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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- “Benefits of the pedicled osteoplastic flap as a surgical approach of mastoidectomy in cochlear implant surgery”(2022) LOPES, P. T.; BENTO, R. F.; GEBRIM, E. M. Mello Santiago; BECK, R. M. de Oliveira; CARVALLO, R. Mota Memede; SANCHES, S. G. Gandolfi; LESSER, J. C. CisnerosObjective: To evaluate the esthetic and functional results of an osteoplastic flap for mastoid cavity closure in cochlear implant surgery. Study design: Double-blind, prospective, randomized clinical trial. Setting: tertiary referral center. Intervention(s): On hundred and twenty-six patients were randomized in 2 groups for cochlear implant surgery. Cases (n: 63) underwent simple mastoidectomy using an anteriorly pedicled osteoplastic flap for mastoid closure. In controls (n: 63), a traditional periosteal flap was used. Evaluation with the POSAS questionnaire was performed 1 year after surgery to assess surgical wound esthetics. Sixteen patients from each group had postoperative CT-scans and wideband tympanometry to assess mastoid aeration and middle ear absorbance. Gender and time after surgery were correlated. Main outcome measure(s): Evaluation of the quality of the surgical wound with the application of a questionnaire validated in the medical literature and translated into Portuguese language called POSAS, considering the perception of the blinded patient and doctor regarding the surgical technique proceeded. A lower POSAS score suggests better esthetics of the surgical wound. Secondary outcomes are volumetric measurement of aeration inside mastoid cavity using 3D computer tomography exam, which aims to analyze the influence of fibrocicatricial retraction in the surgical wound into the mastoid and the interference of its aeration volume in the absorption of sound in the middle ear, using the wideband tympanometry exam. Results: The POSAS questionnaire in the Case group showed a lower level of local pain and itchiness, a skin color and thickness more similar to the surrounding skin and less irregularity and stiffness, with no influence from time after surgery and gender compared to the Control group. The median tomographic volume was 6.37 cc in the cases and 4.60 cc in controls. Wideband tympanometry showed general smaller sound absorbance in the Case group results, specially, at 1000 Hz frequency. No intraoperative or postoperative complications were observed with the osteoplastic flap. Conclusions: This technique is an effective and safe alternative to alleviate common problems of mastoid surgery for cochlear implantation. In addition to esthetic benefits, it has less interference in middle ear physiology of sound absorbance and less fibrous tissue into the mastoid cavity during the follow-up of more than 1 year.
- Tonsillotomy by a Fractional Carbon Dioxide Laser: A New Technique in the Treatment of Chronic Tonsillitis(2022) COSTA, Heloisa Juliana Zabeu Rossi; FRANCESCO, Renata Cantisani Di; GIANCOLI, Suzana Maria; MIRANDA, Fernando Mathias Pereira de; BENTO, Ricardo FerreiraIntroduction: Chronic tonsillitis has a global prevalence, ranging from 5% to 12%. Its clinical manifestations, like recurrent acute tonsillitis, tonsils hypertrophy, caseum and halitosis, can lead adult patients to be submitted to palatine tonsillectomy, surgery that has morbidity and the potential risk of complications, including severe bleeding. This article proposes a new therapy for chronic tonsillitis in adult patients using a fractional carbon dioxide (CO2) laser, which is a fast, minimally invasive procedure capable of removing the need for the traditional tonsillectomy in many patients. The present research aimed to verify the efficacy of tonsillotomy by fractional ablation using the CO2 laser by comparing the number of bacterial infections, tonsils hypertrophy, halitosis and caseum; it is also aimed at analyzing the benefits, risks and complications of the technique. Methods: In this clinical prospective study, 20 patients were subjected to one session of tonsillotomy by fractional ablation and were followed up for a year. The control group was formed by the same patients in the pre-procedure period (one year) without treatment. Statistical analysis: The Wilcoxon paired test, Friedman tests, and multiple non-parametric comparisons were utilized to analyze the data (significance level of 5%). Results: No complications occurred, and the procedure was fast (30 seconds), safe and tolerated well without general anesthesia. After 1 year, there was a total remission of recurrent acute tonsillitis in 95% of the patients, and after 6 months there was a statistically significant improvement in halitosis and caseum, and tonsils size reduction (P < 0.05). The level of satisfaction average was 10 after 3 months and 8 after one year. Conclusion: Tonsillotomy by fractional ablation using the CO2 laser is a safe, efficient procedure for chronic tonsillitis in adults, and it can be incorporated into daily clinical practice.
