Tecnologia auditiva assistiva em usuários de implante coclear em ambientes reverberantes com múltiplas fontes de ruído / Assistive listening technology in cochlear implant users in reverberant environments with multiple noise sources

RESUMO Objetivo Avaliar a contribuição da tecnologia de escuta assistida em usuários de implante coclear (IC) em situações de reverberação e ruído. Métodos Estudo transversal prospectivo aprovado pelo Comitê de Ética Institucional (CAAE 8 3031418.4.0000.0068). Foram selecionados adolescentes e adultos usuários de IC com surdez pré ou pós-lingual. Para usuários bilaterais, cada orelha foi avaliada separadamente. O reconhecimento de fala foi avaliado por meio de listas gravadas de palavras dissílabas apresentadas a 65 dBA a 0° azimute com e sem o Mini Microfone2 (Cochlear™) conectado ao processador de fala Nucleus®6. A reverberação da sala foi medida como 550 ms. Para avaliar a contribuição do dispositivo de escuta assistida (DEA) em ambiente reverberante, o reconhecimento de fala foi avaliado no silêncio. Para avaliar a contribuição do DEA em reverberação e ruído, o reconhecimento de fala foi apresentado a 0° azimute com o ruído proveniente de 8 alto-falantes dispostos simetricamente a 2 metros de distância do centro com ruído de múltiplos falantes usando relação sinal-ruído de +10dB. Para evitar viés de aprendizado ou fadiga, a ordem dos testes foi randomizada. A comparação das médias foi analisada pelo teste t para amostras pareadas, adotando-se nível de significância de p<0,005. Resultados Dezessete pacientes com idade média de 40 anos foram convidados e concordaram em participar, sendo 2 participantes bilaterais, totalizando 19 orelhas. Houve contribuição positiva significante do Mini Mic2 na reverberação e ruído+reverberação (p<0,001). Conclusão DEA foi capaz de melhorar o reconhecimento de fala de usuários de IC tanto em situações de reverberação quanto ruidosas.

ABSTRACT Purpose This study aimed to evaluate the contribution of assistive listening technology with wireless connectivity in cochlear implant (CI) users in reverberating and noise situations. Methods Prospective cross-sectional study approved by the Institutional Ethics Committee (CAAE 8 3031418.4.0000.0068). Adolescents and adults CI users with pre- or post-lingual deafness were selected. For bilateral users, each ear was assessed separately. Speech recognition was assessed using recorded lists of disyllabic words presented at 65 dBA at 0° azimuth with and without the Wireless Mini Microphone 2 (Cochlear™) connected to the Nucleus®6 speech processor. Room reverberation was measured as 550 ms. To assess the contribution of the assistive listening device (ALD) in a reverberating environment, speech recognition was assessed in quiet. To assess the contribution of the ALD in reverberation and noise, speech recognition was presented at 0° azimuth along with the noise coming from 8 loudspeakers symmetrically arranged 2 meters away from the center with multi-talker babble noise using signal to noise ratio of +10dB. To avoid learning bias or fatigue, the order of the tests was randomized. Comparison of means was analyzed by t test for paired samples, adopting significance level of p <0.005. Results Seventeen patients with a mean age of 40 years were invited and agreed to participate, with 2 bilateral participants, totaling 19 ears assessed. There was a significant positive contribution from the Mini Mic2 in reverberation, and noise+reverberation (p <0.001). Conclusion ALD was able to improve speech recognition of CI users in both reverberation and noisy situations.

Can the use of the CROS system provide head shadow effect contribution to unilateral Cochlear Implant Users? / O Sistema CROS pode oferecer contribuição do efeito sombra da cabeça a usuários de implante coclear unilateral?

ABSTRACT Purpose The aim of this study was to evaluate the contribution of the CROS system on the head shadow effect in unilateral implant users. Methods Prospective cross-sectional study, approved by the ethics committee under protocol 2.128.869. Eleven adults with post-lingual deafness users of unilateral Advanced Bionics CI were selected. Speech recognition was evaluated with recorded words presented at 65dBA at 0o azimuth and at 90o on the side contralateral to the CI, with noise at 55dBA, using CI alone and CI + CROS system. The results were analyzed using paired t-test with a 0.05 alpha. Results The mean speech recognition scores were significantly better with CI + CROS in relation to the condition of CI alone (p <0.05, p <0.005 and p <0.005 respectively). In the presentation at 0o azimuth, no significant differences were found. Conclusion Users of unilateral CI without useful residual hearing for the use of hearing aids or unable to undergo bilateral surgery can benefit from the CROS device for speech recognition, especially when the speech is presented on the side contralateral to the CI.

RESUMO Objetivo O objetivo deste estudo foi avaliar o efeito do sistema CROS em fenômenos como efeito sombra da cabeça em usuários de implante coclear unilateral. Método Estudo transversal prospectivo, aprovado pelo conselho de ética sob protocolo 2.128.869. Onze adultos com surdez de instalação pós-lingual usuários de IC Advanced Bionics unilateral foram selecionados. O reconhecimento de fala foi avaliado com palavras gravadas apresentadas a 65dBA a 0o azimute e a (90o no lado contralateral ao IC), com ruído a 55dBA, usando somente o IC e IC+sistema CROS. Os resultados foram analisados usando teste t pareado com alfa de 0,05. Resultados Os escores médios de reconhecimento de fala foram significativamente melhores com IC + CROS em relação à condição apenas IC (p <0,05, p <0,005 e p <0,005 respectivamente). Na apresentação à frente não foram encontradas diferenças significantes. Conclusão Os usuários de IC unilateral sem resíduo útil para uso de prótese auditiva ou impossibilitados de submeter-se à cirurgia bilateral podem se beneficiar do dispositivo CROS para o reconhecimento de fala, sobretudo quando a fala for apresentada ao lado contralateral ao IC.

