Healing criteria: How should an episode of benign paroxistic positional vertigo of posterior semicircular canal's resolution be defined? Prospective observational study.

OBJECTIVES: To compare the outcome of the Epley maneuver (EM) in benign paroxysmal positional vertigo of the posterior canal (CSP-BPPV) depending on the definition used for recovery. DESIGN: Multicenter observational prospective study. SETTING: Otoneurology Units of 5 tertiary reference hospitals. PARTICIPANTS: All patients presenting with unilateral CSP-BPPV assisted for 1-year period. EXCLUSION CRITERIA: Spontaneous nystagmus, positive McClure-Pagnini maneuver, positive bilateral Dix-Hallpike maneuver (DHM), positive DHM for vertigo but negative for nystagmus and atypical nystagmus. MAIN OUTCOME MEASURES: Response to EM was measured after 7 days in 3 different outcomes: disappearance of nystagmus during the DHM in the follow-up visit, disappearance of vertigo during the DHM and general status (GS) during daily life activities. RESULTS: 264 patients were recruited (68 male/166 female, mean age 62 years). After the EM, nystagmus disappeared in 67% of them, vertigo in 54% and 36% were asymptomatic in their daily life. These outcomes were strongly correlated, but they were not concordant in a clinically significant group of cases; only the 26% of patients met all of them. The healing process follows the next sequence: negativization of positional nystagmus, then disappearance of positional vertigo and, finally, the improvement of GS during daily life activities. CONCLUSION: Nowadays, healing criteria for the resolution of an PSC-BPPV episode have not been specifically defined yet. Provided that other otoneurological disorders have been ruled out, the next resolution criterion is proposed: absence of nystagmus and specifically during control DHM and disappearance of symptoms during daily life activities.

Analysis of risk factors influencing the outcome of the Epley maneuver.

Benign paroxysmal positional vertigo (BPPV) is the most frequent type of vertigo. The treatment of canalithiasis of the posterior semicircular canal consists in performing a particle-repositioning maneuver, such as the Epley maneuver (EM). However, the EM is not effective in all cases. The objective of this study is to identify risk factors, which predict the EM failure, among the clinical variables recorded in anamnesis and patient examination. This is an observational prospective multicentric study. All patients presenting with BPPV were recruited and applied the EM and appointed for a follow-up visit 7 days later. The following variables were recorded: sex, age, arterial hypertension, diabetes, hyperlipidemia, smoking habit, alcohol consumption, migraine, osteoporosis, diseases of the inner ear, previous ipsilateral BPPV, previous traumatic brain injury, previous sudden head deceleration, time of evolution, sulpiride or betahistine treatment, experienced symptoms, outcome of the Halmagyi maneuver, laterality, cephalic hyperextension of the neck, intensity of nystagmus, intensity of vertigo, duration of nystagmus, occurrence of orthotropic nystagmus, symptoms immediately after the EM, postural restrictions, and symptoms 7 days after the EM. Significant differences in the rate of loss of nystagmus were found for six variables: hyperlipidemia, previous ipsilateral BPPV, intensity of nystagmus, duration of nystagmus, post-maneuver sweating, and subjective status. The most useful significant variables in the clinical practice to predict the success of the EM are previous BPPV and intensity of nystagmus. In the other significant variables, no physiopathological hypothesis can be formulated or differences between groups are too small.

Probable benign paroxysmal positional vertigo, spontaneously resolved: Incidence in medical practice, patients' characteristics and the natural course.

