A Computed Tomography Scan Near Miss of an Intraorbital Wooden Foreign Body.

When intraorbital wooden foreign bodies are missed, the consequences can be devastating. While the gold standard diagnostic imaging is computed tomography (CT), it has low sensitivity. We present a 61-year-old man with a bamboo injury to his right eye. He underwent two CT scans that failed to raise the possibility of intraorbital foreign bodies. Upon additional review, a rectangular-shaped pocket of air was identified in the orbit which was most consistent with wooden foreign bodies based on the clinical history. A combined mid-lid approach followed by a transconjunctival and transcaruncular extension were employed to remove several wooden splinters. Postoperatively, due to recurrent orbital compartment syndrome, he required a second decompression with an inferior rim osteotomy. He had good recovery at 3 months follow-up. Overall, intraorbital wooden foreign bodies are challenging to diagnose due to imaging limitations. Providing a clear history and suspected diagnosis to radiology is critical for diagnosis.

Manquer des corps étrangers intraorbitaires en bois peut avoir des conséquences désastreuses. L'imagerie diagnostique de référence est la tomodensitométrie (TDM) mais sa sensibilité est faible. Nous présentons le cas d'un homme de 61 ans ayant une plaie par morceau de bambou dans son œil droit. Il a bénéficié de deux tomodensitométrie qui n'ont pas réussi à donner l'alarme sur la possibilité de corps étrangers intraorbitaires. Lors d'un réexamen supplémentaire, une poche d'air de forme rectangulaire a été identifiée dans l'orbite; cette poche était très compatible avec des corps étrangers en bois, selon l'histoire clinique. Un abord combiné à mi-paupière, suivi d'une extension transconjonctivale et transcaronculaire, a été employé pour retirer plusieurs échardes en bois. En postopératoire, le patient a nécessité une deuxième décompression avec ostéotomie du bord inférieur en raison d'un syndrome du compartiment orbitaire récidivant. La récupération a été bonne au suivi de trois mois. Globalement, les corps étrangers intraorbitaires en bois sont difficiles à diagnostiquer en raison des limites de l'imagerie. Fournir au radiologue une histoire claire et un diagnostic suspecté est essentiel au diagnostic.

Oxidative damage associated with exposure to heavy metals present in topsoils in central Chile.

Exposure to heavy metals may cause the overproduction of reactive oxygen species, generating oxidative stress and consequently, various harms to human health. The soil surrounding the Ventanas Industrial Complex, in Puchuncaví and Quintero municipal districts on the central Chilean coast, contains heavy metal concentrations (As, Cu, Pb, Zn, among others) that far exceed the maximum permissible levels established by Italian soil standards (used as a reference). This study aimed to investigate the potential association between heavy metal exposure in humans and the levels of oxidative stress biomarkers in inhabitants of these locations. We took blood samples from 140 adults living in sites with high concentrations of heavy metals in the soil and compared them with blood samples from 140 adults living in areas with normal heavy metal concentrations. We assessed lipid peroxidation, damage to genetic material, and Total Antioxidant Capacity in these blood samples. Our results indicate an association between oxidative damage and heavy metal exposure, where the inhabitants living in exposed areas have a higher level of DNA damage compared with those living in control areas. Given that DNA damage is one of the main factors in carcinogenesis, these results are of interest, both for public health and for public policies aimed at limiting human exposure to environmental pollution.

Arsenic concentration in topsoil of central Chile is associated with aberrant methylation of P53 gene in human blood cells: a cross-sectional study.

Gene expression can be modified in people who are chronically exposed to high concentrations of heavy metals. The soil surrounding the Ventanas Industrial Complex, located on the coastal zone of Puchuncaví and Quintero townships (Chile), contain heavy metal concentrations (As, Cu, Pb, Zn, among others) that far exceed international standards. The aim of this study was to determine the potential association of the heavy metals in soils, especially arsenic, with the status of methylation of four tumor suppressor genes in permanent residents in those townships. To study the methylation status in genes p53, p16, APC, and RASSF1A, we took blood samples from adults living in areas near the industrial complex for at least 5 years and compared it to blood samples from adults living in areas with normal heavy metal concentrations of soils. Results indicated that inhabitants of an area with high levels of heavy metals in soil have a significantly higher proportion of methylation in the promoter region of the p53 tumor suppressor gene compared with control areas (p-value: 0.0035). This is the first study to consider associations between heavy metal exposure in humans and aberrant DNA methylation in Chile. Our results suggest more research to support consistent decision-making on processes of environmental remediation or prevention of exposure.

