Implante coclear: O que fazer em caso de avaria?

Introduction: Cochlear implantation allows auditory stimulation in individuals with bilateral profound hearing loss with limited benefits from conventional hearing aids. This device facilitates language development in children with profound sensorineural congenital hearing loss. The language development of children who use cochlear implants has differences when compared with that of normal-hearing children. This study investigated the linguistic performance of children who use cochlear implant over time and the influence of age at implantation on the results. Materials and methods: Study on the spoken language development in children with profound sensorineural congenital hearing loss implanted between 19 to 60 months of age in Centro Hospitalar de Coimbra. The evaluation instrument was a Portuguese Language Development Test (Teste de Avaliacao da Linguagem na Crianca). The participants were divided into 4 groups, based on age at implantation: before 25 months, from 25 to 36 months, from 37 to 48 months and after 48 months of age. Results: A comparison was made between the results of the four implanted children groups, as well as with normative data available for the test used. The implanted group that showed the best final results and the evolution curve most similar to that of the normative data was the group implanted before 25 months of age. No statistically significant differences were found between the studied groups. Conclusion: The collected data indicates a positive effect of early implantation on language development. The obtained results are in agreement with the literature. New studies should include more individuals and the evaluation of other aspects of child development.

(2010). Linguistic Assessment Tools for the Digisonic® Dual Electric-Acoustic Speech Processor. Cochlear Implants International: Vol. 11, Proceedings of the 9th European Symposium on Paediatric Cochlear Implantation, Warsaw, 2009, pp. 306-311.

TRABECULAR BONE MICROARTCHITECTURE IN ASSOCIATION WITH SYSTEMIC AND LOCAL FACTORS AS POTENTIAL PREDICTORS OF IMPLANT FAILURE By Diego A. Camacho DMD A thesis submitted in partial fulfillment of the requirements for the degree of Master of Science in Dentistry at Virginia Commonwealth University Virginia Commonwealth University, 2016 Major Director: Thomas C. Waldrop DDS, MS, Professor and Director, Graduate Periodontics Clinicians have described the success rates of dental implants. The use of implants is projected to increase in the future. With a 5-10% failure rate, it is unclear the exact factors that are associated with implant failures. To improve upon these success rates, it is critical to understand parameters associated with implant failure including: periodontitis, peri-implantitis, systemic diseases, site preparation, dental history of the implant site, bone quality, materials, occlusion, and treatment timelines. While bone quality is associated with failure, objective measures to assess bone quality and characteristics are scarce. Therefore, the aim of this study is

Cochlear Implants Present and Future

The development of safe implants is one of the key priorities of biomedical engineering. Healthcare professionals are trying to create new and sophisticated strategies to improve and support people with disabilities using implants. The research described in this thesis focuses on developing a power supply from a wireless source for implants that will also serve as a wireless data telemetry channel for communication purposes. The design analysis of inductive coupled biomedical implant is expanded. The proposed method of powering the implant is a Class-E amplifier. An analytic approach is given in relation to tuning the class-E amplifier to maximize power transfer. This thesis culminates in specific recommendations for system level design including coil design, miniaturisation, coupling distance, stability of power supplies, consistent energy transfer and the ensuing electromagnetic exposure. The telemetry system for data transfer between implants and outside world has been also studied. This bio-telemetry system setup should ensure an optimal data rate, proper energy levels, low error rates, and a reliable power source. The efficiency of the system is crucial for these implants, and the use of efficient and low power consumption amplifiers and modulation schemes has been discussed in detail. The advantages of Pulse Width Modulated – Amplitude Shift Keying (PWM-ASK for short) are presented in comparison to current modulation schemes used in nowadays implants. Beside inductive coupled implants, this thesis also introduces a study of designing a wireless powered biomedical implant using capacitive coupling. A comparison between inductive and capacitive coupling is presented, while considering biotelemetry and power efficiency. A capacitive coupled biomedical implant is demonstrated through mathematical terms and simulations.

