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.

Cochlear electrode array misplacement into the superior semicircular canal: a case report and literature review / 临床耳鼻咽喉头颈外科杂志

Electrode array misplacement is a rare complication of cochlear implant. This article reports an 11-year-old boy who was mistakenly implanted the cochlear electrode array into the superior semicircular canal during the initial cochlear implant. After the diagnosis was confirmed, he underwent a second cochlear implant and the electrode array were successfully implanted into the cochlea. This article conducted a systematic review of the literature on electrode array misplacement, and the causes of electrode array misplacement were analyzed from different implantation position.

Impacto da protetização auditiva na qualidade de vida do adulto com deficiência auditiva: revisão de escopo / Impact of hearing aids on the quality of life of adults with adult disabilities: scope review

RESUMO Objetivo Verificar os benefícios da protetização auditiva na qualidade de vida do adulto com deficiência auditiva. Estratégia de pesquisa Revisão de escopo, guiada pelas recomendações PRISMA. Critérios de seleção A busca foi realizada com o auxílio dos unitermos "auxiliares de audição", "aparelho auditivo", "implante coclear", "fonoaudiologia", "deficiência auditiva", "perda auditiva", "qualidade de vida", e seus respectivos em inglês e espanhol, nos bancos virtuais de dados: LILACS, SciELO, PubMed, Scopus, Web of Science e OpenGrey. Os dados foram analisados qualitativamente. Resultados Foram identificados 1.312 registros e selecionados 6 artigos, com população protetizada auditivamente, dos 18 aos 92 anos, de ambos os gêneros, usuários de implante coclear e aparelho de amplificação sonora individual. Foram utilizados os seguintes instrumentos: Questionário de avaliação das expectativas do adulto/idoso novo usuário de próteses auditivas, International Outcome Inventory For Hearing Aids, Questionário Nijmegen de Implantes Cocleares, Questionário de Satisfação do Cliente, Caregiver Strain Questionnaire, Formulário de Questionário Relativo ao Índice, World Health Organization Quality of Life-bref, Glasgow Health Status Inventory, Abbreviated Profile of Hearing Aid Benefit, Cochlear Implant Quality of Life, Caregiver Burden Scale, Escala Quantificada de Denver e Escala Visual Analógica. Os resultados indicaram melhor qualidade de vida nos domínios testados, tanto na visão dos adultos surdos quanto na de seus parceiros. Conclusão Apesar da heterogeneidade dos protocolos de qualidade de vida utilizados nos estudos selecionados, foi possível verificar que a protetização auditiva melhora a qualidade de vida do adulto com deficiência auditiva.

ABSTRACT Purpose To verify the benefits of hearing aids in the quality of life of adults with hearing loss. Research strategy Scoping review guided by PRISMA recommendations. Selection criteria with the help of the keywords "hearing aids", "hearing aid", "cochlear implant", "speech therapy", "hearing impairment", "hearing loss", "quality of life", and their respective in English and Spanish in the virtual databases: LILACS, SciELO, PubMed, SCOPUS, Web of Science and Open Grey. Qualitatively analyzed. Results 1,312 records were identified and six articles were selected, with a hearing aided population from 18 to 92 years old, from both genders, cochlear implant and individual sound amplification device users. Questionnaires were used (assessment of expectations of adults/elderly users of hearing aids, International Outcome Inventory For Hearing Aids, Nijmegen Cochlear Implant, Satisfaction, Caregiver Strain Questionnaire, Relative to the Index, World Health Organization Quality of Life-bref, Glasgow Health Status Inventory, Abbreviated Profile of Hearing Aid Benefit, Cochlear Implant Quality of Life and scales (Care Giving Burden Scale), Denver Quantified and visual analog). The results indicated a better quality of life in the domains tested, both in the view of deaf adults and their partners. Conclusion Despite the heterogeneity of the quality of life protocols used in the selected studies, it was possible to verify that hearing aids increase the quality of life of adults with hearing loss.

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.

