Pólipo piloso nasofaríngeo en un recién nacido con obstrucción intermitente de la vía aérea. Presentación de un caso / Nasopharyngeal hairy polyp in a newborn with intermittent airway obstruction. Case report

Los pólipos pilosos nasofaríngeos son tumores benignos poco frecuentes. Se presenta el caso de esta patología en una paciente recién nacida, quien presentó cianosis y dificultad respiratoria por obstrucción de la vía aérea superior, durante las primeras 24 horas de vida. La paciente requirió maniobras de reanimación e intubación endotraqueal. Estudios diagnósticos confirmaron la presencia de una masa en la pared lateral de la faringe. Se realizó la extirpación quirúrgica exitosa con evolución satisfactoria de la paciente

Nasopharyngeal hairy polyps are rare benign tumors. We present a newborn case with a hairy polyp mass causing cyanosis and respiratory distress due to obstruction of the upper airway during the first 24 hours of life. The patient required resuscitation and endotracheal intubation. Diagnostic studies confirmed the presence of a mass in the lateral pharyngeal wall. Surgical treatment and removal of the mass was performed with satisfactory evolution of the patient

[Nasopharyngeal hairy polyp in a newborn with intermittent airway obstruction. Case report]. / Pólipo piloso nasofaríngeo en un recién nacido con obstrucción intermitente de la vía aérea. Presentación de un caso.

Nasopharyngeal hairy polyps are rare benign tumors. We present a newborn case with a hairy polyp mass causing cyanosis and respiratory distress due to obstruction of the upper airway during the first 24 hours of life. The patient required resuscitation and endotracheal intubation. Diagnostic studies confirmed the presence of a mass in the lateral pharyngeal wall. Surgical treatment and removal of the mass was performed with satisfactory evolution of the patient.

Los pólipos pilosos nasofaríngeos son tumores benignos poco frecuentes. Se presenta el caso de esta patología en una paciente recién nacida, quien presentó cianosis y dificultad respiratoria por obstrucción de la vía aérea superior, durante las primeras 24 horas de vida. La paciente requirió maniobras de reanimación e intubación endotraqueal. Estudios diagnósticos confirmaron la presencia de una masa en la pared lateral de la faringe. Se realizó la extirpación quirúrgica exitosa con evolución satisfactoria de la paciente.

Augmentation of Scarred Vocal Folds With Centrifuged and Emulsified Autologous Fat Grafts.

OBJECTIVE: To review the results of a series of patients with glottic insufficiency caused by scarred vocal folds who underwent injection laryngoplasty with centrifuged and emulsified autologous fat. STUDY DESIGN: Prospective cohort. SETTING: Single center, tertiary institution. SUBJECTS AND METHODS: Examination of the medical records of 21 patients operated on through injection laryngoplasty with fat grafts for the treatment of dysphonia was performed. All patients were operated on between January of 2015 and September of 2019. The voice variables measured were the GRABS (Grade, Roughness, Breathiness, Asthenia, Strain) scale, the Voice Handicap Index-10 (VHI-10), maximum phonation time, jitter, shimmer, and harmonic/noise ratio before surgery and 8 months later. RESULTS: Twenty-six injection laryngoplasties were performed in 21 patients during the reviewed period. Seventeen were men, and 4 were women. Mean age was 57.2 (range, 18-80) years. Mean (SD) follow-up time was 20.7 (9.3) months. Etiology of dysphonia was scarring after tumor resection in 17 patients and sulcus vocalis in 4. Five patients received an additional injection laryngoplasty. Statistically significant improvements were observed in all the parameters evaluated (P < .05). CONCLUSIONS: Injection laryngoplasty with fat grafts processed through centrifugation and emulsification is an effective technique for the treatment of dysphonia caused by glottic insufficiency related to scarred vocal folds, with minimal complication rates.

