Original article
Ear malformations, hearing loss and hearing rehabilitation in children with Treacher Collins syndrome
Malformaciones del oído, hipoacusia y rehabilitación auditiva en los niños con el síndrome de Treacher-Collins
Francisco Rosa
, Miguel Bebiano Coutinho, João Pinto Ferreira, Cecilia Almeida Sousa
Corresponding author
Department of Otolaryngology and Neck-Facial Surgery, Hospital de Santo António-Hospital Centre of Porto, Portugal
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Common manifestations of the syndrome include hypoplasia of the facial bones, in particular the mandible and the zygomatic complex, downslanting palpebral fissures, lower eyelid coloboma and cleft palate.<a class="elsevierStyleCrossRef" href="#bib0150"><span class="elsevierStyleSup">6</span></a> Conductive hearing loss is present in 50% of the cases, which is due to malformations of the outer and middle ear.<a class="elsevierStyleCrossRefs" href="#bib0155"><span class="elsevierStyleSup">7,8</span></a></p><p id="par0010" class="elsevierStylePara elsevierViewall">The approach to these patients is complex and requires integrated care of a large team of experts along their lives.<a class="elsevierStyleCrossRef" href="#bib0155"><span class="elsevierStyleSup">7</span></a> During the evaluation protocol, determining the degree of hearing loss and hearing rehabilitation should be performed as early as possible, through close monitoring by an otolaryngologist, audiologist and speech therapist so as to allow normal development of the language in these children.<a class="elsevierStyleCrossRefs" href="#bib0165"><span class="elsevierStyleSup">9–11</span></a></p><p id="par0015" class="elsevierStylePara elsevierViewall">Since its first use in children in 1984, the bone-anchored hearing aids (BAHA) are an effective way to hearing rehabilitation in children with Treacher-Collins syndrome, with the advantage of being a relatively simple and fast surgical procedure, with a low rate of complications and possible to be performed at pre-school age.<a class="elsevierStyleCrossRefs" href="#bib0180"><span class="elsevierStyleSup">12–15</span></a></p><p id="par0020" class="elsevierStylePara elsevierViewall">This work has two main objectives:<ul class="elsevierStyleList" id="lis0005"><li class="elsevierStyleListItem" id="lsti0005"><span class="elsevierStyleLabel">1.</span><p id="par0025" class="elsevierStylePara elsevierViewall">To characterize the main ear malformations, hearing alterations, type of hearing rehabilitation and outcomes in children with Treacher-Collins syndrome, oriented in our centre.</p></li><li class="elsevierStyleListItem" id="lsti0010"><span class="elsevierStyleLabel">2.</span><p id="par0030" class="elsevierStylePara elsevierViewall">To compare the results with the most recent studies on this topic.</p></li></ul></p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0070">Methods</span><p id="par0035" class="elsevierStylePara elsevierViewall">The authors performed a retrospective analysis of all children with TCS examined at HCP, between January 2003 and January 2013. Patients with definite diagnosis of Treacher-Collins (patients with a mutation in gene TCOF-1 or those with typical phenotype) and below 18 years of age were included in the study. The exclusion criteria were: patients not assessed by computed tomography of the temporal bone (CT-TB), patients without audiometric assessment or totally incomplete clinical process.</p><p id="par0040" class="elsevierStylePara elsevierViewall">Data from clinical processes relating to age, gender, medical history, audiometric evaluation, CT-TB, hearing aid use were collected. In cases of patients with osteo-anchored prosthesis, information about the surgery and its complications were analyzed.</p><p id="par0045" class="elsevierStylePara elsevierViewall">The legal representatives of the children involved have authorized their inclusion in the described study.</p><p id="par0050" class="elsevierStylePara elsevierViewall">In CT-TB the external auditory canal, middle ear, ossicular chain, mastoid cavity, cochlea, vestibule, semicircular canals and internal auditory canal were evaluated.</p><p id="par0055" class="elsevierStylePara elsevierViewall">Hearing evaluation was performed by using pure tone audiometry, free field audiometry with and without use of hearing aids. Hearing loss is presented in pure tone average (PTA), determined by the average of pure tone thresholds of frequencies 500, 1000, 2000 and 4000<span class="elsevierStyleHsp" style=""></span>Hz; and classified according to the International Bureau of Audiophonologie (BIAP) in mild (21–40<span class="elsevierStyleHsp" style=""></span>dB), moderate grade I (41–55<span class="elsevierStyleHsp" style=""></span>dB), moderate grade II (56–70<span class="elsevierStyleHsp" style=""></span>dB), severe grade I (71–80<span class="elsevierStyleHsp" style=""></span>dB) severe grade II (81–90<span class="elsevierStyleHsp" style=""></span>dB) and profound (>90<span class="elsevierStyleHsp" style=""></span>dB). The results are presented as PTA in free field unaided (UA-PTA) with conventional prosthesis (CP-PTA), with Softband (Softband-PTA) or BAHA (BAHA-PTA); audiometric gain with conventional bone prosthesis (Gain-CP<span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>UA-PTA–CP-PTA) with BAHA (Gain-BAHA<span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>UA-PTA–BAHA-PTA) and audiometric gain of the BAHA over conventional prostheses (Gain-<span class="elsevierStyleItalic">BAHAvs</span>CP<span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>CP-PTA–BAHA-PTA). Only the audiometric results obtained after 3 months of use of hearing aids were analyzed.</p><p id="par0060" class="elsevierStylePara elsevierViewall">In the statistical analysis of data the SPSS<span class="elsevierStyleSup">®</span> Statistics 20.0 software was used.</p></span><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0075">Results</span><p id="par0065" class="elsevierStylePara elsevierViewall">In the present study 9 children with TCS were evaluated: 7 female and 2 male, a total of 18 ears were assessed by using CT-TB and audiometry. They were between 1 month and 14 years old, with an average age of 1 year and 7 months in the first observation in this service. The follow-up of the children ranged from 6 to 21 years, and there was no abandonment. Only two of the studied children had kinship with each other (monozygotic twins).</p><p id="par0070" class="elsevierStylePara elsevierViewall">The epidemiological characteristics and key clinical information are summarized in <a class="elsevierStyleCrossRef" href="#tbl0005">Table 1</a>.</p><elsevierMultimedia ident="tbl0005"></elsevierMultimedia><span id="sec0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0080">Ear malformations</span><p id="par0075" class="elsevierStylePara elsevierViewall">The main ear malformations are described in <a class="elsevierStyleCrossRef" href="#fig0005">Graphic 1</a>.</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><p id="par0080" class="elsevierStylePara elsevierViewall">The majority of patients had symmetrical malformations of the pinna (8/9, 89%) being the most common abnormality microtia (95% of cases) that, according to the classification of Marx, can be divided into type I (<span class="elsevierStyleItalic">n</span><span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>5; 28%) and type II (<span class="elsevierStyleItalic">n</span><span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>12, 67%). One patient had cup-ear and all of them had the pinna with morphological changes. All the patients had symmetrical changes in the external auditory canal (EAC) of 2 types: atresia (14/18, 78%) and stenosis (4/18, 22%).</p><p id="par0085" class="elsevierStylePara elsevierViewall">The middle ear cavity was hypoplastic and dysmorphic approximately symmetrically in all subjects (<a class="elsevierStyleCrossRef" href="#fig0010">Fig. 1</a>). In the assessed patients the ossicular chain showed changes mainly symmetrical (7/9, 78%) as dysplasia (8/18, 44%) or absence of the ossicular chain (10/18, 56%).</p><elsevierMultimedia ident="fig0010"></elsevierMultimedia><p id="par0090" class="elsevierStylePara elsevierViewall">No change was observed at the level of the structures of the inner ear (cochlea, vestibule, semi-circular canals and internal auditory canal).</p><p id="par0095" class="elsevierStylePara elsevierViewall">To note that two individuals had bilateral changes in the path of the facial nerve (4/18, 22%) and all the patients had hypoplastic and poorly pneumatized mastoid cavities.