[Peritonsillar infection. Out-patient management]. / Infecciones del espacio periamigdalar. Manejo ambulatorio.

INTRODUCTION: Peritonsillar infections are the most frequent deep infections in head and neck. The estimated annual incidence is 30 cases per 100.000 inhabitants. PATIENTS AND METHODS: A retrospective study was undertaken in 132 patients with peritonsillar infection. A diagnostic and therapeutic protocol was used consisting on diagnostic needle aspiration, incision and drainage and intravenous antibiotic and steroids. RESULTS: 35,6% were peritonsillar phlegmons and 64,4% were abscesses. The median of hospital monitoring was 9,2 hours. Only 25,8% were admitted to the hospital. Six patients had recurrences of the symptoms during the study. DISCUSSION: The needle aspiration is useful in differential diagnosis between phlegmons and abscesses. Bacteriologic studies are not necessary in the routine management of peritonsillitis. Surgical treatment of these patients is controversial. Incision and drainage seems to be appropiated in the management of this pathology. Admission to the hospital is not always necessary if a correct outpatient control is possible.

Infecciones del espacio periamigdalar. Manejo ambulatorio / tittle

Introducción: las infecciones periamigdalares son las infecciones profundas más frecuentes de cabeza y cuello. Se estima una incidencia anual de 30 casos por 100.000 habitantes. Material y Métodos: realizamos un estudio retrospectivo de 132 casos de infección periamigdalar. Se aplicó un protocolo diagnóstico y terapéutico mediante punción aspirativa, incisión y drenaje y tratamiento con antibiótico y glucocorticoide. Resultados: el 35,6% son flemones y el 64,4% son abscesos periamigdalares. La mediana de estancia hospitalaria de los pacientes fue de 9,2 horas. Únicamente un 25,8% requirieron ingreso hospitalario. En 6 pacientes se produjo más de un episodi. Discusión: para diferencial si se trata de un flemón o absceso se puede hacer una punción aspirativa. Los estudios microbiológicos no se consideran necesarios de forma rutinaria. El tratamiento de estos pacientes es controvertido. La incisión y drenaje parece ser una buena opción para el manejo de la patología. El ingreso hospitalario no es necesario si es posible realizar un correcto control ambulatorio

Introduction: Peritonsillar infections are the most frequent deep infections head and neck. The estimated annual incidence is 30 cases per 100.000 inhabitants. Patients and methods: A retrospective study was undertaken in 132 patients with peritonsillar infection. A diagnostic and therapeutic protocol was used consisting on diagnostic neddle aspiration, incision and drainage and intravenous antibiotic and steroids. Results: 35,6% were peritonsillar phlegmons and 64,4% were abscesses. The median of hospital monitoring was 9,2 hours. Only 25,8% were admitted to the hospital. Six patients had recurrences of the symptoms during the study. Discussion: The needle aspiration is useful in differential diagnosis between phlegmons and abscesses. Bacteriologic studies are not necessary in the routine management of peritonsillitis. Surgical treatment of these patients is controversial. Incision and drainage seems to be appropiated in the management of this pathology. Admission to the hospital is not always necessary if a correct outpatient control is possible

[Importance of laser in the surgical technique of otosclerosis and its results]. / Importancia del láser en la técnica quirúrgica de la otosclerosis y sus resultados.

The authors bring up the matter of the usefulness of laser in otosclerosis surgery. They set out some advantages of laser utilization. A bibliografic review is done and some important authors are found explaining the advantages of this instrument. Some new tendencies on stapes surgery are presented. Teaching on otosclerosis surgery problems are stated, with some different criteria. The idea that improvement of audiologic results in stapes surgery is not easy is strengthened, because the results obtained with the classic techniques are excellent, but some of these methods increase the surgical comfort and reduce the potential risks to the patient.

[Malleostapedotomy in the pathology of the incudomalleolar complex combined with fixation of the stapes]. / Tratamiento de la patología del complejo incudomaleolar combinada con fijación del estribo mediante maleoestapedotomía.

