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1.
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
2.
PLoS One ; 15(2): e0228498, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32017804

RESUMO

OBJECTIVES: Tinnitus is a common symptom among patients with hearing loss, and many studies have reported successful tinnitus suppression with hearing devices. Active middle ear implantation of the Vibrant Soundbridge (VSB) is a good alternative to existing hearing devices. This study evaluated the effects of VSB implantation on tinnitus and sought to identify the main audiological factor that affects tinnitus suppression. METHODS: The study participants were 16 adults who had tinnitus with sensorineural hearing loss, and who underwent VSB implantations. Pure-tone audiometry; word recognition test; tinnitus handicap inventory (THI); and visual analog scale (VAS) assessment of loudness, awareness, and annoyance were performed before and 12 months after surgery. Changes in hearing threshold, word recognition scores (WRS), THI scores, and VAS scores were analyzed. RESULTS: VAS scores for loudness (mean difference: 1.9, 95% CI: 0.6, 3.1), awareness (mean difference: 1.6, 95% CI: 0.4, 2.8), and annoyance (mean difference: 1.7, 95% CI: 0.7, 2.8) showed significant improvements from baseline to 12 months after surgery. In addition, THI scores showed a significant decrease (mean difference: 13.8, 95% CI: 2.9, 24.9). The average hearing threshold level, WRS, and most comfortable level (MCL) also showed significant improvements at 12 months after surgery (mean difference: 17.3, 95% CI: 13.3, 21.3; mean difference: -7.6, 95% CI: -15.1, -0.1; mean difference: 26.3, 95% CI: 22.9, 29.6, respectively). Among the aforementioned factors, changes in MCL were best correlated with those in THI scores (mean difference: 2.55, 95% CI: 0.90, 4.21). CONCLUSION: A VSB implant is beneficial to subjects with tinnitus accompanied by sensorineural hearing loss. The changes in THI scores best correlated with those in MCL. This improvement may represent a masking effect that contributes to tinnitus suppression in patients with VSB implants.


Assuntos
Perda Auditiva Neurossensorial/complicações , Perda Auditiva Neurossensorial/cirurgia , Zumbido/diagnóstico , Idoso , Audiometria de Tons Puros , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Prótese Ossicular , Índice de Gravidade de Doença , Zumbido/etiologia , Resultado do Tratamento , Escala Visual Analógica
3.
Otolaryngol Head Neck Surg ; 162(1): 95-101, 2020 01.
Artigo em Inglês | MEDLINE | ID: mdl-31570059

RESUMO

OBJECTIVE: To identify clinical variables associated with the decision to surgically discontinue bone-anchored hearing device function. STUDY DESIGN: Retrospective chart review. SETTING: Tertiary neurotology referral center. SUBJECTS AND METHODS: This study examines surgical interventions performed on existing bone-anchored hearing devices at a single institution from 2008 to 2018. Patient characteristics, indications for implantation, and complications prompting surgical intervention were assessed. RESULTS: Seventy-seven cases were included in this study. Among patients in the younger cohort (<37 years old), 100% (13 of 13) of those discontinuing their device had a contralateral normal-hearing ear. Conversely, 0% (0 of 14) of the younger patients with bilateral hearing loss surgically discontinued their devices. Within the older cohort (≥37 years old), female patients (P = .002) and those with an increased body mass index (P = .035) were more likely to surgically discontinue their devices. Multivariate analysis revealed that a contralateral normal-hearing ear (P = .001) and infection without soft tissue overgrowth of the abutment (P = .026) were the strongest predictors of device discontinuation, after adjusting for potential confounders. CONCLUSION: Surgical discontinuation is associated with several clinical variables. Targeted interventions that are viable alternatives to removal, such as device relocation, should be presented to younger patients with a contralateral normal-hearing ear who experience persistent complications. Patients with persistent infection in the absence of soft tissue overgrowth would especially benefit from enhanced counseling on proper hygiene.


