Audiological findings in patients treated with radio- and concomitant chemotherapy for head and neck tumors

Abstract Objective To evaluate the functionality of the auditory system in patients who underwent radiotherapy and chemotherapy treatment with cisplatin to treat head and neck tumors. Study Design Case series with planned data collection. Setting From May 2007 to May 2008 by the Department of Otorhinolaryngology and the Department of Oncology/Radiotherapy at Faculdade de Medicina de Marília. Subjects and Methods Audiological evaluation (Pure Tone Audiometry (air and bone conduction), Speech Audiometry, Tympanometry, Acoustic Reflex testing and Distortion Product Otoacoustic Emissions) was performed in 17 patients diagnosed with head and neck neoplasia and treated with chemotherapy, using cisplatin, and radiotherapy. Results 12 left ears (70.5%) and 11 right ears (64.7%) presented bilateral decreased hearing soon after the treatment for the frequency 1 kHz (mild auditory damage) and for the frequency 8 kHz (more significant auditory damage). Conclusion Patients with head and neck cancer submitted to the conventional radiotherapy treatment, combined with the chemotherapy with cisplatin, presented a high incidence of decreased hearing by the end of treatment. Strong evidence was observed linking auditory alteration to the amount of radiotherapy treatment.

Questionnaire for monitoring auditory and language development in the first year of life

Purpose: To validate a monitoring questionnaire about hearing and language development applied by community health agents in the first year of life. Methods: Seventy six community health agents, previously trained on infant hearing health, administered a questionnaire to the families of 304 children with ages from 0 to 1 year. The questionnaire contains questions regarding hearing and language development and, for all age groups, the question “Does your child hear well?” was presented. The validity of the questionnaire was assessed by analyzing false positive and false negative rates of the identified children. A double-blind study was conducted so that all children assessed by the questionnaire were submitted to hearing evaluation performed by audiologists. Results: Four children (1.32%) were diagnosed with sensorineural hearing loss (two unilateral), and 69 (22.7%) with conductive hearing loss. The monitoring questionnaire showed specificity of 96% and sensitivity of 67%, with a false-negative rate of 33% for not identifying the unilateral hearing loss, and a false-positive rate of 4%. Conclusion: The questionnaire used has shown to be feasible and relevant to actions of the community health agents of the Family Health Strategy program, with high specificity and moderate sensitivity. The use of the validated instrument should be considered to complement Newborn Hearing Screening Programs, in order to identify late onset or acquired hearing loss.

The influence of speech stimuli contrast in cortical auditory evoked potentials

Studies about cortical auditory evoked potentials using the speech stimuli in normal hearing individuals are important for understanding how the complexity of the stimulus influences the characteristics of the cortical potential generated. OBJECTIVE: To characterize the cortical auditory evoked potential and the P3 auditory cognitive potential with the vocalic and consonantal contrast stimuli in normally hearing individuals. METHOD: 31 individuals with no risk for hearing, neurologic and language alterations, in the age range between 7 and 30 years, participated in this study. The cortical auditory evoked potentials and the P3 auditory cognitive one were recorded in the Fz and Cz active channels using consonantal (/ba/-/da/) and vocalic (/i/-/a/) speech contrasts. Design: A crosssectional prospective cohort study. RESULTS: We found a statistically significant difference between the speech contrast used and the latencies of the N2 (p = 0.00) and P3 (p = 0.00) components, as well as between the active channel considered (Fz/Cz) and the P3 latency and amplitude values. These correlations did not occur for the exogenous components N1 and P2. CONCLUSION: The speech stimulus contrast, vocalic or consonantal, must be taken into account in the analysis of the cortical auditory evoked potential, N2 component, and auditory cognitive P3 potential.

Monitoramento de crianças com indicadores de risco para a deficiência auditiva

Purpose: to describe the proposal of monitoring children in the first year of life, who were not identified in the newborn hearing screening program but had risk factors for hearing loss. Method: the study included 258 risk children who had obtained the result “pass” in the Universal Newborn Hearing Screening Program of Hospital Santa Isabel – Bauru/SP, from June to November 2008. It was applied by the telephone, a validated questionnaire in a previous study, containing questions about hearing and language. For each question there were two possible answers: “yes” or “no” and we considered “failure” to obtain at least one “no” answer. With such result, the child was scheduled to perform an immediate hearing evaluation. Results: the questionnaire was applied with 169 families; with the others, there was no contact. From the total, 164 (97,04%) obtained “passed” and five (2,96%) “failed”. Between these five children, only three showed up for hearing evaluation and one had no disorders; two presented conductive hearing loss. It was observed distinct prevalence among the risk factors and there was no relation (p>0,05) of the risk factors with the evasion in the monitoring process. Conclusion: the monitoring through a questionnaire applied by telephone proved to be feasible, however, it is necessary to develop strategies to support their execution.

