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Abstract Introduction There is only limited information from previous studies that suggest that auditory function may be influenced by hormones. Recent advances in the field have exposed the potential role of hormones in modulating the auditory system. Objective This study aims to investigate the relationship between menstrual cycle and outer hair cell function with audiological examination. Methods This is an analytic study with a cross-sectional design. The sampling was a systematic random sampling. We found 49 women with normal menstrual cycle and collected their data through interviews, physical examination, and examination of the ear, with otoscopic and other routine otorhinolaryngology examinations. We evaluated Tympanometry, distortion-product otoacoustic emissions (DPOAE), and pure tone audiometry. Results We found the audiometric threshold worse in the follicular phase than other phases at 4000 Hz of the right ear, and in the ovulation was found best than any other phases at 1000 Hz of the left ear with significant difference. We found significant difference of DPOAE between ovulation time and follicular phase at 3000 Hz and 1000 Hz in the left ear and between ovulation and luteal phased at 2000 Hz, 3000 Hz and 5000 Hz in the right ear and at 1000 Hz in the left ear with p< 0.05. Conclusion The result of this study showed that only a small part of audiometry threshold had a significant difference between each menstrual phase. In other words, we found no correlation between menstrual and audiometry threshold. Nonetheless, there is a correlation between menstrual cycle phase and DPOAE amplitude.

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Abstract Introduction Law 12.303/10 requires hearing screening in newborns before hospital discharge to detect possible hearing problems within the first three months after birth. If the newborn fails the test or presents signs of risk for hearing loss, it must undergo a retest and monitoring during the first year of life. In practice, this often does not happen. Objective To identify, in a group of mothers of children with risk factors for hearing loss, the determining reasons for non-compliance with the auditory retest. Method This is a cross-sectional quantitative study. For data collection, we handed a semi-structured questionnaire to 60 mothers of babies at risk for hearing loss who did not attend the hearing retest after hospital discharge. The questionnaire investigated their age, education, marital status, level of knowledge about the hearing screening, and reasons for non-compliance with the retest. We compared and analyzed data using the Chi-square test at a significance level of 0.05 %. Results Our study found that 63% of the respondents were unaware of the hearing screening and most did not receive guidance on testing during prenatal care; 30% of participants stated forgetting as the reason for not attending the retest. There was no significant relationship between age, education, and marital status regarding knowledge about the test and the non-compliance with the retest. Conclusion Identified as the most significant determining factors for non-compliance with the newborn hearing screening retest were the surveyed mothers' forgetting the date, and their ignorance as to the importance of retesting.

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Abstract Introduction Mismatch Negativity is a negative component of the event-related potential (ERP) elicited by any discriminable changes in auditory stimulation. Objective The present study aimed to assess pre-attentive auditory discrimination skill with fine and gross difference between auditory stimuli. Method Seventeen normal hearing individual participated in the study. To assess preattentive auditory discrimination skill with fine difference between auditory stimuli, we recorded mismatch negativity (MMN) with pair of stimuli (pure tones), using /1000 Hz/ and /1010 Hz/ with /1000 Hz/ as frequent stimulus and /1010 Hz/ as infrequent stimulus. Similarly, we used /1000 Hz/ and /1100 Hz/ with /1000 Hz/ as frequent stimulus and /1100 Hz/ as infrequent stimulus to assess pre-attentive auditory discrimination skill with gross difference between auditory stimuli. The study included 17 subjects with informed consent. We analyzed MMN for onset latency, offset latency, peak latency, peak amplitude, and area under the curve parameters. Result Results revealed that MMN was present only in 64% of the individuals in both conditions. Further Multivariate Analysis of Variance (MANOVA) showed no significant difference in all measures of MMN (onset latency, offset latency, peak latency, peak amplitude, and area under the curve) in both conditions. Conclusion The present study showed similar pre-attentive skills for both conditions: fine (1000 Hz and 1010 Hz) and gross (1000 Hz and 1100 Hz) difference in auditory stimuli at a higher level (endogenous) of the auditory system.

