Objective To analyze auditory brainstem response (ABR) findings of preterm and term infants in the neonatal intensive care unit (NICU) with perinatal problems. Study Design Case series with chart review. Setting Secondary care hospital. Methods Analysis consisted of a consecutive series of 101 infants (69 preterm and 32 term) admitted in the NICU of Hospital Fernando Fonseca between 2016 and 2018 with perinatal problems who underwent an ABR evaluation. Results The major perinatal problems identified were hyperbilirubinemia, intravenous gentamicin >5 days, mechanical ventilation >5 days, congenital cytomegalovirus infection, meningitis, and periventricular hemorrhage. Gentamicin use significantly increased the absolute latency of wave I in preterm infants (95% CI, 0.01-0.37; P = .037). Mechanical ventilation significantly decreased the latency of wave V and intervals I-V and III-V in preterm infants (95% CI, −0.35 to −0.22; P = .026; 95% CI, −0.33 to −0.00; P = .001; 95% CI, −0.46 to 0.12; P = .049). Congenital cytomegalovirus significantly decreased interval III-V in preterm infants (95% CI, −0.36 to −0.01; P = .042). Multivariate analysis revealed that gentamicin use, lower gestational age, and lower birth weight predicted an increased ABR threshold in preterm infants (95% CI, 1.64-15.31; P = .016; 95% CI −1.72 to −0.09; P = .030; 95% CI, −14.55 to −0.63; P = .033). ABR measurements in term infants were not significantly altered, with the exception of an increased latency of wave III with a lower gestational age (95% CI, −0.49 to −0.01; P = .038). Conclusions These findings suggest that perinatal problems in the NICU significantly impair the ABR threshold and the auditory pathway maturational process in preterm but not term infants.
Temporal bone osteoradionecrosis (TBORN) is a rare complication of head and neck radiotherapy. It usually presents as a unilateral disorder with a long latency between the exposition to radiation and the symptoms onset, which might overlap with other clinical entities, making it difficult to establish the diagnosis. It can be classified as localized, when confined to the tympanic bone; or diffuse, when extended to other portions of the temporal bone, with the inherent implication in treatment selection and prognosis. The authors present a case of a 53 years old patient with multiple comorbidities, including an immunosuppressive state, who presented an infected massive diffuse TBORN bilaterally. The diagnosis was challenging and the patient was initially treated for a malignant otitis externa, but after established diagnosis of TBORN, the patient was treated resorting to surgery, topical treatment and hyperbaric oxygenotherapy, with consequent symptoms resolution. This case illustrates the difficulty in establishing the diagnosing and treatment of TBORN and highlights the importance of a low suspicion threshold for this rare complication of radiotherapy, for which there is still no consensus regarding the best treatment.
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