[Cochlear implants in obliterated or ossified cochleas]. / Implantes cocleares en cócleas obliteradas o semiosificadas.

Our last cases of cochlear implants in obliterated or ossified cochleas are presented, and we had described the surgical technique for double-array or compressed system. In our opinion the best surgical method is the combined approach (endoaural with aticotomy view and posterior timpanotomy) for increased promontory view. This technique provides the advantage that it always preserve the posterior wall of the external ear canal, and the array is positioned easily.

[More of five decades of supraglottic laryngectomy (Alonso's technique)]. / Más de cinco décadas de laringectomía horizontal supraglótica (técnica de Alonso).

In this paper we attempt to prove the relevance of the Spanish and Iberoamerican contribution, in the expansion and development of Alonso's technique for surgical treatment of supraglottic cancer, that began in Spain and South America in the fifties. We mention the most important authors and their ideas, and we explain their contribution to this surgical procedure which has been remained forgotten in the latest publications.

[Extramedullary plasmacytoma of the head and neck. Report of 3 clinical cases]. / Plasmocitoma extramedular de cabeza y cuello. Presentación de 3 casos clínicos.

Plasmocytomas are neoplasic disorders arising from plasma cells that include Multiple Myeloma (MM) Solitary Plasmocytoma of the bone and Extramedullary Plasmacytoma (EMP). EMP are solitary tumours consisting of plasma cell proliferation that occurs in locations other than bone. A variable percentage may be associated at a later date with the development of MM. EMP represent up to 4% of nonepithelial tumours of the upper respiratory tract. They generally occur in the submucosal tissue of the upper airways (80% of cases), with a predilection for nasopharynx, nasal cavity, paranasal sinuses and tonsils. We report 3 cases of Extramedullary Plasmocytoma located one in the upper respiratory tract. All the patients underwent surgical resection or biopsy of the lesion that allowed the histological study, which showed a plasma cell proliferation. Serum and bone marrow studies conclude the diagnosis of Extramedullary Plasmocytoma. The treatment was radiotherapy, with or without previously surgery. Three patients are currently under close follow-up and no evidence of recurrence has been found. We review the clinic, diagnostic, therapeutic and prognostic aspects of this kind of tumours.

[Non-pulsatile aneurysm of the superficial temporal artery: a report of a case]. / Aneurisma no pulsátil de la arteria temporal superficial: a propósito de un caso.

Aneurysms of the superficial temporal artery are an uncommon cause for preauricular or parotid masses. Trauma is the most frequent etiology for a pseudoaneurysm and atheromatosis for the true aneurysm. The diagnosis is clinical due to their vascular signs (pulsatile mass, thrill...), these signs care not present when the aneurysmnas thrombosed, being this an unusual event that will make difficult a proper diagnosis. Radiological investigations are needed and helpful under these circumstances. Surgery is curative and recommended, being the excision after proximal and distal ligation of the artery the most accepted procedure. Aneurysms of the superficial temporal artery are rarely reported in the literature. We report a case that showed up as a non-pulsatile preauricular mass to highlight this unusual condition.

[Tuberculous otitis media. Report of 3 cases]. / Otitis media tuberculosa. Estudio de 3 casos.

Tuberculous otitis media (TOM) is a rare cause of chronic suppurative infection of the middle ear. Due to that the symptoms and signs are often indistinguishable from those of nontuberculosis chronic otitis media and the fact that the index of suspicion is low, there is frequently a considerable delay prior to diagnosis. This can lead to irreversible complications such as facial nerve paralysis and labyrinthitis. Medical therapy with antituberculous drugs is usually effective. We report three cases with TOM diagnosticated and followed up in our Service from january 1993 to july 2001. Their charts were retrospectively reviewed for relevant historical data, physical findings, complementary studies, treatment and clinical response. We performed a review of the literature, emphasizing that TOM should be considered in the differential diagnosis of chronic otitis media.

[Tonsillectomy and obstructive sleep apnea syndrome]. / Amigdalectomía en el síndrome de apneas obstructivas del sueño.

We presents the case of a patient, 12-year-old, asthmatic, diagnosed by means of polysomnography of obstructive sleep apnea syndrome (OSAS). Improvement take place after tonsillectomy. This case provide evidence for the condition in childhood, headache being the sole annoyance noticed and surgery seems successful.

[Goldenhar syndrome: a polymalformation syndrome with conductive hearing loss]. / Síndrome de Goldenhar. Un síndrome polimalformativo con hipoacusia de transmisión

We report the case of a 9-years-old girl showing at examination facial asymmetry, right ear with II degree dysplasy and degree III in the left ear (according Marx classification), cleft palate, renal agenesy, scoliosis and hypoplasy of the left thumb. Otoscopically both external ear canals looked very narrow and very upright positioned. The drumhead image recalling that of chronic mucoid effusion. The measurement of hearing through pure-tone audiometry, PEATC, and tympanometry resulted in a pattern of bilateral transmissive pantonal hearing impairment accounting for 50-60 dB. Scoliosis was due either to bars or hemivertebrae or even to an atlas occipitalization. Chromosoma caryotype was normal.

