Description of 13 Infants Born During October 2015-January 2016 With Congenital Zika Virus Infection Without Microcephaly at Birth - Brazil.

Congenital Zika virus infection can cause microcephaly and severe brain abnormalities (1). Congenital Zika syndrome comprises a spectrum of clinical features (2); however, as is the case with most newly recognized teratogens, the earliest documented clinical presentation is expected to be the most severe. Initial descriptions of the effects of in utero Zika virus infection centered prominently on the finding of congenital microcephaly (3). To assess the possibility of clinical presentations that do not include congenital microcephaly, a retrospective assessment of 13 infants from the Brazilian states of Pernambuco and Ceará with normal head size at birth and laboratory evidence of congenital Zika virus infection was conducted. All infants had brain abnormalities on neuroimaging consistent with congenital Zika syndrome, including decreased brain volume, ventriculomegaly, subcortical calcifications, and cortical malformations. The earliest evaluation occurred on the second day of life. Among all infants, head growth was documented to have decelerated as early as 5 months of age, and 11 infants had microcephaly. These findings provide evidence that among infants with prenatal exposure to Zika virus, the absence of microcephaly at birth does not exclude congenital Zika virus infection or the presence of Zika-related brain and other abnormalities. These findings support the recommendation for comprehensive medical and developmental follow-up of infants exposed to Zika virus prenatally. Early neuroimaging might identify brain abnormalities related to congenital Zika infection even among infants with a normal head circumference (4).

Does a patient with acquired arbovirus infection have a hearing impairment? A scoping review of hearing changes in an adult with Dengue, Chikungunya, and Zika.

OBJECTIVES: To identify and understand the evidence regarding hearing changes related to acquired Dengue, Chikungunya, and Zika virus infection in adult individuals. METHODS: A scoping review was performed according to the recommendations of The Joanna Briggs Institute and guidelines of the Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews in the Embase, PubMed/Medline, ScienceDirect, Scopus, and Web of Science databases without restriction on language and year of publication. Case studies, observational studies, and clinical trials reporting hearing loss in adult subjects (>18-60 years of age) of both sexes with DENV, CHIKV, or ZIKV diagnosed by positive molecular/serological examination by RT-PCR or IgM/IgG by ELISA method were included. RESULTS: Thirteen studies met the inclusion criteria and were selected for review. The occurrence of auditory symptoms caused by arboviroses and the presence of permanent or transient sensorineural hearing loss was variable in adults. CONCLUSIONS: Dengue, Chikungunya, and Zika infections in adults are associated with a variety of auditory symptoms. The frequency of permanent or transient sensorineural hearing loss is low but not negligible.

The Extra-Extended Translabyrinthine Approach for Resection of Large Acoustic Neuroma: 2-Dimensional Operative Video.

The extended translabyrinthine approach to acoustic neuroma (AN) was created to allow improved visualization and access to larger tumors.1,2 The dural opening, however, remained confined to the presigmoid space. Other authors have introduced modifications to increase the dura exposure around the internal auditory canal (IAC).3-5 The extra-extended translabyrinthine approach was conceptualized by the senior author (CC) to maximize AN exposure and early cranial nerve identification. The tentorial peeling was added to allow extradural mobilization of the temporal lobe.6 This allows further safe bone removal around the IAC and petrous apex and consistent opening of the facial canal at IAC fundus. This modification creates 280-to-360-degree dura exposure at the IAC. The dural opening extends to the petrous apex superiorly and the prepontine arachnoid cistern inferiorly and includes resection of a tentorium dural flap created by the tentorial peeling.6 This exposure allows for near circumferential exposure of the tumor and early identification of the glossopharyngeal nerve in the cochlear aqueduct area, the trigeminal nerve at the porus trigeminal, and the facial nerve (FN) at IAC fundus. In addition, this ample exposure permits identification of the FN trajectory in the tumor capsule before any tumor dissection. We present a detailed video of extra-extended translabyrinthine approach technique in a patient with a large left AN (Hannover classification T4B).7 This video does not involve any human research projects not requiring Institutional Review Board/ethic committee approval. The patient consented to the procedure and to the publication of his image. Complete resection was obtained. The FN function was House-Brackman I/VI.

Descriptive study of goat external and middle ear through computed tomography and endoscopic evaluation, compared with the human ear.

