Did our cochlear implant program make any difference in the lives of our patients? Achievements of 30 patients with long term follow-up averaging 20 years after cochlear implantation.

BACKGROUND: Cochlear implants are standard of care for the patients with sensorineural hearing loss not benefited from hearing aids. AIMS: Evaluate qualitatively the impact of cochlear implantation in the long-term. MATERIALS-METHODS: Thirty middle-class patients with similar patterns of loss and social environment averaging 20 years post-implantation responded to 52 questions that evaluated psychosocial benefits from cochlear implantation. RESULTS: All completed secondary education and 93% had postgraduate studies. Educational and workwise they are at the same level as their hearing counterparts. All use their cochlear implants and would recommend one to people who need it. They attribute their success to the implant, the rehabilitation program, their family, and a stimulating social environment. Despite their success, most experience difficulties relating with others (socially and at work) due to their hearing condition. They manage but work much harder than their hearing peers to achieve the same. CONCLUSIONS: We made a difference in the lives of these patients, however, there is more to be done. SIGNIFICANCE: Early intervention, rehabilitation, plus family, and stimulating-environment are crucial in children with sensory deficits.

Otitis media and mastoiditis in temporal bones of prehistoric Chilean populations. A paleopathological and paleoepidemiological study.

BACKGROUND: This study evaluates otitis media in prehistoric populations in northern Chile. AIMS/OBJECTIVES: Determining prevalence of otitis media and diagnostic usefulness of temporal-bone X-rays in skulls. MATERIALS AND METHODS: 444 skulls belonging to three groups: prehistoric-coastal (400-1000 AD), prehistoric-highland (400-1000 AD) and Pisagua-Regional Developments (1000-1450 AD). Skulls were evaluated visually and with Schuller's view X-rays. Five skulls diagnosed as having had otitis media, five diagnosed as normal, and one with temporal bone fistula also had a computed tomography (CT). RESULTS: Changes suggestive of otitis media were present in Prehistoric-coastal 53.57%; Pisagua-Regional Developments 70.73%; prehistoric-highlands 47.90%. Diagnostic effectiveness of Schuller's view X-rays for assesing middle ear disease was confirmed by CT studies. The case with temporal bone fistula had changes suggestive of mastoiditis and possible post auricular abscess. CONCLUSIONS: There was a high prevalence of otitis media in prehistoric populations in Chile. The higher prevalence in one group was presumably due to racial factors. Temporal-bone X-rays are effective for massive evaluation of ear disease in skulls. A case of mastoiditis with temporal bone fistula and possible post-auricular abscess is documented. SIGNIFICANCE: Documenting racial factors in otitis media. Validating X-rays for massive evaluation of otitis media in skulls.

Chances of reversibility in early sensory deprivation of the Homo vulnerabilis: A 5-year (and ongoing) prospective study.

BACKGROUND: This prospective study evaluated the effectiveness of a rehabilitation program in vulnerable children with language deficits. AIMS/OBJECTIVES: Evaluating reversibility of a sensory understimulation. MATERIAL/METHODS: Two groups of five students, each, (sensory and not sensory deprived) were evaluated at ages 5 and 11. Both groups were taught the compulsory national educational program. The sensory deprived group also had a 5-year rehabilitation program. After that time, their language and vocabulary were reevaluated. RESULTS: Both groups became able to read, write and perform mathematical operations. Both groups took the compulsory elementary school national performance test and all of them performed above the national average. Despite these good performances the differences between both groups regarding language persisted. CONCLUSIONS: Deficits in children with early sensory deprivation are improved with rehabilitation programs. In order to achieve better restoration, intervention should be done earlier than at 5 years of age. Even if some deficits are not fully reversible, the improvement is significant and allows social inclusion and the possibility of breaking their circle of vulnerability. SIGNIFICANCE: Documenting the importance of early rehabilitation in sensory deficits.

Experimental evidence suggestive of early intervention in mucoid otitis media.

CONCLUSIONS: Mucoid effusion can undergo a process of organization related to the inflammatory process and hypoventilation; organized effusion in the presence of epithelial breaks is a potential source for formation of granulation tissue and cholesterol granuloma within 3 months of evolution. OBJECTIVES: The aim of this study was to investigate the evolution of mucoid otitis media and its relationship with the organized effusion within a time-span of 3 months. MATERIALS AND METHODS: Two groups of animals were selected. In group I, 15 chinchillas had a chemically modified bovine collagen type 2 gelatin membrane placed through a mechanically induced tympanic membrane perforation, bridging the external auditory canal and the promontory. In group II, 75 cats underwent eustachian tube obstruction with soft grade silastic sponges. Experimental phases and animal sacrifices were performed under general anesthesia. After sacrifice, temporal bones were prepared, stained with hematoxylin and eosin and evaluated under light microscopy. RESULTS: The experimental ears in both groups were observed to undergo gradual pathological changes with increasing survival times. The acute inflammatory phase turned into chronic irreversible changes, which correlated directly with the initial amount of effusion and the areas of epithelial breaks, granulation tissue, cholesterol granuloma, and epithelial migration.

Musical brains: a study of spontaneous and evoked musical sensations without external auditory stimuli.

