Como a judicialização da cirurgia de implante coclear impacta o Sistema Único de Saúde / How the judicialization of cochlear implant surgery impacts the Unified Health System

RESUMO Objetivo Descrever o impacto da judicialização na realização da cirurgia de implante coclear no Sistema Único de Saúde do Brasil, incluindo o serviço público e a saúde suplementar. Métodos Foi realizado um levantamento documental de acórdãos de todos os tribunais nacionais e a jurisprudência dominante, voltados à cirurgia do implante coclear no Sistema Único de Saúde, no período de 2007 a 2019, por meio da Plataforma Jusbrasil, utilizando o termo "implante coclear" para realização da busca. Também foi realizado um levantamento na plataforma DATASUS (Departamento de Informação do Sistema Único de Saúde) sobre quantos procedimentos de implante coclear unilateral e bilateral foram realizados no mesmo período. Resultados De acordo com o DATASUS, no período de 2008 a 2019 foram realizados 8.857 procedimentos de cirurgia de implante coclear pelos entes públicos ou pelas operadoras dos planos de saúde no país. Com relação à judicialização para solicitação da cirurgia do implante coclear, unilateral ou bilateral, foram encontrados 216 processos, representando 2,43% dos casos. Conclusão A judicialização da saúde, quando se considera a cirurgia do implante coclear, tem representado uma parcela mínima dos casos, o que demonstra baixo impacto no orçamento público e não tem expressiva ação na organização do Sistema Único de Saúde.

ABSTRACT Purpose To describe the impact of Judicialization on the performance of Cochlear Implant (CI) surgery in the Brazilian Unified Health System (SUS), including the public service and supplementary health. Methods A documentary survey of judgments of all National Courts and the Dominant Jurisprudence focused on CI surgery in the SUS from 2007 to 2019 was carried out through the Jusbrasil Platform using the term "cochlear implant" to carry out the search. A survey was also carried out on the DATASUS platform on how many uni and bilateral CI procedures were performed in the same period. Results According to DATASUS, from 2008 to 2019, 8,857 CI surgery procedures were performed by Public Entities or Health Plan Operators in the country. With regard to Judicialization, for requesting unilateral or bilateral CI surgery, a total of 216 processes were found, representing a total of 2.43% of Judicialization of Cochlear Implant (CI) surgery. Conclusion In view of the data, it is possible to perceive that the Judicialization of Health when we consider the CI surgery has represented a small portion of the cases, which does not demonstrate a large impact on the public budget and does not have an impact on the organization of the SUS.

Tecnologia auditiva assistiva em usuários de implante coclear em ambientes reverberantes com múltiplas fontes de ruído / Assistive listening technology in cochlear implant users in reverberant environments with multiple noise sources

RESUMO Objetivo Avaliar a contribuição da tecnologia de escuta assistida em usuários de implante coclear (IC) em situações de reverberação e ruído. Métodos Estudo transversal prospectivo aprovado pelo Comitê de Ética Institucional (CAAE 8 3031418.4.0000.0068). Foram selecionados adolescentes e adultos usuários de IC com surdez pré ou pós-lingual. Para usuários bilaterais, cada orelha foi avaliada separadamente. O reconhecimento de fala foi avaliado por meio de listas gravadas de palavras dissílabas apresentadas a 65 dBA a 0° azimute com e sem o Mini Microfone2 (Cochlear™) conectado ao processador de fala Nucleus®6. A reverberação da sala foi medida como 550 ms. Para avaliar a contribuição do dispositivo de escuta assistida (DEA) em ambiente reverberante, o reconhecimento de fala foi avaliado no silêncio. Para avaliar a contribuição do DEA em reverberação e ruído, o reconhecimento de fala foi apresentado a 0° azimute com o ruído proveniente de 8 alto-falantes dispostos simetricamente a 2 metros de distância do centro com ruído de múltiplos falantes usando relação sinal-ruído de +10dB. Para evitar viés de aprendizado ou fadiga, a ordem dos testes foi randomizada. A comparação das médias foi analisada pelo teste t para amostras pareadas, adotando-se nível de significância de p<0,005. Resultados Dezessete pacientes com idade média de 40 anos foram convidados e concordaram em participar, sendo 2 participantes bilaterais, totalizando 19 orelhas. Houve contribuição positiva significante do Mini Mic2 na reverberação e ruído+reverberação (p<0,001). Conclusão DEA foi capaz de melhorar o reconhecimento de fala de usuários de IC tanto em situações de reverberação quanto ruidosas.

ABSTRACT Purpose This study aimed to evaluate the contribution of assistive listening technology with wireless connectivity in cochlear implant (CI) users in reverberating and noise situations. Methods Prospective cross-sectional study approved by the Institutional Ethics Committee (CAAE 8 3031418.4.0000.0068). Adolescents and adults CI users with pre- or post-lingual deafness were selected. For bilateral users, each ear was assessed separately. Speech recognition was assessed using recorded lists of disyllabic words presented at 65 dBA at 0° azimuth with and without the Wireless Mini Microphone 2 (Cochlear™) connected to the Nucleus®6 speech processor. Room reverberation was measured as 550 ms. To assess the contribution of the assistive listening device (ALD) in a reverberating environment, speech recognition was assessed in quiet. To assess the contribution of the ALD in reverberation and noise, speech recognition was presented at 0° azimuth along with the noise coming from 8 loudspeakers symmetrically arranged 2 meters away from the center with multi-talker babble noise using signal to noise ratio of +10dB. To avoid learning bias or fatigue, the order of the tests was randomized. Comparison of means was analyzed by t test for paired samples, adopting significance level of p <0.005. Results Seventeen patients with a mean age of 40 years were invited and agreed to participate, with 2 bilateral participants, totaling 19 ears assessed. There was a significant positive contribution from the Mini Mic2 in reverberation, and noise+reverberation (p <0.001). Conclusion ALD was able to improve speech recognition of CI users in both reverberation and noisy situations.

