OBJECTIVE:Exercise-induced laryngeal obstruction (EILO) is a common cause of breathing difficulties during physical exercise. This study examined the relationship between EILO diagnosis and factors influencing laryngeal function in the cohort of Polish athletes. MATERIAL AND METHODS:We retrospectively analyzed data from 31 patients diagnosed with exertional dyspnea at the National Centre for Sports Medicine over a 2.5-year period. The analysis included results from spirometry, flexible videolaryngoscopy at rest, continuous laryngoscopy during exercise (CLE), assessment of laryngeal reflux using the reflux symptom index (RSI) and reflux finding score (RFS) scales, and palpation of neck muscle tension performed by an otolaryngologist. RESULTS:Out of the 31 athletes, 14 (45%) were diagnosed with EILO, 9 (29%) with asthma, and 1(7%) had both EILO and asthma. In 7 athletes, no specific respiratory conditions were diagnosed. While self-reported reflux symptoms (RSI) were similar between groups, RFS scores reflecting visible laryngeal changes were significantly higher in the non-EILO group (4.53 vs. 1.43). Neck muscle tension levels were similar across both groups. CONCLUSION:The incidence of EILO among Polish athletes diagnosed with exertional dyspnea is consistent with findings in other countries. While laryngopharyngeal reflux disease is not directly correlated with EILO, patients with EILO may report relatively high scores on self-assessment reflux scales due to the similarity of symptoms. Furthermore, neck muscle tension levels were not correlated with EILO in our patient cohort.
INTRODUCTION:Carbon dioxide transoral laser microsurgery (CO₂TOLMS) is a well-established treatment for early-stage glottic carcinoma, offering excellent oncological control with organ preservation. This study evaluates long-term outcomes and prognostic factors in a consecutive cohort. MATERIALS AND METHODS:A retrospective analysis was performed on 161 consecutive patients with Tis-T2 glottic carcinoma treated with CO₂TOLMS between 2016 and 2021. Primary endpoints included overall survival (OS), disease-specific survival (DSS), disease-free survival (DFS), locoregional control (LRC), and laryngeal preservation. Prognostic factors were analyzed using Cox regression models. RESULTS:At a median follow-up of 60.3 months, 5-year OS, DSS, DFS, and LRC were 91.9%, 98.1%, 83.2%, and 82.0%, respectively. Laryngeal preservation was achieved in 96.3% of patients. On univariate Cox analysis, T2 stage (HR 3.39, 95% CI 1.65-7.05, p = 0.003), anterior commissure involvement (HR 2.70, 95% CI 1.32-6.19, p = 0.01), and close or positive margins (HR 6.56, 95% CI 2.82-8.78, p = 0.001) were significantly associated with worse DFS. For OS, significant predictors included age >70 years (HR 3.84, p = 0.035), ASA III status (HR 3.21, p = 0.043), T2 stage (HR 4.61, p = 0.001), anterior commissure involvement (HR 3.12, p = 0.02), and margin status (HR 5.84, p = 0.001). Local recurrence occurred in 14.9% of patients, most within the first two years, and was successfully managed with repeat laser surgery in the majority of cases. CONCLUSIONS:CO₂TOLMS achieves excellent oncological outcomes with high laryngeal preservation in early glottic carcinoma. Tumor stage, anterior commissure involvement, and margin status significantly influence recurrence risk, while age and comorbidity impact overall survival. Careful patient selection and structured follow-up remain essential.
