[Salivary stones and stenosis. A comprehensive classification]. / Lithiases et sténoses salivaires. Une classification pratique des pathologies non tumorales.

INTRODUCTION: Sialendoscopy and sialo-MRI enable diagnosis of salivary gland obstructive pathologies, such as lithiasis, stenosis and dilatations. Therefore, a classification of these pathologies is needed, allowing large series comparisons, for better diagnosis and treatment of salivary pathologies. MATERIAL AND METHODS: With help from people from the European Sialendoscopy Training Center (ESTC), the results of sialographies, sialoMRI and sialendoscopies, a comprehensive classification of obstructive salivary pathologies is described, based on the absence or presence of lithiasis (L), stenosis (S) and dilatation (D) ("LSD" classification). DISCUSSION: It appears that a classification of salivary gland obstructive pathologies should be described. We hope it will be widely used and of course criticized to be improved and to compare the results of salivary gland diagnostic methods, such as sialography and sialendoscopy and also the results and indications for salivary gland therapeutic methods, such as lithotripsy, sialendoscopy and/or open surgery.

Salivary stones and stenosis. A comprehensive classification.

INTRODUCTION: Sialendoscopy and sialoMRI enables diagnosis of salivary gland obstructive pathologies, such as lithiasis, stenosis, and dilatations. Therefore, a classification of these pathologies is needed, allowing large series comparisons, for better diagnosis and treatment of salivary pathologies. MATERIAL AND METHODS: With help from people from the European Sialendoscopy Training Center (ESTC), the results of sialographies, sialoMRI and sialendoscopies, a comprehensive classification of obstructive salivary pathologies is described, based on the absence or presence of lithiasis (L), stenosis (S), and dilatation (D) ("LSD" classification). DISCUSSION: It appears that a classification of salivary gland obstructive pathologies should be described. We hope it will be widely used and of course criticized to be improved and to compare the results of salivary gland diagnostic methods, such as sialography and sialendoscopy, and also the results and indications for salivary gland therapeutic methods, such as lithotripsy, sialendoscopy, and/or open surgery.

[Analysis of the cochlear implant as a treatment technique for profound hearing loss in pre and postlocutive patients]. / Evaluación del implante coclear como técnica de tratamiento de la hipoacusia profunda en pacientes pre y post locutivos.

INTRODUCTION: These are the objectives planned for this study: 1. Evaluate the results from the communication point of view. 2. Evaluate the cochlear implant (CI) impact on the quality of life. 3. Evaluate medical complications and technical failures. 4. Assess direct and indirect costs generated during the phases of a cochlear implantation programme. 5. Determine which factors have a high impact on the clinical evolution and the financial cost. MATERIALS AND METHOD: A population of 877 patients, postlingual and prelingual, adults and children, have been studied. They were treated in 5 Spanish centres with cochlear implant programmes. Audiometric tests and global questionnaires on life quality have been carried out. Medical and CI technology complications have also been computed. Direct and indirect economic costs of a cochlear implant have been calculated. RESULTS: Postlocutive-implanted patients reached the 40 dB SPL threshold in the Pure Tone Audiometry, and this result was maintained during the 12-year evolution. In Vowels test, it evolved from a 30% on pre-stimulation to 80-90%, in Disyllables words test it evolved from a 10% to a 50-60%, and in CID Sentences test it evolved from an 18% to a 60-70%. In the prelocutive population, results were influenced by the child's age at implantation. The best results were obtained by the children who had been implanted earlier. Those implanted between 0 and 3 years old evolved in the Vowels test from 0% during pre-stimulation to 95%, from a 0% to a 90% in Disyllables words test and from a 0% to a 90-95% in CID Sentences test. Also, the speech acquisition and development of the pre-locutive population was also influenced by the implantation age. An 80% of postlocutive adult patients stated a mood and sociability improvement after the cochlear implantation. They did not show health changes in general nor relevant modifications in the attention they usually received from relatives and friends. Severe medical-surgical complications were registered for a 3.42% of the cases, a 7.06% of mild medical-surgical complications and a 3.07% of technical breakdowns in the internal components of the CI. Financial cost of implantation for a post-locutive adult oscillated between 36,912 Euro and 37,048 Euro, and between 37,689 Euro and 44,273 Euro for a pre-locutive child. CONCLUSIONS: Cochlear implants clearly enhance communication skills of the implantees. Results obtained for the prelocutive implanted population justify the creation of hearing screening programmes in new-borns. Postlocutive implanted adults have expressed satisfaction for the results obtained. However, they did perceive some limitations in situations of unfavourable acoustic conditions. An analysis of direct and indirect costs related to a CI programme has been made. It may be useful to carry out reports on the cost-benefit ratio in this field. The low index of complications observed shows which cochlear implant treatment technique complies with the adequate safety margins. The factors influencing the most in the evolution are: duration of hearing deprivation, age at implantation, cochlear anatomy and functionality of the auditory pathway, patient's and relative's motivation, and the coexistence of other handicaps associated to hearing losses.

