A longitudinal study of unilateral Ménière's disease and clinical evolutionary models.

OBJECTIVE: The heterogeneity of Ménière's disease is presently defined by a variety of subtypes. This study introduced three different subtypes of unilateral Ménière's disease based on the evolution of vertigo crises from their inception. METHOD: A longitudinal descriptive study of 327 unilateral Ménière's disease patients was performed. In a subgroup of patients followed from the onset of the disease, 3 subtypes of unilateral Ménière's disease were defined according to the vertiginous crises suffered during the first 10 years of the disorder. RESULTS: Data was available for 87 patients with unilateral Ménière's disease from the start of their disease (26.6 per cent of the original sample). These patients were grouped into three models according to their symptomatic evolution. Model 3 was associated with a worse hearing prognosis, a greater number of Tumarkin's otolithic crises and the need for surgery. Model 1 presented less hearing loss. CONCLUSION: Unilateral Ménière's disease models based on the evolution of vertiginous crises present differences according to aspects such as hearing loss, vertiginous crisis, Tumarkin's otolithic crisis and the need for surgery.

Bilateral Ménière's disease according to its form of debut: synchronous and metachronous disease.

OBJECTIVE: Bilateral Ménière's disease is classified according to the time of appearance of symptoms in each ear into synchronous and metachronous types. A descriptive longitudinal study, involving 59 bilateral Ménière's disease patients, was carried out to assess the two forms of bilateral Ménière's disease. METHOD: Data on symptomatic chronology in each ear, auditory evolution and evolution of vertiginous crisis, among other aspects, were obtained, analysed and compared. Possible risk factors for Ménière's disease becoming bilateral were analysed after conducting nested case-control studies in a cohort. RESULTS: The metachronous form was seen in 76.3 per cent of cases, and the time it took for the disease to become bilateral took a median time of seven years. The symptomatic triad was the most frequent symptomatic debut for the first ear in both forms. Synchronous debut presented a greater average hearing loss. Suffering from migraine and a symptomatic onset with a greater number of symptoms appear to be possible predictors of conversion to bilateral Ménière's disease. CONCLUSION: Bilateral Ménière's disease temporal models presented differences. The study of them helps to better understand, prevent and predict the behaviour of these patients.

[What do MRI and CT scan provide us in patients with vertigo and dizziness? A cost-utility analysis]. / Que aporta la neuroimagen en pacientes con vertigo y mareo? Analisis coste-utilidad.

INTRODUCTION: Vertigo and dizziness are symptoms with a significant burden in the hospital and involve several specialties. There are few guidelines of radiological tests for these symptoms. AIMS: To know which profile of patients with vertigo and dizziness has neuroimaging tests, quantify and describe the radiological findings. To analyze the cost-utility of CT and MRI in the study of these patients. PATIENTS AND METHODS: Descriptive study, we selected patients referred to the hospital for vertigo and dizziness. We analyze demographic and clinical characteristics and quantify the neuroimaging tests requested. We describe the radiological findings, assess their relevance in the diagnosis and detail the cost-benefit. RESULTS: We identified 493 patients, those with neuroimaging test (60%) are older, depressed and frequented the emergency department because of vertigo. The most requested test was the cranial CT scan (5% identifies the cause of the symptom). MRI of the inner ear and cerebellopontine angle was the test that presented the most significant findings (17.7%). The 286 image tests requested for vertigo cost 56,741 euros. The cost for a positive test was 1,576 euros. CONCLUSIONS: A large number of head CT and MRI are made in patients with vertigo and dizziness. A clinical suspicion is recommended from the anamnesis and exploration to make a good selection of test to request. In more than 90% of cases, radiological findings are not shown in relation to vertigo.

