Desenvolvimento de linguagem oral em crianças com surdez pré-lingual submetidos a implante coclear

Introdução: A surdez, especialmente quando ocorre no período anterior à aquisição de linguagem (pré-lingual), tem grande impacto na comunicação e, por consequência, na cognição, desempenho escolar, desenvolvimento emocional e bem-estar psicossocial. Em casos de surdez severa-profunda, o implante coclear (IC) pode ser indicado. Muitos centros realizam este tipo de reabilitação no Brasil através do programa de saúde auditiva do sistema único de saúde (SUS). Contudo, existem poucas publicações na literatura nacional que avaliem o desempenho dos pacientes implantados nestes programas. Objetivo: descrever características (da perda auditiva, sociodemográficas e socioculturais) e o desenvolvimento de linguagem oral em uma amostra de pacientes pediátricos com surdez pré-lingual de um programa público de implante coclear no Brasil. Após, explorar quais as características relacionadas a melhores resultados de linguagem. Métodos: estudo de coorte retrospectivo com crianças que realizaram a cirurgia de implante coclear no Hospital de Clínicas de Porto Alegre (HCPA) entre 2010 e 2020. Dados sobre a história médica pregressa, aspectos sociodemográficos, socioculturais e verificação de adesão ao programa foram coletados através de entrevistas e revisão de prontuário médico. A avaliação de desenvolvimento de linguagem foi realizada através dos questionários MUSS, MAIS e IT-MAIS e comparados com os marcos de desenvolvimento de linguagem. Audiometria em campo livre em uso de implante coclear para os pacientes que não tinham nenhum exame documentado nos 24 meses anteriores à avaliação. Resultados: Das 189 crianças implantadas entre 2010-2020, 129 foram incluídas neste estudo. A taxa de abandono do programa foi, portanto, de 31.7%. A idade média na primeira cirurgia de IC foi de 40.5 (±16.9) meses, com 77.5% dos pacientes tendo recebido implante unilateral. Em relação à escolaridade materna, 27.1% alcançou o nível superior e 7.8% das mães avaliadas relataram diagnóstico de depressão. A reabilitação pós-operatória com fonoterapia frequente não foi realizada por 26.4% dos pacientes e 30% das consultas agendadas para programação do implante coclear não foram realizadas. Resultados de linguagem abaixo do esperado para a idade auditiva (< escore Z -1) para o escore MAIS foram encontrados em 59,7% da amostra enquanto que para o escore MUSS a proporção foi de 62%. Fatores como hábito de leitura frequente, exposição ao bilinguismo e menor média quadritonal foram identificadas como variáveis independentes positivamente associadas ao desfecho de linguagem tanto para o Zescore MAIS quanto para o MUSS. Baixa idade gestacional e maior exposição a telas foram associadas a piores desfechos apenas para o Z-escore MUSS, de forma independente, enquanto que a presença de depressão materna foi associada a piores desfechos para o Z-escore MAIS. Conclusões: O perfil dos pacientes é homogêneo em relação ao status socioeconômico e eles apresentam uma idade média elevada na realização do implante coclear. A adesão ao tratamento pósoperatório revelou falhas, como alta taxa de perda de seguimento e baixa assiduidade às sessões de fala e programação e os pacientes apresentavam baixo desempenho de linguagem receptiva e expressiva.Introduction: Deafness, especially when it occurs in the period before language acquisition (prelingual), has a great impact on communication and, consequently, on cognition, school performance, emotional development and psychosocial well-being. In cases of severe-profound deafness, cochlear implants (CI) may be indicated. Many hospitals provide this treatment in Brazil through the public health system. However, there are few national studies that evaluate the performance of patients implanted in these programs. Objective: to describe characteristics (of hearing loss, sociodemographic and sociocultural) and the development of oral language in a sample of pediatric patients with prelingual deafness from a public cochlear implant program in Brazil. Afterwards, explore which characteristics are related to better language results. Methods: We conducted a retrospective cohort study with children who underwent CI surgery at Hospital de Clínicas de Porto Alegre (HCPA) between 2010 and 2020. Data on past medical history, sociodemographic, sociocultural aspects and verification of adherence to the program were collected through of interviews and review of medical records. The language development assessment was performed using the MUSS, MAIS and IT-MAIS scales. For the classification of language development we used as parameters the values (mean±SD) found in a previous national study. From those values, the Z score for each patient at each hearing age (time of experience with the CI) was calculated. Audiometry for evaluation of pure-tone average for patients who had no documented exams in the 24 months prior to evaluation was performed. Results: Of the 189 children implanted between 2010-2020, 129 were included in this study. Therefore, the rate of loss to follow-up in the program was 31.7%. The mean age at first CI surgery was 40.5 (±16.9) months, with 77.5% of patients having received a unilateral implant. Postoperative rehabilitation with consistent speech therapy was not performed by 26.4% of patients and 30% of appointments scheduled for cochlear implant programming were not performed. Regarding maternal education, 27.1% reached higher education and 7.8% of mothers reported a diagnosis of depression. Language results below the expected for hearing age (< Z score -1) for the MAIS score were found in 59.7% of the sample, while for the MUSS score the proportion was 62%. Factors such as reading habit, exposure to bilingualism and lower pure-tone average were identified as independent variables positively associated with language outcome for both Z-score MAIS and MUSS. Lower gestational age and greater exposure to screens were associated with worse outcomes for the MUSS Z-score alone, independently, while the presence of maternal depression was associated with worse outcomes for the MAIS Z-score. Conclusions: Patients profile is very similar in regard to SES and they have an elevated mean age at cochlear implantation. Engagement to postoperative treatment revealed flaws, such as a high rate of loss to follow-up and low attendance to speech and programming sessions and patients presented with poor receptive and expressive language performances

