Limitation of High Pitch Sound Perception in Nontumor Patients with Auditory Brainstem Implantation / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: Auditory brainstem implantation (ABI) is another option for hearing rehabilitation in non-neurofibromatosis type 2 patients who cannot undergo cochlear implantation (CI). However, the average performance of ABI is worse than that of CI. We analyzed the psycho-electrical parameters of each electrode and psycho-acoustic response to different frequency sounds in nontumor patients with ABI. SUBJECTS AND METHOD: Sixteen patients with ABI from July 2008 to May 2013 were included in the study. They were followed up for 4 to 56 months. Among them, 12 were prelingual deaf with a narrow internal auditory canal or cochlear ossification. The remaining four were post-lingual deaf adults with severely ossified cochleae. We analyzed the electrical parameters [impedance, threshold level (T level), and dynamic range] of each of the 12 electrodes. We also evaluated the sound field pure-tone threshold, Ling 6 sound detection-identification test (Ling 6 test), and pitch ranking data of these patients. RESULTS: The impedance, T level, and dynamic range did not significantly differ among electrodes. However, the pure-tone threshold to sound field stimulation was elevated in the high tone area, where more variables were found than in the low frequency area. Patients could not identify /S/ and /Sh/ sounds in the Ling 6 test. The mean T level and the dynamic range of the three highest pitch-perceiving electrodes in each patient was higher and narrower, respectively, than those of the three lowest pitch-perceiving electrodes. CONCLUSION: The nontumor patients with ABI have difficulty perceiving high pitch sound. More sophisticated penetrating type electrodes and, if possible, bimodal stimulation with CI, could be considered.

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.

A Case of Cochlear Implantation in Neurofibromatosis Type II / 대한이비인후과학회지

Patients with neurofibromatosis type 2 (NF2) develop bilateral vestibular schwannomas that can cause binaural progressive hearing loss in most individuals. Auditory rehabilitation for bilateral profound sensorineural hearing loss in patients with NF2 poses a great therapeutic challenge. An auditory brainstem implantation may be an option after tumor excision, but its hearing results are still relatively unsatisfactory. A cochlear implantation (CI) may be another option in those cases where the cochlear nerve has been left intact after tumor excision or in those cases that have been kept stable after treating with Gamma-Knife. Here we report a case of undergoing CI after having been treated with Gamma-Knife in NF2 and showing improved open-set speech perception.

Sensorineural Hearing Loss: Causes and Hearing Rehabilitation / 한양의대학술지

Sensorineural hearing loss is one of the most common chronic clinical disorders that we can easily encounter. The etiology of sensorineural hearing loss is multifactorial: congenital, idiopathic, traumatic, noise-induced, head injury induced, infectious disease, drug induced, degenerative, immune disorder, vestibular schwannoma and Meniere's disease. Many people are living with the discomfort of hearing loss because fundamental treatment is has not yet been found. Also due to the progress of medical science, human life span has been extended. As the result, the number of patients suffering from hearing loss has increased. But the present situation does not measure up to the demand for recovery of hearing loss. Hearing loss has a great influence on the quality of life. To overcome this situation, neural prostheses such as the cochlear implant and auditory brainstem implant are helpful for the rehabilitation of total deaf patients. Recently, due to the advancement of studies related to hair cell regeneration and the field of gene therapy on the inner ear has made big progress during the last few years. The purpose of this study is to describe the latest known causes and rehabilitation of sensorineural hearing loss.

