Vestibular implant: does it really work? A systematic review / Implante vestibular: ele realmente funciona? Uma revisão sistemática

Abstract Introduction: People with vestibular loss present a deficit in the vestibular system, which is primarily responsible for promoting postural control, gaze stabilization, and spatial orientation while the head moves. There is no effective treatment for a bilateral loss of vestibular function. Recently, a vestibular implant was developed for people with bilateral loss of vestibular function to improve this function and, consequently, the quality of life of these patients. Objective: To identify in the scientific literature evidence that vestibular implants in people with vestibular deficit improves vestibular function. Methods: One hundred and forty six articles were found from five databases and 323 articles from the gray literature mentioning the relationship between vestibular implant and vestibular function in humans. The PICOS strategy (Population, Intervention, Comparison and Outcome) 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 according to the bias risk assessment of the Joanna Briggs Institute through the critical assessment checklist Joanna Briggs institute for quasi-experimental studies and the Joanna Briggs institute critical assessment checklist for case reports. Results: Of the 21 articles included in reading the full text, 10 studies were selected for the qualitative analysis in the present systematic review. All ten articles analyzed through the critical assessment checklist Joanna Briggs institute showed a low risk of bias. The total number of samples in the evaluated articles was 18 patients with vestibular implants. Conclusions: Taken together, these findings support the feasibility of vestibular implant for restoration of the vestibulo-ocular reflex in a broad frequency range and illustrate new challenges for the development of this technology.

Resumo Introdução: Pessoas com perda vestibular apresentam um déficit no sistema vestibular, o qual é o principal responsável pelo controle postural, pela estabilização do olhar e orientação espacial enquanto a cabeça se movimenta. Não há tratamento efetivo para uma perda vestibular bilateral. Recentemente, foi desenvolvido um implante vestibular para pessoas com perda vestibular bilateral para melhorar essa função e, consequentemente, a qualidade de vida desses pacientes. Objetivo: Identificar na literatura científica evidências de que o implante vestibular melhora a função vestibular de pessoas com déficit vestibular. Método: Cento e quarenta e seis artigos foram encontrados em cinco bases de dados e 323 arti-gos da literatura cinzenta, mencionando a relação entre implante vestibular e função vestibular em humanos. A estratégia PICOS (População, Intervenção, Comparação e Desfechos) foi uti-lizada para definir os critérios de elegibilidade. Os estudos que preencheram os critérios de inclusão para esta segunda etapa foram incluídos em uma síntese qualitativa, e cada tipo de estudo foi analisado de acordo com a avaliação de risco de viés do Joanna Briggs Institute através da critical appraisal checklist for quasi-experimental studies e da critical appraisa lchecklist for case reports. Resultados: Dos 21 artigos incluídos cujos textos completos foram lidos, 10 foram selecionados para a análise qualitativa na presente revisão sistemática. Todos os dez artigos analisados ??através da critical appraisal checklist mostraram um baixo risco de viés. O número total de amostras nos artigos avaliados foi de 18 pacientes com implantes vestibulares. Conclusões: Em conjunto, esses achados apoiam a viabilidade do implante vestibular para a restauração do reflexo vestíbulo-ocular em uma ampla faixa de frequências e ilustram novos desafios para o desenvolvimento desta tecnologia.

Minimally Invasive Surgery for Intracochlear Schwannoma Removal and Simultaneous Cochlear Implantation

Abstract Introduction Hearing preservation has not yet been reported in patients undergoing resection of intracochlear schwannomas. This study describes a minimally invasive procedure for intracochlear schwannoma resection with simultaneous cochlear implantation that resulted in good hearing. Objective This study aims to describe a minimally invasive procedure for intracochlear schwannoma resection with simultaneous cochlear implantation. Data Synthesis The technique described in this study was developed for a 55-year-old male with a 20-year history of bilateral progressive hearing loss and tinnitus that had a mass in the left apical turn of the cochleameasuring 0.3 cm. Surgery accessed the apical turn of the cochlea. We performed mastoidectomy and posterior tympanotomy and removed incus and tensor tympani muscle to expose the cochlear apex. The tumor was identified and completely resected. After the cochleawas anatomically preserved, it was implanted with a straight electrode via round window insertion. The histopathological examination confirmed intracochlear schwannoma. Speech perception test revealed 100% speech recognition with closed sentences and the average audiometric threshold (500 to 2000 Hz) was 23 dB. Conclusion Our technique led to rehabilitation of the patient and improved hearing without damaging the intracochlear structure, making it possible to perform CI in the same procedure with good results.