OBJECTIVE: To describe the external and middle ear of goats, using computed tomography and endoscopic dissection, comparing them with the anatomy of the human ear, aiming to evaluate the viability of this animal model for training in otological endoscopic surgery. METHODS: Images of the external and middle ear of goats were produced by computed tomography in the coronal and axial planes and analyzed. The radiological anatomy of the external and middle goat and human ear are described. Some measures of surgical interest were described, such as the length of the external auditory canal, external and internal cross-sectional area of the external auditory canal, middle ear depth, vertical angle of the external auditory canal, length of malleus and incus. After the tomographic study, we analyzed the importance of evaluations through the endoscopic dissection of the goat ear. RESULTS: The bony canal is extremely tortuous and shows a bony prominence with significant elevation near the lower edge of the tympanic membrane. The middle ear has a large tympanic bulla in the hypotympanum region. The malleus is shaped similarly to that of the human, but its handle is located anterior to its head. The mastoid is not pneumatized. Compared to the human mastoid, there was a statistically significant difference in the external and internal cross-sectional area, at the depth of the middle ear, in the vertical angle of the canal and in the length of the incus. CONCLUSION: Goat morphometric anatomy showed that this model is suitable for surgical simulation in the initial training for endoscopic otological surgery. It is an important contribution to the development of skills to accelerate the subsequent endoscopic otological surgical training in humans, despite some differences found.

Frequency-Following Response (FFR) in cochlear implant users: a systematic review of acquisition parameters, analysis, and outcomes. / Frequency-Following Response (FFR) em usuários de implante coclear: uma revisão sistemática dos parâmetros de aquisição, análise e resultados.

PURPOSE: To characterize the acquisition parameters, analysis, and results of the frequency-following response (FFR) in cochlear implant users. RESEARCH STRATEGIES: The search was conducted in Cochrane Library, Latin American and Caribbean Health Sciences Literature (LILACS), Ovid Technologies, PubMed, SciELO, ScienceDirect, Scopus, Web of Science, and gray literature. SELECTION CRITERIA: Studies on FFR in cochlear implant users or that compared them with normal-hearing people, with no restriction of age, were included. Secondary and experimental studies were excluded. There was no restriction of language or year of publication. DATA ANALYSIS: The data were analyzed and reported according to the stages in the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA), 2020. The methodological quality was analyzed with the Joanna Briggs Institute Critical Appraisal Checklist for Analytical Cross-Sectional Studies. Divergences were solved by a third researcher. RESULTS: Six studies met the inclusion criteria. Only one study was comparative, whose control group comprised normal-hearing people. The variations in acquisition parameters were common and the analysis predominantly approached the time domain. Cochlear implant users had different FFR results from those of normal-hearing people, considering the existing literature. Most articles had low methodological quality. CONCLUSION: There is no standardized FFR acquisition and analysis protocol for cochlear implant users. The results have a high risk of bias.

OBJETIVO: Caracterizar os parâmetros de aquisição, análise e resultados do exame Frequency Following Response (FFR) em usuários de implante coclear. ESTRATÉGIA DE PESQUISA: As buscas foram realizadas nas bases Cochrane Library, Literatura Latino-Americana e do Caribe em Ciências da Saúde (LILACS), Ovid Technologies, PubMed, SciELO, ScienceDirect, Scopus, Web of Science e na literatura cinzenta. CRITÉRIOS DE SELEÇÃO: Foram incluídos estudos sobre o FFR em usuários de implante coclear ou que os comparassem à indivíduos com audição normal, sem restrição de idade. Foram excluídos estudos secundários e experimentais. Não houve restrição de idioma e ano de publicação. ANÁLISE DOS DADOS: Os dados foram analisados e redigidos de acordo com as etapas do Preferred Reporting Items for Systematic Reviews and Meta-Analyse (PRISMA) 2020. Para análise da qualidade metodológica foi utilizado o instrumento Joanna Briggs Institute Critical Appraisal Checklist for Analytical Cross Sectional Studies. As divergências foram resolvidas por um terceiro pesquisador. RESULTADOS: Seis estudos atenderam aos critérios de inclusão. Apenas um estudo foi do tipo comparativo com grupo controle de indivíduos com audição normal. As variações nos parâmetros de aquisição foram comuns e as análises predominaram no domínio do tempo. Usuários de implante coclear apresentaram diferenças nos resultados do FFR quando comparados a indivíduos com audição normal, considerando a literatura existente. A maioria dos artigos teve baixa qualidade metodológica. CONCLUSÃO: Não existe padronização de um protocolo de aquisição e análise para o FFR em usuários de implante coclear. Os resultados são de alto risco de viés.