Estudio comparativo entre implantación coclear uni y bilateral en niños de 1 y 2 años de edad / Comparative study between unilateral and bilateral cochlear implantation in children of 1 and 2 years of age

Introducción: Los estudios que han evaluado la efectividad de los implantes cocleares bilaterales en niños sugieren una mejoría de la capacidad auditiva en cuanto a la localización del sonido y la discriminación del lenguaje. En este trabajo mostramos las diferencias en los logros audio-lingüísticos con la implantación coclear bilateral precoz frente a la unilateral, así como las diferencias entre la implantación bilateral secuencial y simultánea. Material y métodos: Presentamos 88 niños diagnosticados de hipoacusia neurosensorial profunda bilateral tratados mediante implantación coclear bilateral en 32 casos, y unilateral en 56 casos, durante los primeros 12 meses (27 niños) y entre los 12 y 24 meses (61 niños). Se compararon los resultados en la audiometría tonal, en las escalas IT-Mais, Nottingham y LittlEars, así como en las pruebas logoaudiométricas. Resultados: No se detectan diferencias significativas en los umbrales auditivos y en los cuestionarios IT-Mais, Nottingham y LittlEars entre los niños implantados bilateral y unilateralmente, tanto en el primer como en el segundo año. Las pruebas verbales sí que muestran diferencias estadísticamente significativas, ya que los niños con un implante coclear bilateral alcanzan antes el 100% en el reconocimiento de bisílabos y frases, sin que los niños con un solo implante lleguen a igualar dichos resultados a los 5 años de la cirugía. No existen diferencias entre implantación bilateral simultánea y secuencial. Conclusión: Con este estudio remarcamos la importancia de asegurar un buen cribado audiológico precoz, para poder llevar a cabo una implantación coclear temprana, a ser posible bilateral, logrando así un desarrollo de las habilidades audio-lingüísticas equiparable al de los normooyentes (AU)

Introduction: The studies that have evaluated the effectiveness of bilateral cochlear implantation in children suggest an improvement in hearing about sound localization and speech discrimination. In this paper we show the differences in audio-linguistic achievements with early bilateral cochlear implantation versus unilateral, and differences between simultaneous and sequential bilateral implantation. Material and methods: We present 88 children with bilateral profound sensorineural hearing loss, treated with bilateral cochlear implantation in 32 cases and unilateral in 56 cases, during the first 12 months (27 children) of life and between 12 and 24 months (61 children). We conducted a statistical comparison of both groups in the audiometry, IT-Mais, Nottingham, LittlEars scales and verbal tests. Results: No significant differences in hearing thresholds and questionnaires between unilateral and bilateral implantation were detected in either the first or second year. Verbal tests do show statistically significant differences: children with bilateral cochlear implant obtain 100% recognition of disyllabic and phrases within 2-3 years after implantation whilst children with one implant do not obtain those results at 5 years after surgery. No differences between simultaneous and sequential bilateral implantation were detected. Conclusion: We emphasize the importance of ensuring good early audiological screening, to carry out an early and bilateral cochlear implantation with the consequent development of audio-language skills similar to normal hearing children (AU)

Comparative study between unilateral and bilateral cochlear implantation in children of 1 and 2 years of age. / Estudio comparativo entre implantación coclear uni y bilateral en niños de 1 y 2 años de edad.

INTRODUCTION: The studies that have evaluated the effectiveness of bilateral cochlear implantation in children suggest an improvement in hearing about sound localization and speech discrimination. In this paper we show the differences in audio-linguistic achievements with early bilateral cochlear implantation versus unilateral, and differences between simultaneous and sequential bilateral implantation. MATERIAL AND METHODS: We present 88 children with bilateral profound sensorineural hearing loss, treated with bilateral cochlear implantation in 32 cases and unilateral in 56 cases, during the first 12 months (27 children) of life and between 12 and 24 months (61 children). We conducted a statistical comparison of both groups in the audiometry, IT-Mais, Nottingham, LittlEars scales and verbal tests. RESULTS: No significant differences in hearing thresholds and questionnaires between unilateral and bilateral implantation were detected in either the first or second year. Verbal tests do show statistically significant differences: children with bilateral cochlear implant obtain 100% recognition of disyllabic and phrases within 2-3 years after implantation whilst children with one implant do not obtain those results at 5 years after surgery. No differences between simultaneous and sequential bilateral implantation were detected. CONCLUSION: We emphasize the importance of ensuring good early audiological screening, to carry out an early and bilateral cochlear implantation with the consequent development of audio-language skills similar to normal hearing children.

