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1.
PLoS One ; 15(5): e0232421, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32369519

RESUMO

OBJECTIVES: This study aimed to provide a descriptive analysis of recent evidence available in the literature in relation to the efficacy of unilateral cochlear implantation in adults, the general findings of these studies, and the populations to which these findings apply. It also aimed to appraise the individual success rate and the magnitude of benefit following implantation. DESIGN: A scoping review was conducted to identify English-language, peer-reviewed journal articles published between 2000 and 2018 assessing the outcomes of cochlear implantation in adults who received their first cochlear implant from 2000 onwards. To be included, studies had to report speech perception or self-reported measures of listening or quality of life at least three months after implantation. Systematic searches were conducted in Medline, Embase, Web of Science and Google Scholar. A two-stage screening approach was used, with seven reviewers independently screening titles and abstracts against inclusion criteria and three from this group further reviewing full-texts. A data charting form was developed and trialled, with 10% of the study data extracted in duplicate to compare results and further refine the form. Data relevant for efficacy analyses were extracted from studies with sample sizes of at least 10 participants. RESULTS: A total of 4182 abstracts were screened against inclusion criteria, and of these, 603 full-texts were further screened. After exclusion of non-eligible articles, 201 articles were included in the first part of this scoping review. The majority of these articles were case series or comparative studies without a concurrent group, and had small sample sizes. Data synthesis conducted with the 102 articles with more than 10 participants highlighted that the average word perception ability improved from 8.2% to 53.9% after implantation. Self-reported benefit improved by 21.5 percentage points. At the individual level, 82.0% of adults with postlingual hearing loss and 53.4% of adults with prelingual hearing loss improved their speech perception ability by 15 percentage points or more. A small proportion had poorer ability after implantation or had stopped using the cochlear implant. CONCLUSIONS: Despite broad inconsistencies in measurement, research design, and reporting across articles, it is evident that cochlear implantation is beneficial to the majority of adults of any age who have limited aided speech perception abilities. While many adults with severe-to-profound hearing loss may also have poor speech perception abilities with hearing aids, the validity of using hearing loss severity as a criterion for cochlear implantation has not been demonstrated. Clinical and research recommendations derived from this review are provided.


Assuntos
Implante Coclear , Adulto , Implantes Cocleares , Feminino , Perda Auditiva/fisiopatologia , Perda Auditiva/psicologia , Perda Auditiva/cirurgia , Humanos , Masculino , Pessoa de Meia-Idade , Qualidade de Vida , Autorrelato , Percepção da Fala , Resultado do Tratamento
2.
Orv Hetil ; 161(19): 780-788, 2020 05.
Artigo em Húngaro | MEDLINE | ID: mdl-32365050

RESUMO

Otosclerosis is a human-specific ear disease characterised by complex bone-remodelling with multifactorial aetiology. It affects the bony labyrinth capsule and consequently fixates the stapes to the oval window rim. The fixation of the ossicular chain leads to a decrease in the middle ear's acoustic impedance-fitting and amplifier function that leads to conductive hearing loss. The process is progressive and when it involves the inner ear structures, it deteriorates the sensorineural function as well. The course of the illness can be prevented or delayed if hearing reconstructive surgery is performed on time. The development of stapes surgery spans the 20th century, and despite the major surgical steps - laid down by Shea and Marquet in the 1960s - are quite conservative, fine adjustments are still being made mainly due to technical progress. Several studies confirm that stapedotomy remained the first-to-offer therapeutic option in otosclerosis. With an adequate surgical technique, significant improvement can be achieved in the air conduction threshold, the air-bone gap may be minimalized or ceased over the speech frequencies, which significantly improves the quality of life of the patients. In this quest, we reviewed the Hungarian and the international literature as well in context with otosclerosis, with special attention to the newest methods in diagnostics and treatment management. Orv Hetil. 2020; 161(19): 780-788.


