Factor analysis and correlation between Dizziness Handicap Inventory and Dizziness Characteristics and Impact on Quality of Life scales.

In order to assess the different dimensions of disability and handicap analyzed in the Dizziness Handicap Inventory (DHI) and Dizziness Characteristics and Impact on Quality of Life (UCLA-DQ) questionnaires a factor analysis study was done. The instruments used were the corresponding transculturally adapted versions of the originals into Spanish. The study included 337 patients with dizziness, independent of location and etiology, who were able to respond to all the items in the questionnaires given before vestibular testing. Factor analysis was used to determine the structure of both scales; a principal components analysis with orthogonal rotation (Varimax) was conducted on data collected from the patients. A three-factor solution was obtained in the DHI and a two-factor solution for the UCLA-DQ. The factors obtained from the DHI were related to vestibular handicap, vestibular disability and visuo-vestibular disability; the factors from the UCLA-DQ were related to frequency and severity of dizziness. There was no coincidence between the items in each of the factor obtained in the DHI questionnaire and the items in the subscales provided in the original version. The main relation between factors was found between vestibular handicap and frequency. The DHI and UCLA-DQ questionnaires are multidimensional questionnaires for the assessment of the impact of dizziness and provide a model for vestibular disability and handicap.

Influence of canal paresis and compensation on gain and time constant of nystagmus slow-phase velocity to yaw-axis rotation.

In order to assess the influence of canal paresis and compensation on the yaw-axis rotatory chair test parameters gain and time constant, a study was conducted in 435 patients diagnosed with unilateral peripheral vestibulopathy. Patients were grouped according to the amount of canal paresis found in the caloric test and by the result of a bedside examination of the vestibulo-ocular reflex (VOR). The time constant of the VOR diminishes as canal paresis increases and, when using a high-velocity sinusoidal test, there is a similar reduction in gain. Mean time constant was reduced when rotations were to the side of the lesion (ipsilesional) and to the normal (contralesional) and differences between both rotations were found for 21-80%, canal paresis. Ipsilesional gain was significantly less than contralesional gain, which had a normal result independent of the amount of canal paresis; differences between them were significant when canal paresis was > 41%. Spontaneous nystagmus significantly influenced the appearance of asymmetries in gain and time constant in the tests performed while, with high-velocity sinusoidal rotation, gain was found to be significantly different for ipsilesional and contralesional rotations in non-acute symptomatic patients.

[Reconstruction of oropharyngeal defects with lateral arm flap]. / Reconstrucción de defectos orofaríngeos con colgajo lateral de brazo.

The lateral arm flap, is a fasciocutaneous flap with great versatility, but underused in head and neck reconstruction. Its qualities include a intermediate thickness between the radial forearm flap and the pectoralis major, ideal to reconstruct oropharyngeal defect, a consistent vascular pedicle, a pliable soft tissue and a low donor site morbidity. Use of this flap does not require the sacrificing of a major feeding vessel to the arm. We have chosen this technique to reconstruct four cases with surgical defects in oral cavity and oropharynx. The anatomic and functional results have been satisfactory and the complications rate is comparable to other microvascular techniques. We think that the lateral arm free flap is a useful reconstructive technique in specific areas of head and neck.

[Synchronous osteochondroid hamartoma and squamous cell carcinoma of the larynx]. / Hamartoma osteocondroide y carcinoma epidermoide de laringe sincrónicos.

BACKGROUND: Soft-tissue tumors of the larynx are rare, especially hamartomas. Fewer than a dozen well-documented cases have been described. We report the case of a 65 year-old man diagnosed of a synchronous epithelial tumor of the right vocal fold and a soft-tissue tumor of the contralateral lamina of the thyroid cartilage. METHODS: CT scan revealed a low-attenuating, expansive mass involving the left ala of the thyroid cartilage without airway compromise airway. The lesion contained small, scattered calcifications and the mucosa was intact, suggesting a cartilaginous tumor. The patient underwent endoscopic resection of the right vocal fold tumor and subtotal resection of the left ala of the thyroid via median thyrotomy. RESULTS: Pathology revealed a squamous-cell carcinoma of the vocal fold and an osteochondroid hamartoma within the thyroid cartilage. The management of patients with laryngeal lesions suggestive of a cartilaginous nature is discussed. CONCLUSIONS: To our knowledge, this is the first case of a synchronous laryngeal hamartoma and carcinoma reported in the literature.