Mucus physiopathology, update and new therapeutic tendencies.

The knowledge of mucous secretions has advanced considerably with respect to their altered physiological properties in various ear, nose and throat disorders. We review the physicochemical properties of normal mucus and abnormal mucus present in the airways during sinusitis, otitis media with effusion, etc. We have adapted the mucoactive drugs classification to the up-to-date european situation, presenting a bibliographic review. We have attempted to reconcile the agreed findings in the literature with the most recent advances in research that have resulted in new therapeutic strategies for the treatment of pathological hypersecretion in the airways.

[Use of topical ciprofloxacin in chronic suppurating otitis media]. / Utilización del ciprofloxacino tópico en la otitis media crónica supurada.

OBJECTIVE: A prospective study is presented. We carry out an analysis of the results obtained after treatment with different protocols of administration of ciprofloxacin, during the active phase in chronic otitis media and in chronic otorrhea. MATERIAL AND METHOD: A multicenter, prospective study is carried out, in 3 ENT departments, corresponding to 3 reference tertiary hospitals. 300 patients were included ranging from 5 to 73 years old, all were diagnosed of chronic disease of the middle ear: simple chronic otitis media (n = 128), chronic otitis with bone reabsorption (n = 57), cholesteatoma infection (n = 42) and postsurgery ear infection (n = 73). Patients were placed in 5 treatment groups: ciprofloxacin (oral administration) (only adults were included), topical ciprofloxacin (0.5%), topical ciprofloxacin (0.2%), topical ciprofloxacin (0.2%) plus oral ciprofloxacin and ciprofloxacin (0.3%) plus topical fluocinolone. There was a control group treated with polimixin plus neomicine and hidrocortison. RESULTS: The most common isolated bacterias were: Pseudomonas aeruginosa and S. aureus. We found 19 resistant strains to ciprofloxacin. A better therapeutic response was observed in the topical administration groups. In topical administration, a difference was only observed in the cholesteatoma and chronic middle ear infection with bone reabsorption groups, in those patients that were administered the ciprofloxacin with fluocinolone. CONCLUSION: Forms of topical treatment, with ciprofloxacin, in active infection of chronic disease of the middle ear, improve the results compared to oral administration. The association with of topical fluocinolone improves the results in the cases with cholesteatoma infection and chronic middle ear infection.

Utilización del ciprofloxacino tópico en la otitis media crónica supurada / Uses of topical ciprofloxacin in chronic secutory otitis media

