[Spontaneous cervical emphysema and pneumomediastinum with voice disorders]. / Neumomediastino y enfisema cervical espontáneos con alteración en la voz.

Spontaneous cervical emphysema and pneumomediastinum, occurring in the absence of previous disorders or provocating factors, is very rare. The predominant symptoms are retroesternal pain, dyspnea, dysphagia and neck pain. The diagnosis is established radiologically. The evolution is generally good and conservative therapy leads to recovery in most patients. We present an unusual case of pneumomediastinum, cervical and retropharyngeal emphysema that spread to cavum; the suspected symptom was voice alteration as reported by the parents.

[Intra-tympanic gentamicin in the treatment of Ménière's disease: preliminary results ]. / Gentamicina intratimpánica en tratamiento de la enfermedad de Ménière: resultados preliminares.

In the majority of patients suffering of Ménière's disease, medical treatment is sufficient to control symptoms, albeit, in a small number of them, the high intensity and frequency of vertigo spells makes necessary to adopt more aggressive measures, like intratympanic or general aminoglycoside administration, as well as surgical procedures. We present a prospective and longitudinal descriptive study with the results of intratympanic gentamycin in 24 patients labeled of Ménière's disease in the Otolaryngology Department of "Miguel Servet Hospital" in the last two years, after a follow-up period of more than a year, during which controlled medical treatment had been proved unsuccesfull. We go over the efficacy in terms of frequency of vertigo crisis, audition average, logoaudiometry and functional level. We obtained good results over vertigo control (types A and B of the objective criteria based in the improvement index after treatment) in 16 out of the 24 patients (66.6%), (13 were type A with total absence of crisis and 3 were type B) and an acceptable result (type C) in three of them (12.5.%). In the other five patients (20.83%) results were disappointing (types D and E) compelling to apply surgical treatment. We have tried to evaluate intratympanic gentamycin as an alternative treatment to more aggressive technics and we consider it to be a good option, with a low risk and scarce complications in the no pharmacologically controlled Ménière's disease patients.

[Stapedectomy: long term results]. / Resultados a largo plazo de las estapedectomías.

Stapedectomy, with its most innovatory variations, constitutes the treatment of choice for otoesclerosis. Short term results are spectacular, getting GAP closures of less than 5 dB approximatelly in 94% patients, variations depending on the authors. Long term follow up check results show a gradual auditory deterioration. The aim of this study is to audiometric evolution of patients operated of stapedectomy 7 to 10 years ago in our department and to correlate the results with those obtained by other authors, in an attempt to unify conclusions.

[Histologic changes in soft palate in patients with obstructive sleep apnea]. / Cambios histológicos en el paladar blando en pacientes con apnea obstructiva del sueño.

In patients suffering from obstructive sleep apnea syndrome (OSAS) the reiterate injuries against the soft structures of the pharyngeal wall causes macro- and microscopic damages, which differ basically from the alterations verified in subjects without OSAS. We present a comparative histological study of 45 patients with OSAS operated on uvulopalatopharyngoplasties to face up 10 palates coming from normal post-mortem human among which a comparative anatomopathological study of 8 parameters was realized and the differences between the two groups signaled.

[Parotid metastases of a neuroendocrine cutaneous carcinoma]. / Metástasis parotídea de un carcinoma neuroendocrino cutáneo.

A case of metastatic Merkel-cell carcinoma to lymph nodes on the left side of the neck nad left parotid is described. Neuroendocrine cutaneous carcinoma, also called Merkel cell carcinoma (MCC), is an uncommon primary skin tumor most often seen in elderly. Literature is reviewed and comment about more important features of these lesions, like differential diagnosis, prognosis and treatment.

[Tonsillectomy in adults. Our experience]. / Amigdalectomía en adultos. Nuestra experiencia.

Tosillectomy or palatine tonsils removal was by far as the very middle of the twenty century the commonest surgery in childhood, but owing to the abstinence behavior in past decades this operation has dropped considerabily and in consequence numerous grown up presents frequently tonsillar pathology requiring its removal in middle adult life.