Assuntos
Remoção de Dispositivo/métodos , Auxiliares de Audição/efeitos adversos , Perda Auditiva Neurossensorial/cirurgia , Implantação de Prótese/efeitos adversos , Infecções Relacionadas à Prótese/cirurgia , Reoperação/métodos , Adolescente , Adulto , Fatores Etários , Estudos de Coortes , Feminino , Seguimentos , Perda Auditiva Neurossensorial/diagnóstico , Humanos , Masculino , Pessoa de Meia-Idade , Análise Multivariada , Desenho de Prótese , Falha de Prótese , Implantação de Prótese/métodos , Estudos Retrospectivos , Medição de Risco , Fatores Sexuais , Centros de Atenção Terciária , Resultado do Tratamento
4.
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
5.
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
6.
J Int Adv Otol ; 15(3): 364-367, 2019 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-31846912

RESUMO

OBJECTIVES: The aim of the present study was to analyze the outcomes of cochlear implantation (CI) in patients with agenesis of the corpus callosum (CCA). A literature review and a retrospective analysis of our cochlear implant database were performed. MATERIALS AND METHODS: To the best of our knowledge, in the English literature, there was only one case reported with CCA who had undergone CI surgery. This case had Donnai-Barrow syndrome. In the Cukurova University School of Medicine Department of Otorhinolaryngology database, 5 of the 1317 patients who underwent CI surgery who had CCA were selected. The patients' demographic characteristics, operative findings, surgical outcomes, and additional disabilities were investigated. The patients' preoperative and postoperative Listening Progress Profile (LiP) and Meaningful Auditory Integration Scale (MAIS) tests were done to analyze the auditory performances. RESULTS: The participants of the study were 5 (0.38%) individuals (2 male and 3 female patients; ages 5.5, 7.5, 8, 9, and 12 years). Two of the patients had total agenesis, and the other three had partial agenesis of the CCA. In the histories of the patients, one patient had parental consanguinity, and one had febrile convulsion. No patient had an additional disability. None had experienced device failure. No patients were non-users or limited users of cochlear implants. Postoperative LiP and MAIS test scores were improved for all patients nearly as the patients without any deformity. They showed normal auditory performance in the analysis in their postoperative 48 months of follow-up. CONCLUSION: Patients who had CCA are good candidates for CI surgery.


Assuntos
Agenesia do Corpo Caloso/cirurgia , Implante Coclear , Surdez/cirurgia , Agenesia do Corpo Caloso/complicações , Criança , Pré-Escolar , Surdez/congênito , Feminino , Perda Auditiva Neurossensorial/congênito , Perda Auditiva Neurossensorial/cirurgia , Testes Auditivos , Hérnias Diafragmáticas Congênitas/cirurgia , Humanos , Desenvolvimento da Linguagem , Masculino , Miopia/congênito , Miopia/cirurgia , Proteinúria/congênito , Proteinúria/cirurgia , Erros Inatos do Transporte Tubular Renal/cirurgia , Estudos Retrospectivos , Resultado do Tratamento
7.
J Int Adv Otol ; 15(3): 454-458, 2019 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-31846928

RESUMO

Muckle-Wells syndrome (MWS), a subclass of cryopyrin-associated periodic syndrome (CAPS), sometimes includes complications of bilateral progressive sensorineural hearing loss. A 48-year-old woman had been diagnosed with pediatric rheumatic arthritis at aged 6 years; however, systematic therapy with prednisolone and methotrexate showed limited efficacy for her general fatigue and arthritic pain, and it never improved the hearing level. She underwent a cochlear implant surgery for progressive profound bilateral hearing loss. After 7 years of cochlear implant surgery, she was diagnosed with MWS by genetic tests. Interleukin (IL)-1ß monoclonal antibody therapy (canakinumab) improved general fatigue and arthritic pain but showed no effect on cochlear symptoms. Owing to successful cochlear implant surgery, she reacquired the hearing and communication function while being able to understand over 90% of monosyllables and words in the sound field of her daily life at 65 dB SPL for the next 13 years of her life. This suggests that peripheral cochlear damage induced by chronic inflammation contributes to the sensorineural hearing loss in cases with MWS, and that cochlear implantation can provide long-term hearing efficacy for patients with MWS with irreversible profound hearing loss.


