RESUMEN
OBJECTIVES: The current study characterizes age and incidence of cochlear implantation among qualifying children with congenital bilateral profound hearing loss in the U.S. STUDY DESIGN: Deidentified cochlear implantation data were acquired from prospectively collected patient registries from two cochlear implant (CI) manufacturers (Cochlear Americas and Advanced Bionics). Children <36 months old were assumed to have congenital bilateral profound sensorineural hearing loss. SETTING: U.S. CI centers. PATIENTS: Children <36 months old who received CIs. INTERVENTIONS: Cochlear implantation. MAIN OUTCOME MEASURES: Age at implantation and incidence. RESULTS: A total of 4,236 children <36 months old underwent cochlear implantation from 2015 to 2019. The median age at implantation was 16 months (interquartile range, 12-24 mo) and did not change significantly during the 5-year study period ( p = 0.09). Patients residing closer to CI centers ( p = 0.03) and treated at higher-volume centers ( p = 0.008) underwent implantation at a younger age. Bilateral simultaneous implantation increased from 38% to 53% of CI surgeries in 2015 and 2019, respectively. Children who received bilateral simultaneous CIs were younger compared with those receiving unilateral or bilateral sequential CIs (median, 14 versus 18 mo; p < 0.001). The incidence of cochlear implantation increased from 7,648 per 100,000 person-years in 2015 to 9,344 in 2019 ( p < 0.001). CONCLUSION: Although the incidence of pediatric CI recipients and the frequency of bilateral simultaneous implantation increased over the study period, age at implantation did not change significantly and far exceeded current Food and Drug Administration (9 mo) and American Academy of Otolaryngology and Head and Neck Surgery position statement (6-12 mo) guidelines.
Asunto(s)
Implantación Coclear , Implantes Cocleares , Pérdida Auditiva Sensorineural , Percepción del Habla , Niño , Humanos , Preescolar , Implantación Coclear/efectos adversos , Incidencia , Pérdida Auditiva Sensorineural/epidemiología , Pérdida Auditiva Sensorineural/cirugía , Pérdida Auditiva Sensorineural/rehabilitación , Implantes Cocleares/efectos adversos , Pérdida Auditiva Bilateral/cirugía , Resultado del TratamientoRESUMEN
Abstract Introduction: The use of the bilateral cochlear implants can promote the symmetrical development of the central auditory pathways, thus benefiting the development of auditory abilities and improving sound localization and the ability of auditory speech perception in situations of competitive noise. Objective: To evaluate the ability of speech perception in children and adolescents using sequential bilateral cochlear implants, considering the association of these variables: age at surgery, time of device use and interval between surgeries. Methods: A total of 14 individuals between 10 and 16 years of age, who demonstrated surgical indication for the use of sequential bilateral cochlear implants as intervention in the auditory habilitation process, were assessed. The speech perception ability was assessed through sentence lists constructed in the Portuguese language, presented in two situations: in silence, with fixed intensity of 60 dB SPL, and in competitive noise, with a signal-to-noise ratio of +15 dB. The evaluation was performed under the following conditions: unilateral with the first activated cochlear implant, unilateral with the second activated cochlear implant and bilateral with both devices activated. Results: The results of the speech perception tests showed better performance in both silence and in noise for the bilateral cochlear implant condition when compared to the 1st cochlear implant and the 2nd cochlear implant alone. A worse result of speech perception was found using the 2nd cochlear implant alone. No statistically significant correlation was found between age at the surgical procedure, interval between surgeries and the time of use of the 2nd cochlear implant, and the auditory speech perception performance for all assessed conditions. The use of a hearing aid prior to the 2nd cochlear implant resulted in benefits for auditory speech perception with the 2nd cochlear implant, both in silence and in noise. Conclusion: The bilateral cochlear implant provided better speech perception in silence and in noise situations when compared to the unilateral cochlear implant, regardless of the interval between surgeries, age at the surgical procedure and the time of use of the 2nd cochlear implant. Speech perception with the 1st cochlear implant was significantly better than with the 2nd cochlear implant, both in silence and in noise. The use of the hearing aid prior to the 2nd cochlear implant influenced speech perception performance with the 2nd cochlear implant, both in silence and in noise.
