[Treatment of the benign paroxysmal positional vertigo (BPPV) by Epley maneuver]. / Tratamiento del vértigo posicional paroxístico benigno (VPPB) mediante la maniobra de epley.

Benign paroxysmal positional vertigo (BPPV) is the most common of the peripheral vertigo. We report the case of a 45 years old female with that pathology suspected by the symptoms which the patient related to head changes of positions and movements. Her diagnosis was confirmed by the maneuver of Dix-Hallpike, that was positive, and the treatment consisted in a maneuver of canalicular reposition according to Epley's technique. Such maneuver was successful and actually the patient is without symptoms after more than 2 years since the first episode. Finally we have performed a bibliographic review to verify the effectiveness of that treatment.

[Sudden cervical hematoma after hypertensive crisis. Report of a case]. / Hematoma cervical brusco tras crisis hipertensiva. Presentación de un caso.

We report the case ofa 61 years old woman with multiple pathologies: HTA, diabetes, relapsing polychondritis, hypercholesterolemia, iatrogenic Cushing, cardiopathy, cystic fibrosis, etc. She began, an increment of TA (220/130 mm Hg) or hypertensive crisis, with a sudden left cervical hematoma located on the carotid bifurcation according to CT imaging. We oractice an arteriography that was informed as normal and the patient was admitted and controlled of an ORL as Vascular Surgeon. The bleeding stop spontaneously we treat the patient conservativity.

[Otolaryngologic manifestations of Churg-Strauss sindrome. Report of a case and review of the literature]. / Manifestaciones otorrinolaringológicas del sindrome de Churg-Strauss. A propósito de un caso y revisión de la literatura.

Churg-Strauss Sindrome or allergic granulomatosis is a small vessel systemic vasculitis characterized by asthma, hypereosinophilia and necrotizing vasculitis with extravascular eosinophil granulomas. We describe a case assisted in our hospital who presented pulmonary infiltrates, fever, peripherical neuropathy, weight loss, myalgia, rhinosinusitis, with antecedents of nasal polyposis, and facial edema. Our aim is to review the main otolaryngologic manifestations of this rare illness that is treated with oral corticosteroids, immunosupresor drugs like ciclofosfamide and plasmapheresis.

[Reoperation because of ectopic parathyroid adenoma with previous removal of lipothymoma. Importance of intraoperative PTH]. / Reintervención por adenoma ectópico de paratiroides con extirpación previa de lipotimoma. Importancia de la PTH intraoperatoria.

Sometimes the surgery of hyperparathyroidism is not easy and the surgical team find difficulties to locate the pathological gland or glands. We report a case of primary hyperparathyroidism due to an ectopic parathyroid adenoma which required two interventions. First we removed what it seems an adenoma but resulted to be a lipotimoma. In the reintervention practiced one week later, having then the rapid or turbo intraoperative PTH and previous digital scintigraphy, it was possible to remove an adenoma histologically confirmed, with 3,5 cm diameter located in depth to right thyroid lobe towards the superior mediastinal straits. The postoperative evolution of the patient was satisfactory and no complications were registered.

[Olfactory neuroblastoma in an old patient. Report of a case]. / Neuroblastoma olfatorio en paciente de edad avanzada. Presentación de un caso.

Olfactory neuroblastoma or esthesioneuroblastoma is a rare embrionary tumor, much more in old patients, which uses to present as a pollipoid mass with nasal obstruction, epistaxis and anosmia of long evolution. We report the case of a 82-year-old male with such symptoms diagnosed by biopsy as neuroblastoma class III according the histologic Hyams grading. Due to the age of the patient and grade of the tumor we did not perform surgery and, although a chemotherapy-radiotherapy treatment was suggested, the patient was not agree with it and he has not been attended or followed in our consulting rooms.

[Statistical study regarding anemia in patients admitted with epistaxis. Importance of its control and the associated risk factors]. / Estudio estadistico sobre anemia en pacientes ingresados por epistaxis. Importancia de su control y de los factores de riesgo asociados.

OBJECTIVE: To emphasize the importance of hemodinamic control and risk factors in the patients hospitalized due to epistaxis. MATERIAL AND METHODS: Retrospective study of 200 consecutive patients admitted by such cause between 1997 and 2004 of whom 46 (23%) developed some degree of anemia. Among other clinical variables we analyze the present risk factors, age, sex, levels of hematocrit and hemoglobin, origin of the nasal hemorrhage, number of transfusions that were required and type of nasal packing used. RESULTS: We prove a significant statistical association (p<0,01)) between epistaxis with anemia and risk factors. About 39% of the anemizing epistaxis needed a transfusion, generally red cell concentrates. CONCLUSIONS: Every admitted epistaxis needs a good hemodinamic study and control of the patient and the treatment of the base pathology associated.

[Giant cells undifferentiated parotid carcinoma. Report of two cases]. / Carcinoma parotídeo indiferenciado de células grandes. Presentación de dos casos.

