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Morales-Puebla JM, Fernández-Fournier M, Plana-Blanco A, Lassaletta L. Variations in the treatment of acute peripheral facial paralysis. A nationwide survey. Acta Otorrinolaringol Esp (Engl Ed) 2024; 75:31-39. [PMID: 37722655 DOI: 10.1016/j.otoeng.2023.09.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2023] [Accepted: 05/09/2023] [Indexed: 09/20/2023]
Abstract
BACKGROUND Acute peripheral facial paralysis may be diagnosed and treated by different specialists. OBJECTIVE The aim of this study was to explore the variability in the treatment of Bell's palsy (BP) and Ramsay Hunt Syndrome (RHS) among different medical specialties. METHODS An anonymous nationwide online survey was distributed among the Spanish Societies of Otorhinolaryngology (ORL), Neurology (NRL) and Family and Community Medicine (GP). RESULTS 1039 responses were obtained. 98% agreed on using corticosteroids, ORL using higher doses than NRL and GP. Among all, only 13% prescribed antivirals in BP routinely, while 31% prescribed them occasionally. The percentage of specialists not using antivirals for RHS was 5% of ORL, 11% of NRL, and 23% of GP (GP vs. NRL p = 0.001; GP vs. ORL p < 0.0001; NRL vs. ORL p = 0,002). 99% recommended eye care. Exercises as chewing gum or blowing balloons were prescribed by 45% of the participants with statistically significant differences among the three specialties (GP vs. NRL p = 0.021; GP vs. ORL p < 0.0001; NRL vs. ORL p = 0.002). CONCLUSION There is general agreement in the use of corticosteroids and recommending eye care as part of the treatment of acute peripheral facial paralysis. Yet, there are discrepancies in corticosteroids dosage, use of antivirals and recommendation of facial exercises among specialties.
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Affiliation(s)
- José Manuel Morales-Puebla
- Department of Otolaryngology, La Paz University Hospital, IdiPaz, Paseo de La Castellana 261, 28046, Madrid, Spain; Otology Commission of the Spanish Society of Otolaryngology and Head and Neck Surgery, Spain; Biomedical Research Networking Centre on Rare Diseases (CIBERER), Institute of Health Carlos III, U761, Madrid, Spain; Autonomous University of Madrid, School of Medicine, Madrid, Spain.
| | - Mireya Fernández-Fournier
- Neurology Department, La Paz University Hospital, IdiPaz, Paseo de La Castellana 261, 28046, Madrid, Spain; Neuroepidemiology Coordinator of the Spanish Society of Neurology, Spain
| | - Antoni Plana-Blanco
- Primary Care Center of Balàfia-Pardinyes-Secà de St. Pere, Lleida, Spain; Neurology Coordinator of the Spanish Society of Family and Community Medicine, Spain; University of Lleida, School of Medicine, Lleida, Spain
| | - Luis Lassaletta
- Department of Otolaryngology, La Paz University Hospital, IdiPaz, Paseo de La Castellana 261, 28046, Madrid, Spain; Otology Commission of the Spanish Society of Otolaryngology and Head and Neck Surgery, Spain; Biomedical Research Networking Centre on Rare Diseases (CIBERER), Institute of Health Carlos III, U761, Madrid, Spain; Autonomous University of Madrid, School of Medicine, Madrid, Spain
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Kaur IP, Mughal MS, Aslam F, Schram J, Bansal P. Non-surgical treatment of aseptic olecranon bursitis: A systematic review. Reumatol Clin (Engl Ed) 2023; 19:482-487. [PMID: 37945181 DOI: 10.1016/j.reumae.2023.05.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/29/2022] [Accepted: 02/23/2023] [Indexed: 11/12/2023]
Abstract
OBJECTIVE Olecranon bursitis (OB), characterized by inflammation and fluid collection in the olecranon bursa is a commonly encountered out-patient condition. The data is heterogeneous regarding a stepwise and standardized approach to aseptic OB treatment and the efficacy of intra-bursal corticosteroid injections (CSI). The objective of this review is to systematically evaluate the non-surgical treatment options for aseptic OB. METHODS This systematic review was conducted in accordance with PRISMA recommendations. The English and non-English literature search was performed in 5 medical databases to identify studies evaluating the treatment of OB. All included studies were evaluated for risk of bias (RoB) using the revised Cochrane RoB tool for randomized control trials (RCTs) and the Newcastle-Ottawa Scale (NOS) for case-control and cohort studies. RESULTS For the final analyses, 2 RCTs and 2 observational studies were included. The RoB for the RCTs was high and both failed to demonstrate a significant difference in terms of the resolution of OB and bursal tenderness among various invasive and non-invasive treatment options. Corticosteroid injection (CSI) was associated with a significant decline in the duration of symptoms. However, it was associated with a higher number of complications including bursal infection and skin atrophy. CONCLUSION Based on the available data, it appears that the clinical resolution of aseptic OB can occur with conservative methods if implemented earlier in the disease course. Although CSI is more effective than other treatments, it should be reserved for refractory cases because of a higher complication rate.
