Paola Angelica Samuel

Hearing preservation using topical dexamethasone alone and associated with hyaluronic acid in cochlear implantation

Abstract Conclusion: Topical dexamethasone associated with hyaluronic acid in cochlear implant surgery demonstrated a statistically significant difference in the preservation of low-frequency thresholds when compared with topical dexamethasone alone and a control group. Topical dexamethasone alone was not superior in hearing preservation when compared to the control group. Objective: To compare the effects of topical dexamethasone alone and associated with hyaluronic acid intraoperatively in hearing preservation in cochlear implantation. Methods: Eighteen severely to profoundly hearing-impaired adult patients with measurable hearing were divided into three groups preoperatively: cochlear implantation as a control group (group 1), cochlear implantation using topical dexamethasone intraoperatively (group 2), and cochlear implantation using topical dexamethasone associated with hyaluronic acid intraoperatively (group 3). Preimplant and postimplant low-frequency pure-tone averages (PTAs) were calculated from unaided audiograms at 125, 250, and 500 Hz. Results: The mean changes in the low-frequency PTA comparing postoperative against preoperative thresholds were 28.03 ± 6.77 dB in group 1, 30 ± 14.53 dB in group 2, and 7.23 ± 6.12 dB in group 3. There was statistical difference when comparing group 3 with groups 1 and 2 using one-way ANOVA (p = 0.002) followed by Scheffé post hoc test.

Remote programming of cochlear implants.

PURPOSE To verify the effectiveness of remote programming of cochlear implants by stimulation levels and results in the perception of speech and free-field audiometry tests. METHODS Twelve patients from both genders, aged between 18 and 59 years, users of internal cochlear implant and speech processor of the same model for at least 12 months, were selected. Both the remote programming (RP) and the live programming (LP) were performed on the same day, measuring the minimum (T) and maximum (C) stimulation levels of five electrodes with the interpolation of the remaining ones. Speech perception tests were applied using 65 dBSPL (recorded open context sentences and monosyllables). The patients were submitted to free-field audiometry at 250-8,000 Hz frequencies. The results for the RP and LP were compared. RESULTS Differences in mean of the T levels for three electrodes and the C levels for one electrode were found. No difference between the results was obtained in the speech perception tests and audiometric thresholds in the RP and LP. CONCLUSION The RP is a simple and effective procedure for programming cochlear implant devices and, although there were differences in the stimulation levels of some electrodes, it did not interfere in the speech perception outcomes.

Audiological outcomes of cochlear implantation in Waardenburg Syndrome

Summary Introduction: The most relevant clinical symptom in Waardenburg syndrome is profound bilateral sensorioneural hearing loss. Aim: To characterize and describe hearing outcomes after cochlear implantation in patients with Waardenburg syndrome to improve preoperative expectations. Method: This was an observational and retrospective study of a series of cases. Children who were diagnosed with Waardenburg syndrome and who received a multichannel cochlear implant between March 1999 and July 2012 were included in the study. Intraoperative neural response telemetry, hearing evaluation, speech perception, and speech production data before and after surgery were assessed. Results: During this period, 806 patients received a cochlear implant and 10 of these (1.2%) were diagnosed with Waardenburg syndrome. Eight of the children received a Nucleus 24® implant and 1 child and 1 adult received a DigiSonic SP implant. The mean age at implantation was 44 months among the children. The average duration of use of a cochlear implant at the time of the study was 43 months. Intraoperative neural responses were present in all cases. Patients who could use the speech processor effectively had a pure tone average of 31 dB in free-field conditions. In addition, the MUSS and MAIS questionnaires revealed improvements in speech perception and production. Four patients did not have a good outcome, which might have been associated with ineffective use of the speech processor. Conclusion: Despite the heterogeneity of the group, patients with Waardenburg syndrome who received cochlear implants were found to have hearing thresholds that allowed access to speech sounds. However, patients who received early intervention and rehabilitation showed better evolution of auditory perception.

