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Nasal obstruction (NO) is defined as the subjective perception of discomfort or difficulty in the passage of air through the nostrils. It is a common reason for consultation in primary and specialized care and may affect up to 30%-40% of the population. It affects quality of life (especially sleep) and lowers work efficiency. The aim of this document is to agree on how to treat NO, establish a methodology for evaluating and diagnosing it, and define an individualized approach to its treatment. NO can be unilateral or bilateral, intermittent or persistent and may be caused by local or systemic factors, which may be anatomical, inflammatory, neurological, hormonal, functional, environmental, or pharmacological in origin. Directed study of the medical history and physical examination are key for diagnosing the specific cause. NO may be evaluated using subjective assessment tools (visual analog scale, symptom score, standardized questionnaires) or by objective estimation (active anterior rhinomanometry, acoustic rhinometry, peak nasal inspiratory flow). Although there is little correlation between the results, they may be considered complementary and not exclusive. Assessing the impact on quality of life through questionnaires standardized according to the underlying disease is also advisable. NO is treated according to its cause. Treatment is fundamentally pharmacological (topical and/or systemic) when the etiology is inflammatory or functional. Surgery may be necessary when medical treatment fails to complement or improve medical treatment or when other therapeutic approaches are not possible. Combinations of surgical techniques and medical treatment may be necessary.

Summary Background and aims Nursing care requires knowledge of the best possible care techniques and plays a significant role in the nutritional status of cancer patients. The main purpose was assessing the changes in the nutritional profile between the preoperative and postoperative periods for patients with laryngeal cancer and their relationship to pharyngocutaneous fistula. Methods Observational study of 40 patients. During April 2010 and December 2011 nutritional risk assessment on admission and evaluation of nutritional parameters on admission (t0), at 7 (t1) and 14 (t2) days were carried out. Statistical techniques for longitudinal (or repeated) data were used and Generalised Estimating Equations models (GEE), Results On admission, 37.5% of patients had reduced their usual weight by a percentage greater than or equal to 5%, and had a moderate risk of suffering malnutrition; of the patients, 62.5% for [t0, t1] and 80% for [t1, t2] reduced their weight by a percentage greater than or equal to 2%. The average of weight loss was 4328 (SD 2.20 [3.62–5.03]) for [t0, t2] kg. Biochemical parameters decreased for [t0, t1] and recovered for [t1, t2]. Twenty seven point five percent of the patients had a pharyngocutaneous fistula, which was significantly associated with the percentage of weight loss (p-value = 0.032), lower levels of albumin, and prealbumin, with a mean difference of 0.365 g/dl (p-value = 0.014) and 7.65 mg/dl (p-value = 0.005), respectively. Conclusion Patients lose weight before and during treatment and the weight loss is a poor prognosis in the development of pharyngocutaneous fistula in patients with total laryngectomy.

The choice of technique will depend on the glottic gap observed by stroboscopy, the alteration of the Voice Handicap Index (VHI) and the recorded values of harmonics-to-noise ratio (HNR), jitter and shimmer, and the general health, age and underlying pathology. There are statistically significant differences between the values of VHI, shimmer and jitter in favour of those cases operated on within 6 months of diagnosis. Alternatives are discussed.This study analysed and compared the functional, morphological and acoustic results, after surgery, through the techniques of medialization thyroplasty and infiltration of biomaterials to correct incomplete closure of the glottis.A total of 21 patients with dysphonia due to vocal fold insufficiency (13 women and 8 men) and ages ranging between 30 and 65 years (mean age 40.84, SD 12.5) were evaluated. The material used for augmentation surgery consisted of calcium hydroxylapatite microspheres. Measurements (VHI, jitter, shimmer and HNR) were performed before surgery and at 6 and 24 months post-intervention.Overall, statistically significant differences were observed relating to measurements (p0.01) and surgical techniques (p0.05) analyzed. In particular, these differences were located in pairs pre-surgery - 6 months post-surgery and pre-surgery - post 24 months, in the four variables, and between the two techniques used in jitter (p = 0.008), HNR (p = 0.045) and VHI (p = 0.035).

