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Introduction Surface electromyographic activity may not be symmetric, even in subjects with no facial paralysis history. Objective To evaluate the contribution of the index of electromyographic (IEMG) activity in the identification of the two extremes of the facial paralysis course. Methods Thirty-four subjects with unilateral peripheral facial paralysis were selected. A control group was composed of volunteers without a history of facial paralysis. The electromyographic assessment of the facial muscle was performed by placing surface electrodes during movements of the forehead, eyes and lips using MIOTEC equipment, such as the MIOTOOL (Miotec, Porto Alegre, Brazil) software. The electromyographic activity was also recorded in other channels during the primary activity to identify the presence of synkinesis. The statistical analysis was performed using the Statistical Package for Social Sciences for Macintosh (SPSS Inc, Chicago, IL, USA). The IEMG activity was obtained from the division of the electromyographic activity root mean square (RMS) values on both sides. Results There was a statistically significant difference among the groups in all the analyzed indexes. The ocular-oral synkinesis in all patients must be correctly identified (with 100% sensitivity and specificity) using an IEMG activity of 1.62 as a cutoff point. The oral-ocular synkinesis must be correctly identified (93.3% sensitivity and 95.9% specificity) using the IEMG activity of 1.79 as a cutoff point. Conclusion The IEMG activity is below the normal scores in patients in the flaccid stage, whereas patients in the sequelae stage can either show normal values or values above or below the normal scores. The IEMG activity was shown to have high sensitivity and specificity in the identification of synkinesis.

Profound hearing loss is a disability that affects personality and when it involves teenagers before language acquisition, these bio-psychosocial conflicts can be exacerbated, requiring careful evaluation and choice of them for cochlear implant. AIM: To evaluate speech perception by adolescents with profound hearing loss, users of cochlear implants. STUDY DESIGN: Prospective. MATERIALS AND METHODS: Twenty-five individuals with severe or profound pre-lingual hearing loss who underwent cochlear implantation during adolescence, between 10 to 17 years and 11 months, who went through speech perception tests before the implant and 2 years after device activation. For comparison and analysis we used the results from tests of four choice, recognition of vowels and recognition of sentences in a closed setting and the open environment. RESULTS: The average percentage of correct answers in the four choice test before the implant was 46.9% and after 24 months of device use, this value went up to 86.1% in the vowels recognition test, the average difference was 45.13% to 83.13% and the sentences recognition test together in closed and open settings was 19.3% to 60.6% and 1.08% to 20.47% respectively. CONCLUSION: All patients, although with mixed results, achieved statistical improvement in all speech tests that were employed. A surdez profunda é uma deficiência que afeta a personalidade e quando se trata de adolescentes com surdez profunda pré-lingual, esses conflitos biopsicossociais são exacerbados, necessitando de cautela na avaliação e escolha destes candidatos ao implante coclear. OBJETIVO: Avaliar a percepção de fala em adolescentes portadores de surdez pré-lingual do tipo neurossensorial grave a profunda bilateral com implante coclear. FORMA DE ESTUDO: Prospectivo. CASUÍSTICA E MÉTODO: Vinte e cinco indivíduos com surdez pré-lingual, sensório-neural, de grau severo ou profundo, que foram submetidos ao implante coclear na adolescência, definida entre 10 a 17 anos e 11 meses, passaram por testes de percepção de fala pré-implante e 2 anos após a ativação do dispositivo. Para análise, utilizamos os resultados dos testes de four choice, reconhecimento de vogais e sentenças em conjunto fechado e aberto. RESULTADOS: A média da porcentagem de acertos do teste de four choice antes do implante coclear era de 46,9% e após, 2 anos de uso do dispositivo, a média foi para 86,1%; no teste de vogais, a média foi de 45,13% a 83,13%; e no teste de sentenças em conjunto fechado e aberto foi de 19,3% a 60,6% e de 1,08% a 20,47%, respectivamente. CONCLUSÃO: Embora com resultados heterogêneos, todos obtiveram melhora estatística nos testes aplicados.

