The P300 Auditory Evoked Potential in Cochlear Implant Users: A Scoping Review

Abstract Introduction The P300 auditory evoked potential is a long-latency cortical potential evoked with auditory stimulation, which provides information on neural mechanisms underlying the central auditory processing. Objectives To identify and gather scientific evidence regarding the P300 in adult cochlear implant (CI) users. Data Synthesis A total of 87 articles, 20 of which were selected for this study, were identified and exported to the Rayyan search software. Those 20 articles did not propose a homogeneous methodology, which made comparison more difficult. Most articles (60%) in this review compare CI users with typical hearing people, showing prolonged P300 latency in CI users. Among the studies, 35% show that CI users present a smaller P300 amplitude. Another variable is the influence of the kind of stimulus used to elicit P300, which was prolonged in 30% of the studies that used pure tone stimuli, 10% of the studies that used pure tone and speech stimuli, and 60% of the studies that used speech stimuli. Conclusion This review has contributed with evidence that shows the importance of applying a controlled P300 protocol to diagnose and monitor CI users. Regardless of the stimuli used to elicit P300, we noticed a pattern in the increase in latency and decrease in amplitude in CI users. The user's experience with the CI speech processor over time and the speech test results seem to be related to the P300 latency and amplitude measurements.

Efeito da idade no equilíbrio corporal e nos resultados do vídeo teste do impulso cefálico em pacientes com insuficiência cardíaca / Effect of age on body balance and on the results of the video head impulse test in patients with heart failure

RESUMO Objetivo verificar se existe associação entre a avaliação clínica do equilíbrio e o ganho do reflexo vestíbulo-ocular com o avanço da idade em pacientes com insuficiência cardíaca. Métodos estudo transversal analítico-descritivo, de caráter observacional, que incluiu pacientes com diagnóstico de insuficiência cardíaca, divididos em dois grupos, por idade (G1, menos de 60 anos e G2, 60 anos ou mais). Os pacientes foram avaliados por meio de anamnese, avaliação cardiológica, avaliação clínica do equilíbrio corporal (triagem da função cerebelar e avaliação do equilíbrio estático e dinâmico) e instrumental da função vestibular (Video Head Impulse Test-vHIT). Os achados obtidos foram descritos e comparados por meio de análise estatística inferencial. Resultados foram avaliados 34 pacientes com média de idade de 55 anos e 9 meses, a maioria homens (71,49%). Não houve associação do ganho do reflexo vestíbulo-ocular, simetria dos canais semicirculares e avaliações do equilíbrio corporal com o avanço da idade. Observaram-se associações entre os resultados da prova de Unterberger-Fukuda com o ganho do reflexo vestíbulo-ocular do canal semicircular lateral direito e posterior esquerdo e com os percentuais de simetria dos canais semicirculares anteriores para os pacientes do Grupo 2. Para os indivíduos do Grupo 1, foi observada associação entre os resultados da prova de Unterberger-Fukuda com os valores de simetria dos canais semicirculares anteriores e do ganho de reflexo vestíbulo-ocular dos canais semicirculares anterior esquerdo e posterior direito. Conclusão não houve associação entre os resultados da avaliação clínica do equilíbrio corporal e dos achados do vHIT com o avanço da idade, em pacientes com insuficiência cardíaca. Entretanto, observou-se diferença entre o ganho do reflexo vestíbulo-ocular específico para alguns canais semicirculares, com maiores índices de alteração na prova de equilíbrio dinâmico, em ambos os grupos. Os resultados dos testes aplicados permitiram caracterizar o predomínio da hipofunção vestibular crônica de origem periférica nos pacientes com insuficiência cardíaca, independentemente da faixa etária.

ABSTRACT Purpose to verify whether there is an association between the clinical assessment of balance and the gain in the vestibulo-ocular reflex with advancing age in patients with heart failure. Methods analytical-descriptive, observational cross-sectional study, which included patients diagnosed with heart failure, divided into two groups by age (G1, under 60 years old and G2, 60 years old or older). The patients were evaluated through anamnesis, cardiac assessment, clinical assessment of body balance (cerebellar function screening and assessment of static and dynamic balance) and instrumental assessment of vestibular function (Video Head Impulse Test-vHIT). The findings were described and compared through inferential statistical analysis. Results 34 patients with a mean age of 55 years and 9 months, mostly men (71.49%). There was no association between vestibulo-ocular reflex gain, symmetry of the semicircular canals and body balance with advancing age. Associations were observed between the results of the Unterberger-Fukuda test with the gain in the vestibulo-ocular reflex of the right lateral and left posterior semicircular canals and with the percentages of symmetry of the anterior semicircular canals for patients in Group 2. In Group 1, an association was observed between the results of the Unterberger-Fukuda test and the symmetry values of the anterior semicircular canals and the gain in the vestibulo-ocular reflex of the left anterior and right posterior semicircular canals. Conclusion there was no association between the results of the clinical assessment of body balance and the vHIT findings with advancing age in patients with heart failure. However, there was a difference between the gain of the specific vestibulo-ocular reflex for some semicircular canals, with higher rates of alteration in the dynamic balance test, in both groups. The results of the applied tests allowed characterize the predominance of chronic vestibular hypofunction of peripheral origin in patients with heart failure, regardless of age group.

