ACTA DE OTORRINOLARINGOLOGÍA & CIRUGÍA DE CABEZA Y CUELLO
Acta de Otorrinolaringología & Cirugía de Cabeza y Cuello is the official publication of the Asociación Colombiana de Otorrinolaringología y Cirugía de Cabeza y cuello, Maxilofacial y Estética Facial (ACORL). It is addressed to health professionals and especially to those interested in the specialty of otorhinolaryngology and its areas of competence. The journal is published 4 times a year in March, June, September and December. Supplements are also published in the same format of the Journal and their topics are related to specific contents of the specialty of Otorhinolaryngology.
Este artículo es publicado por la Revista Acta de Otorrinolaringología & Cirugía de Cabeza y Cuello. Este es un artículo de acceso abierto, distribuido bajo los términos de la LicenciaCreativeCommons Atribución-CompartirIgual 4.0 Internacional.( http://creativecommons.org/licenses/by-sa/4.0/), que permite el uso no comercial, distribución y reproducción en cualquier medio, siempre que la obra original sea debidamente citada. eISSN: 2539-0856 ISSN: 0120-8411
Vertigo and Dizziness in Women: What We Still Need to Understand
Vertigo and Dizziness in Women: What We Still Need to Understand In the current context of medical practice—marked by a pursuit of diagnostic and therapeutic precision—there remains an area requiring greater attention: the differences in the incidence and presentation of vestibular disorders according to the patient's sex. Various population-based studies have shown that women experience vertigo and dizziness more frequently than men, with significant implications for the diagnosis, management, and prognosis of these conditions. Epidemiological data indicate that up to 29.5% of the population has experienced episodes of vertigo, with a higher prevalence in women. This difference has been linked to physiological factors, including hormonal fluctuations associated with the menstrual cycle, pregnancy, contraceptive use, and menopause. The presence of estrogen and progesterone receptors in the inner ear suggests a direct role of these hormones in vestibular function, potentially explaining both the higher incidence and the variability in clinical presentation of vestibular disorders among women. For example, benign paroxysmal positional vertigo (BPPV) accounts for approximately 8% of moderate to severe dizziness cases, with a lifetime prevalence of 2.4% and a marked female predominance (65% of cases), especially among women aged 50 to 70 years. The decline in estrogen during menopause has been associated with increased frequency of BPPV, possibly due to alterations in calcium metabolism affecting the stability of otoliths. Some studies suggest that hormone therapy could reduce the incidence of BPPV in postmenopausal women, although further research is needed to establish clear clinical recommendations. Similarly, Ménière’s disease—characterized by episodes of vertigo, hearing loss, and tinnitus—has an incidence of 13 per 100,000 people, with women accounting for approximately 65% of cases. In women of reproductive age, attacks have been observed to coincide with phases of the menstrual cycle when estradiol levels drop, while hormonal contraceptive use may reduce the frequency and intensity of episodes. One proposed hypothesis is that hormonal changes affect microcirculation in the inner ear, potentially disrupting endolymphatic balance and contributing to symptom onset. Traditionally, when neurological or cardiovascular causes were ruled out, dizziness in women was often attributed to psychosocial factors. However, recent findings on hormonal influence offer plausible physiological explanations that must be considered in the comprehensive evaluation of patients with dizziness or vertigo. In this regard, the work of Dr. Carolin Lerchenmüller in the field of cardiology has been key in paving the way toward a gender-based approach to medicine—one that seeks to recognize and understand the biological and hormonal differences between men and women as a fundamental element for more accurate diagnosis and treatment. This approach is becoming increasingly relevant in other specialties, and in otolaryngology there is a clear need to delve deeper into these differences, not only in the context of vertigo and dizziness but also in other areas that impact women’s auditory and vestibular health. Incorporating this knowledge into clinical practice can enable more accurate diagnoses and personalized management—particularly for populations such as women undergoing significant hormonal changes. Moreover, there is a clear need for prospective research to confirm these findings and to define therapeutic strategies based on the underlying pathophysiology. In conclusion, recognizing and studying sex-based differences in the presentation of vestibular disorders is essential to optimizing medical care, improving quality of life, and advancing toward more precise, evidence-based medicine. Further research is needed to fully understand how the hormonal and physiological characteristics specific to each sex influence the incidence, manifestation, and progression of vestibular disorders, with the aim of developing diagnostic and therapeutic strategies that improve patient outcomes across the board. Sincerely, Melissa Castillo Bustamante Director, Acta de Otorrinolaringología & Cirugía de Cabeza y Cuello
