ABSTRACT
A día de hoy, todavía no disponemos de un conocimiento ni una concienciación adecuados sobre las consecuencias que alcanza en la calidad de vida la pérdida de audición en personas mayores. De la misma manera, tampoco existe información suficiente en cuanto a la relación de la presbiacusia y las alteraciones del equilibrio con otras comorbilidades. Dicho conocimiento puede contribuir a mejorar tanto la prevención como el tratamiento de estas patologías, a reducir su impacto en otras áreas como la cognición o la autonomía, así como para poseer una información más certera sobre el impacto económico que generan en la sociedad y en el sistema sanitario.Por ello, con la realización de este artículo de revisión nos planteamos actualizar la información sobre el tipo de hipoacusia y las alteraciones del equilibrio en personas mayores de 55 años, así como sus factores asociados; analizar el impacto que genera en la calidad de vida de estas personas y el que se puede generar a nivel personal y poblacional (tanto en el ámbito sociológico como económico) si se persigue una intervención temprana en estos pacientes. (AU)
At this time, we still do not have adequate knowledge and awareness of the consequences of hearing loss in the elderly on quality of life. Similarly, there is also insufficient information on the relationship of presbycusis and balance disorders with other comorbidities. Such knowledge can contribute to improve both prevention and treatment of these pathologies, to reduce their impact on other areas such as cognition or autonomy, as well as to have more accurate information on the economic impact they generate in society and in the health system.Therefore, with this review article we aim to update the information on the type of hearing loss and balance disorders in people over 55 years of age, and their associated factors; to analyze the impact on the quality of life of these people and the one which can be generated at a personal and population level (both sociological and economic) if an early intervention in these patients is pursued. (AU)
Subject(s)
Humans , Middle Aged , Aged , Aged, 80 and over , Presbycusis , Hearing Loss , Cognition , Otolaryngology , Presbycusis/prevention & control , Hearing Loss/complications , Hearing Loss/therapyABSTRACT
At this time, we still do not have adequate knowledge and awareness of the consequences of hearing loss in the elderly on quality of life. Similarly, there is also insufficient information on the relationship of presbycusis and balance disorders with other comorbidities. Such knowledge can contribute to improve both prevention and treatment of these pathologies, to reduce their impact on other areas such as cognition or autonomy, as well as to have more accurate information on the economic impact they generate in society and in the health system. Therefore, with this review article we aim to update the information on the type of hearing loss and balance disorders in people over 55 years of age, and their associated factors; to analyze the impact on the quality of life of these people and the one which can be generated at a personal and population level (both sociological and economic) if an early intervention in these patients is pursued.
Subject(s)
Deafness , Presbycusis , Humans , Aged , Presbycusis/therapy , Presbycusis/epidemiology , Quality of Life , CognitionABSTRACT
OBJECTIVE: The biallelic inheritance of an expanded intronic pentamer (AAGGG)exp in the gene encoding replication factor C subunit 1 (RFC1) has been found to be a cause of cerebellar ataxia, neuropathy, and vestibular areflexia syndrome (CANVAS). This study describes clinical and genetic features of our patients with clinical suspicion of the syndrome. STUDY DESIGN: A retrospective descriptive study from an ataxia database comprising 500 patients. SETTING: The study was performed at the Otorhinolaryngology Department of a hospital in the north of Spain. METHODS: Specific genetic testing for CANVAS was performed in 13 patients with clinical suspicion of complete or incomplete syndrome. The clinical diagnosis was supported by quantitative vestibular hypofunction, cerebellar atrophy, and abnormal sensory nerve conduction testing. RESULTS: Nine of 13 (69%) patients met clinical diagnostic criteria for definite CANVAS disease. The first manifestation of the syndrome was lower limb dysesthesia in 8 of 13 patients and gait imbalance in 5 of 13. Eleven of 13 (85%) patients were carriers of the biallelic (AAGGG)exp in RFC1. CONCLUSION: A genetic cause of CANVAS has recently been discovered. We propose genetic screening for biallelic expansions of the AAGGG pentamer of RFC1 in all patients with clinical suspicion of CANVAS, since accurate early diagnosis could improve the quality of life of these patients.
