[Surgical multiple level reconstruction of the upper airways for treatment of obstructive sleep apnea. Two clinical cases]. / Reconstrucción quirúrgica multinivel de la vía aérea superior en el tratamiento del síndrome de apneas obstructivas durante el sueño. Dos casos clínicos.

Techniques for surgical correction of the soft palate are used commonly to treat obstructive sleep apnea syndrome (OSAS), but a satisfactory cure cannot be ensured because such techniques usually involve localized correction of the upper airways (UA) whereas UA collapse during sleep involves the entire length. The development of correction techniques for the entire extension of the UA may help to solve this problem. We report the first two cases of multilevel UA surgical reconstruction in OSAS performed in Spain. The excellent results obtained favor routine use of this type of surgery once it has been validated in clinical practice.

[Evaluation of the cephalometric structure of the upper airway on the configuration of the obstructive sleep apnea syndrome]. / Evaluación de la influencia de la estructura cefalométrica de las vías aéreas superiores en la configuración del síndrome de apneas obstructivas durante el sueño.

Thirty aleatory patients polysomnographically diagnosed as sleep apnea syndrome (SAOS) with an apnea-hypoapnea index (AHI) accounting for 61.3 +/- 31.1 were, bipedal and in decubitus, cephalometrically explored, aiming at establish the correlation between the cephalometric quantum of the upper airway and the anthropomorphic and polysomnographic parameters clearly establishing the syndrome. The weak correlation confirmed among the AHI and the back passage in decubitus (PASDEC), even between the nocturnal oxymetric nadir and the length of the palate, advice against considering the gravity of the OSAS as sole function of the altered cephalometric degree checked in the test.

[Anatomical alterations of the upper airway in the sleeping apnea syndrome. Diagnostical and therapeutic implications]. / Alteraciones anatómicas de las vías aéreas superiores en el síndrome de apneas durante el sueño. Implicaciones diagnósticas y terapéuticas.

In this paper are assessed through ENT-exam, rhinomanometry and cephalometry both bipedal and in dorsal decubitus, the anatomical alterations occurring in the upper airways in 100 consecutive patients, polysomnographically diagnosed of SAOS. The patients were classified in 4 groups (after Fujita's modified classification): 2 having oropharyngeal obstruction (I and IIa) and other 2 with hypopharyngeal obstruction (IIb and III), which were subdivided in its time with nasal obstruction present (N+) or absent (N-). Group I and IIa (68 %) -theoretical candidates to an uvulopalatopharyngoplasty, UPPP-showed its predominance, followed by a high incidence of nasal obstruction (N+, 48 %) and a non negligeable number of hypopharyngeal alterations (32 %).

Hearing and diabetes.

The results of the audiological evaluation of 47 diabetics are presented. The patients were divided into two groups: A (17/47), type I early diabetics, and B (30/47), type I chronic diabetics. The evaluation included puretone audiometry, high-frequency audiometry and auditory brainstem response. There was a control group consisting of 30 healthy subjects. In group 1 the audiological assessment was normal in all cases. In group 2 hearing loss was found in 30% of cases (9/30). Hearing loss was significantly correlated with age (p = 0.0019) and duration of diabetes (p = 0.0143), but not with diabetic microangiopathy (p = 0.1506). The authors conclude that hearing loss is not a usual feature in diabetic patients. When present, hearing loss should be attributed to the effect of diabetes on the age-related physiological impairment of the inner ear. The pathogenic mechanisms remain obscure.

[Adaptable and portable cephalometric devices: a new method in obtaining cephalometrics]. / Dispositivo cefalométrico portátil y adaptable. Un nuevo método de obtención de celfalometrías.

Cephalometric radiographic explorations are widely recommended in the diagnosis of the obstructive sleep apnea syndrome (OSAS). In order to improve their diagnostic value, its practice in the upright and supine position has been proposed. A rigorous practice of cephalometric requires the employment of cephalometric devices in order to assure a correct positioning of the head and provide reliable X-ray pictures, comparable within reasonable accuracy over a period of time. The commercialized cephalostats are often expensive due to the structural conditions needed for their development and usually they not allow the simultaneous practice of upright and supine cephalometric. In this paper we describe a cephalometric adaptable device, developed by our research group, that may solve such problems.

[Carotid paraganglioma: a case report]. / Paraganglioma carotídeo. Caso clínico.

Carotid paraganglioma are tumors arising from chemoreceptor paraganglioma cells. These cells have proved to have an embryologic origin from the neural crests. Due to their low incidence these tumors are not an habitually found in daily practices. We present a case of carotid body paraganglioma diagnosed by clinical exploration, CT scan, magnetic resonance imaging and magnetic resonance angiography which was successfully treated by surgery. The diagnostic and therapeutic difficulties present in these tumors are discussed.

[Primary meningioma of the nasal cavity]. / Meningioma primario de fosas nasales.

Meningiomas are benign tumors developed from aracnoid meningeal cells. Its primary extracranial and extravertebral onset is a rarity, arising more frequently in the scalp and orbit. Its beginning in nasal fosae is considered exceptional. Diagnosis will be based on cranial CTY scan and histology of the whole tumour once extirpated. A case of advanced primary nasal meningioma is reported. The AA. emphasize the difficulties in presurgical diagnosis in this type of growths.

[The incidence of the inappropriate ADH secretion syndrome (SIADH) in major otorhinolaryngologic surgery]. / Incidencia del sindrome de secrecion inadecuada de ADH (SIADH) en la cirugia mayor otorrinolaringologica.

