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Pascual M, Alignani D, Vilas-Zornoza A, Delgado JA, Vázquez I, Malumbres R, Rodriguez I, Barriuso R, Calasanz MJ, Paiva B, Agirre X, Prósper F, Cervera-Paz FJ. Use of human pharyngeal and palatine tonsils as a reservoir for the analysis of B-cell ontogeny in 10 paired samples. Clin Otolaryngol 2016; 41:606-11. [PMID: 26384863 DOI: 10.1111/coa.12540] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/10/2015] [Indexed: 12/16/2022]
Affiliation(s)
- M Pascual
- Centro de Investigación Médica Aplicada (CIMA), IDISNA, Pamplona, Spain
| | - D Alignani
- Centro de Investigación Médica Aplicada (CIMA), IDISNA, Pamplona, Spain
| | - A Vilas-Zornoza
- Centro de Investigación Médica Aplicada (CIMA), IDISNA, Pamplona, Spain
| | - J A Delgado
- Hematology Department, Clínica Universidad de Navarra, Pamplona, Spain
| | - I Vázquez
- Centro de Investigación Médica Aplicada (CIMA), IDISNA, Pamplona, Spain
| | - R Malumbres
- Hematology Department, Clínica Universidad de Navarra, Pamplona, Spain
| | - I Rodriguez
- Hematology Department, Clínica Universidad de Navarra, Pamplona, Spain
| | - R Barriuso
- Centro de Investigación Médica Aplicada (CIMA), IDISNA, Pamplona, Spain
| | - M J Calasanz
- Centro de Investigación Médica Aplicada (CIMA), IDISNA, Pamplona, Spain
| | - B Paiva
- Centro de Investigación Médica Aplicada (CIMA), IDISNA, Pamplona, Spain.,Hematology Department, Clínica Universidad de Navarra, Pamplona, Spain
| | - X Agirre
- Centro de Investigación Médica Aplicada (CIMA), IDISNA, Pamplona, Spain
| | - F Prósper
- Hematology Department, Clínica Universidad de Navarra, Pamplona, Spain
| | - F J Cervera-Paz
- ENT Department, Clínica Universidad de Navarra, Pamplona, Spain.
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Gallegos-Constantino V, Cervera-Paz FJ, Salvador J, Ba FK, Perez-Fernandez N. Hyperglycemia after intratympanic dexamethasone treatment in a diabetic patient. Rev Laryngol Otol Rhinol (Bord) 2011; 132:153-155. [PMID: 22533068] [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] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Abstract
The treatment of patients with idiopathic sudden sensorineural hearing loss must be performed as an emergency measure in order to prevent long term hearing deficit. Steroids in monotherapy provide the best outcome. There is some controversy regarding the most efficient route but in order to prevent side effects, intratympanic treatment is the preferred choice, especially in diabetic patients. We here present the case of a patient that developed hyperglycemia after systemic and intratympanic dexamethasone treatment for sudden hearing loss. We conclude that after intratympanic treatment great caution must be taken.
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Abstract
The purpose of the auditory brainstem implant (ABI) is to directly stimulate the cochlear nucleus complex and offer restoration of hearing in patients suffering from profound retrocochlear sensorineural hearing loss. Electrical stimulation of the auditory pathway via an ABI has been proven to be a safe and effective procedure. The function of current ABIs is similar to that of cochlear implants in terms of device hardware with the exception of the electrode array and the sound-signal processing mechanism. The main limitation of ABI is that electrical stimulation is performed on the surface of the cochlear nuclei, thereby making impractical the selective activation of deeper layers by corresponding optimal frequencies. In this article, we review the anatomical, and experimental basis of ABIs and the indications, and surgical technique for their implantation. To the best of our knowledge, we describe the first pathology images of the cochlear nucleus in a patient who had received an ABI.
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Affiliation(s)
- F J Cervera-Paz
- Department of Otorhinolaryngology, Head & Neck Surgery, Clinica Universitaria, University of Navarra, Pamplona, Spain.