Electrococleografía en implante coclear / Electrocochleography in cochlear implant

La electrococleografía es una técnica electrofisiológica desarrollada en modelos animales hace más de 90 años. En la actualidad se utiliza en la práctica clínica en audiolo-gía y otoneurología, ya que permite evaluar la función coclear, a través del registro del potencial microfónico coclear, y la funcionalidad del nervio auditivo por medio del registro del potencial de acción compuesto. Debido al avance de la tecnología de los implantes cocleares, actualmente existe la posibilidad de realizar mediciones clínicas a tiempo real con electrococleografía intraoperatoria, por lo que se puede monitorizar la función auditiva residual durante la inserción de los electrodos del implante coclear. En este artículo se presenta una revisión narrativa del uso y aplicación clínica de la electrococleografía en la evaluación de pacientes con implante coclear para predecir el desempeño auditivo y la percepción del habla. La literatura muestra que la electroco-cleografía es una técnica que se encuentra, plenamente, vigente para evaluar la función auditiva en pacientes usuarios de implantes cocleares. Si bien las respuestas cocleares han demostrado ser un buen predictor de los umbrales perceptuales auditivos y del habla en silencio en adultos, aún es una técnica que requiere más desarrollo para ser una herramienta clínica que permita predecir el habla en ruido y la función auditiva en niños y adultos mayores.

Electrocochleography is an electrophysiological technique developed in animal models more than 90 years ago. It is currently used in clinical practice in audiology and otoneurology, since it allows the evaluation of cochlear function, through the recording of the cochlear microphonic potentials, and the functionality of the auditory nerve by means of compound action potential recordings. Due to the advancement of cochlear implant technology, there is currently the possibility of real-time clinical measurements with intraoperative electrocochleography, so that residual hearing function can be monitored during the insertion of the cochlear implant electrodes. This article presents a narrative review of the use and clinical application of electrocochleography in the evaluation of patients with cochlear implants to predict auditory performance and speech perception. The literature shows that electrocochleography is a technique that is fully in force to assess hearing function in patients who use cochlear implants. Although cochlear responses have been shown to be a good predictor of auditory perceptual thresholds and speech in quiet in adults, it is still a technique that requires further development to become a clinical tool for predicting speech in noise and auditory function in children and older adults.

Adaptación transcultural al español chileno de las escalas CAP-II y SIR en formato online para padres de niños(as) con audífonos o implantes cocleares / Chilean spanish transcultural adaptation of CAP-II and SIR scales in an online format for parents of children with hearing aids or cochlear implants

La adquisición de lengua oral representa un desafío para niñas/os sordas/os o con pérdida auditiva (NSPA) que utilizan audífonos o implante coclear (CI). Tomar decisiones a tiempo durante el tratamiento con dispositivos es esencial y requiere de evaluaciones adecuadas. Dos instrumentos usados en la toma de decisiones son las escalas "Categories of Auditory Performance Index II" (CAP-II) y "Speech Intelligibility Rating Scale" (SIR). Estas escalas han mostrado ser útiles para la evaluación continua del desarrollo de habilidades auditivas y de la lengua oral en variados idiomas, pero estas no están disponibles para el español chileno. El objetivo de este estudio es crear traducciones en español chileno de las escalas CAP-II y SIR, las que puedan ser usadas como auto-reporte online por padres y cuidadores con el fin de asistir a profesionales en el monitoreo del progreso de niños/as NSPA, considerando las restricciones impuestas por el COVID-19. El método usado en el proceso comienza con la traducción de una propuesta de auto-reporte de las versiones originales en inglés de las escalas CAP-II y SIR. Finalmente, las versiones en español chileno fueron testeadas en 107 padres-cuidadores de niñas/os NSPA con CI. Los resultados sugieren que estos instrumentos serían adecuados para su uso en el contexto chileno.

Spoken language acquisition is challenging for very young deaf or hard-of-hearing children (DHH) who wear hearing aids or cochlear implants (CI). Timely decision-making for treatment is essential for these children and requires suitable assessments. Two such assessments are the Categories of Auditory Performance Index II (CAP-II) and the Speech Intelligibility Rating Scale (SIR). These have been shown to be helpful for the ongoing evaluation of developing speech perception and spoken language skills in various languages, but they are not available in Chilean Spanish. This study aimed to create a Chilean Spanish translation of the CAP-II and SIR, appropriate for online self-administration by parents-caregivers in Chile, to assist professionals in monitoring DHH children's progress, considering the COVID-19 restrictions. The methods used in the process started with translating a self-report proposal from the original English versions of the CAP-II and SIR scales. Finally, the Chilean Spanish versions were tested in 107 Chilean parents-caregivers of DHH children with CIs. The results suggest these instruments are suitable for use in a Chilean context.

