Did our cochlear implant program make any difference in the lives of our patients? Achievements of 30 patients with long term follow-up averaging 20 years after cochlear implantation.

BACKGROUND: Cochlear implants are standard of care for the patients with sensorineural hearing loss not benefited from hearing aids. AIMS: Evaluate qualitatively the impact of cochlear implantation in the long-term. MATERIALS-METHODS: Thirty middle-class patients with similar patterns of loss and social environment averaging 20 years post-implantation responded to 52 questions that evaluated psychosocial benefits from cochlear implantation. RESULTS: All completed secondary education and 93% had postgraduate studies. Educational and workwise they are at the same level as their hearing counterparts. All use their cochlear implants and would recommend one to people who need it. They attribute their success to the implant, the rehabilitation program, their family, and a stimulating social environment. Despite their success, most experience difficulties relating with others (socially and at work) due to their hearing condition. They manage but work much harder than their hearing peers to achieve the same. CONCLUSIONS: We made a difference in the lives of these patients, however, there is more to be done. SIGNIFICANCE: Early intervention, rehabilitation, plus family, and stimulating-environment are crucial in children with sensory deficits.

Clinical performance of the Osia™ system, a new active osseointegrated implant system. Results from a prospective clinical investigation.

Background: Bone-conduction hearing implants are standard of care devices.Aims/Objectives: Evaluation of a new active magnetic bone-conduction hearing implant: Cochlear Osia™ system.Material and methods: This device uses a transcutaneous connection between an external sound-processor and an osseointegrated implant that generates vibrations using a piezoelectricity-based internal bone-conduction system. Nine patients with conductive-hearing loss were implanted. Surgical efficacy, hearing performance and quality-of-life were evaluated. Hearing performance in quiet and in noise was compared with unaided hearing and hearing with the Baha 5 Power® Sound Processor on a softband.Results: Surgery and healing were uneventful. Statistically significant improvements in audibility, speech-understanding, speech-recognition and quality-of-sound in noise and quiet were found for the Osia™ compared to preoperative unaided hearing and aided hearing with the Baha 5 Power® Sound Processor on a softband. The active vibration system provided improvement at low and high frequencies. At 6 months postoperatively, all patients continue to use the device.Conclusions and significance: The Osia™ is safe and effective, improving speech-recognition in quiet and in noise, at low and high frequencies, thus delivering better quality-of-hearing than passive devices.

Chances of reversibility in early sensory deprivation of the Homo vulnerabilis: A 5-year (and ongoing) prospective study.

BACKGROUND: This prospective study evaluated the effectiveness of a rehabilitation program in vulnerable children with language deficits. AIMS/OBJECTIVES: Evaluating reversibility of a sensory understimulation. MATERIAL/METHODS: Two groups of five students, each, (sensory and not sensory deprived) were evaluated at ages 5 and 11. Both groups were taught the compulsory national educational program. The sensory deprived group also had a 5-year rehabilitation program. After that time, their language and vocabulary were reevaluated. RESULTS: Both groups became able to read, write and perform mathematical operations. Both groups took the compulsory elementary school national performance test and all of them performed above the national average. Despite these good performances the differences between both groups regarding language persisted. CONCLUSIONS: Deficits in children with early sensory deprivation are improved with rehabilitation programs. In order to achieve better restoration, intervention should be done earlier than at 5 years of age. Even if some deficits are not fully reversible, the improvement is significant and allows social inclusion and the possibility of breaking their circle of vulnerability. SIGNIFICANCE: Documenting the importance of early rehabilitation in sensory deficits.

Manejo interdisciplinario de pacientes quemados. Pilar fundamental para la reducción de secuelas funcionales / Multidisciplinary management of burned patients: Fundamental pillar for reduction of functional sequelae

Las secuelas de quemaduras representan una patología muy frecuente en nuestro medio y su impacto en la calidad de vida de los pacientes que las padecen es muy importante. El objetivo del trabajo fue demostrar la eficacia del manejo interdisciplinario en pacientes con quemaduras AB y B de zonas funcionales para reducir las secuelas. Se realizó un estudio retrospectivo que incluyó 53 pacientes tratados en nuestro servicio, detectando 15 pacientes secuelados; en el 90% de los casos la causa fue el incumplimiento de la terapia indicada luego del alta y el 10% la cicatrización patológica rebelde al tratamiento. Los pacientes con secuelas funcionales por abandono del tratamiento kinesiológico indicado fueron: cinco con retracción en la región cervical anterior, cuatro con retracción en la articulación del codo y cuatro con retracción axilar. Se detectaron dos pacientes que a pesar del tratamiento instaurado sufrieron cicatrices retráctiles, uno de ellos en cuello y el otro paciente en axila.

