Is the spread of excitation different between adults and children cochlear implants users?

PURPOSE: While cochlea is adult size at birth, etiologies and bone density may differ between children and adults. Differences in neural response thresholds (tNRT) and the spread of excitation (SOE) width may impact the use of artificial intelligence algorithms in speech processor fitting. AIM: To identify whether neural response telemetry threshold and spread of excitation width are similar in adults and children. METHODS: Retrospective cross-sectional study approved by the Ethical Board. Intraoperative tNRT and SOE recordings of consecutive cochlear implant surgeries in adults and children implanted with Cochlear devices (Cochlear™, Australia) were selected. SOE was recorded on electrode 11 (or adjacent, corresponding to the medial region of the cochlea) through the standard forward-masking technique in Custom Sound EP software, which provides SOE width in millimeters. Statistical comparison between adults and children was performed using the Mann-Whitney test (p ≤ 0.05). RESULTS: Of 1282 recordings of intraoperative evaluations, 414 measurements were selected from children and adults. Despite the tNRT being similar between adults and children, SOE width was significantly different, with lower values in children with perimodiolar arrays. Besides, it was observed that there is a difference in the electrode where the SOE function peak occurred, more frequently shifted to electrode 12 in adults implanted. In straight arrays, there was no difference in any of the parameters analyzed on electrode 11. CONCLUSION: Although eCAP thresholds are similar, SOE measurements differ between adults and children in perimodiolar electrodes.

Is the spread of excitation width correlated to the speech recognition in cochlear implant users?

PURPOSE: To assess whether there is an interference of the spread of excitation (SOE) on speech recognition. METHODS: Retrospective cross-sectional study, approved by the institution's ethics committee (CAAE03409212.8.0000.0068). Adult patients with intraoperative neural response telemetry (NRT) performed on electrodes 6, 11 and 16 implanted with Cochlear Ltd (Sydney, Australia) devices were selected. Patients with partial array insertion, pre-lingual hearing loss, deafness etiology due to and CI experience less than 12 months were excluded. SOE was recorded at 10 current units above the NRT threshold (tNRT) and its width in millimeters was collected at point 0.75 of the function. Speech recognition test was 25-recorded monosyllables list, presented at 65 dBHL at 0° azimuth in a sound treated booth. The analysis was divided into groups by electrode array type, regarding the tNRT, SOE width, SOE's peak amplitude and electrode peak. RESULTS: A 126 SOE measurements of the 3 tested electrodes were obtained from 43 patients. Patients with straight array had significantly wider SOE, greater peak amplitude at electrode 6 and higher tNRTs. In the perimodiolar array, there was a negative correlation between SOE and monosyllables recognition at electrodes 6 and 11, and in the combined average of the three electrodes, with a significant difference in electrode 11. Sixty-six percent of the SOE measurements had their peak shifted to adjacent electrodes. CONCLUSION: It was observed, in perimodiolar array, the greater the dispersion of electrical current, the worse the speech recognition, especially in the medial electrode.

Contribution of noise reduction pre-processing and microphone directionality strategies in the speech recognition in noise in adult cochlear implant users.

PURPOSE: Refinement currently offered in new sound processors may improve noise listening capability reducing constant background noise and enhancing listening in challenging signal-to-noise conditions. This study aimed to identify whether the new version of speech processor preprocessing strategy contributes to speech recognition in background noise compared to the previous generation processor. METHODS: This was a multicentric prospective cross-sectional study. Post-lingually deaf adult patients, with at least 1 year of device use and speech recognition scores above 60% on HINT sentences in quiet were invited. Speech recognition performance in quiet and in noise with sound processors with previous and recent technologies was assessed under four conditions with speech coming from the front: (a) quiet (b) fixed noise coming from the front, (c) fixed noise coming from the back, and (d) adaptive noise ratios with noise coming from the front. RESULTS: Forty-seven cochlear implant users were included. No significant difference was found in quiet condition. Performance with the new processor was statistically better than the previous sound processor in all three noisy conditions (p < 0.05). With fixed noise coming from the back condition, speech recognition was 62.9% with the previous technology and 73.5% on the new one (p < 0.05). The mean speech recognition in noise was also statistically higher, with 5.8 dB and 7.1 dB for the newer and older technologies (p < 0.05), respectively. CONCLUSION: New technology has shown to provide benefits regarding speech recognition in noise. In addition, the new background noise reduction technology, has shown to be effective and improves speech recognition in situations of more intense noise coming from behind.

