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Journal Cover   International Archives of Otorhinolaryngology
  [SJR: 0.141]   [H-I: 4]   [1 followers]  Follow
  This is an Open Access Journal Open Access journal
   ISSN (Print) 1809-9777 - ISSN (Online) 1809-4864
   Published by Thieme Publishing Group Homepage  [173 journals]
  • Prof. Dr. Aroldo Miniti – A Great Master
    • Int Arch Otorhinolaryngol 2016; 20: 291-293
      DOI: 10.1055/s-0036-1592419

      Thieme Publicações Ltda Rio de Janeiro, Brazil

      Article in Thieme eJournals:
      Table of contents     open access Full text

      Int Arch Otorhinolaryngol 2016; 20: 291-2932016-10-13T00:00:00+01:00
      Issue No: Vol. 20, No. 04 (2016)
  • Rhinoplasty Complications and Reoperations: Systematic Review

    • Authors: Crosara; Paulo Fernando Tormin Borges, Nunes, Flávio Barbosa, Rodrigues, Danilo Santana, Figueiredo, Ana Rosa Pimentel, Becker, Helena Maria Gonçalves, Becker, Celso Goncalves, Guimarães, Roberto Eustáquio Santos
      Abstract: Introduction This article is related to complications of rhinoplasty and its main causes of reoperations. Objectives The objective of this study is to perform a systematic review of literature on complications in rhinoplasty. Data Synthesis The authors conducted a survey of articles related to key terms in the literature by using three important databases within 11 years, between January 2002 and January 2013. We found 1,271 abstracts and selected 49 articles to this review. Conclusion The main results showed that the number of primary open rhinoplasty was 7902 (89%) and 765 closed (11%) and the percentage of reoperations in primary open complete rhinoplasties was 2.73% and closed complete was 1.56%. The statistical analysis revealed a value of p = 0.071. The standardization of terms can improve the quality of scientific publications about rhinoplasty. There is no difference between primary open or closed rhinoplasty techniques in relation to reoperations.
      Citation: Int Arch Otorhinolaryngol ; : -
      PubDate: 2016-09-22T00:00:00+01:00
      DOI: 10.1055/s-0036-1586489
  • Relation between Ossicular Erosion and Destruction of Facial and Lateral
           Semicircular Canals in Chronic Otitis Media

    • Authors: Bulğurcu; Suphi, Arslan, İlker Burak, Dikilitaş, Bünyamin, Çukurova, İbrahim
      Abstract: Introduction Chronic otitis media can cause multiple middle ear pathogeneses. The surgeon should be aware of relation between ossicular chain erosion and other destructions because of the possibility of complications. Objective This study aimed to investigate the rates of ossicular erosion in cases of patients with and without facial nerve canal destruction, who had undergone mastoidectomy due to chronic otitis media with or without cholesteatoma. Methods We retrospectively analyzed three hundred twenty-seven patients who had undergone tympanomastoidectomy between April 2008 and February 2014. We documented the types of mastoidectomy (canal wall up, canal wall down, and radical mastoidectomy), erosion of the malleus, incus and stapes, and the destruction of facial and lateral semi-circular canal. Results Out of the 327 patients, 147 were women (44.95%) and 180 were men (55.04%) with a mean age 50.8 ± 13 years (range 8–72 years). 245 of the 327 patients (75.22%) had been operated with the diagnosis of chronic otitis media with cholesteatoma. FNCD was present in 62 of the 327 patients (18.96%) and 49 of these 62 (79.03%) patients had chronic otitis media with cholesteatoma. The correlation between the presence of FNCD with LSCC destruction and stapes erosion in chronic otitis media with cholesteatoma is statistically significant (p 
      Citation: Int Arch Otorhinolaryngol ; : -
      PubDate: 2016-09-14T00:00:00+01:00
      DOI: 10.1055/s-0036-1592417
  • Neck Dissection Technique Commonality and Variance: A Survey on Neck
           Dissection Technique Preferences among Head and Neck Oncologic Surgeons in
           the American Head and Neck Society

    • Authors: Hemmat; Shirin M., Wang, Steven J., Ryan, William R.
      Abstract: Introduction Neck dissection (ND) technique preferences are not well reported. Objective The objective of this study is to educate practitioners and trainees about surgical technique commonality and variance used by head and neck oncologic surgeons when performing a ND. Methods Online survey of surgeon members of the American Head and Neck Society (AHNS). Survey investigated respondents' demographic information, degree of surgical experience, ND technique preferences. Results In our study, 283 out of 1,010 (28%) AHNS surgeon members with a mean age of 50.3 years (range 32–77 years) completed surveys from 41 states and 24 countries. We found that 205 (72.4%) had completed a fellowship in head and neck surgical oncology. Also, 225 (79.5%) respondents reported completing more than 25 NDs per year.ND technique commonalities (>66% respondents) included: preserving level 5 (unless with suspicious lymph nodes (LN)), only excising the portion of sternocleidomastoid muscle involved with tumor, resecting lymphatic tissue en bloc, preservation of cervical sensory rootlets, not performing submandibular gland (SMG) transfer, placing one drain for unilateral selective NDs, and performing a ND after parotidectomy and thyroidectomy and before transcervical approaches to upper aerodigestive tract primary site. Variability existed in the sequence of LN levels excised, instrument preferences, criteria for drain removal, the timing of a ND with transoral upper aerodigestive tract primary site resections, and submandibular gland preservation. Results showed that 122 (43.1%) surgeons reported that they preserve the submandibular gland during the level 1b portion of a ND. Conclusions The commonalities and variances reported for the ND technique may help put individual preferences into context.
      Citation: Int Arch Otorhinolaryngol ; : -
      PubDate: 2016-09-05T00:00:00+01:00
      DOI: 10.1055/s-0036-1592153
  • A Comparative Study on Hearing Aid Benefits of Digital Hearing Aid Use
           (BTE) from Six Months to Two Years

