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.

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.

Desarrollo de lenguaje en niños con implante coclear en centro terciario de salud: serie clínica / Language development in children with cochlear implant at a tertiary health care center: clinical series

Resumen Introducción: Desde la década de los 90, los implantes cocleares han progresado desde aplicaciones experimentales a un uso clínico estandarizado en niños con pérdida auditiva severa y profunda. Las investigaciones han producido cambios en la tecnología de los implantes y ha dado lugar a la expansión de los candidatos a implante para incluir a los niños menores de 2 años de edad. El objetivo principal de la implantación coclear pediátrica es facilitar el desarrollo del lenguaje hablado. A pesar de los avances en la tecnología de implantes y los cambios en el manejo de la pérdida auditiva, los resultados de lenguaje en niños son todavía muy variables, participando de este proceso tanto el tratamiento oportuno, la red familiar y nivel socioeconómico entre algunos de ellos. Objetivo: Describir resultados de niños menores 6 años sometidos a cirugía de implante coclear en un centro terciario de salud. Material y método: Estudio longitudinal de cohorte retrospectivo, análisis a 99 pacientes implantados en centro terciario de salud desde inicio programa en 1994 a 2015. Resultados: 99 pacientes, 57% hombres 43% mujeres, edad promedio implantación 16,3 meses. 54,8% casos origen congénito no especificado o prematurez. En 74,4% se objetivó presencia de lenguaje auditivo verbal. El nivel socioeconómico (NSE) mostró asociación con no desarrollo de lenguaje (p =0,009) evidenciando que pacientes de bajo NSE 20% no desarrolla lenguaje. La variable discapacidad asociada (p <0,001) y la variable NSE (p =0,036) se asociaron de manera independiente a lenguaje de señas o no desarrollo de lenguaje oral. Conclusión: Los implantes cocleares ofrecen una opción en la rehabilitación auditiva en hipoacusia sensorio neural profunda, para candidatos de todo el espectro de edad, sin embargo los resultados dependen en gran medida del entorno en el que se utilizan los implantes cocleares.

ABSTRACT Introduction: Since the 90s, cochlear implantation has progressed from experimental to standard clinical practice for children with severe and profound hearing loss. Research has produced changes in implant technology and has led to the expansion of implant candidacy to include children younger than 2 years of age. The primary goal of pediatric cochlear implantation is to facilitate spoken language development. Despite the advances in implant technology and the changes to the management of hearing loss, language outcomes for children are still highly variable, participating in this process both timely treatment, the family network and socio economic level among others. Aim: describe outcomes of patients younger than 6 years undergoing cochlear implant surgery in a tertiary care center. Material and method: retrospective longitudinal cohort study, 99 patients implanted in a tertiary health center since the program's inception in 1994 to 2015 was analyzed. Results: 99 patients, 57 % men 43 % women, average age of implantation 16.3 months. 54.8 % of cases were congenital or prematurity. In 74.4 % they had auditory verbal language. Socioeconomic status (SES) showed association with the lack of language development (p =0.009) demonstrating that low SES patients (20%) do not develop language. The disability associated variable (p <0.001) and the SES variable (p =0.036) were independently associated with sign language or no oral language development. Conclusions: Cochlear implants offer an option for hearing rehabilitation in profound hearing loss, for candidates of all ages, however the results depend largely on the environment in which cochlear implants are used.

¿Qué es un implante coclear? / What is a cochlear implant?

La hipoacusia representa un importante problema de salud. La dificultad de oír y comunicarse es frustrante para las personas provocando aislamiento social, baja autoestima y muchas veces se acompaña de depresión. Según la Organización Mundial de la Salud (OMS), hoy en día se estima que 360 millones de personas en el mundo viven con pérdida auditiva incapacitante. En Argentina nacen aproximadamente 700.000 chicos por año; de estos, entre 1 y 3 de cada mil tienen hipoacusia. La discapacidad auditiva constituye el 18 por ciento de las discapacidades en el país, la cual se reparte en un 86,6 por ciento de dificultad auditiva y un 13,4 por ciento de sordera. El implante coclear es un producto sanitario implantable activo, de alta tecnología y precisión, encaminado a restablecer la audición de aquellas personas que padezcan una sordera causada por la destrucción de las células ciliadas de la cóclea, estimulando directamente las células ganglionares (nervio auditivo) mediante señales eléctricas encargadas de transmitir la información codificada al cerebro. Hay que recordar que, al ser una prótesis, no cura definitivamente la sordera. Hay muy pocas tecnologías sanitarias que se hayan desarrollado tan rápidamente como el Implante Coclear (AU)

Hearing loss is a major health problem. Difficulties in hearing and communicating are frustrating leading to social isolation, low self-esteem and are often associated with depression. According to the World Health Organization (WHO), currently it is estimated that 360 million people in the world live with disabling hearing loss. In Argentina, approximately 700,000 children are born per year; of these, between 1 and 3 each 1,000 have hearing loss. Hearing impairment accounts for 18 percent of disabilities in the country, of which 86.6% consists of hearing loss and 13.4% of deafness. The cochlear implant is a high-technology and high-precision active implantable device aimed at restoring the hearing in individuals who suffer from deafness caused by the destruction of the ciliated cells of the cochlea, directly stimulating the ganglion cells (auditory nerve) through electrical signals that transmit codified information to the brain. It is important to consider that, being a prosthesis, it does not definitively cure deafness. There are very few technological health devices that have been developed as rapidly as the cochlear implant (AU)

