Publications by authors named "Luis Lassaletta"

106 Publications

The Experience of a Facial Nerve Unit in the Treatment of Patients With Facial Paralysis Following Skull Base Surgery.

Otol Neurotol 2020 Dec;41(10):e1340-e1349

Department of Otorhinolaryngology.

: The management of facial paralysis following skull base surgery is complex and requires multidisciplinary intervention. This review shows the experience of a facial nerve (FN) unit in a tertiary university referral center. A multidisciplinary approach has led to the breaking of some old treatment paradigms. An overview of five FN scenarios is presented. For each setting a contemporary approach is proposed in contrast to the established approach. 1) For patients with an anatomically preserved FN with no electrical response at the end of surgery for vestibular schwannoma, watchful waiting is usually advocated. In these cases, reinforcement with an interposed nerve graft is recommended. 2) In cases of epineural FN repair, with or without grafting, and a poor expected prognosis, an additional masseter-to-facial transfer is recommended. 3) FN transfer, mainly hypoglossal-to-facial and masseter-to facial, are usually chosen based on the surgeons' preference. The choice should be based on clinical factors. A combination of techniques improves the outcome in selected patients. 4) FN reconstruction following malignant tumors requires a combination of parotid and temporal bone surgery, involving different specialists. This collaboration is not always consistent. Exposure of the mastoid FN is recommended for lesions involving the stylomastoid foramen, as well as intraoperative FN reconstruction. 5) In patients with incomplete facial paralysis and a skull base tumor requiring additional surgery, consider an alternative reinnervation procedure, "take the FN out of the equation" before tumor resection. In summary, to achieve the best results in complex cases of facial paralysis, a multidisciplinary approach is recommended.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1097/MAO.0000000000002902DOI Listing
December 2020

Diagnostic Accuracy of Intracochlear Test Electrode for Acoustic Nerve Monitoring in Vestibular Schwannoma Surgery.

Ear Hear 2020 Nov/Dec;41(6):1648-1659

Otolaryngology Department, Hospital Universitario La Paz, Madrid, Spain.

Objectives: Cochlear implants (CIs) are a well-known hearing restoration option for patients with vestibular schwannoma (VS) in cases of neurofibromatosis type-2 and, more recently, for patients with sporadic VS. One of the main limitations when performing CI during VS surgery is the capability to preserve the acoustic nerve (AN) anatomically and functionally. Significant efforts have been directed toward developing an intraoperative testing method for monitoring the AN function to determine if, after tumor removal, it is suitable for conducting stimuli delivered by a CI. However, all these methods have significant limitations, and none of them have documented diagnostic efficacy. To overcome these limitations and to obtain reliable information before CI insertion, a minimally invasive intracochlear test electrode (TE) has been recently developed. This TE has demonstrated to be suitable to test the integrity of the AN before CI in patients without any residual hearing by recording electrically evoked auditory brainstem responses (EABR). The present study constitutes the next phase of this research, which was to determine the usefulness of EABR obtained intraoperatively with the intracochlear TE after the resection of a VS and to calculate its diagnostic accuracy to assess the functionality of the AN for CI.

Design: This was a prospective, multicenter study of diagnostic accuracy. It was conducted in three tertiary referral centers between January 2015 and 2018. This study was designed following the Standards for Reporting of Diagnostic Accuracy Studies (STARD) statement guidelines. The STARD statement are guidelines to improve the completeness and transparency of reports of diagnostic accuracy studies. The diagnostic accuracy of the EABR evoked with the intracochlear TE after tumor removal was studied. Accuracy, sensitivity, specificity, positive predictive value, and negative predictive value were calculated. Patients eligible for the study were consecutive adults undergoing surgery for VS with simultaneous CI. The test under evaluation (index test) was the EABR obtained with the intracochlear TE after resection of the tumor. The reference test (gold standard) was the presence of auditory perception with the CI, defined as the presence of sound detection on an audiogram at 500, 1000, 2000, and 4000 Hz of no greater than 50 dB. In all the cases, auditory perception was verified by the presence of a positive EABR evoked with the CI.

Results: Twenty-one patients were included during the study period; seven patients were excluded from the diagnostic efficacy analysis due to inconclusive EABR results or absence of the gold standard to compare (they did not finally receive the CI). Thus, the outcome of the gold standard was assessed in 14 cases: 9 cases had positive EABR, all of them obtained auditory perception with the CI, and 5 cases had negative EABR, only one case had auditory perception with the CI, which constitutes the only false negative of this study. Accuracy of the TE was 93% (95% confidence interval, 66 to 100%), sensitivity 90% (95% confidence interval, 71 to 100%), specificity 100% (95% confidence interval, 100 to 100%), positive predictive value 100% (95% confidence interval, 100 to 100%), and negative predictive value 80% (95% confidence interval, 45 to 100%).

Conclusions: EABR elicited with the intracochlear TE had a diagnostic accuracy of 93% for predicting auditory perception with CIs after VS removal. These results suggest that the intracochlear TE can be used intraoperatively after tumor removal to test the integrity of the AN as a useful tool to complement the surgeon's perception for decision-making regarding implantation.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1097/AUD.0000000000000883DOI Listing
November 2020

Cognitive Improvement After Cochlear Implantation in Older Adults With Severe or Profound Hearing Impairment: A Prospective, Longitudinal, Controlled, Multicenter Study.

Ear Hear 2020 Oct 9. Epub 2020 Oct 9.

Department of Otolaryngology, Hospital Universitario La Paz, Madrid, Spain.

Objective: To compare the cognitive evolution of older adults with severe or profound hearing impairment after cochlear implantation with that of a matched group of older adults with severe hearing impairment who do not receive a cochlear implant (CI).

Design: In this prospective, longitudinal, controlled, and multicenter study, 24 older CI users were included in the intervention group and 24 adults without a CI in the control group. The control group matched the intervention group in terms of gender, age, formal education, cognitive functioning, and residual hearing. Assessments were made at baseline and 14 months later. Primary outcome measurements included the change in the total score on the Repeatable Battery for the Assessment of Neuropsychological Status for Hearing impaired individuals score and on its subdomain score to assess cognitive evolution in both groups. Secondary outcome measurements included self-reported changes in sound quality (Hearing Implant Sound Quality Index), self-perceived hearing disability (Speech, Spatial, and Qualities of Hearing Scale), states of anxiety and depression (Hospital Anxiety and Depression Scale), and level of negative affectivity and social inhibition (Type D questionnaire).

