Did our cochlear implant program make any difference in the lives of our patients? Achievements of 30 patients with long term follow-up averaging 20 years after cochlear implantation.

BACKGROUND: Cochlear implants are standard of care for the patients with sensorineural hearing loss not benefited from hearing aids. AIMS: Evaluate qualitatively the impact of cochlear implantation in the long-term. MATERIALS-METHODS: Thirty middle-class patients with similar patterns of loss and social environment averaging 20 years post-implantation responded to 52 questions that evaluated psychosocial benefits from cochlear implantation. RESULTS: All completed secondary education and 93% had postgraduate studies. Educational and workwise they are at the same level as their hearing counterparts. All use their cochlear implants and would recommend one to people who need it. They attribute their success to the implant, the rehabilitation program, their family, and a stimulating social environment. Despite their success, most experience difficulties relating with others (socially and at work) due to their hearing condition. They manage but work much harder than their hearing peers to achieve the same. CONCLUSIONS: We made a difference in the lives of these patients, however, there is more to be done. SIGNIFICANCE: Early intervention, rehabilitation, plus family, and stimulating-environment are crucial in children with sensory deficits.

Clinical performance of the Osia™ system, a new active osseointegrated implant system. Results from a prospective clinical investigation.

Background: Bone-conduction hearing implants are standard of care devices.Aims/Objectives: Evaluation of a new active magnetic bone-conduction hearing implant: Cochlear Osia™ system.Material and methods: This device uses a transcutaneous connection between an external sound-processor and an osseointegrated implant that generates vibrations using a piezoelectricity-based internal bone-conduction system. Nine patients with conductive-hearing loss were implanted. Surgical efficacy, hearing performance and quality-of-life were evaluated. Hearing performance in quiet and in noise was compared with unaided hearing and hearing with the Baha 5 Power® Sound Processor on a softband.Results: Surgery and healing were uneventful. Statistically significant improvements in audibility, speech-understanding, speech-recognition and quality-of-sound in noise and quiet were found for the Osia™ compared to preoperative unaided hearing and aided hearing with the Baha 5 Power® Sound Processor on a softband. The active vibration system provided improvement at low and high frequencies. At 6 months postoperatively, all patients continue to use the device.Conclusions and significance: The Osia™ is safe and effective, improving speech-recognition in quiet and in noise, at low and high frequencies, thus delivering better quality-of-hearing than passive devices.

Otitis media and mastoiditis in temporal bones of prehistoric Chilean populations. A paleopathological and paleoepidemiological study.

BACKGROUND: This study evaluates otitis media in prehistoric populations in northern Chile. AIMS/OBJECTIVES: Determining prevalence of otitis media and diagnostic usefulness of temporal-bone X-rays in skulls. MATERIALS AND METHODS: 444 skulls belonging to three groups: prehistoric-coastal (400-1000 AD), prehistoric-highland (400-1000 AD) and Pisagua-Regional Developments (1000-1450 AD). Skulls were evaluated visually and with Schuller's view X-rays. Five skulls diagnosed as having had otitis media, five diagnosed as normal, and one with temporal bone fistula also had a computed tomography (CT). RESULTS: Changes suggestive of otitis media were present in Prehistoric-coastal 53.57%; Pisagua-Regional Developments 70.73%; prehistoric-highlands 47.90%. Diagnostic effectiveness of Schuller's view X-rays for assesing middle ear disease was confirmed by CT studies. The case with temporal bone fistula had changes suggestive of mastoiditis and possible post auricular abscess. CONCLUSIONS: There was a high prevalence of otitis media in prehistoric populations in Chile. The higher prevalence in one group was presumably due to racial factors. Temporal-bone X-rays are effective for massive evaluation of ear disease in skulls. A case of mastoiditis with temporal bone fistula and possible post-auricular abscess is documented. SIGNIFICANCE: Documenting racial factors in otitis media. Validating X-rays for massive evaluation of otitis media in skulls.

