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1.
Aust J Gen Pract ; 49(8): 500-504, 2020 08.
Artigo em Inglês | MEDLINE | ID: mdl-32738862

RESUMO

BACKGROUND: Scuba diving-related otological injuries comprise the majority of diving-related incidents that present to general practitioners (GPs). Correct diagnosis and management are key to prevent permanent hearing loss and vertigo. OBJECTIVE: The aim of this article is to increase awareness of the pathophysiology of otological diving injuries and provide an approach to initial assessment and treatment, as well as to highlight particular circumstances in which onward referral is required. DISCUSSION: Accurate diagnosis and treatment of diving-related otological injuries by GPs can have profound positive effects on a patient's long-term outcomes. Complete otolaryngological assessment in those who have previously had a dive-related injury is critical to ensure patient safety prior to recommencing scuba diving.


Assuntos
Mergulho/lesões , Gerenciamento Clínico , Mergulho/efeitos adversos , Orelha/anatomia & histologia , Orelha/lesões , Orelha/fisiopatologia , Perda Auditiva/fisiopatologia , Perda Auditiva/prevenção & controle , Humanos , Exame Físico
2.
Am J Otolaryngol ; 41(4): 102506, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32451291

RESUMO

OBJECTIVE: Mesna is a thiol compound effective in the connective tissue, which is used for its chemical dissector, mucolytic, mucosal damage preventive and antioxidant effects. The aim of this study was to investigate Mesna's effects in easy dissection in type 4 tympanosclerosis cases and in the prevention of formation of new sclerotic plaques. METHODS: 11 patients were included in the study. All patients were in the Wielinga Kerr type 4 class of tympanosclerosis. All patients were administered a 100% concentration of Mesna in the middle ear during tympanosclerosis surgery. All patients underwent audiological evaluation before and 20 months after the operation. Air-conduction thresholds, bone-conduction thresholds and air-bone difference were statistically compared. RESULTS: The patients were followed-up for a mean 20.48 ± 2.37 months. The mean preoperative air-conduction threshold of the patients was 58.09 ± 9.73 dB and the mean postoperative air-conduction threshold was 34.63 ± 15.46 dB and there was a significant difference. The mean preoperative bone-conduction threshold of the patients was 16.27 ± 5.47 dB and the mean postoperative bone-conduction threshold was 14.72 ± 6.11 dB and there was a significant difference. The mean preoperative air-bone gap of the patients was 41.81 ± 10.51, and the mean postoperative air-bone gap was 19.90 ± 12.48, and the difference was statistically significant. CONCLUSION: Mesna prevented hearing loss related to type 4 tympanosclerosis and prevented the formation of new sclerotic structures in our follow-up period. We believe that this effect is due to the chemical dissector and antioxidant effects of Mesna.


Assuntos
Mesna/administração & dosagem , Miringoesclerose/cirurgia , Adolescente , Adulto , Condução Óssea , Feminino , Seguimentos , Perda Auditiva/etiologia , Perda Auditiva/prevenção & controle , Humanos , Masculino , Pessoa de Meia-Idade , Miringoesclerose/complicações , Miringoesclerose/fisiopatologia , Período Perioperatório , Fatores de Tempo , Resultado do Tratamento , Adulto Jovem
3.
Codas ; 32(1): e20180278, 2020.
Artigo em Português, Inglês | MEDLINE | ID: mdl-32049152

RESUMO

PURPOSE: To compare the frequency of risk indicators in preterm and full-term babies; to analyze the possible relationships among the presence of risk for hearing loss with language acquisition and socioeconomic, demographic and obstetric variables. METHODS: This is a longitudinal cohort study, with a sample of 87 babies. Gestational, obstetric and sociodemographic data were collected from mothers and babies. The socioeconomic classification status of the families were classified using the Brazilian Criteria for Economic Classification. The risk for language was assessed using the Language Acquisition Enunciation Signs and the Denver II test. The data were analyzed using the STATISTICA 9.1 software, using the chi-square and the Mann-Whitney U tests and simple and multiple linear regression models. RESULTS: Permanence in a neonatal intensive care (65.52%), ototoxic (48.28%), mechanical ventilation (39.66%) and hyperbilirubinemia (46.55%) were the more frequent risk indicators in the sample. Regarding socioeconomic, demographic and obstetric factors, there was a correlation among prenatal care, gestational age, birth weight, feeding with hearing risk. Acquisition and development of language showed statistical significance with varicella, HIV, Apgar score and birth weight >1500 grams. CONCLUSION: Preterm babies showed higher frequency of risk indicators compared to full-term babies. Among environmental factors, prenatal care, which interferes in the outcome of gestational age, birth weight, Apgar score and presence of infectious diseases, as well as feeding, emerged as significant factors related to hearing and language acquisition. Prematurity was the relevant biological factor related to hearing and language risk.