Radiocirugía como tratamiento del neurinoma del acústico. Diez años de experiencia / Radiosurgery as treatment for acoustic neuroma. Ten years’ experience

Introducción y objetivo: El neurinoma del acústico es un tumor benigno que suele afectar a la porción vestibular del VII par craneal. Representan el 8% de todos los tumores intracraneales y el 80% de los que surgen a nivel del ángulo pontocerebeloso. Existen 3 opciones terapéuticas: la microcirugía, que es la técnica de elección, la radiocirugía y la observación. El objetivo del estudio ha sido valorar los resultados obtenidos con la radiocirugía en el tratamiento del neurinoma del acústico, así como los efectos secundarios derivados del mismo. Material y métodos: Hemos realizado en nuestro hospital una revisión de todos los pacientes tratados con radiocirugía (Gamma Knife y LINAC) a dosis de 1.200-1.300 cGy por neurinoma del acústico unilateral, entre enero de 1999 y enero del 2010. En todos los pacientes se valoraron el estado general, la tasa de control de crecimiento tumoral, entendiéndose como tal que no cambia de tamaño o que se reduce, la afectación del V y VII par craneal, así como alteraciones del sistema nervioso central. También el tiempo de seguimiento y las variaciones de los umbrales auditivos tras la radiocirugía. Resultados: De un total de 35 pacientes estudiados, con una edad media de 58,29 años y sin diferencias estadísticamente significativas en cuanto al sexo, la tasa de control de crecimiento tumoral fue superior al 90%. El principal motivo de consulta (65,71%) fue la hipoacusia unilateral y progresiva. Un 34,28% de los pacientes tratados presentaron empeoramiento en su nivel de audición postratamiento. La afectación de los pares craneales (V-VII) en el 100% de los casos fue transitoria. La radiocirugía tipo Gamma Knife fue administrada en la mayoría de los pacientes (82,85%). Conclusión: Aunque la microcirugía sigue siendo el tratamiento de elección para los neurinomas del acústico, consideramos la radiocirugía como una alternativa válida en pacientes seleccionados (edad avanzada, comorbilidad asociada, pequeño tamaño e hipoacusia neurosensorial, entre otros) (AU)

Introduction and objective: The acoustic neuroma is a benign tumour that usually affects the vestibular portion of the vestibulocochlear nerve. It represents 8% of all intracranial tumours and 80% of those arising at the cerebellopontine angle. There are 3 treatment options: microsurgery (the technique of choice), radiosurgery and observation. The objective of the study was to evaluate the results and side effects obtained using radiosurgery as treatment for acoustic neuroma. Material and methods: We performed a review of all patients treated with radiosurgery (Gamma Knife and linear accelerator) at doses of 1200-1300 cGy for unilateral acoustic neuroma in our hospital from January 1999 until January 2010. In all patients we evaluated the overall state, tumour growth control rate (tumour smaller or remaining the same size), the involvement of V and VII cranial nerves and central nervous system disorders. We also assessed follow-up time and changes in hearing thresholds after radiosurgery. Results: From a total of 35 patients studied, with a mean age of 58.29 years and lacking statistically significant differences in gender, the tumour growth control rate was over 90%. The main reason for visit (65.71%) was unilateral and progressive hearing loss. After treatment, 34.28% of patients had hearing loss. The involvement of the cranial nerves (V-VII) was transitory in 100% of cases. Gamma Knife radiosurgery was administered in 82.85% of patients. Conclusion: Although microsurgery is the treatment of choice for acoustic neuroma, we consider radiosurgery as a valid alternative in selected patients (elderly, comorbidity, small tumour size and sensorineural hearing loss, among others) (AU)

Experiencia inicial con el implante osteointegrado Alpha 1 de Sophono / Initial experience with the Sophono Alpha 1 osseointegrated implant

