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BACKGROUND: Cochlear implants are standard of care for the patients with sensorineural hearing loss not benefited from hearing aids. AIMS: Evaluate qualitatively the impact of cochlear implantation in the long-term. MATERIALS-METHODS: Thirty middle-class patients with similar patterns of loss and social environment averaging 20 years post-implantation responded to 52 questions that evaluated psychosocial benefits from cochlear implantation. RESULTS: All completed secondary education and 93% had postgraduate studies. Educational and workwise they are at the same level as their hearing counterparts. All use their cochlear implants and would recommend one to people who need it. They attribute their success to the implant, the rehabilitation program, their family, and a stimulating social environment. Despite their success, most experience difficulties relating with others (socially and at work) due to their hearing condition. They manage but work much harder than their hearing peers to achieve the same. CONCLUSIONS: We made a difference in the lives of these patients, however, there is more to be done. SIGNIFICANCE: Early intervention, rehabilitation, plus family, and stimulating-environment are crucial in children with sensory deficits.

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Background: Bone-conduction hearing implants are standard of care devices.Aims/Objectives: Evaluation of a new active magnetic bone-conduction hearing implant: Cochlear Osia™ system.Material and methods: This device uses a transcutaneous connection between an external sound-processor and an osseointegrated implant that generates vibrations using a piezoelectricity-based internal bone-conduction system. Nine patients with conductive-hearing loss were implanted. Surgical efficacy, hearing performance and quality-of-life were evaluated. Hearing performance in quiet and in noise was compared with unaided hearing and hearing with the Baha 5 Power® Sound Processor on a softband.Results: Surgery and healing were uneventful. Statistically significant improvements in audibility, speech-understanding, speech-recognition and quality-of-sound in noise and quiet were found for the Osia™ compared to preoperative unaided hearing and aided hearing with the Baha 5 Power® Sound Processor on a softband. The active vibration system provided improvement at low and high frequencies. At 6 months postoperatively, all patients continue to use the device.Conclusions and significance: The Osia™ is safe and effective, improving speech-recognition in quiet and in noise, at low and high frequencies, thus delivering better quality-of-hearing than passive devices.

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BACKGROUND: This study evaluates otitis media in prehistoric populations in northern Chile. AIMS/OBJECTIVES: Determining prevalence of otitis media and diagnostic usefulness of temporal-bone X-rays in skulls. MATERIALS AND METHODS: 444 skulls belonging to three groups: prehistoric-coastal (400-1000 AD), prehistoric-highland (400-1000 AD) and Pisagua-Regional Developments (1000-1450 AD). Skulls were evaluated visually and with Schuller's view X-rays. Five skulls diagnosed as having had otitis media, five diagnosed as normal, and one with temporal bone fistula also had a computed tomography (CT). RESULTS: Changes suggestive of otitis media were present in Prehistoric-coastal 53.57%; Pisagua-Regional Developments 70.73%; prehistoric-highlands 47.90%. Diagnostic effectiveness of Schuller's view X-rays for assesing middle ear disease was confirmed by CT studies. The case with temporal bone fistula had changes suggestive of mastoiditis and possible post auricular abscess. CONCLUSIONS: There was a high prevalence of otitis media in prehistoric populations in Chile. The higher prevalence in one group was presumably due to racial factors. Temporal-bone X-rays are effective for massive evaluation of ear disease in skulls. A case of mastoiditis with temporal bone fistula and possible post-auricular abscess is documented. SIGNIFICANCE: Documenting racial factors in otitis media. Validating X-rays for massive evaluation of otitis media in skulls.

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BACKGROUND: This prospective study evaluated the effectiveness of a rehabilitation program in vulnerable children with language deficits. AIMS/OBJECTIVES: Evaluating reversibility of a sensory understimulation. MATERIAL/METHODS: Two groups of five students, each, (sensory and not sensory deprived) were evaluated at ages 5 and 11. Both groups were taught the compulsory national educational program. The sensory deprived group also had a 5-year rehabilitation program. After that time, their language and vocabulary were reevaluated. RESULTS: Both groups became able to read, write and perform mathematical operations. Both groups took the compulsory elementary school national performance test and all of them performed above the national average. Despite these good performances the differences between both groups regarding language persisted. CONCLUSIONS: Deficits in children with early sensory deprivation are improved with rehabilitation programs. In order to achieve better restoration, intervention should be done earlier than at 5 years of age. Even if some deficits are not fully reversible, the improvement is significant and allows social inclusion and the possibility of breaking their circle of vulnerability. SIGNIFICANCE: Documenting the importance of early rehabilitation in sensory deficits.