Sinaptopatia coclear e perda auditiva oculta: uma revisão de escopo / Cochlear synaptopathy and hidden hearing loss: a scoping review

RESUMO Objetivo Identificar as definições fisiopatológicas adotadas pelos estudos que investigaram a "sinaptopatia coclear" (SC) e "perda auditiva oculta" (PAO). Estratégia de pesquisa Utilizou-se a combinação de unitermos "Auditory Synaptopathy" or "Neuronal Synaptopathy" or "Hidden Hearing Loss" com "etiology" or "causality" or "diagnosis" nas bases de dados EMBASE, Pubmed (MEDLINE), CINAHL (EBSCO) e Web of Science. Critérios de seleção Incluiu-se estudos que investigaram a SC ou PAO em humanos com procedimentos comportamentais e/ou eletrofisiológicos. Análise dos dados Realizou-se a análise e extração de dados quanto a terminologia, definição e população estudada. Resultados Foram incluídos 49 artigos. Destes, 61,2% utilizaram a terminologia SC, 34,7% ambos os termos e 4,1% utilizaram PAO. As condições mais estudadas foram exposição ao ruído e zumbido. Conclusão A terminologia SC foi empregada na maioria dos estudos, com referência ao processo fisiopatológico de desaferenciação entre as fibras do nervo coclear e as células ciliadas internas

ABSTRACT Purpose To identify the pathophysiological definitions adopted by studies investigating "cochlear synaptopathy" (CS) and "hidden hearing loss" (HHL). Research strategies The combination of keywords "Auditory Synaptopathy" or "Neuronal Synaptopathy" or "Hidden Hearing Loss" with "etiology" or "causality" or "diagnosis" was used in the databases EMBASE, Pubmed (MEDLINE), CINAHL (EBSCO), and Web of Science. Selection criteria Studies that investigated CS or HHL in humans using behavioral and/or electrophysiological procedures were included. Data analysis Data analysis and extraction were performed with regard to terminology, definitions, and population. Results 49 articles were included. Of these, 61.2% used the CS terminology, 34.7% used both terms, and 4.1% used HHL. The most-studied conditions were exposure to noise and tinnitus. Conclusion CS terminology was used in most studies, referring to the pathophysiological process of deafferentiation between the cochlear nerve fibers and inner hair cells.

Hearing Performance in Cochlear Implant Users Who Have Facial Nerve Stimulation

Abstract Introduction Facial nerve stimulation (FNS) is a complication in cochlear implant (CI) when the electrical current escapes from the cochlea to the nearby facial nerve. Different management to reduce its effects are available, although changes might result in a less-than-ideal fitting for the CI user, eventually reducing speech perception. Objective To verify the etiologies that cause FNS, to identify strategies in managing FNS, and to evaluate speech recognition in patients who present FNS. Methods Retrospective study approved by the Ethical Board of the Institution. From the files of a CI group, patients who were identified with FNS either during surgery or at any time postoperatively were selected. Data collection included: CI manufacturer, electrode array type, age at implantation, etiology of hearing loss, FNS identification date, number of electrodes that generated FNS, FNS management actions, and speech recognition in quiet and in noise. Results Data were collected from 7 children and 25 adults. Etiologies that cause FNS were cochlear malformation, head trauma, meningitis, and otosclerosis; the main actions included decrease in the stimulation levels followed by the deactivation of electrodes. Average speech recognition in quiet before FNS was 86% and 80% after in patients who were able to accomplish the test. However, there was great variability, ranging from 0% in quiet to 90% of speech recognition in noise. Conclusion Etiologies that cause FNS are related to cochlear morphology alterations. Facial nerve stimulation can be solved using speech processor programming parameters; however, it is not possible to predict outcomes, since results depend on other variables.

Cochlear Implant Activation in the Immediate Postoperative Period in the Operating Room

Abstract Introduction Cochlear implant (CI) activation usually takes place at ∼ 30 days postoperative (PO). In our service, CI surgery is performed with local anesthesia and sedation, so activation is possible with the patient's cooperation, immediately after the CI surgery, still in the operating room (OR). Objective The objective of the present study was to provide the patient with hearing experience with the CI and to assess auditory perception immediately after surgery while still in the OR, as well as to compare impedance telemetry (IT), neural response telemetry (NRT), and comfort (C) level at two moments: in the OR and at the definitive activation, ∼ 30 days PO. Methods Nine adult patients (12 ears) with acquired (postlingual) deafness were included. Auditory perception was evaluated through the Ling Six Sound Check, musical instruments, and clapping, presented in two different programming maps, elaborated using t-NRT, and comparing IT, NRT, and C level between the two moments. Results We observed that while still in the OR, the patient can already present auditory detection and recognition responses. The values of IT, NRT threshold (t-NRT), and C on both dates differed, with statistical significance. Conclusion We concluded that it is possible to provide the patient with an auditory experience with the CI immediately after surgery, and that the auditory experience and the values of electrode IT, NRT, and C vary significantly between the two moments.

