TransOral endoscopic UltraSonic Surgery (TOUSS): a preliminary report of a novel robotless alternative to TORS.

The objective of this study is to describe and evaluate the feasibility of TransOral UltraSonic Surgery (TOUSS), a new endoscopic alternative to transoral robotic surgery for approaching pharyngeal and laryngeal tumours based on ultrasonic scalpel as a resection tool. This is a prospective study on 11 consecutive patients with pharyngeal and supraglottic carcinomas between December 2013 and August 2014. All tumours were resected transorally with 35 cm ThunderbeatTM. Exposure was achieved using GyrusTM FK-retractor and Olympus ENDOEYE Flex 5 mm 2D/10 mm 3D deflecting tip video laparoscopes. We evaluated tumour staging, surgical margins, surgical time, blood transfusions, tracheostomy, enteral feeding, postoperative pain and hospital stay. The operating room setup and procedure are described. This series comprised seven early and four locally advanced carcinomas. The mean setup for TOUSS and resection time were 16 and 70.9 minutes. No major intraoperative complications were identified. The average time of nasogastric feeding tube dependence (n = 9) was 13 days. Gastrostomy was performed in one patient. The average hospital stay was 14.3 days. Postoperative pain was satisfactory treated with nonsteroidal anti-inflammatory drugs. We have described TOUSS as a new feasible and intuitive procedure to approach endoscopically pharyngeal and supraglottic tumours, with good intraoperative conditions and functional outcomes.

Association Between Hearing Loss and Impaired Physical Function, Frailty, and Disability in Older Adults: A Cross-sectional Study.

Importance: Several studies have examined the association between hearing loss (HL) and physical function, with inconsistent results. Few used pure-tone thresholds and considered possible confounders in the association. Objective: To examine the association between hearing loss and impaired lower extremity function, frailty syndrome, and disability in older adults. Design, Setting, and Participants: The Seniors-ENRICA-2 is a cohort study that was established in 2015-2017 in Spain. The present study was conducted from December 2015 to June 2017. Data were analyzed from January 2, 2021, to March 10, 2021. This cross-sectional analysis included 1644 community-dwelling individuals aged 65 years or older (range, 66-91 years) of both sexes. Participants had hearing threshold measurements and data on impaired lower extremity function, frailty syndrome, and disability. Exposures: Hearing loss defined as pure-tone average greater than 40 dB HL in the better ear for standard frequency (0.5, 1, and 2 kHz), speech frequency (0.5, 1, 2, and 4 kHz), and high frequency (3, 4, and 8 kHz). Main Outcomes and Measures: Impaired lower extremity function was defined with the Short Physical Performance Battery; the frailty syndrome was defined as having at least 3 of the 5 criteria, including weakness, slow walking speed, low physical activity, exhaustion, and weight loss; and disability in instrumental activities of daily living (IADL) was evaluated with the Lawton and Brody scale. Results: Of the 1644 participants, 831 were men (50.5%); mean (SD) age was 73.8 (4.3) years. The prevalence of moderate HL was 13.6% at speech frequency. After adjustment for age, sex, lifestyle, comorbidities, impaired cognition, and social isolation, HL in standard frequency was associated with impaired lower extremity function, with an odds ratio (OR) of 2.20 (95% CI, 1.25-3.88); the corresponding estimate for the frailty syndrome was 1.85 (95% CI, 0.98-3.49) and for the IADL disability, was 2.25 (95% CI, 1.29-3.94). When considering speech frequency pure-tone average, HL was also associated with impaired function (OR, 2.59; 95% CI, 1.57-4.28), frailty syndrome (OR, 1.85; 95% CI, 1.06-3.22), and IADL disability (OR, 2.18; 95% CI, 1.32-3.60). Conclusions and Relevance: In this cross-sectional analysis of data from the Seniors-ENRICA-2 cohort study, hearing loss was associated with impaired lower extremity function, frailty syndrome, and IADL disability. It may be useful to examine this association with the mechanisms elucidated in further studies.

Auditory and vestibular assessment of patients with Ménière's disease who suffer Tumarkin attacks.