TITLE: Que aporta la neuroimagen en pacientes con vertigo y mareo? Analisis coste-utilidad.Introduccion. Vertigo y mareo son sintomas que suponen una carga significativa en el hospital e involucran a varias especialidades. Existen pocas guias sobre la solicitud de pruebas radiologicas ante estos sintomas. Objetivos. Conocer que perfil de pacientes con vertigo y mareo tiene realizadas pruebas de neuroimagen, cuantificar y describir los hallazgos radiologicos, y analizar el coste-utilidad de la tomografia computarizada (TC) y la resonancia magnetica (RM) en pacientes con estos sintomas. Pacientes y metodos. Estudio descriptivo en el que se seleccionan pacientes remitidos al hospital por vertigo y mareo. Se analizan caracteristicas demograficas y clinicas y se cuantifican las pruebas de neuroimagen solicitadas. Se describen los hallazgos radiologicos, se valora su relevancia en el diagnostico y se detalla el coste. Resultados. Se identifica a 493 pacientes, el 60% tiene realizada una prueba de neuroimagen; son pacientes de mas edad, depresivos y que han acudido a urgencias por vertigo. La prueba mas realizada fue la TC de craneo sin contraste (el 5% identifica la causa del sintoma). La que presento mas hallazgos significativos fue la RM de la base del craneo (17,7%). Las 286 pruebas de imagen solicitadas por vertigo costaron 56.741 euros. El gasto para obtener un diagnostico radiologico fue de 1.576 euros. Conclusiones. Se realiza un gran numero de TC y RM de cabeza en pacientes con vertigo y mareo. Es recomendable tener un diagnostico de sospecha previo a partir de la anamnesis y la exploracion para hacer una buena seleccion de las pruebas que hay que solicitar. En mas del 90% de los casos no se muestran hallazgos radiologicos en relacion con el vertigo.

Taponamiento nasal en la epistaxis posterior. Comparación de dos métodos / Nasal packing in posterior epistaxis. Comparison of two methods

Objetivo: Evaluar la tolerancia y eficacia de 2 sistemas de taponamiento nasal para epistaxis posteriores refractarias. Pacientes y métodos: Estudio comparativo longitudinal y prospectivo de 5 años en pacientes que acudieron a Urgencias por epistaxis y precisaron taponamiento posterior. Se consideraron 2 grupos: uno atendido con un sistema de hinchado neumático bicameral (n=105); otro en el que se efectuó oclusión posterior con gasa accediendo por boca y refuerzo anterior (n=47). La tolerancia se midió mediante escala analógica de intensidad dolorosa durante la colocación y mantenimiento del tapón, así como por necesidad de analgesia. La eficacia se valoró por índices de resangrado, necesidad de medidas concomitantes, transfusión de hemoderivados y efectos secundarios. Resultados: En los pacientes con taponamiento hinchable la colocación fue significativamente más rápida (36±19s vs. 228±102s; p<0,001) y menos dolorosa (6,7±1,7 vs. 8,3±1,5; p<0,001), precisando menos analgesia hasta su retirada. El taponamiento de gasa presentó menor porcentaje de resangrados (17% Vs. 26%; p<0,001), menos necesidades de transfusión de hemoderivados (15% vs. 18%; p<0,001) o de otros procedimientos (4% vs. 11%; p<0,001). El gasto sanitario con este último fue menor (1327±202€ vs. 1648±318€; p<0,001) y generó menos complicaciones a corto y largo plazo. Conclusiones: El taponamiento posterior clásico con gasa resulta menos cómodo y rápido de adaptar, pero asegura un mayor porcentaje de éxitos en control de epistaxis, genera menos lesiones locales y reduce costes sanitarios con respecto al neumotaponamiento (AU)

Objective: To evaluate tolerance and efficiency of two nasal blocking systems for posterior refractory epistaxis. Patients and methods: A five year comparative and longitudinal prospective study was developed in patients with epistaxis who attended our Emergency Unit and who required posterior nasal packing. Two groups were considered: one group was treated with a bi-chamber pneumatic inflation system (n=105). In other one, posterior occlusion was carried out with gauze, accessing through the mouth and using nasal reinforcement (n=47). The tolerance was measured by means of an analogue scale of pain intensity during the placement and maintenance of the packing, as well as for the need of analgesia. The efficiency was evaluated by episodes of re-bleeding, need for other concomitant measures, blood transfusion and side effects. Results: In patients with inflatable nasal packing its placement was significantly faster (36±19s vs. 228±102s; p<0.001) and less painful (6.7±1.7 vs. 8.3±1.5; p<0.001), requiring less analgesia until its removal. Patients with pack of gauze showed a lower average incidence of re-bleeding (17% vs. 26 %; p<0.001), fewer cases of blood transfusion (15% vs. 18%; p<0.001) or of other procedures (4% vs. 11 %; p<0.001). The sanitary cost of the latter was also lower (1327±202€ vs. 1648±318€; p<0.001) and it generated less short and long-term complications. Conclusions: The classical posterior packing with gauze is less rapid and comfortable to adapt, but it ensures a higher success rate in the control of epistaxis, produces fewer local injuries and reduces sanitary costs in comparison with inflatable balloon packing (AU)

