Coalition for Global Hearing Health Hearing Care Pathways Working Group: Guidelines for Clinical Guidance for Readiness and Development of Evidence-Based Early Hearing Detection and Intervention Programs.

Editor's Note: The following article discusses the timely topic Clinical Guidance in the areas of Evidence-Based Early Hearing Detection and Intervention Programs. This article aims to discuss areas of services needed, guidance to countries/organizations attempting to initiate early hearing detection and intervention systems. Expert consensus and systematic/scoping reviews were combined to produce recommendations for evidence-based clinical practice. In Ear and Hearing, our long-term goal for the Point of View article is to stimulate the field's interest in and to enhance the appreciation of the author's area of expertise. Hearing is an important sense for children to develop cognitive, speech, language, and psychosocial skills. The goal of universal newborn hearing screening is to enable the detection of hearing loss in infants so that timely health and educational/therapeutic intervention can be provided as early as possible to improve outcomes. While many countries have implemented universal newborn hearing screening programs, many others are yet to start. As hearing screening is only the first step to identify children with hearing loss, many follow-up services are needed to help them thrive. However, not all of these services are universally available, even in high-income countries. The purposes of this article are (1) to discuss the areas of services needed in an integrated care system to support children with hearing loss and their families; (2) to provide guidance to countries/organizations attempting to initiate early hearing detection and intervention systems with the goal of meeting measurable benchmarks to assure quality; and (3) to help established programs expand and improve their services to support children with hearing loss to develop their full potential. Multiple databases were interrogated including PubMed, Medline (OVIDSP), Cochrane library, Google Scholar, Web of Science and One Search, ERIC, PsychInfo. Expert consensus and systematic/scoping reviews were combined to produce recommendations for evidence-based clinical practice. Eight essential areas were identified to be central to the integrated care: (1) hearing screening, (2) audiologic diagnosis and management, (3) amplification, (4) medical evaluation and management, (5) early intervention services, (6) family-to-family support, (7) D/deaf/hard of hearing leadership, and (8) data management. Checklists are provided to support the assessment of a country/organization's readiness and development in each area as well as to suggest alternative strategies for situations with limited resources. A three-tiered system (i.e., Basic, Intermediate, and Advanced) is proposed to help countries/organizations at all resource levels assess their readiness to provide the needed services and to improve their integrated care system. Future directions and policy implications are also discussed.

Effectiveness of an online continuing education course in infant hearing health for primary care professionals.

OBJECTIVE: To evaluate the effectiveness of an online continuing education course on infant hearing health for primary care professionals. DESIGN: A prospective longitudinal study with interrupted time series pre-test/post-test design. The effectiveness of the online course was assessed by comparing pre- vs. post-training performance and analysing responses to evaluations of the quality of the course. STUDY SAMPLE: The sample comprised individuals enrolled between September 2018 and August 2019 in a Ministry of Health course, "Actions in primary care for the early identification of hearing impairment" offered on the AVASUS platform. RESULTS: Of the 2908 individuals registered, 1842 (63.3%) completed the course. Their ages ranged from 18 to 77 years, and 67.4% of them were females. Students and doctors were overrepresented among the enrollees. All Brazilian states were included in the sample. Comparisons of pre- and post-training performances showed a significant improvement in knowledge, and 99.3% of the participants provided positive comments regarding the quality of the course. CONCLUSIONS: The course is an effective distance learning tool on infant hearing health for primary care professionals. The online course circumvents the limitations posed by geographical barriers and also facilitates decentralisation.

Analysis of brain activity for speech stimuli and child development of an infant with neurosyphilis: case report. / Análise da atividade cerebral para estímulos de fala e desenvolvimento infantil de um lactente com neurossífilis: relato de caso.

Neurosyphilis is an infection of the central nervous system caused by Treponema pallidum and may be symptomatic or asymptomatic in children with congenital syphilis. This study aims to describe the cortical activation pattern of a four-month-old infant with neurosyphilis using functional near-infrared spectroscopy (fNIRS). Born at term weighing 3,475 kg, she presented a Venereal Disease Research Laboratory (VDRL) test of 1:32 and changes in the cerebrospinal fluid test. She underwent treatment with crystalline penicillin for 10 days before discharge from the hospital. In the audiological evaluation, she presented normal tympanometry, otoacoustic emissions evoked by transient stimulus, brainstem auditory evoked potential with click stimulus at 80 and 30 dB nHL bilaterally. The Bayley III Scale was applied to assess language, cognition and motor development, showing delays in expressive language and broad motor skills. In the fNIRS acquisition, data were collected through 20 channels divided between the cerebral hemispheres. The /ba/ and /da/ stimuli were presented at 40 dB HL with the Psychopy software through a headphone. Data analysis used the MNE and MNE-NIRS toolboxes in the Spyder environment. The average by channel, ROI, and condition was exported for analysis. A similar theta coefficient was observed between the conditions and channels evaluated in both cerebral hemispheres, with a greater amplitude of oxyhemoglobin (HbO) being observed in the anterior position when compared to the posterior region of the temporal lobe. Therefore, this case report highlights the need to monitor the child development of babies with neurosyphilis.

