[Present situation of antibiotic resistances in tonsillar infections]. / Situación actual de las resistencias a antibióticos en infecciones amigdalares.

OBJECTIVE: To obtain the main responsible organisms, its sensitivity and resistances to antibiotics in tonsillitis. MATERIAL AND METHODS: We have studied the post-surgical tonsils, carrying out a microbiologic study, its culture and sensitivity. RESULTS: The most frequent isolated organisms were Staphylococcus aureus (29.3%), followed by Streptococcus pyogenes (23.4%), and Haemophilus influenzae (12.1%). The highest resistances were for the S. aureus (penicillin 91%, erythromycin 18% and 5% to the rest of the beta-lactams), followed by H. influenzae (50% clarithromycin, 30% amoxyciIlin and 2% cephalosporins) and S. pyogenes (28% erytromycin, 10% clindamycin and 3% penicillin). CONCLUSIONS: We noticed the minimal resistance found to cephalosporins, and for this reason they appear to be the safest option, except in children under five years old, in which amoxicillin is still the first line treatment, because the causative agent is S. pyogenes, sensitive to that antibiotic.

Situación actual de las resistencias a antibióticos en infecciones amigdalares / Present situation of antibiotic resistances in tonsillar infections

Objetivo: Obtener los principales microorganismos y resistencias a antibióticos en infecciones amigdalares. Material y métodos: Realizamos un estudio microbiológico con antibiograma de amígdalas palatinas postquirúrgicas. Resultados: Los microorganismos más aislados han sido el Staphylococcus aureus (29,3%) seguido del Streptococcus pyogenes (23,4%), y del Haemophilus influenzae (12,1%). Las mayores resistencias fueron para el S. aureus (91% a la penicilina, 18% a la eritromicina y un 5% al resto de β-lactámicos), seguido del H. influenzae (50% a la claritromicina, 30% a la amoxicilina y 2% a cefalosporinas) y por último el S. pyogenes (28% a la eritromicina, 10% a la clindamicina y 3% a la penicilina). Conclusiones: Destacamos la mínima resistencia encontrada a las cefalosporinas por lo que parece ser el grupo antibiótico más seguro, excepto en los niños menores de 5 años en los cuales la amoxicilina sigue siendo de primera elección dado que están provocadas por S. pyogenes sensibles a dicho antibiótico

Objective: To obtain the main responsible organisms, its sensitivity and resistances to antibiotics in tonsillitis. Material and methods: We have studied the post-surgical tonsils, carrying out a microbiologic study, its culture and sensitivity. Results: The most frequent isolated organisms were Staphylococcus aureus (29.3%), followed by Streptococcus pyogenes (23.4%), and Haemophilus influenzae (12.1%). The highest resistances were for the S. aureus (penicillin 91%, erythromycin 18% and 5% to the rest of the β-lactams), followed by H. influenzae (50% clarithromycin, 30% amoxycillin and 2% cephalosporins) and S. pyogenes (28% erytromycin, 10% clindamycin and 3% penicillin). Conclusions: We noticed the minimal resistance found to cephalosporins, and for this reason they appear to be the safest option, except in children under five years old, in which amoxicillin is still the first line treatment, because the causative agent is S. pyogenes, sensitive to that antibiotic

[Clinical and performance results of functional endoscopic sinus surgery]. / Resultados clínicos y asistenciales de la cirugía endoscópica nasosinusal.

Our aim was to know the clinical performance and management results of Functional Endoscopic Sinus Surgery (FESS) in Spanish hospitals. We sent a survey on the use and results of FESS to 160 Spanish public hospitals in June of 2002, obtaining a response rate of 69%. 82.9% of the interviewed hospitals carried out FESS and 17.1% of the remaining used the classic techniques of approaching the paranasal sinuses. The reported length of stay in hospital was 1.4 days for the FESS and 2.4 for the traditional surgery. The surgical time was 15 minutes shorter for the CENS, and the rate of recurrence was 16% less than for the classic surgery. As years of experience in the practice of the CENS go by, the surgical times tend to decrease, that didn't happen with the rate of recurrence. In conclusion, we consider that FESS seems to improve the analyzed clinical performance and assistential results.

