[Hypoglossal facial anastomosis as a solution to a total peripheral facial palsy. Our experience]. / La anastomosis hipogloso-facial como solución a una parálisis facial residual completa. Nuestra experiencia.

Hypoglossal-facial anastomosis was performed in four patients with total peripheral facial palsy after removal of cerebellopontine tumors (three patients with neurinoma) and pontine aneurysm (one patient). The anastomosis was performed after a period of 3 months to one year from surgery. The results obtained, concerning the facial activity, were clinically valued according to the tests used (questionnary, and the House-Brackmann paralysis index); the EnOG was used for its electrophysiological assessment. The follow-up period was 4 years with a good facial recovery in three patients and poor in one (class V, 27% in ENoG). We observe that the improvement in function greatly depends on the early surgical process performance.

[Lateral sinus thrombosis due to cholesteatoma. Report of a case and literature review]. / Trombosis del seno lateral secundaria a colesteatoma. A propósito de un caso y revisión de la literatura.

After introduction of antibiotics, endocranial complications in otitis media are less common. Lateral sinus thrombophlebitis (LST) incidence has markedly decreased but mortality is still high. This complication should be considered in patients with ear discharge, fever and neurological symptoms. CT-scan and MRI enables early diagnosis and have a role in detecting addition intracranial complications. Surgical intervention should be aggressive and anticoagulation should be considered. We present a case of a woman with othorrea, fever and neurological symptoms. The CT-scan shows us a cholesteatoma that grows intracranial and a LST as complication of it.

[Aural polyp in chronic inflammatory middle ear disease]. / El pólipo aural en la patología inflamatoria crónica del oído medio.

240 patients with chronic otitis media (COM) were studied: 166 ears termed as non cholesteatomatous otitis media and 74 with cholesteatoma. In 38 ears an aural polyp was found with no evidence of cholesteatoma in 19 ears (11.4%) whereas a cholesteatoma was present in the remaining 19 ears. The histology of the polyp and the characteristics of the chronic process were matched: a) The aural polyp is an infrequent complication in COM. b) After histological analysis was found to present two different pictures: The inflammatory reaction polyp, present in non cholesteatomatous COM; and the polyp with granulation tissue and foreign body reaction (keratina) usually found in cholesteatomatous COM. c) The finding of granulation tissue reaction and keratina in an aural polyp is a good predictor for the presence of a cholesteatoma.

[Correlation between otoacoustic emissions and BAEP. The importance of their combined use]. / Correlación entre emisiones otoacústicas y PETC. La importancia de su empleo combinado.

Auditory Brainstem Response (ABR) of 50 newborn with negative transient evoked acoustic emissions (OEAT) was performed. 54% of them had no family history of sensorineural hearing loss (SHNL) and no risk factors were found. In 70% of cases ABR recording was negative. Follow up did show that 60% of them had normal recordings of hearing and in a 40% different stages of hearing loss were seen. To establish a definitive diagnosis a 1 to 9 month period is necessary.

[Evaluation of electroneurography as a prognostic method in the development of peripheral facial paralysis]. / Valoración de la electroneurografía como método pronóstico en la evolución de la parálisis facial periférica.

Electroneurography (EnoG) is a prognostic test used in the assessment of the peripheral facial nerve paralysis. We believe that when performed in standard conditions and together with the clinical evolutive parameters, it is very useful to reveal the critical time for a more radical treatment. We studied 44 patients; 13 patients had greater than 90% neural degeneration on EnoG. 5 of them underwent facial nerve surgical decompression due to a poor clinical outcome and up to three of these patients had a normal facial function after this.

[Forestier's syndrome. Report of two cases]. / Síndrome de Forestier. A propósito de dos casos.

Diffuse idiopathic skeletal hyperostosis (DISH) with cervical involvement which cause dysphagia is a rare disease. The otolaryngologist usually can make its diagnostic with a barium swallowing esophagogram. Two patients with DISH are reported.

[Lymphoepithelial carcinoma of the larynx. Report of 2 cases]. / Carcinoma linfoepitelial de laringe. A propósito de dos casos.

Laryngeal lymphoepithelioma is a rare tumor (16 cases in the literature). It is an association of undifferentiated, non-keratinizing cells and normal lymphocytes and plasma cells. The Epstein-Barr virus is rarely found. To determine the actual nature of the tumor, a complete histochemical workup and/or electron microscopy often are needed. Cervical lymph node involvement is common. We report the cases of two men. In one patient, the tumor was located in the glossoepiglottic fold and in the other it was located in the left ventricule and false vocal cord. EB virus was absent in both cases. Cervical lymph node metastases were found, but not distant metastases. One patient was treated by irradiation and the second underwent surgery (supraglottic laryngectomy and cervical dissection) and was referred to radiotherapy for further treatment.

