Grupos Investigadores

Líneas de Investigación

  • Detección, diagnóstico y tratamiento de las alteraciones auditivas en la etapa prenatal y perinatal.
  • Papel de la audición y el equilibrio en el envejecimiento saludable.
  • Técnicas mínimamente invasivas para el diagnóstico y tratamiento de las alteraciones laberínticas.

Palabras Clave

  • Hipoacusia
  • Inestabilidad
  • Vértigo

Publicaciones Científicas desde 2018

  • Autores: Mendes, I. C. (Autor de correspondencia); Sousa, H.; Manrique Rodríguez, Manuel Jesús; et al.
    Revista: ACTA OTORRINOLARINGOLOGICA ESPAÑOLA
    ISSN: 0001-6519 Vol.74 N° 1 2023 págs. 63 - 65
  • Autores: Román-Naranjo, P. (Autor de correspondencia); Parra-Pérez, A. M.; Escalera-Balsera, A.; et al.
    Revista: CLINICAL AND TRANSLATIONAL MEDICINE
    ISSN: 2001-1326 Vol.12 N° 6 2022 págs. e829
  • Autores: Manzari, L. (Autor de correspondencia); Pérez Fernández, Nicolás; Tramontano, M.
    Revista: FRONTIERS IN NEUROLOGY
    ISSN: 1664-2295 Vol.13 2022 págs. 1034012
  • Autores: Wegmann Vicuña, Ricardo; Manrique Huarte, Raquel; Calavia-Gil, D.; et al.
    Revista: FRONTIERS IN NEUROLOGY
    ISSN: 1664-2295 Vol.13 2022 págs. 808570
    Resumen
    BackgroundThe number of intratympanic gentamicin (ITG) injections needed to achieve vertigo control in patients with intractable Meniere's disease (MD) may vary from a single dose to several instillations. Changes in different vestibular test results have been used to define an endpoint of treatment, including the decrease of the vestibulo-ocular reflex (VOR) gain elicited by the head-impulse test. ObjectiveTo assess the accuracy of the VOR gain reduction after horizontal canal stimulation, as measured with the video head-impulse test (vHIT) 1 month after the first intratympanic injection, in predicting the need for one or more instillations to control vertigo spells in the long term. MethodsThe VOR gain reduction was calculated in 47 patients submitted to (ITG) therapy 1 month after the first instillation. ResultsSingle intratympanic treatment with gentamicin has a 59.6% efficacy in vertigo control in the long term. Hearing change in the immediate period after treatment (1 month) is not significant to pre-treatment result and is similar for patients who needed multiple doses due to recurrence. Chronic disequilibrium and the need for vestibular rehabilitation were less frequent in patients with a good control of vertigo with just one single injection of gentamicin. A fair accuracy was obtained for the VOR gain reduction of the horizontal canal (area under the curve = 0.729 in the Receiver Operating Characteristic analysis) in predicting the need for one or more ITG. ConclusionsSingle intratympanic treatment with gentamicin is an effective treatment for patients with MD. That modality of treatment has very limited damaging effect in hearing. The degree of vestibular deficit induced by the treatment is significant as measured by the reduction in the gain of the VOR but not useful for prognostic purposes.
  • Autores: Garaycochea Mendoza del Solar, Octavio (Autor de correspondencia); Riesgo García, Álvaro; Manrique Huarte, Raquel; et al.
    Revista: OTOLOGY AND NEUROTOLOGY
    ISSN: 1531-7129 Vol.43 N° 5 2022 págs. e597 - e601
    Resumen
    Objective: Flecainide is an oral class IC antiarrhythmic drug whose most common extracardiac adverse reactions are "dizziness" and "visual disturbances." We describe a case of flecainide associated- bilateral vestibulopathy and a literature review of this drug's effect on the vestibular system. Patient: Sixty-nine-year-old man with a 3-month history of unsteadiness and dizziness after an increase in the dose of flecainide. Interventions: Otologic examination, video head-impulse test, vestibular evoked myogenic potentials, pure tone audiometry and high-resolution magnetic resonance imaging. Results: Otologic examination, including the head-impulse test, and vestibular testing revealed bilateral vestibulopathy. Conclusions: Dizziness is a common extracardiac adverse reaction of Flecainide. Based on the clinical case that we present and the literature review carried out, we hypothesized that a possible mechanism by which flecainide might cause dizziness and visual disturbances is bilateral vestibulopathy.
  • Autores: Maier, H. (Autor de correspondencia); Lenarz, T.; Agha-Mir-Salim, P.; et al.
    Revista: OTOLOGY AND NEUROTOLOGY
    ISSN: 1531-7129 Vol.43 N° 5 2022 págs. 513 - 529
    Resumen
    Nowadays, several options are available to treat patients with conductive or mixed hearing loss. Whenever surgical intervention is not possible or contra-indicated, and amplification by a conventional hearing device (e.g., behind-the-ear device) is not feasible, then implantable hearing devices are an indispensable next option. Implantable bone-conduction devices and middle-ear implants have advantages but also limitations concerning complexity/invasiveness of the surgery, medical complications, and effectiveness. To counsel the patient, the clinician should have a good overview of the options with regard to safety and reliability as well as unequivocal technical performance data. The present consensus document is the outcome of an extensive iterative process including ENT specialists, audiologists, health-policy scientists, and representatives/technicians of the main companies in this field. This document should provide a first framework for procedures and technical characterization to enhance effective communication between these stakeholders, improving health care.
  • Autores: Soriano-Reixach, M. M.; Rey-Martínez, J. (Autor de correspondencia); Altuna, X.; et al.
    Revista: JOURNAL OF VESTIBULAR RESEARCH-EQUILIBRIUM AND ORIENTATION
    ISSN: 0957-4271 Vol.32 N° 5 2022 págs. 443 - 451
    Resumen
    OBJECTIVE: Main objectives for this study were to develop a quantification method to obtain a Perez-Rey (PR) score adapted to the VVOR test and to evaluate the correlation of the PR score obtained with quantified VVOR with the PR score of the vHIT test. METHODS: A new PR score calculation method for quantified VVOR test was developed using the MATLAB computational software based on saccadic response time latency variability between each head oscillation cycle of the VVOR test. Retrospective correlation between PR scores in VVOR and vHIT tests, performed in the same vHIT testing session for patients with vestibular neuritis and vestibular neurectomy, was performed to correlate new PR (VVOR) score with the classic PR (vHIT) score. RESULTS: Thirty patients were included: 11 post-neurectomy and 19 subacute vestibular neuritis. Pearson's correlation coefficient (R-2) for the overall sample was 0.92 (p < 0.001) and 95% confidence interval was 0.85 - 0.96. In the linear mixed-effects statistical model developed, only PRVHIT and PRVVOR scores showed statistical association in Wald X-2 test (p = 0.008). CONCLUSION: The new developed PR score for synchronization measurement of saccadic responses in VVOR testing is a valid method that outputs synchronization values and highly correlates with PR score in vHIT test.
  • Autores: Guajardo-Vergara, C.; Suárez Vega, Victor Manuel; Domínguez Echávarri, Pablo Daniel; et al.
    Revista: EUROPEAN ARCHIVES OF OTO-RHINO-LARYNGOLOGY
    ISSN: 0937-4477 Vol.279 N° 12 2022 págs. 5591 - 5600
    Resumen
    Purpose: Current studies show that frequency tuning modification is a good marker for the detection of endolymphatic hydrops (EH) employing magnetic resonance imaging (MRI) in patients with Ménière's disease (MD). The purpose of the present study is to analyze the auditory and vestibular function with audiometric and vestibular-evoked myogenic potentials (VEMP) responses, respectively, in both the affected and unaffected ears of patients with unilateral MD using MRI as diagnostic support for the degree of EH. Methods: We retrospectively reviewed the medical records of 76 consecutive patients with unilateral definite MD (age 55 (28-75); 39 women, 37 men). MRI was used through intravenous gadolinium administration, audiometry, and VEMPs. Functional tests were performed up to a week after the MRI. All were followed up one year after imaging utilizing clinical, auditory, and vestibular testing to rule out bilateral involvement. Results: In the unaffected ear, the mean pure-tone average is normal even in cases with hydrops and, for a similar severity of hydrops is significantly lower than in the affected ear. Significant differences for the amplitude of the response at 0.5 kHz, at 1 kHz between the affected and unaffected ears were found to be lower in the affected ears. The relative amplitude ratio (1 Kz-0.5 kHz) was significantly lower in the affected ear and in the case of the oVEMP response depends on the degree of EH. The response in the unaffected ear was not modified by the presence or the degree of hydrops. Conclusion: In the unaffected ear, hydrops is not associated with hearing deterioration. For a similar degree of hydrops, hearing loss is significantly greater in the affected ear. The endolymphatic hydrops in the vestibule induces a frequency bias in the VEMP response only in the affected ear and not in the unaffected ear. Because of these findings we consider that hydrops does not represent an active disorder in the unaffected ear.
  • Autores: Batuecas-Caletrio, A. (Autor de correspondencia); Jara, A.; Suárez Vega, Victor Manuel; et al.
    Revista: AUDIOLOGY RESEARCH
    ISSN: 2039-4330 Vol.12 N° 2 2022 págs. 202 - 211
    Resumen
    Background: Although diagnostic criteria have been established for superior canal dehiscence syndrome, cases in which the diagnosis is not easy are frequent. On those occasions, some tests such as vibration-induced nystagmus or vestibular-evoked myogenic potentials can offer invaluable help due to their high sensitivity and specificity. Methods: We studied 30 patients showing superior canal dehiscence or "near-dehiscence" in a CT scan. Skull vibration-induced nystagmus and high frequency ocular vestibular-evoked myogenic potentials are performed in each patient. The aim of the study is to determine how useful both tests are for detection of superior canal dehiscence or near-dehiscence. Results: Of the 60 temporal bones studied, no dehiscence was the result in 22, near-dehiscence in 17 and a definite finding in 21. In 10/30 patients, there was no SVIN (Skull vibration induced nystagmus) during otoneurological testing, while in 6/30, induced nystagmus was mainly horizontal, and in 14/30 there was vertical up-beating. All patients had a positive oVEMP (Ocular vestibular evoked myiogenic potentials) at 0.5 kHz in both ears and the HFoVEMP (High frequency ocular vestibular evoked myiogenic potentials) response was positive in 25/60 (41.6%) of the ears studied and in 19/30 of the patients evaluated (in 6 it was positive in both ears). Up-beat SVIN will point to a SCD (Superior Canal Dehiscence) mainly when HFoVEMP are present, and when this is negative there is a high probability that it is not a SCD. Conclusions: When SVIN and HFoVEMP results are added (or combined), they not only improve the possibilities of detecting SCD, but also the affected side.
  • Autores: Alvarez de Linera Alperi, Marta; Garaycochea Mendoza del Solar, Octavio; Calavia, D.; et al.
