ABSTRACT Purpose To characterize hearing thresholds at frequencies of 500, 1000, 2000 and 4000 Hz in children undergoing reimplantation with a follow-up of at least 10 years. Methods Retrospective review of medical records of children who underwent reimplantation surgery for at least 10 years. The auditory thresholds obtained in free-field pure tone audiometry with the cochlear implant were evaluated at frequencies of 500, 1000, 2000 and 4000 Hz at four different times: 1 (before failure), 2 (activation), 3 (five years after reimplantation) and 4 (ten years after reimplantation, regardless of the time of use of the 2nd CI) in patients with a follow-up of at least 10 years. Results Evaluating patients who underwent reimplantation, it was observed that the thresholds of 500, 1000, 2000, 4000 Hz were similar in the long term to those obtained in patients who were implanted only once, thus not presenting damage in the detection of sounds. Conclusion Reimplantation had no long-term effect on the hearing thresholds obtained in children who underwent this surgery due to internal component failure.

RESUMO Objetivo Caracterizar os limiares auditivos nas frequências de 500, 1000, 2000 e 4000 Hz em crianças submetidas ao reimplante com follow-up de no mínimo 10 anos. Método Revisão retrospectiva de prontuários de crianças submetidas a cirurgia de reimplante há pelo menos 10 anos. Foram avaliados os limiares auditivos obtidos na audiometria tonal liminar em campo livre com o implante coclear nas frequências de 500, 1000, 2000 e 4000 Hz em quatro momentos distintos: 1 (antes da falha), 2 (ativação), 3 (cinco anos após o reimplante) e 4 (dez anos após o reimplante, independentemente do tempo de uso do uso do 2o IC) em pacientes com follow-up de no mínimo 10 anos. Resultados Avaliando-se pacientes submetidos ao reimplante, observou-se que os limiares de 500, 1000, 2000, 4000 Hz apresentaram-se a longo prazo semelhante àqueles obtidos nos pacientes implantados somente uma única vez, não apresentando prejuízo assim na detecção dos sons. Conclusão O reimplante não teve efeito de longo prazo sobre os limiares auditivos obtidos em crianças que se submeteram a esta cirurgia por falha do componente interno.

Abstract Introduction Bone conduction implants, responsible for transmitting sound from an external processor to the inner ear, can be divided into active and passive, depending on the vibratory stimulus location. The use of transcutaneous device has increased, given its aesthetic appeal, the complications and limitations of percutaneous devices, and patient’s treatment adherence, focusing mainly on efficacy. However, various complications are associated with the use of transcutaneous prosthesis, which can often be serious. Objective To approach the literature on complications involving transcutaneous bone-anchored prostheses through a systematic review of articles published in the past 10 years (2011–2021). Data Synthesis The MEDLINE, EMBASE, Scopus, and Cochrane Library databases were searched. All articles written in English reporting on currently available transcutaneous prosthesis implantation and its complications were selected. Studies on both children and adults were included. The data on complications were extracted, and complications were classified as minor or major and associated to each device used. Thirty-seven articles were included in the study, of which 14 were prospective cohort studies, 22 were retrospective case series, and 1 was a case report. Most studies (18) included both adults and children. Moreover, 901 implantations were performed, of which 552 implanted Baha Attract (Cochlear Ltd., Sydney, Australia), 244 implanted BoneBridge (MED-EL, Innsbruck, Austria), and 105 implanted Sophono (Sophono Inc., Boulder, CO, USA]). Furthermore, 192 adverse events were reported (total complication rate, 21.3%), with 161 minor complications (84.3%) and 31 major complications (16.1%). Conclusion Transcutaneous prosthesis is an audiological alternative with fewer complications than percutaneous prosthesis. However, its indication should be judicious because complications are common, and although most complications are minor, serious infections requiring explantation may develop.

