Central auditory processing and aphasia: A scoping review / Processamento auditivo central e afasia: uma revisão de escopo

ABSTRACT Purpose: to report scientific evidence on the impact of aphasia on central auditory processing and map the contribution of auditory training to aphasic individuals. Methods: a scoping review approaching national and international databases (SciELO, LILACS, PubMed, Scopus, and Cochrane Library) and the gray literature (Google Scholar and Open Grey). The inclusion criteria covered articles that addressed the interface between central auditory processing and aphasia, excluding duplicates, literature reviews, and scientific abstracts. Literature Review: the review comprised 13 articles that met the eligibility criteria for this study. Seven of the selected articles assessed central auditory processing, four used electrophysiological examinations (such as auditory brainstem response and long-latency auditory evoked potentials) to assess the auditory pathway, and only one analyzed the intervention in aphasic individuals with auditory training. Conclusion: scientific evidence points to an important change in aphasic people's central auditory processing, with impaired figure-ground, auditory closure, temporal resolution and ordering, and binaural integration. Moreover, it is relevant to assess auditory processing, given the contribution of auditory training in speech-language-hearing therapy for a better prognosis in the rehabilitation of aphasia.

RESUMO Objetivo: reportar as evidências científicas do impacto da afasia no Processamento Auditivo Central e mapear a contribuição do Treinamento Auditivo para a população afásica. Métodos: trata-se de uma revisão de escopo realizada nas bases de dados nacionais e internacionais: Scielo, Lilacs, Pubmed, Scopus, Cochrane Library e com uma busca adicional à literatura cinzenta no Google Scholar e Open Grey. Os critérios de inclusão abrangeram artigos que abordassem a interface do processamento auditivo central e afasia, excluindo-se as duplicações, artigos de revisão da literatura e resumos científicos. Revisão de Literatura: selecionaram-se 13 artigos que cumpriram os critérios de elegibilidade deste estudo. Dos artigos selecionados, sete apresentaram a avaliação do Processamento Auditivo Central, quatro apresentaram os exames eletrofisiológicos - como os exames de Potencial Evocado Auditivo de Tronco Encefálico (PEATE) e Potencial Evocado Auditivo de Longa Latência (PEALL) - para avaliação da via auditiva e apenas um estudo analisou a intervenção dos indivíduos afásicos por meio do treinamento auditivo. Conclusão: as evidências científicas apontam importante alteração no Processamento Auditivo Central dos afásicos, apresentando prejuízos nas habilidades auditivas de figura-fundo, fechamento auditivo, resolução e ordenação temporal e integração binaural. Ainda, demonstra-se como relevante a avaliação do processamento, devido à contribuição do Treinamento Auditivo nas terapias fonoaudiológicas para um melhor prognóstico na reabilitação das afasias.

Cochlear radiation dose and hearing loss in patients with vestibular schwannoma undergoing radiosurgery: systematic review

Abstract Objectives: To determine the cut-off point of the cochlear radiation dose as a risk factor for hearing loss in patients with vestibular schwannoma treated with radiosurgery. Methods: A systematic review of the literature was performed without language or publication year restrictions in the MEDLINE/PubMed, EMBASE, Web of Science, LILACS/VHL and Cochrane Library databases. Studies that met the following criteria were included: 1) population: adults of both sexes who underwent radiosurgery for vestibular schwannoma treatment; 2) exposure: cochlear radiation; 3) outcome: hearing loss; 4) type of study: cohort. Two independent reviewers conducted the entire review process. The registration number in PROSPERO was CRD42020206128. Results: From the 333 articles identified in the searches, seven were included after applying the eligibility criteria. There was no standardization as to how to measure exposure or outcome in the included studies, and most studies did not present sufficient data to enable meta-analysis. Conclusion: It was not possible to determine a cut-off point for high cochlear dose that could be considered a risk factor for hearing loss.

Tratamiento multimodal en los schwanomas vestibulares grandes

Introducción: Los schwanomas vestibulares son lesiones clasificadas como grado I por la Organización Mundial de la Salud. Las opciones conductuales incluyen la observación, la radiocirugía o la resección microquirúrgica endoscópica. Objetivo: Describir el rol del tratamiento multimodal en los schwanomas vestibulares. Métodos: Se realizó una búsqueda sistemática de literatura médica para la identificación e inclusión de artículos en las siguientes bases de datos: PubMed/Medline, SciELO y Google Scholar, además de los servidores de preprints BioRvix y MedRvix. Se usaron los siguientes descriptores: vestibular schwanoma OR acoustic neuroma AND nerve centered approach OR combined approach AND partial resection OR subtotal resection OR near total resection. Se excluyeron editoriales, cartas al editor, libros, revisiones, metaanálisis y aquellos artículos con método deficiente de más de 20 años de publicación o sin mención al tema de interés. Fueron incluidos 16 artículos. Desarrollo: Los artículos incluyeron un total de 699 pacientes, de los cuales solo 228 (32,6 %) recibieron radioterapia en el período posoperatorio. El período de seguimiento promedió 49,6 meses. La preservación de la función facial se logró en el 88,3 % de los casos y el control tumoral en el 80,7 %. El estado de la preservación auditiva solo fue informado en el 50 % de los estudios. El uso de la radioterapia adyuvante mostró gran variabilidad. Conclusiones: El tratamiento multimodal para los schwanomas vestibulares grandes -compuesto por la resección subtotal, vaciamiento intratumoral, seguido de radiocirugía- se ha convertido en una opción plausible. Se necesita la publicación de mayor cantidad de reportes para ofrecer recomendaciones y estratificar la conducta.