    • Authors: Verma; Lukeshwari, Sanju, Himanshu Kumar, Scaria, Bibina, Awasthi, Mayank, Ravichandran, Aparna, Kaki, Ashritha, Prakash, Savalam Gnana Rathna
      Abstract: Introduction For many reasons, it is important for audiologists and consumers to document improvement and benefit from amplification device at various stages of uses of amplification device. Professional are also interested to see the impact of amplification device on the consumer's auditory performance at different stages i.e. immediately after fitting and over several months of use. Objective The objective of the study was to measure the hearing aid benefit following 6 months – 1-year usage, 1 year – 1.5 yeaŕs usage, and 1.5 yeaŕs – 2 years' usage. Methods A total of 45 subjects participated in the study and were divided equally in three groups: hearing aid users from 6 months to 1 year, 1 year to 1.5 year, and 1.5 year to two years. All subjects responded to the Hearing Aid Benefit Questionnaire (63 questions), which assesses six domains of listening skills. Result Results showed the mean scores obtained were higher for all domains in the aided condition, as compared with unaided condition for all groups. Results also showed a significant improvement in the overall score between first-time users with hearing aid experience of six months to one year and hearing aid users using hearing aids for a period between 1.5 and 2 years. Conclusion It is possible to conclude that measuring the hearing aid benefit with the self-assessment questionnaires will assist the clinicians in making judgments about the areas in which a patient is experiencing more difficulty in everyday listening environment and in revising the possible technologies.
      Citation: Int Arch Otorhinolaryngol ; : -
      PubDate: 2016-09-02T00:00:00+01:00
      DOI: 10.1055/s-0036-1592117
  • Auditory Evoked Potential Mismatch Negativity in Normal-Hearing Adults

    • Authors: Schwade; Laura Flach, Didoné, Dayane Domeneghini, Sleifer, Pricila
      Abstract: Introduction Mismatch Negativity (MMN) corresponds to a response of the central auditory nervous system. Objective The objective of this study is to analyze MMN latencies and amplitudes in normal-hearing adults and compare the results between ears, gender and hand dominance. Methods This is a cross-sectional study. Forty subjects participated, 20 women and 20 men, aged 18 to 29 years and having normal auditory thresholds. A frequency of 1000Hz (standard stimuli) and 2000Hz (deviant stimuli) was used to evoked the MMN. Results Mean latencies in the right ear were 169.4ms and 175.3ms in the left ear, with mean amplitudes of 4.6µV in the right ear and 4.2µV in the left ear. There was no statistically significant difference between ears. The comparison of latencies between genders showed a statistically significant difference for the right ear, being higher in the men than in women. There was no significant statistical difference between ears for both right-handed and left-handed group. However, the results indicated that the latency of the right ear was significantly higher for the left handers than the right handers. We also found a significant result for the latency of the left ear, which was higher for the right handers. Conclusion It was possible to obtain references of values for the MMN. There are no differences in the MMN latencies and amplitudes between the ears. Regarding gender, the male group presented higher latencies in relation to the female group in the right ear. Some results indicate that there is a significant statistical difference of the MMN between right- and left-handed individuals.
      Citation: Int Arch Otorhinolaryngol ; : -
      PubDate: 2016-09-02T00:00:00+01:00
      DOI: 10.1055/s-0036-1586734
  • Role of Monocyte Count and Neutrophil-to-Lymphocyte Ratio in Survival of
           Oral Cancer Patients

    • Authors: Bobdey; Saurabh, Ganesh, Balasubramaniam, Mishra, Prabhashankar, Jain, Aanchal
      Abstract: Introduction Inflammation seems to play a critical role in the development and progression of numerous cancers. Peripheral blood leukocyte count is an easily assessable parameter of systemic inflammatory response. Objective The aim of this study was to investigate whether the pretreatment leukocyte counts can predict the prognosis of patients with oral cavity cancer. Methods Medical records of 471 oral cavity cancer patients diagnosed between January 2007 and December 2008 were retrospectively analyzed. Receiver operating characteristic curve analysis and Cox proportional hazards analyses were applied to evaluate the associations of leukocyte counts with overall survival. Results The overall five year's survival of the cohort was found to be 49.4%. On univariate analysis, elevated monocyte count (≥500/mm3) and neutrophil-to-lymphocyte ratio (NLR) (>2.38) were associated with poor overall survival (OS) (p = 0.001 and 0.000, respectively). Multivariate Cox proportional hazard analysis showed that higher monocyte and NLR levels were significant independent predictors of worse OS (HR = 1.385, 95% CI = 1.049 - 1.829; p 
      Citation: Int Arch Otorhinolaryngol ; : -
      PubDate: 2016-08-16T00:00:00+01:00
      DOI: 10.1055/s-0036-1587318
  • Sialendoscopy Training: Presentation of a Realistic Model

    • Authors: Pascoto; Gabriela Robaskewicz, Stamm, Aldo Cassol, Lyra, Marcos
      Abstract: Introduction Several surgical training simulators have been created for residents and young surgeons to gain experience with surgical procedures. Laboratory training is fundamental for acquiring familiarity with the techniques of surgery and skill in handing instruments. Objective The aim of this study is to present a novel simulator for training sialendoscopy. Method This realistic simulator was built with a synthetic thermo-retractile, thermo-sensible rubber which, when combined with different polymers, produces more than 30 different formulas. These formulas present textures, consistencies, and mechanical resistance are similar to many human tissues. Results The authors present a training model to practice sialendoscopy. All aspects of the procedure are simulated: month opening, dilatation of papillae, insert of the scope, visualization of stones, extraction of these stones with grasping or baskets, and finally, stone fragmentation with holmium laser. Conclusion This anatomical model for sialendoscopy training should be considerably useful to abbreviate the learning curve during the qualification of young surgeons while minimizing the consequences of technical errors.
      Citation: Int Arch Otorhinolaryngol ; : -
      PubDate: 2016-08-16T00:00:00+01:00
      DOI: 10.1055/s-0036-1586250
  • Emotional Stress Evaluation of Patients with Moderate and Severe Sleep
           Apnea Syndrome

    • Authors: Santos; Micheli Aparecida Gomes dos, Nakano, Tatiana de Cássia, Mendes, Felipe Almeida, Duarte, Bruno Bernardo, Marone, Silvio Antonio Monteiro
      Abstract: Introduction The scientific literature has shown that the damage caused by sleep fragmentation in people affected by Obstructive Sleep Apnea (OSA) can reflect emotionally, generating not only physical symptoms such as drowsiness and tiredness, but also psychical symptoms, such as stress. Objective This study aimed at comparing symptoms of stress in patients with moderate or severe OSA, before and after two months of treatment (clinical or surgical). Method This is an Individual, prospective, longitudinal, and interventional study. All patients underwent polysomnography before treatment. We collected data through the application of Stress Symptoms Inventory for Adults Lipp (ISSL) before and after two months of medical or surgical treatment for moderate or severe OSA. Results The sample consisted of 18 patients (72.2% male) with a mean age of 51.83 years. We found that 77.8% (n = 14) of patients had stress in the first evaluation. In the second evaluation (after treatment), this reduced to 16.7% (n = 3). The average stress symptoms decreased from the first to the second evaluation (M = 13.78 and M = 6.17, respectively), being statistically significant (z = -3.53; p 
      Citation: Int Arch Otorhinolaryngol ; : -
      PubDate: 2016-08-16T00:00:00+01:00
      DOI: 10.1055/s-0036-1586251
  • Tracheostomy in the Intensive Care Unit: a University Hospital in a
           Developing Country Study

