[Intra-laryngeal ectopic thyroid tissue. Report of one case and review of the literature]. / Tejido tiroideo ectópico intralaríngeo. Presentación de un caso clínico y revisión de la literatura.

A Ectopic thyroid is any thyroid tissue not located in his normal anatomic situation. There have been described four general groups within the upper aerodigestive tract: lingual, sublingual, thyroglossal and intralaryngotracheal. Intralaryngotracheal thyroid tissue is rare and constitute 7 per cent of all intratracheal tumours, and it represents a problem of diagnosis and management. The controversy about the genesis of this tumours remains. There are two established theories: "the malformation theory" and "the ingrowth theory". These tumours affect more frequently adult female. Intralaryngotracheal thyroid have been mainly reported on the posterior-left wall of the trachea. The most common clinical feature is stridor due to progressive upper airway obstruction. Up to 75% of the intralaryngotracheal goiters are associated with and external goiter. This paper reports a case of ectopic subglotic thyroid in a 42 year-old-female. The embryology, diagnosis and management of this tumours are discussed.

Tejido tiroideo ectópico intralaríngeo. Presentación de un caso clínico y revisión de la literatura / Intralaryngeal ectopic thyroid tissue. Report of one case and review of the literature

El tiroides ectópico es un tejido tiroideo que no se localiza en su posición anatómica normal. Se han descrito cuatro grupos de tiroides ectópico a nivel del tracto aereodigestivo superior: lingual, sublingual, tirogloso e intralaringotraqueal, siendo el lingual la localización más frecuente. El tiroides intralaringotraqueal es un trastorno raro, constituyendo el 7 por ciento de todos los tumores intratraqueales. Es la forma de tiroides ectópico que más frecuentemente pasa desapercibido y origina la clínica más severa. Su etiopatogenia no es bien conocida, existiendo dos teorías que tratan de explicar la aparición de tejido tiroideo aberrante en el interior de la luz traqueal: "la teoría de la malformación" y "la teoría invasiva". Su mayor incidencia se da en mujeres de mediana edad. A nivel intralaringotraqueal la localización más frecuente es la pared posterolateral izquierda. La clínica de presentación habitual es la disnea progresiva alta, destacando la asociación con un cuadro bociógeno en el 75 por ciento de los casos. Presentamos el caso clínico de una paciente de 42 años con un tiroides ectópico subglótico. Discutimos los aspectos más relevantes con relación a la embriología, diagnóstico y tratamiento de estas lesiones (AU)

A Ectopic thyroid is any thyroid tissue not located in his normal anatomic situation. There have been described four general groups within the upper aerodigestive tract: lingual, sublingual, thyroglossal and intralaryngotracheal. Intralaryngotracheal thyroid tissue is rare and constitute 7 per cent of all intratracheal tumours, and it represents a problem of diagnosis and management. The controversy about the genesis of this tumours remains. There are two established theories: "the malformation theory" and "the ingrowth theory". These tumours affect more frequently adult female. Intralaryngotracheal thyroid have been mainly reported on the posterior-left wall of the trachea. The most common clinical feature is stridor due to progressive upper airway obstruction. Up to 75% of the intralaryngotracheal goiters are associated with and external goiter. This paper reports a case of ectopic subglotic thyroid in a 42 year-old-female. The embryology, diagnosis and management of this tumours are discussed (AU)

[Frontal ethmoid metastases of prostatic carcinoma. Report of one case and review of the literature]. / Metástasis fronto-etmoidal de adenocarcinoma prostático. Presentación de un caso clínico y revisión de la literatura.

Prostatic metastases in the nose and paranasal sinuses are rare. Less than 100 cases have been reported in the literature. Kidney are the commonest site of primary tumour, followed by lung and breast. Only 10 cases have previously been reported in the world literature. Prostatic metastases have been mainly reported in the sphenoid sinus. This paper reports one case of metastases of prostatic carcinoma in the fronto-ethmoid sinus in a 72 years old male. The clinical picture includes acute fronto-ethmoid right sinusitis, severe exophthalmos and chemosis. The CT scan showed extensive soft tissue filling the maxillary, ethmoid cells, sphenoid and frontal right sinuses, with subdural abscess. Biopsies from the fronto-ethmoid mass showed infiltration by adenocarcinoma with positive immunostaining for prostatic specific antigen. We also review the literature about metastases involving the nose and paranasal sinuses.

Metástasis fronto-etmoidal de adenocarcinoma prostático. Presentación de un caso clínico y revisión de la literatura / Fronto-ethmoid metastases of prostatic carcinoma. Report of one case and review of the literature

Los tumores metastásicos en fosas y senos paranasales son enormemente raros, existiendo menos de cien casos descritos en las distintas revisiones bibliográficas. Los tumores primarios de origen de estas metástasis son, en orden de frecuencia, el hipernefroma, el cáncer de pulmón y el cáncer de mama. El adenocarcinoma prostático como productor de metástasis en senos paranasales es excepcional, existiendo únicamente diez casos descritos en la literatura, siendo la localización más común el seno esfenoidal y el maxilar. Presentamos el caso clínico de un paciente varón de 72 años de edad, que debuta con sintomatología de sinusitis aguda frontoetmoidal derecha y celulitis orbitaria ipsilateral. El estudio radiológico mediante TAC demuestra la existencia de una ocupación masiva de todos los senos paranasales derechos, así como una colección subdural frontal, compatible con absceso o empiema subdural. En el acto quirúrgico se comprueba la existencia de una masa tumoral a nivel frontoetmoidal derecho, como proceso de ase, confirmándose posteriormente el diagnóstico histopatológico de adenocarcinoma prostático, con positividad inmunohistoquímica para el Antígeno Prostático Específico (PSA) (AU)