Auditory Rehabilitation in Rhesus Macaque Monkeys (Macaca mulatta) with Auditory Brainstem Implants / 中华医学杂志(英文版)

<p><b>BACKGROUND</b>The auditory brainstem implants (ABIs) have been used to treat deafness for patients with neurofibromatosis Type 2 and nontumor patients. The lack of an appropriate animal model has limited the study of improving hearing rehabilitation by the device. This study aimed to establish an animal model of ABI in adult rhesus macaque monkey (Macaca mulatta).</p><p><b>METHODS</b>Six adult rhesus macaque monkeys (M. mulatta) were included. Under general anesthesia, a multichannel ABI was implanted into the lateral recess of the fourth ventricle through the modified suboccipital-retrosigmoid (RS) approach. The electrical auditory brainstem response (EABR) waves were tested to ensure the optimal implant site. After the operation, the EABR and computed tomography (CT) were used to test and verify the effectiveness via electrophysiology and anatomy, respectively. The subjects underwent behavioral observation for 6 months, and the postoperative EABR was tested every two weeks from the 1 st month after implant surgery.</p><p><b>RESULT</b>The implant surgery lasted an average of 5.2 h, and no monkey died or sacrificed. The averaged latencies of peaks I, II and IV were 1.27, 2.34 and 3.98 ms, respectively in the ABR. One-peak EABR wave was elicited in the operation, and one- or two-peak waves were elicited during the postoperative period. The EABR wave latencies appeared to be constant under different stimulus intensities; however, the amplitudes increased as the stimulus increased within a certain scope.</p><p><b>CONCLUSIONS</b>It is feasible and safe to implant ABIs in rhesus macaque monkeys (M. mulatta) through a modified suboccipital RS approach, and EABR and CT are valid tools for animal model establishment. In addition, this model should be an appropriate animal model for the electrophysiological and behavioral study of rhesus macaque monkey with ABI.</p>

Resultados auditivos y de beneficios comunicativos en pacientes tratados con el implante activo de transmisión ósea Bonebridge® / Hearing results and communication benefits in patients treated with the active bone conduction implant Bonebridge®

El avance en dispositivos de rehabilitación auditiva ha logrado llegar a los dispositivos de transmisión ósea por medio de anclaje al hueso. El BAHA® (Bone Anchored Hearing Aid, Cochlear Co., Australia) es el más usado, dada su ganancia en el rango de frecuencias altas con menor distorsión de la señal; sin embargo, con complicaciones importantes, como infección, pérdida del implante y necesidad de cirugía revisional, que impactan en calidad de vida y costos. Debido a esto se han desarrollado implantes transcutáneos con menos complicaciones y resultados audiológicos similares, como el nuevo sistema activo de conducción ósea Bonebridge®. Objetivo: Describir los resultados auditivos y beneficios comunicativos del sistema implantable transcutáneo activo de conducción ósea Bonebridge® en hipoacusia conductiva y mixta. Diseño: Estudio pseudoexperimental tipo antes y después. Métodos: Se analizó a los pacientes implantados con el Bonebridge® entre octubre del 2012 y agosto del 2013, por el Servicio de Otología del Hospital Universitario Fundación Santa Fe de Bogotá, y se evaluaron ganancia funcional en audiometría, logoaudiometría, beneficio comunicativo y APHAB pre y posquirúrgico. Resultados: No se encontraron diferencias significativas en la vía ósea pre y postoperatoria. En las pruebas en campo libre solo hubo diferencia en la frecuencia de 500 Hz (P < 0,05). Se evidenció ganancia funcional en la discriminación del lenguaje en bisílabos a 60 dB SPL (nivel de presión sonora) (P: 0,042); se encontraron diferencias en el cuestionario de beneficio comunicativo APHAB (P: 0,043) en todas sus subcategorías, exceptuando aversión (P: 0,068). No hubo complicaciones. Conclusiones: El Bonebridge® es seguro y eficaz para la rehabilitación auditiva...