- Outcomes of Early Versus Late Tracheostomy in Patients With COVID-19: A Multinational Cohort Study(2022) SHRECKENGOST, C. S. Harrell; FOIANINI, J. E.; ENCINAS, K. M. Moron; GUARACHI, H. Tola; ABRIL, K.; AMIN, D.; BERKOWITZ, D.; CASTATER, C. A.; DOUGLAS, J. M.; GRANT, A. A.; KHULLAR, O. V.; LANE, A. N.; LIN, A.; NIROULA, A.; NIZAM, A.; RASHIED, A.; REITZ, A. W.; ROSER, S. M.; SPYCHALSKI, J.; ARAP, S. S.; BENTO, R. F.; CIARALO, P. P. D.; IMAMURA, R.; KOWALSKI, L. P.; MAHMOUD, A.; MARIANI, A. W.; MENEGOZZO, C. A. M.; MINAMOTO, H.; MONTENEGRO, F. L. M.; PêGO-FERNANDES, P. M.; SANTOS, J.; UTIYAMA, E. M.; SREEDHARAN, J. K.; KALCHIEM-DEKEL, O.; NGUYEN, J.; DHAMSANIA, R. K.; ALLEN, K.; MODZIK, A.; PATHAK, V.; WHITE, C.; BLAS, J.; EL-ABUR, I. Talal; TIRADO, G.; BENíTEZ, C. Yánez; WEISER, T. G.; BARRY, M.; BOECK, M.; FARRELL, M.; GREENBERG, A.; MILLER, P.; PARK, P.; CAMAZINE, M.; DILLON, D.; SMITH, R. N.OBJECTIVES: Timing of tracheostomy in patients with COVID-19 has attracted substantial attention. Initial guidelines recommended delaying or avoiding tracheostomy due to the potential for particle aerosolization and theoretical risk to providers. However, early tracheostomy could improve patient outcomes and alleviate resource shortages. This study compares outcomes in a diverse population of hospitalized COVID-19 patients who underwent tracheostomy either ""early""(within 14 d of intubation) or ""late""(more than 14 d after intubation). DESIGN: International multi-institute retrospective cohort study. SETTING: Thirteen hospitals in Bolivia, Brazil, Spain, and the United States. PATIENTS: Hospitalized patients with COVID-19 undergoing early or late tracheostomy between March 1, 2020, and March 31, 2021. INTERVENTIONS: Not applicable. MEASUREMENTS AND MAIN RESULTS: A total of 549 patients from 13 hospitals in four countries were included in the final analysis. Multivariable regression analysis showed that early tracheostomy was associated with a 12-day decrease in time on mechanical ventilation (95% CI, -16 to -8; p < 0.001). Further, ICU and hospital lengths of stay in patients undergoing early tracheostomy were 15 days (95% CI, -23 to -9 d; p < 0.001) and 22 days (95% CI, -31 to -12 d) shorter, respectively. In contrast, early tracheostomy patients experienced lower risk-adjusted survival at 30-day post-admission (hazard ratio, 3.0; 95% CI, 1.8-5.2). Differences in 90-day post-admission survival were not identified. CONCLUSIONS: COVID-19 patients undergoing tracheostomy within 14 days of intubation have reduced ventilator dependence as well as reduced lengths of stay. However, early tracheostomy patients experienced lower 30-day survival. Future efforts should identify patients most likely to benefit from early tracheostomy while accounting for location-specific capacity. Copyright © 2022 The Authors.