Desenvolvimento de habilidades auditivas de crianças no primeiro ano após o implante coclear unilateral e bilateral / Development of children's auditory skills in the first year after unilateral and bilateral cochlear implant

RESUMO Objetivo identificar se as diferenças no desenvolvimento da aquisição das habilidades auditivas iniciais em crianças após o implante coclear, unilateral ou bilateral, podem ser evidenciadas durante o primeiro ano de uso. Métodos estudo longitudinal retrospectivo de levantamento de prontuários. Foram incluídas crianças que receberam o implante coclear antes dos 4 anos de idade, separadas em dois grupos. O primeiro, composto por crianças implantadas unilateralmente e o segundo, por crianças implantadas bilateral e simultaneamente. Foram coletados os dados referentes à escala IT-MAIS (Infant-Toddler Meaningful Auditory Integration Scale) antes da cirurgia e três meses, seis meses e um ano após a cirurgia. Esses resultados foram comparados com os marcadores clínicos já existentes. Além disso, as famílias foram classificadas segundo a Escala de Avaliação de Envolvimento Familiar. Resultados foram avaliados os resultados de 29 crianças com implante coclear bilateral e 30 crianças com implante coclear unilateral. A pontuação obtida no IT-MAIS dos dois grupos foi semelhante aos marcadores clínicos. Quanto à Escala de Avaliação de Envolvimento Familiar, houve diferença, mostrando que as famílias do grupo dos bilaterais estavam mais envolvidas. Conclusão no primeiro ano de uso do implante coclear, o desenvolvimento da aquisição das habilidades auditivas iniciais das crianças implantadas bilateralmente não diferiu do desenvolvimento de crianças implantadas unilateralmente, sugerindo que as habilidades auditivas iniciais são passíveis de desenvolvimento com entrada auditiva unilateral.

ABSTRACT Purpose To identify the development of initial auditory skills in children with unilateral and bilateral cochlear implant during the first year of use. Methods Retrospective longitudinal study of medical records of children who received cochlear implant under the age of four, separated into two groups. The first, composed of children implanted unilaterally and the second, by children implanted and simultaneously. Data on the IT-MAIS scale (Infant-Toddler Meaningful Auditory Integration Scale) were collected before surgery and three months, six months and one year after surgery. These results were compared with the existing Clinical Markers. In addition, the family's classification was noted, according to the Family Involvement Assessment Scale. Results The data of 29 children with bilateral cochlear implant and 30 children with unilateral cochlear implant were evaluated. The IT-MAIS score of the two groups was similar to the Clinical Markers. Regarding the Family Involvement Assessment Scale, there was a difference, showing that families in the bilateral group were more involved. Conclusion In the first year of use of the cochlear implant, the development of children implanted bilaterally did not differ from the development of children implanted unilaterally, suggesting that initial auditory skills are likely to develop with unilateral auditory input.

Avaliação do Naída CI Q70 e estratégia UltraZoom para o reconhecimento de fala em situações reverberantes e com ruído competitivo / Assessment of the benefits of the Naída CI Q70 and its Ultrazoom strategy for speech recognition in reverberating and noisy listening conditions

RESUMO Objetivo identificar a contribuição do microfone omnidirecional (T-Mic) e microfone direcional adaptativo (UltraZoom) do processador de som Naída CIQ70 para o reconhecimento da fala no ruído e em ambiente reverberante. Identificar a contribuição do processador de som Naída CIQ70 para usuários do processador Harmony. Métodos participaram do estudo sete adultos com implante coclear unilateral, usuários do processador de som Harmony. O reconhecimento de sentenças foi avaliado em silêncio, em sala reverberante (RT60 de 553 ms) e ruído de 42,7 dBA (Leq), com os processadores Harmony e Naída CIQ70. A contribuição do microfone direcional UltraZoom foi avaliada no ruído. As sentenças gravadas foram apresentadas a 0° azimute. O ruído (babble noise) foi apresentado a + 5 dB SNR, a 90° azimute. Os participantes avaliaram subjetivamente a clareza do som e a dificuldade de escutar nas várias condições do teste. Resultados a média do reconhecimento de sentenças no silêncio com reverberação foi de 38,5% com o Harmony e 66,5% com o Naída CIQ70. A pontuação média de reconhecimento de sentenças no ruído foi de 40,5% com o Naída CIQ70, sem UltraZoom, e de 64,5% com UltraZoom. Nas classificações subjetivas de clareza do som e facilidade de escuta no ruído, nenhuma diferença foi identificada entre as condições de teste. Conclusão para usuários experientes do processador de som Harmony, a compreensão da fala em silêncio em uma sala reverbente foi significativamente melhor com o Naída CIQ70. O uso de uma tecnologia de microfone direcional adaptativa (UltraZoom) contribuiu para o reconhecimento de fala no ruído.

Abstract Purpose 1) To measure speech understanding in noise with the Naída Q70 in the omnidirectional microphone mode (T-Mic) and adaptive directional microphone mode (UltraZoom) in reverberating acoustics and noisy conditions. 2) To measure improvement in speech understanding with use of the Advanced Bionics (AB) Naída Q70 sound processor for existing Harmony users. Methods Seven adult unilateral cochlear implant (CI) recipients, who were experienced users of the Harmony sound processor, participated in the study. Sentence recognition was evaluated in quiet in a reverberating room, with Harmony and Naída CI Q70 processors. Effectiveness of Naída CI Q70's UltraZoom directional microphone was evaluated in noise. Target stimuli were recorded Portuguese sentences presented from 0° azimuth. Twenty-talker babble was presented at +5dB SNR from ±90° azimuth. In addition to sentence recognition, the participants also rated the clarity of sound and difficulty of listening in the various test conditions. In order to evaluate the outcomes under more realistic acoustic conditions, tests were conducted in a non-sound treated reverberant room (RT60 of 553 ms and noise floor of 42.7 dBA (Leq). Results The average sentence recognition in quiet in the reverberant non-sound treated room was 38.5% with the Harmony and 66.5% with Naída CI Q70. The average sentence recognition score in noise was 40.5% with Naída CI Q70 without UltraZoom and 64.5% with UltraZoom. For subjective ratings of sound clarity and listening ease in noise no difference were identified between the test conditions. Conclusion For experienced users of the Harmony sound processor, speech understanding in quiet in a reverberating room was significantly improved with the Naída CI Q70. The use of an adaptive directional microphone technology (UltraZoom) enhanced speech perception in noise.

