[Meta-analysis on the efficacy of Epley's manoeuvre in benign paroxysmal positional vertigo]. / Estudio metaanalítico de la eficacia de la maniobra de Epley en el vértigo posicional paroxístico benigno.

INTRODUCTION: Benign paroxysmal positional vertigo (BPPV) is one of the most common conditions that cause the physiognomy of peripheral vertigo. OBJECTIVE: To evaluate the effectiveness of Epley's manoeuvre (EM) in the treatment of BPPV using a critical review of the medical literature and a meta-analysis. METHODS: Searches were made in the databases of MEDLINE (PubMed), in the Cochrane collection (Cochrane Register of controlled studies), BIREME and LILACS (all of them up to December 2008). The search words used were: canalith repositioning procedure, canalith repositioning manoeuvre, Epley manoeuvre, Dix-Hallpike, benign vertigo, benign positional vertigo, benign paroxysmal positional vertigo and BPPV. The meta-analysis was performed using the program RevMan 5.0. RESULTS: The patients on whom an EM was performed had a six and half times more chance of their clinical symptoms improving compared to the control group of patients (OR=6.52; 95% CI, 4.17-10.20). Similarly, the likelihood of having a negative Dix-Hallpike (DH) test are 5 times greater in patients had the EM performed than in those who did not (OR=5.19; 95% CI, 2.41-11.17). CONCLUSIONS: The EM is effective in controlling BPPV.

[History of epistaxis since the ancient times to the first half of the XXth century]. / Historia de la epistaxis desde la antigüedad clásica hasta la primera mitad del siglo XX.

Epistaxis is one of the more frequent entities in the otolaryngological practice. The term is attributed to CULLEN (1785). Since them, multiple theories concerning etiology, clinical manifestacions, diagnosis and management have been reported in the medical literature. Nevertheless, an impressive improvement of awareness about these questions have emerged in the last half of past century. The objective of this work is to revise the history of epistaxis since the ancient times to the first half of the 20th century.

[Frontal pyomucocele]. / Piomucole frontal.

Mucoceles are strictly defined as chronic, expanding, mucosa-lined lesions of the frontal sinus and containing insipissated secretion. We present a 48-years-old female who complains right periorbital and frontal swelling of approximately 1,5 years duration. Radiological and exploratory findings confirm the diagnosis of infected mucocele (pyomucocele). Under general anesthesia an endoscopic sinus surgery was performed. One year later, the patient is alive and well with no evidence of primary disease.

[Neurotrophic action of insulin-like growth factor-I in the inner ear]. / Acciones neurotróficas del factor de crecimiento similar a la insulina de tipo I en el oído interno.

INTRODUCTION: Loss of hearing constitutes one of the most frequent disabling sensory impairments in the developed world. Different therapeutic approaches are currently being studied, including treatment with stem cells, genetic manipulation and pharmacological protection. AIM: To evaluate the role played by insulin-like growth factor-I (IGF-I) in the development, maintenance and repair of auditory functioning. DEVELOPMENT: Proper development of the inner ear is dependent on a suitable coordination of the cell processes of proliferation, differentiation, neurogenesis and programmed cell death, which are regulated by different factors, one of which is IGF-I. During the embryogenesis of the inner ear, this factor is expressed in abundance and is essential for cell survival and maintaining neuronal precursors. Studies conducted in Igf-1-/- null mice have highlighted its importance in the development and continued functioning of the inner ear. Mice with a deficit in this gene display morphological disorders that correspond to severe functional deficiencies, which are confirmed by analysing brainstem auditory evoked potentials. A deficit of IGF-I in humans is also accompanied by profound sensory hypoacusis. CONCLUSIONS: In a scenario like this, IGF-I appears as a key factor in the development of auditory functioning and a candidate for regenerative therapy of the inner ear.

[Comparative analysis of the therapeutic costs to control the recurrent acute otitis media]. / Análisis comparativo de los costos terapéuticos para el control de la otitis media aguda de repetición.

In order to assess a cost analysis in the management of recurrent acute otitis media (RAOM) in children, we performed a prospective study with data obtained from 80 patients with RAOM, evaluated between january 1998 and february 2000. A good outcome with the antibiotic prophylaxis was obtained in 67 cases (83,7%), with either amoxicillin or azythromicin. Applying the model of assumptions the control of RAOM with ear tube insertion was obtained in 66 children (82,5%). Thus, the cost of antibiotic chemoprophylaxis was Euro 83,60 for the amoxicillin patients and Euro 116,60 for the azythromicin ones. Surgical approach of this entity with the use of ear tubes costs Euro 392,95 per case. To sum up, in pediatric patients, without medical contraindications, the initial treatment for RAOM is chemoprophylaxis, with ear tubes reserved its failure.

