Presbycusis and balance disorders in the elderly. Bibliographical review of ethiopathogenic aspects, consequences on quality of life and positive effects of its treatment.

At this time, we still do not have adequate knowledge and awareness of the consequences of hearing loss in the elderly on quality of life. Similarly, there is also insufficient information on the relationship of presbycusis and balance disorders with other comorbidities. Such knowledge can contribute to improve both prevention and treatment of these pathologies, to reduce their impact on other areas such as cognition or autonomy, as well as to have more accurate information on the economic impact they generate in society and in the health system. Therefore, with this review article we aim to update the information on the type of hearing loss and balance disorders in people over 55 years of age, and their associated factors; to analyze the impact on the quality of life of these people and the one which can be generated at a personal and population level (both sociological and economic) if an early intervention in these patients is pursued.

Clinical utility of next-generation sequencing in the aetiological diagnosis of sensorineural hearing loss in a Childhood Hearing Loss Unit. / Utilidad clínica de la secuenciación de nueva generación en el diagnóstico etiológico de la hipoacusia neurosensorial en una Unidad de Hipoacusia Infantil.

INTRODUCTION: Sensorineural hearing loss (SNL) is the most prevalent sensory deficit in our environment. Next generation genomic sequencing (NGS) enables an aetiological diagnosis in a high percentage of patients. Our pilot study shows the results of the systematic application of NGS in a Childhood Hearing Loss Unit, as well as its implications for the clinical management of patients and their families. MATERIAL AND METHOD: We included 27 patients diagnosed with SNL between 2014 and 2017, in which an environmental cause was ruled out. The genetic test consisted of a panel of genes analyzed by NGS (OTOgenicsTM panel). This panel has been designed to include genes associated with sensorineural or mixed hearing loss, early onset or late, syndromic and non-syndromic, regardless of their inheritance pattern. RESULTS: A genetic diagnosis was obtained in 56% (15/27) of the patients (62% in the case of bilateral SNL). Of the patients, 5/27 (19%) presented pathogenic variants in the GJB2 gene and the rest pathogenic and / or probably pathogenic variants in other genes associated with isolated SNL (PR2X2, TECTA and STRC), with syndromic SNL (CHD7, GATA3, COL4A5, MITF and SOX10) or with syndromic and non-syndromic SNL (BSND, ACTG1 and CDH23). DISCUSSION: The aetiological diagnosis of SNL is a challenge in clinical practice. Our series demonstrates that it is possible to implement genetic diagnosis in the care routine and that this information has prognostic and therapeutic implications.

Cutaneous complications in osseointegrated implants: comparison between classic and tissue preservation techniques.

INTRODUCTION AND OBJECTIVES: The standard surgical technique for osseointegrated hearing aids involves removing a large area of subcutaneous tissue down to the periosteum. Recently, the industry has designed a new range of abutment lengths for less invasive surgery with soft tissue preservation. This study compared and evaluated the complications in the standard and the tissue preservation techniques. MATERIAL AND METHODS: This was a prospective study including 29 adult patients that underwent single-stage osseointegrated hearing aids insertion between February 2009 and February 2013. We performed the standard technique in 14 patients, and the tissue preservation technique in 15. Soft tissue complications were graded according to the Holgers classification. RESULTS: No patient required removal of implant or revision surgery. Although the Holgers grade was always worse in the standard technique (reaction score of 3 or higher was 28% versus 7% at a month), the complication rate was not statistically significant between the 2 groups at any postoperative time a week (p=0.233), a month (p=0.470) and a year (p=0.401). CONCLUSION: In our experience the tissue preservation technique, without soft tissue reduction, is the procedure of choice for bone anchored implant surgery. The preservation technique is easier, faster and possible with local anaesthesia and has similar postoperative outcomes.

[Complete facial palsy following surgery for acoustic nerve neurinoma: evolution and associated ophthalmological complications]. / Parálisis facial completa tras cirugía de neurinoma del acústico: evolución y complicaciones oftalmológicas asociadas.

OBJECTIVE: To evaluate the fraction of patients recovering to normal function after complete facial nerve paralysis secondary to acoustic neuroma surgery, and also to address the ophthalmologic complications associated with it and the therapeutic options. MATERIAL AND METHOD: We performed a retrospective review of 30 cases operated on in our department for acoustic neuroma and who, despite anatomical preservation of the facial nerve, developed a complete post-operative facial nerve paralysis (grade VI of House-Brackmann [HB]). We analyzed the evolution of the facial paralysis in relation to the tumour size, patient age, surgical approach and localization of the tumour. In addition, we studied the ophthalmologic complications and their treatment. RESULTS: Only 5 of the 30 cases studied (16.6 %) recovered to normal facial nerve function (HB grade I). We observed a tendency for a poor recovery of the cases with tumour size bigger than 2 cm, males, those older than 65 years and lesions resected by the translabyrinthine approach. Only 1 patient presented serious ophthalmologic complications. CONCLUSIONS: Our study reveals that only a small percentage of patients achieve total recovery of facial function. We have to be on the alert to ocular complications in this kind of patient.