Digisonic Sp® Binaural Cochlear Implant: The Coronal Tunneled Approach [implante Coclear Digisonic Sp® Binaural: Acesso Coronal Tunelizado]

Cochlear implants represent a significant breakthrough in the treatment of hearing loss. Evidence indicates bilateral hearing brings significant benefits to patients, particularly when binaural hearing is offered. Objective: To describe the first case of implantation of a Digisonic SP® Binaural Neurelec device in Brazil (the third implant placed in the Americas, after Mexico and Colombia) and the chosen surgical approach. Method: Description of a surgical approach. Results: The procedure was successfully completed. Discussion: The squelch effect, binaural summation, location of the sound source, and the shadow effect of the head are listed among the reasons to explain the superiority of binaural rehabilitation. Cost of treatment must be considered in the development of public health policies. Conclusion: The cost of cochlear implants has been one of the main impediments to bilateral rehabilitation. The Digisonic SP® Binaural Neurelec device addresses this issue and exposes patients to less risk through a minimally invasive implantation procedure.793298305Fortunato-Tavares, T., Befi-Lopes, D., Bento, R.F., Andrade, C.R.F., Children with cochlear implants: Communication skills and quality of life (2011) Braz J Otorhinolaryngol, 78 (1), pp. 15-25Sprinzl, G.M., Riechelmann, H., Current trends in treating hearing loss in elderly people: A review of the technology and treatment options - a mini-review (2010) Gerontology, 56, pp. 351-358. , http://dx.doi.org/10.1159/000275062, PMid:20090297Turchetti, G., Bellelli, S., Palla, I., Forli, F., Systematic review of the scientific literature on the economic evaluation of cochlear implants in paediatric patients (2011) Acta Otorhinolaryngol Ital, 31 (5), pp. 311-318. , PMid:22287822 PMCid:3262412Brown, K.D., Balkany, T.J., Benefits of bilateral cochlear implantation: A review (2007) Curr Opin Otolaryngol Head Neck Surg, 15 (5), pp. 315-318. , http://dx.doi.org/10.1097/MOO.0b013e3282ef3d3e, PMid:17823546Guevara, N., Sterkers, O., Bébéar, J.P., Meller, R., Magnan, J., Mosnier, I., Multicenter evaluation of the digisonic SP cochlear implant fixation system with titanium screws in 156 patients (2010) Ann Otol Rhinol Laryngol, 119 (8), pp. 501-505. , PMid:20860274Truy, E., Ionescu, E., Ceruse, P., Gallego, S., The binaural digisonic co-chlear implant: Surgical technique (2002) Otol Neurotol, 23 (5), pp. 704-709. , http://dx.doi.org/10.1097/00129492-200209000-00017, PMid:12218623Litovsky, R., Parkinson, A., Arcaroli, J., Sammeth, C., Simultaneous bilateral cochlear implantation in adults: A multicenter clinical study (2006) Ear Hear, 27 (6), pp. 714-731. , http://dx.doi.org/10.1097/01.aud.0000246816.50820.42, PMid:17086081 PMCid:2651401Yoon, Y.S., Li, Y., Kang, H.Y., Fu, Q.J., The relationship between binaural benefit and difference in unilateral speech recognition performance for bilateral cochlear implant users (2011) Int J Audiol, 50 (8), pp. 554-565. , http://dx.doi.org/10.3109/14992027.2011.580785, PMid:21696329Freyman, R.L., Balakrishnan, U., Helfer, K.S., Spatial release from informational masking in speech recognition (2001) J Acoust Soc Am, 109 (5 PART 1), pp. 2112-2122. , http://dx.doi.org/10.1121/1.1354984, PMid:11386563Hyppolito, M.A., Bento, R.F., Directions of the bilateral cochlear implant in Brazil (2012) Braz J Otorhinolaryngol, 78 (1), pp. 2-3. , PMid:22392231Culling, J.F., Jelfs, S., Talbert, A., Grange, J.A., Backhouse, S.S., The benefit of bilateral versus unilateral cochlear implantation to speech intelligibility in noise (2012) Ear Hear, 33 (6), pp. 673-682. , http://dx.doi.org/10.1097/AUD.0b013e3182587356, PMid:22717687Summerfield, A.Q., Barton, G.R., Getting acceptable value for money from bilateral cochlear implantation (2003) Cochlear Implants Int, 4 (SUPPL. 1), pp. 66-67. , http://dx.doi.org/10.1002/cii.112, PMid:18792183Verhaert, N., Lazard, D.S., Gnansia, D., Bébéar, J.P., Romanet, P., Meyer, B., Speech performance and sound localization abilities in Neurelec Digisonic® SP binaural cochlear implant users (2012) Audiol Neurootol, 17 (4), pp. 256-266. , http://dx.doi.org/10.1159/000338472, PMid:22584289Achiques, M.T., Morant, A., Muñoz, N., Marco, J., Llópez, I., Latorre, E., Cochlear implant complications and failures (2010) Acta Otorrinolaringol Esp, 61 (6), pp. 412-417. , http://dx.doi.org/10.1016/j.otorri.2010.07.005, PMid:20947060Brito, R., Monteiro, T.A., Leal, A.F., Tsuji, R.K., Pinna, M.H., Bento, R.F., Surgical complications in 550 consecutive cochlear implantation (2012) Braz J Otorhinolaryngol, 78 (3), pp. 80-85. , http://dx.doi.org/10.1590/S1808-86942012000300014, PMid:2271485