Resumo Introdução: A utilização do implante coclear bilateral pode promover o desenvolvimento das vias auditivas centrais de maneira simétrica, beneficiando, assim, o desenvolvimento das habilidades auditivas e melhorando a localização sonora e a habilidade de percepção auditiva da fala em situações de ruído competitivo. Objetivo: Avaliar a habilidade de reconhecimento de fala em crianças e adolescentes usuários do implante coclear bilateral sequencial, considerando a relação das variáveis: idade cirúrgica, tempo de uso do dispositivo e intervalo entre as cirurgias. Método: Foram avaliados 14 indivíduos entre 10 e 16 anos, que receberam indicação cirúrgica para implante coclear bilateral sequencial como forma de intervenção no processo de habilitação auditiva. A habilidade de reconhecimento de fala foi avaliada por meio de listas de sentenças construídas na língua portuguesa, apresentadas em duas situações: no silêncio, com intensidade fixa de 60 dB NPS, e no ruído competitivo, com a relação sinal/ruído de + 15 dB. A avaliação foi feita nas seguintes condições: unilateral com o 1° implante coclear ativado, unilateral com o 2° implante coclear ativado e bilateral com ambos os dispositivos ativados. Resultado: Os resultados dos testes de reconhecimento de fala demonstraram melhor desempenho tanto no silêncio quanto no ruído para a condição implante coclear bilateral, quando comparado ao 1° implante coclear e 2° implante coclear isoladamente. Um pior resultado de reconhecimento de fala foi encontrado com o uso do 2° implante coclear isoladamente. Não foi encontrada correlação estatisticamente significante entre idade cirúrgica, intervalo entre as cirurgias e tempo de uso do 2° implante coclear e o desempenho de percepção auditiva da fala para todas as condições avaliadas. O uso do aparelho de amplificação sonora individual anterior ao 2° implante coclear beneficiou os resultados de percepção auditiva da fala com o 2° implante coclear, tanto no silêncio quanto no ruído. Conclusão: O implante coclear bilateral proporcionou melhor reconhecimento de fala em situações de silêncio e de ruído, quando comparado com o implante coclear unilateral, independentemente do intervalo entre as cirurgias, da idade cirúrgica e do tempo de uso do 2° implante coclear. O reconhecimento de fala com o 1° implante coclear foi significativamente melhor do que com o 2° implante coclear, tanto no silêncio quanto no ruído. O uso do aparelho de amplificação sonora individual anterior ao 2° implante coclear influenciou o desempenho de reconhecimento de fala com o 2° implante coclear, tanto no silêncio quanto no ruído.
Asunto(s)
Humanos , Niño , Adolescente , Percepción del Habla/fisiología , Implantes Cocleares , Implantación Coclear/métodos , Pérdida Auditiva Bilateral/cirugía , Vías Auditivas , Percepción Auditiva , Localización de Sonidos/fisiología , Audición/fisiología , Ruido/efectos adversosRESUMEN
Abstract Introduction: Despite recent advancement in the prediction of cochlear implant outcome, the benefit of bilateral procedures compared to bimodal stimulation and how we predict speech perception outcomes of sequential bilateral cochlear implant based on bimodal auditory performance in children remain unclear. Objectives: This investigation was performed: (1) to determine the benefit of sequential bilateral cochlear implant and (2) to identify the associated factors for the outcome of sequential bilateral cochlear implant. Methods: Observational and retrospective study. We retrospectively analyzed 29 patients with sequential cochlear implant following bimodal-fitting condition. Audiological evaluations were performed; the categories of auditory performance scores, speech perception with monosyllable and disyllables words, and the Korean version of Ling. Audiological evaluations were performed before sequential cochlear implant with the bimodal fitting condition (CI1 + HA) and one year after the sequential cochlear implant with bilateral cochlear implant condition (CI1 + CI2). The good performance group (GP) was defined as follows; 90% or higher in monosyllable and bisyllable tests with auditory-only condition or 20% or higher improvement of the scores with CI1 + CI2. Age at first implantation, inter-implant interval, categories of auditory performance score, and various comorbidities were analyzed by logistic regression analysis. Results: Compared to the CI1 + HA, CI1 + CI2 provided significant benefit in categories of auditory performance, speech perception, and Korean version of Ling results. Preoperative categories of auditory performance scores were the only associated factor for being GP (odds ratio = 4.38, 95% confidence interval - 95% = 1.07-17.93, p = 0.04). Conclusions: The children with limited language development in bimodal condition should be considered as the sequential bilateral cochlear implant and preoperative categories of auditory performance score could be used as the predictor in speech perception after sequential cochlear implant.