RESUMO Objetivo Avaliar a satisfação e qualidade de vida em usuários de Implante Auditivo de Tronco Cerebral. Método Trata-se de um estudo transversal e descritivo realizado na Divisão de Clínica Otorrinolaringológica do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, Brasil. Para a realização da pesquisa, 19 usuários de implante auditivo de tronco cerebral responderam aos seguintes questionários: KINDLR (Questionnaire for Measuring Health-Related Quality of Life in Children and Adolescents) para crianças e adolescentes, pais e/ou cuidadores; o questionário WHOQOL-BREF para os participantes adultos; e o questionário SADL (Satisfaction with Amplification in Daily Life), adaptado culturalmente para o português brasileiro. Resultados A qualidade de vida das crianças usuárias de implante auditivo de tronco cerebral do ponto de vista dos pais apresentou resultados acima da média para o resultado global e para a maioria dos domínios, exceto o domínio de bem-estar emocional. Os adultos apresentaram resultados acima da média para todos os domínios. Com relação à satisfação com o dispositivo, os adultos usuários de implante auditivo de tronco cerebral estavam satisfeitos de modo geral, exceto no que diz respeito à imagem pessoal, e os pais das crianças mostraram insatisfação para todas as subescalas, exceto para a subescala de serviços e custos. Conclusão Os resultados indicaram que, apesar de os pacientes estarem insatisfeitos em alguns aspectos com o dispositivo, de modo geral, a qualidade de vida foi classificada como boa, para a maioria dos aspectos avaliados.

ABSTRACT Purpose To evaluate satisfaction and quality of life of users of Auditory Implant Brainstem. Methods This is a cross-sectional and descriptive study conducted at Divisão de Clínica Otorrinolaringológica of Hospital das Clínicas of Faculdade de Medicina da Universidade de São Paulo, Brazil. For the research, 19 users of an Auditory Brainstem Implant answered the following questionnaires: KINDLR (Questionnaire for Measuring Health-Related Quality of Life in Children and Adolescents), for children and adolescents, their parents and/or caregivers; WHOQOL-BREF questionnaire, for adult participants; and the Satisfaction with Amplification in Daily Life (SADL) questionnaire culturally adapted to Brazilian Portuguese. Results The quality of life of children using Auditory Brainstem Implant from the perspective of their parents showed global results above average, as for most domains, except for the emotional well-being domain. Adults showed results above average for all domains. Regarding satisfaction with the device, the adult users of auditory brainstem implant were satisfied in general, except with regard to personal image. The parents of the children showed dissatisfaction in all subscales, except for the subscale of services and cost. Conclusion The results indicated that although patients are dissatisfied with the device in some aspects, overall the quality of life was rated as good for most of the aspects assessed.

Introduction Hearing loss is the most common clinical finding in patients with malformation of the external ear canal. Among the possibilities of treatment, there is the adaptation of hearing aids by bone conduction and the adaptation of implantable hearing aids. Objective To assess speech perception with the use of Vibrant Soundbridge (VBS - MED-EL, Innsbruck, Austria) associated with additional amplification in patients with bilateral craniofacial malformation. Method We evaluated 11 patients with bilateral malformation over 12 years with mixed hearing loss or bilateral conductive. They were using the Softband (Oticon Medical, Sweden) and bone conduction hearing aid in the ear opposite the one with the VSB.We performed the evaluation of speech perception using the Hearing in Noise Test. Results Participants were eight men and three women with a mean of 19.5 years. The signal / noise ratio presented significant results in patients fitted with VSB and bone conduction hearing aid. Conclusion The results of speech perception were significantly better with use of VBS combined with bone conduction hearing aids.

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 Currently the cochlear implant allows access to sounds in individuals with profound hearing loss. The objective methods used to verify the integrity of the cochlear device and the electrophysiologic response of users have noted these improvements. Objective To establish whether the evoked compound action potential of the auditory nerve can appear after electrical stimulation when it is absent intraoperatively. Methods The clinical records of children implanted with the Nucleus Freedom (Cochlear Ltd., Australia) (CI24RE) cochlear implant between January 2009 and January 2010 with at least 6 months of use were evaluated. The neural response telemetry (NRT) thresholds of electrodes 1, 6, 11, 16, and 22 during surgery and after at least 3 months of implant use were analyzed and correlated with etiology, length of auditory deprivation, and chronological age. These data were compared between a group of children exhibiting responses in all of the tested electrodes and a group of children who had at least one absent response. Results The sample was composed of clinical records of 51 children. From these, 21% (11) showed no NRT in at least one of the tested electrodes. After an average of 4.9 months of stimulation, the number of individuals exhibiting absent responses decreased from 21 to 11% (n = 6). Conclusion It is feasible that absent responses present after a period of electrical stimulation. In our sample, 45% (n = 5) of the patients with intraoperative absence exhibited a positive response after an average of 4.9 months of continued electrical stimulation.