Reforma do Estado e as políticas para a educação superior no Brasil nos anos 90 State Reforma and federal policies for higher education in Brazil in the 1990s

O presente artigo propõe-se a discutir as políticas educacionais implementadas no Brasil nos anos 90, do século XX, no que concerne à educação superior. Nessa ótica, parte da compreensão de que tais políticas são demarcadas por opções e interesses sociopolíticos articulados às mudanças no cenário contemporâneo, que se traduzem na apreensão das determinantes históricas que balizam o processo de reforma do Estado brasileiro. Essa lógica implica alterações no campo das políticas públicas, especialmente das políticas sociais, na medida em que estão em curso propostas e projetos que se configuram pela minimização do papel do Estado, marcado pela interpenetração das esferas pública e privada em detrimento da primeira. As políticas para a educação superior, nesse cenário, são analisadas indicando-se seus paradoxos e seus desdobramentos efetivos no que concerne aos processos de diversificação e diferenciação institucional, sistema de avaliação, expansão e privatização desse nível de ensino.<br>This article aims at discussing the federal policies for higher education implemented in Brazil in the 1990s. It assumes that such policies are based on socio-political choices and interests linked to the changes occurring in the contemporary Brazilian scene, changes that have deep historical roots, which emerge in the process of reformation of the Brazilian State. This situation implies alterations in the field of public policies, and more particularly in that of social policies, since the on-going official proposals and projects are characterized by a decrease of the role of State. The borders between public and private affairs have become increasingly blurred in a process detrimental to the former. The contradictions in the federal policies for higher education are analyzed here, as well as their results as for the following fields: institutional diversification and differentiation; assessment criteria, broadening and privatization of this level of education

Associação da variabilidade da precipitação pluvial em Santa Maria com a Oscilação Decadal do Pacífico Linking rainfall variability in Santa Maria with the Pacific Decadal Oscillation

O objetivo deste trabalho foi verificar a associação da variabilidade interdecadal da chuva em Santa Maria, RS, com a Oscilação Decadal do Pacífico. Parte da variabilidade interanual da precipitação pluvial é explicada pelo fenômeno El Niño Oscilação Sul (ENOS), que acontece no Oceano Pacífico. Na segunda metade da década de 1990, foi relatada outra oscilação na temperatura do Oceano Pacífico, de duração maior que o ENOS, denominada Oscilação Decadal do Pacífico (ODP). Foram usados os dados mensais acumulados de precipitação do período 1912-2008, da Estação Climatológica principal de Santa Maria, e os valores mensais do índice ODP do mesmo período. A análise foi realizada em nível anual, semestral (primeiro e segundo semestre), sazonal (verão, outono, inverno e primavera) e mensal. Existe associação entre a chuva e a ODP, de modo que décadas com chuvas acima da normal são associadas à fase quente da ODP, intercaladas com décadas com chuva abaixo da normal associadas à fase fria da ODP, o que indica oscilações periódicas de médio e longo prazo na precipitação pluvial em Santa Maria, RS.<br>The objective of this work was to verify the association of the interdecadal variability of rainfall in Santa Maria, Rio Grande do Sul state, Brazil, with the Pacific Decadal Oscillation. Part of the interannual variation in rainfall is explained by the El Niño Southern Oscillation (ENSO) in the Pacific Ocean. In the second half of the 1990s, another oscillation in the surface temperature of the Pacific Ocean was reported, with greater duration than ENSO, named the Pacific Decadal Oscillation (PDO). Monthly precipitation data collected at the Meteorological Station of Santa Maria of the 1912-2008 period and monthly PDO indices of the same period were used. The analyses were performed on an annual, semestral (first and second semester), seasonal (Summer, Fall, Winter, and Spring), and monthly basis. There is a link between rainfall and PDO, because decades with precipitation higher than normal are associated with a warm phase of PDO, followed by decades with below-normal rainfall associated with a cool phase of PDO, which indicate mid and long-term periodic oscillations of rainfall in Santa Maria