Copyright (c) 2025 ACTA DE OTORRINOLARINGOLOGÍA & CIRUGÍA DE CABEZA Y CUELLO https://creativecommons.org/licenses/by-sa/4.0
Upon assuming the leadership of Acta de Otorrinolaringología & Cirugía de Cabeza y Cuello, I would like to express my sincere gratitude to Dr. Tatiana García Rey and her editorial team. Their commitment and leadership have been essential in the development and consolidation of the journal as a valuable resource for our scientific community in otorhinolaryngology. Thanks to their work, we now have a solid foundation on which to build, and we are excited to continue and promote their excellent stewardship. For this new period, we have set a series of goals that reflect our commitment to achieving greater visibility and reach for the journal. With the support of a renewed scientific and editorial committee, we aspire for Acta de Otorrinolaringología & Cirugía de Cabeza y Cuello to be recognized not only in Colombia but throughout Latin America as a leading publication, capable of disseminating and promoting the high-quality scientific knowledge produced in our region. We want this to be a space where the work of our researchers is celebrated, shared, and, above all, impacts the clinical practice of our colleagues in Latin America. One of our main objectives is the internationalization of the journal. To achieve this, we will increase the production of articles in English, with the aim of expanding the reach of our publications and generating greater visibility for our authors' findings and contributions globally. This approach will open up indexing opportunities in highly relevant databases, which will contribute to positioning the journal as a reliable and frequently consulted source for the international academic community. Furthermore, we will strengthen our collaborative ties with external reviewers from Latin America and the United States, who will contribute their experience and perspective to optimize our editorial processes. Having a broad and diverse network of reviewers will allow us to raise the standards of quality and rigor of our publications, ensuring that each article reflects a high scientific level and effectively contributes to the development of our specialty. We want to recognize the important role of reviewers in this process. Therefore, those who participate as reviewers will receive recertification points according to the type of article evaluated: • Research articles: 20 points. • Topic review: 15 points. • Clinical cases: 10 points. • Popular or thought-provoking articles: 10 points. • Translation of classic or current texts: 10 points. • Short articles: 5 points. We are convinced that Acta de Otorrinolaringología & Cirugía de Cabeza y Cuello will continue to evolve as a fundamental channel for the dissemination of scientific knowledge in otorhinolaryngology, and that our growth and collaboration efforts will strengthen the journal as an influential and high-impact platform for the Latin American community.
Vestibular Medicine (VestMed) Curriculum proposed by the Bárány Society
Abstract: This document presents the initiative of the Bárány Society to improve diagnosis and care of patients presenting with vestibular symptoms worldwide. The Vestibular Medicine (VestMed) concept embraces a wide approach to the potential causes of vestibular symptoms, acknowledging that vertigo, dizziness, and unsteadiness are non-specific symptoms that may arise from a broad spectrum of disorders, spanning from the inner ear to the brainstem, cerebellum and supratentorial cerebral networks, to many disorders beyond these structures. The Bárány Society Vestibular Medicine Curriculum (BS-VestMed-Cur) is based on the concept that VestMed is practiced by different physician specialties and non-physician allied health professionals. Each profession has its characteristic disciplinary role and profile, but all work in overlapping areas. Each discipline requires good awareness of the variety of disorders that can present with vestibular symptoms, their underlying mechanisms and etiologies, diagnostic criteria and treatment options. Similarly, all disciplines require an understanding of their own limitations, the contribution to patient care from other professionals and when to involve other members of the VestMed community. Therefore, the BS-VestMed-Cur is the same for all health professionals involved, the overlaps and differences of the various relevant professions being defined by different levels of detail and depth of knowledge and skills. The BS-VestMed-Cur defines a Basic and an Expert Level Curriculum. The Basic Level Curriculum covers the VestMed topics in less detail and depth, yet still conveys the concept