Detección precoz de la sordera mediante otoemisiones. Análisis de los resultados en 200 niños consecutivos explorados / Early hearing loss detection by otoemissions. Analysis of the results in 200 consecutive children reviewed

Presentamos un estudio retrospectivo de 200 niños consecutivos explorados en nuestro hospital entre noviembre del 2005 y abril del 2006 del programa o protocolo de Detección Precoz de Soderas establecido desde hace varios años en nuestra Comunidad. Aquellos niños con sospecha de hipoacusia tras la realización de las otoemisiones acústicas son sometidos a potenciales evocados auditivos de tronco cerebral (PEATC) 3 meses después

We present a retrospective study of 200 consecutive children explored in our hospital between november 2005 and april 2006, as a part of the protocole or program of early identification hearing loss stablished several years ago in our Comunity. In case of suspected hypoacusia after performing otoacoustic emissions, children must be sent to PEATC 3 months later

[Early hearing loss detection by otoemissions. Analysis of the results in 200 consecutive children reviewed]. / Detección precoz de sorderas mediante otoemisiones. Análisis de los resultados en 200 niños consecutivos explorados.

We present a retrospective study of 200 consecutive children explored in our hospital between november 2005 and april 2006, as a part of the protocole or program of early identification hearing loss stablished several years ago in our Comunity. In case of suspected hypoacusia after performing otoacoustic emissions, children must be sent to PEATC 3 months later.

Melanoma maligno de pabellón auricular. Importancia del diagnóstico, tratamiento y factores pronósticos / Malignant melanoma of the pinna. Importance of its diagnosis, treatment and prognostic factors

Alrededor del 25%-30% de los melanomas malignos primarios afectan a la región de cabeza y cuello y de ellos menos del 10% se originan en el oído externo, sobre todo en la zona del hélix y el lóbulo de la oreja. La profundidad o espesor del melanoma y la presencia de metástasis ganglionares o a distancia son factores adversos para el pronóstico. Se presenta un caso de este tumor que asentaba sobre el pabellón auricular derecho y que fue intervenido por nuestro Servicio de ORL con buena evolución, encontrándose el paciente libre de enfermedad tras 5 años de seguimiento

About 25%-30% of the primary malignant melanomas occur in the headand neck regionand of these less than 10% arise on the external ear, mainly on helix and the lobule of the pinna. Melanoma thickness and nodal or distant metastases are advers factors for its prognosis. We report a case of a tumor that affected the right pinna and was removed by our ENT, department with good evolution, being the patient free of disease after 5 years follow-up

Reintervención por adenoma ectópico de paratiroides con extirpación previa de lipotimoma. Importancia de la PTH en intraoperatoria / Reoperation because of ectopic parathyroid adenoma with previous removal of lipotimoma. Importance of intraoperative PTH

En ocasiones la cirugía del hiperparatiroidismo no resulta sencilla y el equipo quirúrgico se encuentra con dificultades para localizar la glándula o glándulas patológicas. Presentamos un caso de hiperparatiroidismo primario debido a adenoma de paratiroides en situación ectópica que requirió dos intervenciones. En la primera se extirpó lo que parecía un adenoma pero resultó ser un lipotimoma. En la reintervención efectuada una semana después, contando entonces con la determinación de PTH intraoperatoria rápida o turbo y una gammagrafía digital previa, se consiguió extirpar un adenoma confirmado histológicamente, de 3,5 cm de diámetro localizado en profundidad al lóbulo tiroideo derecho y que descendía hacia el estrecho mediastínico superior. La evolución postoperatoria de la paciente fue satisfactoria y no se registraron complicaciones

Sometimes the surgery of hyperparathyroidism is not easy and the surgical team find difficulties to locate the pathological gland or glands. We report a case of primary hyperparathyroidism due to an ectopic parathyroid adenoma which required two interventions. First we removed what it seems an adenoma but resulted to be a lipotimoma. In the reintervention practiced one week later, having then the rapid or turbo intraoperative PTH and previous digital scintigraphy, it was possible to remove an adenoma histologically confirmed, with 3,5 cm diameter located in depth to right thyroid lobe towards the superior mediastinal straits. The postoperative evolution of the patient was satisfactory and no complications were registered

[Sudden cervical hematoma after hypertensive crisis. Report of a case]. / Hematoma cervical brusco tras crisis hipertensiva. Presentación de un caso.