Cross-cultural adaptation of the new Reynell developmental language scales to Brazilian Portuguese

Abstract Objective: Translation and cross-cultural adaptation of The New Reynell Developmental Language Scales (NRDLS) to Portuguese spoken in Brazil. Method: We followed the steps recommended in the manual Multilingual Toolkit da NRDLS: translation of the test, adaptation of items from the scales, and use of NRDLS in a pilot study with Brazilian children. It was included a back-translation and analysis by a group of specialists in the area that helped to review the adapted version. A quantitative descriptive analysis of results from the pilot group was performed, and we used a one-way repeated measures ANOVA. Results: The Brazilian Portuguese version of the NRDLS seems very similar to the original NRDLS in terms of conceptual equivalence. The children understood well the translated and adapted words, and they had more difficulty in the last sessions. Some of the mistakes made by the children helped us to adapt specific items for a better evaluation of the abilities of Brazilian children. Conclusion: The suggestions in the Multilingual Toolkit, the input from the group of specialists, and the experience with the children in the pilot group helped the adaptation of the NRDLS to Brazilian Portuguese. The adapted version of NRDLS was effective, it reflected the gradual evolution of complexity in the scales. We suggest the application of the adapted version in a large group of children with normal development to validate it.

Task force Guideline of Brazilian Society of Otology - hearing loss in children - Part II - Treatment

Abstract Objectives: To provide an overview of the main evidence-based recommendations for the diagnosis of hearing loss in children and adolescents aged 0-18 years. Methods: Task force members were educated on knowledge synthesis methods, including electronic database search, review and selection of relevant citations, and critical appraisal of selected studies. Articles written in English or Portuguese on childhood hearing loss were eligible for inclusion. The American College of Physicians' guideline grading system and the American Thyroid Association's guideline criteria were used for critical appraisal of evidence and recommendations for therapeutic interventions. Results: The topics were divided into 2 parts: (1) treatment of sensorineural hearing loss: individual hearing aids, bilateral cochlear implants, cochlear implants in young children, unilateral hearing loss, and auditory neuropathy spectrum disorder; and (2) treatment of conductive/mixed hearing loss: external/middle ear malformations, ventilation tube insertion, and tympanoplasty in children. Conclusions: In children with hearing loss, in addition to speech therapy, Hearing AIDS (HAs) or implantable systems may be indicated. Even in children with profound hearing loss, both the use of HAs and behavioral assessments while using the device are important.

COVID-19 e a adaptação ao ensino remoto emergencial: revisão de escopo / COVID-19 and the adaptation to emergency remote teaching: a scoping review

Objetivo: Mapear o conhecimento sobre os principais desafios e as possíveis oportunidades advindas do ensino remoto emergencial durante a pandemia da COVID-19 sob a perspectiva de docentes e discentes dos cursos de ensino superior das áreas de Ciências da Saúde. Método: Trata-se de uma revisão de escopo pautada nas reco-mendações do The Joanna Briggs Institute. Foram realizadas buscas em duas bases de dados a fim de identificar estudos primários publicados em português, inglês e espanhol, entre os anos de 2020 e 2021, das quais foram identificadas 15 publicações que abordavam o ensino remoto emergencial em cursos de ensino superior da área de saúde. Resultados: Das publicações analisadas, 73,3% eram estudos transversais. Sete dos estudos tiveram os discentes como grupo de estudo, quatro abordaram a perspectiva docente, e três trouxeram a percepção conjunta de discentes e docentes. Os principais desafios identificados foram: o cumprimento das atividades de prática clínica, o distanciamento e menor interação entre pares, aumento da carga de trabalho, dificuldade/disparidade no acesso à internet e problemas técnicos, presença de distratores dificultando foco e motivação, dificuldade de manter aten-ção nesta modalidade de ensino, qualidade do ensino, baixa adesão dos discentes, insatisfação com as atividades em grupo e dificuldades em relação ao uso do dispositivo. Como oportunidades, a flexibilidade das aulas, o uso de tecnologias interativas, economia de tempo, melhoria de interação entre os discentes e docentes, possibilidades de cooperação vencidas pela barreira física. Conclusão: Do ponto de vista de discentes e docentes, existiram inúme-ros desafios sociais, tecnológicos (acesso e conhecimento) e pedagógicos. No entanto, este contexto também trou-xe novas oportunidades, que devem ser refletidas e analisadas pela comunidade acadêmica como pontos positivos, e incorporadas estrategicamente a fim de transformar o sistema educacional. (AU)

Objective: To map the knowledge of the main challenges and possible opportunities in emergency remote teaching during the COVID-19 pandemic from the perspective of higher education health science professors and students. Method: This scoping review was based on the recommendations of the Joanna Briggs Institute. The search was conducted in two databases to identify primary studies published in Portuguese, English, or Spanish in 2020 and 2021; 15 publications that approached emergency remote teaching in higher education programs in the field of health were identified. Results: Of the analyzed publications, 73.3% were cross-sectional studies. Seven studies comprised students in the study group; four addressed professors' perspectives; and three analyzed both students' and professors' perceptions. The following main challenges were identified: carrying out practical clinical activities, peer distancing and less interaction, increased workload, Internet access difficulties/disparities and technical problems, presence of distractors hindering focus and motivation, attention difficulties in this teaching modality, quality of teaching, low student adherence, dissatisfaction with group activities, and difficulties using devices. The opportunities included class flexibility, interactive technology use, time saving, improved student-professor interaction, cooperation possibilities otherwise impossible due to physical barriers. Conclusion: From the students' and professors' standpoint, there were countless social, technological (access and knowledge), and pedagogical challenges. On the other hand, this context also provided new opportunities, which the academic community must consider and analyze as positive aspects incorporated strategically to transform the educational system. (AU)

Is there a change in P300 evoked potential after 6 months in cochlear implant users?

