[Factors predicting Voice Handicap Index]. / Indice de Incapacidad Vocal: factores predictivos.

OBJECTIVE: To assess factors that may be predictive of patient perception of dysphonia severity, as quantified by the Voice Handicap Index (VHI) score. MATERIAL AND METHODS: A prospective study is carried out in 81 voice samples from patients diagnosed with benign vocal fold lesions. Variables assessed for predictive value to VHI score are maximum fonation time, narrow band spectrogram, jitter, shimmer, HNR, NNE, F0 and the auditory perceptual evaluation of severity of dysphonia GRABS. RESULTS: HNR, F0 and B and S parameters of GRABS were predictors of total VHI score, functional and emotional subscales. No parameter was found to predict the physical subscale. CONCLUSIONS: VHI score is correlated with the perceived breathy voice and its acoustic attributes, such as signal-to-noise ratio. In other studies, patient perception of dysphonia is independent of many factors commonly assessed during the evaluation of voice disorders. It is reasonable to assume that the severity of glottic gap caused by benign vocal folds lesions is related to a low signal-to-noise ratio and the breathy phonation as its perceptual correlate. The physical subscale appears to be an independent element in the assessment of the patient perception of dysphonia.

[Distant metastases in head and neck cancer]. / Metástasis a distancia en el cáncer de cabeza y cuello.

INTRODUCTION: The presence of distant metastasis (DM) after the initial treatment of head and neck squamous cell carcinoma (HNSCC) is not considered a common event and it is associated to a poor outcome. PURPOSE: To investigate the prevalence and risk factors associated with the diagnosis of distant metastasis in SCC. METHODS AND MATERIALS: A retrospective study of 633 patients with HNSCC to describe the clinical characteristics of the DM. RESULTS: During the follow-up period after the initial treatment, 6.2% of the patients were diagnosed of having distant metastasis. The site of primary tumor was hypopharynx in 14.4%, unknown origin in 11.8% and oropharynx in 8.5%. The most common sites of DM were the lungs (58%) and the bone (22%). Three year overall survival in patients with DM was 2.5% (versus 49,5% in the control group). CONCLUSIONS: This study confirms that DM have an adverse impact in survival. There is a need of guidelines for screening of distant metastases in patients with HNSCC in order to get an early diagnosis and a more effective treatment. Because of the poor prognosis of DM, protocols including adjuvant chemotherapy should be investigated.

[Gastric pull-up reconstruction in hypopharyngeal and cervical oesophageal cancer]. / Reconstrucción con interposición gástrica en el cáncer de hipofaringe y esófago cervical.

OBJECTIVE: To determine the results of gastric pull-up reconstruction following pharyngo-laryngo-esophagectomy. METHODS: The clinical data of 12 patients who were treated with pharyngolaryngo/esophagectomy were analysed, from 1995 to 2000. All patients had advanced disease, and required a gastric pull-up reconstruction. Clinical swallowing function and morbidity were evaluated postoperatively and the survival group was studied using a Kaplan-Meier survival curve. RESULTS: Five cases of hypopharyngeal cancer and seven cases of cervical esophageal cancer were studied. In three cases a regional flap was used. A total of 16 cervical dissections were carried out. Only in 2 patients the nodes were free of metastasis. There were four hospital deaths. At discharge, 7 patients out of the 8 had a good swallowing. The most common complications were pulmonary (58%). The five years survival was 31%. CONCLUSION: Gastric pull up transposition must be used for reconstruction following pharyngolaryngoesophagectomy. Proper selection of patients may reduce considerably the morbidity and mortality of this surgical procedure.

[Otorhinolaryngological consultation material in PDA: SEORL-PDA]. / Material de Consulta de Otorrinolaringología en PDA: SEORL-PDA.

OBJECTIVES: Occasionally, the Otolaryngologist needs to accede quickly to medical information in order to retrieve data or to solve doubts. In this way, it seems to be of interest to design a clinical guide that could be consulted as a PDA program (Pocket PC and Palm versions), in a personal computer or Internet. MATERIAL AND METHODS: Clinical contents of protocols, guides, and articles, preferably based on the evidence and the clinical experience of 102 authors. Implementation of a program that allows the guide to be used in a PDA, to update it or to add notes using tools that could be downloaded from a web page. RESULTS: A clinical practice guide SEORL-PDA version 1.1, with thirteen ENT's topics, calculation algorithms, internal links and possibility of update the content and to add notes. DISCUSSION: SEORL-PDA is a clinical guide in PDA format, with enough information and possibilities. Its downloading and installation is easily done following the instructions of the web created with these purposes.

