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Organizing CommitteeRichard Louis VoegelsRicardo Ferreira Bento

14th Congress of Otorhinolaryngology Foundation – August 13–15, 2015

OTORHINOLARYNGOLOGYOffi cial Publication of the Otorhinolaryngology Foundation and Societas Oto-Rhino-Laryngologia Latina

INTERNATIONAL ARCHIVES OF

Editor-in-ChiefGeraldo Pereira Jotz

Co-EditorAline Gomes Bittencourt

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IAO is an international peer-reviewed journal focusing on disorders of the ear, nose, mouth, pharynx, larynx, cervical region, upper airway system, audiology and communication disorders. Published quarterly, the journal covers the entire spectrum of otorhinolaryngology – from prevention, to diagnosis, treatment and rehabilitation.

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International Archives of Otorhinolaryngology

Organizing Committee

General Coordination

Richard Louis Voegels

Ricardo Ferreira Bento

FO Board

Luiz Ubirajara Sennes (President)

Richard Louis Voegels (Treasury)

Ronaldo Frizzarini (Secretariat)

Congress Board Members

Adriana Hachiya

Carlos Alberto Caropreso

Mariana Hausen Pinna

Fábio de Rezende Pinna

Fabrízio Ricci Romano

Graziela Souza Queiroz Martins

Ítalo Medeiros

José Roberto Parisi Jurado

Isabela de Souza Jardim

Gislaine Ferro Cordeiro

Maysa Tibério Ubrig

Renata Pilan

Ronaldo Frizzarini

Editor

Geraldo Pereira JotzUFRGS, Porto Alegre, Brazil

Co-Editor

Aline Gomes BittencourtUSP, São Paulo, Brazil

International Archives of Otorhinolaryngology


Thieme Publicações Ltda

Oral PresentationsS1 Otorhinolaryngology August 13, 2015, 8am to 12:15pm Room: Havana and Anfi teatro da Oftalmologia - ICHC

S7 Speech, Language and Hearing Sciences August 13, 2015, 1:45pm to 6:00pm August 14, 2015, 8:00am to 3:00pm Room: Havana

E-PostersS20 Otorhinolaryngology

S58 Speech, Language and Hearing Sciences Date: August 13 to August 15, 2015 Room: Exhibition Area Time: 8am to 6pm

S-iii Author Index

The content and the text of all published abstracts are of entire responsibility of the authors and have not suffered journal corrections.

Oral PresentationsOtorhinolaryngology

A39. Analysis From The Middle Ear Aspirated Of PatientsUndergoing TympanostomyEduardo de Barros Sarolli, José Fernando Polanski, MarcosMocellinHospital de Clínicas da Ufpr

Introduction: The serous otitis or otitis media witheffusion (OME) is a very common disease and amajor cause ofhearing loss in children. Although some studies show frag-ments or bacterial growth in the middle ear, it is believed thatthis liquid is sterile. The most effective treatment is theplacement of ventilation tube through tympanostomy.

Objective: This study aims to investigate the occur-rence of microorganisms in themiddle ear aspirate in patientswith serous otitis media.

Methods: There were selected patients from ENT HC-UFPR with Serous Otitis Media with clinical indication forsurgical treatment. Intraoperatively, the tympanostomy wasperformed for placement of the ventilation tube, and aspiratethe content from the middle ear when it was present. Thiscontent was sent tomicrobiological analysis and antibiogram.

Results: Until now, 10 middle ear aspirates wereanalyzed, and the result was negative in all tests for bacteriagrowth.

Conclusion: The sample showed no bacterial growth,justifying the assumption that the serous otitismedia is not aninfectious disease, but probably only inflammatory, reactiveand obstructive. In the literature there is a large discrepancy inthe aspirate culture positivity, but the PCR was able to detectfragments of bacteria the culture tests were unable todemonstrate.

Keywords: Serous otitis, middle ear ventilation, tim-panostomy tube

A393. Are The Vocal Alterations Caused By Chronic SmokingIn The Reinke’s Edema Completely Reversible AfterMicrosurgery?Regina Helena Garcia Martins, Elaine Lara Mendes Tavares,Adriana Bueno Benito Pessin, Thaís Gomes Abrahão Elias,Caroline Fernandes RimoliFaculdade de Medicina de Botucatu (Unesp)

Introduction: Reinke’s edema is frequent in femalesmoking. Their voices present pitch lowed similar to malevoices. The treatment is the microsurgery, however somepatients complain that their voices are not completely normaleven after the surgery and smoking cessation.

Objective: To investigate if the vocal alterations causedby chronic smoking in the Reinke’s edema are completelyreversible after microsurgery.

Methods: Twenty female smoking with Reinke’s ede-mawere submitted to acoustic vocal analysis in twomoments,pre and post-surgery (six months after surgery). The values ofthe post-surgery moment were compared to the normalvoices values. Parameters studied: f0, jitter (%), PPQ, shimmer(%), APQ, NHR, SPI and Maximum time phonation (MTP). All

patients underwent the same conventional microsurgery tothe Reinke’s edema. Only patients who stopped smoking aftersurgery were included in the study.

Results: We identified significant improvement in allvocal acoustic measures of patients six month after thesurgery. When we compared the acoustic measurements ofpost-surgery moment (six months after surgery) to the nor-mal voices values we observed that some parameters keepschanged, especially fo which still has lower values.

Conclusion:We identified significant improvement invocal acoustic measures of patients after sixmonth of surgery.However these measures still differ from normal voices,justifying the symptoms of many patients. So, we believethat the tobacco causes irreversible voice disorders who donot recover completely even after six months of surgery andsmoking cessation.

Keywords: Reinke’s edema, voice, dysphonia

A525. Assessment of the Balance in Children with HearingLoss through the Berg’s Scale in before and after Practice ofCapoeiraRafaela de Paula Peres, Vinicius Ribas Fonseca, FernandoRogerio de CarvalhoInstituição Universidade Tuiuti do Paraná - Programa de Mestrado eDoutorado em Distúrbios da Comunicação

Introduction: The hearing disability is a obstacle thatinterferes in daily life, because the infant is organized toperform a continuous feedback through the sense of hearing.Therefore, hearing loss change the body functionality andstructure, disabling the infant and restricting their daily livingactivities. The Capoeira, improves the development of motorcoordination, laterality, body scheme and kinesthetic of infantwith hearing disability who practice this sport.

Objective: To evaluate the balance, through the Berg’sscale, before and after the practice of capoeira in childrenwithhearing disability.

Methods: Quantitative, clinic and observational stud-ies. Twenty five children between 10 and 16 years old, of bothgender. with severe and profound hearing loss, were evaluat-ed with Berg’s balance scale in 2 times: before the practice ofcapoeira and after a 6 month period. The research wasperformed in a School for Children with hearing impariment.

Results: The test compared results was performed byWilcoxon, significance level 0.05, which result p ¼ 0.0039,there is a significant difference in the results between totalscores, before and after training, that shows the capoeiraincreases significantly the total score.

Conclusion: Through the analysis noticed an improve-ment in the balance and locomotor development of capoeirapractitioners children.

Keywords: Balance, Hearing Disability, Berg’s scale,Capoeira

A385. Comparative Study Between The Friedman Index AndThe Pharyngeal Obstruction Sites In the DISE (Drug-InducedSleep Endoscopy)Alonço da Cunha Viana Junior, Ana Carolina Daflon Scoralick,Nathalia Senra Santos, Daniel Braz Nunes Azevedo, DaniellaLeitao Mendes, Maria Helena de Araujo MeloHospital Naval Marcílio Dias

DOI http://dx.doi.org/.ISSN .

Copyright © 2015 by Thieme PublicaçõesLtda, Rio de Janeiro, Brazil

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Oral Presentations S1

Introduction: The location of the upper airway ob-struction site in patients with obstructive sleep apnea (OSA)has been evaluated according to different methods, amongwhich DISE (Drug-Induced Sleep Endoscopy), a test thatallows to observe the anatomic area responsible for producingthe noise and the(s) site(s) of pharyngeal narrowing andobstruction in conditions that mimic the physiological sleep.

Objective: Through DISE and using the NOHL (NoseOropharynxHypopharynx Larynx) classification, compare theseverity of obstruction sites of the oropharynx and of thehypopharynx with the results obtained through the Friedmanindex

Method: Retrospective study of 50 patients withmoderate and severe OSA, between 18-65 years of age, ofboth sexes, with a body mass index less than 35, submitted toDISE, using NOHL and Friedman classifications. All patientswere from the Sleep Clinic of the Otorhinolaryngology De-partment of the Naval Hospital Marcilio Dias.

Results: It was observed that most patients showedoropharyngeal and / or hypopharynxobstruction greater than75%, regardless of content Friedman. It was not possible toestablish a statistical relationship between the severity ofobstruction at the level of the oropharynx, through DISE,and the Friedman index.

Conclusion: The Friedman index has been insufficientin the correlation with the sites of pharynx obstruction, thusstressing the relevance of DISE in the assessment of OSApatients.

Keywords:Obstructive sleep apnea syndrome, Endos-copy, Pharynx, Propofol, Sleep, BIS

A550. Ergonomic EvaluationOf Clinical And Surgical PracticeApplied To OtorhinolaryngologyBruno Amaral Hay, Michel Balvedi Nomura, Vinicius RibasFonsecaHospital Cruz Vermelha-Pr / Universidade Positivo

Introducion: Occupationl diseases represent a majorconcern of professionasl in health, specialy in ENT area. Astudy in UK found that 72% of ORL have back pain and/or neck.

Objective: The aim of this study was to examine theergonomic issues in daily activities of anotorhinolaringologist.

Methods: Through ergonomic assessment tools(Strain Index, RULA and OWAS) was stratified the risk ofpoor posture , applying forces and other risk factors found inENT physical examination and in the surgical area.

Results: The ergonomic analysis of ENT physical ex-amination revealed a low risk by the Strain Index index; theOWAS method found that the acquired posture deservesattention to possible risks and according to the RULA methodis required investigation and immediate changes. Surgicalergonomic study evaluated the septoplasty and tonsillectomy.The first surgical procedure was evaluated by Strain Index aslow risk; by OWAS a normal posturewas found , but should beverified in further studies, and the RULA method showedresults that is similar to the physical examination. The secondsurgerywas questionable via Strain Index index; OWAS showsthe same result found in septoplasty and the RULA methodwarns about futures research and changes.

Conclusion: We can highlight that much of posturesand repetitive power applications performed by an ENT inyour work environment can be detrimental to your health.Besides that more studies must be stimulated in this area toimprove the knowledge of occupational health.

Keywords: ENT, ergonomic, otorhinolaringologist

A711. Evaluation Of Screening Questionnaires ForObstructive Sleep Apnea In Adults With Repaired Cleft LipAnd PalateLetícia Dominguez Campos, Alícia G. Noronha Silva Salgueiro,Rafaeli Higa Scarmagnani, Eliete Janaina Bueno Bighetti, IvyKiemle Trindade Suedam, Inge Elly Kiemle TrindadeHospital de Reabilitação de Anomalias Craniofaciais, Universidade deSão Paulo

Introduction: Obstructive sleep apnea (OSA) is highlyprevalent in the general population. Easy-to-use question-naires, such as the Berlin, Pittsburgh and Epworth SleepinessScale (ESS), have been developed for OSA screening. However,their performance may differ among specific populationsdepending on the presenting symptoms. In patients with cleftlip and palate, in particular, the risk factors for OSA may differfrom those of the general population, such as pharyngeal flap,nasal deformities, and maxillomandibular discrepancies,which are not taken into account in those questionnaires.

Objective: to evaluate the performance of OSA screen-ing questionnaires in adults with cleft lip and palate.

Methods: Forty-two subjects with repaired cleft pal-ate � lip underwent nocturnal polysomnography (PSGâ€“EMBLA-N7000 system). Subjects were divided into twogroups, according to PSG findings: OSA group (n ¼ 29, AHIgreater than 5 events/hour of sleep), and Non-OSA group(n ¼ 13, AHI lower than 5/h). All patients were evaluatedwiththe validated Berlin, Pittsburgh and ESS questionnaires.

Results: Groups matched for BMI, abdominal andcervical circumferences. Results from the three questionnairesdid not differ between the groups. Sensitivity, specificity,positive and negative predictive values of the Berlin question-naire to predict OSAwere 48%, 85%, 88% and 42%, respectively.For the Pittsburgh questionnaire were 90%, 23%, 72% and 50%,and for the ESS, 38%, 62%, 69% and 31%, respectively.

Conclusion:Accuracy of the Berlin, Pittsburgh and ESSquestionnaires to predict OSA in patients with cleft lip andpalate was shown to be low. Specific screening questionnairesfor the cleft population should be developed.

Keywords: Sleep Apnea, Questionnaires, Cleft Palate

A271. Gastro-Esophageal RefluxAnd Laryngeal PachydermiaIn Obstructive Sleep ApneaAlonço da Cunha Viana Junior, Ana Carolina Daflon Scoralick,Nathalia Senra Santos, Nilce Sanny Costa da Silva Behrens,Daniella Leitao Mendes, Maria Helena de Araujo MeloHospital Naval Marcilio Dias

Introduction: Obstructive sleep apnea (OSA) is char-acterized by recurrent episodes of collapse of the pharynx thatresult in snoring, apnea or hypopnea, a decrease in oxygensaturation and frequent awakenings during the night. Thesymptomatic gastro-esophageal reflux is more prevalent inthese patients, but its occurrence is not significantly influ-enced by the OSA severity.

Objective: To assess the prevalence of gastro-esoph-ageal reflux and laryngeal pachydermia, and their relationshipwith the severity of OSA during the DISE (Drug-Induced SleepEndoscopy).

Methods: Cross-sectional study with 45 patients withOSA, all of them from the Sleep Clinic of the Otorhinolaryn-gology Department of the Naval Hospital Marcílio Dias, be-tween 18-65 years of age, of both sexes, with a body massindex less than 35, submitted toDISE, and evaluated accordingto pachydermia laryngeal rating.

Results: In this study the prevalence of gastro-esoph-ageal reflux was 35.5%. But when analyzing the findings bynasofibrolaryngoscopy during the DISE, about 97.7% of

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14th Congress of Otorhinolaryngology Foundation—August 13–15, 2015

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subjects had laryngeal pachydermia, 22.2% (10) grade I, 64.4%(29) grade II, 11.2% (5) grade III, and it was absent from only2.2% (1) of the patients. The study has observed a greaterprevalence of laryngeal pachydermia grade II in all levels ofOSA severity.

Conclusion: The study showed an association be-tween laryngeal pachydermia andOSA, but it was not possibleto establish a relationship between the severity of OSA andlaryngeal pachydermia.

Keywords:Obstructive sleep apnea syndrome, Endos-copy, Pharynx, Propofol, Sleep

A681. Genetic Etiology In Cochlear Implant Patients FromHospital das Clínicas-FMUSPJuliana Sampaio Silva, Karina Lezirovitz Mandelbaum, CláudiaRegina de Marchi Lopes Hemza, Robinson Koji Tsuji, RicardoFerreira Bento, Jeanne OiticicaOtolaringology Lab/LIM32 School Of Medicine Clinics Hospital,University Of São Paulo; Cochlear Implant Group, School Of MedicineClinics Hospital, Universidade de São Paulo - Usp, São Paulo, Sp, Brazil

Introduction: Genetic Etiology contributes to 60% ofnonsyndromic deafness.

Objective: Investigate genetic etiology in deaf patientswho received cochlear implants in Hospital das Clínicas-FMUSP.

Methods: Search for mutations in the coding region ofGJB2 gene (connexin 26), screen for deletions of GJB6 gene(connexin 30) and the mitochondrial mutation A1555G (MT-RNR1 gene) in all implanted patients evaluated at the GeneticCounseling Unit of the Otolaryngology Lab (LIM32 HCFMUSP).

Results: Up to date, 56 implanted patients with sen-sorineural deafnesswere evaluated, 64%with prelingual onsetand 36% postlingual. In 29/56 (52%), the most probableetiology was genetic. Pathogenic mutations were found innine (31%) validating the genetic etiology (seven prelingualcases and two postlingual). Four of these seven prelingualcaseswere found to be homozygous for the c.35delGmutation(GJB2 gene) and three compound heterozygous for mutationsin GJB2 gene (c.35delG/p.W24X, c.35delG/p.Val27fs, c.35delG/p.Lys112fs). The p.W24X and P.Lys112fs mutations have al-ready been associated with deafness. However, the p.Val27fsmutation (c.79_81delGTCCinsAGA) has not been previouslydescribed. It is a frameshift that leads to a premature stopcodon, thus pathogenic. Among the postlingual cases withmutations, one presented the A1555G mutation, usuallyassociated with aminoglycoside induced/worsened deafness.Indeed this patient exhibited progressive hearing loss afteraminoglycoside exposure. The other case presented the het-erozygosous p.R75Q mutation (GJB2 gene). The patientpresents also palmoplantar keratoderma, phenotype thatalready been attributed to the mutation.

Conclusion: GJB2 mutations represents an importantcause of deafness in cochlear implant patients explaining 14%of our cases, while m.A1555G explained 2%.

A682. Genetic Etiology Of Deafness And Cochlear ImplantResults In A Patient From Hospital das Clínicas-FMUSPJuliana Sampaio Silva, Karina Lezirovitz Mandelbaum, AnaCristina Hiromi Hoshino, Robinson Koji Tsuji, Ricardo FerreiraBento, Jeanne OiticicaOtolaringology Lab/LIM32 â€“ School Of Medicine Clinics Hospital,University Of São Paulo; Cochlear Implant Group, School Of MedicineClinics Hospital, Universidade de São Paulo - Usp, São Paulo, Sp, Brazil

Introduction:GJB2 genemutations is a frequent causeof nonsyndromic deafness and may exhibit autosomal reces-sive and autosomal dominant inheritance.

Objectives: Investigate the genetic etiology and corre-late with cochlear implant results in an implanted patient.

Methods: Search for mutations in the coding region ofGJB2 gene (connexin 26), screen for deletions of GJB6 gene(connexin 30) and the mitochondrial mutation A1555G (MT-RNR1 gene).

Results: The patient exhibited bilateral sensorineuralprogressive hearing loss starting at seven years old. She alsocomplained about a skin disease affecting hands and feet.Sequencing of GJB2 gene revealed the heterozygous c.G224A(p.R75Q) mutation. Indeed this mutation has already beenassociated deafness and Palmoplantar Keratoderma. We alsostudied three affected members of her family, two daughterswith both conditions and the p.R75Q mutation and one nicewith deafness and the p.R75Q mutation but no diagnosis ofPalmoplantar Keratoderma so far. The patient received left-earcochlear implant with 35 years of age. Before the Implant, sheshowed severe to profound deafness with no benefit withhearing aids; speech perception scores were closed-set 30%and open-set 0%. One year after implant, pure tone average(PTA) was 25dB and speech perception scores 80%.

Conclusion: We identified the cause of deafness andPalmoplantar Keratoderma in an implanted patient and per-formed genetic counselling to other affected members of thefamily. In addition, she showed a good Speech Perceptionperformance, which is in line with many other implantedpatients described in the literature with causative GJB2mutations.

A1. Gentamicin Conditioning Confers Auditory ProtectionAgainst Noise TraumaAlex Strose, Miguel Angelo HyppolitoDepartment Of Ophthalmology, Otorhinolaryngology And Head AndNeck Surgery, Faculty Of Medicine Of Ribeirão Preto, University Of SãoPaulo

Auditory conditioning consists of the pre-exposure tolow levels of a potential harmful agent to protect against asubsequent harmful presentation. It was first tested withnoise. More recently, it was successfully tested with otheragents. Nonetheless, the vastmajority of the studies utilize thesame agent to both condition and cause the damage. The aimof this studywas to verifywhether conditioning with an agentdifferent from the agent used to cause the trauma can also beeffective. Thus, the following groups were organized: groupA1, which is the noise trauma control group, was exposed to110-dB broadband noise centered at 4 kHz for 72 hours;group A2, which is the gentamicin conditioning control group,was administered 30 mg/kg of gentamicin daily for 30 conse-cutive days; and group A3 was conditioned with gentamicinsimilarly to group A2 and then subjected to a noise traumasimilarly to group A1. The animals were functionally andmorphologically evaluated through the measurement of theAuditory Brainstem Response (ABR) and scanning electronmicroscopy (SEM), respectively. The following variables wereinvestigated: outer hair cell injury and auditory thresholdshift. The group that was conditioned with the drug exhibitedsignificantly less outer hair cell damage, 10.8% and 22.9%,respectively (p ¼ 0.0146), although did not maintain theproper functioning of the auditory system. We thereforeconclude that conditioning with a different agent from thatused to cause the trauma is effective, which suggests that bothagents that were used promote similar mechanisms of self-protection.

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A679. Hes1 Expression Knocking-Down Gives Rise To NewHair Cells In Organ Of Corti CulturesAna Carla Batissoco, Karina Lezirovitz Mandelbaum, DanielaBertolini Zanatta, Milene Massucci Bissoli, Luciana dos ReisVasques, Jeanne OiticicaDepartment Of Genetics And Evolutionary Biology, InstituteBiosciences - Usp. Department Of Otolaryngology, Medical School -Usp. Viral Vector Laboratory, Translational Research Center ForOncology, Cancer Institute Of São Paulo State.

Introduction: Hair cells and supporting cells in theauditory sensory epithelium of the inner ear arise from acommon progenitor. Recent evidence suggests that NOTCHpathway proteins, including HES1 (hairy and enhancer of split1), play a role in keeping supporting cells phenotype andpreventing them from becoming hair cells. This is the majorlimitation for hair cells regeneration and hearing loss recoveryin the elderly.

Objective: The aim of this study was to compare theexpression of hair supporting cells markers after knockdownof Hes1 transcripts in organ of Corti organotypic cultures frompostnatal day 3 mice.

Methods:About 48h after lentiviral transduction, RNAfrom organ of Corti cultures was extracted and cDNA synthe-tized from each of the three experiments: negative controland two shRNA with different targets for silencing of Hes1.Quantitative RT-PCR (qRT-PCR) was performed to assessmRNA levels of Hes1 and to evaluate hair and supportingcells markers expression (Math1, Myo7a, Sox2, Pax2 andp27kip1). OC HC and SC marker proteins expression wasinvestigated by flow cytometry (Myo7a) and immunofluores-cence analysis (Myo7a, Math1 and p27kip1).

Results and Conclusion: A 30% reduction in Hes1expression disclosed a significant increase in the mRNA levelof Myo7a, which was a consequence of the augmentednumber of cells expressing the protein Myo7a in vitro in theorgan of Corti. These findings suggest that even a modestreduction in the Hes1 expression leads to gene expressionalteration specifically related to the organ of Corti hair celldifferentiation phenotype.

A561. How Effective Are Unattended Sleep Studies InChildrenSilke Anna Theresa Weber, Iury Lima Veloso, José VicenteTagliarini, Sergio Henrique Kiemle TrindadeFaculdade de Medicina de Botucatu,Unesp

Introduction: Lower costs and the facilities of a lesscomplex exam of unattended sleep studies may increase thescreening of severe OSA.

Aim: to analyze the quality of unattended sleep stud-ies in children on a waiting list for adenotonsillectomy (AT) ina University Hospital, the frequency of failure, which agegroup was more exposed to failure and which sensor wasmore easily lost.

Methods: During the last three years, 135 children,aged 3 to 12 years old, with hypertrophy of the tonsils,realized unattended polysomnography for severe OSA screen-ing.We analyzed the frequency of failure of first night exam indifferent age groups, and the sensor more easily lost.

Results:Out of 135 children(57.8% boys), 69were aged3 to 6 years old. 38.6% of the children confirmed severe OSA.28.1% PSGs failed at first night, more frequently (47.2%) in agegroup 3 to4 years old. Airflowsensor showed thehighest errorindex. Failure was higher at first year of our experience (52%)with improvement and a lower rate in the third year (15%).

Conclusions: Unattended sleep studies are helpful forsevere OSA screening. However, children aged 3-4 years

showed highest failure rate, probably due to more restlesssleep and are more difficulties for cooperation when puttingon the equipment. Airflow sensor was lost more easily duringthe night, mostly due to difficulty in fixing it in the face. Goodtraining of the team is fundamental, as an optimal fixation ofthe sensors is crucial for an acceptable result.

A44. Olfactory Epithelium Involvement In Alzheimer’sDisease: A Clinicalpathological StudyMaria Dantas Costa Lima Godoy, Luciana Fernandes Costa,MarcoAurélio Fornazieri, Fábio de Rezende Pinna, Richard LouisVoegelsFaculdade de Medicina - Universidade de São Paulo

Introduction: Alzheimers disease (AD) is consideredthe most prevalent type of dementia. AD diagnosis is per-formed exclusively through clinical criteria. However, clinicalsymptoms are preceded by a long asymptomatic period, withsilent deposit of tau and Î2-amyloid proteins in brain tissue.Recent studies demonstrate the same findings in the olfactoryepithelium, which could contribute to the early diagnosis ofAD.

Objectives: Correlate the prevalence of tau and amy-loid proteins in the olfactory epithelium with clinical andneuropatholocial criteria used for diagnosis of AD and todetermine the sensitivity and specificity of the olfactoryepithelium involvement for the diagnosis of AD.

Methods: Ninety-two individuals, included in theBrain Bank of the Aging Brain Study Project form Universityof Sao Paulo, had collected blocks of olfactory mucosa duringautopsy. Cognitive evaluation was gathered through an inter-view with a knowledgeable informant using the CDR (ClinicalDementia Rating) and IQCODE (Informant Questionnaire onCognitive Decline in the Elderly) scales. Neuropathologicalexaminationwas carried out based on accepted criteria, usingimmunohistochemistry, and classified in CERAD criteria andBraak & Braak staging. The presence of tau and Î2-amyloidprotein deposits in the olfactory epithelium was comparedwith clinical and neuropathological parameters.

Results: The superior turbinate olfactory epitheliumanalysis allowed us to identify the tau and Î2-amyloid proteinswith high sensitivity when compared with neuropathologicalscales (> 80%) and assessed by clinical analysis of CDR (> 90%)and IQCODE (>78%).

Conclusion: Analysis of the olfactory epithelium mayrepresent a potential biomarker for early diagnosis of AD.

A1731. PerturbationMeasures on the Degree of Naturalnessof Synthesized VowelsRosiane Yamasaki, Arlindo Neto Montagnoli, Adriana Hachiya,Eloisa Maria Santiago Gebrim, JorgeVicente Lopes da Silva,Emi Zuiki Murano, Mara Behlau, Domingos Hiroshi TsujiFaculdade de Medicina da Universidade de São Paulo

Introduction: The effect of jitter and shimmer onsynthesized voice is not completely known. To verify theinfluence of these perturbation measures on the degree ofnaturalness, a mathematical model generated glottal pulsesand then an magnetic resonance images based solid model ofvocal tract generated a synthesized vowel.

Objective: To evaluate perceptually the degree ofnaturalness of synthesized vowels with and without short-time perturbations.

Methods: Eighty synthesized glottal pulses were gen-erated with four perturbation conditions (jitter, shimmer,jitter þ shimmer and no-perturbation) from 20 original voicesamples. These pulses were amplified, sent to a driver, and

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transferred to a solid model of the vocal tract that generated80 synthesized vowels â€œéâ€. Experiment 1: Three judgesrated 120 vowels, 20 humans þ 80 synthesized þ 20% repe-tition, as â€œhumanâ€ or â€œsynthesizedâ€. Experiment 2:Three judges rated 20 sequences of synthesized vowels, plus20% repetition, with four perturbation conditions each. Theyranked each four-vowel/sequence as most natural (1) to mostartificial (4).

Results: Experiment 1: 100% human vowels wereclassified as human, and 27/80 synthesized as human (15/20 jitter þ shimmer, 10/20 jitter, 2/20 no-perturbation and 0/20 shimmer). Experiment 2: Two judges considered thevowels with jitter þ shimmer as the most natural samples,followed by those with jitter. The other judge considered thevowels with jitter as the most natural, followed by jitter þsimmer. All rated the vowelswithout perturbation as themostartificial.

Conclusions: Jitter and shimmer increased the degreeof naturalness of synthesized vowels, and jitter alone seems toprovide more naturalness than shimmer alone.

A713. Polysomnographic Findings In Subjects WithObstructive Sleep Apnea Syndrome Who Underwent NasalSeptoplastySergio Henrique Kiemle Trindade, José Vicente Tagliarini, IngeElly Kiemle Trindade, Silke Anna Theresa WeberDisciplina de Otorrinolaringologia e Cirurgia de Cabeça e Pescoço,Faculdade de Medicina de Botucatu, Unesp; Laboratório deDiagnóstico e Terapêutica dos Distúrbios Respiratórios do Sono,Faculdade de Medicina de Botucatu, Unesp

Introduction: The impact of septal deviation in thepathogenesis of obstructive sleep apnea syndrome (OSAS)remains unclear. Nasal septoplasty improves airflow throughnasal cavities, by reducing airway resistance, and, because ofthat may reduce OSAS severity.

Objective: To compare polysomnographic findings insubjects with OSAS before and after nasal septoplasty.

Methods: Pre - and postoperative polysomnographic(PSG) findings from 23 adults (aged 20 to 60y, both genders)with OSAS in different degrees of severity were retrospective-ly analyzed. The following PSG variables were investigated:Apnea andHypopnea Index (AHI), Apnea Index (AI), HypopneaIndex (HI), Sleep Efficiency (SE), Pulse Oximetry (PO).

Results: Mean AIH decreased from 14.6 � 11.5 to9.9 � 7.3 after surgery; however, the difference was notstatistically significant (p ¼ 0.07). On the other hand, a signif-icant decrease (p < 0.005) in AI mean values (from 6.6 � 5.3to 3.4 � 3.6) and a significant improvement in SE (from81.5 � 12.8% to 85.9 � 12.5%) were observed when com-paring pre - and postoperative data (p < 0.05). No significantchanges were observed between for HI and PO mean values.

Conclusion: Nasal septoplasty had a significant im-pact over some polysomnographic parameters, reducing anindex used to indicate the severity of sleep apnea and im-proving sleep efficiency.

Keywords: Polysomnography, nasal surgical proce-dures, obstructive sleep apnea

A399. Scanning Electron Microscopy Of The Senile LarynxRegina Helena Garcia Martins, Tatiana Maria Goncalves,Adriana Bueno Benito Pessin, Thaís Gomes Abrahão Elias,Norimar Hernandes DiasFaculdade de Medicina de Botucatu (Unesp)

Introduction: Histological studies show in the senilelarynx reduction glands, atrophy of epithelium and muscle,

increase of collagen and diminution of elastic fibers and acidhialurônico. We didnâ€™t identify studies of scanning elec-tron microscopy (SEM) that confirm some of these findings.

Objectives: To examine the elderly larynx by SEM foridentify marked changes of presbylarynx.

Methods: 16 larynxes were removed during autopsy,eight from cadavers aged 30-50 years (controls) and eightfrom cadavers over 70 years (elderly). The vocal fold wasdissected, fixed in glutaraldehyde, processed for SEM andexamined by scanning electron microscope. All surface wasexamined quadrant by quadrant, and photographed at in-creasing magnification.

Results: The surface of the vocal folds of larynxcontrols showed flat and juxtaposed cells, with few cells inpeeling and some ripples. The elderly larynx had increasedcells in desquamation and cell junctions marked by depthsulcus. Sub epithelial space (lamina propria) of the larynxcontrols had a loose web of collagen fibers arranged in cordsentwined with some more delicate fibers (elastic fibers). Thisarrangement had less dense array than in elderly larynx,whose collagen network formed tighter tangle and in someplaces the fibers were arranged so close together that seemedto form a rigid enclosure on the vocal muscle.

Conclusions: the scanning electron microscopy of theelderly larynx showed higher epithelial cells in desquamationin the surface, sulcus in intercellular junctions and densenetwork of collagen fibers covering the vocal muscle.

Keywords: presbylarynx, scanning electronmicrosco-py, vocal folds

A586. The Bispectral Index In Obstructive Sleep ApneaDuring Drug-Induced Sleep EndoscopyAlonço da Cunha Viana Junior, Ana Carolina Daflon Scoralick,Daniel Braz Nunes Azevedo, Luiz Felipe Lira deMoraes, DaniellaLeitao Mendes, Maria Helena de Araujo MeloHospital Naval Marcílio Dias

Introduction: The Bispectral Index (BIS) is a neuro-physiological monitoring device which continually analyzesthe EEG tracing. During DISE, BIS helps to measure the depthof sedation and allowing set sedation levels as close to naturalsleep.

Objective: To relate average BIS and the severity ofobstructive sleep apnea (OSA) in episodes of apnea during theDISE.

Methodology:A prospective study in 45 patients withmoderate and severe OSA, between 18-65 years of age, of bothsexes, with bodymass index less than 35, submitted to DISE intarget-controlled infusion of propofol and monitoring withBIS, from the sleep clinic of Otorhinolaryngoly Service of NavalHospital Marcilio Dias.

Results: The BIS found ranged between 70 and 53witha median of 63. Among patients with moderate OSA, the BISranging from 70 to 53, while those with severe OSA, 68 to 62.We observed a greater homogeneity between the patientswith severe OSA.

Conclusion: Patients with moderate OSA had greatervariability of BIS, which may suggest that this group is morevulnerable to change the real sites of obstruction during therealization of the DISE

Keywords:Obstructive sleep apnea syndrome, Endos-copy, Pharynx, Propofol, Sleep, BIS

Oral Presentations


S5

A680. The Expression Of The Gap Junction Connexins 26, 30And 43 From Inner Ear Support Cells IsMaintained In Vitro InOtospheresAna Carla Batissoco, Regina Célia Mingroni Netto, KarinaLezirovitz Mandelbaum, Cláudia Regina de Marchi LopesHemza, Jeanne OiticicaHuman Genome And Stem Cell Center , Department Of Genetics AndEvolutionary Biology, Institute Of Biosciences, USP; Department OfOtolaryngology, Medical School - Usp

Introduction: Most forms of congenital and acquireddeafness result from damage to cochlear hair cells or theirassociated neurons. Although regeneration in the auditoryorgan of Corti is limited, isolation of stem cells has beenreported from mouse inner ear sensory epithelium. In non-adherent culture conditions, these cells can self-renew andform otospheres, floating cell colonies expressing inner earprogenitor cell markers. Supporting cells are primary targetsfor inducing hair cells regeneration and are the primaryexpression site of Connexin26 and Connexin30 gap junctionproteins. Mutations or deletions in the genes that encoded theConnexin26 and Connexin30 are the most common causes ofnonsyndromic inherited deafness in humans. Different inves-tigators reported that various connexin isoforms are ex-pressed in stem cells of from different sources and there isevidence that suggest a role of connexins in the maintenanceof pluripotency these cells. It has been observed that Con-nexin43 represent a pluripotency marker of iPS and may playan important role in the reprogramming process.

Objective: Investigate the expression of Connexins 26,30 and 43 in otospheres.

Methods: The proteins expressionwas investigated byflow cytometry and immunofluorescence analysis.

Results and Conclusion: Here we demonstrate, byflow cytometry and immunofluorescence analysis, that oto-spheres within three days in vitro express Cx26, Cx30 andCx43. Otospheres have never been investigated regardingexpression of connexins. Although further phenotype charac-terization is necessary, this is thefirst time that the expressionof Cx26, Cx30 and Cx43 could be demonstrated in suspensioncultures from mouse cochlear sensory epithelium.

A705. The External Ear Molding: Technique Description AndAchievement Of Auriculocephalic And ConchoscaphalAnglesDaniela Dranka Cristoff, Caio Marcio Correia Soares, MarcosMocellinHospital de Clínicas - Universidade Federal do Paraná

Introduction: The proeminent ears, the most com-mon auricular anatomic defect, reach about 5% of worldpopulation. The excess of concha and malformation of anti-helix are the main alterations and can be corrected withotoplasty surgery. The auriculocephalic and conchoscaphalangles are increased in patiens with proeminent ears and thevalues of this angles are usefull parameters to comparedifferent surgical techniques and pre and pos operatoryresults.

Objective: Describe with details the technique ofauricular molding with alginate, the pros and cons of thematerial, and how to get the main angles of the ears.

Methods: Molding with alginate and mensuration ofauricular angles of rigth ear of 15 volunteers, with richdescription and photos of the all process.

Results:We found a simple execution technique, withgood reproducibility and low cost.

Conclusion: The production of an ear alginate moldetomensure the ears angles is a simple process and can be veryusefull as an objective parameter to compare surgical results.

S6 Oral Presentations


Speech, Language and Hearing Sciences

A200. A Comparison of Water (44°C/30°C) and Air (50°C/24°C) Caloric ResponsesLucia Kazuko Nishino, Fernanda Laiz HiramatsuIrmandade Santa Casa de Misericórdia de São Paulo

Introduction:With the advent of caloric test using airand its systematic use, much controversy has been raised,especially concerning the reference values of this test incomparison to the stimulation by water.

Objective: To verify the equivalence of the nystagmusresponses between water and air stimulation in the calorictest.

Methods:We analyzed 280 medical records, betweenJanuary 2011 and November 2014, of adult patients above 18years old with symmetric responses to the caloric test of up to20%. The pacients were divided into two groups: int the first84 patients underwent air stimulation at 50°C and 24°C (GAR)and in the second 196 patients underwent water stimulationat 44°C and 30°C (GAG). The equipment used was the Con-tronic otocalorimeter EI07AR and E96AG.

Results: The mean values found were:In the GAR group, hot stimulation RE: 20.73; hot

stimulation LE: 20.78; cold stimulation RE: 16.5 and coldstimulation LE: 16.89.

In the GAG group the mean values of the angularvelocity of the slow component were: hot stimulation RE:18.75; hot stimulation LE: 19.19; cold stimulation RE: 19.72and cold stimulation LE: 20.32,

Therewas no significant statistical difference betweenthe caloric tests using water and air in both hot and coldstimulation (p ¼ 1,781842).

Conclusion: In the caloric stimulus using air at 50°Cand 24°C is equivalent to using water at 44°C and 30°C.

Keywords: caloric tests, electronystagmography,physiologic nystagmus

A454. Analysis Of Ocular Vestibular Evoked MyogenicPotentials In Normal Listeners Without VestibularComplaintsThaísa Rodrigues Brusco, Laura Flach Schwade, FranciscoCarlos Zuma e Maia, Pricila SleiferUniversidade Federal do Rio Grande do Sul

Introduction: Ocular Vestibular Evoked MyogenicPotentials are composed by myogenic responses activatedby sound stimulation registered by surface electromyographypositioned in the periocular musculature.Recent evidenceshows that this test has the utriculus and the vestibularsuperior nerve as its main source.Because it is a complementin the otoneurological assessment, it is necessary to know thisexam’s patterns of normality.

Objectives: To compare the latencies and amplitudesof Ocular Vestibular Evoked Myogenic Potential between earsand genders.

Methods: Were assessed 20 normal listener adultswith no vestibular complaints, 10 men and 10 women. Theequipment usedwas the Eclipse-Otoacess, from Interacoustic.Were performed 500 toneburst incentives, with 500Hz fre-quency and an intensity of 100dBHL, band-pass filter from20Hz to2000Hz. The obtained tracingswere analyzed over thefirst biphasic potential.

Results: There was no statistically significant differ-ence between the amplitudes and latencies between thestimulated ears (p ¼ 0.131), as well as gender (p ¼ 0.148).

The median latency of the positive peak was 15.11ms in theright ear, and 15.33ms in the left ear, and the median of thenegative peak was 10ms in the right ear, and 10.33 in the leftear.

Conclusion: It was found that there was no statisticaldifference in the analysis of latencies and amplitudes of wavesbetween genders and ears. It is thought that the OcularVestibular Evoked Myogenic Potential is a promising testand it is believed that the normal standards for the valuesof latency and amplitudemust be stipulated according to eachequipment.

Keywords: Vestibular Evoked Myogenic Potentials;Evoked Potentials; Vestibular Function Tests

A304. Assessment Of The Immediate Effect Of The Semi-Occluded Vocal Tract Exercise In VelopharyngealMechanismIn Five Patients With Cleft Lip And Palate- Pilot StudyMariana Arioza Fernandes Almeida, Sílvia Dornelles, LuiseStumpf Hubner, Chenia Moreira Blessmann GarciaUniversidade Federal do Rio Grande do Sul

Introduction: The non syndromic cleft lip and palateare included between the severe craniofacial malformationsmost frequent in human population. The attacked individualmay have changes in the velopharyngealmechanismand thus,put in danger the speech intelligibility.

Objective: To analyze the immediate effect of exercisewith semi-occluded vocal tract in the velopharyngeal mecha-nism of patients with cleft lip and palate.

Method: The sample was composed by 5 individualswith surgically repaired cleft lip and palate submitted to amultidimensional exam, videonasoendoscopy, dynamic im-ages analysis of using specialized software, speech analysisthrough perceptual evaluating and the acoustic analysis andinference self-reported.

Results:All patients had connected speech better afterthe exercise, accentuated improvement in the overall impres-sion on the emission and vocal projection, greater velophar-yngeal closure and positive effect on self-evaluation.

Conclusion: It was observed positive effect of semi-occluded vocal tract exercise when applied to this sample.

Keywords: velopharyngeal sphincter; clef tlip, cleftpalate; rehabilitation, semi-occluded vocal tract

A25. Audiologic Findings In Patients With Fetal AlcoholSyndromeAdriana Guerta de Souza, Jacqueline Aquino do Nascimento,Melissa Zattoni AntoneliHospital de Reabilitação de Anomalias Craniofaciais da Universidadede São Paulo (Hrac/USP)

Introduction: The fetal alcoholic spectrum disorder isa developmental disorder that affects about 0.2% of births andthe main etiology is the prenatal alcohol exposure. Clinicalfindings include cleft lip and palate, micrognathia, hyper-telorism, microcephaly and digital anomalies. The Fetal Alco-holic Syndrome (FAS) is themost severe formof this spectrum.Three types of hearing impairment are associated with fetalalcoholic spectrum, including delayed maturation of theauditory system, sensory hearing loss and intermittent con-ductivehearing loss. The last one occurs as a result of recurrentserous otitis media caused by a malformed Eustachian tube,due to embryogenic alterations of the first and second bran-chial arches.

Objective: Describe the audiometric findings in 10patients with FAS.

S7Oral Presentations


Methods: This retrospective study included medicalrecords analysis of 10 individuals with FAS enrolled at theHospital for Rehabilitation of Craniofacial Anomalies (HRAC-USP), previously submitted to audiological assessment com-posed by audiometry, tympanometry and hearing antece-dents by experienced audiologists of the Speech andHearing Division of HRAC-USP.

Results: Most subjects had positive hearing antece-dents: hypoacusis was referred by 42% and 58% had at leastone current or previous episode of otalgia, otorrhea or otitis.All types of tympanometric curves were found, with a higherprevalence of the abnormal ones (60%). Pure tone audiometrythresholds were within the normal range in most cases (85%),with conductive hearing loss in only 3 ears (15%).

Conclusion: Individuals with FAS showed a high rateof hearing complaints and tympanometric abnormalities,requiring a long term audiological and otological follow-up.

A352. Audiology Students Attitudes And Hearing BehaviorsNátali Romano, Beatriz Araujo dos SantosUniversidade Estadual de Campinas

Introduction: Young people are usually exposed tonoise, so it’s important to know about their attitudes andbehaviors towards noise, and the consequences of thoseexposures. It includes investigations about these questionsin young who studies about hearing.

Objectives: To identify the attitudes and the hearinghabits of audiology students about environmental noise andleisure activities and to relation with their major.

Methods: 50 audiology students of a Brazilian Univer-sity from both genders, with age between 17 and 24 years oldwere included in this study. They answered an adaptedversion of Youth Attitude to Noise Scale (YANS) questionnaire.They also answered about some hearing symptoms and feel-ings in relation to noise. Descriptive statistics was used tocharacterize data.

Results: Hearing habits questions showed studentsare eventually or never exposed to noise in their activities,except for loud music on headphones, but most of students(76%) does not have hearing problems. Most students do notadapt with daily noises around them, they feel loud noises asproblem and they hope they can help to change this. Half ofstudents believe their habits are not harmful to hearing and60% believe their habits have changed since them ingressed inUniversity.

Conclusion: Audiology students worry about theirhearing and they are struggling to be in silent rooms. Theybelieve their attitudes can influence environment. Physiologyand hearing diseases classes may change attitudes and be-haviors towards noise.

Keywords: Audiology, Hearing, Noise Effects, NoisePerception

A1722. Auditory Evoked Potentials of Late Latency andCognitive Potential in Aphasic IndividualsAmanda Zanatta Berticelli, Kamila Grotto, Vanessa Onzi Rocha,Amalia Moura Jornada, Lenisa Brandão, Pricila SleiferUniversidade Federal do Rio Grande do Sul

Introduction: Considering the neurological disordersas risk factor for auditory processing disorders, aphasic pa-tients constitute a risk group. Auditory processing disorderscan be identified byelectrophysiological tests such as auditoryevoked potentials of late latency (LLAEP) and cognitive (P3),which verify the integrity and functioning of the auditorypathway.

Objective: To analyze the findings of the auditoryevoked potentials of late latency (LLAEP) and cognitive (P3)in aphasic individuals.

Methods: Seventeen aphasic individuals due to astroke, with a mean age of 63.4, were evaluated by LLAEPand P3.

Results: Of the 17 individuals, only 11 got the wavesP1 and N1, 10 presented the wave P2 and only six presentedthewaves N2 e P3. Associationwas foundwhen correlated thefindings of LLAEP with gender only for P1 in the left ear(p ¼ 0.027). Association were found when correlated thefindings of LLAEP with age (p ¼ 0.049), education(p ¼ 0.041) and characterization of aphasia. There was nocorrelation with the time of presentation of stroke andcompletion of speech therapy before evaluation.

Conclusion: The LLAEP and P3 have proved useful andimportant for evaluating aphasic individuals.

Keywords: evoked potentials, auditory; electrophysi-ology; aphasia; event-related potentials

A451. Auditory Steady-State Evoked Potentials In PretermInfants: Follow The Maturation ProcessPricila Sleifer, Ana Francisca Constantino Ferreira de Sousa,Dayane Domeneghini DidonéUniversidade Federal do Rio Grande do Sul

Introduction: Auditory Steady-State Evoked Poten-tials(ASSR) is used to determine the hearing thresholds inchildren, and this test is important for audiological diagnosis.It is known that premature babies have neurological immatu-rity, which may influence in the ASSR, which depends onneural synchrony.

Objective: The aim of this study was correlate theASSR thresholds in preterm and full-term during the firstmonth of life and 18 months old.

Methodology: 33 preterm and 30 full-term infantswere evaluated during the the first month of life.All babiespassed the Newborn Hearing Screening. All children wereevaluated using ASSR. Simultaneous tonepips (0.5, 1, 2 and 4kHz) with an amplitude modulated at different rates from 77to 103 Hz were presented to both ears by insert phones. Theintensitywas presented in a decreasing level in order to detectthe minimum level of responses. At 18 months the childrenwere reassessed in all procedures described. Of the 33 pretermchildren, 26 returned andwere comparedwith the 30 childrenfull-term. Comparisons were performed according to gesta-tional age.

Results:During thefirst month of life ASSR thresholdswere higher in the preterm than in full term babies(p ¼ 0.004). There were no significant differences betweenears and gender. At 18 months there was no differencebetween groups (p ¼ 0.098) in all the variables described.Conclusion:In the first month of life preterm infants hadhigher thresholds in ASSR, but that difference did not occurat 18 months, showing improved neural synchrony of prema-ture throughout their development.

Keywords: Evoked Potentials, Auditory; Newborn;Premature; Electrophysiology

A686. Auditory Training And The Performance Of TheTrained And The Untrained Ear In Dichotic TaskAline Priscila Cibian, Liliane Desgualdo PereiraUniversidade Federal de São Paulo

Introduction: Studies shows that despite train the earthat had the worst performance in dichotic task, can occur aswell, an improvement of untrained ear.



Objective: Check the performance of the trained earand the untrained in Staggered Spondaic Word test, afterauditory training.

Methods: 12 individuals, 12-15 years who had asym-metry in the percentages between the ears in StaggeredSpondaicWord; this asymmetry variedwith aminimumvalueof 2.5% and a maximum of 17.5% between the ears and wasobserved in all subjects. The samplewas divided in groups, thealtered physiological mechanism of selective attention groupand the altered selective attention and temporal processinggroup. Both were submitted to the auditory training the earwith the worst performance, organized in eight sessions.

Results: There was improvement of Staggered Spon-daic Word after the intervention, with statistical significancein all groups, both in the right ear and the left ear. In the groupwith the alteration selective attention mechanism, the aver-age values in percentage of correct answers in the right earchanged 80.42% to 94.17% at the end of training; in the left ear,changed 76.25% to 94.17%. In the group with alterationselective attention and temporal processing, the averagevalues in percentage of correct answers in the right earchanged 77.08% to 92.92% at the end of training; in the leftear, changed 80.83% to 94.17%. All subjects improved theirperformance in both ears, reaching the normal range.

Conclusion: The training was effective for both theears.

A168. Body Balance: A Portrait of elderly active populationwith complains of DizzinessIsabela Schroer Neis, Luciele da Silva Prates, Valdete AlvesValentins dos Santos FilhaUniversidade Federal de Santa Maria

Introduction: Combined with multiples comorbid,arising from age, balance disorders are considered mainsignificant aspects identified in this population, with empha-sis on dizziness, imbalance and falling, as the major factorswhich limit the life of elderly. The posturography evaluationand visual analogue scale have been valuable tools in evalua-tion of body balance in the elderly population.

Objective: Evaluate the integration of visual system,somatosensory, vestibular system in elderly active populationwith dizziness and/or vertigo, through dynamic posturogra-phy, relating to the degree of the uncomfortable symptom ofthese on quality of life.

Methods: The sample is constituted by 33 activeelderly, that have complaints about dizziness and/or vertigo,75% women and 24,2% men, the mean age of 65 years old. Allparticipants underwent anamnesis, posturography, and askedabout the level of discomfort of complaint, by evaluating theEscala Visual Análoga- EVA (Visual Analog Scale) during ahealthy action in the university.

Results: It was found that 42,43% of elderly partici-pants complained about the dizziness and vertigo, 30,30%imbalance, 27,27% imbalance associated with falls. Regardingto posturography, 25% of the elderly had good integration onthe sensory systems; 33% difficulty in integration of systems,especially the visual preference and 42% had difficulty inintegration of all systems. In the Escala Visual Análoga wasobserved degree of notes between 4 and 10 on discomfort ofsymptoms, with mean of 7.3.

Conclusion: The population evaluated, mostly wom-en, presented difficulty in integration between systems; withan impact of dizziness on quality of life in elderly people.

A62. Characterization Of Patients Assisted At A HearingHealth Service In 2014Georgea Espindola Ribeiro, Daniela Polo Camargo da Silva,Priscila Suman Lopez, Jair Cortez MontovaniFaculdade de Medicina de Botucatu

Introduction: Hearing is considered essential forcommunication between people, ensuring the participationof the same society we live in. One of the possible solutions tominimize hearing difficulties arising from a hearing im-pairment is the use of hearing aids.

Objective: To characterize the patients prothetizadesin the public hospital during one year.

Methods: In 2014, participated in the study 763patients, 50% males (n ¼ 381) and 50% female (n ¼ 382). Ofthese 52% (n ¼ 398) were new cases and 48% (n ¼ 365) werereplacement cases.

Results: 98% (n ¼ 753) of the patients showed bilat-eral hearing loss and 1.3%(n ¼ 10) unilateral. Most showedsensorineural hearing loss with moderate degree. 1416 re-ceived hearing aids, being 92% (n ¼ 1308) bilateral and 8%(n ¼ 108) unilateral. Regarding the type of hearing aid, 58%(n ¼ 447) were fitted with BTE with conventional mold, 25%(n ¼ 194) with intracanal, 10% (n ¼ 76) witn open fit and 6%(n ¼ 46) with receiver-in-the-ear. As for technology classifiedby the Unified Health System, 51.5% of the patients (n ¼ 393)werefittedwith hearing aids type A, 38% type B (n ¼ 290) and10.4% of type C (n ¼ 80).

Conclusion:Most of the patients received hearing aidsfor the first time, had bilateral sensorineural hearing loss withmoderate degree, received the type A BTE model with con-ventional mold.

A308. Check The Degree Of Comfort/Discomfort Of StudentsIn Relation To The Acoustic Environment Of A MunicipalSchool Of ParanáAdele Cristina Segala Castro, Teresa Maria Momensohn dosSantosIeaa - Instituto de Estudos Avançados da Audição

Introduction: the student must spend a greater effortto concentrate during the school periodwhen the backgroundnoise of the classroom is high.

Objective: to verify the degree of comfort/discomfortcaused by acoustic environment where the teaching-learningprocess occurs for students at a municipal school of Paraná.

Method: 184 students enrolled in 4th. and 5th. yearsof elementary school responded to a questionnaire on theirperception of environmental noise based on Hans (2000) andLibardi et al. (2006). Each Participant answered to the ques-tionnaire individually in the classroom.

Results: to the question "what is bothering you atschool?" 67% responded "too noisy", 8%, â€œlow illumina-tionâ€ and 7% â€œtemperatureâ€ and â€œinadequate fur-nishingsâ€. To the question "what’s the annoyance that noisebrings you in the classroom", 36.4% complained of difficulty tohear professor; 27.2% complained of interference when theyare in an evaluation moment; 20.7% that noise bothers inreading text aloud; 11.4% complained about the difficulty insolving math exercises and 4.3% of the negative effect onproduction activities and text interpretation. Lickert scaleanalysis for acoustic comfort showed that higher discomfortlevelswere the talk inside and outside the classroom, the noiseof dragging furniture, the noise in the sports court and reformsin school.

Conclusion: Noise background in school bothers notonly teachers but students too. Actions to improve thisenvironment are very necessary.



A291. Clinical And Videofluoroscopic Evaluation OfSwallowing In Children With Suspected DysphagiaLenice de Fatima da SilvaMunhoz, Suelly Cecilia Olivan LimongiFaculdade de Medicina da Universidade de São Paulo

Introduction: Studies which describe and compareclinical and videofluoroscopic evaluation of swallowing inchildren with suspected dysphagia are few.

Objectives: To describe the clinical signs and symp-toms indicators of pharyngeal phase swallowing dysfunctionobserved in clinical evaluation of swallowing and the video-fluoroscopic findings of oral, pharyngeal and esophagealphases in children with suspected dysphagia; and to identifyclinical signs and symptoms associatedwith isolated laryngealpenetration and laryngeal aspiration.

Methods: Retrospective analysis of data from clinicaland videofluoroscopic evaluations carried out in 55 childrenfrom 1 month to 7 years and 11 months old. To clinicalevalution, the â€œProtocol for Clinical Assessment of PediatricDysphagia was used. To videofluoroscopy, oral, pharyngealand esophageal phases dysfunctions were analysed. To statis-tical analysis, Chi-square and Fisher’s Exact Tests were used.

Results: Cervical auscultation alteration, cough, chok-ing and oxygen desaturation were the clinical signs andsymptoms more observed. In videofluoroscopy, oral phasedysfunctions were less frequent with thin fluid (p ¼ 0.032)and more frequent with purée (p < 0.001). Pharyngeal phasedysfunctions were more frequent with thin fluid (p ¼ 0.010)and less frequent with thickened fluid (p ¼ 0.003) and purée(p ¼ 0.045). In esophageal phase, about half of the childrenshowed gastroesophageal reflux. Choking was the only clini-cal sign associated with isolated laryngeal penetration thinfluid (p ¼ 0.044).

Conclusion: The professional should be alert on theswallowing dysfunctions types that patient presents to definethe more safe consistencies to swallow, and on chokingpresence in thin fluid clinical evaluation due to probablyisolated laryngeal penetration occurrence in children withsuspected dysphagia.

A314. Comparison Of Two Protocols In The Analysis OfBrainstem Auditory Evoked Potential - Baep With SpeechStimulusDébora Durigon da Silva, Rúbia Soares Bruno, Jordana da SilvaFolgearini, Fernanada Freitas Vellozo, Mirtes Bruckmann,Michele Vargas GarciaUniversidade Federal de Santa Maria

Introduction: BAEP with speech stimuli is producedin the subcortical region, reaching greater synaptic coveragethan non-verbal stimuli. It is indicated to evaluate individualswith alterations in speech, language, auditory processing andlearning.

Aim: Comparing the different BAEP protocols withspeech stimulus, analyzing morphology and latency of thewaves.

Method: This study consisted of 32 subjects, fromclinical audiology service of a University Hospital. We usedthe Intelligent Hearing Sistems (IHS) equipment with twostimulation protocols: three series of 1000 sweeps followed bytwo series of 3000 sweeps, analyzed by the resulting wave-form in both cases. After marking, the information was con-fronted with the navigator-Pró equipment. Visual analysis ofthe tests was carried out by the researcher. For the morpho-logical analysis, it was considered the increase of amplitude ofthe waves C, D, E and F and, the abrupt reduction in theamplitude of thewaveO, for the latencies, the reference valueswere considered.

Results: There was no difference between the twoused protocols in relation to morphological analysis, becausein both protocols the tracing differs from the navigator-Pró. Inthe latency analysis, there was no difference between the twoprotocols. However, when compared to navigator-Pró values,there is a significant difference.

Conclusion: It was possible to compare the differentprotocols and the morphology tracing in IHS is different fromthe Navigator-Pró in both protocols, as its latencies cannot beused in research with IHS equipment.

A532. Correlation Between Acoustic Reflex AndPerformance In The Sustained Auditory Attention AbilityTestMaria Renata José, Maria Fernanda Capoani Mondelli, MarizaRibeiro FenimanFob/USP

Introduction: Studies have raised the relationshipbetween auditory attention and the acoustic reflex, and theinfluence of this mechanism in the separation between stim-ulus and noise so that the focus of attention is only to thestimulus.

Objective: To verify the correlation between theacoustic reflex and performance of adult and elderly subjectsin Sustained Auditory Attention Ability Test (SAAAT).

Methods: Ethical approval: process #34/2011 (FOB-USP). Participated 76 subjects aged between 18 to 83, of bothgenders and without complaint of inattention. The assess-ment consisted of applying, pure tone audiometry, speechaudiometry, immittance and SAAAT. The test performance isverified by the total error score (the result of a sum ofinattention errors and impulsivity) and the vigilancedecrement.

Results: Was observed a weak correlation (negative)between the total error score and contralateral acousticstimulation (CAS) in the frequencies of 500 Hz and 2000 Hzin the right ear and, 1000 Hz in the left ear. Regarding the typeof response, weak correlation (negative) was found betweeninattention and CAS in the frequency of 500 Hz in the right earand 2000 Hz in the left ear and, as impulsivity, there was aweak correlation (positive) between the ipsilateral reflexes infrequency of 2000 Hz and CAS in 1000Hz (negative) in the leftear.

Conclusion: This study found correlation between theacoustic reflex, in some surveyed frequencies, mainly incontralateral condition, in the performance of subjects inSAAAT, suggesting influence of the acoustic reflex in thesustained auditory attention ability.

A503. Correlation Between High-Frequency Hearing LossAnd Hearing Loss At Medium Frequencies And ThePerformance Of Adults And Elderly In The SustainedAuditory Attention Ability TestMaria Renata José, Maria Fernanda Capoani Mondelli, MarizaRibeiro FenimanFob/USP

Introduction: studies conducted with children ob-served the influence of hearing loss on Sustained AuditoryAttention Ability Test (SAAAT).

Objective: To investigate the correlation betweenhigh-frequency hearing loss and hearing loss at mediumfrequencies and the performance of adults and elderly sub-jects in the Sustained Auditory Attention Ability Test.

Methods: Ethical approval: process #34/2011 - EthicsCommittee in Research of the FOB-USP. Participated in the



study 90 subjects: GI: 40 subjects with bilaterally normalhearing; GII: 27 subjects with bilateral sensorineural hearingloss in high frequencies (4000 Hz, 6000 Hz and 8000Hz); and,GIII: 27 subjects with bilateral sensorineural hearing loss atmedium frequencies (500 Hz, 1000 Hz and 2000 Hz) and highfrequencies, aged over 18, of both genders and withoutcomplaint of inattention. The assessment consisted of apply-ing Attention Questionnaire, pure tone audiometry, speechaudiometry, immittance and SAAAT. The test performance isverified by the total error score (the result of a sum ofinattention errors and impulsivity) and the vigilancedecrement.

Results: Regarding the type of response was observedweak correlation (positive) between hearing loss (mediumand high frequencies) and inattention, and moderate correla-tion (positive) between hearing loss and impulsivity. In theperformance of the SAAATwas verified moderate correlation(positive) between the total error score and hearing loss.

Conclusion: There was verified correlation betweenhigh-frequency hearing loss and hearing loss at mediumfrequencies in the performance of SAAAT, showing negativeinfluence of hearing loss in the performance of adults andelderly in SAAAT.

Keywords: Attention; Hearing

A50. Correlation Between Results Of Hearing Screening AndSocial Participation Restriction In Middle-Aged Adults AndElderlyAdriane Ribeiro Teixeira, Andréa Kruger Gonçalves, PatriciaPérez Coradini, Maira Rozenfeld OlchikUniversidade Federal do Rio Grande do Sul (UFRGS)

Introduction: The restriction of social participationby hearing loss is often the individual ages.

Objective: To investigate the correlation between theresults of the hearing screening and evaluation of participa-tion restriction caused by hearing loss in middle-aged adultsand elderly.

Methods: The sample consisted of individuals of bothgenders. Initially it was performed otoscopy. The followingparticipants answeredHearingHandicap Inventory for Elderly(HHIE-S) and following thehearing screeningwasmade, usingportable equipment (Hearcheck Screener, Siemens). Theequipment emits pure tones at 1000Hz (20, 35 and 55dBHL)and 3000Hz (35, 55 and 75 dBHL). As a criterion of "pass", theindividual should hear all sounds except 20dBHL at 1000Hz,for even individuals with normal thresholds may not realizethe pure tone that intensity.

Results:We evaluated 71 patients, aged 53 to 87 years(mean 69.27 � 7.71 years), 66 women (92.96%). They passedthe hearing screening 14 (19.72%) individuals.With respect toHHIE-S results, it was found that the score ranged from 0 to 34points (mean 6.37 � 8.64). Only 13 (18.31%) subjects hadscores indicative of participation restriction. When the analy-sis was made between the results of the hearing screening(pass / fail) and the results of theHHIE-S (presence / absence ofsocial participation restriction), it was found that therewas nocorrelation (r ¼ 0.15 - p ¼ 0.8).

Conclusion: among the evaluated indivídos there wasno correlation between the results of the hearing screeningand restriction of social participation.

Keywords: hearing loss, middle aged, aged

A77. Depressive Symptomatology In Elderly Users OfHearing AidClaudia Andriguetto Maoski Moretti, Angela RibasUniversidade Tuiuti do Paraná.

Introduction: To get old is part of all human bodies.Associated with aging, we can find hearing loss and depres-sion, becoming difficult the contact of elderly with others,generating loneliness and difficulty in their oralcommunication.

Objective: To assess elderly patients at the hearinghealth service accredited by the National Health System in thecity of Curitiba, Brazil and verifies that the use of hearing aidcan reduce depressive symptoms in this population.

Methodology: This is an experimental study from adescriptive nature, where it analyzes the results obtained byapplying Geriatric Depression Scale in a group of 61 individu-als before and after the use of hearing aids.

Results: All individuals completed the questionnairebefore the adaptation of the prosthesis and at least six monthsafter use. From 61 respondents 34% had signs of depression.When comparing the results of the questionnaire before theuse of hearing aids and after six months of use, a reduction of21% was found.

Conclusion: The study led us to conclude that use ofhearing aids in patients with depressive symptoms is not onlyaway tominimize the negative effects of hearing loss, but alsominimize the depressive symptoms of these patients. Thequestionnaire proved to be easily applicable. In the nearfuture, it is expected that the hearing health service applythe questionnaire in order to facilitate access to necessary careto this population with depressive symptoms, focusing onquality of life.

Keywords: Elderly, depression, hearing loss, hearingaid

A33. Determining Factors In The Improvement AndWorsening Of Tinnitus PerceptionClaudine Devicari Bueno, Adriane Ribeiro Teixeira, AlexandreHundertmarck Lessa, Letícia Petersen Schmidt Rosito, CelsoDall’IgnaUniversidade Federal do Rio Grande do Sul (Ufrgs) Hospital de Clínicasde Porto Alegre (Hcpa)

Introduction: In the assessment of patients withtinnitus, the report that some factors may diminish or en-hance the perception of this symptom is common.

Objective: To analyze factors considered as determi-nants of improvement and worsening in the tinnitus percep-tion by individuals affected by the symptoms.

Methodology: The participants of this study wereseen at an outpatient clinic for evaluation of individualswith chronic tinnitus. All mentioned completed a question-naire about the factors that mayworsen and improve tinnitus,prepared by the group responsible for the research. For a list ofsituations presented by the researchers, based on specializedliterature, individuals should respond if there was improve-ment, worsening or if the situation did not change theperception of tinnitus.

Results: The sample consisted of 698 patients seenbetween 2002 and 2014, with 466 (66.76%) females and 232(33.2%) were male. The ages ranged from 9 to 89 years, mean58.1 years. Through analysis of the factors, it became clear thatthe silence (65.4%), night time (62.4%) and anxiety (49.7%) arefactors that accentuate the perception of tinnitus. As improve-ment factor, individuals mentioned especially the presence ofenvironmental noise (37.1%) and rest (16.9%).

Conclusion: In this analysis is possible to verify that inthis sample, quiet situations and anxiety accentuate theperception of tinnitus. The presence of environmental noiseand rest help to decrease the perception of the symptom.

Keywords: tinnitus, anxiety, rest



A629. Development Of A Virtual Environment On BreathingFunctionGabriele Ramos de Luccas, Ana Paula FukushiroFaculdade de Odontologia de Bauru - Universidade de São Paulo

Introduction: breathing is one of the vital functions ofthe body and is essential for the maintenance of life. Preven-tive actions of respiratory disorders can be used by thepopulation as well as the early self-diagnosis and the earlycare for treatment based on the knowledge of the subject.

Objectives: this study aimed to develop a VirtualLearning Environment on breathing function for young peo-ple, in particular adolescents.

Methods: the Virtual Learning Environment was elab-orated by Wordpress tool, and the stages of analysis, design,development and implementationwere followed. All the textsare available on the Virtual Learning Environment and wereevaluated by the Flesch Reading Index.

Results: the Virtual Learning Environment, in blogformat, designed for adolescents, containing information onbreathing functionwas developed in eight separate topics anda session of "curiosities". Clear and accessible language for thetarget audiencewas used in all posts. Current topics of interestsuch as mouth breathing, snoring, apnea, respiratory allergieswere written in more detail.

Conclusion: the virtual page "How do I breathe?" isavailable for access on internet at the address: https://co-moeurespiro.wordpress.com. Regarding the theme, it is ex-pected that Virtual Learning Environment providesinformation to adolescents on breathing function, allowingthem to disseminate such knowledge to others and identifysigns and symptoms of changes in respiratory function andthus contribute to early diagnosis.

Keywords: Breathing, Distance Education, Internet

A660. Dysphagia and Level Of Intake Analysis By Mouth ofAIDS Patients With Progressive MultifocalLeukoencephalopathyMariana Saconato, Katia Alonso Rodrigues, Graziela UltramariRodriguesInstituto de Infectologia Emilio Ribas

Introduction: Progressive multifocal leukoencephal-opathy is a demyelinating disease, whosemain symptoms are:hemiparesis, ataxy, aphasia, dysarthria and dysphagia.

Objective: Verify the presence of dysphagia pre andpost therapy in patients with HIV and progressive multifocalleukoencephalopathy.

Methodology: The presence, degree of dysphagia andlevel of intakebymouthwere analyzed through theDysphagiaOutcome and Severity Scale (O’Neil) and the Functional OralIntake Scale (FOIS) in 12 patients with a mean age of 48 years.

Results: Two patients (16%) had normal swallowing,with FOIS level 7. Five (42%), moderate oropharyngeal dys-phagia, 40%with initial FOIS 4 and 60%with initial FOIS 5. Five(42%) patients had severe oropharyngeal dysphagia, initialFOIS 1. Only two (40%) of the patients with moderate dyspha-gia were rehabilitated and started to present functionalswallowing with FOIS 6, after an average of 7 sessions oftherapy. Only one patient (20%) with severe oropharyngealdysphagia was rehabilitated, with final FOIS 5 after 6 sessionsof therapy. The remaining patients with severe dysphagia(80%) evolved to gastrostomy after 12 therapy sessions.

Discussion: The high number of patients with moder-ate and severe dysphagia was justified by the high viral loadand reduced CD4þ cell counts associated with local lesions,which in this study was presented mostly on the posteriorfossa and temporoparietal lobe.

Conclusion: Moderate and severe dysphagia werefound in nearly 85% of the sample and most patients werenot rehabilitated.

Keywords: Dysphagia, Progressive multifocal leu-koencephalopathy, Acquired Immunodeficiency Syndrome

A412. Efficacy Of Vestibular Rehabilitation Exercises InElderly Patients With Benign Paroxysmal Positional VertigoPricila Sleifer, Bibiana Fuzer da Silva, Amanda Zanatta BerticelliUniversidade Federal do Rio Grande do Sul

Introduction: Benign paroxysmal positional vertigo(BPPV) is a vestibular disorder in which patients reportepisodes of rotary dizziness upon changes of cephalic orbody position. Vestibular rehabilitation (VR) provides,through specific and repeated exercises, the activation ofthe neural plasticity mechanism of the central nervous sys-tem, trying to reach vestibular compensation.

Objective: To determine the efficacy of vestibularrehabilitation exercises of Cawthorne-Cooksey rehabilitationprotocols through the scores obtained with the Berg BalanceScale (BBS) and the Dizziness Handicap Inventory (DHI)applied before and after vestibular rehabilitation in elderlypeople with BPPV.

Methodology: The patients went through otorhino-laryngological evaluation, balance evaluation, by the BBS scaleand answered the DHI questionnaire. Cawthorne-Cookseyrehabilitation exercises were applied in order to promotedynamic return of balance in movement and restore thespatial orientation. Ninety days after initiating the vestibularrehabilitation, the BBS scale and DHI questionnaire werereapplied to compare the scores.Results:The sample wascomposed by 41 elderly, 23 being women and 18 beingmen, with an average age of 68.1years. Comparing the scoresof pre and post VR, therewas a significant increase in scores ofDHI and decrease of BBS after VR. The scores are related to thegender of the elderly (p <0.001). Women presented betterscores of the DHI and BBS post VR, compared with men,although is not related to the age group (p> 0.100).

Conclusion: The significant increase in scores of theDHI and decrease of the BBS after VR, demonstrated that VR isan effective therapeutic procedure for elderly patients withbenign paroxysmal positional vertigo.

Keywords: elderly,vestibular rehabilitation,benignparoxysmal positional vertigo

A122. HINT Brazil: Speech in Noise Recognition Test InChildren - Preliminary StudyCarolina Veronica Lino Novelli, Nádia Giulian de Carvalho,Maria Francisca Colella-SantosUniversidade Estadual de Campinas

Introduction: Auditory processing refers to the effi-ciency by which the Central Nervous System uses auditoryinformation and is related to certain auditory skills such asspeech recognition in noise. The â€Hearing in Noise Test’(HINT) allows themeasurement of the Speech / Noise ratio (S /N). It has been used in the evaluation of patients with cochlearimplantation or Hearing Aid users. In Brazil, it was adaptedinto Portuguese and applied in adults. There are no studies toestablish the parameters of normality for children, in thebrazilian literature; if so, they could help diagnose studentswith complaints of auditory processing.

Objective: Analyze speech recognition in noise fornormal hearing children.

Method: Therewere evaluated 26 students between 8and 10 years, of both genders, without hearing or school



complaints, and results within the normal range in the basicaudiological evaluation and on the dichotic digits test. Usingheadphones, 4 lists were applied with 20 sentences each, andsearched the S / N ratio in the following conditions: Noisefront, Noise right and Noise left. At the end, the equipmentcalculated the Composite Noise, which corresponds to theweighted average of the tested conditions.

Results: The S / NNoise ratio for maleswas -6.15 dBHLand for females was -6.11 dBHL. Regarding age, the averagewas -5.28 dBHL at 8 years, -6.03 dBHL at 9 and -6.74 dBHL at10.

Conclusion: The evaluated children recognized thesentences presented at a lower intensity to noise, around 5 dB.

A56. Hospitalized Nursing Mothers Knowledge aboutBreastfeeding, Speech and Language PathologyBruna Gonçalves Batista, Andréa Monteiro Correia Medeiros,Ikaro Daniel de Carvalho BarretoUniversidade Federal de Sergipe

Introduction: Group guidelines about breastfeedingand speech and language healthy cover aspescts such aslanguage, myofunctional orfacial system, speech and hearing.

Objective: Investigate the hospitalized nursing moth-ers knowledge about breastfeeding and speech and languagepathology aspects. Verify acceptance of made groupintervention.

Methods: It’s a interventionist and comparative studywith 163 hospitalized nursing mothers from a public mater-nity hospital in Aracaju. Nursingmothers were divided in twogroups according to type of hospitalization (Kangaroo Neona-tal Intermediate Care Unit and Common Postpartum Room).Assertiveness Test was applied it and it concerns aboutbreastfeeding, speech and language pathology, followed bythe guidelines. Acceptance test were applied too. We modelthe nursing mother knowledge in the assertiveness test usingBirnbaum’s Unidimensional 3 Parameters Model under ItemResponse Theory that describes the items. We used Mann-Whitney test to compare estimated knowledge between thegroups. P-values under 5% were considered statisticalsignificant.

Results: There was no statistical significant correla-tion with hospitalization time and knowledge level. Accep-tance hits values above 85%.

Conclusion: Nursing mother group guidance as dis-cursive practice about breastfeeding, speech and languagepathology was considered well accepted. This health educa-tional activity provided access to information independent ofhospitalization time and hospitalization type of nursingmothers. The good intervention acceptance concludes viabili-ty of expand those practices in hospital environmental.

Keywords: Common Postpartum Room; KangarooNeonatal Intermediate Care Unit; Health Promotion; Breast-feeding; Humanization of Assistance

A306. Identification Of Sources Of Noise And Estimation OfClassroom Noise Level Of A Municipal School In The City OfCambé, ParanáTeresa Maria Momensohn dos Santos, Adele Cristina SegalaCastroIeaa - Instituto de Estudos Avançados da Audição

Introduction: The higher is the noise level and thenumber of sources, the worse is the condition for the child tolisten, pay attention, understand, assimilate, learn orconcentrate.

Objective: to identify the noise sources and to esti-mate the sound pressure level of the noise inside classrooms ofa school in the city of Cambé (PR).

Methods: the sample was comprised of 184 studentsenrolled in 4th. and 5th. years of elementary school and 18teachers/staff of a school in the city of Cambé/Paraná. Soundlevels of the classroom and the playground during physicaleducation class were estimated with a sound pressure levelmeter before and after a hearing awareness program.

Results: The most frequent causes of noise in theclassroom were people talking (36%) noise from the sportscourt (24%), the noise of chairs and tables (16%) and schoolreform (11 percent). Noisier locations were the sports court(40%), the schoolyard (42%) and the classroom (9%). The noiselevel in the classrooms showed medians between 50 and84 dB (A). The courtyard, during activity time, peaked at89 dB (A) decreased to 52 dB (A) outside these hours.

Conclusion: the values in dB (A) found on schooloutweigh the values recommended by resolution 01/90ABNT, 40-50dB (A) to classroom. Background noise can inter-fere in the teaching learning process.

A704. InfluenceOfMusic Education InTheAuditory BehaviorOf Children 8-9 Years OldJuliana Jannini Jose, Jayne Guterres de Mello, Letícia Splendor,Liliane Desgualdo PereiraUniversidade Federal de São Paulo

Introduction:Music is seen as a resource to encouragethe development of skills involved in auditory processing.Purpose: To evaluate and compare the everyday auditorybehavior reported by parents of children 8-9 years old, withand without musical education.

Method: The study included 40 children aged 8 and 9years of both sexes: 20 students ofmusic (study group) and 20without music education (control group). Was used the SABScale, consisting of a questionnaire on the auditory behaviorwith 12 questions about how the individual deals with theworld of sounds in everyday situations, which was answeredby the parents of the children. The higher the score obtainedon the scale, better the auditory behavior the individual,which 60 points the highest score possible. The statisticalanalysis took into account the level of significance of 5%.

Results: children without musical education had ascore of 50.8 and 50 points in the age group of 8 and 9 years,respectively. With regard to children with music education,the score obtained was 54 and 56.4 in children aged 8 and 9years, respectively. Thus, the results showed better auditorybehavior in childrenwithmusical experiencewhen comparedto children of the same age without music education, with astatistically significant difference between the groups withand without music education in the range of 9 years.

Conclusion: There was influence of musical experi-ence in everyday auditory behavior of children.

A30. Late Latency Auditory Evoked Potential and Cognitive:virus holders of Acquired Immune Deficiency SyndromeLetícia Gregory, Pricila SleiferUniversidade Federal do Rio Grande do Sul

Introduction: central nervous system and the im-mune system are the main targets of infection by humanimmunodeficiency virus, which may cause impairmentthroughout the auditory pathway, including the central audi-tory system. In this case, are common changes in electrophys-iological tests. Objectives: To describe and analyze theresponses obtained in the late latency auditory evoked



potential (LLAEP) and cognitive potential in children andadolescents with HIV, compared with the control group;investigate possible correlations between changes inelectrophysiological evaluation and the use of antiretroviralmedications.

Methods: Cross-sectional, comparative and contem-porary study of children and adolescents 8-16 years old, HIVpositive. Participants had anamnesis, pure tone and speechaudiometry, acoustic impedance and electrophysiologicalevaluation.

Results: study group had 14 children and adolescentswith HIV and the control group had 14 children and adoles-centswith no risk for HIV. Therewas an increase of latencies inthe P1-N2 complex in both ears, and reduced amplitude in theleft ear. About P3, people with virus showed increased latencywhen compared with children and adolescents in the controlgroup. Was found reduction in the amplitude of P3, but thiswas not significant. The drugs most used were zidovudine,didanosine, lopinavir/r and lamivudine. It was not possible tocorrelate the changes in the electrophysiological evaluationand the use of a specific anti-retroviral medication, becausethe subjects used different drugs.

Conclusion: Children and adolescents living with HIVhave changes in LLAEP and cognitive potential, particularlywith respect to latency.

Keywords: Hearing; Late Latency Auditory EvokedPotential; HIV

A91. Piercing Lingual And Its Effects On Oral FunctionsTaísa Giannecchini Gonçalves de SouzaFaculdades Metropolitanas Unidas - São Paulo

Introduction: The piercing is a form of adorning thehuman body, typically via perforations introduced sterilizedwhere metal pieces are inserted. However, there are numer-ous factors that harm the pierced site, causing lesions in 100%of cases. The lingual Piercing causes changes in the mucosaand serves as a focus for many infections.

Objectives: To describe the effects of tongue piercingto perform oral functions specified by users and develop aprevention program.

Resumed Report: participants were 30 users LingualPiercing for at least one year, who answered a questionnaireabout the effects of adornment for your general health andwith respect to oral functions. 80% reported difficulty speak-ing after laying Piercing, mainly feel tongue-tied and pain onaverage up to 2months after placement. 60% felt discomfort ordifficulty to produce any sound and all reported difficulties inchewing, but got used to the new tongue movements. 60%developed a parafunctional habit to show the Piercing and 40%had throat infections after placement. 90% consider their rightspeech, but refer excessive salivation and locked articulation.

Conclusion: After placing the lingual Piercing, usershave speech disorders and chewing for at least two months.60% of respondents developed a parafunctional habit and 90%reported excessive salivation and locked articulation, whichare symptoms that impair intelligibility Speech. We believethat the speech pathologist as a health agent should informetheir clients about these consequences and move on to guidethem. The simple removal of Piercing eliminates its negativeeffects.

Keywords: piercing, speech

A634. Profile Analysis Of Patients Attending The HearingHealth Service Derdic / Pucsp For 9 YearsGiovana Esturaro, Beatriz Andrade Mendes, Beatriz Cavalcantide Albuquerque Caiuby NovaesPontifícia Universidade Católica de São Paulo

Introduction: Considering the hearing impairmentissues in Brazil, the Ministry of Health realized the need toorganize the rehabilitation system in the different levels ofcare, which culminated in the establishment of the nationalpolicies - Política Nacional de Atenção à Saúde Auditiva in2004. After nine years of implementation it is possible toevaluate the work done by proposing improvements for thecoming year.

Objective: to analyze the waiting time between thediagnostic process and the hearing aid (HA) selection andbetween the selection and delivery of HA of 8179 patientsattending the Hearing Health Service (HHS), from 2004 to2012.

Method: The records of the institutionwere analyzed,through an Excel spreadsheet and controlled by the adminis-trative sector. Place of reference, date of birth, gender, age,etiology, diagnosis date, date of HA selection, receiving date ofHA and date of audiological follow up were analyzed and asimple statistical analysis was performed.

Results: The results point to the growth in the numberof visits, with stability from the year 2008; the number ofpatients did not have excessive growth over the years, thusmaintaining an average of 918 patients between 2006 and2012. The characterization according to gender and age alsohas no change over the years. The timebetween the diagnosticprocedures, selection and receiving date of HA have varied themost.

Conclusion: there is a necessity to control the pro-cesses performed for the constant improvement of service andbetter patient care.

A38. Prolonged Endotracheal Intubation And Dysphagia InPediatric PatientsNatália Borges Calmon Du Pin Galvão, Karina Elena CadioliBernardis Buhler, Fabíola Custódio Flabiano Almeida, SuellyCecilia Olivan LimongiHospital Universitário - Usp

Introduction: Prolonged intubation has been re-ported in the literature as a predictor of oropharyngealdysphagia.

Objective: To describe the impairments in swallowingpattern of pediatric patients undergoing prolonged intubation(> 48 hours), by systematic bedside evaluations using theClinical Pediatric Dysphagia Assessment Protocol (PAD-PED).

Methods: Prospective observational cross-sectionalstudy. Ten children (age range: one month to seven years)were assessed 24 to 48 hours after extubation, and swallowingwas classified according to the Pediatric Dysphagia SeverityScale. Subsequent bedside assessments were also conducteduntil oral-feeding reintroduction.

Results: Alterations in both oral and pharyngealphaseswere found formost patients undergoing endotrachealintubation. The initial assessment after extubation revealedmoderate to severe dysphagia in 70% of the subjects (p-value¼ 0.02). All patients underwent on average five subsequentassessments. At discharge, the final assessment revealed that70% of subjects presented normal swallowing and 30% pre-sented mild dysphagia, according to the PAD-PED Scale. Thisimprovement on patients’ swallowing was statistically signif-icant (p-value ¼ 0.02). Spearman Correlation Test showedpositive and significant correlation between endotracheal



intubation for more than five days and the occurrence ofdysphagia (R¼ 0.88, p-value ¼ 0.01).

Conclusion: Most of the subjects presented abnor-malities in oral and pharyngeal phases of swallowing, show-ing an important risk for tracheal aspiration, especially forthose who have undergone endotracheal intubation for morethan five days. However, future studies with a larger sampleusing complementary objective methods of evaluation arenecessary, in order to corroborate the clinical findings.

Keywords: intubation tracheal; dysphagia; swallow-ing disorders

A26. Relationship Between The Presence OfVideolaryngoscopic Signs SuggestiveOf LaryngopharyngealReflux And Voice Disorders In TeachersBruna Mateus Rocha de Andrade, Susana Pimentel PintoGiannini, André de Campos Duprat, Leslie Piccolotto FerreiraPontifícia Universidade Católica de São Paulo

Objective: To analyze the relationship between thepresence of videolaryngoscopic signs suggestive of laryngo-pharyngeal reflux (LPR) and the voice disorder (VD) forteachers.

Method: research, cross-cutting, with conveniencesample that had as inclusion criteria, subjects have over 18years, be a teacher female, seek care with complaining of VDand/or LPR. The exclusion criteriawere: smoking, and providerespiratory changes. All subjects met the following instru-ments: Vocal Production Condition - Teacher (VPC-T), includ-ing the Screening Index for Voice Disorder (SIVD); and VoiceHandicap Index (VHI). There was sample collection speaks forvoice perceptual assessment and all underwent review ofotolaryngology.

Results: Were evaluated 121 teachers, with a meanage of 43 years and 7.8 class hours per day. Only 24.0% of theteachers did not have vocal fold lesions and 42.1% had video-laryngoscopic signs suggestive of LPR. In the group of teacherswith the presence of LPR signs, the most common symptomsof SIVD were: dry throat, hoarseness, throat clearing; theaverage VHI was 17.9 points. There wasn’t association be-tween voice disorder and presence of videolaryngoscopicsigns suggestive of LPR. In the multiple binary logistic regres-sion analysis, the independent factors for the LPR were ageand score (tertile: 13-20) VHI.

Conclusion: There was no association between VDand LPR, but between age and VHI score.

A47. Relationship Between The Result Of BinauralInteraction Test And The Phonological System In ChildrenWith Phonological DisordersDianaWeber Bartz, Carolina Nunes Laux, Cecilia Vieira Peruch,Maria Inês Dornelles da Costa Ferreira, Márcia SalgadoMachado, Letícia Pacheco RibasUniversidade Federal de Ciências da Saúde de Porto Alegre

Introduction: During the process of language acqui-sition, hearing plays a fundamental role, because through theintegrity of the structures involved, enables quality of soundinformation by exposure to speech. To assess these structures,there is a battery of behavioral assessments aimed at identi-fying which hearing abilities are altered, called assessment ofcentral auditory processing.

Objective: To investigate the relationship between theresult of binaural interaction test Masking Level Difference,which comprises the assessment of central auditory process-ing, and the composition of the phonological system ofchildren with phonological disorders, in order to check for

associations that can help understanding of atypical languageacquisition process.

Methods: A quantitative, observational and descrip-tive study, developed through secondary lifting a databaseconsisting of speech therapy evaluations of 57 children withphonological disorders, aged between 5 and 10 years (CEPprocess n° 621.047).

Results: Of these 57 children, 23 (40.3%) present theresult Masking Level Difference standard and 34 (59.7%) havechanged the result. In the relationship between phonologicalacquisition of phonemes in initial andmedial onset, therewasstatistical significance between the non-acquisition of /S/ and/R/ early-onset and /S/ and /Z/ in medial onset with the testresult changed.

Conclusion: The results of this study indicate weakrelationship between binaural interaction and the phonologi-cal disorder, and possibly other skills are involved. Studiesrelating the entire battery of assessments of auditory process-ing in more homogeneous samples are fundamental to theunderstanding of these cases and to formulate new rehabili-tation proposals.

A43. Risk Factors For TheDisorder Of Swallowing in CerebralPalsyRuth Siqueira Grawer, Michelle Apellanis Borges, Laura FuchsNunesCasa do Menino Jesus de Paraga

Introduction: Cerebral Palsy represents a group ofpermanent motor disorders in developing brain. These dis-orders can result in changes in swallowing, leading to respi-ratory and nutritional disorders.

Objectives: Analyze the clinical risk factors for thedisorder of swallowing in 37 individuals with Cerebral Palsy.

Method: transversal study of qualitative and quanti-tative character in a philanthropic institution in Porto Alegre-RS. Were included in the survey individuals diagnosed withCerebral Palsy. Using clinical evaluations in deglutition Proto-col, which are the variables: cheek tone, alterations of bite,sialorrhea, breathing, labial occlusion, laryngeal elevation,Classification of motor function Grossa (GMFCS) and Func-tional Oral Intake Scale - FOIS.

Results: The patients studied, 55.5% were male andthe average age was 16 years. Among them, 97.2% possesssome degree of swallowing disorder. It has been observed inindividuals that 67.5% showed facial tone changed, of these,64% showed hipotonic tone; 78.3% presented alterations ofbite, being the open bite (72.4%) the most frequent; 81%absence or incompetence of labial occlusion; 37.8% presentedsialorrhea. About to breath, 56.7% use Oro-nasal breathing,21.6% oral, 10.8% nose and 10.8% use of tracheotomy; 67.5%presented elevation and anteriorization laryngeal adequateduring swallowing of saliva; about GMFCS 70.2%, are at level 5and in FOIS 32.4% are at level 1.

Conclusions: Disorders in swallowing are associatedwith respiratory complications andwith increase inmortality,the findings of the assessment being essential to assist inspeech therapy prognosis and therapeutic process.

Keywords: Cerebral Palsy; Deglutition; Disorders

A322. Speech Of A Child With Unilateral Hearing Loss:Phonetic EvidencesKarina Arreco Fiorotti Cruz, Maria Sarah Tristão Ferraz, MabelGonçalves Almeida, Aline Neves Pessoa-AlmeidaUniversidade Federal do Espírito Santo - Ufes



Introduction: Acoustic and perceptual analysis can beconsidered useful clinical tools to investigate the speechcharacteristics of unilateral hearing loss children. Studiesthat analyze the correspondence between evidence of thedevelopment of prosodic aspects indicate to the diversityparameters that are used in the evaluation and monitoringof these subjects that relate the implications of articulatoryacoustic feedback.

Objectives: Aimed at describing methodological ap-proach with perceptual and acoustic correlates of the speechsamples from of unilateral hearing loss children.

Methods: Speech samples of a child, 8 years boy, werecollected during speech therapy sessions. The perceptualanalysis was based on the Vocal Profile Analysis Scheme forBrazilian Portuguese and the recorded corpus was analyzedthrough the ExpressionEvaluator script ran by Praat softwarev5.2.10. The measures extracted comprised the fundamentalfrequency-f0, first f0 derivative, intensity, spectral slope andlong-term mean spectrum.

Results: Such methodological addressed leads to thepossibility todetail the articulatorymaneuvers adopted by thechildren, which indicates probable strategies in trying toattain the acoustic-articulatory targets.In this example case,association of minimized of amplitude movement of articu-lators with adjustments of laryngeal hypotension, decrease inrate of speech andminimized extension of pitch and loudness,associated with falsetto showed thatcases of unilateral hear-ing lossrequire therapeutic strategies that consider the insep-arable relationship between auditory processing and speechproduction adjustments.

Conclusion: The phonetic model showed the varietyof possible and predictable vocal configurations resultingfrom the perception and speech production in unilateralhearing loss.

Keywords: Auditory Perception; Acoustic Analysis;Cochlear Implant

A547. Speech Recognition In Elderly Listeners WithComplaint Of Difficulty Of Understanding Of Fast SpeechBianca Peres Santana, Liliane Desgualdo PereiraUniversidade Federal de São Paulo

Introduction: The time-compressed speech test hasrecently published in Brazilian Portuguese in the manual ofcentral auditory processing Pereira and Schochat, 2011.

Objective: To evaluate the performance in this testthat measures the ability of auditory closure in the elderlylisteners and compare difference about the age and presenceof complaint.

Method: The first group was composed of 18 elderlyparticipants with self-reported complaints of difficulty un-derstanding fast speech. They were distributed in two agegroups: 60-69 years (n ¼ 10) and 70-79 years (n ¼ 8). 15elderly people without the complaint, distributed in the sametwo age groups: 60-69 years (n ¼ 10) and 70-79 years (n ¼ 5),formed the second group. All the elderly speakers of BrazilianPortuguese, had symmetrical hearing, and hearing level withthresholds less than or equal to 55 dB HL in both ears. Theparticipants were assessed by the time-compressed speechauditory test withmonosyllabic and disyllabic words. The testwas applied separately in each ear.

Results: It was observed that the younger group had abetter performance for all stimuli presented, in both ears andindependent of complaint presence. The performance wassimilar for monosyllables and disyllables, in both ears, inde-pendent of complaint presence or age group. It was not foundstatistically significant difference between the groupwith andwithout the complaint.

Conclusion: The auditory closure was not affected bythe presence of complaint of difficulty understanding fastspeech. However, the younger group had a better performancewhen compared with the older group.

