[Immunomediation or hyperviscosity in rapidly progressive sensorineural hearing loss. A therapeutic approach]. / Inmunomediación o hiperviscosidad en la hipoacusia neurosensorial rápidamente progresiva. Una aproximación terapéutica.

INTRODUCTION: To evaluate the therapeutic response and the rheologic and immunological characteristics in subjects bearing of rapidly progressive sensorineural hearing loss (RPSHL). PATIENTS AND METHODS: A comparative prospective study on three groups of damaged ears treated with piracetam (n=29), corticosteroids (n=32) and plabcebo (n=25). Hearing loss and recovery level, whole blood filterability (WBF) and a Western-blot (WB) to anticochlear antibodies were evaluated. RESULTS: Recovery average was 20,8 +/- 55,9% in the first group, with progressive of deafness in the rest (p<0,01). WB did not show differences among groups. The higher WBF at the end of therapy was detected on group 1 (20,36 +/- 2,54 Vs 18,42 +/- 3,42 microl/seg on group 3; p<0,05). Moreover, it impaired only on those treated with piracetam, with statistically significative differences over the other two groups. CONCLUSIONS: We detected alterations on WBF in patients with RPSHL that justify the use of rheoactive measures as a pathophysiological therapy.

[Blood viscosity profile in rapidly progressive sensorineural hearing loss with positive Western-blot]. / Perfil de la viscosidad sanguínea en la hipoacusia rápidamente progresiva con Western-blot positivo.

OBJECTIVE: To value a possible association between disorders in blood viscosity of patients with rapidly progressive sensorineural hearing loss (RPSHL) of autoimmune origin. PATIENTS AND METHODS: We studied the viscoelastic properties of blood in 43 subjects bearing of RPSHL and a positive Western-blot for anticochlear antibodies: whole blood viscosity (WBV) at different shear rates and erythrocyte filterability (EF). These results were related to hearing loss initially detected and recovery average one year later from steroid therapy. RESULTS: Just WBV at 230 sec(-1) shear rate was significatively higher in cases than in controls (p < 0.01). Hearing recovery degree correlated in an statistically way to increased values of EF (p < 0.01). There was no relation between initial hearing loss level and any rheology parameter. CONCLUSIONS: Autoimmune RPSHL does not show a pathophysiology mechanism associated to blood hyperviscosity. So, rheoactive therapies as plasmapheresis warrant no clinical improvement.

[Hearing loss measurement. An equation for a rapid calculation]. / Medida de la pérdida auditiva. Una ecuación para su cálculo rápido.

Hearing loss must be easily calculated by mean of the rules of actual legislation on handicap. It is just necessary to know the hearing thresholds for 500, 1000, 2000 and 4000 Hz tones. Calculation of a linear regression equation allows to obtain quickly hearing loss average from these thresholds.

[Hearing loss associated to ulcerative colitis]. / Hipoacusia asociada a colitis ulcerosa.

OBJECTIVE: To value the eventual immunomediation in sensorineural hearing loss (SHL) on patients bearing of ulcerative colitis (UC). MATERIAL AND METHODS: In a group of forty-nine cases with a mean age of 41.6+/-9.3 years old we studied the hearing loss level, the disease activity index, the peripheral blood inflammation markers and the anticochlear antibodies by mean of Western-blot technique (WB). RESULTS: The 26.5% knew about their deafness, although SHL was detected in 59.1% of cases. The mean age of onset was 40.3+/-9.8 years. 48.9% showed a positive WB, always in 68-70 kDa molecular weight blots. Moreover, patients with positive WB showed more severe deafness, higher disease activity and more altered parameters, especially erythrosedimentation rate. CONCLUSIONS: Audiologic and peripheral blood findings observed allow us to establish a reasonable suspicion of an autoimmune or immunomediated pathway of hearing loss on UC.

[Anticochlear antibodies titles measured by Western-blot and hearing recovery level after corticoid therapy in patients with sudden deafness]. / Titulación de anticuerpos anticocleares mediante Western-bloty grado de recuperación auditiva tras corticoterapia en pacientes con sordera súbita.

