Hyperglycemia after intratympanic dexamethasone treatment in a diabetic patient.

The treatment of patients with idiopathic sudden sensorineural hearing loss must be performed as an emergency measure in order to prevent long term hearing deficit. Steroids in monotherapy provide the best outcome. There is some controversy regarding the most efficient route but in order to prevent side effects, intratympanic treatment is the preferred choice, especially in diabetic patients. We here present the case of a patient that developed hyperglycemia after systemic and intratympanic dexamethasone treatment for sudden hearing loss. We conclude that after intratympanic treatment great caution must be taken.

Auditory brainstem implants: past, present and future prospects.

The purpose of the auditory brainstem implant (ABI) is to directly stimulate the cochlear nucleus complex and offer restoration of hearing in patients suffering from profound retrocochlear sensorineural hearing loss. Electrical stimulation of the auditory pathway via an ABI has been proven to be a safe and effective procedure. The function of current ABIs is similar to that of cochlear implants in terms of device hardware with the exception of the electrode array and the sound-signal processing mechanism. The main limitation of ABI is that electrical stimulation is performed on the surface of the cochlear nuclei, thereby making impractical the selective activation of deeper layers by corresponding optimal frequencies. In this article, we review the anatomical, and experimental basis of ABIs and the indications, and surgical technique for their implantation. To the best of our knowledge, we describe the first pathology images of the cochlear nucleus in a patient who had received an ABI.

[Analysis of the cochlear implant as a treatment technique for profound hearing loss in pre and postlocutive patients]. / Evaluación del implante coclear como técnica de tratamiento de la hipoacusia profunda en pacientes pre y post locutivos.

INTRODUCTION: These are the objectives planned for this study: 1. Evaluate the results from the communication point of view. 2. Evaluate the cochlear implant (CI) impact on the quality of life. 3. Evaluate medical complications and technical failures. 4. Assess direct and indirect costs generated during the phases of a cochlear implantation programme. 5. Determine which factors have a high impact on the clinical evolution and the financial cost. MATERIALS AND METHOD: A population of 877 patients, postlingual and prelingual, adults and children, have been studied. They were treated in 5 Spanish centres with cochlear implant programmes. Audiometric tests and global questionnaires on life quality have been carried out. Medical and CI technology complications have also been computed. Direct and indirect economic costs of a cochlear implant have been calculated. RESULTS: Postlocutive-implanted patients reached the 40 dB SPL threshold in the Pure Tone Audiometry, and this result was maintained during the 12-year evolution. In Vowels test, it evolved from a 30% on pre-stimulation to 80-90%, in Disyllables words test it evolved from a 10% to a 50-60%, and in CID Sentences test it evolved from an 18% to a 60-70%. In the prelocutive population, results were influenced by the child's age at implantation. The best results were obtained by the children who had been implanted earlier. Those implanted between 0 and 3 years old evolved in the Vowels test from 0% during pre-stimulation to 95%, from a 0% to a 90% in Disyllables words test and from a 0% to a 90-95% in CID Sentences test. Also, the speech acquisition and development of the pre-locutive population was also influenced by the implantation age. An 80% of postlocutive adult patients stated a mood and sociability improvement after the cochlear implantation. They did not show health changes in general nor relevant modifications in the attention they usually received from relatives and friends. Severe medical-surgical complications were registered for a 3.42% of the cases, a 7.06% of mild medical-surgical complications and a 3.07% of technical breakdowns in the internal components of the CI. Financial cost of implantation for a post-locutive adult oscillated between 36,912 Euro and 37,048 Euro, and between 37,689 Euro and 44,273 Euro for a pre-locutive child. CONCLUSIONS: Cochlear implants clearly enhance communication skills of the implantees. Results obtained for the prelocutive implanted population justify the creation of hearing screening programmes in new-borns. Postlocutive implanted adults have expressed satisfaction for the results obtained. However, they did perceive some limitations in situations of unfavourable acoustic conditions. An analysis of direct and indirect costs related to a CI programme has been made. It may be useful to carry out reports on the cost-benefit ratio in this field. The low index of complications observed shows which cochlear implant treatment technique complies with the adequate safety margins. The factors influencing the most in the evolution are: duration of hearing deprivation, age at implantation, cochlear anatomy and functionality of the auditory pathway, patient's and relative's motivation, and the coexistence of other handicaps associated to hearing losses.

