Your browser doesn't support javascript.
loading
Mostrar: 20 | 50 | 100
Resultados 1 - 20 de 2.299
Filtrar
1.
J Laryngol Otol ; 134(6): 519-525, 2020 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-32613920

RESUMO

OBJECTIVE: To present our data evaluating the feasibility of simultaneous cochlear implantation with resection of acoustic neuroma. METHODS: This paper describes a case series of eight adult patients with a radiologically suspected acoustic neuroma, treated at a tertiary referral centre in Newcastle, Australia, between 2012 and 2015. Patients underwent cochlear implantation concurrently with removal of an acoustic neuroma. The approach was translabyrinthine, with facial nerve monitoring and electrically evoked auditory brainstem response testing. Standard post-implant rehabilitation was employed, with three and six months' follow-up data collected. The main outcome measures were: hearing, subjective benefit of implant, operative complications and tumour recurrence. RESULTS: Eight patients underwent simultaneous cochlear implantation with resection of acoustic neuroma over a 3-year period, and had 25-63 months' follow up. There were no major complications. All patients except one gained usable hearing and were daily implant users. CONCLUSION: Simultaneous cochlear implantation with resection of acoustic neuroma has been shown to be a safe treatment option, which will be applicable in a wide range of clinical scenarios as the indications for cochlear implantation continue to expand.


Assuntos
Implante Coclear/métodos , Terapia Combinada/métodos , Audição/fisiologia , Neuroma Acústico/cirurgia , Adolescente , Idoso , Austrália/epidemiologia , Terapia Combinada/estatística & dados numéricos , Potenciais Evocados Auditivos do Tronco Encefálico/fisiologia , Nervo Facial/cirurgia , Estudos de Viabilidade , Seguimentos , Testes Auditivos/métodos , Humanos , Pessoa de Meia-Idade , Recidiva Local de Neoplasia/epidemiologia , Neuroma Acústico/diagnóstico por imagem , Neuroma Acústico/patologia , Neuroma Acústico/reabilitação , Complicações Pós-Operatórias/epidemiologia , Estudos Retrospectivos , Centros de Atenção Terciária , Resultado do Tratamento
2.
J Laryngol Otol ; 134(6): 493-496, 2020 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-32618542

RESUMO

OBJECTIVE: Safe cochlear implantation is challenging in patients with canal wall down mastoid cavities, and the presence of large meatoplasties increases the risk of external canal overclosure. This paper describes our results of obliteration of the mastoid cavity with conchal cartilage as an alternative procedure in cases of canal wall down mastoidectomy with very large meatoplasty. METHODS: The cases of seven patients with a canal wall down mastoidectomy cavity who underwent cochlear implantation were retrospectively reviewed. Post-operative complications were analysed. The mean follow-up duration was 4.5 years. RESULTS: There was no hint of cholesteatoma recurrence and all patients have been free of symptoms during follow up. Only one patient showed cable extrusion six months after surgery, and implantation of the contralateral ear was needed. CONCLUSION: Pseudo-obliteration of the mastoid cavity with a cartilage multi-layered palisade reconstruction covering the electrode may be a safe alternative in selected patients with a large meatoplasty.


Assuntos
Cartilagem/transplante , Meato Acústico Externo/cirurgia , Processo Mastoide/cirurgia , Mastoidectomia/efeitos adversos , Adulto , Idoso , Colesteatoma da Orelha Média/epidemiologia , Doença Crônica , Implante Coclear/métodos , Eletrodos Implantados/efeitos adversos , Feminino , Seguimentos , Humanos , Masculino , Processo Mastoide/patologia , Pessoa de Meia-Idade , Otite Média/epidemiologia , Complicações Pós-Operatórias/epidemiologia , Procedimentos Cirúrgicos Reconstrutivos/métodos , Recidiva , Estudos Retrospectivos
3.
Orv Hetil ; 161(24): 1015-1019, 2020 06.
Artigo em Húngaro | MEDLINE | ID: mdl-32469843

RESUMO

Due to the remarkable development in the field of hearing implantation, almost all kinds of hearing loss can be successfully rehabilitated. The first Hungarian Codacs™ (Cochlear's direct acoustic cochlear stimulator; Cochlear, Sydney, Australia) implantation was performed at the Department of Otorhinolaryngology and Head-Neck Surgery, Clinical Centre, University of Pécs. This electromechanical middle-ear implant can be offered for patients with bilateral, severe to profound, mixed-type hearing loss. In our case, a 67-year-old male patient with bilateral advanced otosclerosis was implanted, which led to significant improvement of the hearing threshold and speech reception. Orv Hetil. 2020; 161(24): 1015-1019.


