Hearing loss and vestibular function correlation in Menière's disease patients.

OBJECTIVES: To analyse the correlation between vestibular dysfunction and hearing level of patients diagnosed with Menière's disease. METHODS: Retrospective study on the correlation between hearing level and unilateral weakness in 100 Menière's disease patients. In order assess the effect of disease severity in such correlation, the study group included 50 patients who subsequently were treated with oral medication and 50 who later received intratympanic gentamicin to control their symptoms. Audiogram and caloric tests were performed before beginning both of the treatments. Patients were classified according to the AAO-HNS guidelines. Handicap was assessed with the Functional Level of the AAO-HNS and the Dizziness Handicap Inventory. RESULTS: No correlation was found between pure tone average and canal paresis neither when patients were analysed as a whole nor when correlation was controlled for the treatment installed afterwards. Nevertheless, when they were grouped by hearing loss AAO-HNS stages, we found a greater canal paresis in those with a higher hearing loss (groups 3 and 4). CONCLUSION: No correlation was found between hearing loss and canal paresis of patients diagnosed with Menière's disease. However patients with a higher amount of hearing damage have a tendency to abnormal caloric results.

[Facial solitary infantile myofibromatosis]. / Miofibromatosis infantil solitaria de la cara.

Infantile myofibromatosis is an infrequent and benign pathology. It can turn up as a single or multiple tumour. The prognosis depends on visceral involvement. The differential diagnosis includes some pathologies with similar clinical appearance but worse prognosis. We report a 6 months old boy that arrived to our office refering a short progress and fast growth facial mass. The diagnosis after hystologic study and immunohistochemistry was infantile myofibromatosis. After more than a year of monitoring he is actually disease free.

Miofibromatosis infantil solitaria de la cara / Facial solitary infantile myofibromatosis

La miofibromatosis infantile es una patología benigna poco frecuente. Puede presentarse en forma de tumor único o múltiple. El pronóstico varía según la afectación visceral. Se debe diferenciar de otras entidades clínicamente similares que presentan peor pronóstico. Presentamos el caso de un varón de 6 meses con una tumoración facial de corta evolución y rápido crecimiento. Fue diagnosticado de miofibromatosis infantil tras estudio histológico de la pieza, confirmado mediante inmunohistoquímica. Tras más de un año de seguimiento el paciente sigue libre de enfermedad

Infantile myofibromatosis is an infrequent and benign pathology. It can turn up as a single or multiple tumour. The prognosis depends on visceral involvement. The differential diagnosis includes some pathologies with similar clinical appearance but worse prognosis. We report a 6 months old boy that arrived to our office refering a short progress and fast growth facial mass. The diagnosis after hystologic study and immunohistochemistry was infantile myofibromatosis. After more than a year of monitoring he is actually disease free

[Peritonsillar infection. Out-patient management]. / Infecciones del espacio periamigdalar. Manejo ambulatorio.

INTRODUCTION: Peritonsillar infections are the most frequent deep infections in head and neck. The estimated annual incidence is 30 cases per 100.000 inhabitants. PATIENTS AND METHODS: A retrospective study was undertaken in 132 patients with peritonsillar infection. A diagnostic and therapeutic protocol was used consisting on diagnostic needle aspiration, incision and drainage and intravenous antibiotic and steroids. RESULTS: 35,6% were peritonsillar phlegmons and 64,4% were abscesses. The median of hospital monitoring was 9,2 hours. Only 25,8% were admitted to the hospital. Six patients had recurrences of the symptoms during the study. DISCUSSION: The needle aspiration is useful in differential diagnosis between phlegmons and abscesses. Bacteriologic studies are not necessary in the routine management of peritonsillitis. Surgical treatment of these patients is controversial. Incision and drainage seems to be appropiated in the management of this pathology. Admission to the hospital is not always necessary if a correct outpatient control is possible.

[Parotid gland myoepitheliomas. Differential diagnosis with pleomorphic adenoma]. / Mioepiteliomas de glándula parótida. Diagnóstico diferencial con el adenoma pleomorfo.

Myoepitheliomas are rare benign tumours of head and neck. The parotid gland is the most common site of origin. It consists on proliferation of myoepithelial cells and it shows some features similar to preomorphic adenoma although the ductal elements are very low. Diagnosis requires histology and immunohistochemistry because fine needle aspiration often shows erroneous results. Limited parotidectomy is the choice treatment. We report two cases of parotid gland myoepithelioma confirmed by immunohistochemistry.