Objetivo: Se presenta un estudio prospectivo en el que se analizan los resultados obtenidos tras el tratamiento con diversas formas de ciprofloxacino, aplicado durante la fase activa en otitis media crónica y en otorrea crónica de oído operado. Material y método: Se realiza un estudio prospectivo, multicéntrico en 3 servicios de Otorrinolaringología correspondientes a hospitales terciarios de referencia. Se incluyeron 300 pacientes con edades comprendidas entre 5 y 73 años, todos diagnosticados de otitis crónica: otitis media crónica simple (n=128), otitis media crónica osteítica (n=57), otitis media crónica colesteatomatosa (n=42) y otorrea en oído operado (n=73). Los pacientes se distribuyeron aleatoriamente en 5 grupos de tratamiento: ciprofloxacino vía oral (sólo se incluyeron pacientes adultos), ciprofloxacino tópico al 0,5 por ciento, ciprofloxacino tópico al 0,2 por ciento, ciprofloxacino tópico al 0,2 por ciento asociado a ciprofloxacino oral y ciprofloxacino al 0,3 por ciento asociado a fluocinolona. Al grupo control se le administró polimixina B asociada a neomicina e hidrocortisona. Resultados: Los microorganismos más frecuentemente aislados fueron Pseudomonas aeruginosa y S. aureus. Se encontraron 19 cepas resistentes al ciprofloxacino. Aunque se observó una mejor respuesta terapéutica en las formas tópicas, sólo se observó una diferencia en los grupos de formas osteíticas y en los casos de infección del colestatoma, a los que se les administró el ciprofloxacino con fluocinolona. Conclusión: Las formas de tratamiento tópico, con ciprofloxacino, en formas activas de infección crónica otológica mejoran los resultados de su administración por vía oral. La incorporación de corticoides tópicos mejora los resultados en los casos con formas osteíticas y colesteatomatosas (AU)

OBJECTIVE: A prospective study is presented. We carry out an analysis of the results obtained after treatment with different protocols of administration of ciprofloxacin, during the active phase in chronic otitis media and in chronic otorrhea. MATERIAL AND METHOD: A multicenter, prospective study is carried out, in 3 ENT departments, corresponding to 3 reference tertiary hospitals. 300 patients were included ranging from 5 to 73 years old, all were diagnosed of chronic disease of the middle ear: simple chronic otitis media (n = 128), chronic otitis with bone reabsorption (n = 57), cholesteatoma infection (n = 42) and postsurgery ear infection (n = 73). Patients were placed in 5 treatment groups: ciprofloxacin (oral administration) (only adults were included), topical ciprofloxacin (0.5%), topical ciprofloxacin (0.2%), topical ciprofloxacin (0.2%) plus oral ciprofloxacin and ciprofloxacin (0.3%) plus topical fluocinolone. There was a control group treated with polimixin plus neomicine and hidrocortison. RESULTS: The most common isolated bacterias were: Pseudomonas aeruginosa and S. aureus. We found 19 resistant strains to ciprofloxacin. A better therapeutic response was observed in the topical administration groups. In topical administration, a difference was only observed in the cholesteatoma and chronic middle ear infection with bone reabsorption groups, in those patients that were administered the ciprofloxacin with fluocinolone. CONCLUSION: Forms of topical treatment, with ciprofloxacin, in active infection of chronic disease of the middle ear, improve the results compared to oral administration. The association with of topical fluocinolone improves the results in the cases with cholesteatoma infection and chronic middle ear infection (AU)

[Lymphoma of the nasal cavity, clinical and anatomo-pathologic considerations]. / Linfomas de fosas nasales, consideraciones clínicas y anatomo-patológicas.

Six cases of high-grade lymphoma affecting the nasal cavity are presented. Their main symptoms were nasal obstruction, epistaxis and rhinorrea. Clinical exploration showed an ulcerated lesion in four patients (all of them T/NK cell lymphomas) and an exofitic tumour in the other two (B cell lymphomas). Pathology was diagnostic for high grade lymphoma in all the six cases, immunohistochemical studies revealed that the atypical cells were T/NK in 4 cases and B in the other two cases. Genotypic analysis was done looking for rearrangement of the genes for Ig H or T-cell receptors. In situ hybridisation was done to detect Epstein-Barr virus RNA. Malignant lymphomas arising in the nasal cavity are unusual, its major prognostic factor is the clinical stage at presentation. To perform an early diagnosis this neoplasia must be suspected in the presence of an exofitic tumour (B cell lymphoma) or necrotic and ulcerated lesion (T/NK cell lymphoma).

