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Background: The spread of excitation (SOE) and auditory nerve recovery function (REC) are objective measures recorded by neural response telemetry and may interfere in cochlear implant (CI) stimulation. Objective: To analyze and correlate SOE with the refractory periods in subjects with pre- and postlingual deafness implanted with different electrode arrays. Methods: This was a retrospective study of 323 ears separated by perimodiolar or straight arrays and by pre- or postlingually deaf recipients. Measures were collected intraoperatively on electrode 11. The SOE width was measured in millimeters at the 0.75 point of the curve, and the relative (tau) and absolute (t0) refractory periods were measured in microseconds. Results: There was a statistical correlation between the SOE and the t0 in the patients with postlingual deafness implanted with the perimodiolar array. The SOE width was statistically different between the straight and perimodiolar arrays and between the pre- and postlingual groups in the perimodiolar array. Tau was statistically different between the pre- and postlingual groups with the straight array and the t0, between the pre- and postlingual groups with the perimodiolar array. Neural response threshold and amplitude of the neural response were not statistically different among groups. Conclusion: There was a correlation between SOE width and t0 only in patients with acquired deafness. The findings suggest that different factors influence SOE and REC, considering SOE is different according to the electrode array and REC being different according the onset of deafness.

Objective The present investigation evaluated the speech perception performance of patients with ossified cochlea implanted with the 24M Double Array cochlear implant, using standard and duplicated maps in each of the arrays. Study design Retrospective case review. Setting Tertiary referral center. Patients Sixteen subjects received a Double Array cochlear implant. Among these, 9 fulfilled the following inclusion criteria: bilateral severe-to-profound postlingual deafness; bilateral obliterated cochlea, as shown by a computed tomographic scan; and a minimum age of 14 years to ensure reliable responses in the behavioral tests with the 3 tested maps. Intervention Rehabilitative. Main outcome measures The speech perception performance with the 2 arrays was compared with that with a basal array duplicated map and an apical array duplicated map. Three maps were fitted: the default map with both arrays activated, a double channel map using only the electrodes of the basal array, and a double channel map programmed only with the electrodes of the apical array. The test battery was composed of a vowel test, a 4-choice word test, and sentence recognition in quiet. Results Statistical significance was reached in comparison the all tests in all programming conditions. Speech recognition in the standard map with both electrode arrays activated showed the highest scores. Conclusion Performance with the 2 split electrode arrays was superior to those with the single arrays, regardless of the duplication of channels.

Conclusion. The study shows that there are differences in the measurement of the action potentials with and without the stylet in the Nucleus Freedom Contour Advance that are higher in the apex than in the base of the cochlea. Objectives. To determine if there are differences in the intraoperative impedances and in the neural response telemetry threshold values in the Nucleus Freedom Contour Advance before and after stylet removal. Subjects and methods. This was a prospective clinical study. Intraoperative impedances and neural response telemetry in users of the Freedom Contour Advance Cochlear Implant were measured before and after stylet removal. Results. There was a significant reduction in the impedance values of an average 1.5 kΩ±2.3 in common ground mode and 1.3 kΩ±2.3 for all monopolar modes after the stylet removal (p < 0.001). When analyzing the apical, medium, and basal electrodes, there was a statistically significant reduction in the neural response thresholds after stylet removal only in the ...

