[Cochlear involvement in acute otitis media]

OBJECTIVE

An experimental design with mice has been realized to understand the origin of sensorial hearing loss related to infectious processes in the middle ear. Our aim is to study if the cilliated cells in the Corti organ's are lost after one or more acute otitis media.

MATERIAL AND METHODS

For that, thirty Sprague-Dawley mice have been divided in two groups. In the first one, we have induced one acute otitis media, in the second group we have induced two infections of this kind.

RESULTS

The statistic study shows that the loss of the cilliated cells is greater in the basal turn of the mice is cochlea, in the first group (alpha=0,020) and also in the second (alpha=0,038). We've noticed in the first group the near absence of injury in the middle turn, but in all samples of the second group we found that injury (alpha=0,002).

CONCLUSIONS

In acute otitis media, the loss of ciIliated cells are mainly in the basal turn of the mice is cochlea, and affects the middle turn when the infection is repeated.

[Experimental model of recurrent acute otitis media: morphological study of the cochlear damage using scanning electron microscopy]

We designed an experimental model of acute otitis media to study its effects in the hair cells of the organ of Corti. Thirty Sprague-Dawley rats were used, and divided into three groups. The rats from the first group were exposed to one episode of acute otitis media, the second group to two episodes and the third group were induced with three episodes of acute otitis media. After that, all cochleas were processed by specific surface specimen method. Finally, each organ of Corti was examined using scanning electron microscopy. Damage to hearing cells was compared between the three groups involved in the study. Significant great loss of sensory cells was found when the episodes of acute otitis media were repeated, in both turns of the cochlea: basal (alpha = 0.002) and distal (alpha = 0.001). The results reported in this study indicate the importance of specialized treatment in children affected with recurrent acute otitis media to prevent cochlear damage.

[Otosclerosis surgery with CO2 laser]

Since Shea described the stapedectorny, many physicians have developed modifications of the technique, prosthesis or instrumentation. We have adopted one of the most recent advances to the treatment of otosclerosis, CO2 laser. Interventions were carried out in 20 consecutive ears using CO2 laser. Otosclerosis with type I, II and III foci were diagnosed and stapedectomies were reviewed. Stapedectomy was performed with a Causse prosthesis. We describe the technique and the laser power and application time used. The preoperative and auditory results at 1 month are reported. The advantages of opening otosclerosis with CO2 laser as the first or review procedure are analyzed.

[Fungal sinusitis. Report of four cases]

Fungal sinusitis has a nonspecific clinical presentation, is refractory to standard medical treatment and may produce expansion and erosion of the sinus wall. Various factors have been implicated in the development of fungal sinusitis: anatomical factors in the osteomeatal complex, tissular hypoxia, traumatic factors, massive exposure to fungal spores, allergy and immunosuppression. Our study of four cases diagnosed in the department included the clinical, pathological, and radiological features of fungal sinusitis. Five forms are described. Bacterial infection often occurs. The diagnosis of fungal sinusitis requires a high level of clinical and pathological suspicion. Before surgery, fungal sinusitis is suggested by the clinical and radiological features, and is confirmed by histological study. Culture of the tissue sometimes leads to identification of the fungus. Surgical removal of the infection is the main treatment for every form of fungal sinusitis.

[The reasons for medical and nursing appointments in a primary health care center (Barcelona)]

The programmed visit, which is basically generated by the health care team, permits a rationalization of the demand and the introduction of health promoting activities. We have evaluated our motives (medical and nurse practices) for the appointment of patients during 1987. We have also recorded the age, sex, compliance and source of the appointment in a sample of 198 medical and 223 nurse appointments. 62.5% of the appointed visits corresponded to females and more than 50% to patients over 59 years. The most common type of appointment was to control chronic disease, owing to its high prevalence and the protocolization of its care. In individuals under 45 years appointments were mostly for diagnostic approach and to record the clinical history. The implementation of preventive measures appeared as one of the least common causes. Failure to comply was seen in 25%, being higher in patients under age 45 and in the appointments to record the clinical history. These results point to the need of restructuring the concertation priorities. The health problems of the population and its vulnerability are the factors that should guide health planning.