There are few works dealing with the presentation of the inadequate secretion of antidiuretic hormone in major ENT procedures. In this prospective study done by the AA., based in analytic data, they found out the presence of the syndrome in as many as 39 percent of those operations. Consequently the suggestion is made that major ENT-surgery must be considered among the potential factors of the syndrome.

[Thornwaldt's cyst. The experience of a decade]. / Quiste de Thornwaldt. La experiencia de una decada.

The cyst of the Thornwaldt's bursa is a bulge on the postero-superior wall of the rhinopharynx, due to the closure of the sac's drainage duct. The bursa pharyngea being an embryologic remnant occurring in 3 percent of healthy adults. It is a process well known since a century, but only 11 cases (in 9 several publications) have been quoted in the last 20 years. Perusal of the cases seen at the ENT Department of the Clinic and Provincial Hospital of Barcelona during the latter decade.

[Incidence of Borrelia burgdorferi infection in isolated facial paralysis. A prospective study]. / Incidencia de la infección por Borrelia burgdorferi en la parálisis facial aislada. Estudio prospectivo.

Between the causes of facial paralysis, similar to Bell's palsy, recently are included those due to some families of spirochaeta (Borrelia burgdorferi) transmitted through tick-bite. These bacteria, besides de facial palsy, may produce several degrees of lymphocytic meningitis and subsequently the paralysis of the face, sometimes clumsy or recurrent. The treatment being the antibiotic drugs, never the corticoids. In the paper are explained prospectively the incidence of this disease in the AA's environment.

[Ototoxicity of deferoxamine]. / Ototoxicidad de la deferoxamina.

Deferoxamine or desferrioxamine (DFO) is a chelating agent, largely used in patients with chronic renal failure, although it has many side effects, being ototoxicity one of them. In this paper we studied the eventually adverse otologic effects of DFO in 20 patients receiving haemodialysis. A complete audiological evaluation, including pure-tone audiometry, brainstem auditory evoked potentials and high-frequency audiometry, was performed. The results showed a sensorineural hearing loss of retrocochlear origin in 3/20 cases (15%). We can accept that ototoxic effects of DFO are minimal, but no inexistent. Because of these we considered highly recommendable an accurate control of hearing in patients with renal disease receiving DFO.

[Bilateral chylothorax after radical neck dissection. Apropos of a case]. / Chylothorax bilateral après évidement radical du cou. A propos d'un cas.

Bilateral chylothorax following radical neck dissection is an uncommon complication of head and neck surgery. Only 9 more cases have been reported in the English literature until now. Early recognition is not difficult if it is bear in mind when evaluating dyspnoeic patients with bilateral pleural effusions after neck dissection. In this paper the authors report their experiences with a case and comment on the treatment employed. The authors believe that due to its potential severity, it must be considered when ever head and neck surgery is performed.

Asymptomatic electronystagmographic abnormalities in patients with type I diabetes mellitus.

Only a few studies have investigated vestibular function in diabetes mellitus (DM), showing contradictory results. We have performed an electronystagmographic (ENG) evaluation of 46 individuals with type I DM and 37 healthy controls. No patient reported subjective vestibular symptoms. Duration of caloric-induced nystagmus (DN) was significantly lower (2.1 +/- 0.7 vs. 2.6 +/- 0.4 min, p less than 0.01), and central nystagmus frequency of caloric response also nonsignificantly tended to be decreased (37.4 +/- 16.5 vs. 41.7 +/- 12.7 beats/30s, p = 0.21) in DM patients, as compared to controls. The latter comparison achieved significance after exclusion of newly diagnosed diabetic patients (33.4 +/- 16.1 vs. 41.6 +/- 12.7 beats/s, p less than 0.05). Depressed caloric reactions were seen in 21.8% of patients. DN was lower in patients with microalbuminuria and retinopathy, but this was not observed after exclusion of newly diagnosed diabetic patients, all of whom had normal ENG responses and no chronic diabetic complications. The existence of a lower DN and central nystagmus frequency should be borne in mind when interpreting ENG tracings in patients with long duration type I diabetes mellitus.

Auditory function in young patients with type 1 diabetes mellitus.

Comprehension of the effect of diabetes mellitus on auditory function has been hindered by the fact that previous studies have evaluated hearing function in heterogeneous groups of patients with diabetes mellitus, thus giving conflicting results. We have performed audiometric studies in 46 consecutive patients. 13 with newly diagnosed type 1 diabetes mellitus (group 1) and 33 with type 1 diabetes mellitus of more than 3 years of duration (group 2), of 14 to 40 years of age. The results were compared to an age-matched control group. Pure-tone auditory thresholds were significantly higher in all frequencies 250-8,000 Hz in both groups when compared to the control subjects. Ten patients, all of which belonged to group 2, had auditory thresholds above 30 dB in at least one frequency, showing a conversational hearing loss that ranged between 11 and 44%. However, none of them referred subjective hypoacusia. Univariate analysis revealed significant associations between auditory thresholds and age, duration of disease as well as retinopathy, but not with neuropathy, HbA1c or hypoglycaemic episodes. Only age and duration of disease independently correlated with an auditory threshold using multiple regression. We conclude that type 1 diabetes mellitus can cause mild sensorineural hearing impairment which correlates with age and duration of disease.

[Auditory evoked potentials in chronic alcoholism]. / Potenciales evocados auditivos en el alcoholismo crónico.

Prospective study of about 42 chronic alcoholics and evaluation, by means of auditory evoked potentials, of their auditive pathways. Checking of the damage at the outmost degree of the pathway, in alcoholic encephalopathy. Discussion and evaluation of the tracings.