Otoacoustic emissions and tympanometry in a general adult population in Sweden: Emisiones otoacústicas y timpanometría en la población general adulta de Suecia

The present study concerns a general adult population in Sweden, not exposed to hazardous occupational noise. Tympanometry and spontaneous (SOAE). transient evoked (TEOAE) and distortion-product (DPOAE) otoacoustic emissions were investigated in 493 randomly selected men and women aged from 20 to 79 years. Effects of gender, age, ear side and middle ear state were determined, with and without adjusting for hearing threshold level. No statistically significant effects on middle ear pressure or compliance were present. For TEOAEs and DPOAEs, the effect of gender and age was statistically significant (p < 0.01), with larger signal levels for female subjects and young subjects, even after adjusting for hearing threshold level. No effect of middle ear pressure on otoacoustic emissions was present, but high middle ear compliance was associated with low emission levels (p < 0.01). Reference data for middle ear compliance and pressure and prevalence data on SOAEs, TEOAEs and DPOAEs for male and female subjects in different age groups were determined. Mean signal levels of TEOAEs and DPOAEs are presented.

Sumario

El presente csludio involucra una población general adulta en Suecia que no ha sido expuesta a ruido ocupacional dañiuo. Se practicaron exámenes de timpanometria y de Emisones Otoacústieas Espontáneas (SOAE), Evocadas por Transitorios (TEOAE) y por Produetos de Distorsión (DPOAE) en 493 hombres y mujeres de 20 a 79 años, seleccionados al azar. Se delerminaron los efectos de género, edad, oido derecho o izquierdo y situación del oido medio con y sin ajustes del nivel de los umbrales auditivos. No se encontraron efectos signlficativos en la presión o eompliancia del oído medio. Los efectos de género y edad fueron estadísticamente significativos (p < 0.01), para las TEOAE y DPOAE, con niveles de señales más amplios en mujeres y en jóvenes, incluso después de ajustar los niveles de umbrales auditivos. No se eneontraron efectos en la presión del oido medio y en las emisiones otoacúslicas pero si se apreció una compliancia elevada del oido medio asociada a niveles bajos dc emisiones (p < 0.01). Se determinaron los datos de referenda para la compliancia del oiido medio y presión, asi como los datos de prevalencia de las SOAE, TEOAE y DPOAE en hombres y mujeres en diferentes grupos de edad. Se presentan los niveles promedio de señal de las TEOAE y DPOAE.     

Adaptación transcultural en versión de lengua española del cuestionario Dizziness Handicap Inventory en la población pediátrica. Análisis de su aplicación en niños

BackgroundThe Dizziness Handicap Inventory (DHI) is a questionnaire to assess self-perception of disability produced by the effects of vestibular system disorders.It is a tool used by professionals who treat patients with balance disorders, although it is not widely used in children.The aim of this study is to carry out a cross-cultural and linguistic adaptation of the DHI children/adolescent in the Argentine population from a version already published in Portuguese and to evaluate it in a group of patients.Materials and methodsA cross-cultural adaptation was carried out, maintaining semantic, conceptual, content, technical and criteria equivalence; and it was verified that the new Argentinian version of the DHI for children and adolescents maintains the reliability of the original questionnaire. According to Beaton's et al. recommendations, the questionnaire was translated from Portuguese to Spanish (Argentine) by 2 different translators and a back-translation to the original language by 2 other translators. Since this questionnaire is directed at a paediatric population, some terms were adapted to be understood by children from 4 years old. A psychopedagogue and a psychologist joined the team to delve more deeply into the questions that focus on the emotional or psychological aspects of the symptom.ResultsNo difficulties were found in obtaining equivalent expressions from the original questionnaire to Spanish (Argentine). The internal consistency of this cross-culturally adapted questionnaire was like those already published in other languages. Most paediatric patients do not have disabilities in the areas studied. The patients with the highest total scores presented vestibular migraine as a diagnosis.ConclusionsThis questionnaire will be culturally and linguistically adapted for use in the Argentine population. The emphasis was placed on terms and expressions that could be understood by the paediatric population.     

