Rogério Hamerschmidt

Cognitive evoked potentials and central auditory processing in children with reading and writing disorders

UNLABELLED Learning disorders are often magnified by auditory processing disorders (APD). OBJECTIVE This paper aims to verify whether individuals with reading and writing disorders and P300 latencies above the average also present altered Staggered Spondaic Word (SSW) and speech-in-noise test results suggestive of APD. MATERIALS AND METHODS This is a cross-sectional cohort study. Twenty-one individuals with reading and writing disorders aged between 7 and 14 years were enrolled. RESULTS All subjects had normal findings on ENT examination, audiological tests, and brainstem auditory evoked potentials. The average P300 latency (334,25 ms) of all patients was picked as a cutoff point to divide the subjects into two groups: group A with latencies above 335 ms, and group B with latencies below 335 ms. Individuals in group A underwent SSW and speech-in-noise testing. CONCLUSION Altered results in the SSW and speech-in-noise tests suggestive of APD were found in the group of individuals with reading and writing disorders with P300 latencies above 335 ms.

Local anesthesia for cochlear implant surgery: a possible alternative

UNLABELLED The aim of this paper is to illustrate the possibility of performing a cochlear implant surgery with local anesthesia and sedation, the anesthetic technique and the advantages of that in comparison to a general anesthesia. AIMS prospective study demonstrating the possibility of doing cochlear implant surgery under local anesthesia and sedation. MATERIALS AND METHODS we describe three successful cases operated under local anesthesia, including neural telemetry and the conditions the patient presented after the surgery, with a very good recovery and no complications during and after the procedure. RESULTS these three surgeries show the possibility of doing the cochlear implant surgery with this kind of anesthesia, with a fast recovery, no symptoms of dizziness and vomiting after the surgery, and very few complaints from the patient. CONCLUSION local anesthesia with sedation for cochlear implant surgery in adults is a very good alternative for lowering the morbidity for the patient. It bears fewer risks, low costs for the hospital, with a very good procedure control, being very useful for older patients or the ones that have contraindications for general anesthesia.

Cochlear implant surgery with local anesthesia and sedation: comparison with general anesthesia.

Objectives The purpose of this study is to evaluate the possibility of performing cochlear implant surgery under local anesthesia and sedation and to evaluate the response of patients under sedation at the time of neural telemetry, comparing the differences with general anesthesia. Patients Twenty adult patients with bilateral sensorineural profound hearing loss submitted to cochlear implant surgery under general anesthesia and 20 patients under local anesthesia and intravenous sedation in the period from February 2011 to February 2012. The study was approved by the ethical committee of the institution. Intervention In both groups, we compared the costs of anesthesia, surgical time, time in recovery room, length of hospital stay, postoperative symptoms (pain, nausea, vomiting, and dizziness) and the degree of patient satisfaction. Besides, the reactions of the patients in the moment of the neural telemetry were also analyzed. Main Outcome Measures The endpoint of this study is to establish the possibility of doing cochlear implant surgery with local anesthesia and sedation, discussing the differences and advantages over general anesthesia. Results By t-test variables, time in recovery room, time in hospital stay, and cost of inpatient anesthesia differ between groups, being always lower in the group of local anesthesia with sedation. The same result can be obtained using the Wilcoxon test. The symptoms of nausea, vomiting, and dizziness did not differ in the 2 groups. Conclusion We conclude that the realization of the cochlear implant surgery under local anesthesia, and sedation is perfectly feasible with some advantages over general anesthesia. There were no problems during the neural telemetry performed by the time of the surgery in patients with local anesthesia with sedation.

Hydroxyapatite granules used in the obliteration of mastoid cavities in rats.

UNLABELLED Prospective experimental study in which we created a bony defect in the mastoids of rats and filled it up with hydroxyapatite to evaluate bone regeneration, to solve the problems of open cavities after mastoidectomies that frequently present with otorrhea, infection, granulation tissue and hearing loss. OBJECTIVE The aim was to evaluate bone regeneration in defects created in the mastoids of rats, using hydroxyapatite, to see how much of the cavity we could reduce. MATERIAL AND METHODS Twelve rats Wistar-Furth were used. A 0.5 x 0.5 cm bone defect was created in both temporal bones of the rats, and filled with 15 micrograms of hydroxyapatite. The left side was used as control. The animals were slaughtered 40 days afterwards and histology analyses were carried out. RESULTS In the hydroxyapatite group, the new bone growth involved an area of 68.53% of the total; and in the control group it was only of 15.97%. DISCUSSION AND CONCLUSION It was observed a very good hydroxyapatite integration to the temporal bone in this experimental model. The microscopic results were superior with the use of hydroxyapatite when compared to the control group. It is a safe method and easy to apply to solve the problems of open cavities with chronic discharge and difficult to clean.

