Frequency of GJB2 mutations in patients with nonsyndromic hearing loss from an ethnically characterized Brazilian population / Frequência de mutações de GJB2 em pacientes com perda auditiva não sindrômica em uma população brasileira etnicamente caracterizada

Abstract Introduction: In different parts of the world, mutations in the GJB2 gene are associated with nonsyndromic hearing loss, and the homozygous 35delG mutation (p.Gly12Valfs*2) is a major cause of hereditary hearing loss. However, the 35delG mutation is not equally prevalent across ethnicities, making it important to study other mutations, especially in multiethnic countries such as Brazil. Objective: This study aimed to identify different mutations in the GJB2 gene in patients with severe to profound nonsyndromic sensorineural hearing loss of putative genetic origin, and who were negative or heterozygote for the 35delG mutation. Methods: Observational study that analyzed 100 ethnically characterized Brazilian patients with nonsyndromic severe to profound sensorineural hearing loss, who were negative or heterozygote for the 35delG mutation. GJB2 mutations were detected by DNA-based sequencing in this population. Participants' ethnicities were identified as Latin European, Non-Latin European, Jewish, Native, Turkish, Afro-American, Asian and Others. Results: Sixteen participants were heterozygote for the 35delG mutation; 14 participants, including three 35delG heterozygote's, had nine different alterations in the GJB2 gene. One variant, p.Ser199Glnfs*9, detected in two participants, was previously unreported. Three variants were pathogenic (p.Trp172*, p.Val167Met, and p.Arg75Trp), two were non-pathogenic (p.Val27Ile and p.Ile196Thr), and three variants were indeterminate (p.Met34Thr, p.Arg127Leu, and p.Lys168Arg). Three cases of compound heterozygosity were detected: p.[(Gly12Valfs*2)];[(Trp172*)], p.[(Gly12Valfs*2)](;)[(Met34Thr)], and p.[(Gly12Valfs*2)(;)[(Ser199Glnfs*9)]). Conclusion: This study detected previously unclassified variants and one case of previously unreported compound heterozygosity.

Resumo Introdução: Em diferentes partes do mundo, mutações do gene GJB2 estão associadas a perda auditiva não sindrômica e a mutação homozigótica 35delG (p.Gly12Valfs*2) é uma das principais causas de perda auditiva hereditária. No entanto, a mutação 35delG não é igualmente prevalente em todas as etnias, faz com que seja importante estudar outras mutações, especialmente em países multiétnicos, como o Brasil. Objetivo: Identificar diferentes mutações no gene GJB2 em pacientes com perda auditiva neurossensorial grave ou profunda não sindrômica de origem genética putativa e negativos ou heterozigotos para a mutação 35delG. Método: Estudo observacional que analisou 100 pacientes brasileiros caracterizados etnicamente, com perda auditiva neurossensorial grave ou profunda não sindrômica, negativos ou heterozigotos para a mutação 35delG. As mutações de GJB2 foram detectadas por sequenciamento baseado no DNA nessa população. As etnias dos participantes foram identificadas como latino-europeia, não latino-europeia, judaica, nativa, turca, negra, asiática e outras. Resultados: Dezesseis participantes eram heterozigotos para a mutação 35delG e 14, incluindo três heterozigotos para 35delG, apresentaram nove alterações no gene GJB2. Uma variante, p.Ser199Glnfs*9, detectada em dois participantes, não havia sido relatada anteriormente. Três variantes eram patogênicas (p.Trp172*, p.Val167Met, e p.Arg75Trp), duas não patogênicas (p.Val27Ile e p.Ile196Thr) e três indeterminadas (p.Met34Thr, p.Arg127Leu, e p.Lys168Arg). Três casos de heterozigosidade composta foram detectados: p.[(Gly12Valfs*2)];[(Trp172*)], p.[(Gly12Valfs*2)](;)[(Met34Thr)], e p.[(Gly12Valfs*2)(;)[(Ser199Glnfs*9)]). Conclusão: Este estudo detectou variantes não classificadas anteriormente e um caso de heterozigosidade composta ainda não relatada.

Frequency of GJB2 mutations in patients with nonsyndromic hearing loss from an ethnically characterized Brazilian population.

