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OBJECTIVE To describe the audiological results and complications following active middle ear implant (AMEI) surgery in users with bilateral ear atresia. STUDY DESIGN Observational and retrospective longitudinal follow-up. SETTING A tertiary referral hospital for hearing rehabilitation and craniofacial malformations. PATIENTS Medical records of 27 patients with bilateral congenital aural atresia (34 ears) who underwent surgery for AMEI were reviewed. Data were analyzed using descriptive and inferential statistics. The alpha error was assumed to be 5%. OUTCOME MEASURES Medical and technical complications and audiological results were observed during follow-up. RESULTS The median postoperative follow-up was 37.5 months (27.7-75.5 mo). Medical or technical complications occurred in 35.3% (n = 12) of patients during follow-up, 14.7% (n = 5) required surgical revision. The auditory thresholds in the free field improved from 53.75 dB (46.87-56.25) to 25 dB (21.25-32.5) after 6 months using the AMEI (p

Objective: To assess the health utility scores of Thais with hearing loss, which can be used as a reference value for assessing health-related quality of life and economic evaluations in any interventions among hearing-impaired persons in Thailand. Material and Methods: All hearing-impaired persons who visited Songklanagarind Hospital between January and June 2019 were recruited for the study. The demographic and clinical data of the participants including gender, age, and type and degree of hearing loss were collected. A health-related quality of life interview was conducted using the EuroQoL five-dimensional questionnaire, Thai version. Independent t-test and multiple linear regression analysis were performed to assess which factors were associated independently with the health utility scores. Results: One hundred and eleven participants, 46 males and 65 females, ranging in age from 22 to 92 years, were recruited for the study. The average health utility scores were 0.81 and 0.86 for subjects not using and using hearing aids, respectively, similar to the results from other nations. The average health utility score of subjects with underlying diseases (0.79) was lower than the average health utility score of subjects without underlying diseases (0.87) with statistical significance (p-value=0.038). Additionally, the pure tone average in the better ear was the only variable significantly associated with the health utility scores (regression coefficient: -0.004, p-value=0.002). Conclusion: The average health utility scores among hearing-impaired Thais were 0.81 and 0.86 for subjects not using and using hearing aids, respectively.

Purpose: To determine the prevalence of SARS-CoV-2 in tear samples and to investigate whether it correlates with ocular findings and patients’ prognosis in Brazil. Methods: Tears were collected using Schirmer strips (SS) and conjunctival swabs (CS) from patients hospitalized with laboratory-confirmed SARS-CoV-2 infection. Samples were analyzed using qRT-PCR. Demographic and clinical data, ocular symptoms, and Schirmer tests (ST) were collected from patients. Charlson Comorbidity Index (CCI) was used to rate comorbidities, and patients were monitored until hospital discharge or death. Results: There were 61 hospitalized patients, 33 of which were diagnosed with COVID-19. Within the confirmed COVID-19 patients, SARS-CoV-2 was detected in 18.2% (n = 6) of CS and 12.1% (n = 4) of SS samples. Subjective and objective parameters for dry eye syndrome (e.g., ST COVID-19: 8.3 ± 6.4mm, non-COVID-19: 8.9 ± 6.6mm, p > 0.05) were comparable between COVID-19 (n = 33) and non-COVID-19 patients (n = 28). Among the 16 COVID-19 patients exhibiting ocular symptoms, only tearing was reported significantly more frequently when tear samples were positive for SARS-CoV-2 (p < 0.05). Strikingly, patients whose tears tested positive for SARS-CoV-2 had significantly inferior CCI (pos.: 34.0 ± 31.8%, neg.: 67.6 ± 36.4%, p < 0.05) and higher mortality rates (pos.: 50.0%, neg.: 7.4%, p < 0.01). Conclusions: SARS-CoV-2 was detected with a prevalence of 18.2% on the ocular surface. Decreased CCI and increased mortality rate in the positive tear group suggests that viral detection may relate to prognosis and highlight the need of personal protective measures for healthcare professionals. Most of the patients, regardless of COVID-19 diagnosis, had low tear production and eye discomfort, possibly pointing to the need for artificial tear use during hospitalization.