Infecciones del espacio periamigdalar. Manejo ambulatorio / tittle

Introducción: las infecciones periamigdalares son las infecciones profundas más frecuentes de cabeza y cuello. Se estima una incidencia anual de 30 casos por 100.000 habitantes. Material y Métodos: realizamos un estudio retrospectivo de 132 casos de infección periamigdalar. Se aplicó un protocolo diagnóstico y terapéutico mediante punción aspirativa, incisión y drenaje y tratamiento con antibiótico y glucocorticoide. Resultados: el 35,6% son flemones y el 64,4% son abscesos periamigdalares. La mediana de estancia hospitalaria de los pacientes fue de 9,2 horas. Únicamente un 25,8% requirieron ingreso hospitalario. En 6 pacientes se produjo más de un episodi. Discusión: para diferencial si se trata de un flemón o absceso se puede hacer una punción aspirativa. Los estudios microbiológicos no se consideran necesarios de forma rutinaria. El tratamiento de estos pacientes es controvertido. La incisión y drenaje parece ser una buena opción para el manejo de la patología. El ingreso hospitalario no es necesario si es posible realizar un correcto control ambulatorio

Introduction: Peritonsillar infections are the most frequent deep infections head and neck. The estimated annual incidence is 30 cases per 100.000 inhabitants. Patients and methods: A retrospective study was undertaken in 132 patients with peritonsillar infection. A diagnostic and therapeutic protocol was used consisting on diagnostic neddle aspiration, incision and drainage and intravenous antibiotic and steroids. Results: 35,6% were peritonsillar phlegmons and 64,4% were abscesses. The median of hospital monitoring was 9,2 hours. Only 25,8% were admitted to the hospital. Six patients had recurrences of the symptoms during the study. Discussion: The needle aspiration is useful in differential diagnosis between phlegmons and abscesses. Bacteriologic studies are not necessary in the routine management of peritonsillitis. Surgical treatment of these patients is controversial. Incision and drainage seems to be appropiated in the management of this pathology. Admission to the hospital is not always necessary if a correct outpatient control is possible

Mioepiteliomas de glándula parótida. Diagnóstico diferencial con el adenoma pleomorfo / Parotid gland myoepitheliomas. Differential diagnosis with pleomorphic adenoma

Los mioepiteliomas son tumores benignos poco frecuentes de cabeza y cuello. El lugar de aparición más frecuente es la glándula parótida. Están formados por la proliferación de células mioepiteliales. Presentan algunas características que los asemejan a los adenomas pleomorfos, pero el componente ductal es muy inferior. El diagnóstico requiere el estudio, histológico e inmunohistoquímico porque a menudo la PAAF arroja resultados erróneos. El tratamiento de elección es la parotidectomía limitada. Presentamos 2 casos clínicos de mioepitelioma de glándula parótida confirmados mediante estudio inmunohistoquímico

Myoepithelioma are rare benign tumours of head and neck. The parotid gland is the most common site of origin. It consists on proliferation of myoepithelial cells and it shows some features similar to pleomorphic adenoma although the ductal elements are very low. Diagnosis requires histology and immunohistochemistry because fine ceedle aspiration often shows erroneous results. Limited parotidectomy is the choice treatment. We report two cases of parotid gland myoepithelioma confirmed by immunohistochemistry

[Importance of laser in the surgical technique of otosclerosis and its results]. / Importancia del láser en la técnica quirúrgica de la otosclerosis y sus resultados.

The authors bring up the matter of the usefulness of laser in otosclerosis surgery. They set out some advantages of laser utilization. A bibliografic review is done and some important authors are found explaining the advantages of this instrument. Some new tendencies on stapes surgery are presented. Teaching on otosclerosis surgery problems are stated, with some different criteria. The idea that improvement of audiologic results in stapes surgery is not easy is strengthened, because the results obtained with the classic techniques are excellent, but some of these methods increase the surgical comfort and reduce the potential risks to the patient.

[Extramedullary plasmacytoma of the nasopharynx. Typical versus atypical presentation]. / Plasmocitoma extramedular de nasofaringe. Presentación tipica versus presentación atípica.

Extramedullary plasmacytoma are rare plasma cell neoplasias. Eighty percent of these tumours grow in the ENT region. We report a typical case of a woman with a single tumour in the nasopharynx. Actually she is in complete remission after surgical and radiotherapic treatment. We also report an atypical case of a woman with a tumour in the nasopharynx associated with a cervical metastatic adenopathy and a plasmacytoma of bone. The treatment of this widespread disease was systemic chemotherapy. An update on this subject is done.