Subject(s)
Bilateral Vestibulopathy/diagnosis , Bilateral Vestibulopathy/genetics , Cerebellar Ataxia/diagnosis , Cerebellar Ataxia/genetics , DNA Repeat Expansion/genetics , Replication Protein C/genetics , Aged , Databases, Factual , Diagnosis, Differential , Female , Genetic Testing , Humans , Introns/genetics , Male , Middle Aged , Retrospective Studies , Spain , Symptom Assessment , SyndromeABSTRACT
INTRODUCCIÓN: La hipoacusia neurosensorial (HNS) es el déficit sensorial más prevalente en nuestro medio. La secuenciación genómica de nueva generación (NGS) permite obtener un diagnóstico etiológico en un alto porcentaje de pacientes. Nuestro estudio piloto muestra los resultados de la aplicación sistemática de la NGS en una Unidad de Hipoacusia Infantil, así como sus implicaciones en el manejo clínico de los pacientes y sus familiares. MATERIAL Y MÉTODO: Se incluyó a 27 pacientes diagnosticados de HNS entre 2014 y 2017 en los que se descartó una causa ambiental. El test genético consistió en un panel de genes analizados mediante NGS (panel OTOgenicsTM). Este panel ha sido diseñado para incluir genes asociados con hipoacusia neurosensorial o mixta, de inicio precoz o tardío, sindrómica y no sindrómica, independientemente de su patrón de herencia. RESULTADOS: Se obtuvo un diagnóstico genético en el 56% (15/27) de los pacientes (62% en el caso de las HNS bilaterales); 5/27 (19%) presentaron variantes patogénicas en el gen GJB2 y el resto variantes patogénicas o probablemente patogénicas en otros genes asociados con HNS aislada (PR2X2, TECTA y STRC), con HNS sindrómicas (CHD7, GATA3, COL4A5, MITF y SOX10) o con HNS sindrómicas y no sindrómicas (BSND, ACTG1 y CDH23). DISCUSIÓN: El diagnóstico etiológico de la HNS supone un desafío en la práctica clínica. Nuestra serie demuestra que es posible implementar el diagnóstico genético en la rutina asistencial y que esta información tiene implicaciones pronósticas y terapéuticas
INTRODUCTION: Sensorineural hearing loss (SNL) is the most prevalent sensory deficit in our environment. Next generation genomic sequencing (NGS) enables an aetiological diagnosis in a high percentage of patients. Our pilot study shows the results of the systematic application of NGS in a Childhood Hearing Loss Unit, as well as its implications for the clinical management of patients and their families. MATERIAL AND METHOD: We included 27 patients diagnosed with SNL between 2014 and 2017, in which an environmental cause was ruled out. The genetic test consisted of a panel of genes analyzed by NGS (OTOgenicsTM panel). This panel has been designed to include genes associated with sensorineural or mixed hearing loss, early onset or late, syndromic and non-syndromic, regardless of their inheritance pattern. RESULTS: A genetic diagnosis was obtained in 56% (15/27) of the patients (62% in the case of bilateral SNL). Of the patients, 5/27 (19%) presented pathogenic variants in the GJB2 gene and the rest pathogenic and / or probably pathogenic variants in other genes associated with isolated SNL (PR2X2, TECTA and STRC), with syndromic SNL (CHD7, GATA3, COL4A5, MITF and SOX10) or with syndromic and non-syndromic SNL (BSND, ACTG1 and CDH23). DISCUSSION: The aetiological diagnosis of SNL is a challenge in clinical practice. Our series demonstrates that it is possible to implement genetic diagnosis in the care routine and that this information has prognostic and therapeutic implications
Subject(s)
Humans , Male , Female , Infant, Newborn , Infant , Child, Preschool , Child , Hearing Loss/diagnosis , Hearing Loss/genetics , High-Throughput Nucleotide Sequencing/methods , Hearing Loss/etiology , DNA/genetics , Genomic Structural Variation/geneticsABSTRACT
La parálisis de Bell es la forma más común de paresia o parálisis facial. Sin embargo, no todos los pacientes con parálisis facial tienen una parálisis de Bell. Otras causas frecuentes incluyen las secuelas del tratamiento del neurinoma del VIII par, el cáncer de cabeza y cuello, la iatrogenia, el zóster ótico y los traumatismos. El abordaje de cada una de estas situaciones es totalmente diferente. El objetivo de esta guía es servir de consejo para el tratamiento y el seguimiento de los pacientes con parálisis facial. Nuestra idea es que la guía sea práctica, haciendo hincapié en recomendaciones efectivas y útiles en el manejo diario de los pacientes. Esta guía ha sido promovida por la Sociedad Española de ORL y escrita por médicos con experiencia en la enfermedad del nervio facial, incluyendo al menos un especialista de cada comunidad autónoma. Redactada en un formato de preguntas y respuestas, incluye 56 cuestiones relevantes relacionadas con el nervio facial
