Cirugía de rescate en las recidivas locales del carcinoma de nasofaringe

Introduction and objectives

Chemoradiotherapy is the treatment of choice for nasopharyngeal carcinoma. Local recurrences are one of the leading causes of death in these patients, and surgical salvage the treatment of choice. Our goal was to evaluate and compare the results of salvage surgery in the treatment of local recurrence of nasopharyngeal carcinomas comparing endoscopic to open approaches.

Expresión clínica de las alteraciones del equilibrio en pacientes con síndrome de latigazo cervical

Introduction and objectiveThere are many entities that cause equilibrium disorders. Whiplash syndrome is becoming an important entity as a trigger of equilibrium disorders because of an increase in traffic accidents. There are many hypotheses on the generation of vertigo and dizziness in whiplash syndrome. The objective of this study is to describe and analyze the clinical symptoms of patients who suffered whiplash.Material and methodThirty six patients with equilibrium disorders who suffered whiplash syndrome were studied prospectively. None of these subjects had cranial trauma or a history of vestibular pathology prior to the traffic accident. We conducted an exhaustive anamnesis, videonystagmography and cervical magnetic resonance. Patients were classified by type of equilibrium symptom and degree of cervical lesion.Results55.5 % of patients had a sensation of dizziness associated with postural and cephalic movements, 38.8 % had disequilibrium continuously, and 16.7 % (6 cases) had vertigo. Three of this last group had a diagnosis compatible with benign positional vertigo but this diagnosis was confirmed in only 2 patients; two patients had labyrinth commotion and one patient had vertigo of unknown origin.ConclusionsIn patients with whiplash, the most frequent equilibrium symptom is the sensation of fleeting dizziness associated with head movements, while only a small group suffer from vertigo. Although vestibular tests are normal in most patients, we cannot rule out the existence of otolithic lesions.     

Manifestaciones audiovestibulares en las vasculitis sistémicas

Systemic vasculitides constitute a heterogeneous group of diseases with frequent overlapping in their clinical findings and the size of the vessels involved. They may be primary or secondary to other diseases. Their common characteristic is the inflammation of blood vessels, giving rise to ischaemia. In the present article, we have reviewed the most common audiovestibular features that may be observed in patients with systemic vasculitides. Audiovestibular manifestations may be the first symptom of a systemic vasculitis. Audiological manifestations include sudden hearing loss and progressive sensorineural hearing loss. Vertigo and nystagmus are vestibular symptoms that may be observed in several systemic vasculitides. Vestibular loss in caloric test, abnormal head-shaking nystagmus, head thrust test and positioning test (benign paroxysmal positioning vertigo) may also be found. Improvement of audiovestibular function is frequently observed in patients with giant cell arteritis following corticosteroid therapy.     

Síndrome del síncope del tumor del espacio parafaríngeo

There are several causes of syncopal attacks because of carotid sinus alterations. Recently parapharyngeal tumours have been implicated in its etiology. We reported a man with a cavum tumour who had several syncopes and an haemodynamical angina because of severe bradyarrhythmias. Implicated clinical entities in parapharyngeal space lesions syncope-syndrome, its physiopathological characteristics and differential diagnosis are discussed.     

Miotomía del cricofaríngeo en el tratamiento de la distrofia muscular oculofaríngea

Oculopharyngeal muscular dystrophy (OPMD) is an autosomal dominant myopathic disease which provokes oropharyngeal dysphagia, palpabral ptosis and proximal limb weakness. It is the abnormal expression of the GCG triplet in the PABPN1 gene on chromosome 14 that causes this disease. The study of the oropharyngeal dysphagia that these patients suffer from should include upper gastrointestinal endoscopy, barium video-radiology and oesophageal manometry. Genetic study confirms the diagnosis. We report 6 patients (3 of whom were siblings) referred to our department with a confirmed diagnosis of OPMD, who underwent cricopharyngeal myotomy to achieve normal swallowing.     

