Chagas vertical: una realidad en España / Vertically-transmitted Chagas: a reality in Spain

La enfermedad de Chagas, o tripanosomiasis americana, es una patología endémica en amplias regiones de América, desde el sur de Estados Unidos hasta el sur de Argentina y Chile. En la actualidad, el peligro de contraer la enfermedad no sólo está en Latinoamérica. Debido a los movimientos migratorios de la población de dichas regiones, la infección está llegando a ser un problema mundial. Es necesario actualizar los conocimientos sobre esta enfermedad emergente, que ya es una realidad en nuestro medio, mediante una revisión bibliográfica. Las mujeres embarazadas infectadas pueden transmitir la enfermedad por vía vertical o transplacentaria a su hijo; esta última es la vía que nos interesa, por dar lugar al Chagas congénito. En áreas endémicas la prevalencia de transmisión por vía transplacentaria oscila entre el 2 y el 12%.Es importante solicitar las pruebas serológicas a las mujeres embarazadas provenientes de áreas endémicas y, en caso de ser positivas, realizar el diagnóstico precoz de sus hijos y el posterior tratamiento durante el primer año de vida(AU)

Chagas disease, or American trypanosomiasis, is endemic to large regions of America, from the southern United States to the south of Argentina and Chile. Currently, the risk of being infected with the disease does not exist only in Latin America. This infection is beginning to be a serious problem all over the world because of immigration from the endemic regions. It is necessary to update our knowledge concerning this emergent disease, which is already a reality in our patient population, by means of a literature review. Infected pregnant women can transmit the disease to the fetus either vertically or via the placenta. We are interested in transplacental transmission because this is the form that leads to congenital Chagas. In endemic areas, the prevalence of transmission by this route ranges between 2% and 12%.It is very important to request serologic tests for pregnant women from endemic areas. Should the results be positive, their children should have early diagnostic testing, followed by treatment throughout their first year of life(AU)

[Prevalence of dental caries: comparison between immigrant and autochthonous children]. / Prevalencia de la caries dental en el niño inmigrante: estudio comparativo con el niño autóctono.

INTRODUCTION: Immigration to Spain has been high in recent years, especially in some autonomous communities. In both deciduous and permanent teeth, immigrant children have a higher number of dental caries and a lower number of restored teeth than autochthonous schoolchildren. Few studies have compared the prevalence of dental caries between immigrant and autochthonous children. OBJECTIVE: To determine the prevalence of dental caries in two groups of children: an immigrant group and an autochthonous group. MATERIAL AND METHOD: The study sample consisted of 600 children (235 immigrant children and 365 autochthonous children) aged between 6 and 10 years old who were living in the autonomous community of Valencia. The children were examined by two specialists, an odontologist and a pediatrician. RESULTS: The prevalence of dental caries was higher in immigrant children than in autochthonous children. In deciduous dentition, the prevalence of caries was 47.23 % and 32.05 % in immigrants and autochthonous children, respectively. In permanent dentition, the prevalence was 53.19 % and 35.34 %, respectively. CONCLUSIONS: The prevalence of dental caries was higher in immigrant children than in autochthonous children. Pediatricians and/or odontologists should aim to improve knowledge of good dental health care and habits among immigrant children and their parents.

Prevalencia de la caries dental en el niño inmigrante: estudio comparativo con el niño autóctono / Prevalence of dental caries: comparison between immigrant and autochthonous children

Introducción La llegada de inmigrantes a España es una realidad en nuestro país que depende en gran medida de la comunidad autónoma que analicemos. Es evidente por parte de estos niños inmigrantes la existencia de un notorio peor estado de salud dental que los niños autóctonos, con una elevada prevalencia de la caries dental tanto en dientes temporales como permanentes. Son pocos los estudios existentes que comparen la incidencia de la caries dental entre niños inmigrantes y autóctonos. Objetivo Determinar la incidencia de la caries dental en un grupo de niños inmigrantes comparado con un grupo control de niños autóctonos. Material y método Un total de 600 escolares (235 inmigrantes y 365 autóctonos) residentes en la Comunidad Valenciana, con edades comprendidas entre los 6 y los 10 años de edad, fueron explorados por 2 examinadores, un pediatra y un odontólogo. Resultados Hay una mayor incidencia de la caries dental en niños inmigrantes. La incidencia en dentición temporal fue de 47,23 y de 32,05 % en inmigrantes y autóctonos, respectivamente, y de 53,19 % frente a 35,34 % en dentición permanente. Conclusiones Los niños inmigrantes presentan altos niveles de caries dentales en comparación con los niños autóctonos. Es necesario un refuerzo por parte del pediatra y/o odontólogo en las acciones de promoción de la salud dental, con el objetivo de mejorar el estado de salud de este grupo de población

