Brazilian Society of Otology task force - Vestibular Schwannoma ‒ evaluation and treatment.

OBJECTIVE: To review the literature on the diagnosis and treatment of vestibular schwannoma. METHODS: Task force members were educated on knowledge synthesis methods, including electronic database search, review and selection of relevant citations, and critical appraisal of selected studies. Articles written in English or Portuguese on vestibular schwannoma were eligible for inclusion. The American College of Physicians' guideline grading system and the American Thyroid Association's guideline criteria were used for critical appraisal of evidence and recommendations for therapeutic interventions. RESULTS: The topics were divided into 2 parts: (1) Diagnosis - audiologic, electrophysiologic tests, and imaging; (2) Treatment - wait and scan protocols, surgery, radiosurgery/radiotherapy, and systemic therapy. CONCLUSIONS: Decision making in VS treatment has become more challenging. MRI can diagnose increasingly smaller tumors, which has disastrous consequences for the patients and their families. It is important to develop an individualized approach for each case, which highly depends on the experience of each surgical team.

Effect of melatonin on otoprotection in rodents: a systematic review with meta-analysis

Abstract Objectives: To determinate the otoprotective efficacy of melatonin.in experimental models of rodents through a systematic review of the literature. Methods: Altogether, 154 articles were found in four databases. The PICOS strategy (Population, Intervention, Comparison, and Outcome) was used to define the eligibility criteria. Studies that met the inclusion criteria for the second step were included in a qualitative synthesis. Each study type was analyzed with the CAMARADES quality of assessment's checklist and the SYRCLE RoBS risk of bias. Results: Seven articles were selected, and four were included in the meta-analysis. It was possible to obtain seven outcomes according to the standard auditory frequencies presented among the studies, considering a minimum of three standard frequencies. The outcomes analyzed were for the frequencies of 1500, 2000, 3000, 4000, 5000, 6000, and 8000 Hz. Conclusion: Melatonin can provide protection against the ototoxic effects of cisplatin and aminoglycosides at 5000 Hz, 6000 Hz, and 8000 Hz, thereby minimizing the reduction in Otoacustic Emissions (OAE) amplitude. The same effect was not observed in the lower frequencies. Despite the limited number of studies that were evaluated, the results appeared consistent in higher frequencies. However, the methodology of the available studies did not meet the necessary methodological rigor that promotes the safe replicability of these studies.

Brazilian Society of Otology task force - Otosclerosis: evaluation and treatment

Abstract Objectives: To review and provide evidence-based recommendations for the diagnosis and treatment of otosclerosis. Methods: Task force members were educated on knowledge synthesis methods, including electronic database search, review and selection of relevant citations, and critical appraisal of selected studies. Articles written in English or Portuguese on otosclerosis were eligible for inclusion. The American College of Physicians' guideline grading system and the American Thyroid Association's guideline criteria were used for critical appraisal of evidence and recommendations for therapeutic interventions. Results: The topics were divided into 2 parts: 1) Diagnosis - audiologic and radiologic; 2) Treatment - hearing AIDS, pharmacological therapy, stapes surgery, and implantable devices - bone-anchored devices, active middle ear implants, and Cochlear Implants (CI). Conclusions: The pathophysiology of otosclerosis has not yet been fully elucidated, but environmental factors and unidentified genes are likely to play a significant role in it. Women with otosclerosis are not at increased risk of worsening clinical condition due to the use of contraceptives or during pregnancy. Drug treatment has shown little benefit. If the patient does not want to undergo stapedotomy, the use of hearing aids is well indicated. Implantable systems should be indicated only in rare cases, and the CI should be indicated in cases of profound deafness.

Changes in the communicative skills of young people as a result of a communication training.

PURPOSE: To analyze the effect of communication training developed for adolescents on the youth's communication skills. METHODS: Forty-one young people participated in the study and were divided into two groups. Group I received intervention - communication training for five weeks; Group II - were guided on the importance of voice for communication. Participants had their communication skills assessed before/after interventions through a self-administered questionnaire, answered by the participant and parents. Both groups had oral presentations recorded on video, which were analyzed by speech therapists through the evaluation of the communication profile, listing the aspects that should be observed as a point of strength/opportunity for improvement. Association between qualitative variables was assessed using Fischer's exact test, Pearson's chi-square test, McNemar's test, and McNemar-Bowker's test. To compare groups, paired t-test and t-test for independent samples, p level <0.05, were used. RESULTS: The analysis of questionnaires showed improvement in GI in two of the four skills assessed and no difference for GII. The video evaluations showed a significant difference between the groups in terms of eye contact and speech velocity. CONCLUSION: This study points out that the communication training method applied to young people might improve communicative skills, providing some insights into their communication strengths and potential areas for development.

