Autologous Tragal Perichondrium Graft for Vocal Fold Scar and Sulcus Vocalis.

Between 2006 and 2016 in a Tertiary Academic Center, 11 patients underwent phonomicrosurgery with tragal perichondrium graft placement in Reinke's space for the treatment of sulcus (Ford type 2) and vocal fold scar. A total of six patients out of 11 had an additional autologous fat implantation in order to improve the glottic closure. We evaluated the functional outcome using the Spanish validated version of the VHI- 30 before and 6 months after the surgery. We also measured the subjective appreciation of the obtained outcome, a perceptual voice evaluation using GRBAS scale, and changes in videostroboscopy examinations concerning mucosal wave and glottic closure. In the VHI-30 questionnaire, we observed an improvement in all patients (six of which showed an improvement of 50% or more) with statistically significant results (P = 0.003), and no significant differences between sulcus (Ford type 2) and vocal cord scar patients (P = 0.7579). The results obtained from the single question assessing changes in voice quality showed a high improvement in seven patients. According to the GRBAS scale, all cases improved. Concerning the results of the videostroboscopy, two patients obtained very favorable results, eight of them presented a moderate recovery and only one improved slightly. The following complications were identified: two granulomas, a graft extrusion and a tragal infection. The tragal perichondrium used as an autograft in Reinke's space appears to be a safe and satisfactory choice, comparable to other grafts such as temporalis fascia or autologous fat.

Phone Speech Recognition Improvement in Noisy Environment: Use of a Bluetooth Accessory.

OBJECTIVE: To evaluate speech understanding in noise and patient satisfaction using the new Cochlear Wireless Phone Clip device. MATERIAL AND METHODS: Twenty-nine experienced cochlear implant (CI) users (>6 months usage) were situated in a soundproof room where a 65 dB SPL Spanish cocktail noise was generated continuously from 4 loudspeakers. Lists of disyllabic words were presented through the clinic landline telephone to the patients. Patients were tested first holding the phone and then with the Cochlear Phone Clip© paired to the CP910 using various mixing ratios (2:1, 4:1, and Phone Clip© only). RESULTS: Statistically significant (P < .001) improvement of speech recognition performance was found in cell phone usage by wireless transmission and also when using this new device. Kepler questionnaire results showed that before using Phone Clip in everyday life, 55.2% of patients described themselves highly or greatly affected by their deafness for telephone use and 80% moderately to greatly affected. Kim questionnaire results showed statistically significant differences (P < .001) in the subjective satisfaction of the Bluetooth-implemented CI compared to the conventional mode for sound quality, noise interference, and sound accuracy. CONCLUSIONS: The wireless Phone Clip© device helps implanted people to improve subjective and objective speech recognition performance through the phone in noisy environments.

Clinical Validity of Quantified Visually Enhanced Vestibulo-ocular Reflex Test to Detect Horizontal Semicircular Canal Hypofunction.

OBJECTIVE: To investigate the clinical validity of the mathematical measured VVOR test results to detect horizontal semicircular canal hypofunction. STUDY DESIGN: Prospective, nonrandomized, observational study. SETTING: Tertiary referral center, hospital. PATIENTS: Consecutive patients on first time visit to otoneurology unit. INTERVENTION(S): Diagnostic. MAIN OUTCOME MEASURE(S): Values of statistical indicators of clinical validity for VVOR test to detect horizontal canal hypofunction were used considering vHIT horizontal aVOR gain values as gold standard. RESULTS: Area under curve of ROC curve for quantified VVOR testing was 0.92. Head movement frequency on VVOR test and contralateral VVOR gain were identified as significant influence factors of (unilateral) VVOR gain (p < 0.0001) on statistical linear model. CONCLUSIONS: According to the obtained results, the quantified VVOR test has excellent clinical validity for detecting angular horizontal VOR hypofunction.

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.