</p></span><span id="sec0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0085">Audiometric results</span><p id="par0100" class="elsevierStylePara elsevierViewall">All the patients had bilateral conductive hearing loss, which according to the classification of BIAP, ranged from moderate grade I to severe grade II, with an average hearing loss (± standard deviation) of 64.3<span class="elsevierStyleHsp" style=""></span>±<span class="elsevierStyleHsp" style=""></span>8.5<span class="elsevierStyleHsp" style=""></span>dB. Of all the assessed ears, 3 had moderate hearing loss grade I (52.3<span class="elsevierStyleHsp" style=""></span>±<span class="elsevierStyleHsp" style=""></span>2.5<span class="elsevierStyleHsp" style=""></span>dB), 12 had moderate hearing loss grade II (63.8<span class="elsevierStyleHsp" style=""></span>±<span class="elsevierStyleHsp" style=""></span>4.1<span class="elsevierStyleHsp" style=""></span>dB), 2 had severe hearing loss grade I (75.5<span class="elsevierStyleHsp" style=""></span>±<span class="elsevierStyleHsp" style=""></span>2.1<span class="elsevierStyleHsp" style=""></span>dB) and 1 had severe hearing loss grade II (83<span class="elsevierStyleHsp" style=""></span>dB). In 3 individuals, the degree of bilateral hearing loss did not fall into the same category; however, the difference was only of one category (moderate grade I/moderate grade II, grade II moderate/severe grade I, grade I severe/severe grade II) and averaging 7.3<span class="elsevierStyleHsp" style=""></span>±<span class="elsevierStyleHsp" style=""></span>4.2<span class="elsevierStyleHsp" style=""></span>dB. The right hearing loss values were in average 65.3<span class="elsevierStyleHsp" style=""></span>±<span class="elsevierStyleHsp" style=""></span>9.4<span class="elsevierStyleHsp" style=""></span>dB and left 63.2<span class="elsevierStyleHsp" style=""></span>±<span class="elsevierStyleHsp" style=""></span>7.9<span class="elsevierStyleHsp" style=""></span>dB, with an average difference between the two ears of 5<span class="elsevierStyleHsp" style=""></span>±<span class="elsevierStyleHsp" style=""></span>3.8<span class="elsevierStyleHsp" style=""></span>dB. The free field audiometry (without hearing aid) showed an average hearing loss of 60<span class="elsevierStyleHsp" style=""></span>±<span class="elsevierStyleHsp" style=""></span>5.3<span class="elsevierStyleHsp" style=""></span>dB.</p><p id="par0105" class="elsevierStylePara elsevierViewall">The relationship between the ear malformations (external and middle ear) and the degree of hearing loss was analyzed as described in <a class="elsevierStyleCrossRef" href="#tbl0010">Table 2</a>. For this purpose, at the external ear level only changes of EAC (atresia or stenosis) were analyzed, since the authors believe that the alterations found at the pinna, besides being similar, slightly contribute to the overall degree of hearing impairment. At the middle ear level, since all individuals had similarly hypoplastic tympanic cavities and only the ossicular chain showed significant variability, just changes at the level of the ossicular chain (dysplasia or absence) were considered.</p><elsevierMultimedia ident="tbl0010"></elsevierMultimedia></span><span id="sec0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0090">Conventional hearing aids</span><p id="par0110" class="elsevierStylePara elsevierViewall">All individuals were subjected to hearing rehabilitation by conventional bone conduction hearing aid applied in stem glasses, headband or in using Softband, having two children first used the prosthesis in headband and then the Softband, one due to headband maladaptive and the other as a form of adaptation and preparation for BAHA. The use of hearing aids began in average at 5 months of age.</p><p id="par0115" class="elsevierStylePara elsevierViewall">The average PTA in free field with conventional prostheses by bone conduction was 26.8<span class="elsevierStyleHsp" style=""></span>±<span class="elsevierStyleHsp" style=""></span>4.1<span class="elsevierStyleHsp" style=""></span>dB, with an estimated 32.8<span class="elsevierStyleHsp" style=""></span>±<span class="elsevierStyleHsp" style=""></span>8.3<span class="elsevierStyleHsp" style=""></span>dB gain. When analyzed separately, the prosthesis by bone conduction in the stem of the glasses/headband obtained an average PTA of 30.1<span class="elsevierStyleHsp" style=""></span>±<span class="elsevierStyleHsp" style=""></span>2.3<span class="elsevierStyleHsp" style=""></span>dB, with a gain of 29.3<span class="elsevierStyleHsp" style=""></span>±<span class="elsevierStyleHsp" style=""></span>5.5<span class="elsevierStyleHsp" style=""></span>dB; the Softband got an average PTA of 23.2<span class="elsevierStyleHsp" style=""></span>±<span class="elsevierStyleHsp" style=""></span>2.7, with a gain of 39.5<span class="elsevierStyleHsp" style=""></span>±<span class="elsevierStyleHsp" style=""></span>6.2<span class="elsevierStyleHsp" style=""></span>dB.</p></span><span id="sec0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0095">Bone-anchored hearing aid – BAHA</span><p id="par0120" class="elsevierStylePara elsevierViewall">Four of 9 of the children involved in this study placed BAHA, having this procedure been performed by the same surgical team, using the same surgical technique under general anaesthesia and not integrated with other procedures. The average age of children at the time of the surgery was 9<span class="elsevierStyleHsp" style=""></span>±<span class="elsevierStyleHsp" style=""></span>5.5 years, with ages between 5 and 17. No child received bilateral BAHA and all of them were implanted on the right side. The site of implantation was decided according to the thickness of the temporal bone, the laterality of the patient and degree of hearing loss in each ear. All surgeries took place in two stages, with an average interval between procedures of 6<span class="elsevierStyleHsp" style=""></span>±<span class="elsevierStyleHsp" style=""></span>2.9 months and all had no intraoperative complications. As postoperative complications, there is a case of extrusion of the implant 6 months after 2nd surgery time, which was promptly surgically solved by placing the abutment 5<span class="elsevierStyleHsp" style=""></span>mm away from the initial site. To note that one of the children, 3 years after the placement of BAHA, suffered a concussion during a football game with destruction of the BAHA processor without any other complications, so it was only necessary to adapt to a new processor. The average PTA in a free field audiometry with BAHA was 18.3<span class="elsevierStyleHsp" style=""></span>±<span class="elsevierStyleHsp" style=""></span>1.3<span class="elsevierStyleHsp" style=""></span>dB, with an average gain of 38<span class="elsevierStyleHsp" style=""></span>±<span class="elsevierStyleHsp" style=""></span>5.5<span class="elsevierStyleHsp" style=""></span>dB relatively to the background values and of 11<span class="elsevierStyleHsp" style=""></span>±<span class="elsevierStyleHsp" style=""></span>1.4<span class="elsevierStyleHsp" style=""></span>dB to the conventional hearing aids.</p></span><span id="sec0040" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0100">Multidisciplinary approach</span><p id="par0125" class="elsevierStylePara elsevierViewall">Apart from the follow-up in Otorhinolaryngology, the children were observed by other areas, such as: Plastic and Reconstructive Surgery (<span class="elsevierStyleItalic">n</span><span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>9); Stomatology (<span class="elsevierStyleItalic">n</span><span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>7), Ophthalmology (<span class="elsevierStyleItalic">n</span><span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>5), Speech Therapy (<span class="elsevierStyleItalic">n</span><span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>7), Psychology (<span class="elsevierStyleItalic">n</span><span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>6), Pulmonology (<span class="elsevierStyleItalic">n</span><span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>1), Paediatrics (<span class="elsevierStyleItalic">n</span><span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>9), Dermatology (<span class="elsevierStyleItalic">n</span><span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>2), Cardiology (<span class="elsevierStyleItalic">n</span><span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>2) and Genetic Medicine (<span class="elsevierStyleItalic">n</span><span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>6). Including the placing of BAHA, in average, the analyzed children were subjected to 3 surgeries, a minimum of 2 and a maximum of six procedures. The most commonly performed surgical procedures were: correction colobomas/external canthopexy (<span class="elsevierStyleItalic">n</span><span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>8); otoplasty (<span class="elsevierStyleItalic">n</span><span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>6); BAHA (<span class="elsevierStyleItalic">n</span><span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>4); Mandibular distraction (<span class="elsevierStyleItalic">n</span><span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>3); cleft palate repair (<span class="elsevierStyleItalic">n</span><span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>3); malar and zygomatic reconstruction (<span class="elsevierStyleItalic">n</span><span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>3); tooth extraction (<span class="elsevierStyleItalic">n</span><span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>2) and tracheostomy (<span class="elsevierStyleItalic">n</span><span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>1).</p></span></span><span id="sec0045" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0105">Discussion</span><p id="par0130" class="elsevierStylePara elsevierViewall">The TCS, for its clinical importance and impact on the child development, has been approached under various aspects, having the authors of the present work focused on an otologic and audiologic manifestations approach, as well as on hearing rehabilitation, stressing the importance of a multidisciplinary team and an early intervention of the otolaryngologist in these cases.