RESUMO Objetivo Descrever os benefícios nos limiares auditivos e no desempenho de reconhecimento de sentenças no silêncio e no ruído em indivíduos com a adaptação unilateral do Sistema Ponto®. Métodos Estudo observacional, retrospectivo, de seguimento longitudinal. A casuística foi composta por fontes de dados secundários de dez indivíduos com perda auditiva condutiva ou mista, que foram submetidos à cirurgia com o Sistema Ponto®. Os resultados foram analisados nas seguintes condições: a) pré-cirúrgicas: sem AASI; com AASI por condução aérea ou óssea e com o processador Ponto Pro® acoplado a uma banda elástica; b) pós-cirúrgicas: na ativação e após seis meses de uso. Resultados Os limiares da audiometria tonal por conduções aérea e óssea mantiveram-se estáveis após a cirurgia, enquanto os limiares auditivos em campo livre e o reconhecimento de fala no silêncio e no ruído foram estatisticamente melhores na ativação e após seis meses de uso do Sistema Ponto®. Não houve diferença nos resultados com os indivíduos utilizando o Sistema Ponto® com a banda elástica e após a cirurgia. Conclusão O Sistema Ponto® propiciou benefício nas habilidades auditivas de detecção em todas as frequências testadas, assim como no reconhecimento de sentenças no silêncio e no ruído. ABSTRACT Purpose To describe the benefits in hearing thresholds and sentence recognition performance in silence and noise, in users of the unilateral Ponto® system. Methods An observational, retrospective, longitudinal study. The sample consisted of secondary data sources from 10 individuals with conductive or mixed hearing loss who underwent surgery with the Ponto® System. The results were analyzed in the following pre-surgical conditions (without hearing aids; with hearing aids by air or bone conduction; with the Ponto Pro® processor with a soft band) and post-surgical (on activation and after six months of use). Results The thresholds of pure tone audiometry by air and bone conductions remained stable after surgery, while the auditory thresholds in free field and speech recognition in silence and in noise were statistically better when using the Ponto® system. There was no difference between the results obtained with the individuals using Ponto® with soft band and post-surgically. Conclusion The Ponto® system provided benefits in hearing detection skills in all tested frequencies, as well as, in recognition of the sentence in silence and noise.

Schirmer strips and conjunctival swabs are used in ophthalmology for the collection of tears and fluids. One of the biggest challenges during the COVID-19 pandemic has been accurate diagnosis and, in some cases, ocular manifestations are among the first symptoms. In this context, this study aimed to collect evidence to support the use of Schirmer strips and conjunctival swabs as a method of sample collection for viral analysis. A literature search was conducted following the Scoping Review protocol defined by The Joanna Briggs Institute. Studies were analyzed regarding virus research, collection methods, and sample analysis. The findings support that viruses can be detected on the ocular surface through analysis of Schirmer strips and conjunctival swabs. However, additional studies with larger samples and time data are necessary to confirm these conclusions.

Purpose Schirmer Strips and Conjunctival swabs are used in ophthalmology for tears and fluids collection. During the COVID-19 pandemic, one of the biggest challenges is accurate diagnosis, and it is known that, in some cases, ocular manifestations are one of the first symptoms. In this context, this study has the objective of raising scientific evidence that highlights the use of Schirmer strips and conjunctival swabs as a method of sample collection for viral analysis to support future research on this theme. Methods A literature search was conducted in the PubMed, Web of Science and BVS databases, following the Scoping Review protocol defined by Joanna Briggs Institute (JBI) after the guiding question “Is it possible to detect viruses on the ocular surface with Schirmer Test and/or conjunctival swab?”.Results A total of 418 studies were identified, and after discerning analysis, 36 English written studies were selected. Three researchers analyzed studies after virus research, collection methods, and sample analysis. Publications were mainly on adenovirus, herpes simplex virus and SARS-CoV-2, and there is also evidence of ocular detection of more viruses types. Conjuntival swab analyzed through Polymerase Chain Reaction (PCR) or Reverse Transcriptase-PCR (RT-PCR) were the most used methods.Conclusions Studies have generally been conducted to understand viral infection, to develop accurate diagnostic methods and to follow the patients’ response to treatment. Most studies were performed with a small number of patients and lacked clear definitions of collection time and viral persistence since the onset of diseases. Viruses can be detected on the ocular surface through the analysis of Schirmer strips and conjunctival swabs. However, additional studies with larger populations and time permanence are necessary to develop more assertive conclusions on the theme.

Purpose To analyze the surgical management of cholesteatoma in patients with craniofacial abnormalities, cleft lip/palate by reviewing the institutional experience. The secondary aim was to identify and describe the epidemiological profile of the collected data, and to relate the cleft palate and cholesteatoma. Design and methods This retrospective chart review includes 97 patients with craniofacial abnormalities and acquired cholesteatoma with anatomopathological proven in 118 ears. The following data were collected from the medical records between 1994 and 2018. Results The first surgery performed on 76 of the 118 ears (64.4%) was the wall up mastoidectomy, while 42 of the 118 ears (35.5%) received the wall down technique. During the follow-up period of these patients, which ranged from 2 to 29 years, with an average of 13.4 years (±5.88), 77 wall up (40.3%) and 114 wall down (59.6%) mastoidectomies were performed. This brought the total to 191 mastoidectomy surgeries in 118 ears of 97 patients. Of the wall up mastoidectomies, 65 of the 77 (84.4%) presented with cholesteatoma recurrence. In the wall down mastoidectomies follow up, there were new surgical approaches in 15 of the 114 procedures (13.1%), with 6 patients (5.2%) having anatomopathologically proven cholesteatoma recurrences and 9 (7.8%) having clinical instability for cavity cleaning without identification of disease recurrence. Conclusions Early approach with wall down/modified techniques guided by specific indication criteria may be more resolute, prevent multiple procedures, and preserve the bone pathway to facilitate possible future hearing rehabilitation in these patients.