Assuntos
Implante Coclear/métodos , Implantes Cocleares , Procedimentos Cirúrgicos Otológicos , Otosclerose/cirurgia , Acústica , Idoso , Austrália , Humanos , Hungria , Masculino , Resultado do Tratamento
5.
Otolaryngol Head Neck Surg ; 162(5): 731-736, 2020 May.
Artigo em Inglês | MEDLINE | ID: mdl-32180504

RESUMO

OBJECTIVE: To explore the immediate and 1-year outcomes of patients who underwent implantation with the slim modiolar electrode (SME). STUDY DESIGN: Consecutive case series with chart review. SETTING: Tertiary referral academic center. SUBJECT AND METHODS: Between May 2016 and August 2018, a total of 326 cochlear implantations (CIs) were performed. Intraoperative x-rays were performed in all cases to identify tip rollovers. Scalar location was identified for 76 CIs that had postoperative computed tomography reconstructions. Speech outcomes were measured at 3, 6, and 12 months with consonant-nucleus-consonant word and AzBio sentences in quiet and noise (+10-dB signal-to-noise ratio). Preservation of hearing was defined as maintaining a low-frequency pure tone average ≤80 dB at 250 and 500 Hz. RESULTS: Among 326 CIs, 23 (7%) had tip rollovers. Postoperative reconstructions revealed 5 of 76 (6.6%) scalar translocations. A subset of 177 cases met criteria for evaluation of speech perception scores. The marginal mean differences between presurgery and 12 months for speech tests were as follows: consonant-nucleus-consonant, 43.7 (95% CI, 39.8-47.6); AzBio in quiet, 49.7 (95% CI, 44.9-54.4); and AzBio in noise, 29.9 (95% CI, 25.2-34.7). Sixty-one patients were identified with preservable hearing (low-frequency pure tone average ≤80 dB), and 12 of 61 (20%) preserved hearing at 1 year. CONCLUSION: CI with SME provides reliable scala tympani insertion in a consistent perimodiolar position. An initially increased tip rollover rate improved with case volume and sheath design improvement. For long-term outcomes, speech performance was comparable to that of other cochlear implants. While hearing preservation for the SME may be better than prior perimodiolar electrodes, consistent outcomes are unlikely.


Assuntos
Implante Coclear/métodos , Implantes Cocleares , Eletrodos Implantados , Adulto , Idoso , Idoso de 80 Anos ou mais , Audiometria de Tons Puros , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Desenho de Prótese , Rampa do Tímpano/cirurgia , Percepção da Fala , Tomografia Computadorizada por Raios X
6.
Otolaryngol Head Neck Surg ; 162(6): 926-932, 2020 06.
Artigo em Inglês | MEDLINE | ID: mdl-32178574

RESUMO

OBJECTIVE: Default frequency filters of cochlear implant (CI) devices assign frequency information irrespective of intracochlear position, resulting in varying degrees of frequency-to-place mismatch. Substantial mismatch negatively influences speech recognition in postlingually deafened CI recipients, and acclimatization may be particularly challenging for older adults due to effects of aging on the auditory pathway. The present report investigated the influence of mismatch and age at implantation on speech recognition within the initial 6 months of CI use. STUDY DESIGN: Retrospective review. SETTING: Tertiary referral center. SUBJECTS AND METHODS: Forty-eight postlingually deafened adult CI recipients of lateral wall electrode arrays underwent postoperative computed tomography to determine angular insertion depth of each electrode contact. Frequency-to-place mismatch was determined by comparing spiral ganglion place frequencies to default frequency filters. Consonant-nucleus-consonant (CNC) scores in the CI-alone condition at 1, 3, and 6 months postactivation were compared to the degree of mismatch at 1500 Hz and age at implantation. RESULTS: Younger adult CI recipients experienced more rapid growth in speech recognition during the initial 6 months postactivation. Greater degrees of frequency-to-place mismatch were associated with poorer performance, yet older listeners were not particularly susceptible to this effect. CONCLUSIONS: While older adults are not necessarily more sensitive to detrimental effects of frequency-to-place mismatch, other factors appear to limit early benefit with a CI in this population. These results suggest that minimizing mismatch could optimize outcomes in adult CI recipients across the life span, which may be particularly beneficial in the elderly considering auditory processing deficits associated with advanced age.


