Myriam de Lima Isaac

Birth Prevalence and Natural History of Congenital Cytomegalovirus Infection in a Highly Seroimmune Population

BACKGROUND The natural history of congenital cytomegalovirus (CMV) infection is scarcely known in populations with high maternal CMV seroprevalence. This study evaluated the birth prevalence, clinical findings at birth, and hearing outcome in CMV-infected children from such a population. METHODS Consecutively born infants were screened for the presence of CMV in urine and/or saliva specimens during the first 2 weeks after birth. Neonatal clinical findings were recorded, and CMV-infected children were tested to document hearing function during follow-up. A subset of mothers of CMV-infected infants were prenatally tested for the presence of anti-CMV immunoglobulin G antibodies. RESULTS Congenital CMV infection was confirmed in 87 (1.08%; 95% confidence interval [CI], 0.86%-1.33%) of 8047 infants. Seven infants (8.1%; 95% CI, 3.3%-15.9%) had at least 1 clinical finding suggestive of CMV infection, and 4 (4.6%; 95% CI, 1.3%-11.3%) had >3 findings of systemic disease. Sensorineural hearing loss was found in 5 (8.6%; 95% CI, 2.9%-19.0%) of 58 children tested at a median age of 21 months. Bilateral profound hearing loss was observed in 2 children, and the hearing threshold was >60 decibels in all 5 children with hearing loss, including 2 children born to mothers with probable nonprimary CMV infection. CONCLUSIONS The results of this large newborn screening study in a population with high CMV seroimmunity provide additional evidence that congenital CMV disease occurs in populations with high seroprevalence rates, with a similar incidence of CMV-related hearing loss to that reported in the offspring of women from populations in developed countries with lower rates of seroimmunity to CMV.

Congenital Cytomegalovirus Infection as a Cause of Sensorineural Hearing Loss in a Highly Immune Population

Background: The burden of congenital cytomegalovirus (CMV)-associated sensorineural hearing loss (SNHL) in populations with CMV seroprevalence approaching 100% is unknown. The purpose of this study was to assess the rate, associated factors, and predictors of SNHL in CMV-infected infants identified by newborn screening in a highly seropositive maternal population. Methods: Newborns with positive saliva CMV-DNA that was confirmed by virus isolation in the first 2 weeks of life were enrolled in a prospective follow-up study to monitor hearing outcome. Results: Of 12,195 infants screened, 121 (1%) were infected with CMV and 12 (10%) had symptomatic infection at birth. Hearing function could be assessed in 102/121 children who underwent at least one auditory brainstem evoked response testing at a median age of 12 months. SNHL was observed in 10/102 (9.8%; 95% confidence interval: 5.1–16.7) children. Median age at the latest hearing evaluation was 47 months (12–84 months). Profound loss (>90 dB) was found in 4/5 children with bilateral SNHL while all 5 children with unilateral loss had moderate to severe deficit. The presence of symptomatic infection at birth (odds ratio, 38.1; 95% confidence interval: 1.6–916.7) was independently associated with SNHL after adjusting for intrauterine growth restriction, gestational age, gravidity, and maternal age. Among 10 infants with SNHL, 6 (60%) were born to mothers with nonprimary CMV infection. Conclusions: Even in populations with near universal immunity to CMV, congenital CMV infection is a significant cause of SNHL demonstrating the importance of CMV as a major cause of SNHL in children worldwide. As in other populations, SNHL is more frequently observed in symptomatic CMV infection.

Emissão otoacústica evocada transitória: instrumento para detecção precoce de alterações auditivas em recém-nascidos a termo e pré-termo

Introduction: The early diagnostic and intervention in the hearing alterations are of fundamental importance in the infantile development. The register of the otoacoustic emissions has been enlargement indicated for being a fast exam, easily applied. Aim: The objectives of the present study were to value the peripheral hearing function of full term neonate and adequate and small preterm neonate for the gestacional age, by the research of the transient otoacoustic emissions, identifying the prevalence of hearing alterations in this population; to verify the influence from the variable gestacional ages and weight in the moment of the birth, as well as the kinds of treatment, mechanics ventilations, administration of ototoxicity medicines and the permanence in the incubator and to analyze the factors that interfere in the programs of neonatal hearing screening. Study design: Clinical prospective. Material and method: There were appraised 157 children, whose 43 were born full term, 79 preterm adequate to gestacional age and 35 small preterm to gestacional age. It had been observed that premature neonates fail more in the answers from otoacoustic emissions. Results: The prevalence of conductive hearing impairment in the population studied was from 29 ears to 1000 and for the sensory-neural hearing impairment from the 16 to 1000. The low weight children in the birth were the most difficult to be appraised. The transient otoacoustic emissions were observed from the beginning of 27 gestacional weeks old. The kinds of treatments used were factors that influenced negatively in the answers of the otoacoustic emissions in premature groups. Conclusion: The early diagnostic work of the hearing impairment must be objective of the interdisciplinary team ¾ neonatologist, pediatrician, ear/nose and throat doctor, audiologist and speech-language pathologist, nurse and relatives ¾ and must be followed, immediately, by the early interventions programs.