Chances of reversibility in early sensory deprivation of the Homo vulnerabilis: A 5-year (and ongoing) prospective study.

BACKGROUND: This prospective study evaluated the effectiveness of a rehabilitation program in vulnerable children with language deficits. AIMS/OBJECTIVES: Evaluating reversibility of a sensory understimulation. MATERIAL/METHODS: Two groups of five students, each, (sensory and not sensory deprived) were evaluated at ages 5 and 11. Both groups were taught the compulsory national educational program. The sensory deprived group also had a 5-year rehabilitation program. After that time, their language and vocabulary were reevaluated. RESULTS: Both groups became able to read, write and perform mathematical operations. Both groups took the compulsory elementary school national performance test and all of them performed above the national average. Despite these good performances the differences between both groups regarding language persisted. CONCLUSIONS: Deficits in children with early sensory deprivation are improved with rehabilitation programs. In order to achieve better restoration, intervention should be done earlier than at 5 years of age. Even if some deficits are not fully reversible, the improvement is significant and allows social inclusion and the possibility of breaking their circle of vulnerability. SIGNIFICANCE: Documenting the importance of early rehabilitation in sensory deficits.

Mastoid osteoma in a prehispanic cranium (1390 A.D.) from Northern Chile.

OBJECTIVE: Osteomas are slow-growing benign tumors that can affect the skull, most frequently the parietal and frontal. Temporal bone osteomas are more common in the external acoustic meatus and exceptional in the mastoid region. The rarity of mastoid osteomas is confirmed by the fact that very few cases have been reported in the clinical and paleopathological literature. The aim of this paper is to report a new paleopathological case of mastoid tumor in a Pre-Hispanic adult cranium. MATERIALS: The skull derives from the Chunchuri (today Dupont-1 site) Pre-Hispanic site in Northern Chile (1390 A.D). METHODS: Macroscopical examination and high-resolution tomography were used to assess the cranium. RESULTS: The CT scan revealed a well demarcated lesion suggestive of a mastoid osteoma. CONCLUSIONS: This case adds new evidence regarding the antiquity of primary neoplasms in ancient populations and reinforces the importance of high resolution imaging in paleopathological research. SIGNIFICANCE: Due to the antiquity of the remains this is probably the oldest reported case of mastoid osteoma. LIMITATIONS: The patrimonial nature of the remains did not allow histopathological studies. SUGGESTIONS FOR FURTHER RESEARCH: Further intensive review of archeological skeletal collections is needed to better understand the epidemiology of neoplastic lesions in past populations.

External ear canal exostosis and otitis media in temporal bones of prehistoric and historic chilean populations. A paleopathological and paleoepidemiological study.

CONCLUSIONS: External ear canal exostosis is more prevalent in northern coastal groups than in the highlands, suggesting that ocean activities facilitate the appearance of exostosis. However, southern coastal groups exposed to colder ocean water have a lesser incidence of exostosis, possibly due to less duration of exposure. There was a high incidence of otitis media in all groups of native population in Chile. One coastal group had a higher incidence, presumably due to racial factors. BACKGROUND: This is a paleopathological and paleoepidemiological study in temporal bones which assesses external ear canal exostosis and otitis media in prehistoric and historic native populations in Chile. MATERIALS AND METHODS: A total of 460 temporal bones were evaluated for exostosis (ex) and 542 temporal bones were evaluated for otitis media (om). The study involved four groups: (1) Prehistoric Coastal (400-1000 AD) populations in Northern Chile (Pisagua-Tiwanaku) (22 temporal bones ex; 28 om); (2) Prehistoric Highland (400-1000 AD) populations in Northern Chile (292 temporal bones ex; 334 om); (3) Pisagua-Regional Developments (coastal) in Northern Chile (1000-1450 AD) (66 temporal bones ex; 82 om); and (4) Historic (1500-1800 AD) coastal populations in Southern Chile (80 temporal bones ex: 18 Chonos, 62 Fuegians. 98 om: 22 Chonos, 76 Fuegians). Skulls were evaluated visually and with an operating microscope. In addition, the otitis media group was evaluated with Temporal bone radiology - -lateral XRays-Schuller view - to assess pneumatization as evidence of previous middle ear disease. RESULTS: Prehistoric northern coastal groups had an incidence of exostosis of 15.91%, the northern highlands group 1.37%, and the southern coastal group 1.25%. There were changes suggestive of otitis media in: Pisagua/Tiwanaku 53.57%; Pisagua/Regional Developments 70.73%; Northern Highlands population 47.90%; Chonos 63.64%; and Fuegian tribes 64.47%.

