[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.

[Hearing loss measurement. An equation for a rapid calculation]. / Medida de la pérdida auditiva. Una ecuación para su cálculo rápido.

Hearing loss must be easily calculated by mean of the rules of actual legislation on handicap. It is just necessary to know the hearing thresholds for 500, 1000, 2000 and 4000 Hz tones. Calculation of a linear regression equation allows to obtain quickly hearing loss average from these thresholds.

[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.

[A patient with hereditary spherocystosis and sudden deafness after splenectomy]. / Un paciente con esferocitosis hereditaria y sordera súbita tras esplenectomía.

We report the case of a 29 year-old male with of hereditary spherocytosis, who developed two episodes of sensorineural hearing loss in his right ear after splenectomy due to repetitive hemolytic crisis. We discuss the eventual altiopathogenic mechanism of this audiological disorder.

Autoimmune identification of sudden hearing loss.

OBJECTIVE: To identify autoantibody bands using Western blotting in patients with idiopathic sudden sensorineural hearing loss (ISSNHL). MATERIAL AND METHODS: All patients admitted to our emergency ward with ISSNHL during a 3-year period (n = 51) were included in a diagnostic laboratory protocol, which included a non-specific test battery for immune disorders and a Western blot (WB) for bovine cochlear antigen, and underwent corticosteroid therapy. RESULTS: In 16 cases (31%) a band was identified in the WB. Cases with a positive WB showed abnormal results in a greater number of non-specific laboratory tests (3.6 +/- 1.3 vs 0.9 +/- 1.1; p < 0.001) and had greater hearing recovery (33.8% +/- 17.7% vs 50.6% +/- 18.5%; p < 0.01). Moreover, patients with a positive WB showed good correlations between the degree of hearing recovery and both early onset of treatment (0.5504x + 43.621; R2 = 0.8603; p < 0.01) and age (0.4053x + 56.298; R2 = 0.8952; p < 0.01). The non-specific test battery showed a sensitivity of 78% and a specificity of 94% for detecting an autoimmune disorder compared with WB. CONCLUSION: A positive WB predicts a good response to corticosteroid therapy in ISSNHL patients. If it is not possible to perform a WB then the non-specific test battery has a good capability for predicting autoimmune disorders.

[Presentation of 2 cases of sudden deafness in patients with sickle-cell anemia and trait]. / Presentación de dos casos de sordera súbita en pacientes afectos de anemia y rasgo drepanocíticos.

We report two cases of sudden deafness which appeared during vaso-occlusive crisis of a sickle cell anaemia (homozygous form of disease) and a sickle cell trait (heterozygous form) in two males aged sixteen and twenty-two, respectively. A high erythrocyte aggregability and low deformability were proved in both young men. Although hearing disorders have been reported in this disease, a sudden onset is not common. The treatment used was useful in the removal of painful crisis and infections, but deafness did not improve in either of then.

[Clinical and functional analysis of long-term results of uvulopalatopharyngoplasty]. / Análisis clínico y funcional de los resultados de la uvulopalatofaringoplastia a largo plazo.

In order to evaluate the clinical and functional effectiveness of uvulopalatopharyngoplasty (UPPP) in chronic roncopathy, we studied the subjective improvement of operated patients and compared to pulsioximetry findings before and after surgery. A follow-up was made on 72 patients entitled of chronic roncopathy--51 with obstructive sleep apnea syndrome (OSAS) and 21 with simple snoring-, for a mean period of time of 41 months. Preoperatory study included on ENT exploration, fibre optic endoscopy, Müller maneuver, pharyngeal CT, value of daytime sleepiness with Epworth's scale, espirometry and pulsioximetry, and the postoperatory study included of pulsioximetry and a health questionnaire over snoring and daytime sleepiness. Snoring improved or disappeared in 13 of 21 patients (61.8%), and daytime sleepiness did it in 26 of 39 (66.6%). Therapeutic failure in snoring was mainly due to an increase in the body mass index. After UPPP in OSAS, only 21 patients (41.1%) showed all positive response criteria (decrease into ODI > or = 50% or in absolute values < 6, CT 90% < 1%, and SaO2 Min > or = 85%). UPPP failed in long term evaluation in the rest of individuals. Patient selection is mandatory to optimize clinical response of UPPP for snoring, without OSAS success depends on body mass index, respiratory disturbances ratios and the eventual presence of another upper airways collapses below velopharyngeal segment.

