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"documento" => "article" "crossmark" => 0 "subdocumento" => "sco" "cita" => "Acta Otorrinolaringol Esp. 2013;64:157-60" "abierto" => array:3 [ "ES" => true "ES2" => true "LATM" => true ] "gratuito" => true "lecturas" => array:2 [ "total" => 3201 "formatos" => array:3 [ "EPUB" => 39 "HTML" => 2480 "PDF" => 682 ] ] "en" => array:13 [ "idiomaDefecto" => true "cabecera" => "<span class="elsevierStyleTextfn">Case Study</span>" "titulo" => "Schwannoma of the Larynx. An Infrequent Laryngeal Tumour" "tienePdf" => "en" "tieneTextoCompleto" => "en" "tieneResumen" => array:2 [ 0 => "en" 1 => "es" ] "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "157" "paginaFinal" => "160" ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Schwannoma laríngeo. Un tumor de laringe poco común" ] ] "contieneResumen" => array:2 [ "en" => true "es" => true ] "contieneTextoCompleto" => array:1 [ "en" => true ] "contienePdf" => array:1 [ "en" => true ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:7 [ "identificador" => "fig0005" "etiqueta" => "Figure 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 840 "Ancho" => 1350 "Tamanyo" => 187142 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">Cervical, magnetic resonance imaging (MRI) scan in the sagittal plane. (A) T2-weighted sequence showing a slightly hyperintense mass (*) originating in the laryngeal surface of the epiglottis and obstructing the laryngeal vestibule. (B) T1-weighted sequence showing a well-defined, noninvasive, isointense mass (*).</p>" ] ] ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "Fernando López-Álvarez, Justo R. Gómez-Martínez, Carlos Suárez-Nieto, José L. Llorente-Pendás" "autores" => array:4 [ 0 => array:2 [ "nombre" => "Fernando" "apellidos" => "López-Álvarez" ] 1 => array:2 [ "nombre" => "Justo R." "apellidos" => "Gómez-Martínez" ] 2 => array:2 [ "nombre" => "Carlos" "apellidos" => "Suárez-Nieto" ] 3 => array:2 [ "nombre" => "José L." 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"documento" => "article" "crossmark" => 0 "subdocumento" => "sco" "cita" => "Acta Otorrinolaringol Esp. 2013;64:150-3" "abierto" => array:3 [ "ES" => true "ES2" => true "LATM" => true ] "gratuito" => true "lecturas" => array:2 [ "total" => 2951 "formatos" => array:3 [ "EPUB" => 48 "HTML" => 2082 "PDF" => 821 ] ] "en" => array:13 [ "idiomaDefecto" => true "cabecera" => "<span class="elsevierStyleTextfn">Case Study</span>" "titulo" => "Salivary Duct Carcinoma: Diagnostic Clues, Histology and Treatment" "tienePdf" => "en" "tieneTextoCompleto" => "en" "tieneResumen" => array:2 [ 0 => "en" 1 => "es" ] "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "150" "paginaFinal" => "153" ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Carcinoma ductal salival: claves diagnósticas, histología y tratamiento" ] ] "contieneResumen" => array:2 [ "en" => true "es" => true ] "contieneTextoCompleto" => array:1 [ "en" => true ] "contienePdf" => array:1 [ "en" => true ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:7 [ "identificador" => "fig0005" "etiqueta" => "Figure 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 776 "Ancho" => 1400 "Tamanyo" => 120680 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">Magnetic resonance imaging and computed tomography scans showing a well-encapsulated lesion in the left parotid tail.</p>" ] ] ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "Elena Pont, Ángel Plá, Julia Cruz Mojarrieta, Eduardo Ferrandis, Simón Brotons, Juan B. Vendrell" "autores" => array:6 [ 0 => array:2 [ "nombre" => "Elena" "apellidos" => "Pont" ] 1 => array:2 [ "nombre" => "Ángel" "apellidos" => "Plá" ] 2 => array:2 [ "nombre" => "Julia" "apellidos" => "Cruz Mojarrieta" ] 3 => array:2 [ "nombre" => "Eduardo" "apellidos" => "Ferrandis" ] 4 => array:2 [ "nombre" => "Simón" "apellidos" => "Brotons" ] 5 => array:2 [ "nombre" => "Juan B." 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Locoregional involvement is common and may include otological manifestations. Otolaryngologists represent an essential part of the multidisciplinary teams involved in the diagnosis and treatment of this disease.