Introduction  The complaints associated with the use of conventional amplifying hearing aids prompted research at several centers worldwide that ultimately led to the development of implantable devices for aural rehabilitation. Objectives  To review the history, indications, and surgical aspects of the implantable middle ear hearing devices. Data Synthesis  Implantable hearing aids, such as the Vibrant Soundbridge system (Med-El Corporation, Innsbruck, Austria), the Maxum system (Ototronix LLC, Houston, Texas, United States), the fourth-generation of Carina prosthesis (Otologics LLC, Boulder, Colorado, United States), and the Esteem device (Envoy Medical Corporation - Minnesota, United States), have their own peculiarities on candidacy and surgical procedure. Conclusion  Implantable hearing aids, which are currently in the early stages of development, will unquestionably be the major drivers of advancement in otologic practice in the 21st century, improving the quality of life of an increasingly aged population, which will consequently require increased levels of hearing support.

INTRODUCTION: Few cases of cochlear implantation (CI) in neurofibromatosis type 2 (NF2) patients had been reported in the literature. The approaches described were translabyrinthine, retrosigmoid or middle cranial fossa. OBJECTIVES: To describe a case of a NF2- deafened-patient who underwent to vestibular schwannoma resection via RLA with cochlear nerve preservation and CI through the round window, at the same surgical time. RESUMED REPORT: A 36-year-old woman with severe bilateral hearing loss due to NF2 was submitted to vestibular schwannoma resection and simultaneous CI. Functional assessment of cochlear nerve was performed by electrical promontory stimulation. Complete tumor removal was accomplishment via RLA with anatomic and functional cochlear and facial nerve preservation. Cochlear electrode array was partially inserted via round window. Sound field hearing threshold improvement was achieved. Mean tonal threshold was 46.2 dB HL. The patient could only detect environmental sounds and human voice but cannot discriminate vowels, words nor do sentences at 2 years of follow-up. CONCLUSION: Cochlear implantation is a feasible auditory restoration option in NF2 when cochlear anatomic and functional nerve preservation is achieved. The RLA is adequate for this purpose and features as an option for hearing preservation in NF2 patients.

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.

A técnica clássica para o implante coclear é realizada através de mastoidectomia e timpanotomia posterior. A abordagem pela fossa craniana média provou ser uma alternativa valiosa, embora venha sendo usada para o implante coclear apenas esporadicamente e sem normatização. OBJETIVO: Descrever uma nova abordagem para expor o giro basal da cóclea para o implante coclear através da fossa craniana média. MÉTODO: Cinquenta ossos temporais foram dissecados. A cocleostomia foi realizada através de uma abordagem via fossa craniana média, na parte mais superficial do giro basal da cóclea, usando o plano meatal e seio petroso superior como pontos de reparo. A parede lateral do meato acústico interno foi dissecada após o broqueamento e esqueletização do ápice petroso. A parede dissecada do meato acústico interno foi acompanhada longitudinalmente até a cocleostomia. Design: Estudo anatômico de osso temporal. RESULTADOS: Em todos os ossos temporais, apenas a parte superficial do giro basal da cóclea foi aberta. A exposição do giro basal da cóclea permitiu que as escalas timpânica e vestibular fossem visualizadas. Assim, não houve dificuldade na inserção do feixe de eletrodos através da escala timpânica. CONCLUSÃO: A técnica proposta é simples e permite exposição suficiente do giro basal da cóclea.

