Evaluation of vinpocetine as a therapy in patients with sensorineural hearing loss: A phase II, open-label, single-center study.

The progressive degeneration of the excitable cells of the ear depends on the sustained excitation of the voltage-sensitive sodium channels, so the negative pharmacological modulation could be a rational therapeutic strategy against the damage of these cells. The objective was to demonstrate the effectiveness of Vinpocetine (VPC), a potent sodium channel blocker, as a treatment for acquired sensorineural hearing loss. A phase II, longitudinal and prospective open clinical study, was conducted over a period of 12 months with patients older than 18 years, to demonstrate the effectiveness of Vinpocetine (VPC) as a treatment for acquired sensorineural hearing loss, using evoked potentials, otoacoustic emissions, audiometry and logoaudiometry, analyzing the results at 6 and 12 months of treatment with Vinpocetine (30 mg/day in 3 doses). It was observed that from 0 to 6 months there was hearing impairment (which was already expected due to the age of the patients). From 6 to 12 months and from 0 to 12 months there were significant differences with a tendency towards improvement, indicating that the aforementioned deterioration not only stopped, but that with the use of vinpocetine, the hearing capacity improved. It is concluded that Vinpocetine helps to stop hearing impairment and even improve hearing.

Equations to establish a regression between current units with respect to patient`s age and the use time of cochlear implants.

OBJECTIVE: Propose a system of multivariate multiple regression equations in order to establish a mathematical association that allows estimating the current units needed during the adjustment phase with respect to age and time that were used the implants. METHOD: Descriptive cross-sectional study. A total of 41 pediatric patients with a unilateral cochlear implant participated. Three groups were formed and multivariable multiple regression equations were constructed. RESULTS: For Group 1, in electrode Groups 3 and 4, there is a lower standard deviation and a similar index of asymmetry of the current units; in Group 2, the groups of electrodes with similar index of asymmetry were 2 and 4, while group of electrodes 3 presented average of 21.54 and dispersion smaller (16.25); in Group 3, groups of electrodes 3 and 4 presented similar standard deviation and average and smaller standard deviation. With respect to the standard estimation error, the lowest variability of current units was obtained in Group 2 for electrode Group 3. CONCLUSION: The proposed equations could be used in the clinical area by knowing the units current needed with respect to age and time of use the implant.

OBJETIVO: Proponer un sistema de ecuaciones de regresión múltiple multivariable para establecer una asociación matemática que permita estimar las unidades de corriente necesarias durante la fase de ajuste con respecto a la edad y el tiempo de uso del implante coclear. MÉTODO: Estudio transversal descriptivo. Participaron 41 pacientes pediátricos con implante coclear unilateral. Se conformaron tres grupos y se construyeron ecuaciones de regresión múltiple multivariable. RESULTADOS: Para el grupo 1 se observa en los grupos de electrodos 3 y 4 menor desviación estándar y similar índice de asimetría de las unidades de corriente; en el grupo 2, los grupos de electrodos con similar índice de asimetría fueron el 2 y el 4, y el grupo de electrodos 3 presentó un promedio de 21.54 y una dispersión más pequeña (16,25); en el grupo 3, los grupos de electrodos 3 y 4 presentaron similar desviación estándar y promedio y desviación estándar más pequeños. Con respecto al error estándar de estimación, se obtuvo una menor variabilidad de unidades de corriente en el grupo 2 para el grupo de electrodos 3. CONCLUSIÓN: Las ecuaciones propuestas son de utilidad clínica al conocer las unidades de corriente necesarias considerando la edad y el tiempo de uso del implante coclear.

Validación y confiabilidad del Cuestionario de Tamizaje Auditivo Escolar en adolescentes usuarios de reproductores de música comprimida.

