DOI: 10.1371/journal.pgen.1005094
ISSN: 1553-7404
Citações Scopus: 36
Citações ISI: 35
Fator de Impacto JCR: 5.917
Qualis: A1
Abstract: In the United States, roughly 10% of the population is exposed daily to hazardous levels of noise in the workplace. Twin studies estimate heritability for noise-induced hearing loss (NIHL) of approximately 36%, and strain specific variation in sensitivity has been demonstrated in mice. Based upon the difficulties inherent to the study of NIHL in humans, we have turned to the study of this complex trait in mice. We exposed 5 week-old mice from the Hybrid Mouse Diversity Panel (HMDP) to a 10 kHz octave band noise at 108 dB for 2 hours and assessed the permanent threshold shift 2 weeks post exposure using frequency specific stimuli. These data were then used in a genome-wide association study (GWAS) using the Efficient Mixed Model Analysis (EMMA) to control for population structure. In this manuscript we describe our GWAS, with an emphasis on a significant peak for susceptibility to NIHL on chromosome 17 within a haplotype block containing NADPH oxidase-3 (Nox3). Our peak was detected after an 8 kHz tone burst stimulus. Nox3 mutants and heterozygotes were then tested to validate our GWAS. The mutants and heterozygotes demonstrated a greater susceptibility to NIHL specifically at 8 kHz both on measures of distortion product otoacoustic emissions (DPOAE) and on auditory brainstem response (ABR). We demonstrate that this sensitivity resides within the synaptic ribbons of the cochlea in the mutant animals specifically at 8 kHz. Our work is the first GWAS for NIHL in mice and elucidates the power of our approach to identify tonotopic genetic susceptibility to NIHL.

DOI: 10.1534/g3.116.032516
ISSN: 2160-1836
Citações Scopus: 13
Citações ISI: 14
Fator de Impacto JCR: 3.154
Qualis: A2
Abstract: The discovery of environmentally specific genetic effects is crucial to the understanding of complex traits, such as susceptibility to noise-induced hearing loss (NIHL). We describe the first genome-wide association study (GWAS) for NIHL in a large and well-characterized population of inbred mouse strains, known as the Hybrid Mouse Diversity Panel (HMDP). We recorded auditory brainstem response (ABR) thresholds both pre and post 2-hr exposure to 10-kHz octave band noise at 108 dB sound pressure level in 5-6-wk-old female mice from the HMDP (4-5 mice/strain). From the observation that NIHL susceptibility varied among the strains, we performed a GWAS with correction for population structure and mapped a locus on chromosome 6 that was statistically significantly associated with two adjacent frequencies. We then used a “genetical genomics” approach that included the analysis of cochlear eQTLs to identify candidate genes within the GWAS QTL. In order to validate the gene-by-environment interaction, we compared the effects of the postnoise exposure locus with that from the same unexposed strains. The most significant SNP at chromosome 6 (rs37517079) was associated with noise susceptibility but was not significant at the same frequencies in our unexposed study. These findings demonstrate that the genetic architecture of NIHL is distinct from that of unexposed hearing levels and provide strong evidence for gene-by-environment interactions in NIHL.

DOI: 10.1097/MAO.0000000000000859
ISSN: 1531-7129
Citações Scopus: 2
Citações ISI: 1
Fator de Impacto JCR: 2.311
Qualis: B1
Abstract: Plasmacytoma, a non-Hodgkin’s lymphoma, arises from a monoclonal proliferation of plasma cells. Solitary extraosseous (extramedullary) plasmacytomas (SEPs) represent 4% of plasma cell neoplasms (1). Between 80% and 90% of SEPs localize to the upper respiratory tract and may involve cervical lymph nodes in ~15% of cases (2). Isolated SEPs showing dural infiltration may mimic meningioma because of their similar appearance on magnetic resonance imaging (MRI) (3). Given that the MRI findings of intracranial plasmacytoma are not specific, final diagnosis is confirmed by histopathologic examination. We report a case of SEP in a patient with a cerebellopontine angle (CPA) mass originally thought to be a meningioma.

DOI: 10.1097/MAO.0b013e3182976f5f
ISSN: 1531-7129
Citações Scopus: 3
Citações ISI: 2
Fator de Impacto JCR: 2.311
Qualis: B1
Abstract: Objective: To compare the degree of sensorineural hearing loss in patients with Ménière’s disease (MD) with and without hyperinsulinism by different methods of assessment. Study design: Historical cohort study. Setting: Ménière’s Disease Care and Research Clinics of Hospital de Clínicas de Porto Alegre, a tertiary care university hospital in Southern Brazil. Patients: Patients with a definite diagnosis of MD based on the American Academy of Otolaryngology-Head and Neck Surgery (AAO-HNS) guidelines. Intervention: Patients were assessed by glucose overload tests (5-h glucose and insulin curves) and under baseline physiological conditions (Homeostasis Model Assessment/Insulin Resistance [HOMA-IR], Quantitative Insulin Sensitivity Check Index [QUICKI], and glucose/insulin ratio). These patients underwent annual pure-tone audiometry and were analyzed using 4-tone average (FTA), that is, arithmetic mean of 500, 1,000, 2,000, and 3,000 Hz, during the third, fourth, and fifth years of disease progression. Main outcome measure: Hearing loss assessed by FTA and classified in Stages I to IV (AAO-HNS). Results: Forty-nine (76.6%) patients were defined as hyperinsulinemic and 15 (23.4%) as normoinsulinemic. Impairment on FTA was higher in the hyperinsulinemic group (52.04 ± 17.5 versus 39.75 ± 9.20, p = 0.027) when assessed by the 5-hour insulin curve. Hyperinsulinemic subjects were 3.5 times more likely to develop hearing damage greater than 40 dB (i.e., Stages III and IV) than normoinsulinemic subjects (OR = 3.52; 95% CI, 1.05-11.76). A moderate correlation between the insulin curve and the HOMA-IR was found (r = 0.524, p = 0.001). Conclusion: Hyperinsulinism in MD is associated with greater clinical hearing damage.

DOI: 10.1016/j.bjorl.2020.04.002
ISSN: 1808-8694
Citações Scopus: 18
Citações ISI: 12
Fator de Impacto JCR: 1.811
Qualis: B2
Introduction: We are facing a pandemic with a great impact worldwide, as a result of the rapid spread of the novel coronavirus (COVID-19). The medical community is still getting to know behavior of this virus and the consequences from a population point of view. All this knowledge is extremely dynamic, so some behaviors are still not well established. Otorhinolaryngologists have a central role in the management of this situation, in which they must assess the patient, avoid contamination to and by health professionals and other patients. Thus, the recommendations of the Brazilian Association of Otorhinolaryngology and Cervical-Facial Surgery (ABORL-CCF) have the main objective of reducing the spread of the new coronavirus during otorhinolaryngological care and assisting in the management of these patients. Methods: Review of the main recommendations of national and international scientific societies, decisions by government agencies and class councils. The topics will be related to the general aspects of COVID-19, personal protective equipment, care in patient assistance, endoscopic exam routines and the management of sinonasal, otological and pediatric evaluations related to COVID-19. Results: The use of personal protective equipment is considered crucial in routine ENT care. We recommend postponing appointments, exams and elective surgeries to reduce the spread of COVID-19. Similarly, we recommend changing routines in several areas of otolaryngology. Additionally, guidance is provided on the use of telemedicine resources during the pandemic period.
Conclusions: We are still at the beginning of the COVID-19 pandemic and scientific evidence is still scarce and incomplete, so these ABORL-CCF recommendations for otorhinolaryngologists may be updated based on new knowledge and the pattern of the new coronavirus spread.
Keywords: Coronaviruses; Coronavírus; Doença ORL; ENT disease; Otolaryngologist; Otorrinolaringologista.