[Second primary tumors in head and neck cancer]. / Segundos tumores primarios en el cáncer escamoso de cabeza y cuello.

INTRODUCTION: The development of second primary tumors (SPT) in patients with head and neck squamous cell carcinoma (HNSCC) has become an increasingly important factor in clinical treatment decisions. PURPOSE: To define favourable clinical characteristics for overall survival, in patients with SP head and neck cancer. MATERIAL AND METHOD: Records of 633 patients with SCC treated from 1984 to 2004 were reviewed to describe clinical characteristics of the SPT. RESULTS: The overall incidence of SPT was 11%. The incidence of the index tumors was as follows: supraglottic cancer 21% and oral cancer 16%. The most common SPT occurred in head and neck area in 47%, lung in 32% and esophagus in 11%. Second primary was associated with a poor 5 years survival in patients with HN-SCC (23 versus 53% in control group). CONCLUSION: Because of the high rate of second primary tumors, protocols including chemoprophylaxis should be investigated. Prevention and early detection are indicated.

[Research in the professional practice of the medical speciality]. / La investigación en el ejercicio profesional de la medicina especializada.

Research has a very important role in the financial development of countries; it improves our life quality in all aspects and helps to face unexpected happenings. In Spain science has been left to a second plane and we feel necessary to reverse this situation. Amongst the different kinds of research (basic, clinical and translational) the two last ones are most interesting for clinical doctors. Training of the doctor in the research field helps to a better practice as the advances in research can be applied to clinical practice. There is a tendency for doctors to be involved less in research and it is very important to modify this situation. Research should start in Medical school and play an important role throughout the training period. Once training has concluded, those with capacity and interest in research should follow a 3-4 years training in the field and after that period they can undertake both clinical and research roles. Finally, in Spain our speciality needs to create specific research laboratories in those ENT departments in hospitals with adequate infrastructure to develop research.

[Prognostic factors in adenoid cystic carcinoma of salivary glands]. / Factores pronósticos en el carcinoma adenoide quístico de glándulas salivares.

OBJECTIVE: Adenoid cystic carcinoma (ACC) is a relatively rare tumor which is characterized by its long clinical history, with multiple recurrences and late distant metastasis. The aim of the present study is to show our experience in the management of this tumor and the relationship of different clinico-pathological parameters with its prognosis. MATERIAL AND METHODS: A retrospective study was carried out between 1984 and 2004 in 28 patients with ACC of the salivary glands, analyzing the most outstanding clinico-pathological variables in this tumor related to the prognosis of the tumor and the survival. RESULTS: The overall survival rates at 5, 10 and 15 years were 88%, 69% and 52% respectively. Ten (36%) patients presented local recurrence and 10 (36%) presented distant metastasis (four of which also have local recurrence). Although the differences were not statistically significant, the patients with solid histological subtype (p=0.17), with positive margins status (p=0.2), with perineural invasion (p=0.59), and those treated with surgery alone (p=0.19), presented a worse survival. DISCUSSION/CONCLUSION: Our study confirms that the ACC is a tumor with a high tendency to local recurrence and development of distant metastasis, even long term, which means a close follow-up for life. Nevertheless, it also demonstrates that acceptable survival rates can be obtained with aggressive treatment.

[Endoscopic nasal surgery for pterigopalatine fossa schwannoma]. / Abordaje de un schwannoma de la fosa pterigo-palatina por cirugía endoscópica nasal.

Schwannomas are tumors of nerve sheath origin, the lesion being derived from the Schwann cells surrounding neural tissue in most of the peripheral, cranial and autonomic nerves. Schwannomas occurring in the head and neck represent 25-35% of all reported schwannomas, and most commonly arise from the acoustic or the neumogastric nerves. In the nose and paranasal sinuses these tumors are very uncommon (fewer than 4% of all schwannomas). In the pterygopalatine fossa they are very rare, and arise in this case from the ophthalmic and maxillary branches of the trigeminal nerve. In this exceptional site, the tumor is classically approached through a Caldwell-Luc incision. In this case, we report the removal of a schwannoma of the pterygopalatine fossa by endoscopic sinus surgery.

[Multimedia educational material. A tool of support to the Otolaryngology training]. / Material educativo multimedia. Una herramienta de apoyo a la enseñanza de la Otorrinolaringología.

