Presbiacusia y trastornos del equilibrio en personas mayores. Revision bibliográfica de aspectos etiopatogénicos, consecuencias sobre la calidad de vida y efectos positivos de su tratamiento / Presbycusis and balance disorders in the elderly. Bibliographical review of ethiopathogenic aspects, consequences on quality of life and positive effects of its treatment

A día de hoy, todavía no disponemos de un conocimiento ni una concienciación adecuados sobre las consecuencias que alcanza en la calidad de vida la pérdida de audición en personas mayores. De la misma manera, tampoco existe información suficiente en cuanto a la relación de la presbiacusia y las alteraciones del equilibrio con otras comorbilidades. Dicho conocimiento puede contribuir a mejorar tanto la prevención como el tratamiento de estas patologías, a reducir su impacto en otras áreas como la cognición o la autonomía, así como para poseer una información más certera sobre el impacto económico que generan en la sociedad y en el sistema sanitario.Por ello, con la realización de este artículo de revisión nos planteamos actualizar la información sobre el tipo de hipoacusia y las alteraciones del equilibrio en personas mayores de 55 años, así como sus factores asociados; analizar el impacto que genera en la calidad de vida de estas personas y el que se puede generar a nivel personal y poblacional (tanto en el ámbito sociológico como económico) si se persigue una intervención temprana en estos pacientes. (AU)

At this time, we still do not have adequate knowledge and awareness of the consequences of hearing loss in the elderly on quality of life. Similarly, there is also insufficient information on the relationship of presbycusis and balance disorders with other comorbidities. Such knowledge can contribute to improve both prevention and treatment of these pathologies, to reduce their impact on other areas such as cognition or autonomy, as well as to have more accurate information on the economic impact they generate in society and in the health system.Therefore, with this review article we aim to update the information on the type of hearing loss and balance disorders in people over 55 years of age, and their associated factors; to analyze the impact on the quality of life of these people and the one which can be generated at a personal and population level (both sociological and economic) if an early intervention in these patients is pursued. (AU)

Presbycusis and balance disorders in the elderly. Bibliographical review of ethiopathogenic aspects, consequences on quality of life and positive effects of its treatment.

At this time, we still do not have adequate knowledge and awareness of the consequences of hearing loss in the elderly on quality of life. Similarly, there is also insufficient information on the relationship of presbycusis and balance disorders with other comorbidities. Such knowledge can contribute to improve both prevention and treatment of these pathologies, to reduce their impact on other areas such as cognition or autonomy, as well as to have more accurate information on the economic impact they generate in society and in the health system. Therefore, with this review article we aim to update the information on the type of hearing loss and balance disorders in people over 55 years of age, and their associated factors; to analyze the impact on the quality of life of these people and the one which can be generated at a personal and population level (both sociological and economic) if an early intervention in these patients is pursued.

Normative data for static balance testing in healthy individuals using open source computerized posturography.

PURPOSE: Computerized posturography is the gold standard for balance assessment. Because of the great cost and dimensions of commercial equipments, low-cost and portable devices have been developed and validated, such as RombergLab, a software in open source term which works connected with a low-cost force platform. The objective of this study was to obtain normative posturography data using this software. METHODS: A multicentric prospective and descriptive study, with 350 healthy participants, was designed. Static postural stability (measured using the modified clinical test of sensory interaction on balance) was evaluated using the software connected to the force platform. Using the confidence ellipse area (CEA) in each condition, global equilibrium score (GES) was calculated and adjusted for significant variable factors using cluster analysis. RESULTS: Mean (SD) GES was 0.72 (0.22). Age (p < 0.01), height (p < 0.01) and recruitment center (p < 0.05) were found as influence factors for GES. Cluster analysis obtained 16 groups stratified by age and height. GES decreases with age and height (p < 0.005). No significant interaction of age nor height was found with GES in these clusters (p > 0.05). After correction for height and age, GES was no longer influenced by the recruitment center (p > 0.05). CONCLUSIONS: With the introduction of the global equilibrium score values of the present study into the software, we consider RombergLab v1.3 a reference posturography tool for healthy individuals. Further studies are needed for validating it as a suitable instrumented test for screening between healthy and pathologic subjects and its reliability over time for the follow-up of patients.

Mathematical Methods for Measuring the Visually Enhanced Vestibulo-Ocular Reflex and Preliminary Results from Healthy Subjects and Patient Groups.

