Audiogram Estimation by Auditory Brainstem Response with NB CE-Chirp LS stimulus in Normal Hearing Infants.

Introduction NB CE-Chirp LS was developed to improve the audiogram estimation by auditory brainstem response (ABR) thresholds during audiological assessment of infants and difficult to test children. However, before we know how the stimulus behaves in several types of hearing loss, it is important we know how the stimulus behaves in normal hearing infants. Objective To describe ABR thresholds with NB CE-Chirp LS stimulus for 500, 1,000, 2,000, and 4,000 Hz, as well as the amplitude and absolute latency for ABR thresholds. Methods Auditory brainstem response thresholds were evaluated with the Eclipse EP25 system. NB CE-Chirp LS was presented using an ER-3A insert earphone. EEG filter was 30 Hz high-pass and 1,500 Hz low-pass. The ABR threshold was defined as the lowest intensity capable of clearly evoke wave V, accompanied by an absent response 5 dB below. Results Eighteen normal hearing infants were evaluated. The mean and standard deviation (SD) of the ABR threshold (dB nHL) were: 23.8 (±4.2); 14.4 (±5.7); 6.0 (±5.0); and 7.0 (±5.9). The mean and SD of the absolute latency (ms) were: 8.86 (±1.12); 9.21 (±0.95); 9.44 (±0.78); and 9.64 (±0.52). The mean amplitude (nV) and SD were: 0.123 (±0.035); 0.127 (±0.039); 0.141 (±0.052); and 0.105 (±0.028), respectively, for 500, 1,000, 2,000 and 4,000 Hz. Conclusion Auditory brainstem response threshold with NB CE-Chirp LS reaches low levels, in special for high frequencies. It provides absolute latencies similar between frequencies with robust amplitude. The results obtained brings to the examiner more confidence in the results registered.

Auditory brainstem response with click and CE-Chirp® Level Specific stimuli in hearing infants.

INTRODUCTION: The assessment of the integrity of the neural responses with ABR, aims to assist in the differential diagnosis of retrocochlear alterations. The gold standard stimulus for this assessment is Click. However, the CE-Chirp® Level Specific was developed to optimize the triggering of neural responses. OBJECTIVE: to compare neural responses obtained with CE-Chirp® LS stimulus to those obtained with Clicks at 70 dB nHL in hearing infants, in order to analyze advantages in using CE-Chirp® LS. METHODS: Eighteen infants with normal hearing were evaluated with Eclipse EP25 ABR System. Clicks and CE-Chirp® LS stimuli were presented using ER-3A insert earphones at 70 dB nHL, rate 45.1/s, and alternating polarity. A 30 Hz high-pass and 1500 Hz low-pass filter was applied, and ±40 µV artifact rejection level. Absolute latency of waves I, III and V and their interpeak intervals I-III, III-V and I-V were measured, as well as interaural difference for wave V and interpeak I-V, and wave V amplitude. RESULTS: Although 18 infants were included in the study, it was possible to collect data only in 30 ears for Click stimulus, and 33 ears for CE-Chirp® LS, according to exclusion criteria. It was possible to record waves I, III, and V for both stimuli at 70 dB nHL in all normal-hearing infants. CE-Chirp® LS stimulus evoked a higher wave V amplitude than Click (p < 0.001). Wave I absolute latency was statistically different between stimuli (p < 0.001), being delayed for CE-Chirp® LS. Wave III absolute latency was statistically different between stimuli only for the right ear (p = 0.021), and wave V absolute latency was similar in both stimuli (p = 0.210). Interpeak intervals I-III and I-V were statistically different between stimuli (p < 0.001), being reduced for CE-Chirp® LS. Interpeak interval III-V was different between the stimuli only for right ears (p = 0.006). There was no difference between stimuli for interaural difference wave V (p = 1.33) and interaural difference interpeak I-V (p = 0.409). CONCLUSION: It is possible to use CE-Chirp® LS stimulus in order to analyze neural synchrony in infants at 70 dB nHL, since better morphology waveforms were observed, and higher wave V amplitudes could be recorded. We suggest that new studies with infants with neurological disabilities and various hearing status, to observe how CE-Chirp® LS stimulus evokes neural responses in these conditions.

Speech-language disorders in children with congenital Zika virus syndrome: A systematic review.