O implante auditivo de tronco cerebral foi desenvolvido para restaurar alguma audição útil em pacientes que apresentam ausência de nervo coclear bilateralmente. OBJETIVOS: Discutir a indicação, cirurgia e resultados em quatro pacientes submetidos à cirurgia para colocação de implante auditivo de tronco cerebral. CASUÍSTICA E MÉTODOS: Quatro pacientes com diagnóstico de schwannomas vestibulares bilaterais foram submetidos à cirurgia para colocação de Implante Auditivo de Tronco Cerebral durante o mesmo ato cirúrgico utilizado para a exérese de um dos tumores. Aspectos clínicos e técnicos e as referências anatômicas da cirurgia e os resultados auditivos foram analisados. RESULTADOS: Em todos os casos foram identificados as referências anatômicas ao forame de Luschka. As complicações cirúrgicas se resumiram à fístula liquórica em dois pacientes. Os eletrodos foram bem posicionados e a sensação auditiva foi suficiente para reconhecimento de sons e auxílio à leitura labial. CONCLUSÃO: Os resultados auditivos de nossos pacientes abrem uma perspectiva importante aos pacientes com surdez profunda bilateral sem integridade anatômica das vias auditivas centrais. Auditory Brainstem Implants were developed to partially restore the hearing capabilities of patients without cochlear nerves bilaterally. AIM: this paper aims to discuss the clinical and surgical findings of four ABI patients. MATERIALS AND METHOD: four patients diagnosed with bilateral schwannomas received auditory brainstem implants (ABI) and had one of their tumors resected in the same surgical procedure. Clinical aspects, surgical technique, anatomic landmarks, and outcomes were analyzed. RESULTS: the anatomic landmarks were identified in all four patients in relation to the foramina of Luschka. Two patients had CSF leaks. The electrodes were well positioned and hearing sensation was good enough to allow for sound recognition and assist patients perform lip reading. CONCLUSION: the outcomes observed in our patients were quite encouraging and offer great perspectives for those suffering from deep bilateral deafness and impaired central auditory pathways.

Electrically Evoked Compound Action Potential is a measure of synchronous cochlear nerve fibers activity elicited by electrical stimulation of the cochlear implant. The electrophysiological nerve responses may contribute to explain the variability in individual performance of cochlear implant recipients. AIM: To compare speech perception tests’ performances of cochlear implant users according to the presence or absence of intraoperative neural telemetry responses. MATERIAL AND METHOD: Prospective study design with 100 "Nucleus 24" cochlear implant users divided in two groups according to the presence or absence of intraoperative neural telemetry responses. Speech perception tests were performed after 6 months of continuous use of the device and compared among groups. RESULTS: Intraoperative action potentials were observed in 72 % of individuals. Open-set sentence test results were better in implant users who had neural telemetry responses when compared to implant users in whom this potential was absent (averages 82.8 % versus 41 %, p = 0.005). There was a strong association between post meningitis-related deafness and absence of intraoperative potentials. CONCLUSION: The absence of intraoperative neural telemetry responses was associated with worse performances in speech perception tests and meningitis as etiology of deafness. On the other hand, the presence of these potentials suggests excellent prognosis.

Summary Electrically Evoked Compound Action Potential is a measure of synchronous cochlear nerve fibers activity elicited by electrical stimulation of the cochlear implant. The electrophysiological nerve responses may contribute to explain the variability in individual performance of cochlear implant recipients. Aim To compare speech perception tests’ performances of cochlear implant users according to the presence or absence of intraoperative neural telemetry responses. Material and Method Prospective study design with 100 “Nucleus 24” cochlear implant users divided in two groups according to the presence or absence of intraoperative neural telemetry responses. Speech perception tests were performed after 6 months of continuous use of the device and compared among groups. Results Intraoperative action potentials were observed in 72 % of individuals. Open-set sentence test results were better in implant users who had neural telemetry responses when compared to implant users in whom this potential was absent (averages 82.8 % versus 41 %, p = 0.005). There was a strong association between post meningitis-related deafness and absence of intraoperative potentials. Conclusion The absence of intraoperative neural telemetry responses was associated with worse performances in speech perception tests and meningitis as etiology of deafness. On the other hand, the presence of these potentials suggests excellent prognosis.

