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Intense bleeding of the surgical field is a potential factor influencing success of functional endoscopic sinus surgery (FESS). Hypotensive anesthesia with α2 intravenous agonists reduces intraoperative bleeding, but which is the best agent is unknown. The main objective of this trial was to compare the current standard adjuvant drug for hypotensive anesthesia, clonidine, with the recently available alternative dexmedetomidine. A randomized clinical trial compared the efficacy of clonidine and dexmedetomidine during FESS. Treatment was open label for the anesthesiologist and operating surgeon, but blind for an external evaluator who evaluated video-recorded surgeries. A Boezaart scale was assessed every 30 min during FESS until surgery completion. Main end-point was the proportion of patients with mean Boezaart scores > 2 (heavy bleeding) by external blinded evaluator. Secondary end-points included other bleeding parameters, surgery duration, hemodynamic measures and surgical complications. 94 patients were randomized. There were no significant differences in the proportion of patients with mean Boezaart scores > 2 in clonidine (42.6%) and dexmedetomidine (42.6%). Consistently, no differences were observed in secondary variables of bleeding, duration or complications. Small differences in mean heart rate were observed that might reflect different pharmacological profiles of the products, but are of uncertain clinical relevance. No significant differences were observed between clonidine and dexmedetomidine when used as anesthetic adjuvants in the reduction of surgical bleeding in FESS. A longer experience with clonidine and its lower costs suggest it may be a preferable option as an adjuvant for hypotensive anesthesia.

We assessed the evidence for the use of αWe systematically reviewed randomized clinical trials (RCTs) assessing A2AAs in endoscopic sinus surgery. Abstracts were reviewed by 2 investigators for eligibility, and selected articles were fully reviewed. Data on study design, population, A2AA drug and control groups, bleeding and surgical field quality outcomes, and adverse effects were extracted and synthesized.A total of 13 RCTs that included 896 individuals (7 double-blind trials, 5 single-blind trials, and 1 open-label trial) were selected that assessed the efficacy of clonidine (6 RCTs, 407 patients), dexmedetomidine (6 RCT, 423 patients), or both (1 RCT, 66 patients). Clonidine was compared with placebo (3 RCTs), midazolam (1 RCT), and remifentanil (2 RCTs). Dexmedetomidine was compared with esmolol (2 RCTs), remifentanil (2 RCTs), nitroglycerin and esmolol (1 RCT), and magnesium sulfate (1 RCT). Clonidine and dexmedetomidine were compared in 1 RCT. Clonidine reduced the proportion of individuals with an impaired surgical field by 23% vs placebo (number needed to treat = 4). Clonidine was better than midazolam and remifentanil in 2 trials, and dexmedetomidine was better than magnesium sulfate and esmolol in 2 trials but was not superior to esmolol, remifentanil, or nitroglycerin in 4 trials. Dexmedetomidine produced significantly better differences in bleeding outcomes versus clonidine. Adverse events were infrequent and mainly caused by hypotension or bradycardia.RCTs consistently report that A2AAs reduce bleeding and improve surgical field quality during endoscopic sinus surgery. Adverse event reporting was often omitted in RCTs. Well-designed RCTs with appropriate sample sizes are desirable to identify the best A2AAs and confirm their potential effects on clinical outcomes.

Objectives/Hypothesis The Tonsil and Adenoid Health Status Instrument (TAHSI) is a disease-specific questionnaire, intended for completion by parents, for assessing quality of life related to tonsil and adenoid disease or its treatment in children with throat disorders. The aim of this study was to validate the Spanish adaptation of the TAHSI, thus allowing comparison across studies and international multicenter projects. Study Design Multicenter prospective instrument validation study. Methods Guidelines for the cross-cultural adaptation process from the original English-language scale into a Spanish-language version were followed. The psychometric properties (reproducibility, reliability, validity, responsiveness) of the Spanish version of the TAHSI (s-TAHSI) were assessed in 51 consecutive children undergoing adeno/tonsillectomy (both before and 6 months after surgery) and a separate cohort of 50 unaffected children of comparable age range. Results Test-retest reliability (γ = 0.8) and internal consistency reliability (α = 0.95) were adequate. The s-TAHSI demonstrated satisfactory content validity (r > 0.40). The instrument showed excellent between-groups discrimination (P