The effects of cognitive effort on academic performance of learners with cochlear implants in a private mainstream school in Gauteng

This research investigated the phenomenon of learners with cochlear implants and their challenges with cognitive effort in private mainstream schools in Gauteng. Many learners with cochlear implants encounter academic and social challenges at school, despite the advanced technology. Objectives: This study aimed to explore how learners with cochlear implants experience cognitive effort and whether it impacts their academic potential. Methods: Research was conducted using a phenomenological design. Phenomenography was used as theoretical framework to perceive, interpret and understand experiences of the cochlear implant recipients. The six former learners who were recipients of cochlear implants were selected using purposive sampling. Semi structured interviews were utilised to gather information, which was analysed using thematic content analysis. Results: Five themes emerged from the analysis, namely auditory challenges, cognitive functioning, peer interactions, emotional health and concealed disability. This article only presents the first theme of cognitive functioning and highlights three subthemes related to cognitive effort. Findings show that many learners struggled with their concentration span and fatigue, as a result of their cognitive effort difficulties. Conclusion: This study demonstrated how learners with cochlear implants face challenges with cognitive effort at their mainstream schools. It indicates the need for awareness of and training on educating learners with cochlear implants to help them reach their academic potential. Contribution: This study contributes a unique focus on learners with cochlear implants in mainstream schools in South Africa. The study highlights that cognitive effort of learners with cochlear implants influenced their capabilities to multitask and retain information, despite the effort they have to put into listening. Further research should be conducted to develop interventions that could lesson cognitive effort while increasing learner productivity. The article responds to disability studies and inclusive education

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.

Hipoacusia sensorioneural unilateral: Revisión de los manejos posibles en nuestra realidad nacional / Unilateral sensorineural hearing loss: Review of possible management in our national reality

La hipoacusia unilateral (HUL) definida como la pérdida auditiva de cualquier grado en un solo oído tiene prevalencias en edad escolar de 3% a 6%. La etiología es desconocida en la mayoría de los casos, pero destacan las anormalidades anatómicas severas a diferencia de las hipoacusias bilaterales, lo que le otorga importancia al estudio de imágenes. También se recomienda realizar evaluación oftalmológica. El impacto de la HUL se observa en la localización sonora, reconocimiento del habla, desarrollo del lenguaje, desempeño social y conducta, pero por sobre todo en el rendimiento académico. En este sentido es relevante mencionar que además de existir mayor probabilidad de repitencia de curso, es necesario mayor apoyo educacional individualizado para evitar dicha repitencia o lograr mismo éxito académico que un normoyente. En relación al diagnóstico aún faltan normas o protocolos, siendo éste un desafío en las zonas donde no hay screening universal. Se discute la importancia de las encuestas para realizar evaluaciones y seguimiento en estos casos. Finalmente se abordan las estrategias de intervención disponibles, además de un plan individualizado considerando al niño, su familia y sus expectativas, particularmente se discuten las características o factores a tomar en cuenta en el momento de la adaptación, para así lograr un tratamiento tendiente al éxito.

Unilateral hearing loss (UHL) defined as hearing loss of any degree in only one ear has a school-age prevalence of 3% to 6%. The etiology is unknown in most cases, but severe anatomical abnormalities stand out as opposed to bilateral hearing loss, which gives importance to the study of images. Ophthalmological evaluation is also recommended. The impact of UHL is observed in sound localization, speech recognition, language development, social performance and behavior, but above all in academic performance. In this sense, it is relevant to mention that in addition to having a higher probability of repeating the course, it is necessary to have more individualized educational support to avoid this repetition or achieve the same academic success as a normal listener. Regarding the diagnosis, there are still missing norms or protocols, this being a challenge in areas where there is no universal screening. The importance of surveys to carry out evaluations and follow-up in these cases is discussed. Finally, the available intervention strategies are discussed, in addition to an individualized plan considering the child, his family and his expectations, particularly, the factors to be taken into account at the time of adaptation, in order to achieve a success treatment.