We report the case ofa 61 years old woman with multiple pathologies: HTA, diabetes, relapsing polychondritis, hypercholesterolemia, iatrogenic Cushing, cardiopathy, cystic fibrosis, etc. She began, an increment of TA (220/130 mm Hg) or hypertensive crisis, with a sudden left cervical hematoma located on the carotid bifurcation according to CT imaging. We oractice an arteriography that was informed as normal and the patient was admitted and controlled of an ORL as Vascular Surgeon. The bleeding stop spontaneously we treat the patient conservativity.

[Adenoid cystic carcinoma of tongue. Report of a case and literature review]. / Carcinoma adenoide quístico de lengua. A propósito de un caso y revisión de la literatura.

We report the clinical case of an adenoid cystic carcinoma on the base of the tongue, a rare malignant tumor of slow-growing but aggressive with a propepnsity for perineural invasion. Treatment modalities more common include surgery and radiotherapy but locorregional recurrences are frequent and relatively early in the first years. A review of the literature of this pathology is performed.

[Otogenic cerebrospinal fistula. Report of an atypical case]. / Fístula otica de líquido cefalorraquídeo. Presentación de un caso atípico.

We report the case of a female patient who consulted to the Room Emergencies due to abundant watery otorrea of 3 months without another symptom or apparent cause. The studys confirmed the presence of cerebrospinal fluid (CSF) and the imaging tests (CT and MRI) demonstrated the existence of a communication between the right ear and middle cerebral fossa through tegmen timpani. The woman was operated by ORL (closing the fistula) and neurosurgery (placing an external lumbar drainage) with good postsurgical evolution.

[Ramsay-Hunt syndrome associated to unilateral recurrential paralysis]. / Síndrome de Ramsay-Hunt asociado a parálisis recurrencial unilateral.

Varicella herpes zoster (VZV) virus reactivaction can produce multiple neuropathies of the cranial and cervical region being the peripheral facial paralysys the most common one. We report one case of Ramsay-Hunt syndrome with eruption of vesicles on left auricular pinna and face besides facial palsy which associated to ipsilateral laryngeal or recurrential paralysis nonexisting previously. Our patient was treated by oral aciclovir (800 mg, 5 times daily) for 1 week. 3 months later she returned to Emergencies due to another cause and the ENT exploration showed a recovery in the mobility of the left cord but it persisted the affectation of VII pair, specially the inferior branch or cervicofacial. It is advised that the larynx should be examined in all cases of herpes zoster that involve the head and neck.

Hematoma cervical brusco tras crisis hipertensiva. Presentación de un caso / Sudden cervicalhematoma after hypertensive crisis. Report of a case

Presentamos el caso de una mujer de 61 años con múltiples patologías de base: HTA, diabetes, policondritis recidivante, hipercolesterolemia, Cushing yatrógeno, cardiopatía, fibrosis quística, etc, que coincidiendo con una subida de TA (220/130 mm Hg) o crisis hipertensiva debutó bruscamente con un hematoma laterocervical izquierdo localizado a nivel de la bifurcación carotídea según la imagen del TAC. Se practicó una arteriografia que fue informada como normal y la paciente fue ingresada y controlada tanto por ORL como por cirugía vascular. No fue necesario realizar una intervención quirúrgica debido al cese del sangrado y al estado hemodinámicamente estable en todo momento a 10 largo de su evolución clínica

We report the case of a 61 years old woman with multiple pathologies: HTA, diabetes, relapsing polychondritis, hypercholesterolemia, iatrogenic Cushing, cardiopathy, cystic fibrosis, etc. She began, an increment of TA (220/130 mm Hg) or hypertensive crisis, with a sudden left cervical hematoma located on the carotid bifurcation according to CT imaging. We practice an arteriography that was informed as normal and the patient was admitted and controlled of an ORL as Vascular Surgeon. The bleeding stop spontaneously we treat the patient conservativity

Carcinoma adenoide quístico de lengua. A propósito de un caso y revisión de la literatura / Adenoid cystic carcinoma of tongue. Report of a case and literature review

Presentamos un caso clínico de carcinoma adenoide quístico de base de lengua, tumor maligno raro de crecimiento lento pero agresivo con tendencia a la invasión perineural. Las modalidades de tratamiento más comunes incluyen la cirugía y la radioterapia pero las recidivas locorregionales son frecuentes y relativamente precoces en los primeros años. Realizamos una revisión de la literatura al respecto de esta patología

