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Lorente-Piera J, Prieto-Matos C, Manrique-Huarte R, Garaycochea O, Domínguez P, Manrique M. Otic Capsule Dehiscences Simulating Other Inner Ear Diseases: Characterization, Clinical Profile, and Follow-Up-Is Ménière's Disease the Sole Cause of Vertigo and Fluctuating Hearing Loss? Audiol Res 2024; 14:372-385. [PMID: 38666903 PMCID: PMC11047452 DOI: 10.3390/audiolres14020032] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2024] [Revised: 04/09/2024] [Accepted: 04/11/2024] [Indexed: 04/29/2024] Open
Abstract
INTRODUCTION We present a series of six cases whose clinical presentations exhibited audiovestibular manifestations of a third mobile window mechanism, bearing a reasonable resemblance to Ménière's disease and otosclerosis. The occurrence of these cases in such a short period has prompted a review of the underlying causes of its development. Understanding the pathophysiology of third mobile window syndrome and considering these entities in the differential diagnosis of conditions presenting with vertigo and hearing loss with slight air-bone gaps is essential for comprehending this group of pathologies. MATERIALS AND METHODS A descriptive retrospective cohort study of six cases diagnosed at a tertiary center. All of them went through auditive and vestibular examinations before and after a therapeutic strategy was performed. RESULTS Out of 84 cases of dehiscences described in our center during the period from 2014 to 2024, 78 belonged to superior semicircular canal dehiscence, while 6 were other otic capsule dehiscences. Among these six patients with a mean age of 47.17 years (range: 18-73), all had some form of otic capsule dehiscence with auditory and/or vestibular repercussions, measured through hearing and vestibular tests, with abnormalities in the results in five out of six patients. Two of them were diagnosed with Ménière's disease (MD). Another two had cochleo-vestibular hydrops without meeting the diagnostic criteria for MD. In two cases, the otic capsule dehiscence diagnosis resulted from an intraoperative complication due to a gusher phenomenon, while in one case, it was an accidental radiological finding. All responded well to the proposed treatment, whether medical or surgical, if needed. CONCLUSIONS Otic capsule dehiscences are relatively new and unfamiliar entities that should be considered when faced with cases clinically suggestive of Ménière's disease, with discrepancies in complementary tests or a poor response to treatment. While high-sensitivity and specificity audiovestibular tests exist, completing the study with imaging, especially petrous bone CT scans, is necessary to locate and characterize the otic capsule defect responsible for the clinical presentation.
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Affiliation(s)
- Joan Lorente-Piera
- Otorhinolaryngology Department, University of Navarra Clinic, 31008 Pamplona, Navarra, Spain
| | - Carlos Prieto-Matos
- Otorhinolaryngology Department, University of Navarra Clinic, 31008 Pamplona, Navarra, Spain
| | - Raquel Manrique-Huarte
- Otorhinolaryngology Department, University of Navarra Clinic, 31008 Pamplona, Navarra, Spain
| | - Octavio Garaycochea
- Otorhinolaryngology Department, University of Navarra Clinic, 31008 Pamplona, Navarra, Spain
| | - Pablo Domínguez
- Radiology Department, University of Navarra Clinic, 31008 Pamplona, Navarra, Spain
| | - Manuel Manrique
- Otorhinolaryngology Department, University of Navarra Clinic, 31008 Pamplona, Navarra, Spain
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Garaycochea O, Pérez-Fernández N. Variants of posterior semicircular canal involvement in benign paroxysmal positional vertigo. Acta Otorrinolaringol Esp (Engl Ed) 2024:S2173-5735(24)00045-0. [PMID: 38438080 DOI: 10.1016/j.otoeng.2024.01.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2023] [Accepted: 01/24/2024] [Indexed: 03/06/2024]
Abstract
Benign paroxysmal positional vertigo is the most common cause of peripheral vertigo. It is characterized by short and recurrent episodes of vertigo, trigged by specific head movements that displace otoconia within the semicircular canals. The movement of dislodge otoconia from the utricle cause abnormal positional endolymphatic currents. Primary treatment involves reposition maneuvers aimed at moving the displaced otoconia out the affected canal, therefore correct identification of the affected canal is essential for the diagnosis. The posterior semicircular canal (PSC) is the most frequently affected due to its spatial orientation and the force of gravity. Recent technological advances have allowed for better assessment of positional nystagmus during diagnostic and therapeutic maneuvers, revealing various possible scenarios of PSC involvement. Regarding the PSC, otoconia may be found in different parts of the canal, and not just in the expected location, floating in the long arm of the canal. The understanding of these variants is crucial, as the prognosis and the disease progression differ in such cases. This review aims to describe the six possible variants of PSC involvement described so far.
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Affiliation(s)
- Octavio Garaycochea
- Departamento de Otorrinolaringología, Hospital Vall d'Hebron, Barcelona, Spain.
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Manrique-Huarte R, Garaycochea O, Troconis DP, Pérez-Fernández N, Manrique M. Histopathological reaction in the vestibule after cochlear implantation in Macaca fascicularis. J Neurol Sci 2023; 450:120672. [PMID: 37210936 DOI: 10.1016/j.jns.2023.120672] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2022] [Revised: 05/02/2023] [Accepted: 05/05/2023] [Indexed: 05/23/2023]
Abstract
Cochlear implantation surgery (CI) is considered a safe procedure and is the standard treatment for the auditory rehabilitation in patients with severe-to-profound sensorineural hearing loss. Although the development of minimally traumatic surgical concepts (MTSC) have enabled the preservation of residual hearing after the implantation, there is scarce literature regarding the vestibular affection following MTCS. The aim of the study is to analyze histopathologic changes in the vestibule after CI in an animal model (Macaca fascicularis). Cochlear implantation was performed successfully in 14 ears following MTCS. They were classified in two groups upon type of electrode array used. Group A (n = 6) with a FLEX 28 electrode array and Group B (n = 8) with HL14 array. A 6-month follow-up was carried out with periodic objective auditory testing. After their sacrifice, histological processing and subsequent analysis was carried out. Intracochlear findings, vestibular presence of fibrosis, obliteration or collapse is analyzed. Saccule and utricle dimensions and neuroepithelium width is measured. Cochlear implantation was performed successfully in all 14 ears through a round window approach. Mean angle of insertion was >270° for group A and 180-270° for group B. In group A auditory deterioration was observed in Mf 1A, Mf2A and Mf5A with histopathological signs of scala tympani ossification, saccule collapse (Mf1A and Mf2A) and cochlear aqueduct obliteration (Mf5A). Besides, signs of endolymphatic sinus dilatation was seen for Mf2B and Mf5A. Regarding group B, no auditory deterioration was observed. Histopathological signs of endolymphatic sinus dilatation were seen in Mf 2B and Mf 8B. In conclusion, the risk of histological damage of the vestibular organs following minimally traumatic surgical concepts and the soft surgery principles is very low. CI surgery is a safe procedure and it can be done preserving the vestibular structures.
