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BackgroundTo date, the burden and severity of the full spectrum of bilateral vestibulopathy (BVP) symptoms has not yet been measured in a standardized manner. Since therapeutic interventions aiming to improve BVP symptoms are emerging, the need for a new standardized assessment tool that encompasses the specific aspects of BVP arises. Therefore, the aim of this study was to develop a multi-item Patient Reported Outcome Measure (PROM) that captures the clinically important symptoms of BVP and assesses its impact on daily life.MethodsThe development of the Bilateral Vestibulopathy Questionnaire (BVQ) consisted of two phases: (I) initial item generation and (II) face and content validity testing. Items were derived from a literature review and individual semi-structured interviews focusing on the full spectrum of reported BVP symptoms (I). Subsequently (IIa), individual patient interviews were conducted using “thinking aloud” and concurrent verbal probing techniques to assess the comprehensibility of the instructions, questions and response options, and the relevance, missing domains, or missing items. Interviews continued until saturation of input was reached. Finally, international experts with experience in the field of the physical, emotional, and cognitive symptoms of BVP participated in an online focus group to assess the relevance and comprehensiveness of the BVQ (IIb).ResultsThe BVQ consisted of two sections. The first section included 50 items scored on a six-point Likert scale arranged into seven constructs (i.e., imbalance, oscillopsia, other physical symptoms, cognitive symptoms, emotional symptoms, limitations and behavioral changes and social life). The second section consisted of four items, scored on a visual analog scale from 0 to 100, to inquire about limitations in daily life, perceived health and expectations regarding future recovery. Interviews with BVP patients [n= 8, 50% female, mean age 56 years (range 24–88 years)] and the expert meeting confirmed face and content validity of the developed BVQ.ConclusionThe BVQ, which was developed to assess the spectrum of BVP symptoms and its impact on daily life, proved to have good face and content validity. It can be used to characterize current self-reported symptoms and disability and to evaluate symptom burden before and after therapeutic interventions in future research and clinical practice.

OBJECTIVE To determine and compare audiological and speech/language discrimination results in patients with osteo-integrated auditory devices, by comparing two different systems including different audiological indications in adult population. STUDY DESIGN Descriptive and analytic, cross-sectional, cohort, and retrospective case review. SETTING Tertiary referral center. MATERIALS AND METHODS Fifty patients >14 years old, with conductive, mixed, or unilateral sensorineural hearing loss were compared. The variables studied were the following: pure tone audiometry results, air-bone gap, and the percentage of speech/language discrimination using Disyllabic Word Test. The patients were tested preoperative and 12 months after surgical procedure. Subsequently, a comparative analysis of the both systems was carried out. RESULTS With both implants, pure tone audiometry results and the difference in auditory thresholds and between the air-bone gap improved significantly. Speech discrimination increased significantly after implantation too. A significant difference was observed after implantation of both devices. Patients implanted with one of the implants showed better audiological results, but no significant differences were found with the other device. So, it was shown that the type of device and the type of hearing loss have no influence on the audiological results or complications. CONCLUSION Both implants represent a good choice for audiological rehabilitation in patients with transmissive hearing loss, mixed hearing loss, or unilateral sensorineural hearing loss with a high success and low complication rates.

INTRODUCTION The radiological analysis following a cochlear implantation offers insight into the audiological outcomes of cochlear implant recipients. The wrapping factor (WF) is the most common radiological analysis measuring the modiolar position and depth of insertion of an electrode array. New measurements like the intracochlear position index (ICPI) or the homogeneity factor (HF) can offer more accurate information regarding the electrode's intracochlear position. We have also studied a new method to calculate the WF, by normalizing it with a new methodology (WFn). OBJECTIVES To analyze and compare the results of the WF, ICPI, HF, and WFn obtained using a cone beam computer tomography (CBCT) with the histological analysis on temporal bone. MATERIAL A perimodiolar electrode array (Nucleus Slim CI532) was inserted in three temporal bones. A perfect insertion was performed in the first temporal bone, according to the correct specifications. In the second specimen, a slightly over-inserted electrode was analyzed and in the third specimen a completely over-inserted electrode array was studied. METHOD A CBCT was performed following the implantations and then, a histological analysis with slices perpendicular to the cochlea axis (modiolus). Each measurement was made 10 times by 10 experts (radiologist and otologist) with a total amount of 600 measurements (100 for each data, 3 CBCT and 3 histology). A t test statistical analysis was performed to compare the measurements between CBCT and histology. RESULTS It was observed that the ICPI and the HF correctly identify the three different insertions. Regarding the WF no significant difference in the two over-inserted specimens was found. The ICPI was the only measurement that shows no statistical difference between the CBCT and the histology, so it was considered the most accurate method. Finally, the WF shows a statistical difference between the CBCT and the histology in all cases, indicating the poor value of the radiological method. The WFn analysis includes the modiolar wall length in the measurement. This improves the final result as it reduces the error induced by the size of the cochlea. CONCLUSION The ICPI and the HF provide better radiological information than the WF, regarding the intracochlear position of the electrode array. The most relevant difference is that the ICPI, HF, and WFn include modiolar and lateral wall dimensions, thereby using the diameter of the cochlear duct for the analysis.

To report residual hearing preservation outcomes in patients with low frequency hearing, after cochlear implant (CI) electrode insertion with two types of electrode arrays: one straight and other perimodiolar, when using intraoperative intracochlear electrocochleography (ECochG) during (CI) electrode insertion.Prospective, randomized study.Tertiary referral otology center.Fifteen patients ranging from 33 to 54 years old (mean 51.19). They had been diagnosed with a bilateral, profound sensorineural hearing loss and treated with a unilateral cochlear implant: eight of them with the CI532 and seven of them with the CI522 (Cochlear Ltd, Sydney, Australia).Pure-tone audiometry was performed preoperatively and at 1 and 6 months postoperatively. Interoperatively, intracochlear ECochG was performed using the apical-most electrode. The amplitude of the first harmonic was plotted and monitored in real time by the audiologist-surgeon team during their CI electrode insertion. The different ECoch patterns of the insertion track were recorded and analyzed.In 12 cases ECochG responses were successfully recorded. In three cases no ECochG responses could be recorded with no residual hearing observed postoperatively in two of them. With respect to the first harmonic amplitude changes, we found: four cases with an overall increase in amplitude measured from the beginning of insertion until completion, all of them showed residual hearing (15 dB HL) at 6 months postoperation. Three cases with an increasing amplitude at the beginning of insertion, with a decrease in amplitude as insertion progressed to completion, in two cases dropping of residual hearing (15-30 dB HL) were observed after 6 months postoperation and, in one case, complete residual hearing was observed at 6 months postoperatively. And finally five cases presented amplitudes at the start of insertion with modifications of amplitude during the insertion dynamic, with increasing and descending in amplitude range during the whole insertion, two of them showed residual hearing at 6 months postoperation and three cases a drop of residual hearing (15-30 dB HL) was observed after 6 months postoperation. No statistical differences between CI532 and CI522 electrodes were found. Data of the ECochG responses are also presented (p value ≥ 0.05).ECochG is a useful tool to evaluate the residual hearing in CI patients with straight and perimodiolar cochlear implant. More studies are needed to fully understand the relationship between ECochG and the presence of residual hearing, cochlear trauma, and functional outcomes.