Assuntos
Surdez/etiologia , Perda Auditiva/etiologia , Estudos de Coortes , Surdez/prevenção & controle , Feminino , Perda Auditiva/prevenção & controle , Humanos , Recém-Nascido , Recém-Nascido Prematuro , Unidades de Terapia Intensiva Neonatal , Desenvolvimento da Linguagem , Estudos Longitudinais , Masculino , Nascimento Prematuro , Cuidado Pré-Natal , Fatores de Risco , Fatores Socioeconômicos
4.
PLoS One ; 15(1): e0227978, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-31961907

RESUMO

AIM: Occupational exposure to styrene has been shown to be associated with an increased probability of developing hearing loss. However, the sites of lesions in the auditory system in humans remain unknown. The aim of this study was to investigate the possible adverse effects of styrene exposure on the cochlea of human subjects. DESIGN: The hearing function of 98 styrene-exposed male workers from the glass fibre-reinforced plastics industry (mean concentration of 55 mg/m3) was evaluated bilaterally using pure-tone audiometry (1000-16000 Hz), distortion product otoacoustic emissions (DPOAEs), and auditory brainstem response (ABR). The results were compared to a group of 111 male workers exposed to noise (above 85 dBA) and 70 male white-collar workers exposed to neither noise nor solvents. Age and noise exposure levels were accounted for as confounding variables in all statistical models. RESULTS: Styrene exposure was significantly associated with poorer pure-tone thresholds (1-8 kHz), lower DPOAE amplitudes (5-6 kHz), and shorter wave V latencies in both ears compared to control-group subjects. Similar results were found among noise-exposed subjects. A further analysis with wave V latency showed that styrene-exposed subjects showed significantly shorter latencies than expected according to normative data. These results suggest that occupational exposure to styrene at moderate concentrations is associated with cochlear dysfunction, at least at high frequencies. DPOAEs may be considered a valuable diagnostic tool in hearing conservation programs in workers exposed to styrene.


Assuntos
Cóclea/fisiopatologia , Perda Auditiva , Exposição Ocupacional/efeitos adversos , Emissões Otoacústicas Espontâneas , Estireno/toxicidade , Adulto , Limiar Auditivo , Perda Auditiva/diagnóstico , Perda Auditiva/fisiopatologia , Perda Auditiva/prevenção & controle , Humanos , Masculino , Pessoa de Meia-Idade , Ruído/efeitos adversos , Adulto Jovem
5.
BMC Public Health ; 19(1): 1601, 2019 Nov 29.
Artigo em Inglês | MEDLINE | ID: mdl-31783833

RESUMO

BACKGROUND: Hearing loss is a prevalent sensorineural disorder and a major public health issue in China. It is suggested that half of all cases of hearing loss can be prevented through public health measures. However, national strategies for hearing healthcare are not implemented well in Guangdong and some other regions in China. METHODS: To develop a community-based service model for the prevention and control of hearing loss in Guangdong, we integrated the model with multiple maternal and child healthcare models, and set up a series of clinical programs along with an optimum timeline for the preventive measures and intervention treatments to take place. A total of 36,090 families were enrolled in the study, including 358 high-risk families and 35,732 general-risk families. RESULTS: The study lasted for 6.5 years, and 30,769 children were born during that period. A total of 42 children were born with congenital deafness; 17 of them were born into families with advanced genetic risks for hearing loss, 9 were born with specific medical conditions, and 16 were born into general-risk families. About one third of them were diagnosed prenatally, others were diagnosed within 3 months of age, and 72% of them received interventions initiated before 6 months of age. 13 children presented with delayed hearing loss; 9 of them were diagnosed with delayed hereditary sensorineural deafness in neonatal period, and 4 were diagnosed within 3 months after onset. Timely interventions were provided to them, with appropriate referrals and follow-ups. Beside these, 80 families were identified with genetic susceptibility to aminoglycoside ototoxicity. Detailed medication guides were provided to prevent aminoglycoside-induced hearing loss. Moreover, through health education and risk reduction strategies, the prevalence of TORCH syndrome decreased from 10.7 to 5.2 per 10,000. Additionaly, the awareness rates of health knowledge about hearing healthcare significantly increased in the cohort. CONCLUSIONS: Adapting national strategies for local or district projects could be an important step in implementing hearing loss prevention measures, and developing community-based service models could be of importance in carrying them out.


Assuntos
Serviços de Saúde Comunitária/métodos , Assistência à Saúde/métodos , Perda Auditiva/prevenção & controle , Criança , Pré-Escolar , China/epidemiologia , Estudos de Coortes , Feminino , Predisposição Genética para Doença , Perda Auditiva/epidemiologia , Humanos , Lactente , Masculino , Modelos Teóricos , Prevalência , Fatores de Risco
7.
Bull World Health Organ ; 97(10): 652-653, 2019 Oct 01.
Artigo em Inglês | MEDLINE | ID: mdl-31656329

RESUMO

Bolajoko Olusanya talks to Sophie Cousins about her personal experience with hearing impairment and her efforts to advance paediatric hearing health in Nigeria.


