Percepção auditiva e desenvolvimento de linguagem oral após cirurgia de implante auditivo de tronco encefálico: uma revisão de escopo / Auditory perception and oral language in brainstem auditory implant users: a scoping review

RESUMO Objetivo mapear as evidências atuais em relação à percepção auditiva da fala e desenvolvimento de linguagem oral em usuários de implante auditivo de tronco encefálico (auditory brainstem implant - ABI), para responder à seguinte questão norteadora: "O que se sabe sobre a habilidade de percepção auditiva da fala e de linguagem oral em indivíduos usuários de implante auditivo de tronco encefálico?" Estratégia de pesquisa a busca foi realizada nas bases de dados BVSalud, PubMed e SciELO e, para literatura cinzenta, utilizou-se a fonte de informação Google Acadêmico, por meio dos descritores: implante auditivo de tronco encefálico (auditory brainstem implantation), linguagem (language), audição (hearing) e percepção auditiva (auditory perception). Critérios de seleção foram incluídos estudos nos quais foram aplicados testes para avalição da percepção auditiva ou para verificar desenvolvimento de linguagem oral em crianças e/ou adultos usuários de ABI. Foram incluídos artigos publicados nos últimos cinco anos e excluídos estudos secundários. Resultados Foram encontrados 1767 artigos nas bases de dados e fonte de informação, dos quais, 27 foram incluídos na revisão. Observou-se que a maioria dos usuários de ABI torna-se capaz de perceber alguns sons ambientais, alguns tornam-se capazes de reconhecer vocábulos, porém, poucos atingem o reconhecimento de frases. Conclusão a maioria dos usuários de ABI não avança para a habilidade de reconhecimento auditivo em conjunto aberto e há unanimidade na recomendação de métodos de comunicação visual para esses indivíduos.

ABSTRACT Purpose This scope review aims to map current evidence in relation to auditory perception of speech and oral language development in users of Auditory Brainstem Implant - ABI, to answer the following guiding question: "what do we know about the ability of auditory perception of speech and oral language in auditory brainstem implants users?" Research strategy The search was performed in the BVSalud, PubMed and SciELO databases and for gray literature the source of information Google Academic, using the descriptors: auditory brainstem implantation , language, hearing and auditory perception. Selection criteria Studies were included in which tests were applied to assess auditory perception or to verify oral language development in children and/or adults using ABI. Articles published in the last five years were included and secondary studies were excluded. Results 1767 articles were found in the databases and source of information, of which 27 studies were included. It was observed that most users of ABI become able to perceive some environmental sounds, some become able to recognize words, but few reach the recognition of sentences. Conclusion Most ABI users do not advance towards the open set auditory recognition skill and there is unanimity in recommending visual communication methods for these individuals.

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

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

A Case of Cochlear Implantation in Neurofibromatosis Type II / 대한이비인후과학회지

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

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

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

Implante auditivo de tronco encefálico: revisão de literatura / Auditory brainstem implant: a review

OBJETIVO: pesquisar aspectos relevantes sobre implante auditivo de tronco encefálico como conceito, finalidade, métodos de implantação, indicações do procedimento e benefícios. MÉTODOS: realizou-se compilação dos trabalhos disponíveis nas bases de dados LILACS, MEDLINE e SCIELO utilizando os descritores: implante auditivo de tronco encefálico, reabilitação de deficientes auditivos, perda auditiva neurossensorial, procedimentos cirúrgicos otológicos. RESULTADOS: o implante auditivo de tronco encefálico é semelhante ao implante coclear, exceto pela configuração do eletrodo que é projetado para ser colocado no complexo do núcleo coclear, no tronco encefálico. Originalmente foi desenvolvido para restaurar a audição em pacientes com ausência ou lesão no nervo coclear. Hoje é indicado para pacientes que por motivos anatômicos ou funcionais não podem receber estímulos elétricos pela orelha interna, como em casos de malformação/ausência de nervo coclear, ossificação coclear e neuropatia auditiva. Os efeitos relatados são: restabelecimento da audição em pacientes com perda auditiva total, níveis de detecção e discriminação dos sons similares às obtidas com implante coclear e acesso a sons ambientais e da fala. CONCLUSÃO: o implante auditivo de tronco encefálico proporciona o restabelecimento da sensação auditiva em sujeitos não beneficiados pelo uso de próteses auditivas e implante coclear. A quase totalidade dos pacientes implantados obteve algum benefício na comunicação.

PURPOSE: to study important aspects about auditory brainstem implant, such as concept, purpose, methods of implantation, indication of the procedure and benefits. METHODS: a compilation was carried out of the available works in LILACS, MEDLINE and SCIELO databases, using the descriptors: auditory brainstem implantation, rehabilitation of hearing impaired, sensorineural hearing loss, otologic surgical procedures. RESULTS: the auditory brainstem implant is similar to cochlear Implant, except for the configuration of the electrode that is designed to be placed in the cochlear nucleus complex, at the brain stem. It was developed originally to restore the hearing in patients with absence of or injury in the cochlear nerve. Today it is indicated for patients who for anatomical or functional reasons can not receive electric stimulations by the inner ear, as in cases of malformation/absence of cochlear nerve, ossified cochleae, and auditory neuropathy. The effects showed are hearing recovery in patients with total hearing loss, levels of detection obtained discrimination of sounds similar to those obtained with cochlear Implant and access to environmental and speech sounds. CONCLUSIONS: the auditory brainstem implant provides hearing recovery in subjects that are not benefited by the use of hearing aids and cochlear Implant. Almost the totality of the implanted patients got some communication benefit.

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

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

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

Implante auditivo de tronco cerebral en el tratamiento de la hipoacusia sensorio neural: [revisión] / Auditory brainstem implant in the treatment of sensoneural hypoacousia: [review]

Los Implantes Auditivos de Tronco Cerebral (IATC) estimulan directamente el núcleo coclear en el tronco encefálico y fueron creados para las personas con neurofibromatosis tipo 2 (NF2). La correcta colocación del IATC es comprobada en forma intraoperatoria con los potenciales evocados de troncoencéfalo (EABR). El desempeño observado con el IATC no es tan bueno como el obtenido con un implante coclear pero se ha observado que sirven como ayuda para la lectura de labios. Los primeros resultados son promisorios e incluye, en algunos de los pacientes implantados, cierta habilidad en las pruebas de formato abierto. Actualmente se continúa investigando para mejorar su desempeño.