Introducción y objetivo: El síndrome VEXAS (SV) es una entidad de descripción reciente que afecta fundamentalmente a varones, y se debe a una mutación somática en el gen UBA1. Puede cursar con ...múltiples manifestaciones sistémicas, siendo la afectación de cabeza y cuello muy frecuente. El objetivo de este estudio fue describir las manifestaciones otorrinolaringológicas del SV, que contribuyan a un diagnóstico y tratamiento temprano de la enfermedad.
Método: Se realizó una revisión de la literatura médica, utilizando los criterios PRISMA adaptados al tipo de estudio, de las manifestaciones otorrrinolaringológicas del SV, utilizando la base de datos Pubmed.
Resultados: Fueron incluidos en nuestro trabajo 81 artículos que cumplían los criterios de inclusión del mismo, los cuales describían 133 casos. Los resultados mostraron que el SV se produce sobre todo, en varones mayores de 50 años de edad, presentando en más de la mitad de los casos, manifestaciones de cabeza y cuello, entre las que destacan la CA, la condritis nasal y el edema periorbitario,
Conclusiones: Con frecuencia el SV es confundido, en los pacientes con manifestaciones otorrinolaringológicas, con la policondritis recurrente. El conocimiento por parte del otorrinolaringólogo de las manifestaciones de cabeza y cuello asociadas al mismo, puede contribuir a un diagnóstico y tratamiento temprano mejorando el pronóstico de la enfermedad.
IgG4-related disease (IgG4-RD) is a systemic autoimmune fibroinflammatory disease characterized by multiorgan infiltration of IgG4-positive plasma cells, fibrosis and vasculopathy that determine ...dysfunction of the affected organ. This review aims to characterize the otologic manifestations of the disease.
We have conducted a systematic review of the biomedical literature published describing cases of IgG4-RD with otologic manifestations. For the review, the bibliographic databases utilized were Pubmed, Web of Science and Scopus. We selected 48 cases from which we extracted several data collections.
About 52% of the patients were male between the ages of 19 and 79 years. Otologic findings were characterized by pseudotumoral lesions that most often caused a clinical presentation similar to otitis media with effusion, with cochlear involvement or sensorineural hearing loss (uni- o bilateral). Less frequent presentations included auricular chondritis, eosinophilic otitis, or hypertrophic pachymeningitis. In 32 patients (67%) the otologic manifestation was the first symptom of the ER-IgG4.
Sixteen patients (33%) were treated with mastoidectomies as a result of delayed diagnosis and lack of knowledge about this entity. Two patients needed a cochlear implant.
Although the otologic manifestations of IgG4-RD are unusual, it is important for the otorhinolaryngologist to know the otologic manifestations of this entity as it can be the onset of the disease, in order to allow early diagnosis and adequate treatment, avoiding permanent sequelae.
La enfermedad relacionada con IgG4 (ER-IgG4) constituye un proceso fibroinflamatorio autoinmune sistémico caracterizado por la infiltración multiorgánica de células plasmáticas positivas para IgG4, fibrosis y vasculopatía que determinan la disfunción del órgano afecto. La presente revisión tiene por objetivo caracterizar las manifestaciones otológicas de la enfermedad.
Se realizó una revisión sistemática de la literatura biomédica publicada describiendo los casos de ER-IgG4 con manifestaciones otológicas. Para la búsqueda utilizamos las siguientes bases de datos: Pubmed, Web ofScience y Scopus. Seleccionamos 48 casos de los que se extrajeron diferentes variables para caracterizar las manifestaciones otológicas de la misma.
Alrededor del 52% de los pacientes eran varones con edades comprendidas entre los 19 y los 79 años. La forma más habitual de presentación fueron lesiones psudotumorales con presentación clínica similar a una otitis seromucosa, con lesión coclear asociada o una hipoacusia neurosensorial (uni o bilateral). Presentaciones menos frecuentes fueron un síndrome vertiginoso, condritis auricular, otitis eosinofílica o paquimeningitis hipertrófica con afectación cocleovestibular. En 32 pacientes (67%), la manifestación otológica constituyó la forma de presentación de la ER-IgG4.
Dieciséis pacientes (33%) fueron sometidos a cirugías agresivas como consecuencia del retraso diagnóstico y el desconocimiento de esta entidad clínica. Dos pacientes precisaron un implante coclear.
Si bien las manifestaciones óticas de la ER-IgG4 son infrecuentes, es importante que el otorrinolaringólogo conozca las formas de presentación otológicas de esta entidad, ya que pueden ser la primera manifestación de la enfermedad, permitiendo un diagnóstico precoz y un tratamiento adecuado, evitando secuelas permanentes posteriores.