Assuntos
Perda Auditiva/cirurgia , Prótese Ossicular , Otosclerose/cirurgia , Cirurgia do Estribo/métodos , Condução Óssea/fisiologia , Perda Auditiva/etiologia , Perda Auditiva Condutiva , Humanos , Otosclerose/complicações , Otosclerose/diagnóstico , Qualidade de Vida , Estudos Retrospectivos , Resultado do Tratamento
3.
J Laryngol Otol ; 134(5): 398-403, 2020 May.
Artigo em Inglês | MEDLINE | ID: mdl-32308176

RESUMO

OBJECTIVES: To evaluate the surgical techniques, approaches, audiological outcomes and complications of endoscopic stapes surgery. METHODS: Systematic searches of the literature were performed in PubMed, Web of Science and Scopus databases, to identify studies of patients who underwent stapes surgery using endoscopic approaches and studies reporting objective post-operative hearing outcomes. The following information was extracted: surgery duration, complications, surgical technique and audiometric results. RESULTS: Fourteen studies were selected for appraisal, which included a total of 282 ears subjected to endoscopic stapes surgery. Endoscopic stapes surgery seems to provide adequate visualisation of the middle-ear structures, thereby allowing less invasive surgery and potentially equivalent audiological outcomes as compared with a traditional microscopic approach. Other advantages of endoscopic stapes surgery include decreased surgery time, a reduced need for drilling, and auditory results comparable to those of microscopic techniques. CONCLUSION: Studies have shown that endoscopic stapes surgery has similar surgical and functional advantages as compared with microscopic surgery.


Assuntos
Endoscopia/métodos , Microcirurgia/métodos , Cirurgia do Estribo/métodos , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Criança , Feminino , Perda Auditiva/complicações , Perda Auditiva/cirurgia , Humanos , Masculino , Pessoa de Meia-Idade , Duração da Cirurgia , Otosclerose/complicações , Otosclerose/cirurgia , Complicações Pós-Operatórias/etiologia , Resultado do Tratamento , Adulto Jovem
5.
Br J Radiol ; 93(1109): 20190741, 2020 May 01.
Artigo em Inglês | MEDLINE | ID: mdl-31944820

RESUMO

Active middle ear implants augment sound waves and directly stimulate the middle ear structures. The most frequently utilised active middle ear implant is the Vibrant Soundbridge TM (VSB).CT plays a vital role in appropriate patient selection and surgical planning of active middle ear implant surgery. The VSB TM offers a number of options for implant placement. The ideal location is influenced by the patient's middle ear and mastoid anatomy as well as the type and severity of the hearing loss. CT provides important information on the surgical access to the middle ear and helps determine the most appropriate implant site by assessing the adjacent middle ear anatomy and the continuity of the ossicular chain. Post-operative active middle ear implant imaging may be indicated in the setting of poor auditory outcomes and when revision surgery is being considered so as to assess for suboptimal implant placement or migration.This pictorial review will describe the VSB TM middle ear device and explain the role of imaging in both the pre-operative and post-operative settings.


Assuntos
Orelha Média/cirurgia , Perda Auditiva/cirurgia , Prótese Ossicular , Adulto , Lista de Checagem , Orelha Média/diagnóstico por imagem , Humanos , Planejamento de Assistência ao Paciente , Cuidados Pós-Operatórios/métodos , Cuidados Pré-Operatórios/métodos , Desenho de Prótese , Som , Tomografia Computadorizada por Raios X , Vibração
6.
Ann Otol Rhinol Laryngol ; 129(4): 380-387, 2020 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-31771342

RESUMO

PURPOSE: To compare intra- and postoperative outcomes between the standard linear incision with tissue preservation and the Minimally Invasive Ponto Surgery (MIPS). STUDY DESIGN: A non-randomized retrospective cohort series. METHODS: Medical files were reviewed of adult and pediatric bone anchored hearing implant recipients. Extracted outcomes included patient characteristics, implant survival, operative time, anesthesia use, intra and postoperative complications, soft tissue tolerability assessed by the Holger's classification, and implant stability assessed by the Resonance Frequency Analysis (RFA). Outcomes were compared between two surgeries. RESULTS: A total of 59 implants were placed (21 MIPS; 38 linear). Conductive hearing loss was the most common etiology for implantation. Surgery was conducted under local anesthesia in 67% of MIPS patients and 16% of linear patients. No intraoperative complications were reported for both surgical approaches and no implants were lost. Patients undergoing implantation via the MIPS approach displayed less skin reaction postoperatively, however this was not significant (P = .2848). The most common Holgers score for both groups was grade 1. The median and mean surgical duration for the MIPS group was statistically lower than the linear group (P = .0001). Implant stability measured by the RFA implant stability quotient was greater in the MIPS cohort. CONCLUSION: The MIPS approach seems either similar or superior to the linear approach in all perioperative outcomes evaluated. Outcomes such as surgical duration, anesthesia choice and implant stability measurements support implantation through the MIPS approach for patients meeting eligibility criteria.


