Surgical Procedures for Ménière’s Disease

The aim of this chapter is to present a literature review on some of the main articles describing different interventions for the treatment in patients with progressive intractable Ménière disease symptoms. Even though each paper presents good results in defending its techniques, there have been few well-designed clinical studies, that is, studies involving control groups or long-term observation, in the efficacy of surgery with respect to vertigo control and hearing preservation. Focusing on presenting the different techniques established in the literature, we discuss the main indications and results obtained regarding the control of vertigo and the audiological outcomes after the procedure. Physicians should offer additional treatment strategies for Meniere’s disease patients with a long history of limiting symptoms or associated hearing loss. The surgical options for such patients should be considered carefully because surgery can damage the ipsilateral ear and the hearing function of the contralateral ear is often suboptimal. Its importance is that alternatives for treatment can only be offered to a patient when doctor knows them

Development of a digital hearing aid to meet the Brazilian Government's Ordinance 587 (APAC)

O tratamento das disacusias sensório-neurais está balizado no uso de próteses auditivas, conhecidas como aparelhos auditivos ou aparelhos de amplificação sonora individuais. As próteses auditivas adquiridas pelo Governo Brasileiro para a condução de políticas públicas têm como uma de suas características a utilização de componentes dedicados, o que traz benefícios, mas que encarece a aquisição e pode inviabilizar os serviços de reparo após o término da garantia do fabricante. OBJETIVO: Desenvolver próteses auditivas digitais no desenho retroauricular, construídas a partir de componentes padronizados oriundos da própria cadeia de suprimentos dos fabricantes de próteses auditivas. FORMA DE ESTUDO: Experimental. MATERIAL E MÉTODO: Identificar a cadeia de suprimentos destes fabricantes, solicitar amostras e montar próteses auditivas em laboratório. RESULTADOS: As próteses auditivas desenvolvidas apresentaram recursos eletroacústicos não inferiores àquelas adquiridas pelo Governo, sendo adicionalmente atestadas pela mesma norma técnica internacional de referência. CONCLUSÃO: É possível desenvolver próteses auditivas digitais no desenho retroauricular montados a partir de componentes padronizados da cadeia de suprimentos dos fabricantes de próteses auditivas. Suas vantagens residem no baixo custo operacional - aquisição (com vantagens para o Governo) e de manutenção (com vantagens para o paciente).The treatment of sensorineural hearing loss is based on hearing aids, also known as individual sound amplification devices. The hearing aids purchased by the Brazilian Government, aiming at fulfilling public policies, are based on dedicated components, which bring about benefits, but also render them expensive and may impair repair services after manufacture's warranty expires. AIM: to design digital behind-the-ear hearing aids built from standardized components coming from the very supply chain of these manufacturers. STUDY DESIGN: experimental. MATERIALS AND METHODS: to identify the supply chain of these manufacturers, request samples and set up hearing aids in the laboratory. RESULTS: The developed hearing aids did not show lesser electroacoustic characteristics when compared to those acquired by the Government, also being tested by the same reference international technical standard. CONCLUSION: It is possible to develop digital behind-the-ear hearing aids based on off-the-shelf components from hearing aid manufacturers' supply chain. Their advantages include low operational costs - for acquisition (with clear advantages for the Government) and service (advantage for the patient)

