Diagnostic accuracy of the video otoscope in tympanic membrane perforation

Abstract Objective The video otoscope has already proven to be useful for the diagnosis of several pathologies, so the objective of this study was to evaluate the diagnostic accuracy of the video otoscope in cases of tympanic membrane perforation. Methods This is a diagnostic accuracy study performed at the hearing health division of a tertiary-level referral hospital. Patients older than 8 years of age who had any symptom that could be related to perforation (otalgia, otorrhea, tinnitus, and/or hypoacusis) were invited to participate in the study. Participants were evaluated by three different diagnostic methods (otomicroscope, conventional otoscope, and video otoscope) performed by three different evaluators in a blind fashion. The microscope was considered the reference standard. Results 176 patients were evaluated, totaling 352 tympanic membranes. Twenty-seven tympanic membrane perforations were diagnosed by the microscope, a prevalence of 7.7%. The video otoscope showed a sensitivity of 85.2% (95% CI 81.5%‒88.9%), specificity of 98.1% (95% CI 96.7%‒99.5%) and accuracy of 97.1% (95% CI 95.4 %-98.8 %). The conventional otoscope showed a sensitivity of 96.3% (95% CI 94.3-98.3), specificity of 98.8% (95% CI 97.7-99.9) and accuracy of 98.6% (95% CI 97.4-99.8). The Kappa value between the microscope and the video otoscope was 0.8 and between the microscope and the conventional otoscope was 0.9. Regarding the participants' perception, 53.4% (p < 0.001) considered the video otoscope as the best method for understanding the tympanic membrane condition presented by them. Conclusions The video otoscope showed relevant sensitivity and specificity for clinical practice in the diagnosis of tympanic membrane perforation. Moreover, this is an equipment that can facilitate the patient's understanding of the otologic pathology presented by him/her. In this regard, this method may be important for better patient compliance, requiring further studies to evaluate this hypothesis. Level of evidence Is this diagnostic or monitoring test accurate? (Diagnosis)—Level 2 (Individual cross-sectional studies with consistently applied reference standard and blinding).

Reabilitação auditiva com sistemas Baha® transcutâneo e percutâneo / Hearing rehabilitation with Baha® transcutaneous and percutaneous systems

RESUMO Objetivo Verificar longitudinalmente a influência dos limiares tonais auditivos obtidos com as próteses auditivas ancoradas no osso transcutâneas e percutâneas na percepção da fala em indivíduos com malformação de orelha externa e/ou média e Otite Média Crônica. Método Estudo observacional, retrospectivo, de seguimento longitudinal de 30 indivíduos usuários unilaterais de sistema Baha® transcutâneo e percutâneo, para coleta de dados secundários dos limiares tonais obtidos por meio da audiometria em campo livre e do limiar de reconhecimento de sentenças no silêncio e no ruído nas condições: sem a prótese; no momento de ativação; no primeiro mês de uso (pós 1); e no terceiro mês (pós 2). Resultados Houve diferença significante entre os limiares tonais obtidos nas frequências de 3 e 4kHz, com melhores resultados para o percutâneo em todos os momentos de avaliação. Para os dois sistemas, observou-se melhor desempenho no reconhecimento de sentenças no silêncio e ruído, com diferença significante na ativação (p<0,001), porém manteve-se estável nos demais momentos de avaliação. O sistema percutâneo mostrou melhor benefício no reconhecimento de sentenças no ruído apenas na ativação (p=0,036), quando comparado ao transcutâneo. Conclusão O sistema percutâneo possibilitou melhor audibilidade para as frequências altas; contudo, tal audibilidade não influenciou no reconhecimento de sentenças na situação de silêncio para ambos os sistemas. Para a situação de ruído, melhores respostas foram observadas no sistema percutâneo; porém, a diferença não se manteve no decorrer do tempo.

ABSTRACT Purpose Longitudinally verify the influence of auditory tonal thresholds obtained with transcutaneous and percutaneous bone-anchored hearing aids on speech perception in individuals with external and/or middle ear malformation and chronic otitis media. Methods Observational, retrospective, longitudinal follow-up study of 30 unilateral users of the transcutaneous and percutaneous Baha® system for the collection of secondary data on pure tone thresholds obtained through free field audiometry and sentence recognition threshold in silence and noise in conditions: without the prosthesis; at the time of activation; in the first month of use (post 1); and in the third month (post 2). Results There was a significant difference between pure tone thresholds obtained at frequencies of 3 and 4kHz with better results for the percutaneous technique at all evaluation moments. For both systems, better performance was observed in sentence recognition in silence and in noise, with a significant difference in activation (p<0.001), but it remained stable during the other evaluation moments. The percutaneous system showed better benefit in recognizing sentences in noise only on activation (p=0.036), when compared to the transcutaneous system. Conclusion The percutaneous system provided better audibility for high frequencies; however, such audibility did not influence sentence recognition in the silent situation for both systems. For the noise situation, better responses were observed in the percutaneous system, however, the difference was not maintained over time.

