Tres nuevas estrategias para mejorar la precisión de la estimulación vestibular calórica monotérmica / Three new strategies to improve the accuracy of monothermal caloric screening testing

Objetivo: Encontrar una forma de estimar el valor de paresia canalicular (PC) a través de la estimulación vestibular calórica monotérmica (EVCM) que pueda utilizarse en cualquier laboratorio, controlando el error que se produce al utilizarla. Método: Se incluyó en este estudio a 2.304 pacientes de nuestro servicio a los cuales se les realizó una videonistagmografía con pruebas calóricas entre 2003 y 2011. El cálculo de la PC se realizó de 3 formas diferentes: utilizando los valores de las 4 estimulaciones calóricas (forma bitérmica) o exclusivamente con los 2 valores de una misma temperatura (formas monotérmica caliente y fría respectivamente). Se estudiaron 3 estrategias para mejorar la precisión de la EVCM: análisis de variables que empeoran la predicción, delimitación de un área gris de predicción deficiente y localización de un punto de separación entre sanos y enfermos de máxima utilidad. Resultados: 1) Corregir la fórmula de Jongkees con el valor del nistagmo espontáneo permite incluir como candidatos a la EVCM a sujetos con nistagmo espontáneo o inversión nistágmica. 2) Establecer una zona gris de predicción deficiente evita aproximadamente el 38% de las estimulaciones bitérmicas realizadas, con una sensibilidad y especificidad del 95%. 3) La máxima utilidad de la EVCM se obtiene al considerar como función vestibular normal la de sujetos con valores de EVCM caliente menores o iguales al 16%, suponiendo patológica una asimetría mayor del 20%. Conclusión: Las nuevas herramientas estadísticas permiten a los clínicos tomar decisiones que afecten al manejo de sus pacientes basados en los resultados de la EVCM (AU)

Objective: The objective was to find a way to estimate the value of inter-ear difference (IED) through monothermal caloric screening testing (MCST) that can be used at any laboratory, controlling and minimising the resulting error. Methods: We retrospectively included in this study 2304 patients from our department to whom a videonystagmography with caloric testing was performed between 2003 and 2011. The IED was calculated in 3 different ways: Using the values of the 4 caloric stimulations (bithermal form) and using only the 2 same-temperature values (warm monothermal and cool monothermal forms). We studied 3 strategies to improve the accuracy of MCST: Analysis of variables that could impair the prediction, delimitation of a grey area of insufficient prediction and location of a maximum utility cut-off point. Results: Correcting Jongkees’ formula with the value for spontaneous nystagmus makes it possible to include subjects with spontaneous nystagmus or nystagmus inversion. Establishing 2 cut-off points to classify the subjects avoids approximately 38% of bithermal stimulations performed with a sensitivity and specificity of 95%. Maximum utility was obtained diagnosing as healthy those subjects with IED values lesser than or equal to 16% in warm MCST when the pathological IED was set as greater than 20%. Conclusion: New statistical tools help clinicians to make decisions that affect their patients based on the results of MCST (AU)

Three new strategies to improve the accuracy of monothermal caloric screening testing.

OBJECTIVE: The objective was to find a way to estimate the value of inter-ear difference (IED) through monothermal caloric screening testing (MCST) that can be used at any laboratory, controlling and minimising the resulting error. METHODS: We retrospectively included in this study 2304 patients from our department to whom a videonystagmography with caloric testing was performed between 2003 and 2011. The IED was calculated in 3 different ways: Using the values of the 4 caloric stimulations (bithermal form) and using only the 2 same-temperature values (warm monothermal and cool monothermal forms). We studied 3 strategies to improve the accuracy of MCST: Analysis of variables that could impair the prediction, delimitation of a grey area of insufficient prediction and location of a maximum utility cut-off point. RESULTS: Correcting Jongkees' formula with the value for spontaneous nystagmus makes it possible to include subjects with spontaneous nystagmus or nystagmus inversion. Establishing 2 cut-off points to classify the subjects avoids approximately 38% of bithermal stimulations performed with a sensitivity and specificity of 95%. Maximum utility was obtained diagnosing as healthy those subjects with IED values lesser than or equal to 16% in warm MCST when the pathological IED was set as greater than 20%. CONCLUSION: New statistical tools help clinicians to make decisions that affect their patients based on the results of MCST.

