Resultado do PEATE e Resposta Auditiva de Estado Estável em lactentes com e sem falha na TANU / Results of BAEP and Auditory Steady State Response in infants with and without UNHS failure / Resultados del PEATC e Respuesta Auditiva del Estado Estable en lactantes con y sin falla de CANU

Introdução: A triagem auditiva neonatal universal (TANU) é realizada por meio do exame de potencial evocado auditivo de tronco encefálico (PEATE), na população com indicador de risco para deficiência auditiva. A resposta auditiva de estado estável (RAEE) é uma técnica objetiva e automática de determinação dos limiares auditivos por frequência específica, porém ainda pouco explorada antes da alta hospitalar. Objetivo: analisar os resultados obtidos no exame de PEATE e RAEE em lactentes com indicadores de risco para deficiência auditiva, antes da alta hospitalar, com e sem falha na TANU. Métodos: Estudo observacional analítico prospectivo feito em lactentes com risco para a deficiência auditiva e que realizaram o PEATE e a RAEE na mesma sessão. Resultados: Atenderam ao critério de inclusão 66 lactentes, de ambos os gêneros, idade mediana de 1,2 meses, idade gestacional média de 31 semanas, peso médio ao nascimento 1601 g. Tiveram PEATE normal, 53 (80%) lactentes, denominados de G1 e 13 (20%) tiveram PEATE alterado, denominados de G2. Os limiares eletrofisiológicos da RAEE foram estatisticamente menores nos lactentes de G1. Conclusão: Houve relação entre os achados dos exames de PEATE e RAEE em lactentes de risco para deficiência auditiva, quando realizado antes da alta hospitalar. A mediana dos limiares eletrofisiológicos da RAEE foi menor para os lactentes que tiveram PEATE normal e maior para aqueles que tiveram PEATE alterado na TANU.

Introduction: Universal neonatal hearing screening (UNHS) is performed by examining brainstem auditory evoked potential (BAEP), in the population with a risk indicator for hearing loss. The auditory steady-state response (ASSR) is an objective and automatic technique for determining hearing thresholds by specific frequency, but still little explored before hospital discharge. Objective: to analyze the results obtained in the BAEP and RAEE tests in infants with risk indicators for hearing loss, before hospital discharge, with and without failure in UNHS. Methods: Prospective analytical observational study carried out in infants at risk for hearing loss and who underwent BAEP and ASSR in the same session. Results: 66 infants attempted the inclusion criteria, of both genders, the median age was 1.2 months, the mean gestational age was 31 weeks and the mean weight at birth was 1601 g. 53 (80%) infants, called G1, had normal BAEP, and 13 (20%) had abnormal BAEP, called G2. The electrophysiological thresholds of ASSR were statistically lower in infants of G1. Conclusion: There was a relationship between the findings of the BAEP and ASSR exams in infants at risk for hearing loss, when performed before hospital discharge. The median of the ASSR electrophysiological thresholds was lower for the infants who had normal BAEP and higher for those who had abnormal BAEP in the UNHSque tenían un PEATC normal y mayor para aquellos que tenían un PEATC alterado en CANU.

Introducción: El cribado auditivo neonatal universal (CANU) se realiza examinando el potencial evocado auditivo del tronco cerebral (PEAC), en la población con un indicador de riesgo de hipoacusia. La respuesta auditiva en estado estable (RAEE) es una técnica objetiva y automática para determinar los umbrales de audición por frecuencia específica, pero aún poco explorada antes del alta hospitalaria. Objetivo: analizar los resultados obtenidos en la exploración de PEAC y RAEE en lactantes con indicadores de riesgo de hipoacusia, antes del alta hospitalaria, con y sin fallo en CANU. Metodos: Estudio observacional analítico prospectivo realizado en lactantes con riesgo de hipoacusia a los que se les realizó PEATC y RAEE en una misma sesión. Resultados: Los criterios de inclusión cumplieron con 66 lactantes, de ambos sexos, edad media de 1,2 meses, edad gestacional media de 31 semanas, peso medio al nacer 1601 g. Tenían un PEATC normal, 53 (80%) lactantes, llamados G1 y 13 (20%) tenían un PEATC anormal, llamado G2. Los umbrales electrofisiológicos de RAEE fueron estadísticamente más bajos en lactantes del G1. Conclusión: Hubo una relación entre los hallazgos de los exámenes PEATC y RAEE en lactantes con riesgo de hipoacusia, cuando se realizaron antes del alta hospitalaria. La mediana de los umbrales electrofisiológicos de RAEE fue menor para los lactantes.

Impacto da exposição à sífilis materna no sistema auditivo de recém-nascidos / Impact of exposure to maternal syphilis on the newborn's auditory system

RESUMO Objetivo Avaliar os achados audiológicos de recém-nascidos expostos à sífilis materna, tratada adequadamente na gestação. Métodos Estudo de coorte única não concorrente, realizado em um hospital público. Fizeram parte da amostra recém-nascidos filhos de mães que apresentaram sorologia positiva para sífilis e que realizaram o tratamento adequado durante a gestação, compondo o grupo estudo, e recém-nascidos sem indicadores de risco para deficiência auditiva, grupo comparação. Resultados Participaram do estudo 90 recém-nascidos, sendo 41 do grupo estudo e 49 do grupo comparação. No exame de emissões otoacústicas por estímulo transiente, todos apresentaram presença de resposta bilateralmente e, na comparação das amplitudes de respostas nas bandas de frequências de 3,0 kHz, 3,5 kHz e 4,0 kHz observou-se menor amplitude de resposta no grupo exposto, com diferença estatisticamente significativa para a frequência de 4 kHz à direita. Na análise das respostas do exame de potencial evocado auditivo de tronco encefálico, não se observou assimetria de resposta entre as orelhas que sugerisse alteração retrococlear e nem diferenças nos valores das latências absolutas ou intervalos interpicos, entre os grupos. Conclusão As respostas eletroacústicas foram discretamente inferiores nos recém-nascidos exposto à sífilis materna, enquanto que as respostas eletrofisiológicas foram semelhantes às encontradas na população de baixo risco para deficiência auditiva.