Frequency-Following Response and Auditory Behavior in Children with Prenatal Exposure to the Zika Virus.

Introduction Prenatal exposure to the Zika virus can impair neurodevelopment and cause auditory damage. Objective To analyze the frequency-following response (FFR) and the auditory behavior (with the LittlEars ® questionnaire) of children with and without prenatal exposure to Zika virus infection. Methods A total of 30 children participated in the present study, divided into 3 groups: 10 children with microcephaly and prenatal exposure to the Zika virus; 10 normocephalic children with prenatal exposure to the Zika virus; and 10 children with no evidence of prenatal exposure to the virus. The FFR test was performed with the /da/ syllable. The LittlEars ® questionnaire was used with parents/guardians. Results For the FFR measurements, there was no difference between the groups. The children with exposure to the Zika virus presented a final score in the questionnaire below what is expected from children with normal hearing. A significant difference was observed for the final, semantic, and expressive scores between the group with microcephaly and the other groups. A strong negative correlation was seen between the LittlEars ® questionnaire final score and the FFR measurements for the group with microcephaly when compared with the other groups. Conclusion Children exposed to the Zika virus, with and without microcephaly, presented FFR patterns similar to what was seen in children with no evidence of virus exposure. However, they showed signs of immature auditory behavior, suggesting auditory development delay.

Hearing and communicative skills in the first years of life in children with congenital Zika syndrome.

INTRODUCTION: Microcephaly is recognized as one of the main consequences of congenital Zika syndrome, but other serious problems such as global hypertonia, irritability, excessive crying, swallowing disorders, seizures, visual impairment and sensorineural hearing loss have been identified as associated with the syndrome. OBJECTIVE: Describe the developmental characteristics of hearing and language skills in the first year of life of children with normal hearing thresholds' and congenital Zika syndrome. METHODS: This is a cross-sectional study that evaluated hearing and language skills in the first year of life of 88 children with normal peripheral hearing and confirmed congenital Zika syndrome. All children were submitted to a behavioral auditory test and a validated questionnaire addressed to parents or caregivers, which was used as an instrument for assessing hearing and communicative skills. RESULTS: The delay in communicative skills was present in 87.5% of the children, while 44.3% of them demonstrated a delay in hearing acuity. Only the alteration of cervical motor control presented as a statistically significant association with delays in both skills (p-value=0.006 and <0.001 for hearing and communicative skills, respectively), while the presence of microcephaly and the degree of its severity were only associated with delayed development of communicative skills. CONCLUSION: Despite a normal peripheral auditory system, children with congenital Zika syndrome may demonstrate delayed language development by having neurological damage at the center of auditory processing, requiring more specific studies to clarify language acquisition in this population.

Clinical and Radiological Profiles of COVID-19 Patients with Neurological Symptomatology: A Comparative Study.

Patients with COVID-19 can require radiological examination, with chest CT being more frequent than neuro-imaging. The objective is to identify epidemiological, clinical and radiological factors considered as predictors of neurological involvement in patients with COVID-19 assessed by neuroimaging and to describe the neuroimaging findings. This retrospective study was performed with 232 consecutive confirmed COVID-19 patients, from two radiological units, which were divided into two groups: (1) those who underwent a brain CT/MRI scan (n = 35) versus (2) those who did not undergo the brain CT/MRI scan, but underwent only chest CT (n = 197). There was a statistically significant difference with associations regarding the COVID-19 brain scan group for: admission to ICU, greater severity of lung injuries, the use of a mechanical ventilator and sepsis. Statistical tendency was found for chronic renal failure and systemic arterial hypertension. Forty-percent of COVID-19 patients from the brain scan group were abnormal on brain CT and/or brain MRI (22.9% of the cases with bleeding or microbleeding, 8.6% with restricted diffusion lesions). One ischemic stroke case was associated with irregularity at the M1 segment of the right middle cerebral artery. There was a case of left facial nerve palsy with enhancement of the left geniculate ganglia. An analysis of the olfactory bulbs was possible in 12 brain MRIs and 100% had enhancement and/or microbleeding. In conclusion, a more severe COVID-19 disease from ICU, a more severe form of lung disease, the use of mechanical ventilator and sepsis were associated to the COVID-19 patients with neurological involvement who had undergone brain scans. Microvascular phenomenon was a frequent finding in the brain and olfactory bulbs evaluated by neuroimaging.