Resumen Introduccion y objetivos En la ultima decada se han producido numerosos y relevantes avances en el tratamiento de la hipoacusia transmisiva y mixta que han desembocado en una ampliacion de las indicaciones de los implantes de conduccion de via osea y la aparicion de nuevos dispositivos. La Comision Cientifica de Audiologia de la Sociedad Espanola de Otorrinolaringologia y Cirugia de Cabeza y Cuello (SEORL-CCC), junto con las comisiones de Otologia y Otoneurologia, ha llevado a cabo una revision del estado actual de los implantes de via osea con la finalidad de ofrecer a los especialistas de Otorrinolaringologia, a los profesionales de la sanidad, a las autoridades sanitarias y a la sociedad en general una guia clinica sobre implantes de conduccion de via osea. Metodos Esta guia clinica sobre implantes de conduccion osea contiene informacion sobre los siguientes temas: 1) definicion y descripcion de los implantes auditivos de via osea; 2) indicaciones actuales y emergentes de los implantes de via osea; compatibilidad y resonancia magnetica, y 3) requisitos organizativos para un programa de implantes de via osea. Resultado y conclusiones La finalidad de esta guia es describir los diferentes sistemas de conduccion osea, sus particularidades e indicaciones, con el objeto de aportar unas coordenadas que ayuden a todos estos agentes en las tomas de decisiones que deban asumir en los diferentes ambitos de responsabilidad en los que estan enmarcados en sus areas de trabajo.

Background: The proximity of the electrode to the modiolar wall may be of interest to investigate the effect of pitch discrimination. This research establishes the relation between these factors and whether perimodiolar positions may provide benefits regarding improved electrode discrimination. Methods: A prospective randomized study including 24 post-lingual deaf adults was performed. A psychoacoustic study was done by using a psychoacoustic research platform. Radiological study, and a cone-beam computed tomography was used to assess post cochlear implantation electrodes’ position. Trans-impedance matrix (TIM) analysis was performed after cochlear implant insertion in all cases, and pupillometry test was also performed. Results: 12 patients received a slim perimodiolar electrode array, and 12 patients received a straight electrode array. Although all the patients showed similar speech test results after 12 months follow-up, those implanted with a perimodiolar electrode obtained better scores in electrode discrimination test and pupillometry test, and showed more homogenous TIM patterns. Conclusions: The better positioning of the electrode array seams to provide a better hearing resolution and less listening effort trans-impedance matrix seems to be a useful tool to analyze positioning of the perimodiolar array.

To investigate the long-term effects of cochlear implants as a treatment for patients with severe to profound neurosensory loss associated with severe tinnitus.Prospective study in 17 adult patients with severe to profound sensorineural hearing loss associated with severe tinnitus, indicated with a Tinnitus Handicap Inventory (THI) score ≥ 58%, and hyperacusis. Measures were made on hearing, tinnitus, hyperacusis and quality of life up to 5 years after activation of the sound processor of the cochlear implant. It was evaluated by using the disyllabic test, THI, visual analogue scale and Glasgow Benefit Inventory questionnaire.60 months after cochlear implantation, improvements in loudness and discomfort of tinnitus, speech discrimination and hyperacusis were observed. Subjects perceive an important subjective benefit upon receiving the cochlear implant.Cochlear implants can be used as treatment for patients with severe to profound sensorineural hearing loss associated with severe tinnitus and hyperacusis with long-term benefits on quality of life and lasting relief of tinnitus.L’annullamento del tinnitus mediante stimolazione elettrica negli adulti: follow-up a lungo termine.Mostrare gli effetti a lungo termine degli impianti cocleari nei pazienti con perdita neurosensoriale grave e profonda, associata ad acufene.Studio prospettico su 17 pazienti adulti con ipoacusia neurosensoriale da grave a profonda associata ad acufene grave, con un punteggio Tinnitus Handicap Inventory (THI) ≥ 58% e iperacusia. Abbiamo analizzato udito, tinnito, iperacusia e qualità della vita durante un follow-up di 5 anni dopo l’attivazione dell’elaboratore del suono dell’impianto cocleare. Mediante test disillabico, abbiam valutato il THI, la scala analogica visiva e il questionario Glasgow Benefit Inventory.60 mesi dopo l’impianto cocleare, si osservano miglioramenti nell’intensità e grado di discomfort da acufene, nella discriminazione del linguaggio ed iperacusia. I soggetti percepiscono un importante beneficio soggettivo post impianto cocleare.gli impianti cocleari possono essere utilizzati come trattamento per i pazienti con ipoacusia neurosensoriale da grave a profonda associata ad acufene grave e iperacusia, poiché si osservano benefici a lungo termine sulla qualità della vita e un sollievo duraturo sull’acufene.

Idiopathic sudden hearing loss (SHL) is a relatively frequent entity in the adult population with unk nown cause in most cases. There are few studies in pediatric age and its diagnosis and management are a challenge for health professionals.To relate macrolide therapy as a causal agent of sudden hearing loss in pediatric patients.3-year-old girl with no relevant pathological history, with normal neonatal hearing screening and age-appropriate language development. She consulted due to an upper airway infectious process, treated on an outpatient basis with azithromycin for 3 days. One week later, she developed bilateral hearing loss, confirmed with Brainstem Auditory Evoked Potentials (BAEP), and started treatment with oral methylprednisolone and intratympanic corticosteroids. During treatment, imaging, laboratory, and genetic studies were performed, ruling out other causes of SHL, so the recent use of macrolides was considered as a possible diagnosis. As no clinical improvement was observed 6 weeks after the treatment, confirmed by the absence of response in the steady-state auditory evoked potentials and BAEP, simultaneous bilateral cochlear implant surgery was carried out. Four years after surgery, the patient showed good speech-language develop ment and adequate school performance.Ototoxicity is a cause that must be considered in the case of SHL in childhood. A multidisciplinary approach will allow effective treatment in these patients, in which early management with an adequate hearing aid will restore hearing and achieve adequate speech development and linguistic competence.

OBJECTIVE To determine the audiological and clinical results of cochlear implantation in children below the age of 12 years old with congenital and acquired single-sided deafness. DESIGN Observational, descriptive, transversal study. MAIN OUTCOME MEASURES Speech reception thresholds, Cortical responses, Auditory Lateralization Test and SSQ questionnaire. PARTICIPANTS Children < 12 implanted for congenital or acquired SSD. RESULTS All the children with congenital SSD showed positive cortical responses. Positive results were obtained in the Auditory Lateralization Test for the following modalities: 0o, 45o and 90o. With respect to the Speech Test, the children with acquired SSD showed the following results: 92% and 100% in recognition and 48% and 68% (Azimuth modalities), Signal CI side 52% and 68% and Signal normal hearing side 44% - 60% (p < 0.05). In both group the processor was used for 6-12 hours. With respect to the SSQ questionnaire results, the parents were more satisfied within the post-operative period than within the pre-operative period (P

