Wideband Acoustic Absorbance in Otosclerosis: Does Stapedotomy Restore Normal Tympanic Cavity Function?

Abstract Introduction Otosclerosis is characterized by the fixation of the stapes to the oval window, thereby impairing acoustic signal absorbance. A commonly used surgical technique for improving hearing in cases of otosclerosis is stapedotomy. However, it is unclear whether this surgery restores all the physical characteristics of the tympano-ossicular system. Objective To evaluate the tympano-ossicular system in individuals with fenestral otosclerosis pre and poststapedotomy using wideband tympanometry. Method A total of 47 individuals and 71 ears were assessed. The subjects were divided into three groups: presurgery otosclerosis; postsurgery; and a control group of normal-hearing adults. A handheld tympanometer with a wideband module (226-8,000 Hz) was used to take measurements at ambient pressure and under pressurized conditions. The level of statistical significance adopted was p ≤ 0.05. Results Acoustic absorbance at 226 Hz was low for all groups. At frequencies in the range 630 to 5,040 Hz, each group had a characteristic absorbance curve, allowing them to be distinguished from one another. In the presurgery group, absorbance values were below normal levels, with energy absorbance below 10%. Low energy absorbance was most evident at 1,000 Hz in the presurgery group, but this was not observed in the postsurgery group. Although there was an improvement in hearing, the surgery failed to restore the tympano-ossicular system to normal. Conclusion Wideband acoustic absorbance proved able to differentiate normal ears and otosclerotic ears pre and postsurgery, under both ambient pressure and pressurized conditions.

Analysis of wideband tympanometry in Ménière's disease / Análise da timpanometria de banda larga na doença de Ménière

Abstract Introduction: Endolymphatic hydrops is the pathophysiological substrate of Ménière's disease. The changes in the inner ear, transmitted to the middle ear through changes in the ossicular chain mobility, can be quantified by wideband tympanometry, through the measurement of the acoustic absorbance at multiple frequencies, represented by the sound energy absorbed by the middle ear, even at its early stages. Studying the behavior of the middle ear through the absorbance in patients with endolymphatic hydrops under ambient pressure and under peak pressure can be useful for detecting Ménière's disease. Objective: To characterize acoustic absorbance behavior in subjects with symptomatic and asymptomatic Ménière's disease compared to controls, in order to verify the ability of wideband tympanometry to detect Ménière's disease. Methods: We carried out a cross-sectional study with a diagnostic approach comparing the findings of wideband tympanometry at ambient pressure and peak pressure between the ears of the control group (n = 30), the asymptomatic group (n = 21) and the symptomatic group (n = 9). Results: Different peak pressure values were found between the ears of the control group (0daPa), the asymptomatic group (−11 daPa) and the symptomatic group (−192 daPa), with p < 0.05 by the Kruskal-Wallis test, Mann Whitney test and Bonferroni correction. Different absorbance values were found between the ears of the symptomatic group and the asymptomatic group compared to the control group for low frequencies at ambient pressure and peak pressure, with p < 0.05 by the Kruskal-Wallis test, Mann Whitney test and Bonferroni correction. Conclusions: The Wideband Tympanometry test was capable of identifying the presence of Ménières disease, and to differentiate between asymptomatic and symptomatic patients, when comparing them with healthy individuals.

Resumo Introdução: A hidropsia endolinfática é o substrato fisiopatológico da doença de Ménière. As alterações desencadeadas na orelha interna, transmitidas à orelha média pelas modificações na mobilidade da cadeia ossicular, podem ser quantificadas pela timpanometria de banda larga, através da medida da absorvância acústica sob múltiplas frequências, representadas pela energia sonora absorvida pela orelha média, mesmo em estágios iniciais de sua instalação. Estudar o comportamento da orelha média através da absorvância em pacientes com hidropisia endolinfática sob pressão ambiente e sob o pico de pressão pode ser útil na detecção da doença de Ménière. Objetivo: Caracterizar o comportamento da absorvância em indivíduos com diagnóstico da doença de Ménière sintomáticos e assintomáticos, comparados com controles, a fim de verificar a capacidade da timpanometria de banda larga em detectar variações clínicas relacionadas a possível hidropisia endolinfática. Método: Foi realizado um estudo transversal, com enfoque diagnóstico, que comparou os achados da timpanometria de banda larga na pressão ambiente e no pico de pressão entre orelhas do grupo controle (n = 30), grupo assintomático (n = 21) e grupo sintomático (n = 9). Resultados: Foram encontrados valores do pico de pressão diferentes entre orelhas do grupo controle (0 daPa), do grupo assintomático (-11 daPa) e do grupo sintomático (-192 daPa), com p <0,05 pelos testes de Kruskal-Wallis, Mann Whitney e correção de Bonferroni. Foram encontrados valores de absorvância diferentes entre orelhas do grupo sintomático e do grupo assintomático em relação ao grupo controle para as frequências baixas na pressão ambiente e na pressão de pico, com p < 0,05 pelos testes de Kruskal-Wallis, Mann Whitney e correção de Bonferroni. Conclusão: A timpanometria de banda larga foi um teste capaz de identificar a presença da doença de Ménière e de diferenciar os pacientes assintomáticos e sintomáticos, comparando-os com indivíduos hígidos.