Bell's palsy is the most common diagnosis associated with facial nerve weakness or paralysis. However, not all patients with facial paresis/paralysis have Bell's palsy. Other common causes include treatment of vestibular schwannoma, head and neck tumours, iatrogenic injuries, Herpes zoster, or trauma. The approach to each of these conditions varies widely. The purpose of this guideline is to provide clinicians with guidance on the treatment and monitoring of patients with different causes of facial paralysis. We intend to draft a practical guideline, focusing on operationalised recommendations deemed to be useful in the daily management of patients. This guideline was promoted by the Spanish Society of Otolaryngology and developed by a group of physicians with an interest in facial nerve disorders, including at least one physician from each Autonomous Community. In a question and answer format, it includes 56 relevant topics related to the facial nerve
Subject(s)
Humans , Facial Paralysis/diagnosis , Facial Paralysis/therapy , Societies, Medical/standards , Otolaryngology/methods , Bell Palsy/etiology , Spain , Facial Nerve/physiopathology , Facial Paralysis/etiologyABSTRACT
Bell's palsy is the most common diagnosis associated with facial nerve weakness or paralysis. However, not all patients with facial paresis/paralysis have Bell's palsy. Other common causes include treatment of vestibular schwannoma, head and neck tumours, iatrogenic injuries, Herpes zoster, or trauma. The approach to each of these conditions varies widely. The purpose of this guideline is to provide clinicians with guidance on the treatment and monitoring of patients with different causes of facial paralysis. We intend to draft a practical guideline, focusing on operationalised recommendations deemed to be useful in the daily management of patients. This guideline was promoted by the Spanish Society of Otolaryngology and developed by a group of physicians with an interest in facial nerve disorders, including at least one physician from each Autonomous Community. In a question and answer format, it includes 56 relevant topics related to the facial nerve.
Subject(s)
Bell Palsy/therapy , Facial Paralysis/therapy , Otolaryngology , Societies, Medical , Age Factors , Bell Palsy/diagnosis , Diagnosis, Differential , Diagnostic Imaging , Emergencies , Facial Paralysis/diagnosis , Facial Paralysis/etiology , Female , Humans , Ophthalmology , Pregnancy , Pregnancy Complications/drug therapy , Referral and Consultation , SpainABSTRACT
INTRODUCTION: Sensorineural hearing loss (SNL) is the most prevalent sensory deficit in our environment. Next generation genomic sequencing (NGS) enables an aetiological diagnosis in a high percentage of patients. Our pilot study shows the results of the systematic application of NGS in a Childhood Hearing Loss Unit, as well as its implications for the clinical management of patients and their families. MATERIAL AND METHOD: We included 27 patients diagnosed with SNL between 2014 and 2017, in which an environmental cause was ruled out. The genetic test consisted of a panel of genes analyzed by NGS (OTOgenicsTM panel). This panel has been designed to include genes associated with sensorineural or mixed hearing loss, early onset or late, syndromic and non-syndromic, regardless of their inheritance pattern. RESULTS: A genetic diagnosis was obtained in 56% (15/27) of the patients (62% in the case of bilateral SNL). Of the patients, 5/27 (19%) presented pathogenic variants in the GJB2 gene and the rest pathogenic and / or probably pathogenic variants in other genes associated with isolated SNL (PR2X2, TECTA and STRC), with syndromic SNL (CHD7, GATA3, COL4A5, MITF and SOX10) or with syndromic and non-syndromic SNL (BSND, ACTG1 and CDH23). DISCUSSION: The aetiological diagnosis of SNL is a challenge in clinical practice. Our series demonstrates that it is possible to implement genetic diagnosis in the care routine and that this information has prognostic and therapeutic implications.