Sequels of burns represent a very frequent pathology in our environment and its impact on the quality of life of patients suffering from them is very important. The objective of the study was to demonstrate the effectiveness of the interdisciplinary management in patients with burns AB and B of functional areas to reduce the consequences. This is a retrospective study that included 53 patients treated in our service. Fifteen patients with sequelae were detected. In 90% of the cases the cause was a failure in following the prescriptions ordered in hospital discharge, and in10% it was due to rebel to treatment scarring. The patients with functional sequelae due to the absence of the indicated kinesiological treatment were: five with retraction in the anterior cervical region, four with retraction in the elbow joint and four with axillary retraction. Two patients were detected that in spite of the established treatment they suffered retractile scars, one of them in neck and the other patient in armpit.

Central auditory processing. Are the emotional perceptions of those listening to classical music inherent in the composition or acquired by the listeners?

CONCLUSIONS: There is seemingly some inherent component in selected musical compositions that elicits specific emotional perceptions, feelings, and physical conduct. OBJECTIVES: The purpose of the study was to determine if the emotional perceptions of those listening to classical music are inherent in the composition or acquired by the listeners. METHODS: Fifteen kindergarten students, aged 5 years, from three different sociocultural groups, were evaluated. They were exposed to portions of five purposefully selected classical compositions and asked to describe their emotions when listening to these musical pieces. All were instrumental compositions without human voices or spoken language. In addition, they were played to an audience of an age at which they were capable of describing their perceptions and supposedly had no significant previous experience of classical music. RESULTS: Regardless of their sociocultural background, the children in the three groups consistently identified similar emotions (e.g. fear, happiness, sadness), feelings (e.g. love), and mental images (e.g. giants or dangerous animals walking) when listening to specific compositions. In addition, the musical compositions generated physical conducts that were reflected by the children's corporal expressions. Although the sensations were similar, the way of expressing them differed according to their background.

Musical brains: a study of spontaneous and evoked musical sensations without external auditory stimuli.

CONCLUSIONS: Our observations confirm that musical sensations with no external stimuli, either spontaneous or evoked, occur in normal individuals and that a biological substrate can be demonstrated by brain single photon emission computed tomography (SPECT). OBJECTIVES: There are individuals, usually musicians, who are seemingly able to evoke and/or have spontaneous musical sensations without external auditory stimuli. However, to date there is no available evidence to determine if it is feasible to have musical sensations without using external sensory receptors, or if there is a biological substrate for these sensations. SUBJECTS AND METHODS: A group of 100 musicians and another of 150 otolaryngologists were asked if they had spontaneous musical auditory sensations and/or were capable of evoking them. SPECT evaluations with Tc(99m)-HMPAO were conducted in six female musicians while they were evoking these sensations or, in one case, while she was having them spontaneously. In three of them an additional SPECT was conducted in basal conditions (having been asked to avoid evoking music). RESULTS: In all, 97 of 100 musicians had spontaneous musical sensations; all 100 could evoke and modify them. Of the 150 otolaryngologists, 18 (12%) were musicians. Of the 132 nonmusicians, spontaneous musical sensations occurred in 52 (39.4%), 72 (54.5%) could evoke and 23 (17.4%) were able to modify them, 58 (43.9%) did not have spontaneous musical sensations nor could they evoke them. The musical sensations of the 72 otolaryngologists that could evoke were less elaborated than those of musicians. NeuroSPECT during voluntary musical autoevocation demonstrated significant (>2 SD) increased activation of executive frontal cortex in Brodmann areas 9 and 10, secondary visual cortex (area 17), and paracingulate (areas 31 and 32). There was also activation in the para-executive frontal cortex (areas 45 and 46). In the basal ganglia there was activation in thalamus and lentiform nucleus. Deactivation below 2 SD was demonstrated by mean values in the cingulate gyrus, Brodmann areas 23 and 24, and subgenual area 25. Deactivation was also demonstrated when minimal values were analyzed in the same areas plus area 4 and areas 36 and 38, the latter in the pole of the temporal lobes. In three patients comparison of basal state with autoevocation demonstrated activation in executive frontal cortex (areas 8 and 9), para-executive cortex (area 45), primary auditory cortex (area 40), the right thalamus, and lentiform nucleus.