<a class="elsevierStyleCrossRef" href="#bib0005"><span class="elsevierStyleSup">1</span></a> Facial nerve involvement has been described during the course of the disease, although it is very rare for it to appear as an initial symptom or in the form of bilateral facial paralysis (BFP).<a class="elsevierStyleCrossRef" href="#bib0010"><span class="elsevierStyleSup">2</span></a></p><p id="par0010" class="elsevierStylePara elsevierViewall">BFP is a rare entity which usually appears as a manifestation of a systemic disease, with the most common causes being Lyme disease, Guillain–Barre syndrome, sarcoidosis, bacterial meningitis and cranioencephalic lesions.<a class="elsevierStyleCrossRef" href="#bib0015"><span class="elsevierStyleSup">3</span></a></p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle">Case Report</span><p id="par0015" class="elsevierStylePara elsevierViewall">We present the case of 33-year-old female suffering WG, primarily affecting the upper respiratory and aural (repeated otitis) pathways. Since June 2009, she presented persistent otic inflammatory activity, prompting repeated consultations at the Otorhinolaryngology and Collagenosis Services. The patient presented chronic dizziness, unsteadiness, headaches and frequent episodes of nausea and vomiting.</p><p id="par0020" class="elsevierStylePara elsevierViewall">In late August 2009, she was diagnosed with otitis media with effusion (OME) and underwent myringotomy with placement of bilateral ventilation tubes. Following this intervention, the headaches worsened, hearing loss increased and, 2 weeks later, she developed right, peripheral facial palsy of grade III in the House–Brackmann classification, for which she was admitted to hospital. During admission we initially requested the following tests: (1) blood count and biochemical analysis, which were normal; (2) ESR, which was 74; (3) otic exudate cultures, with normal flora; (4) lumbar puncture and CSF analysis, which was normal, and (5) chest radiography and Mantoux test, which were negative. Being an immunosuppressed patient, we initially stopped glucocorticoids and cytostatics until we obtained the first microbiological data. We took into account the possibility of bacterial, tuberculous and fungal meningitis, and the patient was treated with meropenem and ampicillin.</p><p id="par0025" class="elsevierStylePara elsevierViewall">We requested a magnetic resonance imaging (MRI) scan, which showed bilateral, chronic otomastoiditis with an acute inflammatory appearance but without intracranial repercussion. During admission, the paralysis became bilateral and we observed the loss of the ventilation tube in the left ear, so a new one was placed. We requested a computed tomography (CT) scan, which revealed occupation of the right ear mastoid, without signs of erosion of bone structures, as well as an intact facial nerve, without dehiscence. Finally, the patient developed peripheral dizziness symptoms. She received a total of 8 boluses of 1<span class="elsevierStyleHsp" style=""></span>g methylprednisolone and the previous immunosuppressants were replaced by mycophenolate sodium. This treatment achieved a partial improvement and she was discharged with outpatient follow-up (<a class="elsevierStyleCrossRefs" href="#fig0005">Figs. 1 and 2</a>).</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><elsevierMultimedia ident="fig0010"></elsevierMultimedia><p id="par0030" class="elsevierStylePara elsevierViewall">At present, dizziness, OME and BFP symptoms have improved. However, cophosis is permanent and the patient has been included in a cochlear implant programme at another hospital.</p></span><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle">Discussion</span><p id="par0035" class="elsevierStylePara elsevierViewall">Involvement of the ENT region represents a classic symptom of patients with WG and it appears in over 70% of patients as an initial symptom. Almost all patients present some ENT manifestation during the course of the disease.<a class="elsevierStyleCrossRef" href="#bib0020"><span class="elsevierStyleSup">4</span></a> Otic involvement in WG may include OME, chronic otitis media, sensorineural hearing loss, facial paralysis and vertigo. OME is the most common type of otic involvement, with tubal obstruction or nasopharyngeal inflammation being the most common causes.