    Revista: AUDIOLOGY RESEARCH
    ISSN: 2039-4330 Vol.12 N° 3 2022 págs. 337 - 346
    Resumen
    Benign paroxysmal positional vertigo (BPPV) is one of the most common disorders that causes dizziness. The incidence of horizontal semicircular canal (HSC) BPPV ranges from 5% to 40.5% of the total number of BPPV cases diagnosed. Several studies have focused on establishing methods to treat BPPV caused by the apogeotropic variant of the HSC, namely, the Appiani maneuver (App). In 2016, a new maneuver was proposed: the Zuma e Maia maneuver (ZeM), based on inertia and gravity. The aim of this study is to analyze the efficacy of App versus ZeM in the resolution of episodes of BPPV produced by an affectation of the horizontal semicircular canal with apogeotropic nystagmus (Apo-HSC). A retrospective, quasi-experimental study was conducted. Patients attended in office (November 2014-February 2019) at a third-level hospital and underwent a vestibular otoneurology assessment. Those who were diagnosed with Apo-HSC, treated with App or ZeM, were included. To consider the efficacy of the maneuvers, the presence of symptoms and/or nystagmus at the first follow up was studied. Patients classified as A were those with no symptoms, no nystagmus; A/N+: no symptoms, nystagmus present during supine roll test; S: symptoms present. Previous history of BPPV and/or otic pathology and calcium levels were also compiled. From the 54 patients included, 74% were women. The average age was 69. Mean follow-up: 52.51 days. In those patients without previous history of BPPV (n = 35), the probability of being group A was 63% and 56% (p = 0.687) when treated with App and ZeM, respectively, while being A/N+ was 79% and 87% for App and ZeM (p = 0.508). Of the 19 patients who had previous history of BPPV, 13% and 64% were group A when treated with App and ZeM (p = 0.043), and 25% and 82% were A/N+ after App and ZeM, respectively (p = 0.021). In conclusion, for HSC cupulolithiasis, ZeM is more effective than App in those cases in which there is a history of previous episodes of BPPV (A: 64% (p = 0.043); A/N+: 82% (p = 0.021)).
  • Autores: Garaycochea Mendoza del Solar, Octavio (Autor de correspondencia); Pérez Fernández, Nicolás; Manrique Huarte, Raquel
    Revista: BRAZILIAN JOURNAL OF OTORHINOLARYNGOLOGY
    ISSN: 1808-8694 Vol.88 N° 5 2022 págs. 708 - 716
    Resumen
    Introduction: In patients with benign paroxysmal positional vertigo, BPPV; a torsional-vertical down beating positioning nystagmus can be elicited in the supine straight head-hanging position test or in the Dix-Hallpike test to either side. This type of nystagmus can be explained by either an anterior canal BPPV or by an apogeotropic variant of the contralateral posterior canal BPPV Until now all the therapeutic maneuvers that have been proposed address only one possibility, and without first performing a clear differential diagnosis between them. Objective: To propose a new maneuver for torsional-vertical down beating positioning nystagmus with a clear lateralization that takes into account both possible diagnoses (anterior canal-BPPV and posterior canal-BPPV). Methods: A prospective cohort study was conducted on 157 consecutive patients with BPPV. The new maneuver was performed only in those with torsional-vertical down beating positioning nystagmus with clear lateralization. Results: Twenty patients (12.7%) were diagnosed with a torsional-vertical down beating positioning nystagmus. The maneuver was performed in 10 (6.35%) patients, in whom the affected side was clearly determined. Seven (4.45%) patients were diagnosed with an anterior canal-BPPV and successfully treated. Two (1.25%) patients were diagnosed with a posterior canal-BPPV and successfully treated with an Epley maneuver after its conversion into a geotropic posterior BPPV. Conclusion: This new maneuver was found to be effective in resolving all the cases of torsional-vertical down beating positioning nystagmus-BPPV caused by an anterior canal-BPPV, and in shifting in a controlled way the posterior canal-BPPV cases of the contralateral side into a geotropic-posterior-BPPV successfully treated during the followup visit. Moreover, this new maneuver helped in the differential diagnosis between anterior canal-BPPV and a contralateral posterior canal-BPPV.
  • Autores: Garaycochea Mendoza del Solar, Octavio (Autor de correspondencia); Manrique Huarte, Raquel; Calavia, D.; et al.
    Revista: JOURNAL OF INTERNATIONAL ADVANCED OTOLOGY
    ISSN: 1308-7649 Vol.18 N° 1 2022 págs. 13 - 18
    Resumen
    Background: Hearing loss causes a significant reduction in the quality of life of patients with Ménière's disease. Although speech recognition is also affected, it has not been extensively studied. The objective of the study was to describe speech recognition behavior during a prolonged period in patients with unilateral Ménière's disease. Methods: A prospective case-control study was performed. The case group included patients with defined unilateral Ménière's disease and the control group included patients with progressive non-fluctuating hearing loss. Patients underwent an auditory evaluation periodically. Pure-tone audiometry and speech recognition tests-speech recognition threshold and speech discrimination score-were administered. The dissociation between pure-tone audiometry and speech recognition was assessed through a linear regression analysis. During follow-up, Ménière's disease patients were subdivided into a stable and fluctuating subgroup (a change of >20% in the speech discrimination score with a change no greater than 15 dB in pure-tone audiometry). Results: The average follow-up time was 79.9 months. Fifty-seven patients were included (30 cases, 27 controls). Dissociation between puretone audiometry and speech recognition threshold began to appear in the case group after 21 months, and it was statistically significant at 108 months. Duration of the disease was the only variable studied that influenced the dissociation. The fluctuation subgroup in cluded 56.6% of the cases. Conclusion: We described 2 audiological peculiarities in Ménière's disease patients: dissociation between pure-tone audiometry and speech recognition during the evolution of the disease and the fluctuation of speech recognition regardless of the change in pure-tone audiometry. Our results highlight the importance of performing speech recognition tests during follow-up in patients with Ménière's disease.
  • Autores: Acle-Cervera, L. (Autor de correspondencia); González-Aguado, R.; Bauer, M.; et al.
    Revista: ACTA OTORRINOLARINGOLOGICA ESPAÑOLA
    ISSN: 0001-6519 Vol.73 N° 6 2022 págs. 394 - 405
    Resumen
    Computed tomography scan of the temporal bone is a fundamental imaging modality for both the diagnosis and treatment of a wide range of pathologies affecting this complex structure. Temporal bone computed tomography scan provides a more detailed depiction of bone structures, compared with magnetic resonance imaging and, for this reason computed tomography scan is the imaging modality of choice in the planning of otological surgery. The aim of this article is to present a checklist to allow the otolaryngologist to assess systematically and in an organized manner the main anatomical landmarks, anatomical variants, as well as the most common postoperative surgical changes, which can be identified before any safe otological surgery. This revision was promoted by the Spanish Society of Otolaryngology and elaborated in a checklist template divided into the different areas of the temporal bone and the lateral skull base.
  • Autores: Hoppe, U.; Brademann, G.; Stover, T.; et al.
    Revista: AUDIOLOGY AND NEURO-OTOLOGY
    ISSN: 1420-3030 Vol.27 N° 5 2022 págs. 347 - 355
    Resumen
    Introduction: Transimpedance measurements from cochlear implant electrodes have the potential to identify anomalous electrode array placement, such as tip fold-over (TFO) or fold-back, basal electrode kinking, or buckling. Analysing transimpedance may thus replace intraoperative or post-operative radiological imaging to detect any potential misplacements. A transimpedance algorithm was previously developed to detect deviations from a normal electrode position with the aim of intraoperatively detecting TFO. The algorithm had been calibrated on 35 forced, tip folded electrode arrays in six temporal bones to determine the threshold criterion required to achieve a sensitivity of 100%. Our primary objective here was to estimate the specificity of this TFO algorithm in patients, in a prospective study, for a series of electrode arrays shown to be normally inserted by post-operative imaging. Methods: Intracochlear voltages were intraoperatively recorded for 157 ears, using Cochlear's Custom Sound (TM) EP 5 electrophysiological software (Cochlear Ltd., Sydney, NSW, Australia), for both Nucleus (R) CI512 and CI532 electrode arrays. The algorithm analysed the recorded 22 x 22 transimpedance matrix (TIM) and results were displayed as a heatmap intraoperatively, only visible to the technician in the operating theatre. After all clinical data were collected, the algorithm was evaluated on the bench. The algorithm measures the transimpedance gradients and corresponding phase angles (theta) throughout the TIM and calculates the gradient phase range. If this was greater than the predetermined threshold, the algorithm classified the electrode array insertion as having a TFO. Results: Five ears had no intraoperative TIM and four anomalous matrices were identified from heatmaps and removed from the specificity analysis. Using the 148 remaining data sets (n = 103 CI532 and n = 45 CI512), the algorithm had an average specificity of 98.6% (95.80%-99.75%). Conclusion: The algorithm was found to be an effective screening tool for the identification of TFOs. Its specificity was within acceptable levels and resulted in a positive predictive value of 76%, with an estimated incidence of fold-over of 4% in perimodiolar arrays. This would mean 3 out of 4 cases flagged as a fold-over would be correctly identified by the algorithm, with the other being a false positive. The measurements were applied easily in theatre allowing it to be used as a routine clinical tool for confirming correct electrode placement.
  • Autores: Manrique Rodríguez, Manuel Jesús; Patiño García, Ana; Prieto Matos, Carlos (Autor de correspondencia); et al.
    Revista: JOURNAL OF PEDIATRICS RESEARCH REVIEWS & REPORTS
    ISSN: 2755-0281 Vol.3 N° 1 2021 págs. 1 - 7
    Resumen
    Current early hearing detection and intervention (EHDI) programs for children indicate that the diagnosis and treatment must be carried out within the first six months of life. Genetic testing can identify the causal variant of the hereditary hearing loss and is very useful for that. Implementing this testing would enable personalized medicine, avoiding other more costly and time consuming tests, and the negative effect of treating a child outside of the period of greatest hearing sensitivity. Genetic tools are not part of EHDI programs. These programs are based on testing hearing. If genetic tools are used, the most likely gene is selected and analyzed via Sanger sequencing. The latest next-generation sequencing (NGS) can be applied to EHDI programs. From 100 to 200 genes associated to hearing loss can be analyzed through NGS in one blood sample or saliva set, bringing down the cost of analysis and enabling the causal diagnosis of hearing loss in a short time span. This paper reviews the current state of early hearing detection and intervention programs in children, discusses the next generation gene sequencing tools applied to hearing loss in children, presents potential approaches to the EHDI programs and analyzes the key issues to personalize the treatment of hearing loss.
  • Autores: Guajardo-Vergara, C. (Autor de correspondencia); Pérez Fernández, Nicolás
    Revista: LARYNGOSCOPE
    ISSN: 0023-852X Vol.131 N° 2 2021 págs. E582 - E582
  • Autores: Moreno Rueda, A. M.; Suárez Vega, Victor Manuel; Milán Tomás, Ángela; et al.
