Sudden sensorineural hearing loss : evaluation of co-morbidities and potential clinical associations

RESUMO: A surdez s��bita (SS) caracteriza-se por uma perda abrupta de audi����o, mais frequentemente unilateral e associada a sensa����o de preenchimento aural, acufenos e vertigem. Afecta 5-20/100.000pessoas/ano (sobretudo adultos em fase activa na d��cada de 40), com grande impacto na qualidade de vida. Poss��veis causas incluem doen��as infecciosas, circulat��rias, traum��ticas, imunol��gicas, neopl��sicas, neurol��gicas, t��xicas e cocleares. No entanto, a causa da SS permanece desconhecida na maioria dos casos (80%), o que origina tratamentos controversos e frequentemente ineficientes. Os tratamentos dispon��veis variam desde corticoster��ides a antivirais, vasodilatadores, anti-agregantes, anticoagulantes, vitaminas e oxig��nio hiperb��rico (OHB). Atendendo a falta de informa����o relativa �� etiologia e fisiopatologia da SS, pretendemos avaliar a evolu����o cl��nica dos doentes com SS tratados com OHB no Centro de Medicina Subaqu��tica e Hiperb��rica (CMSH) de Lisboa entre 2000 e 2005, durante um per��odo m��nimo de 5 anos, na tentativa de identificar eventuais factores de risco ou noxas cl��nicas com a SS. O estudo retrospectivo proposto baseia-se na revis��o de processos cl��nicos do CMSH e na aplica����o telef��nica de question��rios m��dicos de ���follow-up��� confidenciais ��� tanto a doentes (grupo de estudo), como aos respectivos esposos/companheiros/membros pr��ximos da fam��lia (grupo de controlo) ���, com particular ��nfase nos antecedentes m��dicos e hist��ria cl��nica actual. Um estudo preliminar de 20 pessoas (10 doentes e 10 controlos) foi efectuado para antecipar dificuldades e estimar as necessidades log��sticas. As dificuldades identificadas foram: 1) selec����o dos doentes com n��meros de telefone v��lidos e processos cl��nicos completos (com audiograma inicial e final); 2) contacto telef��nico com os participantes de ambos os grupos (de estudo e controlo); 3) recursos humanos requeridos. Dado que a SS n��o �� uma doen��a em si, mas um sintoma de uma doen��a subjacente, acreditamos que este estudo epidemiol��gico seja importante e ��til, capaz de gerar novas luzes sobre a fisiopatologia e mecanismos desta entidade cl��nica.-------------ABSTRACT:Sudden sensorineural hearing loss (SSHL) is characterized by abrupt, mostly unilateral loss of hearing, frequently associated to aural fullness, tinnitus and vertigo. It affects 5-20/100.000 people/year (particularly working adults in the 40ths), with huge impact on quality of life. Possible causes include infectious, circulatory, traumatic, immunologic, metabolic, neoplastic, neurologic, toxic and unidentified cochlear diseases. Nevertheless, SSHL���s etiology remains unknown in most cases (80%), giving rise to controversial (and frequently ineffective) treatments. Available therapies range from corticosteroids to antivirals, vasodilators, antiaggregants, anticoagulants, vitamins and hyperbaric oxygen (HBO). Given the lack of data concerning SSHL���s etiology and physiopathology, we intend to evaluate clinical evolution of such patients treated with HBO in the Underwater and Hyperbaric Medical Center (UHMC) at Lisbon from 2000 to 2005 during a minimum period of 5 years, in an attempt to identify eventual risk factors or clinical associations to SSHL. The intended retrospective study is based on the review of patients��� medical charts from UHMC and confidential follow-up questionnaires applied telephonically both to patients (study group) and patients��� spouse/partner/close family member (control group), focusing past and present medical history. A preliminary study of 20 subjects (10 of each group) was performed to anticipate difficulties and to estimate the required logistics. The identified difficulties were: 1) selection of subjects with valid phone numbers and complete medical charts (with initial and final audiograms); 2) telephonic contact with subjects from the study and control group; 3) human logistics required. As it is believed that SSHL is not a disease by itself but rather a symptom of an underlying disease, we believe that this epidemiologic study is important and will hopefully generate sound scientific knowledge concerning physiopathology and mechanism of disease of SSHL.