O Potencial de Ação Composto Evocado Eletricamente reflete a atividade do nervo auditivo, podendo ser registrado através dos eletrodos do implante coclear. A determinação dos elementos neurais estimuláveis pode contribuir para explicar a variabilidade de desempenho entre indivíduos implantados. OBJETIVO: Comparar o desempenho nos testes de percepção da fala entre pacientes que apresentaram e que não apresentaram potencial de ação composto evocado eletricamente no momento intra-operatório. MATERIAL E MÉTODO: Estudo prospectivo no qual 100 indivíduos usuários do implante coclear Nucleus 24 foram divididos em dois grupos de acordo com a presença ou ausência do potencial de ação intra-operatório. Após 6 meses de uso do dispositivo, os resultados dos testes de percepção de fala foram comparados entre os grupos. RESULTADOS: O potencial foi observado em 72% dos pacientes. A percepção no teste de frases em formato aberto foi melhor nos indivíduos com presença de potencial (média 82,8% contra 41,0%, p = 0,005). Houve associação entre ausência do potencial e etiologia da surdez por meningite. CONCLUSÃO: Ausência de potencial neural intraoperatório esteve associada ao pior desempenho na percepção da fala e à etiologia da surdez por meningite. Por outro lado, a presença do potencial de ação intraoperatório sugere ótimo prognóstico.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.

INTRODUÇÃO: A surdez profunda é uma deficiência que afeta a personalidade, o relacionamento e todo o estilo de vida do paciente e quando se trata de adolescentes com surdez profunda pré-lingual, esses conflitos biopsicossociais são exacerbados, necessitando de cautela na avaliação e escolha destes candidatos ao implante coclear. OBJETIVO: Avaliar a percepção de fala em adolescentes portadores de surdez pré-lingual do tipo neurossensorial severa a profunda bilateral com implante coclear. FORMA DE ESTUDO: Prospectivo. CASUÍSTICA E MÉTODO: O estudo foi desenvolvido no Ambulatório de Implante Coclear do grupo de Otologia do Hospital das Clinicas da Faculdade de Medicina da USP. 25 indivíduos com surdez pré-lingual, sensório-neural, de grau severo ou profundo, que foram submetidos ao implante coclear na adolescência, definida entre 10 a 17 anos e 11 meses, passaram por testes de percepção de fala pré-implante coclear e 2 anos após a ativação do dispositivo. Para a comparação e análise utilizamos os resultados dos testes de four choice, reconhecimento de vogais e reconhecimento de sentenças em conjunto fechado e aberto. RESULTADOS: Devido a assimetria na distribuição dos dados, os mesmos estão sumarizados como mediana e intervalo interquartis (percentil 25 percentil 75). Houve variação estatisticamente significante entre as avaliações pré e pós- implante para todos os testes analisados. CONCLUSÃO: Todos os pacientes, embora com resultados heterogêneos, obtiveram melhora estatística em todos os testes de fala que foram aplicados INTRODUCTION: The profound deafness is a disability that affects personality, relationships and lifestyle of the patient and when it comes to teenagers with profound hearing loss before language, these conflicts are exacerbated biopsychosocial, requiring careful evaluation and choice of candidates implant. OBJECTIVE: To evaluate speech perception in Cochlear Implants for adolescents with severe to profound prelinguistic deafness. STUDY DESIGN: Prospective. MATERIAL AND MÉTHOD: The study was conducted at the Ambulatório de Implante Coclear do grupo de Otologia do Hospital das Clinicas da Faculdade de Medicina da USP. 25 individuals with severe or profound prelinguistic deafness who underwent cochlear implantation in adolescence, set between 10 to 17 years and 11 months, passed tests of speech perception pre-implant and 2 years after activation of the device. For comparison and analysis were used the results of tests of four choice, recognition of vowels and recognition of sentences in closed set and open set. RESULTS: Because of asymmetry in the distribution of data, they are summarized as median and interquartile range (25th percentile - 75th percentile). The results have very significant differences between pre-and post-implant for all tests analyzed. CONCLUSION: All patients, although with mixed results, achieved statistical improvement in all speech tests that were applied

