Elaboración de una escala de puntuación predictiva de infección periamigdalina basada en signos y síntomas / Design of a predictive score table for peritonsillar infection based on signs and symptoms

Introducción La infección periamigdalina (IPA) supone un motivo de consulta urgente entre las molestias de garganta. Un diagnóstico diferido o incorrecto puede comprometer la vía aerodigestiva alta y resultar mortal en su evolución. Nuestro objetivo fue desarrollar un modelo predictivo de presencia de IPA que ayude en su rápida detección. Pacientes y métodos Un estudio observacional retrospectivo de 66 meses desde 2017 fue desarrollado en un hospital comarcal y su centro terciario de referencia, recogiendo datos de todos los pacientes diagnosticados de IPA y un volumen proporcional de sujetos con sintomatología faríngea sin IPA. Recopilación de datos clínicos, exploratorios y demográficos entre participantes. Su mayor riesgo relativo de presencia de IPA los etiquetó como variables a testar. Elaboración de una escala de puntuación de probabilidad de padecerla y análisis de regresión logística, con obtención de la curva ROC que ofreciera mejor correlación diagnóstica. Validación interna y cálculo de los valores predictivos de este modelo. Resultados Sobre 348 casos de IPA, la escala de valoración puntuó la presencia de 6 variables: trismus (3), disfagia-odinofagia unilateral (2), abombamiento velar (2), otalgia refleja (1), faringolalia (1) y edad de 16-46 años (1). Con un rango de 0 a 10, un cut-off≥6 ofreció una sensibilidad del 96,1%, una especificidad del 93,9% y una eficienca del 94,9%. El área bajo la curva ROC fue de 0,979. Conclusiones La validación interna de este modelo basado en signos y síntomas la faculta como herramienta muy útil para detectar precozmente IPA en otorrinolaringología y atención primaria (AU)

Background Peritonsillar infection (PTI) is a reason for urgent consultation due to intense throat discomfort. A delayed or inaccurate diagnosis can jeopardize the upper aerodigestive tract and be fatal in its evolution. Our objective was to develop a predictive model for the presence of IPA helping in its rapid detection. Patients and methods A 66-month retrospective observational study from 2017 was carried out in a county and tertiary referral hospitals, registering data from all patients diagnosed with PTI and a proportional volume of subjects with pharyngeal symptoms without PTI. Collection of clinical, exploratory and demographic data among participants. Their higher relative risk of PTI presence allowed them to be considered as variables to be tested. Development of a scoring scale for the probability of suffering from it and logistic regression analysis, obtaining the ROC curve with the best diagnostic correlation. Internal validation and estimation of the predictive values of the model. Results On 348 cases of PTI, the assessment scale scored the presence of six variables: trismus (3), unilateral dysphagia-odynophagia (2), velar bulging (2), reflex otalgia (1), pharyngolalia (1) and age between 16 and 46 years (1). With a range of 0-10, a cut-off ≥6 offered a sensitivity of 96.1%, a specificity of 93.9%, and an efficiency of 94.9%. The area under the ROC curve was 0.979. Conclusions The internal validation of this model based on signs and symptoms makes it a very useful tool for early detection of PTI in otorhinolaryngology and primary care (AU)

[Design of a predictive score table for peritonsillar infection based on signs and symptoms]. / Elaboración de una escala de puntuación predictiva de infección periamigdalina basada en signos y síntomas.

BACKGROUND: Peritonsillar infection (PTI) is a reason for urgent consultation due to intense throat discomfort. A delayed or inaccurate diagnosis can jeopardize the upper aerodigestive tract and be fatal in its evolution. Our objective was to develop a predictive model for the presence of IPA helping in its rapid detection. PATIENTS AND METHODS: A 66-month retrospective observational study from 2017 was carried out in a county and tertiary referral hospitals, registering data from all patients diagnosed with PTI and a proportional volume of subjects with pharyngeal symptoms without PTI. Collection of clinical, exploratory and demographic data among participants. Their higher relative risk of PTI presence allowed them to be considered as variables to be tested. Development of a scoring scale for the probability of suffering from it and logistic regression analysis, obtaining the ROC curve with the best diagnostic correlation. Internal validation and estimation of the predictive values of the model. RESULTS: On 348 cases of PTI, the assessment scale scored the presence of six variables: trismus (3), unilateral dysphagia-odynophagia (2), velar bulging (2), reflex otalgia (1), pharyngolalia (1) and age between 16 and 46 years (1). With a range of 0-10, a cut-off ≥6 offered a sensitivity of 96.1%, a specificity of 93.9%, and an efficiency of 94.9%. The area under the ROC curve was 0.979. CONCLUSIONS: The internal validation of this model based on signs and symptoms makes it a very useful tool for early detection of PTI in otorhinolaryngology and primary care.

