A implementação de programa de triagen auditiva neonatal universal em um hospital universitário brasileiro / Universak newborn hearing screeening program assessment in a Brazilian university

Objetivo: avaliar os resultados de implementação do Programa de Triagem Auditiva Neonatal Universal (PT aNU) no Hospital Universitário da Universidade de São Paulo (HU-USP), São Paulo, SP. Casuística e Métodos: Programaou-se a avaliação universal por triagem auditiva...

Time trends analysis of hearing loss: an alternative approach to evaluating hearing loss prevention programs.

Two general approaches for evaluating the performance of hearing loss prevention programs (HLPPs) are described in the literature: (1) a comparison of the rate of hearing loss in an HLPP with a reference population and (2) a comparison of audiometric variability or annual incidence of hearing loss with an established set of criteria that rank HLPP performance on a graded scale. This article discusses a third method, time trends analysis, which assesses patterns in hearing loss over time. Patterns may reflect program improvement (decreased hearing loss incidence over time), deterioration (a pattern of increased incidence), or stasis (unchanged incidence). To demonstrate this method, a time trends analysis was conducted on a population of 44,547 industrial workers. Subjects were divided into 11 subgroups based on year of enrollment in the HLPP (1980-1990) and followed retrospectively for 3 years to determine the incidence of hearing loss. Hazard ratios (HRs) were estimated for each subgroup by gender using the Cox Proportional Hazards model and adjusting for age, race, and hearing threshold at enrollment in the HLPP. For women, plots of adjusted HRs against enrollment years produced a statistically significant (p < 0.05) quadratic trend of an initial increase in hearing loss, followed by decreasing incidence over time. For men, there was a statistically significant linear trend of decreasing hearing loss over time. The downward trend, particularly during the late 1980s, indicates improved HLPP performance during the latter portion of the decade. Time trends analysis can be a valuable tool for assessing HLPP performance for those with access to follow-up data and ability to work with statistical models.

[Objective audiologic assessment of children treated with amikacin]. / Amikacinnal kezelt gyermekek objektív audiológiai vizsgálata.

Hearing assessment of 14 children suffered from urinary tract infection and treated by amikacin is reported. The dosage of amikacin was 7.5 mg/kg/daily for 10 days and the serum level of amikacin not exceeded the 35 mcg/ml. The aim of the study was on the one hand to determine the hearing damaging side effect of amikacin and on the other to assess the usefulness of objective methods for detection of hearing loss in this population. Authors used for screening a transient otoacoustic emission (TEOAE) during and after (2-4 weeks) therapy. If subjective and objective (TEOAE) methods gave a good result, no further checkup has considered as necessary, but if there were no evoked emission, acoustic brainstem response audiometry has been carried out for verification. It result no hearing loss could be detected in the measured specimen. In conclusion it has been stated that by proper dosage and serum level screening amikacin may no lead to hearing loss in children, and objective methods are valuable for hearing screening and monitoring of such population of children.

Global problem of drug-induced hearing loss.

Clinically used drugs and chemical agents may potentially cause adverse effects to the human auditory and vestibular systems. Many of them, such as aminoglycosides and cisplatin, can play a critical role in the treatment of serious or life-threatening diseases; others, like loop diuretics or salycilates, offer such important therapeutical effects compared to the ototoxic side effects that the ototoxicity risk can be considered to be of minor importance. The problem of ototoxic side effects is more acute in developing countries, where highly effective and low-cost drugs are more easily prescribed without adequate monitoring. Medical awareness of doses, forms of administration, populations at risk, and possible synergism is necessary in order to develop appropriate care in the prescription of drugs with ototoxic side effects. Relatively recent issues such as risk-benefit analysis, patient-informed consent, and quality-of-life considerations, particularly when life expectancy can be low, are also to be considered. At present, a uniform method of monitoring for all potentially ototoxic therapeutics does not seem reasonable or practical. It is recommended, however, that individual auditory function be noted for a particular drug being employed. Protocols and exams should be easy, quick, sensitive, reliable, and as objective as possible. Benefits of audiological monitoring include the opportunity to change the patient's treatment course, improvement of patient and family awareness of the impact of hearing impairment, and timely prescription of amplification devices. Finally, particular attention should be paid to high-risk populations such as neonatal intensive care unit patients.

[Results of suboccipital removal of acoustic neurinomas in Denmark 1979-1990]. / Resultater af suboccipital acusticusneurinomfjernelse i Danmark 1979-1990.

In the period from 1979 to 1990, a series of 59 patients with 59 acoustic neuromas were operated upon in five departments of neurosurgery by at least five different neurosurgical teams, employing the suboccipital approach. The perioperative mortality rate was 8.5%. Complications including hematoma, ventricular hemorrhage, meningitis, hemiparalysis, abducens nerve paralysis, recurrent nerve paralysis, postoperative wound infection and CSF leak were observed in 21 patients (35.6%). Radical removal of the tumor was not possible in 17 patients (28.8%). Converting the postoperative facial nerve function to the House-Brackmann (HB) classification, 34 patients (57.6%) were regarded as HB VI. Reconstruction of the facial nerve was attempted in 19 patients (32.2%). Attempts at preservation of hearing were unsuccessful in all patients. Failure to attain better results and the importance of the centralized Danish model of acoustic neuroma surgery are emphasized.