Keywords: auditory perception, auditory tests, elderly

A53. Subjective Visual Vertical And Caloric Test In VertigoPatientsMaristelaMian Ferreira, AdrianaMarques da Silva, Thais Grigol,Leslie Palma Gorski, Heloisa Helena Caovilla Malavasi Ganança,Mauricio Malavasi GanançaUniversidade Federal de São Paulo/Escola Paulista de Medicina(Unifesp-Epm)

Introduction: The ability to judgewhether an object isin the vertical position is called subjective visual vertical(SVV); and caloric test stimulates each ear and thus helpsidentify the injured labyrinth.

Objective: To compare findings in the SVV and calorictest in vertigo patients.

Materials andMethods: 108 patients were submittedto two assessments. Binocular SVV was measured by thebucket method. The patients indicated the estimated positionin which a fluorescent line within a bucket reached thevertical position. It was considered as a normal result whenthe average deviation was found up to 3°. The caloric test wasperformed at temperatures of 50°C and 24°C and were classi-fied as normal or altered. Data were tabulated and submittedto statistical analysis.

Results: In the SVV evaluation, 70 patients presentednormal measures (64.8%) and 38 abnormal results (35.2%). Inthe caloric test, 60 patients presented normal results (55.5%)and 48 abnormal findings (44.5%). Abnormal SSV and normalcaloric test results occured in 23 cases (21.3%), normal SVVand abnormal caloric test results occured in 33 cases (30.5%),combined abnormal SSV and abnormal caloric test resultsoccured in 15 cases (13.8%). There was no significant differ-encebetween the number of normal and abnormal findings ofSVV and caloric test (p ¼ 0.444).

Conclusion: Separately or concomitantly, SVV andcaloric test often reveal abnormal findings in vertiginouspatients, highlighting the importance of performing bothprocedures in the neurotological evaluation.

A15. Telefitting at a Public Rehab ClinicRicardo Ferreira Bento, Silvio Pires Penteado, Ana AdelinaGiantomassi Della Torre, Mara GândaraFaculty Of Medicine University Of Sao Paulo

Introduction: There are 139 credentialed clinics toattend the BrazilianHearing Rehab Public Policies (Ordinances587 and 589 - October 2004) to cover 190,732,694 citizensirregularly spread alongside a territory of 8,515,767,049 km2 -5th world largest. The hearing impairment faced to manyhurdles from home to a credentialed center as long distance,lack of infrastructure, social inequalities â€“ just to name few.ENT and audiologist professional services are for free, also theexams and aids, but to access a credentialed center for exams,fitting, reassessments, et cetera, all turns a more complexchoice for hearing impaired, besides the full gratuity providedby SUS. Telefitting (fit aids remotely) offers hearing rehab backat any place, anytime.

Objective: Bring the results of remote fitting based ona SUS credentialed clinic and a research center (FundaçãoOtorrinolaringologia) based on the aids designed for publicpolicies (â€œgeneric digital aidsâ€).



Materials and Methods: Eleven patients fitted atReouvir were asked for a subsequent fitting remotely withthe audiologist landed at Fundação Otorrinolaringologia andpatients stand at Reouvir. All related materials were acquiredlocally with a low-cost price structure in mind.

Results: Robust willingness from patients whose as-serted the potential of having a clinic to perform fittingservices nearly their dwelling.

Conclusion: Telefitting is an important tool to cravemore public clinics near patients dwelling with the back of acredentialed clinic.

Keywords: Hearing aids, patient satisfaction, publicpolicies, telemedicine, quality improvement

A37. The Effect Of Auditory Training In Self-Perception OfVoice Quality Of Voice ProfessionalsLoriane Gratão de Mesquita, Patricia Barbarini TakakiUniversidade Federal de São Paulo- Unifesp

Introduction:Hearing disabilities can affect the treat-ment of dysphonia.

Objective: To evaluate the effect of the process ofisolated vocal speech therapy and combined with auditorytraining for the improvement of vocal self-perception of voiceprofessionals.

Method: 12 young adults, professional voice, bothgenders, with dysphonia. All participated in assessment andreassessment vocal and PAC, comprising the questionnaireQVV, Visual Analogue Scale (VAS), GRBASI -G scale, VocalAssessment Protocol and voice recording; Dicótico de Dígitos-TDD test, Frequency- Pattern Test TPF , RandomGap DetectionTest - RGDT, before and after the approaches of isolated andcombined vocal intervention, and without intervention. Sta-tistics performedwith non-parametric tests, significance levelof 0.10 due to the sample size.

Results: The combined intervention provided signifi-cant improvement (p ¼ 0.068) in the auditory abilities ofordering and temporal resolution. Interventions, isolatedand combined, proved to be effective (p ¼ 0.068) for the vocalself-perception. In perceptual assessment andphonation time,post- intervention, the group of subjects with vocal interven-tion and or hearing improved.

Conclusion: The vocal intervention combined withauditory training had a positive impact on self-perception ofvocal quality and effectiveness in the improvement of theauditory abilities of temporal ordering and temporalresolution.

A31. The Influence Of Personal Habits In The Perception OfTinnitusCamila Zander Neves, Adriane Ribeiro Teixeira, AlexandreHundertmarck Lessa, Letícia Petersen Schmidt Rosito, CelsoDall’IgnaUniversidade Federal do Rio Grande do Sul (Ufrgs) Hospital de Clínicasde Porto Alegre (Hcpa)

Introduction: Tinnitus can have a negative effect onpatient’s quality of life. The professional responsible for theevaluation, diagnosis and treatment can help the patient toidentify situations where the symptom is perceived with lessintensity, which can assist in the therapy to be adopted.

Objective: To determine which habits interfere withthe patient’s perception of tinnitus, accentuating or reducingthe perception of the symptom.

Methodology:We assessed 725 patients treated in anespecialised outpatient clinic, with 272 (37.52%) men and 453(62.48%) women. All patients answered a questionnaire de-

veloped by the research group, based on specialized literature,containing information regarding daily habits and the percep-tion of improvement or worsening of the tinnitus symptom.For each habit presented by the researcher, individuals shouldrespond if they perceived improvement, deterioration or ifthere was no change of the tinnitus perception.

Results: Most patients report that the practice ofphysical exercises (77.43%), eating habits (93.40%), fasting(91.69%), alcohol consumption (83.26%) and tobacco(92.76%) do not change the perception of tinnitus, againstexpected by researchers and described in the literature. Still inrelation to physical exercise, we highlight the presence ofcontradictory data regarding the habit. While most do notrealize the difference (77.43%), some consider it an improve-ment factor (9.14%) and other (13.41%) worsening of thesymptoms’ perception.

Conclusion: The data analysis shows that the group ofpatients evaluated do not observe relationship between habitsand the improvement or worsening of tinnitus perception.

Keywords: habits; tinnus; questionnaire

A356. The Performance Of Auditory Training Sessions InIndividuals With Auditory Processing DisorderAline Priscila Cibian, Liliane Desgualdo PereiraUniversidade Federal de São Paulo

Introduction: For the auditory training is challengingis recommended to keep the rate of success versus errorapproximate 70/30%.

Objective: Check the performance of individuals withauditory processing disorder in auditory training sessionswith dichotic listening.

Methods: 19 individuals 12 to 15 years, of both sexes.These were submitted to auditory training based on DichoticInteraural Intensity Difference, proposed by FrankMusiek andorganized in eight sessions, lasting 50 minutes each. Stimuliwere worked numbers, onomatopoeia, phrases and syllables,on the steps of separation and binaural integration. Subjectswere separated by group, according to the alteration in thephysiological mechanisms: selective attention and temporalprocessing. In each of them, called Group selective attentionandGroup temporal processing, and bothmechanisms: Groupselective attention and temporal processing.

Results: The groups had averages above the expectedhits. In the first four sessions were worked stimuli withnumbers, onomatopoeia and phrases (binaural separation)and all groups had averages above 90% correct. The fifth andsixth session, held with syllables stimuli were more challeng-ing groups had averages above 69%. In the seventh session,with stimuli numbers, binaural integration stage, the groupshad averages above 80%; in thefirst stage of the eighth session,with onomatopoeia stimuli, binaural integration stage, thegroups had averages above 97%, in the second stage of theeighth session, with syllabic stimuli, binaural integrationstage, the groups had averages above 48%.

Conclusion: The auditory training found that syllablesweremore challenging than stimuliwith digits, onomatopoeicsounds and phrases.

A51. Tinnitus In Patients With Chronic Otitis MediaAdriane Ribeiro Teixeira, Camila Zanetti, Letícia PetersenSchmidt Rosito, AlexandreHundertmarck Lessa, Sady Selaimenda CostaUniversidade Federal do Rio Grande do Sul (Ufrgs) e Hospital deClínicas de Porto Alegre (Hcpa)



Introduction: Chronic otitismedia is an inflammatorycondition lasting at least three months, usually accompaniedby irreversible tissue changes. Among the many symptomspresent in individuals with chronic otitis media is tinnitus.

Objective: To verify the presence of tinnitus in pa-tients treated at a chronic otitis media clinic.

Method: patient records datawere analyzed treated ata specialized clinic in the care of patients with chronic otitismedia in a tertiary hospital. Theywere included in the analysisthe results of evaluations carried out from 1999 to 2014.

Results: A total of 1103 medical records of patients ofboth genders,with similar distribution among females (51.2%;n ¼ 565) and male (47.8%, n ¼ 538). The age of patientsranged from 2 to 89 years, with a mean of 28.9 � 18.9 yearsand median of 24 years old. In relation to tinnitus, 55.5%(n ¼ 612) reported the presence of this feature, and 28.9%(n ¼ 177) mentioned bilateral tinnitus and 70.2% (n ¼ 435)unilateral tinnitus, and 35.1% (n ¼ 215) in the righr ear and35.1% (n ¼ 215) in the left ear. In five cases the patients wereunable to determine whether the tinnitus was unilateral orbilateral (0.8%).

Conclusion: The data analysis showed high preva-lence of tinnitus in patients with chronic otitis media, and inmost cases there was presence of unilateral tinnitus.

Keywords: otitis, tinnitus, otitis media

A144. Transition From Tube To Oral Feeding In A NewbornWith Laryngomalacia And Oropharyngeal DysphagiaGabriela Oliveira de Castro, Fabíola Custódio Flabiano Almeida,Suelly Cecilia Olivan Limongi, Karina Elena Cadioli BernardisBuhlerHospital Universitário da Universidade de São Paulo

Introduction: Laryngomalacia is the most commoncause of inspiratory stridor in children and it may be associ-ated to dysphagia, leading to prolonged hospitalization.

Objective: To describe speech-language therapy forswallowing and feeding transition in a newborn diagnosedwith laryngomalacia and oropharyngeal dysphagia.

Resumed Report: Case report of a preterm newborn(27w3d), extremely low birth-weight (795g), adequate forgestational age. At 56 days of life, the patient underwent toa bed-side swallowing-feeding evaluation which revealedabnormal non-nutritive sucking pattern with uncoordinatedtongue movement, and impaired breathing-swallowing coor-dinationwith increase of inspiratory stridor. Speech-languagetherapy consisted of oral-motor stimulation associated toswallowing training with minimum volume. The transitiontime from tube to full oral feeding was 54 days, and a total of33 speech-language therapy sessions were carried out. Thevolume for swallowing trainingwas gradually increased as thenewborn have not presented changes in cardiorespiratoryparameters. At 84 days of life, the newborn underwent tonasofibroscopy and videofluoroscopy that revealed a mildlaryngomalacia and silent micro-aspirations for thin liquids,respectively. Based on these results, themilk was thickened tonectar-like consistence for flow control. At 86 days of life, thenewborn have reached full oral feeding without difficulties onsucking-swallowing-breathing coordination.

Conclusion: This study reinforces the important roleof speech-language therapy associated to an accurate diagno-sis given by objective exams on the transition to oral feeding,in a more secure and efficient way.

Keywords: deglutition disorders, laryngomalacia,infant

A302. Vocal Evaluation AndVoice Handicap Index In PatientsWith Adductor Spasmodic Dysphonia Being Treated WithBotulinum ToxinGleidy Vannesa Espitia Rojas, Lílian Neto Aguiar Ricz, HiltonMarcos Alves RiczDepartamento de Oftalmologia, Otorrinolaringologia e Cirurgia deCabeça e Pescoço da Faculdade de Medicina de Ribeirão Preto daUniversidade de São Paulo

Introduction: Adductor spasmodic dysphonia is char-acterized by involuntary spasms of the laryngeal muscles,committing communication.

Objective: Assess the effectiveness of treatment withbotulinum toxin using the perceptual vocal and visual param-eters and the Voice Handicap Index.

Method: 16 individuals with adductor spasmodicdysphonia. All individuals were subjected to: the applicationof botulinum toxin type A, recording of the vocal soundwaves,filling the Voice Handicap Index before the botulinum toxininjection, in thefirst follow-up on average 36 days after, and inthe second follow-up on average after 137 days.

Results: for the perceptual auditory and visual anal-ysis of vocal sound waves, conducted by two adjudicatingvoice specialists, revealed in the comparison between thepre-application and the first follow-up a decrease in theseverity of the oscillation intensity, voice breaks, and vocaltremor (p ¼ 0.002). Comparing the pre-application and thefirst follow-up, for the Voice Handicap Index, a decrease inthe values of total score (p ¼ 0.039) and of emotionalmastery (p ¼ 0.035) was observed, whereas comparingthe pre-application and the second follow-up, there was asignificant decrease only for functional mastery (p ¼ 0.03).In this way, between, grading the severity of vocal qualityand the total score of the Voice Handicap Index, a moderatecorrelation was evident in the pre-application and secondfollow-up.

Conclusion: the treatment with botulinum toxin forindividuals who participated in this study proved effective-ness in the decrease of symptoms, as well as in a vocal impactwhich created changes in the phonatory function and facili-tated communication.

A164. Vocal Self-Assessment Protocols Provide The SameInformation About The Dysphonic Patient?Mara Behlau, Fabiana Copelli Zambon, Felipe Moreti, JuniorEuro de Barros CoutoUniversidade Federal de São Paulo â€“ Unifesp, Centro de Estudos daVoz â€“ Cev, Sindicato dos Professores de São Paulo â€“ Sinpro/SP

Introduction: The use of self-assessment instrumentsgives specific information of the voice problem impact thatcannot be derived from any other kind of evaluation.

Objectives: To compare the results of six instrumentsanswered by patients with behavioral â€“ BD and organic â€“OD dysphonia, correlating them with vocal aspects.

Methods: 103 patients (77 with BD, 26 with OD)answered the Brazilian versions of six instruments: Voice-Related Quality of Life â€“ V-RQOL, Voice Handicap Index â€“VHI, Vocal Performance Questionnaire â€“ VPQ, Vocal TractDiscomfort Scale â€“ VTD, Voice Symptom Scale â€“ VoiSS andVocal Signs and Symptoms List â€“ SSL. Vocal samples werecollected for auditory-perceptual analysis to classify the dys-phonia severity and type (rough, breathy or tense).

Results: None of the instruments correctly identified100% of the dysphonic individuals. The SSL identified 102 ofthe 103 dysphonic patients and the VoiSS, 100 of the 103.Numerous correlationswere found among the protocols,moreprevalent in subjects with BD; the strongest correlation was



between frequency and intensity scales of the VTD: corr¼ 0.946 and the total score of the VHI andVoiSS: corr ¼ 0.917.The VHI and VoiSS showedweak correlations with speech andsustained vowel tasks, voice type did not cause greaterscreening error in the protocols.

Conclusion: Different instruments of voice problemimpact provide supplementary information, especially topatients with BD. Evaluation of the vocal deviation for speechtask correlates better with the self-assessment protocols,apart from the voice type.

Keywords:Voice; Dysphonia; Evaluation Studies; Self-Assessment

A8. Vocal Welfare Of Teachers: A Proposal For InterventionDeveloped By Distance Mode LearningAna Terra Santos Pompeu, Leslie Piccolotto FerreiraPontifícia Universidade Católica de São Paulo

Introduction: Among the professional voice users,teachers have beenmuch researched, however, few initiativeshave been directed to review the speech-language interven-tion related to this audience.

Objective: The objective of this study is to present theresults of a pilot study of the Program Welfare Vocal, in theDistance Learning mode for the teachers of the public schoolsof São Paulo city, developed in partnership between the CityHall of São Paulo and the Voice laboratory of the CatholicUniversity of São Paulo. The program is focus on to aware theteachers regarding to Welfare Vocal.

Method: 75 teachers finished a workshop of 40 hoursoffered in Distance Learning mode containing two presentialmeetings, 8 modules, 8 Forums, 8 reviews and 16 chats. In theend, a questionnaire in Likert scale, was distributed in order toassess the form and content of theworkshop.We opted for thedescriptive analysis of the data.

Results: Most of the answers, corresponding to 71teachers was: the workshop was important for professionallearning (94%); reflect about the content (94%); enabled exposeideas to other participants (68%); had support from tutors (81%);felt encouraged to stay in the workshop (80%); and believe thatthe course duration fit their needs (77%).

Conclusion: The perspective of health education inthe Distance Learning may be an important option for theaspects of health promotion and disease prevention, reachingasmuch people as possible, thus promoting teachers self-care.



E-PostersOtorhinolaryngology

A269. Vertigo as the first symptom of a central lesion: a casereportRonaldo Kennedy de Paula Moreira, Mirian Cabral Moreira deCastro, Cintia Elisa Gonçalves CostaSanta Casa de Belo Horizonte

Introduction: Medulloblastoma is a primary neo-plasm of the CNS, which develops in the cerebellum, commonin children, with one third of those in adolescents and adults,and inmen. The symptoms are insidious and progressive, withintracranial hypertension frame, ataxia, nystagmus, amongothers.

Objectives: To show that a vertigo frame with nystag-mus highly suggestive of peripheral frame positioning, mayreveal a central lesion in a little affected age group. Show theimportance of infrared digital videonystagmography in help-ing in the topographic diagnosis of central lesions.

Resumed report: 43 year old male patient, complain-ing of occasional dizziness of 5 minutes long, two months ofevolution,whichworsenedwhen the patient turned to the leftand improved at bedtime. Dizziness evolved insidiously to apersistent and more intense picture. The Dix-Hallpike re-vealed a horizontal nystagmus without latency, beating tothe right position to left and left to right positioning, a littlemore intense than the last. In the maneuver to side channelshowed nystagmus with the same features found in the Dix-Hallpike. Patient did not respond to canalicular repositioningmaneuver for side channel when it was referred to neurologi-cal assessment. MRI showed a lesion in the posterior fossa,involving both cerebellar hemispheres, cerebellar vermis andbrainstem. Immunohistochemistry confirmed diagnosis ofmedulloblastoma.

Conclusion: Rare tumor in adults, with an insidiousvertigo and nystagmus positioning suggesting lateral canalBPPV, had the final outcome one medulloblastoma. Diagnosisconfirmed by immunohistochemical study following incon-clusive biopsy.

A581. Acute Invasive Fungal Rhinosinusitis and GadoliniumEnhanced Magnetic Resonance Imaging: A Case ReportJoão Augusto Bergamaschi, Felipe da Costa Huve, JeffersonAndré Bauer, Fabio Andre Selaimen, Camila Degen MeottiHospital de Clínicas de Porto Alegre

Introduction: Acute invasive fungal rhinosinusitis(AIFRS) is an aggressive and rapidly progressive infectionthat predominantly affects immunocompromised patients.Gadolinium (Gd) enhanced magnetic resonance imaging(MRI) is the gold standard exam to evaluate intracranial andorbitary extension.

Objective: This case report aims to highlight theimportance of Gd MRI in the early approach of suspectedAIFRS.

Resumed report: We report a case of a 1-year-oldpatient presenting pancytopenia, fever and rhinorrhea, in acontext of failure of bonemarrow transplant due tomyelodys-plastic syndrome. CT scan of nasal sinuses showed thickeningof paranasal sinuses mucosa on both sides. Nasal endoscopicevaluations in a 3 day-period didn’t evidence any lesions onnasal mucosa. Two days after, patient presented edema of leftinferior eyelid and proptosis. New CT scan showed worsening

in nasal congestion on left nasal cavity and periorbital edema.We performed endoscopic evaluation under general anesthe-sia, with no evidence of necrosis or ischemia, but lack ofbleeding after biopsy of nasal mucosa. Fungal culture showedaspergillus. Gd MRI was performed and demonstrated non-enhancing areas in post-contrast T1-weighted images of leftnasal cavity, rhinofarynx, soft palate, periorbital soft tissueand meninges, suggesting necrosis/ischemia caused by AIFRS,with no possibility of surgery resection. There was not recov-ery of pancytopenia, and patient died three days after.

Conclusion: Because of the aggressive nature of AIFRS,early diagnosis is most important to achieve a better treat-ment outcome. Besides serial nasal endoscopic evaluation, GdMRI should be considered sooner in the approach of immu-nocompromised patient presenting fungal rhinosinusitis.

A1727. Adductor Spasmodic Dysphonia - ManagementupdateDaniel Vasconcelos D’Avila, Mabel Ayme Queliz Gonzalez,Karen Vitols Brandão, Adriana Hachiya, Rui Imamura,Domingos Hiroshi TsujiDivisão de Otorrinolaringologia do Hospital das Clínicas da Faculdadede Medicina da Universidade de São Paulo

Introduction: Adductor spasmodic dysphonia (AdSD)is a focal dystonia of the intrinsic laryngeal adductor muscu-lature. For several years, AdSD was seen as a psychosomaticcondition or a personality disorder. Therefore, the offeredtherapeutic optionwas limited to speech therapy and psycho-therapy. Over the years a better understanding of the patho-physiology of the disease allowedmore satisfactory treatmentoptions.

Objectives: To provide an evidence-based update onthe treatment of adductor spasmodic dysphonia (AdSD) basedon recent publications.

Data Synthesis: This article reviews the recent pub-lications over the past 10 years with respect the therapeuticmanagement of AdSD. Although not curative, treatment ofAdSD is commonly performed with injections of botulinumtoxin. The best method and dosing for injection remain inquestion. The addition of speech therapy to botulinum toxinhas been reported with mixed results. Surgical treatmentsinclude selective recurrent laryngeal nerve section, thyroar-ytenoid muscle myectomy, endoscopic laser thyroarytenoidmyoneurectomy, type II thyroplasty, and selective laryngealadductor denervation-reinnervation, all of which have beenvalidated in the literature.

Conclusion: Periodic injection of botulinum toxintype A into the vocal folds is the most common and widelyaccepted and clinically proven treatment of AdSD. However,surgical treatment options have also been reported as a viablealternative. All of these options still need further researchwith a larger number of patients and long-term follow-up. Thesurgeons experience is essential for the choice of surgicaltechnique. It is important to provide patients with thoroughexplanation based on advantages and disadvantages of eachprocedure.

A7. Allergic Fungal Rhinosinusitis: Case Report andLiterature ReviewEmelyn dos Santos Barril, Mariana Lombardi Guidi, KrystalCalmeto Negri, Godofredo Campos Borges, Jose Jarjura Jorge JrPontificia Universidade Católica de São Paulo

Introduction: Rhinosinusitis can be defined as in-flammation of the nasal mucosa and paranasal sinuses. Aller-gic fungal rhinosinusitis is presented in a subclinical formwith

S20 E-Posters


signs and symptoms that derive from a local and/or systemicinflammatory response. Computed tomography is the goldstandard for diagnosis and surgical planning confirmation.The procedure of choice called FESS (functional endoscopicsinus surgery) aims to restore the physiology of ventilationand drainage of the sinuses.

Objectives: Reporting a case of allergic fungal rhino-sinusitis and identifying important aspects of this pathologyand treatment.

Resumed report: Female, 63, with chief complaint ofheadache pain in the infra-orbital region for 12 years withouteffective treatment, accompanied by nasal obstruction andgreenish secretion in the left nasal cavity. The computedtomography scan of the left maxillary sinus shows the sinusto be completely obliterated by content with soft tissuedensity. During the surgery, brownish purulent materialwas visualized in the left nasal cavity and polyposis degener-ation in the middle meatus, compatible with fungalrhinosinusitis.

Conclusion: For the diagnosis of allergic fungal rhi-nosinusitis, the present mucin characteristics are more im-portant than the histology of respiratory mucosa. The goals ofsurgery are to restore the permeability and ventilation of themeatal ostium, to establish a diagnosis and to remove thethickened allergic mucin. The surgery improves symptomsand quality of life, but it does not work in all aspects of thecomplex pathophysiology of this disease and, consequently,has no healing power alone.

Keywords: Rhinosinusitis, Chronic Rhinosinusitis, Al-lergic Fungal Rhinosinusitis

A465. Analysis of Nasal Polyposis Recurrence Rate inPatients undergoing Polypectomy Surgery in a UniversityHospitalPaula Lourençato, Silvio Antonio Monteiro Marone, BrunoBernardo Duarte, Hednaldo Jose Marques Bastos, Alessandrade Oliveira Brandão Pinheiro, Natália Cerqueira RezendePuc-Campinas

Introduction: Nasal polyposis is a disorder affecting1-4% of the population and its treatment of choice is endo-scopic sinus surgery. It is known that the recurrence rate is notuncommon, often resulting in the need for other surgicalapproaches.

Objectives: To analyze the nasal polyposis recurrencerate in patients undergoing polypectomywith sinusectomy inUniversity Hospital

Methods: A retrospective, self-study, with 128 pa-tients undergoing endoscopic nasal surgery between 2010and 2014. We conducted a review of medical records, analyz-ing the results of pathology, the nasal polyposis recurrencerate through nasal endoscopy and the need of surgicalreapproach.

Results: Of the 128 selected patients who underwentendoscopic nasal surgery, 113 had pathology result of inflam-matory nasal polyps and 15 with other diagnoses (invertedpapilloma, lymphoid hyperplasia, olfactory neuroblastomaand squamous cell carcinoma). Were excluded 14 patientswhose medical records were not possible to be revised(external file) as well as 15 patients with other diagnoses.Patients who could not have their postoperative results ana-lyzed for various reasons was 5%. The nasal polyposis recur-rence rate was 4.2% up to 2 months, 12.7% of 2 to 6 months,11.7% of 6 months to 1 year and 7.4% after a postoperativeyear. Of patients with relapse that required surgical rap-prochement totaled 17%.

Keywords: nasal, polyposis, endoscopic, recurrence

A215. Analysis of Results and Post-Operative Complicationsin Tympanoplasty - Hospital Otorrinos Feira De Santana - BAKarolline Estrela Campodonio Nunes, Natália Maria Couto BemMendonça, Sandro de Menezes Santos Torres, Matheus FreitasLeite, Maria Laíza Fernandes Neves Abreu, Lucas Soares PassosGuimaraesHospital Otorrinos Feira de Santana- Ba

Introduction: Tympanoplasty is a surgical procedurefor chronic perforation closure of the tympanic membraneand / or reconstruction of the ossicular chain. The size andlocation of the perforation depends on the infectious agent,the severity of the infection and its chronicity.

Methods: The study was conducted prospectivelywith patients with chronic otitis who underwent tympano-plasty during the period from 2008 to 2014. The data wasstatistically analyzed through software SPSS 17.

Results: 112 patients undergoing tympanoplastywere analyzed after being diagnosed with chronic otitis.Amoung those, 92% progressed without surgical infectionand 9 (8%) with infection; 77% had full tympanic membraneand 23% had residual perforation; 66 (59%) reported improve-ment of hearing, 26 (24%) stated that thehearing remained thesame and 20 (17%) reported worsening; 104 (93%) did notpresent any complications at the end of follow-up.

Conclusion: The chronic otitis is a disease that leads tochronic inflammation of the middle ear, associated withperforation of the tympanic membrane (TM) and intermittentotorrhea. Changes in the middle ear mucosa and mastoid arenot permanent and, in general, the symptoms are mild withlong periods without otorrhea. CT is unnecessary and gener-ally does not present changes. Surgical treatment consists oftympanoplasty.

A258. Angioleiomyoma of the Nasal Septum: Case ReportFlávia Oliveira Ballesteros, Estefane Costa Loureiro, João Batistade Oliveira Andrade, David Albuquerque Mourão, Ana LuizaCosta Lage, Rayanne Pereira ChalubNucleo de Otorrino BH

Introduction: Leiomyomas arebenign tumors ofmyo-genic origin that may occur wherever smooth muscle ispresent. They are classified into 3 histological subtypes:vascular (angioleiomyoma), nonvascular and epithelioid. Vas-cular leiomyoma is an uncommon type of leiomyomas that israrely found in head and neck area. Due to the lack of smoothmuscle in the nasal cavity, which can be found only among thewalls of blood vessels and as piloerector muscle in the vesti-bule, they rarely occur in this region, presenting only about 1%of all benign tumors in the nose and paranasal sinus. Theseptum is the rarest place of onset.

Objectives: Presenting a rare case of an angioleio-myoma of the nasal septum.

Resumed report: M.M.M.B, a 18 year-old male, pre-sented at our service with a painless mass in his left nostril,whichwas growing progressively in the last four months untilobstructing his left nostril. He complained nasal obstruction,and some episodes of epistexes. The rinoscopy showed areddish, well-demarcated, solitary mass that seemed to beattached at the nasal septum. The computerized tomographyshowed a polypoid neoformation of soft tissue density in theanterior part of the left nasal cavity attached to the nasalseptum. He underwent a nasal endoscopic surgery where weremoved the mass and the pathology study revealed anangioleiomyoma.

Conclusion: Even though those are a rare type oftumor, they should be considered as differential diagnosisof nasal tumors.

S21E-Posters


Keywords: angioleiomyoma; leiomyoma; nasalseptum

A266. Angiolymphoid Hyperplasia with Eosinophilia: CaseReportDaniel Pains Nogueira, Estefane Costa Loureiro, Ana LuizaCosta Lage, Flávia Oliveira Ballesteros, David AlbuquerqueMourão, Lucas Sol da CostaNucleo de Otorrino Bh

Introduction: Angiolymphoid hyperplasia with eo-sinophilia is an uncommon vascular tumor. Its etiopatho-genesis remains undefined, probably representing vascularneoplasm or reactive cicatricial phenomenon. Its incidence ishigher in the third and fifth decades of life, and predominantlyin females. Most lesions are located in the periauricular, scalpand forehead. It is characterized by nodules or papules withangiomatoid aspect and, in their majority, asymptomatic. Thestandard treatment is surgical excision and there is no knownrisk of malignant transformation.

Objectives: Uncommon case of angiolymphoid hyper-plasia with eosinophilia in a male patient, which was sub-jected to the procedure of surgical excision with good results.

Resumed report: IADS, 68 years old, male, complain-ing of a nodular lesion andpruritus in right auditory canal for 6months. Upon examination, it was observed a granulomatousnodule in internal region of right tragus and was indicated tobiopsy resection. After return in a month, the surgical woundwas in good cicatricial aspect, and incisional biopsy showedcuts of skin revealing proliferation of blood vessels lined byendothelium prominent epithelioid in the dermis. There wasassociated lymphocytic inflammatory infiltratewith scatteredeosinophils. The lesion was removed with free margins andthe findings were compatible with angiolymphoid hyperpla-sia with eosinophilia.

Conclusion: As a general rule, the angiolymphoidhyperplasia with eosinophilia is an asymptomatic disease,however, they may cause pain, itching and spontaneouslybleeding. The treatment of choice is surgical excision. Thepatient in question was greatly benefited by surgery, withoutrecurrences.

Keywords: angiolymphoid hyperplasia; eosinophilia;auditory canal

A601. Atypical Presentation of Malignant Otitis ExternalGustavo Barreto da Cunha, Thiago Cavalcante Ribeiro, MichelleQueiroz Aguiar Silva, Nara Nunes Barbosa, Jose Ney Ribeiro deAlmeida, Nilvano Alves AndradeSanta Casa de Misericórdia - Hospital Santa Izabel

Introduction:Malignant otitis externa is a potentiallylethal necrotizing infection of the external auditory canal,mainly affecting immunocompromised individuals. It shouldalways be suspected in patients with persistent ear pain orotorrhea that does not respond to routine treatment for acutediffuse otitis externa.

Objectives: This study presents an atypical case ofmalignant otitis externa with confounding physical examina-tion. Diagnosis was resolved through imaging studies.

Resumed report: Sixty-three year old male patient,with commorbidities such as hypertension, diabetes andadvanced nephropathy, presented with persistent earache,with hyperemia and edema of external auditory canal. Nogranuloma was present at physical examination. Peripheralfacial paralysis House Brackmann grade IV was associated.Signs of osteomyelitis diagnosed by bone scintigraphy per-formed for the follow up of prostate cancer were present.

Temporal bone CT scan revealed bone erosion particularly atthe tip of mastoid. Patient rapidly improved earache withintravenous and topical ciprofloxacin treatment, however,facial paralysisworsened. Antibioticwas switched to cefepimeand patient underwent radical mastoidectomy.

Conclusion: Malignant otitis externa corresponds toone of the most difficult to treat ear disorders. Despite theabsence of all typical signs and symptoms, it must alwaysremain as a differential diagnosis of persistent earache, espe-cially in immunocompromised patients.

A209. Evaluation of patients with hearing loss seen at theAudiology Clinic of otorhinolaryngology service in BahiaMatheus Freitas Leite, Rodrigo Betelli Alves, Lucas SoaresPassos Guimaraes, Maria Laíza Fernandes Neves Abreu, LiviaModesto Sotero, Sandro de Menezes Santos TorresHospital Otorrinos de Feira de Santana

Introduction: Hearing loss affects a significant por-tion of the world population and has important socio-eco-nomic impacts. It is extremely important the specificdefinition of hearing loss and its degrees, if it’s conductiveor mixed sensorioneural (SNHL), as well as the age of installa-tion, if prenatal, perinatal or postnatal.

Objective: To evaluate the audiological findings ofpatients with SNHL served in audiology clinic in Bahia.

Materials and Methods: This prospective study eval-uated 401 patients with SNHL outpatient clinic of the HospitalAudiology Otorrinos in Feira de Santana in Bahia, in the period2012-2015.

Results: The bilateral loss was 61.3% of patients,progressive 70.3%. Idiopathic 74.2% and 18.7% presbycusis.

Conclusion: The evaluation of audiological findings isimportant to define the etiology of loss and appropriateintervention.

A645. Bilateral Stenosis of the Internal Auditory Conduit:Case ReportDanielle Sofia da Silva, Daniel Buarque Tenório, LidianneMoreira Sales Veloso, Larissa Pinto de Farias TenórioInstituto de Otorrinolaringologia e Fonoaudiologia de Alagoas

Introduction:MLMOL , 7 months Age in Hearing LossResearch , IN fails the hearing screening and Imaging examsindicate bilateral stenosis of the internal auditory Conduit.During follow-up after two years and rigorous evaluation tohearing status of the patient was suitable bilateral cochlearimplant.

Objective: Describe OS post audiological results co-chlear implant hum patient with bilateral profound hearingloss , arising from bilateral stenosis of the internal auditoryConduit.

Resumed report: Patient with profound hearing lossdue to stenosis of bilateral internal auditory canal and sus-pected of cochlear nerve agenesis. Despite significant radio-logical changes to child during audiological evaluations hadresidual hearing signals. Bilateral cochlear implant was ap-pointed and since then the patient continues with speechtherapy , evolving with improved sound perception andimproves the behavioral pattern

Conclusion: Despite significant changes in imagingtests , which suggested cochlear nerve agenesis , we empha-size the importance of hearing and behavioral assessmentpreoperatively in order to predict more safely the benefits of apatient in relation to the cochlear implant.

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A179. Calcifying Epithelioma of Malherbe (Pilomatricoma):Case ReportRodrigo Augusto de Souza Leão, Adriana Xavier Tavares,Nathalia Anaissi Rocha Pessoa, Marcela Maria Rabelo Pinto,Erideise Gurgel da Costa, Raquel Barbosa RodriguesHospital Agamenon Magalhães

Pilomatricoma is a benign skin tumor whose origin isin the hair cells. It represents 0.1% of skin tumors. It can occurat any age, but most often in children and young adults. Thereis no consensus in the literature about the prevalence ofgender.

Objective: To report an unusual case report on afemale patient, elderly, with scalp lesion.

Resumed report: C.C.C, 66 years, presents a nodule inleft posterior cervical region, on the scalp 1 year ago, painless,with rapid growth in the last twomonths. The patient also hasnasal polyposis, asthma, hypertension and osteoporosis. Phys-ical examination revealed a nodule of 1.5 cm,firm consistency,solitary, painless, in nape of the neck. Ultrasonographyshowed solid nodule on the nape of the neck measuring1.6 � 1.6 cmwith linear hyperechoic foci that produce poste-rior acoustic shadowing suggesting calcification, adjacent tothis, it was observed nodular hypoechoic elongated formationmeasuring 0.9 cm without lymphnode enlargement. Therewas made the ressection with no injury. Histologic examina-tion showed in macroscopy a brownish firm nodular forma-tion of 2.5 � 2.0 � 1.4 cm. The histologic cuts are compactwith cretaceous granules.

Microscopy: histologic cuts using HE show circum-scribed benign skin tumor. It is characterized by trabecularproliferation of squamous epithelium with areas of necrosis(mummification) accompanied by dystrophic calcification.This result is compatiblewith pilomatricoma. After sixmonthsof follow-up, doesn’t have relapses.

Conclusion: It is important to consider the piloma-trixomas as differential diagnosis of head and neck nodes inorder to provide appropriate treatment.

A351. Case Report: Restorative Palatopharyngoplasty inVelo-Pharyngeal StenosisNathalia Senra Santos, Ana Carolina Daflon Scoralick, FelipeFigueiredo, Luiz Felipe Lira de Moraes, Alonço da Cunha VianaJunior, Daniella Leitao MendesHospital Naval Marcílio Dias

Introduction: Oralpharyngeal surgery is one of thetechniques for the surgical treatment of OSAS, with goodresults when properly indicated. Like any surgical procedure,it has risks. Among the postoperative complications, the velo-pharyngeal stenosis presents with incidence of 1% and is avery serious situation because of the limitations of surgicalcorrection, but mainly for their recurrent nature. This compli-cation can be related to exaggerated and large resection of thepalatal mucosa, as well as bleeding.

Objectives: Description of the surgical technique forthe resolution of velo-pharyngeal stenosis.

Resumed report: Male, 39 years, with a history ofOSA, submitted to 3 pharyngeal surgery in 2011 - the last twomotivated by nasopharyngeal stenosis and palatal scar retrac-tion in the first one, referring snoring and nasal obstruction inlate postoperative period. Fibronasolaryngoscopy demon-strating fibrous scar tissue around the circumference in thetransition from the nasopharynx to the oropharynx, with asignificant decrease in spot diameter, and Videolaryngoscopydemonstrating fibrocicatricial stenosis posterior tonsillar pil-lars and soft palate with the posterior wall of the oropharynx,except for tiny region in the uvula. Submitted restorative

palatopharyngoplasty with affixing skin graft from the supra-clavicular region on the posterior wall of the pharynx and flaprotation of the buccal mucosa toward the nasopharynx ex-tending the retropalatal space. After 6 months follow-up stillholds patent airway.

Conclusion: The technique used seems to be a treat-ment option for the correction of velo-pharyngeal stenosis,requiring longer follow-up to assess the long-term outcome.

A182. Case Report: Fibrous Dysplasia of the MiddleTurbinateRoberto Hyczy Ribeiro Filho, Caroline Peschel Alves BrustolinIplinski, Bárbara Maryam Abou Saab, Carlos Augusto SeijiMaeda, Marco AntonioTerreri, Brunno Fernando CorreiaMunizde ResendeIrmandade da Santa Casa de Misericórdia de Curitiba

Introduction: Fibrous Dysplasia is a rare benign fibro-osseous lesion that happens replacement of normal bone byfibrous connective tissue, with the presence of irregularosteoid trabeculae. It mainly affects the population in the firstthree decades of life. Fibrous Dysplasia affect particularlymembranous bones such as the tibia and femur, and rarelyoccurs in the sinonasal tract and is therefore unusual in themiddle turbinate.

Objectives: To report a case of a patient with FibrousDysplasia in middle turbinate, diagnosed by pathology.

Resumed report: Female, 46 year-old, complaining ofchronic predominantly frontal throbbing headache, high in-tensity. The pacient reported improvement using paracetamoland worsening the handling of the hair, pressure and highintensity sounds. On physical examination, space occupyinglesion inmiddle turbinate the right nostril. TC: enlargement ofright middle turbinate with ground-glass appearance. It per-formed endonasal surgery to remove the tumor, with lowerand middle right turbinectomy and correction of cerebrospi-nal fluid fistula. The pathological examination showed respi-ratorymucosa and bone tissuewithmesenchymal spindle cellproliferation, consistent with Fibrous Dysplasia. On the 12thday after surgery, the patient presents with headache, nobleeding or runny nose and crusts at rhinoscopy.

Conclusion: Fibrous Dysplasia in middle turbinatedespite its benign behavior and unusual location should notbe overlooked. To diagnose recurrence and malignant degen-eration early is essential to accurate monitoring.

A506. Case Report: Oral PemphigusÉrica Carla Figueiredo de Souza, Paloma Simoni Gama Ferreira,Gisela Andrea Yamashita, Camila Lira Holanda de Lima Barros,Samuel Neiva Almino, Gabriella Soares de SouzaHospital do Servidor Público Municipal de São Paulo

Introduction: Pemphigus is a rare autoimmune dis-ease in which the immune system produces autoantibodiesagainst skin proteins, like desmoglein. The desmoglein pro-teins maintain the skin intact and, as it ruptures, it maydevelop cutaneous and mucosal (including oral mucosa)bullous dermatitis. The cause of pemphigus is unknown,however there is evidence of people genetically predisposed.

Objective:Report a case of oral pemphigus and discussits importance for clinical practice.

Resumed report: 77 year oldwhitemale presented atthe consult with painful oral lesion for about 1 year. Thepatient used dental prostheses both superior an inferior withmal adaptation. Physical exam evidenced erytematous, ulcer-ative, non secretive erosion at genianmucosa and hard palate.Biopsy was preformed and histopathology suggested findings

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compatible with pemphigus. The patient started on cortico-therapy and regression of the lesion could be observed.

Conclusion: Pemphigus is one cause of oral lesionamong a large variety of differential diagnosis. As rare disease,it is often misdiagnosed. Therefore, it is important to theotolaryngologist to be aware of this pathology so it can beearly detected and treated.

Keywords: pemphigus, oral lesion, autoimmunedisease

A119. Case Report: A Rare Case Of Bilateral SchwanomaPilar Campos Saavedra, Aline Araujo Saraiva, Paulo Tinoco,Lucas Sieburger Zarro, Marina Bandoli de Oliveira Tinoco, SauloBandoli de Oliveira TinocoHospital São José do Avaí

Introduction: Vestibular schwannomas are the mostcommon benign tumors originating from the posterior cranialfossa; intracranial tumors represent between 2 and 7% ofcases. The annual incidence in the population is 1.2: 100,000.However cases of bilateralism are rarer and are associatedwith syndromic diagnosis such as neurofibromatosis type 2.Sudden deafness and vertigo occur in 26% and 27% of cases,respectively, and are associated with sudden occlusion of thelabyrinthine artery due to tumor expansion. The facial paral-ysis occurs between 10 and 30% of cases, typically in tumorslarger than 2 cm, generating facial paralysis or numbness inthe face. Audiometric tests, electrophysiological and vestibu-lar are used for etiologic diagnosis. MRI has a close to 100%sensitivity for this type of tumor. The treatment may beperformed by clinical observation, the growth control bystereotactic radiation therapy or surgical excision.

Objective: To report the clinical case patient withbilateral schwannomas associated with sudden deafness.

Resumed report:RAPS, 50,white. Patient entering theHSJA with deafness, left peripheral paralysis and vertigo whitsudden beggining three days ago. Denies comorbidities and /or systemic symptoms. Normal otoscopy and paresthesia ofleft facial. Audiometry: bilateral sensorineural hearing losswith low index of discrimination. MASTOID CT: normal. MRIskull: bilateral schwannoma and fourth ventricle tumor.Complementary exams showed nodule mammary and afterbiopsy was diagnosed infiltrating ductal carcinoma. Liquor:absence of neoplastic cells.

Conclusion: Patient clinically stable, with primarytumor in the mammary region being assisted by the neuro-ciruriga team, waiting oncology conduct.

A582. Case Series - Use of Tracheosophageal Prosthesis inPatients who Underwent LaryngectomyJanaina Kopp, Nathalia Tessarolo Dias, Gustavo GuimaraesRangel, SharonMaria Soares de Lima Avila, Christiane de SousaLopes, Renato Ponte Portela AguiarHospital Federal dos Servidores do Estado

Introduction: The larynx is one of themost importantorgans of the neck.It is responsible for basic functions such asspeech (phonation), breathing and swallowing (airway pro-tection). Frequently the surgical treatment proposed for se-verelaryngeal pathologies generates loss of vocal function.One of the vocal rehabilitation options is the tracheoesopha-geal prosthesis.

Objective: The purpose of this paper is to demonstratethe experience of HFSE Otorhinolaryngology service in appli-cation and exchange of voice-producing prosthesis.

Resumed reports: Three patients were selected forthe implementation of tracheoesophageal prosthesis, two

male and one female. These patients underwenttotal laryn-gectomy due to laryngeal cancer. It was performed marginexpansion of tracheostomy and placement of voice prosthesisunder general anesthesia in patient 1. Patient 2 went throughapplication of prosthesis phonation under local anesthesia.Patient 3 was subjected to voice prosthesis exchange underlocal anesthesia.

Conclusion: The tracheoesophageal phonation pros-thesisis a good choice for vocal rehabilitation inlaryngectom-ized patients, with low risk of postoperative complicationsand significant improvement in quality of life. In addition tobringing advantages such as not compromising the principlesof cancer surgery, not being contraindicated in patients whowill undergo radiotherapy, ease of learning and adaptation,good voice quality and more.

Keywords: phonation prosthesis; vocal rehabilitation;laryngectomy; tracheoesophageal prosthesis

A673. Challenge in the Diagnosis of Mucosal Leishmaniasis:Case ReportHelena Cunha Sarubi, Emidio Oliveira Teixeira, Renata CristinaCordeiro Diniz Oliveira, Danielly Solar Andrade Oliveira, SânzioTupinambá ValleHospital Socor

Introduction: Leishmaniasis is a group of diseasescaused by protozoan parasites ofLeishmania genus. Isolatedmucosal leishmaniasis is an infrequent presentation of Amer-ican TegumentaryLeishmaniasis (ATL). Although the nasalmucosa is the preferred site for the mucosal form of thedisease, it can also be located on the lips, mouth, pharynxand larynx. They are characterized by ulcerative-vegetativelesion accompanied by coarse granulations. Patients usuallycomplain of pain, dysphagia and odynophagia.The differentialdiagnosis can be done with other granulomatous diseasessuch as blastomycosis, leprosy and tuberculosis.

Objectives: The aim of the present study is to describean atypical presentation of ATL, without cutaneous manifes-tations, and to discuss its approach.

Resumed report: A 64-year-old man, farmer in anendemic area, complained of persistent dysphagia and nasalobstruction of 6 months’ duration. Physical examinationrevealed extensive ulcero-infiltrative lesion in soft palateand uvula, accompanied by mucosal edema and purulentdischarge. Tissue biopsy showed a non-specific granuloma-tous reaction, with an inflammatory infiltrate, without leish-manias. Treatment with parenteralpentavalent antimonial atadose of 20 mg/kg/day was initiated. Complete healing withonly residual nasal adhesions was seen after 1 month.Conclu-sion:Besides the difficulty in identifying parasites, the diseaseis often mistaken with other benign or malignant lesions.Thus, it is necessary to use several methods to confirmdiagnosis and it is very important to consider epidemiologicfeatures concerning leismaniasis since its laboratorial diagno-sis is not very sensitive and it is often inaccessible.

Keywords: Mucosal leishmaniasis, diagnosis, Ameri-can Tegumentary leishmaniasis

A378. Cholesteatoma of External Auditory Canal Simulatinga Malignant Tumor of Temporal Bone. Report of Two CasesAndré Yassuo Prappas Yamamoto, Gabriela Carolina NazarethPinto, Érica Gonçalves Jeremias, Carlos Eduardo BorgesRezende, Luan AmaralMoletta, Isabela Hohlenwerger SchettiniFaculdade de Medicina do Abc

Introduction: The cholesteatoma of external auditorycanal is a rare disease. The squamous cell carcinoma and the

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basal cell carcinoma can be differencial diagnosis. This caserelates has the objective to report two cases of cholesteatomaof external auditory canal in kids, with fast evolution.

Resumed report: LEOA, 11 years, female, presented a40 days left otalgia, with hearing loss and purulent otorrhea.At the otoscopy, therewas a nodulated lesion, with hyperemiaand secretion in the external auditory canal. The computer-ized tomography (CT) sean showed a tumor eroding bonylimits of the left external auditory canal. The pacient wassubmitted to surgeryand biopsy, that indicated cholesteatomaof external auditory.

SAB, 11 years, female, presented a 2 months foul andyellowish otorrhea, with hearing loss in the right ear. At theotoscopy, there was purulent secretion and epithelial lamel-laes in the external auditory canal, with an integrate tympa-num. Audiometry showed conductive hearing loss at right,and the CT sean revealed a bony eroding limits of the rightexternal auditory canal with a lesion at the tympanum cavity.The pacient was submitted to a explorer tympanotomy toremove this epithelial peeling from the external auditorycanal, and the histology showed a cholesteatoma of externalauditory.

Conclusion: Pacients with otalgia and otorrhea thatpresented a tumor at the external auditory canal could havecholesteatoma, malignant tumors or benign tumors. The CTand the intrasurgical findings can be used to measure pathol-ogy and programming surgery.

A180. Chondroma and Chondrosarcoma of the Larynx:Report of 4 CasesJosé Antônio Pinto, Larissa Souza Barreto, Heloisa dos SantosSobreira Nunes, Davi Knoll Ribeiro, Caue Duarte, GabrielSantos de FreitasNúcleo de Otorrinolaringologia e Cirurgia de Cabeça e Pescoço de SãoPaulo

Introduction: Chondroma and chondrosarcoma arerare head and neck tumors from cartilaginous tissue. Current-ly, approximately 250 to 600 cases of laryngeal chondromaand chondrosarcoma have been reported in the medicalliterature. Because both chondroma as well as chondrosar-coma are slow-growing lesions, symptoms can be presentfrom a few weeks to a few years before diagnosis

Objective: To present the surgical results and the longfollowupof 4 patientswith cartilaginous tumors of the larynx,one chondroma of the cricoid progressing to low-gradechondrosarcoma, 2 chondromas of cricoid and 1 thyroidchondroma

Material and methods: Three of the tumors were ofthe cricoid cartilage and one of thyroid cartilage. Patientsweresubmitted to: total laryngectomy (1), Cricotireoideotraqueos-tomy (2), and tracheostomy with partial laryngofissure (1),follow up 2-15 years (mean - 9.25 years)

Discussion: Most of the previously described laryn-geal cartilaginous tumors originally were reported as chon-dromas, with possible misdiagnosis to low-gradechondrosarcoma. The main problem in managing is the highrecurrence rate after local excision, which has to be attributedto the frequent involvement of the cricoid cartilage and theminimal resection margins often required to preserve afunctional residual larynx

Conclusion: Diferents diagnosis has to be remind inpatients with cough, hoarseness, dysphagia, dyspnea andmainly in unexplained vocal cord paralisis with subgloticmass. The head and neck CT scan is the best exam to indentifythose lesions. In chodroma and chondrosarcoma tumors theconservative surgery has being proposed with good results

Keywords: Chondroma; Chondrosarcoma; Cartilagi-nous tumors; Larynx

A685. Chronic Otitis Media with Effusion in Adult withDifficult Treatment – A Differential DiagnosisAna Carolina Feitosa Riedel, Douglas Salmazo Rocha MoralesUniversity Hospital Of The University Of Sao Paulo - Usp

Introduction: In cases of chronic otitis media witheffusion in adult, it’s important to investigate a tumor in theipsilateral nasopharynx. Other cause of fluid in middle ear iscerebrospinal fluid leak, is a rare event and usually related totemporal bone trauma.

Objective: To highlight the importance of investiga-tion in cases of chronic otitis media with effusion.

Resumed report: A female, 71 years old, with hearingloss and tinnitus in the left side for 4 months. She had nohistory of otorrhea or temporal bone trauma. The exampresented slight retraction in the left tympanic membrane.The audiometric exam demonstrated light sensorineural lossin the right side and mixed loss in the left side, with gap of20 dB, tympanometry with type B curve. The computedtomographyof temporal bone showed liquid in the left middleear, ossicular chain intact and no tumors in nasopharynx. Atympanotomy was performed, with exit of clear effusion andplacement of ventilation tube. Afterwards, the patient pre-sented intermittent clear otorrhea. A tomography and amagnetic resonance were done. Both exams showed liquidin middle ear and no communicational signal to the centralnervous system was found. A tympanomastoidectomy wasperformed and during the surgery was found a cerebrospinalleak in the tegmen tympani that was repaired.

Conclusion: Chronic otitis media with effusion mightrepresent the presence of cerebrospinal fluid in the middleear, even if there isn’t a history of temporal bone trauma ormeningitis.

Keywords: otitis media, effusion, cerebrospinal fluidleak, otoliquorrhea

A348. Chronic Rhinosinusitis in Childhood: TherapeuticUpdateLaís Tamie Hiroshima, Isabel Marrach de Pasqual, TifaniDawidowicz FernandesCentro Universitário São Camilo

Introduction: Chronic rhinosinusitis is an inflamma-tory disease that affects the mucosa of the nose and thesinuses, and lasts at least 12 weeks. This condition is commonin children and the treatment prevents recurrences andcomplications. The treatment is initially clinical. In case oftherapeutic failure we can resort to surgical treatment.

Objectives: To evaluate the main therapeutic meth-ods, both clinically and surgically. Among the available sur-geries, wewill approach the adenoidectomy, Balloon CatheterSinuplasty and Functional Endoscopic Sinus Surgery.

Data synthesis: The antibiotic therapy lasts, on aver-age, 4 weeks. Adenoidectomy is the first choice for surgicaltreatment of chronic rhinosinusitis, specially in younger chil-dren, but exhibited effectiveness only in half of the patients.Functional Endoscopic Sinus Surgery is the best option inchildren older than 6 years and didn’t show significant changein facial growth. Balloon Catheter Sinuplasty assists andcomplements Functional Endoscopic Sinus Surgery, butcouldn’t replace it. For being less invasive, is very effectiveand has fewer complications.

Conclusion: Chronic rhinosinusitis is a common prob-lem in children, and often is associated with asthma, allergic

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rhinitis, nasal polyposis, among others. When clinical treat-ment failure occurs, surgical treatment should be considered,but it must be in accordancewith the indications for each typeof pathological condition, age and be the least invasive aspossible. Among the surgical treatments available we con-clude that the adenoidectomy, Functional Endoscopic SinusSurgery and Balloon Catheter Sinuplasty are effective and safeprocedures, with few complications.

Keywords: Rhinosinusitis, treatment, functional en-doscopic sinus surgery, adenoidectomy, children

A87. Branchial Cystas a Cause of Incomum Bulging of TonsilLícia Oliveira Resende, Rosane SicilianoMachado, Roberta Bak,Luiza de Souza MelloHCPM

Introduction: Branchial cysts, although congenital,are rarely visible at birth, since at this time there is no liquidinside to slacken it. Presents a branchial cyst case of 2nd crackcausing bulging tonsils.

Resumed report:Male patient, 82, sought ENT Servicewith dysphagia for all consistencies, globus and drooling for 5years. Oroscopy if observed bulging in-store right tonsil reach-ing midline. Puncture of the lesion with milky material outlethas beenmade. SubmittedResection getting histopathologicalresults of branchial cyst. The patient developed significantremission.

Discussion: Cysts may have communication with thebase of the tonsil and extend from the supraclavicular fossa tothe skull base. However, this is not the habitual.

Final comments: This case demonstrates that thebranchial cyst may be the cause of bulging of tonsillar andshould be considered in the differential diagnosis for thiscondition.

Keywords: branchial cyst, dysphagia, otolaryngologi-cal complaints

A421. Nasolabial CystLuiza de SouzaMello, Roberta Bak, Natashi Nizzo, Lícia OliveiraResende, Rosane Siciliano MachadoHospital Central da Polícia Militar

Introduction: The Nasolabial cyst is a rare cyst devel-opment, non-odontogenic and soft tissue, unilateral andsometimes bilateral. Often asymptomatic, promoting nose’swings elevation and nasolabial folds deletion. Those mostaffected arewomen between 40 and 50 years. The diagnosis isobtained through clinical, radiographic and histopathology.

Objective: To review a present literature on the sub-ject and showa case of nasolabial cyst in a female patient with61 years old.

Resumed report: 61 years old female, went to theotorhinolaryngology service with a increased right nasalcavity accompanied by local pain and partial nasal obstructionfrom the right nostril. It was did a clinical examinationtogether with a nasal endoscopy and radiology images. Onthe CT scan it was found a mild septal deviation to the right.According with clinical and radiological features, the hypoth-esis has been elucidated of a nasolabial cyst. She underwent asurgery and histopathological studies to confirm the diagno-sis. After surgery, the patient showed clinical improvement.

Conclusion: The diagnosis is done by clinical, imagingand histopathology studies. Clinically, it is characterized by anincrease in volume, slow growing, asymptomatic or symp-tomatic. It presents as a lump or swelling smooth,mobile, onlyin soft tissue between the upper lip and nasal aperture. It cancause elevation of the nostrils, facial asymmetry, and nasal

obstruction. Histopathological study is the best to confirm thediagnosis. The treatment is total excision of the lesion, theprognosis is favorable with few relapses.

Keywords: non-odontogenic cyst nasolabial, diagno-sis, treatment

A499. Clinical and Histopathological IndependentPrognostic Factors in Oral Squamous Cell Carcinoma: ARetrospective Study of 90 CasesPaola Morales Salarini Pinto, Leticia de Avila CambraiaHospital Araújo Jorge

Introduction: This retrospective hospital-based studyreviewed and evaluated the outcome of patients with oralsquamous cell carcinoma (OSCC) with the aim of identifyingfactors affecting the clinical course and survival.

Methods: Patients with a follow-up of at least 12months were included. The data collected such as tumorsize, staging, histological grading, locoregional involvementand survival rates were statistically analyzed for the presenceof factors valuable for prognosis; survival curves were proc-essed in accordance with the Kaplan-Meier method. Differ-ences in the expression of variables in different grading levelswere investigated. Cox’s proportional hazard model for (grad-ing, age, T, N) also was calculated.

Results: Mean patient age was 55.7 years in women(n ¼ 29) and 62.4 years in men (n ¼ 61). A total of 5 patientswere identified with Broder’s/World Health Organizationgrade 1 histology, 52 with grade 2, and 31 with grade 3; 2patients were identified as carcinoma in situ. Gender and riskfactors seemed to be unrelated to prognosis, whereas asignificant increase in mortality was seen in patients overage 70. Histological grading, tumor size, and neck involvementwere related, as independent factors, in predicting survival.

Conclusions: Our analysis reveals a statistically sig-nificant relationship among histological Broder’s grading ofmalignancy, tumor size, locoregional involvement, and sur-vival rates, underscoring the utility of tumor differentiation inpredicting the clinical course and outcome of OSCC.

A98. Clinical Manifestations And Nasal Endoscopic Finds OfAllergic Rhinitis In PatientsWith Cystic Fibrosis - Case SeriesIn A Reference Center On Brazilian NortheastThais Sampaio Silva, Bianca da Silva Vinagre Nascimento,Tassia Milenna Oliveira de Souza, Clara Monica Figueiredo deLima, Marcus Miranda Lessa, Edna Lucia Santos de SouzaFederal University Of Bahia

Introduction: Allergic Rhinitis occurs in 31.7% ofBrazilian children between 7 and 14 years and it has an impacton heath quality. There are few data about its prevalenceamong cystic fibrosis patients.

Objective: To describe the clinical manifestations andendoscopic finds of allergic rhinitis prevalence among cysticfibrosis patients.

Methodology: descriptive study, case series. Patientswere submitted to otolaryngology evaluation and flexiblenasal endoscopy. Inclusion criteria were diagnosis of cysticfibrosis and more than 2 years old. Exclusion criteria werenon-execution of nasal endoscopy or clinical evaluation.

Results: 38 patients were selected, with a mean age of10.81 years (� 4.34), 65,78% were male. Clinical manifesta-tions of allergic rhinitis were anterior rhinorrhea (63.15%),nasal obstruction (57.89%), nasal itching (52.63%) and sneez-ing (39.47%). The nasal endoscopic finds were hyaline secre-tion (78.94%), nasal mucosa edema (78.94%) and nasalmucosapaleness (26.31%).

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Conclusion: The population of this study presented ahigher prevalence than the pediatric population in general.The control of allergic rhinitis is important to improve healthquality and respiratory condition of cystic fibrosis patients.

Keywords: clinical manifestations, endoscopy, cysticfibrosis, allergic rhinitis

A523. Clinical, Histopathologic And Prevalence Of OralLeukoplakiaOrlando Schuler de Lucena, Amanda Carvalho Villa deCamargo, Fernanda Wiltgen Machado, Pablo Alves AuadMoreira, Luciene Mayumi Sato, Antonio Carlos CedinReal e Benemérita Sociedade Portuguesa de Beneficência de São Paulo- Clinica Ivan F Barbosa

Introduction: Oral leukoplakia is the most commonlesion found in the oral cavity, term first used by ErnstSchwimmer in 1877, to characterize white lesions of theoral mucosa unknown cause. This injury is characterized asa white board of the oral mucosa, not removable by scraping,whose surface can presentar is smooth, rough or warty, whichis located more frequently in the oral mucosa and the labialcommissure. This injury has an important clinical feature ofcancer due to their enhanced potential for malignant trans-formation related to exogenous carcinogens such as tobacco,alcohol, sunlight, and infections of the oral cavity. There is asignificance in the early diagnosis and treatment to preventmalignant transformation of these lesions. For both authorsmake a thorough literature review of clinical forms andcharacteristics of the lesion, as well as the various forms oftreatment possible.

Objective: Conduct a literature review of variouspublications on the prevalence of these lesions, their diagnosisand treatment.

Data Synthesis: scientific research in sites such asMedline, Pubmed and Capes journals, published articles andbooks related to lesions of the oral cavity. It was observed thatthere is little literature on this subject, and this when pre-sented is very old.

Conclusion: A correct approach, with early diagnosisand treatment, enables the excision of lesions that have astrong pre-malignant character, thus highlighting the impor-tance of a thorough investigation.

Keywords: leukoplakia; oral epithelial dysplasia; ma-lignant transformation; oral diseases

A672. Clival ChordomaPresenting As NasopharyngealMass:Case ReportHelena Cunha Sarubi, Renata Cristina Cordeiro Diniz Oliveira,Emidio Oliveira Teixeira, Danielly Solar Andrade Oliveira,Aureliano Carneiro BarreirosHospital Socor

Introduction: Skull base chordomas represent a chal-lenge to the otolaryngologist because of its rarity, biologicalbehavior, and resistance to treatment. Chordomas are knownto originate from embryonic remnants of the notochord,presenting from the skull base to sacrum. Chordomas arisingfrom the skull base/clivus are typically locally aggressive withlytic bone destruction.The ideal treatment may be radiother-apy alone or combined with a gross total resection. Because ofthe risk of late complications, the radiotherapy dose is oftenlimited and the probability of cure is low. Recently, thetransnasal endoscopic approach has improved morbidityand mortality allowing also for excellent removal rates.

Objectives:Our aimwith this case report is to describethe incidental finding of a clivuschordomain nasopharynx andto discuss its approach.

Resumed report: A 19 year-old male sought medicalattention because of ear fullness, nasal obstruction and snor-ing, refractory to clinical treatment. Nasal endoscopy revealedseptal deviation to the right (Cottle zones II and III) and tissuein adenoid topography occupying 80% of the cavum. It wasproposed to the patientseptoplasty and adenoidectomy butduring the procedure a nasopharyngeal mass was identifiedand biopsied. Tissue histology was compatible with chor-doma. After workup performed, surgical approach wasplanned with neurosurgery.

Conclusion: Chordoma of skull base can sometimespresent as nasopharyngeal mass which can be mistaken forprimary nasopharyngeal mass. To avoid delay in diagnosis,nasopharyngeal extension of an intracranial chordoma shouldbe considered in the differential diagnosis of any mass innasopharynx.

Keywords: Clivalchormoma, nasopharyngeal mass,skull base

A1732. Cochlear Implant In Waardenburg Syndrome Type 4Danilo Augusto Nery dos Passos Martins, Eduardo BoaventuraOliveira, RamonMarchiori, Fernanda Alves Lunardi, AlcebiadesAlves de Liz, Manuela Athayde OliveiraHospital de Reabilitação em Anomalias Cranio Faciais

Introduction: Waardenburg syndrome (WS) is a au-tosomal dominant inherited pigmentary disorder in whichabnormal distribution of melanocytes, characterized by apiebald-like distribution of patchy depigmentation of thehair and skin. Other distinctive noncutaneous features includepigmentary abnormalities of the iris (heterochromia irides)and a broad nasal root, secondary to lateral displacement ofthe inner canthi of the eyes. Congenital sensorineural hearingloss occurs in one infive patients and, conversely, an estimated2 to 35 percent of cases of congenital deafness results from thedisorder. WS type 4 also has features of Hirschsprung disease(deafness and pigmentary abnormalities in association withaganglionic megacolon). While the prevalence of WS is esti-mated at one in 40,000, the WS type 4 is much less commonthan the other types.

Objectives: To report a case of a patient with WS type4 underwent cochlear implant surgery and discuss the pre-sentation, incidence, and diagnostic audiology evaluation inthe light of current literature.

Resumed report: A girl of 10 months old, carrier ofcongenital megacolon, was referred to our hospital to investi-gation diagnosed of fail in newborn hearing screening. Theexamination and investigation concluded the diagnosis ofWS4 and profound bilateral congenital sensorineural hearingloss. The patient underwent cochlear implant.

Conclusion: Children with hearing loss should have acompletehistory, physical examination, and formal audiologictesting to determine the type and etiology of hearing loss andthe optimal treatment plan. Early identification and effectivetreatment of hearing loss improves language, communication,and cognitive skills.

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A390. Intra and Extracanial Developments inMediumOtitis:Literature ReviewStephanie Rissio, Carlos Eduardo Borges Rezende, William JoseGilioti, Morgana Moreno BoschiCentro Universitário São Camilo

Introduction: Otitis media have various forms andamong main ones are acute otitis media and chronic otitismedia (cholesteatoma or not). Otitis media generally have agood outcome, but there are risks of complications. These aredivided into extra and intracranial. Extracranial: labyrinthinefistula, subperiosteal abscess, mastoiditis, temporozigomáticoabscess, Bezold’s abscess, parapharyngeal abscess, facial pa-ralysis, petrositis and labyrinthitis. Intracranial: meningitis,epidural abscess, subdural empyema, brain abscess, sigmoidsinus thrombophlebitis and otogenic hydrocephalus.

Objectives: Identifing the complications of otitis me-dia, distinguishing as the incidence, development, manage-ment and treatment of each entity.

Data synthesis: Among extracranial complications,the brain abscess is the most lethal entity and subperiostealabscess is commoniest. Of the chronic cholesteatomatousotitis media, predominates the labyrinthine fistula. It is theerosion of the bone overlying the semicircular canal. Alreadylabyrinthitis results from the spread of infection from thecochlear window membrane. The most common intracranialcomplication is meningitis, more associated with acute otitsmedia. The treatment of complications is based on admissionof patient, myringotomy with culture and sensitivity, intrave-nous antibiotics and mastoidectomy in all cases related tochronic otitis media or recorrentes.

Conclusion: When the doctor knows the complica-tions and signs and symptoms, the early diagnosis and thebestprognosis. Computed tomography is mandatory when yoususpect some otogenic complication. The incidence and mor-tality of complications reduced after the advent of antibiotics.The extracranial complications are more common, but theintracranial are more lethal.

Keywords: otitis media, intracranial complications,extracranial complications

A102. Complication Of Tonsillectomy - Lingual ArteryPseudoaneurysm, Branch Of The External Carotid ArteryPilar Campos Saavedra, Lucas Sieburger Zarro, Paulo Tinoco,Saulo Bandoli de Oliveira Tinoco, Aline Araujo Saraiva, LaraBonani de Almeida BritoHospital São José do Avaí

Introduction: Adenotonsillectomy is one of the mosttraditional surgeries performed in the world. Many compli-cations can arise from this procedure, including pseudoaneur-ysm, rare entity, but which can result in death.

Objectives: Report case occurred lingual artery pseu-doaneurysm occurred at our institution.

Resumed report: Minor, five years, underwent ad-enotonsillectomy surgerywithout complications and releasedafter 24 hours of admission in good condition. In a review ofthe 7th postoperative day, the patient was asymptomatic. Onthe 12th postoperative day, the child presented 02 episodes ofvomiting with blood. On examination: dehydrated, pallor,tachycardia, normotensive, oroscopy unchanged. Laboratorytests with 16% hematocrit. Minor sent to the operating room,being viewed major bleeding in left tonsil store. Held regionalsuture and cauterized to control bleeding. Referred to thePediatric ICU where he presented new oral bleeding withhemodynamic instability. He returned to the operating roomfor new cauterization, required transfusion of six red bloodcells bags. After controlling bleeding, returns to the pediatric

ICU where he remained sedated, intubated for 02 days withhemodynamically stable. Arteriography performed by vascu-lar surgery team, which identified lingual artery pseudoa-neurysm, branch of the external carotid artery. Embolizationperformed uneventfully.

Conclusion: Although rare, pseudoaneurysms canlead patients to death and should be considered in cases ofsevere bleeding after tonsillectomy. Patient had no bleeding,with hemodynamic stability. At time found to outpatienttreatment.

A103. Cystic Adenoid of Larynx: A Case ReportPilar Campos Saavedra, Lucas Sieburger Zarro, Aline AraujoSaraiva, PauloTinoco, Marina Bandoli de Oliveira Tinoco, SauloBandoli de Oliveira TinocoHospital São José do Avaí

Introduction: Adenoid cystic a relatively commontumor in major and minor salivary glands, however, its rarein the larynx due to shortage of this cell type in this region. Theincidence is higher in females of 5th-6th decade of life, andsubglottic. The patient is usually asymptomatic and whensymptoms are present, are characterized by progressive dys-pnea, cough and airway obstruction.

Objectives: Report a rare case of laryngeal adenoidcystic.

Resumed report: ZDS, 36,male, blackwith complaintsof dysphonia a year ago, recently associated with decubitusdyspnea. It evolved to orthopnea, dysphagia, weight loss.Smoker for over 10 years with smoking history of 10 pack /year. Clinical examination oroscopy unchanged. Videolar-yngoscopy: they were not displaying the vocal cords becauseof the presence of tumor vegetating in supreglottic region(piriform sinuses, aritenoides and epigote). Referred to theoperating room held laryngeal microsurgery and biopsy. Inthe immediate postoperative patient developed respiratorydistress and stridor, requiring tracheostomy. Biopsy of thelesion showed undifferentiated neoplasm, and requested thatimmunohistochemical revealed adenoid cystic. Forwarded tothe Oncology Service, where it was held radiotherapy. Withclinical improvement, is in attendance a year ago and current-ly decannulation process.

Conclusions: Adenoid cystic carcinomas are rare inthe larynx, especially in young males. Treatment is muchdiscussed, some authors advocate surgical treatment, withor without association with radiotherapy because althoughthe tumor is radiosensitive there is no cure reports. In thepatient report showed clinical improvement does not requiresurgical approach. It is eupneic in decannulation process.

A577. Daytime Sleepiness Prevalence Among Truck DriversIn The State Of Pará, BrazilJessica Ramos Tavares, Fabrício Leocadio Rodrigues de Sousa,Guilherme Silva Machado, Erika Baptista Luiz Badarane,Giovanni Vielmond Borges da Silva, Vanessa Fernandes de BritoHospital Universitário Bettina Ferro de Souza / Universidade Federal doPará

Introduction:According to the Brazilian Federal High-way Police, 186,698 highwayaccidentswere recorded in Brazilin 2013 and 68,593 in 2014. The excessive sleepiness is acommon cause of traffic accidents to be associated with longworking hours, fatigue, stress, deprivation and poor sleepquality.

Objective: To evaluate the prevalence of daytimesleepiness among truck drivers in Pará, Brazil, in 2013 and2014.

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Methods: Observational and cross-sectional studywith application of the Epworth Sleepiness Scale and epide-miological questionnaires to 400 truck drivers in Pará, Brazil.Data collection occurred during the program "Health Com-mand on the Highways" of the Brazilian Federal HighwayPolice in 2013 and 2014. Statistics Analysis was taken byBiostat 5.0.

Results: The mean age was 41.77 � 10.09 [15-72].99.75% were male. The average working hours was10.8 � 2.90 [2-24]. The average daily sleep time was7.83 � 1.59 [3-12]. The average of Epworth Sleepiness Scalewas 4.51 � 3.17 [0-16] and its evaluation revealed that 79.75%had normal patterns of daytime sleepness [0-6], 12% hadborderline values [7-9], 7.5% had mild daytime sleepiness[10-14] and 0.75% had moderate daytime sleepiness [15-20].

Conclusion: The prevalence of mild daytime sleepi-ness in truck drivers in Pará, Brazil, found was 7.5% and,moderate, 0.75%. There was no excessive daytime sleepiness.However, 12% of respondents had scores in the borderline ofEpworth Sleepiness Scale, which supports the need of addi-tional protocols and clinical evaluation to diagnose sleepdisorders in this population.

A261. Deviated Non-Traumatic Nose As A Child : Case ReportKarolline Estrela Campodonio Nunes, Natália Maria Couto BemMendonça, Susan Benaion Tabasnik, Gustavo Cittadin DelPrato, Artur Grinfeld, Lucas Soares Passos GuimaraesHospital Otorrinos Feira de Santana- Ba

Introduction: Rhinoplasty has become one of theleading cosmetic surgeries today.

Resumed report: B.A.T., male, 14 years old, afrodescendent, single, student, reported to Hospital Otorrinosplastic surgery service with nose diverted since childhoodwithout history of traum. Themain component of such nose isdefect in the development of the nasal septum. In this patient,we performed rhinoplasty with open technique and correc-tion of the septum according to Goldman. Nasal tip definitionwas performed with Strut, placing the spreader graft in theconcave side of the septum through subperichondral tunneland side, transverse and paramedian osteotomies. To obtainsatisfactory surgical results, one must understand the nasalanatomical and physiological structures, with a preoperativeand intraoperative thorough diagnostic.

Conclusion: The surgical approach requires deviatednoses anatomical knowledge, combined with good surgicaltechnique to lead to good results. Correction determines, inaddition to a significant improvement in quality of life forpatients, improved nasal functionality.

A264. Deviated Nose After Functonal Septoplasty:CaseReportNatália Maria Couto Bem Mendonça, Karolline EstrelaCampodonio Nunes, Susan BenaionTabasnik, Gustavo CittadinDel Prato, Matheus Freitas Leite, Artur GrinfeldHospital Otorrinos Feira de Santana- Ba

Introdution: Rhinoplasty has become one of theleading cosmetic surgery today.

Resumed report: N.Q., male, 16, student, afro descen-dent, single, reported to Hospital Otorrinos plastic surgeryservice with nose diverted one year after performing func-tional septoplasty with no history of trauma. Surgical ap-proach in this patient consisted of rhinoplasty with opentechnique and correction of deviated nasal septum accordingto Goldman. After that, nasal tip definition was performedwith Strut, placing Spreader Graft on the concave side of the

septum through subperichondral tunnel, lateral and para-median osteotomies. The patient in question had performedseptoplasty by Goldman technique one year earlier, especiallysuitable for cartilaginous deviations. In this technique, wemust preserve the K area, avoiding postoperativecomplications.

Conclusion: To obtain satisfactory surgical results, onemust understand the nasal anatomical and physiologicalstructures, with a preoperative and intraoperative thoroughdiagnostic. Children with nasal obstruction caused by septaldeviation must be thoroughly evaluated prior to surgicalindication, thus avoiding excessive resection of the septalcartilage, leading to surgical failure.

A636. Ectopic Tooth In Maxillary Sinus - Case Report AndReview Of The LiteratureSalete Mauricia Mariosa RodriguesUniversidade do Vale Sapucaí - Pouso Alegre/MG

Introduction: Ectopic teeth have no defined etiology,ectopic eruption occurs in rare form in different regions of theoral cavity, such as the nasal septum, coronoid process,mandibular condyle, palate. Occasionally, a tooth can eruptin the maxillary sinus and present local sinonasal symptomsattributed to chronic sinusitis or may be asymptomatic, foundonly in routine examinations. Headache, sinusitis and nasalobstruction are some of the associated symptoms. The differ-ential diagnosis includes foreign bodies, infections, benign andmalign lesions. We report a case of ectopic tooth in themaxillary sinus without apparent cause, with review of theliterature.

Objective: To present our experience with ectopictooth in maxillary sinus.

Resumed report: K.S., 21 years old, sought the servicepresenting rhinosinusitis symptoms, like headache and post-nasal secretion, showing no improvement with clinical treat-ment. Ectopic tooth was identified in the tomography of thesinus, situated in the medial wall of the right maxillary sinus.Was performed surgical resection by Caldwell-Luc access.There was complete remission of symptoms after post-surgi-cal recovery.

Conclusions: There are few reports about the ectopictooth resection of literature in the maxillary sinus, there arealso reports about endonasal access for this procedure. Al-though the tooth ectopic not be obstructing the drainageostium, was keeping the process of chronic rhinosinusitisand was a good option to surgical management. The routeCaldwell-Luc access, although not as widely used, still provedto be a good option in some cases.

Keywords: maxillary sinus, sinusitis, headache

A278. Ectrodactyly Associated To Ectodermal Dysplasia AndCleft Lip/Palate: Report Of A Family Case of EEC SyndromeJulianne Wagner, Letícia Gregory, Pricila Sleifer, Gabriela daCunha Pereira, Paulo Ricardo Gazzola Zen, Rafael FabianoMachado RosaUniversidade Federal de Ciências da Saúde de Porto Alegre

Introduction: EEC syndrome (Ectrodactyly â€“ Ecto-dermal dysplasia â€“ Clefting) is an autosomal dominantgenetic disorder characterized by a variable clinical picturethat includes ectrodactyly ("lobsterâ€ hands and feet), ecto-dermal dysplasia and oral clefts.Objectives: to report a familycase of EEC syndrome.

Resumed report: The patient is the second child ofparents with age 26 years (mother) and 42 years (father). Shewas born by cesarean section due to fetal distress weighing

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2,700 grams, measuring 43 cm, with a head circumference of34 cm and Apgar scores of 9/10. She was referred by PediatricSurgery at 1 year and 2 months of age due to a mother withsimilar features: cleft lip and palate associated to ectrodactylyof hands and feet. She was waiting for surgical correction ofthe oral clefts. There were no other similar cases in the family.The sister of the patient was a five-year-old healthy girl. Atphysical examination, it was also noted a sparse and dry hair.These findings were also checked on her mother. The evalua-tion of the child through the karyotype was normal (46,XX).Her neuropsychomotor development was appropriate for herage.

Conclusion: Our report aims to draw attention to thediagnosis and genetic counseling of EEC syndrome. As this isan autosomal dominant genetic condition, the risk to off-spring, both for the mother as the child in the future, is 50%.Moreover, this is a syndrome in which individuals, despiteusually having multiple malformations, often have a normalintelligence.

Keyword: EEC syndrome

A110. Endoscopic Surgery In ChildWith Periorbital CellulitisAnd Epidural AbscessPilar Campos Saavedra, Aline Araujo Saraiva, Lucas SieburgerZarro, Paulo Tinoco, Marina Bandoli de Oliveira Tinoco, SauloBandoli de Oliveira TinocoHospital São José do Avaí

Introduction: When the infectious process extendsbesides the nasal mucos, we’re facing to a complication ofacute rhinosinusitis. The spread of infection can occur withcontinuity (retrograde thrombophlebitis) or contiguity (Di-rect extension of the sinus wall). A small number of individu-als develops complications, that can be bone, intracranial(meningitis, abscess, empyema) or orbital complications.The frontal sinus is the most commonly associated withintracranial infection, followed ethmoid, sphenoid and max-illary sinus. Treatment is due with intravenous antibiotictherapy accompanied by surgery depending on the extensionof the sinus and intracranial disease and should be consultedhum neurosurgeon. In all cases and performed an endoscopicsinus surgery.

Objectives: Report clinical case of evolution of acuterhinosinusitis in our institution.

Resumed report: ELG, 15 years old, white, residing inMuriaé-MG. The patient was referred HSJA with periorbitaledema in left eye after acute rhinosinusitis episode. Made useof antibiotics featuring worsening periorbital edema, photo-phobia and local pain. CT sinuses; opacification of the maxil-lary, ethmoid and frontal sinus in left side with obstruction ofdrainage ostium. CT scan: pneumoencephalus and epiduralabscess in left frontal region. Patient taken to the operatingroom for endoscopic sinus surgery. Conservative treatment infor Neurosurgery team.

Conclusion: Patient evolved satisfactorily after sur-gery, with reduction of periorbital edema and epidural ab-scess. It is receiving outpatient treatment for Otolaryngologyand Neurosurgery teams.

A477. Endoscopic Surgery Of Juvenile NasopharyngealAngiofibroma Associated With A Literature Review OfHematological Complications After EmbolizationNathalia Tessarolo Dias, Gustavo Guimaraes Rangel, JanainaKopp, Sharon Maria Soares de Lima Avila, Christiane de SousaLopes, Renato Ponte Portela AguiarHospital Federal dos Servidores do Estado

Introduction: Juvenile Nasopharyngeal Angiofibromais a rare benign tumor, although considered aggressive be-cause of its local invasion capacity, with cranial invasion in tento twenty percent of the cases. It is commonly found inteenagers and young men, the gold standard treatment iscomplete surgical resection of the tumor.

Objective: The objective of this study is to report a caseof Juvenile Nasopharyngeal Angiofibroma, which was sub-jected to endoscopic surgery after embolization, inwhich, wasassociated with a review of the literature emphasizing onpreoperative and post-surgical hematological complicationsafter embolization.

Resumed report: The patient is a male teenager, 14years old, whowas seekingmedical treatment due to tumor inleft nostril, epistaxis, nasal obstruction ipsilateral and head-ache. These symptoms began in July 2014. He went throughpreoperative embolization and endoscopic sinus surgery,successfully resecting completely the tumor in February2015. During surgery the total blood loss was 1820ml, how-ever blood transfusion was not necessary.

Conclusion: The endoscopic sinus surgery alone,without any external incisions, for the treatment of JuvenileNasopharyngeal Angiofibromawas enough to safely resect thepatient’s tumor completely. Despite the embolization, duringthe intra-operative stage the patient’s blood loss was of1820ml. Therefore, blood transfusion was not considerednecessary. In the literature, there is still controversiesbetweenrisks and benefits on Juvenile Nasopharyngeal Angiofibromapreoperative embolization.

Keywords: Juvenile Nasopharyngeal Angiofibroma;endoscopic sinus surgery; embolization

A101. Endoscopic Transnasal Access Transphenoidal ForPituitary Adenomas : Surgical Experience Of A TertiarySouthern Brazil HospitalSamantha Fernandez de Castro, Rafaela Santim Reginatto,Geraldo Druck Santanna, Tainã Crestani Mistura, LucieleStocheroSanta Casa de Misericórdia de Porto Alegre

Introduction: Endoscopic transnasal transsphenoidalapproach has been well established as a technical option inskull base surgeries. It allows preservation of nasal anatomyand less post-operative discomfort than the traditional mi-croscopic technique. The present study was aimed to review acase series.

Methods: Retrospective study of pituitary tumorsoperated on at Hospital São José by the endoscopic transnasaltranssphenoidal approach between 2010 and 2014. Thirty-nine patients (25women) from 11 to 71 years-old. All patientswere operated on by the otorhinolaryngologist and then theneurosurgeon. The closurewas performedwith amucosalflapplus the abdominal muscle fascia and fibrin glue.

Results: Twenty-five tumors (67%) were macroade-nomas and 13 (33%) weremicroadenomas. Themost commonsymptomswere progressive visualfield impairment (69%) andheadache (23%). Thirteen patients (33%) had cerebral spinalfluid leakage and received a lumbar drain in the immediatepost-operative. The main complications were post-operativeepistaxis (20%), late cerebral spinal fluid fistulae (5 cases),transient post-operative diabetes insipidus (7 cases) andtransient ophthalmic deficit. One patient died because ofpost-operative meningitis related to cerebral spinal fluidleakage of difficult resolution.

Conclusion: Endoscopic transnasal transsphenoidalapproach is a useful method to offer less morbidity. Thepresent study demonstrates that a learning curve is a keypoint in this approach, as less complication ratewas observed.

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A significant improvement was the reduction of intensive careunit staying and total hospitalization period. The endoscopyand adequate interaction between otorhinolaryngologist andneurosurgeon allow better results for treating this pathology.

A578. Enlarged Vestibular Aqueduct: A Report CaseJúlia da Silva Almeida, Flavia Vieira Dias, Edna Patricia CharryRamirez, Maria Eugenia Pedruzzi Dalmaschio, Raphaella CostaMoreira SimenHospital Universitário Antonio Pedro - Universidade FederalFluminense

Introduction: Enlarged vestibular aqueduct is a con-genitalmalformation of the temporal bone that predisposes toearly onset of hearing loss and vestibular disorders. Somecases are associated to other inner ear malformations or togenetic syndromes. The age of hearing loss diagnosis variesfrom infant to adult. It may present progressive, sudden orfluctuating pattern. The criteria that define this condition attemporal bone computed tomography are: a diameter largerthan 1.5mm in the midpoint or than 2mm in the externaloperculum. Hearing aids are recommended for moderate orsevere cases and cochlear implantation has presented goodresults.

Objective: To present a case of a 14-year-old patientwith sudden hearing impairment and tinnitus in right ear,with imaging evaluation showing bilateral enlarged vestibularaqueduct.

Resumed Report: A 14-year-old male patient withsudden tinnitus and hearing loss in the right ear. History ofpoor school performance. No risk factors for hearing loss andfamilial history was reported. Physical examination was nor-mal. The audiometry revealed neurosensorial hearing loss,severe in the right ear and moderate in the left, with speechrecognition threshold of 52% and 96%, respectively. Computedtomography of the temporal bone showed enlarged vestibularaqueduct on both sides. We chose to treat with hearing aidsand regular follow up, with audiological evaluation.

Conclusion: The variety of onset and clinical presen-tation of enlarged vestibular aqueduct requires special atten-tion in the diagnostic process. Early diagnosis allows morefavorable rehabilitation treatments such as cochlear implantswhich is a possibility for the patient studied.

A112. Epidemiologic Profile of the Ambulatory of Tinnitus ofthe Hospital Otorrinos Feira de Santana, BahiaMatheus Freitas Leite, Erica Cristina Campos e Santos, MariaLaíza Fernandes Neves Abreu, Lucas Soares Passos Guimaraes,Karolline Estrela Campodonio Nunes, Sandro de MenezesSantos TorresHospital Otorrinos de Feira de Santana

Introduction: Tinnitus is a very common simtom atthe ENT clinic. By definition is a sound not being generated inthe environment at that time. It affects about 17% of thepopulation in some countries. In Brazil, the data are not yetwell defined, but it is possible that some 28 million Brazilianshave already had some form of tinnitus.

Objective: Evaluate the epidemiological profile ofpatients bearers of tinnitus the ambulatory of tinnitus theHospital otorrinos in the period 2011-014. Material and

Methods: In a total of 162 patients with tinnituscomplaint was instituted a questionnaire about the character-istics of tinnitus. A profile of these patients wasmountedwithsubjective responses.

Results: Most of our patients are females (75%) andshow hi discomfort level (52%). The cause is most frequently

idiopathic (59%) and patients showed good acceptance andadaptation to AASI (53%).

Conclusion: The most tinnitus is idiopathic and im-proves with time. Adaptation using AASI is evident.

Keywords: buzz, sound amplification device, genera-tor suppression of tinnitus

A210. Epidemiological Profile of Patients Suffering FromVestibulopathies Treated In Hospital Naval Marcílio DiasAlexandre José de Sousa Cunha, Daniella Leitao Mendes, LuizFelipe Lira de Moraes, Thiago Chalfun de Matos Fonseca,Natalia Mello do Vale, Elisa da Costa Carvalho Almeida LopesHospital Naval Marcílio Dias

Introduction: Dizziness is one of the most commonsymptons related during otolaryngologists visits. The apro-priate diagnosis of the most variable disorders that presentsthis symptom is essential for a better handling of the patient.To do that, the otolaryngologist physician has vast resources,among which , the clinical history, physical examination,laboratory, imaging and audiologic exams, and thevectonystagmography.

Objectives: Evaluate the profile of patients with ves-tibulopathies submited to vectonystagmography in HospitalNaval Marcílio Dias.

Methods: Descriptive, transversal and retrospectivestudywith 320 patients, conducted from January/2013 to July/2014. Variables studied: sex; age; type of vestibulopathy â€“irritative, bilateral deficit, unilateral déficit and central.

Results: The sample consisted of 320 patients, 43,7 %males and 56,3% females, the prevalent age group was >51years. The most common vestibulopathy was peripheric irri-tative (61%), followed by deficit(30%) and central (9%).

Conclusion: Vestibulopahies affected more women,with more than 51 years, and the irritative type was the mostcommon type found. The results encountered in HospitalNaval Marcílio Dias were similar to the general population.Even now, vectonystagmoraphy continues to be a valuablemethod in the evalution of patients with dizziness.

Keywords: Dizziness, Vestibulopathies, Vectonystag-mography, Irritative, Deficit

A252. Epidemiological Profile Of PatientsWith Chronic Ear -Hospital Otorrinos Feira De Santana - BAMatheus Freitas Leite, Luciana Brito Corrêa, Thiara Lessa Silva,Maria Laíza Fernandes Neves Abreu, Lucas Soares PassosGuimaraes, Sandro de Menezes Santos TorresHospital Otorrinos

Introduction: Chronic otitis media (COM) is a processof inflammatory nature of middle ear and mastoid with orwithout a tympanic membrane perforation and otorrhea,potentially leading to a conductive or mixed hearing loss. Itis estimated that over 20 million people worldwide sufferfrom COM. COM can be divided into two groups: simple andsuppurative. The latter group is subdivided into not choles-teatomatous (COMNC) and Cholesteatomatous (CCOM). Theradical mastoidectomy surgery is indicated for these cases,and constitutes in cleaning and clearing of the mastoid andposterior and superior bony wall of the external auditorycanal (EAC).

Methods: Study was conducted prospectively withpatients with COMNC and CCOM. They underwent surgeryin a medical residency in otolaryngology in Feira de Santana -BA during the period between 2008 and 2014. We monitoredduring postoperative for 8 months.

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Results: We performed 259 surgeries in the period,18% of the surgeries were radical mastoidectomy (MR), 39%tympanomastoidectomy (TM) and 43% tympanoplasties (TP).There was a predominance of females in all types of surgeries,with assessment of hearing subjectively postoperative andimportant improvement percentage.

Discussion: The data obtained in this study confirmsthe benefit of surgery in the treatment of chronic otitis media.

Conclusion: Other studies correlating both subjectiveand objective improvement of hearing in the evaluation ofpatients with chronic otitis media undergoing surgery areneeded.

A405. Epithelioid Hemangioma: Case Report And LiteratureReviewCarolina Affonso Solano, Flavia Capone, Sarah Cristina Beirith,Danielle de Araujo Torres, Jacqueline de Mattos Coelho, CassioAguiar CoelhoHospital Federal da Lagoa

Introduction: The epithelioid hemangioma is a rarebenign vascular neoplasm, usually located in the head andneck. The treatment is eminently surgical, being the diagnos-tic made after histopathological examination. The disease ismost prevalente among women and recurrent bleeding canlead to anemia.

Objectives: The aim is to present a case of epithelioidhemangioma of the external auditory canal and report aliterature review of this disease.

Resumed report: The case report is about a 31 yearoldwomanwith hearing loss and a tumor in the right externalauditory canal, first noted three years earlier, with progressivegrowth, notably during the pregnancy. At physical examina-tion, a compressible mass was observed in the externalauditory canal, apparently without involvement of the tym-panic membrane. The audiometry detected a conductivehearing loss and the computed tomography showed a masswith density of soft tissues, located at the external auditorycanal,without contiguitywith themiddle ear.We performed asurgery, with total resection of the tumor and the histopato-logical examination revealed epithelioid hemangioma. Thepatient is in clinical follow up, with no relapse of the diseaseuntil now.

