ABSTRACT
OBJECTIVES: Currently, cochlear implant procedures are becoming increasingly broad and have greatly expanded. Bilateral cochlear implants and cochlear implants are more frequently applied in children. Our hypothesis is that the video head impulse test may be more sensitive than the caloric test in detecting abnormal vestibular function before cochlear implant surgery. The objective of this study was to compare the video head impulse test and caloric test results of patients selected for cochlear implant procedures before surgery. METHODS: The patients selected for cochlear implant surgery were submitted to a bithermal caloric test and video head impulse test. RESULTS: By comparing angular slow phase velocity values below 5° in the bithermal caloric test (hypofunction) and video head impulse test with a gain lower than 0.8, we identified 37 (64.9%) patients with vestibular hypofunction or canal paresis and 21 (36.8%) patients with abnormal video head impulse test gain before the cochlear implant procedure. Of the 37 patients with caloric test vestibular hypofunction, 20 (54%) patients exhibited an abnormal gain in the video head impulse test. CONCLUSION: The caloric test is more sensitive than the video head impulse test (Fisher's exact test, p=0.0002) in detecting the impaired ear before cochlear implant delivery. The proportion of caloric test/video head impulse test positive identification of abnormal vestibular function or caloric test/video head impulse test sensitivity was 1.8:1.
Subject(s)
Humans , Male , Female , Adult , Middle Aged , Caloric Tests/methods , Vestibular Diseases/diagnosis , Sensitivity and Specificity , Cochlear Implants , Head Impulse Test/methods , Paresis/diagnosis , Video Recording , Preoperative Care/methods , Cross-Sectional Studies , Predictive Value of TestsABSTRACT
Abstract Introduction: Cochlear implants are undeniably an effective method for the recovery of hearing function in patients with hearing loss. Objective: To describe the preoperative vestibular assessment protocol in subjects who will be submitted to cochlear implants. Methods: Our institutional protocol provides the vestibular diagnosis through six simple tests: Romberg and Fukuda tests, assessment for spontaneous nystagmus, Head Impulse Test, evaluation for Head Shaking Nystagmus and caloric test. Results: 21 patients were evaluated with a mean age of 42.75 ± 14.38 years. Only 28% of the sample had all normal test results. The presence of asymmetric vestibular information was documented through the caloric test in 32% of the sample and spontaneous nystagmus was an important clue for the diagnosis. Bilateral vestibular areflexia was present in four subjects, unilateral arreflexia in three and bilateral hyporeflexia in two. The Head Impulse Test was a significant indicator for the diagnosis of areflexia in the tested ear (p = 0.0001). The sensitized Romberg test using a foam pad was able to diagnose severe vestibular function impairment (p = 0.003). Conclusion: The six clinical tests were able to identify the presence or absence of vestibular function and function asymmetry between the ears of the same individual.
Resumo Introdução: Os implantes cocleares (IC) são indiscutivelmente um método eficaz de recuperação da função auditiva de pacientes surdos. Objetivo: Descrever o protocolo de avaliação vestibular pré-operatória em sujeitos que serão submetidos ao IC. Método: Nosso protocolo institucional prevê o diagnóstico vestibular por meio de seis testes simples: testes de Romberg e Fukuda, nistagmo espontâneo, Head Impulse Test, Head Shaking Nistagmus, prova calórica. Resultados: Foram avaliados 21 pacientes com média de 42,75 ± 14,38 anos. Apenas 28% da amostra apresentaram todos os testes normais. A presença de informação vestibular assimétrica foi documentada pela prova calórica em 32% da amostra e o nistagmo espontâneo mostrou-se pista importante para seu diagnóstico. A arreflexia vestibular bilateral foi diagnosticada em quatro sujeitos; arreflexia unilateral em três e hiporreflexia bilateral em dois. O Head Impulse Test mostrou-se indicador significante (p = 0,0001) para diagnosticar arreflexia da orelha testada. O teste de Romberg sensibilizado em almofada foi capaz de diagnosticar os comprometimentos severos da função vestibular (p = 0,003). Conclusão: Os seis testes clínicos foram capazes de identificar a presença ou não de função vestibular e assimetria da função entre as orelhas de um mesmo indivíduo.