Analysis of wideband tympanometry in Ménière's disease.

INTRODUCTION: Endolymphatic hydrops is the pathophysiological substrate of Ménière's disease. The changes in the inner ear, transmitted to the middle ear through changes in the ossicular chain mobility, can be quantified by wideband tympanometry, through the measurement of the acoustic absorbance at multiple frequencies, represented by the sound energy absorbed by the middle ear, even at its early stages. Studying the behavior of the middle ear through the absorbance in patients with endolymphatic hydrops under ambient pressure and under peak pressure can be useful for detecting Ménière's disease. OBJECTIVE: To characterize acoustic absorbance behavior in subjects with symptomatic and asymptomatic Ménière's disease compared to controls, in order to verify the ability of wideband tympanometry to detect Ménière's disease. METHODS: We carried out a cross-sectional study with a diagnostic approach comparing the findings of wideband tympanometry at ambient pressure and peak pressure between the ears of the control group (n = 30), the asymptomatic group (n = 21) and the symptomatic group (n = 9). RESULTS: Different peak pressure values were found between the ears of the control group (0 daPa), the asymptomatic group (-11 daPa) and the symptomatic group (-192 daPa), with p < 0.05 by the Kruskal-Wallis test, Mann Whitney test and Bonferroni correction. Different absorbance values were found between the ears of the symptomatic group and the asymptomatic group compared to the control group for low frequencies at ambient pressure and peak pressure, with p < 0.05 by the Kruskal-Wallis test, Mann Whitney test and Bonferroni correction. CONCLUSIONS: The Wideband Tympanometry test was capable of identifying the presence of Ménière´s disease, and to differentiate between asymptomatic and symptomatic patients, when comparing them with healthy individuals.

Traumatic perforations of the tympanic membrane: immediate clinical recovery with the use of bacterial cellulose film / Perfurações traumáticas da membrana timpânica: recuperação clínica imediata com o uso de fragmento de celulose bacteriana

Abstract Introduction: Perforation of the tympanic membrane is a reasonably frequent diagnosis in otorhinolaryngologists' offices. The expectant management is to wait for spontaneous healing, which usually occurs in almost all cases in a few weeks. However, while waiting for healing to be completed, the patients may experience uncomfortable symptoms. Although some research suggests the use of various materials to aid in the recovery of the tympanic membrane, none presented robust evidence of improvement in the cicatricial process. Nevertheless, the occlusion of the perforation with some material of specific texture and resistance can alleviate the patients' symptoms and accelerate the healing process. Objective: To evaluate the clinical (symptomatic and functional) improvement after the placement of bacterial cellulose film (Bionext®) on tympanic membrane perforations (traumatic). Methods: We evaluated 24 patients, victims of traumatic perforations of the tympanic membrane, who were evaluated in the Otorhinolaryngology Emergency Room. Following otoscopy and audiometric examination was performed, before and after the use of cellulose film occluding the tympanic membrane perforation. Results: Twenty-four patients were included, whose degree of overall discomfort caused by the tympanic membrane perforation and the presence of symptoms of autophonia, ear fullness and tinnitus were investigated. The mean score attributed to the overall annoyance caused by tympanic membrane perforation was 7.79, decreasing to a mean value of 2.25 after the film application. Symptom evaluation also showed improvement after using the film: autophonia decreased from a mean value of 6.25 to 2.08, tinnitus from 7 to 1.92 and ear fullness from 7.29 to 1.96. The auditory analysis showed mean threshold values still within the normal range at low and medium frequencies, with slight hearing loss at acute frequencies, but with significant improvement at all frequencies, with the exception of 8000 Hz, after film use. Conclusion: The use of bacterial cellulose film fragment on traumatic perforations of the tympanic membrane promoted immediate functional and symptomatic recovery in the assessed patients.