Results: Improvements of the overall cognitive functioning (p = 0.05) and the subdomain "Attention" (p = 0.02) were observed after cochlear implantation in the intervention group; their scores were compared to the corresponding scores in the control group. Significant positive effects of cochlear implantation on sound quality and self-perceived hearing outcomes were found in the intervention group. Notably, 20% fewer traits of Type D personalities were measured in the intervention group after cochlear implantation. In the control group, traits of Type D personalities increased by 13%.

Conclusion: Intervention with a CI improved cognitive functioning (domain Attention in particular) in older adults with severe hearing impairment compared to that of the matched controls with hearing impairment without a CI. However, older CI users did not, in terms of cognition, bridge the performance gap with adults with normal hearing after 1 year of CI use. The fact that experienced, older CI users still present subnormal cognitive functioning may highlight the need for additional cognitive rehabilitation in the long term after implantation.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1097/AUD.0000000000000962DOI Listing
October 2020

MRI after Bonebridge implantation: a comparison of two implant generations.

Eur Arch Otorhinolaryngol 2020 Sep 23. Epub 2020 Sep 23.

Department of Otorhinolaryngology, La Paz University Hospital, IdiPAZ Research Institute, Paseo de la Castellana, 261, 28046, Madrid, Spain.

Purpose: Analysis of head magnetic resonance images (MRI) of patients with active bone conduction implants (BCIs) is challenging. Currently, there are two generations of the transcutaneous Bonebridge system (BCI601 and BCI602), the main difference between them being the transducer design and thickness. The aim was to compare the effect of transducer placement and artifact reduction sequences on legibility of MRI scans.

Methods: Four Thiel-fixed human head specimens were used: BCI601 was implanted in sinodural and middle fossa placement, and BCI602 in middle fossa and retrosigmoid approach. Images were obtained with a Signa 1.5T MR. A metal artifact reduction sequence known as MAVRIC (multiacquisition variable-resonance image combination) was used. Each specimen was scanned using standard axial T2 SE and compared with axial MAVRIC artifact reduction sequences.

Results: Qualitatively, limits of the artifact produced by the implant were better defined with MAVRIC than with standard T2 sequences. Assessment of contralateral internal auditory canal (IAC) was possible in all cases. Placement of the BCI602 in the middle fossa allowed the view of the ipsilateral IAC using MAVRIC sequence. Quantitatively, the artifact was reduced with MAVRIC sequence from 6.3 to 59.7%, depending on the position of implant and model; the middle fossa placement and the BCI602 being those generating shorter artifact radio.

Conclusion: Artifact optimized sequences as MAVRIC reduce the artifact caused by the Bonebridge system. The middle fossa approach allows a better visualization of IAC canal in the ipsilateral ear with both implant versions, but the effect is more prominent with the BCI602.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1007/s00405-020-06380-2DOI Listing
September 2020

Drug development for noise-induced hearing loss.

Expert Opin Drug Discov 2020 12 25;15(12):1457-1471. Epub 2020 Aug 25.

Institute for Biomedical Research "Alberto Sols" CSIC-UAM , Madrid, Spain.

Introduction: Excessive exposure to noise is a common occurrence that contributes to approximately 50% of the non-genetic hearing loss cases. Researchers need to develop standardized preclinical models and identify molecular targets to effectively develop prevention and curative therapies.

Areas Covered: In this review, the authors discuss the many facets of human noise-induced pathology, and the primary experimental models for studying the basic mechanisms of noise-induced damage, making connections and inferences among basic science studies, preclinical proofs of concept and clinical trials.

Expert Opinion: Whilst experimental research in animal models has helped to unravel the mechanisms of noise-induced hearing loss, there are often methodological variations and conflicting results between animal and human studies which make it difficult to integrate data and translate basic outcomes to clinical practice. Standardization of exposure paradigms and application of -omic technologies will contribute to improving the effectiveness of transferring newly gained knowledge to clinical practice.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1080/17460441.2020.1806232DOI Listing
December 2020

Fibrovascular Tumor-Like Lesions of the Facial Nerve.

Audiol Neurootol 2021 29;26(1):27-34. Epub 2020 Jun 29.

Department of Otorhinolaryngology, La Paz University Hospital, Madrid, Spain.

Background: Facial nerve tumors (FNTs) are relatively rare benign lesions that arise from any segment of the facial nerve (FN). About half of all patients present with FN dysfunction, mainly long-standing or progressive facial paralysis. Diagnosis of an FNT is usually based on radiological imaging and confirmed by histological study. Most reported cases of FNTs are schwannomas and hemangiomas.

Objectives: The aim of this study was to review 4 cases of lesions with clinical, radiological, and surgical findings that suggested an FNT, the pathology revealing a fibrovascular proliferation with no clear signs of a specific tumor.

Method: Medical records of patients who had surgery due to an FN lesion were reviewed. Cases with known tumoral lesions were excluded. Four patients with tumor-like lesions were identified. Their imaging studies were re-evaluated. The pathological study included hematoxylin-eosin, Masson's trichrome, and immunohistochemistry for S100 protein, neurofilaments, CD31, Wilms' tumor 1 (WT1), and D240.

Results: The 4 cases revealed tumor-like fibrovascular lesions that could not be classified as typical pathological entities. All cases had a complete facial palsy preoperatively. Computed tomography and magnetic resonance imaging (MRI) suggested schwannoma or hemangioma. A complete excision was achieved, and a facial reconstruction was performed immediately after interruption. Postoperative FN function was improved in all cases. The histological study showed nervous tracts of normal morphology, with fibrous and vascular tissue interspersed in variable proportions. All cases showed areas of fibrosis with Masson's stain. In all cases, nervous tissue and Schwann cells tested positively for neurofilaments and S100, respectively. In vascular areas, endothelial cells stained positively for CD31, and negatively for D240 and WT1.

Conclusions: Fibrovascular lesions of the FN may mimic primary FNTs, especially schwannomas and hemangiomas. Surgical excision with grafting or nerve transfer is the procedure of choice if a complete facial paralysis is found. This unusual condition should be considered when counseling patients with FN lesions. The lack of hyperintensity on MRI T2-weighted images may suggest the presence of fibrous tissue.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1159/000508025DOI Listing
June 2020

A retrospective European multicenter analysis of the functional outcomes after active middle ear implant surgery using the third generation vibroplasty couplers.