Clinical performance of a new magnetic bone conduction hearing implant system: results from a prospective, multicenter, clinical investigation.

OBJECTIVE: The aim of the investigation was to prospectively evaluate, in a multicenter setting, the clinical performance of a new magnetic bone conduction hearing implant system. METHODS: The test device was the Cochlear Baha Attract System (Cochlear Bone Anchored Solutions AB, Mölnlycke, Sweden). Instead of the skin-penetrating abutment of traditional bone conduction hearing implants, the test device uses an implantable and an external magnet to transmit sound from the sound processor (SP) through intact skin to the skull bone. Twenty-seven adult patients with a conductive or mild mixed hearing loss or single-sided sensorineural deafness were included in the clinical investigation across four investigational sites. The patients were followed for 9 months after implantation. The study evaluated efficacy in terms of hearing performance compared with unaided hearing and with hearing with the SP on a softband. Patient benefit, soft tissue status, device retention, and safety parameters were monitored continuously throughout the investigation. RESULTS: Surgery and healing was uneventful. Statistically significant improvements in audibility and speech understanding in noise and quiet were recorded for the test device compared with preoperative unaided hearing. Speech recognition was similar or better than tests performed with the same SP on a softband. Good soft tissue outcomes were reported, without major pressure-related complications. At the end of the investigation, all patients continued to use and benefit from the device. CONCLUSION: The test device provides good hearing performance in patients with a conductive hearing loss or single-sided sensorineural deafness, with good wearing comfort and minimal soft tissue complications.

Central auditory processing. Are the emotional perceptions of those listening to classical music inherent in the composition or acquired by the listeners?

CONCLUSIONS: There is seemingly some inherent component in selected musical compositions that elicits specific emotional perceptions, feelings, and physical conduct. OBJECTIVES: The purpose of the study was to determine if the emotional perceptions of those listening to classical music are inherent in the composition or acquired by the listeners. METHODS: Fifteen kindergarten students, aged 5 years, from three different sociocultural groups, were evaluated. They were exposed to portions of five purposefully selected classical compositions and asked to describe their emotions when listening to these musical pieces. All were instrumental compositions without human voices or spoken language. In addition, they were played to an audience of an age at which they were capable of describing their perceptions and supposedly had no significant previous experience of classical music. RESULTS: Regardless of their sociocultural background, the children in the three groups consistently identified similar emotions (e.g. fear, happiness, sadness), feelings (e.g. love), and mental images (e.g. giants or dangerous animals walking) when listening to specific compositions. In addition, the musical compositions generated physical conducts that were reflected by the children's corporal expressions. Although the sensations were similar, the way of expressing them differed according to their background.

Functional studies (NeuroSPECT) of the human auditory pathway after stimulating binaurally with pure tones.