<a class="elsevierStyleCrossRef" href="#bib0025"><span class="elsevierStyleSup">5</span></a> Sensorineural hearing loss is also common among these patients.<a class="elsevierStyleCrossRef" href="#bib0030"><span class="elsevierStyleSup">6</span></a></p><p id="par0040" class="elsevierStylePara elsevierViewall">Facial paralysis in patients with WG is infrequent and is rarely the first sign of disease. It is normally secondary to compression of the nerve in the middle ear, especially in its path through the Fallopian canal, when it is dehiscent or due to the existence of vasculitis affecting the microcirculation.<a class="elsevierStyleCrossRef" href="#bib0035"><span class="elsevierStyleSup">7</span></a></p><p id="par0045" class="elsevierStylePara elsevierViewall">BFP is a rare condition, which usually indicates a more severe alteration than unilateral paralysis.<a class="elsevierStyleCrossRef" href="#bib0015"><span class="elsevierStyleSup">3</span></a> There are few case series of BFP in the literature. In the series of Keane with 43 patients, Bell's palsy was noted as the most common cause, followed by Guillain–Barre syndrome.<a class="elsevierStyleCrossRefs" href="#bib0015"><span class="elsevierStyleSup">3,8</span></a> The series of Wormald was smaller, with only 24 patients, but also noted Bell's palsy as the most common cause.<a class="elsevierStyleCrossRefs" href="#bib0015"><span class="elsevierStyleSup">3,9</span></a> Other series are much smaller and limited to several cases of BFP. These series do not make reference to WG as the cause of bilateral paralysis. We have found only 1 reference in the literature of a patient suffering WG who developed BFP.<a class="elsevierStyleCrossRef" href="#bib0050"><span class="elsevierStyleSup">10</span></a></p><p id="par0050" class="elsevierStylePara elsevierViewall">Other systemic diseases affecting the middle ear and temporal bone which should be included in the differential diagnosis of otic involvement of WG are tuberculosis, fungi, syphilis, Lyme disease, sarcoidosis, polyarteritis nodosa, Churg–Strauss and tumours in neighbouring structures.<a class="elsevierStyleCrossRef" href="#bib0050"><span class="elsevierStyleSup">10</span></a> Early diagnosis and prompt initiation of treatment are essential to improve the prognosis of facial nerve involvement.<a class="elsevierStyleCrossRefs" href="#bib0055"><span class="elsevierStyleSup">11,12</span></a></p><p id="par0055" class="elsevierStylePara elsevierViewall">In the present case, glucocorticoids were discontinued and treatment with broad spectrum antibiotics was initiated upon suspicion of infection. After conducting complementary tests which did not reveal the existence of infection, treatment was replaced by boluses of methylprednisolone and mycophenolate sodium. Placement of ventilation tubes in the ears was performed upon suspicion of facial nerve compression. Following improvement, the patient was discharged, with immunosuppressive therapy and outpatient controls. Although BFP and dizziness symptoms remitted, unfortunately cophosis was irreversible and the patient was eventually included within a cochlear implant programme.</p><p id="par0060" class="elsevierStylePara elsevierViewall">The treatment of vasculitis with ANCA (anti-neutrophil cytoplasmic antibodies) has been well defined, but must conform to the characteristics of each patient and the severity of the granulomatosis. Furthermore, the risk of side effects inherent to the treatment should also be considered. Relapses are still common among patients with WG. These patients typically receive a combination of corticosteroids and immunosuppressants. After achieving remission, cyclophosphamide is often replaced by a less toxic immunosuppressant. Biological drugs should be initiated with caution, since their adverse effects are few, but potentially severe.<a class="elsevierStyleCrossRef" href="#bib0065"><span class="elsevierStyleSup">13</span></a> Improvement in the prognosis of these patients is due to an adequate treatment, correctly adjusted prophylaxis and careful management of complications.