Resumo Introdução: A perfuração da membrana timpânica é uma condição clínica relativamente frequente em consultórios de otorrinolaringologistas. A conduta é quase sempre expectante, aguardando cicatrização espontânea, que costuma ocorrer na quase totalidade dos casos em algumas semanas. No entanto, enquanto não se completa, os pacientes mantêm sintomas desconfortáveis. Embora algumas pesquisas sugiram o uso de materiais diversos para auxiliar na recuperação da membrana timpânica, nenhuma apresentou evidência substancial de melhoria no processo cicatricial. Por outro lado, a oclusão da perfuração com alguns materiais de textura e resistência específicas poderia aliviar os sintomas dos pacientes durante o processo cicatricial. Objetivo: Avaliar a melhoria clínica (sintomática e funcional) após a colocação de película de celulose bacteriana (Bionext®) sobre a perfuração da membrana timpânica (traumática). Método: Foram avaliados pacientes com perfurações traumáticas da membrana timpânica que deram entrada no pronto-socorro de otorrinolaringologia. Eles foram avaliados em relação a suas queixas e exame audiométrico, antes e após a aplicação de película de celulose que oclui a perfuração da membrana timpânica. Resultados: Foram incluídos 24 pacientes, nos quais foram pesquisados o grau de incômodo global causado pela perfuração da membrana timpânica e a presença de sintomas de autofonia, plenitude auricular e tinnitus. A média da nota atribuída ao incômodo global causado pela perfuração foi de 7,79; caiu para valor médio de 2,25 após a aplicação da película. A avaliação dos sintomas também apresentou melhoria após uso da película, autofonia caiu de valor médio de 6,25 para 2,08; zumbido de 7 para 1,92 e plenitude auricular de 7,29 para 1,96. A análise auditiva apresentou um valor médio de limiares ainda dentro da normalidade em frequências baixas e médias, com perda de audição leve em frequências agudas, porém com melhoria significante em todas as frequências, com exceção de 8000 Hz, após a colocação da película. Conclusão: A aplicação de fragmento de película de celulose bacteriana sobre perfurações traumáticas da membrana timpânica promoveu recuperação funcional e sintomática imediata nos pacientes estudados.

Traumatic perforations of the tympanic membrane: immediate clinical recovery with the use of bacterial cellulose film.

INTRODUCTION: Perforation of the tympanic membrane is a reasonably frequent diagnosis in otorhinolaryngologists' offices. The expectant management is to wait for spontaneous healing, which usually occurs in almost all cases in a few weeks. However, while waiting for healing to be completed, the patients may experience uncomfortable symptoms. Although some research suggests the use of various materials to aid in the recovery of the tympanic membrane, none presented robust evidence of improvement in the cicatricial process. Nevertheless, the occlusion of the perforation with some material of specific texture and resistance can alleviate the patients' symptoms and accelerate the healing process. OBJECTIVE: To evaluate the clinical (symptomatic and functional) improvement after the placement of bacterial cellulose film (Bionext®) on tympanic membrane perforations (traumatic). METHODS: We evaluated 24 patients, victims of traumatic perforations of the tympanic membrane, who were evaluated in the Otorhinolaryngology Emergency Room. Following otoscopy and audiometric examination was performed, before and after the use of cellulose film occluding the tympanic membrane perforation. RESULTS: Twenty-four patients were included, whose degree of overall discomfort caused by the tympanic membrane perforation and the presence of symptoms of autophonia, ear fullness and tinnitus were investigated. The mean score attributed to the overall annoyance caused by tympanic membrane perforation was 7.79, decreasing to a mean value of 2.25 after the film application. Symptom evaluation also showed improvement after using the film: autophonia decreased from a mean value of 6.25 to 2.08, tinnitus from 7 to 1.92 and ear fullness from 7.29 to 1.96. The auditory analysis showed mean threshold values still within the normal range at low and medium frequencies, with slight hearing loss at acute frequencies, but with significant improvement at all frequencies, with the exception of 8000Hz, after film use. CONCLUSION: The use of bacterial cellulose film fragment on traumatic perforations of the tympanic membrane promoted immediate functional and symptomatic recovery in the assessed patients.