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OBJECTIVE: Osteomas are slow-growing benign tumors that can affect the skull, most frequently the parietal and frontal. Temporal bone osteomas are more common in the external acoustic meatus and exceptional in the mastoid region. The rarity of mastoid osteomas is confirmed by the fact that very few cases have been reported in the clinical and paleopathological literature. The aim of this paper is to report a new paleopathological case of mastoid tumor in a Pre-Hispanic adult cranium. MATERIALS: The skull derives from the Chunchuri (today Dupont-1 site) Pre-Hispanic site in Northern Chile (1390 A.D). METHODS: Macroscopical examination and high-resolution tomography were used to assess the cranium. RESULTS: The CT scan revealed a well demarcated lesion suggestive of a mastoid osteoma. CONCLUSIONS: This case adds new evidence regarding the antiquity of primary neoplasms in ancient populations and reinforces the importance of high resolution imaging in paleopathological research. SIGNIFICANCE: Due to the antiquity of the remains this is probably the oldest reported case of mastoid osteoma. LIMITATIONS: The patrimonial nature of the remains did not allow histopathological studies. SUGGESTIONS FOR FURTHER RESEARCH: Further intensive review of archeological skeletal collections is needed to better understand the epidemiology of neoplastic lesions in past populations.

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CONCLUSIONS: External ear canal exostosis is more prevalent in northern coastal groups than in the highlands, suggesting that ocean activities facilitate the appearance of exostosis. However, southern coastal groups exposed to colder ocean water have a lesser incidence of exostosis, possibly due to less duration of exposure. There was a high incidence of otitis media in all groups of native population in Chile. One coastal group had a higher incidence, presumably due to racial factors. BACKGROUND: This is a paleopathological and paleoepidemiological study in temporal bones which assesses external ear canal exostosis and otitis media in prehistoric and historic native populations in Chile. MATERIALS AND METHODS: A total of 460 temporal bones were evaluated for exostosis (ex) and 542 temporal bones were evaluated for otitis media (om). The study involved four groups: (1) Prehistoric Coastal (400-1000 AD) populations in Northern Chile (Pisagua-Tiwanaku) (22 temporal bones ex; 28 om); (2) Prehistoric Highland (400-1000 AD) populations in Northern Chile (292 temporal bones ex; 334 om); (3) Pisagua-Regional Developments (coastal) in Northern Chile (1000-1450 AD) (66 temporal bones ex; 82 om); and (4) Historic (1500-1800 AD) coastal populations in Southern Chile (80 temporal bones ex: 18 Chonos, 62 Fuegians. 98 om: 22 Chonos, 76 Fuegians). Skulls were evaluated visually and with an operating microscope. In addition, the otitis media group was evaluated with Temporal bone radiology - -lateral XRays-Schuller view - to assess pneumatization as evidence of previous middle ear disease. RESULTS: Prehistoric northern coastal groups had an incidence of exostosis of 15.91%, the northern highlands group 1.37%, and the southern coastal group 1.25%. There were changes suggestive of otitis media in: Pisagua/Tiwanaku 53.57%; Pisagua/Regional Developments 70.73%; Northern Highlands population 47.90%; Chonos 63.64%; and Fuegian tribes 64.47%.

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CONCLUSIONS: There is seemingly some inherent component in selected musical compositions that elicits specific emotional perceptions, feelings, and physical conduct. OBJECTIVES: The purpose of the study was to determine if the emotional perceptions of those listening to classical music are inherent in the composition or acquired by the listeners. METHODS: Fifteen kindergarten students, aged 5 years, from three different sociocultural groups, were evaluated. They were exposed to portions of five purposefully selected classical compositions and asked to describe their emotions when listening to these musical pieces. All were instrumental compositions without human voices or spoken language. In addition, they were played to an audience of an age at which they were capable of describing their perceptions and supposedly had no significant previous experience of classical music. RESULTS: Regardless of their sociocultural background, the children in the three groups consistently identified similar emotions (e.g. fear, happiness, sadness), feelings (e.g. love), and mental images (e.g. giants or dangerous animals walking) when listening to specific compositions. In addition, the musical compositions generated physical conducts that were reflected by the children's corporal expressions. Although the sensations were similar, the way of expressing them differed according to their background.

