Impact of subject's position and acoustic stimulus type on vestibular evoked myogenic potentials (VEMPs) in normal subjects.

Vestibular evoked myogenic potentials (VEMPs) are currently considered a diagnostic tool for studying the vestibular system, specifically the saccule and inferior vestibular nerve. This prospective study aimed at evaluating the impact of patient position and type of acoustic stimulus on VEMPs results using 60 healthy subjects who underwent otoscopy, pure tone audiometry and VEMPs in different conditions affecting their position and the type of acoustic stimulus. Corrected amplitude is significantly greater when the patient is seated and latency difference and amplitude asymmetry do not change with either patient position or type of stimulus. The results obtained in different test conditions are not comparable. Being seated is the most appropriate position for the test.

Age-adjusted normality patterns for posturography by Sway Star system.

Technological advances have led to the development of new measurement techniques that have improved the evaluation, diagnosis, and treatment of patients with vertigo, dizziness and balance disorders. The objective of this study was to propose population normality patterns, adjusted for age, for summary option (balance control summary, BCS) of Sway Star system. Prospective study involving 70 healthy individuals (average age 44.9 years) evenly distributed in seven age groups and who underwent a postural study with the Sway Star system. The normality patterns for the BCS are presented in Tables 2, 3 and 4. No influence of the gender variable was found. Age had an influence in the more sensorially complex stance tests, and the sensory analysis (visual and vestibular contributions). No influence of age in gait tests or in balance control indexes was found. The BCS option is the most feasible way of systematically using the Sway Star, because it provides complete information of the patient's postural capacity in sensorially complex settings. Establishing normality patterns is the initial and essential step to validate the usefulness of Sway Star in the study of patients with balance disorder. Gait test results were not influenced by age because of their greater capacity to reproduce physiological situations; these could be the tests of choice for detecting elderly patients with a tendency to fall.

Influence of age and gender in the sensory analysis of balance control.

Postural control is achieved through the integration at the central nervous system level of information obtained by the visual, somatosensory and vestibular systems. Computerized dynamic posturography and the Sway Star system are both used to carry out sensory analysis. The purpose of this study was to determine the influence of sex and age on sensory analysis, measured with these two systems, and to compare their results. A prospective trial was conducted with 70 healthy individuals (average age: 44.9 years) uniformly distributed in seven age groups, who underwent postural study with both systems. We used SPSS 16.0 for statistical study: comparison of means test for influence of gender and age and Pearson's correlation test (p < 0.05). Gender variable had no influence. The influence of age in vestibular input was found to be significant with both posturography systems, while visual input was only found to be significant with the Sway Star. The results with the two systems were not comparable. Sensory contribution does not remain stable throughout life. Visual information decreases with age, reaching a minimum at 40-49 years, and may correspond to the deterioration of eyesight with age. Propioceptive information showed no statistically significant changes, and several forms of treatment might correct the deterioration of this system. Vestibular information reaches a maximum in the 40-49 years age group in an attempt to compensate for visual deterioration, and decreases again in subsequent decades. This may be due to aging of the vestibular system and the difficulty in its correction.

Vestibular rehabilitation with computerised dynamic posturography in patients with Parkinson's disease: improving balance impairment.

PURPOSE: In patients with Parkinson's disease (PD), balance impairment involves considerable morbi-mortality from the numerous falls that may result. In an earlier postural study, we detected that a deteriorated processing of vestibular input is implicated. The aim of the present study is to assess the effectiveness of vestibular rehabilitation in improving overall stability in patients with PD. METHOD: Out of an initial group of 45 patients with PD, we chose those presenting a high risk of falls, based on their score on the timed up and go test (TUG). Rehabilitation was performed on 10 patients using computerised dynamic posturography (CDP). Improvement was assessed using the dizziness handicap inventory (DHI), the TUG and the CDP. RESULTS: We found statistically significant improvement in the sensorial organisation test (SOT) and the limits of stability and rhythmic weight shift tests measured by the CDP, the DHI and the TUG. These improvements continue to be statistically significant 1 year post-treatment. CONCLUSION: Vestibular rehabilitation in PD has shown to be effective in improving the activities of daily life, gait velocity and balance, as well as in reducing the risk of falls. Moreover, these benefits persist over time.