Advances in hearing rehabilitation devices have developed bone conduction devices through bone anchorage, BAHA® (Cochlear Bone Anchored Hearing Aid Co., Australia) is the most used because of its profit in the range of higher frequencies with less signal distortion, however, ought to its complications such as infection, implant loss and need for revisional surgery, which impact in costs and quality of life; transcutaneous implants have been developed with fewer complications and similar audiological results as the new active system Bonebridge® bone conduction. Objective: To describe the auditory results and communicative benefits of the active transcutaneous bone conduction implantable system Bonebridge® for treatment of conductive and mixed hearing loss. Desing: Pseudoexperimental before and after study. Methods: Patients who were implanted with Bonebridge® between October 2012 and August 2013 were analized by the Otology Department from the Fundación Santa Fe University Hospital in Bogotá, assessing functional gain in audiometry, speech audiometry and communicative benefit, APHAB, before and after surgery. Results: No significant differences in bone conduction were found before or after surgery. In free field test there was only a significant difference for 500 Hz frequency (P < 0.05), functional gain was observed in speech discrimination at 60 dB SPL disyllabic (P 0.042). There were differences for communicative benefit questionnaire (P 0.043) with the use of the device in every subcategories except aversion (P 0.068). There were no complications. Conclusion: Bonebridge® is safe and effective for hearing rehabilitations...

Implantes auditivos de conducción ósea percutáneo, transcutáneo: comparación / Percutaneous, Transcutaneous Bone Conduction Hearing Implants: comparison

Introducción: Los implantes de conducción ósea son alternativas en rehabilitación para pacientes con sordera conductiva/mixta o unilateral. Objetivo: Analizar desenlaces audiológicos, calidad de vida y percepción subjetiva de beneficios en pacientes con sordera conductiva y/o mixta o unilateral, usuarios del sistema transcutáneo Bonebridge®, o del sistema percutáneo BAHA®. Método: Estudio prospectivo en diez pacientes usuarios del sistema transcutáneo, y comparación con diez usuarios del sistema percutáneo. Evaluación audiológica, percepción de calidad de vida y satisfacción. Resultados: Con el sistema transcutáneo en sordera conductiva/mixta se registró ganancia promedio de 39 dB SPL (desviación estándar [DE] ±4; intervalo de confianza [IC] 95% 35-43), y con el sistema percutáneo, 33 dB SPL (DE ±7; IC 95% 26-40); diferencia de 6 dB SPL (EE ±3; IC 95% -1-13, p = 0,09). Discriminación de lenguaje con sistema transcutáneo 100% a 63 dB (DE ±2 dB; IC 95% 61-65) y con sistema percutáneo 100% a 58 dB (DE ±7 dB; IC 95% 51-65), diferencia de 5 dB (EE ±3 dB; IC 95% -2-12, p = 0,12). En sordera unilateral, la comparación de umbrales promedio con los dispositivos: 37 dB SPL (DE ±4; IC 95% 31-43) para el sistema transcutáneo y 32 dB SPL (DE ±3, IC 95% 27-37) para el sistema percutáneo, diferencia de 5 dB SPL (EE ±3; IC 95% -1-11, p = 0,09). Discriminación de lenguaje para sistema transcutáneo 100% a 66 dB SPL (DE ±7; IC 95% 55-77) y con sistema percutáneo 100% a 64 dB SPL (DE ±5; IC 95% 56-72), diferencia de 2 dB SPL (EE ±4; IC 95% –9-13, p = 0,7). Promedio total para percepción de beneficios con el uso de los dispositivos: 33 (DE ±18; IC 95% 20-46) para el sistema transcutáneo y 22 (DE ±12; IC 95% 13-31) en sistema percutáneo, diferencia de 11 puntos (EE ±7; IC 95% –3-25, p = 0,12). El nivel de satisfacción fue cuantificado de manera semejante, excepto en: Aspectos generales, sub-ítem Comodidad a favor del sistema transcutáneo. Conclusiones: Los beneficios audiológicos, satisfacción y calidad de vida identificados en los pacientes con el sistema Bonebridge son evidentes y comparables a los que han logrado los pacientes con el sistema BAHA...

