Active Bone Conduction Implant and Adhesive Bone Conduction Device: A Comparison of Audiological Performance and Subjective Satisfaction.

Introduction Atresia of the external auditory canal affects 1 in every 10 thousand to 20 thousand live births, with a much higher prevalence in Latin America, at 5 to 21 out of every 10 thousand newborns. The treatment involves esthetic and functional aspects. Regarding the functional treatment, there are surgical and nonsurgical alternatives like spectacle frames and rigid and softband systems. Active transcutaneous bone conduction implants (BCIs) achieve good sound transmission and directly stimulate the bone. Objective To assess the audiological performance and subjective satisfaction of children implanted with an active transcutaneous BCI for more than one year and to compare the outcomes with a nonsurgical adhesive bone conduction device (aBCD) in the same users. Methods The present is a prospective, multicentric study. The audiological performance was evaluated at 1, 6, and 12 months postactivation, and after a 1-month trial with the nonsurgical device. Results Ten patients completed all tests. The 4-frequency pure-tone average (4PTA) in the unaided condition was of 65 dB HL, which improved significantly to 20 dB HL after using the BCI for 12 months. The speech recognition in quiet in the unaided condition was of 33% on average, which improved significantly, to 99% with the BCI, and to 91% with the aBCD. Conclusion The aBCD demonstrated sufficient hearing improvement and subjective satisfaction; thus, it is a good solution for hearing rehabilitation if surgery is not desired or not possible. If surgery is an option, the BCI is the superior device in terms of hearing outcomes, particularly background noise and subjective satisfaction.

Active smoking effect in allergic rhinitis.

BACKGROUND: Tobacco smoke has been described as causing increased prevalence of rhinitis symptoms and decreased atopy. Furthermore, these nasal symptoms and quality of life in smokers with Allergic Rhinitis (AR) were not significantly different to non-smokers. As a result of this duality, a comparison study between the quality of life and inflammatory markers of atopy among active smokers and non-smokers having AR was put forward. MATERIAL AND METHODS: Cross-sectional study in adult smokers and non-smokers, with a clinical diagnosis of AR and positive Skin Prick Test (SPT). Smoking status was confirmed by salivary cotinine measurements. Functional respiratory evaluation was performed, and quality of life between groups was compared using Mini-RQLQ questionnaire. Immunological markers in serum and nasal washes (IgE, IL-4, IL 5, IL 13, IL 17, IL 33) were evaluated, while samples from a third group of passive smokers was incorporated for serological comparison exclusively. The statistical analysis included Student T test, x2, Mann Whitney U (Anova 2-way), and Kruskal Wallis for 3 groups analysis. Values of P < 0.05 were considered significant. RESULTS: Twenty-two patients per group with similar demographics and allergen sensitivity were studied. Regarding inflammatory markers, a reduction of IL 33 in the serum of smokers (P < 0.001) was the only statistically significant different parameter revealed, showing a remarkable trend in nasal lavage. Salivary cotinine levels were absolutely different (P < 0.0001), but pulmonary function evaluations were not statistically significant after multiple adjusting. There were no significant differences in quality of life parameters. CONCLUSIONS: In our study of AR, active smokers do not demonstrate impaired nasal related quality of life or impact on atopic inflammatory parameters, compared to non-smokers. Reduced levels of IL33 could explain a lack of symptoms alerting smokers of the harmful consequences of smoking.

[Post- stapedectomy tinnitus´ perception. Experience in a university hospital] / Cambios perceptuales del tinnitus post- estapedectomia. Experiencia de un Hospital universitario.

INTRODUCCION: La otosclerosis es un trastorno de remodelación ósea caracterizada por disminución de la movilidad del estribo, lo que se traduce en una pérdida auditiva y tinnitus. El tratamiento mas comúnmente utilizado y mas eficaz es la cirugía. El objetivo principal es una mejora significativa en la pérdida auditiva, pero la reducción del tinnitus es un beneficio adicional. OBJETIVOS: Determinar los cambios en la sensación del tinnitus después de la estapedectomía en pacientes con otosclerosis operados en nuestro medio; así también como los factores que podrían asociarse con dichos cambios. MATERIALES Y METODOS: Realizamos un estudio prospectivo, observacional, analítico y longitudinal, en el que se incluyeron 15 pacientes con otosclerosis operados en el Sanatorio que se sometieron a un examen completo con Audiometría, Acúfenometría y Tomografía computada; se recopilaron datos mediante la Escala de Impresión Clínica Global y el Indice Funcional del Tinnitus, al momento previo a la cirugía y a los tres meses de intervenidos. Se utilizó el Soft R- medic e Infostat para analizar las variables y graficar los resultados. RESULTADOS: Las diferencias entre el estado de audición pre y postoperatoria fueron estadisticamente significativas (p<<0.001). Se comprobó además, diferencias estadísticamente significativas entre la percepción del tinnitus antes y despues de la cirugía (p<<0.001). Y que dicha diferencia se relaciona estadíticamente con la mejoría de la audición (p=0.01). DISCUSION- CONCLUSION: La mayoría de los pacientes refirieron una mejoría en el estado de percepción del acúfeno; además de la mejoría en su audición; resultando en asociación significativa ambas variables.

