[Treatment of the benign paroxysmal positional vertigo (BPPV) by Epley maneuver]. / Tratamiento del vértigo posicional paroxístico benigno (VPPB) mediante la maniobra de epley.

Benign paroxysmal positional vertigo (BPPV) is the most common of the peripheral vertigo. We report the case of a 45 years old female with that pathology suspected by the symptoms which the patient related to head changes of positions and movements. Her diagnosis was confirmed by the maneuver of Dix-Hallpike, that was positive, and the treatment consisted in a maneuver of canalicular reposition according to Epley's technique. Such maneuver was successful and actually the patient is without symptoms after more than 2 years since the first episode. Finally we have performed a bibliographic review to verify the effectiveness of that treatment.

Tratamiento del vértigo posicional paroxístico benigno (VPPB) mediante la maniobra de Epley / Treatment of the benign paroxysmal positional vertigo (BPPV) by Epley maneuver

El vértigo posicional paroxístico benigno (V.P.P.B) es el más común de los v´rtigos periféricos. Presentamos el caso clínico de una mujer de 45 años con esta patología sospechada en base a la clínica que la paciente relacionaba con movimientos y cambios cefálicos. El diagnóstico fue confirmado con la maniobra de Dix-Hallpike, que fue positiva , y el tratamiento consistió en la maniobra de reposición canalicular según técnica de Epley. Dicha maniobra fue efectiva y actualmente la paciente se encuentra asintomática tras más de 2 años desde el primer episodio, Se realiza finalmente una revisión bibliográfica para comprobar la efectividad de este tratamiento

Benign paroxysmal positional vertigo (BPPV) is the most common of the peripheral vertigo. We report the case of a 45 years old female with that pathology suspected by the symptoms which the patient related to head changes of positions and movements. Her diagnosis was confirmed by the maneuver of Dix-Hallpike, that was positive, and the treatment consisted in a maneuver of canalicular reposition according to Epley's technique. Such maneuver was successful and actually the patient is without symptoms after more than 2 years since the first episode. Finally we have performed a bibliographic review to verify the effectiveness of that treatment

Reintervención por adenoma ectópico de paratiroides con extirpación previa de lipotimoma. Importancia de la PTH en intraoperatoria / Reoperation because of ectopic parathyroid adenoma with previous removal of lipotimoma. Importance of intraoperative PTH

En ocasiones la cirugía del hiperparatiroidismo no resulta sencilla y el equipo quirúrgico se encuentra con dificultades para localizar la glándula o glándulas patológicas. Presentamos un caso de hiperparatiroidismo primario debido a adenoma de paratiroides en situación ectópica que requirió dos intervenciones. En la primera se extirpó lo que parecía un adenoma pero resultó ser un lipotimoma. En la reintervención efectuada una semana después, contando entonces con la determinación de PTH intraoperatoria rápida o turbo y una gammagrafía digital previa, se consiguió extirpar un adenoma confirmado histológicamente, de 3,5 cm de diámetro localizado en profundidad al lóbulo tiroideo derecho y que descendía hacia el estrecho mediastínico superior. La evolución postoperatoria de la paciente fue satisfactoria y no se registraron complicaciones

Sometimes the surgery of hyperparathyroidism is not easy and the surgical team find difficulties to locate the pathological gland or glands. We report a case of primary hyperparathyroidism due to an ectopic parathyroid adenoma which required two interventions. First we removed what it seems an adenoma but resulted to be a lipotimoma. In the reintervention practiced one week later, having then the rapid or turbo intraoperative PTH and previous digital scintigraphy, it was possible to remove an adenoma histologically confirmed, with 3,5 cm diameter located in depth to right thyroid lobe towards the superior mediastinal straits. The postoperative evolution of the patient was satisfactory and no complications were registered

[Sudden cervical hematoma after hypertensive crisis. Report of a case]. / Hematoma cervical brusco tras crisis hipertensiva. Presentación de un caso.

We report the case ofa 61 years old woman with multiple pathologies: HTA, diabetes, relapsing polychondritis, hypercholesterolemia, iatrogenic Cushing, cardiopathy, cystic fibrosis, etc. She began, an increment of TA (220/130 mm Hg) or hypertensive crisis, with a sudden left cervical hematoma located on the carotid bifurcation according to CT imaging. We oractice an arteriography that was informed as normal and the patient was admitted and controlled of an ORL as Vascular Surgeon. The bleeding stop spontaneously we treat the patient conservativity.