Assuntos
Prótese Ancorada no Osso , Perda Auditiva , Complicações Pós-Operatórias , Implantação de Prótese , Adulto , Anestesia/métodos , Anestesia/estatística & dados numéricos , Canadá/epidemiologia , Criança , Feminino , Perda Auditiva/diagnóstico , Perda Auditiva/etiologia , Perda Auditiva/cirurgia , Testes Auditivos/métodos , Testes Auditivos/estatística & dados numéricos , Humanos , Masculino , Procedimentos Cirúrgicos Minimamente Invasivos/efeitos adversos , Procedimentos Cirúrgicos Minimamente Invasivos/métodos , Duração da Cirurgia , Avaliação de Processos e Resultados em Cuidados de Saúde , Complicações Pós-Operatórias/diagnóstico , Complicações Pós-Operatórias/epidemiologia , Complicações Pós-Operatórias/etiologia , Falha de Prótese , Implantação de Prótese/efeitos adversos , Implantação de Prótese/métodos , Retenção da Prótese/métodos , Retenção da Prótese/estatística & dados numéricos , Estudos Retrospectivos
7.
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
8.
Otolaryngol Clin North Am ; 53(1): 103-113, 2020 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-31648821

RESUMO

Auditory brainstem implants (ABIs) stimulate the auditory system at the cochlear nucleus, bypassing the peripheral auditory system including the auditory nerve. They are used in patients who are not cochlear implant candidates. Current criteria for use in the United States are neurofibromatosis type 2 patients 12 years or older undergoing first- or second-side vestibular schwannoma removal. However, there are other nontumor conditions in which patients may benefit from an ABI, such as bilateral cochlear nerve aplasia and severe cochlear malformation not amendable to cochlear implantation. Recent experience with ABI in the pediatric population demonstrates good safety profile and encouraging results.


Assuntos
Implante Auditivo de Tronco Encefálico/métodos , Implantes Auditivos de Tronco Encefálico , Neoplasias da Orelha/cirurgia , Perda Auditiva/cirurgia , Neurofibromatose 2/cirurgia , Criança , Nervo Coclear , Humanos , Seleção de Pacientes , Percepção da Fala , Resultado do Tratamento
9.
J Int Adv Otol ; 15(3): 368-372, 2019 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-31846913

RESUMO

OBJECTIVES: Differential sensitivity of intensity is known to be important for the perception of the relative distance of sounds in the environment, emotions of speakers, and localize sounds. However, a few features in listening devices, such as cochlear implants, used by individuals with hearing loss alter the output intensity heard by them. This makes soft sounds loud and loud sounds soft. Hence, the aim of the present study was to compare the intensity discrimination of children using cochlear implants with that of typically developing children. MATERIALS AND METHODS: Intensity discrimination of 30 children (15 using cochlear implants and 15 typically developing children) was obtained for three warble tones (500 Hz, 1000 Hz, and 4000 Hz) and three vowels (/a/, /i/, and /u/). The responses of the two participant groups, obtained using a 3-alternative forced-choice technique, were compared. RESULTS: Children using cochlear implants performed significantly poorer than typically developing children for the 4000 Hz warble tone and for the vowels /a/ and /u/. However, there was no significant difference for the remaining stimuli. CONCLUSION: The study indicated that the intensity discrimination threshold varies as a function of the frequency of the signals in children using cochlear implants. Intensity discrimination for high-frequency tones was significantly poorer for typically developing children, but not for low-frequency tones. In contrast, children using cochlear implants performed similarly to typically developing children for the high-frequency vowel but not for the mid- and low-frequency vowel.


Assuntos
Implante Coclear , Perda Auditiva/fisiopatologia , Audição , Localização de Som , Percepção da Fala , Adolescente , Criança , Desenvolvimento Infantil , Implantes Cocleares , Feminino , Perda Auditiva/cirurgia , Humanos , Masculino , Período Pós-Operatório
10.
PLoS One ; 14(9): e0223121, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31557251