Adenoma pleomorfo gigante de glándula salivar menor. Extirpación a través de un abordaje transoral / Giant pleomorphic adenoma of minor salivary gland. Transoral resection

El adenoma pleomorfo es un tumor benigno de las glándulas salivaresformado por la combinación de elementos epiteliales y mesenquimales.Generalmente constituyen el 60-70% de los tumores de la glándula parótiday el 40-60% de los de glándula submaxilar. Menos frecuentemente essu desarrollo a partir de una glándula salivar menor, presentándose comouna masa intraoral dependiente de paladar o labio. Se expone el caso de unadenoma pleomorfo gigante de paladar duro y su exéresis por la vía transoral(AU)

Pleomorphic adenoma is a benign tumor of the salivaryglands that consists of a combination of epithelial and mesenchymalelements. The tumor most commonly arises from the parotid (60-70%) or submandibular glands. It develops less frequently on aminor salivary gland, presenting as an intraoral mass dependenton the palate or lip. A case is reported of giant pleomorphic adenomaresected using a transoral approach(AU)

Fracturas de peñasco. Nuestra experiencia: 1999-2004 / Petrous bone fracture. Our experience: 1999-2004

Objetivo: Realizar una revisión de las fracturas de peñasco ocurridas en los últimos 5 años (1999-2004) en nuestro hospital, su manejo, control y análisis de los factores implicados. Analizar los protocolos de actuación y la bibliografía actual. Material y métodos: Se revisan 266 fracturas de hueso temporal, 74 con implicación del peñasco. Se analizan estas fracturas en función de la distribución por sexo, gravedad del traumatismo, clínica otorrinolaringológica debut, mecanismo traumático de producción, y hallazgos radiológicos. Se discuten minuciosamente los resultados y se comparan con la bibliografía actual. Concluciones: Las fracturas de peñasco se han de sospechar siempre en los pacientes con antecedente de traumatismo craneoencefálico (TCE) especialmente en los de gravedad moderada a grave y sobre todo si hay otorragia. Es necesaria una estrecha colaboración entre los servicios de neurocirugía, radiología y ORL para un adecuado manejo, valoración y seguimiento de los pacientes

Objective: To review the petrous bone fractures during the last five years (1999-2004) in our hospital, its manage, control, and analysis onf the associated factors. To analyse the managing protocoles and current bibliography. Material and methods: We review 266 temporal bone fractures, 74 with petrous bone association. We analyse these fractures by sex distribution, injurie severity, otorhinolaryngological clinical findings, production mechanism and radiological findings. The cases are discussed and compared with current bibliography. Conclussions: Petrous bone fractures must be always suspected in patients with head trauma, specially if it associates severity and otorrhagia. It is necessary a deep colaboration between neurosurgeons, radiologists and otorhinolaryngologists to obtain a good management, control and follow up of the patients

[Management of peritonsillar infections]. / Tratamiento de la infección periamigdalina.

OBJECTIVE: To evaluate the clinical and epidemiologic characteristics in children with peritonsillar infections. PATIENTS AND METHODS: A longitudinal retrospective study was performed through a review of the clinical histories of patients attending the emergency unit in the previous 6 years. The variables gathered were age, sex, recurrent tonsillitis, previous upper airway infection, antibiotic administration, and therapeutic approach. RESULTS: Twenty-nine children were admitted, with a mean age of 7.4 +/- 1.6 years (boys 1.6:1). Twenty-seven percent had recurrent tonsillitis. At the visit, 57.8 % had an upper respiratory infection and 65 % were taking antibiotic treatment, especially macrolides. The treatment selected at our center consisted of the association of penicillin or amoxicillin-clavulanate acid with clindamycin, including corticosteroids. Ten children underwent computed tomography and nine underwent fine-needle aspiration. Drainage was performed in 20.6 % of confirmed abscesses. The mean length of hospital stay was 5.6 +/- 1.6 days. Delayed tonsillectomy was performed in 31 %, except in one patient who developed a parapharyngeal abscess. Currently, 18.9 % of all peritonsillar infections occur in the pediatric population. CONCLUSIONS: The increase in these infections is probably related to inappropriate use of antibiotics in respiratory diseases. Diagnosis is clinical, and infections are often resolved by intravenous administration of beta-lactams with clindamycin and an expectant attitude. When an abscess is suspected or there is no clinical improvement, fine-needle aspiration or computed tomography is warranted and drainage should be performed if an abscess is confirmed. Tonsillectomy, usually delayed, is only indicated in patients with recurrent tonsillitis.