DOI: 10.1159/000514143
ISSN: 1420-3030
Citações ISI: 0
Fator de Impacto JCR: 1.854
Qualis: B2
Background: Although several candidate-gene association studies have been conducted to investigate noise-induced hearing loss (NIHL) in humans, most are underpowered, unreplicated, and account for only a fraction of the genetic risk. Mouse genome-wide association studies (GWASs) have revolutionized the field of genetics and have led to the discovery of hundreds of genes involved in complex traits. The hybrid mouse diversity panel (HMDP) is a collection of classic inbred and recombinant inbred strains whose genomes have been either genotyped at high resolution or sequenced. To further investigate the genetics of NIHL, we report the first GWAS based on distortion product otoacoustic emission (DPOAE) measurements and the HMDP. Methods: A total of 102 strains (n = 635) from the HMDP were evaluated based on DPOAE suprathreshold amplitudes before and after noise exposure. DPOAE amplitude variation was set at 60 and 70 dB SPL of the primary tones for each frequency separately (8, 11.3, 16, 22.6, and 32 kHz). These values provided an indirect assessment of outer hair cell integrity. Six-week-old mice were exposed for 2 h to 10 kHz octave-band noise at 108 dB SPL. To perform local expression quantitative trait locus (eQTL) analysis, gene expression microarray profiles were generated using cochlear RNA from 64 hybrid mouse strains (n = 3 arrays per strain). Results: Several new loci were identified and positional candidate-genes associated with NIHL were prioritized, especially after noise exposure (1 locus at baseline and 5 loci after exposure). A total of 35 candidate genes in these 6 loci were identified with at least 1 probe whose expression was regulated by a significant cis-eQTL in the cochlea. After careful analysis of the candidate genes based on cochlear gene expression, 2 candidate genes were prioritized: Eya1 (baseline) and Efr3a (post-exposure). Discussion and conclusion: For the first time, an association analysis with correction for population structure was used to map several loci for hearing traits in inbred strains of mice based on DPOAE suprathreshold amplitudes before and after noise exposure. Our results identified a number of novel loci and candidate genes for susceptibility to NIHL, especially the Eya1 and Efr3a genes. Our findings validate the power of the HMDP for detecting NIHL susceptibility genes. Keywords: Animal models; Distortion product otoacoustic emission; Genome-wide association study; Noise; Noise-induced hearing loss.

DOI: 10.1159/000471840
ISSN: 1420-3030
Citações Scopus: 5
Citaçõe ISI: 5
Fator de Impacto JCR: 1.854
Qualis: B2
Abstract: Objective: The aim of this work was to describe the dimensions of the crista fenestra and determine its presence by means of high-resolution computed tomography (CT) for the purpose of cochlear implantation via the round window approach. Methods: A series of 10 adult human temporal bones underwent high-resolution CT scanning and were further dissected for microscopic study of the round window niche. Results: In all of the specimens, the round window membrane was fully visualized after the complete removal of bony overhangs. The crista fenestra was identified as a sharp bony crest located in the anterior and inferior borders of the niche; its area ranged from 0.28 to 0.80 mm2 (mean 0.51 ± 0.18). The proportion of the area occupied by the crista fenestra in the whole circumference of the round window ranged from 23 to 50% (mean 36%). We found a moderate positive correlation between the area of the niche and the dimensions of the crista fenestra (Spearman rho: 0.491). In every case, high-resolution CT scanning was unable to determine the presence of the crista fenestra. Conclusion: The crista fenestra occupies a variable but expressive area within the bony round window niche. Narrower round window niches tended to house smaller crests. The presence of the crista fenestra is an important obstacle to adequate access to the scala tympani. Nevertheless, a high-resolution CT scan provides no additional preoperative information with regard to its presence for the purpose of surgical access to the scala tympani via the round window niche. Keywords: Cochlear implant; Crista fenestra; Round window.

DOI: 10.1007/s10162-016-0578-4
ISSN: 1525-3961
Citações Scopus: 1
Citações ISI: 1
Fator de Impacto JCR: 3.057
Qualis: A2
Abstract: This study aimed to investigate the genetic causes of vestibular dysfunction. We used vestibular sensory-evoked potentials (VsEPs) to characterize the vestibular function of 35 inbred mouse strains selected from the Hybrid Mouse Diversity Panel and demonstrated strain-dependent phenotypic variation in vestibular function. Using these phenotypic data, we performed the first genome-wide association study controlling for population structure that has revealed two highly suggestive loci, one of which lies within a haplotype block containing five genes (Stard6, 4930503L19Rik, Poli, Mbd2, Dcc) on Chr. 18 (peak SNP rs29632020), one gene, deleted in colorectal carcinoma (Dcc) has a well-established role in nervous system development. An in-depth analysis of Dcc-deficient mice demonstrated elevation in mean VsEP threshold for Dcc (+/-) mice (-11.86 dB) compared to wild-type (-9.68 dB) littermates. Synaptic ribbon studies revealed Dcc (-/-) (P0) and Dcc (+/-) (6-week-old) mice showed lower density of the presynaptic marker (CtBP2) as compared to wild-type controls. Vestibular ganglion cell counts of Dcc (-/-) (P0) was lower than controls. Whole-mount preparations showed abnormal innervation of the utricle, saccule, and crista ampullaris at E14.5, E16.5, and E18.5. Postnatal studies were limited by the perinatal lethality in Dcc (-/-) mice. Expression analyses using in situ hybridization and immunohistochemistry showed Dcc expression in the mouse vestibular ganglion (E15.5), and utricle and crista ampullaris (6-week-old), respectively. In summary, we report the first GWAS for vestibular functional variation in inbred mice and provide evidence for the role of Dcc in the normal innervation of the peripheral vestibular system. Keywords: Hybrid Mouse Diversity Panel; axonal migration; crista; deleted in colorectal carcinoma (Dcc); genome-wide association study; utricle; vestibular ganglia; vestibular sensory evoked potential; vestibular system.