OBJECTIVES:To characterize spinal accessory nerve (SAN) related shoulder dysfunction under standardized, controlled conditions following anatomically nerve-preserving bilateral selective neck dissection, integrating objective functional, electromyographic, and patient-reported outcomes. DESIGN:Prospective cohort study. SETTING:Single tertiary referral centre, [blinded institution], Spain. PARTICIPANTS:Twenty-six patients with head and neck squamous cell carcinoma requiring bilateral selective neck dissection of levels II-IV including level IIB. MAIN OUTCOME MEASURES:Shoulder range of motion (ROM) by digital inclinometry, electromyography (EMG) amplitude and latency of the trapezius muscle, muscle strength (British Medical Research Council scale), shoulder girdle examination, and patient-reported outcomes (Neck and Shoulder Disability Index), assessed preoperatively and at 1, 3, and 6 months postoperatively. Intraoperative neuromonitoring with compound muscle action potential recording was performed before and after dissection. RESULTS:Despite stable intraoperative neuromonitoring amplitudes, significant reductions in abduction (mean 30.5 °, p = 0.0003) and flexion ROM (mean 23.8°, p = 0.0008) persisted at 6 months. EMG amplitude decreased from 8.85 to 4.47 mV at 1 month (p = 0.0003), with partial recovery at 6 months. Latency increased transiently. Strength deficits (BMRC ≤4/5) were present in 19.2% of patients at 6 months. Neck Disability Index increased significantly (p = 0.004). CONCLUSION:Spinal accessory nerve dysfunction can occur despite anatomical preservation and stable intraoperative monitoring, suggesting neurapraxic changes arising from mechanisms not captured in real time such as possibly traction or perineural disruption at level IIB. These findings highlight the importance of postoperative surveillance and early targeted rehabilitation.
OBJECTIVE:To simultaneously evaluate peripheral and central auditory pathways in individuals with sickle cell disease (SCD), identifying patterns of auditory impairment and potential initial sites of lesion. MATERIALS AND METHODS:This cross-sectional study included 107 participants (aged 7-49 years), 54 with SCD (HbSS or HbSC) and 53 controls (HbAA). Participants with abnormal otoscopic findings, comorbidities, or auditory risk exposures were excluded. Assessments included pure-tone audiometry, tympanometry, contralateral acoustic reflex testing, brainstem auditory evoked potentials (BAEP), and cortical auditory evoked potentials (P300). Clinical data, hydroxyurea use, and transfusion history were collected. Statistical analyses included association tests and binary logistic regression. RESULTS:Sensorineural hearing loss (SNHL) was present in 29.6% of the SCD group, significantly higher than in controls (p < 0.001). Among participants without SNHL, elevated contralateral acoustic reflex thresholds were more frequent, particularly at 2 and 4 kHz in both ears (p < 0.05). No significant differences were observed in BAEP absolute or interpeak latencies, nor in P300 latency between groups. Logistic regression did not identify independent clinical predictors of SNHL. CONCLUSIONS:Individuals with SCD exhibit a high prevalence of SNHL and subclinical auditory dysfunction. Although BAEP and P300 responses did not differ between groups, alterations in contralateral acoustic reflex thresholds suggest early and localized dysfunction at the level of brainstem auditory circuits, even in individuals with normal hearing thresholds. These subclinical findings highlight the importance of regular audiological monitoring using sensitive objective measures to enable early detection and longitudinal follow-up of auditory changes in this population.
ANTECEDENTS AND OBJECTIVE:Laryngeal disorders are an important but often underrecognized cause of dyspnea in otorhinolaryngology practice. The assessment of symptom severity is challenging due to the episodic nature of symptoms and the limited availability of objective tests during symptomatic episodes. The Dyspnea Index (DI) is a validated patient-reported outcome measure specifically designed to assess laryngeal dyspnea; however, a Spanish version has not previously been validated. The objective of the present study is to translate, culturally adapt and validate the Spanish version of the Dyspnea Index (DI). METHODS:A single-center, cross-sectional validation study was conducted, including patients aged ≥12 years who complained of laryngeal dyspnea, excluding comorbid conditions causing dyspnea of other origin. Healthy adult controls without otorhinolaryngologic or pulmonary disorders were recruited among medical students and hospital staff. The DI was translated by three independent otolaryngologists, synthesized into a consensus version, and back-translated by a professional translator. Psychometric evaluation included internal consistency (Cronbach's α), known-group validity (Welch's t, Mann-Whitney U, Cohen's d), floor/ceiling effects, and exploratory factor analysis (PCA). RESULTS:Forty-three patients and forty-three healthy controls were analyzed. Mean DI scores were 21.44 ± 10.08 in patients and 1.23 ± 1.96 in controls (p < 0.0001; Cohen's d = 2.78). Internal consistency was excellent overall (α = 0.955) and good-to-excellent in patients (α = 0.879). A floor effect was present in 33.7% and a ceiling effect in 1.2%. PCA supported a predominantly unidimensional structure (PC1 eigenvalue = 4.99, explained variance = 48.7%). CONCLUSION:The Spanish DI demonstrates excellent reliability and validity, with psychometric properties comparable to validated versions in other languages. It is a robust tool for the assessment of laryngeal dyspnea in Spanish-speaking settings.
