Bilateral Ménière's disease according to its form of debut: synchronous and metachronous disease.

OBJECTIVE: Bilateral Ménière's disease is classified according to the time of appearance of symptoms in each ear into synchronous and metachronous types. A descriptive longitudinal study, involving 59 bilateral Ménière's disease patients, was carried out to assess the two forms of bilateral Ménière's disease. METHOD: Data on symptomatic chronology in each ear, auditory evolution and evolution of vertiginous crisis, among other aspects, were obtained, analysed and compared. Possible risk factors for Ménière's disease becoming bilateral were analysed after conducting nested case-control studies in a cohort. RESULTS: The metachronous form was seen in 76.3 per cent of cases, and the time it took for the disease to become bilateral took a median time of seven years. The symptomatic triad was the most frequent symptomatic debut for the first ear in both forms. Synchronous debut presented a greater average hearing loss. Suffering from migraine and a symptomatic onset with a greater number of symptoms appear to be possible predictors of conversion to bilateral Ménière's disease. CONCLUSION: Bilateral Ménière's disease temporal models presented differences. The study of them helps to better understand, prevent and predict the behaviour of these patients.

A longitudinal study of unilateral Ménière's disease and clinical evolutionary models.

OBJECTIVE: The heterogeneity of Ménière's disease is presently defined by a variety of subtypes. This study introduced three different subtypes of unilateral Ménière's disease based on the evolution of vertigo crises from their inception. METHOD: A longitudinal descriptive study of 327 unilateral Ménière's disease patients was performed. In a subgroup of patients followed from the onset of the disease, 3 subtypes of unilateral Ménière's disease were defined according to the vertiginous crises suffered during the first 10 years of the disorder. RESULTS: Data was available for 87 patients with unilateral Ménière's disease from the start of their disease (26.6 per cent of the original sample). These patients were grouped into three models according to their symptomatic evolution. Model 3 was associated with a worse hearing prognosis, a greater number of Tumarkin's otolithic crises and the need for surgery. Model 1 presented less hearing loss. CONCLUSION: Unilateral Ménière's disease models based on the evolution of vertiginous crises present differences according to aspects such as hearing loss, vertiginous crisis, Tumarkin's otolithic crisis and the need for surgery.

[What do MRI and CT scan provide us in patients with vertigo and dizziness? A cost-utility analysis]. / Que aporta la neuroimagen en pacientes con vertigo y mareo? Analisis coste-utilidad.

INTRODUCTION: Vertigo and dizziness are symptoms with a significant burden in the hospital and involve several specialties. There are few guidelines of radiological tests for these symptoms. AIMS: To know which profile of patients with vertigo and dizziness has neuroimaging tests, quantify and describe the radiological findings. To analyze the cost-utility of CT and MRI in the study of these patients. PATIENTS AND METHODS: Descriptive study, we selected patients referred to the hospital for vertigo and dizziness. We analyze demographic and clinical characteristics and quantify the neuroimaging tests requested. We describe the radiological findings, assess their relevance in the diagnosis and detail the cost-benefit. RESULTS: We identified 493 patients, those with neuroimaging test (60%) are older, depressed and frequented the emergency department because of vertigo. The most requested test was the cranial CT scan (5% identifies the cause of the symptom). MRI of the inner ear and cerebellopontine angle was the test that presented the most significant findings (17.7%). The 286 image tests requested for vertigo cost 56,741 euros. The cost for a positive test was 1,576 euros. CONCLUSIONS: A large number of head CT and MRI are made in patients with vertigo and dizziness. A clinical suspicion is recommended from the anamnesis and exploration to make a good selection of test to request. In more than 90% of cases, radiological findings are not shown in relation to vertigo.