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Affiliation(s)
- Raquel Manrique-Huarte
- Department of Otorhinolaryngology, Clinica Universidad de Navarra, University of Navarra, Pamplona, Spain.
| | - Octavio Garaycochea
- Department of Otorhinolaryngology, Clinica Universidad de Navarra, University of Navarra, Pamplona, Spain.
| | - Daniella Parillis Troconis
- Department of Otorhinolaryngology, Clinica Universidad de Navarra, University of Navarra, Pamplona, Spain.
| | - Nicolás Pérez-Fernández
- Department of Otorhinolaryngology, Clinica Universidad de Navarra, University of Navarra, Pamplona, Spain.
| | - Manuel Manrique
- Department of Otorhinolaryngology, Clinica Universidad de Navarra, University of Navarra, Pamplona, Spain.
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Garaycochea O, Alcalde J, Fernandez S. Aerodynamic Measures in Muscle Tension Dysphonia. J Voice 2023; 37:463. [PMID: 36931985 DOI: 10.1016/j.jvoice.2023.02.033] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/17/2023]
Affiliation(s)
- Octavio Garaycochea
- Clinica Universidad de Navarra, University of Navarra, Pamplona, Navarra, Spain
| | - Juan Alcalde
- Clinica Universidad de Navarra, University of Navarra, Pamplona, Navarra, Spain
| | - Secundino Fernandez
- Clinica Universidad de Navarra, University of Navarra, Pamplona, Navarra, Spain
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Garaycochea O, Van Strahlen CR, Alobid I, Mullol J. Pheno-Endotyping Antrochoanal Nasal Polyposis. Curr Allergy Asthma Rep 2023; 23:165-180. [PMID: 36773125 DOI: 10.1007/s11882-023-01066-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/05/2022] [Indexed: 02/12/2023]
Abstract
PURPOSE OF REVIEW Antrochoanal polyps (ACPs) are benign polypoid lesions arising from the inner wall of the maxillary sinus and extending into the choana. Although the diagnosis and treatment strategies of ACP have changed since this entity was first described, the underlying pathogenic mechanism of APC is poorly understood. This article reviews the current knowledge of the etiology, inflammatory parameters, and microscopic findings of ACP. RECENT FINDINGS The inflammatory pattern of ACP appears to center around a neutrophilic inflammation T1-dominant endotype. Apart from the inflammatory component of ACP, at the microscopic level, the presence of tissue remodeling, mostly fibrin deposition and edema, and cysts in the epithelium and lamina propria has been described. Although the origin of this T1-dominant endotype immune response of ACPs is not entirely clear, it could be related to a lymphatic obstruction mechanism. This review serves to define a phenotype of ACP with potential endotypes based on the characteristics of the inflammatory parameters, microscopic findings, and hypotheses about the pathogenesis of ACP.
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Affiliation(s)
- Octavio Garaycochea
- Rhinology and Skull Base Unit, Department of Otorhinolaryngology, Hospital Clinic, IDIBAPS, CIPERES, Barcelona University, Barcelona, Spain.,Department of Otorhinolaryngology, Clinica Universidad de Navarra, University of Navarra, Pamplona, Spain
| | - Camilo Rodríguez Van Strahlen
- Rhinology and Skull Base Unit, Department of Otorhinolaryngology, Hospital Clinic, IDIBAPS, CIPERES, Barcelona University, Barcelona, Spain.
| | - Isam Alobid
- Rhinology and Skull Base Unit, Department of Otorhinolaryngology, Hospital Clinic, IDIBAPS, CIPERES, Barcelona University, Barcelona, Spain.,Unidad Alergo Rino, Centro Médico Teknon, Barcelona, Spain
| | - Joaquim Mullol
- Rhinology and Skull Base Unit, Department of Otorhinolaryngology, Hospital Clinic, IDIBAPS, CIPERES, Barcelona University, Barcelona, Spain
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Garaycochea O, Santamaría-Gadea A, Alobid I. State-of-the-art: septal perforation repair. Curr Opin Otolaryngol Head Neck Surg 2023; 31:11-16. [PMID: 36729895 DOI: 10.1097/moo.0000000000000857] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
PURPOSE OF REVIEW To provide a comprehensive overview of the evolution of the different techniques described for the surgical repair of nasal septal perforation, and a surgical decision-making algorithm for its surgical treatment. RECENT FINDINGS Septal perforation surgery has evolved and improved in recent years. It has gone from being an avoided or discouraged surgical procedure to a procedure with success rates of >90%. Nowadays, there is no standard approach or single technique. The different techniques described include unilateral random pattern flaps, interposition grafts, unilateral pedicle septal local flaps, free mucosal grafts and bilateral random patter flaps. The incidence of success is higher in pediculated septal flaps such as the anterior ethmoidal artery flap or the greater palatine artery pedicled flap combined with additional techniques. SUMMARY Nowadays, surgical closure of septal perforation is possible and should be an option to consider in symptomatic patients without response to medical treatment. The surgical approach that we recommend when planning the surgical closure of nasal septum (or nasoseptal) perforation is based on the osseocartilaginous support and the location of the defect.
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Affiliation(s)
- Octavio Garaycochea
- Rhinology and Skull Base Unit, Department of Otorhinolaryngology, Hospital Clínic, IDIBAPS, CIPERES, Barcelona University. Barcelona
- Department of Otorhinolaryngology, Clinica Universidad de Navarra, University of Navarra, Pamplona
| | - Alfonso Santamaría-Gadea
- Rhinology and Skull Base Unit, Department of Otorhinolaryngology, Hospital Universitario Ramón y Cajal
| | - Isam Alobid
- Rhinology and Skull Base Unit, Department of Otorhinolaryngology, Hospital Clínic, IDIBAPS, CIPERES, Barcelona University. Barcelona
- Unidad Alergo Rino, Centro Médico Teknon, Barcelona, Spain
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Fernandez S, Ferran S, Alcalde JM, Garcia-Tobar L, Garaycochea O. Spindle cell carcinoma: Two instances mistaken for vocal polyps. Otolaryngology Case Reports 2023. [DOI: 10.1016/j.xocr.2022.100503] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023] Open
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Garaycochea O, Rodríguez Van Strahlen C, Rojas-Lechuga MJ, Alobid I. How to Improve the Outcomes of Anterior Septal Perforations Repair With Combined Flaps. Laryngoscope 2022. [PMID: 36317778 DOI: 10.1002/lary.30447] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2022] [Revised: 09/26/2022] [Accepted: 09/28/2022] [Indexed: 11/07/2022]
Abstract
The combination of a partial inverted edges with an either extended anterior ethmoidal flap or greater palatine artery flap, in which the anterior incision includes contralateral mucosa (ZigZag anterior flap-incision). Laryngoscope, 2023.