of the wide net approach. It is designed for health professionals as an introduction to, and first step toward, VestMed expertise. The Expert Level Curriculum defines a Focused and Broad Expert. It covers the VestMed spectrum in high detail and requires a high level of understanding. In the Basic and Expert Level Curricula, the range of topics is the same and runs from anatomy, physiology and physics of the vestibular system, to vestibular symptoms, history taking, bedside examination, ancillary testing, the various vestibular disorders, their treatment and professional attitudes. Additionally, research topics relevant to clinical practice are included in the Expert Level Curriculum. For Focused Expert proficiency, the Basic Level Curriculum is required to ensure a broad overview and additionally requires an expansion of knowledge and skills in one or a few specific topics related to the focused expertise, e.g. inner ear surgery. Broad Expert proficiency targets professionals who deal with all sorts of patients presenting with vestibular symptoms (e.g. otorhinolaryngologists, neurologists, audiovestibular physicians, physical therapists), requiring a high level of VestMed expertise across the whole spectrum. For the Broad Expert, the Expert Level Curriculum is required in which the minimum attainment targets for all the topics go beyond the Basic Level Curriculum. The minimum requirements regarding knowledge and skills vary between Broad Experts, since they are tuned to the activity profile and underlying specialty of the expert. The BS-VestMed-Cur aims to provide a basis for current and future teaching and training programs for physicians and non-physicians. The Basic Level Curriculum could also serve as a resource for inspiration for teaching VestMed to students, postgraduate generalists such as primary care physicians and undergraduate health professionals, or anybody wishing to enter VestMed. VestMed is considered a set of competences related to an area of practice of established physician specialties and non-physician health professions rather than a separate clinical specialty. This curriculum does not aim to define a new single clinical specialty. The BS-VestMed-Cur should also integrate with, facilitate and encourage translational research in the vestibular field.
Respetados Colegas, Nos complace presentar una nueva versión de las Guías para el Diagnóstico y Tratamiento de las Patologías más Frecuentes en Otorrinolaringología, este trabajo es el resultado de un esfuerzo conjunto de los diferentes Servicios Universitarios de Otorrinolaringología de nuestro país y asociados de la ACORL. Exaltamos el compromiso de la Junta directiva ACORL 2022-2024 en cabeza del Dr. Luis Humberto Jiménez Fandiño quien lideró esta iniciativa y la Junta Directiva 2024 -2026 actual presidencia del Dr. Gustavo Adolfo Romero Caballero con su apoyo incondicional para finalizar este importante aporte a la comunidad médica. En este proyecto se ha unido el conocimiento y la dedicación de quienes aportaron su experiencia y compromiso para consolidar estas guías como un documento de apoyo al ejercicio profesional de nuestra especialidad. Les invitamos a utilizarlas en su práctica diaria y a seguir construyendo juntos el camino hacia la excelencia en la atención de la Otorrinolaringología de nuestro país. Estas guías pueden ser adaptadas y/o adoptadas por nuestros asociados, instituciones de prestación de servicios para su trabajo diario y en la habilitación de consultorios tanto en prestadores independientes como instituciones prestadoras de servicios de salud. También se han desarrollado dos protocolos y un consentimiento informado, muy útiles en nuestro que hacer de la práctica diaria. Con nuestro más sincero reconocimiento, agradecemos especialmente a los servicios universitarios, profesores, residentes, asociados de la ACORL y al equipo metodológico quienes participaron en esta iniciativa: Fundación Universitaria de Ciencias de la Salud FUCS - Jefe del servicio: Martín Alonso Pinzón Navarro, MD Fundación Universitaria Sanitas - Jefe del servicio: Leonardo Elías Ordóñez Ordóñez, MD Pontificia Universidad Javeriana - Jefe del servicio: Luis Humberto Jiménez Fandiño, MD Universidad de Antioquia - Jefe del servicio: Santiago Andrés Osorno Ortiz, MD Universidad de Cartagena - Jefe del servicio: Volney Enrique Bello Avena, MD Universidad Nacional de Colombia - Jefe del servicio: Juan Carlos Izquierdo Velásquez, MD Universidad Militar Nueva Granada Hospital Clínica San Rafael - Jefe del servicio: José Alberto Prieto Rivera, MD Universidad Militar Nueva Granada Hospital Militar Central - Jefe del servicio: Ricardo Silva Rueda, MD Universidad del Rosario - Jefe del servicio: Juan Carlos Avellaneda Hernández, MD Universidad del Valle - Jefe del servicio: Francisco Javier González Eslait, MD Asesora general metodológica - Diana Quijano García, MD Revisora metodología - Mary Eugenia Posada Álvarez, MD Director Científico Guías ACORL Coordinador Comité Académico Permanente ACORL - Ricardo Silva Rueda, MD.
