Retraso en el diagnóstico de sordera infantil: el valor de los falsos negativos en el Programa de Detección Precoz de Hipoacusias Neonatales / Delayed diagnosis of childhood deafness: the value of false negatives in the Programme for Early Detection of Neonatal Hearing Loss

Introducción: A pesar de su importancia, la existencia de falsos negativos (pacientes a los que se les dice que oyen bien, pero en realidad son hipoacúsicos) no suele ser evaluada en los programas de detección precoz de hipoacusia. El objetivo de este estudio es determinar las variables que pueden a llevar a un retraso diagnóstico, en especial la existencia de falsos negativos así como la falta de registro de factores de riesgo. Métodos: Se ha realizado un estudio observacional retrospectivo de prevalencia, analizando las historias clínicas de los pacientes con hipoacusia neurosensorial nacidos entre 2005 y 2012 en las áreas de salud del estudio. Resultados: De 32 niños con hipoacusia neurosensorial, 16 pasaron las OEA, 12 no pasaron las OEA y a 4 no se les realizaron. De los pacientes con hipoacusia pero que pasaron las OEA, el 57% tiene una hipoacusia severa y/o profunda. El 66% de los niños con hipoacusia presentaban algún factor de riesgo de hipoacusia, siendo los antecedentes familiares de hipoacusia el más frecuente, pero solo el 7% de los que tenían antecedentes familiares fueron incluidos en el grupo de riesgo. La tasa de pacientes falsos negativos en el estudio es muy elevada. Conclusiones: Los resultados del estudio indican que el diagnóstico tardío de las hipoacusias infantiles en las áreas estudiadas está relacionado con la presencia de falsos negativos a las OEA y con la falta de registro de los factores de riesgo (AU)

Introduction: Despite its importance, the existence of false negatives (patients who are told they hear well, but they have some degree of hipacusia) is rarely evaluated in programs for early detection of hearing loss. The aim of this study is to determine the variables that can lead to a delayed diagnosis, especially the existence of false negatives and the lack of registration of risk factors. Methods: A retrospective study of prevalence has been carried out, in which the medical records of children diagnosed with sensorineural hearing loss born within 2005 and 2012 in the health centers of study have been analyzed. Results: Of the 32 children with sensorineural hearing loss, 16 passed the OAE, 12 did not passed the OAE, and in four they were not carried out. Of the children who passed the OAE, 57% have severe hearing loss. 66% of children with hearing loss presented a risk factor for hearing loss at birth, being the most frecuent family history of hearing loss, but only 7% of those with family history of hearing loss were included in the risk group. Conclusions: The results of the study indicate that the late diagnosis of hearing loss is related to the presence of false negatives to the OAE and the non-registration of risk factors (AU)

Delayed diagnosis of childhood deafness: the value of false negatives in the Programme for Early Detection of Neonatal Hearing Loss. / Retraso en el diagnóstico de sordera infantil: el valor de los falsos negativos en el Programa de Detección Precoz de Hipoacusias Neonatales.

INTRODUCTION: Despite its importance, the existence of false negatives (patients who are told they hear well, but they have some degree of hipacusia) is rarely evaluated in programs for early detection of hearing loss. The aim of this study is to determine the variables that can lead to a delayed diagnosis, especially the existence of false negatives and the lack of registration of risk factors. METHODS: A retrospective study of prevalence has been carried out, in which the medical records of children diagnosed with sensorineural hearing loss born within 2005 and 2012 in the health centers of study have been analyzed. RESULTS: Of the 32 children with sensorineural hearing loss, 16 passed the OAE, 12 did not passed the OAE, and in four they were not carried out. Of the children who passed the OAE, 57% have severe hearing loss. 66% of children with hearing loss presented a risk factor for hearing loss at birth, being the most frecuent family history of hearing loss, but only 7% of those with family history of hearing loss were included in the risk group. CONCLUSIONS: The results of the study indicate that the late diagnosis of hearing loss is related to the presence of false negatives to the OAE and the non-registration of risk factors.

