COVID-19-associated mucormycosis, diabetes and steroid therapy: Experience in a single centre in Western Mexico.

BACKGROUND: COVID-19-associated mucormycosis (CAM) has emerged as a challenging complication as the current pandemic has increased the population requiring treatment with corticosteroids. CAM has caused a massive outbreak in India, reported to be causing cases in Iran, Egypt and The Netherlands. OBJECTIVES: To describe CAM cases occurring in a single centre in Western Mexico. METHODS: Our group carried out a retrospective study from May 2020 to May 2021 to identify CAM cases in patients with previous COVID-19 diagnosis. RESULTS: Six CAM cases occurred in a single centre in Western Mexico during the study period, most of them with diabetes (n = 5/6) and all received corticosteroid therapy even when only three had severe COVID-19. After analysing local COVID-19 burden, it was estimated that in this region, CAM was 300 times more frequent among COVID individuals than the estimates for general population. CONCLUSION: Similar to large reports in India and other countries, CAM cases reported in this study were diagnosed in individuals with diabetes, hyperglycaemic status and with history of previous use of corticosteroids. Identifying these individuals at risk can help the early identification of CAM. In addition, strict glycaemic control and avoidance of unnecessary corticosteroid in non-severe COVID-19 cases could help in preventing this complicated fungal infection.

Morphological rational operator for contrast enhancement.

Contrast enhancement is an important task in image processing that is commonly used as a preprocessing step to improve the images for other tasks such as segmentation. However, some methods for contrast improvement that work well in low-contrast regions affect good contrast regions as well. This occurs due to the fact that some elements may vanish. A method focused on images with different luminance conditions is introduced in the present work. The proposed method is based on morphological transformations by reconstruction and rational operations, which, altogether, allow a more accurate contrast enhancement resulting in regions that are in harmony with their environment. Furthermore, due to the properties of these morphological transformations, the creation of new elements on the image is avoided. The processing is carried out on luminance values in the u'v'Y color space, which avoids the creation of new colors. As a result of the previous considerations, the proposed method keeps the natural color appearance of the image.

Visible-NIR Image Fusion Based on Top-Hat Transform.

The near-infrared band of the electromagnetic spectrum has become an important tool for enhancing image quality. Commonly, outdoor color images are degraded by bad weather conditions that lead to a loss of contrast and fine details in color images since light scattering produces attenuation and smoothing effects. Despite the fact that current Visible-NIR fusion methods achieve image enhancement features, some issues like edge preservation and color oversaturation still need to be addressed. In this work, a method that performs a selective Visible-NIR fusion of the most relevant image structures through top-hat transform is proposed. The performance of the method is evaluated by quantifying the new information added to the image and the change in color. Experimental results show a high degree of detail in preserving the edges while maintaining the color of the image. Moreover, the proposed method demonstrates that the image quality improvements were not significantly affected by a change in the color space.

Morphological background detection and enhancement of images with poor lighting.

In this paper, some morphological transformations are used to detect the background in images characterized by poor lighting. Lately, contrast image enhancement has been carried out by the application of two operators based on the Weber's law notion. The first operator employs information from block analysis, while the second transformation utilizes the opening by reconstruction, which is employed to define the multibackground notion. The objective of contrast operators consists in normalizing the grey level of the input image with the purpose of avoiding abrupt changes in intensity among the different regions. Finally, the performance of the proposed operators is illustrated through the processing of images with different backgrounds, the majority of them with poor lighting conditions.

Detection and measurement of the intracellular calcium variation in follicular cells.

This work presents a new method for measuring the variation of intracellular calcium in follicular cells. The proposal consists in two stages: (i) the detection of the cell's nuclei and (ii) the analysis of the fluorescence variations. The first stage is performed via watershed modified transformation, where the process of labeling is controlled. The detection process uses the contours of the cells as descriptors, where they are enhanced with a morphological filter that homogenizes the luminance variation of the image. In the second stage, the fluorescence variations are modeled as an exponential decreasing function, where the fluorescence variations are highly correlated with the changes of intracellular free Ca(2+). Additionally, it is introduced a new morphological called medium reconstruction process, which helps to enhance the data for the modeling process. This filter exploits the undermodeling and overmodeling properties of reconstruction operators, such that it preserves the structure of the original signal. Finally, an experimental process shows evidence of the capabilities of the proposal.