Resumen Introduccion La electrodiseccion con bisturi de Colorado® se utiliza desde hace 30 anos como alternativa a la diseccion fria. Alexander fue el primero en publicar resultados de la mascarilla laringeaen otorrinolaringologia y cirugia maxilofacial.Posteriormente se ha introducido como alternativa anestesica habitual en nuestra especialidad. Objetivo El objetivo de este estudio es comprobar los resultados de la aplicacion combinada de estas 2 tecnicas en amigdalectomias, ya por separado han demostrado sus beneficios. Metodos Presentamos un estudio observacional prospectivo de 107 amigdalectomias con o sin adenoidectomia pediatricas. Se analizan una serie de variables durante todo el proceso como el dolor (escala de Brodman), la analgesia, el sangrado, el edema de uvula, los dias hasta normalizar la dieta, la habituacion a la vida normal y los tiempos quirurgico, anestesico y total de quirofano. Resultados La tecnica de electrodiseccion con bisturi de Colorado® minimiza el sangrado intraoperatorio y la necesidad de hemostasia. El edema de uvula y el dolor local aumenta comparado con la diseccion en frio. No hay variaciones clinicas en cuanto a los dias que tarda el paciente en recuperar su vida normal. La combinacion de la anestesia con mascarilla laringea y la electrodiseccion con Colorado® reduce el tiempo quirurgico, anestesico y total de quirofano. Conclusiones La combinacion de ambas tecnicas es un metodo seguro, rapido y eficaz que se beneficia de las ventajas de ambas sin suponer un aumento de los riesgos quirurgicos ni anestesicos..

Introduction The Colorado® microdissection needle has been used for 30 years as an alternative to cold dissection. Alexander was the first to publish the results of laryngeal mask in otorhinolaryngology and maxillofacial surgery. Later on it was introduced as a standard anaesthetic technique in our speciality. Objective The objective of this study was to compare the results of using laryngeal mask combined with Colorado® microdissection needle in tonsillectomies. The benefits of each of these 2 techniques are already known. Methods We present a prospective observational study of 107 paediatric tonsillectomies associated or not to adenoidectomy. Variables analysed are pain (Brodman scale), analgesia, bleeding, uvula oedema and days up to the restoration of diet and normal life. Surgical, anaesthetic and total surgery room times are also discussed. Results The Colorado® electrodissection technique minimised intraoperative bleeding and the need for haemostasis. However, uvula oedema and local pain increased compared with cold dissection. There were no clinical variations in the recovery of normal life. Combining the Colorado® microdissection needle and laryngeal mask reduced intraoperative, anaesthetic and total surgery room times. Conclusions The combination of these two techniques is a secure, quick and effective method that derives benefits from the advantages of both of them, without increasing surgical or anaesthetic risks.

Purpose We assessed the evidence for the use of α2-adrenergic agonists (A2AAs) in bleeding control and field quality in endoscopic sinus surgery. Methods We systematically reviewed randomized clinical trials (RCTs) assessing A2AAs in endoscopic sinus surgery. Abstracts were reviewed by 2 investigators for eligibility, and selected articles were fully reviewed. Data on study design, population, A2AA drug and control groups, bleeding and surgical field quality outcomes, and adverse effects were extracted and synthesized. Findings A total of 13 RCTs that included 896 individuals (7 double-blind trials, 5 single-blind trials, and 1 open-label trial) were selected that assessed the efficacy of clonidine (6 RCTs, 407 patients), dexmedetomidine (6 RCT, 423 patients), or both (1 RCT, 66 patients). Clonidine was compared with placebo (3 RCTs), midazolam (1 RCT), and remifentanil (2 RCTs). Dexmedetomidine was compared with esmolol (2 RCTs), remifentanil (2 RCTs), nitroglycerin and esmolol (1 RCT), and magnesium sulfate (1 RCT). Clonidine and dexmedetomidine were compared in 1 RCT. Clonidine reduced the proportion of individuals with an impaired surgical field by 23% vs placebo (number needed to treat = 4). Clonidine was better than midazolam and remifentanil in 2 trials, and dexmedetomidine was better than magnesium sulfate and esmolol in 2 trials but was not superior to esmolol, remifentanil, or nitroglycerin in 4 trials. Dexmedetomidine produced significantly better differences in bleeding outcomes versus clonidine. Adverse events were infrequent and mainly caused by hypotension or bradycardia. Implications RCTs consistently report that A2AAs reduce bleeding and improve surgical field quality during endoscopic sinus surgery. Adverse event reporting was often omitted in RCTs. Well-designed RCTs with appropriate sample sizes are desirable to identify the best A2AAs and confirm their potential effects on clinical outcomes.

