Acta otorrinolaringologica espanola最新文献

Background and objectives: Post-COVID-19 olfactory dysfunction persists in many patients and significantly affects quality of life. The primary objective was to evaluate olfactory function using psychophysical tests (BAST-24) and quality-of-life questionnaires. Secondary objectives included analysing correlations between questionnaires and the relationship between subjective and psychophysical measures.

Materials and methods: A prospective study was conducted including 86 adults with olfactory dysfunction ≥ 6 months after SARS-CoV-2 infection. Clinical and demographic data and scores from the Visual Analog Scale for smell (VAS-smell) and the SNOT-22, svQOD-NS, and QVOLF questionnaires were collected. Olfactory function was assessed using the BAST-24 (detection, identification, and olfactory memory). Descriptive statistics, Spearman's correlation coefficient, and the Mann-Whitney U test were used (p < 0.05).

Results: Mean age was 49 years (SD = 14); 76.7% were women. According to the VAS, 90.7% had hyposmia and 8.1% anosmia. Mean scores (SD) were: VAS 6 (2), SNOT-22 26 (20), svQOD-NS 4 (4), and QVOLF 127 (50), suggesting a moderate impact on quality of life. BAST-24 scores: detection 91% (22), identification 52% (25), and memory 35% (20). QVOLF and svQOD-NS showed a strong correlation (ρ = 0.797; p < 0.001), while SNOT-22 correlated moderately with both. No significant correlations were found between any questionnaire and BAST-24.

Conclusions: QVOLF and svQOD-NS questionnaires are more sensitive than SNOT-22 for assessing olfactory dysfunction. The lack of correlation with psychophysical tests highlights the need to combine both approaches fora comprehensive evaluation.

Introduction: Laryngopharyngeal reflux (LPR) represents a diagnostic and therapeutic challenge due to the nonspecific nature of its clinical manifestations and the absence of objective biomarkers. The aim of this work is to establish a national consensus on its definition, diagnosis, and treatment through a modified Delphi methodology that integrates the perspectives of otolaryngologists (ENT) and gastroenterologists (GI).

Materials and methods: A scientific committee composed of three ENTs and two GIs developed 117 items distributed across seven thematic sections. The Delphi process involved 73 panellists in the first round, of whom 65 (89%) completed both rounds of voting. Participants were representative of the Spanish autonomous communities, with an average of 17 years of clinical experience and a multidisciplinary profile (63.1% ENT; 36.9% GI).

Results: After two rounds of voting, positive consensus was reached on 76 items (64.9%), distributed as follows: 14 on definition and pathophysiology; 12 on symptoms and pharyngeal findings; 2 on associations with other ENT diseases; 10 on diagnostic methods; 3 on validated questionnaires; 15 on treatment and recommendations; and 11 on clinical follow-up.

Conclusion: The results of the consensus reflect the suitability and effectiveness of the Delphi methodology used to create a consensus document on the definition, presentation, diagnosis, and management of a condition that until now has been poorly defined, such as LPR. The aim is to support specialists in their daily clinical practice, and unlike previous efforts, it has succeeded in unifying within a single document the criteria of the two specialties most involved in managing these patients.

Introduction: To perform the cross-cultural adaptation into Spanish and the psychometric validation of the Nasal Polyposis Quality of Life Questionnaire (NPQ) for use in patients with chronic rhinosinusitis with nasal polyps (CRSwNP).

Methods: A total of 140 adult patients diagnosed with CRSwNP were included. The original NPQ was adapted from Italian into Spanish following established international guidelines. Construct validity was assessed through exploratory factor analysis (EFA) with principal components. Internal consistency was analyzed using Cronbach's alpha coefficient. Test-retest reliability was determined by the intraclass correlation coefficient (ICC). Concurrent validity was examined using Pearson correlations with the SNOT-22 and NOSE-E questionnaires. Discriminant validity was analyzed using ROC curves.

