[Goya, his deafness and his time]. / Goya, su sordera y su tiempo.

We have made a bibliographyc review of the most important otology books from the end of the XVIII to the begining of the XIX century. We propose several hipothesis of the diagnoses and treatment of Goya's deafness in relation to the contemporary otological advances.

[Cochlear implants using the Ultracision harmonic scalpel]. / Implantación coclear con bisturí armónico Ultracision.

We have evaluated the utility, indications and disadvantages of the Ultracision harmonic scalpel, in the cochlear implants, and his advantages compare to other electrocoagulation's systems. These aspects were evaluated in 50 cases of cochlear implants, made along the last years. We concluded that the Ultracision harmonic scalpel is indicated, mainly, in the otology field, in these situations in wich the cochlear implant is in the cochlea, and is mandatory the use of an electrocoagulation system. In this situation, the Ultracision harmonic scalpel was quick, safe and sure, and with many advantages, over the traditional scalpel and the bipolar diathermy.

[Fiber endoscopy of the nasopharynx: its indications]. / La fibroendoscopia del cavum: sus indicaciones.

The AA have planned a series of indications regarding the endoscopy of the nasoopharynx. Among 631 explorations done in a three-year term, normal findings were seen in 260 subjects. In the other cases several aspects of the inflammatory or neoplastic pathology could be verified. One individual showed an esthesioneuroblastoma in an early evolutive stage.

[The influence of hypercholesterolemia and noise on human auditory function]. / Influencia de la hipercolesterolemia y el ruido en la audición humana.

A cross-sectional study on occupational noise exposure and hypercholesterolemia was conducted in a group of 1.209 workers exposed to industrial noise. Clinical examinations and audiograms were compared in exposed and not exposed subjects to noise. There was a strong relationship between severe noise induced hearing loss and hypercholesterolemia in all de workers. But the relationship was not convincing when the workers were considered stratified in groups of age, because the number of hard of hearing labourers with high levels of cholesterol, increases as they get older. The AA, support the point of view that the age is an important confounding factor, and in their study there is no relation between noise induced hearing loss and hypercholesterolemia.

[Diagnostic role of the biopsy in angiofibroma of the cavum]. / Papel diagnóstico de la biopsia en el angiofibroma de cavum.

The AA. inform about the case of a child, 13, with an antro-choanal Polyp of angiofibromatous structure, diagnosed as Angiofibroma. Though in the greater number of instances the arteriography is enough to support the suspicion, the confirmation through histopathology is compulsory.

[Congenital absence of major salivary glands]. / Ausencia congénita de glándulas salivares mayores.

Congenital absence of major salivary glands is infrequent, with only a few cases in the world medical literature. We found 30 documented cases in a bibliographic search. We report a case of total agenesia of the parotid gland diagnosed in the course of a study motivated by symptoms of facial pain and the temporomandibular joint. Agenesia of a major salivary gland (specially the partial ones) usually develops with no manifestation that motivates the patient to seek treatment. Parotid aplasia can be an isolated finding or associated with the absence of other glands or with abnormalities such as aplasia of the lacrimal gland, mandibulofacial dysostosis, and ectodermic dysplasia.

[Homotransplants in cervical trachea: clinical and histopathologic results]. / Homotrasplantes en tráquea cervical: resultados clínicos e histopatológicos.

An experimental study about homotransplant of cervical trachea in Wistar rats is presented. Surgical approachment consists in excision of 7 or 9 tracheal rings and their posterior end-to-end anastomosis. The animals are divided in two groups. In the first one an homotransplant of cervical trachea is practised and compared with the second one as control group. Clinical and histopathological results are similar in both groups. Our findings are also discussed, comparing with other authors.

[Results of tracheal reconstructive surgery using homografts preserved in formaldehyde]. / Resultados de la cirugía reconstructiva traqueal mediante homotransplantes conservados en formaldehido.

The present study was designed to investigate the results of homograft of cervical trachea preserved in formaldehyde. Surgical approach consists in end-to-end anastomosis. In all our cases the graft was rejected, and the animals could only live 13 days as a maximum. We find tracheal mucosa is responsible for graft antigens. The results both clinical and histopathological are compared with a control group and with those obtained by other authors using different conservation methods.

[Indices of biomedical bibliography in otolaryngology]. / Repertorios de bibliografía biomédica en otorrinolaringología.