Speech Recognition of Cochlear Implant Users Inside a Noisy Helicopter Environment.

In this study, we tested whether the speech recognition, through radio communications, of cochlear implant (CI) users inside a noisy helicopter cockpit is adequate for safe flight. METHOD: Speech recognition tests (sentences, numbers and disyllables) through a very-high-frequency radio were administered to 12 CI users in a soundproof booth, inside a helicopter with the engine turned off and turned on. RESULTS: In quiet environments, radio communications were impacted only for disyllable intelligibility, but in noisy situations, all tests were affected. CONCLUSIONS: CI subjects did not achieve the auditory levels recommended by the International Civil Aviation Organization.

Hearing Performance in Cochlear Implant Users Who Have Facial Nerve Stimulation.

Introduction Facial nerve stimulation (FNS) is a complication in cochlear implant (CI) when the electrical current escapes from the cochlea to the nearby facial nerve. Different management to reduce its effects are available, although changes might result in a less-than-ideal fitting for the CI user, eventually reducing speech perception. Objective To verify the etiologies that cause FNS, to identify strategies in managing FNS, and to evaluate speech recognition in patients who present FNS. Methods Retrospective study approved by the Ethical Board of the Institution. From the files of a CI group, patients who were identified with FNS either during surgery or at any time postoperatively were selected. Data collection included: CI manufacturer, electrode array type, age at implantation, etiology of hearing loss, FNS identification date, number of electrodes that generated FNS, FNS management actions, and speech recognition in quiet and in noise. Results Data were collected from 7 children and 25 adults. Etiologies that cause FNS were cochlear malformation, head trauma, meningitis, and otosclerosis; the main actions included decrease in the stimulation levels followed by the deactivation of electrodes. Average speech recognition in quiet before FNS was 86% and 80% after in patients who were able to accomplish the test. However, there was great variability, ranging from 0% in quiet to 90% of speech recognition in noise. Conclusion Etiologies that cause FNS are related to cochlear morphology alterations. Facial nerve stimulation can be solved using speech processor programming parameters; however, it is not possible to predict outcomes, since results depend on other variables.

Speech recognition and frequency of hearing loss in patients treated for cancer in childhood.

BACKGROUND: The aim of this study was to characterize the audiological profile accompanying oncological treatment in patients who had cancer in childhood and had been free of oncological treatment for at least 8 years. Our main interest lay in identifying the affected frequencies that interfered with speech intelligibility (SI) in those who had acquired hearing loss after treatment. PROCEDURE: Two hundred patients who had cancer in childhood were evaluated. Diagnosis was made at the mean age of 6 years old, and hearing evaluation was performed at a mean age of 21 years. Fifty-one of these patients received chemotherapy without cisplatin, carboplatin or head and neck radiotherapy; 64 received cisplatin without head and neck radiotherapy; 75 received head and neck radiotherapy without cisplatin; and 10 received both head and neck radiotherapy and cisplatin chemotherapy. All patients underwent pure tone audiometry and speech audiometry. RESULTS: Patients who had hearing loss primarily had bilateral symmetric sensorineural hearing loss. Although the average SI for ears with hearing loss in the frequency range from 4 to 8 kHz was normal, the Kruskall-Wallis test showed a significant difference between ears without hearing loss and those with hearing loss between 4 and 8 kHz. The average SI score in ears with hearing loss between 1 and 8 kHz was significantly different from all other ears. CONCLUSIONS: Hearing loss involving frequencies at and above 4 kHz determines a decline in SI.