The classic approach for cochlear implant surgery includes mastoidectomy and posterior tympanotomy. The middle cranial fossa approach is a proven alternative, but it has been used only sporadically and inconsistently in cochlear implantation. OBJECTIVE: To describe a new approach to expose the basal turn of the cochlea in cochlear implant surgery through the middle cranial fossa. METHOD: Fifty temporal bones were dissected in this anatomic study of the temporal bone. Cochleostomies were performed through the middle cranial fossa approach in the most superficial portion of the basal turn of the cochlea, using the meatal plane and the superior petrous sinus as landmarks. The lateral wall of the internal acoustic canal was dissected after the petrous apex had been drilled and stripped. The dissected wall of the inner acoustic canal was followed longitudinally to the cochleostomy. RESULTS: Only the superficial portion of the basal turn of the cochlea was opened in the fifty temporal bones included in this study. The exposure of the basal turn of the cochlea allowed the visualization of the scala tympani and the scala vestibuli, which enabled the array to be easily inserted through the scala tympani. CONCLUSION: The proposed approach is simple to use and provides sufficient exposure of the basal turn of the cochlea.

INTRODUCTION: Cochlear implants may guarantee sound perception and the ability to detect speech at a close-to-normal hearing intensity; however, differences have been observed among implantees in terms of performance on discrimination tests and speech recognition. OBJECTIVE: To identify whether patients with post-meningitis deafness perform similarly to patients with hearing loss due to other causes. METHOD: A retrospective clinical study involving post-lingual patients who had been using Nucleus-22 or Nucleus-24 cochlear implants for at least 1 year. These patients were matched with respect to age (± 2 years), time since the onset of deafness (± 1 year), and the duration of implant use with implant users who had hearing loss due to other causes. Speech perception was assessed using the Portuguese version of the Latin-American Protocol for the Evaluation of Cochlear Implants. RESULTS: The sample consisted of 52 individuals (26 in each of the 2 groups). The post-meningitic group had a median of 18.5 active electrodes. The group with hearing loss due to other causes had a median of 21, but no significant statistical difference was observed (p = 0.07). The results of closed- and open-set speech recognition tests showed great variability in speech recognition between the studied groups. These differences were more pronounced for the most difficult listening tasks, such as the medial consonant task (in the vowel-consonant-vowel format). CONCLUSION: Cochlear implant recipients with hearing loss due to bacterial meningitis, who had been using the device for 1 year performed more poorly on closed- and open-set speech recognition tests than did implant recipients with hearing loss due to other causes.

INTRODUÇÃO: O BAHA (Bone Ancored Hearing Aid) é um dispositivo auditivo de condução óssea que propaga o som diretamente à orelha interna, utilizado principalmente em pacientes com perda auditiva condutiva associada a atresia aural, mas atualmente também em perdas mistas e neurossensoriais. OBJETIVO: Revisar as principais indicações do BAHA, analisar os resultados audiométricos e os benefícios proporcionados aos pacientes, e compará-los com outras modalidades de tratamento além de comparar os dados da literatura com nossa casuística de 13 pacientes. MÉTODO: A pesquisa foi realizada em bases de dados abrangendo trabalhos em inglês, espanhol e português, sem limites de intervalos de anos, comparando com os resultados dos nossos 13 pacientes submetidos a esse procedimento, no período de 2000 a 2009. RESULTADOS: A maioria dos trabalhos mostrou vantagens do BAHA em comparação à cirurgia reconstrutiva, tanto pelos resultados audiológicos quanto em relação a complicações e recidiva. Os resultados pós-operatórios nos 13 pacientes operados por nossa equipe foi satisfatório e compatível com os da literatura, com fechamento do gap aéreo-ósseo em 7 pacientes e gap aéreo-ósseo de até 10 dB em 6 pacientes. Não houve complicações pós-operatórias. CONCLUSÃO: O BAHA é uma ótima opção de tratamento para pacientes com surdez condutiva bilateral, fato demonstrado pelos bons resultados audiológicos e por se tratar de um procedimento cirúrgico relativamente simples e com baixa taxa de complicações. Os estudos mais recentes vêm abordando seu uso para surdez condutiva e neurossensorial unilateral.