    Revista: OTOLARYNGOLOGY CASE REPORTS
    ISSN: 2468-5488 Vol.21 2021 págs. 100362
    Resumen
    Background: Meniere's disease is often characterized by a changing horizontal nystagmus during the crisis; however, vertical nystagmus is not often detected. The horizontal nystagmus is frequently studied in the irritative or destructive phases of the disease. Clinical findings: We report the case of a 70 years-old man suffering for 3 years of Meniere's disease in his right ear. During an attack we found an infrequent nystagmus that was a downbeat nystagmus in primary position. He was then closely followed in the ward during 5 days and daily tests were performed. We first ruled out a central cause and were able to explain that as due to a peripheral deficit in the right posterior semicircular canal. Other features of the vertigo attacks in patients with MD were recorded. We studied a patient presenting a vertigo attack with a downbeat nystagmus. Our findings show that this nystagmus was caused by his own Meniere's disease, specifically by a posterior canal hypofunction, and not by a central disorder. There is no evidence about this kind of nystagmus in Meniere disease and, to the best to our knowledge, this is one of the first reports its evaluation using the test nowadays available. Conclusion: In this case, our result demonstrate that the downbeat nystagmus was caused by a hypofunction of the posterior semicircular canal.
  • Autores: Manrique Huarte, Raquel; Alvarez de Linera Alperi, Marta (Autor de correspondencia); Parilli, D.; et al.
    Revista: HEARING RESEARCH
    ISSN: 0378-5955 Vol.404 2021 págs. 108228
    Resumen
    Objectives The method of drug delivery directly into the cochlea with an implantable pump connected to a CI electrode array ensures long-term delivery and effective dose control, and also provides the possibility to use different drugs. The objective is to develop a model of inner ear pharmacokinetics of an implanted cochlea, with the delivery of FITC-Dextran, in the non-human primate model. Design A preclinical cochlear electrode array (CI Electrode Array HL14DD, manufactured by Cochlear Ltd.) attached to an implantable peristaltic pump filled with FITC-Dextran was implanted unilaterally in a total of 15 Macaca fascicularis (Mf). Three groups were created (5 Mf in each group), according to three different drug delivery times: 2 hours, 24 hours and 7 days. Perilymph (10 samples, 1¿L each) was sampled from the apex of the cochlea and measured immediately after extraction with a spectrofluorometer. After scarifying the specimens, x-Rays and histological analysis were performed. Results Surgery, sampling and histological analysis were performed successfully in all specimens. FITC-Dextran quantification showed different patterns, depending on the delivery group. In the 2 hours injection experiment, an increase in FITC-Dextran concentrations over the sample collection time was seen, reaching maximum concentration peaks (420-964µM) between samples 5 and 7, decreasing in successive samples, without returning to baseline...
  • Autores: Montesdeoca, I. R.; de-Miguel, A. R.; González, J. C. F.; et al.
    Revista: FRONTIERS IN NEUROLOGY
    ISSN: 1664-2295 Vol.2021 N° 12 2021 págs. 663803
    Resumen
    Objective: Several studies have demonstrated the possibility to obtain vestibular potentials elicited with electrical stimulation from cochlear and vestibular implants. The objective of this study is to analyze the vestibular-evoked myogenic potentials (VEMPs) obtained from patients implanted with cochlear and vestibulo-cochlear implant. Material and Methods: We compared two groups: in the first group, four cochlear implant (CI) recipients with present acoustic cVEMPs before CI surgery were included. In the second group, three patients with bilaterally absent cVEMPs and bilateral vestibular dysfunction were selected. The latter group received a unilateral cochleo-vestibular implant. We analyze the electrically elicited cVEMPs in all patients after stimulation with cochlear and vestibular electrode array stimulation. Results: We present the results obtained post-operatively in both groups. All patients (100%) with direct electrical vestibular stimulation via the vestibular electrode array had present cVEMPs. The P1 and N1 latencies were 11.33-13.6 ms and 18.3-21 ms, respectively. In CI patients, electrical cVEMPs were present only in one of the four subjects (25%) with cochlear implant ("cross") stimulation, and P1 and N1 latencies were 9.67 and 16.33, respectively. In these patients, the responses present shorter latencies than those observed acoustically. Conclusions: Electrically evoked cVEMPs can be present after cochlear and vestibular stimulation and suggest stimulation of vestibular elements, although clinical effect must be further studied.
  • Autores: Vigliano, M. (Autor de correspondencia); Huarte Irujo, Alicia; Borro Yagüez, Diego; et al.
    Revista: AUDIOLOGY AND NEURO-OTOLOGY
    ISSN: 1420-3030 Vol.26 N° 5 2021 págs. 317 - 326
    Resumen
    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 m(2) 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 degrees 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.
  • Autores: James, C. J. (Autor de correspondencia); Graham, P. L.; Reinoso, F. A. B.; et al.
    Revista: FRONTIERS IN AGING NEUROSCIENCE
    ISSN: 1663-4365 Vol.13 2021 págs. 589296
    Resumen
    Older adults with mild or no hearing loss make more errors and expend more effort listening to speech. Cochlear implants (CI) restore hearing to deaf patients but with limited fidelity. We hypothesized that patient-reported hearing and health-related quality of life in CI patients may similarly vary according to age. Speech Spatial Qualities (SSQ) of hearing scale and Health Utilities Index Mark III (HUI) questionnaires were administered to 543 unilaterally implanted adults across Europe, South Africa, and South America. Data were acquired before surgery and at 1, 2, and 3 years post-surgery. Data were analyzed using linear mixed models with visit, age group (18-34, 35-44, 45-54, 55-64, and 65+), and side of implant as main factors and adjusted for other covariates. Tinnitus and dizziness prevalence did not vary with age, but older groups had more preoperative hearing. Preoperatively and postoperatively, SSQ scores were significantly higher (Delta 0.75-0.82) for those aged <45 compared with those 55+. However, gains in SSQ scores were equivalent across age groups, although postoperative SSQ scores were higher in right-ear implanted subjects. All age groups benefited equally in terms of HUI gain (0.18), with no decrease in scores with age. Overall, younger adults appeared to cope better with a degraded hearing before and after CI, leading to better subjective hearing performance.
  • Autores: Sluydts, M. (Autor de correspondencia); Curthoys, I. ; Vanspauwen, R.; et al.
    Revista: AUDIOLOGY AND NEURO-OTOLOGY
    ISSN: 1420-3030 Vol.25 N° 1 - 2 2020 págs. 6 - 24
    Resumen
    Background: In patients with bilateral vestibulopathy, the regular treatment options, such as medication, surgery, and/or vestibular rehabilitation, do not always suffice. Therefore, the focus in this field of vestibular research shifted to electrical vestibular stimulation (EVS) and the development of a system capable of artificially restoring the vestibular function. Key Message: Currently, three approaches are being investigated: vestibular co-stimulation with a cochlear implant (CI), EVS with a vestibular implant (VI), and galvanic vestibular stimulation (GVS). All three applications show promising results but due to conceptual differences and the experimental state, a consensus on which application is the most ideal for which type of patient is still missing. Summary: Vestibular co-stimulation with a CI is based on "spread of excitation," which is a phenomenon that occurs when the currents from the CI spread to the surrounding structures and stimulate them. It has been shown that CI activation can indeed result in stimulation of the vestibular structures. Therefore, the question was raised whether vestibular co-stimulation can be functionally used in patients with bilateral vestibulopathy. A more direct vestibular stimulation method can be accomplished by implantation and activation of a VI. The concept of the VI is based on the technology and principles of the CI. Different VI prototypes are currently being evaluated regarding feasibility and functionality. So far, all of them were capable of activating different types of vestibular reflexes. A third stimulation method is GVS, which requires the use of surface electrodes instead of an implanted electrode array. However, as the currents are sent through the skull from one mastoid to the other, GVS is rather unspecific. It should be mentioned though, that the reported spread of excitation in both CI and VI use also seems to induce a more unspecific stimulation. Although all three applications of EVS were shown to be effective, it has yet to be defined which option is more desirable based on applicability and efficiency. It is possible and even likely that there is a place for all three approaches, given the diversity of the patient population who serves to gain from such technologies.
  • Autores: Manrique Huarte, Raquel (Autor de correspondencia); Zulueta Santos, Cristina; Garaycochea Mendoza del Solar, Octavio; et al.
    Revista: AUDIOLOGY AND NEURO-OTOLOGY
    ISSN: 1420-3030 Vol.25 N° 43862 2020 págs. 42 - 49
    Resumen
    Background: Histological study of vestibular end organs has been challenging due to the difficulty in preserving their structures for histological analysis and due to their complex geometry. Recently, radiology advances have allowed to deepen the study of the membranous labyrinth. Summary: A review and analysis of surgical implications related to the anatomy of the vestibular end organ is performed. Radiological advances are key in the advancement of the knowledge of the anatomy and pathology of the vestibule. Thus, application of such knowledge in the development or improvement of surgical procedures may facilitate the development of novel techniques. Key Messages: During the last few decades, the knowledge of the anatomy of the auditory system through histology and radiology had improved. Technological advances in this field may lead to a better diagnosis and therapeutic approach of most common and important diseases affecting the inner ear.
  • Autores: Prieto Matos, Carlos; Garaycochea Mendoza del Solar, Octavio; Calavia, D.; et al.
    Revista: ACTA OTORRINOLARINGOLOGICA ESPAÑOLA
    ISSN: 0001-6519 Vol.71 N° 4 2020 págs. 225 - 234
    Resumen
    Introduction: Cochlear implants have been able to treat some types of hearing loss, but those related to cochlear nerve impairment made it necessary to find new ways to manage these deficits; leading to auditory brainstem implants (ABI). Aim: Our objective is to present the clinical profile of patients treated through an ABI and the results obtained from 1997 to 2017. Material and methods: On the one hand, patients with statoacoustic nerve tumours (VIIIcranial nerve) were selected, and on the other hand, patients withoutVIII tumours with congenital malformations of the inner ear. Before and after the placement of the ABI, hearing was assessed through tonal audiometry, from which the PTA (Pure Tone Average) and the CAP (Categories of Auditory Performance) scale were obtained. Results: A total of 20 patients undergoing ABI surgery were included. Eight were of tumour cause (40%) and 12 non-tumour (60%). In 15 subjects (75%) a suboccipital approach was performed and in 5 (25%) translabyrinthine. The mean of active electrodes before the implantation of Cochlear® (Nucleus ABI24) was 13/21 (61.90%) versus 8.5/12 (70.83%) of the Med-el® (ABI Med-el). An improvement in the mean PTA of 118.49dB was found against 46.55dB at 2years. On the CAP scale, values of1 were obtained in the preimplantation and of 2.57 (1-5) in the 2-year revision. Conclusion: The ABI is a safe option, and with good hearing results when the indication is made correctly.
  • Autores: Trinidad-Ruiz, G. (Autor de correspondencia); Rey-Martinez, J.; Matino-Soler, E. ; et al.