Eur Arch Otorhinolaryngol 2021 Jan 25;278(1):67-75. Epub 2020 May 25.

Department of Otorhinolaryngology, Head and Neck Surgery "Otto Körner", University Medical Center Rostock, Rostock, Germany.

Purpose: To evaluate the safety and performance of three novel vibroplasty couplers that allow attachment of the floating mass transducer of a transcutaneous active middle ear implant (AMEI) to the round window (RW) membrane, the long process (LP), or the incus body and the short process (SP) of the incus.

Methods: Retrospective multicenter cohort study of 25 AMEI users with sensorineural or mixed hearing loss that were among the first implanted with an AMEI vibrating ossicular prosthesis in combination with the third generation of vibroplasty couplers between 2014 and 2016. Main Outcome Measures were bone-conduction pure-tone and vibroplasty thresholds, postoperative aided sound field thresholds and postoperative aided word recognition score (WRS).

Results: Bone conduction threshold changes of more than 10 dB in 4PTA were observed in two subjects. A mean improvement of 57.8% in speech recognition was observed with a mean WRS at 65 dB SPL improving from 14.8% (SD 21.9%) preoperatively to a mean aided score of 72.6% (SD 18.6%). Sound field thresholds improved from an average 4PTA of 64.1 dB HL (SD 9.8 dB HL) to 37.0 dB HL (SD 8.9 dB HL), resulting in a mean functional gain of 27.1 dB. There was no significant difference in WRS or functional gain between the coupler types.

Conclusion: Initial experience shows that all three third generation vibroplasty couplers represent safe and efficient attachment options for the FMT allowing the surgeon to choose the coupling type based on the present pathology.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1007/s00405-020-06064-xDOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7814408PMC
January 2021

Does bimodal hearing increase self-assessed abilities and hearing outcomes when compared to unilateral cochlear implantation?

Int J Audiol 2020 Sep 14;59(9):654-660. Epub 2020 Mar 14.

Department of Otolaryngology, "La Paz" University Hospital. IdiPAZ Research Institute, Madrid, Spain.

The primary objective of this study was to compare the applicability and benefit of providing unilateral cochlear implant (CI) users with a contralateral hearing aid (HA). This retrospective (case-control) study was conducted in a hospital-based CI centre. Participants self-assessed their hearing via two questionnaires (SSQ and HISQUI). Objective postoperative speech perception was assessed via aided thresholds and speech perception tests (monosyllabic words, disyllabic words, and sentences) in quiet and noise. A CI-only group (n = 113, mean age 55.1 ± 14.2 years) and a bimodal group (n = 50, mean age 56.7 ± 15.2) participated in the study. No significant difference in SSQ or HISQUI scores was observed between groups. The bimodal group had a significantly better aided hearing level ( = 0.020) and speech discrimination score ( = 0.019). Bimodal (CI + HA) users have significantly better speech understanding than unilateral CI-only users, although this benefit may not be reflected in self-assessed outcomes. Counselling about bimodal hearing must cover expectations about potential benefits.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1080/14992027.2020.1735653DOI Listing
September 2020

The reliability of hearing implants: report on the type and incidence of cochlear implant failures.

Cochlear Implants Int 2020 07 10;21(4):228-237. Epub 2020 Mar 10.

Instituto de ORL, Av Ambrosio Olmos 754, Córdoba, Argentina.

This study presents the data collected through a database on the type and incidence of cochlear implant device failures and major complications and quantifies the risk of failures across time based on the Association for the Advancement of Medical Instrumentation (AAMI) CI86:2017 standard. Information on reliability of MED-EL cochlear implants was collected from the MED-EL complaint database between 2003 and2013. Explants were categorized and device reliability was calculated according to the AAMI CI86:2017 standard principles. Data were collected for 11662 devices (5462 children, 6200 adults). The mean duration of follow up was 46.16 months. The total failure rate for all devices and all subjects was 2.41%. Medical related explants (MRE) were significantly worse for children than for adults with the ceramic implants, C40+ ( = 0.008) and PULSAR ( = 0.020). Device failure explants (DFE) were significantly worse for children than for adults with all four devices in the study, the C40+ ( < 0.001), PULSAR ( < 0.001), SONATA ( < 0.001), and CONCERTO ( = 0.023). The mean annual failure rate for all subjects and devices was 0.63% (1.03% for children, 0.28% for adults). The mean annual failure rate was 0.90% for the C40+; 0.57% for the PULSAR; 0.46% for the SONATA; and 0.39% for the CONCERTO. Compared to adults, children had significantly worse MRE and DFE due to a higher risk of head trauma and more vulnerable skull anatomy. Further, the authors conclude that the AAMI standard will ensure a more comprehensive and transparent evaluation of cochlear implant reliability in the future.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1080/14670100.2020.1735678DOI Listing
July 2020

Integrated management for sustainable cropping systems: Looking beyond the greenhouse balance at the field scale.

Glob Chang Biol 2020 Jan 10. Epub 2020 Jan 10.

European Commission, Joint Research Centre (JRC), Ispra, Italy.

Cover crops (CC) promote the accumulation of soil organic carbon (SOC), which provides multiple benefits to agro-ecosystems. However, additional nitrogen (N) inputs into the soil could offset the CO mitigation potential due to increasing N O emissions. Integrated management approaches use organic and synthetic fertilizers to maximize yields while minimizing impacts by crop sequencing adapted to local conditions. The goal of this work was to test whether integrated management, centered on CC adoption, has the potential to maximize SOC stocks without increasing the soil greenhouse gas (GHG) net flux and other agro-environmental impacts such as nitrate leaching. To this purpose, we ran the DayCent bio-geochemistry model on 8,554 soil sampling locations across the European Union. We found that soil N O emissions could be limited with simple crop sequencing rules, such as switching from leguminous to grass CC when the GHG flux was positive (source). Additional reductions of synthetic fertilizers applications are possible through better accounting for N available in green manures and from mineralization of soil reservoirs while maintaining cash crop yields. Therefore, our results suggest that a CC integrated management approach can maximize the agro-environmental performance of cropping systems while reducing environmental trade-offs.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1111/gcb.14989DOI Listing
January 2020

Biomarkers in Vestibular Schwannoma-Associated Hearing Loss.

Front Neurol 2019 18;10:978. Epub 2019 Sep 18.