Resumo Introdução: Apesar dos avanços recentes na predição do resultado do implante coclear, ainda não está claro o benefício do procedimento bilateral em comparação com a estimulação bimodal e como podemos prever resultados de percepção da fala com implante coclear bilateral sequencial com base no desempenho auditivo bimodal em crianças. Objetivos: Este estudo foi realizado para: 1) Determinar o benefício do implante coclear bilateral sequencial e 2) Identificar os fatores associados com o resultado do implante bilateral sequencial. Método: Estudo observacional e retrospectivo. Analisamos retrospectivamente 29 pacientes com implantes sequenciais após a adaptação bimodal. Avaliações audiológicas foram realizadas; os escores das categorias de desempenho auditivo, a percepção da fala com palavras monossílabas e dissílabas e a versão coreana de Ling. As avaliações audiológicas foram realizadas antes do implante sequencial com o ajuste bimodal (IC1 + AH) e um ano após o implante coclear sequencial com implante bilateral (IC1 + IC2). O grupo com bom desempenho (BD) foi definido da seguinte forma: 90% ou mais em testes com monossílabos e dissílabos com condição apenas auditiva ou melhoria de 20% ou mais dos escores com IC1 + IC2. A idade no primeiro implante, o intervalo interimplante, o escore categorias de desempenho auditivo e as diversas comorbidades foram analisadas através de análise de regressão logística. Resultados: Em comparação com o IC1 + AA, IC1 + IC2 demonstraram benefícios significativos nos escores categorias de desempenho auditivo, percepção da fala e a versão coreana de Ling. Os escores de categorias de desempenho auditivo pré-operatórios foram o único fator associado para ser do grupo BD (odds ratio - OR = 4,38, intervalo de confiança de 95% - IC 95% = 1,07-17,93, p = 0,04). Conclusões: As crianças com desenvolvimento limitado de linguagem em condição bimodal devem ser consideradas, pois o implante coclear bilateral sequencial e o escore pré-operatório das categorias de desempenho auditivo poderiam ser usados como preditores na percepção da fala após implante sequencial.
Asunto(s)
Humanos , Masculino , Femenino , Lactante , Preescolar , Niño , Adolescente , Percepción del Habla/fisiología , Implantes Cocleares , Implantación Coclear/métodos , Pérdida Auditiva Bilateral/cirugía , Estudios Retrospectivos , Estudios de Seguimiento , Resultado del Tratamiento , Audición/fisiologíaRESUMEN
INTRODUCTION: The use of the bilateral cochlear implants can promote the symmetrical development of the central auditory pathways, thus benefiting the development of auditory abilities and improving sound localization and the ability of auditory speech perception in situations of competitive noise. OBJECTIVE: To evaluate the ability of speech perception in children and adolescents using sequential bilateral cochlear implants, considering the association of these variables: age at surgery, time of device use and interval between surgeries. METHODS: A total of 14 individuals between 10 and 16 years of age, who demonstrated surgical indication for the use of sequential bilateral cochlear implants as intervention in the auditory habilitation process, were assessed. The speech perception ability was assessed through sentence lists constructed in the Portuguese language, presented in two situations: in silence, with fixed intensity of 60dB SPL, and in competitive noise, with a signal-to-noise ratio of +15dB. The evaluation was performed under the following conditions: unilateral with the first activated cochlear implant, unilateral with the second activated cochlear implant and bilateral with both devices activated. RESULTS: The results of the speech perception tests showed better performance in both silence and in noise for the bilateral cochlear implant condition when compared to the 1st cochlear implant and the 2nd cochlear implant alone. A worse result of speech perception was found using the 2nd cochlear implant alone. No statistically significant correlation was found between age at the surgical procedure, interval between surgeries and the time of use of the 2nd cochlear implant, and the auditory speech perception performance for all assessed conditions. The use of a hearing aid prior to the 2nd cochlear implant resulted in benefits for auditory speech perception with the 2nd cochlear implant, both in silence and in noise. CONCLUSION: The bilateral cochlear implant provided better speech perception in silence and in noise situations when compared to the unilateral cochlear implant, regardless of the interval between surgeries, age at the surgical procedure and the time of use of the 2nd cochlear implant. Speech perception with the 1st cochlear implant was significantly better than with the 2nd cochlear implant, both in silence and in noise. The use of the hearing aid prior to the 2nd cochlear implant influenced speech perception performance with the 2nd cochlear implant, both in silence and in noise.
Asunto(s)
Implantación Coclear/métodos , Implantes Cocleares , Pérdida Auditiva Bilateral/cirugía , Percepción del Habla/fisiología , Adolescente , Vías Auditivas , Percepción Auditiva , Niño , Audición/fisiología , Humanos , Ruido/efectos adversos , Localización de Sonidos/fisiologíaRESUMEN
INTRODUCTION: Despite recent advancement in the prediction of cochlear implant outcome, the benefit of bilateral procedures compared to bimodal stimulation and how we predict speech perception outcomes of sequential bilateral cochlear implant based on bimodal auditory performance in children remain unclear. OBJECTIVES: This investigation was performed: (1) to determine the benefit of sequential bilateral cochlear implant and (2) to identify the associated factors for the outcome of sequential bilateral cochlear implant. METHODS: Observational and retrospective study. We retrospectively analyzed 29 patients with sequential cochlear implant following bimodal-fitting condition. Audiological evaluations were performed; the categories of auditory performance scores, speech perception with monosyllable and disyllables words, and the Korean version of Ling. Audiological evaluations were performed before sequential cochlear implant with the bimodal fitting condition (CI1+HA) and one year after the sequential cochlear implant with bilateral cochlear implant condition (CI1+CI2). The good performance group (GP) was defined as follows; 90% or higher in monosyllable and bisyllable tests with auditory-only condition or 20% or higher improvement of the scores with CI1+CI2. Age at first implantation, inter-implant interval, categories of auditory performance score, and various comorbidities were analyzed by logistic regression analysis. RESULTS: Compared to the CI1+HA, CI1+CI2 provided significant benefit in categories of auditory performance, speech perception, and Korean version of Ling results. Preoperative categories of auditory performance scores were the only associated factor for being GP (odds ratio=4.38, 95% confidence interval - 95%=1.07-17.93, p=0.04). CONCLUSIONS: The children with limited language development in bimodal condition should be considered as the sequential bilateral cochlear implant and preoperative categories of auditory performance score could be used as the predictor in speech perception after sequential cochlear implant.