TITLE: Que aporta la neuroimagen en pacientes con vertigo y mareo? Analisis coste-utilidad.Introduccion. Vertigo y mareo son sintomas que suponen una carga significativa en el hospital e involucran a varias especialidades. Existen pocas guias sobre la solicitud de pruebas radiologicas ante estos sintomas. Objetivos. Conocer que perfil de pacientes con vertigo y mareo tiene realizadas pruebas de neuroimagen, cuantificar y describir los hallazgos radiologicos, y analizar el coste-utilidad de la tomografia computarizada (TC) y la resonancia magnetica (RM) en pacientes con estos sintomas. Pacientes y metodos. Estudio descriptivo en el que se seleccionan pacientes remitidos al hospital por vertigo y mareo. Se analizan caracteristicas demograficas y clinicas y se cuantifican las pruebas de neuroimagen solicitadas. Se describen los hallazgos radiologicos, se valora su relevancia en el diagnostico y se detalla el coste. Resultados. Se identifica a 493 pacientes, el 60% tiene realizada una prueba de neuroimagen; son pacientes de mas edad, depresivos y que han acudido a urgencias por vertigo. La prueba mas realizada fue la TC de craneo sin contraste (el 5% identifica la causa del sintoma). La que presento mas hallazgos significativos fue la RM de la base del craneo (17,7%). Las 286 pruebas de imagen solicitadas por vertigo costaron 56.741 euros. El gasto para obtener un diagnostico radiologico fue de 1.576 euros. Conclusiones. Se realiza un gran numero de TC y RM de cabeza en pacientes con vertigo y mareo. Es recomendable tener un diagnostico de sospecha previo a partir de la anamnesis y la exploracion para hacer una buena seleccion de las pruebas que hay que solicitar. En mas del 90% de los casos no se muestran hallazgos radiologicos en relacion con el vertigo.

[Management of peritonsillar infections]. / Tratamiento de la infección periamigdalina.

OBJECTIVE: To evaluate the clinical and epidemiologic characteristics in children with peritonsillar infections. PATIENTS AND METHODS: A longitudinal retrospective study was performed through a review of the clinical histories of patients attending the emergency unit in the previous 6 years. The variables gathered were age, sex, recurrent tonsillitis, previous upper airway infection, antibiotic administration, and therapeutic approach. RESULTS: Twenty-nine children were admitted, with a mean age of 7.4 +/- 1.6 years (boys 1.6:1). Twenty-seven percent had recurrent tonsillitis. At the visit, 57.8 % had an upper respiratory infection and 65 % were taking antibiotic treatment, especially macrolides. The treatment selected at our center consisted of the association of penicillin or amoxicillin-clavulanate acid with clindamycin, including corticosteroids. Ten children underwent computed tomography and nine underwent fine-needle aspiration. Drainage was performed in 20.6 % of confirmed abscesses. The mean length of hospital stay was 5.6 +/- 1.6 days. Delayed tonsillectomy was performed in 31 %, except in one patient who developed a parapharyngeal abscess. Currently, 18.9 % of all peritonsillar infections occur in the pediatric population. CONCLUSIONS: The increase in these infections is probably related to inappropriate use of antibiotics in respiratory diseases. Diagnosis is clinical, and infections are often resolved by intravenous administration of beta-lactams with clindamycin and an expectant attitude. When an abscess is suspected or there is no clinical improvement, fine-needle aspiration or computed tomography is warranted and drainage should be performed if an abscess is confirmed. Tonsillectomy, usually delayed, is only indicated in patients with recurrent tonsillitis.

[Immunomediation or hyperviscosity in rapidly progressive sensorineural hearing loss. A therapeutic approach]. / Inmunomediación o hiperviscosidad en la hipoacusia neurosensorial rápidamente progresiva. Una aproximación terapéutica.

INTRODUCTION: To evaluate the therapeutic response and the rheologic and immunological characteristics in subjects bearing of rapidly progressive sensorineural hearing loss (RPSHL). PATIENTS AND METHODS: A comparative prospective study on three groups of damaged ears treated with piracetam (n=29), corticosteroids (n=32) and plabcebo (n=25). Hearing loss and recovery level, whole blood filterability (WBF) and a Western-blot (WB) to anticochlear antibodies were evaluated. RESULTS: Recovery average was 20,8 +/- 55,9% in the first group, with progressive of deafness in the rest (p<0,01). WB did not show differences among groups. The higher WBF at the end of therapy was detected on group 1 (20,36 +/- 2,54 Vs 18,42 +/- 3,42 microl/seg on group 3; p<0,05). Moreover, it impaired only on those treated with piracetam, with statistically significative differences over the other two groups. CONCLUSIONS: We detected alterations on WBF in patients with RPSHL that justify the use of rheoactive measures as a pathophysiological therapy.

[Correlation between the contralateral supressor effect and the auditory fatigue using transitory acoustic otoemissions]. / Estudio de la correlación existente entre el efecto supresor contralateral y la fatiga auditiva mediante otoemisiones acústicas transitorias.