A neurossífilis é uma infecção do sistema nervoso central causada pelo Treponema pallidum, podendo ser sintomática ou assintomática nas crianças com sífilis congênita. Este estudo visa descrever o padrão de ativação cortical de uma lactente de quatro meses com neurossífilis utilizando o funcional near-infrared spectroscopy (fNIRS). Nascida a termo com 3.475 Kg, apresentou teste Venereal Disease Research Laboratory (VDRL) de 1:32 e alteração no exame de líquor cefalorraquidiano. Realizou tratamento com penicilina cristalina por 10 dias antes da alta hospitalar. Na avaliação audiológica apresentou normalidade na timpanometria, emissões otoacústicas evocadas por estímulo transiente, potencial evocado auditivo de tronco encefálico com estímulo clique a 80 e 30 dB nNA bilateralmente. Foi aplicada a Escala Bayley III para a avaliação do desenvolvimento de linguagem, cognição e motor, apresentando atrasos na linguagem expressiva e no motor amplo. Na aquisição do fNIRS os dados foram coletados por 20 canais divididos entre os hemisférios cerebrais. Os estímulos /ba/ e /da/ foram apresentados a 40 dB NA com o auxílio do programa Psychopy por um fone de ouvido. A análise dos dados utilizou as toolboxes MNE e MNE-NIRS no ambiente Spyder. A média por canal, ROI e condição foi exportada para análise. Observou-se um coeficiente theta similar entre as condições e canais avaliados de ambos os hemisférios cerebrais, sendo observado maior amplitude da oxihemoglobina (HbO) na posição anterior quando comparados a região posterior do lobo temporal. Desta forma, este relato de caso evidencia a necessidade de monitoramento do desenvolvimento infantil de lactentes com neurossífilis.

Inhibitory effect of contralateral noise on transient otoacoustic emissions in infants with congenital syphilis.

OBJECTIVES: Analyze the inhibitory effect of contralateral noise on transient otoacoustic emissions in infants with congenital syphilis (CS). METHODS: Cross-sectional study, approved by the Research Ethics Committee n° 3.360.991. Infants with treated CS at birth and infants without risk indicators for hearing impairment were selected. Both groups had the waves I, III and V presence at 80 dB nHL with click BAEP and the presence of response in the nonlinear TEOAEs at 80 dB NPS bilaterally. For suppression, TEOAE were analyzed without the contralateral noise, with the linear stimulus at 60 dB SPL. The neonates who presented a response in three frequencies per ear performed the second TEOAE collection with the contralateral white noise at an intensity of 60 dB SPL. Inferential analysis were performed using the Mann-Whitney and Wilcoxon test, adopting a significance level p < 0.05. RESULTS: The sample consisted of 30 subjects divided into two groups, the Study Group (SG), consisting of 16 infants, and the Control Group (CG), consisting of 14 infants with no risk indicators for hearing loss. No differences were observed between the groups and the inhibition values, in the SG 30.8% presented inhibition and 25% for the CG in the right ear, in the left ear it was 46.7% in the SG and 38.5% in the CG. The SG demonstrated greater inhibition in the RE for the frequency bands from 1.5 to 4 KHz. CONCLUSIONS: The analyses adopted in this study point out that the inhibitory effect of contralateral noise on TEOAEs in infants with CS does not differ from infants without risk indicators for hearing loss.

The prevalence of risk for hearing impairment in newborns with congenital syphilis in a newborn hearing screening program (NHS).

Objective: To study the prevalence of risk for hearing impairment in neonates with congenital syphilis in a newborn hearing screening program. Study design: The study design is retrospective, documentary, and is cross-sectional. The sample consisted of newborns who were born between January 2019 and December 2021 and who underwent neonatal hearing screening in a public maternity hospital. Demographic data and the presence and specification of risk indicators for hearing impairment (RIHL) were collected. In retest cases, the results and the final score were also collected. For data analysis, the Kruskal-Wallis and Conover-Iman post-hoc tests were used, comparing the groups that passed and failed the hearing screening that had RIHL, using a significance level of p of <0.5. Results: Among the RIHL observed in the sample, prematurity was more frequent in newborns who passed the screening (55.26%) than in those who failed the test (45.67%). Congenital syphilis was the ninth most frequent RIHL (8.04%) among the newborns who passed the test and the 15th factor (3.03%), with the highest occurrence in those who failed the hearing screening. When comparing the two groups (pass and fail), we found significant differences (p < 0.05) between them. Conclusion: Congenital syphilis was the ninth risk indicator for the most common hearing impairment and, in isolation, did not present a risk for failure in neonatal hearing screening. Notably, congenital syphilis can cause late hearing loss during child development. Thus, there is an indication of audiological monitoring of these neonates.

Accuracy of smartphone-based hearing screening tests: a systematic review.

PURPOSE: To verify the accuracy of smartphone apps to identify hearing loss. RESEARCH STRATEGIES: A systematic review followed the PRISMA-DATA checklist. The search strategies were applied across four databases (Lilacs, PubMed, Scopus and Web of Science) and grey literature (Google Scholar, OpenGrey, and ProQuest Dissertations and Thesis). SELECTION CRITERIA: The acronym PIRD was used in review. This included populations of any gender and all age groups. The Index test is the smartphone-based hearing screening test; the Reference test is the pure-tone audiometry, which is considered the gold reference for hearing diagnostics; the diagnosis was performed via validity data (sensitivity and specificity) to identify hearing loss and diagnostic studies. DATA ANALYSIS: Two reviewers selected the studies in a two-step process. The risk of bias was assessed according to the criteria of the QUADAS-2. RESULTS: Of 1395 articles, 104 articles were eligible for full-text reading and 17 were included. Only four met all criteria for methodological quality. All of the included studies were published in English between 2015 and 2020. The applications Digits-in noise Test (5 articles), uHear (4 articles), HearScreen (2 articles), hearTest (2 articles) and Hearing Test (2 articles) were the most studied. All this application showed sensitivity and specificity values between 75 and 100%. The other applications were EarScale, uHearing Test, Free field hearing (FFH) and Free Hearing Test. CONCLUSION: uHear, Digit-in-Noise Test, HearTest and HearScreen have shown significant values of sensitivity and specificity and can be considered as the most accurate methods for screening of hearing impairment.

Digits-in-noise test in Brazilian Portuguese: how demographic and socioeconomic variables influence normal-hearing subjects. / Teste de dígitos no ruído no Português Brasileiro: influência das variáveis demográficas e socioeconômicas em normo-ouvintes.

