Extended phenotype and clinical subgroups in unilateral Meniere disease: A cross-sectional study with cluster analysis.

OBJECTIVES: To define clinical subgroups by cluster analysis in patients with unilateral Meniere disease (MD) and to compare them with the clinical subgroups found in bilateral MD. DESIGN: A cross-sectional study with a two-step cluster analysis. SETTINGS: A tertiary referral multicenter study. PARTICIPANTS: Nine hundred and eighty-eight adult patients with unilateral MD. MAIN OUTCOME MEASURES: best predictors to define clinical subgroups with potential different aetiologies. RESULTS: We established five clusters in unilateral MD. Group 1 is the most frequently found, includes 53% of patients, and it is defined as the sporadic, classic MD without migraine and without autoimmune disorder (AD). Group 2 is found in 8% of patients, and it is defined by hearing loss, which antedates the vertigo episodes by months or years (delayed MD), without migraine or AD in most of cases. Group 3 involves 13% of patients, and it is considered familial MD, while group 4, which includes 15% of patients, is linked to the presence of migraine in all cases. Group 5 is found in 11% of patients and is defined by a comorbid AD. We found significant differences in the distribution of AD in clusters 3, 4 and 5 between patients with uni- and bilateral MD. CONCLUSIONS: Cluster analysis defines clinical subgroups in MD, and it extends the phenotype beyond audiovestibular symptoms. This classification will help to improve the phenotyping in MD and facilitate the selection of patients for randomised clinical trials.

[Postural control related to age in patients with benign positional paroxysmal vertigo]. / Control postural según la edad en pacientes con vértigo posicional paroxístico benigno.

OBJECTIVE: To study the relationship between age and posturography in patients with benign positional paroxysmal vertigo. MATERIAL AND METHODS: Prospective study performed in 65 patients with benign positional paroxysmal vertigo (BPPV) in any variant. Sensory Organization Test outcomes were recorded and compared with their equivalents in a control group by means of scatter-plot diagrams and regression line. For statistical study, Mann-Whitney's U-test was used. RESULTS: Slope for regression lines in composite was -0.0934 in group NORMAL; in group BPPV it was -0.4284. This difference is due to conditions 5 and 6. Results were statistically significative. CONCLUSIONS: BPPV patients have a worse postural control than control group. The difference is bigger the older the patient is. It is due to a failure in conditions 5 and 6, so it should be from a vestibular origin.

Control postural según la edad en pacientes con vértigo posicional paroxístico benigno / Postural control related to age in patients with benign positional paroxysmal vertigo

Objetivo: Estudiar la relación entre la edad y el control postural en pacientes con vértigo posicional paroxístico benigno. Material y método: Estudio prospectivo realizado en 65 pacientes diagnosticados de vértigo posicional paroxístico benigno (VPPB) en cualquiera de sus variantes. Se miden los resultados del Test de Organización Sensorial, comparándolas con sus equivalentes en un grupo control mediante nube de puntos y recta de regresión. Para el estudio estadístico se usó el test U de Mann-Whitney. Resultados: En el grupo NORMAL, la recta de regresión del resultado global tiene una pendiente de –0,0934; en el grupo VPPB, de –0,4284. Esta diferencia se debe fundamentalmente a las condiciones 5 y 6, siendo los resultados estadísticamente significativos. Conclusiones: Los pacientes con VPPB tienen un peor control postural que el grupo control. Esta diferencia es mucho más acusada cuanto mayor es la edad del paciente, y es de origen vestibular

Objective: To study the relationship between age and posturography in patients with benign positional paroxysmal vertigo. Material and methods: Prospective study performed in 65 patients with benign positional paroxysmal vertigo (BPPV) in any variant. Sensory Organization Test outcomes were recorded and compared with their equivalents in a control group by means of scatter-plot diagrams and regression line. For statistical study, Mann-Whitney’s U-test was used. Results: Slope for regression lines in composite was –0.0934 in group NORMAL; in group BPPV it was –0.4284. This difference is due to conditions 5 and 6. Results were statistically significative. Conclusions: BPPV patients have a worse postural control than control group. The difference is bigger the older the patient is. It is due to a failure in conditions 5 and 6, so it should be from a vestibular origin

Postural control according to the age in patients with benign paroxysmal positional vertigo.

OBJECTIVES: To study the relationship between age and postural control in patients with benign paroxysmal positional vertigo. MATERIAL AND METHODS: Prospective study performed in 65 diagnosed patients with benign paroxysmal positional vertigo (BPPV) in any of its variants. The results of the Sensory Organization Test are compared with their equivalent in a control group by means of scatterplot and regression lines. For the statistical study the Mann-Whitney's U test was used. RESULTS: In the NORMAL group, the regression line for composite has a 0.0934 slope; in the BPPV group, 0.4284. This difference is due to conditions 5 and 6 fundamentally, the results being statistically significant. CONCLUSIONS: The patients with BPPV have a worse postural control than the group control. This difference is much more pronounced the older the patient, and is of vestibular origin.