In our study, pedicled nasal flap (NF) did not provide better results than free nasal graft (NG) for primary closure of cerebrospinal fluid (CSF) rhinorrhea. In the future, a multicenter randomized study would be needed to confirm this result. The choice of surgical technique will depend on the surgeon's experience, and the position and size of the defect.To evaluate our results in repairing CSF leaks, comparing the two techniques we used: free NG and pedicled NF.A total of 33 patients diagnosed with CSF rhinorrhea were operated on between June 2000 and May 2010; 17 were women. The mean age was 44.7 years (± 13.0). Twenty-two (66.6%) NFs of the middle and lower turbinate and septum were performed, the rest being NGs of the middle and lower turbinate only. A descriptive statistical analysis and a Kaplan-Meier survival analysis were carried out and the log-rank statistic was used to compare both techniques.In the present study, 78% of defects were closed in all cases; NF was used in 86% (19) and NG in 63.63% (7). The mean follow-up was 71.5 (95% confidence interval (CI), 56.9-86.1) months. There were no statistically significant differences (p0.05).

Objective To describe the clinical picture and treatment of dural arteriovenous fistulas (DAVFs) presenting as pulsatile subjective tinnitus. Study design Review of prospectively collected data. Setting Academic referral center. Patients Fourteen patients with clinically and radiographically diagnosed DAVFs. Interventions Treated by endovascular route. Main outcome measures Treatments, clinical course, complications, and evolution were evaluated. Results All patients presented with sleep-disruptive pulsatile tinnitus. Other symptoms included severe headaches, papilledema, proptosis, blepharoptosis, visual disturbances, and hemiparesis. Cortical venous drainage was present in 4 cases. Endovascular treatment was performed at least once by the arterial route in 14 patients and the venous route in 4 patients. The origin of tinnitus was always a vessel in or above the petrous bone. When these arteries or veins could not be visualized in the final control, the tinnitus disappeared. In the patients whose tinnitus returned, a vessel in the petrous bone could always be seen. There was no mortality. Conclusion Endovascular treatment is an effective and safe treatment of DAVFs presenting as tinnitus.

Objectives:We report an extremely rare case of a large solitary fibroma of the paranasal sinus, which we treated by sinonasal endoscopic surgery. We describe its clinical and histopathological features, and we report the endoscopic technique used to deal with such a large sinonasal mass (penetrating the pterygomaxillary and infratemporal fossae); we also offer a brief survey of the literature.Case report:A woman presented with an approximately one-year history of nasal obstruction. Nasal endoscopy revealed an irregularly shaped, friable, reddish mass that occupied the whole of the right nasal fossa. Magnetic resonance imaging of the paranasal sinuses revealed a large mass that occupied the anterior and posterior ethmoids and the maxillary and sphenoid sinuses, displacing the septum and penetrating the pterygomaxillary fossa, having destroyed the lateral wall of the right nasal fossa. The tumour was resected by means of sinonasal endoscopic surgery; an endoscopic medial maxillectomy with extension to the pterygomaxillary and infratemporal regions was performed. Histological analysis confirmed the diagnosis of solitary fibrous tumour. During follow up, we performed regular nasal endoscopies, as well as computed tomography scans one and six months post-operatively.Conclusions:Endoscopic techniques are currently the approach of choice for the treatment of such tumours of the sinonasal cavity and pterygomaxillary and infratemporal regions. The size of the lesion did not contraindicate endoscopic sinonasal surgery as a curative treatment.

