JEANNE DA ROSA OITICICA RAMALHO
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.
- P3 Cognitive Potential in Cochlear Implant Users(2018) GRASEL, Signe; GRETERS, Mario; GOFFI-GOMEZ, Maria Valeria Schimidt; BITTAR, Roseli; WEBER, Raimar; OITICICA, Jeanne; BENTO, Ricardo FerreiraIntroduction The P3 cognitive evoked potential is recorded when a subject correctly identifies, evaluates and processes two different auditory stimuli. Objective to evaluate the latency and amplitude of the P3 evoked potential in 26 cochlear implant users with post-lingual deafness with good or poor speech recognition scores as compared with normal hearing subjects matched for age and educational level. Methods In this prospective cohort study, auditory cortical responses were recorded from 26 post-lingual deaf adult cochlear implant users (19 with good and 7 with poor speech recognition scores) and 26 control subjects. Results There was a significant difference in the P3 latency between cochlear implant users with poor speech recognition scores (G-) and their control group (CG) (p = 0.04), and between G-and cochlear implant users with good speech discrimination (G+) (p = 0.01). We found no significant difference in the P3 latency between the CG and G+. In this study, all G-patients had deafness due to meningitis, which suggests that higher auditory function was impaired too. Conclusion Post-lingual deaf adult cochlear implant users in the G-group had prolonged P3 latencies as compared with the CG and the cochlear implant users in the G+ group. The amplitudes were similar between patients and controls. All G-subjects were deaf due to meningitis. These findings suggest that meningitis may have deleterious effects not only on the peripheral auditory system but on the central auditory processing as well.
- Neurotology: definitions and evidence-based therapies - Results of the I Brazilian Forum of Neurotology(2020) SALMITO, Marcio Cavalcante; MAIA, Francisco Carlos Zuma e; GRETES, Mario Edvin; VENOSA, Alessandra; GANANCA, Fernando Freitas; GANANCA, Mauricio Malavasi; MEZZALIRA, Raquel; BITTAR, Roseli Saraiva Moreira; GASPERIN, Alexandre Camilotti; PIRES, Anna Paula Batista de Avila; RAMOS, Bernardo Faria; BERTOLDO, Cesar; JR, Cicero Ferreira; REAL, Danilo; GUIMARAES, Humberto Afonso; OITICICA, Jeanne; LAVINSKY, Joel; LOPES, Karen Carvalho; DUARTE, Juliana Antoniolli; MORGANTI, Ligia Oliveira Goncalves; SANTOS, Lisandra Megumi Arima dos; JOFFILY, Lucia; LAVINSKY, Luiz; SANTOS, Monica Alcantara de Oliveira; MANO, Patricia Mauro; ARAUJO, Pedro Ivo Machado Pires de; ALBERNAZ, Pedro Luis Mangabeira; CAL, Renato; DORIGUETO, Ricardo Schaffeln; GUIMARAES, Rita de Cassia Cassou; CARVALHO, Rogerio Castro Borges deIntroduction: Neurotology is a rapidly expanding field of knowledge. The study of the vestibular system has advanced so much that even basic definitions, such as the meaning of vestibular symptoms, have only recently been standardized. Objective: To present a review of the main subjects of neurotology, including concepts, diagnosis and treatment of Neurotology, defining current scientific evidence to facilitate decision-making and to point out the most evidence-lacking areas to stimulate further new research. Methods: This text is the result of the I Brazilian Forum of Neurotology, which brought together the foremost Brazilian researchers in this area for a literature review. In all, there will be three review papers to be published. This first review will address definitions and therapies, the second one will address diagnostic tools, and the third will define the main diseases diagnoses. Each author performed a bibliographic search in the LILACS, Sci ELO, PubMed and MEDLINE databases on a given subject. The text was then submitted to the other Forum participants for a period of 30 days for analysis. A special chapter, on the definition of vestibular symptoms, was translated by an official translation service, and equally submitted to the other stages of the process. There was then a in-person meeting in which all the texts were orally presented, and there was a discussion among the participants to define a consensual text for each chapter. The consensual texts were then submitted to a final review by four professors of neurotology disciplines from three Brazilian universities and finally concluded. Based on the full text, available on the website of the Brazilian Association of Otorhinolaryngology and Cervical-Facial Surgery, this summary version was written as a review article. Result: The text presents the official translation into Portuguese of the definition of vestibular symptoms proposed by the Barany Society and brings together the main scientific evidence for each of the main existing therapies for neurotological diseases. Conclusion: This text rationally grouped the main topics of knowledge regarding the definitions and therapies of Neurotology, allowing the reader a broad view of the approach of neurotological patients based on scientific evidence and national experience, which should assist them in clinical decision-making, and show the most evidence-lacking topics to stimulate further study. (C) 2019 Associacao Brasileira de Otorrinolaringologia e Cirurgia Cervico-Facial.
