[Spontaneous cervical emphysema and pneumomediastinum with voice disorders]. / Neumomediastino y enfisema cervical espontáneos con alteración en la voz.

Spontaneous cervical emphysema and pneumomediastinum, occurring in the absence of previous disorders or provocating factors, is very rare. The predominant symptoms are retroesternal pain, dyspnea, dysphagia and neck pain. The diagnosis is established radiologically. The evolution is generally good and conservative therapy leads to recovery in most patients. We present an unusual case of pneumomediastinum, cervical and retropharyngeal emphysema that spread to cavum; the suspected symptom was voice alteration as reported by the parents.

[Diagnostic methods in parotid gland pathology]. / Métodos diagnósticos en la patología parotídea.

A check over the used techniques on salivary glands pathology, that is to say: anamnesis, inspection, palpation, laboratory tests, quantitative and qualitative sialometry, gammagram, single radiology, sialography, CAT, MRI, fine needle biopsy in tumorous and non tumorous pathology. It is seen the practical value of each one of these techniques and when they must be utilized. Nowadays are of great value the CAT and MRI. Under the anatomical pathology are of great importance fine needle biopsy for tumoral studies and Daniel's biopsy for Sjögren' syndrome. Regarding surgery to get an untimely biopsy is fundamental.

[The solitary ear]. / El Oído Unico.

An unique ear refers to those cases of individuals with an air and/or bone conduction allowing a serviceable hearing in one ear, being the other one totally lost, owing to any disease. So it is relatively frequent patients presenting only one ear normal, being the other one deaf. The puzzle rises when the sole running good ear must be operated, for whichever pathology. It may be that these various circumstances were: double cholesteatoma, cholesteatoma with extreme loss of hearing, otosclerosis with total deafness and even patients with chronic middle ear otitis and progressive impairment of bilateral hearing. Before to take the final decision on behalf of surgery we must consider: the ear condition, the age and physical state, the job and the social activity and finally the desire and resolution of the patient himself as well. The paper explain our experience in dealing with 10 solitary ears seen in the last 6 years.

[WIll there ever exist the ideal auditive prosthesis for the reconstructive surgery of the middle ear?]. / Existirá la prótesis auditiva ideal en la cirugía reconstructiva del oído medio?

The AA. of the paper review the several materials used for the reconstruction of the middle ear ossicular chain. They inform about each material, including the auto- and homologous grafts of ossicles, cortical bone and cartilage. Palavit, Polyethylene-90, Teflon, metallic implants. Porous plastic materials: Proplast, Plastipore and Polycel. Bioactive ceramic prosthesis (ceramics of aluminium oxyde): Frialit and CORP. Bioactive vitroceramic prosthesis: Macor, Bioglass and Ceravital. Also bioactive of phosphate of calcium: Hydroxyapatite and Apaceram. Prosthesic material of nacre, coal-coal and Polymetacrylate (Ossiculoplast). The most important matter is to get an ear in the best conditions in order to accept the prosthesis, that is to say, a bed completely dry with no inflammatory clues in the tympanic cleft and with a correct functionalism of the Eustachian tube. The healthy ossicular rennants of the chain must be spared. The apatites, bioactive ceramica, are the prosthesis of the future owing to its similitude to the bone. Nevertheless will be difficult to obtain an absolutely inert material inside the middle ear, of the stability of the cleft is not secured.

[Our experience with reconstructive surgery++ of the middle ear in tympanoplasties with mastoidectomy]. / Nuestra experiencia en la cirugía reconstructiva del oído medio en timpanoplastias con mastoidectomía.

In our department, we studied 243 patients who underwent open or close tympanoplasty, from 1984 to 1989, generally caused by cholesteatoma (229 cases) or by non-cholesteatomatous chronic suppurative otitis media (14 cases). Extrusion of the prosthesis occurred in 15 (11.11%) of a total of 136 cases after an average time of 12.46 months during a 4 to 8 years evolution period. From these cases 5 out of 59 were made with plastipore Porp (8.47%) and 10 out of 76 with plastipore Torp (13.15%). autologous ossicles did not extrude in any case. In the cases of cholesteatoma, open (62.7%) and close (37.3%) techniques were performed, and after above mentioned period of evolution, recidivism of cholesteatoma occurred in 4.11% of patients.

[The comparative audiometric statistical study of the results obtained with plastipore or with autologous material in tympanoplasty with mastoidectomy]. / Estudio estadístico audiométrico comparativo de los resultados obtenidos con plastipore o con material de autoinjerto en timpanoplastias con mastoidectomía.

Two hundred forty-three patients underwent from 1984 to 1989 open (OT) or closed (CT) tympanoplasty and mastoidectomy, generally for cholesteatoma or non-cholesteatomatous chronic suppurant otitis media with some type of destruction of the ossicular chain. The results of the audiometric studies of 8 groups who underwent the same surgical technique using plastipore PORP or TORP, or autologous ossicle or cortical mastoid bone, were compared statistically after 2 years of evolution. Except for one of them, none of groups studied presented statistically significant differences, but the existence of more extrusions with the plastipore caused us to stop using it. The material of choice in our service is the autologous ossicle.