[The implementation of endoscopic sinus surgery in Spain]. / Implantación de la cirugía endoscópica nasosinusal en España.

The purpose of this study is to find out more about the implementation of functional endoscopic sinus surgery (FESS) in our country. To do that, we designed a survey which was sent to 160 public hospitals (June 2002). We received the answers of 111 hospitals. 82.9% of hospitals and 58% of surgeons performed FESS, with some differences among autonomic regions. The percentage of surgeons who performed FESS was higher in small hospitals and their mean experience time was 6.2 years. We consider the implementation of endoscopic sinus surgery very high, this can reflect that there are evident advantages for those who specialists who use it.

Resultados clínicos y asistenciales de la cirugía endoscópica nasosinusal / Clinical and performance results of functional endoscopic sinus surgery

Nuestro objetivo fue conocer los resultados clínicos y asistenciales de la Cirugía Endoscópica Nasosinusal (CENS) en hospitales españoles. Enviamos una encuesta sobre su utilización y resultados a 160 hospitales públicos españoles en junio de 2002, obteniendo una tasa de respuesta del 69 por ciento de los centros. El 82,9 por ciento de los hospitales encuestados realizaba CENS y el 17,1 por ciento restante utilizaba las técnicas clásicas de abordaje de senos paranasales. La estancia media hospitalaria declarada fue de 1,4 días para la CENS y 2,4 para la cirugía tradicional. El tiempo quirúrgico medio fue 15 minutos menor para la CENS, obteniéndose un 16 por ciento menos de recidivas frente a la cirugía clásica. A más años de experiencia en la práctica de la CENS, los tiempos quirúrgicos tienden a reducirse, lo que no ocurrió con el porcentaje de recidivas. En conclusión, consideramos que la CENS parece mejorar los parámetros clínicos y asistenciales analizados (AU)

Our aim was to know the clinical performance and management results of Functional Endoscopic Sinus Surgery (FESS) in Spanish hospitals. We sent a survey on the use and results of FESS to 160 Spanish public hospitals in June of 2002, obtaining a response rate of 69%. 82.9% of the interviewed hospitals carried out FESS and 17.1% of the remaining used the classic techniques of approaching the paranasal sinuses. The reported length of stay in hospital was 1.4 days for the FESS and 2.4 for the traditional surgery. The surgical time was 15 minutes shorter for the CENS, and the rate of recurrence was 16% less than for the classic surgery. As years of experience in the practice of the CENS go by, the surgical times tend to decrease, that didn't happen with the rate of recurrence. In conclusion, we consider that FESS seems to improve the analyzed clinical performance and assistential results (AU)

Implantacion de la cirugía endoscopica nasosinusal en España / The implementation of endoscopic sinus surgery in Spain

El objetivo del trabajo es conocer la implantación existente de la Cirugía Endoscópica Nasosinusal (CENE) en nuestro país. Para ello, se diseñó una encuesta que se envió a 160 hospitales de la red pública española (junio / 2002). Se obtuvo una participación de 111 hospitales; de los cuales el 82,9 por ciento realizaban CENS con un porcentaje de especialistas implicados en la técnica del 58 por ciento, existiendo algunas diferencias entre Comunidades Autónomas. En los hospitales más pequeños el porcentaje de facultativos que realizaban CENS fue mucho mayor que en los grandes hospitales regionales. La experiencia media obtenida se situó en 6,2 años. Consideramos que el grado de implantación de CENS obtenido es muy elevado, lo que puede reflejar que las ventajas de su uso son muy evidentes para los clínicos que la utilizan (AU)

The purpose of this study is to find out more about the implementation of functional endoscopic sinus surgery (FESS) in our country. To do that, we designed a survey which was sent to 160 public hospitals (June 2002). We received the answers of 111 hospitals. 82.9% of hospitals and 58% of surgeons performed FESS, with some differences among autonomic regions. The percentage of surgeons who performed FESS was higher in small hospitals and their mean experience time was 6.2 years. We consider the implementation of endoscopic sinus surgery very high, this can reflect that there are evident advantages for those who specialists who use it (AU)

[Objective study of the voice in a normal population and in dysphonia caused by nodules and vocal polyps]. / Estudio objetivo de la voz en población normal y en la disfonía por nódulos y pólipos vocales.