Wideband acoustic absorbance in children with Down syndrome / Absorvância acústica de banda larga em crianças com síndrome de Down

Abstract Introduction: Tympanometry is currently the most frequently used tool for assessing the status of the middle ear, commonly assessed using a single 226 Hz tone. However, the use of the Acoustic Immittance Measures with a wideband stimulus is a promising high-resolution evaluation, especially in individuals known to have middle ear alterations, such as Down syndrome patients. Objective: The aim of this study was to analyze the acoustic absorbance measurements in children with Down syndrome. Methods: Cross-sectional study, approved by the institution's ethics committee. Data were collected from 30 children, with a mean age of 8.4 years, 15 with Down syndrome (DS-study group) and 15 children with typical development and no hearing complaints (control group). Energy absorbance was measured at frequencies of 226-8000 Hz at ambient pressure and at peak pressure as a function of frequency using TITAN equipment. Statistical analysis was performed using the established level of statistical significance of 5%. Results: With the 226 Hz probe tone, 30 ears of the control group and 22 of the study group exhibited Type A tympanograms, whereas Type B was observed in eight children in the study group. The mean acoustic absorbance ratio of the study group was lower than that of the control group at frequencies centered at 2520 Hz (p = 0.008) for those with normal tympanometry results, and 226-4000 Hz (p < 0.03) for those with a Type B tympanometry curve. Conclusion: The low energy absorption in the presence of normal tympanograms in children with Down syndrome may suggest middle ear abnormalities.

Resumo Introdução: A timpanometria é a ferramenta mais usada para avaliar o status da orelha média, comumente avaliada por meio de uma única frequência com o tom de 226 Hz. No entanto, o uso da medida de imitância acústica com estímulo de banda larga é uma avaliação de alta resolução promissora, especialmente em pacientes conhecidos por frequentemente apresentar alterações da orelha média, como na síndrome de Down. Objetivo: Analisar as medidas de absorvância acústica em crianças com síndrome de Down. Método: Estudo transversal, aprovado pelo comitê de ética da instituição. Foram coletados dados de 30 crianças, com idade média de 8,4 anos, sendo 15 com síndrome de Down (SD-grupo de estudo) e 15 crianças desenvolvimento típico e sem queixas auditivas (grupo controle). A absorvância de energia foi medida nas frequências de 226-8.000 Hz à pressão ambiente e no pico de pressão em função da frequência, usou-se o equipamento Titan. A análise estatística foi feita com o nível de significância estatística adotado de 5%. Resultados: Com o tom de sonda de 226 Hz foram observadas 30 orelhas do grupo controle e 22 do grupo estudo com timpanometria Tipo A e o Tipo B foi observado apenas em oito crianças do grupo estudo. A razão média de absorvância acústica do grupo estudo foi menor do que a do controle nas frequências centradas em 2.520 Hz (p = 0,008) para aqueles com resultados timpanométricos normais e de 226-4.000 Hz (p < 0,03) para aqueles com curva timpanométrica Tipo B. Conclusão: A baixa absorção de energia na presença de timpanogramas normais nas crianças com síndrome de Down pode sugerir anormalidades na orelha média.

Water protection in patients with tympanostomy tubes in tympanic membrane: a randomized clinical trial.

OBJECTIVE: To analyze the incidence of otorrhea in the postoperative period of patients submitted to tympanotomy to place ventilation tube, and who did not protect the ear when exposed to water. METHODS: Open, randomized-controlled trial. Eighty patients submitted to unilateral or bilateral ear grommet tympanostomy were included and divided into two groups: Auricular Protection and Non-Protection to water during bathing and activities in water. RESULTS: In the first postoperative month, the Non-Protection Group presented a significant increase in the number of patients with otorrhea and in the incidence. Four patients of the Protection Group (11%) presented at least one episode of otorrhea in this period, representing an incidence of 0.11 (standard deviation ±0.32) episode/month, whereas in the Non-Protection Group there were 12 episodes (33%; p=0.045) and incidence of 0.33 (±0.48; p=0.02). Between the 2nd and the 13th postoperative months, there was no difference between groups. Seven patients in the Protection Group (20%) had at least one episode of otorrhea, representing an incidence of 0.04 (±0.09) episodes/month, while in the Non-Protection Group there were seven episodes (22%; p=0.8) and incidence of 0.05 (±0.1; p=0.8). CONCLUSION: Patients who underwent ear protection when exposed to water had a lower incidence of otorrhea in the first postoperative month than those who did not undergo protection. From the second month, there was no difference between groups.

Wideband acoustic absorbance in children with Down syndrome.