CONCLUSIONS: Our observations support the concept of bilateral cortical activation with monaural and binaural auditory stimulation. The observation that most of the significantly activated areas were the same with monaural or binaural stimulation suggests that the differences in auditory perception with binaural stimulation are not due to the involvement of significantly different processing centers but, more likely, to the type of information that reaches these centers for processing. The observation that the degree of stimulation was less intense in binaural than in monaural stimulation supports the concept that a richer binaural auditory stimulation compared with monaural stimulation does not mean summation of stimuli but integration and better processing of the information. For normal bilateral hearing subjects, a monaural stimulus is an uncommon event and may thus explain the more intense response. The repeatability of the results for monaural and binaural stimulation with pure tones in the same subjects confirms the consistency of the testing method. OBJECTIVES: (1) To determine which areas of the cerebral cortex and basal ganglia are activated by binaural stimulation with pure tones (left and right ear simultaneously) and what type of response occurs (e.g. excitatory or inhibitory) in these different areas. (2) To determine the degree of ipsilateral and/or contralateral cortical activation and/or inhibition. (3) To compare the data with our previous reports of monaural stimulation using the same technique and the same subjects. (4) To evaluate the consistency of our testing method. METHODS: Brain perfusion single photon emission computed tomography (SPECT) evaluation was conducted using auditory binaural stimulation with pure tones in six normal volunteers. Both ears were stimulated simultaneously. Tc99m HMPAO was injected while pure tones were delivered and the SPECT imaging was done 1 h later. RESULTS: After delivering pure tones there was bilateral activation in Brodmann areas 7 (somatosensory association cortex), 9 and 10 (executive frontal areas), 17, 18, and 19 (associative visual cortex). There was also activation in temporal areas 21, 22 (auditory association areas), and parietal areas 39 and 40 (Wernicke). There was also marked activation in both thalami. These activated areas were the same as those in our previous reports with monaural stimulation in the same subjects. However, except for areas 17, 18, 23, 31, and 32 (which remained over 4 SD above the normal maximum), the degree of activation was less intense in binaural compared with monaural stimulation. Inhibition was also less intense in binaural stimulation.

Experimental evidence suggestive of early intervention in mucoid otitis media.

CONCLUSIONS: Mucoid effusion can undergo a process of organization related to the inflammatory process and hypoventilation; organized effusion in the presence of epithelial breaks is a potential source for formation of granulation tissue and cholesterol granuloma within 3 months of evolution. OBJECTIVES: The aim of this study was to investigate the evolution of mucoid otitis media and its relationship with the organized effusion within a time-span of 3 months. MATERIALS AND METHODS: Two groups of animals were selected. In group I, 15 chinchillas had a chemically modified bovine collagen type 2 gelatin membrane placed through a mechanically induced tympanic membrane perforation, bridging the external auditory canal and the promontory. In group II, 75 cats underwent eustachian tube obstruction with soft grade silastic sponges. Experimental phases and animal sacrifices were performed under general anesthesia. After sacrifice, temporal bones were prepared, stained with hematoxylin and eosin and evaluated under light microscopy. RESULTS: The experimental ears in both groups were observed to undergo gradual pathological changes with increasing survival times. The acute inflammatory phase turned into chronic irreversible changes, which correlated directly with the initial amount of effusion and the areas of epithelial breaks, granulation tissue, cholesterol granuloma, and epithelial migration.

Is there a difference in activation or in inhibition of cortical auditory centers depending on the ear that is stimulated?

CONCLUSIONS: 1.With auditory stimuli cortical activation of Brodmann's areas 39 and 40 and inhibition of area 38 is bilateral. Inhibitory and excitatory relays play a role in the auditory pathways. 2. A statistically significant increased activation on the left side in areas 39 and 40, regardless of the stimulated ear, is suggestive that pure tones are preferably processed in the left hemisphere. 3. The significant difference in central inhibition depending on which ear is stimulated is supportive of the idea of a leading ear. OBJECTIVES: The objectives were to determine cortical activation/inhibition, ipsi/contralateral in response to monaural stimulation with pure tones, and if the response differs for right/left ear stimulation. SUBJECTS AND METHODS: Tc99m-HMPAO brain perfusion SPECT was done during monaural stimulation with pure tones in 10 volunteers. Ears were tested independently. RESULTS: During auditory stimulation perfusion increased in both hemispheres in Brodmann's areas 39-40 and decreased in area 38,>2 SD above and below the normal mean respectively, in both hemispheres, regardless of which side was stimulated. A significantly more intense response was seen in left versus right in areas 39 and 40. In area 38 there was bilateral inhibition, significantly more intense in response to left than right ear stimulation.

