Análisis y resultados de la cirugía endoscópica nasosinusal en rinosinusitis crónica con pólipos / Analysis and results of endoscopic sinus surgery in chronic rhinosinusitis with polyps

Introducción y objetivos. Actualmente la cirugía endoscópica nasosinusal es el procedimiento quirúrgico de elección en los casos de poliposis nasosinusal refractaria al tratamiento médico. El objetivo de este estudio es mostrar nuestra experiencia en el manejo de dichos pacientes intervenidos mediante cirugía endoscópica nasosinusal. Método. Estudio retrospectivo de 246 pacientes con rinosinusitis crónica con pólipos intervenidos mediante cirugía endoscópica. Estudiamos las características de la población, síntomas, grado de afectación, complicaciones y recidivas. Resultados. La comorbilidad más frecuente es el asma (34,6%) y su relación con la tríada de Samter (16,3%). Prevalecen los grados 2 y 3 de poliposis según la estadificación de Lildholdt por nasofibroscopia coincidiendo con la estadificación radiológica prequirúrgica. El microdebridador no supone acortamiento del tiempo quirúrgico pero sí disminución de las complicaciones. La reducción de la estancia media con el uso de hemostáticos absorbibles y su eficacia en el control de la hemostasia es estadísticamente significativa. Se describen 23,2% de complicaciones; solo una (0,4%) es una complicación mayor, siendo el resto complicaciones menores, de las que la sinequia es la más frecuente (16,3%). Conclusión. La cirugía endoscópica nasosinusal es una técnica mínimamente invasiva y segura. Los hemostáticos absorbibles son un método alternativo eficaz para obtener una completa y estable hemostasia disminuyendo la estancia media hospitalaria. Las sinequias continúan siendo las complicaciones más frecuentes, y el hecho de que muchos pacientes intervenidos recidiven, pero sin complicaciones, habla en favor de una evolución natural de la enfermedad y no de la influencia de la técnica (AU)

Introduction and objectives. Endoscopic sinus surgery is currently the surgical procedure chosen in cases of sinonasal polyposis refractory to medical treatment. The aim of this study was to show our experience in managing such patients operated using endoscopic sinus surgery. Method. A retrospective study of 246 patients with chronic rhinosinusitis and nasal polyps who were operated by endoscopic surgery. We studied the characteristics of the population, symptoms, grade of affectation, complications and recurrences. Results. The most frequent comorbidity was asthma (34.6%) and its relationship with Samter's triad (16.3%). Grades 2 and 3 polyposis prevailed according to Lildholdt staging by nasofibroscopy, coinciding with the radiological preoperative staging. The microdebrider did not shorten surgical time but it lowered complications. Reducing the average stay with the use of absorbable haemostatic agents and their effectiveness in controlling hemostasis were statistically significant. We found 23.2% complications, with only one (.4%) being a major complication; the rest were minor complications, with synechiae as the most frequent (16.3%). Conclusion. Endoscopic sinus surgery is a minimally invasive and safe technique. Absorbable haemostatic agents are an effective alternative to get complete and stable hemostasis, reducing mean hospital stay. Synechiae continue being the most frequent complication. The fact that many patients recurred but without complications speaks in favour of a natural evolution of the disease and not of the influence of technique (AU)

Analysis and results of endoscopic sinus surgery in chronic rhinosinusitis with polyps. / Análisis y resultados de la cirugía endoscópica nasosinusal en rinosinusitis crónica con pólipos.

INTRODUCTION AND OBJECTIVES: Endoscopic sinus surgery is currently the surgical procedure chosen in cases of sinonasal polyposis refractory to medical treatment. The aim of this study was to show our experience in managing such patients operated using endoscopic sinus surgery. METHOD: A retrospective study of 246 patients with chronic rhinosinusitis and nasal polyps who were operated by endoscopic surgery. We studied the characteristics of the population, symptoms, grade of affectation, complications and recurrences. RESULTS: The most frequent comorbidity was asthma (34.6%) and its relationship with Samter's triad (16.3%). Grades 2 and 3 polyposis prevailed according to Lildholdt staging by nasofibroscopy, coinciding with the radiological preoperative staging. The microdebrider did not shorten surgical time but it lowered complications. Reducing the average stay with the use of absorbable haemostatic agents and their effectiveness in controlling hemostasis were statistically significant. We found 23.2% complications, with only one (.4%) being a major complication; the rest were minor complications, with synechiae as the most frequent (16.3%). CONCLUSION: Endoscopic sinus surgery is a minimally invasive and safe technique. Absorbable haemostatic agents are an effective alternative to get complete and stable hemostasis, reducing mean hospital stay. Synechiae continue being the most frequent complication. The fact that many patients recurred but without complications speaks in favour of a natural evolution of the disease and not of the influence of technique.