Brazilian Society of Otology task force - Otosclerosis: evaluation and treatment.

OBJECTIVES: To review and provide evidence-based recommendations for the diagnosis and treatment of otosclerosis. METHODS: Task force members were educated on knowledge synthesis methods, including electronic database search, review and selection of relevant citations, and critical appraisal of selected studies. Articles written in English or Portuguese on otosclerosis were eligible for inclusion. The American College of Physicians' guideline grading system and the American Thyroid Association's guideline criteria were used for critical appraisal of evidence and recommendations for therapeutic interventions. RESULTS: The topics were divided into 2 parts: 1) Diagnosis - audiologic and radiologic; 2) Treatment - hearing AIDS, pharmacological therapy, stapes surgery, and implantable devices - bone-anchored devices, active middle ear implants, and Cochlear Implants (CI). CONCLUSIONS: The pathophysiology of otosclerosis has not yet been fully elucidated, but environmental factors and unidentified genes are likely to play a significant role in it. Women with otosclerosis are not at increased risk of worsening clinical condition due to the use of contraceptives or during pregnancy. Drug treatment has shown little benefit. If the patient does not want to undergo stapedotomy, the use of hearing aids is well indicated. Implantable systems should be indicated only in rare cases, and the CI should be indicated in cases of profound deafness.

Effect of melatonin on otoprotection in rodents: a systematic review with meta-analysis.

OBJECTIVES: To determinate the otoprotective efficacy of melatonin.in experimental models of rodents through a systematic review of the literature. METHODS: Altogether, 154 articles were found in four databases. The PICOS strategy (Population, Intervention, Comparison, and Outcome) was used to define the eligibility criteria. Studies that met the inclusion criteria for the second step were included in a qualitative synthesis. Each study type was analyzed with the CAMARADES quality of assessment's checklist and the SYRCLE RoBS risk of bias. RESULTS: Seven articles were selected, and four were included in the meta-analysis. It was possible to obtain seven outcomes according to the standard auditory frequencies presented among the studies, considering a minimum of three standard frequencies. The outcomes analyzed were for the frequencies of 1500, 2000, 3000, 4000, 5000, 6000, and 8000 Hz. CONCLUSION: Melatonin can provide protection against the ototoxic effects of cisplatin and aminoglycosides at 5000 Hz, 6000 Hz, and 8000 Hz, thereby minimizing the reduction in Otoacustic Emissions (OAE) amplitude. The same effect was not observed in the lower frequencies. Despite the limited number of studies that were evaluated, the results appeared consistent in higher frequencies. However, the methodology of the available studies did not meet the necessary methodological rigor that promotes the safe replicability of these studies.

Task force Guideline of Brazilian Society of Otology - hearing loss in children - Part II - Treatment.

OBJECTIVES: To provide an overview of the main evidence-based recommendations for the diagnosis of hearing loss in children and adolescents aged 0-18 years. METHODS: Task force members were educated on knowledge synthesis methods, including electronic database search, review and selection of relevant citations, and critical appraisal of selected studies. Articles written in English or Portuguese on childhood hearing loss were eligible for inclusion. The American College of Physicians' guideline grading system and the American Thyroid Association's guideline criteria were used for critical appraisal of evidence and recommendations for therapeutic interventions. RESULTS: The topics were divided into 2 parts: (1) treatment of sensorineural hearing loss: individual hearing aids, bilateral cochlear implants, cochlear implants in young children, unilateral hearing loss, and auditory neuropathy spectrum disorder; and (2) treatment of conductive/mixed hearing loss: external/middle ear malformations, ventilation tube insertion, and tympanoplasty in children. CONCLUSIONS: In children with hearing loss, in addition to speech therapy, Hearing AIDS (HAs) or implantable systems may be indicated. Even in children with profound hearing loss, both the use of HAs and behavioral assessments while using the device are important.

