Intraoperative Intracochlear Electrocochleography and Residual Hearing Preservation Outcomes When Using Two Types of Slim Electrode Arrays in Cochlear Implantation.

OBJECTIVES: To report residual hearing preservation outcomes in patients with low frequency hearing, after cochlear implant (CI) electrode insertion with two types of electrode arrays: one straight and other perimodiolar, when using intraoperative intracochlear electrocochleography (ECochG) during (CI) electrode insertion. STUDY DESIGN: Prospective, randomized study. SETTING: Tertiary referral otology center. PATIENTS: Fifteen patients ranging from 33 to 54 years old (mean 51.19). They had been diagnosed with a bilateral, profound sensorineural hearing loss and treated with a unilateral cochlear implant: eight of them with the CI532 and seven of them with the CI522 (Cochlear Ltd, Sydney, Australia). INTERVENTION: Pure-tone audiometry was performed preoperatively and at 1 and 6 months postoperatively. Interoperatively, intracochlear ECochG was performed using the apical-most electrode. The amplitude of the first harmonic was plotted and monitored in real time by the audiologist-surgeon team during their CI electrode insertion. The different ECoch patterns of the insertion track were recorded and analyzed. RESULTS: In 12 cases ECochG responses were successfully recorded. In three cases no ECochG responses could be recorded with no residual hearing observed postoperatively in two of them. With respect to the first harmonic amplitude changes, we found: four cases with an overall increase in amplitude measured from the beginning of insertion until completion, all of them showed residual hearing (<15 dB HL) at 6 months postoperation. Three cases with an increasing amplitude at the beginning of insertion, with a decrease in amplitude as insertion progressed to completion, in two cases dropping of residual hearing (15-30 dB HL) were observed after 6 months postoperation and, in one case, complete residual hearing was observed at 6 months postoperatively. And finally five cases presented amplitudes at the start of insertion with modifications of amplitude during the insertion dynamic, with increasing and descending in amplitude range during the whole insertion, two of them showed residual hearing at 6 months postoperation and three cases a drop of residual hearing (15-30 dB HL) was observed after 6 months postoperation. No statistical differences between CI532 and CI522 electrodes were found. Data of the ECochG responses are also presented (p value ≥ 0.05). CONCLUSION: ECochG is a useful tool to evaluate the residual hearing in CI patients with straight and perimodiolar cochlear implant. More studies are needed to fully understand the relationship between ECochG and the presence of residual hearing, cochlear trauma, and functional outcomes.

Single-sided deafness and cochlear implantation in congenital and acquired hearing loss in children.

OBJECTIVE: To determine the audiological and clinical results of cochlear implantation in children below the age of 12 years old with congenital and acquired single-sided deafness. DESIGN: Observational, descriptive, transversal study. MAIN OUTCOME MEASURES: Speech reception thresholds, Cortical responses, Auditory Lateralization Test and SSQ questionnaire. PARTICIPANTS: Children < 12 implanted for congenital or acquired SSD. RESULTS: All the children with congenital SSD showed positive cortical responses. Positive results were obtained in the Auditory Lateralization Test for the following modalities: 0º, 45º and 90º. With respect to the Speech Test, the children with acquired SSD showed the following results: 92% and 100% in recognition and 48% and 68% (Azimuth modalities), Signal CI side 52% and 68% and Signal normal hearing side 44% - 60% (p < 0.05). In both group the processor was used for 6-12 hours. With respect to the SSQ questionnaire results, the parents were more satisfied within the post-operative period than within the pre-operative period (P<0.001). CONCLUSIONS: Cochlear implant provides children with congenital SSD with significant audiological and subjective benefits. Children with congenital SSD and implanted after a longer period may not have an important benefit (binaural) although other bilateral effects can be achieved. Children with post-lingual unilateral deafness and after a short period of hearing deprivation probably integrated the normal acoustic hearing with the cochlear implant electrical signal and showed binaural benefits.

