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

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

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

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

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

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

Molecular and genetic characterization of a large Brazilian cohort presenting hearing loss.

Hearing loss is one of the most common sensory defects, affecting 5.5% of the worldwide population and significantly impacting health and social life. It is mainly attributed to genetic causes, but their relative contribution reflects the geographical region's socio-economic development. Extreme genetic heterogeneity with hundreds of deafness genes involved poses challenges for molecular diagnosis. Here we report the investigation of 542 hearing-impaired subjects from all Brazilian regions to search for genetic causes. Biallelic GJB2/GJB6 causative variants were identified in 12.9% (the lowest frequency was found in the Northern region, 7.7%), 0.4% carried GJB2 dominant variants, and 0.6% had the m.1555A > G variant (one aminoglycoside-related). In addition, other genetic screenings, employed in selected probands according to clinical presentation and presumptive inheritance patterns, identified causative variants in 2.4%. Ear malformations and auditory neuropathy were diagnosed in 10.8% and 3.5% of probands, respectively. In 3.8% of prelingual/perilingual cases, Waardenburg syndrome was clinically diagnosed, and in 71.4%, these diagnoses were confirmed with pathogenic variants revealed; seven out of them were novel, including one CNV. All these genetic screening strategies revealed causative variants in 16.2% of the cases. Based on causative variants in the molecular diagnosis and genealogy analyses, a probable genetic etiology was found in ~ 50% of the cases. The present study highlights the relevance of GJB2/GJB6 as a cause of hearing loss in all Brazilian regions and the importance of screening unselected samples for estimating frequencies. Moreover, when a comprehensive screening is not available, molecular diagnosis can be enhanced by selecting probands for specific screenings.

Can the use of the CROS system provide head shadow effect contribution to unilateral Cochlear Implant Users? / O Sistema CROS pode oferecer contribuição do efeito sombra da cabeça a usuários de implante coclear unilateral?

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

RESUMO Objetivo O objetivo deste estudo foi avaliar o efeito do sistema CROS em fenômenos como efeito sombra da cabeça em usuários de implante coclear unilateral. Método Estudo transversal prospectivo, aprovado pelo conselho de ética sob protocolo 2.128.869. Onze adultos com surdez de instalação pós-lingual usuários de IC Advanced Bionics unilateral foram selecionados. O reconhecimento de fala foi avaliado com palavras gravadas apresentadas a 65dBA a 0o azimute e a (90o no lado contralateral ao IC), com ruído a 55dBA, usando somente o IC e IC+sistema CROS. Os resultados foram analisados usando teste t pareado com alfa de 0,05. Resultados Os escores médios de reconhecimento de fala foram significativamente melhores com IC + CROS em relação à condição apenas IC (p <0,05, p <0,005 e p <0,005 respectivamente). Na apresentação à frente não foram encontradas diferenças significantes. Conclusão Os usuários de IC unilateral sem resíduo útil para uso de prótese auditiva ou impossibilitados de submeter-se à cirurgia bilateral podem se beneficiar do dispositivo CROS para o reconhecimento de fala, sobretudo quando a fala for apresentada ao lado contralateral ao IC.

Avaliação do Naída CI Q70 e estratégia UltraZoom para o reconhecimento de fala em situações reverberantes e com ruído competitivo / Assessment of the benefits of the Naída CI Q70 and its Ultrazoom strategy for speech recognition in reverberating and noisy listening conditions

RESUMO Objetivo identificar a contribuição do microfone omnidirecional (T-Mic) e microfone direcional adaptativo (UltraZoom) do processador de som Naída CIQ70 para o reconhecimento da fala no ruído e em ambiente reverberante. Identificar a contribuição do processador de som Naída CIQ70 para usuários do processador Harmony. Métodos participaram do estudo sete adultos com implante coclear unilateral, usuários do processador de som Harmony. O reconhecimento de sentenças foi avaliado em silêncio, em sala reverberante (RT60 de 553 ms) e ruído de 42,7 dBA (Leq), com os processadores Harmony e Naída CIQ70. A contribuição do microfone direcional UltraZoom foi avaliada no ruído. As sentenças gravadas foram apresentadas a 0° azimute. O ruído (babble noise) foi apresentado a + 5 dB SNR, a 90° azimute. Os participantes avaliaram subjetivamente a clareza do som e a dificuldade de escutar nas várias condições do teste. Resultados a média do reconhecimento de sentenças no silêncio com reverberação foi de 38,5% com o Harmony e 66,5% com o Naída CIQ70. A pontuação média de reconhecimento de sentenças no ruído foi de 40,5% com o Naída CIQ70, sem UltraZoom, e de 64,5% com UltraZoom. Nas classificações subjetivas de clareza do som e facilidade de escuta no ruído, nenhuma diferença foi identificada entre as condições de teste. Conclusão para usuários experientes do processador de som Harmony, a compreensão da fala em silêncio em uma sala reverbente foi significativamente melhor com o Naída CIQ70. O uso de uma tecnologia de microfone direcional adaptativa (UltraZoom) contribuiu para o reconhecimento de fala no ruído.

