Impact on the first year of life of newborns with gestational infection by SARS-COV-2. Analysis of auditory effects.

Introduction: One of the causes of congenital hearing loss are infections suffered by the mother during pregnancy. The objective of this study was to investigate the effects on hearing in newborns to SARS-CoV-2 seropositive mothers during pregnancy. We also studied the hearing impact in the first year of life of the newborns to investigate whether neonatal infection produced a risk of infantile sensorineural hearing loss. Material and methods: All children born in our center whose mother had been infected with SARS-CoV-2 positive COVID were included and were audiologically studied at two and a half months and at one year of life. All infants were evaluated by brainstem evoked response audiometry (BERA) and auditory steady-state responses (ASSR). Results: The range of the latencies for BERA founded were inside the desired ranges of normality both at two and a half months and at one year of life No significant differences by sex and ears were found in the BERA performed (p > 0,05). The mean ASSR values were found to be significantly below 30 dB in all frequencies studied both at two and a half months, and at one year of life (p < 0,05). Conclusion: There is no association between COVID-19 infection during pregnancy and neonatal hearing loss. Further studies are needed to clarify this field since it is still unclear whether pregnant women infected with SARS-CoV-2 can produce hearing alterations in their newborns according to the current evidence in the literature.

Effect of Tinnitus in Distortion Products Otoacoustic Emissions (DPOAEs) in Normal Hearing Patients.

Tinnitus is a symptom whose pathophysiology remains still unclear. Its diagnosis and treatment is complicated, due to its subjectivity. The generation of tinnitus is commonly linked with the impaired functioning of the outer hair cells (OHC) inside the cochlea. Distortion product otoacoustic emissions (DPOAEs) are the objective test used to assess their activity. This study investigates the cochlear outer hair cell function in patients with tinnitus and normal hearing using DPOAEs. We performed a prospective study of the cochlear function in normal hearing patients complaining of tinnitus by analysing DPOAEs amplitude and signal/noise (S/N) ratio. We gathered a sample of 21 ears from adults that attended to the ENT Department complaining of tinnitus with normal hearing. We compared their results with a control group of 21 ears, with the same demographic characteristics, presenting normal hearing but without tinnitus in order to exclude the influence of age in DPOAEs results. A decreased mean of S/N levels in DPOAEs was found in tinnitus and normal hearing group comparing with control group, although these differences were not statistically significant (p > 0.05). Based on the results, OHC dysfunction is not necessary to experience tinnitus. The majority of the patients that present OHC dysfunction do not present a tinnitus at the moment. Other mechanisms in auditory pathway may be evaluated in the tinnitus development.

Tracheostomy in patients with SARS-CoV-2 reduces time on mechanical ventilation but not intensive care unit stay.

Cross-sectional study to know if tracheostomy influences the time on mechanical ventilation and reduces the ICU stay in patients with SARS-CoV2. From February 14 to May 31, 2020, 29 patients: 23 men and 6 women, with an average age (SD) of 66.4 years (±6,2) required tracheostomy. The average intensive care unit (ICU) stay was 36 days [31-56.5]. The average days on mechanical ventilation was 28,5 days (±9.7). Mean time to tracheostomy was 15.2 days (±9.5) with an average disconnection time after procedure of 11.3 days (±7.4). The average hospital stay was 55 days [39-79]. A directly proportional relation between the number of days of MV and the number of days from ICU admission until tracheostomy showed a significant value of p = 0.008. For each day of delay in tracheostomy, the days of mechanical ventilation were increased by 0.6 days. There was no relation between days to tracheostomy and days to disconnection (p = 0.092). PaO2 / FiO2 (PAFI) before tracheostomy and Simplified Acute Physiology Score III (SAPS III) at admission presented a statistical relation with mortality, with an OR of 1.683 (95%CI; 0.926-2.351; p = 0.078) and an OR of 1.312 (CI95%: 1.011-1.703; p = 0.034) respectively. The length of stay in the ICU until the tracheostomy was not related to the risk of death (p = 0.682). PEEP and PaO2/FiO2 (PAFI) at admission and before tracheostomy and APACHE II, SAPS III and SOFA at admission did not show influence over time on MV. We conclude that the delay in tracheostomy increase the days on mechanical ventilation but does not influence stay or mortality.

Cepstral analysis in patients with a vocal fold motility impairment: advantages of the cepstrum over time-based acoustic analysis.

