Arytenoid asymmetry in opera singers.

INTRODUCTION: Otolaryngologists commonly observe asymmetrical movements of the arytenoid cartilages, but few authors have described the clinical implications of this asymmetry, especially in singers. OBJECTIVES: The aim of this study was to determine the epidemiological and clinical characteristics of arytenoid asymmetry in adduction in a group of healthy opera singers and to evaluate the impact of this asymmetry on the voice. PATIENTS AND METHODS: The medical charts and laryngeal video recordings of 245 healthy opera singers were retrospectively reviewed. Arytenoid asymmetry was defined in relation to the position of the corniculate cartilages, cuneiform cartilages and aryepiglottic angle. RESULTS: The subjects had a mean age of 38.54years (range: 18 to 85 years) and presented a male-to-female sex ratio of 1.02. About 5% of subjects had a history of smoking. The most common vocal symptoms were occasional dysphonia (4%), followed by vocal fatigue (2%) and pharyngeal dryness (2%). Arytenoid asymmetry was slightly more common in males (50.6%) and predominantly affected the right side (64.5%). The most common form of asymmetry was cuneiform asymmetry (37.5%), followed by aryepiglottic angle asymmetry in 33.1% of cases and corniculate asymmetry in 29.4% of cases. Mild asymmetry was observed in the majority of cases. No correlation was observed between arytenoid asymmetry and vocal symptoms. CONCLUSION: Almost one out of two singers was likely to present arytenoid asymmetry in adduction. The presence of this asymmetry does not appear to be correlated with any vocal symptoms.

Rhinophyma: Our experience based on a series of 12 cases.

INTRODUCTION: Rhinophyma is a rare, benign and unsightly disease of the skin of the nose that was first described a very long time ago, as illustrated by portrait of an old man with a bulbous nose holding his grandson, by Ghirlandaio in 1490. It was described for the first time by Ferdinando Hebra Von (1816-1880), as the third stage of rosacea. The objective of this study is to report the author's experience and propose a new treatment option in the management of rhinophyma. MATERIAL AND METHODS: We describe our experience of rhinophyma based on a retrospective case study. RESULTS: We identified 12 cases over a 12-year period, with a marked male predominance. The therapeutic approach was the same in all patients, consisting of a combination of dermabrasion, decortication and application of fibrin glue, with a favourable outcome in every case with complete epithelialisation. CONCLUSION: Rhinophyma is a rare condition of uncertain pathophysiology. Management is surgical and, in view of the many techniques and procedures proposed, we advocate the slogan "to each his own technique", until a consensus has been reached. Our technique combining dermabrasion, decortication and application of fibrin glue has given very good results.

Intraorbital foreign body: A rifle bullet removed 20 years after the accident.

INTRODUCTION: Trauma of the orbit and eyeball is common, but intraorbital bullet is a relatively rare event. CLINICAL CASES: The authors report the management of a patient with chorioretinitis sclopetaria secondary to a gunshot wound twenty years previously. DISCUSSION: The clinical, diagnostic and therapeutic aspects of this unusual case of intraorbital foreign body are discussed.

Post-traumatic Pott's puffy tumour: A case report.

INTRODUCTION: Osteomyelitis of the frontal sinus is a rare clinical entity and generally occurs as a complication of trauma to the forehead or frontal sinusitis. It can be responsible for life-threatening complications, as the first symptoms may appear to be minor. Early diagnosis and appropriate management to prevent central nervous system complications significantly reduce the morbidity and mortality. CASE REPORT: The authors report the case of a 34-year-old man with Pott's puffy tumour following trauma to the frontal sinus. DISCUSSION: The diagnosis was suggested clinically and confirmed radiologically. Treatment was surgical with craniotomy and external drainage.

[Dermatofibrosarcoma protuberans of the face: Long term patient of a follow up].

We report the case of a patient 40 years old affected by a facial tumour diagnosed as a dermatofibrosarcoma protu­berans. He has been followed in our clinic for the last 22 years. He got a recurrency after 11 years and after an other surgery he his actually free of disease. The purpose of this article is to evaluate the tumoral recurrency and the long term follow up.

[The silent sinus syndrome: A reconstruction of the orbital floor with Medpor implant]. / Le silent sinus syndrome: reconstruction orbitaire par implant Medpor.

INTRODUCTION: The silent sinus syndrome (SSS) is a rare clinical entity in both ENT and ophthalmology. It is characterized by enophthalmos and ptosis associated with a reduction in pressure in the maxillary sinus caused by chronic hypoventilation. The objective of this study was to demonstrate the importance of maxillary hypoplasia whether congenital or acquired in this disease, and the use of Medpor implant for reconstruction of the orbital floor. MATERIAL AND METHODS: We report 3 cases of silent sinus syndrome proved clinically and radiologically. The first is a 45 year old male patient complaining of enophthalmos which occurred gradually, without any medical history; the second case is that of a woman of 39 years with a gradual onset enophthalmos, with a history of sinusitis; the third case, a man of 25 years who had a history of nasal trauma and consults for enophthalmos and diplopia. RESULTS: Endoscopic surgery is performed quickly allowing a disappearance of enophthalmos and diplopia. All patients underwent a reconstruction of the orbital floor with a Medpor implant fixed by miniplates without complications.