Objective: estimate the prevalence of anxiety in laryngectomy patients in the pre and postoperative periods and its relation with the self-care level. Method: observational research of 40 patients with stage IV laryngeal cancer. Three observations took place: in the preoperative phase, at seven and at 14 days after the surgery; between June 2010 and December 2012. Two self-care levels were defined: self-sufficient and needing help for activities of daily living and treatment-related activities. To assess the anxiety levels, Zigmond's hospital anxiety scale (1983) was used. Results: in the preoperative and postoperative phases, the patients presented high levels of anxiety. Concerning self-care, on average, self-sufficient patients presented lower levels of anxiety than patients who needed help to accomplish activities of daily living and activities deriving from the surgery, without significant differences. Conclusion: anxiety is present at all times in laryngectomy patients and the reduction of the self-care deficit seems to decrease it, without putting a permanent end to it. Resumo Objetivo: estimar a prevalência de ansiedade do paciente laringectomizado no pré-operatório e pós-operatório e sua relação com o nível de autocuidado. Método: pesquisa observacional de 40 pacientes com câncer da laringe estágio IV. Foram realizadas 3 observações: no pré-operatório, a 7 e 14 dias pós-operatório, no período de junho de 2010 a dezembro de 2012. Dois níveis de autocuidado foram definidos: autossuficientes e precisar ajuda para as atividades da vida diária e relacionadas ao tratamento. Para avaliar a ansiedade, foi utilizada a escala de ansiedade hospitalar de Zigmond (1983). Resultados: no pré-operatório e pós-operatório, os pacientes apresentaram níveis elevados de ansiedade. Com relação ao autocuidado, os pacientes autossuficientes apresentaram na média níveis inferiores de ansiedades que os pacientes que precisavam de ajuda para realizar as atividades da vida diária y as derivadas da cirurgia, sem chegar a ser significativas estas diferenças. Conclusão: a ansiedade está presente a todo momento no paciente laringectomizado e a diminuição do déficit de autocuidados parece diminuí-la sem acabar definitivamente com ela. Resumen Objetivo: estimar la prevalencia de ansiedad del paciente laringectomizado, en el preoperatorio y postoperatorio y su relación con el nivel de autocuidados. Método: investigación observacional de 40 pacientes con cáncer de laringe estadio IV. Se realizaron 3 observaciones: en el preoperatorio, a los 7 y 14 días del postoperatorio; en el periodo junio 2010 a diciembre de 2012. Se definieron dos niveles de autocuidados: autosuficientes y necesitar ayuda para las actividades de la vida diaria y derivadas del tratamiento; para evaluar la ansiedad se utilizó la escala de ansiedad hospitalaria de Zigmond (1983). Resultados: en el preoperatorio y postoperatorio los pacientes presentaron niveles elevados de ansiedad. En relación a los autocuidados, los pacientes autosuficientes presentaron en media niveles más bajos de ansiedad que los pacientes que necesitaban ayuda para realizar las actividades de la vida diaria y las derivadas de la cirugía, sin llegar a ser significativas estas diferencias Conclusión: la ansiedad está presente en todo momento en el paciente con laringectomia y la disminución del déficit de autocuidados parece disminuirla sin terminar definitivamente con ella.

Resumen Los avances en optica y endoscopia han revolucionado la cirugia, permitiendo el abordaje endoscopico de la region selar de forma minimamente invasiva, a traves de la cavidad nasal por el seno esfenoidal. Hemos realizado un analisis de los resultados quirurgicos de 20 pacientes intervenidos de tumores hipofisarios mediante abordaje transseptal-transesfenoidal en los ultimos 2 anos en nuestro hospital. La edad media de los pacientes fue de 45,6 anos, siendo mujeres el 75%. El 30% de los casos fueron adenomas no secretores y otro 30% acromegalia, seguido de enfermedad de Cushing (25%) y prolactinoma (10%). No existieron incidencias intraoperatorias, destacando como complicaciones postquirurgicas, la aparicion de diabetes insipida en 2 casos (10%) y un solo caso de fistula de LCR. Dos pacientes estan actualmente en tratamiento hormonal sustitutivo por panhipopituitarismo. El resto han presentado buena evolucion, sin recidivas, normalizandose los niveles hormonales.

Resumen Los grandes avances realizados en instrumental quirurgico han revolucionado la cirugia, permitiendo el abordaje de la hipofisis de forma minimamente invasiva, por medio de la endoscopia, a traves de la cavidad nasal por el seno esfenoidal. En nuestro estudio analizamos los resultados quirurgicos de 20 pacientes intervenidos de tumores selares mediante abordaje endoscopico transseptal transesfenoidal desde Marzo de 1999 hasta Junio de 2002 en nuestro hospital. La edad media de los pacientes fue de 45,6 anos, siendo la mayoria mujeres. 6 de los casos fueron adenomas no secretores (30%) y otros 6 casos acromegalia, seguido de enfermedad de Cushing (25%) y prolactinoma (10%). No existieron incidencias intraoperatorias, destacando como complicaciones postquirurgicas, la aparicion de diabetes insipida en 2 casos (10%) y un solo caso de fistula de LCR. 2 pacientes estan actualmente en tratamiento hormonal sustitutivo por panhipopitui-tarismo. El resto han presentado buena evolucion, sin recidivas, normalizandose los niveles hormonales.

