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.     

Análisis del género en las autorías de las publicaciones científicas del acta otorrinolaringológica española en la última década

IntroductionIn recent decades, progress has been made in tackling inequality between men and women, encouraging publications that analyse and provide recommendations to eliminate this issue. The aim of this study is to analyse the gender differences in the authorship of the studies published in the journal Acta Otorrinolaringológica Española.MethodsA cross-sectional study of issues published between January 2010 and December 2019, including number of authors (total, men and women), type and year of publication, institution and country (first, second and last author), and area of specialisation. Women's participation was calculated based on female/male ratio, trend and associated factors.ResultsA total of 615 articles with 2,841 authors (1,017 women and 1,824 men) from Spain were collected. A total of 244 (39.7%) women and 371 (60.3%) men were listed as first authors (P = .879), 245 (39.84%) women and 370 (60.16%) men as second authors (P = .919), and 137 (22.28%) women and 478 (77.72%) men as final signatories (P < .000). All the ratios calculated were below the recommended figures.DiscussionThe participation of female authors in the scientific production of Acta Otorrinolaringológica Española is acceptable, following a similar distribution to the current number of female ENT specialists. Further efforts are needed to increase the number of final signatories and to change the decreasing trend recorded over the last decade.     

Evaluación de la vía aérea mediante laringoscopia indirecta en pacientes con hipertrofia de la amígdala lingual

Introduction and objectivesPrevalence of the lingual tonsillar hypertrophy is unknown but it is believed that its presence is associated with the difficult airway. To investigate this, indirect laryngoscopy was performed on patients in the preoperative evaluation and this pathology was diagnosed. The relationship with difficulty of viewing the larynx, intubation and ventilation, under general anaesthesia and using direct laryngoscopy, was then studied.MethodsWe performed the demographic variable checks and tests for predicting difficult intubation (mouth opening, thyromental distance, cervical flexion-extension, neck thickness and Mallampati test), in the preoperative step on 300 patients who were going to be submitted to general anaesthesia. We then performed indirect laryngoscopy on them using a 70° rigid laryngoscope to ascertain the frequency of appearance of lingual tonsillar hypertrophy. Next, under general anaesthesia, we carried out direct laryngoscopy to verify whether there was difficulty in viewing the larynx and intubation and ventilation. We then investigated the association of demographic predictors of difficult intubation, including indirect laryngoscopy, with the presence of this condition.ResultsPrevalence of lingual tonsillar hypertrophy was 2%. No relationship between the appearance of this entity and the difficulty of viewing the larynx, intubation and ventilation was found. Only indirect laryngoscopy was linked to the appearance of this pathology.ConclusionsLingual tonsillar hypertrophy is a relatively frequent disorder, whose presence is not usually associated with difficult airway.     

Electrococleografía extratimpánica en la enfermedad de Ménière

IntroductionElectrocochleography is the registration of an electrophysiological event which takes place in the cochlea after an acoustical stimulus. Most of the authors consider an increased summating potential (SP)/action potential (AP) ratio as characteristic of endolymphatic hydrops.MethodsA longitudinal, prospective study of a unilateral Ménière's population diagnosed according to the American Academy of Otolaryngology-Head and Neck Surgery classification was carried out. A complete clinical history and bedside examination were performed, in addition to complete auditory and vestibular testing and an extratympanic electrocochleography. We selected 20 normal hearing subjects with no history of vestibular and otological pathology as a control group.ResultsOf the 100 patients included in the study, 62 were diagnosed as definite Ménière's disease, and 13 and 25 as probable and possible Ménière's disease, respectively. In the electrocochleography, 85% of all the patients had an SP/AP ratio above 0.5. A sensibility of 92%, 78% and 75% was obtained in the definite, probable and possible Ménière's disease patients respectively.Discussion and conclusionsElectrocochleography is a useful method for diagnosing and evaluating patients with Ménière's disease syndrome. It provides information about the progression of the process and shows a significant correlation with the clinical stage.     

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.     

Tumor desmoplásico de células pequeñas redondas. Morfología atípica en la glándula submaxilar

Desmoplastic small round cell tumour (DSRCT) is a rare disease usually affecting young males. There are no other articles with a sub-maxillary location. The tumour consists of nests and masses of undifferentiated small round cells embedded in a desmoplastic stroma. The co-expression of epithelial, muscular and neuronal antigens distinguishes this entity from other small round cell tumours. The t(11;22)(p13;q12) translocation is a recurrent characteristic of this type of tumour.We report a case of desmoplastic small round cell tumour of the sub-maxillary gland, with an evolution of 8 months, affecting a 36 year old male. He suffered chronic lymphatic leukaemia five years ago and needed a bone marrow transplant. There was a 4×3 cm tumour. There were no signs of malignancy on the CT scan. A right sub-maxillectomy was performed. The pathology analysis gave a diagnosis of DSRCT. Post-surgical radiotherapy was given.The definitive diagnosis was reached using immunohistochemical techniques, such as polyphenotypical differentiation (epithelial, mesenchymal and neural), and by demonstration of translocation (11;22)(p13;q12). Sub-maxillary location is very rare.     