Utilidad de la petrosectomía subtotal en el tratamiento de la otitis media crónica / Management of chronic otitis media by subtotal petrosectomy

Introducción y Objetivos: La petrosectomía subtotal consiste en la eliminación completa de todas las celdas neumáticas del hueso temporal. La Trompa de Eustaquio se oblitera y el conducto auditivo externo se cierra. El objetivo de este estudio es describir el uso de esta técnica en el manejo de determinados casos de otitis media crónica. Material y Método: Se realiza un estudio retrospectivo de los pacientes intervenidos en nuestro hospital de petrosectomía subtotal para el tratamiento de otitis medias crónicas en un período de 5 años (2008-2012). Se recogieron datos de su historia clínica, exploración otomicroscópica, audiometría, radiología, hallazgos quirúrgicos, complicaciones postquirúrgicas y seguimiento posterior (incluyendo Resonancia magnética con difusión) con un mínimo de 24 meses de seguimiento. Resultados: En este período se realizaron 28 petrosectomías para el tratamiento de otitis medias crónicas. 15 casos fueron secundarias, es decir, el oído ya había sido intervenido con anterioridad y en 13 casos se trató de una actitud primaria. 15 de estos casos no tenían una audición útil. El postoperatorio inmediato transcurrió sin incidencias en todos los casos salvo en uno en el que ocurrió una infección. A largo plazo, debieron reintervenirse dos casos por mostrar la Resonancia restricción en la difusión a los dos años de la cirugía. Conclusiones: La necesidad del empleo de la petrosectomía subtotal en el tratamiento de las otitis medias crónicas es rara pero deberemos tenerlo en cuenta en aquellos casos recurrentes en los que exista una hipoacusia severa a profunda así como en casos con buena reserva coclear si coexiste una complicación añadida (AU)

Introduction and Objectives: Subtotal petrosectomy is the complete exenteration of all air cell tracts of the temporal bone. The isthmus of the Eustachian tube is obliterated and the external auditory canal is closed. The aim of this study was to describe the use of this technique in the management of certain cases of chronic otitis media. Material and Methods: We conducted a retrospective revision of the patients treated in our Institution with this technique for chronic otitis media in a 5-year period (2008-2012). All charts were reviewed and data from the otomicroscopy, audiometry, radiology, surgical findings, postoperative complications and follow-up (including diffusion magnetic resonance imaging, MRI) of a minimum of 24 months were collected. Results: In this period petrosectomy was performed on 28 patients for chronic otitis media. We treated 13 cases as primary cases, while 15 cases were secondary (patients that had already undergone another procedure in that ear). Fifteen cases had no serviceable hearing. Only 1 case had an immediate postoperative complication (infection); during the posterior follow-up, 2 cases had to be reoperated for diffusion restriction in the mastoid area revealed in the MRI 2 years after surgery. Conclusions: A subtotal petrosectomy is rarely performed for the treatment of chronic otitis media. However, it is a technique that we have to keep in mind for the treatment of certain cases where there is recurrence and deep hearing loss, as well as in cases with good cochlear reserve if the disease coexists with other complications (AU)

Management of chronic otitis media by subtotal petrosectomy. / Utilidad de la petrosectomía subtotal en el tratamiento de la otitis media crónica.

INTRODUCTION AND OBJECTIVES: Subtotal petrosectomy is the complete exenteration of all air cell tracts of the temporal bone. The isthmus of the Eustachian tube is obliterated and the external auditory canal is closed. The aim of this study was to describe the use of this technique in the management of certain cases of chronic otitis media. MATERIAL AND METHODS: We conducted a retrospective revision of the patients treated in our Institution with this technique for chronic otitis media in a 5-year period (2008-2012). All charts were reviewed and data from the otomicroscopy, audiometry, radiology, surgical findings, postoperative complications and follow-up (including diffusion magnetic resonance imaging, MRI) of a minimum of 24 months were collected. RESULTS: In this period petrosectomy was performed on 28 patients for chronic otitis media. We treated 13 cases as primary cases, while 15 cases were secondary (patients that had already undergone another procedure in that ear). Fifteen cases had no serviceable hearing. Only 1 case had an immediate postoperative complication (infection); during the posterior follow-up, 2 cases had to be reoperated for diffusion restriction in the mastoid area revealed in the MRI 2 years after surgery. CONCLUSIONS: A subtotal petrosectomy is rarely performed for the treatment of chronic otitis media. However, it is a technique that we have to keep in mind for the treatment of certain cases where there is recurrence and deep hearing loss, as well as in cases with good cochlear reserve if the disease coexists with other complications.