[Serum immunoglobulin levels in tonsillectomized patients. An unsolved mystery]. / Niveles séricos de inmunoglobulinas en pacientes adenoamigdalectomizados. Un misterio sin resolver.

In a prospective study of 117 patients scheduled for tonsillectomy, with or without adenoidectomy, immunoglobulin levels were measured preoperatively and 1 to 6 months after intervention. Small deficiencies in IgG levels were observed, but levels were within normal limits. We have attempted to clarify the controversial topic of the immunological disturbances that may appear after this common intervention.

[Intranasal meningoencephalocele. A case report]. / Meningoencefalocele intranasal. A propósito de un caso.

Intranasal meningoencephaloceles are rare. The tumor's appearance may suggest the diagnosis of a nasal polyp or glioma. This may lead to an inappropriate surgical approach and serious neurological complications. We report the case of an intranasal meningoencephalocele initially treated as a nasal polyp and complicated by nasal leakage of cerebrospinal fluid. The differential diagnosis of the tumor using CT and MRI and surgical treatment are described.

[Nasal mucosa and systemic repercussion of the topical and prolonged use of budesonide in patients with perennial allergic rhinitis]. / Repercusión sobre la mucosa nasal y sistémica del uso tópico y prolongado de la Budesonide en pacientes con rinitis alérgica perenne.

In a prospective study, measurement of a 9.00 a.m. basal serum cortisol and biopsies of the inferior turbinate mucosa were taken from 40 patients using topical nasal corticosteroid (Budesonide) continuously for month or years. No systemic adverse effects and no histopathological changes of significance were found. These findings do no suggest that topically corticosteroids are harmful to the nasal mucosa and no produce systemic effects.

Influence of human wet cerumen on the growth of common and pathogenic bacteria of the ear.

The available data on the effect of human wet cerumen on bacterial growth are not conclusive. Nevertheless it is widely accepted that cerumen has a bactericidal effect. In this study the activity of human wet cerumen on bacterial growth was assessed by applying cerumen suspensions to bacterial cultures. Bacterial counts were performed before and after application of cerumen suspensions. A total of 383 assays was carried out with 73 pools of cerumen that were tested against cultures of Staphylococcus aureus, Staphylococcus epidermidis, Corynebacterium spp., Escherichia coli, Proteus mirabilis, Pseudomonas aeruginosa and Serratia marcescens. An increase in growth occurred much more frequently than a decrease in growth in almost every microrganism tested, with the mean increase percentage being much higher than the mean decrease percentage, except in the case of S. aureus. The largest average growth increase was obtained with E. coli. The largest average decrease in bacterial growth was recorded with S. marcescens. Our study does not support the conception of a decrease in bacterial growth produced by humen wet cerumen. In vitro, the most observable effect was in fact an increase in microbial growth.

[Polyps, nodules, and Reinke edema. An epidemiological and histopathological study]. / Pólipo, nódulo y edema de Reinke. Estudio epidemiológico e histopatológico.

A retrospective epidemiological and histopathological review was made of 258 patients. Forty had laryngeal polyps, 35 vocal fold nodules, and 41 Reinke edema. One hundred forty-two records were excluded for lack of epidemiological or histopathological data. No dysplastic changes were observed in nodules or polyps. One patient with edema had mild dysplasia. The epidemiological data showed that voice abuse or misuse was the main factor in patients with vocal fold nodules; smoking was the main factor in polyps and edema.

[Facial nerve anomaly. A morphohistological study. Apropos a case]. / Anomalía del nervio facial. Estudio morfohistológico. A propósito de un caso.

A malformation of the facial nerve in the temporal bone of an otherwise normal adult is reported. The abnormality consisted in the facial nerve obstructing the oval window in the second part of its intrapetrosal section.

[A new case of craniofacial fibrous dysplasia and cytogenetic study]. / Un nuevo caso de displasia fibrosa craneo-facial con estudio citogenético.

Fibrous dysplasia is an uncommon condition, which most obvious expression is the disorder of the osseous tissue setting up. Craniofacial bones are preferential sitting targets. We report a new case, in a 14-year-old boy, whose cytogenetic study neither in peripheral blood nor in tumor cells showed significantly differences.

[High-frequency audiometry: variations in auditory thresholds in the premenstrual period]. / Audiometría de alta frecuencia: variaciones de los umbrales auditivos durante el período premenstrual.