Since 19th century the trends to medical specialization produced an increase of otorhinolaryngological publications. Due to the impossibility for the otorhinolaryngologist to gather all the medical literature, indexes and medical bibliographies have become an essential tool to physicians and medical investigators, helping them to select relevant literature. In the present work we describe the most interesting indexes of biomedical bibliography for the otorhinolaryngologist. Also, we give a list of the seventy most prestigious otorhinolaryngological journals in the world and the repertories in which they are included.

[Effectiveness of tonsillectomy, evaluated by acoustic rhinometry]. / Eficacia de la adenoidectomía evaluada mediante rinometría acústica.

Hypertrophy adenoid commonest cause of nasal obstruction in paediatrics. The morbility can be try alteration in the respiratory physiology, as well as in the face development and function of the middle ear. We used the acoustic rhinometry to evaluate the surgical results of the adenoidectomy in children with hypertrophy adenoid, compiling the data on their clinic, and correlating them as well with the rhinometric results. The acoustic rhinometry is a relatively new method of exploration of the nasal cavity. We obtain space measures that are going to allow to us to prove it. These measures are the cross-sectional areas and volumes registered in the nasal cavity when this cavity is divided longitudinally in two zones, the previous one until 32 mm measured from the narina, and the later one to 64 mm from the same point. For this study we have taken 45 patients with hypertrophied adenoids. We have made measurements pre and post surgery. Our results show a clear gain in areas as in volumes after surgery and also show the utility of the acoustic rhinometry like method of exploration at the time of quantifying the morphometric alterations of the nasal cavity.

[Selective therapeutic embolization in intractable epistaxis]. / Embolización selectiva terapéutica en epistaxis incoercibles.

Epistaxis is a common otolaryngologic emergency that is controlled frequently with conservative measures. On the other hand, more aggressive treatments are required in refractory or severe epistaxis, which may have systematical impact. About intractable posterior epistaxis, selective embolization of external carotid territory is an effective option for managing. Three patients with severe epistaxis successfully treated with selective embolization and a review of literature are exposed.

[Interaction between hypertriglyceridemia and noise in human hearing]. / Interacción de la hipertrigliceridemia y el ruido en la audición humana.

We carry out a cross-sectional study on 1205 workers exposed to industrial noise. After the clinical, analytical and audiological examination, we can't demonstrate any influence of hypertriglyceridemia on noise induced hearing loss. We get a statistically significant relationship between noise and hearing loss only in the group of workers with normotriglyceridemia.

[Interaction of arterial blood pressure and industrial noise on human hearing]. / Interacción de la tensión arterial y el ruido industrial sobre la audición humana.

A cross-sectional study of occupational noise exposure and high blood pressure was conducted in a group of 1584 workers. Clinical examination, audiograms, and body mass index were compared in exposed and not to noise finding a strong relationship between severe noise induced hearing loss and high blood pressure in all the staff, as it has been marked by different authors. But when we stratify the population in groups of age, we can't find any influence between noise exposure and hypertension, or between the appearing of high blood pressure and noise induced hearing loss.

[Changes in the middle ear mucosa of the Wistar rat after experimental resection and obstruction of the eustachian tube]. / Modificaciones en la mucosa del oído medio de la rata Wistar tras sección y obstrucción experimental de la trompa de Eustaquio.

Eustachian tube (ET) disfunction, alone or combined with other factors, is the main source of middle ear pathogenesis and can lead to other physiopathological events that originate disease (serous otitis media, adhesive otitis, cholesteatoma). In seven Wistar rats (study group), experimental mechanical obstruction of the left Eustachian tube was performed. Using an anterior cervical incision, the osteocartilaginous junction of the ET was severed and obliterated with a bit of muscle in order to prevent rechanneling. After a period of six months, the middle ear mucosa was removed for histological study. Comparisons were made of the experimental ear and the opposite ear, as well as the ears of three rats in the control group. We compared our findings with those of other authors and reviewed experimental animal models of serous otitis media and cholesteatoma that have been used to study the influence of ET in middle ear disease.

[Invasive giant prolactinoma]. / Prolactinoma invasivo gigante.

Large prolactin-secreting tumors are rare and their endocrinological and surgical management may be complex. We report the case of a patient with a prolonged history of unilateral tinnitus and sensation of a stopped-up ear who had a very large, invasive and aggressive tumor of the sphenoidal region with bone destruction, invasion of structures in every direction from the sellar region and extracranial extension to the ethmoid and nasopharynx. Serum prolactin level at the time of diagnosis was 16,860 ng/ml (normal: 3-17 ng/ml). Medical treatment with bromocriptine reduced the prolactin level to 31 ng/ml and reduced the size of the tumor, although less than expected. The literature is reviewed and the rarity of such large, invasive prolactinomas is highlighted, as well as the absence of symptoms and signs suggesting the presence of such a large tumor of the skull base.