DOI: 10.1016/j.heares.2015.12.006
ISSN: 0378-5955
Citações Scopus: 13
Citações ISI: 13
Fator de Impacto JCR: 3.208
Qualis: A2
Abstract: A cornerstone technique in the study of hearing is the Auditory Brainstem Response (ABR), an electrophysiologic technique that can be used as a quantitative measure of hearing function. Previous studies have published databases of baseline ABR thresholds for mouse strains, providing a valuable resource for the study of baseline hearing function and genetic mapping of hearing traits in mice. In this study, we further expand upon the existing literature by characterizing the baseline ABR characteristics of 100 inbred mouse strains, 47 of which are newly characterized for hearing function. We identify several distinct patterns of baseline hearing deficits and provide potential avenues for further investigation. Additionally, we characterize the sensitivity of the same 100 strains to noise exposure using permanent thresholds shifts, identifying several distinct patterns of noise-sensitivity. The resulting data provides a new resource for studying hearing loss and noise-sensitivity in mice. Keywords: Hearing loss; Inbred strain; Mouse; Noise.

DOI: 10.1055/s-0037-1608654
SSN: 2193-6331
Citações Scopus: 4
Citações: ISI: 4
Fator de Impacto JCR: 1.826
Qualis: B2
Abstract: Objectives To review a surgical series of petroclival meningiomas and the factors considered in the choice of approach. Design Retrospective review. Setting The study was conducted in a university hospital in southern Brazil. Participants Twenty-two patients with petroclival meningioma originating from the upper two-thirds of the clivus medial to the fifth cranial nerve. Main Outcome Measures Gross-total resection, mortality, major morbidity, new cranial nerve deficits and tumor progression or recurrence. Results Retrosigmoid approach was used in tumors <3 cm and in those at or below the internal auditory meatus. Posterior petrosectomy was performed for tumors extending into the middle fossa. Gross-total resection was performed in 11 patients (50%). The mean follow-up time was 32 months (6-75 months). There were four cases of tumor progression or recurrence, which were treated with radiosurgery. Conclusions Resection of petroclival meningiomas remains challenging. In most cases, the retrosigmoid approach was sufficient, without affecting the degree of tumor resection. Petrosal approaches were reserved for patients with tumor extension into the middle fossa. Keywords: brain tumor; clivus; meningioma; petroclival; skull base.

DOI: 10.1534/g3.115.021592
ISSN: 2160-1836
Citações Scopus: 7
Citações ISI: 10
Fator de Impacto JCR: 3.154
Qualis: A2
Abstract: Genome-wide association studies (GWAS) have been successfully applied in humans for the study of many complex phenotypes. However, identification of the genetic determinants of hearing in adults has been hampered, in part, by the relative inability to control for environmental factors that might affect hearing throughout the lifetime, as well as a large degree of phenotypic heterogeneity. These and other factors have limited the number of large-scale studies performed in humans that have identified candidate genes that contribute to the etiology of this complex trait. To address these limitations, we performed a GWAS analysis using a set of inbred mouse strains from the Hybrid Mouse Diversity Panel. Among 99 strains characterized, we observed approximately two-fold to five-fold variation in hearing at six different frequencies, which are differentiated biologically from each other by the location in the cochlea where each frequency is registered. Among all frequencies tested, we identified a total of nine significant loci, several of which contained promising candidate genes for follow-up study. Taken together, our results indicate the existence of both genes that affect global cochlear function, as well as anatomical- and frequency-specific genes, and further demonstrate the complex nature of mammalian hearing variation. Keywords: ABR; Hybrid Mouse Diversity Panel (HMDP); cochlear function; genetics; genome-wide association study (GWAS); genomics; hearing.

DOI: 10.1016/j.amjoto.2015.02.001
ISSN: 0196-0709
Citações Scopus: 1
Citações ISI: 1
Fator de Impacto JCR: 1.808
Qualis: B2
Abstract: Vestibular schwannoma and superior semicircular canal dehiscence are both uncommon entities, especially when present in the same ear. Here we illustrate how both of these pathologies can be repaired through the same surgical exposure, of the middle cranial fossa, with complete preservation of the cochlear nerve function and relief of symptoms caused by canal dehiscence.

DOI: 10.1016/j.otohns.2007.04.004
ISSN: 0194-5998
Citações Scopus: 19
Citações ISI: 19
Fator de Impacto JCR: 3.497
Qualis: A2
Abstract: Objective: Evaluate the hypopharyngeal packing effectiveness on prevention of postoperative nausea and vomiting (PONV) in nasal surgery. Study design and setting: A randomized clinical trial was conducted from July 2004 to October 2005. The intervention group was submitted to hypopharyngeal packing after orotracheal tube placement. The control group had no hypopharyngeal packing. Occurrence of nausea, vomiting, use of antiemetic drugs, and throat pain were checked blindly on recovery period. Results: One hundred forty-four patients were included in the study. There was no difference related to postoperative nausea (RR 1.34; CI 0.72-2.48), vomiting (RR 0.52; CI 0.19-1.47), use of antiemetic drugs (RR 1.54; CI 0.80-2.95), and throat pain (RR 0.91; 0.62-1.34) between both groups. A beta error could not be excluded. Conclusion: Results suggest there is no benefit in hypopharyngeal packing on PONV prevention in nasal surgery. New studies with a greater number of patients should be carried out in order to confirm these results.

DOI: 10.1590/S1808-86942012000200018
ISSN: 1808-8694
Citações Scopus: 7
Citações ISI: 7
Fator de Impacto JCR: 1.811
Qualis: B2
Abstract: The combined approach technique (CAT) is a variation of the classical the mastoidectomy-posterior tympanotomy technique (MPTA) that combines a transcanal approach to cochleostomy with a reduced posterior tympanotomy for insertion of electrodes. Aim: To compare and evaluate long-term safety and effectiveness outcomes obtained with the CAT and with MPTA approach in patients submitted to cochlear implant (CI) surgery. Design: series study. Methods: Patients who underwent CI using CAT or MPTA at a Brazilian center were followed in a cohort study. Main outcomes were complications, audiometric performance and radiological evaluation of electrode position. Results: Fourty-four patients were implanted using CAT and 31 MPTA. There were no cases of facial nerve paralysis, mastoiditis, cholesteatoma or cerebrospinal fluid leaks after 3.4±1.0 years. Radiological evaluation of electrode position revealed that the median number of electrodes outside the cochlea was 0 in CAT and 3 in MPTA groups (p < 0.001). There were no differences between both surgical approaches in terms of mean pure-tone thresholds with CI at all frequencies. Conclusion: Long-term follow-up data showed that the transcanal route to cochleostomy, combined with a reduced posterior tympanotomy, is a safe alternative approach in cochlear implant surgery, with no related major complications and fewer cases of electrode migration when compared with the MPTA. These findings encourage the use of the transcanal route to cochleostomy as an alternative approach option.

