Brazilian Society of Otology task force - Otosclerosis: evaluation and treatment

Abstract Objectives: To review and provide evidence-based recommendations for the diagnosis and treatment of otosclerosis. Methods: Task force members were educated on knowledge synthesis methods, including electronic database search, review and selection of relevant citations, and critical appraisal of selected studies. Articles written in English or Portuguese on otosclerosis were eligible for inclusion. The American College of Physicians' guideline grading system and the American Thyroid Association's guideline criteria were used for critical appraisal of evidence and recommendations for therapeutic interventions. Results: The topics were divided into 2 parts: 1) Diagnosis - audiologic and radiologic; 2) Treatment - hearing AIDS, pharmacological therapy, stapes surgery, and implantable devices - bone-anchored devices, active middle ear implants, and Cochlear Implants (CI). Conclusions: The pathophysiology of otosclerosis has not yet been fully elucidated, but environmental factors and unidentified genes are likely to play a significant role in it. Women with otosclerosis are not at increased risk of worsening clinical condition due to the use of contraceptives or during pregnancy. Drug treatment has shown little benefit. If the patient does not want to undergo stapedotomy, the use of hearing aids is well indicated. Implantable systems should be indicated only in rare cases, and the CI should be indicated in cases of profound deafness.

The P300 Auditory Evoked Potential in Cochlear Implant Users: A Scoping Review

Abstract Introduction The P300 auditory evoked potential is a long-latency cortical potential evoked with auditory stimulation, which provides information on neural mechanisms underlying the central auditory processing. Objectives To identify and gather scientific evidence regarding the P300 in adult cochlear implant (CI) users. Data Synthesis A total of 87 articles, 20 of which were selected for this study, were identified and exported to the Rayyan search software. Those 20 articles did not propose a homogeneous methodology, which made comparison more difficult. Most articles (60%) in this review compare CI users with typical hearing people, showing prolonged P300 latency in CI users. Among the studies, 35% show that CI users present a smaller P300 amplitude. Another variable is the influence of the kind of stimulus used to elicit P300, which was prolonged in 30% of the studies that used pure tone stimuli, 10% of the studies that used pure tone and speech stimuli, and 60% of the studies that used speech stimuli. Conclusion This review has contributed with evidence that shows the importance of applying a controlled P300 protocol to diagnose and monitor CI users. Regardless of the stimuli used to elicit P300, we noticed a pattern in the increase in latency and decrease in amplitude in CI users. The user's experience with the CI speech processor over time and the speech test results seem to be related to the P300 latency and amplitude measurements.

Does the Number of Stimuli Influence the Formation of the Endogenous Components of the Event-Related Auditory Evoked Potentials?

Abstract Introduction The number of stimuli is important to determine the quality of auditory evoked potential records. However, there is no consensus on that number in studies, especially in the sample studied. Objectives To investigate the influence of the number of rare stimuli on forming N2 and P3 components, with different types of acoustic stimuli. Methods Cross-sectional, descriptive, comparative study, approved by the ethics committee of the institution. The sample comprised 20 normal hearing adults of both sexes, aged 18 to 29 years old, with normal scores in the mental state examination and auditory processing skills. The event-related auditory evoked potentials were performed with nonverbal (1 kHz versus 2 kHz) and verbal stimuli (/BA/ versus /DA/). The number of rare stimuli varied randomly in the recordings, with 10, 20, 30, 40, and 50 presentations. Results P3 latency was significantly higher for nonverbal stimuli with 50 rare stimuli. N2 latency did not show any difference between the type and number of stimuli. The absolute P3 and N2-P3 amplitudes showed significant differences for both types of stimuli, with higher amplitude for 10 rare stimuli, in contrast with the other ones. The linear tendency test indicated significance only for the amplitude - as the number of rare stimuli increased, the amplitude tended to decrease. Conclusion The components were identifiable in the different numbers of rare stimuli and types of stimuli. The P3 and N2-P3 latency and amplitude increased with fewer verbal and nonverbal stimuli. Recording protocols must consider the number of rare stimuli.