Asunto(s)
Implantación Coclear/métodos , Implantes Cocleares , Pérdida Auditiva Bilateral/cirugía , Percepción del Habla/fisiología , Adolescente , Niño , Preescolar , Femenino , Estudios de Seguimiento , Audición/fisiología , Humanos , Lactante , Masculino , Estudios Retrospectivos , Resultado del TratamientoRESUMEN
OBJECTIVE: To describe, in terms of functional gain and word recognition, the audiological results of patients under 18 years of age implanted with the active bone conduction implant, Bonebridge™. DESIGN: Retrospective case studies conducted by reviewing the medical records of patients receiving implants between 2014 and 2016 in the public health sector in Chile. STUDY SAMPLE: All patients implanted with the Bonebridge were included (N = 15). Individuals who had bilateral conductive hearing loss, secondary to external ear malformations, were considered as candidates. RESULTS: The average hearing threshold one month after switch on was 25.2 dB (95%CI 23.5-26.9). Hearing thresholds between 0.5 and 4 kHz were better when compared with bone conduction hearing aids. Best performance was observed at 4 kHz, where improvements to hearing were observed throughout the adaptation process. There was evidence of a significant increase in the recognition of monosyllables. CONCLUSIONS: The Bonebridge implant showed improvements to hearing thresholds and word recognition in paediatric patients with congenital conductive hearing loss.
Asunto(s)
Conducción Ósea , Microtia Congénita/cirugía , Conducto Auditivo Externo/cirugía , Pérdida Auditiva Bilateral/cirugía , Pérdida Auditiva Conductiva/cirugía , Prótesis Osicular , Reemplazo Osicular/instrumentación , Percepción del Habla , Adolescente , Conducta del Adolescente , Desarrollo del Adolescente , Umbral Auditivo , Niño , Conducta Infantil , Desarrollo Infantil , Preescolar , Chile , Microtia Congénita/diagnóstico , Microtia Congénita/fisiopatología , Microtia Congénita/psicología , Conducto Auditivo Externo/anomalías , Conducto Auditivo Externo/fisiopatología , Femenino , Pérdida Auditiva Bilateral/diagnóstico , Pérdida Auditiva Bilateral/fisiopatología , Pérdida Auditiva Bilateral/psicología , Pérdida Auditiva Conductiva/diagnóstico , Pérdida Auditiva Conductiva/fisiopatología , Pérdida Auditiva Conductiva/psicología , Humanos , Masculino , Diseño de Prótesis , Reconocimiento en Psicología , Recuperación de la Función , Estudios Retrospectivos , Resultado del TratamientoRESUMEN
OBJECTIVE: The relationship between unilateral preimplantation and postimplantation auditory performance in patients undergoing sequential cochlear implantation (SCI) has not been clearly defined. A greater understanding of this relationship could affect preoperative counseling to patients regarding choice of initial side to implant. STUDY DESIGN: Retrospective case series. SETTING: Tertiary otologic practice. PATIENTS: Adult/pediatric SCI recipients. OUTCOME MEASURES: Unilateral auditory performance preimplantation and postimplantation was assessed. To compare interaural preimplantation performance, we defined a "better-hearing ear" as better pure tone average or speech awareness/reception threshold by at least 10 dB or open/closed-set speech perception score at least 10 percentage points higher. RESULTS: Ninety patients underwent SCI from 1997 to 2011; 34 children and 22 adults with at least 6 months of bilateral implant use underwent further analysis. Preoperatively, the first-implanted ear was better hearing in 6 cases, poorer hearing in 15 cases, and equal hearing in 35 individuals. The proportion of SCI recipients exhibiting better long-term performance of the first-implanted ear was not significantly different from the proportion exhibiting equal or better performance of the second-implanted ear (p = 0.79, χ²), irrespective of preoperative hearing status. The first-implanted ear exhibited better closed/open-set speech perception scores in 41% (9/22) adult and 59% (20/34) pediatric patients at a mean most recent test point of 25 and 39 months, respectively. CONCLUSION: Preimplantation unilateral hearing status was not found to influence relative interaural performance differences after SCI. This finding highlights the relative unimportance of preoperative audiometry and speech recognition scores for guiding clinical decisions regarding implant ear selection.