Assuntos
Implante Coclear , Síndromes Periódicas Associadas à Criopirina/complicações , Perda Auditiva Neurossensorial/cirurgia , Cóclea/fisiopatologia , Feminino , Audição , Perda Auditiva Neurossensorial/congênito , Perda Auditiva Neurossensorial/fisiopatologia , Humanos , Pessoa de Meia-Idade , Período Pós-Operatório , Fatores de Tempo , Resultado do Tratamento
8.
Rev Chil Pediatr ; 90(4): 437-442, 2019 Aug.
Artigo em Inglês, Espanhol | MEDLINE | ID: mdl-31859717

RESUMO

INTRODUCTION: Bartter syndrome (BS) is a rare inherited tubulopathy that has two presentation forms, the first one is a severe form of antenatal onset (neonatal Bartter) and the second one is a later on set form during the first years of life (classic Bartter). In the antenatal form, it manifests with fetal polyuria, polyhydramnios of early and severe onset, premature delivery, and intrauterine growth restriction. In the postnatal stage, it presents recurrent episodes of dehydration and electrolyte im balance that can compromise the survival of the patient. OBJECTIVE: To report a clinical case of neo natal BS and a review of the literature. CLINICAL CASE: Premature newborn of 35 weeks of gestation with history of severe polyhydramnios diagnosed at 27 weeks of gestation, without apparent cause. From birth, the patient presented polyuria and hypokalemic metabolic alkalosis making a diagnosis of Neonatal Bartter Syndrome in the first week of life. Laboratory tests confirmed urinary electrolyte losses. The patient was treated with strict water balance and sodium and potassium supplementa tion, achieving weight and electrolyte imbalance stabilization. The patient remains in control in the nephrology unit, with potassium gluconate and sodium chloride supplementation. At the fourth month, ibuprofen was added as part of treatment. At the seventh month of life, renal ultrasound showed nephrocalcinosis. At one year of life, profound sensorineural hearing loss was observed re quiring a cochlear implant. CONCLUSION: The presence of severe polyhydramnios of early onset with no identified cause should lead to suspicion of neonatal BS which even when infrequent determines severe hydroelectrolytic alterations and should be treated early.


Assuntos
Síndrome de Bartter/diagnóstico , Poli-Hidrâmnios/diagnóstico , Adulto , Síndrome de Bartter/fisiopatologia , Síndrome de Bartter/terapia , Feminino , Perda Auditiva Neurossensorial/diagnóstico , Perda Auditiva Neurossensorial/cirurgia , Humanos , Ibuprofeno/administração & dosagem , Lactente , Recém-Nascido , Nefrocalcinose/diagnóstico , Nefrocalcinose/etiologia , Poli-Hidrâmnios/etiologia , Gravidez
9.
Ann Saudi Med ; 39(5): 350-353, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31580711

RESUMO

BACKGROUND: Congenital sensorineural hearing loss (SNHL) is a common disability in children. It can affect normal language development and educational achievement. Today, the time to cochlear implant is delayed for many children, which in turn delays intervention and impacts outcomes. Lack of knowledge and experience with congenital SNHL in the family are critical factors that can delay identification and intervention. OBJECTIVES: Compare treatment seeking behavior in families for a first and second congenitally deaf child. DESIGN: Analytical, cross-sectional using medical record data. SETTING: Ear specialist hospital in Riyadh. SUBJECTS AND METHODS: All patients who presented to the cochlear implant committee from March 2016 to March 2018 and met criteria were included in the study. Data on when the subjects presented to hospital and were approved for cochlear implant were retrieved from the patient files and through phone calls to the family. The age of first suspicion, audiological testing, diagnosis, hearing aid fitting, and the decision for cochlear implant were compared between the first and second child in families with multiple children with congenital SNHL. MAIN OUTCOME MEASURES: The timing difference between the first and second deaf child in seeking treatment. SAMPLE SIZE: 116 (58 pairs). RESULTS: The second child was suspected to have hearing loss 13.6 months earlier than the first child and presented to the cochlear implant committee for final decision 16.7 months earlier than his\her sibling. Differences in the mean ages at suspicion of hearing loss, presentation to the hospital for audiological evaluation, hearing aid fitting, diagnosis, and decision for cochlear implant by cochlear implant committee were statistically significant ( P<.001). CONCLUSION: Experience and knowledge has a major effect on early identification. We need to implement educational programs for the public to increase awareness of how to recognize a deaf child and what steps to take. LIMITATIONS: Single-centered. CONFLICT OF INTEREST: None.


