ABSTRACT
INTRODUCTION: We present a prospective study with the aim of assessing the differences found between position-triggered vertiginous syndromes, those diagnosed as benign paroxysmal positional vertigos (BPPV) in primary care and non-specific clinics, and those classified as BPPV at an otoneurology unit. PATIENTS AND METHOD: Over a 17 month period, 432 consecutive patients were included after evaluation at a otoneurology unit receiving all referrals for vestibular pathologies. The existence of trigger factors was investigated, as was the distribution of the diagnoses associated with a positional trigger. The characteristics of the patients with a final diagnosis of BPPV were also studied. RESULTS: Of this population, 217 patients (50.23%) reported a positional change as the trigger for their symptoms, 106 (24.53%) were referred from their initial care centres with a diagnosis of BPPV, and 128 (29.62%) were classified as truly BPPV. The coincidence between the preliminary diagnosis and the definitive one was 52.8%. A history of positional paroxysmal vertigo during seconds was linked to BPPV in 78% of cases. Only in 4.7% of the BPPV cases diagnosed at the otoneurology unit had provoking manoeuvres been performed. CONCLUSIONS: We have found that an adequate anamnesis is capable of providing accurate guidance for diagnostic purposes in most cases of BPPV, but the performance of provoking manoeuvres and the correct specific treatment for this pathology is of paramount importance when classifying a patient with suspected BPPV.
Subject(s)
Vertigo/diagnosis , Vertigo/physiopathology , Diagnosis, Differential , Female , Humans , Male , Middle Aged , Prospective Studies , Risk Factors , Vertigo/etiologyABSTRACT
Introducción: Presentamos un estudio prospectivo para valorar las diferencias encontradas entre los síndromes vertiginosos de desencadenante posicional, los cuadros diagnosticados como vértigo posicional paroxístico benigno (VPPB) por médicos de atención primaria y consultas no específicas, y los diagnosticados de VPPB en una unidad de otoneurología. Pacientes y método: Se estudió a 432 pacientes atendidos de forma consecutiva durante 17 meses en una unidad de otoneurología que recibe a todos los pacientes derivados al servicio de otorrinolaringología por afección vestibular. Se investigó si había factores desencadenantes y se valoró la distribución de los diagnósticos relacionados con un desencadenante posicional. También se estudió las características de los pacientes con diagnóstico final de VPPB. Resultados: Referían síntomas desencadenados por los cambios de posición 217 (50,23 %) pacientes; 106 (24,53 %) fueron remitidos con diagnóstico de VPPB establecido en sus centros de referencia, y 128 (29,62 %) resultaron ser VPPB realmente. La coincidencia entre el diagnóstico de derivación y el definitivo fue del 52,8 %. La historia clínica de vértigo posicional paroxístico de segundos de duración coincidió con el diagnóstico de VPPB en el 78 % de los casos. Solamente en el 4,7 % de los VPPB diagnosticados en la unidad de otoneurología se habían realizado maniobras de provocación antes de la derivación. Conclusiones: El adecuado interrogatorio del paciente puede aportar una orientación diagnóstica precisa en la mayor parte de los casos de VPPB, aunque la realización de maniobras de provocación y tratamientos adecuados y específicos para esta afección es de vital importancia para la correcta clasificación de los pacientes con sospecha de este cuadro
Introduction: We present a prospective study with the aim of assessing the differences found between position-triggered vertiginous syndromes, those diagnosed as benign paroxysmal positional vertigos (BPPV) in primary care and non-specific clinics, and those classified as BPPV at an otoneurology unit. Patients and method: Over a 17 month period, 432 consecutive patients were included after evaluation at a otoneurology unit receiving all referrals for vestibular pathologies. The existence of trigger factors was investigated, as was the distribution of the diagnoses associated with a positional trigger. The characteristics of the patients with a final diagnosis of BPPV were also studied. Results: Of this population, 217 patients (50.23 %) reported a positional change as the trigger for their symptoms, 106 (24.53 %) were referred from their initial care centres with a diagnosis of BPPV, and 128 (29.62 %) were classified as truly BPPV. The coincidence between the preliminary diagnosis and the definitive one was 52.8 %. A history of positional paroxysmal vertigo during seconds was linked to BPPV in 78 % of cases. Only in 4.7 % of the BPPV cases diagnosed at the otoneurology unit had provoking manoeuvres been performed. Conclusions: We have found that an adequate anamnesis is capable of providing accurate guidance for diagnostic purposes in most cases of BPPV, but the performance of provoking manoeuvres and the correct specific treatment for this pathology is of paramount importance when classifying a patient with suspected BPPV