</p><p id="par0135" class="elsevierStylePara elsevierViewall">In the present study, we found more cases in individuals of female gender. However, it is not described in the bibliography any predominance of gender.<a class="elsevierStyleCrossRefs" href="#bib0125"><span class="elsevierStyleSup">1,6</span></a> This can be explained by the limited number of analyzed cases.</p><p id="par0140" class="elsevierStylePara elsevierViewall">All the studied individuals had bilateral and mostly symmetrical malformations of the outer and middle ear. The most common abnormalities of the outer ear were microtia (95%), the atresia (78%) and stenosis of the EAC (22%); and of middle ear were hypoplastic and dysmorphic tympanic cavity (100%), dysplastic ossicular chain (56%) or absent (44%). These results are consistent with those found in most sudies.<a class="elsevierStyleCrossRefs" href="#bib0200"><span class="elsevierStyleSup">16–18</span></a> Symmetry of ear malformations is one of the features that allows the differential diagnosis of TCS with other syndromes of different aetiologies but of similar characteristics, such as facial microsomia.<a class="elsevierStyleCrossRef" href="#bib0200"><span class="elsevierStyleSup">16</span></a></p><p id="par0145" class="elsevierStylePara elsevierViewall">No children showed changes in the inner ear. This finding is consistent with the bibliography consulted, because the inner ear malformations are rarely described in association with TCS, since this has distinct embryological origin and development of the middle and outer ear.<a class="elsevierStyleCrossRefs" href="#bib0165"><span class="elsevierStyleSup">9,17</span></a></p><p id="par0150" class="elsevierStylePara elsevierViewall">About 50% of individuals with TCS have unilateral or bilateral conduction hearing loss, usually of moderate or high degree, mainly motivated by otologic malformations of the middle ear.<a class="elsevierStyleCrossRefs" href="#bib0150"><span class="elsevierStyleSup">6,8,19</span></a> In our study, all subjects had moderate or high conduction hearing loss, roughly symmetrical in most cases, which is in line with most of the anatomical changes in the external and middle ear, yet they are also symmetric. By analysing the relationship between malformations of the outer and the middle ear and the degree of hearing loss, we found that most ears had atresia of the EAC and, simultaneously, the absence of the ossicular chain, being these changes associated in average with a higher degree of hearing loss than the others (70<span class="elsevierStyleHsp" style=""></span>±<span class="elsevierStyleHsp" style=""></span>6.1<span class="elsevierStyleHsp" style=""></span>dB). As well as in the consulted bibliography, this study showed that, in average, atresia of the EAC (67.4<span class="elsevierStyleHsp" style=""></span>±<span class="elsevierStyleHsp" style=""></span>6.7<span class="elsevierStyleHsp" style=""></span>dB) and the absence of the ossicular chain (70<span class="elsevierStyleHsp" style=""></span>±<span class="elsevierStyleHsp" style=""></span>6.1<span class="elsevierStyleHsp" style=""></span>dB) are associated with a higher degree of hearing loss than stenosis of the EAC (53.3<span class="elsevierStyleHsp" style=""></span>±<span class="elsevierStyleHsp" style=""></span>2.8<span class="elsevierStyleHsp" style=""></span>dB) and the ossicular dysplasia (57.1<span class="elsevierStyleHsp" style=""></span>±<span class="elsevierStyleHsp" style=""></span>4.8<span class="elsevierStyleHsp" style=""></span>dB).<a class="elsevierStyleCrossRefs" href="#bib0165"><span class="elsevierStyleSup">9,16</span></a></p><p id="par0155" class="elsevierStylePara elsevierViewall">Early detection of conduction hearing loss improves the possibility for rehabilitation of hearing and speech, and in this context, brainstem auditory evoked response plays a very important role.<a class="elsevierStyleCrossRef" href="#bib0155"><span class="elsevierStyleSup">7</span></a> The hearing rehabilitation of such patients should be conducted as early as possible, usually using conventional prostheses by bone conduction, or more recently using the Softband.<a class="elsevierStyleCrossRef" href="#bib0220"><span class="elsevierStyleSup">20</span></a> Our study, as well as others, found that in average, the results of Softband are slightly higher than those of conventional prosthesis.<a class="elsevierStyleCrossRefs" href="#bib0175"><span class="elsevierStyleSup">11,20</span></a></p><p id="par0160" class="elsevierStylePara elsevierViewall">In patients with STC, the BAHA is a very effective method of hearing rehabilitation, enabling better audiometric results compared with conventional prostheses and the Softband.<a class="elsevierStyleCrossRef" href="#bib0185"><span class="elsevierStyleSup">13</span></a> The results of this study with an average PTA in free field with BAHA 18.3<span class="elsevierStyleHsp" style=""></span>±<span class="elsevierStyleHsp" style=""></span>1.3<span class="elsevierStyleHsp" style=""></span>dB, with an average audiometric gain of 38<span class="elsevierStyleHsp" style=""></span>±<span class="elsevierStyleHsp" style=""></span>5.5<span class="elsevierStyleHsp" style=""></span>dB relatively to background values, and of 11<span class="elsevierStyleHsp" style=""></span>±<span class="elsevierStyleHsp" style=""></span>1.4<span class="elsevierStyleHsp" style=""></span>dB over conventional hearing aids are similar to those found in other studies with children.<a class="elsevierStyleCrossRefs" href="#bib0220"><span class="elsevierStyleSup">20,21</span></a> The functional gains analyzed were very close to normal hearing, being the degree of satisfaction of patients and their caregivers very high. The main advantages of using BAHA over conventional prosthesis are: the best amplification and sound quality, better bone conduction, comfort and aesthetic appearance, a relatively simple and fast surgical procedure with few complications.<a class="elsevierStyleCrossRef" href="#bib0180"><span class="elsevierStyleSup">12</span></a> In the analyzed patients, and in accordance with international guidelines for paediatric BAHA, this surgery was performed only after 3 years of age.<a class="elsevierStyleCrossRef" href="#bib0230"><span class="elsevierStyleSup">22</span></a> The option of performing surgery in a single operation or in two surgical times is a target matter of great debate, especially in patients where general anaesthesia and intubation can be complicated.<a class="elsevierStyleCrossRef" href="#bib0235"><span class="elsevierStyleSup">23</span></a> The choice of two surgical times, spaced over a recommended period of 3–6 months allows a better bone integration of the titanium implant.<a class="elsevierStyleCrossRef" href="#bib0230"><span class="elsevierStyleSup">22</span></a> One of the inherent risks to the use of the BAHA is the possibility of the prosthesis destruction with or without extrusion of the implant, associated for example, to trauma, as it was the case of one of our children. These risks can be significantly reduced through a psychological evaluation of the patient, teaching of postoperative care to children and their caregivers. The fact that the bone integration of the implant has failed in a child is in accordance with recent studies indicating that the failure rate is about 20%.<a class="elsevierStyleCrossRef" href="#bib0240"><span class="elsevierStyleSup">24</span></a></p><p id="par0165" class="elsevierStylePara elsevierViewall">The malformation peculiarities of children with TCS require a multidisciplinary team approach, with the aim of functional and aesthetic correction, and normal psychosocial development, as it can be proved by the high number of medical consultations in different specialties and surgical procedures performed. Despite not having occurred in this study, we noted that the placement of BAHA should, wherever possible, be combined with other surgical procedure, given the anaesthetic risk and the high number of surgeries that these children are subject to.<a class="elsevierStyleCrossRef" href="#bib0185"><span class="elsevierStyleSup">13</span></a></p></span><span id="sec0050" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0110">Conclusions</span><p id="par0170" class="elsevierStylePara elsevierViewall">The Treacher-Collins syndrome (or mandibulofacial dysostosis) is a hereditary entity with autosomal dominant transmission characterized by abnormalities of the structures that are developed from the 1st and 2nd branchial arches, affecting 1 in every 50,000 live births. Most children have bilateral and symmetrical morphological alterations of the outer and middle ear, conditioning different degrees of conduction hearing loss. Hearing rehabilitation in these children is extremely important, and the BAHA is the chosen method, since these children usually have difficulty in adapting to conventional hearing aids due to malformations of the external ear.</p></span><span id="sec0055" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0115">Conflict of interest</span><p id="par0175" class="elsevierStylePara elsevierViewall">The authors declare no conflict of interest.