BACKGROUND: Probable benign paroxysmal positional vertigo, spontaneously resolved (pBPPVsr), is a variant of benign paroxysmal positional vertigo (BPPV) in which there is no observable nystagmus and no vertigo with any positional maneuver. OBJECTIVES: To calculate the incidence pBPPVsr, compare the characteristics of the patients with pBPPVsr and BPPV not spontaneously resolved and describe the spontaneous resolution in the natural course of BPPV. METHODS: Multicenter prospective descriptive study. During a one-year period, all patients with suspected BPPV that presented to the Neurotology Units of five participating centers were recruited. The incidence of pBPPVsr was calculated as a percentage of the total number of patients with BPPV. The prevalence of several variables was compared between pBPPVsr and BPPV not spontaneously resolved. The timing of spontaneous resolution was estimated using Kaplan-Meier curves. RESULTS: 457 patients met the inclusion criteria. The incidence of pBPPVsr was 33.5%. It was significantly higher in males, in patients with normal bone mass and in patients who were not taking sulpiride. A rate of 18% of spontaneous resolution after the first month and 51% after the first year was found. This percentage did not change in a significant way after this moment. The curves for males, patients under 50 and patients with normal blood pressure decreased significantly faster. CONCLUSIONS: In our serie, BPPV spontaneously resolved in half of the patients with BPPV during the first year. This seemed to occur more commonly in males and could have been hindered by sulpiride intake, osteoporosis, advanced age and high blood pressure.

AHL, SSD and bimodal CI results in children.

OBJECTIVE: This article aims to demonstrate that children with asymmetric hearing loss (AHL), specifically those with single side deafness (SSD condition) and pure SSD, with substantial hearing (>70% normal speech discrimination) in the ear with hearing aid (HA), obtain clinically relevant speech perception benefit after cochlear implantation in the contralateral side. RESULTS: Retrospective study of two groups: (1) 36 AHL children with bimodal hearing and (2) SSD children with SSD. They had follow-ups of 24 and 12 months duration, respectively. The AHL children where implanted on one ear and depending on the contralateral ear condition, they were divided into two groups: children who reach a disyllabic speech test score lower than 50% in quiet at 65dB-SPL without lip reading (27) and children with test score higher than 70% (9). The second group consisted on 2 children implanted to obtain SSD condition, as preliminary data, with 1 year of follow-up. They showed benefits of binaural stimulation. CONCLUSION: Children in a bimodal situation, with substantial hearing (>70% speech discrimination) in the ear with HA, obtain clinically relevant speech perception benefit after cochlear implantation in the contralateral side.

LifeQuestionnaire. A new tool for the evaluation of quality of life in patients with hearing loss-using WhatsApp.

OBJECTIVE: Develop an online application that sends questions at different times of the day over an interval set by the user. It consists of a web interface that sends out WhatsApp messages containing questions from already validated or customized questionnaires (previous license) and shows the evolution of each question and patient over time and their average. MATERIAL AND METHOD: The Laboratory of Psychoacoustics developed a platform that allows patients to answer surveys from remote locations. RESULTS: Hence, the developed tool allows to: (1) answer a test repeatedly under different personal situations and (2) evaluate the patient remotely. Hence, obtaining a more reliable assessment of the patient's QoL. CONCLUSION: Preliminary results using 5 teenagers aged 12-18 that answered the KINDL questionnaire is used to evidence the value of this new tool.

[Aetiology and therapeutic considerations in chronic otitis media. Analysis of a 5 year period]. / Etiología y consideraciones terapéuticas en otitis media crónica. Análisis de un período de 5 años.

BACKGROUND: This study provides an update on the bacterial aetiology of chronic otitis media in our area and the antibiotic sensivity of the bacteria involved in this pathology. METHODS: A retrospective study from 2000 to 2004, is carried out in a total of 127 adults diagnosed of chronic otitis media. Isolated bacteria were tested in vitro regarding sensitivity to fluoroquinolones, aminoglyosides, colistin, oxacilin, amoxicillin-clavulanic acid and cephalosporins. RESULTS: The most common pathogens we found were gram-negative organisms, especially Pseudomonas aeruginosa (47.7%), but among gram positive organisms, Staplhylococcus aureus, was involved in a significant number of infections (21%). The main findings that we found were as follows: 18% of P. aeruginosa strains were resistant to ciprofloxacin and 21.8% S. aureus strains were resistant to levofloxacin. 10.8% of S. aureus strains showed resistance to beta-lactams. CONCLUSION: The most important pathogen in our study was P. aeruginosa along with a variety of other gram-negative organisms and S. aureus. There is growing concern over the use of antibiotics and the development of resistance. We need to evaluate the antimicrobial activity by determining the susceptibility of a particular antibiotic against a specific bacterial strain.