INTRODUCCIÓN: El uso frecuente de reproductores de archivos de música y la intensidad del volumen son factores de riesgo para el desarrollo de hipoacusia. OBJETIVO: Validar el Cuestionario de Tamizaje Auditivo Escolar (CUTAE) para identificar alteraciones auditivas en adolescentes usuarios de reproductores de archivos música comprimida (RPAMC). MÉTODO: Se estudiaron adolescentes usuarios de RPAMC, sin hipoacusia ni patología de oído medio. Se aplicó el CUTAE y se realizó audiometría. Se determinó reproducibilidad (coeficiente correlación intraclase-CCI), consistencia interna (alfa de Cronbach), validez de apariencia (técnica Delphi), validez concurrente CUTAE-audiometría (correlación de Pearson) y validez predictiva (regresión múltiple) del cuestionario. RESULTADOS: Se evaluaron 59 adolescentes (118 oídos), 66 % del sexo femenino, con edad promedio fue de 13 años; 90 oídos con parámetros normales, 18 con umbral menor de 20 dB con morfología de trauma acústico (TA) en la frecuencia de 6 KHz y 10 con TA. El cuestionario tuvo CCI de 0.788, alfa de Cronbach de 0.807, correlación de Pearson de 0.290 a 0.368 (p < 0.05); las variables predictivas fueron horas de uso del dispositivo, dificultad para escuchar a las personas (p < 0.05) y tipo de zumbido (p = 0.07). CONCLUSIÓN: El CUTAE tiene propiedades clinimétricas para considerarlo una prueba de tamizaje en la detección de alteraciones auditivas en adolescentes usuarios de RPAMC. INTRODUCTION: Frequent use of audio file players and volume intensity are risk factors for the development of hypoacusis. OBJECTIVE: To validate the school-age hearing screening questionnaire (CUTAE, by its Spanish acronym) for hearing disorders detection in teenage users of compressed audio file players (CAFP). METHODS: Adolescent CAFP users without hypoacusis or middle ear pathology were studied. The CUTAE was applied and audiometry was carried out. Reproducibility (intraclass correlation coefficient-ICC), internal consistency (Cronbach's alpha), face validity (Delphi technique), CUTAE-audiometry concurrent validity (Pearson's correlation) and predictive validity (multiple regression) of the questionnaire was assessed. RESULTS: Fifty nine adolescents (118 ears), 66% females, average age of 13 years, were assessed. Ninety ears had normal parameters, 18 showed a threshold decrease < 20 dB, with morphology associated with acoustic trauma (AT) at 6 kHz and 10 with AT. The questionnaire had an ICC of 0.788, a Cronbach alpha-value of 0.807, Pearson's correlation values of 0.290 to 0.368 (p < 0.05); the predictive variables were usage hours, difficulty hearing others (p < 0.05) and type of buzzing (p = 0.07). CONCLUSION: The CUTAE has adequate clinimetric properties to be considered as a screening test in the detection of hearing disorders in adolescent users of CAFP.

[Conditional probability analysis between tinnitus and comorbidities in patients attending the National Rehabilitation Institute-LGII in the period 2012-2013]. / Análisis de probabilidad condicional entre el acúfeno y comorbilidades asociadas en pacientes que acudieron al Instituto Nacional de Rehabilitación-LGII en el periodo 2012-2013.

BACKGROUND: Tinnitus is defined as the conscious perception of a sensation of sound that occurs in the absence of an external stimulus. This audiological symptom affects 7% to 19% of the adult population. The aim of this study is to describe the associated comorbidities present in patients with tinnitus usingjoint and conditional probability analysis. PATIENTS: Patients of both genders, diagnosed with unilateral or bilateral tinnitus, aged between 20 and 45 years, and had a full computerised medical record, were selected. METHODS: Study groups were formed on the basis of the following clinical aspects: 1) audiological findings; 2) vestibular findings; 3) comorbidities such as, temporomandibular dysfunction, tubal dysfunction, otosclerosis and, 4) triggering factors of tinnitus noise exposure, respiratory tract infection, use of ototoxic and/or drugs. RESULTS: Of the patients with tinnitus, 27 (65%) reported hearing loss, 11 (26.19%) temporomandibular dysfunction, and 11 (26.19%) with vestibular disorders. When performing the joint probability analysis, it was found that the probability that a patient with tinnitus having hearing loss was 2742 0.65, and 2042 0.47 for bilateral type. The result for P (A ∩ B)=30%. Bayes' theorem P (AiB) = P(Ai∩B)P(B) was used, and various probabilities were calculated. Therefore, in patients with temporomandibulardysfunction and vestibular disorders, a posterior probability of P (Aі/B)=31.44% was calculated. CONCLUSIONS: Consideration should be given to the joint and conditional probability approach as tools for the study of different pathologies.

[Otoacoustic emissions as cochlear function analyser in children with language disorders]. / Emisiones otoacústicas como analizador de la función coclear en niños con problemas de lenguaje.