Abstract Purpose 1) To measure speech understanding in noise with the Naída Q70 in the omnidirectional microphone mode (T-Mic) and adaptive directional microphone mode (UltraZoom) in reverberating acoustics and noisy conditions. 2) To measure improvement in speech understanding with use of the Advanced Bionics (AB) Naída Q70 sound processor for existing Harmony users. Methods Seven adult unilateral cochlear implant (CI) recipients, who were experienced users of the Harmony sound processor, participated in the study. Sentence recognition was evaluated in quiet in a reverberating room, with Harmony and Naída CI Q70 processors. Effectiveness of Naída CI Q70's UltraZoom directional microphone was evaluated in noise. Target stimuli were recorded Portuguese sentences presented from 0° azimuth. Twenty-talker babble was presented at +5dB SNR from ±90° azimuth. In addition to sentence recognition, the participants also rated the clarity of sound and difficulty of listening in the various test conditions. In order to evaluate the outcomes under more realistic acoustic conditions, tests were conducted in a non-sound treated reverberant room (RT60 of 553 ms and noise floor of 42.7 dBA (Leq). Results The average sentence recognition in quiet in the reverberant non-sound treated room was 38.5% with the Harmony and 66.5% with Naída CI Q70. The average sentence recognition score in noise was 40.5% with Naída CI Q70 without UltraZoom and 64.5% with UltraZoom. For subjective ratings of sound clarity and listening ease in noise no difference were identified between the test conditions. Conclusion For experienced users of the Harmony sound processor, speech understanding in quiet in a reverberating room was significantly improved with the Naída CI Q70. The use of an adaptive directional microphone technology (UltraZoom) enhanced speech perception in noise.

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

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

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

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

Vocabulário expressivo em crianças usuárias de implante coclear / Expressive vocabulary in children with cochlear implants

RESUMO Objetivo: verificar a aquisição de vocabulário em crianças surdas, usuárias de implante coclear, bem como os fatores que influenciam esse desenvolvimento. Métodos: foi aplicada a parte de vocabulário do teste de linguagem infantil ABFW em 20 crianças usuárias de implante coclear por no mínimo três anos. Além disso, foi avaliada a participação familiar no desenvolvimento dessas crianças. Resultados: foi observado que as crianças implantadas apresentam possibilidade de alcançar o desenvolvimento normal de vocabulário, quando comparadas às crianças ouvintes, a depender de diversos fatores. O fator que apresentou influência estatisticamente significante no vocabulário foi a participação familiar, sendo que quanto maior o envolvimento da família no processo terapêutico, melhores os resultados no teste de vocabulário. Conclusão: as crianças implantadas podem apresentar desempenho similar às crianças ouvintes no teste de vocabulário, a depender das variáveis que transcendem a idade à implantação ou mesmo o tempo de uso do implante coclear. A estimulação/ participação familiar no desenvolvimento das crianças se mostrou de extrema importância no desenvolvimento da linguagem oral.

ABSTRACT Objective: to verify whether children with cochlear implants (CI) acquire vocabulary at the same pace as normally hearing children, and which factors influence their acquisition. Methods: the vocabulary test of the ABFW was performed on 20 children who had been using the cochlear implant for at least three years. Historical information, such as age at time of implant, hearing age (i.e., at time of implant use), and family participation in the rehabilitation process, was gathered from patients' files. Correlation statistical analysis was then performed. Results: it was observed that children with CI may acquire vocabulary similar to that of hearing children, depending on many aspects. The age at time of implantation and hearing age did not significantly correlate to the vocabulary results. The factor that demonstrated statistical significance was family participation, which showed a positive correlation: the more the family was involved in the rehabilitation process, the better the children's results on the vocabulary test. Conclusion: it was, thus, possible to conclude that children with CI develop their vocabulary in a similar manner as hearing children, depending on factors that transcend the child's age at time of implantation and hearing age. Family participation, in the rehabilitation process, was shown to be of critical importance in the child's vocabulary development.