Does a patient with acquired arbovirus infection have a hearing impairment? A scoping review of hearing changes in an adult with Dengue, Chikungunya, and Zika

Abstract Objectives To identify and understand the evidence regarding hearing changes related to acquired Dengue, Chikungunya, and Zika virus infection in adult individuals. Methods A scoping review was performed according to the recommendations of The Joanna Briggs Institute and guidelines of the Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews in the Embase, PubMed/Medline, ScienceDirect, Scopus, and Web of Science databases without restriction on language and year of publication. Case studies, observational studies, and clinical trials reporting hearing loss in adult subjects (>18-60 years of age) of both sexes with DENV, CHIKV, or ZIKV diagnosed by positive molecular/serological examination by RT-PCR or IgM/IgG by ELISA method were included. Results Thirteen studies met the inclusion criteria and were selected for review. The occurrence of auditory symptoms caused by arboviroses and the presence of permanent or transient sensorineural hearing loss was variable in adults. Conclusions Dengue, Chikungunya, and Zika infections in adults are associated with a variety of auditory symptoms. The frequency of permanent or transient sensorineural hearing loss is low but not negligible.

Bulimia nervosa as a risk factor for voice disorders--literature review.

UNLABELLED: Bulimia nervosa (BN) is a type of feeding disorder that starts in adolescence and presents a variety of symptoms, recurrent vomiting in the oral cavity that may reach down to the larynx - similarly to gastro-esophageal reflux, causing laryngeal and voice disorder alterations. AIM: These studies aimed at surveying the literature and investigate the studies that considered BN a risk factor for voice disorders. RESULTS: of the ninety three papers we found, twenty-three were used as a basis for this review, among them, only three discuss BN as an etiology factor associated with voice changes in adult women, and we did not find any paper associating this with bulimic teenagers. CONCLUSION: It is necessary to observe laryngeal and vocal signs and symptoms associated with BN, especially in teenagers whose voices are going through a period of change.

Manejo das fraturas mandibulares associadas à exodontia de 3º molar inferior / Management of mandibular fractures associated with lower third molar extraction

A remoção cirúrgica dos terceiros molares é um procedimento comumente realizado por cirurgiões bucomaxilos, e acidentes e complicações podem estar relacionados a esse procedimento. A fratura mandibular é um acidente incomum, mas que apresenta grande potencial de gerar morbidade aos pacientes. Diante disso, evidencia-se a importância de uma abordagem precoce após o trauma, bem como o acompanhamento posterior e a determinação correta do tratamento. Nesse sentido, este estudo objetiva investigar na literatura os protocolos existentes de tratamentos de fraturas mandibulares transoperatórias associadas à exodontia de terceiros molares inferiores. Para isso, foi realizada uma revisão de literatura sistemática, de caráter exploratório e descritivo, na base de dados Pubmed através dos descritores mandibular fracture, extraction e treatment. As buscas foram realizadas com restrição de tempo de 2016 a 2021. Dos 18 artigos compatíveis à proposta, 6 artigos passaram pelos critérios de inclusão e exclusão. Desses, a análise da maioria dos autores é clara em se referir às exodontias de terceiros molares como fator para fraturas mandibulares e mencionar qual protocolo de atendimento seguir, caso aconteça a fratura. Conclui-se que a redução fechada ou aberta são possibilidades de abordagem, entretanto existe uma preferência, pela redução aberta por acesso extraoral ou intrabucal com fixação interna rígida, visto que, ela elimina o período de bloqueio maxilomandibular, facilitando o retorno à função.