[Middle ear carcinoma]. / Carcinoma de oído medio.

Middle-ear cancer represents 5 to 10% of all ear neoplasms. Risk factors include chronic suppurative pathology of the middle ear and prior irradiation. Most malignant tumors are squamous-cell carcinomas. We report the case of a 51-year-old woman with this process. The ideal treatment is mastoidectomy or pterosectomy followed by radiotherapy. We made a bibliographic review of the clinical manifestations, diagnosis, treatment, and prognosis of middle-ear cancer. Five-year survival rates range from 25 to 50% in patients who undergo surgery and radiotherapy.

[Immunohistochemical expression of P53 suppressor genes and retinoblastoma in laryngeal carcinoma]. / Expresión inmunohistoquímica de genes supresores p53 y retinoblastoma en el carcinoma de laringe.

Carcinoma of the larynx is responsible for 1% of all tumors and for 25% of oncologic disease of the head and neck. Tumor suppressor genes control cell proliferation by suppressing specific mechanisms that stimulate the proliferative response. Rb and p53, both nuclear, are the most studied tumor suppressor genes. We evaluated the immunoexpression of these markers in 72 carcinomas of the larynx and correlated it with patients' clinical parameters: age, sex, occupation, tobacco and alcohol use, marital status, etc. Biological and anatomopathological parameters (tumor stage, histological type, degree of local invasion, and lymph node metastases) also were studied. Statistically significant differences were found in mean immunostaining for the Rb gene with respect to histological grade, lymph node enlargement, and smoking. We observed no positive correlation between p53 and the classic clinical-pathological parameters, although important trends were evident, as well as relatively frequent immunostaining (about 40%) of the total neoplastic population.

[Study of bcl-2 oncogene in squamous-cell carcinoma of the larynx]. / Estudio del oncogén Bcl-2 en el carcinoma escamoso de laringe.

Apoptosis is a special type of programmed cell death that occurs in the embryonic period, in normal adult tissues, and in several pathological situations. The Bcl-2 gene (B-cell leukemia/lymphoma) is the first member of an oncogene family whose main function is to increase cell survival and inhibit apoptosis, thus participating in the carcinogenic process. This relationship motivated our study of antiapoptosis through the immunohistochemical expression of Bcl-2 oncogene in 72 patients with cancer of the larynx who underwent surgery in our department. The correlation between immunohistochemical expression and clinical factors was analyzed: age, sex, work, smoking and drinking history, marital status, etc., as well as other known biological and histopathological prognostic factors (tumoral stage, histological grade, neck metastases, and local invasion). Bcl-2 expression showed a statistically significant correlation with histological grade and regional lymph node involvement, but no correlation with the other parameters studied.

[Olfactory esthesioneuroblastoma. Review of seven cases]. / Estesioneuroblastoma olfatorio. Revisión de siete casos.

Esthesioneuroblastomas are fairly rare malignant tumors: only 20 cases have been reported in Spanish records. It is locally aggressive and produces late recurrences. There is no such thing as a universally accepted treatment model. We describe our experience with 7 cases seen in our hospital from 1980 to 1996. A or B stages can be treated with irradiation, surgery or a combination of both. C stages with the most aggressive tendencies may require the combined use of preoperative irradiation, surgery and chemotherapy. We analyzed the forms of presentation, diagnosis, differential diagnosis, treatment, prognosis, and survival. The 5-year survival rate was 75, 60 and 41% for stages A, B and C, respectively.

[ENT outpatient surgery]. / Cirugía ambulatoria en ORL.

The number of patients who undergo outpatient surgery is constantly growing in Spain. Outpatient surgery is interesting not only because of its economy, but also the social benefits that derive from patients returning home sooner and the rapid reduction of the waiting list. We discuss our experience in the last year with 40 patients who underwent surgery. We made a comparative study of patients with the same pathology and anesthetic risk who were treated by outpatient surgery and those treated by inpatient surgery with a traditional technique who were admitted 24 hours before surgery. Our rate of complications (19%) was close to the traditional rate. However, 3, 927, 000 pesetas were saved and the patients were very satisfied, which encouraged us to continue. Indications and complications are discussed.