Assuntos
Implante Coclear/estatística & dados numéricos , Perda Auditiva Neurossensorial/diagnóstico , Pais , Aceitação pelo Paciente de Cuidados de Saúde/estatística & dados numéricos , Fatores Etários , Pré-Escolar , Estudos Transversais , Feminino , Perda Auditiva Neurossensorial/congênito , Perda Auditiva Neurossensorial/cirurgia , Humanos , Lactente , Masculino , Arábia Saudita , Irmãos
10.
PLoS One ; 14(8): e0220439, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31415595

RESUMO

A cochlear implant is a small electronic device that provides a sense of sound for the user, which can be used unilaterally or bilaterally. Although there is advocacy for the benefits of binaural hearing, the high cost of cochlear implant raises the question of whether its additional benefits over the use of an acoustic hearing aid in the contralateral ear outweigh its costs. This cost-effectiveness analysis aimed to separately assess the cost-effectiveness of simultaneous and sequential bilateral cochlear implantations compared to bimodal hearing (use of unilateral cochlear implant combined with an acoustic hearing aid in the contralateral ear) in children with severe-to-profound sensorineural hearing loss in both ears from the Singapore healthcare payer perspective. Incremental quality-adjusted life year (QALYs) gained and costs associated with bilateral cochlear implants over the lifetime horizon were estimated based on a four-state Markov model. The analysis results showed that, at the 2017 mean cost, compared to bimodal hearing, patients receiving bilateral cochlear implants experienced more QALYs but incurred higher costs, resulting in an incremental cost-effectiveness ratio (ICER) of USD$60,607 per QALY gained for simultaneous bilateral cochlear implantation, and USD$81,782 per QALY gained for sequential bilateral cochlear implantation. The cost-effectiveness of bilateral cochlear implants is most sensitive to utility gain associated with second cochlear implant, and cost of bilateral cochlear implants. ICERs increased when the utility gain from bilateral cochlear implants decreased; ICERs exceeded USD$120,000 per QALY gained when the utility gain was halved from 0.03 to 0.015 in both simultaneous and sequential bilateral cochlear implantations. The choice of incremental utility gain associated with the second cochlear implant is an area of considerable uncertainty.


Assuntos
Implante Coclear/economia , Implantes Cocleares/economia , Análise Custo-Benefício , Perda Auditiva Neurossensorial/cirurgia , Modelos Teóricos , Criança , Implante Coclear/métodos , Custos de Cuidados de Saúde , Perda Auditiva Neurossensorial/economia , Humanos , Anos de Vida Ajustados por Qualidade de Vida , Singapura
11.
Eur Arch Otorhinolaryngol ; 276(11): 3089-3094, 2019 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-31463602