ABSTRACT Purpose To evaluate the audiological findings of newborns exposed to maternal syphilis, properly treated during pregnancy. Methods This was a single, non-concurrent cohort study conducted in a public hospital. The sample included newborns whose mothers had positive syphilis serology and who underwent adequate treatment during pregnancy, composing the study group, and newborns without risk indicators for hearing loss, as a comparison group. Results Ninety newborns participated in the study, 41 were the study group and 49 were the comparison group. In the transient evoked otoacoustic emissions test, all newborns showed a bilateral response, and when comparing the amplitudes of responses in the 3.0 kHz, 3.5 kHz and 4.0 kHz frequency bands, a smaller amplitude of response in the studied group with a statistically significant difference for the frequency of 4 kHz on the right was observed. An analysis of the response of the brainstem auditory evoked potential test showed no asymmetry of response between the ears that suggest a retrocochlear alteration, nor difference in the values of absolute latencies or interpeak intervals between groups. Conclusion The electroacoustic responses were slightly lower in newborns exposed to maternal syphilis, whereas their electrophysiological responses were similar to those found in the population at low risk for hearing loss.

Influência do Apgar baixo na primeira triagem auditiva do neonato / Influence of low Apgar on the first hearing screening of the neonate

INTRODUÇÃO: Diversos são os indicadores de risco para deficiência auditiva. O índice de Apgar, quando menor que quatro no primeiro minuto e/ou menor que seis no quinto minuto de vida, é considerado um indicador de risco para surdez. Tais valores estão associados à ocorrência de asfixia, que é uma das causas mais comuns de lesão e morte celular e, desta forma, algum dano ao sistema auditivo pode ocorrer. OBJETIVO: Verificar a influência do indicador de risco para deficiência auditiva, Apgar baixo, na primeira avaliação auditiva do neonato. MÉTODOS: Estudo clínico transversal, realizado em hospital público no período de janeiro de 2012 a dezembro de 2016. Os neonatos realizaram a avaliação audiológica por meio do exame de emissões otoacústicas evocadas por estímulo transiente (EOE-t). A relação entre Apgar baixo e "falha" nas EOE-t foi analisada por regressão logística simples. RESULTADOS: Foram avaliados 6.301 neonatos, desses 15,82% (n=996) tinham indicadores de risco para deficiência auditiva e 6,57% (n=415) obtiveram Apgar baixo. Apresentaram falha no exame de EOE-t, uni ou bilateral, 6,5% (n=415) dos neonatos triados. Outros indicadores de risco aumentaram as chances de "falha" na EOE-t, porém o Apgar baixo, isoladamente, aumentou as chances de "falha" em neonatos com peso ao nascimento maior que 1.500 g (OR: 1,58; p=0,02) e sem hemorragia peri-intraventricular (OR: 1,56; p=0,01). CONCLUSÃO: O índice de Apgar baixo foi o principal causador de "falha" na primeira avaliação auditiva dentre os neonatos com peso maior de 1.500 g e sem hemorragia peri-intraventricular.

INTRODUCTION: There are several risk indicators for hearing loss. The Apgar score, when less than four in the first minute and/or less than six in the fifth minute of life, is considered an indicator of risk for hearing loss. Such values are associated with the occurrence of asphyxia, which is one of the most common causes of cell death and injury and, therefore, some damage to the auditory system may occur. OBJECTIVE: To check the influence of risk indicator for hearing loss, low Apgar, in the first neonatal hearing evaluation. METHODS: Cross-sectional study conducted in a public hospital from January 2012 to December 2016. The neonates underwent hearing evaluation by examining transient-evoked otoacoustic emissions (TEOAE). The relation between low Apgar and "refer" in the TEOAE was analyzed by simple logistic regression. RESULTS: A total of 6,301 newborns were evaluated, of which 15.82% (n=996) had risk indicators for hearing loss and 6.57% (n=415) had with low Apgar. 6.5% (n=415) of the neonates screened showed failure of the EOE-t test, uni or bilateral. Others risk indicators increased the chances of "refer"; however, the presence of low Apgar alone increased the chances of "refer" in the TEOAE in newborns with birth weight greater than 1,500 g (OR: 1.58; p=0.02) and without peri-intraventricular hemorrhage (OR: 1.56; p=0.01). CONCLUSION: The low Apgar score was the mainly cause of "refer" on the first hearing evaluation among neonates with with birth weight greater than 1,500 g and without peri-intraventricular hemorrhage.

The effect of peri-intraventricular hemorrhage on the auditory pathway of infants.

OBJECTIVE: To verify the effect of peri-intraventricular hemorrhage on the auditory pathway of preterm infants. METHOD: It is a non-concurrent cohort study. This study was conducted in a tertiary public. Preterm infants with peri-intraventricular hemorrhage comprised the study group, and preterm infants without peri-intraventricular hemorrhage were included as a comparison group, both were similar in relation to gestational age and risk indicators for hearing loss. Participants had to meet the following inclusion criteria: have been born at the study site, presence of otoacoustic emissions by transient stimulus in both ears and brainstem auditory evoked potentials with all components bilaterally identified. RESULTS: 44 infants with an average age of 3 months with peri-intraventricular hemorrhage and 2,6 months without peri-intraventricular hemorrhage met the inclusion criteria. Regarding the brainstem auditory evoked potentials results, a significant increase was observed in absolute latency values of waves I, III and V, as well as in the interpeak intervals I-III and I-V, bilaterally, in infants with peri-intraventricular hemorrhage. CONCLUSION: This study concluded that infants with peri-intraventricular hemorrhage presented a delay in the neural conduction of sound, which justifies the monitoring of the auditory function in these infants during the period of language development.

Transient evoked otoacoustic emissions and auditory brainstem response in infants with perinatal asphyxia.

