Speech perception in patients submitted to cochlear reimplantation. / Percepção auditiva da fala após o reimplante coclear.

PURPOSE: To analyze the performance of auditory speech perception (PF) after cochlear implant (CI) replacement surgery and associations with age, times of use of the first CI, deprivation, recovery and use of the second device. METHODS: The retrospective study analyzed the medical records of 68 participants reimplanted from 1990 to 2016, and evaluated with PF performance tests, considering as a reference, the greater auditory capacity identified during the use of the first CI. Also analyzed were: Etiology of hearing loss; the reasons for the reimplantation; device brands; age range; sex; affected ear; age at first implant; time of use of the first CI, deprivation, recovery and use of the second device. The analyzes followed with the Chi-Square and Spearman, Mann-Whitney and Kruskal-Wallis tests (CI=95%; p≤0.05; Software SPSS®.v22). RESULTS: Most were children with hearing loss due to idiopathic causes and meningitis. Abrupt stoppage of operation was the most common cause for device replacement. Most cases recovered and maintained or continued to progress in PF after reimplantation. Adults have the worst recovery capacity when compared to children and adolescents. The PF capacity showed a significant association (p≤0.05) with: age at first implant; time of use of the first and second CI. CONCLUSION: Periodic programming and replacement of the device when indicated are fundamental for the maintenance of auditory functions. Being young and having longer use of implants represent advantages for the development of speech perception skills.

OBJETIVO: Analisar o desempenho da percepção auditiva da fala (PF) após cirurgia de substituição do implante coclear (IC) e identificar associações com a idade, tempos de uso dos dispositivos, privação e recuperação. MÉTODO: O estudo retrospectivo analisou os prontuários de 1990 a 2016 e considerou como referência o maior escore da capacidade auditiva identificada ao longo do uso do primeiro IC. Foram coletados dados epidemiológicos; etiologia; causas da substituição e marca dos dispositivos; classificação etária; idades no primeiro e segundo implante; tempos de utilização, privação e de recuperação da capacidade auditiva. Os dados foram avaliados por meio de testes estatísticos não paramétricos (IC=95%; p<0.05). RESULTADOS: Foram avaliados 68 participantes (31 adultos e 37 crianças), sendo 52,9% do sexo feminino e as principais etiologias da perda auditiva foram: idiopática (48,5%), infecciosa (33,8%) e outras causas não infecciosas (17,6%). A idade média verificada na implantação do primeiro e do segundo IC, foram: 102±143,4 e 178,9±173,4 meses. Os tempos médios de uso do primeiro IC, privação, recuperação e uso do segundo IC, foram respectivamente: (76,1±63,3); (2,8±2,4); (6,5±7,1); (75,6±48,3) meses. A substituição foi motivada principalmente pela parada abrupta de funcionamento (77,9%) e 85,3% dos participantes recuperaram a PF, que esteve significativamente associada à idade no primeiro IC, e os tempos de utilização dos dispositivos (p<0.05). CONCLUSÃO: A maior parte dos indivíduos submetidos ao reimplante conseguem recuperar e/ou continuar o desenvolvimento das habilidades auditivas. A idade mais jovem e o tempo de uso dos dispositivos são fatores que influenciam na capacidade de recuperação da PF em reimplantados.

Analysis of aided thresholds in children who have undergone cochlear reimplantation: a ten-year follow-up. / Análise de limiares tonais de crianças submetidas ao reimplante: seguimento de 10 anos.

PURPOSE: To characterize hearing thresholds at frequencies of 500, 1000, 2000 and 4000 Hz in children undergoing reimplantation with a follow-up of at least 10 years. METHODS: Retrospective review of medical records of children who underwent reimplantation surgery for at least 10 years. The auditory thresholds obtained in free-field pure tone audiometry with the cochlear implant were evaluated at frequencies of 500, 1000, 2000 and 4000 Hz at four different times: 1 (before failure), 2 (activation), 3 (five years after reimplantation) and 4 (ten years after reimplantation, regardless of the time of use of the 2nd CI) in patients with a follow-up of at least 10 years. RESULTS: Evaluating patients who underwent reimplantation, it was observed that the thresholds of 500, 1000, 2000, 4000 Hz were similar in the long term to those obtained in patients who were implanted only once, thus not presenting damage in the detection of sounds. CONCLUSION: Reimplantation had no long-term effect on the hearing thresholds obtained in children who underwent this surgery due to internal component failure.