A study of the objective evaluation of voice was made of 100 voices of healthy adults and 60 with disphonia (nodules and polyps). A laryngostroboscopy and an acoustic analysis was made to everyone. A sustained vowel "a" was carried out and digitalized with Dr. Speech Science software. These parameters were estimated: fundamental frequency (Fo, according to gender), Jitter, Shimmer and glottic noise (NNE, HNR, SNR). In the healthy group Fo was 139.72 in men and 267.33 in women, jitter 0.24 and shimmer 2.10. In disphonic patients (nodules) Fo was 126.96 in men and 240.72 in women, jitter 0.35 and shimmer 3.25. In disphonic patients (polyps) Fo was 119.75 in men and 218.26 in women, jitter 0.50 and shimmer 4.34. These difference were statistically significant. Glottic Noise in healthy group was: NNE -13.62, HNR 24.07 and SNR 24.49; in disphonic patients (nodules) was: NNE -10.65, HNR 25.21 and SNR 25.55; in disphonic patients (polyps) was: NNE -8.24, HNR 29.63 and SNR 28.22. Only the difference in the NNE was statistically significant. We highlight the importance of objective evaluation of voice disorders.

Estudio objetivo de la voz en población normal y en la disfonía por nódulos y pólipos vocales / Study objetive of voice in normal poblation and disphonia for nodules and polyps

Presentamos un estudio sobre la evaluación objetiva de la voz en 100 adultos sanos y en 60 sujetos con disfonía por nódulos o pólipos vocales. A todos se les realizó una laringoestroboscopia y un análisis acústico vocal. Se registró y digitalizó la vocal "a" con el programa Dr. Speech Science. Se estimaron los parámetros: frecuencia fundamental (Fo, expresada en función del sexo), jitter, shimmer y Ruido Glótico (NNE, HNR y SNR). La Fo en el grupo normal fue de 139.72 en varones y 267.33 en mujeres, jitter 0.24 y shimmer 2.10. En pacientes disfónicos por nódulos Fo fue 126.96 en varones y 240.72 en mujeres, jitter 0.35 y shimmer 3.25. En pacientes disfónicos por pólipos Fo fue 119.75 en varones y 218.26 en mujeres, jitter 0.50 y shimmer 4.34. Todas estas diferencias fueron estadísticamente significativas. El Ruido Glótico en población normal fue de: NNE -13.62, HNR 24.07 y SNR 24.49; en pacientes con nódulos: NNE -10.65, HNR 25.21 y SNR 25.55; en pacientes con pólipo vocal: NNE -8.24, HNR 29.63 y SNR 28.22. Sólo existió diferencia estadísticamente significativa en el parámetro NNE. Destacamos la importancia de la valoración objetiva de los trastornos de la voz (AU)

A study of the objective evaluation of voice was made of 100 voices of healthy adults and 60 with disphonia (nodules and polyps). A laryngostroboscopy and an acoustic analysis was made to everyone. A sustained vowel "a" was carried out and digitalized with Dr. Speech Science software. These parameters were estimated: fundamental frequency (Fo, according to gender), Jitter, Shimmer and glottic noise (NNE, HNR, SNR). In the healthy group Fo was 139.72 in men and 267.33 in women, jitter 0.24 and shimmer 2.10. In disphonic patients (nodules) Fo was 126.96 in men and 240.72 in women, jitter 0.35 and shimmer 3.25. In disphonic patients (polyps) Fo was 119.75 in men and 218.26 in women, jitter 0.50 and shimmer 4.34. These difference were statistically significant. Glottic Noise in healthy group was: NNE -13.62, HNR 24.07 and SNR 24.49; in disphonic patients (nodules) was: NNE -10.65, HNR 25.21 and SNR 25.55; in disphonic patients (polyps) was: NNE -8.24, HNR 29.63 and SNR 28.22. Only the difference in the NNE was statistically significant. We highlight the importance of objective evaluation of voice disorders (AU)

[Mediofacial degloving in extramedullary plasmacytoma with orbital invasion]. / Degloving medio-facial en un plasmocitoma extramedular con invasión orbitaria.

