Potencial evocado miogênico vestibular por estimulação galvânica e potenciais evocados auditivos de longa latência na mielopatia associada ao HTLV-1

Introduction: Human T-cell lymphotropic virus type 1 (HTLV-1) causes inflammatory damage in the spinal cord and brain. The aims of this study were to evaluate the spinal cord motor function using vestibular evoked myogenic potential with galvanic stimulation (GVEMP) and to evaluate the cognition using neuropsychological tests and long latency auditory evoked potentials (P300, N200, P160 and N100) in individuals infected with HTLV- 1 in different phases of progression of HTLV-1-associated myelopathy/ tropical spastic paraparesis (HAM/TSP). Methods: We conducted a cross-sectional and comparative study. The postural evaluation was performed in 122 subjects, 45 not-infected (control) and 77 infected with HTLV-1: 26 asymptomatic, 26 with possible HAM/TSP and 25 with HAM/TSP, according to neurological evaluation. VEMP was generated by 2mA/400ms binaural galvanic vestibular stimulation (GVS). The G-VEMP was recorded from gastrocnemius muscles. The G-VEMP studied parameters were the short-latency (SL) and the medium-latency (ML) components of the VEMP wave. The cognition was evaluated in 113subjects, 40 controls and 73 infected with HTLV-1 (27 asymptomatic, 26 with possible HAM/TSP and 20 with HAM/TSP). The variables of interest were the scores of neuropsychological tests, latency and amplitude of long latency auditory evoked potentials. Results: The groups were similar in gender, age, height, and education. Abaout G-VEMP, the components SL and ML were delayed in HTLV-1 groups compared to controls (p0.05). Compared to controls, possible HAM/TSP and HAM/TSP groups presented a worse performance to execute the Rey Auditory Verbal Learning Test (RAVLT), attesting a worse verbal memory (p0,05). Comparado aos controles, os grupos possívelHAM/TSP e HAM/TSP apresentaram pior desempenho na realização do teste Rey Auditory Verbal Learning Test (RAVLT), que avalia memória verbal (p<0,001). Os grupos HTLV-1- assintomáticos, possível HAM/TSP e HAM/TSP apresentaram pior desempenho na realização do teste Nine Hole Peg Test (NINE HOLE), que avalia habilidades motoras e atenção(p<0,001). Os grupos HTLV-1-assintomáticos, possível HAM/TSP e HAM/TSP apresentaram latência aumentada do P300 na comparação com os controles (p<0,001) e o grupo HAM/TSP apresentou latência aumentada do N200 na comparação com os controles (p<0,001). O piordesempenho no RAVLT se correlacionou com aumento de latência de N200 e P300; o tempo aumentado para realizar o NINE HOLE se correlacionou com o aumento da latência do N200 e P300. O estudo indicou comprometimento cognitivo nos pacientes infectados pelo HTLV-1 nas habilidades de memória verbal, de aprendizado, de discriminação auditiva e de atenção. P-300 e NINE HOLE identificaram alterações subclínicas relacionadas à função cortical em indivíduos com HAM/TSP e também entre aqueles com infecção aparentementeassintomática. Conclusão: O G-VEMP e o P300 identificaram alterações subclínicas relacionadas, respectivamente, às funções medular e cortical em indivíduos infectados pelo HTLV-1 aparentemente assintomáticos. Possivelmente, esses indivíduos terão maior risco dedesenvolver HAM/TSP quando comparados com infectados assintomáticos com a avaliação neurocognitiva e eletrofisiológica normais

Manifestações otoneurológicas em indivíduos infectados pelo HTLV-1 assintomáticos e com mielopatia: estudo comparativo