Evaluation of Functional Outcomes after Stapes Surgery in Patients with Clinical Otosclerosis in a Teaching Institution

Introduction Otosclerosis is a primary disease of the temporal bone that leads to stapes ankylosis. Hearing loss is the main symptom. Treatment includes surgery, medical treatment, and sound amplification therapy alone or in combination. Objective To evaluate the functional outcomes of patients with clinical diagnosis of otosclerosis undergoing primary stapes surgery in a teaching institution. Method Retrospective descriptive study. Results A total of 210 ears of 163 patients underwent stapes surgery. Of the 163 patients, 116 (71.2%) underwent unilateral surgery and 47 (28.8%) underwent bilateral surgery. Six of the 210 operated ears had obliterative otosclerosis. The average preoperative and postoperative air-bone gap was 32.06 and 4.39 dB, respectively. The mean preoperative and postoperative bone conduction threshold was 23.17 and 19.82 dB, respectively. A total of 184 (87.6%) ears had a residual air-bone gap <10 dB, and 196 (93.3%) had a residual air-bone gap ±15 dB. Two patients (0.95%) had severe sensorineural hearing loss. Conclusion Stapes surgery showed excellent functional hearing outcomes in this study. This surgerymay be performed in educational institutions with the supervision of experienced surgeons.

Contribution of audiovestibular tests to the topographic diagnosis of sudden deafness

Sudden hearing loss (SHL) is an ENT emergency defined as sensorineural hearing loss (SNHL) > 30 dB HL affecting at least 3 consecutive tonal frequencies, showing a sudden onset, and occurring within 3 days. In cases of SHL, a detailed investigation should be performed in order to determine the etiology and provide the best treatment. Otoacoustic emission (OAE) analysis, electronystagmography (ENG), bithermal caloric test (BCT), and vestibular evoked myogenic potential (VEMP) assessments may be used in addition to a number of auxiliary methods to determine the topographic diagnosis. OBJECTIVE: To evaluate the contribution of OAE analysis, BCT, VEMP assessment, and magnetic resonance imaging (MRI) to the topographic diagnosis of SHL. METHOD: Cross-sectional and retrospective studies of 21 patients with SHL, as defined above, were performed. The patients underwent the following exams: audiometry, tympanometry, OAE analysis, BCT, VEMP assessment, and MRI. Sex, affected side, degree of hearing loss, and cochleovestibular test results were described and correlated with MRI findings. Student's t-test was used for analysis of qualitative variables (p < 0.05). RESULTS: The mean age of the 21 patients assessed was 52.5 ± 15.3 years; 13 (61.9%) were women and 8 (38.1%) were men. Most (55%) had severe hearing loss. MRI changes were found in 20% of the cases. When the audiovestibular test results were added to the MRI findings, the topographic SHL diagnosis rate increased from 20% to 45%. CONCLUSION: Only combined analysis via several examinations provides a precise topographic diagnosis. Isolated data do not provide sufficient evidence to establish the extent of involvement and, hence, a possible etiology...

Middle ear adenoma with neuroendocrine differentiation: relate of two cases and literature review

Adenomas with neuroendocrine differentiation are defined as neuroendocrine neoplasms, and they are rarely found in the head and neck. OBJECTIVE: To describe two cases of a middle ear adenoma with neuroendocrine differentiation, with a literature review. CASE REPORT: Patient 1 was a 41-year-old woman who presented with a 3-year history of left aural fullness associated with ipsilateral "hammer beating" tinnitus. Patient 2 was a 41-year-old male who presented with unilateral conductive hearing loss. CONCLUSION: Adenoma with neuroendocrine differentiation of the middle ear is a rare entity, but it should be considered in patients with tinnitus, aural fullness, and a retrotympanic mass and remembered as a diferential diagnosis of tympanic paraganglioma...