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Affiliation(s)
- Octavio Garaycochea
- Rhinology and Skull Base Unit, Department of Otorhinolaryngology, Hospital Clínic, IDIBAPS, CIPERES, Barcelona University, Barcelona, Spain
| | - Camilo Rodríguez Van Strahlen
- Rhinology and Skull Base Unit, Department of Otorhinolaryngology, Hospital Clínic, IDIBAPS, CIPERES, Barcelona University, Barcelona, Spain
| | - María J Rojas-Lechuga
- Rhinology and Skull Base Unit, Department of Otorhinolaryngology, Hospital Clínic, IDIBAPS, CIPERES, Barcelona University, Barcelona, Spain
| | - Isam Alobid
- Rhinology and Skull Base Unit, Department of Otorhinolaryngology, Hospital Clínic, IDIBAPS, CIPERES, Barcelona University, Barcelona, Spain.,Unidad Alergo Rino, Centro Médico Teknon, Barcelona, Spain
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Martínez-Arellano A, Campo A, Del Rio B, Garaycochea O, Fernandez S. The Irrintzi and Other Folk Cries High Pich and Loud Emission. Can We Learn Something? J Voice 2022:S0892-1997(22)00262-4. [PMID: 36319554 DOI: 10.1016/j.jvoice.2022.08.019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2022] [Revised: 08/15/2022] [Accepted: 08/17/2022] [Indexed: 11/06/2022]
Abstract
INTRODUCTION In various cultures there are vocal sounds and cries associated with the folk tradition. All these cries are emitted in a single breath, have a high frequency and are loud. They are consequently audible over long distances and cut through other vocal expressions or other sounds generated by instruments. OBJECTIVES The objective of this work is to acoustically analyze some of these folkloric cries and study elements common to all of them. METHODS In this study, Irrintzi, Aturuxo, Tzagrit, ululation Darfur and Kurava cries were subjected to descriptive acoustic spectrographic analysis, and the resulting descriptions were compared both quantitatively, in terms of various acoustic parameters, and qualitatively, in terms of spectrographic characteristics and the way the cries sound. RESULTS All of the cries contained high frequencies. Spectrograms of the cries revealed that they had a common pattern: a lower initial frequency ascends rapidly (the attack) and is then maintained throughout a stable phase of the emission (the body) before a final drop in frequency (the ending or coda). The body is the longest phase. CONCLUSIONS This initial study of five sounds of folk tradition has opened up a wealth of acoustic and cultural discoveries. Broader studies are now needed to determine if the characteristics we have reported are common to other cries, to look for other similarities, and to delve into meanings, implications and possible applications. In-depth understanding of the mechanism of emission of traditional cries could provide tools for voice re-education in patients with dysphonia due to vocal strain (muscle tension dysphonia, vocal nodules, etc.), for improving voice quality, and for increasing the efficiency of vocal performance.
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Affiliation(s)
- Ana Martínez-Arellano
- Department of Otolaryngology Head and Neck Surgery, Clinica Universidad de Navarra, Universidad de Navarra, Pamplona, Spain
| | - Arantza Campo
- Department of Pulmonology, Clinica Universidad de Navarra, Universidad de Navarra, Pamplona, Spain
| | - Beatriz Del Rio
- Department of Otolaryngology Head and Neck Surgery, Clinica Universidad de Navarra, Universidad de Navarra, Pamplona, Spain
| | - Octavio Garaycochea
- Department of Otolaryngology Head and Neck Surgery, Clinica Universidad de Navarra, Universidad de Navarra, Pamplona, Spain
| | - Secundino Fernandez
- Department of Otolaryngology Head and Neck Surgery, Clinica Universidad de Navarra, Universidad de Navarra, Pamplona, Spain.
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Garaycochea O, Alobid I. On the Cottle areas and the proposal for a new classification of septal areas. Rhinology 2022; 61:190-192. [PMID: 36259677 DOI: 10.4193/rhin22.229] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Affiliation(s)
- O Garaycochea
- Rhinology and Skull Base Unit, Department of Otorhinolaryngology, Hospital Clínic, IDIBAPS, CIPERES, Barcelona University, Barcelona, Spain.,Department of Otorhinolaryngology, Clinica Universidad de Navarra, University of Navarra, Pamplona, Spain
| | - I Alobid
- Rhinology and Skull Base Unit, Department of Otorhinolaryngology, Hospital Clínic, IDIBAPS, CIPERES, Barcelona University. Barcelona, Spain.,Unidad Alergo Rino, Centro Médico Teknon, Barcelona, Spain
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Martínez-Arellano A, Campo A, Del Rio B, Garaycochea O, Fernandez S. Describing the Acoustic and Vocal Production Characteristics of the Irrintzi: Feasibility of Its Use for the Treatment of Voice Disorders. J Speech Lang Hear Res 2022; 65:3789-3797. [PMID: 36083832 DOI: 10.1044/2022_jslhr-21-00394] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
PURPOSE The aims of this study were to analyze and characterize the irrintzi (a folkloric shout emitted in a single breath used by the Basque people) acoustically and to describe the mechanism by which it is emitted. METHOD Thirty-six sound samples of 12 female volunteers were analyzed. Acoustic analysis included primarily fundamental frequency (f o), spectral analysis in the time domain with a narrowband filter, and the use of linear predictive coding (LPC). Laryngeal and pharyngeal movements while emitting an irrintzi were studied by fiberoptic nasal endoscopy. Postural and mandible movements were observed and video recorded. Movements of the larynx and the vocal tract were also studied by lateral pharyngo-laryngeal radioscopy. RESULTS The central part of an irrintzi spectrogram contains a peculiar, repeated M-shaped motif unseen in the spectrogram of any other human vocal emission, and intensity was over 90 dB SPL in all cases. f o was very high (1487 Hz) especially at the end of the irrintzi. Fiberoptic nasal endoscopy consistently revealed considerable elevation of the glottis, with the larynx swinging forward and retraction of the ventricular bands. Lateral radioscopy showed a very high larynx and a high tongue dorsum. CONCLUSIONS The irrintzi is a sound emitted in a single breath and characterized by its shrillness and loudness, qualities that make it audible in noisy environments and over large distances and the vocal technique observed when it is produced can be explained by the Estill voice model (Steinhauer et al., 2017). The use of this technique may help in the treatment of voice disorders and improve efficiency in singers, teachers, actors, and people who use their voice at high volume or at high frequency. SUPPLEMENTAL MATERIAL https://doi.org/10.23641/asha.20779405.