- Population epidemiological study on the prevalence of dizziness in the city of Sao Paulo(2013) BITTAR, Roseli Saraiva Moreira; OITICICA, Jeanne; BOTTINO, Marco Aurelio; GANANCA, Fernando Freitas; DIMITROV, RivaThe epidemiology of dizziness is essential in clinical practice. Objective: To establish the prevalence of dizziness in the adult population of Sao Paulo, its clinical characteristics and level of discomfort. Method: A prospective cross-sectional study ran from April to October of 2012 by a field questionnaire, totaling 1,960 interviews. The predictor variables assessed were age, gender, type of dizziness and the dizziness disability index. The statistical tools used to assess the significance between variables were the chi-square test, Student's t-test and logistic regression. We used a 95% confidence interval for estimated values. Results: The prevalence of dizziness in the city of Sao Paulo was established at 42%. We found two peak of complaints, 49% in the range of 46-55 years and 44% in the elderly. Vestibular-related dizziness was estimated to affect 8.3% of the population, mainly women (p < 0.001). The symptoms caused disability in 27% of symptomatic interviewees and it is more bothersome to females (p < 0.001), who more frequently seek medical care (p < 0.001). Conclusion: The prevalence of dizziness in Sao Paulo was found to be 42%. It affects daily activities in 67% of symptomatic patients, but only 46% of them seek medical help.
article 13 Citação(ões) na Scopus Pegylated interferon/ribavirin-associated sudden hearing loss in a patient with chronic hepatitis C in Brazil(2011) MENDES-CORREA, Maria Cassia Jacintho; BITTAR, Roseli Saraiva Moreira; SALMITO, Norma; OITICICA, JeanneSudden hearing loss is defined as a sensorineural hearing loss, equal to or greater than 30 dB, at three or more consecutive frequencies, which takes place within 72 hours. Both peginterferon and ribavirin are well-known to be associated with significant adverse effects, but sudden hearing loss is uncommon. We report a 65-year-old male patient who developed sudden-onset hearing loss during combination therapy with pegylated interferon-alpha and ribavirin for chronic hepatitis C. Peginterferon and ribavirin may cause sudden hearing loss that may not recover after discontinuation of therapy. Immediate treatment for all possible etiologies is essential, along with targeted investigations and early referral for an Ear, Nose and Throat specialist. Physicians should be aware of the possible ototoxic effects of peginterferon and ribavirin combination therapy requiring appropriate surveillance.- Video head impulse test relevance in the early postoperative period after cochlear implantation(2019) BITTAR, Roseli Saraiva Moreira; SATO, Eduardo; RIBEIRO, Douglas Josimo Silva; OITICICA, Jeanne; GRASEL, Signe Schuster; MEZZALIRA, Raquel; TSUJI, Robinson Koji; BENTO, Ricardo FerreiraBackground: Cochlear implantation (CI) is the gold standard therapy for profound or severe sensorineural hearing loss. It is a safe surgical procedure but, because of the proximity of the cochlea and vestibule, postoperative vestibular disorder may occur. Our hypothesis is that the video head impulse test (vHIT) may be a good tool to achieve a topographic diagnosis of dizziness in the early postoperative period after CI. Aims/Objectives: To evaluate patients with instability, imbalance and vertigo between 7 and 14 days after CI procedure. Material and methods: A total of 31patients scheduled for unilateral CI were included in this study. vHIT for horizontal semicircular canal was performed before CI and between days 7 to 14 after the surgery. Results: Six subjects had dizziness complaints after CI: instability (N = 2), imbalance (N = 2) and vertigo (N = 2). The postoperative vHIT test turned abnormal only in subjects with vertigo as compared to the preoperative vHIT test results. Conclusion and significance: vHIT is a good vestibular function test during the first 2 weeks after CI surgery when vertigo is the main complaint
- Dizziness profile and clinical features: a population based survey in São Paulo City, Brazil(2015) BITTAR, Roseli Saraiva Moreira; MEZZALIRA, Raquel; GRASEL, Signe Schuster; OITICICA, JeanneOBJECTIVE: This is a cross-sectional epidemiological survey designed to estimate the prevalence of dizziness among the adult population of the city of São Paulo, Brazil, and to describe the clinical features and level of discomfort. METHOD: This population based study was conductedin the city of São Paulo, Brazil, between April and October 2012. A total of 1,960 household interviews were completed. The following variables were assessed: gender, age, clinical characteristics of dizziness, and dizziness disability index. Chi-square test, Student's t-test,Tukey test and logistic regression were used for statistical analysis. RESULTS: The dizziness prevalence in São Paulo was 42%. Peaks of dizziness were observed in two age groups: 49% among the 46 to 55 year-old, and 44% among the elderly subjects(> 65 years-old). Vestibular vertigo was detected in 8.3% of patients, with a strong female preponderance (p < 0.001). Symptoms caused disability in 27% of the affected respondents and were more frequent among women (p < 0.001). These sought medical care more frequently (p < 0.001). The dizziness disability index was significantly higher (p = 0.0165) among subjects with a lower educational level. There was no correlation between dizziness discomfort and the type of job. CONCLUSION: The prevalence of dizziness in São Paulo, Brazil, was established at 42%. Among the symptomatic subjects, 67% reported interruption of daily activities, but only 46% of them sought medical attention.