Surgical removal of third molars is a common procedure performed by bucomaxilos surgeons, and accidents and complications can be related to this procedure. Mandibular fracture is an uncommon accident, but it has great potential to generate morbidity in patients. Because of this, the importance of an early approach after trauma is evident, as well as the subsequent follow-up and correct determination of treatment. In this sense, this objective is to investigate in the literature the existing protocols for the treatment of transverse mandibular fractures associated with the extraction of lower third molars. To this end, a systematic exploratory and descriptive literature review were conducted in the Pubmed database using the descriptors mandibular fracture, extraction and treatment. The searches were performed with a time restriction from 2016 to 2021. Of the 18 articles compatible with the proposal, 6 articles passed the inclusion and exclusion criteria. Of these, the analysis of most authors is clear in referring to third molar extractions as a factor for mandibular fractures and mentioning which treatment protocol to follow if a fracture occurs. It is concluded that closed or open reduction are possible approaches, however there is a preference for open reduction by extraoral or intraoral access with rigid internal fixation, since it eliminates the period of maxillomandibular block, facilitating the return to function.

The Value of Electrically Evoked Stapedius Reflex in Determining the Maximum Comfort Level of a Cochlear Implant.

BACKGROUND: One of the most important steps for good user performance with a cochlear implant (CI) is activation and programming, aimed at determining the dynamic range. In adults, current levels are determined by psychophysical measures. In babies, small children, or individuals with multiple disorders, this procedure requires techniques that may provide inconsistent responses because of auditory inexperience or the age of the child, making it a very difficult process that demands the collaboration of both the patient and the family. PURPOSE: To study the relationship between the electrically evoked stapedius reflex threshold (ESRT) and maximum comfort level for stimulating electrodes (C-level) in postoperative CI users. RESEARCH DESIGN: Cross-sectional analytical observational case series study. STUDY SAMPLE: We assessed 24 patients of both sexes, aged between 18 and 68 yr, submitted to CI surgery. INTERVENTION: Otoscopy and immittance. Next, an implant speech processor connected to an Itautec® computer containing the manufacturer's software (custom sound Ep 3-2) was used, as well as an AT 235h probe inserted into the ear contralateral to the CI to capture the stapedius reflex, obtaining electrically evoked stapedius reflex thresholds. DATA COLLECTION AND ANALYSIS: Data from the last programming, defining C-levels for each electrode studied, were extracted from the databank of each patient. The manual decay function of the AT 235h middle ear analyzer was used to observe ESRT response in a same window for a longer response capture time. Electrodes 22, 16, 11, 6, and 1 were tested when active, with the aim of using electrodes over the entire length of the CI, and ESRT was considered present when compliance was ≥0.05 ml. Stimuli, in current units, were always initiated at 20 cu above the C-level. The analysis of variance parametric test, Tukey's honest significant difference test, the t-test, Wilcoxon nonparametric test, and the Kolmogorov-Smirnov test examined whether significant relationships existed between these other factors. RESULTS: The results demonstrate that all the electrodes selected for the study exhibited higher mean reflex threshold values than their mean C-level counterparts. However, there was no significant difference between them, for electrodes 1, 6, 11, and 16. The data provided allow the use of ESRT to define C-level values and make it possible to stipulate a correction factor ranging between 6 and 25.6 electrical units. CONCLUSION: The use of electrically evoked stapedius reflex thresholds can help the team in charge of programming CIs, making the process faster and safer, mainly for infants, small children, or individuals with multiple disorders.

Descriptive study of goat external and middle ear through computed tomography and endoscopic evaluation, compared with the human ear

Abstract Objective: To describe the external and middle ear of goats, using computed tomography and endoscopic dissection, comparing them with the anatomy of the human ear, aiming to evaluate the viability of this animal model for training in otological endoscopic surgery. Methods: Images of the external and middle ear of goats were produced by computed tomography in the coronal and axial planes and analyzed. The radiological anatomy of the external and middle goat and human ear are described. Some measures of surgical interest were described, such as the length of the external auditory canal, external and internal cross-sectional area of the external auditory canal, middle ear depth, vertical angle of the external auditory canal, length of malleus and incus. After the tomographic study, we analyzed the importance of evaluations through the endoscopic dissection of the goat ear. Results: The bony canal is extremely tortuous and shows a bony prominence with significant elevation near the lower edge of the tympanic membrane. The middle ear has a large tympanic bulla in the hypotympanum region. The malleus is shaped similarly to that of the human, but its handle is located anterior to its head. The mastoid is not pneumatized. Compared to the human mastoid, there was a statistically significant difference in the external and internal cross-sectional area, at the depth of the middle ear, in the vertical angle of the canal and in the length of the incus. Conclusion: Goat morphometric anatomy showed that this model is suitable for surgical simulation in the initial training for endoscopic otological surgery. It is an important contribution to the development of skills to accelerate the subsequent endoscopic otological surgical training in humans, despite some differences found.