Analysis of otoacoustic emissions in neonates at term and preterm.

UNLABELLED The transient evoked otoacoustic emissions (TEOAEs) have been widely used in neonatal hearing screening. OBJECTIVE To compare the TEOAEs in newborns at term and preterm vis-à-vis the following variables: ear side, gender, frequency spectrum and gestational age. METHOD By means of a cross-sectional cohort of 66 newborns up to the 28th day of life (41 newborns at term and 25 premature babies), we recorded TEOAEs. All the individuals did not have risk indicators for hearing loss. RESULTS There was a signal/noise ratio improvement with frequency increase. No differences were observed between genders and between the ears, but there were differences among the children born at term and preterm in the frequency bands at 3 kHz and 4 kHz. CONCLUSION The TEOAEs test is important for assessing the peripheral auditory system of newborns at term and preterm, making it possible to have responses regardless of gender and gestational age.

Prevalence of auditory neuropathy spectrum disorder in an auditory health care service

UNLABELLED Auditory neuropathy spectrum disorder (ANSD) is characterized by impairment of the auditory nerve associated with preservation of outer hair cell function. OBJECTIVE To establish the prevalence of ANSD in subjects with sensorineural hearing loss (SNHL). METHOD This retrospective study was carried out between 2010 and 2012 and included the charts of 2,292 individuals with SNHL. Data from otolaryngological and audiological examinations based on pure-tone and speech audiometry, impedance tests, otoacoustic emissions (OAEs), and brainstem auditory evoked potentials (BAEPs) were collected. INCLUSION CRITERIA presence of OAEs and/or cochlear microphonic (CM); absent or altered BAEPs, and normal MRI scans of the brain. RESULTS Twenty-seven (1.2%) of the 2,292 subjects with SNHL had ANSD (37% males; 63% females). Mild SNHL was seen in 29.6% of the individuals with ANSD; 55.5% had moderate SNHL; 7.4% had severe SNHL; and 7.5% had profound SNHL. In terms of age, 14.8% were aged between zero and 20 years, 44.1% were 41 to 60 years old, and 7.4% were above the age of 60. CONCLUSION ANSD was seen in 1.2% of the individuals with SNHL included in this study.Auditory neuropathy spectrum disorder (ANSD) is characterized by impairment of the auditory nerve associated with preservation of outer hair cell function. OBJECTIVE: To establish the prevalence of ANSD in subjects with sensorineural hearing loss (SNHL). METHOD: This retrospective study was carried out between 2010 and 2012 and included the charts of 2,292 individuals with SNHL. Data from otolaryngological and audiological examinations based on pure-tone and speech audiometry, impedance tests, otoacoustic emissions (OAEs), and brainstem auditory evoked potentials (BAEPs) were collected. Inclusion criteria: presence of OAEs and/or cochlear microphonic (CM); absent or altered BAEPs, and normal MRI scans of the brain. RESULTS: Twenty-seven (1.2%) of the 2,292 subjects with SNHL had ANSD (37% males; 63% females). Mild SNHL was seen in 29.6% of the individuals with ANSD; 55.5% had moderate SNHL; 7.4% had severe SNHL; and 7.5% had profound SNHL. In terms of age, 14.8% were aged between zero and 20 years, 44.1% were 41 to 60 years old, and 7.4% were above the age of 60. CONCLUSION: ANSD was seen in 1.2% of the individuals with SNHL included in this study.

P300 in individuals with sensorineural hearing loss

INTRODUCTION Behavioral and electrophysiological auditory evaluations contribute to the understanding of the auditory system and of the process of intervention. OBJECTIVE To study P300 in subjects with severe or profound sensorineural hearing loss. METHODS This was a descriptive cross-sectional prospective study. It included 29 individuals of both genders with severe or profound sensorineural hearing loss without other type of disorders, aged 11 to 42 years; all were assessed by behavioral audiological evaluation and auditory evoked potentials. RESULTS A recording of the P3 wave was obtained in 17 individuals, with a mean latency of 326.97ms and mean amplitude of 3.76V. There were significant differences in latency in relation to age and in amplitude according to degree of hearing loss. There was a statistically significant association of the P300 results with the degrees of hearing loss (p=0.04), with the predominant auditory communication channels (p<0.0001), and with time of hearing loss. CONCLUSIONS P300 can be recorded in individuals with severe and profound congenital sensorineural hearing loss; it may contribute to the understanding of cortical development and is a good predictor of the early intervention outcome.

