Are hearing protection devices used in the workplace really efficient? A systematic review.

BACKGROUND: The most common current hearing protection devices (HPDs) on the market include earplugs and earmuffs. A variety of materials can be used to manufacture these devices, and each offers a level of noise attenuation that is informed by the manufacturer although it does not always correspond to the attenuation observed in real-world use. OBJECTIVE: To evaluate the noise attenuation of HPDs available to workers exposed to noise. METHODS: The most relevant studies originally published in English, Portuguese, or Spanish that investigated the noise attenuation effectiveness of HPDs used by workers exposed to noise were analyzed. The following electronic databases were searched by 2 independent reviewers for studies published from 1999 to 2019: MEDLINE (PubMed), Scopus, Web of Science, EMBASE, Cochrane Library (OVID), ProQuest, and BVS-Bireme. Different combinations of the following search terms (MeSH terms) were used for all databases: "Hearing Loss, Noise-Induced", "Ear Protective Devices" (Efficacy OR Effectiveness)", "Noise, Occupational". RESULTS: The search strategy yielded a total of 326 potentially relevant studies. After the removal of duplicates, 156 remained for the screening of titles and abstracts. After reviewing titles and abstracts, 46 studies were selected for full-text reading. Of these, six were included in this systematic review. CONCLUSION: Hearing protection devices reduced the noise exposure and were effective in all included studies in different countries, types of activity, and sound pressure exposure.

Is it necessary to perform occupational audiometric testing at 6-months of employment? / É necessário fazer teste audiométrico ocupacional 6 meses após a admissão?

Abstract Introduction: Current Brazilian legislation requires that all workers exposed to noise are to be given an audiogram upon hiring, after 6 months of employment (first periodic test), and annually after the first periodic test. In other countries, the regulations of hearing conservation programs do not include the requirement for audiometric testing at 6 months of employment, but only annually. There is no evidence that the periodicity adopted by Brazilian legislation is the most appropriate. Objective: The present study aimed to evaluate the first 3 occupational audiometric tests of workers exposed to noise. Methods: Historical cohort study with cross-sectional analysis. Participants were all male metallurgy workers aged up to 40 years. The first 3 audiograms of each worker were analyzed: pre-employment audiometric test, periodic audiometric test 1, and periodic audiometric test 2. For each worker, mean frequency thresholds were calculated at 3, 4, and 6 kHz in the left and right ears for each test. Statistical analysis was performed using the nonparametric Wilcoxon test. Results: A total of 988 workers were included. There was a significant difference in auditory thresholds between the pre-employment test and the 2 subsequent periodic tests for the right and left ears. There was no significant difference between Test1 and Test2 in either ear. Conclusion: Given the lack of difference between the first 2 periodic tests, we believe that they could be merged into a single test, i.e., first periodic audiometric testing could be performed at 12 months of employment without compromising workers' health.

Resumo Introdução: A legislação brasileira atual exige que todos os trabalhadores expostos a ruído recebam um audiograma na admissão, 6 meses após a admissão (primeiro teste periódico), e anualmente após o primeiro teste periódico, mas em outros países as regulamentações dos programas de conservação auditiva não incluem a exigência de teste audiométrico após 6 meses de admissão, mas apenas anualmente. Não há evidências de que a periodicidade adotada pela legislação brasileira seja a mais adequada. Objetivo: Avaliar os três primeiros exames audiométricos ocupacionais de trabalhadores expostos ao ruído. Método: Estudo de coorte histórica com análise transversal. Os participantes eram todos trabalhadores metalúrgicos do sexo masculino com até 40 anos. Os três primeiros audiogramas de cada trabalhador foram analisados: teste audiométrico pré-admissão, teste audiométrico periódico 1 e teste audiométrico periódico 2. Para cada trabalhador, os limiares de frequência médios foram calculados em 3, 4 e 6 kHz nas orelhas esquerda e direita para cada teste. A análise estatística foi feita através do teste não paramétrico de Wilcoxon. Resultados: Foram incluídos 988 trabalhadores. Houve uma diferença significante nos limiares auditivos entre o teste pré-admissão e os 2 testes periódicos subsequentes para as orelhas direita e esquerda. Não houve diferença significante entre o teste 1 e o teste 2 em nenhuma das orelhas. Conclusão: Dada a falta de diferença entre os 2 primeiros testes periódicos, acreditamos que eles poderiam ser combinados em um único teste, ou seja, o primeiro teste audiométrico periódico poderia ser feito após 12 meses de admissão sem comprometer a saúde dos trabalhadores.