Tumours of the salivary glands represent a 5% of all head and neck neoplasms. Their origin is the parotid gland in about 80% of the cases. Most of them are benign. We are reporting two cases of patients diagnosed, by our ENT Department, as undifferentiated giant cells parotid carcinoma with cervical metastasis. They were operated by total parotidectomy and radical neck disection and later recieved treatment with radiotherapy. After two years-follow-up both patients are standing alive. The tumoral size is the most important pronostic factor in this histological type.

[Simultaneous bilateral sudden deafness. Report of a clinical case]. / Sordera súbita bilateral simultánea. Presentación de un caso.

Bilateral sudden deafness is uncommon and characterized by an acute sensorineural hearing loss in both ears of 30 dB or more in 3 consecutive frequencies. We report the case of a 57 yeras old female with this diagnosis who presented a right anacusia and a severe audiometric loss on left ear without vestibular pathology associated. She was admitted and treated by the protocol of medical therapy that we have performed in our E.N.T. Department (4 days EV and then 10 ones oral medication) with improvement in her audition 25-30 dB average. If sudden bilateral sensorineural deafnes is founded, we must consider an immuno-mediated inner ear disease (IMIED).

[Statistical study and clinical results by comparison of two different protocols in the treatment of sudden hearing loss]. / Estudio estadístico y resultados clínicos de la comparación de dos protocolos diferentes en el tratamiento de la hipoacusia brusca.

Sudden deafness goes on being a clinical entity of unknown cause for which several theories and treatments have been proposed. We are reporting a comparative study of two different protocols that we have performed on 60 patients (divided in two groups of 30) diagnosed and admitted with sudden hearing loss between 1989 and 2003. The main goal is to prove if there is a statistical and significant difference among both, in respect of the audiologic improvement obtained, after two weeks of therapy at east. We have applied the normal approximation of Mann-Whitney's test and we can argue, after its result, our current protocol (piracetam, pentoxifiline, metilprednisolone), which includes 4 days of endovenous treatment another 10 days at home. The presence of vestibular symptoms darkens the prognosis since about 95% of the patients with them have not improved significantly (p<0.05).

[Ethmoidal epidermoid carcinoma showing as cluster headache. Report of a case and literature review]. / Carcinoma epidermoide etmoidal manifestándose con cluster headache. Caso clínico y revisión de la literatura.

We report the case of a 54 years old male diagnosed as ethmoidal epidermoid carcinoma which, after almost 1 year--asymptomatic period, debuted with facial pain (cluster headache) without another associated clinic. Sino-nasal malignant tumours represent about 5%-6% in all ENT carcinomas and they use to be of later diagnosis, with high probability of local recurrence and invasiveness on structures like orbit and skull base. The main treatment for ethmoidal squamous carcinomas is surgery and depending on staging can require radiotherapy and/or chemotherapy. A bibliographic review is done at this respect.

[Association among hypocalcemia, AP result and surgical technique in hyperparathyroidism. A statistical study]. / Asociación entre hipocalcemia, resultado AP y técnica quirúrgica en el hiperparatiroidismo. Estudio estadístico.

The main goal of this article was to know if there was any relations statistically significant among the post-operative hypocalcemia, type of surgery for hyperparathyroidism in our series and its anatomopathological result (AP). 122 patients affected of such illness (30 men and 92 women) were studied and operated and we obtained 30 hypocalcemias (27 transitory and 3 permanent ones). The subtotal and total parathyroidectomies compared with adenomas removal have showed us a percentage for that complication significantly higher (p<0.001). Besides we have found a clear association between parathyroid hyperplasia and hypocalcemia (p<0.05).

[Sino-nasal undifferentiated carcinoma. Report of 1 case and literature review]. / Carcinoma indiferenciado nasosinusal. Presentación de 1 caso y revisión de la literatura.

Sinonasal undifferentiated carcinomas are rare neoplasms but highly malignant and aggressive. We are reporting the case of a 75 year-old female who had related recurrent epistaxis, facial pain and progressive nasal obstruction. The clinical data collected by the exploration joint to CT showed us the presence of a tumoral mass located in the right nasal fossa and homolateral maxillary sinus, eroding structures around. Its biopsy was informed as undifferentiated carcinoma and the patient was sent to Oncology Department, where she was treated by Radiotherapy (68 Gy) and weekly carboplatin during 2 months. After a short improvement of her symptoms and due to poor prognosis in this type of tumors, she died a few months later.

[Hyperparathyroidism due to chronic renal failure. Analysis of 32 operated patients]. / Hiperparatiroidismo debido a insuficiencia renal crónica. Análisis de 32 pacientes operados.

We report our study of 32 patients diagnosed as hyperparathyroidism due to chronic renal failure (27 secondary forms and 5 tertiary ones), between June 1990 and 2003, that were sent from Nefrology Department for to surgical intervention. The following parameters have been analysed: Age, sex, clinical symptoms, kind of surgery performed, postoperative complications and anatomopathologic result (AP). On 64 nerves exposed, there were no recurrent nerve palsies. 12 patients suffered a symptomatic hypocalcemia (37,5%) although only one was permanent. The control of calcium, phosporus and calcitriol is essential to try to avoid a hyperplasia of the parathyroid glands.