A hearing report from Brazil

The past several decades, the need for hearing health services is still great, especially in the northeast, the Amazonian, and the southern regions Brazil, officially Federative Republic of Brazil, is the largest Portuguese-speaking country, and the fifth largest country in the world by population and by land. The vast land not only brings rich natural resources but also large varieties of exotic vegetation and wildlife. One hundred and ninety-three million inhabitants live in five geographical regions with diverse cultural practices influenced by immigrants from Italy, Spain, Japan, Germany, and other countries. Brazilian people generally are warm-hearted, very welcoming, and resilient. They are optimistic and creative despite having encountered many economic downturns and political challenges throughout history. A bachelor's degree is the entry level for the profession. As only 19 percent of the population aged 18–24 years have access to higher education, the competition for admissions is fierce, especially in government institutions. High school students need to pass tests of general knowledge in a national examination and a university-specific examination. Government educational institutions offer good education without charging tuition. The majority of scientific papers are also produced by scholars working in government institutions. Private institutions are generally ranked lower in academic rigor (Behlau and Gasparini, 2006), except for a few top-ranking institutions. The fields of speech-language pathology and audiology are marked by rapid changes in recent years. Currently, there are 104 undergraduate programs recognized by the Ministry of Education and distributed in all but three federal states of Brazil.

Relação entre limiares audiométricos, handicap e tempo para procura de tratamento da deficiência auditiva

OBJETIVO: Verificar a relação entre limiares audiométricos, autopercepção do handicap e tempo para procura de tratamento em indivíduos atendidos em um serviço público de saúde auditiva. MÉTODOS: Trata-se de estudo retrospectivo, com análise de prontuários de 152 idosos e 48 adultos deficientes auditivos. As médias de limiares audiométricos ISO (500 Hz a 4 kHz) e de altas frequências (2 a 6 kHz), os limiares de reconhecimento de fala e a pontuação total e das subescalas social e emocional dos Questionários de Handicap Auditivo para Adultos (HHIA) e Idosos (HHIE) foram comparados com o tempo compreendido entre o início da queixa auditiva e o momento da procura por tratamento. RESULTADOS: O tempo médio para procura do tratamento foi de 7,6 anos. Não houve diferença entre adultos e idosos para as médias dos limiares ISO e de alta frequência, pontuação total e das subescalas do HHIA/E, e tempo para procura do tratamento. Correlações negativas fracas, porém significativas, foram observadas entre os limiares audiométricos e o tempo para procura de tratamento. Não foram encontradas relações entre o tempo para procura de tratamento e as variáveis referentes à escolaridade, nível sócio econômico e percepção do handicap. CONCLUSÃO: Os limiares audiométricos parecem influenciar a procura pelo tratamento. A despeito dos avanços tecnológicos e mudanças no acesso à informação e ao tratamento, o tempo de procura pelo tratamento é similar ao encontrado há 30 anos.

Ressonância natural da orelha e sua relação com os volumes equivalentes das orelhas externa e média

INTRODUÇÃO: Modificações decorrentes da senilidade podem alterar as características do sistema de transmissão da orelha média bem como a ressonância da orelha externa, trazendo implicações para o processo de verificação do aparelho de amplificação sonora individual (AASI), quando utilizados targets e medidas do ganho de inserção (REIG). OBJETIVO: Comparar o ganho da orelha externa (REUG) e os volumes da orelha externa (VeqOE) e média (VeqOM) em idosos e adultos. MÉTODO: Estudo retrospectivo. Foram analisados dados de prontuário de 28 idosos (idade entre 61 e 102 anos, média limiares auditivos entre 38,75 a 85 dBNA) e 23 adultos (idades entre 20 e 59 anos, média limiares auditivos entre 31,25 a 116,25 dBNA) com perda auditiva neurossensorial bilateral e sem histórico de alteração de orelha média. Resultados da imitanciometria (VeqOE, VeqOM e pressão do pico de máxima complacência) e REUG (frequência e amplitude do pico primário) foram recuperados, totalizando 40 orelhas analisadas. Foram comparados tais dados entre adultos e idosos bem como entre homens e mulheres, por meio do teste "t" de Student. Foram verificadas correlações (Pearson) entre os dados da imitanciometria e da REUG. RESULTADOS: Não houve diferença estatisticamente significativa (p<0,01) dos dados da imitanciometria e das medidas do REUG entre adultos e idosos ou entre homens e mulheres. Houve correlação negativa, fraca, porém significativa entre o VeqOE e a frequência do pico primário da REUG. CONCLUSÃO: Os dados obtidos indicam que a verificação do AASI pode ser realizada com targets e medidas do REIG na população de idosos.