RESUMO

PURPOSE: To assess preoperative features that could predict the audiological outcome after cochlear implantation in the elderly, in terms of pure tone audiometry, speech audiometry, and speech perception performance. METHODS: All available records of patients with cochlear implants aged 65 or more at the time of their implantation at our Institution were reviewed (50 patients, mean age 70.76 ± 4.03 years), recording preoperative clinical features. Pure tone audiometry, speech audiometry, and speech perception performance 1 year after cochlear implant activation and fitting were used as outcome measures. RESULTS: No statistically significant association emerged between clinical features and pure tone audiometry. On univariate analysis, progressive sensorineural hearing loss of unknown origin was associated with a better outcome in terms of speech audiometry and speech perception performance (p = 0.035 and p = 0.033, respectively). On multivariate analysis, progressive sensorineural hearing loss retained its independent prognostic significance in terms of speech perception performance (p = 0.042). The discriminatory power of a two-variable panel (age and etiology of hearing loss) featured an AUC (ROC) of 0.738 (an acceptable discriminatory power according to the Hosmer-Lemeshow scale). CONCLUSIONS: A progressive sensorineural hearing loss of unknown origin was associated with a better outcome in terms of speech perception in the elderly in our case study. Further features that can predict audiological outcome achievable with cochlear implants in the elderly are desirable to perform adequate counselling and rehabilitation programs.


Assuntos
Audiometria de Tons Puros/métodos , Audiometria da Fala/métodos , Implante Coclear , Perda Auditiva Neurossensorial , Perda Auditiva , Idoso , Implante Coclear/efeitos adversos , Implante Coclear/métodos , Implante Coclear/estatística & dados numéricos , Feminino , Perda Auditiva/classificação , Perda Auditiva/diagnóstico , Perda Auditiva/fisiopatologia , Perda Auditiva/cirurgia , Perda Auditiva Neurossensorial/diagnóstico , Perda Auditiva Neurossensorial/fisiopatologia , Perda Auditiva Neurossensorial/cirurgia , Humanos , Masculino , Avaliação de Processos e Resultados em Cuidados de Saúde , Valor Preditivo dos Testes , Prognóstico , Percepção da Fala
12.
Orv Hetil ; 160(33): 1296-1303, 2019 Aug.
Artigo em Húngaro | MEDLINE | ID: mdl-31401862

RESUMO

Introduction: The success of cochlear implantation can be evaluated with audiological measurements and quality of life questionnaires. Aim: Our aim was to translate and introduce the Cochlear Implant Function Index (CIFI) test to analyze the physical, psychological and social state of our cochlear implant patients. Method: Between 01. 11. 2016 and 31. 05. 2018, 30 patients filled the questionnaire before and 6 and 12 months after the implantation. Results and conclusion: Results showed a remarkable improvement in the quality of life in several patients even after 6 months. Further improvements could be measured after 12 months. Orv Hetil. 2019; 160(33): 1296-1303.


Assuntos
Implante Coclear/psicologia , Implantes Cocleares/psicologia , Perda Auditiva Neurossensorial/cirurgia , Qualidade de Vida , Percepção da Fala , Implante Coclear/métodos , Implantes Cocleares/efeitos adversos , Testes Auditivos , Humanos , Hungria , Inquéritos e Questionários , Resultado do Tratamento
13.
Artigo em Chinês | MEDLINE | ID: mdl-31315354