Comparación de 2 protocolos analgésicos en el control del dolor postamigdalectomía en pacientes adultos ambulatorios

Introduction and objectivesTonsillectomy causes a moderate to severe postoperative pain, and its treatment is an unsolved problem.The objective of this study was to compare the effectiveness of 2 analgesic protocols and their related complications.MethodsTwo groups of adult patients submitted to ambulatory tonsillectomy were studied. In group 1, 52 patients received a combination of tramadol and NSAIDs postoperatively; in group 2, 60 patients were treated with prednisone and NSAIDs. Two surgical techniques were used: cold dissection or dissection with electrocautery. Pain was recorded on days 4, 7 and 15, using a numerical scale from 0 to 10.ResultsBoth groups showed similar pain at postoperative day 4. At day 7, pain was higher in group 2 (P=.049), while at day 15 both groups showed only some discomfort. Sickness and vomiting was more frequent in group 1, and haemorrhage and hospitalisation in group 2. Cold dissection patients showed lower levels of pain at days 4 and 7, independently of analgesic protocol, and had lower haemorrhage and emergency visit rates.ConclusionsThe efficacy of both protocols was similar in terms of control of pain, with the exception of day 7; however, the protocol with prednisone showed fewer secondary effects. Patients operated using cold dissection had less pain and fewer complications.     

Estudio del daño otolítico en pacientes con vértigo posicional paroxístico benigno mediante potenciales vestibulares miogénicos evocados

IntroductionBenign paroxysmal positional vertigo (BPPV) pathophysiology is based on otoconia migration from the utricle and saccule to the semicircular canals, however, the role of the saccule is still under study. Our aim is to study the otolith damage in these patients with vestibular evoked myogenic potentials (VEMPS) and correlate the results with those of computerised dynamic posturography (CDP).Material and methodsWe present 79 patients diagnosed with BPPV between March and June 2017. VEMPS and CDP studies were performed. We selected 67 patients with posterior semi-circular canal BPPV and we compared them with 60 healthy subjects.ResultsBPPV group had abnormal cervical VEMPS in 49.25% of patients compared to 16.67% in the control group. Ocular VEMPS were altered in 61.19% of the patients and 6.67% of the healthy subjects. Abnormal ocular VEMPS in patients with recurrent BPPV was statistically significant. There was no significant correlation with CDP results.ConclusionsUtricular and saccular dysfunction in BPPV patients proved by VEMPS is higher than in healthy individuals. This result may be related to symptoms of instability experienced by these patients occasionally.     

Tumores primarios del espacio parafaríngeo. Nuestra experiencia en 51 pacientes

Introduction and objectivesTumours of the parapharyngeal space are rare, representing only 0.5 % of head and neck oncology. The aim of this study is to present our experience with the diagnosis and therapies for these tumours.Patients and methodThis study is a retrospective review of 51 patients diagnosed as having tumours of the parapharyngeal space and treated surgically between 1984 and 2006. Tumours originating in the deep lobe of parotid gland were excluded.ResultsSeventy percent of the parapharyngeal space neoplasms were benign and thirty percent malignant. Pleomorphic adenoma was the most common neoplasm (37 %), followed by miscellaneous benign tumours (34 %), paraganglioma (21 %), and neurogenic tumours (8 %). Surgery was chosen in all case, with the transcervical approach used in 32 cases, the cervical-transparotid approach in 13 cases, the transmandibular approach in 4 cases (with mandibulectomy in 1 patient), the transoral approach in 1 case, and the infratemporal fossa approach in 1 case. The most common complications were those deriving from damage to nerve structures.ConclusionsMost parapharyngeal space tumours can be removed surgically with a low rate of complications and recurrence. The transcervical approach is the most frequently used.     

Validez de las medidas del pico cepstral para la valoración objetiva de la disfonía en sujetos de habla hispana

Introduction and objectivesPerceptual rating of overall voice quality and other more specific perceptual dimensions is difficult, as such judgments depend on the listener's subjectivity. Thus, finding objective, valid, and accessible clinical measures to include in comprehensive voice evaluation protocols is a priority.The purposes of this study were to 1) determine the diagnostic accuracy of a single acoustic measure, smoothed cepstral peak prominence (CPPS), to predict voice disorder status from sustained vowels and connected speech samples using the software Praat; 2) to determine the relationship between measures of CPPS and perceptual ratings of vocal quality; and 3) describe the normative values of CPPS.MethodMeasures of CPPS were obtained from connected speech and sustained vowel recordings of 72 Spanish-speaking subjects with voice disorders and 52 nondysphonic Spanish-speaking subjects with no vocal disorders using freely downloadable Praat software. IBM SPSS Statistics software version 23 was used to complete the statistical analyses.Resultsresults revealed a 70% sensitivity rate, a specificity rate of 85%. Estimated severity for sustained vowels and connected speech were strongly correlated and significantly associated with listener ratings of dysphonia severity.ConclusionsA single acoustic measure of CPPS was highly predictive of voice disorder status using Praat software. Clinicians may consider using CPPS to complement clinical voice evaluation and screening protocols.     

