An Overview on Research in a University Hospital, Using a Payback Framework Categorization Approach.

BACKGROUND AND OBJECTIVE: Little information is available on how to assess the impact of research studies conducted in government hospitals in Latin America and specifically in Mexico. We aimed to determine the returns on investment of the research projects that were carried out in the Hospital General "Dr. Manuel Gea Gonzalez" (HGMGG), a general university hospital located in Mexico City, using a categorization model. METHODS: We conducted a study including bibliometric analyses of publications associated with all research studies performed during the period 2016-2019 in the HGMGG and investigator interviews, according to the payback framework categorization model. RESULTS: All studies analyzed had a positive impact based on outcomes in 5 "payback categories": (1) knowledge; (2) research targeting, capacity building, and absorption; (3) policy and product development; (4) health benefits; and (5) broader economic benefits. CONCLUSIONS: To date, it has not been possible to establish a set of indicators that show the results of the investigations carried out by medical specialists in training, who carry out the bulk of medical care in general hospitals and in the National Institutes of Health in Mexico. We identified, in the 5 categories of the payback framework model, different areas of opportunity to improve the benefits of the hospital's medical services through the development of scientific research projects.

Rhino-Orbital mucormycosis in an immunocompetent pediatric patient with hyperglycemia of the hospitalized patient.

INTRODUCTION: Acute invasive rhino-orbital mucormycosis usually affects diabetic or neutropenic patients, and only exceptionally develops in immunocompetent adults and children. METHODOLOGY: A 12-years-old immunocompetent female, presented with complicated rhinosinusitis with a subperiosteal orbital abscess, without improvement after initial medical and surgical management, the patient also developed hyperglycemia of the hospitalized patient that represented a challenging and potentially lethal clinical scenario. RESULTS: Diagnosed with an unsuspected rhino-orbital mucormycosis by direct microscopy and PCR, she survived after amphotericin B and surgical treatment. CONCLUSIONS: In cases with torpid clinical evolution, even in apparently immunocompetent patients, appropriate multidisciplinary workup must be performed to rule out opportunistic etiologies including mucormycosis to improve survival.

Association between cycle threshold (Ct ) values and clinical and laboratory data in inpatients with COVID-19 and asymptomatic health workers.

In-house assays for the diagnosis of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) by quantitative reverse-transcription polymerase chain reaction (qRT-PCR), are feasible alternatives, particularly in developing countries. Cycle threshold (Ct ) values obtained by qRT-PCR were compared with clinical and laboratory data from saliva of inpatients with COVID-19 and asymptomatic health workers (AHW) were studied. Saliva specimens from 58 inpatients confirmed by qRT-PCR for SARS-CoV-2 using nasopharyngeal specimens, and 105 AHW were studied by qRT-PCR using three sets of primers for the N (N1, N2, and N3) gene of SARS-CoV-2, according to the CDC Diagnostic Panel protocol, showing a positivity of 88% for inpatients and 8% for AHW. Bivariate analysis revealed an association between Ct < 38.0 values for N2 and mechanical ventilation assistance among patients (p = .013). In addition, values of aspartate-transaminase, lactate dehydrogenase, and ferritin showed significant correlations with Ct values of N1 and N3 genes in inpatients. Therefore, our results show that Ct values correlate with some relevant clinical data for inpatients with COVID-19.

Cervical lymph node tuberculosis and TNF, IL8, IL10, IL12B and IFNG polymorphisms.

