Jaime Marco

Surgical planning after sleep versus awake techniques in patients with obstructive sleep apnea.

This study examined correlations between surgical recommendations based on either drug‐induced sleep endoscopy (DISE) or common awake examination methods in patients with obstructive sleep apnea syndrome (OSAS).

Time Course of Episodes of Definitive Vertigo in Ménière’s Disease

OBJECTIVE To evaluate the frequency and duration of episodes of definitive vertigo in Ménières disease. DESIGN Prospective longitudinal study. SETTING Multiple tertiary referral centers. PATIENTS Five hundred ten individuals from 8 hospitals that met the American Academy of Otolaryngology-Head and Neck Surgery diagnostic criteria for definitive Ménières disease. INTERVENTION Conservative treatment. MAIN OUTCOME MEASURE Frequency and duration of episodes of definitive vertigo during follow-up. RESULTS Ménières disease affects both sexes and both ears equally, with onset generally in the fourth decade of life. The number of episodes of vertigo is greater in the first few years of the disease. Although episodes of vertigo that last longer than 6 hours are less frequent than shorter episodes, they occur with similar frequency throughout the natural course of the disease. The percentage of patients without episodes of vertigo increases as the disease progresses, and 70% of patients who did not have an episode of vertigo for 1 year will continue to be free of episodes during the following year. Thus, there is a relationship between the frequency of episodes in consecutive years, although this association decreases rapidly as the number of years increases. CONCLUSION The frequency of definitive episodes of vertigo in Ménières disease decreased during follow-up, and many individuals reached a steady-state phase free of vertigo.

Cis-Diaminedichloro Platinum Ototoxicity: An Experimental Study

Four groups of guinea pigs received different doses of cis-platinum. SEM and TEM showed a direct relation between the dose and the damage. The first row of OHC is the first one to be damaged. The IHC are more resistant than the OHC. The pattern of destruction is similar to the one produced by the aminoglucoside antibiotics.

Morphologic and Quantitative Study of the Efferent Vestibular System in the Chinchilla: 3-D Reconstruction

An HRP study of the EVN has been performed. Three groups of somas have been identified: Those located in the proximity of the vestibular nuclei, those sandwiched between the facial genu and the IVth ventricle, and those in the RF, surrounding the abducens nucleus. The number of somas is greater in the contralateral brain-stem side. Axons could be followed through the midline, but could not be traced to a labelled soma. A 3-D reconstruction of the EVN within the brain stem is presented.

An experimental comparative study of dexamethasone, melatonin and tacrolimus in noise-induced hearing loss

Conclusion: The calcineurin inhibitor tacrolimus (TCR) and the pineal gland hormone and antioxidant melatonin (MLT) have been shown to possess otoprotective properties against noise-induced hearing loss (NIHL). In contrast, dexamethasone (DXM) was not effective as an otoprotective agent against NIHL. Further studies are needed to understand the exact molecular mechanisms involved. Objective: Exposure to noise pollution and use of audio devices for long periods of time at high volume is known to cause hearing loss or NIHL. Our goal was to evaluate the effectiveness of various known compounds such as the anti-inflammatory DXM, the antioxidant MLT and the immunosuppressant TCR against NIHL. Materials and methods: Thirty-two Wistar rats were randomly divided into groups that were then exposed to intense white noise at 120 dB SPL for 4 h. The day before and for a period of 14 days, test groups were administered one of the three compounds. The efficacy of the compounds against NIHL was determined after examining the shifts in the levels of distortion product otoacoustic emissions (DPOAEs) and changes in the threshold of auditory brainstem responses (ABRs). Cytocochleograms and determination of gene expression in whole rat cochlea were carried out at day 21. Results: Treatment with DXM had no otoprotective effect, while animals treated with MLT experienced an improvement in their hearing functionality. This effect, which is probably linked to MLTs ability to reduce c-fos and TNF-α gene expression thereby preventing outer hair cell (OHC) loss, was even more pronounced in week 3. For its part, TCR provided protection against injury to the cochlea from week 1, eventually leading to a full recovery in hearing. The compound reduced both c-fos and TNF-α expression, as well as OHC loss.

Randomized study comparing two tongue base surgeries for moderate to severe obstructive sleep apnea syndrome

Objective: To compare the effectiveness and morbidity of the tongue base radiofrequency and tongue base suspension techniques combined with uvulopalatopharyngoplasty for moderate to severe obstructive sleep apnea. Study Design and Setting: Prospective and randomized surgical trial at a university hospital. Methods: In total, 57 patients received either tongue base radiofrequency reduction (n = 29) or tongue base suspension (n = 28). Apnea-hypopnea index, lowest oxygen saturation (polysomnography), Epworth score, and side effects were assessed. Success was defined as a ≥50 percent reduction and final apneahypopnea index < 15/h, and an Epworth score < 11. Results: The success rates of the two procedures were 57.1 percent and 51.7 percent, respectively (P = 0.79), but only 12.5 percent and 10 percent, respectively (P = 0.87), in obese patients. Body mass index (P = 0.0002) was the main predictor of success in a logistic regression analysis. Tongue base suspension demonstrated higher morbidity (P < 0.05). Conclusions: The effectiveness of tongue base suspension was similar to that of tongue base radiofrequency reduction, although with significantly higher morbidity, for moderate to severe obstructive sleep apnea. The effectiveness of both techniques was lower in obese patients. Significance: Neither technique should be used in obese patients who have moderate to severe obstructive sleep apnea.