Subject(s)
Humans , Female , Male , Middle Aged , Vertigo/physiopathology , Modalities, Position , Vertigo/diagnosis , Prospective Studies , Dizziness/diagnosis , Dizziness/physiopathology , Syncope/diagnosisABSTRACT
OBJECTIVES: We present a prospective study assessing the real incidence, aetiology, and evolution of vocal impairment following total thyroidectomy. PATIENTS AND METHOD: Sixty-six patients who underwent total thyroidectomy between 2003 and 2006 were included, recording demographic and analytic variables, with emphasis on subjective vocal changes observed after surgery, measured by means of the GRABS scale. A control group of 25 patients operated under general anaesthesia and oro-tracheal intubation was chosen using random sampling. RESULTS: In 30 patients (45.5 %), post-operative dysphonia was observed. Among these, only 2 (3 %) were permanent, and 11 were due to nerve damage (10 inferior and 1 superior laryngeal nerves). In 8 patients (12.2 %), GRABS score was above 5. In the rest of these 30 patients, the complaint was a single decreased tone (10 cases), lack of intensity (9 cases) and vocal fatigue (3 cases), always with a GRABS score equal to or less than 2 points. The most significantly related factor with the onset of dysphonia was the section of strap muscles (OR=12.5). CONCLUSIONS: Dysphonia is a common complication of total thyroidectomy, but its incidence is not always related to nerve injury. Some technical (and sometimes avoidable) factors, such as the section of prelaryngeal muscles, could have an important relationship with this adverse event.
Subject(s)
Health Status , Postoperative Complications , Voice Disorders/etiology , Female , Humans , Intraoperative Complications , Male , Prospective Studies , Recurrent Laryngeal Nerve/physiology , ThyroidectomyABSTRACT
Objetivos: Presentamos un estudio prospectivo para valorar la incidencia real de los trastornos vocales en la tiroidectomía total, así como su posible etiología y su evolución. Pacientes y método: Se incluyó en el estudio a 66 pacientes intervenidos de tiroidectomía total entre 2003 y 2006. Se comprobó en cada caso variables referidas a los cambios vocales, subjetivos y medidos atendiendo a la escala GRABS, aparecidos tras la intervención. Como grupo control se empleó una selección aleatoria de 25 pacientes intervenidos con anestesia general e intubación orotraqueal sin afección cervical. Resultados: De 30 (45,5 %) pacientes en que se desarrolló disfonía postoperatoria, sólo 2 (3 %) fueron definitivas y 11 se explicaron por lesión nerviosa (10 laríngeos inferiores y 1 superior). En 8 (12,2 %) pacientes la puntuación en la escala GRABS fue > 5. El resto de estos 30 pacientes refirió cambios vocales postoperatorios por disminución del tono (10 casos), de la intensidad (9 casos) o fatiga vocal (3 casos) de forma aislada, y con una repercusión en la escala GRABS siempre <= 2 puntos. La única variable estudiada que mostró una relación significativa con la aparición de cambios vocales postoperatorios fue la sección de músculos prelaríngeos (odds ratio = 12,5). Conclusiones: La relación de las disfonías con la tiroidectomía total es bien conocida, aunque encontramos una incidencia mucho mayor que la explicada simplemente por la lesión nerviosa. Factores técnicos (y en ocasiones evitables), como la sección de músculos prelaríngeos, podrían tener una relación importante con este evento postoperatorio
Objetives: We present a prospective study assessing the real incidence, aetiology, and evolution of vocal impairment following total thyroidectomy. Patients and method: Sixty-six patients who underwent total thyroidectomy between 2003 and 2006 were included, recording demographic and analytic variables, with emphasis on subjective vocal changes observed after surgery, measured by means of the GRABS scale. A control group of 25 patients operated under general anaesthesia and oro-tracheal intubation was chosen using random sampling. Results: In 30 patients (45.5 %), post-operative dysphonia was observed. Among these, only 2 (3 %) were permanent, and 11 were due to nerve damage (10 inferior and 1 superior laryngeal nerves). In 8 patients (12.2 %), GRABS score was above 5. In the rest of these 30 patients, the complaint was a single decreased tone (10 cases), lack of intensity (9 cases) and vocal fatigue (3 cases), always with a GRABS score equal to or less than 2 points. The most significantly related factor with the onset of dysphonia was the section of strap muscles (OR=12.5). Conclusions: Dysphonia is a common complication of total thyroidectomy, but its incidence is not always related to nerve injury. Some technical (and sometimes avoidable) factors, such as the section of prelaryngeal muscles, could have an important relationship with this adverse event