[Neurosensory sudden deafness, blood hyperviscosity syndrome, and diabetes mellitus]. / Sordera súbita neurosensorial, síndrome de hiperviscosidad sanguínea y diabetes mellitus.

Diabetes mellitus is considered a risk factor for sensorineural sudden deafness. Its pathogenesis remains unknown. However, the physiopathological implication of a hyperviscosity syndrome in diabetics and patients bearing of sudden deafness can mean the nexus between the two entities. Total blood viscosity and erythrocyte adhesion were haemorheological parameters significatively higher in blood of diabetics with sudden deafness than in normal hearing controls. Moreover, erythrocyte filterability and deformability were lower in diabetics, but it was not statistically significative. These findings help to guide therapy in these patients towards specific measures to improve blood viscoelastic properties.

[Tonsillar and erythrocyte levels of superoxide dismutase in children with and without recurrent tonsillitis]. / Niveles de superóxido dismutasa amigdalar y eritrocitaria en niños con y sin amigdalitis de repetición.

BACKGROUND AND OBJECTIVES: Oxidative stress secondary to infant tonsillar infection produces the expression of local and systemic antioxidants. Its determination seems to be useful as a marker of tonsillar suffering before tonsillectomy but is currently unknown. The aim of this study was to determine the evolution of this parameter in tonsillectomized children during a long-term follow-up. METHODS: One hundred thirty-six children underwent tonsillectomy, 46 for tonsillar hypertrophy without infection and 90 for recurrent tonsillitis. Superoxide dismutase (SOD) concentrations were measured before tonsillectomy and at 6, 12, 24 and 36 months post-tonsillectomy. RESULTS: Infection provoked significantly higher SOD concentrations than tonsillar hypertrophy in tonsillar tissue (223.06 30.46 vs 156.39 54.05 U/l, p < 0.001) and in blood (1124.91 141.73 vs 1007.19 97.03 U/gr Hb, p < 0.001). There was a strong correlation between tonsillar and erythrocyte concentrations. During the 3-year follow-up, SOD concentrations in blood progressively decreased until stabilizing in all patients. Stabilization was reached at 6 months post-tonsillectomy in the group with tonsillar hypertrophy and at 2 years in the group with infection. Children with recurrent tonsillitis consistently showed higher SOD concentrations in blood throughout the follow-up. CONCLUSIONS: Oxidative damage in tonsillar tissue results from the incidence and severity of focal infections. Tonsillectomy reduces SOD levels but, as a consequence of oxidative stress, these do not return to normal.

[Steady state multi-frequency auditory evoked potentials as a technique to determine hearing threshold]. / Potenciales evocados auditivos de estado estable a multifrecuencia como técnica de determinación de umbrales auditivos.

OBJECTIVE: Since the set up of Steady-State Auditory Evoked Potentials as a routine technique, it has became necessary the establishment of clinic capabilities and limitations. In this study, we have compared SSEP to behavioural thresholds, considering the last one as "gold standard" technique. MATERIALS AND METHODS: We have recorded SSEP to multiple frequencies and behavioural thresholds in 84 ears. The obtained data were statistically processed to obtain correlations and others indicators. RESULTS: SSEP thresholds are slightly higher than behavioural, whose average difference was calculated as 23 dB. It is worth to note that this difference diminishes at high frequencies and hearing loss cases. CONCLUSIONS: SSEP to multiple frequencies technique is capable to determine auditory thresholds accurately, being closer to the behavioural value at high frequencies and high threshold values. It is necessary the establishment of exploration protocols to assure the highest accuracy of the system. In this work, a diagnostic algorithm has been proposed to reach better results by using SSEP.