INTRODUCTION: In different parts of the world, mutations in the GJB2 gene are associated with nonsyndromic hearing loss, and the homozygous 35delG mutation (p.Gly12Valfs*2) is a major cause of hereditary hearing loss. However, the 35delG mutation is not equally prevalent across ethnicities, making it important to study other mutations, especially in multiethnic countries such as Brazil. OBJECTIVE: This study aimed to identify different mutations in the GJB2 gene in patients with severe to profound nonsyndromic sensorineural hearing loss of putative genetic origin, and who were negative or heterozygote for the 35delG mutation. METHODS: Observational study that analyzed 100 ethnically characterized Brazilian patients with nonsyndromic severe to profound sensorineural hearing loss, who were negative or heterozygote for the 35delG mutation. GJB2 mutations were detected by DNA-based sequencing in this population. Participants' ethnicities were identified as Latin European, Non-Latin European, Jewish, Native, Turkish, Afro-American, Asian and Others. RESULTS: Sixteen participants were heterozygote for the 35delG mutation; 14 participants, including three 35delG heterozygote's, had nine different alterations in the GJB2 gene. One variant, p.Ser199Glnfs*9, detected in two participants, was previously unreported. Three variants were pathogenic (p.Trp172*, p.Val167Met, and p.Arg75Trp), two were non-pathogenic (p.Val27Ile and p.Ile196Thr), and three variants were indeterminate (p.Met34Thr, p.Arg127Leu, and p.Lys168Arg). Three cases of compound heterozygosity were detected: p.[(Gly12Valfs*2)];[(Trp172*)], p.[(Gly12Valfs*2)](;)[(Met34Thr)], and p.[(Gly12Valfs*2)(;)[(Ser199Glnfs*9)]). CONCLUSION: This study detected previously unclassified variants and one case of previously unreported compound heterozygosity.

Avaliação vestibular de crianças e adolescentes com tontura / Analysis of vestibular system in children and teenagers with vertigo

Objetivo: Descrever as características clínicas da vestibulopatia e os fatores a ela associados, a partir dos resultados da vectoeletronistagmografia (VENG) na população pediátrica referida para avaliação no Setor de Otoneurologia de um Hospital Universitário. Métodos: Estudo observacional, descritivo, transversal, com coleta retrospectiva de dados de fichas do Setor de Otoneurologia de um Hospital Universitário, contendo a anamnese otoneurológica e os resultados de VENG realizados em crianças e adolescentes com tontura, durante o período de maio de 1998 a dezembro de 2010. Resultados: Foram avaliadas 16 pacientes, com idade entre quatro e 18 anos, com distribuição igualitária de gênero. A maioria apresentava tontura rotatória, acompanhada de zumbido e de náuseas ou vômitos, sem alteração à VENG. A história de traumatismo craniano foi o único fator significativamente associado à presença de alteração à VENG, estando presente nos três pacientes que apresentaram resultados compatíveis com síndrome vestibular periférica. Conclusão: A sintomatologia vestibular periférica predomina na infância. Ainda assim, na maioria das vezes a VENG se apresenta normal, o que sugere uma limitação diagnóstica deste exame. No entanto, quando a sintomatologia vestibular persistente ocorre após quadro de traumatismo craniano, a VENG não só é útil à diferenciação de afecções periféricas de centrais, como auxilia a conduta terapêutica a ser tomada. (AU)

Objective: To describe the clinical features of vestibular disease and factors associated with it, based on the results of vectoelectronystagmography (VENG) in the pediatric population evaluated at the Otoneurology of an University Hospital. Methods: This observational, descriptive, cross-sectional study, with retrospective data collection of registration forms of Otoneurology Department of a University Hospital, containing otoneurologic interviews and the results of VENG, was performed in children and adolescents with dizziness from May 1998 to December 2010. Results: Sixteen patients 4-18 years old were evaluated, with equal gender distribution. Most patients had vertigo accompanied by tinnitus and nausea or vomiting, without changing the VENG. A history of brain damage was the only factor significantly associated with the presence of alterations in the VENG, which was observed in three patients who showed consistent results with peripheral vestibular syndrome. Conclusion: The peripheral vestibular symptomatology predominates in childhood. However, most cases the VENG seems to be normal, which suggests a limitation of this diagnostic testing. But, when persistent vestibular symptoms occur after the episode of brain trauma, VENG is useful to differentiate peripheral from central disorders, and helps in the therapeutic conduct to be adopted. (AU)

Profile of patients assessed for cochlear implants.

