Task force of the Brazilian Society of Otology — evaluation and management of peripheral facial palsy

Abstract Objective To review key evidence-based recommendations for the diagnosis and treatment of peripheral facial palsy in children and adults. 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 peripheral facial palsy 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 main parts: (1) Evaluation and diagnosis of facial palsy: electrophysiologic tests, idiopathic facial palsy, Ramsay Hunt syndrome, traumatic peripheral facial palsy, recurrent peripheral facial palsy, facial nerve tumors, and peripheral facial palsy in children; and (2) Rehabilitation procedures: surgical decompression of the facial nerve, facial nerve grafting, surgical treatment of long-term peripheral facial palsy, and non-surgical rehabilitation of the facial nerve. Conclusions Peripheral facial palsy is a condition of diverse etiology. Treatment should be individualized according to the cause of facial nerve dysfunction, but the literature presents better evidence-based recommendations for systemic corticosteroid therapy.

Effect of melatonin on otoprotection in rodents: a systematic review with meta-analysis

Abstract Objectives: To determinate the otoprotective efficacy of melatonin.in experimental models of rodents through a systematic review of the literature. Methods: Altogether, 154 articles were found in four databases. The PICOS strategy (Population, Intervention, Comparison, and Outcome) was used to define the eligibility criteria. Studies that met the inclusion criteria for the second step were included in a qualitative synthesis. Each study type was analyzed with the CAMARADES quality of assessment's checklist and the SYRCLE RoBS risk of bias. Results: Seven articles were selected, and four were included in the meta-analysis. It was possible to obtain seven outcomes according to the standard auditory frequencies presented among the studies, considering a minimum of three standard frequencies. The outcomes analyzed were for the frequencies of 1500, 2000, 3000, 4000, 5000, 6000, and 8000 Hz. Conclusion: Melatonin can provide protection against the ototoxic effects of cisplatin and aminoglycosides at 5000 Hz, 6000 Hz, and 8000 Hz, thereby minimizing the reduction in Otoacustic Emissions (OAE) amplitude. The same effect was not observed in the lower frequencies. Despite the limited number of studies that were evaluated, the results appeared consistent in higher frequencies. However, the methodology of the available studies did not meet the necessary methodological rigor that promotes the safe replicability of these studies.

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.

Changes in the communicative skills of young people as a result of a communication training / Alterações das habilidades comunicativas de adolescentes como resultado de um treinamento em comunicação

ABSTRACT Purpose To analyze the effect of communication training developed for adolescents on the youth's communication skills. Methods Forty-one young people participated in the study and were divided into two groups. Group I received intervention - communication training for five weeks; Group II - were guided on the importance of voice for communication. Participants had their communication skills assessed before/after interventions through a self-administered questionnaire, answered by the participant and parents. Both groups had oral presentations recorded on video, which were analyzed by speech therapists through the evaluation of the communication profile, listing the aspects that should be observed as a point of strength/opportunity for improvement. Association between qualitative variables was assessed using Fischer's exact test, Pearson's chi-square test, McNemar's test, and McNemar-Bowker's test. To compare groups, paired t-test and t-test for independent samples, p level <0.05, were used. Results The analysis of questionnaires showed improvement in GI in two of the four skills assessed and no difference for GII. The video evaluations showed a significant difference between the groups in terms of eye contact and speech velocity. Conclusion This study points out that the communication training method applied to young people might improve communicative skills, providing some insights into their communication strengths and potential areas for development.

RESUMO Objetivo Analisar o efeito de um treinamento em comunicação desenvolvido para adolescentes nas habilidades comunicativas dos jovens. Método Quarenta e um jovens participaram do estudo divididos em dois grupos. Grupo I - treinamento de comunicação por duas semanas; Grupo II - palestra sobre importância da voz. Os participantes tiveram suas habilidades comunicativas avaliadas antes e após as intervenções mediante questionário autoaplicado respondido pelos jovens e seus pais. Ambos os grupos tiveram apresentações orais gravadas antes e após as intervenções, que foram avaliadas por fonoaudiólogos através de questionário, listando características da comunicação. A associação entre variáveis qualitativas foi verificada usando teste exato de Fisher, qui-quadrado de Pearson, teste de McNemar e teste de McNemar-Bowker. Para comparação entre os grupos, foram usados teste t para amostras pareadas e teste t para amostras independentes com nível de significância de 95%. Resultados A análise dos questionários mostrou melhora do Grupo I em duas das quatro habilidades avaliadas, não havendo diferença no Grupo II. A avalição dos vídeos mostrou diferença significativa entre os grupos no contato visual e na velocidade da fala. Conclusão O estudo mostrou que o método de treinamento de comunicação aplicado aos jovens, melhorou habilidades comunicativas, fornecendo autoconhecimento sobre seus pontos fortes e pontos que podem ser melhorados.

