Nuestros investigadores

Raquel Manrique Huarte

Clínica Universidad de Navarra. Clínica Universidad de Navarra

Publicaciones científicas más recientes (desde 2010)

Autores: Manrique, Raquel; et al.
ISSN 0196-0202  Vol. 38  Nº 1  2017  págs. e57 - e68
OBJECTIVES:: The objectives of this study were to evaluate the effect of reimplanting a cochlear implant electrode in animal normal-hearing cochlea to propose measures that may prevent cochlear injury and, given its close phylogenetic proximity to humans, to evaluate the macaque as a model for electroacoustic stimulation. DESIGN:: Simultaneous, bilateral surgical procedures in a group of 5 normal-hearing specimens (Macaca fascicularis) took place in a total of 10 ears. Periodic bilateral auditory testing (distortion product otoacoustic emissions and auditory brainstem evoked responses [ABR]) took place during a 6-month follow-up period. Subsequently, unilateral explantation and reimplantation was performed. Auditory follow-up continued up to 12 months, after which animals were sacrificed and both temporal bones extracted for histological analysis. RESULTS:: Implantation and reimplantation surgeries were performed without complications in 9 of 10 cases. Full insertion depth was achieved at reimplantation in four of five ears. Auditory evaluation: Statistically significant differences between implanted and reimplanted were observed for the frequencies 2000 and 11,000 Hz, the remaining frequencies showed no differences for distortion product otoacoustic emission. Before the procedure, average thresholds with click-stimuli ABR of the five animals were 40 dB SPL (implanted group) and 40 dB SPL (reimplanted group). One week after first implantation, average thresholds were 55 dB SPL and 60 dB, respectively. After 12 months of follow-up, the average thresholds were 72.5 dB SPL (implanted group) and 65 dB SPL (reimplanted group). Hearing loss appeared during the first weeks after the first implantation and no deterioration was observed thereafter. Differences for ABR under click stimulus were not significant between the two ear groups. Similar results were observed with tone-burst ABR. A 15 dB shift was observed for the implanted group preoperatively versus 1-week post surgery and an additional 17.5 dB shift was seen after 12-month follow-up. For the reimplanted group, a 20 dB shift was observed within the first week post reimplantation surgery and an additional 5 dB after 6 months follow-up. Statistical analysis revealed significant differences between the implanted and reimplanted ear groups for frequencies 4000 Hz (p = 0.034), 12000 Hz (p = 0.031), and 16,000 Hz (p = 0.031). The histological analysis revealed that the electrode insertion was minimally traumatic for the cochlea, mainly indicating rupture of the basilar membrane in the transition area between the basal turn and the first cochlear turn only in Mf1 left ear. CONCLUSIONS:: With application of minimally traumatic surgical techniques, it is possible to maintain high rates of hearing preservation after implantation and even after reimplantation. Partial impairment of auditory thresholds may occur during the first weeks after surgery, which remains stable. Considering the tonotopic distribution of the cochlea, we found a correlation between the histological lesions sites and the auditory findings, suggesting that a rupture of the basilar membrane may impact hearing levels. The macaque was observed to be a functionally and anatomically an excellent animal model for cochlear implantation
Autores: Frejo L, ; Martin-Sanz E; Teggi R; et al.
ISSN 1749-4478  Vol. 42  Nº 6  2017  págs. 1172-1180.
Cluster analysis defines clinical subgroups in MD, and it extends the phenotype beyond audiovestibular symptoms. This classification will help to improve the phenotyping in MD and facilitate the selection of patients for randomised clinical trials
Autores: Huarte, Alicia; Martínez, Marta; Manrique, Raquel; et al.