OBJECTIVE: The purpose of this study is the identification of susceptible individuals to develop noise induced hearing loss. For it we use the capacity of the transitory otoacoustic emissions (TEOAE) for the identification of functional alterations at different levels from the auditory system. MATERIAL AND METHODS: 67 normal hearing subjects have been studied, we have recorded TEOAE in one ear in three different conditions: in normal conditions (SIN register), simultaneously to the stimulation of the contralateral cochlea (EAC register), and after stimulation we can observe (EAI register). We compare the amplitude of the TEOAE with the SIN and EAC registers to quantity the contralateral suppresor effect, and the SIN and EAI, register to study the auditory fatigue. RESULTS: We can observe a reduction in the amplitude of the TEOAE obtained by acoustic stimulation of the ipsilateral ear (0.954 dB SPL), or after the ipsilateral acoustic stimulation (0.75 dB SPL), being able to see an inverse correlation between both values. CONCLUSIONS: The study of the TEOAE obtained in different conditions of acoustic stimulation, ipsilateral or contralateral, and the inverse correlation obtained between the magnitude of the auditory fatigue and the contralateral suppresor effect, provides arguments for the identification of individuals susceptible of developing noise induced hearing loss.

[Changes on blood filterability in patients with fluctuant hearing loss]. / Variaciones en la filtrabilidad sanguínea en pacientes con hipoacusia fluctuante.

We developed a two year follow-up in thirteen subjects bearing of fluctuant sensorineural hearing loss measuring their blood filterability (BF) and making a correlation to appearance of deafness episodes. We could observe a decrease on BF in all patients when they felt a hearing loss. When they recovered the hearing level, BF increased too. The use of reoactive techniques to avoid these decreases on BF in fluctuant deafness could potentially prevent or improve them.

[Cormobidity of sensorineural hearing loss and other autoimmune diseases. Usefulness of laboratory tests]. / Estudio de comorbilidad de la hipoacusia neurosensorial y otras enfermedades de patogenia autoinmune. Utilidad de las pruebas de laboratorio.

OBJECTIVES: To value if the sensorineural hearing loss (SHL) in several autoimmune diseases (AD) is also secondary to immunomediation. PATIENTS AND METHODS: In 342 cases with SHL and any AD and 301 normoacoustic controls with AD a non-specific immunologic battery of tests and a Western-blot (WB) for anticochlear autoantibodies were developed, and cases with SHL were treated with deflazacort. RESULTS: Alterations in non-specific battery were similar between cases and controls. But a 12,5% of cases with SHL and a 1,6% of normoacoustic showed a positive WB (p<0,001). Steroid therapy improved hearing in 14,3% of cases. In them, sensitivity and specificity of non-specific battery were 78,4% and 75,5%, respectively, to predict response to therapy. These were 98,9% and 81,6% for WB. CONCLUSIONS: The SHL in cases with AD can be considered immunomediated in a discrete average, but the diagnostic efficiency of WB to predict an improvement after steroid therapy is high.

[Blood viscosity profile in rapidly progressive sensorineural hearing loss with positive Western-blot]. / Perfil de la viscosidad sanguínea en la hipoacusia rápidamente progresiva con Western-blot positivo.

OBJECTIVE: To value a possible association between disorders in blood viscosity of patients with rapidly progressive sensorineural hearing loss (RPSHL) of autoimmune origin. PATIENTS AND METHODS: We studied the viscoelastic properties of blood in 43 subjects bearing of RPSHL and a positive Western-blot for anticochlear antibodies: whole blood viscosity (WBV) at different shear rates and erythrocyte filterability (EF). These results were related to hearing loss initially detected and recovery average one year later from steroid therapy. RESULTS: Just WBV at 230 sec(-1) shear rate was significatively higher in cases than in controls (p < 0.01). Hearing recovery degree correlated in an statistically way to increased values of EF (p < 0.01). There was no relation between initial hearing loss level and any rheology parameter. CONCLUSIONS: Autoimmune RPSHL does not show a pathophysiology mechanism associated to blood hyperviscosity. So, rheoactive therapies as plasmapheresis warrant no clinical improvement.

[Petrous bone fracture. Our experience: 1999-2004]. / Fracturas de peñasco. Nuestra experiencia: 1999-2004.