Abstract Objective: There are few studies on long-latency auditory evoked potential (P300) in people with hearing loss who use a cochlear implant. Central auditory system evaluation with behavioral and electrophysiological tests is believed to help understand the neuroplasticity mechanisms involved in auditory functioning after cochlear implant surgery. This study investigated the electrophysiological processing of cortical level acoustic signals in a group of 21 adult individuals with postlingual bilateral severe-to-profound hearing loss who were submitted to cochlear implant surgery. Methods: Data were collected in three phases: pre-cochlear implant surgery, at cochlear implant activation, and 6 months after surgery. P300 measures were also registered during all phases. Tone-burst and speech stimuli were used to elicit P300 and were presented in free field. Results: Mean P3 component latency with tone-burst and speech stimuli were 352.9 and 321.9 ms in the pre-cochlear implant phase, 364.9 and 368.7 ms in the activation phase, 336.2 and 343.6 ms 6 months after the surgery. The P3 component mean latency values using tone-burst at activation were significantly different from those 6 months after cochlear implant. They were also significantly different using speech, between pre-cochlear implant and activation phases. Lower P3 component latency occurred 6 months after cochlear implant activation with tone-burst and pre-cochlear implant with speech stimulus. There was a weak correlation between mean P3 component latency with speech stimulus and time of hearing loss. There was no difference in amplitude between phases or in the comparison with the other variables. Conclusion: There were changes in P3 component latency during the period assessed, for both speech and pure-tone stimuli, with increased latency in the activation phase and similar lower results in the two other phases, Pre-CI and 6 months after CI use. Mean amplitude measures did not vary in the three phases.

Surgical and audiological results of bone-anchored hearing aids: comparison of two surgical techniques / Resultados cirúrgicos e audiológicos de próteses ancoradas no osso: comparação de duas técnicas cirúrgicas

Abstract Introduction: The bone-anchored hearing system has become the most viable treatment option for subjects with conductive or mixed hearing loss, who are unable to benefit from conventional hearing aids or middle ear surgery. Objective: To compare the surgical and audiological outcomes between the minimally-invasive Ponto surgery and a linear incision with soft tissue preservation techniques in bone-anchored hearing system recipients. Methods: A retrospective study was carried out from January 2017 to June 2018. Forty-two adult patients eligible for unilateral bone-anchored hearing system surgery with the Ponto system were included in the study. The implant and abutment lengths used varied from 3 to 4 mm and from 6 to 14 mm, according to the bone and skin thickness of the participants, respectively. Results: Twenty-two surgeries were performed using the minimally invasive Ponto surgery technique (52.4%) and 20 (47.6%) using the linear incision. The mean age of the subjects implanted with minimally invasive Ponto surgery and linear incision techniques were 42.0 and 33.3 years old, respectively. Ten male (45,5%) and 14 (70%) female patients were implanted using minimally invasive Ponto surgery and the linear incision techniques, respectively. There were no differences between pure tone audiometric thresholds and monosyllabic word recognition scores of the subjects, when comparing both surgical techniques. The minimally invasive Ponto surgery technique significantly reduced the surgical time compared to the linear incision technique. There were no differences between both surgical techniques for skin-related complications; (Holgers 3 and 4) which occurred in 18.8% for MIPS and in 25% for linear incision. Subjects included in the minimally invasive Ponto surgery technique group showed a superior cosmetic outcome, with no surgical scar or additional sutures. Conclusion: The surgical and audiological outcomes were satisfactory and were not correlated to the surgical technique selected in all subjects. When compared to the linear incision, the minimally invasive Ponto surgery technique showed reduced surgical time and superior esthetic outcomes in the postoperative follow-up.

Resumo Introdução: As próteses auditivas ancoradas ao osso têm se tornado a opção de tratamento mais viável para indivíduos com perda auditiva condutiva ou mista, incapazes de se beneficiar de aparelhos auditivos convencionais ou cirurgia da orelha média. Objetivo: Comparar os resultados cirúrgicos e audiológicos entre as técnicas minimally invasive Ponto surgery e incisão linear com preservação de tecidos moles em usuários de próteses auditivas ancoradas ao osso. Método: Foi feito um estudo retrospectivo de janeiro de 2017 a junho de 2018. Foram incluídos no estudo 42 pacientes adultos candidatos para cirurgia de prótese auditiva ancorada ao osso unilateral com o sistema Ponto. Os comprimentos de implante e pilar usados variaram de 3-4 milímetros e de 6-14 milímetros, de acordo com a espessura óssea e subcutânea dos participantes, respectivamente. Resultados: Foram feitas 22 cirurgias com uso da técnica minimally invasive Ponto surgery (52,4%) e 20 (47,6%) com incisão linear. A idade média dos indivíduos implantados com técnicas minimally invasive Ponto surgery e incisão linear foi de 42 e 33,3 anos, respectivamente. Dez homens (45,5%) e 14 (70%) mulheres foram implantadas com técnicas minimally invasive Ponto surgery e incisão linear, respectivamente. Não houve diferenças entre os limiares audiométricos em campo livre e as pontuações de reconhecimento de palavras monossilábicas dos sujeitos, quando comparadas as duas técnicas cirúrgicas. A técnica minimally invasive Ponto surgery reduziu significantemente o tempo cirúrgico em comparação com a técnica de incisão linear. Não houve diferenças entre as duas tecnicas cirúrgicas para complicações cutâneas maiores (Holgers 3 e 4), que ocorreram em 18,18% para MIPS e em 25% para incisão linear. Os indivíduos incluídos no grupo da técnica minimally invasive Ponto surgery apresentaram aspecto cosmético superior, sem cicatriz cirúrgica ou sutura adicional. Conclusão: Os resultados cirúrgicos e audiológicos foram satisfatórios e não se correlacionaram com a técnica cirúrgica empregada em todos os indivíduos. Quando comparada à incisão linear, a técnica minimally invasive Ponto surgery apresentou tempo cirúrgico reduzido e resultados estéticos superiores no seguimento pós-operatório.

