Patrícia Cotta Mancini

Avaliação do efeito da cafeína no teste vestibular

Ha controversias sobre a interferencia da cafeina no teste vestibular. O cafe e a fonte mais rica em cafeina. Enquanto em alguns servicos os pacientes sao orientados a suspender a ingestao de cafe 24 a 48 horas antes da realizacao do teste, outros nao consideram necessaria a suspensao da ingestao dessa bebida. OBJETIVO: Avaliar o efeito da cafeina no resultado do teste vestibular. FORMA DE ESTUDO: clinico com coorte transversal. MATERIAL E METODO: Estudo comparativo, transversal, pareado. O teste vestibular foi realizado em duplicidade, com intervalo maximo de cinco dias entre um e outro exame. No primeiro teste, os pacientes foram orientados a nao ingerir cafe 24 horas antes do exame; no segundo teste, os pacientes foram orientados a beber cafe como de costume. Todos os participantes tinham indicacao clinica de se submeter ao teste vestibular e tinham o habito de tomar cafe. RESULTADOS: Participaram do estudo 19 mulheres com idade media de 49,5 anos. O consumo medio de cafe foi de tres xicaras por dia. As queixas de ansiedade e cefaleia foram associadas ao teste realizado com suspensao do cafe. Nao houve diferenca estatisticamente significante nos resultados dos exames realizados com e sem ingestao de cafe. CONCLUSAO: A ingestao moderada de cafe nao interferiu no resultado do teste vestibular. Considerando ser recomendavel que o paciente esteja tranquilo ao se submeter ao teste vestibular e que a meia-vida da cafeina e de apenas seis horas, sugerimos que a orientacao para a suspensao subita e completa da ingestao moderada de cafe antes do teste vestibular para os individuos habituados a ingestao diaria seja reavaliada.

Evaluation of the caffeine effect in the vestibular test

UNLABELLED Exists controversy about the interference of the caffeine in the vestibular test. Coffee is the richest source of caffeine. While in some services, the patients were oriented to suspend the ingestion of caffeine 24 to 48 hours before the vestibular test, others did not consider the suspension of this drink necessary. AIM To evaluate the effect of caffeine in the vestibular test result. STUDY DESIGN Clinical with transversal cohort. MATERIAL AND METHOD Sectional and matched research. The vestibular test was performed twice in the same patient, with five days interval between the exams. In the first test, the patient did not drink coffee 24 hours before the exam; in the second, the patient drunk coffee as usual. All of the participants had clinical indication for vestibular test and were used to drinking coffee. RESULTS Nineteen women, medium age of 49.5 years, participated. The average coffee consumption was three cups per day. The complaints of anxiety and headache were associated with the submission to the vestibular test without coffee. The exams were not statistically different comparing the results of the tests performed with and without the coffee ingestion. CONCLUSION The moderate ingestion of coffee was not shown to interfere in the results of the vestibular test. Considering that it is recommended that the patient be calm to be submitted to the vestibular test and that the half-life of the caffeine is only six hours, we suggest that the orientation of complete and abrupt drinking coffee suspension of moderate dose before the vestibular test for the individuals used to daily drinking coffee be reevaluated.

Medidas de biossegurança em audiologia

BACKGROUND: biosafety precautions for audiologic practice. PURPOSE: to review the biosafety precautions suggested in the literature for infection control in audiology. The biosafety precautions suggested for many health professionals were adapted for the inherent activities of audiologic practice in Audiology Service at Hospital das Clinicas of UFMG. CONCLUSION: the submitted biosafety precautions can be used by any institution, hospital or clinic where the audiologic performance is becoming more widespread and, consequently, demanding specific precautions for audiologic practice.

Achados audiológicos em crianças com fenilcetonúria

OBJETIVO: Investigar a existencia de alteracoes na audicao de criancas com fenilcetonuria diagnosticadas e tratadas precocemente e comparar os resultados com os encontrados nas avaliacoes auditivas de criancas normais de mesma idade. METODOS: Foram realizadas imitanciometria e audiometria tonal e vocal em 63 criancas, sendo 30 no grupo controle, com media de idade de 8,1 anos, e 33 com fenilcetonuria no grupo de estudo, com media de idade de 7,7 anos. O grupo de estudo foi subdividido em 15 criancas com controle adequado da dieta e 18 criancas com controle inadequado da dieta, com medias de idade 8,1 e 7,2, respectivamente. A analise estatistica utilizou o Teste t ou ANOVA. RESULTADOS: A audiometria revelou 83,3% de criancas com audicao normal no grupo controle e 16,7% de perdas auditivas condutivas uni ou bilaterais. No grupo com fenilcetonuria, 66,7% das criancas apresentaram audicao normal e 33,3% com perdas auditivas condutivas. Na imitanciometria, observou-se curvas normais em 91,7% das criancas do grupo controle e em 72,7% das criancas do grupo com fenilcetonuria. Houve diferenca na comparacao entre grupos para limiares aereos, reflexos estapedianos, limiares de recepcao da fala e indice de reconhecimento de fala. Nao foi observada diferenca entre os resultados das avaliacoes auditivas de criancas fenilcetonuricas com dieta adequada e inadequada. CONCLUSAO: As criancas com fenilcetonuria diagnosticadas e tratadas precocemente apresentaram piores limiares de audibilidade por via aerea, limiares de recepcao de fala e indice de reconhecimento de fala evidenciados a audiometria tonal e vocal, quando comparadas com criancas normais.