Musical brains: a study of spontaneous and evoked musical sensations without external auditory stimuli.

CONCLUSIONS: Our observations confirm that musical sensations with no external stimuli, either spontaneous or evoked, occur in normal individuals and that a biological substrate can be demonstrated by brain single photon emission computed tomography (SPECT). OBJECTIVES: There are individuals, usually musicians, who are seemingly able to evoke and/or have spontaneous musical sensations without external auditory stimuli. However, to date there is no available evidence to determine if it is feasible to have musical sensations without using external sensory receptors, or if there is a biological substrate for these sensations. SUBJECTS AND METHODS: A group of 100 musicians and another of 150 otolaryngologists were asked if they had spontaneous musical auditory sensations and/or were capable of evoking them. SPECT evaluations with Tc(99m)-HMPAO were conducted in six female musicians while they were evoking these sensations or, in one case, while she was having them spontaneously. In three of them an additional SPECT was conducted in basal conditions (having been asked to avoid evoking music). RESULTS: In all, 97 of 100 musicians had spontaneous musical sensations; all 100 could evoke and modify them. Of the 150 otolaryngologists, 18 (12%) were musicians. Of the 132 nonmusicians, spontaneous musical sensations occurred in 52 (39.4%), 72 (54.5%) could evoke and 23 (17.4%) were able to modify them, 58 (43.9%) did not have spontaneous musical sensations nor could they evoke them. The musical sensations of the 72 otolaryngologists that could evoke were less elaborated than those of musicians. NeuroSPECT during voluntary musical autoevocation demonstrated significant (>2 SD) increased activation of executive frontal cortex in Brodmann areas 9 and 10, secondary visual cortex (area 17), and paracingulate (areas 31 and 32). There was also activation in the para-executive frontal cortex (areas 45 and 46). In the basal ganglia there was activation in thalamus and lentiform nucleus. Deactivation below 2 SD was demonstrated by mean values in the cingulate gyrus, Brodmann areas 23 and 24, and subgenual area 25. Deactivation was also demonstrated when minimal values were analyzed in the same areas plus area 4 and areas 36 and 38, the latter in the pole of the temporal lobes. In three patients comparison of basal state with autoevocation demonstrated activation in executive frontal cortex (areas 8 and 9), para-executive cortex (area 45), primary auditory cortex (area 40), the right thalamus, and lentiform nucleus.

Musical brains: a study of evoked musical sensations without external auditory stimuli: preliminary report of three cases

Existen personas, generalmente músicos, que tienen la capacidad de evocar sensaciones musicales sin un estímulo auditivo externo. Sin embargo, hasta la fecha no hay evidencias que sugieran que sea posible tener estas sensaciones, ni que exista un sustrato biológico para ellas. Diseño del trabajo: Se hicieron dos estudios de neuroSPECT con [99mTc]-HMPAO en cada una de tres mujeres músicos. El primer estudio fue hecho en condiciones basales (sin evocar) y el segundo mientras estaban evocando sensaciones musicales. Resultados: En el estudio de las voluntarias que fueron evaluadas mientras evocaban una composición musical, hubo un aumento significativo de perfusión en los hemisferios derecho e izquierdo en las áreas de Brodmann 9 y 8 (área ejecutiva frontal) y en el área 40 en el lado izquierdo (área auditiva). Sin embargo, en condiciones basales no hubo aumento de perfusión en las áreas 9, 8, 39 y 40. En un caso hubo mayor aumento de perfusión en el área 45 durante la autoevocación respecto a la condición basal. Conclusiones: Estos hallazgos son sugerentes de un sustrato biológico para el proceso de evocar sensaciones musicales.

Spontaneous musical auditory perceptions in patients who develop abrupt bilateral sensorineural hearing loss. An uninhibition syndrome?

