Otologic, audiometric and speech findings in patients undergoing surgery for cleft palate.

BACKGROUND: Although considerable progress has been made in the last 30 years in the treatment of cleft palate (CP), a multidisciplinary approach combining examinations by a paediatrician, maxillofacial surgeon, otolaryngologist and speech and language pathologist followed by surgical operation is still required. In this work, we performed an observational cross-sectional study to determine whether the CP grade or number of ventilation tubes received was associated with tympanic membrane abnormalities, hearing loss or speech outcomes. METHODS: Otologic, audiometric, tympanometric and speech evaluations were performed in a cohort of 121 patients (children > 6 years) who underwent an operation for CP at the Vall d'Hebron Hospital, Barcelona from 2000 to 2014. RESULTS: The most and least frequent CP types evaluated according to the Veau grade were type III (55.37%) and I (8.26%), respectively. A normal appearance of the membrane was observed in 58% individuals, of whom 55% never underwent ventilation ear tube insertion. No statistically significant associations were identified between the CP type and number of surgeries for insertion of tubes (p = 0.820). The degree of hearing loss (p = 0.616), maximum impedance (p = 0.800) and tympanic membrane abnormalities indicative of chronic otitis media (COM) (p = 0.505) among examined patients revealed no statistically significant association with the grade of CP. However, an association was identified between hypernasality and the grade of CP (p = 0.053), COM (p = 0.000), hearing loss (p = 0.000) and number of inserted ventilation tubes. CONCLUSION: Although the placement of tympanic ventilation tubes has been accompanied by an increased rate of COM, it is still important to assess whether this is a result of the number of ventilation tubes inserted or it is intrinsic to the natural history of middle ear inflammatory disease of such patients. Our results do not support improvements in speech, hearing, or tympanic membrane abnormalities with more aggressive management of COM with tympanostomy tubes.

Lipoma de conducto auditivo interno / Internal auditory canal lipoma

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Síndrome de Ramsay Hunt: nuestra experiencia / Ramsay Hunt syndrome: our experience

Introducción: El síndrome de Ramsay Hunt (SRH) es causado por el virus Varicela-Zoster (VVZ) y está caracterizado clínicamente por erupciones cutáneas a nivel auricular, parálisis facial periférica (PFP), y afectación cócleo-vestibular. Objetivo: Analizar la evolución clínica de los síntomas más frecuentes del SRH y valorar la evolución de los mismos en un período superior a los 6 meses. Métodos: Estudio retrospectivo y descriptivo que incluye a todos los pacientes que acudieron al servicio de urgencias con el diagnóstico de SRH entre enero de 1995 y diciembre de 2004, y que fueron controlados por un período superior a los 6 meses. Resultados: Total de 54 pacientes. Rango de edad: 16 y 74 años, media de 49 años. El 7,5% de los pacientes debutaron con PFP seguido de síntomas cócleo-vestibulares mientras que el 20,2% presentaron de forma concomitante ambos síntomas. El 72,4% presentó clínica cócleo-vestibular previa a la PFP. La otodinia se presentó en un 83% en las primeras 48h. La hipoacusia fue referida en el 26% de los enfermos, acúfenos en un 7% y síntomas vestibulares en 84% de los casos. Conclusión: La recuperación de la PFP se relaciona con el grado de afectación inicial. Las manifestaciones cócleo-vestibulares son más frecuentes en pacientes con un mayor grado de afectación del nervio facial. La hipoacusia suele presentar una evolución tórpida. Los síntomas vestibulares tienen una buena respuesta clínica. La hipoacusia puede pasar inadvertida en estos pacientes y debe ser siempre confirmada con las pruebas complementarias (AU)

Introduction: Ramsay Hunt syndrome (RHS) is a disease caused by the Varicella Zoster virus and characterised by skin rash, peripheral facial palsy and otologic symptoms. Objective: This was an epidemiological study on the incidence and prognosis of this syndrome. Methods: A retrospective study was carried out on the patients diagnosed with RHS who were seen in the emergency room between January 1995 and December 2004, and were followed up for more than 6 months. Results: Of the 54 patients included in this study, 7.5% had facial palsy as their first symptom, followed by otologic signs (20.2% had both simultaneously); 72.5% presented otologic signs before facial palsy. Hypoacusis was reported in 26% of the patients, but was objectively present in all of them. The level of facial palsy determined the prognosis. Conclusion: In this syndrome, the prognosis of facial palsy depends on the initial symptoms and clinical findings. Otologic symptoms occur more frequently in patients having a greater degree of facial nerve affectation. Vestibular symptoms have a good prognosis. Hypoacusis is much more frequent than reported; as it may go unnoticed in these patients, it should always be confirmed by complementary tests (AU)

[Ramsay Hunt syndrome: our experience]. / Síndrome de Ramsay Hunt: nuestra experiencia.

INTRODUCTION: Ramsay Hunt syndrome (RHS) is a disease caused by the Varicella Zoster virus and characterised by skin rash, peripheral facial palsy and otologic symptoms. OBJECTIVE: This was an epidemiological study on the incidence and prognosis of this syndrome. METHODS: A retrospective study was carried out on the patients diagnosed with RHS who were seen in the emergency room between January 1995 and December 2004, and were followed up for more than 6 months. RESULTS: Of the 54 patients included in this study, 7.5% had facial palsy as their first symptom, followed by otologic signs (20.2% had both simultaneously); 72.5% presented otologic signs before facial palsy. Hypoacusis was reported in 26% of the patients, but was objectively present in all of them. The level of facial palsy determined the prognosis. CONCLUSION: In this syndrome, the prognosis of facial palsy depends on the initial symptoms and clinical findings. Otologic symptoms occur more frequently in patients having a greater degree of facial nerve affectation. Vestibular symptoms have a good prognosis. Hypoacusis is much more frequent than reported; as it may go unnoticed in these patients, it should always be confirmed by complementary tests.