{"id":117433,"date":"2018-03-11T10:46:57","date_gmt":"2018-03-11T10:46:57","guid":{"rendered":"https:\/\/www.deberes.net\/tesis\/sin-categoria\/experiencia-inicial-2003-2010-del-programa-de-implantes-cocleares-del-hospital-cla%c2%adnico-universitario-virgen-de-la-arrixaca\/"},"modified":"2018-03-11T10:46:57","modified_gmt":"2018-03-11T10:46:57","slug":"experiencia-inicial-2003-2010-del-programa-de-implantes-cocleares-del-hospital-cla%c2%adnico-universitario-virgen-de-la-arrixaca","status":"publish","type":"post","link":"https:\/\/www.deberes.net\/tesis\/cirugia-de-garganta-nariz-y-oidos\/experiencia-inicial-2003-2010-del-programa-de-implantes-cocleares-del-hospital-cla%c2%adnico-universitario-virgen-de-la-arrixaca\/","title":{"rendered":"Experiencia inicial (2003-2010) del programa de implantes cocleares del hospital cl\u00ednico universitario virgen de la arrixaca."},"content":{"rendered":"<h2>Tesis doctoral de <strong> Jos\u00e9 Domingo Cubillana Herrero <\/strong><\/h2>\n<p>El implante coclear (ic) se define como un dispositivo electr\u00f3nico que sustituye al o\u00eddo externo, medio e  interno, capaz de recoger los sonidos, transformarlos en est\u00edmulos el\u00e9ctricos para transmitirlos al nervio auditivo, y restablecer el flujo de informaci\u00f3n auditiva que llega al cerebro. \tel programa de implantes cocleares del hospital cl\u00ednico universitario virgen de la arrixaca (pic-hcuva) comenz\u00f3 en el a\u00f1o 2003. Surge de la necesidad de dar respuesta en forma de tratamiento global a las demandas surgidas del programa regional de screening de hipoacusias implantado dos a\u00f1os antes. \tuna vez iniciado el programa, en concreto 4 a\u00f1os m\u00e1s tarde, diversas asociaciones de padres de ni\u00f1os sordos cuestionaron los resultados del pic-hcuva. Dicha inquietud provoc\u00f3 que desde diversas instancias incluido el propio servicio de otorrinolaringolog\u00eda (orl) del hcuva  se planteara una evaluaci\u00f3n externa de los resultados de nuestro programa. Desde la secretaria auton\u00f3mica de atenci\u00f3n al ciudadano se cre\u00f3 un comit\u00e9 de evaluaci\u00f3n.  una vez ya asentado el pic-hcuva, analizamos los resultados del programa, tras 10 a\u00f1os de implantaci\u00f3n, con los siguientes objetivos: en primer lugar mostrar los resultados iniciales a fin de comprobar que estos son acordes a la literatura; en segundo lugar, servir de modelo, a partir de nuestra experiencia,  para todos aquellos grupos con inter\u00e9s en poner en marcha un programa propio de implantes cocleares.; Y finalmente, y en base al segundo de los objetivos, elaborar una curva de aprendizaje que permita identificar un n\u00famero m\u00ednimo total, y un n\u00famero m\u00ednimo por a\u00f1o de pacientes implantados a partir de los que los resultados obtenidos sean acordes a los est\u00e1ndares mundiales. la serie consta de 64 pacientes, todos ellos sometidos a un implante coclear entre enero de 2003 y diciembre de 2010. Treinta y dos de los casos eran mujeres (50%). La edad media fue de 5,56 a\u00f1os con un rango de edad de 1-64 a\u00f1os. S\u00f3lo en 8 casos (12,5%) existieron antecedentes familiares de inter\u00e9s. El implante coclear se efectu\u00f3 sobre el o\u00eddo derecho en 49 casos (76,6%), mientras que en 15 pacientes (23,4%) el implante fue sobre el o\u00eddo izquierdo. El tipo de implante colocado fue el freedom\u00c2\u00bf en 32 casos (50%), el contour\u00c2\u00bf 24 en 17 casos (26,6%), y el nucleus 5\u00c2\u00bf en los restantes 15 casos (23,4%). La estancia hospitalaria media de de 5,56 d\u00edas, con un rango de 2-9 d\u00edas y una moda de 5 d\u00edas (20 casos, 20,3%). El 51,6% de los casos tuvo una estancia inferior a los 5 d\u00edas, y el 90% por debajo de la semana. El 87,5% de los casos (56 casos) no presentaron complicaci\u00f3n postquir\u00fargica alguna, present\u00e1ndose \u00e9stas s\u00f3lo en 8 casos (13,5%): 4 casos de dehiscencias de piel (6,3%), 1 f\u00edstula de lcr (1,6%), 1 necrosis d\u00e9rmica (1,6%), 1 hemorragia (1,6%) y 1 caso de seroma postoperatorio. respecto de los resultados funcionales, basados en las audiometr\u00edas efectuadas de forma postoperatoria, los dividiremos por frecuencias. As\u00ed, en el nivel de los 250hz, el 87,5% de los casos o\u00eda a 35db, con una media de 29,5db y una moda de 25db (14 casos, 21,9%). A 500hz, el 89,3% o\u00eda a 40db, con una media de 32,2 db y una moda de 30db (17 casos, 26,6%). A 1000hz, el 91,1% de los casos o\u00eda a 45db, con una media de 35,5db y una moda de 30db (15 casos, 23,4%). A 2000hz, el 91,1% o\u00eda a 45 db, con una media de 33,4db y una moda de 25db (17 casos, 26,6%). Finalmente, a 4000hz, el 91,1% o\u00eda a 40db, con una media de 32,2db y una moda de 25db (17 casos, 26,6%). Por otra parte, y por lo que respecta al test de respuesta neural, \u00e9ste, que se efectu\u00f3 en el 100% de los casos, fue positivo en 63 de los 64 casos (98,4%), pues s\u00f3lo en 1 caso fue negativo. en conclusi\u00f3n: 1.- El modelo de creaci\u00f3n, puesto en marcha y funcionamiento de nuestro programa de ic queda avalado por los resultados in\u00edciales obtenidos al ser estos acordes a lo publicado en la literatura internacional. 2.-Al igual que en otros tipos de intervenci\u00f3n  quir\u00fargica, existe una curva de aprendizaje en la cirug\u00eda del implante coclear. 3.- La experiencia obtenida en las fases in\u00edciales de este programa puede ser de gran utilidad a la hora de exportar e implantar un modelo semejante de programa de implantes  cocleares  en otros hospitales.   cochlear implants are electronic devices which replace the function of the outer, medium and inner ear, able to turn sounds into electric stimuli to be transmitted through the auditory nerve, and restore the flow of hearing information that reaches the brain.   the cochlear implant program from the clinical university virgen de la arrixaca hospital (pic-hcuva) was started in 2003. It comes up from the need of global treatment for all those cases appeared after the hearing impairment screening, which was started up two years earlier.   once the program started, several associations of parents of deaf children questioned the results of the pic-hcuva. This concern made several institutions set out an external evaluation of the result of the program from the autonomous secretary of citizen-help a evaluation committee was created.   ten years after being settled, we analyzed the program outcomes with the next goals. First, show the initial results in order to verify that they are consistent with the literature; secondly, serve as a model, based on our experience, for groups with an interest in starting a cochlear implants program up; and finally, according to the second objective, develop a learning curve which allows to identify a minimum number, and a minimum number of implanted patients annually from which the results are in compliance with world standards.  the series is made up of 64 patients, all of them with a cochlear implant made between january of 2003 and december of 2010. 