Converted and upgraded maps programmed in the newer speech processor for the first generation of multichannel cochlear implant.

OBJECTIVE: To identify the technological contributions of the newer version of speech processor to the first generation of multichannel cochlear implant and the satisfaction of users of the new technology. Among the new features available, we focused on the effect of the frequency allocation table, the T-SPL and C-SPL, and the preprocessing gain adjustments (adaptive dynamic range optimization). STUDY DESIGN: Prospective exploratory study. SETTING: Cochlear implant center at hospital. PATIENTS: Cochlear implant users of the Spectra processor with speech recognition in closed set. Seventeen patients were selected between the ages of 15 and 82 and deployed for more than 8 years. INTERVENTIONS: The technology update of the speech processor for the Nucleus 22. MAIN OUTCOME MEASURES: To determine Freedom's contribution, thresholds and speech perception tests were performed with the last map used with the Spectra and the maps created for Freedom. To identify the effect of the frequency allocation table, both upgraded and converted maps were programmed. One map was programmed with 25 dB T-SPL and 65 dB C-SPL and the other map with adaptive dynamic range optimization. To assess satisfaction, SADL and APHAB were used. RESULTS: All speech perception tests and all sound field thresholds were statistically better with the new speech processor; 64.7% of patients preferred maintaining the same frequency table that was suggested for the older processor. The sound field threshold was statistically significant at 500, 1,000, 1,500, and 2,000 Hz with 25 dB T-SPL/65 dB C-SPL. Regarding patient's satisfaction, there was a statistically significant improvement, only in the subscale of speech in noise abilities and phone use. CONCLUSION: The new technology improved the performance of patients with the first generation of multichannel cochlear implant.

Quais as frequências audiométricas acometidas são responsáveis pela queixa auditiva nas disacusias por ototoxicidade após o tratamento oncológico? / What are the audiometric frequencies affected are the responsible for the hearing complaint in the hearing loss for ototoxicity after the oncological treatment?

INTRODUÇÃO: A perda auditiva neurossensorial bilateral simétrica resultante do tratamento oncológico é subestimada, pois os pacientes têm a detecção auditiva preservada, relatando queixa em determinadas situações, ou a não compreensão de parte da mensagem. OBJETIVO: Investigar quais as frequências audiométricas acometidas são responsáveis pela presença de queixa auditiva. MÉTODO: Estudo prospectivo avaliando 200 pacientes com câncer na infância fora de tratamento oncológico há no mínimo 8 anos, com idade média ao diagnóstico de 6,21 anos (4,71). Foi aplicada anamnese para investigar a presença de queixa auditiva e realizada audiometria tonal limiar. Para verificar a associação entre queixa e perda auditiva, foi empregado o teste exato de Fisher, com um erro a=5%. Os pacientes foram divididos em: audição normal, perda auditiva em 8kHz, perda em 6-8kHz, perda em 4-8kHz, perda em 2-8kHz e perda em <1-8kHz. RESULTADOS: Encontramos 125 pacientes com audição normal, 10 apresentaram queixa auditiva. Entre os pacientes com perda auditiva, 16 apresentaram perda somente em 8kHz, e 1 com queixa; 22 com perda em 6-8kHz, sendo 3 com queixa; 16 com perda em 4-8kHz, destes 10 com queixa; 15 com perda 2-8kHz, sendo 14 com queixa e 6 com perda em <1-8kHz todos com queixa. Houve relação estatisticamente significante entre perda e queixa auditiva (p<0.001), quando a frequência de 4kHz foi envolvida. CONCLUSÃO: Quanto maior o número de frequências acometidas maior a ocorrência de queixa auditiva, sobretudo quando as frequências da fala estão envolvidas, sendo que o acometimento de 4kHz já determina o aparecimento das queixas.

INTRODUCTION: The neurosensory bilateral simetric hearing loss resulting of the oncological treatment is underestimated, because the patients has the hearing detection preserved, reporting complaints in determined situation, or the not comprehension of part of the message. OBJECTIVE: Investigate which are the audiometric frequencies affected are the responsible by the presence of hearing complaints. METHOD: Prospective study evaluating 200 patients with cancer in the childhood out of the oncological treatment in at least 8 years, with average age to the diagnosis of 6,21 years (4,71). Was applied anamnesis to investigate the presence of hearing complaints and performed a tonal threshold audiometry. To check the association between the complaint and the hearing loss, was applied the Exact test of Fisher, with one error a=5%, the patients were split into: normal hearing, hearing loss in 8kHz, loss in 6-8 kHz, loss in 4-8 kHz, loss in 2-8 kHz and loss in < 1-8 kHz. RESULTS: We found 125 patients with hearing loss, 10 presented hearing complaints. Between the patients with hearing loss, 16 presented loss only at 8kHz, and 1 with complaint; 22 with loss in 6-8 kHz, being 3 with complaint; 16 with loss in 4-8 kHz, from them 10 with complaint; 15 with loss 2-8 kHz, being 14 with complaint and 6 with loss in < 1-8 kHz all with complaints. There were a significant relationship between the loss and hearing complaint (p<0,001), when the frequency of 4 kHz was involved. CONCLUSION: The bigger the number of affected frequencies the bigger the occurrence of hearing complaint, most of all when the speech frequencies are involved, and the involvement of 4 kHz already determines the appearing of the complaints.