Introduction: Vestibular schwannomas are lesions classified as grade I by the World Health Organization. Behavioral options include observation, radiosurgery or endoscopic microsurgical resection. Objective: To describe the role of multimodal treatment for vestibular schwannomas. Methods: A systematic search of medical literature, for the identification and inclusion of articles, was carried out in the databases PubMed/Medline, SciELO and Google Scholar, as well as in the preprint servers BioRvix and MedRvix. The following descriptors were used: vestibular schwannoma OR acoustic neuroma AND nerve centered approach OR combined approach AND partial resection OR subtotal resection OR near total resection. Editorials, letters to the editor, books, reviews and metaanalyses were excluded, as well as articles with deficient method of more than 20 years of publication or not mentioning the topic of interest. Sixteen articles were included. Development: The articles included a total of 699 patients, of which only 228 (32.6 %) received radiotherapy in the postoperative period. The average follow-up period was 49.6 months. Preservation of facial function was achieved in 88.3 % of cases; and tumor control, in 80.7 %. Hearing preservation status was reported in only 50 % of the studies. The usage of adjuvant radiotherapy showed great variability. Conclusions: Multimodal treatment for large vestibular schwannomas -composed of subtotal resection and intratumoral draining, followed by radiosurgery- has become a plausible option. The publication of a greater amount of reports is necessary to provide recommendations and stratify the behavior.

Síndrome de Wildervanck: reporte de un caso clínico / Wildervanck syndrome: clinical case report

El síndrome de Wildervanck (cérvico-óculo-acústico) es una patología muy rara, caracterizada por la tríada clásica de fusión de vértebras cervicales o anomalía de Klippel-Feil, síndrome de Duane (paresia del VI par craneal) e hipoacusia. Se han descrito, además, otras afecciones a nivel vascular, cardíaco y musculoesquelético. En este caso clínico, describimos a una paciente que cumple la tríada cardinal, además de presentar datos clínicos adicionales que no han sido reportados con anterioridad, lo cual contribuye a la ampliación del fenotipo de la enfermedad. Asimismo, realizamos una revisión de la literatura respecto a este síndrome

Wildervanck syndrome (also known as cervico-oculo-acoustic dysplasia) is a very rare disease, characterized by the typical triad of cervical vertebral fusion or Klippel-Feil anomaly, Duane syndrome (paresis of the sixth cranial nerve), and hearing loss. Other vascular, cardiac, and musculoskeletal conditions have also been described. In this case report, we describe a patient who met the cardinal triad and also presented additional clinical data that have not been previously reported, which contribute to broadening the disease phenotype. We have also reviewed the bibliography related to this syndrome.

Perfusion-weighted imaging in vestibular schwannoma: the influence that cystic status and tumor size have on perfusion profiles / Perfusão por ressonância magnética em schwannoma vestibular: influência do tamanho e estádio cístico no perfil da perfusão

Abstract Objective: The perfusion profile of vestibular schwannomas (VSs) and the factors that influence it have yet to be determined. Materials and Methods: Twenty patients with sporadic VS were analyzed by calculating parameters related to the extravascular extracellular space (EES)—the volume transfer constant between a vessel and the EES (Ktrans); the EES volume per unit of tissue volume (Ve); and the rate transfer constant between EES and blood plasma (Kep)—as well as the relative cerebral blood volume (rCBV), and by correlating those parameters with the size of the tumor and its structure (solid, cystic, or heterogeneous). Results: Although Ktrans, Ve, and Kep were measurable in all tumors, rCBV was measurable only in large tumors. We detected a positive correlation between Ktrans and rCBV (r = 0.62, p = 0.031), a negative correlation between Ve and Kep (r = -0.51, p = 0.021), and a positive correlation between Ktrans and Ve only in solid VSs (r = 0.64, p = 0.048). Comparing the means for small and large VSs, we found that the former showed lower Ktrans (0.13 vs. 0.029, p < 0.001), higher Kep (0.68 vs. 0.46, p = 0.037), and lower Ve (0.45 vs. 0.83, p < 0.001). The mean Ktrans was lower in the cystic portions of cystic VSs than in their solid portions (0.14 vs. 0.32, p < 0.001), as was the mean Ve (0.37 vs. 0.78, p < 0.001). There were positive correlations between the solid and cystic portions for Ktrans (r = 0.71, p = 0.048) and Kep (r = 0.74, p = 0.037). Conclusion: In VS, tumor size appears to be consistently associated with perfusion values. In cystic VS, the cystic portions seem to have lower Ktrans and Ve than do the solid portions.

Resumo Objetivo: O perfil de perfusão do schwannoma vestibular (SV) não tem sido estudado, nem os fatores que o influenciam. Materiais e Métodos: Vinte pacientes com SV esporádico foram analisados usando Ktrans, Ve, Kep e rCBV e correlacionados com tamanho e estádio cístico. Resultados: Ktrans, Ve e Kep foram medidos em todos os casos. rCBV só foi possível em tumores grandes. Ktrans e rCBV estavam correlacionados positivamente (r = 0,62, p = 0, 0 31 ) . Ve e Kep estavam negativamente correlacionados (r = -0,51, p = 0,021). Ktrans estava correlacionado positivamente com Ve em SVs sólidos (r = 0,64, p = 0,048). Em SVs pequenos, Ktrans foi menor (0,13 vs 0,029, p < 0,001), Kep foi maior (0,68 vs 0,46, p = 0,037) e Ve foi menor (0,45 vs 0,83, p < 0,001) que nos SVs grandes. Ktrans e Ve foram menores dentro dos cistos que nas porções solidas dos SVs císticos (0,14 vs 0,32, p < 0,001; 0,37 vs 0,78, p < 0.001, respectivamente). Foi encontrada correlação positiva em Ktrans (r = 0,71, p = 0,048) e Kep (r = 0,74, p = 0,037) entre as áreas sólidas e císticas. Conclusão: Nos SVs, o tamanho está consistentemente associado com os valores da perfusão. Nos SVs císticos, as porções císticas parecem ter valores menores de Ktrans e Ve do que nas porções sólidas.