[Salivary gland choristoma (hamartoma) of the middle ear: a case report]. / Cas clinique : choristome de glande salivaire au niveau de l'oreille moyenne.

OBJECTIVE: Middle ear salivary gland choristoma are extremly rare. We report a case, describe the clinical management and review the literature. CLINICAL CASE: A 12 year old boy presented with unilateral conductive hearing loss associated with a large inferior retraction pocket on otoscopy. CT scan demonstrated a large mass in the left middle ear cavity. The incus was absent and the stapes was partially eroded. Middle ear exploration demonstrated an 8 mm yellow/red mass in the region of the fallopian canal. This mass was comptly removed and histopathology confirmed salivary gland choristoma. CONCLUSION: These lesions result from an abnormal development of the second branchial arch. It is important to consider these lesions as part of the differential diagnosis for any unilateral hearing loss associated with a middle ear mass in children.

Traditional and emerging indications in cochlear and auditory brainstem implants.

Electrical stimulation of the auditory pathway via a cochlear or an auditory brainstem implant has been proved to an effective and safe procedure in the treatment of many patients suffering from a profound sensorineural hearing loss of cochlear and retrocochlear origin. In this paper we will present the impact of experience, technical advances in the design of auditory implants, and improvements in stimulation strategies in traditional criteria for implantation. Besides current indications for cochlear and auditory brainstem implants, we will review a continuously expanding group of potential candidates, namely emerging indications. This review will be exemplified with data from the University of Navarra Cochlear Implant Program, currently accounting for more than 500 patients implanted.

[Surgery for Atresia auris. Retrospective study of our results and correlation with Jahrsdoerfer prognostic criterium]. / Cirugía de la Atresia auris. Estudio retrospectivo de nuestros resultados y correlación con los criterios pronósticos de Jahrsdoerfer.

OBJECTIVES: The study goal was to evaluate the hearing follow up results in patients who underwent surgery for congenital aural atresia. We studied hearing results and correlated them with Jahrsdoerfer prognostic classification. Protocols management of unilateral and bilateral atresia auris are written considering to our results and other authors. METHODS: We conducted a retrospective review of 12 ears who underwent surgery for congenital aural atresia between 1989 and 2002. CT scan was used to evaluate Jahrsdoerfer prognostic classification and the correlation with the hearing results. RESULTS: There are significant statistical differences (p = 0.003) in air-bone gap closure before and after surgery, also a lineal significant correlation (p = 0.016) between Jahrsdoerfer prognostic classification and air-bone gap closure. CONCLUSION: Atresiaplasty surgery in individuals with congenital aural atresia can yield good hearing results in selected cases.

Sobre el término `desinervación' / Regarding the term `denervation'

No disponible

Audición y lenguaje en niños menores de 2 años tratados con implantación coclear / Hearing and speech in children under 2 years of age with a cochlear implant

Fundamento. Valorar los resultados auditivos y de lenguaje en niños con una sordera congénita tratados mediante implantación coclear antes de los 2 años de edad y analizar las complicaciones surgidas en el proceso de selección, cirugía, programación y seguimiento de estos niños.Material y métodos. Se estudiaron 130 niños de forma prospectiva mediante la comparación de sus resultados individuales repetidos. Los niños se dividieron en dos grupos de edad: menores de 2 años (n=36) y niños entre 2 y 6 años (n=94). La valoración preoperatoria incluyó: 1. Historia, exploración física y ORL. 2. Valoración neuropediátrica, familiar y psicológica. 3. Potenciales auditivos troncoencefálicos. 4. Tomografía computarizada de alta resolución de peñascos. 5. Consejo terapéutico y consentimiento informado. La audición y el lenguaje se valoraron, antes y anualmente después de la cirugía (hasta 5 años), mediante pruebas logoaudiométricas en contexto cerrado y abierto, y con la prueba de Peabody y las escalas de Reynell. Resultados. La audición y el lenguaje mejoraron significativamente en todos los niños, independientemente de su edad. Los resultados, sin embargo, fueron mejores en los niños implantados antes de 2 años. Las pruebas de lenguaje mostraron que el desarrollo del lenguaje en estos niños es comparable al de niños normo-oyentes. La tasa de complicaciones no aumentó en los niños menores de 2 años. Conclusiones. La implantación coclear antes de los 2 años, ofrece unos resultados auditivos y de lenguaje mejores y más rápidos, en comparación con los alcanzados por niños de mayor edad, sin aumento de las complicaciones (AU)