OBJECTIVE To review an institutional experience with the surgical and clinical management of acquired middle ear cholesteatoma in patients with ectrodactyly, ectodermal dysplasia, cleft lip/palate (EEC) syndrome. STUDY DESIGN Retrospective chart review. SETTING Tertiary referral center. PATIENTS Eight patients with medical history significant for EEC syndrome who underwent surgery for acquired middle ear cholesteatoma between 1996 and 2016. INTERVENTION(S) Appropriate surgical interventions at the time of admission. MAIN OUTCOME MEASURE(S) History of ventilation tube insertion, status of the contralateral ear, surgical technique, cholesteatoma recidivism, presence of postoperative external auditory canal stenosis, pre and postoperative audiograms. RESULTS Cholesteatoma was diagnosed in all patients, 3 (37.5%) unilateral and 5 (62.5%) bilateral, totalizing 13 ears. Six ears (46.2%) underwent a canal wall up mastoidectomy but required conversion to a canal wall down technique in a second procedure due to recurrent cholesteatoma. In the remaining seven ears (53.8%) a canal wall down mastoidectomy was performed. Of all meatoplasty performed, seven (53.8%) evolved with stenosis of the external auditory canal. CONCLUSIONS Our results suggest that most patients with EEC syndrome and middle ear cholesteatoma should be considered for a canal wall down mastoidectomy due to extensive disease and a high rate of recidivism. In addition, a high percentage of postoperative stenosis of the external auditory canal was found in this group.

Introdução: A atresia aural congênita refere-se a um espectro de deformidades da orelha presentes ao nascimento que envolve algum grau de falha no desenvolvimento do canal auditivo externo, e, muitas vezes, da membrana timpânica e dos ossículos da orelha média. Uma das consequências da atresia aural congênita é a perda auditiva condutiva que deve ser tratada precocemente a fim de evitar complicações. O uso do Vibrant soundbridge no tratamento da perda auditiva tem propiciado a melhora da audição destes pacientes em serviços de todo o mundo. Objetivo: Sistematizar e descrever a técnica cirúrgica do Vibrant soundbridge em pacientes com atresia aural congênita bilateral e descrever os resultados das avaliações audiológicas após a realização da cirurgia. Método: Doze pacientes com atresia aural congênita bilateral realizaram a cirurgia do Vibrant soundbridge e foram submetidos às avaliações audiológicas em dois momentos: antes e após seis meses da realização da cirurgia. As avaliações realizadas foram: audiometria tonal limiar, audiometria em campo livre, reconhecimento auditivo de palavras no silêncio (lista de monossílabos) e limiar de reconhecimento de sentença, e relação sinal/ruído (HINT - Brasil). Foi feita a análise dos dados por meio das estatísticas descritivas e inferenciais. Resultados: O protocolo cirúrgico utilizado para implantação do dispositivo Vibrant soundbridge em pacientes com atresia aural congênita bilateral foi descrito. Não ocorreram complicações intra ou pós-operatórias. Os limiares auditivos em campo livre melhoraram de 53,5 dB para 27,2 dB após seis meses de uso do Vibrant soundbridge (p < 0,001). O reconhecimento auditivo de palavras monossílabas melhorou significantemente após a cirurgia (de 61,0% para 91,3%). No HINT, também foi encontrada melhora estatisticamente significante (p < 0,001) do limiar de reconhecimento de sentenças que passou de 67,1dB para 45,9 dB e a média da relação sinal/ruído (S/R) melhorou de 5,6 dB para 1,4 dB (p=0,009). Conclusões: Sistematizar a técnica cirúrgica do Vibrant soundbridge em pacientes com atresia aural congênita bilateral permitiu a realização de uma cirurgia segura, sem complicações pós-operatórias, resultando na obtenção de resultados audiológicos positivos nesta população Introduction: Congenital aural atresia refers to a spectrum of ear deformities present at birth that involve some degree of failure in the development of the external auditory canal, and often the tympanic membrane and middle ear ossicles as well. One of the consequences of congenital aural atresia is conductive hearing loss that must be treated early to avoid complications. The use of Vibrant soundbridge(TM) for treating hearing loss has improved the hearing of these patients in practices worldwide. Objective: To systematize and describe the surgical technique for implanting the Vibrant soundbridge(TM) in patients with bilateral congenital aural atresia and to describe the results of postoperative audiological evaluations. Method: Twelve patients with bilateral congenital aural atresia underwent Vibrant soundbridge(TM) implantation surgery and audiological evaluations at two instances: before and 6 months after surgery. The evaluations included threshold tonal audiometry, free field audiometry, auditory word recognition in silence (list of monosyllables), sentence recognition threshold, and signal to noise ratio (HINT - Brazil). Data were analyzed through descriptive and inferential statistical methods. Results: The surgical protocol used for implantation of the Vibrant soundbridge(TM) device in patients with bilateral congenital aural atresia was described. There were no intraoperative or postoperative complications. The free-field auditory thresholds improved from 53.5 dB to 27.2 dB after 6 months of Vibrant soundbridge(TM) use (p < 0.001). The auditory recognition of monosyllable words improved significantly after surgery (from 61.0% to 91.3%). In HINT, we also found a statistically significant improvement (p < 0.001) in the sentence recommencement threshold from 67.1 dB to 45.9 dB and the mean S/R ratio improved from 5.6 dB to 1.4 dB (p = 0.009). Conclusions: Systematization of the Vibrant soundbridge(TM) surgical technique in patients with bilateral congenital aural atresia allowed safe surgery without postoperative complications and resulted in positive audiological results in the test population

