Marcelo Ribeiro de Toledo Piza

Achado ocasional de doenças neurológicas durante a pesquisa da surdez infantil através do BERA

One of the most important applications of the Brainstem evoked response audiometry (ABR) is in the evaluation of hearing loss in children. Today the ABR is also indicated in the screening of cochleo-vestibular syndromes to detect retrocochlear lesions, to monitor patients in a coma (brain death), in monitoring the brainstem during skull base surgery, etc. Among the many BERA qualities, is its capacity to evaluate the neurophysiologic integrity of the auditory brainstem pathway. In doing so, sometimes while evaluating hearing function in children we are faced with ABR waves that suggest the presence of retrocochlear lesions (trace asymmetry, increased interpeak intervals), many times confirmed through image studies. These cases are seen as occasional findings of neurologic disorders during children hearing loss evaluation. In this study we report 2 cases of neurologic disorders diagnosed with the use of the ABR to evaluate hearing loss in children.

O BERA como instrumento de avaliação funcional do tronco cerebral em cirurgias com hipotermia profunda e parada circulatória total

AIM: The authors propose the use of ABR as an instrument for the detection of brainstem dysfunction in the trans- and post-operatory period of surgeries with total circulatory arrest (TCA) and deep hypothermia for correction of aneurysms of the thoracic aorta. STUDY DESIGN: Longitudinal Cohort. MATERIAL AND METHOD: Eight adult patients that underwent surgery for correction of aneurisms of thoracic aorta had their brainstem monitored through ABR. The patients had their body temperature lowered to 18oC. At this moment, TCA was performed for a period of up to 60 minutes. The recordings were done at the following: before lowering the body temperature, during the cooling process, at the time of TCA (18oC), and during the re-warming process. RESULTS: The initial tracings (35oC) were normal. At 26oC, ABR waves disappeared. At 18oC and TCA, ABR showed isoelectric tracings. Waves I, III and V reappeared at 27oC, although with prolonged latencies. When temperature reached 35oC, latencies were back to normal. CONCLUSIONS: The ABR seems to be a useful monitor for evaluating brainstem function during surgeries with TCA and deep hypothermia. Our experience showed the extreme usefulness of the evoked auditory potentials in such procedures as a noninvasive, reliable and objective method for the monitoring of variations in the neurophysiological pattern of the brainstem. This can be of great value in presuming the patients neurological outcome in a moment when the neurological status cannot be clinically accessed due to the several drugs used during surgery.

The flexible endaural tympanoplasty: pathology-guided, pathogenesis-oriented surgery for the middle ear.

The flexible approach to tympanoplasty has been found to be adaptable to various forms of pathologic conditions found in the temporal bone, including inflammation and infection, congenital stenosis, benign and malignant tumors, and traumatic injuries. This approach finds its best indication among all pathologic conditions in the temporal bone, in the surgical treatment of otitis media, and its sequelae. A procedure conceived to treat this dynamic process must be adaptable to new circumstances and new findings and be ready to manage unexpected situations. The flexible tympanoplasty is a step-wise approach designed to explore the contents of the middle ear methodically and in the process disclose, confirm, and often treat disease.

Latex biomembrane: a new method to coat the open cavity in tympanomastoidectomies

UNLABELLED The new cavity created after an open cavity tympanomastoidectomy (OCTM) is filled with an antibiotic impregnated cotton pack (cotton tape, umbilical tape, gauze). The removal of this pack usually causes some bleeding and discomfort for the patient. We propose the use of a latex biomembrane to cover the cavity, which will act as an interface between the raw bone surface and the packing. STUDY DESIGN clinical prospective. AIM To study the performance of the latex biomembrane as an interface between the raw bone surface and the pack, and to analyze its role in cavity epithelization. MATERIAL AND METHODS 64 ears of patients submitted to OCTM were studied. The biomembrane was used in the packing of 54 ears and in the 10 remaining ears the regular cotton tape packing was used. RESULTS In the majority of the cases where the biomembrane was used the packing was removed much easier with no bleeding or pain for the patient and also showed an earlier cavity epithelization. CONCLUSION The use of the latex biomembrane has proven to be an effective method to cover the mastoid cavity facilitating epithelization and removal of mastoid cavity packing.

Occasional finding of neurological disorders during children hearing loss evaluation using the ABR

One of the most important applications of the Brainstem evoked response audiometry (ABR) is in the evaluation of hearing loss in children. Today the ABR is also indicated in the screening of cochleo-vestibular syndromes to detect retrocochlear lesions, to monitor patients in a coma (brain death), in monitoring the brainstem during skull base surgery, etc. Among the many BERA qualities, is its capacity to evaluate the neurophysiologic integrity of the auditory brainstem pathway. In doing so, sometimes while evaluating hearing function in children we are faced with ABR waves that suggest the presence of retrocochlear lesions (trace asymmetry, increased interpeak intervals), many times confirmed through image studies. These cases are seen as occasional findings of neurologic disorders during children hearing loss evaluation. In this study we report 2 cases of neurologic disorders diagnosed with the use of the ABR to evaluate hearing loss in children.

Overview of neonatal hearing screening programs in Brazilian maternity hospitals

Approximately 25 years ago, a few isolated pioneers began performing neonatal hearing screening, initially in a few private hospitals and later in private practice in Brazil, using objective screening methods (evoked otoacoustic emissions [OAEs] and brainstem auditory evoked potentials [BAEPs/ABR]). Initially, screening was directed at children who had a risk factor according to the Joint Committee on Infant Hearing and subsequently, after almost ten years, it was extended to all newborns. During most of the time, one of the greatest difficulties was to convince pediatricians of the need to perform this test in children without any risk factors. Local, state, and federal-level demands for the test to be obligatory were initiated by otorhinolaryngologists and audiologists, which were successful on only rare occasions. Most of the time, the test was indicated by a pediatrician during a private consultation or consultation through health insurance, which, however, did not cover the test procedure. After much effort at the several governmental levels, Federal Law 12,303 of August of 2010 made the test obligatory and free of charge in maternity hospitals. Almost four years have passed and we still we still have difficulties achieving the goal of a universal newborn hearing screening (UNHS) program. In 2012, after seeking collaboration through representatives of the Brazilian Association of Otorhinolaryngology and Cervical-Facial Surgery, the Brazilian Society of Otology, the Brazilian Society of Pediatrics, the Brazilian Society of Audiology and Speech Therapy, the Brazilian Academy of Audiology, and the Ministry of Health, the latter released the document entitled

Problems with the mastoid cavity

This article comments on mastoid development and the main types of surgical interventions available in the surgical armamentarium. The importance of preoperative evaluation is stressed and the various problems that may occur during mastoid surgery are discussed. Special attention is given to intraoperative complications such as bleeding, dural and facial nerve exposure, and facial paralysis. The different types of mastoidectomy (closed cavity, open cavity, and intact bridge mastoidectomy) and accessory methods such as mastoid obliteration (Palvas method) and Thiersch grafting are reviewed. Postoperative care of the cavity and the importance of accessory methods to facilitate it are reassessed.

149 Eustachian Tube Obstruction (ETO) in Cats and Chinchillas: Preliminary Results

tal, and anterior inferior cerebellar arteries. Right-side mastoid exploration was done after embolization of the feeding vessels. Profuse bleeding was noted during dissection. The tumor contained fragile bone pieces and invaded the mastoid portion of the facial nerve and sigmoid sinus. The tumor was completely removed using a translabyrinthine and petrosal approach. The pathologic diagnosis was a papillary adenoma of endolymphatic sac. The patient is free of disease 5 months after treatment.