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Affiliation(s)
- Ikwinder Preet Kaur
- Department of Rheumatology, University of Florida College of Medicine, 653-1 8th St W, Jacksonville, FL 32209, United States
| | - Mohsin Sheraz Mughal
- Department of Cardiology, UHS Wilson Medical Center, Johnson City, NY 13790, United States
| | - Fawad Aslam
- Department of Rheumatology, Mayo Clinic - Arizona, 13400 E Shea Blvd, Scottsdale, AZ 85259, United States
| | - Jennifer Schram
- Librarian and Supervisor, Mayo Clinic Libraries - Wisconsin, Mayo Clinic Health System, 1400 Bellinger Street, Eau Claire, WI 54701, United States
| | - Pankaj Bansal
- Department of Rheumatology, Mayo Clinic Health System, 1400 Bellinger Street, Eau Claire, WI 54701, United States.
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Fernández Jiménez-Ortiz H, Escribá de la Fuente SM, Sampedro Yáñez R, Maroto Rodríguez B, Toledano Fernández N, Villarrubia Torcal B. Corticodependent bilateral trochleitis. Arch Soc Esp Oftalmol (Engl Ed) 2022; 97:340-343. [PMID: 35676027 DOI: 10.1016/j.oftale.2020.12.018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/21/2020] [Accepted: 12/26/2020] [Indexed: 06/15/2023]
Abstract
Trochleitis is usually a transient and non-disabling inflammation of the trochlea of superior oblique. The case is presented of a difficult to manage bilateral trochleitis in a 29-year-old woman. After an exhaustive aetiological study with neuro-imaging tests, as well as an analysis of autoimmunity and infection, no underlying cause was found. Multiple injections of corticosteroids were required in both eyes, with a partial effect. Surgical intervention was finally decided in order to visually examine the trochlea, take biopsies, and inject methylprednisolone. These were effective in relieving the symptoms. This case is exceptional due to it involving both eyes and its severity, and represented a therapeutic challenge for the clinical team.
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Affiliation(s)
| | - S M Escribá de la Fuente
- Servicio de Medicina Física y Rehabilitación, Hospital de Nuestra Señora del Prado, Hospital General Talavera de la Reina, Toledo, Spain
| | - R Sampedro Yáñez
- Servicio de Oftalmología, Hospital Universitario de Fuenlabrada, Fuenlabrada, Madrid, Spain
| | - B Maroto Rodríguez
- Servicio de Oftalmología, Hospital Universitario de Fuenlabrada, Fuenlabrada, Madrid, Spain
| | - N Toledano Fernández
- Servicio de Oftalmología, Hospital Universitario de Fuenlabrada, Fuenlabrada, Madrid, Spain
| | - B Villarrubia Torcal
- Servicio de Oftalmología, Hospital Universitario de Fuenlabrada, Fuenlabrada, Madrid, Spain
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Fernández Jiménez-Ortiz H, Fuente SMEDL, Yáñez RS, Rodríguez BM, Fernández NT, Torcal BV. Corticodependent bilateral trochleitis. Arch Soc Esp Oftalmol (Engl Ed) 2021; 97:S0365-6691(21)00031-9. [PMID: 33627238 DOI: 10.1016/j.oftal.2020.12.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/21/2020] [Revised: 12/16/2020] [Accepted: 12/26/2020] [Indexed: 10/22/2022]
Abstract
Trochleitis is usually a transient and non-disabling inflammation of the trochlea of superior oblique. The case is presented of a difficult to manage bilateral trochleitis in a 29-year-old woman. After an exhaustive aetiological study with neuro-imaging tests, as well as an analysis of autoimmunity and infection, no underlying cause was found. Multiple injections of corticosteroids were required in both eyes, with a partial effect. Surgical intervention was finally decided in order to visually examine the trochlea, take biopsies, and inject methylprednisolone. These were effective in relieving the symptoms. This case is exceptional due to it involving both eyes and its severity, and represented a therapeutic challenge for the clinical team.