[Cultural adaptation of 2 questionnaires for health measurement in patients with vertigo]. / Adaptación cultural de dos cuestionarios de medida de la salud en pacientes con vértigo.

OBJECTIVE: To perform a transcultural adaptation form English to Spanish of two common questionnaires of handicap assessment in vestibular disorders. STUDY DESIGN: Prospective study. PATIENTS: 337 patients seen for non-acute dizziness from peripheral or central origin in a tertiary referral setting. MAIN OUTCOME MEASURES: Dizziness Handicap Inventory test and UCLA-Dizziness Questionnaire after transcultural adaptation following the method of translation-backtranslation, expert assessment and statistical validation. RESULTS: The results after cultural adaptation and reliability assessment provide a firm basis to demonstrate the close relation of the Spanish and English version in all the items and their meaning. CONCLUSION: This adapted questionnaires can be used to assess vestibular disability with no loss of metric values of the original version.

[Positron-emission tomography (PET) in the diagnosis of malignancy, recurrence, and staging in patients with head and neck tumors]. / Tomografía por emisión de positrones (PET) en el diagnóstico de malignidad, recurrencia y el estadiaje en pacientes con tumores de cabeza y cuello.

We report a prospective study with 15 patients with the diagnosis of head and neck tumors. They underwent two types of studies, the radiological one with computed tomography or magnetic resonance image scan and the positron emission tomography (PET) with 18-fluorodeoxyglucose (FDG). Five patients did not receive any treatment before, and the PET was performed to evaluate the possibility of malignancy, to determine the stage of the disease and if a recurrence was suspected. The study with the PET has the advantage of detecting small lesions and it is not influenced by radiotherapy or surgery.

[Health measurement instruments in patients with vertigo]. / Instrumentos de medida de la salud en pacientes con vértigo.

OBJECTIVE: Compare disability and handicap in patients with dizziness by means of two questionnaires. STUDY DESIGN: Prospective study. PATIENTS: 337 patients seen for non-acute dizziness from peripheral or central origin in a tertiary referral setting. MAIN OUTCOME MEASURES: Spanish version of the Dizziness Handicap Inventory test and UCLA-Dizziness Questionnaire after transcultural adaptation following the method of translation-back-translation. RESULTS: We obtained a good correlation between the frequency of dizzy spells and quality of health as perceived by the patient; also there was good correlation between the intensity of each spell and limitation for performance of daily activities. Quality of life is mainly related to handicap in these patients. CONCLUSION: Vertigo, as a non-fatal health outcome, can be studied following the two main conceptual frameworks of Impairment, Disabilities and Handicap and Health-Related Quality of Life.

Cerebral auditory plasticity and cochlear implants.

Previous animal research and clinical experiences in humans suggest the existence of an auditory critical period in language acquisition. We review the literature and present the changes within the cochlear nuclei in bilaterally deafferentated adult non-human primates. We also present and analyse the results of 98 prelingually deaf children and teenagers who underwent a cochlear implantation at the University of Navarra. Patients received a Nucleus 22 or 24 multichannel cochlear implant (CI). They were grouped in five categories according to their age at surgery. Performance is compared with a control group of 58 postlinguals. Only early-implanted prelingual children (before 6 years of age) achieved a complete open-set speech recognition, even with better performance than postlinguals. These results clearly demonstrate the existence of a period of high neural auditory plasticity within the first 6 years of life. The introduction of auditory stimulation with a CI can not restore the loss of neural plasticity out of this period. Prelingual children under 6 years of age should receive a CI as soon as there is a reliable diagnosis of bilateral sensorineural hearing loss.

[Study of surgical complications and technical failures (correction of technical defects) of cochlear implants]. / Estudio de las complicaciones quirúrgicas y los fallos técnicos de los implante cocleares.

