Characteristics of responsiveness of cochlear nerve to electrical stimulation in patients with cochlear nerve deficiency / 中华耳鼻咽喉头颈外科杂志

Objectives: This study aimed to evaluate the responsiveness of cochlear nerve to electrical stimulation in patients with cochlear nerve deficiency(CND), to compare their results with those measured in implanted children with normal-sized cochlear nerves, and to investigate the characteristics of the cochlear nerve injury of children with CND. Methods: Participants were children who underwent cochlear implantation at Shandong Provincial ENT Hospital from January 2012 to January 2020, including CND group and control group. The CND group included 51 subjects (male:20; female: 31) who were diagnosed with CND and had normal cochlea. For the CND group, four children had been bilaterally implanted, the mean implantation age was (2.7±1.5) years old. The control group included 21 subjects (male:10; femal:11) who had normal-sized cochlear nerve and normal cochlea. For the control group, all children had been unilaterally implanted except one, and the mean implantation age was (3.0±1.9)years old. Three subjects in the CND group used CI422 electrode arrays, and all the other subjects used CI24RECA/CI512 electrode arrays. The electrically evoked compound action potentials (ECAP) had been tried to record for each electrode using Custom Sound EP software (v. 4.3, Cochlear Ltd.) at least six months post first activation. Furthermore, ECAP amplitude growth functions (AGF) were measured at multiple electrode locations across the electrode array. Generalized linear mixed effect models with the subject group and electrode location as the fixed effects and subjects as the random effect were used to compare results of ECAP measurements. Results: In the control group, ECAP could been recorded at all electrodes (100%), but it could only be recorded in 71% (859/1 210) electrodes in the CND group. Additionally, the percentage of electrodes with measurable ECAP decreased from electrode 1 to electrode 22 in the CND group. Compared to the control group, the ECAP thresholds significantly increased, the ECAP amplitudes and AGF slopes significantly decreased, and the ECAP latency significantly increased in the CND group (P<0.01). GLMM showed that the stimulating site had a significant effect on the ECAP threshold, maximum amplitude, and AGF slope (P<0.01), but had no significant effect on the ECAP latency (P>0.05) in the CND group. However, the stimulating site had no significant effects on the ECAP measurements in the control group. Furthermore, the functional status of cochlear nerve varied greatly among CND group. From electrode 1 to electrode 22, the ECAP thresholds gradually increased, the ECAP maximum amplitudes and AGF slopes gradually decreased in the CND group. Conclusion: Compared with patients with normal-sized cochlear nerve, not only the number of residual spinal ganglion neurons reduce,but also the function of spinal ganglion neurons damages in CND patients. The degree of cochlea nerve deterioration varies greatly among CND patients. Generally, the deterioration of cochlear nerve tends to increase from the basal to the apical site of the cochlea.

Analysis of rehabilitation effects of cochlear implantation in elderly patients with prelingual deafness / 临床耳鼻咽喉头颈外科杂志

Objective:The auditory and speech rehabilitation effects were assessed by the Categories of Auditory Performance（CAP） and the speech intelligibility rating scale（SIR） after cochlear implantation（CI） in prelingually elderly patients by telephone follow-up or face-to-face conversation. Methods:The clinical data of the prelingually deaf patients who underwent unilateral CI in the Department of Otorhinolaryngology and Head and Neck Surgery, Shanxi People's Hospital, from December 2016 to December 2021 were collected. Thirty-eight patients were divided into Group A（SIR 1, 17 cases）, Group B（SIR 2, 10 cases） and Group C（SIR 3, 11 cases） according to the preoperative SIR Score. Nineteen patients with post-lingual hearing impairment were selected as the control group（Group D, 19 cases）. The effects of hearing and speech rehabilitation were evaluated using CAP and SIR Scores before surgery, 6 months after startup, and 1 year after startup. Results:There were no significant differences in CAP scores among the three groups of patients with prelingually deaf patients at 6 months and 1 year after startup（P>0.05）, but there were significant differences between group A and group D at 6 months and 1 year after startup（P<0.05）; the SIR Score of group A had statistical difference before surgery and 6 months after startup（P<0.05）, group B had statistical difference before surgery and 1 year after startup（P<0.05）, and group C and D had no statistical difference before surgery and 6 months and 1 year after startup, respectively（P>0.05）. Conclusion:For the prelingually deaf elderly patients, hearing will develop rapidly 6 months after startup, and the effect of postoperative auditory rehabilitation was positively correlated with the preoperative speech ability. In the aspect of speech, the prelingually dear elderly patients who have poor preoperative speech ability could benefit more from CI early after surgery. CI is not contraindicated in prelingually deaf elderly patients, even those with poor preoperative speech function.

Application of intraoperative CT-assisted positioning in difficult cases of cochlear implantation / 临床耳鼻咽喉头颈外科杂志

Objective:To report the experience of using CT-guided cochlear implant surgery in difficult cases such as severe inner ear deformities and anatomical abnormalities, and to discuss the application value of intraoperative CT-assisted localization in difficult cases of cochlear implant surgery. Methods:Retrospectively analyzed the clinical data of 23 cases of difficult cochlear implant surgery cases completed by our team with the assistance of intraoperative CT, and collected their medical data, including preoperative imaging manifestations, surgical conditions, and intraoperative imaging images for evaluation. Results:During the study period, 23 difficult cases（27 ears） underwent cochlear implantation under the guidance of intraoperative CT, and 4 cases were bilaterally implanted. Including 6 cases of incomplete segmentation type Ⅰ（IP-Ⅰ）, 1 case of incomplete segmentation type Ⅱ（IP-Ⅱ）, 10 cases of incomplete segmentation type Ⅲ（IP-Ⅲ）, 3 cases of common cavity deformity（CC） and 3 cases of cochlear ossification after meningitis. Facial nerve anatomy was abnormal in 9 cases, cerebrospinal fluid "blowout" was serious in 14 cases, electrode position was abnormal in 3 cases requiring intraoperative adjustment of electrode position, anatomical difficulties required intraoperative CT to assist in finding anatomical landmarks in 2 cases, and electrodes were not fully implanted in 3 cases. Conclusion:When faced with difficult cases with challenging and complex temporal bone anatomy, intraoperative CT can accurately evaluate the electrode position and provide intraoperative anatomical details, allowing immediate adjustment of the electrode position if necessary, providing safety guarantee for difficult cases of cochlear implant surgery and ensure accurate implantation of electrodes.

