Mariana Cardoso Guedes

Resultados auditivos com o implante coclear multicanal em pacientes submetidos a cirurgia no Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo

Complete hearing loss is a very important handicap resulting in sensory deprivation and affecting an individuals personality, relationships and life style. Individuals with profound deafness are unable to hear environmental sounds as doorbells, telephones, traffic noises and sirens that are an important alert for dangerous situations in the daily life. They are also unable to hear their own voices and for this people with profound deaf do not modulate their voices. The hearing aids are the first choice to treat deafness, but there are patients with severe damage of the auditory systems who cannot receive a useful hearing from normal hearing aids. The cochlear implant is the alternative for patients that cannot have good discriminatory ability wearing a powerful hearing aid and wish or need a better hearing. AIM: To study the hearing results of the adult patients who are using a multichannel cochlear implant system at the Department of Otolaryngology - University of Sao Paulo. STUDY DESIGN: Series study. MATERIAL AND METHOD: We selected 61 patients with a severe bilateral hearing loss that have been using the cochlear implant for at least six months. The hearing evaluation performed after using the device for six months included word and sentence recognition tests. RESULTS: The PTA of four patients reached 38.7 dB. Speech perception tests showed 713% recognition of open set sentences, 86.5% of vowels and 52.60% of monosyllabic. Most of our patients are able to speak on the telephone. CONCLUSION: Most of patients showed excellent results in open-set sentence and word tests.A surdez profunda e uma deficiencia que afeta a personalidade, o relacionamento e todo o estilo de vida do paciente. Incapacita os individuos de escutarem sons ambientes como sirenes e alarmes que constituem alerta em situacoes da vida diaria e nao permite a modulacao vocal, tornando a voz esteticamente ruim. A protese auditiva convencional e eficiente no tratamento de grande parte das deficiencias auditivas, porem existem pacientes que nao conseguem obter discriminacao de palavras e sentencas mesmo com uma protese auditiva potente. O implante coclear e a alternativa atual para estes pacientes. OBJETIVO: Avaliar o resultado auditivo dos pacientes adultos implantados com o implante coclear multicanal pelo Grupo de Implante Coclear da Disciplina de Otorrinolaringologia da Faculdade de medicina da Universidade de Sao Paulo. FORMA DE ESTUDO: Estudo de serie. CASUISTICA E METODO: Foram selecionados 61 pacientes com surdez profunda bilateral que utilizam o implante coclear multicanal por pelo menos seis meses e estudados os resultados auditivos atraves de testes de reconhecimento de palavras e sentencas. RESULTADOS: O PTA medio obtido pelos pacientes foi 38.7 dB NPS. A media em reconhecimento de sentencas em formato aberto foi de 71.3%, vogais em 86.5%, monossilabos em 52.60% e consoante medial em 52.6%. A maioria dos pacientes esta apta ao uso do telefone. CONCLUSAO: A avaliacao auditiva obtida seis meses apos a primeira programacao do implante demonstra que pacientes de lingua portuguesa obtem excelentes resultados em testes de reconhecimento de palavras e sentencas em apresentacao aberta, readquirindo uma audicao util.

Telemetria de resposta neural intra-operatória em usuários de implante coclear

A possibilidade de realizar o implante coclear em criancas pequenas torna necessario o uso de medidas objetivas para auxiliar a programacao do processador de fala. Telemetria e a propriedade que permite, no Nucleus 24®, a obtencao do potencial de acao composto evocado do VIII par (EAP) utilizando o implante como instrumento de estimulacao e gravacao para o estudo das propriedades neurais remanescentes. OBJETIVO: Descrever a utilizacao do sistema de telemetria para a gravacao do EAP, caracterizando as respostas obtidas e a sua prevalencia na condicao intraoperatoria. FORMA DE ESTUDO: clinico com coorte transversal. MATERIAL E METODO: Medidas das impedâncias dos eletrodos e do EAP em um grupo de 17 individuos usuarios do implante Nucleus 24® durante a cirurgia. Analise das respostas de acordo com a etiologia, o tempo de duracao da surdez e a posicao dos eletrodos dentro da coclea. RESULTADOS: Maior prevalencia nos eletrodos apicais e limiares mais elevados nos casos de meningite e otosclerose. CONCLUSAO: A telemetria e eficiente para a verificacao da integridade dos eletrodos na condicao intraoperatoria e para a gravacao do EAP, apresentando alta prevalencia na populacao estudada.

Neural response thresholds in the Nucleus Contour cochlear implant before and after stylet removal

Conclusion. The study shows that there are differences in the measurement of the action potentials with and without the stylet in the Nucleus Freedom Contour Advance that are higher in the apex than in the base of the cochlea. Objectives. To determine if there are differences in the intraoperative impedances and in the neural response telemetry threshold values in the Nucleus Freedom Contour Advance before and after stylet removal. Subjects and methods. This was a prospective clinical study. Intraoperative impedances and neural response telemetry in users of the Freedom Contour Advance Cochlear Implant were measured before and after stylet removal. Results. There was a significant reduction in the impedance values of an average 1.5 kΩ±2.3 in common ground mode and 1.3 kΩ±2.3 for all monopolar modes after the stylet removal (p < 0.001). When analyzing the apical, medium, and basal electrodes, there was a statistically significant reduction in the neural response thresholds after stylet removal only in the apical electrodes (p = 0.001).

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

Abstract 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 psychoacoustical 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.

Preservação da audição residual em pacientes usuários de implante coclear multicanal: estudo piloto

Introduction: Technological development of Cochlear Implants allowed patients with residual hearing, thats to say, severe sensorineural hearing losses, to be considered as candidates (Hodges et al., 1997). Nevertheless, it is not clear whether the electrode array insertion may destroy remaining auditory structures. Aim: The purpose of this research was to verify the maitainance of residual hearing in multichannel cochlear implant users, by the comparison between the pre and post pure tone audiometry. Study design: Clinical prospective randomized. Material and method: Nine Nucleus 22 device and one Combi 40+ device users were evaluated. Results: In this sample hearing preservation was observed in 50% of the subjects, when considering the mid frequencies (speech frequencies) criterium of preservation. On the other hand, when the whole range of frequencies (including low frequencies) was considered as a criterium the preservation was revealed in 80% of the subjects. Conclusion: The average decrement in pure tone thresholds was 4 dB in the implanted ear and 0 dB in the contralateral ear.

Effect of Adenotonsillectomy on Attention Tests

Objective: To evaluate the performance of children and adolescents in tests of visual attention before and after surgical treatment of upper airway obstruction (adenotonsillectomy). Method: Study group: 27 children (6-17 years) with excessive daytime sleepiness undergoing surgical treatment of upper airways obstruction. Control group: 30 children (same age) without respiratory or sleep-related complaints. TAVIS-3 test was performed at baseline and 60 days after the surgery (patients) or first evaluation (controls). Results: The initial study population was comprised of 60 children, 29 in the treatment group and 31 in the control group. The final analysis included 57 patients, 27 in the treatment group and 30 in the control group. Mean Epworth Sleepiness Scale–Children (ESSC) decreased from 9.9 ± 2.8 to 5.1 ± 2.1 (P < .001) in patients and from 4.7 ± 1.6 to 4.6 ± 1.7 for controls. Response time, number of action errors, and number of omission errors decreased significantly (P < .001) between the 2 evaluations in patients when compared to controls. Conclusion: Surgical treatment of upper airway obstruction and resolution of daytime sleepiness promote improvement in visual attention in children and adolescents.