[The role of video-nystagmography in the diagnosis of acoustic neuroma]. / El papel de la videonistagmografía en el diagnóstico del neurinoma del acústico.

AIM: Schwannoma of the vestibular nerve represents 75% of all expansive processes affecting the pontocerebellosum angle. Hearing loss is the most frequent symptom at diagnosis (86%) with or without tinnitus, in the intracanalicular tumors. Vestibular symptoms are described in 60% of patients. MATERIAL AND METHOD: We study twenty cases of acoustic neuromas diagnosed between years 2000 and 2002 in both Otolaryngology and Neurosurgery Departments in our hospital. Videonystagmography (VNG) was performed in all of them. Videonystagmographic findings were analyzed statistically together with the tumoral size and hypoacusia level. DISCUSSION AND CONCLUSION: According to the medical literature reviewed for this paper, we conclude that caloric tests are the most frequently altered ones (77%), showing vestibular hyporreflexia or arreflexia.

[Non-benign paroxysmal positional vertigo]. / Vértigo posicional paroxístico no benigno.

Positional vertigo is a frequent clinical manifestation of vertigo of very different etiologies, being the benign paroxystic positional vertigo (BPPV) the most frequent one of them, representing in some series even the most found etiology of peripheral vertigo. Usually of severe entities, positional vertigo may appear in the context of severe entities and of difficult diagnosis. In these cases, the bearing of the symptoms in spite of the repositioning manoeuvers, the association with otological or neurological symptoms, and the atypical nystagmus evoked by Dix-Hallpike manoeuver, must take the otolaryngologist to suspect of a feasible non benign pathology. We report a case of positional paroxysmal vertigo caused by an intracranial tumour and we review the clinical signs that shoved help us to suspect of non benign pathologies that can mimic a positional vertigo.

[Neuroendocrine carcinoma of the nasal fossa. An independent entity?]. / Carcinoma neuroendocrino de fosa nasal. Una entidad independiente?

We present one case of a neuroendocrine carcinoma of nasal fossa and paranasal sinuses, of aggressive behavior, which has been controlled with chemo-radiotherapy after a double postsurgical recurrence. We do a literature revision emphasizing the anatomopathologic differentiation of these tumors with the olfactory neuroblastomas, and the therapeutic controversies in advanced stages.

[Kikuchi-Fujimoto's disease and the association with systemic lupus erythematosus]. / Enfermedad de Kikuchi-Fujimoto y su asociación a lupus eritematoso sistémico.

Kikuchi-Fujimoto's disease (KFD), Histiocytic Necrotizing lymphadenitis, is a rare self-limiting condition characterized by lymphadenopathy, fever and neutropenia. The aetiology of KFD is controversial, and its diagnosis is confirmed histologically. Although KFD has rarely been reported associated to Systemic lupus erythemotosus (SLE) should be ruled out given its different prognosis and management. We present the clinical, histological and evolution the two cases of patients with Kikuchi's disease; one case had evolution classic and the other case were associated with SLE.

[Tonsillectomy in adults. Our experience]. / Amigdalectomía en adultos. Nuestra experiencia.

Tosillectomy or palatine tonsils removal was by far as the very middle of the twenty century the commonest surgery in childhood, but owing to the abstinence behavior in past decades this operation has dropped considerabily and in consequence numerous grown up presents frequently tonsillar pathology requiring its removal in middle adult life.

[Cordectomy in the surgical treatment of tumors T1 of the vocal cords. Review of our cases (1974-1990)]. / La cordectomía en el tratamiento quirúrgico de los tumores T1 de cuerda vocal. Revisión de nuestra casuística (1974-1990).

We decided to review the results of cordectomy in our surroundings over the 22 years of existence of our Service. 631 clinic histories of patients undergoing surgery for laryngeal cancer in our Department, between 1974 and 1990, were reexamined, and from those selected 56 pertaining to T1 tumors treated with cordectomy. In this reduced group were studied epidemiology, clinical and pathologic data, complications, survival and death causes as well. The 58 considered were of male sex, middle aged (58-86) excepting 9 patients under 50. Their relation with tobacco eas clear, although less than in our general series (87.93% smokers). Of the 58 patients group 4 of then disappear during the 5 years follow-up term (8.62%). Three died: one from ganglion disease, other from local recurrence and the last one from other condition. In brief, global survival are accounted for 94.34% and the adjusted survival was 96.1%.

[Surgery of cancer of the larynx. Analysis of the results of our cases]. / Cirugía del cáncer de laringe. Análisis de resultados de nuestra casuística.

