Síndrome de lemierre: Tromboflebitis séptica de la yugular interna secundaria a amigdalitis aguda

Lemierre´s syndrome is an uncommon clinical entity. It consists of an acute oropharyngeal infection, with secondary septic thrombophlebitis of the internal jugular vein frequently complicated with multiple metastatic infections. It is generally caused by anaerobic Gramnegative organisms. Although it is rarely reported in the antibiotic era, this disease must be taken into account because it is a potentially lifethreatening infection requiring a specific and early treatment. We report a case of Lemierre´s syndrome managed in our hospital.     

Meningitis de repetición asociada a síndrome de Duane tipo 1

We present the case of a 17-month-old male patient with a bilateral Duane syndrome type 1 associated to unilateral cochleovestibular dysplasia, perilymphatic fistula and recurrent meningitis. Diagnosis was carried out by MRI and CT scan. His management and treatment are described, as well as the postoperative evolution. We believe this is an exceptional case due to the low frequency of this syndrome, as well as to the otoneurological complications.     

Recomendaciones de la Guía de Práctica Clínica de la exploración de la vía aérea superior para pacientes adultos con sospecha de síndrome de apnea-hipoapnea obstructiva del sueño (versión reducida)

In November 2014 the Spanish Society of Otolaryngology, the Spanish Sleep Society and the Spanish Society of Maxillofacial Surgery proposed and endorsed the development of a Clinical Practice Guideline on the physical examination of the upper airway in patients with obstructive sleep apnoea.The Guideline strictly followed the recommendations of the manual for the preparation of clinical practice guidelines of the National Health System 2007 and 2009 and the manual of the Scottish Intercollegiate Guidelines Network (SIGN) 2015.The final document could be highly useful for the purposes that were originally proposed: to act as a reference to unify the regions that should be explored in patients with obstructive sleep apnoea-hypopnoea syndrome, the type of examination and how to grade it, and specific to all the care areas to which these patients have access.The conclusions and recommendations are based on a thorough and up-to-date review of the literature with a high level of evidence, as well as the experience and knowledge demonstrated by all the members of the drafting group.This group was formed bearing in mind at all times the transversality of the project, and, therefore, specialists from all the involved areas participated (maxillofacial surgery, family medicine, pneumology, clinical neurophysiology, odontology and otolaryngology). The external reviewers of the final text were selected along the same lines.     

Aportación al estudio de la otosclerosis y del síndrome de van der hoeve

Morphological and microchemical changes that effect to the otosclerotic stape in the Van der Hoeve’s syndrome were examined with a scanning electron microscope equipped with an energy dispersive X-ray fluorescence. Using the Ca/P ratio as criterion –measured by the characteristic x-ray fluorescence– it was shown that the Van der Hoeve stape had a higher Ca/P ratio (2.6:1) as compared to the normal stape (2:1). The Van der Hoeve’s syndrome lesions as poorly mineralized, with low calcium salt and apparent increase of phosphates. This finding indicates a possible change from hydroxyapatite (or apatite) to brushite, which imply an acidification of bone.     

Tratamiento quirúrgico del síndrome de apneas obstructivas durante el sueño: de la cirugía palatofaríngea a la reconstrucción quirúrgica multinivel de la faringe. bases,resultados y perspectivas futuras

In this paper is evaluated the effectiveness, as a function of the morphologic structure of the Upper Airways (UA) -evaluated by vigil ENT exploration plus cephalometrics- in the treatment of Obstructive Sleep Apnea Syndrome (OSAS) of the UPPP with or without Nasal Surgery (NS), performed on 33 OSAS patients, and the Multilevel UA Reconstruction (MUAR), performed on 13 patients with multilevel UA obstruction. 10 patients of this group were also evaluated by UA Pressure Measurements during Sleep (PMS). UPPP shows an effectiveness of 60% in cases of favourable UA topography: Predominant palatal obstruction (Type I: euthopic palate with no hypopharyngeal obstruction and Type IIa: palate of low implantation with no hypopharyngeal obstruction, either N+ (nasal obstruction present) or N- (nasal obstruction obsent) and 0% in cases of unfavourable UA structure: Extrapalatal obstruction (Type IIb: palatal and hypopharyngeal obstruction and Type III: hypopharyngel obstruction, either N+ or N-). The maximum UPPP effectiveness is achieved in UA topography IN+ (80%), followed by IIaN- (60%), IIaN+ (57%) and IN- (47%). MUAR, applied on failures of UPPP and patients with UA topography unfavourable to UPPP (Types IIb and III) that rejected CPAP therapy, shows a success rate of 50% in IIaN+ UA type (allowing the recuperation of the 50% of the UPPP failures having this UA topography), 80% in type IIbN+ (where UPPP is contraindicated) and 0% in types IIaNand IIbN-. PMS shows UA multilevel obstruction during sleep. The role of UPPP, NS and MUAR in the treatment of SAOS is are discussed.     