Tratamiento de la infección periamigdalina / Management of peritonsillar infections

Objetivo Analizar las características clínicas y epidemiológicas de niños afectados de infección periamigdalar. Pacientes y métodos Estudio longitudinal y restrospectivo de revisión de historias clínicas en los casos detectados los últimos 6 años atendidos en Urgencias. Se anotaron las variables de edad, sexo, amigdalitis de repetición, catarro previo de vías altas, administración de antibiótico y actitud terapéutica adoptada. Resultados Fueron ingresados 29 niños cuya edad media era de 7,4 +/- 1,6 años (varones 1,6:1). El 27 % cursaba con amigdalitis de repetición y el 57,8 % con catarro en el momento de la consulta, de los que el 65 % llevaba tratamiento antibiótico, especialmente macrólidos. El tratamiento seleccionado en nuestro centro fue la asociación penicilina o amoxicilina-ácido clavulánico con clindamicina, incluyendo corticoides. En 10 niños se practicó estudio de imagen mediante tomografía axial (TC) y en nueve punción-aspiración mediante aguja fina (PAAF). Ante la confirmación de absceso, se efectuó drenaje en el 20,6 % de los casos. La estancia hospitalaria fue de 5,6 +/- 1,6 días. Se practicó amigdalectomía diferida en el 31 %, excepto en un caso que desarrolló un absceso parafaríngeo. La población infantil padece en la actualidad el 18,9 % de todos los casos de infección periamigdalina. Conclusiones Este incremento está probablemente relacionado con el tratamiento inapropiado de antibióticos en enfermedades respiratorias. El diagnóstico es clínico y a menudo la administración intravenosa de betalactámicos con clindamicina y una actitud expectante son resolutivos. La sospecha de absceso o la ausencia de mejoría clínica recomiendan realizar PAAF y/o TC y drenaje ante su confirmación. La amigdalectomía, normalmente diferida, debería indicarse sólo en casos de amigdalitis de repetición

Objective To evaluate the clinical and epidemiologic characteristics in children with peritonsillar infections. Patients and methods A longitudinal retrospective study was performed through a review of the clinical histories of patients attending the emergency unit in the previous 6 years. The variables gathered were age, sex, recurrent tonsillitis, previous upper airway infection, antibiotic administration, and therapeutic approach. Results Twenty-nine children were admitted, with a mean age of 7.4 +/- 1.6 years (boys 1.6:1). Twenty-seven percent had recurrent tonsillitis. At the visit, 57.8 % had an upper respiratory infection and 65 % were taking antibiotic treatment, especially macrolides. The treatment selected at our center consisted of the association of penicillin or amoxicillin-clavulanate acid with clindamycin, including corticosteroids. Ten children underwent computed tomography and nine underwent fine-needle aspiration. Drainage was performed in 20.6 % of confirmed abscesses. The mean length of hospital stay was 5.6 +/- 1.6 days. Delayed tonsillectomy was performed in 31 %, except in one patient who developed a parapharyngeal abscess. Currently, 18.9 % of all peritonsillar infections occur in the pediatric population. Conclusions The increase in these infections is probably related to inappropriate use of antibiotics in respiratory diseases. Diagnosis is clinical, and infections are often resolved by intravenous administration of Beta-lactams with clindamycin and an expectant attitude. When an abscess is suspected or there is no clinical improvement, fine-needle aspiration or computed tomography is warranted and drainage should be performed if an abscess is confirmed. Tonsillectomy, usually delayed, is only indicated in patients with recurrent tonsillitis

[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.

[Correlation between the contralateral supressor effect and the auditory fatigue using transitory acoustic otoemissions]. / Estudio de la correlación existente entre el efecto supresor contralateral y la fatiga auditiva mediante otoemisiones acústicas transitorias.

