[Positional vertigo. Symptom, clinical sign, or disease?]. / Vértigo posicional. Síntoma, signo o enfermedad?

INTRODUCTION: We present a prospective study with the aim of assessing the differences found between position-triggered vertiginous syndromes, those diagnosed as benign paroxysmal positional vertigos (BPPV) in primary care and non-specific clinics, and those classified as BPPV at an otoneurology unit. PATIENTS AND METHOD: Over a 17 month period, 432 consecutive patients were included after evaluation at a otoneurology unit receiving all referrals for vestibular pathologies. The existence of trigger factors was investigated, as was the distribution of the diagnoses associated with a positional trigger. The characteristics of the patients with a final diagnosis of BPPV were also studied. RESULTS: Of this population, 217 patients (50.23%) reported a positional change as the trigger for their symptoms, 106 (24.53%) were referred from their initial care centres with a diagnosis of BPPV, and 128 (29.62%) were classified as truly BPPV. The coincidence between the preliminary diagnosis and the definitive one was 52.8%. A history of positional paroxysmal vertigo during seconds was linked to BPPV in 78% of cases. Only in 4.7% of the BPPV cases diagnosed at the otoneurology unit had provoking manoeuvres been performed. CONCLUSIONS: We have found that an adequate anamnesis is capable of providing accurate guidance for diagnostic purposes in most cases of BPPV, but the performance of provoking manoeuvres and the correct specific treatment for this pathology is of paramount importance when classifying a patient with suspected BPPV.

Vértigo posicional. ¿Síntoma, signo o enfermedad? / Positional vertigo. Symptom, clinical sign, or disease?

Introducción: Presentamos un estudio prospectivo para valorar las diferencias encontradas entre los síndromes vertiginosos de desencadenante posicional, los cuadros diagnosticados como vértigo posicional paroxístico benigno (VPPB) por médicos de atención primaria y consultas no específicas, y los diagnosticados de VPPB en una unidad de otoneurología. Pacientes y método: Se estudió a 432 pacientes atendidos de forma consecutiva durante 17 meses en una unidad de otoneurología que recibe a todos los pacientes derivados al servicio de otorrinolaringología por afección vestibular. Se investigó si había factores desencadenantes y se valoró la distribución de los diagnósticos relacionados con un desencadenante posicional. También se estudió las características de los pacientes con diagnóstico final de VPPB. Resultados: Referían síntomas desencadenados por los cambios de posición 217 (50,23 %) pacientes; 106 (24,53 %) fueron remitidos con diagnóstico de VPPB establecido en sus centros de referencia, y 128 (29,62 %) resultaron ser VPPB realmente. La coincidencia entre el diagnóstico de derivación y el definitivo fue del 52,8 %. La historia clínica de vértigo posicional paroxístico de segundos de duración coincidió con el diagnóstico de VPPB en el 78 % de los casos. Solamente en el 4,7 % de los VPPB diagnosticados en la unidad de otoneurología se habían realizado maniobras de provocación antes de la derivación. Conclusiones: El adecuado interrogatorio del paciente puede aportar una orientación diagnóstica precisa en la mayor parte de los casos de VPPB, aunque la realización de maniobras de provocación y tratamientos adecuados y específicos para esta afección es de vital importancia para la correcta clasificación de los pacientes con sospecha de este cuadro

Introduction: We present a prospective study with the aim of assessing the differences found between position-triggered vertiginous syndromes, those diagnosed as benign paroxysmal positional vertigos (BPPV) in primary care and non-specific clinics, and those classified as BPPV at an otoneurology unit. Patients and method: Over a 17 month period, 432 consecutive patients were included after evaluation at a otoneurology unit receiving all referrals for vestibular pathologies. The existence of trigger factors was investigated, as was the distribution of the diagnoses associated with a positional trigger. The characteristics of the patients with a final diagnosis of BPPV were also studied. Results: Of this population, 217 patients (50.23 %) reported a positional change as the trigger for their symptoms, 106 (24.53 %) were referred from their initial care centres with a diagnosis of BPPV, and 128 (29.62 %) were classified as truly BPPV. The coincidence between the preliminary diagnosis and the definitive one was 52.8 %. A history of positional paroxysmal vertigo during seconds was linked to BPPV in 78 % of cases. Only in 4.7 % of the BPPV cases diagnosed at the otoneurology unit had provoking manoeuvres been performed. Conclusions: We have found that an adequate anamnesis is capable of providing accurate guidance for diagnostic purposes in most cases of BPPV, but the performance of provoking manoeuvres and the correct specific treatment for this pathology is of paramount importance when classifying a patient with suspected BPPV

[Influence of non-neuronal factors on post-thyroidectomy dysphonia]. / Influencia de factores no neuronales en la disfonía tras tiroidectomía.