[Surgery of cancer of the larynx. Analysis of the results of our cases]. / Cirugía del cáncer de laringe. Análisis de resultados de nuestra casuística.

After 20 years of existence of this Department we decided to carry out a review of the characteristics of our series and also of the results of treatment, according to the protocol elaborated and followed in agreement with the Tumour Committee if the Hospital. 631 medical histories of patients diagnosed and operated for cancer of larynx between 1974 and 1990 were reviewed. 83 of which (13.154%) disappeared during the 5 year follow-up period. Epidemiological, clinical, location, extension and treatment fdata were considered as well as the survival results and a single descriptive statistical analysis performed. The mean age of our study was 59.02 years, showing a clear relation to exposure to tobacco (91.44% were smokers and 63.39% of more than 20 cigarettes per day). The predominant location of the growth was supraglottic (64.05% of cases) followed by glottic in 33.76%. The most frequently used surgical technique was the total laryngectomy and total and extended to either the pharynx or tongue basis in 76.28%, followed by supraglottic laryngectomy in 13m5%. The stages were rather advanced with predominance of stage III /40.60%) and stage IV (21.17%). Global survive rate of our series accounted for 68.61% while the adjusted survival rate was 71.4%.

[Neurinoma of the cervical hypoglossal nerve. A clinical case and review of the literature]. / Neurinoma del hipogloso cervical. Caso clínico y revisión de literatura.

Neurilemmomas are relatively rare tumors derived from Schwann cells that may occur at any part of the body. Many are encapsulated and they are more frequently encountered in adults. A neurilemmoma of the hypoglossal cervical nerve, an unusual site, is reported. Submaxillary angioma was initially suspected.

[Otologic manifestations of Langerhans cell histiocytosis]. / Manifestaciones otológicas de la histiocitosis de células de Langerhans.

A case of temporal bone eosinophilic granuloma is reported. The patient had no symptoms other than aural discharge, conductive hearing loss and postauricular swelling. Otic features of Langerhans cell histiocytosis, diagnosis preferences and therapeutic choices are reviewed.

[Acute epiglottitis in the adult. Retrospective study of 14 cases]. / Epiglotitis aguda del adulto. Análisis retrospectivo de 14 casos.

Acute epiglottitis instead of been a well recognised disease in children, is a rare condition in adult patients. Failure to diagnose epiglottitis early, in adults, undoubtedly contributes to its continuing mortality. We report our experience with acute epiglottitis in grown-up people with a retrospective series of 14 patients seen in our Department from 1993 to 1997. We comment about clinical features and therapeutic management of these patients.

[Benign positional paroxysmal vertigo in the general ear, nose, and throat clinic]. / El vértigo posicional paroxístico benigno en la consulta de ORL general.

Benign positional paroxysmal vertigo is a common disease which may be caused by abnormal movement of utricular debris in the posterior semicircular canal. It is diagnosed by the Dix-Hallpike positional maneuver eliciting vertigo and nystagmus. Treatment generally consists of physical exercises with the Epley or Semont maneuvers. We review 43 consecutive patients diagnosed as BPPV in the last year and treated with physical therapy (Epley maneuvers). Results were very good, with a cure rate of 88.37% (53.5% after a single maneuver). Physical therapy is an effective treatment for BPPV.

[Hernia of the external ear canal of uncommon origin]. / Hernia de etiología infrecuente en el conducto auditivo externo.

The temporo-mandibular joint is directly related to the anterior wall of the external ear canal. Therefore, defects in this wall may lead to herniation of the soft tissues of the temporo-mandibular joint into the external ear canal. Such herniation usually is secondary to external injuries, iatrogenic trauma, neoplasms, and so on, but it may also be congenital. We report a well-documented case of temporo-mandibular joint herniation into the external ear canal of probable congenital origin.

[Diffuse deep cervical infection. Report of three cases]. / Infección cervical profunda difusa. A propósito de tres casos.