    Revista: EAR AND HEARING
    ISSN: 0196-0202 Vol.41 N° 5 2020 págs. 1397 - 1406
    Resumen
    Objective: To evaluate the effect of artifacts on the impulse and response recordings with the video head impulse test (VHIT) and determine how many stimuli are necessary for obtaining acceptably efficient measurements. Methods: One hundred fifty patients were examined using VHIT and their registries searched for artifacts. We compared several variations of the dataset. The first variation used only samples without artifacts, the second used all samples (with and without artifacts), and the rest used only samples with each type of artifact. We calculated the relative efficiency (RE) of evaluating an increasingly large number of samples (3 to 19 per side) when compared with the complete sample (20 impulses per side). Results: Overshoot was associated with significantly higher speed (p= 0.005), higher duration (p< 0.001) and lower amplitude of the impulses (p= 0.002), and consequent higher saccades' latency (p= 0.035) and lower amplitude (p= 0.025). Loss of track was associated with lower gain (p= 0.035). Blink was associated with a higher number of saccades (p< 0.001), and wrong way was associated with lower saccade latency (p= 0.012). The coefficient of quartile deviation escalated as the number of artifacts of any type rose, indicating an increment of variability. Overshoot increased the probability of the impulse to lay on the outlier range for gain and peak speed. Blink did so for the number of saccades, and wrong way for the saccade amplitude and speed. RE reached a tolerable level of 1.1 at 7 to 10 impulses for all measurements except the PR score. Conclusions: Our results suggest the necessity of removing artifacts after collecting VHIT samples to improve the accuracy and precision of results. Ten impulses are sufficient for achieving acceptable RE for all measurements except the PR score.
  • Autores: Pérez Fernández, Nicolás (Autor de correspondencia); Álvarez Gómez, Laura; Manrique Huarte, Raquel
    Revista: AUDIOLOGY AND NEURO-OTOLOGY
    ISSN: 1420-3030 Vol.25 N° 1 - 2 2020 págs. 72 - 78
    Resumen
    Objectives: Bilateral vestibulopathy is a clinical syndrome in which laboratory testing plays a crucial diagnostic role. We aimed to establish the frequency of detection of that finding in a tertiary level hospital considering the new methods of laboratory vestibular examination nowadays in use, with respect to the conventional caloric and rotatory chair test approaches. Design: Two similar time periods (5 years) were retrospectively evaluated, and the demographic, clinical data and test results from 4,576 patients were reviewed. In the first period, the diagnosis was based on caloric and rotatory chair tests and, in the second, on the video head impulse test. Results: Of the patients included, 3.77% in the first period and 4.58% in the second met the criteria for bilateral vestibular hypofunction; there was no significant difference between both periods. Conclusions: The functional vestibular evaluation to detect bilateral deficiency makes no significant difference to the number of patients diagnosed with a bilateral vestibulopathy. New diagnostic categories probably depend not only on the availability and accessibility of complete vestibular and visual-vestibular evaluation, but also on recent advances in defining vestibular disorders. Bilateral vestibular hypofunction manifests with very different patterns. Progress in more detailed definition (clinical and laboratory) is needed, in particular when all 6 semicircular canals and both maculae are available for testing.
  • Autores: Garaycochea Mendoza del Solar, Octavio (Autor de correspondencia); Manrique Huarte, Raquel; Vigliano, M.; et al.
    Revista: EUROPEAN ARCHIVES OF OTO-RHINO-LARYNGOLOGY
    ISSN: 0937-4477 Vol.277 N° 6 2020 págs. 1645 - 1650
    Resumen
    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.
  • Autores: Batuecas-Caletrio, A. (Autor de correspondencia); Trinidad-Ruiz, G.; Rey-Martínez, J.; et al.
    Revista: EAR AND HEARING
    ISSN: 0196-0202 Vol.41 N° 2 2020 págs. 323 - 329
    Resumen
    Objectives: Oscillopsia is a disabling condition for patients with bilateral vestibular hypofunction (BVH). When the vestibulo-ocular reflex is bilaterally impaired, its ability to compensate for rapid head movements must be supported by refixation saccades. The objective of this study is to assess the relationship between saccadic strategies and perceived oscillopsia. Design: To avoid the possibility of bias due to remaining vestibular function, we classified patients into two groups according to their gain values in the video head impulse test. One group comprised patients with extremely low gain (0.2 or below) in both sides, and a control group contained BVH patients with gain between 0.2 and 0.6 bilaterally. Binary logistic regression (BLR) was used to determine the variables predicting oscillopsia. Results: Twenty-nine patients were assigned to the extremely low gain group and 23 to the control group. The BLR model revealed the PR score (saccades synchrony measurement) to be the best predictor of oscillopsia. Receiver operating characteristic analysis determined that the most efficient cutoff point for the probabilities saved with the BLR was 0.518, yielding a sensitivity of 86.6% and specificity of 84.2%. Conclusions: BVH patients with higher PR values (nonsynchronized saccades) were more prone to oscillopsia independent of their gain values. We suggest that the PR score can be considered a useful measurement of compensation.
  • Autores: Garaycochea Mendoza del Solar, Octavio; Manrique Huarte, Raquel; Manrique Rodríguez, Manuel Jesús
    Revista: BRAZILIAN JOURNAL OF OTORHINOLARYNGOLOGY
    ISSN: 1808-8694 Vol.86 N° Supl. 1 2020 págs. 38 - 40
  • Autores: Manrique Huarte, Raquel (Autor de correspondencia); Zulueta Santos, Cristina; Calavia, D.; et al.
    Revista: OTOLOGY AND NEUROTOLOGY
    ISSN: 1531-7129 Vol.41 N° 7 2020 págs. e812 - e822
    Resumen
    Objectives: The aim of this study was to determine whether the dexamethasone-eluting electrode (DEXEL) has a protective anti-inflammatory effect in a normal hearing implanted cochlea, as well as its performance and safety. Design: Ten healthy and normal hearing cynomolgus macaques (Mf) were divided into two cohorts: DEXEL group (DG) (CONCERTO CI device containing a DEXEL) and conventional CI group (CG) (unmodified CONCERTO CI device). The electrode was inserted into the scala tympani via the round window with an angle of insertion of 270 degrees. Auditory, impedance, electrically evoked compound action potential (eCAP), and recovery of function measurements were recorded monthly until sacrifice at 6 months post-implantation. A histologic analysis was also performed. Results: At 6 months, measurement of auditory brainstem responses revealed a mean threshold shift, as well as a mean impedance value, lower in the DEXEL group. The minimum eCAP for the remaining active contacts in the DEXEL group was 68% of that in the conventional CI group. Also at 6 months, the eCAP amplitude produced by a stimulating current of 800 cu (eCAP800) was almost 2.5-fold higher in the DEXEL group than in the conventional CI group (1338.86 +/- 637.87 mu V versus 545.00 +/- 137.37 mu V; p = 0.049). Tissue reactions, in particular fibrosis and ossification, were more common in the conventional CI group. Conclusions: The CI electrode array equipped with a dexamethasone-eluting component tested in ...
  • Autores: Garaycochea Mendoza del Solar, Octavio; Manrique Huarte, Raquel (Autor de correspondencia); Lazaro, C.; et al.
    Revista: EUROPEAN ARCHIVES OF OTO-RHINO-LARYNGOLOGY
    ISSN: 0937-4477 Vol.277 N° 1 2020 págs. 69 - 76
    Resumen
    Purpose To compare the surgical and audiological outcomes with two perimodiolar electrode arrays (Nucleus 512-Contour Advance (R) y Nucleus 532-Slim Perimodiolar (R)) and a straight electrode array (Nucleus 422/522). Methods Patients were retrospectively selected from our cochlear implant program database. Only patients with a history of bilateral, sensorineural postlingually profound hearing loss who underwent cochlear implant surgery with either a N512, a N532 or a N422 were included. Throughout a year of follow-up, pure tone audiometry (PTA), speech perception, Impedances and T-C Thresholds levels were analyzed. Surgical data were also analyzed. Results 66 patients were included (19-CI532, 20-CI512 and 27-CI422). The most common type of cochlea access with the N532, N512 and N422 was through an extended round window, a promontorial cochleostomy and a pure round window, respectively. No significant differences were observed after 12 months in Mean PTA and Speech recognition. No significant differences were seen in the levels of hearing preservation at frequencies of 250 and 500. The average values of the impedances were significantly higher in the CI group N532 and N422 than in the N512. The mean values of the T and C levels were significantly lower in the CI groups N532 and N422 compared with the N512. Conclusions No significant differences were observed after 12 months in Mean PTA and Speech recognition; however, a faster acquisition of auditory results were observed in the group of patients treated with the CI N532. The type of electrode array influences in the type of cochleostomy.
  • Autores: Marx, M. (Autor de correspondencia); Mosnier, I.; Belmin, J. ; et al.
    Revista: BMC GERIATRICS
    ISSN: 1471-2318 Vol.20 N° 1 2020 págs. 252
    Resumen
    Background: Given an increase in the aging population and its impact on healthcare systems, policy makers for provision of health and social services are aiming to keep older adults in good health for longer, in other words towards 'healthy aging'. Our study objective is to show that rehabilitation with cochlear implant treatment in the elderly with hearing impairment improves the overall health-related quality of life and general well-being that translate into healthy aging. Methods: The multicentre, prospective, repeated measures, single-subject, clinical observational study will accrue 100 elderly, first-time, unilateral CI recipients (>= 60 years) and analyze changes on specific measurement tools over ca. 20 months from preimplant to postimplant. Evaluations will consist of details collected through case history and interview questionnaires by clinicians, data logging, self-report questionnaires completed by the recipients and a series of commonly used audiometric measures and geriatric assessment tools. The primary indicator of changes in overall quality of life will be the HUI-3. Discussion: The protocol is designed to make use of measurement tools that have already been applied to the hearing-impaired population in order to compare effects of CI rehabilitation in adults immediately before their implantation, (pre-implant) and after gaining 1-1.5 years of experience (post-implant). The broad approach will lead to a greater understanding of how useful hearing impacts the quality of life in elderly individuals, and thus improves potentials for healthy aging. Outcomes will be described and analyzed in detail.
  • Autores: Soriano-Reixach, M. M.; Prieto Matos, Carlos; Pérez Fernández, Nicolás; et al.