En esta edición especial de la Revista Acta de Otorrinolaringología y Cirugía de Cabeza y Cuello celebramos un hito significativo en la consolidación del conocimiento médico en nuestra especialidad: la presentación de las Guías Clínicas de la Asociación Colombiana de Otorrinolaringología (ACORL). Este proyecto ha sido posible gracias a la destacada participación de los programas de residencia colombianos, quienes, en colaboración con médicos especialistas, epidemiólogos y revisores expertos en todas las áreas de la otorrinolaringología, han desarrollado estas guías como una herramienta clave para optimizar la atención de nuestros pacientes. Agradecemos profundamente el esfuerzo y la dedicación de cada uno de los involucrados en este trabajo colectivo, que refleja un compromiso invaluable con la excelencia académica y asistencial. En esta edición se encuentra publicada la mayor parte de estas guías, y ya se está preparando una nueva actualización que se presentará en uno de los próximos números de nuestra revista. Es importante resaltar que este año marca también una renovación significativa en nuestra revista, con la incorporación de un nuevo comité editorial y la creación de comités asesores tanto a nivel nacional como internacional. Estos comités están conformados por referentes destacados en el área, quienes contribuirán a elevar aún más el nivel académico y científico de nuestras publicaciones; esto fortalece la visión y la misión de esta revista como líder en el ámbito de la otorrinolaringología. Extendemos nuestro más sincero reconocimiento a las juntas directivas saliente y entrante de la ACORL y, en especial, a los presidentes líderes de ambas gestiones, quienes han facilitado la realización de este trabajo y han dado prioridad a la implementación de estas guías, que se convertirán en una base esencial para el cuidado integral de nuestros pacientes. Con esta edición cerramos un año editorial lleno de aprendizajes y avances, y damos la bienvenida a un 2025 que traerá nuevas oportunidades para continuar posicionando nuestra revista. En este año se implementarán importantes cambios, como la inclusión de artículos en inglés, la publicación de trabajos internacionales y el avance en los procesos de indexación internacional, lo que consolida nuestro lugar como un referente académico de calidad en el ámbito de la otorrinolaringología. Esperamos que estas guías nacionales sean una herramienta útil y un apoyo fundamental en la toma de decisiones clínicas en todo el país. Los invitamos a consultarlas y analizarlas en sus servicios de salud, con el objetivo de seguir fortaleciendo la atención médica basada en la mejor evidencia disponible. Como directora de la revista pongo a su disposición mi correo ante cualquier duda o sugerencia frente a los contenidos publicados en esta edición. Mi mención especial y agradecimiento final también va para todo nuestro equipo editorial y administrativo de nuestra sociedad.
Guide for the diagnosis and treatment of otitis media with effusion
Otitis media with effusion (OME) is a disease characterized by fluid accumulation in the middle ear, without symptoms or signs of acute infection (1-3). The main symptom is hearing impairment. Diagnosis is based on clinical suspicion, a physical examination with pneumatoscopy, and the results of appropriate audiometry and tympanometry if necessary. (1-3).
Clinical practice guideline for the diagnosis and treatment of acute otitis media
Acute otitis media is a common pathology, predominantly in childhood. The American Academy of Pediatrics (AAP) defines it as a combination of middle ear effusion, evidence of middle ear inflammation on pneumatoscopy, and onset within 48 hours. It is diagnosed clinically and treatment is focused on the age group and severity of the acute otitis media.
Protocol and consent for intratympanic injection
The intratympanic injection is used to treat cochleovestibular symptoms associated with inner ear diseases such as Ménière’s disease or sudden sensorineural hearing loss. The most commonly used drugs are corticosteroids and aminoglycosides, and recently studies have been published on the use of N-acetylcysteine.
