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Orientador: Paulo Henrique Ferreira Caria / Dissertação (mestrado) - Universidade Estadual de Campinas, Faculdade de Odontologia de Piracicaba / Made available in DSpace on 2018-08-22T04:10:47Z (GMT). No. of bitstreams: 1 PaulaJunior_FaustoAntoniode_M.pdf: 1772766 bytes, checksum: 78c522c3972255a7ea165ea489f7c456 (MD5) Previous issue date: 2013 / Resumo: O diagnóstico diferencial entre indivíduos portadores de otalgia pode ser um grande desafio clínico devido à sobreposição de sinais e sintomas e principalmente quando não há uma doença diagnosticada pela otoscopia, portanto, o objetivo desta pesquisa foi fornecer elementos diagnósticos que permitam aprimorar o diagnóstico diferencial das otalgias primárias e secundárias à disfunção temporomandibular (DTM). Foram selecionados 112 voluntários (90 mulheres e 22 homens) com idade igual ou acima de 18 anos (idade média: 45,39 ± 17,2), que compareceram entre janeiro e setembro de 2012, ao ambulatório de Otorrinolaringologia do Hospital e Maternidade Santa Casa de Limeira com queixa de otalgia. Todos os voluntários foram examinados de acordo com uma ficha clínica elaborada de acordo com 3 guidelines: 1) Academia Americana de Otorrinolaringologia, 2) Associação Brasileira de Otorrinolaringologia e Cirurgia Cérvico Facial e 3) Eixo I do Research Diagnostic Criteria for Temporomandibular Disorders (RDC/TMD). Os exames possibilitaram classificar os voluntários em portadores de Otalgia Primária (OP), Otalgia Secundária à Disfunção Termporomandibular (OSDTM) e Otalgia Não Relacionada à Disfunção Temporomandibular (OSNDTM) e às DTMs em: grupo I (desordem muscular), grupo II (deslocamento de disco) e grupo III (artralgia, osteoartrite e osteoartrose). Após o diagnóstico, os voluntários foram comparados em relação às características da dor, frequência de dor à palpação muscular, ruídos articulares e presença de sintomas otológicos. Utilizou-se o teste Qui-quadrado para comparar as características da otalgia em pacientes com OSDTM e OP e o teste de Mann- Whitney para avaliar a associação dos sintomas otológicos, palpação muscular e ruídos articulares nos voluntários com otalgia secundária e primária. Estabeleceu se 5% como nível de significância para todos os testes. Os resultados mostraram que 92 (82,1%) voluntários foram diagnosticados com OSDTM, 15 (13,4%) com OP e cinco (4,5%) com OSNDTM. No tocante aos diagnósticos orientados pelo RDC/TMD obtivemos artralgia e dor miofascial com as maiores prevalências, respectivamente, 71 (77,2%) e 54 (58,7%). Os voluntários com OSDTM apresentaram otalgia prolongada (anos): 39 (42,4%), recorrente: 66 (71,7%), do tipo puntiforme: 49 (53,3%) e irradiada para duas ou mais regiões: 62 (67,4%). Em relação aos voluntários classificados como OP, prevaleceu à dor com menor tempo de duração (dias) ao diagnóstico: 10 (66,7%), constante: 13 (86,6%), do tipo pulsátil em seis (40%) dos casos e pontada em outros seis (40%), e irradiada para apenas uma região: 12 (80%). Observou-se ainda, que os voluntários com OSDTM, em relação aos pacientes com OP, apresentaram significativamente maior frequência de dor à palpação da musculatura avaliada e de ruídos articulares. No tocante aos sintomas otológicos, tontura e prurido auricular prevaleceram nos voluntários com OSDTM e nos voluntários com OP foram mais frequente os sintomas de plenitude auricular e zumbido. Concluiu-se que os voluntários com otalgia secundária à DTM e otalgia primária apresentam um perfil de dor com diferenças significativas em relação ao tempo de dor, frequência, irradiação e caráter. Além disso, os voluntários portadores de OSDTM apresentam maior prevalência de dor à palpação da musculatura indicada pelo RDC/TMD e maior frequência de ruídos articulares. Portanto, diante de um paciente com otalgia, os sintomas (características da dor) e sinais (palpação muscular e ruídos articulares) podem indicar o provável diagnóstico / Abstract: Differential diagnosis among individuals with otalgia can be a major clinical challenge due to overlapping symptoms, and especially without an elemental disease on otoscopy, therefore, the aim of this research was to provide diagnostic elements to improve the differential diagnosis of primary otalgias and secondary otalgias to temporomandibular disorder (TMD). It was selected 112 volunteers (90 women and 22 men) with aged greater than or igual to 18 years old (average age 45.39±17.2 years old), who came between January and September 2012, at the Otorhinolaryngology Department of the Santa Casa Hospital in Limeira, complaining otalgia. All volunteers were examined according to a clinical record prepared of according to 3 guidelines: 1º) American Academy of Otolaryngology, 2º) Brazilian Association of Otolaryngology and Facial Surgery and 3º) Axis 1 of