ISSN 0001-6519  Vol. 68  Nº 2  2016  págs. 92 - 97
Introducción El objetivo de este trabajo es conocer el impacto que el implante coclear (IC) tiene en la vida laboral de las personas implantadas, a través de una primera versión de un cuestionario elaborado en el programa de implantes cocleares de la Clínica Universidad de Navarra. Se pretende demostrar que el IC está teniendo un impacto significativo en la vida laboral de estos pacientes. Material y métodos Se estudia una población de 60 pacientes de 48 años de edad media, con hipoacusia neurosensorial profunda bilateral tratada con un IC, a la que se le presenta un cuestionario elaborado para evaluar su calidad de vida laboral con carácter retrospectivo. Resultados El 94,23% de los pacientes que completaron el cuestionario están actualmente satisfechos con su trabajo. El 93,05% se sienten más motivados para ir a trabajar tras su IC. Un 79,31% se consideran más competentes tras la cirugía y activación del dispositivo. Un 67,23% de los pacientes han mejorado sus relaciones interpersonales en el ámbito de trabajo tras la implantación coclear. Conclusiones El IC proporciona una ayuda positiva en la esfera profesional al igual que en las destrezas sociales al beneficiar la capacidad de comunicación de los pacientes implantados. El desarrollo de herramientas para evaluar el grado de satisfacción laboral de los pacientes tratados con un IC es de gran interés.
Autores: Manrique, Raquel; Calavia D; Huarte, Alicia; et al.
ISSN 1420-3030  Vol. 21.  Nº Supl 1  2016  págs. 29-35
The study aim was to determine the benefit of cochlear implantation and hearing aids in older adults diagnosed with hearing loss and to evaluate the index of depression, anxiety and quality of life after such treatments. A retrospective cohort comprised 117 patients older than 65 years and diagnosed with moderate to profound hearing loss who were included and classified into 2 groups (treated vs. non-treated). A battery of tests including auditory (pure-tone average, disyllabic words in quiet at 65 dB SPL) and findings from a series of questions relevant to quality of life were compared between both groups. Auditory outcomes for disyllabic words were 58.21% for the cochlear implant-treated group and 82.8% for the hearing aid-treated group. There was a positive effect on anxiety, depression, health status and quality of life in the cochlear implant group versus the profound hearing loss control group. We conclude that older adults with moderate to profound hearing loss gain benefit from hearing aids or cochlear implants not only in terms of improved hearing function, but also in terms of positive effects on anxiety, depression, health status and quality of life.
Autores: Manrique, Raquel; Calavia, D.; et al.
ISSN 1664-5537  Vol. 21  Nº Supl. 1  2016  págs. 29 - 35
The study aim was to determine the benefit of cochlear implantation and hearing aids in older adults diagnosed with hearing loss and to evaluate the index of depression, anxiety and quality of life after such treatments. A retrospective cohort comprised 117 patients older than 65 years and diagnosed with moderate to profound hearing loss who were included and classified into 2 groups (treated vs. non-treated). A battery of tests including auditory (pure-tone average, disyllabic words in quiet at 65 dB SPL) and findings from a series of questions relevant to quality of life were compared between both groups. Auditory outcomes for disyllabic words were 58.21% for the cochlear implant-treated group and 82.8% for the hearing aid-treated group. There was a positive effect on anxiety, depression, health status and quality of life in the cochlear implant group versus the profound hearing loss control group. We conclude that older adults with moderate to profound hearing loss gain benefit from hearing aids or cochlear implants not only in terms of improved hearing function, but also in terms of positive effects on anxiety, depression, health status and quality of life.
Autores: Sanhueza IA; Manrique, Raquel; Huarte, Alicia; et al.
ISSN 1308-7649  Vol. 12  Nº 1  2016  págs. 16-22.
Bimodal stimulation provides better results than any monaural hearing mode, regardless of whether it involves the use of a hearing aid alone or a cochlear implant alone.
Autores: Restrepo C; Manfredini D; Castrillon E, ; et al.
