Laura Cavallé Garrido

Effect of changing pulse rate on profile parameters of perceptual thresholds and loudness comfort levels and relation to ECAP thresholds in recipients of the Nucleus CI24RE device.

Abstract The Nucleus CI24RE ‘Freedom’ device offers higher stimulation rates and lower noise levels in action potential measurements (ECAPs) than previous devices. A study including ten European implant teams showed that the effect of changes in rate from 250 to 3500 pulses per second on tilt and curvature of the T and C profiles is insignificant. When changing rate one may change the levels at all electrodes by the same amount. Using an automated procedure ECAPs could be measured quickly and reliably at a noise level of only 1 μV. However, this did not result in improved correlations between the tilt and curvature parameters of the ECAP profiles and those of the T and C profiles. Average C levels appear to differ markedly among implant centers; a better assessment protocol is required. When increasing stimulus rate one should take into account that this requires higher pulse charges per second and more power consumption. Sumario El dispositivo Nucleus CI24RE “Freedom” ofrece tasas de estimulación mayores, y menores niveles de ruido en las mediciones del potencial de acción (ECAPs) que los dispositivos anteriores. Un estudio que incluyó diez grupos europeos de implantes, mostró que el efecto de los cambios en la tasa de 250 a 3500 pulsos por segundo en la inclinación y la curvatura de los perfiles T y C es insignificante. Cuando se cambian las tasas, uno puede cambiar los niveles de todos los electrodos en la misma medida. Utilizando un procedimiento automatizado, los ECAPs pueden medirse en forma rápida y confiable a un nivel de ruido de solo 1mV. Sin embargo, esto no conlleva (a) una mejoría en las correlaciones entre los parámetros de inclinación y de curvatura de los perfiles ECAP y aquellos de los perfiles de T y C. Los niveles C promedio parecen diferir marcadamente entre los centros de implante; se requiere un mejor protocolo de evaluación. Cuando se incrementa la tasa de estimulación uno debe tomar en cuenta que eso requiere una mayor carga de pulsos por segundo y mayor poder de consumo.

Capacidad diagnóstica de la resonancia magnética con técnica de difusión no eco-planar en la detección de colesteatomas primarios y recurrentes

INTRODUCTION AND AIMS the aim of this study was to determine the certainty of non-echo-planar imaging diffusion-weighted magnetic resonance imaging (non-EPI DW MRI) in the diagnosis of primary and recurrent cholesteatoma in patients with clinical suspicion of cholesteatoma, assessing the sensitivity and specificity of the test in both groups. METHODS Seventy-five patients with clinical suspicion of cholesteatoma were included in our study. Forty-eight cases had primary suspicion of cholesteatoma and 27 cases had recurrent suspicion of cholesteatoma. All patients received non-EPI DW MRI tests before surgery, and radiological and surgical findings were compared. RESULTS Sensitivity, specificity and the positive and negative predictive value for primary diagnosis of cholesteatoma group were 91.2%, 50%, 81.6% and 70%, respectively. For the recurrent cholesteatoma group these results were 100%, 66.7%, 90.9% and 100%, respectively. CONCLUSION Non-echo-planar imaging diffusion-weighted magnetic resonance imaging is a high sensitivity imaging test for detecting cholesteatoma, for both primary diagnosis and for recurrent cases.

Meningitis de repetición asociada a síndrome de Duane tipo 1

We present the case of a 17-month-old male patient with a bilateral Duane syndrome type 1 associated to unilateral cochleovestibular dysplasia, perilymphatic fistula and recurrent meningitis. Diagnosis was carried out by MRI and CT scan. His management and treatment are described, as well as the postoperative evolution. We believe this is an exceptional case due to the low frequency of this syndrome, as well as to the otoneurological complications.

Transoral Fully Robotic Dissection of a Parapharyngeal Hemangioma.

AbstractSoft tissue robotics found its trigger for success in minimally invasive surgery. The minimization of the surgical damage is more obvious as the surgical alternative is more aggressive. In head and neck surgery, potential sequelae are both functional and cosmetic. Robotic instrumentation might allow for further development of the transoral approach to the deep regions of the face.The authors present an uneventful, fully robotic, transoral surgical excision of a parapharyngeal hemangioma. The authors discuss management alternatives, surgical risks, and safety measures. The medial approach is the natural choice, provided it is safe and technically feasible. Transoral robotic surgery could be a reasonable minimally invasive approach for selected parapharyngeal tumors.

Guía clínica sobre implantes de conducción de vía ósea

INTRODUCTION AND GOALS During the last decade there have been multiple and relevant advances in conduction and mixed hearing loss treatment. These advances and the appearance of new devices have extended the indications for bone-conduction implants. The Scientific Committee of Audiology of the Sociedad Española de Otorrinolaringología y Cirugía de Cabeza y Cuello SEORL-CCC (Spanish Society of Otolaryngology and Head and Neck Surgery), together with the Otology and Otoneurology Committees, have undertaken a review of the current state of bone-conduction devices with updated information, to provide a clinical guideline on bone-conduction implants for otorhinolaryngology specialists, health professionals, health authorities and society in general. METHODS This clinical guideline on bone-conduction implants contains information on the following: 1) Definition and description of bone-conduction devices; 2) Current and upcoming indications for bone conduction devices: Magnetic resonance compatibility; 3) Organization requirements for a bone-conduction implant programme. RESULTS AND CONCLUSIONS The purpose of this guideline is to describe the different bone-conduction implants, their characteristics and their indications, and to provide coordinated instructions for all the above-mentioned agents for decision making within their specific work areas.

Late Diagnosis of Isolated Agenesis of Cranial Nerve VIII

La hipoacusia es uno de los motivos mas frecuentes de consulta en otorrinolaringologia. Ante la sospecha, es fundamental realizar un estudio audiologico completo y complementarlo con tecnicas de imagen adecuadas. La tomografia computarizada (TC) tiene una elevada sensibilidad para evaluar el conducto auditivo interno (CAI), mientras que la resonancia magnetica nuclear (RMN) aporta informacion mucho mas detallada para conocer su contenido, ya que un CAI de diametro normal en la TC podria presentar una ausencia del VIII par craneal, siendo la RMN el unico medio para detectarlo. Presentamos el caso clinico de un nino de 11 anos remitido a nuestro servicio por sospecha de hipoacusia de oido izquierdo (OI), detectada de forma casual por sus padres. No presentaba antecedentes familiares ni factores de riesgo de hipoacusia. Lenguaje normal y adaptacion escolar adecuada a su edad. No antecedentes de otitis medias de repeticion ni sintomas vestibulares. La otoscopia es normal bilateral. Figura 2

Agenesia aislada del VIII par de diagnóstico tardío

Hearing loss is one of the most frequent reasons for attending an otorhinolaryngology clinic. When suspected, it is essential to conduct a complete audiological study and complement this with suitable imaging techniques. Computed tomography (CT) is extremely sensitive for the assessment of the internal auditory canal (IAC), while nuclear magnetic resonance (NMR) provides much more detailed information on its contents, as a normal-sized IAC on a CT scan might present absence of cranial nerve VIII and NMR is the only means for its detection. We report the case of an 11-year-old boy referred to our department due to suspected hearing loss in the left ear (LE), detected by chance by his parents. He presented no familial history or risk factors for hearing loss. Language acquisition was normal and his adaptation to schooling was adequate for his age. There was no prior history of recurrent