Percepção e atuação de professores sobre o aluno com perda auditiva na escola / Teachers' perception and action toward the student with hearing loss at school / Percepción y desempeño de los maestros sobre los estudiantes con pérdida auditiva en la escuela

Introdução: O aluno com perda auditiva que utiliza a comunicação oral pode necessitar de diferentes adequações na escola e condutas adequadas são fundamentais para o seu desenvolvimento. Visto que o professor é importante nesse processo e sua formação não o capacita para atuar com esses alunos, torna-se relevante a parceria entre as áreas da Saúde e Educação. Objetivo: Verificar a percepção e a atuação dos professores sobre o seu aluno com perda auditiva, usuário de aparelho de amplificação sonora individual (AASI) e/ou implante coclear (IC), que utiliza comunicação oral. Método: Participaram 42 professores que atuavam com alunos com perda auditiva em escolas públicas do município de Marília. Os dados foram obtidos por meio do questionário de acompanhamento mensal e de reuniões com a equipe escolar. As respostas foram categorizadas e analisada a frequência de ocorrência. Foi aplicado o Teste de Igualdade de Duas Proporções, admitindo-se como significância (p<0,05). Resultados: Observou-se que o questionário de acompanhamento mensal permitiu o registro das informações de forma detalhada, em relação às reuniões, com frequência de ocorrência estatisticamente significante para as categorias "Acadêmica" (p=0,024), "Comunicação" (p<0,001) e "Participação em sala" (p=0,034). Os professores apresentaram relatos com frequência de ocorrência variável, para cada categoria. Conclusão: Os achados deste estudo em relação à percepção e à atuação dos professores demonstraram respostas aos aspectos com frequência de ocorrência substancialmente diferentes, as quais não conotam uma atuação focada nas necessidades do aluno com perda auditiva que utiliza comunicação oral, no ambiente escolar.

Introduction: The student with hearing loss who uses oral communication might need different adaptations at school and appropriate conducts are essential for their development. Since the teachers are important in this process and their training does not enable them to work with these students, the partnership between the areas of Health and Education is relevant. Objective: To verify the perception and actions of the teachers towards their students with hearing loss, users of hearing aids (HA) and/or cochlear implant (CI), who use oral communication. Methods: Forty-two (42) teachers who taught students with hearing loss in public schools in Marília participated in this study. The data was obtained through the monthly monitoring questionnaire and meetings with school staff. The answers were categorized, and the frequency of occurrence was analyzed. The Two-Proportion Equality Test was applied and assuming a level of significance (p<0.05). Results: It was observed that the monthly follow-up questionnaire allowed the recording of information in detail, in relation to meetings, with frequency of statistically significant occurrence for the "Academic" (p=0.024), "Communication" (p<0.001) and "Participation in the classroom" (p=0.034) categories. The teachers presented reports with variable frequency of occurrence for each category. Conclusion: The findings of this study in relation to the perception and action of teachers showed responses to the aspects evaluated with substantially different frequency of occurrence, indicating a lack of action focused on the needs of students with hearing loss who use oral communication at school.

Introduccion: El estudiante con pérdida auditiva que usa la comunicación oral puede necesitar diferentes adaptaciones en la escuela y los comportamientos adecuados son fundamentales para su desarrollo. Dado que el maestro es importante en este proceso y su formación no le permite trabajar con estos estudiantes, la alianza entre las áreas de Salud y Educación cobra relevancia. Objetivo: Verificar la percepción y desempeño de los maestros sobre su estudiante con pérdida auditiva, usuario de audífono y/o implante coclear (IC), que utiliza la comunicación oral. Metodos: En este estudio participaron cuarenta y dos maestros que enseñaron a estudiantes con pérdida auditiva en escuelas públicas en Marília. Los datos se obtuvieron a través del cuestionario de seguimiento mensual y reuniones con el equipo escolar. Las respuestas se categorizaron y se analizó la frecuencia de ocurrencia. Se aplicó el Test de Igualdad de Dos Proporciones, asumiendo significancia (p <0.05). Resultados: Se observó que el cuestionario de seguimiento mensual permitió registrar información detalladamente, en relación a las reuniones, con una frecuencia de ocurrencia estadísticamente significativa para las categorías "Académico" (p = 0.024), "Comunicación" (p <0.001) y "Participación en el aula" (p = 0,034). Los maestros presentaron informes con frecuencia variable de ocurrencia, para cada categoría. Conclusión: Los hallazgos de este estudio en relación a la percepción y desempeño de los maestros evidenciaron respuestas a aspectos con frecuencia de ocurrencia sustancialmente diferente, que no connotan una acción enfocada en las necesidades de los estudiantes con pérdida auditiva que utilizan la comunicación oral en el ámbito escolar.