INTRODUCTION: Cochlear implants (CI) have proved their clinical efficacy and have overcome a routine treatment for profound sensorineural impairment. In the present paper we review our CI program concerning surgical complications and equipment failures. MATERIAL AND METHODS: One-hundred and thirty-five patients (69 younger and 66 older than 14 years of age) are subjects of the study. They suffered from pre-lingual (86 cases) or post-lingual (49 cases) profound bilateral sensorineural hearing impairment, and all of them received a Mini Nucleus 22 CI in our CI program. We analyze minor and major surgical complications and also CI and external equipment failures. RESULTS: In 6.1% of the patients (8 cases) a surgical complication occurred, 3 of them flap-related complications. In 2 of these cases (1.54%) complications were major. Three patients (2.17%) developed a complete CI failure, while in 8 cases malfunction of one or more electrodes was detected. Cumulative survival of CI was 87 months, without significant differences related to age or gender. Cumulative survival of the processors was 78.6 months, without significant differences related to the type of processor (MSP or Spectra) or gender but related to the age. The microphone failed in 42.2% of the cases. CONCLUSIONS: The CI is a low-morbidity treatment with adequate characteristics of durability and reliability. Nevertheless, some of the external components remain quite vulnerable.

[Surgery of the posterior semicircular duct for the treatment of BPPV]. / Cirugía del conducto semicircular posterior para el tratamiento del VPPB.

Benign paroxysmal positional vertigo (BPPV) is the most common cause of vertigo in the otolaryngology clinic. The liberatory maneuvers are the treatment of choice in this entity. In a low percentage of patients, about 5-10%, we found no response to the maneuvers. The occlusion of the posterior semicircular canal is offered for intractable cases. We report a case of woman with an intractable BPPV in which an occlusion of the posterior semicircular was done. We describe the indications, how to perform the surgery and the functional results of this technique.

[Multi-dimensional analysis of vocal function. A case-control study]. / Análisis multidimensional de la función vocal. Estudio de casos y controles.

The aim of this study was to select the most appropriate methods for analyzing vocal function from an array of existing tests. A case-control study (64 patients and 64 controls) was made of teaching staff in Logroño, Spain. The 64 patients had 25 nodules, 7 polyps, 15 hyperfunctional dysphonia, 6 hypofunctional dysphonia, 6 submucosal suffusion and 5 chronic laryngitis. The study methods included anamnesis, ENT examination, videostrobolaryngoscopy, perceptual evaluation of hoarse voices, basic aerodynamic tests, the frequency range of phonation, physical analysis of the voice signal of the vowel /a/ and the sentence ìmi padre era castellanoî, and spectrographic analysis of Spanish vowels according to Yanagiharaís classification using Sound Scope 1.0 software. We found no single test that consistently differentiated between hoarse and normal voices; values always overlapped. In contrast the phonation quotient (PQ), maximum phonation time (MPT) of the vowel /a/, S/Z quotient (Eckel and Boone), frequency range of phonation, APQ (average perturbation quotient), HNR (harmonic-to-noise ratio), BR (breathiness, or the high-frequency content of the source wave), RAP (relative average perturbation), standard deviation (SD) of the fundamental frequency (F0) of the vowel /a/, intensity and SD of the sentence ìmi padre era castellanoî, and the sound spectrographic analysis of Spanish vowels disclosed statistically significant differences between hoarse and normal voices.

[Prevalence of voice disorders among educational professionals. Factors contributing to their appearance or their persistence]. / Estudio de la prevalencia de los trastornos de la voz en los profesionales de la enseñanza. Factores que intervienen en su aparición o en su mantenimiento.

A study was made of the prevalence of voice disorders and their risk factors in teaching professionals of Logroño, Spain. A prevalence and case-control study was made, including interviews, ENT examination, videostrobolaryngoscopy, perceptual evaluation of hoarseness, basic aerodynamic tests, the physical range of phonation, and a physical analysis of the acoustic signal. The prevalence of voice disorders among Logroño teachers was 17.7% (confidence interval: 12.1-25%). Nodular lesions (8.1%) were the most frequent pathology, followed by hyperfunctional dysphonia (4.1%), chronic laryngitis (2.7%), polyps (1.4%), hypofunctional dysphonia (0.7%), and submucous suffusion (0.7%). Voice disorders were more prevalent in women (19.3%) than in men (15.6%), and among teachers of the lowest grades: 36.4% in nursery schools, 25% in elementary school, and 20.8% in junior school. The width and depth of classrooms, larger number of students, longer classroom hours, and noise level were related with the frequency of voice disorders.