IdiPAZ Research Institute, Madrid, Spain.

Vestibular schwannomas (VSs) are benign tumors composed of differentiated neoplastic Schwann cells. They can be classified into two groups: sporadic VS and those associated with neurofibromatosis type 2 (NF2). VSs usually grow slowly, initially causing unilateral sensorineural hearing loss (HL) and tinnitus. These tumors cause HL both due to compression of the auditory nerve or the labyrinthine artery and due to the secretion of different substances potentially toxic to the inner ear or the cochlear nerve. As more and more patients are diagnosed and need to be managed, we are more than ever in need of searching for biomarkers associated with these tumors. Owing to an unknown toxic substance generated by the tumor, HL in VS may be linked to a high protein amount of perilymph. Previous studies have identified perilymph proteins correlated with tumor-associated HL, including μ-Crystallin (CRYM), low density lipoprotein receptor-related protein 2 (LRP2), immunoglobulin (Ig) γ-4 chain C region, Ig κ-chain C region, complement C3, and immunoglobulin heavy constant γ 3. Besides, the presence of specific subtypes of heat shock protein 70 has been suggested to be associated with preservation of residual hearing. It has been recently demonstrated that chemokine receptor-4 (CXCR4) is overexpressed in sporadic VS as well as in NF2 tumors and that hearing disability and CXCR4 expression may be correlated. Further, the genetic profile of VS and its relationship with poor hearing has also been studied, including DNA methylation, deregulated genes, growth factors, and gene mutations. The knowledge of biomarkers associated with VS would be of significant value to maximize outcomes of hearing preservation in these patients.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.3389/fneur.2019.00978DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6759574PMC
September 2019

Facial nerve repair: the impact of technical variations on the final outcome.

Eur Arch Otorhinolaryngol 2019 Dec 19;276(12):3301-3308. Epub 2019 Sep 19.

Department of Otorhinolaryngology, La Paz University Hospital, IdiPAZ Research Institute, Paseo La Castellana #261, 28046, Madrid, Spain.

Objectives: To analyze the outcome of facial nerve (FN) reconstruction, the impact of technical variations in different conditions and locations, and the importance of additional techniques in case of suboptimal results.

Study Design: Retrospective study.

Setting: University-based tertiary referral center.

Patients: Between 2001 and 2017, reconstruction of the FN was performed on 36 patients with varying underlying diseases.

Interventions: FN repair was performed by direct coaptation (n = 3) or graft interposition (n = 33). Microsurgical sutures were used in 17 patients (47%) and fibrin glue was used in all cases. Additional reinnervation techniques (hypoglossal-facial or masseter-facial transfers) were performed in five patients with poor results after initial reconstruction.

Main Outcome Measures: FN function was evaluated using the House-Brackmann (HB) and the electronic clinician-graded facial function (eFACE) grading systems. Minimum follow-up was 12 months.

Results: FN reconstruction yielded improvement in 83% of patients, 21 patients (58.3%) achieving a HB grade III. The eFACE median composite, static, dynamic and synkinesis scores were 69.1, 78, 53.2, and 88.2 respectively. A tendency towards better outcome with the use of sutures was found, the difference not being significant. All patients undergoing an additional reinnervation procedure achieved a HB grade III, eFACE score being 74.8.

Conclusions: FN reconstruction offers acceptable functional results in most cases. No significant differences are expected with technical variations, different locations or conditions. In patients with poor initial results, additional reinnervation techniques should be always considered. The eFACE adds substantial information to the most used HB scale.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1007/s00405-019-05638-8DOI Listing
December 2019

Auditory Performances in Older and Younger Adult Cochlear Implant Recipients: Use of the HEARRING Registry.

Otol Neurotol 2019 09;40(8):e787-e795

St. Petersburg ENT & Speech Research Institute, St. Petersburg, Russia.

Objective: To evaluate the hearing outcomes of cochlear implantation in different age groups by using data collected in the HEARRING registry.

Methods: A multicenter study. Data of 146 patients were collected in a HEARRING registry. Patients were divided into three different age groups; ≤ 55 years old (age group 1, n = 66), 56 to 69 years old (age group 2, n = 45), and ≥ 70 years old (age group 3, n = 35). Speech in quiet (SPIQ), speech in noise (SPIN), and hearing implant sound quality index (HISQUI19) scores were evaluated for the different age groups at different test moments (preoperatively, 3, 6, 12, and 24 mo after first fitting).

Results: A statistically significant difference (p < 0.01) was found between preoperative scores and the scores on all the follow-up moments across all age groups. For SPIQ and SPIN, none of the time points showed a statistically significant age effect (p = 0.88 and p = 0.89). For HISQUI19 scores, a statistically significant age effect was found at 12 months after first fitting. The oldest age group scored significantly lower on the HISQUI19 compared with the youngest age group.

Conclusion: Hearing outcomes of adult cochlear implant users of different age groups were evaluated. The SPIQ and SPIN tests showed no significant differences between the different age groups. Nevertheless, the youngest group scored significantly better on self -perceived benefit (HISQUI19) with a cochlear implant compared with the oldest age group.Further research is needed to receive more insight into cochlear implantation in the elderly and its implications on rehabilitating and supporting this expanding older population.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1097/MAO.0000000000002333DOI Listing
September 2019

Auditory Skills following Cochlear Implantation in Children with the Charge Syndrome.

Audiol Neurootol 2019 10;24(3):139-146. Epub 2019 Jul 10.

Department of Otorhinolaryngology, La Paz University Hospital, Madrid, Spain.

Objectives: To assess the auditory outcomes and skills of pediatric cochlear implant (CI) users with the CHARGE syndrome. To determine the influence of inner ear malformations on the surgical procedure and speech understanding outcomes in this population.

Study Design: Observational, retrospective study.

Materials And Methods: Imaging, auditory testing, intraoperative findings, complications, and postoperative auditory skills and outcomes of pediatric CI users with CHARGE syndrome were recorded.

Results: 6 children (8 ears) were included, 5 of whom had prelingual deafness. Their mean age at implantation was 37 months. Six of the 8 ears presented cochlear malformation; the most frequent was hypoplasia type III. Intraoperatively, the transmastoid facial recess approach was used in 5 ears, and abnormalities of facial nerve anatomy were found in 5 ears. All electrode insertions were complete. All children were, to a varying degree, able to detect and identify sound. Verbalization skills were developed by 2 children, 1 of whom used oral language as his primary mode of communication.

