Maria Valéria Schmidt Goffi-Gomez

Avaliação eletromiográfica do músculo masseter em pessoas com paralisia facial periférica de longa duração

PURPOSE: to check the masseter electrical activity in long lasting facial paralysis patients. METHODS: six subjects, with facial paralysis for over a period of twelve months, males and females, took part in this study. Patients should not show any masticatory complaints or have any diagnoses of temporo-mandibular joint dysfunction, having at least six teeth in each half dental ridge. All subjects filled out a questionnaire regarding oral habits and were assessed by surface electromyography of the masseter muscle of both sides. Electromyographic records were taken with lips closed at rest, teeth tightness, besides usual mastication, and unilateral mastication on both sides with raisins. RESULTS: in all electromyographic tests there were no statistically significant differences (p=0.05) between both sides, with and without facial paralysis. CONCLUSION: it was observed that the strength of the masseter muscle is not under the influence of long lasting facial paralysis.

Voice Analysis of Postlingually Deaf Adults Pre- and Postcochlear Implantation

OBJECTIVESnTo ascertain whether cochlear implantation (CI), without specific vocal rehabilitation, is associated with changes in perceptual and acoustic vocal parameters in adults with severe to profound postlingual deafness.nnnHYPOTHESISnMerely restoring auditory feedback could allow the individual to make necessary adjustments in vocal pattern.nnnSTUDY DESIGNnProspective and longitudinal.nnnMETHODSnThe experimental group composed of 40 postlingually deaf adults (20 males and 20 females) with no previous laryngeal or voice disorders. Participants voices were recorded before CI and 6-9 months after CI. To check for chance modifications between two evaluations, a control group of 12 postlingually deaf adults, six male and six female, without CI was also evaluated. All sessions composed of the recording of read sentences from Consensus Auditory-Perceptual Evaluation of Voice and sustained vowel /a/. Auditory and acoustic analyses were then conducted.nnnRESULTSnWe found a statistically significant reduction in overall severity, strain, loudness, and instability in auditory analysis. In vocal acoustic analysis, we found statistically significant reduction fundamental frequency (F0) values (in male participants) and F0 variability (in both genders). The control group showed no statistically significant changes in most vocal parameters assessed, apart from pitch and F0 (in female participants only). On comparing the interval of variation of results between the experimental and control groups, we found no statistically significant difference in vocal parameters between CI recipients and nonrecipients, with the exception of F0 variability in male participants.nnnCONCLUSIONSnThe patients in our sample showed changes in overall severity, strain, loudness, and instability values, and reductions in F0 and its variability. On comparing the variation of results between the groups, we were able to prove in our study that implant recipients postlingually deaf adults (experimental group), without specific vocal rehabilitation, differed from nonrecipients (control group) in loudness and F0 variability sustained vowel /a/ in male participants.

Auditory brainstem implant outcomes and MAP parameters: report of experiences in adults and children.

UNLABELLEDnThe auditory brainstem implant (ABI) was first developed to help neurofibromatosis type 2 patients. Recently, its use has been recently extended to adults with non-tumor etiologies and children with profound hearing loss who were not candidates for a cochlear implant (CI). Although the results has been extensively reported, the stimulation parameters involved behind the outcomes have received less attention.nnnOBJECTIVEnThe aim of this study is to describe the audiologic outcomes and the MAP parameters in ABI adults and children at our center.nnnMETHODSnRetrospective chart review. Five adults and four children were implanted with the ABI24M from September 2005 to June 2009. In the adult patients, four had Neurofibromatosis type 2, and one had postmeningitic deafness with complete ossification of both cochleae. Three of the children had cochlear malformation or dysplasia, and one had complete ossified cochlea due to meningitis. Map parameters as well as the intraoperative electrical auditory brainstem responses were collected. Evaluation was performed with at least six months of device use and included free-field hearing thresholds, speech perception tests in the adult patients and for the children, the Infant-Toddler Meaningful Auditory Integration Scale (IT-MAIS) and (ESP) were used to evaluate the development of auditory skills, besides the MUSS to evaluate.nnnRESULTSnThe number of active electrodes that did not cause any non-auditory sensation varied from three to nineteen. All of them were programmed with SPEAK strategy, and the pulse widths varied from 100 to 300 μs. Free-field thresholds with warble tones varied from very soft auditory sensation of 70 dBHL at 250 Hz to a pure tone average of 45 dBHL. Speech perception varied from none to 60% open-set recognition of sentences in silence in the adult population and from no auditory sensation at all to a slight improvement in the IT-MAIS/MAIS scores.nnnCONCLUSIONnWe observed that ABI may be a good option for offering some hearing attention to both adults and children. In children, the results might not be enough to ensure oral language development. Programming the speech processor in children demands higher care to the audiologist.

