Walter Adriano Bianchini

Hearing preservation and cochlear implants according to inner ear approach: multicentric evaluation.

INTRODUCTION Electroacoustic stimulation is an excellent option for people with residual hearing in the low frequencies, who obtain insufficient benefit with hearing aids. To be effective, the subjects residual hearing should be preserved during cochlear implant surgery. OBJECTIVES To evaluate the hearing preservation in patients that underwent implant placement and to compare the results in accordance with the approach to the inner ear. METHODS 19 subjects underwent a soft surgical technique, and the electrode MED-EL FLEX™ EAS, designed to be atraumatic, was used. We evaluated pre- and postoperative tonal audiometric tests with an average of 18.4 months after implantation, to measure the rate of hearing preservation. RESULTS 17 patients had total or partial preservation of residual hearing; 5 had total hearing preservation and two individuals had no preservation of hearing. The insertion of the electrode occurred through a cochleostomy in 3 patients, and in 2 of these there was no hearing preservation; the other 16 patients experienced electrode insertion through a round window approach. All patients benefited from the cochlear implant, even those who are only using electrical stimulation. CONCLUSION The hearing preservation occurred in 89.4% of cases. There was no significant difference between the forms of inner ear approach.

Digisonic SP® Binaural cochlear implant: the coronal tunneled approach.

UNLABELLED Cochlear implants represent a significant breakthrough in the treatment of hearing loss. Evidence indicates bilateral hearing brings significant benefits to patients, particularly when binaural hearing is offered. OBJECTIVE To describe the first case of implantation of a Digisonic SP® Binaural Neurelec device in Brazil (the third implant placed in the Americas, after Mexico and Colombia) and the chosen surgical approach. METHOD Description of a surgical approach. RESULTS The procedure was successfully completed. DISCUSSION The squelch effect, binaural summation, location of the sound source, and the shadow effect of the head are listed among the reasons to explain the superiority of binaural rehabilitation. Cost of treatment must be considered in the development of public health policies. CONCLUSION The cost of cochlear implants has been one of the main impediments to bilateral rehabilitation. The Digisonic SP® Binaural Neurelec device addresses this issue and exposes patients to less risk through a minimally invasive implantation procedure.

Undifferentiated head and neck tumors: the contribution of immunohistochemical technique to differential diagnosis.

CONTEXT Undifferentiated head and neck and skull base tumors are not unusual. They can arise in mucosa as well as in salivary glands, soft tissues or lymph nodes. Suitable therapy and prognosis for each case depends upon precise histopathological diagnosis. OBJECTIVE To evaluate the role of immunohistochemical techniques in determining the conclusive diagnosis. The occurrence of these tumors in our service and the way in which they were distributed according to cell pattern, patients age and tumor location was also evaluated. TYPE OF STUDY Cross-sectional study. SETTING Hospital das Clínicas, Universidade Estadual de Campinas, Campinas, São Paulo, Brazil. PARTICIPANTS 43 biopsies performed between January 1990 and December 1997, diagnosed as undifferentiated head and neck tumors. PROCEDURES We applied an immunohistochemical panel in accordance with the avidin-biotin-peroxidase complex method. The final diagnosis was achieved after new analysis in conjunction with biopsies stained using the hematoxylin-eosin technique. MAIN MEASUREMENTS This study evaluated undifferentiated tumors in head and neck, and the way in which they were distributed, according to cell pattern, patients age and tumor location. RESULTS The most frequent locations for undifferentiated tumors were the lymph nodes, 20.9%; pharynx and neck, 16.3%; paranasal sinus, 14%; and nose, 11.6%. They were most prevalent during the seventh decade of life (34.9%), and twice as prevalent in men as in women. The immunohistochemical technique allowed conclusive diagnosis for 60.5% of the tumors and was suggestive for 20.9% of the biopsies. The most prevalent cell pattern was round cells (51.2%), followed by epithelioid cells (20.9%), spindle cells (16.3%), myxoid pattern (9.3%) and pleomorphic cells (2.3%). CONCLUSION Our results demonstrate the fundamental role of the immunohistochemical technique for conclusive diagnosis of undifferentiated tumors.

Electro acoustic stimulation of the auditory system: UNICAMP's surgical approach

UNLABELLED A new era has arrived in auditory rehabilitation with the introduction of new technologies such as electroacoustic stimulation (EAS). EAS is indicated for patients with residual hearing at low frequencies and severe or profound hearing loss at high frequencies. These patients have no indication for conventional cochlear implant and have difficulties in adapting to individual sound amplification devices. Preservation of hearing is vital in this process; the surgical technique must be based on this concept. OBJECTIVES To present the cochlear implant surgical technique with MED-EL Mand FlexEAS to preserve hearing in patients with hearing loss at high frequencies and to maintain low frequency hearing. We are the first institution to carry out this treatment in Brazil. METHODS A case report of the surgical technique carried out in four patients; the procedure was carried out by the cochlear implant group of a specialized clinical hospital. RESULTS The procedures were successful and uneventful. CONCLUSION We described the technique used at our institution for implants using EAS; the surgical technique is complex and includes steps for preservation of hearing.

