Assessing the hearing of children exposed to zika virus with an initially normal newborn hearing screen: a longitudinal cohort study.

BACKGROUND: Zika virus (ZIKV) infection can result in hearing loss in babies, consequently, audiological monitoring is necessary. AIMS: This study aimed to evaluate the frequency of hearing impairment in neonates and children exposed to ZIKV during the intrauterine period. MATERIALS AND METHODS: A cohort of 30 children born to mothers infected with ZIKV during pregnancy (March 2016-January 2017) underwent repeated hearing assessments performed 48 h after birth. Universal Newborn Hearing Screening revealed normal results in all children at 6, 13, 24, and 36 months. Children were divided into two subgroups based on real-time polymerase chain reaction: RT-PCR(+) and RT-PCR(-). RESULTS: At 24 months, the cumulative incidence of hearing alteration was 57.1%. There was no significant difference in the detection of hearing alteration between RT-PCR(+) and (-) groups. None of the children had sensorineural hearing loss. CONCLUSIONS AND SIGNIFICANCE: None of the children had sensorineural hearing loss. Total incidence conductive type (per 1000 live births), RT-PCR ZIKV (-) 2.2, prevalence 20% and RT-PCR ZIKV 3.1, prevalence 35.7%.The incidence of hearing alteration was highest at 24 months of age (57.1%, n = 8; only conductive type).

In Vivo Study of Nasal Bone Reconstruction with Collagen, Elastin and Chitosan Membranes in Abstainer and Alcoholic Rats.

The aim of the present study was to evaluate the use of collagen, elastin, or chitosan biomaterial for bone reconstruction in rats submitted or not to experimental alcoholism. Wistar male rats were divided into eight groups, submitted to chronic alcohol ingestion (G5 to G8) or not (G1 to G4). Nasal bone defects were filled with clot in animals of G1 and G5 and with collagen, elastin, and chitosan grafts in G2/G6, G3/G7, and G4/G8, respectively. Six weeks after, all specimens underwent radiographic, tomographic, and microscopic evaluations. Bone mineral density was lower in the defect area in alcoholic animals compared to the abstainer animals. Bone neoformation was greater in the abstainer groups receiving the elastin membrane and in abstainer and alcoholic rats receiving the chitosan membrane (15.78 ± 1.19, 27.81 ± 0.91, 47.29 ± 0.97, 42.69 ± 1.52, 13.81 ± 1.60, 18.59 ± 1.37, 16.54 ± 0.89, and 37.06 ± 1.17 in G1 to G8, respectively). In conclusion, osteogenesis and bone density were more expressive after the application of the elastin matrix in abstainer animals and of the chitosan matrix in both abstainer and alcoholic animals. Chronic alcohol ingestion resulted in lower bone formation and greater formation of fibrous connective tissue.

Comparison of Arterial Repair through the Suture, Suture with Fibrin or Cyanoacrylate Adhesive in Ex-Vivo Porcine Aortic Segment.

INTRODUCTION: Tissue adhesives can be used as adjacent to sutures to drop or avoid bleeding in cardiovascular operations. OBJECTIVE: To verify the efficiency of fibrin and cyanoacrylate adhesive to seal arterial sutures and if the adhesives penetrate through suture line to the inner of arteries. METHODS: 20 abdominal aorta segments of pigs were divided into two groups according to the adhesive which would be used as adjacent to the suture. In every arterial segment an arteriotomy was done, followed by a conventional artery closure. Afterwards a colloidal fluid was injected inside the arterial segment with a simultaneous intravascular pressure monitoring up to a fluid leakage through the suture. This procedure was repeated after application of one of the adhesives on the suture in order to check if the bursting pressure increases. The inner aorta segments also were analyzed in order to check if there was intraluminal adhesive penetration. RESULTS: In Suture 1 group, the mean arterial pressure sustained by the arterial suture reached 86±5.35 mmHg and after the fibrin adhesive application reached 104±11.96 (P<0.002). In the Suture 2 group, the mean arterial pressure sustained by the suture reached 83±2.67 mmHg and after the cyanoacrylate adhesive application reached 152±14.58 mmHg (P<0.002). Intraluminal adhesive penetration has not been noticed. CONCLUSION: There was a significant rise in the bursting pressure when tissue adhesives were used as adjacent to arterial suture, and this rise was higher if the cyanoacrylate adhesive was used. In addition, the adhesives do not penetrate through the suture line into the arteries.