[Malleostapedotomy in the pathology of the incudomalleolar complex combined with fixation of the stapes]. / Tratamiento de la patología del complejo incudomaleolar combinada con fijación del estribo mediante maleoestapedotomía.

INTRODUCTION: Stapes fixation combined with disorders of the incudo-malleolar complex disorders requires a sound transmission reconstruction that often is difficult to solve. This circumstance can turn up in several pathologies and also in revision surgery for otosclerosis. PATIENTS AND METHODS: We present our experience with four patients that underwent to malleostapedotomy with removal of the malleus anterior ligament and the malleus anterior apophysis. RESULTS: We discuss the previous findings in each case. Two patients reached a gap closure and the other two patients obtained an auditive gain without complete gap closure. DISCUSSION: We set out the ethiology of malleus and incus hipomobility. We do a bibliographic review on the results of this technique in revision stapedectomy.

Importancia del láser en la técnica quirúrgica de la otosclerosis y sus resultados / Importance of laser in the surgical technique of otosclerosis and its results

Los autores plantean la utilización del láser en la cirugía. Se revisa la literatura, en la que se encuentran autores que nos hablan de las ventajas que supone la utilización de este instrumento. También se recogen nuevas tendencias en la cirugía del estribo. Se plantea la enseñanza de la cirugía de la otosclerosis, con diferentes criterios. Se refuerza la idea de que es dificil mejorar los rendimientos auditivos, ya que los que se obtienen con técnicas clásicas son excelentes, pero si que se mejora la comodidad y se disminuyen los riesgos

The authors bring up the matter of the usefulness of laser in otosclerosis surgery. They set out some advantages of laser utilization. A bibliografic review is done and some important authors are found explaining the advantages of this instrument. Some new tendencies on stapes surgery are presented. Teaching on otosclerosis surgery problems are stated, with some different criteria. The idea that improvement of audiologic results in stapes surgery is not easy is strengthened, because the results obtained with the classic techniques are excellent, but some of these methods increase the surgical comfort and reduce the potential risks to the patient

Plasmocitoma extramedular de nasofainge / Extramedullary plasmacytoma of the nasopharinx. Typical versus atypical presentation

Los plasmocitomas extramedulares son neoplasias de células plasmáticas poco frecuentes. El 80% de estos tumores se originan en el territorio ORL. Presentamos un caso típico de una mujer con un tumor único en nasofaringe. Actualmente está en remisión completa tras cirugía y radioterapia. También presentamos un caso muy atípico de una mujer con un tumor en nasofaringe asociado a una adenopatía metastásica cervical y un foco de plasmocitoma óseo. En este caso debió realizarse tratamiento sistémico con quimioterapia. Realizamos una actualización sobre el tema

Extramedullary plasmacytoma are rafe plasma cell neoplasias. Eighty percent of these tumours grow in the ENT region. We report a typical case of a woman with a single tumour in the nasopharynx. Actually she is in complete remission after surgical and radiotherapic treatment. We algo report an atypical case of a woman with a tumour in the nasopharynx associated with a cervical metastatic adenopathy and a plasmacytoma of bone. the treatment of this wide spread disease was systemic chemotherapy. An update on this subject is done

Tratamiento de la patología del complejo incudomaleolar combinada con fijación del estribo mediante maleoestapedotomía / Malleostapedotomy in the pathology of the incudomalleolar complex combined with fixation of the stapes

Introducción: La fijación del estribo combinada con trastornos del complejo incudo-maleolar requiere una reconstrucción de la transmisión del sonido, que, a menudo, resulta difícil de resolver. Esta situación puede presentarse en diversas patologías u observarse en revisiones de estapedectomía. Pacientes y métodos: Presentamos nuestra experiencia de cuatro pacientes en los que hemos realizado una maleoestapedotomía, con eliminación del ligamento anterior y la apófisis anterior del mango del martillo. Resultados: Comentamos los hallazgos observados en cada uno de los casos, previos a la realización de la técnica. En dos casos se consiguió un cierre del umbral diferencial audiométrico, mientras en los otros dos se obtuvo una mejoría auditiva sin cierre completo. Discusión: Exponemos las distintas causas que pueden originar la hipomovilidad del martillo y del yunque. Realizamos una revisión de la literatura sobre los resultados obtenidos mediante esta técnica en revisiones de estapedectomía

Introduction: Stapes fixation combined with disorders of the incudo-malleolar complex disorders requires a sound transmission reconstruction that often is difficult to solve. This circumstance can turn up in several pathologies and also in revision surgery for otosclerosis. Patients and methods: We present our experience with four patients that underwent to malleostapedotomy with removal of the malleus anterior ligament and the malleus anterior apophysis. Results: We discuss the previous findings in each case. Two patients reached a gap closure and the other two patients obtained an auditive gain without complete gap closure. Discussion: We set out the ethiology of malleus and incus hipomobility. We do a bibliographic review on the results of this technique in revision stapedectomy

[Cidofovir activity in infantile recurrent respiratory papillomatosis]. / Actividad del cidofovir en la papilomatosis respiratoria infantil recidivante.