OBJECTIVE: The objective of this study was to verify the effects of perinatal asphyxia on different parts of the auditory system. METHODS: This was a non-concurrent cohort study conducted on a fixed population in a tertiary public hospital. Participants included 181 infants born at term who underwent the transient evoked otoacoustic emission test as a part of a neonatal hearing screening program, with a "pass" result in both ears, and by auditory brainstem response testing. The infants were divided into 3 groups: G1, 20 infants who had perinatal asphyxia; G2, 111 infants with an Apgar score lower than 4 in the first minute and/or lower than 6 in the fifth minute (called "low Apgar" at birth); and G3, 50 infants with first- and fifth-minute Apgar scores ≥7. RESULTS: The signal-to-noise ratio of transient evoked otoacoustic emissions were greater in G3 compared with G1 and G2 at 4 kHz frequency for males. An increased latency of waves I and III in the auditory brainstem response of male infants in G1 was observed. CONCLUSION: This study demonstrated that alterations occurred in both the cochlear and the neural components in male infants who had perinatal asphyxia.

Influência dos indicadores de risco nas diferentes etapas da Triagem Auditiva Neonatal / Influence of risk indicators on different Universal Newborn Hearing Screening steps

RESUMO Objetivo Determinar os indicadores de risco para deficiência auditiva, que afetam as diferentes etapas de avaliação de um programa de triagem auditiva neonatal universal. Métodos Estudo retrospectivo longitudinal de triagem auditiva neonatal, realizado em 832 neonatos nascidos em hospital público terciário, no período de janeiro a dezembro de 2012. O exame de Emissões Otoacústicas Evocadas por Estímulo Transiente foi realizado na primeira avaliação auditiva de todos os neonatos. Nos casos de "falha" na primeira avaliação, foi aplicado um reteste e, quando houve a permanência da "falha", foi realizado o Potencial Evocado Auditivo de Tronco Encefálico (PEATE). Os neonatos com indicador de risco para deficiência auditiva realizaram o PEATE independente do resultado das emissões otoacústicas. Resultados A presença de, ao menos, um indicador de risco para deficiência auditiva, associado ou não a malformações craniofaciais, síndromes genéticas e peso menor que 1500 g ao nascimento, aumentaram significativamente as chances de "falha" na avaliação por emissões otoacústicas. Meningite e malformações craniofaciais aumentaram de maneira expressiva as chances de PEATE alterado. Dois neonatos com emissões otoacústicas normais apresentaram diagnóstico de neuropatia auditiva. Conclusão A malformação craniofacial é um indicador fortemente associado ao diagnóstico da surdez, independente de a triagem auditiva ter sido realizada por emissões otoacústicas ou por PEATE em suas diferentes etapas, o que justifica o monitoramento contínuo e sistemático do serviço de triagem, na busca da melhoria da qualidade do programa de saúde auditiva do neonato.

ABSTRACT Purpose To determine risk indicators for hearing loss affecting different evaluation steps of a universal newborn hearing screening program. Methods Longitudinal, retrospective study of newborn hearing screening in a tertiary public hospital, including 832 newborns born between January and December 2012. Transient evoked otoacoustic emissions were measured at the first hearing evaluation in all newborns and retested in cases of "failure". When a "failure" result persisted, auditory brainstem responses (ABR) was performed. All newborns with risk indicator for hearing loss were evaluated with ABR screening regardless of the outcome of the otoacoustic emissions test. Results The presence of at least one risk indicator for hearing loss, associated or not with craniofacial malformations, genetic syndromes and birth weight below 1500 g significantly increased the chances of "failure" in the otoacoustic emissions test. Meningitis and craniofacial malformations significantly increased the odds of an abnormal ABR. Two newborns with normal otoacoustic emissions were diagnosed with auditory neuropathy. Conclusion Craniofacial malformation was an indicator strongly associated with a diagnosis of deafness, regardless of the hearing screening being performed by otoacoustic emissions or ABR at different steps of a universal newborn hearing screening program. This finding justifies continuous and systematic monitoring of the screening service seeking quality improvement of the newborn health hearing program.

The importance of retesting the hearing screening as an indicator of the real early hearing disorder / A importância do reteste da triagem auditiva como indicador da real alteração auditiva precoce

INTRODUCTION: Early diagnosis of hearing loss minimizes its impact on child development. We studied factors that influence the effectiveness of screening programs.OBJECTIVE: To investigate the relationship between gender, weight at birth, gestational age, risk factors for hearing loss, venue for newborn hearing screening and "pass" and "fail" results in the retest.METHODS: Prospective cohort study was carried out in a tertiary referral hospital. The screening was performed in 565 newborns through transient evoked otoacoustic emissions in three admission units before hospital discharge and retest in the outpatient clinic. Gender, weight at birth, gestational age, presence of risk indicators for hearing loss and venue for newborn hearing screening were considered.RESULTS: Full-term infants comprised 86% of the cases, preterm 14%, and risk factors for hearing loss were identified in 11%. Considering the 165 newborns retested, only the venue for screening, Intermediate Care Unit, was related to "fail" result in the retest.CONCLUSIONS: Gender, weight at birth, gestational age and presence of risk factors for hearing loss were not related to "pass" and/or "fail" results in the retest. The screening performed in intermediate care units increases the chance of continued "fail" result in the Transient Otoacoustic Evoked Emissions test.