Indications and counterindications for cochlear implantation in children.

OBJECTIVE: This study is aimed to analyze the current indications and counterindications of cochlear implantation (CI) in children. STUDY DESIGN: This study reviews the children implanted in our institution looking specifically at the following aspects: 1) auditory criteria for candidate selection; 2) age at implantation; 3) educational environment; and 4) associated handicapping conditions. SETTING: Tertiary referral center with experience in CI since 1989 with inpatient and outpatient care. INTERVENTION: All children received a Mini Nucleus 22 CI device (Cochlear Limited, Australia) in a standard surgical procedure. RESULTS: Regarding auditory criteria, children with average hearing level of 100-105 dB HL are more likely to obtain benefit from a CI than from a hearing aid. The minimum age for CI should be as soon as there is a reliable diagnosis of bilateral profound hearing loss, while the maximum age for CI depends on strict selection criteria of candidates. The educational environment is of a great importance in the rehabilitation process, permitting a progressive change to oral communication. Our experience in CI of children with multiple handicapping conditions is limited to a case of a deaf-blind child who was implanted with a good performance. In the selection of these children it is mandatory to have extensive multidisciplinary evaluation. CONCLUSIONS: An experienced team is needed in the selection of children for CI. Candidates should meet anatomic criteria, have a reliable diagnosis of bilateral profound hearing loss, an evaluation of communication skills, and extensive neuropediatric and socioeducational evaluation.

[Cochlear implants in post-lingual persons: results during the first five years of the clinical course]. / Implantes cocleares en personas postlinguales: resultados durante los primeros cinco años de evolución.

Abundant literature is available on the results of cochlear implants in postlingual persons. Nevertheless, there are few long-term studies with a follow-up of more than 1 year. We present the outcomes of 37 postlingual patients with a 5-year follow-up period. We examined the modifications that occurred with changes in coding strategy (MPEAK-SPEAK). After activation, the coding strategy was SPEAK in 10 patients. MPEAK in 20: 7 other SPEAK had changed from MPEAK. Significant improvement (p < 0.01) was observed in all the tests in the first 6 months. Subsequent assessments revealed a constant improvement in all tests. The results were statistically significant (p < 0.05) for vowels, consonants and bisyllables. Performance with the SPEAK strategy was better than with MPEAK. These results were statistically significant for consonants (p < 0.05), monosyllables (p < 0.05) and bisyllables (p < 0.01). We concluded that the results of postlingual patients after cochlear implantation showed clear benefits of these devices in profound bilateral deafness, better results with the SPEAK coding strategy than with MPEAK and constant improvement in results, even after the first year of surgery.

Use of distortion-product otoacoustic emissions for auditory evaluation in Menière's disease.

Otoacoustic emissions are a relatively new tool for assessment of inner ear function. We studied 65 patients diagnosed as having Menière's disease. In order to obtain and characterize responses at different frequencies we used distortion-product otoacoustic emissions (DPOAE). In unilateral cases, the difference in response between ears on the diseased and healthy sides was evident at all frequencies. In the former the result was lower than expected for a group of normally hearing subjects, while in the latter it was better than expected according to pure tone averages. Reduction in amplitude and increment in threshold of the DPOAE in the diseased ear was a significant finding and could be correlated to the stage of the disease. In those subjects treated with Betahistine after 1 year's follow-up, DPOAE testing showed the recovery of response at low frequencies and a reduction of its threshold at all frequencies studied.

[Distortion product otoacoustic emissions in Ménière's disease]. / Otoemisiones acústicas de productos de distorsión en la enfermedad de Ménière.

We present the results of the distortion product otoacustic emission testing performed in 24 patients diagnosed of Ménière's disease. Significant differences in the evoked response of both normal and pathologic ears, and a correlation between lesion degree and auditive impairment, were found. On the other hand, response of the normal ears was lower than in a same age, normal-hearing subjects group.