Frequency-Following Response (FFR) em usuários de implante coclear: uma revisão sistemática dos parâmetros de aquisição, análise e resultados / Frequency-Following Response (FFR) in cochlear implant users: a systematic review of acquisition parameters, analysis, and outcomes

RESUMO Objetivo Caracterizar os parâmetros de aquisição, análise e resultados do exame Frequency Following Response (FFR) em usuários de implante coclear. Estratégia de pesquisa As buscas foram realizadas nas bases Cochrane Library, Literatura Latino-Americana e do Caribe em Ciências da Saúde (LILACS), Ovid Technologies, PubMed, SciELO, ScienceDirect, Scopus, Web of Science e na literatura cinzenta. Critérios de seleção Foram incluídos estudos sobre o FFR em usuários de implante coclear ou que os comparassem à indivíduos com audição normal, sem restrição de idade. Foram excluídos estudos secundários e experimentais. Não houve restrição de idioma e ano de publicação. Análise dos dados Os dados foram analisados e redigidos de acordo com as etapas do Preferred Reporting Items for Systematic Reviews and Meta-Analyse (PRISMA) 2020. Para análise da qualidade metodológica foi utilizado o instrumento Joanna Briggs Institute Critical Appraisal Checklist for Analytical Cross Sectional Studies. As divergências foram resolvidas por um terceiro pesquisador. Resultados Seis estudos atenderam aos critérios de inclusão. Apenas um estudo foi do tipo comparativo com grupo controle de indivíduos com audição normal. As variações nos parâmetros de aquisição foram comuns e as análises predominaram no domínio do tempo. Usuários de implante coclear apresentaram diferenças nos resultados do FFR quando comparados a indivíduos com audição normal, considerando a literatura existente. A maioria dos artigos teve baixa qualidade metodológica. Conclusão Não existe padronização de um protocolo de aquisição e análise para o FFR em usuários de implante coclear. Os resultados são de alto risco de viés.

ABSTRACT Purpose To characterize the acquisition parameters, analysis, and results of the frequency-following response (FFR) in cochlear implant users. Research strategies The search was conducted in Cochrane Library, Latin American and Caribbean Health Sciences Literature (LILACS), Ovid Technologies, PubMed, SciELO, ScienceDirect, Scopus, Web of Science, and gray literature. Selection criteria Studies on FFR in cochlear implant users or that compared them with normal-hearing people, with no restriction of age, were included. Secondary and experimental studies were excluded. There was no restriction of language or year of publication. Data analysis The data were analyzed and reported according to the stages in the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA), 2020. The methodological quality was analyzed with the Joanna Briggs Institute Critical Appraisal Checklist for Analytical Cross-Sectional Studies. Divergences were solved by a third researcher. Results Six studies met the inclusion criteria. Only one study was comparative, whose control group comprised normal-hearing people. The variations in acquisition parameters were common and the analysis predominantly approached the time domain. Cochlear implant users had different FFR results from those of normal-hearing people, considering the existing literature. Most articles had low methodological quality. Conclusion There is no standardized FFR acquisition and analysis protocol for cochlear implant users. The results have a high risk of bias.

Frequency-Following Response and Auditory Behavior in Children with Prenatal Exposure to the Zika Virus

Abstract Introduction Prenatal exposure to the Zika virus can impair neurodevelopment and cause auditory damage. Objective To analyze the frequency-following response (FFR) and the auditory behavior (with the LittlEars® questionnaire) of children with and without prenatal exposure to Zika virus infection. Methods A total of 30 children participated in the present study, divided into 3 groups: 10 children with microcephaly and prenatal exposure to the Zika virus; 10 normocephalic children with prenatal exposure to the Zika virus; and 10 children with no evidence of prenatal exposure to the virus. The FFR test was performed with the /da/ syllable. The LittlEars® questionnaire was used with parents/guardians. Results For the FFR measurements, there was no difference between the groups. The children with exposure to the Zika virus presented a final score in the questionnaire below what is expected from children with normal hearing. A significant difference was observed for the final, semantic, and expressive scores between the group with microcephaly and the other groups. A strong negative correlation was seen between the LittlEars® questionnaire final score and the FFR measurements for the group with microcephaly when compared with the other groups. Conclusion Children exposed to the Zika virus, with and without microcephaly, presented FFR patterns similar to what was seen in children with no evidence of virus exposure. However, they showed signs of immature auditory behavior, suggesting auditory development delay.

