Position paper on nasal obstruction: evaluation and treatment.

Nasal obstruction (NO) is defined as the subjective perception of discomfort or difficulty in the passage of air through the nostrils. It is a common reason for consultation in primary and specialized care and may affect up to 30%-40% of the population. It affects quality of life (especially sleep) and lowers work efficiency. The aim of this document is to agree on how to treat NO, establish a methodology for evaluating and diagnosing it, and define an individualized approach to its treatment. NO can be unilateral or bilateral, intermittent or persistent and may be caused by local or systemic factors, which may be anatomical, inflammatory, neurological, hormonal, functional, environmental, or pharmacological in origin. Directed study of the medical history and physical examination are key for diagnosing the specific cause. NO may be evaluated using subjective assessment tools (visual analog scale, symptom score, standardized questionnaires) or by objective estimation (active anterior rhinomanometry, acoustic rhinometry, peak nasal inspiratory flow). Although there is little correlation between the results, they may be considered complementary and not exclusive. Assessing the impact on quality of life through questionnaires standardized according to the underlying disease is also advisable. NO is treated according to its cause. Treatment is fundamentally pharmacological (topical and/or systemic) when the etiology is inflammatory or functional. Surgery may be necessary when medical treatment fails to complement or improve medical treatment or when other therapeutic approaches are not possible. Combinations of surgical techniques and medical treatment may be necessary.

[Oculographic findings in 145 patients with benign paroxysmal positional vertigo]. / Hallazgos oculográificos en 145 pacientes con vértigo posicional paroxístico benigno.

OBJECTIVE: Benign paroxysmal positional vertigo (BPPV) can be produced by specific manoeuvres and be studied by electrooculography (EOG). It allows an exhaustive study of features in the positional nystagmus. Although most of the patients with BPPV express typical nystagmus, there exists a group of them that exhibit a non typical form. In this work, a comparative study was carried out between two groups of patients. MATERIAL AND METHODS: We have studied retrospectively 145 patients with BPPV and Dix-Hallpicke (D-H) positive manoeuvre registered by EOG techniques. All patients were explored in a complete EOG tests. Two groups were identified: typical response/atypical response according to the features of nystagmus response. Possible alterations in other EOG tests in each group were investigated and differences between both types of response were analyzed. RESULTS: 83.5% of cases showed typical nystagmus and atypical in the rest. Other EOG alterations observed in these patients, were (group typical response/atypical response): caloric hypofunction (17.3%/23%), positional nystagmus (12.4%/62.5%), alterations in visual-oculomotor function tests (10%/50%). CONCLUSIONS: Frequent alterations were observed in the classic manoeuvres and also in the rest of EOG tests. Probably atypical response in the first is due to or can explain the existence of the second.

[Eosinophils in nasal polyposis pathogenia. Bibliographic revision]. / Los eosinofilos en la patogenia de la poliposis nasal. Una revisión bibliográfica.

The aim of this work is to do a review on relations between the eosinophils and nasosinusal polyps. The etiopathogenical action of eosinophils are reviewed, from bone narrow to nasal mucosa infiltration. The mechanism of tissue eosinophilic mediated inflammation, his regulation and the significance of the balance between positive (IL-5) and negative (TGFbeta and IL10) mediators are discussed. We conclude that the degree of eosinophilic infiltration and degranulation's patterns are important aspects conditioning the severity and prognosis of chronic rhinosinusitis and nasosinusal polyps.

[Pleomorphic adenoma of deep lobe of the parotid gland]. / Adenoma pleomorfo gigante de lóbulo profundo de la parótida: a propósito de un caso.

Parapharyngeal space tumors are rare. Salivary neoplasms being the most frequent ones. The important volume they can reach, their silent character, and the complex anatomic relationships of this area makes their surgical resection difficult. This report describes a case of a pleomorphic adenoma in the deep lobe of the parotid gland presented like a parapharyngeal mass, and its diagnosis and treatment.

[Benign paroxysmal positional vertigo of the horizontal semicircular canal]. / Vértigo posicional paroxístico benigno del canal horizontal.

OBJECTIVE: Assesment of 8 new cases of benign paroxysmal positional vertigo of the horizontal semicircular canal (BPPV-HC), since this variant of benign positional vertigo occurs rarely. An oculographic study of features in the positional response was carried out. Electrooculograpy (EOG) allows an exhaustive study of positional nystagmus. MATERIAL AND METHODS: We have studied retrospectively 8 patients with BPPV-HC and positive head rotation manoeuvre registered by EOG techniques. Possible alterations in other EOG tests in the group of patients were analyzed. RESULTS: Most of the patients (7/8) expressed bilateral horizontal geotropic changing-direction nystagmus. One patient exhibited apogeotropic horizontal nystagmus. 5/8 cases showed caloric hypofunction. CONCLUSIONS: We have proven that BPPV-HC is an uncommon disorder. In most of the cases, provocative manoeuver generates bilateral horizontal geotropic changing-direction nystagmus that probably is due to canalitiasis of the horizontal semicircular canal. The rest, a few cases, exhibit apogeotropic horizontal response that can be secondary to cupulolitiasis or location particles in the anterior portion of the horizontal canal. A caloric test showed abnormal in many and can help to locatize the affected ear.

