Pediatric Barcelona Olfactory Test ̶ 6 (pBOT-6): Validation of a Combined Odor Identification and Threshold Screening Test in Healthy Spanish Children and Adolescents.

BACKGROUND AND OBJECTIVE: Few odor tests have been developed for children. Objectives: The aim of the present study was to develop and validate a simple and quick olfactory test to evaluate odor identification and threshold in a Spanish pediatric population. METHODS: The Pediatric Barcelona Olfactory Test-6 (pBOT-6) consisted of a set of 6 odorants for a forced choice identification test and a 6-dilution phenyl ethyl alcohol geometric series for the threshold test. The pBOT-6 was compared with the Universal Sniff test (a validated international pediatric smell test) in 131 healthy Spanish volunteers aged 6-17 years. A Bland-Altman plot was used to determine the agreement between the 2 tests. Reliability was analyzed in 15 volunteers using the intraclass correlation coefficient. Normative data were obtained, and 8 children diagnosed with subjective loss of smell were tested for validation. RESULTS: The Bland-Altman analysis demonstrated a minimal bias of -1.71% with upper and lower limits of agreement of -31.1% and 27.6%, respectively. The intraclass correlation coefficient was 0.83 (95%CI, 0.6-0.96) for the identification test and 0.73 (95%CI, 0.36-0.9) for the threshold test, with excellent and good consistency between measurements over time. Mean pBOT-6 scores were significantly higher in healthy volunteers than in patients with loss of smell. Discrimination between normosmia and loss of smell was achieved with a sensitivity of 96.9% and a specificity of 100%. CONCLUSIONS: pBOT-6 offers an effective and fast method that is useful in clinical routine to distinguish, with high sensitivity and specificity, between pediatric patients with normosmia and those with loss of smell.

Ovine ear model for fully endoscopic stapedectomy training.

Endoscopic surgery of the middle ear is progressively gaining the interest of otologists, as technological advances have overcome some of its main drawbacks. The long learning curve required to master this technique, urges the search for models to practice it. After the validation of sheep's ear as a proper training model for microscopic stapedectomy, our objective is to demonstrate its adequacy for practicing stapes surgery but performed through a fully endoscopic approach. Endoscopic stapedectomy was performed by two surgeons in 40 sheep ears (20 specimens each). To analyze the effects of the learning curve on surgical success, complication rates and surgical time reduction, the sample was divided in two groups: group 1 being the first ten procedures of each surgeon, and group 2 the second set of stapedectomies. The impact of the operated side and the resection of the chordal spine were also studied. No statistically significant differences were found considering the operated side. A statistically significant improvement in some of the surgical steps was demonstrated comparing both groups and also after the resection of the chordal spine. Mean surgical time declined from 38 to 31.5 min (p < 0.05). Using this model for endoscopic stapedectomy, a learning curve was objectively demonstrated, along with other subjective appreciations such as improvement in depth perception and one-hand instrument handling. We believe that sheep ear is an optimal model for endoscopic middle ear surgery, as it allows for the acquisition of the skills required to master this technique.

Cochlear obliteration following a translabyrinthine approach and its implications in cochlear implantation.

The most frequent sequelae following a translabyrinthine approach for vestibular schwannoma resection is complete hearing loss on the affected side. Such patients could benefit from a cochlear implant, provided that two essential requisites are met before surgery: a preserved cochlear nerve and a patent cochlea to accommodate the electrode array. The goal of our study is to determine the prevalence and extent of cochlear ossification following a translabyrinthine approach. Postoperative MRI of 41 patients were retrospectively reviewed. Patients were classified according to the degree of cochlear obliteration into three groups (patent cochlea, partially obliterated cochlea and totally obliterated cochlea). The interval between surgery and the first MRI was studied as well as its relationship with the rate of cochlear ossification. At first postoperative MRI (mean interval of 20 months), 78% of patients showed some degree of cochlear ossification. Differences were found in the time interval between surgery and first MRI for each group, showing a smaller interval of time the patent cochlea group (p > 0.05). When MRI was performed before the first year after surgery, a larger rate of patent cochlea was found (p > 0.05). The present study suggests that cochlear ossification is a time-depending process, whose grounds are still to be defined.