Bioformulado de Beauveria bassiana (ATCC MYA-4886) y Trichoderma lignorum (ATCC-8751) como biocontrolador de Atta cephalotes / Bioinsecticide study for controlling the carrier ant (Atta cephalotes), using filamentous fungi spores Beauveria bassiana (ATCC MYA-4886) and Trichoderma lignorum (ATCC-8751) / Bioformulação de Beauveria bassiana (ATCC MYA-4886) e Trichoderma lignorum (ATCC-8751) como biocontrolador de Atta cephalotes

Resumen I. La hormiga arriera está asociada a pérdidas en el sector agrícola, debido a su actividad defoliadora. El control de la especie se ha venido realizado artesanal, química y biológicamente, esta última con beneficios ambientales y de bajo riesgo para la salud humana. El objetivo de esta investigación fue desarrollar una formulación biológica para el control de la hormiga arriera (Atta cephalotes) utilizando una mezcla de esporas de dos hongos filamentosos (Beauveria bassiana y Trichoderma lignorum). M. Se desarrollaron 5 formulaciones empleando las relaciones: 1:1,6:4,4:6,3:7,2:8, de cepas de B. bassiana (ATCC MYA-4886) y T. lignorum (ATCC 8751), realizándoles prueba de viabilidad, patogenicidad y pureza. La colonización de las esporas en tejidos, se evaluó mediante la exposición de ratas Wistar a la formulación y sus componentes, realizando diagnóstico veterinario (disección) y cultivo microbiológico. R. Las formulaciones presentaron viabilidad a 24 h del 95+2 %, el 100% de las formulaciones no se contaminaron después de 10 días, las formulaciones 6.4, 1:1, 2:8 infectaron la totalidad de los individuos en 6 días, las formulaciones 4:6 y 3:7 a los 8 días, no se observó colonización de las cepas en la formulación, ni en tejidos de los biomodelos. C. Las formulaciones 6.4, 1:1, 2:8 de Beauveria bassiana y Trichoderma lignorum, poseen mayor actividad infecciosa sobre la hormiga arriera (Atta cephalotes).

Abstract I. The Leaf cutting Ant is associated with losses in the agricultural sector for the most part in the cultivation of citrus fruit sector due to its activity defoliator Control of the species has been handmade, chemical and biologically, the latter with environmental benefits and low risk to human health. This research had as objective develop a formulation biological for the control of the Leaf cutting Ant (Atta cephalotess using a mixture of spores of two fungi filamentous (Beauveria bassiana and Trichoderma lignorum), M. He was the isolation of Beauveria bassiana (ATCC MYA-4886) and Trichoderma lignorum (ATCC 8751), through cultivation YPDA and was conducted identifying fungal imprint and biochemical tests. Developing five formulations with ratios of 1:1, 6:4, 4:6, 3:7, 2:8 of Beauveria bassiana and Trichoderma lignorum respectively they underwent the test of viability in nutrient agar pathogenicity by immersion test and proof of purity; the tests were performed in triplicate. R. The formulations presented viability to 24 h 95% 2, I00% of the formulations were pure after 10 days, formulations 6.4, 2:8 infected all of the individuals in 6 days, formulations 4:6 and 3:7-8 days of exposure. C. Formulations 6.4, 2:8 of Beauveria bassiana and Trichoderma lignorium, present infectious activity on the Leaf cutting Ant (Atta cephalotess in laboratory.

Resumo I. O formigueiro está associado a perdas no setor agrícola, devido à sua atividade desfolhadora. O controle das espécies tem sido realizado artesanalmente, quimicamente e biologicamente, este último com benefícios ambientais e baixo risco para a saúde humana. O objetivo desta pesquisa foi desenvolver uma formulação biológica para o controle de formigas (Atta cephalotess usando uma mistura de esporos de dois fungos filamentosos (Beauveria bassiana e Trichoderma lignorum), M. 5 As formulações foram desenvolvidas usando a relação: 1 : 1,6: 4,4: 6,3: 7,2: 8 estirpes de B, bassiana (ATCC MAA-4886) e T. lignorum (ATCC 875I), realizándoles Teste de viabilidade, patogenicidade e pureza. A colonização dos esporos nos tecidos foi avaliada pela exposição de ratos Wistar à formulação e seus componentes, realizando diagnóstico veterinário (dissecção) e cultura microbiológica. R. As formulações mostraram viabilidade em 24 h de 95 + 2%, 100% das formulações não foram contaminadas após I0 dias, as formulações 6,4, 1: 1, 2: 8 infectaram todos os indivíduos em 6 dias, as formulações 4: 6 e 3: 7 aos 8 dias, nenhuma colonização das cepas foi observada na formulação, nem nos tecidos dos biomodelos. C. As formulações 6.4, 1: 1, 2: 8 de Beauveria bassiana e Trichoderma lignorum, apresentam maior atividade infecciosa sobre os antirretera (Atta cephalotess).