OBJECTIVE: To review the petrous bone fractures during the last five years (1999-2004) in our hospital, its manage, control, and analysis onf the associated factors. To analyse the managing protocoles and current bibliography. MATERIAL AND METHODS: We review 266 temporal bone fractures, 74 with petrous bone association. We analyse these fractures by sex distribution, injurie severity, otorhinolaryngological clinical findings, production mechanism and radiological findings. The cases are discussed and compared with current bibliography. CONCLUSIONS: Petrous bone fractures must be always suspected in patients with head trauma, specially if it associates severity and otorrhagia. It is necessary a deep colaboration between neurosurgeons, radiologists and otorhinolaryngologists to obtain a good management, control and follow up of the patients.

[Near-total laryngectomy. Experience, complications and acoustic analysis]. / Laringuectomía casi total. Experiencia, complicaciones y análisis de voz.

OBJECTIVE: To investigate the oncological efficiency, voice and complications of Pearson's near-total laryngectomy for advanced laryngeal cancers (T3, T4). MATERIAL AND METHODS: A retrospective review of 23 cases of near-total laryngectomy (carried out in our Hospital in the last nine years) was undertaken. RESULTS: None of the cases developed laryngeal mucosal recurrences. The overall three and five years disease free survival were 91,3% and 86,9%. Mean phonation time was 51 days. A statistically significant results were observed in our voice analysis (words/minute, taking as a reference healthy people (Medivoz). The pharyngeal fistula was the most frequent complication (60,86%). CONCLUSIONS: The local control of cancer was similar to that expected with total laryngectomy. Near-total laryngectomy is a valid alternative for extended laryngeal and neighbouring cancers with an acceptable morbidity and success rate for voice preservation.

[Auditory requirement for group 2 vehicle driving licences. An update in accordance with valid legislation in Spain]. / Requerimiento auditivo en licencias de conducción de vehículos del Grupo 2. Actualización conforme a la legislación vigente en España.

INTRODUCTION: Hearing loss level admitted for acquisition of Group 2 driving licences is actually 35%, but this measurement is not standarized. METHODS: In 35 drivers with Group 2 licence bearing of hearing loss, it was measured in the usual way -considering threshold as an average-, and also in accordance with valid legislation, which considers deafness when hearing thresholds are under 25 dB in each tone. RESULTS: Binaural hearing loss average was 41.3+/-6.3% for the first model, and 30.7+/-10.2% for the second. There was a good correlation between the two models by mean of lineal regression (y=1.4785x-30.382; R2=0.8467). CONCLUSIONS: In Group 2 licences, hearing loss average must be standarized in its quantifyng technique, because there is a wide difference in the results, depending on the model used to measure. In our country there are rules and regulations about quantifying for disable people, valid for establishing deafness measurement patterns in vehicle driving too.

[Cerebro spinal fluid (CSF) leaks in ear: revision of 5 cases]. / Fístulas de líquido cefalorraquídeo en oído: a propósito de 5 casos.

CSF leaks in the ear are the result of an abnormal communication between subarachnoid and tympano mastoid areas, most of then as a result of trauma (90%). They mean a lisk of meningitis (4-50%) directly related to the etiology. Our aim is to present the CSF leak cases seen in our hospital in the last 2 years and a revision of their management. The main factor for a sucessful surgical repair is to use a multilayer tecnhique with a sucess rate close to 100%.

[Hearing level and intensive use of mobile phones]. / Nivel auditivo y uso intensivo de teléfonos móviles.

INTRODUCTION: Wide studies and substantial controversies build on utilization of actual mobile phones and appearance of systemic disorders or even tumours, but there is no knowledge about an eventual involvement on early hearing loss. PATIENTS AND METHODS: In a group of three hundred and twenty-three healthy and normoacoustic volunteers who were usual costumers of mobile phones an audiometric evaluation was made at the beginnig of its use and three years later, inquiring about the periods of time per day and year employed on direct contacts with phone. A healthy and normoacoustic control group of non users was studied too. RESULTS: Cases carried out 24.3 +/- 8.2 active contacts, reaching 50.4 +/- 27.8 days of mobile phone employment in three years. Audiometric curve was similar in cases and controls at the beginning of the study. After this follow-up, cases showed an increase on hearing threshold between 1 and 5 dB HL more than controls in speech tones (p<0.001). Moreover, there was a trend to correlate time of phone use to hearing impairment, but this finding did not result statistically significative. CONCLUSIONS: Frequent management of mobile phones in a middle period of time allows to detect a mild hearing loss, but the cause of this disorder keeps unclear.

[Hearing loss associated to ulcerative colitis]. / Hipoacusia asociada a colitis ulcerosa.

