ROBERTO MIQUELINO DE OLIVEIRA BECK
Projetos de Pesquisa
Unidades Organizacionais
Instituto Central, Hospital das Clínicas, Faculdade de Medicina
LIM/32 - Laboratório de Otorrinolaringologia, Hospital das Clínicas, Faculdade de Medicina
LIM/32 - Laboratório de Otorrinolaringologia, Hospital das Clínicas, Faculdade de Medicina
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- Contribution of audiovestibular tests to the topographic diagnosis of sudden deafness(2013) OITICICA, Jeanne; BITTAR, Roseli Saraiva Moreira; CASTRO, Claudio Campi de; GRASEL, Signe; PEREIRA, Larissa Vilela; BASTOS, Sandra Lira; RAMOS, Alice Carolina Mataruco; BECK, RobertoINTRODUCTION: Sudden hearing loss (SHL) is an ENT emergency defined as sensorineural hearing loss (SNHL) > 30 dB HL affecting at least 3 consecutive tonal frequencies, showing a sudden onset, and occurring within 3 days. In cases of SHL, a detailed investigation should be performed in order to determine the etiology and provide the best treatment. Otoacoustic emission (OAE) analysis, electronystagmography (ENG), bithermal caloric test (BCT), and vestibular evoked myogenic potential (VEMP) assessments may be used in addition to a number of auxiliary methods to determine the topographic diagnosis. OBJECTIVE: To evaluate the contribution of OAE analysis, BCT, VEMP assessment, and magnetic resonance imaging (MRI) to the topographic diagnosis of SHL. METHOD: Cross-sectional and retrospective studies of 21 patients with SHL, as defined above, were performed. The patients underwent the following exams: audiometry, tympanometry, OAE analysis, BCT, VEMP assessment, and MRI. Sex, affected side, degree of hearing loss, and cochleovestibular test results were described and correlated with MRI findings. Student's t-test was used for analysis of qualitative variables (p < 0.05). RESULTS: The mean age of the 21 patients assessed was 52.5 ± 15.3 years; 13 (61.9%) were women and 8 (38.1%) were men. Most (55%) had severe hearing loss. MRI changes were found in 20% of the cases. When the audiovestibular test results were added to the MRI findings, the topographic SHL diagnosis rate increased from 20% to 45%. CONCLUSION: Only combined analysis via several examinations provides a precise topographic diagnosis. Isolated data do not provide sufficient evidence to establish the extent of involvement and, hence, a possible etiology.
bookPart Métodos Objetivos de Avaliação Audiológica(2014) GRASEL, Signe Schuster; BECK, Roberto Miquelino de Oliveira; RAMOS, Henrique Faria; ROSSI, Amanda Costa; ALMEIDA, Edigar Rezende de- “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.
- Evaluation of residual hearing in cochlear implants candidates using auditory steady-state response(2015) RAMOS, Henrique Faria; GRASEL, Signe Schuster; BECK, Roberto Miquelino de Oliveira; TAKAHASHI-RAMOS, Marystella Tomoe; RAMOS, Bernardo Faria; ALMEIDA, Edigar Resende de; BENTO, Ricardo Ferreira; NETO, Rubens de BritoConclusion: The correlations between behavioral and auditory steady-state response (ASSR) thresholds were significant at 500, 1000, 2000, and 4000 Hz. ASSR presented high sensitivity and specificity in the detection of residual hearing in cochlear implant candidates when compared with warble-tone audiometry. Objectives: To assess residual hearing in cochlear implant candidates by comparing the electrophysiological thresholds obtained in dichotic single-frequency ASSR with behavioral thresholds at 500, 1000, 2000, and 4000 Hz. Methods: This was a comparative study between ASSR and warble-tone audiometry thresholds in 40 cochlear implant candidates (80 ears) before cochlear implantation with bilateral severe-to-profound sensorineural hearing loss. Results: Thresholds were obtained in 62.5% of all frequencies evaluated in warble-tone audiometry and in 63.1% in the ASSR. ASSR sensitivity was 96% and specificity was 91.6%. Mean differences between behavioral and ASSR thresholds did not reach significance at any frequencies. Strong correlations between behavioral and ASSR thresholds were observed in 500, 1000, and 2000 Hz and moderate in 4000 Hz, with correlation coefficients varying from 0.65 to 0.81. On 90% of occasions, ASSR thresholds were acquired within 10 dB of behavioral thresholds.
bookPart Peate com estímulo de fala - fequency following response (FFR)(2020) FáVERO, Mariana Lopes; GRASEL, Signe; BECK, Roberto- Are Auditory Steady-State Responses Useful to Evaluate Severe-to-Profound Hearing Loss in Children?(2015) GRASEL, Signe Schuster; ALMEIDA, Edigar Rezende de; BECK, Roberto Miquelino de Oliveira; GOFFI-GOMEZ, Maria Valeria Schmidt; RAMOS, Henrique Faria; ROSSI, Amanda Costa; TSUJI, Robinson Koji; BENTO, Ricardo Ferreira; BRITO, Rubens deObjective. To evaluate Auditory Steady-State Responses (ASSR) at high intensities in pediatric cochlear implant candidates and to compare the results to behavioral tests responses. Methods. This prospective study evaluated 42 children with suspected severe-to-profound hearing loss, aged from 3 to 72 months. All had absent ABR and OAE responses. ASSR were evoked using binaural single frequency stimuli at 110 dB HL with a 10 dB down-seeking procedure. ASSR and behavioral test results were compared. Results. Forty-two subjects completed both ASSR and behavioral evaluation. Eleven children (26.2%) had bilateral responses. Four (9.5%) showed unilateral responses in at least two frequencies, all confirmed by behavioral results. Overall 61 ASSR responses were obtained, most (37.7%) in 500 Hz. Mean thresholds were between 101.3 and 104.2 dB HL. Among 27 subjects with absent ASSR, fifteen had no behavioral responses. Seven subjects showed behavioral responses with absent ASSR responses. No spurious ASSR responses were observed at 100 or 110 dB HL. Conclusion. ASSR is a valuable tool to detect residual hearing. No false-positive ASSR results were observed among 42 children, but in seven cases with absent ASSR, the test underestimated residual hearing as compared to the behavioral responses.