Importance of Margins, Radiotherapy, and Systemic Therapy in Mucosal Melanoma of the Head and Neck.

OBJECTIVES/HYPOTHESIS: The ideal strategy in the treatment of mucosal melanoma of the head and neck (MMHN) remains unclear. Our objective was to evaluate the importance of surgical margins, radiotherapy, and systemic therapy in MMHN. STUDY DESIGN: Retrospective Single Institutional Review. METHODS: Retrospective review of patients with MMHN treated at a tertiary care oncology center between 1999 and 2016. RESULTS: Seventy-six patients were included, 60 of whom were treated with curative intent. Negative or close margins compared with positive margins were associated with higher 3-year overall survival (OS) (62% vs. 29% vs. 13% P = .012), disease-free survival (33% vs. 29% vs. 4% P = .003), and distant control (48% vs. 29% vs. 22% P = .039). Cases with pre-/postoperative radiotherapy had a marginally higher locoregional control versus without (69% vs. 59%, P = .117). Immunotherapy for recurrent and/or metastatic disease was associated with an increase in 3-year OS (15% vs. 3% P = .01). CONCLUSION: Achieving negative surgical margins is relevant in disease control. Despite small sample size, our data suggest that radiotherapy may enhance surgical outcomes. Immunotherapy has therapeutic benefit. LEVEL OF EVIDENCE: 3 Laryngoscope, 131:2269-2276, 2021.

Scoping review of head and neck neoplasms presenting with obstructive sleep apnoea: the importance of flexible nasendoscopy.

BACKGROUND: Obstructive sleep apnoea (OSA) can be caused by neoplasms involving the upper aerodigestive tract. Currently, many of these patients have this diagnosis missed, as most adults diagnosed with OSA do not undergo adequate head and neck examination including flexible nasendoscopy. We performed a review of the literature to shed light on this phenomenon and outline the pathologies and issues surrounding this sub-population of patients diagnosed with OSA. METHODS: A scoping review of the literature was conducted on head and neck neoplasms presenting with OSA. Data were extracted on demographics, clinical presentation, histopathology, treatment and patient outcomes. RESULTS: Sixty-seven articles were included, describing 79 patients. Mean age was 45.8 years, and 77.2% were male. Symptoms of OSA were present for an average of 29.2 months before a diagnosis of causative neoplasm was made. Forty-two different benign and malignant histopathological entities were reported. At diagnosis, the causative pathology of 100% of patients was visible on head and neck examination including flexible nasendoscopy, while only 53.2% were visible on trans-oral examination. One-third of patients had commenced inappropriate treatment for OSA, including three who had undergone sleep surgical procedures. The majority of patients were treated with surgery alone (72.2%). CONCLUSION: Although rare, neoplasms of the upper aerodigestive tract should be considered as a cause of OSA, especially in patients experiencing other symptoms in addition to the typical symptoms of OSA. They should particularly be considered in patients with comparatively lower body mass index or those with worsening OSA without an apparent cause identified.

Clear cell chondrosarcoma of the larynx.

Chondrosarcomas represent a group of malignant tumours composed of cells producing cartilage, and clear cell chondrosarcomas (CCC) represent a variant of these. A rare case of a laryngeal CCC is presented. The patient was a 70-year-old man who presented with a 6-week history of throat pain, worsening dysphonia and a lump in the neck. Examination revealed a level 3 neck mass and positron emission tomography imaging revealed a metabolically active right laryngeal mass. Biopsies revealed a cartilaginous neoplasm. The patient underwent total laryngectomy, and the pathology confirmed CCC of the larynx. Chondrosarcomas are the most common type of sarcoma in the larynx but the CCC variant is rare. CCC are usually low-grade tumours affecting long bones, with a male predominance. Less than six cases have been described in the literature affecting the larynx. Management of these malignancies is complete surgical excision given the high risk of local recurrence.

Hemitransdomal versus Dome-Binding Suture.