INTRODUCTION: Inflammatory manifestations are characteristic of the Human T-lymphotropic virus type 1 (HTLV-1)/ associated myelopathy/ tropical spastic paraparesis (HAM/TSP), which can affect the vestibulospinal tract and could be the explanation for the higher frequency of otoneurological manifestations described in HAM/TSP. However, this finding has not been systematically studied, so far. OBJETIVE: To compare the frequency of otoneurological manifestations in individuals infected with HTLV-1 that are asymptomatic and with HAM/TSP. METHODOLOGY: The participants of this study are included in the cohort of the Interdisciplinary Group of HTLV Researches GIPH, started at 1997 and with 637 ex-blood donors infected by HTLV-1 and 232 blood donors (controls) enrolled in the cohort at the moment of this analysis. The present study is a sectional evaluation of 120 individuals of the cohort, 60 of whom were infected with HTLV-1 (30 asymptomatic and 30 with HAM/TSP, according to neurological evaluation) and 60 not-infected, who were matched for gender and age with the HTLV-1-infected group. All participants underwent an interview about general health status and otoneurological manifestations. The participants who complained of dizziness, tinnitus or hearing loss were evaluated by the otolaryngologist and submitted to specific tests to define the diagnosis. The vestibular-evoked myogenic potential (VEMP) was performed to test the function of the vestibulospinal tract in those that complained of dizziness. The frequency of otoneurologic manifestations was then compared. RESULT: The complaint of hearing loss (p=0.506) and tinnitus (p=0.498) were similar. Dizziness predominated in the HAM/TSP group (p=0,002). Instability was the most frequent type of dizziness among the individuals infected by HTLV-1 (p=0,006). VEMP was altered in 43% of the asymptomatic carries and in 85% of the individuals with HAM/TSP. CONCLUSION: Dizziness as the sensation of instability was found to be a clinical manifestation of HAM/TSP. Vestibulospinal tract injury was demonstrated through VEMP to occur more frequently in HAM/TSP. Possibly, the complaint of dizziness in asymptomatic carriers may be an early indicator of progression to HAM/TSP.INTRODUÇÃO: Alterações inflamatórias são características da infecção pelo Vírus Linfotrópico Humano de Células T tipo 1 (HTLV-1), em especial dos portadores da mielopatia associada ao HTLV-1/paraparesia espástica tropical (HAM/TSP), o que pode comprometer o trato vestibuloespinhal e poderia ser a justificativa para a maior frequência de manifestações otoneurológicas descritas na HAM/TSP. Contudo, esse achado não foi, até o presente momento, estudado de forma sistematizada. OBJETIVO: Comparar a frequência de manifestações otoneurológicas em indivíduos infectados HTLV-1 assintomáticos e com HAM/TSP. METODOLOGIA: Os participantes desse estudo estão incluídos na coorte do Grupo Interdisciplinar de Pesquisas em HTLV-1 - GIPH, iniciada em 1997 e com 637 ex-doadores de sangue infectados pelo HTLV-1 e 232 doadores de sangue (controles) cadastrados na coorte no momento dessa análise. O presente estudo trata-se de uma avaliação transversal de 120 indivíduos da coorte, sendo 60 infectados pelo HTLV-1 (30 assintomáticos e 30 com HAM/TSP, segundo avaliação neurológica) e 60 não infectados que foram pareados por gênero e idade com o grupo infectado pelo HTLV-1. Todos os participantes foram submetidos à entrevista sobre saúde geral e queixa otoneurológica. Todos os participantes que apresentaram queixas de tontura, zumbido ou perda auditiva foram avaliados pelo otorrinolaringologista e realizados exames específicos para definição do diagnóstico. O potencial evocado miogênico vestibular (VEMP) foi utilizado para testar a função do trato vestibuloespinhal naqueles com queixa de tontura. A frequência de alterações otoneurológicas foi comparada entre os grupos. RESULTADOS: Perda auditiva (p=0,506) e zumbido (p=0,498) foram semelhantes entre os grupos. A queixa de tontura predominou naqueles com HAM/TSP (p=0,002). Instabilidade foi o tipo mais frequente de tontura entre os indivíduos infectados pelo HTLV-1 (p=0,006). Dentre esses indivíduos com tontura do tipo instabilidade, o VEMP foi alterado em 43% dos portadores assintomáticos e em 85% dos indivíduos com HAM/TSP. CONCLUSÃO: Tontura se apresentando como uma sensação de instabilidade pode ser uma manifestação clínica da HAM/TSP. Lesão do trato vestibuloespinhal foi demonstrada através da alteração do VEMP ocorrer de modo mais frequente na HAM/TSP. Possivelmente, a queixa de tontura em portadores assintomáticos pode ser um indicador de início de evolução para HAM/TSP

Use of hearing devices and fluency in Brazilian Sign Language and oral language fluency in deaf students