Auto-percepção de usuários de implante coclear unilateral sobre o uso combinado de prótese auditiva contralateral / Self-reported perception of unilateral cochlear implantees on the contralateral use of hearing aid / Auto-percepción de usuarios de implante coclear unilateral sobre el uso de audifono contralateral

Vários estudos mostram a importância do uso combinado do aparelho de amplificação sonora individual (AASI) com implante coclear (IC), entretanto nem todos os usuários de IC usam a adaptação bimodal efetivamente. Objetivos: Identificar as características e os motivos que permeiam o uso combinado dos dispositivos em adultos usuários de IC com AASI na orelha contralateral. Método: Foi aplicado um questionário com 39 perguntas fechadas relacionadas à experiência com AASI antes e após a cirurgia do IC em usuários bimodais. A amostra foi dividida segundo as médias tritonais de limiares na orelha contralateral ao IC. Grupo 1: até 100 dBHL e Grupo 2: acima de 100 dBHL. Resultados: Foram avaliados 49 adultos, com mediana de limiares auditivos no grupo 1: 92 dB e no grupo 2: 114 dB. Após a cirurgia do IC, 78% do grupo 1 e 73% do grupo 2 continuaram a usar AASI por 10 horas diárias ou mais. 41% do grupo 1 e 65% do grupo 2 precisaram de um a três ajustes por ano no AASI, porém 41% do grupo 1 e 31% do grupo 2 não haviam realizado nenhuma regulagem no último ano. Ambos os grupos responderam que sentem benefícios na estimulação bimodal para situações silenciosas, ruidosas, em locais reverberantes e na percepção da música. Na percepção da localização sonora apenas 35% do grupo 1 e 12% do grupo 2 percebem que usar o bimodal ajuda na identificação da direção do som. Conclusão: A maioria dos pacientes prefere usar a estimulação bimodal em situações diárias, independentemente do resíduo auditivo do ouvido contralateral ao IC.

Several studies showed the importance of the combined use of the hearing aid (HA) with cochlear implant (CI), but not all CI users wear bimodal stimulation effectively. Objective: To identify the characteristics and reasons that explain the use of combined devices in adult CI users with HA in contralateral ear. Methods: A questionnaire was applied with 39 closed questions related to the experience with HA before and after CI surgery in bimodal users. The sample was divided according to the three-frequency pure tone average in the non-implanted ear. Group 1: below or equal 100 dBHL and Group 2: above 100 dBHL. Results: 49 adults were evaluated, with median auditory thresholds in group 1: 92 dB and group 2: 114 dB. After IC surgery, 78% (group 1) and 73% (group 2) continued to use HA for 10 hours daily or more. 41% (group 1) and 65% (group 2) required one to three adjustments per year in the HA, but 41% (group 1) and 31% (group 2) had not made any adjustments during the former year. Both groups responded that they feel benefits in bimodal stimulation for quiet, noisy situations, in reverberant places and in the perception of music. In the perception of sound localization, only 35% (group 1) and 12% (group 2) perceived that using bimodal helps in the identification of the direction of sound. Conclusion: The majority of patients prefer to use bimodal stimulation in daily basis, independently of residual hearing in the contralateral ear to CI.

Vários estudios demuestran la importancia del uso combinado del audífonos con el implante coclear (IC), aunque nó todos los usuários de IC usan la adaptación bimodal efectivamente. Objectivos: Identificar las características y los motivos por detrás del uso combinado de los dos dispositivos en adultos usuários de IC y audífono en el oído contralateral. Método: Se aplico um cuestionario con 39 preguntas cerradas relacionadas a la experiencia con audífonos antes y después de la cirugía del IC en usuários bimodales. La muestra se dividió en dos grupos según el umbral promedio tritonal en el oído contralateral al IC. Grupo 1: hasta 100 dBHL y Grupo 2: más de 100 dBHL. Resultados: Fueron evaluados 49 adultos, con mediana de umbrales auditivos en el grupo 1: 92dB y en el grupo 2: 114dB. Despues de la cirugía del IC, 78% del grupo 1 y 73% del grupo 2 siguieron usando el audífono por 10 horas diárias o más. El 41% del grupo 1, y 65% del grupo 2 necesitaron entre um y tres ajustes anuales del audífono. Por outro lado, el 41% del grupo 1 y 31% del grupo 2, nó habían hecho ningún ajuste durante el último año. Ambos grupos reportaron benefícios de la estimulación bimodal en situaciones silenciosas, ruidosas, en locales reverberantes y en la percepción de música. En la percepción de localización sonora, solo un 35% del grupo 1 y 12% del grupo 2 reportaron que la estimulación bimodal ayuda en la identificación de la dirección del sonido. Conclusion: La mayoria de los pacientes prefieren usar la estimulación bimodal en situaciones diárias, independientemente del resíduo auditivo del oido contralateral al IC.

Use of remote control in the intraoperative telemetry of cochlear implant: multicentric study / Uso do controle remoto na telemetria intraoperatória do implante coclear: estudo multicêntrico

Abstract Introduction: The conventional evaluation of neural telemetry and impedance requires the use of the computer coupled to an interface, with software that provides visualization of the stimulus and response. Recently, a remote control (CR220®) was launched in the market, that allows the performance of intraoperative tests with minimal instrumentation. Objective: To evaluate the agreement of the impedance values and neural telemetry thresholds, and the time of performance in the conventional procedure and by the remote control. Methods: Multicentric prospective cross-sectional study. Intraoperative evaluations of cochlear implants compatible with the use of CR220® were included. The tests were carried out in the 22 electrodes to compare the time of performance in the two situations. The agreement of the neural telemetry threshold values obtained from five electrodes was analyzed, and the agreement of impedance was evaluated by the number of electrodes with altered values in each procedure. Results: There were no significant difference between the impedance values. There was a moderate to strong correlation between the electrically-evoked compound action potential thresholds. The mean time to perform the procedures using the CR220 was significantly lower than that with the conventional procedure. Conclusion: The use of the CR220 provided successful records for impedance telemetry and automatic neural response telemetry.