INTRODUCTION: Knowledge of the characteristics related to profound hearing loss is a matter of great importance, as it allows for the etiological and prognostic identification and strategic planning for public health interventions. OBJECTIVE: To assess the different etiologies of hearing loss, age at diagnosis of the hearing loss, its relation to language acquisition, and the age at the first consultation in this service for cochlear implant assessment. METHODS: This was a historical cohort, cross-sectional study, using retrospective analysis of the records of 115 patients with confirmed sensorineural hearing loss, who were followed in a university hospital, based on gender, age of hearing loss, age at the first consultation, language, and hearing loss etiology. RESULTS AND CONCLUSION: The majority of patients assessed for cochlear implants attend the first consultation when they are older than one year (an alarming mean of 3.8 years in the prelingual group) in spite of the early diagnosis of hearing loss. This reflects an already deficient health care system, in terms of referral. The idiopathic cause remains the most frequently identified. Among the known causes, the most prevalent are perinatal causes and meningitis.

Profile of patients assessed for cochlear implants / Perfil dos pacientes em avaliação para implante coclear

INTRODUCTION: Knowledge of the characteristics related to profound hearing loss is a matter of great importance, as it allows for the etiological and prognostic identification and strategic planning for public health interventions. OBJECTIVE: To assess the different etiologies of hearing loss, age at diagnosis of the hearing loss, its relation to language acquisition, and the age at the first consultation in this service for cochlear implant assessment. METHODS: This was a historical cohort, cross-sectional study, using retrospective analysis of the records of 115 patients with confirmed sensorineural hearing loss, who were followed in a university hospital, based on gender, age of hearing loss, age at the first consultation, language, and hearing loss etiology. RESULTS AND CONCLUSION: The majority of patients assessed for cochlear implants attend the first consultation when they are older than one year (an alarming mean of 3.8 years in the prelingual group) in spite of the early diagnosis of hearing loss. This reflects an already deficient health care system, in terms of referral. The idiopathic cause remains the most frequently identified. Among the known causes, the most prevalent are perinatal causes and meningitis. .

INTRODUÇÃO: O conhecimento das características relacionadas à perda auditiva profunda é de extrema importância já que permite a identificação etiológica e de fatores prognósticos e planejamento estratégico para intervenções de saúde pública. OBJETIVO: Verificar as diferentes etiologias da perda auditiva, idade de diagnóstico da perda, relacionada ou não à aquisição de linguagem e idade dos pacientes ao procurar o serviço para a avaliação de implante coclear. MÉTODO: Estudo de casos, de coorte histórica transversal, com análise retrospectiva de arquivos de 115 pacientes com perda auditiva neurossensorial comprovada acompanhados num hospital universitário, com base em sexo, idade da perda, idade na primeira consulta, linguagem e etiologia da perda. RESULTADOS E CONCLUSÃO: os pacientes avaliados para implante coclear chegam à primeira consulta, em sua maioria, com mais de um ano de idade (média preocupante de 3,8 anos no grupo pré-lingual), apesar de o diagnóstico da perda ser precoce, o que reflete um sistema ainda deficiente em termos de referenciamento. A causa idiopática ainda é a mais encontrada. Dentre as etiologias conhecidas, as mais prevalentes são as perinatais e a meningite. .

Antibiotic prophylaxis in otolaryngologic surgery

Aim: Antibiotic prophylaxis aims to prevent infection of surgical sites before contamination or infection occurs. Prolonged antibiotic prophylaxis does not enhance the prevention of surgical infection and is associated with higher rates of antibiotic-resistant microorganisms. This review of the literature concerning antibiotic prophylaxis, with an emphasis on otolaryngologic surgery, aims to develop a guide for the use of antibiotic prophylaxis in otolaryngologic surgery in order to reduce the numbers of complications stemming from the indiscriminate use of antibiotics...

Antibiotic prophylaxis in otolaryngologic surgery.

AIM: Antibiotic prophylaxis aims to prevent infection of surgical sites before contamination or infection occurs. Prolonged antibiotic prophylaxis does not enhance the prevention of surgical infection and is associated with higher rates of antibiotic-resistant microorganisms. This review of the literature concerning antibiotic prophylaxis, with an emphasis on otolaryngologic surgery, aims to develop a guide for the use of antibiotic prophylaxis in otolaryngologic surgery in order to reduce the numbers of complications stemming from the indiscriminate use of antibiotics.