Cochlear implant speech processors compress a wide acoustical dynamic range of sounds into a smaller electrical dynamic range. Some patients show wider electrical dynamic ranges than others and most of them have good speech perception performance. The knowledge of the average psycho-acoustical dynamic range in adults will help the audiologist program children who do not give reliable responses.This study was conducted to analyse the dynamic ranges of experienced Nucleus 22 cochlear implant users with good speech-perception and patients with poor speech-perception performances.Thirty-one maps of adult subjects with Nucleus 22 cochlear implants using the SPEAK processing strategy, in bipolar stimulation were analysed. By the time of this study, all of them had used a cochlear implant for over a year. They were divided into two groups: group 1, composed of those with good speech perception for sentences (better than 80%), and group 2, composed of those with speech perception results for sentences worse than 70%.Results showed that both dynamic ranges were wide in the two groups (average 50 units).Although dynamic ranges vary among subjects and electrodes, a lower variability was observed within the group of patients with better speech perception.

Summary Background Due to the condition known as middle ear squeeze, scuba diving has become one of the main causes of barotrauma, and the acute form of this condition has been relatively well established. However, there are few reports available on clinical or laboratory findings in divers who practise repeated diving. The objective of the present study was to assess the otological effects of repeated dives. Method This was an observational study conducted on 19 recreational scuba divers, considered to be experienced divers according to the criteria established by the Professional Association of Dive Instructors (PADI). These divers undertook four dives per day on five consecutive days, and their tympanic membranes were assessed using tympanometry and otoscopy. Data were analysed using the χ 2 -test for trend. The level of statistical significance was set at p Results The findings suggest that multiple scuba dives over a short period of time cause damage to the structures of the ear, as evidenced by the tympanometric and otoscopic findings, which revealed cumulative effects of pressure against the tympanic membrane and within the middle ear. This condition was not observed when surface intervals exceeded 11 h. Conclusions The results suggest that extending surface intervals may offer protection against middle ear barotrauma in recreational scuba diving.

Objective: The aim of this study was to evaluate Auditory Steady-State Responses (ASSR) at high intensities in pediatric cochlear implant candidates and to compare the results to behavioral test responses.Method: This prospective study evaluated 54 children with severe-to-profound hearing loss, aged from 3 to 72 months, between January and December 2011. All had absent ABR and OAE responses. ASSR were evoked using binaural single frequency stimuli at 110 dBHL with a 10 dB-down seeking procedure. ASSR and behavioral test results were compared.Results: Forty-two subjects completed both ASSR and behavioral evaluation. In 13 children behavioral tests were not available, 1 had inconclusive ASSR. Among 42 children with absent ABR and OAE, 11 (26.1%) had bilateral ASSR, 10 correlated well to behavioral results. Four (9.5%) showed unilateral responses in at least 2 frequencies, all confirmed by behavioral results. Among 27 subjects with absent ASSR, 8 had no behavioral responses; 12 had responses only in low freq...

Devido aos avanços na tecnologia dos implantes cocleares e das estratégias de processamento, indivíduos com surdez grave a profunda puderam ouvir sons e reconhecer fala em diferentes graus. A variabilidade nos resultados audiológicos em portadores de surdez pós-lingual tem sido grande e a indicação para o implante coclear tem se estendido e inclui uma população cada vez maior. OBJETIVO: Avaliar em quais pacientes portadores de surdez pós-lingual o implante coclear traz benefício auditivo superior ao da prótese auditiva convencional. MATERIAIS E MÉTODOS: consulta a artigos científicos por busca no banco de dados SciELO, Cochrane, MEDLINE e LILACS-BIREME. Foram selecionadas publicações com força de evidência A ou B até a data da investigação, que comparassem aparelhos de amplificação sonora e implante coclear na população com surdez pós-lingual. Desenho do Estudo: revisão sistemática. RESULTADOS: Entre os 2169 artigos consultados, 11 trabalhos se mostram pertinentes ao tema e apresentaram força de evidência B. Seis estudos são do tipo coorte prospectivo, quatro são estudos transversais e um ensaio clinico. CONCLUSÃO: A avaliação dos benefícios obtidos por portadores de surdez pós-lingual reabilitados com o uso de implante coclear mostra que este dispositivo é efetivo e apresenta melhores resultados quando comparado aos aparelhos de amplificação sonora individual. The technological advances in cochlear implants and processing strategies have enabled subjects affected by severe to profound hearing loss to hear sounds and recognize speech in various different degrees. The variability of hearing outcomes in subjects with post-lingual deafness has been significant and cochlear implant indications have been extended to include an ever larger population. OBJECTIVE: This paper aims to look into the groups of post-lingual deafness patients to find where cochlear implants have yielded better outcomes than conventional hearing aids. MATERIALS AND METHODS: Review the literature available on databases SciELO, Cochrane, MEDLINE, and LILACS-BIREME. The publications selected for review were rated as A or B on evidence strength on the day of the review. Their authors analyzed and compared hearing aids and cochlear implants in populations of post-lingually deaf patients. Study Design: Systematic review. RESULTS: Eleven out of the 2,169 papers searched were found to be pertinent to the topic and were rated B for evidence strength. Six studies were prospective cohort trials, four were cross-sectional studies and one was a clinical trial. CONCLUSION: The assessment done on the benefits yielded by post-lingually deaf subjects from cochlear implants showed that they are effective and provide for better results than conventional hearing aids.