DOI: 10.5935/1808-8694.20120045
ISSN: 1808-8694
Citações Scopus: 5
Citações ISI: 7
Fator de Impacto JCR: 1.811
Qualis: B2
Introduction: Susac syndrome (SS) is a rare and potentially devastating disease, consisting of a triad of encephalopathy, visual defects and hearing loss, resulting from microan-giopathy of the brain, retina and cochlea. Otolaryngologists should be familiar with Susac syndrome, since hearing loss may be the initial presenting symptom. Sensorioneural Hearing loss (SNHL) in SS usually affects low and middle frequencies suggesting that this manifestation is caused mainly by microinfarcts in the apical cochlea. Although the classical triad is pathognomonic of Susac syndrome, a high index of suspicion is necessary in the majority of cases, since most patients do not present with the complete triad at the time of onset of symptoms1, 2.
Magnetic resonance imaging (MRI) is very useful in the diagnosis of SS indicating multiple small foci of increased signal intensity in T2 in both gray and white matter. Currently, there is no therapeutic algorithm for SS2. Thus, treatment is empirical, but there is a certainty: early treatment, even empirical, may reduce permanent sequelae1.Unfortunately, there are few reports in the literature about cochlear implantation (CI) in population. The current paper describes clinical outcomes of CI in a SS patient presenting with SNHL.

DOI: 10.1055/s-0039-1688840
ISSN: 1809-9777
Citações Scopus: 1
Citações ISI: 1
Fator de Impacto (SJR): 1.345
Qualis: B2
Abstract: Introduction The prevalence of tinnitus is higher in individuals with temporomandibular joint disorder (TMD) than in the general population. Magnetic resonance imaging (MRI) of the temporomandibular joint (TMJ) is the method of choice for investigation, and it has been hypothesized that specific MRI findings might be observed in TMD with comorbid tinnitus. Objective To comparatively describe MRI findings in patients with TMD with and without tinnitus, identifying the most common TMJ alterations and determining whether a correlation exists between severity of TMD and tinnitus. Methods A cross-sectional study of 53 adult patients with bilateral or unilateral TMD (30 with and 23 without tinnitus). The association between tinnitus and morphological aspects of TMD (changes in condylar morphology, articular eminence morphology, and disc morphology), disc displacement (with/without reduction), condylar translation, and intra-articular effusion was analyzed on MRI images. Results The mean patient age was 46.12 ± 16.1 years. Disc displacement was the most common finding in both groups (24 patients with tinnitus versus 15 without; p = 0.043). Only the frequency of disc displacement with reduction was significantly different between groups. Conclusion Additional imaging techniques should be explored to detect specific aspects of the relationship between tinnitus and TMD. Keywords: magnetic resonance imaging; temporomandibular joint; temporomandibular joint disorders; tinnitus.

DOI: 10.1016/j.bjorl.2020.05.001
ISSN: 1808-8694
Citações Scopus: 28
Citações ISI: 20
Fator de Impacto JCR: 1.811
Qualis: B2
Introduction: Sudden olfactory dysfunction is a new symptom related to COVID-19, with little data on its duration or recovery rate. Objective: To characterize patients with sudden olfactory dysfunction during the COVID-19 pandemic, especially their recovery data. Methods: An online survey was conducted by the Brazilian Society of Otorhinolaryngology and Cervico-Facial Surgery, and Brazilian Academy of Rhinology, including doctors who assessed sudden olfactory dysfunction patients starting after February 1st, 2020. Participants were posteriorly asked by e-mail to verify data on the recovery of sudden olfactory loss and test for COVID-19 at the end of the data collection period. Results: 253 sudden olfactory dysfunction patients were included, of which 59.1% were females with median age of 36 years, with a median follow-up period of 31 days. 183 patients (72.3%) had been tested for COVID-19, and of those 145 (79.2%) tested positive. Patients that tested positive for COVID-19 more frequently showed non-specific inflammatory symptoms (89.7% vs. 73.7%; p=0.02), a lower rate of total recovery of sudden olfactory dysfunction (52.6% vs. 70.3%; p=0.05) and a longer duration to achieve total recovery (15 days vs. 10 days; p=0.0006) than the ones who tested negative for COVID-19. Considering only positive-COVID-19 patients, individuals with sudden hyposmia completely recovered more often than the ones with sudden anosmia (68.4% vs. 50.0%; p=0.04). Conclusion: Positive-COVID-19 patients with sudden olfactory dysfunction showed lower total recovery rate and longer duration than negative-COVID-19 patients. Additionally, total recovery was seen more frequently in positive-COVID-19 patients with sudden hyposmia than the ones with sudden anosmia. Keywords: Anosmia; COVID-19; Olfactory disorders; Transtornos do olfato.

DOI: 10.1002/ccr3.3273
ISSN: 2050-0904
Citações Scopus: 0
Fator de Impacto SJR: 0.21
Qualis: B3
Bezold’s abscess is a rare complication of acute otitis media, but it should be recognized and aggressively treated. Otolaryngologists must be aware of this diagnosis, and multidisciplinary care should be provided as soon as possible. Keywords: Acute otitis media; Bezold’s abscess; Necrotizing fasciitis.

DOI: 10.1016/j.bjorl.2019.11.002
ISSN: 1808-8694
Citações Scopus: 0
Fator de Impacto JCR: 1.811
Qualis: B2
Introduction: Neurotology is a rapidly expanding field of knowledge. The study of the vestibular system has advanced so much that even basic definitions, such as the meaning of vestibular symptoms, have only recently been standardized. Objective: To present a review of the main subjects of neurotology, including concepts, diagnosis and treatment of Neurotology, defining current scientific evidence to facilitate decision-making and to point out the most evidence-lacking areas to stimulate further new research. Methods: This text is the result of the I Brazilian Forum of Neurotology, which brought together the foremost Brazilian researchers in this area for a literature review. In all, there will be three review papers to be published. This first review will address definitions and therapies, the second one will address diagnostic tools, and the third will define the main diseases diagnoses. Each author performed a bibliographic search in the LILACS, SciELO, PubMed and MEDLINE databases on a given subject. The text was then submitted to the other Forum participants for a period of 30 days for analysis. A special chapter, on the definition of vestibular symptoms, was translated by an official translation service, and equally submitted to the other stages of the process. There was then a in-person meeting in which all the texts were orally presented, and there was a discussion among the participants to define a consensual text for each chapter. The consensual texts were then submitted to a final review by four professors of neurotology disciplines from three Brazilian universities and finally concluded. Based on the full text, available on the website of the Brazilian Association of Otorhinolaryngology and Cervical-Facial Surgery, this summary version was written as a review article. Result: The text presents the official translation into Portuguese of the definition of vestibular symptoms proposed by the Bárány Society and brings together the main scientific evidence for each of the main existing therapies for neurotological diseases. Conclusion: This text rationally grouped the main topics of knowledge regarding the definitions and therapies of Neurotology, allowing the reader a broad view of the approach of neurotological patients based on scientific evidence and national experience, which should assist them in clinical decision-making, and show the most evidence-lacking topics to stimulate further study. Keywords: Dizziness; Neurotology; Otoneurologia; Tontura; Vertigem; Vertigo.

