ROBINSON KOJI TSUJI
Projetos de Pesquisa
Unidades Organizacionais
Instituto Central, Hospital das Clínicas, Faculdade de Medicina
LIM/32 - Laboratório de Otorrinolaringologia, Hospital das Clínicas, Faculdade de Medicina
LIM/32 - Laboratório de Otorrinolaringologia, Hospital das Clínicas, Faculdade de Medicina
17 resultados
Resultados de Busca
Agora exibindo 1 - 10 de 17
- Speech Perception Performance of Double Array Multichannel Cochlear Implant Users With Standard and Duplicated Maps in Each of the Arrays(2013) BENTO, Ricardo Ferreira; GOFFI-GOMEZ, Maria Valeria Schmidt; TSUJI, Robinson Koji; FONSECA, Anna Carolina de Oliveira; IKARI, Liliane Satomi; BRITO NETO, Rubens Vuono deObjective: The present investigation evaluated the speech perception performance of patients with ossified cochlea implanted with the 24M Double Array cochlear implant, using standard and duplicated maps in each of the arrays. Study Design: Retrospective case review. Setting: Tertiary referral center. Patients: Sixteen subjects received a Double Array cochlear implant. Among these, 9 fulfilled the following inclusion criteria: bilateral severe-to- profound postlingual deafness; bilateral obliterated cochlea, as shown by a computed tomographic scan; and a minimum age of 14 years to ensure reliable responses in the behavioral tests with the 3 tested maps. Intervention: Rehabilitative. Main Outcome Measures: The speech perception performance with the 2 arrays was compared with that with a basal array duplicated map and an apical array duplicated map. Three maps were fitted: the default map with both arrays activated, a double channel map using only the electrodes of the basal array, and a double channel map programmed only with the electrodes of the apical array. The test battery was composed of a vowel test, a 4-choice word test, and sentence recognition in quiet. Results: Statistical significance was reached in comparison the all tests in all programming conditions. Speech recognition in the standard map with both electrode arrays activated showed the highest scores. Conclusion: Performance with the 2 split electrode arrays was superior to those with the single arrays, regardless of the duplication of channels.
- Microangiopathy of the inner ear, deafness, and cochlear implantation in a patient with Susac syndrome(2011) BITTENCOURT, Aline Gomes; SANTOS, Andrea Felice Dos; GOFFI-GOMEZ, Maria Valeria Schmidt; KUTSCHER, Kellen; TSUJI, Robinson Koji; BRITO, Rubens De; BENTO, Ricardo FerreiraConclusion: The cochlear implant was beneficial as an attempt to restore hearing and improve communication abilities in this patient with profound sensorineural hearing loss secondary to Susac syndrome. Objective: To report the audiological outcomes of cochlear implantation (CI) in a young woman with Susac syndrome after a 6-month follow-up period. Susac syndrome is a rare disorder. It is clinically characterized by a typical triad of sensorineural deafness, encephalopathy, and visual defect, due to microangiopathy involving the brain, inner ear, and retina. Methods: This was a retrospective review of a case at a tertiary referral center. After diagnosis, the patient was evaluated by a multidisciplinary team and received a cochlear implant in her right ear. Results: The patient achieved 100% open-set sentence recognition in noise conditions and 92% monosyllable and 68% medial consonant recognition in quiet conditions after 6 months of implant use. She reported the use of the telephone 3 months after activation.
- Hearing preservation using topical dexamethasone alone and associated with hyaluronic acid in cochlear implantation(2015) RAMOS, Bernardo Faria; TSUJI, Robinson Koji; BENTO, Ricardo Ferreira; GOFFI-GOMEZ, Maria Valeria Schmidt; RAMOS, Henrique Faria; SAMUEL, Paola Angelica; BRITO, RubensConclusion: Topical dexamethasone associated with hyaluronic acid in cochlear implant surgery demonstrated a statistically significant difference in the preservation of low-frequency thresholds when compared with topical dexamethasone alone and a control group. Topical dexamethasone alone was not superior in hearing preservation when compared to the control group. Objective: To compare the effects of topical dexamethasone alone and associated with hyaluronic acid intraoperatively in hearing preservation in cochlear implantation. Methods: Eighteen severely to profoundly hearing-impaired adult patients with measurable hearing were divided into three groups preoperatively: cochlear implantation as a control group (group 1), cochlear implantation using topical dexamethasone intraoperatively (group 2), and cochlear implantation using topical dexamethasone associated with hyaluronic acid intraoperatively (group 3). Preimplant and postimplant low-frequency pure-tone averages (PTAs) were calculated from unaided audiograms at 125, 250, and 500 Hz. Results: The mean changes in the low-frequency PTA comparing postoperative against preoperative thresholds were 28.03 +/- 6.77 dB in group 1, 30 +/- 14.53 dB in group 2, and 7.23 +/- 6.12 dB in group 3. There was statistical difference when comparing group 3 with groups 1 and 2 using one-way ANOVA (p = 0.002) followed by Scheffe post hoc test.