Comparison of arterial repair through the suture, suture with fibrin or cyanoacrylate adhesive in ex-vivo porcine aortic segment

Abstract Introduction: Tissue adhesives can be used as adjacent to sutures to drop or avoid bleeding in cardiovascular operations. Objective: To verify the efficiency of fibrin and cyanoacrylate adhesive to seal arterial sutures and if the adhesives penetrate through suture line to the inner of arteries. Methods: 20 abdominal aorta segments of pigs were divided into two groups according to the adhesive which would be used as adjacent to the suture. In every arterial segment an arteriotomy was done, followed by a conventional artery closure. Afterwards a colloidal fluid was injected inside the arterial segment with a simultaneous intravascular pressure monitoring up to a fluid leakage through the suture. This procedure was repeated after application of one of the adhesives on the suture in order to check if the bursting pressure increases. The inner aorta segments also were analyzed in order to check if there was intraluminal adhesive penetration. Results: In Suture 1 group, the mean arterial pressure sustained by the arterial suture reached 86±5.35 mmHg and after the fibrin adhesive application reached 104±11.96 (P<0.002). In the Suture 2 group, the mean arterial pressure sustained by the suture reached 83±2.67 mmHg and after the cyanoacrylate adhesive application reached 152±14.58 mmHg (P<0.002). Intraluminal adhesive penetration has not been noticed. Conclusion: There was a significant rise in the bursting pressure when tissue adhesives were used as adjacent to arterial suture, and this rise was higher if the cyanoacrylate adhesive was used. In addition, the adhesives do not penetrate through the suture line into the arteries.

Subcutaneous Immunotherapy Improves the Symptomatology of Allergic Rhinitis

Introduction The relevance of allergic rhinitis is unquestionable. This condition affects people s quality of life and its incidence has increased over the last years. Objective Thus, this study aims to analyze the effectiveness of subcutaneous injectable immunotherapy in cases of nasal itching, sneeze, rhinorrhea and nasal congestion in allergic rhinitis patients. Methods In the present study, the same researcher analyzed the records of 281 patients. Furthermore, the researchers identified allergens through puncture cutaneous tests using standardized extracts containing acari, fungi, pet hair, flower pollen, and feathers. Then, the patients underwent treatment with subcutaneous specific immunotherapy, using four vaccine vials for desensitization, associated with environmental hygiene. The authors analyzed conditions of nasal itching, sneeze, rhinorrhea, and nasal congestion throughout the treatment, and assigned them with a score ranging from zero (0), meaning absence of these symptoms to three (3), for severe cases. The symptoms were statistically compared in the beginning, during, and after treatment. Results In this study, authors analyzed the cases distribution according to age and the evolution of symptomatology according to the scores, comparing all phases of treatment. The average score for the entire population studied was 2.08 before treatment and 0.44 at the end. These results represent an overall improvement of ±79% in symptomatology of allergic rhinitis in the studied population. Conclusion The subcutaneous immunotherapy as treatment of allergic rhinitis led to a reduction in all symptoms studied, improving the quality of life of patients, proving itself as an important therapeutic tool for these pathological conditions.

Estudo retrospectivo comparativo com dois biomateriais diferentes para enxerto sinusal maxilar ­ cinco anos de acompanhamento / Comparative retrospective study on two different biomaterials for sinus grafting ­ 5 years of follow-up

Objetivo: avaliar o índice de sobrevida de implantes osseointegráveis instalados em maxilas submetidas previamente ao enxerto sinusal e à remodelação óssea, ocorrida após o período de reparo do enxerto. Material e métodos: foram selecionados 12 pacientes que receberam implantes osseointegráveis em maxilares submetidos à elevação de membrana sinusal, seguido da aplicação de substituto ósseo heterógeno composto de origem bovina (GenMix, Baumer, Mogi Mirim, Brasil) ou do biomaterial sintético à base de fosfato ß-tricálcio (Cerasorb, Curasan AG, Kleinostheim, Alemanha). Foi avaliado o índice de sobrevida dos implantes e o nível da remodelação óssea vertical. Foram digitalizadas radiografi as panorâmicas, e mensuradas a extensão linear vertical do remanescente ósseo (T0) e a extensão linear vertical, após o período de incorporação do enxerto ósseo (T1) e após período de osseointegração do implante (T2). Resultados: o índice de sobrevida dos implantes no período de 60 a 84 meses foi de 90% nos seios maxilares, preenchidos por substituto ósseo heterógeno composto de origem bovina. Nos seios preenchidos por biomaterial sintético à base de fosfato ß-tricálcio, o índice de sobrevida dos implantes no período de 60 a 76 meses foi de 88,89%. Foram perdidos dois implantes, um em seio preenchido por osso heterógeno composto e o outro em seio preenchido por fosfato ß-tricálcio. O nível de remodelação óssea foi de 3,29 mm e 1,6 mm, respectivamente, para o osso heterógeno composto de origem bovina, e para o biomaterial sintético a base de fosfato ß-tricálcio. Não houve diferenças estatisticamente signifi cativas entre o nível de remodelação dos dois biomateriais. Conclusão: diante dos resultados obtidos, concluiu-se que ambos os materiais mostraram-se adequados para ossificação intrasinusal, por meio da técnica de elevação da membrana sinusal.