Conclusion: Although the localization of this kind ofneoplasm in the pinna is known as the most common one,there are few reports of epithelioid hemangioma in otorhi-nolaryngologic literature. It is important to the ear, nose andthroat physicians to recognize the epithelioid hemangioma asone of the differential diagnoses of the head and neck masses.

Keywords: epithelioid hemangioma, external audito-ry canal, vascular neoplasm

A488. Ethmoidal Mucocele: Case ReportsLuiz Felipe Lira de Moraes, Nathalia Senra Santos, Ana CarolinaDaflon Scoralick, Felipe Figueiredo, Alonço da Cunha VianaJunior, Daniella Leitao MendesHospital Naval Marcílio Dias

Introduction: Mucoceles are cysts (epithelium-linedcavities) of mucous content that affect the paranasal sinuses.They develop because of scarring and obstruction of the sinusostium, whether from chronic sinusitis, trauma, or surgery.They have expansive nature, slow growth, commonly erodethe bony sinus wall and can have serious complications ofbrain and orbital invasion, with potential for abscess andrupture.

Objectives: To report two cases of patients withethmoidal mucocele associated to visual symptoms

Resumed report: Case 1: Female, 36 years old, with-out comorbidities, complains of diplopia, frontal headacheand retro-orbital pain andnasal congestion. Case 2: Female, 45years old, complains of partial visual loss, diplopia and imbal-ance, associated with nasal symptoms. After initial clinicalevaluation and complementary exams (including CT of thesinuses), both cases were diagnosed ethmoidal mucocele andsubmitted to surgical treatment, evolving with reduction ofsymptoms after the procedures.

Conclusion: In general, the treatment by drainage andmarsupialisation of an affected sinus is sufficient. If large bonydefects are present, as orbital floor, reconstructive surgerymay be necessary. If drainage remains impaired, recurrencemay occur.

A476. Evaluation Of Cardiovascular Risk Factors InProfessional Drivers With Excessive Daytime SleepinessFabrício Leocadio Rodrigues de Sousa, Erika Baptista LuizBadarane, Guilherme Silva Machado, Jessica Ramos Tavares,Giovanni Vielmond Borges da Silva, Mariana Tótola ForçaHospital Universitário Bettina Ferro de Souza

Introduction: The work activities are hampered byexcessive sleepiness, as well as increasing the risk of trafficaccidents in the case of professional drivers. In Brazil, up to7.6 % of traffic accidents are due this problem. The sleepquality as well as quality of life is reduced in patients withchronic diseases. The Epworth Sleepiness Scale is an easy toperform questionnaire which evaluates daytime sleepiness.Several breathing sleep disorders such as obstructive sleepapnea syndrome are related to cardiovascular risk factors andsystemic hypertension.

Objectives: To identify cardiovascular risk factors inprofessional drivers with excessive daytime sleepiness diag-nosed by the Epworth Sleepiness Scale.

Methods: Cross-sectional, retrospective, descriptivestudy in which we used the database of the Federal HighwayPolice. 400 drivers’ datawere analyzed. Of the total sample, 33had excessive daytime sleepiness (Epworth sleep scale above10) and of these, 06 (18.18 %) had hypertension, 06 (18.18 %)were smokers, 01 (3.03%) had diabetes mellitus and 20 (60.6%) were alcoholics.

Conclusion: The main cardiovascular risk factor inprofessional drivers with excessive daytime sleepiness wasalcoholism. Alcohol is probably the inducing sleep substancemost used by mankind, in other words, has a synergisticrelationship with sleep deprivation, which increases thechances of traffic accidents.

Keywords: Excessive daytime sleepiness, cardiovascu-lar risk factors, Epworth

A595. Evaluation Of Excessive Daytime Sleepiness And BodyMass Index Among Truck DriversGuilherme Silva Machado, Jessica Ramos Tavares, FabrícioLeocadio Rodrigues de Sousa, Rafael Scherer, GiovanniVielmond Borges da Silva, Erika Baptista Luiz BadaraneHospital Universitário Bettina Ferro de Souza

Introduction: The leading cause of excessive sleepi-ness is chronic sleep deprivation. In motorists the poor sleepquality can lead to health hazards and affect their concentra-tion, increasing the risk of accidents.

Objectives: To evaluate the possible correlation be-tween EPWORTH and body mass index (BMI) among truckdrivers enrolled in the program "Health Command on

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Highways" developed by the Federal Highway Police fromJanuary 2013 to December 2014.

Methods: The study is analytical and descriptivestatistical nature, quantitative reasoning, following a cross-sectional and retrospective approach, based on the FederalHighway Police database. They included all questionnairesrecords and anthropometricmeasures applied to truckdriversin the survey period.

Results: 400 truck drivers were evaluated, most ofthemmales and only one female. Age ranged between 19 and72 years old. More than half of truck drivers had high BMIvalues, 40%were obese and 40%were overweight. 5,25% of thetruck drivers participants had the score of Epworth SleepinessScale above 10. The Relative Risk Ratio was 2,08 amongtruckers overweight or obese compared to those with normalBMI, and P > 0,05 (Binominal Test).

Conclusion: was concluded that overweight or obesetruckers have twice as daytime sleepiness compared to thosewith normal BMI.

A570. Extensive Fibrous Dysplasia of the Temporal andSphenoid BonesEliana Freitas Cardoso, Alexandra Torres Cordeiro Lopes deSouza, Caroline Catherine Lacerda Elias, Pablo de Oliveira Lima,Carolina Figueira Selorico, Nicolau Tavares BoechemHospital Federal de Bonsucesso

Introduction: Fibrous Dysplasia is a osteodysplasiawhich etiology is still controversial. The disease often occursisolated on a single bone.The involvement of the cranio-facialskeleton is not uncommon, occurring mainly in the jawbone,mandible and more rarely in the temporal bone.Men andcaucasians are more affected.

Objectives: To report a rare presentation case ofFibrous Dysplasia which not only affect the temporal bone,but also involves the sphenoid bone.

Resumed Report: A 23-years-old previosly healthywhite man presented with history of intermitent tighteningtemporo-parietal headache, which started 5 years beforeadmission and gradually increased in severity. Moreover, hedescribed aural fullness, intermittent otorrhea and righttemporal enlargement.On examination, there was narrowingof the external auditory canal with debris and fetid eardischarge. Nasal endoscopy showed polyps lesions in septalside of right middle turbinate. Mastoid CT scan showedhomogeneous radiodense “grounded glassâ€ like image inright temporal bone extending to the sphenoid bone. Image ofparanasal sinuses showed right opacification in sphenoidsinus with homogeneous density material, beyond the“grounded glass” appearance throughout the sphenoidbone. Patient underwent a right sphenoid sinusotomy.Histo-pathological test confirmed the hypothesis of fibrous dyspla-sia. Patient is receiving outpatient treatment.

Conclusion: This case illustrates the importance ofFibrous Dysplasia in otorhinolaringology, specially whenthere is neck and face involvement. It can affect vital struc-tures of the skull base, destroy tympanic membrane and formcholesteatomas. There is no specific therapy and constantmonitoring is required.

A172. Extracranial MeningiomaAna Júlia Elorza Moraes dos Santos, Eron Mosciati, CamilaNogueira Merlo, José Roberto ChodrauiNucleo de Otorrinolaringologia de Ribeirao Preto

Introduction: Meningiomas account for 14-18% ofintracranial neoplasms. About 20% of these present extracra-

nial expansion to locations such as the orbit, nasal cavity,paranasal sinuses, middle ear and nasopharynx. Primaryextracranial meningioma of the sinonasal region is a rareneoplasm, especially in children. The diagnosis of thesetumors is difficult, based on clinical history, physical exami-nation and diagnostic procedures (fiberoptic endoscopic ex-amination, computed tomography and magnetic resonanceimaging).

Objectives: The extracranial meningioma, althoughrare, should be part of the differential diagnosis of epithelialtumors, neurogenic lineage, odontogenic tissues, vascular andhematology.

Resumed Report: Patient, female, 14 years old, shedeveloped diplopia insidiously sought ophthalmic specialty,who asked cranial computed tomography. After, the patientwas referred to the otolaryngology service due to a mass thatwas in the frontal sinus, not compromising intracranial region,seen in the picture. Underwent complete tumor excision andsent to the pathological, which showed meningioma.

Conclusion: Treatment for primary meningioma ofthe sinonasal region is surgical with complete excision of thelesion and with no need of adjuvant treatments.

A211. Extramedullary PlasmocytomaWithinTheMiddle EarCleft: An Unusual PresentationRoberto Dihl Angeli, Gisiane Munaro, Flavia Ribas Demarco,Marina LiseUniversity Hospital, Universidade Luterana do Brasil (Ulbra)

Introduction: Solitary extramedullary plasmocyto-mas (EP) are neoplasms of the plasma cell system that ariseoutside of the bone marrow. These lesions make up 4% of allplasma cell tumors and occur mainly in the upper aerodiges-tive tract. Its occurance in the temporal bone is absolutelyunusual.

Objective: To describe a case of solitary EP within themiddle ear cleft and its surgical management.

Resumed report: 62 year-old female presented in ourdepartment with a several-month history of progressiveright-sided tinnitus. Audiological assessment revealed a mod-erate, conductive low-frequency hearing loss in the right sideand normal thresholds in the left side. CT and MRI scansshowed a single lesion involving the long process of the incus,stapes, and the oval window. No bone erosion was observed.Exploratory tympanonomy was performed under generalanesthesia. As the lesion was surrounding the stapes andthe footplate, it was decided to perform a near-total removal.Histological analysis revealed a low-grade plasma cell tumor.Systemic hematological assessment, including bone marrowbiopsy, was normal. The patient was further submitted toradiotherapy and oral chemotherapy. After 6months of followup, imaging assessment of the temporal bone revealed totalremission. A small air-bone gap was still observed and thepatient referred a mild, well-tolerated tinnitus.

Conclusion: expansive lesions within the temporalbone may represent a focal manifestation of a systemicdisease. In the absence of an ultimate diagnosis, a partial,near-total removal proved to be the best surgical option inorder to preserve ossicular integrity.

A569. Facial Stimulation Due To Cochlear Implantation: ACase ReportJoão Augusto Bergamaschi, Daniela Pernigotti Dall Igna, CelsoDall’Igna, Letícia Petersen Schmidt Rosito, Sady Selaimen daCostaHospital de Clínicas de Porto Alegre

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Introduction: Cochlear Implant is a commonly per-formed procedure for severe to profound deafness. Post-implantation facial nerve stimulation is one of the best knownand most frequent complications of the cochlear implant (CI)procedure.

Objective: This case reports aims to present a case ofan 18-year-old patient presenting inadvertent facial nervestimulation after CI.

Resumed report: Patient was diagnosed with pro-found bilateral sensorineural hearing loss at 1-year-old. Sheestablished oral language but didn’t show good gain withhearing aids. At 17 years old, she started evaluation for CI. CTscan of temporal bone showed a duplicated internal acousticmeatus and cochleas were permeable. It was performed the CIon the left side. There were no complications during surgery,with satisfactory impedance and telemetry. CI activationoccurred 4 weeks after and patient showed ipsilateral facialnerve stimulation when were emitted sounds. The audiolo-gists couldnt set a map with satisfactory hearing responsewithout facial spam, turning off and on each electrode andmeasuring auditory response and extra-auditory symptoms.CTscan of temporal bone confirmed the close proximity of thebasal turn of the cochlea and the labyrinthine segment of thefacial nerve.

Conclusion: Literature data presents prevalence offacial nerve stimulation ranging from 7 to 14%. We experi-enced our third case in a 450-case-series during the past 14years. As we did not observe correlation between facial nervestimulation and the contiguous electrodes, we were not ableto control this signal through programming mode changes.Otology crew and family decided to remove the CI.

A402. Follow-Up of Respiratory Papillomatosis LaryngealGiant: A Case ReportFernanda Wiltgen Machado, Amanda Carvalho Villa deCamargo, Luciene Mayumi Sato, Orlando Schuler de Lucena,Cristiana Vanderlei de Melo, Alexandre Minoru EnokiReal Benemérita Beneficência Pórtuguesa de São Paulo - Clínica Dr.Ivan F. Barbosa

Introduction: Papilloma is considered the most com-mon benign tumor of larynx with great tendency to recur-rence. It presentswith hoarseness, butmaypresentwith acuteobstruction of the airways. The glottis is the most commonsite.

Objective: To report the follow-up twoyears of patientwith laryngeal giant respiratory papillomatosis.

Resumed report: MCA , 38, male. Sought servicereferring accompanied dysphonia dyspnea at rest since child-hood with worsening there 03 years. He was diagnosedpreviously with bronchial asthma. Nasofibrolaryngoscopyperformed which showed : the presence of vegetative injury,pedicle , extensive and covering the right vocal fold withsignificant obstruction route area. Ressected June / 2013without the need for tracheostomy. After the procedure,patients showed significant improvement in voice and dys-pnea. Since then, with monthly clinical follow-upwith a slightrelapse in October / 2013 and submitted to a new resection(March / 2014). Keeping up without relapse to date (March /2015).

Conclusion: Although it is a benign condition whendiagnosis is delayed may present with great vocal and respi-ratory effects, and acute respiratory failure one. Even withhigh rates of relapse, it is noted that the above case evolvedwith single submission within 2 years.

Keywords: Papillomatosis laryngeal, recidive, dyspnea

A467. Frontal Reconstruction With Modified Lotropi WithEndonasal Endoscopic SurgeryFernanda Tan Miyamura, Bruno Salgado de Campos, AnaCarolina Favaro de Santana, Flaviana Magalhaes Lima Verde,Alexandre Felippu Neto, Antonio Mauricio Lopes FacchinettiInstituto Felippu de Rinologia

Resumed report: T.S.A, male, 38 years old, with frontCCT history 15 years ago in Japan. The frontal bone and skullbase was submitted reconstruction surgery with titânioboard.One year ago oneself developed severe frontal headacheand acute rhinosinusitis recorrentes.The pacient even came toour service because the symptoms above without improve-ment with requested clinics. We ask him face sinus CT scanand cranial NMR.

A321. Fronto-Ethmoidal Osteoma in Gardner SyndromeChristiane de Sousa Lopes, Sharon Maria Soares de Lima Avila,Nathalia Tessarolo Dias, Janaina Kopp, Renato Ponte PortelaAguiar, Gustavo Guimaraes RangelHospital Federal dos Servidores do Estado

Introduction: Gardner syndrome is an autosomaldominant form of polyposis characterized by the presenceof multiple polyps in the colon together with tumors outsidethe colon. This disease is caused by mutation in the APC geneand it is a form of familial adenomatous polyposis. It can beassociated with osteomas, supernumerary or retained teeth,nasopharyngeal angiofibroma, desmoid tumors, amongothers. Osteomas are more frequent in males, between thesecond and fourth decades of life and in 80% of cases located inthe frontal sinuses followed by ethmoidal sinuses.

Objective: Report a case of Gardner syndrome inwhich the diagnosis was based on the findings of fronto-ethmoidal osteoma, supranumerary teeth in maxillary si-nuses, seen in the CT scan of paranasal sinuses.

Resumed report: An 18-year-old male, who searchedfor medical care due to frontal headache, for several months.The TC SPN showed fronto-ethmoidal osteoma bigger than 3cm, combined with supernumerary and unerupted teeth inmaxillary sinuses. The clinical examination revealed a 2cmosteoma in the occipital region. The clinical suspicion ofGardner’s syndrome was raised. Colonoscopy and the follow-ing histological examination confirmed the presence of co-lonic adenomatous polyps. Afterwards, he underwent uppergastrointestinal endoscopy confirming adenomatous polypsin the gastric fundus.

Conclusion: After closing the diagnosis, the patientwas scheduled to conduct total colectomy with ileorectalanastomosis and his family members advised to undergocolonospic examination. After surgical recovery, he will besubmitted to resection the osteoma by external osteoplasticapproach.

Keywords: Osteoma; Gardner Syndrome; Adenoma-tous Polyps

A438. Fulminant Case Of Death From Otitis MediaAdriano Sergio Freire Meira, Christiane Kulzer Birck, ThaísEugênio Gomes, Junior Alvaro Vitorino de Pontes, BrunoLeonardo Barbosa Machado, Nelson Jose Barboza QuintinoS.O.S Otorrino

Introduction: In nowdays the use of antibiotics andvaccination has prevented the death from otitis media, wepresent the case of a child who died in just 20 hours ofsymptoms began

Objectives: To present a rare case.

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Resumed Report: Male, 3 years old, comes to theoffice after previous treatment for otitis media, prior treat-ment was done with clindamycin 14 days, audiometric andimpedance examswere normal after that , arrives at the officewith symptoms that had started the night before and com-plaining of ear pain without vomiting ,otoscopy was per-formed with intense bulging , starts the use of ceftriaxonein hospital and scheduledmyringotomyeight hours later, afterfasting , four hours after all, father reports child with mentalconfusion. On the way to the surgical center has a Cardiore-spiratory arrest being sent to intensive care unit, after sixhours, brain death was diagnosed, culture was made anddiscovered an extremely aggressive form of Streptococcuspneumonia.

Conclusion: Streptococcus pneumoniae bacteria aregrampositive, facultative anaerobic organisms, are commoninhabitants of the respiratory tract and may be isolated fromthe nasopharynx of 5% to 70% of healthy adults, before routineuse of pneumococcal conjugate vaccine, the burden of pneu-mococcal disease among children younger than 5 years of agewas significant, In USA an estimated 200 children died everyyear as a result of invasive pneumococcal disease, in this casethe child was not at risk group but had not made use of thevaccine.

Keywords: otitis, pneumococcal, middle ear

A311. Giant Cell Tumors Of Temporal Bone AndInfratemporal FossaNorimar Hernandes Dias, José Vicente Tagliarini, ReginaHelena Garcia Martins, Thaís Gomes Abrahão Elias, AntonioCarlos Marao, Iury Lima VelosoHospital das Clínicas - Faculdade de Medicina de Botucatu - Unesp

Introduction: Giant cell tumors (GCT) are rare benignneoplasms commonly found in the long bones. Only 1-2% ofthese lesions present in the head and neck, skull base being acommonly reported site (temporal, sphenoid and ethmoidbones) and other sites including the mandible, maxilla andsoft tissues of the neck. The temporal bone is a common site ofoccurrence of GCT in the skull base, and has a locally destruc-tive character potentially dangerous.

Objective: Report a case of GCT in the temporal boneand infratemporal fossa.

Resumed report: Male patient, 44, referred to ourhospital with progressive hearing loss the right for 6 years andear fullness. Submitted to three previous mastoidectomies noimprovement of symptoms, with diagnosis of cholesteatoma.Audiometry moderate mixed hearing loss. CT: expansivelesion infiltrating the temporal bone, 5 � 7cm, projected bythe deep lobe of the parotid gland, eroding the lateral marginof the jugular foramen and the carotid canal. High densitywith heterogeneous impregnation contrast. MRI: the lesionextended superiorly to the temporal fossa, however no thebrain parenchyma signs of invasion. Thin peripheral uptake ofparamagnetic contrast. Infratemporal fossa type B approachallowed the complete removal of the lesion and MRI postop-eratively showed no residual disease. The histological analysisconfirmed bone tumor giant cells associated withcholesteatoma.

Conclusion: GCT of temporal bone is a benign lesionthat is locally aggressive. Most patients present with slowlyprogressive hearing loss. Wide local excision is required toensure optimal outcomes in the treatment.

A235. Inflammatory Pseudotumor in Nasopharynx : CaseReportManayra Lourenzo Cunha Carvalho, Alessandra de OliveiraBrandão Pinheiro, Paula Lourençato, Bruno Borges Taguchi,Silvio Antonio Monteiro Marone, João Paulo Peral ValenteHospital e Maternidade Celso Pierro - Puc Campinas

Introduction: Inflammatory Pseudotumor (IPT) is abenign process mimicking malignant processes and has beenfound in almost every organ system. The orbit is the mostcommon location in the Head and Neck. Sinonasal pseudotu-mors are extremely rare and typically have an aggressivepresentation.

Objective: Describe a large skull base presentation ofinflammatory pseudotumor in a elderly patient.

Resumed report: AC, 79, female, complaining of pain,fullness and otorrhea in right ear for about 4 months.She hadundergone various treatments, including antibiotics and ste-roids. Otoscopy showed a polypoid lesion in right externalauditory canal (EAC). Audiogram test revealed a right mixedhearing loss. Nasal endoscopy:mild edemaof the Rosenmullerfossa (without any exofitic lesion). CT/MRI: Solid lesion withinfiltrative enhancement and poorly defined boundaries andepicenter located on the right nasopharynx and bone destruc-tion in the skull base. Sorologies and autoimmune tests werenegatives. First biopsy (Rosenmüller fossa and EAC polyp)showed only a nonspecificchronic inflammatory process.After that a transnasal endoscopic approach to the skullbasewas used to reach the lesion deeply and the IPT diagnosiswas confirmed by histhopatological analysis.

Conclusion: IPT are idiopathic lesions of uncertainetiologyits believed to be initiated by any inflammatorystimulus and its often misinterpreted as a carcinoma. Headand neck IPT account in less than 5% of all cases. The mostcommon clinical presentation is nonspecific nasal mass. Mul-tiple biopsies are often needed to diagnosis. Steroids are thefirst line treatment, but also surgery and radiotherapy havebeen used.

A657. Invasive Fungal Rhinosinusitis : An Interesting CaseSimone Rennó Rosa, Marcelo Mendes Tepedino Júnior, DéboraFridman, Frederico Vieira deOliveira, Ana Claudia Alves, MiguelSoares TepedinoPoliclínica de Botafogo

Introduction: Invasive fungal rhinosinusitis (RSFI)presents classically in immunocompromised patients, charac-terized by high morbidity and mortality, fundamental rapiddiagnosis, in order to correct the etiological factor for thefavorable outcome. Chronic RSFI evolution is beyond 4 weeks,particularly seen in type II diabetics, characterized byminimalvascular invasion, with invasion of subepithelial tissue, with-out evidence of immune system involvement.

Resumed report: A male patient, 36, without comor-bidities, with chronic nasal obstruction and exophthalmos inthe right eye. Nasal endoscopy showed mucosal degenerationin middle meatus of right nasal cavity and paranasal sinusesCT scan showed an expansive lesion right with skull baseinvasion and ipsilateral orbit, important osteitis associated, inaddition to opacification of the paranasal sinuses. After twobiopsies performed via endoscopic endonasal, it was notevidenced fungus or histopathological alterations that provingfungal etiology. Considering the clinical history, ENT physicalexamination and imaging tests, after the event discussedwithneurosurgeon and infectious decided on treatment as chronicRSFI, associating surgical dissection wide local and systemicantifungals. During patient monitoring developed progressive

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improvement, despite not confirming the histopathologicallevel of disease.

Discussion: In the case presented, although no labo-ratory evidence of fungal etiology of invasive nature of thedisease, the patient had a goodoutcomewith the institution ofthe classical treatment for chronic RSFI, warning of particularcases in which the clinical history associated with imagingtests are become sovereign in initiating treatment.

A216. Inverted Papilloma With Severe InfecciousComplication: Case ReportAlexandre José de Sousa Cunha, Daniella Leitao Mendes,Alonço da Cunha Viana Junior, Luiz Felipe Lira de Moraes,Sabryna Farneze, Thiago Chalfun de Matos FonsecaHospital Naval Marcílio Dias

Introduction: Inverted papilloma is a rare benignneoplasm that predominantly affects men between 40-70years and generally stems from the lateral wall of the nasalcavity, which may compromise the paranasal sinuses. Al-though benign, it presents locally invasive behavior, with atendency to recurrence andmalignization potential. The signsand symptoms are nonspecific and may be nasal obstruction,epistaxis and recurrent sinusitis. Diagnosis is made fromhistory, physical examination and complementary tests,such as CT and MRI. The treatment is surgical and thetechniques that will be employed needs to be studied andindividualized.

Objective: To report a case of inverted papillomawhich developed with bacterial sinusitis, osteomyelitis andreduced visual acuity.

Resumed report: 50 years, male with previous endo-scopic resection of inverted papilloma 4 years ago, returnedwith severe headache, pain and edema in the right frontalregion, beyond partial blindness in the right eye. Nasal endos-copy showed polypois in right middle meatus and CT showedright frontal sinusitis with osteomyelitis signals. He wastreated with systemic antibiotics and surgery.A Lothrop wasperformed with the complete removal of the recurrent in-verted papilloma and drainage of the abscess. After,an exter-nal frontal access was made, with removal of the affectedfrontal bone and posterior closing with metallic plate. Itevolved with remission and partial improvement of visualacuity.

Conclusion: Inverted papilloma is an uncommoncondition that should always be suspected in unilateral poly-posis.Despite being a benign tumor, can present aggressivebehavior and frequent relapses. The complete removal of thelesion is essential to avoid the recurrence.

A104. Jugular Glomus - Case ReportPilar Campos Saavedra, Aline Araujo Saraiva, Lucas SieburgerZarro, Paulo Tinoco, Marina Bandoli de Oliveira Tinoco, SauloBandoli de Oliveira TinocoHospital São José do Avaí

Introduction: Glomus tumors are the most commonbenign tumors of the temporal bone, often with slow growthand may causing bone erosion; rarely have aggressive behav-ior. Incidence peaks in the 5th decade of life, with lowincidence slight predilection for females. Glomus tumors arevery vascularized and the most common symptoms arepulsating tinnitus and hearing loss, sometimes it can beexpensive, appering a bleeding mass in external auditorycanal. CT and MRI scans are very useful in the diagnosis.Arteriography and venography are the main exams in tumordiagnosis and are of great value in determining the surgical

approach. The use of embolization preoperatively, reducingthe risk of bleeding and facilitates surgical removal.

Objectives: Report case in our Institution of jugularglomus.

Resumed report:MADF 45 years. It presents otorrheaframe has 05 years, refractory to otologic treatments andrecently hearing loss the same side. Otoscopy bleeding masspresence in the external auditory canal. CT of mastoid: nochange, no abnormal contrast enhancement. Performed sur-gical excision of lesion, intraoperative profuse bleeding andsending the sample to pathology. Report: spindle cell neo-plasm with suspected extra-cranial meningioma, recom-mended immunohistochemical study that confirmedglomus tumor. Patient returns for assessment, when re-quested cranial MRI: expansive lesion, solid, contrast captantethe jugular foramen right. Realized angioresonance and per-formed brain tumor embolization with posterior approach byneurosurgery team.

Conclusion: Patient with good postoperative evolu-tion, currently lies inmonitoring theOtorhinolaryngology andNeurosurgery teams.

A97. Laboratory Evaluation Of Immunity In Patients WithCystic Fibrosis From A Reference Center In BrazilianNortheastThais Sampaio Silva, Bianca da Silva Vinagre Nascimento,Tassia Milenna Oliveira de Souza, Clara Monica Figueiredo deLima, Marcus Miranda Lessa, Edna Lucia Santos de SouzaFederal University Of Bahia

Introduction: Laboratory evaluation of Immunity isuseful on cystic fibrosis patients follow up. The neutrophil/lymphocyte rate on this group is related to clinical status ofthese patients.

Objective: To determine the prevalence of laboratorialchanges on red cells and immunoglobulins (IgE, IgA, IgM andIgG) levels in patients with cystic fibrosis.

Methodology: Descriptive and cross-sectional study,with records collection about blood rates and immunoglobu-lins (IgE, IgA, IgM and IgG) during the follow up of cysticfibrosis patients from a reference center in Brazilian Northeastin 2014. Excluding criteria were impossibility of recordsreview.

Results: 20 patients, 55% female, the mean age was10 � 4,72 years. 85% of hemoglobin and hematocrit werenormal and 15% were reduced. 80% of leukocytes values werenormal, 10% of leukopenia and 10% of leukocytosis. Therewere 55% normal values of segmented neutrophils, 30% oflymphocytopenia, 20% lymphocytosis, 45% eosinophilia, 40%monocytosis. The segmented neutrophils/lymphocyte ratewas less than 3 in 70% cases. 8 (66,7%) of 12 patients hadhigh IgE level, 1 (8,33%) of 12 patients had high IgA level. 9(90%) of 10 patients had normal IgM level, 8 (88,9%) of 9patients had normal IgG level.

Conclusion: The neutrophil/lymphocyte rate was lessthan 3 in most patients, indicating a good clinical status ofthem. It can be related with a good control of disease withdrugs and follow up.

Keywords: cystic fibrosis, laboratory evaluation,immunity

A189. Langerhans Cells Histiocytosis: Otologic InvolvementIn An Unusual WayRafaela Santim Reginatto, José Faibes Lubianca Neto, RenataLoss Drummond, Rodrigo André Soccol, Talita Lopes Silva,Samantha Fernandez de CastroSanta Casa de Misericórdia de Porto Alegre

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Introduction: Langerhans cell histiocytosis is a disor-der of reticuloendothelial system , characterized by the pro-liferation of macrophages. May involve skin, bones and guts.The otologic involvement is common and usually affectsmiddle ear and mastoid.

Objectives: To report a case with unusual otologicinvolvement, where the disease is restricted to external ear.

Resumed report: Three-year-old boy hospitalized forliver pretransplant evaluation after diagnosis of probableprimary sclerosing cirrhosis. He presented unilateral otorrhea,which was treated in this hospital with intravenous cefurox-ime and ciprofloxacin topic, obtaining partial improvement.After this, a polyp in the left external auditory canal was foundon otoscopy. He underwent to computed tomography, dem-onstrating polyp in the external ear without involvement ofmiddle ear and mastoid. Excision of the lesion was performedin the operating room and sent for pathology and bacteriolo-gy; the results were inflammatory polyp and Pseudomonasaeruginosa. Bone scan with technetium-99 for malignantexternal otitis was conducted showing no bone involvement.After 30 days of intravenous ceftazidime without furtherclinical improvement, biopsy was performed and immuno-histochemical study was conducted - bone erosion and Lan-gerhans cells are present. It was performed canaloplasty.Onco-hematology evaluated and started chemotherapy forLangerhans cell histiocytosis.

Conclusion: This patology must be suspected byrecurrent otological symptoms and by the presence of granu-lation tissue. The biopsy with characteristic findings andpositive immunohistochemistry for CD1a are diagnostic. Che-motherapy may be the initial treatment or adjuvant in refrac-tory or recurrent forms.

Keywords: Langerhans cell histiocytosis, otorrhea,otological symptoms

A14. Large Improvements at a Public Rehab ClinicRicardo Ferreira Bento, Silvio Pires Penteado, Mara Gândara,Ana Adelina Giantomassi Della TorreFaculty Of Medicine University Of Sao Paulo

Introduction: Ordinances 587 and 589 (October2004) implemented regulated and organized the BrazilianHearing Rehab Public Policies in the country. Trained andqualified ENTs and audiologists are supplied by best Brazilianinstitutions and mostly of then earned post-graduation titlesto excel the wide range of clinical challenges as aids are nowlocally designed and manufactured to attend public policiesrequirements. How to measure patient satisfaction then?Besides such Ordinances demands for a measurement sortof it turned a big deal how to outcome this specification.Reouvir is a SUS credentialed clinic for rehab and hadoutreached over 11,000 patients and now is about tomeasuresubjective patient satisfaction based on Satisfaction Amplifi-cation in Daily Life questionnaire (SADL) also to measure theobjective Real Ear Insertion Gain (REIG).

Objective: Introducing the results of a pilot project tomeasure patient satisfaction based on SADL and REIG.

Materials and Methods: Twenty patients fitted atReouvir were asked to answer the SADL also to pass throughREIG. An experienced interviewer applied SADL to patients toget their subjective experiences about fitting. Later on anexperienced audiologist could have access to more objectivemeasurement REIG.

Results: Both SADL and REIG convey how pleasantlyare their positive experience with aids rehab.

Conclusion: The SADL and REIG are important toolsexecuted even in few retail clinics and gradually will be

consistent part of Reouvir routine in accordance with theregulation.

Keywords: Hearing aids, patient satisfaction, publicpolicies, questionnaires

A1720. Laryngeal Candidiasis: Different ClinicalLaryngoscopic FindingsNataly Caroline de Almeida Albornoz, Renata Christofe Garrafa,Adriana Hachiya, Domingos Hiroshi Tsuji, Rui ImamuraOtorrinolaringologia do Hcfmusp

Introduction: The laryngeal candidiasis in immuno-competents patients is uncommon. The classical clinical pre-sentation is the presence of white plaque orpseudomembrane. Unusual findings include chronic laryngi-tis with leukoplakia and gross appearance mimicking laryn-geal carcinoma.

Objectives: Characterize patients with laryngeal can-didiasis by age, habits and laryngoscopic findings, as well asreview the literature on the diagnosis andmanagement of thedisease.

Methods: Thirty-one patients were included in aretrospective chart review of all cases seen at the Voice Clinic,Division of Otolaryngology, Clinics Hospital, University of SãoPaulo School of Medicine, from Jan 2005 to Jan 2015.

Results: The mean age was 56,42 years (9-80 years),67,7% patients were on steroid inhalation, 32,2% were smok-ers, 41,9% former smokers and 25,8% non-smorkers. Themainly complaints were dysphonia and dysphagia. The mostcommon presentation was the classical white plaque. Somepatients present with a granulomatosis gross aspect andulcers and it is mandatory in these cases to rule out carcinomaand other systemic diseases. Diagnosis of laryngeal candidia-sis in immunocompetent patients can be given based onvideolarygoscopy findings. The definitive diagnosis is madebuy the demonstration of fungal spores, hyphae or pseudo-hyphae either by tissue biopsy or culture.

Conclusion: Because of the similarity of findings andthe clinicalmanifestation, is important that the physician keepin mind the possibility of fungal laryngitis in cases of refrac-tory laryngitis with leukoplakia. If is not considered it canresult in inappropriate treatment and even an unnecessarysurgical intervention.

A642. Laryngeal Congenital Malformations: SurgicalApproach of 36 CasesJosé Antônio Pinto, Larissa Souza Barreto, Elcio IzumiMizoguchi, Davi Knoll Ribeiro, Caue Duarte, Gabriel Santos deFreitasNúcleo de Otorrinolaringologia e Cirurgia de Cabeça e Pescoço de SãoPaulo

Introduction: The laryngeal congenital malforma-tions are the most common cause of stridor in newborn childand infantswhomayhave different patterns dependingon thesite of obstruction. We described: laryngomalacia, stenosis,laryngeal cyst, laryngocele, hemangioma, lymphangioma.

Objective: To report and evaluate the cases underwentthe surgical treatment of patients with laryngeal congenitalmalformation. Material and method: Retrospective study ofcharts of patients with laryngeal congenital malformationwhich required surgical intervention during the period Janu-ary 1984 to April 2014.

Results: 40 patients selected, 21 (52.5%) were femalesand 19 (47.5%) males, the diseases were found: 20 laryngealstenosis (50%) being 1 supraglottic stenosis, 5 stenosis glottic,8 glottic plus subglottic stenosis, and 6 subglottic stenosis; 15

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laryngomalacia (37.5%); 2 laryngeal cysts (5%); 1 laryngocele(2,5%); 1 hemangioma (2.5%); 1 lymphangioma (2.5%). Weperformed laryngeal microsurgerywith the use of cold scalpelor CO2 laser and / or via external approach.

Conclusion: The presence of stridor is not unusual,and its presence and etiology should always be investigated.Successful treatment depends on the indication and surgicaltechnique.

Keywords: Laryngeal congenital malformations, CO2laser, Stridor

A116. Laryngeal Dysplastic Lesions Diversity In The SamePatientJosé Antônio Pinto, Larissa Souza Barreto, Heloisa dos SantosSobreira Nunes, Davi Knoll Ribeiro, Caue Duarte, GabrielSantos de FreitasNúcleo de Otorrinolaringologia e Cirurgia de Cabeça e Pescoço de SãoPaulo

Introduction: Laryngeal cancer is about 25% of malig-nant tumors of the head and neck and 2% of all malignanciesand squamous cell carcinoma is themost common type (about90% of cases). Occurs varying degrees of histological differen-tiation in about 90% of cases are originated from previousmorphological changes in laryngeal epithelium, pre-malig-nant lesions.

Resumed report: The purpose of this study was toevaluate the clinical presentation and themanifestation of thelesion on the vocal folds at different time of the diseaseoccurring in the same patient. The patient is being followedin the service for seven years. It underwent eleven surgicalprocedures for removal epithelial lesions, which were pre-sented distinctly.

Discussion: Gross lesions in the larynx are clinicallyevaluated by the emergence of a hyperkeratosis. Importantly,the macroscopic analysis is unable to define the true neoplas-tic potential they possess. The development of a malignanttumor involves complex interactions between endogenousand exogenous factors. Its clinical manifestations are quitevariable and may occur alone or associated injuries, affectingone or both vocal folds, still continuous or separated. Newtechniques are being developed in an attempt to improve thediagnosis, such as rigid and contact endoscopy, endoscopicautofluorescence and Optical coherence tomography.

Conclusion: This article presents the clinical hetero-geneity wih which intraepithelial lesions, dysplasia and carci-noma in situ, may appear. As well as the importance ofadequate follow-up in order to prevent progression to malig-nancy and enhancing cure rates.

Keywords: laryngeal dysplasia, hyperkeratosis, fol-low-up, cancer

A703. Laryngeal Malformation in Richieri-Costa PereiraSyndrome: New FindingsChristiano de Giácomo Carneiro, Ramon Marchiori, HalineCoracine MiguelHospital de Reabilitação de Anomalias Craniofaciais

Richieri-Costa Pereira syndrome was described byRichieri-Costa and Pereira, as a new syndrome of acrofacialdysostosis comprising Robin sequence, cleft mandible, andlimb defects in five Brazilian individuals.

Introduction: It is a rare Brazilian autosomal-reces-sive syndrome, with short stature, pre and post-axial handanomalies, clubfeet, and laryngeal anomalies. Mainly clinicalsigns include microstomia, micrognathia, clinical or radiolog-ical abnormal fusion of the mandible, cleft palate/Robin

sequence, absent central lower incisors, minor ear anomalies,hypoplastic thumbs, hypoplastic thenar/hypothenar region,mesomelic shortness of upper and lower limbs, hypoplastichhalluces, learning disability and language delay. Laryngealdefects were described previously, these defects are charac-terized by a small round larynx, absence or hypoplasia ofepiglottis, hypertrophy of arytenoids and aryepiglottic folds,and a fold in the posterior region of larynx, situated above theglottic level.

Objectives: The present study was previously pub-lished on American Journal of Medical Genetics and describeslaryngeal structural anomalies in 13 new cases with thissyndrome, and reviewed four reported cases.

Methods: An ear nose and throat specialist and aspeech pathologist performed the exam using a flexiblenasolaryngoscope and described larynx size and shape, epi-glottis, arytenoids, aryepiglottic folds, vocal folds view, vocalfolds, a fold at posterior region of the larynx, vocal disorder,and ariepiglottic fold medialization

Conclusions: The 17 individuals examined had thetypical laryngeal anomalies. The new findings are laryngealmicroweb observed in three patients and anteriorizationmovement of arytenoids observed in 14 patients.

A590. Laryngeal Oncocytic Cyst: Uncommom Cause OfDysphoniaNatashi Nizzo, Rosane Siciliano Machado, Roberta Bak, LíciaOliveira Resende, Luiza de Souza Mello, Gabriela OliveiraMonteiroHospital Central da Polícia Militar

Introduction: Laryngeal oncocytic cyst is a rare andbenign lesion, glotic exclusive. Presenting with dysphonia,mainly. More prevalent in the elderly. Etiology is unknown,leading theories about inflammatory phenomenon, degener-ation and aging. Treatment is conservativewith lowpercent ofmorbity and mortality.

Objective: Elucidate medical community about thisillness because of its benign condition, with simple diagnosticways and less invasive methods.

Resumed report: An old female showed isolateddysphonia. First, indirected laringoscopic findings was a bighematic cyst in the supraglotic area. Antibiotics and cortico-steroids were administrated. A new laringoscopic finding wasa lesion on the left vocal fold and CT gave a regular nodule,pedunculated, in this region. After excision by laryngealmicrosurgery, histopathological study confirmed laryngealoncocytic cist.

Conclusion: Dysphonia in the elderly associated withothers laryngeal disfunctions, may mobilize physicians in away tofindmalignant conditions. But benign lesions shouldn’tbe forgotten. Not just to tranquilize pacient, but to continue ina investigation with low invasive methods, allowing lowmorbity and mortality. Also reducing iatrogenic lesions, pre-serving a good life quality.

A658. Laryngeal Papillomatosis In ChildhoodAdriano Sergio Freire Meira, Bruno Leonardo BarbosaMachado, Thaís Eugênio Gomes, Christiane Kulzer Birck,Nelson Jose Barboza Quintino, Josemar dos Santos SoaresSos Otorrino

Introduction: Laryngeal papillomatosis is the mostcommon benign tumor of the larynx in the pediatric age, theclinical findings usually starts with progressive dysphonia andmay be accompanied by stridor and dyspnea.

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Objectives: To report a case of laryngeal papilloma-tosis in an infant who developed glottic obstruction.

Resumed report: Child, 1 year and 10 months old,male, was admitted into the pediatric ENTservicewith stridorand respiratory distress story with nocturnal exacerbationand during crying. The mother reported onset of symptomsfrom birth, with progressive worsening. Physical examinationshowed the presence of intercostal retractions and inspiratorystridor, being held fibronasopharyngolaryngoscopy whichshowed extensive exophytic lesion in glottis, suggesting la-ryngeal papillomatosis. Surgical treatment was performedopting for the diode laser. Histopathology revealed suggestiveHPV infection. Postoperatively, the patient evolved with fa-vorable breathing pattern, being able to hospital dischargeand follow-up.

Conclusion: Laryngeal papillomatosis is a benign tu-mor lesion, often in childhood, associated with infection bythe human papilloma virus (HPV), the most prevalent sero-types are 6 and 11. The sexual route of transmission is themost common; however, the vertical transmission and pla-cental liquid are other common forms. The diode laser wasused to allow act on large areas with less scarring andminimizes adjacent tissue damage. we noted the importanceof early diagnosis and intervention to maintain patent airwayand minimizing the possible morbid consequences.

Keywords: laryngeal papillomatosis, infant, HPV, laserdiode

A99. Laryngomalacia : Surgical Treatment In A TertiaryPediatric HospitalRafaela Santim Reginatto, Samantha Fernandez de Castro, JoséFaibes Lubianca Neto, Rita Carolina Krumenauer, Renata LossDrummondSanta Casa de Misericórdia de Porto Alegre

Introduction: Laryngomalacia is the cyclical collapseof supraglottic tissues during inspiration, causing airwayobstruction; it is the most common cause of stridor inchildhood, accounting for 60% to 75% of cases in children upto 30 months. The characteristic finding is inspiratory stridor;up to 20% of patients have severe cases, requiring surgicalintervention. The supraglottoplasty is the procedure of choice.It is considered the presence of comorbidities such as greaterprognostic factor for surgical success.

Objectives: To describe the sample of tertiary pediat-ric hospital, reporting techniques, surgical success rates andanalyzing prognostic factors.

Methods: A cohort study included 32 patients withsevere laryngomalacia underwent surgery between July 2007and December 2014 in a tertiary pediatric otolaryngologyservice.

Results: In a group of 32 patients, 18 (56%) weremale;the average age at which underwent surgery was 5.5 months.In endoscopy, 21 (65%) had type associations laryngomalacia,34% had associated faringomalácia and 3 (9%) were synchro-nously tracheomalacia. Twenty-six (81%) patients underwentonly resection of aryepiglottic folds and 19% required anotherprocedure. Twenty patients (62%) were isolated laryngoma-lacia and 12 patients (38%) hadgastro-esophageal reflux. Afterthe procedure, 18 patients (56%) were asymptomatic and 2(6%) required tracheostomy. Comorbidities were the onlypredictor of postoperative unfavorable outcome.

Conclusion: Supraglottoplasty is a safe procedure,providing significant improvement of severe laryngomalaciain patients without comorbidities.

Keywords: stridor, laryngomalacia andsupraglottoplasty

A631. Laryngotracheobronchitis Associated WithCoinfection And Superinfection: A Case ReportBárbara das Neves Linhares, Flavia Andrea Krepel ForondaUniversidade Católica de Brasília

Introduction: Laryngotracheobronchitis (croup) is acommon respiratory tract infection in children, most oftencaused by parainfluenza virus - types 1 to 3. It is characterizedby acute onset bark cough, hoarseness, inspiratory stridor andrespiratory distress.

Objective: Report a case of severe laryngotracheo-bronquitis associated with viral coinfection and fungalsuperinfection.

Resumed report:A1-year-old girlwas admitted to thepediatric intensive care unit for evolution of dyspnea associ-ated with suprasternal and intercostal retractions. She hadstridor at rest associated with agitation, barking cough,hoarseness, inspiratory wheezing.There was no responsiveafter 5 days with oxygen therapy, methylprednisolone, nebu-lized salbutamol and adrenaline and after 2 days with clari-thromycin.The radiography of the neck showed the steeplesign.The respiratory virus PCR testing was positive for Para-influenza types 2 and 4. She also received heliox and bude-sonide. Nasofibrolaryngoscopy revealed intense edema ofglottic and supraglottic areas and presence of ulcers coveredwith fibrin and hyaline secretion, presence of edema of theinterarytenoid region with narrowing of glottis opening esigns of tracheitis. So it was administreted intravenous dexa-methasone and fluconazole, considering a fungal infectiondue to prolonged use of corticosteroids.The clinical symptomsresolved and she was discharged after 2 days from intensivecare unit.

Conclusion: Typically, croup symptons are short-lived.However, some infants with croup have more than one virusdetected and 17% with other coinfections.Therefore, whenthere are prolonged symptons other causes of stridor must beconsidered and excluded in order to avoid complications likesinequias e acute respiratory failure.

Keywords: croup, superinfection, coinfection, severe

A353. Larynx Neuroendocrine Tumor : Case ReportDébora Angélica Lopes Reis, Jacqueline deMattos Coelho, CarlaAbranches Duarte Machado, Maria Cecilia Sodré Ramos deSouza, Felipe Barbosa Madeira, Rafael ZdanowskiHospital Federal da Lagoa

Introduction: Neuroendocrine neoplasms of the lar-ynx are rare representing approximately 1% of all larynxneoplasms. There are 4 histologic neuroendocrine subtypes:paraganglioma, typical carcinoid, atypical carcinoid tumorand small cell neuroendocrine tumors. Diagnosis is basedprimarily on light microscopy and confirmed by immunohis-tochemistry and electron microscopy. Natural history, treat-ment and prognosis vary widely for the different histologicsubtypes, but wide local excision is usually required.

Objectives: To report a case of neuroendocrine tumorof the larynx, in order to discuss management with conserva-tive laryngeal surgery.

Resumed Report: A 60 years old caucasian manpresented with one-year history of persistent hoarseness.Computed tomography and laryngeal endoscopy revealed aright supraglottic mass, occupying the posterior third ofaryepiglottic fold and reducing arytenoid mobility. Directlaryngoscopic biopsy suggested low grade neuroendocrinetumor. A conservative partial laryngectomy via right lateralpharyngotomy, including right aryepiglottic fold, right aryte-noid cartilage and posterior third of the true vocal cord wasperformed. Tracheotomywasperformed andwas closed in the

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second postoperative week. Histopathologic exam confirminitial diagnosis.

Conclusion: Laryngeal neuroendocrine tumors arerare, and its evolution depends on thehistopathologic subtypeand stage. Although the reporteddata suggest that awide localexcision is adequate treatment, this patient underwent aconservative laryngectomy, with free margins, and an excel-lent post-operative outcome.

A599. Lateral Skull Base Inflammatory Pseudotumor: A CaseReportJosé Márcio Barcelos Costa Júnior, Marcelo Castro Alves deSousa, Cintia Elisa Gonçalves Costa, Carolina Bongiolo, MirianCabral Moreira de CastroHospital Santa Casa de Belo Horizonte

Introduction: Inflammatory pseudotumor (IPT) is arare benign tumor, which occur frequently in the lungs, butcan also be found in temporal bone. In these cases, clinicalpresentation involves more often hearing loss, followed byotalgia, otorrhea and tinnitus. IPT is very aggressive anddamages critical local structures, which is showed on radio-logical studies. Therefore, it may be misdiagnosed as malig-nancy. The mean histopathological findings include fibrosisand inflammatory cell infiltration. Diagnosis of IPT includesthose clinical, radiological and histopathological findings.Surgical treatment provided highest number of disease-freepatient.

Objective: Report a case of IPT which evidences itslocal damage and aggressively.

Resumed report: Fifty-seven years old male patient,complaining about dizziness andhearing loss symptoms in theleft ear. Computadorized Tomography (CT) evidenced softtissue and erosion in the mastoid, tegmen, and corticalbone reaching dura mater of the left middle fossa. He under-went a mastoidectomy and the histopathological study re-vealed fibrosis and inflammatory cells. The patient presenteda progressive hearing loss to anacusis and a few months laterhad the same clinical event at the right ear.

Conclusion: IPT is a rare benign tumor, locally aggres-sive, frequentlymisdiagnosed asmalignancy due to its clinicaland radiological findings. The correct diagnosis includinghistopathological studies should be performed as quickly aspossible, as well as surgical treatment associated withcorticosteroids.

A521. Ludwig’s angina: Case Report and Literature ReviewOrlando Schuler de Lucena, Amanda Carvalho Villa deCamargo, Pablo Alves Auad Moreira, Fernanda WiltgenMachado, Ricardo Alexandre Basso, Antonio Carlos CedinReal e Benemérita Sociedade Portuguesa de Beneficência de São Paulo- Clinica Ivan F Barbosa

Introduction: The Ludwig’s angina is a cellulite origi-nated by an odontogenic infection in the second and thirdmolars involving the submandibular, sublingual and submen-tal spaces. Patients usually present with recent tooth extrac-tion history or poor dental hygiene. It features rapiddevelopment, with pain, dysphagia, trismus, neck bulgingand respiratory distress in severe cases. The diagnosis isclinical, supplemented by computed tomography and mag-netic resonance, indicating extent of the injury and airwaycompromise. Treatment focuses on airway maintenance,drainage, antibiotic therapy and removal of the causativefactor.

Objectives: Present the case of Ludwig’s angina inprivate hospital outpatient, clarifying relevant aspects in thedifferential diagnosis of angina.

Resumed report: A.L.O. , 52, male, merchant, dentaltreatment history three months before the onset. Seven daysafter second molar extraction began intense pain, fever anddysphagia. Treated with NSAIDs, without improvement. Ad-mitted to the ER of Beneficência Portuguesa de SP Hospitalwith lockjaw, submandibular bulging, severe sore throat andworsening of general condition. Held abscess drainage andintravenous antibiotic therapy with ceftriaxone and clinda-mycin. Discharged after three days, with considerable im-provement in the general condition and without lockjaw.

Conclusion: Although uncommon in patients withbetter socioeconomic and hygienic conditions, the otolaryn-gologist should always be aware of the diagnosis of Ludwig’sangina in patients with trismus, submandibular edema andhistory of dental treatment.

Keywords: Ludwig’s angina; Odontogenic infection;submandibular cellulitis; lockjaw

A709. Managing Drooling For Dysphagic Patients: TheExperience Of A Reference Service On The Treatment OfDysphagic PatientsÉvelyn Saiter Zambrana, Patricia Paula Santoro, Rui Imamura,Elza Maria Lemos, Roberta Ismael Dias GarciaHospital das Clínicas das Faculdade de Medicina da Universidade deSão Paulo

Introduction: Patients with dysphagia have difficultcontrolling saliva. The cause of this difficulty may be associat-ed with cerebral palsy, muscular distrophy, post stroke, de-myelinating and degenerative diseases. Drooling varies inintensity and is a real problem for these patients and theirfamilies. Infections and difficulties chewing are examples ofcomplications due to drooling. The effective managing ofdrooling is not a consensus and is a real difficulty for thefamily and the doctor, who must decide which interventionsare safe and effective for the patient, depending on the state ofthe drooling and its consequences.

Objectives: To present the sequence of treatmentmanaging drooling for dysphagic patients and the outcomesfor them, from 2006 to 2015 at the Hospital das Clínicas daUniversidade de Sao Paulo.

Resumed report: Drooling is more commonly associ-ated with a disfunction of the oral phase of the swallow thandue to excessive production of the saliva. Many interventionsare used to reduce or eliminate drooling. Surgery, medica-tions, botulinum toxin are examples of these therapies.

Conclusion: There is insuficient evidence to supportone intervention over another. The outcomes observed usual-ly have a sequence depending on the severity of the patient atthat moment. The first step usually is based on medications,the subsequent is the therapy with botulinum toxin. Usually,only after these interventions, the family considers surgicaltreatment: Stensen’s duct ligation and submandibulectomy(orWharton’s duct ligation). The last one, but most efficient toprevent infections and aspirative pneumonia is laringotra-cheal separation.

Keywords: Drooling Dysphagia Outcomes

A425. Mantle Cell Lymphomas: Case ReportRafael Toledo Enes Nogueira, Fernanda Rodrigues da CunhaServiço de Otorrinolaringologia e Cirurgia Cervico Facial do HospitalRegional de Presidente Prudente - SP

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Introduction: Mantle cell lymphomas are usuallylymphoid malignancies disseminated diagnosis, representingapproximately 6% of non-Hodgkin’s lymphomas (LNHs 1),characterized genetically by translocation t (11, 14) (q13;q32) leading to expression of cyclin D1 (CyD1).

Objective: Report a rare case of mantle lymphoma injaw.Case Report: LHYH, 66, female, with mass story angle ofthe mandible for 60 days, painless, hardened, with rapidgrowth. It states that in 15 days had doubled in size andaffected the left temporal region, associated with blurredvision. Denies fever, headache. It further loss of 5 kg duringthis period. Denies hypertension and diabetes.

Methods: During hospitalization was conducted to-mography face and neck which showed oval mass measuring9.0 � 5.0 � 6.0 cm, heterogeneous, affecting lateral wall oforbit, zygomatic arch, mandibular branch and lateral andposterior wall of the left maxillary sinus.

Results: Core biopsy performedwith removal of threefragments result of mantle cell lymphoma patient and sent toOncology Service To start chemotherapy. Patient underwentsix cycles of chemotherapy so far, remaining asymptomatic inthe period.

Conclusion: This report portrays a mantle, atypicallymphoma, because it is a more common disease in men,progression not as fast, although age compatible with thedisease. Despite being a type of lymphoma is difficult to treat,early diagnosis and initiation of chemotherapy increase thechance of long-term survival of this patient.

A307. Mastoid Osteoma: Case ReportTatiana Cunha de Carvalho Matos, Hagada Cristiane CoelhoFerreira Santiago, Thais Marques da Costa, Gustavo LimaCardosoHospital Santo Antônio (Obras Sociais Irmã Dulce)

Introduction: Mastoid osteoma is a benign mesen-chymal origin’s tumor which is rare in head and neck originwith incidence of 0.1-1% benign tumors in this area. If theirgrowth signicantly occludes the meathus, they may causecosmetics deformities, conductive hearing loss and recurrentear infection.The etiology is poorly understood. Surgical re-section is the preferred treatment of choice.

Objectives: Describe a rare case of mastoid osteomaleading to conductive hearing loss in a patient with a anacusiccontralateral ear.

Resumed report: Young 25-year-old female patientpresented to the hospital with the complaints of suddenhearing loss in the left ear. The swelling of the external canalwas first noticed the week before. On examination of thepatient, a total obstruction of the external canal was visual-ized. The patient has a anacusic contralateral ear since birth.Computed tomography (CT) showed densely calcified bonelesion in the conduct oringin from themastoid. Themiddle earcavity, ossicular chain, inner table of skull were normal withno extension intracranially. Above findings sugested mastoidosteoma. The audiometry showed conductive hearing loss atleft ear.

Conclusion: Mastoid osteoma is a mesenchymal be-nign tumor, which is a rare tumor of head and neck origin.It ismore common in females occurring in second and thirddecades predominantly. The osteoma usually arising fromcortex. It shows osteoblastic activity predominantly. Rarely,it can involve the petrous part of the temporal bone. CT is themodality of choice for the diagnosis of mastoid osteoma.Surgical resection is the treatment of choice.

A22. Maxillary Sinus Giant OsteomaCamila Pereira de Moraes, Daniella Neves Marques de Souza,Matheus Moro Rabesquine, Fabio Augusto Winckler Rabelo,Andressa Côrtes Cavalleri, Thaís BrunherotoIrmandade da Santa Casa de Misericórdia de Santos

Introduction: Osteomas are rare benign tumors, butare themost common benign tumors of the paranasal sinuses.They are slow growing and are usually found as an occasionalfinding in imaging studies. Clinically they can be asymptom-atic or symptomatic depending on the location, leading toobstruction of the sinus drainage ostium causing symptoms ofrhinosinusitis. The treatment involves surgical removal ofosteomas in symptomatic cases and expectant managementin asymptomatic ones.

Objective: this article aims to describe a case ofmaxillary sinus giant osteoma and the importance of surgicaltreatment on prognosis.

Resumed report: A.C.L.M.O. female patient, 41 yearsold, came to an ORL department with headache twoyears ago.Patient reported that two years ago started with unilateralheadache on the right side, with 10/10 degree, reportingirradiation to the hemifacial region and teeth on the rightside. Due to significant pain component, it was requested a CTscan of the paranasal sinuses which showed opacificationwith heterogeneous density of the right maxillary sinus,which was seen a bone component occupying and involvingthe corresponding ostiomeatal unit. The osteoma was re-moved surgically via nasal endoscopy, with excision of theentire lesion. The pathology confirmed the suspicion of max-illary sinus osteoma on the right side.

Conclusion: The authors presented a case ofmaxillarysinus giant osteoma in woman, benign tumor with unusuallocation and gender, which caused ostiomeatal obstructionand significant symptoms. Due to severe pain, the patientunderwent surgical treatment with satisfactory surgicalresult.

A361. Maxillary Sinus Melanoma: Case ReportKarolline Estrela Campodonio Nunes, Erica Cristina Campos eSantos, Matheus Freitas Leite, Lucas Soares Passos Guimaraes,Maria Laíza Fernandes Neves Abreu, Tercio Guimarães ReisHospital Otorrinos de Feira de Santana

Introduction: Sinonasal malignancies account foronly 1% of all malignant tumors and 3-5% of those are locatedin the head and neck. Malignant neoplasms ofmelanoma typedevelop from melanocytes, and its presentation in the ex-tremely rare nasal mucosa with an incidence of 0.3 to 2%.

Objective: The objective of this study is to report anasal malignant neoplasm of rare incidence.

Resumed report: GGS 72 year-old male presentedhimself at the otorhinolaryngology clinic reporting episodesof epistaxis for 2 days. Nasal endoscopy showed hypertrophyof unciform and active bleeding from the sphenopalatineartery. Performed surgical cauterization and unciform processincision, with the finding of lumpy content and chocolate inthe right maxillary sinus, and material sent for biopsy. Histo-pathologic examination and subsequently immunohis-tochemistry, showed results compatible with melanoma.Staging diagnosed liver metastasis, he was referred to theClinical Oncology.

Conclusion: Sinonasal melanomas are rare and withpoor prognosis.

Keywords: Melanoma, nasal, sinus

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A605.Mixture of 5-Fluoracil and Triamcinolone inTreatmentof Pharyngeal Stenosis after TonsillectomyJuliana Cristina Mesti, Laura Schwartz Maranho, MarianaNagata Cavalheiro, Vinicius Ribas Fonseca, Michel BalvediNomuraHospital da Cruz Vermelha, Filial do Paraná

Introduction: There are several surgical techniquesfor tonsillectomy, and his feared complication is pharyngealstenosis, it is difficult to correct, and it takes a narrowing in theoropharynx. The local injections of triamcinolone acetonide isa therapeutic option but studies show effectiveness of otherdrugs in combination with trincilonona.

Objectives: The aim of the report is to evaluate theefficacy of the mixture of 5-fluorouracil and triamcinolone inthe treatment of pharyngeal stenosis post-tonsillectomy.

Resumed report: Included in this report three pa-tients who underwent tonsillectomy in the Cruz VermelhaHospital ENT service in 2013. After a month of surgerypatients reported nasal obstruction. In an oroscopy, obstruc-tion of the soft palate was observed, with accession to theposterior pharyngeal wall. In a rhinoscopy adherence of thesoft palate was found, with stenosis and partial obstruction ofthe airway. Were performed dissection and loosening of theadhesions,with injection of 2.5ml on each side of the posteriorwall of the oropharynx and palate with a mixture of 5-fluorouracil and triamcinolone. In patients 1 and 2, 5 appli-cations were performed, and in patient 3, 8 applications, all ofwhich presented partial reversal of adhesions and completeimprovement of palatal function.

Conclusion: In the reported cases, the combined useof triamcinolone acetate and 5-fluorouracil, interspersedwithsurgical intervention to the partial reversal of adhesions,succeeded to the regression of pharyngeal stenosis, changingthe focus in the treatment of choice.

Keywords: tonsillectomy; pharyngeal stenosis; treat-ment; triamcinolone; 5-fluorouracil

A505. Mucosal Leishmaniasis And Septal PerforationPaloma Simoni Gama Ferreira, Érica Carla Figueiredo de Souza,Camila Lira Holanda de Lima Barros, Samuel Neiva Almino,Nicole Martuscelli de Almeida, Gabriella Soares de SouzaHospital do Servidor Público Municipal de São Paulo

Introduction: Leishmaniasis has a world prevalenceof about 12 milion with 400.000 new cases per year. It is achronic, non contagious, endemic infectious disease caused byprotozoans of the genus Leishmania. Transmission is oftendueto bites of sandflies in the genus of Phlebotomus and Lutzo-mia. The nasal cavity is the most affected area for mucosallesion and it can occur evenwithout the cutaneous form of thedisease. Most common symptoms are nasal obstructions,recurrent epistaxis, nasal discharge and nasal discomfortduring forced inspiration.

Objective: Report a case of mucosal leishmaniasis anddiscuss its importance on clinical practice

Resmued report R.A.S.M , female, 48 years old, bornand living at São Paulo complains of fetid nasal odor, recurrentepistaxis, and nasal pain for 2 years. Anterior rhinoscopyrevealed an anterior septal perforation with granulomatousborders. Lesion biopsy was performed as well as serologicaltests for granulomatous diseases. Histopathology showed anunspecified inflammatory process. Montenegro test was neg-ative. The first serology test for Leishmaniasis was undeter-mined (1:40) and second was positive (1:80). After clinicaltreatment, the septal perforation closed.

Conclusion: The differential diagnosis for mucosalnasal lesion is wide, and Leishmanias is an important cause

that should always be investigated. The knowledge of thesediseases is fundamental for the otolaryngologist practice asthe early diagnosis and treatment can prevent deformities.

Keywords: Leishimanias, septal perforation,granulomatous

A204. Nasal Lymphoma T / NK - Case ReportFernanda Rodrigues da Cunha, Rafael Toledo Enes Nogueira,Guilherme Tadeu Franco de Faria RauleServiço de Otorrinolaringologia e Cirurgia Cervico Facial do HospitalRegional de Presidente Prudente - SP

Introduction: Non-Hodgkin extranodal lymphomaspresent different cell phenotypes: B-cell , T-cell and NaturalKiller (NK) 1 The primary nasal lymphoma is uncommon andrepresents 0.44% of all extranodal lymphomas located in thisregion.2 Themarkers of this lynphoma has tropism for vessels,increasing their membership and causing devastating efects.3

Such features lead to rapid destruction of nose and midfacewith necrotic granulomatous so the term "midline lethalgranuloma" is use to set this disease.4 The extranodal lym-phomas of NK / T Nasal is an entity described recebtly by theWHO classification, prognosis and best treatment strategyneed to be better defined.

Objective: To report case of nasal lymphoma T/NKattended at Hospital Regional of Presidente Prudente - SP.

Resumed report: DTSS, 24, male, searched servicewith nasal painful injury that communicated with palate,accompanied by scabs, pus and swelling of the face. Evolutionof 2months. Sinus tomography identified destruction of nasalseptum and maxillary and ethmoid veiling bilateral. Wasconducting surgical debridement and collects material tobiopsy. Histopathological diagnosed Lymphoma T / NK. Pa-tient performed chemotherapy. Follow up hematology serviceand otolaryngology with no signs of recurrence tumor.

Conclusion: The sinonasal lymphoma is uncommonneoplasm that cause significant destructive lesions. Follow upwith hematology is fundamental to driving the disease. Thus,this type of lymphoma should be considered as a differentialdiagnosis of tumors in this region due to its aggressive anddestructive behavior.

A509. Nasal Myiasis On HomelessÉrica Carla Figueiredo de Souza, Paloma Simoni Gama Ferreira,Camila Lira Holanda de Lima Barros, Samuel Neiva Almino,Gabriella Soares de Souza, Fatima Regina Abreu AlvesHospital do Servidor Público Municipal de São Paulo

Introduction: Myiasis is an infestation of flies larvaethat feed on living or dead tissue of the host. Low socioeco-nomic status, immunocompromised, mental retardation, con-ditions of poor hygiene are factors that predispose to thisinfestation.

Objective: The aim of this study is to report an unusualcase of nasal myiasis.

Resumed report: PVM, 80, male, homeless, was ad-mitted at hospital, brought by strangers, with mental confu-sion and larvae in the nose. Sinus CT scan showed only slightthickening of maxillary sinus. After use of ivermectin,we didendonasal surgery to remove larvae, and found 258 in thenasal cavity, without commitment of sinus. After surgery, hewas referred to plastic for nasal reconstruction.

Conclusion: Treatment of myiasis is easy to performand depends on early diagnosis. The starting point of Myiasiscontrol is countering the risk factors.

Keywords: myiasis, homeless, nose

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A708. Nasal Reconstruction Biosynthetic Prosthesis: CaseReportRenata Cristina Cordeiro Diniz Oliveira, Helena Cunha Sarubi,Danielly Solar Andrade Oliveira, Aureliano Carneiro Barreiros,Juliana Altavilla Van Petten MachadoHospital Socor

Introduction: The nose is a structure vulnerable totrauma and if it is not corrected suitably, the traumawill resultin anatomo-physiological sequel. In post traumatic surgicalapproach, open rhinoplasty is the most used technique.

Objectives: To report a case of nasal reconstructionwith biosynthetic prosthesis held by the Hospital of Otorhi-nolaryngology Socor.

Resumed report: L.B.C., 50, falling victim with nasaltrauma, submitted at the time to surgical treatment to stabi-lize the fracture and control epistaxis. However, in the latepostoperative period, the patient developed nasal obstructionand functional impairment due to trauma. Showed flatteningof the nasal root and the middle third of the nose, septaldeformity with loss of cartilage tissue and the presence ofsynechia in bilateral nasal valve region. The patient under-went rhinoplasty byopen technique under general anesthesia,where the entire structure of the nasal septum, back andpyramid were rebuilt. In this case, nasal surgical reconstruc-tion has become possible with the use of ear cartilage and abiosynthetic prosthesis constituted by phospho-calcium ce-ramic designed exclusively for the patient. After surgery, therewas recovery of respiratory function and we obtained cos-metic improvement

Conclusion: The use of biosynthetic prosthesis isextremely valuable in facial and nasal reconstruction espe-cially when there is significant bone loss and cartilage, pro-viding better anatomical and functional restructuring withsuccessful surgical result.

Keywords: biosynthetic prosthesis, rhinoplasty, nose,trauma

A316. Nasal Rhabdomyosarcoma in a ChildAdriano Sergio Freire Meira, Christiane Kulzer Birck, JuniorAlvaro Vitorino de Pontes, Yuri Ferreira Maia, Nelson JoseBarboza Quintino, Bruno Leonardo Barbosa MachadoSos Otorrino

Introduction: A case of rhabdomyosarcoma in a 2-year-old boy without a pre-existing predisposing factor infamily.

Objectives: Describe the case, treatment and findings.Resumed report: A two-year-old boy was brought in

the Ear Nose Throat (ENT) emergency by her parents with amass blocking the left nares completely; causing difficulty inbreathing she was diagnosed in the basic attention unit ascomplicated sinusitis and sent to ER. The blockage had lastedalready several weeks it was possible to see a very smallproptosis. There were no palpable cervical glands. On admis-sion and after a complete blood count and blood chemistry allresults were found to be normal. CTwas performed and showsa big mass in left nares coming from back to front with braininvasion. It was obvious that a biopsy would provide thecorrect diagnosis. This was done under general anesthesiawith an oro-tracheal intubation and histopathological diag-nosis RM. Proptosis becames huge after the biopsy.

Conclusion: RM arise from mesenchymal tissue. Thehead and neck region is themost common site of origin in 40%of cases; RM is themost common type of head and neckcancerin the first 2 years of life. It was not possible to do surgery inthat time; the child was referred to the pediatric oncologistand was prescribed chemotherapy, after 9 months resolution

of the proptosis and nasal obstruction, in preparation forsurgery.

Keywords: rhabdomyosarcoma, nose, child

A107. Neuroblastoma In Infant: Case ReportPilar Campos Saavedra, Aline Araujo Saraiva, Lucas SieburgerZarro, Paulo Tinoco, Marina Bandoli de Oliveira Tinoco, SauloBandoli de Oliveira TinocoHospital São José do Avaí

Introduction: Neuroblastomas are originate of thesympathetic nervous system. Despite being corresponds tothe extracranial solid tumor most common of childhood, itsincidence in children under one year is rare, especiallywhen itcomes to cervical region. The symptomcommonly found is theincrease in abdominal volume by the growth of the tumormass, unlike the symptoms reported in the case described asstridor, tachypnea and cough.

Objectives: Report a rare case of neuroblastoma in thecervical region in our hospital.

Resumed report: Infant, 41 days of life, male. Motherreports that infant began presenting tachypnea frame, coughand respiratory stridor an increase of 15 days. Worsenedbreathing pattern and fever after admission. The examinationshowed small mass in the left cervical region. Oroscopy:normal. Neck CT scan: tumor in the left cervical region withcompression and deviation of the trachea. Laryngoscopyshowed hardened mass in pharyngeal wall. Taken to theoperating room for biopsy of the lesion and tracheotomy toensure airway. Histopathology confirmed neuroblastoma.Referred to the pediatric oncology service for follow-up andtreatment. Performed with chemotherapy reduced the tumormass.

Conclusions: Neuroblastoma is a rare tumor de-scribed in topography and in infants at that age. The treatmentis debatable and can be done by combining chemotherapy andsurgical resection. In the report, the infant had an uneventfulclinical after chemotherapy, not requiring surgical approach atthe time. It is eupneic in respiratory adaptation and clinicaland normal neurological growth.

A194. Neurocysticercosis And OtorhinolaryngologicPresentation: A Case ReportSarah Cristina Beirith, Jacqueline de Mattos Coelho, FlaviaCapone, Danielle de Araujo Torres, Felipe Barbosa Madeira,José Eduardo Esposito AlmeidaHospital Federal da Lagoa

Introduction:Neurocysticercosis is themost commonparasitic infection of central nervous system. It’s an endemicdisease in SouthAmerica, causedby thehelmint Taenia soliumand it affects humans as definite and suins as intermeditatehost. Different locations, the amount of cysticercal and thepatient immune response determine the disease’s severity.The most common signs and symptoms are seizures, head-each, intracranial hypertension, meningitis, psychiatric dis-orders, hydrocephalus and dementia. Otorhinolaryngologicpresentation can be also observed depending on cysticercallocation in brain parenchyma.

Objectives: The aim of this report is to present a caseof neurocysticercosis with otorhinolaryngologic symptoms asinitial presentation.

Resumed report: We report a case of a male patient,62 years old, complaining about dysphagia, dysphonia and drycough for a month, progressively worse and evolving with leftleg paresis. The computed tomography showed multiplehypodense nodular lesions with perypherical contrast

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enhancement distributed along brain parenchyma. The crani-al magnetic resonance revealed cystic lesions containing thescolex. Despite the treatment, the patient presented aggrava-tion of dysphagia. Nasofibroscopy showed bilateral vocal foldpalsy in paramedial position, demanding urgenttracheostomy.

Conclusion: Laryngologic symptons could be the firstone present, specially when the nucleus of tratus solitarius isstriken. In this case, the otorhinolaryngological evaluationwasprimordial to assure a safety airway and thereafter to preservethe patient’s life.

Keywords: neurocysticercosis, vocal fold palsy,dysphonia

A437. Neuroendocrine Tumor Of The Larynx : Case ReportDébora Angélica Lopes Reis, Jacqueline deMattos Coelho, CarlaAbranches Duarte Machado, Maria Cecilia Sodré Ramos deSouza, Felipe Barbosa Madeira, Rafael ZdanowskiHospital Federal da Lagoa

Introduction: Neuroendocrine neoplasms of the lar-ynx are rare representing approximately 1% of all larynxneoplasms. There are 4 histologic neuroendocrine subtypes:paraganglioma, typical carcinoid, atypical carcinoid tumorand small cell neuroendocrine tumors. Diagnosis is basedprimarily on light microscopy and confirmed by immunohis-tochemistry and electron microscopy. Natural history, treat-ment and prognosis vary widely for the different histologicsubtypes, but wide local excision is usually required.

Objectives: To report a case of neuroendocrine tumorof the larynx, in order to discuss management with conserva-tive laryngeal surgery.

Resumed Report: A 60 years old caucasian manpresented with one-year history of persistent hoarseness.Computed tomography and laryngeal endoscopy revealed aright supraglottic mass, occupying the posterior third ofaryepiglottic fold and reducing arytenoid mobility. Directlaryngoscopic biopsy suggested low grade neuroendocrinetumor. A conservative partial laryngectomy via right lateralpharyngotomy, including right aryepiglottic fold, right aryte-noid cartilage and posterior third of the true vocal cord wasperformed. Tracheotomywasperformed andwas closed in thesecond postoperative week. Histopathologic exam confirminitial diagnosis.

Conclusion: Laryngeal neuroendocrine tumors arerare, and its evolution depends on thehistopathologic subtypeand stage. Although the reporteddata suggest that awide localexcision is adequate treatment, this patient underwent aconservative laryngectomy, with free margins, and an excel-lent post-operative outcome.

A1715. Neurotological Disease In Intracranial TumorsHelio Afonso Guizoni Teive, Luísa Bordignon Félix de Oliveira,Vinicius Ribas Fonseca, Rafaela Mabile Ferreira dos Santos,Bianca Simone ZeigelboimHospital da Cruz Vermelha do Paraná

Introduction: The balance disorders may have theirorigins in the malfunction of the vestibular receptors or becaused by lesions of various vestibular pathways in the centralnervous system, especially the structures located in thecerebelopontine angle region, where the clinical manifesta-tions are externalized, according to areas compromised bymany neurotological dysfunctions.

Objective: To verify the labyrinthine alterations inpatients with intracranial tumors.

Methods: It was performed a retrospective cross-sectional study. We evaluated 21 patients with 13 cases ofVestibular Schwannoma, 4 cases of Von Recklinghausen’sdisease, 1 case of squamous cell tumor, 1 case of cerebralhematoma, 1 case of craniopharyngioma and 1 case of arach-noid cyst, aged from 19 to 78 years (14 famales and 7 males).All patients underwent the following procedures: anamnesis,ENT examination and vestibular assessment(electronystagmography).

Results: Patients showed prevalence of imbalancewhenwalking (83.7%), motion incoordination (48.8%), nystag-mus (42.7%) and headache (41.8%). There was prevalence ofalteration in the central vestibular system with a predomi-nance of unilateral vestibular deficit disorder (62.0%).

Conclusions: Central signswere very variables in eachcase and the bidirectional ond multiple semi-spontaneousnystagmus type was the most often central sign.

Keywords: vestibulo-ocular-reflex (VOR); cognitivedysfunction; dysarthria; eye movement

A3. Noise Evaluation in Shopping Mall’s Food Court of theCity of São PauloGiovana Scachetti, Edmir Américo LourençoFaculdade de Medicina de Jundiaí

Introduction: Currently, noise levels have been in-creasingnotonly in industrial activities, aswell as in social andrecreational. It is noticed that the noise is intrinsically linkedto the development of cities, being larger, the proportionarising harmful urban facilities and typically new city enter-tainment activities. For this reason, there has been concernwith controlling the noise level in the field of architecturalacoustics, aiming to eliminate, reduce or control the presenceof unwanted sounds inside the buildings. The effects broughtby noise can cause hearing loss from a temporary to severehearing symptoms.

Objectives: This research aims to quantify soundpressure levels in food courts of shopping malls in the cityof São Paulo in order to assess the risk that professionals andpatrons of these establishments are exposed.

Methods: For this measurements were performed inthe center of the food courts in peak hours. The head of themeasuring apparatus was a decibel meter Minipa ® brand,model MSL - 1352C.

Conclusions: At the end, we found that the noisegenerated in relation to time of exposure of employees andusers are not able to generate irreversible hearing loss, butnegatively affects the metabolic and psychological health ofthese, being the managers and health agencies responsiblesearch for measures aimed at improvement of the quality ofthese environments, like the sound insulation and separationof food courts in more than one environment.

A494. Oral Squamous Cell Carcinoma: An EpidemiologicalStudy Conducted At Hospital Araújo Jorge In Goiânia - GoiásPaola Morales Salarini Pinto, Leticia de Avila Cambraia, TeylorGerhardt, Rommell Vieira, Camila TaniguttiHospital Araújo Jorge

Introduction: The purpose of this work was to iden-tify the epidemiological profile of oral squamous cell carcino-ma (SCC) patients, who were treated at the Hospital AraujoJorge in Goiânia â€“ Goiás, Brazil, from 2008 to 2012.

Method: This is a descriptive, cross-sectional study.The studied population comprised 90 cases of oral cancertreated at our department. Data were collected from theregister book of head and neck surgeries and from patient

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health charts of the Hospital. The following variables wereevaluated: age, sex, patient origin, cancer clinical and patho-logic staging, anatomical localization and treatment.

Results: Results showed that 68% of the cases occurredin men, within the age range of 32 to 86 years. The mostcommon anatomical localizations was oral tongue (44%) andfloor of mouth (28%) As per cancer staging, 65% of the patientswere classified as stage III or IV, with a 33% regional metasta-sis. Most of the patients were submitted to surgery associatedto radiotherapy and chemotherapy (52%). A significant statis-tical relation (p < 0.05) was found between the variables sexand age, sex and anatomical localization and this latter withage.

Conclusion: The results suggest the need of imple-menting a prevention and oral cancer control policy in GoiásState, Brazil, aiming the reduction of new cases, early diagno-sis and better prognostic, alongside the treatment of theseneoplastic diseases.

A365. Ortner Sindrome: Case Report Of Three CasesRegina Helena Garcia Martins, Adriana Bueno Benito Pessin,Norimar Hernandes Dias, Roberto Santos TunesFaculdade de Medicina de Botucatu (Unesp)

Introduction: Ortner’s syndrome corresponds to vo-cal fold paralysis due to recurrent laryngeal nerve compres-sion in intrathoracic path caused bycardiovascular alterations.Hoarseness and aspiration are common.

Objectives: To present three cases of Ortner’s syn-drome secondary to aneurysms of aortic arch.

Resumed report: Case 1: 80 years old, M, smoker,diabetic, hypertensive, sudden hoarseness a year ago. Video-laryngoscopy: left vocal fold paralysis. Normal CT scan ofbrain, cervical and thyroid. Torax CT identified saccular aneu-rysm in aortic arch (4 � 4). Patient without surgical condi-tions, keeps the vocal fold paralysis after six months. Case 2:79 years old, F, smoker, hypertension, chronic renal, hoarse-ness, cough and aspiration one month. Videolaryngoscopy:left vocal fold paralysis and aspiration. Normal CT of brain,cervical and thyroid. Torax CT identified aneurysm in aorticarch (6.9 � 5.8), and trachea deviation. Patient had no surgicalconditions and keeps the vocal symptoms after four months.Case 3: 80 years old, M, extabagista, diabetic, hypertensive,chronic coronary insufficiency, sudden hoarseness and vocalfadigue two months ago. Videolaryngoscopy: left vocal cordparalyzed. Normal CT of brain and cervical. Torax CT showedsaccular aneurysm in aortic arch (4 � 4). Patient keeps vocalsymptoms after five months.

Conclusions: Left recurrent laryngeal nerve is vulner-able to intrathoracic compressions as in the Ortner’s syn-drome. We highlight the importance of image exams to thetopographic diagnosis of vocal fold paralysis and it associationwith the aortic arch aneurysm in the elderly.

Keywords: Ortner’s syndrome, vocal fold paralysis,aneurysm

A231. Chronic Otitis Media cholesteatomatous withetxratemporal complication : a case report and literaturereviewPablo de Oliveira Lima, Caroline Catherine Lacerda Elias,Nicolau Tavares Boechem, Alexandra Torres Cordeiro Lopes deSouza, Vanessa de Araújo Souza, Mariana Azevedo SilvaHospital Federal de Bonsucesso

Introduction: Intracranial complications are relative-ly rare in chronic otitis media, occurring more frequently incases of cholesteatoma. Complications of suppurative otitis

media are classified into temporal and extratemporal. Extra-temporal are subdivided into intracranial and extracranial.Themost common aremeningitis, epidural abscess and lateralsinus thrombophlebitis.

Objective: To report a case of complication of chronicotitis media in young patients.

Resumed report: Patient 18 years, male, with suppu-rative otitis during eight years, without improvement withantibiotics. A week ago with ear pain, pain, retroauricularedema, left temporo-frontal. On examination, lucid patientswithout neurological disorders. Otoscopy observed otorrheawith granulation tissue in the external ear canal, preventingvisualization of tympanic membrane. Erythema and edemawith temporo-frontal fluctuation and left mastoid. Computedtomography showed opacification of the left mastoid, exten-sive bone erosion and material with soft parts subperiostealgas in between. With a clinical diagnosis of otomastoiditiswith subperiosteal and extradural abscess was performedpercutaneous drainage with collection of material for culture,antibiotic and tympanomastoidectomy with subsequent clin-ical and radiological control. The patient keeps monitoring,presents no signs of infection or neurological deficit.

Conclusion: Although the incidence of complicationsandmortality rates have declined in the post antibiotic era, theearly diagnosis of complications and consequently its treat-ment to reduce morbidity and mortality rates should alwayspay attention to aggressive and destructive character ofcholesteatoma is important.

A702. Otolaryngological and PhonoaudiologicalIntervention in the Therapeutic Process Pre and PostSurgical Cochlear Implant in the Municipality of Lagarto/SELucileide dos Santos, Alex Carvalho CostaCentro Municipal de Especialidades Médica

Introduction: The cochlear implant is a method de-veloped for people with severe or profound hearing losswhere the hearing can be partially restored and the individualcan perform communication through speech.

Objectives: To describe the first case of cochlearimplant occurred in the municipality of Lagarto /SE.

Resumed report: The otolaryngological interventionwas as follows: In the initial consultation, were requestedmedical examinations, such as otoacoustic emissions, immit-tance essays, brainstem audiometry in order to diagnose thehearing loss with profound degree. With the speech thera-pist’s assessment, the patient started using the Sound Ampli-fication Device. After audiological training, the patient wasreferred to cochlear implant. It was observed that aftercochlear implant the patient has developed satisfactorily thehearing skills reproducing the conclusions stated by Hippolitoand Bento (2012).

Conclusion: The cochlear implant have been pre-sented as a satisfactory method in improving the quality oflife of patient by improving the speech perception and result-ing in good social interaction. The effectiveness of the methodwas observed in the patient studied in this case, who has usedthe implant successfully for four years as reports the accom-paniment made by the team of the Centro de EspecialidadesMédica.

Keywords: Cochlear Implant, Rehabilitatio, Otolaryn-gological, phonoaudiological

A568. Otologic MyiasisJose Jarjura Jorge Jr, Heliel Tadeu Ruiz, Guilherme Rocha Netto,Godofredo Campos Borges, Mariana Lombardi Guidi

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Pontifícia Universidade Católica de São Paulo -Faculdade deMedicina eCiências da Saúde

Introduction:Myiasis can be defined as an infestationof the subcutaneous tissue or mucous membrane or bodycavities of living human or vertebrate animal, for dipterouslarvae (Cochliomya macellaria). Such as an illness that affectsmucous membrane or subcutaneous tissue, the ear canal canbe a place to development of myiasis, featuring a case ofotologic myiasis. The clinical relevance of myiasis leads thispathology to be considered as an emergency in otorhinolar-yngology, demanding immediate treatment. Even with thedevelopment of knowledge about myiasis in the past fewyears, there still no protocols clearly defined to treat thiscondition. One option of treatment involves the use of me-chanical removal or pharmacologic treatment with iodofor-mium and ivermectin.

Objectives: The present paper intends to discourseabout historical and actual treatments about otologic myiasis,as describe the applied conduct of our service.

Methods: Our Conduct in Otologic Myiasis: Due theimportance of the rapid treatment to prevent future compli-cations in the affected ear, initially, we perform the mechani-cal removal of larvae and, after the removal of all visiblemacroscopic larval bodies,we use topic iodoformium (3 drops,one time at ambulatory) in the ear affected. Because of therecent researches that points out to the association of otologicmyiasis and secondary bacterial ear infection mainly dueKlebsiella sp, we prescribe ivermectin (posology: 24 mg,orally one time).

Conclusion: The use of iodoformium and ivermectin,after the mechanical removal, as used in our Ambulatory ofOtorhinolaryngology, shows a very efficient method of treat-ment of otologic myiasis.

A1724. Otoneurological Abnormalities In Patients WithFriedreich AtaxiaJuliana Cristina Mesti, Rafaela de Paula Peres, Vinicius RibasFonseca, Bianca Simone Zeigelboim, Helio Afonso GuizoniTeive, Laura Schwartz MaranhoHospital da Cruz Vermelha, Filial do Paraná

Introduction: The Friedreich ataxia is a neurodegen-erative disease and progressive by nature, it has autosomalrecessive inheritance and early onset in most cases. Theaffected gene plays the role of encodingmitochondrial proteinfrataxin that is involved in the iron metabolism. The deficit ofthis protein compromises mitochondrial respiratory chain.

Objective: To examine vestibular disorders in patientswith Friedreich ataxia.

Methods: A retrospective cross-sectional study wasconducted. 30 patients were evaluated ranging from six to 72years of age (mean age of 38.6 (� 14.7) and underwent thefollowing procedures: case history, ENT and vestibularevaluations.

Results: Clinically, the patients commonly had symp-toms of incoordination of movement (66.7%), gait disturban-ces (56.7%) and dizziness (50%). In vestibular testing,alterations were predominantly evident under caloric testing(73.4%), testing for gaze nystagmus (50.1%), rotational chairtesting (36.7%) and optokinetic nystagmus (33.4%). The pres-ence of alterations occurred under examination in 90%, withthe majority occurring in those with central vestibular dys-function, 70% of the examinations.

Conclusion: The most evident neurotological symp-tomswere incoordination ofmovement, gait disturbances anddizziness. Alterations in vestibular examinations occurred in90% of patients, mostly in the caloric test, with a predomi-

nance of deficient central vestibular system dysfunction. Thisunderscores the importance of the contribution of topodiag-nostic labyrinthine evaluations for neurodegenerative dis-eases since, in most cases, the initial symptoms areneurotological, and these evaluations should also be includedin the choice of procedures to be performed in clinical andtherapeutic monitoring.

Keywords: Spinocerebellar Degenerations, Spinocer-ebellar Ataxias, Ataxia, Vestibular Dysfunction, Nystagmus

A18. Our Experience With Hypocrites In RegularOccupational Audiometric EvaluationsCarlos Augusto Ferreira de Araujo, Avenilda de Azevedo SilvaFaculdade de Medicina de Petrópolis - Petrópolis - RJ

Introduction: The man has suffered the risks of theirwork. That will affect it slowly not only hearing, AND YES,YOUR QUALITY OF LIFE. The audiometric responses haveshown in many cases of masking. Learned in the occupationalarea being the simulation disclosed as a joint venture.Thereare workers in the interview reported not having hearingproblems and is not always true their "auditory self-percep-tions". There are significant changes that, in general, theworker should feel the loss of his hearing.

Objectives: Experience the real audiometric results.Clarify the truth of the cover-up in periodic reviews; guidanceto workers about the hazards of such behavior and promotethe extinction themost of this concealment or any other ghostbehavior.

Methods: We evaluated 122 workers, with hearingloss; a weaving , whose sound pressure levels ranging from62.0dB to 96.2dB. Were performed: anamnesis, otoscopy,audiometry and others.

Results: In the 2ndmoment of casehistories,we foundthat some workers were aware of their hearing loss, that is, oftheir deceit. Stealth framewas foundmore frequently in olderworkers. (31 ¼ 25.4%).

Conclusion: We believe that workers concealed byrequiring his salary to remedy your expenses and that aretirement would reduce their salaries and, in older getanother job would not be as easy or even impossible. Thepresent are alcohol and other problems, showing a dissatis-faction (?).

Keywords: Occupational hearing loss, dissimulation,audiometry, quality of life

A512. Parapharyngeal Abscess: Case ReportPaloma Simoni Gama Ferreira, Érica Carla Figueiredo de Souza,Camila Lira Holanda de Lima Barros, Samuel Neiva Almino,Maria Carmela Cundari Boccalini, Nicole Martuscelli de AlmeidaHospital do Servidor Público Municipal de São Paulo

Introduction: Parapharyngeal abscesses are pus col-lection inside the virtual parapharyngeal space which con-nects to every other fascial neck space. With highmorbimortality, it is a challenging diagnosis, specially onpediatrics population as the symptoms and signs are lessspecific and physical exam is poorly tolerated.

Objective: Report a case of parapharyngeal abscess ona child.

Resumed report: B.F.F., 13 year old female, presentedat the pediatrics emergency room complaining of fever(38oC), fatigue, hypersalivation, cervical enlargement andodynophagia for 7 days with no improvement of clinicalparameters after the use of azitrhomycin. At physical exam:normal oral cavity exam, left anterior cervical mass extendingfrom the mandibule angle to cervical level III, trismus and no

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signs of respiratory failure. Indirect viedolaryngoscopy evi-denced mass involving both left pyriform sinus and vallecula.CT scan showed multiloculated mass with post contrastperipherial enhancement measuring 7,9 � 5,5 � 4,7 cm ex-tending 1,4 cm superiorly from the cricoid cartilage to thethyroid cartilage dislocating trachea and oropharynx. Thepatient started on intravenous antibiotics (metronidazoleand ceftriaxona) and corticotherapy. She was taken to theoperating room and the abscess was drained with an anteriorcervical approach. Penrose drain was inserted and removedafter 2 days. The patient recovered well and was dischargedafter the third operation day.

Conclusion: Treatment of supurative infections fromthe parapharyngeal space should be initiated as soon aspossible in order to avoid its complications, specially thespread to subjacent areas such as the mediastinum.

Keywords: parapharyngeal abscess, odynophagia,children

A575. Patient Management With Penetrating Injury ByWhite Weapon In The Face. Three Cases ReportLorena Cássia de Carvalho Oliveira, Emilio Santana MartinsXavier Nunes, Halina Araujo Souza, Elaine Alves Carneiro,Gustavo Bachega Pinheiro, Thiago Bittencourt Ottoni deCarvalhoHospital de Base do Distrito Federal

Introduction: Injuries by white weapons on the faceare scarcely reported in the national literature. The highestincidence occurs in male individuals between 15 and 35 yearsold, with prevalence for left facial. In the initial treatment, therecognition of lesions and implementing measures are madeto maintain life. Imaging studies are essential for the assess-ment of damages and surgical planning. Must assess theextent and depth of the injuries, injuries to important struc-tures, need for immediate reconstruction after removal of theobject and the time elapsed since the trauma. Treatmentinvolves removal of the object and repair of injuries, tryingto preserve the craniofacial function and esthetics.

Objective: To present the rapid and multidisciplinarymanagement of three cases of injury by white weapon (knife)in right hemiface, not removed in the pre-hospital, in malepatients, averaging 26 years old who were admitted to theEmergency Room of the Base Hospital of Federal District.

Resumed report: Patients presented with the housedobject that affected: the right orbit to hypopharynx; rightorbit to right cervical region, with penetration into jugularvein; and right nasal dorsum to spinal canal. With the stabi-lized phase, the Otolaryngology teams, Head and Neck Sur-gery and Ophthalmology started treatment together.