The dome-binding suture (DBS) and hemitransdomal suture (HTS) are suture techniques used to narrow and define the nasal tip. The DBS can create a pinched, unnatural appearance, while the HTS puts the lateral crus in a more favorable orientation. This allows a natural contour between the nasal tip and alar lobule while maintaining alar margin support. Objective measurement of the rotational axis of the lateral crus between the DBS and the HTS has not been reported in the literature. To determine whether the DBS or HTS technique results in a more favorable rotational axis of the lateral crus as measured by the alar surface septal angle (ASSA). Open rhinoplasty with cephalic trim and placement of a DBS or HTS was performed in 6 cadaveric heads, for a total of 12 lower lateral cartilages at the VirtuOHSU Simulation and Surgical Training Center at Oregon Health and Science University (OHSU). ASSA measurements were taken at baseline and after placement of either a DBS or HTS. A total of 36 ASSA measurements were obtained. The median baseline ASSA prior to suture placement was 142 degrees (interquartile range [IQR]: 131.5-145 degrees), following DBS placement was 141 degrees (IQR: 33-150.5 degrees), and following HTS placement was 112 degrees (IQR: 108-117 degrees). There was no statistically significant difference of ASSA measurements between baseline and DBS placement (p = 0.24), but there was a statistically significant difference between baseline and HTS (p < 0.0001) and between DBS and HTS (p < 0.0001). The HTS technique creates a more favorable rotational axis of the lateral crus as compared with the DBS, as measured by the ASSA. This study provides objective data to support the use of the HTS for nasal tip contouring.

Utilidad de la evaluación por otorrinolaringología en atención primaria de salud: Evaluación piloto / Usefulness of otolaryngology evaluation in primary health care: Pilot evaluation

Introducción: En Atención Primaria de Salud (APS), las consultas por causas otorrinolaringológicas alcanzan hasta el 40%-50%. De éstos, muchos son enviados para evaluación al nivel secundario de salud. Objetivo: Evaluar la utilidad de una atención de otorrinolaringología en APS para tamizar el número de interconsultas al especialista. Explorar estrategias que permitan replicar la experiencia. Material y método: Se consideran las consultas de otorrinolaringología realizadas en dos escenarios diferentes, donde se evaluaron pacientes que se encontraban a la espera de atención formal por el nivel secundario. Resultados: Se evaluaron 201 pacientes. El 60,9% fueron de sexo femenino y el 39,1% masculino. La mediana de tiempo de espera para la derivación fue de 20 meses, con un rango intercuartil de 8-29 meses. El tiempo máximo de espera de interconsulta fue de 6 años (73 meses). Del total de interconsultas, 71,7% fueron dadas de alta con tratamiento según la causa, mientras que sólo en el restante 28,3% de las interconsultas se consideró necesario mantener la interconsulta al nivel secundario. Conclusión: Los resultados de la presente evaluación permiten plantear la utilidad de una evaluación otorrinolaringológica en APS. Esto permitiría reducir el flujo de derivaciones y listas de espera hacia el sector secundario, descongestionar el sistema, priorizar las derivaciones más pertinentes, crear canales de comunicación expeditos entre los niveles de atención, contribuir a la capacitación continua en ambos equipos y niveles.

Introduction: In primary health care, medical appointments for otorhinolaryngological causes reach up to 40%-50%. Of these cases, many are referred for the evaluation of the tertiary level of health. Aim: Assess the usefulness of an otorhinolaryngology evaluation at the primary health care level to screen the number of referrals to specialist. Explore strategies to replicate the experience. Material and method: Attention by otorhinolaryngologist is considered in two different scenarios, where patients who were waiting for formal care by the secondary level were evaluated. Results: 201 patients were evaluated. 60.9% of the patients were females and 39.1% were males. The median waiting time for referral was 20 months, with an interquartile range of 8 - 29 months. The maximum waiting time for consultation was 6 years (73 months). Of the total number of consultations, 71.7% were discharged with treatment according to the cause, while only the remaining 28.3% of the consultations were considered necessary to maintain consultation at the tertiary level. Conclusion: The results of this evaluation allow us to propose the usefulness of an otorhinolaryngological evaluation in primary health care. This would reduce the flow of referrals and waiting lists to the secondary sector, decongest the system, prioritize the most relevant referrals, create expedited channels of communication between levels of care, contribute to continuous training in both teams and levels.