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Affiliation(s)
- Ana Martínez-Arellano
- Department of Otolaryngology - Head and Neck Surgery, Clínica Universidad de Navarra, Universidad de Navarra, Pamplona, Spain
| | - Arantza Campo
- Department of Pulmonology, Clínica Universidad de Navarra, Universidad de Navarra, Pamplona, Spain
| | - Beatriz Del Rio
- Department of Otolaryngology - Head and Neck Surgery, Clínica Universidad de Navarra, Universidad de Navarra, Pamplona, Spain
| | - Octavio Garaycochea
- Department of Otolaryngology - Head and Neck Surgery, Clínica Universidad de Navarra, Universidad de Navarra, Pamplona, Spain
| | - Secundino Fernandez
- Department of Otolaryngology - Head and Neck Surgery, Clínica Universidad de Navarra, Universidad de Navarra, Pamplona, Spain
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Garaycochea O, Baptista P, Calvo-Imirizaldu M, Terrasa D, Moffa A, Casale M, Alcalde J, O'Connor-Reina C, Plaza G, Fernández S. Surgical anatomy of the lingual nerve for palate surgery: where is located and how to avoid it. Eur Arch Otorhinolaryngol 2022; 279:5347-5353. [PMID: 35771281 PMCID: PMC9519696 DOI: 10.1007/s00405-022-07432-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2022] [Accepted: 04/30/2022] [Indexed: 11/24/2022]
Abstract
PURPOSE To describe the anatomic relationship of the lingual nerve with the lateral oropharyngeal structures. METHODS An anatomic dissection of the lateral oropharyngeal wall was conducted in eight sides from four fresh-frozen cadaveric heads. Small titanium clips were placed along the lingual nerve and the most anterior and medial border of the medial pterygoid muscle. Radiological reconstructions were employed for optimal visualization; the coronal view was preferred to resemble the surgical position. The distance between the lingual nerve and the medial pterygoid muscle at its upper and lower portion was measured radiologically. The trajectory angle of the lingual nerve with respect to the pterygomandibular raphe was obtained from the intersection between the vector generated between the clips connecting the upper and lower portion of the medial pterygoid muscle with the vector generated from the lingual nerve clips. RESULTS The mean distance from the upper portion of the medial pterygoid muscle and superior lingual nerve clips was 10.16 ± 2.18 mm (mean ± standard deviation), and the lower area of the medial pterygoid muscle to the lingual nerve was separated 5.05 ± 1.49 mm. The trajectory angle of the lingual nerve concerning to the vector that describes the upper portion of the most anterior and medial border of the medial pterygoid muscle with its lower part was 43.73º ± 11.29. CONCLUSIONS The lingual nerve runs lateral to the lateral oropharyngeal wall, from superiorly-inferiorly and laterally-medially, and it is closer to it at its lower third.
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Affiliation(s)
- Octavio Garaycochea
- Department of Otorhinolaryngology, Clinica Universidad de Navarra, University of Navarra, Pamplona, Spain. .,Otorhinolaryngology Department, Hospital Clínic de Barcelona, c/ Paris 146-3º-2ª, 08036, Barcelona, Spain.
| | - Peter Baptista
- Department of Otorhinolaryngology, Clinica Universidad de Navarra, University of Navarra, Pamplona, Spain
| | - Marta Calvo-Imirizaldu
- Department of Otorhinolaryngology, Clinica Universidad de Navarra, University of Navarra, Pamplona, Spain
| | - David Terrasa
- Department of Otorhinolaryngology, Clinica Universidad de Navarra, University of Navarra, Pamplona, Spain
| | - Antonio Moffa
- School of Medicine, Campus Bio-Medico University, Unit of Integrated Therapies in Otolaryngology, Fondazione Policlinico Universitario Campus Bio-Medico, Rome, Italy
| | - Manuele Casale
- School of Medicine, Campus Bio-Medico University, Unit of Integrated Therapies in Otolaryngology, Fondazione Policlinico Universitario Campus Bio-Medico, Rome, Italy
| | - Juan Alcalde
- Department of Otorhinolaryngology, Clinica Universidad de Navarra, University of Navarra, Pamplona, Spain
| | | | - Guillermo Plaza
- Otorhinolaryngology Department, Hospital Universitario de Fuenlabrada, Universidad Rey Juan Carlos, Madrid, Spain
| | - Secundino Fernández
- Department of Otorhinolaryngology, Clinica Universidad de Navarra, University of Navarra, Pamplona, Spain
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Alvarez de Linera-Alperi M, Garaycochea O, Calavia D, Terrasa D, Pérez-Fernández N, Manrique-Huarte R. Apogeotropic Horizontal Canal Benign Paroxysmal Positional Vertigo: Zuma e Maia Maneuver versus Appiani Variant of Gufoni. Audiol Res 2022; 12:337-346. [PMID: 35735368 PMCID: PMC9220154 DOI: 10.3390/audiolres12030035] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2022] [Revised: 06/06/2022] [Accepted: 06/16/2022] [Indexed: 11/16/2022] Open
Abstract
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)).
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Fernandez S, Ferran S, Garaycochea O. Multiple vocal fold lesions in a single patient. Clin Case Rep 2022; 10:e05476. [PMID: 35356176 PMCID: PMC8943114 DOI: 10.1002/ccr3.5476] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2021] [Revised: 12/30/2021] [Accepted: 01/14/2022] [Indexed: 11/07/2022] Open
Abstract
We report the case of a 48‐year‐old woman, a teacher, with recurrent severe dysphonia and multiple and different lesions at the same time in her vocal folds. The evolution of the lesions and the possible mechanism by which they have been associated in the same patient are commented.