Cochlear Implant Evaluation: Prognosis Estimation by Data Mining System.

OBJECTIVE: Prediction of speech recognition (SR) and quality of life (QoL) outcomes after cochlear implantation is one of the most important challenges for otologists. By sifting through very large amounts of data, data mining reveals trends, patterns, and relationships that might otherwise have remained undetected. There are identifiable pre-implantational factors that condition the cochlear implantation outcome. Our objective is to design a data mining system to predict and classify cochlear implant (CI) predictable benefits in terms of SR and QoL in each patient. MATERIALS AND METHODS: This is an observational study of CI users for at least one year. Audiological benefits and its relation to QoL are analyzed using the Glasgow Benefit Inventory (GBI) and the Specific Questionnaire (SQ). Sociodemographic and medical variables are processed in SPSS Statistics 19.0, MatLab® and Weka®. Classifiers are designed using the nearest neighbour and decision tree algorithms. Estimators are created by linear logistic regression. RESULTS: A total of 29 patients (mean age, 55.3 years; 52% female and 48% male) including 48% unilateral CI users and 51% bimodal CI users were included in the study. GBI improved by 36 points and SQ by 1.7 (p<0.05). Using Nearest Neighbour (IB1) algorithm for classifiers, interesting attributes were identified for SR and SQ result classification (success rate: 80.7%). Decision tree algorithm (J48) showed influencing variables for GBI (success rate: 81%). Estimators by linear logistic regression analysis disclosed a precision of 85%, 68%, and 71% for SR, GBI, and SQ, respectively. CONCLUSION: Our study proposes a systematized system to classify and estimate SR and QoL improvement based on our initial evaluation to complement decision making and patients' information.

Relación entre hiperbilirrubinemia neonatal e hipoacusia neurosensorial / The relationship between neonatal hyperbilirubinemia and sensorineural hearing loss

Introducción y objetivos: La ictericia severa que precisa exanguinotransfusión se ha convertido en una situación relativamente rara en la actualidad. El 60% de los neonatos a término y el 80% de los pretérmino se pondrán ictéricos dentro de la primera semana de vida. La hiperbilirrubinemia al nacer es un factor de riesgo asociado a hipoacusia que generalmente se asocia a otros que podrían tener efecto sobre la audición de manera sinérgica. El objetivo del estudio es establecer la relación entre la hiperbilirrubinemia al nacer como factor de riesgo de hipoacusia neurosensorial en los niños nacidos en el Complejo Hospitalario Universitario Insular Materno-Infantil de Gran Canaria, período 2007-2011. Método: Estudio retrospectivo de 796 recién nacidos con hiperbilirrubinemia al nacer, mediante otoemisiones acústicas provocadas transitorias y potenciales evocados auditivos de tronco cerebral. Resultados: Ciento ochenta y cinco recién nacidos (23,24%) fueron derivados a potenciales evocados auditivos de tronco cerebral. Treinta y cinco recién nacidos (4,39%) presentaron diagnóstico de hipoacusia, 18 (51,43%) hipoacusias de transmisión, 17 (48,57%) hipoacusias neurosensoriales y de estos 3 con hipoacusia profunda bilateral. La asociación a otro factor de riesgo se presenta en la mitad de los niños estudiados, siendo el más frecuente la exposición a ototóxicos. Conclusiones: El porcentaje de niños con diagnóstico de hipoacusia neurosensorial entre los recién nacidos con hiperbilirrubinemia al nacer es superior a la esperada en la población general. De los diagnosticados de hipoacusias neurosensoriales ninguno presentó niveles de bilirrubina indirecta en sangre ≥ 20 mg/dl, el 47% tenían solo la hiperbilirrubinemia al nacer como factor de riesgo mientras que el 53% evidenciaba otro factor de riesgo auditivo asociado (AU)