Avaliação audiológica em bebês nascidos de mães que tiveram covid-19 no período gestacional / Audiological assessment in babies born to mothers who had covid-19 during gestation / Evaluación audiológica en bebés nacidos de madres que tenían covid-19 durante la gestación

Introdução: No final de dezembro de 2019, um grupo de casos inexplicáveis de pneumonia foi relatado em Wuhan, China. Alguns dias depois, o agente causador dessa misteriosa doença foi identificado como um novo coronavírus que se disseminou de forma rápida. As infecções maternas, contraídas antes ou durante a gravidez, podem ser transmitidas ao feto, durante a gestação (infecção congênita), durante o parto (infecção perinatal) e pela amamentação (infecção pós-natal) e podem causar danos ao feto ou ao recém-nascido. Objetivo: descrever a avaliação audiológica realizada em uma série de crianças cujas mães tiveram COVID-19, em sua forma leve, no período gestacional. Metodologia: Para a avaliação audiológica foram realizadas a anamnese e os exames de emissões otoacústicas por produto de distorção, nas frequências de 1,5 a 12KHz e pontencial auditivo de tronco encefálico por click. Resultados: A amostra foi composta por 47 recém-nascidos recém-nascidos. Os resultados dos testes das emissões otoacústicas evocadas por produto de distorção indicaram funcionalidade das estruturas avaliadas apontando normalidade da função coclear com nível de resposta adequado para a média de resultados obtidos até a frequência de 11kHz para a amplitude de resposta e para a relação sinal-ruído. Foi possível encontrar em toda a amostra a presença das ondas I, III e V na intensidade de 80dBHL e presença da onda V nas intensidades de 50 e 35dBHL bilateralmente. Conclusão: Não foi estabelecida uma correlação direta da infecção materna pelo vírus da covid-19 com os achados audiológicos nos recém- nascidos. Cabe mencionar que esse foi um estudo preliminar e que essas crianças precisam continuar em acompanhamento para investigação de futuros desfechos tardios no aparelho auditivo.

Introduction: In late December 2019, a cluster of unexplained pneumonia cases was reported in Wuhan, China. A few days later, the causative agent of this mysterious disease was identified as a new coronavirus that spread rapidly. Maternal infections, contracted before or during pregnancy, can be transmitted to the fetus during pregnancy (congenital infection), during childbirth (perinatal infection) and through breastfeeding (postnatal infection) and can cause harm to the fetus or newborn. -born. Objective: to describe the audiological evaluation carried out in a series of children whose mothers had COVID-19, in its mild form, during the gestational period. Methodology: For the audiological evaluation, anamnesis and distortion product otoacoustic emissions tests were carried out, at frequencies from 1.5 to 12KHz and brainstem auditory potential by click. Results: The sample consisted of 47 newborns. The results of the distortion product evoked otoacoustic emissions tests indicated functionality of the evaluated structures, pointing to normal cochlear function with an adequate response level for the average of results obtained up to a frequency of 11kHz for the response amplitude and the signal-to-noise ratio. . It was possible to find in the entire sample the presence of waves I, III and V at an intensity of 80dBHL and the presence of wave V at intensities of 50 and 35dBHL bilaterally. Conclusion: A direct correlation between maternal infection by the Covid-19 virus and audiological findings in newborns was not established. It is worth mentioning that this was a preliminary study and that these children need to continue being monitored to investigate future late outcomes with the hearing aid.

Introducción: A finales de diciembre de 2019, se informó un grupo de casos de neumonía inexplicable en Wuhan, China. Unos días después, el agente causante de esta misteriosa enfermedad fue identificado como un nuevo coronavirus que se propagó rápidamente. Las infecciones maternas, contraídas antes o durante el embarazo, pueden transmitirse al feto durante el embarazo (infección congénita), durante el parto (infección perinatal) y a través de la lactancia (infección posnatal) y pueden causar daños al feto o al recién nacido. Objetivo: describir la evaluación audiológica realizada a una serie de niños cuyas madres tuvieron COVID-19, en su forma leve, durante el período gestacional. Metodología: Para la evaluación audiológica se realizaron pruebas de anamnesis y otoemisiones acústicas de productos de distorsión, en frecuencias de 1,5 a 12KHz y potencial auditivo de tronco encefálico mediante click. Resultados: La muestra estuvo compuesta por 47 recién nacidos. Los resultados de las pruebas de distorsión producto de emisiones otoacústicas evocadas indicaron funcionalidad de las estructuras evaluadas, apuntando a una función coclear normal con un nivel de respuesta adecuado para los resultados promedio obtenidos hasta una frecuencia de 11kHz para la amplitud de respuesta y la relación señal-ruido. . Se pudo encontrar en toda la muestra la presencia de ondas I, III y V con una intensidad de 80dBHL y la presencia de la onda V con intensidades de 50 y 35dBHL de forma bilateral. Conclusión: No se estableció una correlación directa entre la infección materna por el virus Covid-19 y los hallazgos audiológicos en los recién nacidos. Cabe mencionar que este fue un estudio preliminar y que estos niños necesitan seguir siendo monitoreados para investigar futuros resultados tardíos con el audífono.