Introduction: Hearing bone conduction implants are alternatives available for hearing rehabilitation in patients with conductive mixed hearing loss or unilateral deafness. Objective: To analyze audiological outcomes, quality of life and subjective hearing benefits perception in patients with conductive mixed hearing loss or unilateral deafness, users of percutaneous BAHA® system, or transcutaneous active bone conduction system Bonebridge®. Materials and Methods: Prospective study on 10 patients with transcutaneous system compared with 10 users of percutaneous system. Audiometries, speech recognition with and without the system, Glasgow Benefit Inventory (GBI) and Hearing Device Satisfaction Scale (HDSS) surveys tools. Results: With transcutaneous system, conductive mixed hearing loss group, achieved postoperatory mean gain of 33 dB SPL (Standard error [SE] ±3, 95% confidence interval [95% CI] 26-40, p>0.00001); with percutaneous system 38 dB SPL (SE ±6) 5% CI 25-51, p>0.00001); difference 5 dB SPL (SE ±3, 95% CI 1-11, p = 0.09). Postoperative speech discrimination, transcutaneous system 100% @63 dB (Standard deviation [SD] ±2 dB, 95% CI 61-65); percutaneous system 100% @58 dB (SD ±7 dB, 95% CI 51-65); difference 5 dB (SE ±3 dB, 95% CI -2 – 12, p = 0.12). In Single Sided Deafness (SSD), postoperative, transcutaneous system 82 dB SPL (SE ±4, 95% CI 72-92); percutaneous system 92 dB SPL (SE ±7, 95% CI 76-108); difference of 10 dB SPL (SE ±4, 95% CI 0.1-20, p = 0.047). Speech discrimination, postoperative, transcutaneous system 100% @66 dB SPL (SD ±7, 95% CI 55-77), percutaneous system 100% @64 dB (SD ±5, 95% CI 56-72); difference 2 dB (SE ±4, 95% CI -9-13, p = 0.7). For benefit perception with the devices, for transcutaneous system mean total scored 33 (SD ±18, 95% CI 20-46); for percutaneous system, 22 (SD ±12, 95% CI 13-31); difference 11 points (EE ±7, 95% CI -3-25, p = 0.12). Satisfaction with the device survey scored similarly except for the Comfort sub-item in the General Aspects favorable to the transcutaneous system. Conclusions: Audiological, satisfaction and –quality of life benefits identified in patients with Bonebridge® system are evident and comparable to those achieved by patients with the BAHA® system...

Neurofibromatose 2: opções de restauração auditiva / Neurofibromatosis 2: hearing restoration options

Neurofibromatose 2 (NF2) é uma doença autossômica dominante que, invariavelmente, cursa com surdez. Restauração auditiva pode ser realizada por meio do implante coclear (IC) ou implante auditivo de tronco encefálico (ABI). OBJETIVO: Avaliar resultados auditivos de IC e ABI em pacientes com NF2 e revisão de literatura. MÉTODO: Foram avaliados prospectivamente quatro pacientes com NF2 submetidos à exérese tumoral e implantação de IC ou ABI ipsilateral simultâneo, dependendo se o nervo coclear foi preservado ou não cirurgicamente. São descritos resultados auditivos em longo prazo (12-48 meses). RESULTADOS: Todos pacientes implantados obtiveram percepção sonora, com melhora dos limiares tonais. A paciente com IC não discrimina vogais nem sentenças. Os três pacientes com ABI apresentam discriminação média de vogais de 70% e teste 4-choice 86%. Um paciente não discrimina sentenças. Os outros dois discriminam 100% de sentenças em formato fechado e em formato aberto 10% e 20%. CONCLUSÃO: A escolha do tipo de implante usado na restauração auditiva de portadores NF2 dependerá da preservação anatômica e funcional do nervo coclear na cirurgia de ressecção tumoral. Embora nossa experiência mostre o contrário, a literatura mostra que, se essa condição for alcançada, IC fornecerá melhores resultados auditivos. Caso contrário, ABI trará maiores benefícios.