Prostatic metastases in the nose and paranasal sinuses are rare. Less than 100 cases have been reported in the literature. Kidney are the commonest site of primary tumour, followed by lung and breast. Only 10 cases have previously been reported in the world literature. Prostatic metastases have been mainly reported in the sphenoid sinus. This paper reports one case of metastases of prostatic carcinoma in the fronto-ethmoid sinus in a 72 years old male. The clinical picture includes acute fronto-ethmoid right sinusitis, severe exophthalmos and chemosis. The CT scan showed extensive soft tissue filling the maxillary, ethmoid cells, sphenoid and frontal right sinuses, with subdural abscess. Biopsies from the fronto-ethmoid mass showed infiltration by adenocarcinoma with positive immunostaining for prostatic specific antigen. We also review the literature about metastases involving the nose and paranasal sinuses (AU)

Clinical design and evaluation of the prototype of a new digital audioprosthesis for profound hearing loss: speech recognition aspects.

The design and implementation of the prototype of a digital hearing aid and its computerized fitting interface, followed by a basic preliminary clinical evaluation concerning speech recognition aspects, is reported. The final device is particularly destined to those patients suffering sensorineural hearing losses with recruitment and problems for speech recognition. The prototype is based on the digital signal processor TMS320C30. The host is a personal computer. The primary concept of the processing strategy is the 'integral treatment of acoustic information' within the remaining auditory field of the patient leading to minimum modification of the signal profile. The processing stages include linear amplification, specially designed AD conversion, real fast Fourier transform, 128 multiband single treatment (compression threshold and magnitude of compression), inverse fast Fourier transform, and DA conversion. Compression parameters and pure-tone audiometry data are entered by the computerized fitting interface which also provides real time information of input and output spectral profile. The preliminary clinical evaluation here reported corresponds to a series of 13 patients and it is focused on speech recognition performances. Ten patients had sensorineural hearing loss. Three subjects served as controls. All subjects were studied by an extensive audiological protocol. In 6 patients the prototype improved the maximum intelligibility with respect to unaided hearing reaching levels in the range of 90-100%. In 4 patients using conventional hearing aids, the prototype improved the maximum intelligibility with respect to the previous aided hearing. Values reached the same range as in the former 6 patients. Straightening of the speech audiometry curves was observed in those patients with recruitment. Two controls with previously normal speech recognition showed no worsening and others with conductive deafness reported additional improvement of the responses in noisy conditions with respect to the audioprosthesis in use.

[The sensorineural component of hearing loss associated with cholesteatoma]. / El componente neurosensorial de la hipoacusia asociada al colesteatoma.

Patients with cholesteatoma often suffer neurosensorial hearing loss with variable bone conduction thresholds. Its origin is debated and has been attributed to the ototoxicity of topical drugs, immune reactions, effects of ototoxic antibiotics applied to the ear, etc. A selected series of 50 patients who underwent surgery for chronic ear disease due to cholesteatoma in our ENT department were studied to evaluate the possible origin of the bone conduction component of hearing loss. Different clinical, audiological, and surgical aspects were analyzed, including cholesteatoma site and extension, age, sex, evolution of the symptoms, pure tone audiometry data, middle ear involvement, the operation performed, and the occurrence of complications. Bone conduction thresholds were reported as pure tone differential thresholds (affected vs non-affected ear). A specific cholesteatoma-related neurosensorial hearing loss was observed that might lead to irreversible hearing loss. Neurosensorial involvement seems to be related mainly to the duration of symptoms, type of surgery, certain specific clinical aspects, and complications.

[Deafness secondary to lumbar puncture]. / Sordera secundaria a la punción lumbar.

INTRODUCTION AND OBJECTIVE: Disorders of hearing have been described in patients who have undergone lumbar puncture. The lower frequencies are most affected, temporarily and with spontaneous recovery in most cases. It would seem that the cochlea aqueduct (AC) (an anatomical structure found in the internal ear) is the part involved in the pathogenesis of this infrequent complication. The object of this paper is to review the different hypothesis put forward by various authors on the subject, emphasizing the one which seems most probable. At the same time, we offer a new vision of this little known and often forgotten anatomical structure of the internal ear. The anatomy and physiology of the AC is considered, studying the part played by the labyrinth fluid when the patient undergoes an operation involving the cerebro-spinal fluid (CSF) or the subarachnoid space. CONCLUSIONS: Whenever this technique is to be used, it is essential to obtain a clinical history to find out whether the patient has, or has had, any problems of hearing, and if so of what type. All patients should be warned of the possibility of deafness, in most cases temporary, and if the patient has hydrops endolymphaticus (syndrome of Ménière) of the high risk of worsening his hearing threshold. We therefore recommend precise evaluation of the use of this technique.