Results: EFA revealed a five-factor structure explaining 67% of the total variance. The Spanish NPQ showed excellent internal consistency (Cronbach's α = 0.917) and high test-retest reliability (ICC = 0.991; 95% CI: 0.983-0.996). The standard error of measurement (SEM) was 2 points, and the minimal detectable change (MDC95) was 5 points. Strong correlations were observed with the NOSE-E (r = 0.802) and SNOT-22 (r = 0.870). The NPQ total score demonstrated high discriminative ability for severe symptoms (AUC = 0.947), with a cutoff point >41 providing 88.9% sensitivity and 93.3% specificity.

Conclusions: The Spanish version of the NPQ is a valid, reliable, and clinically useful instrument for assessing symptom burden in patients with CRSwNP. Its multidimensional structure allows capturing the specific impact of this phenotype and supports its use in both clinical practice and research.

Background and objective: Nasopharyngeal carcinoma (NPC) is an uncommon neoplasm in non-endemic regions such as Spain, with most data coming from Asia. The aim of this study is to describe the epidemiological characteristics, oncological and functional outcomes, and treatment-related toxicities in a cohort of patients from a single centre in northern Spain.

Patients and methods: A retrospective study was conducted including 64 patients diagnosed with NPC between 2010 and 2022. Demographic and clinicopathological data, treatments received, survival outcomes, relapse patterns, and long-term sequelae were collected and analysed.

Results: A total of 87.5% of the cases received primary treatment at our hospital, while the remaining 12.5% were referred from other centres for the management of either recurrence or treatment-related toxicities. The mean age was 52 years, with a predominance of males (76.6%). The most common histological subtype was undifferentiated (70.3%), although Epstein-Barr virus (EBV) was negative in 61% of cases. A total of 68.8% of patients were diagnosed at advanced stages. All patients received radiotherapy, which was intensity-modulated radiotherapy (IMRT) in 78.1% of cases, and 85.9% received concomitant chemotherapy. The 5-year disease-free survival was 68.4%. Most relapses were local (56.2%), and the most frequent long-term sequela was xerostomia (53.5%). Endoscopic surgery was an effective and safe treatment for local recurrences.

Conclusions: The epidemiology of NPC in this northern Spanish cohort is similar to that of endemic regions. Oral functional sequelae are the main treatment-related toxicity. Endoscopic surgery is a safe and effective treatment option for local recurrences.

Introduction and aim of the study: The frontal sinus is the paranasal cavity with the greatest anatomical variability. Since the level of difficulty in dissecting the frontal recess during surgery is directly related to these anatomical variations, identifying them in the preoperative stage is crucial. This study aims to determine the most prevalent tomographic characteristics of the frontal sinus in paranasal sinus CT scans performed at a tertiary-level hospital in Lima, Peru, during the period 2023-2024.

Materials and methods: This is an observational, descriptive, cross-sectional study. Paranasal sinus CT scans obtained between July 2023 and June 2024 were analyzed. Sinus morphology, anteroposterior diameter of the frontal ostium, frontal angle, and frontal ostium grade were evaluated. Identification of ethmoidal cells and measurement of the distance from the columella to the frontal beak and to the anterior skull base were also included. Data was collected using Excel spreadsheets, and frequency tabulations were performed using IBM SPSS Statistics software.

Results: A total of 328 CT scans were included. In our sample, the most frequent age group was 30-59 years (54.6%), and the female sex predominated (55.2%). The most frequent morphology of the frontal sinus was medium size (66.5% on the right side and 59.5% on the left side). Hyperplasia predominated in males. More than 60% of the analyzed CT scans presented an anteroposterior distance of the frontal ostium between 5-10 mm (64.63% on the right side and 60.98% on the left). Adults over 30 years of age showed a diameter >10 mm more frequently than those aged 18-29 years. The frontal angle between 45° and <60° was the most frequent (65.55% on the right side and 62.80% on the left), and the most common grade was positive (62.80% on the right side and 65.55% on the left). The mean D-CFB was approximately 5.6 mm on the right side and 5.7 mm on the left side. Males presented greater measurements (approximately 0.5 mm more) than females. The mean D-CASB was 6.39 mm (right) and 6.53 mm (left). Males presented a significantly greater distance (∼0.5-0.6 mm more) than females (P < .001). The most prevalent cells were the agger nasi cell (90.55% on the right side and 92.38% on the left side) and the suprabullar cell (67.68% on the right side and 72.26% on the left side).