Hearing loss and complaint in patients with head and neck cancer treated with radiotherapy.

OBJECTIVEnTo investigate occurrences of hearing loss and hearing complaints among patients with head and neck tumors who underwent radiotherapy.nnnDESIGNnProspective case-control study.nnnSETTINGnTertiary care hospital.nnnPARTICIPANTSnTwo hundred eighty-two participants underwent evaluation, including 141 with head and neck tumors and 141 as an age-matched control group. The controls had never undergone oncological treatment that put their hearing at risk.nnnMAIN OUTCOME MEASURESnResults of audiological evaluation, including the Hearing Handicap Inventory for the Elderly questionnaire and pure-tone, speech, and immittance audiometry, and radiation dose received by the auditory system (based on the percentage of the external auditory canal included in the radiation field).nnnRESULTSnWe observed occurrences of hearing loss in 102 (72.3%) of the participants exposed to radiotherapy and 69 (48.9%) of the control group (Pxa0<xa0.001). Hearing losses were mostly sensorineural and of mild degree, but those exposed to radiotherapy more frequently presented with severe and mixed-type hearing losses (Pxa0<xa0.001). Of the participants exposed to radiotherapy, 19.1% had a severe handicap (Pxa0<xa0.001).nnnCONCLUSIONnPatients undergoing radiotherapy in the head and neck region have a higher incidence of hearing loss and more severe hearing handicap. Trial Registrationxa0 clinicaltrials.gov Identifier: NCT01102621.

Estudo eletromiográfico do músculo masseter durante o apertamento dentário e mastigação habitual em adultos com oclusão dentária normal

PURPOSE: To analyze the difference between both sides of the face during the electromyographic activity of the masseter muscle in adults with normal occlusion. METHODS: Thirty healthy individuals with ages ranging from 21 to 30 years old were selected. Surface electromyography was performed on right and left masseter muscles during maximal voluntary clenching and habitual chewing with raisins. The mean values of three teeth clenching and fifteen seconds of habitual chewing were calculated for each subject. The analysis considered the sides with higher and lower electromyographic activity. RESULTS: During maximal voluntary clenching, the mean difference between sides was 20.0 microvolts (μV), with confidence interval (95%) between 14.0 and 26.0 μV. During habitual chewing, the mean difference between sides was 10.3 μV, with confidence interval (95%) between 6.7 and 13.8 μV. CONCLUSION: There was a statistically significant difference between both sides of the face in healthy adult subjects, with a relation between sides of 24% for maximal voluntary clenching and 27% during habitual chewing.

Report on hearing loss in oncology

UNLABELLEDnCisplatin is used frequently as an antineoplastic drug in the treatment of many different cancers. However, when used in doses over 360mg/m(2), ototoxicity may ensue, resulting in loss of hearing. Criteria for identifying and quantifying hearing loss have been devised.nnnAIMnTo describe the features of different hearing loss classification systems and to identify their implications and use in oncologic patients.nnnMETHODnHearing loss was classified in 31 patients before and after chemotherapy, according to different criteria, assessing the sensitivity and specificity of each classification system.nnnRESULTSnHearing loss results were highly variable (ranging from 29% to 61%). Only 4 of 31 subjects with post-therapy hearing loss were identified by all the methods. A few subjects with hearing loss were classified as normal hearing in some of the criteria. A normal PTA was found in 18 of 31 subjects in the post-treatment evaluation.nnnCONCLUSIONnNone of the criteria assesses the complaints of patients. The criteria described in this study were inadequate to identify hearing loss following chemotherapy, requiring additional information for physicians to better understand the hearing losses and their implications for the quality of life of patients.