Neurofibromatosis 2 (NF2) is an autosomal dominant disease in which hearing loss is predominant. Auditory restoration is possible using cochlear implants (CI) or auditory brainstem implant (ABI). OBJECTIVE: To assess the auditory results of CI and ABI in NF2 patients and review the literature. METHODS: Four NF2 patients were prospectively evaluated. They were submitted to tumor resection followed by ipsilateral CI or ABI depending on cochlear nerve preservation. Long term auditory results were described for CI (12 months) and ABI (48 months). RESULTS: All patients achieved auditory perception improvements in their hearing thresholds. The CI patient does not recognize vowels or sentences. The 3 ABI patients discriminate 70% of vowels and 86% in the 4-choice test. One of them does not recognize sentences. The other two recognize 100% of closed sentences and 10% and 20% of open sentences. CONCLUSION: The choice of implant type to restore hearing to NF2 patients will relay on anatomical and functional cochlear nerve preservation during tumor resection surgery. Although our experience was different, the literature shows that if this condition is achieved, CI will offer better auditory results. If not, ABI is recommended.

Estudio comparativo en pacientes usuarios de implantes Vibrant Soundbridge® (VSB) y sistema osteointegrado BAHA® / Comparative study on patients users of Vibrant Soundbridge® and osseointegrated BAHA® implants

Objetivo: presentar la experiencia de una institución en la rehabilitación de pacientes con pérdida auditiva utilizando el implante de oído medio Vibrant Soundbridge® (VSB). Diseño: estudio retrospectivo. Materiales y métodos: se revisaron registros médicos, quirúrgicos y audiológicos de pacientes a los que se les implantó el sistema Vibrant Soundbridge (VSB), evaluando la ganancia auditiva establecida por la diferencia en los promedios de las frecuencias 0.5 a 3 kHz en la audiometría tonal postimplante con el sistema y sin él. Se evaluó también la satisfacción de uso con el dispositivo mediante la encuesta Escala de Satisfacción de Audición con Dispositivo (HDSS, Hearing Device Satisfaction Scale). Realizamos comparación de desenlaces audiológicos con una población de usuarios de similares características del sistema osteointegrado BAHA®. Resultados: 25 pacientes con pérdida auditiva predominantemente mixta recibieron un implante VSB colocando el Transductor de Masa Flotante (FMT) en ventana redonda en 23 casos (92%). La ganancia auditiva promedio fue de 36 ± 16 decibeles (dB). No se identificaron diferencias significativas en la ganancia auditiva entre los procesadores AP404-36 dB y Amadé-38 dB, p = 0.6. La ganancia auditiva en el grupo de usuarios del sistema BAHA fue de 37 dB y la discriminación de lenguaje a 65 dB fue de 93% y 100% para VSB y BAHA® respectivamente. En ambos sistemas el puntaje global de satisfacción fue de 4/5.

Objective: Present the institutional experience on the auditory rehabilitation of patients implanted with the middle ear prosthesis Vibrant Soundbridge®. Design: Retrospective study of a cases series. Materials and Methods: Medical, surgical and audiological charts review of patients implanted with the middle ear system VSB. Hearing gain was established by the mean differences calculated on 0.5 to 3 kHz in the pure tone audiometries pre and post implantation, with and without the device. Satisfaction with the device was assessed with the Hearing Device Satisfaction Scale tool. In addition, audiological and satisfaction comparison with a population with similar characteristics of BAHA implant users was made. Results: 25 patients with conductive and mixed hearing loss were implanted with the VSB, placing the FMT on the round window in 23cases (92%). Mean auditory gain was 36 ± 16 decibels (dB). There were no significance gains between processors AP404-36 dB and Amadé-38 dB, p = 0.6. Mean auditory gain in the BAHA® users was 37 dB; speech discrimination at 65 dB was 93% and 100% for VSB and BAHA® users respectively. Overall satisfaction score for both systems was 4/5. Conclusion: The middle ear implant system VSB gives a satisfactory hearing gain to patients with moderate mixed hearing loss comparable with the BAHA® as well in satisfaction and quality of life issues.