INTRODUCTION: Having verified the true association between the Zika virus and the occurrence of microcephaly, studies were conducted to evaluate the effects of the infection on fetal development. Congenital Zika virus syndrome is a currently known condition but little addressed regarding speech, language, and hearing disorders in children. OBJECTIVE: To conduct a systematic review of speech, language, and hearing disorders in children with congenital Zika virus syndrome. METHODS: This systematic review followed the PRISMA instructions and the Joanna Briggs Institute guidelines, and it was registered in PROSPERO (CRD42018111764). The databases consulted were Cochrane, SciELO, PubMed, LILACS, Scopus, Web of Science, and ScienceDirect. OpenGrey and OpenThesis were used to partially capture the "grey literature". Observational studies of children with microcephaly due to congenital Zika virus syndrome were included. The risk of bias was analyzed using the 2017 Joanna Briggs Institute. RESULTS: 707 records were obtained and, after excluding the duplicates, 644 studies remained. After applying the inclusion criteria, 24 articles were considered eligible. Children with congenital Zika virus syndrome presented abnormal persistence of primitive reflexes (94.7%), impaired cognitive development (95.1%), delayed neuropsychomotor development (between 92.8 and 100%), hypertonia (between 74.7% and 90.1%), impaired language development (between 68.42% and 100%), retrognathia (38.6%), craniofacial disproportion (between 32.9% and 95.8%), altered tongue frenulum (between 30% and 36.36%), the absence of stapedial reflexes (27.3%), dysphagia (between 14% and 88.9%), and hearing changes (between 5.8% and 68.42%). CONCLUSION: Children with congenital Zika virus syndrome may have speech, language, and hearing disorders such as hearing loss, dysphagia, alteration in the tongue frenulum, and delays in neuropsychomotor and language development.

Audiogram Estimation by Auditory Brainstem Response with NB CE-Chirp LS stimulus in Normal Hearing Infants

Abstract Introduction NB CE-Chirp LS was developed to improve the audiogram estimation by auditory brainstem response (ABR) thresholds during audiological assessment of infants and difficult to test children. However, before we know how the stimulus behaves in several types of hearing loss, it is important we know how the stimulus behaves in normal hearing infants. Objective To describe ABR thresholds with NB CE-Chirp LS stimulus for 500, 1,000, 2,000, and 4,000 Hz, as well as the amplitude and absolute latency for ABR thresholds. Methods Auditory brainstem response thresholds were evaluated with the Eclipse EP25 system. NB CE-Chirp LS was presented using an ER-3A insert earphone. EEG filter was 30 Hz high-pass and 1,500 Hz low-pass. The ABR threshold was defined as the lowest intensity capable of clearly evoke wave V, accompanied by an absent response 5 dB below. Results Eighteen normal hearing infants were evaluated. The mean and standard deviation (SD) of the ABR threshold (dB nHL) were: 23.8 (±4.2); 14.4 (±5.7); 6.0 (±5.0); and 7.0 (±5.9). The mean and SD of the absolute latency (ms) were: 8.86 (±1.12); 9.21 (±0.95); 9.44 (±0.78); and 9.64 (±0.52). The mean amplitude (nV) and SD were: 0.123 (±0.035); 0.127 (±0.039); 0.141 (±0.052); and 0.105 (±0.028), respectively, for 500, 1,000, 2,000 and 4,000 Hz. Conclusion Auditory brainstem response threshold with NB CE-Chirp LS reaches low levels, in special for high frequencies. It provides absolute latencies similar between frequencies with robust amplitude. The results obtained brings to the examiner more confidence in the results registered.

Diagnóstico audiológico de lactentes após falha na triagem auditiva neonatal universal / Hearing assessment after referral in universal newborn hearing screening

RESUMO Objetivo Estudar o processo de diagnóstico audiológico de lactentes que falharam na Triagem Auditiva Neonatal Universal (TANU). Métodos Análise dos prontuários de 51 lactentes que falharam na TANU nas maternidades do munícipio e que foram encaminhados a um centro de referência em saúde auditiva para diagnóstico audiológico, entre janeiro e junho de 2021. Foram identificados os lactentes que finalizaram o diagnóstico, aqueles que não compareceram ao agendamento para exames ou evadiram durante o processo. Tentativas de contato foram realizadas com os responsáveis pelos lactentes que evadiram, para identificar o motivo da evasão. Resultados O comparecimento ao diagnóstico ficou em 75%, com evasões entre o encaminhamento da maternidade para o centro de referência, bem como durante o processo de diagnóstico. Cinquenta por cento dos sujeitos concluíram as avaliações audiológicas até os 3 meses de vida. A tentativa de contato foi bem-sucedida com os responsáveis pelos lactentes que evadiram, sendo os motivos mais frequentes: adoecimento do lactente, distância entre a moradia e o centro de referência, horário de trabalho dos pais. Conclusão Na etapa de diagnóstico, o índice de comparecimento e o tempo de conclusão até o terceiro mês de vida da criança ficaram abaixo dos índices recomendados, diminuindo a efetividade do Programa de Triagem Auditiva Neonatal Universal (PTANU). A busca ativa por contato telefônico e uso de aplicativo de mensagem telefônico foi importante para reduzir a evasão em 76%. Outras ferramentas que aprimorem o processo para um diagnóstico não prolongado, evitando evasões, necessitam ser estudadas.

