Actividad de la enzima diaminoxidasa en pacientes con rinitis alérgica (estudio DAO-RIN): resultados preliminares

[Resumen] Introducción: La rinitis es una inflamación del revestimiento mucoso de la nariz caracterizada por: rinorrea, estornudos, picor nasal, congestión nasal, secreción postnasal. La histamina es una de los principales mediadores de esta patología. La intolerancia a la histamina resulta de un desequilibrio de la histamina acumulada y la capacidad para su degradación, siendo su causa principal un déficit en la degradación de la histamina causado por un error en la función enzimática de la DAO. El objetivo de este estudio es identificar la prevalencia de déficit en la actividad de la DAO en pacientes con rinitis alérgica. Material y métodos: Estudio descriptivo y analítico observacional de corte transversal con pacientes diagnosticados de rinitis alérgica reclutados de manera consecutiva de las consultas externas de Otorrinolaringología del Complexo Hospitalario Universitario A Coruña. Resultados: Un total de 105 pacientes con rinitis alérgica fueron reclutados, 33.33 % hombres y 66.67 % mujeres. La prevalencia de déficit de actividad DAO en pacientes con rinitis alérgica fue del 46.3% (IC95% 0.44 – 0.63). El peakflow nasal inspiratorio en pacientes con déficit de la actividad DAO fue de 80.40 ± 31.87 L/ min frente a los 91.72 ± 39.83 L/ min de los pacientes con actividad enzimática normal (p = 0.081). Discusión: El análisis preliminar de los resultados mostró que alrededor de la mitad de los pacientes con rinitis alérgica padecen de manera concomitante déficit de actividad DAO, no existiendo estudios previos que puedan servir de comparación en este tipo de población. La diferencia existente entre el flujo inspiratorio en pacientes con actividad normal frente a pacientes con déficit de actividad no resultó estadísticamente significativa. A pesar de ello, estas diferencias sí pueden ser clínicamente significativas, por lo que estos resultados preliminares deben ser tomarlos con prudencia y realizar un nuevo análisis cuando se obtenga el tamaño muestral.[Abstract] Introduction: Rhinitis is an inflammation of the mucous lining of the nose characterized by: rhinorrhea, sneezing, nasal itching, nasal congestion, postnasal secretion. Histamine is one of the main mediators of this pathology. The histamine intolerance results from an imbalance of accumulated histamine and the capacity for its degradation, being its main cause a deficit in the degradation of histamine caused by an error in the enzymatic function of the DAO. The objective of this study is to identify the prevalence of deficit in the activity of DAO in patients with allergic rhinitis. Material and methods: Cross-sectional descriptive and analytical observational study with patients diagnosed with allergic rhinitis consecutively recruited from the Otorhinolaryngology department of the Complexo Hospitalario Universitario A Coruña. Results: A total of 105 patients with allergic rhinitis were recruited, 33.33% men and 66.67% women. The prevalence of DAO activity deficit in patients with allergic rhinitis was 46.3% (CI95% 0.44 - 0.63). The inspiratory nasal peakflow in patients with a deficit in DAO activity was 80.40 ± 31.87 L/ min compared to 91.72 ± 39.83 L/ min in patients with normal enzymatic activity (p = 0.081). Discussion: The preliminary analysis of the results showed that about half of the patients with allergic rhinitis concomitantly suffer a deficit of DAO activity, and there are no previous studies that can be used as a comparison in this type of population. The difference between inspiratory flow in patients with normal activity versus patients with activity deficit was not statistically significant. In spite of this, these differences can be clinically significant, so these preliminary results should be taken prudently and perform a new analysis when the sample size is obtained.[Resumo] Introdución: A rinite é unha inflamación do revestimento mucoso do nariz, caracterizado por: rinorreia, espirros, prurido nasal, conxestión nasal e goteo post-nasal. A histamina é un dos principais mediadores desta patoloxía. A intoleracnia a histamina resulta dun desequilibrio entre a histamina acumulada e a capacidade de degradación, sendo a súa principal causa un déficit na degradación de histamina causada por un erro na función enzimática da DAO. O obxectivo deste estudo é identificar a prevalencia de déficit na actividade da DAO en pacientes con rinite alérxica. Material e métodos: Estudo observacional de tipo transversal descritivo e analítico con pacientes diagnosticados de rinite alérxica recrutados consecutivamente das consultas de Servizo de Otorrinolaringoloxía do Complexo Hospitalario Universitario A Coruña. Resultados: Un total de 105 pacientes con rinite alérxica foron reclutados, 33,33% homes e 66,67% mulleres. A prevalencia do déficit de actividade DAO en pacientes con rinite alérxica foi do 46,3% (IC do 95%: 0,44 a 0,63). O peakflow nasal inspiratorio en pacientes con déficit de actividade DAO foi 80,40 ± 31,87 L/ min contra 91,72 ± 39,83 L/ min en doentes con actividade enzimática normal (p = 0,081). Discusión: A análise preliminar dos resultados mostrou que preto da metade dos pacientes con rinite alérxica sofren concomitantemente déficit da actividade DAO, non existindo estudos previos que poden servir de comparación para esta poboación. A diferenza entre o fluxo inspiratorio en pacientes con actividade normal fronte a pacientes con déficit de actividade non foi estadísticamente significativo. Con todo, estas diferenzas en si pode ser clínicamente significativas, polo que estes resultados preliminares debe ser tomados con precaución e realizar unha nova análise, cando o tamaño da mostra sexa obtida.Traballo fin de mestrado (UDC.FCS). Asistencia e investigación sanitaria. Especialidade en investigación clínica. Curso 2017/201

