RICARDO FERREIRA BENTO
Projetos de Pesquisa
Unidades Organizacionais
Departamento de Otorrinolaringologia e Oftalmologia, Faculdade de Medicina - Docente
Instituto Central, Hospital das Clínicas, Faculdade de Medicina
LIM/32 - Laboratório de Otorrinolaringologia, Hospital das Clínicas, Faculdade de Medicina - Líder
Instituto Central, Hospital das Clínicas, Faculdade de Medicina
LIM/32 - Laboratório de Otorrinolaringologia, Hospital das Clínicas, Faculdade de Medicina - Líder
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- Ear Parade: A Call for Preventive Actions to Strengthen the Healthcare System against Hearing Loss(2021) LOPES, Paula Tardim; BENTO, Ricardo FerreiraIntroduction Approximately 10 million people in Brazil have some hearing impairment. Because of the natural progression of hearing impairment to presbycusis, coupled with the increasing number of young people exposed to the risk factors for early hearing loss, the social impact of hearing impairment is high. Objective A team of otolaryngologists and speech therapists conducted an unprecedented worldwide campaign in the primary health sector, aiming to reduce the global burden of hearing impairment with preventive measures. Methods A cultural information campaign called ""Ear Parade"" was developed. It lasted 3 months, during which SAo Paulo received information on the prevention of deafness and the importance of hearing rehabilitation to reduce prejudice against the use of hearing aids. Results The information was relayed through an art exhibition of public paintings, including 62 sculptures of ears, 2.40 meters high, which colored the city, elucidating the beauty of hearing. The media coverage impacted 170 million people, and at the end of the campaign, a nongovernmental organization was established to raise resources for hearing rehabilitation. In addition, an auction of the ear sculptures raised money toward hearing aid batteries and stem-cell research for hearing. Conclusion The present paper presents the effects of this campaign. Information dissemination is a powerful preventive measure for the primary healthcare system to reduce future treatment expenditures.
- Is There Any Correlation between Spread of Excitation Width and the Refractory Properties of the Auditory Nerve in Cochlear Implant Users?(2021) SILVA, Juliana Coutinho da; GOFFI-GOMEZ, Maria Valeria Schmidt; TSUJI, Robinson Koji; BENTO, Ricardo; BRITO NETO, RubensBackground: The spread of excitation (SOE) and auditory nerve recovery function (REC) are objective measures recorded by neural response telemetry and may interfere in cochlear implant (CI) stimulation. Objective: To analyze and correlate SOE with the refractory periods in subjects with pre- and postlingual deafness implanted with different electrode arrays. Methods: This was a retrospective study of 323 ears separated by perimodiolar or straight arrays and by pre- or postlingually deaf recipients. Measures were collected intraoperatively on electrode 11. The SOE width was measured in millimeters at the 0.75 point of the curve, and the relative (tau) and absolute (t0) refractory periods were measured in microseconds. Results: There was a statistical correlation between the SOE and the t0 in the patients with postlingual deafness implanted with the perimodiolar array. The SOE width was statistically different between the straight and perimodiolar arrays and between the pre- and postlingual groups in the perimodiolar array. Tau was statistically different between the pre- and postlingual groups with the straight array and the t0, between the pre- and postlingual groups with the perimodiolar array. Neural response threshold and amplitude of the neural response were not statistically different among groups. Conclusion: There was a correlation between SOE width and t0 only in patients with acquired deafness. The findings suggest that different factors influence SOE and REC, considering SOE is different according to the electrode array and REC being different according the onset of deafness.