    • Authors: El-Anwar; Mohammad Waheed, Nofal, Ahmad Abdel-Fattah, Shawadfy, Mohammad A. El, Maaty, Ahmed, Khazbak, Alaa Omar
      Abstract: Introduction Tracheostomy is the commonest surgical procedure in intensive care units (ICUs). It not only provides stable airway and facilitates pulmonary toilet and ventilator weaning, but also decreases the direct laryngeal injury of endotracheal intubation, and improves patient comfort and daily living activity. Objective The objective of this study is to assess the incidence, indications, timing, complications (early and late), and the outcome of tracheostomy on patients in the intensive care units (ICU) at a university hospital in a developing country. Methods This study is an observational prospective study. It was performed at the otolaryngology department and ICU new surgery hospital on 124 ICU admitted patients. We collected patients' demographic records, cause of admission, indications of tracheostomy, mechanical ventilation, and duration of ICU stay. We also gathered patientś tracheostomy records including the incidence, timing, technique, type, early and late complications, and outcome. All tracheostomized patients received follow-up for 12 months. Results The indication for tracheostomy in ICU patients was mostly prolonged intubation (80.5%), followed by diaphragmatic paralysis (19.5%). All tracheostomies were done by the open approach technique. Tracheostomy for prolonged intubation was done within 17 to 26 days after intubation with a mean of 19.4 ± 2.07 days. Complications after tracheostomy were 13.9% tracheal stenosis and 25% subglottic stenosis. Conclusion Prolonged endotracheal intubation is the man indication of tracheostomy, performed after two weeks of intubation. Although there were no major early complications, laryngotracheal stenosis is still a challenging sequel for tracheostomy that needs to be investigated to be prevented.
      Citation: Int Arch Otorhinolaryngol ; : -
      PubDate: 2016-07-26T00:00:00+01:00
      DOI: 10.1055/s-0036-1584227
  • Sudden Sensorioneural Hearing Loss and Autoimmune Systemic Diseases

    • Authors: Rossini; Bruno Almeida Antunes, Penido, Norma de Oliveira, Munhoz, Mario Sergio Lei, Bogaz, Eduardo Amaro, Curi, Renata Souza
      Abstract: Introduction Several authors have demonstrated the relationship between sudden sensorineural hearing loss (SNHL) and systemic autoimmune diseases (SAD). Immune-mediated SNHL can rarely present as unilateral sudden SNHL and manifests itself in the contralateral ear only after years. It presents clinical relevance for being one of the few SNHL that may be reversible given that early and appropriate treatment is applied. Objective The objective of this study is to describe the clinical presentations and audiological findings from patients with idiopathic sudden SNHL and SAD associated with a probable diagnosis of immune-mediated SNHL. Furthermore, we strive to estimate the prevalence of SAD in patients with sudden SNHL. Methods This is an observational retrospective cohort. We have selected and studied patients with SAD. Revision of available literature on scientific repositories. Results We evaluated 339 patients with sudden SNHL. Among them, 13 (3.83%) patients suffered from SAD. Three patients had bilateral involvement, a total of 16 ears. We evaluate and describe various clinical, epidemiological, and audiological aspects of this sample. Conclusion In our sample of patients with sudden SNHL, the prevalence of SAD was found relevant. The majority had tinnitus and dizziness concomitant hearing loss, unilateral involvement and had experienced profound hearing loss at the time of the installation. In spite of instituted treatment, most cases showed no improvement in audiometric thresholds. Apparently, patients with sudden SNHL and SAD have a more severe initial impairment, higher percentage of bilateral, lower response to treatment, and worse prognosis than patients with sudden SNHL of unknown etiology.
      Citation: Int Arch Otorhinolaryngol ; : -
      PubDate: 2016-07-26T00:00:00+01:00
      DOI: 10.1055/s-0036-1586162
  • Auditory Speech Perception Development in Relation to Patient's Age with
           Cochlear Implant

    • Authors: Ciscare; Grace Kelly Seixas, Mantello, Erika Barioni, Fortunato-Queiroz, Carla Aparecida Urzedo, Hyppolito, Miguel Angelo, Reis, Ana Cláudia Mirândola Barbosa dos
      Abstract: Introduction A cochlear implant in adolescent patients with pre-lingual deafness is still a debatable issue. Objective The objective of this study is to analyze and compare the development of auditory speech perception in children with pre-lingual auditory impairment submitted to cochlear implant, in different age groups in the first year after implantation. Method This is a retrospective study, documentary research, in which we analyzed 78 reports of children with severe bilateral sensorineural hearing loss, unilateral cochlear implant users of both sexes. They were divided into three groups: G1, 22 infants aged less than 42 months; G2, 28 infants aged between 43 to 83 months; and G3, 28 older than 84 months. We collected medical record data to characterize the patients, auditory thresholds with cochlear implants, assessment of speech perception, and auditory skills. Results There was no statistical difference in the association of the results among groups G1, G2, and G3 with sex, caregiver education level, city of residence, and speech perception level. There was a moderate correlation between age and hearing aid use time, age and cochlear implants use time. There was a strong correlation between age and the age cochlear implants was performed, hearing aid use time and age CI was performed. Conclusion There was no statistical difference in the speech perception in relation to the patient's age when cochlear implant was performed. There were statistically significant differences for the variables of auditory deprivation time between G3 - G1 and G2 - G1 and hearing aid use time between G3 - G2 and G3 - G1.
      Citation: Int Arch Otorhinolaryngol ; : -
      PubDate: 2016-07-20T00:00:00+01:00
      DOI: 10.1055/s-0036-1584296
  • Methods of Hearing Preservation during Cochlear Implantation

