LA OTORRINOLARINGOLOGIA EN ARGENTINA

ENTNews | SEP/OCT 2008 | VOL 17 NO 4 67
Argentina is in the extreme south of Latin
America; it covers a vast area of 2,800,000
km2; it is 3,700 km long and 1,300 km wide
in its central area. Due to its large dimensions,
Argentina is considered the eighth
biggest country in the world. There are
around 40 million inhabitants, which is
small taking into account the dimensions,
and there are about 4,000 ORL specialists
who offer otorhinolaryngology assistance
to the population.
In order to be loyal to the large number
of important specialists who every day
make a great effort to help ORL develop in
Argentina and not to provide you with an
incomplete list of these professionals, I
apologise for having decided not to mention
any of the present specialists working
in our country but to focus on the original
founders of the ENT speciality.
Historical background
Dr Juan Manuel Tato (1902-2004) was a
great master of several generations of
specialists who still remember him with
gratitude and love. He was a greatman who
was a pioneer of otorhinolaryngology and
audiology and who created innovative
surgical procedures and published several
books on the speciality. He established the
basis of modern ORL in our country and
introduced it to an international audience.
Santiago Luis Aráuz (p), Alejandro Agra,
Luis Samengo, Jaime Del Sel, Norberto Von
Soubiron, Santiago y Carlos Aráuz, José
Bello, Eugenio Romero Díaz, Osvaldo
Suárez y Heraldo Tavella were other specialists
who also contributed in exalting
Argentine ORL.
About the author
I feel the need to make reference to my
professional activity - past and present -
according to the national reports
previously published in ENT News.
I have worked as the Chief Doctor of
otorhinolaryngology in four of the most
important hospitals in Buenos Aires city:
Rawson, Durand, Alvarez and Pirovano.
I have contributed to the development
of important chapters in the speciality,
such as:
• Fractures of the temporal bone
(otoneurotraumatology)
• Surgery of the middle ear (mastoidecto
my, tympanoplasty)
• Otoneurosurgery (temporalectomy, glomus
yugularis and temporal bone cancer
surgery)
• Facial nerve surgery
• Functional endoscopic sinus surgery
• Microdebrider-assisted FESS
• Laser-assisted FESS,
• Facial paralysis
• Office management of facial Bell´s palsy.
I have organised three of the most
important congresses in our speciality in
Argentina, summoning some of the most
outstanding doctors in this speciality at
international level: David Kennedy, Robert
Jahrsdoerfer, Jack Pulec, Nickil Bhatt, Helen
Fox Krause, Mirko Tos, Edgar Chiossone-
Lares, Aldo Stamm, Carlo Zini, Ernesto
Ried, Richard Trevino, J Sterkers, Herbert
Silverstein and many others.
This way we had the first otorhinolaryngology
satellite conference in our country
with the participation of Dr Howard and
John House, Antonio de la Cruz, Decio
Castro, Jean B Causse and Ugo Fisch.
Together with Dr Norberto Turín I have
set up an extensive assistance net made up
of five medical otorhinolaringology centres
allocated in a city like Buenos Aires, which
has a population of more than 12 million
inhabitants and which is assisted by 26 ORL
specialists.
At present, my scientific interest is completely
devoted to the Nasal Allergy
Combined Integral (O+A) Treatment
Programme. I have designed this programme
to have complete control of its
symptoms by means of a holistic conception
totally different from the traditional
one.
This is the result of vast experience in the
treatment of this complex illness. It results
ENT in Argentina
Prof Dr Miguel A
Lacour, MD,
Past President of
the Argentine
Association of
Otorhinolaryngology,
Buenos Aires,
Argentina.
Correspondence
Email: lacourdr
@yahoo.com.ar
Declaration of
Competing Interests
None declared.
Our country has given birth to an ENT School which has an enviable
development, proportional to the one found worldwide in the most
important leading countries in the subject.
Argentine ORL
stands out because
of its high
academic and
technological level
and its
permanent
presence in the
most important
international
forums of the
speciality
68 ENTNews | SEP/OCT 2008 | VOL 17 NO 4
from the combination of both disciplines -
otorhinolaryngology and allergy - which
integrated in a compact block to optimise
isolated achievements by applying innovative
physiopathological, diagnostic and
therapeutical concepts as well as miniinvasive
lasers of the latest generation.
We have expanded the field of action
of our speciality by achieving the control
of this pathology, which mainly affects a
big percentage of the population making
an impact on the patients´ health, altering
their quality of life and resulting in less
sporting, social, working, intellectual and
educational capacity.
By controlling this disease, success is
achieved in the treatment of overnight
snoring and the sleep apneas (OSAS)
which have their origin in nasal problems.
Both overnight snoring and apneas produce
insomnia, drowsiness and chronic
fatigue, existing a clear relationship
between the deterioration of sleep and
the appearance of cardiovascular, respiratory,
metabolic and psychiatric diseases.
This also applies to certain diseases
which appear as side-effects, such as
bronchial asthma, diabetes, high blood
pressure, coronary diseases, diabetes,
headaches, migraine, anxiety, stress and
nervous depression. (Sleep Lab;
Northwestern University, Chicago, USA)
In this way it is possible to establish a
strong link between otorhinolaryngology,
allergy, cardiology, nutrition, endocrinology,
neurology, gynecology, plastic surgery
and aesthetic medicine.
