Dayse Távora-Vieira

Cochlear implantation for unilateral deafness with and without tinnitus: A case series

Objectives/Hypothesis To investigate cochlear implantation (CI) in patients with unilateral deafness with and without tinnitus. Study Design Prospective case series of patients undergoing cochlear implantation for unilateral deafness and tinnitus in a tertiary academic unit. Methods Nine postlingually deafened subjects with unilateral hearing loss, with and without tinnitus ipsilaterally, and functional hearing in the contralateral ear were implanted with a standard electrode. Speech perception in noise was tested using the Bamford-Kowal-Bench presented at 65 dB SPL. The Speech, Spatial, and Qualities (SSQ) of Hearing Scale was used to evaluate the subjective perception of hearing outcomes, and the Tinnitus Reaction Questionnaire assessed the effect on tinnitus. Results All patients were implanted with the Med-El Flex soft electrode, Innsbruck, Austria. They are regularly wearing the speech processor and find it beneficial in improving their ability to hear, particularly in noise. Decrease of tinnitus perception and an improvement of sound localization sounds were also reported by these patients. Conclusion In our case series, CI was successful for all nine patients, with improvement of speech recognition in noise, self-perceived improvement of hearing, and for tinnitus control. Several factors such as deafness duration, age of deafness onset, the presence of residual hearing, patient motivation, and the rehabilitation intensity need to be further investigated in order to understand their impact on performance after implantation. Level of Evidence 4.To investigate cochlear implantation (CI) in patients with unilateral deafness with and without tinnitus.

The impact of cochlear implantation on speech understanding, subjective hearing performance, and tinnitus perception in patients with unilateral severe to profound hearing loss.

Objectives This study aimed to determine the impact of cochlear implantation on speech understanding in noise, subjective perception of hearing, and tinnitus perception of adult patients with unilateral severe to profound hearing loss and to investigate whether duration of deafness and age at implantation would influence the outcomes. In addition, this article describes the auditory training protocol used for unilaterally deaf patients. Design This is a prospective study of subjects undergoing cochlear implantation for unilateral deafness with or without associated tinnitus. Methods Speech perception in noise was tested using the Bamford-Kowal-Bench speech-in-noise test presented at 65 dB SPL. The Speech, Spatial, and Qualities of Hearing Scale and the Abbreviated Profile of Hearing Aid Benefit were used to evaluate the subjective perception of hearing with a cochlear implant and quality of life. Tinnitus disturbance was measured using the Tinnitus Reaction Questionnaire. Data were collected before cochlear implantation and 3, 6, 12, and 24 months after implantation. Results Twenty-eight postlingual unilaterally deaf adults with or without tinnitus were implanted. There was a significant improvement in speech perception in noise across time in all spatial configurations. There was an overall significant improvement on the subjective perception of hearing and quality of life. Tinnitus disturbance reduced significantly across time. Age at implantation and duration of deafness did not influence the outcomes significantly. Conclusion Cochlear implantation provided significant improvement in speech understanding in challenging situations, subjective perception of hearing performance, and quality of life. Cochlear implantation also resulted in reduced tinnitus disturbance. Age at implantation and duration of deafness did not seem to influence the outcomes.

Cochlear Implant Programming: A Global Survey on the State of the Art

The programming of CIs is essential for good performance. However, no Good Clinical Practice guidelines exist. This paper reports on the results of an inventory of the current practice worldwide. A questionnaire was distributed to 47 CI centers. They follow 47600 recipients in 17 countries and 5 continents. The results were discussed during a debate. Sixty-two percent of the results were verified through individual interviews during the following months. Most centers (72%) participated in a cross-sectional study logging 5 consecutive fitting sessions in 5 different recipients. Data indicate that general practice starts with a single switch-on session, followed by three monthly sessions, three quarterly sessions, and then annual sessions, all containing one hour of programming and testing. The main focus lies on setting maximum and, to a lesser extent, minimum current levels per electrode. These levels are often determined on a few electrodes and then extrapolated. They are mainly based on subjective loudness perception by the CI user and, to a lesser extent, on pure tone and speech audiometry. Objective measures play a small role as indication of the global MAP profile. Other MAP parameters are rarely modified. Measurable targets are only defined for pure tone audiometry. Huge variation exists between centers on all aspects of the fitting practice.

