[The vestibulocollic reflex: assessment and characteristics of vestibular-evoked myogenic potentials analysed by age groups]. / Reflejo vestibulocervical. Valoracion y caracteristicas de los potenciales vestibulares miogenicos evocados analizados por tramos de edad.

INTRODUCTION: Obtaining vestibular-evoked myogenic potentials (VEMP) by means of the vestibulocollic reflex is a readily available technique that provides an image of vestibular functioning and is useful for evaluating the pathologies that involve compromise of the anatomical pathway of the reflex. Although normal patterns do exist, responses vary at different ages. AIM: To obtain reference values of the vestibulocollic reflex according to different age groups. SUBJECTS AND METHODS: We studied 40 volunteers with no symptoms of auditory or vestibular compromise. Each ear was stimulated separately by a series of clicks (sounds lasting 0.1 s; 3 pps; intensities of 100 dB nHL and 85 dB nHL) and recordings were made in the sternocleidomastoid muscles by means of surface electrodes as patients who were lying on their backs contracted these muscles as they lifted their heads. We studied the latency of the initial p13-n23 positive-negative potential and the peak-to-peak amplitude. The existence of later n34-p44 potentials was evaluated. RESULTS: No statistically significant differences were found between genders or between the two ears. We did not find any differences between the latencies of the waves according to the intensity of the stimulus, but there is a relationship between the amplitude of the p13-n23 potential and the intensity of the stimulus. The latencies of the responses in children under 10 years of age differ from those of the other groups, but no differences were found among those over the age of 11. CONCLUSIONS: The VEMP display steady and easily identifiable latencies. We obtained different reference values for latency in children under the age of 10 and those over 11 years old. The amplitude decreases with the intensity of the stimulus.

[Ménière's disease and migraine]. / Enfermedad de Ménière y migraña.

INTRODUCTION: The possible link between vertigo and migraine has been known for a long time as well as its association with Ménière's disease. OBJECTIVE: To determine the lifetime prevalence of migraine in EM patients and to compare it with the prevalence of migraine in general population according to the International Headache Society (IHS) criteria. METHODS: We interviewed 65 EM patients. Our results have been compared with a sex- and age-matched control group with no otological antecedent. RESULTS: The lifetime prevalence of migraine was significantly higher in Ménière group compared to the age- and sex-matched control group (35.4% versus 15.4%, p < or = 0.05). Nine patients with EM and migraine related an evident relationship between their vertigo episodes and the migraine. CONCLUSIONS: The results obtained in our study suggest the possibility of common pathophysiological mechanisms to both pathologies and it may lead to new therapeutic options for treatment of EM and migraine patients.

[Blood viscosity profile in rapidly progressive sensorineural hearing loss with positive Western-blot]. / Perfil de la viscosidad sanguínea en la hipoacusia rápidamente progresiva con Western-blot positivo.

OBJECTIVE: To value a possible association between disorders in blood viscosity of patients with rapidly progressive sensorineural hearing loss (RPSHL) of autoimmune origin. PATIENTS AND METHODS: We studied the viscoelastic properties of blood in 43 subjects bearing of RPSHL and a positive Western-blot for anticochlear antibodies: whole blood viscosity (WBV) at different shear rates and erythrocyte filterability (EF). These results were related to hearing loss initially detected and recovery average one year later from steroid therapy. RESULTS: Just WBV at 230 sec(-1) shear rate was significatively higher in cases than in controls (p < 0.01). Hearing recovery degree correlated in an statistically way to increased values of EF (p < 0.01). There was no relation between initial hearing loss level and any rheology parameter. CONCLUSIONS: Autoimmune RPSHL does not show a pathophysiology mechanism associated to blood hyperviscosity. So, rheoactive therapies as plasmapheresis warrant no clinical improvement.

[Vestibular evoked myogenic potential: a contribution to the vestibular physiology and pathology knowledge. Quantitative patterns in healthy subjects]. / Potencial vestibular miogénico evocado: un aporte al conocimiento de la fisiología y patología vestibular. Patrones cuantitativos en la población normal.