Assuntos
Implante Coclear/métodos , Surdez/reabilitação , Percepção da Fala/fisiologia , Adulto , Idoso , Idoso de 80 Anos ou mais , Surdez/diagnóstico , Surdez/fisiopatologia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Tomografia Computadorizada por Raios X
7.
Otolaryngol Head Neck Surg ; 162(6): 933-941, 2020 06.
Artigo em Inglês | MEDLINE | ID: mdl-32182164

RESUMO

OBJECTIVE: To investigate the influence of cochlear implant (CI) use on subjective benefits in quality of life in cases of asymmetric hearing loss (AHL). STUDY DESIGN: Prospective clinical trial. SETTING: Tertiary academic center. SUBJECTS AND METHODS: Subjects included CI recipients with AHL (n = 20), defined as moderate-to-profound hearing loss in the affected ear and mild-to-moderate hearing loss in the contralateral ear. Quality of life was assessed with the Speech, Spatial, and Qualities of Hearing Scale (SSQ) pragmatic subscales, which assess binaural benefits. Subjective benefit on the pragmatic subscales was compared to word recognition in quiet and spatial hearing abilities (ie, masked sentence recognition and localization). RESULTS: Subjects demonstrated an early, significant improvement (P < .01) in abilities with the CI as compared to preoperative abilities on the SSQ pragmatic subscales by the 1-month interval. Perceived abilities were either maintained or continued to improve over the study period. There were no significant correlations between results on the Speech in Quiet subscale and word recognition in quiet, the Speech in Speech Contexts subscale and masked sentence recognition, or the Localization subscale and sound field localization. CONCLUSIONS: CI recipients with AHL report a significant improvement in quality of life as measured by the SSQ pragmatic subscales over preoperative abilities. Reported improvements are observed as early as 1 month postactivation, which likely reflect the binaural benefits of listening with bimodal stimulation (CI and contralateral hearing aid). The SSQ pragmatic subscales may provide a more in-depth insight into CI recipient experience as compared to behavioral sound field measures alone.


Assuntos
Implante Coclear/métodos , Perda Auditiva Súbita/reabilitação , Perda Auditiva Unilateral/reabilitação , Qualidade de Vida , Localização de Som/fisiologia , Percepção da Fala/fisiologia , Idoso , Feminino , Seguimentos , Perda Auditiva Súbita/fisiopatologia , Perda Auditiva Unilateral/fisiopatologia , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos , Inquéritos e Questionários , Resultado do Tratamento
8.
J Laryngol Otol ; 134(3): 219-221, 2020 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-32127054

RESUMO

BACKGROUND: Endoscopes provide a magnified view of the middle ear and visualisation of hidden areas. Otoendoscopes facilitate excellent visualisation of the round window niche during cochlear implantation. OBJECTIVE: To compare microscopic and endoscopic visualisation of the round window membrane during cochlear implantation in 20 patients. METHODS: Twenty patients who underwent cochlear implantation were included in the study. After maximum exposure of the round window, the accessibility of the round window membrane was graded according to the St Thomas Hospital classification, first by microscope and then by endoscope. RESULTS: With the use of the endoscope, visualisation of the round window membrane improved in all the patients as compared to the microscope. The electrode array was inserted via a round window or extended round window approach in all but two cases; the latter cases required bony cochleostomy because of unfavourable anatomy. CONCLUSION: The main benefit of endoscope-assisted cochlear implantation is improved visibility of the round window region.