Objective: to evaluate the survival rate of osseointegrated implants placed on maxillary arches submitted to sinus graftings and also the bone remodeling after the graft repair period. Material and methods: twelve patients were selected to receive maxillary osseointegrated implants after the use of a bovine composite bone (GenMix, Baumer, Mogi Mirim, Brazil) or a synthetic ß-tricalcium phosphate biomaterial (Cerasorb, Curasan AG, Kleinostheim, Germany). The implant survival and bone remodeling rates were evaluated on digitized panoramic radiographs being measured the linear extension of the remaining bone (T0), the vertical linear extension after graft incorporation (T1), and after the implant osseointegration period (T2). Results: the implant survival rates were 90% after 60-84 months (bovine composite bone) and 88.89% after 60-76 months (ß-tricalcium phosphate) of follow-ups. Two implants were lost (1 for each group). The bone remodeling values were 3.29 mm and 1.6 mm for the composite bovine bone and the ß-tricalcium phosphate materials. No statistically signifi cant differences were observed between these materials regarding the bone remodeling process. Conclusion: within the results of this study, it can be concluded that both materials are adequate for intrasinus ossification in the sinus lifting membrane technique.

Subcutaneous Immunotherapy Improves the Symptomatology of Allergic Rhinitis.

Introduction The relevance of allergic rhinitis is unquestionable. This condition affects people's quality of life and its incidence has increased over the last years. Objective Thus, this study aims to analyze the effectiveness of subcutaneous injectable immunotherapy in cases of nasal itching, sneeze, rhinorrhea and nasal congestion in allergic rhinitis patients. Methods In the present study, the same researcher analyzed the records of 281 patients. Furthermore, the researchers identified allergens through puncture cutaneous tests using standardized extracts containing acari, fungi, pet hair, flower pollen, and feathers. Then, the patients underwent treatment with subcutaneous specific immunotherapy, using four vaccine vials for desensitization, associated with environmental hygiene. The authors analyzed conditions of nasal itching, sneeze, rhinorrhea, and nasal congestion throughout the treatment, and assigned them with a score ranging from zero (0), meaning absence of these symptoms to three (3), for severe cases. The symptoms were statistically compared in the beginning, during, and after treatment. Results In this study, authors analyzed the cases distribution according to age and the evolution of symptomatology according to the scores, comparing all phases of treatment. The average score for the entire population studied was 2.08 before treatment and 0.44 at the end. These results represent an overall improvement of ∼79% in symptomatology of allergic rhinitis in the studied population. Conclusion The subcutaneous immunotherapy as treatment of allergic rhinitis led to a reduction in all symptoms studied, improving the quality of life of patients, proving itself as an important therapeutic tool for these pathological conditions.

[Universal newborn hearing screening: knowledge of pediatricians and neonatologists in the city of Jundiaí, São Paulo, Brazil]. / Triagem auditiva neonatal universal: conhecimento dos pediatras e neonatologistasem Jundiaí, São Paulo, Brasil.

INTRODUCTION: Hearing loss has severe emotional, psychological, and social consequences. The early identification of hearing impairment is crucial. OBJECTIVE: To evaluate and quantify the knowledge of neonatologists, pediatricians, and residents in pediatrics regarding detection, risk factors, early diagnosis, and referral for rehabilitation of patients with neonatal hearing loss in Jundiaí, state of São Paulo, Brazil. METHODS: This was a cross-sectional contemporary cohort study including 47 physicians from three hospitals and a questionnaire with 15 items. RESULTS: Most of the respondents (83%) had received information about hearing loss in their medical courses, but had no knowledge of techniques for hearing evaluation, and degrees and types of loss. All physicians agreed that in the first six months of life, it is possible to evaluate hearing function and that it is the physician's responsibility to assess the newborn. Regarding the age that the child can receive auditory rehabilitation, the end of the first year and the second year of life predominates. CONCLUSION: Most respondents know the risk factors for the detection of neonatal hearing impairment, know how to perform procedures, and recognize the importance of diagnosis of hearing loss and the need to refer suspected cases, but most do not know the techniques used to assess hearing in newborns.