    • Authors: Khater; Ahmed, El-Anwar, Mohammad Waheed
      Abstract: Introduction Recent advances in surgical techniques and electrode design have made residual hearing preservation during cochlear implantation (CI) possible, achievable, and desirable. Objectives The objective of this study was to review the literature regarding methods used for hearing preservation during CI surgery. Data Synthesis We performed a search in the LILACS, MEDLINE, SciELO, PubMed databases, and Cochrane Library, using the keywords CI, hearing preservation, CI electrode design, and CI soft surgery. We fully read about 15 studies that met the criteria described in “study selection”. The studies showed that several factors could contribute to possible cochlear damage during or after CI surgery and must be kept in mind; mechanical damage during electrode insertion, shock waves in the perilymph fluid due to implantation, acoustic trauma due to drilling, loss of perilymph and disruption of inner ear fluid homeostasis, potential bacterial infection, and secondary intracochlear fibrous tissue formation. The desire to preserve residual hearing has led to the development of the soft-surgery protocols with its various components; avoiding entry of blood into the cochlea and the use of hyaluronate seem to be reasonably supported, whereas the use of topical steroids is questionable. The site of entry into the cochlea, electrode design, and the depth of insertion are also important contributing factors. Conclusion Hearing preservation would be useful for CI patients to benefit from the residual low frequency, as well as for the children who could be candidate for future regenerative hair cell therapy.
      Citation: Int Arch Otorhinolaryngol ; : -
      PubDate: 2016-07-12T00:00:00+01:00
      DOI: 10.1055/s-0036-1585094
  • Thyroid Carcinoma Pattern Presentation According to Age

    • Authors: Girardi; Fábio Muradás
      Abstract: Introduction Patients with thyroid cancer in different age groups present with different prognosis. Objective The objective of this study is to analyze the clinicopathological pattern of thyroid carcinoma presentation according to age groups. Methods This is a retrospective study. From 2000 to 2010, 623 patients underwent thyroidectomy for cancer in our institution, with 596 enrolled. Patients were divided into groups of 10 years and then in four age subgroups (≤ 24, 25–44, 45–64, and ≥65 years) for statistical analysis. We compared age, gender, and histopathological characteristics between groups. Results Individuals belonging to the earlier age group presented with a highest prevalence of neuro-vascular invasion, capsular invasion and lymph node metastasis. Together with individuals of advanced age, that group also had larger tumor diameter and higher prevalence of extra-glandular disease. Even when analyzed only cases with well-differentiated carcinoma, younger individuals remain with a highest prevalence of lymph node metastasis, neuro-vascular invasion and larger tumor diameter. Conclusion We observed a distinct pattern of clinicopathological manifestation of thyroid cancer according to age. Individuals belonging to age extremes resemble in several pathological features, and young people usually present with more aggressive disease characteristics.
      Citation: Int Arch Otorhinolaryngol ; : -
      PubDate: 2016-07-12T00:00:00+01:00
      DOI: 10.1055/s-0036-1585095
  • Longitudinal Comparison of Auditory Steady-State Evoked Potentials in
           Preterm and Term Infants: The Maturation Process

    • Authors: Sousa; Ana Constantino, Didoné, Dayane Domeneghini, Sleifer, Pricila
      Abstract: Introduction Preterm neonates are at risk of changes in their auditory system development, which explains the need for auditory monitoring of this population. The Auditory Steady-State Response (ASSR) is an objective method that allows obtaining the electrophysiological thresholds with greater applicability in neonatal and pediatric population. Objective The purpose of this study is to compare the ASSR thresholds in preterm and term infants evaluated during two stages. Method The study included 63 normal hearing neonates: 33 preterm and 30 term. They underwent assessment of ASSR in both ears simultaneously through insert phones in the frequencies of 500 to 4000Hz with the amplitude modulated from 77 to 103Hz. We presented the intensity at a decreasing level to detect the minimum level of responses. At 18 months, 26 of 33 preterm infants returned for the new assessment for ASSR and were compared with 30 full-term infants. We compared between groups according to gestational age. Results Electrophysiological thresholds were higher in preterm than in full-term neonates (p  0.05) in all the variables described. Conclusion In the first evaluation preterm had higher thresholds in ASSR. There was no difference at 18 months of age, showing the auditory maturation of preterm infants throughout their development.
      Citation: Int Arch Otorhinolaryngol ; : -
      PubDate: 2016-07-01T00:00:00+01:00
      DOI: 10.1055/s-0036-1584888
  • Is There A Systemıc Inflammatory Effect of Cholesteatoma'

    • Authors: Kılıçkaya; M. Mustafa, Aynali, Giray, Tuz, Mustafa, Bagcı, Özkan
      Abstract: Introduction Inflammation causes squamous epithelial transformation of the mucosa in the middle ear cavity and plays a role in the onset, growth, spread, and recurrence of cholesteatoma. Objectives The objective of this study is to investigate the systemic inflammatory effect in chronic otitis with cholesteatoma. Methods The study included a total of 311 patients comprising 156 patients with a pathology diagnosis of cholesteatoma and a control group of 155 with no active inflammation. The Neutrophil-to-lymphocyte Ratio (NLR) was calculated by dividing the neutrophil value by the lymphocyte value. Results The mean NLR was 1.94 ± 0.91 in the patients with cholesteatoma and 1.94 ± 0.85 in the control group. We determined no statistically significant difference between the groups in respect of NLR (p = 0.983). We calculated the NLR as 2.01 ± 1.00 in patients with ossicle erosion and 1.82 ± 0.69 in those without ossicle erosion, 1.86 ± 0.85 in patients with bone erosion and 1.98 ± 0.95 in those without bone erosion. We determined no statistical difference between these values (p = 0.175). Conclusion The results of this study showed that NLR had no predictive value in respect of bone erosions and associated complications in patients with cholesteatoma. The inflammatory effect of cholesteatoma is not systemic but remains more local.
      Citation: Int Arch Otorhinolaryngol ; : -
      PubDate: 2016-06-06T00:00:00+01:00
      DOI: 10.1055/s-0036-1584363
  • Treatment Challenges of Group A Beta-hemolytic Streptococcal

