RESUMO
RESUMEN Introducción: La programación adecuada de los implantes cocleares permiten lograr niveles de estimulación auditivos óptimos. Se realiza de forma individualizada, siendo la detección del umbral de confort ideal un desafío. Se ha descrito la utilidad de los potenciales auditivos del tronco encefálico eléctrico (ePEATC) y el reflejo eléctrico estapedial (eREE) para este propósito. Objetivo: Determinar la posibilidad de realizar ePEATC y eREE en pacientes adultos y pediátricos con implantes cocleares, y evaluar cambios en la programación de los implantes cocleares luego de las mediciones objetivas. Material y método: Se realizó un estudio prospectivo, descriptivo, de pacientes con implante coclear marca MED-EL®, separando los pacientes en dos grupos: el grupo adulto (n =5) y el grupo pediátrico (n =5). Todos los pacientes incluidos presentaron más de 6 meses de encendido del implante. Se evaluaron variables epidemiológicas y tiempo de encendido del implante. Se realizó una otoscopía, prueba básica de funcionamiento del implante, y las mediciones objetivas eléctricas (ePEATC, eREE). Con estos resultados se ajustó el umbral de confort. Resultados: El tiempo promedio de encendido del implante en el grupo adulto fue de 27 meses, y 30 meses en el grupo pediátrico. El ePEATC requiere más tiempo y cooperación al compararlo con eREE. Luego de estas evaluaciones objetivas, fue necesario el ajuste del umbral de confort en tres pacientes adultos, y en dos pacientes pediátricos. Fue necesario realizar una audiometría de campo libre para estimar el umbral de confort en dos pacientes pediátricos que no presentaron respuesta en eREE. Conclusión: Fue posible realizar estas mediciones objetivas en pacientes adultos y pediátricos, siendo mejor tolerado y requiriendo menos tiempo, el eREE.
ABSTRACT Introduction: Mapping a cochlear implant allows for adjusting ideal electrical stimulation limits. It is an individualized process and detecting the most comfortable loudness level can be challenging. The use of electrically evoked auditory brainstem response (ePEATC) and electrically evoked stapedius reflex thresholds (eREE) have been considered for this purpose. Aim: To determine the feasibility of performing ePEATC and eREE on adult and pediatric patients with a cochlear implant, and to evaluate changes in programming following these objective measures. Material and method: A prospective, descriptive study was completed, of patients with MED-EL® cochlear implants, separating patients into two groups: adults (n=5) and children (n=5). All of the patients included had their implants activated for 6 months or longer. Epidemiological variables and duration of implant activation were evaluated. Otoscopy, a basic implant functioning evaluation, and objective measures (ePEATC, eREE) were performed. With these results, comfortable loudness levels were adjusted. Results: Average duration of implant activation was 27 months and 30 months, for adults and children respectively. Performing ePEATC required more time and cooperation as compared to eREE. Following the objective measures, adjustment of the comfortable loudness levels was required for three adult and two pediatric patients. Sound field audiometry was necessary for two pediatric patients in order to estimate the comfortable loudness levels because the eREE responses were absent. Conclusions: It is feasible to perform these objective measures for both adult and pediatric patients, with eREE requiring less time and being better tolerated by patients.
Assuntos
Humanos , Masculino , Feminino , Pré-Escolar , Criança , Adulto , Pessoa de Meia-Idade , Adulto Jovem , Implantes Cocleares , Implante Coclear/métodos , Reflexo Acústico , Audiometria , Telemetria , Estudos Prospectivos , Potenciais Evocados Auditivos do Tronco Encefálico , Programação de Serviços de SaúdeRESUMO
INTRODUCTION AND OBJECTIVE: Auditory steady state responses to continuous amplitude modulated tones at rates between 70 and 110Hz, have been proposed as a feasible alternative to objective frequency specific audiometry in cochlear implant subjects. The aim of the present study is to obtain physiological thresholds by means of auditory steady-state response in cochlear implant patients (Clarion HiRes 90K), with acoustic stimulation, on free field conditions and to verify its biological origin. METHODS: 11 subjects comprised the sample. Four amplitude modulated tones of 500, 1000, 2000 and 4000Hz were used as stimuli, using the multiple frequency technique. The recording of auditory steady-state response was also recorded at 0dB HL of intensity, non-specific stimulus and using a masking technique. RESULTS: The study enabled the electrophysiological thresholds to be obtained for each subject of the explored sample. There were no auditory steady-state responses at either 0dB or non-specific stimulus recordings. It was possible to obtain the masking thresholds. A difference was identified between behavioral and electrophysiological thresholds of -6±16, -2±13, 0±22 and -8±18dB at frequencies of 500, 1000, 2000 and 4000Hz respectively. CONCLUSIONS: The auditory steady state response seems to be a suitable technique to evaluate the hearing threshold in cochlear implant subjects.