Conclusions: Cochlear implantation performed by an experienced surgeon in patients with the CHARGE syndrome is a safe procedure with adequate treatment planning. All children had improved auditory skills although the improvement was variable.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1159/000500659DOI Listing
April 2020

Facial paralysis: Clinical practice guideline of the Spanish Society of Otolaryngology.

Acta Otorrinolaringol Esp 2020 Mar - Apr;71(2):99-118. Epub 2019 May 13.

Servicio de Otorrinolaringología, Hospital Universitario La Paz, Madrid, España.

Bell's palsy is the most common diagnosis associated with facial nerve weakness or paralysis. However, not all patients with facial paresis/paralysis have Bell's palsy. Other common causes include treatment of vestibular schwannoma, head and neck tumours, iatrogenic injuries, Herpes zoster, or trauma. The approach to each of these conditions varies widely. The purpose of this guideline is to provide clinicians with guidance on the treatment and monitoring of patients with different causes of facial paralysis. We intend to draft a practical guideline, focusing on operationalised recommendations deemed to be useful in the daily management of patients. This guideline was promoted by the Spanish Society of Otolaryngology and developed by a group of physicians with an interest in facial nerve disorders, including at least one physician from each Autonomous Community. In a question and answer format, it includes 56 relevant topics related to the facial nerve.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1016/j.otorri.2018.12.004DOI Listing
December 2020

Future global pig production systems according to the Shared Socioeconomic Pathways.

Sci Total Environ 2019 May 8;665:739-751. Epub 2019 Feb 8.

PBL Netherlands Environmental Assessment Agency, 2500 GH The Hague, the Netherlands.

Global pork production has increased fourfold over the last 50 years and is expected to continue growing during the next three decades. This may have considerable implications for feed use, land requirements, and nitrogen emissions. To analyze the development of the pig production sector at the scale of world regions, we developed the IMAGE-Pig model to describe changes in feed demand, feed conversion ratios (FCRs), nitrogen use efficiency (NUE) and nitrogen excretion for backyard, intermediate and intensive systems during the past few decades as a basis to explore future scenarios. For each region and production system, total production, productive characteristics and dietary compositions were defined for the 1970-2005 period. The results show that due to the growing pork production total feed demand has increased by a factor of two (from 229 to 471Tg DM). This is despite the improvement of FCRs during the 1970-2005 period, which has reduced the feed use per kg of product. The increase of nitrogen use efficiency was slower than the improvement of FCRs due to increasing protein content in the feed rations. As a result, total N excretion increased by more than a factor of two in the 1970-2005 period (from 4.6 to 11.1 Tg N/year). For the period up to 2050, the Shared Socio-economic Pathways (SSPs) provide information on levels of human consumption, technical development and environmental awareness. The sustainability of pig production systems for the coming decades will be based not only on the expected efficiency improvements at the level of animal breeds, but also on four additional pillars: (i) use of alternative feed sources not competing with human food, (ii) reduction of the crude protein content in rations, (iii) the proper use of slurries as fertilizers through coupling of crop and livestock production and (iv) moderation of the human pork consumption.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1016/j.scitotenv.2019.02.079DOI Listing
May 2019

Long-term changes in greenhouse gas emissions from French agriculture and livestock (1852-2014): From traditional agriculture to conventional intensive systems.

Sci Total Environ 2019 Apr 9;660:1486-1501. Epub 2019 Jan 9.

SU CNRS EPHE UMR 7619 Metis, BP 123, Tour 56-55, Etage 4, 4 Place Jussieu, 75005 Paris, France.

France was a traditionally agricultural country until the first half of the 20th century. Today, it is the first European cereal producer, with cereal crops accounting for 40% of the agricultural surface area used, and is also a major country for livestock breeding with 25% of the European cattle livestock. This major socioecological transition, with rapid intensification and specialisation in an open global market, has been accompanied by deep environmental changes. To explore the changes in agricultural GHG emissions over the long term (1852-2014), we analysed the emission factors of NO from field experiments covering major land uses, in a gradient of fertilisation and within a range of temperature and rainfall, and used CH emission coefficients for livestock categories, in terms of enteric and manure management, considering the historical changes in animal excretion rates. We also estimated indirect CO emissions, rarely accounted for in agricultural emissions, using coefficients found in the literature for the dominant energy consumption items (fertiliser production, field work and machinery, and feed import). From GHG emissions of ~30,000 ktons CO Eq yr in 1852, reaching 54,000 ktons CO Eq yr in 1955, emissions more than doubled during the 'Glorious thirties' (1950-1980), and peaked around 120,000 ktons CO Eq yr in the early 2000s. For the 2010-2014 period, French agriculture GHG emissions stabilised at ~114,000 ktons CO Eq yr, distributed into 49% methane (CH), 22% carbon dioxide (CO) and 29% nitrous oxide (NO). A regional approach through 33 regions in France shows a diversity of agriculture reflecting the hydro-ecoregion distribution and the agricultural specialisation of local areas. Exploring contrasting scenarios at the 2040 horizon suggests that only deep changes in the structure of the agro-food system would double the reduction of GHG emissions by the agricultural sector.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1016/j.scitotenv.2019.01.048DOI Listing
April 2019

Cochlear Implant Users with Otosclerosis: Are Hearing and Quality of Life Outcomes Worse than in Cochlear Implant Users without Otosclerosis?

Audiol Neurootol 2018 8;23(6):345-355. Epub 2019 Feb 8.

Department of Otolaryngology, La Paz University Hospital, IdiPAZ Research Institute, Madrid, Spain,

Background: The otosclerotic process may influence the performance of the cochlear implant (CI). Difficulty in inserting the electrode array due to potential ossification of the cochlea, facial nerve stimulation, and instability of the results are potential challenges for the CI team.

Objectives: To evaluate hearing results and subjective outcomes of CI users with otosclerosis and to compare them with those of CI users without otosclerosis.

Method: Retrospective review of 239 adults with bilateral profound postlingual deafness who underwent unilateral cochlear implantation between 1992 and 2017. Hearing and speech understanding were assessed via pure-tone audiometry and speech perception tests. Subjective outcomes were assessed via the Nijmegen Cochlear Implant Questionnaire (NCIQ), the Glasgow Benefit Inventory (GBI), and the Hearing Implant Sound Quality Index (HISQUI19) at 6 months, 12 months, and at the last follow-up.