ABSTRACT Purpose To study the process of hearing assessment in infants who were referred by professionals responsible for Universal Newborn Hearing Screening (UNHS). Methods Analysis of the medical records of 51 infants referred by maternity hospitals where UNHS was performed and were referred to a Hearing Health Center, between January and June 2021. Infants who completed hearing assessment, who never attended the appointments, or were lost during the diagnostic process were identified. Attempts were made to contact infants' guardians in order to understand the reason for missing the appointments. Results The attendance to the diagnosis was 75%. Fifty percent of the infants completed hearing assessment as recommended, up to 3 months of life. The attempt to contact parents who missed the appointments was successful, and the most frequent reasons are: the infant was ill on the day of scheduled appointment, distance from home to the hearing health center, parents' working hours. Conclusion For the diagnostic stage, the attendance rate and the age for completing hearing assessment were below the recommended. The active search for telephone contact and use of phone messaging application was important to reduce evasion by seventy-six percent. Tools that optimize the diagnostic process with less infants missing still must be studied.

Hearing Screening in children with Congenital Zika Virus Syndrome in Fortaleza, Ceará, Brazil, 2016. / Triagem auditiva de crianças com síndrome congênita pelo vírus Zika atendidas em Fortaleza, Ceará, 2016.

OBJECTIVE: to describe the results of hearing screening performed in children with Congenital Zika Virus Syndrome (CZS) in Fortaleza, Ceará, Brazil. METHODS: this was a descriptive cross-sectional study involving children with CZS receiving health care in Fortaleza, 2016; the hearing screening tests performed were immittance audiometry, transient otoacoustic emissions (TOAE), acoustic reflexes, and cochleopalpebral reflex (CPR). RESULTS: The study included 45 children with an average age of 10 months. 44 of them underwent tympanometric screening, with 16 of these having the right ear within the normal range and 22 having the left ear within the normal range. Among the 43 children evaluated by TOAE, 30 "passed" in both ears, nine "refered" in both ears and four "refered" just in ear; 13/43 "refered" and needed to repeat screening. 43 children evaluated by CPR, 37 showed responses. CONCLUSION: most of the children evaluated had completed cochlear function and middle ear results refer in compatible with their age range.

Electrophysiologic threshold study in air and bone conduction in children with 2 months or less age.

UNLABELLED: The differential diagnosis of hearing loss with air and bone Auditory Brainstem Response in small children has not been enough studied in Brazil. AIM: To compare air and bone Auditory Brainstem Response results in children under 2 months of age with normal hearing. STUDY DESIGN: clinical with transversal cohort. MATERIALS AND METHODS: 12 children who passed the hearing screening were evaluated using air and bone Auditory Brainstem Response. No contralateral masking was used in the bone conduction test. The responses were compared and analyzed by the McNemar test and repetitive measurements of the variance test. RESULTS: There were no statistic differences between air and bone conduction Auditory Brainstem Response thresholds (p>0.05). The bone conduction latency for wave V was statistically higher than air conduction latency (p=0.000). CONCLUSION: There was agreement on the results recorded for air and bone conduction Auditory Brainstem Response for threshold intensities; latency for bone conduction wave V was statistically higher than the air conduction latency.

[Distortion product otoacoustic emissions in infants from birth to two months]. / Emissões otoacústicas: produto de distorção em lactentes até dois meses de idade.