[Hearing and speech in children under 2 years of age with a cochlear implant]. / Audición y lenguaje en niños menores de 2 años tratados con implantación coclear.

BACKGROUND: To compare the auditory abilities and speech performance of children with a profound prelingual bilateral hearing impairment, treated with a cochlear implant (CI) before or after 2 years of age. To analyze the complications arising during the selection process of the children, or as a result of the implantation, programming and follow-up. METHODS: Prospective cohort single-subject repeated-measures study of 130 children who received an implant at our center. The children were divided into two age groups: 0-2 (n=36), and 2-6 years of age (n=94). Preoperative evaluation included: 1. History, physical exploration, and ENT examination. 2. Neuropaediatric examination, family evaluation, and psychological assessment. 3. Auditory brainstem responses. 4. High resolution computed tomogram of temporal bones. 5. Counseling and informed consent. The children were evaluated prior to, and each year following, the intervention (for up to 5 years), using closed and open-set logoaudiometric tests, and speech perception tests. Speech was evaluated according to the Peabody Picture Vocabulary and Reynell general oral expression scale. RESULTS: Auditory and speech perception tests improved significantly in all children after CI, regardless of the follow-up time. The infant's performance was better in the group of early implantees. Speech tests showed that the development of children treated before 2 years of age was similar to that of normal children. No additional complications were observed when compared to CI in older children. CONCLUSIONS: When performed before 2 years of age, CI offers a quicker and better improvement of performance, with no increase in complications when compared with a later intervention.

[Laryngeal metastasis from colloid adenocarcinoma of the colon: report of a case]. / Metástasis laríngea de adenocarcinoma coloide de colon: a propósito de un caso.

Metastatic involvement of the laryngeal is very rare, with around 150 cases reported to the literature. In eight of these cases, the primary tumor was a colon adenocarcinoma. We report the case of a 80 year-old woman treated of a colloid adenocarcinoma of 7 years earlier, referred to us for chronic and progressive dyspnea. Endoscopic examination showed a subglottic spherical mass, which caused an important compromise of the respiratory airway. Tomographic studies revealed also a thyroid mass. The patient was treated with a tracheostomy, resection of the subglottic mass (with intraoperative diagnosis of "mucin producing tumor"), and total thyroidectomy. The final pathologic diagnosis of the subglottic mass was a metastasis of colloid adenocarcinoma of the colon. In the literature reviewed there are no previous reports of metastatic involvement of the larynx with this type of colon adenocarcinoma. We discuss the clinical and radiological findings, and therapeutic options for metastasis to the larynx, as well as pathological differential diagnosis.

Anestesia general intubada en primates para cirugía otoneurológica experimental / General anesthesia by intubation in primates in experimental otoneurologic surgery