Universal newborn hearing screening: knowledge of pediatricians and neonatologists in the city of Jundiaí, São Paulo, Brazil / Triagem auditiva neonatal universal: conhecimento dos pediatras e neonatologistas em Jundiaí, São Paulo, Brasil

INTRODUCTION: Hearing loss has severe emotional, psychological, and social consequences. The early identification of hearing impairment is crucial. OBJECTIVE: To evaluate and quantify the knowledge of neonatologists, pediatricians, and residents in pediatrics regarding detection, risk factors, early diagnosis, and referral for rehabilitation of patients with neonatal hearing loss in Jundiaí, state of São Paulo, Brazil. METHODS: This was a cross-sectional contemporary cohort study including 47 physicians from three hospitals, including a questionnaire with 15 items. RESULTS: Most respondents (83%) had received information about hearing loss in their medical courses, but most had no knowledge of techniques for hearing evaluation, and degrees and types of loss. All physicians agreed that in the first six months of life, it is possible to evaluate hearing function and that it is the physician's responsibility to assess the newborn. Regarding the age that the child can receive auditory rehabilitation, the end of the first year and the second year of life predominate. CONCLUSION: Most respondents know the risk factors for the detection of neonatal hearing impairment, know how to perform procedures, and recognize the importance of diagnosis of hearing loss and the need to refer suspected cases, but most do not know the techniques used to assess hearing in newborns. .

INTRODUÇÃO: A deficiência auditiva acarreta graves consequências emocionais, psicológicas e sociais, sendo imprescindível a identificação precoce de alterações auditivas. OBJETIVO: Avaliar e quantificar o conhecimento de médicos neonatologistas, pediatras e residentes em Pediatria, sobre detecção, fatores de risco, diagnóstico precoce e encaminhamento para reabilitação dos pacientes acometidos por deficiência auditiva neonatal no município de Jundiaí, SP. MÉTODO: Estudo de coorte contemporânea com corte transversal, incluindo 47 médicos de três instituições hospitalares, com aplicação de um questionário de 15 perguntas. RESULTADOS: Grande parte dos entrevistados (83%) teve informações sobre deficiência auditiva em seus cursos médicos, em sua maioria desconheciam técnicas de avaliação auditiva na infância, graus e tipos de perda. Todos relataram que nos primeiros seis meses de vida já é possível avaliar a audição, sendo dever do médico se preocupar com sua comunicação. Com relação à idade em que a criança pode receber a reabilitação auditiva, predominaram o final do primeiro e o segundo ano de vida. CONCLUSÃO: A maioria dos entrevistados conhece os fatores de risco para a detecção neonatal da deficiência auditiva, realiza procedimentos, reconhece a importância do diagnóstico da deficiência auditiva e a necessidade de efetuar encaminhamento dos casos suspeitos, porém desconhece técnicas de avaliação da audição em neonatos. .

Detection of Respiratory Viruses in Nasopharyngeal Swab and Adenoid Tissue from Children Submitted to Adenoidectomy: Pre- and Postoperative Analysis

Introduction: The presence of respiratory viruses in lymphoid tissues of the nasopharynx and oropharynx and its impact on recurrent infections and hypertrophy of these tissues are not yet fully understood. Objective: To identify and determine the prevalence of major respiratory viruses in nasopharyngeal secretions and adenoid tissue pre- and postoperatively of children undergoing adenoidectomy. Methods: A prospective observational study was conducted in 36 patients under 12 years of age with upper airway lymphoid hypertrophy who were undergoing adenoidectomy, in which various respiratory viruses were investigated using real-time polymerase chain reaction in adenoid tissue and nasopharyngeal secretions collected preoperatively and 30 days postoperatively. Results: At least 1 viral agent was isolated in any of the samples collected in 58.3% of children and 25.9% of total samples. Respiratory viruses were identified in 33.8% of preoperative nasopharyngeal specimens and in 19.8% of postoperative secretion. Of the 21 patients with positive results for any respiratory virus, 6 (28.6%) had more than 1 virus. Considering all 36 respiratory viruses found, the main agent isolated was rhinovirus (27.8%), followed by bocavirus (22.2%). Conclusion: The virus found more frequently in all samples was rhinovirus. After removal of adenoid tissue, there was a decrease in the prevalence of the virus contained in nasopharyngeal secretion 30 days after surgery...

Detection of respiratory viruses in nasopharyngeal swab and adenoid tissue from children submitted to adenoidectomy: pre- and postoperative analysis.