CONCLUSIONS: Spontaneous musical auditory perceptions commonly occur in patients who develop abrupt bilateral sensorineural hearing loss. The findings in both subjects who were image tested while having these perceptions are suggestive of a biological substrate for this process and of a central locus for auditory memory seemingly located in and around area 39 of Brodmann. When an individual has abrupt bilateral sensorineural hearing loss, stored musical memory can be released and this person can have musical perceptions without an external source. It is likely that an abrupt bilateral loss of inner ear function might uninhibit neuronal groups storing auditory memory. OBJECTIVES: The objectives of this study were as follows. (1) To determine if spontaneous musical auditory perceptions occur in patients who develop abrupt bilateral severe sensorineural hearing loss (not necessarily simultaneously). (2) To determine if there is a biological substrate to the process of recalling previous auditory perceptions. (3) To compare these findings with our normal databases of unstimulated and pure tone-stimulated volunteers. (4) To establish a hypothesis for the mechanisms of these occurrences. PATIENTS AND METHODS: Thirty two patients who had had abrupt bilateral severe sensorineural hearing loss (the interval between the losses of both ears could have been years) were contacted. They were asked if they had ever had the sensation of having musical auditory perceptions without external auditory stimuli. Two of these patients were image tested with single photon computerized emission tomography (neuroSPECT) while they were having these perceptions. RESULTS: All of the 32 subjects had musical auditory perceptions following their hearing loss in the second ear or when hearing loss in both ears occurred simultaneously. The two patients who were image tested with neuroSPECT had similar findings. There was a statistically significant increase in perfusion in area 39 of Brodmann, more intense on the right side, with increased perfusion also in both frontal lobes at the middle gyrus, with bilateral hypoperfusion in area 38 of Brodmann. These findings are similar to those observed in normal volunteers stimulated with pure tones.

Latin American experience with the cochlear implant.

CONCLUSIONS: Complications such as migration, extrusion, skin inflammation by magnets and implant failures are mostly related to the type of device. Meticulous technique rather than specific surgical approaches seems to be the key in avoiding complications. The overall results of the Latin American experience are comparable with those reported recently in the literature. OBJECTIVE: To review the experience of Latin American groups with the cochlear implant. MATERIAL AND METHODS: A questionnaire was sent to all cochlear implant teams in Latin America. The main questions involved: (i) the type of device; (ii) the techniques used for placing and fixing the implant, surgical incision and closure; (iii) migration, exposure and failure of the implant; and (iv) skin erosion and infection. A total of 41 groups participated in the study. The total number of implanted patients involved was 3773, representing 92% of Latin American cases. RESULTS: Of the 3773 devices implanted, 5 were experimental prototypes and therefore 3768 were considered for calculations. The occurrence of complications was as follows. Migration: 13 cases (0.35%), mostly related to ceramic implants (p =0.016). Extrusion: 15 cases (0.4%), mostly related to large implants (p =0.0103). Implant failure secondary to trauma: 18 cases (0.48%) (9 in ceramic and 9 in soft implants). Spontaneous failure: 86 cases (2.28%), 74/1293 (5.72%) in ceramic and 11/2418 (0.45%) in soft implants (p = 0.0001). The most reliable implant was the Nucleus 24, with a failure rate of 0.3%. Skin inflammation by magnet: 35 cases (0.9%), mostly related to soft implants (p =0.0103). INFECTION: 26 cases (0.7%), with no significant relationship to device type.

Functional studies of the human auditory pathway after monaural stimulation with pure tones. Establishing a normal database.