En los últimos años los implantes osteointegrados han probado su utilidad en el tratamiento de la hipoacusia de transmisión mixta, uni o bilateral, y la neurosensorial unilateral. El implante Alpha 1 de Sophono ofrece una ventaja sustancial, la falta de acoplador externo y su unión al receptor por medio de magnetismo. Presentamos el caso de 3 niños que padecen malformaciones de oído externo y medio de origen congénito. Los estudios audiométricos revelan hipoacusias de transmisión de carácter moderado. En los 3 pacientes se propuso la colocación del implante Alpha 1 de Sophono. Los pacientes evolucionaron de forma satisfactoria. A los 30 días se les aplicó el procesador, y en las audiometrías de control se evidenció una notable mejoría de los umbrales auditivos, aunque sin conseguir un cierre completo del umbral diferencial auditivo. Con cuidados mínimos, la piel sobre el implante se mantuvo en excelentes condiciones, siendo el resultado estético inmejorable (AU)

In the last several years, bone anchored hearing aids have proven to be useful in treating conductive and mixed unilateral or bilateral hearing loss, as well as for sensorineural unilateral hearing loss. The Sophono Alpha 1 model has the advantage of not requiring an abutment, with it being coupled by magnetism instead. We report the cases of 3 infants with congenital malformations of external and middle ear. Audiometry showed conductive hearing loss. All 3 patients were implanted with Alpha 1 model (Sophono). Patients evolved satisfactorily. After 30 days we applied the processor and the control audiometry showed a marked improvement of hearing thresholds, although without a complete closure of the gap. With minimal care, the skin over the implant remained in excellent condition, with a very satisfactory cosmetic outcome (AU)

Evolución clínica y radiológica de un grupo de neurinomas del acústico no tratados / Clinical and radiological evolution of a group of untreated acoustic neuromas

Introducción: El neurinoma del acústico es un tumor benigno que se origina en la rama vestibular del viii par craneal. Su tratamiento de elección es quirúrgico, pero muchos autores defienden que en pacientes de edad avanzada o en neurinomas de pequeño tamaño se puede optar por simple vigilancia. Métodos: Estudio retrospectivo, del 2007 al 2013, que incluye a 27 pacientes diagnosticados de neurinoma del acústico que no fueron tratados, bien por el tamaño del tumor, por la edad y las comorbilidades asociadas, o por decisión del paciente. Se evaluaron el estado general, los umbrales auditivos, el grado de paresia canalicular y las posibles alteraciones a nivel central. Resultados: A los 6 años de seguimiento, la clínica - hipoacusia (70%), acúfeno (15%) y vértigo (4%) - de 18 pacientes se mantuvo sin variaciones; 5 casos experimentaron caída del umbral auditivo y desarrollaron acúfeno, 2 casos intensificaron su acúfeno y 2 casos presentaron vértigo. Los controles radiológicos por resonancia magnética demostraron que los diámetros máximos iniciales (5-16 mm) se incrementaron en 1,7 mm como media, con tasas de crecimiento anual inferiores a 0,5 mm. Conclusión: En casos seleccionados, neurinomas de pequeño tamaño y pacientes de edad avanzada, la opción conservadora mediante vigilancia estrecha con resonancia magnética es una alternativa importante, puesto que, según nuestra muestra, ni la clínica ni la imagen radiológica sufren cambios significativos y, en caso de que lo hagan, siempre estamos a tiempo de una actuación terapéutica (AU)

Introduction: The acoustic neuroma is a benign tumour that originates in the vestibular branch of the eighth cranial nerve. The main treatment is surgery, but many authors suggest that with elderly patients or in small neuromas we can opt for watchful waiting. Methods: This was a retrospective study from 2007 to 2013 that included 27 patients diagnosed of acoustic neuroma that had not been treated due to the size of the tumour, age and comorbidities, or by patient choice. We evaluated overall condition, hearing thresholds, degree of canal paresis and central disorders. Results: After 6 years of follow up, clinical manifestations of 18 patients remained unchanged, 5 patients underwent hearing loss and developed tinnitus, 2 cases had more intense tinnitus and 2 cases had dizziness. The radiological controls by magnetic resonance imaging showed that the initial maximum diameters (5-16 mm) increased by 1.7 mm on average, with annual growth rates below 0.5 mm. Conclusion: In selected cases, such as for small neuromas and in elderly patients, the conservative option of close monitoring with magnetic resonance imaging is an important alternative given that, in our cases, clinical features and radiological image did not suffer major changes. If there were any such changes, therapeutic options could be proposed (AU)

Radiosurgery as treatment for acoustic neuroma. Ten years' experience.