False positive for ß2-transferrin in rhinorrhoea. Ocular trauma. / Un falso positivo para ß2-transferrina en rinorrea. Traumatismo ocular.

Ocular perforations require an action depending on the findings observed. Additionally, the closeness of the orbit to the nasal cavity and the anterior cranial fossa requires any collateral damage in these spaces to be ruled out. The presence of a penetrating ocular injury associated with ipsilateral rhinorrhoea in which the presence of ß2-transferrin -a highly specific and sensitive marker to identify cerebrospinal fluid- is detected, obliges to suspect and locate any possible leakage. A case is presented in which this unbound protein is detected in post-traumatic rhinorrhoea with an origin in the eyeball, making the diagnosis of a CSF leak into a false positive.

[Pleomorphic adenoma of deep lobe of the parotid gland]. / Adenoma pleomorfo gigante de lóbulo profundo de la parótida: a propósito de un caso.

Parapharyngeal space tumors are rare. Salivary neoplasms being the most frequent ones. The important volume they can reach, their silent character, and the complex anatomic relationships of this area makes their surgical resection difficult. This report describes a case of a pleomorphic adenoma in the deep lobe of the parotid gland presented like a parapharyngeal mass, and its diagnosis and treatment.

[Bilateral peripheral facial paralysis secondary to Lyme disease]. / Parálisis facial periférica bilateral secundaria a enfermedad de Lyme.

Simultaneous bilateral facial paralisis (SBFP) occurs in 0.3-2% of all facial paralisis. We report a case of SBFP in association with Lyme disease. A review of literature about SBFP is made, studing specially the one caused by Borrelia burgdorferi. We present a diagnostic guideline of SBFP. Suspect diagnosis of Lyme disease is based on clinical and epidemiological criteria. Culture isolation of this bacteria is difficult, therefore serologic testing is required. Neuroborreliosis treatment is intravenous Ceftriaxone or Cefotaxime. Oral Doxycycline is useful in the treatment of neuritis without central nervous system involvement.

Parálisis facial periférica bilateral secundaria a enfermedad de Lyme

La parálisis facial periférica bilateral simultánea (PFBS) representa entre el 0,3 y el 2 por ciento de todas las parálisis faciales periféricas. Presentamos un caso de PFBS secundaria a enfermedad de Lyme. Se hace una revisión de la literatura en torno a las posibles causas de PFPS haciendo especial hincapié en el estudio de la provocada por la Borrelia burgdorferi. Se expone un protocolo diagnóstico de la PFBS. El diagnóstico de sospecha de enfermedad de Lyme se basa en criterios clínicos y epidemiológicos. El aislamiento del germen mediante cultivo es difícil, por lo que se recurre a la serología. El tratamiento de la neuroborreliosis es la Ceftriaxona o la Cefotaxima por vía parenteral. La Doxiciclina vía oral se ha mostrado eficaz en el tratamiento de neuritis sin afectación del sistema nervioso central (AU)

[Our experience with extranodal lymphomas of the ORL region]. / Nuestra experiencia en linfomas extranodales del área ORL.

Head and neck extranodal lymphomas are rare. Waldeyer lymphatic ring is the most common localisation of these lymphomas, followed by oral cavity and parothoid glands. We have done a retrospective study of patients with extranodal lymphomas diagnosed in our hospital between 1991 and 1999. We have included in this study 23 patients, 15 males and 9 females. We have used the REAL classification. All of them have been non-Hodgkin lymphomas. The rhinopharynx has been the most affected region, followed by the palatine tonsils and oral cavity. Most of them were of medium degree and they were in the initial stages. The presentation symptoms varied depending on the localisation. The age, stage and histologic degree were important for the treatment election.