Application of high-frequency ultrasound combined with virtual touch tissue imaging and quantification for assessing limb muscle tone after stroke / 中国基层医药

Objective:To investigate the clinical value of high-frequency ultrasound combined with virtual touch tissue imaging and quantification in the assessment of limb muscle tension after stroke in patients.Methods:A total of 31 patients with stroke who received treatment in Wenzhou Hospital of Integrated Traditional Chinese and Western Medicine from January 2020 to May 2022 and 41 healthy controls who concurrently underwent physical examination in the same hospital were included in this study. Before rehabilitation treatment, the shear wave velocity of the main muscle groups of the limbs was measured using virtual touch tissue imaging and quantification in all participants. The shear wave velocity of the main muscle groups was compared between the affected and healthy sides of patients between two sides of patients. The patient's muscle tension was evaluated using the modified Ashworth Scale. The shear wave velocity of the affected muscle groups in patients was correlated with the modified Ashworth Scale score.Results:There were no significant differences in the shear wave velocities of the main muscle groups of upper (biceps, flexor digitorum sublimis, flexor digitorum profundus) and lower [medial head of the gastrocnemius muscle, lateral head of the gastrocnemius muscle] limbs between the left [(2.46 ± 0.26) m/s, (2.81 ± 0.50) m/s, (2.96 ± 0.31) m/s, (2.49 ± 0.44) m/s, (2.21 ± 0.20) m/s] and right [(2.42 ± 0.29) m/s, (2.80 ± 0.47) m/s, (3.02 ± 0.36) m/s, (2.54 ± 0.37) m/s, (2.18 ± 0.17) m/s] sides in healthy controls ( t = 0.78, 0.04, 0.83, 0.58, 1.15, P = 0.435, 0.967, 0.405, 0.558, 0.216). The shear wave velocities of the main muscle groups of upper [flexor digitorum sublimis (3.74 ± 0.67) m/s, flexor digitorum profundus (3.64 ± 0.60) m/s), biceps (3.63 ± 0.64) m/s] and lower [medial head of the gastrocnemius muscle (3.28 ± 0.61) m/s, lateral head of the gastrocnemius muscle (2.90 ± 0.37) m/s] limbs on the affected side in patients with stroke were significantly higher than (2.56 ± 0.40) m/s, (2.67 ± 0.38) m/s, (2.78 ± 0.41) m/s, (2.30 ± 0.21) m/s, (2.25 ± 0.23) m/s on the healthy side ( t = 11.81, 8.21, 8.75, 8.91, 10.43, all P < 0.001). The shear wave velocities of the main muscle groups of the upper (flexor digitorum sublimis, flexor digitorum profundus, and biceps) and lower (medial head of the gastrocnemius muscle and lateral head of the gastrocnemius muscle) limbs were positively correlated with the modified Ashworth Scale score ( r = 0.77, 0.70, 0.72, 0.74, 0.78, P = 0.007, 0.029, 0.021, 0.016, 0.001). Conclusion:Monitoring the shear wave velocities of the main muscle groups of the upper and lower limbs using high-frequency ultrasound combined with virtual touch tissue imaging and quantification can effectively reflect the change in limb muscle tension of patients with stroke, which is highly valuable for evaluating rehabilitation efficacy and prognosis in patients with stroke.

Membranophone percussion instruments in music therapy with adult patients in the health context: a scope review / Instrumentos de percusión de membranófono en musicoterapia con pacientes adultos en el contexto de la salud: revisión de alcance / Instrumentos de percussão membranofones na musicoterapia com pacientes adultos no contexto de saúde: revisão de escopo

ABSTRACT Objective: To map scientific knowledge about the use of percussion instruments in music therapy in individuals over 18 years of age in the health context. Method: Scope review with search strategy implemented in September 2021, in 13 databases, using indexed descriptors and keywords. Studies on the use of membranophones for care of people over 18 years of age were included. Studies with the participation of pregnant women, psychiatric patients (schizophrenia, psychosis, addiction), or people with hearing impairment, and journal editorials were excluded. The selection process was carried out by two independent researchers. Results: Thirteen studies were included and the results showed that the membranophones have a positive impact on the physical, psychological, and social health of people in different care environments, and allow them to repeat rhythmic patterns and play music. Active music therapy was the strategy predominantly used in interventions, and the most used membranophone was the djembe. Conclusion: The results suggest that music therapy with membranophones proved to be a viable intervention with beneficial results in improving physical, psychological, and social health of people over 18 years of age.

RESUMEN Objetivo: Mapear el conocimiento científico sobre el uso de instrumentos de percusión en musicoterapia en mayores de 18 años en el contexto de la salud. Método: Revisión de alcance con estrategia de búsqueda implementada en septiembre de 2021, en 13 bases de datos, utilizando descriptores indexados y palabras clave. Se incluyeron estudios sobre el uso de membranófonos en el cuidado de personas mayores de 18 años. Se excluyeron los estudios con la participación de mujeres embarazadas, pacientes psiquiátricos (esquizofrenia, psicosis, adicción) o personas con discapacidad auditiva; editoriales de revistas. El proceso de selección fue realizado por dos investigadores independientes. Resultados: Se incluyeron trece estudios y los resultados mostraron que los membranófonos tienen un impacto positivo en la salud física, psicológica y social de las personas en diferentes entornos de atención, además de permitirles repetir patrones rítmicos y reproducir música. La musicoterapia activa fue la estrategia predominantemente utilizada en las intervenciones, y el membranófono más utilizado fue el djembe. Conclusión: Los resultados sugieren que la musicoterapia con membranófonos demostró ser una intervención viable con resultados beneficiosos en la mejora de la salud física, psicológica y social de las personas mayores de 18 años.