Implantes cocleares ópticos: una herramienta promisoria de tratamiento para la hipoacusia / Optical cochlear implants: a promising treatment tool for hearing loss

La hipoacusia afecta a más de 1.500 millones de personas mundialmente. Los principales medios de rehabilitación usados son los audífonos e implantes cocleares (IC). El IC eléctrico convierte el sonido en impulsos eléctricos que estimulan, directamente, a las neuronas del ganglio espiral para proveer sensación auditiva. Tiene como desventaja una amplia dispersión espacial de la corriente, limitando la resolución espectral y el rango dinámico de codificación sonoro, lo que conduce a una mala comprensión del habla en entornos ruidosos y mala apreciación de la música. En los últimos años se ha estudiado utilizar estimulación óptica en vez de eléctrica, pues emite estímulos con mayor selectividad espacial. Se han descrito IC ópticos usando luz infrarroja y otros con métodos de optogenética, estos últimos requieren de la expresión de proteínas fotosensibles inducidas por virus adenoasociados. Se ha visto que la selectividad espectral de la estimulación optogenética es indistinguible de la acústica, y permitió tasas de disparo casi fisiológicas con buena precisión temporal hasta 250 Hz de estimulación. Estudios que compararon un sistema de IC óptico con uno eléctrico concluyen que el uso de optogenética permitiría una restauración de la audición con una selectividad espectral mejorada en comparación con un IC eléctrico.

Hearing loss affects more than 1.5 billion people worldwide. The main means of rehabilitation used are hearing aids and cochlear implants (CI). The electrical CI converts sound into electrical impulses that directly stimulate neurons in the spiral ganglion to provide auditory sensation; it has the disadvantage of a wide spatial dispersion of the current, limiting the spectral resolution and the dynamic range of sound coding, which leads to a poor understanding of speech in noisy environments and a poor appreciation of music. In recent years, the use of optical stimulation instead of electrical stimulation have been studied since it emits stimuli with greater spatial selectivity. Optical CIs have been described using infrared light and others using optogenetic methods, the latter requiring the expression of photosensitive proteins induced by adeno-associated viruses. The spectral selectivity of optogenetic stimulation has been found to be indistinguishable from acoustic stimulation and allowed near-physiological firing rates with good temporal accuracy up to 250 Hz stimulation. Studies comparing an optical and an electrical CI system conclude that the use of optogenetics would allow hearing restoration with improved spectral selectivity compared to an electrical CI.

Postoperative rehabilitation effect and influence factors of adult prelingual deafness with cochlear implant / 中华耳鼻咽喉头颈外科杂志

Objective: To investigate whether pre-lingual deafness adult caused by inadequate auditory compensation in childhood can benefit from cochlear implants and the related influencing factors. Methods: A total of 26 prelingual deafness as experimental group [11 males and 15 females, the age of operation was (24.5±5.7) years] and 13 postlingual deafness as control group [5 males and 8 females, the age at the time of operation was (42.2±11.4) years] were recruited. Objective assessment included hearing threshold and speech recognition rate tests while wearing cochlear implants. Subjective assessment used Nijmegen Cochlear Implant Questionnaire to assess hearing-related quality of life of subjects. The changes of hearing ability in the prelingual deafness group before and after operation and the differences with the postlingual deafness group were compared, and the correlation between speech recognition ability and the age diagnosed as severe or profound deafness, the age of hearing aid invalid, and duration of wearing cochlear implant were analyzed as factor indicators. All statistical results were analyzed by SAS 9.4 software. Results: In terms of objective indicators, the speech recognition rate of pre-lingual deafness was significantly lower than that of post-lingual deafness [(35.4±28.0)% vs (80.9±8.0)%,t=7.67, P<0.001], while there was no statistical difference in hearing threshold between the two groups [(34.8±4.0) dB HL vs (33.1±3.7) dB HL, t=1.30, P>0.05]. The indicators in the subjective questionnaire showed that the prelingual deafness group was only weaker in advanced sound perception, confidence and total mean score than the post-lingual deafness group (P<0.05), and there was no significant difference in other aspects(P>0.05), meanwhile, all indicators of the prelingual deafness group were significantly improved compared with the preoperative level (P<0.001). There was a moderate positive correlation between the hearing quality and the speech recognition rate in the prelingual deafness group(r=0.51, P=0.008). The regression analysis showed that the invalid age of hearing aid was the exact influencing factor of speech recognition rate. Conclusions: Certain prelingual deaf adults can adapt to cochlear implants and obtain different degrees of auditory assistance. Compared with the improvement of objective auditory ability assessment, the patient who received cochlear implantation gain more improvement in auditory related quality of life subjectively. The ineffective age of preoperative hearing aid is an important factor, which needs to be aroused sufficient preoperative attention.

Laberintectomía quirúrgica e implante coclear simultáneo en paciente con enfermedad de Ménière bilateral / Simultaneous labyrinthectomy with cochlear implantation in a patient with bilateral Ménière's disease

Los pacientes con enfermedad de Ménière representan un desafío terapéutico para el médico tratante, especialmente cuando no responden al tratamiento médico conservador. Presentamos un caso de un paciente de 45 años con enfermedad de Ménière activa en oído izquierdo sometido a laberintectomía quirúrgica con implante coclear simultáneo en dicho oído. Se evaluaron resultados clínicos y audiométricos en un seguimiento de 9 meses posencendido del implante y el paciente presentó PTP de 21 dB, con 92% de discriminación a disílabos a 45 dB en el oído implantado, sin tinnitus ni síntomas vestibulares. La combinación de laberintectomía con implante coclear en un mismo tiempo quirúrgico, fue efectiva en controlar los síntomas vestibulares y audiológicos del paciente estudiado.

