Desórdenes temporomandibulares y acúfenos / Temporomandibular joint disorders and tinnitus

Ensayos clínicos recientes han demostrado la mayor prevalencia de acúfenos en pacientes diagnosticados de desórdenes temporomandibulares. A día de hoy el mecanismo fisiopatológico del acúfeno aún no se ha confirmado y las distintas teorías planteadas para relacionar ambas entidades tampoco se han podido demostrar en su totalidad. El objetivo de este trabajo es realizar una revisión bibliográfica del tema, exponiendo aquellas hipótesis que se consideran más relevantes en la actualidad (AU)

Recent clinical trials have demonstrated the greater prevalence of tinnitus in patients diagnosed with temporomandibular disorders. To date the physiopathological mechanism of the tinnitus has not yet been confirmed and it has not been possible to demonstrate completely the different theories proposed to relate the two entities. The objective of this work is to perform a bibliographical review of the subject, setting out the hypotheses that are considered more relevant at present (AU)

[Delayed vertigo after stapedotomy with good hearing results]. / Vértigo diferido tras estapedotomía con buen resultado auditivo.

Stapedial surgery is able to obtain excellent hearing results in the long-term in most otosclerotic patients. Nevertheless, some cases have vertigo and/or tinnitus after surgery, that may lead them to revision surgery. Out of a consecutive series on 115 patients, we present three cases (2,6%) with persistent vertigo after stapedotomy. These patients had residual unsteadiness despite good hearing after surgery, with a minimum follow-up of 12 months. Videonystagmography showed spontaneous nystagmus towards the contralateral ear in one case, whereas the other two had a canalicular paresis in the operated side, signs of vestibular hypofunction. After vestibular rehabilitation, unsteadiness resolved in all cases, with good spontaneous compensation, without any further surgery.

Vértigo diferido tras estapedotomía con buen resultado auditivo / Delayed vertigo after stapedotomy with good hearing results

La cirugía del estribo consigue Buenos resultados auditivos a largo plazo en la mayoría de los pacientes con otosclerosis. Sin embargo, existen pacientes que sufren debutan cono tros síntomas como vértigo o acúfenos tras la cirugía, que pueden ser la causa de revisión. De una serie de 115 pacientes, presentamos tres casos (2,6%) de vértigo persistente en pacientes intervenidos de estapedotomía. Se trata de pacientes que padecen inestabilidad residual tras estapedotomía con buena ganancia auditiva, tras un seguimiento mínimo de doce meses. En uno de ellos, la videonistagmografía evidenciaba la presencia de nistagmo espontáneo hacia el oido no operado, mientras que en los otros dos demostraba una paresia canalicular del lado operado, todo ellos signos de hipofunción vestibular. Tras seguimiento y rehabilitación vestibular, la inestabilidad se resolvió en todos los casos, con buena compensación espontánea, sin necesidad de revisión quirúrgica. Realizamos una revisión de la fisiopatología del vértigo posoperatorio en la cirugía del estribo, especialmente en aquellos casos en los que existe ganancia auditiva

Stapedial surgery is able to obtain excellent hearing results in the long term in most otosclerotic patients. Neverthless, some cases have vertigo and/or tinnitus after surgery, that may lead them to revision surgery. Out of a consecutive series on 115 patients, we present three cases (2,6%) with persistent vertigo after stapedotomy. These patients had residual unsteadiness despite good hearing after surgery, with a minimum follow-up of 12 months. Videonystagmography showed spontaneous nystagmus towards the contralateral ear in one case, whereas the other two had a canalicular paresis in the operated side, signs of vestibular hypofunction. After vestibular rehabilitation, unsteadiness resolved in all cases, with good spontaneous compensation, without any further surgery. We review the physiopathology of postoperative vertigo alter stapedial surgery, especially in those cases with good hearing recovery

[Neuro-otological manifestations as presentacion of type I Chiari malformation]. / Manifestaciones otoneurológicas como presentación de la malformación de Chiari tipo I.