RESUMO Objetivo: Mapear o conhecimento científico sobre o uso de instrumentos de percussão na musicoterapia, em indivíduos maiores de 18 anos, no contexto de saúde. Método: Revisão de escopo com estratégia de busca implementada em setembro de 2021, em 13 bases de dados, utilizando-se descritores indexados e palavras-chave. Foram incluídos estudos sobre o uso de membranofones no cuidado a pessoas maiores de 18 anos. Foram excluídos estudos com participação de gestantes, pacientes psiquiátricos (esquizofrenia, psicose, adição) ou pessoas com déficit auditivo; e editoriais de revistas. O processo de seleção foi realizado por dois pesquisadores independentes. Resultados: Treze estudos foram incluídos e os resultados mostraram que os membranofones impactam de forma positiva na saúde física, psicológica e social das pessoas, em diferentes ambientes de cuidado, além de habilitá-los a repetir padrões rítmicos e musicar. A musicoterapia ativa foi a estratégia predominantemente utilizada nas intervenções, e o membranofone mais utilizado foi o djembê. Conclusão: Os resultados sugerem que a musicoterapia com membranofones mostrou ser uma intervenção viável com resultados benéficos na melhora da saúde física, psicológica e social em pessoas maiores de 18 anos.

Análise não linear pela reconstrução do espaço de fase de vozes saudáveis de idosos / Nonlinear analysis by phase space reconstruction of healthy elderly voices

RESUMO Objetivo Verificar medidas acústicas das vozes de idosos pela análise não linear e realizar a comparação entre os sexos. Método Participaram 29 idosos, falantes do Português Brasileiro, vocalmente saudáveis: 14 homens e 15 mulheres. Todas as vozes foram julgadas como vocalmente saudáveis por três fonoaudiólogas treinadas, por meio de avaliação perceptivo-auditiva. A análise acústica não linear foi realizada pela análise da Reconstrução de Espaço de Fase utilizando o programa Análise de Voz. Resultados Foi observado diferença significativa no parâmetro irregularidade (p=0,001) e espaçamento (p=0,005) entre os sexos, com resultados piores no grupo masculino. Enquanto 93% das vozes masculinas apresentaram graus 2 ou 3 de irregularidade, estes graus foram observados em 53% das vozes femininas. Em 78,6% das vozes masculinas foi observado espaçamento de médio a grande, fato observado somente em 26,7% das mulheres. Conclusão Os resultados da análise não linear, por meio da REF, com a utilização do protocolo CIE, em vozes de idosos, mostraram o melhor resultado quanto ao número de curvas (quatro ou mais). Em relação à irregularidade do traçado, nos homens, a maioria apresentou graus 2 e 3 e nas mulheres, a metade apresentou grau 1. Relativo ao espaçamento, 78,6% das vozes masculinas foi observado espaçamento de médio a grande, fato observado somente em 26,7% das mulheres. Houve diferença entre os sexos nos achados vocais de idosos pelo protocolo CIE com a análise de Reconstrução de Espaço de Fase, apontado piores resultados na irregularidade e espaçamento na população masculina, o que sugere maior aperiodicidade vocal em homens idosos.

ABSTRACT Purpose To compare the results of the non-linear acoustic analysis of elderly male and female voices, speakers of Brazilian Portuguese. Methods Recordings of 14 men and 15 women were used. The voices were consensually judged to be vocally healthy by three trained speech therapists. The non-linear acoustic analysis was performed by the Phase Space Reconstruction (PSR) analysis using the Voice Analysis program. Results A significant difference was observed in the parameter irregularity (p = 0.001) and spacing (p = 0.005), with worse results for the male group. While 93% of male voices presented degrees 2 or 3 of irregularity, these degrees were observed in 53% of female voices. In 78.6% of male voices, medium to large spacing was observed, a fact observed only in 26.7% of women. Conclusion The results of the non-linear analysis, through the Phase Space Reconstruction, using the CIS Protocol, in the voices of the elderly, showed the best result in terms of the number of curves (four or more). Regarding the irregularity of the tracing, in men, the majority presented grades 2 and 3 and in women, half presented grade 1. Regarding the spacing, 78.6% of the male voices had medium to large spacing, a fact observed only in 26.7% of women.There was a difference between the sexes in the vocal findings of the elderly by the CIS protocol with the PSR, pointing out worse results irregularity and spacing in the male population, which suggests greater vocal aperiodicity in elderly men.

Campo dinâmico vocal: avaliação da funcionalidade da voz / Dynamic vocal analysis: vocal functionality evaluation

RESUMO O campo dinâmico vocal (CDV) é uma estratégia de avaliação vocal perceptivo-auditiva e acústica que oferece estimativas sobre a biomecânica e a aerodinâmica da produção vocal por meio da realização de tarefas de variação de frequência e de intensidade e do uso da espectrografia acústica da voz. Esse relato de experiência tem como objetivo demonstrar a aplicação do CDV na avaliação da funcionalidade vocal de indivíduos disfônicos e não-disfônicos, com foco especial na musculatura laríngea. As tarefas fonatórias envolvem emissão de vogal sustentada e/ou de fala encadeada em três intensidades autosselecionadas (habitual autorreferida, fraca e forte) e em três frequências (habitual autorreferida, aguda, grave), além do glissando. As tarefas de variação de intensidade e de frequência possibilitam a avaliação da musculatura laríngea no controle da adução glótica e do alongamento e encurtamento das pregas vocais. A tarefa de variação de frequência permite também a análise da musculatura extrínseca no controle da posição vertical da laringe no pescoço. Enquanto a vogal sustentada avalia a funcionalidade vocal com foco na laringe, a fala encadeada permite a avaliação dos ajustes articulatórios empregados. A aplicação do CDV será demonstrada por meio de pranchas espectrográficas de indivíduos normais e disfônicos. Indivíduos vocalmente saudáveis realizam as tarefas do CDV de forma equilibrada, com qualidade vocal adequada e sem esforço fonatório, denotando boa funcionalidade vocal. Por outro lado, indivíduos com dificuldade na realização das tarefas do CDV, com piora da qualidade vocal e/ou com aumento da tensão muscular, podem apresentar funcionalidade vocal alterada.

