BrazJOtorhinolaryngol.2015;81(6):581---582
www.bjorl.org
Brazilian
Journal
of
OTORHINOLARYNGOLOGY
EDITORIAL
Phoniatry:
otorhinolaryngology
expands
its
limits
夽
Foniatria:
a
otorrinolaringologia
expandindo
os
seus
limites
Several areas of human knowledge are evolving rapidly. Otorhinolaryngology is one of them: endoscopic surgery, cochlearimplants,androboticsurgeryarenowareality.
Until a few years ago, we faced difficulties obtaining an early diagnosis and treating infants born with hearing impairment(HI).Diagnosticadvances,includingotoacoustic emission,auditorybrainstemresponse (ABR),steady-state potentials --- as well as therapeutic advances with digi-tal amplification devices, cochlear implants, implantable prostheses, etc. --- have completely changed the progno-sisforchildrenwithHI.Nowadays,thankstotechnological advances, we canguarantee a completely normallife for theseinfants.
The main contemporary challenges for professionals workingwithchildrenexhibitinglanguagedelayarerelated todiseasesthathavenoavailablelaboratoryteststo estab-lishthe diagnosis and nosurgical or clinical treatment to changeitsevolution.Theprognosisdependsonestablishing thediagnosis assoon aspossible andonthe rightspecific speechtherapy. In thisscenario, the twomost significant diseases areautistic spectrum disorder (ASD)andspecific languagedisorder(SLD).
Upon learning of this subject, perhaps many otorhino-laryngologistswonder:‘‘Wherearethesechildren,forIdo notseethem?’’Certainly,theyarebeingseeninthesesame professionals’ offices, becausethese are highly prevalent diseases,althoughtheyarenotbeingdiagnosed.
The various disciplinesstudying language development inchildren---suchasspeechtherapy,developmental pedi-atrics,psychiatry,andpediatricneurology---arefindingan increasedincidenceofASD.The2014reportof CDC (Cen-ter for Disease Control) relates an ASDincidence of 1:68 for8-year-oldchildren, fivetimesmorefrequentin males (1:42) than in females (1:189).1 Several genetic and
epi-geneticstudies arebeingconductedto trytounravel the
夽 Pleasecitethisarticleas:RamosBD.Phoniatry:
otorhinolaryn-gologyexpandsitslimits.BrazJOtorhinolaryngol.2015;81:581---2.
etiologyofASD.Genome sequencingprojectsshowedthat therearehundredsofASD-associatedgenes.
Regarding SLD, the NIH (National Institutes of Health) states that this disease affects about 7---8% of preschool childrenandthatin50---70%ofcasesthereisatleastone rel-ativesufferingthesamedisturbance.2Thecorrectdiagnosis
ofSLDfollowedbyadequatespeechtherapyminimizes its consequences,whichincludereadingandwritingdisorders. InBrazil,noepidemiologicalstudiesonASDandSLDhave beenconducted,butitispossiblethattheBrazilianratesare similartothoseoftheUnitedStates.
Hearingrepresentstheworld’slargestinformation gate-way.But having normal hearingthresholds is not enough: weneedtoprocessandrecognizetheauditoryinformation inaquickandcorrectway.3 Intoday’sworld,wherequick
thinkersaremorevalued,itiscriticaltoidentifyandtreat any disease that can interfere with auditory processing. The incidenceof otitismedia, one of the main causes of auditory processingdisorder, increasedwhen there wasa dramaticincreaseinwomenenteringthelabormarketand placingtheirinfantsinnurserieswheretheyencounteredan increaseinthenumberofairwayinfections.
Through electrophysiological tests, such as ABR with speech stimuli, we can identify children with auditory processingdisorderwhichmaypresentreadingandwriting learningdifficultiesintheirearlyyearsoflife.4
Inmostcases,patientswithlanguagedelay orlearning disabilityareinitiallyseen byan otorhinolaryngologistfor suspectedHI.
Whatshouldbetheroleoftheotorhinolaryngologistin thesecases?Everytimeweseeachildwithlanguagedelay and with normal hearing, we must think that, by simply stating that the exam is normal, that everything is fine, and that the child should talk soon, we may be delay-ingthecorrectdiagnosisandlosingafew monthsofgreat neuroplasticity.
Amorethoroughassessment,followedbyaproper guid-ance,candramaticallychangethefutureofachild.
Similarly, it is important to investigate the auditory processingof thosechildren withlearningdisabilities, for
http://dx.doi.org/10.1016/j.bjorl.2015.08.004
1808-8694/©2015Associac¸ãoBrasileirade OtorrinolaringologiaeCirurgiaCérvico-Facial.Published byElsevierEditoraLtda.Allrights
582 EDITORIAL
without an accuratediagnosis, theycan wasteyears with inadequateandineffectivetherapies.
Formanyyears,otolaryngologiststreatedhearing prob-lemsin the cochlea. But thanks to ABR, hearing alsocan beassessedinthebrainstem.Today,wemustbeprepared toassesshearinginthebrain.MismatchNegativity(MMN), P300,ABRwithspeechstimuli,andbehavioralassessments ofauditoryprocessingoffermuchinformationthatcanassist in the diagnosis and therapeutic management of patients withoralorwrittenlanguagedisordersandnormalhearing thresholds.
Forthosewhoareinterestedinthesetopics,theABORL hasbeenofferingtheExtensiveTrainingCourseinPhoniatry fortwoyears.
Conflicts
of
interest
Theauthordeclaresnoconflictsofinterest.
References
1. http://www.cdc.gov/media/releases/2014/p0327-autism-spectrum-disorder.html
2. http://www.nidcd.nih.gov/health/voice/pages/specific-language-impairment.aspx
3.TallalP.Improvinglanguageandliteracyisamatteroftime.Nat RevNeurosci.2004;5:721---8.
4.Anderson S, Skoe E, Chandrasekaran B, Kraus N. Neural tim-ing is linked to speech perception in noise. J Neurosci. 2010;30:4922---6.
BereniceDiasRamosa,b,c aPreceptorofPediatricOtorhinolaryngologyand
Phoniatry,PontifíciaUniversidadeCatólicadoRioGrande doSul(PUC-RS),PortoAlegre,RS,Brazil bMasterdegreeinOtorhinolaryngology,Universidade
FederaldeSãoPaulo(UNIFESP),SãoPaulo,SP,Brazil cProfessorofAudiologyandAuditoryProcessing,Extensive