Background : Dysphonia is a common clinical symptom in children. Methods and results : A seven-year-old boy presented with a chronic dysphonia that was secondary to a subglottal inflammatory pseudotumor. The patient was treated by means of endoscopic microsurgery and is currently asymptomatic and without signs of recidivism. Conclusions : Inflammatory pseudotumor of the larynx is seldom encountered in the pediatric age range, and it is diagnosed by means of specific immunohistochemical techniques. The treatment of choice is endoscopic resection by CO 2 laser. Due to its capacity for recidivism and metastasis, the syndrome requires stringent follow-up.

A study of the objective evaluation of voice was made of 100 voices of healthy adults and 60 with disphonia (nodules and polyps). A laryngostroboscopy and an acoustic analysis was made to everyone. A sustained vowel "a" was carried out and digitalized with Dr. Speech Science software. These parameters were estimated: fundamental frequency (Fo, according to gender), Jitter, Shimmer and glottic noise (NNE, HNR, SNR). In the healthy group Fo was 139.72 in men and 267.33 in women, jitter 0.24 and shimmer 2.10. In disphonic patients (nodules) Fo was 126.96 in men and 240.72 in women, jitter 0.35 and shimmer 3.25. In disphonic patients (polyps) Fo was 119.75 in men and 218.26 in women, jitter 0.50 and shimmer 4.34. These difference were statistically significant. Glottic Noise in healthy group was: NNE -13.62, HNR 24.07 and SNR 24.49; in disphonic patients (nodules) was: NNE -10.65, HNR 25.21 and SNR 25.55; in disphonic patients (polyps) was: NNE -8.24, HNR 29.63 and SNR 28.22. Only the difference in the NNE was statistically significant. We highlight the importance of objective evaluation of voice disorders.

A new surgical technique for the treatment of cholesteatoma is reported. The technique involvesautoexclusion for exteriorization of the attic and tympanic box only. The resulting cavity is rather small.The technique allows visual post-operative control of the attic and tympanic membrane. There isno visual access to the mastoid cavity which, however, is the most unlikely site for occurrenceof a residual cholesteatoma.The proposed technique was applied to 102 patients and both the anatomic and functional resultsobtained are reported.

Endoscopic medial maxillectomy (EMM) is a safe, effective method for the treatment of inverted papillomas (IPs) of the paranasal sinuses.To evaluate the efficacy of EMM as a surgical technique in the treatment of IP compared with non-endoscopic techniques.This was a retrospective study of 52 patients with an IP diagnosed by biopsy from 1990 to 2004. EMM was performed in 34 patients (65.4%), whereas non-endoscopic techniques were used in 18 (34.6%). The mean duration of follow-up was 54.2 months.Recurrence occurred in 4 of the 34 patients who underwent EMM (11.8%; 95% confidence intervals (CI) = 39 at 26%) and in 8 of the 18 patients treated using non-endoscopic techniques (44.4%; 95% CI = 23.2 at 67.3%). There was a statistically significant difference (p0.05) between treatments, assessed by Kaplan-Meier estimator and log-rank testing. Of the 12 patients who suffered a recurrence, 6 (50%) were treated with endoscopic surgery, 4 (33%) with mediofacial degloving and 2 (17%) were merely followed up; no malignant degeneration occurred.

We present a case of a 67-year-old man who was an active smoker, with a clinical history of ischaemic cardiopathy, hypertension, who presented to the emergency room with hoarseness of voice of 2 weeks duration. No other neurological or cardiorespiratory symptoms were found. Physical examination revealed an aortic regurgitation murmur with radial pulse difference between the upper limbs and femoral pulse difference on lower limbs. Laryngoscopy examination revealed a left vocal cord paralysis in the paramedian position, without signs of malignancy. Thoracoabdominal CT angiography was performed to rule out an aortic dissection. CT revealed a dissection in the descending thoracic aortic arch and abdominal aorta. Cardiovascular surgery was consulted and decided to place endoprosthesis at the thoracic and abdominal aortic area. Hoarseness eventually resolved during the following weeks. Ortner's syndrome is described as hoarseness of voice caused by compression of the left recurrent laryngeal nerve of cardiovascular origin.