Patients with Méniére's disease represent a therapeutical problem for physicians, especially in those who do not respond to conservative approaches. We report the case of a 45-year-old male with bilateral Ménière's disease, active in the left ear, who underwent simultaneous cochlear implantation combined with labyrinthectomy surgery. Audiometric and clinical results were evaluated, 9 months after the activation of the implant the patient's PTA was 21 dB, with 92% disyllabic word's discrimination at 45 dB in the implanted ear, without tinnitus or vestibular symptoms. The combined surgical labyrinthectomy and cochlear implantation are efficient for the treatment of vestibular and audiological symptoms of the patient.

Application value of magnetic resonance hydrography of the inner ear in cochlear implantation

SUMMARY OBJECTIVE This study aims to investigate the application value of magnetic resonance (MR) hydrography of the inner ear in cochlear implantation. METHODS 146 patients were enrolled. MR hydrography and spiral CT examinations for the intracranial auditory canal were performed before surgery, and all imaging results were statistically analyzed in order to explore the application value of MR hydrography of the inner ear in cochlear implantation. RESULTS 146 patients (292 ears) were examined. Among these patients, 13 were diagnosed with abnormal vestibular aqueducts (20 ears) by MR hydrography, while five were diagnosed with this disease by CT; 15 patients were diagnosed with inner ear malformation (19 ears) by MR hydrography, while 11 were diagnosed by CT (four were misdiagnosed); five patients were diagnosed with internal acoustic canal stenosis (eight ears) by MR hydrography, while two were diagnosed by CT (three were misdiagnosed); and four patients were diagnosed with cochlear fibrosis (five ears) by MR hydrography, while four were diagnosed by CT (four ears). The correct rate of diagnosis was 77.40% (113/146) based on CT, while the rate was 93.84% (137/146) based on MR hydrography. CONCLUSIONS MR hydrography imaging technique can be applied to the preoperative evaluation of cochlear implantation, providing accurate and reliable anatomic information on the inner membranous labyrinth and nerves in the internal acoustic canal and an accurate basis for the diagnosis of cochlear fibrosis and nerve development. This has a guiding significance for the selection of treatment schemes.

RESUMO OBJETIVO Este estudo visa investigar o valor da aplicação da hidrografia por ressonância magnética (RM) do ouvido interno no implante coclear. MÉTODOS Cento e quarenta e seis pacientes foram inscritos. Os exames da hidrografia por RM e do CT espiral para o canal auditivo intracraniano foram executados antes da cirurgia, e todos os resultados da imagem foram analisados estatisticamente, a fim de explorar o valor da aplicação da hidrografia por RM do ouvido interno no implante coclear. RESULTADOS Centro e quarenta e seis pacientes (292 ouvidos) foram examinados. Dentre esses pacientes, 13 foram diagnosticados com aquedutos vestibulares anormais (20 ouvidos) pela hidrografia por RM, enquanto cinco pacientes foram diagnosticados com esta doença pelo CT; 15 pacientes foram diagnosticados com malformação do ouvido interno (19 ouvidos) pela hidrografia por RM, enquanto 11 pacientes foram diagnosticados por CT (quatro foram diagnosticados erroneamente); cinco pacientes foram diagnosticados com estenose de canal acústico interno (oito ouvidos) pela hidrografia por RM, enquanto dois pacientes foram diagnosticados por CT (três foram diagnosticados erroneamente); e quatro pacientes foram diagnosticados com fibrose coclear (cinco ouvidos) pela hidrografia por RM, enquanto quatro foram diagnosticados por CT (quatro ouvidos). A taxa correta de diagnóstico foi de 77,40% (113/146) com base no CT, enquanto a taxa foi de 93,84% (137/146) com base na hidrografia por RM. CONCLUSÕES A técnica de imagem da hidrografia por RM pode ser aplicada à avaliação pré-operatória do implante coclear, que pode fornecer informações anatômicas precisas e confiáveis sobre o labirinto membranoso interno e os nervos no canal acústico interno, além de uma base exata para o diagnóstico da fibrose coclear e do desenvolvimento do nervo. Isso tem um significado orientador para a seleção de esquemas de tratamento.

Sequential bilateral cochlear implant: results in children and adolescents / Implante coclear bilateral sequencial: resultados em crianças e adolescentes

Abstract Introduction: The use of the bilateral cochlear implants can promote the symmetrical development of the central auditory pathways, thus benefiting the development of auditory abilities and improving sound localization and the ability of auditory speech perception in situations of competitive noise. Objective: To evaluate the ability of speech perception in children and adolescents using sequential bilateral cochlear implants, considering the association of these variables: age at surgery, time of device use and interval between surgeries. Methods: A total of 14 individuals between 10 and 16 years of age, who demonstrated surgical indication for the use of sequential bilateral cochlear implants as intervention in the auditory habilitation process, were assessed. The speech perception ability was assessed through sentence lists constructed in the Portuguese language, presented in two situations: in silence, with fixed intensity of 60 dB SPL, and in competitive noise, with a signal-to-noise ratio of +15 dB. The evaluation was performed under the following conditions: unilateral with the first activated cochlear implant, unilateral with the second activated cochlear implant and bilateral with both devices activated. Results: The results of the speech perception tests showed better performance in both silence and in noise for the bilateral cochlear implant condition when compared to the 1st cochlear implant and the 2nd cochlear implant alone. A worse result of speech perception was found using the 2nd cochlear implant alone. No statistically significant correlation was found between age at the surgical procedure, interval between surgeries and the time of use of the 2nd cochlear implant, and the auditory speech perception performance for all assessed conditions. The use of a hearing aid prior to the 2nd cochlear implant resulted in benefits for auditory speech perception with the 2nd cochlear implant, both in silence and in noise. Conclusion: The bilateral cochlear implant provided better speech perception in silence and in noise situations when compared to the unilateral cochlear implant, regardless of the interval between surgeries, age at the surgical procedure and the time of use of the 2nd cochlear implant. Speech perception with the 1st cochlear implant was significantly better than with the 2nd cochlear implant, both in silence and in noise. The use of the hearing aid prior to the 2nd cochlear implant influenced speech perception performance with the 2nd cochlear implant, both in silence and in noise.

