Cochlear implantation in the elderly: outcomes, long-term evolution, and predictive factors.

OBJECTIVE: Our goal in this study is to find out the outcomes of cochlear implantation in elderly (> 60 years) and check if this improvement is similar to that of their younger counterparts in short- and long-term evolution. In addition, we have attempted to ascertain the predictive factors that might affect the verbal comprehension results of older patients. STUDY DESIGN: Retrospective cohort study. METHODS: Ninety-four patients older than 40 years, divided into two groups. 40-60 years n = 55 and > 60 years n = 39. A pure-tone audiometry, a disyllabic word test, and the test of phonetically balanced sentences of Navarra were made in silence to each patient. These measurements were made pre-implantation and 1, 5, and 10 year post-implantation. Peri- and postoperative complications were registered. The hypothetic predictive factors of post-implanted performance were evaluated in the elderly. RESULTS: Our study shows no significant difference between young and old adult´s outcomes in short- and long-term evolutions, nor in the complication rate. Furthermore, we proved the significant influence of the side of implantation, use of hearing aids, and duration of hearing loss in the short- and long-term results in the elderly. CONCLUSION: This study shows that cochlear implantation in the elderly is as safe, useful, and worthwhile as in young adults. Age has a low influence in cochlear implant outcomes; however, we have found the significant influence of the side of implantation, the use of hearing aids, and the duration of hearing loss in the short- and long-term results.

The role of subtotal petrosectomy in cochlear implant recipients.

Describe the indications and outcome of subtotal petrosectomy for cochlear implant recipients. Tertiary care referral center. This is a retrospective study of all subtotal petrosectomies and cochlear implants performed between January 2012 and December 2014. We review the charts of these patients collecting the following data: age, gender, otologic history, audiologic tests, indication of subtotal petrosectomy, data of surgery, surgical and immediate complications, late complications and follow-up of for at least 2.5 years. 12 cases of subtotal petrosectomies with cochlear implantation in 11 patients were performed during this period; 2 children and 10 adults. The indication for a cochlear implant was in 10 cases bilateral severe to profound sensorineural hearing loss and in the remaining 2 cases was asymmetric hearing loss or unilateral hearing loss. The reason for performing a subtotal petrosectomy was chronic otitis media with or without cholesteatoma, radical cavities from previous surgeries or electrode extrusion of previously implanted devices. All cases were performed in one stage. One patient had an infectious complication that required revision surgery and finally an explantation. No other complications are described. Subtotal petrosectomy combined with cochlear implantation is a procedure required in certain situations. It is an effective and safe procedure for managing middle ear problems and creating a safe cavity to receive a cochlear implant either in adults and children.

Revisión de nuestra experiencia en fonocirugía infantil / A review of our experience in phonosurgery in children

Introducción y objetivos: La disfonía es un problema frecuente en los niños, especialmente en edad escolar. La exploración de las cuerdas vocales suele ser más difícil y menos precisa que en los adultos. La lesión que más a menudo encontramos en niños con disfonía crónica son los nódulos vocales, seguido de los quistes epidermoides y de las demás lesiones congénitas, como sulcus y puente mucoso. El tratamiento es multidisciplinar y se basa fundamentalmente en rehabilitación vocal. Indicamos tratamiento quirúrgico en niños mayores de 9 años en los que persiste el problema tras la rehabilitación, sobre todo si sospechamos una lesión congénita de la cuerda vocal. Métodos: Presentamos un estudio retrospectivo de la fonocirugía infantil realizada en nuestro hospital durante 9 años (2005-2013). Se incluye a 51 niños, con edades comprendidas entre los 9 y los 16 años. Analizamos la distribución de las diferentes lesiones, tanto congénitas como adquiridas. Evaluamos los resultados mediante la valoración subjetiva de los familiares de los niños intervenidos. Resultados: Obtuvimos una distribución del 76% (n = 39) de lesiones congénitas y un 24% (n = 12) de lesiones adquiridas. Encontramos un porcentaje global de mejoría tras la cirugía del 90%, con mejores resultados en los nódulos vocales, aunque sin alcanzar significación estadística.Conclusiones: La valoración de los resultados de esta cirugía es controvertida y en este estudio se hace con una única pregunta a los familiares. Encontramos un resultado global de mejoría en el 90% de los casos intervenidos, sin ninguna complicación. Tenemos mejores resultados con los nódulos vocales, aunque no alcanzan significación estadística (AU)