[Community-acquired pneumonia in the elderly: clinical and nutritional aspects]. / Neumonía adquirida en la comunidad en el anciano hospitalizado: Aspectos clínicos y nutricionales.

BACKGROUND: Community acquired pneumonia (CAP) in the elderly has unique features and there is little information about the effects of nutrition status on its outcome. AIM: To assess the clinical manifestations and prognostic factors of CAP in immunocompetent elderly patients requiring hospitalization. PATIENTS AND METHODS: Prospective study of all patients with CAP, admitted to Puerto Montt Hospital, Chile over one year. Epidemiológica! and clinical information and laboratory results were recorded. A nutritional assessment was also performed. Outcomes of elderly (>65 years) and young patients were compared. RESULTS: Two hundred patients aged 63+/- 19 years were studied. Of these, 109 were older than 65 years (78.4+/-8 years) and 91 were younger than 65 years (45.5+/-11 years). Multiple associated diseases, altered mental status, absence of fever, malnutrition and mortality were more common in the older group. Suspected aspiration pneumonia was more common in younger patients, probably related to alcoholism. Malnutrition was associated with longer hospital stay and mortality at any age. An univariate analysis showed that a low serum albumin (<3.4 g/dl) and a mid arm muscle circumference below the 25th percentile were associated with higher mortality. CONCLUSIONS: CAP in the elderly has specific features and malnutrition is associated with a worse prognosis in young and elderly patients.

Neumonía adquirida en la comunidad en el anciano hospitalizado: aspectos clínicos y nutricionales / Community-acquired pneumonia in the elderly: clinical and nutritional aspects

Community acquired pneumonia (CAP) in the elderly has unique features and there is little information about the effects of nutrition status on its outcome. Aim: To assess the clinical manifestations and prognostic factors of CAP in immunocompetent elderly patients requiring hospitalization. Patients and methods: Prospective study of all patients with CAP, admitted to Puerto Montt Hospital, Chile over one year. Epidemiológica! and clinical information and laboratory results were recorded. A nutritional assessment was also performed. Outcomes of elderly (>65 years) and young patients were compared. Results: Two hundred patients aged 63± 19 years were studied. Of these, 109 were older than 65 years (78.4±8 years) and 91 were younger than 65years (45.5±11 years). Multiple associated diseases, altered mental status, absence of fever, malnutrition and mortality were more common in the older group. Suspected aspiration pneumonia was more common in younger patients, probably related to alcoholism. Malnutrition was associated with longer hospital stay and mortality at any age. An univariate analysis showed that a low serum albumin (<3.4 g/dl) and a mid arm muscle circumference below the 25th percentile were associated with higher mortality. Conclusions: CAP in the elderly has specific features and malnutrition is associated with a worse prognosis in young and elderly patients.

[Etiology and prognostics factors of community-acquired pneumonia among adults patients admitted to a regional hospital in Chile]. / Etiología y factores pronósticos de la neumonía adquirida en la comunidad en el adulto hospitalizado, Puerto Montt, Chile.

BACKGROUND: Community-acquired pneumonia (CAP) is a common and serious illness in Chile. AIM: To evaluate the etiology, severity, prognostic factors and blood culture yield of CAP requiring hospitalization in Puerto Montt in Southern, Chile. PATIENTS AND METHODS: All non immunocompromised adults with CAP admitted at Puerto Montt Hospital during one year, were prospectively studied. Clinical and radiological assessment was done in all patients. Blood and sputum cultures were obtained and serology for atypical agents was determined. RESULTS: We studied 200 patients, aged 63+/-19 years (109 males). The prognostic factors associated with mortality were an age over 65 years, an altered mental status, shock and acute renal failure. Etiology was demonstrated in 29% of patients. The most frequent pathogens were Streptococcus pneumoniae (40.7%), Haemophilus influenzae (23.7%) and Chlamydia pneumoniae (16.9%). Mixed infections were found in 17%. Fifteen atypical pathogens were identified in 12 patients. Of these only two received a specific treatment but no one died and their length hospital stay was similar than in the rest of the patients. Overall, blood cultures were positive in 12.5% of patients, but among alcoholics, 58% were positive. In only one percent of cases, positive cultures motivated therapeutic changes among clinicians. Eight percent of S pneumoniae strains were penicillin resistant. CONCLUSIONS: Atypical agents were a common cause of CAP in this group of patients, but their pathogenic role and treatment requirements are debatable. Focusing blood cultures on specific groups could improve their yield. The rate of Penicillin resistance for S pneumoniae was.