[Malignant fibrohistiocytoma of the larynx]. / Fibrohistiocitoma maligno de laringe.

The paper deals with 2 malignant fibrohistiocytoma cases sitting on the larynx, one of them associated with a laryngeal cancer "in situ". These are uncommon growths particularly in this location, of difficult anatomopathologic diagnosis. Placing of these exceptional tumors were the epiglotis and piriform sinus. The treatment of choice is a large resection alone or followed with radiotherapy, at least that is the opinion shared by several authors.

[Involvement of the facial nerve in tumors of the neck and face. Report of 17 cases]. / Afectación del nervio facial en los tumores de localización cervico-facial. Presentación de casos.

Seventh nerve involvement for tumors of the neck of the face is an event not too much infrequent. The paralysis can present due to direct propagation or for not close vicinity. Seventeen (17) patients with facial palsies in association with neoplasties seen in a four years term (1989 - 1992) are contemplated. This figure represents a 6.6 percent of the whole number studied (N. = 270). The paper deals with clinical, etio-pathogenic features and especially with the so-called "alarm signals".

[Beta-lactamase-producing bacteria in recurrent childhood tonsillitis]. / Bacterias productoras de betalactamasa en amigdalitis recurrente infantil.

Beta-lactamase production by the normal pharyngeal flora could account for the failure of penicillin treatment in patients with recurrent tonsillitis. We studied the microbial flora of tonsils from 22 healthy children (control group) and from 40 children with recurrent tonsillitis who were treated with penicillin. Cultures were made before treatment and repeated 15 days after the first culture. Streptococcus pyogenes was recovered in 25% of the patients in the recurrent tonsillitis group. Beta-lactamase producing bacteria were recovered in 100% of children with tonsillitis and in 86.4% of the healthy children. We found a 65% failure rate of penicillin therapy in recurrent tonsillitis. Our results suggest that beta-lactamase production by pharyngeal organisms does not fully explain the failure of penicillin therapy for recurrent tonsillitis.

[Antimicrobial therapy in chronic suppurative otitis media]. / Terapéutica antimicrobiana en otitis media crónica supurada.

A randomized study was made of 125 patients with chronic middle ear infection. The most frequently isolated microorganisms were: Pseudomonas aeruginosa, Staphylococcus aureus and Enterobacteriaceae. Ciprofloxacin is very active against the microorganisms usually isolated and it has been shown to provide effective therapy in ear infections. In order to study the effectiveness of ciprofloxacin in chronic otitis media, we selected four different treatment groups: oral ciprofloxacin (500 mg/12 h); 0.5 and 0.2% topical solutions of ciprofloxacin (3 drops/8 h), and oral ciprofloxacin plus 0.2% topical solution. Topical polymyxin and neomycin were used as controls. Topical ciprofloxacin (0.2%) was the most effective regimen of those tested for the treatment of chronic otitis media.

[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.

[Vogt-Koyanagi-Harada syndrome; a model of autoimmune neurosensory hypoacusia]. / Síndrome de Vogt-Koyanagi-Harada; un modelo de hipoacusia neurosensorial autoinmune.

The immunological disorders appearing in several kinds of autoimmune sensorineural hearing loss, are not unusual in daily practice. We present a case with Vogt-Koyanagi-Harada's disease with hearing impairment, and describe its clinics aspects, and the diagnosis and therapeutics methods we used.

[Horizontal supraglottic laryngectomy. A study of 83 cases]. / Laringectomía horizontal supraglótica. Un estudio de 83 casos.

We present the results obtained in 83 patients with supraglottic laryngeal carcinoma treated by supraglottic laryngectomy. We studied the results, complications and the survival of these patients treated with this conservative surgery. We concluded that this surgical technique improved the survival rates in supraglottic carcinomas.