INTRODUCTION AND OBJECTIVE: The acoustic neuroma is a benign tumour that usually affects the vestibular portion of the vestibulocochlear nerve. It represents 8% of all intracranial tumours and 80% of those arising at the cerebellopontine angle. There are 3 treatment options: microsurgery (the technique of choice), radiosurgery and observation. The objective of the study was to evaluate the results and side effects obtained using radiosurgery as treatment for acoustic neuroma. MATERIAL AND METHODS: We performed a review of all patients treated with radiosurgery (Gamma Knife and linear accelerator) at doses of 1200-1300 cGy for unilateral acoustic neuroma in our hospital from January 1999 until January 2010. In all patients we evaluated the overall state, tumour growth control rate (tumour smaller or remaining the same size), the involvement of v and vii cranial nerves and central nervous system disorders. We also assessed follow-up time and changes in hearing thresholds after radiosurgery. RESULTS: From a total of 35 patients studied, with a mean age of 58.29 years and lacking statistically significant differences in gender, the tumour growth control rate was over 90%. The main reason for visit (65.71%) was unilateral and progressive hearing loss. After treatment, 34.28% of patients had hearing loss. The involvement of the cranial nerves (v-vii) was transitory in 100% of cases. Gamma Knife radiosurgery was administered in 82.85% of patients. CONCLUSION: Although microsurgery is the treatment of choice for acoustic neuroma, we consider radiosurgery as a valid alternative in selected patients (elderly, comorbidity, small tumour size and sensorineural hearing loss, among others).

Initial experience with the Sophono Alpha 1 osseointegrated implant.

In the last several years, bone anchored hearing aids have proven to be useful in treating conductive and mixed unilateral or bilateral hearing loss, as well as for sensorineural unilateral hearing loss. The Sophono Alpha 1 model has the advantage of not requiring an abutment, with it being coupled by magnetism instead. We report the cases of 3 infants with congenital malformations of external and middle ear. Audiometry showed conductive hearing loss. All 3 patients were implanted with Alpha 1 model (Sophono). Patients evolved satisfactorily. After 30 days we applied the processor and the control audiometry showed a marked improvement of hearing thresholds, although without a complete closure of the gap. With minimal care, the skin over the implant remained in excellent condition, with a very satisfactory cosmetic outcome.

[Clinical and radiological evolution of a group of untreated acoustic neuromas]. / Evolución clínica y radiológica de un grupo de neurinomas del acústico no tratados.

INTRODUCTION: The acoustic neuroma is a benign tumour that originates in the vestibular branch of the eighth cranial nerve. The main treatment is surgery, but many authors suggest that with elderly patients or in small neuromas we can opt for watchful waiting. METHODS: This was a retrospective study from 2007 to 2013 that included 27 patients diagnosed of acoustic neuroma that had not been treated due to the size of the tumour, age and comorbidities, or by patient choice. We evaluated overall condition, hearing thresholds, degree of canal paresis and central disorders. RESULTS: After 6 years of follow up, clinical manifestations of 18 patients remained unchanged, 5 patients underwent hearing loss and developed tinnitus, 2 cases had more intense tinnitus and 2 cases had dizziness. The radiological controls by magnetic resonance imaging showed that the initial maximum diameters (5-16mm) increased by 1.7mm on average, with annual growth rates below 0.5mm. CONCLUSION: In selected cases, such as for small neuromas and in elderly patients, the conservative option of close monitoring with magnetic resonance imaging is an important alternative given that, in our cases, clinical features and radiological image did not suffer major changes. If there were any such changes, therapeutic options could be proposed.