[Treatment of thyroid cancer. Retrospective study and review of the literature]. / Tratamiento del cáncer de tiroides. Estudio retrospectivo y revisión de la literatura.

We present a retrospective study about our experience in the treatment of thyroid carcinoma. For that, between 1992 and 1997, we have collected 37 malignant thyroid tumours (15%) over 250 operations on thyroid gland by our ENT Service. We analysed several variables: Age, sex, personal antecedents, clinical symptoms, results of the complementary tests (thyroid hormones, ultrasonography, scintigraphy and FNAB), type of surgery complications and number of recurrences. The thyroid carcinomas, specially differentiated tumors, are an increasing pathology with tendency to affect females. In our serie usually they are solitary thyroid nodes, scintigraphically cold ones, in which FNAB as the best test. We think that a total thyroidectomy is the best treatment and it must be made by an ENT.

[The use of scintigraphy and fine needle aspiration biopsy (FNAB) in thyroid surgery and review of literature]. / Utilidad de la gammagrafía y la PAAF en la cirugía tiroidea. Estudio retrospectivo y revisión de la literatura.

Our aim is to know the usefulness of gammagraphy and FNAB (fine-needle aspiration biopsy) in thyroid surgery done in our ENT-Department during 12 years lapse. In this period of time are considered the outcomes of 461 thyroid gammagraphies and 469 FNAB for diagnostic comparison with the final anatomopathological (AP) issues. We emphasize the 42.3% of cold nodules most of which (21.5%) were thyroid carcinomas (80.95% papillary Ca; 14.28% follicular Ca and the remainder medullary Ca). Between 319 folliculary proliferations according of FNAB only 17 were malignant tumours and when the aspiration puncture informed about positive malignant etiology (51 cases), 5 cases final diagnosis were benign pathology and the other 2 the pathology was of malignancy, but different to that of the initial diagnosis. We considerer that the sensibility of this test is about 86.28% in our series. Finally, our results are compared with those of other publications.

[Sudden deafness. 12 year of experience]. / Sordera súbita. 12 Años de experiencia.

We report 48 cases of sudden deafness admitted in our Hospital between 1990 and 2001. A series of variables were analyzed like affected ear, evolution time, personal precedents, clinic, audiometry, complementary tests, treatments followed (according protocol), clinical evolve and average stay. Four cases annually, more or less, have been registered, with little predominance of men (28) than women (13), being the happy medium 48 years (between 22 and 74 years). 43 percent of cases came to Urgency ward before 24 hours since the beginning of symptoms and 31 percent came three or more days later. 45 patients (93.7%) with an audiometric loss of 500 Hz, 1,000 Hz and 2,000 Hz over 55 dB, with 11 cases of total deafness. In our Department two several treatment protocol have been employed, which results are considered in the paper. Generally 52 percent showed little improvement and only 7 cases gain more than 40 dB, with 2 complete recovery and 23 without improvement. We think that this pathology must be i.v. precociously treated with the selected protocols although without any warranty of hearing improvement, as reflected in our paper.

[Papillary carcinoma on thyroglossal duct cyst]. / Carcinoma papilar sobre quiste de conducto tirogloso.

Papillary carcinoma ansing on a thryroglosal duct cyst is a rare tumor. Since Ucherman described first case in 1915, only 150 cases have been reported. We present clinic evolution and treatment of a new case and review literature and discussion about tumor origin, adequate diagnosis test and treatment. This should include Sistrunk procedure but further surgery on thyroid gland is not accepted by all authors.

[Primary carcinoma of the trachea. Report of 2 cases]. / Carcinoma primitivo de tráquea. A propósito de dos casos.

Tumours of the trachea remain relatively rare, the incidence of tracheal carcinomata is less than 0.1 per cent. Tumours of the larynx and lungs are, respectively, 75 and 180 times more frequent than malignant lesions of windpipe. Two patients with primary tracheal tumours were evaluated. The present study was undertaken in order to describe and analyse the most pertinent clinical and pathologic features of tracheal carcinomas as they relate to treatment and prognosis.

[Primary extramedullary plasmocytoma of the tongue base]. / Plasmocitoma extramedular primario de base de lengua.

Primary extramedullary plasmacytoma (PEP) are malignant neoplasm of plasma cells. They are very rare, however 80% of the cases appear in head and neck region. We reported a rare case of PEP of the base of the tongue, in a 44-year-old male with oral bleeding.

[Laryngeal paraganglioma]. / Paraganglioma laríngeo.

A case of laryngeal paraganglioma in a 65-year-old male was treated by supraglotic laryngectomy. This controversial tumor is analyzed and guidelines are given for its clinical and histological (immunohistochemical) diagnosis and treatment.