Aesthetic comparison of the ideal nasal radix height in Brazilians.

UNLABELLED: The harmony of the facial profile is widely influenced by the height and form of the nasal dorsum. A few millimeters can make the lateral view aesthetically more or less pleasing and adequate in a subject's face. Professionals working with facial aesthetics should focus not only on the surgical techniques for proposed outcomes, but also with the subtleties and subjectivity that characterize aesthetic concepts and judgment. MATERIAL AND METHODS: A prospective survey to evaluate the preferences of a group of healthcare professionals working with facial aesthetics, a group of fine artists, and lay people about the best nasal radix height; the survey involved comparing 3 different nasal radix heights using computer-altered photographs of women with measurements close to the Caucasian standard. RESULTS AND CONCLUSION: The lowest position of the nasal radix--close to the height of the pupil--was preferred (53%), followed by the middle position (superior crease of the eye). The highest position, resembling classic Greek statues, was considered the worst. The authors evaluated the effect of age, gender, and educational level on the choice of the best and worst female profiles.

Aesthetic comparison of the ideal nasal radix height in brazilians / Comparação estética da altura ideal do radix nasal em uma população brasileira

The harmony of the facial profile is widely influenced by the height and form of the nasal dorsum. A few millimeters can make the lateral view aesthetically more or less pleasing and adequate in a subject's face. Professionals working with facial aesthetics should focus not only on the surgical techniques for proposed outcomes, but also with the subtleties and subjectivity that characterize aesthetic concepts and judgment. MATERIAL AND METHODS: A prospective survey to evaluate the preferences of a group of healthcare professionals working with facial aesthetics, a group of fine artists, and lay people about the best nasal radix height; the survey involved comparing 3 different nasal radix heights using computer-altered photographs of women with measurements close to the Caucasian standard. RESULTS AND CONCLUSION: The lowest position of the nasal radix - close to the height of the pupil - was preferred (53 percent), followed by the middle position (superior crease of the eye). The highest position, resembling classic Greek statues, was considered the worst. The authors aos evaluated the effect of age, gender, and educational level on the choice of the best and worst female profiles.

A harmonia facial da visão de perfil é muito influenciada pela altura e forma do dorso nasal. Poucos milímetros podem determinar as diferenças que tornam o perfil esteticamente agradável e adequado a uma determinada face. Além da discussão a respeito de técnicas cirúrgicas para obter determinados objetivos, os profissionais também precisam se aprofundar nas sutilezas e subjetividades que envolvem o julgamento estético. Com forma de estudo tipo inquérito, o objetivo foi pesquisar a preferência de um grupo de profissionais de saúde que lidam com estética facial, um grupo de artistas e outro de leigos sobre três possíveis variações da altura da raiz do nariz. MATERIAIS E MÉTODOS: Fotografias de mulheres, com medidas muito próximas do modelo caucasiano, foram modificadas com computação gráfica e opiniões sobre estas variações colhidas entre profissionais, artistas e leigos. RESULTADOS E CONCLUSÃO: A população de entrevistados considerou o perfil alto, tipo grego, como indesejável. Tal convicção foi muito evidente em todos os grupos. A preferência foi pelo perfil com raiz nasal próxima da altura da pupila em 53 por cento, seguido do perfil na altura da prega tarsal. Avaliou-se também a influência da idade, sexo e escolaridade dos entrevistados sobre as escolhas dos melhores e piores perfis femininos.

The impact of gender, age and hearing loss on tinnitus severity.

UNLABELLED: Tinnitus is a symptom present in approximately 15% of the world population. Most patients are between 40 and 80 years of age; the prevalence above 60 reaches 33%. About 20% have moderate to severe impact in the quality of life but the factors associated with the tinnitus annoyance are not completely known. AIM: The objective of this study is to evaluate the relationship between age, gender and hearing loss on tinnitus annoyance. MATERIALS AND METHODS: 68 patients were evaluated at the tinnitus center at our hospital, from March 2007 to march 2008, with a detailed interview, complete otolaryngological examination, the Portuguese version of the Tinnitus Handicap Inventory and pure tone audiometry. RESULTS: Age varied from 24 to 83 (mean=59); the mean THI value was 39 (females: 36; males: 44). THI grades were: slight: 32.3%; mild: 19.1%; moderate: 20.6%; severe: 13.2% and catastrophic: 14.7%. No significant correlation was found between gender (p=0.30), age (p=0.77) hearing loss (p>0.05 for all averages analyzed) and tinnitus severity. CONCLUSION: Gender, age and hearing loss do not influence tinnitus annoyance, using the THI.