INTRODUCTION AND OBJECTIVES: Speech perception that takes place in the cochlea is involved in the process of language. The objective was to describe the findings in transient otoacoustic emissions in children with language problems before and after 6 months of speech therapy. METHODS: There were 17 children with language problems between 3 and 6 years of age diagnosed with anarthric language delay (expressive and mixed language disorder). They underwent medical history, otoscopy, intelligence level testing, initial language test, tympanometry of 226Hz, audiometry and transient otoacoustic emission test. RESULTS: We evaluated the 17 patients again after 6 months of attending speech therapy. The percentage of overall reproducibility of transient otoacoustic emissions in both ears was adequate to perform frequency analysis. We found a statistically significant difference (P≤0.01) in the frequency of 1kHz reproducibility when comparing results before and after therapy in the right ear. There was a significant difference (P≤0.05) when comparing the results of audiometry at frequencies of 0.5, 1.5, 2, 4 and 8kHz in the right ear and a highly significant difference (P=0.001) in the frequency of 3kHz in the left ear. CONCLUSIONS: The analysis of sound through the cochlea is involved in the process of language acquisition. A poor processing of speech sounds in the peripheral system could result in poor processing at the central level. Consequently, it is important to consider our results when making a diagnosis and carrying out rehabilitation treatment in children with language disorders.

Diagnostic utility of the acoustic reflex in predicting hearing in paediatric populations.

INTRODUCTION AND OBJECTIVES: The sensitivity of prediction of acoustic reflex, in determining the level of hearing loss, is especially useful in paediatric populations. It is based on the difference between the pure tone stapedius reflex threshold and contralateral white noise. The white noise threshold was 60 dB and that of pure tone was 80 dB. Our objective was to determine the diagnostic sensitivity of the prediction of the acoustic reflex. METHODS: We studied children aged <10 years, from October 2011 to May 2012, by measuring the acoustic reflex with white noise and pure tone. We used contrast tests, with X2 and student t-test. Concordance was measured with Kappa. Results were considered significant at P≤.05. Our protocol was approved by Institutional Ethics Committee. Informed consent was obtained from the parents in all cases. RESULTS: Prediction of normal hearing was 0.84 for the right ear and 0.78 in left ear, while for hearing loss of an unspecified grade, it was 0.98 for the right ear and 0.96 in the left ear. Kappa value was 0.7 to 0.6 for the right ear and left ear. CONCLUSIONS: The acoustic reflex is of little diagnostic utility in predicting the degree of hearing loss, but it predicts more than 80% of normal hearing. The clinical utility of the reflex is indisputable, as it is an objective method, simple and rapid to use, that can be performed from birth and whose results are independent of the cooperation and willingness of the subject. It is proposed as an obligatory part of hearing screening.

[Hearing gain with binaural-bimodal adaptation in patients with a cochlear implants].

Binaural hearing allows the optimal performance of the auditory system with a better perception of the sounds that make up language and better discrimination in noisy environments. The use of binaural-bimodal stimulation includes a combination of 2 different pacing modes: a cochlear implant in one ear , and acoustic stimulation through a conventional hearing aid in the other. The aim of this study is to determine the hearing gain in patients with cochlear implant alone and hearing aid. Twenty prelingually hearing impaired patients, 11 female and 9 male subjects were recruited with mean age at implantation and 3.91 ± 1.56 years and 6.07 ± 2.18 years at the time of audiological assessment at six months post-implantation. Implanted patients were assessed per month after the surgery for the first telemetry subsequently were reassessed every month to make changes to schedules stimulation map according to the auditory responses and progress shown in speech therapy. When calculating the mean and standard deviation of the auditory response in implanted subjects, you can appreciate that in the group of patients with cochlear implant plus hearing aid using the values obtained were lower at all frequencies, indicating a higher gain using auditory hearing aid over a cochlear implant, in comparison to patients who only used the cochlear implant. Comparing auditory responses in patients implanted with and without hearing aid, statistically significant differences were observed at all frequencies except at 2 kHz, showing that there is a better discrimination in noisy environments. The patients use more AA gain greater hearing gain compared with patients who only used the IC.

[Modification of thresholds T in cochlear implant patients as an alternative programming time in relation to the time].