Indolent T-cell lymphoproliferative disorder of the gastrointestinal tract (iTLPD-GI) is a rare lymphoproliferative disorder with a heterogeneous clinical presentation. Although primarily involving the gastrointestinal tract, head and neck manifestations have been sporadically reported and remain poorly characterized. We conducted a systematic review of case reports and case series, in accordance with PRISMA guidelines, to describe the otorhinolaryngological manifestations of iTLPD-GI and to facilitate early diagnosis and appropriate clinical management. MEDLINE/PubMed, LILACS, Cochrane Library and Web of Science Core Collection were searched to identify case reports and case series published from January 1995 to January 2026 that described head and neck involvement in patients with histologically confirmed iTLPD-GI. Ten studies comprising 13 patients with head and neck manifestations were identified. Patients ranged in age from 22 to 77 years and were predominantly male. Oral and oropharyngeal ulcerations were observed in all patients with head and neck involvement, most frequently affecting the soft palate, while laryngeal involvement was reported in three cases. In eight patients, head and neck manifestations represented the initial presentation of the disease, including three cases with isolated oral or oropharyngeal lesions. Lesions were predominantly ulcerative in appearance, whereas pseudotumoral presentations were less common. Most patients experienced recurrent spontaneous resolution of head and neck lesions, although some showed clinical improvement only after systemic treatment. Head and neck involvement in iTLPD-GI, although rare, may precede gastrointestinal manifestations and should be considered in the differential diagnosis of persistent or treatment-resistant oral or oropharyngeal ulcers.
Control of intraoperative blood loss and improvement of surgical field quality remain among the most challenging technical issues in functional endoscopic sinus surgery (FESS). This systematic review and meta-analysis aimed to evaluate randomized clinical trials investigating clonidine in FESS, with a focus on its role in reducing blood loss and improving surgical field quality. This systematic review was conducted in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Nineteen studies were included in this systematic review recruiting a total of 1281 patients. In studies that compared clonidine to placebo/control, clonidine administration was associated with significantly lower blood loss [standardized mean difference (SMD) (95% CI): -1.16 (-1.86, -0.46), p = 0.001] and better surgical field quality [SMD (95% CI): -1.11 (-1.65, -0.58), p<0.0001]. In contrast, clonidine was comparable to dexmedetomidine regarding blood loss [SMD (95% CI): 0.76 (-0.10, 1.62), p = 0.08] and surgical field quality [SMD (95% CI): 0.83 (-0.17, 1.83), p = 0.1]. In conclusion, clonidine use in FESS appears to be associated with better surgical field quality and lower intraoperative blood loss when compared with placebo/control. Its effects are comparable to that of dexmedetomidine.
Hyperacusis is marked by an abnormal sensitivity to everyday sounds, causing considerable distress and hindrance in daily life. It is frequently linked with other hearing disorders like tinnitus and may occur alongside neurological and psychiatric conditions such as autism, migraines, and depression. Recent research into hyperacusis treatment has explored various sound therapy methods, including counselling and the use of therapeutic sounds. Consequently, the current systematic review investigated whether sound-based therapy programs could alleviate the effects of hyperacusis. A total of 149 articles were retained for this study. After a thorough examination of the full text of the 14 articles that satisfied the inclusion criteria, nine quantitative studies were ultimately selected. These comprised one retrospective study, three studies comparing pre- and post-intervention outcomes, three randomized controlled trials, and two case studies. These nine studies collectively demonstrated that sound generator therapy significantly reduced the debilitating symptoms of hyperacusis, with all investigations reporting substantial symptomatic improvement post-intervention. Collectively, the nine studies demonstrated significant therapeutic benefits of sound generator interventions in reducing hyperacusis-related disability. However, the current evidence base would benefit from further randomized controlled trials to more comprehensively evaluate the clinical efficacy of sound-based treatments for this condition.