ABSTRACT Dynamic vocal analysis (DVA) is an auditory-perceptual and acoustic vocal assessment strategy that provides estimates on the biomechanics and aerodynamics of vocal production by performing frequency and intensity variation tasks and using voice acoustic spectrography. The objective of this experience report is to demonstrate the use of DVA in the assessment of vocal functionality of dysphonic and non-dysphonic individuals, with a special focus on the laryngeal musculature. Phonatory tasks consisted of sustained vowel, "a" or "é", and/or connected speech, in three intensities (habitual, soft, and loud) and three frequencies (habitual, high, and low), as well as ascending and descending glissando. The adjustments of the laryngeal and paralaryngeal muscles can be inferred from the different DVA tasks. The main characteristics of the laryngeal muscles analyzed are control of glottic adduction, stretching, and shortening of the vocal folds; the main characteristics of the paralaryngeal musculature are mainly related to the vertical laryngeal position in the neck. While the sustained vowel evaluates the vocal functionality with a focus on the larynx, connected speech allows the evaluation of the articulatory adjustments employed. An acoustic spectrographic software can be used to visualize the performance of such tasks. The clinical application of the DVA will be exemplified using acoustic spectrography plates from normal and dysphonic voices, taken from a voice bank. Individuals who perform the DVA tasks in a balanced way, with adequate vocal quality and without phonatory effort, demonstrate good vocal functionality. On the other hand, difficulties in performing these tasks with worsening vocal quality and/or increased muscle tension may be indications of altered vocal functionality.

Peak nasal inspiratory flow in children and adolescents with sickle cell disease: a case-control study

SUMMARY OBJECTIVE: Sickle cell disease is the most frequent of the hereditary hemoglobinopathies and it presents multisystemic effects. A manifestation that is commonly found in sickle cell disease is upper airway obstruction, particularly adenotonsillar hypertrophy. This study aims to evaluate the peak nasal inspiratory flow measurements of children and adolescents with sickle cell disease. METHODS: This is a case-control study on children aged between 8 and 15 years who were diagnosed with sickle cell disease. Peak nasal inspiratory flow measurements were obtained from patients. RESULTS: A total of 279 patients were enrolled in this study, with 93 in the case group and 186 in the control group. The case group had an 82.83% chance of having lower peak nasal inspiratory flow values than the control group. In the case group, 75% of the peak nasal inspiratory flow values were in the lower standards, whereas in the control group, only 25% were in the lower standards. CONCLUSION: This study showed a high prevalence of reduced peak nasal inspiratory flow values in children with sickle cell disease and could certainly be incorporated into the day-to-day clinical evaluation of patients as a screening instrument.

Study of aged central auditory function using the auditory middle latency response

Abstract Objective Investigate the auditory function of the elderly using the middle latency potentials. Methodology Group 1 (G1): 20 healthy individuals of both genders, older than 60 years, without hearing loss. Group 2 (G2): 20 healthy individuals of both sexes, older than 60 years, with hearing loss in frequencies from 4 to 8 kHz. Potential recording was performed with unilateral and bilateral stimulation and the Binaural Interaction Component was calculated. Results Na latency in C3A1 was greater in the stimulation of the right ear in G2 and the amplitude of Na-Pa was greater in the stimulation of the right ear and recording in C3A1 in G1. The latency of the Pa component was higher in the stimulation of the right ear recorded in C4A2. The Pb component in G2 by bilateral stimulation and recorded in C4A2 had higher latency. The first and second negative and positive peaks presented greater amplitude in G1. In C3A1, the 1st negative peak was more negative in G1 and the 2nd positive peak showed greater amplitude in C4A2 in both groups. Conclusion The transmission of auditory information to the primary auditory cortex is impaired with aging, especially in unilateral stimulation, reinforced by losses in elderly people with peripheral hearing loss, such as in the binaural interaction at the cortical and subcortical levels. Thus, the AMLR has shown to be a sensitive examination to investigate neuroauditory disorders in the elderly, especially related to high-frequency hearing loss and primary auditory cortex dysfunctions caused by the aging process.

VoxMore: artefato tecnológico para auxiliar a avaliação acústica da voz no processo ensino-aprendizagem e prática clínica / VoxMore: technological artifact to assist voice acoustic evaluation in the teaching-learning process and clinical practice

RESUMO Objetivo apresentar um artefato tecnológico, o plugin VoxMore, para auxiliar o ensino acadêmico da avaliação acústica da voz, bem como otimizar a intervenção fonoaudiológica na prática da clínica vocal. Método trata-se de um estudo metodológico de caráter multidisciplinar para o desenvolvimento de um artefato tecnológico, plugin, a ser utilizado no software Praat. Essa ferramenta realiza análise acústica vocal e gera um relatório, com informações e imagens referentes aos domínios do tempo, frequência, tempo-frequência, e quefrência, bem como valores de medidas acústicas relacionadas a frequência fundamental (f0), medidas de período, medidas de perturbação do período da f0, medidas de perturbação de amplitude da f0, medidas espectrais, medidas de ruído glotal e medidas cepstrais. Resultados no relatório acústico do VoxMore são gerados quatro arquivos com as seguintes informações: oscilogramas do sinal de voz e traçados da f0 e intensidade; imagens relacionadas ao domínio da frequência, espectro de Fourier e espectro de LPC, e ao domínio do tempo-frequência, espectrograma; informações sobre a análise cepstral e cepstrograma; valores de todas as medidas acústicas, no formato de resultados numéricos e em gráficos de barras verticais. Conclusão o VoxMore pode contribuir tanto com o processo de ensino-aprendizagem, atuando como ferramenta auxiliar com caráter formativo nas disciplinas de graduação e pós-graduação em Fonoaudiologia, quanto com o processo da prática clínica, tornando viável a utilização da análise acústica na clínica vocal e apoiando a tomada de decisão dos fonoaudiólogos.