Subdermal contraceptive implant is approved in more than 60 countries and used by millions of women around the world. Although relatively safe in nature, their implantation and removal may be associated with potential complications, some of which may require surgical intervention. Two types of peripheral neurological complications are reported: complications related to compressive neuropathy caused by device decubitus and complications related to device improper removal. An healthy 35-year-old woman come to our attention for paresthesia from medial side of right elbow to fourth and fifth fingers. Tinel sign was positive on medial side of distal third of right arm, above the elbow, as well. Clinical history of patients revealed a subcutaneous placement of a etonogestrel implant 3 years before. Patients reported disappearing of tactile feeling of subcutaneous contraceptive implant since two months. At clinical examination, implant was not felt in its original subcutaneous place. X-rays control revealed its proximal and deep migration. Surgical exploration for subcutaneous contraceptive implant removal revealed it lying on the ulnar nerve. Patient referred immediate paresthesia disappearing after surgery. At 1 month follow up no motor or sensory alteration were evident. Removal of implants inserted too deeply must be carefully performed to prevent damages to nervous and vascular structures and it should be performed by operators who are very familiar with the anatomy of the arm. In case of chronic neuropathy caused by implant nerve compression only an appropriate patients information about rare but possible neuropathic symptoms related to device migration and a careful medical history collecting can avoid a mistaken diagnosis of canalicular syndrome. (www.actabiomedica.it)

<b>Purpose: </b>There is a well-established relationship between hearing loss and psychological symptoms. To ensure audiological rehabilitation is provided appropriately for older adults with comorbid psychological symptoms, a greater understanding of their preferences and experiences is needed. This study sought to understand experiences of hearing loss and audiological rehabilitation from the perspective of older adults with comorbid psychological symptoms (e.g., depression, anxiety, psychosis).<b>Design: </b>A qualitative study using in-depth semistructured interviews was conducted with older adults who had attended audiological rehabilitation within the last year and scored above established cutoffs on measures of depression, anxiety, and psychosis. A thematic analysis generated themes that related to participants’ experiences of hearing loss and audiological rehabilitation.<b>Results:</b> Participants included 14 older adults (eight men and six women) with an average age of 70.5 years (<i>SD</i> = 4.45, range: 64–80) who received hearing aids or a cochlear implant. Three major themes emerged from the analysis of participant interviews. “The cumulative impact of hearing loss and psychological symptoms” theme describes the two-way, additive relationship between hearing ability and psychological symptoms. “The experience of loss throughout hearing loss and audiological rehabilitation” captures subjective losses, the impact they have, and how participants cope with them. In contrast, “The experience of gain throughout hearing loss and audiological rehabilitation” describes the participants’ reported gains, their related impacts, and coping strategies.<b>Conclusions: </b>The experiences of participants revealed that the presence of comorbid psychological symptoms can influence the experience of hearing loss and audiological rehabilitation. These findings have implications for how audiological rehabilitation is provided to ensure optimal outcomes for adults with hearing loss and comorbid psychological symptoms.<br><b>Supplemental Material S1. </b>Sampling matrix containing number of participants fulfilling criteria (gender, age, hearing device, psychological symptoms) to obtain maximum variation sampling.<br><b>Supplemental Material S2.</b> Interview topic guide containing initial and follow-up open-ended questions.<br>Laird, E. C., Bennett, R. J., Barr, C. M., &amp; Bryant, C. A. (2020). Experiences of hearing loss and audiological rehabilitation for older adults with comorbid psychological symptoms: A qualitative study. <i>American Journal of Audiology.</i> Advance online publication. https://doi.org/10.1044/2020_AJA-19-00123