Having complete control thanks to the
Combined Integral (O+A) Treatment we
contribute together with these clinical
specialities, to a solution to its co-existent
diseases.
Present status
Argentine ORL stands out because of its
high academic and technological level, its
permanent presence in the most important
international forums of the speciality
and its well-balanced development of its
sub-specialities of otology, otoneurosurgery,
cochlear implantation, rhinology,
laryngology, OSAS surgery, laser-assisted
ENT surgery and maxillo-facial surgery.
In otosurgery, we have the chronic middle
ear otitis and cholesteatoma surgery;
stapediovestibular surgery, laser-assisted
stapedotomy, stapedectomies; tympanoplasty
with reconstructive biomaterials,
ossiculoplasty; atresioplasty or bone
anchored hearing aid for microtia and
aural atresia; laser microsurgery and endoscopic
surgery of the ear and the skull base;
surgery for dizziness, saccus decompression,
vestibular neurectomy.
In otoneurosurgery, we have all surgical
procedures performed concerning the
skull base because of acoustic or facial
neuroma, neurofibromatosis I and II;
subtotal temporalectomies because of
squamous cell carcinoma, glomus
yugularis tumour, granulomatous and
tumoural lesions with dura mater patches
and granular hydroxylapatite; grafts and
decompression of the facial nerve because
of trauma of the temporal bone.
In Argentina, otorhinolaryngologists
together with neurosurgeons, ophthalmologists,
neurologists, oncologists and
speech therapists have developed multiple
multidisciplinary surgeries of the anterior
and posterior skull base.
In cochlear implantation surgery, auditory
brainstem implantation and middle
ear implant surgery, there are several
groups and interdisciplinary teams that
perform them. Also audiologists, speech
therapists and psychologists trained in
clinical evaluation of the candidates for
this type of surgery.
In Argentina, severe / deep deafness is
considered a severe discapacity, therefore
it is protected by the National Law of
Discapacity, which covers the cost of the
cochlear implant by the National State.
In rhinology, we perform all kinds of
adult and paediatric FESS and the superspecialised
surgery with access to the
anterior skull base: to the sella turcica area
because of pituitary adenoma, orbital
decompression in exophtalmos because
of hyperthyroidism, multidisciplinary
videoendoscopic laser-assisted surgery and
others which involve the orbit, dacryocystorhinostomy
and surgery of the inverted
papilloma, the esthesioneuroblastoma,
nasal tumours and the choanal atresia.
In the rhinopharyngeal cavum surgery
our country stands out for having developed
innovative techniques to treat the
juvenil angiofibroma of cavum and the
rinopharyngeal cancer.
In laryngology, having had Master teachers
such as Alejandro Agra, Carlos Aráuz,
Jaime del Sel, Osvaldo Suarez, it is not
surprising to see how high this subespeciality
has been developed. We have
oncologic or functional laryngeal surgery,
phonosurgery, laser-assisted microsurgeries,
partial or total laryngectomies with
tracheoesophageal puncture and prótesis
for post-op voice restoration and radical
neck dissection.
Other procedures such as the snoring
and obstructive sleep apnea syndrome,
OSAS laser- radio frequency-assisted
surgery, with the latest generation
technology.
Clinical assessement methods. As far as
additional studies is concerned, we should
focus on the completeness of the selection
of specialised procedures available:
video-fibrescopy, rhinomanometry; audiology,
tinnitus and labyrynthology evaluation;
polysomnography for OSAS detection,
otoacoustic emissions, newborn
hearing screening, evoked auditory potentials
(BSER), video-stroboscopy, swallowing
disorders and voice clinic.
Postgraduate ORL training
The postgraduate teaching function in the
speciality is done through the corresponding
academic institutions, generating
continual teaching places and also by distance
learning: Buenos Aires National
University (UNBA), private universities, the
Argentine Association of ORL (AMA),
ORL Club and the Argentine Association
of the Voice. These institutions carry out
their teaching courses by means of seminars,
meetings, telemedicine and scientific
events.
ORL specialisation centres on a
program of hospital internships to train
the specialist, in a professional environment,
in presenting activities including
early detection by means of the dissection
of the temporal bone and endoscopic
cadaveric surgery. The organisation of educational,
bibliographic, image diagnosis
and evening seminars as well as multidiscipline
workshops enable the specialist to
correctly diagnose and implement the
right medical and surgical ORL treatments.
FASO (the Argentine Federation of ORL
Societies) is the institution in charge of
both promoting the unity of this speciality
at a national level and also of the scientific
interchange between national and international
specialists. FASO is affiliated with
the International Federation of ORL
Societies (IFOS). Its purpose is to optimise
the speciality by motivating scientific
endeavour, especially by means of the
uninterrupted publication of ‘FASO magazine’
for the last 13 years.
This institution acts as the national
ORL, scientific reference and permanent
consulting institution for the official
organisations. Its main activity is post graduate
teaching, holding an annual refresher
course, organising national congresses and
re-certifying those specialists who require
it, while maintaining a high level of excellence
within the complex discipline of
ENT.

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