[Arguments in favor of hearing loss screening programs]. / Argumentos en favor de programas de screening de hipoacusia.

In recent years criteria for the cochlear implant candidacy have been widened to childhood, therefore we are compelled to look for the earlier possible diagnosis of deafness. With this aim the AA. have reviewed the diagnostic process of hearing loss made during the last two decades and, consequently, be aware of the problems and planning solutions to avoid unnecesary delays in the treatment.

[Parapharyngeal abscess secondary to peritonsillar abscess in childhood]. / Absceso parafaríngeo secundario a un absceso periamigdalino en la infancia.

We report a case of parapharyngeal abscess in a five-years-old girl, secondary to a local extension of a peritonsillar abscess. The typical signs of peritonsillar abscess, medially displaced tonsil and displacement of the uvula toward the opposite side, were either less pronounced than usual. In this case, with parapharyngeal involvement, the treatment was abscess tonsillectomy under intravenous anti-.

[The acoustic distortion products application in noise pathology]. / Aplicación de los productos de distorsión acústica en la patología del ruido.

We study a total of 40 individuals exposed to noise in 3 forms of presentation: continuous (metal-workers), impact (hunters and policemen) and acute (bombs or fireworks). All them underwent a study with otoscopy, pure-tone audiometry, speech audiometry, tympanometry and recording of DP 2f1-f2 in the DPgram form. The results showed an early damage in DP (3 to 6 kHz). That are demonstrated by a decrease in recording in direct relation with increased audiometric threshold. Being obvious at 6 kHz among subjects exposed to continuous noise, though the smaller extent data are expressed in the records of 3 and 4 kHz, independently of noise form of exposure.

[Pathophysiological rationale for the use of piracetam in sudden deafness]. / Argumentación fisiopatológica al empleo de piracetam en la sordera brusca.

To determine if blood viscosity disorders affect the clinical course of idiopathic sudden deafness, we studied the usefulness of the rheoactive agent piracetam and prednisolone compared with steroid/vasodilator therapy. The piracetam group (n = 17) showed clinical improvement in 82.3% and a mean hearing gain in 54.1%, compared with 68.7% and 49.3%, respectively, for the group without piracetam (n = 6). In both groups, clinical severity correlated with increased whole blood viscosity and erythrocyte aggregability and filterability rates. On the seventh day after onset, all the viscosity parameters had returned to normal in the piracetam group, but the non-piracetam group still showed no improvement in whole blood viscosity and erythrocyte filterability. Piracetam seemed to be effective in this sensorineural deafness, probably as a result of its effect on the viscoelastic properties of blood. Measurement of these properties seven days after beginning therapy provides information about long-term potential for hearing recovery.

[Monitoring drug ototoxicity with distortion products]. / Monitorización de la ototoxicidad por fármacos con productos de distorsión.

Distortion products are currently considered an objective method for rapidly evaluating the functional status of the cochlea, which is interesting for the monitoring of drug ototoxicity. We studied 40 ears from patients who had received an ototoxic drug, tobramycin. Two consecutive measurements were made using distortion products 2f1-f2, before and after taking the ototoxic agent. A significant reduction was observed in the amplitudes of the DP-grams. At the same time, we evaluated the influence of previous hearing loss on the DP-grams and divided the patients into two groups: normal hearing and sensorineural hearing loss. Patients were evaluated at the same time by conventional audiometry to compare the effect of tobramycin on both tests. To conclude, tobramycin had little effect on audiometric thresholds, but produced an evident change in the amplitude of the distortion products.

[Radiological identification of the otic capsule in severe rickets]. / Identificación radiológica de la cápsula ótica en un caso de raquitismo severo.

We report the case of a patient with no otorhinolaryngologic symptoms who had an unusual radiological finding in the petrous bone secondary to congenital rickets. The impaired ossification of the rickets did not affect the compact bone of the otic capsule, making the bony labyrinth perfectly visible inside the temporal bone of osteoid substance.

[Clinical study on the ototoxicity of cisplatin with distortion products]. / Estudio clínico de la ototoxicidad del cisplatino con productos de distorsión.