[Nasal leiomyosarcoma]. / Leiomiosarcoma nasal.

Leiomyosarcoma is an infrequent soft-tissue tumor that generally occurs in the myometrium and gastrointestinal tract. Primary tumors of the veins are unusual and generally occur in the inferior vena cava and only exceptionally in peripheral veins, such as the jugular or its branches. We report a case of leiomyosarcoma located in the left inferior turbinate. The 87 year-old male patient presented nasal obstruction and recurrent nosebleed. He had pulmonary and mediastinal metastases at the time of diagnosis.

[Benign necrotizing osteitis of the external ear canal. A report of a clinical case]. / Osteítis necrotizante benigna del conducto auditivo externo. Descripción de un caso clínico.

Benign necrotizing osteitis of the external ear canal is a process of unknown origin. This necrotic process with sequestration of the tympanic bone occurs in healthy, non-diabetic patients. It should be differentiated from malignant otitis externa and radionecrosis of the tympanic bone. A case is reported and the literature on this rare clinical entity is discussed.

Plasmocitoma extramedular nasofaringeo. reporte de caso / Extramedulary plasmocytoma in the nasopharynx. case report

Los plasmocitomas extramedulares (PEM) son tumores solitarios de células plasmáticas localizada en lugares lejanos al hueso. Un porcentaje variable puede desarrollar con posterioridad un mieloma múltiple. Los PEM representan cerca de un 4 por ciento de los tumores no epiteliales del tracto respiratorio superior. Generalmente se desarrollan en el tejido submucoso de vías aéreas superiores con predilección por la nasofaringe, las fosas nasales, los senos paranasales y las amígdalas. Los tumores rinofaríngeos son raros; una revisión en Medline encontró 10 casos en la nasofaringe, uno de ellos en España. Presentamos el caso clínico de un paciente varón de 69 años, con patología tubárica crónica, cuyo examen clínico reveló la existencia de una lesión polipoide en nasofaringe, sin adenopatías cervicales. La resección endoscópica transnasal permitió el estudio histológico de la pieza, que mostró una proliferación de células plasmáticas. Los estudios séricos y de médula ósea permitieron concluir el diagnóstico de plasmocitoma extramedular. El tratamiento fue completado con radioterapia, no existiendo evidencia de recurrencia de la enfermedad después de 18 meses

[Study of Cyfra 21-1 as a new tumor marker for the diagnosis of epidermoid carcinoma of the head and neck]. / Estudio del Cyfra 21-1 como un nuevo marcador tumoral en el diagnóstico del carcinoma epidermoide de cabeza y cuello.

Serum concentrations of Cyfra 21-1, a soluble cytokeratin fragment, were evaluated in 157 healthy patients, 66 patients with benign ear, nose or throat disease, and 102 patients with untreated epidermoid carcinoma of the head and neck. The technique had a sensitivity of 53.9% and specificity of 98.4% for a cutoff value of 1.5 ng/ml. Cyfra 21-1 levels differed significantly with tumor location (p < 0. 005) and tumor stage (p < 0.005), but not with the degree of histological differentiation.

[Benign paroxysmal vertigo in childhood]. / Vértigo benigno paroxístico de la infancia.

Benign paroxysmal vertigo of childhood is a clinical disorder that usually begins at age 4. The child's otoneurological examination is normal in the intercrisis and the brief episodes of true vertigo are typical. In this paper we describe six new cases that had a follow-up of at least one year after diagnosis. Only a few of the patients had demonstrated vasomotor migraine, but all the children had a family history of migraine, which supports the hypothesis that this disorder is a migraine equivalent. The pathogenesis may be related with a transitory vascular disturbance that produces ischemia of the vestibular nuclei and pathways, as occurs in other vascular territories during typical migraine. One longer-than-usual episode is reported. Otherwise, the evolution of this condition is favorable.

[Questionnaire for disability assessment in vestibular pathology]. / Cuestionario para la evaluación de la minusvalía en patología vestibular (CEMPV).

The QADVP (questionnaire for assessment of disabled by vestibular pathology) is self-employed and consists of a series of 46 questions divided into 3 scales (emotional, functional and organic) from which direct and proportionate scores (both for each scale and as a whole for the full questionnaire) are gained. The aim of the paper is to show its application-way, the outcome of assessments and the disability degree drawn out from the scores. A prospective study fulfilled within 2 years term (May, 1st 1994 until May, 1st 1996) between patients of the Health Area of Zamora, seen at the ENT outpatients Department. The validation's study (reliability, homogeneity and discriminatory power in each scale and of the whole questionnaire) was made from a sample of 30 patients suffering of recurring-paroxysmal vestibular disease of several etiologies. In order to establish the handicap degree the questionnaire was employed in 60 patients suffering postural-paroxysmal vertigo or Ménière disease, grouped in 4 homogenous sets after the evolutive time. The series in each scale and globally for the whole questionnaire make sharp 4 levels of handicap (from I to IV). Zero degree is equivalent to absence of vestibular disorder. The QADVP is a measuring tool allowing: assessment several degrees of incapacity, to control the development of the disorder and try therapeutic changes.