<a class="elsevierStyleCrossRef" href="#bib0065"><span class="elsevierStyleSup">13</span></a></p></span><span id="sec0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle">Conflict of Interests</span><p id="par0065" class="elsevierStylePara elsevierViewall">The authors have no conflict of interests to declare.</p></span></span>" "textoCompletoSecciones" => array:1 [ "secciones" => array:9 [ 0 => array:2 [ "identificador" => "xres194027" "titulo" => "Abstract" ] 1 => array:2 [ "identificador" => "xpalclavsec180565" "titulo" => "Keywords" ] 2 => array:2 [ "identificador" => "xres194028" "titulo" => "Resumen" ] 3 => array:2 [ "identificador" => "xpalclavsec180564" "titulo" => "Palabras clave" ] 4 => array:2 [ "identificador" => "sec0005" "titulo" => "Introduction" ] 5 => array:2 [ "identificador" => "sec0010" "titulo" => "Case Report" ] 6 => array:2 [ "identificador" => "sec0015" "titulo" => "Discussion" ] 7 => array:2 [ "identificador" => "sec0020" "titulo" => "Conflict of Interests" ] 8 => array:1 [ "titulo" => "References" ] ] ] "pdfFichero" => "main.pdf" "tienePdf" => true "fechaRecibido" => "2011-09-20" "fechaAceptado" => "2011-11-03" "PalabrasClave" => array:2 [ "en" => array:1 [ 0 => array:4 [ "clase" => "keyword" "titulo" => "Keywords" "identificador" => "xpalclavsec180565" "palabras" => array:3 [ 0 => "Wegener's granulomatosis" 1 => "Otitis" 2 => "Bilateral facial paralysis" ] ] ] "es" => array:1 [ 0 => array:4 [ "clase" => "keyword" "titulo" => "Palabras clave" "identificador" => "xpalclavsec180564" "palabras" => array:3 [ 0 => "Enfermedad de Wegener" 1 => "Otitis" 2 => "Parálisis facial bilateral" ] ] ] ] "tieneResumen" => true "resumen" => array:2 [ "en" => array:2 [ "titulo" => "Abstract" "resumen" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Bilateral facial paralysis (BFP) is an uncommon condition that typically occurs as a manifestation of systemic disease. We present a female patient with Wegener's granulomatosis (WG), particularly upper respiratory and ear impairment who develops hypoacusis and BFP, resistant to immunosuppressive therapy and steroid boluses. Her imaging tests showed no involvement of the facial nerve as it passed through the ear structures. The patient finally improved the BFP; however, deafness is permanent and she has entered into a cochlear implant programme. Published papers on BFP are rare and they make no reference to WG as a possible aetiology.</p>" ] "es" => array:2 [ "titulo" => "Resumen" "resumen" => "<p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">La parálisis facial bilateral (PFB) es una entidad infrecuente, que habitualmente se presenta como manifestación de una enfermedad sistémica. Presentamos el caso de una mujer afecta de granulomatosis de Wegener (GW), con especial afectación de las vías respiratorias altas y ótica, que desarrolló hipoacusia y PFB resistente a tratamientos inmunosupresores y bolos de corticoides, con pruebas de imagen que no muestran afectación del nervio facial en las estructuras óticas. Finalmente, la paciente mejoró de la PFB, pero la cofosis es permanente y se ha realizado un implante coclear. Las series publicadas sobre PFB son escasas, y no hacen referencia a la GW como posible etiología.</p>" ] ] "NotaPie" => array:1 [ 0 => array:2 [ "etiqueta" => "☆" "nota" => "<p class="elsevierStyleNotepara">Please cite this article as: Gómez-Torres A, et al. Granulomatosis de Wegener causante de parálisis facial y cofosis bilaterales. Acta Otorrinolaringol Esp. 2013;64:154–6.</p>" ] ] "multimedia" => array:2 [ 0 => array:7 [ "identificador" => "fig0005" "etiqueta" => "Figure 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 1127 "Ancho" => 950 "Tamanyo" => 103575 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">Cerebral MRI scan showing bilateral otomastoiditis with an acute inflammatory appearance, with no evidence of intracranial repercussion.</p>" ] ] 1 => array:7 [ "identificador" => "fig0010" "etiqueta" => "Figure 2" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr2.jpeg" "Alto" => 950 "Ancho" => 950 "Tamanyo" => 87280 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0020" class="elsevierStyleSimplePara elsevierViewall">Cerebral CT scan showing no abnormalities in facial nerve paths.