Manejo del absceso de la glándula tiroides / Management of thyroid gland abscess

Introducción: La enfermedad supurativa de la glándula tiroides-absceso de tiroides o tiroiditis supurativa aguda- supone una infrecuente situación clínica. Presentamos nuestra experiencia en los casos asistidos durante 41 años. Materiales y métodos: Estudio longitudinal retrospectivo anotando características epidemiológicas, conducta diagnóstico-terapéutica y resultado clínico, detectando 14 casos -9 varones y 5 mujeres, entre 19 y 68 años, con una media de edad de 40,6 ± 15,4 años- con 22 episodios. En 2 pacientes la condición se había reproducido hasta en 4 ocasiones. Resultados: Supusieron el 0,29% de todos los abscesos cervicales atendidos. La punción-aspiración fue efectuada en 13 de ellos para su tratamiento e identificación del agente causal. Los agentes más habitualmente implicados fueron Mycobacterium tuberculosis y Staphylococcus aureus. Se realizó un estudio de imagen mediante ecografía en 9 casos y de tomografía computarizada en 7. En 10 pacientes el tratamiento definitivo fue quirúrgico, efectuándose drenaje del absceso en 7 de ellos, tiroidectomía total en 4 y hemitiroidectomía en 2. Otros tratamientos admitidos fueron la antibioterapia sistémica o mediante irrigación intralesional y la esclerosis. Aunque en un caso la fase aguda comenzó con hipertiroidismo y tirotoxicosis, a los 6 meses del alta existió hipotiroidismo definitivo en 5 casos. Las opciones terapéuticas adoptadas consiguieron la curación en el 100% de los casos. Conclusión: La supuración de la glándula tiroidea es una circunstancia extremadamente rara en el contexto de la enfermedad cervical, variando las opciones terapéuticas desde alternativas conservadoras al drenaje con tiroidectomía según los hallazgos microbiológicos y radiológicos

Background: Thyroid abscess or acute suppurative thyroiditis is an unusual clinical condition. We present our experience with cases attended over 41 years. Materials and methods: A retrospective study was performed on these patients reviewing their epidemiological characteristics and the diagnostic and therapeutic manoeuvres chosen for them all, as well as their clinical outcome. A group of 9 males and 5 females was studied, with ages ranging from 19 to 68 (mean of 40.6±15.4). These patients suffered 22 acute episodes, and 2 patients each had 4 episodes. Results: Suppurative thyroiditis comprised 0.29% of the neck abscesses. Fine needle aspiration was performed in 13 cases to evacuate the collection and isolate the aetiological agent. Mycobacterium tuberculosis and Staphylococcus aureus were the most frequently identified. Nine patients underwent ultrasound and 7 computed tomography imaging studies. Surgery was the option for 10 patients, including drainage for 7, thyroidectomy for 4 and hemithyroidectomy for the remaining 2. Systemic or intralesional antibiotics and sclerosis of the gland were also carried out. Although one case presented with hyperthyroidism and thyrotoxicosis in the acute phase, definitive hypothyroidism was observed in 5 patients at 6 months following discharge. The rate of success was 100%. Conclusion: Thyroid gland suppuration is a very infrequent circumstance in neck pathology, and the options for its treatment are varied, from conservative to invasive techniques according to the microbial and radiologic findings

Management of thyroid gland abscess. / Manejo del absceso de la glándula tiroides.

BACKGROUND: Thyroid abscess or acute suppurative thyroiditis is an unusual clinical condition. We present our experience with cases attended over 41 years. MATERIALS AND METHODS: A retrospective study was performed on these patients reviewing their epidemiological characteristics and the diagnostic and therapeutic manoeuvres chosen for them all, as well as their clinical outcome. A group of 9 males and 5 females was studied, with ages ranging from 19 to 68 (mean of 40.6±15.4). These patients suffered 22 acute episodes, and 2 patients each had 4 episodes. RESULTS: Suppurative thyroiditis comprised 0.29% of the neck abscesses. Fine needle aspiration was performed in 13 cases to evacuate the collection and isolate the aetiological agent. Mycobacterium tuberculosis and Staphylococcus aureus were the most frequently identified. Nine patients underwent ultrasound and 7 computed tomography imaging studies. Surgery was the option for 10 patients, including drainage for 7, thyroidectomy for 4 and hemithyroidectomy for the remaining 2. Systemic or intralesional antibiotics and sclerosis of the gland were also carried out. Although one case presented with hyperthyroidism and thyrotoxicosis in the acute phase, definitive hypothyroidism was observed in 5 patients at 6 months following discharge. The rate of success was 100%. CONCLUSION: Thyroid gland suppuration is a very infrequent circumstance in neck pathology, and the options for its treatment are varied, from conservative to invasive techniques according to the microbial and radiologic findings.