OBJECTIVE To demonstrate the surgical technique and audiological results of a middle ear implant for restoring hearing in patients with bilateral aural atresia and microtia with conductive or mixed hearing loss. MATERIALS AND METHODS In this prospective study, 12 subjects aged 12 years and older presenting with hearing loss and bilateral congenital aural atresia underwent surgical insertion of a middle ear implant. The patients underwent tympanomastoidectomy with a wide opening of the attic and preservation of the roof of the atresic tympanic bone to expose the middle ear and position the floating mass transducer of the implant. RESULTS There were no intraoperative or postoperative complications. The hearing threshold averages in a free field were 53.5 dB preoperatively and 25.6 dB postoperatively. Monosyllabic word recognition averaged 61% preoperatively and 91.3% postoperatively. The average speech perception in quiet conditions during the hearing in noise test improved from 67.11 dB to 45.99 dB, and the signal-to-noise ratio improved from 5.64 to 1.31. CONCLUSION The tested system is an excellent option for auditory rehabilitation of conductive hearing loss due to bilateral ear atresia. The surgery is well structured and safe and provides several alternatives to the surgeon, which is valuable in difficult cases.

Introdução: O Vibrant Soundbridge® (VSB) é atualmente o mais utilizado e estudado dos implantes disponíveis de orelha média (IAOM). Tem indicação para pacientes com perda auditiva sensorioneural, mista ou condutiva que não se beneficiam com o uso dos aparelhos auditivos convencionais ou que não podem utilizá-los. O uso desses implantes é uma opção para pacientes com atresia aural com microtia uni ou bilateral. Objetivo: O objetivo deste trabalho é descrever os resultados audiológicos e complicações vistas no seguimento de longo prazo do implante ativo de orelha média VSB em usuários com atresia de orelha bilateral. Método: Vinte e sete pacientes com atresia aural congênita bilateral (sete com cirurgia bilateral; portanto, 34 orelhas) que foram submetidos a cirurgia do VSB tiveram seus prontuários revisados. A análise dos dados foi realizada por meio das estatísticas descritivas e inferenciais. O nível de significância utilizado para todas as análises foi 5%. Resultados: A mediana de acompanhamento pós-operatório foi de 37,5 meses (27,7-75,5 meses). Treze indivíduos (38.2%) tinham outras malformações e/ou síndromes associadas a malformação de orelhas. As variáveis pontuação pela Escala de Pontuação de Jahrsdoerfer, o ponto de acoplamento do FMT, ter realizado cirurgia otológica prévia e a idade não se mostraram estatisticamente significativos em relação ao risco de complicação. Houve 35,3% (n=12) de complicações médicas ou técnicas no seguimento desses pacientes, sendo que 14,7% (n=5) necessitaram de revisão cirúrgica. Os limiares auditivos em campo livre melhoraram de 53,75dB:46,87-56,25 para 25dB:21,25-32,5 após seis meses de uso do VSB (p

Este estudo tem como objetivo levantar e analisar as jurisprudências relacionadas com as matérias de gestão de saúde que possuem participação das OSSs no âmbito do SUS e como objetivos específicos : a) Identificar as jurisprudências relacionadas ao fato; b) agrupar os resultados encontrados por jurisdição e semelhança de tema; c) analisar as jurisprudências com temas de maior frequências. Trata-se de um descritivo realizado junto às bases de dados abertas dos Tribunais de Justiças dos Estados do Brasil. Para seleção dos acórdãos foram utilizadas as palavras chaves: Organização Social de Saúde, Sistema Único de Saúde, regulamentação, hospital, convênios, contrato de gestão, terceiro setor, repasses públicos, certificados, qualificação como OSS, operacionalização, execução do ajuste, prestação de contas, terceirização, responsabilidade dos gestores e improbidade administrativa e os termos boleanos OR, AND ou NOT. Foram encontrados 57 acórdãos apresentados na forma de Quadros e discutidos com base na literatura e legislação que trata do assunto. Os dados encontrados demonstraram que os estados federativos onde há maior discussão do assunto são os estados de São Paulo e Rio de Janeiro e as jurisprudências mais frequentes Responsabilidade civil por erro médico, Improbidade administrativa, Outras ações indenizatórias e Chamada pública para credenciamento de OSS, além de muitas outras com frequência menor. Apesar da existência da via judiciária para dirimir conflitos, no qual é possível identificar