Surgical and audiological results of bone-anchored hearing aids: comparison of two surgical techniques.

INTRODUCTION: The bone-anchored hearing system has become the most viable treatment option for subjects with conductive or mixed hearing loss, who are unable to benefit from conventional hearing aids or middle ear surgery. OBJECTIVE: To compare the surgical and audiological outcomes between the minimally-invasive Ponto surgery and a linear incision with soft tissue preservation techniques in bone-anchored hearing system recipients. METHODS: A retrospective study was carried out from January 2017 to June 2018. Forty-two adult patients eligible for unilateral bone-anchored hearing system surgery with the Ponto system were included in the study. The implant and abutment lengths used varied from 3 to 4mm and from 6 to 14mm, according to the bone and skin thickness of the participants, respectively. RESULTS: Twenty-two surgeries were performed using the minimally invasive Ponto surgery technique (52.4%) and 20 (47.6%) using the linear incision. The mean age of the subjects implanted with minimally invasive Ponto surgery and linear incision techniques were 42.0 and 33.3 years old, respectively. Ten male (45,5%) and 14 (70%) female patients were implanted using minimally invasive Ponto surgery and the linear incision techniques, respectively. There were no differences between pure tone audiometric thresholds and monosyllabic word recognition scores of the subjects, when comparing both surgical techniques. The minimally invasive Ponto surgery technique significantly reduced the surgical time compared to the linear incision technique. There were no differences between both surgical techniques for skin-related complications; (Holgers 3 and 4) which occurred in 18.8% for MIPS and in 25% for linear incision. Subjects included in the minimally invasive Ponto surgery technique group showed a superior cosmetic outcome, with no surgical scar or additional sutures. CONCLUSION: The surgical and audiological outcomes were satisfactory and were not correlated to the surgical technique selected in all subjects. When compared to the linear incision, the minimally invasive Ponto surgery technique showed reduced surgical time and superior esthetic outcomes in the postoperative follow-up.

Surgical and audiological results of bone-anchored hearing aids: comparison of two surgical techniques / Resultados cirúrgicos e audiológicos de próteses ancoradas no osso: comparação de duas técnicas cirúrgicas

Abstract Introduction: The bone-anchored hearing system has become the most viable treatment option for subjects with conductive or mixed hearing loss, who are unable to benefit from conventional hearing aids or middle ear surgery. Objective: To compare the surgical and audiological outcomes between the minimally-invasive Ponto surgery and a linear incision with soft tissue preservation techniques in bone-anchored hearing system recipients. Methods: A retrospective study was carried out from January 2017 to June 2018. Forty-two adult patients eligible for unilateral bone-anchored hearing system surgery with the Ponto system were included in the study. The implant and abutment lengths used varied from 3 to 4 mm and from 6 to 14 mm, according to the bone and skin thickness of the participants, respectively. Results: Twenty-two surgeries were performed using the minimally invasive Ponto surgery technique (52.4%) and 20 (47.6%) using the linear incision. The mean age of the subjects implanted with minimally invasive Ponto surgery and linear incision techniques were 42.0 and 33.3 years old, respectively. Ten male (45,5%) and 14 (70%) female patients were implanted using minimally invasive Ponto surgery and the linear incision techniques, respectively. There were no differences between pure tone audiometric thresholds and monosyllabic word recognition scores of the subjects, when comparing both surgical techniques. The minimally invasive Ponto surgery technique significantly reduced the surgical time compared to the linear incision technique. There were no differences between both surgical techniques for skin-related complications; (Holgers 3 and 4) which occurred in 18.8% for MIPS and in 25% for linear incision. Subjects included in the minimally invasive Ponto surgery technique group showed a superior cosmetic outcome, with no surgical scar or additional sutures. Conclusion: The surgical and audiological outcomes were satisfactory and were not correlated to the surgical technique selected in all subjects. When compared to the linear incision, the minimally invasive Ponto surgery technique showed reduced surgical time and superior esthetic outcomes in the postoperative follow-up.