[Association between endolymphatic hydrops and benign paroxysmal positional vertigo: coincidence or causality?]. / Asociación entre el hydrops endolinfático y vértigo posicional paroxístico benigno: casualidad o causalidad?

INTRODUCTION: The aim of this study was to determine the prevalence of benign paroxysmal positional vertigo (BPPV) in patients diagnosed with endolymphatic hydrops (EH) and to analyze whether this association is a factor for poor prognosis in these patients. MATERIAL AND METHODS: A retrospective study was carried out in our department among the patients definitively diagnosed as having Ménière's disease according to the criteria of the American Academy of Otolaryngology and BPPV by the usual triggering manoeuvres. RESULTS: The prevalence of BPPV in our patients with EH was 5.1%. The rate of cure with the repositioning manoeuvres is 90.9%, however success with the first manoeuvre was only 63.36%. Recurrences occurred in up to 22.22%. We found a lower success rate with the first manoeuvre in relation to the rest of the patients with BPPV without EH. This difference is statistically significant (P=0.042). DISCUSSION: We did not find that these patients to have a lower rate of cure with the repositioning manoeuvres or a higher rate of recurrence. But in our protocol the first manoeuvre had a lower success rate than in the rest of the patients.

[Alterations of balance in patients under 16 years of age distributed by age groups]. / Alteraciones del equilibrio en pacientes menores de 16 años distribuidos por grupos de edad.

OBJECTIVE: To evaluate the prevalence and clinical characteristics of children with altered balance, as well as to establish the level of importance of the audiological, balance and imaging studies in the diagnosis of infantile vestibular pathology. PATIENTS AND METHOD: We report a descriptive, retrospective and non-randomized study performed at the Otorhinolaryngology Department of the Complejo Hospitalario Universitario de Santiago de Compostela (Santiago de Compostela University Hospital, Santiago de Compostela, Spain). The study included 125 patients under 16 years of age who consulted due to alterations in their balance over a period of twelve years (1996 to 2007); they are distributed into three groups based on age: 0 to 5, 6 to 10, and 11 to 15 years. RESULTS: Childhood benign paroxysmal vertigo (64 %) is the most frequent syndrome in our series, with 32.5 % of patients associating common migraine. Together with diagnoses of infantile positional vertigo and psychogenic vertigo, was more frequently found in the 11 to 15 year-old age group (P< .05). Age, gender and the results of the imaging studies (computerized tomography of the brain and magnetic resonance of the head) were not related to the presentation of associated migraine nor to the diagnosis (P>.05). CONCLUSIONS: Clinical history and the neuro-otological examination are the key elements of the diagnosis of infantile vestibular pathology; it is also important to standardize and group patients by age. Imaging studies only contribute high diagnostic performance in children presenting neurological symptoms, persistent headache or who have sustained head trauma.

[Laryngeal adenocarcinoma: case report]. / Adenocarcinoma de laringe: presentación de un caso.

Laryngeal adenocarcinomas are extremely unusual (only 0.35 %-0.5 % of all laryngeal malignancies). It usually behaves as a highly malignant tumour, with tendency for local lymph node and distant organ metastases. We report a case of a 64-year-old man with an adenocarcinoma of the larynx with cervical lymph node involvement at the moment of the diagnosis. The patient was treated with surgery (total laryngectomy and cervical lymph node dissection) and post-operative radiotherapy. Seven months later, the patient had a local recurrence.

[Association between cerebrospinal fluid leakage and persistence of Sternberg's canal: coincidence or cause?]. / Asociación entre fístula de líquido cefalorraquídeo y persistencia del canal de Sternberg: ¿coincidencia o causa?

Endoscopic surgical techniques allow treating various pathological diseases of the cranial base, including cerebrospinal fluid leaks (CSF). These approaches have a high success rate and reduce surgical time and morbidity. However, when they are located in the lateral wall of the sphenoid, the surgery is more complex. In our case, the CSF appeared to be related with a Sternberg's canal. Predisposing factors were also associated with an extensive unilateral pneumatization of the sinus and benign intracranial hypertension. The closure of the leak was achieved using an endoscopic transethmoidal transpterygoid approach for proper exposition of the lateral wall of the sphenoid. After five years of monitoring, the patient has had no more episodes of rhinoliquorrhea.

Comparative study of computerized dynamic posturography and the SwayStar system in healthy subjects.

