Alessandra Ramos Venosa

Vestibular rehabilitation exercises in acute vertigo.

Objectives/Hypothesis: To evaluate the effect of vestibular rehabilitation exercises in the early stages of peripheral vestibular disorders.

Hearing Preservation in Cochlear Implant Surgery

In the past, it was thought that hearing loss patients with residual low-frequency hearing would not be good candidates for cochlear implantation since insertion was expected to induce inner ear trauma. Recent advances in electrode design and surgical techniques have made the preservation of residual low-frequency hearing achievable and desirable. The importance of preserving residual low-frequency hearing cannot be underestimated in light of the added benefit of hearing in noisy atmospheres and in music quality. The concept of electrical and acoustic stimulation involves electrically stimulating the nonfunctional, high-frequency region of the cochlea with a cochlear implant and applying a hearing aid in the low-frequency range. The principle of preserving low-frequency hearing by a “soft surgery” cochlear implantation could also be useful to the population of children who might profit from regenerative hair cell therapy in the future. Main aspects of low-frequency hearing preservation surgery are discussed in this review: its brief history, electrode design, principles and advantages of electric-acoustic stimulation, surgical technique, and further implications of this new treatment possibility for hearing impaired patients.

Nasal Involvement in Obstructive Sleep Apnea Syndrome

Numerous studies have reported an association between nasal obstruction and obstructive sleep apnea syndrome (OSAS), but the precise nature of this relationship remains to be clarified. This paper aimed to summarize data and theories on the role of the nose in the pathophysiology of sleep apnea as well as to discuss the benefits of surgical and medical nasal treatments. A number of pathophysiological mechanisms can potentially explain the role of nasal pathology in OSAS. These include the Starling resistor model, the unstable oral airway, the nasal ventilatory reflex, and the role of nitric oxide (NO). Pharmacological treatment presents some beneficial effects on the frequency of respiratory events and sleep architecture. Nonetheless, objective data assessing snoring and daytime sleepiness are still necessary. Nasal surgery can improve the quality of life and snoring in a select group of patients with mild OSAS and septal deviation but is not an effective treatment for OSA as such. Despite the conflicting results in the literature, it is important that patients who are not perfectly adapted to CPAP are evaluated in detail, in order to identify whether there are obstructive factors that could be surgically corrected.

The mismatch negativity test in ears with and without tinnitus-a path to the objectification of tinnitus.

INTRODUCTION The mismatch negativity (MMN) test evaluates neural responses to unexpected sounds, providing objective data on the neural plasticity of the auditory system. OBJECTIVES In this study, we assessed whether the MMN test could identify failure of neural habituation of the auditory pathway in patients with severe tinnitus. MATERIALS AND METHODS Patients with normal hearing were compared to tinnitus patients, via the MMN test. The Tinnitus Handicap Inventory (THI) and a visual analog scale (VAS) were used to evaluate tinnitus-derived annoyance. The Hospital Anxiety and Depression (HAD) scale was used to assess anxiety and depression. RESULTS The average MMN amplitudes in the tinnitus group were -0.88 uV in the right ear (RE), and -1.13 uV in the left ear (LE), while in control group the corresponding amplitudes were 1.01 uV and -1.19 uV. Mean latencies in the tinnitus group were 208.34 ms in the RE, and 209.92 ms in the LE, while in the control group the corresponding latencies were 217.38 ms and 215.69 ms. The differences in mean latencies between the groups were statistically significant. CONCLUSION The MMN test may be useful for evaluating the habituation process of the central auditory pathways in tinnitus patients.

The Effect of Gingko Biloba (EGB 761) as an Otoprotector Against Cisplatin Ototoxicity