[Post operative Caldwell-Luc procedure maxillary cyst: Report of a case]. / Syndrome post Caldwell Luc: à propos d'un cas.

Rare complication of radical surgery (Caldwell Luc procedure) of the maxillary sinus, maxillary cyst can occurred several years after. We describe the case of a patient 56 years old, who came to our consultationfor repeated pain in the right maxillary region with moderate facial asymmetry. In her history we noted a previous sinus surgery (Caldwell Luc) more than 10 years before. The imaging showed an expansive process filled with proteinic tissue of the posterior wall of the maxillary. With the history of the former surgery, we suspected the existence of a mucocele. She underwent an endonasal surgery and the pathological examination of the specimen revealed an intra osseous cyst lined with ciliated respiratory type mucosa post surgery of the maxillary sinus. The diagnosis of a maxillary cyst complicating a Caldwell Luc was established based on the results obtained with the clinico-radiological and pathological results.

[Oncocytoma of the parotid gland: a case report]. / Oncocytome de la glande parotide: a propos d'un cas.

Oncocytoma is a rare benign salivary gland tumour with an incidence rate about 1-2%. It is located in the parotid gland in 82% of cases. The aging mitochondrial hypothesis could explain the predilection between 70 and 90 years. Clinical and radiological features of the parotid oncocytoma are not different from those of the others parotid benign tumors. We report a case of oncocytoma of the left parotid gland in a 69 years woman in whom fine needle aspiration cytology (FNAC) was for a pleomorphic adenoma. Through this case we highlight the importance of histopathology in the positive diagnosis of parotid oncocytoma as well as in it's differential diagnosis and also the place of FNAC.

[Setting up a "Bonebridge"]. / Mise en place d'un "Bonebridge".

Hearing rehabilitation after bilateral radical mastoidectomy has different options. The Bonebridge is a new type of middle ear implant bone conduction. It leaves the external ear canal opened and offers acoustic and aesthetic advantages that make it a new alternative of choice. We report our first case of Bonebridge implanted on a 17 years old patient. He had bilateral conductive hearing loss secondary to a bilateral radical mastoidectomy with open technique and meatoplasty for a bilateral cholesteatoma. The surgical technique is described. After 8 months of use the hearing gain is stable without cutaneous adverse effect.

Infección por Helicobacter pylori: Asociación a Patologías gástricas y Métodos de diagnóstico / Infection by Helicobacter pylori: Association to `gastric` Pathologies and Methods of diagnosis

La infección por helicobacter pylori está distribuida a nivel mundial, la prevalencia es del 50%. Esta infección está asociada a enfermedades como las gastritis, úlceras, cancer gástrico y linfoma de MALT. El objetivo es describir la relación existente entre enfermedad e infección por helicobacter pylori.

Actividad anti-helicobacter pylori de Plantago major, Clinopodium bolivianum, Caléndula officinalis y Piper angustifolium por el método de difusión de disco / Activity anti-Helicobacter pylori of Plantago major, Clinopodium bolivianum, Calendula officinalis and Piper angustifolium by the method of dissemination of disk

Helicobacter pylori es una bacteria asociada a patologías gástricas como gastritis, ulceras, cancer y linfoma de MALT. De acuerdo a estudios realizados en la ciudad de La Paz-Bolivia aproximadamente el 50% de la población esta infectada por esta bacteria.

[Cochlear implant in a patient with dilatation of the endolymphatic sac and vestibular aqueduct]. / Implante coclear en paciente con dilatación del saco endolinfático y del acueducto del vestíbulo.

We present an 8 years patient old with a giant dilatation of the vestibular aqueduct associated with profound and progressive bilateral sensorineural hearing loss. The patient received a cochlear implant and during the surgery a pulsatile clear fluid via the cochleostomy was observed, without gusher. We present all the problems, and offer some advices for this kind of surgery.