Clinical practice guidelines guide for the diagnosis and treatment of foreign bodies in the ear, nose and airway
Foreign bodies in the ear, nose and respiratory tract are a frequent cause of consultation in emergency services and their assessment should be the responsibility of all otorhinolaryngologists. The most frequent symptoms after the introduction of a foreign body into the ear are otalgia, otorrhagia, otorrhea, aural fullness, itching, tinnitus and fever; at the nasal symptoms are: local pain, unilateral rhinorrhea, epistaxis and nasal obstruction. Aspiration of a foreign body in children is considered an emergency condition, especially in young children, in whom higher mortality is described.
Protocol for universal neonatal hearing screening
Newborn hearing screening is a prevention and health promotion strategy aimed at identifying newborns with congenital and/or acquired hearing loss; its universal protocol includes all newborns with and without risk factors for hearing loss. Hearing loss is one of the most common congenital sensory diseases, with an incidence of 1 to 3per thousand live births. If hearing screening is not performed universally, more than 30% of newborns with hearing loss would not be diagnosed before 6 months of age.
Copyright (c) 2024 ACTA DE OTORRINOLARINGOLOGÍA & CIRUGÍA DE CABEZA Y CUELLO https://creativecommons.org/licenses/by-sa/4.0
En esta edición especial de la Revista Acta de Otorrinolaringología y Cirugía de Cabeza y Cuello celebramos un hito significativo en la consolidación del conocimiento médico en nuestra especialidad: la presentación de las Guías Clínicas de la Asociación Colombiana de Otorrinolaringología (ACORL). Este proyecto ha sido posible gracias a la destacada participación de los programas de residencia colombianos, quienes, en colaboración con médicos especialistas, epidemiólogos y revisores expertos en todas las áreas de la otorrinolaringología, han desarrollado estas guías como una herramienta clave para optimizar la atención de nuestros pacientes. Agradecemos profundamente el esfuerzo y la dedicación de cada uno de los involucrados en este trabajo colectivo, que refleja un compromiso invaluable con la excelencia académica y asistencial. En esta edición se encuentra publicada la mayor parte de estas guías, y ya se está preparando una nueva actualización que se presentará en uno de los próximos números de nuestra revista. Es importante resaltar que este año marca también una renovación significativa en nuestra revista, con la incorporación de un nuevo comité editorial y la creación de comités asesores tanto a nivel nacional como internacional. Estos comités están conformados por referentes destacados en el área, quienes contribuirán a elevar aún más el nivel académico y científico de nuestras publicaciones; esto fortalece la visión y la misión de esta revista como líder en el ámbito de la otorrinolaringología. Extendemos nuestro más sincero reconocimiento a las juntas directivas saliente y entrante de la ACORL y, en especial, a los presidentes líderes de ambas gestiones, quienes han facilitado la realización de este trabajo y han dado prioridad a la implementación de estas guías, que se convertirán en una base esencial para el cuidado integral de nuestros pacientes. Con esta edición cerramos un año lleno de aprendizajes y avances, y damos la bienvenida a un 2025 que traerá nuevas oportunidades para continuar posicionando nuestra revista. Este próximo año se implementarán importantes cambios, como la inclusión de artículos en inglés, la publicación de trabajos internacionales y el avance en los procesos de indexación internacional, lo que consolida nuestro lugar como un referente académico de calidad en el ámbito de la otorrinolaringología. Finalmente, deseamos a nuestros lectores, autores, revisores y a toda nuestra comunidad académica una Feliz Navidad y un próspero Año Nuevo. Que este 2025 sea una oportunidad para seguir creciendo juntos en el conocimiento y en el servicio a nuestros pacientes. Melissa Castillo Bustamante Directora, Revista ACORL
Guide for the diagnosis and treatment of idiopathic peripheral facial paralysis
Idiopathic peripheral facial paralysis occupies the highest percentage of all causes of facial paralysis, representing approximately 60%-75%. It results from a complete or partial alteration of the muscular movements of the affected hemiface, as its name indicates, its cause is unknown, but several theories have been generated and its diagnosis is by exclusion. A facial deficit of the lower motor neuron type, unilateral, of rapid onset, occurs. However, patients may have other symptoms such as hyperacusis, dysgeusia, facial pain, and epiphora. The differential diagnosis of facial paralysis is extensive and can be divided into broad categories such as congenital, cerebrovascular, infectious, neoplastic, inflammatory or autoimmune, and traumatic.