Tratamiento de la ingestión de cuerpos extraños en una unidad de urgencias de otorrinolaringología: estudio prospectivo de 204 casos

AimsTo determine how often ingested foreign bodies are found and what parameters may predict their retrieval.MethodsDuring 1 year, we prospectively studied all patients referred to our Ear Nose and Throat Emergency Unit because of foreign body ingestion.ResultsDuring the study, 204 (median age-42 years [10 months-84 years]) patients were admitted because of ingested foreign body. The most common was fish bone (88%). Most patients were admitted <24-hour after ingestion (72%) and complained of symptoms above the cricoid cartilage (79%). A foreign body was removed by Ear Nose and Throat team in 108 (53%) patients. Twenty-three (11%) patients were referred to Gastroenterology. In 9 (39%) of these patients, a foreign body was identified by esophagogastroscopy, always from the esophagus. Predictive variables for retrieval of foreign body by Ear Nose and Throat team were ingested fish bone (P=.000; odds ratio [OR] = 17.3), short duration (<6 hours) of symptoms (P=.001; OR = 2.3) and symptoms above or at the level of cricoid cartilage (P=.000; OR = 8.9). In patients with symptoms below the cricoid cartilage the rate of retrieval of foreign body by Ear Nose and Throat team (11%) was significantly increased by Gastroenterology (41%; P=.03).ConclusionsPatients with ingestion of foreign body who ingest fish bone, present within the first 6 hours or complain of symptoms at or above cricoid cartilage deserve greater investment in terms of time and resources for retrieval of ingested foreign body by Ear Nose and Throat team.     

Evaluación de las coberturas de vacunación en pacientes con implante coclear de un hospital de referencia del norte de España

Background and objectiveThe risk of bacterial meningitis increases in cochlear implant patients. Therefore, pneumococcal, influenza and Haemophilus influenzae type b vaccination is indicated in this group. The aim of this study was to determine compliance with the vaccination calendar in patients implanted in a referral hospital.Materials and methodsPatients with cochlear implant operated between 2005 and 2015 were included. Vaccine coverage for seasonal influenza, Haemophilus influenzae type b and pneumococcal conjugate 13-serotypes and pneumococcal polysaccharide 23-serotypes was evaluated. The sample was divided into 2 age groups (< 14 years and ≥ 14 years). A univariate and bivariate analysis was performed.ResultsOf the 153 patients studied (28.01% 0-13 years old and 71.9% ≥ 14), only 2 (5.71%) had 100% adherence to the vaccination schedule, while 65.71% had compliance of 50% or less. Overall, vaccination coverage against the sequential pneumococcal pattern was 48.57%. The paediatric population exceeded 90% coverage for the vaccine against Haemophilus influenzae type b and pneumococcal conjugate 13-serotypes while in those over 14 years of age it barely exceeded 50%. Influenza coverage was less than 40%. An inverse correlation was obtained between age and compliance, although not statistically significant.ConclusionsVaccination coverage in patients with cochlear implant is lower than expected. Close collaboration between Otolaryngology departments and the Vaccination Units is proposed as the main strategy for improvement.     

Effect of Ageing on Otoacoustic Emissions and Efferent Suppression in Humans: Efectos de la edad en las emisiones otoacústicas y (EN LA) supresión eferente en humanos

Transiently evoked otoacoustic emissions (TEOAEs) without and with contralateral acoustical stimulation, were recorded on 52 subjects ranging from 20 to 78 years. Subject selection was based on the hearing levels from 0.5 to 4 kHz being better than 25 dB HL, normal tympanograms and stapedial reflexes, presence of TEOAEs in at least one ear and no history of otological disease, noise exposure, ototoxic drugs, metabolic disease associated with hearing loss or a family history of hearing loss. The ear with better audiological thresholds was selected as the test ear. If there was no difference between the ears, the ear with stronger TEOAEs was selected. Subjects were divided into five age groups: 20–34 years (n=12, mean age 23.7). 35–44 (n=11, mean age 39.7), 45–54 (n=8, mean age 48.1), 55–64 (n=10, mean age 60), 65–78 (n=11, mean age 71). TEOAEs were never absent in the first two groups, but they were absent in two ears in the 45–54 group, and in one ear of the 55–64 and 65–78 groups. Mean TEOAE amplitude decreased with age, but the differences between the five groups were not significant. Contralateral white noise suppressed emission amplitude, but the amount of suppression was not significantly different between the five groups. A linear regression analysis showed a significant correlation between age and hearing levels, and a negative correlation between age and TEOAE amplitude. In addition, a significant negative correlation between hearing threshold and TEOAE amplitude was evident. No effect of age on the amplitude of the efferent suppression was found.     