    Revista: CLINICAL NEUROPHYSIOLOGY
    ISSN: 1388-2457 Vol.131 N° 8 2020 págs. 1839 - 1847
    Resumen
    Objective: To investigate the main effects of some testing and analysis variables on clinically quantified visually enhanced vestibulo-ocular reflex (VVOR) and vestibulo-ocular reflex suppression (VORS) results using video head impulse test. Methods: This prospective observational clinical study included 19 healthy participants who underwent the VVOR and VORS tests. The effect of demographic variables, head oscillation frequency, rotation direction, visual acuity and analysis time window width and location of the recorded tests on the quantified results of both VVOR and VORS were evaluated. And specifically, for the VORS test the effect of cognitive reinforcement of the participant during testing was evaluated. Results: A statistically significant difference was observed among the VVOR, non-reinforced VORS, and reinforced VORS tests for mean gain values of 0.91 ± 0.09, 0.6 ± 0.15, and 0.57 ± 0.16, respectively (p < 0.001). The optimized linear mixed-effect model showed a significant influence of frequency on the gain values for the reinforced and non-reinforced VORS tests (p = 0.01 and p = 0.004, respectively). Regarding the gain analysis method, statistically significant differences were found according to the short time interval sample location of the records for the initial location of the VVOR test (p < 0.006) and final location of the reinforced VORS test (p < 0.023). Conclusion: Significant differences were observed in the gain values according to VVOR and VORS testing. Head oscillation frequency is a significant factor that affects the gain values, especially in VORS testing. Moreover, in VORS testing, participant concentration has a significant effect on the test for obtaining suppression gain values. When a short time interval sample is considered for VVOR and VORS testing, intermediate time samples appear the most adequate for both tests. Significance: The quantified visually enhanced vestibulo-ocular reflex (VVOR) and vestibulo-ocular reflex suppression (VORS) tests have recently been added to the assortment of available clinical vestibular tests. However, despite the clinical validity of these quantified tests that appear to be of increasing clinical interest, the effects of most of the clinical testing methods and mathematical variables are not well defined. In this research we describe what are the main collecting and analysis variables that could influence to the VVOR and VORS tests. Specially for VORS test, participant concentration on test tasks will have positive effect on the measured vestibulo-ocular reflex (VOR) suppression.
  • Autores: Barona, L.; Krstulovic, C. (Autor de correspondencia); Bejarano, B.; et al.
    Revista: JOURNAL OF INTERNATIONAL ADVANCED OTOLOGY
    ISSN: 1308-7649 Vol.16 N° 1 2020 págs. 138 - 140
    Resumen
    A 52-year-old man presented with left hemifacial spasm (HFS). A magnetic resonance imaging scan showed compression of the left facial nerve at the cerebellopontine angle by a dolichoectatic basilar artery, The neurotological evaluation showed an otolithic deficit, with canalicular preservation and normal hearing. The deficit improved after surgical decompression. No previous report has described the impairment of vestibular function in patients presenting with HFS.
  • Autores: Manrique Rodríguez, Manuel Jesús (Autor de correspondencia)
    Revista: HNO
    ISSN: 0017-6192 Vol.67 N° 10 2019 págs. 738 - 738
  • Autores: Eggers, S. D. Z. (Autor de correspondencia); Bisdorff, A.; von Brevern, M.; et al.
    Revista: JOURNAL OF VESTIBULAR RESEARCH-EQUILIBRIUM AND ORIENTATION
    ISSN: 0957-4271 Vol.29 N° 2-3 2019 págs. 57 - 86
    Resumen
    This paper presents a classification and definitions for types of nystagmus and other oscillatory eye movements relevant to evaluation of patients with vestibular and neurological disorders, formulated by the Classification Committee of the Barony Society, to facilitate identification and communication for research and clinical care. Terminology surrounding the numerous attributes and influencing factors necessary to characterize nystagmus are outlined and defined. The classification first organizes the complex nomenclature of nystagmus around phenomenology, while also considering knowledge of anatomy, pathophysiology, and etiology. Nystagmus is distinguished from various other nystagmus-like movements including saccadic intrusions and oscillations.
  • Autores: Domenech-Vadillo, E. (Autor de correspondencia); Aguilera-Aguilera, G. ; Sanchez-Blanco, C. ; et al.
    Revista: EUROPEAN ARCHIVES OF OTO-RHINO-LARYNGOLOGY
    ISSN: 0937-4477 Vol.276 N° 1 2019 págs. 41 - 48
    Resumen
    PurposeComputerized posturography is the gold standard for balance assessment. Because of the great cost and dimensions of commercial equipments, low-cost and portable devices have been developed and validated, such as RombergLab, a software in open source term which works connected with a low-cost force platform. The objective of this study was to obtain normative posturography data using this software.MethodsA multicentric prospective and descriptive study, with 350 healthy participants, was designed. Static postural stability (measured using the modified clinical test of sensory interaction on balance) was evaluated using the software connected to the force platform. Using the confidence ellipse area (CEA) in each condition, global equilibrium score (GES) was calculated and adjusted for significant variable factors using cluster analysis.ResultsMean (SD) GES was 0.72 (0.22). Age (p<0.01), height (p<0.01) and recruitment center (p<0.05) were found as influence factors for GES. Cluster analysis obtained 16 groups stratified by age and height. GES decreases with age and height (p<0.005). No significant interaction of age nor height was found with GES in these clusters (p>0.05). After correction for height and age, GES was no longer influenced by the recruitment center (p>0.05).ConclusionsWith the introduction of the global equilibrium score values of the present study into the software, we consider RombergLab v1.3 a reference posturography tool for healthy individuals. Further studies are needed for validating it as a suitable instrumented test for screening between healthy and pathologic subjects and its reliability over time for the follow-up of patients.
  • Autores: Ward, B. K.; Zee, D. S. (Autor de correspondencia); Roberts, D. C.; et al.
    Revista: FRONTIERS IN NEUROLOGY
    ISSN: 1664-2295 Vol.9 2019
    Resumen
    Background: Strong static magnetic fields such as those in an MRI machine can induce sensations of self-motion and nystagmus. The proposed mechanism is a Lorentz force resulting from the interaction between strong static magnetic fields and ionic currents in the inner ear endolymph that causes displacement of the semicircular canal cupulae. Nystagmus persists throughout an individual's exposure to the magnetic field, though its slow-phase velocity partially declines due to adaptation. After leaving the magnetic field an after effect occurs in which the nystagmus and sensations of rotation reverse direction, reflecting the adaptation that occurred while inside the MRI. However, the effects of visual fixation and of head shaking on this early type of vestibular adaptation are unknown. Methods: Three-dimensional infrared video-oculography was performed in six individuals just before, during (5, 20, or 60 min) and after (4, 15, or 20 min) lying supine inside a 7T MRI scanner. Trials began by entering the magnetic field in darkness followed 60 s later, either by light with visual fixation and head still, or by continuous yaw head rotations (2 Hz) in either darkness or light with visual fixation. Subjects were always placed in darkness 10 or 30 s before exiting the bore. In control conditions subjects remained in the dark with the head still for the entire duration. Results: In darkness with head still all subjects developed horizontal nystagmus inside the magnetic field, with slow-phase velocity partially decreasing over time. An after effect followed on exiting the magnet, with nystagmus in the opposite direction. Nystagmus was suppressed during visual fixation; however, after resuming darkness just before exiting the magnet, nystagmus returned with velocity close to the control condition and with a comparable after effect. Similar after effects occurred with continuous yaw head rotations while in the scanner whether in darkness or light. Conclusions: Visual fixation and sustained head shaking either in the dark or with fixation inside a strong static magnetic field have minimal impact on the short-term mechanisms that attempt to null unwanted spontaneous nystagmus when the head is still, so called VOR set-point adaptation. This contrasts with the critical influence of vision and slippage of images on the retina on the dynamic (gain and direction) components of VOR adaptation.
  • Autores: Sanhueza Torres, Ignacio Andrés (Autor de correspondencia); Manrique Huarte, Raquel; Calavia, D. ; et al.
    Revista: JOURNAL OF INTERNATIONAL ADVANCED OTOLOGY
    ISSN: 1308-7649 Vol.15 N° 1 2019 págs. 62 - 69
    Resumen
    OBJECTIVES: Bimodal stimulation for asymmetric hearing loss is an emerging treatment with proven audiometric outcomes. Our objectives are to assess the changes of the hearing impairment and the quality of life of patients treated with this type of stimulation, when compared to a unilateral Cochlear Implant (CI) stimulated condition. MATERIALS and METHODS: 31 patients with asymmetric hearing loss (Group 1) were recruited for the study. They were divided into three groups, based on their hearing loss in the ear treated with the hearing aid: Group 1A (Pure Tone Audiometry (PTA) between 41 and 70 decibels (dB)); Group 1B, (PTA between 71 and 80 dB) and Group 1C (PTA between 81 and 90 dB). 30 patients had profound, bilateral hearing loss. Then, users of a unilateral cochlear implant were recruited for the control group. Their hearing impairment and quality of life were analyzed with questionnaires Abbreviated Profile of Hearing Aid Benefit (APHAB), Speech, Spatial and Qualities of Hearing Scale (SSQ) and the Health Utilities Index (HUI). They were followed up for at least 2 years. RESULTS: The group with the asymmetric hearing loss obtains a statistically significant clinical improvement in the APHAB under category "with hearing aid" compared to "without hearing aid". The group with the asymmetric hearing loss benefits more across basically all variables compared with the control group in the SSQ. Group 1A obtains the best outcome of the sample in the HUI. CONCLUSION: Bimodal stimulation and better hearing in the ear treated with the hearing aid reduce hearing impairment and improve the quality of life.
  • Autores: Cervera Paz, Francisco Javier (Autor de correspondencia); Jordano-Cabrera, M.
    Revista: ACTA OTORRINOLARINGOLOGICA ESPAÑOLA
    ISSN: 0001-6519 Vol.70 N° 3 2019 págs. 151 - 157
    Resumen
    Objectives: To characterize laryngo-pharyngeal reflux (LPR) in patients over 60 years of age. Methods: Retrospective review of patients over 60 years of age with symptoms suspicious of LPR, seen from 2005 to 2014 at an ENT Department of an academic hospital. Eighty-five consecutive patients (54 females, 31 males) who had completed a dual-sensor 24-hour pH-metry were included (considered "gold-standard" in LPR diagnosis). Body mass index, and reflux information and interventions were revised. pH-metries were evaluated according to DeMeester & Johnson's criteria. Symptoms were assessed according to the Reflux Symptom Index (RSI) and classified as abnormal if score was ¿13. A naso-fibro-laryngoscopy enabled findings to be documented according to the Reflux Finding Score (RFS), and they were classified as abnormal if the score was ¿7. Results: The patients' mean age was 67 years. A positive pH-metry was present in 70 patients (82.5%). Fifty patients (59%) had abnormal body mass index, and almost 90% of them had an abnormal pH-metry. Mean RSI score was 9.8, with abnormal results in 24 patients (28%). Only 20 patients (23%) with abnormal RSI had a positive pH-metry. Posterior commissure hypertrophy was the most common finding (90% of patients). Mean RFS score was 9.07, with abnormal results in 69 patients (81%). Sixty-one patients (70%) with abnormal RFS had a positive pH-metry. Only 18 patients (20%) had coincidental abnormal pH-metry, RSI, and RFS. Conclusions: In ageing patients, abnormal body mass index is strongly associated with abnormal pH-metry. RSI is a weak indicator of LPR, whereas RFS has a moderate value.
  • Autores: Pérez Fernández, Nicolás; Domínguez Echávarri, Pablo Daniel; Manrique Huarte, Raquel; et al.