Cristales oportunos: cistinosis nefropática. Reporte de caso / Timely cristals: nephropathic cystinosis. Case report

Objetivo: Describir el caso clínico de un paciente con Cistinosis Nefropática diagnosticado a muy temprana edad. Método: Reporte de caso. Resultados: Se reporta el caso de una paciente de 7 meses de edad, quien consulta con poliuria, piolidipsia, glucosuria y bajo peso para la edad. De acuerdo a protocolos de evaluación interdisciplinaria establecidos con el servicio de Pediatría se logra evidenciar hallazgos oculares que orientan al diagnóstico final de la paciente. Conclusión: La Cistinosis es una enfermedad rara, cursa con manifestaciones oculares que podrían orientar un diagnóstico temprano e incluso predecir la severidad de la enfermedad y brindar la posibilidad de un tratamiento temprano. Es importante establecer protocolos interdisciplinarios, de apoyo diagnóstico, ante la sospecha de enfermedades sistémicas con posible compromiso ocular, en lugar de desistir ante la dificultad para valorar a los niños en la consulta de oftalmología, sobre todo en aquellos menores de un año. Se demuestra este caso con fines académicos teniendo en cuenta la baja incidencia de la enfermedad, pero también para destacar la importancia de contar con protocolos de atención interdisciplinaria ante la sospecha de enfermedades metabólicas en todas las edades.

Purpose: To describe a case of an infant with Nephropathic Cystinosis and the ocular fi ndings that leads to the diagnosis. Method: Case report. Results: Th is report describe a prompt and accurate diagnosis of a 7 months old patient, who consults with polyuria, piolidipsia, glucosuria and low weight. According to interdisciplinary evaluation protocols previusly established with Pediatrics services, it was possible to demonstrate ocular fi ndings of the disease, guiding the physician to the fi nal diagnosis. Conclusion: Cystinosis is a rare disease, its clinical presentation has ocular manifestations that could guide diagnosis and even predict its severity, off ering the possibility of an early treatment. When one suspect a systemic disease, It is important to establish interdisciplinary protocol, instead of surrendering to the challenge of an ophthalmological examination of an infant. We choose this case due to its low incidence, but also to highlight the importance of having interdisciplinary care protocols when a metabolic disease is suspected.

Transcultural adaptation to Spanish of the instrument "Effectiveness of Auditory Rehabilitation" for the assessment of quality of life in patients using hearing aids.

INTRODUCTION AND OBJECTIVES: It is becoming increasingly important to have reliable and valid questionnaires. This becomes especially important when evaluating hearing loss. THE AIM OF THIS WORK WAS TO VALIDATE: the "Effectiveness of Auditory Rehabilitation" (EAR) questionnaire for the Spanish-speaking population. This instrument assesses quality of life and hearing aspects in patients using hearing aids. MATERIAL AND METHOD: Cross-sectional validation study. A cultural adaptation through the use of English to Spanish translations and re-translations was carried out. The validity and reliability of the newly adapted instrument were evaluated. RESULTS: A total of 69 individuals (44 older adults and 25 younger adults) were examined. The pure-tone averages (PTA, 500, 1,000 and 2,000 Hz) were 47.3 dB HL and 47.1 dB HL for the left and right ears, respectively. The mean maximum speech discrimination in silence for monosyllables were 83.3% and 82.9% for the left and right ears, respectively. Internal consistency presented Cronbach alpha values of 0.85 and 0.77 for the internal and external dimensions, respectively. The intraclass correlation coefficients were 0.80 for the internal module and 0.85 for the external module. Construct validity reported a correlation coefficient of 0.71 at baseline and 0.76 at 3 months after the initial assessment for the internal module, and 0.62 at baseline and 0.74 at 3 months after the initial assessment for the external module. The size effects were 1.3 and 1.1 for the internal and external modules, respectively. DISCUSSION: The Spanish version of the EAR questionnaire seems to be a reliable and valid instrument. The evaluation of audiological aspects, as well as aspects relating to aesthetics and comfort are the main strengths of this instrument. Finally, the EAR scale is more sensitive to change than other scales.