the Research Diagnostic Criteria for Temporomandibular Disorders. The tests allowed to classify volunteers with primary otalgia (PO), secondary otalgia to termporomandibular disorder (SOTMD) and otalgia not related to temporomandibular disorder (SONTMD) and the TMDs in: group I (muscle disorder) group II (disc displacement) and group III (arthralgia, osteoarthritis and osteoarthoroses). After diagnosis, the volunteers were compared to the characteristics of pain, frequency of pain on muscle palpation, joint sounds and otologic symptoms. The chi-square test was used to compare the characteristics of otalgia in volunteers with SOTMD and PO. It was used the Mann-Whitney test to evaluate the association of otologic symptoms, muscle palpation and joint souds in volunteers with primary and secondary otalgia. It was established as 5% the significance level for all tests. The results showed that 92 (82.1%) volunteers were diagnosed with SOTMD, 15 (13.4%) with PO and five (4.5%) with SONTMD. Regarding to the diagnoses guided by RDC/TMD the arthralgia and miofascial pain showed the highest prevalence's, respectively, 71 (77.2%) e 54 (58.7%). The volunteers with SOTMD presented with a longer duration of otalgia: 39 (42.4%), reoccurring: 66 (71,7%), having a sensation like an input spear 49(53.3%) and spreading over more than a single region: 62 (67,4%). The individuals classified as PO had greater frequency of acute pain, lasting for days: 10 (66.7%), constant: 13 (86.6%) and pulsating in 40% of the cases, stabbing in another 40%, and radiating over one region: 12 (80%). It was also observed that the volunteers with SOTMD, compared to volunteers with PO, have significantly higher frequency of pain on palpation in most muscles examined and joint sounds. Regarding to otologic symptoms, dizziness and ear pruritus were more common in volunteers classified as having SOTMD, while in the PO volunteers the symptoms of stuffy sensation and tinnitus were more frequent. It was concluded that subjects with secondary otalgia to TMD and primary otalgia reveals a profile of pain with significant differences in relation to duration, frequency, irradiation and character. Moreover, the SOTMD volunteers present a higher prevalence of pain upon muscle palpation and joint sounds. Therefore, facing a patient with otalgia, the symptoms (pain characteristics) and signs (muscle palpation and joint sounds) may indicate a likely diagnosis / Mestrado / Anatomia / Mestre em Biologia Buco-Dental

"Hearing loss affects approximately 1 in 10 people in the world and this percentage is increasing every year. Some of the most common causes of hearing loss are disorders of the middle-ear. Early detection and diagnosis of hearing loss as well as research to understand the hearing processes depend on medical and research tools for quantification of hearing capabilities and the function of the middle-ear in the complex acousto-mechanical transformation of environmental sounds into vibrations of the middle-ear, particular of the human tympanic membrane (TM or eardrum). Current ear exams assess the state of a patient’s hearing capabilities mainly based on qualitative evaluation of the healthiness of the TM. Existing quantitative clinical methods for description of the motion of the TM are limited to either average acoustic estimates (admittance or reflectance) or single-point displacement measurements. Such methods could leave examiners and researchers blind to the complex spatio-temporal response of the nanometer scale displacements of the entire TM. Current state-of-the-art medical research tools provide full-field nanometer displacement measurements of the surface of the human TM excited by steady state (tonal) stimuli. However, to fully understand the mechanics of hearing, and the complex acousto-mechanical characteristics of TM in particular, new tools are needed for full-field high-speed characterization of the nanometer scale displacements of the human TM subjected to impulse (wideband) acoustic excitation. This Dissertation reports the development of a new high-speed holographic system (HHS) for full-field nanometer transient (i.e., > 10 kHz) displacement measurement of the human middle-ear and the tympanic membrane, in particular. The HHS allows spatial (i.e., >500k data points) and temporal (i.e., > 40 kHz) resolutions that enable the study of the acoustical and mechanical characteristics of the middle-ear at a level of detail that have never been reached before. The realization of the HHS includes the development and implementation of novel phase sampling and acquisition approaches that allow the use of state-of-the-art high-resolution (i.e., >5 MP) and high-speed (> 80,000 fps) cameras through modular and expandable control architectures. The development of novel acquisition approaches allows