    • Authors: Brook; Itzhak
      Abstract: Introduction Despite its in vitro efficacy, penicillin often fails to eradicate Group A β-hemolytic streptococci (GABHS) from patients with acute and relapsing pharyngo-tonsillitis (PT). Objective This review of the literature details the causes of penicillin failure to eradicate GABHS PT and the therapeutic modalities to reduce and overcome antimicrobial failure. Data Synthesis The causes of penicillin failure in eradicating GABHS PT include the presence of β lactamase producing bacteria (BLPB) that “protect” GABHS from any penicillin; the absence of bacteria that interfere with the growth of GABHS; co-aggregation between GABHS and Moraxella catarrhalis; and the poor penetration of penicillin into the tonsillar tissues and the tonsillo-pharyngeal cells, which allows intracellular GABHS and Staphylococcus aureus to survive. The inadequate intracellular penetration of penicillin can allow intracellular GABHS and S. aureus to persist. In the treatment of acute tonsillitis, the use of cephalosporin can overcome these interactions by eradicating aerobic BLPB (including M. catarrhalis), while preserving the potentially interfering organisms and eliminating GABHS. Conclusion In treatment of recurrent and chronic PT, the administration of clindamycin, or amoxicillin-clavulanic acid, can eradicate both aerobic and anaerobic BLPB, as well as GABHS. The superior intracellular penetration of cephalosporin and clindamycin also enhances their efficacy against intracellular GABHS and S. aureus.
      Citation: Int Arch Otorhinolaryngol ; : -
      PubDate: 2016-06-03T00:00:00+01:00
      DOI: 10.1055/s-0036-1584294
  • Frequency of Serous Otitis Media in Children without Otolaryngological

    • Authors: Kocyigit; Murat, Ortekin, Safiye Giran, Cakabay, Taliye, Ozkaya, Guven, Bezgin, Selin Ustun, Adali, Mustafa Kemal
      Abstract: Introduction Otitis media with effusion is the fluid in the middle ear with no signs or symptoms of acute ear infection. Objective This study aims to research the frequency of serous otitis media in patients referred to the pediatric clinic between 3–16 years of age without any active ear, nose, and throat complaints. Methods This study included 589 children patients (280 boys, 309 girls; mean age: 9.42; range 3–16) who were administered to the pediatric clinic without otolaryngologic complaints. Patients underwent examination with flexible nasopharyngoscopy for adenoid hypertrophy. An otorhinolaryngologist examined all children on both ears using an otoscope and tested with tympanometry. We used tympanometry results to diagnose SOM. Results The study included 589 patients that underwent fiber optic examination of the nasopharynx with an endoscope. Adenoid vegetation was present in 58 patients (9.8%) and was not detected in 531 patients (90.2%). We found serous otitis media in 94 (15.9%) patients. We obtained Type A tympanogram in 47 (81%) of 58 patients with adenoid vegetation, 6 (10.3%) Type B, and 5 (8.6%) Type C. When comparing 58 patients with adenoid vegetation with 538 patients without adenoid vegetation for serous otitis media, the frequency was not statistically significant (p > 0.05). Conclusion We believe that in children without any ear, nose, and throat complaints, it is possible to detect serous otitis media with adenoid vegetation. Thus, pediatric patients should undergo screening at regular intervals.
      Citation: Int Arch Otorhinolaryngol ; : -
      PubDate: 2016-06-03T00:00:00+01:00
      DOI: 10.1055/s-0036-1584362
  • Parental Expectation from Children with Cochlear Implants in Indian
           Context: a Questionnaire Based Study

    • Authors: Kumar; Prawin, Sanju, Himanshu Kumar, Mishra, Rajkishor, Singh, Varun, Mohan, Priyanka
      Abstract: Introduction Parental support is important in the habilitation/rehabilitation of children using cochlear implant devices. Hence, it is important for families to know the realistic expectations regarding outcomes from CIs. Objective The objective of the present study is to know the parents' expectation from children using CIs. Methods For this study, we recruited 23 parents of children using CIs. We administered 15 questions translated in to Hindi related to communication abilities, social skills, academic achievement, change in future life, rehabilitation demand, and stress due to hearing impairment. Results The response of the questions (5-point rating scale) related to communication abilities showed that parents were expecting children using CIs to use the telephone (95%), to be able to detect soft sounds (99%), to listen in crowds (86%), to be able to easily understand others (76%), and to show improvement in communication skills (78%). Similarly, for questions related to social skills showed 90% of the parents expecting that their children with CIs should be able to easily make friends with normal hearing peers, and 80% of the parents were expecting the children to achieve high standards in their reading and writing skills. Questions related to change in future life showed 86% of the parents expecting their children with CIs to act like normal hearing children. Further, 78% parents showed positive response regarding importance of intensive training. However, 70% of the parents reported stress in the family due to the existence of the hearing impaired child. Conclusion Overall, the existing questionnaire-based study showed that parents have high expectations from their children with cochlear implant.
      Citation: Int Arch Otorhinolaryngol ; : -
      PubDate: 2016-05-30T00:00:00+01:00
      DOI: 10.1055/s-0036-1584228
  • Use of an Osteoplastic Flap for the Prevention of Mastoidectomy
           Retroauricular Defects

    • Authors: Bento; Ricardo Ferreira, Tsuji, Robinson Koji, Fonseca, Anna Carolina de Oliveira, Alves, Ricardo Dourado
      Abstract: Introduction After mastoidectomy, patients usually complain of bone depressions in the retroauricular region in the surgical site, especially in procedures that require extensive cortical resections. This causes inconveniences such as difficulty wearing glasses, cleaning, and aesthetics complaints. Objective This study aims to describe a vascularized flap surgical technique that uses the mastoid cortical bone adhered to the periosteum, which is pedicled on the anterior portion and repositioned at the end of the surgery. This ensures the coverage of the mastoid cavity generated by surgery and prevents ear retraction into the cavity. This preliminary report describes the technique and intraoperative and immediate postoperative complications. Methods After retroauricular incision, periosteal exposure is performed. A U-shaped incision is required for the procedure and delimits a periosteum area appropriate to the size of the mastoidectomy. The cortical bone is opened using a 2.5 mm drill around the perimeter of the “U,” at a 3 mm depth. A chisel is introduced through the surface cells of the mastoid, and a hammer evolves into the anterior direction. The flap is lifted, leaving the periosteum adhered to it and forming a cap. The flap is anteriorly fixed to not hinder the surgery, and repositioned at the end. The periosteum is then sutured to the adjacent periosteum. Results The first 14 cases had no intraoperative complications and were firm and stable when digital pressure was applied during the intraoperative and immediate postoperative periods. Conclusion The osteoplastic flap pedicle is a safe and simple procedure, with good results in the immediate postoperative period.
      Citation: Int Arch Otorhinolaryngol ; : -
      PubDate: 2016-05-30T00:00:00+01:00
      DOI: 10.1055/s-0036-1584266
  • Psychoacoustic Characteristics of Tinnitus versus Temporal Resolution in
           Subjects with Normal Hearing Sensitivity