Introducción: En este trabajo aportamos nuestra experiencia en el manejo anestésico y quirúrgico de primates (M. fascicularis) en un procedimiento de cirugía otoneurológica experimental. Material y Métodos: Veintiún primates adultos fueron sometidos a la sección translaberíntica del VIII par craneal. Seguidamente, en 14 animales se colocó unilateralmente un prototipo de implante auditivo en el tronco cerebral para estimular en superficie a los núcleos cocleares. Como medicación pre-anestésica se usó una mezcla en inyección intramuscular de clorhidrato de ketamina, midazolam y sulfato de atropina. El procedimiento quirúrgico se realizó bajo anestesia general con intubación, conseguida tras la administración de propofol (1.5 mg/kg) y mantenida con óxido nitroso y halotano. Resultados: La mezcla de clorhidrato de ketamina, midazolam y sulfato de atropina produjo una anestesia profunda en 4ñ1.7 minutos, lo que permitió la manipulación segura de los animales. La intubación nasotraqueal atraumática, evitando el uso de miorrelajantes, fue posible en todos los animales sin dificultades. Los animales se mantuvieron adecuadamente anestesiados, sin presentar incidencias destacables durante la cirugía, y fueron extubados a los 10ñ2.5 minutos después del cese de la administración de óxido nitroso y halotano. Tampoco hubo complicaciones destacables desde el punto de vista quirúrgico. Conclusiones: Aportamos una técnica anestésica que proporciona una inmovilización y anestesia óptimas para el trabajo otoneurológico experimental con primates. Esta técnica permite una rápida recuperación anestésica y suprime el uso de relajantes musculares para la intubación, por lo que podría ser usada de forma segura en otros tipos de procedimientos quirúrgicos (AU)

[Synchronous osteochondroid hamartoma and squamous cell carcinoma of the larynx]. / Hamartoma osteocondroide y carcinoma epidermoide de laringe sincrónicos.

BACKGROUND: Soft-tissue tumors of the larynx are rare, especially hamartomas. Fewer than a dozen well-documented cases have been described. We report the case of a 65 year-old man diagnosed of a synchronous epithelial tumor of the right vocal fold and a soft-tissue tumor of the contralateral lamina of the thyroid cartilage. METHODS: CT scan revealed a low-attenuating, expansive mass involving the left ala of the thyroid cartilage without airway compromise airway. The lesion contained small, scattered calcifications and the mucosa was intact, suggesting a cartilaginous tumor. The patient underwent endoscopic resection of the right vocal fold tumor and subtotal resection of the left ala of the thyroid via median thyrotomy. RESULTS: Pathology revealed a squamous-cell carcinoma of the vocal fold and an osteochondroid hamartoma within the thyroid cartilage. The management of patients with laryngeal lesions suggestive of a cartilaginous nature is discussed. CONCLUSIONS: To our knowledge, this is the first case of a synchronous laryngeal hamartoma and carcinoma reported in the literature.

Experimental study following inactive implantation of an auditory brain stem implant in nonhuman primates.

We report changes in the cochlear nuclei (CNs) after 3 months of bilateral auditory deafferentation and simultaneous unilateral implantation of a dummy auditory brain stem implant (ABI) in 6 nonhuman primates (Macaca fascicularis). These specimens were compared to CNs of 9 controls and 7 bilaterally deafferented animals without implantation. The ABI array consists of 3 platinum electrodes mounted on a silicone pad with the back side covered with Dacron. No migration of the ABI was observed. All deafferented animals showed astrocytic reorganization in the CNs. Histologic changes consisted of superficial reactions around the implant, with formation of fibrillar bundles of fusiform cells, and the presence of giant cells close to the Dacron. Other findings were related to surgical trauma. The dummy ABI did not itself provoke serious adverse reactions in the CNs. Our observations support the possibility of ABI reimplantation surgery.

Auditory brainstem implantation in primates: lessons for human surgery and application.

We report on the surgical technique for surface electro-auditory prosthesis (EAP) implantation, pathological changes occurring at the cochlear nucleus complex (CNC), and its relation with electrical stimulation. Fourteen Macaca fascicularis were operated upon for a translabyrinthine bilateral auditory neurectomy, and simultaneous unilateral EAP implantation. Six animals were not stimulated, and the remaining eight were connected to an external active device. Stimulation was planned for 1000 hours. Biotolerance to the materials was adequate without significant reactions in the CNC surface, but an ependymal reaction. Lesions attributed to surgical trauma were also found. Two animals being stimulated could not complete the planned course due to cable break or EAP extrusion. One stimulated animal developed an asymptomatic brainstem abscess. A good knowledge of CNC topography is required to avoid surgical trauma. Externally connected devices may facilitate extrusion of the EAP or ascending infections.