Conclusion: This type of trauma can result inmultipleinjuries of vital structures. The rapid multidisciplinary inter-vention, coupled with the surgical technique minimizes therisk of complications and sequelae.

Keywords: facial trauma; white weapon; penetratinginjury; multidisciplinary management

A470. Pediatric Tympanoplasty: Is The Age A PrognosticFactor?Amanda Oliveira Benevides, carolina affonso solano, LucasFerreira Rocha, Patricia Ciminelli Linhares Pinto, Danielle deAraujo Torres, Sarah Cristina BeirithHospital Federal da Lagoa

Introduction: Tympanoplasty is a valid treatmentmodality for tympanic membrane perforation in the pediatricpopulation and the rate of success depends on many factors.

Deciding which patients benefit from surgical repair andwhen is the optimal age to perform it continues to be widelydebated.

Objectives: This update reviews the recent as well asthe past literature on prognostic factors in pediatric tympa-noplasty, focusing on patients age.

Data Synthesis: The rate of success of pediatric tym-panoplasty is likely not a matter of age, but a matter of patientselection. Careful attention to factors such as technique,eustachian-tube function, and site and size of the perforationwill likely increase the rate of an intact tympanic membranewith improvement in hearing. There are several specific thatdetermine the results.

Conclusion: According to the revised articles, there isstill no consensus in the best age to indicate tympanoplasty.The success of the surgery is related toproper patient selectionand surgical technique used.

Keywords: Tympanoplasty, prognostic factors,children

A275. Pierre Robin Sequence Associated To EyeAbnormalities: Stickler SyndromeKariny Zencke da Silva, Letícia Gregory, Gabriela Pereira daSilva, Pricila Sleifer, Rafael Fabiano Machado Rosa, PauloRicardo Gazzola ZenUniversidade Federal de Ciências da Saúde de Porto Alegre

Introduction: Pierre Robin sequence is a conditionthat can occur lonely or associated to some syndromes.

Objectives: to describe a patient with Pierre Robinsequence, presenting Stickler syndrome.

Resumed report: the patient came referred for evalu-ation at 2 months of age due to cleft palate associated to asyndromic aspect. The child was the first son of parents aged25 (mother) and 28 years (father). Therewere no similar casesin family. He was born vaginally, premature of 8 months,weighing 2,605 grams, measuring 46 cm, with a head circum-ference of 30 cm and Apgar score of 10 in the first minute. Thefinding of cleft palate associated to micrognathia and glos-soptosis (i.e., Pierre Robin sequence) was observed at birth. Onphysical examination, it was verified growth retardation, bigeyes, small mouthwithmicrorretrognathia and posterior cleftpalate, besides clenched hands with overlapping fingers.Ophthalmologic evaluation was consistent with congenitalglaucoma associated to posterior staphyloma. Computed to-mography scan disclosed increased size of eyeballs. Audio-metric evaluation revealed bilateral hearing loss. Radiographydisclosed only delayed bone age. His karyotype was normal(46,XY).

Conclusion: The findings of our patient were consis-tent with the clinical diagnosis of Stickler syndrome. This isconsidered the genetic and syndromic condition most oftenseen among patients with Pierre-Robin sequence. Our aimwas to emphasize such association.

Keywords: Pierre-Robin sequence; Stickler syndrome;eye abnormalities

A387. Postoperatory Pain Management In ChildrenFollowing Tonsillectomy SurgerySarah Cristina Beirith, Carolina Affonso Solano, Flavia Capone,Amanda Oliveira Benevides, Danielle de Araujo Torres, MariaRichelle Rufino CecílioHospital Federal da Lagoa

Introduction: Tonsillectomy is the one of the mostfrequently surgical procedure in children. It is associated with

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severe postoperative pain that usually requires analgesics,including opioids.

Objectives: The purpose of this study is to review theliterature and the guidelines about postoperatory pain man-agement, in children, following tonsillectomy surgery. To thisend, a search of Medline/Pubmed was conducted, from 2010until 2015.

Data synthesis: In 2012 the United States Food andDrug Administration issued a safety communication followinga review of reports of children experiencing serious adverseevents, including death, after the use of codeine at normaldoses, for pain relief posttonsillectomy. Dipyrone has a sub-stantial use in many centers however it may increase the riskof agranulocytosi. Intravenous paracetamol with a well estab-lished safety profile may be a reasonable alternative in thesepatients. Guidelinesworldwide recommend the routine use ofibuprofen after tonsillectomy, with no significantly postoper-ative bleeding. In case of inadequate pain control, alternatingdoses of ibuprofen and acetaminophen provided an effectivetreatment. Positive results were achieved using therapeuticlaser for pain relief after tonsillectomy so less analgesicmedication was requiered. The peritonsillar infiltration usinglocal anesthetic is controversial.

Conclusion: Pain control is still a great problem aftertonsillectomy surgery. Even after the United States Food andDrug Administration announcement of contraindication ofcodeine, its use is still a reality in Brazil. Otorhinolaryngolo-gists must discuss the effectiveness and risk of differentoptions on postoperatory pain management in order topurpose an updated guideline.

Keywords: Postoperatory pain, tonsillectomy,analgesia

A81. Prevalence Of Obstructive Sleep Apnea Syndrome InPatients With Cystic Fibrosis In A Brazilian NortheastHospitalBianca da Silva Vinagre Nascimento, Thais Sampaio Silva,Tassia Milenna Oliveira de Souza, Clara Monica Figueiredo deLima, Marcus Miranda Lessa, Edna Lucia Santos de SouzaFederal University Of Bahia

Introduction: Tonsil or adenoid enlargement is animportant risk factor of Obstructive Sleep Apnea Syndrome inchildren without comorbidities (e.g., obesity). There are fewdata about this prevalence in Cystic Fibrosis patients.

Objective: To determine the prevalence of risk factorfor Obstructive Sleep Apnea Syndrome in children with cysticfibrosis

Methods: Descriptive study, case series. Patients weresubmitted to otolaryngology evaluation and nasal endoscopy.Inclusion criteria were diagnosis of cystic fibrosis and morethan 2 years old. Exclusion criteria were tonsillectomy and/oradenoidectomy and those who didn’t permit the execution ofnasal endoscopy or evaluation.

Results: Selection of 36 patients, 36,8% were female.The mean of age was 10 years (� 4,52).There were relate ofsnoring at night in 52,6% and mouth breathing in 36,8%.According to Brodsky Grading System, 50% were grade I,31,6% were grade II and 15,8% were grade III. There was nograde IV. Analysing the nasal endoscopy, there were 13,1% ofobstructive adenoid enlargement. On this group, there were80% of snoring at night and 40% of mouth breathing. Consid-ering the patients with obstructive tonsil grade (III and IV),therewere 33,3% of night snoring and 50% ofmouth breathing.

Conclusion: The prevalence of snoring and otherObstructive Sleep Apnea Syndrome symptoms on this studywas higher than in general pediatric population, according toguidelines of Obstructive Sleep Apnea Syndrome.

Keywords: Cystic Fibrosis, Obstructive Sleep ApneaSyndrom

A473. Profile of Disphonic Patients Submitted to LaryngealMicrosurgery: Evaluation of Improved PostoperativeNatália Collodetto Soares, Roberto Hyczy Ribeiro Filho,Cristiano Roberto Nakagawa, Marco Antonio Terreri, BrunnoFernando Correia Muniz de Resende, Bruno Amaral HayIrmandade da Santa Casa de Misericórdia de Curitiba

Introduction: Dysphonia is a common complaint inotorhinolaryngology clinics and offices, because it is a symp-tom that generates significant social and psychological reper-cussions. Identify risk factors, establish preventive measuresand execute early diagnosis and appropriate treatment be-comes primordial.

Objective: Analyze the profile of patients with dys-phonia of the Otorhinolaringology Ambulatorys of HospitalsSanta Casa and Cajuru, located in the city of Curitiba-Paraná,who were submitted a surgical treatment and identify post-operative response. METHODS Data collect from medicalrecords of patients undergoing laryngeal microsurgery be-tween the years 2007 to 2013.

Results: 130 patientswere selected, and these 88werefemale and 42 were male, with a mean age of approximately46 years (patients above 14 to 76 years). Smoking was presentin 53% of patients. In the histopathological analysis thefollowing types of lesions were identified: 69 polyps, 20 cysts,27 Reinke’s edema, 13 papillomas, 8 nodules and 3 leukopla-kias. It was observed clinical improvement in 73% of patients.

Conclusion: Benign laryngeal lesions mostly presentwith dysphonia symptoms. In our sample there was disagree-ment with the literature since the polyps were more preva-lent. It is important to point out smoking as amajor risk factor,present in more than half of patients. The indication of alaryngeal surgery must be very careful and individualized,since it presents variable results in dysphonia symptomimprovement according to etiology presented byeach patient.

A419. Prophylactic Antibiotics for Ear Surgery – What DoesThe Evidence Tells UsJacqueline de Mattos Coelho, Carla Abranches DuarteMachado, Thais de Araujo Freitas Gomes, José Arnaldo CruzBezerra de Menezes Filho, Flavia Capone, Danielle de AraujoTorresHospital Federal da Lagoa

Introduction: The use of prophylactic antibiotics forear surgery is widely discussed and used to decrease intra-operative and postoperative infection rates. Infection can be ofthewound itself, discharge the external auditory canal, failureof grafting or even labyrinthitis. The indiscriminate use ofantibiotics is linked to increased bacterial resistance, whichmay cause toxic reactions and immune deficit, in addition tohigh costs.

Objectives: The aim of this report is to review the useof antibiotic prophylaxis in ear surgery and its benefit inpreventing postoperative complications. To this end, a searchof Medline/Pubmed was conducted, from 2008 until 2015.

Data Synthesis: In general, tympanoplasties, stape-dectomies, ossicular chain reconstructions and surgery withdry ears are considered clean. Chronic otitis media with orwithout cholesteatoma are considered clean-contaminated,contaminated or even dirty, depending on the authors andappearance of ear discharge. There was no evidence for large-scale use of prophylactic antibiotics to clean or clean-

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contaminated surgery. However, its use for contaminated ordirty surgery seems to bring benefit in preventing infection.The use of topical antibiotic demonstrated no guarantee ofsuccess of tympanoplasty grafts and no significant differencebetween the use of topical or systemic antibiotics was found.

Conclusion: The use of profilatic antibiotics for earsurgey is routine in otorhinolaryngologic services in Brazil,even with no strong evidence of its benefit. Its discussion isessencial to change our daily practice, that must be based incientific evidence.

Keywords: antibiotic, prophylactic, ear, surgery

A197. RamsayHunt Syndrome In Immunocompetent Patient- Case ReportFernanda Rodrigues da Cunha, Guilherme Trindade Batistão,Rafael Toledo Enes NogueiraServiço de Otorrinolarigologia e Cirurgia Cervico Facial do HospitalRegional de Presidente Prudente - SP

Introduction: The Ramsay Hunt syndrome is charac-terized by paralysis injuries, facial herpes in external auditorycanal and ear flag that occurs due to recurrence of varicellazoster virus in latent state in facial nerve. The prognosis isgood and 75% have a full recovery. For topographic diagnosisof facial injury is use Schirmer test, taste test and impedance.The treatment is based corticosteroids at high doses. Agentssuch as acyclovir gained importance. In severe cases, facialnerve decompression surgery can be done.

Objective: Relate a case of Ramsay Hunt syndrome inimmunocomptent patient attended at Hospital Regional dePresidente Prudente - SP.

ResumedReport: LRTS,male, 20, attended the Otorhi-nolaryngology service with facial paresis degree V (HouseBrackmann), the vesico bullous law of evolution 2 days.Electrophysiological study showed severe diffuse axonal inju-ry of the right facial nerve, impedance negative reflex. Wastreatedwith acyclovir and corticosteroids intravenously. After11 days was regression of lesions and paralysis grade III. Stillfollowing up at ambulatory.

Conclusion: The Ramsay Hunt syndrome is variableaccording presentations extension and involvement of facialnerve. Clinical suspicion and early treatment allow successfuloutcome and avoid sequelae.

A468. Report Of A Family Case Of Treacher Collins Syndrome:Importance Of Early RecognitionSheila Tamanini de Almeida, Letícia Gregory, Bárbara CristinaPezzi Sartor, Taís Rosa de Oliveira, Rafael Fabiano MachadoRosa, Paulo Ricardo Gazzola ZenUniversidade Federal de Ciências da Saúde de Porto Alegre

Introduction: Treacher Collins syndrome is a condi-tion related to craniofacial development.

Objectives: to describe a patient with Treacher Collinssyndrome, with a family history of the condition.

Resumed report: the patient was referred for geneticevaluation at 7 years of age due to face malformations. Thechild was the daughter of parents with 35 years (mother) and40 years of age (father). She was born vaginally at term,weighing 3,740 grams, measuring 49 cm, with a head circum-ference of 36 cm and Apgar scores of 8 and 9. Cleft palate wasidentified at birth. At school, it was evidenced hearing loss. Onphysical examination, at 7 years of age, there was hypoplasiaof the zygomatic arches and middle face, down-slantingpalpebral fissures, eyelids coloboma, microstomia, posteriorcleft palate, micrognathia, microtia grade II with absence ofthe external ear canal and thoracic scoliosis. Her father had

similar craniofacial findings. In addition, there was the de-scription in the family of affected more individuals, includingbrothers and cousins.

Conclusion: the clinical characteristics of the patient,together with her family history, were consistent with thediagnosis of Treacher Collins syndrome. This is an autosomaldominant genetic condition, where affected individuals pres-ent a riskof 50% tohave an affected offspring. As noted, this is asyndrome characterized by craniofacial involvement, wheredeafness, particularly conductive, is a common finding. Thishighlights the importance of the early recognition of theseindividuals.

Keywords: Treacher Collins syndrome; early recogni-tion; genetic condition

A492. Report of Parathyroid Carcinoma Case in Araújo JorgeHospital in GoianiaPaola Morales Salarini Pinto, Teylor Gerhardt, Rommel Vieira,Letícia de Ávila Cambraia, Camila TaniguttiHospital Araújo Jorge

Introduction: Parathyroid carcinoma is a rare condi-tion, comprising less than 1% of the cases of primary hyper-parathyroidism. Nonetheless, due to its aggressiveness, andhaving prognosis dependent on the precocity of diagnosis andradical therapeutic approach.

Objectives: Rare Case Report of parathyroid carcino-ma in Goiania, Hospital Araújo Jorge.

Resumed Report: JRdaS, 56anos, white, natural Goia-tuba, Goiás, salesman.. In March 2014 complaining of a "lumpin the neck." Referred to the Head and Neck Surgery Service ofHospital Araújo Jorge in Goiania. In the first complaint of painin the lower query and results of examinations members asdesnsitometria with bone loss, thyroid scintigraphy uptake inleft parathyroid, thyroid ultrasound with parathyroid nodulemeasuring 3, 4 � 2,0 cm. Laboratory tests changed calci-um12,6 and PTH 534. History of smoking and drinking.Performed surgery lobectomy and left parathyroid. Anatomi-cal Pathology compatible with parathyroid carcinoma. Aftersurgery, patient was clinical and laboratory gradual improve-ment. No adjuvant therapy performed. In follow-up to theMay2015 without relapses.

Conclusion: The clinical features are compatible witha case severe, symptomatic HPP with cervical tumor> 1.5 cm,and may be palpable. Management is surgical and shouldinclude ipsilateral thyroidectomy and cervical exploration.The postoperative is compatible with the severity of pre-existing metabolic disorder, is common the tendency tohypocalcemia. The long-term prognosis depends on the diag-nosis early, surgical success and control of hypercalcemia.

A253. Respiratory Epithelial Adenomatoid Hamartoma:Case ReportEstefane Costa Loureiro, Roberto Eustáquio Santos Guimarães,Amanda Cristina Ferreira, Paulo Fernando Tormin BorgesCrosara, Flávia Oliveira Ballesteros, David AlbuquerqueMourãoNucleo de Otorrino Bh

Introduction: Respiratory epithelial adenomatoid ha-martoma is a benign tumor of the nasal cavity and paranasalsinuses, characterized by the enlargement of the olfactory pitsvisualized on computed tomography (CT) of the paranasalsinuses. Complete excision is essentially curative and recur-rence is rare.

Objectives: Report a rare case of hamartoma of thenasal cavity and paranasal sinuses. Draw attention to thisdisease. Show the effectiveness of the endoscopic treatment.

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Resumed Report: MSS, 73, male, with a history ofchronic nasal obstruction, hyposmia and recurrent upperairway infections. He underwent endoscopic sinus surgeryin another service due towhat it seemed to be polyposis. Thenhe presented at our service where we made further investi-gation. The nasal endoscopy, showed an abundance of polyps,making impossible the progression of the optical fiber. A CTscan of the paranasal sinuses revealed opacification of thenasal cavities and all paranasal sinus, plus the enlargement ofthe olfactory pits. We performed a preoperative biopsy thatshowed bilateral eosinophilic inflammatory polyps. The treat-ment was performed through the nasal surgery by endoscopicapproach, with full sinusotomy. The patient presented symp-tom improvement postoperatively.The pathology study of theremoved lesion from the olfactory pits, showed a respiratoryepithelial adenomatoid hamartoma.

Conclusion: Although invariably benign, the respira-tory epithelial adenomatoid hamartoma can grow into rela-tively large sizes and are associated with other naso-sinusaldiseases, leading to clinical concerns. Therefore, the earlydiagnosis and the surgical approach are of great importance.

Keywords: hamartoma; nasal cavity; paranasalsinuses

A517. Scalp Angiosarcoma: Case ReportJacqueline deMattos Coelho, DéboraAngélica Lopes Reis, CarlaAbranches Duarte Machado, José Eduardo Esposito Almeida,José Arnaldo Cruz Bezerra de Menezes Filho, Ana CarlaWanderley CostaHospital Federal da Lagoa

Introduction: The angiosarcoma is a rare and aggres-sive tumor of the head and neck. Corresponds to 0.1% ofneoplasms of that site, being more common in scalp. Usuallyaffects older men and is diagnosed at an advanced stage. Itsetiology is unknown, but sun exposure and prior radiation areconsidered risk factors, and its features are red plate, chronicedema, cellulitis or skin ulceration.

Objectives: The aimof this case is to inform the clinicalpresentation of the neoplasm, and its diagnose and treatment,in order to increase survival.

Resumed Report: HFR, 63, male, reports mass emer-gence scalp of small size, in October, 2013. He was submittedto biopsy of the lesion, significantly increasing in size. Thehistopathological report diagnosed angiosarcoma. In July2014 ,there was a vegetant lesion, infiltrative , in the anteriorregion of the scalp. The pacient underwent

Conclusion: The angiosarcoma is an aggressive malig-nant tumor that can metastasize to lymph nodes, lungs andliver. The suspected diagnosis is based on clinical features, butcan only be confirmed by biopsy histopathology. It should becarried out differential diagnosis with hemangioendothe-lioma, Kaposi’s sarcoma and inflammatory carcinoma. Inimmunohistochemistry, markers of poorly differentiated tu-mors are CD31, CD34 and antigen related to factor VII. Imagingtests should be performed to extension of the analysis, depthand distant metastases. The treatment, when possible, shouldbe surgical, and radiation therapy is reserved for the inopera-ble cases. The patient underwent neoadjuvant chemotherapyfor subsequent surgical resection of the lesion, with goodoutcome.

A196. Schwannoma with ear nose and throat atypicalmanifestations: case report and literature reviewCaroline Catherine Lacerda Elias, Pablo de Oliveira Lima,Mariana Azevedo Silva, Vanessa de Araújo Souza, Nicolau

Tavares Boechem, Alexandra Torres Cordeiro Lopes de SouzaHospital Federal de Bonsucesso

Introduction: The schwannoma is the most commonbenign tumor in the posterior cranial fossa. It grows slowlyand can remain asymptomatic until adulthood. Thebigger andyounger its appearance, the higher the growth rate andvarious symptoms: hearing loss, tinnitus, dizziness, paresthe-sia, diplopia, dysphonia, dysphagia or even mastoiditis andsubperiosteal abscess as in our case.

Objectives: To report a case of a schwannoma withatypical and invasive initial manifestation, making differentialdiagnosis with infectious lesions of the mastoid.

Resumed report: Male patient, 14 years old withmajor headache history developed inflammatory signs inthe left ear. Physical examination: normal otoscopy, normalfacial movements. Denies history of otorrhea. Performed acomputed tomography of ear and mastoid that showed ex-tensive lesion with soft tissue density occupying the leftmastoid with bone destruction and exposure of the tegmentimpani. Audiometry with mild conductive hearing loss in theleft ear. He was hospitalized and treated with intravenousantibiotics and drainage of the abscess. After ENT evaluation,underwent emergency mastoidectomywith infiltrative tissuebiopsy in mastoid and histopathological diagnosis of schwan-noma. Actually asymptomatic, in attendance with conductingnuclear magnetic resonance of cerebellar angle point ofcontrol.

Conclusion: The schwannoma is a benign tumor thatusually presents with symptoms of hearing loss, tinnitus orvertigo according to their growth and compression of adjacentstructures. However, the otorhinolaryngologist should beaware of its possible growth towards the mastoid, hinderingdrainage of secretions and initial presentationwith coalescentmastoiditis and subperiosteal abscess secondary to itsprogression.

A131. Septal Abscess in Immunocompromised Patient: CaseReportMilene Lopes Frota, Gustavo Figueiredo Nunes Rabelo, Brunode Castro, Mirian Cabral Moreira de Castro, Natanael Alves deSouzaSanta Casa de Belo Horizonte

Introduction: septal abscess is defined as a collectionof pus between the cartilaginous or bony septum and itscorresponding mucoperichondrium or mucoperiosteum. Na-sal trauma is the most often cause. Other less common causesare sinusopathy, dental infection, furunculosis and surgicalprocedures. Non-traumatic septal abscess is mainly reportedin immunocompromised patients. Nasal obstruction is themost common symptom of septal abscess, but local pain,headache and fever also can occur. The diagnosis is performedby clinical examination, being found uni- or bilateral edema inthe septum, narrowing the nasal cavity. Treatment is theimmediate abscess drainage followed by antibiotic therapyto prevent orbital and intracranial complications and nasaldeformities.

Objective: To present a case of spontaneous septalabscess in immunocompromised patient.

Resumed report: Male patient, 45, with a history ofhaving undergone the allogeneic bone marrow transplanta-tion because of acutemyeloid leukemia, had nasal obstructionwith progressive worsening for two months, associated withfever lasting one week. In the anamnesis he denied nasaltrauma. On examination we could see important bilateralbulging in the nasal septum, floating and mobile to palpation.Abscess drainage was performed by puncture in the septum

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and it was prescribedAmoxicillin-clavulanate. Patient showedimprovement of symptoms, but evolved with a saddle-nosedeformity.

Conclusion: Septal abscess is a condition requiringimmediate treatment in order to avoid severe complications.Drainage is the gold standard treatment, followed by septalreconstruction in cases of deformities.

A349. Septal Abscess Intranasal Foreign BodyAlessandra de Oliveira Brandão Pinheiro, Manayra LourenzoCunha Carvalho, Paula Lourençato, Gustavo Pegos RodriguesCoy, José Eduardo Faria Martins, Silvio Antonio MonteiroMaroneHospital e Maternidade Celso Pierro - Puccampinas

Introduction: Intranasal foreign body is a commomfinding in pediatric emergency, with highest incidence be-tween 0 to 4 years of age, mainly in males, its complicationsare rare, the most common are epistaxis, followed by nasalvestibulitis and tissue necrosis. Reports of nasal septumabscess as a complication of foreign body are rare.

Objectives: Report a rare case of nasal septum abscessas a complication of intranasal foreign body.

Resumed Report: GASX, 8 years old, male, 25 dayswith mass in both nasal passages, purulent rhinorrhea, epi-staxis, face’s swelling and pain. Rhinoscopy: pink mass, soft-ened and bulged in the septum, obstructing both nasalcavities, impossibilitating nasal endoscopy. The nasal dorsumpalpation evidenced absence of septal cartilage, saddle nose.CT sacan of paranasal sinuses: limited damage of nasal sep-tum, with hypodense central area and peripheral enhance-ment. Probable diagnosis: nasoangiofibroma. During theexcision purulent secretion and foreign bodies (beans) cameout of the lesion. Nasal reconstruction was programmed inanother surgical time.

Conclusion: Intranasal foreign body starts with puru-lent rhinorrhea and unilateral smell, sometimes unilateralnasal obstruction and epistaxis, however it can be asymptom-atic with higher risk of complications and difficulty in diag-nosis, evenwith rhinoscopy, nasal endoscopy and radiologicalexams help, and it can be misdiagnosed as nasal tumors, as ihhas heppened in our report.

Keywords: foreign; body; nasal; abscess; septum

A71. Septic Thrombosis of the Sigmoid Sinus: A Case ReportAlinne Santos Teixeira, Lorenna Firmino da Silva, RonaldoCarvalho Santos Júnior, Arlete Cristina Granizo Santos, ValériaMaria Prado BarretoUniversidade Federal de Sergipe

Introduction: Septic thrombosis of the sigmoid sinusis an intracranial complication of chronic otitis media that stillhas a high mortality.

Objective: Report a case of sigmoid sinus thrombosissecondary to chronic otitis media with cholesteatoma.

Resumed report: GFS 31anos, presented otorrhearight from childhood with numerous treatments withoutsuccess. 2 years ago evolved with oppressive pain in her righthemi face accompanied by paresthesia. No signs of facialparalysis. Otoscopy reddish lesion on (polypoid?) In theexternal auditory canal and otorrhea. Requested temporalbone CT scan with contrast showed erosion of ossicular chainand spur Chaussé well as obliteration of epitympanic lateralrecess right. Erosion of the inner wall of the process aftermastoid determining continuity with the adjacent sigmoidsinus thrombosis and the jugular bulb and the right willsigmoid sinus. Requested intracranial magnetic resonance

angiography with findings consistent with thrombosis ofthe sigmoid sinus mainly jugular bulb and small distal seg-ment of the right internal jugular vein by otomastoiditis withmeningeal dural involvement in the posterior fossa andtemporal lobe rights. Underwent radical mastoidectomy rightwith removal of the lesion. Started anticoagulant therapy after30 days of surgery with clinical improvement. Control An-giorresonância showed thrombosis with partial recanaliza-tion signals in the proximal portion of the internal jugularvein, jugular bulb and sigmoid sinus.

Conclusion: The average chronic otitis cholesteatom-atous require early treatment because of the potential forserious complications.

Keywords: complications, mastoiditis, otitis media,intracranial sinus thrombosis

A124. Wallenberg Syndrome: Case ReportPablo de Oliveira Lima, Caroline Catherine Lacerda Elias,Alexandra Torres Cordeiro Lopes de Souza, Nicolau TavaresBoechem, Vanessa de Araújo Souza, Mariana Azevedo SilvaHospital Federal de Bonsucesso

Introduction: Vertigo spells are classified as periph-eral when the labyrinthine origin and VIII cranial nerve, andcentral. The basilar stroke is a difficult entity to be recognizedby semiological data. The lateral infarction bulb producesWallenberg’s syndrome, which is the dorsolateral region ofischemia of the spinal cord, and is most often due to occlusionof the proximal vertebral artery.

Objective: To describe the importance of semioticexamination in patients with vertigo frame.

Resumed report: JGS, 46, valued at emergency roomwith rotational vertigo, nausea and vomiting, and abruptonset of dysphonia diagnosed with "labyrinthitis" less than24 hours and was discharged after medication and referred tothe ENT specialist. It is treated in this service after a month ofonset with improvement of nausea and vomiting, dizzinessand keeping dysphonia. ENT examination showed paralysis ofthe right vocal fold, horizontal-rotational spontaneous nys-tagmus, ataxic gait, medium-fixed pupils and little photo-reactive. Raised Stroke as diagnosis, the CTscan showed a littleobvious right vertebral artery, and the MRI lesion on the rightside and rear of thebulb, indicative of vascular insult sequel. Atthe time with little improvement of dysphonia and dizziness.

Conclusion: Differentiation in the peripheral framesof plants is essential in the treatment and prognosis, it isimportant for the general practitioner and the specialist havea high index of suspicion and the expertise to diagnoseWallenberg syndrome and its variants.

A587. Squamous Cell Carcinoma Of The External AuditoryMeatus: A Report CaseMaria Eugenia Pedruzzi Dalmaschio, Júlia da Silva Almeida,Flavia Vieira Dias, Edna Patricia Charry Ramirez, Larissa MariaAlencar XerezHospital Universitário Antonio Pedro - Universidade FederalFluminense

Introduction: External auditory meatus cancers areextremely rare, representing less than 0,2% of head and necktumors. Squamous cell carcinoma is themost common type toaffect the region. It occurs between the 5th and 6th decades,often in women.

Objective: The objective of this study is to describe acase of squamous cell carcinoma of the external auditorymeatus in a male with a story of right otorrhea withouthclinical improvement.

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Resumed report: A 59 year-old male reports long-standing right ear otorrhea, worse for a few months, associat-ed with otalgia and itching. No associated diseases. Smoker of40 pack-years. Presents swelling of the external auditorymeatus and purulent otorrhea with enlarged and painfulretroauricular lymph nodes. Treated with amoxiciline-clavu-lanate for 14 days, with no improvement. Skin biopsy of themeatus revealed moderately differentiated squamous cellcarcinoma. Mastoid tomography and magnetic resonanceshowed thickening of the external auditory meatus andexpressive reduction of its air space. The tumor was removed,aswell as the parothyd gland and neck levels 2 and 3, followedby 10 days of endovenous amoxiciline-clavulanate. The pa-tient presented with grade III House-Brackmann facial paral-ysis. The operatory wound has healed well and the patient isundergoing radiotherapy.

Conclusion: Squamous cell carcinoma of the externalauditory meatus is a rare condition of difficult diagnosis. Thetreatment is surgical removal of the tumor with assessment ofnearby sctructures. In certain cases, radiotherapy is indicatedas an adjuvant, eliminating areas of remaining cancer cells,thus lowering the risk of recurrence.

A630. Subjective Sleep Assessment Of Truck Drivers In Pará,BrazilJessica Ramos Tavares, Fabrício Leocadio Rodrigues de Sousa,Guilherme Silva Machado, Erika Baptista Luiz Badarane,Giovanni Vielmond Borges da Silva, Jussandra CardosoRodriguesHospital Universitário Bettina Ferro de Souza / Universidade Federal doPará

Introduction: In Brazil, professional truck drivershave irregular working hours and often reverse the sleep-wake cycle, leading to partial sleep deprivation chronically.This situation predisposes to higher levels of daytime sleepi-ness and increase the risk of accidents.

Objective: Subjective sleep assessment of truck driv-ers in Pará, Brazil.

Methods: Observational, cross-sectional study withapplication of the Epworth Sleepiness Scale, sleep self-assess-ment and epidemiological questionnaire to 400 of Pará truckdrivers during the program "Health Command on the High-ways" of the Brazil Federal Highway Police in 2013 and 2014.

Results: The average daily sleep time was 7.83 � 1.59[3-12]. 65.5% considered the optimal sleep; 30.75%, reason-able; and 3.75% bad. The average of Epworth Sleepiness Scalewas 4.51 � 3.17 [0-16] and its evaluation revealed that 79.75%had normal patterns of daytime sleepness [0-6], 12% hadborderline values [7-9] and 8.25% had some degree of daytimesleepiness [â‰¥10]. There was no significant statistical rela-tionship between subjective sleep assessment and the Ep-worth Sleepiness Scale (X2 / p ¼ 0.1157). The average ofworking hours per day was 10.8 � 2.90 [2-24]. 22% reportedinvolvement in traffic accidents. 16.5% were carrying danger-ous goods.

Conclusion: When asked about the quality of sleep,65.5% considered it as great, despite the Epworth SleepinessScale reveal 12% of borderline score and 8.25% some degree ofdaytime sleepiness. Therefore, the subjective assessment ofsleep quality shown not effective in the diagnosis of sleepdisorders in this population and should be complemented bytargeted protocols and clinical evaluation.

A175. Sudden DeafnessCamila Nogueira Merlo, EronMosciati, Igor Guerra Guimarães,Tacito Elias SgorlonNucleo de Otorrinolaringologia de Ribeirao Preto

Introduction: Sudden deafness is defined as a hearingloss of at least 30dB in three contiguous frequencies andinstalled within 72 hours. It affects between 5 to 20 casesper 100,000 inhabitants per year, mostly among the over-45s.It is usually unilateral, associated with aural fullness, tinnitus,sensation of hearing and vestibular complaints distortion.

Objectives: More than 80% of cases does not havedefined etiology, signed between the causes are circulatory /hematological, autoimmune and viral infection.

Resumed Report: Patient 42, female, has been pre-sented there 85 hours hearing loss, tinnitus and aural fullnessleft, confirmed by audiometry.

Conclusion: Although 25-50% of patients have spon-taneous recovery of hearing thresholds, there is clinical evi-dence that sudden deafness should be treated early.

A174. Superior Semicircular Canal DehiscenceCamila Nogueira Merlo, EronMosciati, Igor Guerra Guimarães,Marcela Estrela TavaresNucleo de Otorrinolaringologia de Ribeirao Preto

Introduction: The superior semicircular canal dehis-cence syndrome is a rare disease and was first described in1998 by Minor. It is characterized by a failure in the bonecovering on the upper portion of the canal, initiating vestibu-lar symptoms induced by sound stimulations.

Objectives: The pathogenesis of this anatomical alter-ation is still unknown although it is likely to be a geneticmutation, which brings up symptoms in adulthood. It isestimated a prevalence of 0.7 to 1.3% in the general popula-tion. The diagnosis is confirmed by a high resolution comput-ed tomography of the temporal bone. The surgical orconservative treatment is conditioned by the intensity ofsymptoms.

Resumed Report: Patient JLS, 50 years old, male,presenting some dizziness and ear fullness when exposed toloud sounds. The audiometry was done under conductivehearing loss, up to 2kHz from the left side. He was diagnosedwith superior semicircular canal dehiscence by a digital eartomography.

Conclusion: Despite of being considered a rare alter-ation with several aspects still unknown, the syndrome of thesuperior semicircular canal dehiscence must be includedamong the several causes of dizziness. It is considered atreatable dehiscence and in the case of a clinical suspicion,it has the advantage of at least avoiding inappropriate diag-nostic or therapeutic approaches.

A10. Supernumerary Tooth in Nasal FossaIvana de Rezende Bastos, Maria Luiza Coelho Pinto TorresDoctor’s Office

Resumed report: Patient, female, 24 years with crustsremoval report and epistaxis 2 months of intermittent char-acter. Clinical examination of anterior rhinoscopy

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complemented by videonasoscopia with rigid endoscope 30°,shows the presence of granular aspect of fabric yellowing,with crusting and granulation tissue at the base, hardened tothe touch in the left nostril floor. CT scan showed the presenceof a supernumerary toothmorphology incisive in the left nasalcavity floor implanted in the jaw and adjacent mucosalthickening in the maxillary sinuses. Note that the tooth isinverted in relation to all of the upper dental arch. The patientwas referred for surgical treatment of ENT and Maxillofacialteam.

A190. Surgical Treatment of Cholesteatoma of ExternalAuditory Canal - Case ReportDavid Albuquerque Mourão, Ana Luiza Costa Lage, CelsoGonçalves Becker, Estefane Costa Loureiro, Lucas Sol da Costa,Flávia Oliveira BallesterosNúcleo de Otorrino Belo Horizonte

Introduction: Cholesteatoma of External AuditoryCanal (CEAC) is uncommon, affecting especially elderly peo-ple. Its evolution is slow and little symptomatic, these mayresult in a delayed diagnosis, with progressive bone destruc-tion and involvement of adjacent structures.

Objectives: To report a case of CEAC showing one of itscomplications and to describe the surgical technique used forresolution.

Resumed report: MAMF, 60, male, complaining dis-comfort in right ear for 50 days associated with autophoniaand hearing loss. Topical and systemic antibiotics showed noimprovement. Otoscopy revealed crust stuck in the posteriorregion of the right External Auditory Canal (EAC). Pure ToneAudiometry revealed mild conductive hearing loss on theright and Computed Tomography (CT) showed posteriorwall erosion of EAC with involvement of mastoid cells in theneighborhood and mastoid antrum. Performed conservativeright mastoidectomy with removal in block of cortical bone,drilling, complete removal and proper cleaning of the borderpreviously eroded by the disease. The removed cortical bonewas remodeled sealing the erosion area in the wall of the EACand covered with superficial temporal fascia graft.

Conclusion: CEAC should be regarded in cases ofchronic ear complaintswithout tympanicmembrane changes.Patients should undergo CT of Mastoid to assess the extent ofthe injury and the involvement of adjacent structures. Surgicaltreatment should aim to eradicate the disease and to seal thebone erosion and prevent recurrence with epithelial invagi-nation. The reconstruction of the bone wall of the EAC allowstreatment with hearing preservation.

Keywords: cholesteatoma; auditory; canal

A594. The Association Of Laryngoceles With Squamous CellCarcinoma Of The Larynx: A Case reportFlavia Vieira Dias, Júlia da Silva Almeida, Edna Patricia CharryRamirez, Maria Eugenia Pedruzzi Dalmaschio, Larissa MariaAlencar XerezHospital Universitário Antonio Pedro - Universidade FederalFluminense

Introduction: Laryngocele is an unusual disease de-fined as an anomalous dilation of the laryngeal ventricles. Itcan be internal or external and usually occurs inwhite men inthe 5th or 6th decade. Most cases are unilateral. Its cause isunknown, but the disease is associated with chronic cough,woodwinds and laryngeal carcinoma. Common symptoms aredysphonia, foreign body sensation, sore throat and cough, andin some cases cause obstruction of the upper airways. The

diagnosis is made by laryngoscopy and computerized tomog-raphy. Treatment can be surgical or expectant.

Objective: To present a case of laryngocele secondaryto squamous cell carcinoma.

Resumed report: 57 year-old white man, admitted toHospital Universitário Antonio Pedro for facial cellulitis. Hewas evaluated by theOtorhinolaryngologydepartment, due tointermittent dysphonia and dry cough. Former alcoholic andformer smoker (80 pack-years). Videolaryngoscopy: pedun-culated tumor in the right ventricle of Morgagni. Computer-ized tomogtaphy of the neck showed an infiltrative lesion inthe paraglottic region, vocal and vestibular folds to the right.After excision of the tumor, the right vocal fold presentedwithan infiltrative lesion, being submitted to biopsy. The reportshowed "squamous cell carcinoma predominantly in situ withminimal focus of invasion." Specific treatment was made.

Conclusion: Laryngocele is a benign disease, but canbe caused by a malignant tumor such as squamous cellcarcinoma which is the main subtype of laryngeal cancerand requires early treatment, demonstrating the need forthorough investigation, especially when there are risk factorssuch as alcoholism and smoking.

A24. The Key To An Effective Approach In The Treatment Of"Vestibular Rehabilitation" Promoting GenuineRehabilitation Of Vestibular Diseases Of The FrameCarlos Augusto Ferreira de Araujo, Avenilda de Azevedo SilvaFaculdade de Medicina de Petrópolis

Introduction: dizziness are signs of change bodybalance , which is maintained by the functional interactionbetween the maze , eyes , skin receptors, muscles, joints andcentral nervous system. The conflict in the integration ofinformation from these bodies promote dizziness and othersymptoms. The causes can be many : peripheral , central andmixed. In our research we are working with a group ofcomplaining of dizziness. Our differential to achieve successare ESM - systematic exercises and monitoring.

Objectives: Provide an effective treatment from diag-nosis , recovery of confidence ... improve your vertigo individ-ually. Focusing on the achievement corretado year; providingeffective rehabilitation.

Methods: The group was evaluated and diagnosed asvestibular , with cervical spine changes. Are seamstresses(adopt erroneous systematic positions). The process of reha-bilitation and monitoring of the group is being carried outindividually and systematically. Their ages vary between 19and 30 years.

Results: Of the 32 womenwho underwent the Vestib-ular rehabilitation for ESM with cervical abnormalitiesshowed significant improvements without recurrence. Theseexercises conducted in accordancewith the guidance and nowafter 10 months continue with the exercises (smoother), nocomplaints as initials. Three people in this group showimprovements and relapses and continue with themedication.

Keywords: vestibular, dizziness, vestibular rehabilita-tion, changes of the cervical spine

A674. The Role Of The Otorhinolaryngologist In TheManagement Of Subcutaneous Emphysema Secondary ToDental ProcedureRenata Cristina Cordeiro Diniz Oliveira, Helena Cunha Sarubi,Danielly Solar AndradeOliveira, EmidioOliveira Teixeira, SânzioTupinambá ValleHospital Socor

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Introduction: Subcutaneous emphysema as a compli-cation of a dental procedure is uncommon. Even though suchcomplications are more commonly seen by dental and oro-maxillofacial surgeons, otolaryngologists should be aware ofthis condition since we are often asked to consult in thesecases. Management in most cases involves close observationwhile awaiting spontaneous resolution. However, in somecases the emphysema can progress to serious complicationsand even death.

Objectives: Our aim is to describe a case of an exten-sive subcutaneous emphysema secondary to a dental proce-dure and review the clinical presentation,diagnostic workup,and management of this complication.Resumed Report: Wereport the case of a 61-year-old man who presented to theemergency department of our institution with an unusuallydramatic acute-onset cervicofacial swelling after he had un-dergone a dental procedure earlier in the day. Physical exami-nation and computed tomography revealed extensive leftcervicofacial subcutaneous emphysema,extending to masti-catory, parapharyngeal and danger spaces. The patient wasadmitted to the hospital for close observation, analgesia andantibiotic prophylaxis. Within 48 hours his condition hadimproved significantly.

Conclusion: Early recognition of this conditionmay beof extreme importance in initiating treatment and to preventpossible secondary infections and cardiopulmonarycomplications.

Keywords: Subcutaneous emphysema, cervicofacialemphysema, dental treatment, complications

A16. Tinnitus Therapy Through Telemedicine (T4)Ricardo Ferreira Bento, Silvio Pires PenteadoFaculty Of Medicine University Of Sao Paulo

Introduction: The idea behind Telemedicine in theENT and Audiology fields combined is to supply to under-served areas the ability to promote screening (remote audi-ometry and video-otoscopy), diagnosis (intraoperativemonitoring and auditory balance response), intervention(hearing aids and cochlear implants fitting), and patientsperceptions (questionnaires, forums). Tinnitus-sufferershave few choices but Cognitive Behavior Therapy (CBT) andAcceptance and Commitment Therapy (ACT) as describedresearchers in Sweden. While the former relies virtuallyexclusively on text-based material, the latter makes use ofmore experimental exercises (mindfulness exercises), andmore picture-based material. Both treatments are in theform of guided internet-delivered self-help, also with use ofmanuals and supportive on-line health professional.

Objective: Introduce a tinnitus therapy through inter-net based on sound therapy with or without sound amplifica-tion delivered through BTE hearing aids (aids).

Materials and Methods: Backed by Fundação Otorri-nolaringologia researchers designed aids with sound therapybuilt in, so it can deliver amplification (hearing rehab), soundtherapy (tinnitus), or both. Through the Internet with freeapps one can support tinnitus-sufferer with online audio andvideo streaming counselling, also can adjust aids themselvesto promote relieve and comfort.

Results: The novelty relies on adjusting theirs soundgenerators through the internet when tinnitus-sufferers needto. It was not ever done before.

Conclusion: Aids with sound generator built in ad-justed through the Internet promises to deliver a new therapyno matter where the tinnitus-sufferer dwell.

Keywords:Hearing aids, patient satisfaction, telemed-icine, tinnitus, technological development and innovationprojects

A88. Tomographical Findings In Adult Patients UndergoingRevision Endoscopic Sinus SurgeryJonas Mello, Barbara Batista Baltha, Jan Alessandro SocherUniversidade Regional de Blumenau

Introduction: Many patients undergoing functionalendoscopic sinus surgery still have uncontrolled clinical dis-ease in the late post-operative period. Studies show that up to11.4% of the patients will require a revision surgery.

Objectives: To describe the tomographical findings ofadult patients undergoing revision endoscopic sinus surgery.To describe the profile of those patients. To verify the mucosalthickening level of the paranasal sinus using the score of Lund-Mackay.

Methods: Data were collected from medical recordsand computed tomography reports of 28 patients undergoingrevision sinus surgery on a private service in Blumenau-SCbetween 2007 and 2014. The score of Lund-Mackay was usedto verify mucosal thickening level.

Results: Among the 28 patients, 23 were re-operatedonce, 3 were re-operated twice, and 2 were re-operated threetimes. The most relevant findings were mucosal thickening ofthe maxillary sinus (89.28%), deviated septum (75%), thicken-ing of the ethmoid (50%) and esfenoidal sinus (39.28%)pneumatization of themiddle turbinate (39.28%), frontal sinusthickening (28.57%), lateralization of the middle turbinate(10,71%), residual uncinated process (7,14%) and Haller cells(7,14%). The average obtained in Lund-Mackay scorewas 5.71,with most patients classified in the lower range ofpunctuation.

Conclusion: The analysis of computed tomographyscan showed persistent structures that may be responsible forprimary surgery failure. Computed tomography is a useful toolto plan the surgery and to quantify the post-operative success.

Keywords: Revision endoscopic sinus surgery, Func-tional endoscopic sinus surgery, Chronic rhinosinusitis, Tomo-graphical findings, Lund-Mackay score

A191. Traumatic Cerabral Spinal Fluid Otorrhea: A CaseReportSamantha Fernandez de Castro, Tainã Crestani Mistura, LucieleStochero, Joel Lavinsky, Rodrigo André Soccol, Rafaela SantimReginattoSanta Casa de Misericórdia de Porto Alegre

Introduction: Ear and nose leakage can be identifiedby the presence of cerebrospinal fluid inside the ear canal andthe nasal cavity. This condition is associated with a higher riskof developingmeningitis. The otorrhinolaringologist is crucialin diagnosis and treatment of this life threatning condition inorder to prevent meningeal infection and its complication.

Objective: To present a case of CSF (cerebral spinalfluid) leakage resulting in otorrhea and rhinorrhea.

Resumed report: A 52 year man with a history oftraumatic head injury 2 years-ago presented with headache,rinorrhea, hipoacusia and sense of fullness in left ear. Atotoscopy left ear effusion could be noted and a deviatedseptum, nasal polyps and clear rinorrhea could be seen atrinoscopy. Facial sinus CT evidenced polyposis and deviatedseptum. The patient was submitted to septoplasty and tym-panotomy with myringotomy tube insertion in left eardrum.

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He developed persistent clear otorrhea and headache later inthat admission. Cisternotomography showed communicationbetween endocraneum and epitympanum. The patient devel-oped signs ofmeningoradicular irritation and a infected CSF atlumbar punction. The patient was treated with antibioticssystemic and topic, without complete recovery. It was per-formed a combined approach (transmastoid andmiddle fossa)to close the defect using fascia, glue and bone wax.

Conclusion: CSF otorrhea is an uncommon complica-tion of head injuries (surgical or traumatic). Its most dreadedcomplication is central nervous system infection. Persistentcerebral spinal fluid must be avaluated to discard a possiblefistula and decide for surgical treatment.

A597. Tuberculosis of the Middle Ear: A Case ReportVanessa de Araújo Souza, Eliana Freitas Cardoso, AlexandraTorres Cordeiro Lopes de Souza, Caroline Catherine LacerdaElias, Pablo de Oliveira Lima, Mariana Azevedo SilvaHospital Federal de Bonsucesso

Introduction: Tuberculosis is one of the major infec-tious diseases with predominant involvement of lung andlymphnodes, but tuberculosis of themiddle ear is uncommon.

Objectives: This case report aims to emphasize thisimportant cause of chronic otitis media refractory to usualmedical treatment. The diagnosis can often become a chal-lenge because there are no specific clinical features thatindicate tuberculosis as the etiological nature of the middleear disease.

Resumed Report: The patient is a 64 year-old, female,with a history of intermittent otorrhea from her left ear andbilateral hearing loss, worse on the left side,for about ninemonths. She referred the use of quinolone antibiotics admin-istered topically and orally, with no improvement. She hadmedical history of pulmonary tuberculosis. Otoscopy revealedleft tympanic membrane with a large perforation, and thickotorrhea; the right side did not show significant changes. Afterevaluation of hearing losswith audiometry,a temporal bone ctscan showed anatomic impairment of middle ear andmastoidcells secondary to chronic inflammation, and bacteriologicalstudies were negative for bacterial growth.The diagnosis ofmiddle ear tuberculosis was confirmed with the promptclinical response to the usual therapeutic scheme for tuber-culosis,with cessation of otorrhea and partial improvement ofleft sided hearing loss.

Conclusion:Middle ear tuberculosis should always beconsidered in differential diagnosis of chronic middle earinlammatory disease that does not respond to usualtreatment.

A303. Turbinate Bone And Ear Resconstruction, Is ItPossible?Adriano Sergio Freire Meira, Christiane Kulzer Birck, YuriFerreira Maia, Junior Alvaro Vitorino de Pontes, Nelson JoseBarboza Quintino, Thaís Eugênio GomesSos Otorrino

Introduction: Many techniques have been used inreconstruction of the ossicular chain , prostheses , use of themiddle ear bones with variable results in gap resolution.

Objectives: The Aim of this summary is to describe anew material that can be used under surgery by a differentapproach, endoscopic.

Resumed Report: Female patient of 19 years withconductive hearing loss presenting gap greater than 30dB ,had secondary loss by slap received from her boyfriend , hasperforated tympanicmembranewith around 70 % of area, she

had nose obstruction and turbinectomy was done. The sur-gery was done by endoscopic tympanoplasty approach andthe use of turbinate bone, and biological glue as material fordisjunction reconstruction were performed under the sameendoscopic approach. Turbinate bone was treated and assem-bled to fit in articulationwith the placement of biological glueand then repairing the ossicular movement.

Conclusion: Two months after surgery the patient,had full reparation of the tympanic membrane and audiome-try examination was performed and revealed the completeclosure of the gap and normal hearing. We believe that thischeap and secure way can be used as a new way to do it.

A105. Tympanic Glomus - Case ReportPilar Campos Saavedra, Lucas Sieburger Zarro, Aline AraujoSaraiva, PauloTinoco, Marina Bandoli de Oliveira Tinoco, SauloBandoli de Oliveira TinocoHospital São José do Avaí

Introduction: Glomus tumors are the most commonbenign tumor of the middle ear. They are highly vascularizedand originate from glomus bodies located in the temporalbone. May occur elsewhere in the head and neck, getting thesite name that occurs. Glomus tumors rarely suffer malignant,however, can cause bone erosion. The most frequently associ-ated symptoms are pulsating tinnitus and hearing loss, andothers may arise from the site of involvement and or expan-sion. Diagnosis ismadeby imaging studies such as CT andMRI.How are bleeding tumors, preoperative angiography andembolization may be required. The tumor is treatable bysurgery. Radiotherapy is only a adjuvant treatment.

Objectives: Report a case of glomus tympanic oc-curred at our hospital.

Resumed report: GMP, 43 years. Complains of pulsa-tile tinnitus inmy left ear for 01 years. Denies hearing loss and/ or other symptoms. Otoscopy: retrotympanic reddish mass.TC: small nodulemeasuring 3 � 2mmwith soft tissue densityadjacent to the left cochlear promontory in mesotympanumcompatible with glomus tympanic.

Conclusion: Patient is currently awaiting surgicalapproach.

A82. Upper Respiratory Infections in patients with CysticFibrosis – Case SeriesBianca da Silva Vinagre Nascimento, Thais Sampaio Silva,Tassia Milenna Oliveira de Souza, Clara Monica Figueiredo deLima, Edna Lucia Santos de Souza, Marcus Miranda LessaFederal University Of Bahia

Introduction: Physiologic conditions of the respirato-ry tract are modified in patients with cystic fibrosis and itcontributes to recurrent upper respiratory infections.

Objective: To determine the incidence of upper respi-ratory infection during 2014 in patients with cystic fibrosisfrom a reference center in Brazilian northeast

Methods: Descriptive study of a case series, withrecords collection about frequency of upper respiratory in-fections during 2014 and the period of dornase alfa. Inclusioncriteria were the previous diagnosis of cystic fibrosis.

Results: It was collected data of 21 patients, 52,4%female. Mean agewas 11 years (� 4,62). Themean frequencyof upper respiratory infections was 1,09 � 1,04 per year.Among these patients, 61,9%were using dornase alfa. It wasn’tfound data about this drug using in 5 patients records. Andamong those who were not using (3), 2 patients (66,7%)presented 1 upper respiratory infection episode.

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Conclusion: Frequency of Upper Respiratory Infectionin children is 6 to 8 per year, according to Brazilian studies. Theadvances on cystic fibrosis treatment can be a possibility toexplain the similar frequency of upper respiratory infectionamong these patients and the general pediatric population.

Keywords: Cystic fibrosis, Upper Respiratoryinfections

A462. Vagal Paraganglioma - Case Report And LiteratureReviewLaura Schwartz Maranho, Vinicius Ribas Fonseca, GustavoFerreira BernardiHospital da Cruz Vermelha - Filial do Paraná

Introduction: paragangliomas (PG) are rare tumors,highly vascularized, which oiginate in derived neural crestcells associatedwith the autonomic nervous system. The vagalPG are neoplasms that account for less than 2.5% of all PG headand neck.

Objectives: to report a case of vagal paragangliomawith preoperative embolization, followed by surgical excision.Having a complication dysphonia due to paralysis of the leftvocal fold, and subsequente medicalization through thyro-plasty type 1 Isshiki.

Resumed report: 54, male, sought Oncology servisebecause of the left cervical tumor on the medial side of thesternocleidomastoidmuscle, no other complaints. On physicalexamination, tumor of soft and elastic consistency, painless,measuring about 05 cm. The first hypothesis was vagal para-ganglioma. Preoperatiove embolization was performed. An-giographic control showed deleting almost the entire lesion.Tha pathology confirmed the diagnosis of vagal paragan-glioma. After 20 days of surgery, presented dysphonia com-plaints, choking, hoarse voise/breathy moderate to severe.Videolaryngoscopy diagnosed left vocal fold paralysis. Afterspeech therapy right vocal fold has reached the limit in termsof coaptation, decided to have thyroplasty type 1 Isshiki. Afterone month, the patients presents clear and satisfactory voice.

Conclusion: in paraganglioma, the treatment is surgi-cal and may needed preoperative embolization. Among thesurgical complications, nerve injuries are the most common(40% of cases). If there is a complication unilateral vocal foldparalysis, type I thyroplasty become the procedure of choice.

A585. Vestibular Evoked Myogenic Potential, Video HeadImpulse Test and Nystagmography: Diagnosis, Prognosisand Evolution of the Superior Vestibular Neuritis - CaseStudyPedro Luis Coser, Valdete Alves Valentins dos Santos Filha,Luciele da Silva Prates, Thalisson Francisco Finamor da SilvaUniversidade Federal de Santa Maria

Introduction: The diagnosis of Vestibular Neuritis(NV) Acute requires objective findings, indicating completeor partial unilateral loss of vestibular function2 and, usually,affects the Superior Vestibular Nerve (SVN) more severelythan inferior fibers branch1.

Objetives: To present the NV progress during 45 daysthrough Nystagmography, Video Head Impulse Test (vHIT)and Ocular and Cervical Vestibular Evoked Myogenic Poten-tials (oVEMP and cVEMP).

Resumed Report: Female, 32 years old, with suddendizziness, constant nausea and imbalance, evaluated by thetests mentioned above, at the first few hours, 4th Day, 8th dayand 45th day after the onset of symptoms. Thefirst evaluation:Nystagmography with presence of spontaneous nystagmus toleft (eyes closed), Rotatory Chair Test (RCT) with directional

predominance (100%) to right and right Labyrinthine Predom-inance (LP) of 60% in caloric test, normal vHIT and VEMPs. 4thDay: vHIT Lateral and LeftAnterior Semicircular Canal (CSC)dysfunction, oVEMP absent to the left and normal cVEMP. 8thDay: normal vHIT and oVEMP present with increased latency.45th Day: no symptoms, tests normalized except caloric test,with Left Hyporeflexia and right LP (60%).

Conclusion: vHIT and VEMPs allow the differentialdiagnosis between Neuronitis of SNV, Inferior or both. Thenystagmography detected acute peripheral vestibular dys-function early, in few hours of symptoms, while vHIT andVEMPs were normal. The vHIT and oVEMP normalized withthe reduction of vestibular symptoms and caloric test per-sisted changedwith complete remission of symptoms and RCTnormalization.

Keywords: Vertigo, Vestibular Neuritis, Video HeadImpulse Test, Vestibular Evoked Myogenic Potential,Electronystagmography

A1721. Vestibular Rehabilitation With Virtual Reality InSpinocerebellar AtaxiaLaura Schwartz Maranho, Juliana Cristina Mesti, Vinicius RibasFonseca, Bianca Simone Zeigelboim, Helio Afonso GuizoniTeiveHospital da Cruz Vermelha

Introduction: The spinocerebellar ataxias (SCA) are aheterogeneous group of neurodegenerative diseases that arecharacterized by progressive cerebelar ataxia and their firstclinical manifestations are balance and coordination deterio-ration besides eye disorders.

Objective: To verify the benefits of the vestibularrehabilitation (VR)with virtual reality through the assessmentbefore and after the application of the Berg Balance Scale (BBS)in four cases of spinocerebellar ataxia (SCA).

Methods: The cases were underwent the followingprocedures: anamnesis, ear inspection, vestibular assessmentand application of the BBS before and after VR with virtualreality using games from Wii Fit device. The cases describesfour patients that were diagnosed with genetically inherited,three of them were female and one was male, with agesranging from 30 to 62 years.

Results: the patients presented otoneurological symp-toms and the vestibular test showed the presence of semi-spontaneous nystagmus, absence of post-rotational nystag-mus, hyporeflexia, and asymmetric directional preponder-ance of the nystagmus in the caloric test. Patients from cases 1and 2 have showed an improvement in motor coordinationand in body balance, even though the score presented by theBBShad demonstratedmedium risk for falling before and afterthe exercises. In case 3, the patient’s loss of balance and BBSscore have improved, presenting low risk of falling; whereasthe patient in case 4 did not show any improvement in theassessment after the exercises.

Conclusions: This case study shows the applicabilityof VR exercises withvirtual stimuli in SCA with improvedmotor coordination and postural balance.

A444. Vídeo Head Impulse Test in Pilots of BrazilianAeronautical: Preliminary ResultsNatalia Martinez Fernandes, Thalisson Francisco Finamor daSilva, Pedro Luis Coser, Valdete Alves Valentins dos Santos FilhaUniversidade Federal de Santa Maria

Introduction: Integrity of the Vestibulo-ocular Reflex(VOR) is essential for Pilots, as their career requires a func-tional vestibular system. Pressure changes during flight can

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initiate disturbances within the human body, therefore phys-iological dysfunction prevention is essential for labor activi-ties. The Video Head Impulse Test (vHIT) aims to assess theVOR via eye movement responses to head impulses, in turndetecting possiblemalfunctions of the six Semicircular Canals,independently.

Objective: Determine the parameters of vHIT re-sponses in Pilots from the Brazilian Aeronautical, located inSanta Maria - RS.

Methods: Eleven male pilots, aged 28-56 years wereevaluated. All underwent vHIT, computerized ICS Impulse,using goggle with high resolution and speed camera thatobtains eye movement response to head impulses in thelateral planes, RightAnterior-LeftPosterior (RALP) and Left-Anterior-RightPosterior (LARP). It was used as values of speed:

100-250°/sec for lateral impulses and 50-200°/sec for verticalimpulses.

Results: The mean values of gain for right and leftlateral CSC, right anterior, left posterior, left anterior and rightposterior were: 1, 0.95, 0.98, 0.94, 0.97, 0,92, respectively,witha standard deviation: 0.07, 0.05, 0.07, 0.09, 0.12, 0.096. Thesymmetry was 2% compared to the synergistic pairs (CSClaterals, RALP and LARP) of left and right ears, with a standarddeviation of 0.018, 0.028 and 0.035, respectively.

Conclusion: The vHIT contributes to technologicalupgrading, by the assessment of horizontal and vertical CSC.Evaluation of specific populations is necessary for early detec-tion of vestibular disorders.

Keywords: Neurotology, Vestibular Function Tests,Aerospace Medicine, Video Head Impulse Test

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Speech, Language and Hearing Sciences

A106. Accessibility of the Dangerous Decibels® EducationalProgramfor Low-VisionAndBlindAdolescents: Initial AssessLetícia Maria Malandrin da Silva, Keila Alessandra BaraldiKnobelUniversidade Estadual de Campinas

Introduction: Hearing is considered to be the mainsensory input for vision impaired persons when it relates tocommunication and to danger signs awareness. Nonetheless,to the best of our knowledge, there are no conservationprograms accessible for this population.

Objectives: To develop and to evaluate adjustments onthe Brazilian version of the Dangerous Decibels® that couldprovide accessibility for low-vision and blind adolescents.

Methods: Literature review and exploratory research.The only part of the Dangerous Decibels educational programthat needed adjustments were the “how do we hea” part. Forthe ear anatomy authors used a detailed 3x life size represen-tation of the ear (commercially available). Authors developedand constructed two different materials to explain the organof Corti, considering tactile and visual approaches that includethe use of texture and color contrast: (i) a 3D model madebasically with felt, polyester filling, false eyelashes and glue;and (ii) a high relief draw made with colored glue. Fiveadolescents (13 to 19 years old) with visual impairmentattended to an accessible Dangerous Decibels educationalprogram and were asked to judge the degree of accessibilityof the presented materials.

Results: All participants considered that they couldunderstand all the components of the Dangerous Decibelseducational program. Low-visionparticipants preferred visualresources other than the tactile ones.

Conclusion: Thoughminor, the adjustments related tothe presentation of the hearing system promoted the accessi-bility to vision impaired adolescents.

A683. Acoustic and Tactile-Kinaesthetic Analysis before andAfter Continues Speech Test In Healthy ElderlyYara Helena Rodrigues, Gleidy Vannesa Espitia Rojas, LílianNeto Aguiar RiczFaculdade de Medicina de Ribeirão Preto

Introduction: The process of aging of larynx, relatedto continuous use of voice, generate many questions, as thiscan trigger vocal fatigue, or if there is or not changes on self-perception auditory and tactile-kinaesthetic, and in the acous-tic measurement of voice individual signal.

Objective: Analysis and compare vocal acoustic mea-sure and self-perception tactile-kinaesthetic on elderly wom-enwithout vocalmodification before and after the continuousspeech test.

Method: There were twenty-one women with anaverage age of 70 years. An analysis was performed of vocalacoustic measure pre and after the continuous speech duringone hour, using MDVP-Adv KayPentax® software and self-evaluation perceptual-auditory and tactile-kinaesthetic mea-sure. The statistic analysis of data was realized according t-Student Test to quantitative paired data.

Results: On the self-evaluation perceptual-auditoryand tactile-kinaesthetic it showed significant differences afterprolonged use on the voice symptoms as hoarseness, drythroat feeling, breaks in the voice, difficulty speaking, highvoice, greater effort to speak, pain when swallowing saliva,moreweakly voice, tired to talk and need to cough or clear her

throat.Related to analysis of fundamental frequency of vocalacoustic measure (F0/Hz), phonation range F0 semitones(PFR), jitter (%), average relative perturbation (RAP /%), pitchperturbation quotient (PPQ /%), shim (%), quotient of distur-bance amplitude (APQ /%) , the amplitude variation (VAM /%)and harmonic-noise ratio (NHR / dB) did not have significantdifferences pre and after the test.

Conclusion: the increase of significance perception ofsymptoms concludes that, perhaps, acts as protective larynxacts, informing that the realized test is requiringmoreworkoflaryngeal intrinsic muscles.

A270. Acoustic Impedance Measurements Using DifferentTones Tests: Correlationwith the Findings of ElectroacousticExamsGabriela Roberta Coan, Maria Sarah Tristão Ferraz, MabelGonçalves Almeida, Aline Neves Pessoa-AlmeidaUniversidade Federal do Espírito Santo

Introduction: The early diagnosis of hearing lossinvolves the use of procedures which, when combined, canprovide an accurate diagnosis. Among these procedures, theacoustic impedance is awidely used tool in clinical practice inassessing middle ear abnormalities that can be used fordifferent frequency tones. However, in many cases, tympan-ometry alone does not provide sufficient information for adifferential diagnosis, it is used in conjunction with otherprocedures, such as otoacoustic emissions.

Objective: To describe results of immittance with testtones of 226 Hz, 678 Hz and 1000 Hz and compare thefindings of Transient Evoked Otoacoustic Emissions in adults.

Method: Adults of both genres were evaluated, agedfrom 19 to 58 years old and with normal hearing. All partic-ipants were submitted to the following procedures: audiom-etry, immittanciometry with test tones of 226 Hz, 678 Hz and1000 Hz and Transient Otoacoustic Evoked Emissions. De-scriptive analysis was compared according to the type of testtone, genre and ear. The results of the acoustic immittance foradmittance measurement were compared with the TransientOtoacoustic Evoked Emissions outcomes. The results of Tym-panometry and Transient Otoacoustic Evoked Emissions theywere compared, being established specificmeasures, negativepredictive value and accuracy.

Results: higher absolute values for admittance werefound for the 678 Hz curve. The admittance in 226 Hz wasmore specific and accurate.

Conclusion: the 226 Hz probe tone test showedhigher specificity and accuracy for the population studied,however, these results cannot be generalized.

Keywords:Hearing; Audiometry; Acoustic ImpedanceTests

A553. Acquisition of Initially Stabilized Phonemes in thePhonological System Compared to Phonological Disorder ofMedium Degree of Speech Intelligibility and AuditoryProcessing Altered in a Case ReportKariny Zencke da Silva, Laura dos Santos Abon Zahr, BrunaSantos Sant’Anna, Rayane Abreu do Nascimento, JulianneWagner, Letícia Pacheco RibasUniversidade Federal de Ciências da Saúde de Porto Alegre

Introduction: Many studies try to associate the Pho-nological Disorder with Auditory Processing. It is known thatalterations of certain phonemes may be associated withaltered skills in evaluating this in the typical acquisition ofphonological system.

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Objective: To report a case of a childwith PhonologicalDisorder with medium degree of speech intelligibility andAuditory Processing tests.

Resumed Report: Quantitative-descriptive study ap-proved by the CEP 995 344. From a Database with speechtherapy evaluations of children diagnosed with PhonologicalDisorder. It was used the following inclusion criteria: havingmedium degree of speech intelligibility, have not been stabi-lized at least one of the first phonemes to be acquired bychildren / p, b, t, d / and nasal, and have all Auditory Processingtests of the complete database: SSI (Synthetic Sentence Iden-tification), Digits Dichotic (DD), SSW (Staggered SpondaicWord), PPS (Pitch Pattern Sequence), MLD (Masking LevelDifference), RGDT (Randon Gap Detection Test) and GIN(Gaps In Noise). The only child with these criteria weremale, 9 years old, having stabilized the dorsal nasal in theirphonological system and still not having much of onsetcomplex. Auditory Processing tests that were altered are:MLD, DD, SSW and PPS.

Conclusion: Even childrenwith Phonological Disorderof medium degree of speech intelligibility may have initiallyacquired phonemes not stabilized. In the case reported,according to Auditory Processing, the child shows alterationsin interaction skills and binaural integration, directed atten-tion, recognition / identification and temporal sequencing.

Keywords: Phonological Disorder; Acquisition Lan-guage; Auditory Processing

A256. Analysis of Auditory Perception of Vocational CollegeStudentsLuciele da Silva Prates, Isabela Schroer Neis, Valdete AlvesValentins dos Santos Filha, Gicélia Barreto Nascimento, MaríliaTrevisan SonegoUniversidade Federal de Santa Maria

Introduction:Normal hearing, acoustic comfort in theclassrooms and in the laboratories are primary factors forsustained attention, storage of information, and therefore thelearning of students, which are exposed to noise in severalfields generators.

Objectives: To analyze the self-perception of studentsthat are in vocational college about the hearing itself, theenvironment the’re exposed to noise and the botheringcaused about noise also the auditory symptoms and extra-auditory.

Methods: It’s a descriptive study. The sample is about32 students, that are 56.25% women and 43.75% men, themean age is 26 years. The sample answered a questionnaireabout the auditory perception and issues related to noise.

Results: In relation to the auditory perception, 23(71.88%) of the sample reported that they have good hearingand nine (28.12%) a reasonable hearing. All pointed to workenvironmentwith somedegree of noise,with 45.71% referringnot to be bothering with noise exposure; 44.42% mentioned anuisance bothering an 9.87% are bothered by noise. Aboutcomplaints reported, 31.24% have tinnitus; 37.5% migraine;43.75% stress; 37.5% lack of attention; 21.88% fatigue; 12.4%anxiety and 6.25% dizziness, which are isolates or concomi-tant. In addition to this, 84.38% of the students reported theyhave knowledge about auditory and extra-auditory effectsinduced by exposure to noise.

Conclusion: The data from the self-perception of thevocational college students showed up significant to theunderstanding for the auditory characteristics, and the im-portance of the auditory and extra-auditory effects caused bythe noise.

A57. Analysis of Otoacoustic Emissions Responses and AbrLatencies in Infants with AsphyxiaGeorgea Espindola Ribeiro, Daniela Polo Camargo da Silva, JairCortez MontovaniFaculdade de Medicina de Botucatu

Introduction: The newborn hearing screening allowsto detect the hearing loss early in newborns, especially inthose with risk factors.

Objective: To investigate the effect of "low Apgarscore" (Apgar 0-4 in the first minute and / or less than 6 inthe fifth minute of life) and of the perinatal asphyxia in thetransient evoked otoacoustic emissions (TEOAE) and auditorybrainstem response (ABR) performance.

Method: The studywas conducted in a public hospital.The samplewas consisted of 181 infantswho had result "pass"in TEOAE andwith all ABR parameters. Theywere divided into3 groups: G1 with 20 infants who had perinatal asphyxia, G2with 111 infants with only "low Apgar score" at birth and G3with 50 infants who had Apgar score 1 and 5 minutes.

Results: The TEOAE amplitude in G3 showed highervalues when compared to G1 and G2 especially in the fre-quency of 4 kHz for males. No differences were found infemale infants. Also in male infants was observed increasedlatency of waves I and III bilaterally in the G1 group.

Conclusion: The TEOAE was reduced in infants whosuffered asphyxia or low Apgar and differences in ABR laten-cies show that these infants may have injuries not only incochlear outer hair cells but aswell as in the auditory pathway.

A317. Analysis of Outcome Indicator of Speech Therapy inTracheostomized Patients: Time Until DecannulationFlavia Monique Cardozo da Silva, Mariana Pinheiro BrendimUniversidade Federal do Rio de Janeiro

Introduction: Studies show that prolonged tracheos-tomy may favor several late complications, so the decannula-tion process is of great importance in the rehabilitation ofcritically ill patients.

Objectives: To analyze the outcome indicator ofspeech therapy - time until decannulation and the correlationbetween it and the clinical conditions of tracheostomy pa-tients in a university hospital.

Methods: Retrospective analysis of medical records ofhospitalized patients who underwent speech therapy be-tween March 2012 and October 2014. The variables analyzedwere: age, sex, underlying disease, number of speech therapysessions, speech therapy time, length of stay, time of trachealtube, tracheostomy time, respiratory support, nutritionalsupport, functional oral intake scale, severity of dysphagia,speech and language disorders and clinical complications.

Results: 34 patients were decannulated (18 womenand 16 men). The decannulation rate was 65.4%. The mediantime until decannulationwas 20 days (interquartile range: 10-31). Significant association was observed between the timeuntil decannulation and the variables: length of stay (r ¼ 0.6),tracheostomy time (r ¼ 0.6), number of speech therapy ses-sions (p ¼ 0:05) and time of speech therapy (p ¼ 0:05). Therewere significant differences between time of decannulationand respiratory disease (p ¼ 0.009) and degree of dysphagia(p ¼ 0.05).

Conclusion: The mean time of decannulation in thepatients was 25 days. The conditions related to the time untildecannulation were: respiratory disease, dysphagia, numberof speech therapy sessions and speech therapy time.

Keywords: Quality indicator; health care; Deglutitiondisorders; Speech Therapy; Tracheostomy

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A442. Analysis of Temporal Resolution in Elderly PatientsWith Sensorineural Hearing LossVânia CarolinaDevitte Ruiz, Monique Rolim Sequeira, AndressaOrtiz Birck, Maria Inês Dornelles da Costa Ferreira, Thais deSena TeixeiraUniversidade Federal de Ciências da Saúde de Porto Alegre (Ufcspa)

Introduction: The auditory temporal processing in-volves the ability to process aspects of the changing temporalcharacteristics. The elderly suffer with the decrease of thisability and are commonly affected by hearing loss, signed bythe difficulties of discrimination.

Objectives: To assess the temporal auditory process-ing in patients with sensorineural hearing loss.

Methods: The sample included the participation of 52elderly, over 60 years with sensorineural, bilateral, symmetri-cal and mild to moderately severe hearing loss, users of theUnified Health System, referred to the hearing aid sector ofCentre health Clelia Manfro - Hearing Unit. Patients wereassessed through the test Random Gap Detection Test (RGDT).

Results: The mean frequency of the pure tone airconduction audiometry - 500Hz, 1000Hz and 2000Hz - heldin both ears, was compared with the result of RGDT. Thecomparative analysis showed no statistical significance for theright ear (p ¼ 0.164) and a trend of correlation for the left ear(p ¼ 0.056).

Conclusion: There was no significant relation be-tween the temporal resolution of measurement and thedegree of hearing loss, revealing that this ability is not directlyinfluenced by the degree of hearing loss.

A706. Analysis of the Main Characyeristics of Patients withVestibular HyperreflexiaMidiany de Oliveira Soares, Carolina Kalil, Bárbara NiegiaGarcia de Goulart, Edson Ibrahim MitreUniversidade Federal do Rio Grande do Sul

Introduction: Hyperreflexia can be associated to acentral or peripheral vestibular diseases and refers to thecaloric induced nystagmus that exceeds the bounds of nor-mality. Purpose: To analyze the main characteristics of pa-tients with vestibular hyperreflexia.

Methods: We analyzed the records of history from2010 to 2011 for patients diagnosed with vestibular hyper-reflexia two clinics in Porto Alegre (RS). All informationprovided during the interview were transcribed to a databaseand transcribed to the Statistical Package for Social Sciences(SPSS), version 19, where the analyzes were performed.Collected the data of individuals regarding age, gender, dizzi-ness and/or vertigo, associated symptoms , health history ingeneral and diagnosis of the vestibular hyperreflexia bilateralor unilateral.

Results: The sample consisted of 264 individuals ofboth genders and aged between 17 and 76 years.We observeda higher frequency of dizziness (53.8%) and nausea (51.5%),increased frequency of symptoms in the group with bilateralvestibular hyperreflexia. The action of moving the head is themost reported as a cause of symptoms of dizziness and/orvertigo (75 people). The unilateral vestibular hyperreflexiawas present in 99 subjects and bilateral hyperreflexia in 164individuals. Observed a higher frequency of symptoms re-ported in the group of individuals diagnosed with bilateralvestibular hyperreflexia.

Conclusion: The main characteristics analyzed werethe presence of symptoms such as dizziness, nausea, vertigo,tinnitus, headache, vomiting and imbalance. The symptomswere more frequent in patients with bilateral vestibularhyperreflexia, aged 45 to 59 years.

Keywords: Electronystagmography, Vestibular Dis-eases, Dizziness, Vertigo, Labyrinth Diseases

A32. Analysis of the Relationship Between the Time of theTinnitus Perception and Scoring in Tinnitus HandicapInventoryÍcaro da Silva Walbrohel, Adriane Ribeiro Teixeira, AlexandreHundertmarck Lessa, Letícia Petersen Schmidt Rosito, CelsoDall’IgnaUniversidade Federal do Rio Grande do Sul (UFRGS) Hospital deClínicas de Porto Alegre (HCPA)

Introduction: Tinnitus can be caused by otologic andextra-otologic factors. In the assessment of a patient, extreme-ly useful rating scales may be applied. The rating scales allowprofessionals to analyze the impact of symptoms on dailyactivities undertaken by affected individuals. One of theworld’s most used is the Tinnitus Handicap Inventory (THI).

Objective: The objective of this study is to analyze therelationship between the time of the tinnitus perception andthe THI score. Methodology: Individuals of both genders wereincluded in the sample of this study. All subjects suffered fromtinnitus and responded to an interview where relevant datawas investigated, including the time of the perception of thesymptom and THI scale. The results were statistically analyzedusing Spearman’s correlation test. The project was approvedby the Institutional Ethics Committee.

Results: The sample consisted of 688 subjects, 62.5%males and 37.5% females, aged between nine and 89 years(mean 59.24 � 12.73 years). The tinnitus symptom timevaried between three months to 61 years (mean6.29 � 6.61 years). The THI score ranged between zero and100 points (average 43.14 � 25.65 points). Statistical analysisshowed no significant correlation between the time of theperception of tinnitus and the THI score (p ¼ 0.167).

Conclusion: The data analysis showed that the time oftinnitus perception does not influence the impact caused by it.

Keywords: Tinnitus, Questionnaires, Audiology

A712. Association between chronic obstructive pulmonarydisease and dysphagia: A Systematic ReviewAmanda Manera Freiry, Marcieli Ghisi, Renato Gorga Bandeirade Mello, Emilio Moriguchi, Maira Rozenfeld OlchikUniversidade Federal do Rio Grande do Sul

Introduction: Chronic Obstructive Pulmonary Dis-ease (COPD) is associated with limiting airflow that is pro-gressive and irreversible, with consequent impact onbreathing. Oropharyngeal dysphagia is a symptom related toany change in the act of swallowing. The coordination ofswallowing and breathing events prevents pulmonaryaspiration.

Objective: To determine the association betweenCOPD and oropharyngeal dysphagia.

Data Synthesis: Systematic review was conducted inthe databases MEDLINE / PubMed, SciELO and LILACS, usingthe keywords chronic obstructive pulmonary disease anddysphagia. Published articles were selected from 2000 to2015. Four articles met the inclusion criteria: Kobayashi,Kubo and Yanai (2007) evaluated patients with chronic ob-structive pulmonary disease and demonstrated impairmentof the swallowing reflex. O’Kane and Groher (2009), conclud-ed that patients with exacerbated disease had oropharyngealdysphagia. Chaves et.al. (2011) found that patients withChronic Obstructive Pulmonary Disease showed significancecomplaints for swallowing difficulties, however, in anotherstudy (Chaves et.al., 2014), showed that videofluoroscopy

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findings did not evidenced aspiration and penetration in anyof the tested consistency.

Conclusion:Despite the relevance of dysphagia symp-tom in patients with chronic obstructive pulmonary disease,only a few studies investigate this association. The availablestudies support the conclusion that patients with chronicobstructive pulmonary disease have dysphagia complaints,however videofluoroscopic evaluation showed no direct com-mitment in the stages of oropharyngeal and pharyngealswallowing. Therefore, studies about this association shouldbe expanded.

Keywords: Dysphagia; Chronic Obstructive Pulmo-nary Disease, Speech therapy

A432. Association Between Clinical Picture of CerebellarMutism and Dysphagia in Children: Case ReportLiliane Menzen, Maria Cristina de Almeida Freitas Cardoso,Lisiane de Rosa Barbosa, Vanessa Souza GigoskiUniversidade Federal de Ciências da Saúde de Porto Alegre/IrmandadeSanta Casa de Misericórdia de Porto Algre

Introduction: The mutism is facing extreme dysar-thria, aphasia or anarthria Broca type. Its etiology is manifold,including head trauma, vascular processes, psychosis andtumor resection surgeries. The mutism can occur by injuryof structures adjacent to the inner worm injury.

Objectives: Report an association of clinical case cere-bellar mutism and dysphagia in children.

Resumed Report: Girl, 4.5 years, with posterior fossatumor relapse - pilocytic astrocytoma grade 1 in the cerebel-lum, with cerebellar lesionwormwith psychomotor agitation,initial dysarthria and dysphagia, requiring sedation. Thepersistence of symptoms triggered cerebellar mutism frame-work and evolution of severe dysphagia, requiring feedingalternative route. The speech therapy intervention at thebedside accompanied worsening and evolution of the frame-work for full recovery in 57 days. The patient was X therapeu-tic sessions during this period, being held sensory stimulationand reintroduction of oral feeding, and guidance to families.Study approved by CEP:467.673.

Conclusion: Speech difficulties, mutism, dysphagiaand intense emotional lability signs are described in theliterature after resection of cerebellar vermis tumors in chil-dren. The silence of the installation time varies and may beobserved soon after the surgical process, hours or days aftersurgery, disappearing between 4 days and 4 months after itsinception. The case reported shows the commitment torecurrence and subsequent resection of the tumor, withsevere degree, and the importance of speech therapists inaction at the bedside.

Keywords:Deglutition Disorders; Dysarthria;Mutism

A296. Association Between Neurological Injury andImpaired Swallowing in Patients After StrokeSheila Tamanini de Almeida, Danielle Martins OttoUniversidade Federal de Ciencias da Saude de Porto Alegre

Introduction: Oropharyngeal dysphagia (OPD) is adifficulty swallowing that may hinder one’s ability to ingestfood. The OPD has a high incidence after stroke, the leadingcause of mortality related to respiratory complications andmalnutrition.

Objective: To verify impairment of the swallowingprocess after stroke, associating the degree of impairmentwith the severity, type of stroke, and localization of theneurological injury.

Methods: Cross-sectional descriptive study of 42 pa-tients diagnosed with stroke hospitalized in the NeurologicDepartment of the Irmandade Santa Casa de Misericórdia dePorto Alegre (ISCMPA â€“ Brazil / RS) during the period ofJanuary to August 2013. The Research Ethics Comitee of theISCMPA approved the study, under protocol number 41354/12. All individuals underwent a neurological clinical evalua-tion and application of the National Institute of Health StrokeScale (NIHSS), chart review and clinical Speech LanguagePathologist (SLP) evaluation â€“ application of the FunctionalOral Intake Scale (FOIS) and Investigation of OropharyngealDysphagia in Adults Protocol.

Results: 52.4% of the patients were women, with anaverage age of 65.7 years; 92.9% presented ischemic stroke;59.5% presented impairment of the anterior cerebral circula-tion. There was a statistically significant association betweenthe neurological scale (NIHSS) scores and the swallowingimpairment scale (p ¼ 0,016).

Conclusion: There is an association between thestroke severity and the swallowing disorder. There were ahigh proportion of patients with severe oropharyngeal dys-phagiawho presented ischemic strokewith impairment of theanterior cerebral circulation as location area of neurologicalinjury.

Keywords: Stroke; Deglutition Disorders; NeurologicExamination

A638. Association of Hearing and Extra-Auditory Complaintsto the Use of Headphones in AdolescentsKarla Anacleto de Vasconcelos, Jonathan Grassi RodriguesUniversidade Federal do Espírito Santo

volumes and, although they recognize the hearingdamage resulting therefrom, do not know how to identifythe signs and symptoms of these losses.

Objective: investigate the frequency of reports ofhearing and extra-hearing complaints in teenagers users ofportable audio equipment and verify if after speech therapistguidance the participants associate those complaints to theuse of headphones.

Methods: We conducted an intervention study, ap-proved by the CEP / UFES(n°237.295). 182 teenagers users ofheadphones participated. They answered a questionnairespecifically developed for this study, at two different times:1 time(M1) and time 2(M2), before and after the speechtherapist guidance.

Results: Participants had a average age of 14 years and55.5% were female. In M1 and M2, respectively, the followingsigns have been identified: listening to TV at higher volumethan the other family members(21.4% -29.9%); frequent diffi-culty of understanding speech (34.1% -29.9%) and clearlybetter hearing in one ear(13.7% -21.9%). The symptoms re-ported were: ear fullness(18.1% -22.4%); tinnitus(22.0%-28.8%); headache(22.0% -24.0%) and frequent irritation ornervousness (18.7% -19.3%). Participants that did not reportany sign or symptom(29.9% -45.5%). Regarding the associationof complaints to the use of headphones, the number ofparticipants who recognize this association remained thesame in the two moments (47.6%), but the percentage ofparticipants who did not recognize the symptoms reduced tothe value (14.2% -8.2%).

Conclusion: Teenagers have limited knowledge aboutthe signs and symptoms related to inappropriate use ofheadphones.

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A439. Association of Tinnitus, Dizziness and AudiometricFindings in Adult SubjectsPatrícia Faggion Schramm, Márcia Salgado Machado, CristinaLoureiro Chaves SolderaUniversidade Federal de Ciências da Saúde de Porto Alegre

Introduction: Many times what leads the individualto seek an evaluation with otolaryngologist or audiologist isthe existence of some symptoms related to the auditorysystem (such as tinnitus and dizziness) that may or may notbe related to hearing loss. The studyof the audiological profile,relating it to the auditory complaints, it becomes an importantepidemiological tool for searching and defining new healthpolicies, as well as assisting in medical diagnosis and, conse-quently, the development of new techniques for auditoryrehabilitation.

Objective: To associate the prevalence of tinnitus and/or dizziness complaints to audiometric findings of subjectsassisted in a philanthropic hospital. Methods A retrospectivestudy, through analysis of medical records of 554 individuals,assisted at the audiology department of a philanthropichospital in Porto Alegre/RS.

Results: Significant associations were found betweencomplaining of tinnitus and complaining of dizziness(p < 0.001). Relating to gender, women reported havingmore dizziness than men (p ¼ 0.002). Significant associationswere found between the absence of tinnitus and normalhearing, aswell as betweenmild hearing loss and the presenceof tinnitus (p ¼ 0.006). Regarding the type of hearing loss, theassociation was significant between the conductive hearingloss and unilateral ipsilateral tinnitus, hearing loss neuro-sensorial with bilateral tinnitus and no loss and no complaint(p ¼ 0.001).

Conclusion: It was found significant association be-tween hearing complaints - dizziness and tinnitus - to theaudiometric findings, allowing a more accurate diagnosis toestablish the best therapeutic approach.

Keywords: Tinnitus; Dizziness; Audiometry, Pure-Tone

A96. Audiologic Findings in Patients with Richieri-Costa-Pereira SyndromeAdriana Guerta de Souza, Jacqueline Aquino do Nascimento,Melissa Zattoni AntoneliHospital de Reabilitação de Anomalias Craniofaciais da Universidadede São Paulo

Introduction: Richieri-Costa-Pereira Syndrome is anacrofacial dysostosis characterized by microstomia, micro-gnathia, cleft palate, Robin sequence, absence of lower centralincisors, minor ear anomalies, limb defects, laryngeal anoma-lies and learning disability. In Brazil, 32 cases of this syndromewere described and one study focused on hearing status wasfound. The authors reported conductive hearing loss in 5 of 9studied patients, probably related to the cleft palate. Literatureis sparse regarding hearing disorders in this syndrome.

Objective: To describe audiological findings of 10patients diagnosed with Richieri-Costa-Pereira syndrome.

Methods: Medical records of 10 individuals withRichieri-Costa-Pereira Syndrome, enrolled at the Hospitalfor Rehabilitation of Craniofacial Anomalies (HRAC-USP), pre-viously submitted to audiological assessment, were reviewed.Tonal and vocal audiometry and tympanometry were per-formed and hearing antecedents obtained by experiencedaudiologists of the Speech and Hearing Division of HRAC-USP.

Results: Normal results in all tests was found in only20% of patients. Hearing and/or otological complaint waspresent in 70%. Audiometric evaluation showed that 40% of

patients had normal thresholds in both ears. Considering thepatients with abnormal audiometry, 50% had unilateral con-ductive hearing loss, 33% unilateral mixed hearing loss and17% bilateral conductive hearing loss. Tympanometry wasperformed in 9 patients and 2 of them presented the normaltype A curve in both ears. Type B curve was the most common(44%).

Conclusion: Patients with Richieri-Costa-Pereira syn-drome have a high prevalence of hearing disorders and anappropriate hearing screening protocol for these patientsshould be part of a multidisciplinary treatment protocol.

A700. Audiological and Psychological Considerations onDiabetes Mellitus Type I: A Case ReportMarília Cancian Bertozzo, Maiara Aparecida Bolotti Giacomelli,Valéria Cristina Zane, Rosicler Moreno Castanho, Valdéia Vieirade OliveiraDivisão de Saúde Auditiva - Hospital de Reabilitação de AnomaliasCraniofaciais - Universidade de São Paulo

Introduction: Diabetes mellitus 1 (DM1) is a disorderof metabolic, vascular and neuropathic complications, inwhich associated hearing loss may occur, compromisingperipheral and/or central hearing areas. It changes the indi-vidual’s daily activities and is influenced by emotional factors,becoming a risk factor for the development of psychologicaldisorders.

Objective: To describe the case of a patient with DM1and hearing impairment, emphasizing the importance ofaudiological and psychological attendance.

Resumed Report: Patient J.M.S.J., 23-year-old malediagnosed with insulin-dependent DM1 at the age of 2,complains of vertigo, comprehension difficulty, anxiety andslowness in information processing. Audiological evaluationsrevealed mild to moderate sensorineural hearing loss. Incon-sistencies on several electrophysiological exams and audiom-etry were observed, showing variations in the presence oftransient and distortion-product otoacoustic emissions bilat-erally and with Auditory Brainstem Response indicative ofretrocochlear alteration. A CT scan was performed, showingnormal results. The vectoelectronystagmography indicatedvestibular dysfunction, and the possibility of associated cen-tral impairment was raised due to constant rotational oscil-latory eye movements. The auditory handicap evaluationquestionnaire revealed severe self-perception of participationrestriction. Psychological evaluation identified vulnerability,low self-esteem, insecurity, fear of abandonment, anxiety,emotional lability and irritability, indicating psychologicaland/or psychiatric disorders associated with the disease andits confrontation, confirmed in verbal reports of the patient.

Conclusion: Early diagnosis of diabetes is essential toprevent the development of complications and possible asso-ciated hearing loss. It highlights the importance of audiologi-cal and psychological attendance on improving the quality oflife of these patients.

Keywords: Hearing Loss; Diabetes Mellitus;Psychology

A123. Audiological Assessment in Young Users of PersonalStereos with TinnitusMoniane Aparecida Sumera, Vitor Della Rovere Binhardi,Isabella Bonamigo da Silva, Ariane Barros Oliveira, Ana ClaudiaVieira CardosoUniversidade Estadual Paulista - Unesp - Campus de Marília

Introduction: Young adults hearing has been a con-stant source of concern to health professionals considering the

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habits of these young people, who in their leisure time,attends noisy environments and use personal stereos.

Objectives: To characterize and compare the audio-logical profile of individual users or not of personal stereos,with and without tinnitus.

Methods: descriptive, comparative and cross-section-al study, conducted in a public university clinic. The sampleconsisted of 60 individuals of both genders, aged between 18and 30whowere divided into four groups according to the useor not of personal stereos and the presence or absence oftinnitus. The evaluation consisted of the following proce-dures: interview, visual inspection of the external auditorycanal, pure tone audiometry, tympanometry and distortionproduct otoacoustic emissions.

Results: the analysis showed that on the four groupsstudied the audiometric thresholdswerewithin normal limitsbut showed a worsening in the frequency of 6000 Hz bilater-ally and distortion product otoacoustic emissionswere absentin the frequency of 1000 Hz bilaterally. Statistical analysisshowed no difference between the results of these two tests inthe groups evaluated.

Conclusion: Although this population have harmfulhearing habits, there was no change in hearing of these youngpeople due to the use of personal stereos and tinnitus.

Keywords: Tinnitus, Young Adult, Habits, Hearing,Noise

A417. Audiological Findings in Individuals with 22q11.2Deletion Syndrome: A Systematic ReviewBibiana Fuzer da Silva, Rafael Fabiano Machado Rosa, PauloRicardo Gazzola Zen, Pricila SleiferUniversidade Federal do Rio Grande do Sul

Introduction: 22q11.2 deletion syndrome, alsoknown as DiGeorge, velocardiofacial syndrome or CATCH22,was identified in the beginning of the 1990 decade andcurrently is one of the most common human genetic micro-deletion syndromes.