    • Authors: Ibraheem; Ola Abdallah, Hassaan, Mohammad Ramadan
      Abstract: Introduction Cochlear or neural mechanisms of tinnitus generation may affect auditory temporal resolution in tinnitus patients even with normal audiometry. Thus, studying the correlation between tinnitus characteristics and auditory temporal resolution in subjects with tinnitus may help in proper modification of tinnitus management strategy. Objective This study aims to examine the relationship between the psychoacoustic measures of tinnitus and the auditory temporal resolution in subjects with normal audiometry. Methods Two normal hearing groups with ages ranging from 20 to 45 years were involved: control group of 15 adults (30 ears) without tinnitus and study group of 15 adults (24 ears) with tinnitus. Subjective scaling of annoyance and sleep disturbance caused by tinnitus, basic audiological evaluation, tinnitus psychoacoustic measures and Gaps in Noise test were performed. Data from both groups were compared using independent sample t-test. Psychoacoustic measures of tinnitus and Gaps in Noise test parameters of the tinnitus group were correlated with Pearson's correlation coefficient. Results Significantly higher hearing threshold, higher approximate threshold and lower correct Gaps in Noise scores were observed in tinnitus ears. There was no significant correlation between psychoacoustic measures of tinnitus and Gaps in Noise test parameters of the tinnitus group. Conclusion Auditory temporal resolution impairment was found in tinnitus patients, which could be attributed to cochlear impairment or altered neural firing within the auditory pathway. It is recommended to include temporal resolution testing in the tinnitus evaluation battery to provide a proper management planning.
      Citation: Int Arch Otorhinolaryngol ; : -
      PubDate: 2016-05-05T00:00:00+01:00
      DOI: 10.1055/s-0036-1583526
  • Tonic Investigation Concept of Cervico-vestibular Muscle Afferents

    • Authors: Dorn; Linda Josephine, Lappat, Annabelle, Neuhuber, Winfried, Scherer, Hans, Olze, Heidi, Hölzl, Matthias
      Abstract: Introduction Interdisciplinary research has contributed greatly to an improved understanding of the vestibular system. To date, however, very little research has focused on the vestibular system's somatosensory afferents. To ensure the diagnostic quality of vestibular somatosensory afferent data, especially the extra cranial afferents, stimulation of the vestibular balance system has to be precluded. Objective Sophisticated movements require intra- and extra cranial vestibular receptors. The study's objective is to evaluate an investigation concept for cervico-vestibular afferents with respect to clinical feasibility. Methods A dedicated chair was constructed, permitting three-dimensional trunk excursions, during which the volunteer's head remains fixed. Whether or not a cervicotonic provocation nystagmus (c-PN) can be induced with static trunk excursion is to be evaluated and if this can be influenced by cervical monophasic transcutaneous electrical nerve stimulation (c-TENS) with a randomized test group. 3D-video-oculography (VOG) was used to record any change in cervico-ocular examination parameters. The occurring nystagmuses were evaluated visually due to the small caliber of nystagmus amplitudes in healthy volunteers. Results The results demonstrate: no influence of placebo-controlled c-TENS on the spontaneous nystagmus; a significant increase of the vertical nystagmus on the 3D-trunk-excursion chair in static trunk flexion with cervical provocation in all young healthy volunteers (n = 49); and a significant difference between vertical and horizontal nystagmuses during static trunk excursion after placebo-controlled c-TENS, except for the horizontal nystagmus during trunk torsion. Conclusion We hope this cervicotonic investigation concept on the 3D trunk-excursion chair will contribute to new diagnostic and therapeutic perspectives on cervical pathologies in vestibular head-to-trunk alignment.
      Citation: Int Arch Otorhinolaryngol ; : -
      PubDate: 2016-05-05T00:00:00+01:00
      DOI: 10.1055/s-0036-1583759
  • Adaptation and Assessment of Reliability and Validity of the Greek Version
           of the Ohkuma Questionnaire for Dysphagia Screening

    • Authors: Papadopoulou; Soultana L., Exarchakos, Georgios, Christodoulou, Dimitrios, Theodorou, Stavroula, Beris, Alexandre, Ploumis, Avraam
      Abstract: Introduction The Ohkuma questionnaire is a validated screening tool originally used to detect dysphagia among patients hospitalized in Japanese nursing facilities. Objective The purpose of this study is to evaluate the reliability and validity of the adapted Greek version of the Ohkuma questionnaire. Methods Following the steps for cross-cultural adaptation, we delivered the validated Ohkuma questionnaire to 70 patients (53 men, 17 women) who were either suffering from dysphagia or not. All of them completed the questionnaire a second time within a month. For all of them, we performed a bedside and VFSS study of dysphagia and asked participants to undergo a second VFSS screening, with the exception of nine individuals. Statistical analysis included measurement of internal consistency with Cronbach's α coefficient, reliability with Cohen's Kappa, Pearson's correlation coefficient and construct validity with categorical components, and One-Way Anova test. Results According to Cronbach's α coefficient (0.976) for total score, there was high internal consistency for the Ohkuma Dysphagia questionnaire. Test-retest reliability (Cohen's Kappa) ranged from 0.586 to 1.00, exhibiting acceptable stability. We also estimated the Pearson's correlation coefficient for the test-retest total score, which reached high levels (0.952; p = 0.000). The One-Way Anova test in the two measurement times showed statistically significant correlation in both measurements (p = 0.02 and p = 0.016). Conclusion The adapted Greek version of the questionnaire is valid and reliable and can be used for the screening of dysphagia in the Greek-speaking patients.
      Citation: Int Arch Otorhinolaryngol ; : -
      PubDate: 2016-05-04T00:00:00+01:00
      DOI: 10.1055/s-0036-1580613
  • Outcomes of Late Implantation in Usher Syndrome Patients