Intervenção guiada por videofeedback a famílias de crianças com deficiência auditiva / Video feedback for families of hearing impaired children

RESUMO Para melhoria do desenvolvimento das habilidades auditivas e da linguagem na criança com deficiência auditiva, além da terapia fonoaudiológica, a família deve ser o agente modificador para uma resposta terapêutica satisfatória. Estudos que analisem a efetividade de programas de intervenção fonoaudiológica por meio de videofeedback são importantes, dados os efeitos positivos desta ferramenta para a modificação de comportamentos com famílias de crianças com deficiência. Acredita-se, assim, que a intervenção por meio do videofeedback contribuirá para a melhoria das interações comunicativas entre as famílias e crianças atendidas pelos serviços de reabilitação auditiva. Os objetivos deste estudo foram investigar a interação entre as famílias e as crianças com deficiência auditiva, analisar a autoestima e a satisfação das famílias antes e após um programa de intervenção por meio do videofeedback. Ensaio clínico não randomizado, com estudo de casos em dois grupos, experimental (n=5) e controle (n=5). A intervenção contou com o apoio do vídeo de interação e de instrumentos adaptados. Protocolos pré e pós-intervenção foram aplicados. Observou-se melhora nas interações entre as famílias e crianças com deficiência auditiva nos casos do grupo experimental, bem como melhora na autoestima dos participantes deste grupo. O grupo experimental demonstrou satisfação com a intervenção realizada. Concluiu-se que o programa de intervenção fonoaudiológica baseado no videofeedback teve efeitos positivos na interação entre a família e criança e na autoestima dos pais. Estudos com controles metodológicos rigorosos deverão ser realizados para a comprovação de sua eficácia para famílias de crianças com deficiência auditiva.

ABSTRACT In order to improve speech-language development in children with hearing impairment, in addition to speech-language therapy, the family should be the modifying agent for a satisfactory therapeutic response. Studies that analyze the effectiveness of speech-language pathology (SLP) intervention programs through video feedback are important, given the positive effects of this tool on the modification of behaviors with families of children with disabilities. Therefore, it is believed that video feedback interventions contribute improve the communicative interactions between the families and children assisted by auditory rehabilitation services. The objectives of this study were to investigate the interaction between families and children with hearing loss and analyze the self-esteem and satisfaction of families before and after the intervention program. This is a non-randomized, clinical trial with case report in two groups: Experimental (n=5) and Control (n=5). The intervention was supported by family-child interaction videos and adapted instruments. Pre- and post-intervention protocols were applied. In the EG, improvement was observed in the interaction between the families and children with hearing loss and in the self-esteem of participants. The EG showed satisfaction with the intervention. We conclude that the SLP intervention program based on video feedback has positive effects on the family/child interaction and on parent self-esteem. Further studies with stricter methodological controls should be conducted to prove the efficacy of video feedback intervention for families of children with hearing loss.

Cochlear Implantation through the Middle Fossa Approach: A Review of Related Temporal Bone Studies and Reported Cases

Abstract Introduction Middle fossa approach has been suggested as an alternative for patients in whom other routes of electrode insertion are contraindicated. Even though there are temporal bone studies about the feasibility of introducing the cochlear implant through the middle fossa, until now, very few studies have described results when cochlear implant surgery is done through this approach. Objective The objective of this study is to review a series of temporal bone studies related to cochlear implantation through the middle fossa and the results obtained by different surgical groups after cochlear implantation through this approach. Data Sources PubMed, MD consult and Ovid-SP databases. Data Synthesis A total of 8 human cadaveric temporal bone studies and 6 studies reporting cochlear implant surgery through the middle fossa approach met the inclusion criteria. Temporal bone studies show that it is feasible to perform cochlear implantation through this route. So far, only two surgical groups have performed cochlear implantation through the middle fossa with a total of 15 implanted patients. One group entered the cochlea in the most upper part of the basal turn, inserting the implant in the direction of the middle and apical turns; meanwhile, the other group inserted the implant in the apical turn directed in a retrograde fashion to the middle and basal turns. Results obtained in both groups were similar. Conclusions Themiddle fossa approach is a good alternative for cochlear implantation when other routes of electrode insertion are contraindicated.

Hearing performance as a predictor of postural recovery in cochlear implant users / Desempenho auditivo como preditor de recuperação postural em usuários de implante coclear

Abstract Objective This study aimed to evaluate if hearing performance is a predictor of postural control in cochlear implant (CI) users at least six months after surgery. Methods Cross-sectional study including (CI) recipients with post-lingual deafness and controls who were divided into the following groups: nine CI users with good hearing performance (G+), five CI users with poor hearing performance (G−), and seven controls (CG). For each patient, computerized dynamic posturography (CDP) tests, a sensory organization test (SOT), and an adaptation test (ADT) were applied as dual task performance, with first test (FT) and re-test (RT) on the same day, including a 40–60 min interval between them to evaluate the short-term learning ability on postural recovery strategies. The results of the groups were compared. Results Comparing the dual task performance on CDP and the weighted average between all test conditions, the G+ group showed better performance on RT in SOT4, SOT5, SOT6, and CS, which was not observed for G− and CG. The G− group had significantly lower levels of short-term learning ability than the other two groups in SOT5 (p = 0.021), SOT6 (p = 0.025), and CS (p = 0.031). Conclusion The CI users with good hearing performance had a higher index of postural recovery when compared to CI users with poor hearing performance.