Epidemiología de los trastornos del equilibrio en atención primaria

Background and objectiveIn our country, there are no series of patients that have described the incidence of the different diseases which cause balance disorders (BD) in primary care. The objective of this study is to calculate the incidence of each disease to propose specific training measures.Materials and methodProspective cross-sectional study. Patient data of five primary care physicians in five different primary care centres in our hospital area were collected. All patients who attended consultations for any type of vertigo, imbalance or dizziness over one year as the main reason for consultation were recruited. Using a diagnostic-therapeutic algorithm, patients were diagnosed and treated in primary care or referred for study in hospital care.ResultsThe population studied was 7,896 people. An annual incidence of BD of 2.2% was detected. Of the cases, 56.1% could be diagnosed and treated in primary care. Of the patients, 53.8% were diagnosed with some type of positional vertigo; the next three most frequent diagnoses were vestibular migraine, central nervous system ischaemia and medication side effects. These four groups accounted for 87.9% of the population.ConclusionsThe incidence of BD in primary care requires an approach that includes training in the diagnosis and treatment of benign paroxysmal positional vertigo, headache, cardiovascular risk factors and pharmacology. It is not necessary to prescribe vestibular suppressants in most patients.     

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.     

Evaluación del tratamiento del vértigo posicional paroxístico benigno mediante el cuestionario DHI-S

Benign paroxysmal positional vertigo (BPPV) is a recurrent chronic disease and its handicap is usually understimated. The aim of this study is to determine the impact of the treatment by Epley maneuver on short-term BPPV- related quality of life. Forty-two individuals with BPPV were included: 39 with posterior canal afected, 2 with the lateral canal and one with the anterior canal. Diagnosis was established if a consistent clinical history was found and Dix-Hallpike test (DHT) in cases with canal posterior involvement. Subjects with positive DHT were treated by a single Epley maneuver and were recommended to avoid supine for the next 48 hours. The BPPV relapses were investigated at 7th and 30th day post-treatment. BPPV-associated quality of life was evaluated by the Dizzness Handicap Inventory Short-form (DHI-S) at days 1st and 30th post-treatment. Total and partial scores for emotional, physical and functional subscales were compared by Wilcoxon test for paired samples. Dix-Hallpike test was found positive in el 59% individuals (23/39), and 41% cases did not required any treatment. Among 23 patients treated with Epley maneuver, DHT was found negative in 90% at 30th day follow-up. Mean and standard deviation of the total scores obtained in the DHI-S at the first day were 19.22 ± 9.66 in the DHT positive- patients and 19.79 ± 10.14 in the whole group (DHT positive or negative). These scores significantly decreased to 10.84 ± 10.99 at 30 days post-treatment (p= 0.002 and p=0.001, respectively). In conclusion, the DHI-S is a specific health questionnaire able to assess BPPV –related health and the effectiveness of treatment.     

Cambios en la vía aérea superior de pacientes con apnea obstructiva del sueño y/o roncopatía crónica en tratamiento con posicionadores mandibulares

We have analysed the possible modifications in the upper airways (UA) of the lateral craneal teleradiography in 25 adult males with Obstructive Sleep Apnea (OSAS) and/or chronic snoring, with dental and squeletal Class I, treated with advance mandibular appliances (MAD). Results of our study showed a clear increase of the UA in the oropharinx in all the subjects studied.The study of the changes in the UA using the lateral craneal teleradiography in order to evaluate the eflectiveness of the MAD can contribute to consider its eflectiveness in the cases with OSAS when they are indicated. However it will be needed to contrast these results with polisomnography.     