Resumo Introdução: A utilização do implante coclear bilateral pode promover o desenvolvimento das vias auditivas centrais de maneira simétrica, beneficiando, assim, o desenvolvimento das habilidades auditivas e melhorando a localização sonora e a habilidade de percepção auditiva da fala em situações de ruído competitivo. Objetivo: Avaliar a habilidade de reconhecimento de fala em crianças e adolescentes usuários do implante coclear bilateral sequencial, considerando a relação das variáveis: idade cirúrgica, tempo de uso do dispositivo e intervalo entre as cirurgias. Método: Foram avaliados 14 indivíduos entre 10 e 16 anos, que receberam indicação cirúrgica para implante coclear bilateral sequencial como forma de intervenção no processo de habilitação auditiva. A habilidade de reconhecimento de fala foi avaliada por meio de listas de sentenças construídas na língua portuguesa, apresentadas em duas situações: no silêncio, com intensidade fixa de 60 dB NPS, e no ruído competitivo, com a relação sinal/ruído de + 15 dB. A avaliação foi feita nas seguintes condições: unilateral com o 1° implante coclear ativado, unilateral com o 2° implante coclear ativado e bilateral com ambos os dispositivos ativados. Resultado: Os resultados dos testes de reconhecimento de fala demonstraram melhor desempenho tanto no silêncio quanto no ruído para a condição implante coclear bilateral, quando comparado ao 1° implante coclear e 2° implante coclear isoladamente. Um pior resultado de reconhecimento de fala foi encontrado com o uso do 2° implante coclear isoladamente. Não foi encontrada correlação estatisticamente significante entre idade cirúrgica, intervalo entre as cirurgias e tempo de uso do 2° implante coclear e o desempenho de percepção auditiva da fala para todas as condições avaliadas. O uso do aparelho de amplificação sonora individual anterior ao 2° implante coclear beneficiou os resultados de percepção auditiva da fala com o 2° implante coclear, tanto no silêncio quanto no ruído. Conclusão: O implante coclear bilateral proporcionou melhor reconhecimento de fala em situações de silêncio e de ruído, quando comparado com o implante coclear unilateral, independentemente do intervalo entre as cirurgias, da idade cirúrgica e do tempo de uso do 2° implante coclear. O reconhecimento de fala com o 1° implante coclear foi significativamente melhor do que com o 2° implante coclear, tanto no silêncio quanto no ruído. O uso do aparelho de amplificação sonora individual anterior ao 2° implante coclear influenciou o desempenho de reconhecimento de fala com o 2° implante coclear, tanto no silêncio quanto no ruído.

Evaluation of surgery and surgical results of Baha® Attract system implantations - single centre experience of hundred twenty five cases / Avaliação da cirurgia e resultados cirúrgicos dos implantes do sistema Baha® Attract - experiência de um único centro com cento e vinte e cinco casos

Abstract Introduction: Bone-anchored hearing aids are currently well-established solutions for treatment of hearing-impaired patients. Objective: To evaluate the surgery of the Baha® Attract system, healing process and soft tissue condition after the processor activation. Methods: 125 patients implanted with the Baha® Attract system during a 3 year period in a single ENT department were analysed. Evaluated parameters comprised: details of surgery, healing process and soft tissue condition at the time of the processor activation and on subsequent follow-up visits. Results: The implantation was conducted under local anaesthesia in 96% of patients. The mean surgery time was 42 min. Soft tissue reduction was performed in 43.2% of cases; bone polishing in 23.2% and bipolar coagulation in all the cases. Healing was uneventful in 92.8%. 10 days after the surgery, pain was reported in 48% of cases. On subsequent follow-up visits, 1 month and 3 months after the surgery, pain was present in 18.4% and 2.4% of cases respectively. Similarly, numbness and paresthesia, initially reported in 84% and 15.2%, were present in 60% and 11.2% after a month, and in 17.6% and 1.6% after three months. After the processor attachment, no serious problems were observed in the analysed group during follow-up visits. However, mild redness and/or mild pain over the magnet were observed in 9.6% of patients. Conclusion: Implantation of the Baha® Attract system is an easy and safe procedure. It can be performed under local anaesthesia in adults. There are no major surgical problems or complications, and the healing process proceeds efficiently in most patients. Postoperative pain is usually mild and gradually decreases in the following months. Numbness in the operated area is frequent, but as reinnervation occurs in time, the numb patch decreases in size and finally completely disappears in most cases.

Resumo Introdução: Os processadores de implantes auditivos de ancoragem óssea são atualmente soluções bem estabelecidas para o tratamento de pacientes com deficiência auditiva. Objetivo: Avaliar a cirurgia de implante do sistema Baha® Attract, o processo de cicatrização e a condição dos tecidos moles após a ativação do processador. Método: Foram analisados 125 pacientes implantados com o sistema Baha® Attract durante um período de 3 anos em um único departamento de otorrinolaringologia. Os parâmetros avaliados compreenderam: detalhes da cirurgia, processo de cicatrização e condição dos tecidos moles no momento da ativação do processador e nas consultas de seguimento subsequentes. Resultados: O implante foi realizado sob anestesia local em 96% dos pacientes. O tempo médio de cirurgia foi de 42 minutos. A redução de tecido mole foi realizada em 43,2% dos casos; polimento ósseo em 23,2% e coagulação bipolar em todos os casos. A cicatrização transcorreu sem complicações em 92,8%. Dez dias após a cirurgia, dor foi relatada em 48% dos casos. Nas consultas de seguimento subsequentes, 1 mês e 3 meses após a cirurgia, a dor esteve presente em 18,4% e 2,4% dos casos, respectivamente. Da mesma forma, dormência e parestesia, inicialmente relatados em 84% e 15,2%, estavam presentes em 60% e 11,2% dos casos após um mês, e em 17,6% e 1,6% após três meses. Após a fixação do processador, nenhum problema grave foi observado no grupo analisado durante as consultas de seguimento. No entanto, vermelhidão leve e/ou dor leve sobre o ímã foram observados em 9,6% dos pacientes. Conclusão: O implante do sistema Baha® Attract é um procedimento fácil e seguro. Ele pode ser realizado sob anestesia local em adultos. Não há grandes problemas ou complicações cirúrgicas, e o processo de cicatrização é contínuo e eficaz na maioria dos pacientes. No pós-operatório, a dor é geralmente leve e diminui gradualmente nos meses seguintes. A dormência na área operada é freqüente, mas como a reinervação ocorre com o tempo, a área dormente diminui de tamanho e finalmente desaparece por completo na maioria dos casos.