Papiloma invertido de oído medio y hueso temporal / Inverted papilloma of middle ear and temporal bone

No disponible

Valoración audiológica y subjetiva del dispositivo Baha(R) Attract / Audiologic and subjective evaluation of Baha(R) Attract device

Se incluyeron en el estudio 9 pacientes implantados con el dispositivo Baha(R) Attract. A todos los pacientes se les realizó, con y sin el dispositivo, una audiometría tonal en campo libre, una audiometría verbal en campo libre, y una audiometría verbal con ruido de fondo, así como la aplicación de los cuestionarios Glasgow Benefit Inventory (GBI) y Abbreviated Profile of Hearing Aid Benefit (APHAB). Las valoraciones audiológicas con el dispositivo mostraron unos umbrales auditivos promedios de 35,8 dB, con ganancias medias de 25,8 dB. El umbral de recepción verbal promedio con el dispositivo se situó en 37 dB, mostrando una ganancia de 23 dB. Los resultados promedio del umbral de discriminación máxima fueron de 60 dB con el dispositivo. El Baha(R) Attract logra alcanzar unas ganancias auditivas en los pacientes indicados correctamente, con una consiguiente valoración subjetiva positiva por parte de los pacientes, presentando no obstante un efecto atenuativo en su transmisión transcutánea, que le impide alcanzar mayores ganancias (AU)

We included 9 patients implanted with Baha(R) Attract. All our patients were evaluated by free field tonal audiometry, free field verbal audiometry and free field verbal audiometry with background noise, all the tests were performed with and without the device. To evaluate the subjective component of the implantation, we used the Glasgow Benefit Inventory (GBI) and Abbreviated Profile of Hearing Aid Benefit (APHAB). The auditive assessment with the device showed average auditive thresholds of 35.8 dB with improvements of 25.8 dB over the previous situation. Speech reception thresholds were 37 dB with Baha(R) Attract, showing improvements of 23 dB. Maximum discrimination thresholds showed an average gain of 60 dB with the device. Baha (R). Attract achieves auditive improvements in patients for whom it is correctly indicated, with a consequent positive subjective evaluation. This study shows the attenuation effect in transcutaneous transmission, that prevents the device achieving greater improvements (AU)

Hipo. Actitud en otorrinolaringología en pacientes que consultan. Aproximación diagnóstica y terapéutica / Hiccups. Attitude in otorhinolaryngology towards consulting patients. A diagnostic and therapeutic approach

Introducción. Las crisis de hipo suelen ser autolimitadas y benignas, pero los episodios prolongados alteran la calidad de vida y requieren asistencia, ya que existen causas identificables que el otorrinolaringólogo debe conocer para su diagnóstico y tratamiento. Su manifestación última es un ruido glótico espasmódico con alteraciones cervicales características. Pacientes y métodos. Desde 1979 se revisaron todos los casos que consultaron por hipo persistente o recidivante, anotando cronobiología, patología concomitante, resultados de las exploraciones, tratamiento y respuestas al mismo. Resultados. Se asistieron 37 pacientes con una edad media de 45,5±13,5 años, de los cuales 30 eran varones; 23 pacientes (el 62%) presentaron hipo persistente. En 24 casos (el 65%) se evidenció una causa potencialmente asociable: enfermedades del esófago en 14 —la mayoría reflujo gastroesofágico— y en 8 se apreció o descubrió patología oncológica concomitante. Solo 3 casos fueron intervenidos como resultado de los hallazgos efectuados. Los protocolos de tratamiento incluyeron metoclopramida en 18 sujetos, clorpromazina en 17 y baclofeno en 13, pero también carbamazepina o haloperidol. Se empleó neuroestimulación del nervio frénico en 6 pacientes. El hipo desapareció en 32 casos. De los 22 sujetos en los que se pudo efectuar seguimiento, se constató recidiva en 5 —precisando por ello nuevas terapias— y 11 fallecieron. Conclusiones. El hipo crónico implica un reto multidisciplinar con potencial afectación en cabeza y cuello, una sistemática diagnóstica de descarte, frecuente patología de base esofágica y una incidencia de neoplasia maligna alta. Los agentes procinéticos y neurolépticos con efecto antidopaminérgico y anticolinérgico suponen la base del tratamiento (AU)