Task force Guideline of Brazilian Society of Otology - hearing loss in children - Part II - Treatment

Abstract Objectives: To provide an overview of the main evidence-based recommendations for the diagnosis of hearing loss in children and adolescents aged 0-18 years. Methods: Task force members were educated on knowledge synthesis methods, including electronic database search, review and selection of relevant citations, and critical appraisal of selected studies. Articles written in English or Portuguese on childhood hearing loss were eligible for inclusion. The American College of Physicians' guideline grading system and the American Thyroid Association's guideline criteria were used for critical appraisal of evidence and recommendations for therapeutic interventions. Results: The topics were divided into 2 parts: (1) treatment of sensorineural hearing loss: individual hearing aids, bilateral cochlear implants, cochlear implants in young children, unilateral hearing loss, and auditory neuropathy spectrum disorder; and (2) treatment of conductive/mixed hearing loss: external/middle ear malformations, ventilation tube insertion, and tympanoplasty in children. Conclusions: In children with hearing loss, in addition to speech therapy, Hearing AIDS (HAs) or implantable systems may be indicated. Even in children with profound hearing loss, both the use of HAs and behavioral assessments while using the device are important.

Clinical implications of intraoperative eABRs to the Evo®-CI electrode array recipients / Implicações clínicas do eABR intraoperatório para usuários do feixe de eletrodos Evo

Abstract Introduction Electrically evoked auditory brainstem responses provide reliable clinical information to assist professionals in the auditory rehabilitation of cochlear implant users. Objective This study aimed to investigate intraoperative evoked auditory brainstem response recordings in Evo®-cochlear implant electrode array recipients and its correlation with their behavioral levels and auditory performance. Methods This is a retrospectivey study. Intraoperative evoked auditory brainstem responses were recorded in adult Evo®-cochlear implant electrode array recipients. Wave V latencies, amplitudes and interpeak III-V intervals were recorded in three different electrode locations and compared to the sentence recognition scores obtained from subjects after six months of device use. Evoked auditory brainstem responses thresholds were also recorded and compared to the behaviorally determined levels of the subjects in the sound processor activation. Results Evoked auditory brainstem responses thresholds were significantly correlated with both, behavioral T- and C-levels and they were recorded at audible electrical stimulation levels in all subjects. There was a significant correlation between interpeak III-V interval recorded in the apical electrode and sentence recognition scores of the subjects. Conclusions Intraoperative evoked auditory brainstem responses can be used to establish audible levels for fitting the sound processor in Evo®-cochlear implant recipients and it could help professionals to plan further actions aiming to improve their auditory performance.

Resumo Introdução Os potenciais auditivos de tronco encefálico evocados eletricamente fornecem informações clínicas confiáveis que auxiliam no processo de reabilitação auditiva de usuários de implante coclear. Objetivo Investigar o registro intraoperatório dos potenciais auditivos de tronco encefálico evocados eletricamente em usuários do feixe de eletrodos Evo® e sua correlação com os níveis comportamentais e desempenho auditivo dos indivíduos. Método Estudo retrospectivo. Os potenciais auditivos de tronco encefálico intraoperatórios foram registrados em usuários adultos de implante coclear com feixe de eletrodos Evo®. As latências e amplitudes da onda V e os intervalos interpico III-V foram registrados em três diferentes eletrodos e comparados às pontuações de reconhecimento de sentenças após 6 meses de uso do implante coclear. Os limiares dos eABRs foram comparados aos níveis comportamentais dos indivíduos na ativação do processador de som. Resultados Os limiares do eABR foram significativamente correlacionados aos níveis comportamentais T e C e registrados em níveis de estimulação elétrica audíveis em todos os indivíduos. Houve uma correlação significativa entre o intervalo interpico III-V no eletrodo apical e a pontuação de reconhecimento de sentenças dos indivíduos. Conclusões O eABR intraoperatório pode ser usado para estabelecer níveis audíveis de estimulação elétrica na ativação do processador sonoro em usuários de implante coclear‐Evo® e pode auxiliar os profissionais no planejamento de ações visando melhorar o desempenho auditivo nesses pacientes.