OBJECTIVES: Detection of antichoclear antibodies in patients with sudden deafness (SD) ranges from five to forty one percent depending on authors. We tried to correlate the level of antibodies measured by Western-blot (WB) and hearing loss. PATIENTS AND METHODS: Forty nine subjects bearing of SD and a positive WB for bovine cochlear antigen. Hearing loss average was measured at the onset and after treatment with deflazacort 1 mg/kg per day by means of audiometry, and antibody titles were quantified in the diluted sera. RESULTS: Initial loss was 49.4+/-20.6%, and after corticotherapy it was 15.9+/-18.0%. There was no statistically significative correlation titles-hearing loss (y=0.1122x+30.613; R2=0.7552) nor titles-recovery (y=-0.0818x+8.,65; R2=0.3229). CONCLUSIONS: Although predictive capability for treatment response is accepted for WB, quantifying of the antibody titles in patients with SD does not allow to make a prognosis about the average hearing recovery.

[Tonsillar mast cell infiltration and allergic tonsillitis]. / Infiltración mastocitaria amigdalar y amigdalitis alérgica.

We report the case of a seven year-old boy bearing of exudative acute tonsillitis after strawberry ingestion with no previous infectious history. After having diagnosed it as hypersensitivity type I, this patient began to suffer repetitive episodes of exudative and purulent tonsillitis, related to cool drinks and direct manipulation of tonsils. These were hyperplastic and Staphylococcus sp. and Streptococcus sp. were isolated in them. The episodes were shortened by the use of corticosteroids. Tonsillectomy was the definitive therapy. Biopsy informed of mast cells infiltration in germinal centers of both palatine tonsils.

[Variations of salivary dismutase superoxide in tonsillar infection]. / Variaciones de la superóxido dismutasa salivar en la infección amigdalar.

The antioxidant effect of superoxido dismutase in saliva was measured in children bearing of tonsillar hypertrophy, recidivant tonsillitis or peritonsillar abscess. These levels were compared to those detected on tonsillar tissue obtained from tonsillectomy (p < 0.001). Although salivary SOD concentration in children with tonsillar infection was higher than hypertrophy, there was not a significative correlation to tonsillar value of the enzyme (R2 = 0.2276), so we can not accept a predictive value for salivary SOD of tonsillar suffering and, eventually, of tonsillectomy.

Autoimmune identification of sudden hearing loss.

OBJECTIVE: To identify autoantibody bands using Western blotting in patients with idiopathic sudden sensorineural hearing loss (ISSNHL). MATERIAL AND METHODS: All patients admitted to our emergency ward with ISSNHL during a 3-year period (n = 51) were included in a diagnostic laboratory protocol, which included a non-specific test battery for immune disorders and a Western blot (WB) for bovine cochlear antigen, and underwent corticosteroid therapy. RESULTS: In 16 cases (31%) a band was identified in the WB. Cases with a positive WB showed abnormal results in a greater number of non-specific laboratory tests (3.6 +/- 1.3 vs 0.9 +/- 1.1; p < 0.001) and had greater hearing recovery (33.8% +/- 17.7% vs 50.6% +/- 18.5%; p < 0.01). Moreover, patients with a positive WB showed good correlations between the degree of hearing recovery and both early onset of treatment (0.5504x + 43.621; R2 = 0.8603; p < 0.01) and age (0.4053x + 56.298; R2 = 0.8952; p < 0.01). The non-specific test battery showed a sensitivity of 78% and a specificity of 94% for detecting an autoimmune disorder compared with WB. CONCLUSION: A positive WB predicts a good response to corticosteroid therapy in ISSNHL patients. If it is not possible to perform a WB then the non-specific test battery has a good capability for predicting autoimmune disorders.

[Oxidative profile of tonsil infection. Study of antioxidant enzymes in tonsil and blood]. / Perfil oxidativo de la infección amigdalar. Estudio de las enzimas antioxidantes en amígdala y sangre.