Assuntos
Perda Auditiva , Criança , Pré-Escolar , Política de Saúde , Perda Auditiva/diagnóstico , Perda Auditiva/prevenção & controle , Perda Auditiva/psicologia , Humanos , Nigéria , Desenvolvimento de Programas , Saúde Pública , Apoio Social
9.
Trends Hear ; 23: 2331216519878983, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31621509

RESUMO

Over the past two decades, significant technological advances have facilitated the identification of hundreds of genes associated with hearing loss. Variants in many of these genes result in severe congenital hearing loss with profound implications for the affected individual and their family. This review collates these advances, summarizing the current state of genomic knowledge in childhood hearing loss. We consider how current and emerging genetic technologies have the potential to alter our approach to the management and diagnosis of hearing loss. We review approaches being taken to ensure that these discoveries are used in clinical practice to detect genetic hearing loss as soon as possible to reduce unnecessary investigations, provide information about reproductive risks, and facilitate regular follow-up and early treatment. We also highlight how rapid sequencing technology has the potential to identify children susceptible to antibiotic-induced hearing loss and how this adverse reaction can be avoided.


Assuntos
Genômica , Perda Auditiva/diagnóstico , Perda Auditiva/prevenção & controle , Criança , Perda Auditiva/genética , Humanos
10.
Audiol Neurootol ; 24(5): 237-244, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31574511

RESUMO

INTRODUCTION: In recent years, the preservation of residual hearing has become a major factor in patients undergoing cochlear implantation (CI). In studies attempting to pharmaceutically improve hearing preservation rates, glucocorticoids (GCs) applied perioperatively in many institutions have emerged as a promising treatment regimen. Although dexamethasone is most commonly used and has been applied successfully by various research groups, recently pharmacological properties have been reported to be relatively unsuitable for topical delivery to the inner ear. Consequently other glucocorticoids merit further evaluation. The aim of this study was therefore to evaluate the otoprotective effects of the topical application of a sustained-release triamcinolone acetonide (TAAC) hydrogel in CI with hearing preservation. METHODS: Normal-hearing pigmented guinea pigs were randomized into a group receiving a single dose of a 6% TAAC poloxamer 407 hydrogel, a group receiving a 30% TAAC hydrogel and a control group. All hydrogel applications were performed 1 day prior to CI. After a cochleostomy was drilled, a specifically designed silicone electrode was inserted into the scala tympani for 5 mm. Frequency-specific compound action potentials of the auditory nerve (0.5-32 kHz) were measured pre- and directly postoperatively as well as on days 3, 7, 14, 21, and 28. Finally, temporal bones were harvested for histological evaluation. RESULTS: Application of the TAAC hydrogels resulted in significantly reduced hearing threshold shifts in low, middle and high frequencies and improved spiral ganglion cell survival in the second turn of the cochlea. Outer hair cell numbers in the basal and second turn of the cochlea were slightly reduced after TAAC application. CONCLUSION: In summary, we were able to demonstrate functional benefits of a single preoperative application of a TAAC hydrogel in a guinea pig model for CI, which persisted until the end of the observational period, that is, 28 days after surgery.


Assuntos
Implante Coclear/efeitos adversos , Implantes Cocleares , Perda Auditiva/prevenção & controle , Audição/efeitos dos fármacos , Hidrogéis/administração & dosagem , Triancinolona Acetonida/administração & dosagem , Potenciais de Ação/efeitos dos fármacos , Animais , Sobrevivência Celular/efeitos dos fármacos , Cóclea/efeitos dos fármacos , Cóclea/cirurgia , Preparações de Ação Retardada/administração & dosagem , Cobaias , Perda Auditiva/etiologia , Testes Auditivos , Gânglio Espiral da Cóclea/efeitos dos fármacos
11.
Eur Arch Otorhinolaryngol ; 276(11): 3081-3087, 2019 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-31482334

