Adriane Ribeiro Teixeira

Mechanisms of cisplatin ototoxicity: theoretical review

INTRODUCTION Cisplatin is an effective chemotherapeutic agent commonly used in the treatment of malignant tumours, but ototoxicity is a significant side effect. OBJECTIVES To discuss the mechanisms of cisplatin ototoxicity and subsequent cell death, and to present the results of experimental studies. MATERIAL AND METHODS We conducted a systematic search for data published in national and international journals and books, using the Medline, SciELO, Bireme, LILACS and PubMed databases. RESULTS The nicotinamide adenine dinucleotide phosphate oxidase 3 isoform (also termed NOX3) seems to be the main source of reactive oxygen species in the cochlea. These reactive oxygen species react with other molecules and trigger processes such as lipid peroxidation of the plasma membrane and increases in expression of the transient vanilloid receptor potential 1 ion channel. CONCLUSION Cisplatin ototoxicity proceeds via the formation of reactive oxygen species in cochlear tissue, with apoptotic cell death as a consequence.

Memory training (MT) in mild cognitive impairment (MCI) generates change in cognitive performance

BACKGROUND Longevity can be accompanied by several challenges, among them cognitive decline. The early identification of cognitive impairment offers the opportunity to act with the aim of preventing or delaying dementia. One potential intervention measure is MT. OBJECTIVES To test the effect of MT in a sample of older individuals previously identified as having MCI. METHODS A randomized controlled clinical trial was carried out. Subjects were recruited by the local media for a memory study and were submitted to a battery of cognitive tests. Subjects meeting inclusion criteria (n=112) were classified as normal controls (n=65) and MCI (n=47), according to Gauthier and Touchons criteria (Gauthier & Touchon, 2005). The study sample was randomly assigned to three different intervention groups: MT group, educational intervention (EI) group, and control group (CG). The MT group received eight training sessions to learn mnemonic strategies based on ecological tasks. They also completed tasks which recruited attention and executive functions. Educational content on memory and aging was also offered. The EI participated in the same number of sessions, yet, only the educational content was offered. The CG completed pre- and post-test evaluations, and received training afterwards. RESULTS Training effects were modest and for certain variables they were equivalent to retest effects. However, after training, individuals with MCI in the MT group exhibited cognitive performance typical of individuals without cognitive impairment, suggesting cognitive plasticity. CONCLUSION MT is a feasible non-pharmacological intervention which might bring positive performance change in older adults facing cognitive impairment.

Influência do treinamento de força muscular e de flexibilidade articular sobre o equilíbrio corporal em idosas

INTRODUCTION: Increasing proportion of elderly people in the world population raises the discussion of disabling events in this age group, as the occurrence of falls. Reduction in joint flexibility and muscle strength are the main variable related to the major motor limitations of activities of daily living (ADLs) and high rates of reported falls in elderly. OBJECTIVE: This study aims to assess the influence of muscle strength training and flexibility training on body balance in elderly. METHODOLOGY: The sample was composed by 22 women, from 60 to 75 years old, enrolled in two physical activity programs. Seven subjects were submitted to muscle strength program and 15 subjects were submitted to flexibility training. Body balance was evaluated before and after practicing time (Berg Balance Scale). RESULTS: It was found that both groups had significant improvement in body balance. Average scores in strength training group were 53 and 55.86 points, respectively, before and after training, while the average scores in flexibility group were 52.47 and 55.47 points, before and after training. CONCLUSION: It was found that both training improved the rates of body balance in elderly women, which likely will influence the reduction of incidence of falls and loss of physical independence, as well as better quality of life.

High frequency hearing thresholds and product distortion otoacoustic emissions in cystic fibrosis patients

Introduction The treatment of patients with cystic fibrosis involves the use of ototoxic drugs, mainly aminoglycoside antibiotics. Due to the use of these drugs, fibrocystic patients are at risk of developing hearing loss.INTRODUCTION The treatment of patients with cystic fibrosis involves the use of ototoxic drugs, mainly aminoglycoside antibiotics. Due to the use of these drugs, fibrocystic patients are at risk of developing hearing loss. OBJECTIVE To evaluate the hearing of patients with cystic fibrosis by High Frequency Audiometry and Distortion Product Otoacoustic Emissions. METHODS Cross-sectional study. The study group consisted of 39 patients (7-20 years of age) with cystic fibrosis and a control group of 36 individuals in the same age group without otologic complaints, with normal audiometric thresholds and type A tympanometric curves. High Frequency Audiometry and Distortion Product Otoacoustic Emissions tests were conducted. RESULTS The study group had significantly higher thresholds at 250, 1000, 8000, 9000, 10,000, 12,500, and 16,000Hz (p=0.004) as well as higher prevalence of otoacoustic emission alterations at 1000 and 6000Hz (p=0.001), with significantly lower amplitudes at 1000, 1400, and 6000Hz. There was a significant association between alterations in hearing thresholds in High Frequency Audiometry with the number of courses of aminoglycosides administered (p=0.005). Eighty-three percent of patients who completed more than ten courses of aminoglycosides had hearing loss in High Frequency Audiometry. CONCLUSION A significant number of patients with cystic fibrosis who received repeated courses of aminoglycosides showed alterations in High Frequency Audiometry and Distortion Product Otoacoustic Emissions. The implementation of ten or more aminoglycoside cycles was associated with alterations in High Frequency Audiometry.

