Balloon Eustachian tuboplasty for obstructive Eustachian tube dysfunction: retrospective multicentre cohort study of 248 patients.

OBJECTIVE: To present the results after balloon eustachian tuboplasty (BET) in patients with obstructive Eustachian tube dysfunction (OETD) grouped up into: baro-challenge, chronic serous otitis media and adhaesive otitis media. METHODS: A retrospective study was carried out on patients who underwent BET surgery. As outcome measures, otoscopy, tympanometry, Eustachian tube dysfunction questionnaire-7 (ETDQ-7) and ability to perform the Valsalva manoeuvre were recorded at baseline and at 3, 12 and 24 months after BET. A p value of 0.05 was used to indicate a statistically significant difference for all statistical tests. RESULTS: Three hundred and nineteen ears (248 patients) were included with a 3-month follow-up, 272 ears had a 12-month follow-up, and 171 ears had 24-month follow-up. Globally, a statistical significance improvement in all groups in all outcome measures was found. According to BET indication, in the baro-challenge group, there was no improvement in otoscopy, but ETDQ-7, Valsalva manoeuvre and tympanogram improved significantly. In the chronic serous otitis media group, otoscopy, ETDQ-7 and Valsalva manoeuvre were significantly improved in all the three timelines, including the avoidance of a new transtympanic tube after the BET in over 80% of cases. In the adhaesive otitis media group, Valsalva manoeuvre improved significantly, ETDQ-7 decreased and tympanogram improved but not significantly. Few mild complications were reported. CONCLUSIONS: BET is an effective method for the treatment of OETD in all etiologic groups. The greatest benefit was observed in patients with baro-challenge. A long-term follow-up is recommended since the benefit seems to increase over time.

Clinical Performance Assessment of a New Active Osseointegrated Implant System in Mixed Hearing Loss: Results From a Prospective Clinical Investigation.

OBJECTIVE: Evaluation of a new active osseointegrated bone-conduction hearing implant in moderate to severe mixed-hearing loss. STUDY DESIGN: Prospective observational study of a series of cases. SETTING: Tertial referral center. PATIENTS: Twenty patients with moderate mixed-hearing loss were evaluated (10 Cochlear Osia group and 10 Baha 5 Power Connect -control group). INTERVENTION: Rehabilitative. MAIN OUTCOME MEASURES: Hearing performance in quiet and in noise and quality-of-life were evaluated. RESULTS: Improvements in audibility, speech-understanding, speech-recognition, and quality-of-sound in noise and quiet were found for the Osia System compared with preoperative unaided hearing and performance was similar to that obtained with Baha 5 Power Connect. CONCLUSIONS: The new active transcutaneous bone conduction system provided a tonal improvement in free-field at middle and high frequencies. The performance in speech recognition in quiet and in noise was similar to control group outcomes.

Síndrome de Frey en una niña con neurofibromatosis tipo 1 / Frey syndrome in a child with neurofibromatosis type 1

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Aprendiendo de la demanda asistencial en el síndrome de apnea del sueño infantil / Lessons from healthcare utilization in children with obstructive sleep apnoea syndrome

Introducción y objetivos: El síndrome de apnea-hipopnea del sueño (SAHS) pediátrico engloba alteraciones multisistémicas que afectan al estado general de salud, valorado indirectamente mediante el estudio de la demanda asistencial. Objetivo: cuantificar la frecuentación de consultas médicas en niños con SAHS durante 5 años y compararla con una población sana. Métodos: Estudio casos-control longitudinal ambispectivo en un hospital del sistema nacional de salud. Reclutamos a 69 niños remitidos por SAHS sin otras patologías para que la demanda asistencial fuera predominantemente atribuida al SAHS. Se seleccionó a otros 69 niños sanos como grupo control. Obtuvimos datos de frecuentación durante 5 años: el año en el que se realizó el tratamiento del SAHS («año 0»), 1 y 2 años antes («año -1» y «año -2»), y 1 y 2 años tras el tratamiento («año+1» y «año+2»). Resultados: El índice de frecuentación (IF), descrito como cociente entre demanda asistencial por los niños con SAHS y niños sanos, fue 1,89 durante el año -2 y 2,15 durante el año -1 (p < 0,05). El tratamiento disminuyó la utilización, con IF de 1,59 durante el año+1 y 1,72 en el año + 2 (p < 0,05). Las principales causas de sobrefrecuentación fueron otorrinolaringológicas y neumológicas. Conclusiones: Los niños con SAHS muestran mayor demanda asistencial, al menos 2 años antes del tratamiento, lo que implica un deterioro de la salud global que pudiera estar presente años antes de que la abordemos. El tratamiento repercute en una mejora, aunque permanece alta tras el tratamiento, sugiriendo enfermedad residual o secuelas (AU)