PURPOSE: Verify how demographic and socioeconomic variables on the in-noise speech recognition threshold (SRT) from the digits-in-noise test (DIN) in Brazilian Portuguese influence normal-hearing subjects. METHODS: Cross-sectional, prospective study. The convenience sample had 151 normal-hearing subjects between 12 and 79 years (mean=34.66) who underwent pure tone audiometry and digits-in-noise test with white noise using a sequence of three numbers in diotic stimulus (in-phase) on the same day. The DIN was performed using a Motorola Z3 Play smartphone with internet access and in-ear headphones. In-noise digit speech recognition threshold (SRT) was analyzed for gender, age, educational levels, and socioeconomic status. We used the non-parametric version of the Kruskal-Wallis and Mann-Whitney U tests to compare independent samples adopting a significance level of 5%. RESULTS: The mean SRT was -8.47 dBNA (SD -3.89) with a median of -9.6 dBNA. The SRT was proportionally inverse to educational levels and socioeconomic status and more negative (better) with lower age groups. Gender did not influence the DIN SRT. CONCLUSION: Age, educational levels, and socioeconomic status influenced the DIN threshold. These variables must be considered when analyzing DIN performance in Brazilian Portuguese in normal-hearing subjects.

OBJETIVO: Verificar a influência das variáveis demográficas e socioeconômicas no limiar de reconhecimento de fala no ruído (LRF) obtidos no teste de dígitos no ruído (TDR) no Português Brasileiro em normo-ouvintes. MÉTODO: Estudo transversal e prospectivo. A amostra de conveniência foi composta por 151 sujeitos normo-ouvintes com idade entre 12 e 79 anos (média =34,66) que realizaram audiometria tonal liminar e teste de dígitos no ruído branco com sequência de trios numéricos em estímulo diótico (inphase) no mesmo dia. O TDR foi realizado com um smartphone Motorola Z3 play com acesso à internet com fones de ouvido intra-auriculares. Os limiares de reconhecimento dos dígitos no ruído (LRF) foram analisados em função do sexo, idade, escolaridade e nível socioeconômico. Foi utilizado para comparar as amostras independentes, o teste não-paramétrico Kruskal-Wallis e Mann-Whitney, adotando-se o nível de significância de 5%. RESULTADOS: A média do LRF foi de -8,47 dBNA (dp -3,89), com mediana de -9,6 dBNA. O LRF foi proporcionalmente inverso à escolaridade e nível socioeconômico e mais negativo (isto é, melhor) com menor faixa-etária. Não houve evidência de influência do sexo no LRF do TDR. CONCLUSÃO: Idade, escolaridade e nível socioeconômico mostraram influenciar o limiar no TDR; essas variáveis devem ser consideradas na análise de desempenho do TDR no Português Brasileiro em sujeitos normo-ouvintes.

Frequency-Following Response in Newborns and Infants: A Systematic Review of Acquisition Parameters.

Purpose The purpose of this study is to characterize parameters used for frequency-following response (FFR) acquisition in children up to 24 months of age through a systematic review. Method The study was registered in PROSPERO and followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses' recommendations. Search was performed in six databases (LILACS, LIVIVO, PsycINFO, PubMed, Scopus, and Web of Science) and gray literature (Google Scholar, OpenGrey, ProQuest)as well as via manual searches in bibliographic references. Observational studies using speech stimuli to elicit the FFR in infants with normal hearing on the age range from 0 until 24 months were included. No restrictions regarding language and year of publication were applied. Risk of bias was assessed with the Joanna Briggs Institute Critical Appraisal Checklist. Data on stimulus, presentation rate, time window for analysis, number of sweeps, artifact rejection, online filters, stimulated ear, and examination condition were extracted. Results Four hundred fifty-nine studies were identified. After removing duplicates and reading titles and abstracts, 15 articles were included. Seven studies were classified as low risk of bias, seven as moderate risk, and one as high risk. Conclusions There is a consensus in the use of some acquisition parameters of the FFR with speech stimulus, such as the vertical mounting, the use of alternating polarity, a sampling rate of 20000 Hz, and the /da/ synthesized syllable of 40 ms in duration as the preferred stimulus. Although these parameters show some consensus, the results disclosed lack of a single established protocol for FFR acquisition with speech stimulus in infants in the investigated age range.

Accuracy of affordable instruments for hearing screening in adults and the elderly. / Acurácia de instrumentos de custo acessível para triagem auditiva de adultos e idosos.

PURPOSE: To evaluate the accuracy of affordable instruments for hearing screening of adults and the elderly. METHODS: This study was carried out with users of a Hearing Health Service of the Unified Health System. All were screened with the MoBASA smartphone application, the Telehealth audiometer (TH) and the electronic version of the Hearing Handicap Inventory for the Elderly - screening version - eHHIE-S. The examiners were blinded to the results of the screening tests and pure tone audiometry (PTA). Hearing impairment was considered for those with a PTA quadritonal mean greater than 40 dB in the best ear. Sensitivity, specificity and positive and negative predictive values (PPV and NPV, respectively) were calculated. The Kappa index was used as an agreement indicator between the PTA and the screening results. RESULTS: The sample consisted of 80 individuals between 18 and 94 years old (55.18 ± 20.21). In the PTA test, 21 individuals (26.25%) had typical hearing and 59 (73.75%) hearing loss. In the hearing screening tests, sensitivity, specificity, PPV and NPV values greater than 75% were observed with the MoBASA as well as in terms of sensitivity and NPV of the TH and the eHHIE-S. The TH and the eHHIE-S specificity and PPV were less than 75%. The Kappa index indicated a substantial agreement (0.6) between the PTA and the MoBASA screening results. The TH and the eHHIE-S showed regular agreement (0.3). CONCLUSION: MoBASA proved to be an accurate method for hearing screening of adults and the elderly with disabling hearing loss.