Results: Subjects were 22 CI users with otosclerosis and 217 without otosclerosis. Both groups had a similar duration of deafness and age at CI implantation. Results did not significantly differ according to group: no significant intergroup difference was found regarding the frequency of complete electrode insertion, facial stimulation, reimplantation, or PTA4 scores at the last follow-up. Regarding speech perception, no significant intergroup difference was found on any test or at any interval. Further, subjective outcomes, as measured by the GBI, NCIQ, and HISQUI19, did not significantly differ between groups.

Conclusions: Adults with otosclerosis and profound hearing loss derive significant benefit from CI use. Audiological and self-reported outcomes are not significantly different from that of other CI users with postlingual deafness.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1159/000496191DOI Listing
September 2019

Options for keeping the food system within environmental limits.

Nature 2018 10 10;562(7728):519-525. Epub 2018 Oct 10.

Department of Epidemiology and Department of Nutrition, Harvard T. H. Chan School of Public Health, Boston, MA, USA.

The food system is a major driver of climate change, changes in land use, depletion of freshwater resources, and pollution of aquatic and terrestrial ecosystems through excessive nitrogen and phosphorus inputs. Here we show that between 2010 and 2050, as a result of expected changes in population and income levels, the environmental effects of the food system could increase by 50-90% in the absence of technological changes and dedicated mitigation measures, reaching levels that are beyond the planetary boundaries that define a safe operating space for humanity. We analyse several options for reducing the environmental effects of the food system, including dietary changes towards healthier, more plant-based diets, improvements in technologies and management, and reductions in food loss and waste. We find that no single measure is enough to keep these effects within all planetary boundaries simultaneously, and that a synergistic combination of measures will be needed to sufficiently mitigate the projected increase in environmental pressures.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1038/s41586-018-0594-0DOI Listing
October 2018

Clinical guideline on bone conduction implants.

Acta Otorrinolaringol Esp 2019 Mar - Apr;70(2):105-111. Epub 2018 Apr 13.

Servicio de Otorrinolaringología, Fundación Jiménez Díaz, Madrid, España; Miembro de la Comisión de Otoneurología, Sociedad Española de Otorrinolaringología y Cirugía de Cabeza y Cuello.

Introduction And Goals: During the last decade there have been multiple and relevant advances in conduction and mixed hearing loss treatment. These advances and the appearance of new devices have extended the indications for bone-conduction implants. The Scientific Committee of Audiology of the Sociedad Española de Otorrinolaringología y Cirugía de Cabeza y Cuello SEORL-CCC (Spanish Society of Otolaryngology and Head and Neck Surgery), together with the Otology and Otoneurology Committees, have undertaken a review of the current state of bone-conduction devices with updated information, to provide a clinical guideline on bone-conduction implants for otorhinolaryngology specialists, health professionals, health authorities and society in general.

Methods: This clinical guideline on bone-conduction implants contains information on the following: 1) Definition and description of bone-conduction devices; 2) Current and upcoming indications for bone conduction devices: Magnetic resonance compatibility; 3) Organization requirements for a bone-conduction implant programme.

Results And Conclusions: The purpose of this guideline is to describe the different bone-conduction implants, their characteristics and their indications, and to provide coordinated instructions for all the above-mentioned agents for decision making within their specific work areas.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1016/j.otorri.2017.12.001DOI Listing
November 2019

Guideline on cochlear implants.

Acta Otorrinolaringol Esp 2019 Jan - Feb;70(1):47-54. Epub 2018 Mar 26.

Miembros de la Comisión de Audiología de la Sociedad Española de Otorrinolaringología y Cirugía de Cabeza y Cuello, Madrid, España.

Introduction: In the last decade numerous hospitals have started to work with patients who are candidates for a cochlear implant (CI) and there have been numerous and relevant advances in the treatment of sensorineural hearing loss that extended the indications for cochlear implants.

Objectives: To provide a guideline on cochlear implants to specialists in otorhinolaryngology, other medical specialities, health authorities and society in general.

Methods: The Scientific Committees of Otology, Otoneurology and Audiology from the Spanish Society of Otolaryngology and Head and Neck Surgery (SEORL-CCC), in a coordinated and agreed way, performed a review of the current state of CI based on the existing regulations and in the scientific publications referenced in the bibliography of the document drafted.

Results: The clinical guideline on cochlear implants provides information on: a) Definition and description of Cochlear Implant; b) Indications for cochlear implants; c) Organizational requirements for a cochlear implant programme.

Conclusions: A clinical guideline on cochlear implants has been developed by a Committee of Experts of the SEORL-CCC, to help and guide all the health professionals involved in this field of CI in decision-making to treathearing impairment.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1016/j.otorri.2017.10.007DOI Listing
August 2019

Active middle ear implants.

Acta Otorrinolaringol Esp 2019 Mar - Apr;70(2):112-118. Epub 2018 Mar 17.

Departamento de Otorrinolaringología, Hospital Universitario Río Hortega, Valladolid, España; Comisión de Otología de la SEORL, España.

Active middle ear implants are surgically implanted prosthesis, which intend to stimulate the ossicular chain or the inner ear fluids through the oval or round windows. These implants may be useful for the treatment of certain patients with sensorineural hearing loss as well as for conductive or mixed hearing loss. This clinical guide attempts to summarize the current knowledge concerning the basic characteristics and indications of the most commonly used middle ear implants, including Vibrant Soundbrige (Med-el, Innsbruck), Carina (Cochlear, Australia), and Codacs. (Cochlear, Australia).
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1016/j.otorri.2017.10.001DOI Listing
November 2019

The Role of Insulin-Like Growth Factor 1 in the Progression of Age-Related Hearing Loss.

Front Aging Neurosci 2017 12;9:411. Epub 2017 Dec 12.

"Alberto Sols" Biomedical Research Institute CSIC-UAM, Madrid, Spain.