Benefit and predictive factors for speech perception outcomes in pediatric bilateral cochlear implant recipients / Benefícios e fatores preditivos para os resultados de percepção da fala em pacientes pediátricos com implantes cocleares bilaterais

Abstract Introduction: Despite recent advancement in the prediction of cochlear implant outcome, the benefit of bilateral procedures compared to bimodal stimulation and how we predict speech perception outcomes of sequential bilateral cochlear implant based on bimodal auditory performance in children remain unclear. Objectives: This investigation was performed: (1) to determine the benefit of sequential bilateral cochlear implant and (2) to identify the associated factors for the outcome of sequential bilateral cochlear implant. Methods: Observational and retrospective study. We retrospectively analyzed 29 patients with sequential cochlear implant following bimodal-fitting condition. Audiological evaluations were performed; the categories of auditory performance scores, speech perception with monosyllable and disyllables words, and the Korean version of Ling. Audiological evaluations were performed before sequential cochlear implant with the bimodal fitting condition (CI1 + HA) and one year after the sequential cochlear implant with bilateral cochlear implant condition (CI1 + CI2). The good performance group (GP) was defined as follows; 90% or higher in monosyllable and bisyllable tests with auditory-only condition or 20% or higher improvement of the scores with CI1 + CI2. Age at first implantation, inter-implant interval, categories of auditory performance score, and various comorbidities were analyzed by logistic regression analysis. Results: Compared to the CI1 + HA, CI1 + CI2 provided significant benefit in categories of auditory performance, speech perception, and Korean version of Ling results. Preoperative categories of auditory performance scores were the only associated factor for being GP (odds ratio = 4.38, 95% confidence interval - 95% = 1.07-17.93, p = 0.04). Conclusions: The children with limited language development in bimodal condition should be considered as the sequential bilateral cochlear implant and preoperative categories of auditory performance score could be used as the predictor in speech perception after sequential cochlear implant.

Resumo Introdução: Apesar dos avanços recentes na predição do resultado do implante coclear, ainda não está claro o benefício do procedimento bilateral em comparação com a estimulação bimodal e como podemos prever resultados de percepção da fala com implante coclear bilateral sequencial com base no desempenho auditivo bimodal em crianças. Objetivos: Este estudo foi realizado para: 1) Determinar o benefício do implante coclear bilateral sequencial e 2) Identificar os fatores associados com o resultado do implante bilateral sequencial. Método: Estudo observacional e retrospectivo. Analisamos retrospectivamente 29 pacientes com implantes sequenciais após a adaptação bimodal. Avaliações audiológicas foram realizadas; os escores das categorias de desempenho auditivo, a percepção da fala com palavras monossílabas e dissílabas e a versão coreana de Ling. As avaliações audiológicas foram realizadas antes do implante sequencial com o ajuste bimodal (IC1 + AH) e um ano após o implante coclear sequencial com implante bilateral (IC1 + IC2). O grupo com bom desempenho (BD) foi definido da seguinte forma: 90% ou mais em testes com monossílabos e dissílabos com condição apenas auditiva ou melhoria de 20% ou mais dos escores com IC1 + IC2. A idade no primeiro implante, o intervalo interimplante, o escore categorias de desempenho auditivo e as diversas comorbidades foram analisadas através de análise de regressão logística. Resultados: Em comparação com o IC1 + AA, IC1 + IC2 demonstraram benefícios significativos nos escores categorias de desempenho auditivo, percepção da fala e a versão coreana de Ling. Os escores de categorias de desempenho auditivo pré-operatórios foram o único fator associado para ser do grupo BD (odds ratio - OR = 4,38, intervalo de confiança de 95% - IC 95% = 1,07-17,93, p = 0,04). Conclusões: As crianças com desenvolvimento limitado de linguagem em condição bimodal devem ser consideradas, pois o implante coclear bilateral sequencial e o escore pré-operatório das categorias de desempenho auditivo poderiam ser usados como preditores na percepção da fala após implante sequencial.

Utilidad de mediciones objetivas para la programación en implantes cocleares / Use of objective measures for cochlear implant programming

RESUMEN Introducción: La programación adecuada de los implantes cocleares permiten lograr niveles de estimulación auditivos óptimos. Se realiza de forma individualizada, siendo la detección del umbral de confort ideal un desafío. Se ha descrito la utilidad de los potenciales auditivos del tronco encefálico eléctrico (ePEATC) y el reflejo eléctrico estapedial (eREE) para este propósito. Objetivo: Determinar la posibilidad de realizar ePEATC y eREE en pacientes adultos y pediátricos con implantes cocleares, y evaluar cambios en la programación de los implantes cocleares luego de las mediciones objetivas. Material y método: Se realizó un estudio prospectivo, descriptivo, de pacientes con implante coclear marca MED-EL®, separando los pacientes en dos grupos: el grupo adulto (n =5) y el grupo pediátrico (n =5). Todos los pacientes incluidos presentaron más de 6 meses de encendido del implante. Se evaluaron variables epidemiológicas y tiempo de encendido del implante. Se realizó una otoscopía, prueba básica de funcionamiento del implante, y las mediciones objetivas eléctricas (ePEATC, eREE). Con estos resultados se ajustó el umbral de confort. Resultados: El tiempo promedio de encendido del implante en el grupo adulto fue de 27 meses, y 30 meses en el grupo pediátrico. El ePEATC requiere más tiempo y cooperación al compararlo con eREE. Luego de estas evaluaciones objetivas, fue necesario el ajuste del umbral de confort en tres pacientes adultos, y en dos pacientes pediátricos. Fue necesario realizar una audiometría de campo libre para estimar el umbral de confort en dos pacientes pediátricos que no presentaron respuesta en eREE. Conclusión: Fue posible realizar estas mediciones objetivas en pacientes adultos y pediátricos, siendo mejor tolerado y requiriendo menos tiempo, el eREE.