- Is the spread of excitation width correlated to the speech recognition in cochlear implant users?(2021) SILVA, Juliana Coutinho da; GOFFI-GOMEZ, Maria Valeria Schmidt; MAGALHAES, Ana Tereza; TSUJI, Robinson Koji; BENTO, Ricardo FerreiraPurpose To assess whether there is an interference of the spread of excitation (SOE) on speech recognition. Methods Retrospective cross-sectional study, approved by the institution's ethics committee (CAAE03409212.8.0000.0068). Adult patients with intraoperative neural response telemetry (NRT) performed on electrodes 6, 11 and 16 implanted with Cochlear Ltd (Sydney, Australia) devices were selected. Patients with partial array insertion, pre-lingual hearing loss, deafness etiology due to and CI experience less than 12 months were excluded. SOE was recorded at 10 current units above the NRT threshold (tNRT) and its width in millimeters was collected at point 0.75 of the function. Speech recognition test was 25-recorded monosyllables list, presented at 65 dBHL at 0 degrees azimuth in a sound treated booth. The analysis was divided into groups by electrode array type, regarding the tNRT, SOE width, SOE's peak amplitude and electrode peak. Results A 126 SOE measurements of the 3 tested electrodes were obtained from 43 patients. Patients with straight array had significantly wider SOE, greater peak amplitude at electrode 6 and higher tNRTs. In the perimodiolar array, there was a negative correlation between SOE and monosyllables recognition at electrodes 6 and 11, and in the combined average of the three electrodes, with a significant difference in electrode 11. Sixty-six percent of the SOE measurements had their peak shifted to adjacent electrodes. Conclusion It was observed, in perimodiolar array, the greater the dispersion of electrical current, the worse the speech recognition, especially in the medial electrode.
- Cochlea cell-specific marker expression upon in vitro Hes1 knockdown(2021) BATISSOCO, A. C.; LEZIROVITZ, K.; ZANATTA, D. B.; HEMZA, C. R. M. L.; VASQUES, L. R.; STRAUSS, B. E.; MINGRONI-NETTO, R. C.; HADDAD, L. A.; BENTO, R. F.; OITICICA, J.NOTCH pathway proteins, including the transcriptional factor HES1, play crucial roles in the development of the inner ear by means of the lateral inhibition mechanism, in which supporting cells have their phenotype preserved while they are prevented from becoming hair cells. Genetic manipulation of this pathway has been demonstrated to increase hair cell number. The present study aimed to investigate gene expression effects in hair cells and supporting cells after Hes1-shRNA lentivirus transduction in organotypic cultures of the organ of Corti from postnatal-day-3 mice. Forty-eight hours after in vitro knockdown, Hes1 gene expression was reduced at both mRNA and protein levels. Myo7a (hair cell marker) and Sox2 (progenitor cell marker) mRNA levels also significantly increased. The modulation of gene expression in the organ of Corti upon Hes1 knockdown is consistent with cell phenotypes related to lateral inhibition mechanism interference in the inner ear. The lentivirus-based expression of Hes1-sh RNA is a valuable strategy for genetic interference in the organ of Corti and for future evaluation of its efficacy in protocols aiming at the regeneration of hair cells in vivo.
- Do the minimum and maximum comfortable stimulation levels influence the cortical potential latencies or the speech recognition in adult cochlear implant users?(2021) MARTINS, Kelly Vasconcelos Chaves; GOFFI-GOMEZ, Maria Valeria Schmidt; TSUJI, Robinson Koji; BENTO, Ricardo FerreiraIntroduction: Cochlear implants (CI) programming is based on both the measurement of the minimum levels required to stimulate the auditory nerve and the maximum levels to generate loud, yet comfortable loudness. Seeking for guidance in the adequacy of this programming, the cortical auditory evoked potentials (CAEP) have been gaining space as an important tool in the evaluation of CI users, providing information on the central auditory system. Objective: To evaluate the influence of mishandling of electrical stimulation levels on speech processor programming on hearing thresholds, speech recognition and cortical auditory evoked potential in adult CI users. Material and methods: This is a prospective cross-sectional study, with a sample of adult unilateral CI users of both sexes, aged at least 18 years, post-lingual deafness, with minimum experience of 12 months of device use. Selected subjects should have average free field hearing thresholds with cochlear implant equal to or better than 34 dBHL and monosyllable recognition different from 0%. Individuals who could not collaborate with the procedures or who had no CAEP recordings were excluded. Participants were routinely programmed, and the map was named MO (optimized original map). Then three experimentally wrong maps were made: optimized original map with 10 current units below the maximum comfort level (C), named MC-(map minus C); optimized original map with minus 10 current units at minimum threshold level (T), named MT-(map minus T) and optimized original map with 10 current units above minimum level (T), named MT + (map plus T). In all programs, participants underwent free-field auditory thresholds from 250Hz to 60 0 0Hz, recorded sentences and monosyllabic recognition tests presented at 65dB SPL in quiet and in noise, and free field CAEP evaluation. All tests were performed in an acoustically treated booth, in a randomized order of map presentation. Data were compared by Wilcoxon test. Results: Thirty individuals were selected and signed an informed consent form. The MC-map provided worsening of all free field thresholds, quiet and noise speech recognition, and P1 wave latency delay with significant difference from the results with the MO map. The MT-map worsened the hearing thresholds and statistically significantly reduced the P2 wave latency; MT + map improved free field thresholds except 60 0 0Hz, worsening speech recognition, without statistical significance. Conclusions: The results suggest that maximum levels below the optimal thresholds lead to worse cochlear implant performance in both hearing thresholds and speech recognition tests in quiet and noise, increasing CAEP component P1 latency. On the other hand, the manipulation of minimum threshold levels showed alteration in audibility without significant impact on speech recognition.