Hearing habits of young adolescent students from public and private schools in the Brazilian Federal District / Hábitos auditivos de jovens adolescentes escolares da rede pública e privada do Distrito Federal

ABSTRACT Purpose: to analyze the hearing habits of a group of students between public and private schools and compare the degree of exposure to sound stimuli via earphones. Methods: 1,085 public and private school students received a questionnaire on hearing habits and exposure to amplified music. Their answers to these questions were analyzed and compared between the groups of students. The chi-square test compared hearing habits between public and private schools, with the statistical significance level set at 5% (p < 0.05). Result: in general, most students (92%) reported hearing habits of exposure to amplified music. Questionnaire answers indicated a high prevalence of both earphone use (92%) and attendance at places with loud music (63.6%). Conclusion: private school students use earphones more often than those from public schools.

RESUMO Objetivo: analisar os hábitos auditivos de um grupo de alunos e comparar o grau de exposição ao estímulo sonoro via fones de ouvido entre escolas públicas e privadas. Métodos: foram distribuídos questionários contendo perguntas referentes a hábitos auditivos de exposição à música amplificada, aos 1085 alunos de escolas pública e privada. Em seguida, as respostas aos questionamentos foram analisadas e comparadas entre os grupos de alunos. Utilizou-se o teste Qui-quadrado com um nível de significância estatística estabelecido em 5% (p<0,05) para se comparar os hábitos auditivos entre as escolas públicas e privadas. Resultado: de modo geral, a maioria dos alunos (92%) respondeu que tem hábitos auditivos de exposição à música amplificada. Tanto o uso de fones de ouvido (92%) quanto as idas a lugares com música alta (63,6%) tiveram alta prevalência nas respostas aos questionários. Conclusão: alunos de escolas particulares utilizam mais fones de ouvido frequentemente comparados aos alunos de escolas públicas.

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.

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.

Melatonin prevents age-related hearing loss in the murin experimental model

Abstract Objective: The present study aimed to perform a morphological and morphometric analysis of cochlear structures of C57BL/6J mice receiving oral melatonin for a 12-month period. Methods: 32 male C57BL/6J were divided into control and melatonin groups. Control received saline and ethanol solution and melatonin group, 50 μL of 10 mg of melatonin/kg/day orally for a 12-month period. After de experiment the animals were sacrificed into a 40% concentration of CO2 chamber, and the blades were morphological and morphometrically analyzed. Results: The melatonin group revealed a higher median density of viable cells (45 ± 10.28 cells/100 μm2, 31-73, vs. 32 ± 7.47 cells/100 μm2, 25-48). The median area of stria vascularis was 55.0 ± 12.27 cells/100 μm2 (38-80) in the control, and 59.0 ± 16.13 cells/100 μm2 (40-134) in the melatonin group. The morphometric analysis of the spiral ligament reveals a higher median of total viable neurons in the melatonin (41 ± 7.47 cells/100 μm2, 27-60) than in the control group (31 ± 5.68 cells/100 μm2, 21-44). Conclusion: Although melatonin is a potent antioxidant, it does not completely neutralize the occurrence of presbycusis; however, it may delay the onset of this condition. Level of evidence: 3.

Hearing of neonates without risk indicators for hearing loss and use of antimalarial drugs during pregnancy: a historical cohort study in the Northern Region of Brazil / Audição de neonatos sem indicadores de risco para perda auditiva e utilização de antimaláricos na gestação: um estudo de coorte histórica na Região Norte

Abstract Introduction: Studies have demonstrated the ototoxic effects of antimalarial drugs in individuals who receive these drugs, but little is known regarding the toxicity of these drugs in the newborn auditory system when administered to the mother receive the drug during pregnancy. Objective: To verify the incidence of hearing loss in neonates who have no other associated risk indicators, born to mothers treated for malaria during pregnancy. Methods: A retrospective, quantitative cohort study was developed at Hospital de Base Dr. Ary Pinheiro and Clínica Limiar, both located in the municipality of Porto Velho (Rondônia). The sample consisted of 527 newborns divided into two groups: exposed to antimalarials drugs during pregnancy group (n = 32) and non-exposed group (n = 495). Data collection took place from September 2014 to December 2015, through an interview with the mothers and/or guardians of the newborn, through the newborns' and the mothers' records, and the neonatal hearing screening database of the above-mentioned institutions. Results: All the neonates in the exposed group, assessed through the recording of transient otoacoustic emissions associated with the automated brainstem auditory evoked potential test, underwent neonatal hearing screening in the first examination. Among the newborns in the non-exposed group, 30 showed failure and were retested. Of these, one continued to fail and was referred for diagnosis, in whom the results showed to be within the normal range. Among the neonates of the exposed group, infection with Plasmodium vivax was the most frequent, and was similarly distributed among the gestational trimesters, and chloroquine was the most commonly used antimalarial drug treatment more often given during the third trimester; these findings did not show any influence on the audiological findings of the studied neonates. Conclusion: The present study did not identify any cases of hearing loss in neonates born to mothers who used antimalarial drugs during gestation.

