Flavia A. Barros

Perda auditiva neurossensorial súbita idiopática: evolução na presença de hipertensão arterial sistêmica, diabetes melito e dislipidemias

UNLABELLED Retrospective study aiming at evaluating the interference of associate diseases in the evolution and prognosis of idiopathic sudden sensorineural hearing loss. MATERIALS AND METHODS Case-Control Study. Thirty-five patients with idiopathic sudden sensorineural hearing loss were divided in two groups, one of them with associate diseases (hypertension, diabetes mellitus and dyslipidemias), and another one without co-occurrence of such diseases. The groups were evaluated regarding: age, gender, associate diseases, presence of tinnitus, dizziness and ear fullness sensation, presence of cerebral microangiopathy observed in magnetic resonance imaging, ophthalmoscopic findings, treatment onset, improvements in audiometric findings and at speech discrimination tests. Statistical analysis of data was performed. RESULTS The associate disease group showed higher ages, cerebral microangiopathy observed in magnetic resonance imaging and later improvement in speech discrimination tests, being this difference statistically significant. CONCLUSION Idiopathic sudden sensorineural hearing loss co-occurring with hypertension, diabetes mellitus or dyslipidemias, in older patients, is associated with a higher prevalence of cerebral microangiopathy, revealed by magnetic resonance imaging, and associated with a slower hearing recovering, showed by later improvements in speech discrimination tests.

Clinical, etiological and progression factors of hearing in sudden deafness

UNLABELLED Out of the many forms of therapy for sudden deafness, some require hospitalization and present significant risks. AIM This prospective study analyzes etiology and evolution in cases of sudden deafness (SD) where outpatient oral treatment was used. STUDY DESIGN Clinical with transversal cohort. MATERIAL AND METHOD Forty cases of sudden hearing loss were followed for at least one year. All were submitted to initial clinical evaluation, auditory tests, routine blood analysis, and magnetic resonance imaging. All received initial treatment with pentoxifylline and prednisone. RESULTS 45% (n=18) presented normal auditory thresholds, 40% (n=16) showed some improvement in hearing, 15% (n=6) maintained initial hearing level. Nine cases (22.5%) presented clinical conditions possibly implicated in hearing loss (viral infection, immunomediated hearing loss, vascular disorders, and so on); three (7.5%) had cerebellopontine tumors. Evolution of hearing in these 12 cases with presumed etiology presented no differences from hearing in the 28 cases without any known etiological factor. Clinical treatment within the first seven days was the only statistically significantly different condition in patients who improved hearing. CONCLUSIONS An objective search for etiological bases should be conducted in any case of acute sensorineural hearing loss. The presence of cerebellopontine tumors in 7.5% of cases of SD, among other treated causes, justifies a thorough clinical investigation in these patients. Overall good evolution of hearing was observed in 67.5% of cases of SD, regardless of its etiology. Therapy within the first seven days of SD was significantly related to better outcomes in hearing.

Magnetic resonance imaging in sudden deafness.

Summary The etiology of sudden deafness can remain undetermined despite extensive investigation. This study addresses the value of magnetic resonance imaging in the analysis of sudden deafness patients. Study design: transversal cohort. Material and Method : In a prospective study, 49 patients attended at otolaryngology emergency room of Federal University of Sao Paulo - Escola Paulista de Medicina, from April 2001 to May 2003, were submitted to magnetic resonance imaging. Results : Magnetic Resonance abnormalities were seen in 23 (46.9%) patients and revealed two tumors suggestive of meningioma, three vestibular schwannomas, thirteen microangiopathic changes of the brain and five (21.7%) pathological conditions of the labyrinth. Conclusion : Sudden deafness should be approached as a symptom common to different diseases. The presence of cerebellopontine angle tumors in 10.2% of our cases, among other treatable causes, justifies the recommendation of gadolinium-enhanced magnetic resonance use, not only to study the auditory peripheral pathway, but to study the whole auditory pathway including the brain.