ABSTRACT Introduction: Mapping a cochlear implant allows for adjusting ideal electrical stimulation limits. It is an individualized process and detecting the most comfortable loudness level can be challenging. The use of electrically evoked auditory brainstem response (ePEATC) and electrically evoked stapedius reflex thresholds (eREE) have been considered for this purpose. Aim: To determine the feasibility of performing ePEATC and eREE on adult and pediatric patients with a cochlear implant, and to evaluate changes in programming following these objective measures. Material and method: A prospective, descriptive study was completed, of patients with MED-EL® cochlear implants, separating patients into two groups: adults (n=5) and children (n=5). All of the patients included had their implants activated for 6 months or longer. Epidemiological variables and duration of implant activation were evaluated. Otoscopy, a basic implant functioning evaluation, and objective measures (ePEATC, eREE) were performed. With these results, comfortable loudness levels were adjusted. Results: Average duration of implant activation was 27 months and 30 months, for adults and children respectively. Performing ePEATC required more time and cooperation as compared to eREE. Following the objective measures, adjustment of the comfortable loudness levels was required for three adult and two pediatric patients. Sound field audiometry was necessary for two pediatric patients in order to estimate the comfortable loudness levels because the eREE responses were absent. Conclusions: It is feasible to perform these objective measures for both adult and pediatric patients, with eREE requiring less time and being better tolerated by patients.

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.

Preservation of residual hearing after cochlear implant surgery: an exploration of residual hearing function in a group of recipients at cochlear implant units / Preservação da audição residual após cirurgia de implante coclear: avaliação da função auditiva residual em um grupo de receptores em unidades de implante coclear

Abstract Introduction: The preservation of residual hearing is becoming increasingly important in cochlear implant surgery. Conserving residual hearing is a positive prognostic indicator for improved hearing abilities. Objective: The primary aim of the study was to explore the preservation of residual hearing following cochlear implantation in a group of recipients at two major cochlear implant centers. Methods: A quantitative paradigm was adopted and exploratory research conducted within a retrospective data review design. The sample consisted of 50 surgical records and 53 audiological records from 60 observations (53 patients, seven of whom were implanted bilaterally). The records were selected using purposive sampling and consisted of records from participants ranging from six to 59 years of age. The average time of when the postoperative audiograms were performed in the current study was 24.7 months (s.d. = ±9.0). Data were analyzed through both qualitative and inferential statistics and a comparative analysis of unaided pre- and postoperative audiological test results was conducted. Results: Results indicated a high success rate of 92% preservation of residual hearing with half of the sample exhibiting complete preservation in cochlear implant recipients across all frequencies postoperatively. A total postoperative hearing loss was found in only 8% of cochlear implantees across all frequencies. There was no relationship between preoperative hearing thresholds and preservation of hearing postoperatively. The two main surgical techniques used in the current study were the contour on stylet and the advance off-stylet techniques, with the majority of surgeons utilizing a cochleostomy approach. From the findings, it became apparent that the majority of cases did not have any reported intraoperative complications. This is a positive prognostic indicator for the preservation of residual hearing. Conclusion: Findings suggest improved cochlear implant surgical outcomes when compared to previous studies implying progress in surgical techniques. The surgical skill and experience of the surgeon are evidenced by the minimal intraoperative complications and the high success rate of hearing preservation. This is a positive prognostic indicator for individuals with preoperative residual hearing as the preserved residual hearing allows for the potential of electro-acoustic stimulation, which in turn has its own hearing benefits.

Resumo Introdução: A preservação da audição residual tem se tornado cada vez mais importante na cirurgia de implante coclear. Conservar a audição residual é um indicador prognóstico positivo para melhorar as habilidades auditivas. Objetivo: Avaliar a preservação da audição residual pós-implante coclear em um grupo de pacientes de dois grandes centros de implantes cocleares. Método: Foram adotados um paradigma quantitativo e uma pesquisa exploratória em um projeto retrospectivo de revisão de dados. A amostra consistiu de 50 registros cirúrgicos e 53 registros audiológicos de 60 observações (53 pacientes, sete dos quais foram implantados bilateralmente). Os registros foram selecionados com amostragem proposital e consistiram em registros de participantes de seis a 59 anos. Neste estudo, o tempo médio para audiogramas no pós-operatório foi de 24,7 meses (dp = ± 9,0). Os dados foram analisados através de estatísticas qualitativas e inferenciais, foi feita uma análise comparativa de resultados de testes audiológicos pré e pós-operatórios, sem auxílio de aparelho auditivo. Resultados: Os resultados indicaram uma alta taxa de sucesso, de 92%, de preservação da audição residual, metade da amostra dos implantados exibia preservação completa em todas as frequências no pós-operatório. Perda auditiva total em todas as frequências no pós-operatório foi observada em apenas 8% dos implantes cocleares. Não houve relação entre limiares auditivos pré-operatórios e preservação auditiva no pós-operatório. As duas principais técnicas cirúrgicas usadas no presente estudo foram contour on stylet e a técnica advance off-stylet e a maioria dos cirurgiões usou uma abordagem por cocleostomia. A partir dos achados, tornou-se evidente que a maioria dos casos não apresentou complicação intraoperatória. Esse é um indicador prognóstico positivo para a preservação da audição residual. Conclusão: Os achados sugerem melhoria dos resultados cirúrgicos do implante coclear quando comparados com estudos prévios, sugerem um progresso nas técnicas cirúrgicas. A habilidade cirúrgica e a experiência do cirurgião são evidenciadas pelas complicações intraoperatórias mínimas e pela alta taxa de sucesso de preservação auditiva. Esse é um indicador prognóstico positivo para indivíduos com audição residual pré-operatória, uma vez que a audição residual preservada possibilita o potencial de estimulação eletroacústica (EAS - do inglês Electric Acoustic Stimulation), que, por sua vez, tem benefícios auditivos próprios.

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.