Cervical lymph node tuberculosis (LNTB) is the most common manifestation of extrapulmonary tuberculosis, resulting from the interaction of environmental and genetic factors. The immune response against TB is regulated by several cytokines, which have single nucleotide polymorphisms (SNPs), leading to different levels of expression. The aim of this study was to evaluate the association of LNTB with the TNF, IL8, IL10, IL12B and IFNG gene polymorphisms in Mexican patients. We investigated the association of ten SNPs in 14 patients with LNTB and 138 healthy controls. Significant differences were found for the allele TNF-238A (P=0.03) and the genotypes TNF-238GA (P=0.03), IL8+396GG (P=0.01) and IL12B+1188CC (P=0.04). Allele IL8+781C showed some association trend (P=0.08). Haplotypes TNF-AA and IL10-GTA were of susceptibility, whereas haplotype IL8-ATT was of protection. No association was found with IFNG. The association of these polymorphisms with extrapulmonary TB was compared in different populations. Our results suggest that these cytokine SNPs may influence the manifestation of LNTB in Mexican patients; however, we are aware of the limitations of our study, so it is necessary to make a replica using a larger sample of patients, as well as an increased number of cytokines with SNPs.

An Unexpected Case of Lagochilascariasis: Interdisciplinary Management and Use of 12S and 18S rDNA Analysis.

A Mexican 24-year-old male patient was referred to our hospital due to increased left retroauricular volume with skin fistulisation, resembling an infection by the uncommon worm Lagochilascaris minor. The patient was submitted to lateral skull base surgery. No adult worms or eggs were observed during light and scanning electron microscopy analysis, as well as by histopathologic examination of the small piece of removed tissue, only L3 stage larvae of Lagochilascaris spp. were identified. Polymerase chain reaction-sequencing assays were performed using primers for the mitochondrial 12S and the nuclear 18S rDNA gene. DNA of some L minor adults, previously identified, were used as control. The molecular analysis identified the worm as L minor. According to previous reports, lagochilascariasis is a complicated infection that requires an interdisciplinary management by different clinical specialists. This is the first time that 12S and 18S rDNA genes are reported as molecular markers for diagnosis of L minor.

Tympanic-mastoid and parotid schwannomas of the facial nerve: clinical presentation related to the anatomic site of origin.

Objective: To describe the clinical presentation of the facial nerve schwannomas according to the anatomical site of origin. Method: A retrospective study in which the clinical presentation, diagnostic protocol and treatment of facial nerve tumors in adults was evaluated. Results: We found 6 cases, 4 cases of tympanic-mastoid location at the spectrum of its possible clinical presentation: from symptomatic cases with facial paralysis, to an asymptomatic case in the tympanic portion found as intraoperative finding; and also found two cases located at the parotid gland, one with complete facial paralysis and one without facial palsy. Conclusions: For the diagnosis of intratemporal and parotid schwannomas of the facial nerve, a high clinical suspicion is required given its heterogeneous presentation; its clinical course depends on the segment of origin and expansion: more frequently asymptomatic at the tympanic horizontal portion and symptomatic at the mastoid vertical portion. These tumors must be assessed with imaging studies, incisional biopsy is not recommended. The treatment is surgical resection in symptomatic patients with facial paralysis greater than grade III of House-Brackmann, with immediate reconstruction of the nerve.

Objetivo: Describir la presentación clínica de los schwannomas del nervio facial de acuerdo con el sitio anatómico de origen. Método: Se realizó un estudio retrospectivo en el que se evaluó la presentación clínica, el protocolo diagnóstico y el tratamiento de tumores del nervio facial en adultos. Resultados: Se encontraron seis casos, cuatro de ellos de localización tímpano-mastoidea en los extremos de su posible presentación clínica: desde casos sintomáticos con parálisis facial, hasta un caso asintomático de la porción timpánica encontrado como hallazgo transoperatorio; y se encontraron dos casos de localización parotídea, uno con parálisis facial completa y otro sin parálisis facial. Conclusiones: Para el diagnóstico de tumores intratemporales y parotídeos del nervio facial se requiere una elevada sospecha clínica dado lo heterogéneo de su presentación; su curso clínico depende del segmento de origen y de su extensión: más frecuentemente son asintomáticos los de la porción timpánica y son sintomáticos los de la porción mastoidea. Estos tumores deben evaluarse con estudios de imagen; no se recomienda realizar biopsia incisional. El tratamiento es la resección quirúrgica en los casos sintomáticos con parálisis facial de grado IV o mayor de House-Brackmann, con reconstrucción inmediata del nervio.