Objective: To show that patients with unilateral hearing loss (UHL), with one ear fulfilling cochlear implant (CI) indication criteria, and an additional severe tinnitus handicap can be treated effectively with a CI. Method: A prospective multi-centre study was conducted in five Spanish centres. Sixteen adult patients with UHL and a mean Tinnitus Handicap Inventory (THI) score of at least 58 were implanted. The study design included repeated within-subject measures of quality of life (Health Utility Index Mark 3 [HUI3]), tinnitus (THI, Visual Analogue Scale [VAS] on tinnitus loudness), hearing (Speech, Spatial, and Qualities of Hearing Scale– [SSQ]), and hyperacusis (Test de Hipersensibilidad al Sonido [THS]) up to 12 months after the initial CI fitting. Results: Group data showed significant subjective benefit from CI treatment: the preoperative HUI3 total utility score of 0.45 went up to 0.57 at 6 months and 0.63 at 12 months; the preoperative THI total score of 75 decreased to 40 at 6 months and 35 at 12 months. The preoperative tinnitus loudness VAS score of 8.2 decreased to 2.4 at 6 months and 2.2 at 12 months with the implant “On” and to 6.7 at 6 months and 6.5 at 12 months with the implant “Off.” The preoperative THS total score of 26 decreased to 17 at 12 months. The preoperative SSQ total score of 4.2 increased to 5.1 at 6 months and 6.3 at 12 months. No unanticipated adverse events were reported during the study period. At 12 months after CI activation all subjects (except 1 subject who used the device 6 days a week) wore their devices all day and every day. The primary reason for CI use was split evenly between tinnitus suppression (n = 6) and both hearing and tinnitus (n = 6). Conclusion: A CI should be considered as a treatment option in patients with UHL and a concomitant severe tinnitus handicap. However, appropriate counselling of candidates on the anticipated risks, benefits, and limitations that are inherent to cochlear implantation is imperative.

La hipoacusia súbita (HS) idiopática es una entidad relativamente frecuente en población adulta, y en la mayoría de los casos se desconoce su causa. Hay pocos estudios en edad pediátrica, siendo su diagnóstico y manejo un reto para los profesionales de salud.Objetivo: Relacionar la toma de macrólidos como agente causal de HS en pacientes pediátricos.Caso Clínico: Preescolar de 3 años sin antecedentes patológicos de interés, habiendo pasado screening auditivo neonatal y con desarrollo del lenguaje adecuado a la edad. Consultó por historia de proceso infeccioso de vía aérea superior tratado ambulatoriamente con azitromicina durante 3 días. Después de 1 semana de finalizado el antibiótico, evolucionó con HS bilateral, confirmada con Potenciales Evocados Auditivos de Tronco Cerebral (PEATC). Se trató con metilprednisolona oral y corticoterapia intratimpánica. Paralelamente se completó estudio de imágenes, laboratorio y genético descartando otras causas de HS, quedando como posibilidad diagnóstica el uso reciente de macrólidos. Al no observarse mejoría tras 6 semanas de tratamiento, constatado con la ausencia de respuesta en los Potenciales Evocados Auditivos de estado estable (PEAee) y PEATC, se realizó implantación coclear bilateral simultánea. En los 4 años de seguimiento, evolucionó con buen desarrollo del lenguaje y rendimiento escolar adecuado.Conclusiones: La ototoxicidad se debe tener presente frente a un caso de HS en la infancia. Un abordaje multidisciplinar permitirá un tratamiento eficaz en estos pacientes, en los que un manejo precoz con la ayuda auditiva adecuada permitirá restaurar la audición y alcanzar un desarrollo del habla y una competencia lingüística adecuada.

HYPOTHESIS Modiolar proximity of the cochlear implant electrodes and low impedance values have a positive effect on electrical pitch discrimination. BACKGROUND The proximity of the cochlear electrode to the modiolar wall can determine changes in tissue and fluid environment. With the onset of soft-surgery techniques, the trauma caused during surgery has been reduced, minimizing fibrous growth. METHODS Computed tomography-scan measurements of electrode-inner wall distance and psychoacoustic electrode discrimination tests were done. Neural Response Telemery and impedance data were used in the study. RESULTS It was found that patients fitted with perimodiolar arrays have lower impedance values and smaller electrode-inner wall distances than those fitted with straight arrays. These variables were significantly correlated to electrode discrimination. It was found that a closer distance to the modiolus also results in better electrode discrimination. CONCLUSION Perimodiolar electrodes could be a better solution in terms of pitch discrimination both because they are closer to the modiolus and because their impedance is lower.

Resumen Introduccion y objetivos El conjunto de sintomas relacionados con los trastornos del sistema de equilibrio son comunes en la poblacion general. Sin embargo, hay pocos estudios que cuantifiquen la frecuencia de inicio de los diversos trastornos vestibulares que se presentan en unidades especializadas de otoneurologia. El objetivo de este estudio es establecer la epidemiologia de los trastornos vestibulares,La forma de presentacion y la carga de atencion esperada en una clinica especialista en otoneurologia. Material y metodos Estudio descriptivo observacional retrospectivo sobre los pacientes remitidos a la consulta de Otoneurologia de un centro hospitalario de tercer nivel entre el 1/1/2015 y el 31/12/2015. Resultados Fueron valorados 174 pacientes (121 mujeres y 53 hombres) con una media de edad de 53 ± 17 anos. Durante el periodo de estudio se valoraron 43 individuos por cada 100.000 habitantes. Los pacientes fueron remitidos en su mayoria desde consultas externas de Otorrinolaringologia (36,8%) y desde Atencion Primaria (28,7%). El motivo de consulta mas frecuente fue inestabilidad (40,2%), seguido de vertigo (31%). Los diagnosticos mas frecuentes fueron vertigo posicional paroxistico benigno (28,2%) y migrana vestibular (28,2%) —definida (59%) o probable (41%)—, seguidos de enfermedad de Meniere (13.8%), trastornos de origen vascular (5.7%), mareo subjetivo cronico (4,6%) y neuritis vestibular (4%). Conclusiones Disponer de informacion precisa acerca de la prevalencia e impacto de los trastornos vestibulares es importante para la correcta planificacion de los servicios sanitarios con el objetivo de responder satisfactoriamente a la demanda asistencial esperada en la comunidad. El trastorno mas frecuentemente diagnosticado en una consulta de Otoneurologia es el vertigo posicional paroxistico benigno y la migrana vestibular. Para la comparacion de resultados es indispensable la utilizacion de terminologia sistematica.

Benign paroxysmal positional vertigo (BPPV) is the most frequent type of vertigo. The treatment of canalithiasis of the posterior semicircular canal consists in performing a particle-repositioning maneuver, such as the Epley maneuver (EM). However, the EM is not effective in all cases. The objective of this study is to identify risk factors, which predict the EM failure, among the clinical variables recorded in anamnesis and patient examination. This is an observational prospective multicentric study. All patients presenting with BPPV were recruited and applied the EM and appointed for a follow-up visit 7 days later. The following variables were recorded: sex, age, arterial hypertension, diabetes, hyperlipidemia, smoking habit, alcohol consumption, migraine, osteoporosis, diseases of the inner ear, previous ipsilateral BPPV, previous traumatic brain injury, previous sudden head deceleration, time of evolution, sulpiride or betahistine treatment, experienced symptoms, outcome of the Halmagyi maneuver, laterality, cephalic hyperextension of the neck, intensity of nystagmus, intensity of vertigo, duration of nystagmus, occurrence of orthotropic nystagmus, symptoms immediately after the EM, postural restrictions, and symptoms 7 days after the EM. Significant differences in the rate of loss of nystagmus were found for six variables: hyperlipidemia, previous ipsilateral BPPV, intensity of nystagmus, duration of nystagmus, post-maneuver sweating, and subjective status. The most useful significant variables in the clinical practice to predict the success of the EM are previous BPPV and intensity of nystagmus. In the other significant variables, no physiopathological hypothesis can be formulated or differences between groups are too small.