Subject(s)
Hearing Loss, Sensorineural/genetics , High-Throughput Nucleotide Sequencing , Sequence Analysis, DNA , Child , Child, Preschool , Hearing Loss, Sensorineural/diagnosis , Humans , Infant , Pilot ProjectsABSTRACT
Introduction: Contralateral sensorineural hearing loss (CSNHL) after vestibular schwannoma (VS) is a severe complication, especially in those cases in which hearing preservation in the operated side was not possible. There are several theories that attempt to explain this issue, but there is no established guideline of treatment. Material and methods: We report 4 patients treated in our institution who developed a severe CSNHL after surgery. Results: Of the 185 cases of VS treated with surgery, 4 patients (2.2%) developed a CSNHL after VS surgery. After medical treatment, partial recovery of hearing occurred in one patient the other 3 patients presented a well-established severe SNHL. Conclusions: Established treatment guidelines do not exist, but the use of high doses of corticosteroids has been recommended and cochlear implant in cases with no recovery and complete hearing loss may be useful
Introducción: La hipoacusia neurosensorial contralateral (HNSC) tras cirugía de schwannoma vestibular (SV) es una complicación grave, especialmente en aquellos casos en los que la preservación de la audición del lado intervenido no fue posible. Existen varias teorías que intentan explicar este problema, pero no existe una guía de tratamiento en estos casos. Material y métodos: Presentamos los casos de 4 pacientes tratados en nuestro hospital que desarrollaron una HNSC severa tras cirugía de SV. Resultados: De los 185 casos de SV tratados con cirugía, 4 pacientes (2,2%) desarrollaron una HNSC después de la cirugía. Tras el tratamiento médico se produjo recuperación parcial de la audición en un paciente, los otros 3 pacientes presentaron una HNS severa. Conclusiones: No existen guías de tratamiento, pero se recomienda el uso de altas dosis de corticosteroides y el implante coclear en casos sin recuperación y pérdida completa de la audición
Subject(s)
Humans , Male , Female , Middle Aged , Hearing Loss, Sensorineural/etiology , Neuroma, Acoustic/surgery , Postoperative Complications/etiology , Retrospective StudiesABSTRACT
INTRODUCTION: Contralateral sensorineural hearing loss (CSNHL) after vestibular schwannoma (VS) is a severe complication, especially in those cases in which hearing preservation in the operated side was not possible. There are several theories that attempt to explain this issue, but there is no established guideline of treatment. MATERIAL AND METHODS: We report 4 patients treated in our institution who developed a severe CSNHL after surgery. RESULTS: Of the 185 cases of VS treated with surgery, 4 patients (2.2%) developed a CSNHL after VS surgery. After medical treatment, partial recovery of hearing occurred in one patient the other 3 patients presented a well-established severe SNHL. CONCLUSIONS: Established treatment guidelines do not exist, but the use of high doses of corticosteroids has been recommended and cochlear implant in cases with no recovery and complete hearing loss may be useful.
Subject(s)
Hearing Loss, Sensorineural/etiology , Neuroma, Acoustic/surgery , Postoperative Complications/etiology , Female , Humans , Male , Middle Aged , Retrospective StudiesABSTRACT
El síndrome del primer mordisco es una secuela potencial de la cirugía del espacio infratemporal, lóbulo profundo de parótida y del espacio parafaríngeo. Se trata de un dolor agudo e intenso en la región parotídea que se desencadena con el primer mordisco de cada comida. Se relaciona con el daño de las fibras simpáticas que inervan la parótida, lo que resulta en una hipersensibilidad de las células mioepiteliales a la inervación parasimpática, provocando una intensa contracción de las mismas, responsable del dolor causado. No responde a los analgésicos habituales. La inyección de toxina botulínica tipo A en la parótida afectada se presenta como un tratamiento sencillo y eficaz contra este problema por el bloqueo colinérgico que produce. Presentamos la técnica y los resultados de 5 pacientes a los que se les inyectó la toxina botulínica en la parótida afectada (AU)
First bite syndrome is a potential complication of surgery involving the infratemporal fossa, deep lobe of the parotid gland and parapharyngeal space. It is described as an acute and intense pain in the parotid region caused with the first bite of each meal. It is related to damage to sympathetic innervation of the parotid gland. Parasympathetic hyperactivation is believed to stimulate an exaggerated myoepithelial cell contraction causing pain. Usual analgesic treatments have poor results. Botulinum toxin type A causes parasympathetic nerve paralysis of the parotid gland and this fact would minimize salivation and decrease first bite syndrome. The aim of this study is to show the details of the technique and our outcomes in 5 patients treated with botulinum toxin type A (AU)
Subject(s)
Humans , Parotid Diseases/therapy , Botulinum Toxins/therapeutic use , Pain Management/methods , Sympathetic Nervous System/injuries , Treatment Outcome , Pain MeasurementABSTRACT
First bite syndrome is a potential complication of surgery involving the infratemporal fossa, deep lobe of the parotid gland and parapharyngeal space. It is described as an acute and intense pain in the parotid region caused with the first bite of each meal. It is related to damage to sympathetic innervation of the parotid gland. Parasympathetic hyperactivation is believed to stimulate an exaggerated myoepithelial cell contraction causing pain. Usual analgesic treatments have poor results. Botulinum toxin type A causes parasympathetic nerve paralysis of the parotid gland and this fact would minimize salivation and decrease first bite syndrome. The aim of this study is to show the details of the technique and our outcomes in 5 patients treated with botulinum toxin type A.