Resumo Objetivo O presente estudo teve por objetivo avaliar se o desempenho auditivo é preditor de controle postural em usuários de IC pelo menos seis meses após a cirurgia. Método Estudo transversal que consistiu em recipientes de implante coclear (IC) com surdez pós-lingual e controles, que foram divididos nos seguintes grupos: nove usuários de IC com bom desempenho auditivo (G+), cinco usuários de usuários de IC com desempenho auditivo insatisfatório (G-) e sete controles (GC). Aplicamos os testes de posturografia dinâmica computadorizada (PDC), de organização sensitiva (TOS) e de adaptação (TAd) como desempenho de dupla tarefa, primeiro teste (PT) e reteste (RT) no mesmo dia, com intervalo de 40-60 minutos entre testes, com o objetivo de avaliar a capacidade de aprendizado em curto prazo nas estratégias de recuperação postural. Comparamos os resultados dos testes. Resultados Na comparação do desempenho de dupla tarefa no teste PDC e a média ponderal entre todas as condições de teste, o grupo G+ demonstrou melhor desempenho no RT nos TOS4, TOS5, TOS6 e EC, o que não foi observado para os grupos G- e GC. O grupo G- obteve níveis significantemente mais baixos de capacidade de aprendizado em curto prazo vs. outros dois grupos no TOS5 (p = 0,021), TOS6 (p = 0,025) e EC (p = 0,031). Conclusão Usuários de IC com bom desempenho auditivo tiveram índice melhor de recuperação postural, quando comparados com usuários de IC com desempenho auditivo insatisfatório.

Implicações do uso do Aparelho de Amplificação Sonora Individual na qualidade de vida de idosos / Implications of using the Hearing Aids on quality of life of elderly

RESUMO Objetivo Avaliar, por meio de questionários padronizados, a qualidade de vida de idosos com deficiência auditiva diagnosticada que utilizam ou não a prótese auditiva (AASI) e de idosos sem queixa auditiva. Método Trata-se de um estudo transversal, com amostra não probabilística, distribuída em três grupos divididos da seguinte forma: 30 idosos com perda auditiva diagnosticada e com indicação para uso do aparelho de amplificação sonora individual (AASI), mas que ainda não faziam uso da prótese; 30 idosos com deficiência auditiva que usavam o AASI; e 30 idosos sem queixa auditiva. Os participantes completaram um questionário que investigava dados sociodemográficos e familiares, o Hearing Handicap Inventory for the Elderly Screening Version (HHIE-S) e o World Health Organization Quality of Life - versão breve (WHOQOL-Breve). Além das análises descritivas dos dados, foram realizados testes para comparação dos três grupos, aplicando-se a análise de variância (ANOVA) e o teste post hoc de Bonferroni. Resultados Os três grupos se diferenciaram significativamente em todos os domínios de qualidade de vida. O grupo de idosos com perda auditiva diagnosticada e com indicação para uso do AASI apresentou menores escores que o grupo de idosos com deficiência auditiva que usavam o AASI e que o grupo de referência. O grupo com AASI apresentou os melhores resultados de qualidade de vida. Conclusão A perda auditiva afeta a qualidade de vida do idoso. O uso efetivo da prótese auditiva é benéfico a esta população, melhorando suas condições de vida e saúde.

ABSTRACT Purpose To evaluate through standardized questionnaires the quality of life of elderly people with hearing loss diagnosed with and without the use of hearing aids (HA) and elderly without hearing complaints. Methods This is a cross-sectional study with non probabilistic sample, divided into three groups divided as follows: 30 elderly people with diagnosed hearing loss and indication for use of individual sound amplification devices (hearing aids), but have not yet made use of the prosthesis; 30 individuals with hearing impairment who used hearing aids and 30 elderly without hearing complaints. Participants completed a questionnaire investigating sociodemographic and family data, the Hearing Handicap Inventory for the Elderly Screening Version (HHIE-S) and the World Health Organization Quality of Life - Short version (WHOQOL-BREF). In addition to the descriptive analysis of the data were performed tests to compare the three groups by applying analysis of variance (ANOVA) and the Bonferroni post hoc test. Results The three groups differed significantly in all domains of quality of life. The group of the elderly people with hearing loss diagnosed and with indication for the use of hearing aids presented lower scores and the group of the elderly with hearing disabilities that used the hearing aid and that the reference group. The AASI group presented the best quality of life results. Conclusion The hearing loss affects the quality of life of the elderly. The effective use of hearing aid is beneficial to this population, improving their living and health conditions.