[Comparison of the results obtained through manual and automatic phonetogram]. / Comparación entre los resultados del fonetograma manual y el fonetograma automático.

INTRODUCTION: The phonetogram (F) is the graphic representation of a person phonatory potential. The F carried out with a sonometer and a frequency analyser is what is called "manual phonetogram" (MPh), and the one obtained by means of a computer is called the "automatic phonetogram" (APh). MATERIAL AND METHODS: We have carried out in 12 lyrical singers a standard MPh and an APh with the program Dr. Speech Science 3.0. RESULTS: It was showed a significant difference with a p < 0.0005 in 14 of the 15 measures compared, and a p < 0.05 for the other one, being in general the results of the automatic test different from those of the manual in excess, with a correlation between the results obtained through both methods. CONCLUSIONS: The APh obtained with the program Dr. Speech Science 3.0 is a faster and easier way to obtain the phonetogram than the one used to obtain the MPh, showing however big differences in excess compared with the ones of the MPh in all the usual phonetometric parameters.

[Stroboscopic assessment of chronic laryngitis]. / Valoración estroboscópica de laringitis crónicas.

INTRODUCTION: The laryngostroboscopy allows analysis of the vocal fold vibrations during phonation. Disruption of normal viscoelastic properties of the superficial lamina propria results in aberrant vocal fold vibration and mucosal wave propagation. Therefore, an investigation was performed to relate the stroboscopic results with the anatomopathologic results of chronic laryngitis and glottic cancer. MATERIAL AND METHODS: We performed a retrospective study, which included 30 direct laryngoscopies with biopsy of 25 patients and their corresponding laryngostroboscopies. RESULTS: 60% of the cases of "absence of mucosal wave" displayed severe dysplasia or carcinoma. 20% of the cases of "limited or present mucosal wave" were carcinoma. CONCLUSIONS: The probability of finding severe dysplasia or carcinoma is significantly greater when we find absence of mucosal wave. The presence of mucosal wave does not exclude the possibility of malignant lesion of the vocal fold.

The effect of chronic stress on prenatal development of the central nervous system.

The survival of developing embryos depends on the control and maintenance of homeostasis. Stress caused by chronic immobilization during pregnancy in rats may alter the normal development of the nervous system and increase susceptibility to psychiatric disorders. We investigated the effects of chronic stress on cell proliferation in the forebrains of embryos at 12 days of gestation, and in the hippocampus, dentate gyrus and cortex in embryos at 17 and 21 days of gestation. We examined serial sections of the embryonic brains of control and stressed rats at days 12, 17 and 21 of gestation. Brain sections were immunolabeled with anti-PCNA and stereological analysis was performed on 540 images. The results showed no statistical differences on days 12 and 17 of gestation in the proliferation area of the structures studied, whereas on day 21 of gestation, proliferation decreased in the cortex and dentate gyrus of embryos of the stressed group. These changes were related to decreased prolactin and increased corticosterone concentrations in the plasma.

Acoustic voice analysis in untreated patients with Parkinson's disease.

To quantify several acoustic features of the voice in patients with Parkinson's disease (PD) not treated with dopaminergic drugs, 22 PD patients and 28 age and sex-matched controls were studied. The Computerized Speech Lab 4300 program (Kay Elemetrics) was used. Two seconds of a sustained /a/ and a sentence were captured with a microphone and laryngograph equipment. Measures included fundamental frequency (F(0)), frequency perturbation (jitter), intensity perturbation (shimmer), and harmonic/noise ratio (HIN) of the vowel /a/, and frequency and intensity variability of a sentence, phonational range, dynamic range at the natural frequency, maximum phonational time and s z ratio. All subjects underwent indirect laryngoscopy and/or laryngeal fibroscopy. When compared to controls, PD patients showed higher jitter and shimmer, lower H N ratio, and lower frequency variability of the sentence in the microphonic signal and reported a higher frequency of presence of low voice intensity, monopitch, harshness, voice arrests, and tremor.