RESUMO

INTRODUCTION: In cases with residual-hearing (RH) loss after cochlear implantation, a safe method is needed to provide full spectral resolution and as much auditory information as possible without implant replacement. Aim of this study was to prove the feasibility of accessing a partially inserted cochlear-implant-electrode for complete insertion to its maximum length through the external ear canal using a transcanal approach. METHODS: Two CI electrodes were customized with 18 stimulating channels. The electrode design enables the use of 12 active channels available for electrical stimulation inside the cochlea both after partial and full insertion. 10 CI electrodes were implanted in 10 fresh human cadaveric temporal bones. After initial partial insertion by posterior tympanotomy, the electrode was inserted to its maximum length via a transcanal approach. Radiographs and CT scans were performed to confirm the electrode position. The electrodes were investigated via x-ray after removal. RESULTS: X-ray and CT-scans confirmed the electrode prototypes covering an angular insertion depth between 236° to 307° after initial insertion. Accessing the electrode in the middle ear space was feasible and insertion to its full length was successful. Post-insertion CT confirmed insertion of the 28mm and 31.5mm electrode arrays covering an angular insertion depth between 360° and 540° respectively. No tip foldovers were detected. CONCLUSION: This study confirms the feasibility of extending the electrode insertion to its maximum insertion length using a transcanal approach in temporal bone specimens. This constitutes a second stage procedure on demand in EAS-surgery. This may be beneficial for EAS-patients providing electrical stimulation beyond the basal turn of the cochlea once the functional residual hearing is lost, without replacing the entire CI.


Assuntos
Estimulação Acústica/métodos , Implante Coclear/métodos , Implantes Cocleares , Terapia por Estimulação Elétrica/métodos , Eletrodos Implantados , Perda Auditiva/cirurgia , Estimulação Acústica/instrumentação , Cóclea/diagnóstico por imagem , Cóclea/cirurgia , Implante Coclear/instrumentação , Terapia por Estimulação Elétrica/instrumentação , Desenho de Equipamento , Estudos de Viabilidade , Humanos , Tomografia Computadorizada por Raios X
11.
Int J Pediatr Otorhinolaryngol ; 127: 109669, 2019 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-31494374

RESUMO

OBJECTIVE: It has been suggested that children with higher degree of hearing loss may show more severe externalizing (e.g., aggression) and internalizing (e.g., depression and anxiety) behavioral problems compared to that of their normally hearing peers. The purpose of this study was to investigate the influence of sound amplification through cochlear implants (CIs) on aggressive behaviors in Persian children. METHODS: During a prospective study design, 72 children (40 girls, 32 boys) who underwent unilateral implantation and 72 (40 girls, 32 boys) age-matched normally hearing children (control group) participated. All CI children had age of <4 years at the time of implantation. The Aggression Scale for Preschoolers (ASFP) was utilized to measure various types of aggression including verbal aggression, physical aggression, relational aggression, and impulsive anger. The speech performance of children was also evaluated using Speech Intelligibility Rating (SIR). The ASFP and SIR measurements were conducted at the pre-implantation phase and at 6, 12, and 18 months post-implantation period. RESULTS: A repeated measures analysis of variance showed significant reduction in ASFP scores from "pre-operation" to "post-operative" conditions in CI group. However, aggression level in CI recipients were significantly higher than children in control group. In the analyses of ASFP subscales, we found a reduction and a consequent improvement in verbal aggression, physical aggression and impulsive anger. However, no significant difference was found in relational aggression across various time intervals. Furthermore, children who received CI before 2 years old exhibited better aggression level than children who received their devices at later ages. The significantly negative correlation (r = -0.76, p < 0.001) was found between the SIR and ASFP scores, so that lower speech intelligibity ability scores were associated with more aggressive behavior problems. CONCLUSION: This study suggests that young children with noticeable degree of hearing loss may experience higher level of aggression compared to normally hearing peers. However, when they undergo early implantation and attend at regular post-operative rehabilitation programs, their aggression status will improve seriously.


Assuntos
Agressão , Comportamento Infantil , Implante Coclear , Perda Auditiva/psicologia , Perda Auditiva/cirurgia , Ira , Estudos de Casos e Controles , Pré-Escolar , Implantes Cocleares , Feminino , Humanos , Lactente , Recém-Nascido , Masculino , Estudos Prospectivos , Escalas de Graduação Psiquiátrica , Inteligibilidade da Fala
12.
Int. arch. otorhinolaryngol. (Impr.) ; 23(3): 262-266, July-Sept. 2019. tab, graf
Artigo em Inglês | LILACS | ID: biblio-1040033