Surface electromyography in peripheral facial paralysis patients

OBJETIVO: estudar a atividade eletromiográfica dos músculos frontal, orbicular dos olhos, zigomáticos, orbicular da boca em indivíduos normais e pacientes portadores de paralisia facial e o índice de simetria entre os dois lados da face. MÉTODOS: foram avaliados por meio da eletromiografia de superfície, seis indivíduos sem histórico de alteração na musculatura facial e seis pacientes com paralisia facial periférica. Para a avaliação eletromiográfica foram solicitados os seguintes movimentos (ao esforço máximo): elevação da testa, fechamento de olhos, protrusão labial e retração labial. RESULTADOS: encontrou-se que em indivíduos normais a média dos potenciais eletromiográficos para ambos os lados da face é semelhante, demonstrando que a integridade do nervo facial é fundamental para o equilíbrio da mímica facial. Nos pacientes com paralisia facial a média dos potenciais eletromiográficos para ambos os lados da face é significativamente diferente (evidenciando a falta de inervação neural). CONCLUSÃO: os resultados eletromiográficos mostraram diferença estatisticamente significante entres os dois lados da face nos indivíduos normais e nos pacientes com paralisia facial.PURPOSE: to study the surface electromyographic activity of frontal, orbicular occuli, orbicular oris and zigomatycs muscles in normal subjects and in peripheral facial paralysis patients. METHODS: six volunteers with no facial paralysis history as well as six peripheral facial paralysis patients were evaluated with electromyography using superficial electrodes. Maximum effort muscle activity and symmetry index were measured for the voluntary movements such as: raising eyebrows, eyes closing, smiling, puckering lips. RESULTS: it was found out that in normal subjects the muscle activity values were similar between the two sides of the face, showing that the facial nerve integrity is fundamental to the balance of facial mimics. In facial paralysis patients, the mean electromyographic values for both sides of the face were significantly different (evidencing the lack of facial nerve information to the muscles). CONCLUSION: the electromyographic results showed a statistically significant difference between the two sides of the face in the normal subjects and in facial paralysis patients

Evidence of progenitor cells in the adult human cochlea: sphere formation and identification of ABCG2

OBJECTIVES: The aim of this study was to search for evidence of stem or progenitor cells in the adult human cochlea by testing for sphere formation capacity and the presence of the stem cell marker ABCG2. METHODS: Cochleas removed from patients undergoing vestibular schwannoma resection (n=2) and from brain-dead organ donors (n=4) were dissociated for either flow cytometry analysis for the stem cell marker ABCG2 or a sphere formation assay that is widely used to test the sphere-forming capacity of cells from mouse inner ear tissue. RESULTS: Spheres were identified after 2-5 days in vitro, and the stem cell marker ABCG2 was detected using flow cytometric analysis after cochlear dissociation. CONCLUSIONS: Evidence suggests that there may be progenitor cells in the adult human cochlea, although further studies are required

An Adjuvant Technique in Endovascular Treatment of Post-Dissection Thoraco-Abdominal Aortic Aneurysms

Introduction: In chronic aortic dissection complicated by aneurysmal degeneration, the absence of spontaneous tears between the true and false lumen at visceral artery level may limit treatment by fenestrated/branched endovascular aneurysm repair (F/BEVAR). The creation of new fenestrations may be required to allow access to the visceral vessels. Technique: In this video, the endovascular treatment of a 70 year old white man with chronic type B aortic dissection complicated by Crawford type II thoraco-abdominal aortic aneurysmal degeneration is presented. The right renal artery had a false lumen origin without nearby visible re-entry tears. He underwent dissection flap fenestration at visceral vessel level using a transjugular intrahepatic portosystemic shunt (TIPS) needle and subsequent dilation with a high pressure balloon. A Zenith TX2 dissection endovascular graft was deployed proximally and extended distally with a Zenith dissection endovascular stent until the fenestration level was reached. In a second stage, a F/BEVAR was performed, with fenestration to the left renal artery and branches to right renal artery, superior mesenteric artery, and coeliac trunk. One year follow up computed tomography angiography showed visceral branch patency and a reduction of the aneurysm sac. Discussion: The chronic dissection flap may be thick and fibrotic, creating a technical challenge for endovascular fenestration. The off label use of a TIPS needle in this procedure created a new fenestration at the desired level and allowed definitive post-dissection treatment of the thoraco-abdominal aneurysm.publishersversionpublishe

Teleaudiometry as a screening method in school children

OBJECTIVE: To compare the efficacy and feasibility of teleaudiometry with that of sweep audiometry in elementary school children, using pure-tone audiometry as the gold standard. METHODS: A total of 243 students with a mean age of 8.3 years participated in the study. Of these, 118 were boys, and 125 were girls. The following procedures were performed: teleaudiometry screening with software that evaluates hearing at frequencies of 1,000, 2000 and 4000 Hz at 25 dBHL; sweep audiometry screening in an acoustic booth (20 dBHL at the same frequencies); pure-tone audiometry thresholds in an acoustic booth (frequencies of 500, 1000, 2000 and 4000 Hz); and acoustic immittance measurements. RESULTS: The diagnostic capacities of the teleaudiometry/sweep audiometry screening methods were as follows: sensitivity  ϝ  58%/65%; specificity  ϝ  86%/99%; positive predictive value  ϝ  51%/91%; negative predictive value  ϝ  89%/92%; and accuracy  ϝ  81%/92%. Teleaudiometry and sweep audiometry showed moderate agreement. Furthermore, the use of these methods in series with immittance testing improved the specificity, whereas parallel testing improved the sensitivity. CONCLUSION: Teleaudiometry was found to be reliable and feasible for screening hearing in school children. Moreover, teleaudiometry is the preferred method for remote areas where specialized personnel and specific equipment are not available, and its use may reduce the costs of hearing screening programs