OBJETIVO: Caracterizar os limiares auditivos nas frequências de 500, 1000, 2000 e 4000 Hz em crianças submetidas ao reimplante com follow-up de no mínimo 10 anos. MÉTODO: Revisão retrospectiva de prontuários de crianças submetidas a cirurgia de reimplante há pelo menos 10 anos. Foram avaliados os limiares auditivos obtidos na audiometria tonal liminar em campo livre com o implante coclear nas frequências de 500, 1000, 2000 e 4000 Hz em quatro momentos distintos: 1 (antes da falha), 2 (ativação), 3 (cinco anos após o reimplante) e 4 (dez anos após o reimplante, independentemente do tempo de uso do uso do 2o IC) em pacientes com follow-up de no mínimo 10 anos. RESULTADOS: Avaliando-se pacientes submetidos ao reimplante, observou-se que os limiares de 500, 1000, 2000, 4000 Hz apresentaram-se a longo prazo semelhante àqueles obtidos nos pacientes implantados somente uma única vez, não apresentando prejuízo assim na detecção dos sons. CONCLUSÃO: O reimplante não teve efeito de longo prazo sobre os limiares auditivos obtidos em crianças que se submeteram a esta cirurgia por falha do componente interno.

Análise de limiares tonais de crianças submetidas ao reimplante: seguimento de 10 anos / Analysis of aided thresholds in children who have undergone cochlear reimplantation: a ten-year follow-up

RESUMO Objetivo Caracterizar os limiares auditivos nas frequências de 500, 1000, 2000 e 4000 Hz em crianças submetidas ao reimplante com follow-up de no mínimo 10 anos. Método Revisão retrospectiva de prontuários de crianças submetidas a cirurgia de reimplante há pelo menos 10 anos. Foram avaliados os limiares auditivos obtidos na audiometria tonal liminar em campo livre com o implante coclear nas frequências de 500, 1000, 2000 e 4000 Hz em quatro momentos distintos: 1 (antes da falha), 2 (ativação), 3 (cinco anos após o reimplante) e 4 (dez anos após o reimplante, independentemente do tempo de uso do uso do 2o IC) em pacientes com follow-up de no mínimo 10 anos. Resultados Avaliando-se pacientes submetidos ao reimplante, observou-se que os limiares de 500, 1000, 2000, 4000 Hz apresentaram-se a longo prazo semelhante àqueles obtidos nos pacientes implantados somente uma única vez, não apresentando prejuízo assim na detecção dos sons. Conclusão O reimplante não teve efeito de longo prazo sobre os limiares auditivos obtidos em crianças que se submeteram a esta cirurgia por falha do componente interno.

ABSTRACT Purpose To characterize hearing thresholds at frequencies of 500, 1000, 2000 and 4000 Hz in children undergoing reimplantation with a follow-up of at least 10 years. Methods Retrospective review of medical records of children who underwent reimplantation surgery for at least 10 years. The auditory thresholds obtained in free-field pure tone audiometry with the cochlear implant were evaluated at frequencies of 500, 1000, 2000 and 4000 Hz at four different times: 1 (before failure), 2 (activation), 3 (five years after reimplantation) and 4 (ten years after reimplantation, regardless of the time of use of the 2nd CI) in patients with a follow-up of at least 10 years. Results Evaluating patients who underwent reimplantation, it was observed that the thresholds of 500, 1000, 2000, 4000 Hz were similar in the long term to those obtained in patients who were implanted only once, thus not presenting damage in the detection of sounds. Conclusion Reimplantation had no long-term effect on the hearing thresholds obtained in children who underwent this surgery due to internal component failure.