Late Bilateral Sequential Cochlear Implant and Quality of Life

Abstract Introduction Hearing impairment is one of the main disorders that can interfere with the development of speech and language. In an individual, it can cause significant communication difficulties, social isolation, negative feelings, and depressive disorders. The hearing aids (HAs) and cochlear implant (CI) are options for profound and severe hearing loss, and the CI can be indicated for individuals who do not obtain benefits from HAs. Objective To evaluate the quality of life of individuals who underwent sequential bilateral CIs with a long surgical interval between procedures. Methods Fifteen patients, aged 8 to 70 years old, who underwent sequential bilateral CI, with an interval ≥ 4 years between surgeries, were evaluated. Quality of life was evaluated using three questionnaires: WHOQOL-BREF, SSQ-12 and HHIA in Portuguese. Results The WHOQOL-BREF questionnaire showed that the study participants had a good quality of life in all domains assessed. According to the SSQ-12, few reported inability to listen in communication situations. Most individuals were classified as having medium disability by the HHIA, but the social and emotional effects did not significantly affect the quality of life. Conclusion The use of questionnaires to assess the quality of life of patients with hearing impairment is a valuable tool to measure adaptation to CI. Patients undergoing bilateral sequential CI, even with a long interval between procedures, presented high indices of quality of life.

Guia para a elaboração de relatórios fonoaudiológicos de crianças implantadas: opinião de especialistas / Guide to the preparation of speech reports for implanted children: opinion of specialists

RESUMO Objetivo Desenvolver guia para elaboração de relatórios fonoaudiológicos de crianças implantadas para serem compartilhados entre fonoaudiólogos dos serviços de implante coclear (IC) e reabilitadores. Método O método Delphi foi utilizado para selecionar os itens relevantes e fundamentais que deveriam constar nas duas versões propostas para compor o guia: Guia 1 - Relatórios fonoaudiológicos fornecidos pelo serviço de IC aos reabilitadores, e Guia 2 - Relatórios fonoaudiológicos fornecidos pelos reabilitadores aos serviços de IC. Vinte e um fonoaudiólogos especialistas e com experiência na área de implante coclear e de reabilitação auditiva participaram da discussão e do julgamento dos itens durante as rodadas de seleção. Considerou-se consenso quando o item obteve a concordância igual ou superior a 80% entre os participantes, sendo selecionados para comporem os dois guias. Resultados Após as duas rodadas, 21 itens do Guia 1 obtiveram consenso entre os terapeutas, ou seja, mais de 80% deles concordaram que estes itens deveriam estar presentes no relatório enviado pelo serviço de IC. Para o Guia 2, 22 itens analisados pelos fonoaudiólogos atuantes em serviços de IC setor pós-operatório, foram selecionados na segunda rodada. Conclusão A partir da análise das duas rodadas, foi desenvolvido o "Guia para a elaboração de relatórios fonoaudiológicos: intersecção entre serviço de IC e reabilitadores". Este material pode ser aplicado na rotina de acompanhamento de crianças implantadas, padronizando as informações compartilhadas sobre o dispositivo eletrônico, resultados de avaliações, monitoramento dos resultados e processo terapêutico dessa população.

ABSTRACT Purpose To develop a guide for the preparation of speech-language reports of implanted children to be shared among speech-language pathologists of cochlear implant (CI) services and rehabilitation professionals. Methods The Delphi method was used to select the relevant and fundamental items that should be included in the two versions proposed for the guide: Guide 1 - Speech-language reports provided by the CI services to rehabilitators, and Guide 2 - Speech-language reports provided by the rehabilitators to CI services. Twenty-one speech therapists specialized and with experience in cochlear implants and auditory rehabilitation participated in the discussion and judgment of the items during the selection rounds. Consensus was considered when the item reached agreement equal to or greater than 80% among participants, being selected to compose the two guides. Results After the two rounds, 21 items from Guide 1 reached consensus among therapists, that is, more than 80% of them agreed that these items should be present in the report sent by the CI service. For Guide 2, 22 items analyzed by speech therapists working in CI services in the postoperative sector were selected in the second round. Conclusion Based on the analysis of the two rounds, the "Guide for the preparation of speech-language pathology reports: intersection between CI service and rehabilitators" was developed. This material can be applied in the follow-up of implanted children, standardizing the information shared about the electronic device, evaluation results, monitoring of results and therapeutic process of this population.