Five-Year Longitudinal Cohort Study Determines the Critical Intervals for Periodic Audiometric Testing Based on 5070 Tests of Metallurgical Workers Exposed and Nonexposed to Noise.

OBJECTIVES: To compare the progression of 3-, 4-, and 6-kHz thresholds (pure-tone average) over 5 years and determine the most critical period for occupational risk among workers exposed and nonexposed to noise. DESIGN: Metallurgical workers were divided into 2 groups: noise-exposed and non-noise-exposed groups. The 6 initial audiometric tests of each worker were analyzed as baseline test and annual tests 1 to 5. RESULTS: A total of 845 workers were included, 748 in the noise-exposed group and 97 in the non-noise-exposed group, resulting in 5070 tests analyzed. The nonexposed group showed no significant difference in the mean pure-tone averages between any of the annual tests in either ear. In the exposed group, a significant difference was observed in mean pure-tone averages between baseline and Test1 (p = 0.001 right ear; p = 0.001 left ear), between Test3 and Test4 (p = 0.002 right ear; p = 0.005 left ear), and between Test4 and Test5 (p = 0.003 right ear; p = 0.001 left ear). There was no difference between Test1 and Test2 or between Test2 and Test3 in either ear. CONCLUSIONS: The progression of pure-tone averages at 3, 4, and 6 kHz differed between workers exposed and nonexposed to noise. Noise-exposed workers had a significant progressive worsening of audiometric thresholds after 3 years of employment. This study identified, in an unprecedented way, two critical periods of noise exposure: in the first year and after the third year of employment in a noisy environment.

Is it necessary to perform occupational audiometric testing at 6-months of employment?

INTRODUCTION: Current Brazilian legislation requires that all workers exposed to noise are to be given an audiogram upon hiring, after 6 months of employment (first periodic test), and annually after the first periodic test. In other countries, the regulations of hearing conservation programs do not include the requirement for audiometric testing at 6 months of employment, but only annually. There is no evidence that the periodicity adopted by Brazilian legislation is the most appropriate. OBJECTIVE: The present study aimed to evaluate the first 3 occupational audiometric tests of workers exposed to noise. METHODS: Historical cohort study with cross-sectional analysis. Participants were all male metallurgy workers aged up to 40 years. The first 3 audiograms of each worker were analyzed: pre-employment audiometric test, periodic audiometric test 1, and periodic audiometric test 2. For each worker, mean frequency thresholds were calculated at 3, 4, and 6 kHz in the left and right ears for each test. Statistical analysis was performed using the nonparametric Wilcoxon test. RESULTS: A total of 988 workers were included. There was a significant difference in auditory thresholds between the pre-employment test and the 2 subsequent periodic tests for the right and left ears. There was no significant difference between Test1 and Test2 in either ear. CONCLUSION: Given the lack of difference between the first 2 periodic tests, we believe that they could be merged into a single test, i.e., first periodic audiometric testing could be performed at 12 months of employment without compromising workers' health.

Progressive Asymmetry in Occupational Noise-Induced Hearing Loss: A Large Population-Based Cohort Study With a 15-Year Follow-Up.

BACKGROUND: To evaluate interaural differences between the right and left ears at frequencies from 0.25 to 8 kHz in 3 groups of workers from metallurgy companies. METHODS: This study is a cross-sectional cohort study. Workers were divided into 3 groups: (1) workers without occupational noise exposure and normal audiometric testing; (2) workers with 10 years of occupational noise exposure; and (3) workers with 15 years of occupational noise exposure. The interaural difference from 0.25 to 8 kHz was measured in each group. RESULTS: A total of 2103 workers were included. Of these, 483 workers had been exposed to noise in the workplace for 10 years and 216 workers for 15 years. Group 1, only at 4 and 6 kHz, the difference was statistically significant. Group 2, only at 3 , 4 , and 6 kHz, the difference was statistically significant. Group 3, the difference was statistically significant at the frequencies from 2 to 8 kHz. CONCLUSION: Asymmetry between the right and left ears was observed in all groups, with higher air-conduction thresholds in the left ear. It is important for otolaryngologists be aware that NIHL can also cause or accentuate asymmetry between the right and left ears over time.