ISSN 0960-7439  Vol. 27  Nº 5  2016  págs. 318-25
Autores: Marques, P.; Manrique, Raquel; Pérez-Fernandez, Nicolás;
ISSN 0023-852X  Vol. 125  Nº 8  2015  págs. 1915 - 1920
OBJECTIVE: Assess angular vestibular-ocular reflex (VOR) changes after treatment with intratympanic gentamicin (ITG) for Ménière's disease (MD) and impact on short-term follow-up. DESIGN: Prospective study. METHODS: Patients submitted to ITG for unilateral MD. The gain VOR and the presence of compensatory saccades elicited by rapid head impulses were measured using the video head impulse test (vHIT). RESULTS: The study included 31 subjects (mean age: 59 years). Functional Level Scale (FLS) distributions were 35,5% (FLS3); 32,2% (FLS4); and 32,2% (FLS5). Mean follow-up was 21¿±¿7 months. Multiple injections were needed in nine patients. VOR gain in the treated ear was significantly reduced in all subjects and for all the semicircular canals (paired samples t test; P¿<¿0,05). Gain averages after treatment were 0,61 (superior); 0,69 (horizontal); and 0,47 (posterior). A horizontal canal VOR gain superior to 0,80 after treatment was associated with the need for a second gentamicin injection (Chi-square; P¿=¿0,003). Gain asymmetry between the symptomatic and asymptomatic ear (GASM) was increased after treatment. The rate of vestibular function reduction was 47,9%; 26,0%; and 35,8% for the superior, horizontal, and posterior canals, respectively. According to the receiving operator characteristic curve, the amount of change in GASM must be greater than 7 in order to predict the avoidance of a second procedure (area under the curve [AUC] horizontal canal¿=¿0,861) and the amount of vestibular function reduction in the pathologic ear in patients with a controlled disease must be greater than 17,8% (AUC horizontal canal¿=¿0,843). CONCLUSIONS: When evaluated with the vHIT, intratympanic gentamicin changes in VOR seem to foresee short-term control of vertigo attacks. LEVEL OF EVIDENCE: 4. Laryngoscope, 125:1915-1920, 2015.
Autores: Manrique, Raquel; Huarte, Alicia; Manrique, Manuel Jesús;
ISSN 0937-4477  Vol. 273  Nº 3  2015  págs. 621 - 629
The objective of this study was to review cochlear reimplantation outcomes in the tertiary hospital and analyze whether facts such as type of failure, surgical findings, or etiology of deafness have an influence. A retrospective study including 38 patients who underwent cochlear implant revision surgery in a tertiary center is performed. Auditory outcomes (pure tone audiometry, % disyllabic words) along with etiology of deafness, type of complication, issues with insertion, and cochlear findings are included. Complication rate is 2.7 %. Technical failure rate is 57.9 % (50 % hard failure and 50 % soft failure), and medical failure (device infection or extrusion, migration, wound, or flap complication) is seen in 42.1 % of the cases. Management of cochlear implant complications and revision surgery is increasing due to a growing number of implantees. Cases that require explantation and reimplantation of the cochlear implant are safe procedures, where the depth of insertion and speech perception results are equal or higher in most cases. Nevertheless, there must be an increasing effort on using minimally traumatic electrode arrays and surgical techniques to improve currently obtained results.
Autores: Gónzalez Navarro, M.; Manrique, Raquel; Manrique, Manuel Jesús; et al.
ISSN 0001-6489  Vol. 135  Nº 12  2015  págs. 1245 - 1252
CONCLUSION: Patients with cochlear implants should be treated no differently than non-implanted patients with similar symptomatology. OBJECTIVES: To describe the spectrum of symptomatology, treatment, and long-term follow-up of patients with cochlear implant and vestibular complaints. METHODS: This retrospective study included 25 patients with late onset vestibular complaints (more than 1 month post-implantation). Each patient underwent an extensive interrogatory and physical exam with ancillary test to complete a diagnosis. Treatment was given according to this and all patients followed a vestibular rehabilitation program. RESULTS: The total population was 72% male and 28% female, median age was 58 years; minimal follow-up was 9 months (mean = 51, median = 34). Cochleostomy was performed in eight cases and round window insertion was performed in 19 (two patients were removed from each group in the analysis due to their bilateral implantation under a different approach). The mean time from implant to vestibular symptoms was 53 months, median = 32; a Kaplan Meier graphic showed the round window approach has faster onset of symptoms with statistical significance (p = 0.020). The most common complaint was instability in all patients and after both surgical approaches. No difference in symptoms was found with a Kruskall Wallis test except for vertigo spells (more common in the round window approach). In 12 patients the symptomatology was attributed to the implanted side. In the long-term follow-up a relatively high number of patients (20/25) recovered with standard treatment, suggesting the presence of the implant is not associated with poor recovery prognosis.
