Teresa Rivera

The Prevalence of Dysphonia, Its Association With Immunomediated Diseases And Correlation With Biochemical Markers

INTRODUCTION Patients with autoimmune diseases may suffer from hoarseness and voice disorders because of anatomical and functional alterations. OBJECTIVES To assess the prevalence of dysphonia in rheumatic patients and its impact on their quality of life (QOL). To analyze the association of voice disorders in patients with rheumatoid arthritis (RA), systemic lupus erythematosus (SLE), and Sjögren syndrome (SS). To determine if voice disorders during the acute phase of these diseases are correlated with specific biochemical parameters. METHODS Present an observational and transverse analytic study of 140 patients selected from February 2009 to January 2010. The subjects (80) were diagnosed with RA (44), SLE (32), and SS (4), and the control group (60) presented no voice disorders or rheumatic diseases. Patients were evaluated using the Voice Handicap Index (VHI) and a three items outcome scale (TIOS). A biochemical and C-reactive protein study was performed on 40 patients with a disease outbreak, measuring their complement, sedimentation velocity (VSG), and anti-DNA antibodies. RESULTS The prevalence of dysphonia among the subjects was 32-38% as opposed to 5-8% in the control group. The rheumatic patients presented an odds ratio (OR) for dysphonia of 2.82 (VHI) and 5.04 (TIOS) when compared with healthy individuals (P<0.05). We found statistically significant differences in functional, physical, occupational, and emotional subscales of these tests. No significant differences were found when studying the biochemical parameters. A higher incidence of voice disorders (OR=3.07) was associated with SLE, followed by RA (OR=2.8; 95% CI). CONCLUSIONS Systemic immunomediated diseases may associate voice disorders. Patients with SLE are those who develop these disorders more frequently. The biochemical parameters most affected during a crisis are VSG and anti-DNA antibodies.

Transforming growth factor β1 inhibition protects from noise-induced hearing loss

Excessive exposure to noise damages the principal cochlear structures leading to hearing impairment. Inflammatory and immune responses are central mechanisms in cochlear defensive response to noise but, if unregulated, they contribute to inner ear damage and hearing loss. Transforming growth factor β (TGF-β) is a key regulator of both responses and high levels of this factor have been associated with cochlear injury in hearing loss animal models. To evaluate the potential of targeting TGF-β as a therapeutic strategy for preventing or ameliorating noise-induced hearing loss (NIHL), we studied the auditory function, cochlear morphology, gene expression and oxidative stress markers in mice exposed to noise and treated with TGF-β1 peptidic inhibitors P17 and P144, just before or immediately after noise insult. Our results indicate that systemic administration of both peptides significantly improved both the evolution of hearing thresholds and the degenerative changes induced by noise-exposure in lateral wall structures. Moreover, treatments ameliorated the inflammatory state and redox balance. These therapeutic effects were dose-dependent and more effective if the TGF-β1 inhibitors were administered prior to inducing the injury. In conclusion, inhibition of TGF-β1 actions with antagonistic peptides represents a new, promising therapeutic strategy for the prevention and repair of noise-induced cochlear damage.

Direct drug application to the round window: A comparative study of ototoxicity in rats

Objective: To assess the validity of inducing ototoxicity in rats by applying a sponge soaked in kanamycin and furosemide on the round window. Study Design: Basic, randomized, nonblind experimental study. Setting: Animal models of cochlear damage and reliable methods of local drug delivery are fundamental to study hearing loss and to design new therapies. Subjects and Methods: Four experimental groups of six Wistar rats with different methods of drug administration were used: (1) injection of subcutaneous kanamycin (400 mg/kg) and intravenous furosemide (100 mg/kg); (2) local application of a sponge soaked in saline close to the round window; (3) animals for which the sponge was soaked in a solution containing kanamycin (200 mg/mL) and furosemide (50 mg/mL); and (4) sham-operated rats. The tympanic bulla was exposed using a ventral approach, and a bullostomy was performed to visualize the round window membrane. Cochlear function was assessed by measuring the auditory brainstem response, and hearing thresholds in response to click and tone burst stimuli were determined as peak and interpeak latencies. At the end of the study, cochlear histology was analyzed. Results: Systemic administration of kanamycin and furosemide induced profound hearing loss and severe hair cell damage. Local delivery of these ototoxic drugs caused comparable damage but avoided the systemic side effects of the drug. Sham-operated and saline control animals did not experience functional alterations. Conclusion: Situating a sponge soaked in kanamycin and furosemide on the round window membrane through the ventral approach is a reliable method to provoke local ototoxicity in rats.