In order to investigate the effect of oxidative damage due to free radicals on ENT infectious diseases, levels of superoxide dismutase (SOD), glutathione-peroxidase (GPx) and reductase (GRt) and the total antioxidant status (TAS) were measured by spectrophotometry on tonsillar tissue obtained from tonsillectomy in 538 patients, who were divided in three groups according to their surgical indication: tonsillar hypertrophy (n = 235), recurrent tonsillitis (n = 280) or peritonsillar abscess (n = 23). SOD concentration were also measured on adenoid tissue and middle ear exudate in 75 patients from the first two groups. Erythrocyte and tonsillar SOD levels were significantly greater in the abscess group, and lower in the hypertrophic one. These differences were similar for GPx and TAS. For GRt, its level in abscess were lower than in the other two groups in a statistically significant way. There were strong correlations between erythrocyte and tonsillar SOD, tonsillar SOD and GPx, tonsillar SOD and TAS, and tonsillar GPx and TAS. SOD concentrations from adenoid tissue and middle ear exudate did not affect its blood level. So, we can conclude that tonsillar oxidative damage is determined by the frequency or the severity of local infections, and it can be evaluated by measuring the SOD concentration in the tonsillar tissue or in the peripheral blood. So, it can be considered a good marker of tonsillar damage.

[Clinical and functional analysis of long-term results of uvulopalatopharyngoplasty]. / Análisis clínico y funcional de los resultados de la uvulopalatofaringoplastia a largo plazo.

In order to evaluate the clinical and functional effectiveness of uvulopalatopharyngoplasty (UPPP) in chronic roncopathy, we studied the subjective improvement of operated patients and compared to pulsioximetry findings before and after surgery. A follow-up was made on 72 patients entitled of chronic roncopathy--51 with obstructive sleep apnea syndrome (OSAS) and 21 with simple snoring-, for a mean period of time of 41 months. Preoperatory study included on ENT exploration, fibre optic endoscopy, Müller maneuver, pharyngeal CT, value of daytime sleepiness with Epworth's scale, espirometry and pulsioximetry, and the postoperatory study included of pulsioximetry and a health questionnaire over snoring and daytime sleepiness. Snoring improved or disappeared in 13 of 21 patients (61.8%), and daytime sleepiness did it in 26 of 39 (66.6%). Therapeutic failure in snoring was mainly due to an increase in the body mass index. After UPPP in OSAS, only 21 patients (41.1%) showed all positive response criteria (decrease into ODI > or = 50% or in absolute values < 6, CT 90% < 1%, and SaO2 Min > or = 85%). UPPP failed in long term evaluation in the rest of individuals. Patient selection is mandatory to optimize clinical response of UPPP for snoring, without OSAS success depends on body mass index, respiratory disturbances ratios and the eventual presence of another upper airways collapses below velopharyngeal segment.

[Atypical Cogan syndrome. Clinical and laboratory spectrum. Report of 2 cases]. / Síndrome atípico de Cogan. Espectro clínico y de laboratorio. Presentación de dos casos.

We show two atypical Cogan's syndrome cases in forty-seven and fifty-six years old individuals. Characteristical symptoms of the syndrome were detected in both (interstitial keratitis, sensorineural deafness and vestibular dysfunction), but they could be considered as unusual because of the association of systematic symptoms and an onset with hearing loss. In both cases there was an increase in erythrosedimentation rate and immunoglobulins levels, as well as high titles for rheumatoid factor and non-specific autoantibodies. By means of a Western-blot technique, several chochlear antibodies with distinct molecular weight were detected, but the 68 KD appeared in both. Metil-prednisolone treatment did not avoid ocular and auditive reactivation in ne of the patients.

[Neurosensory sudden deafness, blood hyperviscosity syndrome, and diabetes mellitus]. / Sordera súbita neurosensorial, síndrome de hiperviscosidad sanguínea y diabetes mellitus.

Diabetes mellitus is considered a risk factor for sensorineural sudden deafness. Its pathogenesis remains unknown. However, the physiopathological implication of a hyperviscosity syndrome in diabetics and patients bearing of sudden deafness can mean the nexus between the two entities. Total blood viscosity and erythrocyte adhesion were haemorheological parameters significatively higher in blood of diabetics with sudden deafness than in normal hearing controls. Moreover, erythrocyte filterability and deformability were lower in diabetics, but it was not statistically significative. These findings help to guide therapy in these patients towards specific measures to improve blood viscoelastic properties.

[Tonsillar and erythrocyte levels of superoxide dismutase in children with and without recurrent tonsillitis]. / Niveles de superóxido dismutasa amigdalar y eritrocitaria en niños con y sin amigdalitis de repetición.