OBJETIVO: Avaliar a acurácia de instrumentos de custo acessível para triagem auditiva de adultos e idosos. MÉTODO: Este estudo foi realizado com usuários de um Serviço de Saúde Auditiva do SUS. Todos foram submetidos a triagem com o aplicativo de smartphone MoBASA, o audiômetro Telessaúde (TS) e a versão eletrônica do Questionário de Handicap da Audição para Idosos (Hearing Handicap Inventory for the Elderly ­ screening version - eHHIE-S). Os examinadores foram cegos quanto aos resultados dos testes de triagem e para os dados de audiometria de tom puro (ATP). Foram considerados com deficiência auditiva aqueles com média quadritonal na ATP maiores que 40 dB na melhor orelha. Sensibilidade, especificidade e valores preditivos positivo (VPP) e negativo (VPN) foram calculados. O índice Kappa foi usado como um indicador de concordância entre ATP e os resultados da triagem. RESULTADOS: A amostra constou de 80 indivíduos entre 18 a 94 anos (55,18 ± 20,21). Na ATP, 21 indivíduos (26,25%) apresentaram audição normal e 59 (73,75%) perda auditiva incapacitante. Nos testes de triagem auditiva observou-se valores de sensibilidade, especificidade, VPP e VPN maiores do que 75% no MoBASA e na sensibilidade e VPN do TS e eHHIE-S. Já a especificidade e VPP do TS e eHHIE-S foram inferiores a 75%. O índice Kappa indicou concordância substancial (0,6) entre o ATP e os resultados do MoBASA. No TS e eHHIE-S foi constatada regular concordância (0,3). CONCLUSÃO: O MoBASA demonstrou ser um método acurado para triagem auditiva de adultos e idosos com perda auditiva incapacitante.

Prevalence of Hearing Loss and Associated Factors in School-Age Individuals in an Urban Area of Northeast Brazil.

Introduction Hearing loss interferes in the development of language and verbal capacities, which causes learning difficulties and deleterious effects. Objective To analyze the prevalence and associated factors for hearing loss in school-age individuals of the municipality of Natal, state of Rio Grande do Norte, Northeast Brazil. Methods Cross-sectional study that evaluated 238 school-age individuals (6-17 years old) in municipal public schools. Meatoscopy was performed and school-age individuals answered the questions "Do you think that you hear well?" and "Do you have earaches?". Auditory evaluation was performed with a Telessaúde audiometer. The responsible adults answered socioeconomic, speech and audiology aspects and risk factors for hearing loss questionnaire. Results The prevalence of hearing loss was 16% (11.7-21.4%); 16% reported not to hear well, 18.9% reported earaches, and 26.1% presented altered meatoscopy. The prevalence of hearing loss was higher in school-age individuals who reported hearing difficulties, in children between the ages of 6 and 12, and with altered meatoscopy results ( p < 0.05). Airway infection (PR = 3.37; 95% confidence interval [CI]: 1.48-7.68) was found as a risk factor associated with hearing loss, remaining significant in the multivariate model (PR = 6.79; 95%CI: 1.98-23.26; p = 0.002). Conclusions Hearing loss in this sample is above the values reported in other studies performed in Brazil for this age group. This highlights the necessity of better structure of speech and audiology attention, so that auditory health promotion actions can be systematized for this population.

Early exposure to environment sounds and the development of cortical auditory evoked potentials of preterm infants during the first 3 months of life.

OBJECTIVE: Preterm infants are exposed earlier than their term counterparts to unattenuated sounds from the external environment during the sensitive period of the organization of the auditory cortical circuitry. In the current study, we investigate the effect of preterm birth on the course of development of auditory cortical areas by evaluating how gestational age (GA) correlates with the latency of the P1 component of the cortical auditory evoked potential (CAEP) of two experimental groups measured at 1 or 3 months of age. RESULTS: Our sample consisted of 23 infants delivered at GA ranging from 31.28 to 41.42 weeks and separated into two groups evaluated transversally at 1 or 3 months of corrected age (CA). In the group evaluated at 1-month CA, the latency of the component P1 was similar in both terms and infants classified as late-preterm (GA > 32 weeks). However, in the group evaluated at 3 months CA, P1 latency was significantly smaller in preterms. These preliminary results suggest an acceleration of the development of auditory cortical pathways in preterms, probably due to their early exposure to socially relevant auditory stimuli from the external environment.

Temporal resolution in children: comparing normal hearing, conductive hearing loss and auditory processing disorder.

UNLABELLED: Temporal resolution is essential to speech acoustic perception. It may be altered in subjects with auditory disorders, thus impairing the development of spoken and written language. AIM: The goal was to compare temporal resolution of children with normal hearing, with those bearing conductive hearing loss and auditory processing disorders. MATERIALS AND METHODS: The sample had 31 children, between 7 and 10 years of age, broken down into three groups: G1: 12 subjects with normal hearing; G2: 7 with conductive hearing loss and G3: 12 subjects with auditory processing disorders. This study was clinical and experimental. Selection procedures were: a questionnaire to be answered by the parents/guardians, audiologic and hearing processing evaluation. The study procedure was the test to detect breaks in silence at 50 dB HL above the mean values of 500, 1000 and 2000 Hz in both ears in 500, 1000, 2000 and 4000 Hz. To analyze the data we used the Wilcoxon Test with a 1% significance level. RESULTS: We noticed a difference between G1 and G2 and between G1 and G3 in all the frequencies. On the other hand, this difference was not seen between G2 and G3. CONCLUSION: conductive hearing loss and auditory processing disorders can impact break detection thresholds.

Pitch and Duration Pattern Sequence Tests in 7- to 11-Year-Old Children: Results Depend on Response Mode.