Introduction The presence of respiratory viruses in lymphoid tissues of the nasopharynx and oropharynx and its impact on recurrent infections and hypertrophy of these tissues are not yet fully understood. Objective To identify and determine the prevalence of major respiratory viruses in nasopharyngeal secretions and adenoid tissue pre- and postoperatively of children undergoing adenoidectomy. Methods A prospective observational study was conducted in 36 patients under 12 years of age with upper airway lymphoid hypertrophy who were undergoing adenoidectomy, in which various respiratory viruses were investigated using real-time polymerase chain reaction in adenoid tissue and nasopharyngeal secretions collected preoperatively and 30 days postoperatively. Results At least 1 viral agent was isolated in any of the samples collected in 58.3% of children and 25.9% of total samples. Respiratory viruses were identified in 33.8% of preoperative nasopharyngeal specimens and in 19.8% of postoperative secretion. Of the 21 patients with positive results for any respiratory virus, 6 (28.6%) had more than 1 virus. Considering all 36 respiratory viruses found, the main agent isolated was rhinovirus (27.8%), followed by bocavirus (22.2%). Conclusion The virus found more frequently in all samples was rhinovirus. After removal of adenoid tissue, there was a decrease in the prevalence of the virus contained in nasopharyngeal secretion 30 days after surgery.

Effects of anti-CD3 monoclonal antibody in salivary glands of spontaneously diabetic mice.

BACKGROUND: Diabetes mellitus results in many complications, also compromising the salivary glands. The current treatment for this condition should be a substituting method to exogenous insulin. In this aspect, the immunotherapy has been tested, but, it can be inefficient as an agent for the control of damage caused by diabetes. Thus, the aim of this study was to evaluate the anti-CD3 monoclonal antibody as alternative immunotherapy in the recovery of salivary glands of spontaneously diabetic NOD (nonobese diabetic) mice. METHODS: NOD mice were divided into two groups of 10 animals: group I (untreated diabetic mice) and group II (anti-CD3-treated diabetic mice). After treatment, the samples of salivary glands were collected for histological examination under both transmitted and polarized light microscopy. RESULTS: Alterations in tissue architecture; increase in extracellular matrix and presence of inflammatory process were observed in untreated animals. Recovery of the salivary acinar cells occurred in treated animals. The parotid glands demonstrated a smaller amount of collagen fibers and were not observed severe inflammatory processes. CONCLUSION: These results indicate that immunotherapy contributed to reestablishment of tissue damaged by the hyperglycemic condition, demonstrating that the immunomodulation plays an important role in the recovery of salivary glands.

Ruído em consultórios odontológicos pode produzir perda auditiva? / Can noise in dental clinic produce hearing loss?

Introdução: A perda auditiva sensorial e irreversível induzida por ruído é a maior causa ocupacional evitável de perda auditiva no mundo. Os dentistas são profissionais da saúde expostos a ruídos provenientes dos equipamentos em seus consultórios e podem sofrer perdas auditivas. Objetivo: Medir intensidades de ruído emitidas pelos motores de alta rotação (mar) utilizados em consultórios odontológicos públicos e privados, verificar se são lesivas para a orelha humana e comparar os resultados obtidos entre estes serviços. Método: Estudo de série, prospectivo, com medidas das intensidades de ruído em dBNA com um decibelímetro Minipa MSL-1352C, USA em quatro consultórios odontológicos do serviço público e quatro particulares em Jundiaí-SP, inicialmente do ruído ambiental basal em cada consultório, durante cinco minutos e depois, do ruído emitido pelo motor de alta rotação(mar) em funcionamento durante cinco minutos para obter-se as médias. Resultados: Públicos: 1) basal=56,4dB; mar=77,2dB. 2) basal=61,7dB; mar=73,7dB. 3) basal=61,07dB; mar=75,04dB. 4) basal=63,6dB; mar=77,3dB. Particulares: 1) basal=60,7dB; mar=79,1dB. 2) basal=60,7dB; mar=83,1dB. 3)basal=58,4dB; mar=75,5dB. 4)basal=63dB; mar=76dB. Conclusões: As intensidades aferidas de ruído emitido por motores de alta rotação utilizados em consultórios odontológicos públicos e privados encontram-se abaixo dos limites nocivos à saúde auditiva. No serviço público, a intensidade de ruído basal é superior à dos consultórios particulares, contudo a dos motores de alta rotação é maior nos consultórios particulares.

