Rubens Vuono de Brito Neto

Linguagem oral de crianças com cinco anos de uso do implante coclear

BACKGROUND Cochlear implant (CI) in children. AIM 1) to delineate a profile of receptive and expressive verbal language of children who have been using cochlear implant for five years and five years and eleven months; 2) to verify the influence of time of auditory sensorial privation in the receptive and expressive verbal language of these children. METHOD 19 children users of CI with auditory deficiency acquired before language development, who have been using CI for 5y - 5y11m and who have an average time of sensorial privation of 3y (standard deviation of 1 year). These children were assessed using the Reynell Developmental Scales (RDLS) (Reynell e Gruber, 1990) which is composed of: Comprehension Scale (C), Expression Scale (E) and its Structure Sub-Scales (Es), Vocabulary (Ev) and Content (Ec). RESULTS The median values and the values found for quartile 75 and quartile 25 were: .44, 57 and 54 for C; 48, 60 and 55 for E; 20, 21 and 20 for Es; 15, 19 and 17 for Ev; 15, 22 and 18 for Ec; 96, 116 and 108 for the total score. A statistical correlation between the time of sensorial privation and the score obtained for C (p=- 0.62; R=0.0044) and Ec (p=-0.48; R=0.0348) was observed. Therefore the time of sensorial privation had an influence on the overall score (p=- 0.53; R=0.0174). CONCLUSION The language profile of children who use CI for five years is devious and similar to that of five year old hearing children regarding Expression and to that of four year old hearing regarding Comprehension; time of sensorial privation was statistically significant for the score obtained in C--receptive language--and for the score obtained in the E section (Ec)--expressive language, as well as in the overall score of RDLS.BACKGROND: cochlear implant (CI) in children. AIM: 1) to delineate a profile of receptive and expressive verbal language of children who have been using cochlear implant for five years and five years and eleven months; 2) to verify the influence of time of auditory sensorial privation in the receptive and expressive verbal language of these children. METHOD: 19 children users of CI with auditory deficiency acquired before language development, who have been using CI for 5y - 5y11m and who have an average time of sensorial privation of 3y (standard deviation of 1 year). These children were assessed using the Reynell Developmental Scales (RDLS) (Reynell e Gruber, 1990) which is composed of: Comprehension Scale (C), Expression Scale (E) and its Structure Sub-Scales (Es), Vocabulary (Ev) and Content (Ec). RESULTS: the median values and the values found for quartile 75 and quartile 25 were:.44, 57 and 54 for C; 48, 60 and 55 for E; 20, 21 and 20 for Es; 15, 19 and 17 for Ev; 15, 22 and 18 for Ec; 96, 116 and 108 for the total score. A statistical correlation between the time of sensorial privation and the score obtained for C (p= - 0.62; R= 0.0044) and Ec (p= - 0.48; R = 0.0348) was observed. Therefore the time of sensorial privation had an influence on the overall score (p= - 0.53; R = 0.0174). CONCLUSION: the language profile of children who use CI for five years is devious and similar to that of five year old hearing children regarding Expression and to that of four year old hearing regarding Comprehension; time of sensorial privation was statistically significant for the score obtained in C - receptive language - and for the score obtained in the E section (Ec) - expressive language, as well as in the overall score of RDLS.BACKGROND: cochlear implant (CI) in children. AIM: 1) to delineate a profile of receptive and expressive verbal language of children who have been using cochlear implant for five years and five years and eleven months; 2) to verify the influence of time of auditory sensorial privation in the receptive and expressive verbal language of these children. METHOD: 19 children users of CI with auditory deficiency acquired before language development, who have been using CI for 5y - 5y11m and who have an average time of sensorial privation of 3y (standard deviation of 1 year). These children were assessed using the Reynell Developmental Scales (RDLS) (Reynell e Gruber, 1990) which is composed of: Comprehension Scale (C), Expression Scale (E) and its Structure Sub-Scales (Es), Vocabulary (Ev) and Content (Ec). RESULTS: the median values and the values found for quartile 75 and quartile 25 were:.44, 57 and 54 for C; 48, 60 and 55 for E; 20, 21 and 20 for Es; 15, 19 and 17 for Ev; 15, 22 and 18 for Ec; 96, 116 and 108 for the total score. A statistical correlation between the time of sensorial privation and the score obtained for C (p= - 0.62; R= 0.0044) and Ec (p= - 0.48; R = 0.0348) was observed. Therefore the time of sensorial privation had an influence on the overall score (p= - 0.53; R = 0.0174). CONCLUSION: the language profile of children who use CI for five years is devious and similar to that of five year old hearing children regarding Expression and to that of four year old hearing regarding Comprehension; time of sensorial privation was statistically significant for the score obtained in C - receptive language - and for the score obtained in the E section (Ec) - expressive language, as well as in the overall score of RDLS.

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.