CONCLUSIONS: For healthy subjects, posturography and SwayStar™ results are basically comparable, when they are obtained under the same sensory stimulation conditions. However, the management of the information and the mathematical analyses in the two systems are not comparable. OBJECTIVES: Postural control represents man's ability to maintain the center of pressures inside the limits of stability. Posturography is a set of techniques that objectively studies and quantifies the postural control. The present study analyzed the different parameters of the dynamic computerized posturography and SwayStar systems related to balance, to determine whether the results of the two systems in the same healthy subject are equivalent. METHODS: Seventy healthy individuals, with a mean age of 44.9 years, were homogeneously divided into seven age groups. Postural studies with a Neurocom(®) Smart Balance Master posturography platform (sensorial organization test), with the SwayStar(®) system (14 tests), and another sensorial organization test were recorded simultaneously with the two posturographs. The Pearson correlation test was used for the statistical study (p < 0.05). RESULTS: Comparison of the independent records showed correlation only in the Romberg position with eyes closed on a normal surface and in the Romberg position with open eyes on moving/foam surface. We found correlation for all conditions when simultaneously recorded.

[Influence of gender on the sensory organisation test and the limits of stability in healthy subjects]. / Influencia del sexo en el test de organización sensorial y los límites de estabilidad en sujetos sanos.

INTRODUCTION: The sensory organization test and the limits of stability are the gold standard for dynamic posturography. It is postulated that these measurements vary depending on age, activity of the subject and musculoskeletal system, emotional condition or other factors. The aim of this study was to determine the influence of gender on the above-mentioned analyses. MATERIAL AND METHODS: 70 healthy subjects (35 males and 35 females); mean age: 44.9 years. A clinical history was taken and a physical and otoneurological exploration was performed for each subject, along with a posturography study using the Neurocom SMART Balance Master platform model. The statistical study was carried out with the ANOVA test (p<0.05). RESULTS: Condition 5 presented the lowest percentage of balance in both sexes (64.36%). The highest percentage of balance in males was in Condition 1 (p<0.001) and the lowest in 3 (p=0.030). There were no differences in the sensory analysis. The lowest employment of ankle strategy was in Condition 5 for both sexes (88.61%); women used the ankle strategy in Condition 4 more efficiently (p=0.0129). There were also differences in the time of reaction towards the right (p=0.022) and the mean (p=0.011) (higher in females), and in the speed of movement backwards (p=0.001) and towards the right (p=0.04) (higher in males). In path length and directional control, there were no differences. CONCLUSIONS: Gender differences should be taken into consideration for vestibular rehabilitation. Greater speed in conducting the tests does not lead to better balance control.

[Proposal for presbycusis screening in a primary care clinic]. / Propuesta de cribado de la presbiacusia en una consulta de atención primaria.

OBJECTIVES: Presbycusis is one of the causes of deafness that has increased most in our society. To show the levels of presbycusis in people over 60 who attend our health centre for other reasons and to assess the utility of certain tests employed in primary care to detect hearing problems. PATIENTS AND METHOD: One-hundred and ten people. EXCLUSION CRITERIA: prior specialist diagnosis, lack of consent or impossibility of running the tests. Assessment of auditory invalidity: otoscopy, Weber, Rinne, whispered voice, auditory disability test. Audiological validation by audiometry assessed by ORL. Results analysed with SPSS statistical packet. RESULTS: Mean age 714 (6.1). Otoscopy was normal in 81.8%. Weber's test had no significant relationship with the otoscopy, but did with the Rinne. Presbycusis was seen in 68.2% of the audiometries. Everyone (100%) who had worked in a noisy environment had audiometric deficit. CONCLUSIONS: There were high figures (87%) for hypoacusis in our population of elderly people. In 68.2%, this was due to presbycusis. The sensitivity and negative predictive value (Vp-) of most of the tests used in primary care to detect auditory disorders are low.