CONCLUSIONS: Bilateral activation of Brodmann area 39 provides functional support for the concept of bilateral cortical activation with auditory stimulation. The observation that when Brodmann area 39 is activated, area 38 of the temporal lobe is simultaneously inhibited (a functional observation that has seemingly not been previously reported) supports the concept that inhibitory as well as excitatory relays play a role in the auditory pathways. In addition, this report helps to establish a functional database for future studies. OBJECTIVES: (i) To determine which areas of the cerebral cortex and basal ganglia are activated when the left and right ears are monaurally stimulated with pure tones, and what type of response (e.g. excitatory or inhibitory) occurs in these different areas. (ii) To determine the degree of ipsi- and/or contralateral cortical activation and/ or inhibition depending on the ear that is stimulated. (iii) To use this information as an initial step to develop a normal functional database for future studies. MATERIAL AND METHODS: A brain perfusion single-photon emission CT (SPECT) evaluation was conducted using auditory monaural stimulation with pure tones in 10 normal volunteers. Both ears were tested independently (20 examinations in total). 99mTc hexamethyl-propylenamine-oxime was injected while pure tones were delivered, and the SPECT imaging was done 1 h later. RESULTS: After delivering pure tones there was bilateral cortical activation in Brodmann areas 39 and 40, regardless of which ear was stimulated. Despite marked hyperperfusion in both areas 39, a more intense response was seen on the left compared to the right side, although this was not statistically significant. There was also activation in the executive frontal cortex areas 9 and 10 as well as in the temporal Brodmann areas 21 and 22. Simultaneously, area 38 of the temporal lobe was deactivated. In the subcortical structures there was also marked activation in both thalami and deactivation of the caudate nuclei without lateralization.

Estudios funcionales de la corteza auditiva humana, de la memoria auditiva y alucinaciones auditivas / Functional studies of human auditory cortex, auditory memory and auditory hallucinations

Objetivos. 1. Determinar que áreas de la corteza cerebral son activadas al estimular el oído izquierdo con tonos puros, y que tipo de estimulación ocurre (eg. excitatoria o inhibitoria) en estas diferentes áreas. 2. Usar esta información como una etapa inicial para desarrollar una bases de datos funcional para estudios futuros. 3. Tratar de determinar si existe un sustrato biológico para el proceso de recordar percepciones auditivas previas, y si fuera posible, sugerir un locus para la memoria auditiva. Método. Se hicieron evaluaciones de SPECT: 1-2) Usando estimulación auditiva con tonos puros en 4 voluntarias con audición normal. 3) En una paciente con sordera profunda bilateral, la cual tenía percepciones auditivas de experiencias musicales previas; mientras estaba teniendo la sensación de escuchar una melodía conocida. Resultados. Tanto en la paciente con alucinaciones auditivas como en las voluntarias estimuladas con tonos puros, hubo una diferencia estadísticamente significativa en perfusión del área 39 de Brodmann; más intensa en el lado derecho (derecho a izquierdo p <0.05). Con menor intensidad hubo también activación en el área adyacente 40 e intensa activación en las áreas ejecutivas de la corteza frontal números 6, 8, 9, y 10 de Brodmann. También hubo activación del área 7 de Brodmann; área de asociación audio-visual; más marcada en el lado derecho de la paciente y de los controles normales estimulados. En las estructuras subcorticales también hubo una marcada activación en la paciente con alucinaciones en ambos núcleos lentiformes, el tálamo y los núcleos caudados, también más intensos en el hemisferio derecho, 5, 4.7 y 4.2 desviaciones Standard (S.D.) sobre la media a derecha y 5, 3.3 y 3 S.D. sobre la media en el izquierdo. Hallazgos similares se encontraron en los controles normales. Conclusiones. Después de estimular auditivamente con tonos puros en el oído izquierdo en voluntarias normales, se observa activación del área 39 de Brodmann, más...

Exploratory tympanotomy: an integral part of cochlear implantation.

We report on 113 multichannel intracochlear implantations. Although the surgical approach has evolved as a result of new implant designs, one essential step has remained, namely initial exploratory tympanotomy. This 15-min procedure allows direct anatomical assessment and work in the middle ear. After direct exposure, the lip of the niche is removed and the round window membrane is visualized. The basal turn of the cochlea is then assessed for patency, and the capability of inserting electrodes is verified. The surgical procedure is then performed in the knowledge that an adequate insertion will be possible. This approach allows insertion through the round window instead of a cochleostomy hole, thus avoiding potential damage to remaining neural structures and additional exposure of inner ear structures and electrodes to potential middle ear infections. It also requires a limited mastoidectomy (extended antrotomy) as the facial recess is visualized from the middle ear side (avoiding the need for extensive drilling), and the mastoid and facial recess openings are only used as conduits for the electrode array. In this study, 14/113 patients (12.4%) had either different degrees of ossification (n = 11) or Mondini deformity (n = 3). Direct work in the middle ear allowed handling and drilling as required in all cases. In two cases with severe ossification, a cochlea was sculpted around the modiolus. This included drilling of the anterior portion, which is inaccessible using the facial recess approach.