[Otolaryngologic manifestations of Churg-Strauss sindrome. Report of a case and review of the literature]. / Manifestaciones otorrinolaringológicas del sindrome de Churg-Strauss. A propósito de un caso y revisión de la literatura.

Churg-Strauss Sindrome or allergic granulomatosis is a small vessel systemic vasculitis characterized by asthma, hypereosinophilia and necrotizing vasculitis with extravascular eosinophil granulomas. We describe a case assisted in our hospital who presented pulmonary infiltrates, fever, peripherical neuropathy, weight loss, myalgia, rhinosinusitis, with antecedents of nasal polyposis, and facial edema. Our aim is to review the main otolaryngologic manifestations of this rare illness that is treated with oral corticosteroids, immunosupresor drugs like ciclofosfamide and plasmapheresis.

Manifestaciones otorrinolaringológicas del síndrome de Churg-Strauss. A propósito de un caso y revisión de la literatura / Otolaryngologic manifestations of Churg-Strauss sindrome. Report of a case and review of the literature

El Síndrome de Churg-Strauss o granulomatosis alérgica es una mvasculitis sistémica de pequeños vasos que se caracteriza por asma, hipereosinofilia y vasculitis necrotizante con granulomas eosinófilos extravasculares. Describimos un caso atendido en Urgencias de nuestro hospital que presentaba además infiltrados pulmonares, fiebre, neuropatía periférica, pérdida de peso, mialgias, rinosinusitis, con antecedentes de poliposis nasal, y edema facial. Nuestro objetivo es revisar las principales manifestaciones otorrinolaringológicas de esta rara enfermedad multisistémica cuyo tratamiento incluye los corticoides orales, inmunosupresores como la ciclofosfamida y plasmaféresis

Churg-Strauss Síndrome or allergic granulomatosis is a small vessel systemic vasculitis characterized by asthma, hypereosinophilia and necrotizing vasculitis with extravascular eosinophil granulomas. We describe a case assisted in our hospital who presented pulmonary infiltrates, fever, peripherical neuropathy, weight loss, myalgia, rhinosinusitis, with antecedents of nasal polyposis, and facial edema. Our aim is to review the main otolaryngologic manifestations of this rare illness that is treated with oral corticosteroids, immunosupresor drugs like ciclofosfamide and plasmapheresis

[Reoperation because of ectopic parathyroid adenoma with previous removal of lipothymoma. Importance of intraoperative PTH]. / Reintervención por adenoma ectópico de paratiroides con extirpación previa de lipotimoma. Importancia de la PTH intraoperatoria.

Sometimes the surgery of hyperparathyroidism is not easy and the surgical team find difficulties to locate the pathological gland or glands. We report a case of primary hyperparathyroidism due to an ectopic parathyroid adenoma which required two interventions. First we removed what it seems an adenoma but resulted to be a lipotimoma. In the reintervention practiced one week later, having then the rapid or turbo intraoperative PTH and previous digital scintigraphy, it was possible to remove an adenoma histologically confirmed, with 3,5 cm diameter located in depth to right thyroid lobe towards the superior mediastinal straits. The postoperative evolution of the patient was satisfactory and no complications were registered.

[Olfactory neuroblastoma in an old patient. Report of a case]. / Neuroblastoma olfatorio en paciente de edad avanzada. Presentación de un caso.

Olfactory neuroblastoma or esthesioneuroblastoma is a rare embrionary tumor, much more in old patients, which uses to present as a pollipoid mass with nasal obstruction, epistaxis and anosmia of long evolution. We report the case of a 82-year-old male with such symptoms diagnosed by biopsy as neuroblastoma class III according the histologic Hyams grading. Due to the age of the patient and grade of the tumor we did not perform surgery and, although a chemotherapy-radiotherapy treatment was suggested, the patient was not agree with it and he has not been attended or followed in our consulting rooms.

[Statistical study regarding anemia in patients admitted with epistaxis. Importance of its control and the associated risk factors]. / Estudio estadistico sobre anemia en pacientes ingresados por epistaxis. Importancia de su control y de los factores de riesgo asociados.