Introducción: La otosclerosis es un trastorno de remodelación ósea caracterizada por disminución de la movilidad del estribo, lo que se traduce en una pérdida auditiva y tinnitus. El tratamiento mas comúnmente utilizado y mas eficaz es la cirugía. El objetivo principal es una mejora significativa en la pérdida auditiva, pero la reducción del tinnitus es un beneficio adicional. Objetivos: Determinar los cambios en la sensación del tinnitus después de la estapedectomía en pacientes con otosclerosis operados en nuestro medio; así también como los factores que podrían asociarse con dichos cambios.. Materiales y Métodos: Realizamos un estudio prospectivo, observacional, analítico y longitudinal, en el que se incluyeron 15 pacientes con otosclerosis operados en el Sanatorio que se sometieron a un examen completo con Audiometría, Acúfenometría y Tomografía computada; se recopilaron datos mediante la Escala de Impresión Clínica Global y el Indice Funcional del Tinnitus, al momento previo a la cirugía y a los tres meses de intervenidos. Se utilizó el Soft R- medic e Infostat para analizar las variables y graficar los resultados. Resultados: Las diferencias entre el estado de audición pre y postoperatoria fueron estadisticamente significativas (p<<0.001). Se comprobó además, diferencias estadísticamente significativas entre la percepción del tinnitus antes y despues de la cirugía (p<<0.001). Y que dicha diferencia se relaciona estadíticamente con la mejoría de la audición (p=0.01). Dsicusión-Conclusión: La mayoría de los pacientes refirieron una mejoría en el estado de percepción del acúfeno; además de la mejoría en su audición; resultando en asociación significativa ambas variables

Congenital Aural Atresia prevalence in the Argentinian population.

INTRODUCTION: Congenital Aural Atresia (CAA) or microtia is a malformation that results in esthetic and functional problems. There is little information on prevalence, considering that Latin American is the most affected region in the world. OBJECTIVE: To determine the prevalence of microtia, considering the different ethnical structure of the population. METHODS: A retrospective analysis was performed of the clinical reports of newborn infants (public hospitals) in three different regions. RESULTS: The incidence of CAA in Argentina was 1 case per 7500 new births (i.e. 1.3/10,000). Marked differences were found per geographical area. The means were calculated per year by bilateral parametric estimation, according to the ethnical origins of the population. In the Caucasoid area: 02.47/10,000 (±1.2), in the Mestizo area: 03.99/10,000 (±0.0) and finally in the Amerindian area: 20.93/10,000 (±0.1). CONCLUSION: This study shows different incidences according to the demographic features of the population from 1.90/10,000 to 20.9/10,000. This data indicates that CAA is associated with a genetic problem (ethnic differences).

Morfología de la curva audiométrica en la enfermedad de Ménière al momento del diagnóstico / Audiometric curve configurations in Ménière disease at the first visit / Morfologia do desenho audiometrico na doença de Ménière no momento do diagnostico

INTRODUCCIÓN: La enfermedad de Ménière es una vestibulopatía frecuente que se manifiesta con crisis de vértigo, acúfenos, plenitud aural y pérdida auditiva neurosensorial. La hipoacusia es un síntoma fundamental para realizar el diagnóstico y se puede presentar de diversas formas. OBJETIVO: Describir las morfologías de las curvas audiométricas de los pacientes con enfermedad de Méniére al momento del diagnóstico. MATERIAL Y MÉTODOS: Estudio retrospectivo. Se evaluaron 99 pacientes. Se les realizaron estudios audiométricos y se registró el umbral tonal medio, el estadio correspondiente, la presencia de hipoacusia conductiva y la morfología de la curva audiométrica...