INTRODUCTION: Vestibulocollic reflex is a muscular reflex which is activated by acoustic stimulation. It shows two components: the first one, the vestibular evoked myogenic potential (VMEP) related to the vestibular pathway and the second, to the auditive pathway. The VMEP potential could be useful for vestibular physiology and pathology knowledge. OBJECTIVE: To determine the VMEP's parameters of normality and to evaluate influential factors such as age, sex or stimulation intensity. MATERIAL AND METHODS: Prospective study of the VCR in 40 healthy individuals, distributed in 4 groups according to their age. Stimulation was carried out at 100db and 85db on each ear independently. RESULTS: There are not differences between both ears and sexes. Normal latency levels must be separated between two groups of age: older and younger than 11 years old. Normal absolute values of amplitude response differ depending on muscular contraction, age and stimulation intensity. It is more representative to consider the difference between the values obtained in the two ears of the same individual than to consider the absolute values.

[Kinetic tests representativity in vestibular function]. / Representatividad de las pruebas cinéticas en la función vestibular.

INTRODUCTION: The most frecuently tests used to study the vestibular system, with videonystagmographic register, are the caloric and rotatory ones. MATERIAL AND METHODS: We have carried out a comparative study of the kinetic tests through a sample of 41 patients without vestibular pathology, stratified by age and gender. The performed rotational tests have been: Constant/cycles, postrrotatory test, increasing, decreasing and constant test. RESULTS: We have not observed age or gender influence on the results. We give the numeric results of these tests. CONCLUSION: The obtained data allow to conclude that the information given by the increasing and decreasing pendulous test is similar, phenomenon that doesn't happen in the rest of the practiced tests. We also study the habituation phenomenon to a know stimuli. We point out the importance of each laboratory to have their tests done previously in a normal control group in order to compare the results when performing them in pathological patients.

Mucormycosis of the paranasal sinuses.

Between 1989 and 1992 we had two cases of mucormycosis. The first patient presented with left hemiplegia: radiologic studies showed a right sphenoidal sinus mass, cerebral ischaemic infarction and occlusion of the right carotid artery. The second patient was seen with an abscess of the hard palate after long term steroid therapy. CT scan showed a soft-tissue mass occupying the maxillary sinus, which had eroded its walls and spread to palate, orbit and ethmoidal cells. We have emphasised the presence of hyperglycemia in both cases, the marked tendency of this lesion to invade blood vessels, and the good results obtained by combining liposomal amphotericin B with radical surgical debridement.

[Epidermoid of the petrous apex]. / Epidermoide de punta de peñasco.

The AA. report a case of primary cholesteatoma of the petrous apex. These seldom cases show at the beginning trigeminal symptomatology. They are treated through a middle fossa approach. Survey of the literature.

[Audiometric threshold shift in patients with cochlear implantation]. / Variación de los umbrales audiométricos en pacientes implantados.

A great number of studies have been carried out during many years in order to evaluate the histological changes that take place after the insertion of a cochlear implant, having been experimentally and histologically, in temporal bones, demonstrated its relative harmlessness. We have focused our functional investigation induced by the implants through the shift of pre- and postoperative tonal audiometric thresholds, in 13 carriers on an C. I. Nucleus 22. Most of them suffered minimal or even showed no shift of thresholds. Therefore we consider the functional alterations due to the insertion of electrodes as practically nonexistent.

[Meningoencephalocele: microsurgical endonasal approach. Report of two cases]. / Meningoencefalocele: abordaje con microcirugía endonasal. Dos casos.

Neurosurgery is the commonest way of treating meningoencephaloceles, but there are cases with certain particularities allowing microsurgical approach through the nose, for instance nasoethmoidal sitting, small size,... We report our experience of 2 cases of meningoencephalocele removed through this approach, one of them reoperated because tumor recurrence.

[Vertigos in childhood. Characteristics according to our results]. / Vértigos de la infancia. Características según nuestros resultados.