Outcomes of Late Implantation in Usher Syndrome Patients

Abstract Introduction Usher syndrome (US) is an autosomal recessive disorder characterized by hearing loss and progressive visual impairment. Some deaf Usher syndrome patients learn to communicate using sign language. During adolescence, as they start losing vision, they are usually referred to cochlear implantation as a salvage for their new condition. Is a late implantation beneficial to these children? Objective The objective of this study is to describe the outcomes of US patients who received cochlear implants at a later age. Methods This is a retrospective study of ten patients diagnosed with US1. We collected pure-tone thresholds and speech perception tests from pre and one-year post implant. Results Average age at implantation was 18.9 years (5-49). Aided average thresholds were 103 dB HL and 35 dB HL pre and one-year post implant, respectively. Speech perception was only possible to bemeasured in four patients preoperatively, who scored 13.3; 26.67; 46% vowels and 56% 4-choice. All patients except one had some kind of communication. Two were bilingual. After one year of using the device, seven patients were able to perform the speech tests (from four-choice to close set sentences) and three patients abandoned the use of the implant. Conclusion We observed that detection of sounds can be achieved with late implantation, but speech recognition is only possible in patients with previous hearing stimulation, since it depends on the development of hearing skills and the maturation of the auditory pathways.

Outcomes of Late Implantation in Usher Syndrome Patients.

Introduction Usher syndrome (US) is an autosomal recessive disorder characterized by hearing loss and progressive visual impairment. Some deaf Usher syndrome patients learn to communicate using sign language. During adolescence, as they start losing vision, they are usually referred to cochlear implantation as a salvage for their new condition. Is a late implantation beneficial to these children? Objective The objective of this study is to describe the outcomes of US patients who received cochlear implants at a later age. Methods This is a retrospective study of ten patients diagnosed with US1. We collected pure-tone thresholds and speech perception tests from pre and one-year post implant. Results Average age at implantation was 18.9 years (5-49). Aided average thresholds were 103 dB HL and 35 dB HL pre and one-year post implant, respectively. Speech perception was only possible to be measured in four patients preoperatively, who scored 13.3; 26.67; 46% vowels and 56% 4-choice. All patients except one had some kind of communication. Two were bilingual. After one year of using the device, seven patients were able to perform the speech tests (from four-choice to close set sentences) and three patients abandoned the use of the implant. Conclusion We observed that detection of sounds can be achieved with late implantation, but speech recognition is only possible in patients with previous hearing stimulation, since it depends on the development of hearing skills and the maturation of the auditory pathways.

Mercury Exposure in a Riverside Amazon Population, Brazil: A Study of the Ototoxicity of Methylmercury

Introduction Mercury poisoning causes hearing loss in humans and animals. Acute and long-term exposures produce irreversible peripheral and central auditory system damage, and mercury in its various forms of presentation in the environment is ototoxic. Objective We investigated the otoacoustic emissions responses in a riverside population exposed to environmental mercury by analyzing the inhibitory effect of the medial olivocochlear system (MOCS) on transient otoacoustic emissions (TEOAE). Methods The purpose of the research was to evaluate the entire community independently of variables of sex and age. All of the participants were born and lived in a riverside community. After otolaryngologic evaluation, participants were received tympanometry, evaluation of contralateral acoustic reflexes, pure tone audiometry, and recording of TEOAEs with nonlinear click stimulation. Hair samples were collect to measure mercury levels. Results There was no significant correlation between the inhibitory effect of the MOCS, age, and the level of mercury in the hair. Conclusions The pathophysiological effects of chronic exposure may be subtle and nonspecific and can have a long period of latency; therefore, it will be important to monitor the effects of mercury exposure in the central auditory system of the Amazon population over time. Longitudinal studies should be performed to determine whether the inhibitory effect of the MOCS on otoacoustic emissions can be an evaluation method and diagnostic tool in populations exposed to mercury. .

Mercury exposure in a riverside Amazon population, Brazil: a study of the ototoxicity of methylmercury.