[The epidemiology of Bell's palsy]. / Epidemiología de la parálisis facial de Bell.

AIMS: Bell's palsy (BP) is a frequent condition with an incidence that varies throughout different countries around the world. The aim of this article is to analyse the incidence of BP in different countries around the world. DEVELOPMENT: Different rates of incidence and prevalence have been reported in the medical literature depending on the geographical regions under study. In most of the series published incidence oscillates between 11 and 40 cases per 100,000 inhabitants per year--although figures as low as 8 and as high as 240 cases per 100,000 inhabitants per year have also been reported. The climate, racial factors, the prevalence of predisposing diseases and the demographic features of the regions studied could be involved in these variations in the appearance of BP. Nevertheless, and although they are estimated to be of little significance, both methodological and diagnostic aspects of BP may also exert a certain influence on the results obtained. CONCLUSIONS: The incidence of BP in the world varies, which may reflect both a different frequency of appearance in the geographical regions studied and differences in the diagnostic criteria employed as well as in the methodology used to collect and analyse data.

[Electrooculography findings in Friedreich's ataxia]. / Hallazgos electrooculográficos en la ataxia de Friedreich.

INTRODUCTION: Friedreich's ataxia (FA) is the most frequent of the recessive hereditary ataxias. AIMS. Our aim was to analyse the findings from electrooculography studies in subjects with FA attended in our Service over a 30-year period. PATIENTS AND METHODS: Between the years 1970 and 1999, 51 patients with FA diagnosed in the Neurology Service of our hospital were examined. All of them were submitted to an electronystagmography study and an examination of the oculomotor system using electrooculography (EOG). In the EOG study, saccades, (square-wave) saccadic intrusions, spontaneous, triggered, positional and optokinetic nystagmus (OKN), visual suppression of the vestibulo-ocular reflex (VOR) and following were all evaluated. RESULTS: The disorders that were found most often were ataxic following (72.5%), abnormalities in rotational testing (56.8%) and dysmetria in the saccades (52.9%). The presence of square waves was observed in just over half the traces (52.9%). CONCLUSIONS: In FA the predominant EOG findings are those suggesting a cerebellar disease.

[Middle ear effusion as infrequent cause of sensorineural hearing loss]. / La otitis serosa como causa infrecuente de hipoacusia neurosensorial.

Middle ear efussion (MEE) is the most frequent condition related to conductive hearing loss in children, being rarely the cause of sensorineural hearing loss (SNHL). We present a 5-years-old child without know previous otologic disease who developed MEE with a very adversely effect on hearing. Hearing tests showed a bilateral moderate-severe neural impariment. The patient were programmed for grommet insertion. Hearing showed a total audiometric recovery three months after surgery. To sum up, MEE can be rarely associated with SNHL.

[Facial nerve tumours]. / Tumores del nervio facial.

INTRODUCTION: Tumours originating in the facial nerve are extremely rare and their therapeutic approach requires the aid of specialists from a number of disciplines. AIMS: Our aim was to analyse the cases treated in our centre over a five-year period. PATIENTS AND METHODS: All the subjects submitted to surgical interventions to treat facial nerve tumours between January 1992 and December 1996 were evaluated retrospectively. Data recorded from all patients included age, sex, side affected, time prior to diagnosis, presenting symptom and symptoms observed at the time of diagnosis, previous history of disorders affecting the facial nerve and associated neurological symptoms. We also noted the location of the lesion, the surgical technique used, pathology findings, post-operative complications, length of post-operative stay in hospital, facial sequelae and surgical repair procedures used on the facial nerves involved in the intervention. RESULTS: Six cases, with a mean age of 29 years (range: 16-46 years), were treated. Three of the patients were males (50%). Symptoms of the disease included facial palsy (4), neurosensory hypoacusis (1) and tinnitus (1). All six individuals (100%) had alterations affecting facial functioning in the course of the disease. The pathological diagnosis was schwannoma in four cases and hemangioma in the other two. Neural grafts were carried out in three patients and some kind of deficit was observed at the end of the follow-up in all the cases. CONCLUSIONS: Facial nerve tumours are very infrequent. An early diagnosis is needed to diminish the facial sequelae following surgery performed to treat this clinical entity.

[Predictive clinical factors of extracapsular extension in lymph nodes of the neck]. / Factores clínicos predictivos de la extensión extracapsular en los gánglios linfáticos cervicales.