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Manrique M, Ramos A, Morera C, Cenjor C, Lavilla MJ, Boleas MS, Cervera-Paz FJ. Evaluación del implante coclear como técnica de tratamiento de la hipoacusia profunda en pacientes pre y post locutivos. Acta Otorrinolaringológica Española 2006; 57:2-23. [PMID: 16503028 DOI: 10.1016/s0001-6519(06)78657-5] [Citation(s) in RCA: 32] [Impact Index Per Article: 1.8] [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: 11/20/2022]
Abstract
INTRODUCTION These are the objectives planned for this study: 1. Evaluate the results from the communication point of view. 2. Evaluate the cochlear implant (CI) impact on the quality of life. 3. Evaluate medical complications and technical failures. 4. Assess direct and indirect costs generated during the phases of a cochlear implantation programme. 5. Determine which factors have a high impact on the clinical evolution and the financial cost. MATERIALS AND METHOD A population of 877 patients, postlingual and prelingual, adults and children, have been studied. They were treated in 5 Spanish centres with cochlear implant programmes. Audiometric tests and global questionnaires on life quality have been carried out. Medical and CI technology complications have also been computed. Direct and indirect economic costs of a cochlear implant have been calculated. RESULTS Postlocutive-implanted patients reached the 40 dB SPL threshold in the Pure Tone Audiometry, and this result was maintained during the 12-year evolution. In Vowels test, it evolved from a 30% on pre-stimulation to 80-90%, in Disyllables words test it evolved from a 10% to a 50-60%, and in CID Sentences test it evolved from an 18% to a 60-70%. In the prelocutive population, results were influenced by the child's age at implantation. The best results were obtained by the children who had been implanted earlier. Those implanted between 0 and 3 years old evolved in the Vowels test from 0% during pre-stimulation to 95%, from a 0% to a 90% in Disyllables words test and from a 0% to a 90-95% in CID Sentences test. Also, the speech acquisition and development of the pre-locutive population was also influenced by the implantation age. An 80% of postlocutive adult patients stated a mood and sociability improvement after the cochlear implantation. They did not show health changes in general nor relevant modifications in the attention they usually received from relatives and friends. Severe medical-surgical complications were registered for a 3.42% of the cases, a 7.06% of mild medical-surgical complications and a 3.07% of technical breakdowns in the internal components of the CI. Financial cost of implantation for a post-locutive adult oscillated between 36,912 Euro and 37,048 Euro, and between 37,689 Euro and 44,273 Euro for a pre-locutive child. CONCLUSIONS Cochlear implants clearly enhance communication skills of the implantees. Results obtained for the prelocutive implanted population justify the creation of hearing screening programmes in new-borns. Postlocutive implanted adults have expressed satisfaction for the results obtained. However, they did perceive some limitations in situations of unfavourable acoustic conditions. An analysis of direct and indirect costs related to a CI programme has been made. It may be useful to carry out reports on the cost-benefit ratio in this field. The low index of complications observed shows which cochlear implant treatment technique complies with the adequate safety margins. The factors influencing the most in the evolution are: duration of hearing deprivation, age at implantation, cochlear anatomy and functionality of the auditory pathway, patient's and relative's motivation, and the coexistence of other handicaps associated to hearing losses.
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Affiliation(s)
- M Manrique
- Estudio Multicéntrico realizado por los Grupos de Implantación Coclear de la Clínica Universitaria de Navarra, Pamplona.
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Boleas-Aguirre MS, Ernst S, Cervera-Paz FJ, Panizo A, Manrique M. [Salivary gland choristoma (hamartoma) of the middle ear: a case report]. Rev Laryngol Otol Rhinol (Bord) 2006; 127:247-9. [PMID: 17315790] [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] [Subscribe] [Scholar Register] [Indexed: 05/14/2023]
Abstract
OBJECTIVE Middle ear salivary gland choristoma are extremly rare. We report a case, describe the clinical management and review the literature. CLINICAL CASE A 12 year old boy presented with unilateral conductive hearing loss associated with a large inferior retraction pocket on otoscopy. CT scan demonstrated a large mass in the left middle ear cavity. The incus was absent and the stapes was partially eroded. Middle ear exploration demonstrated an 8 mm yellow/red mass in the region of the fallopian canal. This mass was comptly removed and histopathology confirmed salivary gland choristoma. CONCLUSION These lesions result from an abnormal development of the second branchial arch. It is important to consider these lesions as part of the differential diagnosis for any unilateral hearing loss associated with a middle ear mass in children.
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Affiliation(s)
- M S Boleas-Aguirre
- Hôpital Universitaire et Faculté de Médecine, Université de Navarra, Département d'Otolaryngologie, Pio XII 36, 31008 Pamplona, Espagne.