[Cyst and pseudocyst lesions of the floor of the mouth with submental affectation]. / Lesiones quísticas y pseudoquísticas del suelo de la boca con afectación submentoniana. Diagnóstico diferencial y tratamiento.

There are several lesions which can present as a cyst or pseudocyst of the floor of the mouth with submental repercussion. The aim of this paper is to review the diagnosis methods which can help us to differentiate these lesions such as the surgical peculiarities of every tumour. We are reporting two cases of cystic/pseudocystic lesions of the floor of the mouth with submental repercussion. Both of them were epidermoid cysts. Ranulas, lipomas and lymphangiomas should be considered in the differential diagnosis. Imaging diagnosis, fine needle aspiration and adequate treatment in all of the tumours are reviewed. Both cases were operated via intraoral. They are now free of disease after at least one year. Differential diagnosis of cystic lesions of the floor of the mouth is important because the recommended surgery technique is not exactly the same in all of them. The firmness of the wall of dermoid cysts let their exeresis via intraoral even when they are of a big size. Exeresis of sublingual gland is recommended by most authors to treat ranulas, although it is followed by an important percentage of morbidity.

[Chronic maxillary atelectasis: an uncommon cause of persistent radiological opacification]. / Atelectasia crónica maxilar: causa infrecuente de opacidad radiológica persistente.

Chronic maxillary atelectasis (CMA) is an infrequent entity characterized by a persistent decrease in maxillary sinus volume due to inward bowing of one or more antral walls. The cause of CMA is probably maxillary sinus hypoventilation secondary to ostiomeatal complex obstruction. This creates negative pressure, leading to thinning of the sinus walls. We report the case of a 14-year-old asymptomatic girl with an opacified maxillary sinus on radiology following unsuccessful antibiotic treatment. A coronal computed tomography scan showed partial right antral opacification, with a laterally malpositioned medial infundibular wall and fontanel retraction, and consequently CMA was diagnosed. The interest of this case lies in the infrequency of CMA and the need to distinguish it from maxillary sinusitis.

[Electrooculography. Its value in the diagnosis of the patient with a balance disorder]. / Electrooculografía: aportación al diagnóstico del paciente con alteraciones del equilibrio.

INTRODUCTION: Controversy persists on the value of electrooculography (EOG) in the diagnosis of the unbalanced patient. The aim of this study has been to know the utility of EOG in the diagnosis of patients with equilibrium disorders. MATERIAL AND METHODS: We have examined 1000 patients in whom EOG test has been performed for unbalance symptoms. Results have been classified in peripheric or central pattern. Those patients included in the central pattern group have been compared with the results of imaging techniques. RESULTS: 45.7% of EOG performed showed pathological signs, 29.2% were of peripheral characteristics and 16.5% of central ones, of whom 6% showed different pathologies in the imaging test. DISCUSSIONS AND CONCLUSIONS: EOG in now a days of high value in the diagnosis of unbalanced patient, specially in those cases in which other clinical explorations were normal.

[Study of mucociliary transport and nasal ciliary ultrastructure in patients with Kartagener's syndrome]. / Estudio del transporte mucociliar y de la ultraestructura ciliar nasales en pacientes con síndrome de Kartagener.

OBJECTIVE: Kartagener's syndrome (KS) is a clinical variant of primary ciliary dyskinesia involving situs inversus associated with chronic airway infections. The ciliary defect associated with this syndrome is the absence of dynein arms. The aim of this study was to evaluate mucociliary transport and ciliary ultrastructure in 14 patients with KS. PATIENTS AND METHODS: We studied nasal mucociliary transport using a radioisotopic technique and ciliary ultrastructure in 14 patients with KS. RESULTS: Thirteen patients had mucociliary stasis and 1 had severely slowed transport (1.3 mm/min). Four patients (29%) had cilia with normal dynein arms, 2 patients (14%) had short inner dynein arms, and 8 patients (57.1%) had total absence of inner and outer dynein arms. CONCLUSIONS: We conclude that the typical clinical presentation, together with altered mucociliary transport as identified by an isotopic technique, is diagnostic of KS, even when the ciliary ultrastructure is normal. KS is clinically homogenous and morphologically heterogenous.

[Bilateral peripheral facial paralysis secondary to Lyme disease]. / Parálisis facial periférica bilateral secundaria a enfermedad de Lyme.

Simultaneous bilateral facial paralisis (SBFP) occurs in 0.3-2% of all facial paralisis. We report a case of SBFP in association with Lyme disease. A review of literature about SBFP is made, studing specially the one caused by Borrelia burgdorferi. We present a diagnostic guideline of SBFP. Suspect diagnosis of Lyme disease is based on clinical and epidemiological criteria. Culture isolation of this bacteria is difficult, therefore serologic testing is required. Neuroborreliosis treatment is intravenous Ceftriaxone or Cefotaxime. Oral Doxycycline is useful in the treatment of neuritis without central nervous system involvement.

