cirugia otologica
DESCRIPTION
Cirugia otologicaTRANSCRIPT
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AVANCES EN CIRUGÍA OTOLÓGICA
FEDERACIÓN MÉDICA ECUATORIANAMarzo del 2012
Dr. Vinicio Toscano Mancheno
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EMISIONES OTOACUSTICAS
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POTENCIALES EVOCADOS AUDITIVOS DEL TALLO CEREBRAL
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MICROOTIA, ANOTIA
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CONDUCTO AUDITIVO EXTERNO
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PROTESIS DE LA CADENA OSCICULAR
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APOFISIS MASTOIDES
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TOPODIAGNOSTICO DE LA HIPOACUSIA
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AUDIOMETRIA TONAL
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AUXILIARES AUDITIVOS
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IMPLANTES AUDITIVOSIMPLANTES EN EL OIDO
MEDIO• PIEZOELECTRICO• PISTONIMPLANTES EN LA
CÓCLEAIMPLANTES EN EL TALLO
CEREBRALIMPLANTES DE
CONDUCCION OSEA
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IMPLANTE EN EL OIDO MEDIO
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IMPLANTECIRUGIA DEL LECHO
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IMPLANTE EN OIDO MEDIO PIEZOELECTRICO
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IMPLANTE COCLEAR
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TOMOGRAFIA COMPUTARIZADA DE OIDOS
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IMPLANTE COCLEAR INDICACIONES
• Hipoacusia sensorial profunda o restos auditivos.
• Adulto: No beneficio con prótesis convencional.
• FDA: mayor a 90 dB en .5, 1 y 2 kHz
• Niños: hipoacusia neurosensorial profunda bilateral
• Desde los 12 meses de edad
• Ideal entre los 12 meses a los 3 años de edad
• Adultos: el menor tiempo del inicio de la pérdida auditiva.
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IMPLANTE COCLEAR CONTRAINDICACIONES
• Agenesia coclear• Hipoacusia central• Infeccion en el oído
medio• Enfermedad
psiquiátrica grave• No cumple criterios
audiológicos• Desmotivación
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IMPLANTE TALLO CEREBRAL
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SISTEMA DE AYUDA AUDITIVA SEMIIMPLANTABLE (BAHA)
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BAHA. INDICACIONES AUDIOLOGICAS
• Hipoacusia conductiva o mixta.• Via ósea igual o mejor a
45 dB.• Hipoacusia unilateral:
oido sano con 20 dB VO
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BAHA. INDICACIONES CLINICAS
• Hipoacusia conductiva o mixta.
• El uso de Auxiliar Auditivo Electrico:
Es imposible. Contraindicado. Inefectivo.
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BAHA
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BAHA
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BAHA
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BAHA
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BAHA
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BAHA
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BAHA
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BAHA
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BAHA
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BAHA. CUIDADOS POSTOPERATORIOS
• Higiene: agua y jabón.• No traumatizar el implante.• Inflamacion: antibióticos tópicos.• Granuloma: corticoides mas antibioticos
topicos.
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BAHA. CONTRAINDICACIONES
• Audicion en Via Aérea mayor de 60 dB.
• Niños pequeños (menores de 6 años)
• Incapacidad de llevar adecuadamente los cuidados
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BAHA. COMPLICACIONES• Sangrado de un seno
dural.• Fístula de LCR.• Hematoma subcutáneo.• Absceso.• Hematoma subdural.• Meningitis.• Extrusión (3 a 10%)• Lesiones en la piel.
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BAHA. PRONOSTICO
• Experiencia 25 años• En hipoacusia unilateral Cierre GAP 10 dB (80%) Cierre GAP 5 dB (60%) GAP ideal 30 dB Satisfacción 80% Audición biaural
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BAHA EN NIÑOS
• Hipoacusia bilateral: lo más pronto posible
• Antes de los 6 años de edad: cintillo velcrom
• De 6 años en adelante: método osteintegrado (aprobado por FDA)