BACKGROUND: There is a need to determine parameters for the analyses of the distortion product otoacoustic emissions (DPOAE) of infants so that it can be used as a clinical criterion in auditory assessment. AIM: To describe the DPOAE records of infants from birth to two months, considering the response level, noise level and the signal to noise ratio in all frequencies; the analysis of response level according to the variables of gender, timpanometry pressure peak, state of infant during the test and distribution of the response percentile level. METHOD: 138 infants were evaluated, all of which presented no risk indicators for hearing loss and passed the hearing screening test. The parameters used were: L1=65 dB SPL and L2=50 dB SPL in the equipment ILO292-Otodynamics. RESULTS: 70 male and 68 female were evaluated, with ages between 6 to 65 days. The medians for DPOAE level for each frequency (f2) varied between 6.0 dB SPL and 16.3 dB SPL. The medians for the noise level for each frequency (f2) varied between -12.5 dB SPL and -2.1 dB SPL. The medians for the signal to noise ratio for each frequency (f2) varied between 10.5 dB SPL and 25.5 dB SPL. CONCLUSIONS: There was no statistically significant difference between genders and between ears for the response level. The timpanometry pression peak determined by three groups (between -50 and +50 daPa; <-50 daPa and >+50 daPa) indicated no influence on records of the response level. For clinical interpretation, percentile 5 can suggest hearing loss and percentile 95 can suggest normal hearing. Studies with infants who present hearing loss are considered important in order to complement the clinical criterion in case of presence of DPOAE and hearing loss.

Processo do diagnóstico audiológico de bebês após a falha na triagem auditiva neonatal / Infants Hearing Assessment process after referring newborn hearing screening / Proceso del diagnóstico audiológico de bebés después del fallo en la audición neonatal

Introdução: É imprescindível o diagnóstico audiológico até o terceiro mês de vida para que se possa iniciar uma intervenção precoce, permitindo que a criança desenvolva adequadamente a fala e a linguagem. Porém este processo enfrenta diversas barreiras que dificultam sua conclusão. Objetivo: Analisar o processo do diagnóstico audiológico em bebês que falharam na triagem auditiva neonatal, descrevendo a idade na realização da triagem e do diagnóstico, os motivos das evasões e faltas durante o processo, motivos para demora na finalização do diagnóstico, e os resultados audiológicos daqueles que finalizaram este processo. Métodos: Estudo quantitativo, descritivo, observacional, realizado em um Centro de Referência em Saúde Auditiva. Foram analisados os prontuários de 68 crianças que falharam na TAN, nas maternidades da Prefeitura Municipal de São Paulo, e encaminhadas para o Centro de Referência, no período de janeiro a junho de 2019. Os dados foram analisados com base nos critérios de qualidade estabelecidos por comitês nacionais e internacionais. Resultados: O serviço teve adesão abaixo do esperado no diagnóstico audiológico (76,5%) e o contato com os que evadiram, via telefone, não foi eficiente (75%). O indicador de risco com maior ocorrência foi a permanência na UTI por mais de cinco dias (25%). Das crianças que permaneceram no processo, metade concluiu o diagnóstico, o restante não tinha encerrado (42,2%) ou evadiu do mesmo (7,7%). A maioria das crianças que finalizaram o diagnóstico, apresentavam alguma perda auditiva (65,4%). Conclusão: O critério de qualidade não foi alcançado no comparecimento ao diagnóstico, sendo abaixo dos 90% recomendáveis. Novas estratégias necessitam ser tomadas, diminuindo a evasão no diagnóstico audiológico, dentre elas, outras formas de contato com as famílias e a integração entre atenção básica e os serviços de referência em Saúde Auditiva.

Introduction: Hearing assessment is essential until the third month of life in order to enable early intervention, allowing the child's proper speech and language development. Nevertheless, this process faces several barriers that may delay its conclusion. Purpose: To investigate aspects in the hearing assessment process in infants who refers newborn hearing screening (NHS), describing the age at which screening and diagnosis were performed, the reasons for evasion or loss to follow up, and reasons for missing appointments during the process, reasons for delay in completing the diagnosis, and the audiological results of those who completed this process. Methods: This is a quantitative, descriptive, and observational study that was carried out at a hearing health center in São Paulo. The study analyzed 68 medical records from children who referred NHS, born in São Paulo city maternity hospitals, and then referred to a hearing health center, from January to June 2019. Data were analyzed based on the quality criteria established by national and international committees. Results: There was an adherence lower than expected for hearing assessment (76.5%); contact with parents using mobile phones, after missing the appointments, was not efficient (75%). NICU stay for more than five days was the most common risk indicator (25%). Half of the children analyzed process completed the diagnosis, 42.2% of the children were still in the process, and 7.7% were lost in the process. Most of the children who completed the diagnosis had some type and degree of hearing loss (65.4%). Conclusion: Although NHS is being performed as expected in more than 95% of the newborns, hearing assessment is not being completed in more than 90% of the children who referred NHS. New strategies are needed in order to reduce loss to follow-up in the hearing assessment process.