Complicaciones del implante coclear en adultos y niños del Hospital Universitario Doctor Peset de Valencia, España, desde el 2001 al 2020 / Complications of the cochlear implant in adults and children in the Hospital Universitario Doctor Peset de Valencia, Spain, from 2001 to 2020

RESUMEN Introducción: La cirugía del implante coclear es un método efectivo para la rehabilitación auditiva de los pacientes con hipoacusia neurosensorial severo-profunda, en los que el rendimiento con los audífonos no es suficiente. Aunque la implantación coclear es una técnica segura, es importante conocer sus posibles complicaciones, entre ellas la infección del colgajo o la parálisis facial. Objetivo: Analizar las complicaciones de los pacientes con implante coclear intervenidos en un hospital universitario terciario: El Hospital Universitario Doctor Peset de Valencia, desde enero de 2001 a marzo de 2020. Metodología: Estudio observacional descriptivo de las complicaciones en una muestra de 134 pacientes con implantación coclear en el Hospital Universitario Doctor Peset de Valencia, en un periodo de 20 años. En el análisis estadístico se utilizó estadística descriptiva. Para demostrar diferencias significativas entre variables empleamos el programa R. Se utilizó el test χ2 para proporciones, considerando significativo un valor p < 0.05. Resultados: 134 pacientes fueron implantados. La frecuencia global de complicaciones fue del 17.9%, 4.5% fueron complicaciones mayores y 13.4% fueron complicaciones menores. La complicación más frecuente fue la desactivación o inserción incompleta de algunos electrodos. Discusión: Las proporciones de complicaciones del estudio entran dentro de los rangos encontrados en la literatura (14.9-18.3%). La frecuencia de complicaciones mayores es inferior al 5%, proporción similar a la obtenida en nuestra serie. Conclusiones: El implante coclear es una técnica quirúrgica segura para la rehabilitación de pacientes con hipoacusia severa, aunque no está exenta de riesgo, por lo que se debe conocer sus potenciales complicaciones. MÉD.UIS.2021;34(2):19-28.

ABSTRACT Introduction: Cochlear implantation is an effective method for hearing rehabilitation in patients with severe neurosensory hearing loss in which hearing aids do not provide good discrimination. Although cochlear implantation is a safe technique, adverse effects related to surgery have been described, including flap infection or facial paralysis. Objective: To analyze the complications of cochlear implanted patients in a tertiary university hospital: The Hospital Universitario Doctor Peset of Valencia, from January 2001 to March 2020. Methodology: This is a descriptive observational study of the complications in a sample of 134 patients with cochlear implant surgery in The Hospital Universitario Doctor Peset of Valencia in a period of 20 years. Descriptive statistics were used in the statistical analysis. To demonstrate significant differences between variables we used the R program. The χ2 test was used for proportions, considering significant a p value < 0.05. Results: 134 patients were implanted. The global frequency of complications was 17.9%, 4.5% were major complications and 13.4% were minor complications. The most frequent complication was inactivation or incomplete insertion of some electrodes. Discussion: Our complication rate is within the range published in the literature (14.9-18.3%). The major complication rate is 5% which is similar to our series. Conclusions: The cochlear implant is a safe surgical technique for the rehabilitation of patients with severe neurosensory hearing loss, although it is not riskless, therefore, one must know that complication are possible. MÉD.UIS.2021;34(2):19-28

Cochlear implant and tinnitus-a meta-analysis / Implante coclear e zumbido - Uma metanálise