ABSTRACT Purpose to present a technological artifact, the VoxMore plugin, to assist the academic teaching of voice acoustic assessment, as well as to optimize the speech therapy intervention in the practice of vocal clinics. Methods this is a multidisciplinary methodological study for the development of a technological artifact, a plugin, to be used in the Praat software. This tool performs vocal acoustic analysis and generates a report, with information and images referring to the domains of time, frequency, time-frequency, and que-frequency, as well as values of acoustic measures related to fundamental frequency (f0), period measures, disturbance measures of the period of f0, f0 amplitude perturbation measurements, spectral measurements, glottal noise measurements and cepstral measurements. Results in the VoxMore acoustic report, four files are generated with the following information: oscillograms of the voice signal and traces of f0 and intensity; images related to the frequency domain, Fourier spectrum and LPC spectrum, and to the time-frequency domain, spectrogram; information on cepstral and cepstrogram analysis; the values of all acoustic measurements, in numerical results format and in vertical bar graphs. Conclusion VoxMore can contribute both to the teaching-learning process, acting as an auxiliary tool with a formative character in the undergraduate and graduate courses in Speech-Language Pathology, as well as to the clinical practice process, making the use of acoustic analysis in the vocal clinic feasible and supporting decision-making by speech-language pathologist.

Brazilian Society of Otology task force - Vestibular Schwannoma - evaluation and treatment

Abstract Objective: To review the literature on the diagnosis and treatment of vestibular schwannoma. 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 vestibular schwannoma 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, electrophysiologic tests, and imaging; (2) Treatment - wait and scan protocols, surgery, radiosurgery/radiotherapy, and systemic therapy. Conclusions: Decision making in VS treatment has become more challenging. MRI can diagnose increasingly smaller tumors, which has disastrous consequences for the patients and their families. It is important to develop an individualized approach for each case, which highly depends on the experience of each surgical team.

Study of auditory pathways in type 1 diabetes mellitus through brainstem auditory evoked potentials and contralateral acoustic reflex / Estudo das vias auditivas em diabetes mellitus tipo 1 através dos potenciais auditivos evocados de tronco encefálico e reflexo acústico contralateral

ABSTRACT Purpose To investigate the functionalities of the neural pathways through the auditory evoked potentials of the brainstem and the contralateral stapedial acoustic reflexes in normal-hearing individuals with type 1 diabetes mellitus, in order to detect possible alterations in the central auditory pathways. Methods This is a cross-sectional study with a comparison group and a convenience sample, consisting of 32 individuals with type 1 diabetes mellitus and 20 controls without the disease. All subjects had hearing thresholds within normal limits and type A tympanometric curves. The acoustic reflex arc and brainstem auditory potentials were investigated. Statistical analyses were performed using the SPSS 17.0. The Chi-square test, Student´s t-test, and Multiple linear regression were used. Results The auditory thresholds of the acoustic reflex were statistically lower in the group with the disease at frequencies of 0.5 kHz and 1.0 kHz in the left ear (p=0.01 and p=0.01, respectively). The absolute latencies III and V of the auditory potentials of the brainstem in the right ear and V in the left ear were increased in subjects with type 1 diabetes mellitus (p=0.03, p=0.02 and p=0.03, respectively). Conclusion The findings suggest that subjects with type 1 diabetes mellitus are more likely to present alterations in the central auditory pathways, even with auditory thresholds within normal limits.

RESUMO Objetivo Investigar a funcionalidade das vias neurais por meio dos potenciais evocados auditivos de tronco encefálico e os reflexos acústicos estapedianos contralaterais em sujeitos com diabetes mellitus tipo 1 normo-ouvintes, a fim de detectar possíveis alterações nas vias auditivas centrais. Método Trata-se de um estudo transversal com grupo de comparação, e amostra de conveniência, composta por 32 sujeitos com diabetes mellitus tipo 1 e 20 controles sem a doença. Todos os sujeitos apresentavam limiares auditivos dentro dos padrões de normalidade e curva timpanométrica tipo A. Foram investigados o arco-reflexo acústico e os potenciais auditivos de tronco encefálico. As análises dos resultados foram realizadas no SPSS 17.0. Utilizou-se o Teste Qui Quadrado, Teste T de Studant e Regressão linear múltipla. Resultados Os limiares auditivos do reflexo acústico foram estatisticamente menores no grupo com a doença nas frequências de 0,5 kHz e 1,0 kHz na orelha esquerda (p=0,01 e p=0,01, respectivamente). As latências absolutas III e V dos potenciais auditivos de tronco encefálico da orelha direita e V da orelha esquerda estavam aumentadas em sujeitos com diabetes mellitus tipo 1 (p=0,03, p=0.02 e p=0,03, respectivamente). Conclusão Os achados sugerem que sujeitos com diabetes mellitus tipo 1 estão mais propensos a apresentar alterações nas vias auditivas centrais, mesmo com limiares auditivos dentro dos padrões de normalidade.