Nuestra experiencia en linfomas extranodales del área ORL / Our experience with extranodal lymphomas in ear, nose and throat practice

Los linfomas extranodales de cabeza y cuello son una entidad clínica poco común. El anillo linfático de Waldeyer es la localización más frecuente de estos linfomas, seguida de la cavidad oral y glándulas parótidas. Se ha realizado un estudio retrospectivo de pacientes diagnosticados de linfomas extranodales, entre los años 1991 al 1999 en nuestro Hospital. Se incluyeron en el estudio 23 pacientes, 15 hombres y 9 mujeres. Se empleó la clasificación REAL para su catalogación. Todos lo linfomas fueron linfomas de tipo no-Hodgkin. El cavum fue el lugar más afectado, seguido de amígdalas palatinas y cavidad oral. La mayor parte de los linfomas eran de grado intermedio y se encontraban en estados iniciales. Los síntomas de presentación variaban según la localización. La edad del paciente, estadio y grado histológico fueron importantes para la elección del tratamiento (AU)

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[Inverted papilloma of paranasal sinuses. Our experience of 15 cases. Review of literature]. / Papilomas invertidos de fosas y senos paranasales. Nuestra experiencia a partir de 15 casos. Revisión de la bibliografia.

Fifteen cases of nasosinusal inverted papilloma treated in our department from 1994 to 2000 are reported. The most frequent initial symptom was unilateral nasal obstruction. Some others symptoms were rhinorrea, facial pain and self limited epistaxis. The most frequent surgical procedure performed was the paralateral rhinotomy with medial maxillectomy. The median average for the follow up was 28 months, being diagnosed one recurrence. The paralateral rhinotomy with a medial maxillectomy, under functional endoscopic nasosinusal techniques are being more and more used, decreasing the indications of open techniques.

Papilomas invertidos de fosas y senos paranasales. Nuestra experiencia a partir de 15 casos. Revisión de la bibliografía / Inverted papillomas of nasal and paranasal sinus. Our experience in 15 cases. Revision of literature

Presentamos un estudio retrospectivo de 15 casos diagnosticados de papiloma invertido nasosinusal, tratados en nuestro servicio entre 1994 y 2000. La forma de inicio más frecuente fue la obstrucción nasal unilateral. Otra sintomatología asociada fue rinorrea, algias faciales y epitaxis autolimitadas. El tratamiento quirúrgico más frecuente realizado fue la rinotomía paralateronasal con maxilectomía media. En el control posoperatorio (de 28 meses de media) se observó una recidiva sólo en un paciente. La rinotomía paralateronasal con maxilectomía media con ayuda del microscopio óptico, es considerado el tratamiento de elección. No obstante, la incorporación de la endoscopia y la destreza en su manejo, van limitando las indicaciones de cirugía abierta (AU)

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[An exceptional form of cranio-facial fibrous dysplasia: fibrous dysplasia of middle turbinate]. / Una forma excepcional de displasia fibrosa craneofacial: displasia fibrosa de cornete medio.

Fibrous dysplasia is a rare bone disease that can be misdiagnosed because of the slowness of its symptoms. Although it is a benign disease its clinical behaviour can be severe, with possibility of local growth and malignant degeneration into osteosarcoma. An uncommon case of fibrous dysplasia is reported, affecting only the middle turbinate. Diagnostic and therapeutic problems are discussed.

[Benign sinusal mucor colonization in association with septal deviation]. / Colonización benigna sinusal por mucor asociada a desviación septal.

Mucormycosis is a well recognised opportunistic infection caused by saprophytic fungi of the Mucoraceae family. Usually, the upper aerodigestive tract is the portal of entry. Patients who are debilitated or inmunosuppressed might present with these infections, although sometimes can happen in patients with good health. We present a case of benign mucor colonitation at the sinus maxillary associated a deviated nasal septum.