Asunto(s)
Implantación Coclear , Pérdida Auditiva Bilateral/cirugía , Percepción del Habla/fisiología , Adolescente , Adulto , Audiometría , Niño , Implantes Cocleares , Femenino , Pérdida Auditiva Bilateral/fisiopatología , Pruebas Auditivas , Humanos , Masculino , Estudios Retrospectivos , Resultado del TratamientoRESUMEN
UNLABELLED: Cochlear implants represent a significant breakthrough in the treatment of hearing loss. Evidence indicates bilateral hearing brings significant benefits to patients, particularly when binaural hearing is offered. OBJECTIVE: To describe the first case of implantation of a Digisonic SP® Binaural Neurelec device in Brazil (the third implant placed in the Americas, after Mexico and Colombia) and the chosen surgical approach. METHOD: Description of a surgical approach. RESULTS: The procedure was successfully completed. DISCUSSION: The squelch effect, binaural summation, location of the sound source, and the shadow effect of the head are listed among the reasons to explain the superiority of binaural rehabilitation. Cost of treatment must be considered in the development of public health policies. CONCLUSION: The cost of cochlear implants has been one of the main impediments to bilateral rehabilitation. The Digisonic SP® Binaural Neurelec device addresses this issue and exposes patients to less risk through a minimally invasive implantation procedure.
Asunto(s)
Implantación Coclear/métodos , Implantes Cocleares , Pérdida Auditiva Bilateral/cirugía , Pérdida Auditiva Sensorineural/cirugía , Adulto , Implantación Coclear/instrumentación , Femenino , Humanos , Masculino , Localización de Sonidos , Percepción del Habla , Resultado del TratamientoRESUMEN
O implante coclear é um grande avanço no tratamento da surdez. Há grandes evidências que a audição bilateral traz diversas vantagens ao ser humano e muito mais quando se trata de audição binaural. OBJETIVO: Este artigo tem por objetivo descrever o primeiro caso operado no Brasil, sendo o terceiro país das Américas (México e Colômbia) a realizar, com implante binaural Neurelec Digisonic SP® demonstrando a técnica cirúrgica. MÉTODO: Descrição da técnica cirúrgica. RESULTADOS: Ver técnica cirúrgica. Procedimento ocorreu sem intercorrências. DISCUSSÃO: O efeito "squelch", a somação binaural, a localização da fonte sonora e o efeito sombra da cabeça são umas das principais razões que justificam a superioridade da reabilitação binaural. O custo do tratamento deve ser levado em conta em políticas de saúde pública. CONCLUSÃO: Custo do implante coclear é um dos grandes limitadores da bilateralidade na reabilitação desse grupo de pacientes, porém, com essa tecnologia, é possível solucionar esse problema, expondo o paciente a poucos riscos, com o uso de uma técnica cirúrgica pouco invasiva.
Cochlear implants represent a significant breakthrough in the treatment of hearing loss. Evidence indicates bilateral hearing brings significant benefits to patients, particularly when binaural hearing is offered. OBJECTIVE: To describe the first case of implantation of a Digisonic SP® Binaural Neurelec device in Brazil (the third implant placed in the Americas, after Mexico and Colombia) and the chosen surgical approach. METHOD: Description of a surgical approach. RESULTS: The procedure was successfully completed. DISCUSSION: The squelch effect, binaural summation, location of the sound source, and the shadow effect of the head are listed among the reasons to explain the superiority of binaural rehabilitation. Cost of treatment must be considered in the development of public health policies. CONCLUSION: The cost of cochlear implants has been one of the main impediments to bilateral rehabilitation. The Digisonic SP® Binaural Neurelec device addresses this issue and exposes patients to less risk through a minimally invasive implantation procedure.