The paper deals with a review of 25 cases of infantile dizziness done for a term of 10 years. The protocol employed in the study, the characteristics and the follow-up of the crises are contemplated.

[Results of an auditory screening program in preschool children]. / Resultados de un programa de screening auditivo en niños en edad preescolar.

Although important advances have been made in screening for neonatal hearing loss in recent years, there are no extensive studies of other age groups (2 and 3 years). In an audiological study of 284 children of this age using brainstem evoked potentials, we found some degree of deafness in 6.3%, 17% sensorineural and 70% moderate. The large percentage of hearing deficits found in this preschool population suggests that screening programs should be carried out.

[Hypertrophic osteoarthropathy in a patient with nasopharyngeal carcinoma]. / Osteoartropatía hipertrófica en paciente con carcinoma de nasofaringe.

A clinic-pathological study of a 12 year-old male diagnosed of non-differentiated nasopharyngeal carcinoma (NPC) was carried out. The patients presented secondary hypertrophic osteoarthropathy prior to the development of lung metastases. Hypertrophic osteoarthropathy is a clinic-radiological syndrome characterized by a neoformation of periosteal bone, fundamentally located in long bones and distal ends of metacarpal bones. Polyarticular and synovial involvement is also observed. Association between NPC and hypertrophic osteoarthropathy is uncommon and appears to suggest the existence of metastatic spread (probably to the lung), particularly in young patients.

[Pediatric laryngeal papillomatosis: our experience (three cases)]. / Papilomatosis laríngea infantil. Nuestra experiencia (tres casos).

Three cases of juvenile laryngeal papillomatosis were treated at our hospital between 1984 and 1994. Papillomas were excised in all patients because of upper airway obstruction. Two were given alpha interferon as complementary treatment. Two patients are asymptomatic after years of follow-up and one is still taking alpha interferon.

[Cochleovestibular nerve compression syndrome. A case report]. / Síndrome de compresión del VIII par craneal. Caso clínico.

Cochleovestibular nerve compression syndrome is a term used to describe a group of audiovestibular symptoms produced by vascular compression of the cochleovestibular nerve. The most frequent abnormalities are sensorineural hearing loss, asymmetry of the wave I-III and III-V interval in the auditory brainstem response, and changes in electronystagmography. The clinical presentation varies and symptoms include recurrent vertigo, tinnitus, instability, and motion intolerance. A case is reported of cochleovestibular nerve compression syndrome in a 40-year-old woman with right ear hearing loss and occasional dizziness and tinnitus. Clinical exploration disclosed no relevant findings, but the auditory brainstem response showed an increase in the wave I-V interval. Contrasted magnetic resonance imaging identified a vascular loop near the cochleovestibular nerve. The differential diagnosis and treatment of this rare syndrome are discussed.

[Emergency amygdalectomy and adenoidectomy in children with upper respiratory obstruction]. / Amigdalectomías y adenoidectomías urgentes en niños por obstrucción de la vía aérea superior.

Hypertrophy of the adenoids and tonsils in children sometimes produces life-threatening upper airway obstruction that requires emergency endotracheal intubation followed by adenotonsillectomy. Four patients, age range 18 months to 3 years, who required emergency treatment in the Pediatric Intensive Care Unit were studied for acute respiratory distress syndrome with cyanosis and use of accessory respiratory muscles. Two had orotracheal intubation to stabilize their cardiorespiratory situation before surgery. One presented cardiomegaly and secondary pulmonary arterial hypertension. The third remained stable and adequately ventilated with naso-hypopharyngeal ventilation. The fourth remained in intensive care for its clinical situation, but did not require exceptional measures.

[Primary tuberculous otitis media]. / Otitis media tuberculosa primaria.

Tuberculous otitis media is now an infrequent disease, with an incidence of less than 1%. In most cases the origin is a pulmonary focus and primary cases are rarer. We report a case of primary tuberculous otitis media in an immunocompetent patient. A bibliographic review was made of clinical and etiopathogenic aspects, as well as diagnosis and treatment. We highlight the diagnostic difficulty and the fact that this entity should be included in the differential diagnosis of persistent suppurative otitis media.

