[Amyotrophic lateral sclerosis that begins with voice and deglution alterations]. / Ela que debuta con alteraciones en la voz y en la deglución.

Amyotrophic lateral sclerosis is a progressive degenerative neuromuscular disease of insidious onset. It involves upper and lower motor neurons and causes both spastic and atrophic muscular symptoms. More than one fourth of patients have complaints relating to the head and neck (bulbar palsy); thus, the otolaryngologist may be the first physician to see them. In bulbar forms of Amyotrophic Lateral Sclerosis, voice and/or swallowing difficulties are often the initial signs of disturbance. Predominant symptoms are slurred speech, hoarseness, dysphagia, and dyspnea. Muscular weakness, atrophy, and fasciculation are noted on examination. We show a case and revise bibliography.

ELA que debuta con alteraciones en la voz y en la deglución / Amyotrophic lateral sclerosis that begins with voice and deglution alterations

La esclerosis lateral amiotrófica es una enfermedad neuromuscular degenerativa de comienzo insidioso. Afecta a las neuronas superiores e inferiores y causa síntomas espásticos y atróficos. Más de un cuarto de los pacientes tienen sintomatología referida a cabeza y cuello (parálisis bulbar), por lo que el otorrinolaringólogo puede ser el primer médico en diagnosticarlo. En las formas bulbares de esclerosis lateral amiotrófica, las alteraciones en la voz y la deglución son a menudo los síntomas iniciales de la enfermedad. Los sín tomas predominantes son los trastornos del habla, disfonía, disfagia y disnea. Debilidad muscular, atrofia y fasciculaciones pueden encontrarse también en la exploración. Presentamos un caso y revisamos la bibliografía al respecto

Amyotrophic lateral sclerosis is a progressive degenerative neuromuscular disease of insidious onset. It involves upper and lower motor neurons and causes both spastic and atrophic muscular symptoms. More than one fourth of patients have complaints relating to the head and neck (bulbar palsy); thus, the otolaryngologist may be the first physician to see them. In bulbar forms of Amyotrophic Lateral Sclerosis, voice and/or swallowing difficulties are often the initial signs of disturbance. Predominant symptoms are slurred speech, hoarseness, dysphagia, and dyspnea. Muscular weakness, atrophy, and fasciculation are noted on examination

[The importance of larynx electromyography for the differential diagnosis of vocal cord fixation]. / Importancia de la electromiografía laríngea para el diagnóstico diferencial de la fijación de las cuerdas vocales.

Fourteen patients have been studied, with precedents of endotracheal intubation, suffering dysphonia and fixation of one vocal cord (13 cases) or both (1 case). The lack of neutrogen signs was confirmed through conventional electromyography, and objectivity because the clinical findings pointing to a direct traumatism of the vocal cord, the cricoarytenoid joint or an inflammatory origin of the damage. We support the limitation of electromyographic procedures of the larynx facing the conductive techniques and concede the possibility of the use of magnetic stimulation with this purpose.

[Papillary transitional cell carcinoma of the frontal sinus]. / Carcinoma papilar de células transicionales del seno frontal.

INTRODUCTION: A case is reported of primary transitional-cell carcinoma in the frontal sinus of a 54-year-old woman, which was interesting because of the histological type, evolution, and difficulty of follow-up. CLINICAL CASE: A 54-year-old woman with no history of exposure to risk factors presented swelling of the frontal area of 3 months duration. Fine needle aspiration biopsy revealed an adenoma but TAC showed an intrasinusal tumor with destruction of the inner and outer walls. Surgical exeresis revealed the correct histological diagnosis. Local recurrence at 12 months, without cervical lymph nodes or distant metastases, was treated surgically and the patient remained asymptomatic and disease-free 24 months later. DISCUSSION: Malignant tumors of the frontal sinus are rare in the literature. We describe the histological features of transitional-cell tumor and emphasize its similarity with papilloma, benign behavior and management options, in which surgery is of choice. Prognostic and survival factors in the literature are reviewed.

[Electromyographic study of psychogenic dysphonias]. / Estudio electromiográfico de las disfonías psicógenas.

Psychogenic dysphonia traditionally has been considered a case of dystonia in which the functional disturbance is attributed to a disturbance in the synchronization of the laryngeal abductor and adductor muscles. Five patients with psychogenic dysphonia were studied by telelaryngoscopy and conventional laryngeal electromyography. This excluded the neuromuscular origin of the damage and confirmed the diagnosis. A complete glottic gap was present during phonation at the beginning of the exploration, but at the end of the examination, direct laryngoscopy revealed complete glottic closure with normal phonation. Laryngeal electromyography showed no abnormalities suggestive of a neuromuscular origin. In every case, the effort patterns of motor unit potentials were normal and denervation activity was absent in resting conditions.

[The importance of psychological profile of patients with tinnitus]. / Importancia del perfil psicológico en el enfermo con acúfenos.

We performed a psychological profile study in 43 patients showing tinnitus as only symptom. We have employed two different questionnaires, EPI and STAI, to evaluate the state of neuroticism, extroversion and anxiety. The score of neuroticism and anxiety are very important in order to get and individual treatment.

[Standard electromyography for the diagnosis and prognosis of laryngeal neuromuscular disorders]. / Electromiografía convencional en el diagnóstico y pronóstico de los trastornos neuromusculares de la laringe.

The clinical use of the laryngeal electromyography is still scanty; nevertheless, in our experience it has been shown to be an efficient and objective test in the study of the neurological disorders of the larynx and in the prognosis of recovery after vocal cord paralysis. We have performed conventional electromyography of the thyroarytenoid and cricothyroid muscles in 25 patients with laryngoscopically--confirmed vocal cord paralysis of different etiology. Positive sharp waves, fibrillation potentials and decreased or absent activity on maximal voluntary effort provided enough evidence of denervation in those cases of neurogenic origin. An increased number of polyphasic potentials and increased length of the motor unit potentials recruited in reduced interference patterns were considered suggestive of reinervation, which has an outstanding prognostic value on laryngeal neuropathy. Voluntary motor units, even in some clinically non-mobile vocal cords, were identified in recruitment patterns. Laryngeal electromyography can be done as an office procedure with a minimum of discomfort. It gives objective evaluation of the neuromuscular status, and shows direct evidence of cord function, being useful to distinguish from supranuclear and mechanical disorders of the larynx. It has also shown to be efficient as recovery predictor after vocal cord paralysis.