OBJECTIVE: To emphasize the importance of hemodinamic control and risk factors in the patients hospitalized due to epistaxis. MATERIAL AND METHODS: Retrospective study of 200 consecutive patients admitted by such cause between 1997 and 2004 of whom 46 (23%) developed some degree of anemia. Among other clinical variables we analyze the present risk factors, age, sex, levels of hematocrit and hemoglobin, origin of the nasal hemorrhage, number of transfusions that were required and type of nasal packing used. RESULTS: We prove a significant statistical association (p<0,01)) between epistaxis with anemia and risk factors. About 39% of the anemizing epistaxis needed a transfusion, generally red cell concentrates. CONCLUSIONS: Every admitted epistaxis needs a good hemodinamic study and control of the patient and the treatment of the base pathology associated.

Neuroblastoma olfatorio en paciente de edad avanzada. Presentación de un caso / Olfactory neuroblastoma in an old patient. Report of a case

El neuroblastoma olfatorio o estesioneuroblastoma es un tumor embrionario raro, mucho más en edades avanzadas, que suele presentarse como una masa de aspecto polipoide con obstrucción nasal, epístaxis y anosmia de larga evolución. Presentamos el caso de un varón de 82 años con dichos síntomas, diagnosticado mediante biopsia de neuroblastoma grado III según la clasificación histológica de Hyams. Dada la edad del paciente y el estadío no realizamos cirugía y, aunque se le propuso un tratamiento mediante quimioterapia y/o radioterapia, éste no fue aceptado por el paciente el cual no acudió a revisiones posteriores en nuestras consultas

Olfactory neuroblastoma or esthesioneuroblastoma is a rare embrionary tumor, much more in old patients, which uses to present as a pollipoid mass with nasal obstruction, epistaxis and anosmia of long evolution. We report the case of a 82 year-old male with such symptoms diagnosed by biopsy as neuroblastoma class III according the histologic Hyams grading. Due to the age ofthe patient and grade ofthe tumor we did not perform surgery and, although a chemotherapy-radiotherapy treatment was suggested, the patient was not agree with it and he has not been attended or followed in our consulting rooms

[Giant cells undifferentiated parotid carcinoma. Report of two cases]. / Carcinoma parotídeo indiferenciado de células grandes. Presentación de dos casos.

Tumours of the salivary glands represent a 5% of all head and neck neoplasms. Their origin is the parotid gland in about 80% of the cases. Most of them are benign. We are reporting two cases of patients diagnosed, by our ENT Department, as undifferentiated giant cells parotid carcinoma with cervical metastasis. They were operated by total parotidectomy and radical neck disection and later recieved treatment with radiotherapy. After two years-follow-up both patients are standing alive. The tumoral size is the most important pronostic factor in this histological type.

Estudio estadístico sobre anemia en pacientes ingresados por epístaxis. Importancia de su control y de los factores de riesgo asociados / Statistical study regarding anemia in patients admitted with epistaxis. Importance of its control and the associated risk factors

Objetivo: Destacar la importancia del control hemodinámico y de los factores de riesgo en los pacientes hospitalizados por epístaxis. Material y métodos: Estudio retrospectivo en el que hemos estudiado 200 pacientes consecutivos ingresados por dicho motivo entre los años 1997 y 2004 de los que 46 (23%) desarrollaron algún grado de anemia. Se analizan entre otras variables clínicas los factores de riesgo presentes, edad, sexo, niveles de hematocrito y hemoglobina, origen del sangrado nasal, número de transfusiones requeridas y tipo de taponamiento practicado. Resultados: Asociación estadísticamente significativa (p<0,01) entre epístaxis anemizantes y factores de riesgo. Un 39% de las epístaxis anemizantes precisaron transfusión, generalmente concentrados de hematíes. Conclusiones: En toda epístaxis ingresada es necesario en primer lugar controlar el estado hemodinámico del paciente y el tratamiento de la patología de base asociada

Objective: To emphasize the importance of hemodinamic control and risk factors in the patients hospitalized due to epistaxis. Material and methods: Retrospective study of 200 consecutive patients admitted by such cause between 1997 and 2004 of whom 46 (23%) developed some degree of anemia. Among other clinical variables we analyze the present risk factors, age, sex, levels of hematocrit and hemoglobin, origin of the nasal hemorrhage, number of transfusions that were required and type of nasal packing used. Results: We prove a significant statistical association (p<0,01)) between epistaxis with anemia and risk factors. About 39% of the anemizing epistaxis needed a transfusion, generally red cell concentrates. Conclusions: Every admitted epistaxis needs a good hemodinamic study and control of the patient and the treatment of the base pathology associated

