Progress towards early detection services for infants with hearing loss in developing countries

BACKGROUND: Early detection of infants with permanent hearing loss through infant hearing screening is recognised and routinely offered as a vital component of early childhood care in developed countries. This article investigates the initiatives and progress towards early detection of infants with hearing loss in developing countries against the backdrop of the dearth of epidemiological data from this region. METHODS: A cross-sectional, descriptive study based on responses to a structured questionnaire eliciting information on the nature and scope of early hearing detection services; strategies for financing services; parental and professional attitudes towards screening; and the performance of screening programmes. Responses were complemented with relevant data from the internet and PubMed/Medline. RESULTS: Pilot projects using objective screening tests are on-going in a growing number of countries. Screening services are provided at public/private hospitals and/or community health centres and at no charge only in a few countries. Attitudes amongst parents and health care workers are typically positive towards such programmes. Screening efficiency, as measured by referral rate at discharge, was generally found to be lower than desired but several programmes achieved other international benchmarks. Coverage is generally above 90% but poor follow-up rates remain a challenge in some countries. The mean age of diagnosis is usually less than six months, even for community-based programmes. CONCLUSION: Lack of adequate resources by many governments may limit rapid nationwide introduction of services for early hearing detection and intervention, but may not deter such services altogether. Parents may be required to pay for services in some settings in line with the existing practice where healthcare services are predominantly financed by out-of-pocket spending rather than public funding. However, governments and their international development partners need to complement current voluntary initiatives through systematic scaling-up of public awareness and requisite manpower development towards sustainable service capacities at all levels of healthcare delivery

Universal hearing health care: Where do audiology and hearing aids fit?

link_to_subscribed_fulltex

Resultados auditivos com o implante coclear multicanal em pacientes submetidos a cirurgia no Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo Auditory results with multicanal cochlear implant in patients submitted to cochlear implant surgery at University of São Paulo Medical School - Hospital das Clínicas

A surdez profunda é uma deficiência que afeta a personalidade, o relacionamento e todo o estilo de vida do paciente. Incapacita os indivíduos de escutarem sons ambientes como sirenes e alarmes que constituem alerta em situações da vida diária e não permite a modulação vocal, tornando a voz esteticamente ruim. A prótese auditiva convencional é eficiente no tratamento de grande parte das deficiências auditivas, porém existem pacientes que não conseguem obter discriminação de palavras e sentenças mesmo com uma prótese auditiva potente. O implante coclear é a alternativa atual para estes pacientes. OBJETIVO: Avaliar o resultado auditivo dos pacientes adultos implantados com o implante coclear multicanal pelo Grupo de Implante Coclear da Disciplina de Otorrinolaringologia da Faculdade de medicina da Universidade de São Paulo. FORMA DE ESTUDO: Estudo de série. CASUÍSTICA E MÉTODO: Foram selecionados 61 pacientes com surdez profunda bilateral que utilizam o implante coclear multicanal por pelo menos seis meses e estudados os resultados auditivos através de testes de reconhecimento de palavras e sentenças. RESULTADOS: O PTA médio obtido pelos pacientes foi 38.7 dB NPS. A média em reconhecimento de sentenças em formato aberto foi de 71.3%, vogais em 86.5%, monossílabos em 52.60% e consoante medial em 52.6%. A maioria dos pacientes está apta ao uso do telefone. CONCLUSÃO: A avaliação auditiva obtida seis meses após a primeira programação do implante demonstra que pacientes de língua portuguesa obtêm excelentes resultados em testes de reconhecimento de palavras e sentenças em apresentação aberta, readquirindo uma audição útil.<br>Complete hearing loss is a very important handicap resulting in sensory deprivation and affecting an individual's personality, relationships and life style. Individuals with profound deafness are unable to hear environmental sounds as doorbells, telephones, traffic noises and sirens that are an important alert for dangerous situations in the daily life. They are also unable to hear their own voices and for this people with profound deaf do not modulate their voices. The hearing aids are the first choice to treat deafness, but there are patients with severe damage of the auditory systems who cannot receive a useful hearing from normal hearing aids. The cochlear implant is the alternative for patients that cannot have good discriminatory ability wearing a powerful hearing aid and wish or need a better hearing. AIM: To study the hearing results of the adult patients who are using a multichannel cochlear implant system at the Department of Otolaryngology - University of Sao Paulo. STUDY DESIGN: Series study. MATERIAL AND METHOD: We selected 61 patients with a severe bilateral hearing loss that have been using the cochlear implant for at least six months. The hearing evaluation performed after using the device for six months included word and sentence recognition tests. RESULTS: The PTA of four patients reached 38.7 dB. Speech perception tests showed 713% recognition of open set sentences, 86.5% of vowels and 52.60% of monosyllabic. Most of our patients are able to speak on the telephone. CONCLUSION: Most of patients showed excellent results in open-set sentence and word tests