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Cervera-Paz FJ, Manrique MJ. Traditional and emerging indications in cochlear and auditory brainstem implants. Rev Laryngol Otol Rhinol (Bord) 2005; 126:287-92. [PMID: 16496561] [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] [Subscribe] [Scholar Register] [Indexed: 05/06/2023]
Abstract
Electrical stimulation of the auditory pathway via a cochlear or an auditory brainstem implant has been proved to an effective and safe procedure in the treatment of many patients suffering from a profound sensorineural hearing loss of cochlear and retrocochlear origin. In this paper we will present the impact of experience, technical advances in the design of auditory implants, and improvements in stimulation strategies in traditional criteria for implantation. Besides current indications for cochlear and auditory brainstem implants, we will review a continuously expanding group of potential candidates, namely emerging indications. This review will be exemplified with data from the University of Navarra Cochlear Implant Program, currently accounting for more than 500 patients implanted.
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Affiliation(s)
- F J Cervera-Paz
- Department of Otorhinolaryngology, Head & Neck Surgery, University Hospital & Medical School, University of Navarra, Pamplona, Spain.
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Manrique M, Cervera-Paz FJ, Huarte A, Martínez I, Gómez A, Vázquez de la Iglesia F. Audición y lenguaje en niños menores de 2 años tratados con implantación coclear. An Sist Sanit Navar 2004; 27:305-17. [PMID: 15644884 DOI: 10.4321/s1137-66272004000500003] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [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: 11/11/2022]
Abstract
BACKGROUND To compare the auditory abilities and speech performance of children with a profound prelingual bilateral hearing impairment, treated with a cochlear implant (CI) before or after 2 years of age. To analyze the complications arising during the selection process of the children, or as a result of the implantation, programming and follow-up. METHODS Prospective cohort single-subject repeated-measures study of 130 children who received an implant at our center. The children were divided into two age groups: 0-2 (n=36), and 2-6 years of age (n=94). Preoperative evaluation included: 1. History, physical exploration, and ENT examination. 2. Neuropaediatric examination, family evaluation, and psychological assessment. 3. Auditory brainstem responses. 4. High resolution computed tomogram of temporal bones. 5. Counseling and informed consent. The children were evaluated prior to, and each year following, the intervention (for up to 5 years), using closed and open-set logoaudiometric tests, and speech perception tests. Speech was evaluated according to the Peabody Picture Vocabulary and Reynell general oral expression scale. RESULTS Auditory and speech perception tests improved significantly in all children after CI, regardless of the follow-up time. The infant's performance was better in the group of early implantees. Speech tests showed that the development of children treated before 2 years of age was similar to that of normal children. No additional complications were observed when compared to CI in older children. CONCLUSIONS When performed before 2 years of age, CI offers a quicker and better improvement of performance, with no increase in complications when compared with a later intervention.
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Affiliation(s)
- M Manrique
- Departamento de Otorrinolaringología, Clínica Universitaria, Pamplona, Navarra, 31008, Spain.
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Vázquez de la Iglesia F, Cervera-Paz FJ, Manrique Rodríguez M. [Surgery for Atresia auris. Retrospective study of our results and correlation with Jahrsdoerfer prognostic criterium]. Acta Otorrinolaringol Esp 2004; 55:315-9. [PMID: 15554586 DOI: 10.1016/s0001-6519(04)78529-5] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [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: 11/26/2022]
Abstract
OBJECTIVES The study goal was to evaluate the hearing follow up results in patients who underwent surgery for congenital aural atresia. We studied hearing results and correlated them with Jahrsdoerfer prognostic classification. Protocols management of unilateral and bilateral atresia auris are written considering to our results and other authors. METHODS We conducted a retrospective review of 12 ears who underwent surgery for congenital aural atresia between 1989 and 2002. CT scan was used to evaluate Jahrsdoerfer prognostic classification and the correlation with the hearing results. RESULTS There are significant statistical differences (p = 0.003) in air-bone gap closure before and after surgery, also a lineal significant correlation (p = 0.016) between Jahrsdoerfer prognostic classification and air-bone gap closure. CONCLUSION Atresiaplasty surgery in individuals with congenital aural atresia can yield good hearing results in selected cases.
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Affiliation(s)
- F Vázquez de la Iglesia
- Departamento de Otorrinolaringología Clínica Universitaria, Universidad de Navarra, Pamplona.