Distortion products are an objective method of hearing assessment that provides a rapid way to evaluate the functional status of the cochlea, so they are interesting for monitoring drug ototoxicity. We studied 50 ears from patients who received an ototoxic drug, cisplatin. Two consecutive measurements were made using distortion products 2f1-f2, before and after taking the ototoxic agent. We observed a significant reduction in the amplitudes of the DP-grams. At the same time, we evaluated the influence of previous sensorineural hearing loss on DP-grams, dividing the patients into two groups: normal hearing and sensorineural hearing loss. All these patients were evaluated at the same time by conventional audiometry in order to compare the effect of cisplatin on both tests. We conclude that cisplatin produced little effect on audiometric thresholds and an evident effect on the amplitude of distortion products.

[Lipoperoxidation in otorrhea of the middle ear as a marker of infection. Clinical application]. / Lipoperoxidación en otorreas del oído medio como marcador de infección. Aplicación clínica.

If the generation of free oxygen radicals is a pathophysiological finding in middle-ear infections, as has been reported, demonstration of the oxidative consequences of free radicals in middle-ear exudates may be a quick, simple, objective and accessible test for quantifying the degree of mucosal injury. Therefore, samples of the discharge fluid from cases of acute otitis media (n = 17), cholesteatoma (n = 17), chronic discharge in the absence of cholesteatoma (n = 10), and secretory otitis media (n = 15) were tested using an enzymatic colorimetric assay for lipid peroxide levels due to superoxide and hydroxyl radicals during infection. Lipid peroxide levels in acute otitis media, cholesteatoma, and chronic discharge without cholesteatoma ranged from 575 to 650 nmol/mg of exudate, and was 67 nmol/mg in secretory otitis media, which were statistically significant findings. Infectious otitis media showed findings secondary to increased oxidative metabolism, but not secretory otitis media. Measurement of this oxidative metabolism could serve to monitor the evolution of episodes, as well as to detect relapse or reinfection, and to evaluate response to new therapeutic options for suppurative otitis, such as topical antioxidants.

[Auditory neuropathies in infants]. / Neuropatía auditiva en lactantes.

Auditory neuropathy is a sensorineural disorder characterized by absent or abnormal auditory evoked potentials, and normal cochlear outer hair cell function. It is believed that a variety of processes are involved in its pathophysiology and their influence on hearing can differ. We describe the diagnostic sequence and management of two new cases of auditory neuropathy in infants. The first case was a girl with no risk factors for hearing loss. Her absence of response to sounds was compared with her twin's reactions. Otoacoustic emissions were present but no auditory evoked potential response was detected. Her evolution was characteristic of deep sensorineural hearing loss without a hearing aid. At present she is awaiting a cochlear implant. The second case was a boy who underwent hearing loss screening for hyperbilirubinemia. Examinations were repeated three months later because the mother suspected hearing loss. Objective tests showed a pattern of auditory neuropathy. The boy's evolution was different: in spite of the presence of destructured auditory evoked potentials; it was evident that the boy conserved some hearing and had thresholds suggestive of moderate hearing loss.

[Head and neck lesions caused by systemic progressive ossifying fibrodysplasia (Munchmeyer's disease]. / Lesiones en cabeza y cuello por fibrodisplasia osificante progresiva sistémica (enfermedad de Munchmeyer).

Fibrodysplasia ossificans progressiva is a rare hereditary connective tissue disorder due to an unknown mutation conditioning the ossification of striated muscle and soft tissues frequently related to joints and stimulated by traumatisms or aggressive iatrogenic manouvres. It produces stiffness, pain, disability, swelling and fibro-osseus masses disseminated everywhere, with a very spectacular, invalidant and irreversible clinical picture. Affection of head and neck is unusual, excepting lesions in sternocleidomastoid or masticatiry muscles. We show a systemic case of fibrodysplasia osificans progressiva with enhanced clinical and radiological findings in cervical rhachis, pharynx and larynx, oral cavity, facial bones and ear. Association of biphophonates and steroids for a long period of time seems up to now stopping the evolution but not its regression.