Intraoperative Neural Response Telemetry and Neural Recovery Function: a Comparative Study between Adults and Children

Introduction Neural response telemetry (NRT) is a method of capturing the action potential of the distal portion of the auditory nerve in cochlear implant (CI) users, using the CI itself to elicit and record the answers. In addition, it can also measure the recovery function of the auditory nerve (REC), that is, the refractory properties of the nerve. It is not clear in the literature whether the responses from adults are the same as those from children. Objective To compare the results of NRT and REC between adults and children undergoing CI surgery. Methods Cross-sectional, descriptive, and retrospective study of the results of NRT and REC for patients undergoing IC at our service. The NRT is assessed by the level of amplitude (microvolts) and REC as a function of three parameters: A (saturation level, in microvolts), t0 (absolute refractory period, in seconds), and tau (curve of the model function), measured in three electrodes (apical, medial, and basal). Results Fifty-two patients were evaluated with intraoperative NRT (26 adults and 26 children), and 24 with REC (12 adults and 12 children). No statistically significant difference was found between intraoperative responses of adults and children for NRT or for RECs three parameters, except for parameter A of the basal electrode. Conclusion The results of intraoperative NRT and REC were not different between adults and children, except for parameter A of the basal electrode.

Comparison of turbinoplasty surgery efficacy in patients with and without allergic rhinitis

INTRODUCTION Turbinoplasty is a procedure that aims to reduce the size of the inferior turbinate through exuberant bone removal with high mucosal preservation. The procedure is recommended for patients with or without allergic rhinitis and those showing irreversible hypertrophy of inferior turbinates. OBJECTIVE To evaluate the efficacy of inferior turbinoplasty for obstructive and non-obstructive symptoms in patients with or without allergic rhinitis. METHODS Prospective study with 57 patients who underwent inferior turbinoplasty. They were evaluated for nasal obstruction, snoring, facial pressure, smell alterations, sneezing, nasal itching and runny nose symptoms, surgery time, and intraoperative bleeding. The last evaluation took place three months after surgery. RESULTS Thirty-nine patients with allergic rhinitis and 18 without were assessed. Ninety days after surgery, 94.7% of patients showed degrees IV and V of breathing improvement; 89.5% showed moderate or complete improvement in snoring; all patients showed smell improvement (only one showed moderate improvement; all the others had full improvement); 95.5% experienced complete facial pressure improvement; and 89.7% showed moderate to complete improvement in nasal itching and runny nose symptoms, as well as in sneezing. CONCLUSION The efficacy of inferior turbinoplasty was confirmed not only for obstructive symptoms, but also for non-obstructive symptoms in patients with and without allergic rhinitis.

Cochlear implantation in patient with Dandy-walker syndrome

Summary Introduction: Dandy Walker Syndrome is a congenital abnormality in the central nervous system, characterized by a deficiency in the development of middle cerebelar structures, cystic dilatation of the posterior pit communicating with the fourth ventricle and upward shift of the transverse sinuses, tentorium and dyes. Among the clinical signs are occipital protuberances, a progressive increase of the skull, bowing before the fontanels, papilledema, ataxia, gait disturbances, nystagmus, and intellectual impairment. Objectives: To describe a case of female patient, 13 years old with a diagnosis of this syndrome and bilateral hearing loss underwent cochlear implant surgery under local anesthesia and sedation. Case Report: CGS, 13 years old female was referred to the Otolaryngological Department of Otolaryngology Institute of Parana with a diagnosis of “Dandy-Walker syndrome” for Otolaryngological evaluation for bilateral hearing loss with no response to the use of hearing aids. Final Comments: The field of cochlear implants is growing rapidly. We believe that the presence of Dandy-Walker syndrome cannot be considered a contraindication to the performance of cochlear implant surgery, and there were no surgical complications due to neurological disorders with very favorable results for the patient who exhibits excellent discrimination. It has less need for lip reading with improvement in speech quality.

