Acta otorrinolaringologica espanola最新文献

Purpose: Acute Invasive Fungal Sinusitis (AIFS) is an aggressive infection with significant morbidity and mortality. Early and accurate diagnosis is critical, but its nonspecific clinical presentation often complicates timely detection. This study aims to identify clinical, laboratory, and radiological predictors associated with biopsy-confirmed AIFS in patients with suspected disease.

Methods: A retrospective analysis was conducted on 134 adult patients who underwent biopsies for suspected AIFS at a tertiary referral center between January 2009 and January 2024. Patients diagnosed with chronic invasive fungal sinusitis were excluded. Among the patients, 60 cases (44.8%) were biopsy-confirmed AIFS. Key variables analyzed included demographic data, comorbidities, clinical signs, endoscopic findings, laboratory markers, and imaging findings. Backward stepwise and multivariable logistic regression analyses were used to identify independent predictors.

Results: Of 36 clinical variables initially assessed, stepwise regression identified 5 significant variables for multivariable analysis. Mucosal necrosis in the nasal cavity (OR 39.853; 95% CI 10.278-154.535; p = 0.000) and cranial nerve palsies (OR 25.826; 95% CI 2.738-140.769; p = 0.000) were the strongest predictors. Other significant factors included unilateral mucosal thickening (OR 5.694; 95% CI 1.720-18.855; p = 0.004), diabetes mellitus (OR 3.462; 95% CI 1.202-9.970; p = 0.021), and female sex (OR 2.959; 95% CI 1.060-8.259; p = 0.038).

Conclusion: Cranial nerve palsies and mucosal necrosis in the nasal cavity are strong predictors of biopsy-confirmed AIFS, highlighting the importance of these clinical signs in early diagnosis.

Background and objective: Unilateral cochlear implantation (CI) is the recommended treatment for profound sensorineural hearing loss in older adults when hearing aids fail to provide benefit. This study aimed to determine the direct costs associated with this procedure to support health-care provider decision-making.

Materials and methods: A cross-sectional observational study was performed at a single-centertertiary hospital on 278 cochlear implant recipients aged 60 years or older between 2009 and 2020. A final sample of 71 subjects (37 women, 52.1%) was selected via stratified random sampling. A micro-costing (bottom-up) economic analysis was conducted. Direct costs were allocated according to the Framework Agreement and the Andalusian Health Service salary tables, including the device, allowances, personnel, surgery, hospitalisation, clinical follow-up, complications, and technology upgrades. Costs were updated to 2024 € and calculated over a mean time horizon of 23.3 years.

Results: The mean age at CI was 67.7 ± 5.8 years. Complications occurred in 8.4% of patients, incorporating the costs of one explantation/reimplantation. The mean total cost per patient was € 44,555.08. Device acquisition and processor upgrades represented the largest share (93.58%, € 41,696), while personnel accounted for 6.41% (€ 2,859.08) and complications for 0.67% (€ 297).

Conclusions: The direct costs of a unilateral CI procedure in individuals over 60 amount to an investment of € 44,555.08, driven primarily by device and processor upgrade expenses. Personnel costs are low but involve substantial multiprofessional organisational complexity. Deriving direct costs from primary sources tied to a specific clinical pathway provides a more realistic estimate than probabilistic modelling and can aid health-care administrations in decision-making.

Background: Central compartment atopic disease (CCAD) is an emerging phenotype of type-2 chronic rhinosinusitis (CRS), characterized by inflammation involving the central nasal structures. The absence of standardized diagnostic criteria has hindered its recognition. This study aims to describe the first European cohort of CCAD patients and compare its features with previously published international data.

Materials and methods: A retrospective observational study was conducted including adult patients diagnosed with CCAD at a tertiary rhinology unit (2021-2024), based on predefined endoscopic and radiologic criteria. Demographic, clinical, exploratory, analytical and quality-of-life data were collected. Descriptive statistics were used to characterize the baseline profile of the study population.

Results: The cohort of 93 CCAD patients was predominantly male (65.6%) with a mean age of 48.7 ± 12.2 years. The baseline SNOT-22 score averaged 61.5 ± 24.3, with marked olfactory impairment. Asthma and N-ERD were reported in 40.9% and 7.5% of cases, respectively; allergic sensitization was confirmed in 60.2%. The mean endoscopic scores were 4.0 ± 2.2 for the nasal polyp score and 7.5 ± 2.5 for the modified Lund-Kennedy scale, while the mean CT-scan score was 11.7 ± 3.8. Blood eosinophilia >150 cells/μL was present in 77.4% of patients, and tissue eosinophil counts averaged 49.9 ± 43.8 eosinophils per high-power field.

Conclusion: This study reinforces CCAD as a localized type-2 CRS phenotype with a distinctive atopic signature. Findings underscore the need for standardized diagnostic criteria to improve its recognition and guide more personalized therapeutic strategies.