Musical brains: a study of evoked musical sensations without external auditory stimuli: preliminary report of three cases

Existen personas, generalmente músicos, que tienen la capacidad de evocar sensaciones musicales sin un estímulo auditivo externo. Sin embargo, hasta la fecha no hay evidencias que sugieran que sea posible tener estas sensaciones, ni que exista un sustrato biológico para ellas. Diseño del trabajo: Se hicieron dos estudios de neuroSPECT con [99mTc]-HMPAO en cada una de tres mujeres músicos. El primer estudio fue hecho en condiciones basales (sin evocar) y el segundo mientras estaban evocando sensaciones musicales. Resultados: En el estudio de las voluntarias que fueron evaluadas mientras evocaban una composición musical, hubo un aumento significativo de perfusión en los hemisferios derecho e izquierdo en las áreas de Brodmann 9 y 8 (área ejecutiva frontal) y en el área 40 en el lado izquierdo (área auditiva). Sin embargo, en condiciones basales no hubo aumento de perfusión en las áreas 9, 8, 39 y 40. En un caso hubo mayor aumento de perfusión en el área 45 durante la autoevocación respecto a la condición basal. Conclusiones: Estos hallazgos son sugerentes de un sustrato biológico para el proceso de evocar sensaciones musicales.

Hipoacusia de conducción en hidropesia endolinfática / Conduction deafness in endolymphatic hidropesy

The audiograms of 33 patients suffering from Méniére's disease were studied. A conductive hearing loss was found in about fifty per cent of then. The following criteria was used to consider that a patient had a conductive hearing loss: First, an air-bone gap of at least 20 dB in one frequency, excluding 250 Hz. If in 250 Hz there is an air-bone gap of 20 dB, it is necessary an addtional air-bone gap in other frequency of at least 10 dB. Second, when an air-bone gape of 15 dB exists in one frequency, it must be another air-bone gap of at least 10 dB in other frequency. These conditions must be found in two or more audiograms in the same patient. Two groups were made with the 33 patients. One was conformed by 24 patients that had one or more of the following conditions: 1. A positive glucrol test. 2. Fluctuating hearing loss. It means that the patinte had an improved audiogram in respect to a previous one. 3. An ascending profile in the low frequencies. 3. An ascending profile in the low frequencies. The second group of nine patients had not any of the previous chacracteristics. In the first group the authors found that 62.5% had a conductive hearing loss while in the second group 22.2% had the same condition. This difference is statistically significant (p = 0.05). Nine impedanciometric test belonging to eight of the first group and three of equal number of patients of the second group were analyzed. Only few cualitative changes in the tympanometric curve were found. Five of the eight patients of the first group and none of the three patients of the second group showed an increase of the static compliance

Consideraciones sobre la prueba de Fowler / Fowler test

Se realizó la prueba de Fowler (ABLB) a 37 sujetos, otológica y audiológicamente normales, a los que se provocó una hipoacusia de transmisión unilateral mediante la inserción de un protector auditivo. Lo mismo se efectuó en 26 pacientes portadores de una otitis media crónica unilateral en que se condicionó qu el umbral para la vía ósea del oído afectado fuera de 15 dB o menos. Se encontró, según el criterio empleado, porcentajes variables de pruebas con reclutamiento positivo. Consideramos estos porcentajes como falsos positivos. Pensamos que la prueba de Fowler, así como cualquiera otra prueba clínica, es sugerente de lesión coclear pero no excluyente de lesión neural. Por ello nos permitimos recomendar que a pesar que algunas pruebas audiométricas indiquen lesión sensorial, debe completarse el examen con las pruebas de deterioro tonal o fatiga auditiva