Assuntos
Implante Coclear , Implantes Cocleares , Perda Auditiva/diagnóstico , Perda Auditiva/cirurgia , Estimulação Acústica , Adolescente , Audiometria , Criança , Feminino , Humanos , Masculino , Adulto JovemRESUMO
This work was conducted with the objective of evaluating the influence of different levels of energy in the ration on the performance and carcass characteristics of sheep, finished in feedlot and slaughtered with 32 kg of live weight. Three treatments were evaluated: 2.23, 2.54 and 2.85 Mcal of ME/kg of DM, being the last treatment the recommendation of the National Research Council - NRC (1985) for weight daily gains of 250 g in lambs. Eighteen, intact, Texel crossbred lambs were used; six per treatment. Lambs were fed with isoprotein rations (16.70% CP). The energy recommendations proposed by the NRC (1985) resulted in smaller weight gains than expected. The energy level had a linear effect (P 0.05) on weight gain (?=-190+141X). Diets with greater energy supply rendered greater weight gains, and consequently less time for the termination of the lambs. Carcasses of animals slaughtered with similar weights presented different morphological characteristics.
Este trabalho foi realizado com o objetivo de avaliar a influência de diferentes níveis de energia na ração sobre o desempenho e características da carcaça de ovinos terminados em confinamento e abatidos aos 32 quilos de peso vivo. Foram avaliados três tratamentos: 2,23, 2,54 e 2,85 Mcal de EM/kg de MS, sendo o último tratamento, a recomendação estipulada pelo National Research Council - NRC (1985), para cordeiros com ganhos diários de 250 gramas. Foram utilizados 18 cordeiros inteiros, seis por tratamento, mestiços Texel, alimentados com rações isoprotéicas (16,70% PB). As recomendações de energia propostas pelo NRC (1985) propiciaram ganhos de peso menores do que os esperados. O nível de energia teve efeito linear (P 0,05) sobre o ganho de peso (y =-190+141X). Portanto, dietas com maior aporte energético propiciaram maior ganho de peso e consequentemente reduziram o tempo para a terminação dos cordeiros. Carcaças de animais abatidos com pesos similares apresentaram características morfológicas diferentes.
RESUMO
This work was conducted with the objective of evaluating the influence of different levels of energy in the ration on the performance and carcass characteristics of sheep, finished in feedlot and slaughtered with 32 kg of live weight. Three treatments were evaluated: 2.23, 2.54 and 2.85 Mcal of ME/kg of DM, being the last treatment the recommendation of the National Research Council - NRC (1985) for weight daily gains of 250 g in lambs. Eighteen, intact, Texel crossbred lambs were used; six per treatment. Lambs were fed with isoprotein rations (16.70% CP). The energy recommendations proposed by the NRC (1985) resulted in smaller weight gains than expected. The energy level had a linear effect (P 0.05) on weight gain (?=-190+141X). Diets with greater energy supply rendered greater weight gains, and consequently less time for the termination of the lambs. Carcasses of animals slaughtered with similar weights presented different morphological characteristics.
Este trabalho foi realizado com o objetivo de avaliar a influência de diferentes níveis de energia na ração sobre o desempenho e características da carcaça de ovinos terminados em confinamento e abatidos aos 32 quilos de peso vivo. Foram avaliados três tratamentos: 2,23, 2,54 e 2,85 Mcal de EM/kg de MS, sendo o último tratamento, a recomendação estipulada pelo National Research Council - NRC (1985), para cordeiros com ganhos diários de 250 gramas. Foram utilizados 18 cordeiros inteiros, seis por tratamento, mestiços Texel, alimentados com rações isoprotéicas (16,70% PB). As recomendações de energia propostas pelo NRC (1985) propiciaram ganhos de peso menores do que os esperados. O nível de energia teve efeito linear (P 0,05) sobre o ganho de peso (y =-190+141X). Portanto, dietas com maior aporte energético propiciaram maior ganho de peso e consequentemente reduziram o tempo para a terminação dos cordeiros. Carcaças de animais abatidos com pesos similares apresentaram características morfológicas diferentes.