Children with phenylketonuria treated early: basic audiological and electrophysiological evaluation.

Objectives: Individuals with phenylketonuria (PKU) can exhibit deficits in executive functions, intelligence, attention, visual-spatial processing abilities, and efficiency stemming presumably from deficient neurotransmitter synthesis, even when the disorder is diagnosed and treated early. Basic audiological and electrophysiological evaluations were used to examine the peripheral and central auditory pathways of children with early-treated PKU, who followed adequate versus inadequate diets. Results were compared with those of age-matched children without PKU. Design: The control group included 35 children aged 5 to 16 years, and the experimental group included 25 children with classic PKU, all of whom were diagnosed and treated early. The experimental group comprised children of two subgroups, divided according to their dietary control, as follows: 8 children aged 6 to 13 years with adequate diets (group A); 17 children ages 6 to 15 years demonstrating inadequate diets (group B). All participants underwent auditory evaluations, including otoscopy, pure-tone and speech audiometry, immittance testing (tympanometry and assessment of contralateral stapedial reflex thresholds), and evaluations of auditory brainstem and middle latency responses. The demographic variables and audiological examination results were analyzed for all groups. Results among groups and subgroups were compared using analysis of variance with repeated measures to test statistical significance across factors and measures at the p = 0.05 level. Results: Audiometric evaluation revealed results within normal limits for all groups, except for one child from the inadequate diet group, who showed a mild bilateral conductive hearing loss. Results of speech and immittance audiometry suggested the children in group B as having poorer average speech-discrimination scores and higher stapedial reflex thresholds at 4000 Hz. Auditory brainstem response results revealed longer average latencies for waves III and V and greater interaural differences for wave V in group B, although both groups A and B showed longer average latencies for the interpeak interval I–V, compared with the control group. Middle latency responses showed no significant differences in the latencies of the Na and Pa waves or the Na–Pa amplitude for the experimental group, but electrode or ear effects were present in 87.5% of group A and 58.8% of group B. Conclusions: Overall, differences observed tended to be small (by clinical diagnostic standards), yet suggest that children with PKU exhibit some effect of this disorder on the pontine auditory pathway, even when diagnosed/treated early and independent of the appropriateness of diet. It thus seems prudent to follow PKU children with auditory processing assessments to evaluate functional implications of these findings.

Alterações dos potenciais evocados auditivos do tronco encefálico em pacientes com esclerose múltipla

A presenca de alteracoes nos potenciais evocados auditivos do tronco encefalico (PEATE) em individuos com doencas desmielinizantes sugere lesao do tronco encefalico. OBJETIVOS: O objetivo do presente estudo foi avaliar a incidencia de alteracoes auditivas e dos PEATE em individuos com esclerose multipla (EM). MATERIAL E METODO: Participaram do estudo 16 pacientes do sexo feminino e 9 do sexo masculino com diagnostico definido de EM. Testes audiometricos e pesquisa dos PEATE foram realizados em todos os individuos. Para a classificacao dos PEATE utilizou-se a classificacao proposta por Jerger (1986) na analise da morfologia das ondas. FORMA DE ESTUDO: Estudo de coorte contemporânea com corte transversal. RESULTADOS: Dos 50 PEATE realizados, 70% foram classificados como tipo I (resposta normal) pela classificacao de Jerger. Considerando-se como alterados os PEATE dos tipos II, III, IV ou V da classificacao de Jerger em pelo menos um dos lados, encontrou-se 31,25% de alteracoes no sexo feminino e 44,44% no masculino, totalizando 36%. CONCLUSOES: Estes achados enfatizam a relevância do estudo dos PEATE em casos de suspeita clinica de doencas desmielinizantes e naqueles com diagnostico definido de EM.

Crianças com fenilcetonúria: avaliação audiológica básica e supressão das otoemissões

PURPOSE: To evaluate the auditory pathways of children with early-treated phenylketonuria through audiometry, immitance tests, and suppression of transient otoacoustic emissions. METHODS: Prospective cross-sectional study with sample composed by 28 children: 12 with phenylketonuria and 16 without the disease. Participants underwent auditory evaluations composed of air- and bone-conduction pure-tone audiometry, speech audiometry, immittance tests and suppression of transient otoacoustic emissions. RESULTS: All participants presented normal results in pure-tone and speech audiometry; however, speech discrimination scores were lower on the phenylketonuria group. Immitance tests revealed normal tympanograms for all children, but stapedial reflex thresholds demonstrated higher thresholds in 2 and 4 kHz for children with phenylketonuria. The suppresion of transient otoacoustic emissions did not show difference in the comparison between groups. CONCLUSION: The basic audiologic assessment do not identify hearing disorders in children with phenylketonuria; however, speech discrimination scores were lower and stapedial reflexes were higher in these children, which may indicate auditory processing disorders. The study of the suppression of transient otoacoustic emissions demonstrated integrity of the olivocochlear efferent system in children with phenylketonuria.

