Variación de la impedancia eléctrica a lo largo de cinco años postimplantación y relación con el umbral de confort máximo (MCL) en adultos portadores de implante coclear / Variation of electrical impedance over 5 years post-implantation and relationship with the maximum comfort level (MCL) in adults with cochlear implants

Introducción El umbral de confort máximo o maximum comfort level (MCL), umbral eléctrico o threshold level (THR) e impedancia eléctrica cambian en el postoperatorio del implante coclear durante meses hasta estabilizarse. El objetivo de este artículo es establecer la variación durante cinco años posquirúrgicos de la impedancia, y su relación con MCL en adultos implantados unilateralmente. Métodos Estudio retrospectivo a cinco años, con 78 pacientes adultos implantados con MED-EL en un hospital terciario desde el año 2000 hasta 2015. Se analizó la variación de impedancia, MCL y relación entre ellos, en electrodos basales (9-12), medios (5-8) y apicales (1-4), realizando análisis inferencial ANOVA de medidas repetidas con comparaciones entre tiempos consecutivos, corregidas con criterio Bonferroni. Resultados Treinta y tres hombres (42,3%) y 45 mujeres (57,7%), con edad media 52,7 ± 14,6 años. Se consideró «estabilidad» el momento del seguimiento sin diferencias estadísticamente significativas entre una visita y la siguiente. Los cambios en la impedancia en electrodos medios dejaron de ser estadísticamente significativos a los tres meses, y en apicales a los seis meses, con valores medios de 5,84 y 6,43 kohms. MCL se estabilizó a los dos años en electrodos basales y apicales, y a los tres años en medios, con valores medios de 24,9, 22,7 y 25,6 qu. Hubo correlación entre MCL e impedancia en electrodos medios hasta 3 meses y en apicales hasta un año. Conclusiones La impedancia eléctrica desciende significativamente en electrodos medios y apicales hasta tres y seis meses. El MCL aumenta significativamente hasta dos años. La impedancia se relaciona con MCL hasta seis meses. (AU)

Introduction The maximum comfort level (MCL), threshold level (THR) and electrical impedance change in the postoperative period of the cochlear implant for months until they stabilize. The objective of this article is to establish the variation during 5 post-surgical years of impedance, and its relationship with MCL in unilaterally implanted adults. Methods Retrospective study over 5 years, with 78 adult patients implanted with MED-EL in a tertiary hospital from the year 2000 to 2015. The variation in impedance, MCL and the relationship between them were analyzed in basal (9-12), medial (5-8) and apical electrodes (1-4), performing an inferential ANOVA analysis of repeated measures with comparisons between consecutive times, corrected with Bonferroni criteria. Results 33 men (42.3%) and 45 women (57.7%), with a mean age of 52.7 ± 14.6 years. “Stability” was considered the time of follow-up without statistically significant differences between one visit and the next. Changes in impedance in medial electrodes ceased to be statistically significant at 3 months, and in apicals at 6 months, with mean values of 5.84 and 6.43 kohms. MCL stabilized at 2 years in basal and apical electrodes, and at 3 years in medial, with mean values of 24.9, 22.7, and 25.6 qu. There was a correlation between MCL and impedance in medium electrodes up to 3 months and in apical ones up to one year. Conclusions Electrical impedance drops significantly in medial and apical electrodes up to 3 and 6 months. MCL increases significantly up to two years. Impedance is related to MCL up to 6 months. (AU)

Variation of electrical impedance over 5 years post-implantation and relationship with the maximum comfort level (MCL) in adults with cochlear implants.