Uso do Sistema FM em implante coclear / Use of FM System in cochlear implant

RESUMO Objetivo Verificar o uso do Sistema de Frequência Modulada (FM) e o benefício deste dispositivo em usuários de implante coclear. Método Análise de prontuários dos 113 usuários de Implante Coclear (IC), adaptados com kits de Sistema FM, entre setembro de 2013 e 2015, após publicação da Portaria 1.274 de 25/6/2013, referentes aos resultados dos testes de percepção de fala (TPF) e dos questionários Listening Inventory For Education – Revised (LIFE-R) e Classroom Participation Questionnaire (CPQ). Resultados O uso do Sistema FM em sala de aula foi efetivo por 47,15% dos pacientes, enquanto 21,42% não o utilizaram. Não houve correlação entre o uso do Sistema FM e a faixa etária dos pacientes. Os resultados nos TPF no ruído foram estatisticamente melhores com o uso do FM. Em relação aos questionários, a pontuação obtida na situação “após uso do Sistema FM”, no questionário LIFE-R, foi estatisticamente melhor para o item “situações de escuta em sala de aula” e, no questionário CPQ, para os itens “compreensão dos professores e aspectos positivos”, quando comparada a da situação “sem uso do Sistema FM”. Conclusão Os pacientes beneficiados com a concessão do Sistema FM fizeram uso do dispositivo em sala de aula e mostraram melhora tanto na percepção da fala no ruído quanto na impressão subjetiva da compreensão da fala do professor em sala de aula, após o uso do Sistema FM.

ABSTRACT Purpose To verify the use of the Frequency Modulation System (FM) and its benefit for cochlear implant users. Methods Analysis of medical records of 113 users of Cochlear Implants (CI) adapted with FM System kits between September 2013 and September 2015 after publication of the Administrative Rule 1.274 of 6/25/2013, regarding the results of the speech perception tests (SPT) and the Listening Inventory For Education - Revised (LIFE-R) and Classroom Participation Questionnaire (CPQ). Results The use of the FM System in the classroom was effective for 47.15% of the patients, while 21.42% did not use it. There was no correlation between the use of the FM System and the age group of patients. The results of the SPT regarding noise were statistically better with the use of FM System. Regarding the questionnaires, the score obtained in the LIFE-R in the situation “after use of the FM System” was statistically better for the item “listening situations in the classroom” and in the CPQ, for the items “teacher understanding” and “positive aspects”, when compared to the situation “without using the FM System”. Conclusion Patients benefitting from the concession of the FM System made use of the device in the classroom and improvement in both speech perception in noisy environments and subjective impression of the understanding of teachers’ speech in the classroom was observed after the use of the FM System.

Relação entre percepção auditiva e produção vocal em implantados cocleares: uma revisão sistemática / Relationship between auditory perception and vocal production in cochlear implantees: a systematic review

RESUMO Objetivo Realizar uma revisão sistemática das publicações científicas que estudam a relação entre produção vocal e percepção auditiva em usuários de implante coclear. Estratégia de pesquisa Trata-se de uma revisão sistemática da literatura. Foram consultadas as plataformas/bases de dados Bireme, Pubmed, SciELO, Cochrane, Scopus e Web Of Science e utilizados os descritores voz, implante coclear e percepção auditiva. Critérios de seleção Artigos originais publicados nos idiomas inglês, francês, espanhol ou português, envolvendo o estudo da produção vocal e da percepção auditiva em usuários de implante coclear, foram selecionados e não houve restrição quanto ao ano de publicação dos artigos. Análise dos dados Os estudos selecionados foram analisados segundo autor, local, ano e periódico de publicação, bem como por número amostral, tipo de avaliação da produção vocal e da percepção auditiva, por seus principais achados e grau de recomendação/nível de evidência científica. Resultados Os resultados encontrados sugerem a existência de relação positiva entre produção vocal e percepção auditiva em usuários de implante coclear, bem como indicam que o tempo de implantação apresenta influência positiva nesta relação. Conclusão Nenhum estudo selecionado obteve nível 1 de evidência científica ou grau de recomendação A, o que se relaciona com o caminho metodológico que se pode percorrer com este objeto de estudo. Há uma grande carência de publicações relacionando percepção auditiva e produção vocal de usuários de implante coclear. Essa lacuna é ainda maior quando se trata da população adulta.

ABSTRACT Purpose To conduct a systematic review of the scientific literature studying the relationship between vocal production and auditory perception in cochlear implant users. Research strategies This is an integrative systematic review. The plattforms/databases Bireme, SciELO, Cochrane, Scopus and Web of Science were consulted and the descriptors used were voice, cochlear implant and auditory perception. Selection criteria Original papers published in English, French, Spanish or Portuguese involving the study of vocal production and auditory perception in cochlear implant users were selected and there was no restriction about year of publication of the articles. Data analysis The studies selected were analyzed according to the author, location, year and publication of the article, as well as for their sample size, type of vocal production and auditory perception assessment and for its major findings and recommendation grade/level of scientific evidence. Results The results suggest the existence of positive relationship between vocal production and auditory perception in cochlear implant users, and indicate that the deployment time has a positive influence in this relationship. Conclusion None of the selected studies were rated at level 1 of scientific evidence or grade A of recommendation, which is related to the methodological approach that can go with this subject matter. There is great lack of publications relating auditory perception and speech production in cochlear implant users. This gap is even greater when it comes to the adult population.