Purpose: to assess the relationship between deaf students’ fluency in Brazilian Sign Language (BSL) and oral language and hearing aid use. Method: the sample comprised 112 professional BSL translators, interpreters, and instructors. They answered a questionnaire on hearing characteristics and BSL and oral language fluency of students accompanied by them, who attended municipal schools in a Brazilian city. Association analysis between oral language fluency, BSL fluency, the degree of hearing loss, and device use was made with the chisquare test or Fisher’s Exact test. The significance level was set at p<0.05. Results: the professionals’ responses referred to 88% (n = 126) of all deaf students enrolled in municipal schools. The students’ mean age was 13 years; 72 (57%) were males, 98 (78%) had severe or profound hearing loss, 57 (45%) used electronic hearing devices, 83 (66%) were fluent only in BSL, 12 (10%) were fluent only in oral language, and 18 (14%) were fluent in both BSL and oral language. Hearing device use was statistically associated with oral fluency (p < 0.001). Of all students fluent in oral language (n = 30), 18 (60%) were also fluent in BSL (p < 0.001). Conclusion: BSL was the communication modality most used by students, including those who also used oral language and electronic hearing devices. This may indicate a change in the social perception of deaf people, their language, and their culture.Objetivo: avaliar a relação entre fluência na Libras, fluência na língua oral e o uso de dispositivos auxiliares para audição de estudantes surdos. Métodos: participaram 112 profissionais tradutores, intérpretes ou instrutores de Libras que informaram as características auditivas, fluência na Libras e língua oral dos estudantes acompanhados por eles, matriculados na rede municipal de uma cidade brasileira. A análise da associação entre fluência na Libras, fluência na língua oral, grau da perda auditiva e uso de dispositivo foi realizada por meio do teste qui-quadrado ou teste exato de Fisher, consideraram-se significantes valores de p<0,05. Resultados: as respostas dos profissionais referiram-se a 88% (n=126) do total de estudantes surdos matriculados na rede municipal. A média de idade dos estudantes foi de 13 anos, sendo 72 (57%) meninos, 98 (78%) com perda auditiva severa ou profunda, 57 (45%) usuários de dispositivos eletrônicos auxiliares para audição, 83 (66%) fluentes somente na Libras, 12 (10%) fluentes apenas na língua oral e 18 (14%) fluentes na Libras e língua oral. Estudantes que utilizavam dispositivo auxiliar para audição apresentaram melhor fluência oral (p<0,001). Dos estudantes que apresentavam fluência oral (n=30), 18 (60%) eram fluentes em Libras (p<0,001). Conclusão: a Libras foi a modalidade comunicativa utilizada majoritariamente pelos estudantes surdos, mesmo por aqueles que utilizavam também a língua oral e dispositivos eletrônicos, o que pode indicar mudança de percepção social em relação ao surdo, à sua língua e cultura.FAPEMIG - Fundação de Amparo à Pesquisa do Estado de Minas Gerai

Reliability of contralateral suppression in evoked distortion product otoacoustic emissions

Introduction Distortion product otoacoustic emissions (DPOAE) and their suppression may be considered useful in monitoring cochlear function and the efferent auditory pathway inhibitory effect. Nonetheless, the establishment of reliable parameters of response variations is of great importance. Objectives To verify the replicability of test and retest in the research of the inhibitory effect of the efferent pathway using contralateral suppressing stimulus during DPOAE recording for clinical applicability. Methods Cross-sectional study with 48 volunteers, aged 18 to 30 years, with normal audiometric thresholds. The procedures included were audiometric and immittance measures to overrule any conductive or sensorineural conditions and DPOAE recordings without and with contralateral suppression with a 60 dBHL white noise. Distortion product otoacoustic emissions amplitudes were analyzed and compared in both conditions with Wilcoxon test, and the Spearman correlation test was used to assess test-retest reliability. Results The comparative analysis showed differences between amplitudes in test and retest conditions only in 1,500 Hz for DPOAE measures with all other tested frequencies showing no differences ,and no difference was observed in all recorded frequencies in the test and retest comparison for DPOAE suppression. The degree of correlation between test and retest of DPOAE amplitude was good at 6,000 Hz and strong (r > 0.880) at the other frequencies. For DPOAE with suppression, all frequencies presented strong correlation between test and retest: 1,500 Hz (r ¼ 0.880), 2,000 Hz (r ¼ 0.882), 3,000 Hz (r ¼ 0.940), and 6,000 Hz (r ¼ 0.957). Conclusions The study found good replicability in contralateral suppression of DPOAE with potential clinical applicability, and we recommend conducting the test from 2000Hz to higher frequencies for more reliable results

Validation of the Central Auditory Processing Skill Self-Perception Scale (CAPSSPS) for adults

