C Morera

Hospital Universitari i Politècnic la Fe, Valenza, Valencia, Spain

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Publications (55)47.73 Total impact

  • Acta Otorrinolaringológica Española 03/2014; 65(2):131–132. DOI:10.1016/j.otorri.2012.08.004
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    ABSTRACT: Custom Sound EP™ (CSEP) is an advanced flexible software tool dedicated to recording of electrically evoked compound action potentials (ECAPs) in Nucleus(®) recipients using Neural Response Telemetry™ (NRT™). European multi-centre studies of the Freedom™ cochlear implant system confirmed that CSEP offers tools to effectively record ECAP thresholds, amplitude growth functions, recovery functions, spread of excitation functions, and rate adaptation functions and an automated algorithm (AutoNRT™) to measure threshold profiles. This paper reports on rate adaptation measurements. Rate adaptation of ECAP amplitudes can successfully be measured up to rates of 495 pulses per second (pps) by repeating conventional ECAP measurements and over a wide range of rates up to 8000 pps using the masked response extraction technique. Rate adaptation did not show a predictable relationship with speech perception and coding strategy channel rate preference. The masked response extraction method offers opportunities to study long-term rate adaptation with well-defined and controlled stimulation paradigms.
    Cochlear implants international 02/2014; DOI:10.1179/1754762814Y.0000000063
  • Acta Otorrinolaringológica Española 02/2014; DOI:10.1016/j.otorri.2013.11.007
  • Acta Otorrinolaringológica Española 01/2014;
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    ABSTRACT: Abstract Conclusion: The use of a hearing aid (HA) in combination with a cochlear implant (CI) significantly improved performance for speech perception in quiet, in noise, and for localization compared with monaural conditions. No significant differences in functional performance were observed following optimization of HA fitting. Objectives: To evaluate the binaural benefits derived from using a contralateral HA in conjunction with a CI in subjects with significant functional hearing in the nonimplanted ear and the effects of HA fitting optimization. Methods: Fifteen adult CI users, intra-subject controls, were enrolled in a prospective repeated-measure multicenter study. Evaluation of performance for speech understanding, localization, and subjective impressions was conducted before and following HA fitting optimization for CI alone, HA alone, and CI + HA. Results: For speech testing in quiet, bimodal scores were significantly better than for HA alone and CI alone conditions (p < 0.01). For speech and noise (S0N0) at 0° azimuth the scores were significantly better in the bimodal condition than for CI alone (p = 0.01), indicating binaural summation. When noise was presented to the HA side (S0NHA) bimodal scores were significantly better than for CI alone (p < 0.01 and p < 0.05, respectively), suggesting a significant binaural squelch effect. Sound localization ability was significantly improved in the bimodal condition compared with the CI alone condition (p = 0.002).
    Acta oto-laryngologica 06/2012; 132(10):1084-94. DOI:10.3109/00016489.2012.677546 · 0.99 Impact Factor
  • International Journal of Pediatric Otorhinolaryngology 05/2011; 75:27-28. DOI:10.1016/S0165-5876(11)70142-2 · 1.32 Impact Factor
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    ABSTRACT: This study demonstrates that electric-acoustic stimulation (EAS) significantly decreases the subjective impairment in speech perception. To assess the subjective benefit of EAS over the first 12 months after EAS fitting using the Abbreviated Profile of Hearing Aid Benefit (APHAB). Twenty-three EAS users, implanted with either the PULSAR(CI)(100) FLEX(EAS) provided with the DUET EAS processor or the COMBI40+ Medium provided with the TEMPO+ speech processor, were included. Electric stimulation was activated about 1 month postoperatively; ipsilateral acoustic stimulation was added 2 months thereafter. EAS benefit was measured preoperatively with only a hearing aid and postoperatively at EAS fitting and then 3, 6 and 12 months after EAS fitting using the APHAB. Subjects reported significant improvements in the global score with a mean decrease in impairment from 74% preoperatively to 45% after 3 months of EAS use. Furthermore, clinical relevance was demonstrated in multiple subscales between preoperative and first fitting reflecting a true benefit of EAS with a probability of 95%.