Programming peculiarities in two cochlear implant users with superficial siderosis of the central nervous system.

OBJECTIVE: To report the audiological outcomes of cochlear implantation in two patients with severe to profound sensorineural hearing loss secondary to superficial siderosis of the CNS and discuss some programming peculiarities that were found in these cases. METHOD: Retrospective review. Data concerning clinical presentation, diagnosis and audiological assessment pre- and post-implantation were collected of two patients with superficial siderosis of the CNS. RESULTS: Both patients showed good hearing thresholds but variable speech perception outcomes. One patient did not achieve open-set speech recognition, but the other achieved 70% speech recognition in quiet. Electrical compound action potentials could not be elicited in either patient. Map parameters showed the need for increased charge. Electrode impedances showed high longitudinal variability. CONCLUSION: The implants were fairly beneficial in restoring hearing and improving communication abilities although many reprogramming sessions have been required. The hurdle in programming was the need of frequent adjustments due to the physiologic variations in electrical discharges and neural conduction, besides the changes in the impedances. Patients diagnosed with superficial siderosis may achieve limited results in speech perception scores due to both cochlear and retrocochlear reasons. Careful counseling about the results must be given to the patients and their families before the cochlear implantation indication.

Can the use of the CROS system provide head shadow effect contribution to unilateral Cochlear Implant Users?

PURPOSE: The aim of this study was to evaluate the contribution of the CROS system on the head shadow effect in unilateral implant users. METHODS: Prospective cross-sectional study, approved by the ethics committee under protocol 2.128.869. Eleven adults with post-lingual deafness users of unilateral Advanced Bionics CI were selected. Speech recognition was evaluated with recorded words presented at 65dBA at 0o azimuth and at 90o on the side contralateral to the CI, with noise at 55dBA, using CI alone and CI + CROS system. The results were analyzed using paired t-test with a 0.05 alpha. RESULTS: The mean speech recognition scores were significantly better with CI + CROS in relation to the condition of CI alone (p <0.05, p <0.005 and p <0.005 respectively). In the presentation at 0o azimuth, no significant differences were found. CONCLUSION: Users of unilateral CI without useful residual hearing for the use of hearing aids or unable to undergo bilateral surgery can benefit from the CROS device for speech recognition, especially when the speech is presented on the side contralateral to the CI.

The influence of stimulation levels on auditory thresholds and speech recognition in adult cochlear implant users.

Objective: This study aims to evaluate the influence of minimum and maximum stimulation levels on auditory thresholds and speech recognition abilities in adult cochlear implant users. Method: Fifteen adults implanted with a Cochlear® device with over 12 months listening experience. Participants underwent routine programming for optimization of minimum (T) and maximum comfort (C) stimulation levels, which was saved in Program 1 (MO). Three further maps were constructed artificially adjusting the measured levels: Program 2 - MO with 10 fewer electrical current units at C level (MC-); Program 3 - MO with 10 fewer electric current units at T level (MT-); and Program 4 - MO with 10 more electric current units at T level (MT+). Sound field thresholds, recorded sentence recognition and monosyllable tests were presented in quiet and in noise. Results: There were significantly better thresholds at 1, 3, 4, and 6 kHz frequencies in MT+ and worse in MC-. A statistically significant difference was observed for sentences in quiet and monosyllables in quiet and noise with changing C levels, with worsening of the results for MC- program. Conclusion: The results suggest that T levels above the behavioural threshold provided an improvement in sound field thresholds but did not influence performance on speech recognition tests in quiet and in noise. In contrast, C levels below the behavioural comfort level worsened sound field thresholds and led to poorer performance in tests of sentence recognition in quiet and monosyllable recognition in quiet and in noise.

Do the minimum and maximum comfortable stimulation levels influence the cortical potential latencies or the speech recognition in adult cochlear implant users?