Prevalence and associated factors of hearing aid use among older adults in Chile.

OBJECTIVE: The aim of this study was to determine the prevalence of use of hearing aids by older adults in Chile and the influence of some variables such as education level, income level and geographic area of residence on the prevalence of hearing aids. DESIGN: A national cross-sectional survey which was carried out in 2009. STUDY SAMPLE: A representative sample of 4766 Chilean older adults aged 60 years and above. RESULTS: The percentage of older adults in Chile who self-reported hearing problems and used hearing aids was 8.9%. Such prevalence increased for adults living in urban areas and for those who knew about the new Chilean programme of universal access to health services (AUGE). For older adults who did not know about this programme, significant associations between the use of hearing aids and the variables of age, geographic area of residence, and income level were found. CONCLUSIONS: People's knowledge about AUGE programme may positively influence the use of hearing aids, although a direct effect cannot be attributed.

Avoiding irregularities on the nasal dorsum in rhinoplasty.

Palpable irregularities along the nasal dorsum are a frequent complication of dorsal handling in rhinoplasty because resection techniques are used. This is often a result of improper management of the dorsum after resection. The surgical technique for handling of dorsal irregularities following dorsal resection is described. The key steps to avoid irregularities are diamond rasps, autospreader and morselized cartilage as camouflage. Following resection of the hump, the anatomy of the nasal dorsum should be adequately restructured; thereby we achieve an adequate aesthetic result and ideally preventing irregularities on palpation.

Las complicaciones de un inadecuado manejo del dorso nasal son frecuentes, destacando entre estas la palpación de irregularidades, debido a que en el manejo de la giba nasal se utilizan técnicas resectivas. Se describe una técnica quirúrgica para el manejo del dorso nasal, con énfasis en evitar irregularidades. Los pasos claves para evitar la palpación de irregularidades son: el uso de raspa diamantada, autoespaciador y lámina de cartílago morcelizado como camuflaje. Posterior a la resección de la giba se debe reestructurar de forma adecuada la anatomía del dorso nasal, de esta forma lograremos un resultado estético adecuado e idealmente evitar irregularidades a la palpación.

Programas de rehabilitación auditiva en adultos mayores, ¿qué sabemos de su efectividad? / Auditory rehabilitation programmes for adults: What do we know about their effectiveness?

Introducción y objetivo: La hipoacusia ocupa el tercer lugar entre las patologías que involucran años de vida con discapacidad. El tratamiento habitualmente utilizado es la implementación con audífonos, sin embargo, distintos programas de rehabilitación auditiva han sido desarrollados para mejorar las habilidades comunicativas de quienes padecen hipoacusia. El objetivo de esta revisión fue conocer la efectividad de los programas de rehabilitación auditiva centrados en estrategias comunicativas. Material y métodos: El presente artículo corresponde a una revisión narrativa. Se realizó una búsqueda bibliográfica en PUBMED de aquellas revisiones sistemáticas que examinaban la efectividad de los programas de entrenamiento y rehabilitación auditiva individuales y grupales, centrados en orientación y estrategias comunicativas en sujetos adultos con hipoacusia. Se analizó cada estudio, evaluando el tipo de intervención utilizada y los resultados obtenidos. Resultados: Se identificaron 3 artículos, uno acerca de la efectividad de programas de entrenamiento auditivo y 2 revisiones sistemáticas que evaluaron la efectividad de programas comunicativos en adultos hipoacúsicos. El programa Active Communication Education aparece como un programa de rehabilitación auditiva grupal efectivo y que podría ser implementado con pacientes adultos mayores hispanoparlantes. Conclusiones: La implementación con audífonos y los programas comunicacionales como intervenciones en rehabilitación son positivos para mejorar la participación social y la calidad de vida en pacientes hipoacúsicos, especialmente las estrategias de rehabilitación auditiva grupal, que presentarían un potencial para reducir la limitación de actividades y las restricciones de participación, y mejorar la calidad de vida de los pacientes (AU)

