Experiencia en reimplantación coclear. Estudio descriptivo durante un período de 20 años / Experience in cochlear reimplantation. Descriptive study of a 20-year period

Introducción y objetivos: El implante coclear es un procedimiento quirúrgico que ha presentado un incremento sustancial, debido a que la población pediátrica 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 más frecuente de explantación. Nuestro objetivo es conocer las causas que en nuestra serie nos han llevado a ello y confirmar si se ajusta a la realidad según lo revisado en la literatura médica. Métodos: Estudio retrospectivo observacional y descriptivo de 859 cirugías de implante coclear, realizadas entre octubre de 1991 y mayo de 2011. Las causas de explantación fueron clasificadas según el Consenso Europeo de Fallos y Explantaciones de los Implantes Cocleares. Resultados: La tasa de reimplantación fue de 6,16% (n = 51). La causa más frecuente de explantación fue el fallo técnico del dispositivo (45,5%), seguida de infección/rechazo del implante (23,6%) y actualización del mismo (12,7%). Entre las causas menos frecuentes se encontraron 3 casos (5,6%) por malinserción de los electrodos, 2 casos (3,6%) de fallo por osificación, 2 (3,6%) por traumatismo craneoencefálico, 2 (3,6%) por realización de resonancia nuclear magnética y un caso (1,8%) por enfermedad psiquiátrica. Conclusiones: La reimplantación coclear es un procedimiento seguro, que presenta una baja tasa de complicaciones. En nuestro centro alcanza una tasa global de 6,16%. El fallo técnico del dispositivo sigue siendo la causa más frecuente de este procedimiento, con un importante porcentaje de reimplantes por actualización del dispositivo (AU)

Introduction and objectives: The cochlear implant is a surgical procedure that has increased substantially, because the paediatric population is diagnosed and implanted early and because there are increased potential indications. This device has the inherent risk of failure in performance, as dies any active medical device, which is the most common cause of implant removal. Our goal was to understand what the causes that produced removal in our series were, and confirm if these conformed to reality as reviewed in the literature. Methods: This was a retrospective, descriptive, observational study of 859 cochlear implant surgeries carried out between October 1991 and May 2011. The causes of implant removal were classified according to the European Consensus Statement on Cochlear Implant Failures and Explantations. Results: The reimplantation rate was 6.16% (n = 51). The most common reason for removal was technical device failure (45.5%), followed by infection/rejection (23.6%) and upgrade (12.7%). Less common causes: there were 3 cases (5.6%) of electrode misplacement, 2 cases (3.6%) of labyrinthine ossification, 2 (3.6%) as a result of head trauma, 2 (3.6%) from need for nuclear magnetic resonance imaging and 1 case (1.8%) from psychiatric illness. Conclusions: Cochlear reimplantation is a safe procedure, with a low complication rate. In our centre, it reaches an overall rate of 6.16%. Technical device failure remains the most common cause of this procedure, although there is a significant percentage of reimplantation for device update (AU)

Experience in cochlear reimplantation. Descriptive study of a 20-year period.

INTRODUCTION AND OBJECTIVES: The cochlear implant is a surgical procedure that has increased substantially, because the paediatric population is diagnosed and implanted early and because there are increased potential indications. This device has the inherent risk of failure in performance, as dies any active medical device, which is the most common cause of implant removal. Our goal was to understand what the causes that produced removal in our series were, and confirm if these conformed to reality as reviewed in the literature. METHODS: This was a retrospective, descriptive, observational study of 859 cochlear implant surgeries carried out between October 1991 and May 2011. The causes of implant removal were classified according to the European Consensus Statement on Cochlear Implant Failures and Explantations. RESULTS: The reimplantation rate was 6.16% (n=51). The most common reason for removal was technical device failure (45.5%), followed by infection/rejection (23.6%) and upgrade (12.7%). Less common causes: there were 3 cases (5.6%) of electrode misplacement, 2 cases (3.6%) of labyrinthine ossification, 2 (3.6%) as a result of head trauma, 2 (3.6%) from need for nuclear magnetic resonance imaging and 1 case (1.8%) from psychiatric illness. CONCLUSIONS: Cochlear reimplantation is a safe procedure, with a low complication rate. In our centre, it reaches an overall rate of 6.16%. Technical device failure remains the most common cause of this procedure, although there is a significant percentage of reimplantation for device update.

Trastorno congénito de la glucosilación: experiencia en el primer paciente hipoacúsico tratado con implante coclear / Congenital disorders of glycosylation: first deaf patient treated with a cochlear implant

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Paragangliomas temporales. Experiencia de 12 años / Temporal paragangliomas. A 12-year experience

Objetivo: El objetivo de este trabajo es realizar un estudio retrospectivo en pacientes con diagnóstico de paraganglioma temporal, analizando los resultados según la conducta terapéutica aplicada para cada caso. Material y métodos: Se incluyó a 21 pacientes con diagnóstico de paraganglioma temporal tratados en nuestro servicio entre enero de 1999 y abril de 2011. A todos se les realizó un examen otorrinolaringológico, sistémico y de imagen. En 20 casos se realizó cirugía para su exéresis yen un caso se realizó tratamiento con cirugía estereotáxica. Resultados: Se realizó embolización preoperatoria en 12 casos. Los abordajes quirúrgicos fueron: extirpación endaural, resección transcanal tras abordaje retroauricular, mastoidectomía radical ampliada con abordaje de receso facial y abordaje infratemporal. El diagnóstico de paraganglioma fue confirmado en todos los casos. Las complicaciones postoperatorias más frecuentes fueron: paresia transitoria del VII par, hipoacusia neurosensorial, desequilibrio, parálisis del VII, parálisis del IX y el XI par y fístula salival. No se observó recidiva de enfermedad con seguimiento entre 1 y 12 años. En un caso tratado con radiocirugía persiste el tumor, estabilizado. Conclusiones: En nuestra serie la cirugía constituye la terapia con la que se logró la resección tumoral total en todos los casos. El uso de embolización preoperatoria reduce el tiempo quirúrgico y el sangrado intraoperatorio. La radiocirugía estereotáxica no permite la desaparición tumoral y persiste la enfermedad (AU)