Introduction and objectives: Tympanostomy tube emplacement is a common surgical procedure in paediatric otolaryngological surgery. This surgery has complications that sometimes depend on the disease and at other times on the treatment. The objective of this study is to know the results obtained with tympanostomy tube emplacement and its complications. Material and methods: Retrospective study of all the children operated on for tympanostomy tube emplacement over a period of 18 months and with follow-up for at least 7 years; this amounted to 143 ears operated on for the first time. The study variables were age, gender initial appearance of the ear, inner ear contents, type of grommet inserted, duration of grommet, and the lack of any hospital monitoring needed after extrusion. Results: One complication or another arose in 46% of the ears. The Donaldson type of grommet with a diameter of 1.27 mm is the one that produced most complications. There were more complications in ears that were worse in the otoscopic examination regardless of the grommet inserted. Conclusions: The high prevalence of complications and after-effects after grommet emplacement needs long-term follow-up in patients. The results obtained suggest the use of grommets with a smaller internal diameter.

Background: It has been suggested that an exaggerated immune response to fungi is crucial in the pathogenesis of chronic rhinosinusitis (CRS). Based on this rationale, the use of topical antifungals (amphotericin B) has been advocated. Studies on its clinical effectiveness are, however, contradictory. Objectives: To examine the effect of nasal antifungal treatment on secreted mediators in samples of nasal lavage fluid from patients with CRS with or without nasal polyps (NP). Methods: Part two of a prospective double-blind, placebo-controlled multicenter clinical trial investigating the effect of 13 weeks of treatment with amphotericin B or placebo on the levels of pro-inflammatory cytokines, chemokines and growth factors (i.e., IL-1β, IL-1RA, IL-2, IL-2R, IL-3, IL-4, IL-5, IL-6, IL-7, IL-8, IL-10, IL-12 (p40/p70 subunits), IL-13, IL-15, IL-17, TNF-α, IFN-α, IFN-γ, G-CSF, GM-CSF, MIP-1α, MIP-1β, IP-10, MIG, eotaxin, RANTES, MCP-1, MCP-2, MCP-3, VEGF, EGF, FGF-basic, HGF, Gro-α) and albumin via a fluorescent enzyme immunoassay in nasal lavage specimens of CRS patients with or without NP. Results: Topical amphotericin B had no significant effect on the level of any of the tested pro-inflammatory cytokines, chemokines, and growth factors in CRS nasal lavage samples. Treatment with placebo, however, increased the level of MIP-1α and MIP-1β, which are mediators involved in wound healing. Conclusions: Topical amphotericin B has no significant effect on activation markers of nasal inflammatory cells in chronic rhinosinusitis with or without nasal polyps. Laryngoscope, 2009

Introduccion y objetivos: La colocacion de tubos de ventilacion transtimpanicos (TVT) es una de las cirugias mas habituales de la otorrinolaringologia pediatrica. Esta cirugia no esta exenta de complicaciones que, a veces, dependen de la propia enfermedad y, otras, de su tratamiento. El objetivo de este estudio es conocer los resultados que hemos obtenido con la colocacion de tubos de ventilacion transtimpanicos y sus complicaciones. Material y metodos: Estudio retrospectivo de todos los ninos intervenidos con colocacion de TVT, en un periodo de 18 meses, y un seguimiento minimo de 7 anos, 143 oidos intervenidos por primera vez. Las variables objeto del estudio son: edad, sexo, aspecto inicial del oido, contenido del oido, tipo de TVT colocado, duracion del TVT, complicaciones aparecidas y no necesitar controles hospitalarios tras extrusion del TVT. Resultados: El 46 % de los casos presentaron algun tipo de complicacion. El TVT que mas complicaciones nos ha producido es el tipo Donaldson de 1,27 mm de diametro interno. Aparecen mas complicaciones en los oidos que estaban peor en la otoscopia independientemente del TVT colocado. Conclusiones: La alta incidencia de complicaciones y/o secuelas tras la colocacion de TVT hace necesario el seguimiento de los pacientes durante un largo periodo. Los resultados obtenidos orientan a utilizar TVT de diametro interno mas pequeno. © 2008 Elsevier Espana, S.L. Todos los derechos reservados.

Background: Significant bleeding during functional endoscopic naso-sinusal surgery (FESS) impairs recognition of anatomical references and may negatively affect surgical outcome. Anaesthesia including clonidine as an adjuntive hypotensive agent may reduce intraoperative bleeding. Methods: A randomised comparison of clonidine-based vs remifentanil-based hypotensive anaesthetic regimen was conducted in patients undergoing FESS. The main assessment was the proportion of subjects with Boezaart scores of surgical field bleeding, as blindly assessed from video recordings by a third surgeon not involved in patient care. Results: A total of 47 subjects underwent FESS and were randomised to clonidine or remifentanil. A significantly lower proportion of patients in the clonidine arm had blindly-assessed Boezaart scores higher than 2, with significantly lower mean blind Boezaart scores at 60 minutes and at 120 minutes. Similar findings were reported by the operating surgeon, and when Wormald and VAS scores were used. Objective estimates of bleeding and the duration of surgery and anaesthesia did not differ between groups. Conclusion: The use of clonidine- based controlled hypotensive anaesthesia achieves lower surgical field bleeding during FESS.