Introduction and objective Sixty percent of prelingual hearing loss is of genetic origin. A family history of permanent childhood hearing loss is a risk factor. The objective of the study is to determine the relationship between this risk factor and hearing loss. We have evaluated clinical and epidemiological characteristics and related nonsyndromic genetic variation. Material and method This was a retrospective, descriptive and observational study of newborns between January 2007 and December 2010 with family history as risk factor for hearing loss using transient evoked otoacoustic emissions and auditory brainstem response. Results A total of 26,717 children were born. Eight hundred and fifty-seven (3.2%) had family history. Fifty-seven (0.21%) failed to pass the second test. A percentage of 29.1 (n=16) had another risk factor, and 17.8% (n=9) had no classical risk factor. No risk factor was related to the hearing loss except heart disease. Seventy-six point four percent had normal hearing and 23.6% hearing loss. The mean of family members with hearing loss was 1.25. On genetic testing, 82.86% of homozygotes was normal, 11.43% heterozygosity in Connexin 26 gene (35delG), 2.86% R143W heterozygosity in the same gene and 2.86% mutant homozygotes (35delG). We found no relationship between hearing loss and mutated allele. Conclusions The percentage of children with a family history and hearing loss is higher than expected in the general population. The genetic profile requires updating to clarify the relationship between hearing loss and heart disease, family history and the low prevalence in the mutations analyzed.

Resumen Introduccion y objetivo El 60% de las hipoacusias prelinguales tienen un origen genetico. Entre los factores de riesgo se encuentra el antecedente familiar de hipoacusia permanente en la infancia. El objetivo del estudio es conocer la relacion entre este factor de riesgo y la hipoacusia, evaluandose caracteristicas clinico-epidemiologicas y si existe variacion genetica no sindromica relacionada. Material y metodo Estudio retrospectivo, transversal, descriptivo y observacional de los recien nacidos entre enero de 2007 y diciembre de 2010 con factor de riesgo de antecedente familiar de hipoacusia mediante otoemisiones acusticas provocadas transitorias y potenciales evocados auditivos de tronco cerebral. Resultados Nacieron 26.717 ninos. Ochocientos cincuenta y siete (3,2%) tenian antecedente familiar. Cincuenta y siete (0,21%) no pasan segundas otoemisiones. Un 29,1% (n = 16) tenian otro antecedente de riesgo anadido. Un 17,8% (n = 9) tenian factor de riesgo no clasico. Ningun factor de riesgo tenia relacion con la hipoacusia, excepto la cardiopatia. Segun potenciales, el 76,4% tenian normoaudicion y el 23,6%, hipoacusia. La media de familiares hipoacusicos es de 1,25. En test geneticos el 82,86% son homocigosis normal, el 11,43% heterocigosis para mutacion 35delG del gen de la Conexina 26, el 2,86% heterocigosis R143W del mismo gen y el 2,86% homocigosis mutante 35delG. No se encuentra relacion entre hipoacusia y tener un alelo mutado. Conclusiones El porcentaje de ninos con antecedente familiar diagnosticado de hipoacusia es superior a lo esperado en la poblacion general. Es necesaria la actualizacion del perfil genetico para esclarecer la relacion encontrada entre hipoacusia con cardiopatia, el numero de familiares afectos y la baja prevalencia en las mutaciones analizadas.

Introduction and objectives Endoscopic sinus surgery is currently the surgical procedure chosen in cases of sinonasal polyposis refractory to medical treatment. The aim of this study was to show our experience in managing such patients operated using endoscopic sinus surgery. Method A retrospective study of 246 patients with chronic rhinosinusitis and nasal polyps who were operated by endoscopic surgery. We studied the characteristics of the population, symptoms, grade of affectation, complications and recurrences. Results The most frequent comorbidity was asthma (34.6%) and its relationship with Samter's triad (16.3%). Grades 2 and 3 polyposis prevailed according to Lildholdt staging by nasofibroscopy, coinciding with the radiological preoperative staging. The microdebrider did not shorten surgical time but it lowered complications. Reducing the average stay with the use of absorbable haemostatic agents and their effectiveness in controlling haemostasis were statistically significant. We found 23.2% complications, with only one (0.4%) being a major complication; the rest were minor complications, with synechiae as the most frequent (16.3%). Conclusion Endoscopic sinus surgery is a minimally invasive and safe technique. Absorbable haemostatic agents are an effective alternative to get complete and stable haemostasis, reducing mean hospital stay. Synechiae continue being the most frequent complication. The fact that many patients recurred but without complications speaks in favour of a natural evolution of the disease and not of the influence of technique.

Resumen Introduccion y objetivos Actualmente la cirugia endoscopica nasosinusal es el procedimiento quirurgico de eleccion en los casos de poliposis nasosinusal refractaria al tratamiento medico. El objetivo de este estudio es mostrar nuestra experiencia en el manejo de dichos pacientes intervenidos mediante cirugia endoscopica nasosinusal. Metodo Estudio retrospectivo de 246 pacientes con rinosinusitis cronica con polipos intervenidos mediante cirugia endoscopica. Estudiamos las caracteristicas de la poblacion, sintomas, grado de afectacion, complicaciones y recidivas. Resultados La comorbilidad mas frecuente es el asma (34,6%) y su relacion con la triada de Samter (16,3%). Prevalecen los grados 2 y 3 de poliposis segun la estadificacion de Lildholdt por nasofibroscopia coincidiendo con la estadificacion radiologica prequirurgica. El microdebridador no supone acortamiento del tiempo quirurgico pero si disminucion de las complicaciones. La reduccion de la estancia media con el uso de hemostaticos absorbibles y su eficacia en el control de la hemostasia es estadisticamente significativa. Se describen 23,2% de complicaciones; solo una (0,4%) es una complicacion mayor, siendo el resto complicaciones menores, de las que la sinequia es la mas frecuente (16,3%). Conclusion La cirugia endoscopica nasosinusal es una tecnica minimamente invasiva y segura. Los hemostaticos absorbibles son un metodo alternativo eficaz para obtener una completa y estable hemostasia disminuyendo la estancia media hospitalaria. Las sinequias continuan siendo las complicaciones mas frecuentes, y el hecho de que muchos pacientes intervenidos recidiven, pero sin complicaciones, habla en favor de una evolucion natural de la enfermedad y no de la influencia de la tecnica.

Background: The peripheral vestibular end organ is considered to consist of semi-circular canals (SCC) for detection of angular accelerations and the otoliths for detection of linear accelerations. However, otoliths being phylogenetically the oldest part of the vestibular sensory organs are involved in detection of all motions. Summary: This study elaborates on this property of the otolith organ, as this concept can be of importance for the currently designed vestibular implant devices. Key Message: The analysis of the evolution of the inner ear and examination of clinical examples shows the robustness of the otolith system and inhibition capacity of the SCC. The otolith system must be considered superior to the SCC system as illustrated by evolution, clinical evidence, and physical principles.