Autores: Zulueta-Santos, Cristina; Berumen, O. D.; Manrique, Raquel; et al.
ISSN 0001-6489  Vol. 135  Nº 12  2015  págs. 1253 - 1258
Conclusion: The low clinical efficacy of the treatment for patients included in this work correlates with no noticeable effect on the vestibular function. Objective: To assess follow-up in patients with idiopathic and secondary Ménières disease after treatment with intra-tympanic dexamethasone and correlate clinical findings with changes in the vestibular-ocular reflex elicited after stimulation of each of the six semicircular canals. Methods: This is a single center retrospective review of patients presenting the clinical symptomatology of Meniérès disease treated with intra-tympanic dexamethasone. An audiometric evaluation was performed in each patient before and after treatment. The study cohort was divided into two groups: those evaluated after a short period of time and after a long period of time. Results: The study included 30 patients, mean age = 61 years. Differences in mean pure-tone average before and after treatment were non-significant for both treated (0.61 dB, p = 0.723) and untreated (0.59 dB, p = 0.609) ears. Vestibular-ocular reflex gain averages in the treated ear after treatment were 0.73 (superior semicircular canal), 0.86 (horizontal semicircular canal), and 0.69 (posterior semicircular canal). The gain did not vary significantly in the Superior (p = 0.194), the Horizontal (p = 0.646), or the Posterior Semicircular Canal (p = 0.820). Similar were obtained for the untreated ear.
Autores: Cardier, M; Zulueta-Santos, Cristina; Manrique, Raquel; et al.
ISSN 1420-3030  Vol. 20  Nº Supl 1  2015  págs. 48 - 52
This article presents an analysis of the impact of functional neuroimaging studies (positron emission tomography, PET) in asymmetric hearing loss based on the clinical expertise obtained from a group of 21 patients. In these patients, PET studies are performed at rest and after auditory stimulation in order to measure the increase in brain activity in the ipsi- and contralateral cortex, providing supporting evidence to recommend a specific treatment and the side to implant. In conclusion, PET is a useful tool for selected cases in which information on the metabolic status of the auditory pathway can drive the decision regarding the treatment of the most appropriate ear. However, in view of our small sample, further research is needed to confirm our results in this topic
Autores: Martínez, Marta; Manrique, Raquel; Pérez-Fernandez, Nicolás;
ISSN 2090-6765  Nº 2015  2015  págs. 460 - 757
The aim of this paper is to present for the first time the functional evaluation of each of the vestibular receptors in the six semicircular canals in a patient diagnosed with Meniere's disease during an acute attack. A 54-year-old lady was diagnosed with left Meniere's disease who during her regular clinic review suffers an acute attack of vertigo, with fullness and an increase of tinnitus in her left ear. Spontaneous nystagmus and the results in the video head-impulse test (vHIT) are shown before, during, and after the attack. Nystagmus was initially left beating and a few minutes later an upbeat component was added. No skew deviation was observed. A decrease in the gain of the vestibuloocular reflex (VOR) and the presence of overt saccades were observed when the stimuli were in the plane of the left superior semicircular canal. At the end of the crisis nystagmus decreased and vestibuloocular reflex returned to almost normal. A review of the different possibilities to explain these findings points to a hypothetical utricular damage.
Autores: Manrique, Manuel Jesús; Zubicaray J; Ruiz Erenchun; et al.
