Carcinoma neuroendocrino de fosa nasal ¿una entidad independiente? / Neuroendocrine carcinoma of nasal fossa. An independant entity?

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[The role of video-nystagmography in the diagnosis of acoustic neuroma]. / El papel de la videonistagmografía en el diagnóstico del neurinoma del acústico.

AIM: Schwannoma of the vestibular nerve represents 75% of all expansive processes affecting the pontocerebellosum angle. Hearing loss is the most frequent symptom at diagnosis (86%) with or without tinnitus, in the intracanalicular tumors. Vestibular symptoms are described in 60% of patients. MATERIAL AND METHOD: We study twenty cases of acoustic neuromas diagnosed between years 2000 and 2002 in both Otolaryngology and Neurosurgery Departments in our hospital. Videonystagmography (VNG) was performed in all of them. Videonystagmographic findings were analyzed statistically together with the tumoral size and hypoacusia level. DISCUSSION AND CONCLUSION: According to the medical literature reviewed for this paper, we conclude that caloric tests are the most frequently altered ones (77%), showing vestibular hyporreflexia or arreflexia.

[Non-benign paroxysmal positional vertigo]. / Vértigo posicional paroxístico no benigno.

Positional vertigo is a frequent clinical manifestation of vertigo of very different etiologies, being the benign paroxystic positional vertigo (BPPV) the most frequent one of them, representing in some series even the most found etiology of peripheral vertigo. Usually of severe entities, positional vertigo may appear in the context of severe entities and of difficult diagnosis. In these cases, the bearing of the symptoms in spite of the repositioning manoeuvers, the association with otological or neurological symptoms, and the atypical nystagmus evoked by Dix-Hallpike manoeuver, must take the otolaryngologist to suspect of a feasible non benign pathology. We report a case of positional paroxysmal vertigo caused by an intracranial tumour and we review the clinical signs that shoved help us to suspect of non benign pathologies that can mimic a positional vertigo.

[Neuroendocrine carcinoma of the nasal fossa. An independent entity?]. / Carcinoma neuroendocrino de fosa nasal. Una entidad independiente?

We present one case of a neuroendocrine carcinoma of nasal fossa and paranasal sinuses, of aggressive behavior, which has been controlled with chemo-radiotherapy after a double postsurgical recurrence. We do a literature revision emphasizing the anatomopathologic differentiation of these tumors with the olfactory neuroblastomas, and the therapeutic controversies in advanced stages.

[Intra-tympanic gentamicin in the treatment of Ménière's disease: preliminary results ]. / Gentamicina intratimpánica en tratamiento de la enfermedad de Ménière: resultados preliminares.

In the majority of patients suffering of Ménière's disease, medical treatment is sufficient to control symptoms, albeit, in a small number of them, the high intensity and frequency of vertigo spells makes necessary to adopt more aggressive measures, like intratympanic or general aminoglycoside administration, as well as surgical procedures. We present a prospective and longitudinal descriptive study with the results of intratympanic gentamycin in 24 patients labeled of Ménière's disease in the Otolaryngology Department of "Miguel Servet Hospital" in the last two years, after a follow-up period of more than a year, during which controlled medical treatment had been proved unsuccesfull. We go over the efficacy in terms of frequency of vertigo crisis, audition average, logoaudiometry and functional level. We obtained good results over vertigo control (types A and B of the objective criteria based in the improvement index after treatment) in 16 out of the 24 patients (66.6%), (13 were type A with total absence of crisis and 3 were type B) and an acceptable result (type C) in three of them (12.5.%). In the other five patients (20.83%) results were disappointing (types D and E) compelling to apply surgical treatment. We have tried to evaluate intratympanic gentamycin as an alternative treatment to more aggressive technics and we consider it to be a good option, with a low risk and scarce complications in the no pharmacologically controlled Ménière's disease patients.

[Stapedectomy: long term results]. / Resultados a largo plazo de las estapedectomías.

Stapedectomy, with its most innovatory variations, constitutes the treatment of choice for otoesclerosis. Short term results are spectacular, getting GAP closures of less than 5 dB approximatelly in 94% patients, variations depending on the authors. Long term follow up check results show a gradual auditory deterioration. The aim of this study is to audiometric evolution of patients operated of stapedectomy 7 to 10 years ago in our department and to correlate the results with those obtained by other authors, in an attempt to unify conclusions.