After 20 years of existence of this Department we decided to carry out a review of the characteristics of our series and also of the results of treatment, according to the protocol elaborated and followed in agreement with the Tumour Committee if the Hospital. 631 medical histories of patients diagnosed and operated for cancer of larynx between 1974 and 1990 were reviewed. 83 of which (13.154%) disappeared during the 5 year follow-up period. Epidemiological, clinical, location, extension and treatment fdata were considered as well as the survival results and a single descriptive statistical analysis performed. The mean age of our study was 59.02 years, showing a clear relation to exposure to tobacco (91.44% were smokers and 63.39% of more than 20 cigarettes per day). The predominant location of the growth was supraglottic (64.05% of cases) followed by glottic in 33.76%. The most frequently used surgical technique was the total laryngectomy and total and extended to either the pharynx or tongue basis in 76.28%, followed by supraglottic laryngectomy in 13m5%. The stages were rather advanced with predominance of stage III /40.60%) and stage IV (21.17%). Global survive rate of our series accounted for 68.61% while the adjusted survival rate was 71.4%.

[Acute epiglottitis in the adult. Retrospective study of 14 cases]. / Epiglotitis aguda del adulto. Análisis retrospectivo de 14 casos.

Acute epiglottitis instead of been a well recognised disease in children, is a rare condition in adult patients. Failure to diagnose epiglottitis early, in adults, undoubtedly contributes to its continuing mortality. We report our experience with acute epiglottitis in grown-up people with a retrospective series of 14 patients seen in our Department from 1993 to 1997. We comment about clinical features and therapeutic management of these patients.

[Endocranial invasion of inverted papilloma]. / Invasión endocraneal por papiloma invertido.

Inverted papilloma (PI) is a benign neoplasm of nose and paranasal sinuses. IP's pathophysiology is characterized by its capacity to be locally destructive, its ability to grow rapidly and its tendency to recur. IP's association with carcinoma is about 13 percent of cases. The surgical treatment of IP has evolved over the years, with a progression toward more radical en bloc extirpation. The paper reports an inverted papilloma case of nasal cavities, with destruction of frontal sinus roof and intracranial extension aside frontal lobe displacement.

[Mortality in laryngeal cancer surgery]. / Mortalidad en la cirugía del cáncer de laringe.

UNLABELLED: The causes of death were studied in a series of 171 patients who died in a 5-year follow-up period, out of a total of 631 patients who underwent different surgical techniques for cancer of the larynx. MATERIAL AND METHODS: The case histories of 631 patients who had undergone surgery between 1974 and 1990 were reviewed; 83 did not have a 5-year follow-up and were excluded from the study. A descriptive and inferential statistical study was made of the remaining cases to determine the relation between cause of death and tumoral extension, primary location, degree of tumoral differentiation, surgical technique and other data. RESULTS: Ninety-one patients died from local or regional recurrence, 50 from distant metastases, 20 from diseases other than the tumor, and 10 from postoperative complications. These findings were studied with regard to factors such as tumor extension, location, surgical technique, etc. CONCLUSIONS: The main cause of death in surgery for cancer of the larynx was recurrence, either local, on the tumor bed (62 patients) or regional (29 patients). The mortality rate was higher in older patients, patients with lymph-node involvement in the postoperative histological study, and patients with less differentiated histological forms.

[Results of 769 stapedectomies performed between 1975 and 1993]. / Resultados de 769 estapedectomías realizadas entre 1975 y 1993.

A retrospective review was made of 719 primary stapedectomies and 48 re-operations carried out between 1975 and 1993. Preoperative and postoperative audiograms (6-12 months) were studied, analyzing 250, 500, 1000, 2000 and 4000 Hz, auditory gain and closure of the air-bone gap < or = 10 dB. Ninety percent had an auditory gain of > or = 10 dB at conversational frequencies. Age, the surgeon, and average preoperative pure tone did not influence the final result. Polyethylene prostheses (70.9%) and steel and teflon pistons (21.1%) were the prostheses used most often. Neurosensorial hearing loss (> 10 dB) occurred in 24 cases (3.3%). In revision stapedectomy, 66.6% of patients had air-bone gap closure of < or = 20 dB and 71% had a hearing gain of < or = 10 dB. Prosthesis displacement (43.7%) and incus necrosis (18.7%) were the most common findings in revision stapedectomy.

[The influence of age and previous thresholds on stapedectomy results]. / Influencia de la edad y los umbrales óseos previos en el resultado de las estapedectomías.

This is a retrospective study dealing with 719 primary stapedectomies and 48 reoperations done between 1975 and 1993 by the AA. of the paper. They consider the audiometric tracings before and after surgery (6 and 12 months). Frequencies analyzed were 250 Hz, 500 Hz, 1000 Hz, 2000 Hz and 4000 Hz; the air-bone gap; and modifications of bone thresholds. The patients were ranged in groups according the ages and previous bone thresholds. Thereafter an analysis aiming to a comparison of surgery results en each group was contemplated. The age resulted without influence on the postoperative gap neither in modifications of bone conduction. The previous bone thresholds nor influencing the final gap. Conversely there are significative differences (P > 0.01) regarding the modifications of bone conduction.

[Study of 288 stapedectomies performed between 1986 and 1991]. / Estudio de 288 estapedectomías realizadas entre los años 1986 y 1991.