The type I Chiari malformation consists of an caudal descent of the cerebellar tonsils through the foramen magno towards the spinal cervical channel. The usual clinical presentation are occipital headaches and cervical pain, as well as some otoneurological symptoms. Among them are common dizziness and crisis of central positional vertigo in which down beating nystagmus can be observed. We present our experience with three cases presenting with neurotological manifestations in which MRI showed a type I Chiari malformation. Case 1: a patient of 24 years that had frequent instability, and common crisis ofpositional vertigo. It was possible to see the presence of positional down-beating nystagmus, of central characteristics, that improved after neurosurgical treatment. Case 2: patient of 11 years who suffered from occasional headaches, dizziness and positional vertigo, without severe handicap, and did not need surgery. Case 3: lady of 63 years who had common episodes of vertigo with head tilt, and unsteadiness during walks. Due to the coexistence of hydrocephalus and syringomyelia, surgery was indicated. A revision is done on otoneurological presentation of type I Chiari malformation, especially as differential diagnosis on central positional vertigo.

Manifestaciones otoneurológicas como presentación de la malformación de Chiari tipo I / Neurotological manifestation as presentation of type 1 Chiari malformation

La malformación de Chiari tipo I consiste en un desplazamiento caudal de las amígdalas cerebelosas a través del foramen magno hacia el canal cervical espinal. La presentación clínica habitual de esta anomalía son las cefaleas y dolores cervicales, así como algunos síntomas otoneurológicos. Entre ellos son comunes los cuadros de inestabilidad y episodios de vértigo posicional central en los que se objetiva nistagmo vertical hacia abajo. Presentamos nuestra experiencia en tres casos con alteraciones otoneurológicas en los que la resonancia magnética craneal demostró el diagnóstico de malformación de Chiari tipo I. En primer lugar, una paciente de 24 años que consultó por un cuadro de inestabilidad habitual y frecuentes episodios de vértigo posicional, en los que presentaba nistagmo posicional hacia abajo, que mejoraron tras tratamiento neuroquirúrgico. En segundo lugar, un paciente de 11 años que presentó episodios esporádicos de cefalea, asociada a inestabilidad y vértigo posicional, sin incapacidad evidente, por lo que no se derivó para tratamiento quirúrgico. En tercer lugar, una paciente de 63 años que padecía crisis de vértigo con los movimientos cefálicos, así como inestabilidad en la marcha. Ante la coexistencia de hidrocefalia y siringomielia, se derivó a la paciente para tratamiento neuroquirúrgico. Realizamos una revisión de las alteraciones otoneurológicas con las que puede presentarse la malformación de Chiari tipo 1, especialmente como diagnóstico diferencial dentro de los cuadros de vértigo posicional central

The type I Chiari malformation consists of an caudal descent of the cerebellar tonsils through the foramen magno towards the spinal cervical channel. The usual clinical presentation are occipital headaches and cervical pain, as well as some otoneurological symptoms. Among them are common dizziness and crisis of central positional vertigo in which down beating nystagmus can be observed. We present our experience with three cases presenting with neurotological manifestations in which MRI showed a type I Chiari malformation. Case 1: a patient of 24 years that had frequent instability, and common crisis of positional vertigo. It was possible to see the presence of positional down-beating nystagmus, of central characteristics, that improved after neurosurgical treatment. Case 2: patient of 11 years who suffered from occasional headaches, dizziness and positional vertigo, without severe handicap, and did not need surgery. Case 3: lady of 63 years who had common episodes of vertigo with head tilt, and unsteadiness during walks. Due to the coexistence of hydrocephalus and syringomyelia, surgery was indicated. A revision is done on otoneurological presentation oftype I Chiari malformation, especially as differential diagnosis on central positional vertigo

[The use of magnetic resonance in the study of sensorineural hearing loss in children]. / Utilidad de la rm en el estudio de la hipoacusia neurosensorial unilateral infantil.

Although newborn screening of congenital hearing loss through otoacustic emissions allow prompt recognition, imaging techniques, such as CT and MRI are needed to get a morphological diagnosis. Furthermore they can be very useful in unilateral cases, whose clinical presentation is belated and more insidious. Our aim is to show the utility of MRI in the study of inner ear congenital anomalies, whose presentation is belated. Thus from a series of 88 consecutive patients in which a MRI was performed as screening of assymetric sensorineural hearing loss, we selected 6 cases aged between 6 and 20. Four of them showed an inner ear anomaly on MRI. We present these anomalies commenting the findings on CT and MRI. Imaging techniques are required to start hearing rehabilitation programs early on patients with bilateral inner ear anomalies. But also they are very useful in the evaluation of unilateral assymetric sensorineural hearing loss, in young patients, even if only some frequencies are damned, to determine the nature of hearing loss.

