Facial nerve stimulation after cochlear implantation: Our experience in 448 adult patients.

Facial nerve stimulation (FNS) after cochlear implant activation is a well-known side effect, with an incidence rate raging between 1% and 14.9%. Some causes of deafness have been associated with a higher incidence of this entity, however, there is still no consensus regarding its pathophysiological mechanisms. Although FNS can be solved with changes in speech processor programming, in some cases this can lead to a decrease in performance. The aim of this work was to review the epidemiologic, clinical aspects, and performance results in a group of FNS after cochlear implantation. It was conducted a retrospective chart review of 448 adult patients, all implanted between 1985 and 2016. Speech perception tests results were statistically analysed, using non-parametric tests. We registered a group of 13 patients with FNS, contributing to a prevalence of 2.9%. The causes of hearing loss in this group varied between otosclerosis, Menière's disease, head trauma, and idiopathic cause. Six cases were managed by changing the programming strategy and the other seven required the deactivation of the affected electrodes. Statistical evaluation showed no statistically significant difference between the performance results of the groups with and without FNS. In this series, the overall incidence of FNS was consistent with the literature. Our study supports the current idea that FNS can frequently be eliminated by changing programming strategies or deactivating the involved electrodes, without affecting the implant's performance.

Recidiva oncológica: olhares dos profissionais hospitalares sobre as dificuldades do paciente pediátrico / Cancer recurrence: perspectives of hospital staff on the difficulties of pediatric patients / Recaída oncológica: observación de los profesionales de hospitales sobre las dificultades del paciente pediátrico

Em pediatria oncológica, a taxa de sobrevivência tem sofrido um aumento acentuado, sendo considerável a probabilidade de cura. Não obstante, o processo de confronto com a doença pode sofrer alguns contratempos, nomeadamente uma recidiva. Esta última é responsável por elevado sofrimento, o qual poderá ser ainda maior que o confronto com o diagnóstico. Procurando conhecer as percepções dos profissionais de oncologia, relativamente às principais dificuldades experienciadas pelas crianças e adolescentes cuja doença recidivou, as autoras desenvolveram um estudo investigando o olhar desses profissionais. Entrevistaram-se 17 profissionais, de dois hospitais portugueses, exercendo funções hospitalares na área da saúde, serviço social, psicologia e educação. Suas reflexões apontaram como principais dificuldades a aceitação de ter que passar novamente por um processo física e psicologicamente penoso sendo que, entre os adolescentes ­ mais conscientes da gravidade da doença e suas implicações ­ acrescem as dificuldades em ter esperança na cura. Para os mais pequenos, os profissionais apontaram como mais comum a dificuldade em compreender os motivos de nova submissão a tratamentos dolorosos e do afastamento dos seus contextos de vida. Dando a conhecer uma etapa particularmente desafiante da doença oncológica, o presente estudo traz um olhar multifocal de um grupo de profissionais que acompanham de perto essas crianças/adolescentes (e respectivas famílias). A sua longa e diversa experiência ­ em termos de tipologias de câncer, evolução do quadro clínico, idade ou temperamento dos pacientes (e dos próprios pais) ­ fazem desses profissionais informantes-chave no mapeamento das dificuldades associadas ao processo de recidiva oncológica em pediatria, bem como no desenho e implementação de respostas mais ajustadas à fenomenologia destes processos. (AU)

In pediatric oncology, the survival rate has risen considerably, and nowadays the probability of cure is very high. However, the process of fighting the disease can suffer some setbacks, namely a relapse. This event is responsible for high suffering, which may be even greater than dealing with the diagnosis of cancer. Aiming to understand the perceptions of oncology professionals regarding the main difficulties experienced by children/adolescents whose cancer relapsed, the authors developed a study in which the professionals' perspective was explored. A group of 17 professionals (from the areas of health, social work, psychology and education), working in two Portuguese hospitals, was interviewed. Their reflections indicated that the main difficulties during relapse were the acceptance of having to undergo such a - physically and psychologically - painful process all over again, and among adolescents, who are more aware of the severity of the disease and its implications, also difficulties in keeping up hope. Among the youngest, professional pointed out as more common the difficulty in understanding why they have to be resubmitted to such painful treatments and be parted from their life contexts. Emphasizing recurrence as a particularly challenging stage of the oncologic disease, this study brings a multifocal view of a group of professionals who closely follow these children/adolescents (and their families) all the way trough. Their long and diverse experience - in terms of type of cancer, evolution of the disease, age and/or temperament of the patients (and the parents' themselves) - make these professionals key informants in the mapping of the difficulties related to the pediatric oncological relapse, as well as in the design and implementation of more adjusted responses to the phenomenology of these processes. (AU)