Objective: Conduct a systematic review of the litera-ture trying to identify studies that report audiological findingsin patients with 22q11DS. Data sources: MEDLINE, LILACS,BIREME (SciELO e BBO) databases, were searched for the lastfive years, with the following descriptors “hearing loss”,“hearing”, “22q11.2”, “velocardiofacial syndrome” e“CATCH22”. For this review, we excluded: theoretical review,letter to the editor and case study. After analysis of the articles, we considered the following: objetive of the study , year ofpublication, study design , characteristics of the sample(number, gender and age of the participants), hearing evalua-tion type used , results and conclusions.

Data Synthesis:Of the eighteen studies found, six metthe inclusion criteria. Most of themwere published in the lastfive years. Audiological findings often described in these studyincludedmiddle ear disorderswith hearing loss predominant-ly of conductive or mixed. Hearing losses were attributedmainly to inflammation of the middle ear.

Conclusions: Although we found studies that reportaudiological findings in patients with SD22qq11, still arescarce studies that present assessments of the central levelhearing, thus highlighting the importance of developingmorework in this area.

A90. Audiological Findings inMotorcyclists Use this Practiceas SportPatrícia Arruda de Souza Alcarás, Filipe Stella de AliançaUniversidade do Oeste Paulista

Introduction: the exposure to noise generated bythese means of transport is a worrying factor to the motorcy-clists auditory health, because this harmful agent causesirreversible damage in auditory system.

Objective: to investigate the audiological findings andcomplaints related to hearing on motorcyclists that use thispractice as a sport, as well as to measure the sound pressurelevel produced by each motorcyclist.

Methods: the sample was composed by 13 motorcy-clists, among 21 to 36 years old, male, and which travel ingroups on Saturdays for a period of 6 hours. All participantsunderwent an interview and basic audiological evaluation.Through the decibelimeter it was measured the sound pres-sure level produced by motorcycles, stopped and acceleratingwith 6000 spins.

Results: that all participants had auditory thresholdsand vocals within the normal range, as well as the majorityhad normalmobility of the tympanic-ossicular system. 23,08%of participants showed changes in the acoustic reflex thresh-old in the right ear, and 30,77% in the left ear. About com-plaints related to hearing, only one participant reportedfeeling of pressure in the right ear, constant toothaches andhigh pitch ringing in ear complainant. The sound pressurelevel, even stoppedor accelerating, had high levels reaching upto 119 dB (SPL).

Conclusion: then, it can be concluded that althoughthe studies’ participants don’t have changes in hearing thresh-olds, the sound pressure level in which they are exposed ishigher than recommended by the regulatory norm, whichmakes this agent harmful to this population’s hearing.

A639. Audiological Findings in Two Children with WilliamsSyndrome: A Case ReportBibiana Fuzer da Silva, Paulo Ricardo Gazzola Zen, RafaelFabiano Machado Rosa, Pricila SleiferUniversidade Federal do Rio Grande do Sul

Introduction: The Williams Syndrome syndrome(WS) is a relatively rare disease characterized by being aneurodevelopmental disorder in association with facial ab-normalities , cardiovascular , and behavioral deficits. Individ-uals with the SW have some specific audiologicalcharacteristics, like as abnormal sensitivity to sounds. Previ-ous studies have reported cases of sensorineural or mixedhearing loss , predominantly in high frequencies.

Objective: describe the audiological findings in twochildren with Williams syndrome.

Methodology: Two children, one male, 10 years oldand a female , 11 years old were evaluated. Patients under-went audiological assessment. They performed tonal thresh-old audiometry, acoustic immittance audiometry , speechaudiometry , acoustic impedance and research of the LatencyAuditory Evoked Potential (LLAEP).

Results: In both cases it was found in both ears:ipsilateriais and contralateral acoustic reflexes absent; speechaudiometrywith percentage indexof speech recognition (SRI)and speech recognition threshold (SRT) changed; OAE tran-sient absent; LLAEP changed (increased latency of waves anddecreased amplitudes). School learning difficulties and writ-ten language learning.

Conclusion: In both cases, the subjects had significanthearing disorders. In the case of children at the learningprocess, suggest the need to include in the battery of testscarriers children SW, amore completehearingevaluation to todetect and intervene early if possible changes.

Keywords: williams syndrome; hearing loss; hearing

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A637. Audiological Signs and Symptoms In SubjectsDiagnosed with Temporomandibular DisorderMaria Renata José, Camila de Castro Corrêa, Maria FernandaCapoani Mondelli, Mariza Ribeiro FenimanFob/USP

Introduction: Temporomandibular Disorder (TMD)could be characterized as an association of alterations involv-ing temporomandibular joint, masticatory muscles and asso-ciated structures. Studies report that symptoms of TMD isvaried and include association between TMD and presence ofaudiological signs and symptoms.

Objective: To investigate the audiological signs andsymptoms found in subjects diagnosed with TMD, in order toinvestigate the temporomandibular dysfunction may be relat-ed to disorders in the auditory system.

Methods:A sistematic reviewwas performedwith theresearch of articles available in national and internationaljournals, using the descriptors "Temporomandibular Joint"AND "Hearing" (databases Pubmed and Lilacs). The inclusioncriteria was about studies contained subjects diagnosed withTMD presenting auditory disorders. The exclusion criteriawere: presence of other disorders, beyond DTM and relatedto auditory system; review articles; articles repeated indifferent databases; language different of Portuguese, Englishor Spanish; unavailability of article in full access.

Results: Were found 221 articles and only 17 studiesfollowed the inclusion criteria. The audiological signs andsymptoms were: complaints of hearing loss (even in subjectswith normal hearing); hearing loss at low and mediumfrequencies; tinnitus; aural fullness; vertigo; dizziness; ear-ache and increased middle-ear stiffness.

Conclusion:Were observed the existence of audiolog-ical signs and symptoms in subjects with TMD, which can berelated mainly to the middle ear, and in some studies to theinner ear. By the high variability of audiological signs andsymptoms in TMD, more studies are needed, for betterunderstanding of this clinical condition and improve theintervention.

A664. Audiologist Guidance in the Prevention of HearingDamage in Teenagers Users of HeadphonesKarla Anacleto de Vasconcelos, Jonathan Grassi RodriguesUniversidade Federal do Rio de Janeiro

Introduction: The explosion of access to portableaudio equipment increases the number of reports of hearingloss induced by extreme volumes in young people.

Objective: Investigate the routine of use of head-phones and verify changes in this routine after speech therapyguidance in adolescents.

Method: An intervention study was conducted in twoschools, a high school in Espírito Santo and another elemen-tary school in Rio de Janeiro. The study was approved by theCEP/UFES (n°237.295) and students participated voluntarily.The study was conducted in two moments: moment 1(M1) inwhich students answered a questionnaire about habits relatedto the use of headphones, and then attended a lecture of 30minutes of a professional audiologist, who addressed thedamage caused by extreme volumes. Moment 2(M2) wasperformed after 30 days and the same participants answeredthe same questionnaire.

Results: The study included 188 students. Among allsurveyed items, those with significant changes are: a) thereports of places where headphones are used decreased,except the use in buses, for which the percentage was main-tained, and at home, for which the percentage of answersincreased: during physical activities (56.9%-40.4%), in buses

(54.2%-54.2%), in leisure activities (42.5%-35.1%), school (287%-19.6%) and at home (14.3%-20.7%); b) number of hours perday: 1-2 hours (57.9%-63.2%), 3-4 hours (22.3%-19.6%), 5-6hours (7.4%-5, 8%) and 6 hours (10.1%-4.2%) and c) soundvolume used: low (11.5%-15.3%), medium (57.6%-49.4%), high(36.8%-7.3%).

Conclusion: general campaigns could raise awarenessand benefit the young users of headphones.

A434. Audiometric Profile, Auditory and Extra-AuditorySymptoms in Operators and Supervisors of a Call CenterKariniMayer Silva da Cunha, Márcia SalgadoMachado, CristinaLoureiro Chaves SolderaUniversidade Federal de Ciências da Saúde de Porto Alegre

Introduction: The exposure to high sound pressurelevels can cause auditory and extra-auditory symptoms. Tele-phone operators are one of the professionals that are exposedto these high levels through different sound sources found intheworkplacewith tele service. Themain source of high soundpressure is the headset, a device which combines a handsetdial with headphones that conduct the sound directly to theoperato’s auditory system.

Objective: To evaluate the audiometric profile andauditory and extra-auditory symptoms in operators andsupervisors of a call center.

Methods: Cross-sectional studywith 25 operators andeight supervisors of both sexes aged over 18 years old,regardless the time working in the area. These operatorsunderwent to an audiometric examination and questionnaireto obtain data on occupational history and auditory habits andsymptoms.

Results: Extra-auditory symptoms were present in81.8% of subjects. Of these, 51.9% reported headache anddifficulty to concentrate, 37% felt pressure in the head and33.3% had difficulty to sleep. The auditory symptoms werereported by 45.5% of subjects, of which 86.5% had tinnitus and79.8% had ear fullness. All of them had audiometric hearingthresholdswithin normal limits, but 48.6% had an audiometrywith an audiometric notch configuration.

Conclusion: Telephone operators are at high risk ofdeveloping hearing problems, thus it is necessary to createintervention plans in order to promote occupational hearinghealth.

Keywords: Audiology, Answering Services, Noise, Oc-cupational, Signs and Symptoms

A551. Auditory Ability of Figure-Ground (BinauralIntegration) of Students in Early LiteracyAdriana Aparecida Tahara Kemp, Camila Ribas Delecrode, AnaClaudia Vieira CardosoUniversidade Estadual Paulista "Julio de Mesquita Filho"

Introduction: Figure-ground ability involves discrim-ination of verbal sounds of high predictability presented toboth ears (dichotic listening). Disorders in this skill can causeacademic and language comprehension difficulties, due to thechange in auditory analysis and synthesis.

Objective: To describe the performance of students inauditory ability of figure-ground (binaural integration).

Method: descriptive, cross-sectional study conductedin small town public school in São Paulo state. On thecomposition of the sample, were included students whohad audiometric thresholds within normal ranges from 250to 8000 Hz and type A tympanograms. Thus, were assessed 46students divided into two subgroups, according to age group:G1: six years old students (n ¼ 22); G2: seven years old

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students (n ¼ 24). The procedure used to assess this abilitywas the Dichotic Digit (DD) test.

Results: Analyzing the performance of students inboth groups, it was observed that the DD test was abnormalin 90% of G1 students and 83% of G2. The scores of the right earranged from 27.5% to 97.5% (mean 72.5) in G1, and from 42.5%to 95% (mean 77.5) in G2; the left ear scores ranged from12.5%to 90% (mean 60) in G1, and from 7.5% to 97.5% (mean 67) inG2.

Conclusion: Students of both group presented a highrate of disorder in figure-ground ability.

Keywords: Hearing, Hearing tests, Child

A1728. Auditory and Language Implications in a Case ofSevere Traumatic Brain InjuryMariane Richetto da Silva, Ana Cláudia Mondini Ribeiro,Daniela Gil, Cyntia Barbosa Laureano Luiz, Carolina CalsolariFigueiredo de Godoy, Adriana Neves de AndradeUniversidade Federal de São Paulo (Unifesp)

Introduction: Traumatic brain injury occurs basicallydue to beatings on the skull and its contents, injuries can becaused by the impact and the movement acceleration /deceleration of the brain inside the skull. There may beexpressive and/or receptive language abnormalities (expres-sive and / or receptive) and deficits in the peripheral and / orcentral auditory system.

Objective: To investigate the auditory and languageskills in a child after severe traumatic brain injury.

Resumed Report: ENG, 10, male, suffered severe headinjuries with increased intracranial pressure and underwentdecompressive craniectomy bifrontal. Language and auditoryevaluation included basic audiological evaluation and centralauditory evaluation including short and long latency auditoryevoked potentials and behavioral testing, and the languageassessment. Language evaluation revealed deficits in oralreception, syntactic system deficit, in phonological and se-mantic access the mental lexicon, short-term and operationalmemories and in phonological awareness. Basic audiologicaltests and electrophysiological evaluation showed resultswithin normal criteria bilaterally. Behavioral central auditorytests revealed severe abnormal results involving auditoryskills of auditory closure, figure to ground for verbal andnonverbal sounds and temporal ordering.

Conclusion: Language and auditory disorders wereobserved in this child. It is very important to quantify andqualify these difficulties in order to design a proper rehabili-tation treatment planning aiming atminimizing thesedeficits.

A397. Auditory Brainstem Response (ABR) in Adolescents12-17 Years Old with Normal HearingPaula Soares deMelo, Giselle Goulart de OliveiraMatos, MarciaLourdes Calixto MendesNúcleo de Estudos da Saúde do Adolescente - Universidade do Estadodo Rio de Janeiro (Nesa/UERJ)

Introduction: auditory brainstem response (ABR) arepotential auditory short latency used to evaluate the integrityof the functioning of central auditory pathways. There are fewstudies on this exam in teens.

Objectives: To determine the profile of ABR responsesin adolescents aged 12 to 17 years comparing it with currentreferences.

Method: the study (CEP / HUPE No. 13,224) wasconducted by the speech therapy team Studies Center ofAdolescent Health at the State University of Rio de Janeiro(NESA / UERJ) and evaluated 22 adolescents with normal

hearing, in the period from 02/10 / 2012 to 03/07/2014. Theexamination was made 80dBSPL, alternating polarity, 13.1clicks / s 2000 stimulus.

Results: absolute values of wave one (I): 1.34ms inright ear (RE) and 1.33ms in left ear (LE); Wave three (III):3.48ms in RE and 3.5ms in LE;Wavefive (V): 5.16ms in RE and5.23ms in LE. Interpeak interval values I-III: 2.14ms in RE and2.16ms in LE; III-V: 1.67ms in RE and 1.73ms in LE; and I-V:3.82ms in RE and 3.89ms in LE. Inter-aural difference: 0.12msin girls and in boys 0.11ms. Male values are greater than thefemale (statistically significant p-value) in the analysis of theabsolute values of wave V in both ears andwaves I and III of LE;and interpeak intervals III-V and I-V in the RE.

Conclusion: it defined the profile of this review andfound that the results are consistent with the normal de-scribed the current references.

A618. Auditory Cortical Potential in Children: OddballParadigm with Different Types of Speech StimuliLeticia Saia da Silva, Ana Claudia FrizzoUniversidade Estadual Paulista "Júlio de Mesquita Filho"

Introduction: The auditory cortical potentials areelectrical changes that occur at various levels of the auditorynervous system in response to electrical stimulation.

Objective: To investigate the latency and amplitude ofthe components of auditory cortical potentials (ACP) withdifferent speech stimuli in healthy children.

Methods: We analyzed 15 healthy children, agedbetween 8 and 12 years. The discretion of inclusion were:privation of psychiatric, cognitive, motor or physical involve-ment, without of oral language or written disabilities; satis-factory performance in Portuguese and Mathematics for atone academic semester; pre-selection procedures: pure toneaudiometry and impedance tests with normal results curvetype A, ipsilateral and contralateral reflexes present anddistortion product otoacustic emissions presents. After thesample selection was done the cortical potential - oddballparadigm - discrimination of speech sounds /pa/ x /da/ and/ba/ x /da/ through the auditory evoked potential of portableequipment Biologic Navigator Pro (AEP).

Result: it was not observed significant differencewhen comparing the stimuli /pa/ x /da/ a /ba/ x /da/. Butthe latencyof P1 andN1 components P1 andN1wasminimumincreasedwith speech stimuli /pa/ x /da/ when researched theright ear.

Conclusion: The auditory cortical potential are sensi-tive to the complexity of auditory-linguistic processing arevery useful assesment tools in pediatric populations.

Keywords: Auditory Evoked Potential; Auditory Cor-tex; Electrophysiology

A336. Auditory Evoked Potential for Screening In PortoAlegre According to DatasusJade Zaccarias Bello, Isadora de Oliveira Lemos, Letícia KurtzUFCSPA

Introduction: Hearing has key role in children’s de-velopment, and the hearing screening, first performedthrough the otoacoustic emissions (OAEs), has great impor-tance in the hearing impairment’s early diagnosis. The screen-ing test through auditory evoked potential (ABER) isperformed when there is failure in the test and retest of theOAEs. The prevalence of neonatal hearing loss, has a rangefrom 3: 800 to 3: 1000 births.

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Objective: To quantify the number of ABER examina-tions in relation with the number of births in the city of PortoAlegre.

Methods: DATASUS platform data number of brain-stem auditory evoked potential procedures was used, alongwith IBGE data of births at the city of Porto Alegre in the years2010 to 2012.

Results: According to 2010 IBGE data, there were18,321 births in the city of Porto Alegre. In the same year,there are 718 recordsABER procedures, so 3.9% of infantswerescreened. The following year, there were 18,919 births in themunicipality and 4.8% of these were screened, with a trial’sgrowth of 28.27% in comparisonwith the previous year. Lastly,in 2012, the number of births was 19,470 and 6.3% werescreened, and the growth was 34.52% in comparison to theprevious year.

Conclusion: The trials using ABER have great impor-tance upon high risk newborns and also among those whofaild at OAEs test and retest. In the studied population, theABER allows a better conduct of clinical decisions to be taken.

Keywords: audiology, diagnosis, deafness

A212. Auditory Pathways’ Maturation in Children: ALongitudinal StudyStella Medianeira Soares Quinto, Lidiéli Dalla Costa, SimoneNicolini de Simoni, Ândrea de Melo, Eliara Pinto Vieira Biaggio,Inaê Costa RechiaUniversidade Federal de Santa Maria

Introduction: The Long Latency Auditory EvokedPotential can assist on objective measurement of the matura-tion of central auditory pathways, by analyzing the latency ofexogenous components.

Objectives: To compare the change in latency ofexogenous components of children, past two and a half years,enabling an investigation of this maturation.

Methods: This is a longitudinal study, analyzed de-scriptively. The sample included five children born full termwho carried out the search procedure of Long Latency Audi-tory Evoked Potential on two moments: before 30 days of lifeat the first assessment and with two and a half years old atrevaluation. The potentials were surveyed with frequentspeech stimuli /ba/ and rare /ga/, the intensity of 70 dBHL.

Results: It was observed the potential P1 and N1 intwo moments. The average latencies at the first assessment inthe left ear were: P1 ¼ 271.6ms and N1 ¼ 399.2ms. Onrevaluation the averageswere: P1 ¼ 100.4ms andN1 ¼ 172.4ms. The right ear were observed the averages of latency,respectively: P1 ¼ 266ms, N1 ¼ 399.6 ms and on revaluationwere observed P1 ¼ 90.8 ms and N1 ¼ 174 ms. Differencewas observed for the latencies of P1 and N1 componentsbetween the first and second assessment, showing an ade-quate maturation of the auditory pathway in the periodstudied.

Conclusion: It was observed a decrease in amplitudeof the potential exogenous P1 and N1 Past Two and a halfyears, which allows infer the adequate development of centralauditory skills during this period.

Keywords: Evoked Potentials Auditory; Auditory Dis-eases Central; Auditory Perception; Children

A330. Auditory processing skills in healthy and inhypertensive and diabetic elderly peopleRúbia Soares Bruno, Sheila Jacques Oppitz, Isadora GonçalvesPelissari, Eliara Pinto Vieira Biaggio, Mirtes Bruckmann,Michele Vargas GarciaUniversidade Federal de Santa Maria

Introduction: In elderly people, information process-ing decreases, making hearing comprehension difficult, whichcauses alterations in different hearing skills. Other diseasesmay be associated, mainly, to the ones that deal with meta-bolic functions. Any deficit in the blood supply to the cochleacan generate hearing damage. Diabetes mellitus and hyper-tension are some examples.

Objectives: Comparing the auditory processing skillsin healthy and in hypertensive and diabetic elderly people.

Method: 49 elderly participated of the study, 25healthy people, from the living group of the research institu-tion, where they perform physical activity weekly. The 24diabetic and hypertensive elderly people were patients of aBasic Health Unit in a city in the inland of Rio Grande do Sul.They were previously diagnosed as hypertensive and diabeticand they were already receiving medical treatment. Bothgroups were submitted to the same procedures: Anamnesis,Pure Tone Audiometry, Speech Audiometry, Acoustic Immit-tance Measures and aspects of Auditory Processing regardingthe temporal resolution skills (RGDT), background figure forverbal sounds (Dichotic Digit) and auditory closure (Com-pressed Speech).

Results: Considering the comparison between groups,there were significant differences for the dichotic digits testthat assesses background figure skill for verbal sounds inBinaural Integration stage (right left ears), Binaural separation(right and left ears) and Compressed Speech Test (Right Ear)that assesses the ability of auditory closure, being the findingsconsidered better in the control group.

Conclusion: There are significant differences whencomparing the AP skills of healthy elderly people and elderlypeople with diabetes and hypertension.

A236. Auditory Rehabilitation Program: The Self-Perceptionof Restrictions Participation in Elderly PeopleLidiéli Dalla Costa, Ayra Renata D’Agostini, Bianca Bertuol,Sheila Jacques Oppitz, Michelle Cargnelutti, Eliara Pinto VieiraBiaggioUniversidade Federal de Santa Maria

Introduction: Auditory sensory deprivation in elderlypopulation affects directly in the situations that needs com-munication, depriving to family and social life, which leads toisolation and compromises their quality of life.

Objective: Present and Auditory Rehabilitation pro-gram aimed to elderly that are users of hearing aids, charac-terizing the population assisted in this program, and evaluatethe self-perception about the restrictions in participation.

Methods: This is a descriptive and qualitative re-search. To characterize the population was held an anamnesisinvestigating the followings aspects: type and level of hearingloss, age at the beginning of therapy, time of prothetizationand level of education. The self-perception of participationrestriction was evaluated by Hearing Handicap Inventory forthe Elderly â€“ Screening.

Results: This program includes 12 individual sessionsof speech and audiology therapy with different specific goals.Regarding characterization of the population, was observedthat most of them have low level of education (71,43%)averaging 78% years old and prothetization average of 3.7years. In carrying out the questionnaire, 71,5% had significantparticipation restriction and 28,6% mild to moderate restric-tion. Is worth nothing that no difference was observed inparticipation restriction related to level of hearing loss, pro-thetization time and age.

Conclusion: The study found that the elderly popula-tion treated at the hearing rehabilitation program are of a loweducation levelwithmean age of 78 years and users of hearing

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aids for more than three years. All of them have self-percep-tion significant related to participation restriction.

Keywords: Auditory Perception; Acoustic Stimula-tion; Aged; Aging; Hearing Aids

A23. Auditory Training in Auditory Processing Disorders: ACase StudySusan Renata Stroiek, Lenita da Silva Quevedo, CarlaHernandez Kieling, Ana Carolina Lago BatteziniUniversidade de Passo Fundo

The aim of this study is to verify the effectiveness of anAuditory Training program comparing the initial performancein the tests of auditory processing evaluation, with the per-formance after the auditory training. For this case study,developed at the Speech Therapy clinic in the University ofPasso Fundo, a subject was selected that presented languagealterations, complaints compatibles with auditory processingdisorders, basic hearing evaluation with normal results andaltered results in the auditory processing evaluation. For this,the tests Pediatric Speech Intelligibility, Staggered SpondaicWord, Dichotic Digits, Random Gap Detection Test, MaskingLevel Difference, and Pitch Pattern Sequence were used.Auditory Processing tests reevaluation after 8 sessions ofthe auditory training showed improvements in the abilitiesthat were previously altered, persisting a mild difficulty inorganization. The progression from severe to mild degree ofthe subject proves the effectiveness of the Auditory Training.

A355. Auditory Training with Dichotic Listening and TheirRelation to Skills UntrainedAline Priscila Cibian, Liliane Desgualdo PereiraUniversidade Federal de São Paulo

Introduction: The auditory training with dichoticlistening increases the possibility of speech therapy in indi-viduals with auditory processing disorder.

Objective: Check whether this improvement generat-ed by this specific training can be generalized to otheruntrained listening skills.

Methods: 6 subjects, aged 12-15 years with alterationin the physiological mechanisms of selective attention andtemporal processing, checked through the speech with noisetest, Staggered Spondaic Word test, Random Gap Detectiontest and duration pattern test. These individuals were submit-ted individually to an Auditory Training based on DichoticInteraural Intensity Difference, proposed by Frank Musiek,organized in eight sessions, lasting 50 minutes each. Theyperformed the behavioral auditory processing evaluation ofthe clinical routine in three stages: pre-intervention and post-intervention in the middle of training and at the end of thetraining.

Results: The trained ability tofigure-ground evaluatedby Staggered Spondaic Word, subjects showed significantimprovement, reaching the normal parameters at the end ofthe auditory training. All subjects showed significant im-provement in ability closure through speechwith noise reach-ing the normal parameters. All subjects showed significantimprovement in the ability of temporal resolution through theRandomGap Detection, but 66.6% achieved normal standards.All subjects showed significant improvement in the ability oftemporal ordering through the duration pattern, but 16.7%achieved normal standards.

Conclusion: The auditory training was effective forthe trained ability figure-ground and to the untrained abilityclosure. The skills untrained of temporal resolution and

temporal ordering improved in some individuals, but notreach the expected normal.

A571. Benefit from the Use of Sound Amplification inMusical Hallucinations: Case ReportMarina de Marchi dos Santos, Andressa Vital Rocha, RudmilaPereira Carvalho, Maria Fernanda Capoani MondelliFaculdade de Odontologia de Bauru - Universidade de São Paulo

Introduction: Although there is little scientific evi-dence on the musical hallucination today, it is known thatmostly encompasses themanifestation as psychopathological.It has been described inpatientswithout a history of psychosisand ear symptoms. The musical hallucination has been ap-proached as a possible impact of hearing loss, as well astinnitus. Usually manifest after cochlear lesions that arepredisposing factors for these demonstrations.

Objectives: Evaluate the effect of individual hearingaid use for three months in patients with musicalhallucination.

Resumed Report: HADB, 67 years old, female, diag-nosed with bilateral sensorineural hearing loss severe. Heldhearing aid fitting protocol Speech Therapy Clinic of FOB-USP,reaching the target within the limits 10 dB to plus or minus atall intensities and frequencies evaluated. In the functional gainwere the following resultswithout hearing aid : 250Hz - 70dB ,500Hz - 75dB , 1000Hz - 70 Hz, 2000 Hz - 75dB , 3000Hz -75dB , 4000Hz - 80dB , 6000Hz - 80dB and with hearing aids :250Hz - 50dB 500 Hz - 50 dB , 1000 Hz - 35 Hz, 2000 Hz -30dB , 3000Hz - 35dB , 4000Hz - 55dB , 6000Hz - 55dB. Thenumeric scale used to evaluate the musical hallucinationpointed 9 before the adaptation and 4, after the effectiveuse of hearing aids for three months.

Conclusion: The use of hearing aids in patients withmusical hallucination is effective in the short term , consider-ing the acclimatization period.

A665. Benefit of Open Fitting in Reducing Tinnitus Betweenthe SexesMarina de Marchi dos Santos, Andressa Vital Rocha, MariaFernanda Capoani MondelliFaculdade de Odontologia de Bauru - Universidade de São Paulo

Introduction:Adaptation of hearing aids only in orderto improve hearing does not usually promote satisfactorytinnitus in patients with both complaints. Since there isocclusion of the ear canal. The open fit system not occludethe channel, providing gain preferably at high frequencies.

Objective: Evaluate tinnitus handicapwith use of openfit system to decrease the discomfort caused by tinnitusbetween the sexes.

Methods:One clinical trial for a period of 10months inpatients participating in a private clinic has been developed.30 individuals of both sexes , 17 womenwith a mean age 69.6and 13 men with a mean age of 63.3 years , tinnitus andsensorineural bilateral hearing loss with medical indicationfor fitting a hearing aid. For assessing tinnitus handicap, itused the Tinnitus Handicap Inventory.

Results: For males the average scores before theintervention were 37.2 points to total score, 15.2 points forfunctional score , 13.6 points for emotional score and 8.30points for catastrophic score. Since the average scores after theintervention were: 7.5; 4.6; 2.3 and 0.6; respectively. Forfemales the initial average scores were 40.7 points to totalscore , 18 points for functional score , 14 points for emotionalscore and 8.7 points for catastrophic score. Finally, the meanscores were: 7.7; 4.1; 2.2 and 1.4; respectively.

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Conclusion: It concludes that the system of open fithearing aid was effective in reducing tinnitus handicap nodifferences between the sexes.

A272. Body Balance and Impact of Dizziness on Quality ofLife for Active Elderly PeopleIsabela Schroer Neis, Állan Rodrigo Vieira da Silva, Luciele daSilva Prates, Isabela de Moraes Fattore, Valdete Alves Valentinsdos Santos FilhaUniversidade Federal de Santa Maria

Introduction: Dizziness is a common symptom inelderly population, as result of this; falls are frequent anddetermine complications, impacting negatively on their qual-ity of life.

Objectives: Assess body balance and impact of dizzi-ness on quality of life on active elderly.

Methods: The sample is 32 active elderly, participantson action developed in a university, 75%women and 25%men,mean age of 65,72 years. All submitted to anamnesis, to theDizzinnes Handicap Inventory protocol and assessment ofbalance - static and dynamic tests.

Results: 43,74% had dizziness complaint, 28,13% im-balance and 28,13% imbalance associated with falls. In itsentirety, the elderly showed impairment in quality of life, withfunctional aspects (65%) most affected, followed by physical(22%) and emotional (13%). In static test, Romberg-Barré withopened eyes, 18,75% of the elderly had alterations, 62,5% withclosed eyes and 18,75% in both. In the dynamic tests withclosed eyes, 37,5% presented alteration in Unterberg test,28,13% in Babinski-Weil, these with falls or deviations. Re-garding to functions aspects, 47% of the elderly had alterationin the static test, 9,5% in the dynamic test and 34% in both.

Conclusion: The functional aspect was significant inthe impact of dizziness on the quality of life for elderly activeones, identifying alteration in balance in evidence on Rom-berg-Barré, Unterberg and march-proof. It appears that, re-gardless of the categorization of the elderly, active or inactive,the dizziness deserves attention so it’s possible to providequality of life for this population.

A445. Body Balance Assessment in Young Women withVestibular or Neurovegetative Symptoms to MotionAmanda Steyer Bacellar, Márcia Salgado Machado, CristinaLoureiro Chaves SolderaUniversidade Federal de Ciências da Saúde de Porto Alegre

Introduction: Vestibular and/or neurovegetativesymptoms to movement are clinically referred as motionsickness. This condition occurs basically due to the conflictin sensory responses of visual, vestibular and somatosensorysystems. The diagnosis of motion sickness is generally clinical.However, the predisposition to this conditionmay be assessedthrough complementary exams, searching other factors thatcould compromise the systems involved in body balancemaintenance. The Sensory Organization Test allows deter-mine which body balance maintenance system is more in-volved in postural control and hence in cases of motionsickness.

Objective: To assess the body balance maintenancesystems in young women with vestibular and/or neurovege-tative symptoms to movement.

Methods: This is a case-control study consisting of 40female university students aged between 18 and 30 years ofage, of which 20 constituted the study group and 20 thecontrol group.

Results: The study group had a significant differencein relation to complaints of imbalance in daily activitiescompared with the control group (p ¼ 0.022), and had worstperformances in all conditions of the Sensory OrganizationTest with statistical significance in the conditions III(p ¼ 0.004), V (p ¼ 0.033) and VI (p ¼ 0.040). The mostfrequent symptom reported by the study group was nausea(95%). Furthermore, most subjects reported not seeking med-ical help (90%) and no use of medication during the crisis ofsymptoms (65%).

Conclusion: Subjects who reported motion sicknesshad poorer performance on the Sensory Organization Test.Results suggest an association between motion sickness andperformance in maintaining body balance.

Keywords: Motion Sickness; Dizziness; PosturalBalance

A295. Body Pain in Professional Voice Users: VoiceComplaints and Effect on WorkThays Vaiano, Felipe Moreti, Fabiana Copelli Zambon, AnaClaudia Guerrieri, Sophia Mota Constancio, Clara Rocha daSilva, Mila Cruz do Valle, Gisele Gotardi de Oliveira, MaraBehlauCev - Centro de Estudos da Voz

Introduction: The association between body pain andvoice disorder symptoms has been clinically observed but notproperly investigated. Intense voice use in which there is anoverloading of the vocal mechanism, with strained and effort-ful phonation may cause discomfort or even pain whilespeaking.

Objectives: The purpose of this research was to iden-tify, categorize and compare body pains among differentprofessional voice users, their vocal self-assessment, theirvoice complaints and their sick leave history.

Methods: A total of 840 individuals, 591 women and249 men (150 non-professional voice users, 100 popularsingers, 50 classical choir singers, 150 telemarketers, 150speech-language pathologists, 90 actors and 150 teachers)volunteered to participate in this study. They answered a self-assessment questionnaire that investigated voice usage, voicecomplaints and presence of 13 different body pains.

Results: Teachers presented thehighestmean numberof body pains (7.41) and the group of classical singers pre-sented the lowest mean number (2.46). Those with voicecomplaints presented higher means of body pains (5.68)when compared to those without voice complaints (3.76).In addition, subjects that reported sick leavehadhighermeansof body pains.

Conclusion: Specific voice trainingmay play a positiverole in themanagement, development and perception of bodypain in trained professionals, such as classical singer.

Keywords: Voice; Dysphonia; Pain; Protocols

A72. Breastfeeding as Speech Pathology Prevention:Literature Review of SystematicCarolina Lima Martins Gaspar Rocha, Kellyvane Lopes da Silva,Marta M S Lira-BatistaFaculdade de Ensino Superior do Piauí

Introduction: The exclusive breastfeeding for the firstsix months of life consists of a practice recommended by theWorld Health Organization, however factors such as themothers’ return to work and difficulty breastfeeding, havecontributed to early weaning. The speech therapy can developstrategies that encourage breastfeeding promoting the pre-vention of later alterations of the stomatognathic system.

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Objectives: To conduct a systematic review of articlesthat address breastfeeding as the stomatognathic systemchanges.

Data Synthesis: This research has a descriptive, retro-spective, transverse and quantitative character. The SciELOand PubMed databases were consulted from March to April2015. The following Keywords have been used: "breastfeed-ing" AND "Speech" and "breastfeeding" AND "primary healthcare". The following inclusion criteria were defined: articlespublished in the last 05 years and items available. Articles thatdid not address the established themewere excluded from thestudy.

Results: The PubMed database were found 367 ar-ticles, but after the application of exclusion and inclusioncriteria, totaling 28 articles. When queried, the Scielo data-base, found 24 articles, where only 08 met the proposedcriteria. Therefore, 36 articles were analyzed in this study.

Conclusion: The practice of exclusive breastfeeding inthe first six months of life is low, despite the existence ofprograms that promote. Literature has large collection on theintervention of health professionals to encourage and guideabout breastfeeding, however the inclusion of the speechtherapist is still little mentioned.

A604. Care of Dysphonic Patient: Phonotherapy afterLaryngeal MicrosurgeryMaria Francisca de Paula Soares, Ruana Souza Santos, LuanaAndrade SantosUniversidade Federal da Bahia

Introduction: Laryngealmicrosurgery is the approachof choice in many in cases of dysphonia by benign laryngeallesions. Speech therapy association on the immediate postop-erative period may contribute in the following ways: assis-tance in healing; balance in phonatory system and adequacyof vocal use.

Objective: This work aims to characterize the speechtherapy care in cases of laryngeal microsurgery treated atAmbulatório Magalhães Neto (HUPES/Salvador) voice clinic.Methodology: The data was collected from inspection ofmedical records of patients seen from 2011 to 2014. Theinformation analyzed were: gender, age, origin, laryngealdiagnosis, postoperative time, number and consecutivenessof phonotherapy call; abandonment and number of calls tocomplete the case.

Results: On total of 35 cases were analyzed, 31.4% ofmen and 68.6% women, the majority adults (70,4%). Halfpercent of patients were from the countryside and half fromcapital. The most frequent laryngeal diagnoses were: 31.4%polyp: cyst 31.4%; 20% Reinke’s edema. Most of patientsbegins phonotheraphy within 15 days of postoperative(65%), 14.2% begins between 16° and 30° day and 11.4% after30 days. Half of the cases accomplished 4 to 6 calls (51.4%).Most of the cases accomplished consecutives calls (62%). Agreat number of patients abandoned treatment before endingphonotherapy 48.60% and only 31.4% of patients complete thetreatment. Apparently there is no relationship between aban-donment and live in countryside.

Conclusion: Patients who arrived until 15 days atphonotherapy tend to be successful in a short period of time.

Keywords: phonotheraphy, laryngeal microsurgery;dysphonia

A410. Care of the Tinnitus Carrier in the Primary HealthSystemCarla Salles Chamouton, Helenice Yemi NakamuraUniversidade Estadual de Campinas

Introduction: Tinnitus have increased in the lasttwenty years, affecting 25.3% of the population over 60 years.In many cases, tinnitus appears as indicative abuse of hearingimpairment and needs a specialized evaluation. The NationalPolicy Hearing Health of 2004 established a care line thatbegins in primary care.

Objectives: Raise adults and elderly tinnitus com-plaint and identify the lag time and the routing to treatmentin the public health system.

Methods: This is a qualitative and quantitative re-searchwhich sample consists of 35members, of both genders,30 to 90 years, users of a health center of a large city in thestate of São Paulo. The individuals selected attend the service,have tinnitus and underwent speech therapy. Data werecollected from medical records, statistically analyzed andcategorized by the repetition and relevance of information.

Results: The most frequent is high-pitched tinnitus(n ¼ 21) in women (n ¼ 23), mean age of 63.17 years, withcomorbidities (n ¼ 22) and hearing loss (n ¼ 23). Averagetime of tinnitus was 55.89 months. Average time betweenentry into service and the emergence of the complaint was185.82 months and average of passages in service was 28.85.

Conclusion: Age and comorbidities appear as risk fortinnitus in the population studied. The lack of knowledgeabout the carewith tinnitus carrier by thehealth professionalsand the difficulty in articulation with specialty in publichealth system, favor a significant lapse between the onset ofthe complaint and its approach to service.

A73. Case Report - Specific Language Impairment in theFamilyMarta Gonçalves Gimenez Baptista, Beatriz Cavalcanti deAlbuquerque Caiuby Novaes, Sulene Pirana, Ana Clelia deOliveira RochaPuc-SP

Introduction: Clinical cases of Specific Language Im-pairment (SLI) are frequently reportedwith similar symptomsoccurring in other family members. It can be suggestive offamiliar predisposition when, as found in the literature, therearemore than one case in the same family.With technologicaland research progress in image techniques, there will proba-bly answer many questions raised in the process of diagnosis.In addition, increasing access to information on genetic factorscan shed light on how hereditary factors can interfere in someSLI cases. Objectives: To describe cases of siblings and cousinswith diagnosis of SLI that have been in therapy and arefollowed by speech pathologists and phoniatry MD. It is ourintent to describe difficulties occurring during treatment andclinical history, emphasizing family issues.

Resumed Report: Siblings and cousins in speech-language therapy with language delay and severe praxicdifficulties, presenting childish speech.

Conclusion: SLI children within the same family arenot rare. It can be suggested that for favorable results, treat-ment main steps are: speech disorders interference in familydynamics; phoniatric assessment as a baseline for treatment;demystify guilt issues related to transmission of speech dis-orders and therapy proposal focusing on speech symptoms.

Keywords: speech disorders, case studies, language

A1716. Case Report: Masking Situation as a DifferentialDiagnostic in a Psychogenic DysphoniaKariny Zencke da Silva, Eduarda Oliveira Cunha, Gabriela daCunha Pereira, Mauriceia CassolUniversidade Federal de Ciências da Saúde de Porto Alegre

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Introduction: Psychogenic Dysphonia is character-ized as loss of voice or changes of different acoustic character-istics due to a process of psychological inhibitionwith absenceon presenting changes on the vocal folds structure or neuro-logical alterations.

Objective:Report a case of PsychogenicDysphonia in aHospital with Speech Pathology Service through public healthsystem.

Resumed report: It was approved by the ResearchEthics Committee of Santa Casa under protocol n.1.009.545. C.L.A.S, 55 years old, female, indicated to the service withhistorical of dysphonia during 4 months, and no results tothe use of corticosteroids and anti-allergenic. During the firstevaluation, the patient presents sudden breaking voice as aprincipal complaint. After application of Voice Handicap Index(VHI), it was observed predominant organic emotional score.In the Hospital Anxiety and Depression Scale (HADS) scoredhigher for anxiety (8 points) than depression (4 points). Theauditory-perceptual analysis showed change in the vocalpatterns, from no alterations to breathiness and roughnessduring the sustained vowel sample and connected speech. In amasking situation, it was observed normal parameters ofvoice, different from the first assessment. Subsequently, theresults after therapeutic proof confirmed the PsychogenicDysphonia.

Conclusion: In the assessment of voice is important acareful analysis of the vocal patterns during spontaneoustalking comparing to the voice recorded, excluding the pres-ence of changes on the vocal folds structure. Fluctuations invocal emissions lead to the diagnostic of Psychogenic Dyspho-nia. The Masking Situation is the major contribution to thediagnostic.

Keywords: Psychogenic; Voice; Masking

A298. Case Study: Auditory Training in Hearing Aid UserAline Albuquerque Morais, Tatiane Eisencraft ZalcmanFonoaudiologia Pinheiros - Fopi

Introduction: Sensorineural hearing loss decreasesthe proper perception of acoustic parameters of sounds(frequency, intensity, duration) and therefore can compromiseauditory skills. In such cases, the audiologist interventionshould include both the sound amplification as the improve-ment of auditory skills (through Auditory Training - AT),targeting the full auditory rehabilitation which should reflectin an effective improvement of communication and quality oflife.

Objectives: Training auditory skills of a hearing aid(HA) users with auditory processing disorder.

Methods: Female, 36, bilateral and moderate sensori-neural hearing loss. She was bilaterally adapted with a recep-tor in channel HA by 2 years and had a persistent complainingof speech understanding in noise. In the initial auditoryprocessing assessment was detected poor performance inhearing in noise, dichotic listening and temporal resolution.Ten ATsessions were heldweekly, with an average duration of50 min in a soundproof booth. It were also used specificsoftwares, as well as guidelines of activities to be performedat home and communication strategies. Besides the evaluationof the auditory skills, before and after AT it was applied a self-assessment questionnaire Abbreviated Profile of Hearing AidBenefit (APHAB).

Results:After the TAwas observed an improvement ofall trained auditory skills and decrease of hearing complaints(verified by a better score in all APHAB scales).

Conclusion: The AT proposed was able to optimizecommunication of the individual in difficult listening situa-

tions, such as in the presence of competitive speech, resultingin real-life benefits for everyday communication.

A382. Central Auditory Processing: Implications forTranslation Process from Portuguese to Brazilian SignLanguageMariana de Oliveira Costa, Marisa SacaloskiCentro Universitário das Faculdades Metropolitanas Unidas - Fmu

Introduction: Auditory Processing consists of detect,store and retrieve linguistics and non-linguistics sounds, inother words, it accounts the relation between central andperipheral auditory functions. Indeed, there is a possibility toconsider a connection between functional system quality andvisogestual translation competence. Interpreters of BrazilianSign Language (BSL) / Portuguese must have aptitude forrealize simultaneous and consecutive interpreting with pro-ficience between different linguistic modalities, visogestualand auditory modalities. This flux between linguistics modal-ities incites reflections about the role of auditory processing intranslation process.

Objective: To evaluate influences of auditory process-ing tests’ results from a group of sign language interpretersover the visogestual speech translated.

Method: The sample consisted of 14 interpreters ofBSLwhowhere submitted by 11 auditory processing tests andevaluation of filmed visogestual speech. The subjets weredivided in G1–satisfactory level of translation proficiency –and G2–unsatisfactory level of translation proficiency. For thestatistical analyses, Mann-Whitney test and two proportionequality test were used.

Results: Significant statistical differences were ob-served between the groups for the Duration Pattern Testand Non-Verbal Dicotic test, the difference was caused byworst performing from G2.

Conclusion: The level of proficiency in translation andinterpreting from G2 were influenced by non-verbal gnosisdeficit, which were detected by Duration Pattern Test andNon-Verbal Dicotic test. Findings seem to reveal non-verbalgnosis deficit is a conditional item to realize effective paralin-guistics aspects comprehension in the oral speech which willbe interpreting.

Keywords: Auditory Processing, Translation Process,Bilingualism

A453. Cervical Vestibular Evoked Myogenic Potentials inNormal Listeners without Vestibular ComplaintsThaísa Rodrigues Brusco, Laura Flach Schwade, FranciscoCarlos Zuma e Maia, Pricila SleiferUniversidade Federal do Rio Grande do Sul

Introduction: Cervical Vestibular Evoked MyogenicPotentials are composed by myogenic responses activated bysound stimulation registered by surface electromyography,which assesses the saccule, the vestibular inferior nerve, thepathways related to the vestibule-spinal descendant nervesand the motoreurons of the sternocleidomastoid muscle.Because it is a complement in the otoneurological assessment,it is necessary to know this exam’s patterns of normality.

Objectives: To compare the latencies and amplitudesof the Cervical Vestibular Evoked Myogenic Potential wavesbetween ears and genders.

Methods: Were assessed 20 normal listener adultswith no vestibular complaints, 10 men and 10 women. Theequipment usedwas the Eclipse-Otoacess, from Interacoustic.Were performed 200 tone burst incentives, with 500Hzfrequency and an intensity of 100dBHL, band-pass filter

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from 20Hz to 2000Hz. The obtained tracings were analyzedover the first biphasic potential.

Results: There was no statistically significant differ-ence between the amplitudes and latencies between thestimulated ears (p ¼ 0.098), as well as gender (p ¼ 0.128). Itwas found that the median latency of the positive peak was15,67ms and the median of the negative peak was 26.67ms.

Conclusion:Was verified that there was no statisticaldifference in the latencies and amplitudes of waves betweengenders and ears. Cervical Vestibular Evoked Myogenic Po-tential proved to be a reliable exam in order to support thetopodiagnosis of otoneurological pathologies.

Keywords: Vestibular Evoked Myogenic Potentials;Evoked Potentials; Vestibular Function Tests

A242. Changes in Hearing Thresholds in Cancer TreatmentPriscila Feliciano de Oliveira, Erica Crislane Omena de Lima,Aline Cabral de Oliveira Barreto, Nuala Catalina Santos Habib,Vanessa Menezes de Jesus, Cris MagnaUniversidade Federal de Sergipe

Introduction: Che:motherapy and radiotherapy hasenhanced the survival of patients with neoplasia, but thesetreatments have ototoxic effects. Irreversible hearing lossduring the treatment is reported by the literature that showsa great variability in the incidence of ototoxicity. Follow uphearing thresholds until the end of the medical procedure isessencial to have an early diagnosis. AIM: Assess changes inhearing thresholds in patients undergoing cancer treatment.

Method: Prospective clinical study carried out atOncology in a Public Hospital of Sergipe. Audiological evalua-tion (Pure Tone Audiometry) and speech audiometry wereperformed in 27 patients. It had been approved by the Ethicsin Research Committee, under protocol # 0066.0.107.000-11.

Results: Females and breast cancer exhibited thehighest incidence (68% and 44%, respectively). Almost 35%had sensorioneural hearing loss in the first and second test.The analysis of hearing thresholds, there was a slight worsen-ing for all test frequencies in sequential test, but there wassignificant difference only for the frequency of 4 kHz(p ¼ 0.004). Of these, 16% showed emergence and 18% aggra-vation of hearing loss. Tinnitus was themost complain (81.3%)of all , but there was no statist correlation between hearingloss (p ¼ 0.89).

Conclusion: Cancer treatment lead to a sensorioneu-ral hearing loss and the frequency of 4 kHz had a significantworsening during the treatment. Hearing monitoring re-vealed that there are cases of triggering and worseninghearing loss.

Keywords: ototoxic effects, hearing loss, cancer

A347. Characteristics of Breastfeeding of PrematureNewborn Infants Before the Hospital DischargeSheila Tamanini de Almeida, Paula Colvara de SouzaUniversidade Federal de Ciencias da Saude de Porto Alegre

Introduction: Thebreastfeeding in pretermnewbornsis considerate a dificult point in neonatal care unit becausethose newborns have a incomplet oral development.

Objectives: to investigate the characteristics of breast-feeding in preterm newborns before hospital discharge.

Methods: a pilot study not probabilistic, observation-al, descriptive. The convenience sample was composed of 12mother/baby pairs, internal to a Neonatal Intensive Care Unit.It was performed the suckling observation by means of formadapted for evaluation of breastfeeding in preterm infants.The behavior of the couple was recorded, noting the favorable

and unfavorable aspects of breastfeeding. In addition, datawere collected from medical records of the mother and thebaby and applied a questionnaire with the mothers.

Results: all the mother/baby pairs evaluated pre-sented at least one unfavorable aspect of breastfeeding,with emphasis on those related to the signs of maternal/newborn and for the positioning of the mother/baby duringbreastfeeding (50%). The rooting reflexwas presented the bestindex of favorable behavior (91.66%). There was a statisticallysignificant association (p< 0.05) between the finalization ofthe feed and the transition time to probe for oral diet full.There were no other significant differences between theaspects of breastfeeding and the variables related to theprofile of mothers, conditions of labor and puerperium.

Conclusion: difficultieswith breastfeeding of mother/baby pairs most observedwere the anatomy changes from thebreast, pain while breastfeeding, little standalone standard ofpreterm, inadequatewayof holding thebreast and presence ofsigns of discomfort.

Keywords: Suction, preterm, fonoaudiology

A688. Characteristics of Literary Works on CochlearImplants in the Last Ten YearsAna Carolina Iacuzio ClaroFaculdades Metropolitanas Unidas - Fmu

Introduction: The studies on the social aspects are ofutmost importance to better serve the implanted patients andtheir families.

Objectives: Characterize the literary works producedon the Cochlear Implant in the past decade in Brazil.

Data Synthesis: To obtain data, held compilation ofworks available in the Library Vitual Health, in Medline, Lilacsand Central databases using the keywords cochlear implant,full texts in Portuguese and English. The texts that referred toother repeated themes were raised or not found 78 texts andafter reading and analysis were discarded. The remaining 65full text papers were classified according to originality, inter-ference in the study, type of unit, follow-up period, direction-ality, study type, number of subjects and the issues addressed.Preliminary results revealed that most jobs were primary(77%), interventional (40%) of longitudinal segment(28.95%), clinical research (87%) and prospective (68%). Asfor themes, found papers on the performance of CochlearImplant (43%), surgery (20%), anatomical descriptions andsyndromes (19%) and social aspects involving implanted(18%). Regarding the number of subjects analyzed, the themeCochlear Implant performance involved, according to datapresented, 1,670 subjects, in aspects related to surgery wereinvolved 1648 subject in anatomical studies and syndromic408 pieces or made subject of the research and the socialaspects involving implanted with the participation of 199subjects.

Conclusion: These findings suggest the need for fur-ther studies in areas related to social, since we observed areless addressed issues if we compare his scientific productionwith the other themes.

A305. Characterization of Swallowing Patients with Headand Neck Cancer Undergoing RadiationtherapyLidia Lis Tomasi, Amanda Lupatini, Isadora SilvestrinStrassburg, Eduardo Matias dos Santos Steidl, RenataMancopesUniversidade Federal de Santa Maria

Introduction: the radiotherapy in head and neckcancers can taking a different disorders, as it’s a complex

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region and composite for not similar structures that responddifferently to radiation. Among these disorders, mechanicaldysphagia may be present, due to fibrosis of the muscles andsoft tissues of the larynx and pharynx.

Objectives: This study aimed to characterize the de-glutition of subjects with head and neck cancer undergoingradiotherapy.

Methods: Consultation was conducted to the deglu-titon conditions on database of patients seen by the SpeechTherapy Blood- Oncology Service at a university hospital inthe period from March 2012 to September 2014. The speech-language diagnosis, obtained through the Risk AssessmentSpeech Therapy Protocol for Dysphagia, and the level of oralintake, assessed by the Functional Oral Intake Scale, wascollected.

Results: the sample consisted of 30 subjects with amean age of 58,86 years, 26 males and four females. Normaldeglutition was more frequent and among the swallowingdisorders, to moderate dysphagia had a higher incidence.Regarding the level of oral intake for the majority of patientswas suggested total orally without restrictions.

Conclusion: concluded from this study that althoughradiotherapy is associated with deglutition dysfunction, thesample evaluated showed higher incidence of normal swal-lowing and unrestricted oral route.

A460. Children’s Auditory Performance Scale (C.H.A.P.S)Questionnaire: Cross-Cultural Adaptation to BrazilianPortugueseCaroline Donadon, Christiane Marques do Couto, SthefanyNáthaly Ferraresi Rodrigues Pinto, Maria Francisca Colella-SantosUnicamp

Introduction: The language develops a main role inthe perceptual organization, reception and structuring ofinformations and also in learning process. This way, it isnecessary a health auditory system. One of the ways to detectand identify a person with auditory disorder is throughauditory screening. It can be accomplished with question-naires. Between these questionnaires, we highlighted theChildren’s Auditory Performance Scale (CHAPS).

Objectives: To translate and adapt culturally theCHAPS questionnaire to brazilian portuguese and apply it toverify its effectiveness.

Methods: A cross sectional study. A new translationand cultural adaptation process of the questionnaire wasrealize folowing the guidelines: initial translation stages;synthesis of the translation; retro translation; experts com-mittee and final version. The individuals (7 to 14 years old),without hearing and/or school complaints, underwent tobasic audiologic evaluation and dichotic digit test. The trans-lated and adapted version of the questionnaire CHAPS wasapplied in 20 parents of these individuals.

Results: During the translation and cultural adapta-tion process of the questionnaire to brazilian portuguese,semantic and idiomatic modifications were realized. Thecommittee members agreed in 84% with the cultural adapta-tion of the questionnaire. It was verified that in the noise andmemory auditory tasks, 10% of the individuals presentedresults “risk zoneâ€ for possible school difficulties.

Conclusion: The Brazilian version of the CHAPS wassubmitted for all steps of the cultural adaptation process, itwas obtained substantial support for its content validationaccording to semantic-idiomatic, cultural and experimentalequivalences criteria.

A360. Clinical and Speech Therapy Features in GoltzSyndrome: A Case ReportAndréa Tortosa Marangoni Castan, Juliana Nogueira Chaves,Tyuana Sandim da Silveira Sassi, Luiz Fernando ManzoniLourencone, Bárbara Cristiane Sordi Silva, Marinna Borges deOliveiraUniversidade de São Paulo (USP)

Introduction: Goltz syndrome is a rare genetic dis-ease characterized by skin, eye, dental abnormalities, affectingthe urinary, cardiovascular, gastrointestinal, skeletal and ner-vous systems as well. Its etiology is believed to derive from 24different geneticmutations in the PORCNgene located in the Xchromosome.

Objective: To describe the clinical and speech therapycharacteristics of a child presented with Goltz syndrome.

Resumed Report: This 12-year old female patient,diagnosed with Goltz syndrome and seen by the professionalstaff of the Craniofacial Anomalies Rehabilitation Hospital â€“University of São Paulo, presented the following features onthe right side: alopecia in the frontal area, microphthalmia,blindness, narrow ear canal, notched nasal alae, scaly skin,hypoplastic nipple, ectopic kidney, foot ectrodactyly, aswell astoe ungueal dysplasia. She presented facial asymmetry, largeprominent ears, scoliosis and dental malocclusion, undergo-ing surgery due to omphalocele and syndactyly. Delay in theneuro-psychomotor development of speech and languagewasobserved. The audiology assessment showed severe unilateralmixed right hearing loss, tympanometric type A curve in bothears, as well as the absence of contra-lateral stapedial acousticreflex and ipsilateral bilaterally.

Conclusion: Few studies were found in the literature,highlighting hearing impairment in Goltz syndrome. Hearingloss can occur as a result of this syndrome, thus, the diagnosisand monitoring by a multidisciplinary team is paramount, inorder to avoid or minimize the consequences of auditorydeprivation and provide patients with a better quality of life.

Keywords: Focal dermal hypoplasia, Hearing loss,Child

A564. Clinical Evaluation of Swallowing in InstitutionalizedBedridden PatientsMaira Rozenfeld Olchik, Sabrina Vilanova Cardoso, AnneliseAyresUniversidade Federal do Rio Grande do Sul (Ufrgs)

Introduction: Elderly people go through several ana-tomical and functional changes that may affect the stomatog-nathic system - their structures and functions. Among these,swallowing disorders are common and significant, and canhave serious implications for the elderly, as for example,malnutrition, dehydration, tracheal aspiration and, conse-quently, aspiration pneumonia.

Objective: To correlate the structural alterations of thestomatognathic systemwith swallowing and dysphagia alter-ations in bedridden institutionalized elderly patients.

Methods: It was conducted phonoaudiological evalu-ation of swallowing through the Protocol for bedside clinicalevaluation (Carrara-de Angelis, 2010), in bedridden elderly, ofboth genders, from August to November 2012. The dataanalysis was performed by SPPS 18.0 for Windows, thesignificance level established was 5%.

Results: The sample was composed of 46 elderly,56.5% female, with an average age of 83.3 years (� 10.9)and 43.5% dental prosthesis users. It was observed that30.4% of patients had swallowing alteration and 13% dyspha-gia. It was realized the crossing between the evaluation itemsof stomatognathic structures with the alteration of

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swallowing and dysphagia. Therewas a significant associationbetween the diadochokinesia changes in the palate (p-value¼ 0.04) and mandible (p-value ¼ 0.005) with swallowingalteration. A significant association between lip sensitivityalterations (p-value ¼ 0.007), tongue (p-value ¼ 0.012) anddiadochokinesia of the jaw (p-value ¼ 0.034) with dysphagia.

Conclusion: It is observed that structural alterationsof the stomatognathic system are directly related to swallow-ing and dysphagia changes, although the structures involvedare not the same.

A565. College Student’s Perception of Esophageal andTracheoesophageal VoiceMichelle Ferreira Guimarães, Kamilla Guerra dos Santos,Juliana PortasUniversidade Federal do Espírito Santo

Introduction: Total laryngectomy is an effective treat-ment for patients diagnosed with laryngeal cancer. After thesurgery, the patient should be referred to the speech therapyin order to develop a new form of communication, whether byesophageal voice, electronic larynx or tracheoesophagealvoice.

Objective: Verify college students’ perception ofesophageal and tracheoesophageal voice.

Methods: The sample consisted of 100 college stu-dents who were asked to evaluate, using the Vocal QualityRating Scale, the pleasantness level of the voices of patientsundergoing total laryngectomy whose use esophageal ortracheoesophageal voice to communicate. The assessment ofvoice quality occurred in twomoments: before and after beinginformed about the historical disease reports.

Results: 90% of the students rated the esophagealvoice as unpleasant and 10% as acceptable. After knowingthe patients disease stories, 29% of the students rated thevoices as unpleasant, 64% as acceptable and 7% as pleasant;72% of the students rated the tracheoesophageal voice asunpleasant and 28% as acceptable. After knowing the diseasestories, 22% rated the voices as unpleasant, 65% as acceptableand 13% as pleasant.

Conclusion: In the first moment the students ratedthe voices, both esophageal or tracheoesophageal, as unpleas-ant. Once they were informed about the patients diseasestories they rated both voices as acceptable.

Keywords: Communicate; Empathy; Laryngectomy;Speech Perception; Voice Quality

A290. Comparison of Clinical and VideofluoroscopicEvaluation of Swallowing in Children with SuspectedDysphagiaLenice de Fatima da Silva Munhoz, Karina Elena CadioliBernardis Buhler, Suelly Cecilia Olivan LimongiHospital Universitário da Universidade de São Paulo

Introduction: Studies which verify the accuracy ofclinical evaluation of swallowing in children are few.

Objectives: Toverify the accuracyof clinical evaluationcompared with videofluoroscopic swallowing studies in thedetection of isolated laryngeal penetration and laryngealaspiration in children with suspected dysphagia; to identifyclinical signs and symptoms associatedwith isolated laryngealpenetration and laryngeal aspiration; and to determine thesensitivity and specificity of the clinical signs and symptomsidentified.

Methods: Retrospective analysis of data from clinicaland videofluoroscopic evaluations carried out in 55 childrenfrom 1 month to 7 years and 11 months old. To clinical

evaluation, the “Protocol for Clinical Assessment of PediatricDysphagia” was used. Sensitivity and specificity of clinicalevaluation were analyzed. To statistical analysis, Chi-squareand Fishe’s Exact Tests were used.

Results: Clinical evaluation showed, in general, sensi-tivity of 86% (95% CI:78-94) and specificity of 32% (95% CI:15-47). For isolated laryngeal penetration, clinical evaluationshowed sensitivity of 88% (95% CI:69-98). For laryngeal aspi-ration, clinical evaluation showed sensitivity of 86% (95%CI:70-96). However, specificity values were low for bothalterations. There was no association between clinical evalua-tion and videofluoroscopic findings (p ¼ 0.119). Choking wasassociated with isolated laryngeal penetration thin fluid(p ¼ 0,044) and showed sensitivity of 53% (95% CI:31-73)and specificity of 77% (95% CI:65-87%).

Conclusion: Clinical evaluation was sensible to detectisolated laryngeal penetration and laryngeal aspiration inchildren with suspected dysphagia, however, showed lowspecificity. Choking was the only clinical sign associatedwith isolated laryngeal penetration thin fluid and showedspecificity higher than sensitivity.

A555. Contribution of the Standard Uncertainties of Types Aand B in the Measurement Uncertainty of the Pure ToneAudiometry for Air and Bone ConductionDenise Torreão Corrêa da Silva, Doris Ruthy LewisPontifícia Universidade Católica de São Paulo - Pucsp

Introduction: All measurement results can only beconsidered completewhen coupled uncertainty statement. Toexpress the measurement uncertainty of pure tone audiome-try the ISO 8253-1:2010 proposes a functional model thattakes into account types A and B standard uncertainties.

Objective: To analyze the contribution of type A and Bstandard uncertainty to the uncertaintymeasurement of puretone audiometry.

Methodology: Accuracy tests were performed underconditions of repeatability (same measurement procedure,operator, measurement system, operating conditions andsame site, in a short period of time). Each of the five partic-ipants was submitted to two experiments with five repeti-tions of audiometry by air (250Hz to 8kHz) and bone (500 Hzto4 kHz) conduction. To calculate the combined and expandeduncertainties type A uncertainty (repeatability), and Type B(audiometer calibration certificate, resolution of the audiom-eter, and conditions of the test environment) uncertaintieswere considered.

Results: There were no statistically significant differ-ences within and between participants in different timeintervals. Type A uncertainty ranged from 0dB to 2,7dB byair conduction and 0dB to 2,2dB by bone conduction. Type Buncertainties were 0,4dB (calibration certificate), 1,4dB (res-olution), and 5dB (test environment). For a 95% confidenceinterval expanded uncertainty ranged from 10dB to 12dB forair conduction, and 10dB to 11dB for bone conduction.

Conclusion: The contribution of type B uncertaintieswas predominant, indicating the need to control these vari-ables, aiming at the reliability of the audiometric results inview of its wide use in the health, labor and social securityareas.

A300. Critical Analysis on Artificial Mastoid CalibrationCertificatesViviane Fontes dos Santos, Zemar Martins Defilippo SoaresInstituto Nacional de Metrologia,Qualidade e Tecnologia - Inmetro

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Introduction: Patient safety is the objective of Reso-lution 36/2013 of the Brazilian Health Surveillancy Agency.Health professionals who use medical equipment must becareful with the calibration of these. For calibration of theaudiometer is required different measurement instrumentsincluding artificial mastoid. It must be calibrated annually inthe Inmetro, to be the reference standard for calibration ofbone conduction audiometers.

Objective: This paper presents a national perspectiveof the quality of results in the calibration on artificial mastoidused in the calibration of audiometers.

Methods: Documental analysis of calibration certifi-cates of artificial mastoid that were calibrated over a period of4 years in Eletroacoustics Laboratory of Inmetro.

Results:Were analyzed 105 artificial mastoid calibra-tion certificates of 28 laboratories service provider audiome-ter calibration service in Brazil. 78% of the evaluated mastoidshowed non-compliance with IEC 60318-6. Another result isthat a lot of artificial mastoid returning for annual calibrationrepeats the same non-compliance.

Conclusion: Some service providers in the audiometercalibration area not care about taking corrective actions totreat non-compliance of the artificial mastoid and continueoffering the calibration service. Artificial mastoid that do notmeet the requirements compliance of the IEC 60318-6 maycompromise the calibration of bone conduction and conse-quently to change the results of audiometric test may cause afalse air-bone gap.

A331. Current Overview of Brazilian Scientific Publicationsin the Field of Hearing AidsAnderson Alves da Silva Pereira, Tiago de Melo AraujoFaculdade de Tecnologia Intensiva

Introduction: The constant improvement of hearingaids technology has contributed for this process (from theselection to the effectiveness of treatment) to become apermanent challenge for hearing rehabilitation professionals.Alongside this progress, there is the growth of scientificresearch in the area, which proposes new horizons, exploringthe necessary paths to improve quality of life and contribute tothe excellence of Brazilian Audiology.

Objective: To analyze the current state of Brazilianscientific publications in the field of hearing aids.

Data Synthesis: Searches were performed (in theelectronic databases Scielo, Lilacs and Medline) to find Brazil-ian scientific publications in the year 2014. The keyword usedwas "hearing aids". 25 articles were found, but three weredeleted after reading the abstract, because despite using thesaid keyword, these articles approached different subjects. Ofthe 22 studies analyzed, there was predominance (68%) ofresearch conducted in the Southeast region of Brazil, and theelderlywere themost studied population (63%). Regarding theobjectives of these studies, we can highlight themeasurementof success with sound amplification and its relationship toquality of life (23%), issues of translation, adaptation andverification of the reliability of questionnaires aimed at thechild population, investigation of technical failures of hearingaids and speech and language aspects of hearing impairedpeople (36%).

Conclusion: Recent studies have shown the interest ofresearchers in two areas: treatment effectiveness and publicpolicy, as the replacement of hearing aids is increasing and iscostly to the public health system.

A635. Detection, Time of Deprivation and Main ComplaintsReported by Subjects Diagnosed with Unilateral HearingLossMarina de Marchi dos Santos, Maria Renata José, MariaFernanda Capoani MondelliFaculdade de Odontologia de Bauru - Universidade de São Paulo

Introduction: Unilateral hearing loss is characterizedby decreased hearing in one ear affecting mainly the soundlocalization and subjects find more difficulties than theirnormal hearing counterparts to understand speech in thebackground noise.

Objective: Relate the unilateral hearing loss with earpredominance, age detection of deprivation and main com-plaints related to hearing loss.

Methods: Ethical approval: process n°168/2011 (FOB-USP). Were assessed 279 medical records of subjects enrolledin the Clinic of Speech Pathology and Audiology (FOB/USP)andAuditoryHealthDivision (HRAC/USP). The study inclusioncriteria were: diagnosis of unilateral hearing loss of any type(conductive , mixed or sensorineural) and degree (mild,moderate , severe and profound).

Results: Were analyzed 718 medical records in bothservices, and 279 followed the inclusion criteria. The subjectsaged between 4 to 88 and the average age of detection ofhearing loss varied between 1 to 81 years. It was observed nopredominance on the right (46,88%) or left ear (47,84%), inother words, there was no statistically significant differencebetween the sides of sensory deprivation. Isolated tinnitus, oraccompanied by vertigo, aswell as exposure to noise, were themain complaints related to hearing loss, reported by 97.71 %of the sample.

Conclusion: The subjects aged between 4 to 88 andthe average age of detection of hearing loss varied between 1to 81 years. There was no predominance of laterality ofhearing loss and the main complaints of subjects in thissample were tinnitus, vertigo and exposure to noise.

A376. Development of a Self-Perception Questionnaire: ThePerformance of Using Hearing AidsGeise Corrêa Ferreira, Sineia Neujahr dos Santos, Maristela JulioCostaUniversidade Federal de Santa Maria

Introduction: Procedures to measure user perceptionof hearing aids with different settings make valuable tools toassist in choosing its best programming.

Objectives: Develop a questionnaire easy to apply, toinvestigate the perception of performance with differentschedules hearing aids and verify its adequacy andreproducibility.

Methods: To provide the perception of different set-tings of hearing aids (directionalmicrophone activation or notand noise reduction) in different situations of daily life, withand without noise, six questions were prepared to measuredifferent spatial perceptions of sounds and different noiselevels. A pilot study was conducted with fifteen new hearingaid users. From this study, it was made adjustments tofacilitate understanding and the way answers should bescored as well as its reproducibility.

Results: The questions comprehend communicationsituations in familiar environment in silence and noise;speech perception for television or radio; in noisy internal,external and reverberant environments. Each question hadfive options of closed answers, which were converted intonumerical scales. The minimum score was six, and the maxi-mum 30; the higher score indicates better communicationperception in each environment. The issues were analyzed

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and compared, and it was not found statistically significantdifference.

Conclusion: It was developed a self-perception ques-tionnairewith six questions that is adequate and capable to bereproduced in target population.

Keywords: Questionnaires, hearing aids, speechdiscrimination

A169. Dichotic Sentence Identification Test in ElderlyAlessandra Luana Schwantes, Bruna Pias Peixe, FernanadaFreitas Vellozo, Quemile Pribs Martins, Taissane RodriguesSanguebuche, Michele Vargas GarciaUniversidade Federal de Santa Maria

Introduction: The Dichotic Sentence IdentificationTest (DSI) enables to evaluate the central hearing abilities asa figure-background via binaural separation and integrationusing synthetic sentences.

Objective: Describe the reference values for the DSITest in Elderly.

Materials and Methodology: A group of 36 subjectwere evaluated, being 6 excluded because they presentedasymmetry between the ears. Thus, the samplewas composedby 30 elderly (22 female and 8 male), mean of 66.5 years-old,presenting from normal to moderate bilateral sensorineuralhearing loss. The whole sample was subjected to Anamnesis,Acoustic Meatus Inspection, Pure-Tone Threshold Audiome-try, Logoaudiometry, Acoustic Immittance and DSI.

Results: The following results are preliminary of astudy in progress. Regarding the hearing, 63.3% of elderlypresented normality, mean of 17.29 dB for the right ear (RE)and 16.08 dB for the left ear (LE); and 36.6% presentedmild tomoderate symmetric bilateral hearing loss, mean of 41.76 dBfor the RE and 40.45 for the LE. Among the subjects, 24 (80%)realized the exam and 6 (20%) were unable to realize it,because they presented ophthalmological disorders or hadlower scholar levels. The founded values were around 67.5%for RE and 58.33% for LE in the training track, 71.66% for RE and80% for LE in the binaural integration track and 85.41% in bothears in the directed hearing.

Conclusion: It was possible to realize the DSI test inmost elderly evaluated and the foundedvalues can be used as areference for this population.

A377. Distortion Product Otoacoustic Emissions of CollegeMusiciansVitor Della Rovere Binhardi, Ana Claudia Vieira Cardoso,Moniane Aparecida Sumera, Isabella Bonamigo da Silva, ArianeBarros Oliveira, Vitor Engrácia ValentiUniversidade Estadual Paulista "Júlio de Mesquita Filho" - Unesp

Introduction: Young people playing in college bandsare exposed to high sound pressure levels and this exposurecan cause damage to the hearing system.

Objective: To analyze distortion product otoacousticemissions of musicians.

Method: Cross-sectional, descriptive and prospectivestudy, developedwithmembers of collegebattery. The sampleconsisted of 19 musicians of both sexes, aged between 19 and26 years (mean age of 21.4 years) with an average of exposuretime of 1.9 years. Hearing assessment consisted of distortionproduct otoacoustic emission (DPOAE). Otoacoustic emissionswere performed using Biologic equipment and were capturedby presenting stimuli in two intensity levels (L1 and L2), 65and 55 dB respectively, evaluating the frequencies between2000 and 8000 Hz. The emissions were analyzed consideringsignal / noise ratio and classified as "present or absent".

Results: DPOAE analysis showed that 10 (52.6%) bat-tery members had presence of response at all frequenciestested, on both ears. The frequency with the highest rate ofresponses (92.1%) was 2000 Hz and, with the lowest rate(78.9%), 4000Hz and 6000 Hz.

Conclusion: Despite the short period of exposure tohigh sound pressure levels, it was observed that collegemusicians exhibited changes in cochlear function.

Keywords: Otoacoustic emission; Noise; Hearing

A34. Distress Suffered by Tinnitus Clinic OutpatientsAndressa Colares da Costa Otavio, Adriane Ribeiro Teixeira,Alexandre Hundertmarck Lessa, Letícia Petersen SchmidtRosito, Celso Dall’IgnaUniversidade Federal do Rio Grande do Sul (Ufrgs) Hospital de Clínicasde Porto Alegre (Hcpa)

Introduction: The Tinnitus Handicap Inventory is aquestionnaire for assessing the impact of tinnitus by quanti-fying psychoemotional and functional problems it causes.Objectives: The objective of the study was to analyze answersto the THI in a group of subjects treated at a tinnitus outpatientclinic in a tertiary hospital.

Methods: quantitative, cross-sectional, descriptiveand observational study. Chronic tinnitus patients treated inan outpatient clinic took part. This study was approved by theResearch Ethics Committee.

Results: 683 subjects with a mean age of 59.3 � 5.7years participated. In the overall score, a mean of 37 � 29.7points, with a minimum value of 0 and a maximum value of100 was found. With respect to the level classification ofdistress caused by tinnitus, 18% had negligible distress,26.8%mild, 24%moderate, 18.9% and 12.3% severe catastroph-ic distress. The score analysis according to the age showedsignificant negative correlation, suggesting that the youngerthe individual, the higher the THI score, namely, the greaterthe distress degree (r¼ -0.168, p < 0.001). The score analysisconsidering gender showed no statistical difference betweenthe average score obtained by men and women (p ¼ 0.97).

Conclusions: Data analysis showed that the majorityof evaluated patients had tinnitus distress from mild tomoderate, and the distress level was influenced by age, butnot by gender.

Keywords: tinnitus; questionnaires; age groups; dis-tribution by age and sex

A663. Distribution of Hearing Aids for Elderly in the Servicethe Sergipe StateScheila Farias de Paiva, Sulamita Cysneiros das Chagas Santos,Genef Caroline Andrade RibeiroUniversidade Federal de Sergipe

Introduction: According data the OMS, more than 15million Brazilians have hearing loss. In the last years publicservice expanded access to audiological care through thedeployment of networks of patient care with hearing loss,contemplating from the promotion of hearing health tospeech therapy.

Objective: To present a mapping of elderly patientsusers of hearing prosthesis who are attended at public audi-tory health services in Aracaju.

Method: Transverse and retrospective observationaltype of study through individual records attended fromJanuary to march of 2014, with 60 or more years of ageattended at the high complexity Services at the Health Hear-ing São José Hospital in the city of Aracaju.

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Results: The data shows that 58% of treated cases arein the state interior, 35% the state capital, followed by patientsNossa Senhora do Socorro city, with 5% the cases and Itabaianawith 2% of the total sample.

Conclusion: We realized the organization of threelarge groups. The first tomost of patients living inmunicipali-ties further the interior Sergipe state, followed by the residentpopulation in the capital and after to the cities with largerpopulation and development located closer to the capital. Itconcludes that despite the proximity geographic the capitalthe largest distribution focuses on population resident in theinterior state making more proportionate and allowing allstate access to assistive technology in the listening area.

A669. Drives Vocals: Diverted Voices / Changed? Or SchemesVocals Compounds?Lauro Ariel Coelho da SilvaSociedade Brasileira de Fonoaudilogia

Introduction: The vocals drives constitute an intrigu-ing phenomenon for the voice sciences, for their aesthetic,mechanical and performance technique challenge some of therules considered as basic, along the lines of "well sing"dominant in Western society. It was only with the progressof Sciences voice and vocal pedagogy itself - carried outmainlyin the last four decades - is that the vocals drives were treatedas a legitimate object of scientific research and won, so tospeak, "citizenship status "technical and vocal.

Objective: To unveil the sound-vocal universe of pop-ular singing, presenting an updated framework of research onthe phenomenon and its applicability; establishing,moreover,its physiological correlates.

Data Synthesis Despite the many "comings andgoings" among scholars of the subject, the most immediateresult of studies on the vocal drives is that they are groupedaccording to the laryngeal structures directly involved in thebreakdown of the fundamental frequency of the voice and /break in the continuousflowof air: Glottic Drives, supraglotticand Mixed.

Conclusions: The anatomical and functional demysti-fication laryngeal enabled the didactic and pedagogical de-velopment of a "vocal type": crystal voice, Gregorian voice,clamp voice, in addition to vocal effects such as vibratotechniques and the drives themselves. But decoding / physio-logical precise description of adjustments made during theexecution of the drives, aswell as general issues involved vocalhealth, is still a controversial subject among the authors.

Keywords: singing voice, vocal drives, diverted voices,vocal compounds schemes

A602. Dysphagia in Patients with Neurotoxoplasmosis andAIDSMariana Saconato, Katia Alonso RodriguesInstituto de Infectologia Emilio Ribas

Introduction: Toxoplasmosis is the most commoncause of focal neurological lesions in HIV-positive patientswith CD4þ cell count less than 200 cells/mm3.

Objective: Verify the presence of dysphagia pre andpost therapy in patients with AIDS and neurotoxoplasmosis.METHODOLOGY: The presence, degree of dysphagia and levelof intake by mouth were analized through the DysphagiaOutcome and Severity Scale (O’Neil) and the Functional OralIntake Scale (FOIS) in 24 patients with a mean age of 41 years.

Results: Eight patients (33%) presented normal swal-lowing, with FOIS level 7. Five patients (21,5%) presentedmildoropharyngeal dysphagia, with initial FOIS level 6. Three

patients (12,5%) had a moderate degree of oropharyngealdysphagia, with initial FOIS level 3. Three patients (33%) hadsevere oropharyngeal degree, with initial FOIS level 1. Thepatients with mild dysphagia were rehabilitated and theirfinal FOIS went to 6. Two (66%) of the patients with moderatedysphagia developed mild dysphagia with FOIS 6 and onepatient (34%) progressed to normal swallowing with FOIS 7.Only one patient (12.5%) with severe dysphagia was rehabili-tated to normal swallowing with FOIS 7.

Discussion: For patients with AIDS and neurotoxo-plasmosis, the greater the number and extent of neurologicdamage and lower counts of CD4þ cells, the worse the degreeof dysphagia.

Conclusion: Dysphagia was present in over 50% ofcases. Patients with mild and moderate dysphagia wererehabilitated. Patients with severe dysphagia had their reha-bilitation limited by probable aggravation of the illness.

Keywords: Dysphagia, Toxoplasmosis Cerebral, Ac-quired Immunodeficiency Syndrome

A45. Efectiveness of Speech, Language and Hearing Therapyin Systemic SclerosisLeylane Fonseca Almeida, Camilla Santos Alves, ANNYKAROLINE ANDRADEda SILVA, LUIZ BARROS FILHO, Silvia ElaineZuim de Moraes Baldrighi, Milena Cabral de LimaUniversidade Federal de Sergipe

Introduction: Systemic sclerosis rheumatic autoim-mune disease, progressive, infrequent, of unknown etiology.Reaches vital organs and perioral tissues, causing limitation ofmouth opening, difficulty in chewing and swallowingdisorder.

Objective: Compare results before and after myofunc-tional rehabilitation.

Methods: Descriptive exploratory clinical study inRheumatology sector of the University Hospital and Speech-Language Pathology School-Clinic the Federal University ofSergipe from July / 2012 to December / 2013. Participated fivesubjects, both genders, aged between 23 and 60 years, meanage of 44.6 years and 80% were female and 20% male. All withsystemic sclerosis medical diagnosis and presenting speech-language disorder proven in review. The myofunctionalspeech therapy aimed the muscle modification and restora-tion of oral functions, and the mioterapica sought modifica-tion of the muscle behavior by performing exercises(MARCHESAN, 2005). Were performed 36 weekly sessionsand in the end was performed comparing the clinical indica-tors worked.

Results: The previous test to speech therapy revealedrestriction ofmouth opening in all subjects, the current resultsrevealed increase ranging from 5mm to 14mm. Regarding thetone, mobility of phonoarticulatory organs and orofacialnumbness, improvement was observed and, in most cases,occurred adequacy of stomatognathic functions.

Conclusion: The speech rehabilitation promoted re-sults considered significant in the clinical of these individuals.Therefore, it is evident the importance and need for furtherstudies because of the shortage in the literature, as well as theinclusion of the speech therapist in an interdisciplinary teamcare to these patients.

Keywords: Speech, Language and Hearing Sciences;Scleroderma, Systemic; Speech Therapy

A440. Effect of Lip after Lip Repair Digital Manipulation: ACase ReportVanessa Souza Gigoski, Liliane Menzen, Maria Cristina deAlmeida Freitas Cardoso, Jordana da Silva Freitas, Gabriela

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Pereira da Silva, Lisiane de Rosa BarbosaUniversidade Federal de Ciências da Saúde de Porto Alegre/IrmandadeSanta Casa de Misericórdia de Porto Algre

Introduction: Each type cleft lip needs approach anddifferentiated study on the surgical procedure and techniquesto provide functionality and aesthetic repair to patients. Astrategy to reduce scarring sequelae of lip repair is theapplication of lip massages.

Objective: To report the effects of digital manipula-tions lip after lip repair.

Resumed report: Case report, approved by the CEPNo. 39/12. Boy, 2.7 yearswith unilateral right complete cleft lipand palate, lip repair performed at 6 months and palatoplastywith 1.6 years, featuring in speech orofacial scar sequelevaluation, lip retraction right nose wing lowering rightcontraction mentalis and orbicularis oris, open lips at rest,with anthropometric measurement for caliper of upper lip(UL) held the subnasal point to gnathion 1 cm. Startedfortnightly speech therapy with mother for guidance performdigital manipulations lip 3 times a day. After 3 months therevaluation showed qualitative improvements of lower lipretraction and perioral muscles with proper tone; and quan-titatively measured UL 1.4 cm. After 6 months of earlystimulation, observed, decreased scar sequel, tone adequacyof the perioralmuscles, improved lipmovement, lips parted atrest and measured UL 1.6 cm.

Conclusion: There was a qualitative and quantitativeimprovements in orofacial evaluation of the patient in the6 month follow-up, suggesting effective use of lip digitalmanipulations. The techniquewas an important tool to reducescar sequels of lip repair, beyond the aesthetic benefits,providing greater functionality of muscles.

Keywords: Cleft Lip; Cleft palate MusculoskeletalManipulations

A554. Effectiveness of Myofunctional Exercises Associatedwith Vocal Exercises in the Rehabilitation of NeurogenicOropharyngeal Dysphagia: A Randomized Double BlindClinical TrialBruno Francisco de Fraga, Sheila Tamanini de Almeida, MarciaGrassi Santana, Mauriceia CassolUniversidade Federal de Ciências da Saúde de Porto Alegre

Introduction: in dysphagia, there are changes in thelaryngeal and stomatognathic structures, however, the use ofvocal exercises is poorly described.

Objective: to determine if therapy myofunctionalexercises associated with vocal exercises is more effective torehabilitate swallowing in patients with stroke.

Methodology: it is a pilot clinical trial, randomized,double blind,made up the control group,which heldmyofunc-tional exercises, and experimental group, who performedvocals and myofunctional exercises. The evaluators and pa-tients were blinded to the intervention and randomizationtook place through the list of randomized numbers. In theevaluations, we used the GRBASI Scale and the Functional OralIntake Scale. In the statistical analysis, we use the Wilcoxontest for intragroup analysis and the Mann-Whitney test forintergroup analysis.

Results: The experimental group showed statisticallydifference (p ¼ 0.039) between evaluations before and aftertherapy (median of 4 to 7) indicating that the combination ofmyofunctional exercises with vocal exercises is effective pro-viding greater increased levels of intake orally than in thecontrol group (median of 5 to 6). In the vocal quality markers,breathiness tended to be statistically significant (p ¼ 0.059) in

the experimental group, indicating that the vocal exerciseswere able to improve glottal closure.

Conclusion: The association of myofunctional andvocal exercises in the rehabilitation of neurogenic oropharyn-geal dysphagia was more effective in improving intake levelsorally.

Keywords: voice training; deglutition disorders;stroke

A526. Effects of Different Stimulation Modes on OcularVestibular Evoked Myogenic Potential RecordsAline Cabral de Oliveira Barreto, Grazielle de Farias Almeida,Lins Alberto Cunha Oliveira, Bismark Santos Vasconcelos,Manoela Eleanor Furlan Barreto, Liliane Desgualdo PereiraUniversidade Federal de São Paulo; Universidade Federal de Sergipe

Introduction: The ocular vestibular evoked myogenicpotential (oVEMP) records vestibule-ocular responses, causedby sound stimulus mono or simultaneous binaural issued.Binaural record presents more reliability, because, unlikemonoaural, there is simultaneous binaural capture of re-sponses for the same contraction of the inferior obliquemuscle.

Objectives: To verify the efficiency of binaural simul-taneous stimulation on oVEMP records compared to mono-aural acoustic stimulus.

Methods: 53 adults were evaluated, aged 18 to 35years, paired by gender and age, with normal hearing sensi-tivity and absence of hearing and/or vestibular disordershistory. oVEMP records were performedmonoaurally, contra-lateral to the stimulus and, then, with binaural stimulationand capture. 100 tone-bursts stimuluswere evoked (5Hz rate),pitch of 500Hz (Rise/Fall¼ 1 e Plateu 2), loudness of 100 dBNA,using bandpass filter from 05 to 300Hz, with 50ms latency.Data were processed by SPSS 17.0 software. Values wereconsidered significant when p â‰¤ 0.05 and alpha valuewas 0.1.

Results: There were no significant differences be-tween genders when oVEMP was performed unilaterally.There was significant difference only to amplitude parameterwith binaural stimulus (p ¼ 0.003). In the analysis betweenmonoaural and binaural records of oVEMP, p1 and n1 waveamplitudes were higher for the responses with binaurallystimulus.

Conclusion: Binaural acoustic stimulus provides p1and n1 waves of the oVEMP with higher amplitudes (wider)than monoaural; however no differences were observed withlatency parameter, between both stimulation types.

Keywords: Saculle and Utricle, Ear, Vestibular evokedmyogenic potential

A640. Effects of Vocal Health Promotion in the EducationalSpeech Therapist Intervention: Opinion of Municipal SchoolSystem StudentsChenia Caldeira Martinez, Cristina Ossig da LuzCentro de Atendimento Preventivo ao Educando

Introduction: Studies have shown the prevalence ofdysphonia in children. A major cause of this disorder is vocalabuse, affecting the emotional development of children. Theeducational speech therapist can develop vocal health strate-gies with the school community.

Objectives: To determine the students’ opinion onvocal health promotion activities.

Methods: It’s a cross-sectional study, data collection inlocus, with 19 students of the 3rd school year of municipalelementary schools of Tramandaí, Rio Grande do Sul. The

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procedure was promotion of vocal health, by therapeuticworkshop, containing informations about anatomy and phys-iology of vocal production, awareness of the importance ofvocal care. These activities were carried out through storytell-ing and conversation at the end of the activity, lasting an hour.One day after the activity, students were asked to answer aquestionnaire containing questions about caring voice.

Results: 14 (73.68%) of participants were male. 16(87.5%) knew retell the story heard, narrating the main guide-lines passed by professional in the activity, such as "I learnedabout not to scream", "we learn to speak down", "I take care ofmy voice", "we have to drink eight glasses of water a day".

Conclusion: This study has achieved the proposedobjectives, verifying the student’s opinion about vocal healthpromotion in school environment. It was identified thatpreventive activities in the educational speech therapist’sintervention can promote benefits on student learning andawareness of the importance of taking care of voice. It’ssuggested studies in schools, aiming at positive strategies topromote vocal health.

A279. Efficacy of Auditory Training Computerized inAuditory Skills of Temporal Duration Pattern in ChildrenLaís Ferreira, Amália El Hatal de Souza, Simone Nicolini deSimoni, Bianca Bertuol, Michele Vargas Garcia, Eliara PintoVieira BiaggioUniversidade Federal de Santa Maria - Ufsm

Introduction: In identifying auditory processing dis-order, the computerized auditory training is an interestingtherapeutic indication to rehab altered central auditory skillsin children, as it is dynamic and motivating.

Objective: The aim of this work is verify the effective-ness of the computerized auditory training in children withauditory processing disorders in school age, by comparing theauditory skills of temporal duration patterns before and aftertraining.

Methods: The study is a quantitative cross prospec-tively and was conducted in a public speech therapy service.Participated in this study five children of school age. Amongother behavioral assessment procedures, was realized toassess the auditory skills of temporal pattern, Duration Pat-ternTest. From the identification of the auditory skills altered,it was proposed the computerized auditory training with thesoftware “Pedro na casa mal- assombrada’’ (Pedro in thehaunted house) in six sessions of 40 minutes. After thisintervention, was carried out the revaluation of this temporalskill and compared the performances obtained with theassessment before the training in a descriptive way.

Results: There was a satisfactory improvement in thechildren’s that underwent the computerized auditory train-ing. Of the five children, three of them reached the normalrange expected for tis skill, and two improved 20% taking intoaccount the result of the Duration Pattern Test.

Conclusion: Observed and improvement in the tem-poral pattern skill in all children who have followed thetraining with the software. Therefore, the efficacy of thistype of auditory training was identified in this sample.

A188. Efficiency and Cutoff Values of the Brazilian Version ofVoice Activity and Participation Profile VAPP for Non-teachers and TeachersFabiana Copelli Zambon, Felipe Moreti, Aline Cristina TafareloVargas, Mara BehlauUniversidade Federal de São Paulo â€“ Unifesp, Centro de Estudos daVoz â€“ Cev, Sindicato dos Professores de São Paulo â€“ Sinpro/SP

Introduction: The Voice Activity and ParticipationProfile â€“ VAPP is an interesting tool to assess how a voiceproblem restricts and limits the social and professional vocalactivities. Teachers, compared with non-teachers, reporthigher frequency of vocal and physical vocal complaints intheir professional activity.

Objectives: To identify characteristics of efficiencyandcutoff values of the dimensions of the Brazilian version ofVAPP protocol that discriminate dysphonic and vocallyhealthy subjects; to verify if the cutoff values remain thesame for a sample of teachers.

Methods: Features of efficiency and cutoff values ofVAPP data of 171 subjects were analyzed by Receiver Operat-ing Characteristic â€“ ROC curve: 90 teachers (60 dysphonicand 30 vocally healthy, with similar mean age, p ¼ 0.418) and81 non-teachers (48 dysphonic and 33 vocally healthy, withsimilar mean age, p ¼ 0.934).

Results: The area under the ROC curve â€“AUC and thecutoff values of the total score of VAPP for discriminatingindividuals with andwithout dysphonia are different for non-teachers and teachers. Non-teachers had AUC ¼ 0.986(p < 0.001) and 4.5 points in the total score of VAPP (sensitiv-ity ¼ 95.8%, specificity ¼ 90.9%); teachers had AUC ¼ 0.872(p < 0.001) and 14.6 points of cutoff of the total score (sensi-tivity ¼ 91.7%, specificity ¼ 75.9%).

Conclusion: The cutoff values of VAPP are different fornon-teachers and teachers, higher for teachers, however, withgreater sensitivity and specificity for non-teachers individualsand can be used for screening of large populations at risk forvoice disorders.

Keywords: Voice; Dysphonia; Self-Assessment

A263. Electroacoustic Evaluation of Workers attending aWorkers Health Reference CenterArieli Bastos da Silveira, Luciele da Silva Prates, Nathana daGraça Sartori Rodrigues, Isabela Schroer Neis, Valdete AlvesValentins dos Santos FilhaUniversidade Federal de Santa Maria

Introduction: Exposure to high levels of sound pres-sure on workers may result hearing impairment, such asHearing Loss induced by noise. The electroacoustic evaluationhas been important for early detection of occupational hearingdisorders.

Objective: Detect minimal cochlear alteration in indi-viduals of a Workers Health Reference Center.

Methods: Sample of 96 workers, with 58.3% men and41.6%women,mean age of 46.13 years, treated at theWorkersHealth Reference Center. Was held clinical-occupational an-amnesis, pure tone audiometry, immittance measures andTransient Otoacoustic Emissions.