Introduction Immigration to Spain has been high in recent years, especially in some autonomous communities. In both deciduous and permanent teeth, immigrant children have a higher number of dental caries and a lower number of restored teeth than autochthonous schoolchildren. Few studies have compared the prevalence of dental caries between immigrant and autochthonous children. Objective To determine the prevalence of dental caries in two groups of children: an immigrant group and an autochthonous group. Material and method The study sample consisted of 600 children (235 immigrant children and 365 autochthonous children) aged between 6 and 10 years old who were living in the autonomous community of Valencia. The children were examined by two specialists, an odontologist and a pediatrician. Results The prevalence of dental caries was higher in immigrant children than in autochthonous children. In deciduous dentition, the prevalence of caries was 47.23 % and 32.05 % in immigrants and autochthonous children, respectively. In permanent dentition, the prevalence was 53.19 % and 35.34 %, respectively. Conclusions The prevalence of dental caries was higher in immigrant children than in autochthonous children. Pediatricians and/or odontologists should aim to improve knowledge of good dental health care and habits among immigrant children and their parents

Errores congénitos del metabolismo: una carrera de obstáculos / Congenital errors of metabolism: an obstacle race

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Profilaxis de la transmisión vertical del VIH con zidovudina y lamivudina y neutropenia autoinmune / Prophylaxis against vertical human immunodeficiency virus with zidovudine and lamivudine and autoimmune neutropenia

La transmisión maternofetal es la principal causa de contagio por el virus de la inmunodeficiencia humana (VIH) en niños. La zidovudina (AZT) reduce el riesgo de transmisión vertical. La supresión de la medula ósea, incluyendo anemia y neutropenia, es el mayor efecto tóxico dosisdependiente limitante de la AZT. Excepcionalmente, se ha descrito neutropenia inducida por AZT en presencia de anticuerpos antineutrófilo en niños infectados por el VIH. En niños con infección VIH, se aprecia, con frecuencia, neutropenia como resultado de múltiples causas. La prevalencia de anticuerpos antineutrófilo es frecuente en estos pacientes, pero no parece que exista relación con la evolución a neutropenia. Hay pocos estudios sobre los efectos secundarios de la AZT en niños expuestos desde el periodo perinatal o sobre las posibles consecuencias de la exposición al VIH. Se presenta el caso de una recién nacida que recibe tratamiento para reducir la transmisión vertical por VIH y desarrolla una neutropenia en presencia de anticuerpos antineutrófilo. Esta rara complicación no ha sido descrita previamente en ningún niño expuesto de forma perinatal al VIH y tratado con zidovudina o lamivudina

Mother-to-infant transmission is the major means of infection by the human immunodeficiency virus (HIV) in children, Zidovudine (AZT) reduces the risk of vertical transmission, Bone marrow suppression, associated with disorders that include anemia and neutropenia, is the major dose-limiting toxic effect of AZT. On rare occasions, AZT-induced neutropenia in the presence of antineutrophil antibodies has been reported in HIVinfected children, Neutropenia is frequently detected in these patients and can have multiple causes. Antineutrophil antibodies are also prevalent, but their presence does not appear to correlate with the development of neutropenia. There are few studies on the secondary effects of AZT in children exposed during the perinatal period or on the possible consequences of exposure to HIV. We present the case of a newborn who, after treatment to reduce vertical HIV transmission, developed neutropenia in the presence of antineutrophil antibodies. To the best of our knowledge, this rare complication has not been reported previously in a child perinatally exposed to HIV and treated with zidovudine or lamivudine

[Black stain: a common problem in pediatrics]. / Tinción cromógena: un problema habitual en la clínica pediátrica.