- Central Auditory Nervous System Stimulation through the Cochlear Implant Use and Its Behavioral Impacts: A Longitudinal Study of Case Series(2021) CAVALCANTI, Marina Isabel; SILVA, Liliane Aparecida Fagundes; GOMEZ, Maria Valeria Schmidt Goffi; KOJI, Tsuji Robinson; BENTO, Ricardo Ferreira; CARVALHO, Ana Claudia Martinho de; GENTILE, Matas CarlaThe purpose of this study was to investigate, over a period of five years, the cortical maturation of the central auditory pathways and its impacts on the auditory and oral language development of children with effective use and without effective use of a Cochlear Implant (CI). A case series study was conducted with seven children who were CI users and seven children with normal hearing, with age- and gender-matched to CI users. The assessment was performed by long-latency auditory evoked potentials and auditory and oral language behavioral protocols. The results pronounced P1 latency decrease in all CI users in the first nine months. Over five years, five children with effective CI use presented decrease or stabilization of P1 latency and a gradual development of auditory and oral language skills, although, for most of the children, the electrophysiological and behavior results remained poor than their hearing peers' results. Two children who stopped the effective use of CI after the first year of activation had worsened auditory and oral language behavioral skills and presented increased P1 latency. A negative correlation was observed between behavioral measures and the P1 latency, the P1 component being considered an important clinical resource capable of measuring the cortical maturation and the behavioral evolution.
- Noise Attenuation Effects on Speech Recognition of Cochlear Implant Users Inside Helicopters(2021) CALDEIRA, Juliana Maria Araujo; GOFFI-GOMEZ, Maria Valeria Schmidt; IMAMURA, Rui; BENTO, Ricardo FerreiraBACKGROUND: The speech recognition levels of cochlear implant (CI) users are still incompatible with ICAO hearing requirements for civil aviation pilots testing in the noisy background condition of the helicopter cockpit. In this study, we evaluated noise attenuation effects on speech recognition in the same background condition. METHODS: The study involved the evaluation of 12 Portuguese-speaking CI users with post-lingual deafness and with a pure tone average up to 35 dB HL between 500 and 2000 Hz and up to 50 dB at 3000 Hz on at least one of the ears, and of three normal hearing pilots (controls). We performed speech recognition tests using sentences, numbers, and disyllables for all participants through the VHF radio. The assessment took place inside a helicopter with engine on, using three setups: 1) with headset without the active noise cancellation; 2) activating the noise cancellation system of the headset itself; and 3) connecting the speech processor directly to the helicopter radio system. RESULTS: The headset active noise-cancellation improved only the recognition of sentences. The direct connection system compared to the headset without anti-noise attenuation significantly improved all the recognition tests. The median for numbers was 90%, but the best score for disyllables recognition was 56%. DISCUSSION: The noise attenuation resources proposed in this study improved the CI users'speech recognition when exposed to the noisy helicopter cockpit. However, speech recognition of CI users still did not meet the standards of ICAO, which requires at least 80% for understanding disyllables in the speech in noise test.
