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Introduction Current data show that binaural hearing is superior to unilateral hearing, specifically in the understanding of speech in noisy environments. Furthermore, unilateral hearing reduce onés ability to localize sound. Objectives This study provides a systematic review of recent studies to evaluate the outcomes of cochlear implantation in patients with single-sided deafness (SSD) with regards to speech discrimination, sound localization and tinnitus suppression. Data Synthesis We performed a search in the PubMed, Cochrane Library and Lilacs databases to assess studies related to cochlear implantation in patients with unilateral deafness. After critical appraisal, eleven studies were selected for data extraction and analysis of demographic, study design and outcome data. Conclusion Although some studies have shown encouraging results on cochlear implantation and SSD, all fail to provide a high level of evidence. Larger studies are necessary to define the tangible benefits of cochlear implantation in patients with SSD.

To report the audiological outcomes of cochlear implantation in two patients with severe to profound sensorineural hearing loss secondary to superficial siderosis of the CNS and discuss some programming peculiarities that were found in these cases. Retrospective review. Data concerning clinical presentation, diagnosis and audiological assessment pre- and post-implantation were collected of two patients with superficial siderosis of the CNS. Both patients showed good hearing thresholds but variable speech perception outcomes. One patient did not achieve open-set speech recognition, but the other achieved 70% speech recognition in quiet. Electrical compound action potentials could not be elicited in either patient. Map parameters showed the need for increased charge. Electrode impedances showed high longitudinal variability. The implants were fairly beneficial in restoring hearing and improving communication abilities although many reprogramming sessions have been required. The hurdle in programming was the need of frequent adjustments due to the physiologic variations in electrical discharges and neural conduction, besides the changes in the impedances. Patients diagnosed with superficial siderosis may achieve limited results in speech perception scores due to both cochlear and retrocochlear reasons. Careful counseling about the results must be given to the patients and their families before the cochlear implantation indication.

Summary Introduction: Acoustic nerve tumors have been recognized as a clinico-pathologic entity for at least 200 years, and they represent 90% of cerebellopontine angle diseases. Histologically, the tumors are derived from Schwann cells of the myelin sheath, with smaller tumors consisting of elongated palisade cells, while in large tumors, cystic degeneration can be found in the central areas, possibly due to deficient vascularization. We retrospectively reviewed 825 cases of vestibular schwannomas, reported between January 1984 and August 2006, in which the patients underwent surgery to remove the tumor. Objective: To evaluate signs, symptoms, aspects of clinical diagnosis, including the results of audiological and imaging studies, and surgical techniques and complications. Methods: A retrospective chart review. The medical records of all patients undergoing surgical treatment for schwannoma during the period indicated were reviewed. Results and Conclusion: Hearing loss was the first symptom reported in almost all cases, and tumor size was not proportional to the impairment of the auditory threshold. The surgical techniques allowed safe preservation of facial function. In particular, the retrolabyrinthine route proved useful in small tumors, with 50% preservation of hearing.

Objetivo: comparar o reconhecimento de fala na situação de silêncio e ruído com a prótese auditiva de orelha média totalmente implantável Esteem® em relação à prótese auditiva. Descrever a satisfação auditiva e as complicações cirúrgicas encontradas. Desenho do Estudo: estudo exploratório, prospectivo, intragrupo, sujeito como seu próprio controle. Pacientes: usuários de prótese auditiva com perda neurossensoraial moderada a severa bilateral. Intervenção: dez pacientes submetidos a cirurgia para colocação da prótese totalmente implantável Esteem®. Aplicação de questionário SADL no pré- e pós-operatório. Desfechos: reconhecimento de fala no silêncio e ruído, resultados do SADL e complicações do procedimento foram avaliadas. Resultados: Não houve diferença estatisticamente significante entre reconhecimento de fala nas condições de silencio e ruído em relação as próteses auditivas (p=0,23 e p= 0,0438). Houve diferença estatisticamente significante no score do SADL pré- e pós-operatório (p= 0,0076). Houve três necessidades de reintervenção cirúrgica, em uma delas a prótese precisou ser removida. Conclusões: Melhora da satisfação auditiva, tendência a melhora no reconhecimento de fala nas situações de silêncio e ruído. Procedimento deve ser realizado por cirurgiões otológicos experientes. Objective: to compare speech discrimination in silence and in noise with the Esteem® totally implantable hearing device versus hearing aids, and to describe satisfaction with amplification and surgical complications in patients undergoing implantation of the Esteem® device. Study Design: this was an exploratory, prospective, within-group, subject-as-own-control study. Setting: tertiary referral center. Patients: hearing aid users with moderate to severe bilateral sensorineural hearing loss. Interventions: ten patients underwent placement of the Esteem® totally implantable hearing device. The Satisfaction with Amplification in Daily Life (SADL) questionnaire was administered pre- and postoperatively. Main Outcome Measures: speech discrimination in silence and noise, SADL scores, and complications were evaluated. Results: there were no statistically significant differences between hearing aids and the Esteem® device in speech discrimination in silence (p=0.23) or noise (p=0.0438). There was a significant difference between pre and postoperative SADL scores (p=0.0076). Three patients required reintervention, and one ultimately required explantation of the device. Conclusions: Use of the Esteem® device was associated with improved satisfaction with amplification and a trend toward improvement in speech discrimination in silence and noise. Implantation of the device is challenging and should be performed by experienced otologic surgeons.

Conclusion: The extended retrolabyrinthine approach (RLA) is a safe and reliable approach for auditory brainstem placement in children. The surgical landmarks to reach cochlear nucleus are adequately exposed by this approach. Objective: To describe a new approach option for auditory brainstem implants (ABIs) in children, highlighting the anatomical landmarks to appropriately expose the foramen of Luschka. Methods: Three prelingually deafened children consecutively operated for ABIs via the RLA. Results: ABI placement via the RLA was successfully performed in all children without any further complications except multidirectional nystagmus in one child. The RLA we employed differed from that used for vestibular schwannoma only in the removal of the posterior semicircular canal. The lateral and superior semicircular canals and the vestibule remained intact, and there was no need to expose the dura of the internal auditory meatus. The jugular bulb was completely exposed to allow adequate visualizatio...

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.