BACKGROUND: Black stain is a common discoloration in pediatric patients. It is caused by microorganisms present in the saliva and is characterized by distinctive dark dots localized at the tooth surface parallel to the gingiva, both in deciduous and permanent dentition. OBJECTIVE: To determine the prevalence of black stain in a group of children in Valencia, Spain and its relationship with dental caries. MATERIAL AND METHODS: A total of 1,100 children aged between 4 and 11 years old were examined by a single observer between January and June 2003. RESULTS: The prevalence of black stain varied in the children studied. CONCLUSIONS: The prevalence of black stain was 7.54 % in our study. No differences were found between sexes or between anterior and posterior teeth. Treatment of black stain consists of professional cleaning every couple of months since the discoloration frequently tends to reappear.

[Prevalence of oral habits and teeth alterations in schoolchildren from Valencia (Spain)]. / Prevalencia de los hábitos bucales y alteraciones dentarias en escolares valencianos.

INTRODUCTION: Oral habits are acquired through the repetition of actions that serve to calm an emotional need of the child. All these oral habits can change the position of the teeth and arches. Pediatricians should identify these habits to instigate successful treatment. OBJECTIVE: The aim of the present study was to determine the prevalence of oral habits in 1,100 Valencian schoolchildren and identify the dental alterations associated with these habits. MATERIAL AND METHODS: Between January and June 2003, 1,100 children aged between 4 and 11 years old were examined by two observers, a dentist and a pediatrician, who were specially trained to detect anomalous habits. RESULTS: The prevalence of each of the distinct habits studied varied. CONCLUSIONS: The conclusions of our study were: a) the prevalence of oral habits was 53 %; b) no differences in oral habits were found between boys and girls, and c) open bite, maxillary cross-bite and overjet can be related to oral habits, although this association was not statistically significant.

Tinción cromógena: un problema habitual en la clínica pediátrica / Black stain: a common problem in pediatrics

Antecedentes: La tinción cromógena es una coloración que se presenta con frecuencia en la práctica clínica pediátrica. La causa es la presencia de las bacterias cromógenas en la saliva del sujeto, y las manifestaciones clínicas consisten en una coloración que se adhiere a la superficie del diente en el tercio más cercano a la encía, tanto en dientes temporales o de leche como en dientes definitivos o permanentes. Objetivo: Conocer la prevalencia de la tinción cromógena en una muestra de escolares valencianos, así como su relación con la caries dental. Material y métodos: Se ha realizado un estudio sobre 1.100 escolares con edades comprendidas entre los 4 y los 11 años de edad. El examen clínico se realizó por un solo observador durante los meses de enero a junio de 2003. Resultados: Los resultados mostraron una distribución desigual en la presencia de la tinción. Conclusiones: La tinción cromógena se presenta con una prevalencia del 7,54 % y se detectó igualmente en ambos sexos. La tinción cromógena aparece de igual manera en dientes anteriores que posteriores. El tratamiento es la realización de limpiezas profesionales periódicas, ya que la coloración tiende a reaparecer con frecuencia

Background: Black stain is a common discoloration in pediatric patients. It is caused by microorganisms present in the saliva and is characterized by distinctive dark dots localized at the tooth surface parallel to the gingiva, both in deciduous and permanent dentition. Objective: To determine the prevalence of black stain in a group of children in Valencia, Spain and its relationship with dental caries. Material and methods: A total of 1,100 children aged between 4 and 11 years old were examined by a single observer between January and June 2003. Results The prevalence of black stain varied in the children studied. Conclusions: The prevalence of black stain was 7.54 % in our study. No differences were found between sexes or between anterior and posterior teeth. Treatment of black stain consists of professional cleaning every couple of months since the discoloration frequently tends to reappear

Prevalencia de los hábitos bucales y alteraciones dentarias en escolares valencianos / Prevalence of oral habits and teeth alterations in schoolchildren from Valencia (Spain)

