Therapeutic Management with Airway Clearance in Children with Robin Sequence and Association with Swallowing Outcomes: A Systematic Review and Meta-analysis.

Dysphagia in Robin Sequence can be present in varying degrees, requiring multidisciplinary management and specific swallowing assessment by a specialist. Most studies published to date have evaluated only respiratory outcomes, and the available evidence on the improvement of swallowing is questionable. To conduct a systematic review and meta-analysis of studies evaluating swallowing in children with Robin Sequence before and after airway clearance procedures. The research question was developed based on the PICO strategy. The literature search was performed in electronic databases and gray literature. Studies were selected by 3 independent reviewers. The risk of bias and level of evidence of the studies were assessed. A proportion meta-analysis was performed to calculate the prevalence of dysphagia after airway clearance procedures. The search identified 4938 studies, 5 of which were included. All studies had limitations in terms of design and sample size. The prevalence of dysphagia after airway clearance was obtained by analyzing treatment subgroups: mandibular distraction osteogenesis, mandibular distraction osteogenesis + tracheostomy tube, and nasopharyngeal tube. Clinical and/or instrumental assessment was assessed by a swallowing specialist. The meta-analysis was precluded by the limitations of the studies, especially regarding sample size, which affected the accuracy of the findings. Dysphagia remained unresolved in 55% of children (95% CI 1-99%). The methodological quality of the studies indicated a high risk of bias and very low level of evidence. It was not possible to confirm that airway clearance techniques used in Robin Sequence improve dysphagia.

Correlation of the findings of auditory steady-state evoked potential and of behavioral hearing assessment in infants with sensorineural hearing loss.

PURPOSE: To correlate the findings of an open-field audiometry with the thresholds of steady-state auditory-evoked potentials (SSAEPs) found in infants of up to 6 months of age with sensorineural hearing loss. METHODS: This study included 19 infants with sensorineural hearing loss (8 males and 11 females), with minimum age of 2 months and maximum age of 6 months. The SSAEPs were assessed at 500 and 2000 Hz, and the audiometry was performed in open field through observation of behavioral responses to sound stimuli, at the same frequencies. RESULTS: We observed a significant correlation between the findings of both tests conducted at 500 and 2000 Hz, with p-values of 0.002 and 0.013, respectively. There was no statistical difference between ears (p=0.532) and genders (p=0.615). CONCLUSION: We conclude that there was a significant correlation between the SSAEP thresholds and the findings of the open-field audiometry. Therefore, we can affirm that the SSAEPs are a viable examination, able to predict the degree and configuration of hearing loss in infants of up to 6 months of age, and that they can be included in the clinical routine of hearing assessments conducted in children.

Correlation of the findings of auditory steady-state evoked potential and of behavioral hearing assessment in infants with sensorineural hearing loss / Correlação dos achados do potencial evocado auditivo de estado estável e da avaliação auditiva comportamental em lactentes com perda auditiva sensorioneural

PURPOSE: To correlate the findings of an open-field audiometry with the thresholds of steady-state auditory-evoked potentials (SSAEPs) found in infants of up to 6 months of age with sensorineural hearing loss. METHODS: This study included 19 infants with sensorineural hearing loss (8 males and 11 females), with minimum age of 2 months and maximum age of 6 months. The SSAEPs were assessed at 500 and 2000 Hz, and the audiometry was performed in open field through observation of behavioral responses to sound stimuli, at the same frequencies. RESULTS: We observed a significant correlation between the findings of both tests conducted at 500 and 2000 Hz, with p-values of 0.002 and 0.013, respectively. There was no statistical difference between ears (p=0.532) and genders (p=0.615). CONCLUSION: We conclude that there was a significant correlation between the SSAEP thresholds and the findings of the open-field audiometry. Therefore, we can affirm that the SSAEPs are a viable examination, able to predict the degree and configuration of hearing loss in infants of up to 6 months of age, and that they can be included in the clinical routine of hearing assessments conducted in children. .