Estudo anatômico da cóclea para confecção de instrumental para a cirurgia de implante coclear com 2 feixes de eletrodos em cócleas ossificadas Cochlear anatomy study used to design surgical instruments for cochlear implants with two bundles of electrodes in ossified cochleas

A ossificação da cóclea, decorrente principalmente de meningite, impede a inserção completa do implante coclear convencional. Os implantes com 2 feixes de eletrodos mais curtos do que o convencional foram desenvolvidos especialmente para cócleas ossificadas. Porém, durante essa cirurgia há um grande risco de lesão da artéria carótida interna (ACI). Portanto, a medida da profundidade das cocleostomias para inserir os dois feixes de eletrodos aumentaria a segurança desse procedimento. OBJETIVOS: 1) Obter as distâncias entre as cocleostomias e a ACI em ossos temporais de cadáver; 2) Confeccionar instrumento que possa ser usado na cirurgia de implante coclear com 2 feixes de eletrodos. FORMA DE ESTUDO: Experimental prospectivo. MATERIAL E MÉTODO: Em 21 ossos de cadáveres foi realizada: 1) mastoidectomia cavidade aberta; 2) cocleostomias nos giros basal e médio da cóclea; 3) identificação da ACI; 4) medida da distância entre as cocleostomias e a artéria. RESULTADOS: A medida média ± desvio padrão obtida para o túnel superior foi 8,2 ± 1,1mm e para o túnel inferior foi 8,1± 1,3mm. A menor distância encontrada foi 6,5mm para o túnel superior e 6,0mm para o túnel inferior. CONCLUSÃO: Apesar dos parâmetros calculados concluímos que a melhor medida para ser considerada na confecção do instrumento cirúrgico serão as mínimas medidas obtidas em cada um dos giros cocleares, pois é a maneira mais segura para evitar a lesão da ACI, que pode ser fatal.<br>Cochlear ossification, mainly secondary to meningitis, prevents the complete conventional cochlear implant insertion. Implants with two electrode bundles shorter than the conventional ones were specifically developed for ossified cochleas. However, during surgery there is a high risk of damaging the internal carotid artery (ICA). Therefore, measuring cochleostomy depth in order to insert the two electrode bundles would greatly increase the procedure's safety. AIMS: 1) Find the distances between cochleostomies and ICA in cadaver temporal bones. 2) Design an instrument that can be used in cochlear implant surgery to introduce an implant with two bundles of electrodes. STUDY DESIGN: Experimental prospective. MATERIALS AND METHODS: In 21 temporal bones from cadavers we performed: 1) canal wall down mastoidectomy; 2) cochleostomy in the cochlear basal and middle turns; 3) ICA identification; 4) Length determination between the cochleostomies and the artery. RESULTS: the average distance ± standard deviation obtained for the upper tunnel was of 8.2 ± 1.1 mm and for the lower tunnel it was of 8.1± 1.3 mm. The shortest distance found was of 6.5 mm for the upper tunnel and 6.0 mm for the lower tunnel. CONCLUSION: Despite the values calculated, we concluded that the best value to be considered in creating a surgical instrument are the minimum lengths obtained for each one of the cochlear turns, because this is the safest way to avoid damaging the ICA, that can be fatal