A possibilidade de realizar o implante coclear em crianças pequenas torna necessário o uso de medidas objetivas para auxiliar a programação do processador de fala. Telemetria é a propriedade que permite, no Nucleus 24®, a obtenção do potencial de ação composto evocado do VIII par (EAP) utilizando o implante como instrumento de estimulação e gravação para o estudo das propriedades neurais remanescentes. OBJETIVO: Descrever a utilização do sistema de telemetria para a gravação do EAP, caracterizando as respostas obtidas e a sua prevalência na condição intraoperatória. FORMA DE ESTUDO: clínico com coorte transversal. MATERIAL E MÉTODO: Medidas das impedâncias dos eletrodos e do EAP em um grupo de 17 indivíduos usuários do implante Nucleus 24® durante a cirurgia. Análise das respostas de acordo com a etiologia, o tempo de duração da surdez e a posição dos eletrodos dentro da cóclea. RESULTADOS: Maior prevalência nos eletrodos apicais e limiares mais elevados nos casos de meningite e otosclerose. CONCLUSÃO: A telemetria é eficiente para a verificação da integridade dos eletrodos na condição intraoperatória e para a gravação do EAP, apresentando alta prevalência na população estudada.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.

Introduction The factors that affect the development of children with and without hearing disabilities are similar, provided their innate communication abilities are taken into account. Parents need to mourn the loss of the expected normally hearing child, and it is important that parents create bonds of affection with their child. Objective To conduct a postevaluation of the development and cognition of 20 candidates for cochlear implants between 1 and 13 years of age and to observe important factors in their development. Methods The following instruments were used in accordance with their individual merits: interviews with parents; the Vineland Social Maturity Scale; the Columbia Maturity Scale; free drawings; Bender and Pre-Bender testing; and pedagogical tests. Results The results are described. Conclusion Parental acceptance of a child's deafness proved to be the starting point for the child's verbal or gestural communication development, as well as for cognitive, motor, and emotional development. If the association between deafness and fine motor skills (with or without multiple disabilities) undermines the development of a child's speech, it does not greatly affect communication when the child interacts with his or her peers and receives maternal stimulation. Overprotection and poor sociability make children less independent, impairs their development, and causes low self-esteem. Further observational studies are warranted to determine how cochlear implants contribute to patient recovery.

The Auditory Nerve Recovery Function (REC) may be extracted from the Electrically Evoked Compound Action Potential (ECAP). ECAP may be influenced by the stimulation received (or the deprivation of stimulation) and by the etiology of the hearing loss, consequently it might affect the REC.To verify whether there is a correlation between the REC and each of the following factors: etiology, time of auditory deprivation and time of hearing aid use before cochlear implantation (CI).Retrospective study. Data regarding etiology, time of auditory deprivation, time of hearing aid use before cochlear implantation were collected in children and adults who received a Nucleus®24. All patients who presented neural response at surgery and whose REC was assessed intraoperatively were included in this study. Fifty patients were selected, 26 children and 24 adults. Patients were divided according to the REC classification into three groups (GI: fast recovery; GII: intermediate recovery and GIII: slow recovery) to allow correlation analysis.Data analysis did not show any statistically significant correlation between the recovery function and the pre-implant studied characteristics. Nevertheless, it was observed that there was a greater concentration of both, children and adults, in the intermediate recovery function values. GI did not present individuals with infectious etiologies, such as meningitis, rubella and cytomegalovirus. REC average scores were slower in infectious etiologies for both children and adults.There was no statistically significant correlation between the recovery function and factors such as etiology, time of auditory deprivation and time of hearing aid use prior to CI.

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: alguns estudos relatam a importância da aplicação clínica no acompanhamento da função coclear em tratamentos com medicações ototóxicas ou em exposição a agentes nocivos à cóclea. Pesquisas sobre a reprodutibilidade das emissões otoacústicas foram realizadas para validar sua utilização na monitorização da função coclear, entretanto a experiência clínica nos mostra que os valores de variação entre teste-reteste não coincidem com os descritos na literatura. Objetivo: verificar a variação da amplitude de resposta das emissões otoacústicas transientes evocadas (TEOAEs) e das emissões otoacústicas por produto de distorção (DPOAEs). Forma de estudo: clínico prospectivo randomizado. Material e método: Foram estudados 10 indivíduos jovens com audição normal, usando programa Celesta 503, Madsen. Foram realizadas três avaliações com no mínimo três semanas de intervalo, mantendo-se constantes as variáveis clinicamente controláveis, tais como, tamanho da oliva, número de apresentações e intensidade do estímulo. Resultados: mostram que a amplitude das TEOAEs variou menos do que das DPOAEs, e que a amplitude da resposta inicial não mostrou ser determinante na variabilidade da resposta. Introduction: some studies report the importance of the cochlear function monitoring when dealing with patients exposed to ototoxic drugs or agents. A lot of research about test-retest reliability of the otoacoustic emissions was done to validate its use on cochlear monitoring. Nevertheless, our clinical experience shows us that the measured variations differ from those described in the literature. Aim: verify the variation of the transient evoked otoacoustic emissions and the distortion product otoacoustic emissions. Study design: clinical prospective randomized. Material and method: we studied 10 normal hearing young adults, using the Madsen, Celesta 503 program. Three serial evaluations were done, with a minimal interval of three weeks, maintaining variables such as olive size, number of sweeps and stimulus intensity controlled. Results: showed that the transient evoked otoacoustic emissions amplitude varied less than distortion product otoacoustic emissions amplitude and that the amplitude of the initial response was not determinant in the amount of variability.