Neurofibromatosis 2 (NF2) is an autosomal dominant disease in which hearing loss is predominant. Auditory restoration is possible using cochlear implants (CI) or auditory brainstem implant (ABI). Objective: To assess the auditory results of CI and ABI in NF2 patients and review the literature. Methods: Four NF2 patients were prospectively evaluated. They were submitted to tumor resection followed by ipsilateral CI or ABI depending on cochlear nerve preservation. Long term auditory results were described for CI (12 months) and ABI (48 months). Results: All patients achieved auditory perception improvements in their hearing thresholds. The CI patient does not recognize vowels or sentences. The 3 ABI patients discriminate 70% of vowels and 86% in the 4-choice test. One of them does not recognize sentences. The other two recognize 100% of closed sentences and 10% and 20% of open sentences. Conclusion: The choice of implant type to restore hearing to NF2 patients will relay on anatomical and functional cochlear nerve preservation during tumor resection surgery. Although our experience was different, the literature shows that if this condition is achieved, CI will offer better auditory results. If not, ABI is recommended.

The auditory brainstem implant (ABI) was first developed to help neurofibromatosis type 2 patients. Recently, its use has been recently extended to adults with non-tumor etiologies and children with profound hearing loss who were not candidates for a cochlear implant (CI). Although the results has been extensively reported, the stimulation parameters involved behind the outcomes have received less attention. Objective The aim of this study is to describe the audiologic outcomes and the MAP parameters in ABI adults and children at our center. Methods Retrospective chart review. Five adults and four children were implanted with the ABI24M from September 2005 to June 2009. In the adult patients, four had Neurofibromatosis type 2, and one had postmeningitic deafness with complete ossification of both cochleae. Three of the children had cochlear malformation or dysplasia, and one had complete ossified cochlea due to meningitis. Map parameters as well as the intraoperative electrical auditory brainstem responses were collected. Evaluation was performed with at least six months of device use and included free-field hearing thresholds, speech perception tests in the adult patients and for the children, the Infant-Toddler Meaningful Auditory Integration Scale (IT-MAIS) and (ESP) were used to evaluate the development of auditory skills, besides the MUSS to evaluate. Results The number of active electrodes that did not cause any non-auditory sensation varied from three to nineteen. All of them were programmed with SPEAK strategy, and the pulse widths varied from 100 to 300 μs. Free-field thresholds with warble tones varied from very soft auditory sensation of 70 dBHL at 250 Hz to a pure tone average of 45 dBHL. Speech perception varied from none to 60% open-set recognition of sentences in silence in the adult population and from no auditory sensation at all to a slight improvement in the IT-MAIS/MAIS scores. Conclusion We observed that ABI may be a good option for offering some hearing attention to both adults and children. In children, the results might not be enough to ensure oral language development. Programming the speech processor in children demands higher care to the audiologist.

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.