CONCLUSIONS: Our observations confirm that musical sensations with no external stimuli, either spontaneous or evoked, occur in normal individuals and that a biological substrate can be demonstrated by brain single photon emission computed tomography (SPECT). OBJECTIVES: There are individuals, usually musicians, who are seemingly able to evoke and/or have spontaneous musical sensations without external auditory stimuli. However, to date there is no available evidence to determine if it is feasible to have musical sensations without using external sensory receptors, or if there is a biological substrate for these sensations. SUBJECTS AND METHODS: A group of 100 musicians and another of 150 otolaryngologists were asked if they had spontaneous musical auditory sensations and/or were capable of evoking them. SPECT evaluations with Tc(99m)-HMPAO were conducted in six female musicians while they were evoking these sensations or, in one case, while she was having them spontaneously. In three of them an additional SPECT was conducted in basal conditions (having been asked to avoid evoking music). RESULTS: In all, 97 of 100 musicians had spontaneous musical sensations; all 100 could evoke and modify them. Of the 150 otolaryngologists, 18 (12%) were musicians. Of the 132 nonmusicians, spontaneous musical sensations occurred in 52 (39.4%), 72 (54.5%) could evoke and 23 (17.4%) were able to modify them, 58 (43.9%) did not have spontaneous musical sensations nor could they evoke them. The musical sensations of the 72 otolaryngologists that could evoke were less elaborated than those of musicians. NeuroSPECT during voluntary musical autoevocation demonstrated significant (>2 SD) increased activation of executive frontal cortex in Brodmann areas 9 and 10, secondary visual cortex (area 17), and paracingulate (areas 31 and 32). There was also activation in the para-executive frontal cortex (areas 45 and 46). In the basal ganglia there was activation in thalamus and lentiform nucleus. Deactivation below 2 SD was demonstrated by mean values in the cingulate gyrus, Brodmann areas 23 and 24, and subgenual area 25. Deactivation was also demonstrated when minimal values were analyzed in the same areas plus area 4 and areas 36 and 38, the latter in the pole of the temporal lobes. In three patients comparison of basal state with autoevocation demonstrated activation in executive frontal cortex (areas 8 and 9), para-executive cortex (area 45), primary auditory cortex (area 40), the right thalamus, and lentiform nucleus.

Musical brains: a study of evoked musical sensations without external auditory stimuli: preliminary report of three cases

Existen personas, generalmente músicos, que tienen la capacidad de evocar sensaciones musicales sin un estímulo auditivo externo. Sin embargo, hasta la fecha no hay evidencias que sugieran que sea posible tener estas sensaciones, ni que exista un sustrato biológico para ellas. Diseño del trabajo: Se hicieron dos estudios de neuroSPECT con [99mTc]-HMPAO en cada una de tres mujeres músicos. El primer estudio fue hecho en condiciones basales (sin evocar) y el segundo mientras estaban evocando sensaciones musicales. Resultados: En el estudio de las voluntarias que fueron evaluadas mientras evocaban una composición musical, hubo un aumento significativo de perfusión en los hemisferios derecho e izquierdo en las áreas de Brodmann 9 y 8 (área ejecutiva frontal) y en el área 40 en el lado izquierdo (área auditiva). Sin embargo, en condiciones basales no hubo aumento de perfusión en las áreas 9, 8, 39 y 40. En un caso hubo mayor aumento de perfusión en el área 45 durante la autoevocación respecto a la condición basal. Conclusiones: Estos hallazgos son sugerentes de un sustrato biológico para el proceso de evocar sensaciones musicales.

Latin American experience with the cochlear implant.

CONCLUSIONS: Complications such as migration, extrusion, skin inflammation by magnets and implant failures are mostly related to the type of device. Meticulous technique rather than specific surgical approaches seems to be the key in avoiding complications. The overall results of the Latin American experience are comparable with those reported recently in the literature. OBJECTIVE: To review the experience of Latin American groups with the cochlear implant. MATERIAL AND METHODS: A questionnaire was sent to all cochlear implant teams in Latin America. The main questions involved: (i) the type of device; (ii) the techniques used for placing and fixing the implant, surgical incision and closure; (iii) migration, exposure and failure of the implant; and (iv) skin erosion and infection. A total of 41 groups participated in the study. The total number of implanted patients involved was 3773, representing 92% of Latin American cases. RESULTS: Of the 3773 devices implanted, 5 were experimental prototypes and therefore 3768 were considered for calculations. The occurrence of complications was as follows. Migration: 13 cases (0.35%), mostly related to ceramic implants (p =0.016). Extrusion: 15 cases (0.4%), mostly related to large implants (p =0.0103). Implant failure secondary to trauma: 18 cases (0.48%) (9 in ceramic and 9 in soft implants). Spontaneous failure: 86 cases (2.28%), 74/1293 (5.72%) in ceramic and 11/2418 (0.45%) in soft implants (p = 0.0001). The most reliable implant was the Nucleus 24, with a failure rate of 0.3%. Skin inflammation by magnet: 35 cases (0.9%), mostly related to soft implants (p =0.0103). INFECTION: 26 cases (0.7%), with no significant relationship to device type.

Exploratory tympanotomy: an integral part of cochlear implantation.

We report on 113 multichannel intracochlear implantations. Although the surgical approach has evolved as a result of new implant designs, one essential step has remained, namely initial exploratory tympanotomy. This 15-min procedure allows direct anatomical assessment and work in the middle ear. After direct exposure, the lip of the niche is removed and the round window membrane is visualized. The basal turn of the cochlea is then assessed for patency, and the capability of inserting electrodes is verified. The surgical procedure is then performed in the knowledge that an adequate insertion will be possible. This approach allows insertion through the round window instead of a cochleostomy hole, thus avoiding potential damage to remaining neural structures and additional exposure of inner ear structures and electrodes to potential middle ear infections. It also requires a limited mastoidectomy (extended antrotomy) as the facial recess is visualized from the middle ear side (avoiding the need for extensive drilling), and the mastoid and facial recess openings are only used as conduits for the electrode array. In this study, 14/113 patients (12.4%) had either different degrees of ossification (n = 11) or Mondini deformity (n = 3). Direct work in the middle ear allowed handling and drilling as required in all cases. In two cases with severe ossification, a cochlea was sculpted around the modiolus. This included drilling of the anterior portion, which is inaccessible using the facial recess approach.