[Treatment of chronic snoring with CO2 laser]. / Tratamiento de la roncopatía crónica con láser CO2 (LAUP).

Laser-assisted uvulopalatoplasty (LAUP) is an effective surgical procedure for treating habitual snoring. It is performed under local anesthesia as an outpatient procedure and consists of enlarging the oropharyngeal air space and restructuring the uvula, velum, and pharyngeal pillars. We used LAUP in 112 patients with upper airway resistance syndrome (UARS) (Lipman grade II) over the last three years and achieve a care rate of 87.5%.

[Changes in the nuclear morphometry in oropharyngeal epidermoid carcinoma after induction chemotherapy]. / Cambios en la morfometría nuclear del carcinoma epidermoide de orofaringe tras quimioterapia de inducción.

A cytomorphic, stereological study was made by computerized image analysis of six nuclear morphometric variables and one stereological nuclear variable. Variables were measured on 150 randomly selected tumor cells in oropharyngeal biopsies from 44 patients with oropharyngeal cancer who had not responded completely to induction chemotherapy. The nuclei of tumoral cells were larger (mean nuclear area, perimeter, and volume), more rounded, and had a less irregular nuclear contour index.

[Therapeutic possibilities in recurrent infantile tonsillitis]. / Posibilidades terapéuticas en la amigdalitis recurrente infantil.

The present study compares two therapy protocols in 40 children with recurrent tonsillitis. Twenty of them were randomly treated with penicillin, and the remaining 20 received penicillin + metronidazole. Clinical and microbiological assessment of the results was made. The association of penicillin and metronidazole was most efficient, probably due to its activity against Streptococus pyogenes and anaerobic betalactamase-producing bacterias. The high failure rate in the penicillin group states the necessity to change the therapy with this antibiotic in the treatment of childhood recurrent tonsillitis.

[Psychological alterations in patients with cancer of the larynx before and after laryngectomy]. / Alteraciones psicológicas en pacientes con cáncer de laringe antes y después de la laringectomía.

Our work, about the psychological disorders associated with cancer of the larynx and its therapeutics, study a group of 54 neoplasicos patients who have undergone a laryngectomy, before and after surgical treatment. We analyze in the pre-operation period, the relationship between the cancer and anxiety/state, comparing the patients with a serious neoplasia and those with a more benign pathology. After the operation, we study the relationship between the loss or retention of speech and the existence of anxiety/state and depression. We evaluate anxiety through the (STAI) of Spielberger and depression through the SDS scale of Zung. The pre-operative results indicate that the patients have levels of A/E significantly greater (p < 0.0001) than the mean score in the control group, without there being any significant difference according to the gravity of the cancer. Patients that have lost the capacity to speak after the surgical treatment, have significantly higher levels of anxiety and depression than the control group and those patients that have retained the capacity to speak (p < 0.0005). Other results about the relationship between the two disorders studied and variables of personality, can be found in the analysis section and in the discussion of the results.

[Nystagmic response after bithermal caloric stimulation in elderly subjects: latency, culmination, and finalization]. / Respuesta nistágmica tras estimulación calórica bitermal en ancianos: latencia, culminación y finalización.

We analysed the nystagmic response poscaloric stimulation in 38 healthy elderly persons. Latence, culmination, lasting, central nystagmic frequency and interaural difference are analysed. We establish the normal pattern for the nystagmic response.

[The development of a clinical protocol for the study of peripheral facial paralysis. A computerized database version]. / Desarrollo de un protocolo clínico para el estudio de las parálisis faciales periféricas. Versión de captura de datos informatizada.

We present a protocol for the management and follow up of facial palsies, in which, the clinical, diagnosis and therapeutical informations are obtained in order to evaluate the clinical assessment and pathology of this cranial nerve. We also present a computerized database system in order to develop statistical analysis and further studies on this peripheral nerve lesion.

[Vestibular symptomatology and response to treatment with heterocyclic drugs]. / Sintomatología vestibular y respuesta al tratamiento con fármacos heterocíclicos.

Around 40 percent of the patients that we consult due to vertigo of a probable vestibular origin present an associated depressive syndrome. A study with patients with depressive symptoms and vestibular pathology of diverse aetiology in inactive phase is presented. Treatment using amitriptyline improves de evolutive prognosis of vestibular manifestations while observing a lower reappearance of symptomatology.