Factores de risco biológicos relacionados com o insucesso dos implantes orais

Dissertação para obtenção do grau de Mestre no Instituto Superior de Ciências da Saúde Egas Moniz

Distalização de molares superiores com mini implantes – caso clínico

Poster apresentado nas XXIII Jornadas Internacionais do ISCSEM, 20-21 Março de 2015, Egas Moniz, Caparica.

Harmonic Encoding in Cochlear Implants

Thesis (Master's)--University of Washington, 2016-06

Contractile cochlear frame in the gecko Teratoscincus scincus

It is generally accepted that the cartilaginous frame of the reptilian cochlea has only a passive supportive function. In this study, a ribbon of contractile tissue was revealed within the cartilaginous frame of the cochlea of the gecko Teratoscincus scincus. It consisted of tightly packed cells and received an extensive blood supply. The cytoplasm of the cells was filled with cytoskeletal filaments 5-7 nm thick as revealed by electron microscopy. Isolated tissue permeabilized with Triton X-100 or glycerol reversibly contracted in the presence of ATP. Noradrenaline caused slow relaxation of the freshly isolated tissue placed in artificial perilymph. We suggest that slow motility of the contractile tissue may adjust passive cochlear mechanics to sounds of high intensities. J. Comp. Neurol. 461:539-547, 2003. © 2003 Wiley-Liss, Inc.

Theory-of-mind development in oral deaf children with cochlear implants or conventional hearing aids

Background: In the context of the established finding that theory-of-mind (ToM) growth is seriously delayed in late-signing deaf children, and some evidence of equivalent delays in those learning speech with conventional hearing aids, this study's novel contribution was to explore ToM development in deaf children with cochlear implants. Implants can substantially boost auditory acuity and rates of language growth. Despite the implant, there are often problems socialising with hearing peers and some language difficulties, lending special theoretical interest to the present comparative design. Methods: A total of 52 children aged 4 to 12 years took a battery of false belief tests of ToM. There were 26 oral deaf children, half with implants and half with hearing aids, evenly divided between oral-only versus sign-plus-oral schools. Comparison groups of age-matched high-functioning children with autism and younger hearing children were also included. Results: No significant ToM differences emerged between deaf children with implants and those with hearing aids, nor between those in oral-only versus sign-plus-oral schools. Nor did the deaf children perform any better on the ToM tasks than their age peers with autism. Hearing preschoolers scored significantly higher than all other groups. For the deaf and the autistic children, as well as the preschoolers, rate of language development and verbal maturity significantly predicted variability in ToM, over and above chronological age. Conclusions: The finding that deaf children with cochlear implants are as delayed in ToM development as children with autism and their deaf peers with hearing aids or late sign language highlights the likely significance of peer interaction and early fluent communication with peers and family, whether in sign or in speech, in order to optimally facilitate the growth of social cognition and language.

Conversation repair and adult cochlear implantation: A qualitative case study

Conversation breakdown and repair has been suggested to be a common site of the disability arising from acquired hearing impairment in adults. This qualitative case study reports on certain consequences of the use of general versus specific conversation repair initiators for the resolution of repair sequences. The 47 repair sequences analysed in this paper arose in a single 20-minute free and unstructured conversation between an adult bilateral cochlear implantee and his wife, audio-recorded in a clinic setting. The repairs analysed in this paper were undertaken in response to either general (n = 18) or specific (n = 29) repair requests. No difference was found in the number of turns taken to resolve repairs in response to general or specific repair requests. Qualitative analysis demonstrated that uttering the repair initiator in the immediate vicinity of the miscommunicated portion of talk provided the primary cue to the conversation partner about the location and the content of what had been misunderstood. These preliminary findings imply a change to rehabilitation counselling offered to familiar communication partners. Copyright © 2006 John Wiley & Sons, Ltd.

PÊNDULO ANCORADO EM MINI-IMPLANTES: AVALIAÇÃO DENTÁRIA E ESQUELÉTICA

O aparelho Pêndulo é eficaz na correção das más oclusões de Classe II, com comprometimento dentoalveolar superior. No entanto, a perda de ancoragem caracterizada pela mesialização dos pré-molares superiores, e pela vestibularização e protrusão dos incisivos superiores, constitui um grave efeito colateral deste dispositivo. O objetivo deste estudo foi avaliar as possíveis alterações dentárias e esquelética, sagitais e verticais, decorrentes do uso do Pêndulo modificado, ancorado em mini-implantes. Dez indivíduos foram tratados neste estudo, sendo que telerradiografias em norma lateral foram realizadas no início do tratamento, e imediatamente após a remoção do Pêndulo. Em cada indivíduo foram instalados dois mini-implantes no palato, que receberam carga imediata por meio da ativação do Pêndulo modificado, apoiado nestes dispositivos de ancoragem temporária. Nenhum dos dentes avaliados apresentou alterações verticais estatisticamente significantes; o mesmo ocorreu para as alterações esqueléticas verticais e sagitais, e para o trespasse vertical e horizontal. Com relação às alterações estatisticamente significantes, o primeiro molar superior moveu-se para distal aproximadamente 5,6mm em 6,2 meses, e com inclinação distal média de 7,100. Os segundos pré-molares superiores distalizaram em média 2,7mm e inclinaram 5,550; já os segundos molares superiores moveram-se em média 4,6mm para distal com uma inclinação de 13,700; valores estes também considerados estatisticamente significantes. O sistema de distalização de molares superiores, composto pelo Pêndulo modificado ancorado em mini-implantes, mostrou-se eficaz na correção da má oclusão de Classe II, sem produzir os efeitos de perda de ancoragem. (AU)