Background Chronic rhinosinusitis (CRS) is one of the most common chronic diseases. Recently, it has been suggested that an exaggerated immune response to fungi is crucial in the pathogenesis of the disease. On the basis of this hypothesis, intranasal treatment with amphotericin B should benefit patients with CRS. Data from 2 uncontrolled and 2 controlled trials are conflicting, however. Objective To clarify the role of intranasal antifungal drugs in the treatment of CRS, we conducted a large, double-blind, placebo-controlled, multicenter study comparing the effectiveness of amphotericin B nasal lavages with placebo. Methods A total of 116 randomly selected patients with CRS were instructed to instill 25 mL amphotericin B (100 μg/mL) or placebo to each nostril twice daily for 3 months. Primary outcomes included a reduction in total visual analog scale (VAS) score and nasal endoscopy score. Secondary outcome measures included peak nasal inspiratory flow, polyp score, quality of life (Short Form-36, Rhinosinusitis Outcome Measure-31), and individual VAS scores. Results Analysis was based on intention to treat and involved all patients randomly assigned. Mean VAS scores, Short Form-36 and Rhinosinusitis Outcome Measure-31 data, peak nasal inspiratory flow values, nasal endoscopy scores, and polyp scores were similar in both treatment groups at the time of randomization, and no significant differences were observed after 13 weeks of treatment. Conclusion Amphotericin B nasal lavages in the described dosing and time schedule do not reduce clinical signs and symptoms in patients with CRS. Clinical implications Amphotericin B nasal lavages in the described dosing and time schedule are ineffective and therefore not advised in the treatment of patients with CRS.

Resumen El sindrome del seno silente (SSS) es una entidad infrecuente caracterizada por enoftalmos, y provocada por la atelectasia homolateral del seno maxilar. El diagnostico es clinico con confirmacion radiologica. El tratamiento tiene dos objetivos, regularizar la aireacion del seno maxilar mediante la normalizacion del drenaje desde la cavidad nasal y restaurar la arquitectura orbitaria. Presentamos un caso de SSS tratado en nuestro hospital en un solo tiempo quirurgico.

Silent sinus syndrome (SSS) is an uncommon disease characterised by enophthalmos, caused by ipsilateral maxillary sinus atelectasis. The diagnosis is clinical with radiological confirmation. The treatment has two objectives: to regulate the aeration of the maxillary sinus through achieving normal nasal cavity drainage and to restore the orbital architecture. A case of SSS treated in our hospital in a single surgical intervention is reported.

Tympanostomy tube emplacement is a common surgical procedure in paediatric otolaryngological surgery. This surgery has complications that sometimes depend on the disease and at other times on the treatment. The objective of this study is to know the results obtained with tympanostomy tube emplacement and its complications.Retrospective study of all the children operated on for tympanostomy tube emplacement over a period of 18 months and with follow-up for at least seven years; this amounted to 143 ears operated on for the first time. The study variables were age, gender, initial appearance of the ear, inner ear contents, type of grommet inserted, duration of grommet and the lack of any hospital monitoring needed after extrusion.One complication or another arose in 46% of the ears. The Donaldson type of grommet with a diameter of 1.27 mm is the one that produced most complications. There were more complications in ears that were worse in the otoscopic examination regardless of the grommet inserted.The high prevalence of complications and after-effects after grommet emplacement needs long-term follow-up in patients. The results obtained suggest the use of grommets with a smaller internal diameter.

Smell tests for clinical use have been developed in different countries, but no single test has gained general acceptance. The objectives of the study were to evaluate the smell outcomes in a Spanish population.A prospective study on healthy volunteers (n = 120) without olfactory disturbances was performed. The volunteers were differentiated by gender, age, and smoking habit groups. We used a new olfactory test, the Barcelona Smell Test 24 (BAST-24) that consists of 24 odours scoring smell detection, identification, and forced choice.Volunteers showed the highest scores on smell detection for both 1st (99%) and 5th cranial nerve (98%) odours. Spontaneous smell identification (54.7% and 59.3%) and forced choice (72.2% and 42.6%) scores were lower than those of smell detection, for both 1st and 5th cranial nerves respectively. On smell identification, volunteers scored higher in the left than in the right nostril. Females had better smell identification for both 1st and 5th cranial nerves (62.8%, 66.7%) than males (50.3%, 58.8%). Non-smokers had higher scores (65%) than smokers (59%) on smell identification for the 5th CN.For smell identification, females, non-smokers, and left nostril had higher scores than males, smokers, and right nostril respectively. BAST-24 is a good and reliable method to test the olfactory function in the clinical practice.