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Abstract Introduction Enhanced auditory perception in musicians is likely to result from auditory perceptual learning during several years of training and practice. Many studies have focused on biological processing of auditory stimuli among musicians. However, there is a lack of literature on temporal resolution and active auditory discrimination skills in vocal musicians. Objective The aim of the present study is to assess temporal resolution and active auditory discrimination skill in vocal musicians. Method The study participants included 15 vocal musicians with a minimum professional experience of 5 years of music exposure, within the age range of 20 to 30 years old, as the experimental group, while 15 age-matched non-musicians served as the control group. We used duration discrimination using pure-tones, pulse-train duration discrimination, and gap detection threshold tasks to assess temporal processing skills in both groups. Similarly, we assessed active auditory discrimination skill in both groups using Differential Limen of Frequency (DLF). All tasks were done using MATLab software installed in a personal computer at 40dBSL with maximum likelihood procedure. The collected data were analyzed using SPSS (version 17.0). Result Descriptive statistics showed better threshold for vocal musicians compared with non-musicians for all tasks. Further, independent t-test showed that vocal musicians performed significantly better compared with non-musicians on duration discrimination using pure tone, pulse train duration discrimination, gap detection threshold, and differential limen of frequency. Conclusion The present study showed enhanced temporal resolution ability and better (lower) active discrimination threshold in vocal musicians in comparison to non-musicians.

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Abstract Introduction Hearing difficulties can be minimized by the use of hearing aids. Objective The objective of this study is to assess the speech perception and satisfaction of hearing aids users before and after aid adaptation and to determine whether these measures are correlated. Methods The study was conducted on 65 individuals, 54% females and 46% males aged 63 years on average, after the systematic use of hearing aids for at least three months. We characterized subjectś personal identification data, the degree, and configuration of hearing loss, as well as aspects related to adaptation. We then applied a satisfaction questionnaire and a speech perception test (words and sentences), with and without the use of the hearing aids. Results Mean speech recognition with words and sentences was 69% and 79 %, respectively, with hearing aids use; whereas, without hearing aids use the figures were 43% and 53%. Mean questionnaire score was 30.1 points. Regarding hearing loss characteristics, 78.5% of the subjects had a sensorineural loss, 20% a mixed loss, and 1.5% a conductive loss. Hearing loss of moderate degree was present in 60.5% of cases, loss of descending configuration in 47%, and plain loss in 37.5%. There was no correlation between individual satisfaction and the percentages of the speech perception tests applied. Conclusion Word and sentence recognition was significantly better with the use of the hearing aids. The users showed a high degree of satisfaction. In the present study, there was no correlation observed between the levels of speech perception and levels of user satisfaction measured with the questionnaire.

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Abstract Introduction Tinnitus is a symptom that is often associated with presbycusis. Objective This study aims to analyze the existence of association among hearing thresholds, pitch, and loudness of tinnitus in individuals with presbycusis, considering the gender variable. Methods Cross-sectional, descriptive, and prospective study, whose sample consisted of individuals with tinnitus and diagnosis of presbycusis. For the evaluation, we performed anamnesis along with otoscopy, pure tone audiometry, and acuphenometry to analyze the psychoacoustic characteristics of tinnitus individuals. Results The sample consisted of 49 subjects, with a mean age of 69.57 6.53 years, who presented unilateral and bilateral tinnitus, therefore, a sample of 80 ears. In analyzing the results, as for acuphenometry, the loudness of tinnitus was more present at 0dB and the pitch was 6HKz and 8HKz. Regarding the analysis of the association between the frequency of greater hearing threshold and tinnitus pitch, no statistical significance (p= 0.862) was found. As for the association between the intensity of greater hearing threshold and tinnitus loudness, no statistical significance (p= 0.115) was found. Conclusion There is no significant association between the hearing loss of patients with presbycusis and the pitch and loudness of tinnitus.