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Affiliation(s)
- Secundino Fernandez
- Department of Otolaryngology Head and Neck SurgeryHospital‐School of MedicineUniversity of NavarraPamplonaSpain
| | - Sol Ferran
- Department of Otolaryngology Head and Neck SurgeryHospital‐School of MedicineUniversity of NavarraPamplonaSpain
| | - Octavio Garaycochea
- Department of Otolaryngology Head and Neck SurgeryHospital‐School of MedicineUniversity of NavarraPamplonaSpain
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Baptista PM, Diaz Zufiaurre N, Garaycochea O, Alcalde Navarrete JM, Moffa A, Giorgi L, Casale M, O’Connor-Reina C, Plaza G. TORS as Part of Multilevel Surgery in OSA: The Importance of Careful Patient Selection and Outcomes. J Clin Med 2022; 11:jcm11040990. [PMID: 35207264 PMCID: PMC8878188 DOI: 10.3390/jcm11040990] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2021] [Revised: 01/28/2022] [Accepted: 02/04/2022] [Indexed: 12/10/2022] Open
Abstract
Transoral robotic surgery (TORS) for Obstructive Sleep Apnea (OSA) is a relatively young technique principally devised for managing apneas in the tongue base area. This study summarizes and presents our personal experience with TORS for OSA treatment, with the aim to provide information regarding its safety, efficacy, and postoperative complications. A retrospective study was conducted on patients undergoing TORS with lingual tonsillectomy through the Da Vinci robot. The effectiveness of the surgical procedure was assessed employing the Epworth Sleepiness Scale (ESS) and overnight polysomnography with the Apnea-Hypopnea Index (AHI). A total of 57 patients were included. Eighteen patients (31.6%) had undergone previous surgery. The mean time of TORS procedure was 30 min. Base of tongue (BOT) management was associated with other procedures in all patients: pharyngoplasty (94%), tonsillectomy (66%), and septoplasty (58%). At 6 months follow-up visit, there was a significant improvement in AHI values (from 38.62 ± 20.36 to 24.33 ± 19.68) and ESS values (from 14.25 ± 3.97 to 8.25 ± 3.3). The surgical success rate was achieved in 35.5% of patients. The most frequent major complication was bleeding, with the need for operative intervention in three cases (5.3%). The most common minor complications were mild dehydration and pain. TORS for OSA treatment appears to be an effective and safe procedure for adequately selected patients looking for an alternative therapy to CPAP.
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Affiliation(s)
- Peter M. Baptista
- Department of Otorhinolaryngology, Clinica Universidad de Navarra, Av. de Pío XII, 36, 31008 Pamplona, Spain; (P.M.B.); (N.D.Z.); (O.G.); (J.M.A.N.)
| | - Natalia Diaz Zufiaurre
- Department of Otorhinolaryngology, Clinica Universidad de Navarra, Av. de Pío XII, 36, 31008 Pamplona, Spain; (P.M.B.); (N.D.Z.); (O.G.); (J.M.A.N.)
| | - Octavio Garaycochea
- Department of Otorhinolaryngology, Clinica Universidad de Navarra, Av. de Pío XII, 36, 31008 Pamplona, Spain; (P.M.B.); (N.D.Z.); (O.G.); (J.M.A.N.)
| | - Juan Manuel Alcalde Navarrete
- Department of Otorhinolaryngology, Clinica Universidad de Navarra, Av. de Pío XII, 36, 31008 Pamplona, Spain; (P.M.B.); (N.D.Z.); (O.G.); (J.M.A.N.)
| | - Antonio Moffa
- School of Medicine, Campus Bio-Medico University, Via Alvaro del Portillo 21, 00128 Rome, Italy; (L.G.); (M.C.)
- Integrated Therapies in Otolaryngology, Fondazione Policlinico Universitario Campus Bio-Medico, Via Alvaro del Portillo 200, 00128 Rome, Italy
- Correspondence:
| | - Lucrezia Giorgi
- School of Medicine, Campus Bio-Medico University, Via Alvaro del Portillo 21, 00128 Rome, Italy; (L.G.); (M.C.)
- Integrated Therapies in Otolaryngology, Fondazione Policlinico Universitario Campus Bio-Medico, Via Alvaro del Portillo 200, 00128 Rome, Italy
| | - Manuele Casale
- School of Medicine, Campus Bio-Medico University, Via Alvaro del Portillo 21, 00128 Rome, Italy; (L.G.); (M.C.)
- Integrated Therapies in Otolaryngology, Fondazione Policlinico Universitario Campus Bio-Medico, Via Alvaro del Portillo 200, 00128 Rome, Italy
| | - Carlos O’Connor-Reina
- Otolaryngology Head and Neck Surgery, USP Hospital, Av. Severo Ochoa, 20, 29603 Marbella, Spain;
| | - Guillermo Plaza
- Department of Otolaryngology, Hospital Universitario de Fuenlabrada, Cam. del Molino, 2, 28942 Fuenlabrada, Spain;
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Garaycochea O, Manrique-Huarte R, Calavia D, Girón L, Pérez-Fernández N. Speech Recognition During Follow-Up of Patients with Ménière’s Disease: What Are We Missing? J Int Adv Otol 2022; 18:14-19. [PMID: 35193840 PMCID: PMC9449711 DOI: 10.5152/iao.2022.20016] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
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 pure-tone 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.
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Baptista PM, Garaycochea O, O’Connor C, Plaza G. Tongue Surgery That Works in OSA. Curr Otorhinolaryngol Rep 2021. [DOI: 10.1007/s40136-021-00357-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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Garaycochea O, Pérez-Fernández N, Manrique-Huarte R. A novel maneuver for diagnosis and treatment of torsional-vertical down beating positioning nystagmus: anterior canal and apogeotropic posterior canal BPPV. Braz J Otorhinolaryngol 2020; 88:708-716. [PMID: 33176986 PMCID: PMC9483926 DOI: 10.1016/j.bjorl.2020.09.009] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2020] [Revised: 09/15/2020] [Accepted: 09/22/2020] [Indexed: 11/24/2022] Open
Abstract
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.
