Overcoming developing-world challenges in cochlear implantation: a South American perspective.

PURPOSE OF REVIEW: Effective hearing rehabilitation with cochlear implantation is challenging in developing countries, and this review focuses on strategies for childhood profound sensorineural hearing loss care in South America. RECENT FINDINGS: Most global hearing loss exists in developing countries; optimal cost-effective management strategies are essential in these environments. This review aims to assess and discuss the challenges of cochlear implantation effectiveness in South America. The authors searched electronic databases, bibliographies, and references for published and unpublished studies. Sensitivity analysis was performed to evaluate the effect of device cost, professional salaries, annual number of implants, and failure rate. Costs were obtained from experts in South America using known costs and estimations whenever necessary. Recent studies reported several challenges in unilateral or bilateral cochlear implants: cochlear implant costs, deaf education costs, increasing need for cochlear implant capacity, and training and increasing longevity. SUMMARY: Cochlear implantation was very cost-effective in all South American countries. Despite inconsistencies in the quality of available evidence, the robustness of systematic review methods substantiates the positive findings of the included studies, demonstrating that unilateral cochlear implantation is clinically effective and likely to be cost-effective in developing countries.

Hearing Impairment in Children and Adults With Acquired Middle Ear Cholesteatoma: Audiometric Comparison of 385 Ears.

OBJECTIVE: Evaluate hearing impairment in acquired middle ear cholesteatoma and investigate audiometric differences between children and adults. STUDY DESIGN: Cross-sectional comparative study. SETTING: Tertiary hospital. PATIENTS: Three hundred twenty-three consecutive patients diagnosed as having acquired middle ear cholesteatoma in at least one ear (385 ears) between August 2000 and March 2013 and no surgical history (mean [standard deviation {SD}] age, 32.8 [19.4] yr; 54.3% men and 34.8% children). INTERVENTION: Pure-tone audiometry. MAIN OUTCOME MEASURES: Air-conduction (AC) and bone conduction (BC) thresholds and air-bone gaps (ABGs) measured at the pure-tone average (PTA) and individual frequencies. RESULTS: The mean (SD) AC and BC thresholds at the PTA were 46.8 (22.7) and 17.7 (17.5) dB, respectively. The mean (SD) ABG at the PTA was 29.6 (13.4) dB, and that at 500 Hz was significantly greater than the ABGs at the other frequencies. Only 3.6% of the ears had profound hearing loss, without a significant difference between children and adults. The AC and BC thresholds were significantly greater in adults at all the frequencies (p ≤ 0.05), but the ABGs were not significantly different between the age groups. CONCLUSION: Acquired middle ear cholesteatoma is associated with significant hearing impairment, although profound hearing loss is rare. Adults have greater AC and BC thresholds than those in children but similar ABGs to children.

Contralateral ear in chronic otitis media: a histologic study.

OBJECTIVE: The objective of this study is to determine the prevalence of the contralateral ear changes in human temporal bones of donors with chronic otitis media. STUDY DESIGN: Transversal. MATERIAL AND METHODS: The temporal bones were examined under light microscopy and then described. Chronic otitis media was defined by the presence of irreversible inflammatory alterations in the middle ear cleft. The contralateral ear was defined as the normal or the less affected ear. To compare the qualitative variables, the chi test was used. Spearman's nonparametric test was used for correlations. P values less than or equal to .05 were considered significant. RESULTS: We studied 85 pairs of temporal bones. Cholesteatoma was observed in 22.4% of the more damaged ears. The prevalence of contralateral ears with alterations was 91.8%. The main alterations were granulation tissue (81%), effusion (58%), and tympanic membrane retractions (35%). There was a direct and moderately strong correlation between the extent of granulation tissue in the more damaged ear and the contralateral ear (r(s) = 0.345, P = .004). A strong correlation was observed between the extent of cholesteatoma in the more damaged ear and in the contralateral ear (rs = 0.617, P < .001). CONCLUSION: We observed a high prevalence of changes in the contralateral ear. There was a direct correlation between the extent of both granulation tissue and cholesteatoma between the two ears, demonstrating that the more extensive the manifestation of these pathologies in the more damaged ear, the greater they will be in the contralateral ear.

Auditory brainstem response: prognostic value in patients with a score of 3 on the Glasgow Coma Scale.

OBJECTIVE: To evaluate the prognostic value of auditory brainstem response (ABR) recorded in comatose patients presenting a score of 3 on the Glasgow Coma Scale (GCS = 3). PATIENTS: One hundred thirty-eight patients in coma at GCS = 3 due to various etiologic agents. INTERVENTION: To record and analyze tracings of ABR. MAIN OUTCOME MEASURE: Tracings from ABR were classified into four types (B1, B2, B3, and B4) on the basis of synchrony of waves. RESULTS: The Fischer's exact test used for comparison between death proportions revealed that B1 is different from B2, B3, or B4 and the association B2 + B3 + B4. CONCLUSION: Auditory brainstem response is a useful tool with prognostic value for patients in coma with GCS = 3. It was demonstrated in our series that once the patient presented an abnormal ABR (B2, B3, or B4), he had a greater probability of dying than a patient with a normal ABR (B1).