Raquel Manrique

Revisión de los criterios audiométricos en el tratamiento de la hipoacusia neurosensorial mediante audífonos y prótesis auditivas implantables

La hipoacusia neurosensorial tiene alta incidencia en nuestra poblacion. Sirva de ejemplo que el 50 % de las personas mayores de 75 anos tiene este tipo de discapacidad. Los avances en los dispositivos utilizados para su tratamiento paliativo y su eficacia comprobada hacen necesaria la revision de sus indicaciones y la descripcion detallada de los sistemas audioprotesicos empleados. Estos pueden ser clasificados en protesis externas no implantables (audifonos) y protesis implantables. El grupo de las protesis implantables se subdivide a su vez en implantes activos de oido externo, implantes activos de oido medio, implantes cocleares e implantes auditivos de tronco cerebral (IATC). Las indicaciones establecidas para cada grupo audioprotesico se definen por la tipologia y la topologia de la enfermedad subyacente y por las caracteristicas anatomofuncionales y socioculturales de cada paciente. En esta cuestion debe hacerse hincapie en el protagonismo del especialista a la hora de elegir y seguir el tratamiento. Como norma general, se procura favorecer el acceso del paciente hipoacusico a su entorno sonoro realzando la comprension de la palabra hablada restableciendo la binauralidad y, a la vez, se busca mantener la plasticidad de las vias auditivas centrales a traves de la estimulacion proporcionada por cualquiera de estos sistemas. Se expone las indicaciones emergentes, ya sea en el campo de los implantes cocleares (estimulacion bimodal, implantacion en pacientes con audicion residual, implantaciones bilaterales, etc.) o en el campo de los IATC, en pacientes con afeccion tumoral previamente tratada con radiocirugia y en pacientes con trastornos no tumorales afectos de osificacion coclear bilateral o malformaciones.

Atraumaticity study of 2 cochlear implant electrode arrays.

Hypothesis Evaluate, based on morphologic and histologic parameters, the atraumaticity of 2 electrode arrays implanted in 10 human temporal bones. Background Atraumatic surgery and electrode arrays are current topics in otologic surgery. The preservation of cochlear anatomy and its functions is a priority and morphologic evaluation of the surgical trauma is essential to continue improving in this field. Methods Ten preserved human temporal bones (TB) without anatomic alterations were used in this study. They were divided into 2 groups of 5, and atraumatic surgery was performed to insert HiFocus 1J (group A) and HiFocus Helix (group B) electrode arrays. Anatomic comparisons were performed using computed tomography and histologic analysis. Results Group A: the mean length for the cochlear longitudinal axis was 10.30 mm, and the cochlear transversal axis was 7.2 mm. Scala tympani insertion was achieved in 4/5 TB studied, with a mean depth and angle of insertion of 19.2 mm and 325.5°, respectively. Lateral location of the electrode array was achieved in all specimens. No significant correlation was observed between these dimensions and depth of insertion. Group B: the mean length for the cochlear longitudinal axis was 9.52 mm, and cochlear transversal axis was 6.38 mm. Scala tympani insertion was achieved in 4/5 TB studied, with a mean depth and angle of insertion of 17.5 mm and 352°, respectively. Modiolar location of the electrode array was achieved in all specimens. A positive correlation was established between the linear and angular insertion depths (p = 0.044). Conclusion In summary, it is safe to state that neither electrode array shows significant insertion trauma.

Review of Audiometric Criteria in Treatment of Neurosensorial Deafness With Hearing Aids and Implantable Hearing Devices

Sensorineural hearing loss has a high incidence in our population; as a matter of fact, 50% of people above 75 years of age suffer this impairment. Due to the advances in the devices to alleviate this condition and their verified efficacy, it is now appropriate to review the indications for these devices and provide a detailed description of the audioprosthetic systems used. These systems can be classified as external non-implantable devices (hearing aids) and implantable prostheses. The latter can be sub-divided into active implants in the external ear or middle ear, cochlear implants, and auditory brainstem implants (ABI). Indications for each group are determined by the type and location of the underlying condition as well as by the anatomic, functional, and social characteristics of each patient. It must be stressed that the selection and monitoring of the treatment is up to the specialist. Generally speaking, an attempt is made to facilitate the integration of the hypoacusic patients to their sound setting by enhancing their understanding of the spoken word and restoring binaurality, while at the same time, seeking to retain the plasticity of central auditory routes through the stimulation provided by any of these systems. In the course of this review, we refer to newly-emerging indications in both the field of cochlear implants (bimodal stimulation, implantation in patients with residual hearing, bilateral implants, etc) and in the area of ABI in patients with tumoural disease previously treated with radiosurgery or patients with non-tumour pathologies presenting malformations or bilateral cochlear ossification.

Aticoexposición-antroexclusión como técnica quirúrgica a la demanda para el tratamiento del colesteatoma

INTRODUCTION AND OBJECTIVE Attic exposure and antrum exclusion (AE-AE) is an on demand surgical technique for the treatment of cholesteatoma. Several techniques have been described with variable recurrence rates. The aim of the study was to describe this surgical technique and its indications and to analyse long-term outcomes. MATERIALS AND METHODS Forty-two patients were included. They received AE-AE in a tertiary centre and were followed-up from 6 months to 7 years. The surgical technique exposes the attic by drilling the superior wall of the external auditory canal and excludes the antrum and the mastoid cells by closing the aditus with a cartilage graft. It is indicated if the lesion does not go beyond the aditus or, if it does, it is a delimited cholesteatoma not damaging the labyrinth. The patients were followed-up by physical examination and radiology (CT scan and Non-EPI diffusion-weighted MRI since 2009). RESULTS The recurrence rate of the cholesteatoma was 4.8%. At recurrence, an open canal-wall-down mastoidectomy technique was performed. The rate of otorrhea (2/42 cases), serous otitis (2/42) and other complications was low, so aquatic activities were not contraindicated. The AE-AE did not modify ossicular chain reconstruction with respect to the rest of surgical techniques. CONCLUSIONS AE-AE is a canal-wall-down technique. Its purpose is to remove the lesion and to reduce the recurrence of cholesteatoma. In addition, it allows the entrance of water and reduces the need for 2(nd) look surgery. Non-EPI diffusion-weighted MRI is a reliable technique for follow-up, especially for the excluded mastoid.

Reconstrucción de defectos faríngeos

Reconstruction of pharyngeal defects continues to present a clinical challenge for the Head and Neck surgeon. We have different reconstructive options to preserve speech, airway and swallowing functions. Reconstructive surgery implies a balance between oncologic cure, patient morbidity and quality of life. Classical reconstructive techniques include pedicled cervical cutaneous or myocutaneous flaps and distal myocutaneous flaps such as from the pectoralis major. Current microvascular technique options have a differing incidence of complications but always with high success rates. This article reviews the most current options on reconstructive techniques in pharyngeal defects.

Reconstruction of pharyngeal defects

Reconstruction of pharyngeal defects continues to present a clinical challenge for the head and neck surgeon. We have different reconstructive options to preserve speech, airway, and swallowing functions. Reconstructive surgery implies a balance between oncologic cure, patient morbidity, and quality of life. Classical reconstructive techniques include pedicled cervical cutaneous or myocutaneous flaps and distal myocutaneous flaps such as from the pectoralis major. Current microvascular technique options have a differing incidence of complications but always with high success rates. This article reviews the most current options on reconstructive techniques in pharyngeal defects