Análise da adequação dos itens do Teste de Progresso em medicina / Item analysis of Progress Test in medicine

Resumo: Introdução: A avaliação do estudante deve induzir aprendizagem e ser baseada em competência, ou seja, avaliar (habilidades cognitivas, psicomotoras e afetivas). Para avaliar conhecimento e a habilidade para sua utilização no contexto profissional, o Teste de Progresso (TP) tem sido usado em larga escala, com finalidade somativa e principalmente formativa. Objetivo: Este estudo teve como objetivo verificar a adequação e qualidade de itens que compõem os TP realizados pelos estudantes. Método: Trata-se de estudo exploratório descritivo e retrospectivo que analisou todos os itens de seis provas do TP aplicado a estudantes de Medicina do primeiro ao sexto ano da Faculdade de Medicina de Ribeirão Preto/USP, no período de 2013 a 2018. Os sete indicadores de boas práticas foram: 1. abordar tema relevante na formação médica; 2. ter enunciado maior que as alternativas; 3. avaliar aplicação do conhecimento; 4. definir pergunta clara para o item no enunciado; 5. avaliar apenas um domínio do conhecimento em cada item; 6. ter resposta correta e distratores homogêneos e plausíveis; 7. ausência de erros no item que acrescentam dificuldade desnecessária ou dão pistas da resposta correta. Dois avaliadores independentes analisaram as questões e, quando necessário, revisavam em conjunto os itens discordantes. Resultado: A análise das provas permitiu identificar boa qualidade técnica na maioria dos itens das seis provas, além de indicar que a não adesão foi mais frequente nos indicadores 4 e 5, que podem comprometer tanto a validade quanto a interpretação dos resultados da prova em termos de lacunas do conhecimento por parte dos estudantes. Conclusão: A qualidade das questões das provas analisadas é muito boa, mas foi possível identificar oportunidades de melhoria no processo de elaboração de itens, que servem de base para o desenvolvimento docente dos elaboradores da instituição.

Abstract: Introduction: Assessment drives learning and should follow a competence-based approach. The Progress Test (PT) has been used on a large scale for summative and mainly formative purposes to assess knowledge and the ability to use it in the professional context. Objective: To check the adequacy and quality of the items and that make up the progress tests sat by students. Method: Descriptive and retrospective exploratory study that analyzed all the items of six PT exams applied to medical students from the first to the sixth year of the Faculty of Medicine of Ribeirão Preto/USP, from 2013 to 2018. The seven indicators of good practices were: 1. Addresses a relevant topic in medical training; 2. Statement longer than key answer and distractors; 3. Application of knowledge evaluated; 4.Clear lead-in defined for the item in the statement; 5. Only one domain of knowledge assessed in each item; 6.Plausible and homogeneous key answer and distractors; 7.Absence of flaws that add unnecessary difficulty or give clues to the correct answer. Two independent evaluators analyzed the items and, if necessary, they jointly reviewed any disagreement. Result: The analysis showed a good technical quality of most items in the six PT exams. In addition, they indicated that non-adherence was a bit more frequent for indicators 4 and 5, which can compromise both the validity and the interpretation of the test results in terms of knowledge gaps on the part of students. Conclusion: In general, the quality of the items was very good but there are some opportunities for improvement in the process of item writing based on faculty development within the institution.

Clinical implications of intraoperative eABRs to the Evo®-CI electrode array recipients / Implicações clínicas do eABR intraoperatório para usuários do feixe de eletrodos Evo

Abstract Introduction Electrically evoked auditory brainstem responses provide reliable clinical information to assist professionals in the auditory rehabilitation of cochlear implant users. Objective This study aimed to investigate intraoperative evoked auditory brainstem response recordings in Evo®-cochlear implant electrode array recipients and its correlation with their behavioral levels and auditory performance. Methods This is a retrospectivey study. Intraoperative evoked auditory brainstem responses were recorded in adult Evo®-cochlear implant electrode array recipients. Wave V latencies, amplitudes and interpeak III-V intervals were recorded in three different electrode locations and compared to the sentence recognition scores obtained from subjects after six months of device use. Evoked auditory brainstem responses thresholds were also recorded and compared to the behaviorally determined levels of the subjects in the sound processor activation. Results Evoked auditory brainstem responses thresholds were significantly correlated with both, behavioral T- and C-levels and they were recorded at audible electrical stimulation levels in all subjects. There was a significant correlation between interpeak III-V interval recorded in the apical electrode and sentence recognition scores of the subjects. Conclusions Intraoperative evoked auditory brainstem responses can be used to establish audible levels for fitting the sound processor in Evo®-cochlear implant recipients and it could help professionals to plan further actions aiming to improve their auditory performance.