Gentamicina intratimpánica en tratamiento de la enfermedad de Ménière: resultados preliminares / Intratympanic gentamycin for the treatment of Ménière's disease

En la mayoría de los pacientes con Enfermedad de Ménière, el tratamiento médico es suficiente para controlar los síntomas, sin embargo, en un pequeño porcentaje, la intensidad y la frecuencia de las crisis hacen necesario adoptar medidas más agresivas, entre ellas la administración de aminoglucósidos por vía local o sistémica, o bien procedimientos quirúrgicos. Hemos realizado un estudio descriptivo longitudinal y prospectivo de la respuesta al tratamiento con gentamicina intratimpánica, en 24 pacientes diagnosticados de Enfermedad de Ménière en el Servicio de ORL del Hospital "Miguel Servet" en los dos últimos años, tras más de un año de tratamiento médico inefectivo. Se revisa la eficacia en cuanto a frecuencia de crisis de vértigo, media de audición, audiometría verbal y nivel funcional. Hemos obtenido un buen resultado en cuanto al control del vértigo (clase A y B de los criterios de objetivación según el índice de mejoría tras tratamiento) en 16 de los 24 pacientes (66,6 por ciento) (13 clase A con desaparición total de las crisis y 3 clase B) y un resultado aceptable (clase C) en tres (12,5 por ciento).El resultado fue malo (clase D y E), con necesidad de pasar a tratamiento quirúrgico en otros cinco pacientes (20,83 por ciento). Evaluamos la gentamicina intratimpánica como tratamiento alternativo a técnicas más agresivas, y lo consideramos un tratamiento eficaz, con poco riesgo y escasas complicaciones en la Enfermedad de Ménière no controlada farmacológicamente (AU)

In the majority of patients suffering of Ménière's disease, medical treatment is sufficient to control symptoms, albeit, in a small number of them, the high intensity and frequency of vertigo spells makes necessary to adopt more aggressive measures, like intratympanic or general aminoglycoside administration, as well as surgical procedures. We present a prospective and longitudinal descriptive study with the results of intratympanic gentamycin in 24 patients labeled of Ménière's disease in the Otolaryngology Department of "Miguel Servet Hospital" in the last two years, after a follow-up period of more than a year, during which controlled medical treatment had been proved unsuccesfull. We go over the efficacy in terms of frequency of vertigo crisis, audition average, logoaudiometry and functional level. We obtained good results over vertigo control (types A and B of the objective criteria based in the improvement index after treatment) in 16 out of the 24 patients (66.6%), (13 were type A with total absence of crisis and 3 were type B) and an acceptable result (type C) in three of them (12.5.%). In the other five patients (20.83%) results were disappointing (types D and E) compelling to apply surgical treatment. We have tried to evaluate intratympanic gentamycin as an alternative treatment to more aggressive technics and we consider it to be a good option, with a low risk and scarce complications in the no pharmacologically controlled Ménière's disease patients (AU)

Resultados a largo plazo de las estapedectomías / Stapedectomies. Long term results

La estapedectomía, con sus más innovadoras variantes, constituye el tratamiento de elección de la otoesclerosis. Los resultados a corto plazo de esta intervención son espectaculares. El seguimiento a lo largo de los años de estos enfermos parece reflejar un deterioro auditivo paulatino. El objetivo de nuestro trabajo es saber si existe deterioro audiométrico valorable en los enfermos intervenidos de estapedectomía hace más de 7 años con buen resultado inicial. Material y métodos: Revisamos pacientes intervenidos de estapedectomía hace 7-10 años en nuestro servicio con buen resultado inicial valorado en el primer mes y volvimos a realizar una revisión audiológica. Resultados: Se produce un deterioro auditivo significativo valorado en 1,76 dB por año, pasando de una media auditiva previa de 56,2 dB a una postoperatoria inmediata de 27.07 dB, y por fin a una media postoperatoria tardía de 40,65 dB. Conclusión: Se produce una pérdida auditiva significativa tras la estapedectomía con el paso del tiempo, aunque se mantiene una audición significativamente mejor que la inicial (AU)

Stapedectomy, with its most innovatory variations, constitutes the treatment of choice for otoesclerosis. Short term results are spectacular, getting GAP closures of less than 5 dB approximatelly in 94% patients, variations depending on the authors. Long term follow up check results show a gradual auditory deterioration. The aim of this study is to audiometric evolution of patients operated of stapedectomy 7 to 10 years ago in our department and to correlate the results with those obtained by other authors, in an attempt to unify conclusions (AU)

[Parotid metastases of a neuroendocrine cutaneous carcinoma]. / Metástasis parotídea de un carcinoma neuroendocrino cutáneo.

A case of metastatic Merkel-cell carcinoma to lymph nodes on the left side of the neck nad left parotid is described. Neuroendocrine cutaneous carcinoma, also called Merkel cell carcinoma (MCC), is an uncommon primary skin tumor most often seen in elderly. Literature is reviewed and comment about more important features of these lesions, like differential diagnosis, prognosis and treatment.