Disability is a profoundly relational category, always already created as a distinction from cultural ideas of normality, shaped by social conditions that exclude full participation in society of those considered atypical Faye Ginsburg, Rayna Rapp, Disability worlds, 2013. This article explores how the temporal needs of intervention for deaf people defines therapies inside the clinical spaces, and appears as an essential and political element inside the controversy between associations and institutions deafness related. Inside the clinical/therapeutic process of enabling language for deaf, the “time” – divided by the contradiction “fast”/“slow” – appears as characteristic element as well as useful tool to investigate health system linked to deafness. In a biomedical fieldwork defined by the balance of power between social actors – associations, family, deaf people, audiologists, otorhinolaryngologists, speech therapists – the “time” and “mandate” practical-operational of clinical professionals tend to manage the production of health and disease. From this context, my contribution refers to an ethnographic case that I followed with health and education professionals to structuring an Italian Sign Language educational path, after the “failure” of biomedical approach based on multiple operations for inserting a Cochlear Implant.

Objectives: To adapt the LittlEARS Questionnaire in Tamil language and evaluate it in Tamil speaking cochlear implant children. Methods: LEAQ was translated to the Tamil language by a back-translation method following the guidelines of the World Health Organisation. The translated version was later administered to 100 randomly selected parents of cochlear implantees, scoring was done out of 35 for each child. Statistical analysis was done using SPSS software version 20.0 were descriptive statistics were carried out extracting the mean, standard deviation and range. Results: The results got did not significantly deviate from the normative, thus being able to quantify hierarchical auditory development skills and performance of children. Conclusion: LEAQ is a good subjective tool that can measure the outcome of cochlear implant/hearing aids, it must be translated and validated based on cultural and linguistic background. Article visualizations:

Since many years, inert metals such as stainless steel, cobalt-chromium and titanium alloys have been the primary biomaterials used for load bearing applications. In order to these metallic implants such as pins, screws and plates for repairing the defects have to be removed by secondary surgery once the bone tissue is healed, which will increase the morbidity, pain and cost. Hence conventional metallic biomaterials are biocompatible but not biodegradable. At present, polymeric biomaterials such as poly-lactic acid (PLA) are used in these applications. The main limitations in using polymers in load bearing implants are their low mechanical strength, hardness and wear resistance. Due to this, biodegradable materials are developed for designing temporary implants like fixation devices for fractured bones or stents. The potential for magnesium based alloys, which are biodegradable and bioabsorbable in biomedical applications has been broadly studied as emerging directions. This study gives a review about current status of biodegradable implant materials.

小児人工内耳装用者におけるＦＭ補聴システムの活用状況

More than 80% of the affected 430 million people with disabling hearing loss suffer from sensorineural hearing loss.1,2 When the cause of the hearing loss cannot be determined, it is referred to as idiopathic sudden sensorineural hearing loss (ISSNHL). In the absence of response to standard therapy, the use of hearing aids or cochlear implantation is recommended.2 We present a patient with unilateral ISSNHL who was treated with a cochlear implant and developed hearing threshold recovery 1 year after implantation. A 55-year-old man presented with acute left-sided hearing loss bordering on deafness, intermittent vertigo and numbness on the left side of the face. There was no improvement in the audiogram after coverage of the oval and round window. After 5 years with no further improvement, a cochlear implantation was performed. The patient then achieved speech intelligibility of 80% in the Freiburg monosyllabic test. Nevertheless, in 2021 he complained of pain and vertigo when using the cochlear implant. Audiometry showed a new hearing threshold of 25 dB from 250 Hz to 1 kHz with bone conduction, confirmed by objectiv testing. According to the literature, 21-28% of patients treated for ISSNHL make a full recovery.3 Notably, patients with a more severe form of hearing loss showed a delayed recovery, so sufficient follow-up time (6 months) should be offered.4 Interesting in our case is that the hearing has recovered after 7 years. It is unclear what caused the sudden improvement in hearing in this patient. Investigations with a small study population discovered a possible association between cochlear synaptopathy and full recovery after ISSNHL, suggesting a possible involvement of cochlear synaptopathy in the pathogenesis of ISSNHL.3