Resumo Introdução Os potenciais auditivos de tronco encefálico evocados eletricamente fornecem informações clínicas confiáveis que auxiliam no processo de reabilitação auditiva de usuários de implante coclear. Objetivo Investigar o registro intraoperatório dos potenciais auditivos de tronco encefálico evocados eletricamente em usuários do feixe de eletrodos Evo® e sua correlação com os níveis comportamentais e desempenho auditivo dos indivíduos. Método Estudo retrospectivo. Os potenciais auditivos de tronco encefálico intraoperatórios foram registrados em usuários adultos de implante coclear com feixe de eletrodos Evo®. As latências e amplitudes da onda V e os intervalos interpico III-V foram registrados em três diferentes eletrodos e comparados às pontuações de reconhecimento de sentenças após 6 meses de uso do implante coclear. Os limiares dos eABRs foram comparados aos níveis comportamentais dos indivíduos na ativação do processador de som. Resultados Os limiares do eABR foram significativamente correlacionados aos níveis comportamentais T e C e registrados em níveis de estimulação elétrica audíveis em todos os indivíduos. Houve uma correlação significativa entre o intervalo interpico III-V no eletrodo apical e a pontuação de reconhecimento de sentenças dos indivíduos. Conclusões O eABR intraoperatório pode ser usado para estabelecer níveis audíveis de estimulação elétrica na ativação do processador sonoro em usuários de implante coclear‐Evo® e pode auxiliar os profissionais no planejamento de ações visando melhorar o desempenho auditivo nesses pacientes.

Cochlear implant revision surgeries in children / Cirurgias revisionais de implante coclear em crianças

Abstract Introduction: The surgery during which the cochlear implant internal device is implanted is not entirely free of risks and may produce problems that will require revision surgeries. Objective: To verify the indications for cochlear implantation revision surgery for the cochlear implant internal device, its effectiveness and its correlation with certain variables related to language and hearing. Methods: A retrospective study of patients under 18 years submitted to cochlear implant surgery from 2004 to 2015 in a public hospital in Brazil. Data collected were: age at the time of implantation, gender, etiology of the hearing loss, audiological and oral language characteristics of each patient before and after cochlear implant surgery and any need for surgical revision and the reason for it. Results: Two hundred and sixty-five surgeries were performed in 236 patients. Eight patients received a bilateral cochlear implant and 10 patients required revision surgery. Thirty-two surgeries were necessary for these 10 children (1 bilateral cochlear implant), of which 21 were revision surgeries. In 2 children, cochlear implant removal was necessary, without reimplantation, one with cochlear malformation due to incomplete partition type I and another due to trauma. With respect to the cause for revision surgery, of the 8 children who were successfully reimplanted, four had cochlear calcification following meningitis, one followed trauma, one exhibited a facial nerve malformation, one experienced a failure of the cochlear implant internal device and one revision surgery was necessary because the electrode was twisted. Conclusion: The incidence of the cochlear implant revision surgery was 4.23%. The period following the revision surgeries revealed an improvement in the subject's hearing and language performance, indicating that these surgeries are valid in most cases.

Resumo Introdução: A cirurgia para a implantação do dispositivo interno do implante coclear não é inteiramente livre de riscos e pode apresentar problemas que exigem cirurgias revisionais. Objetivo: Verificar a incidência das indicações de cirurgias revisionais para a implantação do dispositivo interno do implante coclear, sua efetividade e correlacionar às variáveis relacionadas às categorias de linguagem e audição. Método: Estudo retrospectivo de pacientes menores de 18 anos submetidos à cirurgia de implante coclear de 2004 a 2015 em um hospital público no Brasil. Os dados coletados foram: idade no momento da implantação, sexo, etiologia da surdez, características audiológicas e da linguagem oral de cada paciente no pré e pós-operatório, necessidade de revisão cirúrgica e razão para ela. Resultados: Foram feitas 265 cirurgias em 236 pacientes. Oito pacientes foram submetidos ao implante coclear bilateral e 10 necessitaram de cirurgia de revisão. Foram necessárias 32 cirurgias para essas 10 crianças (um implante coclear bilateral), das quais 21 foram cirurgias de revisão. Em duas crianças, a remoção do implante coclear foi necessária, sem realização de reimplante; uma delas apresentava malformação coclear, por partição incompleta tipo I; e a outra, devido a trauma. Quanto à causa da necessidade da cirurgia revisional, das oito crianças que permaneceram com implante coclear, quatro apresentaram calcificação coclear após meningite, seguida de trauma (1), malformação do nervo facial (1), falha do dispositivo interno da IC (1) e torção do feixe de eletrodos (1). Conclusão: A incidência de cirurgias revisionais foi de 4,23%. O pós-operatório das cirurgias revisionais permite uma melhoria no desempenho de audição e na linguagem dos pacientes, indicando que essas cirurgias são válidas na maioria dos casos.

Is there a best side for cochlear implants in post-lingual patients? / Existe um lado melhor para implantes cocleares em pacientes pós-linguais?

Abstract Introduction: Cochlear Implant is a sensory prosthesis capable of restoring hearing in patients with severe or profound bilateral sensorineural hearing loss. Objective: To evaluate if there is a better side to be implanted in post-lingual patients. Methods: Retrospective longitudinal study. Participants were 40 subjects, of both sex, mean age of 47 years, with post-lingual hearing loss, users of unilateral cochlear implant for more than 12 months and less than 24 months, with asymmetric auditor reserve between the ears (difference of 10 dBNA, In at least one of the frequencies with a response, between the ears), divided into two groups. Group A was composed of individuals with cochlear implant in the ear with better auditory reserve and Group B with auditory reserve lower in relation to the contralateral side. Results: There was no statistical difference for the tonal auditory threshold before and after cochlear implant. A better speech perception in pre-cochlear implant tests was present in B (20%), but the final results are similar in both groups. Conclusion: The cochlear implant in the ear with the worst auditory residue favors a bimodal hearing, which would allow the binaural summation, without compromising the improvement of the audiometric threshold and the speech perception.