    Revista: AURIS NASUS LARYNX
    ISSN: 0385-8146 Vol.46 N° 2 2019 págs. 210 - 217
    Resumen
    Objectives It has been suggested that in Ménière¿s disease (MD) a dissociated result in the caloric test (abnormal result) and video head-impulse test (normal result) probably indicates that hydrops affects the membranous labyrinth in the horizontal semicircular canal (HSC). The hypothesis in this study is that based on endolymphatic hydrops¿ cochleocentric progression, hydrops should also be more severe in the vestibule of these patients than in those for whom both tests are normal. Methods 22 consecutive patients with unilateral definite MD were included and classified as NN if both tests were normal or AN if the caloric test was abnormal. MRI evaluation of endolymphatic hydrops was carried out with a T2-FLAIR sequence performed 4 h after intravenous gadolinium administration. The laterality and degree of vestibular endolymphatic hydrops and the presence or absence of cochlear endolymphatic hydrops were recorded. Demographic data, audiometric and vestibular evoked myogenic potentials were collected, and video head-impulse and caloric tests were performed. Results Patients in both groups (NN and AN) were similar in terms of demographic data and hearing loss. The interaural asymmetry ratio was significantly higher for ocular and cervical VEMP in patients in the AN group. There was a significantly higher degree of hydrops in the vestibule of the affected ear of AN patients (¿2; p = 0.028). Conclusion Significant canal paresis in the caloric test is associated with more sev
  • Autores: Valldeperes, A.; Altuna, X.; Martinez-Basterra, Z. ; et al.
    Revista: EUROPEAN ARCHIVES OF OTO-RHINO-LARYNGOLOGY
    ISSN: 0937-4477 Vol.276 N° 11 2019 págs. 3057 - 3065
    Resumen
    Background Classical posturography techniques have been recently enhanced by the use of different motion tracking devices, but for technical reasons they are not used to track directly the body spatial position of a subject. Objective To describe and clinically evaluate a wireless inertial measurement unit-based mobile system to track body position changes. Methods The developed system used a calculus transformation method using the acceleration data corrected by Kalman and Butterworth filters to output position data. A prospective non-randomized clinical study involving 15 healthy subjects was performed to evaluate the agreement between the confidence ellipse areas synchronously measured by the new developed system and a classical posturography system while performing a modified clinical test of sensory interaction in balance. Results The overall intra-class correlation index was 0.93 (CI 0.89, 0.96). Grouped by conditions, under conditions 1-4, Pearson's correlation was 0.604, 0.78, 0.882, and 0.81, respectively. Conclusion The developed wireless inertial measurement unit-based posturography system was valid for tracking the sway variances in normal subjects under habitual clinical testing conditions. Further studies are needed to validate this system on patients and also under other posture conditions.
  • Autores: Guajardo-Vergara, C. (Autor de correspondencia); Pérez Fernández, Nicolás
    Revista: HEARING BALANCE AND COMMUNICATION
    ISSN: 2169-5717 Vol.17 N° 2 2019 págs. 170 - 178
    Resumen
    Objectives: To describe the vestibular evoked myogenic potential (VEMP) response to air-conducted sound (ACS) and bone-conducted vibration (BCV) in patients with unilateral definite Meniere's disease (MD), and the contribution to the usual ACS evaluation of the bone-air index (BAI) and interaural asymmetry ratio (IAR) in the diagnosis. Methods: A case-control study was designed. Fifty-one patients (25 men and 26 women) with an average age of 55 years, and 31 healthy volunteers with no history of vertigo and hearing loss, were included. The BAI was used as a new parameter to describe the amplitude of the response. Results: Only n10 latency ACS evoked was significantly longer than in controls. The ACS cVEMP p13-n23 amplitude of the affected ear of patients with MD was lower than in the non-affected ear (p = .023) and the control group (.001). The IAR was significantly higher in patients with MD both for the ACS and for the BCV cVEMP compared to the control group: p = .004 and .001, respectively. Significant differences were found in oVEMP n10-p16 amplitude between ACS and BCV in the patients with MD (p = .002). The BAI in oVEMP showed a significant increase in the affected ear compared to the control group (p = .001). The acoustic stimulus in cVEMP was the only one that showed significant differences in amplitude according to degree of hearing loss (p = .039). Conclusions: The joint use of an acoustic and vibratory stimulus is an interesting option to characterize the results in this group. The BAI provides useful complementary information, and also turns out to give added value to the traditional VEMP assessment by ACS. We recommend its use when Meniere's disease is suspected.
  • Autores: Manrique Rodríguez, Manuel Jesús; Calavia, D.; Manrique Huarte, Raquel; et al.
    Revista: OTOLOGY AND NEUROTOLOGY
    ISSN: 1531-7129 Vol.40 N° 5S 2019 págs. 53-60
  • Autores: Martín Sanz, Eduardo (Autor de correspondencia); Diaz, J. Y.; Esteban-Sanchez, J.; et al.
    Revista: OTOLOGY AND NEUROTOLOGY
    ISSN: 1531-7129 Vol.40 N° 1 2019 págs. 79 - 87
    Resumen
    Objective: This study aimed to evaluate the changes in the VOR gain after intratympanic gentamicin therapy and to correlate them with the mid-term effects on the control of vertigo, in a population of Meniere's disease patients. Study Design: The study design was a prospective "Outcomes research." Setting: Tertiary referral center. Patients: This study included 20 patients with unilateral Meniere's disease refractory to medical therapy for at least 1 year, and treated with an on demand intratympanic gentamicin protocol. Intervention: Therapeutic. Main Outcome Measure: Audiometry, caloric testing, and a vHIT before beginning the protocol were performed. Patients underwent weekly vHIT assessments until a significant gain reduction was observed. Subsequently we performed vHIT tests 1 month after the therapy completion, and then every 3 months for at least 1 year. Results: Complete vertigo control (class A) was achieved in 14 patients at the 12-month follow-up assessment. We observed a significant reduction in VOR gain values at the 3-week follow-up assessment. We found a significant correlation between the 1-month posttreatment ipsilateral hVOR gain and the rate of vertigo recurrence after the first IT gentamicin treatment (p = 0.012; r(2) = 0.400). At the mid-term assessment, 10 patients exhibited a significant partial recovery of the hVOR gain. Conclusions: The delayed effect of intratympanic gentamicin and the subsequent gain restoration are factors that may influence the patients' outcome. The feasibility of the vHIT system makes it a useful tool to monitorize the VOR changes.
  • Autores: Manrique Rodríguez, Manuel Jesús; Ramos, Á. (Autor de correspondencia); de Paula-Vernetta, C.; et al.
    Revista: ACTA OTORRINOLARINGOLOGICA ESPAÑOLA
    ISSN: 0001-6519 Vol.70 N° 1 2019 págs. 47 - 54
    Resumen
    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.
  • Autores: Lavilla-Martín de Valmaseda, M. J.; Cavalle-Garrido, L.; Huarte Irujo, Alicia; et al.
    Revista: ACTA OTORRINOLARINGOLOGICA ESPAÑOLA
    ISSN: 0001-6519 Vol.70 N° 2 2019 págs. 105 - 111
    Resumen
    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 Espanola de Otorrinolaringologia y Cirugia 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.
  • Autores: Martínez López, Marta; Navedo de las Heras, Ana; López de Mesa, María de los Reyes; et al.
    Revista: ACTA OTORRINOLARINGOLOGICA ESPAÑOLA
    ISSN: 0001-6519 Vol.70 N° 5 2019 págs. 306 - 309
  • Autores: Marques, P. S. (Autor de correspondencia); Dias, C. C. ; Pérez Fernández, Nicolás; et al.
    Revista: AURIS NASUS LARYNX
    ISSN: 0385-8146 Vol.45 N° 5 2018 págs. 943 - 951
    Resumen
    Objective: To estimate how much could intratympanic gentamicin (ITG) interfere with the vestibular-ocular reflex (VOR) parameters on instrumental head impulse test (HIT), either with scleral search coil or video head impulse test and, eventually, foresee the control of vertigo crisis in unilateral intractable Meniere's disease (MD). Methods: A literature search was conducted in PubMed, Scopus, Web of Science and Cochrane search engines. The search terms used were "vestibular ocular reflex", "head impulse test", "gentamicin," and "Meniere's disease". Limitations included text availability to be full text, species to be humans and language to be English. All study types were included. 89 articles were screened identifying four eligible studies were identified. Studies were included after consensus of the authors. Meta-analysis was conducted using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Data was analysed using Review Manager software. Results: Instrumental HIT, after ITG for MD, demonstrated, in the treated ear, a decreased gain in the horizontal, posterior and superior semicircular canals (SCC), of 0.36 (0.26; 0.47; 95% CI), 0.35 (0.22; 0.48; 95% CI) and 0.28 (0.21; 0.35; 95% CI), respectively. Gain asymmetry increases between the treated and non-treated ear of 23.78 (7.22; 40.35; 95% CI), 32.01 (12.27; 51.76; 95% CI) and 17.49 (9.99; 24.99; 95% CI), were similarly detected in the horizontal, posterior and superior SCC, respectively. Significantly smaller gain values after the first treatment were observed for a single injection group versus multiple injection group in the horizontal (p = 0.002) and superior SCCs (p = 0.016). Conclusions: Instrumental HIT is effective in evaluating the SCC function after ITG for intractable unilateral MD. VOR gain changes in the direction of the treated ear in the three SCC have been clearly registered. An increased reduction of the VOR gain in the horizontal and anterior SCC also seemed to foresee the control of vertigo crisis. Still, after meta-analysis, the small number of patients' data available did not allow to define a treatment end-point value. This review also indicated that further and better-designed studies are warranted. (C) 2018 Elsevier B.V. All rights reserved.
  • Autores: Lopez-Escamez, J. A. (Autor de correspondencia); Manrique Huarte, Raquel; Martin-Sanz, E.; et al.
    Revista: ACTA OTORRINOLARINGOLOGICA ESPAÑOLA
    ISSN: 0001-6519 Vol.69 N° 5 2018 págs. 275 - 282
    Resumen
    Introduction: Publishing in scientific journals is an indicator of hospital quality and has become a standard of excellence for medical doctors and institutions. The aim of the study is to identify the scientific publications performed by Otolaryngology Departments in Spain within the period 2011-2015 and to compare them to a previous period between 1998-2002. Material and methods: Original papers published by Otolaryngology Departments in Spain in PubMed within 2011-2015 were retrieved. They were classified according to the type of journal published (international or Acta ORL Espanola) and the following subspecialty areas: Otology, Audiology and Neuro-Otology, Head and Neck Surgery (including Oncology), Rhinology and Paediatric ENT. Hospitals were ranked according to: number of original papers, accumulated impact factor and total number of publications. Results: Between 2011 and 2015, 49342 publications were included in PubMed, 1.44% from Otolaryngology Departments in Spain. Between 1998 and 2002, 3.80% publications were from Spanish ENT departments. Of the 712 papers published within the period 2011-2015, 389 were published in Acta ORL Espanola and 323 in international journals. From the latter, 20.7% belong to the Otology area, 19.2% to Audiology-Neuro-otology, 30.6% to Head and Neck Surgery, 15.2% to Rhinology and 3.4% to Paediatric ENT. Five tertiary centres published at least 10 original papers in the same period. Conclusions: Spanish otolaryngology's contribution to international journals has decreased in the last 12 years. A few institutions are responsible for the majority of publications and they have notably increased the cumulative impact factor. (C) 2018 Sociedad Espanola de Otorrinolaringologia y Cirugia de Cabeza y Cuello. Published by Elsevier Espana, S.L.U. All rights reserved.