- Association between chemosensory impairment with neuropsychiatric morbidity in post-acute COVID-19 syndrome: results from a multidisciplinary cohort study(2023) DAMIANO, Rodolfo Furlan; NETO, Deusdedit Brandao; OLIVEIRA, Joao Vitor Ribeiro; SANTOS, Jonatas Magalhaes; ALVES, Julia Vallin Rodrigues; GUEDES, Bruno F.; NITRINI, Ricardo; ARAUJO, Adriana Ladeira de; OLIVEIRA, Melaine; BRUNONI, Andre R.; VOEGELS, Richard Louis; BENTO, Ricardo Ferreira; BUSATTO, Geraldo; MIGUEL, Euripedes Constantino; FORLENZA, Orestes V.; PINNA, Fabio de RezendePreliminary methodologically limited studies suggested that taste and smell known as chemosensory impairments and neuropsychiatric symptoms are associated in post-COVID-19. The objective of this study is to evaluate whether chemosensory dysfunction and neuropsychiatric impairments in a well-characterized post-COVID-19 sample. This is a cohort study assessing adult patients hospitalized due to moderate or severe forms of COVID-19 between March and August 2020. Baseline information includes several clinical and hospitalization data. Further evaluations were made using several different reliable instruments designed to assess taste and smell functions, parosmia, and neuropsychiatric disorders (using standardized psychiatric and cognitive measures). Out of 1800 eligible individuals, 701 volunteers were assessed on this study. After multivariate analysis, patients reporting parosmia had a worse perception of memory performance (p < 0.001). Moderate/severe hypogeusia was significantly associated with a worse performance on the word list memory task (p = 0.012); Concomitant moderate/severe olfactory and gustatory loss during the acute phase of COVID-19 was also significantly associated with episodic memory impairment (p = 0.006). We found a positive association between reported chemosensory (taste and olfaction) abnormalities and cognition dysfunction in post-COVID-19 patients. These findings may help us identify potential mechanisms linking these two neurobiological functions, and also support the speculation on a possible route through which SARS-CoV-2 may reach the central nervous system.
- Noise Exposure and Distortion Product Otoacoustic Emission Suprathreshold Amplitudes: A Genome-Wide Association Study(2021) LAVINSKY, Joel; KASPERBAUER, Guilherme; BENTO, Ricardo F.; MENDONCA, Aline; WANG, Juemei; CROW, Amanda L.; ALLAYEE, Hooman; FRIEDMAN, Rick A.Background: Although several candidate-gene association studies have been conducted to investigate noise-induced hearing loss (NIHL) in humans, most are underpowered, unreplicated, and account for only a fraction of the genetic risk. Mouse genome-wide association studies (GWASs) have revolutionized the field of genetics and have led to the discovery of hundreds of genes involved in complex traits. The hybrid mouse diversity panel (HMDP) is a collection of classic inbred and recombinant inbred strains whose genomes have been either genotyped at high resolution or sequenced. To further investigate the genetics of NIHL, we report the first GWAS based on distortion product otoacoustic emission (DPOAE) measurements and the HMDP. Methods: A total of 102 strains (n = 635) from the HMDP were evaluated based on DPOAE suprathreshold amplitudes before and after noise exposure. DPOAE amplitude variation was set at 60 and 70 dB SPL of the primary tones for each frequency separately (8, 11.3, 16, 22.6, and 32 kHz). These values provided an indirect assessment of outer hair cell integrity. Six-week-old mice were exposed for 2 h to 10 kHz octave-band noise at 108 dB SPL. To perform local expression quantitative trait locus (eQTL) analysis, gene expression microarray profiles were generated using cochlear RNA from 64 hybrid mouse strains (n = 3 arrays per strain). Results: Several new loci were identified and positional candidate-genes associated with NIHL were prioritized, especially after noise exposure (1 locus at baseline and 5 loci after exposure). A total of 35 candidate genes in these 6 loci were identified with at least 1 probe whose expression was regulated by a significant cis-eQTL in the cochlea. After careful analysis of the candidate genes based on cochlear gene expression, 2 candidate genes were prioritized: Eya1 (baseline) and Efr3a (post-exposure). Discussion and Conclusion: For the first time, an association analysis with correction for population structure was used to map several loci for hearing traits in inbred strains of mice based on DPOAE suprathreshold amplitudes before and after noise exposure. Our results identified a number of novel loci and candidate genes for susceptibility to NIHL, especially the Eya1 and Efr3a genes. Our findings validate the power of the HMDP for detecting NIHL susceptibility genes.