Task force Guideline of Brazilian Society of Otology ‒ hearing loss in children - Part I ‒ Evaluation.

OBJECTIVES: To provide an overview of the main evidence-based recommendations for the diagnosis of hearing loss in children and adolescents aged 0 to 18 years. METHODS: Task force members were educated on knowledge synthesis methods, including electronic database search, review and selection of relevant citations, and critical appraisal of selected studies. Articles written in English or Portuguese on childhood hearing loss were eligible for inclusion. The American College of Physicians' guideline grading system and the American Thyroid Association's guideline criteria were used for critical appraisal of evidence and recommendations for therapeutic interventions. RESULTS: The evaluation and diagnosis of hearing loss: universal newborn hearing screening, laboratory testing, congenital infections (especially cytomegalovirus), genetic testing and main syndromes, radiologic imaging studies, vestibular assessment of children with hearing loss, auditory neuropathy spectrum disorder, autism spectrum disorder, and noise-induced hearing loss. CONCLUSIONS: Every child with suspected hearing loss has the right to diagnosis and appropriate treatment if necessary. This task force considers 5 essential rights: (1) Otolaryngologist consultation; (2) Speech assessment and therapy; (3) Diagnostic tests; (4) Treatment; (5) Ophthalmologist consultation.

Avaliação audiológica em bebês nascidos de mães que tiveram covid-19 no período gestacional / Audiological assessment in babies born to mothers who had covid-19 during gestation / Evaluación audiológica en bebés nacidos de madres que tenían covid-19 durante la gestación

Introdução: No final de dezembro de 2019, um grupo de casos inexplicáveis de pneumonia foi relatado em Wuhan, China. Alguns dias depois, o agente causador dessa misteriosa doença foi identificado como um novo coronavírus que se disseminou de forma rápida. As infecções maternas, contraídas antes ou durante a gravidez, podem ser transmitidas ao feto, durante a gestação (infecção congênita), durante o parto (infecção perinatal) e pela amamentação (infecção pós-natal) e podem causar danos ao feto ou ao recém-nascido. Objetivo: descrever a avaliação audiológica realizada em uma série de crianças cujas mães tiveram COVID-19, em sua forma leve, no período gestacional. Metodologia: Para a avaliação audiológica foram realizadas a anamnese e os exames de emissões otoacústicas por produto de distorção, nas frequências de 1,5 a 12KHz e pontencial auditivo de tronco encefálico por click. Resultados: A amostra foi composta por 47 recém-nascidos recém-nascidos. Os resultados dos testes das emissões otoacústicas evocadas por produto de distorção indicaram funcionalidade das estruturas avaliadas apontando normalidade da função coclear com nível de resposta adequado para a média de resultados obtidos até a frequência de 11kHz para a amplitude de resposta e para a relação sinal-ruído. Foi possível encontrar em toda a amostra a presença das ondas I, III e V na intensidade de 80dBHL e presença da onda V nas intensidades de 50 e 35dBHL bilateralmente. Conclusão: Não foi estabelecida uma correlação direta da infecção materna pelo vírus da covid-19 com os achados audiológicos nos recém- nascidos. Cabe mencionar que esse foi um estudo preliminar e que essas crianças precisam continuar em acompanhamento para investigação de futuros desfechos tardios no aparelho auditivo.

Introduction: In late December 2019, a cluster of unexplained pneumonia cases was reported in Wuhan, China. A few days later, the causative agent of this mysterious disease was identified as a new coronavirus that spread rapidly. Maternal infections, contracted before or during pregnancy, can be transmitted to the fetus during pregnancy (congenital infection), during childbirth (perinatal infection) and through breastfeeding (postnatal infection) and can cause harm to the fetus or newborn. -born. Objective: to describe the audiological evaluation carried out in a series of children whose mothers had COVID-19, in its mild form, during the gestational period. Methodology: For the audiological evaluation, anamnesis and distortion product otoacoustic emissions tests were carried out, at frequencies from 1.5 to 12KHz and brainstem auditory potential by click. Results: The sample consisted of 47 newborns. The results of the distortion product evoked otoacoustic emissions tests indicated functionality of the evaluated structures, pointing to normal cochlear function with an adequate response level for the average of results obtained up to a frequency of 11kHz for the response amplitude and the signal-to-noise ratio. . It was possible to find in the entire sample the presence of waves I, III and V at an intensity of 80dBHL and the presence of wave V at intensities of 50 and 35dBHL bilaterally. Conclusion: A direct correlation between maternal infection by the Covid-19 virus and audiological findings in newborns was not established. It is worth mentioning that this was a preliminary study and that these children need to continue being monitored to investigate future late outcomes with the hearing aid.

