Hearing thresholds at high frequency in patients with cystic fibrosis: a systematic review / Limiares auditivos em altas frequências em pacientes com fibrose cística: revisão sistemática

Abstract Introduction: High-frequency audiometry may contribute to the early detection of hearing loss caused by ototoxic medications. Many ototoxic drugs are widely used in the treatment of patients with cystic fibrosis. Early detection of hearing loss should allow known harmful drugs to be identified before the damage affects speech frequencies. The damage caused by ototoxicity is irreversible, resulting in important social and psychological consequences. In children, hearing loss, even when restricted to high frequencies, can affect the development of language. Objective: To investigate the efficacy and effectiveness of hearing monitoring through high-frequency audiometry in pediatric patients with cystic fibrosis. Methods: Electronic databases PubMed, MedLine, Web of Science and LILACS were searched, from January to November 2015. The selected studies included those in which high-frequency audiometry was performed in patients with cystic fibrosis, undergoing treatment with ototoxic drugs and published in Portuguese, English and Spanish. The GRADE system was chosen for the evaluation of the methodological quality of the articles. Results: During the search process carried out from January 2015 to November 2015, 512 publications were identified, of which 250 were found in PubMed, 118 in MedLine, 142 in Web of Science and 2 in LILACS. Of these, nine articles were selected. Conclusion: The incidence of hearing loss was identified at high frequencies in cystic fibrosis patients without hearing complaints. It is assumed that high-frequency audiometry can be an early diagnostic method to be recommended for hearing investigation of patients at risk of ototoxicity.

Resumo Introdução: A audiometria de altas frequências pode contribuir para a detecção precoce de alterações auditivas causadas por medicações ototóxicas. No tratamento dos pacientes com fibrose cística, existem muitos fármacos ototóxicos amplamente utilizados. A detecção precoce de alterações auditivas deve permitir que sejam identificadas antes que o dano atinja as frequências da fala. A lesão causada pela ototoxicidade é irreversível, traz importantes consequências sociais e psicológicas. Nas crianças, a perda auditiva, mesmo restrita às altas frequências, pode afetar o desenvolvimento da linguagem. Objetivo: Investigar a eficácia e a efetividade do monitoramento da audição por meio da audiometria de altas frequências em pacientes pediátricos com fibrose cística. Método: Foram consultadas as bases de dados eletrônicas PubMed, Medline, Web of Science e Lilacs, de janeiro a novembro de 2015. Foram selecionados os estudos em que foi feita audiometria de altas frequências em pacientes com fibrose cística em tratamento com medicamentos ototóxicos e publicados em português, inglês e espanhol. Para a avaliação da qualidade metodológica dos artigos optou-se pelo uso do sistema Grade. Resultados: No processo de busca feito de janeiro de 2015 a novembro de 2015 foram encontradas 512 publicações, 250 na PubMed, 118 na Medline, 142 na Web of Science e dois na Lilacs. Desses, foram selecionados nove artigos. Conclusão: Identificou-se a ocorrência de perda auditiva em altas frequências em pacientes com fibrose cística sem queixas auditivas. Admite-se que audiometria em altas frequências possa ser um método de diagnóstico precoce a ser recomendado para investigação auditiva de pacientes em risco de ototoxicidade.

Acute effects of Expiratory Positive Airway Pressure (EPAP) on different levels in ventilation and electrical activity of sternocleidomastoid and parasternal muscles in Chronic Obstructive Pulmonary Disease (COPD) patients: a randomized controlled trial

ABSTRACT Objective To investigate the acute effects of EPAP on the activity of sternocleidomastoid (SCM), parasternal muscles and ventilatory parameters in COPD patients. Method Twenty-four patients with COPD were studied using surface electromyography (sEMG) and a ventilometer. Patients were randomly assigned to EPAP 10 cmH2O-EPAP10 or 15 cmH2O-EPAP15 for 20 minutes. Results The parasternal muscle sEMG activity increased during EPAP10 and EPAP15; however, a greater and significant increase was observed with EPAP10 (mean between-group difference: 12.5% RMS, 95% CI: 9.5 to 15.4, p<0.001). In relation to the baseline, at 10 and 20 minutes and upon recovery, respectively parasternal activity increased by 23.9%, 28.9% and 19.1% during EPAP10 and by 10.7% at 10 and 20 minutes and upon recovery, respectively, 11.4% and 6.9% during EPAP15 at 10 and 20 minutes and upon recovery, respectively. The sEMG activity of SCM muscle showed an opposite pattern, increasing with EPAP15 and decreasing with EPAP10 (mean between-group difference: 15.5% RMS, 95% CI: 12.6 to 18.4, p<0.001). SCM muscle activity during EPAP15, increased by 4.8% and 6.1% at 10 and 20 minutes and decreased by -4.0% upon recovery compared to decreases of –5.6%, –20.6% and –21.3% during EPAP10 at 10, 20 minutes, and recovery. Ventilation at both EPAP intensities promoted significant reductions in respiratory rate (RR) and dyspnea, more pronounced in EPAP15: RR (mean between-group difference: –3,8bpm, 95%CI: –7,5 to –0,2, p=0,015) and dyspnea (mean between-group difference: –1.01, 95%CI: –1.4 to –0.53, p=0.028) . Conclusion In COPD patients, the use of EPAP10 was more effective in reducing accessory inspiratory activity and increasing parasternal activity, which was accompanied by an improvement in ventilation and a reduction in dyspnea.

Implicações do fumo na gustação e na olfação: revisando o tema / Implications of Smoke Habit in Gustation and in Olfaction: reviewing the theme

Entre os diversos malefícios causados pelo tabagismo, os efeitos na gustação e na olfação não têm sido abordados pela literatura especializada nacional. Realizou-se um estudo de revisão sobre o tema. Há um predomínio de estudos que se dedicam à investigação da gustação. A exposição ao fumo parece alterar significativamente os dois sistemas quimiorreceptores. A capacidade gustativa está comprometida, quanto à percepção de substâncias salgadas, amargas e doces-principalmente as duas últimas -, bem como à impressão hedônica global (prazer). Dessa forma, a preferência alimentar pode variar. Já na olfação, há alterações ultraestruturais no epitélio, perda na habilidade de identificação de odores (hiposmia) e sensação de queimação e dor na mucosa. Talvez com o esclarecimento da importância desses dois sistemas sensórios e de suas patologias, possam ser efetuados novas revisões e estudos sobre o tema em nosso meio.

Among the variety of general health smoking habit consequences, the effects on gustation and on olfacion have not been reported in the national specialized literature. We did a review study about the issue. There is a predominance of study inquirements on gustation. The smoking habit seems to affect both sensory systems. The gustatory capacity is compromised by a reduction in taste sensibility to salty, bitter and sweet substances (specially the last two), as well by a diminish global hedonic impression (pleasure). Therefore, alimentary preferences may change in smokers. The olfaction is compromised by ultra-estrucutral epithelial alterations. The smell identification ability is reduced (hyposmia), and a sensation of burn and pain on the mucosa is also established. The importance of understanding both sensory systems and their pathology suggests new study requirements among our academic staff.