Fatores clínicos, etiológicos e evolutivos da audição na surdez súbita

Out of the many forms of therapy for sudden deafness, some require hospitalization and present significant risks. AIM: This prospective study analyzes etiology and evolution in cases of sudden deafness (SD) where outpatient oral treatment was used. STUDY DESIGN: clinical with transversal cohort. MATERIAL AND METHOD: Forty cases of sudden hearing loss were followed for at least one year. All were submitted to initial clinical evaluation, auditory tests, routine blood analysis, and magnetic resonance imaging. All received initial treatment with pentoxifylline and prednisone. RESULTS: 45% (n=18) presented normal auditory thresholds, 40% (n=16) showed some improvement in hearing, 15% (n=6) maintained initial hearing level. Nine cases (22.5%) presented clinical conditions possibly implicated in hearing loss (viral infection, immunomediated hearing loss, vascular disorders, and so on); three (7.5%) had cerebellopontine tumors. Evolution of hearing in these 12 cases with presumed etiology presented no differences from hearing in the 28 cases without any known etiological factor. Clinical treatment within the first seven days was the only statistically significantly different condition in patients who improved hearing. CONCLUSIONS: An objective search for etiological bases should be conducted in any case of acute sensorineural hearing loss. The presence of cerebellopontine tumors in 7.5% of cases of SD, among other treated causes, justifies a thorough clinical investigation in these patients. Overall good evolution of hearing was observed in 67.5% of cases of SD, regardless of its etiology. Therapy within the first seven days of SD was significantly related to better outcomes in hearing.

Serotonin Reuptake Inhibitors in Auditory Processing Disorders in Elderly Patients: Preliminary Results

Objective/Hypothesis: One mechanism associated with degeneration in the elderly is the decrease of neurotransmitters. In the central auditory pathway serotonin, can be found from cochlear nucleus to the auditory cortex, and it constitutes one of the most important neuromodulatory circuits in hearing processing. The present study analyzed the action of citalopram, a selective inhibitor of serotonin reuptake, in aged patients with normal to moderate sensorineural hearing loss (HL) and low performance on auditory processing.

Avaliação do processamento auditivo em idosos que relatam ouvir bem

Em idosos, os resultados da avaliacao comportamental das vias auditivas centrais sao considerados de dificil interpretacao devido a possivel interferencia do comprometimento das vias auditivas perifericas. OBJETIVO: Avaliar a eficiencia das funcoes auditivas centrais de idosos que relatam ouvir bem. MATERIAL E METODO: Estudo de casos que incluiu 40 individuos na faixa etaria de 60 a 75 anos. Os pacientes foram submetidos a avaliacao do processamento auditivo que constou de anamnese, exame otorrinolaringologico, audiometria tonal liminar, limiar de reconhecimento de fala, indice de reconhecimento de fala, imitanciometria, pesquisa de reflexos estapedianos, teste de identificacao de sentencas sinteticas com mensagem competitiva ipsilateral, teste de padroes de frequencia e teste de dissilabos alternados por meio de tarefa dicotica. RESULTADOS: Genero, faixa etaria e perda auditiva nao influenciaram os resultados dos testes de padroes de frequencia e dissilabos alternados por meio de tarefa dicotica; faixa etaria e perda auditiva influenciaram os resultados do teste de identificacao de sentencas com mensagem competitiva ipsilateral. Porcentagens de acertos abaixo dos padroes da normalidade de adultos foram observadas nos tres testes que acessam as funcoes auditivas centrais. CONCLUSAO: Individuos idosos que relatam ouvir bem apresentam prevalencia relevante de sinais de ineficiencia das funcoes auditivas centrais.

Ressonância magnética em surdez súbita

The etiology of sudden deafness can remain undetermined despite extensive investigation. This study addresses the value of magnetic resonance imaging in the analysis of sudden deafness patients. STUDY DESIGN: transversal cohort. MATERIAL AND METHOD: In a prospective study, 49 patients attended at otolaryngology emergency room of Federal University of Sao Paulo - Escola Paulista de Medicina, from April 2001 to May 2003, were submitted to magnetic resonance imaging. RESULTS: Magnetic Resonance abnormalities were seen in 23 (46.9%) patients and revealed two tumors suggestive of meningioma, three vestibular schwannomas, thirteen microangiopathic changes of the brain and five (21.7%) pathological conditions of the labyrinth. CONCLUSION: Sudden deafness should be approached as a symptom common to different diseases. The presence of cerebellopontine angle tumors in 10.2% of our cases, among other treatable causes, justifies the recommendation of gadolinium-enhanced magnetic resonance use, not only to study the auditory peripheral pathway, but to study the whole auditory pathway including the brain.