Eficacia del tratamiento vocal rehabilitador en los pacientes con nódulos vocales / Effectiveness of the rehabilitator vocal treatment in patients with vocal nodules

Objetivo: Evaluar la eficacia del tratamiento vocal rehabilitador en los pacientes con nódulos vocales. Material y métodos: Estudio prospectivo sobre 97 pacientes disfónicos diagnosticados de nódulos vocales y tratados exclusivamente con tratamiento vocal rehabilitador sistematizado. La evaluación de la evolución clínica se realiza con medidas perceptuales, aplicando la escala GRBAS antes y después del tratamiento. Resultados: Encontramos que 75 pacientes (77,3%) presentaron mejoría clínica. Observamos que esta patología afecta a los cinco aspectos contemplados por la escala GRBAS y que en la mayoría de los casos la afectación era leve o moderada, con mejoría significativa de los cinco aspectos tras el tratamiento rehabilitador. Conclusión: Consideramos que la terapia vocal es muy efectiva en la mejoría de la calidad de voz en la mayoría de los pacientes con nódulos vocales...

Objective: To evaluate the effectiveness of the rehabilitator vocal treatment in patients with vocal nodules. Material and Methods: A prospective study on 97 dysphonic patients diagnosed of vocal nodules and treated exclusively with a systematized rehabilitator vocal treatment. The evaluation of the clinical evolution is made with perceptuals measures, applying the GRBAS scale before and after the treatment. Results: We found that 75 patients (77,3%) had clinical improvement. Also we observed that this pathology affects the five aspects contemplated by the GRBAS scale and in most of the cases the affectation was slight or moderate, with a significant improvement of the five aspects after the treatment. Conclusion: We considered that the vocal therapy is very effective in the improvement of the quality of voice in most of the patients with vocal nodules...

Asociación entre fístula de líquido cefalorraquídeo y persistencia del canal de Sternberg: ¿coincidencia o causa? / Association between cerebrospinal fluid leakage and persistence of Sternberg’s canal: coincidence or cause?

Las técnicas endoscópicas nasales permiten el tratamiento de diversos procesos patológicos de la base del cráneo, entre las cuales se incluyen las fístulas de líquido cefalorraquídeo (LCR). Estos abordajes tienen una elevada tasa de éxitos y reducen el tiempo quirúrgico y la morbilidad. Sin embargo, cuando se localizan en la pared lateral del esfenoides la cirugía es más compleja. En el caso presentado la fístula parece relacionarse con la persistencia del canal de Sternberg. Además como factores predisponentes asociados encontramos la extensa neumatización unilateral del seno así como una hipertensión intracraneal benigna. El cierre de la fístula se realizó endoscópicamente mediante un abordaje transetmoidal y transpterigoideo para una correcta visualización de la pared lateral del esfenoides. Tras 5 años de seguimiento la paciente no ha vuelto a presentar más episodios de rinolicuorrea(AU)

Endoscopic surgical techniques allow treating various pathological diseases of the cranial base, including cerebrospinal fluid leaks (CSF). These approaches have a high success rate and reduce surgical time and morbidity. However, when they are located in the lateral wall of the sphenoid, the surgery is more complex. In our case, the CSF appeared to be related with a Sternberg's canal. Predisposing factors were also associated with an extensive unilateral pneumatization of the sinus and benign intracranial hypertension. The closure of the leak was achieved using an endoscopic transethmoidal transpterygoid approach for proper exposition of the lateral wall of the sphenoid. After five years of monitoring, the patient has had no more episodes of rhinoliquorrhea(AU)

Asociación entre el hydrops endolinfático y vértigo posicional paroxístico benigno: ¿casualidad o causalidad? / Association between endolymphatic hydrops and benign paroxysmal positional vertigo: Coincidence or causality?

Introducción: El objetivo del presente estudio es conocer la prevalencia del vértigo posicional paroxístico benigno (VPPB) en los pacientes diagnosticados de hydrops endolinfático (HE) y analizar además si la asociación es un factor de mal pronóstico para nuestros enfermos. Material y métodos: Realizamos un estudio retrospectivo en nuestro Servicio de los pacientes diagnosticados de enfermedad de Menière definitiva según los criterios de la Academia Americana de Otorrinolaringología y de VPPB por medio de las maniobras de provocación. Resultados: La prevalencia de VPPB en nuestros enfermos con HE es del 5,1%. El índice de curación con las maniobras de recolocación es del 90,9%; sin embargo, con la primera maniobra sólo fue del 63,36%. Las recidivas se presentaron hasta en un 22,22%. Encontramos menor tasa de éxitos con la primera maniobra en relación con el resto de los enfermos con VPPB sin que padecieran HE. Esta diferencia fue estadísticamente significativa (p=0,042). Discusión: No encontramos que en estos pacientes exista un menor índice de curación con las maniobras de recolocación ni una mayor tasa de recidivas. Sin embargo, nuestra primera maniobra del protocolo tiene un éxito menor que en el resto de los enfermos (AU)