RESUMO

Abstract Introduction Chronic otitis media is a widely prevalent condition in developing countries and is a cause of correctable hearing loss. The most frequent ossicular chain defect found during surgery for chronic otitis media has been a discontinuity of the incudostapedial joint. This study observes the effect of incudostapedial reconstruction using conchal cartilage on the hearing of the patient. Objectives To evaluate improvement in hearing by incudostapedial reconstruction using conchal cartilage interposition graft in tympanoplasty and to identify the independent factors associated with erosion of the long process of incus among patients with chronic suppurative otitis media tubotympanic type. Methods This study was conducted in the department of ear, nose and throat (ENT) amongst 22 patients with tubotympanic-type chronic suppurative otitis media who were found to have erosion of the long process during tympanoplasty. These patients underwent incudostapedial reconstruction using conchal cartilage. Their hearing was again reassessed at 12 weeks postsurgery, and the changes were observed. Results A statistically significant improvement in air conduction by 15.14 dB was found after undergoing incudostapedial reconstruction using conchal cartilage (p < 0.001). There was no statistically significant change in bone conduction (p value > 0.05). A total of 59.1% of patients in the study had an improvement in hearing ranging from11 to 20 dB. It was also found that 50% of the patients had a postoperative hearing of 10 to 20 dB. Conclusion Conchal cartilage interposition graft effectively improved hearing when used for the reconstruction of the incudostapedial joint during tympanoplasty in patients of chronic suppurative otitis media.


Assuntos
Humanos , Masculino , Feminino , Adulto , Otite Média/cirurgia , Cartilagem da Orelha/transplante , Bigorna/cirurgia , Estribo/transplante , Timpanoplastia , Doença Crônica , Resultado do Tratamento , Estudos Controlados Antes e Depois , Perda Auditiva/cirurgia
13.
Otol Neurotol ; 40(8): e787-e795, 2019 09.
Artigo em Inglês | MEDLINE | ID: mdl-31415481

RESUMO

OBJECTIVE: To evaluate the hearing outcomes of cochlear implantation in different age groups by using data collected in the HEARRING registry. METHODS: A multicenter study. Data of 146 patients were collected in a HEARRING registry. Patients were divided into three different age groups; ≤ 55 years old (age group 1, n = 66), 56 to 69 years old (age group 2, n = 45), and ≥ 70 years old (age group 3, n = 35). Speech in quiet (SPIQ), speech in noise (SPIN), and hearing implant sound quality index (HISQUI19) scores were evaluated for the different age groups at different test moments (preoperatively, 3, 6, 12, and 24 mo after first fitting). RESULTS: A statistically significant difference (p < 0.01) was found between preoperative scores and the scores on all the follow-up moments across all age groups. For SPIQ and SPIN, none of the time points showed a statistically significant age effect (p = 0.88 and p = 0.89). For HISQUI19 scores, a statistically significant age effect was found at 12 months after first fitting. The oldest age group scored significantly lower on the HISQUI19 compared with the youngest age group. CONCLUSION: Hearing outcomes of adult cochlear implant users of different age groups were evaluated. The SPIQ and SPIN tests showed no significant differences between the different age groups. Nevertheless, the youngest group scored significantly better on self -perceived benefit (HISQUI19) with a cochlear implant compared with the oldest age group.Further research is needed to receive more insight into cochlear implantation in the elderly and its implications on rehabilitating and supporting this expanding older population.


Assuntos
Implante Coclear , Implantes Cocleares , Perda Auditiva/cirurgia , Resultado do Tratamento , Adulto , Fatores Etários , Idoso , Feminino , Audição , Humanos , Masculino , Pessoa de Meia-Idade , Sistema de Registros , Percepção da Fala , Adulto Jovem
14.
PLoS One ; 14(8): e0220543, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31374092

RESUMO

To demonstrate the feasibility of robotic middle ear access in a clinical setting, nine adult patients with severe-to-profound hearing loss indicated for cochlear implantation were included in this clinical trial. A keyhole access tunnel to the tympanic cavity and targeting the round window was planned based on preoperatively acquired computed tomography image data and robotically drilled to the level of the facial recess. Intraoperative imaging was performed to confirm sufficient distance of the drilling trajectory to relevant anatomy. Robotic drilling continued toward the round window. The cochlear access was manually created by the surgeon. Electrode arrays were inserted through the keyhole tunnel under microscopic supervision via a tympanomeatal flap. All patients were successfully implanted with a cochlear implant. In 9 of 9 patients the robotic drilling was planned and performed to the level of the facial recess. In 3 patients, the procedure was reverted to a conventional approach for safety reasons. No change in facial nerve function compared to baseline measurements was observed. Robotic keyhole access for cochlear implantation is feasible. Further improvements to workflow complexity, duration of surgery, and usability including safety assessments are required to enable wider adoption of the procedure.