In order to assess the main clinical factors predicting extracapsular spread (ECS) in neck lymph nodes of patients with laryngeal cancer, step-wise logistic regression (LR) was applied to data retrospectively obtained from 141 patients surgically treated. Thirty six variables were evaluated in each patient. One hundred twenty eight out of the 141 patients had complete information on the 36 variables studied. With data from these 128 patients a linear discriminant function was obtained with an overall accuracy of 65.4%. The rate of correct prediction was 60.8% for presence of ECS and 71.7% for absence of ECS. Only 3 secondary variables created out of the 36 employed for the analysis were necessary to obtain these results.

[Lymphoproliferative disorders of Waldeyer's ring]. / Linfomas primarios del anillo de Waldeyer.

OBJECTIVE: To investigate the incidence and characteristics of lymphoproliferative disorders of Waldeyer's ring in our pediatric patients. MATERIAL AND METHODS: We retrospectively reviewed 20 children under 14 years of age who underwent surgery in our department for adenoidectomy and/or tonsillectomy between 1 January 1996 and 30 November 2000. In non-immunocompromised children, surgical indication was the recent development of progressive unilateral tonsillar hyperplasia, and in immunocompromised patients indication was mainly the enlargement of adenoids and/or tonsils, although eradication of local Ebstein-Barr virus infection and recurrent acute tonsillitis were also indications. RESULTS: The mean age was 4.6+/-2.3 years (range: 16.9 months-13.9 years). Sixteen patients (80.0 %) were male. In the nine patients with unilateral hyperplasia, histopathological diagnosis was diffuse lymphoid hyperplasia. Of the 11 immunocompromised patients, 5 (45.5 %) had some type of lymphoproliferative disorder. DISCUSSION AND CONCLUSIONS: Lymphoproliferative disorders of Waldeyer's ring are relatively frequent in immunocompromised children who have undergone surgery of the adenoids and/or tonsils. Although no cases of unilateral hyperplasia of the tonsils were diagnosed in our series, tonsillectomy is indicated in patients with this diagnosis, independent of their immunological status.

[Predictive factors of efficacy in antimicrobial prophylaxis for acute recurrent otitis media]. / Factores predictivos de eficacia en las profilaxis antimicrobianas para la otitis media aguda de repetición.

OBJECTIVE: A prospective study was designed to assess the most relevant prognostic factors influencing outcome in children treated with antibiotics for recurrent acute otitis media (AOM). MATERIALS AND METHODS: A prospective study was performed in 69 patients with recurrent AOM who received prophylactic treatment in the Pediatric Otorhinolaryngology Section of our hospital between January 1998 and May 1999. In all patients, 17 variables were registered: age, sex, family history of recurrent AOM, history of prematurity, history of allergies, use of day care centers, household smokers, maternal smoking, coincidence with dental eruption, symptoms of upper respiratory obstruction (snoring, breathing through the mouth, obstructive tonsils), episodes of tonsillitis per year, age at first AOM episode, season in which prophylaxis was started, and characteristics of neonatal feeding (breast or bottle feeding and position). ResultsThe mean age was 35.3 months (range: 9-120 months). There were 38 boys (55.1 %) and 31 girls (44.9 %). The factors related to a more favorable response to treatment were lower age at the first AOM episode (p 0.004) and a positive family history of AOM (p 0.047). CONCLUSIONS: The children that benefitted most from the prophylactic schedules for recurrent AOM were those that had the first episode at an earlier age and who had a positive family history of the disease.

[Results of multinodular goiter surgery]. / Resultados en la cirugía del bocio multinodular.

In order to assess the main complications following surgical treatment of multinodular goiter (total thyroidectomy) a prospective historical study was made in 179 patients operated between 1985 and 1997 in our Department. Permanent hypocalcemia was encountered in 2.2 percent of our cases and permanent recurrent paralyses in 0.5 percent, being null and void the mortality rate. Other complications evaluated include: serohematoma, postoperative bleeding, wound infection and pulmonary embolism. To sum up, total thyroidectomy is a relative safe procedure in experienced hands for both patient and surgeon.

[The impact of extracapsular spread and desmoplasia on local recurrence in patients with malignant tumors of the larynx and hypopharynx]. / Impacto de la extensión extracapsular y la desmoplasia en la recidiva local de pacientes con tumores malignos de laringe e hipofaringe.

A study was made of the impact of the presence of extracapsular spread (ECS) and desmoplastic pattern (DP) in cervical lymph nodes on local recurrence in 119 patients with laryngeal and hypopharyngeal cancer. All patients underwent surgery between 1984 and 1992 for squamous-cell carcinoma and had histologically confirmed lymph node metastasis. The tumor recurred locally in 15.7% of patients without ECS and in 36.1% of patients with ECS (p < 0.03). The frequency of local recurrence did not differ significantly between patients without DP (20.0%) and patients with DP (29.0%) (p > 0.05). Therefore ECS in cervical lymph nodes of patients with laryngeal cancer was related with an increased rate of local recurrence, but DP did not modify the probability of local recurrence.