INTRODUCTION: The bone-anchored hearing aid (BAHA) is a bone conduction hearing device that transmits sound directly into the inner ear. It is mainly used in patients with conductive hearing loss associated with aural atresia, but it is also used in those with mixed and sensorineural hearing loss. GOALS: To review the main indications for BAHA, to analyze the audiometric results and its benefits for patients and compare them with other treatment modalities, and to compare the literature data with our sample of 13 patients. METHOD: The research was performed using a database covering works in English, Spanish, and Portuguese, with no limitations in the years when the procedures were performed. We compared the literature data with our results for the 13 patients who underwent BAHA implantation between the years 2000 and 2009. RESULTS: Most of the studies showed that BAHA has great advantages over reconstructive surgery in terms of hearing results, complications, and disease recurrence. The postoperative results for our 13 patients were satisfactory and comparable with the results from the literature, with closure of the air-bone gap in 7 patients and achieving an air-bone gap of 10 dB in 6 patients. No postoperative complications were observed. CONCLUSION: BAHA is a better treatment option than reconstructive surgery for patients with bilateral deafness. It is a relatively simple surgical procedure with few complications and good hearing results. Recent studies have examined its use in conductive and unilateral sensorineural hearing loss.

INTRODUÇÃO: A maioria dos pacientes com perda auditiva, incluindo casos de perdas severas, é beneficiada com o uso de aparelho de amplificação sonora individual. Acredita-se que o implante coclear estabeleça melhores resultados na reabilitação de uma criança com perda auditiva nos casos em que a gravidade da deficiência torna os aparelhos acústicos convencionais incapazes de fornecer informação sonora adequada, já que estes necessitam de reserva coclear suficiente para que ocorra detecção acústica. OBJETIVO: Avaliar se em pacientes portadores de surdez pré-lingual o implante coclear traz benefício auditivo superior ao da prótese auditiva convencional. SÍNTESE DOS DADOS: Revisão sistemática realizada a partir de consulta a artigos científicos selecionados por busca no banco de dados SciELO, Cochrane, MEDLINE e LILACS-BIREME. Entre os 2169 artigos consultados, 12 trabalhos se mostram pertinentes ao tema e apresentaram força de evidência B. Entre os desenhos de estudos analisados na revisão, 7 são do tipo coorte prospectivo e 5 são estudos transversais. CONCLUSÃO: O implante coclear demonstrou, através de diversos estudos, ser atualmente, a melhor alternativa para os casos de perdas auditivas bilaterais severas ou profundas, atingindo resultados superiores em percepção e desenvolvimento de fala em crianças pré-linguais quando comparados aos aparelhos de amplificação sonora convencionais.

INTRODUCTION: The majority of patients with hearing loss, including those with severe hearing loss, benefits from the use of hearing aids. The cochlear implant is believed to achieve better results in a child with hearing loss in cases where the severity of disability renders hearing aids incapable of providing adequate sound information, as they require sufficient cochlear reserve so that acoustic detention occurs. OBJECTIVE: To assess if cochlear implants provide more benefit than conventional hearing aids in prelingually deaf patients. SUMMARY OF THE FINDINGS : The study was a systematic review of scientific papers selected by a search of the SciELO, Cochrane, MEDLINE, and LILACS-BIREME databases. Among the 2169 articles found, 12 studies proved relevant to the issue and presented an evidence strength rating of B. No publications rated evidence strength A. Seven of the studies analyzed were prospective cohorts and 5 were cross-sectional studies. CONCLUSION: Based on several studies, cochlear implants were demonstrated to be the best current alternative for bilateral severe or profound hearing loss, achieving better results in speech perception and development in prelingual children when compared to conventional hearing aids.

A cirurgia de implante coclear (IC) é método seguro e factível de restaurar audição em pacientes com surdez grave a profunda. OBJETIVO: Descrever complicações do IC. MATERIAL E MÉTODOS: Dados de 591 IC com tempo de seguimento de pelo menos 1 ano foram retrospectivamente analisados. Foram excluídos 41 pacientes por dados incompletos, acesso via fossa media ou perda de seguimento. RESULTADOS: Dos 550 IC analisados, 341 foram realizados em crianças e adolescentes e 209 em adultos. O tempo médio de surdez foi de 6,3 ± 6,7 anos para pré-linguais e 12,1 ± 11,6 anos para os pós-linguais. O tempo médio de seguimento foi 3,9 ± 2,8 anos. Complicações maiores ocorreram em 8,9% casos e menores em 7,8%. Problemas durante a inserção do feixe de eletrodos (3,8%) foi a complicação maior mais frequente, seguido pela deiscência de ferida operatória (1,4%). Paralisia facial temporária (2,2%), lesão muro facial (2,2%) e lesão de membrana timpânica (1,8%) foram as complicações menores mais frequentes. Nenhum óbito foi observado. CONCLUSÃO: Complicações cirúrgicas tiveram baixa ocorrência, sendo a maioria solucionada com sucesso. Esses resultados confirmam que o IC é uma cirurgia segura e a maioria das complicações cirúrgicas pode ser manejada com medidas conservadoras ou intervenções menores.