T1b Glottic Tumor and Anterior Commissure Involvement: Is the Transoral CO2 Laser Microsurgery a Safe Option?

[Abstract] Objectives: Transoral CO2 laser therapy represents the treatment of choice for early-stage laryngeal tumors. The anterior commissure involvement (ACI) is related to a worse local control and a lower rates of organ preservation. The objective of this study is to analyze the differences in survival, local control, and organ preservation in T1b glottic patients according to the presence of ACI. Methods: Observational prospective study in pT1b treated with transoral CO2 laser between 2009 and 2014. Results: Forty patients (37 male and 3 female) with a mean age of 66.43 ± 8.16 years were recruited. Anterior commissure involvement was present in 70% of the patients. The 5-year specific cause survival was 91.66%, with 32.50% of local recurrences. Laryngeal preservation was 80%, being lower in the group with local recurrence (P < .000). The involvement of the anterior commissure does not influence the organ preservation (P = .548), the appearance of local recurrences (P = .391), or the survival (P = .33). Conclusions: Transoral CO2 laser therapy is an effective and reproducible treatment for early-stage laryngeal tumors. The results obtained are similar to previous studies, although they present discrepancies in relation to the role of the ACI. Prospective randomized trials are required focusing also on the patients’ quality of life and functional outcome in order to clarify the role of the ACI and the need to implement changes in its evaluation, staging, and evolution

Laryngopharyngeal Reflux Patient Changes during the COVID-19 Quarantine.

peer reviewedBackground and Objective: To examine the effects of the lockdown on diet adherence and stress levels in patients with laryngopharyngeal reflux (LPR). Materials and Methods: Patients with a positive LPR diagnosis at the hypopharyngeal-esophageal impedance-pH monitoring were treated from a pre- to lockdown period with a 3-month high-protein, low-fat, alkaline, plant-based diet, with behavioral changes, and an association of pantoprazole (20 MG/d) and alginate (Gaviscon 3/d). The following patient-reported outcomes questionnaire and findings instrument were used: Reflux Symptom Score-12 (RSS-12) and Reflux Sign Assessment (RSA). At the posttreatment time, patients were invited to evaluate the impact of lockdown on diet adherence and stress management with a predefined grid of foods and beverages and the perceived stress scale (PSS), respectively. Results: Thirty-two patients completed the evaluations. RSS-12 and RSA significantly improved from baseline to 3-month posttreatment. Most patients experienced mild-to-severe stress levels at the end of the lockdown. The level of stress substantially increased in 11 patients (34%) due to the lockdown, while it did not change in 11 patients (44%). In 11 cases (34%), patients reported that the adherence to the anti-reflux diet was better than initially presumed thanks to the lockdown period, while 44% (N = 14) reported that the lockdown did not impact the adherence to a diet. PSS and RSS-12 were significantly correlated at the end of the pandemic (rs = 0.681; p < 0.001). The increase in stress level was positively associated with the lack of adherence to diet (rs = 0.367; p = 0.039). Conclusions: During the lockdown, the diet habits of LPR patients were improved in one-third and unchanged in 44% of cases. The stress level was increased in one-third of patients, which was associated with an increase in symptom scores

Improving heat and moisture exchanger therapy with a hydrogel base adhesive in laryngectomized patients: an open randomized crossover trial

[Abstract] Objective: To assess individual’s preference, symptoms and compliance between habitual use of Provox XtraFlow and the combination of Provox XtraFlow during the day and Provox Luna during the night for heat and moisture exchanger therapy in laryngectomized patients. Methods: Open randomized crossover trial for 25 days. After this first follow-up and a 5 days wash-out period, a treatment switching was performed for another 25 days. Results: A total of 28 subjects, were enrolled. Differences were found (p=0.009) in the incidence of dermatological problems with XtraFlow (46.4%) versus Provox Luna (14.3%), as well as in the need to abandon the use of adhesives (46.4%vs.10.7%; p=0.003). The 60.7% of the patients referred the Provox Luna system as their preference for heat and moisture exchanger therapy. Conclusions: The Provox Luna system is a viable additive to heat and moisture exchanger therapy, especially in the setting of compliance concerns and in subjects who desire dermatological relief overnight