Abstract Introduction Tinnitus is a frequent symptom in cochlear implant patients, often reported as persistent and disabling in implant candidates. Tinnitus is rarely considered in the preoperative evaluation of patients who are eligible for cochlear implantation. Many studies have shown that a cochlear implant leads to a significant change in the perception of tinnitus. Objective To identify evidence in the scientific literature indicating that cochlear implant in eligible patients with tinnitus can improve tinnitus perception. Methods One hundred forty articles were found from nine databases, and 20 articles from the gray literature mentioned the relationship between cochlear implant and tinnitus perception in patients eligible for cochlear implant. The PICOS (population, intervention, comparison, and outcome) strategy, was used to define the eligibility criteria. The studies that met the inclusion criteria for this second step were included in a qualitative synthesis, and each type of study was analyzed using the Joanna Briggs Institute critical appraisal checklist for quasi-experimental studies and the Joanna Briggs Institute critical appraisal checklist for randomized clinical trials. Results The full texts of 11 articles were read, and 6 studies were selected for the meta-analysis. The total sample size in the evaluated articles was 136 patients with tinnitus who were eligible for cochlear implantation. Conclusions Taken together, these findings support the feasibility of cochlear implantation to reduce the perception of tinnitus, thus providing a new perspective in the treatment of tinnitus in patients with hearing loss who are candidates for cochlear implantation.

Resumo Introdução Zumbido é um sintoma frequente em pacientes com implante coclear, comumente relatado como persistente e incapacitante em candidatos ao procedimento. Entretanto, o zumbido raramente é considerado na avaliação pré-operatória de pacientes elegíveis para o implante coclear. Muitos estudos têm demonstrado que o implante coclear leva a uma mudança significativa na percepção do zumbido. Objetivo Identificar evidências na literatura científica que indiquem que o implante coclear em pacientes com zumbido pode melhorar a percepção. Método Foram encontrados 140 artigos em nove bases de dados e 20 artigos da literatura cinzenta mencionaram a relação entre o implante coclear e a percepção do zumbido em pacientes elegíveis para o procedimento. A estratégia PICOS (população, intervenção, comparação e desfecho) foi usada para definir os critérios de elegibilidade. Os estudos que atenderam aos critérios de inclusão para esta segunda etapa foram incluídos em uma síntese qualitativa e cada tipo de estudo foi analisado com a critical appraisal checklist for quasi-experimental studies e a critical appraisal checklist for randomized clinical trials do Joanna Briggs Institute. Resultados Foram lidos os textos completos de 11 artigos e selecionados 6 estudos para a metanálise. O tamanho total da amostra dos artigos avaliados foi de 136 pacientes com zumbido, elegíveis para o implante coclear. Conclusões Em conjunto, esses achados apoiam a viabilidade do implante coclear para reduzir a percepção do zumbido, proporcionam uma nova perspectiva no tratamento do zumbido em pacientes com deficiência auditiva candidatos a esse procedimento.

Phrases in noise test (PINT) Brasil: efetividade do teste em crianças com deficiência auditiva

Resumo Introdução: Uma das principais implicações da deficiência auditiva é a dificuldade na percepção dos sons da fala, sobretudo em ambientes ruidosos. Dessa forma, o sistema de frequência modulada é considerado uma importante ferramenta educacional para crianças com deficiência auditiva, pois promove a melhoria da percepção da fala em ambientes acusticamente desfavoráveis, como em sala de aula. Entre o protocolo de verificação desse dispositivo é indicada a avaliação da percepção da fala no ruído. Objetivo: Verificar a efetividade do teste de percepção da fala no ruído Phrases in Noise Test Brasil em crianças com deficiência auditiva adaptadas com o sistema frequência modulada. Método: Estudo de corte transversal. A amostra incluiu 40 indivíduos, dos 4 anos até os 11 anos e 11 meses, distribuídos em 4 grupos: (1) 10 crianças normo-ouvintes; (2) 13 crianças adaptadas com aparelho de amplificação sonora individual e com sistema frequência modulada; (3) 12 crianças usuárias de implante coclear e adaptadas com sistema de frequência modulada; e (4) 5 crianças com diagnóstico de desordem do espectro da neuropatia auditiva, adaptadas com aparelho de amplificação sonora individual e/ou implante coclear e com sistema de frequência modulada. Foi usado o Phrases in Noise Test Brasil para avaliar a percepção da fala no ruído nas condições sem e com o sistema frequência modulada. Para a análise estatística dos dados foi adotado nível de significância de 5% (p < 0,05). Resultados: Obteve-se uma diferença significativa entre os grupos quando avaliados com o sistema frequência modulada. O teste também foi validado por meio das medidas de validação concorrente e convergente. O Phrases in Noise Test Brasil é uma opção viável para o acompanhamento do desempenho auditivo no ruído em diferentes grupos de crianças com deficiência auditiva. Conclusão: O Phrases in Noise Test Brasil foi efetivo para avaliar a percepção de fala no ruído e pode contribuir para o aprimoramento dos protocolos de indicação, adaptação e acompanhamento do uso do sistema frequência modulada.