Original articleHigh frequency hearing thresholds and product distortion otoacoustic emissions in cystic fibrosis patientsLimiares auditivos em altas frequências e emissões otoacústicas na fibrose cística

Introduction The treatment of patients with cystic fibrosis involves the use of ototoxic drugs, mainly aminoglycoside antibiotics. Due to the use of these drugs, fibrocystic patients are at risk of developing hearing loss.INTRODUCTION The treatment of patients with cystic fibrosis involves the use of ototoxic drugs, mainly aminoglycoside antibiotics. Due to the use of these drugs, fibrocystic patients are at risk of developing hearing loss. OBJECTIVE To evaluate the hearing of patients with cystic fibrosis by High Frequency Audiometry and Distortion Product Otoacoustic Emissions. METHODS Cross-sectional study. The study group consisted of 39 patients (7-20 years of age) with cystic fibrosis and a control group of 36 individuals in the same age group without otologic complaints, with normal audiometric thresholds and type A tympanometric curves. High Frequency Audiometry and Distortion Product Otoacoustic Emissions tests were conducted. RESULTS The study group had significantly higher thresholds at 250, 1000, 8000, 9000, 10,000, 12,500, and 16,000Hz (p=0.004) as well as higher prevalence of otoacoustic emission alterations at 1000 and 6000Hz (p=0.001), with significantly lower amplitudes at 1000, 1400, and 6000Hz. There was a significant association between alterations in hearing thresholds in High Frequency Audiometry with the number of courses of aminoglycosides administered (p=0.005). Eighty-three percent of patients who completed more than ten courses of aminoglycosides had hearing loss in High Frequency Audiometry. CONCLUSION A significant number of patients with cystic fibrosis who received repeated courses of aminoglycosides showed alterations in High Frequency Audiometry and Distortion Product Otoacoustic Emissions. The implementation of ten or more aminoglycoside cycles was associated with alterations in High Frequency Audiometry.

Pitch and Loudness from Tinnitus in Individuals with Noise-induced Hearing Loss

Introduction  Tinnitus is one of the symptoms that affects individuals suffering from noise induced hearing loss. This condition can be disabling, leading the affected individual to turn away from work. Objective  This literature review aims to analyze the possible association between gender and tinnitus pitch and loudness, the degree of hearing loss and the frequencies affected in subjects with noise-induced hearing loss. Methods  This contemporary cohort study was conducted through a cross-sectional analysis. The study sample consisted of adults with unilateral or bilateral tinnitus, who had been diagnosed with noise-induced hearing loss. The patients under analysis underwent an otorhinolaryngological evaluation, pure tone audiometry, and acuphenometry. Results  The study included 33 subjects with noise-induced hearing loss diagnoses, of which 22 (66.7%) were men. Authors observed no statistical difference between gender and loudness/pitch tinnitus and loudness/pitch in subjects with bilateral tinnitus. Authors found an inverse relation between tinnitus loudness with intensity greater hearing threshold and the average of the thresholds and the grade of hearing loss. The tinnitus pitch showed no association with higher frequency of hearing threshold. Conclusion  Data analysis shows that, among the individuals evaluated, the greater the hearing loss, the lower the loudness of tinnitus. We did not observe an association between hearing loss and tinnitus pitch.

Evaluation of Swallowing in Infants with Congenital Heart Defect

Introduction Surgical repair of congenital heart disease in the first years of life compromises the coordination of the suction, breathing, and swallowing functions. Objective To describe the alterations in swallowing found in infants with congenital heart defect during their hospitalization. Methods Prospective, cross-sectional study in a reference hospital for heart disease. The sample consisted of 19 postsurgical patients who underwent an evaluation of swallowing. The infants included were younger than 7 months and had a diagnosis of congenital heart defect and suspected swallowing difficulties. Results Of the 19 infants with congenital heart defect, the median age was 3.2 months. A significant association was found between suction rhythm and dysphagia (p = 0.036) and between oral-motor oral feeding readiness and dysphagia (p = 0.014). Conclusions The data suggest that dysphagia often occurs after surgery in infants with congenital heart defect. Infants with congenital heart defect had very similar behavior to preterm infants in terms of oral feeding readiness.