Introducción: Los hábitos orales son costumbres adquiridas por la repetición continuada de una serie de actos que sirven para calmar una necesidad emocional. Todos los hábitos anómalos modifican la posición de los dientes y la relación y la forma que guardan las arcadas dentarias entre sí. El pediatra debe identificar estos hábitos de manera precoz para tener éxito en el tratamiento. Objetivo: El objetivo del presente trabajo es conocer la prevalencia de estos hábitos orales anómalos en una muestra de escolares valencianos, así como las alteraciones dentarias asociadas. Material y métodos: Se ha realizado un estudio sobre 1.100 escolares con edades comprendidas entre los 4 y los 11 años de edad. El examen clínico se realizó por dos observadores, un pediatra y un odontólogo, entrenados para ello, durante los meses de enero a junio de 2003 para la detección de estos hábitos anómalos. Resultados: Los resultados mostraron una distribución desigual para cada uno de los diferentes hábitos. Conclusiones: Las conclusiones de nuestro estudio fueron: a) la prevalencia encontrada de los diferentes hábitos fue del 53%; b) estos hábitos aparecen de igual manera independientemente del sexo, y c) las alteraciones de mordida abierta anterior, compresión maxilar y aumento del resalte están relacionadas con la presencia de hábitos orales, aunque sin ser estadísticamente significativo

Introduction: Oral habits are acquired through the repetition of actions that serve to calm an emotional need of the child. All these oral habits can change the position of the teeth and arches. Pediatricians should identify these habits to instigate successful treatment. Objective: The aim of the present study was to determine the prevalence of oral habits in 1,100 Valencian schoolchildren and identify the dental alterations associated with these habits. Material and methods Between January and June 2003, 1,100 children aged between 4 and 11 years old were examined by two observers, a dentist and a pediatrician, who were specially trained to detect anomalous habits. Results: The prevalence of each of the distinct habits studied varied. Conclusions: The conclusions of our study were: a) the prevalence of oral habits was 53 %; b) no differences in oral habits were found between boys and girls, and c) open bite, maxillary cross-bite and overjet can be related to oral habits, although this association was not statistically significant

[Congresses of the Spanish Association of Pediatrics: bibliometric analysis as a springboard for debate]. / Congresos de la Asociación Española de Pediatría: debate a partir de su análisis bibliométrico.

BACKGROUND: Congresses are periodic meetings that are required to make known and discuss advances in the various fields of medicine. Bibliometric indicators are important tools used to determine the quality of scientific publications. However, this type of study is infrequently performed in free communications of congresses. MATERIAL AND METHODS: A bibliometric study of all the free communications published in the congresses of the Spanish Association of Pediatrics over 4 years, divided in two periods (1996-1997 and 2000-2001) (n = 2677) was performed. Bibliometric indicators were classified into quantitative (productivity), qualitative (statistical accessibility) and scientific evidence. RESULTS: Quantitative indicators: There were 928 free communications in 1996, 681 in 1997, 560 in 2000, and 508 in 2001. Eighty-eight percent were in poster format and 87 % were in structured format. There was a median of six authors per communication. The main subject areas were infectology, neonatology, hemato-oncology, neurology and endocrinology. Ninety-five per cent of communications were signed by hospitals with a marked contribution by hospitals in Andalusia and Madrid. Qualitative indicators: Statistical accessibility < 2 in 86 % and > 7 in 2.9 %. Scientific evidence indicators: The quality of scientific evidence was good in only 1 % and was average in 9 %, since 90 % of all the studies were descriptive (mainly clinical cases). Evidence-based methodological concepts were used in only 1.9 %. Compared with 1996-1997, in 2000-2001 there were fewer communications, more posters, and more structured communications, as well as greater statistical accessibility and better scientific evidence indicators, but these differences were not statistically significant. CONCLUSIONS: Bibliometric study of the congresses of the Spanish Association of Pediatrics is a good starting point to analyze the quality of pediatric meetings and discuss possible solutions: a rigorous scientific committee with quality criteria, more analytical and/or experimental studies and fewer descriptive studies (especially clinical cases); restricting the number of authors per communication, greater collaboration with epidemiologists and/or biostatisticians, and favoring structured communications would also improve quality.