Metástasis cutáneas de condrosarcoma laríngeo / Cutaneous metastases of laryngeal chondrosarcoma

No disponible

Tratamiento de dos casos de enfermedad de Forestier-Rotes Querol / Treatment of two cases of Forestier-Rotes-Querol's disease

No disponible

Fístula traquecolónica en un paciente tratado con una coloplastia / Tracheo-colonic fistula in a patient treated with coloplasty

No disponible

Granulomatosis de Wegener causante de parálisis facial y cofosis bilaterales / Wegener’s granulomatosis causing bilateral facial paralysis and deafness

La parálisis facial bilateral (PFB) es una entidad infrecuente, que habitualmente se presenta como manifestación de una enfermedad sistémica. Presentamos el caso de una mujer afecta de granulomatosis de Wegener (GW), con especial afectación de las vías respiratorias altas y ótica, que desarrolló hipoacusia y PFB resistente a tratamientos inmunosupresores y bolos de corticoides, con pruebas de imagen que no muestran afectación del nervio facial en las estructuras óticas. Finalmente, la paciente mejoró de la PFB, pero la cofosis es permanente y se ha realizado un implante coclear. Las series publicadas sobre PFB son escasas, y no hacen referencia a la GW como posible etiología (AU)

Bilateral facial paralysis (BFP) is an uncommon condition that typically occurs as a manifestation of systemic disease. We present a female patient with Wegener's granulomatosis (WG), particularly upper respiratory and ear impairment who develops hypoacusis and BFP, resistant to immunosuppressive therapy and steroid boluses. Her imaging tests showed no involvement of the facial nerve as it passed through the ear structures. The patient finally improved the BFP; however, deafness is permanent and she has entered into a cochlear implant program. Published papers on BFP are rare and they make no reference to WG as a possible aetiology (AU)

Síndrome de Ramsay-Hunt causante de parálisis laríngea / Ramsay-Hunt syndrome presenting laryngeal paralysis

El síndrome de Ramsay-Hunt consiste en la asociación de parálisis facial periférica (PFP) e infección por virus varicela zoster (VVZ) con afectación del conducto auditivo externo y membrana timpánica. Se puede acompañar de sordera, acúfenos y vértigos. En ocasiones puede afectar los pares craneales bajos. Se presenta el caso de un paciente inmunocompetente con afectación de los pares craneales VII, VIII y X (AU)

The Ramsay-Hunt syndrome is the association of facial palsy and varicella-zoster virus infection with involvement of the ear canal and eardrum. It may be associated with deafness, tinnitus and dizziness. It can sometimes affect the lower cranial nerves. A case of an immunocompetent patient with affectation of the VII, VIII and X cranial nerves is presented (AU)

Wegener's granulomatosis causing bilateral facial paralysis and deafness.

Bilateral facial paralysis (BFP) is an uncommon condition that typically occurs as a manifestation of systemic disease. We present a female patient with Wegener's granulomatosis (WG), particularly upper respiratory and ear impairment who develops hypoacusis and BFP, resistant to immunosuppressive therapy and steroid boluses. Her imaging tests showed no involvement of the facial nerve as it passed through the ear structures. The patient finally improved the BFP; however, deafness is permanent and she has entered into a cochlear implant program. Published papers on BFP are rare and they make no reference to WG as a possible aetiology.

[Ramsay-Hunt syndrome presenting laryngeal paralysis]. / Síndrome de Ramsay-Hunt causante de parálisis laríngea.

The Ramsay-Hunt syndrome is the association of facial palsy and varicella-zoster virus infection with involvement of the ear canal and eardrum. It may be associated with deafness, tinnitus and dizziness. It can sometimes affect the lower cranial nerves. A case of an immunocompetent patient with affectation of the VII, VIII and X cranial nerves is presented.

Miotomía del cricofaríngeo en el tratamiento de la distrofia muscular oculofaríngea / Cricopharyngeal myotomy in the treatment of oculopharyngeal muscular dystrophy

La distrofia muscular oculofaríngea (DMOF) es una enfermedad hereditaria autosómica dominante que causa disfagia orofaríngea, ptosis palpebral y debilidad muscular proximal. Es causada por una expresión anormal del triplete GCG del gen PABPN1, situado en el cromosoma 14. El estudio de la disfagia orofaríngea que sufren estos pacientes se basa en la historia clínica, la endoscopia digestiva alta, la radiología con contraste baritado y la manometría esofágica. El diagnóstico definitivo se confirma con el estudio genético. Presentamos 6 casos, 3 de ellos de una misma familia, remitidos a nuestro departamento con el diagnóstico confirmado de DMOF, los cuales se sometieron a una miotomía del cricofaríngeo para conseguir una deglución normal(AU)

Oculopharyngeal muscular dystrophy (OPMD) is an autosomal dominant myopathic disease which provokes oropharyngeal dysphagia, palpabral ptosis and proximal limb weakness. It is the abnormal expression of the GCG triplet in the PABPN1 gene on chromosome 14 that causes this disease. The study of the oropharyngeal dysphagia that these patients suffer from should include upper gastrointestinal endoscopy, barium video-radiology and oesophageal manometry. Genetic study confirms the diagnosis. We report 6 patients (3 of whom were siblings) referred to our department with a confirmed diagnosis of OPMD, who underwent cricopharyngeal myotomy to achieve normal swallowing(AU)

Cricopharyngeal myotomy in the treatment of oculopharyngeal muscular dystrophy.