DOI: 10.1007/s10162-020-00762-3
ISSN: 1525-3961
Citações Scopus: 0
Citações ISI: 1
Fator de Impacto JCR: 3.057
Qualis: A2
This is the first genome-wide association study with the Hybrid Mouse Diversity Panel (HDMP) to define the genetic landscape of the variation in the suprathreshold wave 1 amplitude of the auditory brainstem response (ABR) both pre- and post-noise exposure. This measure is correlated with the density of the auditory neurons (AN) and/or the compliment of synaptic ribbons within the inner hair cells of the mouse cochlea. We analyzed suprathreshold ABR for 635 mice from 102 HMDP strains pre- and post-noise exposure (108 dB 10 kHz octave band noise exposure for 2 h) using auditory brainstem response (ABR) wave 1 suprathreshold amplitudes as part of a large survey (Myint et al., Hear Res 332:113-120, 2016). Genome-wide significance levels for pre- and post-exposure wave 1 amplitude across the HMDP were performed using FaST-LMM. Synaptic ribbon counts (Ctbp2 and mGluR2) were analyzed for the extreme strains within the HMDP. ABR wave 1 amplitude varied across all strains of the HMDP with differences ranging between 2.42 and 3.82-fold pre-exposure and between 2.43 and 7.5-fold post-exposure with several tone burst stimuli (4 kHz, 8 kHz, 12 kHz, 16 kHz, 24 kHz, and 32 kHz). Immunolabeling of paired synaptic ribbons and glutamate receptors of strains with the highest and lowest wave 1 values pre- and post-exposure revealed significant differences in functional synaptic ribbon counts. Genome-wide association analysis identified genome-wide significant threshold associations on chromosome 3 (24 kHz; JAX00105429; p < 1.12E-06) and chromosome 16 (16 kHz; JAX00424604; p < 9.02E-07) prior to noise exposure and significant associations on chromosomes 2 (32 kHz; JAX00497967; p < 3.68E-08) and 13 (8 kHz; JAX00049416; 1.07E-06) after noise exposure. In order to prioritize candidate genes, we generated cis-eQTLs from microarray profiling of RNA isolated from whole cochleae in 64 of the tested strains. This is the first report of a genome-wide association analysis, controlled for population structure, to explore the genetic landscape of suprathreshold wave 1 amplitude measurements of the mouse ABR. We have defined two genomic regions associated with wave 1 amplitude variation prior to noise exposure and an additional two associated with variation after noise exposure. Keywords: GWAS; HMDP; NIHL; eQTL.

DOI: 10.1159/000506894
ISSN: 1420-3030
Citações Scopus: 1
Citações ISI: 1
Fator de Impacto JCR: 1.854
Qualis: B2
Introduction: Noise-induced hearing loss is the most preventable cause of auditory impairment. Periodic audiometric evaluations are essential to monitor the hearing health of noise-exposed workers. Objective: To compare the evolution of audiometric thresholds in the initial three evaluations at frequencies of 3, 4, and 6 kHz in groups of workers exposed or not to noise. Methods: In this historical cohort study, audiometric evaluations were obtained from male workers between 18 and 40 years of age at six different metallurgical companies in Brazil. The workers were separated into noise-exposed and non-noise-exposed groups. The mean thresholds for 3, 4, and 6 kHz were calculated for both ears at baseline and the first and second periodic evaluations. The non-parametric Wilcoxon test was used for statistical analysis. Results: A total of 1,382 metallurgical workers were evaluated (1,199 noise-exposed and 183 non-noise-exposed). There was a significant difference between baseline and the first periodic evaluation (right ear – effect size = 0.62; p = 0.0030 and left ear – effect size = 0.74; p = 0.0063) and between baseline and the second periodic evaluation (right ear – effect size = 0.85; p = 0.004 and left ear – effect size = 0.96; p = 0.0002). In the non-noise-exposed group, there was no difference between baseline and the first periodic evaluation (right ear – effect size = 0.18; p = 0.2703 and left ear – effect size = 0.12; p = 0.7907) and between baseline and the second periodic evaluation (right ear – effect size = 0.29; p = 0.4475 and left ear – effect size = 0.41; p = 0.6381). Conclusion: In noise-exposed workers, there was a significant worsening of audiometric thresholds between baseline and the initial periodic evaluation, but there was no difference between the two post-baseline evaluations. This shows that noise exposure can quickly affect hearing, despite protective measures.

DOI: 10.1007/s10162-016-0578-4
ISSN: 1525-3961
Citações Scopus: 10
Citações ISI: 1
Fator de Impacto JCR: 5.917
Qualis: A1
Neuropilin-1 (Nrp1) encodes the transmembrane cellular receptor neuropilin-1, which is associated with cardiovascular and neuronal development and was within the peak SNP interval on chromosome 8 in our prior GWAS study on age-related hearing loss (ARHL) in mice. In this study, we generated and characterized an inner ear-specific Nrp1 conditional knockout (CKO) mouse line because Nrp1 constitutive knockouts are embryonic lethal. In situ hybridization demonstrated weak Nrp1 mRNA expression late in embryonic cochlear development, but increased expression in early postnatal stages when cochlear hair cell innervation patterns have been shown to mature. At postnatal day 5, Nrp1 CKO mice showed disorganized outer spiral bundles and enlarged microvessels of the stria vascularis (SV) but normal spiral ganglion cell (SGN) density and presynaptic ribbon body counts; however, we observed enlarged SV microvessels, reduced SGN density, and a reduction of presynaptic ribbons in the outer hair cell region of 4-month-old Nrp1 CKO mice. In addition, we demonstrated elevated hearing thresholds of the 2-month-old and 4-month-old Nrp1 CKO mice at frequencies ranging from 4 to 32kHz when compared to 2-month-old mice. These data suggest that conditional loss of Nrp1 in the inner ear leads to progressive hearing loss in mice. We also demonstrated that mice with a truncated variant of Nrp1 show cochlear axon guidance defects and that exogenous semaphorin-3A, a known neuropilin-1 receptor agonist, repels SGN axons in vitro. These data suggest that Neuropilin-1/Semaphorin-3A signaling may also serve a role in neuronal pathfinding in the developing cochlea. In summary, our results here support a model whereby Neuropilin-1/Semaphorin-3A signaling is critical for the functional and morphological integrity of the cochlea and that Nrp1 may play a role in ARHL.