Guide for the diagnosis and treatment of sensorineural hearing loss in adults and children
Abstract: Hearing loss is a partial or total reduction in hearing ability, which can be congenital or acquired. Its prevalence increases with age, and is expected to rise due to demographic transition. Worldwide, 42% of adults over 60 have some form of hearing loss, with 32% in Colombia. In children, the prevalence is 1 to 3 cases per 1000 live births. Sensorineural hearing loss (SNHL) has a multifactorial origin, including genetic factors, age, and exposure to ototoxic substances and chronic noise. This guide aims to provide evidence-based recommendations for diagnosing and treating SNHL, intended for otolaryngologists, audiologists, and other healthcare professionals. It focuses on early diagnosis, personalized treatment, and optimizing healthcare resources. The guide was developed through a review of various scientific sources and quality evidence evaluation to ensure effective recommendations for managing sensorineural hearing loss in adults and childrens.
Guideline for the Diagnosis and Management of Obstructive Sleep Apnea in Pediatrics
Obstructive sleep apnea (OSA) in the pediatric population is a disorder characterized by episodes of total or partial obstruction of the upper airway, which are associated with alterations in blood gas levels and atypical sleep patterns. This condition can have significant repercussions, including behavioral problems, learning difficulties, growth delays, speech impairments, and cardiovascular complications. Unlike adults, children tend to snore less frequently, and any episode of obstructive sleep apnea (OSA) in this population is considered pathological. From a diagnostic perspective, an apnea-hypopnea index (AHI) greater than 1 event per hour is already classified as abnormal in pediatrics (1). Additionally, children with OSA have a higher risk of developing metabolic disorders such as insulin resistance and dyslipidemia, nocturnal enuresis, and excessive daytime sleepiness. These alterations increase the use of medical services and the associated healthcare costs. It is essential to identify and implement appropriate therapeutic interventions in this population to reduce comorbidities and the long-term consequences of this condition (2).
Guide to the diagnosis and treatment of obstructive sleep apnea in adults
Introduction: Obstructive sleep apnea (OSA) is one of the most prevalent respiratory disorders, characterized by the collapsibility of the upper airway during sleep, which leads to intermittent hypoxemia episodes and sleep fragmentation. This negatively impacts patients’ quality of life. The aim is to provide updated information on the diagnosis and treatment of patients with obstructive sleep apnea.
Guide to the diagnosis and treatment of benign paroxysmal positional vertigo
Introduction: Benign paroxysmal positional vertigo (BPPV) is defined as an episode of illusory sensation of rotary movement that occurs with changes in the position of the head in relation to gravity (1-3); it occurs in brief crises (lasting less than 60 seconds) and is accompanied by nystagmus when performing the diagnostic maneuver; the nystagmus has a short latency and becomes fatigued with repetition of the maneuver (4). (5). The diagnosis of BPPV is initially based on data from the interview and later on the characteristics of the nystagmus that occurs with the diagnostic maneuvers; the treatment of BPPV is carried out with vestibular repositioning maneuvers, as well as with the vestibular reeducation exercises of Brand and Daroff (2, 9).
Guide to the diagnosis and treatment of Ménière’s disease in Colombia
Introduction: Meniere’s disease is a chronic multifactorial disorder of the inner ear, characterized primarily by vertigo, low- to mid-frequency sensorineural hearing loss, tinnitus, and aural fullness, usually unilateral; its prevalence ranges from 17 to 513 cases per 100,000 people, being more common in women and older adults. The central hypothesis of the pathophysiology of Meniere’s disease is endolymphatic hydrops; due to its unpredictable and episodic nature of the condition and the severe and disabling attacks of vertigo, patients suffer great deterioration in their quality of life.
Guide for the diagnosis and treatment of acute bacterial pharyngotonsillitis.