Introduction Mercury poisoning causes hearing loss in humans and animals. Acute and long-term exposures produce irreversible peripheral and central auditory system damage, and mercury in its various forms of presentation in the environment is ototoxic. Objective We investigated the otoacoustic emissions responses in a riverside population exposed to environmental mercury by analyzing the inhibitory effect of the medial olivocochlear system (MOCS) on transient otoacoustic emissions (TEOAE). Methods The purpose of the research was to evaluate the entire community independently of variables of sex and age. All of the participants were born and lived in a riverside community. After otolaryngologic evaluation, participants were received tympanometry, evaluation of contralateral acoustic reflexes, pure tone audiometry, and recording of TEOAEs with nonlinear click stimulation. Hair samples were collect to measure mercury levels. Results There was no significant correlation between the inhibitory effect of the MOCS, age, and the level of mercury in the hair. Conclusions The pathophysiological effects of chronic exposure may be subtle and nonspecific and can have a long period of latency; therefore, it will be important to monitor the effects of mercury exposure in the central auditory system of the Amazon population over time. Longitudinal studies should be performed to determine whether the inhibitory effect of the MOCS on otoacoustic emissions can be an evaluation method and diagnostic tool in populations exposed to mercury.

Desempenho auditivo e comportamentos atípicos em crianças usuárias de implante coclear / Hearing performance and atypical behavior in childrens with cochlear implants / Desempeño auditivo y comportamientos atípicos en niños com implante coclear

O diagnóstico diferencial entre a perda auditiva e o autismo se dá por meio dos testes audiológicos e da observação clínica do comportamento geral da criança. O comportamento da criança pode ser avaliado por meio de escalas, como o Autism Behavior Checklist (ABC). O objetivo deste trabalho é analisar se comportamentos atípicos associados à perda auditiva podem interferir no desenvolvimento das habilidades auditivas pós-implante coclear. Este é um estudo híbrido (retro e prospectivo) e observacional. Foram incluídas crianças com perda auditiva neurossensorial bilateral congênita severa e profunda, usuárias de Implante Coclear (IC) multicanal e uso sistemático do IC, por pelo menos 3 meses. Foram excluídas as crianças que apresentaram inserção parcial ou inadequada dos eletrodos; alteração nas impedâncias dos eletrodos; má formação da orelha interna e/ou nervo auditivo; transtorno do Espectro da Neuropatia Auditiva. Foram selecionadas 27 crianças. Obtivemos os limiares auditivos com Aparelho de Amplificação Sonora Individual (AASI) pré-implante, o desempenho auditivo por meio do inventário IT-MAIS/MAIS no pré IC e pós IC e os limiares auditivos com IC. Prospectivamente, as mães responderam ao Inventário de Comportamentos Autísticos (ICA). Não houve correlação significativa entre o ICA, a evolução dos limiares audiométricos e a evolução do IT-MAIS/MAIS. Observou-se que os limiares audiométricos melhoraram consideravelmente pós IC na média do grupo avaliado. O mesmo ocorreu com o questionário IT-MAIS/MAIS. Por meio do questionário ICA, obtivemos a presença de três sujeitos com pontuação considerada alterada. O desenvolvimento das habilidades auditivas pode ser esperado como resultado do IC em crianças com comportamentos gerais atípicos e surdez severa a profunda bilateral associada.(AU)

The differential diagnosis between hearing loss and autism relies on audiological tests and clinical observation of the child?s behavior. The child?s behavior can be estimated by using scales such as the Autism Behavior Checklist (ABC). The objective of this study is to analyze whether atypical behaviors associated with hearing loss can affect the development of auditory skills after cochlear implant (CI). This is a hybrid (prospective and retrospective) observational study in which children with sensorineural hearing loss severe to profound bilateral congenital; multichannel CI recipients with systematic use of the CI for at least 3 months were included. Children were excluded if they had partial insertion of electrodes; change in impedance of the electrodes; malformation of the inner ear and/or auditory nerve; Auditory Neuropathy Spectrum Disorder. Twenty seven children were selected. Aided thresholds (with hearing aids in the pre-implant evaluation and with cochlear implants in the post-implant evaluation) as well as the auditory performance through IT-MAIS/MAIS in both pre and post-evaluations were collected. Prospectively, the mothers responded to the Autism Behavior Checklist (ABC ? Portuguese version ICA). There was no significant correlation between the ABC and the evolution of audiometric thresholds and IT-MAIS/MAIS. It was observed that the average audiometric thresholds improved considerably after the CI in the assessed group. The same occurred with the questionnaire IT-MAIS/MAIS. Through the ICA survey, we obtained the presence of three subjects with abnormal scores. The development of listening skills can be expected as a result of CI even in children with general atypical behaviors associated with severe to profound bilateral deafness.(AU).