PÊNDULO ANCORADO EM MINI-IMPLANTES - ANÁLISE EM MODELOS DIGITAIS

A distalização dos molares superiores é uma opção de tratamento da má oclusão de Classe II, quando o envolvimento é principalmente dentoalveolar. Dispositivos intrabucais como o aparelho Pêndulo, dispensam a colaboração do paciente quanto ao uso, porém promovem efeitos muitas vezes indesejáveis como a vestibularização dos dentes anteriores que participam na ancoragem e a inclinação dos molares distalizados. Após o surgimento dos Dispositivos de Ancoragem Temporária (DATs), como o mini-implante pode-se alcançar a ancoragem de forma previsível e eficiente. Com isto, por meio de um estudo prospectivo, foram avaliadas as alterações dentárias, promovidas pela distalização de molares superiores com um aparelho Pêndulo modificado, apoiado em dois mini-implantes instalados no palato de 10 indivíduos, sendo 2 do sexo feminino e 8 do masculino, com média de idade de 14,3 anos. A amostra foi composta por 20 modelos digitalizados em 3D, obtidos de em duas fases: no início do tratamento (T1) e após distalização com sobrecorreção de 1 mm (T2), permitindo quantificar as alterações dentárias sagitais, transversais e possíveis movimentos de rotação, angulação e movimentos verticais. Os resultados obtidos mostraram que no sentido sagital, houve uma efetiva distalização com significância estatística, para os segundos molares superiores; primeiros molares superiores em média de 4,34 mm e 3,91mm para o lado direito e esquerdo, respectivamente, e para os segundos pré-molares do lado direito e esquerdo de 2,06 mm e 1,95 mm, respectivamente. Porém, para os dentes anteriores, foi constatada a perda de ancoragem. No sentido transversal, o maior aumento ocorreu na região dos dentes posteriores. Os movimentos de rotação, angulação e vertical dos primeiros molares superiores, indicam que houve rotação mesiovestibular e inclinação distal das coroas destes dentes de ambos os lados; as medidas verticais, demonstram que houve movimento significativo apenas para o primeiro molar direito, com inclinação distal pela intrusão da cúspide distal. Este dispositivo mostrou-se eficaz na correção da Classe II em um tempo médio de 6,2 meses.(AU)

Auditory stream segregation of tone sequences in cochlear implant listeners

Previous claims that auditory stream segregation occurs in cochlear implant listeners are based on limited evidence. In experiment 1, eight listeners heard tones presented in a 30-s repeating ABA-sequence, with frequencies matching the centre frequencies of the implant's 22 electrodes. Tone A always stimulated electrode 11 (centre of the array); tone B stimulated one of the others. Tone repetition times (TRTs) from 50 to 200 ms were used. Listeners reported when they heard one or two streams. The proportion of time that each sequence was reported as segregated was consistently greater with increased electrode separation. However, TRT had no significant effect, and the perceptual reversals typical of normal-hearing listeners rarely occurred. The results may reflect channel discrimination rather than stream segregation. In experiment 2, six listeners performed a pitch-ranking task using tone pairs (reference = electrode 11). Listeners reported which tone was higher in pitch (or brighter in timbre) and their confidence in the pitch judgement. Similarities were observed in the individual pattern of results for reported segregation and pitch discrimination. Many implant listeners may show little or no sign of automatic stream segregation owing to the reduced perceptual space within which sounds can differ from one another. © 2006 Elsevier B.V. All rights reserved.

Auditory stream segregation in cochlear implant listeners:measures based on temporal discrimination and interleaved melody recognition

The evidence that cochlear implant listeners routinely experience stream segregation is limited and equivocal. Streaming in these listeners was explored using tone sequences matched to the center frequencies of the implant’s 22 electrodes. Experiment 1 measured temporal discrimination for short (ABA triplet) and longer (12 AB cycles) sequences (tone/silence durations = 60/40 ms). Tone A stimulated electrode 11; tone B stimulated one of 14 electrodes. On each trial, one sequence remained isochronous, and tone B was delayed in the other; listeners had to identify the anisochronous interval. The delay was introduced in the second half of the longer sequences. Prior build-up of streaming should cause thresholds to rise more steeply with increasing electrode separation, but no interaction with sequence length was found. Experiment 2 required listeners to identify which of two target sequences was present when interleaved with distractors (tone/silence durations = 120/80 ms). Accuracy was high for isolated targets, but most listeners performed near chance when loudness-matched distractors were added, even when remote from the target. Only a substantial reduction in distractor level improved performance, and this effect did not interact with target-distractor separation. These results indicate that implantees often do not achieve stream segregation, even in relatively unchallenging tasks.