Resumo Introdução: A avaliação convencional da telemetria neural e de impedâncias implica o uso do computador acoplado a uma interface, o software fornece o estímulo e a visualização das respostas. Recentemente, foi lançado um controle remoto (CR220®), que possibilita testes intraoperatórios com instrumental mínimo. Objetivo: Avaliar a concordância dos valores das impedâncias e dos limiares da telemetria neural e o tempo de execução no procedimento convencional e pelo controle remoto. Método: Estudo prospectivo transversal multicêntrico. Foram incluídas as avaliações intraoperatórias de implante coclear compatível com o uso do CR220®. Os testes foram realizados nos 22 eletrodos para comparar os tempos de execução nas duas situações. Foi analisada a concordância dos valores do limiar da telemetria neural obtidos em cinco eletrodos e a concordância das impedâncias foi avaliada pelo número de eletrodos com valores alterados em cada procedimento. Resultados: Não houve diferença significante entre as impedâncias. Obteve-se moderada a forte correlação entre os limiares do potencial de ação composto eletricamente evocado. O tempo médio para os procedimentos com o CR220 foi significativamente menor do que com o procedimento convencional. Conclusão: O uso do CR220 proporcionou registros bem-sucedidos para a telemetria de impedância e a telemetria automática de respostas neurais.

P3 Cognitive Potential in Cochlear Implant Users

Abstract Introduction The P3 cognitive evoked potential is recorded when a subject correctly identifies, evaluates and processes two different auditory stimuli. Objective to evaluate the latency and amplitude of the P3 evoked potential in 26 cochlear implant users with post-lingual deafness with good or poor speech recognition scores as compared with normal hearing subjects matched for age and educational level. Methods In this prospective cohort study, auditory cortical responses were recorded from 26 post-lingual deaf adult cochlear implant users (19 with good and 7 with poor speech recognition scores) and 26 control subjects. Results There was a significant difference in the P3 latency between cochlear implant users with poor speech recognition scores (G-) and their control group (CG) (p= 0.04), and between G- and cochlear implant users with good speech discrimination (G+) (p= 0.01). We found no significant difference in the P3 latency between the CG and G+. In this study, all G- patients had deafness due to meningitis, which suggests that higher auditory function was impaired too. Conclusion Post-lingual deaf adult cochlear implant users in the G- group had prolonged P3 latencies as compared with the CG and the cochlear implant users in the G+ group. The amplitudes were similar between patients and controls. All G- subjects were deaf due to meningitis. These findings suggest that meningitis may have deleterious effects not only on the peripheral auditory system but on the central auditory processing as well.

Benefit of Cochlear Implantation in Children with Multiple-handicaps: Parent's Perspective

Abstract Introduction The cochlear implants centers in the world are studying the cochlear implantation in children with multiple handicaps. Objective To develop a questionnaire to analyze the subjective benefits of the cochlear implantation in multiple handicapped children according to their parent's perspective. Methods A questionnaire was applied to 14 families of multiple handicapped children, aging from 2-12 years old and having from 11 months to 11 years of implant use. Results The social-emotional abilities were improved because of many factors, such as: auditory exposure, which happened in 84% of the children; recognition of their own names, which increased in 56%; and development of eye contact, in 28% of the subjects. Other benefits appeared to be: music appreciation and more attention and adherence to other therapies and school activities. Besides, some children became interested in objects, playing with other children, and more adapted to daily routines. Thirty-five percent of the children acquired oral language, mainly the bilaterally implanted, while 14% of them were engaged in sign language. Although all of the children showed a significant improvement in communication, the emotional issues of some families and the severity of the handicaps negatively impacted the outcomes. In spite of the families' acknowledgement of some benefits, the diagnosis of autism spectrum disorder caused frustration, requiring a readjustment of the expectations. Conclusion The questionnaire turned out to be an adequate tool to reveal the social-emotional benefits of cochlear implantation. Although oral language was not the major outcome in these cases, the cochlear implant benefits involved the whole family. All of the families recommended the implant to other children in a similar situation.

Outcomes of Late Implantation in Usher Syndrome Patients

Abstract Introduction Usher syndrome (US) is an autosomal recessive disorder characterized by hearing loss and progressive visual impairment. Some deaf Usher syndrome patients learn to communicate using sign language. During adolescence, as they start losing vision, they are usually referred to cochlear implantation as a salvage for their new condition. Is a late implantation beneficial to these children? Objective The objective of this study is to describe the outcomes of US patients who received cochlear implants at a later age. Methods This is a retrospective study of ten patients diagnosed with US1. We collected pure-tone thresholds and speech perception tests from pre and one-year post implant. Results Average age at implantation was 18.9 years (5-49). Aided average thresholds were 103 dB HL and 35 dB HL pre and one-year post implant, respectively. Speech perception was only possible to bemeasured in four patients preoperatively, who scored 13.3; 26.67; 46% vowels and 56% 4-choice. All patients except one had some kind of communication. Two were bilingual. After one year of using the device, seven patients were able to perform the speech tests (from four-choice to close set sentences) and three patients abandoned the use of the implant. Conclusion We observed that detection of sounds can be achieved with late implantation, but speech recognition is only possible in patients with previous hearing stimulation, since it depends on the development of hearing skills and the maturation of the auditory pathways.

Vocabulário expressivo em crianças usuárias de implante coclear / Expressive vocabulary in children with cochlear implants

RESUMO Objetivo: verificar a aquisição de vocabulário em crianças surdas, usuárias de implante coclear, bem como os fatores que influenciam esse desenvolvimento. Métodos: foi aplicada a parte de vocabulário do teste de linguagem infantil ABFW em 20 crianças usuárias de implante coclear por no mínimo três anos. Além disso, foi avaliada a participação familiar no desenvolvimento dessas crianças. Resultados: foi observado que as crianças implantadas apresentam possibilidade de alcançar o desenvolvimento normal de vocabulário, quando comparadas às crianças ouvintes, a depender de diversos fatores. O fator que apresentou influência estatisticamente significante no vocabulário foi a participação familiar, sendo que quanto maior o envolvimento da família no processo terapêutico, melhores os resultados no teste de vocabulário. Conclusão: as crianças implantadas podem apresentar desempenho similar às crianças ouvintes no teste de vocabulário, a depender das variáveis que transcendem a idade à implantação ou mesmo o tempo de uso do implante coclear. A estimulação/ participação familiar no desenvolvimento das crianças se mostrou de extrema importância no desenvolvimento da linguagem oral.