INTRODUCTION: Cochlear implants (CI) programming is based on both the measurement of the minimum levels required to stimulate the auditory nerve and the maximum levels to generate loud, yet comfortable loudness. Seeking for guidance in the adequacy of this programming, the cortical auditory evoked potentials (CAEP) have been gaining space as an important tool in the evaluation of CI users, providing information on the central auditory system. OBJECTIVE: To evaluate the influence of mishandling of electrical stimulation levels on speech processor programming on hearing thresholds, speech recognition and cortical auditory evoked potential in adult CI users. MATERIAL AND METHODS: This is a prospective cross-sectional study, with a sample of adult unilateral CI users of both sexes, aged at least 18 years, post-lingual deafness, with minimum experience of 12 months of device use. Selected subjects should have average free field hearing thresholds with cochlear implant equal to or better than 34 dBHL and monosyllable recognition different from 0%. Individuals who could not collaborate with the procedures or who had no CAEP recordings were excluded. Participants were routinely programmed, and the map was named MO (optimized original map). Then three experimentally wrong maps were made: optimized original map with 10 current units below the maximum comfort level (C), named MC- (map minus C); optimized original map with minus 10 current units at minimum threshold level (T), named MT- (map minus T) and optimized original map with 10 current units above minimum level (T), named MT + (map plus T). In all programs, participants underwent free-field auditory thresholds from 250Hz to 6000Hz, recorded sentences and monosyllabic recognition tests presented at 65dB SPL in quiet and in noise, and free field CAEP evaluation. All tests were performed in an acoustically treated booth, in a randomized order of map presentation. Data were compared by Wilcoxon test. RESULTS: Thirty individuals were selected and signed an informed consent form. The MC- map provided worsening of all free field thresholds, quiet and noise speech recognition, and P1 wave latency delay with significant difference from the results with the MO map. The MT- map worsened the hearing thresholds and statistically significantly reduced the P2 wave latency; MT+ map improved free field thresholds except 6000Hz, worsening speech recognition, without statistical significance. CONCLUSIONS: The results suggest that maximum levels below the optimal thresholds lead to worse cochlear implant performance in both hearing thresholds and speech recognition tests in quiet and noise, increasing CAEP component P1 latency. On the other hand, the manipulation of minimum threshold levels showed alteration in audibility without significant impact on speech recognition.

Balancing the Loudness in Speech Processors and Contralateral Hearing Aids in Users of Unilateral Cochlear Implants.

Introduction The use of cochlear implants and hearing aids (bimodal) has been growing with the expansion of the indication for them, and it is important to ensure protocols so that there is a balance of the loudness regarding the two devices. Objective To evaluate if the limited complex sounds present in the frequency bands of the current devices enable the balance of the loudness in adult users of bimodal stimulation, and to analyze if speech recognition improves after balancing. Methods A prospective cross-sectional study with convenience sampling. The sample was composed of 25 adults who had used either a cochlear implant for at least 6 months or a contralateral hearing aid, with a mean age of 46 years. The balancing of the loudness was performed in an acoustic room with the computer's sound box (0° azimuth at 70 dB SPL). The instrumental sounds were filtered through eight different frequency bands. The patients used both hearing devices and were asked if the sound was perceived to be louder in one of the ears or centrally. The speech test was evaluated with sentence silence (65 dB SPL) and/or noise signal ratio of 0 dB/+ 10 dB in free field at 0° azimuth, before and after balancing. Results : Out of the 25 patients, 5 failed to achieve balance at every tested frequency, and 3 achieved balance at almost every frequency, except 8 kHz. There was a significant difference between the speech recognition test only in silence before and after balancing. Conclusion : Most patients achieved sound equalization at all evaluated frequencies under the complex-sound protocol. Additionally, most patients experienced improved speech recognition after balancing.

Central Auditory Nervous System Stimulation through the Cochlear Implant Use and Its Behavioral Impacts: A Longitudinal Study of Case Series.

