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INTRODUCTION: Previous publications have suggested a link between decreased bone mineral density (BMD) and audiovestibular symptoms. Being the first study, to our knowledge, in the Caribbean region, we aimed to determine the relationship between hearing impairment, vertigo, and tinnitus with BMD in a Dominican postmenopausal population diagnosed with osteoporosis. METHODS: A retrospective, cross-sectional, single-center study was conducted. Patients were enrolled using a previous database of Dominican postmenopausal women from 2008 to 2015, including a total of 101 participants. Patients were questioned for hearing difficulty, tinnitus, and vertigo. Body mass index (BMI), Bone Mineral Density (BMD) using T-scores, FRAX score, serum levels of 25-(OH) vitamin D, corrected calcium, phosphate, albumin, alkaline phosphatase, and smoking history were assessed. Statistical analysis was conducted using Chi-square, Mann-Whitney U test, and Odds Ratio. RESULTS: Median age was 74 years with an interquartile range (IQR) of 12. Fifty-six patients had osteoporosis and 42 osteopenia. Women with osteoporosis diagnosed using a femoral neck T-score demonstrated a greater level of association as well as higher odds of developing vertigo and hearing difficulty than those diagnosed using a hip T-score. CONCLUSION: Special attention to the otologic evaluation of these patients as well as increasing the referral to a specialized consult is suggested. Additional multicenter prospective national studies are needed.
RESUMEN
Granular cell tumors (GCTs) are uncommon neoplasms of unknown origin that can manifest in multiple locations throughout the body. Physicians should be aware of this type of tumor presenting in unusual locations such as the larynx, particularly in pediatric patients with stridor and dysphonia. We describe an 11-year-old female with a large laryngeal mass that obstructed the majority of the laryngeal lumen. A tracheotomy was performed to secure the patient's airway, followed by a direct suspension laryngoscopy, during which the mass was excised in its entirety. The biopsied mass was histopathologically and immunohistochemically examined to confirm the diagnosis of granular cell tumor. She benefited from treatment and experienced a favorable outcome. This case report emphasizes the critical nature of properly diagnosing this type of tumor in patients who present with vocal or respiratory symptoms.
Asunto(s)
Leucocitos Mononucleares/inmunología , Infecciones por Papillomavirus/genética , Infecciones del Sistema Respiratorio/genética , Linfocitos T Reguladores/inmunología , Gemelos Dicigóticos/genética , Alphapapillomavirus/genética , Antivirales/administración & dosificación , Antivirales/uso terapéutico , Preescolar , Cidofovir/administración & dosificación , Cidofovir/uso terapéutico , Expresión Génica/genética , Humanos , Laringoscopía/métodos , Leucocitos Mononucleares/metabolismo , Masculino , Recurrencia Local de Neoplasia/cirugía , Infecciones por Papillomavirus/complicaciones , Infecciones por Papillomavirus/diagnóstico , Infecciones por Papillomavirus/patología , Infecciones por Papillomavirus/cirugía , Infecciones por Papillomavirus/virología , Infecciones del Sistema Respiratorio/diagnóstico , Infecciones del Sistema Respiratorio/patología , Infecciones del Sistema Respiratorio/cirugía , Linfocitos T Reguladores/metabolismo , Linfocitos T Reguladores/virologíaRESUMEN
OBJECTIVE: To address whether a multidisciplinary team of pediatric otolaryngologists, anesthesiologists, pediatric intensivists, speech-language pathologists, and nurses can achieve safe and sustainable surgical outcomes in low-resourced settings when conducting a pediatric airway surgical teaching mission that features a program of progressive autonomy. STUDY DESIGN: Consecutive case series with chart review. SETTING: This study reviews 14 consecutive missions from 2010 to 2019 in Ecuador, El Salvador, and the Dominican Republic. METHODS: Demographic data, diagnostic and operative details, and operative outcomes were collected. A country's program met graduation criteria if its multidisciplinary team developed the ability to autonomously manage the preoperative huddle, operating room discussion and setup, operative procedure, and postoperative multidisciplinary pediatric intensive care unit and floor care decision making. This was assessed by direct observation and assessment of surgical outcomes. RESULTS: A total of 135 procedures were performed on 90 patients in Ecuador (n = 24), the Dominican Republic (n = 51), and El Salvador (n = 39). Five patients required transport to the United States to receive quaternary-level care. Thirty-six laryngotracheal reconstructions were completed: 6 single-stage, 12 one-and-a-half-stage, and 18 double-stage cases. We achieved a decannulation rate of 82%. Two programs (Ecuador and the Dominican Republic) met graduation criteria and have become self-sufficient. No mortalities were recorded. CONCLUSION: This is the largest longitudinal description of an airway reconstruction teaching mission in low- and middle-income countries. Airway reconstruction can be safe and effective in low-resourced settings with a thoughtful multidisciplinary team led by local champions.