El diagnóstico diferencial entre la pérdida de audición y el autismo se hace por medio de pruebas audiológicas y de observación clínica del comportamiento general del niño. El comportamiento del niño se puede evaluar utilizando escalas como el Autism Behavior Checklist (ABC). El objetivo de este estudio es analizar si las conductas atípicas asociadas con la pérdida de la audición pueden afectar el desarrollo de las habilidades auditivas después del implante coclear (IC). Se trata de un estudio hibrido (retro y prospectivo) y observacional. Se incluyeron niños con pérdida auditiva neurosensorial bilateral congénita severa y profunda, usuarios de IC multicanal y uso sistemático del IC durante al menos 3 meses. Se excluieron niños que presentaron inserción parcial o inadecuada de los electrodos; cambio en la impedancia de los electrodos; malformación del oído interno y/o del nervio auditivo, trastorno del Espectro de la Neuropatía Auditiva. Se seleccionaron 27 niños. Obtuvimos los umbrales auditivos con audìfonos pre implante; el rendimiento auditivo a través del inventario IT-MAIS/MAIS pre y post implante, y los umbrales auditivos con IC. En forma prospectiva, las madres respondieron al Inventario de Comportammientos Autisticos (ICA). No hubo correlación significativa entre el ICA, la evolución de los umbrales audiométricos y la evolución del IT-MAIS/MAIS. Se observó que el promedio de los umbrales audiométricos mejoro considerablemente después del IC en el grupo evaluado. Lo mismo ocurrió con el cuestionário IT-MAIS/MAIS. A través de la encuesta ICA, se obtuvo la presencia de tres sujetos con una puntuación considerada anormal. El desarrollo de las habilidades auditivas se puede esperar como resultado del IC en niños con conductas generales atípicas y sordera severa a profunda bilateral asocida.(AU)

Zumbido em uma população ribeirinha exposta ao metilmercúrio / Tinnitus in a riverside population exposed to methyl-mercury

Objetivo : Estudar a prevalência de zumbido, verificando se há associação entre a queixa desse sintoma e o teor de mercúrio e mensurar seu impacto na qualidade de vida. Métodos : Estudo seccional em toda a população do Lago do Puruzinho, localizada na margem esquerda do Rio Madeira, cidade de Humaitá, Estado do Amazonas, Brasil. Todos os residentes maiores de 18 anos, de ambos os gêneros, foram submetidos à anamnese, avaliação otorrinolaringológica e exame audiológico. Os indivíduos que apresentaram queixa de zumbido responderam à versão traduzida do questionário Tinnitus Handicap Inventory (THI). Também foram pesquisados os teores de mercúrio total no cabelo desses indivíduos. Resultados: Para análise dos resultados sobre a queixa de zumbido, os sujeitos foram divididos em dois grupos quanto à presença ou não de zumbido. O Grupo 1 foi composto por indivíduos que apresentaram queixa de zumbido e o Grupo 2, por indivíduos sem zumbido. Foi observado que 40% dos indivíduos apresentaram escores do THI compatíveis com handicap leve. A análise da associação da presença de zumbido com os teores de mercúrio total no cabelo mostrou que ambos os grupos apresentaram níveis elevados de mercúrio, porém não ocorreram diferenças entre os grupos. Conclusão : Um quarto dos ribeirinhos apresentou queixa de zumbido e exposição significativa ao mercúrio, mas não houve associação entre o zumbido e os níveis elevados de mercúrio. .

Purpose : To study the association between the prevalence of tinnitus and mercury exposure and measure the influence of tinnitus on the quality of life. Methods : We conducted a cross-sectional study of men and women aged above 18 years residing in the Lake Puruzinho region, which is located on the left bank of the Rio Madeira, Humaita city, Amazonas state, Brazil. All subjects underwent anamnesis, otorhinolaryngologic evaluation, and an audiology test. Individuals who experienced tinnitus completed the translated Tinnitus Handicap Inventory (THI). We also examined the levels of total mercury in the hair of these individuals. Results : To analyze the results regarding the prevalence of tinnitus, the subjects were divided into two groups according to the presence or absence of tinnitus. Group 1 was composed of subjects with tinnitus and Group 2 was composed of subjects without tinnitus. Consequently, 40% of individuals had scores consistent with mild handicap according to the THI. The analysis of the association between tinnitus and levels of total mercury in hair samples showed that both groups had high levels of mercury. However, this finding was not significantly different between groups. Conclusion : Herein, 25% of the subjects complained of tinnitus and significant exposure to mercury; however, there was no association between the prevalence of tinnitus and high levels of mercury. .