    ORL 01/2011; 73(6):321-9. DOI:10.1159/000331917 · 0.67 Impact Factor
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    ABSTRACT: Current cochlear implants can operate at high pulse rates. The effect of increasing pulse rate on speech performance is not yet clear. Habituation to low rates may affect the outcome. This paper presents the results of three subsequent studies using different experimental paradigms, applying the Nucleus CI24RE device, and conducted by ten European implant teams. Pulse rate per channel varied from 500 to 3500 pulses per second with ACE and from 1200 to 3500 pps with CIS strategy. The results showed that the first rate presented had little effect on the finally preferred rate. Lower rates were preferred. The effect of pulse rate on word scores of post-linguistic implantees was small; high rates tended to give lower scores. However, there were no significant differences between the word scores across subjects if collected at the individually preferred pulse rate. High pulse rates were preferred when the post-implantation threshold was low.
    International journal of audiology 09/2010; 49(9):657-66. DOI:10.3109/14992021003801471 · 1.43 Impact Factor
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    ABSTRACT: IntroductionAcute mastoiditis (AM) is a paediatric infectious complication that raises a specific problem in case of implanted patients.Objective To review the cases of AM in a paediatric cochlear implant (CI) programme to study its incidence and associated problems.Materials and methodsA retrospective study was conducted on 248 children aged between 8 months and 14 years who underwent CI from 1994 to 2009. The demographics, clinical data and their treatment were analyzed.ResultsFive patients developed acute mastoiditis (2.01%), three of them with subperiosteal abscess (1.21%). The mean age of implantation was 2 years and 4 months, and the complication presented between 1 and 33 months post-implantation (mean, 11.6 months). Four patients had episodes of serous otitis preimplantation. The mean age of AM patients was of 3 years and 4 months. The CI type was nucleus in all cases.Conclusions Conservative management is suggested for AM and subperiosteal abscess in children with cochlear implants. Surgical treatment should be avoided to prevent CI contamination. The first option is intravenous antibiotics and simple puncture of the abscess. If surgical drainage is needed, radiological study should be performed to locate the CI electrodes.
    Acta Otorrinolaringológica Española 05/2010; 61(3):180–183. DOI:10.1016/j.otorri.2009.12.007
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    ABSTRACT: Acute mastoiditis (AM) is a paediatric infectious complication that raises a specific problem in case of implanted patients. To review the cases of AM in a paediatric cochlear implant (CI) programme to study its incidence and associated problems. A retrospective study was conducted on 248 children aged between 8 months and 14 years who underwent CI from 1994 to 2009. The demographics, clinical data and their treatment were analyzed. Five patients developed acute mastoiditis (2.01%), three of them with subperiosteal abscess (1.21%). The mean age of implantation was 2 years and 4 months, and the complication presented between 1 and 33 months post-implantation (mean, 11.6 months). Four patients had episodes of serous otitis preimplantation. The mean age of AM patients was of 3 years and 4 months. The CI type was nucleus in all cases. Conservative management is suggested for AM and subperiosteal abscess in children with cochlear implants. Surgical treatment should be avoided to prevent CI contamination. The first option is intravenous antibiotics and simple puncture of the abscess. If surgical drainage is needed, radiological study should be performed to locate the CI electrodes.
    Acta Otorrinolaringológica Española 03/2010; 61(3):180-3.