[Internal ear dysfunction in systemic autoimmune diseases: study of sensorineural hearing loss probably originated by autoimmune disorders (preliminary study)]. / Disfunción del oído interno en enfermedades autoinmunes sistémicas: estudio de la hipoacusia neurosensorial de probable etiopatogenia autoinmune (estudio preliminar).

We analyse the inner ear disorders appearing in patients with autoimmune diseases. We have studied six patients with immunologic disorders and autoimmune sensorineural hearing loss, of a group of thirteen patients studied. The distribution was as follows: 1 systemic lupus erythematosus, 3 vasculitides (1 polyarteritis nodosa, 1 Churg-Strauss disease and 1 Behçet's syndrome), 1 relapsing polychondritis and 1 Vogt-Harada syndrome. The clinic aspects and immunological disorders are reviewed.

[Facial paralysis caused by retroauricular basal cell carcinoma]. / Parálisis facial por extensión de carcinoma basocelular retroauricular.

We make a review of facial palsy of tumoral etiology, including the diagnosis, evolution and treatment. We also present a case of facial palsy caused by retroauricular basal cell carcinoma.

[Changes in the flora of the oral cavity after oral topical antibiotics. Importance in antimicrobial prophylaxis in surgery of the neck and head]. / Análisis de las modificaciones en la flora de la cavidad bucal tras el uso de antibióticos tópicos orales. Importancia en la profilaxis antimicrobiana en cirugía de cabeza y cuello.

A pilot study using 5 healthy adults was performed to assess the influence of topical antibiotics and antiseptics on oral flora. Samples of saliva were cultured before and after rinsing the mouth with several solutions: clindamycin, amoxyciclin + clavulanic, povidone-iodine and placebo. The results of this study suggest that, by reducing concentrations of oral flora, topical oral antibiotic prophylaxis is justified for patients having a high risk of developing a surgical infectious complications.

[Diagnostic and clinical evaluation of the stylohyoid apparatus totally or partially ossified]. / Valoración clínica y diagnóstica en el aparato estilohioideo total o parcialmente osificado.

By means of the presentation of several cases of Stylohyoid Complex partially or totally ossified, the authors emphasize in the necessity to have in mind this diagnosis in every patient with craniofacial pains, although it is in sometimes a casual radiological finding in a asymptomatic patient. The normal exploration of the tonsillar area and the reproduction of the symptoms are the more secure and faster diagnosis methods which are, ratified by radiological systems.

[Ramsay Hunt syndrome. Effects of the treatment with acyclovir (preliminary study)]. / Síndrome de Ramsay Hunt. Efectos del tratamiento con aciclovir (estudio preliminar).

Herpes zoster oticus has a poor prognosis with permanent facial nerve dysfunction. We have studied 11 patients in a total group of 131 facial palsies seen in our service for a 20 month period. Four patients had no treatment. Two were treated with prednisone, and five were infused with acyclovir (10 mg/kg every 8 hours over a 10 day hospitalization period) and prednisone. These treatments were observed for 3 to 6 months. Patients follow up was, acyclovir group, 2 patients have achieved a House grade I, 1 patient grade II, 1 patient grade III and 1 left this treatment because side effects was observed. The other patients, 1 have achieved grade I, 2 patients grade II, 2 patients grade III and 1 patient grade V. The differences and final results are discussed.

[Bacteriologic analysis of ear infection pathology and its therapeutic implications in our milieu]. / Análisis bacteriológico de la patología infecciosa otológica y sus implicaciones terapéuticas en nuestro medio.

This study reports the incidence of different bacteria in 75 cultures from 67 patients with the aim of selecting the drugs most likely to be effective when used prior to the antibiogram or when the antibiogram cannot be done.

[Transtympanic ventilation tubes and serous otitis media. Study of 100 cases]. / Tubos de ventilación transtimpánicos y otitis media serosa. Estudio en 100 casos.

The purpose of this study has been to evaluate the use of 100 ventilation tubes in the treatment of 60 patients with secretory otitis media. A study of the course, the complications and the sequelae has been realized. It is concluded that the use of ventilation tubes is justified in our patients.