Documento de Consenso sobre "Tratamiento Antimicrobiano de la Faringoamigdalitis" / Consensus document re " Pharyngoamigdalitis antimicrobial therapy protocols"

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No disponible

Documento de consenso sobre tratamiento antimicrobiano de la faringoamigdalitis / Consensus statement on antimicrobial of pharyngo-tosillitis

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Linfomas de fosas nasales, consideraciones clínicas y anatomo-patológicas / Lymphoma of the nasal cavity, clinical and anatomopathological considerations

Se presentan 6 casos de linfomas de alto grado que afectaban la cavidad nasal. Clínicamente los síntomas principales fueron obstrucción nasal, epístaxis y rinorrea. La exploración puso de manifiesto una lesión ulcerada en 4 casos (todos ellos linfomas T/NK) y exofítica en los otros dos (linfomas B). La histología fue diagnóstica para linfoma de alto grado en los 6 casos, la inmunohistoquímica reveló que las células atípicas eran T/NK en 4 casos, y B en los dos restantes. Se realizó un estudio de biología molecular buscando reordenamiento para Ig H y receptores de células T, e hibridación in situ para establecer relación con el virus de Epstein-Barr. Los linfomas nasales son tumores de aparición poco frecuente, su extensión es el factor que en mayor medida condiciona el pronóstico. Para diagnosticarlos precozmente su presencia debe sospecharse tanto en lesiones exofíticas (linfomas B) como en necróticas ulceradas (linfomas T/NK) (AU)

Six cases of high-grade lymphoma affecting the nasal cavity are presented. Their main symptoms were nasal obstruction, epistaxis and rhinorrea. Clinical exploration showed an ulcerated lesion in four patients (all of them T/NK cell lymphomas) and an exofitic tumour in the other two (B cell lymphomas). Pathology was diagnostic for high grade lymphoma in all the six cases, immunohistochemical studies revealed that the atypical cells were T/NK in 4 cases and B in the other two cases. Genotypic analysis was done looking for rearrangement of the genes for Ig H or T-cell receptors. In situ hybridisation was done to detect Epstein-Barr virus RNA. Malignant lymphomas arising in the nasal cavity are unusual, its major prognostic factor is the clinical stage at presentation. To perform an early diagnosis this neoplasia must be suspected in the presence of an exofitic tumour (B cell lymphoma) or necrotic and ulcerated lesion (T/NK cell lymphoma) (AU)

[Disorders in gaze saccades in Huntington disease. Clinical correlations]. / Störung der Blicksakkaden bei der Huntington-Krankheit. Klinische Korrelationen.

Oculomotor abnormalities have long been recognized in Huntington's disease (HD). The precise correlation between them and other clinical findings has not yet been determined. Using videonystagmography, we studied reflexive, visually guided horizontal saccades in 32 patients with genetically confirmed HD: nine female and 23 male patients, including six with young onset HD (YOHD), 19 with adult onset HD (AOD), and seven with late onset HD (LOHD). Huntington's patients exhibited increased saccade latency (P < 0.05), decreased saccade velocity (P < 0.0005), and impaired saccade accuracy (P < 0.01). A significant difference between the different groups of patients could be determined, and YOHD was characterized by normal latency and decreased saccade velocity while LOHD showed increased saccade latency but normal velocity. Furthermore, we found a significant difference between the genetic data (length of CAG-repeats) and saccadic abnormalities, with higher repeat numbers corresponding to shorter latency and decreased velocity, as in YOHD. The study of saccade parameters might be useful as an objective method for testing the effectiveness of future therapies.

The effect of levodopa on vocal function in Parkinson's disease.

Phonatory and articulatory dysfunctions are frequent observations in Parkinson's disease. We have investigated, using acoustic measures, the effects of levodopa treatment on vocal function in 20 patients with Parkinson's disease before and after levodopa. These patients were also compared with a matched control group. The mean age was 63.5 +/- 9.66 years, Hoehn-Yahr stage was 2.38 +/- 0.45, and onset mean age was 56.5 +/- 10.36 years. Paired Wilcoxon tests were performed to compare measurements before and after levodopa. The acoustic analysis using Computerized Speech Lab and MultiDimensional Voice Program software programs (Kay Elemetrics, Lincoln Park, NJ, USA) showed that measurements of fundamental frequency (p < 0.017) were significantly increased after medication, whereas short-term frequency perturbation jitter (p < 0.033), soft phonation index (noise parameter) (p < 0.015 ), and frequency tremor intensity index (p < 0.018) were significantly decreased after medication. The objective measurements of acoustic analysis are useful in evaluating the dopaminergic pharmacologic response in Parkinson's disease. The improvement in fundamental frequency and other vocal parameters may be a result of decrease in laryngeal hypokinesia and rigidity.