Áreas temáticas de estudio en los congresos de la Asociación Española de Pediatría / Thematic áreas of study in Congresses of Asociación Española de Pediatría

Antecedentes. Las áreas temáticas (o subespecialidades) en pediatría son una realidad en la práctica clínica en España. Los indicadores bibliométricos son herramientas importantes utilizadas para conocer la calidad de las publicaciones científicas, pero este tipo de estudio es infrecuente en el análisis de las comunicaciones a congresos. El objetivo de este artículo es analizar la dinámica de publicación de las diferentes áreas temáticas en el contexto de los congresos pediátricos. Material y métodos. Se ha realizado un estudio bibliométrico de todas las comunicaciones publicadas en los congresos de la Asociación Española de Pediatría (AEP) durante cuatro años (1996-97 y 2000-01) (n=2.677). La variable dependiente corresponde al área temática de estudio (25 subespecialidades) y las variables independientes son los restantes indicadores bibliométricos, clasificados en tres grupos: cuantitativos (productividad), cualitativos (accesibilidad estadística) y de evidencia científica. Resultados. Las principales áreas temáticas fueron infectología (418 comunicaciones), neonatología (252), hemato-oncología (221), neurología (195) y endocrinología (176). El 95% de las comunicaciones eran firmadas por hospitales, con un papel destacado de los hospitales de Andalucía (Hospital Virgen del Rocío, Carlos Haya, Virgen Macarena, Clínico de Granda, Torrecárdenas, etc) y Madrid (Hospital Gregorio Marañón, Doce de Octubre, Niño Jesús, La Paz, etc). Las provincias con mayor productividad científica son Madrid (710), Sevilla (288), Barcelona (227), Granada (126) y Valencia (108). Madrid es la provincia con mayor productividad en todas las áreas temáticas, salvo en genética-dismorfología (Granada) y reumatología (Valencia). Detectamos indicadores bibliométricos positivos en las áreas de metabolismo-nutrición, endocrinología y neonatología y negativos en las áreas de cirugía pediátrica y genética-dismorfología. Conclusiones. El estudio bibliométrico de las áreas temáticas en los congresos de la AEP es un buen punto de partida para analizar la calidad de las comunicaciones científicas y discutir las posible soluciones para limitar los aspectos negativos detectados y potencia los positivos como, por ejemplo, exigir la estructuración de las comunicaciones, mayor complejidad en la accesibilidad estadística, favorecer el uso de estudios analíticos y/o experimentales, así como el uso de conceptos metodológicos propios de la medicina basada en pruebas (AU)

Background. The thematic áreas (or subspecialties) in Pediatrics is a relaity in clinical practice in Spain. Bibliometric indicators are important tools used to determine the quality of scientific publications, but this type of study is infrequent in the analysis of free communications of congresses. The objective of this article is to analyze the dynamic of publication in the different thematic areas in the context of the congresses of pediatrics. Material and methods. A bibliometric study of all the free communications published in the congresses of Asociación Española de Pediatría (AEP) during four years (1996-1997 and 2000-01), was performed (n=2.677). The dependent variable was thematic area of study (25 subspecialties) and independent variables were the other bibliometric indicators classified in three groups: quantitative (productivity), qualitative (statistical accessibility) and scientific evidence. Results. The main thematic areas were Infectology (418 communications), Neonatology (252), Hemato-oncology (221), Neurology (195) and Endocrinology (176). Ninetyfive percent of communications were signed by hospitals, with a predominant role of the hospitals of Andalusia (hospital Virgen del Rocio, Carlos Haya, Virgen Macarena, Clínico de Granada, Torrecárdenas, etc) and Madrid (hospital Gregorio Marañón, Doce de octubre, Niño Jesús, La Paz, etc). The provinces more scientific productive were Madrid (710), Sevilla (288), Barcelona (227), Granada (126) and Valencia (108). Madrid is the most productive province in all thematic areas, except Genetic-Dysmorphology (Granada) and Reumatology (Valencia). We found positive bibliometric indicators in the areas of Metabolism-Nutrition, Endocrinoloy and Neonatology, and negative ones in Pediatric Surgery and Genetic-Dysmorpholgy. Conclusions. The bibliometric study of thematic areas in congresses of AEP is a good starting point for analyse the quality of their free communications, and discuss possible solutions for limited the negative aspects and favour the positive ones, by example more structured communications, more complex statistical accessibility, more analytical and/or experimental studies, and more use of epidemiological concepts in evidence-based medicine (AU)