Hearing and communicative skills in the first years of life in children with congenital Zika syndrome / Habilidades auditivas e de comunicação nos primeiros anos de vida em crianças com síndrome congênita do Zika

Abstract Introduction Microcephaly is recognized as one of the main consequences of congenital Zika syndrome, but other serious problems such as global hypertonia, irritability, excessive crying, swallowing disorders, seizures, visual impairment and sensorineural hearing loss have been identified as associated with the syndrome. Objective Describe the developmental characteristics of hearing and language skills in the first year of life of children with normal hearing thresholds' and congenital Zika syndrome. Methods This is a cross-sectional study that evaluated hearing and language skills in the first year of life of 88 children with normal peripheral hearing and confirmed congenital Zika syndrome. All children were submitted to a behavioral auditory test and a validated questionnaire addressed to parents or caregivers, which was used as an instrument for assessing hearing and communicative skills. Results The delay in communicative skills was present in 87.5% of the children, while 44.3% of them demonstrated a delay in hearing acuity. Only the alteration of cervical motor control presented as a statistically significant association with delays in both skills (p-value = 0.006 and <.001 for hearing and communicative skills, respectively), while the presence of microcephaly and the degree of its severity were only associated with delayed development of communicative skills. Conclusion Despite a normal peripheral auditory system, children with congenital Zika syndrome may demonstrate delayed language development by having neurological damage at the center of auditory processing, requiring more specific studies to clarify language acquisition in this population.

Resumo Introdução A microcefalia é reconhecida como uma das principais consequências da síndrome congênita do Zika, mas outros problemas graves, como hipertonia global, irritabilidade, choro excessivo, distúrbios da deglutição, convulsões, deficiência visual e perda auditiva neurossensorial, foram identificados como associados à síndrome. Objetivo Descrever as características do desenvolvimento das habilidades auditivas e de linguagem no primeiro ano de vida de crianças com limiares auditivos normais e síndrome congênita do Zika. Método Estudo transversal que avaliou habilidades auditivas e de linguagem no primeiro ano de vida de 88 crianças com audição periférica normal e síndrome congênita do Zika confirmada. Todas as crianças foram submetidas a um teste auditivo comportamental e um questionário validado foi endereçado aos pais ou cuidadores e usado como instrumento para avaliar as habilidades auditivas e de comunicação. Resultados O atraso nas habilidades de comunicação estava presente em 87,5% das crianças, enquanto 44,3% delas apresentaram atraso nas habilidades auditivas. Somente a alteração do controle motor cervical apresentou associação estatisticamente significante com atrasos nas duas habilidades (valor de p = 0,006 e < 0,001 para habilidades auditivas e de comunicação, respectivamente), enquanto a presença de microcefalia e o grau de sua gravidade foram associados apenas ao atraso no desenvolvimento das habilidades de comunicação. Conclusão Apesar de um sistema auditivo periférico normal, crianças com síndrome congênita do Zika podem apresentar atraso no desenvolvimento da linguagem por apresentarem danos neurológicos no centro do processamento auditivo, exige estudos mais específicos para esclarecer a aquisição da linguagem nessa população.

Discordant clinical outcomes of congenital Zika virus infection in twin pregnancies.

Congenital Zika syndrome is an emergent cause of a congenital infectious disorder, resulting in severe damage to the central nervous system and microcephaly. Despite advances in understanding the pathophysiology of the disease, we still do not know all the mechanisms enrolled in the vertical transmission of the virus. As has already been reported in other types of congenital infectious disorders in dizygotic twin pregnancies, it is possible that the virus affects only one of the fetuses. In this article, we report on two cases of twin pregnancies exposed to the Zika virus, but with only one of the fetuses affected with microcephaly and brain damage. This indicates the urgent need for more studies regarding the pathophysiology of viral infection and the mechanisms involved in the natural protection against the virus.