We report the clinical case of an adenoid cystic carcinoma on the base of the tongue, a rare malignant tumor of slow-growing but aggressive with a propensity for perineural invasion. Treatment modalities more common include surgery and radiotherapy but locorregional recurrences are frequent and relatively early in the first years. A review of the literature of this pathology is performed

Fístula ótica de líquido cefalorraquídeo. Presentación de un caso atípico / Otogenic cerebrospinal fistula. Report of an atypical case

Presentamos el caso de una paciente que acudió al servicio de Urgencias or abundante otorrea acuosa de 3 meses de evolución sin otra clinica añadida ni causa aparente. El análisis posterior confirmó la presencia de liquido cefalorraquídeo (LCR) y las pruebas de imagen (TAC y RMN) demostraron la existencia de una comunicación entre el oído derecho y la fosa cerebral media a través del tegmen timpani. La mujer fue intervenida porORL (sellado de la fistula) y neurocirugía (colocación de drenaje lumbar externo) con buena evolución postoperatoria

We report the case of a female patient who consulted to the Room Emergencies due to abundant watery otorrea of 3 months without another symptom or apparent cause. The studys confirmed the presence of cerebrospinal fluid (CSF) and the imaging tests (CT and MRI) demonstrated the existence of a communication between the right ear and middle cerebral fossa through tegmen timpani. The woman was operated by ORL (closing the fistula) and neurosurgery (placing an extemallumbar drainage) with good postsurgical evolution

Síndrome de Ramsay-Hunt asociado a parálisis recurrencial unilteral / Ramsay-Hunt syndrome associated to unilateral recurrential paralysis

La reactivación del virus varicela herpes zóster (VHZ)puede provocar neuropatías múltiples de la región craneocervical siendo la más frecuente la parálisis facial periférica. Presentamos un caso de síndrome de Ramsay -Hunt con erupción vesicular en pabellón izquierdo y cara más parálisis facial que se asoció a parálisis laríngea o recurrencial ipsilateral no existente previamente. La paciente fue tratada con aciclovir vía oral (800mg, 5 veces al día) durante 1 semana. 3 meses después acudió a Urgencias por otro motivo y en la exploración ORL se había recuperado la movilidad de la cuerda izquierda pero persistía la afectación del VII par, especialmente del ramo inferior o cérvicofacial. Recomendamos un examen laríngeo-hipofaríngeo en todos los casos de herpes zóster que afecten a cabeza y cuello

Varicella herpes zoster (VZV) virus reactivaction can produce multiple neuropathies of the cranial and cervical region being the peripheral facial paralysys the most common one. We report one case of Ramsay-Hunt syndrome with eruption of vesicles on left auricularpinna and face besides facial palsy which associated to ipsilateral laryngeal or recurrential paralysis non existing previously. Our patient was treated by oral aciclovir (800 mg, 5 times daily) for 1 week. 3 months later she retumed to Emergencies due to another cause and the ENT exploration showed a recovery in the mobility of the left cord but it persisted the affectation of VII pair, specially the inferior branch or cervicofacial. It is advised that the larynx should be examined in all cases of herpes zoster that involve the head and neck

[Plaut-Vincent's acute necrotizing ulcerative fusospirillum tonsillitis associated to infectious mononucleosis]. / Amigdalitis aguda ulceronecrótica fusoespirilar de Plaut-Vincent asociada a mononucleosis infecciosa.

We report the case of a 14 years old girl patient with recurrent tonsillitis who had been diagnosed and admitted previously with Plaut-Vincent's angina. Six weeks after leaving the hospital she was assited in Emergencies by an infectious mononucleosis associated to unilateral tonsillar necrotizing ulceration from which a sample was taken to microbiological exam finding the fusospirochaetal complex Borrelia vincenti and Fusobacterium necrophorum. A literature review at the respect of such association and its treatment is performed.

[Bogorad syndrome or crocodile tears after Ramsay-Hunt]. / Síndrome de Bogorad o lágrimas de cocodrilo tras Ramsay-Hunt.

Crocodile tears or Bogorad Syndrome describes a complication or sequel after facial palsy with incomplete recovery characterized by an excessive hyperlacrimation during the food ingestion. We report the case of a 50 years old female with that pathology associated to facial syncinesias secondary to suffer a right Ramsay-Hunt syndrome. Its pathogenesis and different treatment modalities are analysed.