Experiencia en reimplantación coclear. Estudio descriptivo durante un período de 20 años / Experience in cochlear reimplantation. Descriptive study of a 20-year period

Introducción y objetivos: El implante coclear es un procedimiento quirúrgico que ha presentado un incremento sustancial, debido a que la población pediátrica es diagnosticada e implantada de forma temprana y al incremento de indicaciones posibles. Este dispositivo tiene el riesgo inherente de presentar fallos en su funcionamiento, siendo esta la causa más frecuente de explantación. Nuestro objetivo es conocer las causas que en nuestra serie nos han llevado a ello y confirmar si se ajusta a la realidad según lo revisado en la literatura médica. Métodos: Estudio retrospectivo observacional y descriptivo de 859 cirugías de implante coclear, realizadas entre octubre de 1991 y mayo de 2011. Las causas de explantación fueron clasificadas según el Consenso Europeo de Fallos y Explantaciones de los Implantes Cocleares. Resultados: La tasa de reimplantación fue de 6,16% (n = 51). La causa más frecuente de explantación fue el fallo técnico del dispositivo (45,5%), seguida de infección/rechazo del implante (23,6%) y actualización del mismo (12,7%). Entre las causas menos frecuentes se encontraron 3 casos (5,6%) por malinserción de los electrodos, 2 casos (3,6%) de fallo por osificación, 2 (3,6%) por traumatismo craneoencefálico, 2 (3,6%) por realización de resonancia nuclear magnética y un caso (1,8%) por enfermedad psiquiátrica. Conclusiones: La reimplantación coclear es un procedimiento seguro, que presenta una baja tasa de complicaciones. En nuestro centro alcanza una tasa global de 6,16%. El fallo técnico del dispositivo sigue siendo la causa más frecuente de este procedimiento, con un importante porcentaje de reimplantes por actualización del dispositivo (AU)

Introduction and objectives: The cochlear implant is a surgical procedure that has increased substantially, because the paediatric population is diagnosed and implanted early and because there are increased potential indications. This device has the inherent risk of failure in performance, as dies any active medical device, which is the most common cause of implant removal. Our goal was to understand what the causes that produced removal in our series were, and confirm if these conformed to reality as reviewed in the literature. Methods: This was a retrospective, descriptive, observational study of 859 cochlear implant surgeries carried out between October 1991 and May 2011. The causes of implant removal were classified according to the European Consensus Statement on Cochlear Implant Failures and Explantations. Results: The reimplantation rate was 6.16% (n = 51). The most common reason for removal was technical device failure (45.5%), followed by infection/rejection (23.6%) and upgrade (12.7%). Less common causes: there were 3 cases (5.6%) of electrode misplacement, 2 cases (3.6%) of labyrinthine ossification, 2 (3.6%) as a result of head trauma, 2 (3.6%) from need for nuclear magnetic resonance imaging and 1 case (1.8%) from psychiatric illness. Conclusions: Cochlear reimplantation is a safe procedure, with a low complication rate. In our centre, it reaches an overall rate of 6.16%. Technical device failure remains the most common cause of this procedure, although there is a significant percentage of reimplantation for device update (AU)

Experience in cochlear reimplantation. Descriptive study of a 20-year period.

INTRODUCTION AND OBJECTIVES: The cochlear implant is a surgical procedure that has increased substantially, because the paediatric population is diagnosed and implanted early and because there are increased potential indications. This device has the inherent risk of failure in performance, as dies any active medical device, which is the most common cause of implant removal. Our goal was to understand what the causes that produced removal in our series were, and confirm if these conformed to reality as reviewed in the literature. METHODS: This was a retrospective, descriptive, observational study of 859 cochlear implant surgeries carried out between October 1991 and May 2011. The causes of implant removal were classified according to the European Consensus Statement on Cochlear Implant Failures and Explantations. RESULTS: The reimplantation rate was 6.16% (n=51). The most common reason for removal was technical device failure (45.5%), followed by infection/rejection (23.6%) and upgrade (12.7%). Less common causes: there were 3 cases (5.6%) of electrode misplacement, 2 cases (3.6%) of labyrinthine ossification, 2 (3.6%) as a result of head trauma, 2 (3.6%) from need for nuclear magnetic resonance imaging and 1 case (1.8%) from psychiatric illness. CONCLUSIONS: Cochlear reimplantation is a safe procedure, with a low complication rate. In our centre, it reaches an overall rate of 6.16%. Technical device failure remains the most common cause of this procedure, although there is a significant percentage of reimplantation for device update.

Results in cochlear implanted children before 5 years of age. a long term follow up.