Assuntos
Implante Coclear/métodos , Endoscopia/métodos , Microscopia/métodos , Otoscopia/métodos , Janela da Cóclea/diagnóstico por imagem , Adolescente , Adulto , Criança , Pré-Escolar , Feminino , Humanos , Lactente , Período Intraoperatório , Masculino , Pessoa de Meia-Idade , Janela da Cóclea/cirurgia , Adulto Jovem
9.
Rev Assoc Med Bras (1992) ; 66(1): 74-80, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32130385

RESUMO

OBJECTIVE: This study aims to investigate the application value of magnetic resonance (MR) hydrography of the inner ear in cochlear implantation. METHODS: 146 patients were enrolled. MR hydrography and spiral CT examinations for the intracranial auditory canal were performed before surgery, and all imaging results were statistically analyzed in order to explore the application value of MR hydrography of the inner ear in cochlear implantation. RESULTS: 146 patients (292 ears) were examined. Among these patients, 13 were diagnosed with abnormal vestibular aqueducts (20 ears) by MR hydrography, while five were diagnosed with this disease by CT; 15 patients were diagnosed with inner ear malformation (19 ears) by MR hydrography, while 11 were diagnosed by CT (four were misdiagnosed); five patients were diagnosed with internal acoustic canal stenosis (eight ears) by MR hydrography, while two were diagnosed by CT (three were misdiagnosed); and four patients were diagnosed with cochlear fibrosis (five ears) by MR hydrography, while four were diagnosed by CT (four ears). The correct rate of diagnosis was 77.40% (113/146) based on CT, while the rate was 93.84% (137/146) based on MR hydrography. CONCLUSIONS: MR hydrography imaging technique can be applied to the preoperative evaluation of cochlear implantation, providing accurate and reliable anatomic information on the inner membranous labyrinth and nerves in the internal acoustic canal and an accurate basis for the diagnosis of cochlear fibrosis and nerve development. This has a guiding significance for the selection of treatment schemes.


Assuntos
Implante Coclear/métodos , Orelha Interna/diagnóstico por imagem , Imagem por Ressonância Magnética/métodos , Adolescente , Adulto , Criança , Pré-Escolar , Orelha Interna/cirurgia , Feminino , Perda Auditiva Neurossensorial/diagnóstico por imagem , Perda Auditiva Neurossensorial/cirurgia , Humanos , Lactente , Doenças do Labirinto/diagnóstico por imagem , Doenças do Labirinto/cirurgia , Masculino , Pessoa de Meia-Idade , Período Pré-Operatório , Valores de Referência , Reprodutibilidade dos Testes , Tomografia Computadorizada Espiral/métodos , Adulto Jovem
10.
Otolaryngol Head Neck Surg ; 162(5): 718-724, 2020 05.
Artigo em Inglês | MEDLINE | ID: mdl-32093543

RESUMO

OBJECTIVE: Studies suggest lateral wall (LW) scala tympani (ST) height decreases apically, which may limit insertion depth. No studies have investigated the relationship of LW ST height with translocation rate or location. STUDY DESIGN: Retrospective review. SETTING: Cochlear implant program at tertiary referral center. SUBJECTS AND METHODS: LW ST height was measured in preoperative images for patients with straight electrodes. Scalar location, angle of insertion depth (AID), and translocation depth were measured in postoperative images. Audiologic outcomes were tracked. RESULTS: In total, 177 ears were identified with 39 translocations (22%). Median AID was 443° (interquartile range [IQR], 367°-550°). Audiologic outcomes (126 ears) showed a small, significant correlation between consonant-nucleus-consonant (CNC) word score and AID (r = 0.20, P = .027), although correlation was insignificant if translocation occurred (r = 0.11, P = .553). Translocation did not affect CNC score (P = .335). AID was higher for translocated electrodes (503° vs 445°, P = .004). Median translocation depth was 381° (IQR, 222°-399°). Median depth at which a 0.5-mm electrode would not fit within 0.1 mm of LW was 585° (IQR, 405°-585°). Median depth at which a 0.5-mm electrode would displace the basilar membrane by ≥0.1 mm was 585° (IQR, 518°-765°); this was defined as predicted translocation depth (PTD). Translocation rate was 39% for insertions deeper than PTD and 14% for insertions shallower than PTD (P = .008). CONCLUSION: AID and CNC are directly correlated for straight electrodes when not translocated. Translocations generally occur around 380° and are more common with deeper insertions due to decreasing LW ST height. Risk of translocation increases significantly after 580°.