ABSTRACT Objective: to verify whether children with cochlear implants (CI) acquire vocabulary at the same pace as normally hearing children, and which factors influence their acquisition. Methods: the vocabulary test of the ABFW was performed on 20 children who had been using the cochlear implant for at least three years. Historical information, such as age at time of implant, hearing age (i.e., at time of implant use), and family participation in the rehabilitation process, was gathered from patients' files. Correlation statistical analysis was then performed. Results: it was observed that children with CI may acquire vocabulary similar to that of hearing children, depending on many aspects. The age at time of implantation and hearing age did not significantly correlate to the vocabulary results. The factor that demonstrated statistical significance was family participation, which showed a positive correlation: the more the family was involved in the rehabilitation process, the better the children's results on the vocabulary test. Conclusion: it was, thus, possible to conclude that children with CI develop their vocabulary in a similar manner as hearing children, depending on factors that transcend the child's age at time of implantation and hearing age. Family participation, in the rehabilitation process, was shown to be of critical importance in the child's vocabulary development.

Satisfação e qualidade de vida em usuários de implante auditivo de tronco cerebral / Satisfaction and quality of life in users of auditory brainstem implant

RESUMO Objetivo Avaliar a satisfação e qualidade de vida em usuários de Implante Auditivo de Tronco Cerebral. Método Trata-se de um estudo transversal e descritivo realizado na Divisão de Clínica Otorrinolaringológica do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, Brasil. Para a realização da pesquisa, 19 usuários de implante auditivo de tronco cerebral responderam aos seguintes questionários: KINDLR (Questionnaire for Measuring Health-Related Quality of Life in Children and Adolescents) para crianças e adolescentes, pais e/ou cuidadores; o questionário WHOQOL-BREF para os participantes adultos; e o questionário SADL (Satisfaction with Amplification in Daily Life), adaptado culturalmente para o português brasileiro. Resultados A qualidade de vida das crianças usuárias de implante auditivo de tronco cerebral do ponto de vista dos pais apresentou resultados acima da média para o resultado global e para a maioria dos domínios, exceto o domínio de bem-estar emocional. Os adultos apresentaram resultados acima da média para todos os domínios. Com relação à satisfação com o dispositivo, os adultos usuários de implante auditivo de tronco cerebral estavam satisfeitos de modo geral, exceto no que diz respeito à imagem pessoal, e os pais das crianças mostraram insatisfação para todas as subescalas, exceto para a subescala de serviços e custos. Conclusão Os resultados indicaram que, apesar de os pacientes estarem insatisfeitos em alguns aspectos com o dispositivo, de modo geral, a qualidade de vida foi classificada como boa, para a maioria dos aspectos avaliados.

ABSTRACT Purpose To evaluate satisfaction and quality of life of users of Auditory Implant Brainstem. Methods This is a cross-sectional and descriptive study conducted at Divisão de Clínica Otorrinolaringológica of Hospital das Clínicas of Faculdade de Medicina da Universidade de São Paulo, Brazil. For the research, 19 users of an Auditory Brainstem Implant answered the following questionnaires: KINDLR (Questionnaire for Measuring Health-Related Quality of Life in Children and Adolescents), for children and adolescents, their parents and/or caregivers; WHOQOL-BREF questionnaire, for adult participants; and the Satisfaction with Amplification in Daily Life (SADL) questionnaire culturally adapted to Brazilian Portuguese. Results The quality of life of children using Auditory Brainstem Implant from the perspective of their parents showed global results above average, as for most domains, except for the emotional well-being domain. Adults showed results above average for all domains. Regarding satisfaction with the device, the adult users of auditory brainstem implant were satisfied in general, except with regard to personal image. The parents of the children showed dissatisfaction in all subscales, except for the subscale of services and cost. Conclusion The results indicated that although patients are dissatisfied with the device in some aspects, overall the quality of life was rated as good for most of the aspects assessed.

Audiological profile of patients treated for childhood cancer / Perfil audiológico de pacientes tratados de câncer na infância

Abstract Objective: To characterize the hearing loss after cancer treatment, according to the type of treatment, with identification of predictive factors. Methods: Two hundred patients who had cancer in childhood were prospectively evaluated. The mean age at diagnosis was 6 years, and at the audiometric assessment, 21 years. The treatment of the participants included chemotherapy without using platinum derivatives or head and neck radiotherapy in 51 patients; chemotherapy using cisplatin without radiotherapy in 64 patients; head and neck radiotherapy without cisplatin in 75 patients; and a combined treatment of head and neck radiotherapy and chemotherapy with cisplatin in ten patients. Patients underwent audiological assessment, including pure tone audiometry, speech audiometry, and immittancemetry. Results: The treatment involving chemotherapy with cisplatin caused 41.9% and 47.3% hearing loss in the right and left ear, respectively, with a 11.7-fold higher risk of hearing loss in the right ear and 17.6-fold higher in the left ear versus patients not treated with cisplatin (p < 0.001 and p < 0.001, respectively). Children whose cancer diagnosis occurred after the age of 6 have shown an increased risk of hearing loss vs. children whose diagnosis occurred under 6 years of age (p = 0.02). Conclusion: The auditory feature found after the cancer treatment was a symmetrical bilateral sensorineural hearing loss. Chemotherapy with cisplatin proved to be a risk factor, while head and neck radiotherapy was not critical for the occurrence of hearing loss.