Patients presenting with nystagmus indicative of benign paroxysmal positional vertigo (BPPV) during the left and the right Dix-Hallpike manoeuvres (DHMs) are frequently seen in clinical practice. In ...such cases, BPPV may be unilateral or bilateral. The aim of this study is to describe the incidence of unilateral and bilateral BPPV when both DHMs are positive, taking into account the sense of the torsional component of nystagmus. This is a prospective multicentre study. BPPV patients were classified into three groups: patients with only one positive DHM (control group, CG), patients showing positive bilateral DHM with nystagmus in the same sense in both DHMs (same sense group, SSG) and patients showing positive bilateral DHM with the torsional component of nystagmus beating in opposite senses in each DHM (opposite sense group, OSG). Only one Epley Manoeuvre (EM) was performed on all patients. Based on the ipsilateral result of the EM, the contralateral result of the same EM and the BPPV resolution rate in the control group, a model was developed to predict the incidence of unilateral and bilateral BPPV in the SSG and the OSG. There were 234 patients in the control group, 20 in the SSG and 23 in the OSG. The model estimated that the percentage of unilateral BPPV would be 89.5% in SSG and 38.7% in OSG. Using these findings, we conclude that when both DHMs are positive, BPPV may be unilateral or bilateral. If the torsional components of both nystagmuses beat in the same sense, it is more likely to be unilateral BPPV. If the torsional components beat in opposite senses, both situations can be considered equally likely.
This study aims to determine the prevalence of vestibular schwannoma (VS) among patients presenting with sudden hearing loss (SHL) and to characterize the clinical features of individuals diagnosed ...with both VS and SHL.
We conducted an observational retrospective review at a tertiary referral center, spanning a 30-year period, focusing on patients diagnosed with SHL where VS was confirmed as the underlying cause. We included patients meeting these criteria while excluding those lacking imaging or with a pre-existing diagnosis of VS. We evaluated the audiological characteristics at the time of diagnosis and assessed clinical outcomes following treatment.
Among the 403 patients presenting with SHL during the study period, 9 (2.2%) were diagnosed with VS, aged between 25 and 72 years. Although audiometric profiles varied, high-frequency hearing loss predominated, mostly categorized as mild to moderate. Six patients (66%) had Koos grade I-II schwannomas. Only 2 patients achieved complete hearing recovery post-treatment, while 4 showed no improvement.
VS is a rare etiology of SHL, accounting for slightly over 2% of cases. Its symptomatology, severity, and audiometric patterns do not significantly differ from SHL caused by other factors. Tumor size does not correlate with hearing characteristics. Treatment modalities resemble those for other SHL cases, and hearing improvement does not obviate the necessity for follow-up magnetic resonance imaging (MRI) scans.
Retropharyngeal Abscess. Clinical Review of Twenty-five Years Sanz Sánchez, Cristina Isabel; Morales Angulo, Carmelo
Acta otorrinolaringológica española (English),
March-April 2021, 2021 Mar-Apr, 2021-03-00, Volume:
72, Issue:
2
Journal Article
Peer reviewed
Retropharyngeal abscess is a serious condition. Its rare occurrence, thus sharing symptoms with other processes, make it a diagnostic challenge for the clinician. Therefore, it is critical to make an ...early diagnosis to prevent delaying treatment and avoid complications.
To gain knowledge of the epidemiology, pathogenesis, clinical manifestations, the most commonly implicated microorganisms, the type of treatment used, morbidity and mortality of retropharyngeal abscesses at a tertiary institution over the last 25 years.
A retrospective study was conducted by reviewing medical records of all patients diagnosed with retropharyngeal abscess in a single centre between 1 January 1990 and 31 February 2016. Thirty-three patients were included in our study. Data such as personal history, present illness, diagnoses and treatment procedures were collected from the medical records.
The incidence during the years of study was 0.2 cases/100000 inhabitants/year. Personal medical histories most often associated were alcoholism, smoking, diabetes and obesity. The most common aetiology found was impaction of a foreign body (especially fishbone). The most common presenting symptoms were odynophagia and neck pain accompanied by fever. Preventive tracheotomy was performed in the initial management of the patient in 9 cases (27%). The most frequent complication was descending necrotising mediastinitis. Surgical drainage of the abscess was required in 27 patients (82%), especially with external approaches (17 cases). Two patients had sequelae: paralysis of unilateral vocal cord and Horner's syndrome. No mortality was observed in the patients of the study.
Retropharyngeal abscesses must be considered medical-surgical emergencies as they are likely to produce serious complications. We must pay attention to the warning symptoms such as odynophagia and cervical pain, associated or otherwise with dyspnoea, stridor, trismus, and neck stiffness. Advances in diagnostic and therapeutic procedures together with advances in critical care have been a key factor in improving the prognosis and mortality of these patients.
Los abscesos retrofaríngeos constituyen una entidad grave. Debido a su escasa frecuencia y a compartir sintomatología con otros procesos, constituyen un reto diagnóstico para el clínico, siendo esencial realizar un diagnóstico temprano para no demorar el tratamiento y evitar así complicaciones.
Conocer la epidemiología, etiopatogenia, manifestaciones clínicas, microorganismos más frecuentemente implicados, tipo de tratamiento realizado y morbimortalidad de los abscesos retrofaríngeos en un hospital terciario en 25 años.