INTRODUCTION: Tympanometry is currently the most frequently used tool for assessing the status of the middle ear, commonly assessed using a single 226Hz tone. However, the use of the Acoustic Immittance Measures with a wideband stimulus is a promising high-resolution evaluation, especially in individuals known to have middle ear alterations, such as Down syndrome patients. OBJECTIVE: The aim of this study was to analyze the acoustic absorbance measurements in children with Down syndrome. METHODS: Cross-sectional study, approved by the institution's ethics committee. Data were collected from 30 children, with a mean age of 8.4 years, 15 with Down syndrome (DS-study group) and 15 children with typical development and no hearing complaints (control group). Energy absorbance was measured at frequencies of 226-8000Hz at ambient pressure and at peak pressure as a function of frequency using TITAN equipment. Statistical analysis was performed using the established level of statistical significance of 5%. RESULTS: With the 226Hz probe tone, 30 ears of the control group and 22 of the study group exhibited Type A tympanograms, whereas Type B was observed in eight children in the study group. The mean acoustic absorbance ratio of the study group was lower than that of the control group at frequencies centered at 2520Hz (p=0.008) for those with normal tympanometry results, and 226-4000Hz (p<0.03) for those with a Type B tympanometry curve. CONCLUSION: The low energy absorption in the presence of normal tympanograms in children with Down syndrome may suggest middle ear abnormalities.

Water protection in patients with tympanostomy tubes in tympanic membrane: a randomized clinical trial / Proteção auricular da água em pacientes com tubo de ventilação em membrana timpânica: ensaio clínico randomizado

ABSTRACT Objective To analyze the incidence of otorrhea in the postoperative period of patients submitted to tympanotomy to place ventilation tube, and who did not protect the ear when exposed to water. Methods Open, randomized-controlled trial. Eighty patients submitted to unilateral or bilateral ear grommet tympanostomy were included and divided into two groups: Auricular Protection and Non-Protection to water during bathing and activities in water. Results In the first postoperative month, the Non-Protection Group presented a significant increase in the number of patients with otorrhea and in the incidence. Four patients of the Protection Group (11%) presented at least one episode of otorrhea in this period, representing an incidence of 0.11 (standard deviation ±0.32) episode/month, whereas in the Non-Protection Group there were 12 episodes (33%; p=0.045) and incidence of 0.33 (±0.48; p=0.02). Between the 2nd and the 13th postoperative months, there was no difference between groups. Seven patients in the Protection Group (20%) had at least one episode of otorrhea, representing an incidence of 0.04 (±0.09) episodes/month, while in the Non-Protection Group there were seven episodes (22%; p=0.8) and incidence of 0.05 (±0.1; p=0.8). Conclusion Patients who underwent ear protection when exposed to water had a lower incidence of otorrhea in the first postoperative month than those who did not undergo protection. From the second month, there was no difference between groups.

RESUMO Objetivo Avaliar a incidência de otorreia no período pós-operatório em pacientes submetidos à timpanotomia para colocação de tubo de ventilação e que não realizaram proteção auricular quando expostos à água. Métodos Ensaio clínico controlado, aberto e randomizado. Foram incluídos 80 pacientes submetidos à timpanotomia para colocação de tubo de ventilação unilateral ou bilateral, divididos em dois grupos: Grupo Proteção e Grupo Não Proteção auricular da água durante o banho e as atividades aquáticas. Resultados No primeiro mês pós-operatório, o Grupo Não Proteção apresentou aumento significativo tanto no número de pacientes com otorreia quanto na incidência. Quatro pacientes do Grupo Proteção (11%) apresentaram ao menos um episódio de otorreia neste período, representando incidência de 0,11 (desvio padrão ±0,32) episódio/mês, enquanto no Grupo Não Proteção ocorreram 12 episódios (33%; p=0,045) e incidência de 0,33 (±0,48; p=0,02). Entre o 2º e o 13º meses pós-operatórios, não houve diferença entre os grupos. Sete pacientes do Grupo Proteção (20%) apresentaram ao menos um episódio de otorreia, representando incidência de 0,04 (±0,09) episódios/mês, enquanto no Grupo Não Proteção foram registrados sete episódios (22%; p=0,8) e incidência de 0,05 (±0,1; p=0,8). Conclusão Pacientes que realizaram a proteção auricular quando expostos à água apresentaram menor incidência de otorreia no primeiro mês pós-operatório do que aqueles que não a realizaram. A partir do segundo mês, não houve diferença entre os grupos.