Objective: Our objective was to perform a retrospective analysis of patients with jugulotympanic paragangliomas. We present the results according to the surgical approach applied in each case. Materials and methods: This retrospective study presents the findings in 21 patients with jugulotympanic paragangliomas who were observed and treated in our department over a 12-year period (1999 to 2011). We performed a general otolaryngology exam, systemic evaluation and radiological exam. Surgical treatment was performed in 20 cases out of 21. In 1 case, treatment with stereotactic radiosurgery was carried out. Results: The surgical approaches were: endaural, retroauricular transcanal, radical or modified mastoidectomy through facial recess and infratemporal fossa approach. Preoperative embolization was used in 12 cases. In all cases the diagnosis of paraganglioma was confirmed. The most frequent postoperative complications found were transitory palsy of the facial nerve, sensorineural hearing loss, imbalance, paralysis of the cranial nerves IX and XI and salivary fistula. No recurrences were found after 12 years of follow-up. One case of persistence was found in the case treated with radiosurgery. Conclusions: In our series surgery was found to be the elective therapy for patients with paraganglioma, with no recurrences after 12 years of follow-up. Preoperative embolization decreases surgery time and intraoperative bleeding. Stereotactic Radiotherapy cannot eliminate the tumour (AU)

[Temporal paragangliomas. A 12-year experience]. / Paragangliomas temporales. Experiencia de 12 años.

OBJECTIVE: Our objective was to perform a retrospective analysis of patients with jugulotympanic paragangliomas. We present the results according to the surgical approach applied in each case. MATERIALS AND METHODS: This retrospective study presents the findings in 21 patients with jugulotympanic paragangliomas who were observed and treated in our department over a 12-year period (1999 to 2011). We performed a general otolaryngology exam, systemic evaluation and radiological exam. Surgical treatment was performed in 20 cases out of 21. In 1 case, treatment with stereotactic radiosurgery was carried out. RESULTS: The surgical approaches were: endaural, retroauricular transcanal, radical or modified mastoidectomy through facial recess and infratemporal fossa approach. Preoperative embolization was used in 12 cases. In all cases the diagnosis of paraganglioma was confirmed. The most frequent postoperative complications found were transitory palsy of the facial nerve, sensorineural hearing loss, imbalance, paralysis of the cranial nerves IX and XI and salivary fistula. No recurrences were found after 12 years of follow-up. One case of persistence was found in the case treated with radiosurgery. CONCLUSIONS: In our series surgery was found to be the elective therapy for patients with paraganglioma, with no recurrences after 12 years of follow-up. Preoperative embolization decreases surgery time and intraoperative bleeding. Stereotactic Radiotherapy cannot eliminate the tumour..

[General indications of middle-ear implants]. / Indicaciones generales de los implantes de oído medio.

Middle ear implants are indicated in bilateral neurosensorial hearing loss in the following situations: bilateral neurosensorial hearing loss with maximal thresholds of air conduction or air conduction within an established range. The differential threshold in frequencies of 500, 1,000, 2,000 and 4,000 Hz should not be above 10 dB in two or more of these frequencies. Minimal speech recognition must be 50% or more. Middle ear function and anatomy must be normal and there must be no evidence that hearing loss is of retrocochlear origin. Use of a hearing aid for at least 6 months in the ear receiving the implant must be proven to be unsatisfactory by a hearing test. Expectations must be realistic and vestibular alterations must be excluded.

Indicaciones generales de los implantes de oído medio / General indications of middle-ear implants

Los implantes de oído medio están indicados en las siguientes situaciones: sordera bilateral neurosensorial, con umbrales de conducción aérea máximos o dentro de los límites establecidos. El umbral diferencial en las frecuencias de 500, 1.000, 2.000 y 4.000 Hz no debe ser superior a 10 dB, en dos o más de estas frecuencias. Reconocimiento mínimo del habla de un 50% o más. Funcionamiento y anatomía normal del oído medio. Si no hay ninguna evidencia de que la pérdida auditiva es de origen retrococlear. Insatisfacción comprobada con pruebas auditivas del uso de la prótesis auditiva, al menos durante 6 meses en el oído a implantar. Expectativas realistas y ausencia de alteraciones vestibulares (AU)

Middle ear implants are indicated in bilateral neurosensorial hearing loss in the following situations: bilateral neurosensorial hearing loss with maximal thresholds of air conduction or air conduction within an established range. The differential threshold in frequencies of 500, 1,000, 2,000 and 4,000 Hz should not be above 10 dB in two or more of these frequencies. Minimal speech recognition must be 50% or more. Middle ear function and anatomy must be normal and there must be no evidence that hearing loss is of retrocochlear origin. Use of a hearing aid for at least 6 months in the ear receiving the implant must be proven to be unsatisfactory by a hearing test. Expectations must be realistic and vestibular alterations must be excluded (AU)