Desempenho auditivo e comportamentos atípicos em crianças usuárias de implante coclear / Hearing performance and atypical behavior in childrens with cochlear implants / Desempeño auditivo y comportamientos atípicos en niños com implante coclear

O diagnóstico diferencial entre a perda auditiva e o autismo se dá por meio dos testes audiológicos e da observação clínica do comportamento geral da criança. O comportamento da criança pode ser avaliado por meio de escalas, como o Autism Behavior Checklist (ABC). O objetivo deste trabalho é analisar se comportamentos atípicos associados à perda auditiva podem interferir no desenvolvimento das habilidades auditivas pós-implante coclear. Este é um estudo híbrido (retro e prospectivo) e observacional. Foram incluídas crianças com perda auditiva neurossensorial bilateral congênita severa e profunda, usuárias de Implante Coclear (IC) multicanal e uso sistemático do IC, por pelo menos 3 meses. Foram excluídas as crianças que apresentaram inserção parcial ou inadequada dos eletrodos; alteração nas impedâncias dos eletrodos; má formação da orelha interna e/ou nervo auditivo; transtorno do Espectro da Neuropatia Auditiva. Foram selecionadas 27 crianças. Obtivemos os limiares auditivos com Aparelho de Amplificação Sonora Individual (AASI) pré-implante, o desempenho auditivo por meio do inventário IT-MAIS/MAIS no pré IC e pós IC e os limiares auditivos com IC. Prospectivamente, as mães responderam ao Inventário de Comportamentos Autísticos (ICA). Não houve correlação significativa entre o ICA, a evolução dos limiares audiométricos e a evolução do IT-MAIS/MAIS. Observou-se que os limiares audiométricos melhoraram consideravelmente pós IC na média do grupo avaliado. O mesmo ocorreu com o questionário IT-MAIS/MAIS. Por meio do questionário ICA, obtivemos a presença de três sujeitos com pontuação considerada alterada. O desenvolvimento das habilidades auditivas pode ser esperado como resultado do IC em crianças com comportamentos gerais atípicos e surdez severa a profunda bilateral associada.

The differential diagnosis between hearing loss and autism relies on audiological tests and clinical observation of the child?s behavior. The child?s behavior can be estimated by using scales such as the Autism Behavior Checklist (ABC). The objective of this study is to analyze whether atypical behaviors associated with hearing loss can affect the development of auditory skills after cochlear implant (CI). This is a hybrid (prospective and retrospective) observational study in which children with sensorineural hearing loss severe to profound bilateral congenital; multichannel CI recipients with systematic use of the CI for at least 3 months were included. Children were excluded if they had partial insertion of electrodes; change in impedance of the electrodes; malformation of the inner ear and/or auditory nerve; Auditory Neuropathy Spectrum Disorder. Twenty seven children were selected. Aided thresholds (with hearing aids in the pre-implant evaluation and with cochlear implants in the post-implant evaluation) as well as the auditory performance through IT-MAIS/MAIS in both pre and post-evaluations were collected. Prospectively, the mothers responded to the Autism Behavior Checklist (ABC ? Portuguese version ICA). There was no significant correlation between the ABC and the evolution of audiometric thresholds and IT-MAIS/MAIS. It was observed that the average audiometric thresholds improved considerably after the CI in the assessed group. The same occurred with the questionnaire IT-MAIS/MAIS. Through the ICA survey, we obtained the presence of three subjects with abnormal scores. The development of listening skills can be expected as a result of CI even in children with general atypical behaviors associated with severe to profound bilateral deafness.

El diagnóstico diferencial entre la pérdida de audición y el autismo se hace por medio de pruebas audiológicas y de observación clínica del comportamiento general del niño. El comportamiento del niño se puede evaluar utilizando escalas como el Autism Behavior Checklist (ABC). El objetivo de este estudio es analizar si las conductas atípicas asociadas con la pérdida de la audición pueden afectar el desarrollo de las habilidades auditivas después del implante coclear (IC). Se trata de un estudio hibrido (retro y prospectivo) y observacional. Se incluyeron niños con pérdida auditiva neurosensorial bilateral congénita severa y profunda, usuarios de IC multicanal y uso sistemático del IC durante al menos 3 meses. Se excluieron niños que presentaron inserción parcial o inadecuada de los electrodos; cambio en la impedancia de los electrodos; malformación del oído interno y/o del nervio auditivo, trastorno del Espectro de la Neuropatía Auditiva. Se seleccionaron 27 niños. Obtuvimos los umbrales auditivos con audìfonos pre implante; el rendimiento auditivo a través del inventario IT-MAIS/MAIS pre y post implante, y los umbrales auditivos con IC. En forma prospectiva, las madres respondieron al Inventario de Comportammientos Autisticos (ICA). No hubo correlación significativa entre el ICA, la evolución de los umbrales audiométricos y la evolución del IT-MAIS/MAIS. Se observó que el promedio de los umbrales audiométricos mejoro considerablemente después del IC en el grupo evaluado. Lo mismo ocurrió con el cuestionário IT-MAIS/MAIS. A través de la encuesta ICA, se obtuvo la presencia de tres sujetos con una puntuación considerada anormal. El desarrollo de las habilidades auditivas se puede esperar como resultado del IC en niños con conductas generales atípicas y sordera severa a profunda bilateral asocida.