ISSN 1137-6627  Vol. 38  Nº 2  2015  págs. 289 - 296
La colocación de un implante coclear es una medida útil para paliar la hipoacusia neurosensorial de grado severo-profundo en aquellos casos en los que el beneficio del audífono es escaso. Desde su inicio hace 30 años los resultados auditivos han mejorado gracias a los progresivas mejoras que se han adoptado en distintos ámbitos: su diseño, estrategia, técnica quirúrgica¿Dados los buenos resultados en este periodo, las indicaciones también han variado. El objetivo de este trabajo es revisar los criterios establecidos y emergentes de indicación de implante coclear, estableciendo de manera consensuada, entre los centros sanitarios de la Comunidad Foral de Navarra, unos criterios actualizados para la indicación del mismo en dicha área territorial, de forma que pueden servir de referencia en situaciones clínicas diferenciadas.
Autores: Manrique, Manuel Jesús; Piciafuocco, S.; Manrique, Raquel; et al.
ISSN 1531-7129  Vol. 35  Nº 4  2014  págs. 619 - 628
HYPOTHESIS: Evaluate, based on morphologic and histologic parameters, the atraumaticity of 2 electrode arrays implanted in 10 human temporal bones. BACKGROUND: Atraumatic surgery and electrode arrays are current topics in otologic surgery. The preservation of cochlear anatomy and its functions is a priority and morphologic evaluation of the surgical trauma is essential to continue improving in this field. METHODS: Ten preserved human temporal bones (TB) without anatomic alterations were used in this study. They were divided into 2 groups of 5, and atraumatic surgery was performed to insert HiFocus 1J (group A) and HiFocus Helix (group B) electrode arrays. Anatomic comparisons were performed using computed tomography and histologic analysis. RESULTS: Group A: the mean length for the cochlear longitudinal axis was 10.30 mm, and the cochlear transversal axis was 7.2 mm. Scala tympani insertion was achieved in 4/5 TB studied, with a mean depth and angle of insertion of 19.2 mm and 325.5°, respectively. Lateral location of the electrode array was achieved in all specimens. No significant correlation was observed between these dimensions and depth of insertion. Group B: the mean length for the cochlear longitudinal axis was 9.52 mm, and cochlear transversal axis was 6.38 mm. Scala tympani insertion was achieved in 4/5 TB studied, with a mean depth and angle of insertion of 17.5 mm and 352°, respectively. Modiolar location of the electrode array was achieved in all specimens. A positive correlation was established between the linear and angular insertion depths (p = 0.044). CONCLUSION: In summary, it is safe to state that neither electrode array shows significant insertion trauma.
Autores: Manrique, Manuel Jesús; Manrique, Raquel; et al.
ISSN 1531-7129  Vol. 35  Nº 2  2014  págs. 216 - 220
OBJECTIVE: To describe the surgical technique under local or general anesthesia of 5 cases that have undergone this procedure and the audiologic results obtained with this new device. PATIENTS: Four patients with mixed hearing loss and 1 patient with single-sided deafness. INTERVENTION: Therapeutic. MAIN OUTCOME MEASURES: The surgery was planned beforehand with a 3D reconstruction of a CT scan. The procedure was documented and timed in every case. Air and bone conductive pure tone audiometry and disyllabic words discrimination were tested after and before the procedure. Results were statistically analyzed. RESULTS: All patients tolerated well the procedure. Four patients were intervened under local anesthesia and 1 under general anesthesia because of an associated procedure. All patients showed statistically significant difference between the presurgery and postsurgery audiologic tests. CONCLUSION: Implantation of the Bonebridge with local or general anesthesia is a safe and feasible procedure, with audiometric results that can come close with the ones provided by BAHD users.
Autores: De Stefano, A.; Dispenza, F.; Suarez, H.; et al.