Congresos de la Asociación Española de Pediatría: debate a partir de su análisis bibliométrico / Congresses ofthe spanish association of pediatrics: bibliometric analysis as a springboard for debate

Antecedentes: Los congresos son reuniones periódicas necesarias para divulgar y discutir los avances en los distintos campos de la medicina. Los indicadores bibliométricos son herramientas importantes utilizadas para conocer la calidad de las publicaciones científicas, pero este tipo de estudio es infrecuente en el análisis de las comunicaciones a congresos. Material y métodos: Se ha realizado un estudio bibliométrico de todas las comunicaciones publicadas en los congresos de la Asociación Española de Pediatría (AEP) durante 4 años, dividido en dos bienios (1996-1997 y 2000-2001) (n= 2.677). Los indicadores bibliométricos se han clasificado en cuantitativos (productividad), cualitativos (accesibilidad estadística) y de evidencia científica. Resultados: Indicadores cuantitativos: el número de comunicaciones presentadas fueron 928 en el año 1996, 681 en 1997, 560 en 2000 y 508 en el año 2001. Las comunicaciones tenían formato póster en el 88 por ciento de los casos y un 87 por ciento eran estructuradas. Mediana de 6 autores por comunicación. Las principales áreas temáticas fueron infectología, neonatología, hematooncología, neurología y endocrinología. El 95 por ciento de las comunicaciones eran firmadas por hospitales, con un papel destacado de los hospitales de Andalucía y Madrid. Indicadores cualitativos: accesibilidad estadística interior a 2 en el 86 por ciento y superior a 7 en el 2,9 por ciento. Indicadores de evidencia científica: buena calidad de la evidencia científica en el 1 por ciento y regular en el 9 por ciento, debido a que el 90 por ciento de todos los estudios son descriptivos (principalmente casos clínicos).Conceptos metodológicos apropiados en medicina basada en la evidencia, en el 1,9 por ciento. Las diferencias encontradas entre los dos períodos de estudio fueron las siguientes para el bienio 2000-2001: menor número de comunicaciones, más formato póster y más comunicaciones estructuradas; mayor accesibilidad estadística y mejores indicadores de evidencia científica, pero sin significación estadística. Conclusiones: El estudio bibliométrico de los congresos de la AEP es un buen punto de partida para analizar la calidad de los congresos y discutir las posibles soluciones de mejora: un comité científico riguroso que utilice criterios de calidad, mayor uso de estudios analíticos y/o experimentales y menos estudios descriptivos (especialmente casos clínicos), limitar el número de autores por comunicación, mayor colaboración de epidemiólogos y/o bioestadísticos y favorecer la estructuración de las comunicaciones (AU)

[Stimulation increase in evoked acoustic otoemissions]. / Aumento del estímulo en las otoemisiones acústicas evocadas.

OBJECTIVE: Evoked otoacoustic emissions (OEAE) are an excellent evaluation method of the hearing organ and are principally useful in newborn screening. During the performance of this technique, doubtful cases sometimes exist and they are customarily considered as failures of the test, increasing the group of children to be re-evaluated. The program IL088 has the possibility of increasing the stimulus intensity (gain). We applied this gain to all children with doubtful OEAE in attempts to give a pass or fail score. PATIENTS AND METHODS: The record of OEAE was accomplished with the system IL088 v3.5. It was applied to 70 ears of healthy newborns, a gain of +15 dB initially and/or +21 dB (if a pass score was not obtained). Some normal ears were included in this group as controls. Of the explored ears, 23 had a normal OEAE, 17 presented a doubtful response and in 30 cases the answers were negative (fail). RESULTS: This study demonstrates that in doubtful cases, the usefulness of increasing the gain is very high permitting that these cases accomplish pass criteria (15/17). In the ears with a lack of response there is an increased response, but it usually does not reach a passing level (6/30). In children with normal response the pass rate does not vary. CONCLUSIONS: The increase in gain in ears with a doubtful response offers a high a rentability, reducing the the initial failure rate of OEAE without altering the real failure rate or affecting those that initially pass allowing a reduction in the number of second evaluations.

[Evoked otoacoustic emissions in school children]. / Otoemisiones acústicas evocadas en escolares.