RESUMO

OBJECTIVES: The aim of this study was to determine influencing factors on tympanic membrane closure and their consequence on absolute risks of closure and hearing improvement in myringoplasties. DESIGN: Retrospective cohort. SETTING: Medium-sized medical centrum. PARTICIPANTS: 195 patients were analysed who underwent a myringoplasty between January 2015 and February 2017 at the Jeroen Bosch Hospital in The Netherlands. MAIN OUTCOME MEASURES: Patient-related data, descriptions of the tympanic defect, surgical data, and the most important follow-up data were collected. Primary outcome is successful closure of the tympanic membrane and the secondary outcome is the amount of air-bone gap improvement after surgery. RESULTS: The overall success rate of the myringoplasty graft was 74.9%. If cartilage and butterfly graft were used, higher success rates of 85.4% and 85.5% were achieved compared to temporalis fascia (61.3%). Success rate of the operation was dependent of the skills of the surgeon. Chances of success are 91.9% if the operation is performed by an experienced surgeon using cartilage and 66.7% if a less experienced surgeon uses fascia. If a postoperative complication occurs or when silastic sheets are used, this might have a negative effect on the success of the operation. The mean ABG improved 10.10 dB if the perforation was closed compared to 3.38 dB after an unsuccessful procedure. CONCLUSION: The success rate of a myringoplasty is dependent of the skills of the surgeon and type of graft used and varies between 91.9 and 52.0% depending on these factors.


Assuntos
Perda Auditiva , Miringoplastia , Complicações Pós-Operatórias , Perfuração da Membrana Timpânica/cirurgia , Adulto , Criança , Feminino , Sobrevivência de Enxerto , Perda Auditiva/diagnóstico , Perda Auditiva/etiologia , Perda Auditiva/prevenção & controle , Testes Auditivos/métodos , Humanos , Masculino , Miringoplastia/efeitos adversos , Miringoplastia/métodos , Miringoplastia/estatística & dados numéricos , Países Baixos/epidemiologia , Complicações Pós-Operatórias/diagnóstico , Complicações Pós-Operatórias/etiologia , Complicações Pós-Operatórias/prevenção & controle , Prognóstico , Estudos Retrospectivos , Fatores de Risco , Resultado do Tratamento , Perfuração da Membrana Timpânica/epidemiologia
12.
S Afr J Commun Disord ; 66(1): e1-e6, 2019 Aug 26.
Artigo em Inglês | MEDLINE | ID: mdl-31478749

RESUMO

BACKGROUND: Knowledge of ear health and hearing loss is essential for early intervention and treatment, but the state of public knowledge of such in Jeddah, Saudi Arabia, remains unknown. OBJECTIVES: To measure public knowledge of ear health and hearing loss. METHOD: This cross-sectional study was conducted during August 2018 in Jeddah, Saudi Arabia. An electronic survey questionnaire was distributed to 2372 residents of various districts in Jeddah. The survey was created in 2013 by adopting previously published World Health Organization material, designed to assess knowledge and perception of ear health. All males and females aged 10 years or older living in Jeddah had the chance to participate in this study. A total of 2372 people participated. Percentages mean ± standard deviation, one-way analysis of variance (ANOVAs) and independent t-tests were applied to determine the significant difference. p-values of 0.05 or less were considered significant. RESULTS: The overall mean number of correct responses on the survey's true/false questionnaire was 10.66 ± 1.92 out of 14. Female participants gave a higher mean number of correct answers than did male participants (10.73 ± 2.03 vs. 10.54 ± 2.03, respectively). Participants with a family history of hearing loss gave a higher mean number of correct answers compared with participants who reported a negative family history (10.89 ± 1.82 vs. 10.53 ± 1.97, respectively). CONCLUSION: Overall awareness of ear health and hearing loss management is fair. However, the results indicate a need for more integrated educational materials to be made available both to the general population as well as to hearing loss individuals and their families.


Assuntos
Conhecimentos, Atitudes e Prática em Saúde , Perda Auditiva , Adolescente , Adulto , Estudos Transversais , Feminino , Perda Auditiva/etiologia , Perda Auditiva/prevenção & controle , Perda Auditiva/terapia , Humanos , Masculino , Arábia Saudita , Inquéritos e Questionários , Adulto Jovem
14.
Acta Neurochir (Wien) ; 161(11): 2265-2269, 2019 11.
Artigo em Inglês | MEDLINE | ID: mdl-31392568

RESUMO

BACKGROUND: Advances in various diagnostic and/or treatment modalities, including radiological imaging, neuromonitoring, and microsurgical techniques, have resulted in treatments of vestibular schwannomas being aimed at preserving facial and hearing functions while achieving optimal tumor control. METHOD: We describe our surgical technique for hearing preservation in vestibular schwannoma surgery. CONCLUSION: The retrosigmoid transmeatal approach under continuous neuromonitoring (auditory brainstem response, cochlear nerve action potentials, and continuous facial nerve monitoring) enables gross-total resection of vestibular schwannomas, while preserving hearing and facial functions. Radiological assessment and microsurgical techniques, such as meticulous tumor dissection, are also essential for functional preservation with sufficient tumor removal.