the use of conventional speed (i.e., <20 fps) cameras to realize high-temporal resolutions (i.e., <15 us) at equivalent sampling rates of > 50,000 fps with minimum hardware cost and modifications. The design and implementation of novel spatio-temporal phase sampling methods utilize the high temporal resolution (i.e., < 5 us exposure) and frame rate (i.e., >80,000 fps) of high-speed cameras without imposing constraints on their spatial resolution (i.e., >20 um pixel size). Additionally, the research and in-vivo applications capabilities of the HHS are extended through the development and implementation of a holographic otoscope head (OH) and a mechatronic otoscope positioner (MOP). The large (i.e., > 1 GB with > 8x10^9 parameters) spatio-temporal data sets of the HHS measurements are automatically processed by custom parallel data mining and interpretation (PDMI) methods, which allow automatic quantification of medically relevant motion parameters (MRMPs), such as modal frequencies, time constants, and acoustic delays. Such capabilities could allow inferring local material properties across the surface of the TM. The HHS is a new medical tool that enables otologists to improve the quality of diagnosis and treatments as well as provides researchers with spatio-temporal information of the hearing process at a level of detail never reached before. "

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Children with hearing loss, mostly show a significant gap in the educational, social and emotional development. After the creation of the National Hearing Health Care in 2004, hearing loss has been discussed in the context of public policies in order to determine and plan actions that aim to develop strategies for promoting quality of life. Objectives: To describe the audiological profile of children attending reference service in High Complexity; determine the map of origin of the patients; correlate hearing loss to gender and age, to identify the type and degree of hearing loss, characterize the type of apparatus Personal Sound Amplification selected and analyze the continuity of the process in the rehabilitation of speech. Methodology: a descriptive study was conducted in 129 children from 0-15 years of old who were referred to the high complexity in Hearing Health at São José Hospital, State of Sergipe. Audiometry, Impedanciometry, Evoked Otoacoustic Emissions and Auditory Brainstem Response to characterize the hearing loss, electrophysiological tests and corresponding age group behavioral responses were used. After clinical evaluation by a multidisciplinary team, the children were sent to check the Sound Amplification Device and speech rehabilitation therapy. Results: children were studied, of both genders, aged 0-15 years old. Regarding gender, 69 (53.5 %) were female. With respect to age, 91 (70.5 %) were from 11-15 years old. Regarding demographic factors, 43 (33.3 %) lived in Aracaju. Hearing loss in both ears, occurred in 124 (96.1 %) cases. According to information gathered in the interview, in 67 (51.9 %) children were reported as unknown etiology. On the type and degree of hearing loss, 111 (86.1 %) children had sensorneural loss and in 101 (78.3 %) the loss was severe to profound. The speech rehabilitation therapy was performed for 46 (35.7 %) children in the study. The Sound Amplification Device selected in 127 (98.4 %) children were of the BTE model, and 79 (61.2 %) belonging to Class |A|. Conclusion: higher percentage of female children aged 11-15 years has been identified. The sensorneural hearing loss of severe to profound bilateral showed high prevalence. The type and model of appliance Sound Amplification selected following the recommendations of the Ministry of Health Among children who did speech therapy, most reside in the capital or near the cities Hearing Health Service. / As crianças que apresentam deficiência auditiva, na sua maioria demonstram defasagem significativa no desenvolvimento pedagógico, social e emocional. Após a criação da Política Nacional de Atenção à Saúde Auditiva em 2004, a deficiência auditiva vem sendo discutida no âmbito das políticas públicas a fim de determinar e de programar ações que objetivam desenvolver estratégias voltadas à promoção da qualidade de vida. Objetivos: descrever o perfil audiológico das crianças atendidas em serviço de referência na Alta Complexidade; determinar o mapa de procedência dos pacientes; correlacionar a perda auditiva ao sexo e faixa etária; identificar o tipo e o grau da perda auditiva; caracterizar o tipo de Aparelho de Amplificação Sonora Individual selecionado e analisar a continuidade do processo na reabilitação de fala. Metodologia: foi realizado estudo descritivo em 129 crianças na faixa etária de 0 a 15 anos de idade encaminhadas ao serviço de alta complexidade em Saúde