- Impact of the COVID-19 Pandemic on Physicians Working in the Head and Neck Field(2021) IMAMURA, Rui; BENTO, Ricardo F.; MATOS, Leandro L.; WILLIAM JR., William N.; MARTA, Gustavo N.; CHAVES, Aline L. F.; CASTRO JR., Gilberto de; KOWALSKI, Luiz P.Background With the COVID-19 pandemic, the clinical practice of physicians who work in the head and neck field in Brazil dropped dramatically. The sustained impact of the pandemic is not known. Methods An anonymous online survey was distributed to Brazilian otolaryngologists, head and neck surgeons, medical and radiation oncologists, asking about their clinical practice in the third to fourth months of the pandemic. Results The survey was completed by 446 specialists. About 40% reported reduction of more than 75% in outpatient care. A reduction of 90% to 100% in airway endoscopies was reported by 50% of the responders, and the same rate of reduction regarding surgeries (pediatric or nasosinusal) was reported by 80% of them. Family income decreased by 50%, and the psychological burden on physicians was considerable. The availability of personal protective equipment and safety precautions were limited, especially in the public sector. Conclusion COVID-19 is still impacting the head and neck field, and safety concerns may hinder the prompt resumption of elective care.
- A tecnologia a favor da educação continuada no implante coclear(2021) MAGALHÃES, Ana Tereza de Matos; GOMEZ, Maria Valéria Schimdt Goffi; TSUJI, Robinson Koji; BENTO, Ricardo FerreiraABSTRACT Purpose To evaluate the teleconsultation synchronously in the mapping of the cochlear implant (CI) as an ongoing professional development tool in training programmes for audiologists. Methods It was a prospective longitudinal study, in the form of clinical preceptor with teleconsultation in a synchronous way directed at assisting the mapping of CI users. Distance learning was offered to fellow audiologists in a hospital and the audiology tutor in the remote unit. The chosen platform allowed the tutor to view and perform interventions on the CI mapping screen. Three questionnaires covering teaching markers were applied; the quality and importance of teleconsultation; interaction between professionals; and self-assessment of confidence in carrying out the mapping steps before and after teleconsultations. Results Seven audiologists participated; 268 consultations were analyzed over three years. The clinical markers showed, on average and individually, that there is a statistical correlation with a decrease in the number of total interventions, in the interventions of CI mapping and clinical reasoning throughout the sessions. The average of the scores of the importance of teleconsultation was 9.7 and the interaction with the tutor was 9.3. In the self-assessment, all audiologists responded that they were “not at all/not very confident” for the mapping steps before the intervention, and at the end of the course they responded “moderately/very confident” for the same steps. Conclusion The use of synchronous teleconsultation was feasible and efficient as a teaching tool for audiologists. It was possible to observe the decrease in the number of interventions over time, evidencing the learning curve.
- Balancing the Loudness in Speech Processors and Contralateral Hearing Aids in Users of Unilateral Cochlear Implants(2021) MAGALHAES, Ana Tereza Matos; CARVALHO, Amanda; TSUJI, Robinson Koji; BENTO, Ricardo Ferreira; GOFFI-GOMEZ, Maria Valeria SchmidtIntroduction The use of cochlear implants and hearing aids (bimodal) has been growing with the expansion of the indication for them, and it is important to ensure protocols so that there is a balance of the loudness regarding the two devices. Objective To evaluate if the limited complex sounds present in the frequency bands of the current devices enable the balance of the loudness in adult users of bimodal stimulation, and to analyze if speech recognition improves after balancing. Methods A prospective cross-sectional study with convenience sampling. The sample was composed of 25 adults who had used either a cochlear implant for at least 6 months or a contralateral hearing aid, with a mean age of 46 years. The balancing of the loudness was performed in an acoustic room with the computer's sound box (0 degrees azimuth at 70dB SPL). The instrumental sounds were filtered through eight different frequency bands. The patients used both hearing devices and were asked if the sound was perceived to be louder in one of the ears or centrally. The speech test was evaluated with sentence silence (65dB SPL) and/or noise signal ratio of 0dB/+10dB in free field at 0 degrees azimuth, before and after balancing. Results : Out of the 25 patients, 5 failed to achieve balance at every tested frequency, and 3 achieved balance at almost every frequency, except 8kHz. There was a significant difference between the speech recognition test only in silence before and after balancing. Conclusion : Most patients achieved sound equalization at all evaluated frequencies under the complex-sound protocol. Additionally, most patients experienced improved speech recognition after balancing.