BACKGROUND: Visually enhanced vestibulo-ocular reflex (VVOR) is a well-known bedside clinical test to evaluate visuo-vestibular interaction, with clinical applications in patients with neurological and vestibular dysfunctions. Owing to recently developed diagnostic technologies, the possibility to perform an easy and objective measurement of the VVOR has increased, but there is a lack of computational methods designed to obtain an objective VVOR measurement. OBJECTIVES: To develop a method for the assessment of the VVOR to obtain a gain value that compares head and eye velocities and to test this method in patients and healthy subjects. METHODS: Two computational methods were developed to measure the VVOR test responses: the first method was based on the area under curve of head and eye velocity plots and the second method was based on the slope of the linear regression obtained for head and eye velocity data. VVOR gain and vestibulo-ocular reflex (VOR) gain were analyzed with the data obtained from 35 subjects divided into four groups: healthy (N = 10), unilateral vestibular with vestibular neurectomy (N = 8), bilateral vestibulopathy (N = 12), and cerebellar ataxia, neuropathy, and vestibular areflexia syndrome (CANVAS) (N = 5). RESULTS: Intra-class correlation index for the two developed VVOR analysis methods was 0.99. Statistical differences were obtained by analysis of variance statistical method, comparing the healthy group (VVOR mean gain of 1 ± 0) with all other groups. The CANVAS group exhibited (VVOR mean gain of 0.4 ± 0.1) differences when compared to all other groups. VVOR mean gain for the vestibular bilateral group was 0.8 ± 0.1. VVOR mean gain in the unilateral group was 0.6 ± 0.1, with a Pearson's correlation of 0.52 obtained when VVOR gain was compared to the VOR gain of the operated side. CONCLUSION: Two computational methods to measure the gain of VVOR were successfully developed. The VVOR gain values appear to objectively characterize the VVOR alteration observed in CANVAS patients, and also distinguish between healthy subjects and patients with some vestibular disorders.

Exploración videosomnoscópica bajo sueño inducido en los trastornos respiratorios del sueño en niños / Drug-induced sleep-endoscopy in children's sleep related breathing disorders

Introducción y objetivos: La somnoscopia es una herramienta válida para evaluar los lugares de obstrucción de la vía aérea superior responsables del síndrome de apnea-hipoapnea del sueño infantil. El objetivo es mostrar la experiencia de un servicio de ORL con somnoscopia en niños candidatos a cirugía de síndrome de apnea del sueño. Métodos: Incluye 56 casos entre 2 y 12 años de edad que acuden a la consulta de otorrinolaringología con clínica de ronquido y apnea. Se practica polisomnografía previa y el IAH medio fue 6,32±8,71. La distribución de casos fue: 10 residuales (17,85%), 15 desproporción clínica (26,78%) y 31 convencionales (55,35%). Todas las exploraciones se llevan a cabo en quirófano y se utiliza la clasificación de Chan para valorar las zonas de colapso. Resultados: En los casos de enfermedad residual las regiones más afectadas son las paredes laterales de la orofaringe (70%) y los cornetes (70%), y la cirugía aplicada con más frecuencia la amigdalectomía total seguida de la reducción de la base de la lengua y la radiofrecuencia de los cornetes. En los casos de desproporción clínica se halló mayor frecuencia de colapso en las paredes laterales de la orofaringe (93,3%) y adenoides (66,6%). La cirugía más frecuente en este grupo fue la adenoidectomía con amigdalotomía por radiofrecuencia. Conclusión: La somnoscopia es una técnica de exploración que puede ser incorporada con facilidad a la práctica habitual, especialmente en niños con síndrome de apnea del sueño residual o en aquellos en los que se sospeche alguna otra causa aparte de la hipertrofia adenoamigdalar (AU)