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.

Communicative and Hearing Performance in Individuals with Cochlear Implants and Delayed Neuropsychomotor Development: A Longitudinal Analysis

Abstract Introduction Between 15% to 30% of individuals with bilateral prelingual sensorineural hearing loss present with associated disabilities. Cochlear implant (CI) is an alternative treatment that provides consistent access to environmental and speech sounds, which results in significant benefits regarding quality of life and auditory and language development. Objectives To study the auditory and communicative performance of individuals with CI and delayed neuropsychomotor development after a minimum of five years using the device. Methods A total of eight patients were included in the study. We collected the multidisciplinary clinical records of participants, as well as the answers for the questionnaires applied remotely, which included the Children with Cochlear Implants: Parental Perspectives (CCIPP), International Classification of Functioning, Disability and Health: Children and Youth Version (ICF-CY), and the Gross Motor Function Classification System (GMFCS). Results We found that throughout the years of CI use, the auditory threshold means improved significantly in all tested frequencies, as did the speech detection threshold and the language and hearing results. Regarding parental perception, parents evaluated aspects related to their children's social relations to be positive, and had worse perceptions regarding aspects related to their education. Conclusion We observed a progression in the participants' auditory and language skills throughout the years of CI use; even in the presence of other associated disabilities. Future multicentric studies with larger samples are needed to further the advancement of rehabilitation in patients with other associated disabilities.

Use of Schirmer strips and conjunctival swabs for virus detection on the ocular surface of adults: a scoping review / Fitas de Schirmer e swab conjunctival para detecção de vírus na superfície ocular de adultos: scoping review

ABSTRACT Schirmer strips and conjunctival swabs are used in ophthalmology for the collection of tears and fluids. One of the biggest challenges during the COVID-19 pandemic has been accurate diagnosis and, in some cases, ocular manifestations are among the first symptoms. In this context, this study aimed to collect evidence to support the use of Schirmer strips and conjunctival swabs as a method of sample collection for viral analysis. A literature search was conducted following the Scoping Review protocol defined by The Joanna Briggs Institute. Studies were analyzed regarding virus research, collection methods, and sample analysis. The findings support that viruses can be detected on the ocular surface through analysis of Schirmer strips and conjunctival swabs. However, additional studies with larger samples and time data are necessary to confirm these conclusions.

RESUMO A fita de Schirmer e o swab conjunctival são utilizados na oftalmologia como métodos de coleta para lágrimas e fluidos. Durante a pandemia da COVID-19, um dos desafios foi o diagnóstico correto e se sabe que, em alguns casos, as manifestações oculares podem ser um dos primeiros sintomas. Nesse contexto, este estudo tem como objetivo levantar evidência que destaque o uso de fitas de Schirmer e de swabs conjuntivais como método de coleta para análise viral. Conduziu-se uma revisão de literatura seguindo o protocolo para Scoping Review definido pelo Joanna Briggs Institute. Os pesquisadores analisaram os estudos em busca do vírus pesquisado, os métodos de coleta e os métodos de análise. Vírus podem ser detectados na superfície ocular através da análise de fitas de Schirmer e de swabs conjuntivais, entretanto novos estudos com populações maiores e com definições claras de tempo são necessários para conclusões mais assertivas no tema.

Avaliação de indicadores de qualidade na gestão do centro cirúrgico de um hospital terciário / Evaluation of quality indicators in the management of an operating room at a tertiary-level hospital

