Manejo de pacientes pediátricos con cuerpos extraños en el tracto laringotraqueobronquial

La aspiración de cuerpos extraños (CE) es un accidentefrecuente en la infancia con frecuencia en laedad pre-escolar.Objetivos: Determinar la población infantil másfrecuentemente afectada en el servicio de ORL. delHospital de Clínicas- Asunción , Determinar el tipo ylocalización del cuerpo extraño, Investigar las circunstanciasque llevaron al accidente y maniobras para laresolución del problema, previo a la consulta a nuestroservicio, Establecer el tipo de procedimiento mas frecuentementerealizado y la evolución de los pacientes.Población y Métodos: estudio retrospectivo,observacional, descriptivo, de corte transversal cuyametodología se baso en la revisión de 54 historias clínicasde pacientes ingresados en el servicio de otorrinolaringologiadel Hospital de Clinicas de Asunción,con diagnóstico o sospecha de aspiración de CE envía aérea desde enero del 2000 a noviembre 2004Resultados: En el 75,92% (41 pacientes) el rangoetario corresponde hasta los 5 años. Se observó levepredominio del sexo masculino. El 92,5% (50) procedierondel interior. La evolución previa al ingresofue de horas en 35,2 % hasta varios días e incluso1 mes en 2 casos. Los síntomas principales fueronla dificultad respiratoria en 43 pacientes (77,77%),tos en 38 pacientes (70,3%), cianosis en 26 pacientes(48,11%). En 22,2 % (12 pacientes) se realizaronmaniobras previas por parte de los padres, en todosde manera infructuosa. La circunstancia del accidentese relacionó en 32 casos con la alimentación. Elmétodo auxiliar de diagnóstico utilizado fue la Rx deTórax (91 %) que solo en el caso de los CE metálicosevidencio la presencia de estos (4 casos).Los procedimientos realizados para la extracciónfueron: broncoscopía rígida (45 pacientes) (83%),Laringoscopía Directa 13%(7 pacientes), Traqueotomía2%(1 paciente), El tipo de CE encontrado correspondióen 38 casos (79,2%) a origen orgánico, de loscuales en 30 correspondieron a semillas. El lugar masfrecuente de hallazgo fue el bronquio fuente derecho(19/48 casos) (40%), seguido por la traquea (12 casos)25%, glotis y subglotis con 19% (9 casos) y bronquiofuente izquierdo (6 casos) 13%, El tiempo de internaciónpromedio fue de 2.4 días. Hubo complicacionesen el 13% (7 casos) de los casos, siendo la más frecuentela neumonía. No se constataron óbitos.Conclusión. La Población más frecuentementeafectada se encontró entre pacientes de 1 y 2 años.El tipo más frecuente de cuerpo extraño encontradofue el orgánico (semilla de sandia) y la localizaciónmas frecuente fue en bronquio fuente derecho. Lascircunstancias que llevaron al accidente fueron alimentación,juegos y menos frecuentemente de formaaccidental. En pocos pacientes se realizaron maniobrasprevias y fueron palmoteo, zarandeo, respiraciónboca a boca, exploración digital y laringoscopíadirecta. Todas infructuosas. El tipo de procedimientomas frecuentemente realizado para la extracciónde cuerpos extraños fue la broncoscopía rígida. Laevolución en todos los casos fue favorable, no constatándoseningún óbito ni secuelas

BioMet®Tools: from modeling and simulation to product design and development

BioMet®Tools is a set of software applications developed for the biometrical characterization of voice in different fields as voice quality evaluation in laryngology, speech therapy and rehabilitation, education of the singing voice, forensic voice analysis in court, emotional detection in voice, secure access to facilities and services, etc. Initially it was conceived as plain research code to estimate the glottal source from voice and obtain the biomechanical parameters of the vocal folds from the spectral density of the estimate. This code grew to what is now the Glottex®Engine package (G®E). Further demands from users in medical and forensic fields instantiated the development of different Graphic User Interfaces (GUI’s) to encapsulate user interaction with the G®E. This required the personalized design of different GUI’s handling the same G®E. In this way development costs and time could be saved. The development model is described in detail leading to commercial production and distribution. Study cases from its application to the field of laryngology and speech therapy are given and discussed