BACKGROUND: Pitch pattern sequence (PPS) and duration pattern sequence (DPS) tests are frequently used in the assessment of auditory processing disorder. Current recommendations suggest alternate, interchangeable modes for responding to stimuli. PURPOSE: The objective of the study is to evaluate the influence of response mode (i.e., humming, pointing, and labeling) and age on PPS and DPS performance of 7- to 11-year-old children. RESEARCH DESIGN: Laboratory-based testing of school children. Cross-sectional comparison of age, with repeated measures of age, test, ear, and response mode. STUDY SAMPLE: From 452 children recruited, 228 right-handed children (109 girls) aged 7 years to 11 years 11 months (mean age 9 years 4 months) completed at least one test (PPS: 211, DPS: 198), and 181 children completed both tests. Audiology inclusion criteria include normal hearing thresholds (≤15 dB HL at octave frequencies 250-8000 Hz); word recognition in quiet ≥92%; tympanogram peak compensated static acoustic compliance 0.4-1.6 mmhos; and tympanometric peak pressure -100 to +50 daPa, all in both ears. Other inclusion criteria were Portuguese as first language; right handed; no musical training; no related, known, or observed phonological, learning, neurologic, psychiatric, or behavioral disorder; otologic history; and delayed neuropsychomotor or language development. DATA COLLECTION AND ANALYSIS: PPS: 30 trials per ear and response condition of three consecutive 500 msec duration intermixed high (1430 Hz) or low (880 Hz) frequency tones presented monaurally at 50 dB HL. The first response condition was humming followed by labeling (naming: high or low). DPS: As per PPS except 1000 Hz tones of intermixed 500 (long) and 250 msec (short) duration. First response was pointing (at a symbolic object) followed by labeling. Trends across age and between tests were assessed using repeated measures generalized linear mixed models. Correlation coefficients were calculated to assess relations among test scores. The two-sided significance level was 0.05. RESULTS: Older children performed better than younger children in all tasks. Humming the tone pattern (PPS humming) produced generally better performance than either articulating the attributes of the tones (labeling) or pointing to objects representing tone duration. PPS humming produced ceiling performance for many children of all ages. For both labeling tasks and DPS pointing, performance was better on the PPS than on the DPS, for stimulation of the right than the left ear, and in boys than girls. Individual performance on the two tasks was highly correlated. CONCLUSIONS: Response mode does matter in the PPS and DPS. Results from humming should not be combined with or be a substitute for results obtained from a labeling response. Tasks that rely on labeling a tonal stimulus should be avoided in testing hearing in children or other special populations.

Prevalence of hearing impairment and associated factors in school-aged children and adolescents: a systematic review.

INTRODUCTION: Hearing impairment is one of the communication disorders of the 21st century, constituting a public health issue as it affects communication, academic success, and life quality of students. Most cases of hearing loss before 15 years of age are avoidable, and early detection can help prevent academic delays and minimize other consequences. OBJECTIVE: This study researched scientific literature for the prevalence of hearing impairment in school-aged children and adolescents, with its associated factors. This was accomplished by asking the defining question: "What is the prevalence of hearing impairment and its associated factors in school-aged children and adolescents?" METHODS: Research included the databases PubMed/MEDLINE, LILACS, Web of Science, Scopus and SciELO, and was carried out by two researchers, independently. The selected papers were analyzed on the basis of the checklist provided by the report Strengthening the Reporting of Observational Studies in Epidemiology. RESULTS: From the 463 papers analyzed, 26 fulfilled the criteria and were included in the review presented herein. The detection methods, as well as prevalence and associated factors, varied across studies. The prevalence reported by the studies varied between 0.88% and 46.70%. Otologic and non-otologic factors were associated with hearing impairment, such as middle ear and air passage infections, neo- and post-natal icterus, accumulation of cerumen, family history, suspicion of parents, use of earphones, age and income. CONCLUSION: There is heterogeneity regarding methodology, normality criteria, and prevalence and risk factors of studies about hearing loss in adolescents and school-aged children. Nevertheless, the relevance of the subject and the necessity of early interventions are unanimous across studies.

Frequência da deficiência auditiva relacionada às infecções congênitas: estudo transversal retrospectivo / Frequency of hearing loss related to congenital infections: retrospective cross-sectional study / Frecuencia de hipoacusia relacionada con infecciones congénitas: un estúdio transversal retrospectivo

Introdução: As infecções congênitas durante a gravidez são indicadores de risco para a deficiência auditiva. Objetivo: Verificar a frequência da deficiência auditiva nas crianças atendidas num serviço público com indicadores de risco de infecções congênitas. Métodos: Trata-se de um estudo transversal retrospectivo. A população do estudo foi de crianças de 0 a 3 anos atendidas no período de 2011 a 2019. Foi realizada consulta e análise no banco de dados da Instituição extraindo informações das crianças quanto à presença de infecção congênita relatada (citomegalovírus, herpes, rubéola, sífilis, toxoplasmose, HIV e Zika vírus) e o diagnóstico audiológico completo. A amostra deste estudo foi constituída por 558 crianças e foram analisadas a presença de coocorrência entre as infecções ou de outros indicadores de risco para a deficiência auditiva. Realizou-se análise descritiva para estabelecer a frequência da deficiência auditiva em relação a cada infecção congênita isolada ou associada a outros indicadores de risco. Resultados: 14,40% das crianças apresentavam o relato de infecção congênita isolada ou em combinação com outro IRDA. A frequência da deficiência auditiva foi de 1,25%, com a presença da perda auditiva sensorioneural em seis crianças (85,71%) e uma perda auditiva do tipo condutiva (14,29%), das quais seis foram bilaterais (85,71%) e uma unilateral (14,29%). Esta frequência de deficiência auditiva foi relacionada ao histórico de citomegalovírus (57,14%), seguido de toxoplasmose (28,57%) e rubéola com Zika vírus (14,29%). Conclusão: A frequência do diagnóstico de deficiência auditiva foi de 1,25% nas crianças com relato de infecções congênitas. (AU)