Etiologíay factores pronósticos de la neumonía adquirida en la comunidad en el adulto hospitalizado, Puerto Montt, Chile / Etiology and prognostics factors of community-acquired pneumonia among adults patients admitted to a regional hospital in Chile

Background: Community-acquired pneumonia (CAP) is a common and serious illness in Chile. Aim: To evaluate the etiology, severity, prognostic factors and blood culture yield of CAP requiring hospitalization in Puerto Montt in Southern, Chile. Patients and methods: All non immunocompromised adults with CAP admitted at Puerto Montt Hospital during one year, were prospectively studied. Clinical and radiological assessment was done in all patients. Blood and sputum cultures were obtained and serology for atypical agents was determined. Results: We studied 200 patients, aged 63±19 years (109 males). The prognostic factors associated with mortality were an age over 65 years, an altered mental status, shock and acute renal failure. Etiology was demonstrated in 29% of patients. The most frequent pathogens were Streptococcus pneumoniae (40.7%), Haemophilus influenzae (23.7%) and Chlamydia pneumoniae (16.9%). Mixed infections were found in 17%. Fifteen atypical pathogens were identified in 12 patients. Of these only two received a specific treatment but no one died and their length hospital stay was similar than in the rest of the patients. Overall, blood cultures were positive in 12.5% of patients, but among alcoholics, 58% were positive. In only one percent of cases, positive cultures motivated therapeutic changes among clinicians. Eight percent of S pneumoniae strains were penicillin resistant. Conclusions: Atypical agents were a common cause of CAP in this group of patients, but their pathogenic role and treatment requirements are debatable. Focusing blood cultures on specific groups could improve their yield. The rate of Penicillin resistance for S pneumoniae was low.

Psychoacoustic dynamic range and cochlear implant speech-perception performance in nucleus 22 users.

BACKGROUND: Cochlear implant speech processors compress a wide acoustical dynamic range of sounds into a smaller electrical dynamic range. Some patients show wider electrical dynamic ranges than others and most of them have good speech perception performance. The knowledge of the average psycho-acoustical dynamic range in adults will help the audiologist program children who do not give reliable responses. AIM: This study was conducted to analyse the dynamic ranges of experienced Nucleus 22 cochlear implant users with good speech-perception and patients with poor speech-perception performances. METHOD: Thirty-one maps of adult subjects with Nucleus 22 cochlear implants using the SPEAK processing strategy, in bipolar stimulation were analysed. By the time of this study, all of them had used a cochlear implant for over a year. They were divided into two groups: group 1, composed of those with good speech perception for sentences (better than 80%), and group 2, composed of those with speech perception results for sentences worse than 70%. RESULTS: Results showed that both dynamic ranges were wide in the two groups (average 50 units). CONCLUSION: Although dynamic ranges vary among subjects and electrodes, a lower variability was observed within the group of patients with better speech perception.

Auditory effects after organ preservation protocol for laryngeal/hypopharyngeal carcinomas.

OBJECTIVE: To investigate the prevalence of hearing loss after concomitant radiochemotherapy in patients enrolled in a larynx preservation protocol. DESIGN: Prospective study. SETTING: Consecutive patients treated in a tertiary cancer center hospital between 2001 and 2002. PATIENTS: Eligible subjects included patients prospectively enrolled in an organ preservation protocol based on concomitant radiotherapy and chemotherapy (cisplatin and paclitaxel). MAIN OUTCOME MEASURES: Descriptive analysis of the results of audiologic evaluations, including pure-tone audiometry and immitance audiometry, which were performed prior to and 8 months after treatment. Change in hearing sensitivity was computed relative to baseline measures. Criteria to indicate hearing decrease after the treatment were defined as either a 20-dB decrease at any single test frequency or a 10-dB decrease at any 2 adjacent test frequencies. RESULTS: A total of 11 patients were analyzed. Four patients (36%) had hearing loss after the treatment. CONCLUSION: Our results suggest that the prevalence of hearing loss after radiochemotherapy in larynx preservation protocols is high (36%); however, it was usually mild and asymptomatic.

Preservaçäo da audiçäo residual em pacientes usuários de implante coclear multicanal: estudo piloto / Hearing conservation after cochlear implant: pilot study

Introduçäo: Com o progresso tecnológico dos implantes cocleares, cada vez mais pacientes com audiçäo residual útil säo candidatos em potencial ao implante (Hodges et al., 1997). Apesar disso, näo se sabe ao certo se a introduçäo dos eletrodos poderia destruir as estruturas auditivas envolvidas nessa audiçäo residual. Objetivo: O objetivo deste estudo foi verificar a conservaçäo da audiçäo residual em pacientes usuários de implante coclear multicanal, comparando a audiometria pré e pós-operatória desses indivíduos. Forma de estudo: Clínico prospectivo randomizado. Material e método: Foram estudados 09 pacientes adultos com disacusia sensorioneural bilateral severa a profunda, usuários de Implante coclear Nucleus 22 e 1 paciente usuário de Implante Combi 40+. Resultado: No grupo estudado a conservaçäo auditiva ocorreu em 50 por cento dos indivíduos, quando considerado o critério de conservaçäo de duas ou mais frequências médias (da fala) e em 80 por cento, se for considerada audiçäo também em frequências graves. Conclusäo: A média de queda dos limiares tonais antes e após a cirurgia foi de 4 dB na orelha implantada e 0 dB na orelha contralateral