context of personalized sleep medicine. HNS is an adjustable medical device that could be titrated in order to improve HNS effectiveness, maintaining patient comfort. Moreover, HNS provides the opportunity for patients to play an active role in their own care, with a potential improvement in therapy adherence and efficacy. This review summarizes the current evidence in patient selection for HNS, highlighting the reasons behind the optimistic future of this OSA treatment in the context of personalized medicine

Sialoendoscopia: una nueva alternativa en el tratamiento de la patología salival. Nuestra experiencia

Objectives: Sialoendoscopy is a procedure used to visualize the salivary ducts and their pathology. It can be used either as a diagnostic method to rule out inflammatory processes in the parotid and submandibular glands (diagnostic sialoendoscopy) or to treat pathological areas (stenosis, extract foreign bodies or sialolithiasis) through the use of appropriate instruments (interventionist sialoendoscopy). We attempt to prove a declining rate of salivary gland excision. Patients and method: Sialoendoscopy was performed in 8 patients. Results: Of these, 50 % of patients were diagnosed as having sialolithiasis and the other 50 % had chronic sialoadenitis. In patients with sialolithiasis, sialoendoscopy allowed the extraction of the calculus in two patients (50 %). In the remainder, sialoendoscopy provided confirmation of the diagnosis in all cases. Conclusions: Sialoendoscopy is a new technique for use in the diagnosis, treatment and post-operative management of sialolithiasis, sialoadenitis and other salivary gland pathologies