Tumarkin attacks are a feature of Ménière's disease that generate a significant degree of disability. The surprising nature of these events is the main reason behind their associated morbidity. In this study we set out to evaluate auditory and vestibular function, as well as disability, in a population of patients who suffer Tumarkin attacks. We found that patients who suffer Tumarkin attacks are more disabled and experience severer and more frequent autonomic symptoms and that their hearing level is significantly worse in the asymptomatic ear, especially at low frequencies. Accordingly, we consider that treatment must be carefully planned to be as conservative as possible in terms of hearing and that psychiatric and/or psychological treatment must always be considered as an adjuvant therapy.

[Reconstruction of pharyngeal defects]. / Reconstrucción de defectos faríngeos.

Reconstruction of pharyngeal defects continues to present a clinical challenge for the Head and Neck surgeon. We have different reconstructive options to preserve speech, airway and swallowing functions. Reconstructive surgery implies a balance between oncologic cure, patient morbidity and quality of life. Classical reconstructive techniques include pedicled cervical cutaneous or myocutaneous flaps and distal myocutaneous flaps such as from the pectoralis major. Current microvascular technique options have a differing incidence of complications but always with high success rates. This article reviews the most current options on reconstructive techniques in pharyngeal defects.

Translation and validation of the MD Anderson Dysphagia Inventory (MDADI) for Spanish-speaking patients.

BACKGROUND: The main objective of this study was to perform the adaptation and cultural translation and validation of the MD Anderson Dysphagia Inventory (MDADI) questionnaire for the Spanish language. METHODS: A total of 69 patients were diagnosed with head and neck cancer treated with surgery; radiotherapy and chemoradiotherapy were included. MDADI was translated and a feasibility, internal consistency, test-retest reliability, and construct validity were assessed. RESULTS: The mean overall score of the MDADI was 51.9 (18-85). Internal consistency for total score was 0.908. The overall score of intraclass correlation coefficient was 0.98 and kappa coefficient scores were almost perfect (test-retest reliability). All domains of MDADI were significantly correlated with physical and mental domains of the SF-12. Construct validity was also evaluated with food texture measures, and with TNM classification. CONCLUSION: The translation and validation of the Spanish version of the MDADI was performed and can be considered an important patient-reported outcomes tool for dysphagia-related quality of life.

[Review of audiometric criteria in treatment of neurosensorial deafness with hearing aids and implantable hearing devices]. / Revisión de los criterios audiométricos en el tratamiento de la hipoacusia neurosensorial mediante audífonos y prótesis auditivas implantables.

Sensorineural hearing loss has a high incidence in our population; as a matter of fact, 50% of people above 75 years of age suffer this impairment. Due to the advances in the devices to alleviate this condition and their verified efficacy, it is now appropriate to review the indications for these devices and provide a detailed description of the audioprosthetic systems used. These systems can be classified as external non-implantable devices (hearing aids) and implantable prostheses. The latter can be sub-divided into active implants in the external ear or middle ear, cochlear implants, and auditory brainstem implants (ABI). Indications for each group are determined by the type and location of the underlying condition as well as by the anatomic, functional, and social characteristics of each patient. It must be stressed that the selection and monitoring of the treatment is up to the specialist. Generally speaking, an attempt is made to facilitate the integration of the hypoacusic patients to their sound setting by enhancing their understanding of the spoken word and restoring binaurality, while at the same time, seeking to retain the plasticity of central auditory routes through the stimulation provided by any of these systems. In the course of this review, we refer to newly-emerging indications in both the field of cochlear implants (bimodal stimulation, implantation in patients with residual hearing, bilateral implants, etc) and in the area of ABI in patients with tumoural disease previously treated with radiosurgery or patients with non-tumour pathologies presenting malformations or bilateral cochlear ossification.

Cluster analysis of auditory and vestibular test results in definite Menière's disease.