- A three-dimensionally printed otological model for cholesteatoma mastoidectomy training(2023) SOUZA, Marcos Antonio de; BENTO, Ricardo Ferreira; LOPES, Paula TardimPurpose To relate the creation and expert validation (face and content validity) of an affordable three-dimensional (3-D) printed model of temporal bones with chronic otitis media with cholesteatoma (COMC) as a simulator for mastoidectomy. Methods We performed computed tomography (CT) of the temporal bones of a patient with COMC followed at the University of Sao Paulo (USP) Hospital with 3-D Slicer to create a 3-D model of the affected bone using light-curing resin and silicone (cholesteatoma). The final 3-D printed images were scored by 10 otologists using a customized version of the Michigan Standard Simulation Scale Experience (MiSSES). Internal consistency and inter-rater reliability were assessed using Cronbach's alpha and intraclass correlations. Results Otologists consistently scored the model positively for fidelity, educational value, reactions, and the overall model quality. Nine otologists agreed that the model was a good educational device for surgical training of COMC. All experts deemed the model ready-or nearly ready-for use. The final cost of the model, including raw materials and manufacturing, was 120 USD. Conclusions Using 3-D printing technology, we created the first anatomically accurate, low-cost, disease-reproducing 3-D model of temporal bones for mastoidectomy training for cholesteatoma.
- Brazilian Society of Otology task force -- Vestibular Schwannoma -- evaluation and treatment(2023) SILVA, Vagner Antonio Rodrigues; LAVINSKY, Joel; PAUNA, Henrique Furlan; VIANNA, Melissa Ferreira; SANTOS, Vanessa Mazanek; IKINO, Claudio Marcio Yudi; SAMPAIO, Andre Luiz Lopes; LOPES, Paula Tardim; LAMOUNIER, Pauliana; MARANHAO, Andre Souza de Albuquerque; SOARES, Vitor Yamashiro Rocha; POLANSKI, Jose Fernando; DENARO, Mariana Moreira de Castro; CHONE, Carlos Takahiro; BENTO, Ricardo Ferreira; CASTILHO, Arthur MeninoObjective: To review the literature on the diagnosis and treatment of vestibular schwannoma. Methods: Task force members were educated on knowledge synthesis methods, including electronic database search, review and selection of relevant citations, and critical appraisal of selected studies. Articles written in English or Portuguese on vestibular schwannoma were eligible for inclusion. The American College of Physicians' guideline grading system and the American Thyroid Association's guideline criteria were used for critical appraisal of evidence and recommendations for therapeutic interventions. Results: The topics were divided into 2 parts: (1) Diagnosis audiologic, electrophysiologic tests, and imaging; (2) Treatment wait and scan protocols, surgery, radiosurgery/radiotherapy, and systemic therapy. Conclusions: Decision making in VS treatment has become more challenging. MRI can diagnose increasingly smaller tumors, which has disastrous consequences for the patients and their families. It is important to develop an individualized approach for each case, which highly depends on the experience of each surgical team.(c) 2023 Associacao Brasileira de Otorrinolaringologia e Cirurgia C ' ervico-Facial.
- Generation of four induced pluripotent stem cells lines from PBMC of the DFNA58 family members: Two hearing-impaired duplication carriers (USPi006-A e USPi007-A) and two normal-hearing noncarriers (USPi004-A and USPi005-A)(2023) KOBAYASHI, Gerson S.; VIEIRA-SILVA, Gleiciele A.; VARELLA-BRANCO, Elisa; MOREIRA, Danielle P.; KITAJIMA, Joao Paulo F. W.; HEMZA, Claudia R. M. L.; MINGRONI-NETTO, Regina C.; LOJUDICE, Fernando H.; OITICICA, Jeanne; BENTO, Ricardo F.; BATISSOCO, Ana C.; LEZIROVITZ, KarinaThe DFNA58 locus contains a genomic duplication involving three protein-coding genes (CNRIP1, PLEK, and PPP3R1 & PRIME;s exon 1) and other uncharacterized lncRNA genes (LOC101927723, LOC107985892 and LOC102724389). To clarify the role of these genes in hearing and precisely determine their role in hearing loss, four iPSC lines were generated from two carriers and two noncarriers of the duplication.