Purpose: To validate a self-report questionnaire to assess the central auditory processing in adults. Methods: The instrument was tested and validated with 123 university students aged 18 to 59 years, without hearing changes or history of treatment for central auditory processing disorder. The participants were submitted to the Gaps-in-Noise and speech-in-white-noise tests. The cutoff scores for changes, sensitivity, and specificity were defined with statistical analysis. Results: The instrument was developed with 21 questions related to health history, life habits, and hearing and learning complaints. After factor analysis, the questions related to life habits and health conditions were removed because they had a low factor loading. Thus, the final version of the scale comprised 13 questions. The first-order constructs and the diagnostic indicator achieved the required levels of reliability. The cutoff scores to indicate abnormal results in the Gaps-inNoise and speech-in-white-noise tests were defined respectively as 6 and 5. Conclusion: The scale obtained valid, reliable, and consistent results and enabled professionals to make inferences about auditory processing.Objetivo: validar um questionário autorreferido para avaliação do processamento auditivo central para adultos. Métodos: o instrumento foi testado e validado com 123 estudantes universitários de 18 a 59 anos, sem alteração auditiva e sem histórico de tratamento para transtorno do processamento auditivo central. Os participantes realizaram os testes Gaps in Noise e Fala com Ruído. Por meio da análise estatística, foi definido o ponto de corte para alterações, a sensibilidade e a especificidade. Resultados: o instrumento foi elaborado contendo 21 questões relacionadas ao histórico de saúde, aos hábitos de vida, às queixas auditivas e de aprendizagem. Após a análise fatorial, as questões relacionadas ao hábito de vida e condições de saúde foram retiradas por apresentarem carga fatorial baixa. Assim, a versão final da escala foi composta por 13 questões. Os constructos de primeira ordem e o indicador diagnóstico apresentaram níveis de confiabilidade exigidos. Foram definidos os pontos de corte 6 e 5 que indicassem alteração nos testes Gaps in Noise e Fala com Ruído branco, respectivamente. Conclusão: a escala apresentou resultados válidos, confiáveis e consistentes e foi capaz de realizar inferências sobre o processamento auditivo

Reading fluency during the covid-19 pandemic: a longitudinal and cross-sectional analysis

Background International studies performed during the periods of social isolation highlighted the potential loss of student’s learning skills. The present study fills a gap in Brazilian research on this topic and focuses on the development of reading fluency.Objective To investigate the development of the reading fluency of students in the early years of elementary school during e-learning as a result of the social distancing measures put into effect due to the coronavirus disease 2019 (COVID-19) pandemic.Methods Students from grades 2 to 5 were recorded. The number of words read per minute and of those read correctly per minute were analyzed. Descriptive statistical analysis was performed, using analysis of variance (ANOVA) for repeated measures with Bonferroni correction in the longitudinal study, and the t-test in the cross-sectional study. Results In the cross-sectional study, 162 students participated. Only the comparison between the 2nd grade classes of 2020 and 2021 showed a statistically significant difference. In the prepandemic classes, the students had better results in reading accuracy than the students assessed during the pandemic. The longitudinal study included 75 students, who improved in fluency rate and accuracy as expected between March and December 2020. In March 2021, the results showed a drop, which may be related to school closures during the Brazilian summer vacation

Hearing and language screening in preschoolers

Purpose: to describe the results of preschooler hearing and language screening and the association between them. Methods: a study with 75 children enrolled in preschool. The language was screened with the Behavior Observation Guide for 0-to-6-Year-Old Children. The hearing of chil dren up to 1 year and 11 months old was screened with meatoscopy, acoustic immittance, behavioral hearing assessment, and otoacoustic emissions, while those in the age range 2 years or older were screened with meatoscopy, acoustic immittance, and play pure-tone audiometry. The children who failed the screening were referred for diagnosis. The results of the hearing and language assessments were compared with the McNemar test. Results: of the 75 children screened, 18 (24%) failed the hearing tests and 11 (15%) failed the language test. Hearing impairment was confirmed in 12 (66%) of those referred for diagnosis, and language impairment, in 10 (90%) of them. There was no association between hearing and language impairments (p = 0.230). Conclusion: hearing and language impairments were found in preschoolers. Although they were not associated, they can impact academic performance. This result empha sizes the need for developing strategies to implement preschooler screening programs that include hearing and language

Manifestações otoneurológicas em indivíduos infectados pelo HTLV-1 assintomáticos e com mielopatia: estudo comparativo

