Mariza Ribeiro Feniman

Prospective clinical trial comparing outcome measures between Furlow and von Langenbeck Palatoplasties for UCLP.

The goal of this prospective randomized clinical trial was to compare 2 cohorts of standardized cleft patients with regard to functional speech outcome and the presence or absence of palatal fistulae. The 2 cohorts are randomized to undergo either a conventional von Langenbeck repair with intravelar velarplasty or the double-opposing Z-plasty Furlow procedure. A prospective 2 × 2 × 2 factorial clinical trial was used in which each subject was randomly assigned to 1 of 8 different groups: 1 of 2 different lip repairs (Spina vs. Millard), 1 of 2 different palatal repair (von Langenbeck vs. Furlow), and 1 of 2 different ages at time of palatal surgery (9–12 months vs. 15–18 months). All surgeries were performed by the same 4 surgeons. A cul-de-sac test of hypernasality and a mirror test of nasal air emission were selected as primary outcome measures for velopharyngeal function. Both a surgeon and speech pathologist examined patients for the presence of palatal fistulae. In this study, the Furlow double-opposing Z-palatoplasty resulted in significantly better velopharyngeal function for speech than the von Langenbeck procedure as determined by the perceptual cul-de-sac test of hypernasality. Fistula occurrence was significantly higher for the Furlow procedure than for the von Langenbeck. Fistulas were more likely to occur in patients with wider clefts and when relaxing incisions were not used.

Crianças com fissura isolada de palato: desempenho nos testes de processamento auditivo

Many children with auditory processing disorders have a high prevalence of otitis media, a middle ear alterations greatly prevalent in children with palatine and lip clefts. AIM: to check the performance of children with palate cleft alone (PC) in auditory processing tests. Prospective study. MATERIALS AND METHODS: twenty children (7 to 11 years) with CP were submitted to sound location tests (SL), memory for verbal sounds (MSSV) and non verbal sounds in sequence (MSSNV), Revised auditory fusion (AFT-R), Pediatric test of speech intelligibility/synthetic sentences (PSI/SSI), alternate disyllables (SSW) and digit dichotic (DD). The children performances in the tests were classified in bad and good. RESULTS: there was no statistically significant difference between genders and ears. The average values obtained were 2.16, 2.42, 4.37, 60.50ms; 40.71 to 67.33%; 96.25 to 99.38%; 73.55 to 73.88% and 58.38 to 65.47% respectively for the MSSNV, MSSV, LS, AFT-R, PSI/SSI tests with ipsilateral (PSI/SSIMCI) and contralateral (PSI/SSI/MCC) competitive message, DD and SSW tests. CONCLUSION: a high percentage of children showed worse results in the AFT-R, DD, SSW tests and in the PSI/SSIMCI tests. The best performances happened in the sound location tests, verbal and non-verbal sounds for sequential memory and for PSI/SSIMCC tests.

Teste de Habilidade de Atenção Auditiva Sustentada (THAAS) em crianças de sete anos com fissura labiopalatina

Cleft lip and palate (CLP) is a risk indicator to middle ear alterations, which may damage the development of auditory abilities such as attention that is essential to learn new skills, oral and written communication. Studies on attention process with CLP population are recent and poorly explored in the specific literature. Thus, this study aims to contribute with new subsidies in the field as it investigates the performance of children with CLP in Sustained Auditory Attention Ability Test (SAAAT). MATERIAL AND METHOD: Comparison of SAAAT performance between children with CLP and children without it. Prospective study. RESULTS: ANOVA was used as variance analysis model with two factors to study the variables such as group and gender. The CLP group showed an average of 2.5 units higher than the control group. This difference is between 0.7 and 4.4 with 95% certain. CONCLUSION: children with cleft lip and palate had poorer performance on SAAAT when compared to those without such craniofacial anomaly, considering attention reduction only.