Resultados del tratamiento del cáncer laríngeosupraglótico mediante cirugía endoscópica con láser CO2 / Treatment of supraglottic cancer by means of CO2 laser endoscopic surgery: results

Hemos estudiado una serie de 253 pacientes con cáncer de laringe, tratados mediante cirugía endoscópica con láser CO2.Cincuenta pacientes presentaban una localización supraglótica. Tras analizar diversos parámetros, se concluye que la cirugía endoscópica láser en los carcinomas supraglóticos tiene una tasa de supervivencia y un tiempo libre de enfermedad muy similares a la cirugía por vía externa. El tiempo de ingreso es mucho más reducido, el riesgo de complicaciones menor y el coste por proceso más bajo que con la cirugía convencional. Se evitó la traqueotomía en la mayor parte de los pacientes. Las recidivas pueden tratarse de nuevo por vía endoscópica, pero, la necesidad de realizar una laringectomía total tras una recidiva, se considera un factor de mal pronóstico (AU)

A group of 253 patients with laryngeal carcinoma was treated by endoscopic laser-CO2 surgery, 50 of them presented a supraglottic localization. The follow up period ranged from 1 to 10 years. From the analysis of different parameters (age, site, stage, histopathology, etc) it could be concluded that survival and free-symptoms-time rates in patients treated with laser endoscopy were similar to those obtained in patients treated with conventional external surgery. However, the endoscopic laser-CO2 surgery reported several advantages such as: no pharyngostoma, less complications, shorter stay in hospital and, consequently, lower health costs. In addition, tracheotomy was almost never necessary. Recurrencies can be also treated endoscopically, but, when total laryngectomy is needed following recurrency, this is considered to be a bad prognostic factor (AU)

[Results of supraglottic laryngeal cancer treatment with endoscopic surgery using CO2 laser]. / Resultados del tratamiento del cáncer laríngeo supraglótico mediante cirugía endoscópica con láser CO2.

A group of 253 patients with laryngeal carcinoma was treated by endoscopic laser-CO2 surgery, 50 of them presented a supraglottic localization. The follow up period ranged from 1 to 10 years. From the analysis of different parameters (age, site, stage, histopathology, etc) it could be concluded that survival and free-symptoms-time rates in patients treated with laser endoscopy were similar to those obtained in patients treated with conventional external surgery. However, the endoscopic laser-CO2 surgery reported several advantages such as: no pharyngostoma, less complications, shorter stay in hospital and, consequently, lower health costs. In addition, tracheotomy was almost never necessary. Recurrencies can be also treated endoscopically, but, when total laryngectomy is needed following recurrency, this is considered to be a bad prognostic factor.

[Epithelial-myoepithelial carcinoma of smaller salivary gland]. / Carcinoma epitelial-mioepitelial de glándula salivar menor.

The epithelial-myoepithelial carcinoma of salivary glands is rarely presented and it's considered as an intermediate grade tumor. Usually are located in the parotid gland, however sometimes occur on minor salivary glands. An epithelial-myoepithelial carcinoma sitting on a palatine minor salivary gland of long course is reported.

[Epithelioid amelanotic melanoma of the nose and paranasal sinuses]. / Melanoma epitelioide amelanótico de fosas y senos paranasales.

Mucous melanomas are rare, representing 1-3% of melanomata and 3% of malignant nasosinusal tumors. The more usual location is the nasal cavity and paranasal sinuses. In early stages occur with a poor and unespecific features, which delays the diagnosis and worsen the prognosis. An amelanotic melanoma case is reported and bibliographic review of these tumors are made.

[Reading test as a qualitative method for evaluating the vestibulo-ocular reflex]. / El test de lectura como método de valoración cualitativa del reflejo vestibuloocular.

In the reading test the patient reads a text while his or her head is passively moved from one side to another with a frequency over 2 Hz. The vestibulo-ocular reflex (VOR) should stabilize the patient's gaze if it is performing adequately, allowing him or her to read well. Reading becomes impossible if the VOR is defective. We tested this method by assessing VOR in a 30-patient series by means of VAT and a previous reading-test score, and we compared the results of both groups. Next, the test was clinically validated with the bithermal caloric test. There were significant differences in ocular asymmetry between normal and strongly positive groups. The sensitivity, specificity, and positive and negative predictive values validated the reading testing as clinically useful.

[Bimastoid leads and bilateral stimulation in the recording of auditory-evoked brain-stem potentials]. / La derivación bimastoidea y estimulación bilateral en el registro de potenciales evocados auditivos de tronco cerebral.

The recording of auditory brain stem potentials (ABR) with bimastoid leads and bilateral stimulation makes it possible to evaluate relative cochlear function and the type of hearing loss. The theoretical background for this technique and the results obtained in patients with disease of the internal-middle ear, cochlea, and auditory nerve are discussed.