Voice handicap Index evaluation in patients with moderate to profound bilateral sensorineural hearing loss.

UNLABELLED: Voice and speech are regulated by hearing. Vocal disorders in patients with hearing loss have not been evaluated yet as to the subjective degree of disability they cause in this group. AIM: to compare the results of the Voice Handicap Index (VHI) obtained for patients with normal hearing and moderate to profound bilateral sensorineural hearing loss. STUDY DESIGN: Controlled, cross-sectional. MATERIALS AND METHODS: A total of 76 adult patients being treated on a University Otolaryngology center were enrolled (38 with and 38 without hearing loss), ages ranging between 19 and 59 years, were asked to complete the Portuguese version of the VHI. RESULTS: Total VHI score median values obtained were 23.5 and 4.0 for the study and control groups, respectively (p = 0.000). Significant differences between the two groups were found for all three VHI subscales (functional, physical and emotional) (p = 0.000). CONCLUSION: Our results lead us to infer a greater social and economical disadvantage as per assessed in the VHI of patients with moderate and higher bilateral sensorineural hearing loss.

Avaliação da relação entre severidade do zumbido e perda auditiva, sexo e idade do paciente / The impact of gender, age and hearing loss on tinnitus severity

O zumbido é um sintoma que afeta aproximadamente 15 por cento da população mundial. Acomete qualquer idade, mas predomina entre 40 e 80 anos e sua prevalência alcança 33 por cento entre os idosos. Aproximadamente 20 por cento dos pacientes incomodam-se com o sintoma, mas ainda não se conhecem todos os fatores determinantes deste incômodo. OBJETIVO: Avaliar a influência do sexo, idade e grau de perda auditiva no incômodo do zumbido. Materiais e métodos: Foram avaliados 68 pacientes do ambulatório de zumbido da nossa instituição, no período de março de 2007 a março de 2008, em estudo com corte transversal. Os procedimentos realizados foram: anamnese com protocolo sistematizado, exame otorrinolaringológico completo, versão brasileira do Tinnitus Handicap Inventory (THI) e audiometria tonal liminar. Resultados: A idade variou de 24 a 83 anos e a média do THI foi de 39 pontos (36 no sexo feminino e 44 no masculino). Os graus de incômodo pelo THI foram: discreto: 32,3 por cento; leve: 19,1 por cento; moderado: 20,6 por cento; severo: 13,2 por cento e catastrófico: 14,7 por cento. Não houve correlação significativa do incômodo pelo zumbido com as variáveis sexo (p=0,30), idade (p=0,77) e grau de perda auditiva (p>0,05 em todas as médias avaliadas). Conclusão: Sexo, idade e perda auditiva não influenciaram no incômodo gerado pelo zumbido.

Tinnitus is a symptom present in approximately 15 percent of the world population. Most patients are between 40 and 80 years of age; the prevalence above 60 reaches 33 percent. About 20 percent have moderate to severe impact in the quality of life but the factors associated with the tinnitus annoyance are not completely known. AIM: The objective of this study is to evaluate the relationship between age, gender and hearing loss on tinnitus annoyance. Materials and methods: 68 patients were evaluated at the tinnitus center at our hospital, from March 2007 to march 2008, with a detailed interview, complete otolaryngological examination, the Portuguese version of the Tinnitus Handicap Inventory and pure tone audiometry. Results: Age varied from 24 to 83 (mean=59); the mean THI value was 39 (females: 36; males: 44). THI grades were: slight: 32.3 percent; mild: 19.1 percent; moderate: 20.6 percent; severe: 13.2 percent and catastrophic: 14.7 percent. No significant correlation was found between gender (p=0.30), age (p=0.77) hearing loss (p>0.05 for all averages analyzed) and tinnitus severity. Conclusion: Gender, age and hearing loss do not influence tinnitus annoyance, using the THI.