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Affiliation(s)
- Octavio Garaycochea
- University of Navarra, Clinica Universitaria de Navarra, Department of Otorhinolaryngology, Pamplona, Spain.
| | - Nicolás Pérez-Fernández
- University of Navarra, Clinica Universitaria de Navarra, Department of Otorhinolaryngology, Pamplona, Spain
| | - Raquel Manrique-Huarte
- University of Navarra, Clinica Universitaria de Navarra, Department of Otorhinolaryngology, Pamplona, Spain
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Fernández S, Garaycochea O, Martinez-Arellano A, Alcalde J. Does More Compression Mean More Pressure? A New Classification for Muscle Tension Dysphonia. J Speech Lang Hear Res 2020; 63:2177-2184. [PMID: 32615843 DOI: 10.1044/2020_jslhr-20-00042] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
Objective The aims of this study were to test the hypothesis that greater supraglottic compression (anteroposterior or lateral) correlates with higher subglottic pressure (SGP) and to develop a classification of muscle tension dysphonia (MTD), based on the degree of supraglottic compression during speech. Method A prospective, cross-sectional study was conducted in a series of 37 consecutive patients diagnosed with MTD with an altered aerodynamic profile characterized by high SGP (more than 90 mmH2O). Supraglottic anteroposterior and lateral compression were categorized in three grades and assessed during the laryngoscopic examination. All patients completed the Spanish Voice Handicap Index (VHI) questionnaire and completed an acoustic and aerodynamic voice assessment. The relationship between compression grade and VHI with SGP was analyzed. Results More than 90% of patients demonstrated some degree of anteroposterior compression, and 67% had some degree of lateral compression. The mean (SD) SGP was 111.03 (16.7) mmH2O, and the mean VHI was 27.86 (12.5). The degree of SGP was statistically different in the different grades of anteroposterior compression, and also anteroposterior compression correlated with an SGP (p < .05). The degree of lateral compression was not correlated with SGP. Neither the degree of anteroposterior or lateral compression nor the value of SGP was found to correlate with VHI. Conclusions Because grade of anteroposterior compression correlates with SGP, these grades can be used for diagnosis and follow-up of MTD patients. To this end and on this basis, we propose a new classification for MTD. Unlike the established classification, our proposed one makes it possible to combine different laryngoscopic features, improving the description of the larynx during phonation.
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Affiliation(s)
- Secundino Fernández
- Department of Otorhinolaryngology-Head and Neck Surgery, University of Navarra Clinic, Pamplona, Spain
- Faculty of Medicine, University of Navarra, Pamplona, Spain
| | - Octavio Garaycochea
- Department of Otorhinolaryngology-Head and Neck Surgery, University of Navarra Clinic, Pamplona, Spain
- Faculty of Medicine, University of Navarra, Pamplona, Spain
| | | | - Juan Alcalde
- Department of Otorhinolaryngology-Head and Neck Surgery, University of Navarra Clinic, Pamplona, Spain
- Faculty of Medicine, University of Navarra, Pamplona, Spain
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Prieto-Matos C, Garaycochea O, Calavia D, Alegre M, Bejarano B, Huarte A, Díez-Valle R, Zubieta JL, Manrique M. Clinical Profile and Results Obtained in Patients Treated by Auditory Brainstem Implants. Acta Otorrinolaringologica (English Edition) 2020. [DOI: 10.1016/j.otoeng.2019.08.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Garaycochea O, Alcalde J, Fernández S. Aerodynamic Measures in Muscle Tension Dysphonia. J Voice 2020; 35:930. [PMID: 32268985 DOI: 10.1016/j.jvoice.2020.03.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2020] [Accepted: 03/04/2020] [Indexed: 10/24/2022]
Affiliation(s)
| | - Juan Alcalde
- Clinica Universidad de Navarra, Pamplona, Navarra, Spain
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Garaycochea O, Manrique-Huarte R, Vigliano M, Ferrán de la Cierva S, Manrique M. Sculpting the temporal bone: an easy reversible cochlear implant electro-array stabilization technique. Eur Arch Otorhinolaryngol 2020; 277:1645-1650. [PMID: 32162058 DOI: 10.1007/s00405-020-05895-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2019] [Accepted: 02/28/2020] [Indexed: 11/29/2022]
Abstract
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.
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Affiliation(s)
- Octavio Garaycochea
- Department of Otorhinolaryngology, Clinica Universitaria de Navarra, University of Navarra, Avenida Pío XII 36, 31008, Pamplona, Spain.
| | - Raquel Manrique-Huarte
- Department of Otorhinolaryngology, Clinica Universitaria de Navarra, University of Navarra, Avenida Pío XII 36, 31008, Pamplona, Spain
| | - Melisa Vigliano
- Department of Otorhinolaryngology, Clinica Universitaria de Navarra, University of Navarra, Avenida Pío XII 36, 31008, Pamplona, Spain
| | - Sol Ferrán de la Cierva
- Department of Otorhinolaryngology, Clinica Universitaria de Navarra, University of Navarra, Avenida Pío XII 36, 31008, Pamplona, Spain
| | - Manuel Manrique
- Department of Otorhinolaryngology, Clinica Universitaria de Navarra, University of Navarra, Avenida Pío XII 36, 31008, Pamplona, Spain
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Prieto-Matos C, Garaycochea O, Calavia D, Alegre M, Bejarano B, Huarte A, Díez-Valle R, Zubieta JL, Manrique M. Clinical Profile and Results Obtained in Patients Treated by Auditory Brainstem Implants. Acta Otorrinolaringol Esp (Engl Ed) 2020; 71:225-234. [PMID: 31937406 DOI: 10.1016/j.otorri.2019.08.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2019] [Revised: 08/05/2019] [Accepted: 08/13/2019] [Indexed: 11/30/2022]
Abstract
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.
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Affiliation(s)
- Carlos Prieto-Matos
- Departamento de Otorrinolaringología, Clínica Universidad de Navarra, Pamplona, España.
| | - Octavio Garaycochea
- Departamento de Otorrinolaringología, Clínica Universidad de Navarra, Pamplona, España
| | - Diego Calavia
- Departamento de Otorrinolaringología, Clínica Universidad de Navarra, Pamplona, España
| | - Manuel Alegre
- Departamento de Neurofisiología, Clínica Universidad de Navarra, Pamplona, España
| | - Bartolomé Bejarano
- Departamento de Neurocirugía, Clínica Universidad de Navarra, Pamplona, España
| | - Alicia Huarte
- Departamento de Otorrinolaringología, Clínica Universidad de Navarra, Pamplona, España
| | - Ricardo Díez-Valle
- Departamento de Neurocirugía, Clínica Universidad de Navarra, Pamplona, España
| | - José Luis Zubieta
- Departamento de Radiodiagnóstico, Clínica Universidad de Navarra, Pamplona, España
| | - Manuel Manrique
- Departamento de Otorrinolaringología, Clínica Universidad de Navarra, Pamplona, España
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Manrique-Huarte R, Zulueta-Santos C, Garaycochea O, Alvarez Linera-Alperi M, Manrique M. Correlation between High-Resolution Computed Tomography Scan Findings and Histological Findings in Human Vestibular End Organs and Surgical Implications. Audiol Neurootol 2020; 25:42-49. [PMID: 31910409 DOI: 10.1159/000504594] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2019] [Accepted: 11/05/2019] [Indexed: 11/19/2022] Open
Abstract
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.