Maria Isaura Pereira de Queiroz: um olhar sobre a política

O artigo, com o título “Maria Isaura Pereira de Queiroz – anotações sobre a política”, agora complementado, foi apresentado na Mesa Redonda “A construção dos paradigmas para a sociologia futura local - a obra de Maria Isaura Pereira de Queiroz’, realizada no 19º Congresso da Sociedade Brasileira de Sociologia, em Florianópolis, em julho de 2019

Correspondência e depoimentos orais: reflexões a partir da comparação entre duas fontes de dados para o estudo do passado

Tomando como objeto a Revolta de 1924 em São Paulo, compara as possibilidades oferecidas por duas fontes de dados: cartas escritas nos dias da Revolta e depoimentos coletados décadas mais tarde. A correspondência analisada mostra também a vida cotidiana de uma família. Aspectos destacados: o cotidiano, a questão do tempo e da memória.Taking as subject the Rebellion of 1924 in São Paulo, this article compares the possibilities offered by two sources of information: letters written during the days of the Rebellion and testimonies collected decades later. The analysis of these letters also shows the daily life of a family. The main aspects focused in this article are: daily life as well as the question of time and memory

Spiritism in Brazil

The Spiritism began in France with the Encode written by Allan Kardec through a dialogue with the Spirits. From this dialogue resulted 'The Spirits' Book". The Spiritism has quickly disseminated in Europe, and in the same century came to Brazil. Kardecist Spiritism is a science, a philosophy and a religion, and as a religion it is a mediunic one. These reflections are based on a research to build the spiritist leader Rino Curti's (1922-2003) biography and to delineate the historic development and activities of the spiritist center created by him, named Coligação Espírita Progressista. Oral history methodology was used as well as documentary and bibliographic analysis and observation. This analysis pointed to the "not said", the "not asked" and the "not undersatood" at that moment. Advantages and disadvantages, facilities and difficulties are discussed, involved in a study of a religious belief, made out by a researcher who can be member of the studied faith or be only an observer. Trying to understand Spiritism, we considered the relational concepts proposed by the French sociologist Pierre Bourdieu, especially the concepts of 'field' and 'capital'. We suggest an extension of the concept of 'field', including the social positions occupied by people who are alive, and also by spirits.O espiritismo teve início na França com a codificação do Livro dos Espíritos por Allan Kardec (1804-1869), por meio de um diálogo com espíritos; difundiu-se na Europa e chegou ao Brasil ainda no século XIX. O espiritismo kardecista é filosofia, ciência e religião e, enquanto tal, uma religião mediúnica. As reflexões apresentadas no texto baseiam-se em pesquisa realizada para construir a biografia do líder espírita Rino Curti (1922-2003) e delinear o histórico e atuação da Coligação Espírita Progressista por ele fundada. Utiliza a metodologia da história oral, recorrendo também à análise de documentação, bibliografia e observação de sessões mediúnicas. A análise apontou "não ditos", "não perguntados" e não compreendidos" no momento. Facilidades e dificuldades do estudo de uma crença por um pesquisador não adepto são destacadas. Buscando compreender o espiritismo, utilizamos a perspectiva relacional proposta pelo sociólogo francês Pierre Bourdieu, especialmente os conceitos de 'campo' e 'capital'. Sugerimos a extensão do conceito de 'campo' para compreender esse universo que inclui o relacionamento entre encarnados e desencarnados