Effect of Noise Exposure on 1,382 Metallurgical Workers in Periodic Audiometric Evaluation: A Cohort Study.

INTRODUCTION: Noise-induced hearing loss is the most preventable cause of auditory impairment. Periodic audiometric evaluations are essential to monitor the hearing health of noise-exposed workers. OBJECTIVE: To compare the evolution of audiometric thresholds in the initial three evaluations at frequencies of 3, 4, and 6 kHz in groups of workers exposed or not to noise. METHODS: In this historical cohort study, audiometric evaluations were obtained from male workers between 18 and 40 years of age at six different metallurgical companies in Brazil. The workers were separated into noise-exposed and non-noise-exposed groups. The mean thresholds for 3, 4, and 6 kHz were calculated for both ears at baseline and the first and second periodic evaluations. The non-parametric Wilcoxon test was used for statistical analysis. RESULTS: A total of 1,382 metallurgical workers were evaluated (1,199 noise-exposed and 183 non-noise-exposed). There was a significant difference between baseline and the first periodic evaluation (right ear - effect size = 0.62; p = 0.0030 and left ear - effect size = 0.74; p = 0.0063) and between baseline and the second periodic evaluation (right ear - effect size = 0.85; p = 0.004 and left ear - effect size = 0.96; p = 0.0002). In the non-noise-exposed group, there was no difference between baseline and the first periodic evaluation (right ear - effect size = 0.18; p = 0.2703 and left ear - effect size = 0.12; p = 0.7907) and between baseline and the second periodic evaluation (right ear - effect size = 0.29; p = 0.4475 and left ear - effect size = 0.41; p = 0.6381). CONCLUSION: In noise-exposed workers, there was a significant worsening of audiometric thresholds between baseline and the initial periodic evaluation, but there was no difference between the two post-baseline evaluations. This shows that noise exposure can quickly affect hearing, despite protective measures.

Cochlear implants: Insertion assessment by computed tomography.

BACKGROUND AND OBJECTIVES: Imaging exams play a key role in cochlear implants with regard to both planning implantation before surgery and quality control after surgery. The ability to visualize the three-dimensional location of implanted electrodes is useful in clinical routines for assessing patient outcome. The aim of this study was to evaluate linear and angular insertion depth measurements of cochlear implants based on conventional computed tomography. METHODS: Tools for linear and angular measurements of cochlear implants were used in computed tomography exams. The tools realized the insertion measurements in an image reconstruction of the CIs, based on image processing techniques. We comprehensively characterized two cochlear implant models while obviating possible changes that can be caused by different cochlea sizes by using the same human temporal bones to evaluate the implant models. RESULTS: The tools used herein were able to differentiate the insertion measurements between two cochlear implant models widely used in clinical practice. We observed significant differences between both insertion measurements because of their different design and construction characteristics (p = 0.004 and 0.003 for linear and angular measurements, respectively; t-test). The presented methodology showed to be a good tool to calculate insertion depth measurements, since it is easy to perform, produces high-resolution images, and is able to depict all the landmarks, thus enabling measurement of the angular and linear insertion depth of the most apical electrode contacts. CONCLUSION: The present study demonstrates practical and useful tools for evaluating cochlear implant electrodes in clinical practice. Further studies should measure preoperative and postoperative benefits in terms of speech recognition and evaluate the preservation of residual hearing in the implanted ear. Such studies can also determine correlations between surgical factors, electrode positions, and performance. In addition to refined surgical techniques, the precise evaluation of cochlear length and correct choice of cochlear implant characteristics can play an important role in postoperative outcomes.

Tonsillar Lymphoma in Children According to Age Group: A Systematic Review.