Evaluación de pruebas psicoacústicas y de potenciales relacionados a eventos P300 en adultos mayores con hiperhomocisteinemia

Introduction and objectivesHyperhomocysteinemia as a risk factor for hearing impairment, neuronal damage and cognitive impairment in elderly patients is controversial and is limited by the small number of studies.The aim of this work was determine if elderly patients detected with hyperhomocysteinemia have an increased risk of developing abnormalities in the central auditory processes as compared with a group of patients with appropriate homocysteine levels, and to define the behaviour of psychoacoustic tests and long latency potentials (P300) in these patients.MethodsThis was a cross-sectional, comparative and analytical study. We formed a group of patients with hyperhomocysteinemia and a control group with normal levels of homocysteine. All patients underwent audiometry, tympanometry and a selection of psychoacoustic tests (dichotic digits, low-pass filtered words, speech in noise and masking level difference), auditory evoked brainstem potentials and P300.ResultsPatients with hyperhomocysteinemia had higher values in the test of masking level difference than did the control group (P=.049) and more protracted latency in P300 (P=.000).ConclusionsHyperhomocysteinemia is a factor that alters the central auditory functions. Alterations in psychoacoustic tests and disturbances in electrophysiological tests suggest that the central portion of the auditory pathway is affected in patients with hyperhomocysteinemia.     

Recomendaciones de la Sociedad Española de Otorrinolaringología y Cirugía de Cabeza y Cuello para la realización de traqueotomías en relación con pacientes infectados por coronavirus COVID-19

The recent COVID-19 (coronavirus) pandemic is causing an increase in the number of patients who, due to their pulmonary ventilatory status, may require orotracheal intubation. COVID-19 infection has demonstrated a high rate of transmissibility, especially via the respiratory tract and by droplet spread. The Spanish Society of Otolaryngology and Head and Neck Surgery, based on the article by Wei et al. of 2003 regarding tracheotomies performed due to severe acute respiratory syndrome (SARS), has made a series of recommendations for the safe performance of tracheotomies.     

Precisión de la PAAF (punción aspiración con aguja fina) y la TAC (tomografía axial computerizada) en la diferenciación de tumores benignos y malignos de parótida en una serie de casos

Introduction

Parotid tumours, in addition to the wide variety of types, are histologically complex. Differentiating between benign and malignant tumours in preoperative diagnosis is important in deciding the type of surgery required. Fine needle aspiration cytology (FNAC) is a simple, quick, low-cost, low-invasive and well-tolerated tool used in the preoperative diagnosis of these tumours.

Correlación entre la clínica y la polisomnografía en los trastornos respiratorios del sueño infantil

IntroductionAlthough polysomnography is the gold standard test for sleep-disordered breathing in children, there is controversy about its indication in all cases. Among the arguments both for and against is the lack of correlation between objective values and the symptoms.ObjectiveTo evaluate the correlation between clinical data and apnea-hypopnoea index (AHI) in our work environment.Material and methodsWe compared the preoperative clinical symptoms and AHI statistically in 170 children with sleep-disordered breathing who underwent polysomnography. We also analysed the correlation to postoperative level, with a subgroup of 80 children who underwent adenotonsillectomy with 1 year of polysomnography follow-up.ResultsBefore surgery, only the degree of tonsillar hypertrophy was statistically significant correlated with AHI. At post-operative follow-up, evidence of correlation between AHI and apnoea was observed: 38.1% of children improved in the group with persistence and 66.7% in the disease resolution group (P=.023). In addition, the correlations showed the level of improvement of snoring, as assessed by visual analogue scale. The mean was 5 points lower in the persistent group and 6.1 lower in the disease resolution group (P=.047).ConclusionDespite the limitations in the correlation between clinical data and polysomnography, especially in preoperative results, polysomnography remains the gold standard diagnostic tool. Efforts should be made to obtain objective parameters that provide higher levels of correlation.     

Cambios en la vía aérea superior de pacientes con apnea obstructiva del sueño y/o roncopatía crónica en tratamiento con posicionadores mandibulares

We have analysed the possible modifications in the upper airways (UA) of the lateral craneal teleradiography in 25 adult males with Obstructive Sleep Apnea (OSAS) and/or chronic snoring, with dental and squeletal Class I, treated with advance mandibular appliances (MAD). Results of our study showed a clear increase of the UA in the oropharinx in all the subjects studied.The study of the changes in the UA using the lateral craneal teleradiography in order to evaluate the eflectiveness of the MAD can contribute to consider its eflectiveness in the cases with OSAS when they are indicated. However it will be needed to contrast these results with polisomnography.     