Resumo Introdução: Estudos comprovam os efeitos ototóxicos dos antimaláricos em pessoas que fazem uso destes medicamentos, porém pouco se sabe sobre a toxicidade destes fármacos no sistema auditivo de neonatos quando ingeridos pelas mães no período gestacional. Objetivo: Verificar a incidência de perda auditiva em neonatos de mães tratadas para malária durante a gestação sem outros indicadores de risco associados. Método: Estudo quantitativo, de coorte retrospectivo, desenvolvido no Hospital de Base Dr. Ary Pinheiro e na Clínica Limiar, ambos em Porto Velho (Rondônia). Compuseram a amostra 527 recém-nascidos divididos em dois grupos: grupo exposto (n = 32) e grupo não exposto (n = 495). A coleta de dados ocorreu de setembro de 2014 a dezembro de 2015, através de entrevista com as genitoras e/ou responsáveis pelo recém-nascido, investigação nos prontuários dos neonatos e das genitoras e no banco de dados da triagem auditiva neonatal das instituições supracitadas. Resultados: Todos os neonatos do grupo exposto, avaliados através do registro das emissões otoacústicas transientes associado a realização do potencial evocado auditivo de tronco encefálico automático passaram na triagem auditiva neonatal no primeiro exame. Já, entre os recém-nascidos do grupo não exposto, 30 apresentaram falha e foram retestados. Destes, um continuou falhando e foi encaminhado para diagnóstico, no qual foram evidenciados resultados dentro da normalidade. Nos neonatos do grupo exposto, a infecção pelo Plasmodium vivax foi a mais frequente, mostrando distribuição semelhante entre os trimestres gestacionais, sendo a cloroquina o antimalárico mais utilizado e o tratamento medicamentoso realizado mais frequentemente no terceiro trimestre, porém tais achados não mostraram influência sobre os achados audiológicos dos neonatos estudados. Conclusão: O presente estudo não identificou casos de perda auditiva nos neonatos de mães que utilizaram antimaláricos na gestação.

Is the Level of Noise in a School Environment be Harmful to the Hearing of Teachers?

Abstract Introduction The excessive noise observed in the school environment can cause damages or losses to the learning process as well as risks to the health of teachers and students, such as physical, mental and social impairments, including, among them, hearing loss. Objective To assess otoacoustic emissions in teachers and determine whether classroom noise reduces distortion-product otoacoustic emissions (DPOAEs) amplitude and signal-to-noise ratio (SNR). Method Sixty-seven teachers were evaluated using otoacoustic emissions testing in two situations: after hearing rest and after the working day. Results Signal amplitude (p = 0.044 [2 kHz]; p = 0.01 [4 kHz]) and SNR for frequencies of 2 kHz (p = 0.008) and 4 kHz (p = 0.001) decreased significantly between time points. Mean classroom noise was associated with the magnitude of the difference in signal amplitude at 2 kHz (p = 0.017) and 4 kHz (p = 0.015), and SNR at 4 kHz (p = 0.023). Conclusions There was a decrease in the amplitude and in the SNR after exposure to the noise in the classroom environment. The high levels of sound pressure that teachers are exposed to on a daily basis can cause a temporary change in the outer hair cells of the Corti organ, and these changes may become permanent over time.

Voice symptoms and handicap in adults with cochlear implants / Sintomas vocais e desvantagem vocal em adultos usuários de implante coclear

ABSTRACT Purpose: to investigate the presence of vocal symptoms and handicap in adults with cochlear implants, and verify the correlation with their self-perception of the voice quality. Methods: twenty-seven adults of both genders, with cochlear implants, in the age range of 19 to 57 years participated. The participants answered the self-assessment protocols Voice Handicap Index and Voice Symptom Scale. Furthermore, the participants answered an additional question about how they rated their voices. Results: for the Voice Handicap Index, the average score was 28.74, in total, and the average score for the Voice Symptom Scale was 29.22, in total. The correlation between the scores of the Voice Handicap Index and the self-perception of the voice showed that the worse the perception, the more handicap in every domain of the protocol. For the Voice Symptoms Scale, the results showed that there is a positive and moderate correlation between the self-perception of the voice and the total scores as well as for the impairment and emotional subscales. Conclusion: this study verified the presence of handicap and symptoms related to voice, mainly, regarding physical, functional and limitation aspects for the adults with cochlear implants. There is a positive and moderate correlation between the score of the protocols applied and self-evaluation of the vocal quality of the participants.