Results: In the right ear, 53.47% of the individuals hadnormal hearing, 27.43% with normal hearing notch on thehigh frequencies, 19.77% hearing loss with otoacoustic emis-sions present in 73.08%, 41.67% and 26.32% respectively. Fortype and level of hearing loss, it was identified 1.04% mildmixed, 2.08% mild conductive, 11.45% mild sensorineural,3.12% moderate sensorineural and 2.08% moderately-severesensorineural. In left ear 46.88% of the individuals had normalhearing, 34.37% with normal hearing notch on the high

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frequencies, 18.75% with otoacoustic emissions present in77.78%, 33.33% e 27.78% respectively, not being held at5.55%. For type and level of hearing loss, was identified1.04% moderate mixed, 1.04% moderately-severe mixed,11.46% mild sensorineural, 2.08% moderate senosorineuraland 3.12% moderately-severe sensorineural.

Conclusion: The population evaluated was character-ized with normal hearing with notch in the high frequencies,indicating minimum cochlear lesions occupational, throughtransient otoacoustic emissions, excellent in early detection ofhearing loss induced by noise.

A448. Electrophysiology as a Monitoring Tool of a TrainingProgram Hearing in Children Underwent BilateralMyringotomyMilaine Dominici Sanfins, Leticia Reis Borges, CarolineDonadon, Maria Francisca Colella-SantosFaculdade de Ciências Médicas - Unicamp

Children with recurrent otitis media history oftenhave problems in processing the sounds and the auditorytraining can improve hearing performance due a reorganiza-tion of the auditory neural substrate. The electropshysiologicassesments has shown good aplicability and efficiency whenyou want to monitor and track, objectively, the changes in theauditory training programs. To analyze the performanceefficiency of an auditory training program through electro-physiologic assesment. We evaluated a total of 3 subjects (2females and 1 male) at the age of 11 years, with a recurrentotitis media history and underwent bilateral myringotomy.Subjects were assessed by complete basic hearing evaluation,auditory processing and electrophysiological assessment withverbal and non-verbal stimuli. After this, individuals wentthrough an acoustically controlled auditory training program(8 sessions) in a soundproof booth and at the end of this, acomplete reassessment was performed with the same initialprocedures. All subjects had an improvement in electrophys-iological assessments after auditory training program. De-creased latency values were observed in the following waves:speech ABR [E, F and O - OD; D, E and F - OE], tone burst P300[P300 - OE] speech P300 [P200, N200 - OD; P300 - OE] andincreasing the amplitude of these waves: speech ABR [C, O -OD; C - OE], tone burst P300 [P300 - OD; N100 - OE], speechP300 [N100, N200, P300 - OD; P300 - OE]. The analysis hasshown that the auditory training program was effective,which can be evidenced by improvements in electrophysio-logical responses.

A1723. Endogenous and Exogenous Potentials in Childrenwith Phonological DisordersLaura Bonfada, Amanda Zanatta Berticelli, Vanessa OnziRocha, Erissandra Gomes, Pricila SleiferUFRGS

Introduction: The phonological disorder is character-ized by changes that occur in the child’s speech. Difficulties inoral language may be closely related to auditory processingdisorders. Auditory processing disorders can be identified byendogenous and exogenous potentials.

Objectives: To analyze and compare the electrophysi-ological findings obtained in evaluations of endogenous andexogenous potentials in childrenwith andwithout phonolog-ical disorders.

Methods: 36 children were evaluated, 22 with pho-nological disorder and 14without phonological disorder, agedbetween 5 and 12 years. All the children were evaluated by

electrophysiological assessment of potential exogenous (N1,P2, and N2) and endogenous (P3).

Results: From the 22 children with phonological dis-orders, 7 of them did not respond at all assessed components;15 (51.7%) children with speech disorders were evaluated,between them 66.7% were male, with a mean age of 8.4 yearsfor the study group and 8.0 years for the control group. Themean latencies were significantly higher in the children ofstudy group when compared to the children of the controlgroup (p < 0,05), and the latency wave N2 was the latest ofthem. Themean amplitudes of N1, P2 e P3 were higher for thecontrol group.

Conclusion: It can be seen that there are significantdifferences in the results of latency and amplitude in thepotential endogenous and exogenous in children with pho-nological disorder compared with children without phono-logical disorder.

Keywords: evoked potentials, auditory; electrophysi-ology; event-related potentials; speech disorders

A566. Evaluation of auditory handicap of elderly users ofhearing aid assisted in a Government Program Hearing AidFittingTeresa Maria Momensohn dos Santos, Amanda MonteiroMagrini, Angelica Biazus Mendonca da FonsecaPontifícia Universidade Católica de São Paulo

Introduction: Evaluation of the degree of benefit orsuccess of a hearing aid has traditionally involved measure-ment of speech reception. Self-report questionnaires providean attractive alternative to clinical speech tests.

Objective: to analyze the auditory handicap of elderlyhearing aid users of a health unit of the unified health system(SUS) in the city of Belém, Pará.

Method: a telephone call to 205 elderly people thatreceived hearing aids from a Government program of hearingaid fitting in the city of Belém, Pará to schedule a follow up atthe Health Unit. All answered to the Hearing HandicapInventory for Elderly â€“ screening version (HHIE-S) besidesthey received orientations about hearing aid use, care, han-dling and maintenance of them.

Results: 99 people assisted at Health Unit. 61 malesand 38 female. Out of them 73 answered to HHIE-S. Related tohandicap perception, results showed That 24,6% (n ¼ 18) didnot present a significative handicap perception; 36,9(n ¼ 27)showed a light/moderate handicap and 38,3% (28) a significa-tive perception. In 47% of sample questions related to Socialaspects were the most influent on the handicap followed bythe emotional aspects (30%). Just for 21% of people theseaspects did not showed any difference.

Conclusion: Data showed that a significative percep-tion was present in majority of individuals. Hearing losscompromises the participation of elderly on daily activitiesaffecting their social life.

A699. Evaluation of Standard Swallowing Indicators inInstitutionalized Patients with Cerebral Palsy withMultiprofissional InterventionCarla Maffei, Paul Joseph Jakobi, Vinicius Ribas Fonseca,Edmary Coutinho de Godoy, Marcal Motta de Mello, Yara Alvesde Moraes do Amaral MannesRed Cross Hospital Of Curitiba/PR

Introduction: Spastic tetra paretic cerebral palsy (CP)mode is a severe pathology diagnosed by clinical andvideodeglutogram.

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Objectives: This study aimed to examine indicators ofthe swallowing function in the oral and pharyngeal phases(videodeglutogram) in institutionalized patients with CP inmultidisciplinary treatment.

Methods: In the images collection of the DigestiveMotility service of the Red Cross Hospital of Curitiba/PR, weselected 8 patients with CP and suspected aspiration pneu-monia fromAPAE of Paranaguá. The swallowingwas evaluatedin different consistencies (thick pasty, pasty thin, liquid) in theoral and pharyngeal phase. To sort through the neuromotorimpairment, we used the GMFCS (Gross Motor FunctionalCoordination System).

Results: The presence of waste and escape (previousand back) was demonstrated during the examination for allconsistencies in both oral and pharyngeal phase of swallow-ing. All patients presented abnormal motility of the tongue.There was no evidence of the presence of tracheal aspiration.For motor control, 75% of children had level IVand 25% level V.The presence of residues and previous escape show that thetypical pattern of oropharyngeal dysphagia in these patients isthe motor incoordination of swallowing. The change in motil-ity of the tongue emphasizes the importance of multidisci-plinary care. Unlike the present study, most of them found thepresence of tracheal aspiration. The change in the posture ofpatients affects the swallowing process.

Conclusion: Multidisciplinary care (speech therapy)results in benefits for patients with CP, with a reduction inlaryngeal penetration in the swallowing process.Key words:Deglutition disorders, cerebral palsy, child

A627. Evaluation of the Hearing Frequency Perception withMusical Stimulus on a Teenager User of AASIScheila Farias de Paiva, Layna Santos SiqueiraUniversidade Federal de Sergipe

Introduction:Hearing deficiency is the total or partialloss of capacity of perception sounds and difficulty in under-standing words and can be classified according to the time itoccurs, site and the degree of injury. The Individual SoundAmplification Device (AASI) is an electronic device that allowssound amplification providing the ald disabled to understandthe speech and to realize environmental sounds. Auditorytraining Musical is a program with musical activities forauditory development in order topromotemusic appreciationthrough music learning using musical stimulus.

Objective: To evaluate the auditory performance ofteenage users of AASI for auditory discrimination tasks formusical sounds with different timbres.

Methodology: It used the tonal frequency pattern test(TPF) with sequences of three four stimuli of different sounds(keyboard and flute contralto), with the use of AASI.

Results: For the keyboard sound, the patient obtainedthree hits total of 10 sequences presented for activity withthree stimulus and a hit to activity with four stimulus. As forthe alto flute , obtained one hits for sequences of threestimulus and five for the sequence of four stimulus.

Conclusion: The patient performed better with theuse of hearing AASI to musical perception with the keyboardtimbre.

A29. Evoked Potentials, Auditory of Late Latency andCognitive in Teenagers Down’s SyndromeAudrei Thayse Viegel de Ávila, Letícia Gregory, Pricila SleiferUniversidade Federal do Rio Grande do Sul

Introduction: The realization of Late Latency AuditoryEvoked Potential (LLAEP) in individuals with Down syndrome

(DS) can provide important data from brain processing ofhearing and their associations necessary for a good languagedevelopment.

Objectives: To evaluate latencies and amplitudes ob-tained fromexogenous and endogenous components of LLAEPin teenagers with DS and correlate the findings betweengenders.

Methods: This study included 11 teenagers with DS,without hearing loss, seven females and four males withminimum age 13 and maximum 17 years. Hearing evaluationand research of the LLAEP were performed, including cogni-tive potential (P3).

Results: The averages found for the latencies of exog-enous components P1, N1, P2, N2 were respectively 110.2ms;180.3ms; 322.2ms and 492.5ms to right ear and 100.2ms;168.3ms; 323.1ms and 497.5ms to left ear. The averages foundfor the amplitudes P1N1 and N1P2 were respectively 15.0µVand 16.0µV to right ear and 16.8µV and 18.7µV to left ear. Themean found for the latency of the P3 wave was 651.7ms andmean amplitude 10.0µV. There was a significant differencebetween genders for N1 latency in the right ear (p ¼ 0.020).

Conclusion: Analyzing P1, N1, P2, N2 and P3 waves, itwas observed increased latencies and amplitudes within thenormal range. Significant correlation was observed betweengenders only for N1 latencies for the right ear, females hadhigher latencies. It is suggested conducting studies that usethe procedures of LLAEP to evaluate and objectively monitorthe interventions and therapeutics evolutions in DS.

Keywords: Hearing; Electrophysiology; DownSyndrome

A78. Exam Normalization Electrophysiological P300 InSubjects Normal HearingMaria Julia Ferreira Cardoso, LucianaMartins Zuliani, LeonardoLuiz BorgesPontifícia Universidade Católica de Goiás

Introduction: The auditory integrity of the researchprocess can be performed by various subjective and objectivetests seeking information related to the peripheral and centralauditory system. For the evaluation of auditory pathways andthe central auditory system have been used the auditoryevoked potentials. The evoked auditory potential long latencyis cognitive and endogen, which characterized for a wave oflarge amplitude, generated approximately 300ms, initiated bythe expectation of the perception of a rare auditory stimulus.The aim of this study was to normalize the values of latencyand amplitude of P300 at EP25 equipment Interacoustic.

Methods: Experimental and cross-sectional study thatevaluated 30 university students with normal hearing ofgenders, 24(80%) women and 6(20%) male aged 18-23 oldyears. There were performed the basic audiological testingand long latency auditory evoked potential P300. Were per-formed the basic audiological testing and long latency audito-ry evoked potential P300.

Results: The average value of latency of component P1was 48.49; N1 of right ear 80.27 and left ear 86.53; P2 in 159;N2 208.49; P300 in 302,13ms with amplitude 8.1µV. Therewas no significant difference between right and left ears forlatency and amplitude of P300.

Conclusion: It is possible normalize the potentialregistry auditory evoked long latency P300 at EP25 Intera-coustic equipment in young individuals with hearing withinnormal limits and the P300 wave latency records werebetween 242 to 362ms, confirming the values establishedby the literature.

Keywords: Audiology, P300 evoked potential, Evokedauditory potentials, Hearing, Electrophysiology

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A545. Experience of an Amateur Singing Group as CareDevice in Primary Health CareLuciana Portella Schiavo, Silvana Basso Miolo, Elenir Fedosse,Fabrício ScapiniUniversidade Federal de Santa Maria (UFSM)

Introduction: the Unified National Health System(1990) calls for the Primary Health Care as the main gatewayfor users to the Health Care Network, and has promotion asone of its principles. The music, as semiotic system remainsacross cultures and generations, enabling and expressingfeelings, memories and thoughts. Considering the importanceof music, a singing group can expand access to leisure andculture, and is presented as a resource to provide betterquality of life and self-esteem of people.

Objective: To discuss an amateur singing group as adevice to promote health in the Primary Health Care.

Method: descriptive and qualitative approach, speechtherapy and physical therapy group techniques, coordinatedby speech therapist/singer and physical therapist with collab-oration of an otolaryngologist (videolaryngoscopy realization)and from a musician (guitar).

Results: No patient presented laryngeal alterations. Itwas noticed improvement in vocal care (vocal hygiene oftendemanded and discussed in the group), providing greaterawareness and self-care. In the course of many meetings, thebody relaxation exercises, articulation, breath and vocal heat-ing increased extent and vocal range and hence dynamic-melodic perception. The guitar favored rhythm, musicalityand disinhibition, "giving life" to the group. Attendance andbond created between participants is a sign of health/life.

Conclusion: The group brings joy, relaxes and produ-ces overshoot, meeting the recommended by the NationalHealth Promotion Policy, providing improved vocal qualityand discovery of musical potential, positively impacting in thequality of life of the participants.

Keywords: Primary Health Care; InterprofessionalRelations; Health Promotion; Singing; Music

A695. Exploring Clinical Evaluation Tools of Naso-Respiratory Function in Repaired Cleft Lip and PalateRafaeli Higa Scarmagnani, Letícia Dominguez Campos, AlíciaG. Noronha Silva Salgueiro, Ana Paula Fukushiro, RenataPaciello YamashitaLaboratório de Fisiologia, Programa de Pós-Graduação em Ciências daReabilitação, Hospital de Reabilitação de Anomalias Craniofaciais,Universidade de São Paulo

Introduction: Cleft lip and palate are often associatedwith nasal deformities. Anterior Rhinomanometry by meansof pressure-flow technique (AR) is an instrumental methodused to estimate nasal patency in a quantitative and objectivemanner. The Altmann millimeter nasal mirror (AMM) is amillimetered metal plate, considered a useful tool by speech-language pathologists in the clinical practice, due to theiraccessibility and convenience to investigate naso-respiratoryfunction.

Objective: To investigate the correlation between ARand AMM evaluation in order to verify the efficiency of theAMM assessment in estimating nasal patency.

Methods: Thirty-six patients of both genders, from 6-year, with repaired cleft palate � lip were evaluated. Partic-ipants underwent AR to provide the nasal cross-sectionalunilateral area by the simultaneous measurement of thedifferential transnasal pressure and nasal air flow duringresting breathing (pressure-flow technique). The total bilater-al areawas calculated by the sumof unilateral areas. The AMMassessment was performed positioning the mirror below the

nostrils during resting breathing. The condensation area onthe metal plate was marked using red pen, transposed to aspecific millimetered sheet that was scanned and, measuredusing the ImageJ software. Correlation test was applied tocompare both methods.

Results: Positive correlation was found (r ¼ 0.469;p ¼ 0.00) showing the association between AR and AMMfindings in the analysis of naso-respiratory function.

Conclusion: These results confirm the importance ofthe AMM evaluation as useful tool in the clinical diagnosis ofnasal patency. However, it is recommended the use of instru-mental evaluation as a complementary method in estimatingnaso-respiratory function.

A598. Exposure to Pesticides on Farm Workers: Effects onHearingValdirene Jesus da Silva, Sabrina Soares Donizette, SimoneSoledade MendonçaFaculdade de Odontologia de Bauru-Universidade de São Paulo

Introduction: The study on hearing care workers wasalmost exclusively on the effects of noise. They are stillincomplete studies on the effects on hearing health on expo-sure of chemicals, especially pesticides. Pesticides are used tocontrol biological organisms harmful to agricultural produc-tion that competewith humans in crops or spreadingdiseases.The extensive use of pesticides in rural production is a majorhealth problem due to contamination of soil, water and air.

Objective: To review and verify, in the literature, theeffects of pesticide contamination on hearing health in ruralworkers.

Methods:Relevant national and international journalswere reviewed indexed in PubMed, Medline, Bireme, LILACS,Google Scholar and dissertations from 2009 to 2015.

Results: Several studies correlating hearing loss withexposure to noise have been seen in the literature, however,there are other risk factors for hearing health that have beenobserved in the workplace. When considering occupationalhearing loss it is important to recognize the potential ofototoxic chemicals, eg pesticides. The studies showed thatthe use of insecticides may be responsible for hearing loss,independent of the noise exposure time, or the inefficient useof personal protective equipment.

Conclusion: In view of these findings, further studiesshould be conducted with this population is using methodsand techniques to investigate hearing damage, since there isevidence that pesticides lead to hearing loss independent ofthe presence of noise.

Keywords: hearing loss, pesticides, noise-inducedhearing loss, ototoxicity

A6. Extended Neuralgic Amyotrophy Syndrome: VoiceTherapy in One Case of Vocal Fold ParalysisAndréa Gomes de Oliveira Aguiar, Marcia Monteiro PinhoUniversidade Federal Fluminense And Otorhinolaryngology, 2ndInfirmary Of Santa Casa de Misericórdia Of Rio de Janeiro

Neuralgic Amyotrophy (NA) is a rare disturb of theperipheral nervous system that can include extreme pain,multifocal paresis and atrophy of the muscles of the upperlimbs. When the nerves located outside of the brachial plexusare involved, the term Neuralgic Amyotrophy Extended (ANE)is used. Diagnosis of NA is clinical and has a series of inclusionand compatibility criteria established by the European CMTConsortium. On this study the clinical history, multidimen-sional vocal assessment data and the vocal techniques used infive-weeks voice therapy for one patient, professional voice,

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with ANE are presented. In this case, sudden and recurrentparalysis of his right vocal fold was the only manifestation ofthe disease. At the end of the fifth week.

The patient’s voice was normal, the spoken and sungvocal ranges were same as before the current episode of ANEand scores of his vocal self-assessment were appropriate.

A292. Factors Associated with the Presence of SwallowingDisorders in Children with Suspected DysphagiaLenice de Fatima da Silva Munhoz, Karina Elena CadioliBernardis Buhler, Suelly Cecilia Olivan LimongiHospital Universitário da Universidade de São Paulo

Introduction: Childrenwith neurological, cardiac andrespiratory disorders, and history of prematurity may presentswallowing disorders. However, only few studies verify therelationship between these clinical factors and swallowingdisorders in this population.

Objective: To identify the clinical factors â€“ specifi-cally, history of prematurity and neurological disorders â€“associated with signs and symptoms observed in the clinicalevaluation of swallowing that may suggest alterations in thepharyngeal phase, and with the oral and pharyngeal findingsof the videofluoroscopic swallowing study.

Methods: Retrospective analysis of data from clinicaland videofluoroscopic evaluations carried out in 55 childrenfrom 1 month to 7 years and 11 months old. Subjects weregrouped according to the history of prematurity or neurologi-cal disorders. To clinical evaluation, the “Protocol for ClinicalAssessment of Pediatric Dysphagiaâ€ was used. In the video-fluoroscopy, the oral and pharyngeal phaseswere assessed. Tostatistical analysis, Chi-square and Fishe”™s Exact Tests wereused.

Results: Prematurity was associated with oxygendesaturation (OR 5.9, 95% CI 1.5-23.8; p ¼ 0.008). No signifi-cant association was found between prematurity and thevideofluoroscopic findings. Neurological disorders were alsoassociated with oxygen desaturation too (OR 5.1, 95% CI 1.4-18.7; p ¼ 0.010). In the videofluoroscopy, neurological disor-ders were significantly associated with oral phase alterations(OR 4.4, 95% CI 1.4-14.0; p ¼ 0.009) and with post-swallowresidue in valleculae and pyriform sinuses (OR 6.2, 95% CI 1.5-25.5; p ¼ 0.007).

Conclusion:Oxygen desaturationwas associatedwithprematurity and neurological disorders. Alterations in the oralphase and post-swallow residue in valleculae and pyriformsinuses were associated with neurological disorders.

A76. Factors in Childhood and Adolescence that MayInfluence the Auditory Processing: A Systematic ReviewNádia Giulian de Carvalho, Carolina Veronica Lino Novelli,Maria Francisca Colella-SantosUniversidade Estadual de Campinas

Introduction: There is a consensus in the literature onthe importance of the auditory system for the development oforal and written language. The Auditory Processing Disorderrefers to the difficulty of processing auditory information.

Objectives: The aim of this systematic literature re-view was to analyze which factors occurring in childhood andadolescence may influence the auditory processing and thatare not necessarily the cause or consequence of the disorder.

Data Synthesis: Two researchers used the PubMedand SciELO databases independently. The descriptors usedwere auditory processing, auditory perception, children andadolescence, in various combinations. Among the 205 articlesidentified, 30 articles matched the inclusion criteria and were

analyzed. Only two studies showed positive factors influenc-ing auditory processing skills: the influence of musical stimu-lation in infancy and the use of methylphenidate as atreatment for attention deficit hyperactivity disorder. Theinfluences are, mostly, negative for the auditory processing,and we emphasize the relationship of the disorder withdyslexia, learning difficulties, specific language impairment,low socioeconomic status, attention deficit hyperactivity dis-order, premature birth, phonological disorders, visual im-pairment, mouth breathing, stuttering, otitis media, cleft lipand palate, anemia, exposure to metallic mercury, obstructivesleep apnea-hypopnea syndrome, CVA, socially vulnerablechildren and dysphonic children.

Conclusion: The Auditory Processing is sensitive tothe negative influences related to environmental and chemi-cal factors, socioeconomic status, and language, auditory andneurological disorders. Exposure to music and the use ofmethylphenidatewere the only factorswith positive influenceon the auditory processing.

Keywords: Hearing Tests; Auditory Perception; Child

A289. Family Involvement in the Initial Stages ofIntervention with Children with Hearing Loss: Culture andCommunity IssuesBruna Capalbo Youssef, Bruna Capalbo Youssef, Juliana Habirode Souza Miguel, Beatriz Cavalcanti de Albuquerque CaiubyNovaesPontifícia Universidade Católica de São Paulo (Puc-SP)

Introduction: The importance of partnership be-tween parents and professionals involved in intervention ofhearing impaired children in the initial stages of therapeuticprocess can be crucial for a favorable prognosis, consideringthat the counseling, orientation and identification of commu-nity resources will determine adhesion to the use of hearingaids and to intervention program.

Method:Weselected two groups of five families in theearly stage of intervention. Parents participated with thechildren in two moments: Speech Therapy and Family Acces-sion Group (FaAG), weekly sessions for the identification ofvalues, experiences regarding the difficulties, doubts andidentification of the community resources.

Results: Parents used the group to ask the doubts andexchange experiences about the differences between theirchildren and their hearing and educational possibilities. Cul-tural aspects and difference between families were identified.Therewas need for guidance on the placement of the earmold,proper functioning of thehearing aids, expectations regardinglanguage of children and recommendation for cochlear im-plant. The identification of community resources depended onwhere the family resided.

Conclusion: The intervention setting that includesparents group in addition to individual therapy was determi-nant for the consistent use of amplification and promotedopportunities for exchange of experiences among parents. Theidentification of the community resourceswas determinant inthe adhesion to intervention including use a hearing aids andthe frequency in therapies.

Keywords: Parents Group, Speech Therapy, HearingLoss

A491. Feeding of Premature Below 34Weeks after HospitalDischargeJanaína de Alencar Nunes, Kamilla Guerra dos Santos, KarinaArreco Fiorotti Cruz, Maria Sarah Tristão Ferraz, Thais PrettChiabai, Maria Claudia CunhaUniversidade Federal do Espírito Santo

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Introduction: The premature has a general immatu-rity which affect the proper functioning oral feeding. Objec-tive: Identify the feeding the preterm with gestational age of34 weeks participants in the Follow-up after discharge fromthe Neonatal Intensive Care Unit.

Methods: From January to April 2015 were evaluatednine preterm in the University Hospital Cassiano AntonioMoraes. The inclusion criteria were selected premature bothsexes under 34 weeks gestational age with birth weights lessthan 1610 grams and who were on oral feeding after dis-charge. Result: Of the nine preterm, six hadgestational age lessthan 30 weeks (extreme) and three between 31 to 34 weeks(moderate preterm). In relation to gender, sixwere female andthreeweremale. In the group of extreme preterm, were foundgestational age between 25 weeeks to 28, birth weight be-tween 665 to 1610 grams with hospital discharge weightvalues between 2010 to 2490 grams. In the group moderatepreterm, it was found gestational age of between 30 - 34, withan average birth weight to 1214.66 grams (between 826 to1545), and hospital discharge weight between 1960-3335grams. With regard to food, among the six extreme pretermthree used the bottle and three in exclusive breastfeeding.Among the three moderate preterm: two in bottle-feedingand one in breast-feeding with supplementation.

Conclusion: After discharge the preterm less than 34weeks of gestational age were using bottle, breastfeeding andbreastfeeding more supplement.

Keywords: Bottle Feeding, Breast Feeding, Premature,Intensive Care

A447. Findings Orofacial Myofunctional of Patients withSleep DisordersVanessa Souza Gigoski, Liliane Menzen, Deisi Cristina GolloMarques VidorUniversidade Federal de Ciências da Saúde de Porto Alegre/IrmandadeSanta Casa de Misericórdia de Porto Algre

Introduction: Snoring is a disorder that affects 20-40% of the population and is a result of vibration of theanatomical structures of the upper airways, it is importantsign for the diagnosis of obstructive sleep apnea andhypopneasyndrome (OSAHS). Objectives: Describe the orofacial myo-functional findings of patients with sleep disorders.

Methods: Crose sectional study of field, conductedwith patiets referred for polysomnography with a randomsample consisting of adult patients of both sexes, with snoringand who were not receiving any form of treatment for sleepdisorder. Antroposcopic speech evaluation was performedand the results of polysomnography were collected in orderto meet the objectives of the work. Approved by CEP 833.492/2014

Results:A significant association between the severityof sleep disturbance and environmental variables was found,such as smoking and alcohol consumption; alsowith individ-ual characteristics such as race, body mass index, waistcircumference and Hypertension. From the point of view ofmyofunctional characteristics, there was a positive relation-ship between the severity of OSAHS and the contraction of thementalis muscle, Mallampati class, elevation of the back of thesoft palate, and change in breathing pattern.

Conclusion: The research enabled a tendency to de-scribe the existence of orofacial myofunctional disorders inindividuals with OSAHS, and also revealed that the greater thedegree of impairment of orofacial structures is, the larger isthe degree of disorder.

Keywords: Sleep Disorders; Sleep Apnea Syndromes;Speech, Language and Hearing Sciences; Snoring

A485. Findings Vestibular in Caloric Test in PatientsDiagnosed with Spectrum Disorder of Auditory NeuropathyAndressa Pelaquim, Luciane Domingues Figueiredo Mariotto,Gláucia Gonçalves RaineriHearing Health Division. Rehabilitation Hospital Of CraniofacialAnomalies - University Of São Paulo.

Introduction: The disorder of the auditory neuropa-thy spectrum characterized by the involvement of the audito-ry branch of the vestibulocochlear nerve. However, studieshave shown that affected individuals may also have vestibulardisorders, arising from possible changes in the vestibularnerve portion. In vectoelectronystagmography, the calorictest enables the evaluation of the side semicircular canaland the superior vestibular nerve of each labyrinth separately,by means of temperature variation in the external auditorycanal.

Objective: The aim of the study was to describe thefindings of vestibular caloric test by vectoelectronystagmog-raphy in individuals diagnosed with Neuropathy SpectrumDisorder Auditory.

Methodology: The study was retrospective, throughchart analysis of six women and eight men, aged 30-60 years.It was considered for the analysis vestibular history, neuro-logic evaluation and research findings of spontaneous nystag-mus, pre-caloric nystagmus and caloric test.

Results: In vestibular entrance history, 10 subjectsreported episodes of dizziness and / or vertigo. There was thepresence of spontaneous nystagmus with eyes closed in eightsubjects, pre-caloric nystagmus in five individuals. The calorictest, there was absence of bilateral response in half of theindividuals. An examination showed the absence of unilateralresponse and other unilateral hypofunction. Five examsshowed no alterations. On neurological examination foundno peripheral or central nervous system changes.

Conclusion: The findings of this study demonstratethat there is clinical evidence of vestibular alteration inindividuals with Spectrum Disorder Auditory Neuropathy,corroborating several international studies on the subject.

Keywords: auditory neuropathy; tests of vestibularfunction; Vectoelectronystagmography

A531. Hearing Behavior of Students in Early LiteracyAdriana Aparecida Tahara Kemp, Camila Ribas Delecrode, AnaClaudia Vieira CardosoUniversidade Estadual Paulista "Julio de Mesquita Filho"

Introduction: the use of questionnaires allows toobtain qualitative information about the auditory behaviorof children, and these may indicate the need to assess theauditory processing (Central).

Objective: To describe and compare hearing difficul-ties of students in everyday situations.

Method: Descriptive and cross-sectional study con-ducted in a public school in a small town of São Paulo state.The sample consisted of 36 students, of both genders, aged sixand seven years. To achieve this objective, parents or guard-ians answered the Scale Auditory Behaviors (SAB) question-naire. The questionnaire consists of twelve questions andfocuses on the frequency of occurrence of auditory behaviorsin some everyday situations. In this study, it was analyzed sixquestions.

Results: The analysis showed that 94.4% of parentsreported some behavior that may indicate difficulty in proc-essing auditory information, the most prevalent behaviorswere: ask to repeat the information (86.1%), did not under-stand rapid speech (72.2%) and difficulties in identificationand discrimination of speech sounds (41.6%). Comparison of

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students’ auditory behavior showed that six years old stu-dents presented higher difficulty to follow oral instructionsand inconsistent responses to auditory information and, sevenyears old students had difficulty to hear or understand innoisy environment.

Conclusion: Most students presented difficulties ineveryday auditory behavior, and this varied according to agegroup.

Keywords: Questionnaires, Hearing, Auditory percep-tion, Hearing tests, Child

A281. Hearing Loss and Cognitive Effects in SentenceRecognition in AgedTaissane Rodrigues Sanguebuche, Débora Durigon da Silva,Maria Madalena Canina Pinheiro, Mirtes Bruckmann, RúbiaSoares BrunoUn

Introduction: Among the alterations found in agedare the presbycusis and the changing in the cognitive aspects.When these two factors occur simultaneously, they lead to theloss of word recognition and sentence comprehension.

Objective: To evaluate the hearing loss and cognitiveeffects in sentence recognition in aged.

Methodology: A group of 30 aged took part of thestudy. Of these, 17 presented normal hearing and formed thecontrol group (CG) and 13 presented hearing loss and formedthe study group (SG). To evaluate the cognition, a Mini MentalState Examination (MMSE) was done and to evaluate theauditory effects the Portuguese Sentence List (PSL) Test wasapplied, in which the sentence recognition thresholds insilence (SRTS) and the signal to noise ratio (S/N) wereresearched.

Results: The attendees’ age mean was 68.5 years-old,the minimum of 60 and the maximum of 88 years. In theMMSE, the CG presented a higher percentual of individualswith alteration than in SG, no statistical significance. In bothSRTS and S/N ratio, the CG presented better thresholds thanthe SG in both ears. Regarding the cognitive aspects, therewasnot significant statistical difference between normal and withalteration groups in the MMSE for SRTS and S/R ratio of thecontrol group and study group in both ears.

Conclusion: The hearing loss exerted influence in therecognition of sentences in silence and at noise. On thecontrary, the cognitive aspects did not interfered in the speechrecognition in both silence and noise.

A247. Hearing Loss and Tinnitus Complain in Head NeckCancer TumorsPriscila Feliciano de Oliveira, Erica Crislane Omena de Lima,Renata Grazielle Souza Santos, Tatiane Costa Carneiro, GrasiellaPereira FerreiraUniversidade Federal de Sergipe

Introduction: The literature shows that head andneckcancer tumors have more complications and complaints dueto treatment as a result of the anatomical cancer location.Cancer treatment has ototoxic effects andhearing loss is one ofthemain complications of head and neck cancer tumors and itcauses comunication desorders.

Aim: To characterize the hearing loss in head and neckcancer tumors and to correlate with tinnitus complain.

Methods: A cohort study of 18 patients, both genders,at the oncology departament of a public hospital of Segipewascarried out. It was performed an Audiological evaluation (PureTone Audiometry) andwas approved by the Ethics in ResearchCommittee, under protocol #33665014.7.0000.5546.

Results: 50% were male and the others female, themain age was 49,5 years. Most of them (61.1%) had a sesnor-ioneural hearing loss characterized by changes from 3kHzfrequency. The hearing loss group had tinnitus (45.5%) as acomplain but there was no significant difference (p ¼ 0.12).25% reported worsening of hearing thresholds after cancertreatment and it was also not observed significant difference(p ¼ 0.61). Mann Withney test showed positive correlationbetween frequencies 1 to 8 kHz in association of normalhearing thresholds with hearing loss (p < 0.05).

Conclusion: Hearing loss is characterized by sensor-ioneural damage that affect frequencies from 3kHz and has nosignificant difference with tinnitus complain.


A430. Hearing Loss in Perrault Syndrome: A Case ReportAna Cláudia BiancoGução, Aline Costa Almeida, Jerusa RobertaMassola de Oliveira, Adriana Sampaio de Almeida MeyerUniversidade de São Paulo

Introduction: Perrault syndrome is characterized bysensorioneural hearing loss in several types, affecting bothmale as female gender. The syndrome is an autossomalrecessive inheritance, has abnormalities in the gene, andvarious clinical signs as ovarian dysgenesis, progressive cere-bellar ataxia, and neurological disorders of speed reduced ofnerve conduction to individuals of the female gender.

Objectives: To present the audiological profile foundin an individual of the female gender, diagnosedwith Perraultsyndrome. Resume report: Female gender patient, 23 years,diagnosed with hearing impairment at 2 years old, possiblydue to the Perrault Syndrome. The patient has progressivesensorineural hearing loss of severe degree, bilateral. She is inhearing rehabilitation using individual hearing aid.

Conclusion: This current case proposes an alert tohearing professionals, as otolaryngologists and audiologistsabout this syndrome and the possibility of hearing loss,associated with Perrault syndrome, in view of early hearingdiagnostics and satisfactory rehabilitation.

Keywords: Hearing Loss, Diagnosis; GonadalDysgenesis

A177. Hearing Screening in Middle-Aged Adults and Elderly:Community Centre ResultsÍcaro da Silva Walbrohel, Adriane Ribeiro Teixeira, AndréaKruger Gonçalves, Patricia Pérez Coradini, Maira RozenfeldOlchikUniversidade Federal do Rio Grande do Sul - Ufrgs

Introduction: The presbycusis diagnosis often doesnot occur because there isn’t a specific hearing loss complaint.Thus, the auditory screening could be an alternative to reducethe time interval between the onset of early symptoms,diagnosis and treatment.

Objective: To assess hearing screening results in mid-dle-aged and older adults who attend a community center.

Methodology: The sample consisted of individuals ofboth genders in a total of 47 individuals, aged between 53 and80 years (mean 67.42 � 6.58 years). 43were females (91.38%).The otoscopy was initially performed, followed by the hearingscreening using portable equipment (Hearcheck Screener,Siemens), in quiet environment. The equipment emits puretones at 1000Hz (20, 35 and 55dBHL) and 3000Hz (35, 55 and75 dBHL). As a criterion of "pass", the subjects should hear thepure tone sounds, except for 20dBHL at 1000Hz, as previousresearch has shown that even peoplewith normal hearing cannot perceive the pure tone in such loudness.

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Results: From the 47 individuals tested, it was foundthat only 6 (12.77%) individuals passed the hearing screeningin both ears. From these, three were middle-aged adults andthreewere elderly. Failed results were found in the right ear in40 (85.11%) patients and in the left ear in 34 (72.34%)individuals.

Conclusion: It was found thatmost of the tested adultsand elderly subjects failed in the hearing screening (87.23%),whereas most of them were found in the left ear.

Keywords: Mass Screening, hearing, Middle Aged,Aged

A514. Hearing Screening Network of Public Schools in PortoAlegreJade Zaccarias Bello, Isadora de Oliveira Lemos, Letícia KurtzUfcspa

Introduction: The adequate process of oral languagedevelopment is directly related to auditory integrity, becausewhen the child has difficulties in the auditory feedbackprocess, the oral language will be impaired and consequentlythe acquisition of written language, as well as their learning ingeneral. Therefore, the school hearing screening plays a keyrole detecting possible hearing difficulties in children ofschool age.

Objectives: To verify the number of hearing screeningconducted in schoolchildren from public schools in the city ofPorto Alegre in the years 2012 and 2013.

Methods:DATASUSdatawere used from January 2012to December 2013.

Results: According to a survey of IBGE from 2012,therewere 137,010 primary school students enrolled inpublicthat same year, there were 222 hearing screening proceduresregistered, representing 0.16% of students. In 2013 therewere342 procedures registered, an increase of 54% of hearingscreening in school in comparison to 2012.

Conclusion: Considering the findings of this study,although there is a considerable increase of 54% from 2012 to2013, it is clear that there is an expressionless number ofhearing screening in public schools, in comparison with thenumber of students enrolled. It is necessary to create publicpolicies that contemplate this type of procedure to detect,diagnose and treat patients with hearing difficulties at schoolage.

Keywords: speech therapy, diagnosis, audiology

A511. High-Frequency Audiometry in Adults with NormalHearingLauanda Barbosa dos Santos, Fatima Cruz Ribeiro de Miranda,Sandy Maira Almeida de Andrade, Beatriz Mendes de AzevedoSoaresUniversidade Federal do Rio de Janeiro

Introduction: Auditory High Frequency evaluates thefrequency of 8.000Hz, 9.000Hz, 10.000Hz, 11.200Hz,12.500Hz, 14.000Hz and 16.000Hz, and it is a test that detectsearly hearing loss situated in the cochlea base, due to aging,exposure to ototoxic drugs, diabetes mellitus and high inten-sity noise.

Objective: To study the auditory profile by conven-tional audiometry and high frequency in a group of youngpeople with and average age of 23 years.

Methodology: Observational, retrospective and pro-spective. Conventional audiometry (250Hz to 8.000Hz) andhigh frequency audiometry (8.000Hz to 16.000Hz) werecarried out. Only young people who had no change in theconventional audiometry were observed. Also applied ques-

tionnaire on symptoms, history, habits and diseases in only 46individuals.

Results: Among 167 individuals evaluated, 14 hadthresholds above 30dB. Of the 14, there was a further declinein the frequency of audibility 14.000Hz and 16.000Hz. Amongthe 46 who completed the questionnaire, 5 individuals dem-onstrate changes in high frequency audiometry and reporteddizziness, tinnitus, ear fullness, diabetes, habit of drinkingalcohol and headset use to listening to loud music. In thequestionnaire themost frequent reports were in drink alcoholand tinnitus.

Conclusion: After analyzing the results, one can ob-serve a decrease in levels of audibility in audiometry and alsothe increase in frequencies.

A714. High-Speed Kymography of Healthy Subjects: AReference PatternMonike Tsutsumi, Regina Aparecida Pimenta, Maria EugeniaDajer, Adriana Hachiya, Domingos Hiroshi Tsuji, Arlindo NetoMontagnoliUniversidade de São Paulo (USP/São Carlos)

Introduction:High-Speed Kymography is a techniqueof laryngeal images analysis currently used by laryngologists.Because of normative data shortage related High-Speed Vid-eolaryngoscopy the goal of this study is to characterize thevocal folds vibratory pattern of healthy subjects calculatingquantitative measurements of high speed kymography.

Method: Laryngeal images from 45 healthy subjectswere collected during emission of sustained vowel withcontrolled frequency and intensity, 26 of female and 19male. Eight parameters were analyzed: phase time (closed,opening, closing, opened), total period of vocal fold vibratorycycle and quotient, (opening, closing and speed). The softwareX-CAD developed by Medical Engineering Research Group(GPEM-CNPq) was used to analyze the images.

Results: Medium values, in milliseconds, of high-speed kymography parameters were: closed phase time:female ¼ 1.75 and male ¼ 3.32; opening phase: female¼ 1.47 and male ¼ 2.32; closing phase: female ¼ 1.51 andmale ¼ 2.22; opened phase: female ¼ 2.91 and male¼ 4.56;and total period of vibratory cycle: female¼ 4.67 and male¼7.89. The quotients were: closing: female ¼ 0.37 and male¼ 0.42; opening: female¼ 0.62 and male¼ 0.57; and speed:female¼ 1.02 and male¼ 1.12. Statistical differences werefound in all phase time of vibratory cycle in comparisonbetween genders (pâ‰¤0.001), and in opening and closingquotients (p ¼ 0.013).

Conclusion: Using specific computational tools toanalyze high-speed laryngeal images we obtained quantita-tive parameters of High-Speed Kymography of healthy sub-jects that can be used as a reference pattern for future studies.

Keywords: High-Speed Videolaryngoscopy, High-Speed Kymography, normative data

A496. Indicators of Risk for Disability Hearing: Rate Hearingin Children 1 Year 2 YearsLenita da Silva Quevedo, Ana Carolina Lago Battezini, MicheliBristotUniversidade de Passo Fundo

Evaluate the occurrence of hearing impairment inchildren with risk factors for infant hearing loss, screened inNeonatal Hearing Screening Program at a hospital within thestate of Rio Grande do Sul. Inclusion criteria were: patientsborn in that hospital, age group of one to two years old, of bothgenders, and that had remained in the pediatric Intensive Care

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Unit (ICU) for more than five days. It was analyzed 110children records that fitted the inclusion criteria. All werecontacted, however, the samplewas composed by 10 children,age group of one to two years old, these being seven boys andthree girls. Most prevalent risk indicators for hearing losswere: mechanical ventilation (5) ototoxic medication (4), ICUfor more than five days (10). In the RE the frequency of4000 Hz presented the lowest value of signal/noise (S/N)relation in TEOAE, and the frequency of 2000 Hz presentedthe highest value of S/R relation. In the LE the frequency withthe lowest value of S/N relation was 1500 Hz, and the highestvalue of S/N relation in 3500 Hz. In the DPOAE the frequencythat presented the lowest value of S/N relation in both earswas 5000 Hz. The frequency with the highest value of S/Nrelation for the RE was in 3000 Hz and for LE was in 2000 Hz.

Conclusion: all children evaluated presented TEOAEand DPOAE presents in both ears, however due to the smallsample size it is suggested further studies of this nature.

A641. Individuals with Genetics Hearing LossNonsyndromic: Audiological FindingsPricila Sleifer, Bibiana Fuzer da Silva, Liliane Razador, RafaelFabiano Machado Rosa, Paulo Ricardo Gazzola ZenUniversidade Federal do Rio Grande do Sul

Introduction:Deafness, whether partial or total,is themost common sensory impairment found in the population.The incidence of genetic deafness in our population reachesabout 16% of cases, and, 95 % of deaf children are born toparentswith normal hearing. 31% of cases of sporadic deafnessare caused by mutations in the connexin 26 generating agenetic hearing loss character of nonsyndromic.

Objective: To report the audiological findings in chil-dren with genetical hearing loss nonsyndromic,proven by thetest of the search of the mutation 35delG of the Connexin 26.

Method: 12 childrenwere studied, 06 cases of siblings,09male children and 03 female children, ages between 04 and12 years old, comming from a service of hearing care in areference hospital, submitted to an otorhinolaryngologicalevaluation, tonal threshold audiometry, acoustic immittancetesting and research of the mutation 35delG of the Connexin26.

Results: The audiometric findings show hearing lossin sensoriouneural and bilateral types in all cases, in which20% in moderate, 46.7% severe and 33.3% deep grades. In theacoustic immittance testing all individuals show tympano-metric curves type A with total or parcial lacking of acousticreflexes.

Conclusion: The mutation 35delG of the Connexin 26is potentially liked to some cases of unclear hearing loss. In thispaper, all children evaluated showed sensorioneural bilateralhearing loss in moderate to deep grade, in this way, it’sbelieved that the research of this mutation could be includedin the series of tests to investigate hearing loss, in order to helpwith the diagnostic etiology and genetic counseling.

Keywords: Hearing, hearing loss, genetic

A369. Infantile Cognitive Vocal Program: Playful CognitiveStrategy For Vocal NodulesKatia Nemr, Marcia Simões Zenari, Ana Flávia de OliveiraNalom, Anne Caroline de Oliveira, Joyce Pinheiro da SilvaUniversidade de São Paulo

Introduction: Dysphonia affects between 6%-38% ofchildren. Rehabilitation programs have been suggested, butliterature is scarce on the subject.

Purpose: To develop an infantile Speech-LanguagePathology program for vocal hyperfunctioning and verify itseffectiveness through vocal assessment.

Method: Adaptation of Vocal Cognitive Program foradults with vocal hyperfunctioning based on the use ofdynamic images/repetitive stimuli aiming to a body reframingbased on the Genetic Epistemology of Jean Piaget was devel-oped for infantile patients. Three children participated in thepilot and all performed larynx examination. The programconsisted of initial assessment and reassessment with vocalrecording for perceptual and acoustic analysis and also voiceassessment by the responsible for the visual analogic scale; sixtherapy sessions involved gradually, breathing, glottis activityand resonance / articulation and finished with reinforcementfor the integration of the three aspects approached and forchanging poor habits; the elected vocal techniques based onliterature relied on cognitive playful strategies which wereadapted to this research, aiming the understanding andretention of the new settings as well as encouraging thepractice of new vocal habits.

Results:All patients showed improvements in percep-tion and acoustic analysis; in the visual analogic scale a childkept the same initial score and two presented improvement.

Conclusion: The Infantile Cognitive Vocal Programproved to be effective and promoted positive shifts in thevoice aspects approached. The cognitive playful strategiesshown to be adequate and may be reproduced in largersamples and may be a highlighted intervention approach inthis age group.

A426. Influence Factors and Reasons for EarlyWeaning Untilthe Third Month of LifeLuíza Silva Vernier, DianaWeber Bartz, Natasha Corrêa Ramos,Sheila Tamanini de AlmeidaUniversidade Federal de Ciências da Saúde de Porto Alegre

Introduction: Breastfeeding is the ideal food for new-borns and those must be exclusively breastfed for the first sixmonths of life to achieve ideal development and health.However, Brazil presents low exclusive breastfeeding indices,with early introduction of other foods on the infants diet.

Objectives: Investigate factors that influence brest-feeding discontinuance and reason reported for earlyweaninguntil infants third month of life.

Methods: Cross-sectional study, with a sample of 150postpartum women. The data was collected from December2013 to June 2014, in two steps. The first on the rooming in atthe hospital, applying two questionnaires and the secondthrough phone interviews, applying a questionnaire at thefirst and the third months of the infants life. The project wasapproved by UFCSPA’s Research Ethics Committee undernumber 481.830.

Results: There was a significant association betweenthe use of pacifiers (p ¼ 0.022) and bottles (p < 0.001) andearly weaning at the first and the third months of the infants’life. Significant, too, was the association between reasonsrelated to weaning: “mother with complaintsâ€ and “insuffi-cient milk”, with the variables education (p < 0.001), returnto work (p < 0.001), immediate postpartum complaints(p ¼ 0.035) and not have breastfed before (p ¼ 0.008).

Conclusion: The use of pacifiers and bottles, amongseveral variables researched, were the ones that presentedsignificant relevance in breastfeeding discontinuance. Insuffi-cient Milk and Complaints were themain reasons for weaningreported bymothers who had already initiated other foods ontheirs infants diet and those are associated to woman withimmediate postpartum complaints and that haven’t breastfedbefore.

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Keywords: breastfeeding; Speech therapy; Earlyweaning

A58. Influence of Risk Indicators for Hearing Loss in theInfant Audiological DiagnosisGeorgea Espindola Ribeiro, Daniela Polo Camargo da Silva, JairCortez MontovaniFaculdade de Medicina de Botucatu

Introduction: Universal neonatal hearing screeningaim to facilitate the early diagnosis of hearing loss in order tominimize the negative effects that this deficiency can result inthe speech development. In addition it is important to knowwhich risk indicators for hearing loss causes this damage, bythis way we can improve the rehabilitation process.

Objective: To analyze the frequency of risk indicatorsfor hearing loss and its influence on the number of hearingimpairment.

Method: The studywas conducted in a public hospitalwith 796 babies.

Results: In the 796 infants screened, 09 had hearingloss with a prevalence of 11: 1000. We found that 132 (16%)showed some risk indicator for hearing loss and the mostfrequent were: intensive care units (ICU) stay, Apgar score 0-4in the first minute and/or less than 6 in the fifth minute of life,birth weight less than 1500g and use of mechanical ventila-tion and ototoxic drugs. There was a statistically significantrelationship between the hearing loss diagnosis with thefollowing risk indicators: ICU stay and use of ototoxic drugs.

Conclusion: Despite the occurrence of certain riskindicators for hearing loss in the sample, who were reallyassociated with hearing impairment were only ICU stay anduse of ototoxic drugs.

A546. Influence of Unilateral and Bilateral Tinnitus in SleepRayane Brum de Fraga, Adriane Ribeiro Teixeira, AlexandreHundertmarck Lessa, Letícia Petersen Schmidt Rosito, CelsoDall’IgnaUFRGS

Introduction: Tinnitus is a disorder of high prevalencein the population. The most frequent complaints related totinnitus are the interference with sleep and concentrationdifficulties in daily activities that can potentially change theemotional balance of the patients.

Objective: To analyze the correlation of the unilateralor bilateral tinnitus and its interference caused in the sleep.

Methodology: The study sample included patients ofboth genders from the tinnitus clinic of an university hospital.They underwent data collection on the presence of unilateralor bilateral tinnitus and the interference of tinnitus in theirsleep, by means of a questionnaire prepared by the clinicalteam. Pearson’s test was performed to evaluate the correlationof sleep interference in cases of unilateral or bilateral tinnitus.

Results:We evaluated 731 subjects, 271men (37.07%)and 460 females (62.93%), aged between nine and 88 years(mean 59.06 � 12.84 years). There was a statistically signifi-cant correlation (p ¼ 0.004; r ¼ -0.107) between the presenceof bilateral tinnitus and the complaint of sleep interference.

Conclusion: The data analysis showed a statisticallysignificant correlation between the variables, indicating thatthe presence of tinnitus in both ears suggests greater interfer-encewith sleep, compared to patientswith unilateral tinnitus.

Keywords: Tinnitus; Sleep; Audiology

A671. Investigating Non-Breastfeeding by HIVþ YoungMothers: Repercussions and Possibilities of InterdisciplinaryInterventionLuíza Silva Vernier, Gabriela Nunes Maia, Gabriela Cássia Ritt,Daniela Centenaro LevandowskiUniversidade Federal de Ciências da Saúde de Porto Alegre

Introduction: The prohibition of breastfeeding forHIVþ mothers may impact the mother-infant relationshipanddamage infant’s feeding,leading to interference in oralmotor development.Thus,this condition becomes adequateto an interdisciplinary intervention, aiming to promote adyad’s health.

Objectives: To analyze the repercussions of non-breastfeeding for young HIV þ mothers and to reflect oninterdisciplinary care strategies.

Methods: Qualitative,exploratory-descriptive andcross-sectional study, with eight HIVþmothers (15-21 years)and their babies (4-9 months)of low socioeconomic status,contacted in health services of Porto Alegre/RS.Mothers havediscovered HIV infection during pregnancy or childbirth.Theyfulfilled a sociodemographic form and were interviewedabout motherhood experience. The project was approved byUFCSPA’s Research Ethics Committee(Protocol 10-617).

Results: Participants reported both the desire tobreastfeed, as well as "indifference" to its impossibility.Thefeeling of unfulfilled motherhood aroused by not breastfeed-ing was overcome by the desire of preventing infant illness,the fear of vertical transmission and the search for newstrategies to deal with motherhood in this context.

Conclusion: These results highlighted the need forinterdisciplinary intervention. The speech therapy couldguide the proper placement of babyduring feeding, and toemphasize the importance of emotional contact during thistime, also providing alternatives to the supply of food properdevelopment of the stomatognathic system. At the same time,psychologistcould address the mother feelings derived fromthis condition and the need for adjustments, promoting themother-baby bond. These interdisciplinary care guidelinesand strategies intend to mitigate the possible adverse effects-non-breastfeeding and to promote baby’s healthydevelopment.

Keywords: HIV; Breastfeeding; Motherhood

A542. Labor Aspect with Emphasis on Hearing and Extra-Hearing of Gas Station WorkersIsabela de Moraes Fattore, Isabela Schroer Neis, Állan RodrigoVieira da Silva, Valdete Alves Valentins dos Santos FilhaUniversidade Federal de Santa Maria

Introduction: Among the factors that may result inoccupational risk,noise is the most frequent. It is believed thatthe constant exposition to chemical agents leads to a potenti-ation of the harming effects of the auditory and extra-hearinghealth of the workers.

Objective: To analyze the labor aspects with emphasison hearing and extra-hearing effects listed by the gas stationworkers facing the daily exposition to noise and ototoxicchemicals.

Methodology: The sample was composed of 51 gasstation workers,being 15% female and 85% men,age mean of36.8 years-old,exposed to noise and chemical agents,sub-jected to a questionnaire application previously developedabout hearing and extra-hearing aspects.

Results: It was found a mean of 7.56 daily hoursworked and 7.6 years of service. Concerning the receipt ofauricular protector IPE, 17% of them received,of which 44% useit continuously. Regarding the auditory perception, 96%

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reported a good hearing and 7.84% reported tinnitus; thetotality is subjected to regular annual hearing tests. As to theextra-hearing manifestation, it was observed the predomi-nance of fatigue, stress, headache and anxiety; 61.53% re-ported at least one of the listed symptoms, 25.50% twosymptoms, 17.64% three symptoms or more and 37.25% nosymptoms. When asked about the relation between noise andthe extra-hearing symptoms and the hearing loss generation,80.40% thought that there is no relation between them.

Conclusion: Despite that the analyzed populationreported labor aspects related to the hearing health, it wasfound the need of awareness about the auditory and extra-auditory effects caused by the exposition to physical andchemical agents.

A400. Laboral Activity in Health Professionals Exposed toChemotherapy Drugs: A Neurotology PerspectiveNatalia Martinez Fernandes, Isadora Gonçalves Pelissari, LíciaAssunção Cogo, Valdete Alves Valentins dos Santos FilhaUniversidade Federal de Santa Maria

Introduction: The handling of antineoplastic drugs isconsidered high risk for accidents and occupational diseases.

Objective: To evaluate the auditory and vestibularsystems of workers exposed to chemotherapy drugs in theUniversity Hospital of Santa Maria and to identify the use ofindividual protection equipment by comparing the obtainedresults.

Methods: A cross-sectional study and quantitativemethod was utilized. 33 male and female workers in thenursing and pharmacy sectors were evaluated, with agesranging from 21 to 60 years old. The workers underwentconventional Audiologic Assessment, Transient Evoked Otoa-coustic Emissions, and ComputerizedVectoelectronystagmography.

Results: The majority of the sample was female(90.9%). Individual protection equipment was used by 90.9%of the workers. 56.25% of nursing workers and 52.94% ofpharmacy workers complained of dizziness. In the audiologi-cal and vestibular assessments, the observed results werewithin normal limits in 96.97% and 74.20% of the samplerespectively. However, audiometric configuration of notchtype was identified in 75.75% of the workers. Notch type onaudiometric configuration (76%) and altered caloric test(100%) were often associated with lack of coal mask use.

Conclusion: Among the workers evaluated, the vesti-bulocochlear system was within the normal range. The pres-ence of notch configuration indicates the need to useindividual protection equipment.

Keywords: Hearing, Drug Therapy, OccupationalHealth Services, Vestibular Function Tests, Dizziness

A282. Language Delay in Children with Cleft Lip and PalateAttended at a Specialized Clinic.Kariny Zencke da Silva, Guilherme Augusto Alff Moreira,Camila de Oliveira Lucas Marques, Graziela da Silva Oliveira,Maria Cristina de Almeida Freitas CardosoUniversidade Federal de Ciências da Saúde de Porto Alegre

Introduction: Cleft lip and palate- CLP- is one of themost common congenital anomalies and classified as follows:Pre-incisive foramen clefts- PIF; Post-incisive foramen clefts-POF; and Trans-incisive foramen clefts- TIF. The nasality andcompensatory articulation disorders are part of the clinicalpicture. Aspects of language delay may occur, although theyare not related to the pathology but triggered by overprotec-tion over the deformity.

Objective: Score the impairment of the languagebecause of the CLP.

Resumed Report: Case studies, approved by the EthicCommittee, number 039/12. Group of children accompaniedweekly at a speech therapy clinic situated in a pediatric carehospital in Porto Alegre/RS, composed by: boy, 2.6 years withTIF; boy, 2.7 years with TIF; girl, 2.10 years with TIF; boy, 3.1years with TIF. They have varied nasality and language delayfor phonetic, phonological, syntactic and semantic levels.Language delay levels observed in these cases are diversifiedand compromises the communication function by interferingin their interpersonal communication.

Conclusion: Regardless of the type of CLP, the focus ofthe speech pathology consists, generally, in oral facial aspectsand speech for correction of commitments generated by theextension of the deformity and its surgical correction. Thespeech therapy for CLP patients should include the evaluation,speech therapy and orientation of the language aspects,aiming at improving the quality of their lives and their family’slives. The family orientation must be careful and directedtowards to the child’s overall development.

Keywords: Cleft Lip; Cleft palate; Language

A527. Laryngeal Tuberculosis: Literature Review on theInterface of Post Pharmacotherapy Sequelae and SpeechTherapyThais Prett ChiabaiUniversidade Federal do Espírito Santo

Introduction: Laryngeal Tuberculosis is an infectiousdisease caused byMycobacterium tuberculosis. The transmis-sion is direct via saliva droplets containing the infectiousagent. The treatment is pharmacological, lasting six monthsand some patients acquire sequelae.

Objectives: To analyze the effects of laryngeal tuber-culosis in the airways tract and its interference in the vocalquality, and discuss the benefits of speech therapy in therehabilitation of these functions.

Data Synthesis: The selection of articles was held invirtual health library (BVS) in LILACS and SciELO database inthe 1983-2014 period with the descriptors "tuberculosis""larynx". Tuberculosis Laryngeal predominates in men andthe most common symptoms include coughing, secretion ,fever, sore throat and weight loss. It is usually diagnosed aslaryngeal cancer erroneously due to similar symptoms. Theincidence of dysphonia is high and speech therapy significant-ly improves the voice quality of these patients seen in thereduction of tension during phonation, improved pneumo-phonoarticulatory coordination, increased loudness and de-creased abrupt vocal attack, which more socially acceptable.Are obtained statistically significant improvements in funda-mental frequency variability, maximum phonation time anddeaf fricative relationship and sound (S / Z).

Conclusion: Speech therapy despite the limitations incases of laryngeal tuberculosis intervene positively in thehealing process of the mucosa of the upper aerodigestivetract, contributing to the best vocal pattern of the patient.Being a rare disease, there is a field still being explored.

Keywords: Laryngeal Tuberculosis; Speech Therapy;post pharmacotherapy sequelae

A75. Lifetime and Amplitude of Transient EvokedOtoacoustic Emissions in NeonatesLauanda Barbosa dos Santos, Silvana Frota, Cristiane FregonesiDutra Garcia, Natália Ramos, Maria Isabel Kós Pinheiro deAndrade, Suzana de Couto MendesUniversidade Federal do Rio de Janeiro

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Introduction: Transient-evoked otoacoustic emis-sions (TEOAE) has been the most widely used test in newbornhearing screening. It is recommended to be performed beforedischarge from hospital.

Objective: Evaluate the influence on the number ofhours of the newborn life on TEOAE amplitude.

Methodology:We observed 535 children. All childrenselectedwere born at term and did not have any risk factor forhearing loss. The study excluded children with TEOAE lowerthan 6 dB in the frequencies of 2, 3 and 4 kHz. The childrenwere divided into three groups: group 1 (193 children be-tween 12 and 24 hours of life), group 2 (169 children between25 and 48 hours of life) and group 3 (173 children between49h and 15 days of life). Statistical analysis were performedusing the Student t test and ANOVA (analysis of variance).

Results: The ANOVA test indicates that when compar-ing the amplitude of the EOA in relation to the three groups onthe right ear, at each frequency, the amplitudes differ ingroups only in frequency 4000 Hz (p-value ¼ 0.044). Forthe left ear, the differences between means of groups weresignificant at frequencies 1.5k (significant difference betweenGroup 1 andGroup 2 andGroup 1 andGroup 3), 3k (significantdifference between Group 1 and Group 2) and 4K (significantdifference between Group 1 and Group 3). When comparingaverage levels of Response, also found significant differences.

Conclusion: The age factor (number of born-hours)influences the amplitude of TEOAE.

A533. Listening in Elderly: Hearing Handicap and Quality ofLifePriscila Silva Passos, Aline Cabral de Oliveira Barreto, MaraMaria Gomes Barros de Andrade, Silmar Gabriela da Silva,Liliane Desgualdo PereiraUniversidade Federal de São Paulo; Universidade Federal de Sergipe

Introduction: The quality of life of the elderly isinfluenced by physiological changes that accompany agingsuch as hearing loss and its social consequences.

Objective: Compare the quality of life of older peoplewith hearing loss with and without complaints of difficulty inunderstanding speech.

Method:A total of 56 elderlywithout neurological andpsychiatric and/or unexpected auditory-vestibular alterationsin presbycusis were assessed. Participants were submitted toaudiological assessment and completed SF-36 and HearingHandicap Inventory for the Elderly: (HHIE) questionnaires inorder to determine the impact of hearing loss on social,functional, emotional and situational aspects.

Results: A negative correlationwas observed betweenemotional and situational and social aspects. There was astatistically significant difference between the number ofindividuals reporting difficulty in understanding speech andthose that did not, with respect to loss of well-being inemotional (p ¼ 0.004), situational (p ¼ 0.005) and functional(p ¼ 0.008) aspects of daily life.

Conclusion: Self-perception of the disadvantagecaused by hearing loss has a negative effect on psychosocialaspects. Elderly with difficulty understanding speech havegreater hearing handicap and poorer quality of life.

Keywords: Hearing Loss; Quality of life; Health of theelderly; Comprehension

A539. Long Latency Auditory Evoked Potential in Term andPremature Neonates: Preliminary FindingsÂndrea de Melo, Pricila Sleifer, Inaê Costa Rechia, Eliara PintoVieira BiaggioUniversidade Federal do Rio Grande do Sul

Introduction: Electrophysiological hearing tests al-low access to central auditory pathways making it possible tocapture full view of the sound by the auditory cortex, as in theLong Latency Auditory Evoked Potential (LLAEP).

Objetives: Investigate the presence of exogenous po-tential in term and preterm neonates.

Methods: It is a cross-sectional, prospective, contem-porary and comparative study. Have been assessed 60 neo-nates, these 40 term infants and 20 preterm, from a referencehospital at Rio Grande do Sul state. The exam records weremade with newborns positioned comfortably in the mother’slap in natural sleep through electrodes positioned with elec-trolytic conductive paste andfixedwithmedical tape,with theactive electrode in the front (Fz), the ground (Fpz) in the front,and the reference placed on the left mastoid (M1) and rightmastoid (M2). To do this, binaurally verbal stimuli werepresented,being /ba/ frequent stimulus and /ga/ the rarestimulus, at an intensity of 70 dBHL through insert earphones.To ensure the test reliability, replication of the trace of waveswas carried out and analyzed for the presence or absence of P1and N1 waves in both groups.Data analysis was performedusingChi-square test, Stata 9.0, considering a significance levellower than 0.5.

Results: 22.5% (n ¼ 9) of term neonates and 70%(n ¼ 14) of premature neonates had no waves.

Conclusion: There was a statistically significant dif-ference (p < 0.001) between the groups of neonates, showingthe influence of maturational factor in preterm group.

Keywords: evoked potentials auditory; prematurity;newborn

A318. Long Latency Auditory Evoked Potential: Differencesin Count Form of Stimulus RareRúbia Soares Bruno, Sheila Jacques Oppitz, Michele VargasGarcia, Eliara Pinto Vieira BiaggioUniversidade Federal de Santa Maria (Ufsm)

Introduction: Potential Long Latency AuditoryEvoked refer to the electrical activity from the peripheralauditory system to the central auditory pathways, allowingthe measurement of precisely the auditory information proc-essing function of time in an objective way.

Objective: To compare the findings of long latencyauditory evoked potentials and different ways to respond rarestimuli.

Methods: This study was prospective and cross-sec-tional, defined for convenience and comprised by 49 subjects,29 female and 20 male. The following procedures wereperformed: Visual inspection of the external auditory canal,pure tone audiometry, acoustic immittance measures andlong latency auditory evoked potentials, with individualsregarding the rare stimuli, mentally counting and markingpaper.

Results: There were statistically significant resultsbetween the ears for latencies P1 and P2 from the methodwhich was marked on paper. However, with values into thenormality range. Between genders, for latency P2, N2 (in bothmethods), in P1 amplitude and also in P3 amplitude, but onlythrough the paper marked method. By analyzing the differ-ences between methods, there was difference only in P2latency.

Conclusion: There was no difference for long latencypotentials latencies and amplitudes in the rare stimuli count-ing comparison (mentally counting and marking paper) foralmost all potentials, except P2 potential marked on paper.

Keywords: Evoked Potential P3, Hearing, Auditoryperception, Cognitive Potential

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A584. Mapping of the Deaf School in The Public SchoolSystem in LagartoScheila Farias de Paiva, Maria Denise Andrade de AraujoRodrigues, Genef Caroline Andrade Ribeiro, Ana ClaudiaNascimento SantosUniversidade Federal de Sergipe

Introduction: The law of Guidelines and Bases fornational education 9394/96, ensures every child, the right toeducation, including children with physical, sensory andmental disabilities, which is offered on regular network ofteaching and assured as a right for all.

Objective: To Conduct a mapping of Hearing impairedChildren enrolled in municipal schools of Lagarto.

Method: This is a mapping of schools and the deafstudents in the city of Lagarto/SE through the data provided bythe Municipal Education and Regional Department 2 (DR2) inthe city of Lagarto/SE.

Results: The results show that over 78 schools identi-fied as inclusive, only 55 have students with cases of Inclusion,of these, only 16 schools have students with D. A totaling 24students enrolled in the public network (State andmunicipal)distributed among youth and education adults (EJA) andfundamental education I and II.

Conclusion: It concludes that the majority of pupilswith hearing impairments in the municipal attend betweenthe 5th grade to 8th grade of elementary school II, followed bystudents from 1st to 4th year of kindergarten and findthemselves at a school level more advanced than expected.

A89. Mapping of Vocal Risk in Amateur ChoirMilka Botaro Rosa, Mara BehlauUniversidade Federal de São Paulo - Unifesp

Introduction: Amateur choir singers can exhibit voicesymptoms due to lack of guidance.

Objective: To verify vocal risk in singers.Methods: 526 volunteers, 186 males and 340 females,

answered to four instruments: Voice Symptom Scale (VoiSS),Modern Singing Handicap Index (MSHI), List of Vocal Symp-toms and Sign (LSS) and Generalized Anxiety Disorder Scale(GAD-7). Participants were classified according to the cut-offvalue of the VoiSS protocol into pass and failure groups. Theywere also classified according to the number of vocal symp-toms in no risk (less than1.7 symptoms) and with risk (morethan 1.7). Four groups were created: failed in both protocols,failed only in one of them (VoiSS, LSS and no risk).

Results: 102 singers (19.4%) failed only VoiSS; 54(10.3%) failed only LSS; 169 (32.1%) failed both tests and201 (38.2%) tested normal. The level of anxiety in singerswas low, but it was higher with presence of vocal risk. Thefailed both tests group and failed VoiSS had a mild level ofanxiety. The failure group presented the total average scoredon VoiSS was 26.34; the MSHI was 20.97. For the pass group,the VoiSS total average score was 8.27; MSHI was 6.11.

Conclusions: Amateur choir singers can have a highnumber of vocal symptoms. Self-assessment instruments mayassist the conductor to screen singers for further specializedevaluation. Anxiety can be higher when vocal symptoms arepresent. The combined use of the two protocols can enhancethe possibility to identify individuals with potential problems.

Keywords: voice, singing, dysphonia

A560. Middle Ear Disorders Characteristics of PreschoolersAmanda Venuti Cerqueira, Ana Claudia Vieira Cardoso, CamilaRibas DelecrodeUniversidade Estadual Paulista "Júlio de Mesquita Filho"

Introduction: middle ear disorders are very commonin childhood and may have a negative impact on auditory,speech and language development; due to the sensory depri-vation that this disease causes.

Objective: to characterize middle ear disorders inpreschoolers and verify if this disorder is influenced by seriesand period that the child attends school.

Method: Descriptive and cross-sectional study devel-oped in a Municipal School of Infantile Education of São Paulostate. 107 children of both genders, aged between four and sixyears, composed the sample. Of these, 55 preschoolers at-tended Infant I and 52 Infant II. In this study was used theanswers from a questionnaire, regarding the hearing health ofchildren, which was sent to parents. For the data analysis wasused a descriptive statistics.

Results:Analysis of the questionnaires showed that 28(26.1%) preschoolers had an episode of middle ear disorders;of these 57.1% were from Infant I and 42.8% from Infant II. Itwas also observed that preschoolers from integral had a lowerincidence of middle ear disorders (17.8%) when compared tothe part-time (78.6%). Of the 28who hadmiddle ear disorders,the most common age group was between two and six years(53.5%), with one episode per year (42.8%).

Conclusion: There were few reports of middle eardisorders in preschoolers and this complaint was more prev-alent in preschoolers from Infant I that attend school part-time.

A452. Monitoring of Hearing and Language in Primary Care:A Pilot P of Partial DataJulianne Wagner, Márcia Salgado Machado, Laura FabianaBurkhard, Andressa Ortiz Birck, Cristina Loureiro ChavesSoldera, Andrea Wander BonamigoUniversidade Federal de Ciências da Saúde de Porto Alegre

Introduction: A good hearing is essential for thehearing and language development. The community healthworkers are the crucial link between the community and theUnified Health System and for this reason they can contributeto the identification of hearing loss and perform an interven-tion during the critical period of child development, if needed.

Objective: To analyze the accession of the communityhealth workers to a pilot project to monitor hearing andlanguage.

Methods: Forty-one community health workers fromfive Health Centers were invited to implement a monthlyquestionnaire during the first year of age of babies belongingto the coverage area, according to the proposal of Alvarenga etal. (2012).

Results: Thirty-nine (95%) community health workersagreed to participate. During the first twomonths (March andApril/2015), seventeen infants were included and monitoredby the questionnaire. There was dropping out of any commu-nity health worker so far. Among of the difficulties encoun-tered themost challenging issuewas the communicationwiththe Health Centers participants in order to obtain themonthlyresults.

Conclusion: So far the agreement of communityhealth workers to proceed with the monitoring of hearingand language has been satisfactory.

Keywords: Hearing Loss, child, Community HealthWorkers

A443. Multidiaciplinary Intervention in Pregnant Group: ACase ReportVanessa Souza Gigoski, Liliane Menzen, Bruna de MeloMenezes, Camila da Cunha Niedermeyer, Sara Oliveira Pinheiro

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Schuck, Katherine FlachUniversidade Federal de Ciências da Saúde de Porto Alegre/IrmandadeSanta Casa de Misericórdia de Porto Algre

Introduction: During pregnancy women experiencesbiological, emotional and socio-cultural aspectsmodificationsas well as starts to build a bond with baby. In this context,doubts and uncertainties may emerge, signaling a need forspecial attention from health care to this important period ofthe life cycle.

Objectives: To present a case of revitalization of apregnant women group in Primary Care by Patient Care Team.

Resumed Report: The concerned pregnant group ispart of a Family Health Strategy (FHS) in a neighborhood ofPorto Alegre, coordinated by a community health agent (CHA)and a doctor. Participation was mandatory prior to prenatalappointment. After watching three meetings, it was proposedthe group’s revitalization by a multidisciplinary team ofspeech therapist, pharmacist, physiotherapist, nutritionist,nurse and psychologist. A guiding portfolio was designedand selected topics to be approached at each meeting. AtFHS, posters were released with the schedule of issues to beapproched at eachmeeting so that pregnant womenwere notrestricted to participate only when they had scheduled ap-pointments. During the meetings, participants were able toshare their doubts, fears and expectations about pregnancy.Dynamics and practices were usedwhich included the use of adoll, to show the baby care.

Conclusion: The intervention allowed greater adher-ence to the pregnant group, and improvement of activities aswell as the provided guidance. The expertise of different areascontributed considerably to the groups renewal and enrich-ment in a multidisciplinary perspective.

Keywords: Pregnant Women; Patient Care Team;Guidance

A676. Multiple Aspects of Language in Dementia: AComparative between Domestic and Institutional ContextJayne Guterres de Mello, Elenir Fedosse, Michele Vargas GarciaUniversidade Federal de Santa Maria

This study aimed to analyze the expression and inter-pretation verbal and their underlying mechanisms (hearing,body balance, voice and orofacial motricity) of two elderlywomenwith clinical symptoms of dementia - one living in thehouse with family and another in a home for the aged.Presented two elderly’ cases: a 85-year-old woman, withAlzheimer Dementia diagnosis, living with her husband andone of her daughters; and a 90-year-oldwoman,with VascularDementia diagnosis, living in a Long Permanence Elder Insti-tution. A full speech, language and hearing evaluation tookplace, considering language in its many aspects (hearing, bodybalance, voice and orofacial motricity), in which were ob-served linguistic manifestations that depict less verbal pro-duction from the institutionalized elderly. Results obtainedthrough hearing evaluation (acuity and processing) bodybalance, voice and orofacial motricity revealed expectedfeatures in healthy aging process. The elderly’ organic-physio-logical conditions were compatible with natural aging pro-cess, while linguistic-cognitive conditions appear morecompromised. Language operation shows similar features â€“ expected in aging with demential process â€“ in bothelderly, but the institutionalized elderly presents linguistic-cognitive manifestations more compromised. This reportshows the convenience of speech therapist performance ataging with dementia, as much in family as in institutionalcontext.

A707. Musical education and temporal ordering skill inchildren with 8-9 years oldJuliana Jannini Jose, Jayne Guterres de Mello, Letícia Splendor,Liliane Desgualdo PereiraUniversidade Federal de São Paulo

Introduction: Music is view like a feature that canfavor the development of auditory processing skills. A hypoth-esis is that themusical education improves one hearing skill oftemporal ordering.

Objectives: To determine and compare the judgmentof the children about temporal sequences of sounds musicalsof different frequencies and different durations in children 8and 9 years old, with and without musical education.

Method: Study40 individuals in age group 8-9 years ofboth sexes, sendo 20 music students (study group) and 20without music education (control group). Were realized thetests of recognition of tonal melodic pattern which differenti-ate regarding duration (TPD) and frequency (TPF) with an-swer-type appointment and imitation. The statistical analysistook into account the level of 5% significance.

Results: Children with musical education presented abetter average in the TPF, in both types of responses (appoint-ment and imitation), compared children no music experiencein both the children groupwith eight year as children of groupwith nine years, as well as in total group. Therewas nomusicaleducation influence on results of TPD.

Conclusion: Music education can positively affect thetemporal ordering skill of children with 8 and 9 years of age.

A40. Myofunctional Treatment in the Pre and Post-Surgicalof Orthognathic SurgeryMaria Theresa Alves da Cunha Kalil, Maria Theresa Alves daCunha KalilUniversidade Federal Fluminense

Introduction: The goal of this work is the realizer of ameta-analysis of the role of the speech therapist in thetreatment of orthognathic surgery in Brazil to find whattherapeutic performance of election at different stages ofrehabilitation.

Material and Methods: A meta-analysis of the role ofthe speech therapist in the treatment of orthognathic surgeryin Brazil to find what therapeutic performance of election atdifferent stages of rehabilitation.

Results: Through a meta-analysis of the role of thespeech therapist in the treatment of orthognathic surgery inBrazil, it was verified that the therapeutic action of choice invarious stages of rehabilitation.

Conclusion: A clinical assessment in the pre-surgicalorthognathic surgery aims of an analysis of the stomatog-nathic system in order tomeet the standards changed in orderto verify the presence of parafunctional habits and musclework in stomatognathic function, with anatomical conditions,andmuscular important. In theworkof postsurgical becomesevenmore the intervention Speech, eliminatingmuscular andfunctional alterations, ensuring the successful outcome andpreventing any recurrence.

A411. Nasalance of Adults from Two Different BrazilianState, Speakers of the Same LanguageDenise Silva Maturo, Melissa Nara de Carvalho Picinato Pirola,Lílian Neto Aguiar Ricz, Luciana Vitaliano Voi TrawitzkiFaculdade de Medicina de Ribeirão Preto - USP

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Introduction: Nasalance is the acoustic correlate ofperceived nasality. According to some international studies,nasality may vary by location.

Objectives: To get the values of nasalance in youngadults, Brazilian Portuguese speakers of states São Paulo andMinas Gerais, to investigate if the factors as dialect variationhas influence in the nasalance and differences of its valuesbetween the genders.

Methods: It was evaluate the nasality of 36 subjects,being 20 native from the State of São Paulo and living in thatplace (mean age of 23 years), and 16 people fromMinas Gerais(mean age of 24 years), keeping the same criteria, using theinstrumental Nasometer IImodel 6400 (Kay PENTAX) by threetexts reading (nasal, oral, oronasal).

Results: the nasalance scores in São Paulo and MinasGerais population were, respectively, 49.3% e 49.9% for nasaltext; 14.2% e 9.8% for oral text; and 52.6% e 48.8% for oronasaltext. In the statistical analysis comparing the mean of nasal-ance score of both population, there was a difference statisti-cally significant only in oral text, being biggest on São Paulopopulation. However, the gender had no influence in thevalues of nasalance of the subjects studied.

Conclusion: despite the nasalance of people fromMinas Gerais was inferior than São Paulo, both of thempresented the scores in the normal standards. And the genderit was not a relevant factor, in this case, however nasalancescore of women from Minas Gerais seems to be higher thanmen in the same group.

A481. Neonatal Auditory Healt in the Basic Attention Healthand Family Health CareJosé Carlos Sabbag, Adriana Bender Moreira de LacerdaUniversidade Tuiuti do Paraná

The object of this study was to evaluate the quality inall area of auditory care: Universal Audiological Study forNeonatal in the Basic Attention Health and Family Health CareUnit aligned with Criança Curitibana Protocol- 2012; more-over, diagnostic and accompaniment of communication dis-turbances in Average/High Complexity Service at SUS. It is aretrospective study to analyze about quantity care in Curitibapublic health to newborn (zero to one year) with or withoutfactor of risk of auditory deficiency. A questionnaire had beenapplied in interview with families, about: neonatal auditoryscreening in hospital or ambulatories, unit of average/highcomplexity and integrality of attendance, answered by mainresearcher of the study. The results from questionnairesindicate an decentralized, integrated, articulated networkexists. The network on basic attention guides neonates tomore complex examinations, when they had any auditory lostsuspect. This study concluded that TANUnot yet is universal inthe analyzed unit. The actions in auditory health show someproblems like: lackof knowledge from families aboutNeonatalAuditory Screening, miss continuous trainment to all memberfrom network and a frequently analyses from quality ofattendance.

A689. Neonatal Hearing Screening: A ProgramCharacterizationBeatriz Araujo dos Santos, Maria Cecília Marconi Pinheiro LimaFaculdade de Ciências Médicas- Universidade Estadual de Campinas

Introduction: Hearing impairment in children mayinterfere in the process of oral language acquisition and intheir social development. Initiatives that contribute to thepractical advancement on diagnosis and intervention of hear-ing loss are decisive in prognosis.

Objective: To describe a neonatal hearing screeningprogram at a public hospital in the city of Campinas.

Methods: We conducted a retrospective, descriptivestudy approved through the Research Ethics Committee of theState University of Campinas (No.808.835/2014). The datawere stored in EPIINFO Database 6.2. Neonates who remainedin a rooming-in care of a public hospital were referred to anoutpatient hearing screening service after discharge. We usedthe Transient Otoacoustic Emission and the research for riskIndicators for hearing loss.We studied the variables: attendingthe hearing screening (2013), fail in the test, presence of riskindicators and its relationship with the diagnosis.

Results: A total of 2031 infants were referred tohearing screening and 1780 (87,64%) actually came to theservice. There were 38 (2.13 %) and 33 (1.85 %) cases of failurein the left and right ear, respectively. Among those who cameto the test, 404 (22.7%) presented risk indicators. There weretwo (0.11 %) confirmed cases of hearing loss, one of whomhadrisk indicator (50%).

Conclusion: There is a need for strategies to reducethe evasion for newborn hearing screening and reinforces theimportance of achieving universal screening as half of patientsdiagnosed with hearing loss did not have risk indicators fordeafness.

Keywords: Triage, newborn, hearing loss

A450. Newborn Hearing Screening in Newborns Exposed toPsychoactive Drugs in Gestational PeriodRuth Siqueira Grawer, Bárbara Machado Costa, CristinaLoureiro Chaves Soldera, Márcia Salgado Machado, GabrielaPereira da Silva, Stefanie Kuhn BenvenuttiUniversidade Federal das Ciências da Saúde de Porto Alegre

Introduction: The exposure to psychoactive drugsduring pregnancy is not considered as an indicator of riskfor hearing impairment. but your use can be associated withother indicators.

Objective: to analyze the results of hearing screeningin newborns wichwere exposed to psychoactive drugs duringpregnancy.

Methods:Weanalyzed themedical records pertainingto the reporting of psychoactive drug use by recent mothers,drugs (as described) and presence of risk indicators for thedeaf of babies of Neonatal ICU who conducted the hearingscreening in a philanthropic hospital.

Results: were analyzed 257 medical records for theperiod October/2014 at April/2015. Of these, 23 (8.9%) moth-ers reported use of psychoactive drugs in pregnancy. Mothersof drug users, 14 (60.8%) did only use of crack, three (13%) onlyuse cocaine, three (13%) other and three (13%) over a drugsimultaneously. Of the total of children exposed, three (13%)failed in hearing screening. Of these, one (33.33%) passed theretest, one (33.3%) didn’t attend the retest and one(33.3%) afailed the retest and was forwarded to high complexity. Thischild remained in Neonatal ICU for more than five days andpresented a history of maternal infection (syphilis)and ex-posed to crack. Statistical analysis showed no significantassociation between exposure to psychoactive drugs andresults in hearing screening.

Conclusion: The exposure to psychoactive drugs dur-ing pregnancy in the sample studied showed no associationwith changes in hearing screening of neonates exposed.

Keywords: Drugs; Neonatal Screening; Hearing Loss

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A409. Newborn Hearing Screening in Philanthropic Hospitalin Porto AlegreBárbara Machado Costa, Ruth Siqueira Grawer, CristinaLoureiro Chaves Soldera, Márcia Salgado Machado, StefanieKuhn BenvenuttiUniversidade Federal das Ciências da Saúde de Porto Alegre

Introduction: Neonates who stay intensive care unit(ICU) may have multiple risk factors for hearing loss, favoringthe occurrence of hearing deficits in this population.

Objectives: Analyze the results obtained in hearingscreening in newborns from the neonatal ICU of a philan-thropic hospital in Porto Alegre.

Methods: This is a cross-sectional observational study,which was carried out by chart analysis of 257 neonatesderived from the neonatal ICU, who conducted the initialhearing screening from January to December 2013. All babiesunderwent transient evoked otoacoustic emissions (TEOAE)testing as an initial procedure, retest by same procedure and,in case of failure, retest with BERA.

Results:Of the 257 infants assessed, 30 infants (11.7%)failed the initial screening and were referred to retest withTEOAE. Ten infants (33.3%) did not attend and 20 (66.6%)underwent retesting. Among these, 13 (65%) failed and sevenpassed, showing false positive rate of 35% for the procedure.The 13 babies who failed the screening with TEOAE werereferred for retesting with BERA, in which only five attended(61.5% dropout rate); two have failed and three (1.16% of thetotal sample) failed and were referred to audiologicaldiagnosis.

Conclusion: The findings corroborate the literaturedata and showed that, despite all the advances in earlydetection of hearing loss, the high drop-out rates to retest isstill an aspect to be discussed and studied, especially in thenetwork of primary health.

Keywords: Risk Factors; Neonatal Screening; HearingLoss

A583. Normative Values for Nasal Syllables for BrazilianPortuguese SpeakersThaís Bogaz Hernandes, Vanessa Moraes Cardoso, VivianeCristina de Castro Marino, Nathalia Cuel PizziFaculdade de Filosofia e Ciências - Campus Marília

Introduction: The speake’s oral-nasal balance is com-monly assessed perceptually. While the thorough auditory-perceptual assessment is indispensable and supersedes anyinstrumental measures, quantify instrumental measures cannevertheless serve to corroborate and augment the perceptualassessment. Nasalance measures using nasal syllables stimulican be used to evaluate children and adultswhohave evidenceof hiponasality due to upper airway obstruction.

Objective: The purpose of the study was to establishnasalance scores for nasal syllables from Brazilian Portuguesespeakers.

Methods: Nasalance scores were collected for nasalsyllables (MacKay-Kummer SNAP Test-R) using Nasometer II6400. The participants were 245 speakers of Brazilian Portu-guese (121 males and 124 females) in four age groups(children, adolescents, young adults and adults). They wereasked to repeat each nasal syllable (ma, na; mi, ni) at least 6times and the mean nasalance scores for each syllable werecalculated.

Results: Nasalance means scored on average 60% fornasal þ /a/ syllables and 80% nasal þ /i/ syllables. The 20points difference between syllables with vowel /a/ and /i//were statistically significant (p < 0.001). Adult females scored

on average higher than adult males. Age differences were notfound between groups.

Conclusion: Normative nasalance values were estab-lished for the nasal syllables from Brazilian Portuguese speak-ers. The scores obtained for the nasal syllables were similar tothose reported for other languages and also showed the samepattern between vowels. These norms may be used to acous-tically evaluate hiponasality due to upper airway obstruction,corroborating with clinical perceptual evaluation.

A580. Normative Values for Oral Syllables for BrazilianPortuguese SpeakersNathalia Cuel Pizzi, Viviane Cristina de Castro Marino, VanessaMoraes Cardoso, Thaís Bogaz HernandesUniversidade Estadual Paulista "Julio de Mesquita Filho" Faculdade deFilosofia e Ciências de Marília

Introduction:Acommonly used instrumental adjunctto the assessment of oral-nasal balance is the nasalancemeasurement with a nasometer. Measures of nasalancehave been used to corroborate perceptual impressions ofhypernasality presented by numerous clinical populations,including cleft palate, neurogenic dysarthrias, and hearingimpairment. Nasalancemeasures usingoral syllables stimuli isparticularly recommended to evaluate children and adultswith poor literacy. Additionally, the homogeneity of thisspeech stimulus may be helpful for diagnostic procedure.

Objective: The purpose of the study was to establishnasalance scores for oral syllables from Brazilian Portuguesespeakers.

Methods: Nasalance scores were collected for oralsyllables (MacKay-Kummer SNAP Test-R) using Nasometer II6400. The participants were 245 speakers of Brazilian Portu-guese (121 males and 124 females) in four age groups(children, adolescents, young adults and adults). They wereasked to repeat each oral syllable (pa, ta, ka, sa, Sa, pi, ti, ki, Si)at least 6 times and the mean nasalance scores for eachsyllable were calculated.

Results:Nasalancemeans for oral þ /a/ syllables wereon average 5-8% and for /i/ syllables were on average 13-19%.The difference on nasalance scores between oralþ/a/ syllablesand /i/ syllables were statistically significant (p < 0.001).Adult females scored on average higher than adult males.Age differences were not found between groups.

Conclusion: Normative nasalance values were estab-lished for oral syllables from Brazilian Portuguese speakers.Findings from this study provide important information forBrazilian clinicians before nasalance scores for syllables can beused for clinical purposes.

A593. Occurrence of Oral Habits in Childhood: Report ofExtension PracticeGabriela Pereira da Silva, Fabiana de Oliveira, Marcia AngelicaPeter Maahs, Lisiane de Rosa BarbosaUniversidade Federal de Ciências da Saúde de Porto Alegre

Introduction: Oral habits are automations acquiredpersistent after infant oral phase. Depend on the frequency,duration, intensity and facial typology, changes in the stoma-tognathic system can be caused.

Objetives: To describe the occurrence of oral habits inchildhood through reporting extension practice.

Methods: Transversal and descriptive study, con-ducted with parents of patients in the waiting room of thePediatric Hospital, promotes orientation for children showingthe possible consequences occasioned for this practice,

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between July 2013 and May 2015. Approved by Research andEthics Committee of UFCSPA - number 1853/12.

Results: There were used data on the usage of oralhabitsbesides the age, type of habit and whether they hadreceived information about it or not. Among the 176 oriented,76% had usedharmfuloralhabits. Of these, 80% were stillpracticing the habit; 55% did until the age to 5 years and 11months; 49% were bottle users; 47% were bottle and pacifierusers and 4% were pacifier only users. Only 30% of the 176families had already received information aboutharmfuloralhabits.

Conclusion:Most oriented patients still used harmfuloral habit, predominantly aged less than 6 years old. Amongusers, the bottle and the bottle associated with the pacifierstood out. Beyond that it was possible to notice the lack ofinformation provided by health professionals to parents aboutthe harmful oral habits.

Keywords: oral habits; stomatognathic system;children

A548. Occurrence of Process Phonological Net Replacementand the Talking Intelligibility in Children with PhonologicalDisorderJulianne Wagner, Laura dos Santos Abon Zahr, Kariny Zenckeda Silva, Bruna Santos Sant’Anna, Letícia Pacheco RibasUniversidade Federal de Ciências da Saúde de Porto Alegre

Introduction: The Phonological Disorder is an alter-ation found in the phonological system of an individual whichcan be characterized by: substitutions, omissions and/ordistortions of speech sounds. According to Shriberg andKwiatowsk (1982), this alteration may present levels of in-telligibility, as medium, medium-moderate, moderate-severeand severe.

Objectives: Analyze the occurrence of liquid replace-ment in speech samples in children with phonological disor-der and relate to the degree of speech intelligibility.

Methods:A sample of 113 children between the age of4 to 10 years old presenting phonological disorder fromdatabase of speech and language evaluations (CEP 995.344)was used in order to evaluate and observe the occurrence ofliquid replacement and to classify the degree of speechintelligibility for each individual that was tested. For theclassification of the degree of speech intelligibility the formulaCorrect Consonant Percentage calculation Shriberg and Kwia-towsk (1982) was used.

Results: Sixty-two (54 %) children underwent liquidreplacement. Forty-eight percent had medium-moderategrade and only 7 % had severe degree. There were 380 (42%) substitutions 885 targets with liquid. The most frequentsubstitutionswere: liquid side [-Previous] by [l] in 32 childrenand /r/ by [l] in 48 children; in both cases the predominantdegree of intelligibility was the medium-moderate.

Conclusion: The phoneme /l/ demonstrated to havethe highest rate of correct productions and /r/ as replace-ments. The degree of intelligibility is the most frequentmedium-moderate.

A286. Oculoauriculofrontonasal Syndrome: AnInterdisciplinary ApproachMelissa Zattoni Antoneli, Bruna Tozzetti Alves, Haline CoracineMiguel, Andréa Cristina de Almeida Santos Farah, CristianoTonelloHospital de Reabilitação de Anomalias Craniofaciais da Universidadede São Paulo

Introduction: The Oculoauriculofrontonasal Syn-drome (OAFNS) phenotype combines abnormalities of themorphogenesis of the first and second branchial arches(microtia/skin tags, epibulbar dermoids, cleft lip/palate, man-dibular hypoplasia, and facial asymmetry) with malforma-tions due to the anomalous development of the frontonasaleminence and maxillary processes (notched/bifid nasal tip,cleft lip and/or palate, and encephalocele).