Introduction: The sensorial hearing loss and irreversible noise induced is the major evitable occupational cause of hearing loss worldwide. The dentists are health professionals exposed to noises from equipment in their clinics and may suffer hearing losses. Objective: Measure the noise intensities emitted by the high rotation motors (mar) used in public and private dental clinics, check whether they are harmful for the human ear and compare the results obtained in such services. Method: Serial, retrospective study with measures of the noise intensities in dBNA with a decibelimeter Minipa MSL-1352C, USA, in four dental clinics of the public service and four private clinics in Jundiaí-SP, initially from the basal environment noise in each clinic, during five minutes and then from the noise emitted by the high rotation motor (mar) in operation during five minutes to obtain the averages. Results: Public clinics: 1)basal medium=56.4dB;mar=77.2dB. 2)basal medium=61.7dB;mar=73.7dB. 3)basal medium=61.07dB;mar=75.04dB. 4)basal medium=63.6dB;mar=77.3dB. Private clinics: 1)basal medium=60,7dB;mar=79,1dB. 2)basal=60,7dB;mar=83,1dB. 3)basal=58,4dB;mar=75,5dB. 4)basal=63dB;mar=76dB. Conclusion: The intensities measured of noise emitted by high rotation motors used in public and private dental clinics are below the limits harmful to the auditory health. In the public service, the basal medium noise intensity is higher than that of the private clinics, however the one of the high rotation motors is higher in the private clinics.

Avaliação do ruído em Unidades de Terapia Intensiva / Noise Assessment in Intensive Care Units

As Unidades de Terapia Intensiva são ambientes em que existem inúmeras fontes geradoras de ruído. Recomenda-se, em diferentes ambientes hospitalares, níveis de pressão sonora entre 35 e 45db(A). OBJETIVO: Realizar mensuração dos níveis de pressão sonora de três Unidades de Terapia Intensiva de um hospital em Jundiaí, Estado de São Paulo, Brasil. FORMA DE ESTUDO: Observacional. MATERIAL E MÉTODOS: Foi utilizado decibelímetro Minipa modelo MSL1532C (USA) de acordo com as normas da Associação Brasileira de Normas Técnicas (NBR 10151), para medir os níveis sonoros nas Unidades de Terapia Intensiva em períodos variados, isto é, manhã, tarde e noite em horários de pico de atividade. RESULTADOS: Os valores encontrados durante as aferições dos níveis de pressão sonora foram de 64.1dB(A) na Primeira Unidade de Terapia Intensiva, 58.9 dB(A) na Unidade Coronariana e 64dB(A) na Segunda Unidade de Terapia Intensiva. CONCLUSÃO: Níveis elevados de pressão sonora em Unidades de Terapia Intensiva ainda significam um problema importante na morbidade dos pacientes de tais unidades de atendimento à saúde. Nenhuma das três UTI apresentaram níveis maiores que 85dB, demonstrando que não há risco ocupacional para as equipes de saúde nos ambientes pesquisados.

Intensive Care Units are environments with numerous noise sources. In different hospital environments it is recommended to have a sound pressure level between 35 and 45db(A). AIM: To measure the sound pressure levels in three ICU at a hospital in Jundiaí, State of São Paulo, Brazil. STUDY DESIGN: Observational. MATERIALS AND METHODS: we used a Minipa model MSL1532C (USA) sound meter, according to the Brazilian Technical Standards (NBR 10151), in order to measure sound levels in the ICUs at different moments, that is, the morning, afternoon and night at peak times of activity. RESULTS: The values found during the checking of the sound pressure levels were 64.1dB (A) in the First ICU, 58.9 dB (A) in the Coronary Unit and 64dB (A) in the second ICU. CONCLUSION: High sound pressure levels in ICU still mean an important health-related problem for patients in these units. None of the three ICU pad levels above 85dB, showing that there is no occupational risk for the health care teams in the environments studied.

Noise assessment in intensive care units.

UNLABELLED: Intensive Care Units are environments with numerous noise sources. In different hospital environments it is recommended to have a sound pressure level between 35 and 45db(A). AIM: To measure the sound pressure levels in three ICU at a hospital in Jundiaí, State of São Paulo, Brazil. STUDY DESIGN: Observational. MATERIALS AND METHODS: we used a Minipa model MSL1532C (USA) sound meter, according to the Brazilian Technical Standards (NBR 10151), in order to measure sound levels in the ICUs at different moments, that is, the morning, afternoon and night at peak times of activity. RESULTS: The values found during the checking of the sound pressure levels were 64.1dB (A) in the First ICU, 58.9 dB (A) in the Coronary Unit and 64dB (A) in the second ICU. CONCLUSION: High sound pressure levels in ICU still mean an important health-related problem for patients in these units. None of the three ICU pad levels above 85dB, showing that there is no occupational risk for the health care teams in the environments studied.

Evoked response audiometry according to gender and age: findings and usefulness.