Cross-cultural adaptation of the Amsterdam inventory for auditory disability and handicap to Brazilian Portuguese / Adaptação transcultural do Amsterdam inventory for auditory disability and handicap para o português do Brasil

Abstract Introduction Patient-reported outcome measures, inventory and or questionnaire, allow patients to present their perspective of the impact of their individual condition on a day-to-day basis, independent of the analysis of test results by the expert clinician. Outcome measures are recommended when there is evidence showing their reliability, validity and sensitivity. There are standardized patient-reported outcome measures for hearing in English language; however, other languages lack these instruments. Objective Adapt the Amsterdam inventory for auditory disability and handicap to Brazilian Portuguese and analyze its validation measures. Methods We conducted two studies. In Study 1, we translated and adapted the Amsterdam inventory for auditory disability and handicap to Brazilian Portuguese according to good practice guidelines; this included the pre-test stage. In Study 2, we administered the Portuguese version to adults with and without hearing loss (n = 31 and 18, respectively) and analyzed the measures of instrument validation, reliability, and reproducibility. Moreover, we calculated the correlation between pure tone thresholds and scores on the questionnaire. Results The results obtained in Study 1 demonstrated the feasibility of the translation process and the instrument's cultural adaptation, as well as its applicability, resulting in the Portuguese version of the Amsterdam inventory for auditory disability and handicap. In Study 2, the results revealed construct values for the questions and domains, as well as for the total reliable score. The intra-interviewer test-retest condition showed excellent reproducibility (ICC = 0.97). Finally, there was a strong positive correlation (r = 0.83) between the mean pure tone threshold and the hearing difficulties values, as measured by the instrument's scores. Conclusion The English version of the Amsterdam inventory for auditory disability and handicap could be translated and adapted to Brazilian Portuguese. An analyses of the validation process yielded reliable, consistent, and stable results.

Resumo Introdução Medidas de resultados relatados pelo paciente, inventários e/ou questionários, permitem que os pacientes apresentem suas perspectivas do impacto de sua condição no dia a dia, independentemente da análise dos resultados dos testes realizados pelo especialista. Esses instrumentos são recomendados quando há evidências que mostram sua confiabilidade, validade e sensibilidade. Existem medidas de resultados relatados pelo paciente padronizadas para a audição em língua inglesa; no entanto, esses instrumentos não existem em outras línguas. Objetivo Adaptar o Amsterdam inventory for auditory disability and handicap para o português brasileiro e avaliar suas medidas de validação. Método Realizamos dois estudos. No estudo 1, traduzimos e adaptamos o Amsterdam inventory for auditory disability and handicap para o português brasileiro de acordo com as diretrizes de boas práticas; inclusive a fase de pré-teste. No estudo 2, aplicamos a versão em português em adultos com e sem perda auditiva (n = 31 e 18, respectivamente) e analisamos as medidas de validação, confiabilidade e reprodutibilidade do instrumento. Além disso, calculamos a correlação entre os limiares de tons puros e os escores do questionário. Resultados Os resultados obtidos no estudo 1 demonstraram a viabilidade do processo de tradução e adaptação cultural do instrumento, assim como sua aplicabilidade, proporcionaram a versão em português da Amsterdam inventory for auditory disability and handicap. No estudo 2, os resultados revelaram valores de constructo para as questões e domínios, bem como para o escore total confiável. A condição de teste-reteste intraentrevistador mostrou excelente reprodutibilidade (CCI = 0,97). Por fim, houve forte correlação positiva (r = 0,83) entre o limiar médio de tom puro e os valores das dificuldades auditivas, medidos pelos escores do instrumento. Conclusão A versão em inglês do Amsterdam inventory for auditory disability and handicap foi traduzida e adaptada para o português brasileiro. Uma análise do processo de validação produziu resultados confiáveis, consistentes e estáveis.