COVID-19 Pandemic and its Impact on the Management of Head and Neck Cancer in the Spanish Healthcare System

Introduction Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) has represented a major challenge for healthcare systems worldwide, changing the habits of physicians. A reorganization of healthcare activity has been necessary, limiting surgical activity to essential cases (emergencies and oncology), and improving the distribution of health resources. Objective To analyze the impact of the COVID-19 pandemic on head and neck cancer surgery management in Spain. Methods A cross-sectional study, through an anonymous and voluntary online survey distributed to 76 Spanish otorhinolaryngology departments. Results A total of 44 centers completed the survey, 65.9% of which were high-volume. A total of 45.5% of them had to stop high-priority surgery and 54.5% of head and neck surgeons were relocated outside their scope of practice. Surgeons reported not feeling safe during their usual practice, with a decrease to a 25% of airway procedures. A total of 29.5% were "forced" to deviate from the "standard of care" due to the epidemiological situation. Conclusions Approximately half of the departments decreased their activity, not treating their patients on a regular basis, and surgeons were reassigned to other tasks. It seems necessary that the head and neck surgeons balance infection risk with patient care. The consequences of the reported delays and changes in daily practice should be evaluated in the future in order to understand the real impact of the pandemic on the survival of head and neck cancer patients

Long-term outcomes and cost-effectiveness of a magnet-based valve voice prosthesis for endoprosthesis leakage treatment.

peer reviewed[en] PURPOSE: Tracheoesophageal speech is considered the gold standard for rehabilitation following total laryngectomy. The main reason of voice prosthesis failure is the endoprosthesis leakage. Provox ActiValve® incorporates a magnet-based valve system to achieve active closure of the valve to treat these leakages, with the drawback of being significantly more expensive. The aim of the study was to compare the Provox Vega® and Provox ActiValve® duration and costs in patients with replacements increase due to endoprosthetic leakage. METHODS: Prospective case-crossover study in laryngectomized patients with Provox Vega® and endoprosthesis leakage to whom a Provox ActiValve® was placed. Survival and possible factors that affect voice prosthesis were studied using Kaplan-Meier curves and Cox Proportional Hazards Regression. Cost-effectiveness analysis from the perspective of the Spanish Public National Health System with incremental cost-effectiveness calculation was performed. RESULTS: A total of 159 prostheses were evaluated. The most frequent reason for replacement was the endoprosthesis leakage (N = 129; 83.77%) in both models. The mean duration-time of Provox Vega® was 44.77 ± 2.82 days (CI 95%, 39.18-50.35; median 36 days), and 317.34 ± 116.8 days (CI 95% 86.66-548; median 286 days) for the Provox ActiValve® (p < 0.000). For every replacement not made thanks to the Provox ActiValve® there was saving of 133.97€ CONCLUSIONS: The Provox ActiValve® is a cost-effective solution in patients with increased prosthesis replacements due to endoprosthetic leakage, reducing the number of changes and cost compared to Provox Vega®

Cost-Effectiveness Study of Double-Flange Voice Prostheses in the Treatment of Periprosthetic Leakage in Laryngectomized Patients.

peer reviewed[en] BACKGROUND: Tracheoesophageal speech with a voice prosthesis is considered the rehabilitation treatment of choice in laryngectomized patients. The main reasons for prosthesis failure are endoprosthetic leakage and periprosthetic leakage. The Provox XtraSeal® stent incorporates an additional double flange on the esophageal side to prevent periprosthetic leakage. The objective of this study is to compare the duration and costs of the Provox Vega® and Provox XtraSeal® prostheses used in these patients in a tertiary university hospital. MATERIALS AND METHODS: A prospective crossover case study of laryngectomees with Provox Vega® who underwent Provox XtraSeal® placement due to recurrent periprosthetic leaks and decreased theoretical prosthesis life. The duration and possible factors affecting voice prostheses were studied using Kaplan-Meier curves and Cox regression. A cost-effectiveness analysis was carried out from the perspective of the Spanish National Health System with an incremental cost-effectiveness calculation. RESULTS: A total of 38 patients were recruited, 35 men and 3 women, with a mean age of 66.26 ± 9.36 years old. Information was collected from 551 voice prostheses, 484 Provox Vega® and 68 Provox XtraSeal®. The mean duration of Provox Vega® was 119.75 ± 148.8 days and that of Provox XtraSeal® was 181.99 ± 166.07 days (p = 0.002). The most frequent reason for replacement was endoprosthetic leakage in both groups: 283 (60.86%) in the case of Provox Vega® and 29 (48.33%) in that of XtraSeal® (p < 0.000). To obtain no cost differences (ICE ~ 0) between Provox Vega and Provox XtraSeal, the latter should cost EUR 551.63. CONCLUSIONS: The Provox XtraSeal® is a cost-effective option in patients with increased prosthesis replacements due to periprosthetic leakage, reducing the number of replacements, increasing the duration of the prosthesis, and providing savings compared to Provox Vega®