BACKGROUND AND OBJECTIVES: Oxidative stress secondary to infant tonsillar infection produces the expression of local and systemic antioxidants. Its determination seems to be useful as a marker of tonsillar suffering before tonsillectomy but is currently unknown. The aim of this study was to determine the evolution of this parameter in tonsillectomized children during a long-term follow-up. METHODS: One hundred thirty-six children underwent tonsillectomy, 46 for tonsillar hypertrophy without infection and 90 for recurrent tonsillitis. Superoxide dismutase (SOD) concentrations were measured before tonsillectomy and at 6, 12, 24 and 36 months post-tonsillectomy. RESULTS: Infection provoked significantly higher SOD concentrations than tonsillar hypertrophy in tonsillar tissue (223.06 30.46 vs 156.39 54.05 U/l, p < 0.001) and in blood (1124.91 141.73 vs 1007.19 97.03 U/gr Hb, p < 0.001). There was a strong correlation between tonsillar and erythrocyte concentrations. During the 3-year follow-up, SOD concentrations in blood progressively decreased until stabilizing in all patients. Stabilization was reached at 6 months post-tonsillectomy in the group with tonsillar hypertrophy and at 2 years in the group with infection. Children with recurrent tonsillitis consistently showed higher SOD concentrations in blood throughout the follow-up. CONCLUSIONS: Oxidative damage in tonsillar tissue results from the incidence and severity of focal infections. Tonsillectomy reduces SOD levels but, as a consequence of oxidative stress, these do not return to normal.

[Pathophysiological rationale for the use of piracetam in sudden deafness]. / Argumentación fisiopatológica al empleo de piracetam en la sordera brusca.

To determine if blood viscosity disorders affect the clinical course of idiopathic sudden deafness, we studied the usefulness of the rheoactive agent piracetam and prednisolone compared with steroid/vasodilator therapy. The piracetam group (n = 17) showed clinical improvement in 82.3% and a mean hearing gain in 54.1%, compared with 68.7% and 49.3%, respectively, for the group without piracetam (n = 6). In both groups, clinical severity correlated with increased whole blood viscosity and erythrocyte aggregability and filterability rates. On the seventh day after onset, all the viscosity parameters had returned to normal in the piracetam group, but the non-piracetam group still showed no improvement in whole blood viscosity and erythrocyte filterability. Piracetam seemed to be effective in this sensorineural deafness, probably as a result of its effect on the viscoelastic properties of blood. Measurement of these properties seven days after beginning therapy provides information about long-term potential for hearing recovery.

[A prolonged case of intractable sneezing. Pathophysiological hypothesis]. / Un prolongado caso de estornudo incoercible. Hipótesis fisiopatológica.

A 13-year-old boy sneezed paroxysmally and continuously, day and night, for 18 days. Sneezing limited his daily activities and motivated hospital admission. Pediatric clinical examination and all other immunologic, otorhinolaryngologic, pneumologic, neurologic, radiologic, and psychiatric studies were normal. There was no response to treatment with antihistamines, corticoids, or anti-convulsants, which obscured the diagnosis. Definitively effective treatment and its implications in the pathophysiology of sneezing are discussed.

[Head and neck lesions caused by systemic progressive ossifying fibrodysplasia (Munchmeyer's disease]. / Lesiones en cabeza y cuello por fibrodisplasia osificante progresiva sistémica (enfermedad de Munchmeyer).

Fibrodysplasia ossificans progressiva is a rare hereditary connective tissue disorder due to an unknown mutation conditioning the ossification of striated muscle and soft tissues frequently related to joints and stimulated by traumatisms or aggressive iatrogenic manouvres. It produces stiffness, pain, disability, swelling and fibro-osseus masses disseminated everywhere, with a very spectacular, invalidant and irreversible clinical picture. Affection of head and neck is unusual, excepting lesions in sternocleidomastoid or masticatiry muscles. We show a systemic case of fibrodysplasia osificans progressiva with enhanced clinical and radiological findings in cervical rhachis, pharynx and larynx, oral cavity, facial bones and ear. Association of biphophonates and steroids for a long period of time seems up to now stopping the evolution but not its regression.

[The nonserological diagnostic approach to infectious mononucleosis in an emergency service]. / Aproximación diagnóstica no serológica a la mononucleosis infecciosa desde el Servicio de Urgencias.