Subject(s)
Male , Female , Adult , Middle Aged , Aged , Humans , Voice Disorders/etiology , Thyroidectomy/adverse effects , Postoperative Complications , Prospective Studies , Risk FactorsABSTRACT
Choanal atresia is an infrequent congenital malformation. Classically, 4 surgical approaches have been described for its treatment: transnasal, transpalatal, trans-septal, and transantral. Of these, transpalatal was preferred. In recent years, the progress in nasal endoscopy has led to reconsideration of the transnasal route as being less invasive and providing excellent results. The use of stents to prevent re-stenosis is a controversial issue. However, the application of substances such as mitomycin may offer decreased need for stenting by reducing the development of cicatrix tissue. We report the case of a patient with bilateral choanal atresia and its surgical treatment using nasal endoscopy with topical mitomycin. We report the case of a patient with bilateral choanal atresia and the surgical treatment with topical mitomycin.
Subject(s)
Choanal Atresia/surgery , Endoscopy , Female , Humans , PregnancyABSTRACT
La atresia de coanas es una malformación congénita poco frecuente. Clásicamente se han descrito cuatro vías de abordaje para su corrección quirúrgica: transnasal, transpalatina, transeptal y endonasal. De todas ellas se consideraba de elección la vía transpalatina. En los últimos años, debido al avance de la endoscopia nasal, se impone la vía endonasal, por ser menos invasiva y proporcionar excelentes resultados. En cuanto al empleo de stents para prevenir las reestenosis, hay controversia; sin embargo, la aplicación coadyuvante de sustancias como la mitomicina nos permite prescindir de ellos y reducir la formación de tejido de cicatrización. Presentamos el caso de un paciente con atresia de coanas bilateral y su manejo quirúrgico mediante cirugía endoscópica nasal con el empleo de mitomicina tópica
Choanal atresia is an infrequent congenital malformation. Classically, 4 surgical approaches have been described for its treatment: transnasal, transpalatal, trans-septal, and transantral. Of these, transpalatal was preferred. In recent years, the progress in nasal endoscopy has led to reconsideration of the transnasal route as being less invasive and providing excellent results. The use of stents to prevent re-stenosis is a controversial issue. However, the application of substances such as mitomycin may offer decreased need for stenting by reducing the development of cicatrix tissue. We report the case of a patient with bilateral choanal atresia and its surgical treatment using nasal endoscopy with topical mitomycin. We report the case of a patient with bilateral choanas atresia and the surgical treatment with topical mitomycin
Subject(s)
Humans , Pregnancy , Female , Endoscopy/methods , Nasal Cavity/surgery , Choanal Atresia/surgery , Mitomycin/therapeutic useABSTRACT
The association of hyperparathyroidism with thyroid pathology previous to surgery is not very frequent in our cases, almost a 15%, but it means another difficulty for the diagnostic and treatment. Between 1991 and 2001 we have studied and operated 15 patients with this clinic association. 14 were female and only 1 male with a range age of 59 years old. We studied the type of hyperparathyroidism, personal history, clinic, type of thyroid pathology associated, complementary explorations, type of surgery, anatomopathology evolution, and hospital stay. We have done 12 adenoma resections, 1 subtotal parathyroidectomy, 2 total thyroidectomies and 5 hemithyroidectomies. Only in one patient the anatomopathology was informed as a thyroid carcinoma associated to a parathyroid adenoma, being the other patients benign pathologies. We did literaturer revision on this association. We believe that in all patients with a thyroid pathology we should an associated hyperparathyroidism and vice versa.