INTRODUCTION: Lymphoma is a common malignant tumor of the head and neck occurring during childhood. Early diagnosis is very important in terms of prognosis in patients with tonsillar lymphoma.Our objective was to evaluate the clinical manifestations of pediatric tonsillar lymphoma according to different age groups. MATERIALS AND METHODS: A systematic review of available English, Spanish, or Portuguese literature from January 1996 to June 2012 was performedin the BIREME, Cochrane, IBECS, Lilacs, PubMed/Medline, SCIELO, and Scopus databases, using "tonsillar lymphoma" and "children" as keywords. Inclusion criteria were pediatric case reports, patients aged up to 18 years, and information on clinical features at the time of diagnosis. RESULTS: Out of 87 identified publications, 13 articles were selected describing 53 patients. Tonsillar asymmetry was the most common sign. Snoring is a common sign in patients aged under 5 years; clinical lymphadenopathy is frequent among patients aged between 6 and 10 years; and dysphagia is a common sign in patients between 11 and 18 years of age. Burkitt's lymphoma is the most common form among all ages studied, followed by B-cell lymphoma. CONCLUSION: Clinical manifestations differ according to age group. However, tonsillar asymmetry is the most frequent sign regardless of age group.

Histologic correlation of VEGF and COX-2 expression with tumor size in squamous cell carcinoma of the larynx and hypopharynx.

The prognosis and survival of patients with laryngeal and hypopharyngeal squamous cell carcinoma (SCC) are related to the clinical staging. Tumor growth and metastasis are closely related to angiogenesis. Vascular endothelial growth factor (VEGF) and cyclooxygenase 2 (COX-2) are intimately related to the angiogenic process in which the blood supply required for neoplastic evolution is ensured. Considering the contributions of VEGF and COX-2 to the formation, growth, and progression of primary tumors, as well as their metastasis, it has been thought that the expression of these two factors might be related to the size and/or aggressiveness of laryngeal and hypopharyngeal cancer. To test that theory, we conducted a retrospective study to evaluate the expression of VEGF and COX-2 markers in archived specimens of SCC of the larynx and hypopharynx to correlate their expression with tumor size. These specimens had been obtained from 35 patients-31 men and 4 women, aged 37 to 75 years (mean: 57)-who had been treated for laryngeal or hypopharyngeal SCC at our tertiary care university hospital over a period of 15 years. Immunohistochemical analyses were performed with avidin-biotin-peroxidase staining for VEGF and COX-2 antibodies. The degree of VEGF and COX-2 expression was based on the German scale of immunoreactivity. Specimens were separated into groups based on the intensity of expression (none/low and moderate/strong) and tumor size (TNM categories T1/T2 and T3/T4). A total of 7 patients exhibited moderate or strong VEGF expression (3 from the T1/T2 group and 4 from the T3/T4 group), and 17 patients demonstrated moderate or strong COX-2 expression (8 from the T1/T2 group and 9 from the T3/T4 group). We found no statistically significant relationship between tumor size and either VEGF or COX-2 expression. Our study demonstrated that despite the intrinsic connection between and VEGF and COX-2, neither appears to be related to the size of the SCCs of the larynx or hypopharynx. Other factors must be involved in the pathogenesis and progression of this disease, and further studies are needed to identify them.

[Auditory Neuropathy: Clinical Evaluation and Diagnostic Approach]. / Neuropatia Auditiva: Avaliação Clínica e Abordagem Diagnóstica.

INTRODUCTION: Auditory neuropathy is a condition in which there is a change in the neuronal transmission of the auditory stimuli. Our objective was to describe the patients' series within the clinical spectrum of auditory neuropathy. MATERIAL AND METHODS: We designed a transversal, retrospective study, with a description of a consecutive case series. Auditory neuropathy was defined by the presence of acoustic otoemissions plus absent/abnormal auditory brainstem responses with cochlear microphonism. RESULTS: 34 patients with bilateral hearing loss, 23 males and 11 females, were included in the study. Eighty percent of the cases had congenital onset of hearing loss. Acoustic otoemissions were absent in 67% of them. Cochlear microfonism was present in 79% of all cases. Prenatal, perinatal or ambiental factors were present in 35.2% of the cases. DISCUSSION: Medical literature shows great variability in findings related to auditory neuropathy, both in its etiology and epidemiological data. CONCLUSION: Auditory neuropathy presents a broad spectrum of changes that may result from mild to severe changes in the functioning of the auditory pathway, and in our sample we observed that 80% of Auditory neuropathy have congenital onset of hearing loss and/or with cochlear microphonism identified. 91% of patients experience significant hearing impairment and 53% suffer from severe or profound deafness.