Auditory brainstem implant outcomes and MAP parameters: report of experiences in adults and children.

UNLABELLED The auditory brainstem implant (ABI) was first developed to help neurofibromatosis type 2 patients. Recently, its use has been recently extended to adults with non-tumor etiologies and children with profound hearing loss who were not candidates for a cochlear implant (CI). Although the results has been extensively reported, the stimulation parameters involved behind the outcomes have received less attention. OBJECTIVE The aim of this study is to describe the audiologic outcomes and the MAP parameters in ABI adults and children at our center. METHODS Retrospective chart review. Five adults and four children were implanted with the ABI24M from September 2005 to June 2009. In the adult patients, four had Neurofibromatosis type 2, and one had postmeningitic deafness with complete ossification of both cochleae. Three of the children had cochlear malformation or dysplasia, and one had complete ossified cochlea due to meningitis. Map parameters as well as the intraoperative electrical auditory brainstem responses were collected. Evaluation was performed with at least six months of device use and included free-field hearing thresholds, speech perception tests in the adult patients and for the children, the Infant-Toddler Meaningful Auditory Integration Scale (IT-MAIS) and (ESP) were used to evaluate the development of auditory skills, besides the MUSS to evaluate. RESULTS The number of active electrodes that did not cause any non-auditory sensation varied from three to nineteen. All of them were programmed with SPEAK strategy, and the pulse widths varied from 100 to 300 μs. Free-field thresholds with warble tones varied from very soft auditory sensation of 70 dBHL at 250 Hz to a pure tone average of 45 dBHL. Speech perception varied from none to 60% open-set recognition of sentences in silence in the adult population and from no auditory sensation at all to a slight improvement in the IT-MAIS/MAIS scores. CONCLUSION We observed that ABI may be a good option for offering some hearing attention to both adults and children. In children, the results might not be enough to ensure oral language development. Programming the speech processor in children demands higher care to the audiologist.

The role of magnetic resonance imaging in the postoperative management of cholesteatomas

UNLABELLED Conventional CT and MRI scans have low specificity when it comes to differentiating granulation tissue from relapsing cholesteatoma. AIM this paper aims to analyze the use of DWI and delayed post-contrast T1-weighed imaging in the detection of recurring cholesteatomas. MATERIALS AND METHOD this is a cross-sectional prospective study that looked at 17 cholesteatoma patients postoperatively. All patients underwent diffusion magnetic resonance imaging at 1.5T, T1, T2, and delayed post-contrast T1 and images were produced from both coronal and axial planes. Two radiologists assessed the images and decided consensually that the presence of hyperintensive signal in DWI on T2, iso/hypointensive signal on T1, and absence of contrast uptake were indicative of relapsing cholesteatoma. Surgical review findings were compared to DWI scans. RESULTS eleven of the twelve cases of recurring cholesteatoma presented hyperintensive signal in the DWI scans. None of the patients with granulation tissue in the surgical wound presented hyperintensive signal in the DWI scans. A patient with an abscess in the internal acoustic meatus also presented a hyperintensive signal in the DWI scans. Sensibility, specificity, positive predictive value and negative predictive value were 91.6%, 60.0%, 84.6%, and 75.0%, respectively. CONCLUSION DWI combined with delayed post-contrast T1 SE sequence proved to be useful in the differential diagnosis of granulation tissue and recurring cholesteatoma.

Neural response telemetry measures in patients implanted with Nucleus 24

UNLABELLED Cochlear implantation has been recommended for children under 24 months of age. The use of objective measures is needed to help speech processor programming. The electrically evoked compound potential (EAP), which can be assessed by neural response telemetry (NRT), is one of those objective measures. AIM to determine how often the EAP can be recorded by NRT system during surgery and to describe the responses. STUDY DESIGN Clinical with transversal cohort. MATERIAL AND METHOD The impedances and NRT were measured in a group of 17 Nucleus 24 implant users. The responses were analyzed and compared to the etiology, hearing loss duration and electrode array position. RESULTS The EAP was easily recorded in the apical electrodes and, in otosclerosis and meningitis cases the EAP threshold was higher than in the other etiology cases. CONCLUSIONS The NRT can be found in 82% of the cases during surgery. The responses obtained may vary according to etiology and the position of electrodes along the cochlea.

