IMPORTANCE The current coronavirus disease 2019 (COVID-19) pandemic has led to unprecedented needs for invasive ventilation, with 10% to 15% of intubated patients subsequently requiring tracheotomy. OBJECTIVE To assess the complications, safety, and timing of tracheotomy performed for critically ill patients with COVID-19. DESIGN, SETTING, AND PARTICIPANTS This prospective cohort study assessed consecutive patients admitted to the intensive care unit (ICU) who had COVID-19 that required tracheotomy. Patients were recruited from March 16 to April 10, 2020, at a tertiary referral center. EXPOSURES A surgical tracheotomy was performed for all patients following recommended criteria for use of personal protective equipment (PPE). MAIN OUTCOMES AND MEASURES The number of subthyroid operations, the tracheal entrance protocol, and use of PPE. Infections among the surgeons were monitored weekly by reverse-transcriptase polymerase chain reaction of nasopharyngeal swab samples. Short-term complications, weaning, and the association of timing of tracheotomy (early [Յ10 days] vs late [>10 days]) with total required days of invasive ventilation were assessed. RESULTS A total of 50 patients (mean [SD] age, 63.8 [9.2] years; 33 [66%] male) participated in the study. All tracheotomies were performed at the bedside. The median time from intubation to tracheotomy was 9 days (interquartile range, 2-24 days). A subthyroid approach was completed for 46 patients (92%), and the tracheal protocol was adequately achieved for 40 patients (80%). Adequate PPE was used, with no infection among surgeons identified 4 weeks after the last tracheotomy. Postoperative complications were rare, with minor bleeding (in 6 patients [12%]) being the most common complication. The successful weaning rate was higher in the early tracheotomy group than in the late tracheotomy group (adjusted hazard ratio, 2.55; 95% CI, 0.96-6.75), but the difference was not statistically significant. There was less time of invasive mechanical ventilatory support with early tracheotomy compared with late tracheotomy (mean [SD], 18 [5.4] vs 22.3 [5.7] days). The reduction of invasive ventilatory support was achieved at the expense of the pretracheotomy period. CONCLUSIONS AND RELEVANCE In this cohort study, with the use of a standardized protocol aimed at minimizing COVID-19 risks, bedside open tracheotomy was a safe procedure for patients and surgeons, with minimal complications. Timing of tracheotomy may be important in reducing time of invasive mechanical ventilation, with potential implications to intensive care unit availability during the COVID-19 pandemic.

Hearing loss was found in 83 and 84 out of 220 standard audiometries and AudCal hearing tests (Cohen's Kappa = 0.89). The mean difference between AudCal and standard audiogram thresholds was -0.21 ± 6.38 dB HL. Excellent reliability and concordance between standard audiometry and the application's hearing loss assessment test were obtained (Cronbach's alpha = 0.96; intra-class correlation coefficient = 0.93). AudCal vs a web-based calculator were perfectly correlated (Pearson's r = 1).

The high prevalence of habitual snoring (35% of the general population) and the increasing demand for an effective treatment have led, in the last decade, to the generalisation of laser-assisted uvulopalatoplasty (LAUP). However, acceptable studies on its effectiveness are lacking.The present randomised, placebo-controlled study included 25 nonapnoeic and mild obstructive sleep apnoea snorers to evaluate LAUP effectiveness for snoring. Group I received a one-stage LAUP treatment and group II a placebo (simulated snore surgery followed by an oral placebo). Before each treatment and 3 months after, the variables and procedures assessed were: body weight; sleepiness (Epworth sleepiness scale); quality of life (SF-36); subjective snoring intensity (0-10 analogue scale); objective snoring intensity (average decibel intensity); snoring index (number of snores per hour); and apnoea/hypopnea index.No differences were observed in body weight, sleepiness, quality of life, subjective and objective intensity, and frequency of snoring, and apnoea/hypopnea index between the groups before and 3 months after treatment.In conclusion, this study provides evidence of the lack of effectiveness of one-stage laser-assisted uvulopalatoplasty for snoring in nonapnoeic and mild obstructive sleep apnoea patients, with the result that it does not meet the expectations generated by the procedure. Laser-assisted uvulopalatoplasty (LAUP) is an outpatient procedure that involves partial resection of the uvula and soft palate using a laser. It is usually offered as a treatment for snoring or as an alternative treatment in mild obstructive sleep apnoea (OSA). However, methodologically accepted studies on the effectiveness of this treatment are limited since randomised placebo-controlled studies are lacking [1]. The high prevalence of habitual snoring (35% of the general population) [2] and the increasing demand for an effective treatment have led, in the last decade, to the generalisation of LAUP. Its indication has probably been favoured by the widespread belief that surgical procedures are more decisive. Furthermore, disparate results concerning this procedure have been published on the basis of objective measurements of snoring before and after treatment [3][4][5]. This, together with the potential risks and complications of LAUP [1], has cast doubt on the need for treating nonapnoeic snorers [6], and the high cost of treating a growing number of patients has led to the usefulness of LAUP being challenged. Thus, further evidence in support of this treatment is warranted. Accordingly, the authors of the present study conducted a prospective, randomised, placebo-controlled study in patients whose main symptom was disruptive snoring (male sex, age range 30-60 yrs, body mass index (BMI) range 25-30 kg?m -2 , apnoea/ hypopnea index (AHI) f30 and considered to be palatal snorers) to evaluate the effect of LAUP in relieving snoring both subjectively and objectively. Material and methods Study subjectsEntry criteria specified: an initial c...