Relationship between auditory perception and vocal production in cochlear implantees: a systematic review. / Relação entre percepção auditiva e produção vocal em implantados cocleares: uma revisão sistemática.

PURPOSE: To conduct a systematic review of the scientific literature studying the relationship between vocal production and auditory perception in cochlear implant users. RESEARCH STRATEGIES: This is an integrative systematic review. The plattforms/databases Bireme, SciELO, Cochrane, Scopus and Web of Science were consulted and the descriptors used were voice, cochlear implant and auditory perception. SELECTION CRITERIA: Original papers published in English, French, Spanish or Portuguese involving the study of vocal production and auditory perception in cochlear implant users were selected and there was no restriction about year of publication of the articles. DATA ANALYSIS: The studies selected were analyzed according to the author, location, year and publication of the article, as well as for their sample size, type of vocal production and auditory perception assessment and for its major findings and recommendation grade/level of scientific evidence. RESULTS: The results suggest the existence of positive relationship between vocal production and auditory perception in cochlear implant users, and indicate that the deployment time has a positive influence in this relationship. CONCLUSION: None of the selected studies were rated at level 1 of scientific evidence or grade A of recommendation, which is related to the methodological approach that can go with this subject matter. There is great lack of publications relating auditory perception and speech production in cochlear implant users. This gap is even greater when it comes to the adult population.

Treatment of tympanic membrane perforation using bacterial cellulose: a randomized controlled trial.

INTRODUCTION: Promising treatments for tympanic membrane perforation closure have been studied. Therapies derived from tissue engineering probably eliminate the need for conventional surgery. Bacterial cellulose is presented as an alternative that is safe, biocompatible, and has low toxicity. OBJECTIVES: To investigate the effect on healing of direct application of a bacterial cellulose graft on the tympanic membrane compared to the conventional approach with autologous fascia. METHODS: Randomized controlled trial. Forty patients with tympanic membrane perforations secondary to chronic otitis media were included, and were randomly assigned to an experimental group (20), treated with a bacterial cellulose graft (BC) and control group (20), treated with autologous temporal fascia (fascia). We evaluated the surgical time, hospital stay, time of epithelialization and the rate of tympanic perforation closure. Hospital costs were compared. The statistical significance level accepted was established at p<0.05. RESULTS: The closure of perforations was similar in both groups. The average operation time in the fascia group was 76.50 min versus 14.06 min bacterial cellulose in the group (p=0.0001). The hospital cost by the Brazilian public health system was R$ 600.00 for the bacterial cellulose group, and R$ 7778.00 for the fascia group (p=0.0001). CONCLUSION: Bacterial cellulose grafts promoted the closure of the tympanic membrane perforations, and were demonstrated to be innovative, effective, safe, minimally invasive, efficacious and to have a very low cost.

The anatomical orientation of the middle turn of the cochlea: importance during surgical implantation of the ossified cochlea.

HYPOTHESIS: The physical relationship between anatomical landmarks such as the tympanic portion of the facial nerve and the orientation of the middle turn of the cochlea are sufficiently constant to provide guidance to surgeons performing cochlear implantation in the ossified cochlea. BACKGROUND: Placing an implant in an ossified cochlea is technically difficult. The surgeon needs to drill two tunnels through the promontory bone to insert electrode arrays in the region of the basal and middle turns of the cochlea. However, few studies describe the orientation of these tunnels or how to use anatomical landmarks to guide the surgeon during their creation. This problem is particularly true for the superior (middle turn) tunnel. DESIGN: Twenty human temporal bones from adult cadavers were analyzed. They were dissected with exposure of all middle ear structures, followed by the removal of the tympanic ring, tympanic membrane, malleus, and incus. We measured the angle between the tympanic segment of the fallopian canal and a line passing through the lower portion of the middle turn of the cochlea. RESULTS: The measured angles varied from 123 and 152 degrees with an average of 133.85 degrees and the standard deviation of ± 6.83 degrees. CONCLUSION: The tunnel for the middle turn should be created with an inclination of about 134 degrees in relation to the tympanic segment of the facial nerve.