Resumo Objetivo: Caracterizar as alterações auditivas após o tratamento do câncer, segundo o tipo de tratamento identificando os fatores preditivos. Método: Foram avaliados prospectivamente duzentos pacientes que tiveram cancer na infância. A idade média ao diagnóstico foi de 6 anos e à avaliação audiométrica de 21 anos de idade. O tratamento incluiu quimioterapia sem uso de derivados de platina ou radioterapia em cabeça e pescoço em 51 pacientes; quimioterapia com uso de cisplatina sem radioterapia em 64 pacientes; radioterapia em cabeça e pescoço sem cisplatina em 75 pacientes; e 10 pacientes receberam o tratamento combinado de radioterapia em cabeça e pescoço e quimioterapia com cisplatina. Os pacientes foram submetidos à avaliação audiológica incluindo audiometria tonal, audiometria vocal e imitanciometria. Resultados: O tratamento envolvendo quimioterapia com cisplatina levou a 41,9% e 47,3% de perda auditiva na orelha direita e esquerda, respectivamente, apresentando risco 11,7 vezes maior de desenvolver perda auditiva na orelha direita e 17,6 vezes na orelha esquerda do que aqueles que não receberam cisplatina (p < 0,001 e p < 0,001; respectivamente). Crianças cujo diagnóstico do câncer ocorreu após os 6 anos de idade mostraram maior risco de apresentar perda auditiva do que crianças menores do que 6 anos de idade (p = 0,02). Conclusão: A característica audiológica encontrada após tratamento oncológico foi perda auditiva sensorioneural bilateral simétrica. A quimioterapia com cisplatina mostrou ser fator de risco, enquanto a radioterapia em cabeça e pescoço não foi determinante para aquisição da perda auditiva.

Telephone usage and cochlear implant: auditory training benefits

Introduction Difficulties with telephone use by adult users of cochlear implants (CIs) are reported as a limitation in daily life. Studies to improve the speech understanding of CI users on the telephone are scarce in the Brazilian scientific literature. Objective To develop and evaluate the effectiveness of a training program of auditory abilities on the telephone for an adult CI user. Resumed Report The subject was a 55-year-old woman with a degree in accounting who used a CI for 24 months. The program consisted of three stages: pretraining evaluation, eight sessions of advanced auditory abilities training, and post-training evaluation. Auditory abilities with CI were evaluated before and after training in three conditions: sound field, telephone with the speech processor in the microphone function, and telephone with the speech processor in the telecoil function. Speech recognition was assessed by three different lists: one with monosyllabic and dissyllabic words, another with nonsense syllables, and another one with sentences. The Client Oriented Scale of Improvement (COSI) was used to assess whether the needs established by the CI user in everyday telephone use situations improved after training. The auditory abilities training resulted in a relevant improvement in the percentage of correct answers in speech tests both in the telephone use conditions and in the sound field condition. Conclusion The results obtained with the COSI inventory indicated a performance improvement in all situations presented at the beginning of the program.

Remote programming of cochlear implants / Teleprogramação dos sistemas de implante coclear

PURPOSE: To verify the effectiveness of remote programming of cochlear implants by stimulation levels and results in the perception of speech and free-field audiometry tests. METHODS: Twelve patients from both genders, aged between 18 and 59 years, users of internal cochlear implant and speech processor of the same model for at least 12 months, were selected. Both the remote programming (RP) and the live programming (LP) were performed on the same day, measuring the minimum (T) and maximum (C) stimulation levels of five electrodes with the interpolation of the remaining ones. Speech perception tests were applied using 65 dBSPL (recorded open context sentences and monosyllables). The patients were submitted to free-field audiometry at 250-8,000 Hz frequencies. The results for the RP and LP were compared. RESULTS: Differences in mean of the T levels for three electrodes and the C levels for one electrode were found. No difference between the results was obtained in the speech perception tests and audiometric thresholds in the RP and LP. CONCLUSION: The RP is a simple and effective procedure for programming cochlear implant devices and, although there were differences in the stimulation levels of some electrodes, it did not interfere in the speech perception outcomes. .

OBJETIVO: verificar a efetividade da programação remota do implante coclear por meio dos níveis de estimulação e resultados nos testes de percepção de fala e audiometria em campo livre. MÉTODOS: Foram selecionados 12 pacientes de ambos os gêneros, com idade entre 18 e 59 anos, usuários de implante coclear do mesmo modelo de unidade interna e processador de fala por no mínimo 12 meses. As programações remota (PR) e presencial (PP) foram realizadas no mesmo dia, medindo-se os níveis mínimos (níveis T) e máximos (níveis C) de estimulação de cinco eletrodos, com interpolação dos demais. Foram aplicados testes de percepção de fala (frases em contexto aberto e monossílabos - gravação a 65 dBNPS) e audiometria em campo livre nas frequências de 250 a 8.000 Hz. Os resultados foram comparados entre PR e PP. RESULTADOS: Houve diferença na média dos níveis T em três eletrodos e dos níveis C em um eletrodo. Não houve diferença entre os resultados obtidos nos testes de percepção de fala e nos limiares audiométricos na PP e PR. CONCLUSÃO: A realização da programação remota é simples e eficaz para a programação dos dispositivos de implante coclear e, embora tenha mostrado diferenças nos níveis de estimulação, não interferiu no desempenho da percepção de fala. .

Desempenho auditivo e comportamentos atípicos em crianças usuárias de implante coclear / Hearing performance and atypical behavior in childrens with cochlear implants / Desempeño auditivo y comportamientos atípicos en niños com implante coclear

O diagnóstico diferencial entre a perda auditiva e o autismo se dá por meio dos testes audiológicos e da observação clínica do comportamento geral da criança. O comportamento da criança pode ser avaliado por meio de escalas, como o Autism Behavior Checklist (ABC). O objetivo deste trabalho é analisar se comportamentos atípicos associados à perda auditiva podem interferir no desenvolvimento das habilidades auditivas pós-implante coclear. Este é um estudo híbrido (retro e prospectivo) e observacional. Foram incluídas crianças com perda auditiva neurossensorial bilateral congênita severa e profunda, usuárias de Implante Coclear (IC) multicanal e uso sistemático do IC, por pelo menos 3 meses. Foram excluídas as crianças que apresentaram inserção parcial ou inadequada dos eletrodos; alteração nas impedâncias dos eletrodos; má formação da orelha interna e/ou nervo auditivo; transtorno do Espectro da Neuropatia Auditiva. Foram selecionadas 27 crianças. Obtivemos os limiares auditivos com Aparelho de Amplificação Sonora Individual (AASI) pré-implante, o desempenho auditivo por meio do inventário IT-MAIS/MAIS no pré IC e pós IC e os limiares auditivos com IC. Prospectivamente, as mães responderam ao Inventário de Comportamentos Autísticos (ICA). Não houve correlação significativa entre o ICA, a evolução dos limiares audiométricos e a evolução do IT-MAIS/MAIS. Observou-se que os limiares audiométricos melhoraram consideravelmente pós IC na média do grupo avaliado. O mesmo ocorreu com o questionário IT-MAIS/MAIS. Por meio do questionário ICA, obtivemos a presença de três sujeitos com pontuação considerada alterada. O desenvolvimento das habilidades auditivas pode ser esperado como resultado do IC em crianças com comportamentos gerais atípicos e surdez severa a profunda bilateral associada.