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Cervera-Paz FJ. [Regarding the term 'denervation']. Rev Neurol 2004; 39:1000. [PMID: 15573327] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/01/2023]
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Manrique M, Cervera-Paz FJ, Jaúregui I, Vanaclocha V, Pérez N. Auditory brainstem implantation in primates: lessons for human surgery and application. J Laryngol Otol Suppl 2001:18-22. [PMID: 11211431 DOI: 10.1258/0022215001904815] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
We report on the surgical technique for surface electro-auditory prosthesis (EAP) implantation, pathological changes occurring at the cochlear nucleus complex (CNC), and its relation with electrical stimulation. Fourteen Macaca fascicularis were operated upon for a translabyrinthine bilateral auditory neurectomy, and simultaneous unilateral EAP implantation. Six animals were not stimulated, and the remaining eight were connected to an external active device. Stimulation was planned for 1000 hours. Biotolerance to the materials was adequate without significant reactions in the CNC surface, but an ependymal reaction. Lesions attributed to surgical trauma were also found. Two animals being stimulated could not complete the planned course due to cable break or EAP extrusion. One stimulated animal developed an asymptomatic brainstem abscess. A good knowledge of CNC topography is required to avoid surgical trauma. Externally connected devices may facilitate extrusion of the EAP or ascending infections.
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Affiliation(s)
- M Manrique
- Department of Otorhinolaryngology, Head and Neck Surgery, University of Navarra, Pamplona, Spain.
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Boleas Aguirre MS, Toledo G, Cervera-Paz FJ, Okafor O, García-Tapia Urrutia R. [Laryngeal metastasis from colloid adenocarcinoma of the colon: report of a case]. Acta Otorrinolaringol Esp 2001; 52:80-3. [PMID: 11269885 DOI: 10.1016/s0001-6519(01)78182-4] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.1] [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: 12/01/2022]
Abstract
Metastatic involvement of the laryngeal is very rare, with around 150 cases reported to the literature. In eight of these cases, the primary tumor was a colon adenocarcinoma. We report the case of a 80 year-old woman treated of a colloid adenocarcinoma of 7 years earlier, referred to us for chronic and progressive dyspnea. Endoscopic examination showed a subglottic spherical mass, which caused an important compromise of the respiratory airway. Tomographic studies revealed also a thyroid mass. The patient was treated with a tracheostomy, resection of the subglottic mass (with intraoperative diagnosis of "mucin producing tumor"), and total thyroidectomy. The final pathologic diagnosis of the subglottic mass was a metastasis of colloid adenocarcinoma of the colon. In the literature reviewed there are no previous reports of metastatic involvement of the larynx with this type of colon adenocarcinoma. We discuss the clinical and radiological findings, and therapeutic options for metastasis to the larynx, as well as pathological differential diagnosis.
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Affiliation(s)
- M S Boleas Aguirre
- Departamento de Otorrinolaringología, Clínica Universitaria, Universidad de Navarra, Avda. Pío XII, no. 36, 31008 Pamplona
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Panadero A, Sáiz-Sapena N, Cervera-Paz FJ, Manrique M. [General intubation anesthesia in primates for experimental otoneurologic surgery]. Rev Med Univ Navarra 2000; 44:12-8. [PMID: 11341052] [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] [Subscribe] [Scholar Register] [Indexed: 02/20/2023]
Abstract
INTRODUCTION We report our experience in anaesthetic and surgical management of primates (M. fascicularis) in an experimental otoneurosurgical procedure. MATERIAL & METHODS The VIII cranial nerve was bilaterally sectioned in a translabyrinthine approach in 21 adult primates. In 14 animals subsequently, a prototype of auditory brainstem implant was placed unilateraly within the brain stem for surface stimulation of cochlear nuclei. Premedication consisted in an intramuscular mixture of ketamine, midazolam and atropine. Surgical procedure was performed under intubated general anaesthesia, after propofol (1.5 mg/kg) administration and maintained with nitrous oxide and halotane. RESULTS The mixture of ketamine, midazolam and atropine produced a deep anaesthesia in 4 +/- 1.7 minutes, permitting safe animal handling. Atraumatic nasotracheal intubation without muscle relaxing agents was easily achieved in all animals. Anaesthesia was adequately maintained with nitrous oxide and halotane. Animals did not present any relevant incidents during surgery, and were extubated 10 +/- 2.5 minutes after cessation of gas administration. Post-operatively, no relevant surgical complications occurred. CONCLUSIONS We report an anaesthetic technique that provides an optimal restrain and anaesthesia for experimental otoneurosurgical procedures with primates. This technique offers a quick recovery and avoids the use of muscular relaxing agents for intubation, and thus could be safely used in other kind of surgical procedures.