Subject(s)
Acetylcholine Release Inhibitors/administration & dosage , Botulinum Toxins, Type A/administration & dosage , Mastication , Pain Management/methods , Postoperative Complications/drug therapy , Female , Humans , Injections, Intralesional , Male , Parotid Gland/surgery , SyndromeABSTRACT
Introducción y objetivos: La técnica quirúrgica clásica de los implantes oseointegrados tiene como principio fundamental la extirpación del tejido celular subcutáneo hasta la capa perióstica. Recientemente se han diseñado pilares de mayor longitud, lo que ha permitido el desarrollo de la técnica de preservación de tejido, es decir, sin eliminación de los tejidos blandos. Este estudio evalúa las complicaciones cutáneas postquirúrgicas a corto, medio y largo plazo, comparando la técnica clásica con la técnica de preservación de tejido. Material y métodos: Estudio prospectivo de pacientes a los que se les ha colocado un implante oseointegrado desde febrero de 2009 hasta febrero de 2013. Se realizaron un total de 29 cirugías, 14 según la técnica clásica y 15 con cirugía de preservación de tejido. Las complicaciones cutáneas fueron evaluadas según la clasificación de Holgers en revisiones a la semana, al mes, y al año. Resultados: En ningún paciente se registraron complicaciones cutáneas de grado 4 que precisaran la retirada del implante oseointegrado o cirugía de revisión. Aunque la puntuación en la clasificación de Holgers fue siempre más desfavorable en la técnica clásica, sobre todo a corto plazo (a la semana reacción de grado 3 en el 28% de los pacientes versus 7% con técnica de preservación), no se alcanzaron diferencias estadísticamente significativas entre los 2 grupos a la semana (p = 0,233), al mes (p = 0,470) o al año (p = 0,401). Conclusión: En nuestra experiencia, la técnica mínimamente invasiva sin reducción de tejido es la técnica de elección para la cirugía de los implantes oseointegrados por ser más sencilla, más rápida, poder realizarse con anestesia local y resultados postoperatorios iguales (AU)
Introduction and objectives: The standard surgical technique for osseointegrated hearing aids involves removing a large area of subcutaneous tissue down to the periosteum. Recently, the industry has designed a new range of abutment lengths for less invasive surgery with soft tissue preservation. This study compared and evaluated the complications in the standard and the tissue preservation techniques. Material and methods: This was a prospective study including 29 adult patients that underwent single-stage osseointegrated hearing aids insertion between February 2009 and February 2013. We performed the standard technique in 14 patients, and the tissue preservation technique in 15. Soft tissue complications were graded according to the Holgers classification. Results: No patient required removal of implant or revision surgery. Although the Holgers grade was always worse in the standard technique (reaction score of 3 or higher was 28% versus 7% at a month), the complication rate was not statistically significant between the 2 groups at any postoperative time a week (p = 0 .233), a month (p = 0 .470) and a year (p = 0 .401). Conclusion: In our experience the tissue preservation technique, without soft tissue reduction, is the procedure of choice for bone anchored implant surgery. The preservation technique is easier, faster and possible with local anaesthesia and has similar postoperative outcomes (AU)
Subject(s)
Female , Humans , Male , Skin Diseases/etiology , Cochlear Implantation/adverse effects , Cochlear Implants/adverse effects , Foreign-Body Reaction/etiology , Surgical Flaps , Osseointegration , Organ Sparing Treatments/methods , Skin Diseases/pathology , Cochlear Implantation/methods , Foreign-Body Reaction/pathology , Suture Techniques , Connective Tissue/surgery , Prospective Studies , Operative TimeABSTRACT
INTRODUCTION AND OBJECTIVES: The standard surgical technique for osseointegrated hearing aids involves removing a large area of subcutaneous tissue down to the periosteum. Recently, the industry has designed a new range of abutment lengths for less invasive surgery with soft tissue preservation. This study compared and evaluated the complications in the standard and the tissue preservation techniques. MATERIAL AND METHODS: This was a prospective study including 29 adult patients that underwent single-stage osseointegrated hearing aids insertion between February 2009 and February 2013. We performed the standard technique in 14 patients, and the tissue preservation technique in 15. Soft tissue complications were graded according to the Holgers classification. RESULTS: No patient required removal of implant or revision surgery. Although the Holgers grade was always worse in the standard technique (reaction score of 3 or higher was 28% versus 7% at a month), the complication rate was not statistically significant between the 2 groups at any postoperative time a week (p=0.233), a month (p=0.470) and a year (p=0.401). CONCLUSION: In our experience the tissue preservation technique, without soft tissue reduction, is the procedure of choice for bone anchored implant surgery. The preservation technique is easier, faster and possible with local anaesthesia and has similar postoperative outcomes.