OBJECTIVE: The aim of this work was to determine the usefulness of evoked otoacoustic emissions (OEAE) as a screening method for the diagnosis of hearing loss in schoolchildren. PATIENTS AND METHODS: To this end and by using this method, we have studied 1,202 ears of 616 children in the 1st and 2nd grades of elementary school with a mean age of 6.2 years. The equipment employed was an Otodynamic Analyzer (ILO 88) by Otodynamics, Ltd and the program ILO 88, version 3.94. RESULTS: The results were OEAE positive in 1,041 ears (86.6% passed the test) and OEAE negative in 161 ears (13.4% failed the test). We have determined the percentiles of all the parameters of the test and of the responses in order to establish the normal values in this age group. CONCLUSIONS: The use of the OEAE for the detection of hearing loss should not be restricted to newborns. The OEAE can also be used as an auditive screening test in schoolchildren.

[Influence of the middle ear on the measurement of otoacoustic emissions]. / Influencia del oído medio en la prueba de otoemisiones acústicas.

OBJECTIVE: Otoacoustic emissions (OAEs) provide an objective, non-invasive measurement of cochlear function. OAEs have proven to have a high sensitivity and reasonable specificity for hearing impairment diagnosis, especially when used for infant screening. The lower specificity could be due to middle ear function and that this affects otoacoustic emissions. PATIENTS AND METHODS: We have carried out a study in 1,202 ears with a mean age of 6.2 years. Clinical otoscopy and OAE measurements were performed in all cases and tympanometry in those cases with a negative result in the recorded emissions. RESULTS: Statistical analysis of tympanogram type indicated significant association with tympanogram type B and the absence of OAEs, as well as with otoscopic findings of secretory otitis media. CONCLUSIONS: Middle ear function must be taken into consideration when OAEs are used in clinical application. The problem of low specificity is mainly due to the fact that middle ear function affects the presence or absence of emissions with normal cochlear function.

[Diagnosis of otitis media with effusion by acoustic reflectometry]. / Diagnóstico de otitis secretoria mediante reflexometría acústica.

OBJECTIVE: Acoustic reflectometry is a new technique based on a sonar that enables the diagnosis of middle ear effusion. Our objective was to assess its value and to know the cut-off figure for pathology. PATIENTS AND METHODS: In 586 children, from 1 month to 14 years of age, we performed bilateral otoscopy looking for signs of middle ear effusion. Afterwards, 3 measurements with the acoustic otoscope (ENT, Inc.) were taken and the results between the two methods compared. RESULTS: There was a significant association (p < 0.0001, Chi-squared) between results > 4 and middle ear effusion with a sensitivity of 84.2% and a specificity of 98.9%. CONCLUSIONS: Acoustic reflectometry has shown to be a very quick (< 10 seconds/ear), accurate and objective technique. It is painless and easy. It can be made in any child, without collaboration (crying or moving) and at any age.

[Comparative study of tonal liminal audiometry and evoked otoacoustic emissions in school screening programs]. / Estudio comparativo entre audiometría tonal liminar y otoemisiones evocadas en las revisiones escolares.

Early diagnosis of deafness is an important objective during the pediatric age. This study compares two different audiological techniques, otoacoustic emissions (OEA) and tonal audiometry (AUD), to be used as screening methods in school revisions programmed for 6 years olds. The correlation between techniques is very good (97% of the positives and 92% of the negatives). The OEA method is objective and faster if the environmental noise is low; if not, AUD seems to be more reliable. At this age (6 years), the otoacoustic emissions have characteristics of the adult age.

[Comparative study of evoked otoacoustic emissions and auditory potentials of the brain stem in the neonatal period]. / Estudio comparativo entre otoemisiones provocadas y potenciales auditivos tronculares en el período neonatal.

Evoked otoacoustic emissions (EOAE) are a recently discovered technique that is related to a good audiological status. It is a quick, simple and harmless test that can be used in neonatal screening. We report and compare here the results from a series of neonates in which we have performed both, this test and a brainstem response (ABR) test. The correlation between techniques was good, especially in normal positive neonates where the correlation was 100%. However, EOAE only explores the cochlear status and will not detect retrocochlear pathologies.