Assuntos
Perda Auditiva/prevenção & controle , Monitorização Neurofisiológica Intraoperatória/métodos , Neuroma Acústico/cirurgia , Procedimentos Neurocirúrgicos/métodos , Complicações Pós-Operatórias/prevenção & controle , Potenciais Evocados Auditivos do Tronco Encefálico , Nervo Facial/diagnóstico por imagem , Nervo Facial/cirurgia , Feminino , Audição , Perda Auditiva/etiologia , Humanos , Masculino , Neuroma Acústico/diagnóstico por imagem , Procedimentos Neurocirúrgicos/efeitos adversos , Complicações Pós-Operatórias/etiologia
15.
ORL J Otorhinolaryngol Relat Spec ; 81(4): 202-214, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31340214

RESUMO

Cisplatin is an anti-cancer drug that causes oxotoxic side effects such as impairment of inner ear function and hearing loss. We aimed to investigate the effects of allicin against cisplatin-induced stria vascularis damage in mice, and to clarify the mechanism underlying the protective effects of allicin against ototoxicity. Stria vascularis injury was induced in mice by intraperitoneal injection of cisplatin, which was significantly prevented by pretreatment with allicin. Allicin not only reduced cisplatin-activated expression of cleaved caspase-3 in marginal cells, PVM/Ms (perivascular resident macrophage-like melanocytes), and basal cells of the stria vascularis, but also decreased the expression of poly(ADP-ribose) polymerase-1 (PARP-1) and apoptosis-inducing factor (AIF) nuclear translocation in the stria vascularis cells. Our results demonstrate that allicin plays an effective role in protecting stria vascularis injury induced by cisplatin by inhibiting caspase-dependent, as well as caspase-independent PARP-1-AIF-mediated apoptotic pathways. Therefore, allicin may be useful in preventing cisplatin-induced ototoxicity.


Assuntos
Apoptose , Caspase 3/efeitos dos fármacos , Perda Auditiva/prevenção & controle , Poli(ADP-Ribose) Polimerase-1/antagonistas & inibidores , Estria Vascular/efeitos dos fármacos , Ácidos Sulfínicos/farmacologia , Animais , Antioxidantes/farmacologia , Caspase 3/metabolismo , Cisplatino/toxicidade , Modelos Animais de Doenças , Feminino , Perda Auditiva/induzido quimicamente , Perda Auditiva/patologia , Masculino , Camundongos , Camundongos Endogâmicos C57BL , Microscopia Eletrônica de Transmissão , Poli(ADP-Ribose) Polimerase-1/metabolismo , Estria Vascular/metabolismo , Estria Vascular/ultraestrutura
16.
J Int Adv Otol ; 15(2): 237-246, 2019 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-31347504

RESUMO

OBJECTIVES: The aim of our study was to investigate the effects of folic acid on cisplatin-induced ototoxicity. MATERIALS AND METHODS: Thirty Wistar albino rats were divided into five groups. Group I received intraperitoneal cisplatin (IP) 10 mg/kg/day and IP folic acid 10 mg/kg/day; Group II received IP cisplatin 10 mg/kg/day and IP physiological saline; Group III received IP cisplatin 10 mg/kg/day and intratympanic (IT) folic acid 0.15 mL/day; Group IV received IP cisplatin 10 mg/kg/day and IT physiological saline; and Group V received IT folic acid 0.15 mL/day. Before and after drug administration, plasma homocysteine, folic acid levels, and auditory brainstem evoked responses (ABR) were measured. The rats were then sacrificed, and the inner ears were processed for electron microscopy. RESULTS: The differences of ABR thresholds in Group I compared to Group II were significantly smaller at 4 kHz, 8 kHz, and 16 kHz, whereas they were smaller but not statistically significant at 12 kHz in ABR. The differences of ABR thresholds in Group III compared to Group IV were significantly smaller at 12 kHz, and smaller but not statistically significant at 4 kHz, 8 kHz, and 16 kHz. Cisplatin treatment resulted in the degeneration of the cells of the organ of Corti, stria vascularis, and spiral ganglion. The cells of the organ of Corti, stria vascularis, and spiral ganglion showed a partially preserved morphology in both Group I and Group III. CONCLUSION: Our study results suggests that folic acid is a potential agent in preventing cisplatin-induced ototoxicity.