Cochlear implantation is a safe and reliable method for auditory restoration in patients with severe to profound hearing loss. OBJECTIVE:To describe the surgical complications of cochlear implantation. MATERIALS AND METHODS: Information from 591 consecutive multichannel cochlear implant surgeries were retrospectively analyzed. All patients were followed-up for at least one year. Forty-one patients were excluded because of missing data, follow-up loss or middle fossa approach. RESULTS: Of 550 cochlear implantation analyzed, 341 were performed in children or adolescents, and 209 in adults. The mean hearing loss time was 6.3 ± 6.7 years for prelingual loss and 12.1 ± 11.6 years for postlingual. Mean follow-up was 3.9 ± 2.8 years. Major complications occurred in 8.9% and minor in 7.8%. Problems during electrode insertion (3.8%) were the most frequent major complication followed by flap dehiscence (1.4%). Temporary facial palsy (2.2%), canal-wall lesion (2.2%) and tympanic membrane lesion (1.8%) were the more frequent minor complications. No death occurred. CONCLUSION: There was a low rate of surgical complications, most of them been successfully managed. These results confirm that cochlear implant is a safe surgery and most surgical complications can be managed with conservative measures or minimal intervention.

As novas tecnologias do processador Freedom® foram criadas para proporcionar melhorias no processamento do som acústico de entrada, não apenas para novos usuários, como para gerações anteriores de implante coclear. OBJETIVO: Identificar a contribuição da tecnologia do processador de fala Freedom® para implante coclear multicanal, Nucleus22®, no desempenho de percepção de fala no silêncio e no ruído, e nos limiares audiométricos. MATERIAL E MÉTODO: A forma de estudo foi de coorte histórico com corte transversal. Dezessete pacientes preencheram os critérios de inclusão. Antes de iniciar os testes, o último mapa em uso com o Spectra® foi revisto e otimizado e o funcionamento do processador foi verificado. Os testes de fala foram apresentados a 60dBNPS em material gravado: monossílabos; frases em apresentação aberta no silêncio; e no ruído (SNR = 0dB). Foram realizadas audiometrias em campo livre com ambos os processadores de fala. A análise estatística utilizou testes não-paramétricos. RESULTADOS: Quando analisada a contribuição do Freedom® para pacientes com Nucleus22®, observa-se diferença estatisticamente significativa em todos os testes de percepção de fala e em todos os limiares audiométricos. CONCLUSÃO: A tecnologia contribuiu no desempenho de percepção de fala e nos limiares audiométricos dos pacientes usuários de Nucleus22®.

New technology in the Freedom® speech processor for cochlear implants was developed to improve how incoming acoustic sound is processed; this applies not only for new users, but also for previous generations of cochlear implants. AIM: To identify the contribution of this technology - the Nucleus 22® - on speech perception tests in silence and in noise, and on audiometric thresholds. METHODS: A cross-sectional cohort study was undertaken. Seventeen patients were selected. The last map based on the Spectra® was revised and optimized before starting the tests. Troubleshooting was used to identify malfunction. To identify the contribution of the Freedom® technology for the Nucleus22®, auditory thresholds and speech perception tests were performed in free field in sound-proof booths. Recorded monosyllables and sentences in silence and in noise (SNR = 0dB) were presented at 60 dBSPL. The nonparametric Wilcoxon test for paired data was used to compare groups. RESULTS: Freedom® applied for the Nucleus22® showed a statistically significant difference in all speech perception tests and audiometric thresholds. CONCLUSION: The reedom® technology improved the performance of speech perception and audiometric thresholds of patients with Nucleus 22®.