Relationship between Speech Perception and Level of Satisfaction of Hearing Aid Users

Abstract Introduction Hearing difficulties can be minimized by the use of hearing aids. Objective The objective of this study is to assess the speech perception and satisfaction of hearing aids users before and after aid adaptation and to determine whether these measures are correlated. Methods The study was conducted on 65 individuals, 54% females and 46% males aged 63 years on average, after the systematic use of hearing aids for at least three months. We characterized subjectś personal identification data, the degree, and configuration of hearing loss, as well as aspects related to adaptation. We then applied a satisfaction questionnaire and a speech perception test (words and sentences), with and without the use of the hearing aids. Results Mean speech recognition with words and sentences was 69% and 79 %, respectively, with hearing aids use; whereas, without hearing aids use the figures were 43% and 53%. Mean questionnaire score was 30.1 points. Regarding hearing loss characteristics, 78.5% of the subjects had a sensorineural loss, 20% a mixed loss, and 1.5% a conductive loss. Hearing loss of moderate degree was present in 60.5% of cases, loss of descending configuration in 47%, and plain loss in 37.5%. There was no correlation between individual satisfaction and the percentages of the speech perception tests applied. Conclusion Word and sentence recognition was significantly better with the use of the hearing aids. The users showed a high degree of satisfaction. In the present study, there was no correlation observed between the levels of speech perception and levels of user satisfaction measured with the questionnaire.

Anatomical and functional evaluation of tympanoplasty using a transitory natural latex biomembrane implant from the rubber tree Hevea brasiliensis / Avaliação anatômica e funcional da timpanoplastia com a utilização de implante transitório de biomembrana natural de látex proveniente da seringueira Hevea brasiliensis

PURPOSE: To compare the role of transitory latex and sylastic® implants in tympanoplasty on the closure of tympanic perforations. METHODS: A randomized double-blind prospective study was conducted on 107 patients with chronic otitis media submitted to underlay tympanoplasty and divided at random into three groups: control with no transitory implant, latex membrane group, and sylastic® membrane group. RESULTS: Greater graft vascularization occurred in the latex membrane group (p<0.05). Good biocompatibility was obtained with the use of the latex and silicone implants, with no effect on the occurrence of infection, otorrhea or otorragy. CONCLUSION: The use of a transitory latex implant induced greater graft vascularization, with a biocompatible interaction with the tissue of the human tympanic membrane.

OBJETIVO: Investigar os efeitos da biomembrana de látex e silicone no fechamento de perfurações timpânicas. METODOS: Foram estudados 107 pacientes com otite média cronica simples submetidos à cirurgia de timpanoplastia. Os pacientes foram classificados aleatoriamente, por sorteio, em três grupos. Até o final da cirurgia, os cirurgiões não tomavam conhecimento se seria ou não utilizado qualquer material externamente ao enxerto de fáscia temporal. Neste momento, o paciente que fora previamente classificado por uma ordem aleatória de entrada como participante do estudo foi identificado como participante do grupo 1, 2 ou 3, sendo, respectivamente, ausência de implante transitório no primeiro, membrana de látex no segundo e membrana de sylastic® no terceiro grupo. RESULTADOS: Houve uma maior vascularização do enxerto no grupo em que foi utilizado implante transitório de membrana de látex (p<0,05). Obteve-se boa biocompatibilidade com uso de implantes de látex e silicone sem afetar as taxas de ocorrência de infecção, otorreia ou otorragia. A porcentagem de cicatrização da membrana timpânica foi equivalente nos três grupos, assim como a melhora auditiva (p<0,01). CONCLUSÃO: O uso do implante transitório de látex provocou um maior processo de vascularização do enxerto, com interação satisfatória com os tecidos da membrana timpânica humana.