Hearing performance and voice acoustics of cochlear implanted children / Desempenho auditivo e acústica da voz de crianças com implante coclear

ABSTRACT INTRODUCTION: The voice of hearing-impaired individuals has been described extensively, and exhibits abnormalities in quality, articulation and resonance. Having an understanding of the aspects that may have an impact on voice characteristics of cochlear implant users is important for users and for professionals in this field. OBJECTIVE: To verify the existence of correlation between age, time of device use, voice detection threshold, hearing category score and language category score with acoustic data of voices of cochlear implanted children. METHODS: Retrospective study. Fifty-one children ranging in age from 3 years to 5 years and 11 months who unilaterally used cochlear implants participated. Acoustic analysis of the sustained vowel/a/, sequential speech and spontaneous speech was performed. The results were correlated with demographic data and hearing test results. RESULTS: Children with worse voice detection threshold showed higher frequency in the sustained vowel ( p ≤ 0.001) and in the spontaneous speech ( p ≤ 0.005). CONCLUSION: There was a correlation between the voice detection threshold and the frequency values of the sustained vowel and spontaneous speech of the studied population.

RESUMO INTRODUÇÃO: A voz do indivíduo com deficiência auditiva tem sido amplamente caracterizada, estando comprometida em termos de tipo de voz, articulação e ressonância, sendo que o conhecimento dos aspectos que possam ter impacto nas características vocais de usuários de implante coclear é de suma importância para os usuários e profissionais da área. OBJETIVO: Verificar a existência de correlação entre idade, tempo de uso, limiar de detecção de voz, escore da categoria de audição e escore da categoria de linguagem com dados acústicos de vozes de crianças com implante coclear. MÉTODO: Estudo retrospectivo. Participaram 51 crianças usuárias de implante coclear com idade de 3-5 anos e 11 meses. Foi realizada análise acústica da vogal sustentada/a/, fala encadeada e conversa espontânea. Os resultados foram correlacionados com dados demográficos e resultados de testes auditivos. RESULTADOS: Crianças com pior desempenho no teste de detecção de voz apresentam voz mais aguda na vogal sustentada ( p ≤ 0,001) e na conversa espontânea ( p ≤ 0,005). CONCLUSÃO: Houve correlação entre os limiares de detecção de voz e os valores de frequência na vogal sustentada e conversa espontânea na população estudada.

Relationship between otolaryngologic complaints and systemic comorbidities observed in a group of hearing aid users

Introduction Optimization of the selection, adaptation, and benefit of hearing aids is necessary to characterize and manage hearing loss, user expectations, otolaryngologic symptoms, and systemic comorbidities. Objective To compare the occurrence of otologic complaints, systemic diseases, and effective use of hearing aids in men and women with deafness. Methods Patients from a Unified Health System-accredited hearing health service, who reported problems in adapting to their hearing aids, were evaluated by a physician and audiologist. An anamnesis, ENT evaluation, and audiological evaluation were performed. Results During the data collection period, 278 subjects came in for follow-up visits; of these, 61 (21%) reported otologic or operational problems with their equipment. The most prevalent type of hearing loss was basocochlear, a characteristic of presbycusis, in both men and women; the most frequently reported comorbidities were hypercholesterolemia (more significant in women) and hypertension (more significant in men). Fourteen subjects reported using their device discontinuously, with no significant difference between genders; the reasons for discontinuation of use were itching and ringing, with more complaints from women. Conclusion The incidence of systemic and audiological complaints is high in this population. These patients should be evaluated thoroughly, as resolutions of these complaints can contribute to improving the quality of life and assist in the process of hearing aid fitting.

Hearing aid use and adherence to treatment in a publicly-funded health service from the city of São Paulo, Brazil

Introduction Periodic follow-up appointments are important to ensure long-term effectiveness of rehabilitation with hearing aids. However, not all users are able to maintain adherence to recommendations prescribed during the fitting process and some do not attend those appointments, which compromises the effectiveness of treatment. Objective Compare hearing aid use after 1 year between subjects who did not attend a follow-up evaluation appointment at a publicly-funded health service (nonattenders) and those who attended the appointment (attenders). Reasons for nonuse of hearing aids and unscheduled appointments were also analyzed. Methods Prospective observational cross-sectional study. Nonattenders and attenders in a follow-up evaluation appointment were interviewed by telephone about hearing aid use, reasons for nonuse, and unscheduled appointments. Results The nonattenders group consisted of 108 subjects and the attenders group had 200 subjects; in both groups, most users kept bilateral use but the nonuse rate was higher in nonattenders. The main reason for nonuse of hearing aids among nonattenders was health problems; fitting problems was the main reason for nonuse in the attenders group. Health problems and issues like unavailable companion and transportation difficulties were the reasons for unscheduled follow-up appointments. Conclusion Nonattenders had a greater nonuse rate and were more likely to abandon hearing aid use. Measures to increase hearing aid use and adherence to prescribed recommendations are also necessary to ensure long-termeffectiveness of rehabilitation with hearing aids.

The diagnostic value of circulating microRNAs for middle-aged (40–60-year-old) coronary artery disease patients