Introdução: A neuropatia auditiva é uma condição na qual há alteração na condução neuronal do estímulo sonoro. Este trabalho pretende descrever e caracterizar a casuística de doentes com neuropatia auditiva. Material e Métodos: Realizámos um estudo transversal, retrospetivo, com descrição de uma série de casos consecutivos. O diagnóstico da neuropatia auditiva foi definido nas seguintes situações: Presença de otoemissões acústicas com potenciais auditivos de tronco encefálico ausente ou anormal e presença do microfonismo coclear independentemente da presença de otoemissões acústicas. Resultados: Foram avaliados 34 doentes com perda auditiva bilateral, 67% deles do sexo masculino. O aparecimento dos sintomas foi congênito em 80% dos casos. Na pesquisa das otoemissões acústicas, a resposta foi ausente em 67% dos doentes. O microfonismo coclear foi detetado em 79% dos doentes. Antecedentes gestacionais, perinatais ou ambientais relevantes estiveram presentes em 35,3% dos casos. Discussão: A literatura médica ainda apresenta grande variabilidade nos achados relacionados com a neuropatia auditiva, tanto na sua etiologia quanto nos dados epidemiológicos. Conclusão: A neuropatia auditiva apresenta um amplo espectro de alterações que podem resultar em disfunções leves a severas no funcionamento da via auditiva. Na nossa amostra, observámos que 80% das neuropatias auditivas terão tido origem congênita e/ou apresenta microfonismo coclear, 91% dos doentes apresenta défice auditivo significativo e 53% sofrem de surdez severa ou profunda.

Molecular study of patients with auditory neuropathy.

Auditory neuropathy is a type of hearing loss that constitutes a change in the conduct of the auditory stimulus by the involvement of inner hair cells or auditory nerve synapses. It is characterized by the absence or alteration of waves in the examination of brainstem auditory evoked potentials, with otoacoustic and/or cochlear microphonic issues. At present, four loci associated with non­syndromic auditory neuropathy have been mapped: Autosomal recessive deafness­9 [DFNB9; the otoferlin (OTOF) gene] and autosomal recessive deafness­59 [DFNB59; the pejvakin (PJVK) gene], associated with autosomal recessive inheritance; the autosomal dominant auditory neuropathy gene [AUNA1; the diaphanous­3 (DIAPH3) gene]; and AUNX1, linked to chromosome X. Furthermore, mutations of connexin 26 [the gap junction ß2 (GJB2) gene] have also been associated with the disease. OTOF gene mutations exert a significant role in auditory neuropathy. In excess of 80 pathogenic mutations have been identified in individuals with non­syndromic deafness in populations of different origins, with an emphasis on the p.Q829X mutation, which was found in ~3% of cases of deafness in the Spanish population. The identification of genetic alterations responsible for auditory neuropathy is one of the challenges contributing to understand the molecular bases of the different phenotypes of hearing loss. Thus, the present study aimed to investigate molecular changes in the OTOF gene in patients with auditory neuropathy, and to develop a DNA chip for the molecular diagnosis of auditory neuropathy using mass spectrometry for genotyping. Genetic alterations were investigated in 47 patients with hearing loss and clinical diagnosis of auditory neuropathy, and the c.35delG mutation in the GJB2 gene was identified in three homozygous patients, and the heterozygous parents of one of these cases. Additionally, OTOF gene mutations were tracked by complete sequencing of 48 exons, although these results are still preliminary. Studying the genetic basis of auditory neuropathy is of utmost importance for obtaining a differential diagnosis, developing more specific treatments and more accurate genetic counseling.

Exostosis del conducto auditivo interno: 10 años de seguimiento / Exostosis of the Internal Auditory Canal: 10-Year Follow-Up

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High levels of sound pressure: acoustic reflex thresholds and auditory complaints of workers with noise exposure / Níveis elevados de pressão sonora: limiares dos reflexos estapedianos e queixas auditivas de trabalhadores expostos