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Abstract Introduction "Diabetes mellitus is a group of metabolic disorders characterized by elevated blood sugar and abnormalities in insulin secretion and action" ( American Diabetes Association). Previous literature has reported connection between diabetes mellitus and hearing impairment. There is a dearth of literature on auditory temporal resolution ability in individuals with diabetes mellitus type 2. Objective The main objective of the present study was to assess auditory temporal resolution ability through GDT (Gap Detection Threshold) in individuals with diabetes mellitus type 2 with high frequency hearing loss. Methods Fifteen subjects with diabetes mellitus type 2 with high frequency hearing loss in the age range of 30 to 40 years participated in the study as the experimental group. Fifteen age-matched non-diabetic individuals with normal hearing served as the control group. We administered the Gap Detection Threshold (GDT) test to all participants to assess their temporal resolution ability. Result We used the independent t-test to compare between groups. Results showed that the diabetic group (experimental) performed significantly poorer compared with the non-diabetic group ( control ). Conclusion It is possible to conclude that widening of auditory filters and changes in the central auditory nervous system contributed to poorer performance for temporal resolution task (Gap Detection Threshold) in individuals with diabetes mellitus type 2. Findings of the present study revealed the deteriorating effect of diabetes mellitus type 2 at the central auditory processing level.

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Abstract Introduction The manipulation of antineoplastic drugs presents high risk for accidents and occupational diseases. Objective To evaluate the auditory and vestibular systems of workers who are exposed to chemotherapeutic treatment in the University Hospital of Universidade Federal de Santa Maria, Brazil, and to identify the use of individual protection equipment, related to the obtained results. Methods This study is a cross-sectional study using a quantitative method. We evaluate 33 male and female workers, ranging from 21-60 years old, of the nursing and pharmacy sectors. The workers underwent conventional Audiologic Assessment; Transient Evoked Otoacoustic Emissions; and Computerized Vectoelectronystagmography. Results The majority of the sample was female (90.9%). Individual protection equipment was used by 90.9% of the workers. Complaints of dizziness were reported by 56.25% of nursing workers and 52.94% of pharmacy workers. Audiological and vestibular assessment results were within normal limits, 96.97% and 74.20%, respectively. However, audiometric configuration of notch type was identified in 75.75% of all workers. Audiometric notches (76%) and altered caloric test (100%) were often associated with decreased use of coal masks. Conclusion Among the workers evaluated, the vestibulocochlear system was within the normal limits. The presence of notch configuration indicates the need to use individual protection equipment.

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Abstract Introduction Tinnitus is a worldwide problem. Objective The objective of this study is to evaluate the audiometric hearing thresholds of adult patients with ongoing tinnitus as their only otological symptom. Methods We evaluated the hearing thresholds of 43 adult patients with ongoing tinnitus and no history of hearing loss from the otolaryngology department of a tertiary health institution at speech and high frequencies. A total of 56 tinnitus ears were compared against 30 contralateral normal ears as well as with the 100 ears of 50 healthy volunteers. Results The study group consisted of 11 (25.6%) males and 32 (74.4%) females with a mean age of 40.9 11.7. The mean Pure Tone Average of the 56 tinnitus ears was 14.8 9, while that of the 100 control ears was 11.2 6 (U 1/4 2078, p= 0.008). The mean pure tone average of the control was also significantly lower than that of the 30 contralateral normal ears of the tinnitus sufferers (U 1/4 1136, p= 0.02). We observed mild to moderate hearing loss in 10 (23%) of the participants. We observed no hearing loss among the control group. Conclusion A proportion of tinnitus sufferers with self-professed normal hearing are likely to have mildly elevated pure tone audiometric thresholds. In patients with unilateral tinnitus, such elevated pure tone hearing thresholds are likely to be in the tinnitus ear and the contralateral non-tinnitus ear.