as jurisprudências sobre as matérias de gestão de saúde que possuem participação das OSSs no âmbito do SUS, para que haja uma evolução na gestão dos recursos públicos e para que os índices de melhoria na prestação de serviços de saúde pelas OSS sejam elevados a patamares maiores, há necessidade de transparência e fiscalização contínua por parte da sociedade This study aims to raise and analyze the jurisprudence related to health management information that has the participation of Social Health Organization within the scope of Social Health Organization and as specific objectives: a) Identify as jurisprudence related to the fact; b) group the results found by jurisdiction and similarity of theme; c) analyze the jurisprudence with themes of greater frequency. This is a description made with the open databases of the Courts of Justice of the States of Brazil. For selection of judgments, the following keys were used: Social Health Organization, Unified Health System, regular, hospital, agreements, management contract, third sector, public transfers, certificates, qualification, operationalization, execution of adjustment, accountability , outsourcing, management responsibility and administrative improbity and the Boolean terms OR, AND or NOT. There were 57 judgments ordered in the form of tables and discussed based on the literature and legislation dealing with the subject. The data found showed that the Federative States where there is more discussion of the subject are the states of São Paulo and Rio de Janeiro and the most frequent jurisprudence civil responsability for medical error, administrative improbity, other indemnities and call for accreditation of Social Health Organization and many others with less frequency. Despite the existence of the judicial route for direct conflicts, in which it is possible to identify as jurisprudence on health management matters that have the participation of Social Health Organization within the scope of Unified Health System, so that there is an evolution in the management of public resources and so that the Improvement in the provision of health services by Social Health Organization levels of excellence at higher levels, there is a need for transparency and continuous monitoring by society

Introdução: A Síndrome de Treacher Collins (STC) é condição congênita rara associada à malformação de estruturas craniofaciais tais como hipoplasia e retrognatia mandibular, além da fissura labiopalatina, em parte considerável dos casos. Devido à estas condições, que sabidamente reduzem o espaço aéreo posterior, os indivíduos com STC estão sujeitos a desenvolver a apneia obstrutiva do sono (AOS). A hipótese deste estudo é que indivíduos com STC apresentam índice de apneia/hipopneia elevado, associado a sintomas como sonolência excessiva e baixa qualidade de vida. Objetivo: Investigar a prevalência da AOS e sua severidade e sintomas em indivíduos adultos com STC por meio de polissonografia, Questionários de Berlin, Epworth, Questionário de sintomas respiratórios e questionário SF 36. A significância entre as variáveis quantitativas foi determinada pelo teste Correlação de Spearman. Material e Métodos: Avaliou-se, de maneira prospectiva, 20 indivíduos (22,6±5,8 anos, 55% mulheres, e 45% homens) com STC, por meio de questionários de Berlin (risco para AOS), Escala de Sonolência Epworth, Questionário de Sintomas respiratórios e SF36 (qualidade de vida). Dados antropométricos (Indíce de Massa Corpórea-IMC, Circunferência Cervical-CC e Circunferência Abdominal-CA) e dados demográficos (idade, gênero, pressão arterial e realização de cirurgias nas vias aéreas e ósseas para reabilitação da síndrome) foram coletados. Em subgrupo (n=9), avaliou-se , prospectivamente, a ocorrência e severidade da AOS, com polissonografia noturna tipo I (EMBLA N7000, FINDER). Os principais parâmetros avaliados foram: índice de apneia/ hipopneia (IAH), severidade da apneia, índice de despertares (ID), duração das apneias/hipopneias (AHd) e nível da saturação de oxihemoglobina (SatO2). Resultados: Alta prevalência de AOS (44%) foi detectada (valores de referência=7%-24%). Apesar de altamente prevalente, a apneia foi classificada como leve (IAH médio = 11,8, mínimo = 0,6, máximo = 77,5 eventos/h). O ID médio correspondeu a 9,2±9,3 eventos/h (mínimo = 3,1 e máximo = 31,1 eventos/h) O IAH REM médio foi de 16,1±31,8 eventos/h (grau moderado de severidade). A AHd foi de 41±18,5s (duração máxima = 78,4s). Dentre os eventos de apneia, houve predomínio quase que absoluto de apneias obstrutivas (99%). A SatO2 foi de 96,2±3,6% (mínima = 58%). Dados antropométricos como IMC (22,9±5,9), CC (34,1±4,3cm) e CA (80,4±13,6cm) estavam dentro dos parâmetros de normalidade para eutrofia (ABESO, 2016). Por meio dos questionário específicos, detectou-se que: 1) 35% dos indivíduos estavam em risco para AOS, 2) parcela considerável da população estudada apresentava queixas respiratórias crônicas, em especial o ronco (75%), 3) 20% dos indivíduos apresentavam sonolência excessiva diurna, e, 4) Apesar destes achados, que sabidamente impactam negativamente a qualidade de vida, observou-se boa de qualidade de vida nos indivíduos com STC. Forte correlações positivas foram observadas