32 of them were female (50%). The average age was 5.56 years with a range from 1 to 64 years. Only 8 of them (12.5%) had remarkable family history. The implant was made in the right ear in 49 cases (76.6%) while in the left one in 15 patients (23.4%). The model used for the implant was freedom\u00c2\u00bf in 32 cases (50%), contour\u00c2\u00bf24 in 17 patients (26.6%) and nucleus 5\u00c2\u00bf for the remaining 15 cases (23.4%). The average length of stay in hospital was 5.56 days ranged from 2 to 9 days and the mode was 5 days (20 cases, 20.3%). 51.6% of the patients stayed for less than 5 days, and 90% stayed for less than one week. In 87.5% of them (56 cases) post-surgery complications did not occur, they did occur just in 8 cases (13.5%): 4 skin dehiscences (6.5%), 1 case of cerebrospinal fluid fistula (1.6%), 1 of skin necrosis (1.6%) and 1 post-surgery seroma (1.6%).   regarding the functional outcomes, based on post-surgery audiometries, we shall divide them up into different frequencies. Thus, 87.5% of the patients could hear 35 db sounds at 250 hz level frequencies, with an average of 29.5 db and the mode was 25 db (14 cases, 21.9%). At 500 hz level, 89.3% could hear 40 db sounds, with an average of 32.2 db and the mode was 30 db (15 cases, 23.4%). At 2000 hz level, 91.1% could hear 45 db sounds, with an average of 33.4 db and the mode was 25 db (17 cases, 26.6%). Finally, at 4000 hz level, 91.1% could hear 40 db sounds, the average was 32.2 db and the mode was 25 db (17 cases, 26.6%). On the other hand, and according to the neural response test, which was performed in 100% of the cases, it had a positive result in 63 cases (98.4%) and just one negative result.   in conclusion:  1. The creative model and performance of our cochlear implant program are endorsed by the initial results as they are in accordance with worldwide literature.  2. As well as in other specific kinds of surgery, there is a learning curve for the cochlear implant surgery.  3. The experience gathered after the initial phases of this program can be very useful for starting new cochlear implant programs up, similar to ours, in some other hospitals.<\/p>\n<p>&nbsp;<\/p>\n<h3>Datos acad\u00e9micos de la tesis doctoral \u00ab<strong>Experiencia inicial (2003-2010) del programa de implantes cocleares del hospital cl\u00ednico universitario virgen de la arrixaca.<\/strong>\u00ab<\/h3>\n<ul>\n<li><strong>T\u00edtulo de la tesis:<\/strong>\u00a0 Experiencia inicial (2003-2010) del programa de implantes cocleares del hospital cl\u00ednico universitario virgen de la arrixaca. <\/li>\n<li><strong>Autor:<\/strong>\u00a0 Jos\u00e9 Domingo Cubillana Herrero <\/li>\n<li><strong>Universidad:<\/strong>\u00a0 Murcia<\/li>\n<li><strong>Fecha de lectura de la tesis:<\/strong>\u00a0 30\/04\/2015<\/li>\n<\/ul>\n<p>&nbsp;<\/p>\n<h3>Direcci\u00f3n y tribunal<\/h3>\n<ul>\n<li><strong>Director de la tesis<\/strong>\n<ul>\n<li>Juan  Angel Fernandez Hernandez<\/li>\n<\/ul>\n<\/li>\n<li><strong>Tribunal<\/strong>\n<ul>\n<li>Presidente del tribunal: Carlos Sprekelsen gasso <\/li>\n<li>Manuel Sainz quevedo (vocal)<\/li>\n<li>Jos\u00e9 Dalmau galofre (vocal)<\/li>\n<li>Juan  Antonio Gil melgarejo (vocal)<\/li>\n<\/ul>\n<\/li>\n<\/ul>\n<p>&nbsp;<\/p>\n","protected":false},"excerpt":{"rendered":"<p>Tesis doctoral de Jos\u00e9 Domingo Cubillana Herrero El implante coclear (ic) se define como un dispositivo electr\u00f3nico que sustituye al 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