This study aimed to evaluate the neural response in double-array cochlear implant as well as to describe the refractory recovery and the spread of excitation functions. In a prospective study 11 patients were implanted with the double-array cochlear implant. Neural response telemetry (NRT) was performed intra-operatively. NRT threshold could be registered in 6 of the 11 patients, at least in one electrode. The remaining five patients did not show measurable neural response intra-operatively. It was noted that although recovery and spread of excitation functions could be recorded in all the tested electrodes with measurable neural responses, the responses were shown to be different from the usual register in patients with other etiologies.

TEMA: implante coclear (IC) em crianças. Objetivo: traçar um perfil de linguagem oral receptiva e expressiva de crianças usuárias de implante coclear há cinco anos a cinco anos e onze meses; verificar a influência do tempo de privação sensorial na linguagem oral receptiva e expressiva dessas crianças. MÉTODO: 19 crianças deficientes auditivas usuárias de IC com deficiência auditiva pré-lingual, com tempo de uso do IC variando de 5a a 5a11m e média do tempo de privação sensorial de 3a (desvio padrão um ano) foram avaliadas por meio da Reynell Developmental Language Scales (RDLS) (Reynell e Gruber, 1990) que é composta pela Escala de Compreensão (C), Escala de Expressão (E) e suas Sub-Escalas Estrutura (Ee), Vocabulário (Ev) e Conteúdo (Ec). RESULTADOS: a mediana e os valores do quartil 75 e quartil 25 encontrados foram: 44, 57 e 54 para C; 48, 60 e 55 para E; 20, 21 e 20 para Ee; 15, 19 e 17 para Ev; 15, 22 e 18 para Ec; 96, 116 e 108 para a pontuação total. Houve correlação estatística entre o tempo de privação sensorial e a pontuação de C (p = - 0,62; R = 0,0044) e Ec (p = - 0,48; R = 0,0348) tornando o tempo de privação influente na pontuação total (p = - 0,53; R = 0,0174). CONCLUSÃO: o perfil de linguagem das crianças usuárias de implante coclear há cinco anos é desviante e semelhante ao perfil das crianças ouvintes de cinco anos para a Expressão e ao das crianças ouvintes de quatro anos para a Compreensão; a influência do tempo de privação sensorial foi estatisticamente significante na pontuação da C - linguagem receptiva - e na pontuação de uma seção (Ec) da E - linguagem expressiva, sendo significante na pontuação total da RDLS. BACKGROND: cochlear implant (CI) in children. AIM: 1) to delineate a profile of receptive and expressive verbal language of children who have been using cochlear implant for five years and five years and eleven months; 2) to verify the influence of time of auditory sensorial privation in the receptive and expressive verbal language of these children. METHOD: 19 children users of CI with auditory deficiency acquired before language development, who have been using CI for 5y - 5y11m and who have an average time of sensorial privation of 3y (standard deviation of 1 year). These children were assessed using the Reynell Developmental Scales (RDLS) (Reynell e Gruber, 1990) which is composed of: Comprehension Scale (C), Expression Scale (E) and its Structure Sub-Scales (Es), Vocabulary (Ev) and Content (Ec). RESULTS: the median values and the values found for quartile 75 and quartile 25 were:.44, 57 and 54 for C; 48, 60 and 55 for E; 20, 21 and 20 for Es; 15, 19 and 17 for Ev; 15, 22 and 18 for Ec; 96, 116 and 108 for the total score. A statistical correlation between the time of sensorial privation and the score obtained for C (p= - 0.62; R= 0.0044) and Ec (p= - 0.48; R = 0.0348) was observed. Therefore the time of sensorial privation had an influence on the overall score (p= - 0.53; R = 0.0174). CONCLUSION: the language profile of children who use CI for five years is devious and similar to that of five year old hearing children regarding Expression and to that of four year old hearing regarding Comprehension; time of sensorial privation was statistically significant for the score obtained in C - receptive language - and for the score obtained in the E section (Ec) - expressive language, as well as in the overall score of RDLS.