[Unspecific cervical cellulitis of sudden appearance. Report of an atypical case]. / Celulitis cervical inespecífica de aparición brusca. Presentación de un caso atípico.

We report an atypical case of sudden and unspecific cervical cellulitis in a 74 yaers old woman with psoriasis as the only remarkable antecedent. After the initial exploration and successive ones we did not find any etiological causes for her symptoms. CT showed an increase of soft parts on the left side of the neck with displacemnet of the upper airway without purulent collection or abscess. The patient was admitted in IUC and was treated endovenously with cloxaciline and imipenem with good response and satisfactory evolution.

[Cervical abscess by Streptococcus anginosus-milleri after foreign body ingestion and suspicion of esophageal perforation]. / Absceso cervical por Streptococcus anginosus-milleri tras ingestión de cuerpo extraño y sospecha de perforación esofágica.

We report a case of cervical abscess after the ingestion of foreign body (chicken bone) secondary to probable esophageal perforation that it was sent to us with suspicion of mediastinal complication. The girl, 17 years-old, nothing else to arrive our hospitalary center required entrance in ICU due to her severe clinical process: High fever, intense neck-thoracic pain, laterocervical diffuse and progressive left inflammation and bad general state. The CT showed the presence of a well defined abscess and abundant aerial component that dissected the cervical muscles that made necessary to perform drainage verifying intraoperatively no mediastinal involvement. The culture of the purulent collection revealed Streptococcus anginosus/milleri resistant to clindamicine but sensible to penicilina and derivatives. We exposed a serie of considerations at respect of such microorganism and its clinical signification.

[Laryngeal chondrosarcoma of low grade of malignancy. Report of a case located on thyroid cartilage]. / Condrosarcoma laríngeo de bajo grado de malignidad. A propósito de un caso localizado en cartílago tiroides.

Cartilaginous tumors of the larynx are rare. Only a 2-5% of all chondrosarcomas arise on head and neck area while the laryngeal forms represent less than 1% of the malignant neoplasms in that location. Laryngeal chondrosarcoma is three times more frequent in men than in women with average age of presentation about the 6th - 7th decades. Most of them are originated on cricoid (70-75%) followed by the thyroid cartilage (10-20%) as in the case that we are reporting. Its growth often is very slow with delayed clinic being hoarseness, dyspnea and dysphagia the most common symptoms. Laryngeal chondrosarcomas use to be tumors with low-grade of malignancy and their elective treatment is surgery preserving the laryngeal function. Local and late recurrences are frequent and the definitive diagnosis is the anatomopathological exam.

[Adenoid cystic carcinoma of the larynx-hypopharynx. A case report and review of the literature]. / Carcinoma adenoide quístico de laringe-hipofaringe. A propósito de un caso y revisión de la literatura.

Laryngeal or hypopharyngeal localization of adenoid cystic carcinoma is rare due to the poor distribution of the accesory salivary glands in this area. We report one case of such neoplasm on that area, with its diagnosis confirmed histologically. The required a total laryngectomy with later reoperations because of hemorrhage and pharyngeal fistula. One year after the surgery and in spite of postoperative radiotherapy multiple pulmonary metastasis were detected causing the death of the patient. We review the literature of this tumor whose prognosis is much worse than epidermoid or scamous carcinoma.

[Diffuse sclerosing papillary carcinoma mimicking chronic lymphocytic thyroiditis. A unusual neoplasm variant]. / Carcinoma papilar esclerosante difuso simulando tiroiditis crónica linfocitaria. Una variante neoplásica inusual.

We report the clinical case of a 39 years old female diagnosed as a chronic lymphocytic tiroiditis by F.N.A.B. with multinodular goiter of long evolution. The patient was operated by total thyroidectomy and her final anatomopathologic result was papillary carcinoma diffuse sclerosing variant. During the surgical act several cervical nodes were detected and removed being informed the most of them as metastasic. A review of the literature at respect of this malignant neoplasm is performed.

[Parotid phlegmon with involvement of both lobes. Report of a case]. / Flemón parotídeo con afectación de ambos lóbulos. A propósito de un caso.

The pathologic processes involving the parotid gland include a vast group of lesions, acute and chronic inflammations, benign and malign tumors, traumas or degenerative processes. We report the case of a 55 years old male diagnosed as left parotid phlegmon with involvement of both lobes, especially the deep one, who required admission and endovenous medical treatment for 6 days up to the resolution of the symptoms.