Implante coclear en paciente con dilatación del saco endolinfático y del acueducto del vestíbulo / Cochlear implant in a patient with dilatation of the endolymphatic sac and vestibular aqueduct

Presentamos un paciente de 8 años de edad con una dilatación gigante del acueducto vestibular asociado a una hipoacusia neurosensorial profunda bilateral. El paciente recibió un implante coclear y durante la cirugía se observó una pulsación del contenido endococlear sin evidencia de gusher. Presentamos todos los problemas y ofrecemos algunos consejos para este tipo de cirugía

We present an 8 years patient old with a giant dilatation of the vestibular aqueduct associated with profound and progressive bilateral sensorineural hearing loss. The patient received a cochlear implant and during the surgery a pulsatile clear fluid via the cochleostomy was observed, without gusher. We present all the problems, and offer some advices for this kind of surgery

[Sensorineural hearing loss due to neonatal hyperbilirubinemia]. / Hipoacusia neurosensorial por hiperbilirrubinemia neonatal.

In this article, the sensorineural hearing loss is presented as a possible sequelae of neonatal hyperbilirubinemia. In our program of early hipoacusia detection, 241 babies were examined from January 1996 until November 1999; 7 cases had a history of hyperbilirubinemia in the neonatal period and 2 of them were diagnosed of sensorineural hearing loss. We discuss how the bilirubin or any other associated factor might have been the cause and this could explain the selective affectation of some children.

Hipoacusia neurosensorial por hiperbilirrubinemia neonatal / Sensorineural hearing loss due to neonatal hyperbilirubinemia

En este artículo, la hipoacusia neurosensorial es presentada como una posible secuela de la hiperbilirrubinemia neonatal. En nuestro programa de detección precoz de la hipoacusia fueron investigados 241 niños lactantes, desde enero de 1996 hasta noviembre de 1999, de los cuales 7 casos tenían antecedentes de hiperbilirrubinemia neonatal inmediata y, de ellos, 2 presentaron hipoacusia neurosensorial bilateral. Realizamos una discusión de los posibles mecanismos de acción de la bilirrubina y las causas que explicarían la afectación selectiva de algunos niños (AU)

In this article, the sensorineural hearing loss is presented as a possible sequelae of neonatal hyperbilirubinemia. In our program of early hipoacusia detection, 241 babies were examined from January 1996 until November 1999; 7 cases had a history of hyperbilirubinemia in the neonatal period and 2 of them were diagnosed of sensorineural hearing loss. We discuss how the bilirubin or any other associated factor might have been the cause and this could explain the selective affectation of some children (AU)

[Jugular dehiscence in the hypotympanum: report of 9 cases]. / Dehiscencia yugular en el hipotímpano: a propósito de nueve casos.

We report on nine cases with jugular dehiscence in middle ear diagnosticated and followed up in our clinic from 1987 to 2000. Diagnosis was made, in some cases, when carrying out an otoscopy and others by clinical symtomatology, otomicroscopically imaging, audiometry, CT-scan and MRI. All patients were affected of hearing loss. Some of them also suffered pulsatile tinnitus and even vertigo. The follow up of all patients has been stable and devoid of bleeding complications.

[Obstructive sleep apnea in children. Our experience]. / Síndrome de la apnea obstructiva del sueño en el niño. Nuestra experiencia.

We expose our experience in obstructive sleep apnea syndrome (OSAS) in the pediatric population and review the literature. Forty-six nocturnal respiratory polygraphies were performed using a portable device (Eden Trace II Plus) that measures heart rate, chest wall impedance, nasal/oral airflow and oxygen saturation. Seven children have been studied before and six weeks after Adenotonsillectomy. All this children experienced an immediate and important improvement of their obstructive symptoms. After Adenotonsillectomy the number of obstructive sleep apneas disminished up to 87.25% and the number of hypoapneas disminished up to 73.3. The arterial oxygen saturation during the night normalized in the seven patients. The initial treatment of OSAS in children should be the Adenotonsillectomy, although the diagnostic criteria of OSAS in children have to be defined more precisely in the future.

Dehiscencia yugular en el hipotímpano: a propósito de nueve casos / Jugular dehiscence in the hypotympanum: on purpose of nine cases

Se presenta un estudio de nueve pacientes diagnosticados de dehiscencia de la yugular en el oído medio, seguidos durante el periodo 1987-2000. El diagnóstico se hizo, en algunos, de forma casual al realizar una otoscopia, en otros, a través de los síntomas clínicos, audiométricos y todos ellos complementados con el diagnóstico por imagen (TAC, RNM y angioresonancia). Todos los pacientes presentan un cierto grado de hipoacusia, pero en algunos de ellos se asocian acúfenos pulsátiles e incluso vértigo. La evolución en todos ellos ha sido estable y no se han presentado complicaciones hemorrágicas (AU)

We report on nine cases with jugular dehiscence in middle ear diagnosticated and followed up in our clinic from 1987 to 2000. Diagnosis was made, in some cases, when carrying out an otoscopy and others by clinical symtomatology, otomicroscopically imaging, audiometry, CT-scan and MRI. All patients were affected of hearing loss. Some of them also suffered pulsatile tinnitus and even vertigo. The follow up of all patients has been stable and devoid of bleeding complications (AU)