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

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

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

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

Resumo Introdução: A avaliação convencional da telemetria neural e de impedâncias implica o uso do computador acoplado a uma interface, o software fornece o estímulo e a visualização das respostas. Recentemente, foi lançado um controle remoto (CR220®), que possibilita testes intraoperatórios com instrumental mínimo. Objetivo: Avaliar a concordância dos valores das impedâncias e dos limiares da telemetria neural e o tempo de execução no procedimento convencional e pelo controle remoto. Método: Estudo prospectivo transversal multicêntrico. Foram incluídas as avaliações intraoperatórias de implante coclear compatível com o uso do CR220®. Os testes foram realizados nos 22 eletrodos para comparar os tempos de execução nas duas situações. Foi analisada a concordância dos valores do limiar da telemetria neural obtidos em cinco eletrodos e a concordância das impedâncias foi avaliada pelo número de eletrodos com valores alterados em cada procedimento. Resultados: Não houve diferença significante entre as impedâncias. Obteve-se moderada a forte correlação entre os limiares do potencial de ação composto eletricamente evocado. O tempo médio para os procedimentos com o CR220 foi significativamente menor do que com o procedimento convencional. Conclusão: O uso do CR220 proporcionou registros bem-sucedidos para a telemetria de impedância e a telemetria automática de respostas neurais.

Abstract Introduction: The conventional evaluation of neural telemetry and impedance requires the use of the computer coupled to an interface, with software that provides visualization of the stimulus and response. Recently, a remote control (CR220®) was launched in the market, that allows the performance of intraoperative tests with minimal instrumentation. Objective: To evaluate the agreement of the impedance values and neural telemetry thresholds, and the time of performance in the conventional procedure and by the remote control. Methods: Multicentric prospective cross-sectional study. Intraoperative evaluations of cochlear implants compatible with the use of CR220® were included. The tests were carried out in the 22 electrodes to compare the time of performance in the two situations. The agreement of the neural telemetry threshold values obtained from five electrodes was analyzed, and the agreement of impedance was evaluated by the number of electrodes with altered values in each procedure. Results: There were no significant difference between the impedance values. There was a moderate to strong correlation between the electrically-evoked compound action potential thresholds. The mean time to perform the procedures using the CR220 was significantly lower than that with the conventional procedure. Conclusion: The use of the CR220 provided successful records for impedance telemetry and automatic neural response telemetry.

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

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

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

OBJETIVO: verificar a efetividade da programação remota do implante coclear por meio dos níveis de estimulação e resultados nos testes de percepção de fala e audiometria em campo livre. MÉTODOS: Foram selecionados 12 pacientes de ambos os gêneros, com idade entre 18 e 59 anos, usuários de implante coclear do mesmo modelo de unidade interna e processador de fala por no mínimo 12 meses. As programações remota (PR) e presencial (PP) foram realizadas no mesmo dia, medindo-se os níveis mínimos (níveis T) e máximos (níveis C) de estimulação de cinco eletrodos, com interpolação dos demais. Foram aplicados testes de percepção de fala (frases em contexto aberto e monossílabos - gravação a 65 dBNPS) e audiometria em campo livre nas frequências de 250 a 8.000 Hz. Os resultados foram comparados entre PR e PP. RESULTADOS: Houve diferença na média dos níveis T em três eletrodos e dos níveis C em um eletrodo. Não houve diferença entre os resultados obtidos nos testes de percepção de fala e nos limiares audiométricos na PP e PR. CONCLUSÃO: A realização da programação remota é simples e eficaz para a programação dos dispositivos de implante coclear e, embora tenha mostrado diferenças nos níveis de estimulação, não interferiu no desempenho da percepção de fala.

PURPOSE: To verify the effectiveness of remote programming of cochlear implants by stimulation levels and results in the perception of speech and free-field audiometry tests. METHODS: Twelve patients from both genders, aged between 18 and 59 years, users of internal cochlear implant and speech processor of the same model for at least 12 months, were selected. Both the remote programming (RP) and the live programming (LP) were performed on the same day, measuring the minimum (T) and maximum (C) stimulation levels of five electrodes with the interpolation of the remaining ones. Speech perception tests were applied using 65 dBSPL (recorded open context sentences and monosyllables). The patients were submitted to free-field audiometry at 250-8,000 Hz frequencies. The results for the RP and LP were compared. RESULTS: Differences in mean of the T levels for three electrodes and the C levels for one electrode were found. No difference between the results was obtained in the speech perception tests and audiometric thresholds in the RP and LP. CONCLUSION: The RP is a simple and effective procedure for programming cochlear implant devices and, although there were differences in the stimulation levels of some electrodes, it did not interfere in the speech perception outcomes.