Introduction and objectives: Paediatric Obstructive Sleep Apnoea-Hypopnoea Syndrome (OSAS) is a multisystemic condition affecting child's health status that may be investigated analyzing demand for healthcare. Objective: to quantify the frequency of medical consultations in children with OSAS over a 5-year period, compared to a healthy population. Methods: A longitudinal, case-control, ambispective study was conducted at a hospital pertaining to the national public health system. 69 consecutive children referred for OSAS were recruited with no diseases other than OSAS so that healthcare demand was purely attributed to this condition. Matched healthy control children were selected to compare these data. Data regarding frequency of the medical consultations were obtained over 5 years: the year of the treatment ("Year 0"), 1 and 2 years before ("Year -1" and "Year -2" respectively), and 1 and 2 years after treatment ("Year+1" and "Year+2"). Results: Frequentation Index (FI), as ratio between the use of health services by OSAS children and healthy controls was 1.89 during Year-2, and 2.15 during Year-1 (P < .05). Treatment diminishes utilization, with FI of 159 during year+1 and 1.72 during year + 2 (P < .05). The main causes of attendance were otolaryngological and pneumological diseases, improving after treatment. Conclusions: Children suffering from OSAS demand more healthcare services, at least 2 years before treatment, implying that the disease could be present years before we manage it. Therapeutic actions improve healthcare services utilization, although remain higher than for controls, which suggests OSAS sequelae or residual disease (AU)

Lessons from healthcare utilization in children with obstructive sleep apnoea syndrome. / Aprendiendo de la demanda asistencial en el síndrome de apnea del sueño infantil.

INTRODUCTION AND OBJECTIVES: Paediatric Obstructive Sleep Apnoea-Hypopnoea Syndrome (OSAS) is a multisystemic condition affecting child's health status that may be investigated analyzing demand for healthcare. OBJECTIVE: to quantify the frequency of medical consultations in children with OSAS over a 5-year period, compared to a healthy population. METHODS: A longitudinal, case-control, ambispective study was conducted at a hospital pertaining to the national public health system. 69 consecutive children referred for OSAS were recruited with no diseases other than OSAS so that healthcare demand was purely attributed to this condition. Matched healthy control children were selected to compare these data. Data regarding frequency of the medical consultations were obtained over 5 years: the year of the treatment ("Year0"), 1 and 2 years before ("Year -1" and "Year -2" respectively), and 1 and 2 years after treatment ("Year+1" and "Year+2") RESULTS: Frequentation Index (FI), as ratio between the use of health services by OSAS children and healthy controls was 1.89 during Year-2, and 2.15 during Year-1 (P<.05). Treatment diminishes utilization, with FI of 159 during year+1 and 1.72 during year+2 (P<.05). The main causes of attendance were otolaryngological and pneumological diseases, improving after treatment. CONCLUSIONS: Children suffering from OSAS demand more healthcare services, at least 2 years before treatment, implying that the disease could be present years before we manage it. Therapeutic actions improve healthcare services utilization, although remain higher than for controls, which suggests OSAS sequelae or residual disease.

Epistaxis y dabigatrán, nuevo anticoagulante oral no antagonista de la vitamina K / Epistaxis and dabigatran, a new non-vitamin K antagonist oral anticoagulant

Objetivo: Dabigatrán es un nuevo anticoagulante no antivitamina K con efecto antitrombina. Se le atribuyen menos efectos secundarios hemorrágicos, pero no presenta antídoto que revierta su función ni tiempos de coagulación específicos que lo monitoricen. Materiales y métodos: Estudio longitudinal observacional prospectivo anotando las características epidemiológicas, clínicas y terapéuticas más relevantes entre los sujetos tratados con dabigatrán que manifestaron epistaxis. Se compararon resultados frente a un grupo de casos de epistaxis bajo terapia anticoagulante con acenocumarol y otro de epistaxis en controles no anticoagulados. Resultados: Desde su inclusión en el Sistema Nacional de Salud hace casi 3 años dabigatrán ha hecho acudir a urgencias de nuestro centro a 19 sujetos por epistaxis, frente a 59 por acenocumarol y 144 no anticoagulados, con ingresos hospitalarios del 26, 28 y 14%, respectivamente. En 3 de los 5 ingresados tratados con dabigatrán se detectó insuficiencia renal, previamente no documentada. Precisaron transfusión de hemoderivados el 80% de los tratados con dabigatrán, 58% con acenocumarol y 23% no anticogulados, y procedimientos invasivos el 80, 35 y 21%, respectivamente. Aunque el riesgo hemorrágico fue menor para dabigatrán, la estancia hospitalaria fue mayor frente a acenocumarol, y este frente a no anticoagulados. Conclusiones: Dabigatrán ofrece menos casos severos de epistaxis que acenocumarol, pero resultan más difíciles de controlar y revertir (AU)