    • Authors: Hoshino; Ana Cristina H., Echegoyen, Agustina, Goffi-Gomez, Maria Valéria Schmidt, Tsuji, Robinson Koji, Bento, Ricardo Ferreira
      Abstract: Introduction Usher syndrome (US) is an autosomal recessive disorder characterized by hearing loss and progressive visual impairment. Some deaf Usher syndrome patients learn to communicate using sign language. During adolescence, as they start losing vision, they are usually referred to cochlear implantation as a salvage for their new condition. Is a late implantation beneficial to these children' Objective The objective of this study is to describe the outcomes of US patients who received cochlear implants at a later age. Methods This is a retrospective study of ten patients diagnosed with US1. We collected pure-tone thresholds and speech perception tests from pre and one-year post implant. Results Average age at implantation was 18.9 years (5–49). Aided average thresholds were 103 dB HL and 35 dB HL pre and one-year post implant, respectively. Speech perception was only possible to be measured in four patients preoperatively, who scored 13.3; 26.67; 46% vowels and 56% 4-choice. All patients except one had some kind of communication. Two were bilingual. After one year of using the device, seven patients were able to perform the speech tests (from four-choice to close set sentences) and three patients abandoned the use of the implant. Conclusion We observed that detection of sounds can be achieved with late implantation, but speech recognition is only possible in patients with previous hearing stimulation, since it depends on the development of hearing skills and the maturation of the auditory pathways.
      Citation: Int Arch Otorhinolaryngol ; : -
      PubDate: 2016-05-04T00:00:00+01:00
      DOI: 10.1055/s-0036-1583306
  • Test-Retest of Long Latency Auditory Evoked Potentials (P300) with Pure
           Tone and Speech Stimuli

    • Authors: Perez; Ana Paula, Ziliotto, Karin, Pereira, Liliane Desgualdo
      Abstract: Introduction Long latency auditory evoked potentials, especially P300, have been used for clinical evaluation of mental processing. Many factors can interfere with Auditory Evoked Potential - P300 results, suggesting large intra and inter-subject variations. Objective The objective of the study was to identify the reliability of P3 components (latency and amplitude) over 4–6 weeks and the most stable auditory stimulus with the best test-retest agreement. Methods Ten normal-hearing women participated in the study. Only subjects without auditory processing problems were included. To determine the P3 components, we elicited long latency auditory evoked potential (P300) by pure tone and speech stimuli, and retested after 4–6 weeks using the same parameters. We identified P300 latency and amplitude by waveform subtraction. Results We found lower coefficient of variation values in latency than in amplitude, with less variability analysis when speech stimulus was used. There was no significant correlation in latency measures between pure tone and speech stimuli, and sessions. There was a significant intrasubject correlation between measures of latency and amplitude. Conclusion These findings show that amplitude responses are more robust for the speech stimulus when compared with its pure tone counterpart. The P300 indicated stability for latency and amplitude measures when the test-retest was applied. Reliability was higher for amplitude than for latency, with better agreement when the pure tone stimulus was used. However, further research with speech stimulus is needed to clarify how these stimuli are processed by the nervous system.
      Citation: Int Arch Otorhinolaryngol ; : -
      PubDate: 2016-04-26T00:00:00+01:00
      DOI: 10.1055/s-0036-1583527
  • Tinnitus in Elderly Individuals: Discomfort and Impact in the Quality of

    • Authors: Teixeira; Adriane Ribeiro, Rosito, Leticia Petersen Schmidt, Gonçalves, Andréa Kruger, Nunes, Michelle Gassen Paulo, Dornelles, Silvia, Olchik, Maira Rozenfeld
      Abstract: Introduction Tinnitus is a symptom that affects mainly the elderly and can negatively influence their quality of life. Objective The objective of our study is to evaluate the existence of a relationship between the quality of life and the impact caused by tinnitus in elderly individuals, considering the age and gender variables. Method We conducted a cross-sectional study in elderly people of both genders who participate in the extension activities at the university. The evaluation was composed of anamnesis and WHOQOL-OLD instruments, to evaluate the quality of life, and Tinnitus Handicap Inventory (THI) for the evaluation of the tinnitus impact. Result We evaluated 36 elderly individuals with an average age of 68.6 ± 6.8 years old, 72.2 % of them were women. We verified that most of the subjects classified their tinnitus as weak (44.4%) or medium (36.1%). The score average in the THI was 20 points, with predominant classification of tinnitus impact as negligible (41.7%) or mild (30.6%). In the WHOQOL-OLD, the average score was 15.6 ± 1.6 points (total score). The negative correlation between the THI score and the WHOQOL-OLD score was found in the sensory domain operation and total score. Conclusion The results obtained in the study prove that the quality of life of the elderly individuals evaluated is related to a discomfort caused by the tinnitus.
      Citation: Int Arch Otorhinolaryngol ; : -
      PubDate: 2016-04-13T00:00:00+01:00
      DOI: 10.1055/s-0036-1572562
  • Cochlear Implantation through the Middle Fossa Approach: A Review of
           Related Temporal Bone Studies and Reported Cases

    • Authors: Lesser; Juan Carlos Cisneros, Brito Neto, Rubens Vuono de, Martins, Graziela de Souza Queiroz, Bento, Ricardo Ferreira
      Abstract: Introduction Middle fossa approach has been suggested as an alternative for patients in whom other routes of electrode insertion are contraindicated. Even though there are temporal bone studies about the feasibility of introducing the cochlear implant through the middle fossa, until now, very few studies have described results when cochlear implant surgery is done through this approach. Objective The objective of this study is to review a series of temporal bone studies related to cochlear implantation through the middle fossa and the results obtained by different surgical groups after cochlear implantation through this approach. Data Sources PubMed, MD consult and Ovid-SP databases. Data Synthesis A total of 8 human cadaveric temporal bone studies and 6 studies reporting cochlear implant surgery through the middle fossa approach met the inclusion criteria. Temporal bone studies show that it is feasible to perform cochlear implantation through this route. So far, only two surgical groups have performed cochlear implantation through the middle fossa with a total of 15 implanted patients. One group entered the cochlea in the most upper part of the basal turn, inserting the implant in the direction of the middle and apical turns; meanwhile, the other group inserted the implant in the apical turn directed in a retrograde fashion to the middle and basal turns. Results obtained in both groups were similar. Conclusions The middle fossa approach is a good alternative for cochlear implantation when other routes of electrode insertion are contraindicated.
      Citation: Int Arch Otorhinolaryngol ; : -
      PubDate: 2016-04-08T00:00:00+01:00
      DOI: 10.1055/s-0036-1582266
  • Otoneurological Abnormalities in Patients with Friedreich's Ataxia