A review of 288 stapedectomies performed between 1986 and 1991 was carried out. Pre- and post-surgical (within six to nine months) audiometries were studied, analyzing the 250 Hz, 500 Hz, 1,000 Hz, 2,000 Hz and 4,000 Hz frequencies. No significant differences between age and sex, type of prosthesis or final auditive gain were found. Patients were distributed in six groups according to their initial audiometry, achieving higher auditive gain those with and worse initial audition.

[Solitary extramedullary plasmocytoma of the nasal cavity]. / Plasmocitoma extramedular solitario de cávum.

A case of Extramedullary Plasmacytoma of nasopharynx is reported in a 41 years old man. The presenting symptom was bilateral nasal obstruction. Multiple Myeloma was excluded. The treatment was surgical excision and postsurgical radiotherapy. At present the patient is well.

[Cystic lymphangioma]. / Linfangioma quístico.

Lymphangioma is a benign, congenital type of tumour which can be classified as a malformation of the lymphatic vessels with an enlargement and a proliferation of same. It is divided, depending on the calibre of the vessels, into Capillary, Cavernous and cystic. 80% of these lesions are located in the neck; 50% of these cases are already evident at the moment of birth and 90% prior to the 2nd year of life. Its treatment is surgical but, due to the large number of digitations present, its complete removal is difficult to achieve, thereby giving rise to frequent relapses. We are submitting the case of a three and a half-year-old girl who was operated on in our department. With this, we would like to contribute to a greater knowledge of this pathology.

[Nasal hemangiopericytoma]. / Hemangiopericitoma nasal.

We are submitting a case of haemangiopericytoma of the nasal fossae, diagnosed and treated in our department. This is the second case we have seen as the first one was published by J. Marin and al. (1) in 1979. The patient in question is male, 35 years of age, who suffered from a tumour in the nasal partition, in the left nasal fossa and which made itself evident through repetitious epistaxis. The tumour was removed and there has not, so far, been any relapse. We have carried out a study of the available literature concerning haemangiopericytomas located in the nasal fossae and in the paranasal sinuses and come across 50 cases. In 1987 Chawla compiled 23 cases (2). Of the 50 cases, only 6 are described as being located in the nasal wall. We are submitting a list of all the cases that we have published and gathered with the age and sex of each patient and year of their publication.

[Inflammatory pseudotumor of the paranasal sinuses]. / Pseudotumor inflamatorio de senos paranasales.

The inflammatory pseudotumor of the head and of the neck is a lesion of unknown etiology which affects the orbita more frequently but cases have also been described in the paranasal sinuses, larynx, mouth, cervical column and by direct extension from the orbita in the Central Nervous System. In the majority of cases, it behaves as a limited benignant inflammation within the osseous walls of the area where it is to be found; other times it destroys the osseous limits and invades the surrounding areas, behaving as a neoplasia. It must be distinguished from sinusitis, granulomatous inflammations, vasculitis, diseases of the collagen, sarcoidosis, neoplasias and benignant tumours. We present a case of inflammatory pseudotumour, occupying the right maxillary sinus, nasal fossa and rhinopharynx. Surgical extirpation has been the treatment used.

[Juvenile nasopharyngeal angiofibroma. Apropos of a case]. / Angiofibroma nasofaríngeo juvenil. A propósito de un caso.

We present the case of a 14 years old male with juvenile nasopharyngeal angiofibroma, treated in our Department with radiotherapy due to the patient having declined surgery. In the control carried out 2 years after finishing radiotherapy the tumour had disappeared. Up to now, we have not found important secondary effects of the treatment. We go over what has been published during the last few years about this disease.

[Ethmoidofrontal mucoceles. Their clinical picture, diagnosis and differential diagnosis]. / Mucoceles etmoidofrontales. Clínica, diagnóstico y diagnóstico diferencial.

Anterior sitting is the most frequent localisation of frontal or ethmoidal mucocele. Generally its evolution is slow, but some times they evolve as acute inflammatory processes. The AA. report 2 paradigmatic cases of each course. The CAT shows the thinning out of the bone and the spreading of the disease. Comments on the symptomatology, exploratory means and differential diagnosis with other sinusal or orbital conditions.

[Cancer of the nasopharynx: our experience with 34 cases]. / Cáncer de nasofaringe: nuestra experiencia con 34 casos.

Thirty four cases of patients with nasopharyngeal cancer, all white people, are reviewed. The more frequent clinical signs are, in order of frequency: nasal obstruction, which is presented in 65% of patients, transmission deafness, in 59%; adenomegalies in 44%; epistaxis in 26% and migraine in 21% of cases. The mean time evolution between the first clinical symptom and the treatment was four and a half months. The pathologic study was: epidermoid carcinoma in 31 cases (91.9% and non-Hodgkin lymphoma in 3 cases 8.9%). The 31 cases of epidermoid carcinoma were treated with radiotherapy and the 5 years survival was 38%. In 62% of cases, the tumor recurred locally, in lymph nodes or were distant metastasis.