  • American Journal of Medical Genetics Part A 10/2009; 149A(10):2296-302. DOI:10.1002/ajmg.a.33026 · 2.05 Impact Factor
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    ABSTRACT: To evaluate the frequency and duration of episodes of definitive vertigo in Ménière's disease. Prospective longitudinal study. Multiple tertiary referral centers. Five hundred ten individuals from 8 hospitals that met the American Academy of Otolaryngology-Head and Neck Surgery diagnostic criteria for definitive Ménière's disease. Conservative treatment. Frequency and duration of episodes of definitive vertigo during follow-up. Ménière's disease affects both sexes and both ears equally, with onset generally in the fourth decade of life. The number of episodes of vertigo is greater in the first few years of the disease. Although episodes of vertigo that last longer than 6 hours are less frequent than shorter episodes, they occur with similar frequency throughout the natural course of the disease. The percentage of patients without episodes of vertigo increases as the disease progresses, and 70% of patients who did not have an episode of vertigo for 1 year will continue to be free of episodes during the following year. Thus, there is a relationship between the frequency of episodes in consecutive years, although this association decreases rapidly as the number of years increases. The frequency of definitive episodes of vertigo in Ménière's disease decreased during follow-up, and many individuals reached a steady-state phase free of vertigo.
    Archives of otolaryngology--head & neck surgery 12/2008; 134(11):1149-54. DOI:10.1001/archotol.134.11.1149 · 1.75 Impact Factor
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    ABSTRACT: A high rate of hearing preservation during cochlear implantation for electric acoustic stimulation (EAS) is possible, even when surgery is conducted by a number of different surgeons. This study aimed to determine the degree of hearing preservation using surgery for EAS in a European multi-centre clinical investigation. It also aimed to demonstrate the effect of EAS in individuals with residual low frequency hearing, both on speech perception and on subjective quality of life measures. Eighteen patients with profound high frequency hearing loss were recruited in five participating European centres. Subjects were assessed based on an audiologic test battery, as well as on a subjective hearing aid benefit questionnaire. Each subject underwent attempted hearing preservation cochlear implantation using the MED-EL C40 + device with a Medium electrode. Residual ipsilateral hearing and speech discrimination abilities were assessed at defined intervals up to 12 months after the combined electric-acoustic mode was introduced. Results showed that some degree of hearing preservation was possible in 15718 patients. All subjects showed statistically significant benefit on all three speech perception tests over time. These significant benefits were also reflected in the subjective benefit outcomes.
    Acta Oto-Laryngologica 10/2008; 128(9):968-75. DOI:10.1080/00016480701805471 · 0.99 Impact Factor
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    ABSTRACT: Our study results confirm that it is possible to preserve preoperative hearing levels in the majority of subjects when using the Nucleus 24 Contour Advance provided that there is adherence to the major principles of 'soft surgery'. Our study group demonstrated that 71-86% of subjects showed preservation of preoperative hearing thresholds at 6 months to varying degree. The aim of the study was to assess the degree of residual hearing preserved postoperatively in a group of standard cochlear implant (CI) candidates following implantation via soft surgery with a Nucleus 24 Contour Advance CI. Surgical technique variations from the soft surgery guidelines provided were assessed and their potential impact upon the conservation of residual hearing was examined. A prospective multicentre study involving a within-subject repeated measures design with each subject acting as their own control was performed. Pure-tone audiometric thresholds were assessed and compared in both implanted and contralateral ears for each subject preoperatively as baseline measures and at 6 months postoperatively. Surgeons were asked to complete a questionnaire to capture various aspects of the surgical technique used for each subject. Variations in the surgical technique performed were examined for potential correlation with conservation of residual hearing. Twenty-eight adult subjects, with a severe to profound hearing impairment, were enrolled in the study across eight implant clinics in four countries. In all, 36% of subjects demonstrated preservation of thresholds to within 10 dB of preoperative thresholds across the frequency range (0.25, 0.5, 1.0, 2.0 and 4.0 KHz) and for the low frequency range (0.25-1.0 KHz). Approximately two-thirds of subjects demonstrated preservation of preoperative thresholds to within 20 dB. Preservation of low frequency thresholds post-implant was shown to correlate moderately with cochleostomy site, being more likely for subjects with a site anterior-inferior to the round window but also possible with inferior locations; weakly with cochleostomy size, being more likely when smaller than 1.2 mm; and also with the use of Healon as a sealant and lubricant. Preservation of hearing thresholds across up to 4000 Hz was shown to correlate weakly with the use of suction following opening of the endostium and with bone dust contamination, both having a negative effect upon preservation, while no correlation was observed with the preservation of thresholds for low frequencies alone.