Extramedullary solitary plasmacytoma is a rare plasmatic cell tumor occurring in the head and neck. We report the case of a patient with a mass that arose from the sphenoidal base, extended toward the right paranasal sinuses, and invaded the orbit. The clinical characteristics, diagnostic criteria, and therapeutic problems are discussed and reviewed in the literature, with special attention to an alternative therapeutic approach, midfacial degloving.

Degloving medio-facial en un plasmocitoma extramedular con invasión orbitaria / Mediofacial degloving in extramedullary plasmacytoma with orbital invasion

El plasmocitoma solitario extramedular es un raro tumor dentro de los de células plasmáticas que ocurren en cabeza y cuello. Presentamos un caso clínico de un paciente que presenta una masa que naciendo de la base esfenoidal se extiende hacia los senos paranasales derechos llegando a invasión orbitaria. Las características clínicas, criterios diagnósticos y problemas terapéuticos son discutidos y revisados en la literatura, con especial atención a un abordaje terapéutico alternativo: el degloving medio-facial (AU)

Extramedullary solitary plasmacytoma is a rare plasmatic cell tumor occurring in the head and neck. We report the case of a patient with a mass that arose from the sphenoidal base, extended toward the right paranasal sinuses, and invaded the orbit. The clinical characteristics, diagnostic criteria, and therapeutic problems are discussed and reviewed in the literature, with special attention to an alternative therapeutic approach, midfacial degloving (AU)

[Endoscopic closure of nasal fistulas leaking cerebrospinal fluid. Our experience]. / Cierre endoscópico de fístulas nasales de líquido cefalorraquídeo. Nuestra experiencia.

UNLABELLED: Cerebrospinal fluid (SCF) rhinorrea results from a breakdown of the dura and supporting structures of the skull base. Trauma is responsible for 81 to 90 percent of the cases of SCF rhinorrea, and it occurs in approximately 2 percent of all head injuries. This is a retrospective review of 5 patients who underwent endoscopic treatment of CSF rhinorrea during 1997 in our hospital. The aetiology of leaks was: iatrogenic in two cases (by transphenoidal hypophysectomies), traumatic in two cases (by head injuries) and spontaneous in one (nasal encephalocele). CONCLUSION: we recommend endoscopic approach as the first line in managing CSF rhinorrea because it avoids an external incision, requires less cumbersome instrumentation and in our hands in the safest and most successful. Furthermore, we prefer the autogenous mocuperiosteum of the inferior turbinate glued over the fistula offers several advantages: it is readily available in sufficient size for the closure of most defects, only minor surgery for graft harvesting is necessary and, the texture of the mucoperiostium permits a good secure seal.

[Our experience in the management of parapharyngeal tumors]. / Nuestra experiencia en el manejo de los tumores del espacio parafaríngeo.

The rate of occurrence of neoplasma arising from the parapharyngeal space is scarce, about 0.5 percent of neck and face tumors. In the paper is reported our 10-year experience on its clinical diagnosis and therapeutical management as well. We have found 13 percent (3/23) malignancies and 87 percent (20/30) benign growth. 35 percent were paragangliomas and 22 percent represent salivary tumors. Diagnostic procedures, ways of approach and surgical complications are considered.

[Efficacy of topical ciprofloxacin in the treatment of chronic otorrhea]. / Eficacia del ciprofloxacino tópico en el tratamiento de la otorrea crónica.