- Is There Any Correlation between Spread of Excitation Width and the Refractory Properties of the Auditory Nerve in Cochlear Implant Users?(2021) SILVA, Juliana Coutinho da; GOFFI-GOMEZ, Maria Valeria Schmidt; TSUJI, Robinson Koji; BENTO, Ricardo; BRITO NETO, RubensBackground: The spread of excitation (SOE) and auditory nerve recovery function (REC) are objective measures recorded by neural response telemetry and may interfere in cochlear implant (CI) stimulation. Objective: To analyze and correlate SOE with the refractory periods in subjects with pre- and postlingual deafness implanted with different electrode arrays. Methods: This was a retrospective study of 323 ears separated by perimodiolar or straight arrays and by pre- or postlingually deaf recipients. Measures were collected intraoperatively on electrode 11. The SOE width was measured in millimeters at the 0.75 point of the curve, and the relative (tau) and absolute (t0) refractory periods were measured in microseconds. Results: There was a statistical correlation between the SOE and the t0 in the patients with postlingual deafness implanted with the perimodiolar array. The SOE width was statistically different between the straight and perimodiolar arrays and between the pre- and postlingual groups in the perimodiolar array. Tau was statistically different between the pre- and postlingual groups with the straight array and the t0, between the pre- and postlingual groups with the perimodiolar array. Neural response threshold and amplitude of the neural response were not statistically different among groups. Conclusion: There was a correlation between SOE width and t0 only in patients with acquired deafness. The findings suggest that different factors influence SOE and REC, considering SOE is different according to the electrode array and REC being different according the onset of deafness.
- Are Auditory Steady-State Responses Useful to Evaluate Severe-to-Profound Hearing Loss in Children?(2015) GRASEL, Signe Schuster; ALMEIDA, Edigar Rezende de; BECK, Roberto Miquelino de Oliveira; GOFFI-GOMEZ, Maria Valeria Schmidt; RAMOS, Henrique Faria; ROSSI, Amanda Costa; TSUJI, Robinson Koji; BENTO, Ricardo Ferreira; BRITO, Rubens deObjective. To evaluate Auditory Steady-State Responses (ASSR) at high intensities in pediatric cochlear implant candidates and to compare the results to behavioral tests responses. Methods. This prospective study evaluated 42 children with suspected severe-to-profound hearing loss, aged from 3 to 72 months. All had absent ABR and OAE responses. ASSR were evoked using binaural single frequency stimuli at 110 dB HL with a 10 dB down-seeking procedure. ASSR and behavioral test results were compared. Results. Forty-two subjects completed both ASSR and behavioral evaluation. Eleven children (26.2%) had bilateral responses. Four (9.5%) showed unilateral responses in at least two frequencies, all confirmed by behavioral results. Overall 61 ASSR responses were obtained, most (37.7%) in 500 Hz. Mean thresholds were between 101.3 and 104.2 dB HL. Among 27 subjects with absent ASSR, fifteen had no behavioral responses. Seven subjects showed behavioral responses with absent ASSR responses. No spurious ASSR responses were observed at 100 or 110 dB HL. Conclusion. ASSR is a valuable tool to detect residual hearing. No false-positive ASSR results were observed among 42 children, but in seven cases with absent ASSR, the test underestimated residual hearing as compared to the behavioral responses.