    Acta oto-laryngologica 09/2008; 129(6):651-64. DOI:10.1080/00016480802369278 · 0.99 Impact Factor
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    ABSTRACT: Autosomal recessive nonsyndromic hearing impairment (NSHI) is a heterogeneous condition, for which 53 genetic loci have been reported, and 29 genes have been identified to date. One of these, OTOF, encodes otoferlin, a membrane-anchored calcium-binding protein that plays a role in the exocytosis of synaptic vesicles at the auditory inner hair cell ribbon synapse. We have investigated the prevalence and spectrum of deafness-causing mutations in the OTOF gene. Cohorts of 708 Spanish, 83 Colombian, and 30 Argentinean unrelated subjects with autosomal recessive NSHI were screened for the common p.Gln829X mutation. In compound heterozygotes, the second mutant allele was identified by DNA sequencing. In total, 23 Spanish, two Colombian and two Argentinean subjects were shown to carry two mutant alleles of OTOF. Of these, one Colombian and 13 Spanish subjects presented with auditory neuropathy. In addition, a cohort of 20 unrelated subjects with a diagnosis of auditory neuropathy, from several countries, was screened for mutations in OTOF by DNA sequencing. A total of 11 of these subjects were shown to carry two mutant alleles of OTOF. In total, 18 pathogenic and four neutral novel alleles of the OTOF gene were identified. Haplotype analysis for markers close to OTOF suggests a common founder for the novel c.2905_2923delinsCTCCGAGCGCA mutation, frequently found in Argentina. Our results confirm that mutation of the OTOF gene correlates with a phenotype of prelingual, profound NSHI, and indicate that OTOF mutations are a major cause of inherited auditory neuropathy.
    Human Mutation 06/2008; 29(6):823-31. DOI:10.1002/humu.20708 · 5.05 Impact Factor
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    ABSTRACT: There are many different vertigo classifications and different denominations are frequently used for the same clinical processes. The Otoneurology Committee of the Spanish Society for Otorhinolaryngology and Head and Neck Pathology proposes an eminently practical classification of peripheral vertigo to facilitate a common terminology that can be easily used by the general ENT practitioners. The methodology used has been by consensus within our Society and especially among the most outstanding work groups in the area of otoneurology in Spain. Initially vertigo is divided into single-episode vertigo and recurring attacks of vertigo, and these are then sub-divided into 2 groups, depending on whether or not hearing loss is present. Acute vertigo without hearing loss corresponds to vestibular neuritis and if it is associated with hearing loss, it is due to labyrinthitis of different aetiologies and cochleo-vestibular neuritis. Recurrent vertigos without hearing loss are classified as induced, either by posture (BPPV) or pressure (perilymphatic fistula), or as spontaneous, including migraine-associated vertigo, metabolic vertigo, childhood paroxysmal vertigo and vertigo of vascular causes (AITs, vertebral-basilar failure). Finally, recurrent vertigo with hearing loss includes Ménière's disease and others such as vertigo-migraine (with hearing loss), autoimmune pathology of the inner ear, syphilitic infection, and perilymphatic fistula (with hearing loss).