- Caloric test and video head impulse test sensitivity as vestibular impairment predictors before cochlear implant surgery(2019) BITTAR, Roseli Saraiva Moreira; SATO, Eduardo Setsuo; SILVA-RIBEIRO, Douglas Josimo; OITICICA, Jeanne; MEZZALIRA, Raquel; TSUJI, Robinson Koji; BENTO, Ricardo FerreiraOBJECTIVES: Currently, cochlear implant procedures are becoming increasingly broad and have greatly expanded. Bilateral cochlear implants and cochlear implants are more frequently applied in children. Our hypothesis is that the video head impulse test may be more sensitive than the caloric test in detecting abnormal vestibular function before cochlear implant surgery. The objective of this study was to compare the video head impulse test and caloric test results of patients selected for cochlear implant procedures before surgery. METHODS: The patients selected for cochlear implant surgery were submitted to a bithermal caloric test and video head impulse test. RESULTS: By comparing angular slow phase velocity values below 5 degrees in the bithermal caloric test (hypofunction) and video head impulse test with a gain lower than 0.8, we identified 37 (64.9%) patients with vestibular hypofunction or canal paresis and 21 (36.8%) patients with abnormal video head impulse test gain before the cochlear implant procedure. Of the 37 patients with caloric test vestibular hypofunction, 20 (54%) patients exhibited an abnormal gain in the video head impulse test. CONCLUSION: The caloric test is more sensitive than the video head impulse test (Fisher's exact test, p=0.0002) in detecting the impaired ear before cochlear implant delivery. The proportion of caloric test/video head impulse test positive identification of abnormal vestibular function or caloric test/video head impulse test sensitivity was 1.8:1.
- Tinnitus prevalence in the city of Sao Paulo(2015) OITICICA, Jeanne; BITTAR, Roseli Saraiva MoreiraIntroduction: The public and private health care in the city of Sao Paulo has no data on tinnitus prevalence. Objective: Determine tinnitus prevalence in Sao Paulo city. Study design: Series study. Methods: Cross-sectional study by field questionnaire with 1960 interviews. Predictor variables included gender, age, tinnitus. Results: The prevalence of tinnitus was 22%. It affects more women (26%) than men (17%) and increases with advancing age. Approximately one third of cases (32%) assert that they have constant tinnitus (i. e., ""ringing""), while most describe intermittent tinnitus (68%). The majority (64%) reported feeling annoyed, while others (36%) denied any annoyance. Among women, the occurrence of an annoying tinnitus was significantly higher (73%) than among men (50%). The percentages were: mildly annoying (11%), moderately annoying (55%), and severely annoying (34%). Tinnitus interferes with daily activities in 18% of those reporting to be annoyed. Conclusion: The population in the city of Sao Paulo suffering from tinnitus was more prevalent than previously estimated. Generally, it affects more women and those without occupation, and increases significantly with age. Most respondents described the tinnitus as annoying, and this was more prevalent in females. The degree of discomfort measured by a Visual Analogue Scale showed moderate tinnitus, with responses averaging 6.3.
bookPart Perda Auditiva Súbita(2013) BITTAR, Roseli Saraiva Moreira; ZERATI, Fábio Elias; OITICICA, Jeanne