Study of the influence of psychological factors in the etiology of vocal nodules in women.

OBJECTIVE: The role placed by certain psychological factors such as stress and personality on the development of vocal nodules has not yet been established. The aim of this case-control type study is to analyze the relationship between these psychological factors and the presence of vocal nodules while also considering the professional and social aspects of the subjects suffering from this pathology. METHODS: The case group is made up of 50 patients diagnosed with vocal nodules and with at least 6 months of evolution. The control group is made up of 50 patients diagnosed with nasal respiratory insufficiency. All the patients were examined by laryngeal stroboscopy. For the personality study, the perceived stress, and the voice use, the Minnesota Multiphasic Personality Inventory-2, Levenstein Perceived Stress Questionnaire, and Goldman Voice Use Survey were used, respectively. RESULTS: The subjects with vocal nodules presented a mean perceived stress score of 0.41±0.09, which was higher than that of the control group (0.35±0.06), the differences observed being statistically significant (P<0.001). In the personality study (MMPI-2), the only scale that was associated with the presence of the vocal nodules was that of psychomotor acceleration. The mean score obtained for the scale was 51.64±8.25 in the vocal nodule group and 45.02±0.06 in the control group (P<0.001). In the analysis of voice use, the subjects with vocal nodules scored 9.31±1.36, which was significantly higher than the score of the control group (8.07±1.24; P<0.001). In addition, other variables were associated with the presence of vocal nodules, such as being young and working in professions considered to be of vocal risk. CONCLUSIONS: Perceived stress and personality features of hyperactivity and impulsivity are independent factors related to vocal nodules.

Carcinoma neuroendocrino de fosa nasal ¿una entidad independiente? / Neuroendocrine carcinoma of nasal fossa. An independant entity?

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[The role of video-nystagmography in the diagnosis of acoustic neuroma]. / El papel de la videonistagmografía en el diagnóstico del neurinoma del acústico.

AIM: Schwannoma of the vestibular nerve represents 75% of all expansive processes affecting the pontocerebellosum angle. Hearing loss is the most frequent symptom at diagnosis (86%) with or without tinnitus, in the intracanalicular tumors. Vestibular symptoms are described in 60% of patients. MATERIAL AND METHOD: We study twenty cases of acoustic neuromas diagnosed between years 2000 and 2002 in both Otolaryngology and Neurosurgery Departments in our hospital. Videonystagmography (VNG) was performed in all of them. Videonystagmographic findings were analyzed statistically together with the tumoral size and hypoacusia level. DISCUSSION AND CONCLUSION: According to the medical literature reviewed for this paper, we conclude that caloric tests are the most frequently altered ones (77%), showing vestibular hyporreflexia or arreflexia.

Vértigo posicional paroxístico no benigno / No benign paroxystic positival vertigo

El vértigo posicional es una manifestación clínica frecuente de vértigo de causas muy variadas, siendo el vértigo posicional paroxístico benigno (VPPB) el tipo de vértigo posicional más frecuente, representando incluso la causa más frecuente de vértigo periférico en algunas series. Generalmente de etiología benigna, puede aparecer vértigo posicional en el contexto de entidades de gran gravedad y difícil diagnóstico. En estos casos, la persistencia de los síntomas a pesar de las maniobras de reposicionamiento, la asociación con otra sintomatología otológica o neurológica, así como el nistagmo de características atípicas provocado en la maniobra de Dix-Hallpike, deben hacer sospechar al otorrinolaringólogo de la posible existencia de una patología no benigna. Presentamos un caso de VPP causado por una tumoración intracraneal y revisamos los signos clínicos que nos ayudan a sospechar patologías no benignas que pueden simular un vértigo posicional (AU)

Positional vertigo is a frequent clinical manifestation of vertigo of very different etiologies, being the benign paroxystic positional vertigo (BPPV) the most frequent one of them, representing in some series even the most found etiology of peripheral vertigo. Usually of severe entities, positional vertigo may appear in the context of severe entities and of difficult diagnosis. In these cases, the bearing of the symptoms in spite of the repositioning manoeuvers, the association with otological or neurological symptoms, and the atypical nystagmus evoked by Dix-Hallpike manoeuver, must take the otolaryngologist to suspect of a feasible non benign pathology. We report a case of positional paroxysmal vertigo caused by an intracranial tumour and we review the clinical signs that shoved help us to suspect of non benign pathologies that can mimic a positional vertigo (AU)

El papel de la videonistagmografía en el diagnóstico del neurinoma del acústico / The role of videonystagmography in the diagnosis of acoustic neuroma