Evaluation and results of children with Autism Spectrum Disorder using cochlear implants: an integrative literature review / Avaliação e resultados de crianças usuárias de implante coclear com Transtorno do Espectro Autista: revisão integrativa da literatura

ABSTRACT Purpose: to synthesize the evidence of available studies in the literature regarding the benefit of the cochlear implant in children with additional diagnosis of autism spectrum disorder and to verify the protocols used to validate the abilities of auditory perception and oral language of this population. Methods: an integrative literature review, searching in LILACS, MEDLINE/PubMed and SciELO databases and in the Google Scholar. Studies in Portuguese and English that assessed auditory and/or spoken language skills of children using cochlear implants with autism spectrum disorder were included. Literature Review: 16 studies were included. In 72.18% of cases, autism spectrum disorder was diagnosed when the child was already using a cochlear implant. Studies have shown limited benefit from cochlear implants for the studied population. Parents need to be oriented regarding their expectations about the use of the device. Conclusion: the benefit of using a cochlear implant for children with an additional diagnosis of autism spectrum disorder is limited and lower than the results obtained by children who do not have additional diagnoses. There is no standardized protocol for assessing auditory and language skills in this population.

RESUMO Objetivo: sintetizar as evidências de estudos disponíveis na literatura a respeito do benefício do implante coclear em crianças com diagnóstico adicional de transtorno do espectro autista e verificar quais os protocolos utilizados para a avaliação das habilidades de percepção auditiva e de linguagem falada dessa população. Métodos: trata-se de revisão integrativa da literatura. A busca foi realizada nas bases de dados LILACS, PubMed e SciELO e no Google Acadêmico. Foram incluídos estudos nos idiomas português e inglês, que avaliaram habilidades auditivas e/ou de linguagem falada de crianças usuárias de implante coclear com transtorno do espectro autista. Revisão de Literatura: 16 estudos foram incluídos. Em 72,18% dos casos, o diagnóstico do transtorno do espectro autista foi concluído quando a criança já fazia uso do implante coclear. Os estudos demonstram benefício limitado do dispositivo para a população estudada. É necessário que os pais sejam orientados a respeito das expectativas com o uso do dispositivo. Conclusão: o benefício obtido pelo uso do implante coclear por crianças com diagnóstico adicional de transtorno do espectro autista é limitado e inferior aos resultados obtidos por crianças que não apresentam diagnósticos adicionais. Não há um protocolo padronizado para a avaliação das habilidades auditivas e de linguagem dessa população.

Effects of Sequential Bilateral Cochlear Implantation in Children: Evidence from Speech-Evoked Cortical Potentials and Tests of Speech Perception.

INTRODUCTION: Benefits of bilateral cochlear implants (CI) may be compromised by delays to implantation of either ear. This study aimed to evaluate the effects of sequential bilateral CI use in children who received their first CI at young ages, using a clinical set-up. METHODS: One-channel cortical auditory evoked potentials and speech perception in quiet and noise were evoked at repeated times (0, 3, 6, 12 months of bilateral CI use) by unilateral and bilateral stimulation in 28 children with early-onset deafness. These children were unilaterally implanted before 3.69 years of age (mean ± SD of 1.98 ± 0.73 years) and received a second CI after 5.13 ± 2.37 years of unilateral CI use. Comparisons between unilaterally evoked responses were used to measure asymmetric function between the ears and comparisons between bilateral responses and each unilateral response were used to measure the bilateral benefit. RESULTS: Chronic bilateral CI promoted changes in cortical auditory responses and speech perception performance; however, large asymmetries were present between the two unilateral responses despite ongoing bilateral CI use. Persistent cortical differences between the two sides at 1 year of bilateral stimulation were predicted by increasing age at the first surgery and inter-implant delay. Larger asymmetries in speech perception occurred with longer inter-implant delays. Bilateral responses were more similar to the unilateral responses from the first rather than the second CI. CONCLUSION: These findings are consistent with the development of the aural preference syndrome and reinforce the importance of providing bilateral CIs simultaneously or sequentially with very short delays.