The hormonal changes that occur during the premenstrual period have been implicated as a causative factor for many psychological and physical symptoms. The present work was undertaken to determine the effect of these hormonal changes on audition. We studied 60 ears from 30 women (20-30 years old) with regular menstrual cycles and no middle/inner ear pathology. We performed audiometries one week before menstruation and one week after it, testing the range of frequencies from 250 to 16,000 Hz. After calculating the mean pre and postmenstrual threshold the results were compared using the paired <>-Student test. We found statistical significant differences in the frequencies 9,000, 10,000 and 11,200 Hz.

Study of common aerobic flora of human cerumen.

Cerumen is the product of the secretion of the sebaceous, ceruminous or apocrine glands together with cells exfoliated from the cornified stratum of the epithelium of the external auditory canal (EAC). In the present study we identified and quantified common flora of human cerumen. The mean count obtained was 10(6) microorganisms per ml of cerumen suspension. In 24 pools of cerumen (33.3 per cent) the isolates were monomicrobial, Staphylococcus epidermidis (12), Corynebacterium spp (10), Staphylococcus aureus (1) and Streptococcus saprophyticum (1). In 48 pools (66.6 per cent) we found polymicrobial isolates. The most commonly isolated bacteria in these polymicrobial isolates were S. epidermidis (35) and Corynebacterium spp. (43). It is noteworthy that there were isolates of Candida albicans in three cases; in one case of Pseudomonas stutzeri, in one case of Pseudomonas aeruginosa, and, on seven occasions, of S. aureus. The organisms isolated as common bacterial components of human cerumen in our experience were similar to those found by other authors. However, the mean count was much higher. This could be related to climatic conditions and to the length of time the cerumen had remained in the external auditory canal.

[Influence of the necessity of transfusion in anemia on the prognosis of ENT cancer in the protocol with concurrent hyperfractionation of carboplatin and irradiation]. / Influencia de la necesidad de transfusión por anemia sobre el pronóstico del cáncer O.R.L. en un protocolo con hiperfraccionamiento concurrente de carboplatino e irradiación.

Because of the determinant role of hemoglobin level in blood to the response of treatment (viewpoint admitted whether for irradiation or chemotherapic agents) the AA. have lead an analysis of a group of 36 patients suffering an advanced head and neck cancer (18 months mid-follow up and 30 months maximum) which underwent a program of concomitant radio-chemotherapy hyperfraccionated with carboplatin (the cytostatic) as part of each therapeutic fraction. The results in patients being transfused with an erytrocyte concentrate were compared with those from patients not having had any transfusion. The purpose of this study was the assessment of which are the influence on the prognostic of ENT-cancer resulting of the compulsory necessity of transfunding erytrocyte concentrates aroused by serious anemia presenting during the development of the schedule treatment. In brief, in that kind of patients needing transfusions of red blood cells concentrates because of serious anemia during the treatment (17% of the totality treated) were recorded 50% local failures, 33% metastases and only 17% of the totality were free of neoplasma at the end of the follow-up fixed. Instead between patients not having had transfusions (for treating anemia) the differences registered were 20% failures of loco-regional control and 13% metastases, whereas 67% were free of tumor at the end of the study. The conclusion drawn out is: the important influence on the prognostic of these tumors, when in the course of the scheduled treatment, appear severe anemia making the transfusions compulsory.

[Concomitant hyperfractionation of drugs and irradiation in the treatment of advanced ENT cancers]. / Hiperfraccionamiento concomitante de drogas e irradiación en el tratamiento del cáncer avanzado del área O.R.L.

Considering the limited results achieved up to now in the treatment of advanced ENT-cancer, with the classic customary procedures, the AA. suggest a new therapeutic schedule (within the concurrent radio-chemotherapy context) in which the selected cytotoxic drug, the carboplatin, is a part of each therapeutic fraction. A group of 36 patients suffering advanced ENT-cancer (2 cases stage III and 34 stage IV) were studied between Mars 1993 and September 1995, and the outcomes assessed after a 18 months mean follow-up (30 months maximum). There were 11% surgically rescued cases, being the full dosage administered twice daily 8.050 cGy plus 700 mg carboplatin. Tolerance was very good, so 100% of the patients received a complete treatment. Initial response was also fine resulting 93% full remissions on primaries, 96% on neck adenopathies (6% surgical rescues). Regarding the actuarial control after 30 months were controlled 88% of neck adenopathies, control loco-regional amounted for 69%, control on primaries 63% and actuarial survival amounted 55%. The AA. drawn out 10 conclusions, underlining the good tolerance of the therapeutic sketch proposed, because the antineoplastic results are by far better than those experienced with whichever modality of management of tumors of these sites and staging.