Cochlear implant in patients with single sided deafness: hearing results and communicative benefits.

Objective: Evaluate auditory results and communicative benefits in adult patients with single-sided deafness (SSD) treated with cochlear implantation.Study Design: Observational descriptive case series.Setting: Hospital Universitario Fundación Santa Fe de Bogotá.Patients: Ten patients with profound post-lingual SSD were treated with cochlear implantation between January 2011 and March 2016. Two patients were excluded because of incomplete follow-up.Interventions: Medical records included demographic information, pre and post-operative audiometric results, and binaural and monoaural speech discrimination tests in three sound-in-noise configurationswith the cochlear implant turned on and off, respectively. Subjective improvement was evaluated using the Abbreviated Profile of Hearing Aid Benefit (APHAB) and Speech, Spatial, and Qualities of Hearing Scale (SSQ-B).Main Outcome Measures: Pre and post-operative audiometric and speech discrimination results, post-operative binaural and monoaural speech discrimination in noise results, and APHAB and SSQ-B questionnaire results.Results: Significant improvement in speech discrimination in a noisy environment was found when the noise and signal were presented from the front, and when the signal was presented to the implanted ear and the noise to the healthy ear. SSQ-B questionnaire showed improvement in all subscales, while APHAB showed improvement in all subscales except sound aversion.Conclusion: Patients with SSD showed improvement regarding communication skills and sound discrimination in a noisy environment.

Retrospective analysis of skin complications related to bone-anchored hearing aid implant: association with surgical technique, quality of life, and audiological benefit / Análise retrospectiva de complicações cutâneas relacionadas ao implante de prótese auditiva óssea: associação com técnica cirúrgica, qualidade de vida e benefício audiológico

Abstract Introduction: The bone-anchored hearing aid is an effective form of auditory rehabilitation. Due to the nature of the implant, the most common complications are skin related. A number of alternative surgical implantation techniques have been used to reduce the frequency and severity of skin complications, including the U-shaped graft and the linear incision. Objective: To assess skin complications and their association with surgical technique, quality of life, and audiological benefit in patients with bone-anchored hearing aids. Methods: This was a retrospective study conducted in a tertiary referral center in Bogotá, Colombia. Patients who had been fitted with a bone-anchored hearing aid implant (unilaterally or bilaterally) for at least 6 months were included in the study. The Holgers classification was used to classify skin complications (Grade 0 = none; Grade 1 = erythema; Grade 2 = erythema and discharge; Grade 3 = granulation tissue; and Grade 4 = inflammation/infection resulting in the removal of the abutment). The Glasgow Benefit Inventory questionnaire was used to determine quality of life, and the Abbreviated Profile of Hearing Aid Benefit questionnaire was used to determine the subjective audiological benefit. Results: A total of 37 patients were included in the study (30 with unilateral implants and 7 with bilateral implant). Of the 44 implants evaluated, 31 (70.3%) were associated with skin complications (7 [15.9%] Grade 1; 4 [9.1%] Grade 2; 15 [34.1%] Grade 3, 5 [11.4%] Grade 4). The U-shaped graft was statistically associated with major complications (Grades 3 and 4) compared with the linear incision technique (p = 0.045). No statistically significant differences were found between Abbreviated Profile of Hearing Aid Benefit scores and severity of complications. Similarly, no differences were found between Glasgow Benefit Inventory physical health questions and skin complications. Conclusion: Despite the high frequency, skin complications did not seem to affect quality of life or subjective audiological benefits of patients with bone-anchored hearing aids.

Resumo Introdução: A prótese auditiva óssea (BAHA, do inglês Bone-Anchored Hearing Aid) é uma forma eficaz de reabilitação auditiva. Devido à natureza do implante, as complicações mais comuns são relacionadas à pele. Várias técnicas opcionais de implantação cirúrgica têm sido usadas para reduzir a frequência e a gravidade das complicações cutâneas, inclusive o enxerto em forma de U e a incisão linear. Objetivo: Avaliar as complicações cutâneas e sua associação com a técnica cirúrgica, qualidade de vida e benefício audiológico em pacientes com BAHAs. Método: Estudo retrospectivo feito em um centro terciário de referência em Bogotá, Colômbia. Os pacientes que receberam um implante de BAHA (unilateral ou bilateralmente) durante pelo menos seis meses foram incluídos no estudo. A classificação de Holgers foi usada para classificar as complicações cutâneas (Grau 0 = nenhuma, Grau 1 = eritema, Grau 2 = eritema e secreção, Grau 3 = tecido de granulação e Grau 4 = inflamação/infecção, resultou na remoção da estrutura de apoio). O questionário Glasgow Benefit Inventory (GBI) foi usado para determinar a qualidade de vida e o questionário Abbreviated Profile of Hearing Aid Benefit (APHAB) foi usado para determinar o benefício audiológico subjetivo. Resultados: Foram incluídos 37 pacientes (30 com implantes unilaterais e sete com implantes bilaterais). Dos 44 implantes avaliados, 31 (70,3%) foram associados às complicações cutâneas (sete [15,9%] Grau 1; quatro [9,1%] Grau 2; 15 [34,1%] Grau 3 e cinco [11,4%] Grau 4). O enxerto em forma de U foi estatisticamente associado a complicações maiores (Graus 3 e 4) em comparação com a técnica de incisão linear (p = 0,045). Não foram encontradas diferenças estatisticamente significativas entre os escores APHAB e gravidade das complicações. Do mesmo modo, não foram encontradas diferenças entre as questões de saúde física pelo questionário GBI e complicações cutâneas. Conclusão: Apesar da alta frequência, as complicações cutâneas não parecem afetar a qualidade de vida ou os benefícios audiológicos subjetivos de pacientes com BAHAs.