The purpose of this study was to investigate, over a period of five years, the cortical maturation of the central auditory pathways and its impacts on the auditory and oral language development of children with effective use and without effective use of a Cochlear Implant (CI). A case series study was conducted with seven children who were CI users and seven children with normal hearing, with age- and gender-matched to CI users. The assessment was performed by long-latency auditory evoked potentials and auditory and oral language behavioral protocols. The results pronounced P1 latency decrease in all CI users in the first nine months. Over five years, five children with effective CI use presented decrease or stabilization of P1 latency and a gradual development of auditory and oral language skills, although, for most of the children, the electrophysiological and behavior results remained poor than their hearing peers' results. Two children who stopped the effective use of CI after the first year of activation had worsened auditory and oral language behavioral skills and presented increased P1 latency. A negative correlation was observed between behavioral measures and the P1 latency, the P1 component being considered an important clinical resource capable of measuring the cortical maturation and the behavioral evolution.

Speech Perception Changes in the Acoustically Aided, Nonimplanted Ear after Cochlear Implantation: A Multicenter Study.

In recent years there has been an increasing percentage of cochlear implant (CI) users who have usable residual hearing in the contralateral, nonimplanted ear, typically aided by acoustic amplification. This raises the issue of the extent to which the signal presented through the cochlear implant may influence how listeners process information in the acoustically stimulated ear. This multicenter retrospective study examined pre- to postoperative changes in speech perception in the nonimplanted ear, the implanted ear, and both together. Results in the latter two conditions showed the expected increases, but speech perception in the nonimplanted ear showed a modest yet meaningful decrease that could not be completely explained by changes in unaided thresholds, hearing aid malfunction, or several other demographic variables. Decreases in speech perception in the nonimplanted ear were more likely in individuals who had better levels of speech perception in the implanted ear, and in those who had better speech perception in the implanted than in the nonimplanted ear. This raises the possibility that, in some cases, bimodal listeners may rely on the higher quality signal provided by the implant and may disregard or even neglect the input provided by the nonimplanted ear.

Clinical and electromyographic study of lateral preference in mastication in patients with longstanding peripheral facial paralysis.

Peripheral facial paralysis (PFP) usually affects the facial nerve in part or in whole on one side of the face. Most patients with acute PFP find it difficult to chew on the paralyzed side, especially due to compromised buccinator function. In addition, the sagging of the ipsilateral lip commissure tends to compromise lip competence. The purpose of this study was to evaluate the impact of long-standing PFP upon mastication, relating to clinical mastication sidedness as determined by clinical and electromyographic activity of the masseters. The study included 27 male and female subjects aged 16-69 years with permanent natural dentition and long-standing PFP. Patients answered questions on their mastication habits before and after onset of PFP and were submitted to clinical myofunctional examination and electromyographical tests of the masseters during clenching and habitual mastication. According to the anamnesis, 77.8 % claimed to prefer chewing on the unaffected side. Clinically, 70% presented a lateral preference in mastication. In the clinical evaluation the buccinators and orbicularis oris differed significantly (p = 0.025) between the healthy and the paralyzed side. Only 22.2% of the patients showed increased thickness of the contralateral masseters. No statistically significant electromyographic difference was observed between the masseters on the affected and unaffected side. Conclusions In general indicated that subjects with flaccid-stage PFP for 6 months or longer preferred to masticate on the unaffected side. No significant clinical or electromyographic differences were found in masseter activity between the affected and unaffected side in this patient sample.

Tecnologia auditiva assistiva em usuários de implante coclear em ambientes reverberantes com múltiplas fontes de ruído / Assistive listening technology in cochlear implant users in reverberant environments with multiple noise sources