Assuntos
Antineoplásicos/toxicidade , Cisplatino/toxicidade , Ácido Fólico/farmacologia , Ototoxicidade/prevenção & controle , Complexo Vitamínico B/farmacologia , Animais , Antineoplásicos/administração & dosagem , Cisplatino/administração & dosagem , Cóclea/patologia , Esquema de Medicação , Potenciais Evocados Auditivos/fisiologia , Potenciais Evocados Auditivos do Tronco Encefálico/fisiologia , Ácido Fólico/metabolismo , Células Ciliadas Auditivas/ultraestrutura , Perda Auditiva/prevenção & controle , Homocisteína/metabolismo , Masculino , Microscopia Eletrônica , Órgão Espiral/patologia , Ototoxicidade/patologia , Ototoxicidade/fisiopatologia , Ratos Wistar , Limiar Sensorial/fisiologia
17.
Neurosurgery ; 85(6): E1084-E1094, 2019 12 01.
Artigo em Inglês | MEDLINE | ID: mdl-31270543

RESUMO

BACKGROUND: Gamma Knife radiosurgery (GKRS; Elekta AB) remains a well-established treatment modality for vestibular schwannomas. Despite highly effective tumor control, further research is needed toward optimizing long-term functional outcomes. Whereas dose-rate effects may impact post-treatment toxicities given tissue dose-response relationships, potential effects remain largely unexplored. OBJECTIVE: To evaluate treatment outcomes and potential dose-rate effects following definitive GKRS for vestibular schwannomas. METHODS: We retrospectively reviewed 419 patients treated at our institution between 1998 and 2015, characterizing baseline demographics, pretreatment symptoms, and GKRS parameters. The cohort was divided into 2 dose-rate groups based on the median value (2.675 Gy/min). Outcomes included clinical tumor control, radiographic progression-free survival, serviceable hearing preservation, hearing loss, and facial nerve dysfunction (FND). Prognostic factors were assessed using Cox regression. RESULTS: The study cohort included 227 patients with available follow-up. Following GKRS 2-yr and 4-yr clinical tumor control rates were 98% (95% CI: 95.6%-100%) and 96% (95% CI: 91.4%-99.6%), respectively. Among 177 patients with available radiographic follow-up, 2-yr and 4-yr radiographic progression-free survival rates were 97% (95% CI: 94.0%-100.0%) and 88% (95% CI: 81.2%-95.0%). The serviceable hearing preservation rate was 72.2% among patients with baseline Gardner-Robertson class I/II hearing and post-treatment audiological evaluations. Most patients experienced effective relief from prior headaches (94.7%), tinnitus (83.7%), balance issues (62.7%), FND (90.0%), and trigeminal nerve dysfunction (79.2%), but not hearing loss (1.0%). Whereas GKRS provided effective tumor control independently of dose rate, GKRS patients exposed to lower dose rates experienced significantly better freedom from post-treatment hearing loss and FND (P = .044). CONCLUSION: Whereas GKRS provides excellent tumor control and effective symptomatic relief for vestibular schwannomas, dose-rate effects may impact post-treatment functional outcomes. Further research remains warranted.


Assuntos
Audição/efeitos da radiação , Neuroma Acústico/radioterapia , Doses de Radiação , Radiocirurgia/tendências , Adulto , Idoso , Idoso de 80 Anos ou mais , Estudos de Coortes , Feminino , Seguimentos , Audição/fisiologia , Perda Auditiva/diagnóstico por imagem , Perda Auditiva/etiologia , Perda Auditiva/prevenção & controle , Testes Auditivos/tendências , Humanos , Masculino , Pessoa de Meia-Idade , Neuroma Acústico/diagnóstico por imagem , Radiocirurgia/efeitos adversos , Estudos Retrospectivos , Resultado do Tratamento
18.
Eur Arch Otorhinolaryngol ; 276(10): 2705-2714, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-31197530

RESUMO

PURPOSE: Endolymphatic sac tumor (ELST) is a rare, slow-growing, and low-grade malignant tumor arising from the endolymphatic sac in the posterior petrous bone. The purpose of this study is to describe the clinical and radiologic features, and investigate the clinicoradiologic correlation of ELST. METHODS: We retrospectively reviewed the clinical, computed tomography (CT), magnetic resonance imaging (MRI), and pathologic findings of 14 patients with 15 ELSTs. RESULTS: Patients comprised of eight women and six men with a mean age of 42.3 years at the time of diagnosis and 35.2 years at the time of initial symptoms. The mean interval between initial symptoms and diagnosis was 84.7 months. The most frequent cochleovestibular symptom was hearing loss in 14 patients (100%); other cochleovestibular symptoms were tinnitus in eight patients (57.1%), vertigo in three patients (21.4%), and aural fullness in three patients (21.4%). Ten patients (71.4%) presented with facial paralyses and five patients (14.3%) presented lower cranial nerve deficits. CT findings revealed spiculated, stippled, or reticular high density within the tumors. The lesions involved mastoid cells, vertical facial nerve canal, semicircular canal, cochlea, tympanum, jugular foramen, internal auditory canal, or petrous apex. On the available MRI, all the eight lesions showed patchy and/or speckled hyperintensity on unenhanced T1WI. Five lesions showed flow voids on T2WI and T1WI. Three lesions had blood fluid levels within cysts. CONCLUSION: CT and MRI findings of ELSTs are associated with clinical features. Imaging tests should be performed to identify ELSTs early and ensure greater potential for hearing preservation in patients with cochleovestibular symptoms.