Riesgos en salud laboral asociados al uso de un bioinsecticida con esporas de Beauveria bassiana y Trichoderma lignorum / Labor health risks associated with the use of a bioinsecticide with spores of Beauveria bassiana and Trichoderma lignorum / Riscos de saúde do trabalho associados ao uso de bioinsecticida com esporos de Beauveria bassiana e Trichoderma lignorum

RESUMEN El uso de bioinsecticidas para el control de plagas que atacan cultivos con efectos negativos al medio ambiente, es un tema que viene trabajándose a nivel mundial como una alternativa para evitar la contaminación los efectos sobre la salud de los trabajadores del sector agrícola. En este sentido y para controlar la hormiga arriera, se ha creado un bioinsecticida a base de esporas filamentosas de dos hongos entomopatógenos como el Beauveria bassianay el Trichoderma lignorum. En la presente revisión sistemática de literatura se pretende identificar los efectos en la salud que pueden presentar los componentes de la formulación del bioinsecticida, entre ellos, las esporas filamentosas componente principal, los posibles efectos al medio ambiente y los beneficios socioeconómicos por su uso, hallándose datos de enfermedades como abscesos, queratitis y alergias respiratorias de las personas inmunocomprometidas. En investigaciones realizadas se identificó que las esporas filamentosas pueden ingresar al cuerpo humano por vía aérea o mucosa dado su tamaño aproximado de 0,28 μm pueden llegar hasta los alveolos pulmonares. Ambientalmente los efectos ecológicos son positivos además por las ventajas económicas por eso de este tipo de productos agroecológicos.

ABSTRACT The use of bioinsectidas for the control of pests that attack crops with negative effects to the environment is an issue that has been working worldwide as an alternative to avoid contamination the effects on the health of workers in the agricultural sector: In this sense and to control the arriera ant, a bioinsecticide based on filamentous spores of two entomopathogenic fungi such as Beauveria bassiana and Trichoderma lignorum has been created. In the present systematic literature review, the aim is to identify the health effects that the components of the bioinsecticide formulation may have, including the principal component filamentous spores, the possible effects on the environment and the socioeconomic benefits due to its use, being data on diseases such as abscesses, keratitis and respiratory allergies of immunocompromised people. In investigations carried out it was identified that the filamentous spores can enter the human body by air or mucosa given their approximate size of 0.28 μm can reach the pulmonary alveoli. Environmentally the ecological effects are positive, as well as the economic advantages of this type of agroecological products.

RESUMO O uso de bioinsectidas para o controle de pragas que atacam as colheitas com efeitos negativos para o meio ambiente é uma questão que tem trabalhado em todo o mundo como alternativa para evitar a contaminação dos efeitos sobre a saúde dos trabalhadores no setor agrícola. Neste sentido e para controlar a formiga arriera, foi criado um bio-insecticida com base em esporos filamentosos de dois fungos entomopa-togênicos como Beauveria bassiana e Trichoderma lignorum. Na presente revisão sistemática da literatura, o objetivo é identificar os efeitos sobre a saúde que os componentes da formulação de bioinsecticidas podem ter, incluindo o principal componente de esporos filamentosos, os possíveis efeitos sobre o meio ambiente e os benefícios socioeconómicos devido ao seu uso, sendo dados sobre doenças como abcessos, queratites e alergias respiratórias de pessoas imunocomprometidas. Na pesquisa realizada, foi identificado que os esporos filamentosos podem entrar no corpo humano por via aérea ou mucosa, dado que seu tamanho aproximado de 0,28 μm pode atingir os alvéolos pulmonares. Ambientalmente, os efeitos ecológicos são positivos, bem como as vantagens económicas deste tipo de produtos agroecológicos.