INTRODUCTION: The maximum comfort level (MCL), threshold level (THR) and electrical impedance change in the postoperative period of the cochlear implant for months until they stabilize. The objective of this article is to establish the variation during 5 post-surgical years of impedance, and its relationship with MCL in unilaterally implanted adults. METHODS: Retrospective study over 5 years, with 78 adult patients implanted with MED-EL in a tertiary hospital from the year 2000 to 2015. The variation in impedance, MCL and the relationship between them were analyzed in basal (9-12), medial (5-8) and apical electrodes (1-4), performing an inferential ANOVA analysis of repeated measures with comparisons between consecutive times, corrected with Bonferroni criteria. RESULTS: 33 men (42.3%) and 45 women (57.7%), with a mean age of 52.7±14.6 years. "Stability" was considered the time of follow-up without statistically significant differences between one visit and the next. Changes in impedance in medial electrodes ceased to be statistically significant at 3 months, and in apicals at 6 months, with mean values of 5.84 and 6.43kΩ. MCL stabilized at 2 years in basal and apical electrodes, and at 3 years in medial, with mean values of 24.9, 22.7, and 25.6qu. There was a correlation between MCL and impedance in medium electrodes up to 3 months and in apical ones up to one year. CONCLUSIONS: Electrical impedance drops significantly in medial and apical electrodes up to 3 and 6 months. MCL increases significantly up to two years. Impedance is related to MCL up to 6 months.

Primeras experiencias con el dispositivo osteointegrado Ponto(TM) SuperPower / First experiences with the Ponto(TM) SuperPower osseointegrated device

Los dispositivos auditivos osteointegrados (DAO) Power y SuperPower presentan indicaciones para umbrales en vía ósea de 55 y 65dB, respectivamente. Realizamos un estudio observacional prospectivo de una serie de 6 casos con hipoacusia mixta en los que se realizó implantación del DAO Ponto(TM) SuperPower. Se realizaron previo a la implantación y 6 meses tras la adaptación valoraciones tonales y verbales sin y con ruido de fondo (HINTS). Todos los participantes mostraron mejoría en los resultados tonales y verbales, variando según el grado de hipoacusia contralateral. Cabe destacar los resultados verbales con ruido de fondo donde la mayoría de los pacientes obtuvieron una relación señal ruido entre 2 y 4 dB. Los resultados en los cuestionarios APHAB y GBI mostraron una reducción de la percepción del problema y una mejoría en la calidad de vida, respectivamente. Los resultados presentados reflejan la posibilidad de tratamiento de hipoacusias mixtas con el dispositivo DAO Ponto(TM) SuperPower

Osseointegrated hearing devices Power and SuperPower present indications for bone thresholds of 55 and 65 dB respectively. We conducted a prospective observational study of a series of six cases with mixed hearing loss for whom implantation of the DAO Ponto(TM) Super-Power was performed. Tonal and verbal evaluations without and with background noise (HINTS) were performed prior to implantation and six months after adaptation. All the participants showed improvement in tonal and verbal results, varying according to the degree of contralateral hearing loss. The verbal results with background noise were noteworthy, where most of the patients obtained a signal-to-noise ratio between 2 and 4 dB. The results in the APHAB and GBI questionnaires showed a reduction in the perception of the problem and an improvement in quality of life respectively. The results presented reflect the possibility of treatment of mixed hearing loss with the Ponto(TM) SuperPower device

First experiences with the Ponto™ SuperPower osseointegrated device. / Primeras experiencias con el dispositivo osteointegrado Ponto™ SuperPower.

Osseointegrated hearing devices Power and SuperPower present indications for bone thresholds of 55 and 65 dB respectively. We conducted a prospective observational study of a series of six cases with mixed hearing loss for whom implantation of the DAO Ponto™ Super-Power was performed. Tonal and verbal evaluations without and with background noise (HINTS) were performed prior to implantation and six months after adaptation. All the participants showed improvement in tonal and verbal results, varying according to the degree of contralateral hearing loss. The verbal results with background noise were noteworthy, where most of the patients obtained a signal-to-noise ratio between 2 and 4 dB. The results in the APHAB and GBI questionnaires showed a reduction in the perception of the problem and an improvement in quality of life respectively. The results presented reflect the possibility of treatment of mixed hearing loss with the Ponto™ SuperPower device.