Avaliação do Voice Handicap Index em pacientes com perda auditiva neurossensorial bilateral a partir de grau moderado / Voice Handicap Index evaluation in patients with moderate to profound bilateral sensorineural hearing loss

A produção da voz e da fala é processo que envolve mecanismos reguladores dependentes da audição. As alterações vocais em pacientes com perda auditiva ainda não foram avaliadas quanto ao grau subjetivo de incapacidade que trazem a este grupo. Objetivo: Comparar os resultados do Voice Handicap Index (VHI) em pacientes com e sem perda auditiva neurossensorial bilateral a partir de grau moderado. Forma de estudo: Estudo transversal controlado. Material e método: Foram avaliados 76 pacientes adultos (38 com e 38 sem perda auditiva) entre 19 e 59 anos, atendidos em serviço terciário de otorrinolaringologia mediante preenchimento do VHI. Resultados: A mediana da pontuação total do VHI obtida no grupo de pacientes e controle foi de 23,5 e 4,0, respectivamente (p = 0,000). Diferenças significativas entre os dois grupos também foram conseguidas nas medianas dos subitens funcional, físico e emocional do VHI (p = 0,000). Conclusão: Os resultados obtidos permitem verificar a maior desvantagem social e econômica conforme avaliada pelo VHI em pacientes com perda auditiva neurossensorial bilateral a partir de grau moderado.

Voice and speech are regulated by hearing. Vocal disorders in patients with hearing loss have not been evaluated yet as to the subjective degree of disability they cause in this group. AIM: to compare the results of the Voice Handicap Index (VHI) obtained for patients with normal hearing and moderate to profound bilateral sensorineural hearing loss. Study design: Controlled, cross-sectional. Materials and methods: A total of 76 adult patients being treated on a University Otolaryngology center were enrolled (38 with and 38 without hearing loss), ages ranging between 19 and 59 years, were asked to complete the Portuguese version of the VHI. Results: Total VHI score median values obtained were 23.5 and 4.0 for the study and control groups, respectively (p = 0.000). Significant differences between the two groups were found for all three VHI subscales (functional, physical and emotional) (p = 0.000). Conclusion: Our results lead us to infer a greater social and economical disadvantage as per assessed in the VHI of patients with moderate and higher bilateral sensorineural hearing loss.

A auto-percepção da saúde auditiva e vestibular de trabalhadores expostos a organofosforados / Auto-perception of auditory and vestibular health in workers exposed to organophosphate

OBJETIVO: caracterizar os sintomas auditivos e vestibulares de trabalhadores rurais expostos aos agrotóxicos organofosforados. MÉTODOS: foi realizado um estudo epidemiológico descritivo com uma amostra de 50 trabalhadores rurais. A faixa etária variou de 21 a 59 anos, média de 38,3 anos, sendo 20 (40 por cento) trabalhadores de sexo masculino e 30 (60 por cento) de sexo feminino. Foi utilizado um questionário com perguntas relacionadas à saúde auditiva e dados sobre tempo de exposição ao agrotóxico. RESULTADOS: os resultados mostraram que 38 trabalhadores (76 por cento) referiram ter apresentado pelo menos um episódio de tontura em sua vida e destes, 29 (58 por cento) trabalhadores ainda sentem tontura; 27 (54 por cento) sentem zumbidos; 23 (46 por cento) sentem a orelha abafada; 37 (74 por cento) acham que possuem boa acuidade auditiva, porém 35 (70 por cento) acham que, sentem dificuldades na compreensão de palavras, sugerindo que os agrotóxicos podem induzir alterações do sistema auditivo e vestibular por meio de uma intoxicação lenta e silenciosa. CONCLUSÃO: a tontura e a perda auditiva aparecem como sintomas subjetivos e constantes da exposição ocupacional podendo ser um sinal precoce da intoxicação, prejudicando a qualidade de vida destes trabalhadores.

PURPOSE: to characterize the auditory and vestibular symptoms of rural workers under an environmental exposed of organophosphate pesticides. METHODS: this is a descriptive epidemic study that evaluated 50 workers. The age group varied from 21 to 59 years with a mean age of 38.3 years. There were 20 (40 percent) male and 30 (60 percent) female workers. A questionnaire was used with questions related to the auditory health in addition to some specific questions on time exposure. RESULTS: the results showed that 38 (76 percent) workers showed dizziness and 29 (58 percent) of them continued showing these symptom; 27 (54 percent) related tinnitus; 23 (46 percent) fullness sensation. 37 (74 percent) workers don't have problem with hearing but 35 (70 percent) can't understand very well the spoken words. Data suggest that the pesticides induce auditory and vestibular system alterations. It is possible to affirm that it is a slow, insidious and silent intoxication. CONCLUSIONS: dizziness and hearing loss are a constant and subclinical symptoms in occupational exposure suggesting a precocious intoxication signal, harming the quality of life of these workers.