INTRODUCTION: The clinical evaluation of subjects with occupational noise exposure has been difficult due to the discrepancy between auditory complaints and auditory test results. This study aimed to evaluate the contralateral acoustic reflex thresholds of workers exposed to high levels of noise, and to compare these results to the subjects' auditory complaints.METHODS: This clinical retrospective study evaluated 364 workers between 1998 and 2005; their contralateral acoustic reflexes were compared to auditory complaints, age, and noise exposure time by chi-squared, Fisher's, and Spearman's tests.RESULTS: The workers' age ranged from 18 to 50 years (mean = 39.6), and noise exposure time from one to 38 years (mean = 17.3). We found that 15.1% (55) of the workers had bilateral hearing loss, 38.5% (140) had bilateral tinnitus, 52.8% (192) had abnormal sensitivity to loud sounds, and 47.2% (172) had speech recognition impairment. The variables hearing loss, speech recognition impairment, tinnitus, age group, and noise exposure time did not show relationship with acoustic reflex thresholds; however, all complaints demonstrated a statistically significant relationship with Metz recruitment at 3000 and 4000 Hz bilaterally.CONCLUSION: There was no significance relationship between auditory complaints and acoustic reflexes.

INTRODUÇÃO: A avaliação clínico-ocupacional de trabalhadores expostos a ruído é dificultada pela discrepância entre queixas auditivas e resultados dos exames audiológicos. Este estudo pretende avaliar limiares dos reflexos estapedianos contralaterais em sujeitos expostos a níveis elevados de pressão sonora, relacionando-os com queixas auditivas.MÉTODO: Estudo clínico retrospectivo que analisou 364 trabalhadores e seus limiares de reflexos estapedianos contralaterais, relacionado-os com queixas auditivas, idades e tempos de exposição ao ruído.RESULTADOS: Dos trabalhadores avaliados, com idades de 18 a 50 anos (média 39,6) e tempos de exposição entre um e 38 anos (média 17,3); 15,1% (55) tinham queixa de perda auditiva bilateral, 38,5% (140) zumbidos bilaterais, 52,8% (192) irritação ao ouvir sons intensos e 47,2% (172) dificuldades para reconhecer a fala. As variáveis: perda auditiva, dificuldade para reconhecimento da fala, zumbidos, faixa etária e tempo de exposição ao ruído não se relacionaram significativamente com limiares dos reflexos estapedianos, mas todas as queixas apresentaram relação estatisticamente significante com o recrutamento de Metz nas frequências de 3000 e 4000 Hz, bilateralmente.CONCLUSÃO: Não houve relações significativas entre limiares dos reflexos estapedianos e queixas auditivas.

HiFocus Helix™ electrode insertion: surgical approach.

BACKGROUND: Cochlear implants have been used for almost 30 years as a device for the rehabilitation of individuals with severe-to-profound hearing loss. One of the important aspects of cochlear implantation is the type of electrode selected and proper insertion of the electrode array in scala tympani to minimize cochlear damage. The HiFocus Helix™ electrode is a precurved design aimed at placing the electrode contacts close to the spiral ganglion cells in the modiolus. The prescribed insertion techniques are intended to minimize the likelihood of damage to the basilar membrane or lateral wall of the cochlea. CASE PRESENTATION: To describe the first insertion of a HiFocus Helix™ electrode in Brazil exposing surgical particularities and device details in a patient with profound hearing loss, due to Mondini's dysplasia. CONCLUSION: No problems were encountered during the surgical procedure. The patient experienced improvement in hearing thresholds and speech perception. The HiFocus Helix™ electrode proved easy to insert and provided expected hearing benefits for the patient. This manuscript indicates that the HiResolution™ Bionic Ear System with HiFocus Helix™ electrode comprise a cochlear implant system that is practical and beneficial for the treatment of severe-to-profound hearing loss.

High levels of sound pressure: acoustic reflex thresholds and auditory complaints of workers with noise exposure.

INTRODUCTION: The clinical evaluation of subjects with occupational noise exposure has been difficult due to the discrepancy between auditory complaints and auditory test results. This study aimed to evaluate the contralateral acoustic reflex thresholds of workers exposed to high levels of noise, and to compare these results to the subjects' auditory complaints. METHODS: This clinical retrospective study evaluated 364 workers between 1998 and 2005; their contralateral acoustic reflexes were compared to auditory complaints, age, and noise exposure time by chi-squared, Fisher's, and Spearman's tests. RESULTS: The workers' age ranged from 18 to 50 years (mean=39.6), and noise exposure time from one to 38 years (mean=17.3). We found that 15.1% (55) of the workers had bilateral hearing loss, 38.5% (140) had bilateral tinnitus, 52.8% (192) had abnormal sensitivity to loud sounds, and 47.2% (172) had speech recognition impairment. The variables hearing loss, speech recognition impairment, tinnitus, age group, and noise exposure time did not show relationship with acoustic reflex thresholds; however, all complaints demonstrated a statistically significant relationship with Metz recruitment at 3000 and 4000Hz bilaterally. CONCLUSION: There was no significance relationship between auditory complaints and acoustic reflexes.