Introducción: A finales de diciembre de 2019, se informó un grupo de casos de neumonía inexplicable en Wuhan, China. Unos días después, el agente causante de esta misteriosa enfermedad fue identificado como un nuevo coronavirus que se propagó rápidamente. Las infecciones maternas, contraídas antes o durante el embarazo, pueden transmitirse al feto durante el embarazo (infección congénita), durante el parto (infección perinatal) y a través de la lactancia (infección posnatal) y pueden causar daños al feto o al recién nacido. Objetivo: describir la evaluación audiológica realizada a una serie de niños cuyas madres tuvieron COVID-19, en su forma leve, durante el período gestacional. Metodología: Para la evaluación audiológica se realizaron pruebas de anamnesis y otoemisiones acústicas de productos de distorsión, en frecuencias de 1,5 a 12KHz y potencial auditivo de tronco encefálico mediante click. Resultados: La muestra estuvo compuesta por 47 recién nacidos. Los resultados de las pruebas de distorsión producto de emisiones otoacústicas evocadas indicaron funcionalidad de las estructuras evaluadas, apuntando a una función coclear normal con un nivel de respuesta adecuado para los resultados promedio obtenidos hasta una frecuencia de 11kHz para la amplitud de respuesta y la relación señal-ruido. . Se pudo encontrar en toda la muestra la presencia de ondas I, III y V con una intensidad de 80dBHL y la presencia de la onda V con intensidades de 50 y 35dBHL de forma bilateral. Conclusión: No se estableció una correlación directa entre la infección materna por el virus Covid-19 y los hallazgos audiológicos en los recién nacidos. Cabe mencionar que este fue un estudio preliminar y que estos niños necesitan seguir siendo monitoreados para investigar futuros resultados tardíos con el audífono.

Hearing habits of young adolescent students from public and private schools in the Brazilian Federal District / Hábitos auditivos de jovens adolescentes escolares da rede pública e privada do Distrito Federal

ABSTRACT Purpose: to analyze the hearing habits of a group of students between public and private schools and compare the degree of exposure to sound stimuli via earphones. Methods: 1,085 public and private school students received a questionnaire on hearing habits and exposure to amplified music. Their answers to these questions were analyzed and compared between the groups of students. The chi-square test compared hearing habits between public and private schools, with the statistical significance level set at 5% (p < 0.05). Result: in general, most students (92%) reported hearing habits of exposure to amplified music. Questionnaire answers indicated a high prevalence of both earphone use (92%) and attendance at places with loud music (63.6%). Conclusion: private school students use earphones more often than those from public schools.

RESUMO Objetivo: analisar os hábitos auditivos de um grupo de alunos e comparar o grau de exposição ao estímulo sonoro via fones de ouvido entre escolas públicas e privadas. Métodos: foram distribuídos questionários contendo perguntas referentes a hábitos auditivos de exposição à música amplificada, aos 1085 alunos de escolas pública e privada. Em seguida, as respostas aos questionamentos foram analisadas e comparadas entre os grupos de alunos. Utilizou-se o teste Qui-quadrado com um nível de significância estatística estabelecido em 5% (p<0,05) para se comparar os hábitos auditivos entre as escolas públicas e privadas. Resultado: de modo geral, a maioria dos alunos (92%) respondeu que tem hábitos auditivos de exposição à música amplificada. Tanto o uso de fones de ouvido (92%) quanto as idas a lugares com música alta (63,6%) tiveram alta prevalência nas respostas aos questionários. Conclusão: alunos de escolas particulares utilizam mais fones de ouvido frequentemente comparados aos alunos de escolas públicas.