bookPart Imitanciometria(2014) GRASEL, Signe Schuster; BECK, Roberto Miquelino de Oliveira; GUEDES, Mariana Cardoso; ALMEIDA, Edigar Rezende de; ROSSI, Amanda Costa- Are auditory steady-state responses a good tool prior to pediatric cochlear implantation?(2015) BECK, Roberto Miquelino de Oliveira; GRASEL, Signe Schuster; RAMOS, Henrique Faria; ALMEIDA, Edigar Rezende de; TSUJI, Robinson Koji; BENTO, Ricardo Ferreira; BRITO, Rubens deIntroduction: ASSR allow frequency-specific evaluation in intensities up to 120 dB HL and detection of residual hearing in patients with severe-to-profound hearing loss. Aim: to compare ASSR thresholds and behavioral test results in children with suspected severe-to-profound hearing loss. Methods: Cross sectional study to compare ASSR and behavioral responses (VRA or audiometry) in 63 pediatric cochlear implant candidates (126 ears) aged between 6 and 72 months. We included children with normal otomicroscopy, absent responses to click-ABR and otoaccoustic emissions. We excluded children with inner ear malformations, auditory neuropathy spectrum disorder or who did not complete VRA or achieve EEG noise < 30 nV during the ASSR test. Air-conduction ASSR stimuli were continuous sinusoidal tones presented at 0.5, 1, 2 and 4 kHz starting at 110 dB HL Behavioral thresholds were acquired with warble tones presented at 0.5, 1, 2 and 4 kHz in each ear through insert or head phones at maximum presentation level of 120 dB HL Results: Behavioral thresholds were obtained in 36.7% (185/504) of all frequencies in all subjects, 9% in intensities >110 dB HL. Among 504 ASSR measurements, 53 thresholds were obtained (10.5%). Overall 89.5% of the tested frequencies did not show any response at 110 dB HL Most responses were at 500 Hz. Mean differences between behavioral and ASSR thresholds varied from 0.09 to 8.94 dB. Twenty-seven comparisons of behavioral and ASSR thresholds were obtained: 12 at 0.5 kHz, 9 at 1 kHz, Sat 2 kHz and 1 at 4 kHz. Absent responses were observed in both tests in 38.1% at 0.5 kHz, 52.4% at 1 kHz, 74.6% at 2 kHz and 81.0% at 4 kHz. Specificity was > 90% at 1,2 and 4 kHz. In ears with no behavioral response at 120 dB HL all ASSR thresholds were in the profound hearing loss range, 90% of them were >110 dB HL Conclusion: Among 63 pediatric CI candidates, absent responses to high-intensity ASSR was the major finding (specificity > 90%) predicting behavioral thresholds in the profound hearing loss range. These findings can be helpful to confirm the decision for cochlear implantation.
- A rare genomic duplication in 2p14 underlies autosomal dominant hearing loss DFNA58(2020) LEZIROVITZ, Karina; VIEIRA-SILVA, Gleiciele A.; BATISSOCO, Ana C.; LEVY, Debora; KITAJIMA, Joao P.; TROUILLET, Alix; OUYANG, Ellen; ZEBARJADI, Navid; SAMPAIO-SILVA, Juliana; PEDROSO-CAMPOS, Vinicius; NASCIMENTO, Larissa R.; SONODA, Cindy Y.; BORGES, Vinicius M.; VASCONCELOS, Laura G.; BECK, Roberto M. O.; GRASEL, Signe S.; JAGGER, Daniel J.; GRILLET, Nicolas; BENTO, Ricardo F.; MINGRONI-NETTO, Regina C.; OITICICA, JeanneHere we define a similar to 200 Kb genomic duplication in 2p14 as the genetic signature that segregates with postlingual progressive sensorineural autosomal dominant hearing loss (HL) in 20 affected individuals from the DFNA58 family, first reported in 2009. The duplication includes two entire genes, PLEK and CNRIP1, and the first exon of PPP3R1 (protein coding), in addition to four uncharacterized long non-coding (lnc) RNA genes and part of a novel protein-coding gene. Quantitative analysis of mRNA expression in blood samples revealed selective overexpression of CNRIP1 and of two lncRNA genes (LOC107985892 and LOC102724389) in all affected members tested, but not in unaffected ones. Qualitative analysis of mRNA expression identified also fusion transcripts involving parts of PPP3R1, CNRIP1 and an intergenic region between PLEK and CNRIP1, in the blood of all carriers of the duplication, but were heterogeneous in nature. By in situ hybridization and immunofluorescence, we showed that Cnrip1, Plek and Ppp3r1 genes are all expressed in the adult mouse cochlea including the spiral ganglion neurons, suggesting changes in expression levels of these genes in the hearing organ could underlie the DFNA58 form of deafness. Our study highlights the value of studying rare genomic events leading to HL, such as copy number variations. Further studies will be required to determine which of these genes, either coding proteins or non-coding RNAs, is or are responsible for DFNA58 HL.
bookPart Casos clínicos(2020) GRASEL, Signe; BECK, Roberto