Acoustic voice analysis in patients with Parkinson's disease treated with dopaminergic drugs.

To quantify several acoustic features of the voice in patients with Parkinson's disease (PD), 41 patients and 28 age and sex-matched controls were studied. PD severity was assessed with the Unified PD Rating Scale (UPDRS) and the Hoehn and Yahr staging. The Computerized Speech Lab 4300 program (Kay Elemetrics) was used. Two seconds of a sustained /a/ and a sentence were captured with a microphone and laryngograph equipment. Measures included fundamental frequency (F0), frequency perturbation (jitter), intensity perturbation (shimmer), and harmonic/noise ratio (H/N) of the vowel /a/, and frequency and intensity variability of a sentence, phonational range, dynamic range at the natural frequency, maximum phonational time and s/z ratio. All subjects underwent indirect laryngoscopy and/or laryngeal fibroscopy. When compared with controls, PD patients showed higher jitter, lower H/N ratio, lower frequency and intensity variability of the sentence, and lower phonational range and reported a higher frequency of the presence of low voice-intensity, monopitch, voice arrests, and struggle. These features seem to be unaffected by the duration and severity of the disease.

Acoustic voice analysis in patients with essential tremor.

To quantify several acoustic features of the voice in patients with essential tremor (ET), 28 patients and 28 age- and sex-matched controls were studied. ET severity was assessed with the rating scale for tremor of Fahn, Tolosa, and Marín. The Computerized Speech Lab 4300 program (Kay Elemetrics) was used. Two-second samples of a sustained /a/ and a sentence were captured with a microphone and laryngograph equipment. Measures included fundamental frequency (F0), frequency perturbation (jitter, Koike algorithm), intensity perturbation (shimmer, Horii algorithm), and harmonic-to-noise ratio (H/N, Yumoto algorithm) of the vowel /a/, and the frequency and intensity variability of the sentence, phonational range, and dynamic range at the natural frequency, maximum phonational time, and s/z ratio. All subjects underwent indirect laryngoscopy and/or laryngeal fibroscopy. When compared with controls, ET patients showed higher jitter, lower H/N ratio (the last one only with laryngographic signal), of the vowel /a/, lower frequency variability in the microphonic signal, lower intensity variability in the laryngographic signal of the sentence, and significantly lower dynamic range at natural frequency of phonation. ET patients reported higher frequency of the presence of high voice intensity, tremor, and struggle. Several acoustic parameters were influenced by the severity of the disease, including shimmer, jitter, H/N ratio, frequency variability of the sentence, and s/z ratio, although neither of the acoustic analysis values or the phonetometric measurements were affected by the presence of voice tremor or by a successful pharmacological treatment of ET.

[Voice disorders caused by neurological diseases]. / Alteraciones de la voz causadas por enfermedades neurológicas.

OBJECTIVE: To review voice disorders in neurological diseases, with special emphasis to acoustic analysis. DEVELOPMENT: In the first part of this article we describe data regarding neural control of voice, physiology of phonation, and examination of the patient with voice disturbances, including the use of voice laboratory, acoustic analysis fundamentals, phonetometric measures and aerodynamic measures. In the second part, we review the voice disturbances associated to neurological diseases, emphasizing into movement disorders (specially Parkinson s disease, essential tremor, and spasmodic dysphonia). CONCLUSIONS: A number of neurological diseases causing alterations of corticospinal pathway, cerebellum, basal ganglia and upper and/or lower motoneurons can induce voice disturbances. Voice examination using ear, nose & throat examination, endoscopy and videorecording of laryngeal movements, acoustic analysis, elecroglottography, laryngeal electromyography, and aerodynamic measures, could be useful in the clinical examination of some neurological diseases.