OBJECTIVE:To evaluate the impact of nasal septal perforation (NSP) on sinonasal symptoms and quality of life (QoL) using patient-reported outcome measures. METHODS:A prospective observational study was conducted between 2018 and 2024 in two referral centres. Clinical, demographic, symptom-related, and QoL data were collected for all included patients. RESULTS:A total of 153 patients with NSP were included. The main aetiologies were intranasal cocaine abuse (n = 57; 37.3%), post-sinonasal surgery (n = 47; 30.7%), and rhinotillexomania (n = 31; 20.3%). The mean age was 47.8 years (SD 12.9; range 18.2-82.3), and 60.8% of patients were male. Anterior perforations were the most frequent location (n = 88; 57.5%). Mean perforation dimensions were 15.8 mm (SD 6.7) in height and 22.0 mm (SD 10.6) in length, with an estimated elliptic area of 312.9 mm² (SD 265.1; range 14.1-1272.3 mm²). The most frequent and severe symptoms reported on visual analogue scales were nasal obstruction (mean 58.3; SD 28.7), crusting (55.3; SD 34.9), and rhinorrhoea (44.8; SD 34.6). Quality of life was markedly impaired, with mean scores of 46.9 (SD 23.1) on the SNOT-22, 25.3 (SD 10.1) on the NOSE-Perf, and 24.1 (SD 10.1) on the SEPEQOL. The SF-36 physical and mental component summary scores were 45.0 (SD 10.5) and 40.5 (SD 14.2), respectively. CONCLUSION:NSP is associated with a significant burden of sinonasal symptoms and a substantial impairment in quality of life. Patient-reported outcome measures demonstrate an impact on both physical and mental health domains, underscoring the importance of a comprehensive and multidisciplinary approach to the evaluation and management of patients with NSP.
INTRODUCTION:Nasal obstruction is a common complaint in otolaryngology. Choosing between septoplasty or septorhinoplasty may be challenging due to anatomical variability. Computational fluid dynamics (CFD) has emerged as a complementary, patient-specific tool enabling bilateral simulation and virtual planning, allowing simulation of post-surgical outcomes under physiological conditions. MATERIALS AND METHODS:Virtual surgeries were performed on patients with nasal obstruction using Flowgy® software. For each patient, three anatomical models were simulated: baseline, virtual septoplasty, and virtual septorhinoplasty (with turbinoplasty when indicated). CFD analysis was used to assess pressure drop (ΔP), flow symmetry (Φ), and nasal resistance (R), among other airflow parameters. Comparative data were analysed to determine the functional impact of each intervention. RESULTS:In all five cases, septoplasty resulted in improvements in pressure drop ranging from 10.5% to 50.9%, as well as changes in resistance ranging from +2.98% to -64.3%. Septorhinoplasty provided additional functional gains in pressure (up to 44.8%) and resistance (up to 51%) in selected cases. Based on the analysis, surgical benefit thresholds were proposed: ≥30% improvement in ΔP or R from baseline to justify septoplasty, and ≥20-30% additional benefit over septoplasty to indicate septorhinoplasty. CONCLUSIONS:CFD analysis is a valuable adjunct in functional nasal surgery, enabling personalised decision-making. While not a substitute for clinical judgement, CFD-guided planning may enhance the selection of surgical strategy and reduce unnecessary interventions.
INTRODUCTION AND OBJECTIVE:Some patients complain of tinnitus despite having normal conventional audiograms. However, normal audiograms don't exclude the presence of subtle cochlear or neural damage. The study's objective was to assess cochlear function and the cochlear nerve in tinnitus patients with normal audiograms, as well as assessing temporal processing in these patients. MATERIALS AND METHODS:The study included a total of 40 participants: 20 tinnitus patients with normal audiograms and 20 healthy controls without tinnitus. All participants underwent otoscopic examination, tympanometry, acoustic reflex (AR) testing, pure-tone audiometry, extended high-frequency (EHF) audiometry, distortion product otoacoustic emissions (DPOAEs), auditory brainstem response (ABR), and auditory temporal processing assessments, including the auditory fusion test-revised and the pitch pattern sequence test. RESULTS:The tinnitus group showed significant findings across multiple tests, including: elevated EHF thresholds and reduced DPOAE amplitudes (indicating cochlear dysfunction); reduced acoustic reflex responses and delayed ABR wave I latency (suggesting cochlear nerve/synapse involvement); and poorer performance in auditory temporal processing tests. CONCLUSIONS:Our findings provide compelling clinical evidence for subtle, measurable peripheral (cochlear and neural) and central auditory dysfunction in tinnitus patients with normal audiograms. These deficits in the auditory system are essential components of tinnitus pathology and require the integration of advanced audiological assessments for proper diagnosis and management.