Evaluation of the Facial Recess and Cochlea on the Temporal Bone of Stillbirths regarding the Percutaneous Cochlear Implant

Abstract Introduction The literature shows that there are anatomical changes on the temporal bone anatomy during the first four years of life in children. Therefore, we decided to evaluate the temporal bone anatomy regarding the cochlear implant surgery in stillbirths between 32 and 40 weeks of gestational age using computed tomography to simulate the trajectory of the drill to the scala timpani avoiding vital structures. Objectives To measure the distances of the simulated trajectory to the facial recess, cochlea, ossicular chain and tympanic membrane, while performing the minimally invasive cochlear implant technique, using the Improvise imaging software (Vanderbilt University, Nashville, TN, US). Methods An experimental study with 9 stillbirth specimens, with gestational ages ranging between 32 and 40 weeks, undergoing tomographic evaluation with individualization and reconstruction of the labyrinth, facial nerve, ossicular chain, tympanic membrane and cochlea followed by drill path definition to the scala tympani. Improvise was used for the computed tomography (CT) evaluation and for the reconstruction of the structures and trajectory of the drill. Results Range of the distance of the trajectory to the facial nerve: 0.58 to 1.71mm. to the ossicular chain: 0.38 to 1.49 mm; to the tympanic membrane: 0.85 to 1.96 mm; total range of the distance of the trajectory: 5.92 to 12.65 mm. Conclusion The measurements of the relationship between the drill and the anatomical structures of the middle ear and the simulation of the trajectory showed that the middle ear cavity at 32 weeks was big enough for surgical procedures such as cochlear implants. Although cochlear implantation at birth is not an indication yet, this study shows that the technique may be an option in the future.

Medición de impedancias in-vivo durante la cirugía de implante coclear como predictor de la posición de los electrodos dentro de la cóclea / Impedance measures during in-vivo cochlear implantation predict array positioning / Medição das impedâncias in-vivo durante a cirurgia de implante coclear como preditor da posição dos eletrodos no interior da cóclea

INTRODUCCIÓN: Los implantes cocleares son dispositivos protésicos neuronales utilizados para el tratamiento de las hipoacusias neurosensoriales severas a profundas. La activación de electrodos estimula las células del ganglio espiral y las vías nerviosas. Una estimulación más discreta de subpoblaciones neuronales se puede obtener cuando los electrodos están más cerca de las células ganglionares en la pared del modiolo. La distancia del electrodo al modiolo podría ser una de las múltiples variables que influyen en el resultado del paciente con un implante coclear. Actualmente no hay un protocolo establecido para medir esta distancia. Mediante diversas técnicas de imágenes se puede determinar la posición de la guía de electrodos dentro de la cóclea. La tomografía computada cone beam ha sido validada como una herramienta útil para evaluar la posición de los electrodos luego de la implantación. Tykocinski et al. describieron un modelo de la interfase electrodo-electrolito del implante coclear como una resistencia y un condensador en paralelo, y la resistencia del tejido circundante como una resistencia en serie. Realizando un registro detallado de la forma de la curva de voltaje, los datos pueden usarse para calcular la impedancia clínica o total, la resistencia de acceso, la impedancia de polarización y sus subcomponentes: Resistencia de polarización y capacitancia de polarización. El objetivo de este estudio es determinar si la distancia electrodo modiolar de cada uno de los electrodos podría predecirse a partir de mediciones de impedancia...

INTRODUCTION: Cochlear implants are neuronal prosthetic devices used for the treatment of severe to profound sensorineural hearing loss. The activation of electrodes stimulates spiral ganglion cells and nerve pathways. A more discrete stimulation of neuronal subpopulations can be obtained when the electrodes are closer to the ganglion cells in the modiolus wall. The distance from the electrode to the modiolus could be one of the multiple variables that influence the outcome of the patient with a cochlear implant. Currently there is no established protocol to measure this distance. By means of various imaging techniques, the position of the electrode guide inside the cochlea can be determined. Cone beam computed tomography has been validated as a useful tool to evaluate the position of the electrodes after implantation. Tykocinski et al., described a model of the electrode-electrolyte interface of the cochlear implant as a resistance and a capacitor in parallel, and the resistance of the surrounding tissue as a series resistance. By making a detailed record of the shape of the voltage curve, the data can be used to calculate the clinical or total impedance, the access resistance, the polarization impedance and its subcomponents: polarization resistance and polarization capacitance. The objective of this study is to determine if the electrode distance modiolar of each of the electrodes could be predicted from impedance measurements…

INTRODUCÃO: Os implantes cocleares são dispositivos protéticos neuronais utilizados no tratamento da perda auditiva neurossensorial severa a profunda. A ativação de eletrodos estimula as células ganglionares espirais e as vias nervosas. Uma estimulação mais discreta de subpopulações neuronais pode ser obtida quando os eletrodos estão mais próximos das células ganglionares na parede do modíolo. A distância do eletrodo ao modíolo pode ser uma das múltiplas variáveis que influenciam o resultado do paciente com implante coclear. Atualmente não há protocolo estabelecido para medir essa distância. Por meio de várias técnicas de imagem, a posição do guia do eletrodo dentro da cóclea pode ser determinada. A tomografia computadorizada por feixe cônico foi validada como uma ferramenta útil para avaliar a posição dos eletrodos após o implante. Tykocinski et al. Descreveu um modelo da interface eletrodo-eletrólito do implante coclear como uma resistência e um capacitor em paralelo, e a resistência do tecido circundante como uma resistência em série. Realizando um registo detalhado da forma da curva de tensão, os dados podem ser usados para calcular a impedância clínico ou total, a resistência de acesso, a impedância de polarização e seus subcomponentes: resistência de polarização e capacitância de polarização. O objetivo deste estudo é determinar se a distância modiolar do eletrodo de cada um dos eletrodos poderia ser prevista a partir de medidas de impedância...

Parámetros de programación del implante coclear / Parameter fitting for cochlear implant

Resumen: La programación de un paciente con implante coclear resulta un proceso inicialmente estandarizado, pero que debe individualizarse para cada caso. En la mayoría de las ocasiones, dicho proceso implica el establecimiento de parámetros comunes. Sin embargo, existe un porcentaje de usuarios en los que por alguna circunstancia no es posible establecer niveles adecuados de estimulación, por lo que el médico audiólogo tiene que realizar ajustes en parámetros especiales, como cambio de estrategia, tasa de estimulación, ancho de pulso, entre otros, con el fin de obtener un desempeño auditivo de acuerdo a lo esperado.

Abstract: Programming a patient with cochlear impant follows a standardized and individualized protocol, although there is a percentage of users in which, for some reason, it is not possible to establish appropriate levels of stimulation. In these patients, the audiologist has to make adjustments in some special parameters such as a change in the strategy, stimulation rate, pulse width, among others, in order to obtain an auditory performance as expected.