INTRODUCTION: Ménière disease is a frequent vestibular desorder that causes vertigo attacks, tinnitus, aural fullness and sensorineural hearing loss. Hearing loss is an essential symptom to get certain diagnosis and it can appear in several shapes. OBJECTIVE: to describe the configurations of the audiometric curves of patients with Ménière desease at the first visit. MATERIAL AND METHODS: A retrospective study included 99 patients. Audiometric studies were performed and mean tonal thresholds, corresponding stage, conductive hearing loss and audiometric curve configurations were recorded…

INTRODUÇÃO: A doença de Ménière é uma vestibulopatia freqüente que se manifesta com crise de vertigem, zumbido, plenitude aural e perda auditiva neurossensorial. A perda de audição é um sintoma fundamental para fazer o diagnóstico mais pode se apresentar com muitas formas. OBJETIVO: Descrever as morfologias das curvas audiométricas em pacientes com doença de Méniére no momento do diagnóstico. MATERIAL E MÉTODOS: Estudo retrospectivo. 99 pacientes foram avaliados. Estudos audiológicos foram feitos e o limiar tonal meia, o estágio, a presença de perda auditiva condutiva e o desenho da curva audiométrica foram analisados...

Comparative outcomes of active and passive hearing devices by transcutaneous bone conduction.

Conclusion Bonebridge (BB) and Sophono (SP) devices improved hearing; with the BB implant showing a better performance at medium and high frequencies. Furthermore, the BB, as an active implant, showed higher functional gain and increased time of use, when compared to the SP, a passive system. Objectives This study aims to compare surgical and audiological outcomes of SP and BB devices in order to assess and further differentiate the indication criteria. Methods Fourteen patients with conductive and mixed hearing loss were evaluated pre- and post-operatively (BB or SP) (period 2013-2014). Age, gender, surgical history, cause and type of hearing loss, implant use per day, levels of bone and air conduction, and functional gain were recorded. Data was analysed by Wilcoxon singed-rank and Wilcoxon rank-sum tests. Results Fourteen patients (BB; n = 10 and SP; n = 4) with an average age = 25.42 years (CI95 = 12.41-38.43) were evaluated. The gender relation was equal (1:1), with pre-implantation osseous thresholds of 20.42 dB (CI95 = 11.15-29.69), and pre-implantation aerial thresholds of 70.83 dB (CI95 = 62.52-79.14). The SP wearing time was significantly lower than that of the BB (SP = 7-10 h/day, BB = 8-12 h/day; p = 0.0323). The functional gain did not differ significantly between the two devices (BB = 40.00 ± 13.19 dB, SP = 34.06 ± 15.63 dB; p = 0.3434), but a significant improvement from pre- to post-implantation was observed (p < 0.05). BB and SP decreased auditory thresholds at 1 and 2 kHz (< 0.01), respectively. The BB even significantly decreased thresholds at 0.5 kHz (p = 0.0140) and 4 kHz (p < 0.0001). No relevant surgical complications were found.

Hearing preservation and cochlear implants according to inner ear approach: multicentric evaluation / Preservação auditiva e implante coclear de acordo com a abordagem da orelha interna: avaliação multicêntrica

INTRODUCTION: Electroacoustic stimulation is an excellent option for people with residual hearing in the low frequencies, who obtain insufficient benefit with hearing aids. To be effective, the subject's residual hearing should be preserved during cochlear implant surgery. OBJECTIVES: To evaluate the hearing preservation in patients that underwent implant placement and to compare the results in accordance with the approach to the inner ear. METHODS: 19 subjects underwent a soft surgical technique, and the electrode MED-EL FLEX(tm) EAS, designed to be atraumatic, was used. We evaluated pre- and postoperative tonal audiometric tests with an average of 18.4 months after implantation, to measure the rate of hearing preservation. RESULTS: 17 patients had total or partial preservation of residual hearing; 5 had total hearing preservation and two individuals had no preservation of hearing. The insertion of the electrode occurred through a cochleostomy in 3 patients, and in 2 of these there was no hearing preservation; the other 16 patients experienced electrode insertion through a round window approach. All patients benefited from the cochlear implant, even those who are only using electrical stimulation. CONCLUSION: The hearing preservation occurred in 89.4% of cases. There was no significant difference between the forms of inner ear approach. .