Lip trill effects on vocal function, vocal pitch, and harmonics-to-noise ratio: A multiple baseline study of three vocally healthy females

Background@#The lip trill is a semi-occluded vocal tract exercise found to have positive outcomes on vocal parameters of healthy individuals after a single session. However, the effect of several lip trill sessions has not been studied.@*Objective@#This study investigated the effect of a 3- to 4-week lip trill exercise program on Maximum Phonation Time (MPT), Maximum Phonation Frequency Range (MPFR), Harmonics-to-Noise Ratio (HNR), and mean Speaking Fundamental Frequency (mean SFF).@*Methods@#Three vocally untrained healthy females with perceptually normal voices participated in a multiple-baseline, single-case experimental research. Five to seven direct training sessions were randomly assigned. Self-implementation was encouraged thereafter. Participants were assessed on all outcome measures for 15 sessions. Data were visualized and inspected. Cohen’s d was also derived using Standardized Mean Difference for single-subject research.@*Results@#Visual and statistical analyses revealed a decreased MPT when training was introduced, increased MPFR variability during the training phase, and increased stability in mean SFF post-training. Perceived effects include vocal freedom, decreased laryngeal stress, and vocal conditioning. Vocal outcomes in one participant yielded a significant effect on MPFR and mean SFF and a small effect on HNR.@*Conclusion@#There is evidence of lip trill effect on pitch control and vocal conditioning. Findings also revealed that motivation, exercise frequency, and adherence could contribute to positive gains in vocally healthy speakers. Further investigation in consideration of the study findings and limitations is warranted.

Acoustic analysis of an articulation assessment and training system / 中华物理医学与康复杂志

Objective:To compare the differences in important parameters between the articulation assessment and training system of intelligently extracted speech with those from the Praat acoustic software and those manually extracted.Methods:The speech of thirty-two normal subjects was captured using the intelligent articulation assessment and training system and using Praat acoustic software. The former analyzed the mean fundamental frequencies (mF0s), the first formant peaks (F1s) and the second formant peak (F2s) of the sustained vowels /a/, /i/ and /u/. The speech parameters collected by the traditional Praat software were extracted and analyzed by professionals. The two tools′ consistency in terms of these important acoustic parameters was analyzed.Results:The results with all 32 subjects when retested returned ICC values above 0.9 with all three vowels with the exception of mF0 for /u/ (ICC=0.75), indicating excellent retest reliability for the articulation assessment and training system. The ICC values also indicated excellent consistency between the two kinds of software in analyzing mF0, F1 and F2 of the three vowels. The mF0, F1, F2, FCR, VAI, tongue spacing, VSA, and mandibular spacing of all three vowels were mostly distributed within the 95% confidence interval of the data points in Bland-Altman plots, indicating the high accuracy of both acoustic analysis systems in speech measurement. The mean fundamental frequency values of the male long vowels /a/, /i/ and /u/ were all significantly lower than for the female long versions.Conclusions:The retest reliability of the articulation assessment and training system was good, and the results of the articulation check in the natural state were in good consistency compared to the Praat check and were interchangeable in the articulation check.

The Endoscopic Anatomy of the External Acoustic Meatus and of the Middle Ear in Dry Temporal Bones: A Study Conducted Using Digital and Mobile Device Technology

Abstract Introduction The endoscopic anatomy of the middle ear (ME) and of the external acoustic meatus (EAM) has been described in cadavers, in fresh temporal bones, or in vivo using conventional video recording, but not in dry bones or using an alternative inspection and recording technique. Objective To study the anatomy of the ME and of the EAM in dry temporal bones using a smartphone-endoscope system. Methods The EAM and the ME were studied in dry temporal bones using an endoscopic transcanal approach with a telescope connected to a smartphone (M-scope mobile endoscope app and adaptador, GBEF Telefonia, São Paulo, SP, Brazil). Results Out of 50 specimens, 2 had exostosis of the EAM and 3 contained remains of the tympanic membrane. The anterior wall of the EAM was prominent in 10/48 specimens (20.8%). Ossicles were seen in 13/45 (28.8%), stapes at the oval window were seen in 12/45 (26.6%), and the incus was seen in 1/45 (2.2%) specimens. The facial canal was open and protruding in 15/45 (33.3%) and in 7/45 (15.5%) specimens, respectively. Of the 45 MEs evaluated, type A was predominant for finiculus (93.3%), subiculum (100%), and ponticulus (95.6%). The rest were type B. None was classified as type C. According to its position in relation to the round window, the fustis was classified into type A (68.9%) or B (31.1%). The pyramidal eminence, the bony portion of the Eustachian tube, the semicanal of the tensor tympani muscle, and the cochleariform process were visualized completely or partially in all cases. Conclusion The use of a smartphone-based endoscopic transcanal procedure in dry temporal bones allowed the evaluation of anatomical variations in the EAM and in the ME.

Wideband Acoustic Absorbance in Otosclerosis: Does Stapedotomy Restore Normal Tympanic Cavity Function?

Abstract Introduction Otosclerosis is characterized by the fixation of the stapes to the oval window, thereby impairing acoustic signal absorbance. A commonly used surgical technique for improving hearing in cases of otosclerosis is stapedotomy. However, it is unclear whether this surgery restores all the physical characteristics of the tympano-ossicular system. Objective To evaluate the tympano-ossicular system in individuals with fenestral otosclerosis pre and poststapedotomy using wideband tympanometry. Method A total of 47 individuals and 71 ears were assessed. The subjects were divided into three groups: presurgery otosclerosis; postsurgery; and a control group of normal-hearing adults. A handheld tympanometer with a wideband module (226-8,000 Hz) was used to take measurements at ambient pressure and under pressurized conditions. The level of statistical significance adopted was p ≤ 0.05. Results Acoustic absorbance at 226 Hz was low for all groups. At frequencies in the range 630 to 5,040 Hz, each group had a characteristic absorbance curve, allowing them to be distinguished from one another. In the presurgery group, absorbance values were below normal levels, with energy absorbance below 10%. Low energy absorbance was most evident at 1,000 Hz in the presurgery group, but this was not observed in the postsurgery group. Although there was an improvement in hearing, the surgery failed to restore the tympano-ossicular system to normal. Conclusion Wideband acoustic absorbance proved able to differentiate normal ears and otosclerotic ears pre and postsurgery, under both ambient pressure and pressurized conditions.