INTRODUCTION:Improving the quality and equity of oncology care is a strategic priority in Europe. The Organisation of European Cancer Institutes (OECI) Accreditation and Designation Programme provides a unified framework integrating care, research, education, and governance. Its standards emphasise multidisciplinary coordination, digital infrastructures, and patient-centred outcomes. Head and neck cancer remains a major global challenge, with rising incidence and heterogeneous results, highlighting the need for standardised pathways and interoperable data systems. This study describes how a Head and Neck Cancer Unit was redesigned and digitalised to comply with OECI requirements, focusing on elements of the care domain. MATERIALS AND METHODS:A structured organisational redesign was undertaken using workflow mapping, a RACI matrix, and Plan-Do-Act-Check cycles. Governance involved clinical leaders, specialised nurses, quality officers, and IT and engineering staff. Guidelines were updated, fast‑track pathways refined, and synoptic forms integrated into the electronic health record using terminologies compatible with OMOP. PROMs and PREMs were deployed through the institutional portal. A modified Delphi survey assessed team consensus. RESULTS:Between January and October 2025, 353 patients were evaluated, 198 through fast‑track referral. Diagnostic and treatment intervals met targets. PROM completion reached 61%. PREMs highlighted strengths in professionalism and multidisciplinary coordination and identified communication and administrative burden as areas for improvement. The Delphi survey showed strong agreement (α = 0.71), particularly for Multidisciplinary participation and nursing collaboration. DISCUSSION:The redesign, aligned with OECI standards, strengthened governance, digitalisation, and patient‑centred care. The model demonstrates how accreditation can drive sustainable, data‑driven improvement and support integrated cancer networks.
Introducción Los hemangiomas glóticos son tumores vasculares benignos de origen endotelial poco frecuentes en adultos. Por su aspecto se confunden con frecuencia con pólipos de cuerda vocal o, en menor frecuencia, con lesiones malignas. Material y métodos Estudio retrospectivo descriptivo de seis pacientes diagnosticados de hemangiomas cavernosos de cuerda vocal confirmados histopatológicamente entre 2006 y 2023 en el Hospital Universitario Donostia. Resultados Todos los pacientes fueron remitidos por disfonía. En la mayoría de los casos el diagnóstico inicial fue de pólipo de cuerda vocal. Cinco pacientes fueron intervenidos mediante microcirugía laríngea con instrumental frío, con buenos resultados funcionales y sin recurrencias a largo plazo. Conclusiones El hemangioma cavernoso de cuerda vocal, aunque infrecuente en adultos, debe considerarse en el diagnóstico diferencial de las lesiones glóticas. La microcirugía laríngea constituye el tratamiento de elección, con excelentes resultados funcionales y escasa tasa de recidiva.
La rinosinusitis crónica con pólipos nasales (RSCcPN) es una enfermedad inflamatoria crónica de las vías respiratorias superiores caracterizada por inflamación tipo2 (T2) y frecuentemente asociada a comorbilidades respiratorias como asma, rinitis alérgica y enfermedad respiratoria exacerbada por AINE (EREA). Su manejo ha evolucionado desde un enfoque sintomático del tratamiento medicoquirúrgico hacia la medicina de precisión y personalizada, basada en el conocimiento a nivel molecular de los endotipos inflamatorios. Las terapias biológicas han demostrado eficacia en enfermedad grave no controlada, tanto nasosinusal como bronquial, y actualmente están disponibles en el sistema sanitario español.No obstante, persisten desafíos clave: la falta de biomarcadores clínicos validados, la incertidumbre sobre la duración óptima del tratamiento, su combinación con la cirugía nasosinusal y el alto coste de las terapias biológicas. En este contexto, la integración de la ciencia de datos y tecnologías Big Data en el sistema sanitario español representa una oportunidad estratégica para generar evidencia real, mejorar la toma de decisiones clínicas y avanzar hacia una medicina de precisión más equitativa, eficiente y sostenible.