OBJECTIVE: The purpose of this study is the identification of susceptible individuals to develop noise induced hearing loss. For it we use the capacity of the transitory otoacoustic emissions (TEOAE) for the identification of functional alterations at different levels from the auditory system. MATERIAL AND METHODS: 67 normal hearing subjects have been studied, we have recorded TEOAE in one ear in three different conditions: in normal conditions (SIN register), simultaneously to the stimulation of the contralateral cochlea (EAC register), and after stimulation we can observe (EAI register). We compare the amplitude of the TEOAE with the SIN and EAC registers to quantity the contralateral suppresor effect, and the SIN and EAI, register to study the auditory fatigue. RESULTS: We can observe a reduction in the amplitude of the TEOAE obtained by acoustic stimulation of the ipsilateral ear (0.954 dB SPL), or after the ipsilateral acoustic stimulation (0.75 dB SPL), being able to see an inverse correlation between both values. CONCLUSIONS: The study of the TEOAE obtained in different conditions of acoustic stimulation, ipsilateral or contralateral, and the inverse correlation obtained between the magnitude of the auditory fatigue and the contralateral suppresor effect, provides arguments for the identification of individuals susceptible of developing noise induced hearing loss.

[Changes on blood filterability in patients with fluctuant hearing loss]. / Variaciones en la filtrabilidad sanguínea en pacientes con hipoacusia fluctuante.

We developed a two year follow-up in thirteen subjects bearing of fluctuant sensorineural hearing loss measuring their blood filterability (BF) and making a correlation to appearance of deafness episodes. We could observe a decrease on BF in all patients when they felt a hearing loss. When they recovered the hearing level, BF increased too. The use of reoactive techniques to avoid these decreases on BF in fluctuant deafness could potentially prevent or improve them.

Estudio de la correlación existente entre el efecto supresor contralateral y la fatiga auditiva mediante otoemisiones acústicas transitorias / Correlation between the contralateral supressor effect and the auditory fatigue using transitory acoustic otoemissions

Objetivos: La finalidad de este estudio es la identificación de individuos susceptibles al desarrollo de hipoacusia neurosensorial inducida por ruido. Para ello aprovechamos la capacidad de las otoemisiones acústicas transitorias (TEOAE) para la identificación de alteraciones funcionales a distintos niveles de la vía auditiva. Material y métodos: Se han estudiado 67 sujetos normooyentes, obteniendo TEOAE en un oído en tres condiciones diferentes: en condiciones habituales (Registro SIN), simultáneamente a la estimulación de la cóclea contralateral (Registro EAC), y tras la estimulación ipsilateral (Registro EAI). Comparamos la amplitud de las TEOAE de los registros SIN y EAC para la cuantificación del efecto supresor contralateral, y la de los registros SIN y EAI, para el estudio de la fatiga auditiva. Resultados: Se objetiva una reducción en la amplitud de las TEOAE obtenidas simultáneamente a una estimulación acústica contralateral (0,954 dB SPL), o tras la estimulación acústica ipsilateral (0,75 dB SPL, observándose una correlación inversa entre ambos valores. Conclusiones: El estudio de las TEOAE obtenidas en diferentes condiciones de estimulación acústica, ipsilateral o contralateral, y la correlación inversa obtenida entre la magnitud de la fatiga auditiva y el efecto supresor contralateral proporciona argumentos para la identificación de individuos susceptibles al desarrollo de hipoacusia tras la exposición al ruido

Objective: The purpose of this study is the identification of susceptible individuals to develop noise induced hearing loss. For it we use the capacity of the transitory otoacoustic emissions (TEOAE) for the identification of functional alterations at different levels from the auditory system. Material and methods: 67 normal hearing subjects have been studied, we have recorded TEOAE in one ear in three different conditions: in normal conditions (SIN register), simultaneously to the stimulation of the contralateral cochlea (EAC register), and after stimulation we can observe (EAI register). We compare the amplitude of the TEOAE with the SIN and EAC registers to quantity the contralateral suppresor effect, and the SIN and EAI, register to study the auditory fatigue. Results: We can observe a reduction in the amplitude of the TEOAE obtained by acoustic stimulation of the ipsilateral ear (0.954 dB SPL), or after the ipsilateral acoustic stimulation (0.75 dB SPL), being able to see an inverse correlation between both values. Conclusions: The study of the TEOAE obtained in different conditions of acoustic stimulation, ipsilateral or contralateral, and the inverse correlation obtained between the magnitude of the auditory fatigue and the contralateral suppresor effect, provides arguments for the identification of individuals susceptible of developing noise induced hearing loss