Assuntos
Cóclea/cirurgia , Implante Coclear/métodos , Implantes Cocleares , Perda Auditiva/cirurgia , Procedimentos Cirúrgicos Robóticos/métodos , Adulto , Idoso , Estudos de Viabilidade , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Resultado do Tratamento
15.
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
16.
Eur Arch Otorhinolaryngol ; 276(11): 3067-3072, 2019 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-31451899

RESUMO

PURPOSE: To investigate skin-related postoperative outcomes following a tissue preservation technique in percutaneous hydroxyapatite-coated bone-anchored hearing aid (BAHA) abutment implantation. METHODS: A retrospective medical records review of adult patients, who underwent single-stage BAHA implantation between July 2013 and November 2017 at a tertiary centre was conducted. Surgical procedures were performed by a single surgeon using a linear incision soft tissue preservation technique. Patients were reviewed at 1 week, 4 weeks, 3 months, 6 months, and annually postoperatively and soft tissue reactions were graded using Holger's score RESULTS: There were 102 patients included with a slight female preponderance (female:male 56:46). There were 586 follow-up episodes during the study period. From the recorded follow-up episodes, Holger's scores were documented as follows: Holger score 0 (89%); 1 (7%); 2 (2%); 3 (1.9%). Three patients (3%) required peri-abutment soft tissue excision (Holger 3) and insertion of longer abutments. One patient (1%) reported atraumatic implant loss. The BAHA was re-implanted in two patients (2%) due to traumatic dislodgement. There was a statistically significant association (p = 0.009) when the mean time to minor skin complications was compared with mean time to a significant skin reaction. CONCLUSION: Tissue preservation technique is the procedure of choice for BAHA abutment implant surgery. It confers excellent soft tissue outcomes and an excellent implant survival rate.


Assuntos
Durapatita/uso terapêutico , Auxiliares de Audição , Complicações Pós-Operatórias/prevenção & controle , Implantação de Prótese , Dermatopatias , Pele , Materiais Biocompatíveis/uso terapêutico , Prótese Ancorada no Osso , Materiais Revestidos Biocompatíveis/uso terapêutico , Feminino , Perda Auditiva/cirurgia , Humanos , Masculino , Pessoa de Meia-Idade , Tratamentos com Preservação do Órgão/efeitos adversos , Tratamentos com Preservação do Órgão/métodos , Osseointegração , Implantação de Prótese/efeitos adversos , Implantação de Prótese/métodos , Reoperação/estatística & dados numéricos , Estudos Retrospectivos , Dermatopatias/etiologia , Dermatopatias/prevenção & controle
17.
Gait Posture ; 74: 40-44, 2019 10.
Artigo em Inglês | MEDLINE | ID: mdl-31442821

RESUMO

BACKGROUND: Cochlear implantation (CI) procedure carries the potential risk for vestibular system insult or stimulation with resultant dysfunction due to its proximity to the cochlea. The vestibular system plays an essential role in crucial tasks such as postural control, gaze stabilization and spatial orientation. RESEARCH QUESTION: How does standard cochlear implantation influence postural stability in patients with hearing loss? METHODS: The study included 21 individuals (age 51 ± 18 years) qualified to undergo CI due to severe or profound hearing loss. Participants were qualified for both groups by a physician based on an interview, an otoneurological examination and vestibular tests. The first group included patients without vestibular dysfunction, whereas the other group consisted of persons with vestibular dysfunction. The research methodology included medical examinations, anthropometric measurements and stabilometry on the Biodex Balance System SD (BBS) platform. The examinations were carried out twice, i.e. prior to and 3 months post implantation. The recorded data was compared between the first and the second examination using a non-parametric Wilcoxon test. The analysis of variance (ANOVA) and Tukey's post-hoc HSD unequal sample sizes were performed for patients with and without vestibular dysfunction. RESULTS AND SIGNIFICANCE: Study showed that 52.4% of the participants obtained results within the norm, while 47.6% scored below it. The comparison of stability indices of the examined individuals, with and without vestibular dysfunction, did not reveal statistically significant differences. The only difference was the anterior-posterior stability index assessed in static conditions. Three months after the implantation, no changes in the majority of indices were noted, with the exception of anterior-posterior stability index, which improved following the implantation. CI does not affect postural stability changes in the study participants.