DOI: 10.1055/s-0040-1716573
ISSN: 1809-9777
Citações ISI: 1
Fator de Impacto JCR: 1.345
Qualis: B2
Introduction: Temporal bone anatomy is complex and demands a profound anatomical knowledge. Association between surgery and imaging helps in the process of learning three-dimensional (3D) anatomy and surgical techniques. High definition temporal bone imaging can play an important role in dissection training. Objective To describe a computed tomography (CT) image-guided temporal bone dissection course for surgical training in otolaryngology and to verify the satisfaction level of the students with the course. Methods Descriptive research. The course took place at a research laboratory, with three experienced temporal bone surgeons. The participants were 12 otolaryngology residents. The laboratory has 7 modern workstations with microscope and monitors linked with a computerized video system. Cadaveric temporal bones were donated to the university. Imaging acquisition of the cadaveric temporal bones used in the course was performed in a multislice CT scanner. The CT images of cadaveric temporal bones were available with real-time access on the laboratory monitor’s screens during dissections. Results A total of 13 temporal bones were included for dissection. Students had the opportunity to view on the same screen, simultaneously, both the dissection video and the respective CT images of their temporal bone anatomical specimens. This allowed correlating surgical and imaging aspects of temporal bone anatomy. At the end of the course, participants answered a satisfaction survey. Conclusion: Considering imaging methods are routinely used during most otologic surgeries, detailed knowledge of CT imaging should be explored in conjunction with the temporal bone anatomical dissection. Keywords temporal bone – dissection – anatomy – computed tomography 

DOI: 10.1055/s-0040-1715151
ISSN: 1809-9777
Citações Scopus: 0
Citações ISI: 0
Fator de Impacto JCR: 1.345
Qualis: B2
Introduction The role of elastin in tympanic retractions and chronic otitis media is not well established. Williams Syndrome (WS), a pathology related to a mutation in the elastin gene, could generate tympanic retractions. Objective To compare the prevalence of tympanic retractions among patients with WS and controls. Methods WS patients (n = 43 ears) and controls (n = 130 ears) were evaluated by digital otoscopic examination, and the degree of tympanic membrane retraction was classified by 2 blinded experienced otolaryngologists. Results The agreement rate between the evaluators was 71.1% for pars tensa and 65% for pars flaccida retraction (p < 0.001). The pars tensa and pars flaccida retractions are present in patients with WS after an adjusted residue of respectively – 2.8 and – 2.6 (p = 0.011 and p = 0.022) compared with controls.
Conclusions: Tympanic membrane retractions are not more common in the WS group when compared with controls.
Keywords williams syndrome – elastin – chronic otitis media

Background: To evaluate interaural differences between the right and left ears at frequencies from 0.25 to 8 kHz in 3 groups of workers from metallurgy companies.
Methods: This study is a cross-sectional cohort study. Workers were divided into 3 groups: (1) workers without occupational noise exposure and normal audiometric testing; (2) workers with 10 years of occupational noise exposure; and (3) workers with 15 years of occupational noise exposure. The interaural difference from 0.25 to 8 kHz was measured in each group.

Results: A total of 2103 workers were included. Of these, 483 workers had been exposed to noise in the workplace for 10 years and 216 workers for 15 years. Group 1, only at 4 and 6 kHz, the difference was statistically significant. Group 2, only at 3 , 4 , and 6 kHz, the difference was statistically significant. Group 3, the difference was statistically significant at the frequencies from 2 to 8 kHz.

Conclusion: Asymmetry between the right and left ears was observed in all groups, with higher air-conduction thresholds in the left ear. It is important for otolaryngologists be aware that NIHL can also cause or accentuate asymmetry between the right and left ears over time.

Abstract
Objectives: To provide an overview of the main evidence-based recommendations for the diagnosis of hearing loss in children and adolescents aged 0 to 18 years.

Methods: Task force members were educated on knowledge synthesis methods, including electronic database search, review and selection of relevant citations, and critical appraisal of selected studies. Articles written in English or Portuguese on childhood hearing loss were eligible for inclusion. The American College of Physicians’ guideline grading system and the American Thyroid Association’s guideline criteria were used for critical appraisal of evidence and recommendations for therapeutic interventions.

Results: The evaluation and diagnosis of hearing loss: universal newborn hearing screening, laboratory testing, congenital infections (especially cytomegalovirus), genetic testing and main syndromes, radiologic imaging studies, vestibular assessment of children with hearing loss, auditory neuropathy spectrum disorder, autism spectrum disorder, and noise-induced hearing loss.

Conclusions: Every child with suspected hearing loss has the right to diagnosis and appropriate treatment if necessary. This task force considers 5 essential rights: (1) Otolaryngologist consultation; (2) Speech assessment and therapy; (3) Diagnostic tests; (4) Treatment; (5) Ophthalmologist consultation.

Abstract
Objectives: To provide an overview of the main evidence-based recommendations for the diagnosis of hearing loss in children and adolescents aged 0-18 years.

Methods: Task force members were educated on knowledge synthesis methods, including electronic database search, review and selection of relevant citations, and critical appraisal of selected studies. Articles written in English or Portuguese on childhood hearing loss were eligible for inclusion. The American College of Physicians’ guideline grading system and the American Thyroid Association’s guideline criteria were used for critical appraisal of evidence and recommendations for therapeutic interventions.

Results: The topics were divided into 2 parts: (1) treatment of sensorineural hearing loss: individual hearing aids, bilateral cochlear implants, cochlear implants in young children, unilateral hearing loss, and auditory neuropathy spectrum disorder; and (2) treatment of conductive/mixed hearing loss: external/middle ear malformations, ventilation tube insertion, and tympanoplasty in children.

Conclusions: In children with hearing loss, in addition to speech therapy, Hearing AIDS (HAs) or implantable systems may be indicated. Even in children with profound hearing loss, both the use of HAs and behavioral assessments while using the device are important.

Abstract
Background: The most common current hearing protection devices (HPDs) on the market include earplugs and earmuffs. A variety of materials can be used to manufacture these devices, and each offers a level of noise attenuation that is informed by the manufacturer although it does not always correspond to the attenuation observed in real-world use.

Objective: To evaluate the noise attenuation of HPDs available to workers exposed to noise.

Methods: The most relevant studies originally published in English, Portuguese, or Spanish that investigated the noise attenuation effectiveness of HPDs used by workers exposed to noise were analyzed. The following electronic databases were searched by 2 independent reviewers for studies published from 1999 to 2019: MEDLINE (PubMed), Scopus, Web of Science, EMBASE, Cochrane Library (OVID), ProQuest, and BVS-Bireme. Different combinations of the following search terms (MeSH terms) were used for all databases: “Hearing Loss, Noise-Induced”, “Ear Protective Devices” (Efficacy OR Effectiveness)”, “Noise, Occupational”.

Results: The search strategy yielded a total of 326 potentially relevant studies. After removal of duplicates, 156 remained for the screening of titles and abstracts. After reviewing titles and abstracts, 46 studies were selected for full-text reading. Of these, six were included in this systematic review.

Conclusion: Hearing protection devices reduced the noise exposure and were effective in all included studies in different countries, types of activity, and sound pressure exposure.

Background: The surgical ressection of petroclival meningiomas is challenging due to its deep location and relationship with vital neurovascular structures. Usually they are benign injuries, but they can involve or infiltrate skull base bones, dura mater and brainstem. This makes the total removing very difficult or impossible without causing neurological deficits. The objective of this study is to review the surgical approaches used on the treatment of petroclival meningiomas and the knowledge which we achieved upon the surgical management of 30 cases.

Methods: Series of 30 petroclival meningioma-cases. In the beginning of our series we used petrous approach for all the cases, however, with the acquiring of experience, we are indicating the retrosigmoid approach, leaving the petrous and skull-orbito-zigomatics approaches for selected cases.