Papiloma invertido de oído medio y hueso temporal / Inverted papilloma of middle ear and temporal bone

No disponible

Valoración audiológica y subjetiva del dispositivo Baha(R) Attract / Audiologic and subjective evaluation of Baha(R) Attract device

Se incluyeron en el estudio 9 pacientes implantados con el dispositivo Baha(R) Attract. A todos los pacientes se les realizó, con y sin el dispositivo, una audiometría tonal en campo libre, una audiometría verbal en campo libre, y una audiometría verbal con ruido de fondo, así como la aplicación de los cuestionarios Glasgow Benefit Inventory (GBI) y Abbreviated Profile of Hearing Aid Benefit (APHAB). Las valoraciones audiológicas con el dispositivo mostraron unos umbrales auditivos promedios de 35,8 dB, con ganancias medias de 25,8 dB. El umbral de recepción verbal promedio con el dispositivo se situó en 37 dB, mostrando una ganancia de 23 dB. Los resultados promedio del umbral de discriminación máxima fueron de 60 dB con el dispositivo. El Baha(R) Attract logra alcanzar unas ganancias auditivas en los pacientes indicados correctamente, con una consiguiente valoración subjetiva positiva por parte de los pacientes, presentando no obstante un efecto atenuativo en su transmisión transcutánea, que le impide alcanzar mayores ganancias (AU)

We included 9 patients implanted with Baha(R) Attract. All our patients were evaluated by free field tonal audiometry, free field verbal audiometry and free field verbal audiometry with background noise, all the tests were performed with and without the device. To evaluate the subjective component of the implantation, we used the Glasgow Benefit Inventory (GBI) and Abbreviated Profile of Hearing Aid Benefit (APHAB). The auditive assessment with the device showed average auditive thresholds of 35.8 dB with improvements of 25.8 dB over the previous situation. Speech reception thresholds were 37 dB with Baha(R) Attract, showing improvements of 23 dB. Maximum discrimination thresholds showed an average gain of 60 dB with the device. Baha (R). Attract achieves auditive improvements in patients for whom it is correctly indicated, with a consequent positive subjective evaluation. This study shows the attenuation effect in transcutaneous transmission, that prevents the device achieving greater improvements (AU)

Audiologic and subjective evaluation of Baha® Attract device. / Valoración audiológica y subjetiva del dispositivo Baha® Attract.

We included 9 patients implanted with Baha® Attract. All our patients were evaluated by free field tonal audiometry, free field verbal audiometry and free field verbal audiometry with background noise, all the tests were performed with and without the device. To evaluate the subjective component of the implantation, we used the Glasgow Benefit Inventory (GBI) and Abbreviated Profile of Hearing Aid Benefit (APHAB). The auditive assessment with the device showed average auditive thresholds of 35.8dB with improvements of 25.8dB over the previous situation. Speech reception thresholds were 37dB with Baha® Attract, showing improvements of 23dB. Maximum discrimination thresholds showed an average gain of 60dB with the device. Baha® Attract achieves auditive improvements in patients for whom it is correctly indicated, with a consequent positive subjective evaluation. This study shows the attenuation effect in transcutaneous transmission, that prevents the device achieving greater improvements.

Electrococleografía extratimpánica en una población normal. Estudio descriptivo / Extra-tympanic electrocochleography in a normal population. A descriptive study

Introducción y objetivos: La electrococleografía extratimpánica es un registro elecrofisiológico que refleja la actividad eléctrica acontecida en la cóclea tras un estímulo sonoro. Se obtiene mediante la aplicación del estímulo en el conducto auditivo externo y el registro de la actividad eléctrica mediante electrodos de superficie. Dada la escasa literatura existente acerca de la exploración electrococleográfica normal en nuestro medio, este estudio busca regularizar los valores obtenidos mediante esta exploración en sujetos sin enfermedad otoneurológica y explicar detalladamente el proceso mediante el cual se obtiene el registro. Métodos: Exploración mediante electrococleografía extratimpánica de 60 oídos sin enfermedad otoneurológica y análisis estadístico de los resultados obtenidos. De ellos, 30 oídos fueron explorados a 90dB mientras que otros 30 oídos fueron estimulados a 80dB. Resultados: Se muestran los valores medios de amplitud y latencia del potencial de sumación y del potencial de acción, así como las latencias medias de la onda I y la onda II. Asimismo, se presenta el cálculo del cociente potencial de sumación/potencial de acción. Obtenidos estos resultados se comparan en función de la intensidad del estímulo, del sexo del paciente, del oído estudiado y del grupo etario. Conclusiones: Este estudio recopila datos sobre la electrococleografía en una población normal. Los valores obtenidos están en el rango de los valores normales de otros países, expuestos en la literatura internacional. Estos datos pueden ser muy útiles como referencia a la hora de valorar exploraciones en pacientes con dolencias que afectan la estructura o la función coclear (AU)