Objetivo: El Schwannoma del nervio vestibular representa el 75 por ciento de los procesos expansivos del ángulo pontocerebeloso (APC). La hipoacusia con o sin tinnitus es el síntoma debut más frecuente (86 por ciento) en los tumores intrameatales. Los síntomas vestibulares se dan en el 60 por ciento de los pacientes. Material y método: Revisamos 20 casos de neurinomas diagnosticados entre los años 2000 y 2002 en los servicios de Otorrinolaringología y Neurocirugía de nuestro hospital a los que les hemos realizado videonistagmografía (VNG), y analizamos estadísticamente los hallazgos videonistagmográficos en relación con el tamaño tumoral y con el grado de hipoacusia. Discusión y conclusión: Revisamos la literatura médica al respecto y acordamos con ella en que la prueba calórica es la que con más frecuencia se altera (77 por ciento) en forma de hipo o arreflexia vestibular. (AU)

AIM: Schwannoma of the vestibular nerve represents 75% of all expansive processes affecting the pontocerebellosum angle. Hearing loss is the most frequent symptom at diagnosis (86%) with or without tinnitus, in the intracanalicular tumors. Vestibular symptoms are described in 60% of patients. MATERIAL AND METHOD: We study twenty cases of acoustic neuromas diagnosed between years 2000 and 2002 in both Otolaryngology and Neurosurgery Departments in our hospital. Videonystagmography (VNG) was performed in all of them. Videonystagmographic findings were analyzed statistically together with the tumoral size and hypoacusia level. DISCUSSION AND CONCLUSION: According to the medical literature reviewed for this paper, we conclude that caloric tests are the most frequently altered ones (77%), showing vestibular hyporreflexia or arreflexia (AU)

[Non-benign paroxysmal positional vertigo]. / Vértigo posicional paroxístico no benigno.

Positional vertigo is a frequent clinical manifestation of vertigo of very different etiologies, being the benign paroxystic positional vertigo (BPPV) the most frequent one of them, representing in some series even the most found etiology of peripheral vertigo. Usually of severe entities, positional vertigo may appear in the context of severe entities and of difficult diagnosis. In these cases, the bearing of the symptoms in spite of the repositioning manoeuvers, the association with otological or neurological symptoms, and the atypical nystagmus evoked by Dix-Hallpike manoeuver, must take the otolaryngologist to suspect of a feasible non benign pathology. We report a case of positional paroxysmal vertigo caused by an intracranial tumour and we review the clinical signs that shoved help us to suspect of non benign pathologies that can mimic a positional vertigo.

[Neuroendocrine carcinoma of the nasal fossa. An independent entity?]. / Carcinoma neuroendocrino de fosa nasal. Una entidad independiente?

We present one case of a neuroendocrine carcinoma of nasal fossa and paranasal sinuses, of aggressive behavior, which has been controlled with chemo-radiotherapy after a double postsurgical recurrence. We do a literature revision emphasizing the anatomopathologic differentiation of these tumors with the olfactory neuroblastomas, and the therapeutic controversies in advanced stages.

[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.

Gentamicina intratimpánica en tratamiento de la enfermedad de Ménière: resultados preliminares / Intratympanic gentamycin for the treatment of Ménière's disease

En la mayoría de los pacientes con Enfermedad de Ménière, el tratamiento médico es suficiente para controlar los síntomas, sin embargo, en un pequeño porcentaje, la intensidad y la frecuencia de las crisis hacen necesario adoptar medidas más agresivas, entre ellas la administración de aminoglucósidos por vía local o sistémica, o bien procedimientos quirúrgicos. Hemos realizado un estudio descriptivo longitudinal y prospectivo de la respuesta al tratamiento con gentamicina intratimpánica, en 24 pacientes diagnosticados de Enfermedad de Ménière en el Servicio de ORL del Hospital "Miguel Servet" en los dos últimos años, tras más de un año de tratamiento médico inefectivo. Se revisa la eficacia en cuanto a frecuencia de crisis de vértigo, media de audición, audiometría verbal y nivel funcional. Hemos obtenido un buen resultado en cuanto al control del vértigo (clase A y B de los criterios de objetivación según el índice de mejoría tras tratamiento) en 16 de los 24 pacientes (66,6 por ciento) (13 clase A con desaparición total de las crisis y 3 clase B) y un resultado aceptable (clase C) en tres (12,5 por ciento).El resultado fue malo (clase D y E), con necesidad de pasar a tratamiento quirúrgico en otros cinco pacientes (20,83 por ciento). Evaluamos la gentamicina intratimpánica como tratamiento alternativo a técnicas más agresivas, y lo consideramos un tratamiento eficaz, con poco riesgo y escasas complicaciones en la Enfermedad de Ménière no controlada farmacológicamente (AU)

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 (AU)

Resultados a largo plazo de las estapedectomías / Stapedectomies. Long term results