Neuroprótesis en otorrinolaringología: más allá del implante coclear / Neuroprosthesis in otolaryngology: beyond of cochlear implants

Neuroprosthesis or brain-machine interfaces are electronic devices created to directly interact with the nervous system for replacing an absent or damaged sensory or motor function. Three types of auditory neuroprosthetics devices have been developed in Otolaryngology, (i) cochlear implants, (ii) brainstem auditory implants and (iii) auditory midbrain implants. These devices allow young deaf children to acquire oral language and to restore auditory function in deafened adults. On the other hand, a new vestibular prosthesis that could be useful for patients with severe disequilibrium has been developed. Main characteristics and clinical utility of these prostheses are reviewed in this article.

Implante auditivo de tronco cerebral: técnica cirúrgica e resultados auditivos precoces em pacientes com neurofibromatose tipo 2 / Auditory Brainstem Implant: surgical technique and early audiological results in patients with neurofibromatosis type 2

O implante auditivo de tronco cerebral foi desenvolvido para restaurar alguma audição útil em pacientes que apresentam ausência de nervo coclear bilateralmente. OBJETIVOS: Discutir a indicação, cirurgia e resultados em quatro pacientes submetidos à cirurgia para colocação de implante auditivo de tronco cerebral. CASUÍSTICA E MÉTODOS: Quatro pacientes com diagnóstico de schwannomas vestibulares bilaterais foram submetidos à cirurgia para colocação de Implante Auditivo de Tronco Cerebral durante o mesmo ato cirúrgico utilizado para a exérese de um dos tumores. Aspectos clínicos e técnicos e as referências anatômicas da cirurgia e os resultados auditivos foram analisados. RESULTADOS: Em todos os casos foram identificados as referências anatômicas ao forame de Luschka. As complicações cirúrgicas se resumiram à fístula liquórica em dois pacientes. Os eletrodos foram bem posicionados e a sensação auditiva foi suficiente para reconhecimento de sons e auxílio à leitura labial. CONCLUSÃO: Os resultados auditivos de nossos pacientes abrem uma perspectiva importante aos pacientes com surdez profunda bilateral sem integridade anatômica das vias auditivas centrais.

Auditory Brainstem Implants were developed to partially restore the hearing capabilities of patients without cochlear nerves bilaterally. AIM: this paper aims to discuss the clinical and surgical findings of four ABI patients. MATERIALS AND METHOD: four patients diagnosed with bilateral schwannomas received auditory brainstem implants (ABI) and had one of their tumors resected in the same surgical procedure. Clinical aspects, surgical technique, anatomic landmarks, and outcomes were analyzed. RESULTS: the anatomic landmarks were identified in all four patients in relation to the foramina of Luschka. Two patients had CSF leaks. The electrodes were well positioned and hearing sensation was good enough to allow for sound recognition and assist patients perform lip reading. CONCLUSION: the outcomes observed in our patients were quite encouraging and offer great perspectives for those suffering from deep bilateral deafness and impaired central auditory pathways.

Implante auditivo de tronco cerebral en niños / Auditory brainstem implant in children

Objetivo: Mostrar los resultados obtenidos mediante el uso del Implante Auditivo de Tronco Cerebral (IATC) en niños con imposibilidad de recibir un implante coclear (IC), con hipoacusia no asociada a Neurofibromatosis tipo II (NFII). Tipo de estudio: Presentación de casos. Material y método: Se muestran los resultados obtenidos en los dos primeros casos en América en niños (3 y 10 años, respectivamente) a los que se les colocó un I A TC por agenesia de nervio y cóclea. Resultados: Se logró niveles de 30db a 40 db en las audiometrías posteriores a la activación en frecuencias de 250-6.000 Hz, lograron detectar el test de Ling en su totalidad, con buena y rápida respuesta al nombre en una situación estructurada y sin pistas visuales dentro del primer mes de activación. Conclusiones: De acuerdo con nuestra reciente experiencia los casos de niños con agenesia de cóclea y/o nervio, pueden ser considerados para la colocación de un IATC porque la anatomía de los núcleos auditivos está intacta.