Documento de consenso de la Sociedad Española de Medicina Intensiva,Crítica,y Unidades Coronarias (SEMICYUC), la Sociedad Española de Otorrinolaringología y Cirugía de Cabeza y Cuello (SEORL-CCC) y la Sociedad Española de Anestesiología y Reanimación (SEDAR) sobre la traqueotomía en pacientes con COVID-19

The current COVID-19 pandemic has rendered up to 15% of patients under mechanical ventilation. Because the subsequent tracheotomy is a frequent procedure, the three societies mostly involved (SEMICYUC, SEDAR and SEORL-CCC) have setup a consensus paper that offers an overview about indications and contraindications of tracheotomy, be it by puncture or open, clarifying its respective advantages and enumerating the ideal conditions under which they should be performed, as well as the necessary steps. Regular and emergency situations are displayed together with the postoperative measures.     

Cochlear implants in children with craniofacial syndromes: Assessment and outcomes: Implantes cocleares en niños con síndromes craneofaciales: Evaluación y resultados

The aim of this retrospective study was to review the outcomes for children with craniofacial syndromes who had received a cochlear implant. The group comprised four children (three girls, one boy) aged between 3.3 and 10.1 years (mean 6.3 years) at time of implantation with the Cochlear CI-22M device. Two children had the CHARGE association, one had Goldenhar's syndrome and one had brachio-oculo-facial syndrome. All had full electrode insertion at time of surgery. At follow-up, three of the children demonstrated benefit in detection, recognition and identification of environmental sounds, and they continued to gain receptive spoken language skills, although none had intelligible speech. The group required careful mapping and higher levels of electrical stimulation of the implant compared to normal child implantees. Stimulation of the facial nerve was a problem with one child. The pre-implantation assessment of these children requires extensive interdisciplinary discussion and careful radiological investigation. Cases should be carefully selected. Parents should receive realistic counselling about outcomes and the time commitment necessary, as habilitation of these children can take twice as long as that of children without additional special needs. Post-implantation, these children continue to require well-coordinated medical and interdisciplinary management.

Sumario

El objetivo de este estudio retrospectivo fue revisar los resultados obtenidos en niños con síndromes craneofaciales a los que se les realizó un implante coclear. El grupo estaba conslituido por cuatro niños (tres niñas y un niño) de edades entre 3.3 y 10.1 años (media 6.3 años) en el momento del implante, a los que se les implantó un Cochlear Cl 22M. Dos niños presentaban la asociación CHARGE; uno, el Sx de Goldenhar y el cuarto el Sx braquio-oculo-facial. En todos se logró la inserción completa de los electrodos. En el momento del seguimiento tres de ellos demostraban un beneficio en la detección, reconocimiento e identificación de sonidos ambientales y continuaron desarrollando habilidades en el lenguaje oral, aunque ninguno tenía un lenguaje inteligible. El grupo requirió un mapeo cuidadoso y niveles más elevados de estimulación eléctrica del implante en comparación con niños implantados sin esos síndromes. Un niño presentó como problema la estimulación del nervio facial. La evaluación pre-implante de estos niños requiere una profunda discusión interdisciplinaria y un estudio radiológico cuidadoso. Los casos deben ser seleccionados muy cuidadosamente. Los padres deben recibir informacíón realista sobre las expectativas y el tiempo que deberán comprometer pues la habilitación de estos niños puede tomar el doble de tiempo que los niños sin otra necesidad especial adicional a la sordera. Después del implante, estos niños requieren un tratamiento interdisciplinario muy bien coordinado.     

Analysis of counted behaviors in a single-subject design: modeling of hearing-aid intervention in hearing-impaired patients with Alzheimer's disease Análisis del conteo de conductas en un diseño unipersonal: Modelo de intervención con auxiliar auditivo en pacientes hipoacúsicos con enfermedad de Alzheimer

Clinical procedures related to patients with Alzheimer's Disease (AD) largely fail to address the patient's hearing. Given the challenges of this population, unconventional indicators of treatment efficacy may be required. Palmer et al (1999) reported on caregiver-tracked behaviors as outcome measures for hearing aid intervention. Using these data, hearing aid use and subsequent behavior was modeled as a first-order dynamic system, characterized by responses following an exponential time course. The results of such modeling suggest predictable outcomes of hearing aid intervention, or at least useful parameters of quantification (e.g. time-constant and steady-state response), permitting critical assessment of effects of intervention on negative behaviors versus hearing aid use, comparisons among behaviors, and/or comparisons of hearing-aid-use patterns and behavior counts among patients. Use in this and other difficult-to-test populations warrant further study to evaluate clinical efficacy of the analysis described.