Adaptação à distância de próteses auditivas acústicas: a teleaudiologia aplicada na melhoria da condução das Políticas Públicas no Brasil

INTRODUÇÃO: O governo brasileiro atualmente credencia cerca de 140 centros especializados para adaptações de aparelhos de amplificação sonora individual via SUS. Adaptações à distância através da internet podem permitir maior eficiência na prestação deste serviço e com maiores chances de aceitação por parte do paciente do SUS. OBJETIVOS: Descrever o caso de adaptação à distância realizado entre duas cidades, com revisão da literatura. MÉTODO: Equipamentos de informática e de tecnologia da informação, programador universal, aparelhos de amplificação sonora individual. ESTUDO DE CASO: Uma fonoaudióloga lotada num centro especializado introduziu a um centro remoto (distância de 200 km) um novo aparelho de amplificação sonora individual e seu programa de adaptação. O centro remoto assistiu a adaptação de dois pacientes em sua clínica, realizando voluntariamente a adaptação do terceiro paciente. Todo o procedimento foi realizado através da internet, contando com recursos de áudio e vídeo em todos os procedimentos. RESULTADOS: Três pacientes foram adaptados à distância. Três fonoaudiólogas receberam treinamento à distância de como adaptar aparelhos auditivos. CONCLUSÃO: Foi possível adaptar AASI à distância, além de prover treinamento e habilitar um centro remoto na adaptação de um novo aparelho de amplificação sonora individual e de seu programa de adaptação. Tal procedimento pode ser útil ao governo na condução de políticas públicas da saúde auditiva.

Telessaúde: avaliação da eficácia da teleconsulta na programação e adaptação de aparelho de amplificação sonora individual

OBJETIVO: Avaliar a eficácia da teleconsulta para a programação, verificação e adaptação do aparelho de amplificação sonora individual (AASI). MÉTODOS: Cinquenta participantes com deficiência auditiva (idades entre 39 e 88 anos), com média dos limiares audiométricos entre 30 e 68,75 dBNA, foram alocados em dois grupos (randomização estratificada), controle (n=25) e experimental (n=25), submetidos respectivamente à consulta face a face e teleconsulta síncrona com video interativo e controle remoto de aplicativos. Foram realizadas a programação e verificação do AASI (medidas com microfone sonda) e orientação dos participantes quanto ao uso e cuidados com o dispositivo. O tempo para os procedimentos foi cronometrado. Após as consultas um avaliador, cego quanto aos grupos, aplicou o teste de percepção da fala Hearing in Noise Test (HINT) Brasil. Aproximadamente um mês após as consultas, foi verificado o tempo diário de uso do AASI e administrado o questionário International Outcome Inventory for Hearing Aids (IOI-HA). RESULTADOS: Maior tempo para a programação e verificação e menor tempo para orientação foi observado para o grupo experimental. Não houve diferença entre grupos no tempo total do atendimento. A equiparação das medidas com microfone sonda aos respectivos targets de amplificação foi similar para os dois grupos. Não houve diferença entre os grupos quanto aos resultados do HINT-Brasil (silêncio e ruído), o tempo médio de uso diário do AASI e resultados do IOI-HA. CONCLUSÃO: A teleconsulta é um procedimento eficaz para a programação, verificação do AASI e orientação de usuários quando serviços face a face não estiverem disponíveis.

Extraintestinal Crohn's disease mimicking autoimmune inner ear disease: a histopathological approach

Patients with autoimmune inner ear disease develop rapidly progressive sensorineural hearing loss over a period of several weeks or months, often accompanied by vestibular loss. This disease can occur as a distinct clinical entity or in association with an underlying autoimmune disorder. Treatment comprises immunosuppression by corticosteroids, cytostatic drugs or tumor necrosis factor- antagonists. We report histopathological and immunohistochemical findings of the inner ear of a patient with a granulomatous inner ear disease suffering from Crohn's disease that was nonresponsive to treatment and who underwent surgery for bilateral cochlear implants.

Influence of a totally open oval window on bone conduction in otosclerosis

The aim of this study was to evaluate changes in bone conduction thresholds before, during and after total stapedectomy.

Common parietal activation in musical mental transformations across pitch and time

We previously observed that mental manipulation of the pitch level or temporal organization of melodies results in functional activation in the human intraparietal sulcus (IPS), a region also associated with visuospatial transformation and numerical calculation. Two outstanding questions about these musical transformations are whether pitch and time depend on separate or common processing in IPS, and whether IPS recruitment in melodic tasks varies depending upon the degree of transformation required (as it does in mental rotation). In the present study we sought to answer these questions by applying functional magnetic resonance imaging while musicians performed closely matched mental transposition (pitch transformation) and melody reversal (temporal transformation) tasks. A voxel-wise conjunction analysis showed that in individual subjects, both tasks activated overlapping regions in bilateral IPS, suggesting that a common neural substrate subserves both types of mental transformation. Varying the magnitude of mental pitch transposition resulted in variation of IPS BOLD signal in correlation with the musical key-distance of the transposition, but not with the pitch distance, indicating that the cognitive metric relevant for this type of operation is an abstract one, well described by music-theoretic concepts. These findings support a general role for the IPS in systematically transforming auditory stimulus representations in a nonspatial context. (C) 2013 Elsevier Inc. All rights reserved.