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Affiliation(s)
- A Panadero
- Departamento de Anestesiologia y Reanimación, Clínica Universitaria, Facultad de Medicina, Universidad de Navarra
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Quesada JL, Alcalde JM, García-Velloso MJ, Cervera-Paz FJ, García-Tapia R. [Positron-emission tomography (PET) in the diagnosis of malignancy, recurrence, and staging in patients with head and neck tumors]. Acta Otorrinolaringol Esp 2000; 51:629-33. [PMID: 11270042] [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] [Indexed: 02/19/2023]
Abstract
We report a prospective study with 15 patients with the diagnosis of head and neck tumors. They underwent two types of studies, the radiological one with computed tomography or magnetic resonance image scan and the positron emission tomography (PET) with 18-fluorodeoxyglucose (FDG). Five patients did not receive any treatment before, and the PET was performed to evaluate the possibility of malignancy, to determine the stage of the disease and if a recurrence was suspected. The study with the PET has the advantage of detecting small lesions and it is not influenced by radiotherapy or surgery.
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Cervera-Paz FJ, Toledo G, Nicolás AI, García-Tapia R. [Synchronous osteochondroid hamartoma and squamous cell carcinoma of the larynx]. Acta Otorrinolaringol Esp 2000; 51:449-52. [PMID: 11000691] [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] [Indexed: 02/17/2023]
Abstract
BACKGROUND Soft-tissue tumors of the larynx are rare, especially hamartomas. Fewer than a dozen well-documented cases have been described. We report the case of a 65 year-old man diagnosed of a synchronous epithelial tumor of the right vocal fold and a soft-tissue tumor of the contralateral lamina of the thyroid cartilage. METHODS CT scan revealed a low-attenuating, expansive mass involving the left ala of the thyroid cartilage without airway compromise airway. The lesion contained small, scattered calcifications and the mucosa was intact, suggesting a cartilaginous tumor. The patient underwent endoscopic resection of the right vocal fold tumor and subtotal resection of the left ala of the thyroid via median thyrotomy. RESULTS Pathology revealed a squamous-cell carcinoma of the vocal fold and an osteochondroid hamartoma within the thyroid cartilage. The management of patients with laryngeal lesions suggestive of a cartilaginous nature is discussed. CONCLUSIONS To our knowledge, this is the first case of a synchronous laryngeal hamartoma and carcinoma reported in the literature.
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Affiliation(s)
- F J Cervera-Paz
- Departamento de ORL, Clínica Universitaria, Universidad de Navarra, Pamplona, España.
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Manrique M, Jauregui I, Insausti A, Insausti R, Cervera-Paz FJ, Perez N, Vanaclocha V. Experimental study following inactive implantation of an auditory brain stem implant in nonhuman primates. Ann Otol Rhinol Laryngol 2000; 109:163-9. [PMID: 10685568 DOI: 10.1177/000348940010900210] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.3] [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: 11/15/2022]
Abstract
We report changes in the cochlear nuclei (CNs) after 3 months of bilateral auditory deafferentation and simultaneous unilateral implantation of a dummy auditory brain stem implant (ABI) in 6 nonhuman primates (Macaca fascicularis). These specimens were compared to CNs of 9 controls and 7 bilaterally deafferented animals without implantation. The ABI array consists of 3 platinum electrodes mounted on a silicone pad with the back side covered with Dacron. No migration of the ABI was observed. All deafferented animals showed astrocytic reorganization in the CNs. Histologic changes consisted of superficial reactions around the implant, with formation of fibrillar bundles of fusiform cells, and the presence of giant cells close to the Dacron. Other findings were related to surgical trauma. The dummy ABI did not itself provoke serious adverse reactions in the CNs. Our observations support the possibility of ABI reimplantation surgery.