Assuntos
Implante Coclear/métodos , Implantes Cocleares , Eletrodos Implantados , Rampa do Tímpano/anatomia & histologia , Humanos , Desenho de Prótese , Estudos Retrospectivos , Rampa do Tímpano/diagnóstico por imagem , Rampa do Tímpano/cirurgia
11.
Ann Otol Rhinol Laryngol ; 129(4): 347-354, 2020 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-31735055

RESUMO

OBJECTIVE: To identify demographic predictors of patients undergoing cochlear implantation evaluation and surgery. METHODS: Consecutive adult patients between 2009 and 2018 who underwent cochlear implantation evaluation at a university cochlear implantation program were retrospectively identified to determine (1) cochlear implantation qualification rate and (2) pursuit of surgery rate with respect to age, gender, race, primary spoken language, marital status, insurance type, and distance to the cochlear implantation center. RESULTS: A total of 823 cochlear implantation evaluations were analyzed. Overall, 76.3% of patients qualified for cochlear implantation and 61.5% of these patients pursued surgery. Age was the only independent predictor for cochlear implantation qualification, such that, for each year younger, the odds of qualifying for cochlear implantation increased by 2.5% (OR 0.98; 95% CI: 0.96-0.99). Age, race, marital status, and insurance type were each independent predictors of the decision to pursue surgery. The odds of pursuing surgery increased by 2.8% for each year younger (OR 1.03; 95% CI: 1.01-1.05). Compared to White patients, non-Whites were half as likely to pursue surgery (OR 0.47; 95% CI: 0.25-0.88). Single (OR 0.49; 95% CI: 0.26-0.94) and widowed patients (OR 0.46; 95% CI: 0.23-0.95) were about half as likely to pursue surgery as compared to married patients. Patients with military insurance were 13 times more likely to pursue surgery as compared to patients with Medicare (OR 13.0; 95% CI: 1.67-101.4). CONCLUSION: Younger age is an independent predictor for a higher cochlear implantation qualification rate, suggesting the possibility for delayed candidacy referral. Rate of surgical pursuit in qualified cochlear implantation candidates is lower for racial minorities, single and widowed patients, and older patients.


Assuntos
Implante Coclear , Demografia , Disparidades em Assistência à Saúde/estatística & dados numéricos , Perda Auditiva Neurossensorial , Fatores Etários , Implante Coclear/métodos , Implante Coclear/normas , Definição da Elegibilidade/métodos , Definição da Elegibilidade/normas , Estudos de Avaliação como Assunto , Feminino , Perda Auditiva Neurossensorial/epidemiologia , Perda Auditiva Neurossensorial/cirurgia , Humanos , Revisão da Utilização de Seguros , Masculino , Pessoa de Meia-Idade , Seleção de Pacientes , Encaminhamento e Consulta/estatística & dados numéricos , Estados Unidos/epidemiologia
12.
Otolaryngol Clin North Am ; 53(1): 115-126, 2020 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-31677739

RESUMO

Recent research has shown promising results for the development of a clinically feasible vestibular implant in the near future. However, correct electrode placement remains a challenge. It was shown that fluoroscopy was able to visualize the semicircular canal ampullae and electrodes, and guide electrode insertion in real time. Ninety-four percent of the 18 electrodes were implanted correctly (<1.5 mm distance to target). The median distances were 0.60 mm, 0.85 mm, and 0.65 mm for the superior, lateral, and posterior semicircular canal, respectively. These findings suggest that fluoroscopy can significantly improve electrode placement during vestibular implantation.


Assuntos
Implante Coclear/métodos , Neuroestimuladores Implantáveis , Canais Semicirculares/cirurgia , Implante Coclear/instrumentação , Estudos de Viabilidade , Fluoroscopia , Humanos , Estudo de Prova de Conceito , Canais Semicirculares/fisiologia , Nervo Vestibular/patologia , Nervo Vestibular/cirurgia
13.
Otolaryngol Clin North Am ; 53(1): 87-102, 2020 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-31677740

RESUMO

Cochlear implant is the first approved cranial nerve stimulator that works by directly stimulating the cochlear nerve. The medical and societal impact of this revolutionary device cannot be understated. This article reviews the evolving indications for cochlear implant, patient assessment, surgical approach, and outcomes for pediatric and adult cochlear implant that demonstrate its impact. Future concepts in cochlear implant are introduced briefly. This article covers a breadth of information; however, it is not intended be entirely comprehensive. Rather, it should serve as a foundation for understanding cochlear implant.