As the indications for cochlear implant have expanded to include younger patients and individuals with greater degrees of residual hearing, increasing emphasis has been placed on atraumatic surgery and the preservation of the cochlear structure. Here, a descriptive prospective randomized study was performed. It was shown that residual hearing preservation is possible 12 months postoperatively with an atraumatic perimodiolar flexible electrode array CI532® (Cochlear Ltd, Sydney, Australia). Residual hearing preservation, considered as < 15 dB, was obtained in 70% of the cases. Better clinical outcomes and performance could be obtained compared with the previous perimodiolar CI512®, but further research and a longer follow-up are necessary to verify the impact of outcomes.

RESUMEN La hipoacusia representa un importante problema de salud. La dificultad para oir y comunicarse es frustrante para la persona, provocando aislamiento social y baja autoestima, asociandose frecuentemente con depresion y con demencia en la senectud. Hay muy pocas tecnologias en el area sanitaria que se hayan desarrollado tan rapidamente como el Implante Coclear. En este articulo nos centraremos en los aspectos mas importantes, como la innovacion tecnologica, la innovacion en las indicaciones y en la tecnica quirurgica, y como no, en la innovacion en el aspecto educativo y el impacto social. Probablemente queden aspectos por ver, pero en este apartado podremos recoger los aspectos mas importantes de la tecnica que ha revolucionado no solo la otorrinolaringologia como especialidad, sino la forma de abordar un problema medico, social y comunicativo del ser humano.

Introduction: The morphosyntactic aspects of language are important for the interpretation and production of complex messages. Material and Methods: An analytical and descriptive observational study of the morphosyntactic competence in the Spanish language of cochlear implanted children and normal hearing children using the BLOC battery (BLOC-screening version). Results and Discussion: The implanted children showed language skills appropriate for their age, compared with normal hearing children and similar hearing age. It is necessary studies that consider all the patterns and different dimensions of the language. An analysis of the effect of educational models on the acquisition of these patterns should also be considered. Introducción: Los aspectos morfosintácticas del lenguaje son importantes para la interpretación y la producción de mensajes complejos. Material y Métodos: Estudio observacional analítico y descriptivo de la competencia morfosintáctica en el idioma español de niños implantados cocleares y niños oyentes utilizando la batería BLOC (versión BLOC-screening). Resultados y discusión: Los niños implantados mostraron habilidades de lenguaje apropiadas para su edad, comparadas con los niños oyentes y edad auditiva similar. Se necesita un estudio más exhaustivo en muestras mayores y considerar todos los patrones y diferentes dimensiones del lenguaje. También debe considerarse un análisis del efecto de los modelos educativos en la adquisición de estos patrones.

Resumen Introduccion y objetivos La ictericia severa que precisa exanguinotransfusion se ha convertido en una situacion relativamente rara en la actualidad. El 60% de los neonatos a termino y el 80% de los pretermino se pondran ictericos dentro de la primera semana de vida. La hiperbilirrubinemia al nacer es un factor de riesgo asociado a hipoacusia que generalmente se asocia a otros que podrian tener efecto sobre la audicion de manera sinergica. El objetivo del estudio es establecer la relacion entre la hiperbilirrubinemia al nacer como factor de riesgo de hipoacusia neurosensorial en los ninos nacidos en el Complejo Hospitalario Universitario Insular Materno-Infantil de Gran Canaria, periodo 2007-2011. Metodo Estudio retrospectivo de 796 recien nacidos con hiperbilirrubinemia al nacer, mediante otoemisiones acusticas provocadas transitorias y potenciales evocados auditivos de tronco cerebral. Resultados Ciento ochenta y cinco recien nacidos (23,24%) fueron derivados a potenciales evocados auditivos de tronco cerebral. Treinta y cinco recien nacidos (4,39%) presentaron diagnostico de hipoacusia, 18 (51,43%) hipoacusias de transmision, 17 (48,57%) hipoacusias neurosensoriales y de estos 3 con hipoacusia profunda bilateral. La asociacion a otro factor de riesgo se presenta en la mitad de los ninos estudiados, siendo el mas frecuente la exposicion a ototoxicos. Conclusiones El porcentaje de ninos con diagnostico de hipoacusia neurosensorial entre los recien nacidos con hiperbilirrubinemia al nacer es superior a la esperada en la poblacion general. De los diagnosticados de hipoacusias neurosensoriales ninguno presento niveles de bilirrubina indirecta en sangre ≥ 20 mg/dl, el 47% tenian solo la hiperbilirrubinemia al nacer como factor de riesgo mientras que el 53% evidenciaba otro factor de riesgo auditivo asociado.

Resumen Introduccion y objetivos El implante coclear es un procedimiento quirurgico que ha presentado un incremento sustancial, debido a que la poblacion pediatrica es diagnosticada e implantada de forma temprana y al incremento de indicaciones posibles. Este dispositivo tiene el riesgo inherente de presentar fallos en su funcionamiento, siendo esta la causa mas frecuente de explantacion. Nuestro objetivo es conocer las causas que en nuestra serie nos han llevado a ello y confirmar si se ajusta a la realidad segun lo revisado en la literatura medica. Metodos Estudio retrospectivo observacional y descriptivo de 859 cirugias de implante coclear, realizadas entre octubre de 1991 y mayo de 2011. Las causas de explantacion fueron clasificadas segun el Consenso Europeo de Fallos y Explantaciones de los Implantes Cocleares. Resultados La tasa de reimplantacion fue de 6,16% (n = 51). La causa mas frecuente de explantacion fue el fallo tecnico del dispositivo (45,5%), seguida de infeccion/rechazo del implante (23,6%) y actualizacion del mismo (12,7%). Entre las causas menos frecuentes se encontraron 3 casos (5,6%) por malinsercion de los electrodos, 2 casos (3,6%) de fallo por osificacion, 2 (3,6%) por traumatismo craneoencefalico, 2 (3,6%) por realizacion de resonancia nuclear magnetica y un caso (1,8%) por enfermedad psiquiatrica. Conclusiones La reimplantacion coclear es un procedimiento seguro, que presenta una baja tasa de complicaciones. En nuestro centro alcanza una tasa global de 6,16%. El fallo tecnico del dispositivo sigue siendo la causa mas frecuente de este procedimiento, con un importante porcentaje de reimplantes por actualizacion del dispositivo.

BackgroundRegardless of gestational age, any newborn (NB) with a weight at birth of Material and MethodsRetrospective study of 364 NBs with birth weight ResultsFrom 1 January 2007 to 31 December 2010, a total of 26,708 subjects were included in the hearing screening program. Out of these, 364 were NBs of VLBW. Out of 112 NBs with VLBW, 76 (67.8%) had an ABR test done. Of these, 22 showed signs of hearing loss. Eight of them (36.4%) were diagnosed with sensorioneural hearing loss (SNHL), and out of these, 2 infants had bilateral profound SNHL. The risk factor for hearing loss most frequently associated with VLBW was the use of ototoxic medications.ConclusionsHearing loss diagnosis among VLBW NBs is higher than the percentage in the general population. All subjects diagnosed with hearing loss were very premature infants and had one or two other auditory risk factors associated with their VLBW.