We report the case of a 4 year old boy that arrived to our department refering a 4 months history of dysphony complicated in the last week with inspiratory estridor. He was diagnosed of respiratory papillomatosis. In the next 10 months he underwent 6 operations to remove papillomas with CO2 laser. In the last operation we decided to add adjuvant therapy with intralesional injections of cidofovir once all papillomas had been removed. After more than a year of monitoring he remains disease free.

Actividad del cidofovir en la papilomatosis respiratoria infantil recidivante / Cidofovir activity in infantile recurrent respiratory papillomatosis

Presentamos el caso de un varón de 4 años que acude a nuestra consulta por presentar disfonía de 4 meses de evolución que en la última semana se ha complicado con estridor inspiratorio. Es diagnosticado de papilomatosis respiratoria. En los siguientes 10 meses es sometido a 6 intervenciones para resección de papilomas con láser CO2. En la última intervención se decide realizar terapia adyuvante mediante inyección intralesional cidofovir en el lecho resultante tras la exéresis. Tras más de un año de seguimiento el paciente permanece libre de enfermedad

We report the case of a 4 year old boy that arrived to our department refering a 4 months history of dysphony complicated in the last week with inspiratory estridor. He was diagnosed of respiratory papillomatosis. In the next 10 months he underwent 6 operations to remove papillomas with CO2 laser. In the last operation we decided to add adjuvant therapy with intralesional injections of cidofovir once all papillomas had been removed. After more than a year of monitoring he remains disease free

Are some ear drops ototoxic or potentially ototoxic?

In this article we review the literature concerning the capacity of certain substances to cause ototoxicity when administered topically. The ototoxicity experimentally observed in animals only occurs in humans under certain circumstances. It is concluded that many of these products. which are commonly used for treatment in humans, are ototoxic in animals and may also be ototoxic in humans. Therefore, the use of other substances which have the same action but are not ototoxic

Drug-induced otoxicity: current status.

We carried out a review of the literature published over the last 10 years on drug-induced ototoxicity by means of a Medline search using the terms 'clinical ototoxicity' for the period January 1990 to September 2000 and found 414 published articles. In order to summarize the content of these articles, we asked ourselves a series of nine questions and answered them based on the most widely-held views and those we considered of greatest interest in the articles reviewed. The questions asked were: what are the most commonly used ototoxic drugs? what is the site of action of ototoxic drugs? what is the importance of the dose and dosing interval? does age influence ototoxicity? are all humans equally prone to the ototoxic effects of drugs? are there substances that are protective against ototoxicity? can hearing loss be monitored? should hearing loss be attributed to ototoxic drugs in all cases? and is ototoxicity in animals the same as in humans?

Otoxicidad producida por medicamentos. Estado actual / Drug-induced ototoxicity. Current state of matter

Realizamos una revisión de la literatura en los 10 últimos años, sobre la ototoxicidad inducida por fármacos. Para ello hemos usado el Medline y hemos encontrado que desde 1990 hasta septiembre del año 2000, con las palabras Clinical Ototoxicity se encuentran 414 artículos publicados. Para resumir mejor el contenido de los artículos, nos hemos formulado una serie de nueve preguntas a las que hemos ido respondiendo con las opiniones más generalizadas y que nos han parecido de más interés de entre las revisadas en los diversos artículos. Las preguntas formuladas son las siguientes: ¿Cuales son los ototóxicos de uso más habitual? Los ototóxicos ¿a qué nivel producen su ototoxicidad? ¿Cuál es la importancia de las dosis y la cadencia de administración? ¿La edad influye en la ototoxicidad? ¿Tienen todos los humanos la misma predisposición a padecer los efectos ototóxicos de los medicamentos? ¿Existen substancias protectoras frente a la ototoxicidad? ¿Es posible monitorizar la pérdida auditiva? ¿Se debe atribuir la pérdida auditiva a los ototóxicos en todos los casos? ¿La ototoxicidad en los animales es igual que en el humano? (AU)