BioMet®Phon: A system to monitor phonation quality in the clinics

BioMet®Phon is a software application developed for the characterization of voice in voice quality evaluation. Initially it was conceived as plain research code to estimate the glottal source from voice and obtain the biomechanical parameters of the vocal folds from the spectral density of the estimate. This code grew to what is now the Glottex®Engine package (G®E). Further demands from users in laryngology and speech therapy fields instantiated the development of a specific Graphic User Interface (GUI’s) to encapsulate user interaction with the G®E. This gave place to BioMet®Phon, an application which extracts the glottal source from voice and offers a complete parameterization of this signal, including distortion, cepstral, spectral, biomechanical, time domain, contact and tremor parameters. The semantic capabilities of biomechanical parameters are discussed. Study cases from its application to the field of laryngology and speech therapy are given and discussed. Validation results in voice pathology detection are also presented. Applications to laryngology, speech therapy, and monitoring neurological deterioration in the elder are proposed

Wavelet description of the Glottal Gap

The Glottal Source correlates reconstructed from the phonated parts of voice may render interesting information with applicability in different fields. One of them is defective closure (gap) detection. Through the paper the background to explain the physical foundations of defective gap are reviewed. A possible method to estimate defective gap is also presented based on a Wavelet Description of the Glottal Source. The method is validated using results from the analysis of a gender-balanced speakers database. Normative values for the different parameters estimated are given. A set of study cases with deficient glottal closure is presented and discussed

Injection laryngoplasty using autologous fat enriched with adipose-derived regenerative stem cells: a safe therapeutic option for the functional reconstruction of the glottal gap after unilateral vocal fold paralysis

Paralysis of one vocal fold leads to glottal gap and vocal fold insufficiency that has significant impact upon a patient's quality of life. Fillers have been tested to perform intracordal injections, but they do not provide perdurable results. Early data suggest that enriching fat grafts with adipose-derived regenerative cells (ADRCs) promote angiogenesis and modulate the immune response, improving graft survival. The aim of this study is to propose ADRC-enriched adipose tissue grafts as effective filler for the paralyzed vocal fold to use it for functional reconstruction of the glottal gap. Method. This is the first phase I-IIA clinical trial (phase I/IIA clinical trial, unicentric, randomized, controlled, and two parallel groups), to evaluate the safety of a new therapy with ADRC-enriched fat grafting (ADRC: group I) for laryngoplasty after unilateral vocal fold paralysis. Control group patients received centrifuged autologous fat (CAF: group II) grafts. Overall mean age is 52.49 ± 16.60 years. Group I (ADRC): 7 patients (3 males and 4 females), 52.28 ± 20.95 year. Group II (CAF): 7 patients (3 males and 4 females), 52.71 ± 12.59 year. Results. VHI-10 test showed that preoperative mean score was 24.21 ± 8.28. Postoperative mean score was 6.71 ± 6.75. Preoperative result in group I was 21.14 ± 3.58 and postoperative result was 3.14 ± 3.53. Preoperative result for group II was 27.29 ± 10.66. Postoperative score in group II was 10.29 ± 7.52. Wilcoxon and the Student t-tests showed that the patient's self-perception of posttreatment improvement is larger when ADRCs are used. Comparing pre- and posttreatment voice quality analysis, group I showed a p = 0 053. Group II showed a p = 0 007. There would be no significant differentiation between pre- and posttreatment results. This is true for group II and limited for group I. Conclusions. This prospective trial demonstrates the safety and efficacy of the treatment of glottal gap defects utilizing ADRC-enriched fat grafts. This trial is registered with NCT02904824

Evaluación subjetiva de las alteraciones del olfato y del gusto en pacientes con afectación leve por COVID-19 en España

International audienceBackground: Has been described the loss of smell and taste as onset symptoms in SARS-CoV-2. The objective of this study was to investigate the prevalence in Spain. Methods: Prospective study of COVID-19 confirmed patients through RT-PCR in Spain. Patients completed olfactory and gustatory questionnaires. Results: A total of 1043 patients with mild COVID-19 disease. The mean age was 39 ± 12 years. 826 patients (79.2%) described smell disorder, 662 (63.4%) as a total loss and 164 (15.7%) partial. 718 patients (68.8%) noticed some grade of taste dysfunction. There was a significant association between both disorders (p<.001). The olfactory dysfunction was the first symptom in 17.1%. The sQOD-NS scores were significantly lower in patients with a total loss compare to normosmic or hyposmic individuals (p =.001). Female were significantly more affected by olfactory and gustatory dysfunctions (p<.001). The early olfactory recover in 462 clinically cured patients was 315 (68.2%), during the first 4 weeks. Conclusion: The sudden onset smell and/or taste dysfunction should be considered highly suspicious for COVID-19 infection