OBJECTIVE: To value the eventual immunomediation in sensorineural hearing loss (SHL) on patients bearing of ulcerative colitis (UC). MATERIAL AND METHODS: In a group of forty-nine cases with a mean age of 41.6+/-9.3 years old we studied the hearing loss level, the disease activity index, the peripheral blood inflammation markers and the anticochlear antibodies by mean of Western-blot technique (WB). RESULTS: The 26.5% knew about their deafness, although SHL was detected in 59.1% of cases. The mean age of onset was 40.3+/-9.8 years. 48.9% showed a positive WB, always in 68-70 kDa molecular weight blots. Moreover, patients with positive WB showed more severe deafness, higher disease activity and more altered parameters, especially erythrosedimentation rate. CONCLUSIONS: Audiologic and peripheral blood findings observed allow us to establish a reasonable suspicion of an autoimmune or immunomediated pathway of hearing loss on UC.

[Blood viscosity modifications in patients with presbycusis]. / Alteraciones en la viscosidad sanguínea en pacientes con presbiacusia.

OBJECTIVE: [corrected] To evaluate the existence of blood viscosity alterations in presbyacusis as an eventual pathophysiological mechanism. MATERIAL AND METHODS: Nine 75 year-old subjects bearing of bilateral slowly progressive sensorineural deafness were considered to be studied on a yearly basis in a ten year folow-up period, evaluating the binaural hearing loss in speech tones (500, 1000, 2000 and 3000 Hz). Hemorheological profile on peripheral blood included total blood viscosity (BV) at different shear rates (SR), blood filterability (BF), erythrocyte deformability and aggregability (EA). RESULTS: There was a trend of all parameters towards hyperviscosity, with an increase at ten years of BV at high SR and EA at total stasis which were statistically significant. The level of deafness correlated significativelly to low values of BF and increases on BV at high SR. CONCLUSIONS: Presbyacustic patients do show hemorheological evidences that suggest a tendency towards hyperviscosity as a predisposing factor for hearing loss.

[Anticochlear antibodies titles measured by Western-blot and hearing recovery level after corticoid therapy in patients with sudden deafness]. / Titulación de anticuerpos anticocleares mediante Western-bloty grado de recuperación auditiva tras corticoterapia en pacientes con sordera súbita.

OBJECTIVES: Detection of antichoclear antibodies in patients with sudden deafness (SD) ranges from five to forty one percent depending on authors. We tried to correlate the level of antibodies measured by Western-blot (WB) and hearing loss. PATIENTS AND METHODS: Forty nine subjects bearing of SD and a positive WB for bovine cochlear antigen. Hearing loss average was measured at the onset and after treatment with deflazacort 1 mg/kg per day by means of audiometry, and antibody titles were quantified in the diluted sera. RESULTS: Initial loss was 49.4+/-20.6%, and after corticotherapy it was 15.9+/-18.0%. There was no statistically significative correlation titles-hearing loss (y=0.1122x+30.613; R2=0.7552) nor titles-recovery (y=-0.0818x+8.,65; R2=0.3229). CONCLUSIONS: Although predictive capability for treatment response is accepted for WB, quantifying of the antibody titles in patients with SD does not allow to make a prognosis about the average hearing recovery.

[Upper dysphagia due to a chemotherapy resistant Burkitt's lymphoma in a lingual tonsil]. / Disfagia alta por linfoma de Burkitt de amígdala lingual resistente a quimioterapia.

The higher incidence of immunosuppressive status is increasing in the last years the diagnosis of tumours of unusual location and behaviour. We present the case of a HIV-seropositive 41 years-old woman, bearing of high dysphagia and pharyngolalic voice. The exploration showed a tumour emerging in lingual tonsil and spreading out to hypopharynx and larynx. No lymph nodes were observed. Its resistance to chemotherapy made necessary its surgical removal.

[Tonsillar mast cell infiltration and allergic tonsillitis]. / Infiltración mastocitaria amigdalar y amigdalitis alérgica.

We report the case of a seven year-old boy bearing of exudative acute tonsillitis after strawberry ingestion with no previous infectious history. After having diagnosed it as hypersensitivity type I, this patient began to suffer repetitive episodes of exudative and purulent tonsillitis, related to cool drinks and direct manipulation of tonsils. These were hyperplastic and Staphylococcus sp. and Streptococcus sp. were isolated in them. The episodes were shortened by the use of corticosteroids. Tonsillectomy was the definitive therapy. Biopsy informed of mast cells infiltration in germinal centers of both palatine tonsils.