Introduction and objective: Hearing loss ranks third among the health conditions that involve disability-adjusted life years. Hearing aids are the most commonly used treatment option in people with hearing loss. However, a number of auditory rehabilitation programmes have been developed with the aim of improving communicative abilities in people with hearing loss. The objective of this review was to determine the effectiveness of auditory rehabilitation programmes focused on communication strategies. Material and methods: This was a narrative revision. A literature search using PUBMED was carried out. This search included systematic reviews investigating the effectiveness of auditory training and individual and group auditory rehabilitation programmes with the main focus on counselling and communicative strategies for adults with hearing loss. Each study was analysed in terms of the type of intervention used and the results obtained. Results: Three articles were identified: one article about the effectiveness of auditory training programmes and 2 systematic reviews that investigated the effectiveness of communicative programmes in adults with hearing loss. The «Active Communication Education» programme appears to be an effective group programme of auditory rehabilitation that may be used with older Spanish-speaking adults. Conclusions: The utility of hearing aid fitting and communicative programmes as rehabilitation options are associated with improvements in social participation and quality of life in patients with hearing loss, especially group auditory rehabilitation programmes, which seem to have good potential for reducing activity limitations and social participation restrictions, and thus for improving patient quality of life (AU)

[Auditory rehabilitation programmes for adults: what do we know about their effectiveness?]. / Programas de rehabilitación auditiva en adultos mayores, ¿qué sabemos de su efectividad?

INTRODUCTION AND OBJECTIVE: Hearing loss ranks third among the health conditions that involve disability-adjusted life years. Hearing aids are the most commonly used treatment option in people with hearing loss. However, a number of auditory rehabilitation programmes have been developed with the aim of improving communicative abilities in people with hearing loss. The objective of this review was to determine the effectiveness of auditory rehabilitation programmes focused on communication strategies. MATERIAL AND METHODS: This was a narrative revision. A literature search using PUBMED was carried out. This search included systematic reviews investigating the effectiveness of auditory training and individual and group auditory rehabilitation programmes with the main focus on counselling and communicative strategies for adults with hearing loss. Each study was analysed in terms of the type of intervention used and the results obtained. RESULTS: Three articles were identified: one article about the effectiveness of auditory training programmes and 2 systematic reviews that investigated the effectiveness of communicative programmes in adults with hearing loss. The "Active Communication Education" programme appears to be an effective group programme of auditory rehabilitation that may be used with older Spanish-speaking adults. CONCLUSIONS: The utility of hearing aid fitting and communicative programmes as rehabilitation options are associated with improvements in social participation and quality of life in patients with hearing loss, especially group auditory rehabilitation programmes, which seem to have good potential for reducing activity limitations and social participation restrictions, and thus for improving patient quality of life.

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)

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.

Programa de tamizaje universal e intervención precoz (PTUIP) en hipoacusia sensorioneural bilateral congénita: Tarea pendiente desde la perspectiva de políticas públicas de salud en Chile / Universal screening program and early intervention (uspei) in congenital bilateral sensorineural hearing loss in Chile

Congenital hearing loss is the total or partial inability to hear sounds through the ears. It is the most common disability in newborns in Chile and worldwide, and is a permanent condition. The direct impact on children who are not adequately diagnosed is the alteration in acquisition of language and cognitive skills and a decline in their social and school insertion, jeopardizing their professional and potentially productive life. Universal screening programs for hearing loss are essential for the diagnosis, since 50% of infants with hearing loss have no known risk factor. Screening before one month of age, confirmation before 3 months, and effective intervention before 6 months, allows the development of these children as if they had normal hearing. In Chile there is a selective program of screening for infants aged less than 32 weeks or 1,500 grams, as part of Explicit Health Guarantees, but it covers only 0.9% of newborns per year. Therefore, a large majority of children remain without diagnosis. The aim of this review is to compare the situation in Chile with other countries, raising the need to move towards a universal neonatal hearing loss screening program, and propose necessary conditions in terms of justification and implementation of a universal screening public policy.