Hearing Disability Assessment - Report of the Expert Hearing Group

In November 1997, the Department of Health and Children established an expert group to examine and make recommendations on an appropriate system and criteria for the assessment of hearing disability arising from hearing loss, with particular reference to noise induced hearing loss. The group was to prepare a report for the Minister for Health and Children. Download the Report here

An integrated genetic and functional analysis of the role of type II transmembrane serine proteases (TMPRSSs) in hearing loss.

Building on our discovery that mutations in the transmembrane serine protease, TMPRSS3, cause nonsyndromic deafness, we have investigated the contribution of other TMPRSS family members to the auditory function. To identify which of the 16 known TMPRSS genes had a strong likelihood of involvement in hearing function, three types of biological evidence were examined: 1) expression in inner ear tissues; 2) location in a genomic interval that contains a yet unidentified gene for deafness; and 3) evaluation of hearing status of any available Tmprss knockout mouse strains. This analysis demonstrated that, besides TMPRSS3, another TMPRSS gene was essential for hearing and, indeed, mice deficient for Hepsin (Hpn) also known as Tmprss1 exhibited profound hearing loss. In addition, TMPRSS2, TMPRSS5, and CORIN, also named TMPRSS10, showed strong likelihood of involvement based on their inner ear expression and mapping position within deafness loci PKSR7, DFNB24, and DFNB25, respectively. These four TMPRSS genes were then screened for mutations in affected members of the DFNB24 and DFNB25 deafness families, and in a cohort of 362 sporadic deaf cases. This large mutation screen revealed numerous novel sequence variations including three potential pathogenic mutations in the TMPRSS5 gene. The mutant forms of TMPRSS5 showed reduced or absent proteolytic activity. Subsequently, TMPRSS genes with evidence of involvement in deafness were further characterized, and their sites of expression were determined. Tmprss1, 3, and 5 proteins were detected in spiral ganglion neurons. Tmprss3 was also present in the organ of Corti. TMPRSS1 and 3 proteins appeared stably anchored to the endoplasmic reticulum membranes, whereas TMPRSS5 was also detected at the plasma membrane. Collectively, these results provide evidence that TMPRSS1 and TMPRSS3 play and TMPRSS5 may play important and specific roles in hearing.

Mapping Nursing language terms of Parkinson's disease

OBJECTIVE Implementing cross-mapping of Nursing language terms with the terminology of NANDA International, contained in records of patients with Parkinson's disease in rehabilitation. METHOD Descriptive study of cross mapping, carried out in three steps. A simple random sample of 67 files of patients who participated in the rehabilitation in the period between March 2009 and April 2013. RESULTS We identified 454 terms of Nursing language that resulted in 54 diagnoses after cross-mapping, present in 11 of the 13 taxonomy domains. The most mapped diagnosis was "Impaired urinary elimination" (59.7%), followed by "Urgent urinary incontinence" (55.2%), "Willingness to self-control improved health" (50.7%), "Constipation" (47.8%) and "Compromised physical mobility" (29.9%). Seven described terms were not mapped due to a corresponding defining characteristic being absent. CONCLUSION It was possible to determine the profile of patients, as well as the complexity of nursing care in the rehabilitation of patients with Parkinson's disease.

EFNS guidelines on cognitive rehabilitation: report of an EFNS task force.

Disorders of language, spatial perception, attention, memory, calculation and praxis are a frequent consequence of acquired brain damage [in particular, stroke and traumatic brain injury (TBI)] and a major determinant of disability. The rehabilitation of aphasia and, more recently, of other cognitive disorders is an important area of neurological rehabilitation. We report here a review of the available evidence about effectiveness of cognitive rehabilitation. Given the limited number and generally low quality of randomized clinical trials (RCTs) in this area of therapeutic intervention, the Task Force considered, besides the available Cochrane reviews, evidence of lower classes which was critically analysed until a consensus was reached. In particular, we considered evidence from small group or single cases studies including an appropriate statistical evaluation of effect sizes. The general conclusion is that there is evidence to award a grade A, B or C recommendation to some forms of cognitive rehabilitation in patients with neuropsychological deficits in the post-acute stage after a focal brain lesion (stroke, TBI). These include aphasia therapy, rehabilitation of unilateral spatial neglect (ULN), attentional training in the post-acute stage after TBI, the use of electronic memory aids in memory disorders, and the treatment of apraxia with compensatory strategies. There is clearly a need for adequately designed studies in this area, which should take into account specific problems such as patient heterogeneity and treatment standardization.