[Peripheral and central auditory effects of pesticide exposure: a systematic review]. / Efeitos da exposição a agrotóxicos sobre o sistema auditivo periférico e central: uma revisão sistemática.

The World Health Organization reports a total of 3 million annual cases of acute pesticide poisoning (2.1 million cases in the developing countries alone). Pesticide use has reached alarming proportions in Brazil in the last decade. Pesticide sales skyrocketed from 2001 to 2008, making Brazil the world's leading consumer of poisons. This study aimed to assess whether pesticide exposure causes peripheral or central auditory disorders and thus focused on the importance of hearing tests in populations with acute or chronic exposure. This was a systematic review of studies on the effects of pesticide exposure on the auditory system. The context and methodological quality of the full texts were analyzed. The review identified 143 studies on the theme, 16 of which met the inclusion criteria. All articles showed that pesticide exposure is ototoxic and leads to hearing loss.

Converted and upgraded maps programmed in the newer speech processor for the first generation of multichannel cochlear implant.

OBJECTIVE: To identify the technological contributions of the newer version of speech processor to the first generation of multichannel cochlear implant and the satisfaction of users of the new technology. Among the new features available, we focused on the effect of the frequency allocation table, the T-SPL and C-SPL, and the preprocessing gain adjustments (adaptive dynamic range optimization). STUDY DESIGN: Prospective exploratory study. SETTING: Cochlear implant center at hospital. PATIENTS: Cochlear implant users of the Spectra processor with speech recognition in closed set. Seventeen patients were selected between the ages of 15 and 82 and deployed for more than 8 years. INTERVENTIONS: The technology update of the speech processor for the Nucleus 22. MAIN OUTCOME MEASURES: To determine Freedom's contribution, thresholds and speech perception tests were performed with the last map used with the Spectra and the maps created for Freedom. To identify the effect of the frequency allocation table, both upgraded and converted maps were programmed. One map was programmed with 25 dB T-SPL and 65 dB C-SPL and the other map with adaptive dynamic range optimization. To assess satisfaction, SADL and APHAB were used. RESULTS: All speech perception tests and all sound field thresholds were statistically better with the new speech processor; 64.7% of patients preferred maintaining the same frequency table that was suggested for the older processor. The sound field threshold was statistically significant at 500, 1,000, 1,500, and 2,000 Hz with 25 dB T-SPL/65 dB C-SPL. Regarding patient's satisfaction, there was a statistically significant improvement, only in the subscale of speech in noise abilities and phone use. CONCLUSION: The new technology improved the performance of patients with the first generation of multichannel cochlear implant.

Efeitos da exposição a agrotóxicos sobre o sistema auditivo periférico e central: uma revisão sistemática / Peripheral and central auditory effects of pesticide exposure: a systematic review / Efectos de la exposición a los pesticidas en el sistema auditivo periférico y central: una revisión sistemática

De acordo com a Organização Mundial da Saúde, as intoxicações agudas por agrotóxicos são da ordem de 3 milhões anuais, com 2,1 milhões de casos só nos países em desenvolvimento. Na última década, no Brasil, o uso de agrotóxicos assumiu proporções assustadoras. Entre 20012008 a venda desses produtos saltou, quando o país alcançou a posição de maior consumidor mundial de venenos. O objetivo deste estudo foi avaliar por meio de uma revisão sistemática se a exposição ao agrotóxico causa alterações auditivas no sistema auditivo periférico/central, atentando assim para a importância da avaliação auditiva em populações expostas de forma crônica ou aguda. Trata-se de uma revisão sistemática dos estudos publicados sobre os efeitos da exposição ao agrotóxico no sistema auditivo. Analisaram-se os trabalhos contemplados na íntegra e também sua qualidade metodológica. A pesquisa identificou 143 estudos sobre o tema, sendo que 16 se enquadraram nos critérios de inclusão. Todos os artigos analisados evidenciaram que a exposição ao agrotóxico é ototóxica e induz ao dano às vias auditivas.