The differential diagnosis between hearing loss and autism relies on audiological tests and clinical observation of the child?s behavior. The child?s behavior can be estimated by using scales such as the Autism Behavior Checklist (ABC). The objective of this study is to analyze whether atypical behaviors associated with hearing loss can affect the development of auditory skills after cochlear implant (CI). This is a hybrid (prospective and retrospective) observational study in which children with sensorineural hearing loss severe to profound bilateral congenital; multichannel CI recipients with systematic use of the CI for at least 3 months were included. Children were excluded if they had partial insertion of electrodes; change in impedance of the electrodes; malformation of the inner ear and/or auditory nerve; Auditory Neuropathy Spectrum Disorder. Twenty seven children were selected. Aided thresholds (with hearing aids in the pre-implant evaluation and with cochlear implants in the post-implant evaluation) as well as the auditory performance through IT-MAIS/MAIS in both pre and post-evaluations were collected. Prospectively, the mothers responded to the Autism Behavior Checklist (ABC ? Portuguese version ICA). There was no significant correlation between the ABC and the evolution of audiometric thresholds and IT-MAIS/MAIS. It was observed that the average audiometric thresholds improved considerably after the CI in the assessed group. The same occurred with the questionnaire IT-MAIS/MAIS. Through the ICA survey, we obtained the presence of three subjects with abnormal scores. The development of listening skills can be expected as a result of CI even in children with general atypical behaviors associated with severe to profound bilateral deafness.

El diagnóstico diferencial entre la pérdida de audición y el autismo se hace por medio de pruebas audiológicas y de observación clínica del comportamiento general del niño. El comportamiento del niño se puede evaluar utilizando escalas como el Autism Behavior Checklist (ABC). El objetivo de este estudio es analizar si las conductas atípicas asociadas con la pérdida de la audición pueden afectar el desarrollo de las habilidades auditivas después del implante coclear (IC). Se trata de un estudio hibrido (retro y prospectivo) y observacional. Se incluyeron niños con pérdida auditiva neurosensorial bilateral congénita severa y profunda, usuarios de IC multicanal y uso sistemático del IC durante al menos 3 meses. Se excluieron niños que presentaron inserción parcial o inadecuada de los electrodos; cambio en la impedancia de los electrodos; malformación del oído interno y/o del nervio auditivo, trastorno del Espectro de la Neuropatía Auditiva. Se seleccionaron 27 niños. Obtuvimos los umbrales auditivos con audìfonos pre implante; el rendimiento auditivo a través del inventario IT-MAIS/MAIS pre y post implante, y los umbrales auditivos con IC. En forma prospectiva, las madres respondieron al Inventario de Comportammientos Autisticos (ICA). No hubo correlación significativa entre el ICA, la evolución de los umbrales audiométricos y la evolución del IT-MAIS/MAIS. Se observó que el promedio de los umbrales audiométricos mejoro considerablemente después del IC en el grupo evaluado. Lo mismo ocurrió con el cuestionário IT-MAIS/MAIS. A través de la encuesta ICA, se obtuvo la presencia de tres sujetos con una puntuación considerada anormal. El desarrollo de las habilidades auditivas se puede esperar como resultado del IC en niños con conductas generales atípicas y sordera severa a profunda bilateral asocida.

Longitudinal Analysis of the Absence of Intraoperative Neural Response Telemetry in Children using Cochlear Implants

Introduction Currently the cochlear implant allows access to sounds in individuals with profound hearing loss. The objective methods used to verify the integrity of the cochlear device and the electrophysiologic response of users have noted these improvements. Objective To establish whether the evoked compound action potential of the auditory nerve can appear after electrical stimulation when it is absent intraoperatively. Methods The clinical records of children implanted with the Nucleus Freedom (Cochlear Ltd., Australia) (CI24RE) cochlear implant between January 2009 and January 2010 with at least 6 months of use were evaluated. The neural response telemetry (NRT) thresholds of electrodes 1, 6, 11, 16, and 22 during surgery and after at least 3 months of implant use were analyzed and correlated with etiology, length of auditory deprivation, and chronological age. These data were compared between a group of children exhibiting responses in all of the tested electrodes and a group of children who had at least one absent response. Results The sample was composed of clinical records of 51 children. From these, 21% (11) showed no NRT in at least one of the tested electrodes. After an average of 4.9 months of stimulation, the number of individuals exhibiting absent responses decreased from 21 to 11% (n = 6). Conclusion It is feasible that absent responses present after a period of electrical stimulation. In our sample, 45% (n = 5) of the patients with intraoperative absence exhibited a positive response after an average of 4.9 months of continued electrical stimulation...

Audiological outcomes of cochlear implantation in Waardenburg Syndrome

The most relevant clinical symptom in Waardenburg syndrome is profound bilateral sensorioneural hearing loss. AIM: To characterize and describe hearing outcomes after cochlear implantation in patients with Waardenburg syndrome to improve preoperative expectations. METHOD: This was an observational and retrospective study of a series of cases. Children who were diagnosed with Waardenburg syndrome and who received a multichannel cochlear implant between March 1999 and July 2012 were included in the study. Intraoperative neural response telemetry, hearing evaluation, speech perception, and speech production data before and after surgery were assessed. RESULTS: During this period, 806 patients received a cochlear implant and 10 of these (1.2%) were diagnosed with Waardenburg syndrome. Eight of the children received a Nucleus 24® implant and 1 child and 1 adult received a DigiSonic SP implant. The mean age at implantation was 44 months among the children. The average duration of use of a cochlear implant at the time of the study was 43 months. Intraoperative neural responses were present in all cases. Patients who could use the speech processor effectively had a pure tone average of 31 dB in free-field conditions. In addition, the MUSS and MAIS questionnaires revealed improvements in speech perception and production. Four patients did not have a good outcome, which might have been associated with ineffective use of the speech processor. CONCLUSION: Despite the heterogeneity of the group, patients with Waardenburg syndrome who received cochlear implants were found to have hearing thresholds that allowed access to speech sounds. However, patients who received early intervention and rehabilitation showed better evolution of auditory perception...