Simultaneous grouping in cochlear implant listeners:can abrupt changes in level be used to segregate components from a complex tone?

A sudden increase in the amplitude of a component often causes its segregation from a complex tone, and shorter rise times enhance this effect. We explored whether this also occurs in implant listeners (n?=?8). Condition 1 used a 3.5-s “complex tone” comprising concurrent stimulation on five electrodes distributed across the array of the Nucleus CI24 implant. For each listener, the baseline stimulus level on each electrode was set at 50% of the dynamic range (DR). Two 1-s increments of 12.5%, 25%, or 50% DR were introduced in succession on adjacent electrodes within the “inner” three of those activated. Both increments had rise and fall times of 30 and 970 ms or vice versa. Listeners reported which increment was higher in pitch. Some listeners performed above chance for all increment sizes, but only for 50% increments did all listeners perform above chance. No significant effect of rise time was found. Condition 2 replaced amplitude increments with decrements. Only three listeners performed above chance even for 50% decrements. One exceptional listener performed well for 50% decrements with fall and rise times of 970 and 30 ms but around chance for fall and rise times of 30 and 970 ms, indicating successful discrimination based on a sudden rise back to baseline stimulation. Overall, the results suggest that implant listeners can use amplitude changes against a constant background to pick out components from a complex, but generally these must be large compared with those required in normal hearing. For increments, performance depended mainly on above-baseline stimulation of the target electrodes, not rise time. With one exception, performance for decrements was typically very poor.

Auditory grouping in cochlear implant listeners

This thesis describes a series of experiments investigating both sequential and concurrent auditory grouping in implant listeners. Some grouping cues used by normal-hearing listeners should also be available to implant listeners, while others (e.g. fundamental frequency) are unlikely to be useful. As poor spectral resolution may also limit implant listeners’ performance, the spread of excitation in the cochlea was assessed using Neural Response Telemetry (NRT) and the results were related to those of the perceptual tasks. Experiment 1 evaluated sequential segregation of alternating tone sequences; no effect of rate or evidence of perceptual ambiguity was found, suggesting that automatic stream segregation had not occurred. Experiment 2 was an electrode pitch-ranking task; some relationship was found between pitch-ranking judgements (especially confidence scores) and reported segregation. Experiment 3 used a temporal discrimination task; this also failed to provide evidence of automatic stream segregation, because no interaction was found between the effects of sequence length and electrode separation. Experiment 4 explored schema-based grouping using interleaved melody discrimination; listeners were not able to segregate targets and distractors based on pitch differences, unless accompanied by substantial level differences. Experiment 5 evaluated concurrent segregation in a task requiring the detection of level changes in individual components of a complex tone. Generally, large changes were needed and abrupt changes were no easier to detect than gradual ones. In experiment 6, NRT testing confirmed substantially overlapping simulation by intracochlear electrodes. Overall, little or no evidence of auditory grouping by implant listeners was found.

Stochastic beamforming for cochlear implant coding

Cochlear implants are prosthetic devices used to provide hearing to people who would otherwise be profoundly deaf. The deliberate addition of noise to the electrode signals could increase the amount of information transmitted, but standard cochlear implants do not replicate the noise characteristic of normal hearing because if noise is added in an uncontrolled manner with a limited number of electrodes then it will almost certainly lead to worse performance. Only if partially independent stochastic activity can be achieved in each nerve fibre can mechanisms like suprathreshold stochastic resonance be effective. We are investigating the use of stochastic beamforming to achieve greater independence. The strategy involves presenting each electrode with a linear combination of independent Gaussian noise sources. Because the cochlea is filled with conductive salt solutions, the noise currents from the electrodes interact and the effective stimulus for each nerve fibre will therefore be a different weighted sum of the noise sources. To some extent therefore, the effective stimulus for a nerve fibre will be independent of the effective stimulus of neighbouring fibres. For a particular patient, the electrode position and the amount of current spread are fixed. The objective is therefore to find the linear combination of noise sources that leads to the greatest independence between nerve discharges. In this theoretical study we show that it is possible to get one independent point of excitation (one null) for each electrode and that stochastic beamforming can greatly decrease the correlation between the noise exciting different regions of the cochlea. © 2007 Copyright SPIE - The International Society for Optical Engineering.