Resumo Introdução: As próteses auditivas ancoradas ao osso têm se tornado a opção de tratamento mais viável para indivíduos com perda auditiva condutiva ou mista, incapazes de se beneficiar de aparelhos auditivos convencionais ou cirurgia da orelha média. Objetivo: Comparar os resultados cirúrgicos e audiológicos entre as técnicas minimally invasive Ponto surgery e incisão linear com preservação de tecidos moles em usuários de próteses auditivas ancoradas ao osso. Método: Foi feito um estudo retrospectivo de janeiro de 2017 a junho de 2018. Foram incluídos no estudo 42 pacientes adultos candidatos para cirurgia de prótese auditiva ancorada ao osso unilateral com o sistema Ponto. Os comprimentos de implante e pilar usados variaram de 3-4 milímetros e de 6-14 milímetros, de acordo com a espessura óssea e subcutânea dos participantes, respectivamente. Resultados: Foram feitas 22 cirurgias com uso da técnica minimally invasive Ponto surgery (52,4%) e 20 (47,6%) com incisão linear. A idade média dos indivíduos implantados com técnicas minimally invasive Ponto surgery e incisão linear foi de 42 e 33,3 anos, respectivamente. Dez homens (45,5%) e 14 (70%) mulheres foram implantadas com técnicas minimally invasive Ponto surgery e incisão linear, respectivamente. Não houve diferenças entre os limiares audiométricos em campo livre e as pontuações de reconhecimento de palavras monossilábicas dos sujeitos, quando comparadas as duas técnicas cirúrgicas. A técnica minimally invasive Ponto surgery reduziu significantemente o tempo cirúrgico em comparação com a técnica de incisão linear. Não houve diferenças entre as duas tecnicas cirúrgicas para complicações cutâneas maiores (Holgers 3 e 4), que ocorreram em 18,18% para MIPS e em 25% para incisão linear. Os indivíduos incluídos no grupo da técnica minimally invasive Ponto surgery apresentaram aspecto cosmético superior, sem cicatriz cirúrgica ou sutura adicional. Conclusão: Os resultados cirúrgicos e audiológicos foram satisfatórios e não se correlacionaram com a técnica cirúrgica empregada em todos os indivíduos. Quando comparada à incisão linear, a técnica minimally invasive Ponto surgery apresentou tempo cirúrgico reduzido e resultados estéticos superiores no seguimento pós-operatório.

Variabilidade do registro de latência e amplitude do potencial evocado auditivo de Longa Latência (P3) na condição teste e reteste / Variability of registration latency and amplitude of the auditory evoked potential long latency (P3) in the condition test and retest

Objetivo Analisar a variabilidade da amplitude e latência do potencial cognitivo P3 em indivíduos normais, na condição teste e reteste, no período de sete dias. Métodos Foram avaliados 32 sujeitos, com idades entre 18 e 25 anos, 20 do gênero feminino e 12 do gênero masculino, sem queixas auditivas. Todos foram submetidos à avaliação audiológica e potencial evocado auditivo de longa latência. Resultados Os valores médios de latência e amplitude para o P3, obtidos neste estudo, foram de 314,78 ms e 312,40 ms para latência e 5,04 μV e 4,58 μV para amplitude, nas posições Cz e Fz, respectivamente. A média da diferença da latência da onda P3 na condição de reavaliação foi de 10,50 ms (Fz) e 15,25 ms (Cz) para o gênero feminino e de 6,00 ms (Fz) e 5,83 ms (Cz) para o gênero masculino. Conclusão Não houve diferença significativa quando comparadas latência e amplitude, no teste e reteste, com a fixação dos eletrodos em Cz e Fz. Não houve diferença para as latências e amplitude do P3 em todas as seguintes modalidades estudadas: gênero, fixação dos eletrodos (Cz e Fz) e condição teste e reteste. No entanto, para a latência do P3, houve diferença significativa para o gênero feminino, quando comparado em condição de teste e reteste. .