</p></span></span>" "textoCompletoSecciones" => array:1 [ "secciones" => array:11 [ 0 => array:3 [ "identificador" => "xres632854" "titulo" => "Abstract" "secciones" => array:4 [ 0 => array:2 [ "identificador" => "abst0005" "titulo" => "Objective" ] 1 => array:2 [ "identificador" => "abst0010" "titulo" => "Methods" ] 2 => array:2 [ "identificador" => "abst0015" "titulo" => "Results" ] 3 => array:2 [ "identificador" => "abst0020" "titulo" => "Conclusions" ] ] ] 1 => array:2 [ "identificador" => "xpalclavsec645511" "titulo" => "Keywords" ] 2 => array:3 [ "identificador" => "xres632853" "titulo" => "Resumen" "secciones" => array:4 [ 0 => array:2 [ "identificador" => "abst0025" "titulo" => "Objetivo" ] 1 => array:2 [ "identificador" => "abst0030" "titulo" => "Métodos" ] 2 => array:2 [ "identificador" => "abst0035" "titulo" => "Resultados" ] 3 => array:2 [ "identificador" => "abst0040" "titulo" => "Conclusiones" ] ] ] 3 => array:2 [ "identificador" => "xpalclavsec645510" "titulo" => "Palabras clave" ] 4 => array:2 [ "identificador" => "sec0005" "titulo" => "Introduction" ] 5 => array:2 [ "identificador" => "sec0010" "titulo" => "Methods" ] 6 => array:3 [ "identificador" => "sec0015" "titulo" => "Results" "secciones" => array:5 [ 0 => array:2 [ "identificador" => "sec0020" "titulo" => "Ear malformations" ] 1 => array:2 [ "identificador" => "sec0025" "titulo" => "Audiometric results" ] 2 => array:2 [ "identificador" => "sec0030" "titulo" => "Conventional hearing aids" ] 3 => array:2 [ "identificador" => "sec0035" "titulo" => "Bone-anchored hearing aid – BAHA" ] 4 => array:2 [ "identificador" => "sec0040" "titulo" => "Multidisciplinary approach" ] ] ] 7 => array:2 [ "identificador" => "sec0045" "titulo" => "Discussion" ] 8 => array:2 [ "identificador" => "sec0050" "titulo" => "Conclusions" ] 9 => array:2 [ "identificador" => "sec0055" "titulo" => "Conflict of interest" ] 10 => array:1 [ "titulo" => "References" ] ] ] "pdfFichero" => "main.pdf" "tienePdf" => true "fechaRecibido" => "2014-09-06" "fechaAceptado" => "2015-01-25" "PalabrasClave" => array:2 [ "en" => array:1 [ 0 => array:4 [ "clase" => "keyword" "titulo" => "Keywords" "identificador" => "xpalclavsec645511" "palabras" => array:5 [ 0 => "Treacher Collins syndrome" 1 => "Mandibulofacial dysostosis" 2 => "Ear malformations" 3 => "Hearing loss, Bone-anchored hearing aids" 4 => "Hearing rehabilitation" ] ] ] "es" => array:1 [ 0 => array:4 [ "clase" => "keyword" "titulo" => "Palabras clave" "identificador" => "xpalclavsec645510" "palabras" => array:6 [ 0 => "Síndrome de Treacher-Collins" 1 => "Disostosis mandibulofacial" 2 => "Hipoacusia" 3 => "Audífono anclado en hueso" 4 => "Rehabilitación auditiva" 5 => "Malformaciones del oído" ] ] ] ] "tieneResumen" => true "resumen" => array:2 [ "en" => array:3 [ "titulo" => "Abstract" "resumen" => "<span id="abst0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0010">Objective</span><p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">The aim of this study was to assess the main ear malformations, hearing loss and auditory rehabilitation in children with Treacher Collins syndrome.</p></span> <span id="abst0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0015">Methods</span><p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">We performed a retrospective study of 9 children with Treacher Collins syndrome treated in a central hospital between January 2003 and January 2013.</p></span> <span id="abst0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0020">Results</span><p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">This study showed a high incidence of malformations of the outer and middle ear, such as microtia, atresia or stenosis of the external auditory canal, hypoplastic middle ear cavity, dysmorphic or missing ossicular chain. Most patients had bilateral hearing loss of moderate or high degree. In the individuals studied, there was functional improvement in patients with bone-anchored hearing aids in relation to conventional hearing aids by bone conduction.</p></span> <span id="abst0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0025">Conclusions</span><p id="spar0020" class="elsevierStyleSimplePara elsevierViewall">Treacher Collins syndrome is characterized by bilateral malformations of the outer and middle ear. Hearing rehabilitation in these children is of utmost importance, and bone-anchored hearing aids is the method of choice.</p></span>" "secciones" => array:4 [ 0 => array:2 [ "identificador" => "abst0005" "titulo" => "Objective" ] 1 => array:2 [ "identificador" => "abst0010" "titulo" => "Methods" ] 2 => array:2 [ "identificador" => "abst0015" "titulo" => "Results" ] 3 => array:2 [ "identificador" => "abst0020" "titulo" => "Conclusions" ] ] ] "es" => array:3 [ "titulo" => "Resumen" "resumen" => "<span id="abst0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0035">Objetivo</span><p id="spar0025" class="elsevierStyleSimplePara elsevierViewall">Evaluar las principales malformaciones del oído, hipoacusia y la rehabilitación auditiva en los niños con síndrome de Treacher-Collins.</p></span> <span id="abst0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0040">Métodos</span><p id="spar0030" class="elsevierStyleSimplePara elsevierViewall">Estudio retrospectivo de 9 niños con síndrome de Treacher-Collins tratados en un hospital central, entre enero de 2003 y enero de 2013.</p></span> <span id="abst0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0045">Resultados</span><p id="spar0035" class="elsevierStyleSimplePara elsevierViewall">Este estudio demostró una alta incidencia de malformaciones del oído externo y medio, como microtia, atresia o estenosis del conducto auditivo externo, la cavidad timpánica hipoplásica, la cadena de huesecillos dismórfica, o ausente. La mayoría de los pacientes tenían una hipoacusia de conducción grado moderado o alto. En los sujetos estudiados, se observó una mejoría funcional en los pacientes con audífono anclado en hueso en relación con los audífonos convencionales de conducción ósea.</p></span> <span id="abst0040" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0050">Conclusiones</span><p id="spar0040" class="elsevierStyleSimplePara elsevierViewall">El síndrome de Treacher-Collins se caracteriza por malformaciones bilaterales del oído externo y medio. La rehabilitación auditiva en estos niños es muy importante, y el audífono anclado en hueso es el método de elección.</p></span>" "secciones" => array:4 [ 0 => array:2 [ "identificador" => "abst0025" "titulo" => "Objetivo" ] 1 => array:2 [ "identificador" => "abst0030" "titulo" => "Métodos" ] 2 => array:2 [ "identificador" => "abst0035" "titulo" => "Resultados" ] 3 => array:2 [ "identificador" => "abst0040" "titulo" => "Conclusiones" ] ] ] ] "multimedia" => array:4 [ 0 => array:7 [ "identificador" => "fig0005" "etiqueta" => "Graphic 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "pl1.jpeg" "Alto" => 1784 "Ancho" => 3248 "Tamanyo" => 231654 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0065" class="elsevierStyleSimplePara elsevierViewall">The main ear malformations</p>" ] ] 1 => array:7 [ "identificador" => "fig0010" "etiqueta" => "Figure 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 470 "Ancho" => 1950 "Tamanyo" => 115152 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0045" class="elsevierStyleSimplePara elsevierViewall">(A) 3D Reconstruction from the axial skull-brain CT – showing malar and mandibular hypoplasia, absence of the zygomatic complex and atresia of the left EAC; (B) Axial CT of the temporal bone and (C) coronal reconstruction from axial CT – showing hypoplastic tympanic cavity, absence of the ossicular chain, and atresia EAC.</p>" ] ] 2 => array:7 [ "identificador" => "tbl0005" "etiqueta" => "Table 1" "tipo" => "MULTIMEDIATABLA" "mostrarFloat" => true "mostrarDisplay" => false "tabla" => array:2 [ "leyenda" => "<p id="spar0055" class="elsevierStyleSimplePara elsevierViewall">RE – right ear; LE – left ear; BC – bone conduction; AC – air conduction; PTA – pure tone average; FF – free field audiometry; CP – conventional prosthesis; BAHA – bone-anchored hearing aid; M – months; Y – years.