INTRODUCTION: The most relevant clinical symptom in Waardenburg syndrome is profound bilateral sensorioneural hearing loss. AIM: To characterize and describe hearing outcomes after cochlear implantation in patients with Waardenburg syndrome to improve preoperative expectations. METHOD: This was an observational and retrospective study of a series of cases. Children who were diagnosed with Waardenburg syndrome and who received a multichannel cochlear implant between March 1999 and July 2012 were included in the study. Intraoperative neural response telemetry, hearing evaluation, speech perception, and speech production data before and after surgery were assessed. RESULTS: During this period, 806 patients received a cochlear implant and 10 of these (1.2%) were diagnosed with Waardenburg syndrome. Eight of the children received a Nucleus 24® implant and 1 child and 1 adult received a DigiSonic SP implant. The mean age at implantation was 44 months among the children. The average duration of use of a cochlear implant at the time of the study was 43 months. Intraoperative neural responses were present in all cases. Patients who could use the speech processor effectively had a pure tone average of 31 dB in free-field conditions. In addition, the MUSS and MAIS questionnaires revealed improvements in speech perception and production. Four patients did not have a good outcome, which might have been associated with ineffective use of the speech processor. CONCLUSION: Despite the heterogeneity of the group, patients with Waardenburg syndrome who received cochlear implants were found to have hearing thresholds that allowed access to speech sounds. However, patients who received early intervention and rehabilitation showed better evolution of auditory perception.

INTRODUÇÃO: Clinicamente observa-se contribuição da tecnologia do implante coclear (IC) Nucleus 24 (N24). A confirmação dessa evidência seria importante pois afeta diretamente os critérios de indicação do implante coclear. OBJETIVO: Verificar a contribuição da atualização da tecnologia do IC sobre limiares audiométricos e desempenho na percepção de sentenças após 12 meses de uso do implante. MÉTODO: Estudo retrospectivo de corte transversal, com coleta em banco de dados. Critérios de seleção: idade igual ou superior a 18 anos, uso do dispositivo de IC N22 ou N24, tempo de privação auditiva até 20 anos, cuja etiologia da surdez não seja meningite. A amostra foi dividida em G22 (usuários do N22), e G24 (usuários do N24). Os grupos foram comparados em relação aos resultados no teste de percepção de sentenças no silêncio e limiares audiométricos após 12 meses de uso. RESULTADOS: Dos 84 pacientes adultos selecionados, 54 preencheram os critérios de seleção, sendo 13 usuários de N22 e 41 usuários de N24. Não houve diferença estatisticamente significante entre resíduo auditivo pré-operatório e tempo de privação auditiva dos usuários do N22 e N24. Os usuários do N24 apresentaram melhores médias nos limiares audiométricos, mas os testes de percepção de sentenças no silêncio não indicaram diferença entre modelos. CONCLUSÃO: A contribuição da tecnologia foi evidenciada apenas nos limiares audiométricos. Novos estudos estão sendo conduzidos para avaliar a contribuição da tecnologia na percepção de fala em situações auditivas mais difíceis.

INTRODUCTION: Clinically it was observed the contribution of the Nucleus 24 (N24) cochlear implant (CI) technology. The confirmation of this evidence would be important because it affects directly the indication criteria of the cochlear implant. OBJECTIVE: To verify the contribution of the technologys updating of the CI about the auditory thresholds and the performance in the perception of sentences after 12 mouths of implant use. METHOD: A retrospective, cross-sectional study with database collection. Selection criteria: age equal or higher than 18 years old, CI N22 or N24 device use, auditory privation time until 20 years, which deafness etiology does not be meningitis. The sample was divided into G22 (N22 users), and G24 (N24 users). The groups were compared concerning the result in the sentences perception test in the silence and audiometric thresholds after 12 mouths of use. RESULTS: From 84 adults patients selected, 54 filled the selection criteria, being 13 users of N22 and 41 users of N24. There was no difference statistically significant between preoperative auditory residues and time of auditory privation of the N22 and N24 users. The N24 users presented best averages in the audiometric thresholds, but the sentences perception tests in the silence do not indicated difference between models. CONCLUSION: The contribution of the technology was evidenced only in the auditory thresholds. News studies are being performed in order to evaluate the technology contribution in the speech perception in auditory situations more difficult.