Retrospective analysis of skin complications related to bone-anchored hearing aid implant: association with surgical technique, quality of life, and audiological benefit.

INTRODUCTION: The bone-anchored hearing aid is an effective form of auditory rehabilitation. Due to the nature of the implant, the most common complications are skin related. A number of alternative surgical implantation techniques have been used to reduce the frequency and severity of skin complications, including the U-shaped graft and the linear incision. OBJECTIVE: To assess skin complications and their association with surgical technique, quality of life, and audiological benefit in patients with bone-anchored hearing aids. METHODS: This was a retrospective study conducted in a tertiary referral center in Bogotá, Colombia. Patients who had been fitted with a bone-anchored hearing aid implant (unilaterally or bilaterally) for at least 6 months were included in the study. The Holgers classification was used to classify skin complications (Grade 0=none; Grade 1=erythema; Grade 2=erythema and discharge; Grade 3=granulation tissue; and Grade 4=inflammation/infection resulting in the removal of the abutment). The Glasgow Benefit Inventory questionnaire was used to determine quality of life, and the Abbreviated Profile of Hearing Aid Benefit questionnaire was used to determine the subjective audiological benefit. RESULTS: A total of 37 patients were included in the study (30 with unilateral implants and 7 with bilateral implant). Of the 44 implants evaluated, 31 (70.3%) were associated with skin complications (7 [15.9%] Grade 1; 4 [9.1%] Grade 2; 15 [34.1%] Grade 3, 5 [11.4%] Grade 4). The U-shaped graft was statistically associated with major complications (Grades 3 and 4) compared with the linear incision technique (p=0.045). No statistically significant differences were found between Abbreviated Profile of Hearing Aid Benefit scores and severity of complications. Similarly, no differences were found between Glasgow Benefit Inventory physical health questions and skin complications. CONCLUSION: Despite the high frequency, skin complications did not seem to affect quality of life or subjective audiological benefits of patients with bone-anchored hearing aids.

Cochlear Implants Versus Hearing Aids in a Middle-Income Country: Costs, Productivity, and Quality of Life.

OBJECTIVE: In Colombia there are three main treatment approaches for bilateral profound sensorineural hearing loss, also known as profound deafness (PD): cochlear implants (CI), hearing aids (HA), and no treatment (NT). The objective of this study is to determine the optimal treatment approach for PD in terms of productivity and cost-effectiveness. STUDY DESIGN: Hearing levels and SES data were obtained from audiometric tests conducted on 100 patients with CI. For each treatment approach, productivity and cost-effectiveness assessments were estimated using influence diagrams and Monte Carlo simulations. Productivity was calculated as the net present value of a patient's lifetime income divided by total health-related and educational costs. For the CI and HA, the cost-effectiveness indicator was calculated as quality-adjusted life-years (QALYs) gained in comparison with the NT approach divided by the total cost of the treatment option. RESULTS: The results for the CI, the HA, and NT in terms of productivity ratio were 1.53, 0.94, and 1.47, respectively. Patients using CI had a gain of 5.7 QALYs, whereas patients using HA had a gain of 4.6 QALYs. The results for the CI and the HA in terms of cost-effectiveness were $15,169 and $15,430 per QALY, respectively. CONCLUSION: The CI was found to be the optimal treatment for PD, as it was the most efficient and cost-effective in terms of improving patients' productivity and quality of life. We observed that children who had received CI developed hearing and speech abilities that contributed to their productivity and quality of life to a greater extent than those with HA.