RESUMO Objetivo Avaliar a contribuição da tecnologia de escuta assistida em usuários de implante coclear (IC) em situações de reverberação e ruído. Métodos Estudo transversal prospectivo aprovado pelo Comitê de Ética Institucional (CAAE 8 3031418.4.0000.0068). Foram selecionados adolescentes e adultos usuários de IC com surdez pré ou pós-lingual. Para usuários bilaterais, cada orelha foi avaliada separadamente. O reconhecimento de fala foi avaliado por meio de listas gravadas de palavras dissílabas apresentadas a 65 dBA a 0° azimute com e sem o Mini Microfone2 (Cochlear™) conectado ao processador de fala Nucleus®6. A reverberação da sala foi medida como 550 ms. Para avaliar a contribuição do dispositivo de escuta assistida (DEA) em ambiente reverberante, o reconhecimento de fala foi avaliado no silêncio. Para avaliar a contribuição do DEA em reverberação e ruído, o reconhecimento de fala foi apresentado a 0° azimute com o ruído proveniente de 8 alto-falantes dispostos simetricamente a 2 metros de distância do centro com ruído de múltiplos falantes usando relação sinal-ruído de +10dB. Para evitar viés de aprendizado ou fadiga, a ordem dos testes foi randomizada. A comparação das médias foi analisada pelo teste t para amostras pareadas, adotando-se nível de significância de p<0,005. Resultados Dezessete pacientes com idade média de 40 anos foram convidados e concordaram em participar, sendo 2 participantes bilaterais, totalizando 19 orelhas. Houve contribuição positiva significante do Mini Mic2 na reverberação e ruído+reverberação (p<0,001). Conclusão DEA foi capaz de melhorar o reconhecimento de fala de usuários de IC tanto em situações de reverberação quanto ruidosas.

ABSTRACT Purpose This study aimed to evaluate the contribution of assistive listening technology with wireless connectivity in cochlear implant (CI) users in reverberating and noise situations. Methods Prospective cross-sectional study approved by the Institutional Ethics Committee (CAAE 8 3031418.4.0000.0068). Adolescents and adults CI users with pre- or post-lingual deafness were selected. For bilateral users, each ear was assessed separately. Speech recognition was assessed using recorded lists of disyllabic words presented at 65 dBA at 0° azimuth with and without the Wireless Mini Microphone 2 (Cochlear™) connected to the Nucleus®6 speech processor. Room reverberation was measured as 550 ms. To assess the contribution of the assistive listening device (ALD) in a reverberating environment, speech recognition was assessed in quiet. To assess the contribution of the ALD in reverberation and noise, speech recognition was presented at 0° azimuth along with the noise coming from 8 loudspeakers symmetrically arranged 2 meters away from the center with multi-talker babble noise using signal to noise ratio of +10dB. To avoid learning bias or fatigue, the order of the tests was randomized. Comparison of means was analyzed by t test for paired samples, adopting significance level of p <0.005. Results Seventeen patients with a mean age of 40 years were invited and agreed to participate, with 2 bilateral participants, totaling 19 ears assessed. There was a significant positive contribution from the Mini Mic2 in reverberation, and noise+reverberation (p <0.001). Conclusion ALD was able to improve speech recognition of CI users in both reverberation and noisy situations.

Hearing Performance in Cochlear Implant Users Who Have Facial Nerve Stimulation

Abstract Introduction Facial nerve stimulation (FNS) is a complication in cochlear implant (CI) when the electrical current escapes from the cochlea to the nearby facial nerve. Different management to reduce its effects are available, although changes might result in a less-than-ideal fitting for the CI user, eventually reducing speech perception. Objective To verify the etiologies that cause FNS, to identify strategies in managing FNS, and to evaluate speech recognition in patients who present FNS. Methods Retrospective study approved by the Ethical Board of the Institution. From the files of a CI group, patients who were identified with FNS either during surgery or at any time postoperatively were selected. Data collection included: CI manufacturer, electrode array type, age at implantation, etiology of hearing loss, FNS identification date, number of electrodes that generated FNS, FNS management actions, and speech recognition in quiet and in noise. Results Data were collected from 7 children and 25 adults. Etiologies that cause FNS were cochlear malformation, head trauma, meningitis, and otosclerosis; the main actions included decrease in the stimulation levels followed by the deactivation of electrodes. Average speech recognition in quiet before FNS was 86% and 80% after in patients who were able to accomplish the test. However, there was great variability, ranging from 0% in quiet to 90% of speech recognition in noise. Conclusion Etiologies that cause FNS are related to cochlear morphology alterations. Facial nerve stimulation can be solved using speech processor programming parameters; however, it is not possible to predict outcomes, since results depend on other variables.