[Our experience with extranodal lymphomas of the ORL region]. / Nuestra experiencia en linfomas extranodales del área ORL.

Head and neck extranodal lymphomas are rare. Waldeyer lymphatic ring is the most common localisation of these lymphomas, followed by oral cavity and parothoid glands. We have done a retrospective study of patients with extranodal lymphomas diagnosed in our hospital between 1991 and 1999. We have included in this study 23 patients, 15 males and 9 females. We have used the REAL classification. All of them have been non-Hodgkin lymphomas. The rhinopharynx has been the most affected region, followed by the palatine tonsils and oral cavity. Most of them were of medium degree and they were in the initial stages. The presentation symptoms varied depending on the localisation. The age, stage and histologic degree were important for the treatment election.

[Study of 1,000 patients with disequilibrium]. / Estudio de 1.000 pacientes con desequilibrio.

We present a series of one thousand patients tested with electronystagmography (ENG) for evaluation of complaints of unstability. Personal data and electronystagmographic results are analysed.

[Inverted papilloma of paranasal sinuses. Our experience of 15 cases. Review of literature]. / Papilomas invertidos de fosas y senos paranasales. Nuestra experiencia a partir de 15 casos. Revisión de la bibliografia.

Fifteen cases of nasosinusal inverted papilloma treated in our department from 1994 to 2000 are reported. The most frequent initial symptom was unilateral nasal obstruction. Some others symptoms were rhinorrea, facial pain and self limited epistaxis. The most frequent surgical procedure performed was the paralateral rhinotomy with medial maxillectomy. The median average for the follow up was 28 months, being diagnosed one recurrence. The paralateral rhinotomy with a medial maxillectomy, under functional endoscopic nasosinusal techniques are being more and more used, decreasing the indications of open techniques.

[An exceptional form of cranio-facial fibrous dysplasia: fibrous dysplasia of middle turbinate]. / Una forma excepcional de displasia fibrosa craneofacial: displasia fibrosa de cornete medio.

Fibrous dysplasia is a rare bone disease that can be misdiagnosed because of the slowness of its symptoms. Although it is a benign disease its clinical behaviour can be severe, with possibility of local growth and malignant degeneration into osteosarcoma. An uncommon case of fibrous dysplasia is reported, affecting only the middle turbinate. Diagnostic and therapeutic problems are discussed.

[Subtotal arytenoidectomy and posterior cordectomy with CO2 laser in the treatment of bilateral larynx immobility in adduction]. / La aritenoidectomía subtotal y cordectomía posterior con laser CO2 en el tratamiento de la inmovilidad laríngea bilateral en adducción.

This article deals with a retrospective study with 10 patients enduring laryngeal immobility in adduction and treated with CO2 laser. Presurgical assessment, surgical procedure, the causative etiology and end results are contemplated. Comparison with other procedures.

[Benign sinusal mucor colonization in association with septal deviation]. / Colonización benigna sinusal por mucor asociada a desviación septal.

Mucormycosis is a well recognised opportunistic infection caused by saprophytic fungi of the Mucoraceae family. Usually, the upper aerodigestive tract is the portal of entry. Patients who are debilitated or inmunosuppressed might present with these infections, although sometimes can happen in patients with good health. We present a case of benign mucor colonitation at the sinus maxillary associated a deviated nasal septum.

[Topical treatment of rhinitis: current status. Physiopathologic and pharmacologic bases]. / Tratamiento tópico de la rinitis: situación actual. Bases fisiopatológicas y farmacológicas.

Rhinitis is defined as inflammation of the lining of the nose, characterized by one or more of the following symptoms: nasal congestion, rhinorrhea, sneezing and itching. Modifications of nose secretion and of the blood supply of the nasal mucosa are responsible for development of rhinitis. Cholinergic and adrenergic agents as well as histamine, 5-hydroxytriptamine, kallidin and substance P are mediators of inflammation in rhinitis. The topical pharmacological principles we have today for management of rhinitis include: antihistamines, corticosteroids, anticholinergic agents, decongestants, sodium cromoglycate, nasal douching and aromatic inhalations.

[Postoperative clinical and ct-xray evaluation of the septic inflammatory sinus pathology]. / Evaluación posoperatoria clínica y por TAC en la patología sinusal séptico-inflamatoria.

It is classically been though that radical sinus surgery implies a difficulty for ulterior image diagnosis. The reason is postoperative fibrosis of soft tissue may be shown at TC scan as an occupation of paranasal sinuses. We realized that it does not usually happen. The aim of our study is to find out the appearance of sinuses after radical surgery performed to treat chronic sinusitis, mucocele and sinusal cysts. For so doing we have reviewed symptoms and radiological signs before and after surgery.