Complicaciones y fallos de la implantación coclear

INTRODUCTION Cochlear implantation is a relatively safe surgery performed on profound bilateral hearing loss patients. Its surgical indications have increased and the age of implantation has decreased over the last years. As with any other surgery, it presents complications; device failure is one of the most important, given its potential risk for the need to explant and reimplant the device. OBJECTIVE To evaluate cochlear implant complications, determine possible causes and discuss medical and surgical management. MATERIAL AND METHODS A retrospective study of cochlear implants was performed. A total of 246 implants over an eleven-year period were evaluated. The sample consisted of 123 implants in patients younger than 10 years old, and 123 in those older than 10 years old; there were 138 males and 108 females. The devices implanted were 129 Advance Bionics, 95 MED-El, and 22 Cochlear. Complications and device failures were analysed. RESULTS A total of 28 complications were reported, which corresponds to 11.38% of all implants. Seven minor complications and 21 mayor complications were found. Device Failure was the most frequent complication, reported in 6.5% of all implants, and it was more frequent among children less than 10 years old. CONCLUSIONS Cochlear implant surgery has a low complication rate. Complications are usually resolved easily, but device failure continues to be a problem. It is important to keep studying the causes of such failure to find possible solutions that can lead to lowering and resolving its appearance.

Auditory Neuropathy in Children

Auditory neuropathy is a sensorineural disorder characterized by absent or abnormal auditory brainstem evoked potentials and normal cochlear outer hair cell function. A variety of processes is thought to be involved in its pathophysiology and their influence on hearing may be different. We present here the diagnostic sequence and management of two new cases of auditory neuropathy in breastfeeding children.Auditory neuropathy is a sensorineural disorder characterized by absent or abnormal auditory brainstem evoked potentials and normal cochlear outer hair cell function. A variety of processes is thought to be involved in its pathophysiology and their influence on hearing may be different. We present here the diagnostic sequence and management of two new cases of auditory neuropathy in breastfeeding children.

Cochlear implant complications and failures

Abstract Introduction Cochlear implantation is a relatively safe surgery performed on profound bilateral hearing loss patients. Its surgical indications have increased and the age of implantation has decreased over the last years. As with any other surgery, it presents complications; device failure is one of the most important, given its potential risk for the need to explant and reimplant the device. Objective To evaluate cochlear implant complications, determine possible causes and discuss medical and surgical management. Material and methods A retrospective study of cochlear implants was performed. A total of 246 implants over an eleven-year period were evaluated. The sample consisted of 123 implants in patients younger than 10 years old, and 123 in those older than 10 years old; there were 138 males and 108 females. The devices implanted were 129 Advance Bionics, 95 MED-El, and 22 Cochlear. Complications and device failures were analysed. Results A total of 28 complications were reported, which corresponds to 11.38% of all implants. Seven minor complications and 21 mayor complications were found. Device Failure was the most frequent complication, reported in 6.5% of all implants, and it was more frequent among children less than 10 years old. Conclusions Cochlear implant surgery has a low complication rate. Complications are usually resolved easily, but device failure continues to be a problem. It is important to keep studying the causes of such failure to find possible solutions that can lead to lowering and resolving its appearance.

Benefits of the HiRes 120 coding strategy combined with the Harmony processor in an adult European multicentre study

Abstract Conclusion: The Harmony processor was found to be reliable, comfortable and offered a substantially increased battery life compared with the previous generation processor. No significant improvement in speech understanding with HiRes was demonstrated from objective measures, but the majority of subjects showed a clear subjective preference for the combination HiRes 120/Harmony processor. Objectives: To evaluate experience with the Harmony™ sound processor, together with the HiRes 120 strategy. Methods: Postlingually deafened adults implanted with a CII or HiRes 90K were included and divided into three groups: (1) experienced users using the Platinum body-worn processor; (2) experienced users who had been using other processors; (3) new users with the Harmony processor from first fitting. The latter group entered a randomized crossover protocol where half were initially fitted with HiRes and half with HiRes 120. The initial strategy was used for 3 months and the alternative for a further 3 months. Speech perception tests and questionnaires were performed. Results: The study included 65 subjects. Implementing HiRes 120 was straightforward. The speech test group results did not show significant differences between HiRes and HiRes 120. However, the questionnaires showed significantly higher ratings for HiRes 120 in some instances. Subjects were highly satisfied with the Harmony processor.