Hallazgos de potenciales vestibulares miogénicos evocados en la esclerosis múltiple / Vestibular evoked myogenic potential findings in multiple sclerosis

Introducción: La esclerosis múltiple es una enfermedad consistente en la aparición de lesiones desmielinizantes, neurodegenerativas y crónicas del sistema nervioso central. Se propone en esta enfermedad, estudiar los potenciales vestibulares miogénicos evocados, que nos van a permitir evaluar de forma no invasiva el sáculo, el nervio vestibular inferior y la vía vestíbulo-espinal. Métodos: Presentamos 23 pacientes diagnosticados de esclerosis múltiple a los que se les realizaron los potenciales vestibulares miogénicos evocados, comparando resultados con nuestro grupo control, integrado por 35 sujetos sanos. Se registró la latencia de las ondas p13 y n23, la diferencia interaural de amplitud y el índice de asimetría entre ambos oídos. También se llevó a cabo una exploración de otoscopia y audiometría. Resultados: La prolongación de las latencias de las ondas p13 y n23 es la característica a destacar, con una media en la onda p13 de 19,53 ms y 30,06 ms para la n23. El índice de asimetría, por el contrario, no mostraba diferencias estadísticamente significativas con nuestro grupo control. Conclusiones: En el caso de la esclerosis múltiple, la prolongación de la latencia de las ondas p13 y n23 de los potenciales vestibulares miogénicos evocados es una característica que se ha atribuido a un enlentecimiento de la conducción por la desmielinización de la vía vestíbulo-espinal. En este sentido, la alteración de la respuesta o ausencia de la misma en estos potenciales tiene un carácter localizador de la lesión a nivel de troncoencéfalo inferior (AU)

Introduction: Multiple sclerosis is an inflammatory disease involving the occurrence of demyelinating, chronic neurodegenerative lesions in the central nervous system. We studied vestibular evoked myogenic potentials (VEMPs) in this pathology, to allow us to evaluate the saccule, inferior vestibular nerve and vestibular-spinal pathway non-invasively. Methods: There were 23 patients diagnosed with multiple sclerosis who underwent VEMP recordings, comparing our results with a control group consisting of 35 healthy subjects. We registered p13 and n23 wave latencies, interaural amplitude difference and asymmetry ratio between both ears. Subjects also underwent an otoscopy and audiometric examination. Results: The prolongation of p13 and n23 wave latencies was the most notable characteristic, with a mean p13 wave latency of 19.53 ms and a mean latency of 30.06 ms for n23. In contrast, the asymmetry index showed no significant differences with our control group. Conclusions: In case of multiple sclerosis, the prolongation of the p13 and n23 VEMP wave latencies is a feature that has been attributed to slowing of conduction by demyelination of the vestibular-spinal pathway. In this regard, alteration of the response or lack thereof in these potentials has a locator value of injury to the lower brainstem (AU)

Vestibular evoked myogenic potential findings in multiple sclerosis.

INTRODUCTION: Multiple sclerosis is an inflammatory disease involving the occurrence of demyelinating, chronic neurodegenerative lesions in the central nervous system. We studied vestibular evoked myogenic potentials (VEMPs) in this pathology, to allow us to evaluate the saccule, inferior vestibular nerve and vestibular-spinal pathway non-invasively. METHODS: There were 23 patients diagnosed with multiple sclerosis who underwent VEMP recordings, comparing our results with a control group consisting of 35 healthy subjects. We registered p13 and n23 wave latencies, interaural amplitude difference and asymmetry ratio between both ears. Subjects also underwent an otoscopy and audiometric examination. RESULTS: The prolongation of p13 and n23 wave latencies was the most notable characteristic, with a mean p13 wave latency of 19.53 milliseconds and a mean latency of 30.06 milliseconds for n23. In contrast, the asymmetry index showed no significant differences with our control group. CONCLUSIONS: In case of multiple sclerosis, the prolongation of the p13 and n23 VEMP wave latencies is a feature that has been attributed to slowing of conduction by demyelination of the vestibular-spinal pathway. In this regard, alteration of the response or lack thereof in these potentials has a locator value of injury to the lower brainstem.