Introduction. Hiccup crises are generally benign and self-limiting, but longer episodes affect quality of life and must be treated. There are recognisable causes that otorhinolaryngologists must know and be aware for diagnosis and therapeutic alternatives. The main expression is a spasmodic glottic noise with characteristic neck alterations. Patients and methods. This was a retrospective study from 1979 with patients suffering persistent or recurrent hiccups. Chronobiology, comorbidity, findings from explorations, therapies and outcomes were noted. Thirty-seven patients were studied (mean age, 45.5±13.5 years; 30 males), with persistent hiccups in 23 (62%). Results. A potential associated aetiology was observed in 24 cases (65%): oesophageal disorders —mainly gastroesophageal reflux— were detected in 14 cases and concomitant oncological disease was found in 8. Only 3 cases were admitted for surgery due to these findings. Therapeutic strategies with metoclopramide were used in 18 subjects, chlorpromazine in 17 and baclofen in 13, while carbamazepine or haloperidol were used in a minority. Phrenic nerve stimulation was employed in 6 patients. Hiccups disappeared in 32 cases. Out of 22 cases for which follow-up was possible, the hiccups recurred in 5 subjects (the subjects requiring new therapies) and 11 patients died. Conclusions. Chronic hiccup represents a multidisciplinary challenge that includes potential head and neck affection, a diagnostic schedule for ruling out causes, frequent base oesophageal alterations and high incidence of malignant neoplasm. Prokinetic and neuroleptic agents with antidopaminergic and anticholinergic effects are the pillars of its treatment (AU)

Audiologic and subjective evaluation of Baha® Attract device. / Valoración audiológica y subjetiva del dispositivo Baha® Attract.

We included 9 patients implanted with Baha® Attract. All our patients were evaluated by free field tonal audiometry, free field verbal audiometry and free field verbal audiometry with background noise, all the tests were performed with and without the device. To evaluate the subjective component of the implantation, we used the Glasgow Benefit Inventory (GBI) and Abbreviated Profile of Hearing Aid Benefit (APHAB). The auditive assessment with the device showed average auditive thresholds of 35.8dB with improvements of 25.8dB over the previous situation. Speech reception thresholds were 37dB with Baha® Attract, showing improvements of 23dB. Maximum discrimination thresholds showed an average gain of 60dB with the device. Baha® Attract achieves auditive improvements in patients for whom it is correctly indicated, with a consequent positive subjective evaluation. This study shows the attenuation effect in transcutaneous transmission, that prevents the device achieving greater improvements.

Hiccups. Attitude in Otorhinolaryngology Towards Consulting Patients. A Diagnostic and Therapeutic Approach. / Hipo. Actitud en otorrinolaringología en pacientes que consultan. Aproximación diagnóstica y terapéutica.

INTRODUCTION: Hiccup crises are generally benign and self-limiting, but longer episodes affect quality of life and must be treated. There are recognisable causes that otorhinolaryngologists must know and be aware for diagnosis and therapeutic alternatives. The main expression is a spasmodic glottic noise with characteristic neck alterations. PATIENTS AND METHODS: This was a retrospective study from 1979 with patients suffering persistent or recurrent hiccups. Chronobiology, comorbidity, findings from explorations, therapies and outcomes were noted. Thirty-seven patients were studied (mean age, 45.5±13.5 years; 30 males), with persistent hiccups in 23 (62%). RESULTS: A potential associated aetiology was observed in 24 cases (65%): oesophageal disorders -mainly gastroesophageal reflux- were detected in 14 cases and concomitant oncological disease was found in 8. Only 3 cases were admitted for surgery due to these findings. Therapeutic strategies with metoclopramide were used in 18 subjects, chlorpromazine in 17 and baclofen in 13, while carbamazepine or haloperidol were used in a minority. Phrenic nerve stimulation was employed in 6 patients. Hiccups disappeared in 32 cases. Out of 22 cases for which follow-up was possible, the hiccups recurred in 5 subjects (the subjects requiring new therapies) and 11 patients died. CONCLUSIONS: Chronic hiccup represents a multidisciplinary challenge that includes potential head and neck affection, a diagnostic schedule for ruling out causes, frequent base oesophageal alterations and high incidence of malignant neoplasm. Prokinetic and neuroleptic agents with antidopaminergic and anticholinergic effects are the pillars of its treatment.

