Mioclonía palatal como causa de acúfeno objetivo. Uso de toxina botulínica: a propósito de un caso / Objective tinnitus from palatal myoclonus. Use of botulinum toxin: a case report

El acúfeno objetivo o somatoacúfeno puede presentar múltiples etiologías, siendo una de las más infrecuentes la mioclonía palatal generada por la contracción rítmica e involuntaria del paladar blando que genera un click audible por el enfermo y el explorador. La toxina botulínica genera una parálisis temporal a nivel muscular mediante la inhibición presináptica de la acetilcolina a nivel de la unión neuromuscular. Presentamos el caso de una paciente con un acúfeno objetivo de larga evolución y su respuesta a la inyección con toxina botulínica (AU)

Objective tinnitus can have many different etiologies, palatal myoclonus being one of the less frequent. This type of tinnitus is generated by involuntary rhythmic contraction of the soft palate, which generates an audible click for the patient and for the explorer. Botulinum toxin achieves temporary muscle paralysis through presynaptic inhibition of the acetylcholine level at the neuromuscular union. We present a patient with long-term objective tinnitus, along with this patient’s response to botulinum toxin injection (AU)

Objective tinnitus from palatal myoclonus. Use of botulinum toxin: a case report.

Objective tinnitus can have many different etiologies, palatal myoclonus being one of the less frequent. This type of tinnitus is generated by involuntary rhythmic contraction of the soft palate, which generates an audible click for the patient and for the explorer. Botulinum toxin achieves temporary muscle paralysis through presynaptic inhibition of the acetylcholine level at the neuromuscular union. We present a patient with long-term objective tinnitus, along with this patient's response to botulinum toxin injection.

[Considerations on acute otitis externa for its optimized treatment]. / Consideraciones sobre la otitis externa aguda para un tratamiento optimizado.

INTRODUCTION AND OBJECTIVES: To evaluate the optimal treatment for diffuse acute otitis externa (DAOE) by means of a new staging system based on clinical and otoscopic findings. METHODS: Monitoring of otitis cases diagnosed at our Centre over the last 21 months (n=1,026), taking into account those who returned for a second visit, either via the emergency service or with a prior appointment. Staging of otitis externa by degree of obstruction of the external auditory canal (EAC): under 25% (type I, n=174); between 25% and 75% (type II; n=277); over 75% (type III; n=359); total obstruction due to organized oedema (type IV; n=216). RESULTS: In most cases at an advanced stage, the canal was cleared by aspiration and placement of gauze or cellulose sponges. Ototopical drops were chosen in more than 95% of cases in every group, but anti-inflammatory and systemic antibiotic agents were administered in significantly larger amounts to patients in stages III and IV. Stage IV showed a statistically significant increase in the percentage of second visits. These manoeuvres improved pain, fullness and otorrhea significantly faster in stages I and II. CONCLUSIONS: Staging of otitis allows comparisons of the level of involvement and treatment recommendations: aspiration is advisable in stages II, III and IV; placement of a wick inside the canal is necessary in stages III and IV. Ototopical drops seem to be needed in every case and systemic antibiotics almost only in stage IV. Acidifying agents and topic glycerine vehicles access the canal better than aqueous solutions and would be the first choice in advanced stages.

Consideraciones sobre la otitis externa aguda para un tratamiento optimizado / Considerations on acute otitis externa for its optimized treatment

Introducción y objetivo: Evaluar el tratamiento idóneo de la otitis externa aguda difusa mediante un nuevo sistema de estadiaje basado en hallazgos clínicos y otoscopia. Métodos: Seguimiento de los casos de otitis diagnosticados en nuestro centro durante los últimos 21 meses (n=1.026). Recuento del número de pacientes que acudieron a una segunda visita urgente o programada. Estadiaje de la otitis externa si la obstrucción del conducto auditivo externo presentaba obstrucción inferior al 25% (tipo I, n=174), entre el 25/75% (tipo II, n=277), mayor del 75% (tipo III, n=359), u obstrucción completa con edema organizado (tipo IV, n=216). Resultados: La aspiración y el mechado del conducto se colocaron en mayor número de casos con estadios avanzados. Las gotas óticas se colocaron en más del 95% en todos los grupos pero los antiinflamatorios y antibióticos sistémicos se administraron significativamente en mayor cantidad a pacientes de estadios III y IV. El estadio IV presentó de forma estadísticamente significativa un mayor porcentaje de segundas visitas. Con estas maniobras, el dolor, el taponamiento y la otorrea cedieron significativamente más rápido en los estadios I y II. Conclusiones: El estadiaje de la otitis externa permite equiparar grados de afectación y recomendar tratamientos: aspiración aconsejable en estadios II, III y IV, mechado siempre en estadios III y IV. Las gotas óticas parecen necesarias en todos los casos y los antibióticos sistémicos casi únicamente en el estadio IV. Los agentes acidificantes y las formas tópicas glicerinadas acceden mejor al conducto que las acuosas y serían de elección en estadios avanzados (AU)

