Realistic Environment Audiometric Booth: Development and Clinical Validation.

BACKGROUND: Technological developments to treat hearing loss with different types of hearing aids and auditory implants have improved the auditory perception of patients, particularly in highly complex listening conditions. These devices can be fitted and adapted to enhance speech perception. Audiological tests that assess hearing with and without auditory devices have traditionally taken place in sound-attenuated audiometric booths. Although the insights gained from these tests are extremely useful, they do not accurately reflect everyday listening situations, and accurate information about the potential benefits of the hearing device in real acoustic scenarios cannot be established. Consequently, it is difficult to optimize this technology since fitting cannot be customized. OBJECTIVES: The aim of this study was to validate an audiological testing method using a new development, the Realistic Environment Audiometric Booth (REAB), in clinical practice. MATERIALS: We used specifically designed software to perform audiological tests in an 8 m2 sound-attenuated booth. The REAB was designed to conduct audiological tests in standard testing conditions and in new hearing scenarios that simulate real-life situations since sound can be emitted simultaneously or alternately 360° around the patient, along with 3D images. METHODS: Prospective study in which subjects were tested randomly in the REAB and the conventional booth (CB) in free field. RESULTS: 150 subjects were recruited, mean age 56 ± 20.7 years. Auditory outcomes for pure-tone audiometry showed a high correlation; this was also the case for speech audiometries in quiet and in noise. The outcome of the new scenarios with real-life noise was plotted, including the mean values and their confidence intervals. A decreasing trend was observed in the results obtained by the different groups, according to their hearing levels. CONCLUSIONS: We have developed and validated a new audiological testing method that enables hearing ability to be assessed in listening conditions similar to those found in real life. The REAB complements the tests performed in CBs, thereby aiding the diagnostic process by reproducing acoustic and visual scenarios that conventional tests do not offer.

Sculpting the temporal bone: an easy reversible cochlear implant electro-array stabilization technique.

PURPOSE: Since the beginning of cochlear implant (CI) surgery, several techniques to fixate the electrode array at the cochleostomy and stabilize it have been described; however, most techniques use autologous tissues such as fascia, muscle, fat or fibrin glue. We describe a new surgical technique aimed to stabilize the electrode array of a CI without using autologous tissues or artificial materials. MATERIALS AND METHODS: The surgical technique described consists in creating three stabilizing channels in the temporal bone for the electrode array. The first one in a partially opened aditus, the second one in a partially preserved Koerner's septum (KS) and the last one in the sinodural angle. The procedure was performed in five human temporal bones using a straight array; a radiography was made to confirm the correct placement of the electrode array and afterwards all temporal bones were shaken using a Titramax 1000 platform. The correct placement of the array post-shaking was then confirmed using the microscope and another radiography. RESULTS: No migration of the electrodes outside the cochlea was observed. The CI cable remained in the same position at the aditus and the KS in all the temporal bones. In three cases (60%), the electrode array moved away from the groove carved in the sinodural angle. CONCLUSIONS: The new surgical technique described stabilizes the electrode array using the temporal bone's normal anatomy, preserving the middle ear spaces, facilitating the ulterior explantation and reimplantation if necessary, and may reduce cost and surgery time.

La otitis media con efusión como un proceso infeccioso relacionado a la microbiota de la amígdala faríngea / Otitis media with effusion as an infectious process related to the pharyngeal amygdala microbiote / Otitis media com efusão como um processo infeccião relacionadocom o microbiota do faríngea amígdala

Introducción: la otitis media con efusión es una patología muy prevalente en la infancia, frente a la cual se suele indicar tratamiento médico no antibiótico por 90 días. En caso de no revertir, se indica colocación de tubos transtimpánicos, que puede acompañarse de adenoidectomía. La terapéutica suele mejorar la evolución pero la refractariedad de esta patología hace pensar que no es un proceso estéril. Existen estudios que demuestran la presencia de ADN bacteriano en la efusión. El mismo se encontraría junto con la presencia de ARN y proteínas, los cuales son indicadores de metabolismo y actividad bacteriana. Los agentes patógenos más frecuentes, productores de infección de oído medio, incluyen a Streptococcus pneumoniae, Haemophilus influenzae y Moraxella catarrhalis, entre otros, los cuales podrían ser los responsables de la refractariedad de esta patología frente al tratamiento no antibiótico...

Introduction: otitis media with effusion is a very prevalent childhood pathology, usually nonantibiotic medical treatment is indicated for 90 days as its treatment. If there is no improvement, transthympanic tubes are indicated, which may be accompanied by adenoidectomy. These treatments most of the times improve the evolution, nevertheless the refractoriness of this pathology, suggests that it is not a sterile process. There are studies that demonstrate the presence of bacterial DNA in the effusion. Also RNA and proteins were found in it, which indicates metabolism and bacterial activity. The most common pathogens involved in middle ear infections include Streptococcus pneumoniae, Haemophilus influenzae and Moraxella catarrhalis, among others, which could be responsible for the refractoriness of this pathology to non-antibiotic treatment...

Introdução: a otite média com efusão é uma patologia muito prevalente na infância, contra a qual geralmente o tratamento médico não antibiótico é indicado por 90 dias. Se não for revertido, é indicada a colocação de tubos transtimpânicos, que pode ser acompanhada de adenoidectomia. A terapêutica geralmente melhora a evolução, mas a refração desta patologia, sugere que não é um processo esté- ril. Existem estudos que demonstram a presença de DNA bacteriano no derrame. O mesmo seria encontrado junto com a presença de RNA e proteínas, que são indicadores de metabolismo e atividade bacteriana. Os agentes patogénicos mais comuns que causam a infecção da orelha média incluem Streptococcus pneumoniae, Haemophilus influenzae e Moraxella catarrhalis, entre outros, que podem ser responsáveis pela refractariedade desta patologia quando o tratamento não antibiótico é indicado...