Comparison of two otologic suspensions of ciprofloxacin 2 mg/mL and hydrocortisone 10 mg/mL in the treatment of otitis externa: a multicenter, double-blind, randomized study / Comparação de duas suspensões otológicas de ciprofloxacino 2 mg/mL e hidrocortisona 10 mg/mL no tratamento da otite externa: um estudo multicêntrico, duplo-cego e randomizado

This was Phase III multicenter, double-blind, randomized, comparative safety and efficacy study in parallel groups of subjects, assessing non-inferiority between two commercially available otologic suspensions containing ciprofloxacin 2mg/mL and hydrocortisone 10mg/mL (Otociriax and Cipro HC®) in the treatment of acute diffuse otitis externa. Following screening and informed consent, subjects were randomly allocated into two treatment groups: Group A (treated with Otociriax) and Group B (treated with Cipro HC®). Treatment regimen in both groups was three drops, twice daily for seven days. The primary study endpoint was otitis cure, defined as elimination of pain, edema, and otorrhea. The secondary study endpoint was presence of side effects. Efficacy assessments included presence and intensity of otitis externa manifestations. Safety assessments included vital signs and physical examination, as well as adverse event monitoring. Study data analysis was performed using GraphPad Prism 5.0...

Hearing preservation and cochlear implants according to inner ear approach: multicentric evaluation / Preservação auditiva e implante coclear de acordo com a abordagem da orelha interna: avaliação multicêntrica

INTRODUCTION: Electroacoustic stimulation is an excellent option for people with residual hearing in the low frequencies, who obtain insufficient benefit with hearing aids. To be effective, the subject's residual hearing should be preserved during cochlear implant surgery. OBJECTIVES: To evaluate the hearing preservation in patients that underwent implant placement and to compare the results in accordance with the approach to the inner ear. METHODS: 19 subjects underwent a soft surgical technique, and the electrode MED-EL FLEX(tm) EAS, designed to be atraumatic, was used. We evaluated pre- and postoperative tonal audiometric tests with an average of 18.4 months after implantation, to measure the rate of hearing preservation. RESULTS: 17 patients had total or partial preservation of residual hearing; 5 had total hearing preservation and two individuals had no preservation of hearing. The insertion of the electrode occurred through a cochleostomy in 3 patients, and in 2 of these there was no hearing preservation; the other 16 patients experienced electrode insertion through a round window approach. All patients benefited from the cochlear implant, even those who are only using electrical stimulation. CONCLUSION: The hearing preservation occurred in 89.4% of cases. There was no significant difference between the forms of inner ear approach. .

INTRODUÇÃO: A estimulação eletroacústica é uma excelente opção para pessoas com audição residual nas baixas frequências, que obtêm benefício insuficiente com aparelhos auditivos. Para ser eficaz, a audição residual deve ser preservada durante a cirurgia de implante coclear. OBJETIVOS: Avaliar a preservação auditiva de pacientes implantados e comparar os resultados de acordo com a abordagem da orelha interna. MÉTODO: 19 indivíduos foram implantados com uma técnica cirúrgica para preservação auditiva, tendo sido utilizado o eletrodo MED-EL FLEXTM EAS, concebido para ser atraumático. Foram avaliados os exames audiométricos tonais no pré e pós-operatório, com uma média de 18,4 meses após o implante para medir a taxa de preservação da audição residual. RESULTADOS: 17 pacientes tiveram preservação total ou parcial da audição residual; cinco obtiveram preservação da audição total e dois indivíduos não tiveram preservação da audição. A inserção do eletrodo ocorreu por cocleostomia em 3 pacientes; em 2 destes pacientes não houve preservação da audição. Os outros 16 pacientes foram submetidos à abordagem pela janela redonda. Todos os pacientes foram beneficiados com o implante coclear, mesmo aqueles pacientes que utilizando apenas estimulação elétrica. CONCLUSÃO: A preservação auditiva ocorreu em 89,4% dos casos. Não houve diferença significativa entre as formas de abordagem da orelha interna. .