The imaging characteristics and prognosis of patients with cochlear implants whose cochlear nerves are not shown on MRI / 中华耳鼻咽喉头颈外科杂志

Objective: To analyze the temporal bone CT and inner ear magnetic resonance imaging characteristics of cochlear implant patients with no cochlear nerve display in the inner auditory canal under MRI. To retrospectively analyze the long-term hearing and speech rehabilitation effects of such patients after cochlear implant. And to analyze the correlation between the results of imaging examinations and the postoperative effects of cochlear implant patients with this type of cochlear nerve deficiency. Methods: A total of 88 children with cochlear nerve deficiency, who underwent cochlear implantation in Shandong Provincial ENT Hospital from May 2014 to October 2018, were enrolled. Patients with cochlear malformations were excluded,only the patients with cochlear nerve deficiency whose cochlear structure was normal and no cochlear nerve displayed in inner auditory canal under MRI were enrolled. There were 64 patients, including 4 bilaterally implanted, 68 ears in total, with an average age of (2.8±1.7) years (range 1-6 years) at the time of implantation. The implanted product was Cochlear, including 24RECA and 512 models. All patients underwent inner ear magnetic resonance imaging and temporal bone CT scan before operation. Auditory speech function assessments were performed at 12 months, 24 months, and 36 months after surgery, including categories of auditory performance (CAP), speech intelligibility rating (SIR) and hearing aid threshold test. The imaging evaluation content included the width of the cochlear nerve canal of temporal bone CT, the width of the internal auditory canal, the width of the auditory nerve at the cerebellopontine angle of the inner ear MRI, and the ratio of the facial nerve to the width of the auditory nerve at the cerebellopontine angle. The correlations between the results of postoperative hearing aid hearing threshold, CAP, SIR and imaging results were analyzed. Results: Among the 64 cases of cochlear nerve not shown under MRI, 56 ears with CT data showed that the width of the cochlear nerve canal in temporal bone CT was (0.72±0.30) mm (mean±standard deviation, the same below), and the width of the internal auditory canal was (4.07±1.10) mm; 66 ears with MRI data showed that the diameter of the auditory nerve at the cerebellopontine angle of the inner ear MRI was (1.58±0.27) mm, the diameter of the facial nerve was (1.57±0.27) mm, and the ratio of the diameter of the facial nerve to the auditory nerve was (1.02±0.23). The average hearing thresholds at 12, 24, and 36 months after surgery were (46.8±2.5) dB HL, (40.7±0.8) dB HL, and (36.8±1.5) dB HL, respectively. The preoperative and postoperative CAP scores at 12, 24 and 36 months were (1.0±1.0), (3.8±1.4), (4.5±1.4) and (5.1±0.7) points, respectively. The preoperative and postoperative SIR scores at 12, 24, and 36 months were (1.1±0.3), (1.9±0.9), (2.5±0.9), and (2.9±0.6) points, respectively. The hearing threshold at 24 months after surgery was negatively correlated with the width of the internal auditory canal of temporal bone CT (r=-0.349, P=0.037), and the hearing threshold at 36 months after surgery was positively correlated with the ratio of the diameter of the facial nerve to the auditory nerve at the cerebellopontine angle of the inner ear MRI (r=0.740, P=0.001). Conclusions: Children with cochlear implants whose cochlear nerves are not shown on MRI can benefit from cochlear implantation, and their speech and auditory functions can improve significantly after surgery. The width of the internal auditory canal in the temporal bone CT and the ratio of the diameter of the facial nerve to the auditory nerve at the cerebellopontine angle of the inner ear MRI may be related to the long-term hearing threshold after surgery.

