Eosinophilic esophagitis: an underdiagnosed cause of dysphagia and food impaction to be recognized by otolaryngologists.

Eosinophilic esophagitis (EoE) is a recently recognised pathologic entity whose prevalence has risen significantly since first being described in 1993. Defined as a chronic, local immune-mediated disease with predominant eosinophil infiltration, it is nowadays the leading cause of dysphagia and food bolus impaction in children and young adults. Genetic and environmental risk factors, and especially food antigens, trigger the disease and are in the focus of investigation as avoidance can cure three quarters of patients. The most common antigen involved is milk, followed by egg and gluten. These patients frequently come undiagnosed to the otolaryngologist with complaints of dysphagia and recurrent non-sharp food impactions, although pharyngolaryngeal reflux symptoms and other airway complaints could also be a first sign. Delayed diagnosis and treatment can produce fibrostenosis of the esophagus that greatly impairs patients' quality of life.In-office transnasal esophagoscopy with esophageal biopsy offers a unique opportunity to promptly diagnose and follow-up these patients, without causing the morbidity of repeated sedations and reducing exploration overload in gastroenterology departments. The search for food-antigen triggers, response evaluation to swallowed steroids, or proton pump inhibitors (PPIs) make multiple endoscopies and biopsies necessary every 6 to 8 weeks.There are three first-line interchangeable treatments with the same recommendation: PPIs, dietary allergen elimination and topical swallowed steroids. The choice should be discussed with the patient on an individual basis.The objective of this article is to raise awareness of this condition, update otolaryngologists with the new EoE consensus, and highlight the need for biopsy in patients with dysphagia to rule out EoE.

[Basosquamous carcinoma of the floor of the mouth]. / Carcinoma basaloide-escamoso de suelo de boca.

Basaloid-squamous cell carcinoma is a rare tumor characterized by Wain et al in 1986 as a separate pathological entity. In head and neck more than 100 cases have been reported, with a strong predilection for hypopharynx, base of tongue, and supraglotic larynx. This entity also has been described in nasal cavity, oesophagus, tonsils and oral cavity. Only 14 cases has been reported arising in the floor of the mouth, and none in our literature. We present a new case in floor of the mouth and clinicopathological features are emphasized. We have undertaken moreover a bibliographic review of this uncommon and aggressive neoplasm.

[Malignant pleomorphic adenoma of the palate]. / Adenoma pleomorfo maligno del paladar.

Pleomorphic adenoma or mixed tumor is the most common benign neoplasm of the minor salivary glands. These tumors rarely have malignant features. Three varieties are differentiated by histological features and tumor behavior. Whether malignant tumors develop on benign adenomas or are malignant from onset is still not known. A malignant mixed tumor of the minor salivary glands of the palate is reported. The difficulty of histological diagnosis, in spite of immunohistochemical techniques, is emphasized and the surgical treatment is described.

[Hemangiosarcoma of the nasal cavity]. / Hemangiosarcoma de fosas nasales.

Hemangiosarcoma is a rarely diagnosed in the nasal cavity and there are few reports in the ENT literature. The most interesting aspect of our 82-year-old male's case was that he presented all the findings characteristic of angiosarcoma, but the final post-mortem diagnosis was unexpected because of the poor information available until that moment.

[Meningitis and cerebrospinal liquid fistula as a complication from the surgery of endolymphatic sac]. / Meningitis y fístula de LCR como complicación de un caso de cirugía del saco endolinfático.

A 28 years old woman diagnosed of Méniére's disease was surgically treated with a drainage from endolymphatic system and a valve placed. Six years after surgery, the patient presented a bacteria meningitis an a cerebrospinal fluid leak to mastoid was found. New surgery was needed. Complications of endolymphatic system surgery, its treatment and frequency are discussed. This case is a very rare.