Introduction and objectives: Dysphonia is a common problem in children, especially those of school age. Exploration of vocal folds is often difficult and less accurate in children. The most frequent lesions found in children with chronic dysphonia are vocal nodules, followed by epidermoid cysts and other congenital lesions, such as sulci and mucosal bridges. The treatment is multidisciplinary and it is fundamentally based on vocal rehabilitation. We indicate surgical treatment in children older than 9 years of age for whom the problem persists after rehabilitation, especially if we suspect a congenital lesion of the vocal fold. Methods: We present a retrospective study of paediatric phonosurgery performed by the Vocal Pathology Unit of our Hospital over a period of 9 years (2005-2013). Fifty-one children were included, ranging in age from 9 to 16 years old. We analyzed the distribution of the different lesions, both congenital and acquired. We evaluated the results by subjective evaluation by the children's relatives. Results: We obtained a distribution of 76% (n = 39) of congenital lesions and 24% (n = 12) of acquired lesions. After surgery, there was a global percentage of improvement of 90%, with better results in cases of vocal nodules, without statistical significance. Conclusions: The evaluation of the results of this surgery is controversial and in this study is done with a single question survey administered to relatives. We found an overall result of improvement in 90% of operated cases, without any complications. We obtained better results in vocal nodules, although not reaching statistical significance (AU)

A review of our experience in phonosurgery in children. / Revisión de nuestra experiencia en fonocirugía infantil.

INTRODUCTION AND OBJECTIVES: Dysphonia is a common problem in children, especially those of school age. Exploration of vocal folds is often difficult and less accurate in children. The most frequent lesions found in children with chronic dysphonia are vocal nodules, followed by epidermoid cysts and other congenital lesions, such as sulci and mucosal bridges. The treatment is multidisciplinary and it is fundamentally based on vocal rehabilitation. We indicate surgical treatment in children older than 9 years of age for whom the problem persists after rehabilitation, especially if we suspect a congenital lesion of the vocal fold. METHODS: We present a retrospective study of paediatric phonosurgery performed by the Vocal Pathology Unit of our Hospital over a period of 9 years (2005-2013). Fifty-one children were included, ranging in age from 9 to 16 years old. We analyzed the distribution of the different lesions, both congenital and acquired. We evaluated the results by subjective evaluation by the children's relatives. RESULTS: We obtained a distribution of 76% (n=39) of congenital lesions and 24% (n=12) of acquired lesions. After surgery, there was a global percentage of improvement of 90%, with better results in cases of vocal nodules, without statistical significance. CONCLUSIONS: The evaluation of the results of this surgery is controversial and in this study is done with a single question survey administered to relatives. We found an overall result of improvement in 90% of operated cases, without any complications. We obtained better results in vocal nodules, although not reaching statistical significance.

Cordectomía posterior. Nuestra experiencia / Posterior cordectomy. Our experience

Introducción y objetivos: La parálisis bilateral en adducción de las cuerdas vocales ocasiona una disnea de intensidad variable, que puede ser tratada con diferentes procedimientos quirúrgicos. Se realiza una revisión retrospectiva de nuestros casos tratados mediante cordectomía posterior con laser CO2, se analiza tanto el resultado respiratorio (mejoría de la disnea) como el resultado vocal. Métodos: Se realiza un estudio retrospectivo de 13 casos (9 mujeres y 4 varones) con edades comprendidas entre 25 y 79 años. En nuestra serie la causa más frecuente de la parálisis laríngea bilateral es la tiroidectomía (4 casos). Se valora la mejoría de su disnea según la opinión subjetiva de los pacientes y la disfonía generada, utilizando la versión española del Voice Handicap Index (VHI). Resultados: Todos los pacientes mejoraron significativamente de su disnea. Dos pacientes tuvieron que ser ingresados por disnea la primera semana del postoperatorio y uno de ellos fue reintervenido. Tras la intervención la mayoría de los pacientes sufrieron una disfonía leve o moderada. Conclusiones: La cordectomía posterior es un tratamiento fácil y seguro, que proporciona buenos resultados respiratorios con una disfonía leve o moderada en la mayoría de los casos (AU)