- Can the use of the CROS system provide head shadow effect contribution to unilateral Cochlear Implant Users?(2022) HOSHINO, Ana Cristina Hiromi; GOFFI-GOMEZ, Maria Valeria Schmidt; SIERRA, Paola Angelica Samuel; AGRAWAL, Smita; RODRIGUEZ, Carina; CARVALHO, Ana Claudia Martinho de; TSUJI, Robinson KojiPurpose: The aim of this study was to evaluate the contribution of the CROS system on the head shadow effect in unilateral implant users. Methods: Prospective cross-sectional study, approved by the ethics committee under protocol 2.128.869. Eleven adults with post-lingual deafness users of unilateral Advanced Bionics CI were selected. Speech recognition was evaluated with recorded words presented at 65dBA at 0o azimuth and at 90o on the side contralateral to the CI, with noise at 55dBA, using CI alone and CI + CROS system. The results were analyzed using paired t-test with a 0.05 alpha. Results: The mean speech recognition scores were significantly better with CI + CROS in relation to the condition of CI alone (p <0.05, p <0.005 and p <0.005 respectively). In the presentation at 0o azimuth, no significant differences were found. Conclusion: Users of unilateral CI without useful residual hearing for the use of hearing aids or unable to undergo bilateral surgery can benefit from the CROS device for speech recognition, especially when the speech is presented on the side contralateral to the CI.
- Is the spread of excitation width correlated to the speech recognition in cochlear implant users?(2021) SILVA, Juliana Coutinho da; GOFFI-GOMEZ, Maria Valeria Schmidt; MAGALHAES, Ana Tereza; TSUJI, Robinson Koji; BENTO, Ricardo FerreiraPurpose To assess whether there is an interference of the spread of excitation (SOE) on speech recognition. Methods Retrospective cross-sectional study, approved by the institution's ethics committee (CAAE03409212.8.0000.0068). Adult patients with intraoperative neural response telemetry (NRT) performed on electrodes 6, 11 and 16 implanted with Cochlear Ltd (Sydney, Australia) devices were selected. Patients with partial array insertion, pre-lingual hearing loss, deafness etiology due to and CI experience less than 12 months were excluded. SOE was recorded at 10 current units above the NRT threshold (tNRT) and its width in millimeters was collected at point 0.75 of the function. Speech recognition test was 25-recorded monosyllables list, presented at 65 dBHL at 0 degrees azimuth in a sound treated booth. The analysis was divided into groups by electrode array type, regarding the tNRT, SOE width, SOE's peak amplitude and electrode peak. Results A 126 SOE measurements of the 3 tested electrodes were obtained from 43 patients. Patients with straight array had significantly wider SOE, greater peak amplitude at electrode 6 and higher tNRTs. In the perimodiolar array, there was a negative correlation between SOE and monosyllables recognition at electrodes 6 and 11, and in the combined average of the three electrodes, with a significant difference in electrode 11. Sixty-six percent of the SOE measurements had their peak shifted to adjacent electrodes. Conclusion It was observed, in perimodiolar array, the greater the dispersion of electrical current, the worse the speech recognition, especially in the medial electrode.
- Do the minimum and maximum comfortable stimulation levels influence the cortical potential latencies or the speech recognition in adult cochlear implant users?(2021) MARTINS, Kelly Vasconcelos Chaves; GOFFI-GOMEZ, Maria Valeria Schmidt; TSUJI, Robinson Koji; BENTO, Ricardo FerreiraIntroduction: Cochlear implants (CI) programming is based on both the measurement of the minimum levels required to stimulate the auditory nerve and the maximum levels to generate loud, yet comfortable loudness. Seeking for guidance in the adequacy of this programming, the cortical auditory evoked potentials (CAEP) have been gaining space as an important tool in the evaluation of CI users, providing information on the central auditory system. Objective: To evaluate the influence of mishandling of electrical stimulation levels on speech processor programming on hearing thresholds, speech recognition and cortical auditory evoked potential in adult CI users. Material and methods: This is a prospective cross-sectional study, with a sample of adult unilateral CI users of both sexes, aged at least 18 years, post-lingual deafness, with minimum experience of 12 months of device use. Selected subjects should have average free field hearing thresholds with cochlear implant equal to or better than 34 dBHL and monosyllable recognition different from 0%. Individuals who could not collaborate with the procedures or who had no CAEP recordings were excluded. Participants were routinely programmed, and the map was named MO (optimized original map). Then three experimentally wrong maps were made: optimized original map with 10 current units below the maximum comfort level (C), named MC-(map minus C); optimized original map with minus 10 current units at minimum threshold level (T), named MT-(map minus T) and optimized original map with 10 current units above minimum level (T), named MT + (map plus T). In all programs, participants underwent free-field auditory thresholds from 250Hz to 60 0 0Hz, recorded sentences and monosyllabic recognition tests presented at 65dB SPL in quiet and in noise, and free field CAEP evaluation. All tests were performed in an acoustically treated booth, in a randomized order of map presentation. Data were compared by Wilcoxon test. Results: Thirty individuals were selected and signed an informed consent form. The MC-map provided worsening of all free field thresholds, quiet and noise speech recognition, and P1 wave latency delay with significant difference from the results with the MO map. The MT-map worsened the hearing thresholds and statistically significantly reduced the P2 wave latency; MT + map improved free field thresholds except 60 0 0Hz, worsening speech recognition, without statistical significance. Conclusions: The results suggest that maximum levels below the optimal thresholds lead to worse cochlear implant performance in both hearing thresholds and speech recognition tests in quiet and noise, increasing CAEP component P1 latency. On the other hand, the manipulation of minimum threshold levels showed alteration in audibility without significant impact on speech recognition.