OBJECTIVES/HYPOTHESIS: To determine whether patients with Menière's disease can be grouped into distinct subtypes based on a cluster analysis of distinct disease parameters. STUDY DESIGN: Prospective study at a tertiary center associated with a university hospital. METHODS: The study included 153 patients diagnosed with unilateral definite Menière's disease. The main variables employed were taken from auditory, vestibular, posturographic, and disability assessments. RESULTS: A four-cluster solution best fitted the data. Each cluster represented a distinct patient profile. Cluster 1 patients (13.1%) were the eldest, with the worst hearing bilaterally and good vestibular function but with a significant postural impact and a low level of disability. Cluster 2 patients (41.2%) were the least affected in all the parameters that were close to normal. Cluster 3 patients (34.6%) were the most affected, experiencing frequent and intense vertigo attacks, and they were visually dependent. Cluster 4 patients (11.1%) had strong asymmetric hearing between both ears and the most uncompensated vestibular deficit; they were moderately disabled. CONCLUSIONS: We have identified four distinct profiles of patients with definite Menière's disease that we consider as "mildly active elderly," "mildly active young," "active compensated," and "active uncompensated." We have demonstrated that only in a restricted population of patients can the American Academy of Otolaryngology-Head and Neck Surgery staging system provide analysis of subtypes of the disease.

Normal and vestibular patterns in dynamic posturography in patients with Meniere's disease.

INTRODUCTION: The Sensory Organization Test of dynamic posturography allows a reliable assessment of the ability of any given patient to maintain a correct stability when conditions in the visual surrounding and/or support surface are deliberately modified. The results of this test can be analyzed according to the norms of the manufacturer of the device or through the application of specific formulae such as those by Cevette. OBJECTIVES: To evaluate if the Cevette formulae distinguish correctly between the normal and vestibular patterns, as well as observing the differences between these two groups of patients (normal and vestibular), obtained either through standardized calculation or by the Cevette formulae. The work has been restricted to patients diagnosed with unilateral Menière's disease who presented an active form of the disease and who had not suffered a recent crisis. MATERIAL AND METHODS: 63 patients were studied who fulfilled the inclusion criteria for this study. A clinical and instrumental audio-vestibular study was carried out. The results of the sensory organization test were analyzed according to the pattern offered by the device and through the application of the Cevette formulae. RESULTS: In 63 patients the pattern obtained was normal or vestibular. In 41 the pattern obtained through one system of analysis or the other coincided but in 22 they did not. The analysis of patients using the Cevette formulae offers a higher capacity for clinical discrimination but is not sensitive to the bias introduced by age; however, combined with the classification offered by the device, it manages to differentiate two populations (normal and vestibular) with a very good audio-vestibular correlation. CONCLUSION: The combined assessment of the results of the sensory organization test using both the equipment analysis and the Cevette formulae provides much better and real information of clinical differences amongst patients with Menière's disease when the result is normal or of vestibular deficiency.

The ice-water caloric test.

CONCLUSIONS: Three possible results are commonly seen after ice-water caloric irrigation and to correctly interpret them the function of the corresponding vestibular receptor and of normal endolymphatic flow must be taken into account. Bedside vestibular examination helps to interpret discrepant findings. OBJECTIVE: To review the findings obtained with the ice-water caloric test in patients with dizziness and to compare the results with those of the bedside test. PATIENTS AND METHODS: The study was undertaken in a university hospital, tertiary medical center. The indications to perform the ice-water caloric test were: 1) unilateral canal weakness >90%; 2) a maximum slow phase velocity of nystagmus after hot (44 degrees C) and cold (30 degrees C) caloric stimulation in either ear of <9 degrees s(-1); or 3) in both ears <15 degrees s(-1). After irrigating the ear with ice water, nystagmus was recorded in the face-up and face-down positions. The result of the test was classified as a response (nystagmus beats away from the irrigated ear in the supine position and changes when in prone), a gravity-independent response (nystagmus does not change in direction in the prone position) or no response. The spontaneous and post head-shaking nystagmus, as well as the results of the head-impulse test, were also analyzed. When indicated, a rotatory chair test was performed. RESULTS: In the 71 patients that displayed unilateral hypofunction, the ice-water test produced a normal response in 24, a gravity-independent response in 31, and no response in 14. In two of these patients a vertical gravity-independent nystagmus response was observed. Bilateral hypofunction was found in 12 patients and the results in the head-impulse test were in agreement with the results in the ice-water test.