Objective: Several surgical procedures have been proposed for the treatment of respiratory distress secondary to bilateral cord palsy. We performed a retrospective study of our experience in posterior cordectomy with a laser CO2, analysing the improvement of dyspnoea and voice quality after surgery. Methods: This was a retrospective study of 13 cases (9 female, 4 male). The age range was 25-79 years. Iatrogenic post-thyroidectomy (4 cases) was the most common aetiology of bilateral laryngeal palsy in our study. We assessed the subjective improvement of respiratory function and voice quality after laser surgery using the Spanish adaptation of the Voice Handicap Index (VHI). Results: Dyspnoea improved in all patients. Two cases had a worsening of dyspnoea in the immediate postoperative period and one case was successfully solved with a new surgical intervention. After surgery, most of patients suffered from mild or middle dysphonia. Conclusions: The posterior cordectomy is an easy, safe and effective treatment for dyspnoea secondary to bilateral laryngeal palsy, maintaining acceptable voice quality (AU)

Posterior cordectomy. Our experience.

OBJECTIVE: Several surgical procedures have been proposed for the treatment of respiratory distress secondary to bilateral cord palsy. We performed a retrospective study of our experience in posterior cordectomy with a laser CO(2), analysing the improvement of dyspnoea and voice quality after surgery. METHODS: This was a retrospective study of 13 cases (9 female, 4 male). The age range was 25-79 years. Iatrogenic post-thyroidectomy (4 cases) was the most common aetiology of bilateral laryngeal palsy in our study. We assessed the subjective improvement of respiratory function and voice quality after laser surgery using the Spanish adaptation of the Voice Handicap Index (VHI). RESULTS: Dyspnoea improved in all patients. Two cases had a worsening of dyspnoea in the immediate postoperative period and one case was successfully solved with a new surgical intervention. After surgery, most of patients suffered from mild or middle dysphonia. CONCLUSIONS: The posterior cordectomy is an easy, safe and effective treatment for dyspnoea secondary to bilateral laryngeal palsy, maintaining acceptable voice quality.

Worldwide, multicenter study of peristomal geometry and morphology in laryngectomees and its clinical effects.

BACKGROUND: The purpose of this study was to improve attachment of automatic tracheostoma valves, the knowledge on tracheostoma geometry, and its clinical influences preferred. This article investigates whether the number of removed trachea rings, incision of the sternocleidomastoid muscles, neck dissection, reconstruction, time after operation, and age have any effect on the (peri)stomal geometry of the patient. METHODS: (Peri)stomas of 191 patients from 10 institutes worldwide were photographed, measured, and compared. RESULTS: Paired comparisons between the number of trachea rings removed showed significant differences in horizontal and vertical trachea-opening diameters, but failed to demonstrate an effect in the depth of the stoma. T tests did not demonstrate significant differences in peristomal geometry between the sternocleidomastoid-cleaved and non-cleaved group. CONCLUSION: The number of removed tracheal rings during laryngectomy does not seem to influence stoma depth. However, this study does not demonstrate that cleaving the sternocleidomastoid muscle (SCM) at the time of a laryngectomy will result in a geometrically flatter stoma.