Introdução: alguns estudos relatam a importância da aplicação clínica no acompanhamento da função coclear em tratamentos com medicações ototóxicas ou em exposição a agentes nocivos à cóclea. Pesquisas sobre a reprodutibilidade das emissões otoacústicas foram realizadas para validar sua utilização na monitorização da função coclear, entretanto a experiência clínica nos mostra que os valores de variação entre teste-reteste não coincidem com os descritos na literatura. Objetivo: verificar a variação da amplitude de resposta das emissões otoacústicas transientes evocadas (TEOAEs) e das emissões otoacústicas por produto de distorção (DPOAEs). Forma de estudo: clínico prospectivo randomizado. Material e método: Foram estudados 10 indivíduos jovens com audição normal, usando programa Celesta 503, Madsen. Foram realizadas três avaliações com no mínimo três semanas de intervalo, mantendo-se constantes as variáveis clinicamente controláveis, tais como, tamanho da oliva, número de apresentações e intensidade do estímulo. Resultados: mostram que a amplitude das TEOAEs variou menos do que das DPOAEs, e que a amplitude da resposta inicial não mostrou ser determinante na variabilidade da resposta.Introduction: some studies report the importance of the cochlear function monitoring when dealing with patients exposed to ototoxic drugs or agents. A lot of research about test-retest reliability of the otoacoustic emissions was done to validate its use on cochlear monitoring. Nevertheless, our clinical experience shows us that the measured variations differ from those described in the literature. Aim: verify the variation of the transient evoked otoacoustic emissions and the distortion product otoacoustic emissions. Study design: clinical prospective randomized. Material and method: we studied 10 normal hearing young adults, using the Madsen, Celesta 503 program. Three serial evaluations were done, with a minimal interval of three weeks, maintaining variables such as olive size, number of sweeps and stimulus intensity controlled. Results: showed that the transient evoked otoacoustic emissions amplitude varied less than distortion product otoacoustic emissions amplitude and that the amplitude of the initial response was not determinant in the amount of variability.

A possibilidade de realizar o implante coclear em crianças pequenas torna necessário o uso de medidas objetivas para auxiliar a programação do processador de fala. Telemetria é a propriedade que permite, no Nucleus 24®, a obtenção do potencial de ação composto evocado do VIII par (EAP) utilizando o implante como instrumento de estimulação e gravação para o estudo das propriedades neurais remanescentes. OBJETIVO: Descrever a utilização do sistema de telemetria para a gravação do EAP, caracterizando as respostas obtidas e a sua prevalência na condição intraoperatória. FORMA DE ESTUDO: clínico com coorte transversal. MATERIAL E MÉTODO: Medidas das impedâncias dos eletrodos e do EAP em um grupo de 17 indivíduos usuários do implante Nucleus 24® durante a cirurgia. Análise das respostas de acordo com a etiologia, o tempo de duração da surdez e a posição dos eletrodos dentro da cóclea. RESULTADOS: Maior prevalência nos eletrodos apicais e limiares mais elevados nos casos de meningite e otosclerose. CONCLUSÃO: A telemetria é eficiente para a verificação da integridade dos eletrodos na condição intraoperatória e para a gravação do EAP, apresentando alta prevalência na população estudada. 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. HC-FMUSP Santa Casa de Misericórdia de SP HC-FMUSP UNIFESP PUC-SP UNIFESP SciELO