Assuntos
Implante Coclear/métodos , Implantes Cocleares , Perda Auditiva Neurossensorial/terapia , Adulto , Limiar Auditivo , Criança , Cóclea/patologia , Cóclea/cirurgia , Nervo Coclear/fisiologia , Humanos
14.
Am J Otolaryngol ; 41(1): 102338, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-31732318

RESUMO

OBJECTIVES: To report and analyze three cases of subtotal petrosectomy (SP) in cochlear implant surgery at our institution, and establish the indications, surgical technique and complications encountered. MATERIALS AND METHOD: A retrospective descriptive study is proposed, analyzing a series of three clinical cases of subtotal petrosectomy as surgical technique for cochlear implant surgery at San Ignacio University Hospital (Bogotá, Colombia) from year 2004 to 2019. RESULTS: A total of three cases of subtotal petrosectomy as surgical technique in cochlear implant candidates were analyzed. The indications were the presence of a wide mastoid cavity after canal wall down mastoidectomy, extrusion of the electrode into the external auditory canal with a wide mastoid cavity and erosion of the posterior wall of the ear canal, and the presence of cholesteatoma in a cophotic ear with previous surgery. The ear canal was defunctionalized in all three cases; in two of them with obliteration of the Eustachian tube and in none of the cases the mastoid was obliterated. There was a single complication associated with the procedure corresponding to a small retention cholesteatoma in the skin of the obliterated duct sac, that didn't required surgical intervention. CONCLUSION: Subtotal petrosectomy is a surgical alternative for cochlear implant surgery in patients with chronic ear pathology, wide cavities or cochlear implant extrusion, not associated to significant complications.


Assuntos
Implante Coclear/métodos , Perda Auditiva/cirurgia , Osso Petroso/cirurgia , Adolescente , Idoso , Perda Auditiva/etiologia , Humanos , Masculino , Pessoa de Meia-Idade , Osso Petroso/diagnóstico por imagem , Tomografia Computadorizada por Raios X
15.
J Int Adv Otol ; 15(3): 345-351, 2019 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-31846910

RESUMO

OBJECTIVES: The intracochlear electrocochleography (ECoG) could be recorded directly from the cochlear implant (CI) electrode in CI recipients with residual hearing. The primary objective of this study is to identify the most sensitive frequency to record cochlear microphonics (CM) in CI users with a wide degree of hearing abilities and deep electrode insertion. The secondary objective is to identify the optimum location within the cochlea to record intracochlear potentials. MATERIALS AND METHODS: CMs were recorded from the CI electrodes in eight females and eight males implanted with CIs Pulsar, Concerto, or Sonata, Med-El Corp. RESULTS: Among the tone pips of various frequencies, 1k or 500 Hz were the most sensitive for CI users. The most sensitive place in the cochlea to record the CM potentials depended on the tone frequency used. The deeper into the cochlea the mean maximum CM peak-to-peak amplitude was measured, the lower the stimulating tone frequency was. CONCLUSION: The most optimal recording parameters identified for intracochlear CM recording can be useful for intraoperative and postoperative monitoring of cochlear health in CI users with residual hearing.


Assuntos
Cóclea/fisiopatologia , Implante Coclear/métodos , Implantes Cocleares , Potenciais Microfônicos da Cóclea/fisiologia , Audição/fisiologia , Adulto , Audiometria de Resposta Evocada , Cóclea/cirurgia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Adulto Jovem
16.
J Int Adv Otol ; 15(3): 352-357, 2019 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-31846911

RESUMO

OBJECTIVES: Jervell and Lange-Nielsen syndrome is a rare autosomal recessive disease characterized by congenital sensorineural deafness and significant QT interval prolongation. Aims were to study the prevalence of long QT in congenital hearing loss, complications encountered, outcomes by Categories of auditory Performance (CAP) scores and Speech Intelligibility Rating (SIR) scores and to create an algorithm with precautions to be followed in Long QT children. MATERIALS AND METHODS: Study was done at Auditory implant center at a tertiary referral care ENT hospital which includes 41 paediatric patients who were diagnosed to have Long QT during preoperative assessment and underwent cochlear implantation. A standard Protocol was followed in all candidates which includes comprehensive targeted history and investigations, preoperative and intraoperative precautions, and the findings were recorded. RESULTS: Preoperative prophylactic Beta blockers, avoiding sympathetic stimulation and drugs prolonging QT interval with rational use of Magnesium Sulphate and standby of defibrillator were the standard precautions practised. Fatal Arrhythmias were encountered intra-operatively in five patients which was treated with cardiac pacing. Cardiac monitoring was done intraoperatively and during switch-on. Significant improvement in CAP and SIR scores were observed at 3 and 6 months when compared to their base line values. CONCLUSION: With special attention to preoperative evaluation, appropriate intraoperative precautions and monitoring, judicious surgical planning and post surgical follow-up cochlear implantation may be performed safely in patients with JLNS with good postoperative results allowing for improved audition.