Introduction: Acute pharyngotonsillitis is one of the most common diseases in childhood and early adulthood. It is defined as inflammation of the pharynx and tonsils lasting less than 7 days, accompanied by fever, odynophagia, dysphagia, and general discomfort. Its most frequent etiology is viral; however, it is crucial to early identify a possible bacterial cause to initiate prompt and appropriate antibiotic treatment, thus reducing the risk of complications. Methodology: The guideline was updated using a methodology of adaptation, development, and updating. Its methodological quality was assessed using the AGREE II method, and systematic reviews were evaluated with AMSTAR-2, achieving high or moderate confidence ratings. Results: The use of validated clinical scoring systems is recommended for all patients with acute pharyngotonsillitis of infectious origin to determine the need for early and appropriate antibiotic therapy. Laboratory tests or imaging studies are not recommended for uncomplicated bacterial acute pharyngotonsillitis. A correct and complete medical treatment should be prescribed to reduce complications and bacterial resistance. Conclusions: Proper diagnosis and treatment of bacterial acute pharyngotonsillitis decrease the risk of complications and help reduce antibiotic resistance rates in our country.
Guide to the diagnosis and treatment of dysphonia
Dysphonia is defined as an alteration in voice production, caused by changes in airflow or in the vibratory capacity of the vocal folds; it may be associated with local or systemic symptoms such as dysphagia, globus vocalis, dyspnea and even weight loss. Although most disorders that produce dysphonia are benign and self-limiting, the presence of recurrent symptoms may indicate more serious progressive pathologies that require a timely medical diagnosis.
Guideline for diagnosis and treatment of Tinnitus
Introduction: Tinnitus is the perception of a sound in the absence of an external sound. It has a reported prevalence of 10% to 15% in adults, with a similar presentation in men and women (1). Objective: This guideline aims to generate recommendations on the initial clinical approach and updated treatment of tinnitus, based on the best scientific evidence. The target population are adults over 18 years with primary tinnitus. Purpose: Improving the care of patients with tinnitus by reducing the negative personal and social effects and quality of life.
Guide to the diagnosis and treatment of allergic rhinitis
Allergic rhinitis is an inflammatory disease of the nasal mucosa mediated by immunoglobulin E (IgE) and induced by exposure to an inhaled allergen. Characteristic symptoms include hyaline rhinorrhea, nasal itching, sneezing, and nasal obstruction and ocular symptoms; It has a prevalence between 5-50% among the world population. It is classified according to the frequency of symptoms. Treatment is based on environmental, medical and surgical management.
Guide to the diagnosis and treatment of rhinosinusitis in children
Rhinosinusitis is the inflammation of the mucosa that lines the nose and one or more paranasal sinuses (1), and depending on its duration it can be classified as acute or chronic rhinosinusitis (2). Acute rhinosinusitis is usually the result of a common viral cold and in most cases, it is a self-limiting disease; Chronic rhinosinusitis is a multifactorial disease resulting from a dysfunctional interaction between environmental and individual factors (1). The symptoms caused by rhinosinusitis in general can markedly alter the quality of life of patients and their caregivers, and can even lead to major complications that put the patients’ lives at risk (1-3).
Guidelines for the diagnosis and treatment of Epistaxis
Introduction: Epistaxis, or nasal bleeding, is a common condition that can range from mild, self-limiting episodes to severe cases requiring urgent medical intervention. Despite its frequency, epistaxis can present significant clinical challenges due to its wide range of underlying causes and the need for a systematic approach to management. This clinical practice guideline is designed to provide a comprehensive and evidence-based approach to the diagnosis, treatment, and prevention of epistaxis. Its purpose is to assist healthcare professionals in making informed decisions, optimizing patient care, and improving clinical outcomes.
Diagnosis and treatment guide for idiopathic sudden sensorineural hearing loss (sudden deafness)
The specific definition is a unilateral or bilateral sensorineural hearing loss greater than 30 dB that affects at least three consecutive audiometric frequencies and develops in a period less than or equal to 72 hours, most of which is idiopathic (2). It affects 5 to 27 per 100,000 people per year. The causes of sudden sensorineural hearing loss are classified as primary and secondary. Treatment includes systemic and topical corticosteroids, antiviral agents, hyperbaric oxygen therapy, vasodilatory agents, diuretics and other medications as complementary alternative treatments (5).