HYPOTHESIS Subjects with normal hearing (NH) experience lower performance in speech understanding in noise when frequency components of speech above 8 kHz are removed. BACKGROUND Previous studies have explored speech perception in noise under various circumstances, but none have been specifically designed to explore the relevance of frequencies above 8 kHz and, more specifically, for the Spanish language. METHODS Twenty-nine subjects with NH, aged 19 to 55 years, and native speakers of the Spanish language listened to two sets of three disyllabic word lists with background noise. One set of words was unfiltered and included frequency components up to 22 kHz, and another set was band-pass filtered to include frequency components between 70 Hz and 8 kHz. Words were presented at 65 dB sound pressure level. Each set of words was presented with background noise with the same bandwidth limit as the accompanying list and adjusted to construct signal-to-noise ratio (SNR) conditions of +5, 0, and -5 dB. RESULTS Results demonstrate a higher performance for unfiltered words at +5 and -5 dB SNR, although not at 0 dB SNR. For SNR +5 dB and -5 dB, the average success rate in word recognition was 17% higher when words were not filtered. For the case SNR = 0, however, both conditions yield statistically similar results. CONCLUSION This study suggests that high-frequency components above 8 kHz contribute to speech understanding in noise for subjects with NH of the Spanish language. Given these findings, it would be interesting to determine if bandwidth limitations in current hearing prostheses may contribute to known difficulties with perception of speech in noise in hearing-impaired subjects.

OBJECTIVES To compare the outcome of the Epley maneuver (EM) in benign paroxysmal positional vertigo of the posterior canal (CSP-BPPV) depending on the definition used for recovery. DESIGN Multicenter observational prospective study. SETTING Otoneurology Units of 5 tertiary reference hospitals. PARTICIPANTS All patients presenting with unilateral CSP-BPPV assisted for 1-year period. EXCLUSION CRITERIA Spontaneous nystagmus, positive McClure-Pagnini maneuver, positive bilateral Dix-Hallpike maneuver (DHM), positive DHM for vertigo but negative for nystagmus and atypical nystagmus. MAIN OUTCOME MEASURES Response to EM was measured after 7 days in 3 different outcomes: disappearance of nystagmus during the DHM in the follow-up visit, disappearance of vertigo during the DHM and general status (GS) during daily life activities. RESULTS 264 patients were recruited (68 male/166 female, mean age 62 years). After the EM, nystagmus disappeared in 67% of them, vertigo in 54% and 36% were asymptomatic in their daily life. These outcomes were strongly correlated, but they were not concordant in a clinically significant group of cases; only the 26% of patients met all of them. The healing process follows the next sequence: negativization of positional nystagmus, then disappearance of positional vertigo and, finally, the improvement of GS during daily life activities. CONCLUSION Nowadays, healing criteria for the resolution of an PSC-BPPV episode have not been specifically defined yet. Provided that other otoneurological disorders have been ruled out, the next resolution criterion is proposed: absence of nystagmus and specifically during control DHM and disappearance of symptoms during daily life activities.

Introduction and goals During the last decade there have been multiple and relevant advances in conduction and mixed hearing loss treatment. These advances and the appearance of new devices have extended the indications for bone-conduction implants. The Scientific Committee of Audiology of the Sociedad Espanola de Otorrinolaringologia y Cirugia de Cabeza y Cuello SEORL-CCC (Spanish Society of Otolaryngology and Head and Neck Surgery), together with the Otology and Otoneurology Committees, have undertaken a review of the current state of bone-conduction devices with updated information, to provide a clinical guideline on bone-conduction implants for otorhinolaryngology specialists, health professionals, health authorities and society in general. Methods This clinical guideline on bone-conduction implants contains information on the following: (1) Definition and description of bone-conduction devices; (2) Current and upcoming indications for bone conduction devices: Magnetic resonance compatibility; (3) Organisation requirements for a bone-conduction implant programme. Results and conclusions The purpose of this guideline is to describe the different bone-conduction implants, their characteristics and their indications, and to provide coordinated instructions for all the above-mentioned agents for decision making within their specific work areas.

Objective Electrical stimulation of the utricular and saccular portions of the vestibular nerve improves stability in patients suffering from vestibular dysfunction. The main objective of this study was to evaluate a new technique, vestibular response telemetry (VRT), for measuring the electrically evoked vestibular compound action potential (saccular and utricular) after stimulating the otolith organ (saccular and utricular) in adults. This study used evidence that the otolith organ can be electrically stimulated in order to develop a new vestibular implant design to improve the sensation of gravitoinertial acceleration. Materials and methods Four adult patients were evaluated by using a variety of measurement procedures with novel VRT software. VRT values were obtained by stimulating with three full-band Nucleus CI24RE (ST) electrodes. Specific stimuli were used. Simultaneously, electrical ocular vestibular evoked myogenic potentials (eoVEMPs) were recorded in the contralateral side. Results Electrically evoked compound action potentials were obtained in 10 of the 12 electrodes tested, and eoVEMPs were recorded when VRT was present. In addition to the validation of this technique, a set of default clinical test parameters was established. The VRT response morphology consisted of a biphasic waveform with an initial negative peak (N1) followed by a positive peak (P1), and latencies were typically 400 μs for N1 and 800 μs for P1. The consequences for the development of a vestibular implant for the improvement of gravitoinertial acceleration sensation are also presented. Conclusion The VRT measurement technique has been shown to be a useful tool to record neural response on the otolith organ, and thus it is a convenient tool to evaluate whether the implanted electrodes provide a neural response or not. This can be used for the early development of vestibular implants to improve gravitoinertial acceleration sensation.

This study evaluates the design of a thin perimodiolar cochlear implant electrode array (CI532) and assesses insertion-related rotation and fold-over.The study consisted on a cochlear model and temporal bone insertion studies. Twenty insertions were studied, under four different surgical insertion conditions in vitro, the intracochlear disposition of the electrode array and presence of tip fold over were recorded. Also, eight fresh human temporal bones were studied after insertion in two conditions: correct alignment of the electrode array during the insertion and misaligned. These surgical situations were investigated within this study using a video recording of the dynamics of insertion techniques and X-ray, including fluoroscopy, Cone Beam CT, and digital imaging analysis.For electrodes inserted with a correct surgical technique, the placement was perfect, within the scala tympani. The wrapping factor was 0.53, and the perimodiolar distance was below 0.3 mm, with a mean insertion depth of 405°.A perimodiolar position can be achieved with the new CI532 electrode array. The new electrode also seems to be reliable for atraumatic intracochlear placement in scala tympani (ST).

The aim of the present study is to evaluate the effect of electrode discrimination based on electrode to modiolus distance in different cochlear implant models, using image information to estimate the outcomes after an implantation on electrode discrimination METHODS: A descriptive prospective randomized study performed during 16 months. A psychoacoustic platform was used to evaluate patients' electrode discrimination capabilities of patients. For the acquisition of the images, a cone beam computed tomography was used to assess postcochlear implantation of electrodes' position. We considered two other new measurements: the intracochlear position index, which indicates how far is the electrode from the modiolar wall, and the homogeneity factor (HF), which provides us with information about the distance between the electrodes and the modiolus RESULTS: 21 postlingually deaf adults showing different CI models [CI522 (n = 7), CI512 (n = 7), and CI532 (n = 7)] that corresponded to the lateral and perimodiolar array electrodes. The average success rate of the CI522 group was 47%, of the CI512 group was 48%, and of the CI532 group was 77%. There is statistically significant difference between groups CI532-CI522 (p = 0.0033) and CI532-CI512 (p = 0.0027) CONCLUSION: The Nucleus CI532 offers a better perimodiolar placement. HF and IPI measurements provide information about the electrodes location inside the cochlea, being related to electrode discrimination.