OBJECTIVE: To assess the hearing threshold and linguistic results of cochlear implanted children aged 10 months to 5 years, when they reached the age of 12. We studied the benefits of sequential bilateral implantation. METHOD AND RESULTS: This is an observational, descriptive, transversal study comprising 57 cochlear implanted subjects. We performed a free field tonal audiometry at 65dB SPL, speech tests and sentences in quiet and noise (SNR+10) tests. The Objective and Criterial Language Battery (BLOC) was used to assess linguistic competence, in its screening version. RESULTS: Children implanted under the age of 2 and with inter-implant period less than or equal to 4 years reached better statistically significant results in disyllabic and sentences with and without noise (p=0.006) tests and in the disyllabic test with noise (p=0.045) (the hardest speech test). This suggests the acquisition of binaurality, as opposed to children implanted after this age, with inter-implant period longer than 4 years, who do not reach the same performance levels. RESULTS: of language development in the group implanted at ages 10 months to 2 years are better with respect to implanted children at ages 3-5 (<0.05) in both unilateral and bilateral implanted children in relation to the age of implantation. CONCLUSION: Children with pre-lingual deafness implanted before the age of 2, when they are 12 years old obtain more benefits in their language development and in their linguistic competence than children implanted after this age. The audiology results are better in children implanted bilaterally under the age of 2.

Reconocimiento auditivo musical y melódico en pacientes con implante coclear, mediante nuevo método de programación de asignación frecuencial / Recognition of music and melody in patients with cochlear implants, using a new programming approach for frequency assignment

Introducción y objetivo: La música es un fenómeno universal y transcultural. La percepción y el disfrute de la música son objetivos aún no solucionados completamente con la tecnología actual de los implantes cocleares. El objetivo de este artículo es avanzar hacia el desarrollo y la validación de un método de programación para implantes cocleares donde se implementa una estrategia de asignación frecuencial. Se comparan la programación estándar frente a la programación de asignación frecuencial, en cada sujeto. Método: Se estudian cuarenta pacientes portadores de implante coclear. Se realiza ajuste y optimización del programa estándar, luego programación de asignación frecuencial utilizando Custom Sound Suite de Cochlear, versión 3.2. Para las pruebas de habla se utilizó el protocolo para la valoración de la audición en lengua española. En implantados bilaterales se exploraron ambos oídos a la vez. Para los hábitos musicales se utilizó el Cuestionario de Música de Múnich y el software «MACarena». Resultados: Todos los pacientes presentan mejores resultados en reconocimiento de instrumentos, escalas tonales, reconocimiento de armónicos y tono con la programación frecuencial (p < 0,005). Conclusiones: La programación frecuencial asignada a la fundamental mejora la percepción y reconocimiento musical comparada con la programación estándar. Implantados bilaterales presentan mejor percepción de patrones musicales, escalas tonales, armónicas e instrumentos. Esta forma de programación permite disminución de niveles de intensidad de corriente e incremento del rango dinámico, y esto lleva a un mapeo de cada banda de audio menos molesta mejorando la calidad de la señal (AU)

Introduction and objective: Music is a universal, cross-cultural phenomenon. Perception and enjoyment of music are still not solved with current technological objectives of cochlear implants. The objective of this article was to advance the development and validation of a method of programming of cochlear implants that implements a frequency allocation strategy. We compared standard programming vs frequency programming in every subject. Methods: We studied a total of 40 patients with cochlear implants. Each patient was programmed with a optimal version of the standard program, using the Custom Sound Suite 3.2 cochlear platform. Speech tests in quiet were performed using syllable word lists from the protocol for the assessment of hearing in the Spanish language. Patients implanted bilaterally were tested in both ears at the same time. For assessing music listening habits we used the Munich Music Questionnaire and «MACarena» (minimum auditory capability) software. Results: All patients achieved better results in recognition, instrument tests and tonal scales with frequency programming (P <0 .005). Likewise, there were better results with frequency programming in recognising harmonics and pitch test (P < 0.005). Conclusions: Frequency programming achieves better perception and recognition results in patients in comparison with standard programming. Bilateral stimulation patients have better perception of musical patterns and better performance in recognition of tonal scales, harmonics and musical instruments compared with patients with unilateral stimulation. Modification and frequency allocation during programming allows decreased levels of current intensity and increase the dynamic range, which allows (AU)

Recognition of music and melody in patients with cochlear implants, using a new programming approach for frequency assignment.