Assuntos
Implante Coclear/efeitos adversos , Implantes Cocleares/efeitos adversos , Perda Auditiva , Equilíbrio Postural/fisiologia , Adulto , Idoso , Análise de Variância , Feminino , Perda Auditiva/fisiopatologia , Perda Auditiva/cirurgia , Humanos , Masculino , Pessoa de Meia-Idade , Vestíbulo do Labirinto/lesões
18.
Int Tinnitus J ; 23(1): 37-41, 2019 01 01.
Artigo em Inglês | MEDLINE | ID: mdl-31469526

RESUMO

OBJECTIVE: Cochlear Implant (CI) users often suffer difficulties in perceiving speech in noisy environments that could be attributed to reduced Auditory Stream Segregation (ASS) ability. ASS is the process used to separate a complex sound into different perceptual streams. The evidence that CI listeners routinely experience stream segregation skill is limited and equivocal. The present study was aimed to investigate the effects of temporal cues on ASS performance in postlingually deaf listeners with CI. METHODS: Nineteen (age range: 28-64 years old) monaurally cochlear implanted listener participated in this study. They were presented with 30-s sequences of alternating stimuli in a repeating A-B-A-A-B-A…sequence, where "tone A" corresponds to a stimulus applied to electrode 11, and "tone B" to a stimulus on one of the other electrode. To investigate the effect of temporal cues on ASS, four different tone repetition times (TRTs) were utilized: 50, 100, 150, and 200 ms. Speech discrimination scores in noise were also recorded for every CI recipients. RESULTS: Only 6 (32%) CI users demonstrated ASS pattern similar to the normal hearing subjects, while the majority of the users (n=13) possessed poorer ASS skills. An analysis of variance showed a significant effect of electrode separation (p<0.001) and TRT (p=0.041), but there was no significant interaction between electrode separation and TRT variables. The best ASS performance was obtained when TRT was 200 ms, and there was no significant effect for other TRT conditions. Moderate, significant correlations between streaming and speech discrimination measurement in noise was also observed (r=0.62), with better stream segregation associated with better understanding of speech in noise. CONCLUSION: ASS is a contributing factor in the ability to perceive speech in background noise. The inability of some CI recipients to perform stream segregation may therefore contribute to their difficulties in noisy backgrounds. Furthermore, stream segregation ability is related to the tone repetition time between the sounds.


Assuntos
Percepção Auditiva/fisiologia , Implante Coclear/métodos , Implantes Cocleares/estatística & dados numéricos , Perda Auditiva/cirurgia , Percepção da Fala/fisiologia , Estimulação Acústica/métodos , Adulto , Análise de Variância , Implante Coclear/estatística & dados numéricos , Estudos de Coortes , Testes com Listas de Dissílabos/métodos , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Ruído/efeitos adversos , Satisfação do Paciente/estatística & dados numéricos , Estudos Prospectivos , Qualidade de Vida , Resultado do Tratamento
19.
Neurocirugía (Soc. Luso-Esp. Neurocir.) ; 30(4): 179-187, jul.-ago. 2019. ilus, tab
Artigo em Inglês | IBECS | ID: ibc-183584

RESUMO

Objective: The aims of our study were to evaluate tumour response in a series of patients with vestibular schwannoma (VS) treated with linear accelerator stereotactic radiosurgery (LINAC-RS), to describe the complications and to analyze the variables associated with the response to treatment. Material and methods: This retrospective descriptive study included 64 patients treated from 2010 to 2016 with a minimum follow-up of one year, excluding patients with neurofibromatosis. Clinical-radiological parameters were evaluated. The treatment was performed using LINAC-RS. The prescribed dose was 12Gy at 90% isodose. Results: The mean age at treatment was 53 years, 56% were women. Ninety-eight percent of the patients had hearing loss, 71% with grade III according to the Gardner-Robertson Classification. The mean volume at treatment was 2.92cc and the mean follow-up, 40.95 months. The overall therapeutic success was 90%, reaching 100% at 12 and 24 months, and 86% after 36 months of follow-up. The radiological result was significantly related to the initial tumour volume (p<0.037). In 20 patients there was evidence of transient tumour growth compatible with pseudoprogression. Acute complications were present in 37.5%, and transitory complications in 50%. Chronic complications were found in 20%, with 84% being permanent. The rate of acute complications was lower in patients with regression (p<0.016). Chronic complications were more frequent in the 41-60 year old age group (p<0.040). Conclusions: In our study, the overall tumour control was in accordance with other published series. The radiological result significantly related to the tumour volume at the commencement of treatment. The rate of acute complications was lower in patients with regression


