[Diode laser surgery in the endoscopic treatment of laryngeal paralysis]. / Tratamiento quirúrgico endoscópico con láser diodo de la parálisis laríngea en addución.

Several surgical procedures have been proposed for the treatment of respiratory distress secondary to bilateral vocal cord paralysis. The aim of all surgical techniques used is to restore a glottic lumen sufficient to guarantee adequate breathing through the natural airway, without tracheotomy and preserving an acceptable phonatory quality. In this study we present our experience from 1998 to 2004 concerning the use of the diode contact laser for a modified Dennis-Kashima posterior endoscopic cordectomy (extended to the false homolateral chord in 3 cases and to the homolateral arytenoid vocal process in 6 cases). 18 patients (15 male, 3 female) were treated; the age range was 35-84 years. The etiology of paralysis varied: iatrogenic post-thyroidectomy and post-thoracic surgery in 5 cases (28%), post-traumatic in 2 cases (11%), secondary to a central lesion in 11 (61%). The operation was carried out with a diode contact laser (60W; 810 nm). Follow-up was 20 months. Dyspnea improved in all patients; the 9 tracheostomized patients were decannulated within 2 months after surgery. Final voice quality was subjectively good in 16 patients (88%). None of patients had any complications after surgery. In conclusion, the endoscopic posterior cordectomy performed by contact diode laser is an effective and reliable method for the treatment of dyspnea secondary to bilateral laryngeal paralysis, guaranteing a sufficient airway without impairing swallowing and maintaining acceptable voice quality.

[Nasal malignant meningioma]. / Meningioma maligno nasal. manejo de un caso y revisión de la literatura.

Extracraneal meningiomas represent 2% of all meningiomas and can appear in different locations including paranasales sinuses. There are no statistics regarding ectopic malignant meningiomas, but they are considered extremely rare. Due to this, there is no management protocol. We present a patient with a malignant meningioma of the etmoidal sinus, his treatment and the evolution over a five year period.

[Combined intratympanic and intravenous dexomethasone to control vertigo in Meniere disease]. / Dexometasona vía combinada intratimpática-intravenosa para el control del vértigo en la enfermedad de Meniere.

OBJECTIVE: To verify the result in the use of intratympanic corticosteroids, combined with intravenous, in patients with Meniere disease (MD). MATERIAL AND METHODS: Ten patients with vertigo due to MD in stages 4-5 or 6 were included in the study. Combined intratympanic and intravenous dexamethasone was infiltrated. The number of episodes among the months 18 and 24 of treatment, comparing them with the number of episodes 6 months before treatment (according to the norms of the American committee for the hearing and the equilibrium, 1995) are studied. RESULTS: All patients improved significantly. In one of them treatment was repeated after 6 months. A number of patients with hearing improvement were observed. CONCLUSIONS: The use of combined dexamethasone may be useful to control vertigo due to MD, to avoid or to be a prior step to other more aggressive treatments.

[Surgical treatment of inferior turbinate hypertrophy with argon plasma: a long-term follow-up in 157 patients]. / Tratamiento quirúrgico de la hipertrofia de cornetes inferiores con plasma de argón: estudio a largo plazo con 157 pacientes.

Surgical treatment of the inferior turbinate in patients with chronic hypertrophic rhinitis that does not respond to medical treatment is a well established procedure. CO2 laser, YAG laser, KTP laser, conventional electrocautery, cryotherapy, chemosurgery and turbinectomy or submucosal turbinectomy have been performed for the removal of nasal obstruction. Argon Plasma Coagulation (APC) is a new, innovative technique in Otorhinolaryngology which is based on high-frequency electrocoagulation with an argon-gas source. The shorter surgical times, the absence of hemorrhagic complications and, in rhinosurgery, not requiring any kind of nasal packing are remarkable. Between March and November 2000, a group of 157 patients with symptoms of nasal obstruction due to hypertrophic inferior turbinates were treated using APC, at the Otorhinolaryngology Surgical Department of the Hospital of Dolo (Venice). The follow-up period was 24 months. Rhinomanometry was performed to objectively measure the nasal obstruction and to verify the postoperative improvement. The Student t-test was used for statistical data. After 24 months, 87% (p < 0.001) of patients reported to have a better nasal airflow than before the operation. None of the patients needed a nasal packing after APC surgery. We review and discus the indication, advantages, complications, controversies and long-term results of the treatment with APC in rhinosurgery.

[Chronic pharyngitis and macrolides]. / Faringitis crónica y macrólidos.

We have noticed that macrolides can improve the main symptoms of many patients with chronic pharyngitis. We feel that the efficacy of macrolides for chronic pharyngitis can be due to the anti-inflammatory effect of this group of antibiotics. However, we think that at present the use of macrolides is not the therapy of choice for chronic pharyngitis.

["Irritative" pathology of the external auditory canal and decreased sound sensation]. / Patología "irritativa" del conducto auditivo externo y disminución de la sensación sonora.

We have not found in the literature an explanation for the intermittent and transient decreased lesser hearing sensation in patients with dysesthesia of the external auditory canal (EAC). In this paper we offer a possible explanation for it. Our hypothesis is that the stimulation of the sensory fibers of the trigeminal and facial nerves in the EAC is able to increase the stiffness of the ossicular chain by means of a reflex stimulation of malleus and stapes muscles. This intermittent and transient increase of the ossicular stiffness could explain the intermittent and transient decrease of hearing sensation in these patients.

[Diagnostic and therapeutic management of headache caused by nasal contact]. / Manejo diagnóstico y tratamiento de las cefaleas por contacto nasal.

Since 1948, contact between two nasal structures has been accepted as a source of facial pain and numerous medical and surgical techniques have been used to alleviate it. We report a series of 15 patients with unilateral headache and contact between two nasal structures. All patients were tested with topical anesthetic to confirm the diagnosis. Diverse surgical techniques were used depending on the structures involved. In every case, surgery resolved or alleviated headaches.

[Electrophysiological study of cochlear damage in early otosclerosis and after stapedial surgery]. / Estudio electrofisiológico del daño coclear en la otoesclerosis precoz y tras cirugía estapedial.

Otoesclerotic patients usually have neurosensorial hearing toss in addition to a predominantly conductive impairment, but there is no universally accepted explanation for this abnormality. The bone conduction threshold in tonal audiometry is accepted as a test of cochlear function. An early evaluation of damage to the cochlea arid acoustic nerve after surgery was made by studying 99 ears with BERA and latency/intensity curves to test cochlear function. We concluded that early damage was present. Postoperative cochlear damage was found in spite of successful surgery, but it was no greater than the damage present before surgery.

[Subcutaneous sinusoid cavernous hemangioma of the outer ear. Review of literature]. / Hemangioma cavernoso sinusoidal subcutáneo de pabellón auricular. Revisión de la literatura.

Hemangionas of the ear have been rarely described. A few cases have been reported in the world literature involving the middle ear space or tympanic membrane, and a few more involving the inner ear. Cavernous hemangioma often is associated with other hemangiomas, and there is almost always a cutaneous segment that facilitates the diagnosis. The authors report a rare case (to their knowledge, the first to be described) of a subcutaneous cavernous hemangioma of the auricular concha. The diagnosis and treatment are discussed and the literature is reviewed.