RESUMO

Objective: To discuss the benefit of using transmastoid slotted labyrinthotomy approach (TSLA) and customized electrode for common cavity deformity (CCD) patients, and to evaluate the audiological outcomes. Methods: A retrospective analysis of the intraoperative monitoring data and postoperative auditory outcomes of 10 CCD cases who received cochlear implantation in Beijing Tongren Hospital,Capital Medical University from April 2016 to December 2017, was conducted using TSLA and customized electrod as a test group.At the same time, 10 cases of age and gender matched children with severe or severe sensorineural hearing loss and normal inner ear structures were recorded as a control group. Four questionnaires were collected from the two groupspre-operative, 6 months and 1 year after start-up. The Wilcoxon signed rank sum test was used to compare the scores of different time points. Rank sum test of two independent samples was used to compare the scores between different groups. Results: None of the patients exhibited CSF leakage or facial paralysis after operation. The average impedance of 8 CCD children in the experimental group was below 5 kΩ. The total extraction rate of auditory neural response telemetry (ART) of all stimulating electrodes was 55% (33/60), and the amplitude of the electricity induced complex action potential (ECAP) of electrodes at different positions ranged from 50.69 to 170.3 µV.The average surgical time of the TSLA group was 46.4 min, shorter than the traditional approach.There was significant difference between the scores of pre-operative, 6 months and 1 year after start-up for the TSLA group(categories of auditory performance,CAP: 2.0 (2.0,3.0) vs. 4.0 (3.8,4.0) , Z=-3.109, P=0.002; speech intelligibility rating,SIR: 2.0 (2.0,2.3) vs. 3.0 (2.8,4.0) , Z=-2.952, P=0.003; meaningful use of speech scale,MUSS: 4.0 (3.3,6.0) vs. 9.0 (6.0,11.8) , Z=-3.421, P=0.001; meaningful auditory integration scale, MAIS or infant-toddler and meaningful auditory integration scale, IT-MAIS: 5.5 (3.8,9.0) vs. 15.5 (10.8,18.5) , Z=-3.522, P=0.000 for the latter two).In addition, The scores of the TSLA group were significantly worse than the control group at 6 months and 1 year after start-up.The high-resolution CT scan showed good adhesion of the electrodes without displacementone week and one year after surgery. Conclusions: For CCD patients, TSLA and customized electrode is recommended due to lower surgical difficulty and post-operative risk, shortened surgical time; Intraoperative ART monitoring can be used to determine the integrity of the auditory pathway. Children with common cavity deformity have a longer period of auditory rehabilitation, and the individual differences in speech rehabilitation are significantly different, which is significantly worse than those with normal structure.


Assuntos
Implante Coclear/métodos , Orelha Interna/cirurgia , Perda Auditiva Neurossensorial/cirurgia , Pré-Escolar , Implante Coclear/reabilitação , Implantes Cocleares , Orelha Interna/fisiopatologia , Eletrodos Implantados , Perda Auditiva Neurossensorial/etiologia , Perda Auditiva Neurossensorial/reabilitação , Humanos , Lactente , Processo Mastoide/cirurgia , Monitorização Intraoperatória , Estudos Retrospectivos , Inteligibilidade da Fala , Percepção da Fala , Resultado do Tratamento
14.
Otol Neurotol ; 40(8): e782-e786, 2019 09.
Artigo em Inglês | MEDLINE | ID: mdl-31348130

RESUMO

OBJECTIVE: To document the case of a patient with bilateral enlarged vestibular aqueducts who experienced sensorineural hearing loss in the nonimplanted ear following unilateral cochlear implantation complicated by perilymph gusher requiring lumbar drain insertion and to highlight the need to counsel regarding the risk of potential hearing loss to the contralateral ear when preparing for cochlear implants in the setting of inner ear malformations. PATIENTS: One patient with bilateral enlarged vestibular aqueducts in a tertiary referral center. INTERVENTION(S): Cochlear implantation complicated by perilymph gusher requiring lumbar drain insertion. MAIN OUTCOME MEASURE(S): Bone conduction hearing thresholds, word recognition scores. RESULTS: The patient underwent unilateral cochlear implantation, which was complicated by a perilymphatic gusher and necessitated placement of an intraoperative lumbar drain. On postoperative day 1, the patient reported hearing loss in the opposite ear. The word recognition score in the contralateral ear dropped from 24% at preimplantation to 8% at 2-weeks postimplantation, and did not improve at 6 months postimplantation. Moreover, the bone conduction threshold at 1 kHz worsened from 20 dB preoperatively to no response at 75 dB (the limit of the testing equipment) at 2-weeks postoperatively and only partially improved to 40 dB at 6 months postimplantation. CONCLUSION: As patients with inner ear malformations potentially have direct high-pressure anatomical connections between the perilymphatic spaces and the cerebrospinal fluid, they are at risk of hearing loss in the nonimplanted ear during cochlear implantation. This case highlights the need for potential additional patient counseling regarding this risk in the nonimplanted ear.