Summary Cochlear implantation has been recommended for children under 24 months of age. The use of objective measures is needed to help speech processor programming. The electrically evoked compound potential (EAP), which can be assessed by neural response telemetry (NRT), is one of those objective measures. Aim: to determine how often the EAP can be recorded by NRT system during surgery and to describe the responses. Study design: clinical with transversal cohort. Material and Method: the impedances and NRT were measured in a group of 17 Nucleus 24 ® implant users. The responses were analyzed and compared to the etiology, hearing loss duration and electrode array position. Results: The EAP was easily recorded in the apical electrodes and, in otosclerosis and meningitis cases the EAP threshold was higher than in the other etiology cases. Conclusions: The NRT can be found in 82% of the cases during surgery. The responses obtained may vary according to etiology and the position of electrodes along the cochlea.

Introdução: Com o progresso tecnológico dos implantes cocleares, cada vez mais pacientes com audição residual útil são candidatos em potencial ao implante (Hodges et al., 1997). Apesar disso, não se sabe ao certo se a introdução dos eletrodos poderia destruir as estruturas auditivas envolvidas nessa audição residual. Objetivo: O objetivo deste estudo foi verificar a conservação da audição residual em pacientes usuários de implante coclear multicanal, comparando a audiometria pré e pós-operatória desses indivíduos. Forma de estudo: Clínico prospectivo randomizado. Material e método: Foram estudados 09 pacientes adultos com disacusia sensorioneural bilateral severa a profunda, usuários de Implante coclear Nucleus 22 e 1 paciente usuário de Implante Combi 40+. Resultado: No grupo estudado a conservação auditiva ocorreu em 50% dos indivíduos, quando considerado o critério de conservação de duas ou mais frequências médias (da fala) e em 80%, se for considerada audição também em frequências graves. Conclusão: A média de queda dos limiares tonais antes e após a cirurgia foi de 4 dB na orelha implantada e 0 dB na orelha contralateral. Introduction: Technological development of Cochlear Implants allowed patients with residual hearing, that's to say, severe sensorineural hearing losses, to be considered as candidates (Hodges et al., 1997). Nevertheless, it is not clear whether the electrode array insertion may destroy remaining auditory structures. Aim: The purpose of this research was to verify the maitainance of residual hearing in multichannel cochlear implant users, by the comparison between the pre and post pure tone audiometry. Study design: Clinical prospective randomized. Material and method: Nine Nucleus 22 device and one Combi 40+ device users were evaluated. Results: In this sample hearing preservation was observed in 50% of the subjects, when considering the mid frequencies (speech frequencies) criterium of preservation. On the other hand, when the whole range of frequencies (including low frequencies) was considered as a criterium the preservation was revealed in 80% of the subjects. Conclusion: The average decrement in pure tone thresholds was 4 dB in the implanted ear and 0 dB in the contralateral ear.