Avaliação do handicap auditivo do adulto com deficiência auditiva unilateral

UNLABELLED Hearing impairment (HI) is characterized by unilateral hearing loss in one ear and can result in learning difficulties, language impairment and socio-emotional difficulties. To assess the perception of hearing handicap in adult subjects, patients with unilateral sensorineural HI, non-users of individual hearing aids. MATERIALS AND METHODS Prospective study with 52 adult subjects with a mean of 34.5 years of age, from both genders (26 females, 26 males) with hearing loss: sensorineural unilateral, in varying degrees, responded to a questionnaire for assessing hearing handicap, and for that we used the Hearing Handicap Inventory for Adults (HHIA). RESULTS We scored the subscales of the emotional and social/situational aspects, and we found 73.1% of the handicap present being mild, moderate and significant, but at a higher percentage (88.5%) in females. CONCLUSIONS The use of the questionnaire proved to be an effective procedure, because the unilateral HI may, not infrequently, compromise social and emotional aspects of the adult subject and the same degree of HI who can react differently, indicating that the wide variability in the perception of the hearing handicap is associated with non-audiological aspects.

Otologic and audiologic outcomes with the Furlow and von Langenbeck with intravelar veloplasty palatoplasties in unilateral cleft lip and palate.

Objective Cleft palate increases the risk of chronic middle ear disease and hearing loss. The goal of this report was to determine which of two palate surgeries and which timing of palate surgery were associated with better otologic and audiologic outcomes in children with unilateral cleft lip and palate at 5 to 6 years of age. Design Subjects were randomly assigned to the von Langenbeck with intravelar veloplasty or Furlow palate repair, to palate surgery at 9 to 12 months or 15 to 18 months of age, and to the Spina or Millard lip repair. Setting Centralized, tertiary care craniofacial treatment center. Patients A total of 673 infants with unilateral cleft lip and palate. Interventions Palate and lip were repaired using established techniques. Serial otoscopic and audiometric evaluations were performed. Main Outcome Measures Hearing and otoscopic findings at 5 to 6 years old. Results There were 370 children available for analysis. Hearing and need for tympanostomy tube placement did not differ by palatoplasty, age at palatoplasty, cheiloplasty, or surgeon. Risk of developing cholesteatoma or perforation was higher with Millard cheiloplasty (odds ratio = 5.1, 95% confidence interval = 1.44 to 18.11, p = .012). Type and age at palatoplasty were not significantly associated with either the rate of developing these sequelae or the rate of achieving bilaterally normal hearing and ear examinations. Conclusions Type of palatoplasty did not influence otologic and audiologic outcomes in 5- to 6-year-olds with unilateral cleft lip and palate. The potential influence of lip repair on otologic outcomes warrants further investigation.

Longitudinal Study of Growth of Children with Unilateral Cleft-Lip Palate from Birth to Two Years of Age:

Objective: To study the growth of children with complete unilateral cleft lip and palate (UCLP) from birth to 2 years of age and to construct specific UCLP growth curves. Design: Physical growth was a secondary outcome measure of a National Institutes of Health–sponsored longitudinal, prospective clinical trial involving the University of Florida (United States) and the University of São Paulo (Brazil). Patients: Six hundred twenty-seven children with UCLP, nonsyndromic, both genders. Methods: Length, weight, and head circumference were prospectively measured for a group of children enrolled in a clinical trial. Median growth curves for the three parameters (length, weight, head circumference) were performed and compared with the median for the National Center for Health Statistics (NCHS) curves. The median values for length, weight, and head circumference at birth and 6, 12, 18, and 24 months of age were plotted against NCHS median values and statistically compared at birth and 24 months. Setting: Hospital de Reabilitação de Anomalias Craniofaciais, Universidade de São Paulo, Bauru, Brazil (HRAC-USP). Results: At birth, children of both genders with UCLP presented with smaller body dimensions in relation to NCHS median values, but the results suggest a catch-up growth for length, weight, and head circumference for girls and for weight (to some degree) and head circumference for boys. Conclusions: Weight was the most compromised parameter for both genders, followed by length and then head circumference. There was no evidence of short stature. This study established growth curves for children with UCLP.