The aim of the present study was to assess the clinical and bacteriological efficacy of ciprofloxacin in the treatment of chronic otitis media. Ciprofloxacin was randomly administered for ten days to two groups of patients. Group A was given 500 mg. orally twice a day. Group B received drops of ciprofloxacin in saline solution locally twice a day. We obtained a favorable clinical and bacteriological response. Bacteriological response observed in group B was statistically higher than that of group A (p < 0.01). Results obtained in this study suggest that ciprofloxacin locally administered is very effective in the treatment of chronic otitis media.

[Laryngeal fibrosarcoma. Report of 2 new cases]. / Fibrosarcoma laríngeo. Aportación de dos nuevos casos.

Sarcomas constitute less than one percent of laryngeal neoplasms. Fibrosarcomas are by far the most commonly reported mesenchymal tumors of the larynx. We report two cases of fibrosarcoma of the larynx and discuss clinical aspects, diagnosis and treatment.

[A descriptive study of hearing in children]. / Estudio descriptivo de la audición en niños.

The authors made an audiological screening of the entire population of the Valle de los Pedroches entering primary education in 1992. The auditory levels of the children were measured and abnormalities were detected. In a total of 440 children, 43 hypoacusic cases were found. The type of hypoacusis was predominanthy conductive (95.4%), serous otitis media, being the most common cause of hypoacusis in infancy. We deduce that screening is useful for detecting this medical problem.

[The nuclear determination of the DNA content by flow cytometry as a fixed sample of the healthy larynx]. / Contenido de ADN nuclear por citometría de flujo en muestras no fijadas de laringe sana.

We analyzed the DNA nuclear content and cellular cycle distribution of the healthy laryngeal tissues without any laryngeal disease (healthy) and that of from patients afflicted with laryngeal epidermoid carcinoma (healthy/Ca). We have carried out studies on fresh samples, unfixed samples, and analysing them immediately after their extraction in the flow cytometer, using human peripheral blood lymphocytes as control of the ploidy in each case. In the study effected, we did not find any differences in the DNA content of the healthy laryngeal tissues and those macroscopically healthy from patients with epidermoid carcinoma of the larynx. However, the laryngeal tissues show a significantly higher DNA content than the human peripheral blood lymphocytes used as check.

[Tuberculoma as expansive process of the cerebellopontine angle. Case report and bibliographical survey]. / Tuberculoma como proceso expansivo del angulo pontocerebeloso. Presentación de un caso y revisión de la literatura.

We present a case of intracranial Tuberculoma of the cerebellopontine angle and discuss the problems to set up the preoperative etiological diagnosis. Finally we make a review of the literature of the subject.

[Collagen diseases and their manifestations in the head and neck region]. / Enfermedades del colágeno y sus manifestaciones en la región de cabeza y cuello.

We carried out a clinical study on the manifestations of various connective tissue pathologies of the head and neck. The need to suspect the presence of these pathological entities from non-specific ENT symptoms and performing early diagnoses of cochleovestibular diseases on the basis of a clinical and examination protocol is emphasized.

[Idiopathic cerebral hernia in the middle ear]. / Herniación cerebral idiopática en oído medio.

Idiopathic brain herniation into the middle ear and the mastoid process is an infrequent condition. There are only 29 cases reported in the world literature covering the last 40 years. The paper inform on one of those cases, a man, of spontaneous encephalocele and deals with the pathogenesis, the clinical features and the suitable surgical approach.

[Sarcoidosis as a cause of paralysis of the recurrent laryngeal nerve. Presentation of a case]. / Sarcoidosis como causa de parálisis del nervio laringeo recurrente. Presentación de un caso.

A patient with Sarcoidosis presented with hoarseness in the course of the disease, caused by mediastinal adenopathies compressing the left recurrent laryngeal nerve. Vocal cord paralysis is an unusual complication of sarcoidosis. We have found in the consulted worldwide bibliography on the subject only four cases of sarcoidosis with mediastinal enlarged lymph nodes causing compression of the left recurrent nerve and subsequently vocal paralysis.