Resultados auditivos y de beneficios comunicativos en pacientes tratados con el implante activo de transmisión ósea Bonebridge® / Hearing results and communication benefits in patients treated with the active bone conduction implant Bonebridge®

El avance en dispositivos de rehabilitación auditiva ha logrado llegar a los dispositivos de transmisión ósea por medio de anclaje al hueso. El BAHA® (Bone Anchored Hearing Aid, Cochlear Co., Australia) es el más usado, dada su ganancia en el rango de frecuencias altas con menor distorsión de la señal; sin embargo, con complicaciones importantes, como infección, pérdida del implante y necesidad de cirugía revisional, que impactan en calidad de vida y costos. Debido a esto se han desarrollado implantes transcutáneos con menos complicaciones y resultados audiológicos similares, como el nuevo sistema activo de conducción ósea Bonebridge®. Objetivo: Describir los resultados auditivos y beneficios comunicativos del sistema implantable transcutáneo activo de conducción ósea Bonebridge® en hipoacusia conductiva y mixta. Diseño: Estudio pseudoexperimental tipo antes y después. Métodos: Se analizó a los pacientes implantados con el Bonebridge® entre octubre del 2012 y agosto del 2013, por el Servicio de Otología del Hospital Universitario Fundación Santa Fe de Bogotá, y se evaluaron ganancia funcional en audiometría, logoaudiometría, beneficio comunicativo y APHAB pre y posquirúrgico. Resultados: No se encontraron diferencias significativas en la vía ósea pre y postoperatoria. En las pruebas en campo libre solo hubo diferencia en la frecuencia de 500 Hz (P < 0,05). Se evidenció ganancia funcional en la discriminación del lenguaje en bisílabos a 60 dB SPL (nivel de presión sonora) (P: 0,042); se encontraron diferencias en el cuestionario de beneficio comunicativo APHAB (P: 0,043) en todas sus subcategorías, exceptuando aversión (P: 0,068). No hubo complicaciones. Conclusiones: El Bonebridge® es seguro y eficaz para la rehabilitación auditiva...

Advances in hearing rehabilitation devices have developed bone conduction devices through bone anchorage, BAHA® (Cochlear Bone Anchored Hearing Aid Co., Australia) is the most used because of its profit in the range of higher frequencies with less signal distortion, however, ought to its complications such as infection, implant loss and need for revisional surgery, which impact in costs and quality of life; transcutaneous implants have been developed with fewer complications and similar audiological results as the new active system Bonebridge® bone conduction. Objective: To describe the auditory results and communicative benefits of the active transcutaneous bone conduction implantable system Bonebridge® for treatment of conductive and mixed hearing loss. Desing: Pseudoexperimental before and after study. Methods: Patients who were implanted with Bonebridge® between October 2012 and August 2013 were analized by the Otology Department from the Fundación Santa Fe University Hospital in Bogotá, assessing functional gain in audiometry, speech audiometry and communicative benefit, APHAB, before and after surgery. Results: No significant differences in bone conduction were found before or after surgery. In free field test there was only a significant difference for 500 Hz frequency (P < 0.05), functional gain was observed in speech discrimination at 60 dB SPL disyllabic (P 0.042). There were differences for communicative benefit questionnaire (P 0.043) with the use of the device in every subcategories except aversion (P 0.068). There were no complications. Conclusion: Bonebridge® is safe and effective for hearing rehabilitations...

[Economic benefits of the cochlear implant for treating profound sensorineural hearing loss]. / Beneficios económicos del implante coclear para la hipoacusia sensorineural profunda.

OBJECTIVE: Evaluate the cost-benefit, cost-utility, and cost-effectiveness of cochlear implantation, comparing it to the use of hearing aids in children with profound bilateral sensorineural hearing loss. METHODS: The nonparametric propensity score matching method was used to carry out an economic and impact assessment of the cochlear implant and then perform cost-benefit, cost-utility, and cost-effectiveness analyses. Primary information was used, taken randomly from 100 patients: 62 who received cochlear implants (treatment group) and 38 belonging to the control group who used hearing aids to treat profound sensorineural hearing loss. RESULTS: An economic cost differential was found-to the advantage of the cochlear implant-of close to US$ 204,000 between the implant and the use of hearing aids over the expected life span of the patients analyzed. This amount refers to the greater expenses that hearing-aid patients will have. With this adjusted figure, the cost-benefit indicator shows that for each dollar invested to treat the cochlear-implant patient, there is a return on the investment of US$ 2.07. CONCLUSIONS: The cochlear implant produces economic benefits for the patient. It also produces health utilities since positive cost-utility (gain in decibels) and cost-effectiveness (gain in language discrimination) ratios were found.

Parents' narratives on cochlear implantation: reconstructing the experience of having a child with cochlear implant.

This paper discusses parents' narratives on cochlear implantation in Bogotá, Colombia using a qualitative approach. The main research objective was to identify how parents perceived the processes of diagnosis of their child's hearing loss, making the decision for cochlear implantation and the post-surgery period. All participants were hearing couples (n = 13) with similar socio-cultural backgrounds whose children had undergone cochlear implant surgery. Results show why cochlear implants are a very highly valued technological device with great symbolic power for parents. The study also deals with how perceptions about oral/sign language and disability, as well as social expectations for their children's lifetime opportunities, determine how the parents themselves have experienced their journey through the process of their children's cochlear implantation.