INTRODUÇÃO: O diagnóstico precoce da surdez minimiza impactos no desenvolvimento infantil. Fatores que interferem na efetividade dos programas de triagem são estudados.OBJETIVO: Verificar a relação entre sexo, peso ao nascimento, idade gestacional, presença de risco para deficiência auditiva, local de realização da triagem auditiva neonatal e resultados "passa" e "falha" no reteste.MÉTODO: Estudo de coorte prospectiva, em hospital de referência terciário. A triagem foi realizada em 565 neonatos, por meio das emissões otoacústicas evocadas transientes, em três unidades de internação antes da alta hospitalar e o reteste, no ambulatório. Sexo, peso ao nascimento, idade gestacional, presença de indicadores de risco para deficiência auditiva e local de realização do exame foram considerados.RESULTADOS: Nasceram a termo 86%, prematuros 14% e risco para deficiência auditiva, 11%. Dentre os 165 neonatos retestados, apenas o local de realização do exame, Unidade de Cuidados Intermediários, se relacionou com manutenção da "falha" no reteste.CONCLUSÕES: Sexo, peso ao nascimento, idade gestacional e presença de indicadores de risco para deficiência auditiva não se relacionaram com "passar" e/ou "falhar" no reteste. A realização do exame em unidades de cuidados intermediários aumenta a chance de permanência de "falha" no exame de Emissões Otoacústicas Evocadas Transientes.

The importance of retesting the hearing screening as an indicator of the real early hearing disorder.

INTRODUCTION: Early diagnosis of hearing loss minimizes its impact on child development. We studied factors that influence the effectiveness of screening programs. OBJECTIVE: To investigate the relationship between gender, weight at birth, gestational age, risk factors for hearing loss, venue for newborn hearing screening and "pass" and "fail" results in the retest. METHODS: Prospective cohort study was carried out in a tertiary referral hospital. The screening was performed in 565 newborns through transient evoked otoacoustic emissions in three admission units before hospital discharge and retest in the outpatient clinic. Gender, weight at birth, gestational age, presence of risk indicators for hearing loss and venue for newborn hearing screening were considered. RESULTS: Full-term infants comprised 86% of the cases, preterm 14%, and risk factors for hearing loss were identified in 11%. Considering the 165 newborns retested, only the venue for screening, Intermediate Care Unit, was related to "fail" result in the retest. CONCLUSIONS: Gender, weight at birth, gestational age and presence of risk factors for hearing loss were not related to "pass" and/or "fail" results in the retest. The screening performed in intermediate care units increases the chance of continued "fail" result in the Transient Otoacoustic Evoked Emissions test.

Oral changes in individuals undergoing hematopoietic stem cell transplantation / Alterações orais em indivíduos submetidos à transplante de células hematopoiéticas

INTRODUCTION: Patients undergoing hematopoietic stem cell transplantation receive high doses of chemotherapy and radiotherapy, which cause severe immunosuppression. OBJECTIVE: To report an oral disease management protocol before and after hematopoietic stem cell transplantation. METHODS: A prospective study was carried out with 65 patients aged > 18 years, with hematological diseases, who were allocated into two groups: A (allogeneic transplant, 34 patients); B (autologous transplant, 31 patients). A total of three dental status assessments were performed: in the pre-transplantation period (moment 1), one week after stem cell infusion (moment 2), and 100 days after transplantation (moment 3). In each moment, oral changes were assigned scores and classified as mild, moderate, and severe risks. RESULTS: The most frequent pathological conditions were gingivitis, pericoronitis in the third molar region, and ulcers at the third moment assessments. However, at moments 2 and 3, the most common disease was mucositis associated with toxicity from the drugs used in the immunosuppression. CONCLUSION: Mucositis accounted for the increased score and potential risk of clinical complications. Gingivitis, ulcers, and pericoronitis were other changes identified as potential risk factors for clinical complications. .

INTRODUÇÃO: Pacientes submetidos a transplante de células hematopoiéticas recebem altas doses de quimioterapia e radioterapia que podem causar imunossupressão e doenças orais graves. OBJETIVO: Apresentar um protocolo de avaliação de doenças orais antes e após transplante de células hematopoiéticas. MÉTODO: Estudo clínico prospectivo de 65 pacientes com idade acima de 18 anos, com doenças hematológicas submetidas a transplante de células hematopoiéticas, divididos em dois grupos: A (transplante alogênico, 34 pacientes) e B (transplante autólogo). Foram realizadas três avaliações odontológicas: período antes do transplante (momento 1), uma semana (momento 2) e 100 dias após o transplante (momento 3). Em cada momento as alterações orais foram pontuadas e classificadas como leve, moderada e grave. RESULTADOS: As alterações orais mais frequentes foram: gengivite, pericoronite do terceiro molar e úlceras. Entretanto nos momentos dois e três a principal doença foi a mucosite associada a toxicidades das drogas usadas na imunossupressão. CONCLUSÃO: Mucosite foi principal alteração, com a pontuação mais alta e com maior risco de complicações. Gengivites, úlceras e pericoronites foram outras alterações com risco menor de complicações. .

Oral changes in individuals undergoing hematopoietic stem cell transplantation.

INTRODUCTION: Patients undergoing hematopoietic stem cell transplantation receive high doses of chemotherapy and radiotherapy, which cause severe immunosuppression. OBJECTIVE: To report an oral disease management protocol before and after hematopoietic stem cell transplantation. METHODS: A prospective study was carried out with 65 patients aged>18 years, with hematological diseases, who were allocated into two groups: A (allogeneic transplant, 34 patients); B (autologous transplant, 31 patients). A total of three dental status assessments were performed: in the pre-transplantation period (moment 1), one week after stem cell infusion (moment 2), and 100 days after transplantation (moment 3). In each moment, oral changes were assigned scores and classified as mild, moderate, and severe risks. RESULTS: The most frequent pathological conditions were gingivitis, pericoronitis in the third molar region, and ulcers at the third moment assessments. However, at moments 2 and 3, the most common disease was mucositis associated with toxicity from the drugs used in the immunosuppression. CONCLUSION: Mucositis accounted for the increased score and potential risk of clinical complications. Gingivitis, ulcers, and pericoronitis were other changes identified as potential risk factors for clinical complications.

[Assessment of levels of otoacoustic emission response in neonates with perinatal asphyxia]. / Avaliação dos níveis de resposta das emissões otoacústicas em neonatos com asfixia perinatal.