Changes in the communicative skills of young people as a result of a communication training / Alterações das habilidades comunicativas de adolescentes como resultado de um treinamento em comunicação

ABSTRACT Purpose To analyze the effect of communication training developed for adolescents on the youth's communication skills. Methods Forty-one young people participated in the study and were divided into two groups. Group I received intervention - communication training for five weeks; Group II - were guided on the importance of voice for communication. Participants had their communication skills assessed before/after interventions through a self-administered questionnaire, answered by the participant and parents. Both groups had oral presentations recorded on video, which were analyzed by speech therapists through the evaluation of the communication profile, listing the aspects that should be observed as a point of strength/opportunity for improvement. Association between qualitative variables was assessed using Fischer's exact test, Pearson's chi-square test, McNemar's test, and McNemar-Bowker's test. To compare groups, paired t-test and t-test for independent samples, p level <0.05, were used. Results The analysis of questionnaires showed improvement in GI in two of the four skills assessed and no difference for GII. The video evaluations showed a significant difference between the groups in terms of eye contact and speech velocity. Conclusion This study points out that the communication training method applied to young people might improve communicative skills, providing some insights into their communication strengths and potential areas for development.

RESUMO Objetivo Analisar o efeito de um treinamento em comunicação desenvolvido para adolescentes nas habilidades comunicativas dos jovens. Método Quarenta e um jovens participaram do estudo divididos em dois grupos. Grupo I - treinamento de comunicação por duas semanas; Grupo II - palestra sobre importância da voz. Os participantes tiveram suas habilidades comunicativas avaliadas antes e após as intervenções mediante questionário autoaplicado respondido pelos jovens e seus pais. Ambos os grupos tiveram apresentações orais gravadas antes e após as intervenções, que foram avaliadas por fonoaudiólogos através de questionário, listando características da comunicação. A associação entre variáveis qualitativas foi verificada usando teste exato de Fisher, qui-quadrado de Pearson, teste de McNemar e teste de McNemar-Bowker. Para comparação entre os grupos, foram usados teste t para amostras pareadas e teste t para amostras independentes com nível de significância de 95%. Resultados A análise dos questionários mostrou melhora do Grupo I em duas das quatro habilidades avaliadas, não havendo diferença no Grupo II. A avalição dos vídeos mostrou diferença significativa entre os grupos no contato visual e na velocidade da fala. Conclusão O estudo mostrou que o método de treinamento de comunicação aplicado aos jovens, melhorou habilidades comunicativas, fornecendo autoconhecimento sobre seus pontos fortes e pontos que podem ser melhorados.

Brazilian Society of Otology task force - Vestibular Schwannoma - evaluation and treatment

Abstract Objective: To review the literature on the diagnosis and treatment of vestibular schwannoma. Methods: Task force members were educated on knowledge synthesis methods, including electronic database search, review and selection of relevant citations, and critical appraisal of selected studies. Articles written in English or Portuguese on vestibular schwannoma were eligible for inclusion. The American College of Physicians' guideline grading system and the American Thyroid Association's guideline criteria were used for critical appraisal of evidence and recommendations for therapeutic interventions. Results: The topics were divided into 2 parts: (1) Diagnosis - audiologic, electrophysiologic tests, and imaging; (2) Treatment - wait and scan protocols, surgery, radiosurgery/radiotherapy, and systemic therapy. Conclusions: Decision making in VS treatment has become more challenging. MRI can diagnose increasingly smaller tumors, which has disastrous consequences for the patients and their families. It is important to develop an individualized approach for each case, which highly depends on the experience of each surgical team.

Task force of the Brazilian Society of Otology - evaluation and management of peripheral facial palsy.

OBJECTIVE: To review key evidence-based recommendations for the diagnosis and treatment of peripheral facial palsy in children and adults. METHODS: Task force members were educated on knowledge synthesis methods, including electronic database search, review and selection of relevant citations, and critical appraisal of selected studies. Articles written in English or Portuguese on peripheral facial palsy were eligible for inclusion. The American College of Physicians' guideline grading system and the American Thyroid Association's guideline criteria were used for critical appraisal of evidence and recommendations for therapeutic interventions. RESULTS: The topics were divided into 2 main parts: (1) Evaluation and diagnosis of facial palsy: electrophysiologic tests, idiopathic facial palsy, Ramsay Hunt syndrome, traumatic peripheral facial palsy, recurrent peripheral facial palsy, facial nerve tumors, and peripheral facial palsy in children; and (2) Rehabilitation procedures: surgical decompression of the facial nerve, facial nerve grafting, surgical treatment of long-term peripheral facial palsy, and non-surgical rehabilitation of the facial nerve. CONCLUSIONS: Peripheral facial palsy is a condition of diverse etiology. Treatment should be individualized according to the cause of facial nerve dysfunction, but the literature presents better evidence-based recommendations for systemic corticosteroid therapy.