Asunto(s)
Adulto , Femenino , Humanos , Masculino , Implantes Cocleares , Implantación Coclear/métodos , Pérdida Auditiva Bilateral/cirugía , Pérdida Auditiva Sensorineural/cirugía , Implantación Coclear/instrumentación , Localización de Sonidos , Percepción del Habla , Resultado del TratamientoRESUMEN
OBJECTIVES: To report the results of cochlear implantation via the middle fossa approach in 4 patients, discuss the complications, and present a detailed description of the programming specifications in these cases. STUDY DESIGN: Retrospective case review. SETTING: Tertiary-care referral center with a well-established cochlear implant program. PATIENTS: Four patients with bilateral canal wall down mastoid cavities who underwent the middle fossa approach for cochlear implantation. INTERVENTIONS: Cochlear implantation and subsequent rehabilitation. A middle fossa approach with cochleostomy was successfully performed on the most superficial part of the apical turn in 4 patients. A Nucleus 24 cochlear implant system was used in 3 patients and a MED-EL Sonata Medium device in 1 patient. The single electrode array was inserted through a cochleostomy from the cochlear apex and occupied the apical, middle, and basal turns. Telemetry and intraoperative impedance recordings were performed at the end of surgery. A CT scan of the temporal bones was performed to document electrode insertion for all of the patients. MAIN OUTCOME MEASURES: Complications, hearing thresholds, and speech perception outcomes were evaluated. RESULTS: Neural response telemetry showed present responses in all but 1 patient, who demonstrated facial nerve stimulation during the test. Open-set speech perception varied from 30% to 100%, despite the frequency allocation order of the MAP. CONCLUSION: Cochlear implantation via the middle cranial fossa is a safe approach, although it is a challenging procedure, even for experienced surgeons.
Asunto(s)
Implantación Coclear/métodos , Fosa Craneal Media/cirugía , Pérdida Auditiva/terapia , Procedimientos Quirúrgicos Otológicos/métodos , Adulto , Umbral Auditivo/fisiología , Quimioradioterapia/efectos adversos , Colesteatoma del Oído Medio/complicaciones , Colesteatoma del Oído Medio/cirugía , Implantación Coclear/efectos adversos , Fosa Craneal Media/anatomía & histología , Enfermedades del Oído/terapia , Nervio Facial/fisiología , Femenino , Pérdida Auditiva Bilateral/cirugía , Humanos , Masculino , Apófisis Mastoides/cirugía , Persona de Mediana Edad , Monitoreo Fisiológico , Neoplasias Nasofaríngeas/complicaciones , Neoplasias Nasofaríngeas/terapia , Procedimientos Quirúrgicos Otológicos/efectos adversos , Complicaciones Posoperatorias/terapia , Estudios Retrospectivos , Percepción del Habla , Telemetría , Hueso Temporal/diagnóstico por imagen , Tomografía Computarizada por Rayos X , Resultado del TratamientoRESUMEN
UNLABELLED: Neurofibromatosis 2 (NF2) is an autosomal dominant disease in which hearing loss is predominant. Auditory restoration is possible using cochlear implants (CI) or auditory brainstem implant (ABI). OBJECTIVE: To assess the auditory results of CI and ABI in NF2 patients and review the literature. METHODS: Four NF2 patients were prospectively evaluated. They were submitted to tumor resection followed by ipsilateral CI or ABI depending on cochlear nerve preservation. Long term auditory results were described for CI (12 months) and ABI (48 months). RESULTS: All patients achieved auditory perception improvements in their hearing thresholds. The CI patient does not recognize vowels or sentences. The 3 ABI patients discriminate 70% of vowels and 86% in the 4-choice test. One of them does not recognize sentences. The other two recognize 100% of closed sentences and 10% and 20% of open sentences. CONCLUSION: The choice of implant type to restore hearing to NF2 patients will relay on anatomical and functional cochlear nerve preservation during tumor resection surgery. Although our experience was different, the literature shows that if this condition is achieved, CI will offer better auditory results. If not, ABI is recommended.
Asunto(s)
Implantes Auditivos de Tronco Encefálico , Implantación Coclear , Pérdida Auditiva Bilateral/cirugía , Neurofibromatosis 2/complicaciones , Adulto , Femenino , Estudios de Seguimiento , Pérdida Auditiva Bilateral/etiología , Humanos , Masculino , Estudios Prospectivos , Resultado del TratamientoRESUMEN
Neurofibromatose 2 (NF2) é uma doença autossômica dominante que, invariavelmente, cursa com surdez. Restauração auditiva pode ser realizada por meio do implante coclear (IC) ou implante auditivo de tronco encefálico (ABI). OBJETIVO: Avaliar resultados auditivos de IC e ABI em pacientes com NF2 e revisão de literatura. MÉTODO: Foram avaliados prospectivamente quatro pacientes com NF2 submetidos à exérese tumoral e implantação de IC ou ABI ipsilateral simultâneo, dependendo se o nervo coclear foi preservado ou não cirurgicamente. São descritos resultados auditivos em longo prazo (12-48 meses). RESULTADOS: Todos pacientes implantados obtiveram percepção sonora, com melhora dos limiares tonais. A paciente com IC não discrimina vogais nem sentenças. Os três pacientes com ABI apresentam discriminação média de vogais de 70% e teste 4-choice 86%. Um paciente não discrimina sentenças. Os outros dois discriminam 100% de sentenças em formato fechado e em formato aberto 10% e 20%. CONCLUSÃO: A escolha do tipo de implante usado na restauração auditiva de portadores NF2 dependerá da preservação anatômica e funcional do nervo coclear na cirurgia de ressecção tumoral. Embora nossa experiência mostre o contrário, a literatura mostra que, se essa condição for alcançada, IC fornecerá melhores resultados auditivos. Caso contrário, ABI trará maiores benefícios.