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Abstract Introduction Benign Paroxysmal Positional Vertigo is the most common cause of dizziness in elderly people. Recent studies have shown that the elderly present higher Benign Paroxysmal Positional Vertigo recurrence and that vertiginous symptomatology remission varies according to comorbidities and the therapeutic techniques applied. Objective To assess the short-term effectiveness of Vestibular Rehabilitation in addition to Canalith Repositioning Maneuver on positive to negative Dix-Hallpike test, on recurrence and number of maneuvers to achieve a negative test in elderly patients with chronic Benign Paroxysmal Positional Vertigo. Methods In this randomized controlled trial, 7 older adults (median age: 69 years, range 65-78) underwent Canalith Repositioning Maneuver and Vestibular Rehabilitation for thirteen weeks. Seven older adults (median age: 73 years, range 65-76) in the control group received only Canalith Repositioning Maneuver. The participants were assessed at baseline (T0), one (T1), five (T5), nine (T9), and thirteen weeks (T13). We assessed the differences between the groups by Mann-Whitney and Fisher exact tests, and used the Friedman and Wilcoxon tests to determine the intragroup differences. Results No significant differences were found between groups for the positive to negative Dix-Hallpike test, recurrence, and number of maneuvers to achieve a negative test. The number of maneuvers to achieve negative Dix-Hallpike test was lower in intragroup comparisons in the experimental group. Conclusion The findings suggest that additional Vestibular Rehabilitation did not influence the positive to negative Dix-Hallpike test, recurrence, or number of maneuvers to achieve a negative test in elderly patients with chronic Benign Paroxysmal Positional Vertigo.

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Abstract Introduction The preservation of residual hearing is currently an important challenge for cochlear implant surgeries. Indeed, if patients exhibit functional hearing after cochlear implantation, they can benefit from the combination of acoustical stimulation, usually in the low-frequencies and electrical stimulation in the high-frequencies. This combined mode of stimulation has proven to be beneficial both in terms of speech perception and of sound quality. Finding the right procedures for conducting softsurgeries and designing electrode arrays dedicated to hearing preservation is an open issue. Objective The objective of this study is to evaluate the combination of a soft-surgery procedure implicating round-window insertion and the use of dexamethasone and hyaluronic acid during surgery, with the use of a specifically designed straight soft electrode array, on hearing preservation in patients with functional hearing in the low frequencies. Methods This pre-clinical trial was conducted on seven patients with residual hearing in the low frequencies. The surgical method used employed a round window insertion and the use of topical dexamethasone. Results The soft-surgery protocol could be successfully followed in five patients. In this group, the average hearing threshold shift compared with pre-operative values was of 18.7 þ/ 16.1 dB HL up to 500 Hz and 15.7 þ/ 15.1 up to 1 kHz, demonstrating satisfying levels of hearing preservation. Conclusion We were able to demonstrate the possibility of preserving residual hearing in most of the patients using the EVO electrode. Significant residual hearing preservation levels were was obtained when a soft surgical approach involving round window insertion, dexamethasone and hyaluronic use during the surgery.

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Abstract Introduction Due to the close anatomical relationship between the paranasal sinuses and the orbit, involvement or injury of the orbit from paranasal sinuses procedures may occur. Objectives We aimed to study the early and delayed effect of endoscopic sinus surgery on intraocular pressure ( IOP ). Methods We included in the study 38 patients with chronic rhinosinusitis ( CRS), undergoing FESS. We performed FESS with the standard anterior to posterior approach. We measured IOP at the same time one day before surgery as well as day 1 and 6 weeks after surgery. Results One day after surgery, mean IOP in the right eye was 14.176 1.91 mm Hg and in the left eye was 13.79 2.42 mm Hg with statistically non-significant difference from preoperative values. Six weeks postoperative, the mean IOP in the right eye was 15.14 2.28 mm Hg. The difference between the mean preoperative and postoperative IOP values was found to be statistically significant (p 1/4 0.0012). While in the left eye, mean postoperative IOP was 15.14 þ 2.23mm Hg. The difference between the mean preoperative and postoperative IOP values was also found to be highly statistically significant (p 1/4 0.0005). Conclusion Delayed significant increase in IOP can occur after FESS, Thus, special measures must be taken to reduce IOP to protect the patient́s eye from the risk of increased IOP, especially in patients with glaucoma.