entre CC, CA, IMC versus IAH e negativas entre CC, CA, IMC e SatO2. Conclusão: Os resultados do presente estudo permitiram concluir que a AOS é uma condição altamente prevalente na população de adultos com STC, da ordem de 44%. Devido à baixa ocorrência de outros fatores predisponentes para AOS na população estudada, parece-nos que esta alta prevalência é decorrente das alterações craniofaciais impostas pela síndrome Introduction: Treacher Collins syndrome (TCS) is a rare congenital condition associated with malformation of craniofacial structures such as hypoplasia and mandibular retrognathia, in addition to the cleft lip and palate, in a considerable part of the cases. Due to these conditions, which are known to reduce posterior airway space, individuals with TCS are prone to develop obstructive sleep apnea (OSA). The hypothesis of this study is that individuals with TCS have high apnea / hypopnea index, associated with symptoms such as excessive sleepness and low quality of life. Objective: To investigate the prevalence and symptoms of OSA and its severity in adult individuals with TCS using polysomnography, Berlin Questionnaire, Epworth Sleepness Scale, Respiratory Symptoms Questionnaire and SF 36 questionnaire. The significance of the quantitative variables was determined by the Spearman Correlation test. Material and Methods: Twenty individuals (22.6 ± 5.8 years, 55% women, and 45% men) with TCS were prospectively evaluated using Berlin questionnaires (risk for OSA), Epworth Sleepiness Scale, Respiratory Symptoms Questionnaire, and SF36 (quality of life). Anthropometric data (Body Mass Index-IMC, Cervical CircumferenceCC and Abdominal Circumference-AC) and demographic data (age, gender, blood pressure and surgery on the airways and bone for rehabilitation of the syndrome) were collected. In a subgroup (n = 9), the occurrence and severity of OSA, with nocturnal type I polysomnography (EMBLA N7000®, FINDER® 900), was prospectively evaluated. The main parameters evaluated were apnea / hypopnea index (AHI), apnea severity, wakefulness index (ID), apnea / hypopnea duration (AHd) and oxyhemoglobin saturation level (SatO2). Results: A high prevalence of OSA (44%) was detected (reference values = 7%-24%). Although highly prevalent, apnea was classified as mild (mean AHI = 11.8, minimum = 0.6, maximum = 77.5 events / h). The mean REM sleep rate was 16.1 ± 31.8 events / h (moderate degree). The mean REM sleep rate was 9.2 ± 9.3 events / h (minimum = 3.1 and maximum = 31.1 events / h) of severity). AHd was 41 ± 18.5 s (maximum duration = 78.4 s). Among the apnea events, an almost absolute predominance of obstructive apnea (99%) was seen. SatO2 was 96.2 ± 3.6% (minimum = 58%). Anthropometric data such as BMI (22.9 ± 5.9), CC (34.1 ± 4.3 cm) and AC (80.4 ± 13.6 cm) were within normal limits for eutrophy. The specific questionnaires showed that: 1) 35% of the individuals were at risk for OSA, 2) a considerable portion of the population had chronic respiratory complaints, especially snoring (75%), 3) 20% of individuals presented excessive daytime sleepiness, and 4) Despite these findings, which were known to negatively impact quality of life, good quality of life was observed in individuals with TCS. Strong positive correlations were observed between CC, AC, BMI versus AHI and negative between CC, AC, BMI and SatO2. Conclusion: The results of the present study allowed us to conclude that OSA is a highly prevalent condition (44%) in the population of adults with TCS. Due to the low occurrence of other factors predisposing to OSA in the studied population, it seems that this high prevalence is due to the craniofacial conditions imposed by the syndrome

Introdução: A meningite bacteriana é uma das causas mais comuns de perda auditiva neurossensorial profunda adquirida, com obstrução coclear secundária à labirintite ossificante. A inserção de um implante coclear no cenário de labirintite ossificante é um desafio até para os cirurgiões mais experientes. Recomenda-se o implante coclear precoce nesse cenário para aumentar a probabilidade de alcançar uma inserção completa do conjunto de eletrodos. A impedância do eletrodo é a primeira avaliação objetiva realizada durante o procedimento cirúrgico e durante o acompanhamento dos pacientes implantados e fornece informações sobre a integridade dos eletrodos e o ambiente intracoclear. Objetivos: Determinar os valores de impedância após o implante coclear em pacientes surdos pós-meningite, correlacionando com o volume coclear residual e obliteração coclear e comparando diferenças entre os segmentos cocleares. Material e Métodos: Pacientes surdos pós-meningite e aqueles com perda auditiva idiopática (controle) submetidos à cirurgia do implante coclear (dispositivo Cochlear®) foram incluídos no estudo. Os valores de impedância no modo \"terra comum\" (CG) e no modo monopolar (MP1+2) nos segmentos basal, médio e apical foram calculados para cada grupo (no período intraoperatório e após um ano da cirurgia). O grau de ossificação da cóclea foi avaliado a partir de uma tomografia computadorizada, enquanto o grau de obliteração foi determinado no intraoperatório pelo cirurgião. Foi realizada reconstrução tridimensional do