Cochlear implants for adults obtaining marginal benefit from acoustic amplification: a European study.

OBJECTIVE: This study aimed to examine the application of a speech recognition score of 30% on open-set word materials as the upper limit for preoperative performance in determining cochlear implant (CI) candidacy for European non-English-speaking hearing-impaired persons. This study also aimed to determine the effect of implantation on residual pure-tone hearing thresholds and to determine the incidence and benefit of a contralateral hearing aid postimplant. STUDY DESIGN: The single-subject design study, involving 20 postlinguistically deafened subjects, compares preoperative performance with hearing aids to postoperative performance with a CI at 6 months after surgery. Subjects were implanted with either the Nucleus Mini 22 or the Nucleus 24 CI systems implementing the MPEAK and SPEAK coding strategies. Fourteen subjects meeting the selection criteria were accrued consecutively specifically for inclusion in the study, whereas the remaining 6 retrospectively implanted subjects were identified for inclusion via patient records. PATIENTS: The investigation included 8 clinics over 3 countries (France, Germany, and Spain) and involved 20 postlinguistically deafened subjects who obtained marginal benefit from acoustic amplification before surgery. Nineteen subjects were older than 18 years of age with 1 subject being 14 years old included in the data report as well. MAIN OUTCOME MEASURES: Open-set speech recognition was evaluated before and after surgery using recorded word lists and sentence lists in the subject's native language to determine benefit from the treatment. Baseline audiograms were obtained before surgery for frequencies of 0.25-8.0 kHz for both ears and compared to pure-tone hearing thresholds measured at 1 month after surgery to determine the effect of the implantation on residual hearing. Additionally, a questionnaire was administered to determine the incidence and benefit of continued hearing aid use in the contralateral ear postimplant. RESULTS: Nineteen of the 20 study subjects displayed a significant benefit after surgery at 6 months after switch-on for open-set speech recognition. The remaining subject displayed no significant change in performance on objective testing. The implantation resulted in a significant downward shift in hearing thresholds for the implant ear in the majority of subjects. However, 50% of subjects displayed conservation of some residual hearing. For the majority of subjects, hearing aid use in the contralateral ear was discontinued because of lack of perceived benefit after surgery. CONCLUSIONS: The Nucleus Multichannel CI provides a significant benefit for postlinguistically deafened adults who display marginal benefit from acoustic amplification. Therefore, in French-, German-, and Spanish-speaking clinics, a speech recognition score of 30% on open-set word materials is considered an appropriate upper limit for preoperative performance in determining CI candidacy. In view of a significant downward shift in pure-tone thresholds in the implant ear for the majority of subjects, in cases of asymmetry, it is recommended that the poorer ear be implanted. After surgery, the majority of subjects did not perceive an added benefit from continued use of their contralateral hearing aid.

Reflejo vestibulocervical. Valoración y características de los potenciales vestibulares miogénicos evocados analizados por tramos de edad / The vestibulocollic reflex. assessment and characteristics of vestibular-evoked myogenic potentials analysed by age groups

Introducción. La obtención de potenciales vestibulares miogénicos evocados (PVME) mediante la realización del reflejo vestibulocervical es una técnica de fácil obtención que da una imagen de la función vestibular y es útil para valorar las patologías que impliquen afectación de la vía anatómica del reflejo. Aunque existen patrones normales, a distintas edades podemos encontrar variaciones en las respuestas. Objetivo. Obtener valores de referencia por tramos de edad del reflejo vestibulocervical. Sujetos y métodos. Estudiamos a 40 voluntarios sin síntomas de afectación auditiva o vestibular. Se estimula mediante clics (sonidos de 0,1 s de duración; 3 pps; intensidades de 100 dB nHL y 85 dB nHL), cada oído por separado, y se registra en los músculos esternocleidomastoideos mediante electrodos de superficie mientras el paciente los contrae al alzar la cabeza desde el decúbito supino. Hemos estudiado la latencia del potencial positivo-negativo inicial p13-n23 y la amplitud pico-pico. Se valora la existencia de potenciales más tardíos n34-p44. Resultados. No encontramos diferencias estadísticamente significativas entre géneros ni entre ambos oídos. No observamos diferencias entre latencias de las ondas en función de la intensidad del estímulo, y existe una relación entre la amplitud del potencial p13-n23 y la intensidad del estímulo. Las latencias de las respuestas en menores de 10 años difieren del resto de grupos, pero no existen diferencias en los mayores de 11 años. Conclusiones. Los PVME muestran unas latencias estables y fácilmente identificables. Obtenemos los valores de referencia de latencia diferentes para menores de 10 años y para los mayores de 11. La amplitud decrece en función de la intensidad del estímulo