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Affiliation(s)
- M Manrique
- Department of Otorhinolaryngology-Head and Neck Surgery, University Hospital, Pamplona, Spain
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Abstract
BACKGROUND We describe a new technique for the surgical reconstruction of large-sized anterior septal perforations based on the pericranial flap. METHODS The technique requires a standard open rhinoplasty combined with a pericranial flap harvested after a bicoronal approach and tunnelled to the nasal cavity. We present the case of a man with complete destruction of the nasal septum as a result of chronic cocaine abuse. RESULTS Surgery resulted in a permanent and complete closure of the perforation. CONCLUSIONS The main advantage of this technique is the use of well-vascularized autogenous tissue and the minimal donor site morbidity. This technique provides a new method to close large nasal perforations.
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Affiliation(s)
- V Paloma
- Department of Plastic, Reconstructive and Aesthetic Surgery, Hospital Clínico de Barcelona, Barcelona, Spain
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Abstract
Previous animal research and clinical experiences in humans suggest the existence of an auditory critical period in language acquisition. We review the literature and present the changes within the cochlear nuclei in bilaterally deafferentated adult non-human primates. We also present and analyse the results of 98 prelingually deaf children and teenagers who underwent a cochlear implantation at the University of Navarra. Patients received a Nucleus 22 or 24 multichannel cochlear implant (CI). They were grouped in five categories according to their age at surgery. Performance is compared with a control group of 58 postlinguals. Only early-implanted prelingual children (before 6 years of age) achieved a complete open-set speech recognition, even with better performance than postlinguals. These results clearly demonstrate the existence of a period of high neural auditory plasticity within the first 6 years of life. The introduction of auditory stimulation with a CI can not restore the loss of neural plasticity out of this period. Prelingual children under 6 years of age should receive a CI as soon as there is a reliable diagnosis of bilateral sensorineural hearing loss.
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Affiliation(s)
- M Manrique
- Department of Otorhinolaryngology, Head and Neck Surgery, University Hospital and Medical School, University of Navarra, Pamplona, Spain.
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Cervera-Paz FJ, Manrique M, Huarte A, García FJ, García-Tapia R. [Study of surgical complications and technical failures (correction of technical defects) of cochlear implants]. Acta Otorrinolaringol Esp 1999; 50:519-24. [PMID: 10619876] [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] [Indexed: 02/15/2023]
Abstract
INTRODUCTION Cochlear implants (CI) have proved their clinical efficacy and have overcome a routine treatment for profound sensorineural impairment. In the present paper we review our CI program concerning surgical complications and equipment failures. MATERIAL AND METHODS One-hundred and thirty-five patients (69 younger and 66 older than 14 years of age) are subjects of the study. They suffered from pre-lingual (86 cases) or post-lingual (49 cases) profound bilateral sensorineural hearing impairment, and all of them received a Mini Nucleus 22 CI in our CI program. We analyze minor and major surgical complications and also CI and external equipment failures. RESULTS In 6.1% of the patients (8 cases) a surgical complication occurred, 3 of them flap-related complications. In 2 of these cases (1.54%) complications were major. Three patients (2.17%) developed a complete CI failure, while in 8 cases malfunction of one or more electrodes was detected. Cumulative survival of CI was 87 months, without significant differences related to age or gender. Cumulative survival of the processors was 78.6 months, without significant differences related to the type of processor (MSP or Spectra) or gender but related to the age. The microphone failed in 42.2% of the cases. CONCLUSIONS The CI is a low-morbidity treatment with adequate characteristics of durability and reliability. Nevertheless, some of the external components remain quite vulnerable.
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Affiliation(s)
- F J Cervera-Paz
- Departamento de ORL, Clínica Universitaria de Navarra, Pamplona, 31008, España.