Gustatory alteration evaluation in patients with chronic otitis media.

UNLABELLED: Many studies have shown the consequent gustatory alteration caused by ear surgeries. However, few have reported this alteration in patients with chronic otitis media (COM), prior to surgical treatment. AIM: to identify gustatory alterations due to chorda tympani nerve involvement in patients with COM without prior surgery. METHODS: Clinical essay, with tests based on 'taste strips' with different concentrations of salt, sweet, bitter, and sour, was performed in 45 patients with unilateral cholesteatomatous or suppurated COM not previously submitted to otological surgery, using the disease-free ear on the contralateral side as control. The score ranged between 0 and 16. RESULTS: A total of 25 patients presented cholesteatoma and 20 had non-cholesteatomatous disease. The mean score was 6.65 for the affected side and 9.93 for the half of the tongue on the side of the healthy ear (p<0.001). No patients had complained of gustatory alterations before the examination. Among the 24 patients with unilateral hypogeusia, eight cases of unilateral ageusia were found on the affected side. There was an association between cholesteatoma (p=0.055), disease duration (p=0.07) and worsening in gustatory sensitivity. CONCLUSION: Patients with COM can have gustatory alterations, even in the absence of complaints.

Gustatory alteration evaluation in patients with chronic otitis media / Avaliação de alteração gustatória em pacientes com otite média crônica

Many studies have shown the consequent gustatory alteration caused by ear surgeries. However, few have reported this alteration in patients with chronic otitis media (COM), prior to surgical treatment. AIM: to identify gustatory alterations due to chorda tympani nerve involvement in patients with COM without prior surgery. METHODS: Clinical essay, with tests based on "taste strips" with different concentrations of salt, sweet, bitter, and sour, was performed in 45 patients with unilateral cholesteatomatous or suppurated COM not previously submitted to otological surgery, using the disease-free ear on the contralateral side as control. The score ranged between 0 and 16. RESULTS: A total of 25 patients presented cholesteatoma and 20 had non-cholesteatomatous disease. The mean score was 6.65 for the affected side and 9.93 for the half of the tongue on the side of the healthy ear (p<0.001). No patients had complained of gustatory alterations before the examination. Among the 24 patients with unilateral hypogeusia, eight cases of unilateral ageusia were found on the affected side. There was an association between cholesteatoma (p=0.055), disease duration (p=0.07) and worsening in gustatory sensitivity. CONCLUSION: Patients with COM can have gustatory alterations, even in the absence of complaints.

Muitos estudos mostraram a consequente alteração do paladar após cirurgia otológica. Entretanto, poucos reportaram essa alteração como uma queixa de pacientes com otite média crônica (OMC) previamente à cirurgia. OBJETIVO: Avaliar alterações na função gustatória na área inervada pelo nervo corda do tímpano em pacientes com OMC ainda não submetidos à cirurgia. MATERIAL E MÉTODOS: O ensaio clínico, com teste gustatório baseado em "tiras gustativas" com diferentes concentrações de sal, doce, amargo e azedo, foi realizado em 45 pacientes com OMC colesteatomatosa e não-colesteatomatosa unilateral, nunca antes submetidos à cirurgia otológica, utilizando a metade da língua do lado livre de doença otológica como controle. As notas variavam de 0 a 16. RESULTADOS: 25 pacientes apresentavam colesteatoma e o restante OMC não-colesteatomatosa. A pontuação média foi de 6,65 para o lado afetado e 9,93 para a metade da língua do lado sadio (p<0,001). Nenhum paciente se queixava de alteração do paladar antes do exame. Encontramos 24 casos de hipogeusia do lado afetado, sendo 8 (17,7 por cento) casos de ageusia. Houve uma relação entre tempo de doença (p=0,07) e colesteatoma (p=0,055) com piora da sensibilidade gustativa. CONCLUSÃO: Pacientes com OMC podem apresentar alteração gustativa, mesmo na ausência de queixas.

Topical use of adrenaline in different concentrations for endoscopic sinus surgery.