Tinnitus pitch, masking, and the effectiveness of hearing aids for tinnitus therapy

Abstract Objective: To assess the benefits of hearing aids on tinnitus according to the tinnitus reaction questionnaire (TRQ; 36), to verify whether the degree of masking provided by the hearing aid influenced the TRQ score, to examine whether the matched tinnitus pitch predicted the effectiveness of hearing aids in masking tinnitus, and to determine whether prescription of high-frequency amplification might be desirable in tinnitus management when tinnitus pitch is high. Design and study sample: A retrospective evaluation of the clinical outcomes of 70 tinnitus patients fitted with hearing aids was undertaken. The primary outcome measure was the TRQ, with a secondary subjective measure of tinnitus masking. Results: Participants who achieved masking with their hearing aids had greater reduction in TRQ scores. Masking was more likely to be achieved when participants had good low-frequency hearing and tinnitus pitch fell into the frequency range of the hearing aids. Conclusions: The results support the use of hearing aids for tinnitus management, and suggest that masking may be a significant contributor to hearing aid success, implying that high-frequency amplification may be effective in high-pitch tinnitus.

Successful outcomes of cochlear implantation in long-term unilateral deafness: brain plasticity?

To investigate the implications of duration of deafness in the rehabilitation of unilateral deafness utilizing cochlear implantation. From the ongoing prospective cochlear implantation in unilateral deafness study, we looked at five adults who received a cochlear implant for long-term unilateral deafness. Speech perception in noise and subjective evaluation of the benefits of cochlear implantation were measured at 3, 6, and 12 months after implantation. The results were analyzed and compared with published data from normal hearing individuals and adults using cochlear implants bilaterally. Analysis of speech perception in noise showed significant improvement for three spatial configurations: speech and noise from the front (S0/N0; P=0.003), speech from the front and noise from the normal hearing ear (S0/NHE; P=0.001), speech from the implanted ear, and noise from the normal hearing ear (SCI/NHE; P<0.001). The scores obtained at 12 months after surgery improved to values similar to those obtained by individuals with normal hearing. The results of subjective measures showed significant improvement in hearing over time to the scores obtained by individuals with a bilateral cochlear implants and those with normal hearing. In this study, older adults with more than 25 years of unilateral deafness obtained scores in speech perception testing and in subjective evaluation that are similar to those attained by individuals with normal hearing and/or those with bilateral cochlear implants. Therefore, patients with postlingual unilateral deafness should not be excluded as cochlear implant candidates on the basis of a long duration of deafness.

Cochlear implantation improves localization ability in patients with unilateral deafness.

Objectives: One of the major complaints of people with a single-sided deafness is the inability to localize sound sources. Evidence suggests that subjects with a hearing loss can benefit from the use of a cochlear implant (CI) in sound localization. This study aimed to determine the effect of CI use on localization ability in unilaterally deafened subjects. Design: Sixteen adult subjects with postlingual unilateral deafness, fitted with a CI on the deaf side, were included in this study. The auditory speech sounds evaluation (A§E) localization test was used to determine localization with a CI on (binaural) and a CI off (monaural). The root mean square error was used as a measure of the subject’s localization performance. Stratified analyses were performed to test the influence of gender, age of implantation (<55 years and >55 years), and the duration of deafness (<10 years and >10 years) on localization ability. Results: Subjects with a CI on localized significantly better than without a CI. Gender, age, and the duration of deafness had no effect on the localization ability of the subjects. Conclusions: Cochlear implantation is effective in improving localization abilities in subjects with unilateral deafness. The root mean square error dropped significantly with binaural hearing compared to monaural hearing.

Cochlear implantation in children with congenital and noncongenital unilateral deafness: a case series

Objectives Cochlear implantation is rapidly gaining acceptance as the most effective treatment for adult patients with unilateral deafness. The benefits for the pediatric population remain to be investigated. This study aimed to investigate the implications of cochlear implantation in children with congenital and noncongenital unilateral deafness. Design Four children, three with congenital and one with a sudden unilateral deafness, were studied after implantation. The children were aged 17 months, 4.5 years, 6.8 years, and 9 years at the time of implantation. Speech perception in noise and sound localization ability were evaluated using age-appropriate materials. Results The child with postlingual unilateral deafness rapidly integrated the normal acoustic hearing with the electrical signal from the cochlear implant and showed binaural benefits, as indicated by the localization ability and the improvement of speech perception in noise scores. The younger child with congenital unilateral deafness showed some clinical evidence of binaural integration and the two older children with congenital deafness have not yet indicated signs of binaural benefits. Conclusion It seems that cochlear implantation in children with congenital unilateral deafness may provide some of the benefits of binaural hearing if implantation occurs within the critical period for bilateral auditory development.