La estapedectomía, con sus más innovadoras variantes, constituye el tratamiento de elección de la otoesclerosis. Los resultados a corto plazo de esta intervención son espectaculares. El seguimiento a lo largo de los años de estos enfermos parece reflejar un deterioro auditivo paulatino. El objetivo de nuestro trabajo es saber si existe deterioro audiométrico valorable en los enfermos intervenidos de estapedectomía hace más de 7 años con buen resultado inicial. Material y métodos: Revisamos pacientes intervenidos de estapedectomía hace 7-10 años en nuestro servicio con buen resultado inicial valorado en el primer mes y volvimos a realizar una revisión audiológica. Resultados: Se produce un deterioro auditivo significativo valorado en 1,76 dB por año, pasando de una media auditiva previa de 56,2 dB a una postoperatoria inmediata de 27.07 dB, y por fin a una media postoperatoria tardía de 40,65 dB. Conclusión: Se produce una pérdida auditiva significativa tras la estapedectomía con el paso del tiempo, aunque se mantiene una audición significativamente mejor que la inicial (AU)

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 (AU)

[Dilated vestibular aqueduct syndrome in children. Report of a case]. / Síndrome del acueducto vestibular dilatado en la infancia. A propósito de un caso.

Enlarged vestibular aqueduct syndrome is a clinical condition characterized for a progressive perceptive deafness linked to a broadening of vestibular aqueduct greater than 1.5 mm without other otic abnormal structures. We report the case of a 2-year-old child with such congenital malformation. We have reviewed the actual literature and point out its clinical and physiopathologic features as well treatment possibilities of these cases.

[Cervical emphysema caused by Forestier's disease]. / Enfisema cervical por enfermedad de forestier.

Diffuse idiopathic skeletal hyperostosis is a rare cause of dysphagia, preferentially affecting older men. This condition is also known as Forestier's malady, being characterized by a paravertebral ossification of 4 contiguous vertebrae at least. Seldom is the last etiology evoked for high dysphagia after other possible diagnosis exclusion. The diagnosis is confirmed by standard or contrast radiography. Introductory treatment is medical, being the surgery indicated for serious or resisting cases. One case is reported with dysphagia as primary sign of Forestier's malady, and review of possible diagnostic exams and treatments.

[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.

Basalioma terebrante retroauricular con extensión a huesos temporal y occipital / Retroauricular terebranting basalioma with extension to temporal and occipital bones

Presentamos el caso de un paciente con carcinoma basocelular retroauricular de larga evolución y amplia extensión a pabellón auricular, conducto auditivo externo, oído medio, mastoides, llegando hasta temporal y hueso occipital, considerando esta patología inusual en nuestro medio. Aportamos el tratamiento quirúrgico realizado con un colgajo miocutáneo para reconstruir la zona (AU)

[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.

Primary solitary Echinococcosis in cervical spine. Postsurgical successful outcome after long-term albendazole treatment.

STUDY DESIGN: A case report of a young man with isolated cervical hydatidosis treated postoperatively with sustained cyclical albendazole therapy for 9 years of follow-up. OBJECTIVES: To communicate the efficacy and safety of prolonged albendazole treatment in the postoperative management of spinal hydatid disease, and recommend therapeutic regimes for preventing its recurrence. SUMMARY AND BACKGROUND DATA: Bone involvement in hydatid disease is uncommon and the cervical region of the spine is rarely affected. Surgical excision remains the treatment of choice but high rates of postoperative recurrence have highlighted the importance of adjuvant anthelmintic therapy. The selection of the drug(s) and the duration of the medical treatment is still controversial. METHODS: The patient described herein presented with isolated bone lesions, in an unusual cervical location, and without coincidental visceral involvement. Therefore, diagnosis was delayed and surgical debridement was carried out without any preoperative anthelmintic therapy. To prevent late recurrences, therapy with intermittent courses of albendazole has been maintained for nine years and is still ongoing. Response and toxicity related to therapy has been closely monitored by clinical, biochemical and radiological follow up. RESULTS: After surgery the patient has remained asymptomatic without sequelae or evidence of relapses. No clinically relevant side effects has been observed. CONCLUSION: Prolonged albendazole treatment appears to be safe and effective in the prevention of late recurrences after spine hydatidosis surgery. Long-term chemotherapeutic schedules should be considered after surgical excision of spine or bone lesions.

Displasia fibrosa craneofacial. A propósito de dos casos / Craniofacial fibrous dysplasia. About two cases

La displasia fibrosa es un trastorno óseo que se puede asociar a endocrinopatías y a pigmentación cutánea. La patología de esta proliferación expansiva y distorsión del esqueleto es de etiología desconocida. Puede asentar en cualquier región del esqueleto. En la cabeza y cuello, la base craneal y los huesos faciales están involucrados en el 10-25 por ciento de los casos de la displasia fibrosa monostótica y en un 50 por ciento en la variedad poliostótica (Sindrome de McCune-Albright). La afectación craneofacial incluida la mandíbula puede conllevar deformaciones gigantes y disfunciones.Presentamos dos casos de displasia fibrosa y revisamos la patogenia, las características clínicas, el diagnóstico y el tratamiento (AU)