Metástasis parotídea de un carcinoma neuroendocrino cutáneo / Parotideal metastasis of a cutaneous neuroendocrine carcinoma

Presentamos un caso de carcinoma neuroendocrino cutáneo con metástasis cervicales y en glándula parótida izquierda. El carcinoma neuroendocrino cutáneo, también llamado carcinoma de células de Merkel (MCC), es un raro tumor de la piel que aparece en edades avanzadas de la vida. Una vez revisada la literatura, discutimos sobre las características más importantes de estas lesiones, como sonel diagnóstico diferencial, pronóstico y tratamiento (AU)

A case of metastatic Merkel-cell carcinoma to lymph nodes on the left side of the neck nad left parotid is described. Neuroendocrine cutaneous carcinoma, also called Merkel cell carcinoma (MCC), is an uncommon primary skin tumor most often seen in elderly. Literature is reviewed and comment about more important features of these lesions, like differential diagnosis, prognosis and treatment (AU)

[Dilated vestibular aqueduct syndrome in children. Report of a case]. / Síndrome del acueducto vestibular dilatado en la infancia. A propósito de un caso.

Enlarged vestibular aqueduct syndrome is a clinical condition characterized for a progressive perceptive deafness linked to a broadening of vestibular aqueduct greater than 1.5 mm without other otic abnormal structures. We report the case of a 2-year-old child with such congenital malformation. We have reviewed the actual literature and point out its clinical and physiopathologic features as well treatment possibilities of these cases.

[Cordectomy in the surgical treatment of tumors T1 of the vocal cords. Review of our cases (1974-1990)]. / La cordectomía en el tratamiento quirúrgico de los tumores T1 de cuerda vocal. Revisión de nuestra casuística (1974-1990).

We decided to review the results of cordectomy in our surroundings over the 22 years of existence of our Service. 631 clinic histories of patients undergoing surgery for laryngeal cancer in our Department, between 1974 and 1990, were reexamined, and from those selected 56 pertaining to T1 tumors treated with cordectomy. In this reduced group were studied epidemiology, clinical and pathologic data, complications, survival and death causes as well. The 58 considered were of male sex, middle aged (58-86) excepting 9 patients under 50. Their relation with tobacco eas clear, although less than in our general series (87.93% smokers). Of the 58 patients group 4 of then disappear during the 5 years follow-up term (8.62%). Three died: one from ganglion disease, other from local recurrence and the last one from other condition. In brief, global survival are accounted for 94.34% and the adjusted survival was 96.1%.

[Surgery of cancer of the larynx. Analysis of the results of our cases]. / Cirugía del cáncer de laringe. Análisis de resultados de nuestra casuística.

After 20 years of existence of this Department we decided to carry out a review of the characteristics of our series and also of the results of treatment, according to the protocol elaborated and followed in agreement with the Tumour Committee if the Hospital. 631 medical histories of patients diagnosed and operated for cancer of larynx between 1974 and 1990 were reviewed. 83 of which (13.154%) disappeared during the 5 year follow-up period. Epidemiological, clinical, location, extension and treatment fdata were considered as well as the survival results and a single descriptive statistical analysis performed. The mean age of our study was 59.02 years, showing a clear relation to exposure to tobacco (91.44% were smokers and 63.39% of more than 20 cigarettes per day). The predominant location of the growth was supraglottic (64.05% of cases) followed by glottic in 33.76%. The most frequently used surgical technique was the total laryngectomy and total and extended to either the pharynx or tongue basis in 76.28%, followed by supraglottic laryngectomy in 13m5%. The stages were rather advanced with predominance of stage III /40.60%) and stage IV (21.17%). Global survive rate of our series accounted for 68.61% while the adjusted survival rate was 71.4%.

[Benign positional paroxysmal vertigo in the general ear, nose, and throat clinic]. / El vértigo posicional paroxístico benigno en la consulta de ORL general.

Benign positional paroxysmal vertigo is a common disease which may be caused by abnormal movement of utricular debris in the posterior semicircular canal. It is diagnosed by the Dix-Hallpike positional maneuver eliciting vertigo and nystagmus. Treatment generally consists of physical exercises with the Epley or Semont maneuvers. We review 43 consecutive patients diagnosed as BPPV in the last year and treated with physical therapy (Epley maneuvers). Results were very good, with a cure rate of 88.37% (53.5% after a single maneuver). Physical therapy is an effective treatment for BPPV.

[Hernia of the external ear canal of uncommon origin]. / Hernia de etiología infrecuente en el conducto auditivo externo.