INTRODUCTION: Stapes fixation combined with disorders of the incudo-malleolar complex disorders requires a sound transmission reconstruction that often is difficult to solve. This circumstance can turn up in several pathologies and also in revision surgery for otosclerosis. PATIENTS AND METHODS: We present our experience with four patients that underwent to malleostapedotomy with removal of the malleus anterior ligament and the malleus anterior apophysis. RESULTS: We discuss the previous findings in each case. Two patients reached a gap closure and the other two patients obtained an auditive gain without complete gap closure. DISCUSSION: We set out the ethiology of malleus and incus hipomobility. We do a bibliographic review on the results of this technique in revision stapedectomy.

Tratamiento de la patología del complejo incudomaleolar combinada con fijación del estribo mediante maleoestapedotomía / Malleostapedotomy in the pathology of the incudomalleolar complex combined with fixation of the stapes

Introducción: La fijación del estribo combinada con trastornos del complejo incudo-maleolar requiere una reconstrucción de la transmisión del sonido, que, a menudo, resulta difícil de resolver. Esta situación puede presentarse en diversas patologías u observarse en revisiones de estapedectomía. Pacientes y métodos: Presentamos nuestra experiencia de cuatro pacientes en los que hemos realizado una maleoestapedotomía, con eliminación del ligamento anterior y la apófisis anterior del mango del martillo. Resultados: Comentamos los hallazgos observados en cada uno de los casos, previos a la realización de la técnica. En dos casos se consiguió un cierre del umbral diferencial audiométrico, mientras en los otros dos se obtuvo una mejoría auditiva sin cierre completo. Discusión: Exponemos las distintas causas que pueden originar la hipomovilidad del martillo y del yunque. Realizamos una revisión de la literatura sobre los resultados obtenidos mediante esta técnica en revisiones de estapedectomía

Introduction: Stapes fixation combined with disorders of the incudo-malleolar complex disorders requires a sound transmission reconstruction that often is difficult to solve. This circumstance can turn up in several pathologies and also in revision surgery for otosclerosis. Patients and methods: We present our experience with four patients that underwent to malleostapedotomy with removal of the malleus anterior ligament and the malleus anterior apophysis. Results: We discuss the previous findings in each case. Two patients reached a gap closure and the other two patients obtained an auditive gain without complete gap closure. Discussion: We set out the ethiology of malleus and incus hipomobility. We do a bibliographic review on the results of this technique in revision stapedectomy

Importancia del láser en la técnica quirúrgica de la otosclerosis y sus resultados / Importance of laser in the surgical technique of otosclerosis and its results

Los autores plantean la utilización del láser en la cirugía. Se revisa la literatura, en la que se encuentran autores que nos hablan de las ventajas que supone la utilización de este instrumento. También se recogen nuevas tendencias en la cirugía del estribo. Se plantea la enseñanza de la cirugía de la otosclerosis, con diferentes criterios. Se refuerza la idea de que es dificil mejorar los rendimientos auditivos, ya que los que se obtienen con técnicas clásicas son excelentes, pero si que se mejora la comodidad y se disminuyen los riesgos

The authors bring up the matter of the usefulness of laser in otosclerosis surgery. They set out some advantages of laser utilization. A bibliografic review is done and some important authors are found explaining the advantages of this instrument. Some new tendencies on stapes surgery are presented. Teaching on otosclerosis surgery problems are stated, with some different criteria. The idea that improvement of audiologic results in stapes surgery is not easy is strengthened, because the results obtained with the classic techniques are excellent, but some of these methods increase the surgical comfort and reduce the potential risks to the patient

[Cidofovir activity in infantile recurrent respiratory papillomatosis]. / Actividad del cidofovir en la papilomatosis respiratoria infantil recidivante.

We report the case of a 4 year old boy that arrived to our department refering a 4 months history of dysphony complicated in the last week with inspiratory estridor. He was diagnosed of respiratory papillomatosis. In the next 10 months he underwent 6 operations to remove papillomas with CO2 laser. In the last operation we decided to add adjuvant therapy with intralesional injections of cidofovir once all papillomas had been removed. After more than a year of monitoring he remains disease free.