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Affiliation(s)
- M Molina
- Department of Otorhinolaryngology, University Hospital, University of Navarra, Spain
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Manrique M, Ramos A, Morera C, Sainz M, Algaba J, Cervera-Paz FJ. Spanish study group on cochlear implants for persons with marginal benefit from acoustic amplification. Acta Otolaryngol 1998; 118:635-9. [PMID: 9840497 DOI: 10.1080/00016489850183106] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.3] [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: 10/16/2022]
Abstract
Recently the U.S. Food and Drug Administration approved the use of cochlear implants (CI) in patients with severe-to-profound sensorineural hearing loss with marginal benefit (< 30% speech discrimination) from hearing aids (HA). A multicentre trial was developed to determine whether this approval could be applied to the Spanish population. Nine postlingual adults from 3 centres were selected for the study. The mean preoperative unaided PTA threshold (0.25 to 4 KHz) was 108.6 dB HL for the poorer ear and 99.8 dB HL for the better. In all subjects the poorer ear was implanted with a Mini Nucleus 22 device. A single subject design study was used to compare performance with HA preoperatively and with CI postoperatively, or CI with contralateral HA. PTA measures and Spanish open set speech recognition tests were used. Comparing pre-implant levels with results after 6 months of CI use, all subjects improved significantly on all test measures: i) Mean aided soundfield threshold: 73.6 dB vs 39.8 dB ii) Mean bisyllabic recognition: 20% vs 57% iii) Mean consonant discrimination: 20% vs 49% iv) Mean CID sentences: 22% vs 73%. Five subjects discontinued use of the contralateral HA after implantation, three continued occasionally to use the HA, and one continued to use both on a full-time basis. Patients performed significantly better post-implant on speech recognition compared with their best pre-implant HA scores. Therefore the CI appears an appropriate treatment for Spanish speakers with a severe-to-profound hearing loss and marginal benefits with HA.
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Affiliation(s)
- M Manrique
- University Hospital and Medical School, University of Navarra, Pamplona, Spain.
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Lacosta JL, Manrique M, Infante JC, Cervera-Paz FJ. [Craniofacial development in secretory otitis]. An Otorrinolaringol Ibero Am 1998; 25:219-32. [PMID: 9658661] [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] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
The AA. consider in a population of 76 children, the connexion between bony palate, choanae and the M. tensor veli palatini and the occurrence of secretory otitis. They measured for this purpose several craniofacial structures "in vivo". Children suffering secretory otitis presented, contrary to children without aural pathology, a greater incidence of gothic palate (p < 0.001) and a significant decrease of both palatine (p < 0.05) and choanae (p < 0.001). All children showed going through puberty an palatinal and choanal growth as well a closure of the M. tensor veli palatini angle.
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Affiliation(s)
- J L Lacosta
- Hospital San Millán, Servicio de ORL, Logroño
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Manrique M, Huarte A, Cervera-Paz FJ, Espinosa JM, Molina M, Garcia-Tapia R. Indications and counterindications for cochlear implantation in children. Am J Otol 1998; 19:332-6. [PMID: 9596184] [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] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
OBJECTIVE This study is aimed to analyze the current indications and counterindications of cochlear implantation (CI) in children. STUDY DESIGN This study reviews the children implanted in our institution looking specifically at the following aspects: 1) auditory criteria for candidate selection; 2) age at implantation; 3) educational environment; and 4) associated handicapping conditions. SETTING Tertiary referral center with experience in CI since 1989 with inpatient and outpatient care. INTERVENTION All children received a Mini Nucleus 22 CI device (Cochlear Limited, Australia) in a standard surgical procedure. RESULTS Regarding auditory criteria, children with average hearing level of 100-105 dB HL are more likely to obtain benefit from a CI than from a hearing aid. The minimum age for CI should be as soon as there is a reliable diagnosis of bilateral profound hearing loss, while the maximum age for CI depends on strict selection criteria of candidates. The educational environment is of a great importance in the rehabilitation process, permitting a progressive change to oral communication. Our experience in CI of children with multiple handicapping conditions is limited to a case of a deaf-blind child who was implanted with a good performance. In the selection of these children it is mandatory to have extensive multidisciplinary evaluation. CONCLUSIONS An experienced team is needed in the selection of children for CI. Candidates should meet anatomic criteria, have a reliable diagnosis of bilateral profound hearing loss, an evaluation of communication skills, and extensive neuropediatric and socioeducational evaluation.