INTRODUÇÃO: A estimulação eletroacústica é uma excelente opção para pessoas com audição residual nas baixas frequências, que obtêm benefício insuficiente com aparelhos auditivos. Para ser eficaz, a audição residual deve ser preservada durante a cirurgia de implante coclear. OBJETIVOS: Avaliar a preservação auditiva de pacientes implantados e comparar os resultados de acordo com a abordagem da orelha interna. MÉTODO: 19 indivíduos foram implantados com uma técnica cirúrgica para preservação auditiva, tendo sido utilizado o eletrodo MED-EL FLEXTM EAS, concebido para ser atraumático. Foram avaliados os exames audiométricos tonais no pré e pós-operatório, com uma média de 18,4 meses após o implante para medir a taxa de preservação da audição residual. RESULTADOS: 17 pacientes tiveram preservação total ou parcial da audição residual; cinco obtiveram preservação da audição total e dois indivíduos não tiveram preservação da audição. A inserção do eletrodo ocorreu por cocleostomia em 3 pacientes; em 2 destes pacientes não houve preservação da audição. Os outros 16 pacientes foram submetidos à abordagem pela janela redonda. Todos os pacientes foram beneficiados com o implante coclear, mesmo aqueles pacientes que utilizando apenas estimulação elétrica. CONCLUSÃO: A preservação auditiva ocorreu em 89,4% dos casos. Não houve diferença significativa entre as formas de abordagem da orelha interna. .

Hearing preservation and cochlear implants according to inner ear approach: multicentric evaluation.

INTRODUCTION: Electroacoustic stimulation is an excellent option for people with residual hearing in the low frequencies, who obtain insufficient benefit with hearing aids. To be effective, the subject's residual hearing should be preserved during cochlear implant surgery. OBJECTIVES: To evaluate the hearing preservation in patients that underwent implant placement and to compare the results in accordance with the approach to the inner ear. METHODS: 19 subjects underwent a soft surgical technique, and the electrode MED-EL FLEX™ EAS, designed to be atraumatic, was used. We evaluated pre- and postoperative tonal audiometric tests with an average of 18.4 months after implantation, to measure the rate of hearing preservation. RESULTS: 17 patients had total or partial preservation of residual hearing; 5 had total hearing preservation and two individuals had no preservation of hearing. The insertion of the electrode occurred through a cochleostomy in 3 patients, and in 2 of these there was no hearing preservation; the other 16 patients experienced electrode insertion through a round window approach. All patients benefited from the cochlear implant, even those who are only using electrical stimulation. CONCLUSION: The hearing preservation occurred in 89.4% of cases. There was no significant difference between the forms of inner ear approach.

Middle ear implants: functional gain in mixed hearing loss.

UNLABELLED: Osseous atresia and chronic otitis media are diseases benefit with middle ear implants. Surgery for atresia is technically complicated, has significant number of complications and functional results are often poor. The osseointegrated hearing aids are an alternative. They provide a very good functional gain, but have many problems with the skin and osseointegration. In chronic otitis media, the ossiculoplasty solved partially the hearing problem. Unfortunately in some cases of otitis media and in open cavities fitted with conventional hearing aids the gain is unsatisfactory. AIM: To determine the usefulness of an active middle ear implant. MATERIAL AND METHOD: Longitudinal Study. Vibrant-Soundbrigde was implanted in eight patients with severe mixed hearing loss. Four patients had chronic otitis media and four had unilateral atresia. The placement of the stimulator (FMT or Floating Mass Transducer) was in five patients on round window, two in stapes and one in the oval window. RESULTS: Functional gain was 35 dB, 40 dB, 48.7 dB and 50 dB for the frequencies 500, 1000, 2000 and 4000 Hz, respectively. CONCLUSION: Vibrant-Soundbrigde is an excellent option in hearing recovery in severe and profound mixed hearing loss. It also provides an excellent functional gain in diseases difficult to treat with conventional hearing aids.

Prótese implantável do ouvido médio: ganho funcional em perda auditiva mista / Middle ear implants: functional gain in mixed hearing loss

Atresia óssea e otite média crônica são os principais grupos de beneficiários com implantes do ouvido médio. Cirurgia de atresia é tecnicamente complexo, tem muitas complicações e resultados funcionais pobres. Os aparelhos auditivos osseointegrados são uma alternativa. Eles fornecem um ganho funcional muito bom, mas tem muitos problemas de pele e osseointegração. Na otite média crônica, ossiculoplastias resolveram parcialmente o problema de audição. Infelizmente, em alguns casos de otites média e cavidades abertas, equipamentos com aparelhos auditivos convencionais são difíceis e muitas vezes insatisfatórios. OBJETIVO: Determinar a utilidade de um implante do ouvido médio. Desenho de estudo longitudinal. MÉTODOS: Vibrant-Soundbrigde foi implantado em oito pacientes com perda auditiva mista grave. Quatro apresentavam otite média crônica e quatro apresentavam atresia unilateral. A colocação do estimulador (FMT ou Floating Mass Transducer) foi em cinco pacientes na janela redonda, dois no estribo e um na janela oval. RESULTADOS: Ganho funcional foi de 35 dB, 40 dB, 48,7 dB e 50 dB para as frequências de 500, 1000, 2000 e 4000 Hz, respectivamente. CONCLUSÃO: Vibrant-Soundbrigde é uma excelente opção no restabelecimento da audição em perda auditiva mista grave e profunda. Ele fornece um excelente ganho funcional em doenças de difícil tratamento com equipamentos convencionais.