The temporo-mandibular joint is directly related to the anterior wall of the external ear canal. Therefore, defects in this wall may lead to herniation of the soft tissues of the temporo-mandibular joint into the external ear canal. Such herniation usually is secondary to external injuries, iatrogenic trauma, neoplasms, and so on, but it may also be congenital. We report a well-documented case of temporo-mandibular joint herniation into the external ear canal of probable congenital origin.

Sarcoma granulocítico en el área otorrinolaringológica / Granulocytic sarcoma in the field of otorhinolaryngology

El sarcoma granulocítico es un tumor de localización extramedular muy infrecuente. Puede aparecer aislado o asociado a leucemias mieloides agudas o crónicas.Se presenta el caso de una mujer de 71 años de edad con tres sarcomas granulocíticos en la esfera otorrinolaringológica.Hemos realizado una revisión sobre los distintos aspectos de esta entidad, incluyendo ciertas peculiaridades diagnósticas y las opciones terapeúticas descritas actualmente en la bibliografía (AU)

[Mortality in laryngeal cancer surgery]. / Mortalidad en la cirugía del cáncer de laringe.

UNLABELLED: The causes of death were studied in a series of 171 patients who died in a 5-year follow-up period, out of a total of 631 patients who underwent different surgical techniques for cancer of the larynx. MATERIAL AND METHODS: The case histories of 631 patients who had undergone surgery between 1974 and 1990 were reviewed; 83 did not have a 5-year follow-up and were excluded from the study. A descriptive and inferential statistical study was made of the remaining cases to determine the relation between cause of death and tumoral extension, primary location, degree of tumoral differentiation, surgical technique and other data. RESULTS: Ninety-one patients died from local or regional recurrence, 50 from distant metastases, 20 from diseases other than the tumor, and 10 from postoperative complications. These findings were studied with regard to factors such as tumor extension, location, surgical technique, etc. CONCLUSIONS: The main cause of death in surgery for cancer of the larynx was recurrence, either local, on the tumor bed (62 patients) or regional (29 patients). The mortality rate was higher in older patients, patients with lymph-node involvement in the postoperative histological study, and patients with less differentiated histological forms.

[Cogan's syndrome]. / Síndrome de Cogan. Presentación de un caso.

The association of non syphilitic interstitial keratitis with vestibulo-auditory symptoms was first described by Cogan in 1945. Owing to the rarity of this condition our opportunity of dealing with one of such cases is the reason for this paper, in which are contemplated besides the review of the published literature other points concerning the etiopathogenesis, the treatment and the follow-up of the disease.

[Primary extramedullary plasmacytomas of the upper respiratory tract. A study of four cases with infrequent localization]. / Plasmocitomas primarios de vías aerodigestivas altas. A propósito de cuatro casos.

OBJECTIVE: Assessment of the incidence, diagnosis and treatment of three patients afflicted of extramedullary plasmacytoma located in the Waldeyer's ring, and one case afflicted of maxillary sinus disease. PATIENTS: The localization of the masses was the palatine amygdala in two cases, and the rhinopharynx and maxillary sinus in the remaining two patients. Major symptoms were dysphagia respiratory failure with closed rhinolalia, and headache. Diagnosis was made by histological study of biopsied tissue. In every case, general illness or other site of localization were ruled out. RESULTS: In our casuistic, the incidence of primary extramedullary plasmacytoma in Waldeyer's ring is 1.2%. The patient's age were 45, 50, 62, and 73 years respectively, and the male/female ratio was 1. In those cases located in the tonsils, a bilateral tonsillectomy was performed. In the case located at the maxillary sinus, a sinus trepanation was performed according the Caldwell-Luc's technique, followed by local radiotherapy at doses of 40 Gy. In the case located at the rhinopharynx, radiotherapy was the only choice. These three different therapeutical procedures led to the disappearance of the disease, and, after a 12 to 53 month-period, patients remain asymptomatic. A patient died due to other causes not related to the illness.

[Hypernephroma metastasis in frontal sinus]. / Metástasis de hipernefroma en seno frontal.

PURPOSE: We present a case of metastatic neoplasia in the right frontal sinus derived from and hypernephroma, with a clinical picture that initially was interpreted as a mucocele. PATIENTS AND METHODS: Sixty years old male. Personal history: prostatectomy and left nephrectomy because of hypernephroma three years before. In december 92 the patient reported a protrusion in the right frontal sinus. CT scans and NMR revealed a breakage of the external and internal walls of the right frontal sinus and the right orbital roof. In february 93 a surgical exploration of the frontal sinus revealed the metastatic nature of the lesion. DISCUSSION: Metastatic tumors in paranasal sinuses are infrequent since most of the tumors in this localization are primary. Metastatic affectation of the frontal sinus is extremely rare. We recommend the systematic exploration of paranasal sinuses in patients affected by hypernephroma.