INTRODUCTION AND OBJECTIVE: Music is a universal, cross-cultural phenomenon. Perception and enjoyment of music are still not solved with current technological objectives of cochlear implants. The objective of this article was to advance the development and validation of a method of programming of cochlear implants that implements a frequency allocation strategy. We compared standard programming vs frequency programming in every subject. METHODS: We studied a total of 40 patients with cochlear implants. Each patient was programmed with a optimal version of the standard program, using the Custom Sound Suite 3.2 cochlear platform. Speech tests in quiet were performed using syllable word lists from the protocol for the assessment of hearing in the Spanish language. Patients implanted bilaterally were tested in both ears at the same time. For assessing music listening habits we used the Munich Music Questionnaire and «MACarena¼(minimum auditory capability) software. RESULTS: All patients achieved better results in recognition, instrument tests and tonal scales with frequency programming (P<.005). Likewise, there were better results with frequency programming in recognising harmonics and pitch test (P<.005). CONCLUSIONS: Frequency programming achieves better perception and recognition results in patients in comparison with standard programming. Bilateral stimulation patients have better perception of musical patterns and better performance in recognition of tonal scales, harmonics and musical instruments compared with patients with unilateral stimulation. Modification and frequency allocation during programming allows decreased levels of current intensity and increase the dynamic range, which allows mapping of each audio band less obtrusively and improves the quality of representation of the signal.

Evaluación del muy bajo peso (≤ 1.500 g) al nacer como indicador de riesgo para la hipoacusia neurosensorial / Evaluation of very low birth weight (≤ 1.500 g) as a risk indicator for sensorineural hearing loss

Introducción y objetivo: La audición cumple un rol fundamental en la adquisición, desarrollo y mantenimiento de las propiedades del habla y del lenguaje. El peso al nacer es un indicador de maduración biológica del recién nacido (RN). El RN con muy bajo peso al nacer (MBPN ≤ 1500 g) y el gran prematuro es un grupo de población de mayor riesgo para hipoacusia neurosensorial. El objetivo del estudio es conocer el grado de hipoacusia, presencia de hipoacusia neurosensorial y la asociación a otro factor de riesgo para hipoacusia en el RN de MBPN, incluidos en el Programa de Cribaje Universal de la Hipoacusia del Complejo Hospitalario Universitario Insular Materno Infantil de Gran Canaria, período 2007-2010. Material y método: Estudio retrospectivo de 364 RN con MBPN, mediante otoemisiones acústicas provocadas transitorias y potenciales evocados auditivos de tronco cerebral. Resultados: Ciento doce RN (30.8%) fueron derivados a potenciales evocados auditivos de tronco cerebral. Veintidós RN (2,2%) presentaron diagnóstico de hipoacusia, 14 hipoacusias de transmisión, 8 hipoacusias neurosensoriales (HNS), y de estos, 2 con hipoacusia profunda bilateral. La asociación a otro factor de riesgo de los RN con MBPN se presenta en más de la cuarta parte de la muestra estudiada. Todos los diagnosticados de HNS fueron grandes prematuros. Conclusiones: El porcentaje de niños con diagnóstico de hipoacusia entre los RN con MBPN es superior al esperado en la población general. Todos los diagnosticados de HNS fueron grandes prematuros y presentaban uno o 2 factores de riesgo auditivo más, asociados al MBPN (AU)

Introduction and objective: Hearing plays an essential role in the acquisition, development and maintenance of the properties of the speech and language. Birth weight is an indicator of biological maturation of the newborn. Premature newborns with very low birth weight (VLBW < 1,500 g) constitute a group with the highest risk of sensorineural hearing loss. Our objective was to ascertain the degree of hearing loss, sensorineural hearing loss and presence of the association to other risk factors for hearing loss in VLBW infants included in the Universal Hearing Loss Screening Programme at the University Mother-Child Hospital of Gran Canaria (Spain) in the 2007-2010 period. Material and methods: This was a retrospective study of 364 infants with VLBW, measured by transient evoked otoacoustic emissions and auditory brainstem response. Results: There were 112 newborn (30.8%) referred for auditory brainstem response. A diagnosis of hearing loss was given to 22 newborns (2.2%), 14 had conductive hearing loss and 8, sensorineural hearing loss (SNHL), of which 2 had bilateral profound hearing loss. The VLBW newborn presented the association to another risk factor in more than a quarter of the sample studied. All those diagnosed with SNHL were premature. Conclusions: The percentage of VLBW newborns diagnosed with hearing loss is higher than expected in the general population. All those diagnosed with SNHL were premature and presented one or 2 hearing risk factors associated with VLBW (AU)

Evaluation of very low birth weight (≤ 1,500 g) as a risk indicator for sensorineural hearing loss.