Comparación entre los efectos de la varicocelectomía microquirúrgica subinguinal bilateral vs la unilateral en los parámetros seminales / Comparison of the effects of unilateral vs bilateral microsurgical subinguinal varicocelectomy in seminal parameters

INTRODUCCIÓN: El varicocele es una causa frecuente de infertilidad en el hombre, encontrándose en el 40 por ciento de los hombres que consultan por infertilidad, existiendo diversas teorías que explican esta situación. Numerosos estudios apuntan a que la reparación del varicocele se asociaría a una mejoría en los parámetros seminales e incluso en las tasas de fertilidad. Entre las técnicas reparativas la varicocelectomía microquirúrgica (VM) se ha posicionado como la técnica gold standard dado sus mejores resultados en cuanto a éxito, recidiva y seguridad. OBJETIVO: evaluar el rol de la VM en los parámetros seminales de varones que consultan por infertilidad y que son sometidos a VM bilateral en comparación con aquellos en que se realiza VM unilateral. Materiales y método: se seleccionó a pacientes con varicocele clínico que consultaron por infertilidad y que tenían el espermiograma alterado, a los que se realizó VM uni o bilateral según tuvieran la enfermedad en uno o ambos lados. Se tomó el promedio de los parámetros seminales de 2 espermiogramas pre-operatorios y otras variables clínicas y demográficas y se comparó con los parámetros seminales a 6 meses post-cirugía. Además se comparó los resultados del grupo de VM bilateral con el unilateral. RESULTADOS: no hubo diferencias entre los grupos en el pre-operatorio, evidenciándose una mejoría en ambos grupos al analizar los resultados a los 6 meses post-VM. Esta mejoría fue significativamente mayor en el grupo de VM unilateral en cuanto a la concentración espermática (mediana de 6 mill/ml, comparado con 0.75 mill/ml en el grupo de pacientes sometidos a VM bilateral. p Value = 0.02)...

Introduction: Varicocele is a common cause of infertility in men, present in 40 percent of men with infertility, there are several theories that explain this situation. Numerous studies suggest that varicocele repair would be associated with an improvement in semen parameters and even fertility rates. Among the reparative techniques microsurgical varicocelectomy (VM) has positioned itself as the gold standard technique given the best results in terms of success, recurrence and security. Objective: To evaluate the role of the VM in semen parameters of men consulting for infertility and who undergo bilateral VM compared to those VM is performed unilaterally. Materials and Methods: We enrolled patients with clinical varicocele who consulted for infertility and had altered semen analysis, in which VM was performed unilateral or bilateral depending if they had the disease in one or both sides. The average of 2 pre-operative semen parameters was used and other clinical and demographic variables and they were compared with semen parameters at 6 months post-surgery. We also compared the results of the group with unilateral versus that with bilateral VM. Results: There were no differences between groups in the pre-operative, evidence-dose improvement in both groups in analyzing the results at 6 months post-VM. This improvement was significantly greater in the group of unilateral VM regarding sperm concentration (median of 6 mill / ml, compared with 0.75 million / ml in the group of patients undergoing bilateral VM. P Value = 0.02).Discussion: VM improves seminal parameters in patients with unilateral or bilateral varicocele, being unilateral VM group that benefits the most. This could be explained by a greater cumulative damage spermatogenesis in the case of bilateral varicocele. Randomized controlled prospective studies are needed, allowing to determine the real effect of unilateral vs. bilateral VM.

[Vascular endothelial growth factor in malignant and non malignant prostatic tissue: Association with tumor recurrence at one year after prostatectomy]. / Identificación de factor de crecimiento vascular endotelial en células glandulares de tejido prostético maligno y benigno. Relación con la recidiva tumoral al año de la prostatectomía.

BACKGROUND: Prostate cancer (PC) is the second cause of death by cancer in men in Chile. Its behavior is so variable that it is necessary to search reliable prognostic markers. Vascular Endothelial Growth Factor (VEGF) is one of the most powerful pro-angiogenic factors. There is no agreement on its validity as a diagnostic or prognostic factor. AIM: To search for VEFG in prostatic tissue. MATERIAL AND METHODS: This study was performed in prostatectomy tissue coming from 41 patients with PC and 39 patients with benign prostatic hyperplasia (BPH). Specimens were studied using immunohistochemical staining for VEGF. The percentage of stained glandular cells per patient was calculated and associated with pathological diagnosis in cancer patients. RESULTS: PC biopsies had a mean of 82% of VEGF (+) stained cells, while BPH had only 1.6% (p < 0.01). No relationship was found between the percentage of staining and recurrence at one year of follow-up in the case of PC. CONCLUSIONS: These results would rule out VEGF as a prognostic factor in this series of patients.