Introduction and objectives: Extra-tympanic electrocochleography is an electrophysiological register obtained after stimulating the cochlea with an audible stimulus. This stimulus is applied using an earphone over the external auditory canal, while the electrical activity is registered by surface electrodes. There are few studies that analyse normal electrocochleography in our environment. Thus, the main objective of our study was to regularize the values obtained with electrocochleography in ears without any otoneurological diseases. We explain in detail the process of obtaining the register. Methods: Sixty healthy ears were studied by extratympanic electrocochleography. Statistical results were analysed. While 30 ears were studied with a stimulus at 90dB, another 30 ears were studied with a stimulus at 80dB. Results: Summating potential and action potential latencies and amplitudes were measured. Summating potential/action potential ratios were calculated. Wave I and wave II latencies were also determined. These results were analysed in function of stimulus intensity, patient gender, patient age group and ear side studied. Conclusions: This study collected extra-tympanic electrocochleography data in a normal population and the results were in the range of other international studies obtained in other countries. These data can be used as a reference to evaluate illnesses that affect cochlear structure or functions (AU)

Estudio comparativo entre implantación coclear uni y bilateral en niños de 1 y 2 años de edad / Comparative study between unilateral and bilateral cochlear implantation in children of 1 and 2 years of age

Introducción: Los estudios que han evaluado la efectividad de los implantes cocleares bilaterales en niños sugieren una mejoría de la capacidad auditiva en cuanto a la localización del sonido y la discriminación del lenguaje. En este trabajo mostramos las diferencias en los logros audio-lingüísticos con la implantación coclear bilateral precoz frente a la unilateral, así como las diferencias entre la implantación bilateral secuencial y simultánea. Material y métodos: Presentamos 88 niños diagnosticados de hipoacusia neurosensorial profunda bilateral tratados mediante implantación coclear bilateral en 32 casos, y unilateral en 56 casos, durante los primeros 12 meses (27 niños) y entre los 12 y 24 meses (61 niños). Se compararon los resultados en la audiometría tonal, en las escalas IT-Mais, Nottingham y LittlEars, así como en las pruebas logoaudiométricas. Resultados: No se detectan diferencias significativas en los umbrales auditivos y en los cuestionarios IT-Mais, Nottingham y LittlEars entre los niños implantados bilateral y unilateralmente, tanto en el primer como en el segundo año. Las pruebas verbales sí que muestran diferencias estadísticamente significativas, ya que los niños con un implante coclear bilateral alcanzan antes el 100% en el reconocimiento de bisílabos y frases, sin que los niños con un solo implante lleguen a igualar dichos resultados a los 5 años de la cirugía. No existen diferencias entre implantación bilateral simultánea y secuencial. Conclusión: Con este estudio remarcamos la importancia de asegurar un buen cribado audiológico precoz, para poder llevar a cabo una implantación coclear temprana, a ser posible bilateral, logrando así un desarrollo de las habilidades audio-lingüísticas equiparable al de los normooyentes (AU)