Osseous atresia and chronic otitis media are diseases benefit with middle ear implants. Surgery for atresia is technically complicated, has significant number of complications and functional results are often poor. The osseointegrated hearing aids are an alternative. They provide a very good functional gain, but have many problems with the skin and osseointegration. In chronic otitis media, the ossiculoplasty solved partially the hearing problem. Unfortunately in some cases of otitis media and in open cavities fitted with conventional hearing aids the gain is unsatisfactory. AIM: To determine the usefulness of an active middle ear implant. MATERIAL AND METHOD: Longitudinal Study. Vibrant- Soundbrigde was implanted in eight patients with severe mixed hearing loss. Four patients had chronic otitis media and four had unilateral atresia. The placement of the stimulator (FMT or Floating Mass Transducer) was in five patients on round window, two in stapes and one in the oval window. RESULTS: Functional gain was 35 dB, 40 dB, 48.7 dB and 50 dB for the frequencies 500, 1000, 2000 and 4000 Hz, respectively. CONCLUSION: Vibrant-Soundbrigde is an excellent option in hearing recovery in severe and profound mixed hearing loss. It also provides an excellent functional gain in diseases difficult to treat with conventional hearing aids.

[Intratympanic dexamethasone as therapeutic option in sudden sensorineural hearing loss]. / Dexametasona intratimpánica como opción terapéutica en hipoacusia neurosensorial súbita.

INTRODUCTION AND OBJECTIVES: The administration of systemic corticosteroids has demonstrated effectiveness on the treatment of idiopathic sudden sensorineural hearing loss. However, its systemic toxicity and subsequent difficulty for its justification in some patients have led to it being applied intratympanically. The main aim of this study is to determine the effectiveness of intratympanic dexamethasone in these patients. In addition we evaluate the relationship between the prognosis of this condition and the magnitude of initial hearing loss, the presence of vertigo or delay in the beginning of therapy. METHODS: We performed a retrospective case study of 18 patients. All of them were treated with intratympanic dexamethasone (4 mg/ml), administered weekly for 3 weeks. The follow-up was 1 month at least. The therapeutic success was arbitrarily defined to be a mean improvement of 25 dB or greater. RESULTS: 72.2% of the population recovered hearing successfully. The mean auditory threshold prior to treatment was 91+/-25 dB versus 51+/-35 dB after the end of it (p<0.0005). In addition, we observed that the initial severity of the hearing loss, the presence of vertigo and the delay in starting therapy cannot be considered as indicators of poor auditory prognosis. CONCLUSIONS: Intratympanic dexamethasone appears to be an effective therapeutic option for patients with sudden onset sensorineural hearing loss who, for whatever reason, cannot be treated with systemic steroids. Nonetheless, randomized controlled trials should be instituted to improve levels of scientific evidence.

Contribución de la tomografía computada con densitometría ósea en el diagnóstico de la otoesclerosis / Contribution of computed tomography bone densitometry in the diagnosis of otosclerosis

Planteo del problema: la otoesclerosis es una patología que en sus formas clínicas de hipoacusia mixta neurosensorial presenta un desafío diagnóstico no resuelto. El aporte de las imágenes no ha significado una ayuda, debido a técnicas complejas y de difícil interpretación. Se propone una técnica de medición densitométrica en tomografía computada con 10 puntos sobre la cápsula laberíntica para determinar focos de reabsorción o fijación ósea. Objetivos: determinar sensibilidad y especificidad de una nueva técnica de medición densitométrica en tomografía computada de pacientes con otoesclerosis. Material y métodos: se comparan 2 grupos. Un grupo control de 20 oídos sanos, y un grupo problema de 30 pacientes. A todos se les realiza medición de densitometría en Unidades Hounsfield (U.H.) de acuerdo a técnicas sencillas (7 a 10 puntos de medición). Resultados: en el grupo control se hallaron los siguientes valores de referencia: promedio y desviación estándar 2038+-64 U.H. en el grupo problema se hallaron valores por fuera del rango, determinándose un valor de 203 U.H. en más o menos del promedio, como valor altamente sugestivo de enfermedad (sensibilidad 80.8% y especificidad 85%)