Carina® and Esteem®: A Systematic Review of Fully Implantable Hearing Devices

<div><p>Objective</p><p>To review the outcomes of the fully implantable middle ear devices Carina and Esteem regarding the treatment of hearing loss.</p><p>Data Sources</p><p>PubMed, Embase, Scielo, and Cochrane Library databases were searched.</p><p>Study Selection</p><p>Abstracts of 77 citations were screened, and 43 articles were selected for full review. From those, 22 studies and two literature reviews in English directly demonstrating the results of Carina and Esteem were included.</p><p>Data Extraction</p><p>There were a total of 244 patients ranging from 18 to 88 years. One hundred and 10 patients were implanted with Carina and with 134 Esteem. There were registered 92 males and 67 females. Five studies provided no information about patients’ age or gender. From the data available, the follow-up ranged from 2 to 29.4 months.</p><p>Data Synthesis</p><p>The comparison of the results about word recognition is difficult as there was no standardization of measurement. The results were obtained from various sound intensities and different frequencies. The outcomes comparing to conventional HAs were conflicting. Nevertheless, all results comparing to unaided condition showed improvement and showed a subjective improvement of quality of life.</p><p>Conclusion</p><p>There are still some problems to be solved, mainly related to device functioning and price. Due to the relatively few publications available and small sample sizes, we must be careful in extrapolating these results to a broader population. Additionally, none of all these studies represented level high levels of evidence (i.e. randomized controlled trials).</p></div

Demographic characteristics of the studies.

<p>n – number; MED – middle ear device; mths – months; M – male; F – female; NR – not reported.</p><p>Demographic characteristics of the studies.</p

Cortical maturation in children with cochlear implants: Correlation between electrophysiological and behavioral measurement

<div><p>Central auditory pathway maturation in children depends on auditory sensory stimulation. The objective of the present study was to monitor the cortical maturation of children with cochlear implants using electrophysiological and auditory skills measurements. The study was longitudinal and consisted of 30 subjects, 15 (8 girls and 7 boys) of whom had a cochlear implant, with a mean age at activation time of 36.4 months (minimum, 17 months; maximum, 66 months), and 15 of whom were normal-hearing children who were matched based on gender and chronological age. The auditory and speech skills of the children with cochlear implants were evaluated using GASP, IT-MAIS and MUSS measures. Both groups underwent electrophysiological evaluation using long-latency auditory evoked potentials. Each child was evaluated at three and nine months after cochlear implant activation, with the same time interval adopted for the hearing children. The results showed improvements in auditory and speech skills as measured by IT-MAIS and MUSS. Similarly, the long-latency auditory evoked potential evaluation revealed a decrease in P1 component latency; however, the latency remained significantly longer than that of the hearing children, even after nine months of cochlear implant use. It was observed that a shorter P1 latency corresponded to more evident development of auditory skills. Regarding auditory behavior, it was observed that children who could master the auditory skill of discrimination showed better results in other evaluations, both behavioral and electrophysiological, than those who had mastered only the speech-detection skill. Therefore, cochlear implant auditory stimulation facilitated auditory pathway maturation, which decreased the latency of the P1 component and advanced the development of auditory and speech skills. The analysis of the long-latency auditory evoked potentials revealed that the P1 component was an important biomarker of auditory development during the rehabilitation process.</p></div

Correlation between P1 component latencies and IT-MAIS/MAIS and MUSS scores in the children with CI at both time points.

<p>Correlation between P1 component latencies and IT-MAIS/MAIS and MUSS scores in the children with CI at both time points.</p

Correlation between the IT-MAIS/MAIS and MUSS questionnaires in the children with CI at both time points.

<p>Correlation between the IT-MAIS/MAIS and MUSS questionnaires in the children with CI at both time points.</p

Descriptive statistics of P1 component latencies (ms) at the two time points for both groups.

<p>ms, milliseconds; CI, cochlear implants.</p

LLAEP trace recording of a child using CI at the two time points.

<p>ms, milliseconds; μV, microvolts.</p

Descriptive analysis of the percentages obtained in the IT-MAIS/MAIS and MUSS questionnaires for the children with CI at both time points.

<p>Descriptive analysis of the percentages obtained in the IT-MAIS/MAIS and MUSS questionnaires for the children with CI at both time points.</p

Comparison of performance in the second evaluation according to auditory skills obtained in the GASP in the children with CI.

<p>Comparison of performance in the second evaluation according to auditory skills obtained in the GASP in the children with CI.</p