- Cochlear Implantation Via the Middle Fossa Approach: Surgical and Programming Considerations(2012) BENTO, Ricardo Ferreira; BITTENCOURT, Aline Gomes; GOFFI-GOMEZ, Maria Valeria Schmidt; SAMUEL, Paola; TSUJI, Robinson Koji; BRITO, Rubens deObjectives: To report the results of cochlear implantation via the middle fossa approach in 4 patients, discuss the complications, and present a detailed description of the programming specifications in these cases. Study Design: Retrospective case review. Setting: Tertiary-care referral center with a well-established cochlear implant program. Patients: Four patients with bilateral canal wall down mastoid cavities who underwent the middle fossa approach for cochlear implantation. Interventions: Cochlear implantation and subsequent rehabilitation. A middle fossa approach with cochleostomy was successfully performed on the most superficial part of the apical turn in 4 patients. A Nucleus 24 cochlear implant system was used in 3 patients and a MED-EL Sonata Medium device in 1 patient. The single electrode array was inserted through a cochleostomy from the cochlear apex and occupied the apical, middle, and basal turns. Telemetry and intraoperative impedance recordings were performed at the end of surgery. A CT scan of the temporal bones was performed to document electrode insertion for all of the patients. Main Outcome Measures: Complications, hearing thresholds, and speech perception outcomes were evaluated. Results: Neural response telemetry showed present responses in all but 1 patient, who demonstrated facial nerve stimulation during the test. Open-set speech perception varied from 30% to 100%, despite the frequency allocation order of the MAP. Conclusion: Cochlear implantation via the middle cranial fossa is a safe approach, although it is a challenging procedure, even for experienced surgeons.
- Result on speech perception after conversion from Spectra ® to Freedom ®(2012) MAGALHAES, Ana Tereza de Matos; GOFFI-GOMEZ, Maria Valeria Schmidt; HOSHINO, Ana Cristina; TSUJI, Robinson Koji; BENTO, Ricardo Ferreira; BRITO, RubensNew technology in the Freedom (R) speech processor for cochlear implants was developed to improve how incoming acoustic sound is processed; this applies not only for new users, but also for previous generations of cochlear implants. Aim: To identify the contribution of this technology - the Nucleus 22 (R) - on speech perception tests in silence and in noise, and on audiometric thresholds. Methods: A cross-sectional cohort study was undertaken. Seventeen patients were selected. The last map based on the Spectra (R) was revised and optimized before starting the tests. Troubleshooting was used to identify malfunction. To identify the contribution of the Freedom (R) technology for the Nucleus22 (R), auditory thresholds and speech perception tests were performed in free field in soundproof booths. Recorded monosyllables and sentences in silence and in noise (SNR = 0dB) were presented at 60 dBSPL. The nonparametric Wilcoxon test for paired data was used to compare groups. Results: Freedom (R) applied for the Nucleus22 (R) showed a statistically significant difference in all speech perception tests and audiometric thresholds. Conclusion: The reedom (R) technology improved the performance of speech perception and audiometric thresholds of patients with Nucleus 22 (R).