Resumo Introdução: O implante coclear é uma prótese sensorial capaz de restaurar a audição em pacientes com perda auditiva neurossensorial bilateral severa ou profunda. Objetivo: Avaliar se há um melhor lado para o implante coclear em pacientes pós-linguais. Método: Estudo longitudinal retrospectivo; incluiu 40 indivíduos, de ambos os sexos, média de 47 anos, com perda auditiva pós-lingual, usuários de implante coclear unilateral por mais de 12 meses e menos de 24 meses, com perda auditiva assimétrica entre as orelhas (diferença de 10 dBNA, em pelo menos uma das frequências), divididos em dois grupos. O Grupo A foi composto por indivíduos com implante coclear na orelha com melhor audição residual e Grupo B com menor audição residual em relação ao lado contralateral. Resultados: Não houve diferença estatística entre o limiar auditivo tonal antes e depois do implante coclear. Uma melhor percepção da fala nos testes pré-implante coclear foi observada no grupo B (20%), mas os resultados finais foram semelhantes em ambos os grupos. Conclusão: O implante coclear na orelha com pior audição residual favorece uma audição bimodal, o que possibilitaria a somação binaural, sem comprometer a melhora do limiar audiométrico e a percepção da fala.

Auditory Speech Perception Development in Relation to Patient's Age with Cochlear Implant

Abstract Introduction A cochlear implant in adolescent patients with pre-lingual deafness is still a debatable issue. Objective The objective of this study is to analyze and compare the development of auditory speech perception in children with pre-lingual auditory impairment submitted to cochlear implant, in different age groups in the first year after implantation. Method This is a retrospective study, documentary research, in which we analyzed 78 reports of children with severe bilateral sensorineural hearing loss, unilateral cochlear implant users of both sexes. They were divided into three groups: G1, 22 infants aged less than 42 months; G2, 28 infants aged between 43 to 83 months; and G3, 28 older than 84 months.We collectedmedical record data to characterize the patients, auditory thresholds with cochlear implants, assessment of speech perception, and auditory skills. Results There was no statistical difference in the association of the results among groups G1, G2, and G3 with sex, caregiver education level, city of residence, and speech perception level. There was a moderate correlation between age and hearing aid use time, age and cochlear implants use time. There was a strong correlation between age and the age cochlear implants was performed, hearing aid use time and age CI was performed. Conclusion There was no statistical difference in the speech perception in relation to the patient's age when cochlear implant was performed. There were statistically significant differences for the variables of auditory deprivation time between G3 - G1 and G2 - G1 and hearing aid use time between G3 - G2 and G3 - G1.

Implicações do uso do Aparelho de Amplificação Sonora Individual na qualidade de vida de idosos / Implications of using the Hearing Aids on quality of life of elderly

RESUMO Objetivo Avaliar, por meio de questionários padronizados, a qualidade de vida de idosos com deficiência auditiva diagnosticada que utilizam ou não a prótese auditiva (AASI) e de idosos sem queixa auditiva. Método Trata-se de um estudo transversal, com amostra não probabilística, distribuída em três grupos divididos da seguinte forma: 30 idosos com perda auditiva diagnosticada e com indicação para uso do aparelho de amplificação sonora individual (AASI), mas que ainda não faziam uso da prótese; 30 idosos com deficiência auditiva que usavam o AASI; e 30 idosos sem queixa auditiva. Os participantes completaram um questionário que investigava dados sociodemográficos e familiares, o Hearing Handicap Inventory for the Elderly Screening Version (HHIE-S) e o World Health Organization Quality of Life - versão breve (WHOQOL-Breve). Além das análises descritivas dos dados, foram realizados testes para comparação dos três grupos, aplicando-se a análise de variância (ANOVA) e o teste post hoc de Bonferroni. Resultados Os três grupos se diferenciaram significativamente em todos os domínios de qualidade de vida. O grupo de idosos com perda auditiva diagnosticada e com indicação para uso do AASI apresentou menores escores que o grupo de idosos com deficiência auditiva que usavam o AASI e que o grupo de referência. O grupo com AASI apresentou os melhores resultados de qualidade de vida. Conclusão A perda auditiva afeta a qualidade de vida do idoso. O uso efetivo da prótese auditiva é benéfico a esta população, melhorando suas condições de vida e saúde.

ABSTRACT Purpose To evaluate through standardized questionnaires the quality of life of elderly people with hearing loss diagnosed with and without the use of hearing aids (HA) and elderly without hearing complaints. Methods This is a cross-sectional study with non probabilistic sample, divided into three groups divided as follows: 30 elderly people with diagnosed hearing loss and indication for use of individual sound amplification devices (hearing aids), but have not yet made use of the prosthesis; 30 individuals with hearing impairment who used hearing aids and 30 elderly without hearing complaints. Participants completed a questionnaire investigating sociodemographic and family data, the Hearing Handicap Inventory for the Elderly Screening Version (HHIE-S) and the World Health Organization Quality of Life - Short version (WHOQOL-BREF). In addition to the descriptive analysis of the data were performed tests to compare the three groups by applying analysis of variance (ANOVA) and the Bonferroni post hoc test. Results The three groups differed significantly in all domains of quality of life. The group of the elderly people with hearing loss diagnosed and with indication for the use of hearing aids presented lower scores and the group of the elderly with hearing disabilities that used the hearing aid and that the reference group. The AASI group presented the best quality of life results. Conclusion The hearing loss affects the quality of life of the elderly. The effective use of hearing aid is beneficial to this population, improving their living and health conditions.