Stenotrophomonas maltophilia: descripción de un agente altamente infeccioso / Stenotrophomonas maltophilia: description of a highly infectious agent

La Stenotrophomonas maltophilia es una bacteria oportunista que causa diversos tipos de infecciones asociadas con la atención sanitaria en pacientes debilitados, especialmente en aquellos que han recibido antimicrobianos de amplio espectro. La Stenotrophomonas maltophilia se posiciona hoy en día como un patógeno nosocomial de ámbito general, el cual se añade a otros multirresistentes como Staphylococcus aureus, Acinetobacter spp. y Pseudomonas aeruginosa. Presentamos este caso dado que es el primero que encontramos en nuestro servicio (el cual simula una infección recurrente por micobacterias) y con el objetivo de demostrar el protocolo utilizado para el diagnóstico y tratamiento. Este germen se reporta con poca frecuencia y todos los pacientes son inmunosuprimidos o con tratamiento antibiótico prolongado. Este agente infeccioso se debe considerar e incluir entre los diagnósticos diferenciales de conglomerados ganglionares abscedados. En pacientes con inmunosupresión sospechada o conocida es necesario descartar la presencia de microorganismos oportunistas, para poder proporcionarle un diagnóstico adecuado y un tratamiento específico.

Stenotrophomonas maltophilia is an opportunistic bacterium that can cause various types of infections associated with health care in debilitated patients, especially those who have previously received broad-spectrum antimicrobials. Stenotrophomonas maltophilia is positioned today as a nosocomial pathogen of general scope, such as adding other multiresistant Staphylococcus aureus, Acinetobacter spp. and Pseudomonas aeruginosa.We present this case because it is the first thing we find in our service (wich simulates a recurrent mycobacterial infection) and with the aim of demonstrating the protocol used in diagnosis and treatment. This germ is infrequently reported and all patients are immunosuppressed or with prolonged antibiotic treatment. This infectious agent should be considered and included in the differential diagnosis of lymph node abscessed conglomerates. In patients with suspected or known immunosuppression is necessary to rule out opportunistic organisms, to provide a proper diagnosis and specific treatment.

An absence of cilia outer microtubules, an etiology not previously recognized in bilateral mucocele.

Most paranasal sinus mucoceles are unilateral and affect one or at most two contiguous sinuses. We describe the case of a 44-year-old woman with bilateral maxillary sinus mucoceles who presented clinically with left malar pain, right-sided swelling, and proptosis of the right eye. The diagnostic workup included computed tomography and magnetic resonance imaging. In addition, because of the atypical bilateral presentation, we analyzed mucosal sinonasal tissue samples by electron microscopy. Microscopic analysis revealed an absence of one of the microtubule doublets in three of the outer doublets of the axoneme, thereby establishing a diagnosis of isolated ciliary dysfunction. To the best of our knowledge, ciliary dysfunction as a cause of bilateral mucoceles has not been previously reported in the literature. The patient underwent successful surgery for removal of the mucoceles, and she exhibited no evidence of recurrence at the 18-month follow-up. When a diagnosis of bilateral mucocele formation is made, we suggest that ciliary dysfunction be considered in the differential diagnosis and that electron microscopy of the sinonasal mucosa be performed in the workup.

Noma and Noma-like disease in HIV/AIDS patients, a comorbid interaction: A systematic review.