Análise do conhecimento de fonoaudiólogos brasileiros sobre a bateria Evaluation of Auditory Responses to Speech / Analysis of knowledge by Brazilian speech therapists about the battery Evaluation of Auditory Responses to Speech / Análisis del conocimiento de logopedas brasileños sobre la batería de Evaluation of Auditory Responses to Speech

Introdução: O avanço das tecnologias auditivas tem ajudado crianças com deficiência auditiva a ouvir, mas é necessário acompanhar o desenvolvimento das habilidades auditivas e de linguagem oral. Objetivo: O objetivo deste artigo é analisar o conhecimento de fonoaudiólogos brasileiros sobre a bateria EARS, que apresenta nove protocolos de avaliação do desenvolvimento das habilidades auditivas e de linguagem oral. Método: Trata-se de um estudo quantitativo e qualitativo, transversal descritivo. A coleta de dados foi realizada por meio do formulário Google Forms em ambiente digital. O questionário foi composto por 13 questões, sendo quatro sobre o perfil do profissional e nove sobre seu conhecimento e/ou uso de protocolos dos propostos pela bateria EARS. Responderam a este estudo 67 participantes. Resultados: Desse total, 70% atuam diretamente na terapia fonoaudiológica, 41% atendem tanto em serviço privado como público. 97% consideram importante o uso de protocolos de avaliação e monitoramento das habilidades auditivas e de linguagem oral e 92% sentem falta de protocolos validados. Com relação ao uso dos protocolos da bateria EARS, constatou-se que os mais comuns são o MUSS, o MAIS, o GASP e o MTP. Conclusão: Os testes que os fonoaudiólogos brasileiros mais adotam são o MUSS, o MAIS, o GASP e o MPT. A maioria usa mais de um protocolo na avaliação, no monitoramento e mesmo na reabilitação. No entanto, nota-se que ainda há carência de protocolos validados para contemplar as etapas de desenvolvimento das habilidades auditivas e de linguagem oral de crianças com deficiência auditiva. AU)

Introduction: The advancement of hearing technologies has helped hearing-impaired children to hear, but it is necessary to monitor the development of hearing and oral language skills. Objective: The objective of this article is to analyze the knowledge of Brazilian speech therapists about the EARS battery, which presents nine protocols for evaluating the development of auditory and oral language skills. Method: This is a quantitative and qualitative, cross-sectional, descriptive study. Data collection was carried out using the Google Forms in a digital environment. The questionnaire consisted of 13 questions, four about the professional's profile and nine about their knowledge and/or use of protocols proposed by the EARS battery. 67 participants responded to this study. Results: Of this total, 70% work directly in speech therapy, 41% work in both private and public services. 97% consider it important to use protocols for evaluating and monitoring auditory and oral language skills and 92% feel that validated protocols are lacking. Regarding the use of EARS battery protocols, it was found that the most common are MUSS, MAIS, GASP and MTP. Conclusion: The tests that Brazilian speech therapists most adopt are the MUSS, MAIS, GASP and MPT. Most use more than one protocol in assessment, monitoring and even rehabilitation. However, it is noted that there is still a lack of validated protocols to cover the stages of development of auditory and oral language skills in children with hearing impairment. (AU)

Introducción: Los avances tecnológicos relacionados con las tecnologías auditivas han ayudado a los niños con pérdida auditiva a oier mejor, sin embargo es necesario monitorear el desarrollo de las habilidades auditivas y del lenguaje oral. Objetivo: Este artículo trata de un análisis del conocimiento de los fonoaudiólogos brasileños sobre la Batería EARS, que presenta nueve protocolos para evaluar el desarrollo de las habilidades auditivas y la percepción del habla en niños con pérdida auditiva que utilizan dispositivos de amplificación de sonido e implantes cocleares. Método: Se trata de un estudio transversal descriptivo cuantitativo y cualitativo. La recojida de datos se realizó mediante el formulario Google Forms en un entorno digital. El cuestionario constaba de 13 preguntas, siendo cuatro de libre elección y relacionadas con el perfil del profesional y nueve relacionadas con el uso de protocolos y el conocimiento y/o el uso de protocolos propuestos por la Batería EARS. En este estudio participaron 67 encuestados. Resultados: De este total el 70% actuan directamente en terapia fonoaudiologica y el 41 % atienden tanto en el servicio público como privado. El 97% consideran importante el uso de protocolos de evaluación y seguimiento de las habilidades auditivas y del lenguage oral y el 92% afirman que faltan protocolos válidos. Con relación al uso de los protocolos de bateria EARS, se llegó a la conclusión que los más usuales son el MUSS, el MAIS, el GASP y el MTP. Conclusión: Las pruebas más utilizadas por los fonoaudiólogos brasileños son MUSS, MAIS y GASP y MTP. La gran mayoria utiliza mas de un protocolo en la evaluación y seguimiento y en la rabilitación, sin embargo se nota que faltan protocolos. (AU)

Self-Reported Voice-Related Quality of Life in Cochlear Implant Users

Objective: The aim of this study was to identify if cochlear implant (CI) users are perceiving a decrease in life quality due to voice problems. This study evaluated 43 CI user's perception of their voice and how it affects their quality of life through a survey. Approach: Forty-three CI users responded to a survey regarding their demographics, details about their CI, the Hearing Health Quick Test (HHQT), the Voice Related Quality of Life (V-RQOL), and the Voice Handicap Index-10 (VHI-10). The survey responses were analyzed using univariate linear regression analysis. Results: Few of the CI users scored below the cut off for normal voice related quality of life. CI users averaged 93.4 out of 100 on the V-RQOL and only four scored abnormally for the VHI-10. Lower scores on the V-RQOL were correlated with the participants having an associate degree and with participants visiting friends, family, and neighbors less often due to hearing loss. The VHI-10 scores were correlated with gender, education levels, difficulty in social situations due to hearing loss, noise exposure, and tinnitus. Limitations of the study: The small n was the primary limitation of this study. Originality: This study was one of the first to examine the voice-related quality of life in CI users. Conclusions: Overall, respondents did not perceive much voice-related difficulty. However, they were more likely to perceive voice-related difficulty if they experienced difficulty hearing in noise and avoided social situations due to hearing loss.