</p>" "tablatextoimagen" => array:1 [ 0 => array:2 [ "tabla" => array:1 [ 0 => """ <table border="0" frame="\n \t\t\t\t\tvoid\n \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="table-head " align="left" valign="top" scope="col">Patient \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col">Gender \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col">1st consultation \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " colspan="5" align="center" valign="top" scope="col" style="border-bottom: 2px solid black">Without prosthesis</th><th class="td" title="table-head " colspan="6" align="center" valign="top" scope="col" style="border-bottom: 2px solid black">Conventional bone conduction hearing aid</th><th class="td" title="table-head " colspan="9" align="center" valign="top" scope="col" style="border-bottom: 2px solid black">BAHA</th></tr><tr title="table-row"><th class="td" title="table-head " align="" valign="top" scope="col"> \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="" valign="top" scope="col"> \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="" valign="top" scope="col"> \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " colspan="2" align="center" valign="top" scope="col" style="border-bottom: 2px solid black">RE</th><th class="td" title="table-head " colspan="2" align="center" valign="top" scope="col" style="border-bottom: 2px solid black">LE</th><th class="td" title="table-head " align="left" valign="top" scope="col">FF \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " colspan="2" align="center" valign="top" scope="col">Type</th><th class="td" title="table-head " colspan="2" align="center" valign="top" scope="col">FF</th><th class="td" title="table-head " colspan="2" align="center" valign="top" scope="col">Gain</th><th class="td" title="table-head " colspan="2" align="center" valign="top" scope="col">Age</th><th class="td" title="table-head " colspan="2" align="center" valign="top" scope="col">Surgical steps</th><th class="td" title="table-head " colspan="2" align="center" valign="top" scope="col">Interval (months)</th><th class="td" title="table-head " align="left" valign="top" scope="col">PTA \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col">Gain \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col">Gain BAHA vs CP \t\t\t\t\t\t\n \t\t\t\t</th></tr><tr title="table-row"><th class="td" title="table-head " align="" valign="top" scope="col" style="border-bottom: 2px solid black"> \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="" valign="top" scope="col" style="border-bottom: 2px solid black"> \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="" valign="top" scope="col" style="border-bottom: 2px solid black"> \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">BC \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">AC \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">BC \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">AC \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="" valign="top" scope="col" style="border-bottom: 2px solid black"> \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="" valign="top" scope="col" style="border-bottom: 2px solid black"> \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="" valign="top" scope="col" style="border-bottom: 2px solid black"> \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="" valign="top" scope="col" style="border-bottom: 2px solid black"> \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="" valign="top" scope="col" style="border-bottom: 2px solid black"> \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="" valign="top" scope="col" style="border-bottom: 2px solid black"> \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="" valign="top" scope="col" style="border-bottom: 2px solid black"> \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="" valign="top" scope="col" style="border-bottom: 2px solid black"> \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="" valign="top" scope="col" style="border-bottom: 2px solid black"> \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="" valign="top" scope="col" style="border-bottom: 2px solid black"> \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="" valign="top" scope="col" style="border-bottom: 2px solid black"> \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="" valign="top" scope="col" style="border-bottom: 2px solid black"> \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="" valign="top" scope="col" style="border-bottom: 2px solid black"> \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="" valign="top" scope="col" style="border-bottom: 2px solid black"> \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="" valign="top" scope="col" style="border-bottom: 2px solid black"> \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="" valign="top" scope="col" style="border-bottom: 2px solid black"> \t\t\t\t\t\t\n \t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top">1 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">F \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">1<span class="elsevierStyleHsp" style=""></span>M \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">10 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">60 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">10 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">69 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">63 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " colspan="2" align="center" valign="top">Headband</td><td class="td" title="table-entry " colspan="2" align="char" valign="top">27</td><td class="td" title="table-entry " colspan="2" align="char" valign="top">36</td><td class="td" title="table-entry " colspan="2" align="char" valign="top">8</td><td class="td" title="table-entry " colspan="2" align="char" valign="top">2</td><td class="td" title="table-entry " colspan="2" align="char" valign="top">6</td><td class="td" title="table-entry " align="char" valign="top">17 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">46 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">10 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top">2 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">F \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">14<span class="elsevierStyleHsp" style=""></span>Y \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">10 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">67 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">10 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">65 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">57 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " colspan="2" align="center" valign="top">Eyeglass frame</td><td class="td" title="table-entry " colspan="2" align="char" valign="top">33</td><td class="td" title="table-entry " colspan="2" align="char" valign="top">24</td><td class="td" title="table-entry " colspan="2" align="char" valign="top">17</td><td class="td" title="table-entry " colspan="2" align="char" valign="top">2</td><td class="td" title="table-entry " colspan="2" align="char" valign="top">2</td><td class="td" title="table-entry " align="char" valign="top">20 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">37 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">13 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top">3 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">F \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">1<span class="elsevierStyleHsp" style=""></span>M \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">5 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">55 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">5 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">50 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">52 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " colspan="2" align="center" valign="top">Headband</td><td class="td" title="table-entry " colspan="2" align="char" valign="top">29</td><td class="td" title="table-entry " colspan="2" align="char" valign="top">23</td><td class="td" title="table-entry " align="char" valign="top">6 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">7 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">2 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">2 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">5 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">7 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">18 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">34 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">11 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top">4 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">M \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">1<span class="elsevierStyleHsp" style=""></span>M \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">10 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">52 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">10 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">56 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">53 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " colspan="2" align="center" valign="top">Headband</td><td class="td" title="table-entry " colspan="2" align="char" valign="top">28</td><td class="td" title="table-entry " colspan="2" align="char" valign="top">25</td><td class="td" title="table-entry " colspan="2" align="char" valign="top">5</td><td class="td" title="table-entry " colspan="2" align="char" valign="top">2</td><td class="td" title="table-entry " colspan="2" align="char" valign="top">10</td><td class="td" title="table-entry " align="char" valign="top">18 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">35 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">10 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top">5 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">F \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">2<span class="elsevierStyleHsp" style=""></span>M \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">15 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">74 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">15 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">62 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">62 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="center" valign="top">Headband \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="center" valign="top">Softband \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">30 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">20 