Informe de evaluación científica basada en la evidencia disponible: hipoacusia sensorioneural severa profunda bilateral postlocutiva / Scientific evaluation report based on available evidence: post-lingual deep bilateral severe sensorineural hearing loss

INTRODUCCIÓN: El término compuesto "Hipoacusia Sensorioneural Severa o Profunda" (HSN Severa a Profunda) hace referencia, por una parte, a una condición audiológica de disminución, desde 70 dB - 90 dB (Severa ­ Profunda, respectivamente), en la capacidad auditiva y, por otra, a la localización coclear o retrococlear (nervio auditivo) de un daño o lesión, uni o bilateral (1). La pérdida de audición adquirida o hipoacusia adquirida, es aquella discapacidad auditiva producida después del nacimiento, que incluye a las congénitas de aparición tardía, como por ejemplo la causada por citomegalovirus. En el caso específico de las hipoacusias sensorioneurales (HSN), tanto en niños como adultos, puede presentarse posterior al nacimiento como resultado de: la edad, enfermedad de los vasos sanguíneos, enfermedad inmunitaria, Infecciones, tales como meningitis, paperas, escarlatina y sarampión, ruidos o sonidos fuertes o sonidos fuertes que duran mucho tiempo, enfermedad de Ménière, trauma, tumor, como por ejemplo un neurinoma del acústico, uso de ciertos medicamentos o exposición constante a ruidos, por ejemplo por temas laborales o de forma idiopática. TECNOLOGÍA SANITARIA ANALIZADA: Implante Coclear. EFICACIA DE LOS TRATAMIENTOS: Todas las revisiones sistemáticas presentan resultados positivos en los resultados medidos para el implante coclear, ya sea unilateral o bilateral. A pesar de ésto, el nivel de evidencias es bajo, ya que las revisiones sistemáticas carecen de estudios randomizados, presentando heterogeneidad en sus diseños: estudios de casos, estudios de cohortes prospectivos. La percepción del habla y la calidad de vida mejoran con implantación unilateral y bilateral, especialmente en condiciones de ruidos. El IC bilateral con respecto al IC unilateral ofrece ventajas en la audición en ruido (+++), en la localización sonora (+++) y durante la audición en un entorno silencioso (++). ANÁLISIS ECONÓMICO: A excepción de contextos de países con bajo ingreso, el implante coclear es una intervención costo-efectiva en países de mediano y alto ingreso. Es necesario tener en cuenta que la costoefectividad de la intervención es mayor en personas con hipoacusia post-lingual y disminuye en personas con pérdida de la audición profunda durante un tiempo prolongado. Los resultados de la revisión sistemática que buscó evaluaciones económicas del implante coclear en adultos mostró qué, a pesar de la incertidumbre y la calidad metodológica de los estudios encontrados, la evidencia avala el uso del implante coclear unilateral en adultos. CONCLUSIÓN: Para dar cumplimiento al artículo 28° del Reglamento que establece el proceso destinado a determinar los diagnósticos y tratamientos de alto costo con Sistema de Protección Financiera, según lo establecido en los artículos 7° y 8° de la ley N°20.850, aprobado por el decreto N° 13 del Ministerio de Salud, se concluye que el presente informe de evaluación se considera favorable, de acuerdo a lo establecido en el Título III. De las Evaluaciones Favorables de la Norma Técnica N° 0192 de este mismo Ministerio.

Verificação eletroacústica de sistemas de frequência modulada em usuários de implante coclear / Electroacoustic verification of frequency modulation systems in cochlear implant users

O objetivo deste estudo foi realizar e determinar a validade de um protocolo de teste de verificação eletroacústica para Sistemas de Frequência Modulada (FM) acoplados a diferentes processadores de fala de implantes cocleares. Participaram deste estudo 40 crianças, com idades entre 5 e 18 anos incompletos, usuários de quatro modelos diferentes de processadores de fala. A verificação eletroacústica foi realizada por meio do uso do equipamento Audioscan Verifit (VF-1) com acoplador HA-1, além do uso do dispositivo de verificação de escuta correspondente a cada modelo de processador de fala do implante coclear. Nos casos em que a transparência não foi atingida, foi realizada alteração no ajuste do ganho do Sistema FM e avaliação da percepção auditiva da fala no ruído por meio da aplicação da versão brasileira do teste Phrases in Noise Test (PINT). Houve transparência entre o Sistema FM e o implante coclear em 85% dos dispositivos avaliados. Após o ajuste do ganho FM nos outros casos, os dispositivos apresentaram-se transparentes quando o teste de verificação eletroacústica foi repetido. Também foi observado que os participantes submetidos ao teste de percepção de fala no ruído apresentaram melhor desempenho após o novo ajuste, de modo que, nestes casos, a transparência eletroacústica ocasionou em transparência comportamental. Concluiuse que o protocolo de verificação eletroacústica utilizado mostrou-se efetivo para a avaliação da transparência entre o Sistema FM e o implante coclear. A realização prévia do ajuste do processador de fala e do ganho do Sistema FM mostrou-se essencial para que a transparência fosse atingida.(AU)

The purpose of this study was perform and determine the validity of an electroacoustic verification test for FM Systems coupled to different cochlear implant speech processors. The sample included 40 participants between 5-18 years users of four different models of speech processors. For the electroacoustic evaluation, we used the Audioscan Verifit device with the HA-1 coupler and the listening check devices corresponding to each speech processor model. In cases where the transparency was not achieved, was made a modification in the FM gain adjustment and used the Brazilian version of the "Phrases in Noise Test" (PINT) to evaluate the speech perception in competitive noise. It was observed that there was transparency between the FM System and the cochlear implant in 85% of the participants evaluated. After adjusting the gain of the FM receiver in the other participants, the devices showed transparency when the electroacoustic verification test was repeated. It was also observed that they presented better performance in speech perception in noise after a new adjustment, that is, in these cases, the electroacoustic transparency caused behavioral transparency. It was concluded that the electroacoustic evaluation protocol suggested was effective to evaluate transparency between the FM System and the cochlear implant. Performing the adjustment of the speech processor and the FM System gain are essential when fitting this device.(AU)