[Speed of ocular saccades in Huntington disease. Prospective study]. / Velocidad de las sacadas oculares en la enfermedad de Huntington. Estudio prospectivo.

BACKGROUND: Oculomotor abnormalities, especially slow saccades, have long been recognized in Huntington's disease (HD). OBJECTIVES AND METHODS: To study prospectively horizontal saccade velocity by videonystagmography in 21 patients with genetically confirmed HD. The study included a baseline analysis and a second evaluation after 18.8 +/- 7.1 months. We included a control group of 15 subjects. RESULTS: HD group exhibited decreased saccade velocity when compared with that from a control group (for predictive and unpredictive target). HD patients showed decreased saccade velocity with the passage of time (for predictive target, p < 0.01). Finally we found statistical significant correlation between saccade velocity and triplet length. CONCLUSIONS: The measurement of saccade velocity might be an objective method to study the natural evolution of HD, and thus evaluate the effectiveness of future therapies.

[Giant ethmoid neurinoma with intracranial extension]. / Neurinoma etmoidal gigante con extensión intracraneal.

The schwannomas are tumors arising from nervous tissue. It appears very rarely in the nose and paranasal sinuses. Intra and extracraneal extension of these tumors are even more uncommon. In this paper we report a case of a esfeno-ethmoidal schwannoma with anterior skull fossa extension. We describe the CT scan and magnetic resonance imaging and the histological features. Surgical resection was carried through a craniofacial approach. Some data about diagnosis, treatment and outcome of these tumors are revised.

Velocidad de las sacadas oculares en la enfermedad de huntington. Estudio prospectivo / Speed of ocular saccades in Huntington's disease. Prospective study

FUNDAMENTO: Las perturbaciones oculomotoras son muy frecuentes en la enfermedad de Huntington (EH). Probablemente la caída de la velocidad sacádica es el hallazgo más característico desde el punto de vista neuroftalmológico. OBJETIVOS Y MÉTODOS: Estudiar prospectivamente la velocidad de las sacadas horizontales mediante videonistagmografía en 21 pacientes con EH confirmada genéticamente. Se realizó el mismo protocolo en la primera evaluación (tiempo 0) y en la de seguimiento (18,8 ñ 7,1 meses después). Se incluyó un grupo control de 15 individuos sin enfermedad neurológica. RESULTADOS: Los pacientes con EH presentaron una velocidad horizontal sacádica inferior a los controles, tanto para estímulo predecible como no predecible. Además, en el seguimiento manifestaron un deterioro significativo de la velocidad sacádica horizontal (p < 0,01; para estímulo predecible).Asimismo hubo correlación significativa entre la expansión de tripletes y la velocidad sacádica. CONCLUSIÓN: El estudio de la velocidad sacádica podría servir como método objetivo de seguimiento de la EH, especialmente en relación con el empleo de futuras terapias neuroprotectoras (AU)

Neurinoma Etmoidal gigante con extensión intracraneal / Gigant nasal schwannoma with intracranial extension

El neurinoma es un tumor de estirpe nerviosa muy poco común en nariz y senos paranasales. Su extensión simultánea intra y extracraneal aún es más infrecuente. En este trabajo presentamos un caso de neurinoma nasoetmoidal con extensión a fosa craneal anterior. Describimos las pruebas de imagen y los hallazgos histológicos, así como la resección craneofacial de etmoides, realizada mediante un abordaje combinado. Se revisan algunos datos sobre el diagnóstico, tratamiento y evolución de estos tumores (AU)

The schwannomas are tumors arising from nervous tissue. It appears very rarely in the nose and paranasal sinuses. Intra and extracraneal extension of these tumors are even more uncommon. In this paper we report a case of a esfeno-ethmoidal schwannoma with anterior skull fossa extension. We describe the CT scan and magnetic resonance imaging and the histological features. Surgical resection was carried through a craniofacial approach. Some data about diagnosis, treatment and outcome of these tumors are revised (AU)

Nasal hyperreactivity to methacholine measured by acoustic rhinometry in asymptomatic allergic and perennial nonallergic rhinitis.