Objetivo: Los objetivos del estudio fueron evaluar la respuesta tumoral en una serie de pacientes con schwannoma vestibular (SV) tratados con radiocirugía (RC) mediante acelerador lineal de electrones (LINAC), describir las complicaciones y analizar las variables relacionadas con la respuesta al tratamiento. Material y métodos: Estudio descriptivo retrospectivo de 64 pacientes tratados entre 2010-2016 con seguimiento mínimo de un año, excluyendo pacientes con neurofibromatosis. Se evaluaron parámetros clínico-radiológicos. El tratamiento se realizó mediante RC-LINAC. La dosis prescrita fue de 12Gy al 90% de isodosis. Resultados: La edad media al tratamiento fue de 53 años, 56% mujeres. El 98% de los pacientes presentaban hipoacusia, el 71% grado iii según la clasificación Gardner-Robertson. El volumen medio al tratamiento fue de 2,92cc, y la media de seguimiento 40,95 meses. El éxito terapéutico global fue del 90% siendo del 100% a los 12 y 24 meses y del 86% a partir de los 36 meses de seguimiento. El resultado radiológico se relacionaba con el volumen tumoral inicial (p<0,037). En 20 pacientes se evidenció un crecimiento tumoral transitorio compatible con seudoprogresión. El 37,5% tuvieron complicaciones agudas siendo transitorias el 50%. Se recogieron complicaciones crónicas en el 20%, siendo permanentes en el 84%. La tasa de complicaciones agudas era menor en pacientes con regresión (p<0,016). Las complicaciones crónicas fueron más frecuentes en el grupo de 41-60 años (p<0,040). Conclusiones: En nuestra serie, el control tumoral global obtenido es acorde con otras series publicadas. El resultado radiológico estaba relacionado con el volumen tumoral inicial al tratamiento. La tasa de complicaciones agudas fue menor en pacientes con regresión


Assuntos
Humanos , Masculino , Feminino , Adulto , Pessoa de Meia-Idade , Neuroma Acústico/radioterapia , Neuroma Acústico/cirurgia , Radiocirurgia/métodos , Aceleradores de Partículas , Estudos Retrospectivos , Perda Auditiva/radioterapia , Perda Auditiva/cirurgia
20.
Otol Neurotol ; 40(8): e769-e773, 2019 09.
Artigo em Inglês | MEDLINE | ID: mdl-31348128

RESUMO

OBJECTIVE: Examine postoperative speech perception outcomes in a large vestibular aqueduct syndrome (LVAS) patients at a major cochlear implantation center. STUDY DESIGN: Retrospective analysis of the Sydney Cochlear Implant Centre (SCIC) database and medical records from January 1994 to December 2015 was performed. SETTING: Tertiary referral center. PATIENTS: Patients with a diagnosis of LVAS who received a cochlear implant (CI). Only those with speech perception outcomes recorded at least 12 months post implant were included in our analysis. INTERVENTION(S): Therapeutic. MAIN OUTCOME MEASURE(S): Postoperative speech perception scores. RESULTS: Between 1994 and 2015, 176 adult and pediatric patients with a diagnosis of LVAS underwent cochlear implantation at SCIC. Postoperative Bamford-Kowal Bench (BKB) sentence test scores were obtained for 97 patients. The postoperative median BKB score was 93% with a lower quartile score of 85% and an upper quartile score of 98%. Smaller numbers were available for post-CI City University of New York (CUNY) and Consonant-Nucleus-Consonant (CNC) word scores yet similar excellent results were seen. CONCLUSIONS: Our study results suggest the CI should be considered when BKB scores have dropped to 85%. We suggest that rather than LVAS cases representing a challenge to cochlear implantation, they are amongst the best candidates for surgery, and should receive a CI at an earlier stage in hearing loss, when they have better speech perception. This allows stable hearing to be established earlier along with excellent speech perception outcomes.


Assuntos
Implante Coclear/métodos , Doenças do Labirinto/cirurgia , Percepção da Fala , Aqueduto Vestibular/cirurgia , Adulto , Criança , Implantes Cocleares , Surdez/etiologia , Surdez/cirurgia , Feminino , Perda Auditiva/cirurgia , Humanos , Doenças do Labirinto/complicações , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Síndrome , Resultado do Tratamento
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