ISSN 0385-8146  Vol. 41  Nº 1  2014  págs. 31 - 36
Primary objective of this study was to find a statistical link between the most worldwide comorbidities affecting the elderly population (hypertension, diabetes, osteoarthrosis, osteoporosis and depression) and recurrent episodes of BPPV. Secondary objective was defining possible "groups of risk" for people suffering recurrent positional vertigo related to the presence of a well documented comorbidity. METHODS: This was an observational, cross-sectional, multicenter, spontaneous, non-pharmacological study. The data of 1092 patients suffering BPPV evaluated in 11 different Departments of Otolaryngology, Otoneurology and Neurology, referring Centers for positional vertigo evaluation, were retrospectively collected. RESULTS: Regarding evaluated comorbidities (hypertension, diabetes, osteoarthrosis, osteoporosis and depression), data analysis showed the presence of at least one comorbid disorder in 216 subjects (19.8%) and 2 or more in 408 subjects (37.4%). Moreover there was a statistical significant difference between the number of comorbidities and the number of recurrences, otherwise said as comorbidity disorders increased the number of relapses increased too. CONCLUSION: The presence of a systemic disease may worsen the status of the posterior labyrinth causing a more frequent otolith detachment. This condition increases the risk for patients suffering BPPV to have recurrent episodes, even if correctly managed by repositioning maneuvers. The combination of two or more of aforementioned comorbidities further increases the risk of relapsing BPPV, worsened by the presence of osteoporosis. On the basis of this results it was possible to define "groups of risk" useful for predicting BPPV recurrence in patients with one or more comorbidity.
Autores: Pérez-Fernandez, Nicolás; Martínez, Marta; Manrique, Raquel;
ISSN 1651-2553  Vol. 134  Nº 5  2014  págs. 485-490
The mean gain of VOR was within normal limits for the six semicircular canals and there were no significant differences between the same canals on each side of patients with BPPV in whom canalolithiasis was located in the SSC. However, gain asymmetry was different for each pair of canals.
Autores: Manrique, Raquel; Roland J.T. Jr;
ISSN 1068-9508  Vol. 22  Nº 5  2014  págs. 349-352
Much attention has been focused on hearing preservation in the implanted ear. Thus, investigations into electrode array design, surgical technique and pharmacological management have been undertaken. Minimizing damage in the inner ear not only enhances the possibility for hearing preservation and better performance in complex listening scenarios but also conserves inner ear structures for future treatments.
Autores: Zulueta-Santos, Cristina; Lujan, B.; Manrique, Raquel; et al.
ISSN 1651-2553  Vol. 134  Nº 11  2014  págs. 1128 - 1133
Abstract Conclusion: The distribution of abnormal results is not uniform between different canals in each patient; the most frequent gain reduction is obtained for the posterior canal. Gain reduction reflects the disease duration and amount of hearing loss. OBJECTIVE: To test the hypothesis that the vestibulo-ocular reflex (VOR) evoked after stimulation of each semicircular canal behaves in a different manner in patients with unilateral definite Ménière's disease. METHODS: We studied the VOR evoked by rapid head-impulses in the plane of the 6 semicircular canals in 36 patients. It was evaluated with a video system that analyzes the head and eye velocity and the gain was the objective measure. RESULTS: In 12 (33.3%) patients the examination of both ears was normal for all the semicircular canals, in 12 patients the results from the affected ear were abnormal in at least 1 of the semicircular canals, in 11 (30.5%) patients the results were abnormal in at least 1 of the semicircular canals in both the affected and unaffected ears, and in 1 (2.9%) patient the results were abnormal only in the unaffected ear. The most frequent abnormal result was obtained from the posterior canal of the affected ear and from the coupled superior canal of the unaffected ear. The distribution of abnormal findings was dependent on the disease duration and hearing loss.