Introduction: Drug-induced sedation endoscopy is a valid tool to assess site obstruction of the upper airway responsible for children's obstructive Sleep Apnea. The aim is to show the experience of an ENT department with Drug-induced sedation endoscopy in children selected for sleep apnea surgery. Methods: Includes 56 cases between 2 and 12 years old (mean age: 59,13±27,29 months) presenting at the Otorhinolaryngology consultation clinic with snoring and apnea. Prior polysomnography had been practiced and mean AHI was 6,32±8,71. The distribution of cases was 10 persistent sleep apnea (17.85%), 15 clinical disproportion (26.78%) and 31 conventional (55.35%). All sleep endoscopies were performed in the operating room and Chan classification was used to assess the areas of collapse. Results: In cases of residual disease the most affected regions were the side walls of the oropharynx (70%) and turbinate (70%) and the most frequently applied surgery was total tonsillectomy followed by second tongue tonsil reduction and turbinate radiofrequency. In clinical cases of desproportion, the most affected regions were the oropharyngeal side walls (93.3%) and adenoids (66.6%). The most frequently applied surgery in this group was adenoidectomy and radiofrequency tonsillotomy. Conclusion: drug-induced sedation endoscopy is a technique that can be incorporated easily into medical practice, mostly in children with residual sleep apnea syndrome or those suspected to have some cause other than adenotonsillar hypertrophy (AU)

Drug-induced sleep-endoscopy in children's sleep related breathing disorders. / Exploración videosomnoscópica bajo sueño inducido en los trastornos respiratorios del sueño en niños.

INTRODUCTION: Drug-induced sedation endoscopy is a valid tool to assess site obstruction of the upper airway responsible for children's obstructive Sleep Apnea The aim is to show the experience of an ENT department with Drug-induced sedation endoscopy in children selected for sleep apnea surgery METHODS: Includes 56 cases between 2 and 12 years old (mean age: 59,13±27,29 months) presenting at the Otorhinolaryngology consultation clinic with snoring and apnea. Prior polysomnography had been practiced and mean AHI was 6,32±8,71. The distribution of cases was 10 persistent sleep apnea (17.85%), 15 clinical disproportion (26.78%) and 31 conventional (55.35%). All sleep endoscopies were performed in the operating room and Chan classification was used to assess the areas of collapse. RESULTS: In cases of residual disease the most affected regions were the side walls of the oropharynx (70%) and turbinate (70%) and the most frequently applied surgery was total tonsillectomy followed by second tongue tonsil reduction and turbinate radiofrequency. In clinical cases of desproportion, the most affected regions were the oropharyngeal side walls (93.3%) and adenoids (66.6%). The most frequently applied surgery in this group was adenoidectomy and radiofrequency tonsillotomy. CONCLUSION: Drug-induced sedation endoscopy is a technique that can be incorporated easily into medical practice, mostly in children with residual sleep apnea syndrome or those suspected to have some cause other than adenotonsillar hypertrophy.

HITCal: a software tool for analysis of video head impulse test responses.

CONCLUSION: The developed software (HITCal) may be a useful tool in the analysis and measurement of the saccadic video head impulse test (vHIT) responses and with the experience obtained during its use the authors suggest that HITCal is an excellent method for enhanced exploration of vHIT outputs. OBJECTIVE: To develop a (software) method to analyze and explore the vHIT responses, mainly saccades. METHODS: HITCal was written using a computational development program; the function to access a vHIT file was programmed; extended head impulse exploration and measurement tools were created and an automated saccade analysis was developed using an experimental algorithm. For pre-release HITCal laboratory tests, a database of head impulse tests (HITs) was created with the data collected retrospectively in three reference centers. This HITs database was evaluated by humans and was also computed with HITCal. RESULTS: The authors have successfully built HITCal and it has been released as open source software; the developed software was fully operative and all the proposed characteristics were incorporated in the released version. The automated saccades algorithm implemented in HITCal has good concordance with the assessment by human observers (Cohen's kappa coefficient = 0.7).

Correlación entre la clínica y la polisomnografía en los trastornos respiratorios del sueño infantil / Clinical and polysomnographic correlation in sleep-related breathing disorders in children