Associação entre perda auditiva e sintomatologia depressiva em idosos

* Doutora em Gerontologia Biomedica (PUCRS). Professora Adjunta da UFRGS Departamento de Psicologia do Desenvolvimento e da Personalidade Curso de Fonoaudiologia. ** Doutora em Psicologia Social (USP). Professora Adjunta da UFRGS Escola de Educacao Fisica (ESEF). *** Doutora em Ciencias do Movimento Humano (UFRGS). Professora Adjunta da UFSC. **** Doutoranda em Gerontologia Biomedica (PUCRS). Professora da UFCSPA Departamento de Fonoaudiologia. ***** PhD em Medicina pela Tokay University, School of Medicine, Japao. Professor Adjunto da PUCRS Programa de Pos-Graduacao em Gerontologia Biomedica. ****** Doutora em Fitotecnia (UFRGS). Professora Adjunta do Curso de Educacao Fisica da ULBRA Canoas. ****** Doutora em Saude da Crianca e do Adolescente UFRGS. Professora Adjunta da UFRGS Departamento de Psicologia do Desenvolvimento e da Personalidade.

Classification of Cholesteatoma According to Growth Patterns

IMPORTANCE Several classifications of cholesteatoma exist, but there are controversies about their clinical application. OBJECTIVE To classify cholesteatomas and describe the prevalence of the subtypes. DESIGN, SETTING, AND PARTICIPANTS A cross-sectional comparative study of 414 ears in 356 consecutive patients with middle ear cholesteatoma and no history of ear surgery treated at a tertiary hospital was conducted from March 8, 2000, to March 30, 2015. Data analysis was conducted from March 30, 2014, to March 30, 2015. INTERVENTION Otoendoscopy was conducted, and findings for both ears were recorded. MAIN OUTCOMES AND MEASURES Cholesteatoma growth patterns were classified as anterior epitympanic, posterior epitympanic, posterior mesotympanic, 2 routes (both the pars flaccida and the pars tensa are involved), and undetermined. RESULTS Among the 356 patients in this study, mean (SD) patient age was 33.23 (19.81) years (range, 4-82 years), and 125 patients (35.1%) were female. The right ear was identified as the affected ear in 220 patients (61.8%). A total of 272 (65.7%) ears were from adults. Of the 414 ears that underwent otoendoscopy, posterior epitympanic (142 [34.3%]) and posterior mesotympanic (140 [33.8%]) were the most frequent types of cholesteatoma observed, followed by undetermined (67 [16.2%]) and 2 routes (57 [13.8%]). Anterior epitympanic type was the least frequent (8 [1.9%]). Posterior epitympanic cholesteatoma was more prevalent in adults (111 [40.8%]), whereas posterior mesotympanic cholesteatoma was more frequent in children (43.0%) (P < .001). Anterior epitympanic cholesteatoma was observed only in children. CONCLUSIONS AND RELEVANCE Classifying cholesteatomas according to the growth pattern (anterior epitympanic, posterior epitympanic, posterior mesotympanic, 2 routes, and undetermined) includes all existing types of cholesteatomas of the middle ear. In general, the prevalence of posterior epitympanic and posterior mesotympanic cholesteatoma were similar. Whereas anterior epitympanic and posterior mesotympanic cholesteatomas were more prevalent in children, posterior epitympanic cholesteatoma was more frequent in adults.

Use of Hearing Aids and Functional Capacity in Middle-Aged and Elderly Individuals

Introduction Hearing loss is among the sensory changes strongly associated with loss of functional capacity. Objective It aims to determine whether the use of hearing aid contributes to the improvement of instrumental activities of daily living (IADL) for middle aged and elderly hearing-impaired individuals. Methods This is a descriptive, longitudinal, and interventional study. We evaluated 17 subjects, 13 (76.5%) female, aged between 58 and 96 years old (mean 77.1 ± 10.4 years). All were new users of hearing aids. Evaluation included social history, pure tone audiometry, and scale of IADL developed by Lawton and Brody. The subjects were presented daily life situations and were expected to respond if they could do them without assistance (3 points), partially assisted (2 points) or if they were unable to perform them (1 point). IADL was applied before the use of hearing aids adaptation and after a three- and six-month period of use. Results Data analysis revealed that before the use of hearing aids the average score obtained by the subjects was 22.94 ± 4.04 points. Three months after beginning the use the average score was 23.29 ± 4.12 and after six months the average score was 23.71 ± 3.69 points. Statistical analysis revealed a significant difference between scores obtained before the use of hearing aids and six months post-fitting (p = 0.015*) Conclusion The use of hearing aids among the subjects evaluated promoted positive changes in performing IADL, especially to using the telephone.