Introduction: The studies that have evaluated the effectiveness of bilateral cochlear implantation in children suggest an improvement in hearing about sound localization and speech discrimination. In this paper we show the differences in audio-linguistic achievements with early bilateral cochlear implantation versus unilateral, and differences between simultaneous and sequential bilateral implantation. Material and methods: We present 88 children with bilateral profound sensorineural hearing loss, treated with bilateral cochlear implantation in 32 cases and unilateral in 56 cases, during the first 12 months (27 children) of life and between 12 and 24 months (61 children). We conducted a statistical comparison of both groups in the audiometry, IT-Mais, Nottingham, LittlEars scales and verbal tests. Results: No significant differences in hearing thresholds and questionnaires between unilateral and bilateral implantation were detected in either the first or second year. Verbal tests do show statistically significant differences: children with bilateral cochlear implant obtain 100% recognition of disyllabic and phrases within 2-3 years after implantation whilst children with one implant do not obtain those results at 5 years after surgery. No differences between simultaneous and sequential bilateral implantation were detected. Conclusion: We emphasize the importance of ensuring good early audiological screening, to carry out an early and bilateral cochlear implantation with the consequent development of audio-language skills similar to normal hearing children (AU)

Extra-tympanic electrocochleography in a normal population. A descriptive study. / Electrococleografía extratimpánica en una población normal. Estudio descriptivo.

INTRODUCTION AND OBJECTIVES: Extra-tympanic electrocochleography is an electrophysiological register obtained after stimulating the cochlea with an audible stimulus. This stimulus is applied using an earphone over the external auditory canal, while the electrical activity is registered by surface electrodes. There are few studies that analyse normal electrocochleography in our environment. Thus, the main objective of our study was to regularize the values obtained with electrocochleography in ears without any otoneurological diseases. We explain in detail the process of obtaining the register. METHODS: Sixty healthy ears were studied by extratympanic electrocochleography. Statistical results were analysed. While 30 ears were studied with a stimulus at 90dB, another 30 ears were studied with a stimulus at 80dB. RESULTS: Summating potential and action potential latencies and amplitudes were measured. Summating potential/action potential ratios were calculated. Wave I and wave II latencies were also determined. These results were analysed in function of stimulus intensity, patient gender, patient age group and ear side studied. CONCLUSIONS: This study collected extra-tympanic electrocochleography data in a normal population and the results were in the range of other international studies obtained in other countries. These data can be used as a reference to evaluate illnesses that affect cochlear structure or functions.

Comparative study between unilateral and bilateral cochlear implantation in children of 1 and 2 years of age. / Estudio comparativo entre implantación coclear uni y bilateral en niños de 1 y 2 años de edad.

INTRODUCTION: The studies that have evaluated the effectiveness of bilateral cochlear implantation in children suggest an improvement in hearing about sound localization and speech discrimination. In this paper we show the differences in audio-linguistic achievements with early bilateral cochlear implantation versus unilateral, and differences between simultaneous and sequential bilateral implantation. MATERIAL AND METHODS: We present 88 children with bilateral profound sensorineural hearing loss, treated with bilateral cochlear implantation in 32 cases and unilateral in 56 cases, during the first 12 months (27 children) of life and between 12 and 24 months (61 children). We conducted a statistical comparison of both groups in the audiometry, IT-Mais, Nottingham, LittlEars scales and verbal tests. RESULTS: No significant differences in hearing thresholds and questionnaires between unilateral and bilateral implantation were detected in either the first or second year. Verbal tests do show statistically significant differences: children with bilateral cochlear implant obtain 100% recognition of disyllabic and phrases within 2-3 years after implantation whilst children with one implant do not obtain those results at 5 years after surgery. No differences between simultaneous and sequential bilateral implantation were detected. CONCLUSION: We emphasize the importance of ensuring good early audiological screening, to carry out an early and bilateral cochlear implantation with the consequent development of audio-language skills similar to normal hearing children.