Assuntos
Implante Coclear/métodos , Surdez/cirurgia , Perda Auditiva Neurossensorial/cirurgia , Síndrome de Jervell-Lange Nielsen/cirurgia , Percepção Auditiva , Pré-Escolar , Surdez/congênito , Surdez/fisiopatologia , Feminino , Perda Auditiva Neurossensorial/congênito , Perda Auditiva Neurossensorial/fisiopatologia , Humanos , Síndrome de Jervell-Lange Nielsen/complicações , Síndrome de Jervell-Lange Nielsen/fisiopatologia , Masculino , Estudos Prospectivos , Estudos Retrospectivos , Inteligibilidade da Fala , Resultado do Tratamento
17.
Swiss Med Wkly ; 149: w20171, 2019 Dec 16.
Artigo em Inglês | MEDLINE | ID: mdl-31880806

RESUMO

AIM OF THE STUDY: The aim of this multicentre, prospective, open, nonrandomised clinical trial was to demonstrate the clinical efficiency and outcomes of cochlear implants (CIs) in adult patients with post-lingual single-sided deafness (SSD). METHODS: A group of five left and five right SSD participants were investigated with various clinical tests and questionnaires before and 12 months after CI activation. Changes in hearing thresholds, speech understanding in noise, sound localisation, tinnitus (Tinnitus Handicap Inventory; THI), subjective hearing ability (Speech, Spatial and Qualities of Hearing Scale; SSQ), and quality of life (WHOQOL-BREF) were assessed. In addition, the pre- and postoperative results of the SSD patients were compared with an age- and gender-matched normal hearing control group. RESULTS: Surgery was uncomplicated in all patients. Two years after implantation, 9 of the 10 patients used their CI regularly for an average of more than 11 hours a day. A significant improvement in speech understanding in noise measured in the sound field using the Oldenburg sentence test could be demonstrated in the two situations in which patients with SSD experience the greatest difficulty: speech from the front and noise at the healthy ear, and speech to the implanted ear and noise from the front. The sound localisation test showed significant improvement of the mean localisation error and the root mean square error after CI activation. Furthermore, a significant reduction of the THI was measured, and the SSQ showed a significant improvement in the subscale speech comprehension and in the subscale spatial hearing. Also, quality of life measured with the WHOQOL-BREF showed a general improvement, which was significant in the global subscale. For this questionnaire, there was no significant difference between the normal-hearing control group and the patients after 12 months of CI use. CONCLUSION: This study confirmed the clinical benefit of cochlear implantation in patients with SSD. The significant improvement of speech understanding in noise, sound localisation, tinnitus perception, subjective hearing ability, and in particular the improved quality of life support the recommendation that patients with recently acquired SSD should be offered a CI. (Clinical trial registration number on clinicaltrial.gov: NCT01749592).


Assuntos
Implantes Cocleares/psicologia , Perda Auditiva Bilateral/psicologia , Perda Auditiva Bilateral/cirurgia , Qualidade de Vida/psicologia , Adulto , Implante Coclear/métodos , Feminino , Audição , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos , Fala , Inquéritos e Questionários
18.
Medicine (Baltimore) ; 98(50): e18283, 2019 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-31852103

RESUMO

RATIONALE: Cochlear implantation (CI) in CHARGE syndrome is technically challenging because of the anatomical anomalies. This case aims to report a successful case of CI in CHARGE syndrome by using the modified transcanal approach with external auditory canal (EAC) obliteration. PATIENT CONCERNS: The 3-year-old girl presented at the outpatient department with bilateral hearing loss and nasal obstruction since birth. DIAGNOSIS: The patient had bilateral profound sensorineural hearing loss, patent ductus arteriosus, atresia of the choanae, middle and inner ear anomalies, and growth retardation, fulfilling the criteria for typical CHARGE syndrome. High resolution temporal bone computed tomography scan revealed a poorly developed mastoid cavity, cochlear dysplasia, hypoplastic semicircular canals, ossicular chain malformation, and sigmoid sinus engorgement. Magnetic resonance imaging revealed a narrow internal auditory canal and a hypoplastic cochlear nerve. INTERVENTIONS: Modified transcanal approach with external auditory canal obliteration OUTCOMES:: CI was successfully done and there are no intraoperative or postoperative complications occurred after 1 year of follow up. LESSONS: The modified transcanal approach is a reasonable and safer option for CI in CHARGE syndrome.