Purpose To analyze the variability of the amplitude and latency of the P3 cognitive potential in normal individuals, the condition test and retest, in the period of 7 days. Methods We evaluated 32 subjects, with ages between 18 and 25 years, 20 females and 12 males, without hearing complaints. Were submitted to audiologic evaluation and cortical potential. Results The mean values of latency and amplitude for the P3 obtained in this study were of 314.78 ms and 312.40 ms for latency and 5.04 μV and 4.58 μV, for amplitude, in positions Cz and Fz, respectively. No significant difference was found when compared to the latency and amplitude, in the test-retest reliability, with the fixing of the electrodes in Cz and Fz. There was no difference for the latency and amplitude of P3 in all the modalities studied: gender, fixation of the electrodes (Cz and Fz) and condition test and retest. For the latency of the P3 in the female gender and condition of test and retest, there was significant difference. Conclusion The mean values of latency and amplitude found in this study were 313.6 ms and 4.81 μV, respectively. The values of latency and amplitude did not vary according to the position of the electrodes (Cz and Fz) and regarding the condition test as retest. There was a significant difference for the female gender when compared in condition test and retest.The mean difference of the latency of P3 in condition of reassessment was 10.50 ms (Fz) and 15.25 ms (Cz) for the female gender and of 6.00 ms (Fz) and 5.83 ms (Cz) for the male gender. .

Avaliação audiológica pré-cirurgia otológica de indivíduos com fissura labiopalatina operada / Pre-surgical auditory assessment of subjects with operated cleft lip and palate

OBJETIVO: descrever as características audiológicas de indivíduos com fissura labiopalatina operada (FLP) e indicação de cirurgia otológica, comparando os grupos quanto ao tipo e grau da perda auditiva, bem como a curva timpanométrica. MÉTODOS: análise de 150 prontuários, ambos os gêneros, idade igual ou superior a 4 anos, FLP e indicação de cirurgia otológica, divididos em 3 grupos: I - Tubo de ventilação (TV), II - Timpanoplastia e III - Timpanomastoidectomia, analisando aspectos quanto a entrevista audiológica, audiometria tonal limiar e imitanciometria. RESULTADOS: o grupo I apresentou porcentagem maior de cirurgia bilateral (86 por cento), o que não ocorreu nos demais grupos. Na entrevista audiológica, 83 por cento apresentou algum tipo de queixa auditiva, sendo a mais frequente a perda auditiva (64 por cento) com p<0,05 entre os grupos I e II; I e III. O tipo de perda auditiva de maior ocorrência foi condutivo bilateral (56 por cento) seguido de unilateral (35 por cento), com p<0,05 entre os grupos I e II; I e III. A perda de grau leve unilateral foi a de maior ocorrência (41 por cento), seguida de grau leve a moderada bilateral (20 por cento), com p<0,05 entre os três grupos. A curva timpanométrica mais frequente foi a do tipo B bilateral (39 por cento) com p<0,05 entre os três grupos. CONCLUSÃO: a maioria dos indivíduos apresentou algum tipo de queixa na entrevista audiológica e alterações na audiometria tonal limiar e imitanciometria. A maioria dessas alterações foi compatível com problemas de orelha média, com perda auditiva do tipo condutiva, de grau leve e bilateral, independentemente da indicação cirúrgica.

PURPOSE: to describe the auditory characteristics of subjects with operated cleft lip-palate (CLP) referred to otologic surgery and compare groups regarding the type and degree of hearing loss and tympanometric curve. METHODS: analysis of 150 records, of both genders, about 4-year old, with CLP and referred to otologic surgery, were divided in 3 groups (1- Ventilation tube (VT), 2- Timpanoplasty 3- Timpanomastoidectomy). Aspects were analyzed according to an auditory interview, pure-tone test and immitance measures. RESULTS: as for the surgical reference, VT showed higher prevalence of bilateral surgery (86 percent), which has not occurred with the other groups. In auditory interview 83 percent of the subjects had complaints on hearing, especially hearing loss - 64 percent (p<0.05 among groups 1 and 2, 1 and 3). The most recurrent hearing loss type was bilateral conductive (56 percent) followed by unilateral (35 percent) (p<0.05 among groups 1 and 2; 1 and 3), 41 percent had middle unilateral hearing loss and 20 percent had moderate bilateral loss, (p<0.05 among the 3 groups). Bilateral type B was the most frequent regarding the tympanometric curve (39 percent) -p<0.05 among the three groups. CONCLUSION: most of the subjects showed some kind of alteration on the auditory interview, in pure tone test and immitance measures. Many of these alterations were compatible with the middle ear pathology, with middle bilateral conductive hearing loss, regardless of the surgical reference.