Alteraciones del olfato en la consulta ORL general / Olfaction disturbances in general ORL practice

Revisión de las alteraciones olfatorias de los pacientes de una consulta de ORL en un hospital general cuando éste es el motivo fundamental de consulta. Es un estudio retrospectivo y descriptivo. Incluimos en el estudio todos los pacientes con alteraciones del olfato como principal motivo de consulta. La muestra recogida fueron 38 pacientes. Definimos las etiologías de las alteraciones del olfato: viral, idiopática, postraumática, tóxica, medicamentosa e inflamatoria. Los estudios realizados en cada paciente fueron: anamnesis, endoscopia nasal y exploración de imagen. Las alteraciones del olfato son más frecuentes en mujeres (2:1), a partir de los 55 años y la causa más frecuente es la viral (55,3 per cent). La endoscopia nasal fue normal en la mayoría de los casos (68,4 per cent). El estudio de imagen más utilizado en nuestra consulta es la TC (68,4 per cent). La recuperación es mayor en pacientes jóvenes y en aquellas lesiones reversibles (AU)

Analysis of smell disturbances in the ENT outpatients department of in a General Hospital. A retrospective and descriptive study. We include all patients with olfactory alterations as the main reason for consultation. The sample was 38 patients. Viral, postraumatic, toxic, drug-induced and inflammatory. We performed anamnesis, nasal endoscopic and scan images on all patients. Olfactory disturbances were more frequent in women older than 55 (2:1). The viral cause was the most frequent aethiology (55.3%). Nasal endoscopic exploration was normal in 68.4% patients. The CT scan was the main imaging study used (68.4%). The younger patients recovered better than the older ones. Smell disorders provoked by virus, toxic and medical drugs do have a better (AU)

[Olfaction disturbances in general ORL practice]. / Alteraciones del olfato en la consulta ORL general.

Analysis of smell disturbances in the ENT outpatients department of in a General Hospital. A retrospective and descriptive study. We include all patients with olfactory alterations as the main reason for consultation. The sample was 38 patients. Viral, postraumatic, toxic, drug-induced and inflammatory. We performed anamnesis, nasal endoscopic and scan images on all patients. Olfactory disturbances were more frequent in women older than 55 (2:1). The viral cause was the most frequent aethiology (55.3%). Nasal endoscopic exploration was normal in 68.4% patients. The CT scan was the main imaging study used (68.4%). The younger patients recovered better than the older ones. Smell disorders provoked by virus, toxic and medical drugs do have a better.

[Polyps of the external auditory canal and cholesteatoma]. / Pólipos de CAE y colesteatoma.

A retrospective study of 50 patients with an aural polyp located in the external auditory canal was made. Our main objective was to identify predictive factors for underlying cholesteatoma, as well as to determine our management strategy for aural polyps. We analyzed the most important findings of otological imaging, hearing loss, radiological examination, and medical or surgical treatment. The anatomopathological examination in some cases showed a rare pathology that should be considered in our diagnostic evaluation. The presence of cholesteatoma underlying the polyp in 52% of cases indicates the importance of the polyp location and radiological signs as predictive factors for the diagnosis of cholesteatoma.

[Criteria for assessing functional results in middle ear surgery]. / Criterios para valoración de resultados funcionales en la cirugía de oído medio.

INTRODUCTION AND OBJECTIVES: Comparison of reports of the functional results of middle-ear surgery is difficult because there are no standardized criteria, such as; auditory activity, histology, evaluation of functional results, follow-up period, etc. Moreover, surgeons and patients often disagree over the results obtained. The functional results obtained in 246 middle-ear operations performed in our department for postotorrhea sequelae were analyzed. MATERIAL AND METHOD: Using the SMYTH and PATTERSON criteria, benefits were analyzed in 246 patients for whom functional results were available. RESULTS: Benefits were analyzed by type of surgery, type of ossiculoplasty, presence or absence of stapedial superstructure, and subjective patient assessment. DISCUSSION AND CONCLUSIONS: Results were analyzed as surgical evaluation of functional outcome in relation to subjective patient assessment. Guidelines for standardizing criteria for the functional evaluation of middle-ear surgery are proposed.