Percepção de fala e limiares audiométricos em usuários de implante coclear nucleus 22 e nucleus 24

* Fellow em Implante Coclear do Hospital das Clinicas da Faculdade de Medicina da Universidade de Sao Paulo, HC-FMUSP, Sao Paul o, SP. Fonoaudiologa da Equipe deImplante Coclear do Hospital das Clinicas da Faculdade de Medicina da Universidade de Sao Paulo, HC-FMUSP, Sao Paulo, SP.** Doutora em Disturbios da Comunicacao Humana (Fonoaudiologia) pela Universidade Federal de Sao Paulo. Fonoaudiologa; Hospital das Clinicas da Faculdade de Medicinada Universidade de Sao Paulo, HC-FMUSP, Sao Paulo, SP.*** Livre Docencia pela Universidade de Sao Paulo. Fonoaudiologa; Professora Associada da Universidade de Sao Paulo.**** Doutoura em Disturbios da Comunicacao Humana pela Universidade Federal de Sao Paulo. Fonoaudiologa; Professora adjunta da Universidade de Sao Paulo.***** Doutor em Ciencias da Saude pela Universidade de Sao Paulo. Otorrinolaringologista; Hospital das Clinicas da Faculdade de Medicina da Universidade de Sao Paulo,HC-FMUSP, Sao Paulo, SP.****** Livre Docencia pelo Hospital das Clinicas da Faculdade de Medicina da Universidade de Sao Paulo, HC-FMUSP. Otorrinolarin gologista; Hospital das Clinicas da Faculdadede Medicina da Universidade de Sao Paulo, HC-FMUSP, Sao Paulo, SP.******* Livre Docencia pela Universidade de Sao Paulo. Otorrinolaringologista; Hospital das Clinicas da Faculdade de Medicina d a Universidade de Sao Paulo, HC-FMUSP,Sao Paulo, SP.Instituicao: Programa de Aprimoramento em Implante Coclear do Departamento de Fisioterapia, Fonoaudiologia e Terapia Ocupacional da Universi dade de SaoPaulo, e Equipe de Implante Coclear do Hospital das Clinicas da Faculdade de Medicina da Universidade de Sao Paulo.Sao Paulo / SP – Brasil.Endereco para correspondencia: Paola Angelica Samuel – Rua Capote Valente, 432 - Conjunto 14 – Pinheiros – Sao Paulo / SP – Bra sil – CEP: 05409-001 – Telefone:(+55 11) 3898-2210 – E-mail: paolasamuel@yahoo.com.brArtigo recebido em 22 de Abril de 2010. Artigo aprovado em 10 de Junho de 2010.

Use of remote control in the intraoperative telemetry of cochlear implant: multicentric study

INTRODUCTION The conventional evaluation of neural telemetry and impedance requires the use of the computer coupled to an interface, with software that provides visualization of the stimulus and response. Recently, a remote control (CR220®) was launched in the market, that allows the performance of intraoperative tests with minimal instrumentation. OBJECTIVE To evaluate the agreement of the impedance values and neural telemetry thresholds, and the time of performance in the conventional procedure and by the remote control. METHODS Multicentric prospective cross-sectional study. Intraoperative evaluations of cochlear implants compatible with the use of CR220® were included. The tests were carried out in the 22 electrodes to compare the time of performance in the two situations. The agreement of the neural telemetry threshold values obtained from five electrodes was analyzed, and the agreement of impedance was evaluated by the number of electrodes with altered values in each procedure. RESULTS There were no significant difference between the impedance values. There was a moderate to strong correlation between the electrically-evoked compound action potential thresholds. The mean time to perform the procedures using the CR220 was significantly lower than that with the conventional procedure. CONCLUSION The use of the CR220 provided successful records for impedance telemetry and automatic neural response telemetry.

Cochlear implants and bacterial meningitis: a speech recognition study in paired samples

Summary Introduction: Cochlear implants may guarantee sound perception and the ability to detect speech at a close-to-normal hearing intensity; however, differences have been observed among implantees in terms of performance on discrimination tests and speech recognition. Objective: To identify whether patients with post-meningitis deafness perform similarly to patients with hearing loss due to other causes. Method: A retrospective clinical study involving post-lingual patients who had been using Nucleus-22 or Nucleus-24 cochlear implants for at least 1 year. These patients were matched with respect to age (± 2 years), time since the onset of deafness (± 1 year), and the duration of implant use with implant users who had hearing loss due to other causes. Speech perception was assessed using the Portuguese version of the Latin-American Protocol for the Evaluation of Cochlear Implants. Results: The sample consisted of 52 individuals (26 in each of the 2 groups). The post-meningitic group had a median of 18.5 active electrodes. The group with hearing loss due to other causes had a median of 21, but no significant statistical difference was observed (p = 0.07). The results of closed- and open-set speech recognition tests showed great variability in speech recognition between the studied groups. These differences were more pronounced for the most difficult listening tasks, such as the medial consonant task (in the vowel-consonant-vowel format). Conclusion: Cochlear implant recipients with hearing loss due to bacterial meningitis, who had been using the device for 1 year performed more poorly on closed- and open-set speech recognition tests than did implant recipients with hearing loss due to other causes.