INTRODUCTION AND OBJECTIVE: Hearing plays an essential role in the acquisition, development and maintenance of the properties of the speech and language. Birth weight is an indicator of biological maturation of the newborn. Premature newborns with very low birth weight (VLBW<1,500 g) constitute a group with the highest risk of sensorineural hearing loss. Our objective was to ascertain the degree of hearing loss, sensorineural hearing loss and presence of the association to other risk factors for hearing loss in VLBW infants included in the Universal Hearing Loss Screening Programme at the University Mother-Child Hospital of Gran Canaria (Spain) in the 2007-2010 period. MATERIAL AND METHODS: This was a retrospective study of 364 infants with VLBW, measured by transient evoked otoacoustic emissions and auditory brainstem response. RESULTS: There were 112 newborn (30.8%) referred for auditory brainstem response. A diagnosis of hearing loss was given to 22 newborns (2.2%), 14 had conductive hearing loss and 8, sensorineural hearing loss (SNHL), of which 2 had bilateral profound hearing loss. The VLBW newborn presented the association to another risk factor in more than a quarter of the sample studied. All those diagnosed with SNHL were premature. CONCLUSIONS: The percentage of VLBW newborns diagnosed with hearing loss is higher than expected in the general population. All those diagnosed with SNHL were premature and presented one or 2 hearing risk factors associated with VLBW.

Resultados de un programa de detección precoz de la hipoacusia neonatal / Results of an early hearing detection program

Introducción y objetivos: La hipoacusia neonatal es un problema de salud pública, que cumple los requisitos para ser sometido a cribado universal. El objetivo de este artículo es analizar los resultados obtenidos en el programa de detección precoz de la hipoacusia implementado en nuestro centro desde enero de 2007 hasta diciembre de 2010. Métodos: Se estudiaron 26.717 recién nacidos mediante otoemisiones acústicas transitorias (OEAT) en la fase de cribado auditivo. La etapa diagnóstica fue llevada a cabo en la unidad de hipoacusia del servicio. Resultados: En el período entre enero de 2007 y diciembre de 2010 nacieron 27.935 niños. Se practicó el screening a 26.717, de los cuales 24.173 presentaron OEAT positivas, 1.040 tuvieron OEAT ausentes y 1.504 presentaron OEAT en un oído estando ausentes en el oído contralateral. Presentaron factores de riesgo asociado para hipoacusia 4.674 recién nacidos. En una segunda fase del programa se practicó OEAT a 5.156 niños, de los cuales 4.626 presentaron otoemisiones positivas en ambos oídos, 323 no presentaron otoemisiones en un oído y 207 no pasaron esta segunda fase. Fueron derivados a potenciales evocados auditivos de tronco cerebral (PEATC) un 3,8% del total de niños estudiados. Veintiséis niños ingresaron al programa de implantes cocleares. Nuestro programa de detección precoz de la hipoacusia alcanzó una cobertura del 95,64%. Conclusiones: El programa de detección precoz de la hipoacusia de nuestro complejo es adecuado a nuestro funcionamiento, alcanzando una cobertura del 95,64% considerándose muy positiva la relación existente entre eficacia y eficiencia (AU)

Introduction and objectives: Neonatal hearing loss is a public health problem that meets the requirements for submission to universal screening. Our objective was to analyse the results of the early hearing detection and intervention program implemented at our centre between January 2007 and December 2010. Methods: We studied 26,717 newborns during the period mentioned, using transient otoacoustic emissions (TOAEs) for the screening. The diagnostic phase was carried out at the hearing loss department. Results: In our area, there were 27,935 births between January 2007 and December 2010. The screening was performed on 26,717 children. Of these, 24,173 had positive TOAEs, 1,040 had no TOAEs and 1,504 presented TOAEs in 1 ear with absence of TOAEs in the contralateral ear. Risk factors associated with hearing loss were found in 4,674 infants. In a second phase of the program, TOAEs were given to 5,156 children, of whom 4,626 had positive otoacoustic emissions in both ears, 323 had no TOAEs in 1 ear and 207 failed this second phase. Of all children studied, 3.8% were referred to auditory brainstem response (ABR) testing and 26 children entered the cochlear implant program. The program reached coverage of 95.64%. Conclusions: The early hearing detection and intervention program at our hospital is suitable for our environment, reaching 95.64% of coverage. We consider the relationship between effectiveness and efficiency to be positive (AU)