OBJECTIVE: To evaluate the effects of perinatal asphyxia on the level of the response to transient otoacoustic emissions in infants. METHODS: Otoacoustic emissions in 154 neonates were performed: 54 infants who suffered asphyxia at birth, measured by Apgar score and medical diagnosis, and 100 infants without risk were compared. Scores less than 4 in the first minute and/or less than 6 in the fifth minute were considered as "low Apgar". Statistical analysis of the data was performed using the Kruskal, Wilcoxon, and Mann-Whitney nonparametric tests. RESULTS: Lower levels of response were observed in transient otoacoustic emission in the group that suffered perinatal asphyxia, with significant values for the frequencies 2,000, 3,000, and 4,000Hz in the right ear, and 2,000 and 4,000Hz in the left ear. CONCLUSIONS: The analysis of the intrinsic characteristics of the otoacoustic emissions evidenced low performance of outer hair cells in neonates who had perinatal asphyxia, which may affect the development of listening skills in this population.

Avaliação dos níveis de resposta das emissões otoacústicas em neonatos com asfixia perinatal / Assessment of levels of otoacoustic emission response in neonates with perinatal asphyxia

Objetivo: Avaliar os efeitos da asfixia perinatal sobre os níveis de resposta das emissões otoacústicas por estímulo transiente em lactentes. Métodos: Foi realizado, para comparação, o registro das emissões otoacústicas transientes em 154 neonatos: 54 bebês que sofreram asfixia perinatal, medida pela escala de Apgar e diagnóstico médico ao nascimento, e 100 bebês sem risco. Escores abaixo de 4 no primeiro minuto e/ou menores que 6 no quinto minuto foram considerados "Apgar baixo". A análise estatística do conjunto de dados foi efetuada utilizando-se os testes não paramétricos de Kruskal, Wilcoxon e Mann-Whitney. Resultados: Foram observados menores níveis de resposta nas emissões otoacústicas transientes para o grupo que sofreu asfixia perinatal, com valores estatisticamente significantes para as frequências de 2000, 3000 e 4000Hz na orelha direita e 2000 e 4000Hz na orelha esquerda. Conclusão: A análise das características intrínsecas do exame de emissões otoacústicas transientes mostrou baixo desempenho das células ciliadas externas em neonatos que tiveram asfixia perinatal, o que pode afetar o desenvolvimento das habilidades auditivas nessa população...

Objective: To evaluate the effects of perinatal asphyxia on the level of the response to transient otoacoustic emissions in infants. Methods: Otoacoustic emissions in 154 neonates were performed: 54 infants who suffered asphyxia at birth, measured by Apgar score and medical diagnosis, and 100 infants without risk were compared. Scores less than 4 in the first minute and/or less than 6 in the fifth minute were considered as "low Apgar". Statistical analysis of the data was performed using the Kruskal, Wilcoxon, and Mann-Whitney nonparametric tests. Results: Lower levels of response were observed in transient otoacoustic emission in the group that suffered perinatal asphyxia, with significant values for the frequencies 2,000, 3,000, and 4,000 Hz in the right ear, and 2,000 and 4,000 Hz in the left ear. Conclusions: The analysis of the intrinsic characteristics of the otoacoustic emissions evidenced low performance of outer hair cells in neonates who had perinatal asphyxia, which may affect the development of listening skills in this population...

Could the type of treatment for chronic kidney disease affect the auditory system?

INTRODUCTION: Chronic kidney disease (CKD) is defined as the presence of renal injury that leads to the slow and progressive loss of kidney function. AIM: To compare audiological tests between patients with CKD receiving different types of treatment. MATERIAL AND METHOD: This was a clinical and experimental study. Groups were divided according to treatment: hemodialysis (n = 35), peritoneal dialysis (n = 15), and conservative (n = 51), and were compared to 27 healthy controls. Patients older than 60 years; those with congenital hearing loss, genetic syndromes, and middle-ear infections; and those who had been submitted to a kidney transplant were excluded. Audiologic evaluation included pure-tone audiometry, transient evoked otoacoustic emissions, and auditory brainstem response (ABR). The variables considered were gender, age, diagnosis of arterial hypertension, time since the diagnosis of diabetes and hypertension, CKD stage, duration of CKD, and duration of treatment. RESULTS: The variables age, presence of arterial hypertension, and time of CKD were statistically significant and controlled. The auditory thresholds measured by pure-tone threshold audiometry were worse for the conservative treatment group, and the III-V interval of the ABR of the conservative treatment group was significantly greater than that of the hemodialysis groups. CONCLUSION: The conservative treatment group presented worse audiological tests, regardless of hypertension and diabetes, reinforcing that patients need to undergo a complete hearing assessment for better understanding of the disease and its effects on the auditory system.

O tratamento da doenca renal cronica pode afetar a audicao? / Could the type of treatment for chronic kidney disease affect the auditory system?

Introdução: Doença renal crônica (DRC) é definida pela presença de lesão renal levando à perda lenta e progressiva da função renal. Objetivo: Comparar testes auditivos entre pacientes com DRC submetidos a diferentes método de tratamento. Material e método: Estudo clínico transversal. Os grupos foram divididos de acordo com o método de tratamento: hemodiálise (n = 35), diálise peritoneal (n =15), conservador (n = 51) e 27 pacientes saudáveis (controle). Pacientes com idade superior a 60 anos, perda auditiva congênita, síndromes genéticas, infecções de orelha média e transplante renal foram excluídos da pesquisa. A avaliação audiológica incluiu audiometria tonal, emissões otoacústicas evocadas transientes e Potencial Evocado Auditivo de Tronco Encefálico (PEATE); e as variáveis avaliadas foram: sexo, idade, diagnóstico de hipertensão arterial e diabetes, estádio da DRC, tempo de diagnóstico do diabetes e da hipertensão arterial, duração da DRC e do tratamento. Resultados: A idade, presença de hipertensão arterial e tempo de DRC foram estatisticamente significantes e controlados. O grupo conservador apresentou piores limiares auditivos na audiometria tonal e o intervalo III-V do PEATE significativamente maior que o da hemodiálise. Conclusão: O tratamento conservador mostrou piores resultados na avaliação auditiva, independente de diabetes e de hipertensão, reforçando que os pacientes submetidos a tratamento para DRC devem realizar avaliação auditiva completa para melhor compreensão da doença e de seus efeitos sobre o sistema auditivo. .