Influência da estratégia de Estimulação Auditiva Rítmica com música associada à fisioterapia sobre os sintomas depressivos no Parkinson / Influencia de la estrategia de Estimulación Auditiva Rítmica con música asociada a fisioterapia en los síntomas depresivos en el Parkinson / Influence of Rhythmic Auditory Stimulation using music associated with physical therapy on depressive symptoms in Parkinson's

RESUMO A sintomatologia depressiva (SD) é comum na doença de Parkinson (DP) e considerada fator importante para má qualidade de vida e incapacidade do indivíduo. Intervenções terapêuticas baseadas em ritmo e música, a exemplo da Estimulação Auditiva Rítmica (EAR), têm sido utilizadas no tratamento da mobilidade e parecem influenciar positivamente o estado de humor do paciente. O objetivo deste estudo é avaliar o efeito da EAR com música associada à fisioterapia no estado de humor de pessoas com DP, com ênfase na SD. Trata-se de estudo quase experimental, com amostra de 18 pacientes com idades entre 40 e 80 anos e diagnóstico clínico de DP idiopática nos estágios leve a moderado. Os pacientes foram randomizados em dois grupos: grupo EAR e grupo-controle (GC). A SD foi avaliada por meio da versão em português do Inventário de Depressão de Beck (BDI). Os escores do BDI apresentaram redução em ambos os grupos. Entretanto, apenas no grupo EAR essa redução foi significativa, com diferença média no escore três vezes maior do que no GC.

RESUMEN La sintomatología depresiva (SD) es frecuente en la enfermedad de Parkinson (EP) y se considera un importante factor para predecir la mala calidad de vida y la discapacidad del individuo. Las intervenciones terapéuticas basadas en el ritmo y la música, como la Estimulación Auditiva Rítmica (EAR), se han utilizado en el tratamiento de la movilidad y pueden influir positivamente en el estado de ánimo del paciente. El objetivo de este estudio es evaluar el efecto de la EAR con música asociada a la fisioterapia en el estado de ánimo de personas con EP, con énfasis en la SD. Se trata de un estudio cuasiexperimental, realizado con una muestra de 18 pacientes de entre 40 y 80 años de edad, con diagnóstico clínico de EP idiopática en estadios leve a moderado. Los pacientes se dividieron al azar en dos grupos: Grupo EAR y grupo control (GC). La SD se evaluó mediante la versión en portugués del Inventario de Depresión de Beck (BDI). Las puntuaciones del BDI tuvieron una disminución en ambos grupos. Sin embargo, esta reducción fue significativa solo en el grupo EAR, con una diferencia media en la puntuación tres veces mayor que en el GC.

ABSTRACT Depressive symptoms are commonly found in Parkinson's disease and are considered an important factor for an individual's poor quality of life and disability. Therapeutic interventions based on rhythm and music, such as rhythmic auditory stimulation, have been used to treat the mobility and seem to positively influence on mood. This study aims to evaluate the effect of rhythmic auditory stimulation using music associated with physical therapy on mood in individuals with Parkinson's, with an emphasis on depressive symptoms. This is a quasi-experimental study with a final sample of 18 patients aged 40-80 years, with a clinical diagnosis of idiopathic Parkinson's disease, in the mild to moderate stages of the disease. Patients were randomized into two groups: Rhythmic Auditory Stimulation and Control Groups. Depressive symptoms were assessed using the Portuguese version of the Beck Depression Inventory. Both groups reduced their The Beck Depression Inventory scores. However, only in the Rhythmic Auditory Stimulation Group the reduction was significant, with a mean difference in the inventory score three times greater than the Control Group.

The effectiveness of berberine on noise-induced hearing loss: a rat model

SUMMARY OBJECTIVE: Noise-induced hearing loss is a preventable form of hearing loss that has serious social and economic impacts. This study aimed to investigate the protective effect of berberine, a potent antioxidant and anti-inflammatory agent, against Noise-induced hearing loss. METHODS: After applying distortion product otoacoustic emission, 28 female Sprague-Dawley rats were randomly divided into four groups. Group 1 was designated as acoustic trauma group, and rats in this group were exposed to white noise for 12 h at an intensity of 4 kHz 110 dB sound pressure level. Group 2 was the control group. Group 3 was designated as the berberine group, and 100 mg/kg of berberine was administered to rats in this group by intragastric lavage for five consecutive days. Group 4 was designated as the acoustic trauma+berberine group. distortion product otoacoustic emission was repeated on the 6th day of the study and cochlear tissues of rats were dissected for histopathological and immunohistochemical analyses after sacrificing rats. RESULTS: The distortion product otoacoustic emission results showed a significant decrease in signal-noise ratio values at higher frequencies in rats of the trauma group compared to those in other groups. Acoustic trauma caused severe histopathological impairment at cochlear structures together with severe 8-hydroxy-2-deoxyguanosine expression. Rats in the acoustic trauma+berberine group showed mild histopathological changes with mild 8-hydroxy-2-deoxyguanosine expression and better signal-noise ratio values. CONCLUSION: The histopathological and audiological findings of this experimental study showed that berberine provides protection in Noise-induced hearing loss and may have the potential for use in acoustic trauma-related hearing losses.