  • Autores: Lassaletta, L.; Sánchez-Cuadrado, I.; Espinosa, J. M.; et al.
    Revista: ACTA OTORRINOLARINGOLOGICA ESPAÑOLA
    ISSN: 0001-6519 Vol.70 N° 2 2018 págs. 112 - 118
    Resumen
    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 CodacsTM. (Cochlear, Australia).
  • Autores: Marques, P. (Autor de correspondencia); Duan, M.; Pérez Fernández, Nicolás; et al.
    Revista: PLOS ONE
    ISSN: 1932-6203 Vol.13 N° 11 2018 págs. e0207467
    Resumen
    Introduction Middle ear application of gentamicin is a common medical treatment for uncontrolled Meniere's disease. The objective of the study was to evaluate the impact of endolymphatic hydrops on inner ear delivery. Methods Perilymph gentamicin concentrations and correlation with endolymphatic hydrops in an animal model were assessed. A group of 24 guinea pigs was submitted to surgical obstruction of the endolymphatic sac and duct of the right ear. Gentamicin was applied either to the right ear's round window niche or through a transtympanic injection. Perilymph specimens were collected at different times. Histologic morphometry was used to evaluate both turn-specific and overall hydrops degree. Results In animals with endolymphatic hydrops, lower concentrations of gentamicin were observed after 20 or 120 minutes of exposure and in both types of administration, when compared to controls. This difference reached statistical significance in the round window niche application group (Mann-Whitney, p = 0,007). A negative correlation between perilymphatic gentamicin concentration and hydrops degree could be observed in both groups, after 120 minutes of exposure (Spearman correlation, round window niche p<0,001; TT p = 0,005). Conclusions The study indicates that the endolymphatic hydrops degree has a negative interference on the delivery of gentamicin into the inner ear following middle ear application.
  • Autores: Rey-Martinez, J. (Autor de correspondencia); Batuecas-Caletrio, A.; Matino, E.; et al.
    Revista: FRONTIERS IN NEUROLOGY
    ISSN: 1664-2295 Vol.9 N° 69 2018
    Resumen
    Background: Visually enhanced vestibulo-ocular reflex (VVOR) is a well-known bedside clinical test to evaluate visuo-vestibular interaction, with clinical applications in patients with neurological and vestibular dysfunctions. Owing to recently developed diagnostic technologies, the possibility to perform an easy and objective measurement of the VVOR has increased, but there is a lack of computational methods designed to obtain an objective VVOR measurement. Objectives: To develop a method for the assessment of the VVOR to obtain a gain value that compares head and eye velocities and to test this method in patients and healthy subjects. Methods: Two computational methods were developed to measure the VVOR test responses: the first method was based on the area under curve of head and eye velocity plots and the second method was based on the slope of the linear regression obtained for head and eye velocity data. VVOR gain and vestibulo-ocular reflex (VOR) gain were analyzed with the data obtained from 35 subjects divided into four groups: healthy (N = 10), unilateral vestibular with vestibular neurectomy (N = 8), bilateral vestibulopathy (N = 12), and cerebellar ataxia, neuropathy, and vestibular areflexia syndrome (CANVAS) (N = 5). Results: Intra-class correlation index for the two developed VVOR analysis methods was 0.99. Statistical differences were obtained by analysis of variance statistical method, comparing the healthy group (VVOR mean gain of 1 +/- 0) with all other groups. The CANVAS group exhibited (VVOR mean gain of 0.4 +/- 0.1) differences when compared to all other groups. VVOR mean gain for the vestibular bilateral group was 0.8 +/- 0.1. VVOR mean gain in the unilateral group was 0.6 +/- 0.1, with a Pearson's correlation of 0.52 obtained when VVOR gain was compared to the VOR gain of the operated side. Conclusion: Two computational methods to measure the gain of VVOR were successfully developed. The VVOR gain values appear to objectively characterize the VVOR alteration observed in CANVAS patients, and also distinguish between healthy subjects and patients with some vestibular disorders.
  • Autores: Hain, T. C. (Autor de correspondencia); Cherchi, M. ; Pérez Fernández, Nicolás
    Revista: FRONTIERS IN NEUROLOGY
    ISSN: 1664-2295 Vol.9 N° 396 2018
    Resumen
    Patients with inner ear damage associated with bilateral vestibular impairment often ask "how much damage do I have." Although there are presently three clinical methods of measuring semicircular canal vestibular function; electronystagmography (ENG or VENG), rotatory chair and video head-impulse (VHIT) testing; none of these methods provides a method of measuring total vestibular output. Theory suggests that the slow cumulative eye position can be derived from the rotatory chair test by multiplying the high frequency gain by the time constant, or the "GainTc product." In this retrospective study, we compared the GainTc in three groups, 30 normal subjects, 25 patients with surgically induced unilateral vestibular loss, and 24 patients with absent or nearly absent vestibular responses due to gentamicin exposure. We found that the GainTc product correlated better with remaining vestibular function than either the gain or the time constant alone. The fraction of remaining vestibular function was predicted by the equation R=(GainTc/11.3) - 0.6. We suggest that the GainTc product answers the question "how much damage do I have," and is a better measure than other clinical tests of vestibular function.
  • Autores: Garaycochea Mendoza del Solar, Octavio; Domínguez Echávarri, Pablo Daniel; Manrique Rodríguez, Manuel Jesús; et al.
    Revista: JOURNAL OF INTERNATIONAL ADVANCED OTOLOGY
    ISSN: 1308-7649 Vol.14 N° 2 2018 págs. 334 - 336
    Resumen
    Different types of otic capsule dehiscence restricted to the cochlea have been described. Here we describe the case of a patient with a cochlear-internal auditory canal dehiscence associated with a cochlear-facial dehiscence not reported before. A 53-year-old patient with severe to profound sensor ineural hearing loss due to bilateral Meniere's disease under went a cochlear implant surgery on the right ear. Preoperative brain magnetic resonance imaging findings were reported to be normal; dur ing surgery, a cerebrospinal fluid gusher occur red at the time of round window opening. Postoperative computed tomography imaging showed a bony dehiscence at two levels of the otic capsule.
  • Autores: Manrique Rodríguez, Manuel Jesús; Ramos, A.; Pradel, B.; et al.
    Revista: ACTA OTORRINOLARINGOLOGICA ESPAÑOLA
    ISSN: 0001-6519 Vol.69 N° 5 2018 págs. 251 - 259
    Resumen
    INTRODUCTION: This study aims to analyse the knowledge of cochlear implant (CI) candidacy criteria of otorhinolaryngology specialists in Spain, and from the results, consider whether it is necessary to implement training measures aimed at improving knowledge in this area. MATERIAL AND METHODS: A questionnaire was designed for measuring the level of knowledge of cochlear implant candidacy criteria (CI) in people with hearing loss. The questionnaire collected the demographic data of the respondents and their knowledge on the conventional and emergency indications for CI, technical characteristics of CI and results in the implanted population. RESULTS: A total of 222 Spanish specialists in otorhinolaryngology answered the questionnaire (10.29% of the sample surveyed). CONCLUSIONS: The 50% of all respondents showed a medium-high knowledge about CI. Epidemiological data suggest that a high percentage of adults with postlocutive deafness and candidates for a CI are not referred for treatment. The lack of knowledge about the criteria for the indication of CI by otorhinolaryngology specialists may contribute to inadequate guidance of patients who are potential candidates for CI. The greatest shortcomings are found in the most emergency indications for a CI. Among otorhinolaryngology professionals, the greatest knowledge about CI is found in those who work in tertiary hospitals in the areas of otology and otoneurology, either in the public or private sector. This study suggests that training on CI should be increased for otorhinolaryngology professionals, especially for general otorhinolaryngologists.
  • Autores: Manrique Huarte, Raquel; Calavia, D.; Álvarez Gómez, Laura; et al.
    Revista: JOURNAL OF INTERNATIONAL ADVANCED OTOLOGY
    ISSN: 1308-7649 Vol.14 N° 1 2018 págs. 18 - 22
    Resumen
    OBJECTIVES: To measure the auditory (pure tone audiometry and word recognition scores) and vestibular (video head impulse test and vestibular myogenic potentials) outcomes in patients diagnosed with Meniere¿s disease (MD) who underwent cochlear implantation. MATERIAL AND METHODS: This prospective study included 23 cochlear implant users with MD and 29 patients diagnosed with far-advanced oto - sclerosis (the control group). RESULTS: The preoperative mean pure tone average thresholds were 99 and 122.5 dB for the Meniere¿s and control groups, respectively. Word recog- nition scores after cochlear implant yielded a median of 80% and 72% for the Meniere¿s and control groups, respectively. Semicircular canal gain was not observed to vary post implantation (mean variation for lateral, posterior, and anterior plane was 0, 0.03, and 0, respectively). The mean ocular and cervical myogenic potentials asymmetry varied as 9.65% and 18.39%, respectively. CONCLUSIONS: The auditory performance improved in patients with MD similar to the general cochlear implant population. No major dysfunction of otolithic or semicircular canal function was demonstrated after the implantation surgery
  • Autores: Manrique Huarte, Raquel (Autor de correspondencia); Calavia, D.; Gallego Madrid, María Antonia; et al.
    Revista: JOURNAL OF INTERNATIONAL ADVANCED OTOLOGY
    ISSN: 1308-7649 Vol.14 N° 1 2018 págs. 5 - 9
    Resumen
    OBJECTIVES: To determine the feasibility of progressive insertion (two sequential surgeries: partial to full insertion) of an electrode array and to compare functional outcomes. MATERIAL AND METHODS: 8 normal-hearing animals (Macaca fascicularis (MF)) were included. A 14 contact electrode array, which is suitably sized for the MF cochlea was partially inserted (PI) in 16 ears. After 3 months of follow-up revision surgery the electrode was advanced to a full insertion (FI) in 8 ears. Radiological examination and auditory testing was performed monthly for 6 months. In order to compare the values a two way repeated measures ANOVA was used. A p-value below 0.05 was considered as statistically significant. IBM SPSS Statistics V20 was used. RESULTS: Surgical procedure was completed in all cases with no complications. Mean auditory threshold shift (ABR click tones) after 6 months follow-up is 19 dB and 27 dB for PI and FI group. For frequencies 4, 6, 8, 12, and 16 kHz in the FI group, tone burst auditory thresholds increased after the revision surgery showing no recovery thereafter. Mean threshold shift at 6 months of follow- up is 19.8 dB ranging from 2 to 36dB for PI group and 33.14dB ranging from 8 to 48dB for FI group. Statistical analysis yields no significant differences between groups. CONCLUSION: It is feasible to perform a partial insertion of an electrode array and progress on a second surgical time to a full insertion (up to 270º). Hearing preservation is feasible for both procedures. Note that a minimal threshold deterioration is depicted among full insertion group, especially among high frequencies, with no statistical differences.