Manejo de las otolicuorreas / Management of cerebrospinal fluid otorrhea

Introducción: Las fístulas de líquido cefalorraquídeo en el oído derivan de una comunicación anormal entre el espacio subaracnoideo y el timpanomastoideo, la mayoría de etiología traumática. Tienen gran interés desde el punto de vista clínico por el potencial riesgo de meningitis, directamente relacionado con la etiología. Nuestro objetivo es mostrar nuestra experiencia en el manejo de dicho proceso. Métodos: Presentamos un total de 17 pacientes diagnosticados y tratados de fístulas de líquido cefalorraquídeo en el oído desde el año 2003 hasta el 2011. Resultados: En nuestro estudio el mayor porcentaje de casos correspondían a otolicuorreas de tipo espontáneo, con una presentación clínica variada. El diagnóstico se basó en la determinación de la beta-2-transferrina y en estudios de imagen, especialmente importantes por su valor localizador del defecto. El tratamiento quirúrgico fue el de elección. Conclusiones: Las fístulas de líquido cefalorraquídeo en el oído constituyen una entidad rara en la patología otorrinolaringológica. Su diagnóstico se sospecha por signos característicos como la otolicuorrea, pérdida auditiva y sensación de plenitud ótica, mientras que la tomografía computarizada y la resonancia magnética nos ayudan a su localización. La cirugía es la técnica de elección, y su éxito se basa en la técnica multicapas con 2 o más materiales de soporte (AU)

Introduction: Cerebrospinal fluid otorrhea results from an abnormal communication between the subarachnoid space and tympanomastoid compartment; most of them are of traumatic aetiology. They have clinical interest due to the potential risk of meningitis, directly related to the aetiology. Our aim was to show our experience in the management of this process. Methods: A total of 17 patients diagnosed and treated for cerebrospinal fluid otorrhea from 2003 to 2011. Results: In our study, the highest percentage of cases was spontaneous cerebrospinal fluid otorrhea, with a wide clinical presentation. The diagnosis was based on the determination of beta-2-transferrin and radiological studies, especially important for its locator value. The treatment of choice was surgery. Conclusions: Cerebrospinal fluid otorrhea is a rare entity in otorhinolaryngological pathology. Its diagnosis is suspected through otorrhea, hearing loss and aural fullness, while computed tomography and magnetic resonance help us to locate the defect. Surgery is the preferred technique, and its success is based on multilayer technology with 2 or more support materials (AU)

Management of cerebrospinal fluid otorrhea.

INTRODUCTION: Cerebrospinal fluid otorrhea results from an abnormal communication between the subarachnoid space and tympanomastoid compartment; most of them are of traumatic aetiology. They have clinical interest due to the potential risk of meningitis, directly related to the aetiology. Our aim was to show our experience in the management of this process. METHODS: A total of 17 patients diagnosed and treated for cerebrospinal fluid otorrhea from 2003 to 2011. RESULTS: In our study, the highest percentage of cases was spontaneous cerebrospinal fluid otorrhea, with a wide clinical presentation. The diagnosis was based on the determination of beta-2-transferrin and radiological studies, especially important for its locator value. The treatment of choice was surgery. CONCLUSIONS: Cerebrospinal fluid otorrhea is a rare entity in otorhinolaryngological pathology. Its diagnosis is suspected through otorrhea, hearing loss and aural fullness, while computed tomography and magnetic resonance help us to locate the defect. Surgery is the preferred technique, and its success is based on multilayer technology with 2 or more support materials.