Portuguese community in São Paulo - years 2010

This study deals with Portuguese immigrants, their associations andworks in the city of São Paulo and focuses on the present century. It concernsthe insertion process in the country of shelter and the question of identity, andit is oriented by the concepts of migration, identity and insertion, considered inits two poles – integration and preservation of the roots. Besides the bibliography,it used varied data sources, such as: written sources, especially the ones that wereobtained from the community, oral sources, as life reports and testimoniescollected through the methodology of Oral History, radio broadcasting programs,besides photos. As the community is scattered and the Portuguese are not easyto be identified due to the similarity of physiognomic traits and surnames, andthe language being the same, the option for this study was to take the associativemovement and the institutions of the community as basis. The text shows theeffort of the community to preserve the Portuguese roots and the ambiguitythat marks the identity of the Portuguese community in Brazil.O estudo trata de imigrantes portugueses, suas associações e obras na cidade de São Paulo, focalizando o século atual. Diz respeito ao processo de inserção no país de acolhimento e à questão da identidade, orientando-se pelos conceitos de migração, identidade e inserção considerada em seus dois polos –integração e preservação das raízes. Além da bibliografia, utilizou fontes de dados diversas: fontes escritas especialmente obtidas junto à comunidade, fontes orais,como relatos de vida e depoimentos coletados por meio da metodologia da história oral, programas radiofônicos, além de fotos. Sendo esparsa a comunidade na cidade, os portugueses dificilmente identificados dada a semelhança de traços fisionômicos e sobrenomes, a língua sendo a mesma, a opção foi tomar como base o movimento associativo e as instituições da comunidade. O texto mostra o empenho da comunidade na preservação das raízes portuguesas e a ambiguidade de que se reveste a identidade dos portugueses no Brasil

Does universal newborn hearing screening impact the timing of deafness treatment?

Objective To evaluate the impact of the Universal Neonatal Hearing Screening (UNHS) on the age at diagnosis, beginning of treatment, and first cochlear implant surgery. Methods A retrospective cohort study with children up to 12 years old with bilateral hearing loss were divided into two groups: patients who underwent UNHS and the ones who didn't. The groups were compared according to their age at the beginning of the evaluation at a specialized center, at the beginning of the intervention, and, for the ones who had indication, at the cochlear implant surgery. The group who underwent UNHS was divided between the ones who passed the screening test and the ones who didn't. They were compared according to their ages at the same moments as the first two groups. Results 135 patients were included. The median age at the first appointment in a specialized center was 1.42 (0.50 and 2.50) years, at the beginning of treatment 2.00 (1.00 and 3.52) years, and the cochlear implant surgery 2.83 (1.83 and 4.66) years. Children who underwent UNHS were younger than those who didn't, at the three evaluated moments (p < 0.001). In a subanalysis, children who passed the UNHS but were later diagnosed with hearing loss reached the first appointment with a specialist and started treatment older than those who failed the tests. Conclusion Performing UNHS interfered with the timing of deafness diagnosis and treatment. However, children who passed the screening but were later diagnosed with hearing loss were the category with the most important delay

Aural polyps: What's behind them?

Introduction: Polyps in the external auditory canal (EAC) may be present due to inflammation induced by chronic otitis media. In many cases, the type of underlying otitis media is a cholesteatoma.Aim: The aim of this article is to determine the etiology of EAC polyps in patients referred to the Otology Division of a tertiary hospital in south Brazil.Materials and Methods: Cross-sectional study was conducted with a cohort of patients with otologic diseases who were evaluated from July 2001 to December 2020. Patients with unilateral or bilateral aural polyps underwent anamnesis and recorded video-otoscopy and had their online medical chart reviewed.Results: Of the 2432 patients evaluated, 133 (5.4%) had a polyp in the external auditory canal. Of those, 53 were excluded, leaving a final sample of 81 patients (3.3%).Discussion: Middle ear cholesteatoma (MEC) and non-cholesteatomatous chronic otitis media (NCCOM) were responsible for 86.3% of all polyps evaluated and the majority of diagnoses were established through surgery (76.5%).Conclusion: Symptoms associated with polyps and their aspect do not reveal the most probable etiologies making imaging exams, biopsy and surgery necessary steps in aural polyp investigation

Endoscopic-assisted canal wall-up tympanomastoidectomy for reduction of residual cholesteatoma

Introduction The treatment of cholesteatoma is generally surgical, and the major obstacle is the high prevalence of recidivism. The endoscopic ear surgery technique is proposed to minimize this problem. Objectives To utilize endoscopes to visualize andmanipulate cholesteatoma residues after microscopic removal Methods Cross-sectional study. Thirty-two patients with cholesteatoma underwent microscopic wall-up mastoidectomy combined with the endoscopic approach. The subjects were assessed for the presence and location of covert disease. Results Of the 32 cases, 17 (53.12%) had residual cholesteatoma in the endoscopic phase.Minimal disease was found, usually fragments of the cholesteatomamatrix. Pars tensa cholesteatomas had more covert disease than pars flaccida cholesteatomas (62.50% vs 43.75%). Posterior recesses (47.05%) and tegmen tympani (41.17%) were the locations with more covert disease (p<0.05). Conclusion Cholesteatomas of the pars tensa presented more residual disease and were significantly more common in the posterior recesses and tegmen tympani