INTRODUCTION: Programming the cochlear implant (CI) has always been a challenge for all medical specialists in audiology, especially in pediatric patients without language secondary profound hearing loss. For this reason are searched alternatives to achieve normal hearing with the implant during programming in the shortest time possible. OBJECTIVE: To analyze whether through modification threshold T we get faster audiological threshold, describe the differences in time found in patients with sensorineural hearing loss IC users with thresholds T at 10% modified, and T thresholds modified according to clinical responses after obtaining audiological threshold within normal parameters and report the speech coding strategies commonly used at the start of the program and to reach above the hearing threshold to language area. MATERIAL AND METHODS: We performed an observational, cross-sectional, descriptive, comparative study in which we evaluated a total of 31 patients with sensorineural hearing loss, under six years, and both sexes, of cochlear implant users of Advanced Bionics, which were divided in two groups: Group I: 15 patients with modification of thresholds T to 10%, following the manufacturer's recommendations (unmodified) and Group II: 16 patients with T threshold modification according to clinical response cochlear (modified). Were reported strategies most used speech coding in both groups at the start of the program and to reach the threshold audiological within normal parameters. RESULTS: In patients in group I (not modified) were 256 days on average to reach threshold audiological and group II (modified) was 335.6 days. Without statistic significant p = 0.197, with an average of 295.8 days for both groups and the speech coding strategy more used was the Hi-Res P with Fidelity 120, modifying both groups only one patient from power up obtaining threshold. CONCKUSIONS: It was established that thresholds T patient's subjective threshold as compared to T of 10% automatically obtained by SoundWave is not necessary since there are no statistically significant differences in relation to time to take patients implanted normal hearing threshold. The speech coding strategies more widely used and accepted by the patient was the Hi-Res P with Fidelity 120.

Audiometric evaluation short and medium term in cochlear implants.

OBJECTIVE: Our purpose is report the results of cochlear implant program in this Institute, since our first surgery from November 2007, until December 2012. MATERIAL AND METHODS: A cross-sectional study, observational, descriptive, analyzing the information about thresholds before and after implantation, using patients files (diagnosis, onset of hearing loss, brainstem auditory evoked potential (BAEP), computed tomography (CT), magnetic resonance imaging (MRI), implanted ear, brand and model of cochlear implants (CI) and audiometric studies before and after the CI. RESULTS: We report the evolution of 68 patients, age ranged 1 year 8 months to 39 years 3 months old. 94% patients (n = 64) had pre-lingual hearing loss being hereditary non-syndromic hearing loss the most common etiology (29.4%). 100% patients had auditory brainstem responses showing bilateral profound hearing loss, in the 77.9% type A tympanograms were obtained (Jerger's classification), and 100% had absence of stapedial reflexes and otoacoustic emissions with low reproducibility. CT reported as normal in 85.2% of patients, the findings: 5.8% had chronic mastoiditis changes, other findings reported in 1.4% of patients were: digastric right facial nerve, facial nerve canal dehiscence, enlarged vestibular aqueduct, occupation and poor pneumatization of mastoid air cells, lateral semicircular canals agenesis, incomplete partition of the cochlea with wide vestibular and vestibular aqueduct dilatation. Most frequent MR findings of skull with cerebellopontine angle approach were vascular loops of internal auditory canals unilaterally. In 10.2%, 55.8% of patients (n = 38) were implanted in the right ear, 56 (82.3%) with a CI from Advanced Bionics, HiRes 90K model, the remaining with Cochlear, Freedom and Nucleus 5 models. Developments in CI results by audiometric tests: prior to placement was 106.2 dB averages at frequencies assessed, one month later 62.4 dB, at 6 months 44 dB, and with satisfactory threshold 32.9 dB. 55.8% of patients (n = 38) with P + HiRes Fidelity 120 strategy, the remaining with Hires S + Fidelity 120, Hires S and ACE RE. DISCUSSION: Audiology service proposed to place the CI in the worst ear by threshold in audiometric tests, the otolaryngology service proposed the best ear from anatomical point view. Implanted in the INR more Advanced Bionics CI faq frequently due to the donation by the insurance for a new generation. Hearing thresholds using CI have improved since activation.

Clinical significance of auditive involvement in rheumatoid arthritis: a case-control study.