A comparison between neural response telemetry via cochleostomy or the round window approach in cochlear implantation

UNLABELLED There are two techniques for cochlear implant (CI) electrode placement: cochleostomy and the round window (RW) approach. OBJECTIVE This study aims to compare neural response telemetry (NRT) results immediately after surgery to check for possible differences on auditory nerve stimulation between these two techniques. MATERIALS AND METHODS This is a prospective cross-sectional study. Twenty-three patients were enrolled. Six patients underwent surgery by cochleostomy and 17 had it through the RW approach. RESULTS Mean charge units (MCU) for high frequency sounds: patients submitted to the RW approach had a mean value of 190.4 (± 29.2) while cochleostomy patients averaged 187.8 (± 32.7); p = 0.71. MCU for mid frequency sounds: patients submitted to the RW approach had a mean value of 192.5 (± 22) while cochleostomy patients averaged 178.5 (± 18.5); p = 0.23. MCU for low frequency sounds: patients submitted to the RW approach had a mean value of 183.3 (± 25) while cochleostomy patients averaged 163.8 (± 19.3); p = 0.19. CONCLUSION This study showed no differences in the action potential of the distal portion of the auditory nerve in patients with multichannel cochlear implants submitted to surgery by cochleostomy or through the RW approach, using the implant itself to generate stimuli and record responses. Both techniques equally stimulate the cochlear nerve. Therefore, the choice of approach can be made based on the surgeons own preference and experience.

Objective assessment of surgical technique in rotation and nasal projection variation

INTRODUCTION In rhinoplasty, facial esthetic analysis is critical for proper surgical planning. Parameters such as rotation and nasal projection should be routinely evaluated. Few studies have objectively assessed changes in facial angles postoperatively. OBJECTIVE To evaluate the effectiveness of medial intercrural sutures and of rotation of the nasal tip on the increase of rotation and nasal projection in Caucasian patients undergoing primary rhinoplasty. METHODS A prospective study carried out between 2011 and 2013, with 27 patients treated with primary rhinoplasty with a basic technique by the same surgeon, with medial intercrural sutures and rotation of the nasal tip. Rotation and nasal projection were measured from photographs obtained preoperatively and after 12 months. RESULTS All 27 patients completed the study. The mean age was 27.1 years. There was a mean increase of 8.4° in the rotation - a statistically significant value. There was no significant change in the projection. CONCLUSION The medial intercrural and nasal tip rotation sutures are effective in increasing nasal rotation in Caucasian patients undergoing rhinoplasty.

Alterações fonoaudiológicas em crianças com hipotireoidismo congênito: revisão crítica da literatura

O Hipotireoidismo Congenito (HC) e a doenca endocrina congenita mais comum na infância e corresponde a deficiencia de hormonios tireoidianos. Este artigo teve o objetivo de realizar uma revisao critica da literatura, a respeito das possiveis alteracoes fonoaudiologicas relacionadas ao HC. Os descritores utilizados para a busca nas bases de dados eletronicas PUBMED e MEDLINE foram: hypothyroidism OR congenital hypothyroidism AND voice OR hearing OR language. Foram incluidos estudos publicados ate julho de 2011. As analises foram realizadas independentemente por dois dos pesquisadores, com posterior discussao e consenso sobre a inclusao. Dos 324 estudos localizados na analise inicial, apenas 20 compuseram a amostra final apos o estabelecimento dos criterios de inclusao. Observou-se que ha um numero consideravel de artigos sobre a linguagem de criancas com HC, embora com controversias no que se refere aos resultados das avaliacoes. Quanto a Audiologia, nos ultimos anos houve uma reducao no numero de artigos que descrevem alteracoes auditivas em criancas com HC. Na area de Voz, foram localizados apenas dois artigos, que se referiram exclusivamente as anormalidades observadas no choro de bebes com HC. Embora com algumas constatacoes relevantes a respeito do assunto, a grande variabilidade metodologica das pesquisas nao permite que se tenha uma conclusao clara sobre as possiveis alteracoes fonoaudiologicas em criancas portadoras de hipotireoidismo congenito na atualidade.