The World Health Organization reports a total of 3 million annual cases of acute pesticide poisoning (2.1 million cases in the developing countries alone). Pesticide use has reached alarming proportions in Brazil in the last decade. Pesticide sales skyrocketed from 2001 to 2008, making Brazil the world's leading consumer of poisons. This study aimed to assess whether pesticide exposure causes peripheral or central auditory disorders and thus focused on the importance of hearing tests in populations with acute or chronic exposure. This was a systematic review of studies on the effects of pesticide exposure on the auditory system. The context and methodological quality of the full texts were analyzed. The review identified 143 studies on the theme, 16 of which met the inclusion criteria. All articles showed that pesticide exposure is ototoxic and leads to hearing loss.

El objetivo de este artículo es presentar un estudio sobre el uso de la historia oral de vida como estrategia de aproximación entre cuidador y anciano, con el fin de contribuir a la humanización en la relación entre el profesional de la salud y el paciente. Se trata de una investigación cualitativa y descriptiva. Hemos reunido a siete ancianos, varones y mujeres, con más de 65 años que, a partir de entrevistas abiertas y semi-estructuradas, hicieron posible la producción de relatos de vida que, una vez finalizados, fueron devueltos a los colaboradores en forma de cuadernos personalizados para que ellos dispusieran de ellos como quisieran. Como resultado ha sido posible percibir que tal metodología contribuye a la generación de un vínculo entre enfermero y anciano, presentándose no solamente como elemento humanizador, sino también terapéutico.

Evolução audiométrica em usuários de implante coclear multicanal / Audiometric evolution in multichannel cochlear implant users

OBJETIVO: analisar em quanto tempo após a ativação é possível alcançar os limiares auditivos desejados nos indivíduos usuários de implante coclear (IC) multicanal de diferentes faixas etárias. MÉTODO: estudo seccional retrospectivo a partir de banco de dados, aprovado pelo CEP/HCFMUSP, sob número 779/06. Foram incluídos indivíduos implantados no período de Janeiro de 2005(início da formação do banco de dados) a Setembro de 2008(término da coleta de dados), cujos prontuários possuíam dados dos limiares audiométricos pré-implante e 3, 6 e 12 meses após o IC. Setenta e dois pacientes contemplaram os critérios, divididos em dois grupos por faixa etária: GI (até 17 anos) e GII (18 a 66 anos). Foi utilizada a Análise de Variância (ANOVA) de um fator para verificar a interação entre as médias dos limiares audiométricos e o tempo após o IC. RESULTADOS: observou-se que 15 do grupo GI já alcançaram limiares em torno de 30dBNA aos 3 meses pós implante. O mesmo aconteceu com 26 pacientes do grupo GII. Encontrou-se interação significante entre tempo (F(3,140)=91,973, p=0,00) e a média de limiares auditivos. Nas análises Post-hoc do grupo GI foram observadas diferenças estatisticamente significantes para as comparações entre AASI e 3 meses pós implante (p=0,00) e entre 3 e 12 meses (p= 0,28), para o grupo GII, somente para a comparação entre AASI e 3 meses (p=0,00). CONCLUSÃO: uma mudança significante da audição pode ser observada a partir de três meses após o IC, porém este resultado não se encontra em todos os implantados.

PURPOSE: to evaluate how long after activation one can achieve the desired auditory thresholds in individuals multichannel cochlear implant users from different age groups. METHOD: a retrospective cross-sectional from a database, approved by CEP / FMUSP, under number 779/06. Individuals implanted between January 2005 and September 2008, whose files had preoperative audiometric data and 3, 6 and 12 months after CI were included. Seventy-two patients fulfilled the criteria, and they were divided in two groups according to age: group I (17 year old) and GII (18-66 year old). Analysis of variance (ANOVA) of one factor in order to verify the interaction between the mean threshold and time after CI were used. RESULTS: we observed that 15 of the GI have reached around 30dBNA thresholds at 3 months after implant. The same happened to 26 patients of GII. We found significant interaction between time (F (3.140) = 91.973, p = 0.00) and the average hearing thresholds. Post-hoc analysis in the GI group were statistically significant differences for comparisons between HA and 3 months after implantation (p = 0.00) and between 3 and 12 months (p = 0.28). For GII only for comparison between HA and 3 months (p = 0.00). CONCLUSION: a significant hearing change may be observed beginning from three months after IC, but this result is not found in all implanted subjects.