Tracheal inflammatory response to bacterial cellulose dressing after surgical scarification in rabbits.

UNLABELLED: Exuberant scarring tissue formation is among the failure causes of tracheal stenosis surgery. Dressings that could avoid such reaction could be very helpful in these cases. Bacterial cellulose, produced by acetobacter xylinun can be useful in these cases. There are no studies in the laryngotracheal region. AIM: To assess subglottic tissue response in rabbits after scarification and placement of cellulose dressing, and comparing it to a control group. STUDY DESIGN: Experimental. MATERIALS AND METHODS: 26 rabbits underwent laryngotracheal scarification, received the dressing and were compared to the control group. We established four follow up periods. Laryngotracheal specimens underwent histological exam and the results were statistically assessed. RESULTS: The study group had statistically similar results when compared to the control group in the following parameters: vascular congestion, purulent oozing, acute inflammation, epithelial integrity, fibrous proliferation and granulous proliferation. CONCLUSION: We did not observe differences between the study and control groups as far as inflammation and scarring are concerned. There were no inflammatory signs associated with the use of the cellulose membrane that did no occur because of surgery.

Avaliação da resposta inflamatória traqueal ao curativo de celulose bacteriana após escarificação cirúrgica em coelhos / Tracheal inflammatory response to bacterial cellulose dressing after surgical scarification in rabbits

Dentre as causas de insucesso nas cirurgias para a estenose traqueal está a formação de tecidos de cicatrização exuberantes. O uso de curativos para evitar esta reação pode ser de grande valia nestes casos. A celulose bacteriana produzida por acetobacter xylinun pode ser útil nestes casos. Não há estudos na região laringotraqueal. OBJETIVO: Avaliar a resposta tecidual subglótica de coelhos após escarificação e colocação de curativo de celulose, comparando com grupo controle. FORMA DE ESTUDO: Experimental MATERIAL E MÉTODOS: Foram estudados 26 coelhos, submetidos a escarificação da região laringotraqueal e tratados com curativo e comparados com controle. Foram estabelecidos 4 tempos de seguimento. Os seguimentos laringotraqueais foram examinados histologicamente e os resultados foram avaliados estaticamente. RESULTADOS: O grupo de estudo evoluiu com o passar do tempo com resultados estatisticamente semelhantes ao do grupo controle, nos parâmetros Congestão vascular, Exsudato purulento, Inflamação aguda, Integridade do epitélio, Proliferação fibrosa e Reação granulomatosa. CONCLUSÃO: Não foram observadas diferenças entre os grupos controle e de estudo quanto aos parâmetros inflamatórios ou cicatriciais. Não houve sinais inflamatórios relacionados ao uso da membrana de celulose que não tivessem ocorrido devido ao traumatismo cirúrgico.

Exuberant scarring tissue formation is among the failure causes of tracheal stenosis surgery. Dressings that could avoid such reaction could be very helpful in these cases. Bacterial cellulose, produced by acetobacter xylinun can be useful in these cases. There are no studies in the laryngotracheal region. AIM: to assess subglottic tissue response in rabbits after scarification and placement of cellulose dressing, and comparing it to a control group. STUDY DESIGN: experimental. MATERIALS AND METHODS: 26 rabbits underwent laryngotracheal scarification, received the dressing and were compared to the control group. We established four follow up periods. Laryngotracheal specimens underwent histological exam and the results were statistically assessed. RESULTS: the study group had statistically similar results when compared to the control group in the following parameters: vascular congestion, purulent oozing, acute inflammation, epithelial integrity, fibrous proliferation and granulous proliferation. CONCLUSION: we did not observe differences between the study and control groups as far as inflammation and scarring are concerned. There were no inflammatory signs associated with the use of the cellulose membrane that did no occur because of surgery.

Neuropatia auditiva: relato do processo de terapia vocal de um paciente adulto / Voice therapy process report of a patient with auditory neuropathy

Este trabalho teve como objetivo realizar um estudo de caso por meio da descrição do processo terapêutico fonoaudiológico de reabilitação vocal de um indivíduo adulto com diagnóstico de neuropatia auditiva. O paciente foi atendido por um período de seis meses, durante o qual foi submetido à avaliação audiológica completa e a um processo terapêutico baseado num método que priorizou a eficiência glótica de acordo com as características vocais apresentadas pelo paciente. Concluímos que houve melhora importante da qualidade vocal, com aumento da estabilidade do pitch e do loudness e adequação do padrão articulatório.