Assuntos
Neoplasias da Orelha , Saco Endolinfático , Perda Auditiva , Osso Petroso , Zumbido , Vertigem , Adulto , Neoplasias da Orelha/patologia , Neoplasias da Orelha/fisiopatologia , Diagnóstico Precoce , Saco Endolinfático/diagnóstico por imagem , Saco Endolinfático/patologia , Feminino , Perda Auditiva/diagnóstico , Perda Auditiva/etiologia , Perda Auditiva/prevenção & controle , Humanos , Imagem por Ressonância Magnética/métodos , Masculino , Osso Petroso/diagnóstico por imagem , Osso Petroso/patologia , Estudos Retrospectivos , Zumbido/diagnóstico , Zumbido/etiologia , Tomografia Computadorizada por Raios X/métodos , Vertigem/diagnóstico , Vertigem/etiologia
19.
Nat Rev Nephrol ; 15(7): 435-455, 2019 07.
Artigo em Inglês | MEDLINE | ID: mdl-31068690

RESUMO

X-linked hypophosphataemia (XLH) is the most common cause of inherited phosphate wasting and is associated with severe complications such as rickets, lower limb deformities, pain, poor mineralization of the teeth and disproportionate short stature in children as well as hyperparathyroidism, osteomalacia, enthesopathies, osteoarthritis and pseudofractures in adults. The characteristics and severity of XLH vary between patients. Because of its rarity, the diagnosis and specific treatment of XLH are frequently delayed, which has a detrimental effect on patient outcomes. In this Evidence-Based Guideline, we recommend that the diagnosis of XLH is based on signs of rickets and/or osteomalacia in association with hypophosphataemia and renal phosphate wasting in the absence of vitamin D or calcium deficiency. Whenever possible, the diagnosis should be confirmed by molecular genetic analysis or measurement of levels of fibroblast growth factor 23 (FGF23) before treatment. Owing to the multisystemic nature of the disease, patients should be seen regularly by multidisciplinary teams organized by a metabolic bone disease expert. In this article, we summarize the current evidence and provide recommendations on features of the disease, including new treatment modalities, to improve knowledge and provide guidance for diagnosis and multidisciplinary care.


Assuntos
Raquitismo Hipofosfatêmico Familiar/diagnóstico , Raquitismo Hipofosfatêmico Familiar/terapia , Algoritmos , Anticorpos Monoclonais/uso terapêutico , Malformação de Arnold-Chiari/etiologia , Biomarcadores/sangue , Conservadores da Densidade Óssea/uso terapêutico , Osso e Ossos/diagnóstico por imagem , Continuidade da Assistência ao Paciente , Craniossinostoses/prevenção & controle , Técnica Delfos , Assistência Odontológica , Hormônio do Crescimento/uso terapêutico , Perda Auditiva/etiologia , Perda Auditiva/prevenção & controle , Humanos , Fatores Imunológicos/uso terapêutico , Estilo de Vida , Mutação , Procedimentos Ortopédicos , Endopeptidase Neutra Reguladora de Fosfato PHEX/genética , Fosfatos/uso terapêutico , Modalidades de Fisioterapia , Radiografia , Vitamina D/uso terapêutico
20.
Cochrane Database Syst Rev ; 5: CD009219, 2019 05 07.
Artigo em Inglês | MEDLINE | ID: mdl-31063591