OBJECTIVE: Circulating microRNAs have been recognized as promising biomarkers for various diseases. The present study aimed to explore the potential roles of circulating miR-149, miR-424 and miR-765 as non-invasive biomarkers for the diagnosis of coronary artery disease in middle-aged (40–60-year-old) patients. METHODS: Sixty-five stable coronary artery disease patients (49–57 years old), 30 unstable coronary artery disease patients (49–58 years old), and 32 non-coronary artery disease patients (49–-57 years old) who were matched for age, sex, smoking habits, hypertension and diabetes were enrolled in this study. Total RNA was isolated from plasma with TRIzol reagent. Circulating miRNA levels were measured by quantitative real-time polymerase chain reaction. RESULTS: Circulating miR-149 levels were decreased 4.49-fold in stable coronary artery disease patients (1.18 ± 0.84) and 5.09-fold in unstable coronary artery disease patients (1.04 ± 0.65) compared with non-coronary artery disease patients (5.30 ± 2.57) (p<0.001). Circulating miR-424 levels were reduced 3.6-fold in stable coronary artery disease patients (1.18 ± 0.60) and 5-fold in unstable coronary artery disease patients (0.86 ± 0.54) compared with non-coronary artery disease patients (4.35 ± 2.20) (p<0.001). In contrast, circulating miR-765 levels were elevated 3.98-fold in stable coronary artery disease patients (6.09 ± 2.27) and 5.33-fold in unstable coronary artery disease patients (8.17 ± 2.77) compared with non-coronary artery disease patients (1.53 ± 0.99) (p<0.001). Receiver operating characteristic curve analysis revealed that the respective areas under the curve for circulating miR-149, miR-424 and miR-765 were 0.938, 0.919 and 0.968 in stable CAD patients and 0.951, 0.960 and 0.977 in unstable coronary artery disease patients compared with non-coronary artery disease patients. CONCLUSION: Our results suggest that circulating miR-149, ...

Calidad de vida y desempeño en pacientes adolescentes y adultos prelinguales con implante coclear / Performance and quality of life in adolescent and adult patients with prelingual cochlear implant / Qualidade de vida e desempenho em pacientes adolescentes e adultos pré-linguais com implante coclear

Introducción: se ha demostrado en diferentes estudios que la implantación coclear a edades tempranas suele ser más beneficiosa que en edades avanzadas. Las limitaciones del paciente con hipoacusia no sólo son del ámbito auditivo y lingüístico, sino también en su desarrollo cognitivo y social. En este estudio se ha evidenciado de manera subjetiva que también se pueden obtener buenos resultados en pacientes de edades más avanzadas en relación a su calidad de vida...

Introduction: it has been demonstrated in several studies that cochlear implantation at an early ages is often more beneficial than in advanced ages. The limitations of patients with hearing loss are not only in auditory and linguistic field, but also in their cognitive and social development. In this study it has become clear of subjective way that you can also get good results in patients older age in relation to their quality of life...

Introdução: demonstrou-se em diferentes estudos que a implantação coclear em tenra idade constuma ser mais beneficiosa do que em idades avançadas. As limitações do paciente com hipoacusia não são somente no ámbito auditivo e linguístico, mas também no seu desenvolvimento cognitivo e social. Neste estudo, evidenciou-se de maneira subjetiva que também podem-se obter bons resultados em pacientes de idades mais avançadas em relação à sua qualidade de vida...

Parental perspectives of children using cochlear implant / Perspectivas dos pais de crianças usuárias de implante coclear

PURPOSE: To evaluate the parents' perspective with regard to evolution of their child with cochlear implant (CI). METHODS: This was a cross-sectional prospective study conducted at the Centro de Pesquisas Audiológicas of Hospital de Reabilitação de Anomalias Craniofaciais of Universidade de São Paulo. The selection of the sample was performed from the spontaneous demand, among the months from July to December 2011. The final sample comprised 50 parents or guardians of children using CI, with minimum 1 year and maximum of 3 years of device use. The translated and adapted to Brazilian Portuguese version of the questionnaire "Perspectives of parents of children with cochlear implants" was applied. This instrument consists of 74 questions and allows quantification of the parents' perspective on subscales that illustrate the situation of the child and family. Each question has five options scored from one to five responses. The Spearman test for comparison of results between the subscales was applied. RESULTS: The social relationships, self-sufficiency, and communication subscales showed the highest mean score, whereas the worst score was for child support subscale, reflecting the independence and autonomy of the patients. The correlation between the child subscales was realized, and the results showed themselves significant and positive for communication subscale of communication with all others subscales. The family subscales also had a positive correlation with the communication, education, and self-sufficiency. CONCLUSION: These results demonstrate that parents have good expectations regarding communication, independence, and social participation of children after CI surgery, and this questionnaire is a useful tool for use in clinical practice. .

OBJETIVO: Avaliar a perspectiva dos pais em relação ao implante coclear (IC) sobre a evolução da criança usuária do IC. MÉTODOS: Tratou-se de um estudo prospectivo transversal desenvolvido no Centro de Pesquisas Audiológicas do Hospital de Reabilitação de Anomalias Craniofaciais da Universidade de São Paulo. A seleção da casuística foi realizada a partir da demanda espontânea entre os meses de julho e dezembro de 2011. A amostra final foi composta por 50 pais ou responsáveis de crianças usuárias de IC com no mínimo um ano e máximo de três anos de uso do dispositivo. Foi aplicado o questionário Crianças com implante coclear: perspectivas dos pais, traduzido e adaptado para o Português Brasileiro. Este instrumento é composto por 74 questões e permite a quantificação da perspectiva dos pais em subescalas que ilustram a situação da criança e da família. Cada pergunta apresenta cinco opções de respostas pontuadas de um a cinco. Foi aplicado o Teste de Spearman para comparação dos resultados entre as subescalas. RESULTADOS: As subescalas relação social, autossuficiência e comunicação foram as que apresentaram maior média de pontuação. Já a pior pontuação foi da subescala de apoio à criança, reflexo da independência e autonomia dos pacientes. Quando realizada a correlação entre as subescalas relacionadas à criança, observou-se resultado estatisticamente significante e positivo da subescala de comunicação com todas as demais. As subescalas da família também apresentaram correlação positiva com a comunicação, educação e autossuficiência. CONCLUSÃO: Estes resultados demonstram que os pais apresentam boas expectativas ...