Cirugía de implante de estimulador de nervio hipogloso en el síndrome de apnea obstructiva del sueño: nuestra experiencia preliminar

The objective of this communication is to describe our preliminary results in upper airway stimulation surgery via hypoglossal nerve stimulation implantation for obstructive sleep apnoea. We describe 4 cases and the outcomes of the surgery were analysed using the Epworth scale, apnoea-hypopnoea index, minimal O₂ Sat, average O₂ Sat and snoring intensity. In all cases a significant reduction in Epworth scale values and apnoea-hypopnoea index were obtained (P<.05). The minimum and average oxygen saturation had better values after the surgery, however, there was no statistically significant difference. The snoring severity measured subjectively changed from «intense» to «absent» in all cases. The preliminary results obtained with the upper airway stimulation surgery via hypoglossal nerve stimulation showed objective and subjective improvement after the implant activation.     

Parálisis unilateral de cuerda vocal de causa extralaríngea: etiología y pronóstico

Introduction and methodologyUnilateral vocal cord paralysis without laryngeal lesions is a relatively frequent entity. It can be the manifestation of numerous diseases from the thorax, neck, skull or systemic. The objective is to study the extralaryngeal etiology of unilateral vocal cord paralysis, its prognosis and the relationship of both with different clinical variables. Retrospective study of 116 patients with complete unilateral vocal cord paralysis without laryngeal lesions. The patients underwent cervical-thoracic CT +/– evaluation by Neurology with brain MRI to establish the etiology and follow-up for at least 1 year.ResultsThe most common extralaryngeal cause of vocal cord paralysis was cervical surgery (46.5%), followed by tumor (24.1%). Idiopathic paralysis were 15.5%. An association was obtained between sex and etiology (p <0.01), men in relation to malignant pathology and women to iatrogenic disease. Cardiovascular, cerebrovascular, tumor and idiopathic etiology predominate in elderly patients; while in younger patients the surgical one (p <0.01). 18.1% recovered vocal cord mobility. The female sex was related to its recovery (p <0.01). Tobacco and malignant etiology were related to its persistence (p <0.01).ConclusionsThe first extralaryngeal cause of unilateral CV paralysis is surgical followed by lung and thyroid neoplasms. There is a great diversity of lesions that can cause it, in many cases it involves the diagnosis of malignant tumors. Its recovery is more frequent in female patients, non-smokers and with benign pathology.     

Evaluación de la disfunción de la trompa de Eustaquio mediante el cuestionario de disfunción tubárica (ETDQ-7) y la tubomanometría

ObjectiveEvaluation of the severity of Eustachian tube dysfunction using the Spanish validation of the Eustachian Tube Dysfunction Questionnaire-7 (ETDQ-7) and tubomanometry (TMM).Materials and methodsSpanish validation of the ETDQ-7. Patients: Prospective study with 125 patients, 75 of whom reported symptoms compatible with Eustachian tube dysfunction. Outcome measures: The Spanish version of the ETDQ-7 was administered after translation and back-translation. Internal consistency and reliability were established. Usefulness evaluation of TMM plus ETDQ-7 in the study of Eustachian tube dysfunction.ResultsThe Spanish adaptation of the ETDQ-7 showed high reliability and internal consistency. TMM and ETDQ-7 together showed increased sensitivity and specificity in the diagnosis of Eustachian tube dysfunction.ConclusionsThe Spanish adaptation of the ETDQ-7 is valid, reliable and can be used in a clinical setting to quantify the impact and severity of chronic dysfunction on patients’ lives. A new test formed by combining ETDQ-7 and TMM could be a routine test in the diagnosis of Eustachian tube dysfunction.     