Introduction: The aim of this study was to determine the prevalence of benign paroxysmal positional vertigo (BPPV) in patients diagnosed with endolymphatic hydrops (EH) and to analyze whether this association is a factor for poor prognosis in these patients. Results: The prevalence of BPPV in our patients with EH was 5.1%. The rate of cure with the repositioning manoeuvres is 90.9%, however success with the first manoeuvre was only 63.36%. Recurrences occurred in up to 22.22%. We found a lower success rate with the first manoeuvre in relation to the rest of the patients with BPPV without EH. This difference is statistically significant (P=0.042). Discussion: We did not find that these patients to have a lower rate of cure with the repositioning manoeuvres or a higher rate of recurrence. But in our protocol the first manoeuvre had a lower success rate than in the rest of the patients (AU)

Adenocarcinoma de laringe: presentación de un caso / Laryngeal adenocarcinoma: case report

El adenocarcinoma de laringe es un tipo de tumor muy infrecuente, que supone sólo un 0,35-0,5 % de las neoplasias laríngeas malignas. Se caracteriza por su elevada agresividad y por su tendencia a producir metástasis en los ganglios linfáticos regionales y a distancia. Presentamos el caso de un varón de 64 años de edad con un adenocarcinoma de laringe con metástasis ganglionares en el momento del diagnóstico. Fue tratado con una combinación de cirugía y radioterapia postoperatoria. Siete meses después presentó recidiva regional (AU)

Laryngeal adenocarcinomas are extremely unusual (only 0.35%-0.5% of all laryngeal malignancies). It usually behaves as a highly malignant tumour, with tendency for local lymph node and distant organ metastases. We report a case of a 64-year-old man with an adenocarcinoma of the larynx with cervical lymph node involvement at the moment of the diagnosis. The patient was treated with surgery (total laryngectomy and cervical lymph node dissection) and post-operative radiotherapy. Seven months later, the patien thad a local recurrence (AU)

Alteraciones del equilibrio en pacientes menores de 16 años distribuidos por grupos de edad / Alterations of balance in patients under 16 years of age distributed by age groups

Objetivo: Evaluar la prevalencia y las características clínicas de las alteraciones del equilibrio en los niños, así como establecer el grado de importancia de los estudios audiológicos, equilibriométricos y de imagen en el diagnóstico de la afección vestibular infantil. Pacientes y método: Presentamos un estudio descriptivo, retrospectivo y no aleatorizado, realizado en el Servicio de Otorrinolaringología del Complejo Hospitalario Universitario de Santiago de Compostela. Se incluyó a 125 pacientes menores de 16 años que consultaron por alteraciones del equilibrio a lo largo de 12 años (1996-2007); que se distribuyeron en 3 grupos en función de su edad: 0 a 5, 6 a 10,y 11 a 15 años. Resultados: El vértigo paroxístico benigno de la infancia (64 %) es el cuadro más frecuente en nuestra serie, en el32,5 % se asoció migraña común. Éste, junto a los diagnósticos de vértigo posicional infantil y vértigo psicógeno, se encontró con más frecuencia en el grupo etario de 11 a15 años (p < 0,05). La edad, el sexo y los resultados de los estudios de imagen (tomografía computarizada cerebral y resonancia magnética encefálica) no se relacionaron con el hecho de presentar migraña asociada ni con el diagnóstico (p > 0,05).Conclusiones: La historia clínica y la exploración otoneurológica son las piezas clave en el diagnóstico de la afección vestibular infantil; es importante protocolizarlas y sistematizarlas por grupos de edad. Los estudios de imágenes sólo aportan alto rendimiento diagnóstico en niños que presenten clínica neurológica, cefaleas persistentes o el antecedente de traumatismo craneoencefálico (AU)