Se realizó un estudio retrospectivo descriptivo mediante la revisión de historias clínicas de todos los pacientes diagnosticados con absceso retrofaríngeo en un centro entre el 1 de enero de 1990 hasta el 31 de febrero de 2016. Treinta y tres pacientes diagnosticados con absceso retrofaríngeo durante dicho periodo fueron incluidos en nuestro estudio. De la historia clínica se recogieron diferentes variables que fueron agrupadas en las siguientes categorías: antecedentes personales, enfermedad actual, procedimientos diagnósticos realizados y tratamiento.
La incidencia durante los años de estudio fue de 0,2 casos/100.000 habitantes/año. Los factores de riesgo más frecuentemente asociados fueron la diabetes de tipo II y la obesidad, siendo la impactación de un cuerpo extraño la etiología más frecuentemente encontrada (sobre todo, espina de pescado). Los síntomas/signos más frecuentes de presentación fueron la odinofagia y fiebre. La traqueotomía preventiva en el manejo inicial del paciente se realizó en nueve pacientes (27%). La complicación más frecuente fue la mediastinitis necrosante descendente. Se precisó un drenaje quirúrgico del absceso en 27 pacientes (82%), sobre todo con abordajes por vía externa (17 casos). Dos pacientes presentaron secuelas relacionadas con el tratamiento quirúrgico: una parálisis de cuerda vocal unilateral y un síndrome de Horner. No se objetivó mortalidad en los pacientes del estudio.
Los abscesos retrofaríngeos deben ser considerados urgencias médico-quirúrgicas, ya que son susceptibles de producir complicaciones graves. Debemos prestar atención a los síntomas de alarma como son la odinofagia y el dolor cervical, asociado o no, disnea, estridor, trismus, rigidez cervical y síndrome febril. Los avances en procedimientos diagnósticos, terapéuticos y en los cuidados del paciente crítico han sido decisivos en la mejora del pronóstico y mortalidad de estos pacientes.
Background
The question of an optimal strategy and outcomes in COVID-19 tracheostomy has not been answered yet. The critical focus in our case study is to evaluate the outcomes of tracheostomy on ...intubated COVID-19 patients.
Methods
A multicentric prospective observational study of 1890 COVID-19 patients undergoing tracheostomy across 120 hospitals was conducted over 7 weeks in Spain (March 28 to May 15, 2020). Data were collected with an innovative approach: instant messaging via WhatsApp. Outcome measurements: complications, achieved weaning and decannulation and survival.
Results
We performed 1,461 surgical (81.3%) and 429 percutaneous tracheostomies. Median timing of tracheostomy was 12 days (4–42 days) since orotracheal intubation. A close follow-up of 1616/1890 (85.5%) patients at the cut-off time of 1-month follow-up showed that in 842 (52.1%) patients, weaning was achieved, while 391 (24.2%) were still under mechanical ventilation and 383 (23.7%) patients had died from COVID-19. Decannulation among those in whom weaning was successful (
n
= 842) was achieved in 683 (81%) patients.
Conclusion
To the best of our knowledge, this is the largest cohort of COVID-19 patients undergoing tracheostomy. The critical focus is the unprecedented amount of tracheostomies: 1890 in 7 weeks. Weaning could be achieved in over half of the patients with follow-up. Almost one out of four tracheotomized patients died from COVID-19.
INTRODUCTIONRetropharyngeal abscess is a serious condition. Its rare occurrence, thus sharing symptoms with other processes, make it a diagnostic challenge for the clinician. Therefore, it is ...critical to make an early diagnosis to prevent delaying treatment and avoid complications. OBJECTIVESTo gain knowledge of the epidemiology, pathogenesis, clinical manifestations, the most commonly implicated microorganisms, the type of treatment used, morbidity and mortality of retropharyngeal abscesses at a tertiary institution over the last 25 years. METHODSA retrospective study was conducted by reviewing medical records of all patients diagnosed with retropharyngeal abscess in a single centre between 1 January 1990 and 31 February 2016. Thirty-three patients were included in our study. Data such as personal history, present illness, diagnoses and treatment procedures were collected from the medical records. RESULTSThe incidence during the years of study was 0.2 cases/100 000 inhabitants/year. Personal medical histories most often associated were alcoholism, smoking, diabetes and obesity. The most common aetiology found was impaction of a foreign body (especially fishbone). The most common presenting symptoms were odynophagia and neck pain accompanied by fever. Preventive tracheotomy was performed in the initial management of the patient in 9 cases (27%). The most frequent complication was descending necrotizing mediastinitis. Surgical drainage of the abscess was required in 27 patients (82%), especially with external approaches (17 cases). Two patients had sequelae: paralysis of unilateral vocal cord and Horner's syndrome. No mortality was observed in the patients of the study. CONCLUSIONRetropharyngeal abscesses must be considered medical-surgical emergencies as they are likely to produce serious complications. We must pay attention to the warning symptoms such as odynophagia and cervical pain, associated or otherwise with dyspnoea, stridor, trismus, and neck stiffness. Advances in diagnostic and therapeutic procedures together with advances in critical care have been a key factor in improving the prognosis and mortality of these patients.
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