Objetivo: Este estudio identificó si los usuarios de implantes cocleares (IC) están percibiendo una disminución en la calidad de su vida debido a problemas de voz. Además, evaluó la percepción de la voz de 43 usuarios de IC y cómo afecta su calidad de vida a través de una encuesta. Enfoque: Cuarenta y tres usuarios de IC respondieron a una encuesta sobre su demografía, detalles sobre su IC, la Hearing Health Quick Test (HHQT), la Voice Related Quality of Life (V-RQOL) y el Voice Handicap Index-10 (VHI-10). Las respuestas de la encuesta se analizaron mediante un análisis de regresión lineal univariado. Resultados: Pocos usuarios de IC puntuaron por debajo del límite para calidad de vida relacionada con la voz. El promedio V-RQOL fue de 93,4/100; solo 4 participantes tuvieron puntuación anormal en VHI-10. Las bajas puntuaciones en V-RQOL se correlacionaron con título de asociado y menos visitas por pérdida auditiva; las puntuaciones VHI-10, con sexo, educación, dificultad en situaciones sociales, exposición al ruido y tinnitus. Limitaciones del estudio: La pequeña n fue la principal limitación de este estudio. Originalidad: Este estudio fue uno de los primeros en examinar la calidad de vida relacionada con la voz en usuarios de CI. Conclusiones: En general, los encuestados no percibieron mucha dificultad relacionada con la voz. Sin embargo, era más probable que percibieran dificultades relacionadas con la voz si tenían dificultades para oír en ruido y evitaban situaciones sociales debido a la pérdida auditiva.

The P300 Auditory Evoked Potential in Cochlear Implant Users: A Scoping Review

Abstract Introduction The P300 auditory evoked potential is a long-latency cortical potential evoked with auditory stimulation, which provides information on neural mechanisms underlying the central auditory processing. Objectives To identify and gather scientific evidence regarding the P300 in adult cochlear implant (CI) users. Data Synthesis A total of 87 articles, 20 of which were selected for this study, were identified and exported to the Rayyan search software. Those 20 articles did not propose a homogeneous methodology, which made comparison more difficult. Most articles (60%) in this review compare CI users with typical hearing people, showing prolonged P300 latency in CI users. Among the studies, 35% show that CI users present a smaller P300 amplitude. Another variable is the influence of the kind of stimulus used to elicit P300, which was prolonged in 30% of the studies that used pure tone stimuli, 10% of the studies that used pure tone and speech stimuli, and 60% of the studies that used speech stimuli. Conclusion This review has contributed with evidence that shows the importance of applying a controlled P300 protocol to diagnose and monitor CI users. Regardless of the stimuli used to elicit P300, we noticed a pattern in the increase in latency and decrease in amplitude in CI users. The user's experience with the CI speech processor over time and the speech test results seem to be related to the P300 latency and amplitude measurements.

Multidisciplinary Cognitive Function Assessment of Good versus Poor Performance in Children with Cochlear Implants: An Observational Cross-Sectional Study

Abstract Introduction Despite the developing technology of cochlear implants (CIs), implanted prelingual hearing-impaired children exhibit variable speech processing outcomes. When these children match in personal and implant-related criteria, the CI outcome variability could be related to higher-order cognitive impairment. Objectives To evaluate different domains of cognitive function in good versus poor CI performers using a multidisciplinary approach and to find the relationship between these functions and different levels of speech processing. Methods This observational, cross-sectional study used the word recognition score (WRS) test to categorize 40 children with CIs into 20 good (WRS/65%) and 20 poor performers (WRS < 65%). All participants were examined for speech processing at different levels (auditory processing and spoken language) and cognitive functioning using (1) verbal tests (verbal component of Stanford-Binet intelligence [SBIS], auditory memory, auditory vigilance, and P300); and (2) performance tasks (performance components of SBIS, and trail making test). Results The outcomes of speech processing at different functional levels and both domains of cognitive function were analyzed and correlated. Speech processing was impaired significantly in poor CI performers. This group also showed a significant cognitive function deficit, in which the verbal abilities were more affected (in 93.5%) than in the good performers (in 69.5%). Moreover, cognitive function revealed a significant correlation and predictive effect on the CI speech outcomes. Conclusion Cognitive function impairment represented an important factor that underlies the variable speech proficiency in cochlear-implanted children. A multidisciplinary evaluation of cognitive function would provide a comprehensive overview to improve training strategies.