Resultados audiológicos do implante coclear em idosos

Segundo dados do Instituto Brasileiro de Geografia e Estatistica, a populacao de idosos cresceu 47,8% na ultima decada no Brasil. Parte desta populacao tem surdez severa a profunda, nao se beneficiando com o uso dos aparelhos auditivos convencionais. Desse modo, torna-se necessaria a indicacao do implante coclear. Objetivo: Analisar os beneficios do implante coclear nos idosos com relacao a audibilidade, ao reconhecimento de fala e ao uso do telefone. Material e Metodo: Estudo retrospectivo transversal por meio da analise de prontuarios de pacientes com faixa etaria acima de 60 anos usuarios de implante coclear ha pelo menos 1 ano. Resultados: Foram analisados 14 prontuarios. A media de idade dos pacientes foi de 63,07 anos. A media dos limiares tonais entre 500Hz,1kHz,2kHz e 4kHz antes da implantacao foi de 113dBNA. Nenhum dos pacientes, antes de implantar, conseguia discriminar frases em contexto aberto e fechado, apenas 3 conseguiam fazelo com uma media de 17% de acertos. Apos um ano de uso de implante, a media dos limiares em campo passou a ser de 34 dBNA, a discriminacao de frases em contexto aberto de 93,57% e 71% dos pacientes ja conseguiam estabelecer uma conversa ao telefone. Conclusao: Os pacientes idosos usuarios de implante coclear apresentaram ganhos auditivos relevantes, com melhora significativa da compreensao em contexto aberto e no uso de telefones.

Neurofibromatosis 2: hearing restoration options

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.

Aplicação da ressonância magnética no acompanhamento da cirurgia do colesteatoma

Conventional CT and MRI scans have low specificity when it comes to differentiating granulation tissue from relapsing cholesteatoma. AIM: this paper aims to analyze the use of DWI and delayed post-contrast T1-weighed imaging in the detection of recurring cholesteatomas. MATERIALS AND METHOD: this is a cross-sectional prospective study that looked at 17 cholesteatoma patients postoperatively. All patients underwent diffusion magnetic resonance imaging at 1.5T, T1, T2, and delayed post-contrast T1 and images were produced from both coronal and axial planes. Two radiologists assessed the images and decided consensually that the presence of hyperintensive signal in DWI on T2, iso/hypointensive signal on T1, and absence of contrast uptake were indicative of relapsing cholesteatoma. Surgical review findings were compared to DWI scans. RESULTS: eleven of the twelve cases of recurring cholesteatoma presented hyperintensive signal in the DWI scans. None of the patients with granulation tissue in the surgical wound presented hyperintensive signal in the DWI scans. A patient with an abscess in the internal acoustic meatus also presented a hyperintensive signal in the DWI scans. Sensibility, specificity, positive predictive value and negative predictive value were 91.6%, 60.0%, 84.6%, and 75.0%, respectively. CONCLUSION: DWI combined with delayed post-contrast T1 SE sequence proved to be useful in the differential diagnosis of granulation tissue and recurring cholesteatoma.

Evaluation of Intracochlear Trauma Caused by Insertion of Cochlear Implant Electrode Arrays through Different Quadrants of the Round Window.

Hypothesis. This study aimed to evaluate whether there is a difference in the degree of intracochlear trauma when the cochlear implant electrode arrays is inserted through different quadrants of the round window membrane. Background. The benefits of residual hearing preservation in cochlear implant recipients have promoted the development of atraumatic surgeries. Minimal trauma during electrode insertion is crucial for residual hearing preservation. Methods. In total, 25 fresh human temporal bones were subjected to mastoidectomy and posterior tympanotomy. The cochlear implant electrode array was inserted through the anterosuperior quadrant of the round window membrane in 50% of the bones and through the anteroinferior quadrant in the remaining 50%. The temporal bones were dehydrated, embedded in epoxy, serially polished, stained, viewed through a stereomicroscope, and photographed with the electrode arrays in situ. The resulting images were analyzed for signs of intracochlear trauma. Results. Histological examinations revealed varying degrees of damage to the intracochlear structures, although the incidence and severity of intracochlear trauma were not influenced by the quadrant of insertion. Conclusions. The incidence and severity of intracochlear trauma were similar in all samples, irrespective of electrode array insertion through the anterosuperior or anteroinferior quadrant of the round window membrane.

Surdez pós-lingual: benefícios do implante coclear versus prótese auditiva convencional

The technological advances in cochlear implants and processing strategies have enabled subjects affected by severe to profound hearing loss to hear sounds and recognize speech in various different degrees. The variability of hearing outcomes in subjects with post-lingual deafness has been significant and cochlear implant indications have been extended to include an ever larger population. OBJECTIVE: This paper aims to look into the groups of post-lingual deafness patients to find where cochlear implants have yielded better outcomes than conventional hearing aids. MATERIALS AND METHODS: Review the literature available on databases SciELO, Cochrane, MEDLINE, and LILACS-BIREME. The publications selected for review were rated as A or B on evidence strength on the day of the review. Their authors analyzed and compared hearing aids and cochlear implants in populations of post-lingually deaf patients. Study Design: Systematic review. RESULTS: Eleven out of the 2,169 papers searched were found to be pertinent to the topic and were rated B for evidence strength. Six studies were prospective cohort trials, four were cross-sectional studies and one was a clinical trial. CONCLUSION: The assessment done on the benefits yielded by post-lingually deaf subjects from cochlear implants showed that they are effective and provide for better results than conventional hearing aids.