Objectives: Evaluate, by using distortion product oto-acoustic emissions (DPOAE) test, the effect of ginkgo biloba extract (EGB761), which has shown antioxidant properties as a possible otoprotector against cisplatin induced hearing loss. Ototoxicity is an alteration caused by drugs that compromises the auditory and vestibular functions. Cisplatin (CDDP) is a potent antineoplastic agent used for the treatment of cancer although it has several side effects like ototoxicity (a dose-limiting condition). Currently, cisplatin ototoxicity occurs due to alterations in the antioxidant system of the outer hair cells (OHC) of the cochlea. Different antioxidant drugs have been tested to evaluate the potential otoprotector effect combined to cisplatin administration. Distortion product otoacoustic emission test (DPOAE) has been showed to be a sensitive test for diagnosis of OHC injury and has been used for monitoring treatment of ototoxic drugs. Methods: The study was conducted on individuals that would begin cisplatin treatment. They were randomized and allocated in two groups: Control group (CG) (n =07) received placebo and CDDP and study group (SG n = 08) received EGB761 (240mg/day) and CDDP. Both groups ingested the drugs before first cisplatin dose. They were treated and followed up for approximately ninety days. Results: The maximum cumulative cisplatin dosage was 300mg/m2. Comparisons were made between baseline measurements and those records after maximum cumulative cisplatin dosage. The CG showed smaller amplitudes of the signal and signal/noise ratio compared to baseline. Conclusions: These results demonstrate that EGB761, because of their antioxidant properties, showed potential otoprotector effect.

Tinnitus and sound intolerance: evidence and experience of a Brazilian group

INTRODUCTION Tinnitus and sound intolerance are frequent and subjective complaints that may have an impact on a patients quality of life. OBJECTIVE To present a review of the salient points including concepts, pathophysiology, diagnosis and approach of the patient with tinnitus and sensitivity to sounds. METHODS Literature review with bibliographic survey in LILACS, SciELO, Pubmed and MEDLINE database. Articles and book chapters on tinnitus and sound sensitivity were selected. The several topics were discussed by a group of Brazilian professionals and the conclusions were described. RESULTS The prevalence of tinnitus has increased over the years, often associated with hearing loss, metabolic factors and inadequate diet. Medical evaluation should be performed carefully to guide the request of subsidiary exams. Currently available treatments range from medications to the use of sounds with specific characteristics and meditation techniques, with variable results. CONCLUSION A review on tinnitus and auditory sensitivity was presented, allowing the reader a broad view of the approach to these patients, based on scientific evidence and national experience.

The Potential Use of Melatonin for Preventing Cisplatin Ototoxicity: An Insight for a Clinical Approach

Cisplatin, one of the most effective and potent anticancer drugs, is used in the treatment of a wide variety of both pediatric and adult malignancies. However, the chemotherapeutic use of cisplatin is limited by its serious side effects, such as nephrotoxicity and ototoxicity. Ototoxicity produced by cisplatin is usually persistent, depending on the age of the patient, the cumulative number of doses, the number of chemotherapy cycles, the history of noise exposure, and deteriorating renal function. The mechanism of the ototoxicity caused by cisplatin is based on the generation of reactive oxygen species, which interfere with the antioxidant protection of the organ of Corti. Thus, protecting the cochlea with antioxidants ameliorates ototoxicity from cisplatin. In this context, melatonin appears as a therapeutic option for preventing the ototoxic effects of cisplatin, since the research in the last decade has proven its ability to be both a direct free radical scavenger and indirect antioxidant. In this sense, some of the evidence suggesting that melatonin is efficient for combating cisplatin-induced ototoxicity is summarized and discussed in this paper.

Auditory Brainstem Responses (ABR) changes in children treated with high doses cisplatin.

INTRODUCTION Cisplatin can cause cochlear damage by oxidative stress in hair cells, but there are few studies regarding toxicity in the central auditory pathways. OBJECTIVE To study cisplatin neurotoxicity in the central auditory pathways in children treated with high doses cisplatin for solid malignant tumors. METHODS Thirteen children (Group S) aged 3-19 years who had been treated with cisplatin (60-120 mg/m(2)/cycle) were studied using evoked otoacoustic emissions (EOA), conventional auditory evaluation and auditory brainstem response (ABR). Thirteen normal children matched for age and sex composed the control group (Group C). RESULTS Group S - 7.5% percent of ears showed enlargement of latencies of waves I and V, and 3.8% of wave III. Six ears (23%) showed enlarged interpeak intervals. Four ears showed increased interpeak I-III and two showed increased interpeak III-V. The results were compared using the Mann-Whitney test. Interpeak III-V differed significantly between groups S and C when only the left ears were considered. EOA results were normal in both groups. DISCUSSION/CONCLUSION Abnormal values in the interpeak I-III associated with normal distortion product OEA suggest neurotoxicity in the brainstem pathways. The statistical significance reached only in the left ear may be due to small number of cases studied.