    Acta Otorrinolaringológica Española 03/2008; 59(2):76-9. DOI:10.1016/S2173-5735(08)70194-7
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    ABSTRACT: There are many different vertigo classifications and different denominations are frequently used for the same clinical processes. The Otoneurology Committee of the Spanish Society for Otorhinolaryngology and Head and Neck Pathology proposes an eminently practical classification of peripheral vertigo to facilitate a common terminology that can be easily used by the general ENT practitioners. The methodology used has been by consensus within our Society and especially among the most outstanding work groups in the area of otoneurology in Spain. Initially vertigo is divided into single-episode vertigo and recurring attacks of vertigo, and these are then sub-divided into 2 groups, depending on whether or not hearing loss is present. Acute vertigo without hearing loss corresponds to vestibular neuritis and if it is associated with hearing loss, it is due to labyrinthitis of different aetiologies and cochleovestibular neuritis. Recurrent vertigos without hearing loss are classified as induced, either by posture (BPPV) or pressure (perilymphatic fistula), or as spontaneous, including migraine-associated vertigo, metabolic vertigo, childhood paroxysmal vertigo and vertigo of vascular causes (AITs, vertebral-basilar failure). Finally, recurrent vertigo with hearing loss includes Ménière's disease and others such as vertigo-migraine (with hearing loss), autoimmune pathology of the inner ear, syphilitic infection, and perilymphatic fistula (with hearing loss).
    Acta Otorrinolaringológica Española 02/2008; 59(2). DOI:10.1016/S0001-6519(08)73266-7
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    ABSTRACT: The Usher syndrome (USH) is an autosomal recessive hereditary disorder characterized by the association of sensorineural hearing loss, retinitis pigmentosa (RP) and, in some cases, vestibular dysfunction. The USH1G gene, encoding SANS, has been found to cause both Usher syndrome type I and atypical Usher syndrome. 109 Spanish unrelated patients suffering from Usher syndrome type I, type II, type III and unclassified Usher syndrome were screened for mutations in this gene, but only eight different changes without a clear pathogenic effect have been detected. Based on these results as well as previous studies in other populations where mutational analysis of this gene has been carried out, one can conclude that USH1G has a minor involvement in Usher syndrome pathogenesis.
    Ophthalmic Genetics 10/2007; 28(3):151-5. DOI:10.1080/13816810701537374 · 1.23 Impact Factor
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    ABSTRACT: Achieving deep insertions, as well as good speech perception results, the FLEXsoft electrode array allows for some preservation in subjects with measurable low frequency hearing, even after a period of time. This opens the door for future research in electrode design, hearing preservation research and drug delivery systems. The FLEXsoft electrode is designed to be atraumatic to the structures of the cochlea during deep insertion of a cochlear implant electrode. This paper reports on the surgical and functional outcomes in implantations with the FLEXsoft electrode array. Twenty-three adult subjects received a FLEXsoft electrode array and were assessed on speech perception tests (monosyllables, sentences in quiet and in noise), a subjective questionnaire (Nijmegen Cochlear Implant Questionnaire) and a pure-tone audiogram. Results at 1, 3, 6 and 12 months post first fitting were compared to scores from the preoperative interval. Surgery was uneventful in all cases, the surgical handling was satisfactory and correct position of the electrode was achieved in all cases. Hearing could be preserved (as determined by the audiogram) in half of the subjects who had measurable audiograms preoperatively at the 1 month test interval, and in a quarter of subjects after 12 months of device use, despite deep insertion of the electrode. Speech perception scores showed significant improvement over time, as did quality of life scores, and were comparable to results with the standard electrode array as used in the COMBI 40+ and PULSARCI100.
    Acta Oto-Laryngologica 07/2007; 127(6):579-86. DOI:10.1080/00016480600987784 · 0.99 Impact Factor
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    Journal of Medical Genetics 04/2007; 44(3):e71. DOI:10.1136/jmg.2006.045377 · 5.64 Impact Factor

Publication Stats

511 Citations
47.73 Total Impact Points

Institutions

  • 1994–2014
    • Hospital Universitari i Politècnic la Fe
      • Servicio de ORL
      Valenza, Valencia, Spain
  • 2005–2010
    • University of Valencia
      Valenza, Valencia, Spain
  • 1998–2006
    • Universidad de Navarra
      • School of Medicine
      Iruña, Navarre, Spain
    • Hospital Universitario de Canarias
      San Cristóbal de La Laguna, Canary Islands, Spain