Teste Dicótico de Dígitos (etapa de escuta direcionada) em crianças com fissura labiopalatina

Conductive hearing loss in the first years of life may lead to hearing processing and attention deficit disorders, and consequently to communication and learning impairments. AIM: this paper aims to examine the performance of children with cleft lip and palate in dichotic listening tests (directed attention mode) and compare them to a control group without cleft lip and palate. MATERIALS AND METHOD: fifty-two children of both genders were enrolled in the study. Their ages ranged between 7 years and 7 years and 11 months, and they were divided into two groups: a study group featuring children with cleft lip and palate (n=27) and a control group with children without this anomaly (n=25). The children were first interviewed, then underwent a series of conventional hearing tests, and lastly were applied the dichotic hearing test. RESULTS: when submitted to the dichotic listening test (directed attention mode), the children in the study group had lower scores for both ears when compared to those in the control group. Statistical significance was found for variable gender in the groups, with p=0.026. CONCLUSION: in the dichotic listening test only the girls with cleft lip and palate had lower scores than the girls in the control group. This is a prospective clinical study.

Achados otoscópicos e timpanométricos em lactentes com fissura labiopalatina

Tympanometry plays a fundamental role in the identification of middle ear alterations, which are frequent in the population with cleft lip and palate. AIM: do a retrospective analysis of the otoscopy and tympanometric exams of infants with cleft lip and palate who were not operated. Retrospective study. MATERIALS AND METHODS: we analyzed 273 charts from infants with cleft lip and palate whom, from March 1996 to April of 2002 underwent pneumatic otoscopy and tympanometry with a 226 Hz probe. RESULTS: We did not find statistical significance in the otoscopic and tympanometric findings considering ears and genders. We observed 84% of alterations in otoscopy (opacification/83.4%, visible fluid in the middle ear /1.5%, the ear drum does not move during inflation /1.8 and retraction/0.7) and 65% in tympanometric curves (B/38%), A/36.5%, As/21%, C/4% and Ad/0.5%). CONCLUSION: female and male infants with cleft lip and palate did not differ as far as otoscopic and tympanometry findings are concerned. All types of tympanometric curves were present, and types A and B were the most frequent ones. Ear drum opacification was the most frequent otoscopic finding. Pneumatic otoscopy identified a larger number of alterations when compared to conventional tympanometry.

A proposed behavioral tool to assess sustained auditory attention

Sustained attention and vigilance are processeses that characterize attention, and are essential for the development of certain abilities AIM: a prospective study to propose a simple, easy and quick behavioral tool to support the assessment of sustained auditory attention. MATERIAL AND METHODS: volunteer children aged between 6 and 11 years (139 female and 141 male) were selected. The test was named Sustained Auditory Attention Ability Test, and is based on the Continuous Performance Test. It consist of a binaural and diotic presentation of a list of 100 monosyllabic words in which a target monosyllable is included 20 times. This list was presented six times with no breaks. The test was carried out in a soundproofed room, using a CD player attached to a two-channel audiometer at 50 dBSL during 9 minutes. The test resulted in a total score and a vigilance decrement. RESULTS: There was no statistically significant difference between genders, but a significant difference was found between ages. CONCLUSION: The proposed test had no discomfort for the participants, and was shown to be extremely promising to assess the sustained auditory attention ability in children.

Otite média recorrente e habilidade de localização sonora em pré-escolares

OBJETIVO: comparar o desempenho de 40 pre-escolares no teste de localizacao sonora com as respostas de seus pais para um questionario que investigou a ocorrencia de episodios de otite media (OM) e os sintomas indicativos de desordens audiologicas e do processamento auditivo. METODOS: apos aplicacao e analise das respostas do questionario, dois grupos foram formados: GO, com historico de OM, e GC, sem este historico. Cada grupo com 20 pre-escolares de ambos os generos foi submetido ao teste de localizacao da fonte sonora em cinco direcoes (Pereira, 1993). RESULTADOS: a comparacao entre GO e GC nao mostrou diferenca estatisticamente significante (p=1,0000). CONCLUSAO: as otites recorrentes na primeira infância nao influenciaram no desempenho da habilidade de localizacao sonora dos pre-escolares deste estudo. Embora sejam dois instrumentos baratos e de facil aplicacao, o questionario e o teste de localizacao nao foram suficientes para diferenciar os dois grupos testados.