Introduction: Congenital infections during pregnancy are risk indicators for hearing loss. Purpose: To verify the frequency of hearing loss in children attended at the public service with risk indicators for congenital infections. Methods: This is a retrospective cross-sectional study. The population consisted of children aged 0 to 3 years attended in the period from 2011 to 2019. Consultation and analysis were carried out in the Institution's database, extracting information from the children regarding the presence of reported congenital infection (cytomegalovirus, herpes, rubella, syphilis, toxoplasmosis, HIV and Zika virus) and the complete audiological diagnosis. The sample of this study consisted of 558 children and the presence of co-occurrence between infections or other risk indicators for hearing loss was analyzed. Descriptive analysis was performed to establish the frequency of hearing loss in relation to each congenital infection isolated or associated with other risk indicators. Results: 14.40% of the children had a report of isolated congenital infection or in combination with another risk indicator. The frequency of hearing loss was 1.25%, with sensorineural hearing loss in six children (85.71%) and a conductive hearing loss (14.29%), of which six were bilateral (85, 71%) and one unilateral (14.29%). This frequency of hearing loss was related to the history of cytomegalovirus (57.14%), followed by toxoplasmosis (28.57%) and rubella with zika virus (14.29%). Conclusion: The frequency of diagnosis of hearing loss was 1.25% in children with reports of congenital infections. (AU)

Introducción: Las infecciones congénitas durante el embarazo son indicadores de riesgo de hipoacusia. Propósito: Verificar la frecuencia de hipoacusia en niños atendidos en el servicio público con indicadores de riesgo de infecciones congénitas. Métodos: Se trata de un estudio transversal retrospectivo. La población de estudio estuvo constituida por los niños de 0 a 3 años atendidos en el periodo de 2011 a 2019. Se realizó consulta y análisis en la base de datos de la Institución, extrayéndose información de los niños en cuanto a la presencia de infección congénita reportada (citomegalovirus, herpes, rubéola, sífilis, toxoplasmosis, VIH y virus Zika) y el diagnóstico audiológico completo. La muestra de este estudio estuvo constituida por 558 niños y se analizó la presencia de coocurrencia entre infecciones u otros indicadores de riesgo de hipoacusia. Se realizó un análisis descriptivo para establecer la frecuencia de hipoacusia con relación a cada infección congénita aislada o asociada a otros indicadores de riesgo. Resultados: El 14,40% de los niños tenían reporte de infección congénita aislada o en combinación con otro indicador de riesgo. La frecuencia de hipoacusia fue del 1,25%, con hipoacusia neurosensorial en seis niños (85,71%) y hipoacusia conductiva (14,29%), de los cuales seis fueron bilaterales (85,71%) y uno unilateral (14,29%). Esta frecuencia de hipoacusia se relacionó con el antecedente de citomegalovirus (57,14%), seguido de toxoplasmosis (28,57%) y rubéola con virus zika (14,29%). Conclusión: La frecuencia de diagnóstico de hipoacusia fue de 1,25% en niños con reporte de infecciones congénitas. (AU)

Temporal auditory processing and the distinctive features of children with phonological disorder / Processamento auditivo temporal e os traços distintivos de crianças com transtorno fonológico

ABSTRACT Purpose: to assess whether there is a relationship between temporal auditory processing skills and altered distinctive features in cases of phonological disorder. Methods: 18 children aged between 6 and 8 years, diagnosed with phonological disorders participated in the research. All children underwent speech-language screening, phonological assessment and the assessment of temporal processing skills through the GIN - Gap in Noise Test, TPF - Frequency Pattern Test and TPD - Duration Pattern Test. The numbers of altered phonemes and distinctive features and the level at which they were in the Implicational Model of Features Complexity were compared with those of the GIN, TPF and TPD tests. The significance level adopted for all statistical tests was 5% (p<0.05). Results: in no comparison and correlation was there statistical significance, but the subjects evaluated showed low performance in temporal auditory processing tasks, according to normative testing standards. Conclusion: in the general analysis, there was no relationship between temporal auditory skills and distinctive traits in the population assessed, even though they had difficulties in temporal auditory processing tasks.

RESUMO Objetivo: verificar se existe relação entre as habilidades de processamento auditivo temporal e os traços distintivos alterados nos casos de transtorno fonológico. Métodos: participaram da pesquisa 18 crianças com idades entre 6:0 e 8:0 anos, com diagnóstico de transtorno fonológico. Todas as crianças passaram por triagem fonoaudiológica, avaliação fonológica da criança e pela avaliação das habilidades de processamento temporal por meio dos testes GIN - Gap in Noise Test, TPF - Teste Padrão de Frequência e TPD - Teste Padrão de Duração. Foram comparados os números de fonemas e traços distintivos alterados, o nível em que se encontravam no Modelo Implicacional de Complexidade de Traços com os resultados dos testes GIN, TPF e TPD. O nível de significância adotado para todos os testes estatísticos foi de 5% (p<0,05). Resultados: em nenhuma comparação ou correlação houve significância estatística, porém os sujeitos avaliados apresentaram baixo desempenho nas tarefas de processamento auditivo temporal de acordo com os padrões normativos dos testes. Conclusão: na análise geral, não houve a relação entre as habilidades auditivas temporais e os traços distintivos na população avaliada, muito embora tenham apresentado dificuldades nas tarefas de processamento temporal.

Accuracy of smartphone-based hearing screening tests: a systematic review / Acurácia de testes de triagem auditiva baseados em smartphone: uma revisão sistemática

ABSTRACT Purpose To verify the accuracy of smartphone apps to identify hearing loss. Research strategies A systematic review followed the PRISMA-DATA checklist. The search strategies were applied across four databases (Lilacs, PubMed, Scopus and Web of Science) and grey literature (Google Scholar, OpenGrey, and ProQuest Dissertations and Thesis). Selection criteria The acronym PIRD was used in review. This included populations of any gender and all age groups. The Index test is the smartphone-based hearing screening test; the Reference test is the pure-tone audiometry, which is considered the gold reference for hearing diagnostics; the diagnosis was performed via validity data (sensitivity and specificity) to identify hearing loss and diagnostic studies. Data analysis Two reviewers selected the studies in a two-step process. The risk of bias was assessed according to the criteria of the QUADAS-2. Results Of 1395 articles, 104 articles were eligible for full-text reading and 17 were included. Only four met all criteria for methodological quality. All of the included studies were published in English between 2015 and 2020. The applications Digits-in noise Test (5 articles), uHear (4 articles), HearScreen (2 articles), hearTest (2 articles) and Hearing Test (2 articles) were the most studied. All this application showed sensitivity and specificity values between 75 and 100%. The other applications were EarScale, uHearing Test, Free field hearing (FFH) and Free Hearing Test. Conclusion uHear, Digit-in-Noise Test, HearTest and HearScreen have shown significant values of sensitivity and specificity and can be considered as the most accurate methods for screening of hearing impairment.