Introducción: A pesar de que la polisomnografía supone la prueba diagnóstica por excelencia de los trastornos respiratorios del sueño en niños, existe controversia sobre su indicación en todos los casos. De entre los argumentos utilizados, tanto a favor como en contra, se encuentra la falta de correlación existente entre sus valores objetivos y la sintomatología. Objetivo: Evaluar la correlación entre los datos clínicos y el índice de apnea-hipoapnea (IAH), en nuestro entorno de trabajo. Material y método: Se compara estadísticamente la clínica preoperatoria y el IAH de 170 niños con trastorno respiratorio del sueño, sometidos a polisomnografia. También se evalúa la correlación a nivel postoperatorio, con un subgrupo de 80 niños intervenidos de adenoamigdalectomía con seguimiento polisomnográfico a un año. Resultados: A nivel preoperatorio únicamente el grado de hipertrofia amigdalar mostró correlación significativa con el IAH. A nivel postoperatorio se evidencia una correlación entre el IAH y las apneas observadas: 38,1% de los niños mejoran según los padres en el grupo con persistencia polisomnográfica y el 66,7% en el grupo con resolución de la enfermedad (p=0,023). También muestra correlación el nivel de mejora del ronquido, valorado mediante escala analógica visual. La media bajó 5 puntos en el grupo persistente y 6,1 en el grupo con resolución de la enfermedad (p=0,047). Conclusión: A pesar de las limitaciones en la correlación entre la clínica y la polisomnografia, especialmente en el preoperatorio, la prueba objetiva por excelencia sigue siendo esta. Deben hacerse esfuerzos para conseguir parámetros objetivos que aporten mayor nivel de correlación (AU)

Introduction: Although polysomnography is the gold standard test for sleep-disordered breathing in children, there is controversy about its indication in all cases. Among the arguments both for and against is the lack of correlation between objective values and the symptoms. Objective: To evaluate the correlation between clinical data and apnea-hypopnoea index (AHI) in our work environment. Material and methods: We compared the preoperative clinical symptoms and AHI statistically in 170 children with sleep-disordered breathing who underwent polysomnography. We also analysed the correlation to postoperative level, with a subgroup of 80 children who underwent adenotonsillectomy with 1 year of polysomnography follow-up. Results: Before surgery, only the degree of tonsillar hypertrophy was statistically significant correlated with AHI. At post-operative follow-up, evidence of correlation between AHI and apnoea was observed: 38.1% of children improved in the group with persistence and 66.7% in the disease resolution group (P=0.023). In addition, the correlations showed the level of improvement of snoring, as assessed by visual analogue scale. The mean was 5 points lower in the persistent group and 6.1 lower in the disease resolution group (P=0.047). Conclusion: Despite the limitations in the correlation between clinical data and polysomnography, especially in preoperative results, polysomnography remains the gold standard diagnostic tool. Efforts should be made to obtain objective parameters that provide higher levels of correlation (AU)

Clinical and polysomnographic correlation in sleep-related breathing disorders in children.

INTRODUCTION: Although polysomnography is the gold standard test for sleep-disordered breathing in children, there is controversy about its indication in all cases. Among the arguments both for and against is the lack of correlation between objective values and the symptoms. OBJECTIVE: To evaluate the correlation between clinical data and apnea-hypopnoea index (AHI) in our work environment. MATERIAL AND METHODS: We compared the preoperative clinical symptoms and AHI statistically in 170 children with sleep-disordered breathing who underwent polysomnography. We also analysed the correlation to postoperative level, with a subgroup of 80 children who underwent adenotonsillectomy with 1 year of polysomnography follow-up. RESULTS: Before surgery, only the degree of tonsillar hypertrophy was statistically significant correlated with AHI. At post-operative follow-up, evidence of correlation between AHI and apnoea was observed: 38.1% of children improved in the group with persistence and 66.7% in the disease resolution group (P=.023). In addition, the correlations showed the level of improvement of snoring, as assessed by visual analogue scale. The mean was 5 points lower in the persistent group and 6.1 lower in the disease resolution group (P=.047). CONCLUSION: Despite the limitations in the correlation between clinical data and polysomnography, especially in preoperative results, polysomnography remains the gold standard diagnostic tool. Efforts should be made to obtain objective parameters that provide higher levels of correlation.

[Undiagnosed (corrected) cases of obstructive sleep apnoea syndrome: a new reason for involvement of otorhinolaryngologists]. / Casos no diagnosticados de síndrome de apnea obstructiva del sueño: un nuevo motivo de implicación para el otorrinolaringólogo.