This study was carried out to assess nasal response to different doses of methacholine and to evaluate the diagnostic possibilities of this test. Thirty-seven patients with allergic rhinitis induced by pollen (out of season), 16 with nonallergic rhinitis, and 25 normal subjects were evaluated. After provocation with saline, increasing doses of methacholine, ranging from 0.5 to 16 mg/mL, were applied. Nasal obstruction was assessed by acoustic rhinometry 10 minutes after each dose, the minimum cross-sectional area and the nasal volume in both fossae were obtained. Ipratropium bromide was applied after the last dose of methacholine to evaluate reversibility. After methacholine challenge with 0.5, 1, 2, and 4 mg/mL there was a statistically significant decrease (p < 0.05) in nasal area and volume in a dose-dependent manner in patients with allergic and nonallergic rhinitis in comparison with controls. A ROC (receiver-operating characteristic) analysis showed that a decrease in nasal volume > or = 20% at methacholine concentration of 2 mg/mL is able to predict the presence of rhinitis (positive predicted value 93%, negative predicted value 79%) in 75% of subjects. The clinical relevance of this finding suggests that patients with symptomatic nonallergic rhinitis or even asymptomatic patients with allergic rhinitis out of pollen season present a nasal hyperreactivity to methacholine, and that a decrease of nasal volume > 20% by acoustic rhinometry after challenge with methacholine at 2 mg/mL is able to discriminate these patients from normal subjects. This method seems to be a suitable tool in the diagnosis of rhinitis.

Role of Streptococcus pneumoniae and Haemophilus influenzae in the development of acute otitis media and otitis media with effusion in a gerbil model.

The efficacy of amoxicillin/clavulanate and cefuroxime was determined in a gerbil model of otitis media with a mixed Streptococcus pneumoniae plus Haemophilus influenzae middle ear (ME) infection. Results were compared with those obtained in a previous single H. influenzae model. All untreated animals inoculated with the mixed inoculum developed acute otitis media (AOM), whereas 86.7% of those inoculated with H. influenzae developed otitis media with effusion (OME). Antibiotics eradicated H. influenzae from the ME more efficiently in AOM than in OME, and this difference was highly significant (P80% of animals developed culture-negative OME.

Antimicrobial treatment of an experimental otitis media caused by a beta-lactamase positive isolate of Haemophilus influenzae.

A gerbil model of otitis media induced by a beta-lactamase producing and non-serotypeable isolate of Haemophilus influenzae was used to assess the in-vivo efficacy of co-amoxiclav and cefuroxime at low (5 mg/kg) and high (20 mg/kg) doses. The MIC of the antibiotics tested against the pathogen was 1 mg/L (1/0.5 mg/L for co-amoxiclav). The organism was inoculated (+/-10(6) cfu) by transbullar challenge directly in the middle ear and antibiotic treatment was commenced 2 h post-inoculation and continued at 8 h intervals for three doses. Only high dose co-amoxiclav significantly reduced the number of culture-positive specimens as compared with untreated animals or with other treatment groups (91.7% as compared with 36.7% for high dose cefuroxime). The results obtained in any treatment group were related to middle ear antibiotic level/MIC. Antibiotic concentrations in the middle ear 90 min after administration were about 10% of serum levels at 15 min, probably related to a slight inflammatory response. Only after high dose co-amoxiclav did the concentration in the middle ear exceed the MIC by a factor of four. In otitis media with effusion, if indicated, antibiotics active in vitro should be administered in high doses and, to avoid side effects, probably in short courses.