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Affiliation(s)
| | | | - Octavio Garaycochea
- Otorhinolaryngology Department, University of Navarra Clinic, Pamplona, Spain
| | | | - Manuel Manrique
- Otorhinolaryngology Department, University of Navarra Clinic, Pamplona, Spain
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Baptista P, Garaycochea O, Prieto-Matos C, Alperi MADL, Alcalde J. Lacrimal Diversion Devices (Sinopsys Lacrimal Stent): Sharing our Experience with Patients with Chronic Rhinosinusitis without Polyposis. Int Arch Otorhinolaryngol 2019; 23:e422-e426. [PMID: 31649762 PMCID: PMC6805198 DOI: 10.1055/s-0039-1683849] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2018] [Accepted: 02/01/2019] [Indexed: 10/31/2022] Open
Abstract
Introduction Chronic rhinosinusitis (CRS) is a highly prevalent pathology in our society. Due to the prevalence of this condition and to the persisting symptoms despite an appropriate medical treatment, surgical techniques are often required. Lately, minimal invasive techniques have been described, such as lacrimal diversion devices (LDDs). This technique offers a fast and convenient choice for delivery of sinus irrigation and topical medication. Objective We aimed to describe our experience with LDDs and evaluate the safety and effectiveness of the procedure in patients with moderate to severe CRS without nasal polyposis (CRSsNP) and persistent symptomatology despite medical therapy. Methods A total of 7 patients underwent bilateral lacrimal stents placement in the operating room. A retrospective observational study was conducted. The Sino-Nasal Outcome Test-20 (SNOT-20) survey was performed and the score obtained was compared before and 1 month after the procedure. Results The LDDs were used for an average of 80 days. During the follow-up, only three patients had a mild complication with the device (granuloma in the punctum, obstruction, and early extrusion). The mean baseline SNOT-20 score dropped significantly ( p = 0.015) from 25.85 to 11.57 (mean: - 14.29) 1 month after the procedure. Conclusion According to our experience and results, the use of LDD is a novel, feasible, and less invasive technique to treat refractory CRS. It reduces the risk of mucosal stripping, provides short-term outcomes, and the surgical procedure does not require advanced training in endoscopic sinus surgery. Moreover, it can be performed in-office under local anesthesia or sedation.
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Affiliation(s)
- Peter Baptista
- Department of Otorhinolaryngology, Clinica Universitaria de Navarra, Pamplona, Spain
| | - Octavio Garaycochea
- Department of Otorhinolaryngology, Clinica Universitaria de Navarra, Pamplona, Spain
| | - Carlos Prieto-Matos
- Department of Otorhinolaryngology, Clinica Universitaria de Navarra, Pamplona, Spain
| | | | - Juan Alcalde
- Department of Otorhinolaryngology, Clinica Universitaria de Navarra, Pamplona, Spain
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Garaycochea O, Manrique-Huarte R, Lazaro C, Huarte A, Prieto C, Alvarez de Linera-Alperi M, Manrique M. Comparative study of two different perimodiolar and a straight cochlear implant electrode array: surgical and audiological outcomes. Eur Arch Otorhinolaryngol 2019; 277:69-76. [PMID: 31637478 DOI: 10.1007/s00405-019-05680-6] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2019] [Accepted: 10/01/2019] [Indexed: 10/25/2022]
Abstract
PURPOSE To compare the surgical and audiological outcomes with two perimodiolar electrode arrays (Nucleus 512-Contour Advance® y Nucleus 532-Slim Perimodiolar®) 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.
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Affiliation(s)
- Octavio Garaycochea
- Department of Otorhinolaryngology, Clinica Universitaria de Navarra, Pamplona, Spain.,University of Navarra, Avenida Pío XII 36, 31008, Pamplona, Spain
| | - Raquel Manrique-Huarte
- Department of Otorhinolaryngology, Clinica Universitaria de Navarra, Pamplona, Spain. .,University of Navarra, Avenida Pío XII 36, 31008, Pamplona, Spain.
| | - Carlos Lazaro
- University of Navarra School of Medicine, Pamplona, Spain
| | - Alicia Huarte
- Department of Otorhinolaryngology, Clinica Universitaria de Navarra, Pamplona, Spain.,University of Navarra, Avenida Pío XII 36, 31008, Pamplona, Spain
| | - Carlos Prieto
- Department of Otorhinolaryngology, Clinica Universitaria de Navarra, Pamplona, Spain.,University of Navarra, Avenida Pío XII 36, 31008, Pamplona, Spain
| | - Marta Alvarez de Linera-Alperi
- Department of Otorhinolaryngology, Clinica Universitaria de Navarra, Pamplona, Spain.,University of Navarra, Avenida Pío XII 36, 31008, Pamplona, Spain
| | - Manuel Manrique
- Department of Otorhinolaryngology, Clinica Universitaria de Navarra, Pamplona, Spain.,University of Navarra, Avenida Pío XII 36, 31008, Pamplona, Spain
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Garaycochea O, Domínguez PD, Manrique M, Manrique-Huarte R. Cochlear-Internal Canal and Cochlear-Facial Dehiscence: A Novel Entity. J Int Adv Otol 2019; 14:334-336. [PMID: 30256207 DOI: 10.5152/iao.2018.5089] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
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 sensorineural hearing loss due to bilateral Meniere's disease underwent a cochlear implant surgery on the right ear. Preoperative brain magnetic resonance imaging findings were reported to be normal; during surgery, a cerebrospinal fluid gusher occurred at the time of round window opening. Postoperative computed tomography imaging showed a bony dehiscence at two levels of the otic capsule.
