RENATA MOTA MAMEDE CARVALLO
Projetos de Pesquisa
Unidades Organizacionais
Departamento de Fisioterapia, Fonoaudiologia e Terapia Ocupacional, Faculdade de Medicina - Docente
LIM/34 - Laboratório de Ciências da Reabilitação, Hospital das Clínicas, Faculdade de Medicina
LIM/34 - Laboratório de Ciências da Reabilitação, Hospital das Clínicas, Faculdade de Medicina
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- Evaluation of peripheral auditory pathways and brainstem in obstructive sleep apnea(2018) MATSUMURA, Erika; MATAS, Carla Gentile; MAGLIARO, Fernanda Cristina Leite; PEDRENO, Raquel Meirelles; LORENZI-FILHO, Geraldo; SANCHES, Seisse Gabriela Gandolfi; CARVALLO, Renata Mota MamedeIntroduction: Obstructive sleep apnea causes changes in normal sleep architecture, fragmenting it chronically with intermittent hypoxia, leading to serious health consequences in the long term. It is believed that the occurrence of respiratory events during sleep, such as apnea and hypopnea, can impair the transmission of nerve impulses along the auditory pathway that are highly dependent on the supply of oxygen. However, this association is not well established in the literature. Objective: To compare the evaluation of peripheral auditory pathway and brainstem among individuals with and without obstructive sleep apnea. Methods: The sample consisted of 38 adult males, mean age of 35.8 (+/- 7.2), divided into four groups matched for age and Body Mass Index. The groups were classified based on polysomnography in: control (n = 10}. mild obstructive sleep apnea (n = 11) moderate obstructive sleep apnea (n=8) and severe obstructive sleep apnea (n = 9}. All study subjects denied a history of risk for hearing loss and underwent audiometry, tympanometry, acoustic reflex and Brainstem Auditory Evoked Response. Statistical analyses were performed using three-factor ANOVA, 2 factor ANOVA, chi-square test, and Fisher's exact test. The significance level for all tests was 5%. Results: There was no difference between the groups for hearing thresholds, tympanometry and evaluated Brainstem Auditory Evoked Response parameters. An association was observed between the presence of obstructive sleep apnea and changes in absolute latency of wave V (p = 0.03). There was an association between moderate obstructive sleep apnea and change of the latency of wave V (p = 0.01). Conclusion: The presence of obstructive sleep apnea is associated with changes in nerve conduction of acoustic stimuli in the auditory pathway in the brainstem. The increase in obstructive sleep apnea severity does not promote worsening of responses assessed by audiometry, tympanometry and Brainstem Auditory Evoked Response. (C) 2016 Associacao Brasileira de Otorrinolaringologia e Cirurgia Cervico-Facial.
- Efferent inhibition of otoacoustic emissions in preterm neonates(2015) CARVALLO, Renata Mota Mamede; SANCHES, Seisse Gabriela Gandolfi; IBIDI, Silvia Maria; SOARES, Jordana Costa; DURANTE, Alessandra SpadaIntroduction: Abnormalities in auditory function of newborns may occur not only because of preterm birth, but also from the use of medications and from diseases related to prematurity. Objective: To analyze the inhibitory effect from stimulation of the olivocochlear efferent system on transient evoked otoacoustic emissions in preterm neonates, comparing these data with those from full-term neonates. Methods: This was a prospective, cross-sectional, contemporary cohort study with 125 neonates, pooled into two groups: full-term (72 full-term neonates, 36 females and 36 males, born at 37-41 weeks of gestational age); and preterm (53 neonates, 28 males and 25 females, born at <= 36 weeks of gestational age, evaluated at the corrected gestational age of 37-41 weeks). Otoacoustic emissions were recorded using linear and nonlinear click-evoked stimuli, with and without contralateral stimulation. Results: The inhibitory effect of the efferent pathway in otoacoustic emissions was different (p = 0.012) between groups, and a mean reduction of 1.48 dB SPL in full-term births and of 1.02 dB SPL in preterm births was observed for the non-linear click-evoked stimulus. Conclusion: The results suggest a reduced inhibitory effect of the olivocochlear efferent system on otoacoustic emissions in preterm neonates.