Carcinoma parotídeo indiferenciado de células grandes. Presentación de dos casos / Giant cells undifferentiated parotid carcinoma. Report of two cases

Los tumores de las glándulas salivares representan el 5% de las neoplasias de cabeza y cuello afectando en el 80% a la glándula parótida donde la mayoría son benignos. Presentamos dos casos de pacientes diagnosticados por nuestro Servicio de ORL de carcinoma indiferenciado de células grandes parotídeo con metástasis ganglionares. Fueron intervenidos mediante parotidectomía total y vaciamiento cervical radical con posterior tratamiento de radioterapia. Tras dos años de seguimiento ambos continúan vivos. El tamaño tumoral es el factor pronóstico más importante en este tipo histológico

Tumours of the salivary glands represent a 5% of all head and neck neoplasms. Their origin is the parotid gland in about 80% ofthe cases. Most ofthem are benigno We are reporting two cases ofpatients diagno sed, by our ENT Department, as undifferentiated giant cells parotid carcinoma with cervical metastasis. They were operated by total parotidectomy and radical neck disection and later recieved treatment with radiotherapy. After two years- follow-up both patients are standing alive. The tumoral size is the most important pronostic factor in this histological type

[Simultaneous bilateral sudden deafness. Report of a clinical case]. / Sordera súbita bilateral simultánea. Presentación de un caso.

Bilateral sudden deafness is uncommon and characterized by an acute sensorineural hearing loss in both ears of 30 dB or more in 3 consecutive frequencies. We report the case of a 57 yeras old female with this diagnosis who presented a right anacusia and a severe audiometric loss on left ear without vestibular pathology associated. She was admitted and treated by the protocol of medical therapy that we have performed in our E.N.T. Department (4 days EV and then 10 ones oral medication) with improvement in her audition 25-30 dB average. If sudden bilateral sensorineural deafnes is founded, we must consider an immuno-mediated inner ear disease (IMIED).

Sordera súbita bilateral simultánea. Presentación de un caso / Simultaneous bilateral sudden deafness. Report of a clinical case

La sordera súbita bilateral es poco frecuente y se caracteriza por una pérdida auditiva neurosensorial brusca en ambos oídos de al menos 30 dB en 3 frecuencias consecutivas. Presentamos el caso de una mujer de 57 años con este diagnóstico que presentaba cofosis derecha e hipoacusia profunda de oído izquierdo sin patología vestibular asociada. Fue ingresada y sometida al protocolo de tratamiento médico establecido por nuestro Servicio (4 días IV y 10 más vía oral) con mejoría de su audición 25-30 dB de media. Ante una hipoacusia brusca neurosensorial bilateral rápidamente progresiva se debe pensar en la enfermedad del oído interno inmunomediada (EOIIM)

Bilateral sudden deafness is uncommon and characterized by an acute sensorineural hearing loss in both ears of 30 dB or more in 3 consecutive frequencies. We report the case of a 57 years old female with this diagnosis who presented a right anacusia and a severe audiometric loss on left ear without vestibular pathology associated. She was admitted and treated by the protocol of medical therapy that we have performed in our E.N.T. Department (4 days EV and then 10 ones oral medication) with improvement in her audition 25-30 dB average. If sudden bilateral sensorineural deafnes is founded, we must consider an immune-mediated inner ear disease (IMIED)

[Statistical study and clinical results by comparison of two different protocols in the treatment of sudden hearing loss]. / Estudio estadístico y resultados clínicos de la comparación de dos protocolos diferentes en el tratamiento de la hipoacusia brusca.

Sudden deafness goes on being a clinical entity of unknown cause for which several theories and treatments have been proposed. We are reporting a comparative study of two different protocols that we have performed on 60 patients (divided in two groups of 30) diagnosed and admitted with sudden hearing loss between 1989 and 2003. The main goal is to prove if there is a statistical and significant difference among both, in respect of the audiologic improvement obtained, after two weeks of therapy at east. We have applied the normal approximation of Mann-Whitney's test and we can argue, after its result, our current protocol (piracetam, pentoxifiline, metilprednisolone), which includes 4 days of endovenous treatment another 10 days at home. The presence of vestibular symptoms darkens the prognosis since about 95% of the patients with them have not improved significantly (p<0.05).