Osteoblastoma de cartílago tiroides / Osteoblastoma of the thyroid cartilage

No disponible

Electrococleografía extratimpánica en una población normal. Estudio descriptivo / Extra-tympanic electrocochleography in a normal population. A descriptive study

Introducción y objetivos: La electrococleografía extratimpánica es un registro elecrofisiológico que refleja la actividad eléctrica acontecida en la cóclea tras un estímulo sonoro. Se obtiene mediante la aplicación del estímulo en el conducto auditivo externo y el registro de la actividad eléctrica mediante electrodos de superficie. Dada la escasa literatura existente acerca de la exploración electrococleográfica normal en nuestro medio, este estudio busca regularizar los valores obtenidos mediante esta exploración en sujetos sin enfermedad otoneurológica y explicar detalladamente el proceso mediante el cual se obtiene el registro. Métodos: Exploración mediante electrococleografía extratimpánica de 60 oídos sin enfermedad otoneurológica y análisis estadístico de los resultados obtenidos. De ellos, 30 oídos fueron explorados a 90dB mientras que otros 30 oídos fueron estimulados a 80dB. Resultados: Se muestran los valores medios de amplitud y latencia del potencial de sumación y del potencial de acción, así como las latencias medias de la onda I y la onda II. Asimismo, se presenta el cálculo del cociente potencial de sumación/potencial de acción. Obtenidos estos resultados se comparan en función de la intensidad del estímulo, del sexo del paciente, del oído estudiado y del grupo etario. Conclusiones: Este estudio recopila datos sobre la electrococleografía en una población normal. Los valores obtenidos están en el rango de los valores normales de otros países, expuestos en la literatura internacional. Estos datos pueden ser muy útiles como referencia a la hora de valorar exploraciones en pacientes con dolencias que afectan la estructura o la función coclear (AU)

Introduction and objectives: Extra-tympanic electrocochleography is an electrophysiological register obtained after stimulating the cochlea with an audible stimulus. This stimulus is applied using an earphone over the external auditory canal, while the electrical activity is registered by surface electrodes. There are few studies that analyse normal electrocochleography in our environment. Thus, the main objective of our study was to regularize the values obtained with electrocochleography in ears without any otoneurological diseases. We explain in detail the process of obtaining the register. Methods: Sixty healthy ears were studied by extratympanic electrocochleography. Statistical results were analysed. While 30 ears were studied with a stimulus at 90dB, another 30 ears were studied with a stimulus at 80dB. Results: Summating potential and action potential latencies and amplitudes were measured. Summating potential/action potential ratios were calculated. Wave I and wave II latencies were also determined. These results were analysed in function of stimulus intensity, patient gender, patient age group and ear side studied. Conclusions: This study collected extra-tympanic electrocochleography data in a normal population and the results were in the range of other international studies obtained in other countries. These data can be used as a reference to evaluate illnesses that affect cochlear structure or functions (AU)

Relación entre el video head impulse test (vHIT) y la prueba calórica en el estudio evolutivo de pacientes con neuritis vestibular / Relationship between video head impulse test (vHIT) and caloric test in patients with vestibular neuritis

Introducción y objetivos: La prueba calórica es hasta ahora la prueba de referencia para el diagnóstico y el examen de una hipofunción vestibular unilateral. El video head impulse test (vHIT) valora el reflejo vestíbulo-oculomotor, mediante el registro videoasistido de la maniobra impulsiva. Se pretende comparar la variación de los resultados del vHIT y la prueba calórica en pacientes con neuritis vestibular respecto a su estado inicial en diferentes puntos de su evolución, y comprobar su grado de correlación entre sí y con el test Dizziness Handicap Inventory (DHI). Métodos: Exploración en la misma sesión mediante vHIT y prueba calórica de 20 pacientes con neuritis vestibular. Valoración de la correlación de dichas pruebas entre sí y con el test DHI en 2 momentos diferentes de la evolución para cada paciente. Resultados: La asimetría de la ganancia del vHIT y la paresia canalicular de la prueba calórica no evidenciaron una correlación lineal entre ellas. Tampoco se apreció una correlación entre el DHI y la recuperación de los parámetros de estas 2 pruebas. Las sacadas Covert mantienen una velocidad similar mientras están presentes en el vHIT, mientras que las Overt disminuyen su velocidad con el tiempo. Conclusiones: El vHIT y la prueba calórica muestran diferentes respuestas del reflejo vestíbulo-oculomotor, dado que exploran diferentes frecuencias del mismo. No se ha encontrado una correlación entre el vHIT, la prueba calórica y el DHI a lo largo de la evolución de la neuritis vestibular, siendo pruebas complementarias entre sí (AU)