RESUMO Objetivo: investigar a presença de desvantagem vocal e sintomas vocais em usuários adultos de implante coclear e verificar sua correlação com a autoavaliação da qualidade vocal. Métodos: participaram 27 adultos com implante coclear de ambos os sexos com idade entre 19 e 57 anos. Foram aplicados os questionários de autoavaliação Índice de Desvantagem Vocal e Escala de Sintomas Vocais. Além disso, os participantes responderam uma questão sobre autopercepção vocal. Resultados: a pontuação média para o Índice de Desvantagem Vocal foi de 28,74 no total, e a pontuação média da Escala de Sintomas Vocais foi de 29,22. A correlação entre o Índice de Desvantagem Vocal e a questão de autopercepção vocal indicaram que ao passo que a percepção da voz piora, há maior desvantagem vocal em todos os domínios do questionário. Para a Escala de Sintomas Vocais houve correlação positiva e moderada entre a autopercepção vocal e a pontuação dos domínios limitação, emocional e a pontuação total. Conclusão: foi possível verificar presença de desvantagem e sintomas relacionados à voz, no que se refere a questões funcionais, orgânicas e de limitação na população estudada. Existe correlação positiva e moderada entre a pontuação dos questionários e a autoavaliação da qualidade vocal dos participantes.

Hearing Loss in Acromegaly - A Review

Abstract Introduction Acromegaly is a chronic disease caused by growth hormone (GH) excess due to a GH-secreting pituitary adenoma in most cases. There is reasonable data to presume the possible influence of chronic GH and insulin-like growth factor I (IGF-I) hyperproduction on the anatomical structures involved in normal sound perception, and on its conductive and/or sensorineural part. Objectives To review the literature about acromegaly and hearing loss. Data Synthesis A systematic literature search was performed using the MEDLINE database, including hand-searching reference lists from original articles. The search was performed using the terms hearing loss and acromegaly, and only 5 studies were found. Conclusion The results are not consistent, but led to different conclusions. Therefore, more studies with greater numbers of patients with acromegaly are needed.

Tinnitus and sound intolerance: evidence and experience of a Brazilian group / Zumbido e intolerância a sons: evidência e experiência de um grupo brasileiro

Abstract Introduction Tinnitus and sound intolerance are frequent and subjective complaints that may have an impact on a patient's quality of life. Objective To present a review of the salient points including concepts, pathophysiology, diagnosis and approach of the patient with tinnitus and sensitivity to sounds. Methods Literature review with bibliographic survey in LILACS, SciELO, Pubmed and MEDLINE database. Articles and book chapters on tinnitus and sound sensitivity were selected. The several topics were discussed by a group of Brazilian professionals and the conclusions were described. Results The prevalence of tinnitus has increased over the years, often associated with hearing loss, metabolic factors and inadequate diet. Medical evaluation should be performed carefully to guide the request of subsidiary exams. Currently available treatments range from medications to the use of sounds with specific characteristics and meditation techniques, with variable results. Conclusion A review on tinnitus and auditory sensitivity was presented, allowing the reader a broad view of the approach to these patients, based on scientific evidence and national experience.

Resumo Introdução Zumbido e intolerância a sons são queixas frequentes e subjetivas que podem ter impacto na qualidade de vida do paciente. Objetivo Apresentar uma revisão dos principais pontos, inclusive conceitos, fisiopatologia, diagnóstico e abordagem do paciente com zumbido e sensibilidade a sons. Método Revisão da literatura com levantamento bibliográfico na base de dados da LILACS, SciELO, Pubmed e MEDLINE. Foram selecionados artigos e capítulos de livros sobre zumbido e sensibilidade a sons. Os diversos tópicos foram discutidos por um grupo de profissionais brasileiros e as conclusões, descritas. Resultado A prevalência de zumbido tem aumentado ao longo dos anos, muitas vezes associado a perda auditiva, fatores metabólicos e erros alimentares. A avaliação médica deve ser feita minuciosamente no sentido de orientar a solicitação de exames subsidiários. Os tratamentos disponíveis atualmente variam de medicamentos ao uso de sons com características específicas e técnicas de meditação, com resultados variáveis. Conclusão Foi apresentada uma revisão sobre os temas que permitindo ao leitor uma visão ampla da abordagem dos pacientes com zumbido e sensibilidade auditiva baseada em evidências científicas e experiência nacional.

Conhecimento de fonoaudiólogos e otorrinolaringologistas do Distrito Federal acerca do implante coclear / Knowledge of cochlear implants in Federal District Audiologists, Speech-Language Pathologists, and Otolaryngologists

Resumo:OBJETIVO:descrever a auto-avaliação de otorrinolaringologistas e fonoaudiólogos do Distrito Federal acerca do conhecimento em relação ao implante coclear.MÉTODOS:estudo transversal e analítico com coleta de dados obtidos por meio da aplicação de questionários on-line. Participaram do estudo 73 fonoaudiólogos e 33 otorrinolaringologistas que responderam questões acerca do conhecimento do Implante Coclear na cidade de Brasília-Distrito Federal.RESULTADOS:31% (n=22) dos fonoaudiólogos acreditam ter conhecimento suficiente no que se refere ao procedimento cirúrgico, enquanto que no grupo dos otorrinolaringologistas esse número chegou a 59,4% (n=19), apresentando significância estatística entre os grupos (p<0,01). Ambos os grupos mostraram conhecimento insatisfatório em relação ao tipos de implante, mapeamentos, ativação, acompanhamento, custos, manutenção e o IC inserido no SUS.CONCLUSÃO:os profissionais otorrinolaringologistas e fonoaudiólogas pesquisados, atuantes no Distrito Federal, não apresentaram o conhecimento satisfatório acerca do implante coclear na análise geral dos domínios pesquisados.