[Hearing screening in children with risk factors of hearing loss in the area 3 of Madrid]. / Screening auditivo en niños con factores de riesgo de hipoacusia en el área 3 de Madrid.

The early identification of the hearing loss is very important to begin a early rehabilitation and to get a normal development of the language. Because of reason, the newborn hearing screening started, mainly in cases with risk factors. The objective of this report is to study the incidence of hearing loss in children with risk factors in the area 3 of Madrid. We realized hearing screening in 138 children in a period of 3.5 years, by otoacoustic emissions in younger 1 year and auditory brain stem evoked response in older 1 year. The results show that the incidence of sensorineural hearing loss is 4.34% of cases in children with risk factors, and more specifically 2.8% of bilateral profound hearing loss, and too, we detected 6.5% of transmisive hearing loss. The age of identification of hearing loss decreased to 6 months with the hearing screening programs. These results support the need of realization of hearing screening programs with obligatory character, though we advocate for the universal screening to include all cases of hearing loss without risk factors.

[Electroglottography in the research and physiology of larynx]. / La electroglotografía en la investigación y la clínica laríngea.

Electroglottography (EGG) is a noninvasive method of monitoring the movement of the vocal folds by measuring the variation of impedance to a weak alternating current through the tissues of the neck. Basically EGG is an index of the vocal fold contact area. Despite recent controversy EGG continues being an easy to handle method in larynx basic research, with increasing use in clinical diagnosis and rehabilitation of vocal pathology. EGG technique is described and some of its applications in clinical practice and voice research are pointed out.

[Sudden deafness: efficacy of a therapeutic protocol]. / Sordera brusca: eficacia de un protocolo terapéutico.

Sudden hearing loss is an entity of unknown cause. Different theories of its etiology and treatment have been proposed. The objective of our report is to evaluate the efficacy of the therapeutic protocol used in our department in patients with sudden hearing loss. We made a retrospective study of 24 patients who had experienced sudden hearing loss from January 1994 to March 1998. We studied the parameters of age, sex, days of hospitalization, vestibular symptoms, otoscopy, personal history, radiology study, and successive audiograms. The treatment protocol consists of low-dose steroids, pentoxyphylline, and carbogen, and a concentration of 5% CO2 and 95% O2. Treatment was effective, with a recovery rate of 83%. The factors of tinnitus or vertigo, the state of hearing in the opposite ear, and age did not influence the recovery of hearing. However, the form of the audiogram and initial hearing were important prognostic factors.

[Pathophysiological basis of aminoglycoside-induced ototoxicity]. / Bases fisiopatológicas de la ototoxicidad inducida por aminoglucósidos.

Recently proposed etiopathological mechanisms of aminoglycoside-induced toxicity were reviewed, including calcium, phosphatidylinositol, Na-K dependent ATPase, and neuronal sites of antibiotic action. Difficulties in evaluating the true clinical incidence of this aminoglycoside-induced ototoxicity and risk factors were analyzed. The relation between new dosing regimens (single daily dose) and ototoxicity are discussed.

[Harmonic/noise ratio and spectrographic analysis in vocal abuse pathology]. / La relación armónico/ruido y el análisis espectrográfico en la patología de abuso vocal.

Vocal abuse lesions disturb voice production by increasing the presence of noise in the voice. The harmonic-to-noise ratio (H/N) and spectrography are two different ways to evaluate noise components in the voice. A study was made of 52 patients (32 polyps, 11 Reinke's edema and 9 nodules) who underwent microlaryngeal phonosurgery. The grade of glottic closure was determined by stroboscopy; H/N and the long-term average spectrum (LTAS) at low-frequency (0-2000 Hz) were measured with a CSL-4300 instrument. Stroboscopy and acoustic analysis were made before surgery and two week and one month after surgery. Before surgery, the LTAS revealed weak harmonics, as shown by H/N values. After surgery, H/N values and harmonic energy increased. Preoperative and postoperative differences were significant (p < 0.05). Improved glottic closure after surgery improved the acoustic parameters.