Task force Guideline of Brazilian Society of Otology - hearing loss in children - Part II - Treatment

Abstract Objectives: To provide an overview of the main evidence-based recommendations for the diagnosis of hearing loss in children and adolescents aged 0-18 years. Methods: Task force members were educated on knowledge synthesis methods, including electronic database search, review and selection of relevant citations, and critical appraisal of selected studies. Articles written in English or Portuguese on childhood hearing loss were eligible for inclusion. The American College of Physicians' guideline grading system and the American Thyroid Association's guideline criteria were used for critical appraisal of evidence and recommendations for therapeutic interventions. Results: The topics were divided into 2 parts: (1) treatment of sensorineural hearing loss: individual hearing aids, bilateral cochlear implants, cochlear implants in young children, unilateral hearing loss, and auditory neuropathy spectrum disorder; and (2) treatment of conductive/mixed hearing loss: external/middle ear malformations, ventilation tube insertion, and tympanoplasty in children. Conclusions: In children with hearing loss, in addition to speech therapy, Hearing AIDS (HAs) or implantable systems may be indicated. Even in children with profound hearing loss, both the use of HAs and behavioral assessments while using the device are important.

Melatonin prevents age-related hearing loss in the murin experimental model

Abstract Objective: The present study aimed to perform a morphological and morphometric analysis of cochlear structures of C57BL/6J mice receiving oral melatonin for a 12-month period. Methods: 32 male C57BL/6J were divided into control and melatonin groups. Control received saline and ethanol solution and melatonin group, 50 μL of 10 mg of melatonin/kg/day orally for a 12-month period. After de experiment the animals were sacrificed into a 40% concentration of CO2 chamber, and the blades were morphological and morphometrically analyzed. Results: The melatonin group revealed a higher median density of viable cells (45 ± 10.28 cells/100 μm2, 31-73, vs. 32 ± 7.47 cells/100 μm2, 25-48). The median area of stria vascularis was 55.0 ± 12.27 cells/100 μm2 (38-80) in the control, and 59.0 ± 16.13 cells/100 μm2 (40-134) in the melatonin group. The morphometric analysis of the spiral ligament reveals a higher median of total viable neurons in the melatonin (41 ± 7.47 cells/100 μm2, 27-60) than in the control group (31 ± 5.68 cells/100 μm2, 21-44). Conclusion: Although melatonin is a potent antioxidant, it does not completely neutralize the occurrence of presbycusis; however, it may delay the onset of this condition. Level of evidence: 3.

Melatonin prevents age-related hearing loss in the murin experimental model.

OBJECTIVE: The present study aimed to perform a morphological and morphometric analysis of cochlear structures of C57BL/6J mice receiving oral melatonin for a 12-month period. METHODS: 32 male C57BL/6J were divided into control and melatonin groups. Control received saline and ethanol solution and melatonin group, 50 µL of 10 mg of melatonin/kg/day orally for a 12-month period. After de experiment the animals were sacrificed into a 40% concentration of CO2 chamber, and the blades were morphological and morphometrically analyzed. RESULTS: The melatonin group revealed a higher median density of viable cells (45 ±â€¯10.28 cells/100 µm2, 31-73, vs. 32 ±â€¯7.47 cells/100 µm2, 25-48). The median area of stria vascularis was 55.0 ±â€¯12.27 cells/100 µm2 (38-80) in the control, and 59.0 ±â€¯16.13 cells/100 µm2 (40-134) in the melatonin group. The morphometric analysis of the spiral ligament reveals a higher median of total viable neurons in the melatonin (41 ±â€¯7.47 cells/100 µm2, 27-60) than in the control group (31 ±â€¯5.68 cells/100 µm2, 21-44). CONCLUSION: Although melatonin is a potent antioxidant, it does not completely neutralize the occurrence of presbycusis; however, it may delay the onset of this condition.

Etiopathogenic features of severe epistaxis in histological samples from individuals with or without arterial hypertension.