Abstract:PURPOSE:to describe the self-assessment of Otolaryngologists, Audiologists, and Speech-Language Pathologists from the Federal District on their knowledge concerning cochlear implants.METHODS:cross-sectional and analytical study with data collection obtained by applying online questionnaires.73 Audiologists and Speech-Language Pathologists, and 33 Otolaryngologists participated in the study. They answered questions regarding their knowledge of Cochlear Implants in Brasília - Federal District, Brazil.RESULTS:31% (n=22) of the Audiologists and Speech-Language Pathologists believe they have sufficient knowledge regarding the surgical procedure, whereas in the group of otolaryngologists, the figure was 59.4% (n = 19). Statistical significance between groups is observed (p <0.01). Both groups showed poor knowledge regarding implant types, mappings, activation, monitoring, and maintenance costs and cochlear implantation performed by the SUS (Brazilian Unified Health System).CONCLUSION:Otolaryngologists, Audiologists, and Speech-Language Pathologists surveyed, who work in the Federal District, did not show satisfactory knowledge of the cochlear implant in the overall analysis of the areas surveyed.

Dificuldades na comunicação em normo-ouvintes: estudo comportamental e eletrofisiológico / Communication disorders in subjects with normal hearing: a behavioral and electrophysiological study

Olimiar auditivo nem sempre prediz o desempenho em ambientes com redundância extrínseca reduzida. OBJETIVO: Investigar o relato de dificuldades de comunicação de adultos com audiograma normal e verificar o quadro subjacente por meio de avaliações comportamental e eletrofisiológica. MÉTODO: Estudo caso-controle de indivíduos com limiares normais, distribuídos em dois grupos: grupo estudo, 10 adultos com queixas auditivas de comunicação e grupo controle, 10 adultos, sem queixas. Foi medida a frequência em que os participantes apresentam dificuldades de comunicação e realizados testes de fala no silêncio e no ruído, audiometria e potencial evocado auditivo de tronco encefálico. RESULTADOS: O grupo estudo se diferenciou estatisticamente do grupo controle apenas nos escores de dificuldades de comunicação. Foi constatada uma correlação positiva entre os limiares tonais e os escores no autorrelato de dificuldade. CONCLUSÃO: A presença de queixa auditiva na ausência de alterações no audiograma não esteve associada a diferença no desempenho no reconhecimento de fala no ruído, nem nas demais avaliações. Com base na análise de correlação, observou-se que, quanto mais elevados os limiares auditivos, maiores os escores no relato de dificuldades auditivas relacionadas às situações de comunicação, mesmo os limiares variando de 0 a 25 dB.

Hearing thresholds are not always predictive of performance in environments with reduced extrinsic redundancy. OBJECTIVE: To investigate the communication disorders reported by adults with normal hearing, and to assess their underlying conditions through behavioral and electrophysiological testing. METHOD: This case control study enrolled 20 adults with normal hearing thresholds and divided them into two groups: a case group with 10 adults with hearing impairment-related communication disorders and a control group with 10 adults with normal hearing. The frequency of occurrence of communication difficulties was recorded during speech recognition tests run in quiet and noisy conditions, audiometry, and auditory evoked brainstem potential testing. RESULTS: Case group subjects differed statistically from controls only in self-reported scores of hearing impairment. The groups did not differ in the other ratings. A positive correlation was found between hearing thresholds and scores on self-reported impairment. CONCLUSION: The combination of hearing complaints and unaltered audiograms was not correlated with differences in performance in speech recognition testing in noisy conditions or in the remaining evaluations. Correlation analysis showed that the higher the pure tone thresholds, the greater were the reported communication difficulties, even in thresholds between 0 and 25 dB.