Objetivos: Verificar a efetividade da teleprogramação em pacientes usuários de IC comparando os resultados audiológicos do IC e os parâmetros da programação nas condições remota e presencial; verificar a qualidade de transmissão remota e o grau de compreensão das orientações dadas pelo fonoaudiólogo remotamente. Casuística e método: Foi realizado um ensaio clínico randomizado, tipo cross over, no qual a intervenção remota (à distância) foi comparada à presencial. O desfecho do estudo foi a realização da audiometria em campo livre, testes de percepção de fala, além de questionário e escala VAS para análise da satisfação com o atendimento. Os critérios de seleção foram: idade entre 18 e 59 anos, de ambos os gêneros; usuários de IC da marca Cochlear®, unidade interna Nucleus 24® ou Freedom®, com processador de fala Freedom SP®, e tempo de experiência com implante coclear mínima de 12 meses. Os critérios de exclusão foram: dificuldade de compreensão no questionário realizado no início do estudo e deficiência visual que impossibilite a realização da leitura orofacial. Os participantes realizaram duas sessões de programação no mesmo dia: uma presencial - programação presencial (PP) e outra a distância - programação remota (PR). Os mesmos fonoaudiólogos realizaram as duas sessões de programação e a ordem de realização das programações foi randomizada. Foram comparados os níveis mínimos (níveis T) e níveis máximos de estimulação (níveis C) de cinco eletrodos (1, 6, 11, 16, 22). Foram aplicados testes de percepção de fala (frases closed-set, open-set sem ruído e com relação S/R 0 e 10dB, e monossílabos - todos com gravação a 65dB), audiometria em campo livre nas frequências de 250 a 8000Hz, questionário e escala visual analógica (VAS) para satisfação com o atendimento após as programações. Os resultados da audiometria, testes, questionários e do VAS também foram comparados. Resultados: Participaram 20 usuários de IC, com tempo médio de uso do dispositivo de 43 meses. Na comparação entre os níveis T obtidos na PR e PP, houve diferença estatisticamente significante nos eletrodos 22 e 16 (p 0,05). A escala VAS mostrou diferença estatisticamente significante, sendo o maior valor atribuído à PP (p=0,018). No questionário aplicado, houve diferença estatisticamente significante nas questões referentes à qualidade e comunicação no atendimento, mostrando que a PP apresentou menor dificuldade de compreensão e comunicação. Conclusão: A teleprogramação é viável e eficaz quando comparada à programação presencial. Embora tenham sido encontradas diferenças nos níveis de estimulação entre as programações realizadas de forma remota e presencial, não houve diferença nos resultados dos testes de percepção de fala e audiometria realizadas nos dois procedimentos. A programação presencial possibilitou maior facilidade de comunicação e satisfação em relação ao atendimento, quando comparada à programação realizada de forma remota Objectives: To verify the effectiveness of teleprogramming in CI users comparing the audiological results of the IC and the programming parameters in remote and live conditions; to verify the quality of remote transmission and the understanding of the guidance given by the audiologists remotely. Patients and methods: We conducted a randomized controlled trial, with crossover, in which the remote intervention (distance) was compared to the live intervention. The end point was the realization of the free field audiometry, speech perception tests, and questionnaire and VAS scale for analysis of satisfaction with the sections. The selection criteria were: age between 18 and 59 years, of both genders; CI users of Cochlear® device, internal unit Nucleus® 24 or Freedom® with speech processor Freedom® SP, and experience with CI of at least 12 months. Exclusion criteria were: difficulty in understanding the questionnaire completed at baseline and visual disability which makes impossible the realization of lip reading. Participants performed two programming sessions on the same day: a live programming (LP) and a remote programming (RP). The same audiologists conducted the two programming sessions and the order of realization of the sessions was randomized. The minimum (T) and maximum (C) stimulation levels of five electrodes (1, 6, 11, 16, 22) were established. Tests were applied for speech perception using 65dBSNR (closed-set sentences, open-set without noise and speech-in-noise with signal-to noise 0dB and 10db, and monosyllables). The patients were also submitted to free field audiometry from 250 to 8000Hz frequencies, visual analog scale (VAS) and questionnaire after the fittings sections. The results were compared using the Wilcoxon Test. Results: The study included a total of 20 CI users, with average time of use of 43 months. Statistically significant difference was found in the T levels for the electrodes 22 and 16 (p < 0.05), which indicates that levels were higher in RP. Statistically significant difference was found in the C levels for the electrodes 11 and 6 (p < 0.05), which indicates that levels were higher in LP. There were no statistically significant differences between the speech perception tests and thresholds obtained with maps of LP and RP (p > 0.05). The VAS scale showed a statistically significant difference, with the highest scores to LP (p = 0.018). In the questionnaire, there was a statistically significant difference in the questions about quality and communication during the sessions, showing that LP allowed less difficulty of understanding and communication. Conclusion: Teleprogramming is feasible and effective when compared to live programming. Although there were some differences in stimulation levels between the remote and live programming sessions, there was no difference in the results of thresholds in audiometry and speech perception tests performed in the two procedures. The live programming allowed better communication and satisfaction when compared to remote programming