</p>" ] ] ] "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0005" "bibliografiaReferencia" => array:13 [ 0 => array:3 [ "identificador" => "bib0005" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Head and neck manifestations of Wegener's granulomatosis" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:3 [ 0 => "S.P. Gubbels" 1 => "A. Barkhuizen" 2 => "P.H. Hwang" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:6 [ "tituloSerie" => "Otolaryngol Clin North Am" "fecha" => "2003" "volumen" => "36" "paginaInicial" => "685" "paginaFinal" => "705" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/14567060" "web" => "Medline" ] ] ] ] ] ] ] ] 1 => array:3 [ "identificador" => "bib0010" "etiqueta" => "2" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Early diagnosis of Wegener's granulomatosis presenting with facial nerve palsy" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:5 [ 0 => "J.D. Hern" 1 => "L.J. Hollis" 2 => "G. Mochloulis" 3 => "P.Q. Montgomery" 4 => "N.S. Tolley" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:6 [ "tituloSerie" => "J Laryngol Otol" "fecha" => "1996" "volumen" => "110" "paginaInicial" => "459" "paginaFinal" => "461" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/8762317" "web" => "Medline" ] ] ] ] ] ] ] ] 2 => array:3 [ "identificador" => "bib0015" "etiqueta" => "3" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Parálisis facial bilateral simultánea" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:4 [ 0 => "G.M. Torres" 1 => "A.N. Barcellos" 2 => "A.R. Santos" 3 => "M.T. Fonseca" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:6 [ "tituloSerie" => "Acta Otorrinolaringol Esp" "fecha" => "2009" "volumen" => "60" "paginaInicial" => "210" "paginaFinal" => "212" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/19558910" "web" => "Medline" ] ] ] ] ] ] ] ] 3 => array:3 [ "identificador" => "bib0020" "etiqueta" => "4" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Epistaxis y enfermedad sistémica" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:1 [ 0 => "B. Roca" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/j.otorri.2008.11.001" "Revista" => array:6 [ "tituloSerie" => "Acta Otorrinolaringol Esp" "fecha" => "2009" "volumen" => "60" "paginaInicial" => "456" "paginaFinal" => "458" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/19909723" "web" => "Medline" ] ] ] ] ] ] ] ] 4 => array:3 [ "identificador" => "bib0025" "etiqueta" => "5" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Otologic manifestations of Wegener's granulomatosis" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:5 [ 0 => "D. Takagi" 1 => "Y. Nakamaru" 2 => "S. Magachi" 3 => "Y. Faruta" 4 => "S. Fukuda" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1097/00005537-200209000-00029" "Revista" => array:6 [ "tituloSerie" => "Laryngoscope" "fecha" => "2002" "volumen" => "112" "paginaInicial" => "1684" "paginaFinal" => "1690" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/12352687" "web" => "Medline" ] ] ] ] ] ] ] ] 5 => array:3 [ "identificador" => "bib0030" "etiqueta" => "6" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Manifestaciones audiovestibulares en las vasculitis sistémicas" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:4 [ 0 => "J.C. Amor Dorado" 1 => "M.P. Barreira Fernández" 2 => "S. Regueiro Villarín" 3 => "M.A. González-Gay" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:5 [ "tituloSerie" => "Acta Otorrinolaringol Esp" "fecha" => "2009" "volumen" => "6" "paginaInicial" => "432" "paginaFinal" => "442" ] ] ] ] ] ] 6 => array:3 [ "identificador" => "bib0035" "etiqueta" => "7" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Wegener's granulomatosis presenting as otomastoiditis. A case report" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:5 [ 0 => "I. Kloeck" 1 => "R. Crols" 2 => "T. De Belder" 3 => "V. Vandist" 4 => "B. Schmelzer" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:6 [ "tituloSerie" => "B-ENT" "fecha" => "2006" "volumen" => "2" "paginaInicial" => "7" "paginaFinal" => "12" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/16676840" "web" => "Medline" ] ] ] ] ] ] ] ] 