lúmen coclear residual por meio do exame de ressonância nuclear magnética, pré-operatório, para correlação com os valores de impedância. Resultados: Foram incluídos 14 pacientes no grupo com histórico de meningite e 34 no grupo com perda auditiva idiopática. Sinais de calcificação coclear foram identificados nos exames de tomografia computadorizada de oito pacientes com histórico de meningite e em apenas um paciente no grupo idiopático. O volume coclear residual foi maior no grupo com perda auditiva idiopática (p=0,0145). No entanto, não houve correlação com o tempo de perda auditiva e tampouco com os limiares auditivos pré-operatórios. Verificou-se correlação fraca entre volume coclear residual e limiares auditivos pós-operatórios somente no grupo com perda auditiva idiopática (r=0,39; p=0,0222). Foram observadas alterações significativas nas impedâncias dos eletrodos mediais e apicais em ambos os grupos após um ano da cirurgia, embora sem diferenças entre o grupo de pacientes com antecedente de meningite e o grupo idiopático. Discussão: Pacientes com implante coclear exibem impedâncias mais altas nos eletrodos do giro basal, independentemente do grau de ossificação coclear. Altas impedâncias no grupo da meningite podem ser explicadas por alterações na superfície do eletrodo. Esse comportamento ressalta a importância da persistência de fatores intracocleares na influência de parâmetros de ajuste no segmento basal. Conclusões: Os pacientes com implante coclear por surdez relacionada à meningite mostraram impedâncias com comportamento semelhante àquelas do grupo com perda auditiva idiopática, mesmo na região do giro basal, independentemente do grau de ossificação coclear. Para otimizar o resultado do implante coclear nos casos pós-meningite, é aconselhável a cirurgia antes do início da ossificação coclear. Introduction: Bacterial meningitis is one of the most common causes of profound sensorineural hearing loss acquired with cochlear obstruction secondary to ossifying labyrinthitis. The insertion of a cochlear implant in the ossifying labyrinthitis scenario is a challenge for even the most experienced surgeons. Early cochlear implantation is recommended in this scenario to increase the likelihood of achieving a complete insertion of the set of electrodes. Electrode impedance is the first objective assessment performed during the surgical procedure and during the follow-up of implanted patients and provides information on the integrity of the electrodes and the intracochlear environment. Objectives: To determine the impedance values after cochlear implantation of deaf patients after meningitis, correlating with residual cochlear volume and cochlear obliteration and comparing differences between cochlear segments. Material and Method: Post-meningitis deaf patients and idiopathic deaf patients (control) who underwent cochlear implant surgery (Cochlear® device) were included in the study. The impedance values calculated in \"common ground\" (CG) and monopolar (MP1+2) modes in the basal, middle and apical segments were calculated for each group (during the intraoperative period and after one year of surgery). The degree of ossification of the cochlea was assessed using a computed tomography scan while the degree of obliteration was determined intraoperatively by the surgeon. Three-dimensional reconstruction of the residual cochlear lumen was performed with preoperative nuclear magnetic resonance exams, for correlation with the impedance values. Results: Fourteen patients were included in the group with a history of meningitis and 34 patients in the group with idiopathic deafness. Signs of cochlear calcification were identified in computed tomography exams in 8 patients with a history of meningitis and in only one patient in the idiopathic group. Residual cochlear volume was higher in the group with idiopathic deafness (p=0.0145). However, there was no correlation with time of deafness and there was no correlation with preoperative hearing thresholds. We found a weak correlation between residual cochlear volume and postoperative hearing thresholds in the idiopathic deafness group only (r=0.39; p=0.0222). We observed significant changes in the impedances of the medial and apical electrodes in both groups after one year of surgery, although there were no differences between the group of patients with a history of meningitis and patients in the idiopathic group. Discussion: Patients with cochlear implants exhibit higher impedances in the electrodes of the basal turn, however, not correlatedwith the degree of cochlear ossification. High impedances in the meningitis group can be explained by changes on the electrode surface. This behavior highlights the importance of the persistence of intra-cochlear factors in the influence of adjustment parameters in the basal segment. Conclusions: Patients with cochlear implants due to deafness related to meningitis exhibit impedances with similar behavior to those with idiopathic deafness, even in the basal turn, regardless of the degree of cochlear ossification. In order to optimize the result of the cochlear implant in post-meningitis cases, surgery at an early stage before the start of cochlear ossification is advisable.