Aging is associated with impairment of sensorial functions and with the onset of neurodegenerative diseases. As circulating insulin-like growth factor 1 (IGF-1) bioavailability progressively decreases, we see a direct correlation with sensory impairment and cognitive performance in older humans. Age-related sensory loss is typically caused by the irreversible death of highly differentiated neurons and sensory receptor cells. Among sensory deficits, age-related hearing loss (ARHL), also named presbycusis, affects one third of the population over 65 years of age and is a major factor in the progression of cognitive problems in the elderly. The genetic and molecular bases of ARHL are largely unknown and only a few genes related to susceptibility to oxidative stress, excitotoxicity, and cell death have been identified. IGF-1 is known to be a neuroprotective agent that maintains cellular metabolism, activates growth, proliferation and differentiation, and limits cell death. Inborn IGF-1 deficiency leads to profound sensorineural hearing loss both in humans and mice. IGF-1 haploinsufficiency has also been shown to correlate with ARHL. There is not much information available on the effect of IGF-1 deficiency on other human sensory systems, but experimental models show a long-term impact on the retina. A secondary action of IGF-1 is the control of oxidative stress and inflammation, thus helping to resolve damage situations, acute or made chronic by aging. Here we will review the primary actions of IGF-1 in the auditory system and the underlying molecular mechanisms.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.3389/fnagi.2017.00411DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5733003PMC
December 2017

Usefulness of Electrical Auditory Brainstem Responses to Assess the Functionality of the Cochlear Nerve Using an Intracochlear Test Electrode.

Otol Neurotol 2017 12;38(10):e413-e420

*Department of Otolaryngology, "La Paz" University Hospital †Centro de Investigación Biomédica en Red de Enfermedades Raras (CIBERER-U761) ‡Instituto de Investigación Hospital Universitario La Paz (IdiPAZ), Madrid, Spain §Med-El Corporation, Insbruck, Austria ||Instituto de Investigaciones Biomédicas "Alberto Sols" CSIC-UAM, Madrid, Spain.

Objective: To use an intracochlear test electrode to assess the integrity and the functionality of the auditory nerve in cochlear implant (CI) recipients and to compare electrical auditory brainstem responses (eABR) via the test electrode with the eABR responses with the CI.

Setting: Otolaryngology department, tertiary referral hospital.

Patients: Ten subjects (age at implantation 55 yr, range, 19-72) were subsequently implanted with a MED-EL CONCERTO CI on the side without any useful residual hearing.

Interventions: Following identification of the round window (RW), the test electrode was inserted in the cochlea previous to cochlear implantation.

Main Outcome Measures: To assess the quality of an eABR waveform, scoring criteria from Walton et al. (2008) were chosen. The waveforms in each session were classified by detecting waves III and V by the algorithm and visual assessment of the waveform. Speech performance was evaluated with monosyllables, disyllables, and sentence recognition tests.

Results: It was possible to evoke electrical stimulation responses along with both the test electrode and the CI in all subjects. No significant differences in latencies or amplitudes after stimulation were found between the test electrode and the CI. All subjects obtained useful hearing with their CI and use their implants daily.

Conclusions: The intracochlear test electrode may be suitable to test the integrity of the auditory nerve by recording eABR signals. This allows for further research on the status of the auditory nerve after tumor removal and correlation with auditory performance.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1097/MAO.0000000000001584DOI Listing
December 2017

Hearing preservation cochlear implantation in children: The HEARRING Group consensus and practice guide.

Cochlear Implants Int 2018 01 26;19(1):1-13. Epub 2017 Oct 26.

j Antwerp University Hospital , Antwerp , Belgium.

Objectives: To provide multidisciplinary cochlear implant teams with a current consensus statement to support hearing preservation cochlear implantation (HPCI) in children, including those children with symptomatic partial deafness (PD) where the intention is to use electric-acoustic stimulation (EAS). The main objectives are to provide guidelines on who is a candidate, how to assess these children and when to implant if Med-El Flex electrode arrays are chosen for implantation.

Methods: The HEARRING group reviewed the current evidence and practice regarding the management of children to be considered for HPCI surgery emphasizing the assessment needed prior to implantation in order to demonstrate the benefits in these children over time. The consensus statement addresses following three key questions: (1) Should these children be treated? (2) How to identify these children? (3) How to manage these children?

Summary: The HEARRING group concludes that irrespective of the degree of residual hearing present, the concepts of hearing and structure preservation should be applied in every child undergoing cochlear implantation and that HPCI is a safe and reliable treatment option. Early detection and multidisciplinary assessment are key to the identification of children with symptomatic PD, these children should undergo HPCI as early as possible.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1080/14670100.2017.1379933DOI Listing
January 2018

A Comparative Study of Drug Delivery Methods Targeted to the Mouse Inner Ear: Bullostomy Versus Transtympanic Injection.

J Vis Exp 2017 03 8(121). Epub 2017 Mar 8.

Instituto de Investigaciones Biomédicas (IIBm) Alberto Sols CSIC-UAM; Centro de Investigación Biomédica en Red de Enfermedades Raras (CIBERER), Instituto de Salud Carlos III (ISCIII); Facultad de Veterinaria, Universidad Complutense de Madrid.

We present two minimally invasive microsurgical techniques in rodents for specific drug delivery into the middle ear so that it may reach the inner ear. The first procedure consists of perforation of the tympanic bulla, termed bullostomy; the second one is a transtympanic injection. Both emulate human clinical intratympanic procedures. Chitosan-glycerophosphate (CGP) and Ringer´s Lactate buffer (RL) were used as biocompatible vehicles for local drug delivery. CGP is a nontoxic biodegradable polymer widely used in pharmaceutical applications. It is a viscous liquid at RT but it congeals to a semi solid phase at body temperature. RL is an isotonic solution used for intravenous administrations in humans. A small volume of this vehicle is precisely placed on the Round Window (RW) niche by means of a bullostomy. A transtympanic injection fills the middle ear and allows less control but broader access to the inner ear. The safety profiles of both techniques were studied and compared by using functional and morphological tests. Hearing was evaluated by registering the Auditory Brainstem Response (ABR) before and several times after microsurgery. The cytoarchitecture and preservation level of cochlear structures were studied by conventional histological techniques in paraformaldehyde-fixed and decalcified cochlear samples. In parallel, unfixed cochlear samples were taken and immediately frozen to analyze gene expression profiles of inflammatory markers by quantitative Reverse Transcriptase Polymerase Chain Reaction (qRT-PCR). Both procedures are suitable as drug delivery methods into the mouse middle ear, although transtympanic injection proved to be less invasive compared to bullostomy.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.3791/54951DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5407703PMC
March 2017

Electrically evoked compound action potentials are different depending on the site of cochlear stimulation.