Evaluation of Appropriate Maintenance, Repair and Rehabilitation Methods for Iowa Bridges, TR-429, 2003

Most states, including Iowa, have a significant number of substandard bridges. This number will increase significantly unless some type of preventative maintenance is employed. Both the Iowa Department of Transportation and Iowa counties have successfully employed numerous maintenance, repair and rehabilitation (MR&R) strategies for correcting various types of deficiencies. However, successfully employed MR&R procedures are often not systematically documented or defined for those involved in bridge maintenance. This study addressed the need for a standard bridge MR&R manual for Iowa with emphasis for secondary road applications. As part of the study, bridge MR&R activities that are relevant to the state of Iowa have been systematically categorized into a manual, in a standardized format. Where pertinent, design guidelines have been presented. Material presented in this manual is divided into two major categories: 1) Repair and Rehabilitation of Bridge Superstructure Components, and 2) Repair and Rehabilitation of Bridge Substructure Components. There are multiple subcategories within both major categories that provide detailed information. Some of the detailed information includes step-by-step procedures for accomplishing MR&R activities, material specifications and detailed drawings where available. The source of information contained in the manual is public domain technical literature and information provided by Iowa County Engineers. A questionnaire was sent to all 99 counties in Iowa to solicit information and the research team personally solicited input from many Iowa counties as a follow-up to the questionnaire.

Identification of rehabilitation needs after a stroke: an exploratory study

Affiliation: Jacqueline Rousseau : ��cole de r��adaptation, Facult�� de m��decine, Universit�� de Montr��al

Ganancia funcional en ni��os con neuropat��a auditiva

La neuropat��a auditiva es un desorden caracterizado por hipoacusia neurosensorial y ausencia de potenciales evocados auditivos de tallo cerebral, con otoemisiones ac��sticas presentes, encontrando una p��rdida de la audici��n en presencia de funci��n coclear, siendo esta sugestiva anomal��a de una alteraci��n de la sincron��a neural. La neuropat��a presenta una baja incidencia en ni��os con funciones auditivas normales y una incidencia variable en ni��os con hipoacusias severas, el manejo actual de la neuropat��a va encaminado a la rehabilitaci��n auditiva, usando sistemas de amplificaci��n (aud��fonos o implantes cocleares). Se realizo un estudio de corte transversal con el objetivo de comparar la respuesta en ni��os con neuropat��a auditiva y ni��os con hipoacusia neurosensorial en cuanto a la ganancia funcional con sistemas de amplificaci��n. Fueron tomados 4 ni��os con diagnostico confirmado de la patolog��a y se compararon con un grupo control de 16 ni��os con hipoacusias neurosensoriales de otras etiolog��as, se comparo el valor de la ganancia funcional con aud��fono y con implante coclear, obtenido de las audiometr��as. La ganancia funciona global con ambos sistemas de amplificaci��n no muestra diferencias significativas comparados los dos grupos, comparando el grupo de pacientes con neuropat��a auditiva se encontraron diferencias significativas entre aud��fono e implante para las frecuencias medias y agudas. Se puede concluir que el aud��fono en pacientes con neuropat��a auditiva es el sistema de amplificaci��n que ofrece mejores valores de ganancia funcional, aun mejor que el implante coclear.

The study of prefixes and suffixes

This paper contains an outline of study for language development with prefixes and suffixes for hearing impaired children.

An analysis of four reading series at the third grade reading level

This paper discusses a study of four reading series at the third grade reading level for hearing impaired children.

The development of principles underlying auditory training

This paper is a review of auditory training using amplification for hearing impaired children.

A comparison of the QuickSIN and TEN tests: two recent tests designed to predict patient benefit from high frequency amplification

This paper presents a comparison of two tests designed to predict which hearing impaired patients may benefit from high frequency amplification.