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CONCLUSIONS: Our observations support the concept of bilateral cortical activation with monaural and binaural auditory stimulation. The observation that most of the significantly activated areas were the same with monaural or binaural stimulation suggests that the differences in auditory perception with binaural stimulation are not due to the involvement of significantly different processing centers but, more likely, to the type of information that reaches these centers for processing. The observation that the degree of stimulation was less intense in binaural than in monaural stimulation supports the concept that a richer binaural auditory stimulation compared with monaural stimulation does not mean summation of stimuli but integration and better processing of the information. For normal bilateral hearing subjects, a monaural stimulus is an uncommon event and may thus explain the more intense response. The repeatability of the results for monaural and binaural stimulation with pure tones in the same subjects confirms the consistency of the testing method. OBJECTIVES: (1) To determine which areas of the cerebral cortex and basal ganglia are activated by binaural stimulation with pure tones (left and right ear simultaneously) and what type of response occurs (e.g. excitatory or inhibitory) in these different areas. (2) To determine the degree of ipsilateral and/or contralateral cortical activation and/or inhibition. (3) To compare the data with our previous reports of monaural stimulation using the same technique and the same subjects. (4) To evaluate the consistency of our testing method. METHODS: Brain perfusion single photon emission computed tomography (SPECT) evaluation was conducted using auditory binaural stimulation with pure tones in six normal volunteers. Both ears were stimulated simultaneously. Tc99m HMPAO was injected while pure tones were delivered and the SPECT imaging was done 1 h later. RESULTS: After delivering pure tones there was bilateral activation in Brodmann areas 7 (somatosensory association cortex), 9 and 10 (executive frontal areas), 17, 18, and 19 (associative visual cortex). There was also activation in temporal areas 21, 22 (auditory association areas), and parietal areas 39 and 40 (Wernicke). There was also marked activation in both thalami. These activated areas were the same as those in our previous reports with monaural stimulation in the same subjects. However, except for areas 17, 18, 23, 31, and 32 (which remained over 4 SD above the normal maximum), the degree of activation was less intense in binaural compared with monaural stimulation. Inhibition was also less intense in binaural stimulation.

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CONCLUSIONS: Mucoid effusion can undergo a process of organization related to the inflammatory process and hypoventilation; organized effusion in the presence of epithelial breaks is a potential source for formation of granulation tissue and cholesterol granuloma within 3 months of evolution. OBJECTIVES: The aim of this study was to investigate the evolution of mucoid otitis media and its relationship with the organized effusion within a time-span of 3 months. MATERIALS AND METHODS: Two groups of animals were selected. In group I, 15 chinchillas had a chemically modified bovine collagen type 2 gelatin membrane placed through a mechanically induced tympanic membrane perforation, bridging the external auditory canal and the promontory. In group II, 75 cats underwent eustachian tube obstruction with soft grade silastic sponges. Experimental phases and animal sacrifices were performed under general anesthesia. After sacrifice, temporal bones were prepared, stained with hematoxylin and eosin and evaluated under light microscopy. RESULTS: The experimental ears in both groups were observed to undergo gradual pathological changes with increasing survival times. The acute inflammatory phase turned into chronic irreversible changes, which correlated directly with the initial amount of effusion and the areas of epithelial breaks, granulation tissue, cholesterol granuloma, and epithelial migration.

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CONCLUSIONS: 1.With auditory stimuli cortical activation of Brodmann's areas 39 and 40 and inhibition of area 38 is bilateral. Inhibitory and excitatory relays play a role in the auditory pathways. 2. A statistically significant increased activation on the left side in areas 39 and 40, regardless of the stimulated ear, is suggestive that pure tones are preferably processed in the left hemisphere. 3. The significant difference in central inhibition depending on which ear is stimulated is supportive of the idea of a leading ear. OBJECTIVES: The objectives were to determine cortical activation/inhibition, ipsi/contralateral in response to monaural stimulation with pure tones, and if the response differs for right/left ear stimulation. SUBJECTS AND METHODS: Tc99m-HMPAO brain perfusion SPECT was done during monaural stimulation with pure tones in 10 volunteers. Ears were tested independently. RESULTS: During auditory stimulation perfusion increased in both hemispheres in Brodmann's areas 39-40 and decreased in area 38,>2 SD above and below the normal mean respectively, in both hemispheres, regardless of which side was stimulated. A significantly more intense response was seen in left versus right in areas 39 and 40. In area 38 there was bilateral inhibition, significantly more intense in response to left than right ear stimulation.

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