Conclusions: This study provides a detailed tomographic characterization of the frontal sinus in a Peruvian population, serving as a theoretical basis to optimize surgical planning and anticipate potential challenges in the endoscopic approach to this anatomical region. The IFAC classification, frontal ostium diameter, and frontal angle are key factors to consider in surgical decision-making.

Background: Upper airway surgery is an effective treatment for OSA, improving both subjective and objective parameters that define the condition. However, the long-term stability of this improvement remains unclear.

Methods: An ambispective observational study was conducted using data from the Dr. Peset Hospital (Valencia, Spain) on patients who underwent palatal surgery using modern pharyngoplasty techniques between 2015 and 2023. A total of 83 patients were included, with follow-ups conducted at a mean of 7, 35, 51, 68, and 85 months post-surgery. Objective and subjective parameters were analyzed.

Results: Significant improvements were observed in AHI (from 38.82 ± 21.26 to 16.30 ± 16.60), ODI (from 40.71 ± 21.18 to 16.93 ± 18.02), T90 (from 16,31 ± 22.58 to 6.68 ± 10.50), and minimum oxygen saturation (from 76.14 ± 13.54 to 84.52 ± 7.74), as well as in subjective measures, following surgery. At the third follow-up, at a mean of approximately 4.2 years, the AHI was 15.30 ± 11.00, the ODI was 14.30 ± 12.02, the T90 was 8.51 ± 16.99, and the minimum oxygen saturation was 84.66 ± 6.84. These improvements persisted over time, although there is slight worsening in some cases.

Conclusions: Sleep surgery is effective in reducing OSA-related parameters and improving quality of life. Long-term follow-up indicates that these benefits are largely maintained, with minor variations over time. These findings support surgery as stable treatment for OSA, highlighting the importance of individualized surgical approaches and postoperative monitoring.

Introduction: Meningoencephalic herniation (MEH) of the temporal bone is a rare but potentially life-threatening condition that may lead to meningitis, encephalitis, cerebral abscess, or epilepsy. Its incidence appears to be increasing, particularly in spontaneous cases, which are frequently multifocal and associated with obesity and benign intracranial hypertension.

Materials and methods: A retrospective review was performed of 88 patients (95 cases) surgically treated for MEH at a tertiary referral center between January 2000 and February 2023. Inclusion criteria were intraoperatively confirmed MEH and a minimum follow-up of six months. Data collected included demographics, aetiology, surgical approach, symptoms, otoscopic findings, body mass index (BMI), imaging, complications, recurrences, and audiometric outcomes.

Results: The cohort comprised 35 females and 53 males, aged 22-78 years (mean 54.5). Seven patients had bilateral MEH. Aetiology was idiopathic in 46 patients, post-surgical in 29, cholesteatomatous in 10, and traumatic in 3. Surgical approaches included middle cranial fossa (57 patients), transmastoid (21), and subtotal petrosectomy (17). Hearing loss was the most common symptom (22 patients), followed by ear fullness (18), otorrhea (17), and meningitis (16). Life-threatening manifestations occurred in 34.5% of cases. Complications were reported in 11 patients, all transient or medically managed. Mean BMI was 30 (range 21-44); all patients with BMI > 34.99 had idiopathic MEH. Multiple hernias were strongly associated with idiopathic origin. No recurrences were observed.

Discussion: Surgical repair is indicated in all confirmed cases of meningoencephalic herniation to prevent intracranial complications. The selection of approach is guided by hearing status, location, and aetiology. The middle cranial fossa approach is preferred in most spontaneous or multifocal cases, whereas subtotal petrosectomy is reserved for non-serviceable hearing or poor general condition. The transmastoid approach is suitable for isolated defects in the tegmen antri. Autologous grafts remain the gold standard for reconstruction.

Conclusions: The rising incidence of spontaneous MEH highlights the need for tailored surgical strategies. We present one of the largest surgical series of MEH to date and confirm that a tailored surgical strategy is essential for achieving successful outcomes. Our data support an algorithm based on hearing status and aetiology to optimize outcomes while minimizing complications.