Assuntos
Implante Coclear/efeitos adversos , Perda Auditiva Neurossensorial/cirurgia , Complicações Pós-Operatórias/etiologia , Aqueduto Vestibular/anormalidades , Implantes Cocleares , Feminino , Humanos , Pessoa de Meia-Idade , Perilinfa
15.
Eur Arch Otorhinolaryngol ; 276(10): 2775-2781, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-31342145

RESUMO

PURPOSE: The aim of this study was to assess the first outcomes of a fully implantable active middle ear device. METHODS: Retrospective observational nonrandomized group study. SETTINGS: Private hospital. Fifteen patients underwent device implantation between December 2014 and June 2017. The pre-operative and post-operative air conduction (AC) and bone conduction (BC) thresholds were evaluated. The functional gain, speech perception in silence and in noise, and localization abilities were also analyzed. RESULTS: Sixteen active middle ear implantations were performed. Post-operatively, the mean pure tone thresholds were 50.5 dB ( ± 12.64) for BC and 64.9 dB ( ± 15.36) for AC. No differences were found between the post-operative and pre-operative audiometric thresholds before activating the system (p > 0.05). Post-operatively, the mean thresholds in the free field after the device was activated were 46.8 dB, 45.75 dB, 42.6 dB, and 43.38 dB at 1, 3, 6, and 12 months, respectively. The global results of speech understanding in silence were 50.7 dB, 47.18 dB, 42 dB, and 42 dB for 1, 3, 6, and 12 months, respectively. Patients with mixed hearing loss had better results than those with sensorineural hearing loss. Speech discrimination in noise and localization was improved. CONCLUSIONS: Despite the small number of patients, our results confirmed that this fully implantable active middle ear device is a viable treatment for patients with moderate-to-severe sensorineural hearing loss who cannot or do not want to use traditional hearing aids for clinical or cosmetic reasons.


Assuntos
Implantes Cocleares , Orelha Média/cirurgia , Perda Auditiva Neurossensorial/cirurgia , Adulto , Idoso , Audiometria de Tons Puros , Audiometria da Fala , Limiar Auditivo , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Adulto Jovem
16.
Eur Arch Otorhinolaryngol ; 276(10): 2763-2768, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-31256245

RESUMO

OBJECTIVES: To share our experience in cochlear implanted patients with incomplete partition type I, to compare it with the literature results and to disclose difficulties facing cochlear implant teams dealing with these patients. MATERIALS AND METHODS: Clinical records of 1089 cochlear implant procedures in a cochlear implant center were reviewed and data of patients who had incomplete partition type I were enrolled in this study. Their auditory and speech performances were evaluated 3 years after the implantation. RESULTS: Eighteen cases (1.65%) had incomplete partition type I. Cerebrospinal fluid gusher was encountered during opening the cochlea in 15 patients (83.3%). There were no cases of persistent CSF leak or postoperative meningitis. In 61.1% of patients, some additional anomalies were found during the operation. Although in 55.6% of cases no electrically evoked compound action potential was detected even in long-term follow-up, all patients had satisfactory auditory and speech outcome. CONCLUSION: Cochlear implantation is a relatively safe and effective treatment for patients who have incomplete partition type I, even if the procedure may be somehow challenging.


Assuntos
Implante Coclear , Orelha Interna/anormalidades , Perda Auditiva Neurossensorial/cirurgia , Adolescente , Audiometria de Tons Puros , Criança , Pré-Escolar , Feminino , Perda Auditiva Neurossensorial/congênito , Humanos , Masculino , Inteligibilidade da Fala
17.
Otol Neurotol ; 40(5S Suppl 1): S2-S9, 2019 06.
Artigo em Inglês | MEDLINE | ID: mdl-31225816