INTRODUCTION: Noma is an opportunistic polymicrobial infection that cause necrosis of the mouth and face, with high morbidity and mortality, predominantly affecting malnourished children and persons with debilitating diseases. Cases of noma-like disease in adults, although rare, have been increasingly reported in HIV/AIDS patients particularly in developing countries but also in more developed countries. METHODOLOGY: A systematic review of the literature to assess the occurrence and clinical impact of noma and noma-like disease in HIV/AIDS patients was performed on PubMed, Virtual Health Library, Cochrane Library and Google Scholar using the keywords "HIV"[ All Fields] AND "Noma"[All Fields] in December 2016 (years includead for the search: 1985 to 2016). RESULTS: Twenty-four published studies were identified that document the occurrence of noma or noma-like disease in a total of 133 HIV/AIDS children and adult patients in the last 22 years. Although HIV infection is not the principal risk factor for noma, in some regions may play a substantial role in its pathogenesis. The mortality rate for noma-like disease in HIV/AIDS patients was 54.3%, compared to the 15% mortality rate of treated noma patients without HIV/AIDS. Most of the cases have never been on antiretroviral therapy, and their HIV infection was discovered because of the noma-like disease. CONCLUSIONS: The syndemic interaction between HIV/AIDS and noma-like disease adversely impacts the severity of the disease and the mortality rate. Noma-like disease, although not yet considered a specific or frequent disease associated with HIV infection, should be considered as an opportunistic infection for AIDS.

Paragangliomas laríngeos Comparación de su abordaje por faringotomía lateral y por laringofisura en dos casos / Laryngeal paragangliomas Comparing their approach by lateral pharyngotomy and laryngofissure in two cases

Los paragangliomas son las neoplasias vasculares benignas más comunes del cuello. Surgen de células paragangliónicas extraadrenales derivadas de la cresta neural. El 90% se presentan en el tejido adrenal y 10% en tejidos extraadrenales de los cuales el 85% son abdominales, 12% torácicos y 3% en cabeza y cuello. El sitio más común de presentación es el cuerpo carotídeo, seguido por yugulotimpánicos y vagales. Otros sitios infrecuentes incluyen laringe, cavidad nasal, órbita, tráquea, cuerpo aórtico y mediastino. Se presentan los casos de dos pacientes con paragangliomas laríngeos en quienes se realizó faringotomía lateral y laringofisura, para connotar la importancia de tener presentes los diagnósticos diferenciales ante el hallazgo de una masa supraglótica y plantear un flujograma diagnóstico y terapéutico. Aunque con ambos abordajes se logra la remoción completa, son comunes las complicaciones postoperatorias; la faringotomía lateral es técnicamente más difícil y las complicaciones potenciales son más serias que con laringofisura.

Paragangliomas are the most common type of benign vascular tumors of the neck. Extraadrenal paraganglionicas arise from cells derived from the neural crest. 90% occur in the adrenal tissue and 10% in extra-adrenal tissues of which 85% are abdominal, thoracic 12% and 3% in head and neck. The most common site is the carotid body, followed by yugulotimpánicos and vagal. Other rare sites include the larynx, nasal cavity, orbit, trachea, mediastinum and aortic body. We present the cases of two patients with laryngeal paragangliomas who underwent to pharyngotomy and laryngofi ssure; in order to connote the importance of differential diagnoses present before a fi nding of a supraglottic mass and pose diagnostic and therapeutic fl owchart. Although both approaches allows the complete removal of the mass; postoperative complications are common; pharyngotomy approach is technically more diffi cult and potential complications are more serious than laryngofi ssure.

[Rhino-Orbital Mucormycosis. Cohort study of its treatment according disease extent and reversion of its pathophysiology]. / Mucormicosis rinoorbitaria. Estudio de cohorte de su tratamiento de acuerdo a la extensión de la enfermedad y reversión de su fisiopatología.