Potenciais Evocados Auditivos de Média Latência: estudo em crianças saudáveis

OBJETIVO: Investigar os componentes dos PEAMLs em criancas saudaveis para determinar suas propriedades. MATERIAL E METODOS: 32 criancas, de ambos os sexos, 10 a 13 anos de idade, sem doencas neurologicas, participaram do estudo. Os dados foram analisados pela estatistica descritiva (media e desvio padrao) e por analise de variância (teste F). PEAMLs foram pesquisadas usando estimulo tom burst nas intensidades de 50, 60 e 70 dB NA. RESULTADOS E CONCLUSAO: A media de latencia dos componentes foi Na = 20.79ms, Pa = 35.34ms, Nb = 43.27ms e Pb = 53.36ms, a 70dB NA. A media dos valores de amplitude NaPa variou de 0.2 a 1.9 uV (M = 1.0 uV). A amplitude aumentou e a latencia diminuiu com o aumento da intensidade sonora. A inclinacao do complexo de ondas NaPa esteve presente em alguns casos, o que merece atencao em estudos semelhantes ou em mesmo em populacoes de criancas com dificuldade de fala e linguagem e do processamento auditivo. CONCLUSAO: O presente trabalho trouxe informacoes adicionais sobre as AMLRs e pode servir como referencia para outros estudos clinicos ou experimentais em criancas.

Verification of the Mismatch Negativity (MMN) responses in normal adult subjects.

Summary Mismatch Negativity (MMN) is used to evaluate the central auditory system. Aim to characterize the MMN, in normal subjects. Materials and Methods prospective study, 12 subjects, six males and six females, between the ages of 18 and 24. “Mann-Whytnei” test. Exams : Pure Tone Audiometry (PTA), Tympanometry, Otoacoustic Emissions and Short and Long Latency Auditory Potentials (MMN). Results in MMN variable amplitude, the mean value was of −2.757 μV and −3.548 μV, CZA1 and CZA2; of 1.435 μV and −1.867 μV, CZA1 and CZA2. In variable and medium latency, we found in 150.7ms and 153.2ms, CZA1 and CZA2; in 170.4ms and 184.0ms, CZA1 and CZA2 - for females and males respectively. Conclusion related to latency, there was significant statistical difference between the genders in relation to CZA1 and CZA2; and it was lower for females and higher for males.

Avaliação da satisfação do usuário de aparelho de amplificação sonora

PURPOSE: assess satisfaction with hearing aids (HA) by applying the self-assessment questionnaire IOI-HA (International Outcome Inventory for Hearing Aids) and to correlate the characteristics of hearing loss and HA fitting process. METHOD: 98 patients from a healthy public service were assessed, of both genders, with sensorineural hearing loss, and using the HA in a systematic way for at least 3 months. The IOI-HA questionnaire was used as a guide directed structured interview with the patient. Correlated these variables with the level of user satisfaction analyzed by IOI-HA by a factor (which reflects the interaction of the patient with his HA), the second factor (related to the patients experience with other people in their environment), and the total score for each patient. RESULTS: there was no significant correlation between these variables and user satisfaction. However, it is important to note that the averages obtained were positive and therefore the analyzes of the total sum of the IOI-HA, Factors 1 and 2, were also positive and approached the maximum score for each factor. CONCLUSION: this study found that in the studied group of HA users were satisfied with the adaptation of their HA and there were no correlations between variables and the degree of satisfaction with HA through the IOI-HA questionnaire.

Auditory Speech Perception Tests in Relation to the Coding Strategy in Cochlear Implant

Introduction  The objective of the evaluation of auditory perception of cochlear implant users is to determine how the acoustic signal is processed, leading to the recognition and understanding of sound. Objective  To investigate the differences in the process of auditory speech perception in individuals with postlingual hearing loss wearing a cochlear implant, using two different speech coding strategies, and to analyze speech perception and handicap perception in relation to the strategy used. Methods  This study is prospective cross-sectional cohort study of a descriptive character. We selected ten cochlear implant users that were characterized by hearing threshold by the application of speech perception tests and of the Hearing Handicap Inventory for Adults. Results  There was no significant difference when comparing the variables subject age, age at acquisition of hearing loss, etiology, time of hearing deprivation, time of cochlear implant use and mean hearing threshold with the cochlear implant with the shift in speech coding strategy. There was no relationship between lack of handicap perception and improvement in speech perception in both speech coding strategies used. Conclusion  There was no significant difference between the strategies evaluated and no relation was observed between them and the variables studied.