Subject(s)
Humans , Male , Female , Adult , Middle Aged , Vestibular Function Tests/classification , Vestibular Diseases/surgery , Cochlear Implantation , Deafness/surgery , Vestibular Diseases/diagnosis , Cross-Sectional Studies , Cochlear Implants , Deafness/diagnosis , Deafness/etiologyABSTRACT
RESUMO O início da carreira intelectual de Mário de Andrade é marcado por aproximações com o compositor alemão Richard Wagner de diversas maneiras. No presente artigo, apresento três modos pelos quais os autores se encontram: o primeiro é a leitura que Mário faz da obra de Wagner; o segundo, parte da importância do compositor e seu projeto estético na história da música; o terceiro traz o caso da apresentação realizada por Oswald de Andrade que utiliza termos da ópera Parsifal. A partir desses, propõe-se uma leitura do pensamento musical de Mário de Andrade que pode ser utilizada de amparo para a compreensão do seu pensamento estético.
ABSTRACT The beginning of Mário de Andrade's intellectual career is marked by his many approximations to the German composer Richard Wagner. In this article, I would like to present three excerpts that show how these two authors meet: the first is Mário's reading of Wagner's work; the second concerns the importance of this composer and his aesthetic project in the history of music; the third relays the case of a presentation by Oswald de Andrade that makes a comparison to the opera Parsifal. From these excerpts, I would like to propose a reading of Mário de Andrade's musical thought that may be used as a basis to understand his aesthetic thinking.
Subject(s)
Comment , Literature, Modern , MusicABSTRACT
O aprendizado do correto manuseio do auxílio óptico foi treinado: localização, focalização e seguimento com o telescópio de 8x de magnificação. Após essa etapa iniciou-se o aprendizado de cópia da lousa com o auxílio adaptado. Totalizaram-se 17 sessões para a criança receber a prescrição final devido às grandes dificuldades apresentadas pela baixa acentuada das funções visuais.
Training of the proper handling of optical devices was performed: location, targeting and tracking with the 8x magnification telescope. After this step, learning to a copy from a blackboard with the adapted optical aid was initiated. Seventeen sessions were required for the child's final prescription due to severe low vision and loss of visual functions.
Subject(s)
Child , Humans , Male , Optical Devices , Patient Education as Topic/methods , Vision, Low/rehabilitation , Treatment Outcome , Visual AcuityABSTRACT
Prolactinomas são os tumores hipofisários mais comuns, podendo co-secretar GH (hormônio do crescimento). IGF-1 (fator de crescimento insulina-símile-1) é o principal responsável pelas ações do GH e parâmetro diagnóstico de acromegalia. Objetivando determinar por uma dosagem de IGF-1, na avaliação inicial de pacientes com prolactinoma, ocorrência de tumores mistos [GH e prolactina (PRL)], estudamos 7 homens e 27 mulheres, entre 19 e 72 anos, confrontando-os aos resultados de GH basal e durante teste oral de tolerância à glicose, quando GH basal >0,4 ng/mL ou níveis de IGF-1 alterados. A proporção de pacientes com GH >0,4 ng/mL e IGF-1 elevada foi alta; mas, após administração de 75g de glicose por via oral, nenhum paciente foi diagnosticado como acromegálico. Sugerimos, porém que a dosagem de IGF-1 seja realizada pelo risco de co-secreção de GH nos prolactinomas. Atenção especial para pacientes que apresentem significativa diminuição dos níveis de PRL, sem correspondente regressão do tamanho do adenoma.
Prolactinomas are the most frequent pituitary tumors and may co-secrete GH (growth hormone). IGF-1 (insulin-like growth factor-1) is the main responsible for GH actions and a parameter for the diagnosis of acromegaly. With the objective of identifying through a IGF-1 levels analysis, in the initial evaluation of prolactinoma patients, the existence of mixed tumors [GH and prolactin (PRL)], we studied 7 men and 27 women, aged between 19 and 72 years, confronting them with the results of basal and glucose stimulated (glucose tolerance test - GTT) GH levels, indicated when GH >0.4 ng/mL or IGF-1 levels were elevated. The prevalence of patients with GH >0.4 ng/mL and elevated IGF-1 was higher than expected; however, after GTT, no patient fulfilled the diagnostic criteria for acromegaly. However, we suggest that, they should be submitted to IGF-1 evaluation, due to the risk of GH co-secretion in prolactinomas. Special attention should be paid to those who present a significant decrease of PRL levels without concomitant tumor size reduction.