Mucormycosis is a lethal opportunistic fungal infection, described mostly in immunocompromised patients. A comparative cohort study was conducted to compare the evolution of the study group patients with rhino-orbital mucormycosis, in which a therapeutic protocol was instituted, in which the pterygomaxillary fossa is systematically surgically approached and orbital exenteration is performed or not based on the spreading of the infection to the orbital apex or the orbital fissure, with a historical group where these criteria were not applied. Fifteen cases were included, eight in historic group A and seven in the study group B. Medical treatment was provided with control of the underlying disease (amphotericin B and low molecular weight heparin) as well as surgical treatment with extensive debridement including endoscopic ethmoidectomy and exploration of the pterygomaxillary fossa, also performing orbital exenteration only in patients who presented orbital apex syndrome in group B. In group A, there was a mortality rate of 50%, in group B all patients were clinical cured; however, the two patients with hematologic diseases died of complications not related to the fungal infection. With the standardization of a diagnostic and therapeutic protocol, good results in healing and survival of patients can be obtained.

Myopericytoma arising adjacent to the common carotid artery: Case report and systematic review of deep located neck myopericytomas.

BACKGROUND: Myopericytoma is a perivascular tumor of the skin and subcutaneous tissue of the extremities, it is a rare finding in the head and neck, and even rarer is its deep location. METHODS: A 38-year-old woman presented with a slowly growing mass at the right carotid triangle. Contrast-enhanced CT scan revealed a moderately enhancing mass. At surgery, the tumor was firmly attached to the common carotid artery, making it necessary to excise a small portion of the vessel wall. RESULTS: The histopathologic report was myopericytoma. The postoperative course was uneventful, without tumor recurrence. CONCLUSION: The very few deep located myopericytomas at the head and neck region show a predilection to appear near the great neck vessels with a possibility to require vascular repair, or at the parotid space where they can be multicentric. © 2016 Wiley Periodicals, Inc. Head Neck 38: E2479-E2482, 2016.

Descending necrotizing mediastinitis: Systematic review on its treatment in the last 6 years, 75 years after its description.

BACKGROUND: Descending necrotizing mediastinitis is a serious infection involving the neck and the chest, in which an odontogenic, pharyngeal, or cervical infection spreads rapidly to the thoracic cavity, with a high death rate by sepsis and organic failure if not treated quickly and properly. METHODS: A systematic search in the electronic database PubMed was conducted using the keywords "mediastinitis" and "descending necrotizing mediastinitis" resulting in 2560 items, filters were activated (systematic review, meta-analysis, and clinical trial) resulting in 60 articles, from which we selected relevant articles on the topic. RESULTS: The best available evidence we could obtain was from 26 case series with evidence level III. The overall mortality in this period was 17.5%. CONCLUSION: For mediastinitis limited to the upper part of the mediastinum, transcervical drainage may be sufficient; cases that extended below the tracheal carina may require cervical and transthoracic drainage. A multidisciplinary therapeutic approach has allowed a reduction in its mortality. © 2016 Wiley Periodicals, Inc. Head Neck 38: E2275-E2283, 2016.

Myocutaneous sternocleidomastoid flap for reconstruction after the resection of a parapharyngeal heterotopic glioma in a child with cleft palate, and systematic review of parapharyngeal glial heterotopia.

We describe the surgery and reconstruction employed with a sternocleidomastoid myocutaneous flap for the treatment of a heterotopic glioma in a 2-year-old boy with incomplete palatal fissure who presented with dysphagia and snoring, in whom a lateral pharyngeal wall mass obstructing 60% of the airway was noted. Heterotopic gliomas are uncommonly reported in the parapharyngeal space and should be included in the differential diagnosis at this location in children. Parapharyngeal tumors present difficult diagnostic and management challenges; head and neck surgeons must be prepared not only for the resection but also for the reconstruction of these rare lesions.

Rhino-orbito-cerebral mucormycosis. Management strategies to avoid or limit intracraneal affection and improve survival.

