[Near-total laryngectomy. Experience, complications and acoustic analysis]. / Laringuectomía casi total. Experiencia, complicaciones y análisis de voz.

OBJECTIVE: To investigate the oncological efficiency, voice and complications of Pearson's near-total laryngectomy for advanced laryngeal cancers (T3, T4). MATERIAL AND METHODS: A retrospective review of 23 cases of near-total laryngectomy (carried out in our Hospital in the last nine years) was undertaken. RESULTS: None of the cases developed laryngeal mucosal recurrences. The overall three and five years disease free survival were 91,3% and 86,9%. Mean phonation time was 51 days. A statistically significant results were observed in our voice analysis (words/minute, taking as a reference healthy people (Medivoz). The pharyngeal fistula was the most frequent complication (60,86%). CONCLUSIONS: The local control of cancer was similar to that expected with total laryngectomy. Near-total laryngectomy is a valid alternative for extended laryngeal and neighbouring cancers with an acceptable morbidity and success rate for voice preservation.

[Subdural empyema of sinus origin caused by Gemella morbillorum, a strange etiology]. / Empiema subdural de causa sinusal por Gemella morbillorum, una extraña etiología.

We present a case of frontal sinusitis complicated with a subdural empyema, in which the identified microorganism was Gemella morbillorum, a frequent host of the aerodigestive tract and occasionally related to infections. The problem was resolved successfully using endoscopic surgery and an external approach of the sinus. Afterwards it was completed with a subdural drainage through craniotomy. Subdural empyema is a rare complication of sinusitis although very severe. We want to emphasize the importance of early diagnosis of intracranial complications, the need of a detailed microbiology test the method used to obtain samples, and the convenience of a combined approach by the otolaryngologists and the neurosurgeons for its complete drainage.

Vestibular decruitment: an indicator of central pathology?

Torok studied the ratio obtained between the responses to two different heat stimulation intensities of the same temperature. A decrease in response to the strong stimulus (i.e., a diminished ratio) was called "vestibular decruitment," and was regarded as a topodiagnostic indicator of central vestibular lesion, reflecting "adaptation" or "fatigue." The authors studied the reliability of vestibular decruitment obtained by Torok's technique in the indication of central vestibular pathology. Twenty-eight normal individuals and 30 patients previously diagnosed by other methods with diffuse pathology of the central nervous system were evaluated. The results obtained show that the two stimuli used are both supraliminal and of different intensity regarding the labyrinth. In no case was vestibular recruitment obtained. In view of the high percentage of normal individuals (57.14%) who presented vestibular decruitment, we consider the latter to lack topodiagnostic value as an indicator of either central or vestibular pathology; the smaller response to the mass stimulus might be explained by the vestibular habituation phenomenon that occurs on applying Torok's technique in both normal individuals and in patients with central vestibular pathology.