Communicative and Hearing Performance in Individuals with Cochlear Implants and Delayed Neuropsychomotor Development: A Longitudinal Analysis

Abstract Introduction Between 15% to 30% of individuals with bilateral prelingual sensorineural hearing loss present with associated disabilities. Cochlear implant (CI) is an alternative treatment that provides consistent access to environmental and speech sounds, which results in significant benefits regarding quality of life and auditory and language development. Objectives To study the auditory and communicative performance of individuals with CI and delayed neuropsychomotor development after a minimum of five years using the device. Methods A total of eight patients were included in the study. We collected the multidisciplinary clinical records of participants, as well as the answers for the questionnaires applied remotely, which included the Children with Cochlear Implants: Parental Perspectives (CCIPP), International Classification of Functioning, Disability and Health: Children and Youth Version (ICF-CY), and the Gross Motor Function Classification System (GMFCS). Results We found that throughout the years of CI use, the auditory threshold means improved significantly in all tested frequencies, as did the speech detection threshold and the language and hearing results. Regarding parental perception, parents evaluated aspects related to their children's social relations to be positive, and had worse perceptions regarding aspects related to their education. Conclusion We observed a progression in the participants' auditory and language skills throughout the years of CI use; even in the presence of other associated disabilities. Future multicentric studies with larger samples are needed to further the advancement of rehabilitation in patients with other associated disabilities.

Musicoterapia y otorrinolaringología / Music therapy and otorhinolaryngology

La musicoterapia es el uso profesional, planificado y estructurado de la música como intervención terapéutica, con el objetivo de mejorar la salud y calidad de vida del paciente o el grupo intervenido. Esta herramienta se basa en la evidencia de efectos neuroplásticos, psicológicos y cognitivos de la música en las personas. En las últimas décadas se ha encontrado evidencia de múltiples beneficios de musicoterapia como tratamiento adyuvante en medicina, entre ellos se destacan: reducción del dolor en enfermedades crónicas, oncológicas, procedimientos quirúrgicos y trabajo de parto, disminución de síntomas depresivos y ansiosos en trastornos del ánimo y demencia, mejoría de la sincronización motora y perceptiva en enfermedad de Parkinson, entre otros. La otorrinolaringología se ha establecido, asimismo, como un nicho plausible para musicoterapia. Actualmente existen numerosas líneas de investigación que se han dedicado a generar evidencia científica en torno a musicoterapia y su utilidad en diversos campos de la especialidad; esta revisión pretende recopilar y analizar dicha evidencia. Los resultados obtenidos en los diferentes estudios sugieren, con evidencia de calidad baja a moderada, que existen beneficios significativos en la utilización de esta herramienta en el tratamiento multimodal de tinnitus, manejo del dolor y ansiedad en procedimientos médico-quirúrgicos, y en la rehabilitación de pacientes con hipoacusia e implantes cocleares. Si bien se ha encontrado que la música es una modalidad terapéutica segura, barata y con beneficios que parecen ser prometedores, se requieren más estudios clínicos de buena calidad y validez para recomendar el uso de musicoterapia en otorrinolaringología.

Music therapy is the professional, planned, and structured use of music as a therapeutic intervention, with the objective of improving the health and quality of life of the patient or the intervened group. This tool is based on the evidence of neuroplastic, psychological and cognitive effects of music in people. In the last decades there has been evidence of multiple benefits of music therapy as an adjuvant treatment in medicine, among them: reduction of pain in chronic diseases, oncology, surgical procedures and labor, reduction of depressive and anxious symptoms in mood disorders and dementia, improvement of motor and perceptual synchronization in Parkinson's disease, among others. Otorhinolaryngology has also been established as a plausible niche for music therapy. Currently there are numerous research lines that have been devoted to generate scientific evidence on music therapy and its usefulness in various fields of the specialty, this review aims to compile and analyze such evidence. The results obtained in the different studies suggest, with low to moderate quality evidence, that there are significant benefits in the use of this tool in the multimodal treatment of tinnitus, pain and anxiety management in medical-surgical procedures, and in the rehabilitation of patients with hypoacusis and cochlear implants. Even though music has been found to be a safe and inexpensive therapeutic modality with benefits that appear to be promising, more clinical studies of good quality and validity are required to recommend the use of music therapy in otorhinolaryngology.

Implantación coclear en pacientes de edad avanzada: Resultados auditivos / Cochlear implantation in elderly patients: Hearing results

Introducción: El envejecimiento de la población, así como la ampliación en las indicaciones de implantación, hace que cada día haya más pacientes implantados mayores de 65 años, lo que supone un reto a nivel de ajuste y optimización auditiva. Se ha constatado que la implantación coclear en pacientes de edad avanzada generalmente conduce a una mejoría, tanto auditiva como en la neurocognición, la depresión, el aislamiento social, la actividad física y la calidad de vida. Objetivo: Los objetivos de este estudio son valorar las características de los pacientes implantados a partir de 65 años en un centro terciario, analizar los beneficios e identificar particularidades clínicas en este grupo de pacientes. Material y Método: Se llevó a cabo un estudio retrospectivo con un seguimiento de 5 años postcirugía de pacientes con implante MED-EL y se realizó una visita preoperatoria y un seguimiento con audiometría en campo libre y audiometría verbales postquirúrgica al año, 3 años y 5 años postquirúrgico. Resultados: Se incluyó a 16 pacientes implantados unilateralmente. La edad media inicio pérdida fue de 36,75 años. La edad media de cirugía fue de 71,44 años. Los resultados auditivos fueron satisfactorios, con una media de audiometría en campo libre de 44,33 dB al año, 43,33 dB a los 3 años y 41,66 dB a los 5 años. El resultado en las audiometrías verbales (test de bisílabos y test de frases) fue mejor en el grupo de pacientes con adaptación bimodal. Conclusión: En nuestra experiencia, la implantación coclear en ≥65 años sí que logra mejorar las capacidades auditivas medidas, tanto en audiometría de campo libre como en pruebas verbales. La adaptación bimodal mejora los resultados auditivos, a pesar de la dificultad de procesamiento de los dos estímulos diferentes.