OBJETIVO: Correlacionar os achados da audiometria infantil em campo livre com os limiares do Potencial Evocado Auditivo de Estado Estável (PEAEE) encontrados em lactentes de até 6 meses de idade com perda auditiva sensorioneural. MÉTODOS: Foram incluídos no estudo 19 lactentes, oito do gênero masculino e 11 do feminino, com idade mínima de 2 e máxima de 6 meses, que apresentaram perda auditiva sensorioneural. Foi realizada a pesquisa do PEAEE nas frequências de 500 e 2.000 Hz e realizada a audiometria em campo livre por meio da observação das respostas comportamentais frente a estímulos sonoros, nas mesmas frequências. RESULTADOS: Observamos correlação significativa entre os achados das duas testagens nas frequências de 500 e 2.000 Hz, sendo os valores de p=0,002 e p=0,013, respectivamente. Não houve diferença estatística entre orelhas (p=0,532) e gêneros (p=0,615). CONCLUSÃO: Concluímos que há correlação significativa entre os limiares do PEAEE e os achados obtidos na audiometria infantil em campo livre. Sendo assim, podemos afirmar que o PEAEE é um exame viável, capaz de predizer o grau e a configuração da perda auditiva em lactentes menores de 6 meses, podendo ser incluído na rotina clínica da avaliação audiológica infantil. .

Estudo das medidas de imitância acústica com tom sonda de 226 e 1000 Hz em neonatos / Study of acoustic immittance measures with probe tone of 226 and 1000 Hz in neonates

OBJETIVO: Estudar as medidas de volume, pressão do pico e complacência obtidas nas curvas timpanométricas de neonatos, na comparação entre gêneros e orelhas, utilizando tom sonda de 226 e 1000 Hz, e analisar as respostas obtidas na pesquisa dos reflexos acústicos com os dois tons de sonda testados. MÉTODOS: Foram avaliados 73 neonatos, com integridade de células ciliadas externas verificadas pelas emissões otoacústicas evocadas transientes. Foi realizada a avaliação das medidas de imitância acústica nas crianças, tendo como desfecho clínico a observação das respostas obtidas nas timpanometrias e na pesquisa dos reflexos acústicos com tom sonda de 226 e 1000 Hz. RESULTADOS: Observamos diferença entre as curvas de pico único e pico duplo, com maior ocorrência de pico único com tom sonda de 1000 Hz. Verificamos diferença entre os gêneros, na medida complacência em 226 Hz e entre as orelhas, nas medidas complacência e pressão do pico em 226 e 1000 Hz, respectivamente. Encontramos, também, diferença nas médias dos reflexos acústicos ipsilaterais e contralaterais com tom sonda de 1000 Hz, em relação a variável gênero, e entre os reflexos ipsilaterais e contralaterais nas frequências de 1000 e 2000 Hz com tom sonda de 226 e 1000 Hz. CONCLUSÃO: Houve diferença entre as variáveis analisadas com tom sonda de 226 e 1000 Hz. Os valores de compliância e de reflexos foram mais elevados no gênero feminino. Todos os neonatos apresentaram reflexos acústicos, sendo os contralaterais mais elevados que os ipsilaterais.

PURPOSE: Study the measures of volume, peak pressure and complacency in tympanometric curves of neonates with gender, ears and tone probe of 226 and 1000 Hz and analyze the responses obtained in the survey of the acoustic reflections with the two tone probe tested. METHODS: transversal study, observational and contemporary. We evaluated 73 neonatal with integrity of outer hair cells observed by transient evoked otoacoustic emissions. The children performed the evaluation of measures of acoustic immittance clinical outcome, observation of the answers obtained in tympanometries and research of acoustic reflexes with tone probe 226 and 1000 Hz. RESULTS: We observed statistically significant difference between the curves of single and double peak, with a higher occurrence of single peak with tone probe of 1000 Hz. There was statistically significant difference between the genders as complacency in 226 Hz and between the ears in compliance measures and peak pressure in 226 and 1000 Hz, respectively. In addition, we found statistically significant difference in the average of the ipsilateral and contralateral acoustic reflexes with tone probe of 1000 Hz against the variable gender and ipsilateral and contralateral reflexes between the frequencies of 1000 and 2000 Hz with tone probe of 226 and 1000 Hz. CONCLUSION: The results obtained in this study showed statistically significant difference between analyzed variables with tone probe of 226 and 1000 Hz tone. The compliance values and reflexes were higher in females. All neonates had acoustic reflexes, and reflexes contralateral higher than the ipsilateral.