Introduction and objective: Severe jaundice that requires exchange transfusion has become a relatively rare situation today. About 60% of full term neonates and 80% of premature ones will suffer from jaundice within the first week of life. Hyperbilirubinemia at birth is a risk factor associated with hearing loss that is usually further linked to other factors that might have an effect on hearing synergistically. This study aimed to identify the relationship between hyperbilirubinemia at birth as a risk factor for sensorineural hearing loss in children born at Complejo Hospitalario Universitario Insular Materno-Infantil de Gran Canaria, in the 2007-2011 period. Method: This was a retrospective study of 796 newborns that had hyperbilirubinemia at birth, using transient evoked otoacoustic emissions and evoked auditory brainstem response. Results: Hundred eighty-five newborns (23.24%) were referred for evoked auditory brainstem response. Hearing loss was diagnosed for 35 (4.39%): 18 neonates (51.43%) with conductive hearing loss and 17 (48.57%) with sensorineural hearing loss, 3 of which were diagnosed as bilateral profound hearing loss. Half of the children had other risk factors associated, the most frequent being exposure to ototoxic medications. Conclusions: The percentage of children diagnosed with sensorineural hearing loss that suffered hyperbilirubinemia at birth is higher than for the general population. Of those diagnosed, none had levels of indirect bilirubin ≥ 20 mg/dl, only 47% had hyperbilirubinemia at birth as a risk factor and 53% had another auditory risk factor associated (AU)

The relationship between neonatal hyperbilirubinemia and sensorineural hearing loss.

INTRODUCTION AND OBJECTIVE: Severe jaundice that requires exchange transfusion has become a relatively rare situation today. About 60% of full term neonates and 80% of premature ones will suffer from jaundice within the first week of life. Hyperbilirubinemia at birth is a risk factor associated with hearing loss that is usually further linked to other factors that might have an effect on hearing synergistically. This study aimed to identify the relationship between hyperbilirubinemia at birth as a risk factor for sensorineural hearing loss in children born at Complejo Hospitalario Universitario Insular Materno-Infantil de Gran Canaria, in the 2007-2011 period. METHOD: This was a retrospective study of 796 newborns that had hyperbilirubinemia at birth, using transient evoked otoacoustic emissions and evoked auditory brainstem response. RESULTS: Hundred eighty-five newborns (23.24%) were referred for evoked auditory brainstem response. Hearing loss was diagnosed for 35 (4.39%): 18 neonates (51.43%) with conductive hearing loss and 17 (48.57%) with sensorineural hearing loss, 3 of which were diagnosed as bilateral profound hearing loss. Half of the children had other risk factors associated, the most frequent being exposure to ototoxic medications. CONCLUSIONS: The percentage of children diagnosed with sensorineural hearing loss that suffered hyperbilirubinemia at birth is higher than for the general population. Of those diagnosed, none had levels of indirect bilirubin≥20mg/dl, only 47% had hyperbilirubinemia at birth as a risk factor and 53% had another auditory risk factor associated.

Effects of high-frequency suppression for speech recognition in noise in Spanish normal-hearing subjects.

HYPOTHESIS: Subjects with normal hearing (NH) experience lower performance in speech understanding in noise when frequency components of speech above 8 kHz are removed. BACKGROUND: Previous studies have explored speech perception in noise under various circumstances, but none have been specifically designed to explore the relevance of frequencies above 8 kHz and, more specifically, for the Spanish language. METHODS: Twenty-nine subjects with NH, aged 19 to 55 years, and native speakers of the Spanish language listened to two sets of three disyllabic word lists with background noise. One set of words was unfiltered and included frequency components up to 22 kHz, and another set was band-pass filtered to include frequency components between 70 Hz and 8 kHz. Words were presented at 65 dB sound pressure level. Each set of words was presented with background noise with the same bandwidth limit as the accompanying list and adjusted to construct signal-to-noise ratio (SNR) conditions of +5, 0, and -5 dB. RESULTS: Results demonstrate a higher performance for unfiltered words at +5 and -5 dB SNR, although not at 0 dB SNR. For SNR +5 dB and -5 dB, the average success rate in word recognition was 17% higher when words were not filtered. For the case SNR = 0, however, both conditions yield statistically similar results. CONCLUSION: This study suggests that high-frequency components above 8 kHz contribute to speech understanding in noise for subjects with NH of the Spanish language. Given these findings, it would be interesting to determine if bandwidth limitations in current hearing prostheses may contribute to known difficulties with perception of speech in noise in hearing-impaired subjects.