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.

Benefits of the HiRes 120 coding strategy combined with the Harmony processor in an adult European multicentre study.

CONCLUSION: The Harmony processor was found to be reliable, comfortable and offered a substantially increased battery life compared with the previous generation processor. No significant improvement in speech understanding with HiRes was demonstrated from objective measures, but the majority of subjects showed a clear subjective preference for the combination HiRes 120/Harmony processor. OBJECTIVES: To evaluate experience with the Harmony™ sound processor, together with the HiRes 120 strategy. METHODS: Postlingually deafened adults implanted with a CII or HiRes 90K were included and divided into three groups: (1) experienced users using the Platinum body-worn processor; (2) experienced users who had been using other processors; (3) new users with the Harmony processor from first fitting. The latter group entered a randomized crossover protocol where half were initially fitted with HiRes and half with HiRes 120. The initial strategy was used for 3 months and the alternative for a further 3 months. Speech perception tests and questionnaires were performed. RESULTS: The study included 65 subjects. Implementing HiRes 120 was straightforward. The speech test group results did not show significant differences between HiRes and HiRes 120. However, the questionnaires showed significantly higher ratings for HiRes 120 in some instances. Subjects were highly satisfied with the Harmony processor.

Complicaciones y fallos de la implantación coclear / Cochlear implant complications and failures

Introducción: La implantación coclear es una cirugía con poca morbimortalidad que se realiza a pacientes con hipoacusia neurosensorial profunda bilateral. Con el paso del tiempo sus indicaciones han aumentado, y la edad de implantación ha disminuido. Sin embargo, como cualquier cirugía, presenta complicaciones, y dentro de estas el fallo técnico constituye un motivo de preocupación por la inminente necesidad de reimplante. Objetivo: Evaluar las complicaciones derivadas de la implantación coclear, determinar sus causas y discutir el manejo terapéutico. Material y métodos: Se realizó un estudio retrospectivo de los implantes cocleares realizados. Se obtuvieron un total de 246 implantes en un período de 11 años, 123 menores de 10 años y 123 mayores de 10 años. De ellos, 138 hombres y 108 mujeres. Los dispositivos colocados fueron: Advanced Bionics (129), MED-El (95) y Cochlear (22). Se analizaron las complicaciones y los fallos del dispositivo. Resultados: Se reportaron un total de 28 complicaciones, que corresponde a un 11,38%. Encontramos 7 complicaciones menores y 21 mayores, entre las cuales se incluyen 2 casos de mastoiditis y uno de meningitis. El porcentaje de fallos es de 6,5% y constituye la complicación más frecuente. Se reportó un porcentaje de fallos más alto en niños menores de 10 años. Conclusión: La implantación coclear es una técnica con baja incidencia de complicaciones, las cuales suelen resolverse. Sin embargo, el fallo del dispositivo continúa siendo un problema. Es importante estudiar sus causas, ya que esto permitirá desarrollar técnicas y buscar soluciones que permitan disminuir su aparición (AU)

Introduction: Cochlear implantation is a relatively safe surgery performed on profound bilateral hearing loss patients. Its surgical indications have increased and the age of implantation has decreased over the last years. As with any other surgery, it presents complications; device failure is one of the most important, given its potential risk for the need to explant and reimplant the device. Objective: To evaluate cochlear implant complications, determine possible causes and discuss medical and surgical management. Material and methods: A retrospective study of cochlear implants was performed. A total of 246 implants over an eleven-year period were evaluated. The sample consisted of 123 implants in patients younger than 10 years old, and 123 in those older than 10 years old; there were 138 males and 108 females. The devices implanted were 129 Advance Bionics, 95 MED-El, and 22 Cochlear. Complications and device failures were analysed. Results: A total of 28 complications were reported, which corresponds to 11.38% of all implants. Seven minor complications and 21 mayor complications were found. Device Failure was the most frequent complication, reported in 6.5% of all implants, and it was more frequent among children less than 10 years old. Conclusions: Cochlear implant surgery has a low complication rate. Complications are usually resolved easily, but device failure continues to be a problem. It is important to keep studying the causes of such failure to find possible solutions that can lead to lowering and resolving its appearance (AU)

[Cochlear implant complications and failures]. / Complicaciones y fallos de la implantación coclear.

INTRODUCTION: Cochlear implantation is a relatively safe surgery performed on profound bilateral hearing loss patients. Its surgical indications have increased and the age of implantation has decreased over the last years. As with any other surgery, it presents complications; device failure is one of the most important, given its potential risk for the need to explant and reimplant the device. OBJECTIVE: To evaluate cochlear implant complications, determine possible causes and discuss medical and surgical management. MATERIAL AND METHODS: A retrospective study of cochlear implants was performed. A total of 246 implants over an eleven-year period were evaluated. The sample consisted of 123 implants in patients younger than 10 years old, and 123 in those older than 10 years old; there were 138 males and 108 females. The devices implanted were 129 Advance Bionics, 95 MED-El, and 22 Cochlear. Complications and device failures were analysed. RESULTS: A total of 28 complications were reported, which corresponds to 11.38% of all implants. Seven minor complications and 21 mayor complications were found. Device Failure was the most frequent complication, reported in 6.5% of all implants, and it was more frequent among children less than 10 years old. CONCLUSIONS: Cochlear implant surgery has a low complication rate. Complications are usually resolved easily, but device failure continues to be a problem. It is important to keep studying the causes of such failure to find possible solutions that can lead to lowering and resolving its appearance.

[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)

Auditory neuropathy in patients carrying mutations in the otoferlin gene (OTOF).

Inherited hearing impairment affects one in 2,000 newborns. Nonsyndromic prelingual forms are inherited mainly as autosomal recessive traits, for which 16 genes are currently known. Mutations in the genes encoding connexins 26 and 30 account for up to 50% of these cases. However, the individual contribution of the remaining genes to the whole remains undetermined. In addition, for most of the genes there is a need for studies on genotype-phenotype correlations, to identify distinctive clinical features which may direct the molecular diagnosis to specific genes. Here we present a mutation analysis and a genotype-phenotype correlation study on the gene encoding otoferlin (OTOF), responsible for the DFNB9 subtype of prelingual hearing impairment. Four novel mutations were identified: c.2122C>T (p.Arg708Ter), c.4275G>A (p.Trp1425Ter), c.4362+2T>G, and c.5860_5862delATC (p.Ile1954del). A total of 37 subjects with mutations in OTOF were studied clinically. They were phenotypically homogeneous, having profound hearing impairment with very early onset, as shown by pure-tone audiometry and auditory brainstem responses. Magnetic resonance imaging and computed tomography did not reveal any inner ear malformation. Unexpectedly, transient evoked otoacoustic emissions (TEOAEs) were present, either bilaterally or unilaterally in 11 subjects. Altogether, clinical data of these subjects met the diagnostic criteria of auditory neuropathy. A total of 10 subjects had been successfully provided with cochlear implants. The results of our study indicate that genetic diagnosis of subjects with auditory neuropathy and profound hearing impairment should be directed to the otoferlin gene. Our data are of concern to universal screening programs which use TEOAEs as the first detection test for hearing impairment in newborns, since this technique may overlook a nonnegligible proportion of cases.