Assessment of telephone speech perception in individuals who received cochlear implant in the period 1993-2003 / Avaliacao da percepcao de fala ao telefone em individuos que receberam o implante coclear no periodo de 1993 a 2003

OBJECTIVE: To evaluate telephone speech perception in individuals who received cochlear implant in the period 1993-2003. METHODS: Twenty seven CI users were divided into pre and post-lingual groups, being the speech perception assessed in two stages: first by a list of sentences imposed on speakerphone with the same mapping used to evaluate the phone and, in a second stage, using the landline, landline phone adapter with CI and cell phone. RESULTS: In the group of pre-lingual hearing loss, 75% of subjects were able to maintain a dialogue with the interlocutor and 19% did so with difficulty. In the post-lingual group, 89% were able to maintain the dialogue with the interlocutor and 11% did so with difficulty. Both groups of subjects pre and post-lingual use the phone as a media, and most have satisfactory performance without the need for aid or CI accessories. CONCLUSION: One of the benefits of the CI is to introduce the life of the hearing impaired phone use regardless of their technology and accessories, as well as with the phone adapter and cell phone. In this study, most individuals CI users showed satisfactory performance in the comprehension of sentence and questions by the telephone, with better performance, although discrete, for the group post-lingual. Thus, there is the importance of careful indication of the IC and auditory rehabilitation program that minimize the impact of deafness in the communication, especially via telephone, regardless of the time when the hearing was acquired. So, this fact improves the conditions for CI users to maintain their daily activities, following the dynamism of contemporary life. .

OBJETIVO: Avaliar a percepção de fala ao telefone em indivíduos que receberam o implante coclear multicanal no período de 1993 a 2003. MÉTODOS: Vinte e sete usuários de IC foram divididos em grupos pré e pós-lingual, sendo que a percepção de fala foi avaliada em dois momentos: primeiramente por uma lista de sentenças aplicada a viva-voz com o mesmo mapeamento utilizado na avaliação ao telefone e, em um segundo, utilizando-se o telefone fixo, telefone fixo com adaptador para IC e telefone celular. RESULTADOS: No grupo de deficiência auditiva pré-lingual, 75% dos indivíduos foram capazes de manter o diálogo com o interlocutor e 19% o fizeram com dificuldade. Já no pós-lingual, 89% foram capazes de manter o diálogo com o interlocutor e 11% o fizeram com dificuldade. Tanto os indivíduos dos grupos pré quanto os do pós-lingual utilizam o telefone como meio de comunicação, e a maioria apresenta desempenho satisfatório sem a necessidade de auxílio ou acessórios do IC. CONCLUSÃO: Um dos benefícios do IC é introduzir na vida do deficiente auditivo o uso do telefone independente de sua tecnologia e acessórios, bem como o telefone com adaptador e o celular. Neste estudo, a maioria dos indivíduos usuários de IC apresentou desempenho satisfatório de compreensão de sentenças e perguntas ao telefone, com melhor desempenho, apesar de discreto, do grupo pós-lingual. Desta forma, verifica-se a importância da indicação criteriosa do IC e do programa de reabilitação auditiva, que minimizam os prejuízos da surdez na comunicação, principalmente via telefone, independente do momento no qual a deficiência auditiva foi adquirida. Assim, melhoram-se as condições para os usuários de IC manterem suas atividades ...

Influencia da estrategia de processamento de sinal no desempenho auditivo / Influence of signal processing strategy in auditory abilities

Aestratégia de processamento de sinal é um parâmetro que pode influenciar o desempenho auditivo do usuário de implante coclear e torna-se importante otimizar este parâmetro para proporcionar melhor percepção da fala, especialmente em situações de difícil escuta. OBJETIVO: Analisar os resultados individuais do desempenho auditivo de crianças usuárias de implante coclear, utilizando diferentes estratégias de processamento do sinal. MÉTODO: Estudo prospectivo com 11 crianças com deficiência auditiva pré-lingual e com habilidade auditiva de reconhecimento em conjunto aberto. Foi realizada a avaliação em três momentos, de acordo com a estratégia de fala utilizada (HiRes 120 e HiRes). Os participantes foram submetidos à audiometria em campo livre e avaliação da percepção da fala (silêncio e ruído). RESULTADOS: No silêncio, as crianças S1, S4, S5, S7 apresentaram melhor desempenho com a estratégia HiRes 120 e as crianças S2, S9, S11 apresentaram melhor desempenho com a estratégia HiRes. No ruído, também foi possível observar que algumas crianças obtiveram melhor desempenho utilizando a estratégia HiRes 120 e outras com a HiRes. CONCLUSÃO: Nem todas as crianças avaliadas apresentaram o mesmo padrão de resposta com as diferentes estratégias utilizadas neste estudo, o que reforça a necessidade de olhar clínico na otimização da programação do implante coclear. .