Deep cervical infections still appear despite antibiotic use. Necrotizing fasciitis of the head and neck is a rare but serious infection caused by mixed, predominantly anaerobic bacterial flora. The natural course of the disease is spreading necrosis of the soft tissues of the neck and septicemia. Three recent cases of cervical necrotizing soft-tissue infection are presented. The importance of early and aggressive surgical treatment complemented by parenteral antibiotics with an aerobic-anaerobic spectrum is emphasized.

[Sphenoidal mucocele. A case report]. / Mucocele esfenoidal. A propósito de un caso.

Mucocele of the sphenoidal sinus is a rare benign neoplasm. These tumors are probably under-diagnosed as they may be asymptomatic or cause non-specific symptoms. The findings of computed tomography and magnetic resonance imaging increase the precision of the pretherapeutic evaluation. Treatment is surgical. A case of sphenoidal sinus mucocele in a 41-year-old man is reported. Sudden dyplopia was the first symptom. The characteristics of sphenoidal mucocele are reviewed, with special attention to its clinical features and radiodiagnosis.

[The effect of tobacco consumption on acoustic voice analysis]. / Efecto del consumo de tabaco en el análisis acústico de la voz.

An observational study of acoustic voice parameters was made in non-dysphonic adult smokers and non-smokers. The sustained vocal /a/ of 79 smokers and 169 non-smokers was recorded with Mini-Disk equipment. Acoustic analysis was performed with the Dr. Speech Science 3.0 program. Some acoustic parameters differed between smokers and non-smokers: the fundamental frequency (FQ) was lower in smokers. Average jitter (PPQ) and shimmer (APQ) were higher in smokers (Ji:0.27%, Shi: 2.56%) than in non-smokers (Ji: 0.23%, Shi: 2.02%). HNR and NNE values did not differ significantly.

[Our experience in chondrosarcoma. Three case reports]. / Nuestra experiencia en condrosarcomas de laringe. A propósito de 3 casos.

Sarcoma of the larynx are extremely rare neoplasms that account for approximately 1% of all tumors of this organ. Less than 0.1% correspond to chondrosarcomas. Three cases of laryngeal chondromas are described. The patient's age ranged between 65 and 75 years, and all they were men. Two of the tumors arose in the cricoid cartilage, and the other one, in the left wing of the thyroid cartilage. Two of the cases corresponded to high-grade, indifferentiated chondrosarcoma. Two of the patients were alive and free of recurrence of metastases 5 years after surgery.

[Acoustic analysis of the normal voice in nonsmoking adults]. / Análisis acústico de la voz normal en adultos no fumadores.

Acoustic analysis was made of 154 voices of healthy non-smokers adults. A sustained vowel /a/ was recorded on a mini-disc. Acoustic analysis was carried out with Dr. Speech Science software. Fundamental frequency (F0), standard deviation of the fundamental frequency (SD F0), jitter PPQ (%), shimmer APQ (%), harmonic-to-noise ratio (HNR), and normalized noise energy (NNE) were estimated. Mean F0 was 201 Hz in women and 129 Hz in men. F0 increased with age in men. In women, changes in F0 with age were not statistically significant. Age, sex and F0 did not significantly influence jitter, shimmer or HNR. An acceptable normal threshold is 0.5% jitter. Three percent shimmer excludes 13% of healthy persons. Our HNR values were higher than those reported elsewhere (95th percentile: 18 dB). An NNE threshold of -10 dB is unacceptable because it excludes 38% of healthy persons. NNE differed with sex (mean difference: 3-5 dB). Methodology, sample characteristics and the vowel /a/ may account for some of the differences in results.

[MALT lymphoma of the parotid gland associated with Sjögren syndrome. A case report and review of literature]. / Linfoma MALT de glándula parótida en asociación con síndrome de Sjögren. Aportación de un caso y revisión de la literatura.

Sjögren syndrome (SS) is a chronic inflammatory process involving the exocrine glands. Its association with the development of lymphomas is well documented, and this risk has estimated to be 44 times that of the general population. A MALT lymphoma of the parotid gland in a patient with Sjögren syndrome is reported. We review the literature and comment the clinical and histopathological features of these tumors.