Development of P1 cortical auditory evoked potential in children presented with sensorineural hearing loss following cochlear implantation: a longitudinal study / Desenvolvimento do potencial evocado auditivo cortical P1 em criancas com perda auditiva sensorioneural apos o implante coclear: estudo longitudinal

Purpose: To assess the characteristics of P1 component in children presented with pre-lingual hearing loss, users of cochlear implants, and correlate them with speech perception performance. Methods: Ten children presented with pre-lingual sensory neural hearing loss using cochlear implants participated in this research. The cortical auditory evoked potential research was carried out with the /da/ speech stimulus, presented in free field, in three moments: at cochlear implant activation, with three and six months following activation. The Infant-Toddler Meaningful Auditory Integration Scale was used to verify the speech perception. Results: The correlation of the three moments of the test with the latency and the amplitude of P1 component through analysis of variance were observed. The comparison of latency and amplitude of P1 in each assessment moment was performed with Tukey's test. Wilcoxon and t-test showed that the score on the Infant-Toddler Meaningful Auditory Integration Scale increased significantly with the time of cochlear implant use, nevertheless with no correlation with the latency and amplitude of P1 component in the moments assessed, as demonstrated by Spearman's and Pearson's correlations. Conclusion: The latency and amplitude of P1 component diminish as the time of cochlear implant use increases. However, there was no correlation between its development and speech perception performance. .

OBJETIVO: Analisar as características do componente P1 em crianças com perda auditiva pré-lingual usuárias de implante coclear e correlacioná-las com o desempenho na percepção auditiva da fala. MÉTODOS: Participaram desta pesquisa dez crianças com perda auditiva pré-lingual e usuárias de implante coclear. A pesquisa do potencial evocado auditivo cortical foi realizada com o estímulo de fala /da/, apresentado em campo livre, em três momentos: na ativação do implante coclear, com três e seis meses após a ativação. Para verificar a percepção auditiva da fala, foi utilizada a Escala de Integração Auditiva Significativa para Crianças Pequenas. RESULTADOS: Foi observada correlação dos três momentos de avaliação com a latência e amplitude do componente P1 por meio da análise de variância. A comparação da latência e amplitude de P1 em cada momento foi realizada com o teste de Tukey. O teste de Wilcoxon e o teste t demonstraram que a pontuação na Escala de Integração Auditiva Significativa para Crianças Pequenas aumentou de forma significativa com o tempo de uso do implante coclear, porém sem correlação com a latência e amplitude do componente P1 nos momentos avaliados, conforme demonstrado pelas correlações de Spearman e Pearson. CONCLUSÃO: A latência e amplitude do componente P1 diminuem com o aumento do tempo de uso do implante coclear. No entanto, não houve correlação de seu desenvolvimento com o desempenho na percepção da fala. .

The influence of speech stimuli contrast in cortical auditory evoked potentials.

UNLABELLED: Studies about cortical auditory evoked potentials using the speech stimuli in normal hearing individuals are important for understanding how the complexity of the stimulus influences the characteristics of the cortical potential generated. OBJECTIVE: To characterize the cortical auditory evoked potential and the P3 auditory cognitive potential with the vocalic and consonantal contrast stimuli in normally hearing individuals. METHOD: 31 individuals with no risk for hearing, neurologic and language alterations, in the age range between 7 and 30 years, participated in this study. The cortical auditory evoked potentials and the P3 auditory cognitive one were recorded in the Fz and Cz active channels using consonantal (/ba/-/da/) and vocalic (/i/-/a/) speech contrasts. DESIGN: A crosssectional prospective cohort study. RESULTS: We found a statistically significant difference between the speech contrast used and the latencies of the N2 (p = 0.00) and P3 (p = 0.00) components, as well as between the active channel considered (Fz/Cz) and the P3 latency and amplitude values. These correlations did not occur for the exogenous components N1 and P2. CONCLUSION: The speech stimulus contrast, vocalic or consonantal, must be taken into account in the analysis of the cortical auditory evoked potential, N2 component, and auditory cognitive P3 potential.