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

Introducción: Valorar respuesta terapéutica y características reológicas e inmunológicas en sujetos con hipoacusia neurosensorial rápidamente progresiva (HNSRP). Pacientes y métodos: Estudio comparativo prospectivo sobre tres grupos de oídos dañados y tratados con piracetam (n=29), corticoides (n=32) y placebo (n=25). Se evaluó pérdida y recuperación auditiva, filtrabilidad en sangre total (FST) y un test de Western-blot (WB) para anticuerpos anticocleares. Resultados: El porcentaje de recuperación fue del 20,8±55,9% en el primer grupo, existiendo progresión de la hipoacusia en los otros dos (p<0,01). El WB no evidenció diferencias entre grupos. La mayor FST al final del tratamiento fue en el grupo 1 (20,36±2,54 Vs 18,42±3,42 μl/seg en grupo 3; p<0,05) y sólo mostró recuperación en tratados con piracetam, con diferencias estadísticamente significativas sobre los otros dos grupos. Conclusiones: En pacientes con HNSRP se detectan alteraciones en la FST que justifican el empleo de medidas reoactivas como tratamiento fisiopatológico

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 μl/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

Changes on blood filterability in patients with fluctuant hearing loss / Variaciones en la filtrabilidad sanguínea en pacientes con hipoacusia fluctuante

We developed a two year follow-up in thirteen subjects bearing of fluctuant sensorineural hearing loss measuring their blood filterability (BF) and making a correlation to appearance of deafness episodes. We could observe a decrease on BF in all patients when they felt a hearing loss. When they recovered the hearing level, BF increased too. The use of reoactive techniques to avoid these decreases on BF in fluctuant deafness could potentially prevent or improve them

En 13 sujetos afectos de hipoacusia neurosensorial fluctuante con Western-blot negativo se ha podido monitorizar durante dos años el valor de la filtrabilidad sanguínea (FS), correlacionándola con la aparición de episodios de hipoacusia. Pudo constatarse en todos los pacientes un descenso en la FS cuando observaban pérdida de audición. Con la recuperación auditiva el valor de la FS también se normalizaba. El empleo de procedimientos reoactivos que evitaran estos descensos en la FS en las hipoacusias fluctuantes podrían potencialmente prevenirlas o revertirlas

[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.

[Cormobidity of sensorineural hearing loss and other autoimmune diseases. Usefulness of laboratory tests]. / Estudio de comorbilidad de la hipoacusia neurosensorial y otras enfermedades de patogenia autoinmune. Utilidad de las pruebas de laboratorio.

OBJECTIVES: To value if the sensorineural hearing loss (SHL) in several autoimmune diseases (AD) is also secondary to immunomediation. PATIENTS AND METHODS: In 342 cases with SHL and any AD and 301 normoacoustic controls with AD a non-specific immunologic battery of tests and a Western-blot (WB) for anticochlear autoantibodies were developed, and cases with SHL were treated with deflazacort. RESULTS: Alterations in non-specific battery were similar between cases and controls. But a 12,5% of cases with SHL and a 1,6% of normoacoustic showed a positive WB (p<0,001). Steroid therapy improved hearing in 14,3% of cases. In them, sensitivity and specificity of non-specific battery were 78,4% and 75,5%, respectively, to predict response to therapy. These were 98,9% and 81,6% for WB. CONCLUSIONS: The SHL in cases with AD can be considered immunomediated in a discrete average, but the diagnostic efficiency of WB to predict an improvement after steroid therapy is high.

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

Objetivo: Valorar la posible asociación de modificaciones de la viscosidad sanguínea en la hipoacusia neurosensorial rápidamente progresiva (HNSRP) de origen autoinmune. Pacientes y métodos: En 43 sujetos afectos de HNSRP con Western-blot positivo para anticuerpos anticocleares se estudiaron las propiedades viscoelásticas de la sangre: viscosidad en sangre total (VST) a diferentes velocidades de cizallamiento (VC) y filtrabilidad eritrocitaria. Estos resultados se correlacionaron con la pérdida auditiva inicialmente detectada y el grado de recuperación al año del tratamiento esteroideo. Resultados: Sólo la VST a VC de 230 seg-1 resultó significativamente mayor en casos que entre controles (p<0,01). El porcentaje de recuperación auditiva se correlacionó de forma estadísticamente significativa con valores elevados en la FE (p<0,01). La pérdida auditiva inicial no se correlacionó con ningún valor reológico. Conclusiones: La HNSRP autoinmune no presenta una fisiopatología asociada a hiperviscosidad sanguínea, por lo que las terapias reoactivas como la plasmaféresis no garantizan mejoría clínica