Tinnitus before and 6 months after cochlear implantation

In this prospective multicenter study, tinnitus loudness and tinnitus-related distress were investigated in 174 cochlear implant (CI) candidates who underwent CI surgery at a Swiss cochlear implant center. All subjects participated in two session, one preoperatively and one 6 months after device activation. In both sessions, tinnitus loudness was assessed using a visual analogue scale and tinnitus distress using a standardized tinnitus questionnaire. The data were compared with unaided pre- and postoperative pure tone thresholds, and postoperative speech reception scores. 71.8% of the subjects reported tinnitus preoperatively. Six months after CI surgery 20.0% of these reported abolition of their tinnitus, 51.2% a subjective improvement, 21.6% no change and 7.2% a deterioration. Of the 49 (28.2%) subjects with no tinnitus preoperatively, 5 developed tinnitus 6 months after CI. These 5 had poorer speech understanding after CI surgery with their device than the group who remained tinnitus free. We found no correlation between tinnitus improvement, age, duration of tinnitus, or change in unaided hearing thresholds between the two sessions.

A Novel Implantable Hearing System with Direct Acoustic Cochlear Stimulation

A new implantable hearing system, the direct acoustic cochlear stimulator (DACS) is presented. This system is based on the principle of a power-driven stapes prosthesis and intended for the treatment of severe mixed hearing loss due to advanced otosclerosis. It consists of an implantable electromagnetic transducer, which transfers acoustic energy directly to the inner ear, and an audio processor worn externally behind the implanted ear. The device is implanted using a specially developed retromeatal microsurgical approach. After removal of the stapes, a conventional stapes prosthesis is attached to the transducer and placed in the oval window to allow direct acoustical coupling to the perilymph of the inner ear. In order to restore the natural sound transmission of the ossicular chain, a second stapes prosthesis is placed in parallel to the first one into the oval window and attached to the patient's own incus, as in a conventional stapedectomy. Four patients were implanted with an investigational DACS device. The hearing threshold of the implanted ears before implantation ranged from 78 to 101 dB (air conduction, pure tone average, 0.5-4 kHz) with air-bone gaps of 33-44 dB in the same frequency range. Postoperatively, substantial improvements in sound field thresholds, speech intelligibility as well as in the subjective assessment of everyday situations were found in all patients. Two years after the implantations, monosyllabic word recognition scores in quiet at 75 dB improved by 45-100 percent points when using the DACS. Furthermore, hearing thresholds were already improved by the second stapes prosthesis alone by 14-28 dB (pure tone average 0.5-4 kHz, DACS switched off). No device-related serious medical complications occurred and all patients have continued to use their device on a daily basis for over 2 years. Copyright (c) 2008 S. Karger AG, Basel.

Ultrastructural changes in otoconia of osteoporotic rats

The etiology of benign paroxysmal positional vertigo (BPPV) remains obscure in many cases and women are affected more often than men. A recent prospective study, performed in women >50 years of age suffering from recurrent BPPV, showed associated osteopenia or osteoporosis in a large percentage of these patients. These results suggested the possible relationship between recurrent BPPV and a decreased fixation of calcium in bone in women >50 years. To test this hypothesis, an experimental study was performed in adult female rats. Utricular otoconia of female rats in which osteopenia/osteoporosis was induced by bilateral ovariectomy (OVX) were compared to those of sham-operated adult females rats (SHAM), as control group. FIRST STUDY: The morphology of theutricles of OVX and SHAM rats was analyzed with scanning electron microscopy. In osteopenic/osteoporotic rats, the density of otoconia (i.e. the number of otoconia per unit area) was decreased (p = 0.036)and their size was increased (p = 0.036) compared to the control group. SECOND STUDY: To test the role of calcium turnover in such morphological changes, utricular otoconia of 2 other groups of OVX and SHAM rats, previously injected with calcein subcutaneously, were examined by conventional and epifluorescence microscopy. In epifluorescence microscopy, labeling with calcein showed no significant fluorescence in either group. This finding was interpreted as a lack of external calcium turnover into otoconia of adult female rats. The ultrastructural modifications of otoconia in osteopenic/osteoporotic female adult rats as well as the role of estrogenic receptors in the inner ear are discussed. The possible pathophysiological mechanisms which support the relationship between recurrent BPPV in women and the disturbance of the calcium metabolism of osteopenia/osteoporosis are debated.