Neurofibromatosis 2: hearing restoration options

UNLABELLEDnNeurofibromatosis 2 (NF2) is an autosomal dominant disease in which hearing loss is predominant. Auditory restoration is possible using cochlear implants (CI) or auditory brainstem implant (ABI).nnnOBJECTIVEnTo assess the auditory results of CI and ABI in NF2 patients and review the literature.nnnMETHODSnFour NF2 patients were prospectively evaluated. They were submitted to tumor resection followed by ipsilateral CI or ABI depending on cochlear nerve preservation. Long term auditory results were described for CI (12 months) and ABI (48 months).nnnRESULTSnAll patients achieved auditory perception improvements in their hearing thresholds. The CI patient does not recognize vowels or sentences. The 3 ABI patients discriminate 70% of vowels and 86% in the 4-choice test. One of them does not recognize sentences. The other two recognize 100% of closed sentences and 10% and 20% of open sentences.nnnCONCLUSIONnThe choice of implant type to restore hearing to NF2 patients will relay on anatomical and functional cochlear nerve preservation during tumor resection surgery. Although our experience was different, the literature shows that if this condition is achieved, CI will offer better auditory results. If not, ABI is recommended.

A contribuição da leitura orofacial na comunicação do neuropata auditivo

PURPOSE: to evaluate the contribution of lip reading for the recognition of speech in patients with auditory neuropathy. METHODS: four subjects were included in the study according to the following criteria: adult patients with auditory neuropathy, with ages over eighteen and under sixty years; auditory neuropathy diagnosis given by the medical team and minimal literacy level. Speech perception tests were performed with and without lip reading, including dissyllabic and trissyllabic word recognition and open set sentence recognition. RESULTS: there was an important variation regarding the level of hearing loss in all the subjects; and a discrimination varying from poor to moderate was noted in relation to the speech recognition index. We observed that in all the tests with lip reading, there was a significant improvement of speech perception. CONCLUSION: the use of lip reading in specific situations enhances hearing perception, contributing for a more effective communication.

Retrolabyrinthine approach for surgical placement of auditory brainstem implants in children

Abstract Conclusion: The extended retrolabyrinthine approach (RLA) is a safe and reliable approach for auditory brainstem placement in children. The surgical landmarks to reach cochlear nucleus are adequately exposed by this approach. Objective: To describe a new approach option for auditory brainstem implants (ABIs) in children, highlighting the anatomical landmarks to appropriately expose the foramen of Luschka. Methods: Three prelingually deafened children consecutively operated for ABIs via the RLA. Results: ABI placement via the RLA was successfully performed in all children without any further complications except multidirectional nystagmus in one child. The RLA we employed differed from that used for vestibular schwannoma only in the removal of the posterior semicircular canal. The lateral and superior semicircular canals and the vestibule remained intact, and there was no need to expose the dura of the internal auditory meatus. The jugular bulb was completely exposed to allow adequate visualization of the ninth cranial nerve and cerebellar flocculus.

Neural response thresholds in the Nucleus Contour cochlear implant before and after stylet removal

Conclusion. The study shows that there are differences in the measurement of the action potentials with and without the stylet in the Nucleus Freedom Contour Advance that are higher in the apex than in the base of the cochlea. Objectives. To determine if there are differences in the intraoperative impedances and in the neural response telemetry threshold values in the Nucleus Freedom Contour Advance before and after stylet removal. Subjects and methods. This was a prospective clinical study. Intraoperative impedances and neural response telemetry in users of the Freedom Contour Advance Cochlear Implant were measured before and after stylet removal. Results. There was a significant reduction in the impedance values of an average 1.5 kΩ±2.3 in common ground mode and 1.3 kΩ±2.3 for all monopolar modes after the stylet removal (p < 0.001). When analyzing the apical, medium, and basal electrodes, there was a statistically significant reduction in the neural response thresholds after stylet removal only in the apical electrodes (p = 0.001).