Implantes cocleares bilaterales en la población infantil: adquisición de la binauralidad / Bilateral cochlear implants in children: acquisition of binaural hearing

Introducción y objetivos: Numerosos estudios han señalado el beneficio de los implantes cocleares bilaterales en la adquisición de la binauralidad y la bilateralidad. En los niños portadores de un implante coclear ¿se conseguiría adquirir la binauralidad tras un segundo implante? ¿Cuándo sería el momento ideal para implantarlos? El objetivo del estudio es analizar el efecto binaural en niños con implantes bilaterales y analizar las diferencias entre los sujetos implantados de manera simultánea y de manera secuencial con un intervalo corto y otro largo. Pacientes y métodos: Se incluyeron 90 pacientes implantados con una edad comprendida entre uno y 2 años (la primera cirugía), entre 2000 y 2008. Veinticinco niños eran usuarios unilaterales y 65 bilaterales, 17 implantados simultáneamente, 29 implantados de forma secuencial, realizándose el segundo implante antes del año (corto período interimplante) y 19 secuenciales en los que el segundo implante se realizó posteriormente al año de la primera cirugía (largo período interimplante). A todos los pacientes se les relizaron pruebas de percepción verbal en silencio, en ruido y una audiometría tonal liminar. Resultados: Prueba de percepción verbal en silencio: implantes simultáneos y secuenciales con corto período entre implante (media: 84,67%) frente a los implantes secuenciales con largo período entre implantes y los unilaterales (media: 79,66%) siendo estadísticamente significativo (p=0,023). Prueba de percepción verbal en ambiente ruidoso: implantes simultáneos y secuenciales con corto período entre implante (media del 77,17%) frente a los implantes secuenciales con largo período entre implantes y los unilaterales (media: 69,32%) siendo estadísticamente significativo (p=0,002). Conclusiones: Los implantados simultáneamente y los secuenciales de corto período adquirieron las ventajas de la binauralidad (AU)

Introduction and objectives: Several studies have indicated the benefit of bilateral cochlear implants in the acquisition of binaural hearing and bilateralism. In children with cochlear implants, is it possible to achieve binaurality after a second implant? When is the ideal time to implant them? The objective of this study was to analyse the binaural effect in children with bilateral implants and the differences between subjects with simultaneous and sequential implants with both short and long intervals. Patients and methods: There were 90 patients between 1 and 2 years of age (the first surgery), implanted between 2000 and 2008. Of these, 25 were unilateral users and 65 bilateral; 17 patients had received simultaneous implants, 29 had sequential implants before 12 months after the first one (short interimplant period) and 19 after 12 months (long period). All of them were tested for silent and noisy verbal perception and a tonal threshold audiometry was performed. Results: The silent perception test showed that the simultaneous and short period sequential implant patients (mean: 84.67%) versus unilateral and long period sequential implants (mean: 79.66%), had a statistically-significant difference (P=0,23). Likewise, the noisy perception test showed a difference with statistical significance (P=0,22) comparing the simultaneous implanted and short period sequential implants (mean, 77.17%) versus unilateral implanted and long period sequential ones (mean: 69.32%). Conclusions: The simultaneous and sequential short period implants acquired the advantages of binaural hearing (AU)

Results of an early hearing detection program.

INTRODUCTION AND OBJECTIVES: Neonatal hearing loss is a public health problem that meets the requirements for submission to universal screening. Our objective was to analyse the results of the early hearing detection and intervention program implemented at our centre between January 2007 and December 2010. METHODS: We studied 26,717 newborns during the period mentioned, using transient otoacoustic emissions (TOAEs) for the screening. The diagnostic phase was carried out at the hearing loss department. RESULTS: In our area, there were 27,935 births between January 2007 and December 2010. The screening was performed on 26,717 children. Of these, 24,173 had positive TOAEs, 1,040 had no TOAEs and 1,504 presented TOAEs in 1 ear with absence of TOAEs in the contralateral ear. Risk factors associated with hearing loss were found in 4,674 infants. In a second phase of the program, TOAEs were given to 5,156 children, of whom 4,626 had positive otoacoustic emissions in both ears, 323 had no TOAEs in 1 ear and 207 failed this second phase. Of all children studied, 3.8% were referred to auditory brainstem response (ABR) testing and 26 children entered the cochlear implant program. The program reached coverage of 95.64%. CONCLUSIONS: The early hearing detection and intervention program at our hospital is suitable for our environment, reaching 95.64% of coverage. We consider the relationship between effectiveness and efficiency to be positive.