- Medial olivocochlear function in children with poor speech-in-noise performance and language disorder(2017) ROCHA-MUNIZ, Caroline Nunes; CARVALLO, Renata Mota Mamede; SCHOCHAT, ElianeObjectives: Contralateral masking of transient-evoked otoacoustic emissions is a phenomenon that suggests an inhibitory effect of the olivocochlear efferent auditory pathway. Many studies have been inconclusive in demonstrating a clear connection between this system and a behavioral speech-in-noise listening skill. The purpose of this study was to investigate the activation of a medial olivocochlear (MOC) efferent in children with poor speech-in-noise (PSIN) performance and children with language impairment and PSIN (SLI + PSIN). Methods: Transient evoked otoacoustic emissions (TEOAEs) with and without contralateral white noise were tested in 52 children (between 6 and 12 years). These children were arranged in three groups: typical development (TD) (n = 25), PSIN (n = 14) and SLI + PSI (n = 13). Results: PSIN and SLI + PSI groups presented reduced otoacoustic emission suppression in comparison with the TD group. Conclusion: Our finding suggests differences in MOC function among children with typical development and children with poor SIN and language problems.
- Maternal smoking during pregnancy: Impact on otoacoustic emissions in neonates(2011) DURANTE, Alessandra Spada; IBIDI, Silvia Maria; LOTUFO, Joao Paulo Becker; CARVALLO, Renata M. M.Objectives: To determine the effect of maternal smoking during pregnancy on transient evoked otoacoustic emissions levels in neonates. Methods: This was a cross-sectional study investigating neonates in the maternity ward of a university hospital in the city of Sao Paulo, Brazil. A total of 418 term neonates without prenatal or perinatal complications were evaluated. The neonates were divided into two groups: a study group, which comprised 98 neonates born to mothers who had smoked during pregnancy; and a control group, which comprised 320 neonates born to mothers who had not. In order to compare the two ears and the two groups in terms of the mean overall response and the mean transient evoked otoacoustic emissions in response to acoustic stimuli delivered at different frequencies, we used analysis of variance with repeated measures. Results: The mean overall response and the mean frequency-specific response levels were lower in the neonates in the study group (p < 0.001). The mean difference between the groups was 2.47 dB sound pressure level (95% confidence interval: 1.47-3.48). Conclusions: Maternal smoking during pregnancy had a negative effect on cochlear function, as determined by otoacoustic emissions testing. Therefore, pregnant women should be warned of this additional hazard of smoking. It is important that smoking control be viewed as a public health priority and that strategies for treating tobacco dependence be devised.
- Middle ear muscle reflex measurement in neonates: Comparison between 1000 Hz and 226 Hz probe tones(2015) LYRA-SILVA, Kilza Arruda de; SANCHES, Seisse Gabriela Gandolfi; NEVES-LOBO, Ivone Ferreira; IBIDI, Silvia Maria; CARVALLO, Renata Mota MamedeIntroduction: Middle ear muscle reflex (MEMR) evaluation assists in diagnosing hearing problems because normal responses depend on preconditions of a healthy auditory system. Studies in neonates recording the acoustic reflex with 226 Hz probes have described high rates of absence. Other studies using a high frequency probe have found higher rates of presence in normal neonates. However, few studies have compared results between low and high frequency probes in the same newborns. Objective: To comparatively assess the ipsilateral acoustic reflex recorded by 226 Hz and 1000 Hz probes in newborns. Method: A total of 77 newborns, with the presence of transient otoacoustic emissions, underwent tympanometry, wideband acoustic immittance, and ipsilateral reflex investigations with 226 Hz and 1000 Hz tone probes. Results: The acoustic reflex was activated at a much lower intensity with all activating stimuli using the 1000 Hz probe compared with the values of the 226 Hz probe. There was a higher incidence of ipsilateral acoustic reflexes recorded by the 1000 Hz tone probe compared to the 226 Hz tone probe. There was no correlation between the acoustic reflex thresholds and otoacoustic emissions. Conclusion: In newborns, the acoustic reflex measurements obtained with the 1000 Hz probe showed advantages over the 226 Hz probe.