A ovelha para experimentação e treinamento em cirurgia otológica / The sheep for experimentation and training in ear surgery

Os animais atualmente utilizados para o desenvolvimento de pesquisa -e treinamento em otocirurgia, como cães, gatos e macacos, têm um porte distinto do humano e são de difícil manuseio no biotério, por serem agressivos e suscetíveis a doenças. O presente trabalho teve por objetivo determinar a viabilidade do uso da ovelha como modelo de experimentação em procedimentos otológicos. Este animal foi escolhido devido à sua rusticidade, disponibilidade, docilidade, resistência e baixo custo. Material e método: Foram desenvolvidos estudos morfológicos preliminares através da dissecção de seis ossos temporais de ovelha e da análise histopatológica de três ossos temporais. Posteriormente, 12 animais foram submetidos a cirurgia experimental, com anestesia; no ouvido médio e vestíbulo. Foram registrados os eventos ocorridos durante o manuseio pré, trans e pós-operatório, a resposta dos animais ao manuseio em biotério e seu comportamento diante das medidas anestesiológicas. Resultados: O estudo morfológico preliminar revelou semelhanças significativas entre a morfologia do ouvido de ovelhas e de seres humanos, principalmente em relação ao porte das estruturas. Quanto aos eventos relacionados à intervenção cirúrgica, observou-se que os animais apresentam grande resistência a este procedimento. Nenhum evento foi registrado nos períodos pré-operatório, trans-operatório e pós-operatório tardio. Um total de 14 complicações foram registradas no pós-operatório imediato. Houve um caso de infecção, solucionado com antibioticoterapia; sete animais apresentaram desequilíbrio estático, sendo que, destes, cinco também apresentaram alterações do equilíbrio dinâmico que perduraram por, no máximo, 24 horas. Houve um caso de morte por aspiração. Conclusões: A ovelha é um animal adequado para fins de experimentação e treinamento em cirurgia otológica.

The animals which are currently employed as models for research and training in otosurgery, such as dogs, cats, and monkeys, have a different body size than humans; in addition, they are difficult to handle in a laboratory environment, because they are aggressive and susceptible to disease. The present study was conducted to evaluate the applicability of sheep as an experimental model for otological procedures. This animal was chosen due to its rusticity, availability and low cost. Material and methods: Preliminary anatomical and histologic studies were carried out through the dissection of six temporal bones, and through histopathological analysis of these temporal bones. Next, 12 sheep were submitted to an experimental surgical procedure (involving anesthesia) in the inner ear and vestibule. The response of the animals to pre-, trans- and postoperative procedures, confinement, and anesthesia was recorded. Results: The preliminary morphological study revealed significant similarities between human beings and sheep in terms of ear anatomy, especially concerning the size of the structures. Regarding the surgical intervention, our results show that sheep are very resistant. No major events were registered during the pre- trans- and late postoperative periods. Fourteen complications were registered during the early postoperative period. There was one case of infection, controlled with antibiotic therapy; seven animals presented static imbalance, and among these, five also presented dynamic imbalance which disappeared in all cases after 24 hours. There was one case of death by aspiration. Conclusions: Sheep may be useful as a model for experimentation and training in otologic surgery.

Utriculostomia: apresentaçäo de uma nova técnica para tratamento cirúrgico da vertigem / Utriculusstomy: presentation of a new technique for the treatment of vertigo

Objetivo: apresentar uma nova técnica alternativa para o tratamento cirúrgico de vertigem causada pela Doença de Menière, a utriculostomia, desenvolvida no HCPA...