Guide to the diagnosis and treatment of acute vestibular síndrome
Introduction: Acute vertigo is one of the most frequent symptoms of emergency consultation and also one of the most common reasons for referral to otorhinolaryngology and neurology services at the hospital level (1). In 1998, Hoston and Baloh defined acute vestibular syndrome as an acute and continuous vertigo, lasting at least 24 hours, associated with symptoms such as nausea, intolerance to head movements and instability (2); among its main causes are acute peripheral vestibular pathology or vestibular neuritis and central pathology, especially posterior circulation cerebrovascular accident (CVA). (1-5) Despite being such a frequent vestibular pathology, there is no clinical consensus, so the following recommendations are provided for the diagnosis and management of acute vestibular syndrome of peripheral origin in adult patients.
Guidelines for the diagnosis and treatment of acute otitis externa
Introduction: Acute otitis externa (AEO) is defined as a diffuse inflammation of the external auditory canal that may extend to the auricle or the tympanic membrane (1). In most cases (98%) its origin is bacterial and the most common pathogens are Pseudomonas aeruginosa and Staphylococcus aureus, and it may be polymicrobial (2-11); the treatment is based on ototopic agents but in some cases it must be complemented with systemic management. Exposure to water and sweat, soap devices or alkaline drops, dermatological infections, local trauma and allergic reactions may contribute to its pathogenesis (18-20). Preventive strategies include avoiding the accumulation of water and moisture in the external auditory canal, maintaining the natural skin barrier healthy (24-27).
Guide to the diagnosis and treatment of chronic pharyngitis due to gastroesophageal reflux
Introduction: Pharyngitis is defined as inflammation of the mucosa and submucosa of the pharynx; it is classified according to its evolution as acute and chronic; the diagnosis is made through the typical or atypical symptoms reported by the patient and through diagnostic aids; the initial management is symptomatic. Gastroesophageal reflux refers to the passage of gastric contents into the esophagus, due to the alteration of the lower esophageal sphincter, which produces the release of proinflammatory cytokines that generate symptoms in the patient. Chronic pharyngitis due to GERD disease is a condition that compromises the health and quality of life of many patients, overlooking its diagnosis and consequently an untimely treatment.
Fungal Ball in the Maxillary Sinus: It is Not Always a Tumor. Case Report
Introduction: The fungal ball is part of non-invasive fungal rhinosinusitis, which is usually present in the maxillary sinus. Symptoms are shared with chronic rhinosinusitis, and diagnosis is made through diagnostic imaging and endoscopic examination to rule out other causes. Case presentation: A 51-year-old female patient reconsulting with an 8-month history of symptoms of chronic rhinosinusitis without improvement. Computed tomography scan showed occupation of the left maxillary and ethmoid sinuses with osteitis, suspecting a space-occupying lesion requiring magnetic resonance imaging and surgical management. The fungal ball diagnosis was confirmed and not a tumor lesion, with complete improvement postoperatively. Discussion and conclusions: Fungal ball is classified as non-invasive fungal rhinosinusitis without mucin that requires surgical management and should be considered as a differential diagnosis, given that they can simulate tumors.
Nasal trauma approach at a reference center in the Colombian Caribbean: Retrospective analysis and management perspectives
Background: Nasal trauma is a common pathology in the practice of otolaryngologists, requiring comprehensive evaluation and treatment. This study aimed to analyze the demographic characteristics, etiology, and therapeutic approach to nasal trauma in a high-complexity hospital in the Colombian Caribbean. Methods: A retrospective analysis of 157 patients who were treated between January 2021 and January 2024 was conducted. Demographic data and information about the mechanism of trauma, diagnostic procedures, and treatment were collected and analyzed. Results: Most patients were young males. The primary cause of closed nasal fracture was interpersonal violence, while soft tissue trauma was predominantly caused by sharp and penetrating object injuries. Management strategies ranged from conservative measures to surgical intervention, depending on the severity of the injury. Conclusion: Nasal trauma presents with variable manifestations. A comprehensive understanding of trauma mechanisms and lesion characteristics is crucial for effective management strategies. This study provides insights into the epidemiology and management of nasal trauma in our region, aiding in the development of treatment approaches and personalized therapeutic measures.