Indications, Efficacy, Safety, and Clinical Outcomes of 585 nm Pulsed Dye Laser in Non-Malignant Laryngeal Lesions: A Systematic Review.

peer reviewedThe objective of this manuscript was to review the indications, efficacy, and safety of a 585 nm pulsed dye laser (PDL) in non-malignant laryngeal lesions. Following the PRISMA statement recommendations, three independent authors searched for articles published in PubMed/MEDLINE, the Cochrane Library, Google Scholar, Scielo, and Web of Science. A bias analysis was performed following NICE guidance tools. From the 506 identified publications, 19 observational studies met the inclusion criteria. The PDL improves vocal quality objectively and subjectively in vascular lesions (p < 0.005) and improves vocal quality in patients with dysplasia/leukoplasia without changing the natural history of the disease compared to other treatments. Reinke's edema and granulomas require an average of 1.5 PDL sessions for resolution. Treatment of recurrent respiratory papillomatosis requires multiple sessions, with complete remission achieved in 50-70% of patients. Regardless of the lesion, the tolerance of the procedure under local anesthesia is exceptional (84-97%), and the results in terms of regression and vocal quality are promising. The complication rate is minimal, and the procedure does not interfere with other treatment alternatives. There is no consensus on laser settings. The lack of consistent use in evaluating vocal outcomes, whether objective or subjective, prevents the comparability between studies. The 585 nm pulsed dye laser appears to be an effective and safe therapeutic option in patients with non-malignant laryngeal pathology. Future controlled studies are needed to compare the 585 nm pulsed dye laser with other lasers or cold instrument procedures

Olfactory recovery following omicron variant infection: a psychophysical prospective case-control study with six-month follow up.

peer reviewed[en] OBJECTIVE: This study aimed to evaluate the recovery of olfactory function at six months in individuals infected with the coronavirus disease 2019 omicron variant, using psychophysical tests. METHODS: A prospective case-control study that included severe acute respiratory syndrome coronavirus-2 patients infected in February and March 2022 was conducted. Patients underwent the Sniffin' Sticks test within 10 days of infection and again after at least 6 months. The olfactory scores were compared with those of a control group. RESULTS: In all, 102 patients and 120 controls were enrolled in the study. At baseline, 26 patients (25.5 per cent) self-reported smell loss. The median threshold, discrimination and identification score was 33.6 (interquartile range, 12.5) for the cases and 36.5 (interquartile range, 4.38) for the controls (p < 0.001). Based on the threshold, discrimination and identification scores, 12 controls and 34 patients reported olfactory dysfunction (p < 0.001). Eighty cases underwent re-evaluation at six months; the median threshold, discrimination and identification score was 37.1 (interquartile range, 4.75) with no significant differences compared with the controls. CONCLUSION: Six months after infection, the prevalence of olfactory dysfunction in patients did not differ significantly from the control population

Is Continuous Positive Airway Pressure a Valid Alternative to Sildenafil in Treating Sexual Dysfunction among OSA Patients? A Systematic Review and Meta-Analysis.

peer reviewedBackground and Objectives: This study aimed to assess the comparative effectiveness of continuous positive airway pressure (CPAP) therapy and sildenafil pharmacological therapy in improving sexual function among patients with obstructive sleep apnea (OSA) and erectile dysfunction (ED). Materials and methods: Population: Patients affected by OSA and ED; Intervention: CPAP therapy vs. Comparison: Sildenafil pharmacological therapy; Outcomes: Improvement in erectile function, as measured by the International Index of Erectile Function 5 (IIEF-5) scoring system; Time: A systematic review of the literature from the past 20 years; Study Design: Observational studies comparing erectile function improvements after OSA treatment. Results: A total of eight papers were included in the qualitative summary, involving four hundred fifty-seven patients with ED and OSA. Erectile function improvements were observed in both treatment groups. After sildenafil and CPAP treatment, the mean IIEF-5 domain scores were 37.7 and 27.3, respectively (p < 0.001). Sildenafil 100 mg demonstrated a higher therapeutic impact compared to CPAP treatment. Conclusions: CPAP therapy significantly improved sexual parameters in most studies for OSA patients with ED. The findings suggest that CPAP therapy effectively alleviates erectile dysfunction symptoms, resulting in improved sexual performance in OSA patients. The comparison of the two treatments indicates that sildenafil has a more substantial therapeutic impact on erectile function than CPAP therapy; however, a combined treatment will provide a cumulative effect