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.

Auditory Brainstem Implant: surgical technique and early audiological results in patients with neurofibromatosis type 2.

UNLABELLED: Auditory Brainstem Implants were developed to partially restore the hearing capabilities of patients without cochlear nerves bilaterally. AIM: this paper aims to discuss the clinical and surgical findings of four ABI patients. MATERIALS AND METHOD: Four patients diagnosed with bilateral schwannomas received auditory brainstem implants (ABI) and had one of their tumors resected in the same surgical procedure. Clinical aspects, surgical technique, anatomic landmarks, and outcomes were analyzed. RESULTS: the anatomic landmarks were identified in all four patients in relation to the foramina of Luschka. Two patients had CSF leaks. The electrodes were well positioned and hearing sensation was good enough to allow for sound recognition and assist patients perform lip reading. CONCLUSION: the outcomes observed in our patients were quite encouraging and offer great perspectives for those suffering from deep bilateral deafness and impaired central auditory pathways.

Benefit of Cochlear Implantation in Children with Multiple-handicaps: Parent's Perspective.

Introduction The cochlear implants centers in the world are studying the cochlear implantation in children with multiple handicaps. Objective To develop a questionnaire to analyze the subjective benefits of the cochlear implantation in multiple handicapped children according to their parent's perspective. Methods A questionnaire was applied to 14 families of multiple handicapped children, aging from 2-12 years old and having from 11 months to 11 years of implant use. Results The social-emotional abilities were improved because of many factors, such as: auditory exposure, which happened in 84% of the children; recognition of their own names, which increased in 56%; and development of eye contact, in 28% of the subjects. Other benefits appeared to be: music appreciation and more attention and adherence to other therapies and school activities. Besides, some children became interested in objects, playing with other children, and more adapted to daily routines. Thirty-five percent of the children acquired oral language, mainly the bilaterally implanted, while 14% of them were engaged in sign language. Although all of the children showed a significant improvement in communication, the emotional issues of some families and the severity of the handicaps negatively impacted the outcomes. In spite of the families' acknowledgement of some benefits, the diagnosis of autism spectrum disorder caused frustration, requiring a readjustment of the expectations. Conclusion The questionnaire turned out to be an adequate tool to reveal the social-emotional benefits of cochlear implantation. Although oral language was not the major outcome in these cases, the cochlear implant benefits involved the whole family. All of the families recommended the implant to other children in a similar situation.

Auditory brainstem implant in postmeningitis totally ossified cochleae.

INTRODUCTION: An auditory brainstem implant (ABI) is an option for auditory rehabilitation in patients with totally ossified cochleae who cannot receive a conventional cochlear implant. OBJECTIVE: To evaluate the outcomes in audiometry and speech perception tests after the implantation of an ABI via the extended retrolabyrinthine approach in patients with postmeningitis hearing loss. MATERIALS AND METHODS: Ten patients, including children and adults, with postmeningitis hearing loss and bilateral totally ossified cochleae received an ABI in a tertiary center from 2009 to 2015. The extended retrolabyrinthine approach was performed in all the patients by the same surgeons. A statistical analysis compared pure tonal averages and speech perception tests before and at least 12 months after the ABI activation. RESULTS: Eight patients (80%) showed improvements in tonal audiometry and the word and vowel perception tests after an average follow-up of 3.3 years. Two patients recognized up to 40% of the closed-set sentences without lip-reading. Two patients had no auditory response. CONCLUSIONS: The ABI improved hearing performance in audiometry and speech perception tests in cases of postmeningitis hearing loss. The extended retrolabyrinthine approach is a safe surgical option for patients with postmeningitis hearing loss and bilateral totally ossified cochleae.