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.     

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.     

Stéréoaudiométrie et Appareillages Stéréophoniques

La stéréoaudiométrie consiste en la mesure du rendement de l'appareillage en stéréophonie. On applique des appareils identiques sur les deux oreilles; l'appareillage de l'oreille la plus sourde est régié afin de ramener le seuil d'intelligibilité à 30—35 dB environ au-dessus du seuil normal, puis on ramène le seuil d'intelligibilité de l'oreille moins déficiente au niveau du seuil de l'oreille la plus sourde précédement appareillée. II faut que les deux appareils soient en concordance de phase. Un gain de 5 dB dans le seuil d'intelligibilité s'obtient par l'appareillage bilatéral, mais ce gain ne réflète que très incomplètement le but essentiel d'un appareillage stéréophonique, c'est à dire d'améliorer la compréhension de la parole dans les conversations en groupe, en particulier dans le bruit, compréhension qui est intimement liée à la possibilité de localiser les sources sonores. La stéréoaudiomètre mesure cette possibilité. Les épreuves de localisation peuvent ětre également pratiquées en présence de bruit ou dans le silence. Les tests de discrimination spatiale prévoient l'amélioration de l'intelligibilité dans le bruit. La technique des épreuves sera illustrée en détail dans un film.     

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.     

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.     

Neurinoma intralaberíntico: manejo,exéresis y restauración auditiva con implante coclear

Introduction and objectiveVestibular schwannoma is a benign tumour that originates in the eighth cranial nerve. It is termed intralabyrinthine schwannoma (ILS) when it develops in the inner ear, this being a rare origin. We present our experience in the management of three patients with ILS.Material and methodsThe results of tumour excision and cochlear implantation were evaluated in three patients with ILS: two intracochlear schwannomas (ICS) and one intravestibular schwannoma (IVS).ResultsPrior to surgery, all patients presented progressive sensorineural hearing loss and tinnitus. Complete tumour resection and cochlear implantation was possible in all patients, with favourable hearing rehabilitation.ConclusionsThe therapeutic approach will depend on tumour size, growth rate, degree of hearing loss and presence of vestibular symptoms. Cochlear implantation (CI) in patients with ILS is possible when the cochlear nerve is present and functional. CI in patients, whether or not preceded by tumour excision, is an option with good hearing results in selected patients.     

Significación clínica de la asimetría amigdalina

IntroductionAsymptomatic unilateral tonsillar enlargement is usually treated with systematic tonsillectomy under suspicion of malignancy. Due to the fact that most of the cases are benign pathologies, we set out to study the clinical signs that would help us in the diagnosis in order to avoid unnecessary tonsillectomies.Material and methodsWe reviewed 267 tonsillectomies performed from 1996 to 2006 and 30 of these were indicated because of asymmetry. We evaluated risk factors for malignancy: cervical lymphatic node enlargement, sex, age, tonsillar enlargement noticed by the patient, suspicious appearance, systemic symptoms, history of malignancy and immunocompromise.ResultsHistopathologic study revealed 80 % to be benign and 20 % malignant. The risk factors with the strongest association were enlargement of cervical lymphatic nodes and suspicious appearance of the tonsil.ConclusionsStrict control of a unilateral tonsillar enlargement is possible, but it is mandatory to perform a tonsillectomy when the appearance of the tonsil raises suspicions or there are enlarged lymphatic nodes.     

Absceso parafaríngeo: extensión infrahioidea perilaríngea

Parapharyngeal abscesses are located between the skull base and the hyoid bone. Their infrahyoid extension is usually following the retropharyngeal space, but also can be through the medial aspect of the parapharyngeal space. Thus, surrounding the visceral fascia, they might invade the perilaryngeal and perihypopharyngeal spaces. This results in more significant airway compromise. Computed tomography is essential while locating and evaluating the extension of these infections, specially with regards to the great vessels. We report on 8 parapharyngeal abscesses with perilaryngeal and/or perihypopharyngeal extension. We review their clinical and radiological features, based on computed tomography, as well as their medical and surgical treatment. When medical therapy fails, as they are usually medial to the great vessels, it is possible to perform aspiration and drainage transorally, avoiding the need for cervicotomy, in selected cases.