Study on the feature of cortical auditory evoked potential under different auditory tasks in cochlear implant children / 中华耳鼻咽喉头颈外科杂志

Objective: To investigate the variation regularity and influencing factors of cortical auditory evoked potential (CAEP) evoked by pure tone, syllable and tone stimuli in cochlear implant (CI) children. Methods: Cortical auditory evoked potential (CAEP) responses were collected from 46 CI children in the sound field. Pure tones with frequencies of 1 kHz and 2 kHz were used as the standard and the deviant respectively in the pure tone stimulation condition. The Chinese Mandarin tokens/ba/-/pa/and/ba1/-/ba4/pairs were used as the stimuli respectively in the syllable and tone stimulation condition. The latency, amplitude and presence rate of P1 and mismatch negative(MMN) were obtained and the correlation between the difficulty of auditory task, the age of hearing month, the duration of severe-profound hearing loss, the wearing history of hearing aid before CI, the hearing threshold of the better ear before CI and the latency and amplitude of P1 and MMN were analyzed. All statistical analyses and figures were conducted using SPSS 25.0. Results: The P1 presence rate of pure tone, syllable and tone group was 100% (17/17), 100% (13/13) and 75.0% (12/16), respectively, with significant difference (χ²=8.214, P=0.016). There was significant difference between pure tone group and tone group (χ²=4.836, P=0.028), but no significant difference between pure tone group and syllable group, syllable group and tone group. The MMN presence rate of pure tone, syllable and tone group was 94.1% (16/17), 84.6% (11/13) and 62.5% (10/16), respectively, but no significant difference among the three groups with different auditory tasks(χ²=0.066, P=0.066). No significant difference was observed among the three groups of different auditory tasks in the latency and amplitude of P1 and MMN. Multiple linear regression analysis showed that the latency of P1 was positively correlated with the difficulty of auditory task and the hearing threshold of the better ear before CI, and negatively correlated with hearing age and the history of hearing aid before CI. The latency of MMN was positively correlated with the difficulty of auditory task, and negatively correlated with hearing age. Conclusions: The P1 presence rate of pure tone auditory task is significantly higher than that of tone auditory task. The difficulty of auditory task, hearing age, the history of hearing aid before CI, and the hearing threshold of the better ear before CI has significant effects on the P1 latency. The difficulty of auditory task and hearing age has significant effects on the MMN latency.

The development of auditory speech perception and spatial hearing abilities within one year after cochlear implantation in preschool prelingual deaf children / 中华耳鼻咽喉头颈外科杂志

Objective: To investigate the development of auditory speech perception and spatial hearing abilities within one year after cochlear implantation in preschool prelingual deaf children and the relationship between the two abilities. Methods: This retrospective study analyzed 31 preschool children with an average age of (2.3±1.2) years. All cases were assessed at pre-implant, 6 months and 12 months post-implant using the Infant-toddler Meaningful Auditory Integration Scale (IT-MAIS), the Meaningful Auditory Integration Scale (MAIS) and the Mandarin Early Speech Perception test (MESP) to evaluate their listening and speech perception abilities, and using the Speech,Spatial,and Other Qualities of Hearing Scale for Parents (SSQ-P) questionnaires to evaluate their speech perception and spatial hearing abilities. SPSS 23.0 was used for the statistical analysis. Results: All children performed better at 6 months and 12 months post-implant with IT-MAIS/MAIS, MESP than pre-implant, and the scoring rate continued to improve, with a significant difference (P<0.01). For the SSQ-P (Speech) and SSQ-P (Spatial) scores, the mean scores of pre-implant were (0.9±0.2) points and (0.8±0.3) points, those of 6 months post-implant were (4.6±0.2) and (2.6±0.3), and 12 months post-implant were (6.2±0.2) and (6.3±0.3), the scores of the two groups were significantly different at pre-implant, 6 months and 12 months post-implant (P<0.01). The growth rate of SSQ-P (Spatial) from pre-implant to 12 months post-implant was 675.3%, and the growth rate from 6 months post-implant to 12 months post-implant was 140.6%, the growth rate showed an significant increase compared with IT-MAIS/MAIS, MESP and SSQ-P (Speech).SSQ-P (Speech) and SSQ-P (Spatial) scores were moderate correlation at 12 months post-implant(r=0.465, P=0.008). Conclusions: Within one year after cochlear implantation, listening, speech perception and spatial hearing abilities of preschool prelingual deaf children could show a comprehensive, continuous and significant progress as the implantation time increasing. The growth rate of spatial hearing is greater than that of speech perception at 12 months post-implant, and the spatial hearing could still show rapid development characteristics after 6 months post-implant.