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

Estudio de comorbilidad de la hipoacusia neurosensorial y otras enfermedades de patogenia autoinmune. Utilidad de las pruebas de laboratorio / Comorbidity of sensorineural hearing loss and other autoimmune diseases. Usefulness of laboratory tests

Objetivos: Valorar si la hipoacusia neurosensorial (HNS) detectada en diversas enfermedades autoinmunes (EA) es también secundaria a inmunomediación. Pacientes y Métodos: En 342 casos con HNS y alguna EA y 301 controles normoacúsicos con EA se efectuó una batería de pruebas inmunológicas inespecíficas y un Western-blot (WB) para autoanticuerpos anticocleares, tratándose la HNS con deflazacort. Resultados: Las alteraciones en la batería inespecífica entre casos y controles fueron similares, pero el 12,5% de los casos con HNS y el 1,6% de los normoacúsicos presentaban WB positivo (p<0,001). La corticoterapia fue eficaz en el 14,3%. Entre casos, la batería inespecífica evidenció especificidad y sensibilidad del 78,4% y 75,5%, respectivamente, en predecir respuesta al tratamiento y el WB de 98,9% y 81,6%. Conclusiones: La HNS en algunos casos de EA parece ser inmunomediada en un porcentaje discreto de ellos, pero la eficacia diagnóstica del WB en predecir la mejoría tras corticoterapia resulta alta

Objetives: To value if the sensorineural hearing loss (SHL) in several autoimmune diseases (AD) is also secondary to immunomediation. Patients and methods: In 342 cases with SHL and any AD and 301 normoacoustic controls with AD a non-specific immunologic battery of tests and a Western-blot (WB) for anticochlear autoantibodies were developed, and cases with SHL were treated with deflazacort. Results: Alterations in non-specific battery were similar similar between cases and controls. But a 12,5% of cases with SHL and a 1,6% of normoacoustic showed a positive WB (p<0,001). Steroid therapy improved hearing in 14,3% of cases. In them, sensitivity and specificity of non-specific battery were 78,4% and 75,5%, respectively, to predict response to therapy. These were 98,9% and 81,6% for WB. Conclusions: The SHL in cases with AD can be considered immunomediated in a discrete average, but the diagnostic efficiency of WB to predict an improvement after steroid therapy is high

[Petrous bone fracture. Our experience: 1999-2004]. / Fracturas de peñasco. Nuestra experiencia: 1999-2004.

OBJECTIVE: To review the petrous bone fractures during the last five years (1999-2004) in our hospital, its manage, control, and analysis onf the associated factors. To analyse the managing protocoles and current bibliography. MATERIAL AND METHODS: We review 266 temporal bone fractures, 74 with petrous bone association. We analyse these fractures by sex distribution, injurie severity, otorhinolaryngological clinical findings, production mechanism and radiological findings. The cases are discussed and compared with current bibliography. CONCLUSIONS: Petrous bone fractures must be always suspected in patients with head trauma, specially if it associates severity and otorrhagia. It is necessary a deep colaboration between neurosurgeons, radiologists and otorhinolaryngologists to obtain a good management, control and follow up of the patients.

[Near-total laryngectomy. Experience, complications and acoustic analysis]. / Laringuectomía casi total. Experiencia, complicaciones y análisis de voz.

OBJECTIVE: To investigate the oncological efficiency, voice and complications of Pearson's near-total laryngectomy for advanced laryngeal cancers (T3, T4). MATERIAL AND METHODS: A retrospective review of 23 cases of near-total laryngectomy (carried out in our Hospital in the last nine years) was undertaken. RESULTS: None of the cases developed laryngeal mucosal recurrences. The overall three and five years disease free survival were 91,3% and 86,9%. Mean phonation time was 51 days. A statistically significant results were observed in our voice analysis (words/minute, taking as a reference healthy people (Medivoz). The pharyngeal fistula was the most frequent complication (60,86%). CONCLUSIONS: The local control of cancer was similar to that expected with total laryngectomy. Near-total laryngectomy is a valid alternative for extended laryngeal and neighbouring cancers with an acceptable morbidity and success rate for voice preservation.