Auditiva do Hospital São José, Estado de Sergipe. Para caracterizar a perda auditiva, foram utilizados exames eletrofisiológicos e respostas comportamentais correspondentes à faixa etária: Audiometria, Impedanciometria, Emissões Otoacústicas e Potencial Evocado Auditivo de Tronco Encefálico. Após avaliação clínica realizada por uma equipe multidisciplinar, as crianças foram encaminhadas à seleção do Aparelho de Amplificação Sonora e terapia de reabilitação de fala. Resultados: foram estudadas crianças de ambos os gêneros, na faixa etária de 0 a 15 anos de idade. Quanto ao gênero, 69 (53,5%) eram do sexo feminino. Com relação à faixa etária, 91 (70,5%) apresentavam 11 a 15 anos de idade. Quanto aos fatores demográficos, 43 (33,3%) residiam em Aracaju. A perda auditiva acometeu ambas as orelhas em 124 (96,1%) dos casos. De acordo com informações colhidas na entrevista, em 67 (51,9%) crianças a etiologia foi referida como desconhecida. Quanto ao tipo e grau da perda auditiva, 111 (86,1%) crianças apresentaram perda sensorioneural e em 101 (78,3%) a perda era de grau severo a profundo. A terapia de reabilitação de fala foi realizada por 46 (35,7%) crianças do estudo. O Aparelho de Amplificação Sonora selecionado em 127 (98,4%) crianças foi do modelo retroauricular, sendo (79) 61,2% pertencentes à Classe A . Conclusão: foi identificado maior percentual de crianças do sexo feminino com faixa etária de 11 a 15 anos. A perda auditiva do tipo sensorioneural de grau severo a profundo bilateralmente apresentou alta prevalência, sendo indicado o Aparelho de Amplificação Sonora tipo A . A terapia de fala não foi realizada pela maioria das crianças atendidas.

Evidence-based practice, whose roots emanate from the mid-1960s, aims to provide fair, high-quality, and soundly researched health care with patients' best interests as a priority. Clinical practice guidelines are evidence-based and designed to assist clinicians with sound decision making. Despite the importance of evidence-based practice and the efforts invested into its development and dissemination, its uptake and implementation are poor. The disconnect between evidence-based practice and its translation into clinical practice was previously reported in low-to-middle income countries. This study investigated South African audiologists' and otorhinolaryngologists' (ear, nose and throat specialists') self-reported orientation to evidence-based practice. Second, adherence to evidence-based clinical practice guidelines was assessed with reference to the diagnosis and management of benign paroxysmal positional vertigo, a common vestibular condition for which a firm evidence base supporting treatment exists. A two-part quantitative approach was adopted. Part one surveyed South African audiologists and otorhinolaryngologists with the Evidence-Based Practice Profile Questionnaire and an additional researcher-developed questionnaire pertaining to the diagnosis and management of benign paroxysmal positional vertigo. A total of 130 survey responses were included in this study. Independent sample t-tests, one-way ANOVAs and Fisher's Exact tests were used to analyse the survey data. Part two used a retrospective record review at a tertiary academic hospital in the Western Cape of South Africa. Medical folders of patients diagnosed with benign paroxysmal positional vertigo, between 2010 – 2018 (n = 80), were analysed. The diagnosis and management strategies were recorded and compared against a gold standard evidence based guideline for congruence. Descriptive statistics were used to analyse and understand the data. Survey scores showed a positive association between increased years of experience and healthcare professionals' knowledge (p = .008) and confidence (p = .003) in evidence-based practice. Otorhinolaryngologists might be more knowledgeable than audiologists in evidence-based practice due to their increased training and exposure to evidence-based practice in their specialising years. Findings from the retrospective record review suggested adherence to the clinical practice guidelines in the diagnosis and management of posterior semi circular canal benign paroxysmal positional vertigo. The study outcomes propose that evidence-based clinical practice guidelines developed in the Global North may not be appropriate for the different health contexts that exist in low-to-middle income South Africa (e.g., rural settings). However, the benign paroxysmal positional vertigo clinical practice guidelines were adhered to at a tertiary, academic hospital in Cape Town. The results also support the notion that increased exposure to evidence-based practice reinforces its approach. Outcomes from this study raise implications for the development and dissemination of context-appropriate, evidence-based clinical practice guidelines.