Características diferenciales de los pacientes con carcinomas escamosos de cabeza y cuello en función del género

ObjectiveTo analyse the trend in the percentage of patients with squamous cell carcinoma of the head and neck of female gender over the last decades, and differences in survival according to gender.Material and methodsRetrospective study of 5,828 squamous cell carcinoma of the head and neck diagnosed during the period 1985-2019. In the survival analysis we only included only patients with more than two years of follow-up.ResultsThe proportion of tumours in female patients increased significantly over the study period. There was greater increase of tumours located in the oral cavity, oropharynx and larynx in the percentage of female patients. When considering the total number of patients, there were no significant differences in disease-specific survival according to gender. We observed a variable behaviour of disease-specific survival according to gender depending on the primary location of the tumour. For tumours of the larynx and oropharynx the female patients had a disease-specific survival significantly higher than that of men, while for tumours of the oral cavity, the female patients had a significant reduction of disease-specific survival.ConclusionsIn our setting, the percentage of female patients with squamous cell carcinoma of the head and neck has been increasing steadily over recent decades. There were differences in disease-specific survival according to gender depending on the location of the primary tumour.     

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.     

Determinación de pth i en la cirugía del hiperparatiroidismo. nuestra experiencia

Our service of otolaryngology has performed 90 parathyroidectomies at all since april 1990 to 2000 on 92 patients sent to us with diagnosis of hyperparathyroidism. 67 patients were diagnosed as primary hyperparathyroidism; 22 as secondary and 3 cases corresponded to tertiary hyperparathyroidism. we analysed a string of variables before and after the surgery standing out the recent estimate of rapid pth i levels. the kind of surgery we performed was the removal of adenoma in 63 cases; 23 patients were put to subtotal parathyroidectomy and 4 to a total one. an exploratory neck surgery was performed in two patients without finding a parathyroid pathology. we compare the obtained results with other published series and we think it can be useful to determinate the rapid paratohormone levels (pth i) pre and postsurgery (only used in 3 cases by now) in order to predict the clinic response of the patients with hyperparathyroidism     

Correlación entre la clínica y la polisomnografía en los trastornos respiratorios del sueño infantil

IntroductionAlthough polysomnography is the gold standard test for sleep-disordered breathing in children, there is controversy about its indication in all cases. Among the arguments both for and against is the lack of correlation between objective values and the symptoms.ObjectiveTo evaluate the correlation between clinical data and apnea-hypopnoea index (AHI) in our work environment.Material and methodsWe compared the preoperative clinical symptoms and AHI statistically in 170 children with sleep-disordered breathing who underwent polysomnography. We also analysed the correlation to postoperative level, with a subgroup of 80 children who underwent adenotonsillectomy with 1 year of polysomnography follow-up.ResultsBefore surgery, only the degree of tonsillar hypertrophy was statistically significant correlated with AHI. At post-operative follow-up, evidence of correlation between AHI and apnoea was observed: 38.1% of children improved in the group with persistence and 66.7% in the disease resolution group (P=.023). In addition, the correlations showed the level of improvement of snoring, as assessed by visual analogue scale. The mean was 5 points lower in the persistent group and 6.1 lower in the disease resolution group (P=.047).ConclusionDespite the limitations in the correlation between clinical data and polysomnography, especially in preoperative results, polysomnography remains the gold standard diagnostic tool. Efforts should be made to obtain objective parameters that provide higher levels of correlation.     

Comentarios sobre minusvalía en patología vestibular

Handicap of the patient with vestibular disease can be measured by means of scales and questionnaires. The utility of a questionnaire developed and validated in Spanish language is commented (CEMPV). The CEMPV consists of 46 questions distributed in three scales (emotional, functional and organic) whose obtained scores are related to diverse degrees of handicap (global, emotional, functional and organic). The CEMPV is self-employed and evaluates the evolution of the patient and allows to accredit the results obtained between different investigators.     

Eficacia de las maniobras de reposicionamiento canalicular en el vértigo posicional paroxístico benigno: revisión de 176 casos tratados en un centro hospitalario de tercer nivel

Introduction and objectives

Benign paroxysmal positional vertigo is the most common peripheral vertigo disease. The aim of this paper is to review the results obtained with the different specific particle repositioning manoeuvres, evaluating the possible risk factors linked to a poorer prognosis.