Due to multimedia technologies, the medical information has taken an extraordinary growing. Nevertheless, the education at University will turn out to be a more complex pedagogic process. We present a multimedia educational material (MEM), developed as an online course to "Seminars of Otolaryngology", and available free at the University website. MEM was designed and edited by, ENT teachers, pedagogues, and image and computer experts. It has been structured as a series of modules that integrate texts, images, movie clips, video, audio and animations. The schematic presentation stands out with progressive access to the topics through internal and external links. The pedagogic resources give additional support by learning objectives, glossary, references, index and searcher. Finally, the activities and instrumental simulations complete the training in diagnosis and treatment. The MEM is an interactive useful software program for medical training in Otolaryngology, without avoiding the key figure of the teacher.

[The relationship between human papillomavirus and cyclin D1 gene amplification in squamous cell carcinomas of the head and neck]. / Relación entre el virus del papiloma humano y la amplificación del gen de la ciclina D1 en los carcinomas epidermoides de cabeza y cuello.

INTRODUCTION: infection by oncogenic subtypes of human papillomavirus (HPV) and cyclin D1 gene (CCND1) amplification are frequent events in head and neck squamous cell carcinomas. The objective of this paper is to establish the relationship between the presence of human papillomavirus (HPV) gene sequences and the development of CCND1 gene amplification in these tumours. MATERIALS AND METHODS: 59 squamous cell carcinomas of the head and neck were studied for HPV types 6b and 16 and CCND1 gene amplification by polymerase chain reaction. RESULTS: HPV DNA was detected in 14 tumors (24%). Ten of them were positive for the HPV type 6b and 4 for the HPV type 16. CCND1 gene amplification was found in 15 cases (25%). Although we have found a higher frequency of CCND1 amplification in the HPV-positive cases (36%, versus 22% in the HPV-negative cases), these differences were not statistically significant (P= 0,32). CONCLUSIONS: The presence of HPV gene sequences does not seem to be related to a significative higher incidence of CCND1 gene amplification in the squamous cell carcinomas of the head and neck.

[Diagnostic value of head-shaking nystagmus in vestibular clinical evaluation]. / Utilidad del nistagmo de agitación cefálica en la exploración vestibular clínica básica.

OBJECTIVES: To determine the sensitivity and specificity of the head-shaking nystagmus test (HSN), the nystagmus elicited in response to a vigorous rotation of the head in the horizontal plane, in the study of patients with peripheral unilateral vestibular disease. PATIENTS AND METHODS: Retrospectively, we analyze the relationships between the HSN and the rest of the videonystagmographic tests on eighty-three patients with peripheral unilateral vestibular disease. RESULTS: Twenty-three patients showed a positive head-shaking nystagmus; twenty-one of them had unilateral caloric hypofunction and only two had a symmetric caloric test, but both of them showed some type of vestibular dysfunction on other videonystagmographic test. In our series, the HSN sensitivity for the existence of peripheral vestibular disease was 48.8%, while the specificity was 95% in relation to the caloric test, reaching 100% when the gold standard was the presence of any abnormal videonystagmographic test. CONCLUSION: HSN is a simple test that can be useful to identify patients having unilateral vestibular hypofunction.

Analysis of ras oncogene mutations in human squamous cell carcinoma of the head and neck.

The presence of proto-oncogene mutations at codons 12, 13 and 61 of the Ha-, Ki-, and N-ras in primary head and neck squamous cell carcinoma are analysed in this study. Oncogene ras-specific sequences were amplified by the polymerase chain reaction and probed with mutation specific oligonucleotide probes. Mutations were detected in 8 of 22 samples (36.3%). No mutations were detected on patients' peripheral blood DNA. We found that histologically and clinically, squamous cell carcinomas with or without a ras mutation do not differ significantly from each other.

Aggressive fibromatosis of the sphenoid.

A fibromatosis located primarily in the sphenoid, with secondary invasion of the maxilla, orbit, and subtemporal region, was extirpated by means of a combined craniofacial approach.

A rhinological approach for the craniofacial resection of the ethmoid.

The craniofacial resection of the ethmoid is a surgical procedure directed at total extirpation of tumours that extend through the floor of the anterior cranial fossa. We have developed an original approach of the anterior cranial fossa through an osteoplastic frontal flap that has been utilized in a variety of problems of the frontal sinus. The procedure is completed with a facial approach. Different from other types of craniectomy that have been proposed, this method avoids both cosmetic deformity and infectious complications.