Influência dos contrastes de fala nos potenciais evocados auditivos corticais / The influence of speech stimuli contrast in cortical auditory evoked potentials

Estudos voltados aos potenciais evocados auditivos com estímulos de fala em indivíduos ouvintes são importantes para compreender como a complexidade do estímulo influencia nas características do potencial cognitivo auditivo gerado. OBJETIVO: Caracterizar o potencial evocado auditivo cortical e o potencial cognitivo auditivo P3 com estímulos de contrastes vocálico e consonantal em indivíduos com audição normal. MÉTODO: Participaram deste estudo 31 indivíduos sem alterações auditivas, neurológicas e de linguagem na faixa etária de 7 a 30 anos. Os potenciais evocados auditivos corticais e cognitivo auditivo P3 foram registrados nos canais ativos Fz e Cz utilizando-se os contrastes de fala consonantal (/ba/-/da/) e vocálico (/i/-/a/). Desenho: Estudo de coorte, transversal e prospectivo. RESULTADOS: Houve diferença entre o contraste de fala utilizado e as latências dos componentes N2 (p = 0,00) e P3 (p = 0,00), assim como entre o canal ativo considerado (Fz/Cz) e os valores de latência e amplitude de P3. Estas diferenças não ocorreram para os componentes exógenos N1 e P2. CONCLUSÃO: O contraste do estímulo de fala, vocálico ou consonantal, deve ser considerado na análise do potencial evocado cortical, componente N2, e do potencial cognitivo auditivo P3.

Studies about cortical auditory evoked potentials using the speech stimuli in normal hearing individuals are important for understanding how the complexity of the stimulus influences the characteristics of the cortical potential generated. OBJECTIVE: To characterize the cortical auditory evoked potential and the P3 auditory cognitive potential with the vocalic and consonantal contrast stimuli in normally hearing individuals. METHOD: 31 individuals with no risk for hearing, neurologic and language alterations, in the age range between 7 and 30 years, participated in this study. The cortical auditory evoked potentials and the P3 auditory cognitive one were recorded in the Fz and Cz active channels using consonantal (/ba/-/da/) and vocalic (/i/-/a/) speech contrasts. Design: A crosssectional prospective cohort study. RESULTS: We found a statistically significant difference between the speech contrast used and the latencies of the N2 (p = 0.00) and P3 (p = 0.00) components, as well as between the active channel considered (Fz/Cz) and the P3 latency and amplitude values. These correlations did not occur for the exogenous components N1 and P2. CONCLUSION: The speech stimulus contrast, vocalic or consonantal, must be taken into account in the analysis of the cortical auditory evoked potential, N2 component, and auditory cognitive P3 potential.

Development of P1 cortical auditory evoked potential in children presented with sensorineural hearing loss following cochlear implantation: a longitudinal study.

PURPOSE: To assess the characteristics of P1 component in children presented with pre-lingual hearing loss, users of cochlear implants, and correlate them with speech perception performance. METHODS: Ten children presented with pre-lingual sensory neural hearing loss using cochlear implants participated in this research. The cortical auditory evoked potential research was carried out with the /da/ speech stimulus, presented in free field, in three moments: at cochlear implant activation, with three and six months following activation. The Infant-Toddler Meaningful Auditory Integration Scale was used to verify the speech perception. RESULTS: The correlation of the three moments of the test with the latency and the amplitude of P1 component through analysis of variance were observed. The comparison of latency and amplitude of P1 in each assessment moment was performed with Tukey's test. Wilcoxon and t-test showed that the score on the Infant-Toddler Meaningful Auditory Integration Scale increased significantly with the time of cochlear implant use, nevertheless with no correlation with the latency and amplitude of P1 component in the moments assessed, as demonstrated by Spearman's and Pearson's correlations. CONCLUSION: The latency and amplitude of P1 component diminish as the time of cochlear implant use increases. However, there was no correlation between its development and speech perception performance.