Efectividad a 3 y 6 meses de una intervención integral para caries dental en escolares de Sitio del Niño, La Libertad; San Cayetano Istepeque, San Vicente; Ilopango y Ciudad Delgado, San Salvador / Effectiveness at 3 and 6 months of an integral intervention for dental caries in schoolchildren from Sitio del Niño, La Libertad; San Cayetano Istepeque, San Vicente; Ilopango and Ciudad Delgado, San Salvador

El objetivo es determinar la efectividad a 3 y 6 meses de una intervención integral para caries dental en escolares de Sitio del Niño, La Libertad; San Cayetano Istepeque, San Vicente; Ilopango y Ciudad Delgado, San Salvador. Es una intervención comunitaria cuasi experimental con grupo control pre-post realizado en los niños de los centros escolares dentro de la cobertura de las Unidades Comunitarias de Salud Familiar, durante el período comprendido entre abril y diciembre de 2017 y primer trimestre del 2018, con una muestra total de 120 pacientes. Se realizó una evaluación diagnóstica para determinar las necesidades de tratamientos, registrándose los hallazgos en una ficha clínica. Se ejecutaron los tratamientos y posteriormente se determinó la efectividad a tres y seis meses con la disminución de la placa dentobacteriana, las lesiones de caries activas y la sobrevivencia de los tratamientos. El procesamiento y análisis de los datos se realizó en la herramienta informática S-DENT y SPSS. Al inicio de la investigación, se determinó una prevalencia de caries de 3.72; dando una disminución de caries de 0.91 a 3 meses y 0.58 a 6 meses. Así mismo, se evaluó el índice de higiene oral simplificado mostrando que el 40 % de la población estaba clasificada en nivel óptimo y a los 6 meses el porcentaje subió a 83%, con diferencia significativa p< 0.05. La supervivencia de sellantes de fosas y fisuras fue de 82% y de obturaciones fue de 92%. La intervención integral fue efectiva al disminuir el índice de placa dentobacteriana y de caries; así como el alto porcentaje de supervivencia de SFF y obturaciones.

The aim of the study is to determine the effectiveness at 3 and 6 months intervals of an integral intervention for dental caries in school children from Sitio del Niño, La Libertad; San Cayetano Istepeque, San Vicente; Ilopango and Ciudad Delgado, San Salvador. It is a quasy- experimental community intervention treatment with a pre-post control group, carried out among children of school centers within the coverage of the Family Health Community Units, between Apil and December of 2017 and the first trimester of 2018, with a total sample of 120 patients. A diagnostic evaluation was made to determine the necessities of treatments, and the findings were recorded in a clinical record card. The treatments were implemented and later their effectiveness was determined at three and six month intervals with the diminishing of the dento-bacterial plaque, active carious lesions and the survival of the treatments. The processing and analysis of the data were made using the S-DENT and SPDD Programs. At the beginning of the research, a dental caries prevalence of 3.72 was determined; resulting in a caries reduction of 0.91 at 3 months and 0.58 at six months. In the same way, the index of simplified oral hygiene was evaluated, showing that the 40% of the population was classified within the optimal level and in 6 months the percentage increased to 83%, with a significant difference of P< 0.05. The survival of the sealants of pits and fissures was the 82% and of the obturations was the 92%. The integral intervention was effective at decreasing the level of the dentobacterial plaque and caries; as well as the high percentage of survival of the SFFi and obturations.

Evaluación del programa "Active Communication Education" para rehabilitación auditiva en adultos mayores con hipoacusia usuarios de audífonos / Assessment of the "Active Communication Education" program for audiological rehabilitation in patients with hearing loss users of hearing aids

Introducción: La hipoacusia es una condición prevalente en adultos mayores. Sin embargo, la baja adherencia al uso del audífono representa una realidad. Objetivo: Evaluar la utilidad de un programa de intervención para mejorar adherencia en pacientes con hipoacusia mayores de 65 años usuarios de audífono. Material y método: Ensayo clínico aprobado por Comité de Ética. Se incluyeron pacientes beneficiarios del GES de hipoacusia. Se evaluó adherencia al audífono en un corte a 6 meses. Resultados: Fueron evaluados 180 pacientes, correspondiendo a 90 pacientes control y 90 intervenidos. La adherencia global al uso del audífono fue de 78%. No hubo diferencia en los grupos por sexo, edad, ni grado de hipoacusia. El promedio de horas diarias de uso en el grupo control fue de 6,9 horas, comparado con el del grupo intervenido que fue 9,6 horas (p <0,0001). Hubo una asociación significativa entre la intervención y la regularidad del uso del audífono, con 80% de pacientes que lo usaban regularmente en el grupo intervenido contra el 8,9% en el grupo control (p <0,001). Discusión: La intervención implementada ha demostrado excelentes resultados preliminares en términos de tiempo de uso del audífono, por lo que sería de utilidad implementaria como parte de la política GES y difundir su uso.