Colesteatoma causando paralisia facial

Facial paralysis caused by cholesteatoma is uncommon. The portions most frequently involved are horizontal (tympanic) and second genu segments. When cholesteatomas extend over the anterior epitympanic space, the facial nerve is placed in jeopardy in the region of the geniculate ganglion. The aetiology can be related to compression of the nerve followed by impairment of its blood supply or production of neurotoxic substances secreted from either the cholesteatoma matrix or bacteria enclosed in the tumor. AIM: To evaluate the incidence, clinical features and treatment of the facial palsy due cholesteatoma. STUDY DESIGN: Clinical retrospective. MATERIAL AND METHOD: Retrospective study of 10 cases of facial paralysis due cholesteatoma selected through a survey of 206 decompressions of the facial nerve due various aetiologies realized in the last 10 years in UNIFESP-EPM. RESULTS: The incidence of facial paralysis due cholesteatoma in this study was 4,85%, with female predominance (60%). The average age of the patients was 39 years. The duration and severity of the facial palsy associated with the extension of lesion were important for the functional recovery of the facial nerve. CONCLUSION: Early surgical approach is necessary in these cases to improve the nerve function more adequately. When disruption or intense fibrous replacement occurs in the facial nerve, nerve grafting (greater auricular/sural nerves) and/or hypoglossal facial anastomosis may be suggested.

Auditory processing assessment in older people with no report of hearing disability

UNLABELLED In the elderly, the results of central auditory pathways behavioral assessments are considered to be difficult to read because of the possible interference of peripheral auditory pathway involvement. AIM Assess the efficacy of the central auditory function in elderly patients who do not complain of hearing. MATERIALS AND METHODS Case study involving 40 individuals within the age range of 60 to 75 years. The patients underwent auditory processing evaluation based on anamnesis, otorhinolaryngological exam, threshold tonal audiometry, speech recognition threshold, speech recognition index, immittance measures, stapes reflex study, synthetic phrases identification test with ipsilateral competitive message, frequency pattern test and alternate twin-syllable test through dichotic task; age range and hearing loss influenced results from the phrases identification with ipsilateral competitive message. Percentages of right answers below normal standards were seen in the three tests that assessed the central auditory functions. CONCLUSION Elderly individuals who did not complain of hearing presented relevant prevalence of signs of central auditory function inefficiencies.

Magnetic resonance imaging in the evaluation of clinical treatment of otospongiosis: a pilot study.

Objectives To evaluate the applicability of magnetic resonance imaging (MRI) as a method for monitoring the activity of otospongiotic lesions before and after clinical treatment. Study Design Prospective, randomized, controlled, double-blind study. Setting One single tertiary care institution in a large, cosmopolitan city. Methods Twenty-six patients (n = 42 ears) with clinical, audiometric, and tomographic diagnosis of otosclerosis were enrolled. If computed tomography (CT) demonstrated active lesions, these patients underwent MRI to detect otospongiotic foci, seen as areas of gadolinium enhancement. Patients were divided into 3 groups and received treatment with placebo, sodium alendronate, or sodium fluoride for 6 months. After this period, clinical and audiometric evaluations and a second MRI were performed. Each MRI was evaluated by both a neuroradiologist and an otolaryngologist in a subjective (visual) and objective (using specific eFilm Workstation software) manner. Results Otospongiosis was most predominantly identified in the region anterior to the oval window, and this site was reliable for comparing pre- and posttreatment scans. The patients in the alendronate and sodium fluoride groups had MRI findings that suggested a decrease in activity of otospongiotic lesions, more relevant in the alendronate group. These findings were statistically significant for both subjective and objective MRI evaluations. Conclusions MRI shows higher sensitivity than clinical or audiometric assessment for detecting reduction in activity of otospongiosis. The objective MRI evaluation based on software analysis was the most accurate method of monitoring clinical treatment response in otospongiosis.