Exportado OPUSMade available in DSpace on 2019-08-12T14:33:00Z (GMT). No. of bitstreams: 1 ludimila_labanca_2011655664_disserta__o_2012.pdf: 1287681 bytes, checksum: 13c84d435ca7fdfe42f55589f8a96960 (MD5) Previous issue date: 28INTRODUÇÃO: Alterações inflamatórias são características da infecção pelo Vírus Linfotrópico Humano de Células T tipo 1 (HTLV-1), em especial dos portadores da mielopatia associada ao HTLV-1/paraparesia espástica tropical (HAM/TSP), o que pode comprometer o trato vestibuloespinhal e poderia ser a justificativa para a maior frequência de manifestações otoneurológicas descritas na HAM/TSP. Contudo, esse achado não foi, até o presente momento, estudado de forma sistematizada. OBJETIVO: Comparar a frequência de manifestações otoneurológicas em indivíduos infectados HTLV-1 assintomáticos e com HAM/TSP. METODOLOGIA: Os participantes desse estudo estão incluídos na coorte do Grupo Interdisciplinar de Pesquisas em HTLV-1 - GIPH, iniciada em 1997 e com 637 ex-doadores de sangue infectados pelo HTLV-1 e 232 doadores de sangue (controles) cadastrados na coorte no momento dessa análise. O presente estudo trata-se de uma avaliação transversal de 120 indivíduos da coorte, sendo 60 infectados pelo HTLV-1 (30 assintomáticos e 30 com HAM/TSP, segundo avaliação neurológica) e 60 não infectados que foram pareados por gênero e idade com o grupo infectado pelo HTLV-1. Todos os participantes foram submetidos à entrevista sobre saúde geral e queixa otoneurológica. Todos os participantes que apresentaram queixas de tontura, zumbido ou perda auditiva foram avaliados pelo otorrinolaringologista e realizados exames específicos para definição do diagnóstico. O potencial evocado miogênico vestibular (VEMP) foi utilizado para testar a função do trato vestibuloespinhal naqueles com queixa de tontura. A frequência de alterações otoneurológicas foi comparada entre os grupos. RESULTADOS: Perda auditiva (p=0,506) e zumbido (p=0,498) foram semelhantes entre os grupos. A queixa de tontura predominou naqueles com HAM/TSP (p=0,002). Instabilidade foi o tipo mais frequente de tontura entre os indivíduos infectados pelo HTLV-1 (p=0,006). Dentre esses indivíduos com tontura do tipo instabilidade, o VEMP foi alterado em 43% dos portadores assintomáticos e em 85% dos indivíduos com HAM/TSP. CONCLUSÃO: Tontura se apresentando como uma sensação de instabilidade pode ser uma manifestação clínica da HAM/TSP. Lesão do trato vestibuloespinhal foi demonstrada através da alteração do VEMP ocorrer de modo mais frequente na HAM/TSP. Possivelmente, a queixa de tontura em portadores assintomáticos pode ser um indicador de início de evolução para HAM/TSP.INTRODUCTION: Inflammatory manifestations are characteristic of the Human T-lymphotropic virus type 1 (HTLV-1)/ associated myelopathy/ tropical spastic paraparesis (HAM/TSP), which can affect the vestibulospinal tract and could be the explanation for the higher frequency of otoneurological manifestations described in HAM/TSP. However, this finding has not been systematically studied, so far. OBJETIVE: To compare the frequency of otoneurological manifestations in individuals infected with HTLV-1 that are asymptomatic and with HAM/TSP. METHODOLOGY: The participants of this study are included in the cohort of the Interdisciplinary Group of HTLV Researches GIPH, started at 1997 and with 637 ex-blood donors infected by HTLV-1 and 232 blood donors (controls) enrolled in the cohort at the moment of this analysis. The present study is a sectional evaluation of 120 individuals of the cohort, 60 of whom were infected with HTLV-1 (30 asymptomatic and 30 with HAM/TSP, according to neurological evaluation) and 60 not-infected, who were matched for gender and age with the HTLV-1-infected group. All participants underwent an interview about general health status and otoneurological manifestations. The participants who complained of dizziness, tinnitus or hearing loss were evaluated by the otolaryngologist and submitted to specific tests to define the diagnosis. The vestibular-evoked myogenic potential (VEMP) was performed to test the function of the vestibulospinal tract in those that complained of dizziness. The frequency of otoneurologic manifestations was then compared. RESULT: The complaint of hearing loss (p=0.506) and tinnitus (p=0.498) were similar. Dizziness predominated in the HAM/TSP group (p=0,002). Instability was the most frequent type of dizziness among the individuals infected by HTLV-1 (p=0,006). VEMP was altered in 43% of the asymptomatic carries and in 85% of the individuals with HAM/TSP. CONCLUSION: Dizziness as the sensation of instability was found to be a clinical manifestation of HAM/TSP. Vestibulospinal tract injury was demonstrated through VEMP to occur more frequently in HAM/TSP. Possibly, the complaint of dizziness in asymptomatic carriers may be an early indicator of progression to HAM/TSP

Decreased Reemerging Auditory Brainstem Responses Under Ipsilateral Broadband Masking as a Marker of Noise-Induced Cochlear Synaptopathy

International audienc