Introduction and objectives: The caloric test is the gold standard for the loss of vestibular function diagnosis. The Video Head Impulse Test (vHIT) assesses the same reflex by using a video- assisted examination of the impulsive maneuver. We intend to compare the variation of results of the vHIT and the caloric test in patients with vestibular neuritis with respect to their initial condition at two different moments of their evolution and to check the level of correlation between them and with that of the DHI test. Methods: We explored 20 patients with neuritis by using both vHIT and the caloric test on the same day. We assessed the correlation between these two tests and with the DHI test for each patient at two different moments of their evolution. Results: We calculated gain asymmetry and compared it with the canal paresis, but we found neither a linear correlation between them, nor a correlation between the DHI test or improvement of these two other tests. We conclude that the covert saccades maintain a similar speed whilst present in the VHIT, but the overts diminish their speed over time. Conclusions: The VHIT and the caloric test show different responses of the vestibulo-ocular reflex, because they stimulate different frequencies of this reflex. No correlation was found between the VHIT, the caloric test and the DHI test. The tests appear to complement one another (AU)

Extra-tympanic electrocochleography in a normal population. A descriptive study. / Electrococleografía extratimpánica en una población normal. Estudio descriptivo.

INTRODUCTION AND OBJECTIVES: Extra-tympanic electrocochleography is an electrophysiological register obtained after stimulating the cochlea with an audible stimulus. This stimulus is applied using an earphone over the external auditory canal, while the electrical activity is registered by surface electrodes. There are few studies that analyse normal electrocochleography in our environment. Thus, the main objective of our study was to regularize the values obtained with electrocochleography in ears without any otoneurological diseases. We explain in detail the process of obtaining the register. METHODS: Sixty healthy ears were studied by extratympanic electrocochleography. Statistical results were analysed. While 30 ears were studied with a stimulus at 90dB, another 30 ears were studied with a stimulus at 80dB. RESULTS: Summating potential and action potential latencies and amplitudes were measured. Summating potential/action potential ratios were calculated. Wave I and wave II latencies were also determined. These results were analysed in function of stimulus intensity, patient gender, patient age group and ear side studied. CONCLUSIONS: This study collected extra-tympanic electrocochleography data in a normal population and the results were in the range of other international studies obtained in other countries. These data can be used as a reference to evaluate illnesses that affect cochlear structure or functions.

Relationship between video head impulse test (vHIT) and caloric test in patients with vestibular neuritis. / Relación entre el video head impulse test (vHIT) y la prueba calórica en el estudio evolutivo de pacientes con neuritis vestibular.

INTRODUCTION AND OBJECTIVES: The caloric test is the gold standard for the loss of vestibular function diagnosis. The Video Head Impulse Test (vHIT) assesses the same reflex by using a video- assisted examination of the impulsive maneuver. We intend to compare the variation of results of the vHIT and the caloric test in patients with vestibular neuritis with respect to their initial condition at two different moments of their evolution and to check the level of correlation between them and with that of the DHI test METHODS: We explored 20 patients with neuritis by using both vHIT and the caloric test on the same day. We assessed the correlation between these two tests and with the DHI test for each patient at two different moments of their evolution. RESULTS: We calculated gain asymmetry and compared it with the canal paresis, but we found neither a linear correlation between them, nor a correlation between the DHI test or improvement of these two other tests. We conclude that the covert saccades maintain a similar speed whilst present in the VHIT, but the overts diminish their speed over time. CONCLUSIONS: The VHIT and the caloric test show different responses of the vestibulo-ocular reflex, because they stimulate different frequencies of this reflex. No correlation was found between the VHIT, the caloric test and the DHI test. The tests appear to complement one another.