INTRODUCTION: In Spain there are around 2 million people with obstructive sleep apnoea syndrome who should be treated. However, less than 10 % have been diagnosed and treated. Untreated patients are associated with a higher risk of cardiovascular and neurological complications, higher accident rates, reduced quality of life and greater health-care consumption. It is necessary, therefore, to reduce these consequences through early diagnosis and treatment. OBJECTIVE: To demonstrate the usefulness of a simple series of questions and examination as a mechanism to detect patients with undiagnosed obstructive sleep apnoea syndrome, in a consultation with a general otorhinolaryngologist. MATERIAL AND METHOD: Five hundred two consecutive patients coming to an otorhinolaryngological consultation for reasons other than sleep pathology were submitted to a series of questions and an examination of upper aerodigestive tract, to search for indications of suspected sleep apnoea. For the different clinical and anatomical comparisons, a control group of 178 consecutive already-diagnosed patients was used. RESULTS: Of the 502 cases, 74 (14.7%) fulfilled the requirements for suspicion and 35 of them agreed to take a polysomnograph test (47.29%). Of this group, an apnoea/ hypopnoea index greater than 5 was found in 24 of the 35 cases (4.78%). CONCLUSIONS: The prevalence of obstructive sleep apnoea in the group of patients studied is greater than that of the general population. With a simple interview and physical examination, a high rate of success can be obtained in the detection of undiagnosed sleep apnoea cases.

Casos no diagnosticados de síndrome de apnea obstructiva del sueño: un nuevo motivo de implicación para el otorrinolaringólogo / Diagnosed cases of obstructive sleep apnoea syndrome: a new reason for involvement of otorhinolaryngologists

Introducción: En España hay alrededor de 2 millones de sujetos portadores de un síndrome de apnea obstructiva del sueño subsidiarios de tratamiento. Sin embargo, tan sólo se ha diagnosticado y tratado menos del 10 %. Los pacientes no tratados tienen un riesgo superior de complicaciones cardiovasculares y neurológicas, mayor accidentabilidad, reducción en calidad de vida y mayores consumos sanitarios. Es necesario, por tanto, reducir estas consecuencias mediante un diagnóstico y un tratamiento precoces. Objetivo: Demostrar la utilidad de un interrogatorio y una exploración sencillos, como mecanismo de detección de pacientes con síndrome de apnea obstructiva del sueño no diagnosticado, en una consulta de otorrinolaringología general. Material y metodo: A 502 pacientes consecutivos, que acuden a la consulta de otorrinolaringología por un motivo diferente de patología de sueño, se los somete a un interrogatorio y la exloración de vías aerodigestivas altas en busca de criterios de sospecha de apnea del sueño. Los casos con sospecha clínica son invitados a realizar una polisomnografía nocturna. Para las diferentes comparaciones clínicas y anatómicas se ha utilizado un grupo control de 178 pacientes consecutivos ya diagnosticados. Resultados: De los 502 casos, 74 (14,7 %) cumplen los requisitos de sospecha y 35 (47,29 %) de ellos acceden a la práctica de la polisomnografía. En este último grupo se obtuvo un índice de apnea/hipopnea (IAH) superior a 5, en 24 de los 35 casos (4,78 %). Conclusiones: La prevalencia de apnea obstructiva del sueño en el grupo de pacientes analizados es superior a la de la población general. Con un sencillo interrogatorio y la exploración física, se puede obtener un alto rendimiento en la detección de casos no diagnosticados de apnea del sueño (AU)

Introduction: In Spain there are around 2 million people with obstructive sleep apnoea syndrome who should be treated. However, less than 10 % have been diagnosed and treated. Untreated patients are associated with a higher risk of cardiovascular and neurological complications, higher accident rates, reduced quality of life and greater health-care consumption. It is necessary, therefore, to reduce these consequences through early diagnosis and treatment. Objective: To demonstrate the usefulness of a simple series of questions and examination as a mechanism to detect patients with undiagnosed obstructive sleep apnoea syndrome, in a consultation with a general otorhinolaryngologist. Material and method: Five hundred two consecutive patients coming to an otorhinolaryngological consultation for reasons other than sleep pathology were submitted to a series of questions and an examination of upper aerodigestive tract, to search for indications of suspected sleep apnoea. For the different clinical and anatomical comparisons, a control group of 178 consecutive already-diagnosed patients was used. Results: Of the 502 cases, 74 (14.7 %) fulfilled the requirements for suspicion and 35 of them agreed to take a polysomnograph test (47.29 %). Of this group, an apnoea/ hypopnoea index greater than 5 was found in 24 of the 35 cases (4.78 %). Conclusions: The prevalence of obstructive sleep apnoea in the group of patients studied is greater than that of the general population. With a simple interview and physical examination, a high rate of success can be obtained in the detection of undiagnosed sleep apnoea cases (AU)