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Affiliation(s)
- Octavio Garaycochea
- Department of Otorhinolaryngology, Clinica Universidad de Navarra, University of Navarra, Pamplona, Spain
| | - Pablo D Domínguez
- Department of Radiology, Clinica Universidad de Navarra, University of Navarra, Pamplona, Spain
| | - Manuel Manrique
- Department of Otorhinolaryngology, Clinica Universidad de Navarra, University of Navarra, Pamplona, Spain
| | - Raquel Manrique-Huarte
- Department of Otorhinolaryngology, Clinica Universidad de Navarra, University of Navarra, Pamplona, Spain
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Garaycochea O, Navarrete JMA, del Río B, Fernández S. Muscle Tension Dysphonia: Which Laryngoscopic Features Can We Rely on for Diagnosis? J Voice 2019; 33:812.e15-812.e18. [DOI: 10.1016/j.jvoice.2018.04.015] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2017] [Accepted: 04/25/2018] [Indexed: 10/28/2022]
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Wegmann-Vicuña R, Garaycochea O, Domínguez-Echavarri P, Guajardo-Vergara C, García-Eulate R, Pérez-Fernández N. Dissociated responses to caloric and head impulse stimulation in a case of isolated vestibule-lateral semicircular canal dysplasia. Acta Oto-Laryngologica Case Reports 2017. [DOI: 10.1080/23772484.2017.1416955] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022] Open
Affiliation(s)
| | - Octavio Garaycochea
- Department of Otorhinolaryngology, Clínica Universidad de Navarra, Pamplona, España
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Baptista P, Garaycochea O, Álvarez-Gómez L, Alcalde J, Alegre M, Urrestarazu E. Hypoglossal nerve stimulation surgery for obstructive sleep apnoea: Our preliminary experience. Acta Otorrinolaringol Esp (Engl Ed) 2017; 69:42-47. [PMID: 28755767 DOI: 10.1016/j.otorri.2017.02.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2016] [Revised: 02/05/2017] [Accepted: 02/08/2017] [Indexed: 10/19/2022]
Abstract
The objective of this communication is to describe our preliminary results in upper airway stimulation surgery via hypoglossal nerve stimulation implantation for obstructive sleep apnoea. We describe 4 cases and the outcomes of the surgery were analysed using the Epworth scale, apnoea-hypopnoea index, minimal O2 Sat, average O2 Sat and snoring intensity. In all cases a significant reduction in Epworth scale values and apnoea-hypopnoea index were obtained (P<.05). The minimum and average oxygen saturation had better values after the surgery, however, there was no statistically significant difference. The snoring severity measured subjectively changed from «intense» to «absent» in all cases. The preliminary results obtained with the upper airway stimulation surgery via hypoglossal nerve stimulation showed objective and subjective improvement after the implant activation.
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Affiliation(s)
- Peter Baptista
- Servicio de Otorrinolaringología, Clínica Universidad de Navarra, Pamplona, España.
| | - Octavio Garaycochea
- Servicio de Otorrinolaringología, Clínica Universidad de Navarra, Pamplona, España
| | - Laura Álvarez-Gómez
- Servicio de Otorrinolaringología, Clínica Universidad de Navarra, Pamplona, España
| | - Juan Alcalde
- Servicio de Otorrinolaringología, Clínica Universidad de Navarra, Pamplona, España
| | - Manuel Alegre
- Servicio de Neurofisiología, Clínica Universidad de Navarra, Pamplona, España
| | - Elena Urrestarazu
- Servicio de Neurofisiología, Clínica Universidad de Navarra, Pamplona, España
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Garaycochea O, Manrique-Huarte R, Manrique M. Intra-operative radiological diagnosis of a tip roll-over electrode array displacement using fluoroscopy, when electrophysiological testing is normal: the importance of both techniques in cochlear implant surgery. Braz J Otorhinolaryngol 2017. [PMID: 28625811 PMCID: PMC9422506 DOI: 10.1016/j.bjorl.2017.05.003] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Affiliation(s)
- Octavio Garaycochea
- Universidad de Navarra, Clínica Universidad de Navarra, Departamento de Otorrinolaringología, Pamplona, Spain
| | - Raquel Manrique-Huarte
- Universidad de Navarra, Clínica Universidad de Navarra, Departamento de Otorrinolaringología, Pamplona, Spain
| | - Manuel Manrique
- Universidad de Navarra, Clínica Universidad de Navarra, Departamento de Otorrinolaringología, Pamplona, Spain.
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Lukac D, Garaycochea O, Taype-Rondan A, Luque Bustamante L, Mujica-Vasquez A, Zamora D. [Knowledge and perception about tuberculosis among public transport workers in Lima, Peru]. Medwave 2016; 16:e6629. [PMID: 27922582 DOI: 10.5867/medwave.2016.10.6629] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2016] [Accepted: 10/21/2016] [Indexed: 11/27/2022] Open
Abstract
OBJECTIVES To describe the level of knowledge and perception of tuberculosis among public transport workers attending Road Safety Education courses in Lima, Peru. METHODS An observational, cross-sectional, analytic study was conducted between July and August 2014 in public transport workers attending the courses of Road Safety education. In Lima, such courses are mandatory for workers in the public transport area. An anonymous and voluntary survey was applied to obtain the following variables: sociodemographic characteristics, history of tuberculosis, tuberculosis knowledge and attitudes towards the disease. The factors associated to the risk perception of Tuberculosis infection were analysed using Poisson regression. RESULTS From 309 attendees, 216 surveys were analysed (69.9%). Of these, 88.4% were males, 3.2% had a history of tuberculosis. The most widely known symptom was cough with phlegm (44.4%), the most popular source of information was television (39.8%), and only 9.7% had any training about tuberculosis. A 41.2% of respondents believed that working in the public transport sector was an occupation with a high risk of tuberculosis infection. No significant association between risk perception of tuberculosis and sociodemographic characteristics was found. CONCLUSION A considerable lack of knowledge about tuberculosis symptoms and a low perception of risk for tuberculosis exists among public transport workers in Lima. Education strategies directed to this population need to be implemented.
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Affiliation(s)
- Danitza Lukac
- Facultad de Medicina Humana, Universidad San Martín de Porres, Lima, Perú. Address: Leonidas Yerovi 297, San Isidro, Lima, Perú.
| | | | | | | | | | - Dario Zamora
- Facultad de Medicina Humana, Universidad San Martín de Porres, Lima, Perú
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Garaycochea O, Ticona E. Rutas de transporte público y situacion de la tuberculosis en Lima, Perú. Rev Peru Med Exp Salud Publica 2015. [DOI: 10.17843/rpmesp.2015.321.1580] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
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Garaycochea O, Ticona E. [Routes of public transport and the situation of tuberculosis in Lima, Peru]. Rev Peru Med Exp Salud Publica 2015; 32:93-97. [PMID: 26102111] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2014] [Accepted: 11/19/2014] [Indexed: 06/04/2023] Open
Abstract
In order to determine the association between the number of formal urban public transport routes and the situation of tuberculosis (TB) in each district of Lima, a correlational analysis and linear regression model between the two variables was performed. Also determined were the number of public transport routes most likely to transmit TB, the areas of greatest activity of these routes and a mapping of these routes. There is a positive correlation between the number of formal routes through each district of Lima and the situation of tuberculosis; a percentage of the TB situation could be explained by the number of public transport routes. Of the 404 formal routes that run through Lima, 147 (36.4%) are routes of greater probability of transmission of TB. Public transport should be considered in the ongoing fight against TB.
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