Introdução: Por se tratar de um setor complexo e que compreende grande parte dos custos de um hospital, o centro cirúrgico demanda uma contínua avaliação de suas atividades, com o objetivo de propiciar uma melhora da sua eficiência e da segurança dos pacientes. Uma estratégia interessante para se realizar tal avaliação é a utilização de um conjunto de indicadores de qualidade preestabelecidos, dividindo os atributos do serviço em estrutura, processos e resultados. Para que isso seja possível, é necessário que o serviço analisado possua uma fonte de dados bem estruturada, tendo o Núcleo Interno de Regulação um papel importante nesse processo. Objetivo: Este estudo teve como objetivo a análise de índices de gestão do centro cirúrgico de um hospital terciário especializado em cirurgias eletivas através da mensuração de dados referentes a indicadores de qualidade. Metodologia: Trata-se de um estudo observacional descritivo feito de forma retrospectiva em um hospital escola público do interior do estado de São Paulo. Foram mensurados 18 indicadores referentes ao período de 01/06/2019 a 31/12/2019, a partir de consultas a diferentes setores administrativos do local. Os resultados passaram por uma análise estatística descritiva ao final da coleta de dados. Resultados: Os principais resultados encontrados foram: taxa de cumprimento da agenda cirúrgica de 95,8%, taxa de cancelamento de 4,1%, taxa de ocupação de 47,9%, turnover de 23,1 minutos, tempo médio de atraso no início das cirurgias de 32,8 minutos, tempo de permanência na sala de recuperação pós-anestésica de 37,4 minutos, taxa de absenteísmo dos profissionais de 8,94% e as taxas de infecção do sítio cirúrgico, de mortalidade operatória e de acidente de trabalho foram todas 0%. Conclusões: Apesar da alta taxa de cumprimento da agenda cirúrgica, a taxa de ocupação se encontrou aquém do ideal, sugerindo que o agendamento das cirurgias pode ser melhorado. Além disso, demonstrou-se que a estratégia de "cirurgias reservas" adotada no hospital auxilia no cumprimento da meta de cirurgias programadas e no aumento da taxa de ocupação (AU)

Introduction: As a complex sector that results in a large part of the costs in a hospital, the operating room demands a continuous evaluation of its activities, with the objective of providing an improvement in its efficiency and in patient safety. An interesting strategy to carry out such an evaluation is using a set of pre-established quality indicators, by the division of the service's attributes into structure, processes and results, which can provide a broad perspective of the activities developed and facilitate decision-making by the hospital manager. In this analysis process, it is necessary that the service has a well-structured data source, where the Internal Regulation Center plays an important role. Objective: The objective of this study was to analyze, through the measurement of data related to quality indicators, the management indexes of the operating room of a tertiary-level hospital specialized in elective surgeries. Methodology: This is a descriptive observational study that was conducted retrospectively at a public teaching hospital. In this research, 18 indicators, related to the period from 06/01/2019 to 12/31/2019, were measured based on consultations to different administrative sectors of the hospital. The results went through a descriptive statistical analysis at the end of data collection. Results:The main results found were as follows: the fulfillment rate of the surgical schedule was 95.8%, the cancellation rate was 4.1%, the occupancy rate was 47.9%, the turnover time was 23.1 minutes, the mean delay time in the start of surgeries was 32.8 minutes, length of stay in the post-anesthesia care unit was 37.4 minutes, the professionals' absenteeism rate was 8.94%, and the rates of surgical site infection, operative mortality and work accident were all 0%. Conclusions: Despite the high fulfillment rate of the surgical schedule, the occupancy rate was below the ideal, suggesting that scheduling of surgeries can be improved. In addition, it was shown that the "reserve surgeries" strategy adopted at the hospital helped to reach the goal of scheduled surgeries and to increase the occupancy rate (AU)

Avaliação de indicadores de qualidade na gestão do centro cirúrgico de um hospital terciário / Evaluation of quality indicators in the management of an operating room at a tertiary-level hospital

RESUMO: Introdução: Por se tratar de um setor complexo e que compreende grande parte dos custos de um hospital, o centro cirúrgico demanda uma contínua avaliação de suas atividades, com o objetivo de propiciar uma melhora da sua eficiência e da segurança dos pacientes. Uma estratégia interessante para se realizar tal avaliação é a utilização de um conjunto de indicadores de qualidade preestabelecidos, dividindo os atributos do serviço em estrutura, processos e resultados. Para que isso seja possível, é necessário que o serviço analisado possua uma fonte de dados bem estruturada, tendo o Núcleo Interno de Regulação um papel importante nesse processo. Objetivo: Este estudo teve como objetivo a análise de índices de gestão do centro cirúrgico de um hospital terciário especializado em cirurgias eletivas através da mensuração de dados referentes a indicadores de qualidade. Metodologia: Trata-se de um estudo observacional descritivo feito de forma retrospectiva em um hospital escola público do interior do estado de São Paulo. Foram mensurados 18 indicadores referentes ao período de 01/06/2019 a 31/12/2019, a partir de consultas a diferentes setores administrativos do local. Os resultados passaram por uma análise estatística descritiva ao final da coleta de dados. Resultados: Os principais resultados encontrados foram: taxa de cumprimento da agenda cirúrgica de 95,8%, taxa de cancelamento de 4,1%, taxa de ocupação de 47,9%, turnover de 23,1 minutos, tempo médio de atraso no início das cirurgias de 32,8 minutos, tempo de permanência na sala de recuperação pós-anestésica de 37,4 minutos, taxa de absenteísmo dos profissionais de 8,94% e as taxas de infecção do sítio cirúrgico, de mortalidade operatória e de acidente de trabalho foram todas 0%. Conclusões: Apesar da alta taxa de cumprimento da agenda cirúrgica, a taxa de ocupação se encontrou aquém do ideal, sugerindo que o agendamento das cirurgias pode ser melhorado. Além disso, demonstrou-se que a estratégia de "cirurgias reservas" adotada no hospital auxilia no cumprimento da meta de cirurgias programadas e no aumento da taxa de ocupação. (AU)