Trece años de experiencia en parotidectomía parcial superficial como tratamiento de neoformaciones benignas parotideas / Thirteen years’ experience with superficial partial parotidectomy as treatment for benign parotid tumours

Introducción: La mayoría de los autores aceptan la cirugía como tratamiento de elección para los tumores benignos de parótida. La mejor técnica quirúrgica o el grado de extensión de la cirugía permanecen controvertidos. El presente estudio pretende comprobar si la parotidectomía parcial superficial (PPS) es adecuada para el tratamiento de los tumores benignos de glándula parótida. Material y métodos: Seleccionamos 63 pacientes con tumor benigno, operados de glándula parótida, 43 tenían un adenoma pleomorfo y 20 un tumor de Warthin. De este grupo de 63 pacientes no se pudo incluir a 6 (3 fallecidos y 3 no localizados). Estudiamos a 57 pacientes, 41 diagnosticados de adenoma pleomorfo y 16 de tumores de Warthin. En todos ellos realizamos PPS sin monitorización del nervio facial. Resultados: Parálisis transitoria del nervio facial 14 pacientes (24,5%). Diez se resolvieron antes del primer mes y cuatro antes del tercer mes. Un paciente (1,7%) sufrió una dificultad definitiva para mantener alineado el hemilabio inferior en la movilidad forzada, sin alteración en la movilidad de la comisura. Ninguna recidiva (control entre 3 y 13 años). Conclusiones: La PPS es una técnica con unas complicaciones y una tasa de recidivas comparables o menores que otras técnicas empleadas para el tratamiento de adenomas pleomorfos o tumores de Warthin parotídeos. La monitorización del nervio facial puede ser una ayuda durante el acto quirúrgico. La falta de monitorización no sería considerada una contraindicación para la realización de la cirugía (AU)

Introduction: Most authors agree that surgery is the treatment of choice for benign tumours of the parotid gland. However, the best surgical technique and the extent of surgery remain controversial. This study attempts to establish whether the implementation of a partial superficial parotidectomy (PSP) is appropriate for the treatment of benign parotid gland tumours. Material and methods: We selected 63 patients with benign parotid gland surgery, of whom 43 had a pleomorphic adenoma and 20, a Warthin tumour. Of this group of 63 patients, 6 could not be included. We consequently studied 57 patients, 41 of them diagnosed as pleomorphic adenoma and 16, as Warthin tumours. In all of them, a PSP was performed without intraoperative monitoring of the facial nerve. Results: Transient facial nerve paralysis, 14 patients (24.5%). Ten cases were resolved within the first month after surgery and 4 before the third month, after indicating facial physiotherapy. One patient (1.7%) had a permanent difficulty in keeping one side of the lower lip aligned under pressure-mobility, without altering commissure mobility. None of the patients studied had a recurrence (control, 3-13 years). Conclusions: Although PSP is a technique with a few complications, it has a recurrence rate comparable to or lower than other techniques used for the treatment of pleomorphic adenomas or Warthin parotid tumours. Intraoperative facial nerve monitoring can be helpful during surgery. The lack of monitoring would not be considered a contraindication for surgery (AU)

[Thirteen years' experience with superficial partial parotidectomy as treatment for benign parotid tumours]. / Trece años de experiencia en parotidectomía parcial superficial como tratamiento de neoformaciones benignas parotideas.

INTRODUCTION: Most authors agree that surgery is the treatment of choice for benign tumours of the parotid gland. However, the best surgical technique and the extent of surgery remain controversial. This study attempts to establish whether the implementation of a partial superficial parotidectomy (PSP) is appropriate for the treatment of benign parotid gland tumours. MATERIAL AND METHODS: We selected 63 patients with benign parotid gland surgery, of whom 43 had a pleomorphic adenoma and 20, a Warthin tumour. Of this group of 63 patients, 6 could not be included. We consequently studied 57 patients, 41 of them diagnosed as pleomorphic adenoma and 16, as Warthin tumours. In all of them, a PSP was performed without intraoperative monitoring of the facial nerve. RESULTS: Transient facial nerve paralysis, 14 patients (24.5%). Ten cases were resolved within the first month after surgery and 4 before the third month, after indicating facial physiotherapy. One patient (1.7%) had a permanent difficulty in keeping one side of the lower lip aligned under pressure-mobility, without altering commissure mobility. None of the patients studied had a recurrence (control, 3-13 years). CONCLUSIONS: Although PSP is a technique with a few complications, it has a recurrence rate comparable to or lower than other techniques used for the treatment of pleomorphic adenomas or Warthin parotid tumours. Intraoperative facial nerve monitoring can be helpful during surgery. The lack of monitoring would not be considered a contraindication for surgery.