Objectives: To report 7 of the 26 cases with OAFNSregistered at HRAC-USP and currently followed by the cranio-facial interdisciplinary team.

Resumed Report: Six patients are male and 1 female,with ages between 2 and 35 years (one patient died at the ageof 8 months). Dysphagia was present in 3 cases, fromwhich 2required a gastrostomy feeding tube insertion; respiratorydistress and/or nasal obstruction in 4 cases, 2 requiringtracheostomy; hearing loss was diagnosed in 6 cases and 1patient was referred for hearing reassessment; 2 patientsreceived hearing aids and 1 underwent a ventilation tubeinsertion. Speech evaluation was performed in 5 cases and allof them presented speech impairment. Compensatory mis-takes related to velopharyngeal dysfunction was present in 2cases, abnormal oronasal resonance in 3, language delay in 1,lisping in 2, speech therapy was required in 4 cases and 1required a palatal prosthesis.

Conclusion: Clinical findings were variable in oursample, but speech and hearing impairment were very fre-quent findings, followed by respiratory and swallowing prob-lems. Speech and hearing pathology and ENT close follow-upis suggested from birth to maturity and it is performed as aroutine in our craniofacial team.

A464. Open Fit Hearing Aid Adaptation Analysis forIndividuals with Hearing Loss in High FrequenciesBárbara Cristiane Sordi Silva, Ana Cláudia Bianco Gução,Rosana Ribeiro Manoel, Amarilis Barreto dos Santos Andrade,Jerusa Roberta Massola de OliveiraHospital de Reabilitação de Anomalias Craniofaciais - Universidade deSão Paulo

Introduction: Individual hearing aid adaptation ofopen fit type, indicated for hearing loss at high frequency isincreasing, because of the possibility of reducing occlusioneffect. Otherwise, it is clear that success in hearing aid fittingdepends of the satisfaction users, which justifies the choice ofthis type.

Objective: To characterize the audiological profile ofopen fit hearing aid users and describe the device selectionresults, problems and complaints. Methodology: A retrospec-tive studywhere 50 records of open fit hearing aid users wereanalyzed to get information about the audiological dataselection and speech therapy process.

Results:Of the 50 data 44 (88%) were from individualswith bilateral deafness and 6 (12%) unilateral; moderate in 64(64%), mild in 35 (35%) and severe in 1 (1%). Most 40 (80%)were satisfied with the hearing aids, reporting improvedaudibility and speech intelligibility 45 (90%), improved hear-ing ability of sound localization 15 (30%) and reduced and/orabsence of tinnitus perception 5 (15.12%). In 15 (30%) remain-ing complaints/problems regarding the hearing aids were:difficulty of insertion/removal (10%), imbalance in the ear(4%), weak sound (4%), intermitted function (4%) and (2 %) inautophonia, headache and hassle and no amplification.

Conclusion: The results of the open fit selection werepositive opposites to those relating to the presence of com-plaints/problems, which reinforces his indicated as a viablepossibility for sloping audiometric curve.

Keywords: hearing aid, audiological, deafness

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A643. Oral Candidiasis: Main Complaints during Swallowingand its Relation to the Presence of DysphagiaMariana Saconato, Katia Alonso Rodrigues, Graziela UltramariRodriguesInstituto de Infectologia Emilio Ribas

Introduction: Candidiasis is one of the most commoninfections in HIV patients. The most common symptom is:white plaques on the oral mucosa that may be wiped off,diffuse retrosternal pain, dysphagia and / or odynophagia.

Objective: Verify the main complaints during feedingof patients with AIDS and oropharyngeal candidiasis and itsrelation to the presence of dysphagia.

Methodology: A specific questionnairewas applied in20 patients with AIDS and oral candidiasis and the resultswere related to the presence of dysphagia.

Results: 12 patients (60%) presented dysphagia inpreparatory and oral phases. The most common symptomswere xerostomy (33%), difficulty feeling the taste (58%) andsolid consistency harder to swallow than the liquid (83%).Dysphagia in the pharyngeal phase was present in 6 (30%)patients. The following symptoms were foung: odynophagia(100%), difficulty swallowing specific foods (34%), difficulty inswallowing hot food (67%), nasal regurgitation (17%), liquidconsistency harder to swallow than pasty and solid consis-tencies (83%) and excess saliva in the oral cavity (33%). Forpatients with possible esophageal alterations, 2 (10%), 100%had pyrosis as the chief complaint.

Discussion: Patients with oropharyngeal candidiasishave specific complaints during swallowing that should beinvestigated to enable dietary adjustments and life qualityimprovement.

Conclusion: The most common complaint amongpatients with abnormal preparatory and oral phases was:solid consistency harder to swallow than liquids. Amongpatients with dysphagia in the pharyngeal phase, the mostcommon complaints were: odynophagia and difficulty onswallow liquid consistency.

Keywords: Dysphagia, Candidiasis, Acquired Immu-nodeficiency Syndrome

A666. Oral Diet Introduction in Patients with AIDS, Oral andEsophageal Candidiasis - Case ReportMariana Saconato, Katia Alonso Rodrigues, Graziela UltramariRodriguesInstituto de Infectologia Emilio Ribas

Introduction: Candidiasis is more common amongAIDS patients with CD4þ cell counts less than 200 cells/mm.The most common symptoms are: odynophagia, xerostomy,pyrosis and retrosternal pain.

Objectives: Evaluating swallowing and oral diet pro-gression in a patient with AIDS, oral and esophagealcandidiasis.

Resume Report: Patient admitted with complaints ofintense odynophagia, weight loss and dysphagia. Duringevaluation adherent white plaques were observed in buccalmucosa and oropharynx. During swallowing of pasty consis-tency, it is voluntary oral uptake, bolus preparation wasinefficient , delay to start swallowing, moderate stasis in theoral cavity with no clinical signs of penetration / extraction.During swallowing liquids, odynophagia complaint remainedunchanged even in the face of temperature change of thewater andwas not observed changes in the pharyngeal phase.Due to the length of oral lesions was not offered solid. Uppergastrointestinal endoscopy was performed which revealedcoandidíase oral grade 3, according to Kodsi method. Hestarted treatment with Fluconazole for 14 days and it was

necessary to indicate via power alternative. After completionof treatment, esophageal candidiasis regressed and reintro-duced diet was orally in the hydration liquid and homoge-neous pasty consistency, since the oral mucosa stillmaintained the initial lesions.

Keywords: Dysphagia, Candidiasis, Acquired Immu-nodeficiency Syndrome

A536. Oral Intake Introduction in a Case of Post-Brain TumorResectionDaniel Lucas Picanço Marchand, Amanda do Nascimento Pires,Mariana Pombo BofillUniversidade Federal de Ciências da Saúde de Porto Alegre

Introduction: Brain tumor is an abnormal growth ofcells within the skull leading to compression and lesion ofnormal brain cells. Nausea, vomiting, lack of coordination andtone alterations are some of the symptoms experienced byindividuals inflicted by tumors of this nature. These symp-toms have repercussions on the nutrition of these patients,especially in children, requiring immediate intervention of theSpeech therapist to assist in swallowing and prevent potentialfood refusals.

Objective: Case report of speech therapy interventionin an infant after brain tumor resection.

Resumed Report: One and a half-years old child wasreferred to speech therapyafter brain tumor resection, feedingexclusively by nasoenteric probe due to lack of coordinationduring the oral intake. The speech therapy aimed to evolve thenutrition to oral feeding and ensure safe swallowing. The childinitially presented weak and arrhythmic suckings with fewbreaks, irregular tongue movements, extra-oral leak, flabbycheeks and aversion to food. The therapeutic process com-prised oral sensorimotor stimulationwith non-nutritive suck-ing and gustatory stimulationwith textures and varied flavorsto develop children’s nutrition, as well as guidance to care-givers to maintain the benefits from therapy. The child devel-oped sucking-swallowing-breathing coordination, as well asstrengthening of the oral structures, and food acceptance.These conditions enabled the evolution of oral intake to pastyconsistency.

Conclusion: The speech therapy was important todevelop the skills necessary to feed the child, reducing sequels,and bring the patient close to his family.

Keywords: Infant; Speech, Language and HearingSciences; Deglutition Disorders

A294. Oral Motor Intervention in a Case of Newborn withCleft LipSheila Tamanini de Almeida, Danielle Martins OttoUniversidade Federal de Ciencias da Saude de Porto Alegre

Introduction: Difficulty in feeding the newborncomes cracked soon after birth due to losses in sucking andswallowing, resulting from the lack of anatomical integrity.

Objective: To report the Speech Language Pathologist(SLP) intervention in helping to oral feeding in a case ofnewborn (NB) with cleft lip (CL).

Resumed Report: A case study pertaining to projectapproved by number 9742014.0.0000.5335. SR, female, 10days of life, born at term. He admitted in Neonatal IntensiveCare Unit due to neonatal asphyxia, remaining intubated for 2days. The medical staff asked SLP evaluation to aid in thetransition from alternative supply route to the oral route andbreastfeeding. In the structural clinical evaluation, it wasobserved: CL, palate intact, posture parted lips and a reflectionof weak suction. In non-nutritive sucking (NNS) showed:

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weak sucks, standard 8 sucks / pause, rhythmic, crying stresssignals and run. In breastfeeding presented handle and inad-equate suction. It began SLP therapy, with orofacial sensorialend motor stimulation and SNN, in addition to supportingbreastfeeding. After 5 days in SLP therapy, showed adequatecaught in breastfeeding, with strong and efficient, rhythmicsucks, with adequate breaks and is indicated breastfeeding ondemand. The team found that theNBwill discharge conditionswith exclusive breastfeeding.

Conclusions: The SPL intervention is essential in casesof NB cracked due to feeding difficulties that they may have.The clinical case evolved fromweak suction and breastfeedingdifficulties for strong and efficient suckswith adequate caughtin breastfeeding.

Keywords: Speech,Suction; Cleft Lip

A42. Oropharyngeal Dysphagia in a Case ofPolydermatomyositisSilvia Elaine Zuim de Moraes Baldrighi, Bianca GonçalvesBatista, Jacy Christina Santana Prata, Sara Tereza Lima deMenezes Silva, Brenda Carla Lima Araujo, Carla PatríciaHernandez Alves Ribeiro CésarUniversidade Federal de Sergipe

Introduction: Polymyositis and dermatomyositis areautoimmune diseases classified asasidiopathic inflammatorymyopathies, in other words, inflammation of muscle fiberswith unknown cause. Although they are distinct they have acommon feature: weakness of the proximal muscles. Theannual incidence is less than 10 cases per million people.Women are more affected (3: 1). Dysphagia is presented in15% and results from the involvement of the striated musclesof the pharynx and upper esophagus.

Objective: Describe speech therapy demonstrations.Resumed Report: Female patient, 68, was accompa-

nied at the Rheumatology service of the University Hospital ofthe University of Sergipe and was referred for speech therapyassessment with a complaint about mouth opening anddifficulty in swallowing solid consistency.The assessmentrevealed straight facial type, usual position of closed lipswith accumulationof saliva, strength and mobility of lipsand tongue reduced, mouth opening (24.6mm), asymmetricalface with reddish spots, hypofunctioning tongue, oral feedingroute in pasty consistency (yogurt), liquid (water) and solid(cookie). During swallowing, it was observed elevation of thereduced larynx,inappropriate tongue movement for all testedconsistencies,inadequate bolus propulsion for pasty and solidconsistency.It was observed the presence of cough reflex afterswallowing and choking and change in voice quality. It wasconducted a referral for otorhinolaryngological evaluation.

Conclusion: The authors highlight the importance ofthe speech therapist partnership in Rheumatology service,due to the occurrence of oropharyngeal dysphagia in thesecases, in addition to the scarcity of specialized literature.

Keywords: Polymyositis, Dermatomyositis, swallow-ing disorder

A313. Otoacoustic Emissions in a Municipal Nursery of SãoPaulo StateGiovanna Cesar Silva, Adriana Aparecida Tahara Kemp, AnaClaudia Vieira Cardoso, Camila Ribas DelecrodeUnesp- Universidad Estadual Paulista - Julio de Mesquita Filho- CampusMarília

Introduction: otoacoustic emission is an objectivemethod that can be used to assess the hearing of childrenwho attend nursery.

Objective: to describe and compare the results oftransient evoked and distortion product otoacoustic emis-sions of this population.

Method: descriptive and cross-sectional study devel-oped at amunicipal nurseryof a cityof São Paulo,which serveschildren between four and 30 months. The sample consistedof 71 children, who underwent hearing screening with tran-sient evoked otoacoustic emissions (TEOAE) and distortionproduct otoacoustic emission (DPOAE) - AccuScreen-Madsen.To analyze the results were considered that the child passedwhen presented eight peaks of response in the TEOAE andpresence in three frequencies in DPOAE.

Results: The analysis of TEOAE showed that 44 (62%)children passed bilaterally, 12 (17%) passed unilaterally and 15(21%) failed bilaterally. Regarding DPOAE, 36 (51%) childrenpassed bilaterally, 14 (20%) passed unilaterally and 21 (29%)failed bilaterally. When the two procedures were compared itwas observed that 35 (49%) children passed bilaterally in bothprocedures, eight (11%) passed bilaterally only on TEOAE, 15(21%) failed bilaterally in both procedures, eight (11%) failedunilaterally in both procedures and five (8%) failed unilaterallyor bilaterally in the TEOAE and passed or failed unilaterally orbilaterally in DPOAE.

Conclusion: the analysis of the procedures showed ahigh failure rate and demonstrated that children failed moreon DPOAE when compared to TEOAE.

A530. Otoacoustic Emissions in Workers Exposed to Noiseand OrganophosphateLarissa Mayra Rossigali de Jesus, Ana Claudia Vieira CardosoUniversidade Estadual Paulista "Júlio de Mesquita Filho"

Introduction: Exposure to organophosphate and highsound pressure levels can cause damage to outer hair cells.

Objective: to evaluate transient evoked and distortionproduct otoacoustic emissions of workers.

Method: Descriptive and cross-sectional study devel-oped with workers of a state autharchy exposed to noise andorganophosphate. The sample consisted of 52 males, with ageranging from 24 to 59 years. Transient evoked otoacousticemissions (TEOAE) and distortion product otoacoustic emis-sions (DPOAE) were obtained using the Accuscren screeningequipment (Madsen). It was considered that the workerpassed the TEOAE when presented eight peaks of responseand the DPOAEwhen presented response in three frequencies.

Results: The analysis of TEOAE showed that 45 (86.5%)workers passed bilaterally, five (9.7%) passed unilaterally andtwo (3.8%) failed bilaterally. Regarding DPOAEs, 30 (57.7%)workers passed bilaterally, 10 (19.2%) passed unilaterally and12 (23.1%) failed bilaterally. When the two procedures werecompared it was observed that 28 (53.8%) workers havepassed bilaterally in both procedures, 16 (30,7%) passedbilaterally only on TEOA and one (2%) failed bilaterally inboth procedures.

Conclusion: There was a higher rate of failure inDPOAE when compared to the TEOAE.

Keywords: Otoacoustic emissions; noise; organo-phosphate; workers

A436. Participation Restriction Questionnaire HearingHandicap Inventory for the Elderly - Screening Version(HHIE-S)Andressa Ortiz Birck, Vânia Carolina Devitte Ruiz, MoniqueRolim Sequeira, Maria Inês Dornelles da Costa Ferreira, Thais deSena TeixeiraUniversidade Federal de Ciências da Saúde de Porto Alegre (Ufcspa)

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Introduction: Hearing rehabilitation by adapting theIndividual Sound Amplification Device (HA) and auditorytraining provides improved communication skills and thequality of life of the elderly. The participation restrictionquestionnaire HHIE-S is a fast tool, easy to understand andfits this evaluative purpose.

Objectives: Check the effect of auditory training byapplying the HHIE-S before the adaptation of hearing aids andafter auditory training.

Methods: Application of HHIE-S in 39 elderly subjectsover 60 years with sensorineural, bilateral, symmetrical andmild to moderately severe hearing loss, users of the UnifiedHealth System, referred to the hearing aid sector of Centrehealth Clelia Manfro - Hearing Unit.

Results: 25 (64%)male subjects and 14 (35.9%) female.The average age was 74.2 years (� 7.7), with minimum of 61and maximum of 89 years. Regarding education the averagewas 4.4 years (� 2.8) of studywith aminimum time of 0 and amaximum of 12 years. By comparing the variables before andafter the auditory training, statistically significant relationshave not been identified. But when comparing the HHIE-Sperformance held before and after the auditory trainingstatistically significant relations were observed (p�0.001).

Conclusion: There was a reduction in participationrestriction through theHHIE-S questionnaire, indicative of theeffects of hearing aid fitting and auditory training.

A446. Patient Care Team Intervention in Obesity andLaryngomalacia Child CaseVanessa Souza Gigoski, Liliane Menzen, Micheli da SilvaTarnowski, Camila da Cunha Niedermeyer, Sara OliveiraPinheiro Schuck, Katherine FlachUniversidade Federal de Ciências da Saúde de Porto Alegre/IrmandadeSanta Casa de Misericórdia de Porto Algre

Introduction: Laryngomalacia is a common cause ofvocal stridor in childhood. In cases of respiratory difficultiesassociated to that disease often swallowing disorders arefound.

Objectives: To describe the Patient Care Team inter-vention in laryngomalacia and obesity child case.

Resumed Report: A six month old baby, male, laryng-omalacias diagnosed, weighing 12.335 kg. Family was con-tacted by team of speech therapist, physiotherapist,pharmacist, nutritionist, nurse and psychologist. Threehome visits were made to interview, evaluation and to returnprocess. There was low tolerance behavior concerning thechild’s frustration and recurrent crying. Family was condi-tioned to feed the baby whenever he cries, presenting diffi-culties of interaction. He was overeating with inappropriatefood for the age. In clinical phonoaudiological assessment, wasobserved cervical auscultation with increased noise duringand after of liquid supplies and low laryngeal elevation. Childalready has mild neuropsychomotor developmental delay(NPMD) due to obesity. It was possible to prepare a nutritionalmenu about adequate food for children, in pasty consistency(aiming security lower airways) as well as guidance materialabout NPDM and activities and games tips to strengthen tiesand interaction between family and the child which can beused in boy’s frustration moments.

Conclusion: From the Patient Care Team intervention,family and child made gains in the organization of the dailyroutine. It is understood that the view of different professio-nals on the case contributes to the end result, which is betterhealth and lifes quality for patients.

Keywords: Patient Care Team; Laryngomalacia;Obesity

A366. Percentage Analysis of Types of Concerns RegardingTinnitusAlexandre Hundertmarck Lessa, Adriane Ribeiro Teixeira, JoãoPaulo Nogueira Araújo Santos, Letícia Petersen Schmidt Rosito,Celso Dall’IgnaUniversidade Federal do Rio Grande do Sul (Ufrgs); Hospital de Clínicasde Porto Alegre (HCPA)

Introduction: The population that complains abouttinnitus may often associate the perception of sound withoutexternal stimulus with other pathological diseases. Worriesregarding tinnitus may influence its complainer life qualitycausing fear, affliction and horror.

Objective: To analyze the types of concerns related totinnitus symptoms by the individuals that presents it.

Methods: Individuals who complain about tinnituswere picked as sample. The data collection for further analysiswas done through a proper instrument at the Chronic TinnitusAmbulatory. There were four options to answer the questionregarding concerns about tinnitus: 1- Serious Disease; 2-Going deaf; 3- Getting worse; 4- Other. Each patient couldchoose more than one option. After the data collection thepercentage analysis carried out.

Results: The samplewas composed of 732 individuals,of both sexes and between the ages of nine and 89. Thepercentage score of the sample was: 1- Serious Disease(14.34%); 2- Going deaf (25%); 3- Getting worse (24.18%); 4-Other (19.53%); 21.99% didn’t show any concerns.

Conclusion: The results of the sample show a greaterconcern about going deaf and getting worse.

Keywords: Questionnaires, Tinnitus, Audiology

A213. Perception of teachers regarding the change in theauditory abilities in schoolchildrenAmália El Hatal de Souza, Eduarda Pazini, Laís Ferreira, Ândreade Melo, Eliara Pinto Vieira BiaggioUniversidade Federal de Santa Maria - UFMS

Introduction: The auditory processing refers to anal-ysis of the sound stimuli by the central nervous system,involving detection, analysis and interpretation of externalsounds.

Objective: To analyze the perception of teachers onthe auditory processing disorders in schoolchildren and iden-tify children with potential abilities changed.

Methodology: a study of the type prospective, quan-titative, longitudinal, comparative. There was a brief explana-tion about auditory processing to teachers of three publicelementary schools. After the conversationwas requested thatthey were the indication of students with possible changes inauditory processing.

Results:We interviewed 23 teachers, 3 directors and 3special educators, who teach classes in 23 classes, whereinthey referred 74 children for the auditory processing evalua-tion, for believing that these children had change in centralhearing abilities. Of the total number of directed, 28 agreed toparticipate in the study. Of these 39% (n ¼ 11) had two ormore altered abilities, 3.6% (n ¼ 1) diagnosedwith conductivehearing loss and 14.4% (n ¼ 4) were forwarded to otherprofessionals. For each hearing ability in the total number ofchildren, the changes found were: temporal resolution 14.9%(n ¼ 14), selective attention 42.8% (n ¼ 12) and figure-fund35.7% (n ¼ 10).

Conclusion: it was observed that the perception ofteachers is inadequate, because less than half of the childrensent by the schools presented changes in auditory skillsevaluated.

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A475. Perception of Tobacco Growers Exposed to Pesticideson the Quality of LifeAdriana Bender Moreira de Lacerda, Ana Maria CazéUniversidade Tuiuti do Paraná

The aim of this study was to analyze the perception oftobacco growers exposed to pesticides on the quality of lifewith emphasis on working conditions, and general hearinghealth. It is a descriptive, cross-sectional with a quantitativeapproach, conducted in the municipality of Rio Azul-PR, withtobacco growers. Data were collected from November 2012 toNovember 2014, after explicit consent of the subjects. For datacollection, we chose an instrument already validated, the SF-36 and a questionnaire prepared by the working core, healthand UTP society with closed questions onworking conditions,health and hearing health. We evaluated 78 subjects, 40growers and for the control group 38 residents of Blue River,not occupationally exposed to pesticides. The results showedtobacco growers because they have little schooling, do notrealize that they could have a general hearing health andbetter access to better living conditions and perceptions ofyour reality. Regarding health in general showed no signifi-cant difference between the two groups, but in relation tohearing health study showed that tobacco growers in theauditory complaints were significant confirming the studiescited above.

Conclusion: The damage arising from it are natural-ized and tobacco growers do not realize the damage to healthand the loss of quality of life caused by the use of pesticides.

A140. Perceptual Error Identification of Human andSynthesized VoicesMarina Taborda Englert, Glaucya Madazio, Ingrid Gielow,Jorge Carlos Lucero, Mara BehlauUniversidade Federal de São Paulo

Introduction: Perceptual auditory analysis is the goldstandard to evaluate dysphonia. Auditory training gives thisanalysis a greater reliability. Synthesized stimuli are advanta-geous, vocal characteristics are known and can be manipulat-ed, but they must sound natural.

Objectives: Verify the ability of voice specialists, gen-eral speech language pathologist and laymen to discriminatehuman and synthesized voices.

Methods: 70 subjects (20 voice specialists, 20 generalspeech language pathologist, 30 laymen) preformed listeningtask to classify 54 voices: 18 human and 18 synthesizedvowels, male and female (9 each), with different type anddegree of deviation. 50% repetition was used for intraraterreliability. Voice disorders were simulated by vocal frequencyperturbations (roughness); additive noise (breathiness) andby increasing tension and subglottal pressure and decreasingvocal folds separation (strain). Human voices were collectedfrom a vocal clinic database.

Results: Voice specialist presented less error than theothers groups, 31.9%. Voices that had greater perceptualconfusion were human male with severe breathiness, synthe-sized female with mild breathiness and human female withsevere roughness. Voices with breathiness had greater per-ceptual confusion, 42.9% for human and 53.3% for synthesizedbreathiness. There was no difference in the amount of errorconsidering all groups between human (36.8%) and synthe-sized (38.9%) voices(p ¼ 0.452).

Conclusion: High quality of synthetized samples.Human voices with moderate to severe deviation and synthe-sized voices with mild deviation had greater perceptualconfusion. Voice specialist presented lower amount of error,

which allows us to infer that auditory training assists on vocalanalysis tasks.

Keywords: Voice; Dysphonia; Auditory Perception

A543. Performance in MLD Tests (Masking Level Difference)and PSI (Pediatric Speech Intelligibility) of Children withAbnormal Acoustic ReflexBruna Santos Sant’Anna, Laura dos Santos Abon Zahr, KarinyZencke da Silva, Rayane Abreu do Nascimento, Letícia PachecoRibasUniversidade Federal de Ciências da Saúde de Porto Alegre

Introduction: Auditory Processing Disorder can beunderstood as a disorder that affects hearing abilities, com-monly due to some alteration at the brainstem functioning.This structure is also responsible for the occurrence of theacoustic reflex, which is triggered when there is integrity ofthe central and peripheral auditory system. In individualswith normal hearing thresholds is expected the presence ofacoustic reflexes. In these cases, the reflex changes can beexplained by the occurrence of APD.

Objectives: Check the performance of Individualswithout acoustic reflexes and regular hearing thresholds inMLD and PSI tests.

Methods: Quantitative, descriptive and cross-section-al study. The study included 31 children from 6 to 9 years oldwith some absence of contralateral or ipsilateral acousticreflexes. Individuals who belong to a database with speechand language evaluations (CEP 995 344), had results oftympanometry and normal hearing thresholds, with availableresults of MLD and PSI test. It was decided to observe suchtests because these tests evaluate the processing that isperformed in the brainstem.

Results: In approximately 71% of children was ob-served alteration in, at least, one test (23 individuals). Of thesechildren, 54% presented alterations in both tests, while 22%individuals only presented onMLDor PSI. Other resultswill bedemonstrated by statistical analysis.

Conclusion: A significant percentage of the observedsample presented alterations in MLD and PSI tests, suggestingdifficulty in the brainstem’s functioning at the cases wherethere is some absence of acoustic reflexes.

A79. Profile and Prevalence of Hearing Loss of Aged in BrazilAdriane Ribeiro Teixeira, Magda Aline Bauer, Ângelo JoséGonçalves BósPontifícia Universidade Católica do Rio Grande do Sul (PucRS) eUniversidade Federal do Rio Grande do Sul (UFRGS)

Introduction: Hearing is essential for the processingof acoustic events and for the issue and understanding ofspeech signals. Hearing loss can also be associated withcognitive decline and depression.

Objective: This aims to analyze the prevalence ofhearing complaints in Brazilian elderly and to describe theprofile of older people with and without hearing complaints.Methodology: The study included 7315 elderly sample wereinterviewed in their homes, in 59 cities of Rio Grande do Sul.Inclusion criteria were age 60 years or older and acceptparticipate. A questionnaire used was designed from theGlobal age-friendly city guide was applied. For statisticalpurposes was performed chi-square test and logistic regres-sion to assess the correlations between variables.

Results: 139 participants were excluded for not retainanswered the question about auditory perception and 9 selfrefer deafness, a sum total of 7167 elderly. The average ageamong the elderly without hearing complaints was

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69.44 � 6.91 and lag 72.8 � 7.75 years. For the years of study,the elderly without hearing complaints presented5.10 � 3.78 years compared to 4.48 � 3.49 years of com-plaining. The incidence of hearing loss complaint was 28% ofthe elderly, that is 2011 elderly complained.

Conclusions: In the elderly population the prevalencereached 28%.The complaint is more prevalent in men than inwomen, in black then brown and white, in no income elderly,who did not receive health care, in performing social andcommunity activity, the less educated and in the oldest.

Keywords: hearing loss, health profile, aged

A108. Quality Management in Standard OperatingProcedures: Deployment, Evaluation and Critical Analysis inthe Audiology Sector of the Centre of Studies on WorkersHealth and Human EcologyViviane Fontes dos Santos, Geórgia Rosangela Soares Luz,Anelisse Vasco Mascarenhas de Freitas, Elinaldo LeiteQuixabeiro, Viviane Moreira FrancoCentro de Estudos em Saúde do Trabalhador e Ecologia Humana-Fiocruz

Introduction: Since the Industrial Revolution, thequality has been described.The matter is so important thatthe International Organization for Standardization (ISO), pub-lished ISO 9001 establishing requirements for the QualityManagement System (QMS). Standardizing activities is veryimportant to the qualitymanagement effectiveness, establish-ing a unique way of doing a certain activity representedsystematically as Standard Operating Procedure (SOP). TheAudiology Service of the Centre for Studies in the Worker’sHealth andHuman Ecology has proposed the establishment ofSOPs, as a way to standardization tasks.

Objective: To perform evaluation of 3 SOPs in Audiol-ogy Service related to the examination of Brainstem EvokedResponse Audiometry and check if the procedure is effective,or if there is a need of adjustments on the SOPs so that theunderstanding of the task is objective.

Methods: 8 speech pathologists and 7 doctorswithoutprevious experience with the examination or with the equip-ment used took place in it. They read and executed each SOP.At the end they also had to answer a questionnaire forassessment of POP.

Results: All participants were able to complete theSOPs up to the end, but systematic errors were identified by93% of the sample and random errors with smaller propor-tions. Revisions have beenmade in SOPs as part of the processof continuous quality improvement.

Conclusions: Assists the POP on the execution of day-to-day tasks even for those who do not have experience withthe procedure by ensuring safety and quality of the serviceprovided.

A544. Quality of Life in Swallowing: Comparison ofInstitutionalized Elderly and Non-InstitutionalizedMaira Rozenfeld Olchik, Sabrina Vilanova Cardoso, AnneliseAyres, Ícaro da Silva Walbrohel, Adriane Ribeiro TeixeiraUniversidade Federal do Rio Grande do Sul (Ufrgs)

Introduction: From a phonoaudiological point ofview, among the various alterations that we can find in theaging process, swallowing disorders are frequent and signifi-cant. These changes may lead to a impairment of the feedingprocess in elderly, and therefore compromise their quality oflife.

Objective: To compare the quality of life in swallowingof institutionalized and non-institutionalized elderly.

Methods: It was evaluated the quality of life in swal-lowing of institutionalized elderly and non-institutionalized,with swallowing complaints, through the Quality of Life inSwallowing Disorders protocol. The data analysis was per-formed through the SPPS for Windows 18.0, the significancelevel established was 5%.

Results: The sample consisted of 20 elderly, dividedinto two groups matched for age and sex. Group 1 wascomposed by 10 institutionalized elderly, 80% female, withan average age of 74.1 years (SD � 7.9), and average on theMiniMental State Examination 23.5 (SD � 3, 66), Group 2wascomposed by 10 elderly, 80% female, with an average age of73.2 years (SD � 7.2). and average on Mini Mental StateExamination 26.5 (SD � 2.41). It is noted that Group 1 haslower scores in all domains of Quality of Life in SwallowingDisorders when compared with Group 2.

Conclusion: The score of the questionnaire was lowerin Group 1, suggesting worse quality of life related to swal-lowing in institutionalized elderly.

A214. Quality of Life in Voice of Professiona’s Voice in aNortheastern CapitalMaria Inês Lopes de Sousa, Carolina Lima Martins GasparRocha, Marta M S Lira-BatistaFaculdade de Ensino Superior do Piauí

Introduction: The professional of voice it’s one thatuses the produce phonal with instrument of your job. Makepart this group: singers, teachers among others.

Objective: Measure the quality of life in voice ofprofessional that uses the voice in television in this northeast-ern capital.

Methods: The work treat of a research descriptive,retrospective, quantitative and transversal feature. It wasapplied the protocol of quality of life in voice; besides to listthe main strengths points mentioned by professional, in thismeasure of 1(one) to 5 (five) with values that vary of Bad,Midding, Good, Very Good and Excellent. It’s accepted in CAAE(Certificate Submitted to the Ethics Committee):30186014.4.0000.5211. In this card contained: full name,Age, Occupation, and Service Time. The protocol Q V V hasvalues that vary of 0 (zero) to 100 (onehundred)wherever theworse results, more near of 0 (zero) and the best, more near to100 (one hundred). It was utilized the test of Kruskal -Wallis,aiming degree the professional groups to score of RQOL Total,emotional and physical socio aspect.

Result: The average age between participants were24.1 years, 56.5% women; 43.5%men; most frequent occupa-tion was journalist. The scores more affected were phisical71.9% and socioemotional 86.43%.

Conclusion: The professional’s voice in television has agood quality of life in voice. Believes that the Speech TherapyProfessional has contributed positively.

Keywords: Voice, Quality of Life, Journalist

A1726. Quality of Life Perception in Patients withParkinson’s Disease Pre and Post Deep Brain Stimulationthrough the Parkinson Disease Questionnaire-39Marcieli Ghisi, Carlos Roberto de Mello Rieder, Artur FranciscoSchumacher Schuh, Larissa Nogueira Freire, Maira RozenfeldOlchikUniversidade Federal do Rio Grande do Sul

Introduction: Parkinson’s disease is a progressive andchronic disease of the nervous system. Parkinson’s disease canbe disabling and impair the quality of life. Deep Brain Stimu-lation is a form of treatment for patients with Parkinson’s

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disease. It consists in the placement of electrodes in thesubthalamic nucleus that will make the stimulation by aelectric current. It is particularly effective in motor fluctua-tions, tremor or shaking, as well as the quality of life in theseindividuals.

Objective: To evaluate quality of life in Parkinson’sdisease patients before and after Deep Brain Stimulation.

Materials and Methods: Quality of life evaluationswere conducted in 16 individuals with Parkinson’s disease atthe Movement Disorders Center in a Porto Alegre hospital,using the Parkinson Disease Questionnaire-39. The ParkinsonDisease Questionnaire-39 questionnaire contains 39 ques-tions addressing eight domains: Mobility, Daily Life Activities,Emotional Wellness, Stigma, Social Support, Cognition, Com-munication and Body Discomfort.

Results: Twelvemen and four womenwith an averageage of 57, 4 years (43-70) with Hoehn e Yahr stages between 2and 4 participated in this study. The domains of ParkinsonDisease Questionnaire -39 that improved Quality of life afterDeep Brain Stimulation were daily life activities (p ¼ 0.001),body discomfort (p ¼ 0.001), stigma (p ¼ 0.011), social sup-port (p ¼ 0.023) and the Parkinson Disease Questionnairetotal score (p ¼ 0.017).

Conclusion: These findings suggest that Deep BrainStimulation improves Quality of life among individuals withParkinson’s disease.

Keywords: Parkinson Disease, Quality Of Life, DeepBrain Stimulation

A516. Rapid Maxillary Expansion and Hearing Loss:Systematic ReviewErissandra Gomes, Camila Zander Neves, Claudine DevicariBueno, José Renato Prietsch, Pricila SleiferUniversidade Federal do Rio Grande do Sul

Introduction: The rapid maxillary expansion consistsin expanding the maxillary arch and the nasal cavity.It maybring positive results for the oral and nasopharyngeal anato-my, with possible effects on hearing.

Objective: To conduct a systematic review to analyzethe benefits of rapid maxillary expansion in the auditorysystem.

Summary of the findings: data collection in theelectronic databases MEDLINE and BIREME (SciELO,BBO)March 2015.In order to perform the bibliographic research,the following terms and combinationswere used:hearing loss,hearing, rapid maxillary expansion and palatal expansiontechnique.The selection was composed by eight studies clas-sified as clinical trials. The average number of subjects perstudy was 12.85. All subjects underwent audiometric assess-ment. Only five of the studies immitanciomety was con-ducted.In the selected studies, three to four assessmentswere conducted. The first took place prior to treatment,thesecond between seven and twenty days after the expansion,the third at the six months which marked the end of theretention period,and the fourth and last assessment, aboutone or two years after the retention period. The rapid maxil-lary expansion caused improvement in the hearing thresholdsin the majority of the studies due to Eustachian tube betterfunctioning as a result of maxillary expansion and nasopha-ryngeal tissues. It was observed proper functioning andintegrity of the middle ear after the expansion on acousticimpedance measurements.

Conclusion: The rapid maxillary expansion bringsbenefits to the auditory system, both at the expansion activa-tion period and the after the retention period.

Keywords: hearing loss; hearing;palatal expansiontechnique

A233. RelationBetweenPhonological Disorder andAuditoryProcessing DisorderRayane Abreu do Nascimento, Letícia Pacheco RibasUniversidade Federal de Ciências da Saúde de Porto Alegre

Introduction: The Phonological Disorder is a languagedisorder frequent in children, characterized by omissions orswaps in speak sounds. It has been observed associationbetween this language disorder and the Auditory ProcessingDisorder, characterized for difficulty in organizing and com-prehending auditory stimulus. The Auditory Processing Dis-order is diagnosed through a battery of behavioral tests, whichassesses the auditory skills and classifies them in subtypes:Auditory Decoding, Integration and Prosodic.

Objective: Analyze the listening skills of children withPhonological Disorder and determine the presence or absenceof Auditory Processing Disorder, as well as classify it insubtypes.

Methods:Quantitative and descriptive research study,through secondary data analysis collected from a database,approved by the ethical research committee (protocol number995.344). The samplewas composed by 10 subjects diagnosedwith Phonological Disorder, with age between 7 and 10 yearsold. From the behavioral tests battery were observed thefollowing auditory skills: RGDT (temporal resolution); PPS(temporal pattern); MLD (binaural interaction); PSI (back-ground/closing); SSW (binaural integration).

Results: From the affected auditory skills, was deter-mined the presence or absence of Auditory Processing Disor-der and its classification into subtypes. From the 10 subjects,70% presented Auditory Processing Disorder (p ¼ 0.206).From these, 100% presented auditory decoding subtype and43% presented Integration subtype (p ¼ 0.705) and 43% pre-sented prosodic subtype (p ¼ 0.705).

Conclusion: The results suggest association betweenPhonological Disorder and auditory decoding subtype. Thus,the importance of auditory processing endorsement of chil-dren with language disorders is evidenced.

Keywords: Child Language, Language Disorders, Hear-ing Disorders

A1730. Relation between Swallowing and Cognition inBedridden Institutionalized ElderlySabrina Vilanova Cardoso, Annelise Ayres, Maira RozenfeldOlchikUniversidade Federal do Rio Grande do Sul

Introduction: The aging process predisposes severalanatomical and functional changes. Among these, swallowingdisorders and cognitive disorders.

Methods: It was performed phonoaudiological evalu-ation through the Protocol For Bedside Cinical Evaluation(Carrara-de Angelis, 2010), in bedridden individuals of bothgenders, from August to November 2012. The data analysiswas performed through the SPPS for Windows 18.0, thesignificance level established was 5%

Results: The sample was composed by 46 elderly, ofthese 56.5% were female, with an average age of 83.3 years(� 10.9). It was found that 30.4% of the patients presentedswallowing alteration. Regarding the evaluation of behavioralcharacteristics, 82.6% of the elderly were alert at the time ofevaluation and 71.7% cooperative. In the cognitive screening,78.2% of the elderly showed alterations. Regarding the cogni-tive aspects evaluated, it was verified that there was nosignificant association with swallowing disorders (p ¼ 0.10).

Conclusion: Most of the elderly evaluated presentedrisk for cognitive impairment, but it was verified low

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prevalence of swallowing alterations, with no significantrelation between these two alterations.

A416. Relation between Tympanometric Curves, ClinicalHistory of Otitis Media and Complaints of Alterations inChildren’s SpeechRayane Abreu do Nascimento, Kariny Zencke da Silva, IsabelaHoffmeister Menegotto, Cristina Loureiro Chaves Soldera,Letícia Pacheco Ribas, Márcia Salgado MachadoUniversidade Federal de Ciências da Saúde de Porto Alegre

Introduction: It is known that recurrent otitis mediain the childhood can cause fluctuating hearing loss and,consequently, changes in the acquisition of speech sounds.The timpanometry provides data on the functioning of thetympanic-ossicular system and can demonstrate changes inthe sound conduction system.

Objective: To analyze the relation between tympano-metric curves, clinical history of otitismedia and alterations inthe speech of children.

Methods: This is a retrospective, quantitative anddescriptive research study, conducted from secondary datafrom the initial interview and audiological evaluation ofpatients attended at an infant/audiology outpatient clinic.There were analyzed 252 records, selected 57 children from5 to 11 years old, with alterations in the speech and same typeof tympanometry in both ears. The history of recurrent otitismedia was also analyzed.

Results: Of the 57 children with alterations in speech,36 (63.1%) presented normal tympanometric curves (type A,according to Jerger) and 21 (36.91%) presented abnormalcurves (type B or C, according Jerger), with a statisticallysignificative association of alterations in speech and normalcurves (p ¼0.047). Of the 36 children with normal curves, 25(69.4%) had history of otitis, with a statistically significativeassociation between history of otitis and alterations in speech(p ¼ 0,02).

Conclusion: There was statistically significative asso-ciation between history of otitis and alterations in speech,even in children with normal tympanometric curves. There-fore, the results suggest that likely exists a influence of clinicalhistory of recurrent otitis media on language acquisition.

Keywords: Child Language, Hearing, Otitis Media

A501. Relation of Video-Head-Impulse Test and CaloricIrrigation in Patients with VertigoIsabella Marques Pereira Rahme, Geraldo Majela PereiraUniversidade Federal de Minas Gerais

Introduction: The video head impulse test (vHIT) hasbeen proposed as an objective approach to detect peripheralvestibular disorder in a clinical setting. Various studies haveshown that vHIT and air caloric tests may not always identifyvestibular hypofunction; instead, the results of the testsmightbe contradictory.

Objective: Explore the relationship between lateralcanal vestibular occular reflex gain (hVOR) in a sample ofpatients attending a clinic for balance disorder.

Methods: Use of sensitivity and specificity of the vHITtest relative to air caloric test was studied for evaluate canalparesis in clinical sample of 12 patients (12 female) whoattended a private clinic for balance disorders within onemonth.

Results: Of 5 patients in the clinical sample that hadsignificant canal paresis indicated by air calorics, only 1showed a significant abnormality in either canal using ameasurement of vHIT gain. vHIT gain does not correlate

with canal paresis as indicated by air caloric testing. In 4patients we had ipsilesional abnormal caloric testing in thepresence of normal vHIT. Some studies indicate that could be apattern of findings observed in patients who have "definite"Ménière’s disease.

Conclusion: Since caloric irrigation and vHIT measurethehVOR in lowand high frequency ranges, respectively, thesetests have to be considered complementary. The video headimpulse testmay be a useful addition to the existing vestibulartest battery, but it does not appear to be an alternative to it.

Keywords: Caloric test; Ménière; dizziness; vertigo;video-head impulse test

A574. Relationship between Perception of Parents andGuardians, Voice and Quality of Life in your Children ’S VoiceThais Prett Chiabai, Michelle Ferreira Guimarães, Alana TagarroNeves, Alexandra Frasson da SilvaUniversidade Federal do Espírito Santo

Introduction: Vocal disorders in individuals of schoolage are relatively frequent. Such disorders may go unnoticedby the family because dysphonia may not present symptomsinvolving other systems, delaying thus the demand forintervention.

Objective: To assess whether there is a relationshipbetween self-perception of the presence or absence of vocalcomplaints, the vocal quality of individuals and the quality oflife in voice.

Methods: This study was conducted at the pediatricclinic of a university hospital. Participated 23 parents/guard-ians of children and adolescents aged 2-18 years. A vocalscreening protocol and a hearing-perceptual voice assessmentanalyzed by a speech therapist were applied. To analyze theimpact of dysphonia on life quality was applied a protocol ofLife Quality in Voice (Pediatric) answered by the family.

Results: It was observed that 66.7 % showed nochange of vocal disorder complaints. For this group, afterthe hearing-perceptual assessment, 19.1 % were considereddysphonic individuals. The group with vocal complaints cor-responds to 33.3 % of the sample and, after perceptual evalu-ation, 9.8% were categorized as dysphonia. There was noeffective relationship between the presence and absence ofvocal complaints reported by parents/guardians and thescores at the protocol of Life Quality in Voice (Pediatric).

Conclusion: There are indications that the perceptionof parents/guardians at dysphonia in children and adolescentsis not sensitive and that the impact of a vocal disorder onquality of life of these individuals may not have been per-ceived by them.

Keywords: Parents Perception; Vocal Complaints; LifeQuality

A472. Report of Speech Therapy Intervention in Infants withHypoplastic Left Heart SyndromeRuth Siqueira Grawer, Laura Fuchs Nunes, Lisiane de RosaBarbosa, Karen de Oliveira dos Passos, Priscila Regina ReznicekUniversidade Federal das Ciências da Saúde de Porto Alegre

Introduction: The Hypoplastic Left Heart Syndrome iscongenital cyanotic severe heart disease, relatively common,being themost frequent cause of death for heart disease in thefirst week of life. The treatment is surgical, in some casesindicated transplant. During the treatment the patient issubjected to numerous procedures, such as prolonged oro-tracheal intubation and alternative pathway of food.

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Objectives: To report the speech therapy interventionin Infantswith Hypoplastic Left Heart Syndrome. Approved bythe CEP ISCMPA n° 467,673 of 11/5/2013.

Resumed Report: Female patient, diagnosed withhypoplastic left heart syndrome ,intubated for 25 non-conse-cutive days, forwarded the speech therapy in post-operativefor Cardiac Team to oral stimulation. First service held at 28days of age, in Pediatric ICU, 6 days post-surgery, exclusivenutrition for orogastric tube, on Motor-Sensory-oral Evalua-tionwas observed: orofacial tonus and sealing lip appropriate,extraoral leak of saliva and cervical auscultation noisy. Biteand swallowing reflexes are present, with poor suckingpattern. After the patient is transferred to the hospitalization,after 8 sessions conducted, 63 days old, this receiving tube andoral diet, in Bottle presentswith sucking arrhythmic, extraoralleakand the presence of episodes of cough. In breast presentedrhythmic sucking with spontaneous breaks, presence of labialsealing and coughing at the end of the feed.

Conclusion: The Speech Therapist is the professionalenabled to discuss on multidisciplinary team to safely powersupply, encouraging breast feeding when possible, and in thiscase the better performance.

Keywords: Deglutition Disorders, Heart Disease;Breastfeeding

A455. Research about Pregnant Knowledge about NewbornHearing Screening and Effectiveness of Guidelines in HighRisk ClinicVerônica Salazar Moreira, Ana Francisca Constantino Ferreirade Sousa, Juliana Pinheiro Leite, Erissandra Gomes, PricilaSleiferUniversidade Federal do Rio Grande do Sul

Introduction: Believed to be of extreme importanceinvestment in prevention, such as health strategy suggests ,promoting better health and information to the publicthrough educational activities, which is consistent with pro-viding the multidisciplinary committee hearing health, rec-ommending a promotion health of pregnant women ,newborns and infants.

Objective: To evaluate the knowledge of pregnantwomen on universal newborn hearing screening (UNHS)before and after speech therapy guidelines.

Methods: A retrospective, observational study, char-acterized by single-arm clinical trial. 128 pregnant women,accompanied in high-risk clinic, who answered a question-naire before and after UNHS guidelines, were interviewed.

Results: Before the guidelines provided, 52.1 % ofparticipants had heard about the UNHS, but among the 128pregnant women surveyed 92.3 % did not know referencingwhy to perform the test. After orientation 97.8 % of partic-ipants reported knowing the test. Only 36.2 % of participantsdid not know referencing why is important to perform thetest, reducing the percentage in 56.1 %.

Conclusion: It was found the effectiveness of infor-mation of pregnant women about TANU after speech therapyguidelines, which confirms the need for informed action byspeech therapists and other professionals involved in prenatalprograms.

Keywords: Health promotion, Pregnant women, Pre-natal care, Hearing loss, Speech, language and hearing scien-ces, Neonatal screening

A59. Retest of Auditory Brainstem Response in the Infantswith Failure in Hearing ScreeningDaniela Polo Camargo da Silva, Georgea Espindola Ribeiro,Priscila Suman Lopez, Jair Cortez MontovaniFaculdade de Medicina de Botucatu

Introduction: Currently the audiological diagnosis inchildren is carried out by electroacoustic and electrophysio-logical measures. However, such measures may be influencedthe maturation process.

Objective: To retest the results of auditory brainstemresponse (ABR) after failure in newborn hearing screening.

Methods: Retrospective longitudinal study conductedin a tertiary public hospital. All neonates underwent transientevoked otoacoustic emissions and ABR, being this one done intwo steps.

Results: The study included 28 infants of both sexes. Inthe evaluation by otoacoustic emissions, 75% had bilateralfailure and 25% one-sided. All patients underwent evaluationby ABR, with an average age of two months in the firstevaluation and 43% had bilateral alterations and 57% one-sided. In the secondABR,with an average age of 4months, 64%had kept your results in ABR, though 36% had normal ABR inboth ears.

Conclusion: It is not always possible to identify hear-ing loss with a single assessment. The retest of abnormalresults of hearing screening is important for the identificationof the real cases and the correct treatment of hearing loss.

A394. Risk Factors for Hearing Impairment in NeonatalIntensive Care UnitBárbaraMachado Costa, Ruth Siqueira Grawer, Jordana da SilvaFreitas, Karina Mazzotti, Márcia Salgado Machado, CristinaLoureiro Chaves SolderaUniversidade Federal das Ciências da Saúde de Porto Alegre

Introduction:Newbornswith risk indicators aremorelikely to hearing impairment.

Objective: To analyze the risk factors observed innewborns from neonatal Intensive Care Unit.

Methods: We conducted analysis of neonatal hearingscreening clinic database of a philanthropic hospital. Twohundred fifty-seven medical records of infants who wereadmitted to the neonatal intensive care unit in this hospitalwere analyzed and underwent hearing screening from No-vember 2012 to December 2013. We analyzed data on riskindicators for hearing loss and results in newborn hearingscreening.

Results: We observed the prevalence of the followingrisk factors associated with neonatal ICU stay for more thanfive days: mechanical ventilation (47.8%), use of ototoxicmedication (46.3%), post-natal infection (26%). Regardingthe results in hearing screening, 227 (88.3%) passed and 30(11.7%) failed the initial screening. Of the 30 infantswho failedthe initial screening, only five made retest with BrainstemEvoked Response Audiometry, demonstrating 83.33% dropoutrate in the retest. Of the five babies who underwent retesting,three failed and were referred for further evaluation. Theseinfants had two or more risk factors associated, including: useof ototoxic medication, syndromic features and syphilis.

Conclusion: In this sample, the most prevalent riskindicators were: mechanical ventilation, use of ototoxic medi-cation and maternal infection. These indicators were alsoidentified in babies who failed the retest, highlighting theattention they deserve in care related to children’s hearinghealth.

Keywords: Risk factors; neonatal screening; hearingloss

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A662. Satisfaction with use of Hearing Aids and SpeechPerception Test in Subjects with Sensorineural BilateralHearing LossMarina de Marchi dos Santos, Thais Cristina Barbosa Mariano,Maria Renata José, Maria Fernanda Capoani MondelliFaculdade de Odontologia de Bauru - Universidade de São Paulo

Introduction: Hearing loss is the difference betweenhearing performance of the individual and the normal abilityfor sound detection and can be minimized with the use of thehearing aid. Satisfaction is the measurement of auditoryrehabilitation outcome and can be measured. The use ofsentences in speech perception tests, it is important to betterrepresent the everyday listening situation.

Objective: Check satisfaction with the use of hearingaid and speech perception with competitive noise in subjectswith bilateral sensorineural hearing loss.

Methods: Approval of the CEP process n°299.353.Participated 21 subjects of both sexes, aged 45-65 yearsdiagnosed with bilateral sensorineural hearing loss. To evalu-ate the recognition of judgmentswas applied Hearing In NoiseTest (HINT) with speech presented frontally stimulus insilence and with frontal noise, with and without hearingaids. Satisfaction with Amplification in Daily-Life (SADL) wasused to assess the satisfaction, questionnaire with 15 ques-tions divided and four subscales: Positive Effects, Services andCosts, Negative Factors and Personal Image.

Results: The sample was divided into two groupsbased on age : G1 - 45-54 years and G2 - 55 to 65 years. Inthe HINT was no significant difference when comparing theresults with and without the use of hearing aids. The twogroups have shown their satisfaction with the use of hearingaids.

Conclusion: Subjects with sensorineural bilateralhearing loss showed better performance in the perceptionof speech in noise test with the use of hearing aids.

A653. Screening of Motricity Orofacial of Teachers fromPublic Education In Nerópolis – GoiásAlexandre de Paula Sampaio, Angela Silveira Guerra Silva,Silma Moreira dos Santos, Nathália Santana GontijoPontifícia Universidade Católica de Goiás

Introduction: The imbalance of orofacial muscles anddecreased mandibular opening restrict vocal projection, en-abling the emergence of compensation, incorrect use of voiceand speech problems, affecting communication of teacher.

Objective:Describe themain findings of the screeningof orofacial motricity of teachers from public education inNerópolis â€“ Goiás.

Methods: They were evaluated with protocol ofscreening adapted from the protocol of orofacial motricityfrom the clinical speech therapy of Pontifícia UniversidadeCatólica deGoiás that contemplates phonoarticulatory organs,masticatory muscles and breathing.

Results: The sample consisted of 89 teachers, 85women and 4 mens. Morphology of upper lips adequate inonly 48.3%; lower lip in 51.7%; muscle tension of the upper lipadequate in 65.2%; the lower lip by 64%; mobility adequate in73%. The tongue morphology adequate in 50.6%; the appro-priate tension in 70.8%; adequate mobility in 80.9%. Thecheeks are asymmetric in 66.3% of teachers; adequate mobili-ty in just 47.2%. By palpation, masseters are balanced in only46.1%, while the temporalis in 50.6% of teachers. Soft palatemobility adequate in 78.6%. The hard palate is normal in 54%.The predominant mode is the nasal breathing with 80.9%; theairflow is bilateral in 68.5% of teachers. At the end of each

evaluation, teachers were advised to seek expert service forfull evaluation.

Conclusion: Having the main changes in screeningbeen characterized, it is possible to perform educationalactivities in the school environment to promote quality ofcommunication for teachers.

Keywords: Speech, Language and Hearing Sciences;Faculty; Primary Prevention

A471. Semi-Occluded Vocal Tract Exercises In Voice Therapy -Patient With Parkinson’s DiseaseAlexandre de Paula Sampaio, Alessandra Regina BritoPontifícia Universidade Católica de Goiás

Introduction: About 70% of individuals with Parkin-son’s disease have voice disorders, with reduced voice inten-sity, monotony, imprecise articulation, changes in speech rate,tremor, hoarseness and breathiness.

Objectives: To describe the therapeutic results of thetechnique semi-occluded vocal tract in patients with voicedisorders in Parkinson’s disease.

Resumed Report: Patient, 67, male, diagnosed withParkinson’s disease seven years ago, forwarded to clinicalspeech therapy school at the Pontifícia Universidade Católicade Goiás. At baseline had a weak, trembling voice, withlaryngeal-pharyngeal resonance, slurred speech, maximumphonation time of 7.65 seconds, s/z ratio of 0.74 seconds. Inacoustic analysis with vowel /e/ sustained, the fundamentalfrequency was 142.31Hz, minimum intensity of 48.63dB,maximum of 81.70dB, irregularity of 4.24 and 0.40 of noise.The therapywas plannedwith relaxation exercises, breathing,resonance and voice quality, use of corporal method andphonation competence method, semi-occluded vocal tractexercises using speech variations in cup, LaxVox and straw.After five sessions, maximumphonation time 8.91 seconds, s/z ratio of 0.92 seconds, fundamental frequency of 136.34Hz,intensity minimum of 60,28dB, maximum of 60.84dB, 4.03 ofirregularity and 0.37 of noise.

Conclusion: Despite the vocal instability present,balanced resonance, intelligible speech and meaningful prog-ress with use of the technique semi-occluded vocal tract inauditory-perceptive evaluation, as in acoustic analysis whencompared to the first session data.

Keywords: Speech, Language and Hearing Sciences;Parkinson Disease; Voice Disorders; Voice Quality; Voice

A11. Sound System for the DeafRicardo Ferreira Bento, Silvio Pires PenteadoFundação Otorrinolaringologia

Introduction: The primary rehabilitation tool forhearing impairment is hearing aid (aid). Bottleneck technolo-gy (low bandwidth for transducers and DSPs, complexityfitting application â€“ just to name few) do not allow hearingimpairment to take themost of music. In general run best aidshave frequency range from 250 up to 8 kHz with peaks andvalleys amidst the bandwidth. Acoustic feedback, mono auralresponse, resonance, occlusion effect, and low power amplifi-cation are one of the remaining drivers to curb a true musicsensation. An audio power system designed for hearingimpairment can deliver a true stereo music to hearing im-pairment without the need of aid.

Objective: Introducing the very first stereo system forthe deaf.

Materials and Methods: One entire new electronictopology was implemented to excel the demand. It encom-passes a 16-bit DSP, filter bands, pre amplifier, bass, mid and

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high booster, a dedicated fitting application, and an interfacetoHi-Pro. One can connect any Bluetooth® to this systemwithno frills.

Results: A music experience ranging from 80 up to16 kHz, up to 120 dB gain in full stereo system, no occlusioneffect, adjusted through a fitting application. Wired and Blue-tooth® devices enabled.

Conclusion: Take the aids off the ear and take themostof a true stereo sound system designed for hearing im-pairment: an experience second to none.

Keywords: Hearing aids, music, assistive technology,hearing loss, high frequency

A166. Sound-Source Location Test in the Presence Of NoiseGleide Viviani Maciel Almeida, Angela RibasUniversidade Tuiuti do Paraná

Introduction: The difficulty to realize the soundsource is something that people with hearing loss report,even after intervention either with conventional or implantedhearing aids.

Objective: To validate the auditory perception test infree-field, developed to evaluate the sound localization abilityin the presence of noise.

Methods: The sample consisted of 100 healthy sub-jects with normal hearing and aged over 18 years who haveagreed to participate. After the pure tone audiometry wasapplied the sound-source location test. For this, a calibratedfree-field test environment was set where 30 random puretones were presented in two speakers located at 45 degree(right and left of the subject) and the noise in a third located at180 degree. The noise was presented in three listening sit-uations: Hearing optimum condition (no noise), to noise ratioof -10dB and to noise ratio -15dB. The individual should pointout which side he/she perceived the tone pure, even in thepresence of noise.

Results: The 100 participants took the test in anaverage of 99 s. The average score was 21, the median 23and standard deviation of 3.05.

Conclusion: The Sound-Source Location Test in thePresence of Noise proved to be easy to organize and to apply.The results obtained in the test validation suggest that indi-viduals with normal hearing should locate 70% of the pre-sented stimuli. The test can configure an important tool inmeasuring the interference of noise on the ability of soundlocalization.

Keywords: Sound Localization; Hearing Tests; Noise;Hearing

A4. Speech: Awakening Listen to Deaf ChildLorraine da Silva Cabral, Maria Esther de AraújoFaculdade Redentor

Introduction: Childhood deafness affect both theacquisition and the development of speech and language.Therefore, auditory training therapy and the use of hearingaids to amplify sounds, aims to establish communication,enhance auditory skills and perform cognitive and languageskills.

Objective: To demonstrate the effects of speech ther-apy stimulation of speech and language in the hearing aidfitting process in children diagnosed with late deafness.

Methodology: Approved by the Ethics Committee forResearch, No. CAAE 30973514.7.0000. 5648, the research wascarried out in stages, in which an analysis was performed ofthe previous situation of two children who started therapy atsix-nine. After this analysis gave up themonitoring and record

of the evolution of speech therapy after the hearing aid. Thedevelopment of oral languagewas observed during therapy, inthe analysis of the protocols used before and during thetherapeutic process (Auditory Discrimination Test Bostonand Behavioral Observation Protocol) and perception of thefamily and the evolution of communication skills.

Results: The applied protocols showed that bothpatients improved after therapy. This improvement was alsoreported in family perception, especially in social interactionand speech of patients.

Conclusion: speech therapy was a great ally to pro-mote the acquisition and development of children, becauseeven with the late diagnosis, (re) habilitation and hearing anenabling environment for dialogue, enabling the developmentof speech and language.

Keywords: Child; Language Development; Speech;Speechterapy; Hearing loss; hearing aids

A287. Speech Language Pathologist Intervention in a Case ofNewborn with Cleft LipSheila Tamanini de Almeida, Danielle Martins OttoUniversidade Federal de Ciencias da Saude de Porto Alegre

Introduction: Difficulty in feeding the newborncomes cracked soon after birth due to losses in sucking andswallowing, resulting from the lack of anatomical integrity.

Objective: To report the Speech Language Pathologist(SLP) intervention in helping to oral feeding in a case ofnewborn (NB) with cleft lip (CL).

Resumed Report: A case study pertaining to projectapproved by CEP-ISCMPA under number9742014.0.0000.5335. SR, female, 10 days of life, born atterm. He admitted in Neonatal Intensive Care Unit due toneonatal asphyxia, remaining intubated for 2 days. The medi-cal staff asked SLP evaluation to aid in the transition fromalternative supply route to the oral route and breastfeeding. Inthe structural clinical evaluation, it was observed: CL, palateintact, posture parted lips and a reflection of weak suction. Innon-nutritive sucking (NNS) showed: weak sucks, standard 8sucks / pause, rhythmic, crying stress signals and run. Inbreastfeeding presented handle and inadequate suction. Itbegan SLP therapy, with orofacial sensorial end motor stimu-lation and SNN, in addition to supporting breastfeeding. After5 days in SLP therapy, showed adequate caught in breastfeed-ing, with strong and efficient, rhythmic sucks, with adequatebreaks and is indicated breastfeeding on demand. The teamfound that the NB will discharge conditions with exclusivebreastfeeding.

Conclusions: The SPL intervention is essential in casesof NB cracked due to feeding difficulties that they may have.The clinical case evolved fromweak suction and breastfeedingdifficulties for strong and efficient suckswith adequate caughtin breastfeeding.

A589. Speech Therapy Clinical Outcomes at the Bedside inCase of Diabetic KetoacidosisLiliane Menzen, Vanessa Souza Gigoski, Gabriela Pereira daSilva, Lisiane de Rosa Barbosa, Maria Cristina de Almeida FreitasCardosoUniversidade Federal de Ciências da Saúde de Porto Alegre/IrmandadeSanta Casa de Misericórdia de Porto Algre

Introduction: Diabetic ketoacidosis, present in diabe-tes mellitus type 1 patients and some type 2, has the clinicalpicture of absolute lack of insulin, causing metabolic imbal-ance. The applicants complications include hypoglycemia,hyperglycemia, acidosis, polyuria, weight loss, weakness,

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vomiting, drowsiness, abdominal pain, pancreatitis, changesin level of consciousness and cerebral edema. Edema is mostsevere complication is present in 0.5 to 2% of patients.Mortality is between 40 and 90% andmorbidity of 10% to 25%.

Objectives: Report on speech therapy clinical out-comes at the bedside in a case of child diabetic ketoacidosis,admitted to a pediatric hospital. Approved by Research andEthics Committee of UFCSPA â€“ number 467.673.

Resumed Report: Girl, 11 years, with clinical diabetesmellitus type 1, diabetic ketoacidosis developed frame andlater petechial hemorrhage in the basal ganglia. Neurologicalexamination revealed dysmetria, diadochokinesia, left upperlimb hypertension, chorea and hemiballism left. In clinicalassessment it was observed: written language of isolated anddysgraphias words; posture parted lips with saliva previousescape, change the motor and orofacial mobility; difficult tocoordinate chewing and swallowing, dysarthria setting framehyperkinetic and moderate oropharyngeal dysphagia.

Conclusion: After 16 sessions was observed talkingwith two-word phrases; writing sentences; good opening andclosing of the mouth; evolution of oral diet to pasty consis-tency liquefied associated nasoenteric tube. Front of theframe, the patient progressed satisfactorily. By one diabeticketoacidosis framework for speech therapy should be intenseand persistent, respecting the clinical limitations of thepatient.

Keywords: swallowing disorder; metabolism;dysarthria

A522. Speech Therapy in Pediatric Case of Post HemorrhagicCVA DysphagiaLiliane Menzen, Vanessa Souza Gigoski, Lisiane de RosaBarbosa, Maria Cristina de Almeida Freitas CardosoUniversidade Federal de Ciências da Saúde de Porto Alegre/IrmandadeSanta Casa de Misericórdia de Porto Algre

Introduction: Arteriovenous malformation (AVM) is aneurological disorder caused fetal development, manifestingitself at any age, including childhood. Complications can beobserved as Cerebral Vascular Accident (CVA) hemorrhagic,with an incidence of 1.1 / 100.00 children. Post-stroke neuro-genic dysphagia has an incidence of 40% to 70% in ischemiaand greater than 75% in hemorrágicos.

Objective: Describe a case of speech therapists inbleeding after stroke oropharyngeal dysphagia in children.

Resumed report: Approved study by CEP n°:467673.Boy, 16, referred to speech evaluation, with motor im-pairment, dysarthria and oropharyngeal dysphagia, post-sur-gical embolization due to hemorrhagic stroke, caused byMAVinparietal lobe. Theymetorofacial changes in themobility andstrength of the oral structures (lips, tongue and jaw), espe-cially in the earliermovements of speech organs; coordinationand strength in language back, good management and salivaswallowing with adequate cervical auscultation. After 23sessions of speech therapy was observed improvements in:abstraction of food, mouth opening, tongue movement, pho-nation time and vocal intensity. In direct evaluation of swal-lowing with paste food, the patient clean cervical auscultationwithout vocal change. Presented stasis food decreased in oralafter swallowing with subsequent bleaching. Mother andpatient were instructed on how to conducting exercises andtheir importance to the orofacial motor.

Conclusion: It was observed importance of speechtherapy to minimize and assist in the dysphagia described.The post-hemorrhagic stroke dysphagia frames are severe butmay be detected by the bed and recovered swallowing, evenpartially.

Keywords: swallowing disorder; Stroke; pediatrics

A46. Speech Therapy in Systemic Sclerosis: A Case ReportSilvia Elaine Zuim de Moraes Baldrighi, Camilla Santos Alves,Anny Karoline Andrade da Silva, Leylane Fonseca Almeida, LUIZBARROS FILHO, Carla Patrícia Hernandez Alves Ribeiro CésarUniversidade Federal de Sergipe

Introduction: Systemic sclerosis is an autoimmunedisease, a rare, multisystem that affects people aged between30 and 50 years, in a proportion 3-15 women to one man. It ischaracterized by vascular involvement and excessive deposi-tion of collagen in the skin and internal organs, especially thegastrointestinal tract, lungs, heart and kidneys. Some studiesalso show changes in the stomatognathic system.

Objective: Report on speech therapy performance in asystemic sclerosis case.

Resumed report: Male individual with 25 years,diagnosed with systemic sclerosis two years ago, was referredthe rheumatology service at a university hospital for clinicalassessment to present restriction of mouth opening andnumbness in hemiface. Clinical evaluation revealed drymouth, gingival inflammation, intra and extraoral numbnessin the left facial, limited mouth opening (35mm), hardenedface, facial asymmetry, lack of expression lines, nasal tapering,tone and mobility of altered phonoarticulatory organs, inco-ordination pneumophonoarticulatory with use of air booking,speaks with locked joint. Patient was referred for speechtherapy seeking the molecular modification by running iso-tonic and isometric exercises. After an average of 60 weeklysessions showed improvement in all aspects worked, gain8mmmouth opening, and also reported numbness only in thelower third, but less sharply. It is currently managed in followup met once a month with stability in treatment.

Conclusion: Becomes important disclosure and par-ticipation of an speech therapist in multidisciplinary team,mainly due to the improvement in aspects related to thestomatognathic system.

Keywords: Speech, Language and Hearing Sciences;Scleroderma, Systemic; Speech therapy

A549. Speech Therapy Intervention During PatientHospitalization with Cerebral Palsy DiagnosisLaura Fuchs Nunes, Ruth Siqueira Grawer, Priscila ReginaReznicek, Lisiane de Rosa BarbosaUniversidade Federal de Ciências da Saúde de Porto Alegre

Introduction: Cerebral Palsy is a permanent braindamage occurring at the central nervous system maturationperiod, that can affect swallowing control areas and disordersin their processes, causing dysphagia.

Objectives: Report speech therapy intervention dur-ing patient hospitalization with cerebral palsy diagnosis.Approved by CEP ISCMPA n467.673 on 05/11/2013.

Resumed Report: Female patient, 2 years old, withCerebral Palsy due to anoxia. Was hospitalized due breathingdificulties. Caregiver state that always offered oral feeding.Was requested to a clinical evaluation of swallowing due toaspiration pneumonia diagnostic hypothesis. At the interview,the family reported that had never observed signs of aspira-tion offering food. During evaluation was observed: musclehypertonia of the orofacial region and reflex of bite andsuction were still presents. At the feeding, labial closureinefficient, previous oral escape, weak cough, wet cry andinefficient laryngeal elevation. Also, there was an improperhandling at the feeding, both utensils, as position and offerrhythm. Evaluation Conclusion: Oropharyngeal NeurogenicDysphagia moderate-severe. Therefore, indicated use of alter-native pathway to nourishment. Orientations about oral hy-giene, handling and intra/extra-oral stimulation providing

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hypersensitivity reduction and saliva control were given tocaregiver.

Conclusion: The Speech Therapist is the professionalin charge of feeding security of the inpatients and able todiscuss the correct conduct with the medical team about thediet that should be offered at the hospital beds, avoiding theworsening of the respiratory condition of patients.

Keywords: speech therapy, hospitalization, cerebralpalsy

A48. Speech Therapy Practice in NASF: Health EducationAction at the Community Health Agents in Celebration ofthe Day of the VoiceDiana Weber Bartz, Martina Sulek, Karina Antes de SouzaUniversidade Luterana do Brasil

Introduction: The insertion of Speech Therapy inPublic Health has increased considerably, especially afterthe creation and implementation of the Center for FamilyHealth Support (NASF) in 2008 by Decree 154 of the Ministryof Health. This multi corewas created in order to complementand qualify the actions developed by Family Health Teams.Among the NASF assignments are technical and pedagogicalsupport teams, which aims at a more comprehensive care tothe population. The actions of health education are an impor-tant part of technical and pedagogical support, and as suchshould be directed to the whole team, especially the Commu-nity Health Agents, which constitute important link betweenthe minimum staff and users.

Objective: To promote the knowledge of vocal healthto a group of Community Health Agents belonging to sevenfamily health teams, linked to a territory of the city of Canoas -RS.

Resumed report: The action had the participation of18 Community Health Agents, which together account for13.500 users. Conversation circle were held and dynamicseeking guidance on caring for the use of the voice and theinstrumentalization of these professionals so that they canguide the population and assist in the early identification ofpossible vocal alterations. The action had the participation ofSpeech Therapy, Physical Therapy and Physical Education.

Conclusions: The action had a positive balance, be-cause the shared information and the reported experiencesadded knowledge and a fresh look at the individual vocalhealth and assisted population.

A350. Speech Therapy Profile of Adult Patients in an ICUSamara Regina Fávero, Maria Cristina de Almeida FreitasCardoso, Betina ScheerenUniversidade Federal de Ciências da Saúde de Porto Alegre (Ufcspa) eComplexo Hospitalar Santa Casa de Porto Alegre (Iscmpa)

Introduction: The recent practice of speech-languagetherapists in hospitals is growing, and its role is to care for thedysphagic’s patients.

Objective: Characterizing the speech therapy profileof adult patients in an ICU.

Methodology: Retrospective, descriptive study per-formed by the analysis of risk assessment protocols fordysphagia’s patients in an ICU from June, 2012 to April,2014. This study was approved by the Ethics Research Com-mittee of the participant institutions following protocols n°706.298 and n° 760.622.

Results: The sample included 110 records of forwardpatients with clinical manifestations of pulmonary or neuro-genic alterations, between the ages of 17 and 86. Significantassociations between severe dysphagia associated to trache-

otomy (p ¼ 0.007) and mild dysphagia associated to malnu-trition (p ¼ 0.041) were found. Patients with mild dysphagiawere 56.6 years old, on average, while severe patients withsevere dysphagia were 64.5 years old, on average. Patientswith severe dysphagia were male (64%).

Conclusion: The patient profile showed pulmonaryand neurological disorders; moderate dysphagia; with oro-tracheal intubation; nasoenteral feeding tube; without tra-cheotomy; severe dysphagia with tracheotomy; and milddysphagia with malnutrition. Data regarding the age groupand the prevalence of baseline disorders associated to me-chanical ventilation and tracheotomy suggest dysphagia orrisks for the development of the disorder. The degree ofdysphagia varied and was more severe in older patients.Speech-language therapists allow for the early diagnosticsof dysphagia, reduction of hospital costs, and time in the ICU.

Keywords: Deglutition; Swallowing disorders; Inten-sive Care Unit; Tracheotomy; Intratracheal intubation

A677. Speech, Language andHearing Integrated Avaluation:A Protocol Alternative VersionJayne Guterres de Mello, Michele Vargas Garcia, Elenir FedosseUniversidade Federal de Santa Maria

Objective: offering a protocol alternative version thatallows evaluating verbal language (oral andwritten) related tohearing, body balance, voice and orofacial motricity.

Methods: the protocol alternative version results oftheoretical andmethodological effort of Speech, Language andHearing professionals to articulate different specialties of thefield, as in the different aspects implicated in human commu-nication, body balance and feeding process. It’s proposed toevaluate the subjects’ linguistic-cognitive work indicatedabove through some linguistic devices (interview, narratives,comments, proverbs, syllogisms, daily problems), reading andwriting and aspects implicated in language operation: hear-ing, body balance, voice and orofacial motricity. It’s suggestedthat hearing is evaluated by pure tone audiometry, speechaudiometry, behavioral tests of hearing processing and, ifpossible, of Long-Latency Evoked Auditory Potential (LLEAP);body balance through tests of static and dynamic balance andmovement coordination, through sensory organization testand, if possible, vectoelectronystamography; voice throughperceptive-hearing analysis; and orofacial motricity throughobservation of structures and functions of the stomatognathicsystem, especially swallowing dynamics.

Results: a protocol alternative version that allows toevaluate/comprehend an elderly in demential process (or not)relating different implied in language production andinterpretation.

Conclusions: protocol alternative version does notpropose different procedures from those already developedin Speech, Language andHearing Science, but proposes they’refully developed, relating the valued aspects. The script favorsaccurate diagnoses in Speech, Language and Hearing clinics.

A5. Speech-Language Study of the Auditory OccupationalRisks in Workes at Beauty Salons and its Life QualityInterferenceDaianny de Souza Silva, Maria Esther de AraújoFaculdade Redentor

Introduction: In beauty salons, workers are exposedto various risks, including physical and chemical. Noise cancause different effects on the hearing of individuals and, whenassociated with chemicals, damage toworkers’ hearing healthis enhanced.

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Objective: To investigate the presence and perceptionof risk for the hearing of individuals who work in beautysalons.

Methods: Approved by the CEP under n°30973714.5.0000.5648, this cross-sectional study of investi-gative and descriptive character was carried out in five salonsin the city of Itaperuna/RJ. The observation of the workplacewas followed by direct collection with the application of asemi-structured form. The sample consisted of 16 workersand the data were analyzed statistically.

Results: The mean time in the environment is of eighthours. The environment is considered noisy by 93,75% of theworkers and 68,75% of them feel uncomfortable with theodors and gases present. Approximately 40% reported audito-ry symptoms, fatigue and stress. There is no report of the useof hearing EPI and 81,25% state they are aware that noise isharmful to the audition, but 68,75% are unaware not only thatthe chemical can cause deafness but also of the existence ofprotection programs to hearing health.

Conclusion: The study favored a vision of the reality ofhearing risks present in beauty salons, and the perception ofthe worker of their hearing health, emphasizing the impor-tance of implementing health policies in order to betterworking conditions and quality of life.

A392. Spinal Impairment and Dizziness Complaint: APerspective from the Vestibular TestLícia Assunção Cogo, Natalia Martinez Fernandes, AronFerreira da Silveira, Valdete Alves Valentins dos Santos FilhaUniversidade Federal de Santa Maria

Introduction: Knowing the vestibular system and itspossible changes is relevant in clinical practice, such changescan be indicative of impairment of body and can hinder theirdaily activities and consequently quality of life. Changes in thespine may be associated with these changes.

Objective: Describe the vestibular findings of individ-uals with dizziness and self-reported spine changes, andcategorize the sample about the type of dizziness, the site ofspine changes and the presence of tinnitus.

Methods: 16male and 40 femalewere attended in theUniversity Hospital of Santa Maria/ Speech Language Pathol-ogy and Audiology Course from 2012 to 2013, with agesranging from 27 to 79 years old, mean age of 57,83 yearsold. The subjects underwent anamnesis, visual inspection ofthe external acoustic meatus and ComputerizedVectoelectronystagmography.

Results: The complaint of vertigo was reported by44.64% of the subjects. It was found that 21.42% of the subjectshad cervical and lumbar spine alteration, 10.71% cervical,lumbar 12.50%, 1.78% thoracic and 53.57% did not specify.Tinnitus was reported in 60.71% of patients; and the Vectoe-lectronystagmography obtained 71.42% of normality.

Conclusion: Vectoelectronystagmography was pre-dominantly normal. The cervical and lumbar impairmentwas prevalent among subjects who pointed the affectedregion of the spine. However, cannot rule out the possibleassociation between dizziness and spine impairment in28.58% of the subjects with abnormal vestibular tests.

Keywords: Neurotology, Dizziness, Vestibular Func-tion Tests, Spine, Postural balance

A276. State of the Art of Brazilian Literature Production inthe Area of VoiceTelma Dias dos Santos, Ariane Moulin Pedra, Amanda GiglioEugenio Barreiros, Ana Terra Santos Pompeu, Ivana Correa

Tavares Oliveira, Teresa Maria Momensohn dos SantosPontifícia Universidade Católica de São Paulo

Introduction: From the survey of published literaturein a particular area, it is possible to define a problem, knowingthe research methods and the paths used in the scientificmaterial that is published. Themapping of how andwhere arethe scientific contributions in the area of Voice produced byresearchers it is necessary to understand the current land-scape in Brazil.

Objective: to know the State of the art of Brazilianbibliographical production in the area of voice using thequantitative methodology or literature review.

Methods: A survey performed on the Brazilian plat-forms of indexed journals in the health area BIREME, CAPESand SCIELO. The variables were: type of production (originalarticles or review), language (Portuguese), country of affilia-tion (Brazil), thematic (voice) and period (from 2009 to 2013).

Results: we found 334 articles, of which 14 haveappeared at BIREME, 110 in the Scielo and 25 just in CAPESjournals, which results in 198 articles in Portuguese language.As for the literature review, 14 appear at BIREME, six onSCIELO and no one on CAPES. Calls attention to the high rate ofarticles indexed in Scielo platform in relation to indexed inother platforms. This may be a demonstration of the difficultyof the Brazilian researchers to publish in internationallyindexed journals. Investigate the reasons why this occurs isvery important for the international recognition of Brazilianphonoaudiological research.

Conclusion: it is important to invest in scientificproduction of Brazilian phonoaudiologist researcher so hecan publish in international journals.

A557. Stimulating Children’s Oral Language in ProlongedHospitalizationPriscila Regina Reznicek, Ruth Siqueira Grawer, Laura FuchsNunes, Karen de Oliveira dos Passos, Lisiane de Rosa BarbosaUniversidade Federal de Ciências da Saúde de Porto Alegre

Introduction: Short bowel syndrome patients havesevere cases of malabsorption. Total parenteral nutrition isinitially used until the hemodynamic profile is stabilized, sothen the patient can be slowly subjected to the introduction oforal diet. Then the child should be subjected to prolongedhospitalization and consequently the environmental and so-cial stimuli, required to the development of language, becomerestricted. Children with prolonged or repeated hospitaliza-tion experience have developmental delay risk increased.

Objectives: Report the stimulating children’s orallanguage in prolonged hospitalization. Approved CEP ISCMPAn. 467.673, in 05/11/2013.

Resumed Report: Male patient one year and ninemonths’s old, 32 weeks gestation premature, short bowelsyndrome. Sent to follow up with speech therapy team.Initially interviewed, the child’s caregiver reports that thepatient is hospitalized for many months, uses nozzle andbottle and speaks few isolated words. Only his caregiver andhis mother live with the child daily. Language delay diagnosisafter initial assessment. Later, it was told how to perform theoral language stimulating, as example, ask the boy to speakwhat hewants. Also, interaction has been demonstrated usingchildren’s books in which the boy showed oral productioninterest.

Conclusion: The speech therapy is the stimulatingorallanguage capable professional. In prolonged hospitalization,guidance and monitoring are important to provide the child-ren’s communication acquisition and development, minimiz-ing hospital effects.

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Keywords: Speech therapy; language; prolongedhospitalization

A2. Study of the Components of the Auditory EvokedPotential Long Latency and Heart Rate During MentalArithmetic TestViviane Borim de Góes, Simone Fiuza Regaçone, RenataSperancin Marcomini, Ana Claudia FrizzoFaculdade de Filosofia e Ciências - Unesp/Marília-Sp

Introduction: Auditory processing is based on theeffective functioning of the central nervous system (SNC)and the cardiovascular system is regulated byneural pathwayslocated in the brainstem and areas above the brainstem. Theauditory evoked potential long latency (PEALL) evaluates theSNC, which allows the measurement of neuroelectrical activi-ty in different sites of the auditory pathway and the observa-tion of auditory information processing in ms. Heart ratevariability (HRV) is a method that analyzes the cardiac auto-nomic modulation.

Objective: To evaluate whether there is an associationbetween the components of PEALL and indexes of HRV duringmental tests.

Method: Nine healthy female subjects aged between18 and 30 years were analyzed. We recorded HRV of thesubject through theheart ratemonitor (Polar RS800CX) beforeand during the examination of PEALL. PEALL recording wasmade using binaural frequency protocols and duration binau-ral. Registration and analysis of components N2 and P3 wereanalyzed were correlated to the SDNN index.

Results: It can be seen that correlation predominantlyweak and without significance between the components N2andP3 PEALL SDNNwithHRV index in duration and frequencyprotocols.

Conclusion: There was no association between thecomponents of PEALL with parasympathetic and sympatheticmodulation of the heart during a specific mental arithmetictest.

A54. StudyonTinnitus Laterality and the Score on the Visual-Analog ScaleTaís de Azevedo Picinini, Adriane Ribeiro Teixeira, AlexandreHundertmarck Lessa, Letícia Petersen Schmidt Rosito, CelsoDall’IgnaUniversidade Federal do Rio Grande do Sul e Hospital de Clínicas dePorto Alegre

Introduction: Tinnitus is a common symptom inindividuals from different age groups and can affect theindividuals’ quality of life. The use of assessment rating scalescan help professionals to verify the impact of this symptom.

Objective: to verify the relationship between the scoreof the Visual Analog Scale (VAS) and tinnitus laterality.

Methodology: 771 patient records were assessed,seen between the years of 2002 and 2014 in a specializedoutpatient clinic. The data was assessed on the VAS score andlaterality of tinnitus. Data were analyzed quantitatively. Theproject was approved by the ethics committee of theinstitution.

Results: The sample consisted of individuals of bothgenders, aged between nine and 89 years (mean59.14 � 12.92 years) and 487 females (63.16%). Regardingthe laterality of tinnitus, it was found that 140 (18.2%) subjectsreported tinnitus in the right ear, 179 (23.2%) in the left ear,394 (51.1%) in both ears and 52 (6.7%) patients reported theperception of tinnitus in the head. The VAS scores ranged from

0 to 10 points, averaging 7.33 � 2.10. It wasn’t verified anyrelationship between the two variables: (p ¼ 0.94).

Conclusion: It was found that in the sample studied,there was no relationship between the laterality of tinnitusand the score on the VAS.

Keywords: tinnitus, symptoms, questionnaires

A529. StutteringMultidimensional Analysis in ChildrenwhoStutterRayssa Beatriz Onuki de Moura, Talissa Almeida Palharini,Cristiane Moço Canhetti de OliveiraUnesp - Universidade Estadual Paulista "Júlio de Mesquita Filho"

Introduction: Stuttering is a multidimensional fluen-cy disorders that can causewide ranging psychosocial impact.

Objectives: The purpose was to assess the fluency andthe attitudes and feelings of the school-age children whostutterer aware of the disorder.

Methods: This was an analytical cross-sectional, per-formed at the university public clinic of São Paulo state,approved by the Ethics Committee of the Institution (n°0081/2011). Participants were 35 children who stutter(CWS), ages 6-11 years, of both genders, speakers of BrazilianPortuguese. The procedures used were: fluency assessment,application of the questionnaire on awareness of stutteringand the assessment of attitudes and feelings about stutteringby children through the protocols proposed by the StutteringFoundation of America - SFA (Chmela and Reardon, 2005).

Results: The percentage of stuttering syllables rangedfrom 3 to 19.50% (average 7.19%, SD ¼ 4.60). The attributesrelated to stuttering were: (1) negative: stuttering, peopleattitude, humiliation and bullying; (2) positive: speech andspeech therapist. Concerns stuttering were: speaking, sufferteasing and bullying and to be accepted by others.

Conclusion: The most frequent negative feelingsfound in children with persistent developmental stutteringand aware of the disorder were: anxiety, sadness, worry andfatigue. Negative attitudes that prevailed in children’s re-sponses were: child’s concern about the attitude of peopleand disfluent speak their consequences in the social andacademic environment; isolation or avoidance of communi-cative or social situations; the crying and the passivity of somechildren in relation to the speech disorder.

Keywords: Speech Disorders; Stuttering; Evaluation;Child

A80. Subjective Visual vertical with the Bucket Method inBrazilian Healthy IndividualsMaristela Mian Ferreira, Fabiana Cunha, Cristina FreitasGanança, Heloisa Helena Caovilla Malavasi Ganança, MauricioMalavasi GanançaUniversidade Federal de São Paulo/Escola Paulista de Medicina(Unifesp-Epm)

Introduction: The ability to judge whether a line isvertical is called subjective visual vertical.

Objective: To obtain the subjective visual verticalreference value with the bucket method in healthy Brazilianindividuals.

Method: Subjective visual vertical was measured bin-ocular in 100 healthy volunteers, 50 female and 50 male.Volunteers had estimated the true vertical relative to theground line indicating when a fluorescent line inside a bucketreached the vertical position. The bucket was rotated slowly,five times clockwise and five counterclockwise.

Results: The two-dimensional scatter plot was chosento represent the mean of the absolute values of the vertical

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deviations from the age andgender. Thehighest concentrationof values was found to 3° of vertical deviation, regardless ofgender; and, the vertical deviation did not increase with age.In the analysis of the mean absolutes values of the verticaldeviations of 90% of the samplewas found themaximumvalueof 2.6° and in the analysis of the 95%, the maximum value was3.4°.

Conclusion: The absolute deviation limit of subjectivevisual vertical in relation to the true vertical line in healthyBrazilian individuals is 3°.

A588. Support Group Formation for People with Tinnitus: ATreatment ToolMarjana Gois, Isadora Gonçalves Pelissari, Sheila JacquesOppitz, Rúbia Soares Bruno, Michele Vargas GarciaUniversidade Federal de Santa Maria

Introduction: Tinnitus is a symptom characterized assound perception in the absence of external sound source.

Objective: To demonstrate how we organized a sup-port group formation for people with tinnitus combiningcategories of treatment-TATandBCT.

Methods: The sample consisted of 28 participants,forconvenience, 18 females and 10 males, from the HUSMAudiology Service. They were divided in 3 groups. The treat-ment group consisted of 5meetings structuredwith half-hourduration, once per month. The sessions were developed basedon principles of TAT associated withBCT. The groups weremade up of 10 people who attended the monthly sessions assubgroups that were previously divided. Subjects in eachgroup were counseled about tinnitus and general issues thatinfluence. Were scheduled consultations for group and werelistened to patients regarding their demands to delineate thetopics order to be addressed. Thus, the subject was firstdiscussed nutrition and physical inactivity, as regards thedietary errors;importance of fractionation meals and physicalactivity practices. Subsequently, discussed sleep theme, ad-dressing daytime and evening activities that improve sleep;tips on goodhabits for good night’s sleep. The next sessionwasabout thought and emotions, they discussed the possibilitythat everyone has to change their emotional reactions,con-nections between thought and emotional state. All topicswere illustrated with informative material.

Results: Of 30 places available 28 contemplated andparticipated in the support group and performed the com-plete battery auditorytests: Audiometry, SpeechTests, Tym-panometry, Auditory Processing, Transient EvokedOtoacoustic Emissios, Suppression Of Emissions, AuditoryBrainstem Response, Long Latency Auditory Evoked Potential,Acuphenometry. Was researched the tinnitus degree discom-fort through Visual Analogue Scale-VASon first date and atdischarge. Also, answered the questionnaireTHI, and HADscale discomfort IOWA; 11 patients were discharged withonly one group meeting; None was discharged on secondmeeting; 3 gave discharged on fourth meeting; 3 gave high infifth meeting and 11 patients remain in care.

Conclusion: The support group for people with tinni-tus has proven to be useful tool in treatment for tinnitus’speople at different ages and different subgroups.

A534. Swallowing and Speech Alterations in a Case ofPosterior Reversible Encephalopathy SyndromeDaniel Lucas Picanço Marchand, Amanda do Nascimento Pires,Mariana Pombo Bofill

Introduction: The posterior reversible encephalopa-thy syndrome is usually caused by hypertensive encephalop-athy, eclampsia and neurotoxicity cyclosporine-A. Symptomsare progressive and include headache, decreased level ofconsciousness, seizures and visual disturbances. The symp-toms regressed completely if corrected in time the determi-nants, otherwise it may settle irreversible damage such ascortical blindness and death.

Objectives: Report speech therapy findings in a case ofPosterior Reversible Encephalopathy Syndrome.

Resumed Report: 3 years and 8 months old girl,hospitalized due to headache, presented changes in electro-encephalography, pointing to diffuse moderate encephalopa-thy, pronounced in the posterior areas of both hemispheres.Referred to the speech therapy service due to speech andswallowing issues. At the beginning of treatment the patientshowed up poorly responsive, no communicative intentionandwith food refusal. The familywas advised to encourage thechild’s communication through conversation, reading storiesand songs. As for the food, we started therapy with texturesand flavors that the patient like.

Conclusion: Because of early diagnosis, the patienthad a good recovery and speech therapy was essential to keepthe girl’s quality of life. There are few speech therapy studieson posterior reversible encephalopathy syndrome, requiringmore scientific papers on this subject.

Keywords: Syndrome; Speech, Language and HearingSciences; Deglutition Disorders

A559. Swallowing Tests of Association: Case StudyMarcelo Henrique Ferreira, luiza suita fauth, Aline GasparinRabaioli, Maria Cristina de Almeida Freitas CardosoUniversidade Federal de Ciências da Saúde de Porto Alegre

Introduction: hydranencephaly is defined as the con-genital absence of the cerebral hemispheres or the massdestruction of these secondary to interruption of blood flowby occlusion of the internal carotid, remaining the thalamicand hypothalamic regions generally intact and functioning.

Objective: To involve clinical evaluation of dysphagiathe swallowing videofluoroscopy a case hydranencephaly.

Resumed Report: Boy, 9 months, sent by the Neurol-ogy Service, for research and monitoring in speech therapywith the presence of oropharyngeal dysphagia. This studywasapproved by the CEP / UFCSPAunder registration number 039/012. At the request of imaging test was necessary because ofthe direct tests of swallowing, have evidenced the presence ofmoderate dysphagia. In our case, the absence of brain struc-tures raises doubts as to the prognosis of the child andeffectiveness in carrying out the orofacial functions.

Conclusion: The use of diagnostic method with radia-tion emitting equipment X, has become increasingly morecurrent and secure, the exhibition held in recorded mediabeing can be seen several times, with frame-by-frame view-ing, the speed to be, thus preventing re-exposure to theradiation. For the study of swallowing, the possibility to verifythe occurrence of the dynamic event, makes accurate andreliable diagnosis as well as opposite to the case of noprotection mechanism airway video fluoroscopy is the mostefficient method of diagnosis. The results of the patientvideofluoroscopy exam confirm the oropharyngeal dyspha-gia, showing presence of tracheal aspiration.