UNLABELLED: Auditory evoked brainstem responses (ABR) is a non-invasive electrical potential registration which evaluates the auditory tract from the middle ear to the auditory cortex in the first 12 milliseconds (ms). The ABR is an important otoneurological evaluation. AIM: Confirm the test's usefulness, major incidence and topography according to are range gender considering the absolute latencies of the waves and interpeak intervals. MATERIALS AND METHOD: We retrospectively analyzed 403 tests from a private clinic in the city of Jundiaí-São Paulo State-Brazil, from patients suspected of auditory damage or central nervous disorder, and the patients were broken down according to gender and age. RESULTS AND CONCLUSIONS: ABR is an important test to determinate the soundness of the auditory tract, the electrophysiological thresholds and topodiagnosis. We found no differences between type of loss and gender; there was a major incidence of retrocochlear findings among male patients between 12-20 years old; children under one year with risk factors did not present higher incidences of auditory findings when compared with all the population analyzed. The absolute latencies of waves I, III and V were higher in males, but the interpeak intervals were similar in both genders, showing that interval I-III was more frequently altered.

Audiometria de resposta evocada de acordo com sexo e idade: achados e aplicabilidade / Evoked response audiometry according to gender and age: findings and usefulness

A audiometria de respostas evocadas (ABR) é um registro não-invasivo de potenciais elétricos auditivos nos primeiros 12 milissegundos, da orelha média ao córtex auditivo. ABR é importante na avaliação otoneurológica. OBJETIVO: Esclarecer as utilidades do exame, faixas etárias e sexo com maior incidência e topodiagnóstico segundo as latências absolutas e os intervalos interpicos. CASUÍSTICA E MÉTODO: Neste estudo retrospectivo foram analisados 403 prontuários de ABR realizados em clínica particular na cidade de Jundiaí/SP, Brasil, suspeitos de alteração auditiva e/ou doença do SNC, com os pacientes divididos por sexo e faixa etária. RESULTADOS E CONCLUSÕES: ABR é um importante exame para determinar a integridade da via auditiva, limiares eletrofisiológicos e topodiagnóstico, embora o teste não indique a etiologia das alterações. Foi demonstrado que ocorreu maior incidência de achados retrococleares na faixa etária de 12-20 anos e sexo masculino, contudo crianças menores de um ano com fatores de risco não apresentaram um aumento na incidência de alterações condutivas, cocleares e retrococleares em relação à população geral estudada. As latências absolutas das ondas I, III e V foram maiores no sexo masculino e as alterações dos intervalos interpicos foram similares em ambos os sexos, sendo que o intervalo I-III foi o mais freqüentemente alterado.

Auditory evoked brainstem responses (ABR) is a non-invasive electrical potential registration which evaluates the auditory tract from the middle ear to the auditory cortex in the first 12 milliseconds (ms). The ABR is an important otoneurological evaluation. AIM: confirm the test's usefulness, major incidence and topography according to are range gender considering the absolute latencies of the waves and interpeak intervals. MATERIALS AND METHOD: we retrospectively analyzed 403 tests from a private clinic in the city of Jundiaí-São Paulo State-Brazil, from patients suspected of auditory damage or central nervous disorder, and the patients were broken down according to gender and age. RESULTS AND CONCLUSIONS: ABR is an important test to determinate the soundness of the auditory tract, the electrophysiological thresholds and topodiagnosis. We found no differences between type of loss and gender; there was a major incidence of retrocochlear findings among male patients between 12-20 years old; children under one year with risk factors did not present higher incidences of auditory findings when compared with all the population analyzed. The absolute latencies of waves I, III and V were higher in males, but the interpeak intervals were similar in both genders, showing that interval I-III was more frequently altered.

Distribuição dos achados otoneurológicos em pacientes com disfunção vestíbulo-coclear