Cirugía del implante osteointegrado: estudio prospectivo empleando incisión lineal sin reducción de tejido subcutáneo / Bone-anchored hearing device surgery: Linear incision without soft tissue reduction. A prospective study

Introducción y objetivos: La técnica quirúrgica clásica para la colocación de los implantes osteointegrados percutáneos implica la reducción del tejido subcutáneo hasta el periostio y esto ocasiona algunas alteraciones estéticas y sensitivas en el área del implante además de las no poco habituales complicaciones infeccioso-inflamatorias locales. El objetivo de este estudio es el análisis de los resultados empleando una técnica de incisión lineal sin reducción de tejido subcutáneo. Material y método: Se realiza un estudio prospectivo de los pacientes de edad adulta intervenidos por medio de esta técnica en nuestro hospital en un período de 14 meses. Se realiza un seguimiento anotándose los hallazgos en la zona periimplante según escala de Holgers en la semana 1, semana 3, semanas 4-6 y a los 3 meses, 6 meses y 12 meses poscirugía. Resultados: Treinta y cuatro casos consecutivos fueron intervenidos que corresponden a 34 pacientes. Respecto a la irritación periimplante, se aprecia que un 15% de los casos presentan un Holgers 1 y 2 en la primera semana, un 20% en la semana 3 y a partir de la semana 4 solo un paciente presentaba un Holgers 1 que se resolvió en la semana 6. Todos los casos de irritación respondieron a medidas tópicas y no se requirió reintervención en ningún caso. Conclusiones: Nuestros resultados indican que esta técnica quirúrgica, además de simplificar la cirugía, favorece la cicatrización y disminuye el número de reacciones colaterales que pueden verse en los casos operados con la técnica tradicional (AU)

Introduction and objectives: The classic surgical procedure for percutaneous bone-anchored hearing devices involves removal of a large area of subcutaneous tissue down to the periosteum. This leads to alopecia and raises the risk of devascularization of the overlying skin with the potential for infection and scarring. The objective of this study was to determine the results of implant placement using a single, linear incision with no underlying soft tissue reduction. Material and method: A prospective study was conducted in our hospital over a period of 14 months in all consecutive surgeries performed using this technique in adults. Patients were reviewed regularly (week 1, week 3, weeks 4-6 and months 3, 6 and 12) to assess wound healing including evaluation with the Holgers scale. Results: Corresponding to 34 patients, 34 cases were consecutively enrolled in this study. We found that 15% of the patients had minor skin reactions during the first visit (Holgers grade 1 or 2); this number raised to 20% in week 3, but at week 4 only 1 patient had a reaction score of 1 (which was solved by week 6). None of the cases required revision surgery and all skin reactions were treated topically. Conclusions: Our results suggest that the tissue preservation technique is a simple and effective insertion technique with a favourable healing process and cosmesis (AU)

Bone-anchored hearing device surgery: Linear incision without soft tissue reduction. A prospective study.

INTRODUCTION AND OBJECTIVES: The classic surgical procedure for percutaneous bone-anchored hearing devices involves removal of a large area of subcutaneous tissue down to the periosteum. This leads to alopecia and raises the risk of devascularization of the overlying skin with the potential for infection and scarring. The objective of this study was to determine the results of implant placement using a single, linear incision with no underlying soft tissue reduction. MATERIAL AND METHOD: A prospective study was conducted in our hospital over a period of 14 months in all consecutive surgeries performed using this technique in adults. Patients were reviewed regularly (week 1, week 3, weeks 4-6 and months 3, 6 and 12) to assess wound healing including evaluation with the Holgers scale. RESULTS: Corresponding to 34 patients, 34 cases were consecutively enrolled in this study. We found that 15% of the patients had minor skin reactions during the first visit (Holgers grade 1 or 2); this number raised to 20% in week 3, but at week 4 only 1 patient had a reaction score of 1 (which was solved by week 6). None of the cases required revision surgery and all skin reactions were treated topically. CONCLUSIONS: Our results suggest that the tissue preservation technique is a simple and effective insertion technique with a favourable healing process and cosmesis.