Alterações auditivas e fenilcetonúria: uma revisão sistemática

BACKGROUND: phenylketonuria is a genetic disorder that causes biochemical alterations, leading to a deficiency in the synthesis of proteins and neurotransmitters and thereby hindering the myelination process. Structural and functional changes in myelin can alter neural conductivity patterns and or reduce synaptic connection in individuals with phenylketonuria. Essentially, a dietary treatment should be implemented in the first weeks of life in order to avoid clinical and biochemical manifestations of the disease. When diet is continually maintained, children with phenylketonuria show normal development. However, deficits in executive functions, interhemispherical interaction, language and memory have been observed even in children with early treatment and appropriate diet. Some researches were carried out for investigating the relationship between phenylketonuria and alterations in the hearing function. PURPOSE: to systematically review articles dedicated to the research of relationship between hearing disorders and hyperphenylalaninaemias, highlighting the classic phenylketonuria. The bibliographical references were obtained through research in the databases: Lilacs, Medline, Cochrane Library and Scielo and through search in the reference list of the identified and selected articles. CONCLUSION: the relationship among hyperphenylalaninaemias, including phenylketonuria, and hearing alterations is still controversial in the literature. It is suggested that more investigations as for the hearing function are necessary on those individuals in order to elucidate this possible relationship.

The Impact of Dizziness on the Quality of Life of 235 Individuals who Completed Vestibular Testing in Brazil

Introduction In Vestibular Testing (VT), caloric tests allow evaluation of unilateral weakness (UW) and directional preponderance (DP), where different criteria of normality are adopted in Brazil and worldwide. The Brazilian version of the Dizziness Handicap Inventory (Brazilian DHI) evaluates the impact of dizziness on the quality of life of an individual. Objectives The objective of this research is to evaluate the impact of dizziness on the quality of life of patients undergoing VT, and to relate these findings to the results obtained according to national and international criteria. Methods Cross-sectional analytic study of 235 patients referred for VT in two hospitals. The authors performed the Brazilian DHI, history, static, and dynamic balance tests, positional nystagmus, and the Dix-Hallpike maneuver, as well as vectoelectronystagmography. Subjects were divided into three groups according to UW and DP values. Descriptive statistics and comparisons between groups were performed, considering a significance level of 5% in all analyses. Results Patients groups had 20.9% men, and 79.1% women. There was no significant difference between groups for the scores obtained in the Brazilian DHI. There was, however, a statistically significant difference in the redistribution of individuals according to the UW and DP values. Conclusion There was no relationship between VT results and the impact of dizziness in the quality of life. A review of normal values for UW and DP adopted in Brazil is suggested, as well as the application of the Brazilian DHI as an additional tool to evaluate the impact of dizziness on quality of life in all patients undergoing VT.

Achados da avaliação comportamental e eletrofisiológica do processamento auditivo

Objetivo Realizar uma analise descritiva do desempenho de pacientes encaminhados a um hospital de uma instituicao de ensino publico, para avaliacao do processamento auditivo, e correlacionar os achados desta avaliacao a idade, queixas, resultados e as avaliacoes auditivas comportamental e eletrofisiologica.Metodos O estudo incluiu 159 individuos encaminhados pelo sistema publico de saude para avaliacao do processamento auditivo. Todos os participantes realizaram audiometria tonal liminar, medidas de imitância acustica, testes comportamentais do processamento auditivo e avaliacao eletrofisiologica da audicao.Resultados A principal queixa referida foi a de dificuldade de aprendizagem e os testes que avaliam processamento temporal e escuta dicotica foram os que apresentaram maior prevalencia de alteracao. Em todos os testes eletrofisiologicos, o numero de resultados normais foi superior aos alterados. A proporcao de individuos normais e alterados, nos testes comportamentais e eletrofisiologicos, nao diferiu em relacao ao genero. Houve correlacao fraca entre fechamento auditivo e potencial evocado auditivo de media latencia da orelha direita; potencial evocado auditivo de media latencia da orelha esquerda e potencial evocado auditivo de media latencia total; ordenacao temporal e efeito eletrodo direito e P300; processamento temporal e potencial evocado auditivo de media latencia da orelha direita; escuta dicotica e P300 e entre interacao binaural e reflexo acustico das orelhas direita e esquerda.Conclusao A dificuldade de aprendizagem prevaleceu sobre as queixas dos participantes e as habilidades de processamento temporal e escuta dicotica apresentaram maior prevalencia de alteracao. A maioria dos participantes foi encaminhada para a avaliacao do processamento auditivo pelo fonoaudiologo. Os testes eletrofisiologicos apresentaram correlacao fraca com os testes comportamentais.