O equilíbrio corporal é fundamental no relacionamento espacial do organismo com o ambiente. Três sistemas são responsáveis pela manutenção do equilíbrio: a visão, o sistema proprioceptivo e o aparelho labiríntico ou vestibular. FORMA DE ESTUDO: retrospectivo clínico. Foi realizado um estudo retrospectivo de 3701 pacientes submetidos a exame clínico e exame cócleo-vestibular com registro vecto-eletronistagmográfico, em clínica particular de Otorrinolaringologia de Jundiaí, Estado de São Paulo, no período de 1979 a 2004. OBJETIVO: com a finalidade de se determinar a distribuição sindrômica dessa população e correlacioná-la com outros dados como sexo, faixa etária, sintomatologia, achados de exame clínico, audiológico, bem como quais são as especialidades médicas que solicitam essa avaliação com maior freqüência. RESULTADO: Na população estudada, foi encontrada uma maior prevalência do sexo feminino, numa proporção de 1,75:1. A faixa etária de indivíduos de 20 a 59 anos respondeu por 79 por cento dos pacientes estudados, incluindo portanto pessoas em idade laborativa, que apresentaram maior prevalência de síndromes periféricas, contudo não houve predominância de sexo feminino ou idade entre as diferentes síndromes. O estudo também demonstrou a presença de sintomas otoneurológicos comuns aos diferentes tipos de síndromes otoneurológicas, por exemplo, sem o predomínio clássico apontado na literatura das tonturas rotatórias predominarem nos casos de acometimento periférico e as não-rotatórias nos centrais. Alterações da acuidade auditiva, presença de zumbidos e sintomas neurovegetativos ocorreram com maior prevalência nos casos periféricos. Os desvios harmônicos às provas segmentares foram mais prevalentes nos pacientes portadores de síndromes periféricas e os desarmônicos, nas centrais, em consonância com a literatura pesquisada. CONCLUSÃO: As conclusões desta análise retrospectiva apontam para as especialidades de Otorrinolaringologia e Neurologia como as que mais freqüentemente solicitam este tipo de avaliação e o diagnóstico de síndrome periférica foi encontrado em 36 por cento dos pacientes, contudo » da população estudada não apresentou qualquer alteração na avaliação clínica e armada.

Estudo comparativo radiológico e nasofibroscópico do volume adenoideano em criancas respiradoras orais / Comparison between radiological and nasopharyngolaryngoscopic assessment of adenoid tissue volume in mouth breathing children

A tonsila faríngea ou adenóides é a extensão superior do anel linfático de Waldeyer e está localizada na porcão alta da cavidade nasofaríngea, próxima à tuba auditiva e à coana. Ela desempenha um papel relevante nas otites médias recorrentes e freqüentemente sua hipertrofia é responsável pela obstrucão das vias aéreas superiores. A tonsilectomia é um tratamento comumente realizado para doencas crônicas das tonsilas e ainda é o procedimento cirúrgico mais freqüente e mais antigo realizado em criancas e adultos jovens. Os critérios para a realizacão da tonsilectomia, o efeito da mesma na integridade imunológica do paciente e seus riscos inerentes à cirurgia são muito discutíveis e controversos em todo o mundo. Estudos de imagem utilizando-se o raio-X do cavo é um método simples, fácil e confortável para avaliar o tamanho das adenóides e o grau de obstrucão das vias aéreas superiores. Um estudo nasofibroscópico da nasofaringe pode fornecer uma informacão melhor sobre essa região, tendo em vista que ele mostra todas as estruturas presentes na nasofaringe e o grau de obstrucão das vias aéreas superiores de forma dinâmica. FORMA DE ESTUDO: Clínico não randomizado. MATERIAL E MÉTODO: Este estudo comparou o grau de hipertrofia e de obstrucão das vias aéreas superiores, usando os dois métodos acima, em criancas de 3 a 10 anos de idade, constatando que a nasofibroscopia flexível é um método diagnóstico excepcionalmente mais fidedigno do que o raio-x do cavo, na avaliacão volumétrica da adenóide.

Comparison between radiological and nasopharyngolaryngoscopic assessment of adenoid tissue volume in mouth breathing children.

The pharyngeal tonsil (adenoid) constitutes the upper portion of the Waldeyer's ring and is located at the top of the nasopharynx, next to the auditory tube and choana. It plays an important role in recurrent otitis of the middle ear and many times its enlargement is responsible for upper airway obstruction. Tonsillectomy is often the treatment of choice for tonsillar diseases. So far, it is the most frequent and one of the oldest surgical procedures performed in children and young adults. The criteria for tonsillectomy, its effect on patient's immunological integrity and the surgical risks are widely controversial. Image study using paranasal sinuses x-ray is a very simple, easy and comfortable method to evaluate the sizes of adenoids and the grade of upper airway obstruction. Cohen et al. supported that paranasal sinuses x-ray is the best way to determine pharyngeal tonsil hypertrophy. On the other hand, nasopharyngolaryngoscopy can provide more accurate data on the nasopharynx, as it can dynamically reveal its structures and the obstruction status of the upper airway. This study compared the grade of adenoid hypertrophy, as well as upper airway obstruction, using the above-mentioned approaches in children ranging from 3 to 10 years old. The study came to the conclusion that nasopharyngolaryngoscopy is a much more accurate diagnostic procedure than radiological evaluation of the nasopharynx.