Cochlear Implants Int 2016 11 30;17(6):251-262. Epub 2016 Nov 30.

s Institute of Physiology and Pathology of Hearing , Warsaw , Poland.

One of the many parameters that can affect cochlear implant (CI) users' performance is the site of presentation of electrical stimulation, from the CI, to the auditory nerve. Evoked compound action potential (ECAP) measurements are commonly used to verify nerve function by stimulating one electrode contact in the cochlea and recording the resulting action potentials on the other contacts of the electrode array. The present study aimed to determine if the ECAP amplitude differs between the apical, middle, and basal region of the cochlea, if double peak potentials were more likely in the apex than the basal region of the cochlea, and if there were differences in the ECAP threshold and recovery function across the cochlea. ECAP measurements were performed in the apical, middle, and basal region of the cochlea at fixed sites of stimulation with varying recording electrodes. One hundred and forty one adult subjects with severe to profound sensorineural hearing loss fitted with a Standard or FLEX electrode were included in this study. ECAP responses were captured using MAESTRO System Software (MED-EL). The ECAP amplitude, threshold, and slope were determined using amplitude growth sequences. The 50% recovery rate was assessed using independent single sequences that have two stimulation pulses (a masker and a probe pulse) separated by a variable inter-pulse interval. For all recordings, ECAP peaks were annotated semi-automatically. ECAP amplitudes were greater upon stimulation of the apical region compared to the basal region of the cochlea. ECAP slopes were steeper in the apical region compared to the basal region of the cochlea and ECAP thresholds were lower in the middle region compared to the basal region of the cochlea. The incidence of double peaks was greater upon stimulation of the apical region compared to the basal region of the cochlea. This data indicates that the site and intensity of cochlear stimulation affect ECAP properties.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1080/14670100.2016.1240427DOI Listing
November 2016

Water management practices exacerbate nitrogen retention in Mediterranean catchments.

Sci Total Environ 2016 Dec 27;573:420-432. Epub 2016 Aug 27.

Université Pierre et Marie Curie (UPMC), UMR 7619 Metis, Paris 75005, France; PBL, Netherlands Environmental Assessment Agency, 3721 MA Bilthoven, The Netherlands.

Nitrogen (N) retention sensu lato refers to all processes preventing new reactive nitrogen brought into watersheds through agricultural or industrial activities to be exported by river systems to the sea. Although such processes protect marine systems from the threat of eutrophication and anoxia, they raise other environmental issues, including the acidification of soils, the emission of ammonia and greenhouse gases, and the pollution of aquifers. Despite these implications, the factors involved in N retention are still poorly controlled, particularly in arid and semi-arid systems. The present study evaluates the N fluxes of 38 catchments in the Iberian Peninsula with contrasting climatic characteristics (temperate and Mediterranean), land uses, and water management practices. This diversity allows addressing the contribution of physical and socioecological factors in N retention, and more specifically, exploring the relation between N retention and water regulation. We hypothesise that the extreme flow regulation implemented in the Mediterranean enhances the high N retention values associated with arid and semi-arid regions. The results show that reservoirs and irrigation channels account for >50% of the variability in N retention values, and above a certain regulation threshold, N retention peaks to values >85-90%. Future climate projections forecast a decrease in rainfall and an increase in agricultural intensification and irrigation practices in many world regions, most notably in arid and semi-arid areas. Increased water demand will likely lead to greater flow regulation, and the situation in many areas may resemble that of Iberian Mediterranean catchments. High N retention and the associated environmental risks must therefore be considered and adequately addressed.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1016/j.scitotenv.2016.08.007DOI Listing
December 2016

Bilateral Synchronous Ectopic Ethmoid Sinus Olfactory Neuroblastoma: A Case Report.

Am J Case Rep 2016 Apr 21;17:268-73. Epub 2016 Apr 21.

Department of Otolaryngology, La Paz University Hospital, La Paz University Hospital Institute for Health Research (IdiPAZ), Madrid, Spain.

Background: Olfactory neuroblastoma (ONB), also known as esthesioneuroblastoma, is a rare malignant head and neck cancer thought to originate from the olfactory epithelium. It typically invades contiguous structures at presentation. We report a very rare case of multifocal and ectopic ONB.

Case Report: A 41-year-old man presented with left nasal obstruction and occasional left epistaxis associated with headache. Endoscopic examination of the nasal cavities and computed tomography suggested bilateral polypoid masses. Histopathological diagnosis after endoscopic resection established bilateral olfactory neuroblastoma of the ethmoid sinuses. The patient received postoperative radiotherapy. He remains free of disease 4 years after treatment.

Conclusions: To the best of our knowledge this is the second documented case of multifocal ectopic olfactory neuroblastoma. Clinicians should consider ONB in the differential diagnosis of bilateral synchronous nasal and paranasal masses to avoid delayed diagnosis. Endoscopic resection of ONB could be an option in selected cases.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4841357PMC
http://dx.doi.org/10.12659/ajcr.897623DOI Listing
April 2016

Patient management for cochlear implant recipients in audiology departments: A practice review.

Cochlear Implants Int 2016 05 29;17(3):123-8. Epub 2016 Mar 29.

h ENT Super Specialty Institute and Research Center , Calicut , India.

Objectives: To determine and evaluate the time clinics needed to complete the sub-processes involved in the first-fitting and follow-up fitting of people with a cochlear implant.

Methods: Eight HEARRING clinics completed a questionnaire recording how long it took to complete the sub-processes involved in first-fitting and follow-up fitting cochlear implant recipients. The mean times of clinics and procedures were then compared.

Results: Questionnaires on 77 patients were completed. Clinics varied widely on time spent on each sub-process in both first- and follow-up fittings. Total first-fitting times were similar across clinics. Follow-up fitting times varied more across clinics although this may have been due to differences in questionnaire interpretation.

Discussion: If a patient management plan can help increasingly busy cochlear implant clinics provide high-quality care more efficiently, essential first steps are determining which procedures are generally performed and how long their performance takes. Until reliable data are gathered, constructing a patient management plan or reaping the potential benefits of its use will remain elusive; clinics will have to find what solutions they can to meet rising workload demands.

Conclusion: The variation in time spent on each sub-process may suggest that some clinics have more efficient workflow procedures. Compiling a best practice for each process could be instrumental in creating a professional process management plan that would increase efficiency without sacrificing quality of care.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1080/14670100.2015.1115188DOI Listing
May 2016