- Wideband reflectance in Down syndrome(2016) SOARES, Jordana Costa; UROSAS, Juliana Granja; CALARGA, Karenina Santos; PICHELLI, Tathiany Silva; LIMONGI, Suelly Cecilia Olivan; SHAHNAZ, Navid; CARVALLO, Renata Mota MamedeObjective: Children with Down syndrome (DS) have a high incidence of middle ear disorders and congenital abnormalities of the external, middle and inner ear. Energy reflectance (ER), a wideband acoustic immittance (WAI) measurement parameter, can measure the sound energy reflected or absorbed in the ear canal over a wider range of frequencies more efficiently and faster than conventional single-tone 226 Hz tympanometry. The aim of the present study was to compare the WAI measurements of children with DS with those of typically developing, normal-hearing children according to their tympanometric findings. Methods: Four groups of children with Down syndrome (age range: 2 years and 4 months to 16 years and 3 months; mean age: 8.5 yr) with normal tympanograms (19 ears), flat tympanograms (13 ears), mild negative pressure tympanograms (6 ears between -100 and -199 daPa at the admittance peak) and severe negative pressure tympanograms (4 ears at -200 daPa or lower at the admittance peak) were assessed. All findings were compared with data obtained from 21 ears of a healthy control group (age range: 3 years and 1 month to 13 years and 11 months; mean age: 7.9 yr). The subjects underwent tympanometry with a 226-Hz probe tone frequency and ER measurements along the 200-6,000 Hz range with a chirp stimulus using the Middle-Ear Power Analyzer (MEPA3 - HearID) by Mimosa Acoustics (Champaign, IL), software, version 3.3 [38]. Results: Statistically significant differences were observed in the ER curves for some comparisons between the studied groups. There was also a negative correlation between the static acoustic admittance at the tympanic membrane level and ER measured with a chirp stimulus at 500 and 1,000 Hz. The discriminant analysis technique, which used a chirp stimulus at 1,000 and 1,600 Hz to classify the participants' data based on ER values, achieved a correct classification rate of 59.52% for participants with DS. Conclusion: While groups with abnormal middle ear status, as indicated by tympanometry, showed higher ER values compared to the DS tymp A group and the control group, similar reflectance curves were observed between control group and the DS tymp A group. WAI shows promise as a clinical diagnostic tool in investigating the impact of middle ear disorders in DS group. However, further research is required to investigate this issue in narrower age range group and a larger sample size.
- Development of auditory perception in preschool children(2020) VILELA, Nadia; SANCHES, Seisse Gabriela Gandolfi; CARVALLO, Renata Mota MamedeObjective: The aim of this study was to determine whether the auditory skills presented by five-year-old children can predict their performance in auditory processing (AP) tests at seven years old. Design: Thirty five children were evaluated for AP at two different times. At evaluation 1, the children were between 5 years 2 months and 6 years 1 month of age, and at evaluation 2, they were between 7 years 1 month and 7 years 8 months of age. The interval between the evaluations ranged from 18 to 23 months. After evaluation 2, the 7-year-olds were classified according to their performance on central AP tests. The children were divided into three groups: GI included nine children with at least two AP tests that scored two standard deviations below the mean and the presence of a speech complaint; GII included 18 children with at least two AP tests that scored two standard deviations below the mean and no speech complaints; and GIII included eight children with no more than one test scored two standard deviations below the mean and no speech disorders complaint. The analysis was performed considering each test individually and as a battery of applied tests. From the results obtained, a discriminant analysis was performed to assess the differences in test performance between the groups when the children were 5 years old. Results: The discriminant analysis showed that with the results obtained during evaluation 1, it was possible to predict which group 74.3% of the children would be classified into after evaluation 2. The percentage of correct classifications for each group was 77.8% for GI, 66.7% for GII and 87.5% for GIII. That is, 87.5% of the children who were classified as GIII after evaluation 2 had already demonstrated good auditory performance in the tests applied at 5 years of age. Conclusions: Children who exhibited lower scores on AP tests at 7 years of age had demonstrated poor auditory perception at 5 years of age. This finding is relevant because it offers the possibility of stimulating or training these auditory skills in preschoolers to foster their development.