RESUMO Objetivo Verificar a acurácia dos aplicativos de smartphone para identificar a perda auditiva. Estratégias de pesquisa Uma revisão sistemática seguiu o checklist PRISMA-DATA. As estratégias de busca foram aplicadas nos bancos de dados Lilacs, PubMed, Scopus e Web of Science e na literatura cinzenta (Google Scholar, OpenGrey e ProQuest Dissertations and Thesis). Critérios de seleção O anacrônimo PIRD foi usado na revisão. Incluiu populações de qualquer gênero e todas as faixas etárias. O teste Index foi o de triagem auditiva baseado em smartphone; o teste de referência foi a audiometria tonal; o diagnóstico foi realizado por meio de dados de validade (sensibilidade e especificidade) para identificação da perda auditiva e estudos diagnósticos. Análise de dados Dois revisores selecionaram os estudos em um processo de duas etapas. O risco de viés foi avaliado de acordo com os critérios do QUADAS-2. Resultados De 1395 artigos, 104 artigos foram elegíveis para leitura de texto completo e 17 foram incluídos. Apenas quatro preencheram todos os critérios de qualidade metodológica. Todos os estudos incluídos foram publicados em inglês entre 2015 e 2020. Os aplicativos mais estudados foram: Digits-in-noise (5 artigos), uHear (4 artigos), HearScreen (2 artigos), hearTest (2 artigos) e Hearing Test (2 artigos). Todos apresentaram valores de sensibilidade e especificidade entre 75 e 100%. Os outros aplicativos foram EarScale, uHearing, Free Field Hearing e teste Free Hearing. Conclusão uHear, Digit-in-Noise Test, HearTest e HearScreen apresentaram valores significativos de sensibilidade e especificidade e podem ser considerados os métodos mais precisos para rastreamento de deficiência auditiva.

Teste de dígitos no ruído no Português Brasileiro: influência das variáveis demográficas e socioeconômicas em normo-ouvintes / Digits-in-noise test in Brazilian Portuguese: how demographic and socioeconomic variables influence normal-hearing subjects

RESUMO Objetivo Verificar a influência das variáveis demográficas e socioeconômicas no limiar de reconhecimento de fala no ruído (LRF) obtidos no teste de dígitos no ruído (TDR) no Português Brasileiro em normo-ouvintes. Método Estudo transversal e prospectivo. A amostra de conveniência foi composta por 151 sujeitos normo-ouvintes com idade entre 12 e 79 anos (média =34,66) que realizaram audiometria tonal liminar e teste de dígitos no ruído branco com sequência de trios numéricos em estímulo diótico (inphase) no mesmo dia. O TDR foi realizado com um smartphone Motorola Z3 play com acesso à internet com fones de ouvido intra-auriculares. Os limiares de reconhecimento dos dígitos no ruído (LRF) foram analisados em função do sexo, idade, escolaridade e nível socioeconômico. Foi utilizado para comparar as amostras independentes, o teste não-paramétrico Kruskal-Wallis e Mann-Whitney, adotando-se o nível de significância de 5%. Resultados A média do LRF foi de -8,47 dBNA (dp -3,89), com mediana de -9,6 dBNA. O LRF foi proporcionalmente inverso à escolaridade e nível socioeconômico e mais negativo (isto é, melhor) com menor faixa-etária. Não houve evidência de influência do sexo no LRF do TDR. Conclusão Idade, escolaridade e nível socioeconômico mostraram influenciar o limiar no TDR; essas variáveis devem ser consideradas na análise de desempenho do TDR no Português Brasileiro em sujeitos normo-ouvintes.

ABSTRACT Purpose Verify how demographic and socioeconomic variables on the in-noise speech recognition threshold (SRT) from the digits-in-noise test (DIN) in Brazilian Portuguese influence normal-hearing subjects. Methods Cross-sectional, prospective study. The convenience sample had 151 normal-hearing subjects between 12 and 79 years (mean=34.66) who underwent pure tone audiometry and digits-in-noise test with white noise using a sequence of three numbers in diotic stimulus (in-phase) on the same day. The DIN was performed using a Motorola Z3 Play smartphone with internet access and in-ear headphones. In-noise digit speech recognition threshold (SRT) was analyzed for gender, age, educational levels, and socioeconomic status. We used the non-parametric version of the Kruskal-Wallis and Mann-Whitney U tests to compare independent samples adopting a significance level of 5%. Results The mean SRT was -8.47 dBNA (SD -3.89) with a median of -9.6 dBNA. The SRT was proportionally inverse to educational levels and socioeconomic status and more negative (better) with lower age groups. Gender did not influence the DIN SRT. Conclusion Age, educational levels, and socioeconomic status influenced the DIN threshold. These variables must be considered when analyzing DIN performance in Brazilian Portuguese in normal-hearing subjects.