Autores: Manrique, Raquel; Manrique, Manuel Jesús;
ISSN 0001-6519  Vol. 64  Nº 1  2013  págs. 22 - 30
Introducción La aticoexposición-antroexclusión (AE-AE) simple o ampliada, es una técnica a la demanda para el tratamiento del colesteatoma. Las tasas de recurrencia/recidiva descritas con diferentes técnicas quirúrgicas son variables. El objetivo de este estudio es describir la técnica quirúrgica, sus indicaciones y analizar los resultados a largo plazo. Material y métodos Se incluyen 42 pacientes intervenidos de AE-AE en un centro terciario con un seguimiento de 6 meses-7 años. Esta técnica expone completamente el ático fresando la pared superior del conducto auditivo externo y excluye el antro y mastoides cerrando el additus con injertos de cartílago. Se indica en pacientes con colesteatoma localizado en la caja timpánica sin sobrepasar el additus o en caso de hacerlo estar encapsulado sin erosionar la cápsula laberíntica. El seguimiento es clínico y radiológico (TC de peñascos y RM con secuencias de difusión desde 2009). Resultados El 4,8% de los casos presentó una recidiva, los cuales fueron rescatados en un segundo tiempo quirúrgico. En el seguimiento la tasa de otorrea (2/42), otitis serosa (2/42) u otras complicaciones fue baja, no contraindicando las actividades acuáticas. La AE-AE no modificó el tipo de reconstrucción osicular respecto a otras técnicas. Conclusiones La AE-AE es una técnica abierta. Pretende eliminar totalmente la lesión y reducir la recidiva de colesteatoma, facilitando una normalización en los baños y una disminución de revisiones posquirúrgicas. La RM en secuencias de difusión es una técnica fiable en el despistaje y seguimiento, especialmente para el control de los espacios mastoideos tras la AE-AE.
Autores: Manrique, Raquel; Picciafuoco, S.; Cervera, Francisco Javier; et al.
ISSN 0937-4477  Vol. 270   Nº 1  2013  págs. 45 - 52
The purpose of this study is to determine if surgical approach to the inner ear is feasible without generating a hearing loss in an animal model. Five Macaca fascicularis were used as experimental animals and followed up for 27 months. Mastoidectomy, posterior tympanotomy and promontorial cochleostomy were performed on four specimens and one specimen was kept as control animal. Before and after drilling and exposing the endosteal layer and the membranous labyrinth, otoacustic emissions (dPOAE) and auditory brainstem responses (ABR) were used to test hearing. In vivo experimental studies prove it is reliable to expose the membranous labyrinth without causing hearing loss. dPOAE were present after 3, 6, 12, 24 and 26 months of follow-up. Regarding the ABR results from the four M. fascicularis in which a cochleostomy has been carried out, auditory thresholds are within the 20-30 dB interval at 27 months of follow-up. Experimental studies support clinical experiences indicating it is feasible to surgically approach the membranous labyrinth of the cochlea without damaging its hearing function.
Autores: Pérez-Fernandez, Nicolás; et al.
ISSN 0001-6519  Vol. 63  Nº 6  2012  págs. 429-435
Introduction: The assessment of the vestibulo-ocular reflex (VOR) is one of the main steps in clinically evaluating patients with dizziness. It can be performed at the bedside with common head-impulse test in which eye position is analysed at the end of the head-thrust. It is an important test due to its high specificity but low sensitivity. Material and Methods: We studied 179 patients with different types of balance- affecting disorders. The results were analysed in contingency tables. The clinical test was classified as normal or abnormal according to the absence or existence, respectively, of fixation saccades once the head-thrust was ended. The video head-impulse test (vHIT) was classified according to vestibulo-ocular reflex (VOR) gain and presence of fixation saccades. The speed of the slow phase of spontaneous nystagmus was also quantified, as well as the caloric test results. Results: There were significant differences (Chi-square test, P=0.00) for the findings in the clinical evaluation and with the vHIT: 32.1% of the tests performed yielded different findings in both tests. In the vHIT, the differences were due to the finding of normal gain with saccades; in these patients, the mean canal paresis was significantly abnormal: 39% ± 10%. Conclusions: The distribution of findings for the VOR bedside examination and for that with the help of a video system are significantly different; as such, the video head-impulse examination is not simply an added VOR detection and registration system. The difference relies mainly on a vHIT response characterised as of normal gain but with fixation saccades. These have been considered as the cause for the low sensitivity of the bedside VOR examination and sometimes regarded as normal responses; we have demonstrated that these findings are abnormal according to the findings of higher canal paresis in the caloric test.