Subject(s)
Hyperparathyroidism/complications , Thyroid Diseases/complications , Adult , Aged , Female , Humans , Male , Middle Aged , Retrospective Studies , Time FactorsABSTRACT
No disponible
No disponible
Subject(s)
Middle Aged , Adult , Aged , Male , Female , Humans , Time Factors , Thyroid Diseases , Retrospective Studies , HyperparathyroidismABSTRACT
La asociación de hiperparatiroidismo con patología tiroidea previa a la cirugía no es muy frecuente en nuestra casuística, alrededor de un 15 por ciento en la actualidad, pero supone una dificultad añadida tanto para el diagnóstico como el tratamiento. Entre 1991 y 2001 hemos estudiado e intervenido 15 pacientes que presentaban dicha asociación clínica. 14 eran mujeres frente a 1 solo varón siendo la edad media de 59 años. Las variables analizadas fueron el tipo de hiperparatiroidismo, antecedentes personales, clínica, tipo de patología tiroidea asociada, exploraciones complementarias, tipo de cirugía, anatomopatología, evolución y estancia hospitalaria. Practicamos 12 resecciones de adenoma, 1 paratiroidectomía subtotal, 2 tiroidectomías totales y 5 hemitiroidectomías. Sólo la AP de un paciente fue informada como carcinoma de tiroides asociado a adenoma paratiroideo, correspondiendo el resto de resultados a patologías benignas. Realizamos una revisión bibliográfica al respecto de esta asociación. Creemos que ante cualquier paciente que presente una patología tiroidea debería descartarse un hiperparatiroidismo asociado y viceversa (AU)
No disponible
Subject(s)
Middle Aged , Aged , Adult , Male , Female , Humans , Time Factors , Thyroid Diseases , Retrospective Studies , HyperparathyroidismABSTRACT
The cavum or rhinopharynx carcinomas are rare tumors who are divided basically in two histologic types: epidermoid carcinoma and indiferenciated carcinoma. We present a personal revision of 18 patients (15 males and 3 females) diagnosed of cavum carcinoma, the majority (72.2% of indiferenciated type. We have done a descriptive-retrospective study of 12 years (1990-2001) with the following parameters: clinic presentation, associated symptoms, TNM stage, anatomopathology, treatment and clinic evolution. The 38.9% of the patients (7) are actually in complete remission after at last 2 years treatment completion. 3 patients have died and another 2 have not followed the periodic controls in our hospital. The others present a residual tumor in rhinopharynx or in ganglionar level. In one case there are distant metastasis (liver and lungs).
Subject(s)
Carcinoma, Squamous Cell/drug therapy , Carcinoma, Squamous Cell/radiotherapy , Nasopharyngeal Neoplasms/drug therapy , Nasopharyngeal Neoplasms/radiotherapy , Adult , Aged , Combined Modality Therapy , Female , Humans , Male , Middle Aged , Retrospective StudiesABSTRACT
The sinusites orbital complications usually associated to ethmoidites are rare in the childhood. We present a revision of 14 adults patients (10 males and 4 females) 18 to 61 years old. Seven presented a preseptal cellulitis, two had a subperiostial abscess and five an orbitary cellulitis in accordance with the Candler classification. We analyse the personal previous history, the clinical data, complementary tests and treatments (medical and surgical) evolution and hospital stay. We realise a literature revision about this subject.