Cirugía endoscópica nasosinusal: estudio de 110 pacientes con rinosinusitis crónica con pólipos

Introduccion y objetivos La rinosinusitis cronica con polipos es una entidad considerada como un subgrupo dentro de la rinosinusitis cronica. El objetivo de este estudio es valorar los resultados de la cirugia endoscopica nasosinusal de la rinosinusitis cronica con polipos en nuestro hospital. Pacientes y metodo Exponemos una revision de 110 pacientes con rinosinusitis cronica con polipos, operados mediante cirugia endoscopica. Se estudia los sintomas, el grado de afeccion, la ocupacion de los senos (estadificacion de Lund-Mackay), las complicaciones y el porcentaje de curaciones y recidivas. Resultados En esta serie no hay complicaciones mayores. Se describen 21 (19 %) menores, de las que la sinequia es la mas frecuente. Los pacientes con asma, intolerancia al acido acetilsalicilico o ambos trastornos presentan un mayor porcentaje de recidivas. Cuando se trata de cirugia endoscopica de revisiones quirurgicas, no observamos que tengan mayor probabilidad de recidivar. En la serie que estudiamos, las complicaciones no estan relacionadas con las revisiones quirurgicas. La gradacion de la gravedad de la afeccion que utilizamos en la endoscopia nasal se corresponde bien con la estadificacion obtenida en la tomografia computarizada. Conclusiones El asma, la intolerancia al acido acetilsalicilico o ambas se manifiestan como factores de mal pronostico. En la serie revisada, no hay una clara relacion entre la cirugia primaria o de revision con las complicaciones. En la estadificacion utilizada se correlacionan bien el grado de ocupacion de la endoscopia nasal y la tomografia computarizada.

SCREENING AUDITIVO EN NIÑOS CON FACTORES DE RIESGO DE HIPOACUSIA EN EL ÁREA 3 DE MADRID

Resumen La deteccion precoz de la hipoacusia tiene una gran importancia para poder iniciar una rehabilitacion temprana y asi conseguir un desarrollo normal del lenguaje. Por este motivo se han desarrollado programas de screening auditivo neonatal, fundamentalmente en los casos con antecedentes de riesgo de hipoacusia. El objetivo de este trabajo es estudiar la incidencia de la hipoacusia en los ninos con factores de riesgo en el area 3 de Madrid. Se realizo screening auditivo en 138 ninos en un periodo de 3,5 anos, mediante otoemisiones acusticas a los ninos menores de 1 ano y potenciales evocados auditivos a los que superaban esta edad. Los resultados muestran que existe un 4,34% de casos de hipoacusia neurosensorial en ninos con factores de riesgo, y mas concretamente un 2,8% de hipoacusia neurosensorial profunda bilateral; ademas tambien se detecto un 6,5% de hipoacusias transmisivas. El hecho de realizar este programa de screening permitio disminuir la edad de deteccion de la hipoacusia antes de los 6 meses. Estos datos apoyan la necesidad de realizacion de programas de screening auditivo con caracter obligatorio, aunque abogamos por el screening universal para poder abarcar los casos de hipoacusia sin antecedentes de riesgo

Adaptation and validation of Spanish version of the pediatric Voice Handicap Index (P-VHI)

OBJECTIVES The voice in childhood is a communication tool and a form of emotional expression. It is estimated that 6 to 23% of children may have voice disorders. There is a test, the Pediatric Voice Handicap Index (P-VHI), validated in English to assess the specific impact on quality of life of children with speech pathology. Spanish is the second most widely used language in the world in terms of number of speakers, with over 500 million native speakers, so it is necessary to have tools that allow us to evaluate the effects of dysphonia in Spanish-speaking children. The aim of our study is the validation of the Spanish version of the P-VHI. MATERIAL AND METHODS We performed a cross-sectional study including patients between 4 and 15 years of age. The English P-VHI validated version was translated into Spanish and this translation was reviewed and modified by three specialists in Otorhinolaryngology. There were two study groups, children who had dysphonia (n=44) and a control group of children without alterations in voice (n=44). The questionnaire was always answered by parents. RESULTS Significant differences were found between the group of children with dysphonia and the control group in the overall P-VHI score and the different subscales (p<0.001). Optimal internal consistency with a good Cronbachs alpha (α=0.81) was found, with high test-retest reliability (Wilcoxon z: -0847, p>0.05). CONCLUSIONS The Spanish version of the P-VHI is a validated tool that has good internal consistency. It is a reliable test that evaluates the Voice Handicap Index in the pediatric population, with easy application for daily clinical practice.