Neurofibromatosis 2 (NF2) is an autosomal dominant disease in which hearing loss is predominant. Auditory restoration is possible using cochlear implants (CI) or auditory brainstem implant (ABI). OBJECTIVE: To assess the auditory results of CI and ABI in NF2 patients and review the literature. METHODS: Four NF2 patients were prospectively evaluated. They were submitted to tumor resection followed by ipsilateral CI or ABI depending on cochlear nerve preservation. Long term auditory results were described for CI (12 months) and ABI (48 months). RESULTS: All patients achieved auditory perception improvements in their hearing thresholds. The CI patient does not recognize vowels or sentences. The 3 ABI patients discriminate 70% of vowels and 86% in the 4-choice test. One of them does not recognize sentences. The other two recognize 100% of closed sentences and 10% and 20% of open sentences. CONCLUSION: The choice of implant type to restore hearing to NF2 patients will relay on anatomical and functional cochlear nerve preservation during tumor resection surgery. Although our experience was different, the literature shows that if this condition is achieved, CI will offer better auditory results. If not, ABI is recommended.
Asunto(s)
Adulto , Femenino , Humanos , Masculino , Implantes Auditivos de Tronco Encefálico , Implantación Coclear , Pérdida Auditiva Bilateral/cirugía , /complicaciones , Estudios de Seguimiento , Pérdida Auditiva Bilateral/etiología , Estudios Prospectivos , Resultado del TratamientoRESUMEN
UNLABELLED: A new era has arrived in auditory rehabilitation with the introduction of new technologies such as electroacoustic stimulation (EAS). EAS is indicated for patients with residual hearing at low frequencies and severe or profound hearing loss at high frequencies. These patients have no indication for conventional cochlear implant and have difficulties in adapting to individual sound amplification devices. Preservation of hearing is vital in this process; the surgical technique must be based on this concept. OBJECTIVES: To present the cochlear implant surgical technique with MED-EL Mand FlexEAS to preserve hearing in patients with hearing loss at high frequencies and to maintain low frequency hearing. We are the first institution to carry out this treatment in Brazil. METHODS: A case report of the surgical technique carried out in four patients; the procedure was carried out by the cochlear implant group of a specialized clinical hospital. RESULTS: The procedures were successful and uneventful. CONCLUSION: We described the technique used at our institution for implants using EAS; the surgical technique is complex and includes steps for preservation of hearing.
Asunto(s)
Estimulación Acústica/métodos , Implantación Coclear/métodos , Estimulación Eléctrica/métodos , Pérdida Auditiva Bilateral/cirugía , Pérdida Auditiva Sensorineural/cirugía , Pérdida Auditiva Bilateral/rehabilitación , Pérdida Auditiva Sensorineural/rehabilitación , Humanos , Índice de Severidad de la Enfermedad , Resultado del TratamientoRESUMEN
A reabilitação auditiva entrou numa nova era com o desenvolvimento e aperfeiçoamento de próteses implantáveis, principalmente com a associação do conceito de a estimulação eletroacústica (EAS) e implante coclear. A EAS é indicada para pacientes com audição residual nas baixas frequências e disacusia grave/profunda nas médias e altas frequências. Esses pacientes não teriam indicação para o implante coclear convencional e teriam dificuldades na adaptação com o aparelho de amplificação sonoro individual. A técnica cirúrgica utilizada deve-se basear nos conceitos de preservação auditiva e é fundamental nesse processo. OBJETIVOS: Descrever a técnica cirúrgica para procedimento de implante coclear MED-EL Mand FlexEAS, com intuito de preservar o resíduo auditivo e reabilitar satisfatoriamente a audição deteriorada, sendo o primeiro centro a realizar tal tratamento no Brasil. MATERIAL E MÉTODOS: Descrição de técnica cirúrgica utilizada pelo serviço de otologia de hospital terciário por meio de estudo de caso. RESULTADOS: Procedimentos realizados sem intercorrências. A técnica utilizada segue passos que objetivam a preservação auditiva. CONCLUSÃO: Descrevemos a técnica utilizada para implantes com EAS realizados no nosso serviço. A técnica cirúrgica é complexa e inclui passos que visam à preservação auditiva.