The Spanish version of the NOSE (NOSE-e) is a valid tool for measuring the subjective severity of nasal obstruction, and its use is recommended.

Background: The Nasal Obstruction Symptom Evaluation (NOSE) scale is a symptom-specific, self-completed questionnaire for assessing quality of life related to nasal obstruction or its treatment in patients with septal deviation. The aim of this study was to validate the Spanish adaptation of the NOSE, thus allowing comparison across studies and international multicenter projects. Methodology: Multicenter prospective instrument validation study. 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 ("NOSE-e" for "NOSE-espanol") were assessed in 58 consecutive patients undergoing septoplasty (both before and 3 months after surgery) and 58 matched asymptomatic controls. Results: Test-retest reliability and internal consistency reliability were adequate. The NOSE-e demonstrated satisfactory construct validity. Positive correlations between the NOSE-e scores and the score of a visual analog scale measuring the subjective sensation of nasal obstruction were found. The instrument showed excellent between-groups discrimination and high response sensitivity to change. Conclusions: The Spanish version of the NOSE (NOSE-e) is a valid tool for measuring the subjective severity of nasal obstruction, and its use is recommended.

The field of medical applications is currently one of the most dynamic in medicine due to the great potential for improving clinical practice they hold. However, clinicians' opinion around their usability in daily clinical care has not been thoroughly addressed. This study aimed to analyze the otolaryngologists response to a rhinoplasty application. It was designed as a survey of 21 otolaryngologists with regards to a rhinoplasty planning application for the iPhone with the capacity to project potential surgery outcomes through tactile morphing software compared to a photo tracing method used as the gold standard. The participants were asked to rate the usefulness of the two technologies on a visual analog scale from 0-10. Questions addressed included four topics: physician-patient communication; imaging process time; perceived usefulness for preoperative planning; and perceived usefulness for surgery. A one sample t-test was applied to compare the scores of both methods for each question. The test subjects (mean age 43.21 years) rated the utility of the iPhone application as superior to that of the photo tracing method (p < 0.05) concluding that the iPhone application could facilitate an immediate preliminary analysis of the options for nasal improvement.

Objectives: To assess the long-term effectiveness of stapedotomies performed on patients with otosclerosis and preoperative small air-bone gaps (ABGs). Methods: Retrospective study comparing the 10-year postoperative hearing outcomes after primary stapedotomies in patients with small (≤20 dB) and large ABGs (> 20 dB). Ninety out of 175 stapedotomies (22 and 68 in the small and large ABG groups, respectively) were monitored with long-term follow-ups. Results: Ten years after the operation, hearing measurements were similar for both groups, although a significant decline of bone conduction thresholds was evident (p = 0.007 and p < 0.001, respectively). An improvement of ≥10 dB in the postoperative ABG (clinical improvement) was achieved only in the large ABG group. Conclusions: Even though long-term hearing levels will evolve similarly in patients with ≤20 and > 20 dB preoperative ABGs, the lack of clinical improvement found in the small ABG group is not in favor of an early surgery.

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