Prevalência de alterações das células ciliadas externas em estudantes de uma escola do Distrito Federal / Hair cell alteration prevalence rates in students of a school in Distrito Federal

Os jovens estão cada vez mais expostos à música alta, que pode prejudicar a audição. O teste das Emissões Otoacústicas, por ser mais sensível à exposição ao ruído, permite detectar precocemente alterações cocleares. OBJETIVO: Investigar a prevalência de lesão das células ciliadas externas por meio do teste de emissões otoacústicas em uma amostra de estudantes. MATERIAL E MÉTODO: Foram realizados os testes de emissões otoacústicas por estímulo transiente e por produto de distorção em 134 indivíduos. Os exames foram analisados de acordo com o critério "passa/falha". Tipo de estudo: Estudo seccional descritivo de prevalência. RESULTADOS: Dos 134 participantes, 80,6% apresentaram emissões otoacústicas transiente alteradas, sendo a maioria do gênero masculino; 97,8% apresentaram emissões otoacústicas produto de distorção alterada e 79,9% apresentaram alteração tanto em transiente quanto em produto de distorção, sendo a maioria do gênero masculino e, ainda, 94,0% relataram fazer uso de fones de ouvido; e 82,8% declararam frequentar lugar com música amplificada. CONCLUSÃO: A alta prevalência de testes alterados pode indicar precocemente uma disfunção coclear e, pelo alto número de participantes que relatou exposição à música alta, há a suspeita de que esse hábito pode estar provocando as alterações cocleares.

Exposure to loud music is increasing among young people, and so could be the number of hearing impairment cases in this population. Otoacoustic emission tests are sensitive in capturing the effects of exposure to noise, and allow the detection of early cochlear disorders. OBJECTIVE: This study aims to look into the prevalence rates of injuries to outer hair cells in a population of students through otoacoustic emission testing. MATERIALS AND METHOD: One-hundred and thirty-four subjects were submitted to transient evoked and distortion product otoacoustic emission tests. Subjects were assessed on a "pass/fail" scale. This is a cross-sectional descriptive study on prevalence rates. RESULTS: More than four fifths (80.6%) of the 134 subjects had altered transient otoacoustic emissions, most of whom were males; 97.8% had altered distortion product otoacoustic emissions and 79.9% had altered test results in both transient evoked and distortion product OAEs; most were males; 94.0% reported they used earphones; and 82.8% stated they frequented places where loud music was played. CONCLUSION: The high prevalence rates of altered test results seem to indicate the presence of early cochlear disorders in the studied subjects. A significant number of subjects reported exposure to loud music, a habit that may be conducive to the onset of cochlear disorders.

O espectro da neuropatia auditiva pode contribuir para acidente de trabalho? o relato de uma investigação clínica / Can auditory neuropathy spectrum disorder contribute to work accidents? a clinical investigation report

Considerando a possível insuficiência do exame admissional legalmente preconizado para avaliação auditiva no que se refere à identificação de comprometimento da habilidade para reconhecer fala em ambiente ruidoso, este trabalho tem como objetivo relatar o processo de uma investigação clínica, conduzida em 2010, de um trabalhador que sofreu acidente de trabalho, visando identificar possíveis elementos clínicos não previamente considerados, mas que poderiam ter contribuído para a ocorrência do acidente. Utilizou-se a escala Abbreviated Profile of Hearing Aid Benefit para comparar a habilidade de reconhecimento da fala em ambiente ruidoso do trabalhador acidentado com a de ouvintes normais e realizaram-se exames de audiometria, imitanciometria, emissões otoacústicas, potencial evocado auditivo de tronco encefálico e teste de reconhecimento de sentenças no silêncio e no ruído. Identificou-se que o trabalhador apresentava espectro da neuropatia auditiva (ENA) e que a alteração neural prejudicava de forma relevante a compreensão da fala em presença de ruído. A avaliação da sensibilidade auditiva no exame admissional se mostrou insuficiente para identificar a real situação auditiva do trabalhador com ENA, que compromete o reconhecimento de sinais de advertência, levando a um aumento no risco de ocorrência de acidente em ambientes ruidosos.

Considering that the hearing assessment test legally recommended for job admission exams is not adequate to identify impaired ability to recognize speech in noisy environments, this paper reports a clinical investigation conducted in 2010 for a worker who suffered a work accident due to noise. It aimed at identifying clinical elements which were not previously taken into consideration, but that could have contributed to the accident. Abbreviated Profile of Hearing Aid Benefit Scale was used to measure the injured worker's ability to recognize speech in a noisy environment and to compare it with the hearing skill of normal adults. Audiometry, tympanometry, otoacoustic emissions, auditory evoked brainstem potential, and sentence recognition in quiet and in noisy environments were also carried out. They showed that the worker had an Auditory Neuropathy Spectrum Disorder (ANSD) and that the neural disorder significantly impaired speech understanding in noisy surroundings. Hearing sensitivity assessment during job admission exams was not enough to identify the actual hearing ability of the worker with ANSD, as the disorder prevents warning signs from being noticed and increases risk of accidents in noisy environments.