Introduction. Rheumatoid arthritis (RA) can involve the incudomalleolar or incudostapedial articulations. Objective. To know the punctual prevalence of audiological alterations in patients with RA. Patients and Methods. RA patients and their controls (Cs), were evaluated by Tonal Audiometry (AU); if there were alterations in the air conduction (AC), bone conduction (BC), Logoaudiometry (LG), and Tympanometry (T) were performed. Results. 45 RA patients and 45 Cs were evaluated. RA patients had 40% of bilateral and 17.8% unilateral alteration versus Cs with 22.2% bilateral and 4.4% unilateral alteration versus Cs with 22.2% bilateral and 4.4% unilateral in AC audiometry. In conventional T (CT) As-type curves in patients with RA, there were 22 LE (48.8%) and 26 RE (57.7%) versus Cs, there were16 RE (35.5%) and 20 LE (44.4%). In High-frequency T (HFT): the 3B1G pattern in RA more frequent versus Controls (Cs) in RE (P = .002 and LE (P = .01). There were no differences according to RA activity or RA disease evolution. Conclusions. There is a greater tendency of auditive loss of As curves in CT (rigidity in ossicular chain) and of the 3B1G pattern in HFT in RA.

Communication interface and graphic module for audiometry equipment.

The National Rehabilitation Institute (INR) in Mexico City purchased 12 Madsen Orbiter 922 audiometers in 2006. While this audiometer is excellent for diagnosing the degree and type of hearing loss, it has presented problems in transfering, saving and printing the results of special tests and logoaudiometry from audiometer to workstation with the NOAH-3 system. The data are lost when the audiometer is turned off or a new patient is captured. There is no database storing and, shortly after the results have been printed on the thermal paper, the audiograms are erased. This problem was addressed by designing and implementing the InterAudio (AAMS) communication and graphical interface. The limitations and scope of the Automatic Audiometric Measurement System were analyzed, then a search of technical information was performed that included the resources for designing, developing and implementing the transfer interface, the user's graphical module requirements, and the tools for printing and saving the study.

Estandarización de la Audiometría de altas frecuencias / High frequency audiometry standarization

La aplicación primaria de la audiometría de altas frecuencias es útil en pacientes que tienen sospecha de otopatías por causas exógenas o endógenas con afección de las frecuencias mayores a 8 KHz. Se realizo este estudio con el objetivo de estandarizar la prueba en sujetos normo-oyentes que acuden al INCH. El análisis estadístico fue por "t de student" con intervalo de confianza del 95 por ciento. Se estudiaron 200 oídos, con promedio por frecuencias de 20 a 25 dB de 8 a 16 KHz y entre 25 y 28dB en 17 y 18 KHz. En el análisis de respuesta en decibeles entre ambos oídos no existió diferencia significativa (t menor que 0.05) entre ambos oídos. Se concluye que se puede considerar normal la audiometría de altas frecuencias en los pacientes cuya respuesta es hasta 25 dB de 8 a 16 KHz y hasta 30 dB en 17 y 18 KHz.

Hallazgos audiológicos en pacientes con hipoacusia súbita manejados con esteroides y extracto de ginkgo biloba / Audiologic findings in patients with sudden hearing loss treated with steroids and extract of ginkgo biloba

Propósito: Evaluar los resultados audiológicos en pacientes con hipoacusia súbita manejados con Ginkgo biliba y esteroides. Así mismo, evaluar el efecto de este tratamiento médico sobre el acúfeno que surge como secuela del padecimiento. Material y Métodos: Se realizó un estudio prospectivo, lineal y descriptivo, en el cual se revisó una muestra de 52 pacientes. Se administró tratamiento a base de esteroides y extracto de Ginkgo biloba. A todos los pacientes se les realizaron audiometrías seriadas cada 8 o 10 días hasta que se encontró estabilidad audiométrica. Resultados: En los umbrales de tonos puros, se observó mejoría de l a 30 dB HL en el 36.8 por ciento de los pacientes, de 31.60 dB HL en el 40.3 por ciento y de 61.90 dB HL en el 7.0 por ciento. La discriminación mejoró en el 61.66 por ciento. El acúfeno mostró mejoría importante en todos los casos. Conclusión: Aunque se ha reportado que en la hipoacusia súbita puede existir recuperación espontánea, la combinación de esteroides con extracto de Ginkgo biloba produjo recuperación en los umbrales de audiometría tonal y mejoría en la discriminación en la mayoría de los casos estudiados, incluso en pacientes que tenían de 1 a 2 meses de evolución y en los que no había existido mejoría espontánea. La recuperación no fue completa, pero si útil para obtener umbrales aceptables para la rehabilitación mediante una prótesis auditiva