Mucormycosis is a rare opportunistic infection. The aim of the study was to review the cases presented in our department with rhino-orbital mucormycosis and to describe the clinical protocol, diagnosis and therapy used in these patients. We conducted a retrospective, longitudinal, descriptive study, in which we evaluated the records of patients with rhino-orbital mucormycosis in the period from January to October 2013. We found 5 cases. Pterigomaxillary fossa disease was found in 100% of our patients. Medical and surgical treatment performed early by extensive endoscopic debridement (including debridement and resection of pterygomaxillary fossa) and orbital exenteration in patients presenting with orbitary apex syndrome in conjunction with the ophthalmology department of our hospital, with excellent results in the survival of our patients (all patients survived).

Difference between early clinical features of swine origin A H1N1 influenza confirmed and not confirmed infection in Mexico.

INTRODUCTION: The Swine Origin A H1N1 Influenza Virus (SOIV) pandemic emerged in April 2009 affecting people and health-care systems worldwide. This study examined the differences among the early clinical features presented in confirmed SOIV cases, those who tested negative for SOIV infection, fatalities, and hospitalized cases. METHODOLOGY: We reviewed 1,024 initial medical records of patients presenting with acute respiratory symptoms who attended the respiratory emergency room of a general hospital in Mexico and had a confirmatory test for influenza AH1N1 by RT-PCR from April to December 2009. RESULTS: Out of 1,024 cases, 457 (44%) were men with a mean age of 31±17 years; however, of these, SOIV confirmed cases were younger (26±8, p=0.000). SOIV infection was confirmed in 36% of the patients. Most (%?) cases presented mild infection, 20% of the patients required hospitalization, and 0.09% patients died. Asthma was more frequent in confirmed cases (p=0.028). Presence of COPD, systemic arterial hypertension, and diabetes mellitus was significant in confirmed hospitalized cases. Pulmonary rales, wheezing, and sudden symptom onset were more frequent and statistically significant in confirmed patients. Influenza-like illness was more frequent in confirmed cases (p=0.049).  CONCLUSIONS: This study presents one of the largest series of the new SOIV infection confirmed by RT-PCR reported. This infection is frequently mild and affects mainly young adults. Sudden symptoms onset, pulmonary rales, and wheezing are early features of this infection. Asthma, COPD, systemic arterial hypertension, and diabetes mellitus should be identified to identify potentially severe and fatal cases. ILI helps distinguish SOIV infection.

[Histology of submandibular gland tumours, 10 years' experience]. / Histología de tumores de glándulas submandibulares. Experiencia de 10 años.

INTRODUCTION AND OBJECTIVES: There are few reports focused on neoplasms in the submandibular gland because they are uncommon and are frequently grouped with the other salivary glands tumours. In the classical studies, the proportion of malignancy reported in these cases is around 50%. OBJECTIVES: Determining the proportion of malignancy, the most frequent histological types, the gender distribution and average age at diagnosis in patients with submandibular gland neoplasms who were treated in our hospital from 2000 year to 2010. METHODS: A retrospective review of our department database of the patients who underwent surgery for submandibular gland neoplasm in a ten-year period was performed. RESULTS: Twenty-two patient records were included, in which 19 (86%) patients presented benign disease and 3 were of a malignant type (adenocarcinoma, well-differentiated epidermoid carcinoma, follicular lymphoma). Two of the 3 cases of malignant neoplasms were in men. CONCLUSIONS: A greater proportion of benign neoplasm was found in submandibular tumours. The most frequent benign tumour is the pleomorphic adenoma. Women are more commonly affected (76%). Benign tumours appear in younger patients than do malignant ones.

[The role of electromyography in cases of vocal cord paralysis]. / El papel de la electromiografía laríngea en la parálisis de cuerda vocal.