Estudio estadístico y resultados clínicos de la comparación de dos protocolos diferentes en el tratamiento de la hipoacusia brusca / Statistical study and clinical results by comparison of two different protocols in the treatment of sudden hearing loss

La sordera súbita continúa siendo una entidad clínica de etiología desconocida para la cual se han propuesto diversas teorías y tratamientos. Presentamos un estudio comparativo de dos protocolos diferentes que hemos utilizado en 60 pacientes (divididos en dos grupos de 30) diagnosticados e ingresados por hipoacusia brusca entre los años 1989 y 2003. El objetivo principal es comprobar si existe diferencia estadísticamente significativa entre ambos, respecto a la mejoría auditiva obtenida, tras al menos dos semanas de tratamiento. Aplicamos la aproximación normal de la prueba de Mann-Whitney y defendemos, tras su resultado, nuestro protocolo actual (piracetam, pentoxifilina,metilprednisolona), que comprende 4 días de tratamiento intravenoso y 10 más de tratamiento domiciliario. La presencia de síntomas vestibulares asociados ensombrece el pronóstico pues casi el 95% de los pacientes que los presentaban no experimentaron recuperación significativa (p<0,05)

Sudden deafness goes on being a clinical entity of unknown cause for which several theories and treatments have been proposed. We are reporting a comparative study of two different protocols that we have performed on 60 patients (divided in two groups of 30) diagnosed and admitted with sudden hearing loss between 1989 and 2003. The main goal is to prove if there is a statistical and significant difference among both, in respect of the audiologic improvement obtained, after two weeks of therapy at east. We have applied the normal approximation of Mann-Whitney's test and we can argue, after its result, our current protocol (piracetam, pentoxifiline, metilprednisolone), which includes 4 days of endovenous treatment another 10 days at home. The presence of vestibular symptoms darkens the prognosis since about 95% of the patients with them have not improved significantly (p<0.05)

Hiperparatiroidismo debido a insuficiencia renal crónica análisis de 32 pacientes operados / Hyperparathyroidism due to chronic renal failure. Analysis of 32 operated patients

Se presenta un estudio propio de 32 pacientes diagnosticados de hiperparatiroidismo debido a insuficiencia renal crónica (27 secundarios y 5 terciarios), entre junio de 1990 y 2003, remitidos desde el Servicio de Nefrología para intervención quirúrgica. Analizamos los siguientes parámetros y variables: Edad sexo, sintomatología clínica, tipo de cirugía practicada, complicaciones postoperatorias y diagnóstico anaomopatológico (AP). Sobre un total de 64 nervios expuestos no hemos registrado ningún caso de parálisis recurrencial. 12 pacientes experimentaron una hipocalcemia sintomática (37,5 por ciento) aunque sólo fue definitiva en uno de ellos. El control del calcio, fósforo y calcitriol es esencial para la prevención de la hiperplasia de las glándulas paratiroides (AU)

[Ethmoidal epidermoid carcinoma showing as cluster headache. Report of a case and literature review]. / Carcinoma epidermoide etmoidal manifestándose con cluster headache. Caso clínico y revisión de la literatura.

We report the case of a 54 years old male diagnosed as ethmoidal epidermoid carcinoma which, after almost 1 year--asymptomatic period, debuted with facial pain (cluster headache) without another associated clinic. Sino-nasal malignant tumours represent about 5%-6% in all ENT carcinomas and they use to be of later diagnosis, with high probability of local recurrence and invasiveness on structures like orbit and skull base. The main treatment for ethmoidal squamous carcinomas is surgery and depending on staging can require radiotherapy and/or chemotherapy. A bibliographic review is done at this respect.

Carcinoma epidermoide etmoidal manifestándose con cluster headache. Caso clínico y revisión de la literatura / Ethmoidal epidermoid carcinoma showing as culster headache. Report of a case and literature review

Se presenta el caso de un varón de 54 años diagnosticado de un carcinoma epidermoide etmoidal que tras un período de casi 1 año asintomático debutó con algia facial (cluster headache) sin otra clínica asociada. Los tumores malignos rinosinusales representan el 5 por ciento-6 por ciento de todos los carcinomas de la esfera ORL y suelen ser de diagnóstico más tardío, con alta probabilidad de recurrencia local e invasión de estructuras adyacentes como la órbita y la base del cráneo. El tratamiento de elección de los carcinomas escamosos etmoidales es quirúrgico y en función de su extensión puede administrarse radioterapia y/o quimioterapia. Realizamos una revisión bibliográfica al respecto (AU)

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