[Positron-emission tomography (PET) in the diagnosis of malignancy, recurrence, and staging in patients with head and neck tumors]. / Tomografía por emisión de positrones (PET) en el diagnóstico de malignidad, recurrencia y el estadiaje en pacientes con tumores de cabeza y cuello.

We report a prospective study with 15 patients with the diagnosis of head and neck tumors. They underwent two types of studies, the radiological one with computed tomography or magnetic resonance image scan and the positron emission tomography (PET) with 18-fluorodeoxyglucose (FDG). Five patients did not receive any treatment before, and the PET was performed to evaluate the possibility of malignancy, to determine the stage of the disease and if a recurrence was suspected. The study with the PET has the advantage of detecting small lesions and it is not influenced by radiotherapy or surgery.

[General intubation anesthesia in primates for experimental otoneurologic surgery]. / Anestesia general intubada en primates para cirugía otoneurológica experimental.

INTRODUCTION: We report our experience in anaesthetic and surgical management of primates (M. fascicularis) in an experimental otoneurosurgical procedure. MATERIAL & METHODS: The VIII cranial nerve was bilaterally sectioned in a translabyrinthine approach in 21 adult primates. In 14 animals subsequently, a prototype of auditory brainstem implant was placed unilateraly within the brain stem for surface stimulation of cochlear nuclei. Premedication consisted in an intramuscular mixture of ketamine, midazolam and atropine. Surgical procedure was performed under intubated general anaesthesia, after propofol (1.5 mg/kg) administration and maintained with nitrous oxide and halotane. RESULTS: The mixture of ketamine, midazolam and atropine produced a deep anaesthesia in 4 +/- 1.7 minutes, permitting safe animal handling. Atraumatic nasotracheal intubation without muscle relaxing agents was easily achieved in all animals. Anaesthesia was adequately maintained with nitrous oxide and halotane. Animals did not present any relevant incidents during surgery, and were extubated 10 +/- 2.5 minutes after cessation of gas administration. Post-operatively, no relevant surgical complications occurred. CONCLUSIONS: We report an anaesthetic technique that provides an optimal restrain and anaesthesia for experimental otoneurosurgical procedures with primates. This technique offers a quick recovery and avoids the use of muscular relaxing agents for intubation, and thus could be safely used in other kind of surgical procedures.

Surgical technique for reconstruction of the nasal septum: the pericranial flap.

BACKGROUND: We describe a new technique for the surgical reconstruction of large-sized anterior septal perforations based on the pericranial flap. METHODS: The technique requires a standard open rhinoplasty combined with a pericranial flap harvested after a bicoronal approach and tunnelled to the nasal cavity. We present the case of a man with complete destruction of the nasal septum as a result of chronic cocaine abuse. RESULTS: Surgery resulted in a permanent and complete closure of the perforation. CONCLUSIONS: The main advantage of this technique is the use of well-vascularized autogenous tissue and the minimal donor site morbidity. This technique provides a new method to close large nasal perforations.

Cerebral auditory plasticity and cochlear implants.

Previous animal research and clinical experiences in humans suggest the existence of an auditory critical period in language acquisition. We review the literature and present the changes within the cochlear nuclei in bilaterally deafferentated adult non-human primates. We also present and analyse the results of 98 prelingually deaf children and teenagers who underwent a cochlear implantation at the University of Navarra. Patients received a Nucleus 22 or 24 multichannel cochlear implant (CI). They were grouped in five categories according to their age at surgery. Performance is compared with a control group of 58 postlinguals. Only early-implanted prelingual children (before 6 years of age) achieved a complete open-set speech recognition, even with better performance than postlinguals. These results clearly demonstrate the existence of a period of high neural auditory plasticity within the first 6 years of life. The introduction of auditory stimulation with a CI can not restore the loss of neural plasticity out of this period. Prelingual children under 6 years of age should receive a CI as soon as there is a reliable diagnosis of bilateral sensorineural hearing loss.