A pilot study investigating basic fibroblast growth factor for the repair of chronic tympanic membrane perforations in pediatric patients

OBJECTIVE A pilot study to investigate the utility of basic Fibroblast Growth Factor (bFGF) in tympanic membrane perforation (TMP) closure in a small cohort of pediatric patients. METHODS Prospective cohort study. Suitability for inclusion in the study was confirmed by the application of defined inclusion and exclusion criteria, and informed parental consent obtained. The technique used was a modification of the bFGF-technique by Kanemaru et al. Response to treatment was monitored with serial otoscopy and audiometric outcomes were determined. Statistical analysis of the outcomes was carried out. RESULTS TMPs were successfully closed in 7/12 children at the first attempt (58%) and in 10/12 children overall (83%). Hearing improvement was observed in 8/10 successfully treated cases (80%). There were no complications or adverse outcomes. CONCLUSIONS The topical bFGF regeneration technique offers a promising, minimally invasive alternative to conventional myringoplasty in pediatric patients with comparable success and reduced morbidity and cost, especially considering the option of performing repeat applications. Patients with an active infection or inflammation are not suitable for the bFGF-mediated technique.

Neuromonics tinnitus treatment for patients with significant level of hearing loss: An adaptation of the protocol

Abstract Objective: In this study, we aimed to explore a variation of the NTT standard protocol that would be more beneficial for those patients with hearing loss >50 dB HL in the worst ear (average hearing thresholds at 0.5, 1, 2, and 4 KHz). Study sample: This study involved 26 subjects who had previously undergone NTT at a single private practice. Design: Patients with high level of hearing loss were divided into two groups: Standard protocol group (SP) concluded the treatment following the standard NTT protocol proposed by the treatments developers and Neuromonics guidelines. Extended protocol group (EP) was treated using a variation of the standard protocol, in which patients continued in stage 1 of the treatment for a prolonged time. Consistent with previously reported studies of the NTT, the tinnitus reaction questionnaire was used to assess tinnitus distress. Clinical outcomes for the two groups were analysed. Results: Both groups achieved statistically significant improvement of their tinnitus distress. EP group achieved quicker clinical benefits when compared to the SP group. Conclusions: Extension of high stimulation period from two to four months may be beneficial for patients with higher level of hearing loss undergoing NTT. Sumario Objetivo: En este estudio nuestro objetivo fue explorar la variación del protocolo estándar del NTT que puede ser más benéfica para los pacientes con una hipoacusia >50 dB HL en el peor oído (promedio de umbrales de audición a 0.5, 1, 2 y 4 KHz). Muestra: Este estudio incluyó a 26 sujetos que previamente habían recibido NTT en una sola clínica privada. Diseño: Los pacientes con una hipoacusia importante fueron divididos en dos grupos: el grupo del protocolo estándar (SP) concluyó el tratamiento siguiendo el protocolo NTT estándar propuesto por quienes desarrollaron las guías de Neuronomics. El grupo del protocolo extendido (EP) fue tratado utilizando una variación del protocolo estándar en el que los pacientes continuaron en el estadio 1 del tratamiento durante un tiempo prolongado. En concordancia con los resultados previamente reportados del NTT, se aplicó el cuestionario de reacción al acúfeno para evaluar la angustia por el mismo. Se analizaron los resultados clínicos de los dos grupos. Resultados: Ambos grupos alcanzaron una mejoría estadísticamente significativa del la angustia por el acúfeno. El grupo EP alcanzó el beneficio clínico más rápidamente comparado con el grupo SP. Conclusiones: La extensión del periodo de alta estimulación de dos a cuatro meses puede beneficiar a los pacientes con un nivel alto de hipoacusia que reciben NTT.

Hearing preservation cochlear implantation in children: The HEARRING Group consensus and practice guide

Objectives: To provide multidisciplinary cochlear implant teams with a current consensus statement to support hearing preservation cochlear implantation (HPCI) in children, including those children with symptomatic partial deafness (PD) where the intention is to use electric-acoustic stimulation (EAS). The main objectives are to provide guidelines on who is a candidate, how to assess these children and when to implant if Med-El Flex electrode arrays are chosen for implantation. Methods: The HEARRING group reviewed the current evidence and practice regarding the management of children to be considered for HPCI surgery emphasizing the assessment needed prior to implantation in order to demonstrate the benefits in these children over time. The consensus statement addresses following three key questions: (1) Should these children be treated? (2) How to identify these children? (3) How to manage these children? Summary: The HEARRING group concludes that irrespective of the degree of residual hearing present, the concepts of hearing and structure preservation should be applied in every child undergoing cochlear implantation and that HPCI is a safe and reliable treatment option. Early detection and multidisciplinary assessment are key to the identification of children with symptomatic PD, these children should undergo HPCI as early as possible.