Characterisation of laryngo-pharyngeal reflux disease in old and ageing patients. / Caracterización de la enfermedad por reflujo faringolaríngeo en pacientes de edad avanzada y ancianos.

OBJECTIVES: To characterize laryngo-pharyngeal reflux (LPR) in patients over 60 years of age. METHODS: Retrospective review of patients over 60 years of age with symptoms suspicious of LPR, seen from 2005 to 2014 at an ENT Department of an academic hospital. Eighty-five consecutive patients (54 females, 31 males) who had completed a dual-sensor 24-hour pH-metry were included (considered "gold-standard" in LPR diagnosis). Body mass index, and reflux information and interventions were revised. pH-metries were evaluated according to DeMeester & Johnson's criteria. Symptoms were assessed according to the Reflux Symptom Index (RSI) and classified as abnormal if score was ≥13. A naso-fibro-laryngoscopy enabled findings to be documented according to the Reflux Finding Score (RFS), and they were classified as abnormal if the score was ≥7. RESULTS: The patients' mean age was 67 years. A positive pH-metry was present in 70 patients (82.5%). Fifty patients (59%) had abnormal body mass index, and almost 90% of them had an abnormal pH-metry. Mean RSI score was 9.8, with abnormal results in 24 patients (28%). Only 20 patients (23%) with abnormal RSI had a positive pH-metry. Posterior commissure hypertrophy was the most common finding (90% of patients). Mean RFS score was 9.07, with abnormal results in 69 patients (81%). Sixty-one patients (70%) with abnormal RFS had a positive pH-metry. Only 18 patients (20%) had coincidental abnormal pH-metry, RSI, and RFS. CONCLUSIONS: In ageing patients, abnormal body mass index is strongly associated with abnormal pH-metry. RSI is a weak indicator of LPR, whereas RFS has a moderate value.

Cochlear implantation of patients with far-advanced otosclerosis.

OBJECTIVE: This current single-subject, repeated-measures study was to describe our experience with 30 patients who had been diagnosed with "far-advanced otosclerosis" and who were included in our program of cochlear implants. We analyzed the history of the patients and their families before implantation, the surgical findings, and the performance over a follow up of 3 years. MATERIAL AND METHODS: All patients met one or more of the after criteria: 1) previous surgical intervention as a treatment of their otosclerosis; 2) signs of pericochlear hypodensities in high resolution computed tomography (HRCT) scans; and 3) family precedents of otosclerosis. All underwent standard surgical cochlear implantation. RESULTS: In 78% of the cases, a stapedectomy had previously been realized. Cochlear otosclerosis could be appreciated in HRCT in 78% of the patients. A family history of otosclerosis was found in 40%, and 33.3% of patients had familial precedents of nonfilial hypoacusis. The mean results in the two-syllable test were 20% preimplantation, 54% 6 months after implantation, and 52%, 62%, 54% at 1, 2, and 3 years after implantation. In the CID sentence test, they were in the order of 32% preimplantation and of 64% at 6 months, 66% after 1 year, of 68% after 2 years, and reaching 72% after 3 years. No complications related to the surgery were detected. CONCLUSION: Patients diagnosed with far-advanced otosclerosis have a good prognosis with cochlear implantation comparable to that of other patients in whom postlingual implants are performed.

Cochlear wall erosion after cochlear implantation.

OBJECTIVES: Cochlear implantation is a clinically satisfactory procedure, but it is associated with a variable degree of histologic intracochlear trauma. We report a new histologic finding in a cochlear implant specimen from the House Ear Institute collection. METHODS: An analysis of 34 temporal bones with single-channel (n = 23) or multichannel (n = 11) cochlear implants was performed. All temporal bones had been fixed for a month in 10% buffered formalin, progressively decalcified in ethylenediaminetetraacetic acid, and embedded in celloidin. After electrode removal, the bones were cut into 20-microm sections and stained. RESULTS: In 1 specimen, the implanted electrode had caused erosion of the bone through the endosteum into the marrow spaces, at the superior-anterior portion of the basal turn. This area showed an intense lymphocytic infiltration surrounded by some new bone formation. CONCLUSIONS: Trauma may provoke an inflammatory reaction due to the presence of the foreign body after violation of the endosteum.

[Alzheimer's disease and hearing loss]. / Enfermedad de Alzheimer y pérdida auditiva.

INTRODUCTION: Despite the different epidemiological, neurophysiological and morphological studies published in the literature, it is still not known for sure whether there is a relation between Alzheimer's disease (AD) and peripheral hearing loss. In this work we conduct an auditory study in patients with AD and in volunteer controls in order to investigate this possible relationship. SUBJECTS AND METHODS: The sample studied consisted of 14 patients with a clinical diagnosis of probable AD (age: 79 Y 6 years) and 14 volunteers (age: 76 Y 5 years) who visited the Clinica Universidad de Navarra. After applying a set of thorough criteria to preclude any previous hearing problems, all the participants underwent a subjective hearing assessment by means of pure-tone threshold audiometry and vocal audiometry and an objective auditory assessment using a tympanometry study, stapedial reflex, otoacoustic emissions and brainstem auditory evoked potentials. For the analysis, patients with AD and controls were paired homogenously by sex and age. RESULTS: The main obstacle hindering the study was to recruit the participants, due to the fact that they did not see any direct benefit from the study and it demanded an excessive amount of their time. Pure-tone threshold audiometry showed that patients with AD had a pattern of greater hearing loss for acute frequencies, with statistically significant differences. No significant differences were found in the analysis of the rest of the subjective and objective hearing tests. CONCLUSIONS: The findings of our study both agree and disagree with some earlier works from the literature, which suggests that patients with AD may have their own auditory pattern.