RESUMO

BACKGROUND: Platinum-based therapy, including cisplatin, carboplatin, oxaliplatin or a combination of these, is used to treat a variety of paediatric malignancies. One of the most significant adverse effects is the occurrence of hearing loss or ototoxicity. In an effort to prevent this ototoxicity, different otoprotective medical interventions have been studied. This review is the third update of a previously published Cochrane Review. OBJECTIVES: To assess the efficacy of medical interventions to prevent hearing loss and to determine possible effects of these interventions on antitumour efficacy, toxicities other than hearing loss and quality of life in children with cancer treated with platinum-based therapy as compared to placebo, no additional treatment or another protective medical intervention. SEARCH METHODS: We searched the Cochrane Central Register of Controlled Trials, MEDLINE (PubMed) and Embase (Ovid) to 8 January 2019. We handsearched reference lists of relevant articles and assessed the conference proceedings of the International Society for Paediatric Oncology (2006 up to and including 2018), the American Society of Pediatric Hematology/Oncology (2007 up to and including 2018) and the International Conference on Long-Term Complications of Treatment of Children and Adolescents for Cancer (2010 up to and including 2015). We scanned ClinicalTrials.gov and the World Health Organization International Clinical Trials Registry Platform (WHO ICTRP; apps.who.int/trialsearch) for ongoing trials (on 2 January 2019). SELECTION CRITERIA: Randomized controlled trials (RCTs) or controlled clinical trials (CCTs) evaluating platinum-based therapy with an otoprotective medical intervention versus platinum-based therapy with placebo, no additional treatment or another protective medical intervention in children with cancer. DATA COLLECTION AND ANALYSIS: Two review authors independently performed the study selection, data extraction, risk of bias assessment and GRADE assessment of included studies, including adverse effects. We performed analyses according to the Cochrane Handbook for Systematic Reviews of Interventions. MAIN RESULTS: We identified two RCTs and one CCT (total number of participants 149) evaluating the use of amifostine versus no additional treatment in the original version of the review; the updates identified no additional studies. Two studies included children with osteosarcoma, and the other study included children with hepatoblastoma. Children received cisplatin only or a combination of cisplatin and carboplatin, either intra-arterially or intravenously. Pooling of results of the included studies was not possible. From individual studies the effect of amifostine on symptomatic ototoxicity only (i.e. National Cancer Institute Common Toxicity Criteria version 2 (NCICTCv2) or modified Brock grade 2 or higher) and combined asymptomatic and symptomatic ototoxicity (i.e. NCICTCv2 or modified Brock grade 1 or higher) were uncertain (low-certainty evidence). Only one study including children with osteosarcoma treated with intra-arterial cisplatin provided information on tumour response, defined as the number of participants with a good or partial remission. The available-data analysis (data were missing for one participant), best-case scenario analysis and worst-case scenario analysis showed a difference in favour of amifostine, although the certainty of evidence for this effect was low. There was no information on survival for any of the included studies. Only one study, including children with osteosarcoma treated with intra-arterial cisplatin, provided data on the number of participants with adverse effects other than ototoxicity grade 3 or higher (on NCICTCv2 scale). There was low-certainty evidence that grade 3 or 4 vomiting was higher with amifostine (risk ratio (RR) 9.04, 95% confidence interval (CI) 1.99 to 41.12). The effects on cardiotoxicity and renal toxicity grade 3 or 4 were uncertain (low-certainty evidence). None of the studies evaluated quality of life.In the recent update, we also identified one RCT including 109 children with localized hepatoblastoma evaluating the use of sodium thiosulfate versus no additional treatment. Children received intravenous cisplatin only (one child also received carboplatin). There was moderate-certainty evidence that both symptomatic ototoxicity only (i.e. Brock criteria grade 2 or higher) and combined asymptomatic and symptomatic ototoxicity (i.e. Brock criteria grade 1 or higher) was lower with sodium thiosulfate (combined asymptomatic and symptomatic ototoxicity: RR 0.52, 95% CI 0.33 to 0.81; symptomatic ototoxicity only: RR 0.39, 95% CI 0.19 to 0.83). The effect of sodium thiosulfate on tumour response (defined as number of participants with a complete or partial response at the end of treatment), overall survival (calculated from time of randomization to death or last follow-up), event-free survival (calculated from time of randomization until disease progression, disease relapse, second primary cancer, death, or last follow-up, whichever came first) and adverse effects other than hearing loss and tinnitus grade 3 or higher (according to National Cancer Institute Common Toxicity Criteria Adverse Effects version 3 (NCICTCAEv3) criteria) was uncertain (low-certainty evidence for all these outcomes). Quality of life was not assessed.We found no eligible studies for possible otoprotective medical interventions other than amifostine and sodium thiosulfate and for other types of malignancies. AUTHORS' CONCLUSIONS: At the moment there is no evidence from individual studies in children with osteosarcoma or hepatoblastoma treated with different platinum analogues and dosage schedules that underscores the use of amifostine as an otoprotective intervention as compared to no additional treatment. Since pooling of results was not possible and the evidence was of low certainty, no definitive conclusions can be made. Since we found only one RCT evaluating the use of sodium thiosulfate in children with localized hepatoblastoma treated with cisplatin, no definitive conclusions on benefits and harms can be drawn. It should be noted that 'no evidence of effect', as identified in this review, is not the same as 'evidence of no effect'. We identified no eligible studies for other possible otoprotective medical interventions and other types of malignancies, so no conclusions can be made about their efficacy in preventing ototoxicity in children treated with platinum-based therapy. More high-quality research is needed.


Assuntos
Antineoplásicos/efeitos adversos , Perda Auditiva/induzido quimicamente , Perda Auditiva/prevenção & controle , Compostos Organoplatínicos/efeitos adversos , Adolescente , Antineoplásicos/uso terapêutico , Carboplatina , Criança , Pré-Escolar , Cisplatino , Feminino , Humanos , Masculino , Neoplasias/tratamento farmacológico , Compostos Organoplatínicos/uso terapêutico , Oxaliplatina , Ensaios Clínicos Controlados Aleatórios como Assunto
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