Estimulación bimodal en los pacientes con implante coclear / Bimodal stimulation In patients with Cochlear implant

La audición normal es binaural lo cual permite escuchar apropiadamente en ambientes de ruido, localizar el sonido y maximizar el procesamiento auditivo central en las diferentes etapas del desarrollo cortical en lo períodos críticos y en la vida cotidiana. Hoy en día la gran evolución tecnológica en el campo de los implantes cocleares nos ha permitido implantar pacientes desde el primer año de vida y aún antes en casos seleccionados. Igualmente la implantación coclear bilateral tiene importantes ventajas con todo el respaldo científico. En este artículo presentamos la experiencia del Programa de mplante Coclear de la Fundación Santa Fe de Bogotá en pacientes adultos y niños que utilizan audiífono y un implante coclear en el oído con menores restos auditivos(estimulación bimodal). Presentamos una revisión de la literatura donde se confirman las ventajas de este tipo de estimulación como discriminar mejor en ambientes de ruido, compensar el efecto sombra de la cabeza, mejorar la localización del sonido y mejorar la capacidad de filtra el lenguaje en ruido (efecto squelch, silenciamiento).

Normal hearing is binaural which allows for the adequate hearing ability in noisy environments, the proper perception of sound direction and maximization of the central auditory process in the various cortical development stages, both during critical periods of time and everyday life. The advanced technological evolution in the field of cochlear implants has allowed us to implant patients from their first year of age and even before in some selected cases, nowadays. Also bilateral cochlear implantation offers significant advantages with all the scientific support. In this article we present the experience of the Cochlear Implant Program at Fundación Santa Fe de Bogotá in adult patients and in children that use the hearing aid as well as a cochlear implant in the ear with less residual hearing (bimodal stimulation). We present a literature revision that confirms the advantages of this kind of stimulation such as a better sound discrimination ability in noisy environments, the making up for the shadow effect of the head, the enhancement of the ability to track down sounds and also, the improvement of the in noise language filtering skill (the squelch effect, silencing).

Auditory performance and central auditory processing after cochlear implantation in patients deafened by meningitis.

The objective of this study was to describe the auditory performance of patients deafened by meningitis in closed-set, open-set and language tests (Luria's test). Ten paediatric subjects deafened by meningitis were compared with a peer group of ten paediatric congenitally deaf subjects. All the subjects had a full insertion of a Nucleus device. Three of the subjects in each group had a longer follow-up period and were selected to perform the Luria test. The closed-set tests did not show statistically significant differences between the two groups (p < 0.21) but comparative results of open-set bisyllabic tests did show statistically significant differences (p < 0.003). It was concluded that meningitis might affect the central auditory processing and acquisition process of language.

Detección temprana de problemas auditivos en recien nacidos y lactantes de alto riesgo / Early detection of hearing problems in the newborn

El programa de "Detección temprana de pérdidas auditivas en el Recién Nacido y Lactantes de Alto Riesgo" es desarrollado en el Hospital Simón Bolivar como parte integral de un trabajo proyectivo e interdisciplinario en el programa de "Atención integral al bebé de bajo peso" en el cual participan activamente los servicios de Audiología y Otorrinolaringología en conjunto con pediatría, nutrición y enfermería. Desde Agosto de 1992 hasta Diciembre de 1995 se evaluaron 280 bebés con peso entre 900 y 2.500 gramos. A cada uno se le realizó su historia clínica completa haciendo énfasis en los antecedentes importantes y barridos auditivos utilizando un reactómetro en la banda estrecha de 3000 Hz y 70 Db de intensidad observándose la respuesta refleja del bebé (cocleopalpebral, Moro, sobresalto y/o movimientos generalizados). Cuando se presentaba una respuesta dudosa se le realizaba impedanciometría y potenciales auditivos evocados para diagnóstico. Además por ser un programa integral se podía hacer un seguimiento del proceso de maduración de la vía auditiva. Se detectaron alteraciones auditivas en un 11 por ciento del número total de bebés y en un 60 por ciento de los bebés con peso inferior a los 1.500 gramos, factor considerado de Alto riego. Se encontraron otros factores de Riesgo como los antecedentes de Hipoglicemia, Hipoxia Neonatal, Drogas Ototóxicas, Hiperbilirrubinemia, Meningitis y Problema Metabólicos. De esta manera se pudo detectar Hipoacusia Neurosensorial en cinco bebés y determinar el ingreso a programas de estimulación temprana y adaptación de audífonos.