Actividad del cidofovir en la papilomatosis respiratoria infantil recidivante / Cidofovir activity in infantile recurrent respiratory papillomatosis

Presentamos el caso de un varón de 4 años que acude a nuestra consulta por presentar disfonía de 4 meses de evolución que en la última semana se ha complicado con estridor inspiratorio. Es diagnosticado de papilomatosis respiratoria. En los siguientes 10 meses es sometido a 6 intervenciones para resección de papilomas con láser CO2. En la última intervención se decide realizar terapia adyuvante mediante inyección intralesional cidofovir en el lecho resultante tras la exéresis. Tras más de un año de seguimiento el paciente permanece libre de enfermedad

We report the case of a 4 year old boy that arrived to our department refering a 4 months history of dysphony complicated in the last week with inspiratory estridor. He was diagnosed of respiratory papillomatosis. In the next 10 months he underwent 6 operations to remove papillomas with CO2 laser. In the last operation we decided to add adjuvant therapy with intralesional injections of cidofovir once all papillomas had been removed. After more than a year of monitoring he remains disease free

Leishmaniasis laríngea: presentación de dos casos clínicos / Laryngeal leishmaniasis: presentation of two clinical cases

Presentamos 2 casos clínicos de leishmaniasis laríngea, diagnosticados en nuestro hospital. La leishmaniasis aislada de laringe es una rara forma de leishmaniasis mucosa que en el litoral mediterráneo se ha asociado a infección por leishmania donovani ifantum. En nuestros pacientes la aparición de esta extraña forma de leishmaniasis se ha asociado a alcoholismo crónico en el primer caso y a la toma de esteroides inhalados en el segundo. En ninguno de los 2 pacientes existe antecedentes de viajes al extranjero ni se asocia la enfermedad a infección por HIV. El diagnóstico se realizó en los 2 casos por observación directa de las leishmanias en las biopsias mucosas. El tratamiento propuesto fueron los antimoniales, siendo sustituidos en uno de los casos por amfotericina B liposomal por intolerancia a los primeros (AU)

[Secondary hearing impairment due to Paget's disease]. / Hipoacusia secundaria a enfermedad de Paget.

Paget's disease presents frequently in skull bones with incidence in temporal bone, causing vertigo, hearing loss and tinnitus. The AA. present one case in a woman, 60-year-old, diagnosed as Paget's disease, complaining of left ear deafness and hearing impairment of the right ear resulting from a conductive disorder.

[Lymphoepithelioma of the larynx]. / Linfoepitelioma laríngeo.

Non-nasopharyngeal Lymphoepithelioma is a tumor of undifferentiated non-keratinizing cells enclosed in an lymphocytic stroma. The lymphoid tissue does not participate in the tumor process. Its tendency is to precociously spreading in the lymph nodes and viscera, but shows a good radiotherapeutic response. Unlike the nasopharyngeal lymphoepithelioma there is no etiological relationship with the Epstein-Barr virus, in spite of the histological similitudes, therefore the pathogenesis must be different in each. Discrimination between lymphoepithelioma and other neoplasms of the epithelial lineage is important in order to indicate the treatment and also to provide prognostic information.

[Review of ORL manifestations in AIDS. Case series at the Arnau de Vilanova Hospital, Lleida]. / Revisión de las manifestaciones O.R.L. en el SIDA. Casuística del Hospital Arnau de Vilanova, de Lleida.

The majority of patients suffering AIDS-syndrome present with ENT aspects, being the most prevalent lateral adenopathy of the neck firstly, followed by thrush, pharyngo-esophageal candidiasis and herpes simplex. Differences regarding the distribution in percentage in risk groups are signaled by the AA. between their own statistics and those of the americans writers.

[Recurrent polychondritis]. / Policondritis recidivante.

The interest of the relapsing polychondritis is specially due to its otolaryngological implications. The case reported evolved favourably and responded fairish to the corticoidtherapy. Nevertheless an assidous follow-up will be wise in order to stablish the pronostic in view of the outbreacks of the illness. The AA. compare the own case with others referred to in the literature.

[Tuberculous otitis media]. / Otitis media tuberculosa.

Report of a case of middle ear tuberculosis in an elderly woman with a chronic discharging ear withstanding the common treatment. The diagnosis could be made through examination of the pieces taken at surgery (tympanoplasty). The A. advice is to arouse suspicion when findings compatible with tubercular otitis are encountered, in order to treat wisely the patient and avoid complications.