This paper presents a new procedure to design optimal electrodes for cochlear implants. The main objective of this study is to find a set of electrode designs that maximize the focalization and minimize the power consumption simultaneously. To achieve that, a criterion to measure the ability of focalization of an electrode is proposed. It is presented a procedure to determine (1) the electrical potential induced by an electrode by solving the Laplace equation through the finite element method; (2) the response of a neuron to an applied field using NEURON, a compartmentalized cell model; (3) the optimization to find the best electrode designs according to power consumption and focalization by 2 evolutionary multiobjective methods based on the non-dominated sorting genetic algorithm II: a straight multiobjective approach and a seeded multiobjective approach. An electrode design formed by 2 conductive rings with a possible difference of potential between them is proposed. It is analyzed that the response of the neuron is determined by the shape and the difference of the potential between the electrode rings. Our procedure successfully achieves a nondominated set of optimum electrode designs improving a standard electrode in both objectives, as designs with better focalization allow to include extra electrodes in the cochlear implant, and designs with lower power consumption extend the length of the battery.

To assess the hearing threshold and linguistic results of cochlear implanted children aged 10 months to 5 years, when they reached the age of 12. We studied the benefits of sequential bilateral implantation.This is an observational, descriptive, transversal study comprising 57 cochlear implanted subjects. We performed a free field tonal audiometry at 65dB SPL, speech tests and sentences in quiet and noise (SNR+10) tests. The Objective and Criterial Language Battery (BLOC) was used to assess linguistic competence, in its screening version.Children implanted under the age of 2 and with inter-implant period less than or equal to 4 years reached better statistically significant results in disyllabic and sentences with and without noise (p=0.006) tests and in the disyllabic test with noise (p=0.045) (the hardest speech test). This suggests the acquisition of binaurality, as opposed to children implanted after this age, with inter-implant period longer than 4 years, who do not reach the same performance levels.of language development in the group implanted at ages 10 months to 2 years are better with respect to implanted children at ages 3-5 (0.05) in both unilateral and bilateral implanted children in relation to the age of implantation.Children with pre-lingual deafness implanted before the age of 2, when they are 12 years old obtain more benefits in their language development and in their linguistic competence than children implanted after this age. The audiology results are better in children implanted bilaterally under the age of 2.

Introduction and objective Music is a universal, cross-cultural phenomenon. Perception and enjoyment of music are still not solved with current technological objectives of cochlear implants. The objective of this article was to advance the development and validation of a method of programming of cochlear implants that implements a frequency allocation strategy. We compared standard programming vs frequency programming in every subject. Methods We studied a total of 40 patients with cochlear implants. Each patient was programmed with an optimal version of the standard program, using the Custom Sound Suite 3.2 cochlear platform. Speech tests in silence were performed using syllable word lists from the protocol for the assessment of hearing in the Spanish language. Patients implanted bilaterally were tested in both ears at the same time. For assessing music listening habits we used the Munich Music Questionnaire and “MACarena” (minimum auditory capability) software. Results All patients achieved better results in recognition, instrument tests and tonal scales with frequency programming ( P P Conclusions Frequency programming achieves better perception and recognition results in patients in comparison with standard programming. Bilateral stimulation patients have better perception of musical patterns and better performance in recognition of tonal scales, harmonics and musical instruments compared with patients with unilateral stimulation. Modification and frequency allocation during programming allows decreased levels of current intensity and increase the dynamic range, which allows mapping of each audio band less obtrusively and improves the quality of representation of the signal.

Resumen Introduccion y objetivo La musica es un fenomeno universal y transcultural. La percepcion y el disfrute de la musica son objetivos aun no solucionados completamente con la tecnologia actual de los implantes cocleares. El objetivo de este articulo es avanzar hacia el desarrollo y la validacion de un metodo de programacion para implantes cocleares donde se implementa una estrategia de asignacion frecuencial. Se comparan la programacion estandar frente a la programacion de asignacion frecuencial, en cada sujeto. Metodo Se estudian cuarenta pacientes portadores de implante coclear. Se realiza ajuste y optimizacion del programa estandar, luego programacion de asignacion frecuencial utilizando Custom Sound Suite de Cochlear, version 3.2. Para las pruebas de habla se utilizo el protocolo para la valoracion de la audicion en lengua espanola. En implantados bilaterales se exploraron ambos oidos a la vez. Para los habitos musicales se utilizo el Cuestionario de Musica de Munich y el software «MACarena». Resultados Todos los pacientes presentan mejores resultados en reconocimiento de instrumentos, escalas tonales, reconocimiento de armonicos y tono con la programacion frecuencial (p Conclusiones La programacion frecuencial asignada a la fundamental mejora la percepcion y reconocimiento musical comparada con la programacion estandar. Implantados bilaterales presentan mejor percepcion de patrones musicales, escalas tonales, armonicas e instrumentos. Esta forma de programacion permite disminucion de niveles de intensidad de corriente e incremento del rango dinamico, y esto lleva a un mapeo de cada banda de audio menos molesta mejorando la calidad de la senal.

Resumen Introduccion y objetivos La neurofibromatosis tipo ii (NFII) es una enfermedad infrecuente de herencia autosomica dominante que se caracteriza por la aparicion de schwanomas del viii par, alteraciones oculares y meningiomas. Se estima una incidencia de NFII de 1:25.000 y una prevalencia mayor de 1:80.000. Los objetivos de nuestro estudio fueron determinar la prevalencia puntual de NFII en la Comunidad de Cantabria y la provincia de Las Palmas, asi como caracterizar sus manifestaciones de cabeza y cuello. Material y metodos Se trata de un estudio poblacional, retrospectivo, en 3 hospitales de tercer nivel. Resultados El estudio poblacional mostro una prevalencia puntual de 1:600.000 en la Comunidad de Cantabria y 1:280.000 en la provincia de Las Palmas. El tumor mas frecuentemente diagnosticado fue el neurinoma del acustico (n = 15), seguido del neurinoma del trigemino (n = 2) y del vago (n = 1). Conclusiones La NF II en Cantabria y Las Palmas es infrecuente, menor a la descrita en la literatura. El tumor de cabeza y cuello mas frecuentemente descrito en la literatura es el neurinoma del acustico seguido del schwanoma del v y del x par. Estan descritos aisladamente otros tumores, como el schwanoma nasal, laringeo, de chorda timpanae o del vii par. La manifestacion ORL mas frecuente es la hipoacusia, sobre todo unilateral, seguida de masa cervical, acufenos y cefalea. Un diagnostico precoz y el manejo multidisciplinar en centros especializados podrian mejorar la esperanza y calidad de vida en estos pacientes.