Subject(s)
Orbital Diseases/etiology , Sinusitis/complications , Adolescent , Adult , Anti-Bacterial Agents/therapeutic use , Anti-Inflammatory Agents/therapeutic use , Drug Therapy, Combination , Female , Humans , Male , Middle Aged , Orbit , Orbital Diseases/diagnosis , Sinusitis/drug therapy , SteroidsABSTRACT
The antrochoanal polyps or solitary Killian polyps are seldom benign pathologies. Since 1990 to October 2002 we have registered a total of 30 patients with these diagnosis (20 male and 10 female) between 5 and 70 years old. The nasal obstruction, usually unilateral, has been constant in all of them and in more than a 63% they referred it since more than one year. They underwent surgery with Functional Endoscopic Endonasal Surgery. The postoperative results have been satisfactory except in two patients who have had a recidive with another surgery. We analyse also a bibliography revision on this pathology.
Subject(s)
Nasal Polyps/surgery , Adult , Aged , Female , Humans , Male , Middle Aged , Nasal Obstruction/etiology , Nasal Polyps/complications , Terminology as TopicABSTRACT
No disponible
No disponible
Subject(s)
Middle Aged , Adolescent , Adult , Male , Female , Humans , Sinusitis , Steroids , Orbital Diseases , Anti-Bacterial Agents , Anti-Inflammatory Agents , Drug Therapy, Combination , OrbitABSTRACT
No disponible
No disponible
Subject(s)
Middle Aged , Adult , Aged , Male , Female , Humans , Nasal Obstruction , Nasal Polyps , TerminologyABSTRACT
No disponible
No disponible
Subject(s)
Middle Aged , Adult , Aged , Male , Female , Humans , Retrospective Studies , Carcinoma, Squamous Cell , Combined Modality Therapy , Nasopharyngeal NeoplasmsABSTRACT
Citrobacter Freundii es una Enterobacteria oportunista que se aisla rara vez de procesos patológicos, fundamentalmente infecciones urinarias y respiratorias. Presentamos el caso de una mujer de 67 años diagnosticada de una otitis externa aguda derecha, sin antecedentes personales de interés, y en cuyo frotis ótico el Laboratorio de Microbiología aisló este germen. Se trata de una asociación extremadamente rara con pocas referencias en la literatura. La paciente fue tratada con netilmicina (4 días) y metilprednisolona IM (3 días), continuando posteriormente con tratamiento tópico una semana más. La evolución fue satisfactoria con remisión completa de la sintomatología (AU)
Subject(s)
Aged , Female , Humans , Otitis Externa/microbiology , Citrobacter freundii/pathogenicity , Netilmicin/administration & dosage , Otitis Externa/drug therapy , Methylprednisolone/administration & dosageABSTRACT
Entre los años 1990 y 2001 hemos intervenido a un total de 558 pacientes con patología tiroidea remitidos por Endocrinología. 487 eran mujeres (87,27 per cent) frente a 71 varones, con una edad media de 45 años. Recogemos los datos clínicos de los pacientes y valoramos los siguientes estudios preoperatorios: Ecografía, Gammagrafía y P.A.A.F. Los Bocios coloides nodulares representaron el 64,12 per cent de las patologías benignas tiroideas. Los tumores malignos intervenidos fueron 73 (13,08 per cent), siendo la mayoría Carcinomas Papilares (78,08 per cent). Hemos realizado 330 Tiroidectomías Totales, 5 Tiroidectomías Subtotales, 211 Hemitiroidectomías y 12 Istmectomías. Se constataron 58 casos de parálisis recurrencial (sólo 7 definitivas y unilaterales) e hipocalcemia en 148 pacientes (definitiva en un 2,1 per cent).Realizamos una revisión de la literatura comparando nuestros resultados con otras series publicadas y estudiamos la correlación entre Gammagrafía, P.A.A.F. y diagnóstico final AP (AU)
Subject(s)