UNLABELLED: The ideal adrenaline concentration remains unknown. AIM: Compare topical adrenaline solutions in different concentrations. STUDY DESIGN: Prospective, double blind, randomized trial. PATIENTS AND METHODS: 49 patients divided in 3 groups underwent endoscopic sinus surgery, using only topical solutions of adrenaline in different concentrations (1:2,000, 1:10,000 and 1:50,000). We compared the duration of surgery, intra-operative bleeding, plasmatic levels of catecholamines, hemodynamic parameters and changes in heart rhythm. RESULTS: Surgery time was shorter in the group using adrenaline 1:2,000, which also showed less bleeding in all evaluations (objective and subjective - p < 0.0001). Plasmatic levels of epinephrine rose in all groups, more sharply in the 1:2,000 group. There was a trend towards elevation of blood pressure in the groups using adrenaline 1:2,000 and 1:10,000, with a greater occurrence of hypertensive peaks. DISCUSSION: We found a very significance bleeding difference favoring the 1:2,000. The blood pressure elevation in the 1:2,000 and 1:10,000 groups was progressive but very slow throughout the procedure, which could be associated with the anesthesia technique. CONCLUSION: We favor the use of topical adrenalin 1:2,000 due to a clear superiority in hemostasis. Further investigation is needed to corroborate our findings.

Uso tópico da adrenalina em diferentes concentrações na cirurgia endoscópica nasal / Topical use of adrenaline in different concentrations for endoscopic sinus surgery

A concentração ideal de adrenalina tópica a promover hemostasia adequada sem toxicidade ainda é motivo de controvérsia. OBJETIVO: Comparar soluções tópicas de adrenalina em diferentes concentrações. DESENHO DO ESTUDO: Prospectivo, duplo-cego, seleção aleatória. MATERIAIS E MÉTODOS: 49 pacientes submetidos à cirurgia endoscópica nasal, divididos em 3 grupos usando exclusivamente adrenalina tópica, nas concentrações de 1:2000, 1:10.000 e 1:50.000. Comparou-se o tempo operatório, o sangramento, as concentrações plasmáticas de adrenalina e noradrenalina e a variação dos parâmetros cardiovasculares. RESULTADOS: O tempo operatório por procedimento foi menor no grupo que utilizou adrenalina 1:2000, assim como o sangramento (p < 0,0001). As concentrações plasmáticas de adrenalina subiram em todos os 3 grupos, porém mais no grupo que utilizou adrenalina 1:2000. Houve uma tendência de aumento dos níveis tensionais nos pacientes que usaram adrenalina 1:2000 e 1:10.000, com maior ocorrência de picos hipertensivos. Discussão: Os benefícios do uso da solução de adrenalina mais concentrada foram evidentes, principalmente em relação ao sangramento. A tendência de aumento dos níveis tensionais pode ter ocorrido por não termos utilizado técnica anestésica intravenosa exclusiva. CONCLUSÃO: Analisando os prós e contras, sugerimos o uso de solução de adrenalina tópica 1:2000; mais pesquisas que corroborem nossos achados são necessárias.

The ideal adrenaline concentration remains unknown. AIM: Compare topical adrenaline solutions in different concentrations. STUDY DESIGN: Prospective, double blind, randomized trial. PATIENTS AND METHODS: 49 patients divided in 3 groups underwent endoscopic sinus surgery, using only topical solutions of adrenaline in different concentrations (1:2,000, 1:10,000 and 1:50,000). We compared the duration of surgery, intra-operative bleeding, plasmatic levels of catecholamines, hemodynamic parameters and changes in heart rhythm. RESULTS: Surgery time was shorter in the group using adrenaline 1:2,000, which also showed less bleeding in all evaluations (objective and subjective - p < 0.0001). Plasmatic levels of epinephrine rose in all groups, more sharply in the 1:2,000 group. There was a trend towards elevation of blood pressure in the groups using adrenaline 1:2,000 and 1:10,000, with a greater occurrence of hypertensive peaks. DISCUSSION: We found a very significance bleeding difference favoring the 1:2,000. The blood pressure elevation in the 1:2,000 and 1:10,000 groups was progressive but very slow throughout the procedure, which could be associated with the anesthesia technique. CONCLUSION: We favor the use of topical adrenalin 1:2,000 due to a clear superiority in hemostasis. Further investigation is needed to corroborate our findings.