Comparação entre a terapia fonológica isolada ou associada ao treinamento auditivo computadorizado na reabilitação dos transtornos fonológicos em crianças / Comparison between isolated phonological therapy and when associated to computerized auditory training in the rehabilitation of phonological disorders in children / Comparación entre la terapia fonológica aislada o asociada al entrenamiento auditivo computarizado en la rehabilitación de los trastornos fonológicos en niños

Introdução: O treinamento auditivo é um método de intervenção utilizado para aprimorar o desempenho das habilidades auditivas alteradas, de modo que, pode promover melhora no processamento da informação sonora. Objetivo: Verificar a eficácia da estimulação do processamento auditivo central na reabilitação dos transtornos fonológicos. Método: Foi realizado um estudo de caso de seis crianças com idades entre 6:00 e 7:11 de idade, com diagnóstico de transtorno fonológico. Todas as crianças passaram por avaliação fonoaudiológica, com avaliação específica da fonologia por meio da Avaliação Fonológica da Criança (Yavas, Hernandorena e Lamprecht, 2002) e pela avaliação das habilidades de processamento temporal por meio dos testes de ordenação e resolução temporal, pré e pós terapia. Todos os sujeitos passaram por 25 sessões de terapia, sendo que três sujeitos foram submetidos à terapia puramente fonológica (grupo de estudo 1 - GE1), e as outras três crianças receberam terapia fonológica associada ao treinamento auditivo computadorizado (grupo de estudo 2 - GE2), com o software Escuta Ativa. Resultados: Não houve diferença estatisticamente significativa quando comparados os resultados do desempenho em tarefas concernentes a percepção do sistema fonológico e do processamento temporal nos mesmos testes (conjunto de tarefas com habilidades auditivas) aplicados pré e pós terapia do GE1 com o GE2. Contudo, houve melhora no desempenho dos testes de processamento temporal em GE2. Conclusão: A terapia fonológica combinada ao treinamento auditivo computadorizado em crianças com transtorno fonológico não evidenciou diferença estatisticamente diferente, porém demonstrou influenciar no aumento do desempenho dos testes de processamento temporal destas crianças quando comparado ao uso isolado da terapia fonológica.

Introduction: The auditory training is an intervention method used to improve the performance of auditory skills, aiming to enhance the processing of sound information. Objective: To assess the effectiveness of central auditory processing stimulation in the rehabilitation of phonological disorders. Method: A case study of six children aged between 6:00 and 7:11 diagnosed with phonological disorder. All children underwent speech-language assessment, with specific assessment of phonology through the Child's Phonological Assessment (Yavas, Hernandorena e Lamprecht, 2002) and temporal processing skills through the temporal ordering and resolution tests, before and after therapy. All subjects underwent 25 therapy sessions, with three subjects undergoing only phonological therapy (study group 1 - SG1), and the other three went through phonological therapy associated with computerized auditory training (study group 2 - SG2), using the software Escuta Ativa. Results: There was no statistically significant difference when comparing the results of performance in tasks concerning the perception of the phonological system and the temporal processing in the same tests (set of tasks of listening skills) applied before and after therapy of SG1 with SG2. However, there was an improvement in the performance of temporal processing tests for SG2. Conclusion: Phonological therapy combined with computerized auditory training in children with phonological disorders did not show a statistically different difference, however it did influence the increase in the performance of temporal processing tests in these children when compared to the isolated use of phonological therapy.

Introducción: el entrenamiento auditivo es un método de intervención utilizado para perfeccionar el desempeño de las habilidades auditivas alteradas, de modo que, puede promover mejora en el procesamiento de la información sonora. Objetivo: verificar la eficacia de la estimulación del procesamiento auditivo central en la rehabilitación de los trastornos fonológicos. Método: Fue realizado un estudio de casos de seis niños con edades de 6:00 a 7:11 años, con diagnóstico de trastorno fonológico. Todos los niños pasaron por evaluación fonoaudiológica, con evaluación específica de fonología por medio de la Evaluación Fonológica del Niño (Yavas, Hernandorena e Lamprecht, 2002) y por la evaluación de las habilidades de procesamiento temporal por medio de los test de coordinación y resolución temporal, pre y post terapia. Todos los sujetos pasaron por 25 sesiones de terapia, siendo que tres sujetos fueron sometidos a la terapia puramente fonológica (grupo de estudio 1 - GE1),y los otros tres niños recibieron terapia fonológica asociada al entrenamiento auditivo computarizado (grupo de estudio 2 - GE2), con el software Escuta Ativa. Resultados: No hubo diferencia estadísticamente significativa cuando comparados los resultados del desempeño en tareas concernientes a la percepción del sistema fonológico y del procesamiento temporal en los mismos tests(conjunto de tareas con habilidades auditivas)aplicados pre y post terapia del GE1 con el GE2. Sin embargo, se observó mejora en el desempeño de las pruebas de procesamiento temporal en GE2. Conclusión: La terapia fonológica combinada con el entrenamiento auditivo computarizado en niños con Trastorno Fonológico no evidenció diferencia estadísticamente diferente, sin embargo demostró influir en el aumento del desempeño de las pruebas de procesamiento temporal de estos niños cuando comparado al uso aislado de la terapia fonológica.

Development of infants presented with congenital syphilis in their first months of life

ABSTRACT Purpose: to evaluate the cognitive, language, and motor development of infants with congenital syphilis in their first months of life. Methods: a sample of 52 infants, from 21 to 112 days of age, born in public maternity hospitals, divided into a study group of 28 infants with congenital syphilis and a control group 24 infants without risk indicators for hearing loss. They underwent the Neonatal Hearing Screening Protocol with automated Brainstem Auditory Evoked Potential. The research instrument was the Bayley-III Scale, consisting of the cognitive, language (receptive and expressive), and motor (fine and gross) subscales. The raw scores were entered into the software that accompanies the Bayley-III scale kit to calculate the scores (scaled and composite) and perform qualitative analysis. The Mann-Whitney test and the Wilcoxon test was applied and used a 5% significance level. Results: a similarity between groups for the demographic parameters, maternal education level, and socioeconomic level, was seen. There was no statistically significant difference between groups when comparing the cognitive, receptive language, expressive language, fine motor, and gross motor subscales. Conclusion: infants with congenital syphilis treated at birth have a cognitive, language, and motor development within that expected for their age group in their first months of life.