DATASUS as a instrument for developing otologic public health policies / DATASUS como instrumento na elaboração de políticas públicas otológicas

Ear diseases are illnesses which represent a relevant group of morbidity. Otitis media, for instance, still is a public health problem today. OBJECTIVE: To correlate hospital morbidity of ear diseases according to data from the Information Technology Department of the Public Health Care System -SUS (DATASUS), through the Hospital Information System (SIH) with the Human Development Index (IDH) from each unit of the federation. To assess the use of this official data in the creation of otologic public health care policies. MATERIALS AND METHODS: Brazilian states were classified according to their respective IDH values. The percentage population from each state was calculated in relation to the entire population of the country, as well as the percentage of hospital admission caused by ear diseases (SIH) for each state in relation to their total number. The hospital admissions from each state were correlated with their respective IDH values. RESULTS: The state of São Paulo, the third largest IDH was responsible for 38.82 percent of hospital admissions caused by ear diseases, although its population represents 21.64 percent of the national population. States with lower IDH had lower hospital admission rates for ear diseases. CONCLUSION: SIH, a DATASUS tool, even with limitations, can be an instrument used to create public policies concerning ear diseases.

As doenças do ouvido são enfermidades que representam um grupo relevante de morbidade. A otite média, por exemplo, ainda hoje, é um problema de saúde pública. OBJETIVO: Correlacionar a morbidade hospitalar das doenças otológicas segundo dados disponibilizados pelo Departamento de Informática do Sistema Único de Saúde (DATASUS), pelo do Sistema de Informação Hospitalar(SIH) com o Índice de Desenvolvimento Humano (IDH) de cada unidade federativa. Avaliar a utilização destes dados oficiais na elaboração de políticas públicas otológicas. MATERIAL E MÉTODOS: Os Estados brasileiros foram classificados de acordo com os respectivos valores de IDH. Foi calculado o percentual da população de cada Estado em relação à população total do país, bem como o percentual de internações hospitalares por doenças otológicas(SIH) para cada Estado em relação ao número total das mesmas. Correlacionaram-se internações hospitalares de cada unidade federativa com seus respectivos valores de IDH. RESULTADOS: O Estado de São Paulo, terceiro maior IDH, foi responsável por 38,82 por cento das internações hospitalares de causa otológica, apesar de sua população representar 21,64 por cento da população nacional. Estados com menor IDH apresentaram menores taxas de internação hospitalar por doenças otológicas. CONCLUSÃO: O SIH, instrumento do DATASUS, mesmo com limitações, pode ser instrumento na elaboração de políticas públicas otológicas.

Emissões otoacústicas evocadas por estímulo transiente e por produto de distorção em recém-nascidos prematuros / Transient and distortion product evoked otoacoustic emissions in premature infants

Introdução: A correlação entre as emissões otoacústicas evocadas por transientes (EOAET) e por produto de distorção (EOAEPD) pode ser útil para a triagem auditiva neonatal, principalmente em recém-nascidos prematuros, que possuem indicadores de risco para deficiência auditiva. Há a necessidade de aprofundar os conhecimentos referentes às propriedades da cóclea desta população. Objetivos: Comparar o resultado das EOAET e das EOAEPD em neonatos prematuros. Analisar a reprodutibilidade nas EOAET, a amplitude e a relação sinal/ruído nas EOAET e EOAEPD. Método: Foram realizadas as EOAET e EOAEPD em 50 neonatos prematuros. Os testes foram correlacionados com relação ao critério "passa/falha" e comparados segundo parâmetros de amplitude e relação sinal/ruído. Resultados: As EOAET estiveram presentes em 71% da amostra. A frequência de 3kHz apresentou melhor desempenho na reprodutibilidade, amplitude e relação sinal/ruído em média. As EOAEPD estiveram presentes em 97% da amostra. A frequência de 2kHz apresentou maior amplitude em média, os valores da relação sinal/ruído aumentaram proporcionalmente nas frequências altas. Houve forte correlação entre as EOAET e as EOAEPD no critério "passa/falha" (p= 0,006). Conclusão: A correlação entre os resultados das EOAET e EOAEPD foi significante. porém um método complementa o outro e ambos podem ser utilizados na TAN.

Introduction: The correlation between the transient (TEOE) and distortion product (DPOAE) evoked otoacoustic emissions may be useful for the neonatal auditory screening, mainly in premature infants, who have risk indicators for hearing deficiency. There is need for deepening the knowledge regarding this population cochlea features. Objective: To compare the TEOE and DPOAE in premature infants. To analyze the reproducibility in the TEOE, the amplitude and the sign/noise ratio in the TEOE and DPOAE. Method: TEOE and DPOAE were carried out in 50 premature infants. The tests were correlated as for the criterion "pass/failure" and compared according to amplitude and sign/noise ratio parameters. Results: The TEOE were present in 71% of the sample. The frequency of 3kHz presented a better performance in the average reproducibility, amplitude and sign/noise ratio. The DPOAE were present in 97% of the sample. The frequency of 2kHz had a major average amplitude, the values of the sign/noise ratio increased proportionally in the high frequencies. There was a strong correlation between TEOE and DPOAE in the "pass/failure" criterion (p=0.006). Conclusion: The correlation between the TEOE and DPOAE results was significant. But one method compliments the other and both may be used in the TAN.