Adolescent , Adult , Female , Male , Middle Aged , Humans , Thyroid Gland/surgery , Thyroid Gland/pathology , Thyroid Gland , Goiter/complications , Goiter/diagnosis , Thyroidectomy/methods , Adenoma/diagnosis , Adenoma/pathology , Thyroid Neoplasms/diagnosis , Thyroid Neoplasms/pathology , Risk Factors , Postoperative Complications/physiopathology , Paralysis/complications , Paralysis/diagnosis , Recurrence , Hypocalcemia/complications , Hypocalcemia/diagnosisABSTRACT
Durante un período de 6 años (1995-2000, ambos inclusive), hemos registrado un total de 6.814 pacientes con patología otológica que acudieron al Servicio de Urgencias de nuestro Hospital. Realizamos un estudio retrospectivo y descriptivo en el que las Otitis Externas agudas bacterianas representaron el motivo más frecuente de consulta (19,2 per cent de todas las urgencias óticas), seguidas de las otitis medias agudas (13,2 per cent), crónicas (13,1 per cent) y tapones de cerumen (10,2 per cent). Analizando los resultados, podemos establecer en un 15 per cent como máximo el porcentaje de patologías otológicas que justificaban una actuación urgente, mientras que casi un 85 per cent eran patologías banales o susceptibles de tratamiento no urgente. La tendencia actual, sobre todo de los tres últimos años, es al incremento, entre un 10 per cent y 20 per cent, del número de estas patologías que suponen más del 35,6 per cent del global de Urgencias ORL en nuestro Servicio (AU)
Subject(s)
Female , Male , Humans , Emergencies/epidemiology , Otitis Externa/diagnosis , Otitis Externa/epidemiology , Otitis Externa/therapy , Ear/pathology , Ear/physiopathology , Emergency Medical Services/trends , Earache/complications , Earache/diagnosis , Retrospective Studies , Otolaryngology/trends , Bacterial Infections/complications , Bacterial Infections/diagnosis , Bacterial Infections/therapy , Primary Health Care/standards , Primary Health Care/trendsABSTRACT
Presentamos el caso clínico de una mujer de 68 años diagnosticada por nuestro Servicio de Poliposis nasosinusal bilateral que presentaba Meningioma del Surco Olfatorio asociado. Tras la realización de TAC y RMN craneal, la paciente fue intervenida primero por el Servicio de Neurocirugía de nuestro hospital y tres años después practicamos Cirugía Endoscópica Nasosinusal Funcional (C.E.N.F.) sobre su poliposis. El seguimiento medio, por ORL y Neurocirugía, ha sido de 5 años; inicialmente presentó una fístula de LCR (no actualmente).En controles de imagen recientes se constató recidiva del meningioma con mejoría significativa de la permeabilidad nasal y, en menor grado, de su anosmia. Realizamos una revisión bibliográfica de esta patología poco frecuente en la literatura y que requiere un tratamiento quirúrgico en la mayoría de los casos (AU)
Subject(s)
Aged , Female , Humans , Meningioma/diagnosis , Meningioma/surgery , Meningioma , Nasal Polyps/diagnosis , Nasal Polyps/surgery , Tomography, Emission-Computed/methods , Magnetic Resonance Imaging/methods , Fistula/diagnosis , Immunohistochemistry/methods , Skull Neoplasms/diagnosis , Skull Neoplasms/surgery , Skull Neoplasms , Olfaction Disorders/diagnosis , Immunohistochemistry/classification , Immunohistochemistry/trends , Neoplasm Recurrence, Local/diagnosis , Olfaction Disorders/physiopathology , Olfaction Disorders/pathologyABSTRACT
La Histiocitosis X o de células de Langerhans, es una enfermedad poco frecuente caracterizada por el acúmulo de histiocitos en diferentes órganos y tejidos formando granulomas. De expresión clínica y tratamiento variable, presentamos el caso de una paciente joven que debuta con sintomatología ótica de varios meses de evolución. Pretendemos resaltar la importancia de esta patología en la esfera ORL y hacer una revisión de la literatura actual (AU)