Keywords: Hydranencephaly; videofluoroscopy; de-glutition disorders

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A449. Swallowing the Aspects Associated withTracheomalacia: Case ReportAline Gasparin Rabaioli, luiza suita fauth, Maria Cristina deAlmeida Freitas Cardoso, Marcelo Henrique FerreiraUniversidade Federal de Ciências da Saúde de Porto Alegre

Introduction: Tracheomalacia is a frequent congenitalanomaly. Cartilaginous skeleton of the immaturity of followsthat, by not being adequately rigid, allows the collapse of theairway lumen during the inspiratory movement. The clinicalmanifestations presented by the childrenwith tracheomalaciaare: wheezing, difficulty feeding, crying hoarse, hoarseness.Surgical treatment is recommended in cases whose conserva-tive treatment is not enough, and consists of correcting theunderlying etiology, tracheostomy and aortopexia.

Objective: To characterize swallowing front oftracheomalacia.

Resumed Report: Boy, 2 years and 5 months, sent bythe Pneumology team for evaluation and speech therapy,diagnosed with tracheomalacia. For the investigation of dys-phagia we used the Dysphagia Protocol Pediatric (PAD-PED)are recording, lip seal, suitable hold the straw, appropriatepauses, the suck-swallow-breathing and laryngeal elevationpresent in the test liquid in the cup offered and straw. Therewas also adequate funding spoon, chewing pattern suitable forthe age, proper handling of language, breathing-swallowingcoordination and proper oral transit time in the test withheterogeneous pasty consistency. This study was approved bythe Research Ethics Committee / UFCSPA under number 039/12.

Conclusion: Although it is expected compromise re-spiratory function, this case emphasizes coordination be-tween the tasks diagnosed with normal swallowing and theabsence of clinical signs suggestive of dysphagia.

Keywords: Tracheomalacia, swallowing disorders,tracheostomy

A420. Temporal Processing in Adolescents with SchoolDifficulties ComplaintsGiselle Goulart de Oliveira MatosNúcleo de Estudos da Saúde do Adolescente - Universidade do Estadodo Rio de Janeiro (Nesa/UERJ)

Preliminary study, part of a research "cognitive-lin-guistic skills, Sensory and Motor in Adolescents with SchoolDifficulty: evaluation proposal" (Ethics Research CommitteeHUPE/UERJ 21042513.3.0000.5259), developed at the Adoles-cent Health Studies Center of the Rio de Janeiro State Univer-sity (NESA/UERJ).

Objective: To analyze the profile of temporal process-ing of adolescents with school difficulties complaints.

Methodology:Data from the temporal processing (TP)of the 13 adolescentswho completed thebaseline surveywereselected. They performed behavioral Duration Pattern Test(DP), Frequency Pattern Test (FP) and Gaps in Noise test (GIN),in a soundproof booth, with 50dBSL and in two sessions.

Results: Of the 13 assessed, 62% are female and 38%male, with 77% of series / age gap. All (100%) had disorder oftemporal ordering (DP), with a great variety of answers andaverage of 29.02% accuracy. Six teenagers showed alterationsin at least one more test (46.1%). In GIN, 9 individuals beganthe test by right ear (RE) and 4 by left ear (LE); the average gapdetection threshold was 5.61ms in RE and 5.07ms in the LEand the percentage of correct answers of 67.9% in the RE and70.62% in the LE, revealing index below expectations forchildren 11 and 12 years in RE, which may have beeninfluenced by not control the start test ear variable.

Conclusion: the profile of the temporal processingadolescentswith school difficulties complaints shows changesregarding the ordering and temporal resolution Results cor-roborate studies that put the temporal processing as funda-mental to speech intelligibility.

A198. Temporal Resolution: Gap in Noise Test Application inElderlyTaissane Rodrigues Sanguebuche, Alessandra LuanaSchwantes, Bruna Pias Peixe, Fernanada Freitas Vellozo,Quemile Pribs Martins, Michele Vargas GarciaUniversidade Federal de Santa Maria

Introduction: The auditory ability of temporal reso-lution is one of the first to be affected by aging and consists onthe minimum time required to segregate or solve acousticevents, being essential to the speech comprehension.

Objective: To describe the Gap in Noise(GIN) Testfindings in elderly.

Methodology: The study has a descriptive,quantita-tive and transversal character. A number of 35 personsbetween 60 and 82 years-old were evaluated,mean of 68.71years-old,however, 7 of them were excluded by asymmetrybetween the ears and 3 could not understand the test and,therefore, did not realize it. Thus,the sample was consisted by25 subjects,being 17 female and 8 male, mean of 66.56 years-old,presenting from normal hearing to sensorineural hearingloss(SNHL) moderate,bilateral and symmetric. The individualswere subjected to Pure-Tone Threshold Audiometry, Logoau-diometry,Acoustic Immittance Testing and Testing Track 1 ofGIN test,which is composed by 35 white noise segments thatcontain from 0 to 3 gaps of silence each. The gaps duration are2, 3, 4, 5, 6, 8, 10, 12, 15 and 20ms and are presented 6 timeseach.

Results:Among the subjects, 18 had normal hearing, 3mild bilateral and symmetric SNHL and 4 moderate bilateraland symmetric SNHL. A mean was done according to eachsubject’s hearing and it was found 7.4ms as a reference valuefor normal hearing, 9ms for mild SNHL and 9ms for moderateSNHL,where the lower response to stimulus was 2ms and thehigher 15ms.

Conclusion: It was possible to perform the test inmostelderly evaluated and generate reference values to the popu-lation in study.

A165. Test of Hearing Perception in Free-Field in thePresence of NoiseGleide Viviani Maciel Almeida, Angela RibasUniversidade Tuiuti do Paraná

Introduction: Users of conventional and/or implant-able hearing aids complain about the difficulty in understand-ing speech in noisy environments. Speech tests performed inclinics/practices occur in quiet environments.

Objective: Tovalidate theAuditory Perception inNoiseTest, which checks recognition skills of speech in noise in free-field.

Methods: The sample consisted of one hundredhealthy subjects with normal hearing and aged over 18 yearswho have agreed to participate. After the pure tone audiome-try, was applied speech recognition test, with monosyllabicand disyllabicwords, in free-field, with standardizedmaterial,in three listening situations: hearing optimum condition (nonoise), to noise ratio -10dB and to noise ratio -15dB. To do so,was assembled a calibrated free-field test environment wherespeech was presented in two speakers located at 45 degree,and noise in a third located at 180 degree.

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Results: The one hundred subjects were divided intogroups: G1 aged 18 to 40 (n ¼ 72) years and G2 composed ofindividuals above 40.1 (n ¼ 28) years. All had logoaudiometryresults in free-field between 88% and 100% in the threelistening situations. There was no statistically significantdifference between the two groups.

Conclusion: Auditory Perception Test in Free-field inNoise proved to be easy to organize and to apply. The results ofthe test validation suggest that individuals with normalhearing should hit between 88 and 100% of the presentedstimuli. The test can configure an important tool in measuringthe noise interference on speech perception skills.

Keywords: Auditory Perception; Hearing Tests; Noise;Hearing

A17. The Fonoaudiologia Contribution in the ElderlyReinsertion Presbycusis the Labour Market - Hearing AidsBianca Marques Rocha, Maria Esther de AraújoFaculdade Redentor

Objectives: To identify the benefits of using hearingaids related to socialization, communication and labor activityin elderly presbycusis.

Methods: Approved by the CEP (CAAE30980014.0.0000.5648), an empirical / exploratory researchwas conducted,with direct data collection, applied in 9 elderlybetween 60 and 88 years old. The form was composed ofdichotomous questions itemized scale, addressing handicap,sociability and quality of life.

Results: Of the participants, 89% reported improve-ment in relation to the social aspects after the use of hearingaids, especially in the interaction, communication and socialroutine, feeling more secure and satisfied in their workactivities.

Conclusion: Psychosocial factors such as aging spec-trum representation become more challenging when associ-ated with poor hearing ability (MONDELLI & SOUZA, 2012).Presbycusis ultimately cause a gradual withdrawal and some-times definitive of their professional environment, social andfamily. (Russo et al, 2003). The use of hearing aid is theenvironmental sounds and speech improving communicationconditions (Paiva et al, 2011) (Arakawa et al, 2010). Thus thehearing aid, combined with effective adaptation, through thespeech therapist’s role, can provide this old the chance toregain their social activities, rejecting the isolation theywouldbe imposed, bringing back the independence and autonomyoflife of this individual. (Almeida, 2013).

Keywords: presbycusis; Aging; Hearing aids; Returnto Work; Quality of life

A498. The Importance of Therapy in Patient withHyperacusis: Case ReportIsabella Marques Pereira Rahme, Geraldo Majela PereiraUniversidade Federal de Minas Gerais

Introduction: Hyperacusis is defined as abnormallystrong reactions occuring within the auditory pathways re-sulting from exposure to moderate sounds. People experienc-ing hyperacusis typically have negative emotionalassociations with environmental noises or sounds in generalleading to an abnormally high gain (amplification) to signalarriving from cochlea.

Objectives: Describe a case report of 13-year-oldwoman with hyperacusis complaint for 6 months and thesubject treatment conducted.

Resumed Report: There was no specific sound orsound frequency that bother her, reporting discomfort with

sounds of various natures. Tests as Audiometry, Imitanciom-etry, Otoacoustic emissions, Brainstem audiometry were per-formed with all results within normal limits. TheUncomfortable loudness levels test confirmed the diagnosisof hyperacusis, whereas at 500, 1000, 2000 and 4000 Hzfrequencies thresholds were bellow 80 dB. The treatmentconductedwas the Tinnitus Retraining Therapy (TRT) sessionswith sound therapy and directive counseling. We eliminatedany doubt about the hyperacusis, since the patient wasconcerned regarding your clinical complaint. Any drug wastaken during the treatment. The patient reported significantimprovement of hyperacusis where the sounds that usuallybother her she can deal with them with success.

Conclusion: The management of patients with hyper-acusis complaint is of utmost importance, since people withthe condition are so sensitive to noise and their quality of life isaffected in most cases avoiding social situations. TRT is ahelpful method for patients with hyperacusis.

Keywords: hyperacusis, hyper-responsiveness, direc-tive counseling, tinnitus retraining therapy

A293. The Influence of Age on Swallowing DysfunctionPresence in Children with Suspected DysphagiaLenice de Fatima da Silva Munhoz, Karina Elena CadioliBernardis Buhler, Suelly Cecilia Olivan LimongiHospital Universitário da Universidade de São Paulo

Introduction: Studies which verify the influence ofage on swallowing dysfunction in children are scarce.

Objective: To verify the influence of age on clinicalsigns and symptoms indicators of pharyngeal phase swallow-ingdysfunction observed in clinical evaluation and on oral andpharyngeal phases dysfunctions in videofluoroscopy in chil-dren with suspected dysphagia.

Methods: Retrospective analysis of data from clinicaland videofluoroscopic evaluations carried out in 55 childrenfrom 1 month to 7 years and 11 months old. Subjects weredivided in age groups: 1-6 months, 7-14 months, 15-36months, > 37 months, � 1 year and > 1 year. To clinicalevaluation, the “Protocol for Clinical Assessment of PediatricDysphagia” was used. In the videofluoroscopy, the oral andpharyngeal phases were assessed. To statistical analysis, Chi-square and Fishe’s Exact Tests were used.

Results: In clinical evaluation, children of 1-6 monthsshowed less cervical auscultation (p ¼ 0.022) and vocal quali-ty alterations (p ¼ 0.008) and more respiratory distress(p ¼ 0.013); 7-14 months more cervical auscultation alter-ation (p ¼ 0.042); > 1 year more vocal quality alteration(p ¼ 0.041). In videofluoroscopy, children of 1-6 monthsshowed less oral phase dysfunctions and pharyngeal residue(p ¼ 0.001); 7-14 months more thin fluid pharyngeal phasedysfunctions (p ¼ 0,040); 15-36 months more oral phasedysfunctions (p ¼ 0.018); > 37 months more purée pharyn-geal phase dysfunctions (p ¼ 0.036); > 1 year more oralphase dysfunctions and pharyngeal residue (p ¼ 0.002).

Conclusion: It was found differences for clinical signsrelated to age. Oral and pharyngeal phases dysfunctionsobserved were not expected to age in the population studied.

A418. The Influence of Anterior Dental Open BiteMalocclusion on Bite Force in ChildrenJoana Carolina Martins Simões, Lucia Dantas Giglio, JanainaBueno da Silva, Luciana Vitaliano Voi TrawitzkiFaculdade de Medicina de Ribeirão Preto da Universidade de São Paulo- Fmrp - Usp

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Introduction: The anterior dental open bite maloc-clusion occurs when there is no contact between the incisors.Maximal isometric bite force is one component of chewingfunction and is related to many stomatognathic system struc-tures, such as dental occlusion.

Objectives: The aim of the study was to investigate ifthe anterior dental open bite, isolated or associated withothers malocclusions, influences the maximal isometric biteforce in children, compared with age-matched normalsubjects.

Methods: Sixty six young patients, boys and girls,were selected for the study. They were separated in twosamples, with and without malocclusion anterior dentalopen bite. And all children were classified according to agegroup, there was three to five years and six to eight years old.The test group was subdivided in three others samplesaccording with kind of malocclusion: only anterior openbite group, anterior open bite associated with others maloc-clusions and finally a group anterior open bite associatedwithothers malocclusions without cross-bite. For everybody, theexaminers conducted an orofacial myofunctional evaluationand were performed measurements of bite force by an elec-tronic gnathodynamometer.

Results: it was found only a significant differenceabout bite force values relating to age in the group withmalocclusion anterior dental open bite.

Conclusion: in this study the anterior dental openbite, associated with others malocclusions or isolated, did notinfluence the maximal isometric bite force in children around3 to 8 years old.

�This work was supported by Fundação de Amparo àPesquisa do Estado de São Paulo, Brazil.

A461. The Insertion of the Speech-Language Pathologist in aHealth Monitoring Program Focused on Neonates andInfantsDaniel Lucas Picanço Marchand, Andrea Wander BonamigoUniversidade Federal de Ciências da Saúde de Porto Alegre

Introduction: The first year of life is the period inwhich there is themost pronounced development in the life ofan individual, especially in three fields: cognitive, motor andemotional. The child, when deprived of stimulation and careduring this period, is likely to suffer repercussions at somepoint in its life.With purpose of providing aid,monitor growthin neonates and infants, and identify high-risk children, it wascreated Prá-Nene program in Porto Alegre. This program istied to health services and is developed by multidisciplinaryteams. The Speech-Language Pathologist should play an im-portant role with these vigilance teams.

Objectives: Report phonoaudiological experience inPrá-Nene program, developed in a Basic Health Unit (BHU).

Resumed Report: The Prá-Nene activities occurredweekly, with mothers of newborns being grouped to partici-pate of a brief talk with themultidisciplinary team of the BHU,consisting of nurse, dentist, nutritionist and speech therapist.In this lecture addressed to the care needed in thefirstmonthsof a child’s life, the expertise of each professional werehighlighted. Instructions on breastfeeding, language and hear-ing development and newborn hearing screening were sometopics developed by the speech therapist. 51 people werecovered in this program in a 10-week period.

Conclusion: Professionals who joined the program forsome time highlighted the contributions of speech therapy tothe program. The insertion of the speech therapist in thishealth monitoring program was positive and helped spreadknowledge and disseminate the activities of this professional.

Keywords: Public Health; Infant, Newborn

A63. The Knowledge of Pregnant Women about theImportance of Newborn Hearing ScreeningPatrícia Arruda de Souza Alcarás, Fernanda Soares RodriguesUniversidade do Oeste Paulista

Introduction: in recent years, in Brazil, several dis-cussions about hearing impairments have been publicly heldwith the goal of determining what programs and actions canhelp prevent, identify, diagnose and rehabilitate childrenwithhearing impairments.

Objective: investigate how much expectant mothersknow regarding the importance of OAE testing for earlydetection of hearing impairment. All of these pregnant wom-en are participating in a program called Advice for ExpectingMothers developed in a Basic Health Unit located within thestate of Sao Paulo. In addition, therewere informative actions,through lectures, in the same Basic Health Unit, on theNewborn Hearing Screening (NHS) program.

Methods: the sample consisted of 12 pregnant womenwho were in prenatal care, ages 14 to 32 (mean ¼ 24.83,SD ¼ 5.83).

Results: 91.6% did not know about the OAE test, allclaimed ignorance on the factors that can cause hearing loss,83.3% reported never having received information about ababy’s hearing development, 75% are unaware of locationswhere the tests are performed, 83.3% said that there is a lackofdisclosure about at health units about the OAE test, and 100%of the pregnant women have shown intention to have theirbabies tested using the NHS.

Conclusion: concluded that the women in the studydid not have enough knowledge regarding NHS, making itnecessary to carry out actions to enable health promotion andaccess to this population for neonatal screening programs.

Keywords: hearing, hearing loss, screening

A422. The multidisciplinary strategy resource in NeonatalHypoxic-Ischemic Encephalopathy from its clinicalconditionsLuíza Silva Vernier, Chenia Caldeira Martinez, Deisi CristinaGollo Marques VidorUniversidade Federal de Ciências da Saúde de Porto Alegre

Introduction: Neonatal Hypoxic-Ischemic Encepha-lopathy(NHIE) is a cerebral injury that often causes neonatalcomplications and clinical intercurrences.

Objective: To investigate clinical characteristics, com-plications and conditions of NHIE patients and relating withthe need for a multidisciplinary approach.

Methods: Cross-sectional study with data collectedfrom medical records of children with NHIE from 0 to 24months of age, attended in the last five years in a NeurologyOutpatient Clinic of a Hospital in southern Brazil. For statisti-cal analysis, it was used Chi-square and Mann Whitney tests,assuming maximum significance level of 5%(pâ‰¤0.05),SPSS13.0.

Results: Of 208 medical records collected, 111(53.36%) were of boys.These, 76(47.79%) had vaginal birth,mean gestational age of 34.86 weeks (SD � 4.30), mean birthweight of 2392.31g (SD � 973.618), mean Apgar score in firstand fifth minute of 5.25 and 7.18 respectively, wherein 116(60.19%)were preterm. Regardingmultidisciplinary referral, 7(8.17%) were referred to Speech Therapy; 86(41.34%) toPhysical Therapy, with significant association of these varia-bles with referrals prematurity, sepsis and ventilator support(pâ‰¤0.05). The convulsion variable was related only withSpeech Therapy referral(p ¼ 0.005) and respiratory distressonly with Physical Therapy referral (p ¼ 0.008).It was alsoanalyzed the Oral Motor Sensory System variable, observing

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relationship with respiratory distress, sepsis, ventilator sup-port (p < 0.05).

Conclusion: Patientswith EHIN have traits that lead tothe rehabilitation treatment due to specific characteristics oftheir neurological condition, requiring multidisciplinary re-ferrals, including the Physical Therapy and Speech Pathologyinterventions. Specific clinical variables of Speech Therapywere significantly related to the clinical manifestations mostcommonly altered in the sample.

Keywords: Ischemic Hypoxic Encephalopathy; SpeechTherapy; Physical Therapy; Child

A508. The Relationship between Hyperacusis and AutismSpectrum Disorder: A Review LiteratureIsabella Marques Pereira Rahme, Tanit Ganz Sanchez, ErikaMaria Parlato OliveiraUniversidade Federal de Minas Gerais

Introduction: The autism spectrum disorder (ASD) isa developmental problem characterized, in part, by sensoryabnormalities. Different hearing disorders are reportedamong children with ASD, and hyperacusis is one of themost common challenges.

Objectives: Describe the relationship between autismspectrum disorder and sensory-perceptual abnormalities,emphasizing auditory hypersensitivity (hyperacusis) and dis-cuss their effects in auditory pathway.

Data Synthesis: Systematically review literature inPubmed database, using the keywords “autism and hyper-acusis” and “autism and auditory hypersensitivity” in 2005-2015 period in humans. Sound hypersensitivity in the ASDmay be due to abnormality of the efferent auditory system bylack of sufficient contralateral suppression. Auditory sensorymodulation difficulties are common in ASD and may stemfrom a faulty arousal system that compromises the ability toregulate an optimal response. Superior semicircular canaldehiscence (SSCD) was more prevalent in autistic childrenwith hyperacusis. Evoked potentials measures in autistic withhyperacusis can provide a clinical clue of a possible SSCD.Autistic disorder with hypersensitivity showed more delayedM50/M100 peak latencies than without, indicating auditoryhypersensitivity as a characteristic response of the primaryauditory cortex. Atypical P100m lateralization in autism wasassociated with auditory hypersensitivity during the first 2years of life. When hearing impairment exists, hyperacusisshould be taken into consideration when fitting amplificationand planning behavioural intervention. Effect of risperidonefor improving hyperacusis was reported.

Conclusion: The early diagnosis of auditory pathwaydisorders in autism is considered relevant for the possibleidentification of atypical sensorial markers.

Keywords: autism, hyperacusis, hyper-responsive-ness, auditory processing, child behavior

A541. The Relationship Between Recurring Otitis andAcquisition of Coronal FricativesLaura dos Santos Abon Zahr, Kariny Zencke da Silva, BrunaSantos Sant’Anna, Rayane Abreu do Nascimento, LetíciaPacheco RibasUniversidade Federal de Ciências da Saúde de Porto Alegre

Introduction: Studies show that children who haverecurring otitis may have a reduced perception of speechsounds, especially in relation to fricatives such as /s/ and /z/.This fact may explain the difficulty in acquiring these pho-nemes in children with phonological disorder.

Objective: To investigate the history of ear infectionsin children with phonological disorder and the phonemes /s/and /z/ are acquired at different syllabic positions.

Methods: It was evaluated subjects from the databaseVALDEF (CEP 995 344), composed of speech and languageevaluations of 130 children diagnosed with phonologicaldisorder with ages between 4 and 11 years. Of the entireBank, the data was selected from those who had reportedrecurrent otitis in anamnesis and analyzed the phonologicalsystems over phonemes /s/ and /z/, totaling a sample of 37subjects with ages between 5 and 9 years.

Results: From the data analyzed, 16% of children didnot acquire the /s/ in, at least, one of the positions that it mayoccupy (Onset Initial/medial, Medial Coda/Final), 43% did notacquire the phoneme /z/ in Initial Onset and 40% did notacquire in Medial Onset. It is important to note that 5% of thechildren studied did not acquire the fricatives /s, z/ in anyposition.

Conclusion: Based on this study, it can be noticed thatchildren with recurring otitis have a major difficulty in theacquisition of fricatives, especially in relation to /z/.

A21. The Relationship of Complications in Learning Processwith Processing Disorder HearingPriscieli Porto Costa, Maria Esther de AraújoFaculdade Redentor

Objectives: To analyze in cases of learning disability,disorder of evidence in the hearing process.

Methods: Approved by the FACRedentor Ethics Com-mittee (CAAE -30973514.7.0000.5648) the case study wasinitially performed with collection record analyzes of ClinicalSchool (CACI), selecting 7 children between 9 and 14 years,were subsequently submitted to audiological evaluation andscreening of auditory processing. The final data were com-pared and analyzed.

Results: Analysis of the records of the selected audi-ence, there was a change in phonological awareness, reading,writing, attention, auditory memory, dysgraphia, school fail-ure and otitis in thefirst months of life. In audiometry showednormal range, but in auditory processing tests, 5 of the 7children failed.

Conclusion: the sound of attention and auditorymemory skills are important for the development of auditoryprocessing (ALBUQUERQUE, 2007). The integrity of the pe-ripheral auditory system and central auditory processingcontributes to the development of phonological awareness,which is important for the acquisition and development ofreading and writing (NUNES, FLEET & MOUSINHO, 2009). Itwas observed that there was indicative of auditory processingdisorder inmore than 50% of cases. Learning problemsmay berelated to changes in auditory processing (Oliveira Cardosoand CAPELLINI, 2010). It is verified the relevance of auditoryanalysis, especially auditory processing tests in cases of learn-ing disability, enabling better therapeutic positioning in orderto work on specific stimuli.

Keywords: Hearing; Learning; Auditory pathways;Auditory perception; Disorder hearing

A538. The Role of Speech Therapy in Alternative FeedingRoute Indication: A Case ReportCaroline Godois Destri, Bianca Regina Dresc, Karen de Oliveirados Passos, Bárbara Machado Costa, Rayane Abreu doNascimento, Lisiane de Rosa BarbosaUniversidade Federal de Ciências da Saúde de Porto Alegre

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Introduction: Cerebral Palsy is a chronic encephalop-athy, non-progressive, arising from injury at the centralnervous system of a child. Its motor impairment can affectswallowing, requiring rehabilitation and even alternativefeeding route. Speech therapy, by evaluating the deglutition,collaborates with the multidisciplinary team in choosing asecure method to feed these children.

Objectives: Report the role of speech therapy in theindication of alternative feeding route. Approved byethics andresearch committee ISCMPA no 467 673 of 11/05/13.

Resumed Report: Female patient, two years, historyof microcephaly by anoxia and delayed psychomotor devel-opment. Admitted respiratory difficulty and had significantweight loss. In evaluation of swallowing, presented inefficientlip seal, significant anterior oral escape, weak cough, asamended laryngeal elevation, delayed pharyngeal swallowingresponse, and persistent biting reflex. Shewas diagnosedwithmoderate to severe neurogenic oropharyngeal dysphagia. Dueto little time in therapy, the patient remained unable to oralfeeding. Alternative feeding route was indicated â€“ in coop-eration with the medical team - due to the risk of bronchoas-piration, along with indirect therapy for dysphagia. Suchconduct was held in conjunction with the multidisciplinaryteam, based on the case and clinical assessment.

Conclusion: It is noteworthy the importance of speechtherapy actions along the multidisciplinary teams in order toassess, prevent and rehabilitate swallowing disorders, con-tributing to discussions and preserving feeding security ofhospitalized patients.

Keywords: Deglutition Disorders; Cerebral Palsy;Speech Language and Hearing Sciences

A474. Therapeutic Counseling in Individuals with HearingImpairment Presenting TinnitusAline Faure Cabreira, Rosana Ribeiro Manoel, Eliane AparecidaTechi CastiquiniHospital de Reabilitação de Anomalias Craniofaciais - Hrac/USP

Introduction: Tinnitus is a disorder that affects mil-lions of Brazilians. Since tinnitus is a subjective symptom andpresents great impact on the individual’s life, all scientificcontribution becomes significant and valuable. In the pres-ence of hearing loss, hearing aid fitting can interfere withcentral auditory representation of tinnitus, reducing its per-ception, but this therapeutic approach must be linked tocounseling, which should contain basic information abouttinnitus.

Objective: To check effectiveness of counseling asso-ciated with the hearing aid fitting in reducing the degree oftinnitus annoyance.

Methods: 10 adult individuals of both genders, withhearing loss and tinnitus, participated in the study. Themethodology consisted of two groups, a control group andan experimental group, belonging to the Hearing HealthDivision-DSA/HRAC/USP-Bauru. The individuals were submit-ted to the subjective self-assessment questionnaire, TinnitusHandicap Inventory and the Visual-Analogue Scale, before andafter hearing aid fitting. The experimental group participatedin three counseling sessions, which took place in the pre-adaptation level, in the first and third month after fitting.

Results: After three months, in the intragroup analy-sis, most patients showed significant improvement in thetinnitus annoyance. There was no statistically significantdifference between the groups.

Conclusion: The use the hearing aid generated im-provement in reducing the degree of tinnitus annoyance,getting similar responses in both groups. It was not possible

to check significant differences in the effectiveness of thecounseling sessions carried out with the experimental group.

Keywords: Hearing, Tinnitus, Hearing Aids,Counseling

A35. Tinnitus Annoyance in Individuals with and withoutHearing LossLílian Benin, Adriane RibeiroTeixeira, AlexandreHundertmarckLessa, Letícia Petersen Schmidt Rosito, Celso Dall’IgnaUniversidade Federal do Rio Grande do Sul (Ufrgs) Hospital de Clínicasde Porto Alegre (Hcpa)

Introduction: The tinnitus annoyance can be assessedby different scales, and the Tinnitus Handicap Inventory (THI)is one of the most frequently used.

Objective: To compare the annoyance caused by tin-nitus in individuals with and without hearing loss.

Methodology: A retrospective study was performedon records of 795 individuals treated in an outpatient carefacility for chronic tinnitus. Initially were selected the recordsof patients with tinnitus and normal hearing (lower than25dBHL in frequencies from 250 Hz to 8000 Hz) and present-ing history and THI. Subsequently, individual patient recordswere selected with tinnitus and hearing loss and matched inage and sex with the individuals with normal hearing.

Results: From the 25 (3.14%) that had normal hearing,17 (68%) women and 8 (32%) men, the same proportion of thehearing loss group. The first one aged 29 and 69 years (mean52.52 � 9.80 years) and the second, aged between 29 and 69years (mean 52.56 � 9.74 years). To the normal hearinggroup, the THI score ranged between 6 and 84 points, averag-ing 32.52 � 20.76 points and to the hearing loss group,between 8 and 96 points, averaging 36.24 � 23.30 points.Therewas no significant difference in the score of THI betweenindividuals with and without hearing loss (p ¼ 0.55).

Conclusion: It was found that there was no differencein the tinnitus annoyance in individuals with and withouthearing loss.

Keywords: tinnitus, hearing loss, questionnaires,hearing

A248. Tinnitus in Chemotherapy and Radiotherapy as aCancer TreatmentPriscila Feliciano de Oliveira, Erica Crislane Omena de Lima,Sabrina doNascimento dos Santos, Mayza Pereira Santos, LisleyKelly Santos de Aguiar, Wellida Gardeny SilvaUniversidade Federal de Sergipe

Introduction: Tinnitus is highly complex and it refersto a conscious perception of sound heard in the absence ofphysical sound sources. The literature reports that 8 to 15% ofadults experience tinnitus. Its dificult to define the cause, butpeople that have cancer tumors often suffer from it. Its knownthat cancer treatment have ototoxic effects and it is the causeof hearing loss and possibly tinnitus.

Objectives: Asses the tinnitus in cancer treatment andcorrelate with hearing loss.

Method: Cohort clinical study carried out at Oncologyin a Public Hospital of Sergipe. Anamnese and Audiologicalevaluation (Pure Tone Audiometry) were performed in 119patients undergoing chemotherapy and raditherapy. It wasapproved by the Ethics in Research Committee, under protocol# # 33665014.7.0000.5546.

Results: The main age was 44.2 years; female (81.5%)and breast cancer exhibited the highest incidence. 62,2%reported tinnitus and 29% had sensorioneural hearing loss.Subjects with hearing loss told that tinnitus was evident but

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there was no significant difference between them (p ¼ 0.46).Patients that were in themiddle of the treatment had tinnitus(57.3%) and there was a positive statist correlation (p ¼ 0.00).33% reported a change in hearing thresholds after cancertreatment and 85.8% of them had tinnitus as a complainwith a significant difference in Chi square test (p ¼ 0.00).

Conclusion: Tinnitus affects patients with cancertimors, but thre is no correlation between hearing loss.


A667. Tracheostomy Deccanulation Process: A Critic Reviewof Speech Therapy ProceedingJunior Celso Luiz Gonçalves dos SantosMaster’s And Doctoral Program In Communication DisordersUniversidade Tuiuti do Paraná

Introduction: Tracheostomy in a surgical procedurecommonly used in intensive care units (ICU) for the manage-ment of respiratory complications, as to overcome an upperairway mechanical obstacle, reducing respiratory resistance.In the tracheostomy weaning process, a multidisciplinaryapproach shows lower incidence of complications, and betterresults in the rehabilitation of the patient.

Objective: to examine the methodologies that assessthe actions of the multidisciplinary team in tracheostomydecannulation process, emphasizing the Speech LanguagePathologist participation in the period between 1980 and2014.

Data Synthesis: It was performed a systematic reviewof medical and speech therapy literature on speech therapyapproach in tracheostomy decannulation process, coveringthe period from 1980 to 2014, not limited by language ornationality. Among 205 articles found in the exploitation ofthe databases, it was included in this review 9 articles thatmention speech therapy in the tracheostomy decannulationprocess. According to nationality, 4 articles were from the U.S.A., 2 from UK, 1 from Brazil, 1 from Germany and 1 fromCanada. According to the type of study, 4 were prospective, 2were descriptive, 2 were retrospective and 1 was a review.

Conclusion:We found no studies that describe speechtherapy parameters to be followed in the process of manage-ment and total removal of the tracheostomy. It is thereforenecessary that these parameters are researched by speechlanguage pathologists.

A255. Two Dichotic Tests Comparison in ElderlyFernanada Freitas Vellozo, Quemile Pribs Martins, AlessandraLuana Schwantes, Taissane Rodrigues Sanguebuche, MicheleVargas Garcia, Bruna Pias PeixeUniversidade Federal de Santa Maria

Introduction: The dichotic tests consist of differentstimuli presentation in both ears simultaneously or by super-imposition,in syllables,sentences,stories or onomatopoeiaspatterns. The purpose is to evaluate the speech sounds offigure-background ability.

Objective: Compare two dichotic tests in elderly.Methodology: The current study present a transversal

and prospective character. The sample was composed by 30subjects, 19 of them presenting normal hearing and 11presenting sensorineural until moderate, symmetric and bi-lateral hearing loss. The age range was between 60 and 82,mean of 66 years-old. The sample was subjected to visualinspection of the external acoustic meatus,tonal and vocalaudiometry,Acoustic Immittance and binaural integration teststage from the Dichotic Digits Test(DDT) and the DichoticSentence Identification Test(DSI).

Results: The following results are preliminary of astudy in progress. The totality of the sample could realize theDDT and 6(20%) could not realize the DSI Test because theypresented visual difficulties and had lower scholar level. In theDDT,themean percentage of correct answerswas 94% for bothears (BE) in elderly presenting normal hearing(63%) and 88%in BE for elderly presenting hearing loss(37%). In the DSI Test,themean for the right ear(RE)was founded 70% and for left ear(LE) 83% in elderly presenting normal hearing(67%) and 75%for the RE and 74% for the LE in elderly presenting hearing loss.

Conclusion: The DDT yielded higher applicabilitycompared to the DSI Test, however, presenting low alterationpercentage concerning the elderly complaints. Therewith,theDSI proved to be more sensitive to alterations,but lessapplicable.

A176. Two Temporal Resolution Tests ComparisonQuemile Pribs Martins, Alessandra Luana Schwantes, BrunaPias Peixe, Fernanada Freitas Vellozo, Taissane RodriguesSanguebuche, Michele Vargas GarciaUniversidade Federal de Santa Maria

Introduction: The temporal resolution is a hearingability that consists in the minimum time required to segre-gate or solve acoustic events, being essential to the speechcomprehension. It is the first ability affected by the senes-cence. The Random Gap Detection Test(RGDT) and Gap inNoise Test(GIN), which present different acoustic parameters,can evaluate the temporal resolution test.

Objective: Comparing two temporal resolution testsin elderly.

Methodology: This study has a descriptive, quantita-tive and transversal character. A number of 35 persons wereevaluated, being 8 excluded because they presented asymme-try between the ears or they could not realize the tests.Therefore, the samplewas composed by 27 elderly presentingcomplaint about auditory processing, divided in three groupsof age between 60 and 82 years-old, andmean of 67 years-old:group 1(G1) normal hearing,group 2(G2) mild symmetricalsensorineural hearing loss(SNHL) and group 3(G3) moderatesymmetric SNHL. The individualswere subjected to Pure-ToneThreshold Audiometry, Logoaudiometry, Acoustic ImmittanceTesting, RGTD and Testing Track 1 of GIN test.

Results: The following results are preliminary of astudy in progress. In the GIN test, the medium threshold of G1is 7.4ms, of G2 is 9ms and of G3 is 9ms, whereas 2 subjectscould not realize the test. In the RGDT test, the mediumthreshold of G1 is 26.75ms, of G2 is 52.62ms and of G3 is22.08ms;one subject could not realize the test.

Conclusion: In this study, the RGDT demonstratedhigher sensibility to temporal resolution alteration comparedto the GIN Test, concerning the elderly’s complaints.

A540. Using of the Modified Blue Dye Test InTracheostomized ChildrenKaren de Oliveira dos Passos, Bianca Regina Dresc, Lisiane deRosa Barbosa, Bárbara Machado Costa, Rayane Abreu doNascimento, Caroline Godois DestriUniversidade Federal de Ciências da Saúde de Porto Alegre

Introduction: Tracheostomy is an endotracheal tubeinserted surgically for airway clearance and indicated forpatients with prolonged endotracheal intubation. It modifiesintegration of respiratory and swallowing functions and mayresult in dysphagia and aspiration. Speech therapy acts byevaluating swallowing, and may use the modified Blue DyeTest, which consists of swallowing saliva and/or food blue

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dyed and verificating if bluish secretion will come out thetracheostomy afterwards.

Objective: Report use of themodified Blue Dye Test intracheostomised children at Children’s Hospital. Approved byethics and research committee UFCSPA no 467 673 of05.11.2013.

Methodology: The test was applied in 9 children up to24 months old. In 6 subjects feeding through alternativefeeding route, was performed to verify initial aspiration ofsaliva, associated gloved finger suction in infants, being per-formed with food in case of negative findings. Children whoreceived oral feeding were tested with food. The procedurewas performed upon request and recognition of medical staff.

Results: Of the nine children evaluated, 5 (55%) testedpositive for aspiration and 4 (45%) children showed no aspi-ration signs.

Conclusion: The Blue Dye Test has been an alternativein the clinical evaluation of swallowing, although there isshortage of description of its use inchildren in the literature.This way, we recommend further research with more repre-sentative samples to reinforce the importance of this test inthe clinical evaluation of swallowing.

Keywords: Deglutition Disorders; Tracheostomy;Speech Language and Hearing Sciences

A92. Verbal Praxis in Adults: Speech in ExcellenceTaísa Giannecchini Gonçalves de Souza, Marina Martins PereiraPadovaniUniversidade de São Paulo - Bauru

Introduction: Speech Motor Control includes theplanning, preparation and execution of movement plans toresult in muscle contractions and displacement of structures.In this perspective, the non-verbal-stimulation of the PraxisSpeech is a theory that aims to improve the orofacial systemfor use in Speech.

Objective: Stimulate Non-Verbal-Praxis of lips andtongue in adults to promote excellence in articulation pattern.

Resumed Report: participated in this project 8 adults,mean age of 43.5 years. Speech therapy evaluation wasperformed with a test scores with orofacial praxis and evalu-ation and Speech Fluency, with specific text recording tocontrol the Speech patterns. 8 subjects were instructed toperform exercises in sequence of lips and tongue for 60consecutive days, for 5 minutes and 3 reps a day, and per-formedweekly speech therapy sessions. At the end of 60 days,participants were reassessed. 5 subjects showed improve-ment in the test of oral praxis, with score increased bymore than 10 points, which featured greater coordination ofthe muscles involved. The default Speech was marked byincreasing speed in reading, improved speech coordination,articulation more precise and clients perceptions.

Conclusion: The Stimulation may have contributed tothe pattern improves articulation of speech of these adultssubjects. This work can opens up the possibility of a morecomprehensive work with adults speakers, where the coordi-nation of orofacial structures can enable the best possiblemuscular performance. This study suggests that the exerciseof praxis skills can minimize nonverbal speech disorders.

Keywords: adult, motor control, speech

A187. Verifying the Voice Therapy Efficacy in Patients withVestibular PhonationIsadora de Oliveira Lemos, Mauriceia CassolUniversidade Federal de Ciências da Saúde de Porto Alegre

Introduction: The laryngeal muscle tension and thestandard hyperkinetic phonation pattern may cause an im-proper adjustment, which favors the vestibular folds’ useduring phonation. The speech therapy helps the patient toadjust the vocal pattern.

Objective: To determine the phonation adjustmenttechniques’ efficacy in the vestibular phonation.

Methods: A voice therapy secto’s patient database ofthe Hospital Complex Santa Casa of Porto Alegre was used forthe research. The sample included 3 patients of male genderand 1 female, with average age of 60 years, who attended 12therapy sessions on average. In the evaluations the GRBASI(Hirano, 1981; Dejonckere, Remacle and Fresnel-Elbaz, 1996)protocol was used and the findings of breathing were ob-served through anteroposterior chest movement, vertical andtransverse, also the maximum phonation times’ measure-ment. Speech therapy had focus on breathing, body andphonation competence methods, seeking a primary muscleadjustment and sufficiently balanced voice.

Results: In GRBASI protocol, it was found that theoverall voice’s alteration level changed in two patients, fromthe intense degree to the lightest, in the others there was nochange. In chest motion’s evaluation, all patients altered thepattern from high to medium. The pre intervention phona-tion’s maximum time averaged 6.47 seconds and after speechtherapy was 8.51 seconds.

Conclusion: These findings demonstrate the usedmethods’ effectiveness in speech therapy in patients withvestibular phonation, decreasing the effort during phonationand promoting laryngeal muscle adjustments, favoring theadequate and efficient glottal closure.

Keywords: voice disorders, dysphonia hyperkinetic,speech therapy

A497. Vestibular Evoked Myogenic Potential in Dancers:Study of the Vestibule-Spinal ViaAline Cabral de Oliveira Barreto, Bruna Danieli de Carvalho,Acacia Batista Lima Feitosa, Priscila Feliciano de Oliveira,Manoela Eleanor Furlan Barreto, Liliane Desgualdo PereiraUniversidade Federal de São Paulo; Universidade Federal de Sergipe

Introduction: As the vestibulocervical reflex is im-portant for the postural stabilization, the knwoledge of danceeffects on magnitude can contribute not only on basic neuro-science field, but it can also strongly affect practices in neuro-rehabilitation. Objectives: To verify the influence of practiceddance movements on vestibular system and, specifically, tocompare magnitudes of dancers and not dancers vestibulo-cervical via responses.

Methods: The samplewas composed of 61 individuals,aged between 18 and 35 years,with 31 dancers and 30 control.Only subjects with normal hearing sensitivity and no historyof hearing and/or vestibular disorders were included. Acervical vestibular evoked myogenic potential record wasperformed on sternocleidomastoid ipsilateral to stimulation.100 tone-bursts stimulus were evoked in 500Hz, 5Hz rate,95 dB NAn intensity, bandpass filter from 5 to 2.200 Hz. Datawere processed by SPSS 17.0 software using TStudent test orMann-Whitney test. Values were significant when p â‰¤ 0,05and alpha value was 0.1.

Results: Between groups, there was no significantdifference when both right and left years were compared,considering p â‰¤ 0,05. Cervical vestibular evoked myogenicpresented earlier waves and bigger amplitudes when it wasrecorded on dancers group compared to control group. Therewas significant difference for all parameters between bothgroups, except p13 latency and p13-n23 interlatency,p < 0.005.

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Conclusion:Higher amplitudes and lower latencies ondancers vestibulocervical reflex were found when comparedto control groupparameters,what reflects thatdanceprovidesreflex with higher magnitude.

Keywords: Saculle and Utricle, Postural Balance, Ves-tibular evoked myogenic potential

A591. Vestibular Rehabilitation and Quality of Life In PatientTEC VictimScheila Farias de Paiva, Isadora Diniz dos SantosUniversidade Federal de Sergipe

Introduction: Dizziness is a feeling of change in bodybalance and can be rotating or non-rotating character. Theillusory sense of movement as revolve around yourself or theenvironment is an entrance exam symptom called Vertigowhile the instability, oscillation, hesitation hesitancy, floating,sinking rise, instinct, impulse, oscillopsia are not rotationalcharacter and are characterized as dizziness, usually notice-able in chronic condition.

Objective: To do VR for reestablishment of bodybalance and improves the quality of life in patients victimsof traumatic brain injury (TBI). Methodology: it was done fivemeetings that consisted of application of IHL (Dizziness Hand-icap Inventory) and vestibular evaluation before and afterrehabilitation, activities for stimulation of dynamic and staticbalance and implementation of level 1 and 2 of Cowrthorneprotocol and cookseyfor stimulation Reflection OcularVestibule.

Results: In the pre RVevaluation the patient presentedlateropulsion right and anteropulsão the dynamic and staticbalance tests, the DHI the patient presented alterations in alloccupational emotional and physical aspects, since the postRV assessment the balance changes were not so noticeablesince there was an improvement in the DHI mainly in thephysical and emotional aspects.

Conclusion: Thevestibular rehabilitation was effec-tive, significantly improving the patient’s quality of lifethrough the reestablishment of body balance.

A528. Videofluoroscopy Findings of Patients with SevereDysphagiaSheila Tamanini de Almeida, Daniela Salvatori, JulianneWagner, Eduarda Oliveira CunhaUniversidade Federal de Ciências da Saúde de Porto Alegre

Introduction: A videofluoroscopy is an instrumentalthat allows greater visibility of the structures duringswallowing.

Objectives: To report the videofluoroscopy findings ofthree patients with severe dysphagia.

Methods: Retrospective study of medical records ap-proved by the Ethics in Research Committee n. 41354. Initially,a sample of 14 patients with severe dysphagia who werereferred between January to October 2014 were analyzed.These patientswere referred by the InternalMedicine Teamofa hospital to verify the reintroduction of oral feeding. Of these,five did the videofluoroscopy, but only three had the reportdetails in the database. Two of them were male and onefemale, age between 68 and 79 years , with ischemic strokediagnosis followed by hemorrhagic transformation, urinarytract infection and polyneuropathy in critical patients.

Results: In the oral phase, one patient presentedinability in the food uptake due to limitation of mouthopening, with oral extra escape. Two showed prematurespillage to oropharynx, and one of them presented inabilityin the preparation, organization and food ejection. During

pharyngeal phase, two had residues in vallecules and one didnot realized the anterior movement and hyolaryngeal stabili-zation. Still in pharyngeal phase, two patients had trachealaspiration, and one had laryngotracheal penetration. Theesophageal phase was not evaluated in these three patients.

Conclusion: Swallowing disorders with importantimpairments to maintain oral feeding were observed in thissample. The videofluoroscopy complements the speech pa-thology clinical evaluation and it should be solicited whennecessary.

Keywords: Adult, Deglutition Disorders, Techniquesand Procedures

A625. Vocal Characteristics in Subjects with Parkinson’sDiseaseMaria Francisca de Paula Soares, Luana Andrade SantosUniversidade Federal da Bahia

Introduction: Parkinson’s disease is a neurologic pa-thology characterized bymotors symptoms like tremor, rigid-ity and bradykinesia. Difficulties on respiratory, phonatoryand articulatory subsystems may impair the speech negative-ly. Hypophonia is perceived as breathy, tremulous voice andreduced in loudness.

Objective: To describe the acoustics characteristics ofphonatory production of Brazilian Parkinsonian’s speakers.

Methods: 22 individuals diagnosed with Parkinson’sdisease, 16 men and 6 women, mean age 68 years old(standard deviation ¼ 8.4), treated with Levodopa participat-ed in this study. The acoustics analysis was performed and thefollowing parameterswere considered: fundamental frequen-cy, intensity, jitter, shimmer, harmonics to noise ratio andtremor. Only fundamental frequencywas analyzed isolated bygender group.

Results: Males mean frequency was 133.8 Hz (stan-dard deviation ¼ 2.4, n ¼ 16) and females were 168.1Hz(standard deviation ¼ 19.3, n ¼ 6), intensity (mean ¼ 63.5,standard deviation ¼ 1.60) and jitter (mean ¼ 0.6, standarddeviation ¼ 0.2). These values are compatible with the litera-ture. However, standard deviation of fundamental frequencyon the female group was increased. The values of shimmer(mean ¼ 5 %, standard deviation ¼ 1.5), harmonics to noiseratio (mean ¼ 19.4, standard deviation ¼ 0.7), frequency oftremor (mean ¼ 5.2, standard deviation ¼ 2.7) and ampli-tude of tremor (mean ¼ 24.7, standard deviation ¼ 6.6)showed high values.

Conclusion: Although there are evidences in theliterature of reduced loudness on parkinsonian, the findingsof this study do not corroborate this assumption. The values ofstandard deviation, shimmer and noise found in women’sparticipants, indicates variability in cycle-to-cycle and thevalues of tremor suggests difficulties to keep stable thephonatory system, in both short-term and long-term.

Keywords: Parkinson’s disease, dysphonia, acoustics,voice disorders

A576. Vocal Complaints and Voice Characteristics inIndividuals with Parkinson Disease: a Preliminary StudyEvelyn Alves Spazzapan, Eliana Maria Gradim Fabbron, SuelyMayumi Motonaga OnofriFaculdade de Filosofia e Ciências - Universidade Estadual Paulista -Unesp/Marília

Introduction: The voice alterations most commonlyfound in Parkinson’s disease are decreased prosody, low vocalintensity, hoarseness, breathness and vocal tremor.

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Objectives: To verify the voice complaints reported andto analyze the vocal characteristics found in this population.

Methods: Cross-clinical study of 19 adults diagnosedwith ParkinsonDisease, 10men and 09women, aged between57 and 85 years old (mean 73,1). A questionnaire was appliedto raise voice complaints for each participant and was heldrecording sustained vowel /a/ in acoustically isolated room.The recordings ware edited, eliminating the start and the endof emission. The Multi-Dimensional Voice Program andPRAAT softwares analyzed acoustic parameters.

Results: The most frequently reported vocal com-plaints were low intensity (50% by women and 37,5% bymen) and hoarseness (37,5% by women and 50% by men).The acoustic parameters analyzed for men about mean fun-damental frequency, F0 frequency jitter, absolute jitter, jitterpercent, fundamental frequency variation, shimmer in dB,shimmer percent, peak-to-peak amplitude variation, noise-to-harmonic ratio and soft phonation indexwere subsequent-ly: 126,853Hz; 5,445Hz; 109,003us; 1.038%; 2.215%; 0,329dB;3.731%; 17.308%; 0.125; 22.760 and 76,568dB; and for womenwere: 195,755Hz; 4,373Hz; 186,812us; 4.048%; 13.030%;22,430dB; 7.783%; 27.829%; 0.272; 15.303 and 76,091dB.

Conclusion: The individual with Parkinson Diseasepresent vocal complaints and the acoustic analysis measuresshowed in vocal quality to be able to justify their complaints.

A456. Vocal Rehabilitation in a Case of Dysphonia Caused byVestibular Folds PhonationDaniel Lucas Picanço Marchand, Mauriceia CassolUniversidade Federal de Ciências da Saúde de Porto Alegre

Introduction: The voice is the main instrument ofhuman communication. It is producedby themovement of thevocal folds, caused by the expulsion of air from the lungsduring exhalation, and modified in the supraglottic cavities,resulting in the production of sound waves. In some individu-als, there may be the participation of vestibular folds in thephonation process, resulting in changes in voice quality, withsigns of hoarseness and vocal strain. Given the frequentoccurrence of clinical cases of this nature, it is proposed topresent a case of vocal disorder by use of vestibular folds.

Objective: Report vocal rehabilitation in a patientdiagnosed with functional dysphonia caused by vestibularfolds phonation.

Resumed Report: A 64 years-old male, forwarded bythe ENT team to start speech therapy after laryngeal micro-surgery to remove warty lesions and use of vestibular foldsduring phonation. The patient is a former smoker, complain-ing of hoarseness. Applied protocols, evaluations and percep-tual and computerized voice analyzes aiming to characterizethe patient’s clinical status. Presented moderate roughness,breathiness and tension and slight vocal instability. Thepatient received information regarding vocal health, as wellas stretches,massages and vocal techniques, like Finnish tubesand finger kazoo, aiming at the detachment of vestibular folds,balance resonance and decrease laryngeal tension.

Conclusion: The patient demonstrated adherence totreatment, showing improvement in all vocal symptoms. Afternew laryngoscopy, therewasn’t any use of vestibular folds duringphonation, confirming the effectiveness of speech therapy.

Keywords: Speech, Language and Hearing Sciences;Voice; Voice disorders

A484. Voice Disorders Related to Teaching: A Case-ControlStudySusana Pimentel Pinto Giannini, Leslie Piccolotto FerreiraPontifícia Universidade Católica de São Paulo, Brasil.

Introduction: Teachers constitute professional cate-gory with high occurrence of voice disorders due to thisoccupation’s intense vocal demand and to unfavorable workenvironments. Aim. To identify job’s factors associated tovoicedisorders in teachers of the public school of the city of SãoPaulo.

Methods: This is pair matched case-control study. Thecase group was composed of teachers with vocal qualitydeviations and vocal fold lesion. The control group was select-ed at the same schools in which the case group individualsworked. Both groups answered the questionnaires: Conditionsof Vocal Productionâ€“ Teacher(CVP-T), Job Stress Scale(JSS)andWorkAbility Index(WAI). The analysiswas doneusing qui-squared association test and multiple regression models.

Results: The analyses of case and control groups showthat the samples are comparable, with no significant differ-ence in demographic and control variables. In analyzing theassociation of job stress, 78.8% of the control group areconcentrated in lower levels of demand, while 69.3% of thecase group are located at higher levels. Regarding workcontrol, the situation is reversed, 63.1% of the subjects inthe control group manifested higher levels of control, while73.1% of the case group are in the lower categories. Inanalyzing the association of the ability to work, there isassociation between low work ability and voice disorder.

Conclusions: Low and moderate ability to work showhigh correlation with the presence of voice disorder. Thepresence of voice disorder may jeopardize their careersbecause these professionals depend essentially on their voicesto teach.

A277. Where are the Brazilian Bibliographical Productionson the Area of Audiology?Ana Terra Santos Pompeu, Amanda Giglio Eugenio Barreiros,Ivana Correa Tavares Oliveira, Ariane Moulin Pedra, Telma Diasdos Santos, Teresa Maria Momensohn dos SantosPontifícia Universidade Católica de São Paulo

Introduction: The Audiology is one of the BrazilianPhonoaudiology specialty with greater number of scientificproduction. Evaluating the scientific production allows out-line methodological trends, themes and observe the develop-ments of knowledge in the area.

Objective: raise the phonoaudiological productions inAudiology that used quantitative methodology and review ofthe literature on three major search platforms for periodicals.

Method: descriptive documentary study, which ana-lyzes the publications of the audiology area. We conducted abibliographic survey in BIREMEdatabases, periodic CAPES andSCIELO. The variables used in this study were type of produc-tion (original articles), language (Portuguese), country ofaffiliation (Brazil), thematic (audiology welcomes) and period(from 2009 to 2013).

Results:we found 256 quantitative articles 65 articleson literature review. We found that 62 quantitative articlesappear in platformBIREME, 163 on SCIELO and 21 in CAPES. Asfor the literature review 5 appear at BIREME, 34 on SCIELO and30 in CAPES. As for the intersection of information betweenplatforms, 9 quantitative articles appear on three surveyedplatforms, 26 in two of the sites and 167 in a single platform.No articles of literature review appears in three researchplatforms, 25 appear in two platforms and 40 appears inonly one research platform. The path to finding the itemsindexed platforms is easy, but research by keywords onindexed platforms generate unsatisfactory results.

Conclusion:we found 202 articles quantitative and 65articles on literature review about audiology. Not all publica-tions appear on all platforms surveyed.

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Author Index

AAbreu, Maria Laíza Fernandes

Neves S21, S22, S31, S41D’Agostini, Ayra Renata S66Aguiar, Andréa Gomes de Oliveira S81Aguiar, Renato Ponte Portela S24,

S30, S34Albornoz, Nataly Caroline de

Almeida S37Alcarás, Patrícia Arruda de Souza S63,

S112Aliança, Filipe Stella de S63Almeida, Gleide Viviani Maciel S104,

S110Almeida, José Eduardo Esposito S43,

S50Almeida, Jose Ney Ribeiro de S22Almeida, Júlia da Silva S31, S51, S53Almeida, Leylane Fonseca S76, S105Almeida, Mabel Gonçalves S16, S58Almeida, Mariana Arioza Fernandes S7Almeida, Nicole Martuscelli de S42, S46Almeida, Sheila Tamanini de S49,

S61, S71, S77, S86, S95, S104, S117Almino, Samuel Neiva S23, S42, S46Alves, Ana Claudia S35Alves, Fatima Regina Abreu S42Alves, Rodrigo Betelli S22Andrade, Adriana Neves de S65Andrade, Bruna Mateus Rocha de S15Andrade, João Batista de Oliveira S21Andrade, Nilvano Alves S22Angeli, Roberto Dihl S33Antoneli, Melissa Zattoni S7, S62,

S94Araujo, Carlos Augusto Ferreira de

S46, S53Ávila, Audrei Thayse Viegel de S80Avila, Sharon Maria Soares de

Lima S242, S30, S34Azevedo, Daniel Braz Nunes S1, S5

BBacellar, Amanda Steyer S68Badarane, Erika Baptista Luiz S28,

S32, S52Bak, Roberta S26, S32Baldrighi, Silvia Elaine Zuim de Moraes

S76, S96, S105Ballesteros, Flávia Oliveira S21, S22,

S49, S53Baltha, Barbara Batista S54Baptista, Marta Gonçalves Gimenez

S69Barbosa, Lisiane de Rosa S61, S77,S

S93, S101, S104, S105, S107, S113, S115

Barbosa, Nara Nunes S22Barreiros, Aureliano Carneiro S27, S43Barreiros, Amanda Giglio Eugenio S107,

S118

Barreto, Aline Cabral de Oliveira S71, S77, S89, S116

Barreto, Ikaro Daniel de Carvalho S13Barreto, Larissa Souza S25, S37, S38Barreto, Valéria Maria Prado S51Barros, Camila Lira Holanda de Lima

S23, S42, S46Bartz, Diana Weber S15, S86, S106Basso, Ricardo Alexandre S40Bastos, Hednaldo Jose Marques S21Bastos, Ivana de Rezende S52Batissoco, Ana Carla S4, S6Batista, Bruna Gonçalves S13Batistão, Guilherme Trindade S49Battezini, Ana Carolina Lago S67, S85Bauer, Jeff erson André S20Bauer, Magda Aline S98Behlau, Mara S4, S18, S68, S78,

S90, S98Behrens, Nilce Sanny Costa da Silva S2Beirith, Sarah Cristina S32, S43, S47Bello, Jade Zaccarias S65, S85Benevides, Amanda Oliveira S47Benin, Lílian S114Bento, Ricardo Ferreira S3, S16, S37,

S54, S103Bergamaschi, João Augusto S20, S33Berticelli, Amanda Zanatta S8, S12, S79Bertuol, Bianca S66, S78Biaggio, Eliara Pinto Vieira S66, S78,

S89, S97Binhardi, Vitor Della Rovere S62, S75Birck, Andressa Ortiz S60, S90, S96Birck, Christiane Kulzer S34, S38,

S43, S55Boccalini, Maria Carmela Cundari S46Boechem, Nicolau Tavares S33, S45,

S50, S51Bonfada, Laura S79Bongiolo, Carolina S40Borges, Godofredo Campos S20, S45Boschi, Morgana Moreno S28Brandão, Karen Vitols S20Brandão, Lenisa S8Brendim, Mariana Pinheiro S59Brito, Lara Bonani de Almeida S28Brito, Vanessa Fernandes de S28Bruckmann, Mirtes S10, S66, S84Brunheroto, Thaís S41Bruno, Rúbia Soares S10, S66, S84,

S89, S109Brusco, Thaísa Rodrigues S7, S70Bueno, Claudine Devicari S11, S100

CCabral, Lorraine da Silva S104Cabreira, Aline Faure S114Camargo, Amanda Carvalho Villa de

S27, S34, S40Cambraia, Leticia de Avila S26, S44,

S49

Campos, Bruno Salgado de S34Campos, Letícia Dominguez S2, S81Capone, Flavia S32, S43, S47, S48Cardoso, Ana Claudia Vieira S62, S64,

S75, S83, S90, S96Cardoso, Eliana Freitas S33, S55Cardoso, Gustavo Lima S41Cardoso, Maria Cristina de Almeida

Freitas S61, S76, S88, S104, S105, S106, S109, S110

Cardoso, Maria Julia Ferreira S80Cardoso, Sabrina Vilanova S72, S99,

S100Cargnelutti, Michelle S66Carneiro, Christiano de Giácomo S38Carneiro, Elaine Alves S47Carneiro, Tatiane Costa S84Carvalho, Fernando Rogerio de S1Carvalho, Manayra Lourenzo

Cunha S35, S51Carvalho, Nádia Giulian de S12, S82Carvalho, Rudmila Pereira S67Carvalho, Thiago Bittencourt Ottoni de

S47Cassol, Mauriceia S69, S77, S116,

S118Castan, Andréa Tortosa Marangoni

S72Castanho, Rosicler Moreno S62Castro, Adele Cristina Segala S9, S13Castro, Gabriela Oliveira de S18Castro, Mirian Cabral Moreira de S20,

S40, S50Castro, Samantha Fernandez de S30,

S36, S39, S54Cavalleri, Andressa Côrtes S41Cecílio, Maria Richelle Rufi no S47Cedin, Antonio Carlos S27, S40Cerqueira, Amanda Venuti S90Chalub, Rayanne Pereira S21Chamouton, Carla Salles S69Chiabai, Thais Prett S82, S88, S101Chodraui, José Roberto S33Cibian, Aline Priscila S8, S17, S67Claro, Ana Carolina Iacuzio S71Coelho, Cassio Aguiar S32Coelho, Jacqueline de Mattos S32,

S39, S43, S44, S48, S50Cogo, Lícia Assunção S88, S107Colella-Santos, Maria Francisca S12,

S72, S79, S82Constancio, Sophia Mota S68Coradini, Patricia Pérez S11, S84Corrêa, Camila de Castro S64Corrêa, Luciana Brito S31Coser, Pedro Luis S56Costa, Alex Carvalho S45Costa, Ana Carla Wanderley S50Costa, Bárbara Machado S92, S93,

S102, S103, S113, S115Costa, Cintia Elisa Gonçalves S20, S40

Author Index

Author Index

Costa, Erideise Gurgel da S23Costa, Lidiéli Dalla S66Costa, Lucas Sol da S22, S53Costa, Luciana Fernandes S4Costa, Mariana de Oliveira S70Costa, Priscieli Porto S113Costa, Sady Selaimen da S17, S33Costa Júnior, José Márcio Barcelos

S40Coy, Gustavo Pegos Rodrigues S51Cristoff , Daniela Dranka S6Crosara, Paulo Fernando Tormin

Borges S49Cruz, Karina Arreco Fiorotti S15,

S82Cunha, Alexandre José de Sousa

S31, S36Cunha, Eduarda Oliveira S69, S117Cunha, Fernanda Rodrigues da S40,

S42, S49

DDalmaschio, Maria Eugenia Pedruzzi

S31, S51, S53Dall’Igna, Celso S11, S17, S33,

S60, S75, S87, S97, S108, S114Dall’Igna, Daniela Pernigotti S33Delecrode, Camila Ribas S64, S83,

S90, S96Della Torre, Ana Adelina Giantomassi

S16, S37Destri, Caroline Godois S113, S115Dias, Flavia Vieira S31, S51, S53Dias, Nathalia Tessarolo S24, S30, S34Dias, Norimar Hernandes S5, S35,

S45Didoné, Dayane Domeneghini S8Donadon, Caroline S72, S79Dornelles, Sílvia S7Drummond, Renata Loss S36, S39Duarte, Bruno Bernardo S21Duarte, Caue S25, S37, S38

EElias, Caroline Catherine Lacerda

S33, S45, S50, S51, S55Elias, Thaís Gomes Abrahão S1, S5,

S35Englert, Marina Taborda S98Enoki, Alexandre Minoru S34Esturaro, Giovana S14

FFacchinetti, Antonio Mauricio Lopes

S34Farneze, Sabryna S36Fattore, Isabela de Moraes S68, S87Fávero, Samara Regina S106Felippu Neto, Alexandre S34Feniman, Mariza Ribeiro S10, S64Fernandes, Natalia Martinez S56,

S88, S107

Ferraz, Maria Sarah Tristão S15, S58, S82

Ferreira, Geise Corrêa S74Ferreira, Laís S78, S97Ferreira, Marcelo Henrique S109,

S110Ferreira, Maria Inês Dornelles da

Costa S15, S60, S96Ferreira, Maristela Mian S16, S108Ferreira, Paloma Simoni Gama S23,

S42, S46Figueiredo, Felipe S23, S32Folgearini, Jordana da Silva S10Fonseca, Thiago Chalfun de Matos

S31, S36Fonseca, Vinicius Ribas S1, S2,

S42, S44, S46, S56, S79Foronda, Flavia Andrea Krepel S39Força, Mariana Tótola S32Fornazieri, Marco Aurélio S4Fraga, Bruno Francisco de S77Fraga, Rayane Brum de S87Freitas, Gabriel Santos de S25, S37,

S38Fridman, Débora S35Frizzo, Ana Claudia S65, S108Frota, Milene Lopes S50Frota, Silvana S88Fukushiro, Ana Paula S12, S81

GGalvão, Natália Borges Calmon Du Pin

S14Garcia, Chenia Moreira Blessmann S7Garcia, Michele Vargas S10, S66,

S75, S78, S89, S91, S106, S109, S110, S115

Garcia, Roberta Ismael Dias S40Garrafa, Renata Christofe S37Ghisi, Marcieli S60, S99Giacomelli, Maiara Aparecida Bolotti

S62Giannini, Susana Pimentel Pinto S15,

S118Giglio, Lucia Dantas S111Gigoski, Vanessa Souza S61, S76,

S83, S90, S97, S104, S105Gil, Daniela S65Godoy, Carolina Calsolari Figueiredo

de S65Godoy, Edmary Coutinho de S79Godoy, Maria Dantas Costa Lima S4Gois, Marjana S109Gomes, Erissandra S79, S100, S102Gomes, Thaís Eugênio S34, S38, S55Gonçalves, Andréa Kruger S11, S84Goncalves, Tatiana Maria S5Gonzalez, Mabel Ayme Queliz S20Goulart, Bárbara Niegia Garcia de S60Grawer, Ruth Siqueira S15, S92,

S93, S101, S102, S105, S107

Gregory, Letícia S13, S29, S47, S49, S80

Grinfeld, Artur S29Grotto, Kamila S8Gução, Ana Cláudia Bianco S84, S94Guerrieri, Ana Claudia S68Guidi, Mariana Lombardi S20, S45Guimaraes, Lucas Soares Passos S21,

S22, S29, S31, S41Guimarães, Michelle Ferreira S73,

S101Guimarães, Roberto Eustáquio Santos

S49

HHabib, Nuala Catalina Santos S71Hachiya, Adriana S4, S20, S37, S85Hay, Bruno Amaral S2, S48Hemza, Cláudia Regina de Marchi

Lopes S3, S6Hiramatsu, Fernanda Laiz S7Hernandes, Thaís Bogaz S93Hiroshima, Laís Tamie S25Hoshino, Ana Cristina Hiromi S3Hubner, Luise Stumpf S7Huve, Felipe da Costa S20Hyppolito, Miguel Angelo S3

IImamura, Rui S20, S37, S40Iplinski, Caroline Peschel Alves

Brustolin S23

JJakobi, Paul Joseph S79Jeremias, Érica Gonçalves S24Jesus, Larissa Mayra Rossigali de S96Jesus, Vanessa Menezes de S71Jorge Jr, Jose Jarjura S20, S45Jornada, Amalia Moura S8Jose, Juliana Jannini S13, S91José, Maria Renata S10, S64, S74,

S103

KKalil, Carolina S60Kalil, Maria Theresa Alves da

Cunha S91Kemp, Adriana Aparecida Tahara

S64, S83, S96Kieling, Carla Hernandez S67Knobel, Keila Alessandra Baraldi S58Kopp, Janaina S24, S30, S34Krumenauer, Rita Carolina S39Kurtz, Letícia S65, S85

LLacerda, Adriana Bender Moreira de

S92, S98Lage, Ana Luiza Costa S21, S22, S53Lavinsky, Joel S54Leão, Rodrigo Augusto de Souza S23

Author Index

Leite, Matheus Freitas S21, S22, S29, S31, S41

Lemos, Elza Maria S40Lemos, Isadora de Oliveira S65,

S85, S116Lessa, Alexandre Hundertmarck S11,

S17, S60, S75, S87, S97, S108, S114

Lessa, Marcus Miranda S26, S36, S48 S55

Lima, Clara Monica Figueiredo de S26,S36, S48 S55

Lima, Erica Crislane Omena de S71, S84, S114

Lima, Pablo de Oliveira S33, S45, S50, S51, S55

Limongi, Suelly Cecilia Olivan S10, S14, S18, S73, S82, S111

Linhares, Bárbara das Neves S39Lira-Batista, Marta M S S68, S99Lise, Marina S33Liz, Alcebiades Alves de S27Lopes, Christiane de Sousa S24,

S30, S34Lopes, Elisa da Costa Carvalho

Almeida S31Lopez, Priscila Suman S9, S102Loureiro, Estefane Costa S21, S22,

S49, S53Lourenço, Edmir Américo S44Lubianca Neto, José Faibes S36, S39Luccas, Gabriele Ramos de S12Lucena, Orlando Schuler de S27,

S34, S40Luiz, Cyntia Barbosa Laureano S65Lunardi, Fernanda Alves S27

MMachado, Bruno Leonardo Barbosa

S34, S38, S43Machado, Carla Abranches Duarte

S39, S44, S48, S50Machado, Fernanda Wiltgen S27,

S34, S40Machado, Guilherme Silva S28,

S32, S52Machado, Juliana Altavilla Van Petten

S43Machado, Márcia Salgado S15,

S62, S64, S68, S90, S92, S93, S101, S102

Machado, Rosane Siciliano S26, S38Madeira, Felipe Barbosa S39, S43, S44Maeda, Carlos Augusto Seiji S23Maff ei, Carla S79Magna, Cris S71Maia, Yuri Ferreira S43, S55Mandelbaum, Karina Lezirovitz S3,

S4, S6Mannes, Yara Alves de Moraes do

Amaral S79

Maranho, Laura Schwartz S42, S46, 56

Marao, Antonio Carlos S35Marchand, Daniel Lucas Picanço S95,

S109, S112, S118Marchiori, Ramon S27, S38Marone, Silvio Antonio Monteiro

S21, S35, S51Martinez, Chenia Caldeira S77, S112Martins, Danilo Augusto Nery dos

Passos S27Martins, José Eduardo Faria S51Martins, Quemile Pribs S75, S110,

S115Martins, Regina Helena Garcia S1,

S5, S35, S45Matos, Giselle Goulart de Oliveira

S65, S110Matos, Tatiana Cunha de Carvalho

S41Maturo, Denise Silva S91Medeiros, Andréa Monteiro Correia

S13Meira, Adriano Sergio Freire S34,

S38, S43, S55Melo, Ândrea de S66, S89, S97Melo, Cristiana Vanderlei de S34Melo, Maria Helena de Araujo S1,

S2, S5Melo, Paula Soares de S65Mello, Jayne Guterres de S13, S91,

S106Mello, Jonas S54Mello, Luiza de Souza S26, S38Mello, Marcal Motta S79Mello, Renato Gorga Bandeira de S60Mendes, Daniella Leitao S1, S2, S5,

S23, S31, S32, S36Mendes, Marcia Lourdes Calixto S65Mendonça, Natália Maria Couto

Bem S21, S29Menezes Filho, José Arnaldo Cruz

Bezerra de S48, S50Menzen, Liliane S61, S76, S83,

S90, S97, S104, S105Meotti, Camila Degen S20Merlo, Camila Nogueira S33, S52Mesquita, Loriane Gratão de S17Mesti, Juliana Cristina S42, S46,

S56Mingroni Netto, Regina Célia S6Mistura, Tainã Crestani S30, S54Mitre, Edson Ibrahim S60Miyamura, Fernanda Tan S34Mocellin, Marcos S1, S6Moletta, Luan Amaral S24Mondelli, Maria Fernanda Capoani

S10, S64, S67, S74, S103Montagnoli, Arlindo Neto S4, S85Monteiro, Gabriela Oliveira S38Morais, Aline Albuquerque S70

Moraes, Camila Pereira de S41Moraes, Luiz Felipe Lira de S5, S23,

S31, S32, S36Morales, Douglas Salmazo Rocha S25Moreira, Pablo Alves Auad S27, S40Moreira, Verônica Salazar S102Moreti, Felipe S18, S68, S78Moretti, Claudia Andriguetto

Maoski S11Moriguchi, Emilio S60Mosciati, Eron S33, S52Montovani, Jair Cortez S9, S59,

S87, S102Moura, Rayssa Beatriz Onuki de S108Mourão, David Albuquerque S21,

S22, S49, S53Munaro, Gisiane S33Munhoz, Lenice de Fatima da Silva

S10, S73, S82, S111Murano, Emi Zuiki S4

NNakamura, Helenice Yemi S69Nascimento, Bianca da Silva

Vinagre S26, S36, S48, S55Nascimento, Gicélia Barreto S59Nascimento, Jacqueline Abreu do

S7, S62Nascimento, Rayane Abreu do S58,

S87, S98, S100, S101, 113, S115Negri, Krystal Calmeto S20Neis, Isabela Schroer S9, S59, S68,

S78, S87Nemr, Katia S86Neves, Camila Zander S17, S100Nishino, Lucia Kazuko S7Nizzo, Natashi S26, S38Nogueira, Rafael Toledo Enes S40,

S42, S49Nomura, Michel Balvedi S2, S42Novaes, Beatriz Cavalcanti de Albu-

querque Caiuby S14, S69, S82Novelli, Carolina Veronica Lino S12,

S82Nunes, Emilio Santana Martins

Xavier S47Nunes, Heloisa dos Santos Sobreira

S25, S38Nunes, Janaína de Alencar S82Nunes, Laura Fuchs S15, S101,

S105, S107Nunes, Karolline Estrela Campodonio

S21, S29, S31, S41

OOiticica, Jeanne S3, S4, S6Olchik, Maira Rozenfeld S11, S60,

S72, S84, S99, S100Oliveira, Ariane Barros S62, S75Oliveira, Danielly Solar Andrade

S24, S27, S43, S53Oliveira, Eduardo Boaventura S27

Author Index

Oliveira, Frederico Vieira de S35Oliveira, Gisele Gotardi de S68Oliveira, Lorena Cássia de Carvalho

S47Oliveira, Luísa Bordignon Félix de S44Oliveira, Manuela Athayde S27Oliveira, Priscila Feliciano de S71,

S84, S114, S116Oliveira, Renata Cristina Cordeiro

Diniz S24, S27, S43, S53Oliveira, Taís Rosa de S49Oliveira, Valdéia Vieira de S62Oppitz, Sheila Jacques S66, S89, S109Otavio, Andressa Colares da Costa S75Otto, Danielle Martins S61, S95, S104

PPaiva, Scheila Farias de S75, S80,

S90, S117Pasqual, Isabel Marrach de S25Passos, Karen de Oliveira dos S101,

S107, S113, S115Passos, Priscila Silva S89Pelaquim, Andressa S83Pelissari, Isadora Gonçalves S66,

S88, S109Penteado, Silvio Pires S16, S37,

S54, S103Pereira, Anderson Alves da Silva S74Pereira, Gabriela da Cunha S29, S69Pereira, Liliane Desgualdo S8, S13,

S16, S17, S67, S77, S89, S91, S116Peres, Rafaela de Paula S1, S46Pessin, Adriana Bueno Benito S1,

S5, S45Pessoa, Nathalia Anaissi Rocha S23Pessoa-Almeida, Aline Neves S15, S58Picinini, Taís de Azevedo S108Pinheiro, Alessandra de Oliveira

Brandão S21, S35, S51Pinheiro, Gustavo Bachega S47Pinto, José Antônio S25, S37, S38Pinto, Gabriela Carolina Nazareth S24Pinto, Marcela Maria Rabelo S23Pinto, Paola Morales Salarini S26,

S44, S49Pinto, Patricia Ciminelli Linhares S47Pirana, Sulene S69Pizzi, Nathalia Cuel S93Polanski, José Fernando S1Pompeu, Ana Terra Santos S19,

S107, S118Pontes Junior, Alvaro Vitorino de S34,

S43, S55Prates, Luciele da Silva S9, S56,

S59, S68, S78Del Prato, Gustavo Cittadin S29

QQuevedo, Lenita da Silva S67, S85Quintino, Nelson Jose Barboza S34,

S38, S43, S55

Quinto, Stella Medianeira Soares S66

RRabaioli, Aline Gasparin S109, S110Rabelo, Fabio Augusto Winckler S41Rabelo, Gustavo Figueiredo Nunes S50Rahme, Isabella Marques Pereira

S101, S111, S113Ramirez, Edna Patricia Charry S31,

S51, S53Rangel, Gustavo Guimaraes S24,

S30, S34Rechia, Inaê Costa S66, S89Reginatto, Rafaela Santim S30,

S36, S39, S54Reis, Débora Angélica Lopes S39,

S44, S50Reis, Tercio Guimarães S41Resende, Brunno Fernando Correia

Muniz de S23, S48Resende, Lícia Oliveira S26, S38Rezende, Carlos Eduardo Borges

S24, S28Rezende, Natália Cerqueira S21Reznicek, Priscila Regina S101,

S105, S107Ribas, Angela S11, S104, S110Ribas, Letícia Pacheco S15, S58,

S94, S98, S100, S101, S113Ribeiro, Ana Cláudia Mondini S65Ribeiro, Davi Knoll S25, S37, S38Ribeiro, Georgea Espindola S9,

S59, S87, S102Ribeiro, Thiago Cavalcante S22Ribeiro Filho, Roberto Hyczy S23, S48Ricz, Hilton Marcos Alves S18Ricz, Lílian Neto Aguiar S18, 58, S91Riedel, Ana Carolina Feitosa S25Rimoli, Caroline Fernandes S1Rissio, Stephanie S28Rocha, Ana Clelia de Oliveira S69Rocha, Andressa Vital S67Rocha, Bianca Marques S111Rocha, Carolina Lima Martins Gaspar

S68, S99Rocha, Vanessa Onzi S8, S79Rodrigues, Graziela Ultramari S12, S95Rodrigues, Jonathan Grassi S61, S64Rodrigues, Jussandra Cardoso S52Rodrigues, Katia Alonso S12, S76, S95Rodrigues, Raquel Barbosa S23Rodrigues, Salete Mauricia Mariosa

S29Romano, Nátali S8Rosito, Letícia Petersen Schmidt S11,

S17, S33, S60, S75, S85, S97, S108, S114

Rojas, Gleidy Vannesa Espitia S18, S58Rosa, Milka Botaro S90Rosa, Rafael Fabiano Machado S29,

S47, S49, S63, S86

Rosa, Simone Rennó S35Ruiz, Heliel Tadeu S45

SSaab, Bárbara Maryam Abou S23Saavedra, Pilar Campos S24, S28,

S30, S36, S43, S55Sabbag, José Carlos S92Sacaloski, Marisa S70Saconato, Mariana S12, S76, S95Salgueiro, Alícia G. Noronha Silva S2,

S81Sampaio, Alexandre de Paula S103Sanfi ns, Milaine Dominici S79Sanguebuche, Taissane

Rodrigues S75, S84, S110, S115Sant’Anna, Bruna Santos S58, S94,

S98, S113Santana, Bianca Peres S16Santiago, Hagada Cristiane Coelho

Ferreira S41Santoro, Patricia Paula S40Santos, Ana Júlia Elorza Moraes dos

S33Santos, Arlete Cristina Granizo S51Santos, Beatriz Araujo dos S8, S92Santos, Erica Cristina Campose S31,

S41Santos, Lauanda Barbosa dos S85,

S88Santos, Luana Andrade S69, S117Santos, Lucileide dos S45Santos, Marina de Marchi dos S67,

S74, S103Santos, Nathalia Senra S1, S2, S23,

S32Santos, Rafaela Mabile Ferreira dos

S44Santos, Ruana Souza S69Santos, Telma Dias dos S107, S118Santos, Teresa Maria Momensohn

dos S9, S13, S79, S107, S118Santos, Viviane Fontes dos S73,

S99Santos Filha, Valdete Alves Valentins

dos S9, S56, S59, S68, S78, S87, S88, S107

Santos Junior, Celso Luiz Gonçalves dos S115

Saraiva, Aline Araujo S24, S28, S30, S36, S43, S55

Sarubi, Helena Cunha S24, S27, S43, S53

Sato, Luciene Mayumi S27, S34, S117

Scachetti, Giovana S44Scarmagnani, Rafaeli Higa S2, S81Scherer, Rafael S32Schettini, Isabela Hohlenwerger S24Schiavo, Luciana Portella S81Schwade, Laura Flach S7, S70

Author Index

Schwantes, Alessandra Luana S75, S110, S115

Scoralick, Ana Carolina Dafl on S1, S2, S5, S23, S32

Selaimen, Fabio Andre S17, S20, S33Selorico, Carolina Figueira S33Sequeira, Monique Rolim S60, S96Sgorlon, Tacito Elias S52Silva, Állan Rodrigo Vieira da S68, S87Silva, Avenilda de Azevedo S46, S53Silva, Bárbara Cristiane Sordi S72, S94Silva, Bibiana Fuzer da S12, S63, S86Silva, Clara Rocha da S68Silva, Daianny de Souza S106Silva, Daniela Polo Camargo da S9,

S59, S87, S102Silva, Danielle Sofi a da S22Silva, Débora Durigon da S10, S84Silva, Denise Torreão Corrêa da S73Silva, Gabriela Pereira da S47, 92,

93, S104Silva, Giovanna Cesar S96Silva, Giovanni Vielmond Borges

da S28, 32, S52Silva, Isabella Bonamigo da S62,

S75, S90, S112Silva, Jorge Vicente Lopes da S4 Silva, Juliana Sampaio S3Silva, Kariny Zencke da S47, S58,

S69, S88, S94, S98, S101, S113Silva, Kellyvane Lopes da S68Silva, Lauro Ariel Coelho da S76Silva, Leticia Saia da S65Silva, Lorenna Firmino da S51Silva, Mariana Azevedo S45, S50, S55Silva, Michelle Queiroz Aguiar S22Silva, Talita Lopes S36Silva, Thais Sampaio S26, S36, S48,

S55Silva, Thalisson Francisco Finamor da

S56Silva, Valdirene Jesus da S81Silveira, Arieli Bastos da S78Simen, Raphaella Costa Moreira S31Simões, Joana Carolina Martins S111Simoni, Simone Nicolini de S66, S78Sleifer, Pricila S7, S8 ,S12, S13,

S29, S47, S63, S70, S79, S80, S86, S89, S100, S102

Soares, Caio Marcio Correia S6Soares, Josemar dos Santos S38Soares, Maria Francisca de Paula

S69, S117Soares, Natália Collodetto S48Soccol, Rodrigo André S36, S54Solano, Carolina Aff onso S32, S47Soldera, Cristina Loureiro

Chaves S62, S64, S68, S90, S92, S93, S101, S102

Sonego, Marília Trevisan S59Sotero, Livia Modesto S22

Sousa, Ana Francisca Constantino Ferreira de S8, S102

Sousa, Fabrício Leocadio Rodrigues de S28, S32, S52

Sousa, Maria Inês Lopes de S99Sousa, Marcelo Castro Alves de S40Souza, Adriana Guerta de S7, S62Souza, Alexandra Torres Cordeiro

Lopes de S33, S45, S50, S51, S55Souza, Amália El Hatal de S78, S97Souza, Daniella Neves Marques de S41Souza, Edna Lucia Santos de S26,

S36, S48, S55Souza, Érica Carla Figueiredo de S23,

S42, S46Souza, Gabriella Soares de S23, S42Souza, Maria Cecilia Sodré Ramos de

S39, S44Souza, Natanael Alves de S50Souza, Paula Colvara de S71Souza, Taísa Giannecchini Gonçalves

de S14, S116Souza, Vanessa de Araújo S45,

S50, S51, S55Spazzapan, Evelyn Alves S117Splendor, Letícia S13, S91Stochero, Luciele S30, S54Stroiek, Susan Renata S67Strose, Alex S3Suedam, Ivy Kiemle Trindade S2

TTagliarini, José Vicente S4, S5, S35Taguchi, Bruno Borges S35Tavares, Adriana Xavier S23Tavares, Elaine Lara Mendes S1Tavares, Jessica Ramos S28, S32, S52Tavares, Marcela Estrela S52Teive, Helio Afonso Guizoni S44,

S46, S56Teixeira, Adriane Ribeiro S11, S17,

S60, S75, S84, S87, S97, S98, S99, S108, S114

Teixeira, Alinne Santos S51Teixeira, Emidio Oliveira S24, S27, S53Teixeira, Thais de Sena S60, S96Tenório, Daniel Buarque S22Tenório, Larissa Pinto de Farias S22Tepedino, Miguel Soares S35Tepedino Júnior, Marcelo Mendes S35Terreri, Marco Antonio S23, S48Tinoco, Marina Bandoli de Oliveira

S24, S30, S36, S43, S55Tinoco, Paulo S24, S28, S30, S36,

S43, S55Tinoco, Saulo Bandoli de Oliveira

S24, S28, S30, S36, S43, S55Tomasi, Lidia Lis S71Torres, Danielle de Araujo S32,

S43, S47, S48Torres, Maria Luiza Coelho Pinto S52

Torres, Sandro de Menezes Santos S21, S22, S31

Trindade, Inge Elly Kiemle S2, S5Trindade, Sergio Henrique Kiemle

S4, S5Tsuji, Domingos Hiroshi S4, S20,

S37, S85Tsuji, Robinson Koji S3Tsutsumi, Monike S85Tunes, Roberto Santos S45

VVaiano, Thays S68Vale, Natalia Mello do S31Valente, João Paulo Peral S35Valle, Mila Cruz do S68Valle, Sânzio Tupinambá S24, S53Vasques, Luciana dos Reis S4Veloso, Iury Lima S4, S35Veloso, Lidianne Moreira Sales S22Vellozo, Fernanada Freitas S10,

S75, S110, S115Verde, Flaviana Magalhaes Lima S34Vernier, Luíza Silva S86, S87, S112Viana Junior, Alonço da Cunha S1,

S2, S5, S23, S32, S36Voegels, Richard Louis S4

WWagner, Julianne S29, S58, S90,

S94, S117Walbrohel, Ícaro da Silva S60, S84, S99Weber, Silke Anna Theresa S4, S5

XXerez, Larissa Maria Alencar S51, S53

YYamamoto, André Yassuo

Prappas S24Yamasaki, Rosiane S4Yamashita, Gisela Andrea S23Yamashita, Renata Paciello S81Youssef, Bruna Capalbo S82

ZZahr, Laura dos Santos Abon S58,3

S94, S98, S113Zalcman, Tatiane Eisencraft S70Zambon, Fabiana Copelli S18, S68, S78Zambrana, Évelyn Saiter S40Zanatta, Daniela Bertolini S4Zane, Valéria Cristina S62Zarro, Lucas Sieburger S24, S28,

S30, S36, S43, S55Zdanowski, Rafael S39, S44Zeigelboim, Bianca Simone S44,

S46, S56Zen, Paulo Ricardo Gazzola S29,

S47, S49, S63, S86Zuma e Maia, Francisco Carlos S7,

S70

PRELIMINARY SCHEDULE OF COURSES 2ND SEMESTER 2015SET UP AND MAKE YOUR ENTRY

AUGUST DATE LOCATION13TH STOMATOLOGY JOURNEY 28/29 SP

IX PRACTICAL COURSE OF ELETRONISTAGMOGRAFY 31 AUGUST AND 01/02 SEPTEMBER SP

SEPTEMBER DATE LOCATION

XII COURSE OF SWALLOWING DISORDERS AND LARYNGOPHARYNGEAL REFLUX - THEORY AND PRACTICE (HANDS ON) 03/04 SP

VI POLYSOMNOGRAPHIC REPORT INTERPRETATION COURSE 09 SP

XVII COURSE ON SNORING AND OBSTRUCTIVE SLEEP APNEA – THEORY, LIVE CLINIC AND LIVE SURGERY 10/11 SP

OTOMASTER (ENT RECYCLIN COURSE) 14/21 ONLINE

II MULTICENTER COCHLEAR IMPLANT COURSE – AUDIOLOGIST MODULE 24/25/26 PR

INTERNATIONAL WORKSHOP ON HEARING AID VERIFICATION 25/26 SP

ENDOSCOPY COURSE FOR OTOLARYNGOLOGISTS - THEORY AND PRACTICE - PART I AND II 30 SEPTEMBER / 01 AND 02 OCTOBER SP

OCTOBER DATE LOCATIONXII COURSE FOR SPEECH PATOLOGY IN COCHLEAR IMPLANT 02/03 SP

OTOMASTER (ENT RECYCLIN COURSE) 05/19/26 ONLINE

IV NOSE - LIVE ENDOSCOPIC ENDONASAL SURGERY COURSE 07/08 SP

26TH BIG EAR 26/27/28 SP

LARYNGEAL MICROSURGERY COURSE WITH DISSECTION – THEORY AND PRACTICE 21/22/23 SP

2ND ADVANCED DISSECTION COURSE IN OTOLARYNGOLOGY - RINOLOGY 27/28 SP

2ND ADVANCED DISSECTION COURSE IN OTOLARYNGOLOGY - OTOLOGY 28/29/30 SP

NOVEMBER DATE LOCATIONVI BROADCASTED COURSE IN RADIOLOGY IN OTORHINOLARYNGOLOGY 03/04/05/06 ONLINE

OTOMASTER (ENT RECYCLIN COURSE) 09/16/23/30 ONLINE

2ND ADVANCED DISSECTION COURSE IN OTOLARYNGOLOGY - PLASTIC 10/11/12 SP

2ND ADVANCED DISSECTION COURSE IN OTOLARYNGOLOGY - LARINGOLOGY 12/13 SP

V MEETING OF COCHLEAR IMPLANT TEAM OF HCFMUSP WITH PARENTS OF CHILDREN WITH HEARING LOSS 14 SP

109TH TEMPORAL BONE DISSECTION COURSE 30 NOVEMBER / 01 AND 02 DECEMBER SP

DECEMBER DATE LOCATION95TH ENDOSCOPIC SINUS SURGERY COURSE - HANDS ON - BAHIA 03/04/05 BA

OTOMASTER (ENT RECYCLIN COURSE) 07/14 ONLINE

1ST LARYNGEAL MICROANATOMY AND ENDOSCOPY COURSE 11/12 POA

COURSE BLEPHAROPLASTY AND FOREHEAD REJUVENATION SURGERY - HANDS ON 11/12 SP

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YEARS

YEARS

Cursos FORl 2015 ingles - versao 3.indd 1 27/07/2015 09:12:45

22

COURSE COORDINATORS:

Prof. Ricardo F. Bento

Prof. Alfredo Luiz Jacomo

PROMOTION

advanced dissection course in otolaryngology

nd

INDIVIDUAL DISSECTION IN FRESH SPECIMENS (NON-FORMOLIZED), COMPLETELY HANDS-ON

N O W I N

B R A Z I L

Q U A L I T Y O F

F M U S P

AND FORL

WITH THE

ATTENDANCE

LIMITED TO

16 PARTICIPANTS

PER MODULEOUTSTANDING

DISSECTION

COURSE IN FRESH SPECIMENS

ADVANCED ENDOSCOPIC SINUS SURGERYRichard Voegels

FACIAL PLASTIC SURGERY Carlos Alberto Caropreso

SNORING AND SLEEP APNEA SURGERY

Luiz Ubirajara Sennes

OTOLOGIC AND NEUROTOLOGIC SURGERY

Ricardo F. Bento and Rubens Brito

2 7 . O C T. 2 0 1 5TO 30.OCT.2015

1 0 . N OV. 2 0 1 5TO 13.NOV.2015

MODULE I AND II

MODULE III AND IV

SAVETHE

DATE

nd

MODULE IVMODULE IIIMODULE IIMODULE I

OTOLARYNGOLOGY

0

5

25

75

95

100

Anúncio Save The Date (revistas arquivos).pdf 1 24/07/2015 10:29:44

Rio de Janeiro • New York • StuttgartThieme Publicações Ltda, Av. Nilo Peçanha, 50, sala 2508, Rio de Janeiro 20020-906, Brazil

Oral PresentationsS1 Otorhinolaryngology August 13, 2015, 8am to 12:15pm Room: Havana and Anfi teatro da Oftalmologia - ICHC

S7 Speech, Language and Hearing Sciences August 13, 2015, 1:45pm to 6:00pm August 14, 2015, 8:00am to 3:00pm Room: Havana

E-PostersS20 Otorhinolaryngology

S58 Speech, Language and Hearing Sciences Date: August 13 to August 15, 2015 Room: Exhibition Area Time: 8am to 6pm

S-iii Author Index

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