Relationship between Speech Perception and Level of Satisfaction of Hearing Aid Users

Abstract Introduction Hearing difficulties can be minimized by the use of hearing aids. Objective The objective of this study is to assess the speech perception and satisfaction of hearing aids users before and after aid adaptation and to determine whether these measures are correlated. Methods The study was conducted on 65 individuals, 54% females and 46% males aged 63 years on average, after the systematic use of hearing aids for at least three months. We characterized subjectś personal identification data, the degree, and configuration of hearing loss, as well as aspects related to adaptation. We then applied a satisfaction questionnaire and a speech perception test (words and sentences), with and without the use of the hearing aids. Results Mean speech recognition with words and sentences was 69% and 79 %, respectively, with hearing aids use; whereas, without hearing aids use the figures were 43% and 53%. Mean questionnaire score was 30.1 points. Regarding hearing loss characteristics, 78.5% of the subjects had a sensorineural loss, 20% a mixed loss, and 1.5% a conductive loss. Hearing loss of moderate degree was present in 60.5% of cases, loss of descending configuration in 47%, and plain loss in 37.5%. There was no correlation between individual satisfaction and the percentages of the speech perception tests applied. Conclusion Word and sentence recognition was significantly better with the use of the hearing aids. The users showed a high degree of satisfaction. In the present study, there was no correlation observed between the levels of speech perception and levels of user satisfaction measured with the questionnaire.

Auditory Speech Perception Tests in Relation to the Coding Strategy in Cochlear Implant

Abstract Introduction The objective of the evaluation of auditory perception of cochlear implant users is to determine how the acoustic signal is processed, leading to the recognition and understanding of sound. Objective To investigate the differences in the process of auditory speech perception in individuals with postlingual hearing loss wearing a cochlear implant, using two different speech coding strategies, and to analyze speech perception and handicap perception in relation to the strategy used. Methods This study is prospective cross-sectional cohort study of a descriptive character. We selected ten cochlear implant users that were characterized by hearing threshold by the application of speech perception tests and of the Hearing Handicap Inventory for Adults. Results There was no significant difference when comparing the variables subject age, age at acquisition of hearing loss, etiology, time of hearing deprivation, time of cochlear implant use and mean hearing threshold with the cochlear implant with the shift in speech coding strategy. There was no relationship between lack of handicap perception and improvement in speech perception in both speech coding strategies used. Conclusion There was no significant difference between the strategies evaluated and no relation was observed between them and the variables studied.

Variables in P300 recording: task type and electrode position

ABSTRACT Purpose To analyze the latency and amplitude of P300 responses obtained with electrodes positioned at Cz and Fz and in different tasks of infrequent stimulus identification in normal hearing individuals. Methods Forty adults of both genders participated in the study. Three recordings with three different tasks were obtained for the identification of the infrequent stimulus; simultaneous recordings were obtained from Cz and Fz positions. Results Cz position showed significantly greater amplitudes and lower latencies than Fz. Regarding the three tasks, only “pronouncing the word ’thin’” was different from “raising a finger”, with lowest latencies for the verbal task. Regarding amplitude, significantly higher values were observed for “raising a finger”, followed by “pronouncing the word ‘thin’” and mental counting. Conclusion Cz obtained the best values, highest amplitude and lowest latency. Lowest latencies were obtained for the task of “pronouncing the word ‘thin’” and the highest amplitudes were obtained for “raising a finger”.

Morphological analysis of the vestibular system of guinea pigs poisoned by organophosphate / Análise morfológica do sistema vestibular de cobaias intoxicadas por organofosforado

ABSTRACT INTRODUCTION: The vestibular system is responsible for body balance. There are substances that damage it, causing dizziness; these are termed vestibulotoxic substances. Agrochemicals have been investigated for ototoxicity because of studies that identified dizziness as a recurrent symptom among rural workers' complaints. OBJECTIVE: To histopathologically evaluate the vestibular system in guinea pigs exposed to an organophosphate, and to identify the drug's effects on this system. METHODS: Experimental clinical study. Eighteen guinea pigs were used; six of them poisoned with the organophosphate chlorpyrifos at doses of 0.5 mg/kg/day and seven of them at 1 mg/kg/day; and a control group of five guinea pigs was exposed to distilled water, all for 10 consecutive days. Later, ciliary tufts of saccule and utricle maculae were counted by scanning electron microscopy. RESULTS: Comparing the groups, a one-way ANOVA test for the variable "saccule" ( p = 0.0569) and a Kruskal-Wallis test for the variable "utricle" ( p = 0.8958) were performed, revealing no difference among groups in both variables. CONCLUSION: The histopathologic analysis of the vestibular system of guinea pigs exposed to an organophosphate showed no difference in the amount of ciliary tufts of saccule and utricle maculae at the doses tested, although the result for the variable "saccule" was considered borderline, showing a trend for significance.