INTRODUÇÃO: A cirurgia de implante coclear é uma terapia universalmente aceita para o tratamento de pacientes com perda auditiva de grau severo a profundo, permitindo que seus usuários detectem estímulos complexos e alcancem desempenho auditivo bastante satisfatório. No entanto, apesar dos avanços tecnológicos, grande variabilidade na percepção de fala é observada entre os usuários provavelmente porque existem muitos fatores implicados nesse processo, incluindo fatores demográficos, cognitivos e ligados à interface neurônio-eletrodo dentro da cóclea. O objetivo desse protocolo é estudar alguns fatores que podem estar correlacionados com a performance auditiva em usuários de implante coclear, analisando a influência da profundidade angular de inserção (PAI) do feixe de eletrodos nos escores auditivos pós-operatórios e outros cofatores como o tempo de privação auditiva, o tamanho da cóclea e a dispersão de corrente dos eletrodos. MÉTODO: Quarenta e dois pacientes (totalizando 45 ouvidos) foram arrolados para o estudo e foram submetidos à cirurgia de implante coclear com eletrodo CI422® e tomografia computadorizada pós-operatória para avaliar a profundidade de inserção angular do feixe de eletrodos e o diâmetro do giro basal da cóclea. Os testes de percepção de fala foram correlacionados com os dados demográficos, os limiares auditivos tonais, a dispersão de excitabilidade e a profundidade de inserção angular 6 e 12 meses após ativação do implante coclear. RESULTADOS: PAI média foi de 433,1° (310°-517°; DP 49,66) na população estudada e apresentou coeficiente de correlação de -0,343 (p=0,055) com a performance auditiva 6 meses após a cirurgia. O tempo de privação auditiva correlacionou-se negativamente (r=-0,452) com os testes de fala 6 meses após o implante coclear (p=0,004). A dispersão de excitabilidade neural nos eletrodos da região basal e média da cóclea apresentaram correlação significante negativa (p=0,003) e positiva (p=0,04), respectivamente, com a profundidade de inserção. A performance auditiva apresentou melhora progressiva até 12 meses da cirurgia, apresentando estabilidade nos resultados após. CONCLUSÕES: a profundidade de inserção angular não interfere na performance auditiva após 1 ano da cirurgia de implante coclear, apesar de influenciar significantemente na dispersão de excitabilidade de maneiras diferentes ao longo da cóclea. Dentre os demais cofatores estudados, apenas o tempo de privação auditiva influenciou nos resultados auditivos após a cirurgia. O reconhecimento de fala após o implante coclear tende a melhorar até 12 meses após a cirurgia, atingindo um platô após esse tempo INTRODUCTION: Large variations in individual speech performance occur among cochlear implant users, even after optimizing fitting parameters. It is unknown how certain factors related to cochlear implantation, such as; age at implantation, insertion depth, cochlea size and current spread affect hearing outcomes. This study primarily aimed to examine the angular insertion depth, and to determine the relationship between angular insertion depth, spread of neural excitation (SOE), and speech performance. METHODS: Forty-two adults (45 ears) with sensorineural deafness prospectively underwent cochlear implantation (CI422; Cochlear Corporation) and were followed for 12 months. Preoperative and postoperative pure tone average and speech comprehension were analyzed, along with the duration of deafness, age at implantation and electrically evoked compound action potential (ECAP) function in the base, middle, and apex of the cochlea. Postoperative computed tomography was assessed to measure angular insertion depth of electrode array and cochlea size. RESULTS: The median angular insertion depth was 433°. The SOE showed considerable differences over the cochlea and was significantly affected by insertion depth at basal and medial cochlear regions (p = 0.003 and p = 0.04, respectively). No correlation was observed between SOE and speech perception at 12 months after cochlear implant activation; neither between insertion depth and speech understanding. Duration of deafness negatively influenced speech outcomes. CONCLUSIONS: The angular insertion depth of cochlear implant electrode array influences the SOE in distinct ways in different regions of the cochlea. This is relevant to guide mapping and stimulation mode in distinct electrodes along the cochlea. The angular insertion depth should be individualized to improve electric spread from electrodes. Speech perception is not affected by insertion depth of lateral wall electrodes