Introduction: Chronic kidney disease (CKD) is defined as the presence of renal injury that leads to the slow and progressive loss of kidney function. Aim: To compare audiological tests between patients with CKD receiving different types of treatment. Material and method: This was a clinical and experimental study. Groups were divided according to treatment: hemodialysis (n = 35), peritoneal dialysis (n = 15), and conservative (n = 51), and were compared to 27 healthy controls. Patients older than 60 years; those with congenital hearing loss, genetic syndromes, and middle-ear infections; and those who had been submitted to a kidney transplant were excluded. Audiologic evaluation included pure-tone audiometry, transient evoked otoacoustic emissions, and auditory brainstem response (ABR). The variables considered were gender, age, diagnosis of arterial hypertension, time since the diagnosis of diabetes and hypertension, CKD stage, duration of CKD, and duration of treatment. Results: The variables age, presence of arterial hypertension, and time of CKD were statistically significant and controlled. The auditory thresholds measured by pure-tone threshold audiometry were worse for the conservative treatment group, and the III-V interval of the ABR of the conservative treatment group was significantly greater than that of the hemodialysis groups. Conclusion: The conservative treatment group presented worse audiological tests, regardless of hypertension and diabetes, reinforcing that patients need to undergo a complete hearing assessment for better understanding of the disease and its effects on the auditory system. .

Auditory steady state response in hearing assessment in infants with cytomegalovirus / Importancia de lainclusion de larespuesta auditiva de estado estable en la evaluacion auditiva en lactantes concitomegalovirus / Resposta auditiva de estado estavel na avaliacao auditiva em lactentes com citomegalovirus

OBJECTIVE: To report an infant with congenital cytomegalovirus and progressive sensorineural hearing loss, who was assessed by three methods of hearing evaluation. CASE DESCRIPTION: In the first audiometry, at four months of age, the infant showed abnormal response in Otoacoustic Emissions and normal Auditory Brainstem Response (ABR), with electrophysiological threshold in 30dBnHL, in both ears. With six months of age, he showed bilateral absence of the ABR at 100dBnHL. The behavioral observational audiometry was impaired due to the delay in neuropsychomotor development. At eight months of age, he was submitted to Auditory Steady State Response (ASSR) and the thresholds were 50, 70, absent in 110 and in 100dB, respectively for 500, 1,000, 2,000 and 4,000Hz in the right ear, and 70, 90, 90 and absent in 100dB, respectively for 500, 1,000, 2,000 and 4,000Hz in the left ear. COMMENTS: In the first evaluation, the infant had abnormal Otoacoustic Emission and normal ABR, which became altered at six months of age. The hearing loss severity could be identified only by the ASSR, which allowed the best procedure for hearing aids adaptation. The case description highlights the importance of the hearing status follow-up for children with congenital cytomegalovirus. .

OBJETIVO: Relatar el caso de un lactante con citomegalovirus congénito y disacusianeurosensorial progresiva, analizado por tres métodos de evaluación auditiva. DESCRIPCIÓN DEL CASO: En la primera evaluación auditiva, a los cuatro meses de edad, el lactante presentó ausencia de Emisiones Otoacústicas (EOA) y Potencial Evocado Auditivo de Tronco Encefálico (PEATE) dentro de los estándares de normalidad para la franja de edad, con umbral electrofisiológico en 30dBnHL, bilateralmente. Con seis meses, presentó ausencia de PEATE bilateral en 100dBnHL. La evaluación comportamental de la audición se mostró perjudicada debido al retardo en el desarrollo neuropsicomotor. A los ocho meses, fue sometido al examen de Respuesta Auditiva de Estado Estable (RAEE) y los umbrales encontrados fueron 50, 70, ausente en 110 y en 100dB, respectivamente para 500, 1.000, 2.000 y 4.000Hz, a la derecha, y 70, 90, 90 y ausente en 100dB, respectivamente para 500, 1.000, 2.000 y 4.000, a la izquierda. COMENTARIOS: En la primera evaluación, el lactante presentó alteración auditiva en el examen de EOA y PEATE normal, que pasó a ser alterado a los seis meses de edad. La intensidad de la pérdida auditiva solo puede identificarse por el examen de RAEE, permitiendo establecer la mejor conducta en la adaptación de aparato de amplificación sonora individual. Se subraya la importancia del seguimiento audiológico para niños con CMV congénito. .

OBJETIVO: Relatar o caso de um lactente com citomegalovírus congênito e disacusia neurossensorial progressiva, analisado por três métodos de avaliação auditiva. DESCRIÇÃO DO CASO: Na primeira avaliação auditiva, aos quatro meses de idade, o lactente apresentou ausência de Emissões Otoacústicas (EOA) e Potencial Evocado Auditivo de Tronco Encefálico (PEATE) dentro dos padrões de normalidade para a faixa etária, com limiar eletrofisiológico em 30dBnHL, bilateralmente. Com seis meses, apresentou ausência de PEATE bilateral em 100dBnHL. A avaliação comportamental da audição mostrou-se prejudicada devido ao atraso no desenvolvimento neuropsicomotor. Aos oito meses, foi submetido ao exame de Resposta Auditiva de Estado Estável (RAEE) e os limiares encontrados foram 50, 70, ausente em 110 e em 100dB, respectivamente para 500, 1.000, 2.000 e 4.000Hz, à direita, e 70, 90, 90 e ausente em 100dB, respectivamente para 500, 1.000, 2.000 e 4.000Hz, à esquerda. COMENTÁRIOS: Na primeira avaliação, o lactente apresentou alteração auditiva no exame de EOA e PEATE normal, que passou a ser alterado aos seis meses de idade. A intensidade da perda auditiva só pôde ser identificada pelo exame de RAEE, permitindo estabelecer a melhor conduta na adaptação de aparelho de amplificação sonora individual. Ressalta-se a importância do acompanhamento audiológico para crianças com CMV congênito. .