Miringoplastia con cartílago "en isla". Resultados anatómicos y funcionales de 122 casos / Island cartilage myringoplasty. Anatomical and functional results in 122 cases

Introducción y objetivos: En las perforaciones timpánicas con «alto riesgo» de fracaso como son perforaciones grandes, anteriores y/o peritubáricas, reperforaciones, patología de mucosa de oído medio, disfunción tubárica, atelectasia, etc. el porcentaje de fracaso de las miringoplastias es más elevado. Se ha descrito que los materiales que clásicamente se emplean en las miringoplastias (fascia y pericondrio) pueden jugar un papel en este hecho y la miringoplastia con cartílago ofrece mejores resultados. En este trabajo exponemos nuestra experiencia con la miringoplastia con cartílago y describimos la técnica empleada. Métodos: Estudio retrospectivo donde se revisan las historias clínicas de miringoplastias con cartílago realizadas de forma consecutiva durante un período de 5 años (2002–2007). Resultados: Se estudia una muestra de 99 pacientes y 122 intervenciones. Más del 66% de los casos son perforaciones que afectan a más de 3 cuadrantes de la membrana y el 26% de los casos fueron cirugías de revisión tras fracasos previos. A pesar de estos datos a priori desfavorables, la tasa de cierre de perforación de esta serie de 122 casos es del 92%. Los resultados funcionales en los casos de timpanoplastia tipo I muestran una mejoría de la transmisión aérea media con valores estadísticamente significativos. Discusión: Consideramos que la reconstrucción de los defectos timpánicos con cartílago es una alternativa recomendable en determinados casos que denominamos casos de «alto riesgo». Los resultados de esta serie ponen de manifiesto este hecho y además consideramos que son reproducibles de forma sencilla. Conclusiones: Creemos que la miringoplastia con cartílago debe ser tenida en cuenta en los casos que a priori sean desfavorables y donde una miringoplastia con uso de fascia o pericondrio puede fracasar (AU)

Introduction and objectives: In certain situations (“high risk perforations”) such as large perforations, revision cases, middle ear pathology, eustachian tube dysfunction and atelectatic ears, the failure rate of myringoplasty is high. Some authors have suggested that the materials most frequently used for myringoplasty (fascia and perichondrium) may have a role in this failure rate. Cartilage myringoplasty, however, achieves good results in these “high risk” cases. The purpose of this study is to analyze our results and describe the technique. Methods: A retrospective study of all consecutive patient charts for cartilage myringoplasties performed in a 5-year period (2002–2007) was carried out. Results: During the study period, cartilage was used in 99 patients (122 cases). More than 66% of the cases were large perforations and 26% of the cases were revision cases. Successful closure was achieved in 92% of the cases and the functional results show an improvement in the air-bone gap average with statistical significance for type I tympanoplasties. Discussion: The reconstruction of tympanic membrane perforations with cartilage is recommended in certain cases (“high risk” perforations). The results described here show that the anatomical and functional results are good and we consider the technique easy to learn. Conclusions: We consider cartilage myringoplasty a technique that could be used in “high risk” perforations where a technique using fascia or perichondrium may have a higher risk of failure (AU)

[Island cartilage myringoplasty. Anatomical and functional results in 122 cases]. / Miringoplastia con cartílago "en isla". Resultados anatómicos y funcionales de 122 casos.

INTRODUCTION AND OBJECTIVES: In certain situations ("high risk perforations") such as large perforations, revision cases, middle ear pathology, eustachian tube dysfunction and atelectatic ears, the failure rate of myringoplasty is high. Some authors have suggested that the materials most frequently used for myringoplasty (fascia and perichondrium) may have a role in this failure rate. Cartilage myringoplasty, however, achieves good results in these "high risk" cases. The purpose of this study is to analyze our results and describe the technique. METHODS: A retrospective study of all consecutive patient charts for cartilage myringoplasties performed in a 5-year period (2002-2007) was carried out. RESULTS: During the study period, cartilage was used in 99 patients (122 cases). More than 66% of the cases were large perforations and 26% of the cases were revision cases. Successful closure was achieved in 92% of the cases and the functional results show an improvement in the air-bone gap average with statistical significance for type I tympanoplasties. DISCUSSION: The reconstruction of tympanic membrane perforations with cartilage is recommended in certain cases ("high risk" perforations). The results described here show that the anatomical and functional results are good and we consider the technique easy to learn. CONCLUSIONS: We consider cartilage myringoplasty a technique that could be used in "high risk" perforations where a technique using fascia or perichondrium may have a higher risk of failure.