There is a consensus that arterial hypertension (AH) is associated with stroke. Therefore, this study aimed to evaluate the histology of the microvasculature associated with the mucosa of the posterior nasal cavity to identify possible factors related to vascular weakening and rupture. Histological sections were obtained from hypertensive and normotensive individuals, regardless of epistaxis. Our results showed that the group with AH had: (a) smaller median diameter of the lumen of arteries and arterioles; (b) increased thickness of the intimal arteries and arterioles, slight inflammatory infiltrate, and rupture of internal elastic lamina; (c) greater thickness of the middle tunica in arterioles; (d) lower percentage of histological sections with non-injured intimal layers in capillaries, arterioles, and small arteries; (e) lower percentage of histological sections with intact media tunic and/or myocytes juxtaposed in arteries and arterioles; (f) no difference between the diameters of small arteries or arterioles. The intima was thicker in individuals with severe epistaxis than in the normotensive group, but it did not differ from the AH group. Thus, hypertension may cause structural lesions in the vascular layers, and in the absence of tissue repair and the persistence of AH, these lesions may favour vascular rupture, especially during hypertensive peaks.

Dysphonia Interference in Schoolteachers' Speech Intelligibility in the Classroom.

"Among the most common occupations, schooteachers are the ones who experience the most changes throughout their career. Considering this, the present study aims to verify whether dysphonia in three different degrees may compromise the speech intelligibility of schoolteachers in the classroom. METHOD: Overall, 39 students, average age 10 years, randomly selected from a public school in the Federal District, Brazil (Distrito Federal, Brasil) performed a transcription task of 20 sentences spoken by four distinct female voices in a classroom, one with a control voice (normal), another with mild dysphonia, 1 with moderate dysphonia and another with severe dysphonia. None of the voices in the study presented changes, neither in fluency nor articulation nor neurological changes. The sentences were previously recorded in an acoustically treated booth, with a microphone on a pedestal 5 cm away from the speaker's mouth. For each sentence to be recorded, the speech model was provided by the speech therapist and then repeated by the speaker according to the model. Each voice recorded 5 different sentences, phonetically balanced and with equivalent number of words. The students included in the study underwent auditory, auditory processing, sequential memory for verbal sounds and sound source location tests, fulfilling the normality criteria. They also did not have neurological or motor disorders or learning, speech or language disorders. Academic success was also taken into account. For the experiment, a speaker was placed in front of the classroom, 1 m from the wall and 1 m from the floor, and students were randomly assigned to the classroom seats. After listening to each sentence, some time was assigned for its transcription by each student. RESULTS: The occurrence of errors was higher in voices with moderate and severe dysphonia, in which a significant difference was found (P ≤0.003) showing that voices with moderate and severe dysphonia were less intelligible than the normal voice (control voice). No difference was found between the normal voice and the mild dysphonic voice. Binary logistic regression analysis also showed that students had a 2.55 times higher chance of making mistakes with moderate dysphonic voice (P ≤0.011), and that this chance was 3.06 times greater for severe dysphonic voice (P ≤0.002) when compared to the normal voice (control voice). CONCLUSION: Moderate and severe dysphonia in the voices of schoolteachers interferes with the intelligibility of students, and the greater the degree of dysphonia of the teacher, the greater the chance that the student will make intelligibility errors."

Hearing of neonates without risk indicators for hearing loss and use of antimalarial drugs during pregnancy: a historical cohort study in the Northern Region of Brazil / Audição de neonatos sem indicadores de risco para perda auditiva e utilização de antimaláricos na gestação: um estudo de coorte histórica na Região Norte

Abstract Introduction: Studies have demonstrated the ototoxic effects of antimalarial drugs in individuals who receive these drugs, but little is known regarding the toxicity of these drugs in the newborn auditory system when administered to the mother receive the drug during pregnancy. Objective: To verify the incidence of hearing loss in neonates who have no other associated risk indicators, born to mothers treated for malaria during pregnancy. Methods: A retrospective, quantitative cohort study was developed at Hospital de Base Dr. Ary Pinheiro and Clínica Limiar, both located in the municipality of Porto Velho (Rondônia). The sample consisted of 527 newborns divided into two groups: exposed to antimalarials drugs during pregnancy group (n = 32) and non-exposed group (n = 495). Data collection took place from September 2014 to December 2015, through an interview with the mothers and/or guardians of the newborn, through the newborns' and the mothers' records, and the neonatal hearing screening database of the above-mentioned institutions. Results: All the neonates in the exposed group, assessed through the recording of transient otoacoustic emissions associated with the automated brainstem auditory evoked potential test, underwent neonatal hearing screening in the first examination. Among the newborns in the non-exposed group, 30 showed failure and were retested. Of these, one continued to fail and was referred for diagnosis, in whom the results showed to be within the normal range. Among the neonates of the exposed group, infection with Plasmodium vivax was the most frequent, and was similarly distributed among the gestational trimesters, and chloroquine was the most commonly used antimalarial drug treatment more often given during the third trimester; these findings did not show any influence on the audiological findings of the studied neonates. Conclusion: The present study did not identify any cases of hearing loss in neonates born to mothers who used antimalarial drugs during gestation.