Introduction and objectives Neurofibromatosis type 2 (NF2) is an infrequent autosomal dominant disease characterised by the appearance of VIII nerve schwannomas, meningiomas and ocular abnormalities. Incidence of 1:25 000 and prevalence above 1:80 000 are estimated in general. The objectives of our study were to determine current prevalence of NF2 in the Community of Cantabria and the province of Las Palmas, and its head and neck manifestations. Material and methods This was a population-based, retrospective study in 3 tertiary hospitals. Results The study population showed prevalence of 1:600 000 in the Community of Cantabria and 1:280 000 in the province of Las Palmas. The most frequently diagnosed tumour was acoustic neuroma (n = 15), followed by trigeminal neurinoma (n = 2) and vagus (n = 1). Conclusions Cases of NF2 are infrequent in Cantabria and Las Palmas, lower than that reported in the literature. The most frequently described head and neck tumour in the literature is acoustic neuroma, followed by schwannoma of cranial nerves V and X. Other tumours such as nasal, laryngeal, chorda tympani or cranial nerve VII schwannomas are also described. The most frequent ENT manifestation is hearing loss, especially unilateral, followed by cervical mass, tinnitus and headache. Early diagnosis and multidisciplinary management in specialised centres could improve life expectancy and quality of life for these patients.

Introduction and objectives Some studies suggest that simultaneous or sequential cochlear implantation in a short period of time offers additional benefits. There is a controversy regarding the existence of an age limit after which a second implantation offers less benefit for the acquisition of communication skills. The objectives of this study were to confirm that sequential cochlear implantation offers benefits compared to unilateral implantation and to study whether, at 12 years of age, there are significant differences regarding the age at the time of the second implantation. Methods Descriptive and observational study of a population of 12-year-old children carrying cochlear implants (n=69). A liminal pure tone audiometry and an open-field verbal discrimination test (disyllables, common phrases in an open context, with and without noise) were conducted to evaluate audiological benefits. Results Verbal discrimination results were better among patients who had been implanted before the age of 2 years, although the differences were not statistically significant (P>.5). Children who had received bilateral cochlear implants before the age of 2 years and with a period less than 4 years between both implants presented better verbal discrimination percentages (P Conclusions In our sample, early cochlear implantation with a short period between both implants provided significant benefits regarding intelligibility. There seem to be a specific age and interimplant period, after which the auditory benefit on the first implant becomes reduced.

Resumen Introduccion y objetivos Algunos estudios sugieren que la implantacion coclear (IC) simultanea o secuencial en un corto periodo de tiempo aporta beneficios adicionales. Existe controversia acerca de la existencia de una edad limite a partir de la cual la segunda implantacion aporta un beneficio menor en la adquisicion de habilidades comunicativas. Los objetivos de nuestro estudio consisten en corroborar que la implantacion coclear secuencial aporta beneficios sobre la unilateral, y estudiar si existen a los 12 anos diferencias significativas segun la edad en el momento de la segunda implantacion. Metodos Se trata de un estudio observacional descriptivo sobre una poblacion de 12 anos portadores de implante coclear (n = 69). Para evaluar los beneficios audiologicos se llevo a cabo una audiometria tonal liminar y un test de discriminacion verbal a campo libre (bisilabos, frases cotidianas en contexto abierto, con y sin ruido). Resultados Los resultados en terminos de discriminacion verbal fueron mejores en los pacientes implantados antes de los 2 anos de edad, sin embargo no existen diferencias estadisticamente significativas (p > 0,5). Los usuarios de IC bilateral implantados antes de los 2 anos y con un periodo entre interimplante inferior a 4 anos muestran mejores porcentajes de discriminacion verbal (p Conclusiones La implantacion coclear precoz y con un corto periodo interimplante demuestra en nuestra muestra proveer a los pacientes beneficios significativos en terminos de inteligibilidad. Parece haber una edad y un periodo interimplante concreto a partir de la cual se reduce el beneficio auditivo sobre el primer implante.

Introduction and objective: Hearing plays an essential role in the acquisition, development and maintenance of the properties of the speech and language. Birth weight is an indicator of biological maturation of the newborn. Premature newborns with very low birth weight (VLBW

Resumen Introduccion y objetivo La audicion cumple un rol fundamental en la adquisicion, desarrollo y mantenimiento de las propiedades del habla y del lenguaje. El peso al nacer es un indicador de maduracion biologica del recien nacido (RN). El RN con muy bajo peso al nacer (MBPN ≤ 1500 g) y el gran prematuro es un grupo de poblacion de mayor riesgo para hipoacusia neurosensorial. El objetivo del estudio es conocer el grado de hipoacusia, presencia de hipoacusia neurosensorial y la asociacion a otro factor de riesgo para hipoacusia en el RN de MBPN, incluidos en el Programa de Cribaje Universal de la Hipoacusia del Complejo Hospitalario Universitario Insular Materno Infantil de Gran Canaria, periodo 2007-2010. Material y metodo Estudio retrospectivo de 364 RN con MBPN, mediante otoemisiones acusticas provocadas transitorias y potenciales evocados auditivos de tronco cerebral. Resultados Ciento doce RN (30.8%) fueron derivados a potenciales evocados auditivos de tronco cerebral. Veintidos RN (2,2%) presentaron diagnostico de hipoacusia, 14 hipoacusias de transmision, 8 hipoacusias neurosensoriales (HNS), y de estos, 2 con hipoacusia profunda bilateral. La asociacion a otro factor de riesgo de los RN con MBPN se presenta en mas de la cuarta parte de la muestra estudiada. Todos los diagnosticados de HNS fueron grandes prematuros. Conclusiones El porcentaje de ninos con diagnostico de hipoacusia entre los RN con MBPN es superior al esperado en la poblacion general. Todos los diagnosticados de HNS fueron grandes prematuros y presentaban uno o 2 factores de riesgo auditivo mas, asociados al MBPN.

Resumen Introduccion y objetivos La hipoacusia neonatal es un problema de salud publica, que cumple los requisitos para ser sometido a cribado universal. El objetivo de este articulo es analizar los resultados obtenidos en el programa de deteccion precoz de la hipoacusia implementado en nuestro centro desde enero de 2007 hasta diciembre de 2010. Metodos Se estudiaron 26.717 recien nacidos mediante otoemisiones acusticas transitorias (OEAT) en la fase de cribado auditivo. La etapa diagnostica fue llevada a cabo en la unidad de hipoacusia del servicio. Resultados En el periodo entre enero de 2007 y diciembre de 2010 nacieron 27.935 ninos. Se practico el screening a 26.717, de los cuales 24.173 presentaron OEAT positivas, 1.040 tuvieron OEAT ausentes y 1.504 presentaron OEAT en un oido estando ausentes en el oido contralateral. Presentaron factores de riesgo asociado para hipoacusia 4.674 recien nacidos. En una segunda fase del programa se practico OEAT a 5.156 ninos, de los cuales 4.626 presentaron otoemisiones positivas en ambos oidos, 323 no presentaron otoemisiones en un oido y 207 no pasaron esta segunda fase. Fueron derivados a potenciales evocados auditivos de tronco cerebral (PEATC) un 3,8% del total de ninos estudiados. Veintiseis ninos ingresaron al programa de implantes cocleares. Nuestro programa de deteccion precoz de la hipoacusia alcanzo una cobertura del 95,64%. Conclusiones El programa de deteccion precoz de la hipoacusia de nuestro complejo es adecuado a nuestro funcionamiento, alcanzando una cobertura del 95,64% considerandose muy positiva la relacion existente entre eficacia y eficiencia.