ABSTRACT: Introduction: As a complex sector that results in a large part of the costs in a hospital, the operating room demands a continuous evaluation of its activities, with the objective of providing an improvement in its efficiency and in patient safety. An interesting strategy to carry out such an evaluation is using a set of pre-established quality indicators, by the division of the service's attributes into structure, processes and results, which can provide a broad perspective of the activities developed and facilitate decision-making by the hospital manager. In this analysis process, it is necessary that the service has a well-structured data source, where the Internal Regulation Center plays an important role. Objective: The objective of this study was to analyze, through the measurement of data related to quality indicators, the management indexes of the operating room of a tertiary-level hospital specialized in elective surgeries. Methodology: This is a descriptive observational study that was conducted retrospectively at a public teaching hospital. In this research, 18 indicators, related to the period from 06/01/2019 to 12/31/2019, were measured based on consultations to different administrative sectors of the hospital. The results went through a descriptive statistical analysis at the end of data collection. Results:The main results found were as follows: the fulfillment rate of the surgical schedule was 95.8%, the cancellation rate was 4.1%, the occupancy rate was 47.9%, the turnover time was 23.1 minutes, the mean delay time in the start of surgeries was 32.8 minutes, length of stay in the post-anesthesia care unit was 37.4 minutes, the professionals' absenteeism rate was 8.94%, and the rates of surgical site infection, operative mortality and work accident were all 0%. Conclusions: Despite the high fulfillment rate of the surgical schedule, the occupancy rate was below the ideal, suggesting that scheduling of surgeries can be improved. In addition, it was shown that the "reserve surgeries" strategy adopted at the hospital helped to reach the goal of scheduled surgeries and to increase the occupancy rate. (AU)

Prótese auditiva ancorada ao osso percutânea: benefícios auditivos / Percutaneous bone ancored hearing aid: hearing benefits

RESUMO Objetivo Descrever os benefícios nos limiares auditivos e no desempenho de reconhecimento de sentenças no silêncio e no ruído em indivíduos com a adaptação unilateral do Sistema Ponto®. Métodos Estudo observacional, retrospectivo, de seguimento longitudinal. A casuística foi composta por fontes de dados secundários de dez indivíduos com perda auditiva condutiva ou mista, que foram submetidos à cirurgia com o Sistema Ponto®. Os resultados foram analisados nas seguintes condições: a) pré-cirúrgicas: sem AASI; com AASI por condução aérea ou óssea e com o processador Ponto Pro® acoplado a uma banda elástica; b) pós-cirúrgicas: na ativação e após seis meses de uso. Resultados Os limiares da audiometria tonal por conduções aérea e óssea mantiveram-se estáveis após a cirurgia, enquanto os limiares auditivos em campo livre e o reconhecimento de fala no silêncio e no ruído foram estatisticamente melhores na ativação e após seis meses de uso do Sistema Ponto®. Não houve diferença nos resultados com os indivíduos utilizando o Sistema Ponto® com a banda elástica e após a cirurgia. Conclusão O Sistema Ponto® propiciou benefício nas habilidades auditivas de detecção em todas as frequências testadas, assim como no reconhecimento de sentenças no silêncio e no ruído.

ABSTRACT Purpose To describe the benefits in hearing thresholds and sentence recognition performance in silence and noise, in users of the unilateral Ponto® system. Methods An observational, retrospective, longitudinal study. The sample consisted of secondary data sources from 10 individuals with conductive or mixed hearing loss who underwent surgery with the Ponto® System. The results were analyzed in the following pre-surgical conditions (without hearing aids; with hearing aids by air or bone conduction; with the Ponto Pro® processor with a soft band) and post-surgical (on activation and after six months of use). Results The thresholds of pure tone audiometry by air and bone conductions remained stable after surgery, while the auditory thresholds in free field and speech recognition in silence and in noise were statistically better when using the Ponto® system. There was no difference between the results obtained with the individuals using Ponto® with soft band and post-surgically. Conclusion The Ponto® system provided benefits in hearing detection skills in all tested frequencies, as well as, in recognition of the sentence in silence and noise.