Resumo Introdução: Estudos comprovam os efeitos ototóxicos dos antimaláricos em pessoas que fazem uso destes medicamentos, porém pouco se sabe sobre a toxicidade destes fármacos no sistema auditivo de neonatos quando ingeridos pelas mães no período gestacional. Objetivo: Verificar a incidência de perda auditiva em neonatos de mães tratadas para malária durante a gestação sem outros indicadores de risco associados. Método: Estudo quantitativo, de coorte retrospectivo, desenvolvido no Hospital de Base Dr. Ary Pinheiro e na Clínica Limiar, ambos em Porto Velho (Rondônia). Compuseram a amostra 527 recém-nascidos divididos em dois grupos: grupo exposto (n = 32) e grupo não exposto (n = 495). A coleta de dados ocorreu de setembro de 2014 a dezembro de 2015, através de entrevista com as genitoras e/ou responsáveis pelo recém-nascido, investigação nos prontuários dos neonatos e das genitoras e no banco de dados da triagem auditiva neonatal das instituições supracitadas. Resultados: Todos os neonatos do grupo exposto, avaliados através do registro das emissões otoacústicas transientes associado a realização do potencial evocado auditivo de tronco encefálico automático passaram na triagem auditiva neonatal no primeiro exame. Já, entre os recém-nascidos do grupo não exposto, 30 apresentaram falha e foram retestados. Destes, um continuou falhando e foi encaminhado para diagnóstico, no qual foram evidenciados resultados dentro da normalidade. Nos neonatos do grupo exposto, a infecção pelo Plasmodium vivax foi a mais frequente, mostrando distribuição semelhante entre os trimestres gestacionais, sendo a cloroquina o antimalárico mais utilizado e o tratamento medicamentoso realizado mais frequentemente no terceiro trimestre, porém tais achados não mostraram influência sobre os achados audiológicos dos neonatos estudados. Conclusão: O presente estudo não identificou casos de perda auditiva nos neonatos de mães que utilizaram antimaláricos na gestação.

Systematic Review of Auditory Perceptual and Acoustic Characteristics of the Voice of Cochlear Implant Adult Users.

STATEMENT OF PROBLEM: What are the normative data available on the perceptual and acoustic characteristics of the voice of adults of both sexes who have hearing-impairment and who use cochlear implants? PURPOSE: To identify in the literature, normative data about the perceptual auditory and acoustic characteristics of the voice of hearing-impaired cochlear implant adult users. SEARCH STRATEGY: A systematic search was carried out in the Virtual Health Library, Web of Science, Science Direct, SciELO, and SCOPUS databases with no temporal restriction. SELECTION CRITERIA: The articles were selected if they led with citation to normative data of the acoustic analysis of the voice of deaf cochlear implant users. And duplicate articles, case studies, letters to the editor, reviews, and studies that were not directly related to the topic were excluded. DATA EXTRACTION: The data from each article were extracted according to the Preferred Reporting Items for Systematic Reviews and Meta-analysis checklist: title, abstract, year of publication, journal, authors and country of origin, identification of background, purpose, study design, participants, variables, and data measurement. DATA SYNTHESIS: There were 1,052 publications that met the search criteria. After applying the Preferred Reporting Items for Systematic Reviews and Meta-analysis checklist, excluding duplicates, and reading of the full text, 10 papers were selected for further analysis. Although several voice parameters have been studied, there is a great variation in study designs, sample sizes, age of participants, voice samples analyzed, and cochlear implant specifications. CONCLUSION: The normative data available in the literature concerning the voice of cochlear implant users are consistent only in terms of fundamental frequency.