Subject(s)
Cochlear Implantation/adverse effects , Cochlear Implants/adverse effects , Foreign-Body Reaction/etiology , Organ Sparing Treatments/methods , Osseointegration , Skin Diseases/etiology , Surgical Flaps , Adolescent , Adult , Aged , Cochlear Implantation/methods , Connective Tissue/surgery , Female , Foreign-Body Reaction/pathology , Humans , Male , Middle Aged , Operative Time , Prospective Studies , Skin Diseases/pathology , Suture TechniquesABSTRACT
OBJECTIVES: To document musical listening and enjoyment in recipients of Advanced Bionics cochlear implants (CIs) and to compare musical perception in those using early coding strategies with subjects using the newer HiRes and HiRes 120 strategies. METHODS: A questionnaire was completed by 136 adult subjects, including questions on the ability to identify specific musical features. The subjects were in three groups: those using early coding strategies (n = 29), HiRes (n = 59), and HiRes 120 (n = 48), and results were compared with a group of 84 normally hearing (NH) subjects. RESULTS: Of the CI users, 79% reported listening to music. The NH group rated listening frequency and enjoyment higher than the CI users. Thirty-five users reported that they sang and this group had significantly higher overall performance. There were no significant differences in overall perception of specific musical features among the strategy groups, though some individual questions showed significantly higher performance in the HiRes 120 users. DISCUSSION: Users of current CI technology show a high level of musical appreciation, though still significantly less than NH subjects. Frequency of listening and enjoyment were significantly correlated and active participation in musical activities, specifically singing, resulted in significantly higher overall performance scores.
Subject(s)
Auditory Perception/physiology , Cochlear Implants , Deafness/psychology , Deafness/therapy , Music , Adolescent , Adult , Case-Control Studies , Cochlear Implantation , Deafness/physiopathology , Equipment Design , Female , Habits , Happiness , Humans , Male , Middle Aged , Surveys and Questionnaires , Young AdultABSTRACT
The objective of this study was to expose our results in the treatment of petrous bone cholesteatomas (PBC), paying attention to diagnosis, surgical strategy, facial management, results, and recurrences. The main objective is to compare the results of obliterative and open techniques in their management concerning the recurrence rate, due to the controversy elicited on obliterative or closed techniques in large cholesteatomas. A retrospective study was performed from July 1977 to September 2007 at the Tertiary referral cranial base center. Thirty-five patients were treated for PBC through different surgical approaches, and in 25 cases (72%) the surgical cavity was obliterated with a muscle flap. Four patients (11%) had a long-term recurrence. These patients received an open technique and after surgical re-exploration using a closed technique they had no recurrence. There were no recurrences in patients who underwent an obliterative technique and they received periodic MRI controls. The facial function after surgery was acceptable (71% of patients had House-Brackmann grades I to III). PBC is a complex pathology and presents difficulties in its diagnosis and treatment. Surgical technique should be suitable for removing the pathology and preventing damage to structures such as the facial nerve or great vessels. Obliterative techniques, where possible, are at least as safe as open cavity procedures and they have fewer postoperative complications; however, regular follow-up with CT and MRI is mandatory.