Evolución de la otosclerosis hacia la implantación coclear / Evolution of otosclerosis to cochlear implantation

Introducción: La otosclerosis es una osteodistrofia de la cápsula laberíntica que produce hipoacusia de conducción. Si el proceso invade la cóclea, aparece una hipoacusia neurosensorial, siendo el implante coclear una buena alternativa en estos pacientes. Objetivo: Conocer el comportamiento de la otosclerosis en la implantación coclear. Material y métodos: Se revisó una base de datos de 250 pacientes intervenidos de implante coclear realizando un estudio retrospectivo sobre 13 pacientes con criterios clínicos, audiológicos y/o de imagen de otosclerosis bilateral. Se estudian los 26 oídos analizando la historia natural, cirugías previas, evolución hacia hipoacusia profunda, hallazgos en imagen mediante tomografía computarizada, complicaciones y resultados funcionales. Resultados: El 46% fueron mujeres y el 54% hombres con una edad media de 26 años al inicio de la hipoacusia conductiva. La cirugía del estribo fue llevada a cabo en 19 oídos (73%) a una edad media de 29 años y de estos en el 53% se realizó posteriormente un implante coclear. Los resultados de la tomografía computarizada muestran que en el 54% de los oídos existen signos de afectación radiológica en diferente grado. Se registraron un total de 3 complicaciones (23%): un fallo de implante coclear, una estimulación del nervio facial y un acúfeno bilateral. Al año de la implantación obtenemos un porcentaje promedio de aciertos en bisílabos del 80% y del 85% en frases en contexto abierto. Conclusiones: Pacientes que presentan una hipoacusia neurosensorial profunda bilateral secundaria a una otosclerosis se benefician extraordinariamente de la implantación coclear(AU)

Introduction: Otosclerosis is an osteodystrophy of the labyrinthine capsule producing conductive hearing loss. If the process invades the cochlea, a sensorineural hearing loss usually takes place. The cochlear implant is a good alternative in these patients. Objective: To ascertain the behaviour of cochlear implantation in otosclerosis. Material and methods: We reviewed a database of 250 patients that underwent cochlear implantation, performing a retrospective study of 13 patients with clinical, audiological and/or imaging findings of bilateral otosclerosis. The 26 ears were studied as to their natural history, previous surgeries, evolution to profound hearing loss, computed tomography images, complications and functional results. Results: Of the cases studied, 46% were female and 54% were men, with a mean age of 26 years at the onset of conductive hearing loss. Stapes surgery was performed in 19 ears (73%), with a mean patient age of 29 years, and 53% of them underwent cochlear implantation. Computed tomography results showed that there were signs of different degrees of radiological affectation in 54% of the ears. A total of 3 complications took place (23%): implant failure, overstimulation of the facial nerve and bilateral tinnitus were found. One year after implantation, the average percentages of correct 2-syllable words were 80% and 85% in open sentences. Conclusions: Patients having profound bilateral sensorineural hearing loss secondary to otosclerosis obtain great benefit from cochlear implantation(AU)

Evolution of otosclerosis to cochlear implantation.

INTRODUCTION: Otosclerosis is an osteodystrophy of the labyrinthine capsule producing conductive hearing loss. If the process invades the cochlea, a sensorineural hearing loss usually takes place. The cochlear implant is a good alternative in these patients. OBJECTIVE: To ascertain the behaviour of cochlear implantation in otosclerosis. MATERIAL AND METHODS: We reviewed a database of 250 patients that underwent cochlear implantation, performing a retrospective study of 13 patients with clinical, audiological and/or imaging findings of bilateral otosclerosis. The 26 ears were studied as to their natural history, previous surgeries, evolution to profound hearing loss, computed tomography images, complications and functional results. RESULTS: Of the cases studied, 46% were female and 54% were men, with a mean age of 26 years at the onset of conductive hearing loss. Stapes surgery was performed in 19 ears (73%), with a mean patient age of 29 years, and 53% of them underwent cochlear implantation. Computed tomography results showed that there were signs of different degrees of radiological affectation in 54% of the ears. A total of 3 complications took place (23%): implant failure, overstimulation of the facial nerve and bilateral tinnitus were found. One year after implantation, the average percentages of correct 2-syllable words were 80% and 85% in open sentences. CONCLUSIONS: Patients having profound bilateral sensorineural hearing loss secondary to otosclerosis obtain great benefit from cochlear implantation.