Objective: Dabigatran is a new non-vitamin K antagonist (VKA) anticoagulant with anti-thrombin action, with supposedly fewer haemorrhagic complications. However, there are actually no established agents to reverse its effect, nor specific coagulation time tests for monitoring it. Materials and methods: An observational prospective study was developed, noting epidemiological, clinical and therapeutic features among subjects with epistaxis treated with dabigatran. Results were compared with a group of epistaxis cases of individuals under anticoagulant therapy with VKA (acenocoumarol) and a control group without anticoagulation. Results: Since its inclusion in our health system almost 3 years ago, 19 patients with epistaxis and concomitant use of dabigatran have been attended at the Emergency Unit in our hospital, as against 59 under VKA therapy and 144 without anticoagulation, with a mean admittance rate of 26%, 28% and 14%, respectively. In 3 out of 5 individuals admitted due to dabigatran treatment, previously unobserved renal failure was detected. Blood transfusion was needed in 80% of patients using dabigatran, 58% using VKA and 23% without anticoagulation. Invasive procedures to control nosebleed were required in 80%, 35% and 21%, respectively. Although haemorrhagic risk was lower in dabigatran cases, they showed the longest stay in the hospital when compared to the other groups (AU)

Epistaxis and dabigatran, a new non-vitamin K antagonist oral anticoagulant.

OBJECTIVE: Dabigatran is a new non-vitamin K antagonist (VKA) anticoagulant with anti-thrombin action, with supposedly fewer haemorrhagic complications. However, there are actually no established agents to reverse its effect, nor specific coagulation time tests for monitoring it. MATERIALS AND METHODS: An observational prospective study was developed, noting epidemiological, clinical and therapeutic features among subjects with epistaxis treated with dabigatran. Results were compared with a group of epistaxis cases of individuals under anticoagulant therapy with VKA (acenocoumarol) and a control group without anticoagulation. RESULTS: Since its inclusion in our health system almost 3 years ago, 19 patients with epistaxis and concomitant use of dabigatran have been attended at the Emergency Unit in our hospital, as against 59 under VKA therapy and 144 without anticoagulation, with a mean admittance rate of 26%, 28% and 14%, respectively. In 3 out of 5 individuals admitted due to dabigatran treatment, previously unobserved renal failure was detected. Blood transfusion was needed in 80% of patients using dabigatran, 58% using VKA and 23% without anticoagulation. Invasive procedures to control nosebleed were required in 80%, 35% and 21%, respectively. Although haemorrhagic risk was lower in dabigatran cases, they showed the longest stay in the hospital when compared to the other groups. CONCLUSIONS: With dabigatran, there are fewer cases of severe epistaxis than with acenocoumarol, but controlling them is more difficult.

Deformabilidad eritrocitaria patológica en pacientes con sordera súbita / Pathologic erythrocyte deformability in patients with sudden sensorineural hearing loss

Objetivos: Evaluar si las propiedades viscoelásticas de la sangre influyen en la posibilidad de padecer sordera súbita o en la capacidad de responder a un tratamiento específico. Pacientes y métodos: Fueron estudiados 85 oídos de pacientes con sordera súbita, midiéndose el porcentaje de hipoacusia al inicio y el grado de recuperación a los 6 meses tras un tratamiento con corticoides y piracetam. También se anotó la presencia de acúfeno o síntomas vestibulares y se determinó en sangre periférica la filtrabilidad en sangre total (FST) y el índice de rigidez eritrocitaria (IRE). Resultados: La pérdida media al inicio clínico fue del 30,3±19,7% y a los 6 meses del 25,8±39%. En 41 oídos se observó una recuperación auditiva superior al 75% pasado este tiempo. En este grupo -el 48% del total- la FST se elevó y el IRE descendió (p<0,001 en ambos). Los oídos sin acúfeno ni vértigo recuperaron más audición a los 6 meses y mostraron mejoría significativa en su FST y en el IRE. El grado de hipoacusia al inicio se correlacionó con la FST y el de recuperación con el IRE, pero de forma estadísticamente no significativa. Los antecedentes de hipertensión arterial, cardiopatías e hipercolesterolemia fueron los más comúnmente detectados. Hipertensión e hiperuricemia mostraron mayor capacidad de recuperación. Conclusiones: Los parámetros de viscosidad sanguínea FST e IRE se correlacionan bien con el riesgo de padecer sordera súbita y la capacidad de una adecuada recuperación de la misma con terapias reoactivas(AU)