Subject(s)
Cholesteatoma, Middle Ear/surgery , Petrous Bone/surgery , Adult , Aged , Cholesteatoma, Middle Ear/pathology , Female , Humans , Magnetic Resonance Imaging , Male , Middle Aged , Neoplasm Recurrence, Local , Petrous Bone/pathology , Reoperation , Retrospective Studies , Surgical Flaps , Treatment OutcomeABSTRACT
INTRODUCTION: Procalcitonin (PCT) is the precursor of the calcitonin hormone. Plasma concentrations of procalcitonin increase in systemic inflammation, especially when they are caused by bacterial infections. The aim of this study is to analyze and validate the baseline PCT concentrations after different types of skull base surgery and to test the hypothesis that PCT could be useful as an early marker of post-operative infectious complications, especially meningitis. MATERIAL AND METHOD: This is a prospective study of sixteen patients who underwent skull base surgery. PCT and C-reactive protein plasma levels, leukocytes and clinical symptoms were registered pre-operatively and 1, 2, and 5 days post-operatively. RESULTS: All patients had a normal post-operative course without clinical signs of infection. PCT concentrations did not increase above the normal range in any case. CONCLUSIONS: As PCT plasma concentration does not notably increase despite the inflammatory phenomena associated with uncomplicated skull base surgery, it may be possible to use PCT as an early marker for non-invasive study of post-operative infectious complications.
Subject(s)
Calcitonin/blood , Protein Precursors/blood , Skull Base/surgery , Biomarkers/blood , Calcitonin Gene-Related Peptide , Humans , Prospective StudiesABSTRACT
Introducción: La procalcitonina (PCT) es el precursor de la hormona calcitonina. Las concentraciones de PCT en plasma aumentan en relación con las manifestaciones sistémicas de la reacción inflamatoria, especialmente cuando están causadas por una infección bacteriana. El objetivo de este estudio es conocer y validar las concentraciones basales de PCT alcanzadas tras diferentes tipos de cirugía de base de cráneo por si pudiese utilizarse como marcador precoz de complicaciones infecciosas, fundamentalmente meningitis. Material y método: Se realiza un estudio prospectivo sobre 16 pacientes intervenidos de base de cráneo. Se estudiaron las concentraciones de PCT, proteína C reactiva, leucocitos en sangre y síntomas clínicos en el preoperatorio y el primero, el segundo y el quinto día postoperatorios. Resultados: Todos los pacientes tuvieron un postoperatorio sin signos infecciosos generales ni fiebre. Las concentraciones de PCT no aumentaron en ningún caso por encima de los valores normales. Conclusiones: Dado que los fenómenos inflamatorios propios de las intervenciones no complicadas de base de cráneo no elevan de forma reseñable las concentraciones de PCT, se podría utilizarla para estudiar por técnicas no invasivas los casos que sí presenten complicaciones infecciosas intercurrentes
Introduction: Procalcitonin (PCT) is the precursor of the calcitonin hormone. Plasma concentrations of procalcitonin increase in systemic inflammation, especially when they are caused by bacterial infections. The aim of this study is to analyze and validate the baseline PCT concentrations after different types of skull base surgery and to test the hypothesis that PCT could be useful as an early marker of post-operative infectious complications, especially meningitis. Material and method: This is a prospective study of sixteen patients who underwent skull base surgery. PCT and C-reactive protein plasma levels, leukocytes and clinical symptoms were registered pre-operatively and 1, 2, and 5 days post-operatively. Results: All patients had a normal post-operative course without clinical signs of infection. PCT concentrations did not increase above the normal range in any case. Conclusions: As PCT plasma concentration does not notably increase despite the inflammatory phenomena associated with uncomplicated skull base surgery, it may be possible to use PCT as an early marker for non-invasive study of post-operative infectious complications
Subject(s)
Humans , Skull Neoplasms/surgery , Calcitonin/blood , C-Reactive Protein/analysis , Leukocyte Count , Craniotomy/adverse effects , Craniotomy/methods , Meningitis/etiology , Meningitis/prevention & control , Biomarkers/blood , Prospective Studies , Postoperative PeriodABSTRACT
OBJECTIVE: To evaluate the fraction of patients recovering to normal function after complete facial nerve paralysis secondary to acoustic neuroma surgery, and also to address the ophthalmologic complications associated with it and the therapeutic options. MATERIAL AND METHOD: We performed a retrospective review of 30 cases operated on in our department for acoustic neuroma and who, despite anatomical preservation of the facial nerve, developed a complete post-operative facial nerve paralysis (grade VI of House-Brackmann [HB]). We analyzed the evolution of the facial paralysis in relation to the tumour size, patient age, surgical approach and localization of the tumour. In addition, we studied the ophthalmologic complications and their treatment. RESULTS: Only 5 of the 30 cases studied (16.6 %) recovered to normal facial nerve function (HB grade I). We observed a tendency for a poor recovery of the cases with tumour size bigger than 2 cm, males, those older than 65 years and lesions resected by the translabyrinthine approach. Only 1 patient presented serious ophthalmologic complications. CONCLUSIONS: Our study reveals that only a small percentage of patients achieve total recovery of facial function. We have to be on the alert to ocular complications in this kind of patient.