Results: Owing to the difficulty of the access, the petroclival meningiomas usually require different surgical approaches and have distint surgical difficulties. There are three main approaches: fronto-orbito-zigomatics and variants; petrous and variants and retrosigmoid, and they can be combined. The choice for a surgical approach is usually on the location and size of the tumor, on the skull shape, the involvement of venous structures and according to the surgeon´s experience.

Conclusion: Petroclival meningiomas are rare and complex on the skull base. The adequate choice is crucial to achieve the good surgical result.

Abstract
A 47-year-old woman presented with the complaint of sudden hearing loss associated with vertigo. Serological testing was positive for IgM and negative for IgG COVID-19 antibodies, with no other associated factors. Magnetic resonance imaging of the brain showed bilateral intralabyrinthine hemorrhage.

Abstract
Objectives: To compare the progression of 3-, 4-, and 6-kHz thresholds (pure-tone average) over 5 years and determine the most critical period for occupational risk among workers exposed and nonexposed to noise.

Design: Metallurgical workers were divided into 2 groups: noise-exposed and non-noise-exposed groups. The 6 initial audiometric tests of each worker were analyzed as baseline test and annual tests 1 to 5.

Results: A total of 845 workers were included, 748 in the noise-exposed group and 97 in the non-noise-exposed group, resulting in 5070 tests analyzed. The nonexposed group showed no significant difference in the mean pure-tone averages between any of the annual tests in either ear. In the exposed group, a significant difference was observed in mean pure-tone averages between baseline and Test1 (p = 0.001 right ear; p = 0.001 left ear), between Test3 and Test4 (p = 0.002 right ear; p = 0.005 left ear), and between Test4 and Test5 (p = 0.003 right ear; p = 0.001 left ear). There was no difference between Test1 and Test2 or between Test2 and Test3 in either ear.

Conclusions: The progression of pure-tone averages at 3, 4, and 6 kHz differed between workers exposed and nonexposed to noise. Noise-exposed workers had a significant progressive worsening of audiometric thresholds after 3 years of employment. This study identified, in an unprecedented way, two critical periods of noise exposure: in the first year and after the third year of employment in a noisy environment.

Abstract
Introduction: Current Brazilian legislation requires that all workers exposed to noise are to be given an audiogram upon hiring, after 6 months of employment (first periodic test), and annually after the first periodic test. In other countries, the regulations of hearing conservation programs do not include the requirement for audiometric testing at 6 months of employment, but only annually. There is no evidence that the periodicity adopted by Brazilian legislation is the most appropriate.

Objective: The present study aimed to evaluate the first 3 occupational audiometric tests of workers exposed to noise.

Methods: Historical cohort study with cross-sectional analysis. Participants were all male metallurgy workers aged up to 40 years. The first 3 audiograms of each worker were analyzed: pre-employment audiometric test, periodic audiometric test 1, and periodic audiometric test 2. For each worker, mean frequency thresholds were calculated at 3, 4, and 6 kHz in the left and right ears for each test. Statistical analysis was performed using the nonparametric Wilcoxon test.

Results: A total of 988 workers were included. There was a significant difference in auditory thresholds between the pre-employment test and the 2 subsequent periodic tests for the right and left ears. There was no significant difference between Test1 and Test2 in either ear.

Conclusion: Given the lack of difference between the first 2 periodic tests, we believe that they could be merged into a single test, i.e., first periodic audiometric testing could be performed at 12 months of employment without compromising workers’ health.