Aim: To discuss the results obtained with auditory brainstem implant (ABI) in children non-eligible for cochlear implant, presenting with non-NFII related hypoacusia. A case report study. Materials and Method: Two cases are presented, both of children (aged 3 and 10 years old, respectively), who underwent ABI because of nerve and cochlear agenesis Results: Post-implant audiometric levels were 30 to 40 dB for frequencies between 25 and 6000 Hz. Both patients were able to fully detect the Ling sound test with good and fast answers in a structured non-visual cues-situation within the first post-activation month. Conclusions: In our experience, children with nerve and/or cochlear agenesis could be considered for ABS implantation, because the auditory nuclei's anatomy is intact.

Implante auditivo de tronco cerebral en niños / Of auditory brainntem implant in children

El Implante Auditivo del Tronco Cerebral (IATC) se usa desde 1979 para reestablecer la audición en pacientes con Neurofibromatosis tipo II (NF2) con sordera profunda bilateral, en el momento de la remoción tumoral. Hace 5 años, se comienza a efectuar en adultos y niños con imposibilidad de realizarse un Implante Coclear (IC) por otras causas que no sean NF2. Los resultados auditivos obtenidos por el Dr. Vittorio Colletti, primer autor en realizarlos en todo el mundo, son mejores a los obtenidos con el IATC posterior a la remoción tumoral. Los estudios presentados demuestran que se obtienen resultados significativamente mejores, que en los pacientes implantados con NF-2. Colletti y colaboradores obtuvieron con el IATCen casos no tumorales, un promedio de reconocimiento de oraciones en forma sólo auditiva, sin lectura labial del 63 por ciento. En casos tumorales el promedio es de 12,2 por ciento. Mostrar los resultados mediante el uso del IATC en niños con imposibilidad de recibir un IC, con hipoacusia no asociada a NF2. Presentación de casos. Se muestran los resultados obtenidos en los dos primeros casos en América en niños (2 y 10 años respectivamente) a los que se les colocó IATC por agenesia de nervio y cóclea. Se logró niveles de 30 a 40 db en las audiciometrías posteriores a la activación en frecuencias de 250-6000 Hz, lograron detectar el Test de Ling en su totalidad, con buena y rápida respuesta al nombre en una situación estructurada y sin pistas visuales De acuerdo con nuestra reciente experiencia los casos no tumorales pueden ser considerados para la colocación de un IATC porque la anatomía de los núcleos auditivos está intacta. El impacto de este tipo de implantes en la vida de los pacientes ha resultado muy positivo.

Referências anatômicas na cirurgia do implante auditivo de tronco cerebral

O implante auditivo de tronco cerebral é uma opção os pacientes surdos que não têm a integridade das vias auditivas preservada. A cirurgia, por sua complexidade anatômica e funcional, requer treinamento específico em laboratório de anatomia por parte do cirurgião. OBJETIVOS: Estudar a anatomia cirúrgica da cirurgia do implante auditivo de tronco cerebral. FORMA DE ESTUDO: Estudo anatômico. MATERIAL E MÉTODO: Neste estudo dissecamos cadáver fresco preparado com solução corante injetada nas artérias e veias intra-cranianas. O local de inserção do eletrodo do implante auditivo de tronco cerebral foi estudado através do acesso translabiríntico. RESULTADOS: A técnica cirúrgica utilizada para a implantação do eletrodo de tronco cerebral é semelhante à utilizada na remoção do shwannoma vestibular. O complexo de núcleo coclear, composto pelo núcleo coclear ventral e dorsal, é o local para a colocação do eletrodo. O núcleo coclear ventral é o principal núcleo de transmissão de impulsos neurais do VIII par e seus axônios formam a principal via ascendente do nervo coclear. Tanto o núcleo ventral como o dorsal não são visíveis durante a cirurgia e sua localização depende de identificação de estruturas anatômicas adjacentes. CONCLUSÃO: A região de implantação do eletrodo do implante auditivo de tronco cerebral apresenta referências anatômicas que permitem sua fácil identificação durante a cirurgia.