Subject(s)
Cochlear Nerve/pathology , Cochlear Nerve/surgery , Corneal Ulcer/etiology , Facial Paralysis/etiology , Facial Paralysis/physiopathology , Neuroma, Acoustic/pathology , Neuroma, Acoustic/surgery , Peripheral Nervous System Neoplasms/pathology , Peripheral Nervous System Neoplasms/surgery , Postoperative Complications , Adult , Aged , Corneal Ulcer/diagnosis , Disease Progression , Facial Paralysis/diagnosis , Female , Humans , Male , Middle Aged , Retrospective StudiesABSTRACT
The aim of this study is evaluate the unusual ways of initial presentation of the vestibular schwannomas. We performed a retrospective study of the patients who underwent resection of acoustic neuromas on our service, including for analysis only the cases which initial symptom was not the hearing loss. Tumor size, localization, clinical presentation, and age of the patients were considered. Nine patients present with atypical symptoms. The most common complain in this group were facial paresthesias (22,2 %). None of them complained about other otological symptoms. A significant group of patients did not present with the otological symptoms classically associated with vestibular schwannoma. Clinical knowledge of these kinds of symptoms may lead to earlier detection of these lesions.
Subject(s)
Cerebellopontine Angle/pathology , Hearing Loss/etiology , Neuroma, Acoustic/complications , Neuroma, Acoustic/pathology , Adult , Earache/etiology , Female , Headache/etiology , Hearing Loss/diagnosis , Humans , Magnetic Resonance Imaging , Male , Middle Aged , Retrospective Studies , Vertigo/etiologyABSTRACT
Objetivo: Averiguar la fracción de pacientes intervenidos de un neurinoma del acústico que recuperan la función normal del nervio facial tras una parálisis facial completa postoperatoria, atendiendo a las complicaciones oftalmológicas asociadas a la falta de recuperación y sus opciones terapéuticas. Material y método: Se realiza un estudio retrospectivo de 30 pacientes intervenidos de neurinomas del acústico en nuestro servicio que, con preservación anatómica del nervio facial, presentaron una parálisis facial completa (grado VI de House-Brackmann [HB]) postoperatoria. Se analiza la evolución de la parálisis en función del tamaño tumoral, la edad del paciente, el abordaje quirúrgico y la localización del neurinoma. También se estudian las complicaciones oftalmológicas surgidas y su tratamiento. Resultados: De los 30 pacientes estudiados, sólo 5 (16,6 %) recuperaron la función normal facial (grado I de HB). Se observó una tendencia a una peor recuperación en los casos con tamaño tumoral mayor de 2 cm, de sexo masculino, edad mayor de 65 años y abordados por vía translaberíntica. Sólo un paciente presentó complicaciones oftalmológicas graves. Conclusiones: Nuestro análisis revela que un escaso porcentaje de pacientes recupera de forma completa su función facial, y que es necesario estar alerta ante posibles complicaciones oculares en este espectro de pacientes
Objective: To evaluate the fraction of patients recovering to normal function after complete facial nerve paralysis secondary to acoustic neuroma surgery, and also to address the ophthalmologic complications associated with it and the therapeutic options. Material and method: We performed a retrospective review of 30 cases operated on in our department for acoustic neuroma and who, despite anatomical preservation of the facial nerve, developed a complete post-operative facial nerve paralysis (grade VI of House-Brackmann [HB]). We analyzed the evolution of the facial paralysis in relation to the tumour size, patient age, surgical approach and localization of the tumour. In addition, we studied the ophthalmologic complications and their treatment. Results: Only 5 of the 30 cases studied (16.6 %) recovered to normal facial nerve function (HB grade I). We observed a tendency for a poor recovery of the cases with tumour size bigger than 2 cm, males, those older than 65 years and lesions resected by the translabyrinthine approach. Only 1 patient presented serious ophthalmologic complications. Conclusions: Our study reveals that only a small percentage of patients achieve total recovery of facial function. We have to be on the alert to ocular complications in this kind of patient