Objective: To evaluate if viscoelastic properties of blood influence suffering sudden sensorineural hearing loss and the capacity to respond after a specific therapy. Patients and methods: A longitudinal prospective study included 85 ears bearing sudden deafness. In them, the mean hearing loss compared to the healthy ear and the recovery ratio were measured at the onset and 6 months after a treatment with corticoids and piracetam. In addition, tinnitus or vestibular symptoms, whole blood filterability (WBF) and erythrocyte deformability -by means of the erythrocyte rigidity index (ERI)- were determined and noted at the beginning and the end of the study. Results: Mean hearing loss was 30.3±19.7% at the onset, and 25.8±39% at the end. Forty-one ears showed a recovery of more than 75%. In these (48% of the entire study group), an increase in WBF and a decrease in ERI were observed (P<.001). Ears without tinnitus or vestibular crisis recovered more hearing at 6 months and showed a significant improvement in WBF and ERI, not detected among patients with these clinical findings. There were good correlations between mean hearing loss at onset and WBF, and between recovery and ERI at 6 months, but without statistical significance. Patients with arterial hypertension, cardiopathy and hypercholesterolemia were the most frequently detected, while hypertension and hyperuricaemia showed a better hearing recovery ratio. Conclusions: The blood viscosity parameters WBF and ERI offer useful information about the risk of suffering sudden deafness and the capacity to recover hearing with reactive therapies(AU)

Pathologic erythrocyte deformability in patients with sudden sensorineural hearing loss.

OBJECTIVE: To evaluate if viscoelastic properties of blood influence suffering sudden sensorineural hearing loss and the capacity to respond after a specific therapy. PATIENTS AND METHODS: A longitudinal prospective study included 85 ears bearing sudden deafness. In them, the mean hearing loss compared to the healthy ear and the recovery ratio were measured at the onset and 6 months after a treatment with corticoids and piracetam. In addition, tinnitus or vestibular symptoms, whole blood filterability (WBF) and erythrocyte deformability -by means of the erythrocyte rigidity index (ERI)- were determined and noted at the beginning and the end of the study. RESULTS: Mean hearing loss was 30.3±19.7% at the onset, and 25.8±39% at the end. Forty-one ears showed a recovery of more than 75%. In these (48% of the entire study group), an increase in WBF and a decrease in ERI were observed (P<.001). Ears without tinnitus or vestibular crisis recovered more hearing at 6 months and showed a significant improvement in WBF and ERI, not detected among patients with these clinical findings. There were good correlations between mean hearing loss at onset and WBF, and between recovery and ERI at 6 months, but without statistical significance. Patients with arterial hypertension, cardiopathy and hypercholesterolemia were the most frequently detected, while hypertension and hyperuricaemia showed a better hearing recovery ratio. CONCLUSIONS: The blood viscosity parameters WBF and ERI offer useful information about the risk of suffering sudden deafness and the capacity to recover hearing with reactive therapies.

[Paediatric cochlear implantation in the critical period of the auditory pathway, our experience]. / La implantación coclear pediátrica en el periodo crítico de la vía auditiva, nuestra experiencia.

INTRODUCTION: Numerous experimental and clinical studies have suggested a critical or sensitive period in which the auditory pathway develops its greatest potential in terms of plasticity and learning. Early cochlear implantation performed in prelingual deaf children in this period provides a better prognosis for language acquisition. The aim of this study is to show the importance of cochlear implantation before this critical period ends. METHODS: We conducted an observational, longitudinal, retrospective study of 57 children suffering profound prelingual bilateral sensorineural hearing loss who had received Advanced Bionics implants at our ENT department between June, 1998, and November, 2006. Data on their audiometric thresholds, the disyllabic word test adapted to children, open-set sentences recognition test and the Nottingham scale were analyzed. RESULTS: The analysis of audiometric thresholds showed no differences between children receiving the implants at different ages. However, statistically significant differences (p<0.05) were found in speech tests between groups of children receiving the implants before and after 4 years of age. CONCLUSIONS: Our results are in line with other publications showing differences in auditory performance when comparing children with early implants versus children receiving the implants at a later age. We found the greatest differences at 4 years of age. Nevertheless, these findings should not exclude children over this age from implantation.