Síndrome PANDAS: ¿una nueva indicación de amigdalectomía?

PANDAS Syndrome (Paediatric Autoimmune Neuropsychiatric Disorders Associated with Streptococcus) is a rare disease described in 1998. In this disease, there is a relationship between group A beta haemolytic streptococcal tonsil infections and the exacerbation of neuropsychiatric disorders. A case report of a 9-year-old child with PANDAS syndrome is presented. This child has had no further symptoms after tonsillectomy. The understanding about PANDAS syndrome and tonsillectomy is reviewed.     

Estrategias para la práctica de la otorrinolaringología y cirugía de cabeza y cuello durante la fase de control de la COVID-19

The appearance of a new coronavirus disease called COVID-19 at the end of 2019 and its pandemic expansion in the world has changed the usual practice of the specialty of Otorhinolaryngology (ENT). After a phase of exponential growth of infections, it has been possible to enter a phase of control of the spread of the disease in which the possibility of infection persists, and the appearance of new cases is considered acceptable by the health system.The aim of this document is to review the available evidence and propose strategies and recommendations for the medical-surgical practice of otorhinolaryngology and head and neck surgery, which allow establishing the usual activity, adapting the safety and efficacy standards to the current situation. Therefore, it is required to identify and classify patients according to criteria of infectious-immunological status, and to establish recommendations for protection in consultations, hospitalization and the operating room, which avoid the transmission of the disease to other users and healthcare personnel, in the specific context of the development of our specialty. This document is the result of the collaboration of all the scientific commissions and the SEORLCCC COVID-19 committee.     

El síndrome del primer mordisco

First-bite syndrome consists of the appearance of pain in the parotid at the beginning of mastication, due to damage to the cervical sympathetic chain or the sympathetic plexus innervating the parotid gland. Clinical presentation in a patient who has undergone surgery of the parapharyngeal space suggests the diagnosis.We report here the case of a patient who presented first-bite syndrome after being operated on for a cervical sympathetic chain schwannoma.     

Implicación clínica de la lesión iatrogénica de la cuerda del tímpano en la cirugía de la otosclerosis

Introduction: Damage to the chorda tympani nerve is frequent during otologic surgery. This article studies the clinical outcomes of the nerve's section versus its conservation in otosclerosis surgery.Material and method: Retrospective observational study using our department's otosclerosis database and a validated questionnaire on symptoms associated with the chorda tympani nerve. The sample was divided into two groups: section and conservation (patients whose nerve was anatomically conserved). We studied the presence and duration of symptoms, the surgical technique and the audiometric results.Results: 78 patients (88 ears): section group (18 ears; 20 %) and conservation group (70 ears; 80 %). Overall, gustatory symptoms appear in 35 % (39 % section group; 34 % conservation group). Differences between groups are not statistically significant in relation to presence and duration of symptoms, surgical technique or audiometric results. Only 1 patient in each group reports long-term symptoms. Our results suggest there are no major clinical differences following section versus conservation of the chorda tympani nerve. A wide range of factors such as age, presence of previous middle ear pathology, cross innervation and gastronomic culture may play a role in the appearance of symptoms.Conclusions: Symptoms appearing after iatrogenic damage to the chorda tympani nerve have, in general, little clinical relevance, especially in the long term, regardless of whether the nerve is dissected or manipulated to various degrees.     

Doble anomalía de la segunda hendidura branquial

Second branchial cleft anomalies are the most common of this type of neck masses. They can be classified in four types (Bailey/Proctor classification) according to their location. Type II is the most common, and related to vital neck structures such as the carotid artery and jugular vein. Cysts are the most frequent among them. Management consists of surgical excision of the cyst and tract by cervicotomy to avoid recurrence. We present an extremely rare case of a 32-year-old male who presented a sudden appearance of a right lateral neck mass that was identified by an image study as a double branchial cleft cyst. A review of simultaneous branchial cleft cyst in the literature is also made.