    • Authors: Zeigelboim; Bianca Simone, Mesti, Juliana Cristina, Fonseca, Vinicius Ribas, Faryniuk, João Henrique, Marques, Jair Mendes, Cardoso, Rafaella Cardosa, Teive, Hélio Afonso Ghizoni
      Abstract: Introduction Friedreich's ataxia is a neurodegenerative disease and progressive by nature. It has autosomal recessive inheritance and early onset in most cases. Nystagmus and hearing loss (in some cases) make up some of the common symptoms seen in this disorder. Objective The objective of this study is to examine vestibular disorders in patients with Friedreich ataxia. Methods We conducted a retrospective cross-sectional study. We evaluated 30 patients with ages ranging from six to 72 years (mean age of 38.6 ( ±  14.7). The patients underwent the following procedures: anamnesis, ENT, and vestibular evaluations. Results Clinically, the patients commonly had symptoms of incoordination of movement (66.7%), gait disturbances (56.7%), and dizziness (50%). In vestibular testing, alterations were predominantly evident under caloric testing (73.4%), gaze nystagmus testing (50.1%), rotational chair testing (36.7%), and optokinetic nystagmus testing (33.4%). The presence of alterations occurred under examination in 90% of subjects, with the majority occurring in those with central vestibular dysfunction (70% of the examinations). Conclusion The most evident neurotological symptoms were incoordination of movement, gait disturbances, and dizziness. Alterations in vestibular examinations occurred in 90% of patients, mostly in the caloric test, with a predominance of deficient central vestibular system dysfunction.
      Citation: Int Arch Otorhinolaryngol ; : -
      PubDate: 2016-03-31T00:00:00+01:00
      DOI: 10.1055/s-0036-1572529
  • Auditory Processing Assessment in Children with Attention Deficit
           Hyperactivity Disorder: An Open Study Examining Methylphenidate Effects

    • Authors: Lanzetta-Valdo; Bianca Pinheiro, Oliveira, Giselle Alves de, Ferreira, Jane Tagarro Correa, Palacios, Ester Miyuki Nakamura
      Abstract: Introduction Children with Attention Deficit Hyperactivity Disorder can present Auditory Processing (AP) Disorder. Objective The study examined the AP in ADHD children compared with non-ADHD children, and before and after 3 and 6 months of methylphenidate (MPH) treatment in ADHD children. Methods Drug-naive children diagnosed with ADHD combined subtype aging between 7 and 11 years, coming from public and private outpatient service or public and private school, and age-gender-matched non-ADHD children, participated in an open, non-randomized study from February 2013 to December 2013. They were submitted to a behavioral battery of AP tests comprising Speech with white Noise, Dichotic Digits (DD), and Pitch Pattern Sequence (PPS) and were compared with non-ADHD children. They were followed for 3 and 6 months of MPH treatment (0.5 mg/kg/day). Results ADHD children presented larger number of errors in DD (p 
      Citation: Int Arch Otorhinolaryngol ; : -
      PubDate: 2016-03-31T00:00:00+01:00
      DOI: 10.1055/s-0036-1572526
  • Auditory Alterations in Children Infected by Human Immunodeficiency Virus
           Verified Through Auditory Processing Test

    • Authors: Romero; Ana Carla Leite, Alfaya, Lívia Marangoni, Gonçales, Alina Sanches, Frizzo, Ana Claudia Figueiredo, Isaac, Myriam de Lima
      Abstract: Introduction The auditory system of HIV-positive children may have deficits at various levels, such as the high incidence of problems in the middle ear that can cause hearing loss. Objective The objective of this study is to characterize the development of children infected by the Human Immunodeficiency Virus (HIV) in the Simplified Auditory Processing Test (SAPT) and the Staggered Spondaic Word Test. Methods We performed behavioral tests composed of the Simplified Auditory Processing Test and the Portuguese version of the Staggered Spondaic Word Test (SSW). The participants were 15 children infected by HIV, all using antiretroviral medication. Results The children had abnormal auditory processing verified by Simplified Auditory Processing Test and the Portuguese version of SSW. In the Simplified Auditory Processing Test, 60% of the children presented hearing impairment. In the SAPT, the memory test for verbal sounds showed more errors (53.33%); whereas in SSW, 86.67% of the children showed deficiencies indicating deficit in figure-ground, attention, and memory auditory skills. Furthermore, there are more errors in conditions of background noise in both age groups, where most errors were in the left ear in the Group of 8-year-olds, with similar results for the group aged 9 years. Conclusion The high incidence of hearing loss in children with HIV and comorbidity with several biological and environmental factors indicate the need for: 1) familiar and professional awareness of the impact on auditory alteration on the developing and learning of the children with HIV, and 2) access to educational plans and follow-up with multidisciplinary teams as early as possible to minimize the damage caused by auditory deficits.
      Citation: Int Arch Otorhinolaryngol ; : -
      PubDate: 2016-03-14T00:00:00+0100
      DOI: 10.1055/s-0036-1580614
  • Satisfaction of Elderly Hearing Aid Users

    • Authors: Kozlowski; Lorena, Ribas, Angela, Almeida, Gleide, Luz, Idalina
      Abstract: Introduction The impact of auditory sensory deprivation in the life of an individual is enormous because it not only affects one's ability to properly understand auditory information, but also the way people relate to their environment and their culture. The monitoring of adult and elderly subjects with hearing loss is intended to minimize the difficulties and handicaps that occur as a consequence of this pathology. Objective To evaluate the level of user satisfaction with hearing aids. Methods A clinical and experimental study involving 91 elderly hearing aid users. We used the questionnaire Satisfaction with Amplification in Daily Life to determine the degree of the satisfaction provided by hearing aids. We evaluated mean global score, subscales, as well as the variables time to use, age, and degree of hearing loss. Results Mean global score was 4.73, the score for Positive Effects 5.45, Negative Factors 3.2, demonstrating that they were satisfied; Services and Costs 5.98: very satisfied ; 3.65 Personal Image: dissatisfied. We observed statistically significant difference for the time of hearing aid use, age, and degree of hearing loss. Conclusion The SADL is a tool, simple and easy to apply and in this study we can demonstrate the high degree of satisfaction with the hearing aids by the majority of the sample collected, increasing with time of use and a greater degree of hearing loss.
      Citation: Int Arch Otorhinolaryngol ; : -
      PubDate: 2016-03-09T00:00:00+0100
      DOI: 10.1055/s-0036-1579744
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