Advanced Bionics Cochlear Implants in Patients with Prelingual Hearing Loss

Introduction: Cochlear Implants (CI) have become standard in the treatment of prelingual, postlingual and perilingual deafness in children. Bilateral implants are considered standard for bilaterally affected children. Studies also find that the CI provides better access to speech for most children, and this access results in improved speech perception. In earlier times children who did not react to acoustic stimuli and were neither able to understand speech nor to acquire it spontaneously encountered severe discrimination, being dismissed as simple-minded or worse. Different studies broadly agree that one or two of every 1000 newborns have a hearing impairment that on current evidence warrants treatment or observation, i.e., permanent hearing loss with a lowering of the absolute threshold of hearing for speech perception by at least 35 dB. Approximately 50% of severe hearing impairments arising in the inner ear are thought to be hereditary in origin. When new Cochlear Implant (CI) sound processors are being introduced by the manufacturers, usually the newest generation implants benefit first from the new technology in order to release the full potential of the new hardware. Objective: Evaluate the improvement of speech language and sound perception in patients with prelingual deafness that underwent cochlear implant using Advanced Bionics® device. Method: Retrospective study of the medical records of the patients fitted with Advanced Bionics® cochlear implant in our institution between 2011 and 2012. Results: Sixteen patients underwent to cochlear implantation using Advanced Bionics® devices. There were 43,75% prelingual and 43,75% postlingual patients with bilateral hearing loss. Mean age at implantation in the prelingual group was 3.6 years (ranged from 2 to 6 years). There was one case with medical history of deafness in family. All prelingual patients used hearing devices before the cochlear implant. The hearing levels improved after CI in all patients. Conclusion: This study evaluated patients with pre-lingual deafness using the Advanced Bionics® cochlear implants demonstrated significant gains in neural stimulation and language development in children.

Implante coclear Digisonic SP® Binaural: acesso coronal tunelizado

UNLABELLED Cochlear implants represent a significant breakthrough in the treatment of hearing loss. Evidence indicates bilateral hearing brings significant benefits to patients, particularly when binaural hearing is offered. OBJECTIVE To describe the first case of implantation of a Digisonic SP® Binaural Neurelec device in Brazil (the third implant placed in the Americas, after Mexico and Colombia) and the chosen surgical approach. METHOD Description of a surgical approach. RESULTS The procedure was successfully completed. DISCUSSION The squelch effect, binaural summation, location of the sound source, and the shadow effect of the head are listed among the reasons to explain the superiority of binaural rehabilitation. Cost of treatment must be considered in the development of public health policies. CONCLUSION The cost of cochlear implants has been one of the main impediments to bilateral rehabilitation. The Digisonic SP® Binaural Neurelec device addresses this issue and exposes patients to less risk through a minimally invasive implantation procedure.

Satisfaction Level According to the SADL in Patients with EAS Cochlear Implant

Background: Hearing Loss (HL) is one of the most common disorders that affects people. The positive impact of the use of cochlear implants in the lives of the hearing impaired is demonstrated in several studies. Objective: Evaluate the level of satisfaction of patients undergoing hybrid crawl implant by applying the SADL questionnaire. Methods: Clinical study including 14 patients implanted with the brand MED-EL FLEX EAS in a tertiary hospital in the last three years. Results: Fourteen subjects were selected initially for the study, but only 13 reached all inclusion and exclusion criteria according to our methods. There are 5 males and 8 females patients. The average age of the patients, at the cochlear implant surgery moment, were 44.7 years old. Conclusion: Positive effects were very high, with very low negative factors, costs or negative effects on personal image of the patients, indicating that cochlear implantation was very good for these patients.

Evaluation of Audiometric Thresholds and Speech Perception Sentence Test in Adults and Elderly After Cochlear Implantation

AIM To compare the audiometric thresholds and speech perception sentence test, between two groups with bilateral post-lingual, severe to profound sensorineural hearing loss. METHODS Retrospective and analytical study, with 59 patients divided into 2 groups (under 60 years and above 60 years old) implanted between May/2002 and February/2007. RESULTS The first group (control) included 30 patients with a mean age of 44 years. The audiometric threshold value in this group was 26 dB, and the average value of speech perception test was 94%. The second group included 29 patients with a mean age of 69 years. The average audiometric threshold was 29 dB, and the average value of SPT was 90%. The Mann-Whitney U-test was considered significant (P<0.05) only for 6-8 KHz frequencies and for SPT. CONCLUSION Both groups had excellent outcomes in audiometric and speech testing with the use of CI, but with a significantly better performance in the adult group.