To compare the rate of device failure for those cochlear implants (CIs) involved in the 2020 Food and Drug Administration (FDA) voluntary field corrective action (VFCA). Medline, Embase, and Scopus. A systematic review was performed according to the PRISMA guidelines. Publications reporting institutional experiences with implants affected by the VFCA were included. Outcomes assessed included etiology of, rate of, and time to failure and pre-/post-device failure speech perception testing. All outcomes reported in at least two independent studies were included in a meta-analysis. Six studies met criteria for analysis. The overall pooled failure rate was 23.7% (95% CI, 11.6-38.4%). The pooled device, inconclusive, and medical failure rates were 21.5%, 0.2%, and 0.7%, respectively. Pediatric failure rates were higher than those of adults (46.9% [95% CI, 11.2-84.5%] versus 32.6% [95% CI, 8.2-63.7%]). WRS declined with primary implant failure (55.1% [95% CI, 48.0-62.1%] to 34.1% [95% CI, 30.2-38.0%]) but improved after reimplantation (34.1% [95% CI, 30.2-38.0%] to 50.1% [95% CI, 45.2-55.1%]). The rate of pooled reported failure for CIs falling under the 2020 VFCA in the literature thus far is 23.7%. The overwhelming majority of these failures were device related, the rates of which were higher in children. Speech perception improved significantly after reimplantation.

The following report presents a very unusual case of a 50-year-old man with retrograde peri-implantitis secondary to pericoronitis of a horizontal, incompletely impacted mandibular right third molar. A conebeam computed tomography scan revealed the presence of a radiolucency at the apex of the mobile implant at the right first molar site, which was detected one month after implant placement. The case management involved removal of the mobile implant and arrangement of a second implant surgery as well as extraction of the impacted third molar. The lesion gradually resolved over a 1-year period. The implant remained stable with no evidence of recurrence over a 4-year follow-up period.

The most frequent cause for glaucoma surgery failure apart from the progression of dystrophic changes in the eye’s drainage system is morphological changes in connective tissue structures that increase the risk of scarring at the operation site. Since currently available preventive measures, that are either based on medically affecting the wound healing process (e.g. metabolic antagonists) or method improvements, do not always give the intended result, there are also other directions of glaucoma research, one of which focuses on the application of drainage devices and systems. PURPOSE: to study the efficacy and safety of iGen drainage device in primary open-angle glaucoma surgery. METHODS: The study group included 35 male and 51 female patients aged 55 to 79 years (mean age 65.9±9 years). All the patients of the study group (86 patients, 86 eyes) underwent an iGen drainage device implant. Among the patients, 37 (43.1%) had stage II glaucoma, 49 (56.9%) — stage III. Intraocular pressure (IOP) was moderately elevated in 52 patients (60.5%) and significantly elevated in 34 patients (39.5%). Mean IOP prior to the operation was 34.6±9.2 mm Hg with the minimum of24.7 mm Hg and the maximum of56.5 mm Hg. RESULTS. One week follow-up showed mean IOP levels of 15.1±11.3 mm Hg. At day 30 of the post-surgical followup, IOP in the study group increased by 2–3 mm Hg and in average amounted to 17.8±6.4 mm Hg. Further observation showed no IOP increase, and at 12 months it equaled 18.8±2.3 mm Hg. Absolute success of iGen implantation was accomplished in 37 (42.9%) patients. Qualified success (IOP normalization without additional antihypertensive therapy + IOP normalization with additional antihypertensive therapy by 1.8 medications in average) was achieved in 71 (82.1%) patients. Complications frequency and characteristics depended on the initial clinical status and included ciliochoroidal detachment (10.4%), hyphema (10.4%), transient hypertension (1.2%). CONCLUSION: The choice of explant drainage in repeated glaucoma surgery depends on predominant localization of cicatricial blockade of the outflow tracts created during previous surgeries. In cases when conjunctival-scleral adhesions served as the obvious cause of the surgery failure, iGen collagen drainage is preferable as having integral success rate of 82.1%.