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">32 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">42 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="" valign="top"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="" valign="top"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="" valign="top"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="" valign="top"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="" valign="top"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="" valign="top"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="" valign="top"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="" valign="top"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="" valign="top"> \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top">6 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">F \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">2<span class="elsevierStyleHsp" style=""></span>M \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">15 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">83 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">10 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">77 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">69 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="center" valign="top">Headband \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="center" valign="top">Softband \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">33 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">22 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">36 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">47 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="" valign="top"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="" valign="top"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="" valign="top"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="" valign="top"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="" valign="top"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="" valign="top"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="" valign="top"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="" valign="top"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="" valign="top"> \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top">7 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">F \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">1<span class="elsevierStyleHsp" style=""></span>M \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">10 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">68 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">12 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">67 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">62 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " colspan="2" align="center" valign="top">Softband</td><td class="td" title="table-entry " colspan="2" align="char" valign="top">26</td><td class="td" title="table-entry " colspan="2" align="char" valign="top">36</td><td class="td" title="table-entry " align="" valign="top"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="" valign="top"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="" valign="top"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="" valign="top"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="" valign="top"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="" valign="top"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="" valign="top"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="" valign="top"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="" valign="top"> \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top">8 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">M \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">1<span class="elsevierStyleHsp" style=""></span>M \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">9 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">65 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">12 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">65 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">58 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " colspan="2" align="center" valign="top">Softband</td><td class="td" title="table-entry " colspan="2" align="char" valign="top">25</td><td class="td" title="table-entry " colspan="2" align="char" valign="top">33</td><td class="td" title="table-entry " align="" valign="top"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="" valign="top"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="" valign="top"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="" valign="top"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="" valign="top"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="" valign="top"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="" valign="top"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="" valign="top"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="" valign="top"> \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top">9 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">F \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">1<span class="elsevierStyleHsp" style=""></span>M \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">8 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">64 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">8 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">58 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">60 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " colspan="2" align="center" valign="top">Headband</td><td class="td" title="table-entry " colspan="2" align="char" valign="top">31</td><td class="td" title="table-entry " colspan="2" align="char" valign="top">29</td><td class="td" title="table-entry " align="" valign="top"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="" valign="top"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="" valign="top"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="" valign="top"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="" valign="top"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="" valign="top"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="" valign="top"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="" valign="top"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="" valign="top"> \t\t\t\t\t\t\n \t\t\t\t</td></tr></tbody></table> """ ] "imagenFichero" => array:1 [ 0 => "xTab1037966.png" ] ] ] ] "descripcion" => array:1 [ "en" => "<p id="spar0050" class="elsevierStyleSimplePara elsevierViewall">Anagraphic, surgical and audiometric data of the patients included into the study.</p>" ] ] 3 => array:7 [ "identificador" => "tbl0010" "etiqueta" => "Table 2" "tipo" => "MULTIMEDIATABLA" "mostrarFloat" => true "mostrarDisplay" => false "tabla" => array:1 [ "tablatextoimagen" => array:1 [ 0 => array:2 [ "tabla" => array:1 [ 0 => """ <table border="0" frame="\n \t\t\t\t\tvoid\n \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="table-head " align="" valign="top" scope="col"> \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " colspan="2" align="center" valign="top" scope="col" style="border-bottom: 2px solid black">Ossicular chain</th><th class="td" title="table-head " align="left" valign="top" scope="col">Total \t\t\t\t\t\t\n \t\t\t\t</th></tr><tr title="table-row"><th class="td" title="table-head " align="" valign="top" scope="col" style="border-bottom: 2px solid black"> \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Dysplasia \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Absent \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="" valign="top" scope="col" style="border-bottom: 2px solid black"> \t\t\t\t\t\t\n \t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td" title="table-entry " colspan="4" align="left" valign="top"><span class="elsevierStyleItalic">External auditory canal</span></td></tr><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Stenosis \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top"><span class="elsevierStyleItalic">n</span><span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>4<br>53.3<span class="elsevierStyleHsp" style=""></span>±<span class="elsevierStyleHsp" style=""></span>2.8<span class="elsevierStyleHsp" style=""></span>dB \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top"><span class="elsevierStyleItalic">n</span><span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>0 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top"><span class="elsevierStyleItalic">n</span><span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>4<br>53.3<span class="elsevierStyleHsp" style=""></span>±<span class="elsevierStyleHsp" style=""></span>2.8<span class="elsevierStyleHsp" style=""></span>dB \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Atresia \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top"><span class="elsevierStyleItalic">n</span><span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>4<br>61<span class="elsevierStyleHsp" style=""></span>±<span class="elsevierStyleHsp" style=""></span>2.6<span class="elsevierStyleHsp" style=""></span>dB \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top"><span class="elsevierStyleItalic">n</span><span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>10<br>70<span