Patients with infectious mononucleosis often are seen in Emergency Services because the infection may produce tonsillitis resistant to antibiotic therapy. However, the diagnosis of choice is specific serology, which usually takes days or weeks before results become available. Detection of lymphocytosis in peripheral blood, heterophilic antibodies, and the characteristic mononuclear cells by means of specialized blood counters, together with the clinical signs, have improved the quality of diagnosis in emergency services (93% sensitivity and 97.2% specificity). We found that simple identification by optical microscopy of the lymphomonocytes typical of infectious mononucleosis in a drop of peripheral blood, together with the clinical findings, have a better diagnostic sensitivity (96. 5%) and specificity (99.1%) than any other method available in emergency services.

[Recurrent aphthous stomatitis and clinical response to pentoxifylline]. / Estomatitis aftosa recidivante y respuesta clínica a la pentoxifilina.

Lack of a specific and definitive treatment for recurrent aphthous stomatitis allowed to develop several assays with different drugs trying to lighten symptoms and avoid new crisis. The pathophysiological unknown about the illness forces to empiric therapies often disappointing. Immunomodulation by the haemorreoactive agent pentoxifylline inhibiting the *-TNF production seems to produce a neutrophilic and lymphocytic hypoactivity state, which promotes healing of aphthous in AIDS. Nevertheless, its use on healthy subjects got to prevent new episodes just in the 36% from our eleven cases, which is an improvement if compared to other local and systemic alternatives. Congenital or acquired immune factors still undetected determine the sensibility of subject to treatment and different healing rates reported by authors depending on pathologies.

[Comparison of azithromycin, amoxicillin/clavulanic acid and cefaclor in the treatment of acute ENT infections]. / Comparación de azitromicina, amoxicilina/ácido clavulánico y cefaclor en el tratamiento de la infección aguda otorrinolaringológica.

A comparison was made of the clinical effectiveness of azithromycin (once daily for three days at a dose of 10 mg/kg in children or 500 mg/day in adults) and amoxicillin/clavulanic acid and cefaclor (standard doses for 7 to 14 days) in acute ear, nose and throat infections in an open randomized study. The group with azithromycin included 37 otitis media, 24 pharyngotonsillitis and 6 maxillary sinusitis (n = 67). The amoxicillin/clavulanic acid group, 22 otitis media, 19 pharyngotonsillitis and 6 maxillary sinusitis (n = 47) and the cefaclor group, 15 otitis media, 12 pharyngotonsillitis and 4 maxillary sinusitis (n = 31). Fifteen days after beginning treatment, 97% (65/67) of the patients who received azithromycin had improved or cured, compared with 85% (40/47) of those who received amoxicillin/clavulanic acid and 84% (26/31), cefaclor (p < 0.02). Pathogens were not eradicated in 3% (2/58) of the patients who received azithromycin, compared with 13% (4/28) who received amoxicillin/clavulanic acid and 15% (4/28) cefaclor. Patients with azithromycin showed an earlier clinical improvement and more rapid normalization of the leukocyte count, erythrocyte sedimentation rate and acute phase proteins. No patient with azithromycin had adverse effects, versus 15% (7/47) for patients with amoxicillin/clavulanic acid and 16% (5/31) for cefaclor. Treatment compliance was 100, 83 (39/47) and 84% (26/31), respectively (p < 0.01). We conclude that azithromycin treatment for three days is faster and more effective clinically and analytically than standard treatment with amoxicillin/clavulanic acid or cefaclor in acute infections of the ear, nose and throat.

[Effects of adenoidectomy and tonsillectomy on the bacterial flora of the nose and oropharynx]. / Efectos de la adenoidectomía y amigdalectomía sobre la flora bacteriana naso y orofaríngea.

The oropharyngeal and nasopharyngeal microbial flora was studied in 55 children with recurrent tonsillitis and in 85 with chronic adenoiditis. Swabs were made of both regions one day before surgical removal and on postoperative days 10 and 30, swabs were cultured on suitable media and processed for identification and quantitative estimation. Most of the potentially pathogenic species exhibited beta-lactamase production. After adenoidectomy or tonsillectomy this potentially pathogenic flora showed a quantitative decrease in the number identified and in their growth rate. In contrast, Bacteria considered part of the normal flora showed an increase in their were isolated more frequently although a quantitative decrease was observed in some instances. These findings suggest that adenoidectomy and tonsillectomy result in evident modifications in potentially pathogenic flora in these sites as a result of replacement by the normal flora. There are microbiological findings that justify surgical procedures in case of failure of antibiotic treatment.