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Abstract Introduction Granulocyte-macrophage colony-stimulating factor (GM-CSF) is a strong proinflammatory cytokine that takes part in allergic nasal inflammation as an eosinophil colony-stimulating factor. However, the role of GM-CSF in non-allergic rhinitis has not been fully explored. Objectives The aim of this investigation was to assess the concentration of GM-CSF in nasal secretions of patients with non-allergic rhinitis with eosinophilia syndrome (NARES) in comparison to patients with perennial allergic rhinitis (PAR) and healthy subjects, as well as to assess the relationship with the degree of eosinophilic inflammation and clinical characteristics of the patients. Methods Fourteen patients with diagnosis of NARES, 14 PAR patients, and 14 healthy subjects were included in this cross-sectional study. All patients underwent symptom score assessment, nasal endoscopy, allergy testing, and cytological evaluation. The concentration of GM-CSF in nasal secretions of all participants was measured by enzyme-linked immunosorbent assay ( ELISA ). Results We found significantly higher levels of GM-CSF in patients with NARES than in the control group (p= 0.035). The percent of eosinophils in nasal mucosa was higher in NARES patients in comparison to patients with PAR (p< 0.001) and control patients (p< 0.0001). We found positive correlations between GM-CSF levels and eosinophil counts only in NARES patients. Conclusion The concentrations of GM-CSF in nasal secretions correlate well with eosinophil counts in the nasal mucosa of NARES patients. These facts indicate a possible role of GM-CSF as a favorable marker for assessment of nasal disease severity and the degree of chronic eosinophilic inflammation in the nasal mucosa.

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Abstract Introduction The structural changes underlying permanent noise-induced hearing loss (NIHL) include loss of the sensory hair cells, damage to their stereocilia, and supporting tissues within the cochlear lateral wall. Objective The objective of this study is to demonstrate curcumin as a safe and effective therapeutic agent in the prevention and treatment for fibroblasts damage within the cochlear supporting tissues and lateral wall through cell death pathway. Methods We divided 24 Rattus norvegicus into 4 groups, Group 1: control; Group 2: noise (þ); Group 3: noise (þ), 50 mg/day curcumin (þ); Group 4: noise (þ), 100 mg/day curcumin (þ). We provided the noise exposure dose at 100 dB SPL for two hours over two weeks and administered the curcumin orally over two weeks. We examined all samples for the expressions of calcineurin, nuclear factor of activated T-cells cytoplasmic 1 (NFATc1), and apoptotic index of cochlear fibroblasts. Results We found significant differences for the expressions of calcineurin (p< 0.05) in all groups, significant differences for the expressions of NFATc1 (p< 0.05) in all groups, except in Groups 1 and 4, and significant differences for the apoptotic index (p< 0.05) in all groups. Conclusion Curcumin proved to be potentially effective in the prevention and treatment for fibroblasts damage within the cochlear supporting tissues and lateral wall regarding the decreased expression of calcineurin, NFATc1, and apoptotic index of cochlear fibroblasts.

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Abstract Introduction Bismuth subgallate (BS) is a yellow and odorless powder that has hemostatic astringent properties. Some otorhinolaryngologists and dentists currently use this substance to enhance wound healing. Objective The objective of this study is to evaluate the effects of bismuth subgallate on wound healing, through the analysis of inflammatory process, collagen production, and angiogenesis. Method A standard wound was made on the back of 60 male Wistar rats, using a biopsy punch. We created two groups: the experimental group, which underwent daily application of 0.5mg BS over the entire wound, and the control group, which underwent daily application of sodium chloride 0.9%. We performed a qualitative evaluation of the tissue on the third, seventh, and fourteenth day. We assessed inflammatory markers using Hematoxylin and Eosin (HE) stain, used Picrosirius stain for collagen analysis, and immunohistochemistry was used for angiogenesis analysis through evaluation of smooth muscle proliferation. Results Statistically, we found no significant differences between groups regarding inflammatory response on the third (p= 1), seventh (p= 0.474), and fourteenth day (p= 0.303). Also, collagen type I and III production showed no statistical differences between groups on the third (p= 0.436), seventh (p= 0.853), and fourteenth day (p= 0.436) of analysis. Immunohistochemistry did not present differences on angiogenesis between experimental and control group on the third (p= 0.280), seventh (p= 0.971), and fourteenth day (p= 0.218). Conclusion BS does not promote significant changes in inflammatory response, collagen, and angiogenesis. Thus, it does not influence healing on skin wounds on rats.