Endoscopic Sinonasal Surgery: Study of 110 Patients With Nasal Polyposis and Chronic Rhinosinusitis

INTRODUCTION AND OBJECTIVES Nasal polyposis with chronic rhinosinusitis is classified as a subset of chronic rhinosinusitis. The goal of this study is to assess the results of endoscopic sinonasal surgery at our hospital for nasal polyposis with chronic rhinosinusitis. PATIENTS AND METHOD In this review of 110 patients affected by chronic rhinosinusitis and nasal polyps treated with endoscopic sinus surgery, we focus on symptoms, degree of involvement, sinus opacity (Lund-Mackay grading system), complications, rate of improvements, and recurrences. RESULTS Major complications did not occur. Minor complications occurred in 21 patients (19 %) with the most frequent being adhesion. Patients who suffered from asthma, aspirin intolerance, or both were related to a greater rate of recurrences. The endoscopic surgery of recurrences was not linked to a greater rate of failures. In our study, the complications rate was not related to revision surgery. The severity grading used in nasal endoscopy correlated well to the grading assigned by computerized tomography. CONCLUSIONS The presence of asthma, aspirin intolerance, or both adversely affect endoscopic sinus surgery outcome. In this review, the rate of complications is not related to revision surgery. The staging used relates well the degree of occupation shown by the nasal endoscopy to that given by computerized tomography.

Indicaciones actuales de la osteoplastia frontal

INTRODUCTION AND OBJECTIVES Endoscopic sinus surgery is the technique of choice in most of the frontal sinus diseases, both inflammatory and tumour-related. This is why the external approach using osteoplastic flap (OF) would be limited to cases with a difficult endoscopic approach. Our aim was to review the current indications of the osteoplastic flap in the treatment of frontal sinus pathology, through a retrospective study of patients undergoing this technique. METHODS We performed a retrospective study of 14 patients who were treated with the osteoplastic flap procedure. All the surgical indication criteria, type of sinus disease, presence or absence of prior endoscopic surgery, surgical findings, complications and recurrence were reviewed. RESULTS The pathologies found were 1 osteoma (7.1%), 3 inverted papilloma (21.4%) and 10 mucoceles (71.4%). Nine patients had a prior endoscopic surgery and 10 patients had an orbital dehiscence (9 mucocele, 1 papilloma). Frontal osteoma was Grade IV and the papilloma cases were Krouse Stage III. Surgical revision was required for 21.4%. CONCLUSIONS The main indications for an OF in patients with inflammatory disease are lateral extension and frontal recess neo-osteogenesis. In osteoma cases, it depends on the size of the tumour. In inverted papilloma cases, the indication is multifocal implantation with origin in the anterior and lateral wall. In all cases, performing the osteoplastic flap must be individualised.

Corrigendum to: Swept-sine noise-induced damage as a hearing loss model for preclinical assays.

[This corrects the article on p. 7 in vol. 7, PMID: 25762930.].

The expression of oxidative stress response genes is modulated by a combination of resveratrol and N-acetylcysteine to ameliorate ototoxicity in the rat cochlea

Abstract Aminoglycoside antibiotics are used widely in medicine despite their ototoxic side‐effects. Oxidative stress and inflammation are key mechanisms determining the extent and severity of the damage. Here we evaluate the protective effect of a treatment with resveratrol plus N‐acetylcysteine on the ototoxic actions of kanamycin and furosemide in the rat. Resveratrol (10 mg/kg) and N‐acetylcysteine (400 mg/kg) were administered together to Wistar rats on 5 consecutive days. The second day, a concentrated solution of kanamycin and furosemide was placed on the round window to induce ototoxicity. Hearing was assessed by recording auditory brainstem responses before and 5, 16 and 23 days after the beginning of the treatment. Cochlear samples were taken at day 5 (end of the treatment) and at day 23, and targeted PCR arrays or RT‐qPCR were performed to analyze oxidative balance and inflammation related genes, respectively. In addition, the cytoarchitecture and the presence of apoptosis, oxidative stress and inflammation markers were evaluated in cochlear sections. Results indicate that administration of resveratrol plus N‐acetylcysteine reduced the threshold shifts induced by ototoxic drugs at high frequencies (≈10 dB), although this protective effect fades after the cessation of the treatment. Gene expression analysis showed that the treatment modulated the expression of genes involved in the cellular oxidative (Gpx1, Sod1, Ccs and Noxa1) and inflammatory (Il1b, Il4, Mpo and Ncf) responses to injury. Thus, co‐administration of resveratrol and NAC, routinely used individually in patients, could reduce the ototoxic secondary effects of aminoglycosides. Graphical abstract Figure. No Caption available. HighlightsOxidative stress and inflammation are key mechanisms in the ototoxic effects of aminoglycosides in the rat.Co‐administration of resveratrol and NAC reduces the ototoxic secondary effects by aminoglycosides.Gpx1, Il1b, Il4 and Sod1 are target genes in the antioxidant and anti‐inflammatory effect of resveratrol plus NAC.