Enfermedad de Hodgkin en otorrinolaringología / Hodgkin’s lymphoma in otorhinolaryngology

Objetivos: Evaluar la implicación de la enfermedad de Hodgkin en patología otorrinolaringológica. Material y métodos: Estudio longitudinal y retrospectivo de pacientes diagnosticados, tratados y controlados por linfoma de Hodgkin (LH) en nuestro centro entre los años 1996 y 2010. Resultados: De cuatrocientos trece individuos atendidos por linfoma, 120 fueron etiquetados de LH (29%). Fueron varones el 76% y se observó mayor incidencia entre los 15-30 años y los 45-60 años. En 84 casos se obtuvo muestra para estudio biópsico procedente de adenopatías, 61 cervicales, mientras que en 15 la muestra fue de origen extranodal. El hallazgo más frecuente en la consulta fueron la presencia de adenopatías cervicales (86%), axilares (68%) y síntomas B (37%). El anillo de Waldeyer sólo se vio afectado en un 4%. La forma histopatológica más frecuente resultó el LH en su variedad clásica con esclerosis nodular (50%), seguido de la decelularidad mixta (28%). Los pacientes fueron más frecuentemente diagnosticados en estadio I (28%) y II (47%). Se detectó recidiva de enfermedad cervical tras terapia oncológica convencional en 17 pacientes, en 7 de los cuales el informe histopatológico había variado. El índice de mortalidad fue del 8%. Los principales factores de mal pronóstico para recidiva de enfermedad fueron las formas con depleción linfocitaria, las adenomegalias mayores de 10 cm y los síntomas B. Conclusiones: Los hallazgos clínicos del LH se relacionan fuertemente con el área de cabeza y cuello obligando a su sospecha en el diagnóstico diferencial de las masas cervicales (AU)

Objectives: To evaluate the implication of Hodgkin’s lymphoma (HL) in Otorhinolaryngology. Patients and methods: A longitudinal retrospective study on patients with HL diagnosed, treated and followed-up in our Centre from 1996 to 2010. Results: From 413 individuals having lymphoma, 120 were labelled as HL (29%). Patients were males in 76% and greater incidence was observed in ages between 15 and 30 years old, as well as between 45 and 60. Samples for biopsy from adenopathies were obtained in 84 cases (61 from the neck), and in 15 its origin was extranodal. The most usual finding at physical exploration was the presence of cervical (86%) and axillary nodes (68%), followed by B symptoms (37%). Waldeyer’s ring was affected in 4%. The most frequent histopathological variety was classic HL with nodular sclerosis (50%) and mixed cellularity (28%). Patients were usually diagnosed at stages I (28%) and II (47%). Recurrence of disease in the neck after conventional oncologic therapies was detected in 17 patients, in 7 of which the pathologic study had varied. Mortality was 8%. The main unfavourable prognostic factors for neoplasm recurrence were lymphocytedepletion variety, lymphadenopathy larger than 10 cm and B symptoms. Conclusions: Clinical HL findings are strongly associated with the head and neck area, making its suspicion obligatory in differential diagnosis on cervical nodes (AU)

[Hodgkin's lymphoma in otorhinolaryngology]. / Enfermedad de Hodgkin en otorrinolaringología.

OBJECTIVES: To evaluate the implication of Hodgkin's lymphoma (HL) in Otorhinolaryngology. PATIENTS AND METHODS: A longitudinal retrospective study on patients with HL diagnosed, treated and followed-up in our Centre from 1996 to 2010. RESULTS: From 413 individuals having lymphoma, 120 were labelled as HL (29%). Patients were males in 76% and greater incidence was observed in ages between 15 and 30 years old, as well as between 45 and 60. Samples for biopsy from adenopathies were obtained in 84 cases (61 from the neck), and in 15 its origin was extranodal. The most usual finding at physical exploration was the presence of cervical (86%) and axillary nodes (68%), followed by B symptoms (37%). Waldeyer's ring was affected in 4%. The most frequent histopathological variety was classic HL with nodular sclerosis (50%) and mixed cellularity (28%). Patients were usually diagnosed at stages I (28%) and II (47%). Recurrence of disease in the neck after conventional oncologic therapies was detected in 17 patients, in 7 of which the pathologic study had varied. Mortality was 8%. The main unfavourable prognostic factors for neoplasm recurrence were lymphocyte depletion variety, lymphadenopathy larger than 10 cm and B symptoms. CONCLUSIONS: Clinical HL findings are strongly associated with the head and neck area, making its suspicion obligatory in differential diagnosis on cervical nodes.