Avaliação audiológica em pacientes com doenças reumáticas pediátricas / Hearing loss assessment in patients with pediatric rheumatic disorders

OBJETIVO: Realizar avaliação audiológica em crianças e adolescentes acompanhados em um ambulatório de referência para doenças autoimunes, independentemente do diagnóstico específico. MÉTODOS: Foi realizado um estudo cego simples do tipo caso-controle. Foram incluídos 48 pacientes com idades entre 5 e 19 anos e tempo de seguimento de um a 151 meses, divididos em três grupos: 15 pacientes controle com diagnóstico de dor em membros e exclusão de doença autoimune, 23 pacientes com Artrite Idiopática Juvenil, e dez pacientes com outras doenças autoimunes. Os voluntários foram submetidos a avaliações clínica, otológica e audiológica (timpanometria, pesquisa dos reflexos acústicos, audiometria, índice de reconhecimento de fala, emissões otoacústicas e potenciais evocados auditivos de tronco encefálico com estímulo click). RESULTADOS: O grupo com outras doenças autoimunes teve maior número de pacientes sintomáticos e maior número de orelhas alteradas no teste de emissões otoacústicas em comparação com o grupo controle e com o grupo com Artrite Idiopática Juvenil. Ainda no grupo com outras doenças autoimunes, 50% dos sujeitos assintomáticos apresentaram alterações na pesquisa dos reflexos, na audiometria e nas emissões otoacústicas. Na audiometria, o grupo com Artrite Idiopática Juvenil apresentou mais alterações nas frequências altas, e o grupo com outras doenças autoimunes, nas frequências baixas. CONCLUSÃO: Houve maior número de sintomas relacionados à perda auditiva e a alterações audiológicas em crianças e adolescentes com Artrite Idiopática Juvenil e outras doenças autoimunes. As alterações auditivas ocorreram também em pacientes assintomáticos, justificando-se a avaliação audiológica como rotina clínica desses pacientes.

PURPOSE: To perform audiological assessment in children and adolescents followed up at a reference outpatient clinic for autoimmune diseases, regardless of specific diagnoses. METHODS: A single-blind case-control study was conducted. Participants were 48 patients with ages from 5 to 19 years and one to 151 months follow-up, categorized into three groups: 15 control individuals with pain in limbs and no autoimmune disorders, 23 individuals with Juvenile Idiopathic Arthritis, and ten cases diagnosed with other autoimmune disorders. All subjects were submitted to clinical, otological, and audiological assessments (tympanometry, acoustic reflex, audiometry, speech audiometry, otoacoustic emissions, and auditory brainstem response test with click stimuli). RESULTS: The group with other autoimmune disorders had a greater proportion of patients with symptoms and more altered results in the otoacoustic emission test, when compared with the control group and the group with Juvenile Idiopathic Arthritis. In the group with other autoimmune disorders, 50% of the subjects with no symptoms presented impaired acoustic reflexes, alterations in audiometry and in otoacoustic emissions. In the audiometry, the group with Juvenile Idiopathic Arthritis presented more alterations in higher frequencies, and the group with other autoimmune disorders, in lower frequencies. CONCLUSION: Symptoms related to hearing loss and audiological alterations were more frequent in children and adolescents with Juvenile Idiopathic Arthritis and other autoimmune disorders. The hearing alterations also occurred in patients with no symptoms, indicating the need for systematic hearing assessment for these patients in their clinical routine.

Auditory steady state response in hearing assessment in infants with cytomegalovirus.

OBJECTIVE: To report an infant with congenital cytomegalovirus and progressive sensorineural hearing loss, who was assessed by three methods of hearing evaluation. CASE DESCRIPTION: In the first audiometry, at four months of age, the infant showed abnormal response in Otoacoustic Emissions and normal Auditory Brainstem Response (ABR), with electrophysiological threshold in 30dBnHL, in both ears. With six months of age, he showed bilateral absence of the ABR at 100dBnHL. The behavioral observational audiometry was impaired due to the delay in neuropsychomotor development. At eight months of age, he was submitted to Auditory Steady State Response (ASSR) and the thresholds were 50, 70, absent in 110 and in 100dB, respectively for 500, 1,000, 2,000 and 4,000Hz in the right ear, and 70, 90, 90 and absent in 100dB, respectively for 500, 1,000, 2,000 and 4,000Hz in the left ear. COMMENTS: In the first evaluation, the infant had abnormal Otoacoustic Emission and normal ABR, which became altered at six months of age. The hearing loss severity could be identified only by the ASSR, which allowed the best procedure for hearing aids adaptation. The case description highlights the importance of the hearing status follow-up for children with congenital cytomegalovirus.

Comparison between actual and predicted postoperative stair-climbing test, walk test and spirometric values in patients undergoing lung resection.