Introduction and objectives: To evaluate the optimal treatment for diffuse acute otitis externa (DAOE) by means of a new staging system based on clinical and otoscopic findings. Methods: Monitoring of otitis cases diagnosed at our Centre over the last 21 months (n=1,026), taking into account those who returned for a second visit, either via the emergency service or with a prior appointment. Staging of otitis externa by degree of obstruction of the external auditory canal (EAC): under 25% (type I, n=174); between 25% and 75% (type II; n=277); over 75% (type III; n=359); total obstruction due to organized oedema (type IV; n=216). Results: In most cases at an advanced stage, the canal was cleared by aspiration and placement of gauze or cellulose sponges. Ototopical drops were chosen in more than 95% of cases in every group, but anti-inflammatory and systemic antibiotic agents were administered in significantly larger amounts to patients in stages III and IV. Stage IV showed a statistically significant increase in the percentage of second visits. These manoeuvres improved pain, fullness and otorrhea significantly faster in stages I and II. Conclusions: Staging of otitis allows comparisons of the level of involvement and treatment recommendations: aspiration is advisable in stages II, III and IV; placement of a wick inside the canal is necessary in stages III and IV. Ototopical drops seem to be needed in every case and systemic antibiotics almost only in stage IV. Acidifying agents and topic glycerine vehicles access the canal better than aqueous solutions and would be the first choice in advanced stages (AU)

[Hearing impairment in patients with rheumatoid arthritis]. / Deterioro auditivo en pacientes con artritis reumatoide.

OBJECTIVE: To evaluate the characteristics of hearing loss (HL) in patients with rheumatoid arthritis (RA). MATERIAL AND METHOD: A comparative case-control study was performed with 194 patients and 107 healthy subjects. All of them were submitted to pure-tone audiometry and detection of inflammatory parameters and Western blot for anticochlear antibodies. RESULTS: HL was detected in 42.7 % of patients with RA (15.9 % in controls; P.001). This was sensorineural in 38.6 %. Three or more altered blood parameters appeared in 28.9 % of patients with RA (17.6 % in controls; P<.01). We observed positive Western blot in 12 % of patients with RA and HL and none among healthy controls. CONCLUSIONS: There is a predisposition to HL, mainly sensorineural, in RA. In view of this prevalence, audiologic reviews must be performed to try to determine if this disorder shows an immunomediated aspect so that a therapeutic alternative could modify the course of HL.

Deterioro auditivo en pacientes con artritis reumatoide / Hearing impairment in patients with rheumatoid arthritis

Objetivo: Valorar la relación de la hipoacusia con la artritis reumatoide (AR). Pacientes y método: Estudio comparativo de casos y controles equiparados en edad y sexo, de 194 pacientes con AR y 107 sujetos sanos. Se efectuó en todos valoración mediante audiometría tonal y determinación de parámetros inflamatorios y Western blot de anticuerpos anticocleares. Resultados: El 42,7 % de los pacientes con AR presentaron hipoacusia (el 15,9 % de los controles; p < 0,001). En el 38,6 % de ellos fue neurosensorial. El 28,9 % de los casos presentaron 3 o más parámetros alterados (el 17,6 % de los controles; p < 0,01). El 12 % de los sujetos con AR e hipoacusia tuvieron un Western blot positivo. No se detectó ninguno en los controles. Conclusiones: Hay una predisposición a la hipoacusia en los sujetos con AR, principalmente neurosensorial. Esta prevalencia obliga a la revisión audiológica de este grupo e intentar definir si este trastorno tiene un componente inmunomediado que permitiera un tratamiento modificador del curso de la hipoacusia

Objective: To evaluate the characteristics of hearing loss (HL) in patients with rheumatoid arthritis (RA). Material and method: A comparative case-control study was performed with 194 patients and 107 healthy subjects. All of them were submitted to pure-tone audiometry and detection of inflammatory parameters and Western blot for anticochlear antibodies. Results: HL was detected in 42.7 % of patients with RA (15.9 % in controls; P<.001). This was sensorineural in 38.6 %. Three or more altered blood parameters appeared in 28.9 % of patients with RA (17.6 % in controls; P<.01). We observed positive Western blot in 12 % of patients with RA and HL and none among healthy controls. Conclusions: There is a predisposition to HL, mainly sensorineural, in RA. In view of this prevalence, audiologic reviews must be performed to try to determine if this disorder shows an immunomediated aspect so that a therapeutic alternative could modify the course of HL