[Physiology of bone conduction acoustic stimulation and the importance of high-frequency bone conduction]. / Fisiología de la estimulación sonora por vía ósea y la importancia de la transmisión de las frecuencias agudas por vía ósea.

The phenomenon of bone-conducted sound transmission involves more than just vibration of the skull bones to induce movement of the labyrinthine fluid. This mechanical energy is known to be distributed through the outer, middle and inner ear and identifying the precise contribution of each of these parts to total conductance is difficult. Cochlear fluid inertia is the most important contributing factor to bone-conduction hearing, inertia of the ossicles plays a role in medium-frequency conduction, while cochlear wall compression plays a role in high frequencies.

[Radiosurgery treatment of acoustic neuromas. Our experience]. / Tratamiento del neurinoma del acústico con radiocirugía. Nuestra experiencia.

OBJECTIVE: To evaluate the results and side effects obtained using radiosurgery to treat acoustic neuromas. MATERIAL AND METHOD: Between 1999 and 2004 we treated 30 patients with unilateral acoustic neuromas with a mean age of 54 years old (31-76), a mean follow-up of 34 months (12-54), and tumour size between 4 and 38 millimetres (mean, 16.5). All of them were treated with radiosurgery (24 Gamma Knife and 6 LINAC) with doses of 1200-1300 cGy. RESULTS: Tumour growth control rate (smaller or same size) was 93 % (28/30). In 11 patients there was a post-treatment hearing loss (36.6 %). Trigeminal (3/30) and facial (2/30) neuropathy was transient. CONCLUSIONS: Although microsurgery is the treatment of choice for acoustic neuromas, we consider radiosurgical treatment a valid alternative for selected patients (the elderly, co-morbid conditions, small size, contralateral hearing loss...).

Tratamiento del neurinoma del acústico con radiocirugía. Nuestra experiencia / Radiosurgery treatment of acoustic neuromas. Our experience

Objetivo: Valorar los resultados obtenidos, así como los efectos secundarios derivados del tratamiento con radiocirugía del neurinoma del acústico. Material y método: Entre los años 1999 y 2004, hemos tratado a 30 pacientes afectos de neurinoma del acústico (NA) unilateral, con una media de edad de 54 (31-76) años, un tiempo medio de seguimiento de 34 (12-54) meses y un tamaño que osciló en 4-38 (media, 16,5) mm. Se practicó radiocirugía a todos ellos (24 Gamma Knife y 6 LINAC) a dosis de 1.200-1.300 cGy. Resultados: La tasa de control del crecimiento tumoral fue del 93 % (28/30). Un 36,6 % (11/30) presentó empeoramiento de su nivel de audición postratamiento. La afección del V par (3/30), así como la del VII (2/30), fue transitoria. Conclusiones: Aunque la microcirugía sigue siendo el tratamiento de elección para los NA, consideramos la radiocirugía como una alternativa válida en pacientes seleccionados (edad avanzada, comorbilidad asociada, pequeño tamaño, hipoacusia contralateral, entre otros)

Objective: To evaluate the results and side effects obtained using radiosurgery to treat acoustic neuromas. Material and method: Between 1999 and 2004 we treated 30 patients with unilateral acoustic neuromas with a mean age of 54 years old (31-76), a mean follow-up of 34 months (12-54), and tumour size between 4 and 38 millimetres (mean, 16.5). All of them were treated with radiosurgery (24 Gamma Knife and 6 LINAC) with doses of 1200-1300 cGy. Results: Tumour growth control rate (smaller or same size) was 93 % (28/30). In 11 patients there was a post-treatment hearing loss (36.6 %). Trigeminal (3/30) and facial (2/30) neuropathy was transient. Conclusions: Although microsurgery is the treatment of choice for acoustic neuromas, we consider radiosurgical treatment a valid alternative for selected patients (the elderly, co-morbid conditions, small size, contralateral hearing loss...)