The signal processing strategy is a parameter that may influence the auditory performance of cochlear implant and is important to optimize this parameter to provide better speech perception, especially in difficult listening situations. OBJECTIVE: To evaluate the individual's auditory performance using two different signal processing strategy. METHOD: Prospective study with 11 prelingually deafened children with open-set speech recognition. A within-subjects design was used to compare performance with standard HiRes and HiRes 120 in three different moments. During test sessions, subject's performance was evaluated by warble-tone sound-field thresholds, speech perception evaluation, in quiet and in noise. RESULTS: In the silence, children S1, S4, S5, S7 showed better performance with the HiRes 120 strategy and children S2, S9, S11 showed better performance with the HiRes strategy. In the noise was also observed that some children performed better using the HiRes 120 strategy and other with HiRes. CONCLUSION: Not all children presented the same pattern of response to the different strategies used in this study, which reinforces the need to look at optimizing cochlear implant clinical programming. .

Fatores que influenciam na participação dos pais de crianças usuárias de implante coclear na (re)habilitação oral: revisão sistemática / Factors that influence the participation of parents in the oral rehabilitation process of children with cochlear implants: a systematic review

OBJETIVO: Identificar e analisar os fatores que interferem na participação dos pais de crianças usuárias de implante coclear (IC) no processo (re)habilitação aurioral. ESTRATÉGIA DE PESQUISA: Formulação da pergunta da pesquisa, levantamento e seleção dos estudos em bases de dados, com os descritores cochlear implant (implante coclear) e parents (pais). CRITÉRIOS DE SELEÇÃO: Artigos originais e completos publicados na língua portuguesa brasileira ou inglesa, pais de crianças usuárias de IC como participantes diretos da pesquisa. ANÁLISE DOS DADOS: Leitura dos artigos na íntegra e extração de dados para a caracterização dos centros, da metodologia e conteúdo das pesquisas. RESULTADOS: Treze artigos foram selecionados, dos tipos transversal e caso-controle (técnica de entrevista). Foram identificados os fatores sobre a tomada de decisão em realizar ou não a cirurgia (conhecimento prévio sobre IC, expectativas dos resultados, qualidade e quantidade de informações, encaminhamentos realizados, aspectos biomédicos e éticos, inserção na reabilitação, contato com outros pais, apoio social e custos); os fatores preditivos relacionados aos resultados da reabilitação (tempo de uso diário do IC, modalidade aurioral, escola regular, comprometimentos associados, aspectos sócio-demográficos e efetividade do programa); os fatores relacionados aos benefícios e limitações do IC (modalidade comunicativa, evolução das habilidades auditivas e linguísticas, o aprendizado de uma segunda língua oral), bem como o grau de satisfação dos pais. CONCLUSÃO: O engajamento dos pais de crianças usuárias de IC na (re)habilitação aurioral depende de fatores relacionados a diferentes domínios, os quais os fonoaudiólogos devem compreender e considerar na elaboração do programa de intervenção.

PURPOSE: To identify and analyze factors that influence the participation of parents in the rehabilitation process of children with cochlear implants (CI). RESEARCH STRATEGY: Question formulation and articles selection in three databases using the following keywords: cochlear implant (implante coclear) and parents (pais). SELECTION CRITERIA: Complete original articles published in Brazilian Portuguese or English, with direct participation of parents of children with CI. DATA ANALYSIS: Articles were fully read. Data regarding characterization of the centers, research methodology and content were analyzed. RESULTS: Thirteen articles were selected based on the established criteria. The types of studies were cross-sectional and case-control (interview technique). The following influential factors were identified: pre-CI surgery factors (knowledge about CI, quality and quantity of information, specialist's advices, ethical and biomedical aspects, rehabilitation engagement, contact with experienced families, social service support and overall costs); rehabilitation aspects (CI use, oral communication modality, regular school, other disabilities, social and demographic aspects and rehabilitation program's effectiveness); other important influential processes (communication modality, auditory and language development, second oral language learning, as well as parent's behavior and satisfaction). CONCLUSION: The engagement of parents in the rehabilitation process of children with CI depends on several distinct influential factors which audiologists should understand and consider when elaborating a rehabilitation program.

Profile of cochlear implant users of the city of Manaus

Introduction: The cochlear implant is a device that is intended to substitute for the function of cochlear hair cells, electrically stimulate auditory nerve fibers, and contribute to the perception of speech sounds. However, the surgical procedure alone is not enough for the user to achieve favorable results in habilitation/rehabilitation. Objective: To characterize the patients from Manaus who have received cochlear implants based on the criteria for surgery. Methods: We conducted a retrospective cross-sectional study of 15 cases and recorded etiological aspects of deafness, age, gender, duration of implant use, use of hearing aids, and participation in individual therapy. Data were recorded in a protocol designed specifically for this purpose. All patients were natives of Manaus. Results: The leading etiological aspect was ototoxicity associated with prematurity in newborns undergoing treatment in the neonatal intensive care unit. The age at surgery is carefully observed in the evaluation of implant centers, as well as if the candidate is pre-or post-lingual. In this study, 73% of patients were pre-lingual and did not benefit from hearing aids. As to the degree and type of hearing loss, 93% had audiological reports indicating profound bilateral sensorineural hearing loss and 7% had severe bilateral sensorineural hearing loss. This latter finding confirmed one of the basic principles of implant placement. Conclusion: This study allowed us to verify that there are reduced number of cochlear implant recipients in Manaus, but they have met the criteria required by implant centers located in other states of Brazil...