PURPOSE: To assess whether the tests - Forced Expiratory Volume at one second (FEV1), 6-minute walk test (6MWT) and stair-climbing test (SCT) showed proportional changes after the resection of functioning lung. METHODS: Candidates for pulmonary resection were included. Spirometry, 6MWT and SCT were performed preoperatively (pre) and at least 3 months after surgery (pos). SCT was performed on a staircase with a total ascent height of 12.16m. The time taken to climb the total height the fastest possible was defined as stair-climbing time (SCt). Number of functioning segments lost, was used to calculated predicted postoperative (ppo) tests values. Pre, ppo and pos values for each test were compared. Data were analyzed by repeated-measure ANOVA with significance level set at 5%. RESULTS: A total of 40 patients were enrolled. Pulmonary resection results ranged from gain of 2 functioning segments to loss of 9. Pre, ppo and pos values were the following: preFEV1 = 2.6±0.8L, ppo FEV1 =2.3±0.8L, and pos FEV1=2.3±0.8L, (pre FEV1 > ppo FEV1 = pos FEV1); pre6MWT = 604±63m, ppo6MWT= 529±103m, pos6MWT= 599±74m (pre6MWT = pos6MWT > ppo6MWT); preSCt = 32.9±7.6s, ppoSCt = 37.8±12.1s, posSCt = 33.7±8.5s (preSCt = posSCt < ppoSCt). CONCLUSION: In our group of patients, pulmonary resection led to loss of lung function measured by spirometry, but not to exercise capacity measured by stair-climbing and walk tests.

Comparison between actual and predicted postoperative stair-climbing test, walk test and spirometric values in patients undergoing lung resection / Comparação dos testes de escada, caminhada e espirometria preditos com os obtidos no pós-operatório de ressecções pulmonares

PURPOSE: To assess whether the tests - Forced Expiratory Volume at one second (FEV1), 6-minute walk test (6MWT) and stair-climbing test (SCT) showed proportional changes after the resection of functioning lung. METHODS: Candidates for pulmonary resection were included. Spirometry, 6MWT and SCT were performed preoperatively (pre) and at least 3 months after surgery (pos). SCT was performed on a staircase with a total ascent height of 12.16m. The time taken to climb the total height the fastest possible was defined as stair-climbing time (SCt). Number of functioning segments lost, was used to calculated predicted postoperative (ppo) tests values. Pre, ppo and pos values for each test were compared. Data were analyzed by repeated-measure ANOVA with significance level set at 5 percent. RESULTS: A total of 40 patients were enrolled. Pulmonary resection results ranged from gain of 2 functioning segments to loss of 9. Pre, ppo and pos values were the following: preFEV1 = 2.6±0.8L, ppo FEV1 =2.3±0.8L, and pos FEV1=2.3±0.8L, (pre FEV1 > ppo FEV1 = pos FEV1); pre6MWT = 604±63m, ppo6MWT= 529±103m, pos6MWT= 599±74m (pre6MWT = pos6MWT > ppo6MWT); preSCt = 32.9±7.6s, ppoSCt = 37.8±12.1s, posSCt = 33.7±8.5s (preSCt = posSCt < ppoSCt). CONCLUSION: In our group of patients, pulmonary resection led to loss of lung function measured by spirometry, but not to exercise capacity measured by stair-climbing and walk tests.

OBJETIVO: Verificar se os testes: Volume Expiratório Forçado no 1º segundo (VEF1), Teste de Caminhada de 6 minutos (TC6) e Teste de Escada (TE) se alteram proporcionalmente ao pulmão funcionante ressecado. MÉTODOS: Foram incluídos pacientes candidatos a toracotomia para ressecção pulmonar. No pré-operatório (pré) e no mínimo três meses após a cirurgia (pós), realizaram espirometria, TC6 e TE. O TE foi realizado em escada com 12,16m de altura. O tempo para subir todos os degraus o mais rápido possível foi chamado tempo de escada (tTE). Os cálculos dos valores dos testes preditos para o pós-operatório (ppo) foram realizados conforme o número de segmentos funcionantes perdidos. Os valores pré, ppo e pós foram comparados entre si para cada teste. Estatística: foi utilizada a análise de variância para medidas repetidas (ANOVA), com significância de 5 por cento. RESULTADOS: Foram estudados 40 pacientes. A ressecção pulmonar variou desde o ganho de dois segmentos funcionantes até a perda de 9. Os valores pré, ppo e pós foram respectivamente: VEF1 -pré = 2,6±0,8L, ppo = 2,3±0,8L, pós = 2,3±0,8L (VEF1pré > VEF1ppo = VEF1pós), TC6-pré = 604±63m, ppo = 529±103m, pós = 599±74m (TC6pré = TC6pós > TC6ppo), tTE-pré = 32,9±7,6s, ppo = 37,8±12,1s, pós = 33,7±8,5s (tTEpré = tTEpós < tTEppo). CONCLUSÃO: Nas ressecções pulmonares, este grupo de pacientes perdeu função pulmonar medida através da espirometria, mas não perdeu a capacidade de exercício, medida através dos testes de escada e caminhada.

Pharyngotonsillitis in children: view from a sample of pediatricians and otorhinolaryngologists.

UNLABELLED: Acute pharyngotonsillitis is a common upper airway infection in children. AIM: To analyze opinions and practices of pediatricians and otorhinolaryngologists from Sao Paulo State, Brazil, concerning diagnosis, treatment and prevention of pharyngotonsillitis and their complications in children. METHODS: We randomly selected 1,370 pediatricians and 1,000 otolaryngologists from Sao Paulo State, Brazil. A questionnaire was mailed to the specialists. STUDY DESIGN: Cross-sectional. RESULTS: 95.8% of the pediatricians and 91.5% of the otolaryngologists do not perform routine laboratory diagnosis for acute pharyngotonsillitis in children. The antimicrobials more commonly prescribed by pediatricians for treatment of bacterial pharyngotonsillitis were: oral penicillin for 10 days (33.6%) and s single injection of benzathine penicillin G (19.7%). The antimicrobials prescribed more often by otorhinolaryngologists for treatment were: oral penicillin for 10 days (35.4%) and oral penicillin for 7 days (25.7%). Tonsillectomy was considered the most effective measure for prevention of bacterial pharyngotonsillitis by more than half of pediatricians and otolaryngologists. Repeated pharyngotonsillitis was the main reason for otolaryngologists to indicate tonsillectomy for school-aged children and adolescents (49.3% and 53.4% respectively). CONCLUSIONS: It is necessary to standardize the practices of pediatricians and otolaryngologists regarding diagnosis and treatment of pharyngotonsillitis in children.