[Usefulness of laryngeal stroboscopy]. / Utilidad de la estroboscopia laríngea.

The extended use of optic fibers and TV cameras and videos make easier the stroboscopic exploration of the vocal folds. The ENT surgeons must stress the use of this unique method which allows us the study of the laryngeal voice function. This exploration is based on a fictional slow motion movement of the vocal fold that lets us see the mucosal wave. The most useful clinical implications of the laryngeal stroboscopic study are: phonatory function, differential diagnosis between benign and malignant lesions and laryngeal paresis.

[Correlation of clinical, radiologic, and histopathologic findings in laryngeal, hypopharyngeal, and oropharyngeal cancer]. / Correlación entre los hallazgos clínicos, radiológicos e histopatológicos en el cáncer de laringe, hipofaringe y orofaringe.

The correct staging of the tumors has important consequences in the planning of the treatment in the patients with cancer of larynx, hypopharynx and oropharynx. The objective of this paper is to study the correlation of the clinical, radiologic and pathologic staging with the purpose to evaluate if the computed tomography (CT) is effective in the diagnostic of the stage in the different tumoral findings. We did a retrospective study in 34 patients with pharynx and larynx cancer in the "Hospital Universitario Príncipe de Asturias" between the years 1994-1998. The method was: 1. Clinical history and ENT examination. 2. Head and neck CT. 3. Direct laryngoscopy and biopsy. 4. Surgical treatment and posterior pathologic staging of the removed specimen. The lesions were studied according the TNM-UICC classification with the T and N stage. The first thing to do was the clinical stage then the radiologic stage and at last compare it with the pathologic stage after surgical removal. The results are presented in percentages and confirm that the clinical and radiologic combined information improve the correlation between clinical and pathologic staging in the cancer of larynx, hypopharynx and oropharynx.

[Phonetograms in laryngeal lesions due to vocal abuse]. / Fonetograma en lesiones laríngeas por abuso vocal.

Using this test, we measure maximum and minimum vocal capacity (sound pressure in dB) from the lowest to the highest frequency that a person can emit and sustain. These measurements are represented on an easily interpreted graph that allows the magnitude of the vocal area to be evaluated. We made phonetograms of persons with nodules (3), polyps (16) and Reinke edema (10) and compared their results to those of a group of 25 healthy subjects. The vocal fields of patients with laryngeal polyp and Reinke's edema were severely reduced.

[S/z ratio in glottic closure defects]. / El índice s/z en los defectos de cierre glótico.

The quotient between the maximum phonation time (MPT) of the sound /s/ and a vowel sound, measures the relation of resistances to the expiratory air flow. When the sound /s/ is emitted, resistance is located at the teeth, and when a vowel is phonated, the site of resistance is the glottis. Estimating the quotient instead of measuring only the MPT, we avoid the influence of respiratory alterations in the results. We evaluated the utility of the s/z ratio as a clinical indicator of laryngeal pathology in 72 patients with organic vocal cord pathology. We compared the results of the s/z ratio to the degree of glottic closure defect, measured by videolaryngostroboscopy. S/z ratio in 22 normal-speaking subjects was also measured. S/z ratio in normal-speaking subjects was nearly 1.0. When a glottic closure defect was present, the ratio was over 1.4. Organic lesions that difficult glottic closure, produce a decrease of air flow resistance and, therefore, a shortening of the MPT of the vowel sounds.

[Surgery of the laryngeal framework: type I thyroplasty]. / Cirugía del esqueleto laríngeo: tiroplastias tipo I.

Eight type I thyroplasties were performed. All the patients had a breathy voice related with unilateral vocal cord paralysis. Several causes were involved. All 8 patients achieved good glottic closure and the free edges of the vocal cords mi closed uniformly. Acoustic parameters were studied using Dr. Speech version 2.0 for Windows. The SPSS program was used for statistical analysis. The study showed significant improvement in maximum phonation time, shimmer, and normalized noise energy. Modifications in the surgical technique are discussed.