En pediatría oncológica, el índice de sobrevivencia ha experimentado un aumento acentuado, siendo considerable la probabilidad de cura. Sin embargo, el proceso de enfrentar la enfermedad puede sufrir algunos contratiempos, en particular una recaída; ésta es responsable por mucho sufrimiento, el cual puede ser incluso mayor que enfrentar el propio diagnóstico. Tratando de conocer las percepciones de los profesionales de oncología y las principales dificultades experimentadas por los niños/adolescentes que tuvieron recaída, los autores desarrollaron un estudio con participación de 17 profesionales de la salud, trabajo social, psicología y educación de dos hospitales portugueses. Las reflexiones recogidas a través de entrevistas indicaron que las principales dificultades de los niños es aceptar y entender porqué razón tienen que pasar nuevamente por un proceso físico y psicológico tan doloroso y estar lejos de sus contextos naturales. Entre los adolescentes - más conscientes de la gravedad e implicaciones de la enfermedad ­ son mayores las dificultades para creer y tener esperanza en la cura. Describindo la recaída como una etapa particularmente difícil de la enfermedad oncológica, este estudio proporciona una mirada multifocal de un grupo de profesionales que siguen de cerca estos niños/adolescentes (y respectivas familias). Su larga y variada experiencia - en términos de tipos de cáncer, evolución de cuadro clínico, edad y temperamento de los pacientes (y de los propios padres) ­ hace que estos profesionales pasen a ser informantes clave para identificar las dificultades asociadas con la recaída del cáncer pediátrico, así como en el diseño e implementación de respuestas más ajustadas a la fenomenología de estos procesos. (AU)

Cochlear implantation in children with anomalous cochleovestibular anatomy.

OBJECTIVE: The aim of the study is to assess the audiological and surgical outcome after cochlear implantation in children with inner ear malformation and to compare them with a group of congenitally deaf children implantees without inner ear malformation. INTRODUCTION: Children with profound sensorineural deafness with malformations of the inner ear represent a challenge, accounting to 5-15% of congenital sensorineural deafness. These cases were originally regarded as a contraindication for cochlear implant surgery. METHODS: Retrospective study of 26 patients with congenital inner ear malformation, from a total population of 329 cochlear implant patients. Radiological evaluation with high resolution computed tomography and magnet resonance was performed to all patients in order to evaluate all the preoperative conditions. All patients were tested using European Portuguese word discrimination tests (monosyllabic test, number test and sentences test), capacity of auditory performance (CAP) and speech intelligibility rating (SIR). RESULTS: In all 7.9% of deaf children in our center study have inner ear abnormalities. All children underwent successful implantation. CAP yielded an average 7.1 (+/-1.7), SIR 4.3 (+/-1.0). The children without inner ear abnormalities did not achieve statistically significant better scores. Two children had a perilymph gusher, and there were no other complications. CONCLUSION: Cochlear implantation can be successfully performed in children with inner ear malformation. Audiological performance after cochlear implantation in malformed inner ears is comparable to that found in other congenitally deaf patients. The risk of CSF leak is associated with inner ear abnormalities and should be anticipated during surgery.

Plaster body wrap: effects on abdominal fat.

BACKGROUND: Abdominal fat is associated with metabolic disorders, leading to cardiovascular risk factors and numerous diseases. This study aimed to analyze the effect of plaster body wrap in combination with aerobic exercise on abdominal fat. METHODS: Nineteen female volunteers were randomly divided into intervention group (IG; n = 10) performing aerobic exercise with plaster body wrap, and control group (CG; n = 9) performing only exercise. Subcutaneous and visceral fat were measured using ultrasound; subcutaneous fat was also estimated on analysis of skinfolds and abdominal perimeters. RESULTS: At the end of the 10-sessions protocol, the IG demonstrated a significant decrease (p ≤ 0.05) in subcutaneous fat at the left anterior superior iliac spine (ASIS) level and in iliac crest perimeter measurements. A large intervention effect size strength (0.80) was found in subcutaneous fat below the navel and a moderate effect size strength on the vertical abdominal skinfold (0.62) and the perimeter of the most prominent abdominal point (0.57). Comparing the initial and final data of each group, the IG showed a significant decrease in numerous variables including visceral and subcutaneous fat above and below the navel measured by ultrasound (p ≤ 0.05). CONCLUSION: Plaster body wrap in combination with aerobic exercise seems to be effective for abdominal fat reduction.