Mastoidite fúngica em paciente com sida: relato de caso / Fungal mastoiditis in aids patients: reported cases

Introdução: Mastoidite fúngica por Aspergillus fumigatus ocorre predominantemente em pacientes imunossuprimidos. O diagnóstico geralmente é difícil e a doença é potencialmente fatal. O tratamento consiste em terapia antifúngica, desbridamento cirúrgico e correção da imunossupressão. Relato do Caso: Este artigo trata-se de um relato de um caso de mastoidite fúngica em um paciente com síndrome da imunodeficiência adquirida (SIDA). O tratamento realizado foi o cirúrgico associado à terapia antifúngica. O nervo facial deste paciente não estava afetado, o que não exclui complicações potencialmente fatais da mastoidite.

Introduction: Fungal mastoidits by Aspergillus fumigates predominantly occurs in immunosuppressed patients. Diagnosis is usually hard and disease is potentially fatal. Treatment is comprised of antifungal therapy, surgical debridement and immunosuppression correction. Case Report: This article reports a case of fungal mastoiditis in a patient with acquired immunodeficiency syndrome (AIDS). The treatment performed was that of surgery associated with antifungal therapy. The patient's facial nerve was not affected, what does not exclude potentially fatal complications of mastoiditis.

Biosilicate® Ototoxicity and Vestibulotoxicity evaluation in guinea-pigs / Avaliação da ototoxicidade e vestibulotoxicidade do biosilicato® em orelhas de cobaias

Changes, destructions and interruptions in middle ear ossicular chain architecture may be caused by infection, trauma, tumors, congenital alterations or prior surgeries. Nonetheless, infectious and inflammatory processes, focal or generalized which affect the middle ear are the most prevalent, causing a great demand for ossiculoplasty. Biosilicato® is a new material which can be used in the middle ear with the goal of reconstructing the ossicular chain. It is a bioactive type A vitroceramic, in other words, it binds to bone or soft tissue in a matter of a few hours, thanks to the formation of hydroxy-carbonateapatatie in its contact surface when in contact with body fluids. AIMS: The goal of the present paper is to assess biosilicate ototoxicity and vestibular toxicity in experimental animals, for later use in humans. MATERIALS AND METHODS: This a clinical and experimental study in which otoacoustic emissions were performed before and after the placement of Biosilicate in the middle ear of experimental animals and a scanning electron microscopy was carried out in the cochlea, saccule, utriculus and macula of the semicircular canals after 30 and 90 days to assess oto and vestibular toxicity. RESULTS: There were no signs of oto or vestibular toxicity in any of the groups associated with biosilicate. CONCLUSION: Biosilicate is a safe material to be used in ossiculoplasties

As alterações, destruições e interrupções da arquitetura da cadeia ossicular da orelha média podem ser causadas por infecções, trauma, tumores, alterações congênitas ou cirurgias prévias. Entretanto os processos inflamatórios e infecciosos, focais ou generalizados que acometem a orelha média são os mais prevalentes, gerando uma enorme demanda de ossiculoplastias. O Biosilicato® é um novo material que pode ser usado em orelhas médias com o objetivo de reconstruir a cadeia ossicular. Constitui-se de uma vitrocerâmica bioativa do tipo A, ou seja, que se liga a tecido ósseo ou a tecido mole em algumas horas, devido à formação de hidroxicarbonatoapatita em sua superfície de contato quando em contato com fluidos corpóreos. OBJETIVO: O objetivo deste trabalho é avaliar a ototoxicidade e vestibulotoxicidade do Biosilicato em cobaias, para posterior utilização em humanos. MATERIAL E MÉTODO: Trata-se de um estudo clínico e experimental, onde foram realizadas emissões otoacústicas antes e após a colocação de Biosilicato na orelha média de cobaias e realizada microscopia eletrônica de varredura da cóclea, sáculo, utrículo e máculas dos canais semicirculares após 30 e 90 dias para avaliar a oto e vestibulotoxicidade. RESULTADOS: Não houve sinais de oto ou vestibulotoxicidade em nenhum dos grupos relacionados ao Biosilicato. CONCLUSÃO: O Biosilicato é um material seguro para ser usado em ossiculoplastias.