Assuntos
Síndrome CHARGE/cirurgia , Implante Coclear/métodos , Endoscopia/métodos , Síndrome CHARGE/diagnóstico , Pré-Escolar , Meato Acústico Externo , Feminino , Humanos , Tomografia Computadorizada por Raios X
19.
Behav Neurol ; 2019: 1630718, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31871493

RESUMO

The advent of cochlear implants has enormously improved the quality of sensory perception in deaf children. Notwithstanding these advantages, the current literature shows a substantial variability in language proficiency among implanted children. This case series explores the variability of language acquisition in congenitally deaf children with cochlear implants. We report 4 prelingually deaf children (mean age = 10.5; SD = 1.08), affected by a genetically determined bilateral deafness, due to GJB2 gene mutation Cx26. Each implanted child underwent a systematic assessment of speech perception and production, as well as of lexical, morphologic, and syntactic skills in both comprehension and production. Notwithstanding similar clinical histories and similarly good postimplant pure-tone audiometry, two of the four children fared very poorly in speech audiometry, whereas the other two children gained very good results. We suggest that the language impairment detected in (some) implanted children may not be fully accounted for by pure auditory thresholds and that may be the outcome of concomitant damage to core components of the child's linguistic brain.


Assuntos
Desenvolvimento Infantil/fisiologia , Desenvolvimento da Linguagem , Linguística/métodos , Audiometria da Fala/métodos , Criança , Implante Coclear/métodos , Implantes Cocleares/psicologia , Conexinas/genética , Conexinas/metabolismo , Surdez/fisiopatologia , Feminino , Humanos , Masculino , Percepção da Fala/fisiologia
20.
Eur Arch Otorhinolaryngol ; 276(12): 3317-3325, 2019 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-31535291

RESUMO

OBJECTIVE: To investigate a cohort of adult single-sided deafness (SSD) patients who received a cochlear implant and to determine the impact of underlying causes of etiology and duration of deafness on outcome STUDY DESIGN: Retrospective data analysis SETTING: Tertiary referral centre with a large cochlear implant program SUBJECTS AND METHODS: A demographic description of 55 adult patients implanted between 2009 and 2016. The best available speech perception score in every patient using the Freiburg Numbers, Freiburg Monosyllables and the Hochmair-Schulz-Moser (HSM) sentence test measured at the 1-, 3-, 6- and 12-month intervals, and the yearly follow-up appointments were examined. A multivariate regression analysis was conducted on the variables speech test, duration of deafness and etiology. Patients were split into four groups according to their duration of deafness (shorter duration of 10 years or less versus longer duration of more than 10 years) and etiology (inflammatory disease versus other causes). RESULTS: The median word reception score for the Monosyllables at 65 dB SPL were 43.75% (IQR: 29.38) and 67.50% (IQR: 25.63) at 80 dB SPL at 1 year following cochlear implantation. The median percentage score correct for the HSM sentence test was 80% (IQR: 62.95). Etiology of the reviewed patient cohort revealed that most frequent causes for deafness were sudden hearing losses and inflammatory etiologies, e.g. otitis media, labyrinthitis, meningitis, cholesteatoma or mumps. The duration of deafness was not significantly associated with poor speech perception outcome. A significant correlation was found for inflammatory diseases and duration of deafness of longer than 10 years. CONCLUSION: The etiology and duration of deafness are important factors for the estimated outcome in speech perception in SSD patients. Presented data reveal that an inflammatory disease leading to deafness in combination with a long duration of deafness (10 + years) lead to poorer speech perception outcomes.


Assuntos
Implante Coclear/métodos , Implantes Cocleares , Surdez/cirurgia , Percepção da Fala , Adulto , Idoso , Estudos de Coortes , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Fala , Fatores de Tempo , Resultado do Tratamento
SELEÇÃO DE REFERÊNCIAS
DETALHE DA PESQUISA