[The impact of Spanish otolaryngology on the international scientific community in 1981-1990]. / Impacto de la otorrinolaringología española en la comunidad científica internacional en el decenio 1981-1990.

The number of papers published by spanish otolaryngologists, as well as the number of citations received in journals indexed in the Science Citation Index CD-ROM during 1981-1990, were studied. The survey revealed a total of 87 papers published, with 40 of them on basic research, and 195 citations. Finally, the need of a research development in this field is stressed.

[The effect of the design and the direction of cutaneous flaps in the phenomenon of delay: an experimental study on rabbits]. / Efecto del diseño y orientación de los colgajos cutáneos en el fenómeno del diferido: estudio experimental en el conejo.

The effectiveness of two-stage surgery was studied in several skin-flap models in rabbits. The first group (n = 8) of 7 cm x 2 cm skin flaps perpendicular to major regional blood vessels became necrotic after the first stage of surgery. In the second group (n = 16) of 4 cm x 2 cm skin flaps, survival was no better in the two-stage group (n = 8) than in controls (n = 8). In the third group (n = 32) of 7 cm x 2 cm skin flaps parallel to major blood vessels, survival was better (p < 0.001) in the two-stage subgroup (n = 16). We conclude that effective two-stage skin-flap surgery requires the use of narrow skin flaps that are parallel to major blood vessels.

[Insertion of Montgomery salivary bypass tube under local anesthesia in patients with pharyngocutaneous fistula following total laryngectomy]. / Inserción del tubo de derivación salival de Montgomery con anestesia local en pacientes con fístula faringocutánea tras laringectomía total.

Montgomery salivary bypass tube is an effective therapeutic option in the treatment of the pharyngocutaneous fistulas following laryngectomy. The original insertion technique requires general anesthesia to introduce the tube with direct vision of the hypopharynx. In this paper we present an insertion method based in the Seldinger technique that allows the placement of the tube under local anesthesia in a rapid fashion and well tolerated by the patients.

[Perioperative blood transfusions in laryngeal surgery]. / Transfusión perioperatoria en la cirugía de laringe.

OBJECTIVE: To analyze perioperative transfusion risk in patients undergoing larynx surgery. PATIENTS AND METHODS: An analysis was made of the records of patients who underwent surgical procedures on the larynx in 1996. RESULTS: Of 174 operated patients, 22 received (12.6%) blood transfusions. The patients most frequently transfused were over 60 years-old (18.2%), had laryngeal cancer (22%), underwent laryngectomy (28.3%), and were submitted to three or more surgical techniques during the intervention (50%). Regression analysis showed that the main surgical procedure and number of surgical techniques performed were factors independently related with the likelihood of requiring a blood transfusion. CONCLUSIONS: Of the variables studied, only the surgical procedure and number of surgical techniques performed were independently related with the likelihood of requiring a blood transfusion.

[The value of patent-blue and transcutaneous pO2 in predicting the viability of skin flaps treated pharmacologically]. / Valor del patent-blue y de la pO2 transcutánea en la predicción de la viabilidad de los colgajos cutáneos tratados farmacológicamente.

The effect of the patent-blue and the transcutaneous pO2 in the prediction of random flaps viability in the rat were studied. A control group of 12 rats and 8 study groups of 12 rats each were used. Different drugs were injected in the study groups: chlorpromazine, pentoxifylline, terbutaline, allopurinol, phenoxybenzamine, naftidrofuryl, hydralazine and trimetazidine. The stained area of the flap was significantly greater with pentoxifylline, phenoxybenzamine and trimetazidine. The surviving area was notably larger than the stained area, without any correlation between them. The preoperative values of pO2 showed a wide distribution, decreasing considerably in the immediate postoperative. After 48 hours pO2 values at least reached the preoperative levels. No correlation between pO2 measurements and the surviving area of the flap were observed.

[Nasal endoscopic surgery in complicated ethmoiditis]. / Cirugía endoscópica nasal en etmoiditis complicadas.

Spread of infection from paranasal sinuses is uncommon but, when it occurs may lead to serious ocular or intracranial complications. In this article we present four patients, three of them with orbital complications and one with an intracranial abscess, who were successfully treated with endoscopic surgery of the sinuses and antibiotic therapy. We describe some potential advantages of this approach.