La implantación coclear pediátrica en el periodo crítico de la vía auditiva, nuestra experiencia / Paediatric cochlear implantation in the critical period of the auditory pathway, our experience

Introducción: Datos experimentales y clínicos apuntan a que existe un periodo crítico o sensible en el que la vía auditiva desarrolla el mayor potencial de plasticidad y aprendizaje. Se ha demostrado que la implantación coclear precoz en ese periodo conlleva un mejor pronóstico respecto a la adquisición del lenguaje. El objetivo del presente trabajo es demostrar la importancia de la implantación coclear en ese periodo crítico. Métodos: Se ha realizado un estudio observacional, longitudinal y retrospectivo en 57 niños con hipoacusia neurosensorial bilateral profunda de inicio prelingual implantados en nuestro servicio, entre junio de 1998 y noviembre de 2006, con dispositvos de Advanced Bionics. Se han analizado los resultados obtenidos en audiometría tonal liminar, test de bisílabos adaptado a niños, test de frases en abierto y escala de Nottingham. Resultados: No se han observado diferencias en el análisis de los umbrales audiométricos de los niños implantados a distintas edades. Sin embargo, cuando se analizan los resultados de los tests logoaudiométricos, sí se han encontrado diferencias estadísticamente significativas (p<0,05) en los grupos de niños implantados antes y después de los 4 años de edad. Conclusiones: Nuestros resultados son coherentes con los de otras publicaciones en las que se evidencian claras diferencias en el rendimiento auditivo de los niños implantados precozmente con respecto a la implantación más tardía. Hemos encontrado las mayores diferencias en el límite de los 4 años de edad. No obstante, estos hallazgos no deben hacer que se excluya de la implantación a los niños que hayan sobrepasado esa edad (AU)

Introduction: Numerous experimental and clinical studies have suggested a critical or sensitive period in which the auditory pathway develops its greatest potential in terms of plasticity and learning. Early cochlear implantation performed in prelingual deaf children in this period provides a better prognosis for language acquisition. The aim of this study is to show the importance of cochlear implantation before this critical period ends. Methods: We conducted an observational, longitudinal, retrospective study of 57 children suffering profound prelingual bilateral sensorineural hearing loss who had received Advanced Bionics implants at our ENT department between June, 1998, and November, 2006. Data on their audiometric thresholds, the disyllabic word test adapted to children, open-set sentences recognition test and the Nottingham scale were analyzed. Results: The analysis of audiometric thresholds showed no differences between children receiving the implants at different ages. However, statistically significant differences (p<0.05) were found in speech tests between groups of children receiving the implants before and after 4 years of age. Conclusions: Our results are in line with other publications showing differences in auditory performance when comparing children with early implants versus children receiving the implants at a later age. We found the greatest differences at 4 years of age. Nevertheless, these findings should not exclude children over this age from implantation (AU)

Use of telemedicine in the remote programming of cochlear implants.

CONCLUSION: Remote cochlear implant (CI) programming is a viable, safe, user-friendly and cost-effective procedure, equivalent to standard programming in terms of efficacy and user's perception, which can complement the standard procedures. The potential benefits of this technique are outlined. OBJECTIVES: We assessed the technical viability, risks and difficulties of remote CI programming; and evaluated the benefits for the user comparing the standard on-site CI programming versus the remote CI programming. SUBJECTS AND METHODS: The Remote Programming System (RPS) basically consists of completing the habitual programming protocol in a regular CI centre, assisted by local staff, although guided by a remote expert, who programs the CI device using a remote programming station that takes control of the local station through the Internet. A randomized prospective study has been designed with the appropriate controls comparing RPS to the standard on-site CI programming. Study subjects were implanted adults with a HiRes 90K(R) CI with post-lingual onset of profound deafness and 4-12 weeks of device use. Subjects underwent two daily CI programming sessions either remote or standard, on 4 programming days separated by 3 month intervals. A total of 12 remote and 12 standard sessions were completed. To compare both CI programming modes we analysed: program parameters, subjects' auditory progress, subjects' perceptions of the CI programming sessions, and technical aspects, risks and difficulties of remote CI programming. RESULTS: Control of the local station from the remote station was carried out successfully and remote programming sessions were achieved completely and without incidents. Remote and standard program parameters were compared and no significant differences were found between the groups. The performance evaluated in subjects who had been using either standard or remote programs for 3 months showed no significant difference. Subjects were satisfied with both the remote and standard sessions. Safety was proven by checking emergency stops in different conditions. A very small delay was noticed that did not affect the ease of the fitting. The oral and video communication between the local and the remote equipment was established without difficulties and was of high quality.