[Hyalinizing trabecular adenoma of the thyroid]. / Adenoma trabecular hialinizante de tiroides.

Hyalinizing trabecular adenoma (HTA) is a follicle-derived tumor of the thyroid gland that has been described recently. The differential diagnosis includes medullar carcinoma, papillary carcinoma, and paraganglioma of the thyroid. We report a case of thyroid HTA in a 25-year-old woman. The tumor appeared as a <> of the left thyroid in radionuclide scans. Histologically, the tumor showed tumor cells arranged in trabeculae and a prominent hyaline stroma. The neoplastic cells were focally immunoreactive for thyroglobulin and negative for calcitonin, chromogranin, and S-100 protein. Three years after hemithyroidectomy, the patient is alive and free of disease.

[Use of acyclovir in acute peripheral idiopathic facial paralysis (Bell's palsy)]. / Utilización del aciclovir en la parálisis facial aguda periférica idiopática (de Bell).

Recently, acyclovir use has been proposed for the treatment of Bell's palsy in view of the hypothetical viral origin of the disorder. Recent studies suggest that the maximum effect is achieved by combining acyclovir with prednisone. Nevertheless, acyclovir alone appears to be useful in the treatment of some patients (hypertensive subjects). Protocols are defined for the medical treatment of Bell's palsy.

[Surgical treatment of cholesteatoma: are wall-down techniques superior to wall-up techniques? A 50-year-old controversy]. / Tratamiento quirúrgico del colesteatoma: son las técnicas abiertas superiores a las cerradas? Una controversia de cincuenta años.

A retrospective study was made of the evolution of our policies in the surgical treatment of cholesteatoma between 1984 and 1993. An evaluation was made of 103 patients operated by one of the authors [mean age 38 +/- 15 years; 60 (58%) men and 43 (42%) women]. The mean follow-up was 34 +/- 31 years. Binary logistical regression was used to analyze our patient series. Two factors that were associated statistically with the wall-down procedure were the degree of ossicular chain damage and the integrity of the posterior wall of the external auditory canal. The frequency of wall-down procedures has increased in our department.

[Effect of extracapsular extension on cervical recurrence and the survival of patients with laryngeal tumors]. / Influencia de la extensión extracapsular en la recidiva cervical y la supervivencia de pacientes con tumores laríngeos.

The influence of the extracapsular spread (ECS) of metastatic cervical lymph nodes in patients with laryngeal cancer is discussed. The study included 119 patients who underwent surgery between 1984 and 1992 for squamous cell carcinoma of the larynx and lymph node metastasis confirmed by histology. Results were studied from two main aspects: survival and cervical recurrence. The 3-year survival rate was 73.4% in patients without ECS and 28.9% in patients with ECS (p < 0.001). The 3-year local recurrence rate differed significantly: 23.5% in patients without ECS and 58.3% in patients with ECS (p < 0.001). These results showed that ECS had an unfavorable prognostic significance for lymph node metastasis of laryngeal cancer.

["Near-total" laryngectomy: functional results]. / Laringuectomía "casi total": resultados funcionales.

"Near total" laryngectomy is an alternative to total laryngectomy in some advanced laryngeal tumors. A prospective study was made of the results obtained in 40 patients treated with near total laryngectomy. Speech was achieved in 74.3% of patients within a mean time interval of 63 days. Of the subjects who had more than 5 months of follow-up, 84.6% could speak. Half of the patients who achieved speech used the Barton-Mayo button and did not need to use their hand for phonation. Major swallowing problems were found in 13.9%. The most common complication was pharyngo-cutaneous fistula (58.9%).

[EOG findings in patients with multiple sclerosis]. / Hallazgos EOG en pacientes con esclerosis múltiple.

Electroculography (EOG) is useful in the diagnosis of multiple sclerosis (MS), a common disorder. We reviewed the EOG recordings of 192 patients with MS (98 definite, 29 probable, 65 possible diagnoses) to evaluate spontaneous nystagmus, rotation tests, positional tests, vestibulo-ocular reflex visual suppression (VOR), optokinetic nystagmus, saccades and pursuit tracking. The most frequent findings were abnormalities in the pursuit tracking, saccade dysmetria and vestibulo-ocular reflex suppression disorders. Results are discussed and the literature is reviewed.