• Lavinsky, Joel; Silva, VAR; Isolan GR. Acesso Retrossigmóideo. In: Lavinsky, Joel. Práticas em Cirurgia da Base de Crânio: Abordagens para Base Anterior e Lateral/Joel Lavinsky, Fabrizio Ricci Romano & Aloysio Augusto T. Campos Netto. – 1. Ed. – Rio de Janeiro – RJ: Thieme Revinter Publicações, 2021. p 155-161.
• Lavinsky, Joel; Pasqualini, M; Isolan, GR; Lavinsky, L. ABORDAGEM DAS PATOLOGIAS DO SACO ENDOLINFÁTICO. In: Lavinsky, Joel. Práticas em Cirurgia da Base de Crânio: Abordagens para Base Anterior e Lateral/Joel Lavinsky, Fabrizio Ricci Romano & Aloysio Augusto T. Campos Netto. – 1. Ed. – Rio de Janeiro – RJ: Thieme Revinter Publicações, 2021. p 225-231.
• Lavinsky, Joel; Friedman, RA; Isolan GR. Acesso por Fossa Craniana Média para o Schwannoma Vestibular. In: Lavinsky, Joel. Práticas em Cirurgia da Base de Crânio: Abordagens para Base Anterior e Lateral/Joel Lavinsky, Fabrizio Ricci Romano & Aloysio Augusto T. Campos Netto. – 1. Ed. – Rio de Janeiro – RJ: Thieme Revinter Publicações, 2021. P 135-140.
• Pereira, M; Bittencourt, A; Holanda, M; Brito Neto, R; Lavinsky, J; Pereira, F. Descompressão do Nervo Facial In: Lavinsky, Joel. Práticas em Cirurgia da Base de Crânio: Abordagens para Base Anterior e Lateral/Joel Lavinsky, Fabrizio Ricci Romano & Aloysio Augusto T. Campos Netto. – 1. Ed. – Rio de Janeiro – RJ: Thieme Revinter Publicações, 2021. P 209-213.
• Lubianca Neto, J; Lavinsky, J. Surdez Genética. In: PRO-ORL Programa de Atualização em Otorrinolaringologia: Ciclo 14/ organizado pela Associação Brasileira de Otorrinolaringologia e Cirurgia Cérvico-Facial – Porto Alegre: Artmed Panamericana, 2020. P 103-120.
• Lavinsky, J; Moro da Rocha, M. Desafios Diagnósticos e Terapêuticos das Fístulas e Deiscências Labirínticas. In: PRO-ORL Programa de Atualização em Otorrinolaringologia: Ciclo 15/ organizado pela Associação Brasileira de Otorrinolaringologia e Cirurgia Cérvico-Facial – Porto Alegre: Artmed Panamericana, 2020. P 103-120.
• Lavinsky, Joel; Wolff, Michelle Lavinsky, Lavinsky L. Avaliação para Indicação de Implante Coclear. In: Tratado de Otorrinolaringologia/ organização Shirley Shizue Nagata Pignatari, Wilma Terezinha Anselmo-Lima. – 3. ed. – Rio de Janeiro: Grupo Editorial Nacional, 2020.
  Wolff, Michelle Lavinsky; Lavinsky, Joel; Schweiger, Claudia; Lavinsky, Luiz. Perda auditiva. In: Gusso, Gustavo; Ceratti Lopes, José Mauro. Tratado de medicina de família e comunidade: princípios, formação e prática. 2. Ed. Porto Alegre: Artmed, 2019. p. 1585-1591.
• Lavinsky, Joel; Wolff, Michelle Lavinsky; Lavinsky, Luiz. Zumbido. In: Gusso, Gustavo; Ceratti Lopes, José Mauro. Tratado de medicina de família e comunidade: princípios, formação e prática. 2. ed. Porto Alegre: Artmed, 2019. p. 1592-1597.
• Wolff, Michelle Lavinsky; Lavinsky, Joel; Schweiger, Claudia; Lavinsky, Luiz. Disacusia. In: Gusso, Gustavo; Ceratti Lopes, José Mauro. Tratado de medicina de família e comunidade: princípios, formação e prática. 1. Ed. Porto Alegre: Artmed, 2019. p. 1473-1480.
• Lavinsky, Joel; Wolff, Michelle Lavinsky; Lavinsky, Luiz. Zumbido. In: Gusso, Gustavo; Ceratti Lopes, José Mauro. Tratado de medicina de família e comunidade: princípios, formação e prática. 1. ed. Porto Alegre: Artmed, 2019. p. 1480-1487.
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  Grasel SS. Hearing Disorders in Childhood IAPO 2018 Up to Date. In: XVI IAPO MANUAL OF PEDIATRIC OTORHINOLARYNGOLOGY (online).
• Lavinsky, Luiz; Lavinsky, Joel. An Overview of Sensorineural Hearing Loss: Past, Present and Future. In: Paparella, Michael M.; da Costa, Sady Selaimen; Singh, Bhuvanesh. Otolaryngology Principles & Practice. London: JP Medical Ltd, 2017.
• Myint A, Lavinsky J, L. Go J, Friedman R.A. Petrous Apicitis and Intracranial Infection. In: McRackan, Theodore R.; Brackmann, Derald E. Otology, Neurotology and Skull Base Surgery. San Diego: Plural Publishing Inc, 2016. p. 209-220.
• Lavinsky, Luiz; Lavinsky, Joel; Wolff, Michelle Lavinsky. Doenças da Orelha Interna. In: Zeigelboim, Bianca Simone; Jurkiewicz, Ari Leon. Multidisciplinaridade na Otoneurologia. São Paulo: Roca, 2012. p. 209-238.
  Lavinsky, Luiz; Lavinsky, Joel. Antivertiginosos. In: Piltcher, Otavio B.; da Costa, Sady Selaimen; Maahs, Gerson Schulz; Kuhl, Gabriel. Organizadores. Rotinas em Otorrinolaringologia. Porto Alegre: Artmed, 2014. p. 419-421.
• Lavinsky, Luiz; Lavinsky-Wolff, Michelle; Lavinsky, Joel; Scalco, Luis. Vertigens e Tonturas. In: Duncan, Bruce B.; Schmidt, Maria Inês; Giugliani, Elsa E.J.; Duncan, Michael Schmidt; Giugliani, Camila. Medicina Ambulatorial: Condutas de Atenção Primária Baseadas em Evidências. Porto Alegre: Artmed, 2014. P. 767-776.
• Lavinsky, Joel; Nudelmann, Alberto A. Perda auditiva induzida pelo ruído. In: Piltcher, Otavio B.; da Costa, Sady Selaimen; Maahs, Gerson Schulz; Kuhl, Gabriel. Organizadores. Rotinas em Otorrinolaringologia. Porto Alegre: Artmed, 2014. p. 86-90
• Lavinsky, Luiz; Lavinsky-Wolff, Michelle; Lavinsky, Joel. Técnicas Cirúrgicas Alternativas na Cirurgia de Implante Coclear. In: Ferreira Bento, Ricardo; Lima Júnior, Luis Rodolfo Penna; Tsuji, Robinson Koji; Goffi-Gomez, Maria Valéria Schmidt; Lima, Danielle do Vale Silva Penna; Brito, Rubens. Tratado de Implante Coclear e Próteses Auditivas Implantáveis. New York: Thieme, 2014. p. 245-248.
  Lavinsky, Luiz; Lavinsky, Joel. Tratamento Cirúrgico do Paciente Vertiginoso. In: Zuma e Maia, Francisco Carlos; Mangabeira Albernaz, Pedro Luiz; Carmona, Sergio. Otoneurologia Atual. Rio de Janeiro: Revinter, 2013. p. 479-499.
• Lavinsky, Luiz; Lavinsky, Joel; Lavinsky, Michelle. Intratympanic Corticosteroids for Inner Ear Disease. In: Goycoolea, Marcos and friends. Atlas of Otologic Surgery and Magic Otology. Volume 1. Delhi: Jaypee Brothers Medical Publishers Ltd., 2012, p. 1191-1197.
• Lavinsky, Luiz; Lavinsky, Joel; Lavinsky, Michelle; Goycoolea, Marcos. Comparative Study of the Different Surgical Techniques for Cochlear Implantation and the Combined Approach Technique. In: Goycoolea, Marcos and friends. Atlas of Otologic Surgery and Magic Otology. Volume 1. Delhi: Jaypee Brothers Medical Publishers Ltd., 2012, p. 1227-1237.
• Lavinsky, Luiz; Lavinsky, Joel; Lavinsky, Michelle; Motta, Luis Henrique. Cartilage Ossiculoplasty: Functional Impanochondroplasty. In: Goycoolea, Marcos and friends. Atlas of Otologic Surgery and Magic Otology. Volume 1. Delhi: Jaypee Brothers Medical Publishers Ltd., 2012, p. 675-679.
• Dias, Carlos Alberto; Lavinsky, Luiz; Lavinsky, Joel. Tratamento da Otite Média Crônica Supurativa Não-Colesteatomatosa. In: Lavinsky, Luiz. Tratamento em Otologia. Rio de Janeiro: Revinter, 2005. p. 221-223.
  Lavinsky, Luiz; Lavinsky, Joel; D’Ávila, Cíntia. Tratamento das Principais Disacusias Neurossensoriais de Causa Sistêmica. In: Lavinsky, Luiz. Tratamento em Otologia. Rio de Janeiro: Revinter, 2005. p. 414-425.
• Lavinsky, Luiz; Campagnolo, Andréa Maria; Rocha, Mauren Peres; Lavinsky, Joel; Escalera, José María. Antibioticoprofilaxia em Cirurgia Otológica. In: Lavinsky, Luiz. Tratamento em Otologia. Rio de Janeiro: Revinter, 2005. p. 37-40.
• Lavinsky, Luiz. Avaliação para Indicação de Implante Coclear. In: Associação Brasileira de Otorrinolaringologia e Cirurgia Cérvico-Facial. Tratado de Otorrinolaringologia e Cirurgia Cervicofacial. 2 Ed. Volume 2. São Paulo: ABORL-CCF Volume 2. p. 389-400, 2017.
• Lavnsky, J; Moro, M. Exame Físico Otoneurológico. Assunção, A; Ramos, BF; Lavinsky J; Reis, L; Costa, LT; Arena, P; Guimarães, R. Tontura: do PS ao Consultório. 1ª edição. São Paulo/SP. Fundação Otorrinolaringologia (online).
• Lavnsky, J; Moro, M. Migrânea Vestibular. Assunção, A; Ramos, BF; Lavinsky J; Reis, L; Costa, LT; Arena, P; Guimarães, R. Tontura: do PS ao Consultório. 1ª edição. São Paulo/SP. Fundação Otorrinolaringologia (online).