Retrolabyrinthine approach for cochlear nerve preservation in neurofibromatosis type 2 and simultaneous cochlear implantation

Few cases of cochlear implantation (CI) in neurofibromatosis type 2 (NF2) patients had been reported in the literature. The approaches described were translabyrinthine, retrosigmoid or middle cranial fossa. OBJECTIVES: To describe a case of a NF2- deafened-patient who underwent to vestibular schwannoma resection via RLA with cochlear nerve preservation and CI through the round window, at the same surgical time. RESUMED REPORT: A 36-year-old woman with severe bilateral hearing loss due to NF2 was submitted to vestibular schwannoma resection and simultaneous CI. Functional assessment of cochlear nerve was performed by electrical promontory stimulation. Complete tumor removal was accomplishment via RLA with anatomic and functional cochlear and facial nerve preservation. Cochlear electrode array was partially inserted via round window. Sound field hearing threshold improvement was achieved. Mean tonal threshold was 46.2 dB HL. The patient could only detect environmental sounds and human voice but cannot discriminate vowels, words nor do sentences at 2 years of follow-up. CONCLUSION: Cochlear implantation is a feasible auditory restoration option in NF2 when cochlear anatomic and functional nerve preservation is achieved. The RLA is adequate for this purpose and features as an option for hearing preservation in NF2 patients...

Evolução audiométrica em usuários de implante coclear multicanal / Audiometric evolution in multichannel cochlear implant users

OBJETIVO: analisar em quanto tempo após a ativação é possível alcançar os limiares auditivos desejados nos indivíduos usuários de implante coclear (IC) multicanal de diferentes faixas etárias. MÉTODO: estudo seccional retrospectivo a partir de banco de dados, aprovado pelo CEP/HCFMUSP, sob número 779/06. Foram incluídos indivíduos implantados no período de Janeiro de 2005(início da formação do banco de dados) a Setembro de 2008(término da coleta de dados), cujos prontuários possuíam dados dos limiares audiométricos pré-implante e 3, 6 e 12 meses após o IC. Setenta e dois pacientes contemplaram os critérios, divididos em dois grupos por faixa etária: GI (até 17 anos) e GII (18 a 66 anos). Foi utilizada a Análise de Variância (ANOVA) de um fator para verificar a interação entre as médias dos limiares audiométricos e o tempo após o IC. RESULTADOS: observou-se que 15 do grupo GI já alcançaram limiares em torno de 30dBNA aos 3 meses pós implante. O mesmo aconteceu com 26 pacientes do grupo GII. Encontrou-se interação significante entre tempo (F(3,140)=91,973, p=0,00) e a média de limiares auditivos. Nas análises Post-hoc do grupo GI foram observadas diferenças estatisticamente significantes para as comparações entre AASI e 3 meses pós implante (p=0,00) e entre 3 e 12 meses (p= 0,28), para o grupo GII, somente para a comparação entre AASI e 3 meses (p=0,00). CONCLUSÃO: uma mudança significante da audição pode ser observada a partir de três meses após o IC, porém este resultado não se encontra em todos os implantados.

PURPOSE: to evaluate how long after activation one can achieve the desired auditory thresholds in individuals multichannel cochlear implant users from different age groups. METHOD: a retrospective cross-sectional from a database, approved by CEP / FMUSP, under number 779/06. Individuals implanted between January 2005 and September 2008, whose files had preoperative audiometric data and 3, 6 and 12 months after CI were included. Seventy-two patients fulfilled the criteria, and they were divided in two groups according to age: group I (17 year old) and GII (18-66 year old). Analysis of variance (ANOVA) of one factor in order to verify the interaction between the mean threshold and time after CI were used. RESULTS: we observed that 15 of the GI have reached around 30dBNA thresholds at 3 months after implant. The same happened to 26 patients of GII. We found significant interaction between time (F (3.140) = 91.973, p = 0.00) and the average hearing thresholds. Post-hoc analysis in the GI group were statistically significant differences for comparisons between HA and 3 months after implantation (p = 0.00) and between 3 and 12 months (p = 0.28). For GII only for comparison between HA and 3 months (p = 0.00). CONCLUSION: a significant hearing change may be observed beginning from three months after IC, but this result is not found in all implanted subjects.

Cochlear implants and bacterial meningitis: A speech recognition study in paired samples

Introduction: Cochlear implants may guarantee sound perception and the ability to detect speech at a close-to-normal hearing intensity; however, differences have been observed among implantees in terms of performance on discrimination tests and speech recognition. Objective: To identify whether patients with post-meningitis deafness perform similarly to patients with hearing loss due to other causes. Method: A retrospective clinical study involving post-lingual patients who had been using Nucleus-22 or Nucleus-24 cochlear implants for at least 1 year. These patients were matched with respect to age (± 2 years), time since the onset of deafness (± 1 year), and the duration of implant use with implant users who had hearing loss due to other causes. Speech perception was assessed using the Portuguese version of the Latin-American Protocol for the Evaluation of Cochlear Implants. Results: The sample consisted of 52 individuals (26 in each of the 2 groups). The post-meningitic group had a median of 18.5 active electrodes. The group with hearing loss due to other causes had a median of 21, but no significant statistical difference was observed (p = 0.07). The results of closed- and open-set speech recognition tests showed great variability in speech recognition between the studied groups. These differences were more pronounced for the most difficult listening tasks, such as the medial consonant task (in the vowel-consonant-vowel format). Conclusion: Cochlear implant recipients with hearing loss due to bacterial meningitis, who had been using the device for 1 year performed more poorly on closed- and open-set speech recognition tests than did implant recipients with hearing loss due to other causes...