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Affiliation(s)
- M Manrique
- Department of Otorhinolaryngology, Head and Neck Surgery, University Hospital, University of Navarra Medical School, Pamplona, Spain
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Affiliation(s)
- M Manrique
- Department of Oto-Rhino-Laryngology, Head & Neck Surgery, University of Navarra, Pamplona, Spain
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Manrique N, Huarte A, Molina M, Perez N, Espinosa JM, Cervera-Paz FJ, Miranda I. Are cochlear implants indicated in prelingually deaf adults? Ann Otol Rhinol Laryngol Suppl 1995; 166:192-4. [PMID: 7668632] [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] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Affiliation(s)
- N Manrique
- Department of Otorhinolaryngology, University Clinic of Navarra, Pamplona, Spain
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Manrique MJ, Paloma V, Cervera-Paz FJ, Ruiz de Erenchun I, Garcia-Tapia R. Treatment of cutaneous ulceration after cochlear implantation surgery. Ann Otol Rhinol Laryngol Suppl 1995; 166:422-5. [PMID: 7668734] [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] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Affiliation(s)
- M J Manrique
- Department of Otorhinolaryngology, University Clinic of Navarra, Pamplona, Spain
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Manrique M, Paloma V, Cervera-Paz FJ, Ruiz de Erenchun I, Garcia-Tapia R. Pitfalls in cochlear implant surgery in children. Adv Otorhinolaryngol 1995; 50:45-50. [PMID: 7610967 DOI: 10.1159/000424433] [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: 05/21/2023]
Affiliation(s)
- M Manrique
- Department of Otorhinolaryngology, University Clinic of Navarra, Spain
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Calderón E, Cervera-Paz FJ, de Antonio P, Torres LM, Clavo A. [Persistence of the left superior vena cava: apropos of an a-cyanogenic case]. Rev Esp Anestesiol Reanim 1994; 41:336. [PMID: 7839002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
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Cervera-Paz FJ, Dikkers FG. [Ultrastructure and pathogenesis of vocal nodules on the vocal cords]. Acta Otorrinolaringol Esp 1994; 45:261-5. [PMID: 7917477] [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] [Indexed: 01/27/2023]
Abstract
Controlled electron microscopy of the epithelium in voice lesions revealed: thickening and destruction of basement membrane, reduplication of the lamina densa, near absence of normal hemidesmosomes and anchoring fibrils, abundant electro-dense vesicles at the basal cell pole (discharging through the cell membrane), abundant mitochondria, euchromatin and nucleolar prominence. These histologic phenomena suggest that the basal cell layer responds to trauma to its anchorages with metabolic hyperactivity. Therefore the traumatic mechanism should be considered as damaging to the basement membrane.
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Affiliation(s)
- F J Cervera-Paz
- Departamento de Cirugía, Area de ORL, Universidad de Cádiz, Hospital Universitario de Puerto Real
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Cervera-Paz FJ, Roquette Gaona J, Bartual Pastor J. [Ectopic primitive thyroid papillary carcinoma: report of a fatal case and review of literature]. Acta Otorrinolaringol Esp 1994; 45:124-7. [PMID: 8086206] [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] [Indexed: 01/28/2023]
Abstract
One percent of excised thyroglossal duct remnants exhibit histologic malignancy, a thyroid papillary carcinoma in 80% of the cases. The prognosis is excellent except for anaplastic types. We report the case of a 44-year-old woman with primitive thyroid papillary carcinoma diagnosed histologically as thyroglossal cyst. Its unusual aggressiveness produced local and regional spread, metastases and the patient's death in spite of treatment: Sistrunk operation, local excision of a recurrence and laryngothyroidectomy. Thyroid histology revealed the absence of carcinomatous foci. We discuss the most noteworthy aspects of the case in relation to other reports.
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Dikkers FG, Hulstaert CE, Oosterbaan JA, Cervera-Paz FJ. Ultrastructural changes of the basement membrane zone in benign lesions of the vocal folds. Acta Otolaryngol 1993; 113:98-101. [PMID: 8442430 DOI: 10.3109/00016489309135774] [Citation(s) in RCA: 33] [Impact Index Per Article: 1.1] [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: 01/30/2023]
Abstract
The basement membrane zone (BMZ) of the epithelium of the vocal folds was investigated electron microscopically in 10 patients suffering from various benign lesions and in 3 controls. Various defects were observed: a thickening by deposition of electron dense material, a loss of normal architecture, and a near absence of normal hemidesmosomes and anchoring fibers. Beside these previously reported phenomena, many vesicles carrying electron dense material were found near the plasma membrane. The vesicles were observed at various stages of fusion with the plasma membrane, on the other side of which their content was discharged. In the cytoplasm an increase of mitochondria was seen. The amount of condensed chromatin decreased while the nucleoli increased in comparison with the controls. These observations are suggestive of a hyperactivity of the basal cells of the epithelium in response to vibratory stress.
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Affiliation(s)
- F G Dikkers
- Department of Otorhinolaryngology, University of Groningen, The Netherlands
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