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Affiliation(s)
| | - S M Escribá de la Fuente
- Servicio de Medicina Física y Rehabilitación, Hospital de Nuestra Señora del Prado, Hospital General Talavera de la Reina, Toledo, España
| | - R Sampedro Yáñez
- Servicio de Oftalmología, Hospital Universitario de Fuenlabrada, Fuenlabrada, Madrid, España
| | - B Maroto Rodríguez
- Servicio de Oftalmología, Hospital Universitario de Fuenlabrada, Fuenlabrada, Madrid, España
| | - N Toledano Fernández
- Servicio de Oftalmología, Hospital Universitario de Fuenlabrada, Fuenlabrada, Madrid, España
| | - B Villarrubia Torcal
- Servicio de Oftalmología, Hospital Universitario de Fuenlabrada, Fuenlabrada, Madrid, España
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Quijano-Gomero EG, Rodríguez-Zúñiga MJM, Sanz-Montero ME, Durand-Buse D. Clinical, Dermoscopic and Histologic Features of Recurrent Cutaneous Eosinophilic Vasculitis Cases. Actas Dermosifiliogr (Engl Ed) 2019; 110:590-6. [PMID: 29937063 DOI: 10.1016/j.ad.2017.12.012] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2017] [Revised: 12/14/2017] [Accepted: 12/27/2017] [Indexed: 11/22/2022] Open
Abstract
Primary recurrent cutaneous eosinophilic vasculitis is a rare condition characterized by pruritic, erythematous, purpuric plaques associated to edema. We compared and analyze the clinical, dermoscopic and histological features of the disease in 4 patients from our hospital and 13 patients published in the literature. Seventeen patients were included, with a median age of 56yo, a median duration of disease of 6 months. Lesions were most frequently generalized (47%) or localized in lower limbs (41%). The most frequent features were purpuric color (71%), local edema (65%), necrotizing vasculitis (94%) and eosinophil infiltration (100%) in histology. Most of the patients (82.4%) were given oral steroids with a median dose of 30mg. Primary recurrent cutaneous eosinophilic vasculitis might be an infra-diagnosed condition. The analysis of the patients allowed us to propose diagnostic criteria for the definition of this disease. We suggest a therapeutic strategy with high-potency steroids and dapsone, which might be considered as first-line treatment.
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Kosugi EM, Moussalem GF, Simões JC, Souza RDPESFD, Chen VG, Saraceni Neto P, Mendes Neto JA. Topical therapy with high-volume budesonide nasal irrigations in difficult-to-treat chronic rhinosinusitis. Braz J Otorhinolaryngol 2015; 82:191-7. [PMID: 26431825 PMCID: PMC9449040 DOI: 10.1016/j.bjorl.2015.03.014] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2015] [Revised: 03/20/2015] [Accepted: 03/24/2015] [Indexed: 11/17/2022] Open
Abstract
INTRODUCTION Chronic rhinosinusitis (CRS) is termed difficult-to-treat when patients do not reach acceptable level of control despite adequate surgery, intranasal corticosteroid treatment and up to 2 short courses of systemic antibiotics or corticosteroids in the preceding year. Recently, high-volume corticosteroid nasal irrigations have been recommended for CRS treatment. OBJECTIVE To assess high-volume budesonide nasal irrigations for difficult-to-treat CRS. METHODS Prospective uncontrolled intervention trial. Participants were assessed before- and 3 months after nasal irrigation with 1mg of budesonide in 500 mL of saline solution daily for 2 days. Subjective (satisfactory clinical improvement) and objective (SNOT-22 questionnaire and Lund-Kennedy endoscopic scores) assessments were performed. RESULTS Sixteen patients were included, and 13 (81.3%) described satisfactory clinical improvement. SNOT-22 mean scores (50.2-29.6; p=0.006) and Lund-Kennedy mean scores (8.8-5.1; p=0.01) improved significantly. Individually, 75% of patients improved SNOT-22 scores, and 75% improved Lund-Kennedy scores after high volume budesonide nasal irrigations. CONCLUSION High-volume corticosteroid nasal irrigations are a good option in difficult-to-treat CRS control of disease, reaching 81.3% success control and significant improvement of SNOT-22 and Lund-Kennedy scores.
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Affiliation(s)
- Eduardo Macoto Kosugi
- Sector of Rhinology, Department of Otorhinolaryngology and Head and Neck Surgery, Escola Paulista de Medicina, Universidade Federal de São Paulo (EPM/UNIFESP), São Paulo, SP, Brazil.
| | - Guilherme Figner Moussalem
- Sector of Rhinology, Department of Otorhinolaryngology and Head and Neck Surgery, Escola Paulista de Medicina, Universidade Federal de São Paulo (EPM/UNIFESP), São Paulo, SP, Brazil
| | - Juliana Caminha Simões
- Sector of Rhinology, Department of Otorhinolaryngology and Head and Neck Surgery, Escola Paulista de Medicina, Universidade Federal de São Paulo (EPM/UNIFESP), São Paulo, SP, Brazil
| | - Rafael de Paula e Silva Felici de Souza
- Sector of Rhinology, Department of Otorhinolaryngology and Head and Neck Surgery, Escola Paulista de Medicina, Universidade Federal de São Paulo (EPM/UNIFESP), São Paulo, SP, Brazil
| | - Vitor Guo Chen
- Sector of Rhinology, Department of Otorhinolaryngology and Head and Neck Surgery, Escola Paulista de Medicina, Universidade Federal de São Paulo (EPM/UNIFESP), São Paulo, SP, Brazil
| | - Paulo Saraceni Neto
- Sector of Rhinology, Department of Otorhinolaryngology and Head and Neck Surgery, Escola Paulista de Medicina, Universidade Federal de São Paulo (EPM/UNIFESP), São Paulo, SP, Brazil
| | - José Arruda Mendes Neto
- Sector of Rhinology, Department of Otorhinolaryngology and Head and Neck Surgery, Escola Paulista de Medicina, Universidade Federal de São Paulo (EPM/UNIFESP), São Paulo, SP, Brazil
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