Mime functional evaluation in facial paralysis following a stroke

BACKGROUND:functional evaluation of the facial movements in patients with facial paralysis following a stroke. AIM: to evaluate the function of the facial muscles of patients after central facial paralysis following a stroke. METHOD: nine patients referred by the Neurology Service were evaluated. The evaluation focused on spontaneous, voluntary and reflex movements. RESULTS: reflex and voluntary movement of the eyelid and forehead were preserved in all patients. However, spontaneous and voluntary movements of the lips and nose were limited according to the location and extension of lesion. CONCLUSION: the symptoms of central facial paralysis, in which paralysis only of voluntary movements of the lower two-thirds of the face is expected, occurred in the minority of the patients.TEMA:avaliação funcional da mímica facial de pacientes com paralisia facial central por acidente cerebrovascular. OBJETIVO: avaliar os aspectos funcionais da musculatura facial em pacientes com paralisia facial central após acidente cerebrovascular. MÉTODO: foram avaliados nove pacientes do Serviço de Neurologia. A avaliação enfocou movimentos espontâneos, reflexos e voluntários. RESULTADOS: todos os pacientes apresentaram movimentação voluntária e involuntária das pálpebras e testa, mas a movimentação dos lábios e de nariz estava prejudicada em ambos os movimentos, dependendo da localização e extensão da lesão. CONCLUSÃO: a sintomatologia da paralisia facial central, na qual se espera a paralisia da movimentação da parte inferior somente para os movimentos voluntários, ocorre na minoria dos pacientes.Universidade Federal de São Paulo (UNIFESP)Universidade de São Paulo Faculdade de Medicina Hospital das ClínicasUSPUSP FM Departamento de Oftalmologia e ORLUSP FMUSP FM HCUNIFESPSciEL

Protocols of selection and adjustment of auditive prosthesis for adults and elderly individuals

INTRODUÇÃO: A prótese auditiva é uma das alternativas utilizadas no processo de reabilitação auditiva que visa auxiliar a comunicação e minimizar as limitações causadas pela deficiência auditiva. Mesmo com o avanço da tecnologia, a seleção e adaptação da prótese auditiva exigem um processo criterioso para maximizar o desempenho, benefício e satisfação do usuário. OBJETIVO: Descrever o protocolo de seleção e adaptação de prótese auditiva para candidatos adultos e idosos utilizado em um centro de audiologia, cuja elaboração foi embasada em protocolos validados e descritos previamente na literatura científica específica e complementada por informações de evidências clínicas do serviço. COMENTÁRIOS FINAIS: O protocolo fonoaudiológico de seleção e adaptação da prótese auditiva para adultos e idosos demonstra que um maior número de informações coletadas propicia melhor orientação da expectativa real e maior efetividade no aconselhamento ao uso da prótese auditiva, favorecendo, desta maneira, o desempenho auditivo, a satisfação e o benefício do indivíduo.INTRODUCTION: The auditive prosthesis is one of the sed alternative in the auditive rehabilitation process that aims to aid the communication and to diminish the restrictions induced by the auditive deficiency. Even with the techonology advance, the selection and adjustment of the auditive prosthesis require a criteria process to maximize the user's performance, benefit and satisfaction. OBJECTIVE: To describe the protocol of selectiom and adjustment of audictive prosthesis for adults and elderly candidates, used in a Audiology Center, which elaboration ws based in vality protocols and previously described in specific scientific literature and completed by informations of clinic evidences from service. COMMENTS FINAIS: The speech protocol of selection and adjustment of auditicve prosthesis for adults and elderly shows that a great number of collected informations propitiates a better orientation of real expectative and more effectiveness to recommend the audictive prosthesis' usage, favorishing in this way, the audictive performance, the individual satisfaction and benefit