OBJECTIVES: We present a prospective study assessing the real incidence, aetiology, and evolution of vocal impairment following total thyroidectomy. PATIENTS AND METHOD: Sixty-six patients who underwent total thyroidectomy between 2003 and 2006 were included, recording demographic and analytic variables, with emphasis on subjective vocal changes observed after surgery, measured by means of the GRABS scale. A control group of 25 patients operated under general anaesthesia and oro-tracheal intubation was chosen using random sampling. RESULTS: In 30 patients (45.5 %), post-operative dysphonia was observed. Among these, only 2 (3 %) were permanent, and 11 were due to nerve damage (10 inferior and 1 superior laryngeal nerves). In 8 patients (12.2 %), GRABS score was above 5. In the rest of these 30 patients, the complaint was a single decreased tone (10 cases), lack of intensity (9 cases) and vocal fatigue (3 cases), always with a GRABS score equal to or less than 2 points. The most significantly related factor with the onset of dysphonia was the section of strap muscles (OR=12.5). CONCLUSIONS: Dysphonia is a common complication of total thyroidectomy, but its incidence is not always related to nerve injury. Some technical (and sometimes avoidable) factors, such as the section of prelaryngeal muscles, could have an important relationship with this adverse event.

Influencia de factores no neuronales en la disfonía tras tiroidectomía / Influence of non-neuronal factors on post-thyroidectomy dysphonia

Objetivos: Presentamos un estudio prospectivo para valorar la incidencia real de los trastornos vocales en la tiroidectomía total, así como su posible etiología y su evolución. Pacientes y método: Se incluyó en el estudio a 66 pacientes intervenidos de tiroidectomía total entre 2003 y 2006. Se comprobó en cada caso variables referidas a los cambios vocales, subjetivos y medidos atendiendo a la escala GRABS, aparecidos tras la intervención. Como grupo control se empleó una selección aleatoria de 25 pacientes intervenidos con anestesia general e intubación orotraqueal sin afección cervical. Resultados: De 30 (45,5 %) pacientes en que se desarrolló disfonía postoperatoria, sólo 2 (3 %) fueron definitivas y 11 se explicaron por lesión nerviosa (10 laríngeos inferiores y 1 superior). En 8 (12,2 %) pacientes la puntuación en la escala GRABS fue > 5. El resto de estos 30 pacientes refirió cambios vocales postoperatorios por disminución del tono (10 casos), de la intensidad (9 casos) o fatiga vocal (3 casos) de forma aislada, y con una repercusión en la escala GRABS siempre <= 2 puntos. La única variable estudiada que mostró una relación significativa con la aparición de cambios vocales postoperatorios fue la sección de músculos prelaríngeos (odds ratio = 12,5). Conclusiones: La relación de las disfonías con la tiroidectomía total es bien conocida, aunque encontramos una incidencia mucho mayor que la explicada simplemente por la lesión nerviosa. Factores técnicos (y en ocasiones evitables), como la sección de músculos prelaríngeos, podrían tener una relación importante con este evento postoperatorio

Objetives: We present a prospective study assessing the real incidence, aetiology, and evolution of vocal impairment following total thyroidectomy. Patients and method: Sixty-six patients who underwent total thyroidectomy between 2003 and 2006 were included, recording demographic and analytic variables, with emphasis on subjective vocal changes observed after surgery, measured by means of the GRABS scale. A control group of 25 patients operated under general anaesthesia and oro-tracheal intubation was chosen using random sampling. Results: In 30 patients (45.5 %), post-operative dysphonia was observed. Among these, only 2 (3 %) were permanent, and 11 were due to nerve damage (10 inferior and 1 superior laryngeal nerves). In 8 patients (12.2 %), GRABS score was above 5. In the rest of these 30 patients, the complaint was a single decreased tone (10 cases), lack of intensity (9 cases) and vocal fatigue (3 cases), always with a GRABS score equal to or less than 2 points. The most significantly related factor with the onset of dysphonia was the section of strap muscles (OR=12.5). Conclusions: Dysphonia is a common complication of total thyroidectomy, but its incidence is not always related to nerve injury. Some technical (and sometimes avoidable) factors, such as the section of prelaryngeal muscles, could have an important relationship with this adverse event