Bonebridge® bone conduction implant. Hearing outcomes and quality of life in patients with conductive/mixed hearing loss.

PURPOSE: The aim of this study was to analyze the hearing outcomes and quality of life in a series of 52 patients affected by conductive or mixed hearing loss and treated with Bonebridge®. METHODS: 52 of 71 patients implanted with Bonebridge® between October 2012 and January 2022, were included in the study. We compared the air conduction thresholds at the frequencies 500, 1000, 2000, 3000, 4000 Hz, the SRT50% and the World Recognition Score at an intensity of 50 dB with and without the implant. The Abbreviated Profile of Hearing Aid Benefit (APHAB) was employed to assess the quality of life of patients. RESULTS: The liminal tone audiometry (free field) pure tone average for air conduction after 6 months with the implant was 35.12 dB, obtaining a mean gain of 31.83 dB. With Bonebridge®, the mean SRT was 34.17 dB, whereas before the surgery no patient achieved 50% of correct answers at a sound intensity of 50 dB. The world recognition score at 50 dB changed from 11% without the implant to 85% with it. We observed one case of implant failure and one case of implant exposure. The APHAB questionnaire showed an improvement after implantation in practically all the subscales. CONCLUSIONS: The hearing outcomes and the subjective benefits reported by patients obtained in our study are similar to those published in the literature. Bonebridge® represents an excellent method for the rehabilitation of patients with conductive and mixed hearing loss, showing a low rate of complications.

Role of Intratympanic Dexamethasone for Intractable Posterior Canal Benign Paroxysmal Positional Vertigo.

BACKGROUND: Benign paroxysmal positional vertigo is a frequent diagnosed disorder, most of the patients are successfully treated with reposition maneuvers. In between 3-12.5% of these patients remain symptomatic. Recent studies support the use of intratympanic corticosteroid for intractable vertigo with promising results. MATERIAL AND METHODS: Patients diagnosed with benign paroxysmal positional vertigo between June 2017 and December 2019 in a tertiary university hospital and in two private hospitals were included in the study and analyzed prospectively. They were treated and followed with repositioning maneuvers and intratympanic dexamethasone injections if the criteria was met. RESULTS: 4 out 72 patients included in the study developed criteria for intractable vertigo after at least 6 repositioning maneuvers. The posterior semicircular canal was affected in all cases, 3 out of 4 patients experienced symptom resolution, after two, four and five intratympanic dexamethasone injections respectively. CONCLUSIONS: The use of intratympanic steroids to treat patients with refractory benign paroxysmal positional vertigo showed encouraging results. We believe a multicenter randomized clinical trial should be performed to assess the efficacy of intratympanic steroids in the treatment of this pathology.

Oropharyngeal reconstruction with buccinator myomucosal island flaps: Functional outcomes and quality of life. A retrospective observational study.

Background: The buccinator myomucosal island flaps are an excellent option for "like with like" oropharyngeal reconstruction in selected cases. We report a series of 15 patients and discuss the functional outcomes. Methods: From January 1, 2020 to February 31, 2023, 15 patients underwent oropharyngeal tumor resection and reconstruction with myomucosal island flaps. Buccal artery myomucosal island flap and tunnelized facial artery myomucosal island flap were used in 10 and 5 patients, respectively. In four cases, a total soft palate reconstruction was performed. Before removing the nasogastric tube, a videoendoscopy was performed in all cases to assess postoperative swallowing. Functional assessment was evaluated after a follow-up of at least 12 months. Speech intelligibility and patient speech perception were assessed using the Hirose's 10-point scoring system and the Voice Handicap Index. Dysphagia was assessed using the Dysphagia Outcome and Severity Scale and the Dysphagia Handicap Index. Finally, donor site morbidity was analyzed, and quality of life was assessed using the European Organization for Research and Treatment of Cancer (EORTC) Core Quality of Life Questionnaire (QLQ-C30). Results: The median length of hospital stay was 10.5 days. Nasal feeding tube was removed on average in 8.6 days after surgery, and all patients were able to tolerate an oral soft diet. Intelligibility was very good in all cases. No major complications were detected, and donor site morbidity was low. Global quality of life was acceptable in all cases. Conclusions: Buccinator myomucosal island flaps represent a very interesting and versatile option for the functional reconstruction of oropharyngeal defects up to 7-8 cm. Level of Evidence: IV.

Myomucosal island flaps for oropharyngeal reconstruction.

The oropharynx represents one of the most challenging areas to reconstruct for the head and neck surgeon. The buccinator myomucosal island flaps pedicled on the facial artery [tunnelized facial artery myomucosal island flap (t-FAMMIF)] or the buccal artery [buccal artery myomucosal island flap (BAMMIF)] are an ideal reconstructive option for moderate size defects measuring up to 8-9cm. Two fresh specimens have been used to show the step-by-step surgical technique of both island flaps. Design and flap extension, dissection plane, identification of the vascular pedicle, flap rotation and insetting are described. Reconstructive indications and the pros and cons of each one are discussed in this article. Myomucosal island flaps represent a very useful and versatile option for the functional reconstruction of the oropharynx. A detailed knowledge of the vascular anatomy of the cheek is key to obtain a large flap while minimizing the risk of complications.

Right colonic interposition for severe pharyngoesophageal stricture in head and neck patients: A feasible rescue strategy after multiple failed reconstructive options.

Severe pharyngeal stricture is an uncommon complication that may occur afer laryngectomy especially in irradiated patients. Its management is a challenge and high risk of recurrence after reconstruction exists. We present two patients with severe end-stage pharyngoesophageal stricture after several failed attempts of reconstruction with regional and free flaps, in which a right colon transposition was performed. Twenty days after surgery both patients were able to tolerate an oral diet, and no minor or major complications were observed. Right colonic transposition may be a valid option for secondary pharyngeal reconstruction if other less invasive methods such as regional or free flaps have failed to restore the pharyngoesophageal continuity or if the inferior location of stricture makes a tension free anastomosis impossible.

Historical dimensions of population structure in a continuously distributed marine species: The case of the endemic Chilean dolphin.

The complementarity of historical and contemporary processes contributes to understanding the genetic structure of continuously distributed marine species with high dispersal capabilities. Cephalorhynchus eutropia, has a continuous coastal distribution with strong genetic differentiation identified by nuclear DNA markers. We explored the historical dimension of this genetic differentiation between northern and southern populations to evaluate phylogeographic structure. Additionally, we conducted mtDNA and microsatellite analyses to detect past and recent demographic changes. The southern population was characterized by lower genetic diversity with a signal of population expansion, likely associated with ice retreat and habitat extension after the Last Glacial Maximum (LGM). In contrast, structure within the northern population was more consistent with stable historical population size. Approximate Bayesian Computation analyses suggested that during the LGM, C. eutropia persisted in the northern area; while the south was colonized by dispersal ~11,000 years ago followed by population expansion. This study shows that Chilean dolphin population structure is consistent with predictions from the Expansion-Contraction biogeographic model, with a poleward post-glacial shift revealed in current genetic structure. The results also confirm the validity of the population units previously identified, demonstrating their historical origin and highlighting the utility of integrating genetic markers with different temporal scale resolutions.