OBJECTIVES: To determine the usefulness of the smoothed cepstral peak prominence (CPPS) in sustained vowel as objective measure of dysphonia. STUDY DESIGN: This is a retrospective cohort study. 49 patients presenting a vocal cord motility impairment between 2012 and 2018 were included. METHODS: Classical acoustic parameters, including jitter, shimmer and NHR, as well as the CPPS were obtained for each patient with a vocal cord motility impairment confirmed by means of a fiberoptic laryngoscopy. We calculated the S/E ratio of each patient to establish the glottal efficiency. An independent sample t test and a Pearson correlation test were used to compare data. RESULTS: Patients presenting a vocal cord motility impairment present abnormal values of the CPPS. Those patients presenting a vocal cord paralysis present lower values of those presenting a vocal cord paresis, with statistically significant difference (P < 0.005). CPPS and the S/E ratio present a moderate negative correlation (- 0.29). CONCLUSIONS: Subjects with a vocal cord motility impairment present abnormal values for CPPS and those values are lower, the greater the motility impairment is. Therefore, CPPS presents as an objective, measurable and reproducible acoustic parameter of dysphonia that will improve the evaluation of patients presenting vocal pathologies.

Inyección intralesional de corticoide como tratamiento para la estenosis subglótica idiopática / Intralesional corticosteroid injection for treatment of idiopathic subglottic stenosis

No disponible

Applicability of Resonance Tube Phonation in Water for Semi-Occluded Vocal Tract Voice Training and Therapy.

BACKGROUND: Exercises involving tube phonation in water (TPW) have emerged as an alternative to conventional voice therapy techniques. The objective was to determine whether the results of these techniques were comparable to each other for the treatment of voice pathology, as well as to compare the costs implicated in the delivery of each treatment. METHODS: A retrospective, descriptive, and observational study was performed that included all patients evaluated in our voice unit in 2015 who received vocal rehabilitation treatments. They were divided into two groups depending on the treatment technique used. The patients' voice was evaluated subjectively using the GRBAS scale. We compared the clinical results and the specific costs of each technique. RESULTS: A total of 55 patients were studied, of which 28 followed TPW exercises, and 27 underwent supervised vocal rehabilitation (SVR). Most of the patients who received TPW therapy were diagnosed with functional dysphonia, whereas functional-organic dysphonia was the most common pathology in the SVR group. Significant differences were evident when the total GRBAS scores were compared before and after the treatments, yet not when the GRBAS scores were compared between the two rehabilitation techniques. The incremental cost-effectiveness analysis revealed that TPW was less expensive than SVR, with both techniques proving to be equally effective in improving the pathological problems. CONCLUSIONS: TPW is similarly effective as SVR techniques in treating voice pathologies, yet it is significantly cheaper in terms of healthcare costs.

Intratympanic infliximab is a safe and effective rescue therapy for refractory immune-mediated hearing loss.

PURPOSE: To determine the efficacy and safety of the intratympanic infiltration of infliximab at the hearing threshold of patients in follow-up for refractory immune-mediated hearing loss. METHODS: 17 patients were collected with relapses, despite maintenance treatment with oral azathioprine associated or not with oral prednisone at low doses (between 5 and 7.5 ml/day) or refractory relapses to previous intratympanic corticoid treatment being 19 affected ears infiltrated. We measured the hearing threshold by Pure-Tone Average (PTA) 500-3000 Hz, 125-8000 Hz and 250-8000 Hz in pre-infiltration (baseline) and follow-up 3 weeks post-infiltration with auditory threshold at frequencies 125-8000 Hz. RESULTS: The average age was 50.68 years (±15.23 years). After the administration of intratympanic infliximab, an improvement of the hearing threshold was showed in the Pure-Tone Average (PTA) calculated at 500-3000 Hz (p = 0.004), 125-8000 Hz (p = 0.001) and 250-8000 Hz (p = 0.006). An immediate improvement in low frequencies also was observed: 125, 250 and 500 Hz (p = 0.009, p = 0.002 and p < 0.001 respectively) also at 1000 Hz (p = 0.004) and a persistence of the effect at 3 months in the low frequencies: 125 Hz (p = 0.020), 250 Hz (p = 0.006) and 500 Hz (p = 0.002). CONCLUSIONS: Infliximab intratympanic infiltration improves the hearing threshold in patients with immune-mediated hearing loss. The effect of improving the hearing threshold is higher in low frequencies and persists within 3 months of the infiltration. The administration of intratympanic infliximab is an effective and safe technique.