Introduction: Hearing loss is a prevalent condition in elderly population. However, the low adherence to hearing aids is a fact. Aim: To evaluate the utility of a standardized counselling program in elderly patients with hearing loss. Material and methods: A clinical trial was carried out, approved by the Hospital ethics committee. Patients with 65years and older with hearing loss were included. We assessed adherence at a follow-up of 6 months. Results: 180 patients were evaluated, corresponding to 90 control and 90 rehabilitated patients. The overall adherence of hearing aids use was 78%. There was no difference in sex, age, and level of hearing loss between groups. The average daily hours of use in the control group was 6.9 hours, compared with the 9.6 hours in the intervention group (p <0.0001). There was a significant association between the intervention and regular hearing aid use, with 80% of patients who used it regularly in the intervention group compared with 8.9% in the control group (p <0.001). Discussion: The intervention implemented has shown excellent preliminary results in terms of time of use of the hearing aid. It would be useful to include this intervention in the hearing loss national public policy.

Adaptación transcultural al español del instrumento de evaluación de calidad de vida en pacientes usuarios de audífonos «Effectiveness of Auditory Rehabilitation» / Transcultural adaptation to Spanish of the instrument «Effectiveness of Auditory Rehabilitation» for the assessment of quality of life in patients using hearing aids

Introducción y objetivos: Cada vez adquiere mayor importancia el contar con cuestionarios válidos y confiables. Esto cobra mayor relevancia al evaluar la hipoacusia. El objetivo del trabajo es validar en población hispanohablante el cuestionario Effectiveness of Auditory Rehabilitation (EAR), que evalúa la calidad de vida y los aspectos auditivos en pacientes usuarios de audífonos. Material y método: Estudio de validación de instrumento. Se realizó adaptación transcultural por medio de traducción y retraducción, luego comparación con la versión original, y evaluación de confiabilidad y validez. Resultados: Se evaluaron 69 individuos, de los cuales 44 fueron adultos mayores y 25 fueron adultos jóvenes. El umbral de audición promedio (PTP) fue 47,3 dB en oído izquierdo y 47,1 en derecho. La discriminación de monosílabos promedio fue 83,3% en oído izquierdo y 82,9% en derecho. La consistencia interna presentó un alfa de Cronbach de 0,85 y 0,77 para las dimensiones interna y externa. El coeficiente de correlación intraclase fue de 0,80 para el módulo interno y 0,85 para el externo. La validez de constructo informó de una correlación de 0,71 basal y 0,76 a los 3 meses para el módulo interno, y de 0,62 inicial y 0,74 a los 3 meses en el módulo externo. La magnitud de efecto fue de 1,3 y 1,1 para el módulo interno y externo. Discusión: La versión al español del cuestionario EAR parece ser un instrumento confiable y válido. Sus fortalezas son que evalúa aspectos audiológicos, pero además aspectos estéticos y comodidad. Por último, es más sensible al cambio que otras escalas (AU)

Introduction and objectives: It is becoming increasingly important to have reliable and valid questionnaires. This becomes especially important when evaluating hearing loss. The aim of this work was to validate the «Effectiveness of Auditory Rehabilitation» (EAR) questionnaire for the Spanish-speaking population. This instrument assesses quality of life and hearing aspects in patients using hearing aids. Material and method: Cross-sectional validation study. A cultural adaptation through the use of English to Spanish translations and re-translations was carried out. The validity and reliability of the newly adapted instrument were evaluated. Results: A total of 69 individuals (44 older adults and 25 younger adults) were examined. The pure-tone averages (PTA, 500, 1,000 and 2,000 Hz) were 47.3 dB HL and 47.1 dB HL for the left and right ears, respectively. The mean maximum speech discrimination in silence for monosyllables were 83.3% and 82.9% for the left and right ears, respectively. Internal consistency presented Cronbach alpha values of 0.85 and 0.77 for the internal and external dimensions, respectively. The intraclass correlation coefficients were 0.80 for the internal module and 0.85 for the external module. Construct validity reported a correlation coefficient of 0.71 at baseline and 0.76 at 3 months after the initial assessment for the internal module, and 0.62 at baseline and 0.74 at 3 months after the initial assessment for the external module. The size effects were 1.3 and 1.1 for the internal and external modules, respectively. Discussion: The Spanish version of the EAR questionnaire seems to be a reliable and valid instrument. The evaluation of audiological aspects, as well as aspects relating to aesthetics and comfort are the main strengths of this instrument. Finally, the EAR scale is more sensitive to change than other scales (AU)