  • Autores: Rey-Martinez, J. (Autor de correspondencia); Thomas-Arrizabalaga, I. ; Espinosa-Sanchez, J. M.; et al.
    Revista: LARYNGOSCOPE
    ISSN: 0023-852X Vol.128 N° 10 2018 págs. 2383 - 2389
    Resumen
    ObjectiveMethodsTo assess whether there are differences in vestibulo-ocular reflex (VOR) gain for suppression head impulse (SHIMP) and head impulse (HIMP) video head impulse test paradigms, and if so, what are their causes. Prospective multicenter observational double-blind nonrandomized clinical study was performed by collecting 80 healthy subjects from four reference hospitals. SHIMP data was postprocessed to eliminate impulses in which early SHIMP saccades were detected. Differences between HIMP and SHIMP VOR gain values were statistically evaluated. Head impulse maximum velocity, gender, age, direction of impulse, and hospital center were considered as possible influential factors. ResultsConclusionA small significant statistical difference between HIMP and SHIMP VOR gain values was found on repeated measures analysis of variance (-0.050.006, P<0.001). Optimized linear model showed a significant influence of age variable on the observed differences for HIMP and SHIMP gain values and did not find influence between gain values differences and maximum head impulse velocity. Both HIMP and SHIMP VOR gain values were significant lower (-0.09, P<0.001) when the impulses were performed to the left side. We had observed a difference in SHIMP and HIMP gain values not adequately explained by known gain modification factors. The persistence of this slight but significant difference indicates that there are more factors causing lower SHIMP VOR gain values. This difference must to be considered in further studies as well as in the clinical SHIMP testing protocols. We hypothesized that VOR phasic response inhibition could be the underlying cause of this difference. Level of Evidence2b. Laryngoscope, 128:2383-2389, 2018
  • Autores: Ramos Macias, A.; Falcón-González, J. C.; Manrique Rodríguez, Manuel Jesús; et al.
    Revista: AUDIOLOGY AND NEURO-OTOLOGY
    ISSN: 1420-3030 Vol.23 N° 1 2018 págs. 8 - 19
    Resumen
    OBJECTIVE: To show that patients with unilateral hearing loss (UHL), with one ear fulfilling cochlear implant (CI) indication criteria, and an additional severe tinnitus handicap can be treated effectively with a CI. METHOD: A prospective multi-centre study was conducted in five Spanish centres. Sixteen adult patients with UHL and a mean Tinnitus Handicap Inventory (THI) score of at least 58 were implanted. The study design included repeated within-subject measures of quality of life (Health Utility Index Mark 3 [HUI3]), tinnitus (THI, Visual Analogue Scale [VAS] on tinnitus loudness), hearing (Speech, Spatial, and Qualities of Hearing Scale- [SSQ]), and hyperacusis (Test de Hipersensibilidad al Sonido [THS]) up to 12 months after the initial CI fitting. RESULTS: Group data showed significant subjective benefit from CI treatment: the preoperative HUI3 total utility score of 0.45 went up to 0.57 at 6 months and 0.63 at 12 months; the preoperative THI total score of 75 decreased to 40 at 6 months and 35 at 12 months. The preoperative tinnitus loudness VAS score of 8.2 decreased to 2.4 at 6 months and 2.2 at 12 months with the implant "On" and to 6.7 at 6 months and 6.5 at 12 months with the implant "Off." The preoperative THS total score of 26 decreased to 17 at 12 months. The preoperative SSQ total score of 4.2 increased to 5.1 at 6 months and 6.3 at 12 months. No unanticipated adverse events were reported during the study period. At 12 months after CI activation all subjects (except 1 subject who used the device 6 days a week) wore their devices all day and every day. The primary reason for CI use was split evenly between tinnitus suppression (n = 6) and both hearing and tinnitus (n = 6). CONCLUSION: A CI should be considered as a treatment option in patients with UHL and a concomitant severe tinnitus handicap. However, appropriate counselling of candidates on the anticipated risks, benefits, and limitations that are inherent to cochlear implantation is imperative.
  • Autores: Macias, A. R. ; Falcon-Gonzalez, J. C.; Manrique Rodríguez, Manuel Jesús; et al.
    Revista: AUDIOLOGY AND NEURO-OTOLOGY
    ISSN: 1420-3030 Vol.23 N° 1 2018 págs. 8 - 19
    Resumen
    Objective: To show that patients with unilateral hearing loss (UHL), with one ear fulfilling cochlear implant (CI) indication criteria, and an additional severe tinnitus handicap can be treated effectively with a Cl. Method: A prospective multi-centre study was conducted in five Spanish centres. Sixteen adult patients with UHL and a mean Tinnitus Handicap Inventory (THI) score of at least 58 were implanted. The study design included repeated within-subject measures of quality of life (Health Utility Index Mark 3 [HUI3]), tinnitus (THI, Visual Analogue Scale [VAS] on tinnitus loudness), hearing (Speech, Spatial, and Qualities of Hearing Scale- [SSQ]), and hyperacusis (Test de Hipersensibilidad al Sonido [THS]) up to 12 months after the initial CI fitting. Results: Group data showed significant subjective benefit from CI treatment: the preoperative HUI3 total utility score of 0.45 went up to 0.57 at 6 months and 0.63 at 12 months; the preoperative THI total score of 75 decreased to 40 at 6 months and 35 at 12 months. The preoperative tinnitus loudness VAS score of 8.2 decreased to 2.4 at 6 months and 2.2 at 12 months with the implant "On" and to 6.7 at 6 months and 6.5 at 12 months with the implant "Off." The preoperative THS total score of 26 decreased to 17 at 12 months. The preoperative SSQ total score of 4.2 increased to 5.1 at 6 months and 6.3 at 12 months. No unanticipated adverse events were reported during the study period. At 12 months after CI activation all subjects (except 1 subject who used the device 6 days a week) wore their devices all day and every day. The primary reason for CI use was split evenly between tinnitus suppression (n =6) and both hearing and tinnitus (n = 6). Conclusion: A CI should be considered as a treatment option in patients with UHL and a concomitant severe tinnitus handicap. However, appropriate counselling of candidates on the anticipated risks, benefits, and limitations that are inherent to cochlear implantation is imperative. (C) 2018 The Author(s) Published by S. Karger AG, Basel
  • Autores: Trinidad-Ruiz G; Re-Martinez J; Batuecas-Caletrío A.; et al.
    Revista: EAR AND HEARING
    ISSN: 0196-0202 Vol.39 N° 6 2018 págs. 1176-86
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  • Autores: Manrique Rodríguez, Manuel Jesús; Manrique Huarte, Raquel
    Libro: Paparella`s otolaryngology: head & neck surgery
    ISSN: 978-9351524540 Vol.2 2019 págs. 1326 - 1332
  • Autores: Manrique Rodríguez, Manuel Jesús; Garaycochea Mendoza del Solar, Octavio; Prieto Matos, Carlos
    Libro: Tumores de oído y de ángulo ponto-cerebeloso : ponencia sociedad española ORL y cirugía cérvico-facial 2018
    ISSN: 978-84-17528-09-6 2018 págs. 69 - 74

Proyectos desde 2018

  • Título: Descifrando la disociación de resultados en pruebas vestibulares de pacientes con enfermedad de Méniere unilateral
    Código de expediente: PI19/00414
    Investigador principal: NICOLAS PEREZ FERNANDEZ.
    Financiador: INSTITUTO DE SALUD CARLOS III
    Convocatoria: 2019 AES Proyectos de investigación
    Fecha de inicio: 01-01-2020
    Fecha fin: 31-12-2022
    Importe concedido: 68.970,00€
    Otros fondos: Fondos FEDER
  • Título: DEVELOPMENT OF A NEW BIONICS VESTIBULAR IMPLANT FOR BILATERAL VESTIBULAR DISFUNCTION
    Código de expediente:
    Investigador principal: MANUEL JESUS MANRIQUE RODRIGUEZ
    Financiador: COMISIÓN EUROPEA
    Convocatoria: H2020-FETOPEN-1-2017
    Fecha de inicio: 01-09-2018
    Fecha fin: 28-02-2023
    Importe concedido: 454.886,25€
    Otros fondos: -
  • Título: Red de cooperación transnacional para la mejora de los programas de salud de detección precoz de la hipoacusia infantil a través de herramientas genéticas innovadoras de diagnóstico
    Código de expediente:
    Investigador principal: MANUEL JESUS MANRIQUE RODRIGUEZ
    Financiador: INTERREG SUDOE MINISTERIO DE HACIENDA
    Convocatoria: INTERREG SUDOE 2017
    Fecha de inicio: 01-04-2018
    Fecha fin: 31-03-2021
    Importe concedido: 540.000,00€
    Otros fondos: Fondos FEDER
  • Título: IIR-2237 HEARING AND BALANCE IN HEALTHY AGING
    Investigador principal: MANUEL JESUS MANRIQUE RODRIGUEZ
    Fecha de inicio: 01-09-2020
    Fecha fin: 31-01-2027
    Importe: 0
    Otros fondos: -
  • Título: Prototipo planificador para cirugía de implantación coclear
    Investigador principal: MANUEL JESUS MANRIQUE RODRIGUEZ
    Fecha de inicio: 11-01-2019
    Fecha fin: 31-03-2019
    Importe: 0
    Otros fondos: -
  • Título: Pharmacokinetics of the implanted cochlea in a primate
    Investigador principal: MANUEL JESUS MANRIQUE RODRIGUEZ
    Fecha de inicio: 01-07-2018
    Fecha fin: 17-11-2020
    Importe: 0
    Otros fondos: -
  • Título: HEARING AND BALANCE IN HEALTHY AGING
    Investigador principal: MANUEL JESUS MANRIQUE RODRIGUEZ
    Fecha de inicio: 24-05-2017
    Fecha fin: 14-01-2021
    Importe: 0
    Otros fondos: -
  • Título: Research Framework Agreement Investigator Initiated Research
    Investigador principal: MANUEL JESUS MANRIQUE RODRIGUEZ
    Fecha de inicio: 01-10-2015
    Fecha fin: 01-10-2020
    Importe: 0
    Otros fondos: -
  • Título: Progressive insertion of electrode
    Investigador principal: MANUEL JESUS MANRIQUE RODRIGUEZ
    Fecha de inicio: 01-02-2015
    Fecha fin: 30-09-2019
    Importe: 0
    Otros fondos: -
  • Título: Dexamethasone eluting electrode study in Macaca fascicularis
    Investigador principal: MANUEL JESUS MANRIQUE RODRIGUEZ
    Fecha de inicio: 01-07-2013
    Fecha fin: 31-12-2020
    Importe: 0
    Otros fondos: -
  • Título: IIR-20: Asymmetrics, Tinnitus, Hybrid, bilateral, CI
    Investigador principal: MANUEL JESUS MANRIQUE RODRIGUEZ
    Fecha de inicio: 01-01-2010
    Fecha fin: 20-06-2018
    Importe: 0
    Otros fondos: -