RESUMO

OBJECTIVES: To develop a percentile ranking system driven by speech recognition data obtained from different groups of patients treated with a cochlear implant to serve as a tool to monitor the progress of these patients. STUDY DESIGN: Prospective study. SETTING: Tertiary referral center. PATIENTS: Diagnosed with a bilateral, profound sensorineural hearing loss treated with a unilateral cochlear implant. INTERVENTION: Diagnostic. MAIN OUTCOME MEASURE: Six different percentiles (p) were classified taking into account the correlation between speech recognition outcome scores and age at implantation, with reference to the onset of hearing loss. RESULTS: Four hundred sixteen prelingual patients were included. These subjects were divided into subgroups depending on age at implantation.Prelingual group, from the fifth year after implantation, p50 centered on the following percentages of correct words in each subgroup: 100, 94.6, 91.4, 91.0, 79.2, and 63.1% in children implanted under 12 months, 1, 2, 3, 4 to 6, 7 to 10 years, respectively. After a 12-year follow-up, a significant negative correlation between age at implantation and speech recognition was observed in both prelinguals (Rhos=-0.578, p<0.001). CONCLUSION: A percentile system was developed to monitor the postimplant progress of prelingual deaf implanted patients, with potential applications in patient follow-up and handling circumstances that may deteriorate results.


Assuntos
Implante Coclear , Perda Auditiva Bilateral/cirurgia , Perda Auditiva Neurossensorial/cirurgia , Percepção da Fala , Resultado do Tratamento , Criança , Pré-Escolar , Implante Coclear/métodos , Implantes Cocleares , Feminino , Humanos , Masculino , Pessoas com Deficiência Auditiva , Estudos Prospectivos
18.
Otol Neurotol ; 40(5S Suppl 1): S29-S37, 2019 06.
Artigo em Inglês | MEDLINE | ID: mdl-31225820

RESUMO

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


Assuntos
Audiometria de Resposta Evocada/métodos , Implante Coclear/métodos , Implantes Cocleares , Perda Auditiva Bilateral/cirurgia , Perda Auditiva Neurossensorial/cirurgia , Adulto , Austrália , Cóclea/cirurgia , Progressão da Doença , Feminino , Audição , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos , Resultado do Tratamento
19.
Otolaryngol Head Neck Surg ; 161(4): 658-665, 2019 10.
Artigo em Inglês | MEDLINE | ID: mdl-31060442

RESUMO

OBJECTIVE: Human otopathology following drill-out procedures for cochlear implantation (CI) in cases with labyrinthitis ossificans (LO) has not been previously described. This study uses the high sensitivity of histopathology to (1) evaluate surgical drill-out technique with associated intracochlear findings and (2) quantify spiral ganglion neuron populations in a series of patients with LO who underwent CI. STUDY DESIGN: Retrospective otopathology study. SETTING: Otopathology laboratory. SUBJECTS AND METHODS: Temporal bone (TB) specimens from cases with evidence of preoperative intracochlear fibroossification that required a drill-out procedure for CI electrode array insertion were included. All cases were histopathologically evaluated and 3-dimensional reconstructions of the cochleae were performed to interpret drilling paths and electrode trajectories. RESULTS: Five TB specimens were identified, of which 4 underwent drill-out of the basal turn of the cochlea and 1 underwent a radical cochlear drill-out. In multiple TBs, drilling was imprecise with resultant damage to essential structures. Two TBs showed injury to the modiolus, which was associated with substantially decreased or even absent neuronal populations within these areas. In addition, 2 cases with inadequate drill-out or extensive LO of the basal turn resulted in extracochlear placement of electrode arrays into the vestibule due to persistent obstruction within the basal turn. CONCLUSION: Otopathology highlights the challenges of drill-out procedures in cases of LO. Imprecise drilling paths, due to distortion of normal cochlear anatomy, risk injury to the modiolus and adjacent neurons as well as extracochlear placement of electrode arrays, both of which may contribute to poorer hearing outcomes.


Assuntos
Cóclea/patologia , Implante Coclear/efeitos adversos , Labirintite/cirurgia , Osso Temporal/patologia , Idoso de 80 Anos ou mais , Criança , Cóclea/anatomia & histologia , Cóclea/cirurgia , Implante Coclear/métodos , Perda Auditiva Neurossensorial/cirurgia , Humanos , Labirintite/patologia , Pessoa de Meia-Idade , Estudos Retrospectivos , Gânglio Espiral da Cóclea/patologia , Osso Temporal/cirurgia , Resultado do Tratamento
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