A new era has arrived in auditory rehabilitation with the introduction of new technologies such as electroacoustic stimulation (EAS). EAS is indicated for patients with residual hearing at low frequencies and severe or profound hearing loss at high frequencies. These patients have no indication for conventional cochlear implant and have difficulties in adapting to individual sound amplification devices. Preservation of hearing is vital in this process; the surgical technique must be based on this concept. OBJECTIVES: To present the cochlear implant surgical technique with MED-EL Mand FlexEAS to preserve hearing in patients with hearing loss at high frequencies and to maintain low frequency hearing. We are the first institution to carry out this treatment in Brazil. METHODS: A case report of the surgical technique carried out in four patients; the procedure was carried out by the cochlear implant group of a specialized clinical hospital. RESULTS: The procedures were successful and uneventful. CONCLUSION: We described the technique used at our institution for implants using EAS; the surgical technique is complex and includes steps for preservation of hearing.
Asunto(s)
Humanos , Estimulación Acústica/métodos , Implantación Coclear/métodos , Estimulación Eléctrica/métodos , Pérdida Auditiva Bilateral/cirugía , Pérdida Auditiva Sensorineural/cirugía , Pérdida Auditiva Bilateral/rehabilitación , Pérdida Auditiva Sensorineural/rehabilitación , Índice de Severidad de la Enfermedad , Resultado del TratamientoAsunto(s)
Implantación Coclear/métodos , Pérdida Auditiva Bilateral/cirugía , Meningioma/cirugía , Neurofibromatosis 2/cirugía , Pérdida Auditiva Bilateral/etiología , Pérdida Auditiva Bilateral/rehabilitación , Humanos , Masculino , Meningioma/complicaciones , Neurofibromatosis 2/complicaciones , Adulto JovenRESUMEN
The traditional access route for cochlear implantation was initially proposed by William House in 1961. Alternatives to this surgical approach have been suggested by many authors. The combined approach technique (CAT) is a variation of the traditional mastoidectomy-posterior tympanotomy method, which uses a transcanal approach to cochleostomy combined with a small mastoidectomy and an equally small posterior tympanotomy for the insertion of electrodes. This paper presents a detailed description of this alternative procedure, reporting our experience with 50 cases, and adds our contribution regarding possible advantages and implications of using a transcanal cochleostomy. The subjects had profound and severe bilateral hearing loss and had not benefited from external hearing aids. They underwent cochlear implantation at Hospital de Clinicas de Porto Alegre from May 2003. The median follow-up was 29 months. All cases were successfully implanted using CAT. No major complications, such as facial paralysis or paresis, meningitis, cholesteatoma, or cerebrospinal fluid leaks, were observed in any patient. The CAT is a safe and efficient variation of cochlear implantation surgery, which is especially appropriate if cochlear calcification or malformations are present, or whenever cochleostomy has to be performed anteriorly, and when the position of the facial nerve prevents an adequate posterior tympanotomy.
Asunto(s)
Cóclea/cirugía , Implantación Coclear/métodos , Procedimientos Quirúrgicos Otológicos , Adolescente , Adulto , Niño , Preescolar , Femenino , Pérdida Auditiva Bilateral/cirugía , Humanos , Masculino , Apófisis Mastoides/cirugía , Persona de Mediana Edad , Procedimientos Quirúrgicos Otológicos/efectos adversos , Seguridad , Resultado del Tratamiento , Membrana Timpánica/cirugía , Adulto JovenRESUMEN
Objetivo: Mostrar los resultados obtenidos mediante el uso del Implante Auditivo de Tronco Cerebral (IATC) en niños con imposibilidad de recibir un implante coclear (IC), con hipoacusia no asociada a Neurofibromatosis tipo II (NFII). Tipo de estudio: Presentación de casos. Material y método: Se muestran los resultados obtenidos en los dos primeros casos en América en niños (3 y 10 años, respectivamente) a los que se les colocó un I A TC por agenesia de nervio y cóclea. Resultados: Se logró niveles de 30db a 40 db en las audiometrías posteriores a la activación en frecuencias de 250-6.000 Hz, lograron detectar el test de Ling en su totalidad, con buena y rápida respuesta al nombre en una situación estructurada y sin pistas visuales dentro del primer mes de activación. Conclusiones: De acuerdo con nuestra reciente experiencia los casos de niños con agenesia de cóclea y/o nervio, pueden ser considerados para la colocación de un IATC porque la anatomía de los núcleos auditivos está intacta.
Aim: To discuss the results obtained with auditory brainstem implant (ABI) in children non-eligible for cochlear implant, presenting with non-NFII related hypoacusia. A case report study. Materials and Method: Two cases are presented, both of children (aged 3 and 10 years old, respectively), who underwent ABI because of nerve and cochlear agenesis Results: Post-implant audiometric levels were 30 to 40 dB for frequencies between 25 and 6000 Hz. Both patients were able to fully detect the Ling sound test with good and fast answers in a structured non-visual cues-situation within the first post-activation month. Conclusions: In our experience, children with nerve and/or cochlear agenesis could be considered for ABS implantation, because the auditory nuclei's anatomy is intact.