Introduction. Obtaining vestibular-evoked myogenic potentials (VEMP) by means of the vestibulocollic reflex is a readily available technique that provides an image of vestibular functioning and is useful for evaluating the pathologies that involve compromise of the anatomical pathway of the reflex. Although normal patterns do exist, responses vary at different ages. Aim. To obtain reference values of the vestibulocollic reflex according to different age groups. Subjects and methods. We studied 40 volunteers with no symptoms of auditory or vestibular compromise. Each ear was stimulated separately by a series of clicks (sounds lasting 0.1 s; 3 pps; intensities of 100 dB nHL and 85 dB nHL) and recordings were made in the sternocleidomastoid muscles by means of surface electrodes as patients who were lying on their backs contracted these muscles as they lifted their heads. We studied the latency of the initial p13-n23 positive-negative potential and the peak-to-peak amplitude. The existence of later n34-p44 potentials was evaluated. Results. No statistically significant differences were found between genders or between the two ears. We did not find any differences between the latencies of the waves according to the intensity of the stimulus, but there is a relationship between the amplitude of the p13-n23 potential and the intensity of the stimulus. The latencies of the responses in children under 10 years of age differ from those of the other groups, but no differences were found among those over the age of 11. Conclusions. The VEMP display steady and easily identifiable latencies. We obtained different reference values for latency in children under the age of 10 and those over 11 years old. The amplitude decreases with the intensity of the stimulus

Enfermedad de Ménière y migraña / Ménière’s disease and migraine

Introducción: La posible relación del vértigo con la cefalea es conocida desde hace tiempo, al igual que su asociación más concretamente con la Enfermedad de Ménière (EM). Objetivo: Determinar la prevalencia de migraña en pacientes con EM y compararla con la de la población general siguiendo los criterios de la International Headache Society (IHS). Material y métodos: Realizamos una encuesta personal a 65 pacientes con EM. Los resultados han sido comparados con un grupo control formado por 65 personas seleccionadas por edad y sexo y sin patología auditiva previa. Resultados: La prevalencia de migraña en los pacientes con EM resultó ser significativamente superior a la del grupo control (35,4% frente 15,4%, p<=0,05). Nueve pacientes con EM y migraña refieren una relación directa entre los episodios de migraña y los de vértigo. Conclusiones: Los resultados obtenidos nos orientan hacia un posible origen común de estas dos entidades en algunos casos y a plantear alternativas terapéuticas ante pacientes con EM que no mejoran con el tratamiento habitual

Introduction: The possible link between vertigo and migraine has been known for a long time as well as its association with Ménière’s disease. Objective: To determine the lifetime prevalence of migraine in EM patients and to compare it with the prevalence of migraine in general population according to the International Headache Society (IHS) criteria. Methods: We interviewed 65 EM patients. Our results have been compared with a sex- and age-matched control group with no otological antecedent. Results: The lifetime prevalence of migraine was significantly higher in Ménière group compared to the age- and sex-matched control group ( 35,4% versus 15,4% ,p <= 0,05). Nine patients with EM and migraine related an evident relationship between their vertigo episodes and the migraine. Conclusions: The results obtained in our study suggest the possibility of common pathophysiological mechanisms to both pathologies and it may lead to new therapeutic options for treatment of EM and migraine patients