7 => array:3 [ "identificador" => "bib0040" "etiqueta" => "8" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Bilateral seventh nerve palsy: analysis of 43 cases and review of literature" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:1 [ 0 => "J.R. Keane" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:6 [ "tituloSerie" => "Neurology" "fecha" => "1994" "volumen" => "44" "paginaInicial" => "1198" "paginaFinal" => "1202" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/8035915" "web" => "Medline" ] ] ] ] ] ] ] ] 8 => array:3 [ "identificador" => "bib0045" "etiqueta" => "9" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Bilateral facial nerve palsies: Groote Schuur Hospital experience" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:3 [ 0 => "P.J. Wormald" 1 => "S.L. Sellars" 2 => "J.C. De Villiers" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:5 [ "tituloSerie" => "J Otolaryngol Otol" "fecha" => "1991" "volumen" => "105" "paginaInicial" => "625" "paginaFinal" => "627" ] ] ] ] ] ] 9 => array:3 [ "identificador" => "bib0050" "etiqueta" => "10" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Chronic otitis media and facial paralysis as a presenting feature of Wegener's granulomatosis" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:2 [ 0 => "B.N. Shiva Prasad" 1 => "R. Balasubramanian" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:5 [ "tituloSerie" => "Singapore Med J" "fecha" => "2009" "volumen" => "50" "paginaInicial" => "155" "paginaFinal" => "157" ] ] ] ] ] ] 10 => array:3 [ "identificador" => "bib0055" "etiqueta" => "11" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Facial palsy and Wegener's granulomatosis" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:2 [ 0 => "V. Drinias" 1 => "R. Florentzson" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:6 [ "tituloSerie" => "Am J Otolaryngol" "fecha" => "2004" "volumen" => "25" "paginaInicial" => "208" "paginaFinal" => "212" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/15124173" "web" => "Medline" ] ] ] ] ] ] ] ] 11 => array:3 [ "identificador" => "bib0060" "etiqueta" => "12" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Facial paralysis in Wegener's granulomatosis of the middle ear" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:4 [ 0 => "A. Bibas" 1 => "C. Fahy" 2 => "L. Sneddon" 3 => "D. Bowdler" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:6 [ "tituloSerie" => "J Laryngol Otol" "fecha" => "2001" "volumen" => "115" "paginaInicial" => "304" "paginaFinal" => "306" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/11276335" "web" => "Medline" ] ] ] ] ] ] ] ] 12 => array:3 [ "identificador" => "bib0065" "etiqueta" => "13" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Advances in the therapy of Wegener's granulomatosis" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:3 [ 0 => "B. Hellmich" 1 => "P. Lamprecht" 2 => "W.L. Gross" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:6 [ "tituloSerie" => "Curr Opin Rheumatol" "fecha" => "2006" "volumen" => "18" "paginaInicial" => "25" "paginaFinal" => "32" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/16344616" "web" => "Medline" ] ] ] ] ] ] ] ] ] ] ] ] ] "idiomaDefecto" => "en" "url" => "/21735735/0000006400000002/v1_201306280039/S2173573513000392/v1_201306280039/en/main.assets" "Apartado" => array:4 [ "identificador" => "5881" "tipo" => "SECCION" "en" => array:2 [ "titulo" => "Case Studies" "idiomaDefecto" => true ] "idiomaDefecto" => "en" ] "PDF" => "https://static.elsevier.es/multimedia/21735735/0000006400000002/v1_201306280039/S2173573513000392/v1_201306280039/en/main.pdf?idApp=UINPBA00004N&text.app=https://www.elsevier.es/" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2173573513000392?idApp=UINPBA00004N" ]
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Case Study
Wegener's Granulomatosis Causing Bilateral Facial Paralysis and Deafness
Granulomatosis de Wegener causante de parálisis facial y cofosis bilaterales
Antonio Gómez-Torres
, Isabel Tirado Zamora, Antonio Abrante Jiménez, Francisco Esteban Ortega
Corresponding author
Unidad de Gestión Clínica de Otorrinolaringología, Hospital Universitario Virgen del Rocío, Sevilla, Spain