RESUMO INTRODUÇÃO: O sistema vestibular é responsável pelo equilíbrio corporal. Existem substâncias que o danificam, causando tontura; são chamadas vestibulotóxicas. Agrotóxicos tornaram-se objeto de investigação da ototoxicidade a partir de pesquisas que apontaram tontura como sintoma recorrente entre as queixas de trabalhadores rurais. OBJETIVO: Constitui-se em avaliar a histopatologia do sistema vestibular de cobaias expostas a organofosforados, identificando os efeitos nesse sistema. MÉTODO: É um estudo clínico experimental, que utilizou 18 cobaias, sendo seis intoxicadas com organofosforadoclorpirifós na dose de 0,5 mg/kg/dia; sete na dose de 1 mg/kg/dia, e grupo controle com cinco cobaias expostas a água destilada, durante 10 dias consecutivos. Posteriormente realizou-se a contagem dos tufos ciliares nas máculas dos sáculos e utrículos através microscopia eletrônica de varredura. RESULTADOS: Na comparação intergrupos, para a variável sáculo realizou-se o teste ANOVA one-way (p = 0,0569); para a variável utrículo, utilizou-se o teste Kruskal-Wallis (p = 0,8958), revelando não haver diferença entre os grupos em ambas as variáveis. CONCLUSÃO: Análise histopatológica do sistema vestibular de cobaias expostas a organofosforado não demonstrou diferença na quantidade de tufos ciliares nas máculas dos sáculos e utrículos nas doses testadas, apesar do resultado para a variável sáculo ser considerado limítrofe mostrando uma tendência a significância.

Lack of protection against gentamicin ototoxicity by auditory conditioning with noise / Falta de proteção contra a ototoxicidade da gentamicina pelo condicionamento auditivo com ruído

INTRODUCTION: Auditory conditioning consists of the pre-exposure to low levels of a potential harmful agent to protect against a subsequent harmful presentation. OBJECTIVE: To confirm if conditioning with an agent different from the used to cause the trauma can also be effective. METHOD: Experimental study with 17 guinea pigs divided as follows: group Som: exposed to 85 dB broadband noise centered at 4 kHz, 30 minutes a day for 10 consecutive days; group Cont: intramuscular administration of gentamicin 160 mg/kg a day for 10 consecutive days; group Expt: conditioned with noise similarly to group Som and, after each noise presentation, received gentamicin similarly to group Cont. The animals were evaluated by distortion product otoacoustic emissions (DPOAEs), brainstem auditory evoked potentials (BAEPs) and scanning electron microscopy. RESULTS: The animals that were conditioned with noise did not show any protective effect compared to the ones that received only the ototoxic gentamicin administration. This lack of protection was observed functionally and morphologically. CONCLUSION: Conditioning with 85 dB broadband noise, 30 min a day for 10 consecutive days does not protect against an ototoxic gentamicin administration of 160 mg/kg a day for 10 consecutive days in the guinea pig. .

INTRODUÇÃO: O condicionamento auditivo consiste da pré-exposição de um agente lesivo em baixos níveis para proteger contra uma posterior apresentação lesiva. OBJETIVO: Confirmar se o condicionamento com um agente diferente do utilizado para causar o trauma pode ser efetivo. MÉTODO: Estudo experimental com 17 cobaias albinas divididas como a seguir- grupo Som: exposto a um ruído branco de 85 dB centrado em 4 kHz, 30 minutos por dia, por 10 dias consecutivos; grupo Cont: administração intramuscular de gentamicina 160 mg/kg por dia, por 10 dias consecutivos; grupo Expt: condicionado com ruído como o grupo Som. Após cada exposição ao ruído, recebeu gentamicina similarmente ao grupo Cont. Os animais foram avaliados por emissões otoacústicas produto de distorção (EOAPDs), potencial evocado auditivo de tronco encefálico (PEATE) e microscopia eletrônica de varredura (MEV). RESULTADOS: Os animais que foram condicionados com ruído não mostraram qualquer efeito protetor quando comparados com os que receberam apenas a gentamicina em doses ototóxicas. Esta ausência de proteção foi observada tanto funcionalmente quanto morfologicamente. CONCLUSÃO: Os autores concluíram que o condicionamento com ruído branco a 85 dB por 30 minutos, por dia por 10 dias consecutivos, não protege contra uma administração de gentamicina 160 mg/kg/dia, por 10 dias consecutivos. .

Avaliação funcional do sistema vestibular de cobaias intoxicadas agudamente por organofosforado por meio da prova calórica / Functional evaluation of the vestibular system of guinea pigs poisoned by an organophosphate through caloric stimulation

OBJETIVO: avaliar o funcionamento do sistema vestibular de cobaias expostas ao organofosforado clorpirifós, de forma aguda, por meio da prova calórica da eletronistagmografia. MÉTODOS: a pesquisa do tipo experimental realizou a eletronistagmografia de cobaias expostas a organofosforado durante 10 dias consecutivos, nas doses 0,5mg/kg/dia e 1,0mg/kg/dia por via intraperitoneal e comparadas com grupo controle que recebeu administração de água destilada. Foi realizada prova calórica gelada (10ºC) e comparadas as variáveis frequência de aparecimento de nistagmos em 10 segundos (u/s) e velocidade angular da componente lenta (º/s). RESULTADOS: os resultados não demonstraram diferença estatisticamente significante na comparação das variáveis entre os grupos. CONCLUSÃO: conclui-se que nas doses testadas o agrotóxico organofosforado clorpirifós não causou danos funcionais detectáveis na prova calórica. .

PURPOSE: this study aimed to assess the functioning of the vestibular system of guinea pigs exposed to the organophosphate chlorpyrifos, acutely, through caloric stimulation electronystagmography. METHODS: the research conducted an experimental electronystagmography of guinea pigs exposed to organophosphate for 10 consecutive days, at doses 0.5 mg / kg / day and 1.0 mg / kg / day intraperitoneally and compared with a control group that received distilled water administration. We performed caloric ice (10 º C) and compared the variables frequency of appearance of nystagmus in 10 seconds (u / s) and angular velocity of the slow component (º / s). Results: the results showed no statistically significant difference in the comparison of variables between groups. CONCLUSION: we conclude that the tested doses of the pesticide organophosphate chlorpyrifos caused no detectable functional damage in the caloric test. .