BACKGROUND: Several pathologies can involve muscles that control vocal folds. The abnormality can affect peripheral nerves or central nervous system centers. Clinically, muscle function can be assessed by observing the movement of structures themselves or by recording electrical activity of these muscles using (electromyography-EMG). Since EMG is an invasive technique, its use is not very widespread in the diagnosis and management of voice disorders, Laryngeal EMG can be helpful in those patients with voice problems of suspected neurological or neuromuscular etiology. OBJECTIVE: Assess the role of laryngeal EMG in the clinical evaluation of unilateral vocal cord immobility. METHODS: Twenty-five patients with unilateral vocal cord paralysis were studied. Twenty-five patients with unilateral arytenoid dislocation were studied as controls. The sensitivity and specificity of the EMG as a diagnostic marker for vocal fold paralysis were obtained. RESULTS: Laryngeal EMG showed a 100% sensitivity and 92% specificity. Only two patients displaying arytenoid dislocation displayed abnormal EMG recordings. CONCLUSIONS: EMG constitutes a safe and reliable tool to aid the evaluation of patients with vocal fold immobility. EMG recordings were helpful in differentiating vocal cord paralysis from arytenoid dislocation. Moreover, EMG can provide useful data regarding denervation and reinnervation of laryngeal muscles. Aside from its diagnostic usefulness, serial EMG can help to monitor recovery and establish a reliable prognosis. Hence, an adequate treatment plan can be determined.

El papel de la electromiografía laríngea en la parálisis de cuerda vocal / The role of electromyography in cases of vocal cord paralysis

Antecedentes: Existen patologías que pueden involucrar a los músculos que controlan la movilidad de las cuerdas vocales, por afección de la función periférica o del sistema nervioso central. La función muscular puede evaluarse mediante observación directa de la laringe o por electromiografía (EMG), la cual por ser invasiva ha tenido un uso limitado en el diagnóstico y manejo de los trastornos de la voz. Objetivo: El propósito de este estudio fue evaluar la utilidad de la EMG laríngea en la evaluación de la parálisis cordal unilateral. Métodos: Se estudiaron 25 sujetos con parálisis cordal y 25 controles con dislocación unilateral del aritenoides. Se obtuvieron los valores de sensibilidad y especificidad de la EMG como prueba diagnóstica. Resultados: La EMG mostró sensibilidad de 100% y especificidad de 92%. Solo dos pacientes con dislocación de aritenoides mostraron anormalidades en la EMG. Conclusiones: La EMG parece una prueba confiable y segura para complementar la evaluación de alteraciones de la movilidad de una cuerda vocal y diferenciar parálisis cordal de dislocación de aritenoides. Puede proveer evidencia de la denervación muscular y la reinervación, y los datos en serie pueden contribuir a establecer un pronóstico más confiable para delinear un plan de tratamiento adecuado a cada caso.

BACKGROUND: Several pathologies can involve muscles that control vocal folds. The abnormality can affect peripheral nerves or central nervous system centers. Clinically, muscle function can be assessed by observing the movement of structures themselves or by recording electrical activity of these muscles using (electromyography-EMG). Since EMG is an invasive technique, its use is not very widespread in the diagnosis and management of voice disorders, Laryngeal EMG can be helpful in those patients with voice problems of suspected neurological or neuromuscular etiology. OBJECTIVE: Assess the role of laryngeal EMG in the clinical evaluation of unilateral vocal cord immobility. METHODS: Twenty-five patients with unilateral vocal cord paralysis were studied. Twenty-five patients with unilateral arytenoid dislocation were studied as controls. The sensitivity and specificity of the EMG as a diagnostic marker for vocal fold paralysis were obtained. RESULTS: Laryngeal EMG showed a 100% sensitivity and 92% specificity. Only two patients displaying arytenoid dislocation displayed abnormal EMG recordings. CONCLUSIONS: EMG constitutes a safe and reliable tool to aid the evaluation of patients with vocal fold immobility. EMG recordings were helpful in differentiating vocal cord paralysis from arytenoid dislocation. Moreover, EMG can provide useful data regarding denervation and reinnervation of laryngeal muscles. Aside from its diagnostic usefulness, serial EMG can help to monitor recovery and establish a reliable prognosis. Hence, an adequate treatment plan can be determined.