Oculopharyngeal muscular dystrophy (OPMD) is an autosomal dominant myopathic disease which provokes oropharyngeal dysphagia, palpabral ptosis and proximal limb weakness. It is the abnormal expression of the GCG triplet in the PABPN1 gene on chromosome 14 that causes this disease. The study of the oropharyngeal dysphagia that these patients suffer from should include upper gastrointestinal endoscopy, barium video-radiology and oesophageal manometry. Genetic study confirms the diagnosis. We report 6 patients (3 of whom were siblings) referred to our department with a confirmed diagnosis of OPMD, who underwent cricopharyngeal myotomy to achieve normal swallowing.

Vértigo posicional paroxístico benigno: análisis de nuestra población y del papel de las pruebas calóricas / Benign paroxysmal positional vertigo: analysis of our population and role of caloric tests

Introducción y objetivos: El vértigo posicional paroxístico benigno (VPPB) es la causa más frecuente de vértigo diagnosticada en los pacientes que buscan asistencia médica. Aunque inicialmente plantear un estudio con videonistagmografía parece lo más indicado, en nuestro medio hemos tratado de disminuir el número de pruebas calóricas solicitadas para optimizar los recursos y disminuir los costes asociados. Métodos: Para evaluar la necesidad de realizar pruebas calóricas en estos pacientes, hemos elaborado un algoritmo diagnóstico-terapéutico para enfermos con sospecha de VPPB en los que las pruebas de provocación son positivas y hemos analizado los resultados de su aplicación sobre 98 pacientes que durante 15 meses fueron derivados a nuestra consulta de Otoneurología para que se les realizara una videonistagmografía con estimulación bitérmica binaural. Resultados: Hemos conseguido reducir las videonistagmografías practicadas a un 24% de las solicitadas. Al comparar nuestro índice de recurrencia tras un año de seguimiento con los de otra serie de pacientes españoles, no hemos obtenido diferencia significativa. Conclusiones: La videonistagmografía no es estrictamente necesaria en la mayoría de los pacientes con VPPB, debiendo reservarse para los casos de duda diagnóstica (AU)

Introduction and objectives: Benign paroxysmal positional vertigo (BPPV) is the most common cause of vertigo in those patients who seek medical care. Although videonystagmography seems the most indicated diagnostic test, we tried to decrease the requested caloric tests to optimise resources and reduce associated costs. Methods: We developed a diagnostic-therapeutic algorithm for patients with suspected BPPV whose provocation tests are positive to evaluate the need for caloric testing. We analysed the results of its application on 98 patients who were referred to our Neuro-otology Unit over 15 months requesting videonystagmography and caloric tests. Results: Only 24% of the requested tests were performed. No significant difference was found in our recurrence rate compared with other series of Spanish patients. Conclusions: Videonystagmography and caloric tests are not strictly necessary in most patients with BPPV and they should be performed only in patients whose diagnosis is unclear (AU)

[Benign paroxysmal positional vertigo: analysis of our population and role of caloric tests]. / Vértigo posicional paroxístico benigno: análisis de nuestra población y del papel de las pruebas calóricas.

INTRODUCTION AND OBJECTIVES: Benign paroxysmal positional vertigo (BPPV) is the most common cause of vertigo in those patients who seek medical care. Although videonystagmography seems the most indicated diagnostic test, we tried to decrease the requested caloric tests to optimise resources and reduce associated costs. METHODS: We developed a diagnostic-therapeutic algorithm for patients with suspected BPPV whose provocation tests are positive to evaluate the need for caloric testing. We analysed the results of its application on 98 patients who were referred to our Neuro-otology Unit over 15 months requesting videonystagmography and caloric tests. RESULTS: Only 24% of the requested tests were performed. No significant difference was found in our recurrence rate compared with other series of Spanish patients. CONCLUSIONS: Videonystagmography and caloric tests are not strictly necessary in most patients with BPPV and they should be performed only in patients whose diagnosis is unclear.