Introduction: The aging of the population, as well as the expansion in the indications for implantation means that every day there are more implanted patients over 65 years of age, which represents a challenge in terms of hearing adjustment and optimization. Cochlear implantation in elderly patients has been found to generally lead to improvements in hearing and neurocognition, depression, social isolation, physical activity, and quality of life. Aim: The objectives of this study are to assess the characteristics of patients over 65 years of age implanted in a tertiary center, analyze the benefits and identify clinical particularities in this group of patients. Material and Method: A retrospective study was carried out with a 5-year post-surgery follow-up of patients with a MED-EL implant, and a preoperative visit and follow-up with free-field audiometry and post-surgical speech audiometry were performed at one year, 3 years and 5 years post-surgery. Results: Sixteen unilaterally implanted patients were included. The mean age at onset of loss was 36.75 years. The mean age at surgery was 71.44 years. Hearing results were satisfactory, with a mean free field audiometry of 44.33 dB at one year, 43.33 dB at 3 years, and 41.66 dB at 5 years. The result in the verbal audiometries (disyllable test and sentence test) was better in the group of patients with bimodal adaptation. Conclusión: In our experience, cochlear implantation in patients ≥ 65 years of age does manage to improve hearing capacities measured both in free-field audiometry and in verbal tests. Bimodal adaptation improves auditory results, despite the difficulty ofprocessing the two different stimuli.

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.

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.

A relação entre estilos parentais e desenvolvimento auditivo em crianças com implante coclear / The relationship between parenting styles and hearing development in children with cochlear implants

RESUMO Objetivo O objetivo deste estudo foi investigar a relação entre estilos parentais e habilidades auditivas em crianças usuárias de implante coclear. Métodos Este é um estudo analítico observacional. Os participantes foram os cuidadores principais das crianças divididos em grupo estudo (N=50) e grupo controle (N=28). As idades das crianças estavam entre 3 e 7 anos. Os indivíduos do grupo estudo forneceram uma história médica pregressa (HMP) e preencheram o Questionário de Estilos e Dimensões Parentais (QEDP) e a Escala de Integração Auditiva Significativa Infantil-Toddler (IT-MAIS) ou a Escala de Integração Auditiva Significativa (MAIS). Os sujeitos do grupo controle também forneceram um PMH e preencheram o QEDP. O teste de Mann Whitney, o coeficiente de Spearman e o teste de Kruskal-Wallis foram utilizados para análise dos dados, utilizando-se os softwares JASP 0.8 e SPSS 23. Resultados Os grupos estudo e controle não apresentam diferenças significativas em relação aos estilos parentais (p<0,05). A dimensão estilo parental autoritário e punição revelou significância estatística, com escores mais elevados para crianças com desenvolvimento auditivo alterado. Conclusão No presente estudo foi possível verificar que a prática do estilo parental autoritário com dimensões punitivas e coerção física esteve relacionada ao desenvolvimento auditivo alterado em crianças usuárias de implante coclear.

ABSTRACT Purpose The purpose of this study was to investigate the relationship between parenting styles and hearing skills in children with hearing loss who use cochlear implants. Methods This is an observational analytical study. The participants were the children's main caregivers divided into a study group (N=50) and a control group (N=28). The children's ages were between 3 and 7 years old. Subjects in the study group provided a past medical history (PMH), and completed the Parenting Styles and Dimensions Questionnaire (PSDQ) and the Infant-Toddler Meaningful Auditory Integration Scale (IT-MAIS) or the Meaningful Auditory Integration Scale (MAIS). Subjects in the control group also provided a PMH and completed the PSDQ. The Mann Whitney test, the Spearman coefficient, and the Kruskal-Wallis test were used for data analysis, utilizing the JASP 0.8 and SPSS 23 softwares. Results Results showed that The authoritarian parenting style and punishment dimension revealed a statistical significance, with higher scores for children with altered auditory development. Conclusion It was concluded that the practice of authoritarian parenting style with punitive dimensions and physical coercion were related to altered hearing development. Regulation dimension presented a significant correlation with hearing development. The outcome suggested the importance of psychotherapeutic strategies for caregivers who are responsible for children with hearing loss.