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Abstract Introduction High mobility group box 1 is a versatile protein involved in gene transcription, extracellular signaling, and response to inflammation. Extracellularly, high mobility group box 1 binds to several receptors, notably the receptor for advanced glycation end-products. Expression of high mobility group box 1 and the receptor for advanced glycation end-products has been described in many cancers. Objectives To systematically review the available literature using PubMed and Web of Science to evaluate the clinical value of high mobility group box 1 and the receptor for advanced glycation end-products in head and neck squamous cell carcinomas. Data synthesis A total of eleven studies were included in this review. High mobility group box 1 overexpression is associated with poor prognosis and many clinical and pathological characteristics of head and neck squamous cell carcinomas patients. Additionally, the receptor for advanced glycation end-products demonstrates potential value as a clinical indicator of tumor angiogenesis and advanced staging. In diagnosis, high mobility group box 1 demonstrates low sensitivity. Conclusion High mobility group box 1 and the receptor for advanced glycation endproducts are associated with clinical and pathological characteristics of head and neck squamous cell carcinomas. Further investigation of the prognostic and diagnostic value of these molecules is warranted.

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Abstract Introduction Several surgical techniques and modifications have been described to reduce the high recurrence rate after excision of preauricular sinus. Objectives The aim of this study is to review the literature regarding surgical approaches for preauricular sinus. Data Synthesis We performed searches in the LILACS, MEDLINE, SciELO, PubMed databases and Cochrane Library in September, 2015, and the key words used in the search were "preauricular sinus," "sinusectomy," "supra-auricular approach," "methylene blue," and/or "recurrence." We revised the results of 17 studies, including 1270 preauricular sinuses that were surgically excised by sinusectomy in 937 ears and by supra-auricular approach in 333 ears. Recurrence with supra-auricular was 4 (1.3%) while sinusectomy was 76 (8.1%) with significant difference (p< 0.0001). There were no reported facial nerve paresis or paralysis in any of the approaches. The sinusectomy approach showed significantly more complications (p= 0.0048). Conclusion Supra-auricular approach had significantly less recurrence rate than tract sinusectomy approaches. Thus, it could be regularly chosen as the standard procedure for preauricular sinus excision. As such, it would be helpful for surgeons to be familiar with this approach.

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Abstract Introduction Ramsay Hunt syndrome is the second most common cause of facial palsy. Early and correct treatment should be performed to avoid complications, such as permanent facial nerve dysfunction. Objective The objective of this study is to review the prognosis of the facial palsy on Ramsay Hunt syndrome, considering the different treatments proposed in the literature. Data Synthesis We read the abstract of 78 studies; we selected 31 studies and read them in full. We selected 19 studies for appraisal. Among the 882 selected patients, 621 (70.4%) achieved a House-Brackmann score of I or II; 68% of the patients treated only with steroids achieved HB I or II, versus 70.5% when treated with steroids plus antiviral agents. Among patients with complete facial palsy (grades V or VI), 51.4% recovered to grades I or II. The rate of complete recovery varied considering the steroid associated with acyclovir: 81.3% for methylprednisolone, 69.2% for prednisone; 61.4% for prednisolone; and 76.3% for hydrocortisone. Conclusions Patients with Ramsay-hunt syndrome, when early diagnosed and treated, achieve high rates of complete recovery. The association of steroids and acyclovir is better than steroids used in monotherapy.