Objective: To evaluate the prevalence and clinical characteristics of children with altered balance, as well as to establish the level of importance of the audiological, balance and imaging studies in the diagnosis of infantile vestibular pathology. Patients and method: We report a descriptive, retrospective and non-randomized study performed at the Otorhinolaryngology Department of the Complejo Hospitalario Universitario de Santiago de Compostela (Santiago de Compostela University Hospital, Santiago de Compostela, Spain). The study included 125 patients under 16 years of age who consulted due to alterations in their balance over a period of twelve years (1996 to 2007); they are distributed into three groups based on age: 0 to 5, 6 to 10, and 11 to 15 years. Results: Childhood benign paroxysmal vertigo (64 %) is the most frequent syndrome in our series, with 32.5 % of patients associating common migraine. Together with diagnoses of infantile positional vertigo and psychogenic vertigo, was more frequently found in the 11 to 15 year-old age group (P<0.05). Age, gender and the results of the imaging studies (computerized tomography of the brain and magnetic resonance of the head) were not related to the presentation of associated migraine nor to the diagnosis (P>0.05).Conclusions: Clinical history and the neuro-otological examinationare the key elements of the diagnosis of infantile vestibular pathology; it is also important to standardize and group patients by age. Imaging studies only contribute high diagnostic performance in children presenting neurological symptoms, persistent headache or who have sustained head trauma (AU)

Propuesta de cribado de la presbiacusia en una consulta de atención primaria / Proposal for presbycusis screening in a primary care clinic

Objetivo. La presbiacusia es una de las causas de sordera cuyo índice ha aumentado más en nuestra sociedad. El objetivo de nuestro estudio es poner de manifiesto los valores de presbiacusia en personas mayores de 60 años que acuden a nuestro centro de salud por otros problemas, y valorar la utilidad de algunas pruebas utilizadas en atención primaria para detectar problemas auditivos. Pacientes y método. Participaron 110 individuos. Los criterios de exclusión fueron: diagnóstico previo especializado, falta de consentimiento o imposibilidad para hacer las pruebas. La valoración de la discapacidad auditiva se hizo según la otoscopia, prueba de Weber, prueba de Rinne, la voz susurrada y el test de discapacidad auditiva. La validación audiológica se realizó por audiometría valorada por el servicio de otorrinolaringología. El análisis de resultados se efectuó con el paquete estadístico SPSS. Resultados. Edad media 71 ± 6,1 años. La otoscopia fue normal en el 81,8%. La prueba de Weber no tuvo relación significativa con la otoscopia; sin embargo, sí la tuvo la prueba de Rinne. La presbiacusia se objetivó en el 68,2% de las audiometrías. El 100% de las personas que habían trabajado en ambiente ruidoso presentaba déficit audiométrico. Conclusiones. Hay cifras elevadas (87%) de hipoacusia en nuestra población de ancianos, y en el 68,2% de los casos se debe a presbiacusia. La sensibilidad y el valor predictivo negativo de la mayoría de las pruebas para detección de alteraciones auditivas utilizadas en primaria son bajos

Objectives. Presbycusis is one of the causes of deafness that has increased most in our society. To show the levels of presbycusis in people over 60 who attend our health centre for other reasons and to assess the utility of certain tests employed in primary care to detect hearing problems. Patients and method. One-hundred and ten people. Exclusion criteria: prior specialist diagnosis, lack of consent or impossibility of running the tests. Assessment of auditory invalidity: otoscopy, Weber, Rinne, whispered voice, auditory disability test. Audiological validation by audiometry assessed by ORL. Results analysed with SPSS statistical packet. Results. Mean age 714 (6.1). Otoscopy was normal in 81.8%. Weber's test had no significant relationship with the otoscopy, but did with the Rinne. Presbycusis was seen in 68.2% of the audiometries. Everyone (100%) who had worked in a noisy environment had audiometric deficit. Conclusions. There were high figures (87%) for hypoacusis in our population of elderly people. In 68.2%, this was due to presbycusis. The sensitivity and negative predictive value (Vp-) of most of the tests used in primary care to detect auditory disorders are low

Puesta al día en las disfonías funcionales / No disponible

Presentamos una revisión exhaustiva y actualizada de la literatura referente a las disfonías funcionales, suetiopatogenia, clínica, diagnóstico y tratamiento, aportando nuestra experiencia en el manejo de esta patología

We present an exhaustive and updated revision of the literature referring to the functional dysphonis, itsetiopathogeny, clinic, diagnosis and treatment, displaying our experience in the management of this pathology