Ocorrência de alterações nos potenciais evocados auditivos de fumantes: revisão sistemática da literatura / Occurrence of changes in the auditory evoked potentials of smokers: systematic review of the literature

RESUMO Objetivo Verificar a ocorrência de alterações nos exames de potencial evocado (PEA) auditivo em adultos fumantes normo-ouvintes. Estratégia de pesquisa Revisão sistemática da literatura de acordo com recomendações do PRISMA, buscando responder à pergunta: "Há alterações nos resultados do exame de PEA em adultos fumantes?", estratégia PECOS. Pesquisa realizada nas bases de dados PubMed, Embase, CINAHL, LIVIVO, Scopus, Web of Science, LILACS e Scielo. Busca adicional da literatura cinzenta: Google Scholar e ProQuest e busca manual das referências dos estudos incluídos. Critérios de seleção Foram selecionados estudos com delineamento transversal, sem restrição do ano de publicação e idioma. Análise dos dados Primeiramente foram analisados os títulos e resumos de todos os estudos encontrados, seguido da leitura na íntegra dos estudos elegíveis. Resultados Foram obtidos 898 artigos, que após remoção dos duplicados e análise cega por três pesquisadores, foram selecionados oito trabalhos. Grande parte dos estudos encontrou uma associação entre tabagismo ativo e alterações nos testes eletrofisiológicos. Conclusão Adultos fumantes normo-ouvintes apresentam alterações nos exames de PEA de curta e longa latência. No potencial evocado auditivo de tronco encefálico, os principais componentes alterados foram o aumento das latências das ondas I e III e nos interpicos I - III e III - V, bem como diminuição da amplitude das ondas. No Mismatch Negativity, houve aumento significativo da amplitude da onda e da latência. No potencial de longa latência, P300, houve aumento das latências e redução das amplitudes nos componentes N1 (em Fz) e P3.

ABSTRACT Purpose To verify the occurrence of abnormal auditory evoked potentials (AEP) tests in adult smokers. Research strategies Systematic review of the literature according to the PRISMA guidelines, to answer the question: "Are there any changes in the AEP results in adult smokers?", PECOS strategy. Research carried out on PubMed, Embase, CINAHL, LIVIVO, Scopus, Web of Science, LILACS and Scielo databases. Additional search of gray literature: Google Scholar and ProQuest hand searching of reference lists of the included studies. Selection criteria Cross-sectional studies were selected, without restriction on the year of publication and language. Data analysis First, the titles and abstracts of all the studies were analyzed, followed by the full reading of the eligible studies. Results 898 articles were collected, after the duplicate studies were removed and after blind analysis by three researchers, 8 studies of the observational type were selected. Most studies have found an association between active smoking and changes in electrophysiological tests. Conclusion Normal hearing adult smokers present alterations in short and long AEP. In the auditory brainstem response, the main altered components were the increase in waves latencies of I and III and in the interpeaks I - III and III - V, as well as a decrease in the amplitude of the waves. In Mismatch Negativity, there was a significant increase in wave amplitude and latency. In the long latency potential, P300, there was an increase in latencies and decreased amplitudes in the components N1 (in Fz) and P3.

Satisfaction and quality of life in cochlear implant users with long sensory deprivation / Satisfação e qualidade de vida em usuários de implante coclear com longo tempo de privação sensorial

ABSTRACT Purpose The aim of the study was to verify the level of satisfaction of CI users with long periods of hearing deprivation, highlighting the positive and negative aspects of the use of the device and their quality of life. Methods This is a analytical research, of the type observational cross-sectional study. The study was performed with 24 patients from a private Institute of Otorhinolaryngology. Three surveys were applied: Satisfaction with Amplification in Daily Life (SADL), International Outcome Inventory - Cochlear Implant (IOI - CI) to assess cochlear implant satisfaction and WHOQOL- bref to assess the quality of life. The results in the pre and post lingual groups were compared. Results The highest degree of satisfaction was reported with regard to personal image, positive effects, and how the users feel about their CI. The lowest degree of satisfaction was reported regarding the cost-benefit of the CI and the competitive noise. In the WHOQOL-bref assessment, the highest scores were found in physical, psychological and social relations domains. When comparing the results of the surveys, the pre and post-lingual groups showed no difference in relation to the achieved scores. Conclusion The participants had a high level of satisfaction with the use of cochlear implants. The longer the sensory deprivation time, the greater the degree of satisfaction with the device. The use of the CI electronic device reflects on the individual's quality of life.

RESUMO Objetivo Verificar o nível de satisfação de usuários de IC com longos períodos de privação auditiva, destacando os aspectos positivos e negativos do uso do dispositivo e avaliar a qualidade de vida desses indivíduos. Método Trata-se de uma pesquisa analítica, do tipo estudo observacional transversal. O estudo foi realizado com 24 pacientes de um instituto privado de Otorrinolaringologia. Foram aplicados três questionários: Satisfaction with Amplification in Daily Life (SADL), International Outcome Inventory- Implante Coclear (IOI - IC) para avaliar a satisfação com o implante coclear e WHOQOL-bref para avaliar a qualidade de vida. Os resultados nos grupos pré e pós-lingual foram comparados. Resultados O maior grau de satisfação foi relatado em relação à imagem pessoal, efeitos positivos e como os usuários se sentem em relação ao seu IC. O menor grau de satisfação ocorreu em relação ao custo-benefício do IC e ao ruído competitivo. Na avaliação do WHOQOL-bref, os maiores escores foram encontrados nos domínios físico, psicológico e relações sociais. Os grupos pré e pós-lingual não apresentaram diferença em relação aos escores alcançados. Conclusão Os participantes apresentaram alto nível de satisfação com o uso do implante coclear. Quanto maior o tempo de privação sensorial maior o grau de satisfação com o dispositivo. O uso do dispositivo eletrônico de IC reflete melhora na qualidade de vida do indivíduo.