[Bilateral cochlear implants in children: acquisition of binaural hearing]. / Implantes cocleares bilaterales en la población infantil: adquisición de la binauralidad.

INTRODUCTION AND OBJECTIVES: Several studies have indicated the benefit of bilateral cochlear implants in the acquisition of binaural hearing and bilateralism. In children with cochlear implants, is it possible to achieve binaurality after a second implant? When is the ideal time to implant them? The objective of this study was to analyse the binaural effect in children with bilateral implants and the differences between subjects with simultaneous and sequential implants with both short and long intervals. PATIENTS AND METHODS: There were 90 patients between 1 and 2 years of age (the first surgery), implanted between 2000 and 2008. Of these, 25 were unilateral users and 65 bilateral; 17 patients had received simultaneous implants, 29 had sequential implants before 12 months after the first one (short interimplant period) and 19 after 12 months (long period). All of them were tested for silent and noisy verbal perception and a tonal threshold audiometry was performed. RESULTS: The silent perception test showed that the simultaneous and short period sequential implant patients (mean: 84.67%) versus unilateral and long period sequential implants (mean: 79.66%), had a statistically-significant difference (P=0,23). Likewise, the noisy perception test showed a difference with statistical significance (P=0,22) comparing the simultaneous implanted and short period sequential implants (mean, 77.17%) versus unilateral implanted and long period sequential ones (mean: 69.32%). CONCLUSIONS: The simultaneous and sequential short period implants acquired the advantages of binaural hearing.

Acúfeno e implante coclear. Experiencia preliminar / Tinnitus and cochlear implantation. Preliminary experience

Objetivo: Valorar el efecto del implante coclear en pacientes con «acúfeno incapacitante». Materiales: Realizamos una evaluación del efecto de la implantación coclear sobre la evolución del acúfeno incapacitante. Se han evaluado 3 adultos afectos de hipoacusia postlingual implantados en nuestro hospital, con acúfenos preimplantación. Los pacientes fueron evaluados de acuerdo con los efectos del acúfeno en las emociones de los pacientes y las actividades de la vida cotidiana. Resultados: De los tres, uno declaró la supresión del acúfeno, otros dos atenuación tras la cirugía, en diversos grados, no encontrando ningún paciente con peores resultados tras la implantación. Conclusiones: El efecto beneficioso de la implantación coclear sobre el acúfeno, reportado en nuestros pacientes, puede ser debido al enmascaramiento acústico, a través de la estimulación eléctrica del nervio acústico, y todo ello por la reorganización cerebral de las vías del sistema nervioso central (SNC) y las áreas de asociación cerebral tras la implantación coclear (AU)

Objective: To assess the effect of cochlear implantation in patients with disabling tinnitus. Materials: We conducted an evaluation of the effect of cochlear implantation on the development of disabling tinnitus. Three adults with pre-implantation tinnitus, implanted in our hospital, were evaluated for postlingual hearing loss. Patients were evaluated according to the effects of tinnitus on their emotions and activities of daily living. Results: One patient reported that the tinnitus disappeared and two reported different degrees of attenuation. We did not find any patients with worse outcomes after implantation. Conclusions: The beneficial effect of cochlear implantation on tinnitus reported in our patients may be due to acoustic masking, through electrical stimulation of the acoustic nerve, all from brain reorganisation of central nervous system (CNS) pathways and cerebral association areas after cochlear implantation (AU)

[Tinnitus and cochlear implantation. Preliminary experience]. / Acúfeno e implante coclear. Experiencia preliminar.

OBJECTIVE: To assess the effect of cochlear implantation in patients with disabling tinnitus. MATERIALS: We conducted an evaluation of the effect of cochlear implantation on the development of disabling tinnitus. Three adults with pre-implantation tinnitus, implanted in our hospital, were evaluated for postlingual hearing loss. Patients were evaluated according to the effects of tinnitus on their emotions and activities of daily living. RESULTS: One patient reported that the tinnitus disappeared and two reported different degrees of attenuation. We did not find any patients with worse outcomes after implantation. CONCLUSIONS: The beneficial effect of cochlear implantation on tinnitus reported in our patients may be due to acoustic masking, through electrical stimulation of the acoustic nerve, all from brain reorganisation of central nervous system (CNS) pathways and cerebral association areas after cochlear implantation.