- The influence of (central) auditory processing disorder in speech sound disorders(2016) BARROZO, Tatiane Faria; PAGAN-NEVES, Luciana de Oliveira; VILELA, Nadia; CARVALLO, Renata Mota Mamede; WERTZNER, Haydee FiszbeinIntroduction: Considering the importance of auditory information for the acquisition and organization of phonological rules, the assessment of (central) auditory processing contributes to both the diagnosis and targeting of speech therapy in children with speech sound disorders. Objective: To study phonological measures and (central) auditory processing of children with speech sound disorder. Methods: Clinical and experimental study, with 21 subjects with speech sound disorder aged between 7.0 and 9.11 years, divided into two groups according to their (central) auditory processing disorder. The assessment comprised tests of phonology, speech inconsistency, and metalinguistic abilities. Results: The group with (central) auditory processing disorder demonstrated greater severity of speech sound disorder. The cutoff value obtained for the process density index was the one that best characterized the occurrence of phonological processes for children above 7 years of age. Conclusion: The comparison among the tests evaluated between the two groups showed differences in some phonological and metalinguistic abilities. Children with an index value above 0.54 demonstrated strong tendencies towards presenting a (central) auditory processing disorder, and this measure was effective to indicate the need for evaluation in children with speech sound disorder.
- Effect of contralateral stimulation on acoustic reflectance measurements(2015) PICHELLI, Tathiany Silva; SOARES, Jordana Costa; CIBIN, Bruna Carla; CARVALLO, Renata Mota MamedeIntroduction: Acoustic reflectance is an important tool in the assessment of middle ear afflictions, and the method is considered advantageous in relation to tympanometry. There has been a growing interest in the study of contralateral acoustic stimulation and its effect on the activation of the efferent auditory pathway. Studies have shown that the introduction of simultaneous stimulation in the contralateral ear generates alterations in auditory response patterns. Objective: To investigate the influence of contralateral stimulation on acoustic reflectance measurements. Methods: Case study of 30 subjects with normal hearing, of both genders, aged 18-30 years. The test and retest acoustic reflectance was conducted in the frequency range 200-6000 Hz. The procedure was repeated with the simultaneous presence of contralateral white noise at 30 dBNS. Results: The analysis of the conditions of test, retest, and test with contralateral noise showed statistical difference at the frequency of 2 kHz (p =0.011 and p=0.002 in test and retest, respectively) in the right ear. Conclusion: The activation of the auditory efferent pathways through contralateral acoustic stimulation produces alterations in response patterns of acoustic reflectance, increasing sound reflection and modifying middle ear acoustical energy transfer.
- Peripheral hearing in Parkinson's disease: a systematic review(2023) LEME, Mariana S.; SANCHES, Seisse G. G.; CARVALLO, Renata M. M.Objective To investigate the implications of Parkinson's disease (PD) in the peripheral auditory system, a systematic survey of the scientific literature was conducted. Design Systematic review. Study sample An electronic search of the non-gray literature in the last decade was conducted using the digital databases MEDLINE (R) (PubMed interface), LILACS (R) (Virtual Health Library), Web of Science (R) (CAPES publications portal), and SciELO (R). Studies addressing peripheral auditory function as part of the range of nonmotor PD symptoms were selected for analysis. Results Pure tone audiometry data suggested that sensorineural hearing loss was more severe in the PD population than in the control groups. The effects of PD on cochlear function were evidenced by a decrease in the levels of otoacoustic emissions. Conclusions Sensorineural hearing loss and cochlear impairment are more severe in the PD population than in the control groups. Additional studies are recommended to further understand the characteristics of the peripheral auditory system in PD patients, which constitutes an emerging subject in the scientific literature.