Autores: Manrique, Raquel; Pérez-Fernandez, Nicolás;
ISSN 0001-6519  Vol. 63  Nº 2  2012  págs. 120-4.
El temblor ortostático (TO) es una enfermedad neurológica de origen desconocido caracterizada por un temblor de 10-20Hz en las piernas en bipedestación. Se manifiesta por mareo e inestabilidad, que típicamente mejoran al apoyarse o sentarse y la ingesta de pequeñas cantidades de alcohol lo reduce de manera significativa. Se muestran 4 casos clínicos atendidos en nuestra consulta cuyo diagnóstico sugiere ser el de TO. Consideramos que ante un paciente con inestabilidad, es preciso plantearse como diagnóstico diferencial un TO. La historia clínica nos orienta hacia esta entidad y en caso de sospecha, el diagnóstico definitivo viene dado por el registro de la electromiografía en las extremidades inferiores en condición de reposo sentado y en ortostatismo donde se registra un temblor de 10-20Hz. El tratamiento es médico y, se emplea el clonazepam como primera opción terapéutica.
Autores: Manrique, Raquel; Picciaffuoco, S.; Gracia, Javier; et al.
Revista: International Journal of Pediatric Otorhinolaryngology
ISSN 0165-5876  Vol. 75  Nº Supl. 1  2011  págs. 85
Autores: Manrique, Raquel; Guillén, Francisco; Pérez-Fernandez, Nicolás;
Revista: Otology & Neurotology
ISSN 1531-7129  Vol. 32  Nº 3  2011  págs. 4661 - 4665
Autores: Manrique, Manuel Jesús; Manrique, Raquel; et al.
Revista: International Journal of Pediatric Otorhinolaryngology
ISSN 0165-5876  Vol. 75  Nº Supl.1  2011  págs. 27 - 28
Autores: Huarte, Alicia; Manrique, Raquel; et al.
ISSN 1420-3030  Vol. 16  Nº Supl. 1  2011  págs. 13 - 15
Autores: Baptista, Peter Michael; Bejarano, Bartolomé; Fernández, Secundino; et al.
ISSN 0194-5998  Vol. 143  Nº 2 Supl.2  2010  págs. 296
OBJECTIVE Fibrin sealants are widely used as topical hemostatic agents, sealants and tissue adhesives that contain fibrinogen and thrombin. They have become a valuable adjunct in a broad range of surgical procedures (neurosurgery, skull base surgery) to control bleeding, to provide a firm seal in seconds to minutes and to promote tissue growth and repair. A large number of clinical applications are referenced in the medical literature, from closures of fistula to seroma prevention. Provide information about the usefulness and results of fibrin sealants in skull base surgery at our institution. Previous Section Next Section METHOD We present our experience with Vivostat (a patient-derived fibrin sealant, only available in Europe), which was used in 36 patients that were operated for skull base or sinus pathology at the University Clinic of Navarra. Previous Section Next Section RESULTS The experience encompasses Selar pathology (pituitary adenomas), CSF fistulas, vestibular schwannomas, cholesteatoma, carcinoma and endoscopic sinus surgery. We applied Vivostat since it has the advantage of being a patient-derived hemostat and sealant with an efficient component mix and a delivery dosage control. We did not have any complications regarding the use of this product and our results were satisfactory. Previous Section CONCLUSION Fibrin sealant Vivostat has been used as a useful sealant and tissue adhesive with enhanced elasticity and tensile strength that allows a safer and better performance of wound management, especially in skull base surgery.
Autores: Pérez-Fernandez, Nicolás; Manrique, Raquel;
Libro:  Textbook of vertigo: diagnosis and management
2014  págs. 108 - 115
Autores: Manrique, Manuel Jesús; Manrique, Raquel; Bejarano, Bartolomé;
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2014  págs. 415 - 418
Autores: Manrique, Manuel Jesús; Manrique, Raquel;
Libro:  Libro blanco sobre la presbiacusia
2013  págs. 81 - 85
Autores: Manrique, Manuel Jesús; Manrique, Raquel;
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