class="elsevierStyleHsp" style=""></span>±<span class="elsevierStyleHsp" style=""></span>6.1<span class="elsevierStyleHsp" style=""></span>dB \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top"><span class="elsevierStyleItalic">n</span><span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>14<br>67.4<span class="elsevierStyleHsp" style=""></span>±<span class="elsevierStyleHsp" style=""></span>6.7<span class="elsevierStyleHsp" style=""></span>dB \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top">Total \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top"><span class="elsevierStyleItalic">n</span><span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>8<br>57.1<span class="elsevierStyleHsp" style=""></span>±<span class="elsevierStyleHsp" style=""></span>4.8<span class="elsevierStyleHsp" style=""></span>dB \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top"><span class="elsevierStyleItalic">n</span><span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>10<br>70<span class="elsevierStyleHsp" style=""></span>±<span class="elsevierStyleHsp" style=""></span>6.1<span class="elsevierStyleHsp" style=""></span>dB \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top"><span class="elsevierStyleItalic">n</span><span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>18 \t\t\t\t\t\t\n \t\t\t\t</td></tr></tbody></table> """ ] "imagenFichero" => array:1 [ 0 => "xTab1037967.png" ] ] ] ] "descripcion" => array:1 [ "en" => "<p id="spar0060" class="elsevierStyleSimplePara elsevierViewall">Relationship between ear malformations and hearing loss.</p>" ] ] ] "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0005" "bibliografiaReferencia" => array:24 [ 0 => array:3 [ "identificador" => "bib0125" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Genetic syndromes involving hearing" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:3 [ 0 => "A. Martini" 1 => "F. Calzolari" 2 => "A. Sensi" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/S0165-5876(09)70002-3" "Revista" => array:7 [ "tituloSerie" => "Int J Pediatr Otorhinolaryngol" "fecha" => "2009" "volumen" => "73" "numero" => "Suppl. 1" "paginaInicial" => "S2" "paginaFinal" => "S12" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/20114151" "web" => "Medline" ] ] ] ] ] ] ] ] 1 => array:3 [ "identificador" => "bib0130" "etiqueta" => "2" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Obstructive sleep apnoea in Treacher Collins syndrome: prevalence, severity and cause" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "R.G. Plomp" 1 => "H.H. Bredero-Boelhouwer" 2 => "K.F. Joosten" 3 => "E.B. Wolvius" 4 => "H.L. Hoeve" 5 => "R.M. Poublon" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/j.ijom.2012.01.018" "Revista" => array:6 [ "tituloSerie" => "Int J Oral Maxillofac Surg" "fecha" => "2012" "volumen" => "41" "paginaInicial" => "696" "paginaFinal" => "701" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/22521672" "web" => "Medline" ] ] ] ] ] ] ] ] 2 => array:3 [ "identificador" => "bib0135" "etiqueta" => "3" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Novel mutations of TCOF1 gene in European patients with Treacher Collins syndrome" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:6 [ 0 => "C. Conte" 1 => "M.R. D’Apice" 2 => "F. Rinaldi" 3 => "S. Gambardella" 4 => "F. Sangiuolo" 5 => "G. Novelli" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1186/1471-2350-12-125" "Revista" => array:5 [ "tituloSerie" => "BMC Med Genet" "fecha" => "2011" "volumen" => "12" "paginaInicial" => "125" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/21951868" "web" => "Medline" ] ] ] ] ] ] ] ] 3 => array:3 [ "identificador" => "bib0140" "etiqueta" => "4" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Treacher Collins syndrome: clinical implications for the paediatrician – a new mutation in a severely affected newborn and comparison with three further patients with the same mutation, and review of the literature" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "J.U. Schlump" 1 => "A. Stein" 2 => "U. Hehr" 3 => "T. Karen" 4 => "C. Möller-Hartmann" 5 => "N.H. Elcioglu" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1007/s00431-012-1776-7" "Revista" => array:6 [ "tituloSerie" => "Eur J Pediatr" "fecha" => "2012" "volumen" => "171" "paginaInicial" => "1611" "paginaFinal" => "1618" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/22729243" "web" => "Medline" ] ] ] ] ] ] ] ] 4 => array:3 [ "identificador" => "bib0145" "etiqueta" => "5" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Treacher Collins syndrome: a case review" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:1 [ 0 => "G. Jensen-Steed" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1097/ANC.0b013e3182338070" "Revista" => array:6 [ "tituloSerie" => "Adv Neonatal Care" "fecha" => "2011" "volumen" => "11" "paginaInicial" => "389" "paginaFinal" => "394" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/22123469" "web" => "Medline" ] ] ] ] ] ] ] ] 5 => array:3 [ "identificador" => "bib0150" "etiqueta" => "6" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Treacher Collins syndrome" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:2 [ 0 => "S.H. Katsanis" 1 => "E.W. Jabs" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "LibroEditado" => array:2 [ "titulo" => "GeneReviews" "serieFecha" => "1993" ] ] ] ] ] ] 6 => array:3 [ "identificador" => "bib0155" "etiqueta" => "7" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Multidisciplinary treatment approach in Treacher Collins syndrome" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:4 [ 0 => "J.B. Hylton" 1 => "V. Leon-Salazar" 2 => "G.C. Anderson" 3 => "N.L. De Felippe" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:5 [ "tituloSerie" => "J Dent Child (Chic)" "fecha" => "2012" "volumen" => "79" "paginaInicial" => "15" "paginaFinal" => "21" ] ] ] ] ] ] 7 => array:3 [ "identificador" => "bib0160" "etiqueta" => "8" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Application of the Vibrant Soundbridge middle-ear implant for aural atresia in patients with Treacher Collins syndrome" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:3 [ 0 => "E. Lesinskas" 1 => "V. Stankeviciute" 2 => "M. Petrulionis" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1017/S0022215112002344" "Revista" => array:6 [ "tituloSerie" => "J Laryngol Otol" "fecha" => "2012" "volumen" => "126" "paginaInicial" => "1216" "paginaFinal" => "1223" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/23168240" "web" => "Medline" ] ] ] ] ] ] ] ] 8 => array:3 [ "identificador" => "bib0165" "etiqueta" => "9" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Hearing loss in the Treacher-Collins syndrome" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:1 [ 0 => "H.A. Marres" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:6 [ "tituloSerie" => "Adv Otorhinolaryngol" "fecha" => "2002" "volumen" => "61" "paginaInicial" => "209" "paginaFinal" => "215" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/12408086" "web" => "Medline" ] ] ] ] ] ] ] ] 9 => array:3 [ "identificador" => "bib0170" "etiqueta" => "10" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Treacher Collins syndrome: protocol management from birth to maturity" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:3 [ 0 => "J.T. Thompson" 1 => "P.J. Anderson" 2 => "D.J. David" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1097/SCS.0b013e3181be8788" "Revista" => array:6 [ "tituloSerie" => "J Craniofac Surg" "fecha" => "2009" "volumen" => "20" "paginaInicial" => "2028" "paginaFinal" => "2035" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/19881372" "web" => "Medline" ] ] ] ] ] ] ] ] 10 => array:3 [ "identificador" => "bib0175" "etiqueta" => "11" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "The Baha Softband. A new treatment for young children with bilateral congenital aural atresia" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:5 [ 0 => "C.V. Verhagen" 1 => "M.K. Hol" 2 => "W. Coppens-Schellekens" 3 => "A.F. Snik" 4 => "C.W. Cremers" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/j.ijporl.2008.06.009" "Revista" => array:6 [ "tituloSerie" => "Int J Pediatr Otorhinolaryngol" "fecha" => "2008" "volumen" => "72" "paginaInicial" => "1455" "paginaFinal" => "1459" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/18667244" "web" => "Medline" ] ] ] ] ] ] ] ] 11 => array:3 [ "identificador" => "bib0180" "etiqueta" => "12" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Hearing rehabilitation in congenital aural atresia using the bone-anchored hearing aid: audiological and satisfaction results" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "C. Fuchsmann" 1 => "S. Tringali" 2 => "F. Disant" 3 => "G. Buiret" 4 => "C. Dubreuil" 5 => "P. Froehlich" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.3109/00016489.2010.499879" "Revista" => array:6 [ "tituloSerie" => "Acta Otolaryngol" "fecha" => "2010" "volumen" => "130" "paginaInicial" => "1343" "paginaFinal" => "1351" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/20735185" "web" => "Medline" ] ] ] ] ] ] ] ] 12 => array:3 [ "identificador" => "bib0185" "etiqueta" => "13" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Bone-anchored hearing aid (Baha) in patients with Treacher Collins syndrome: tips and pitfalls" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:4 [ 0 => "P. Marsella" 1 => "A. Scorpecci" 2 => "C. Pacifico" 3 => "L. Tieri" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/j.ijporl.2011.07.020" "Revista" => array:6 [ "tituloSerie" => "Int J Pediatr Otorhinolaryngol" "fecha" => "2011" "volumen" => "75" "paginaInicial" => "1308" "paginaFinal" => "1312" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/21839526" "web" => "Medline" ] ] ] ] ] ] ] ] 13 => array:3 [ "identificador" => "bib0190" "etiqueta" => "14" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Congenital aural atresia surgery: long-term results" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:2 [ 0 => "A. De la Cruz" 1 => "K.B. Teufert" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:6 [ "tituloSerie" => "Otolaryngol Head Neck Surg" "fecha" => "2003" "volumen" => "129" "paginaInicial" => "121" "paginaFinal" => "127" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/12869927" "web" => "Medline" ] ] ] ] ] ] ] ] 14 => array:3 [ "identificador" => "bib0195" "etiqueta" => "15" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Atresiaplasty versus BAHA for congenital aural atresia" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:1 [ 0 => "R.F. Yellon" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1002/lary.21408" "Revista" => array:6 [ "tituloSerie" => "Laryngoscope" "fecha" => "2011" "volumen" => "121" "paginaInicial" => "2" "paginaFinal" => "3" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/21181977" "web" => "Medline" ] ] ] ] ] ] ] ] 15 => array:3 [ "identificador" => "bib0200" "etiqueta" => "16" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Ear malformation and hearing loss in patients with Treacher Collins syndrome" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:4 [ 0 => "G. Pron" 1 => "C. Galloway" 2 => "D. Armstrong" 3 => "J. Posnick" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1597/1545-1569(1993)030<0097:EMAHLI>2.3.CO;2" "Revista" => array:6 [ "tituloSerie" => "Cleft Palate Craniofac J" "fecha" => "1993" "volumen" => "30" "paginaInicial" => "97" "paginaFinal" => "103" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/8418881" "web" => "Medline" ] ] ] ] ] ] ] ] 16 => array:3 [ "identificador" => "bib0205" "etiqueta" => "17" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Imaging of ear deformities in Treacher Collins syndrome" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:2 [ 0 => "D.J. Taylor" 1 => "P.D. Phelps" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:6 [ "tituloSerie" => "Clin Otolaryngol Allied Sci" "fecha" => "1993" "volumen" => "18" "paginaInicial" => "263" "paginaFinal" => "267" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/8877182" "web" => "Medline" ] ] ] ] ] ] ] ] 17 => array:3 [ "identificador" => "bib0210" "etiqueta" => "18" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "The ear deformities in mandibulofacial dysostosis (Treacher Collins syndrome)" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:3 [ 0 => "P.D. Phelps" 1 => "D. Poswillo" 2 => "G.A. Lloyd" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:6 [ "tituloSerie" => "Clin Otolaryngol Allied Sci" "fecha" => "1981" "volumen" => "6" "paginaInicial" => "15" "paginaFinal" => "28" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/7273449" "web" => "Medline" ] ] ] ] ] ] ] ] 18 => array:3 [ "identificador" => "bib0215" "etiqueta" => "19" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Treacher Collins syndrome: current evaluation, treatment, and future directions" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:2 [ 0 => "J.C. Posnick" 1 => "R.L. Ruiz" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1597/1545-1569(2000)037<0434:TCSCET>2.0.CO;2" "Revista" => array:5 [ "tituloSerie" => "Cleft Palate Craniofac J" "fecha" => "2000" "volumen" => "37" "paginaInicial" => "434" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/11034023" "web" => "Medline" ] ] ] ] ] ] ] ] 19 => array:3 [ "identificador" => "bib0220" "etiqueta" => "20" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Comparison of traditional bone-conduction hearing AIDS with the Baha system" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:5 [ 0 => "L. Christensen" 1 => "L. Smith-Olinde" 2 => "J. Kimberlain" 3 => "G.T. Richter" 4 => "J.L. Dornhoffer" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.3766/jaaa.21.4.5" "Revista" => array:6 [ "tituloSerie" => "J Am Acad Audiol" "fecha" => "2010" "volumen" => "21" "paginaInicial" => "267" "paginaFinal" => "273" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/20388452" "web" => "Medline" ] ] ] ] ] ] ] ] 20 => array:3 [ "identificador" => "bib0225" "etiqueta" => "21" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "BAHA results in children at one year follow-up: a prospective longitudinal study" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:3 [ 0 => "I. Saliba" 1 => "O. Woods" 2 => "C. Caron" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/j.ijporl.2010.06.004" "Revista" => array:6 [ "tituloSerie" => "Int J Pediatr Otorhinolaryngol" "fecha" => "2010" "volumen" => "74" "paginaInicial" => "1058" "paginaFinal" => "1062" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/20594601" "web" => "Medline" ] ] ] ] ] ] ] ] 21 => array:3 [ "identificador" => "bib0230" "etiqueta" => "22" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Consensus statements on the BAHA system: where do we stand at present?" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "A.F. Snik" 1 => "E.A. Mylanus" 2 => "D.W. Proops" 3 => "J.F. Wolfaardt" 4 => "W.E. Hodgetts" 5 => "T. Somers" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:6 [ "tituloSerie" => "Ann Otol Rhinol Laryngol Suppl" "fecha" => "2005" "volumen" => "195" "paginaInicial" => "2" "paginaFinal" => "12" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/16619473" "web" => "Medline" ] ] ] ] ] ] ] ] 22 => array:3 [ "identificador" => "bib0235" "etiqueta" => "23" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Single-stage BAHA implantation in adults and children: is it safe?" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:3 [ 0 => "D. Kohan" 1 => "L.G. Morris" 2 => "T. Romo 3rd" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/j.otohns.2007.12.019" "Revista" => array:6 [ "tituloSerie" => "Otolaryngol Head Neck Surg" "fecha" => "2008" "volumen" => "138" "paginaInicial" => "662" "paginaFinal" => "666" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/18439475" "web" => "Medline" ] ] ] ] ] ] ] ] 23 => array:3 [ "identificador" => "bib0240" "etiqueta" => "24" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Arkansas BAHA experience: transcalvarial fixture placement using osseointegration surgical hardware" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:4 [ 0 => "C.E. Lee" 1 => "L. Christensen" 2 => "G.T. Richter" 3 => "J.L. Dornhoffer" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1097/MAO.0b013e31820e6daf" "Revista" => array:6 [ "tituloSerie" => "Otol Neurotol" "fecha" => "2011" "volumen" => "32" "paginaInicial" => "444" "paginaFinal" => "447" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/21307809" "web" => "Medline" ] ] ] ] ] ] ] ] ] ] ] ] ] "idiomaDefecto" => "en" "url" => "/00016519/0000006700000003/v1_201605010048/S0001651915000515/v1_201605010048/en/main.assets" "Apartado" => array:4 [ "identificador" => "14123" "tipo" => "SECCION" "es" => array:2 [ "titulo" => "Artículos originales" "idiomaDefecto" => true ] "idiomaDefecto" => "es" ] "PDF" => "https://static.elsevier.es/multimedia/00016519/0000006700000003/v1_201605010048/S0001651915000515/v1_201605010048/en/main.pdf?idApp=UINPBA00004N&text.app=https://www.elsevier.es/" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S0001651915000515?idApp=UINPBA00004N" ]
| Year/Month | Html | Total | |
|---|---|---|---|
| 2023 March | 8 | 4 | 12 |
| 2021 March | 0 | 7 | 7 |
| 2021 February | 0 | 15 | 15 |
| 2021 January | 0 | 3 | 3 |
| 2020 December | 0 | 5 | 5 |
| 2020 November | 0 | 2 | 2 |
| 2020 October | 0 | 2 | 2 |
| 2020 September | 0 | 3 | 3 |
| 2020 July | 0 | 4 | 4 |
| 2020 June | 0 | 4 | 4 |
| 2020 April | 0 | 6 | 6 |
| 2020 March | 21 | 4 | 25 |
| 2020 February | 39 | 14 | 53 |
| 2020 January | 51 | 15 | 66 |
| 2019 December | 89 | 18 | 107 |
| 2019 November | 48 | 18 | 66 |
| 2019 October | 49 | 17 | 66 |
| 2019 September | 47 | 9 | 56 |
| 2019 August | 35 | 13 | 48 |
| 2019 July | 32 | 18 | 50 |
| 2019 June | 65 | 34 | 99 |
| 2019 May | 113 | 40 | 153 |
| 2019 April | 98 | 9 | 107 |
| 2019 March | 31 | 8 | 39 |
| 2019 February | 28 | 10 | 38 |
| 2019 January | 20 | 9 | 29 |
| 2018 December | 20 | 10 | 30 |
| 2018 November | 53 | 18 | 71 |
| 2018 October | 41 | 10 | 51 |
| 2018 May | 1 | 0 | 1 |
| 2018 April | 16 | 7 | 23 |
| 2018 March | 18 | 12 | 30 |
| 2018 February | 16 | 5 | 21 |
| 2018 January | 10 | 9 | 19 |
| 2017 December | 11 | 5 | 16 |
| 2017 November | 19 | 11 | 30 |
| 2017 October | 19 | 14 | 33 |
| 2017 September | 18 | 10 | 28 |
| 2017 August | 21 | 9 | 30 |
| 2017 July | 13 | 6 | 19 |
| 2017 June | 35 | 8 | 43 |
| 2017 May | 24 | 10 | 34 |
| 2017 April | 3 | 1 | 4 |
| 2017 March | 0 | 3 | 3 |
| 2017 February | 21 | 9 | 30 |
| 2017 January | 25 | 5 | 30 |
| 2016 December | 37 | 13 | 50 |
| 2016 November | 46 | 18 | 64 |
| 2016 October | 6 | 9 | 15 |
| 2016 September | 0 | 31 | 31 |
| 2016 August | 0 | 8 | 8 |
| 2016 July | 0 | 8 | 8 |
| 2016 June | 1 | 33 | 34 |
| 2016 May | 1 | 47 | 48 |
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