Introducción: La evaluación después de hacer referencia a la detección auditiva del recién nacido es una parte esencial del proceso y el proceso de diagnóstico debe terminar en el tercer mes de vida, con el fin de iniciar la intervención temprana, lo que permite el mejor desarrollo del habla y el lenguaje posible. Este proceso enfrenta varias barreras que pueden retrasar el deseo de la línea de tiempo. Objetivo: Analizar el proceso del diagnóstico audiológico en los bebés que fallaron en la detección auditiva, describiendo la edad en la que se realizó la selección y el diagnóstico, los motivos de evasión y ausencias durante el proceso, los motivos de la demora en la realización del diagnóstico y los resultados audiológicos correspondientes quien completó este proceso. Métodos: Estudio cuantitativo, descriptivo, observacional, realizado en un Centro de Referencia de Salud Auditiva. Se analizaron las historias clínicas de 68 niños que fallaron la detección auditiva en las maternidades de la Prefectura Municipal de São Paulo y se enviaron al Centro de Referencia, de enero a junio de 2019. Los datos se analizaron en base a los criterios de calidad establecidos por los comités nacionales e internacionales. Resultados: El servicio tuvo una adherencia por debajo de lo esperado en el diagnóstico audiológico (76,5%) y el contacto con los que escaparon, vía telefónica, no fue eficiente (75%). El indicador de riesgo con mayor ocurrencia fue la estancia en UCI por más de cinco días (25%). De los niños que permanecieron en el proceso, la mitad completó el diagnóstico, el resto no lo había terminado (42,2%) o lo había evadido (7,7%). La mayoría de los niños que completaron el diagnóstico tenían alguna pérdida auditiva (65,4%). Conclusión: No se alcanzó el criterio de calidad al momento de atender el diagnóstico, estando por debajo del 90% recomendado. Es necesario tomar nuevas estrategias, reduciendo la evasión en el diagnóstico audiológico, entre ellas, otras formas de contacto con las familias y la integración entre atención primaria y servicios de referencia en Salud Auditiva.

Resultados audiológicos em um grupo de crianças com microcefalia pela síndrome congênita do Zika virus / Audiological results in a group of children with microcephalia by congenital Zika virus syndrome

RESUMO Objetivo investigar a audição de crianças com microcefalia pela síndrome congênita do Zika vírus. Métodos a amostra foi composta de 11 crianças com microcefalia causada pela síndrome congênita do Zika vírus. A coleta teve início no primeiro semestre de 2017, sendo finalizada no primeiro semestre de 2018. Procedimentos realizados: avaliação otorrinolaringológica e audiológica: observação do comportamento auditivo e audiometria de reforço visual; imitanciometria, emissões otoacústicas evocadas por estímulo transiente, potencial evocado auditivo de tronco encefálico por via áerea e potencial evocado auditivo por estado estável com estímulo narrow band CE-chirp. As respostas comportamentais foram comparadas com as respostas do potencial evocado auditivo de estado estável. Resultados apresentaram respostas dentro do esperado para idade, na avaliação comportamental 11 crianças, com 20 dB bilateralmente para tons calibrados em campo, nas frequências de 500 Hz, 1 kHz, 2 kHz e 4 kHz, sendo que 2 delas conseguiram realizar a audiometria em campo com fone de inserção bilateralmente. Em relação às emissões otoacústicas, todas tiveram respostas presentes em ambas as orelhas, 10 crianças apresentaram timpanometria tipo A e uma (1) do tipo Ar. Quanto ao potencial evocado auditivo, as 8 crianças avaliadas apresentaram resultados dentro da normalidade, com nível mínimo de respostas em 20 dBNAn bilateralmente. No potencial evocado auditivo de estado estável, 6 crianças avaliadas apresentaram nível mínimo derespostas em 500 Hz, 1 kHz, 2 kHz e 4kHz, em 20 dBNAn, bilateralmente. Conclusão as crianças avaliadas não apresentaram perda auditiva neurossensorial.

ABSTRACT Purpose to investigate the hearing of children with microcephaly due to congenital Zika virus syndrome. Methods the sample consisted of eleven children with microcephaly due to the congenital Zika virus syndrome. The collection was carried out in the first semester of 2017 until the first semester of 2018. Procedures performed: otorhinolaryngological and audiological evaluation: observation of auditory behavior and visual reinforcement audiometry; immittance testing, transient evoked otoacoustic emissions, brainstem auditory evoked potential, and auditory steady-state evoked potential with narrow band CE-chirp stimulus. The behavioral responses were compared with the responses of the auditory steady-state evoked potential. Results eleven children presented responses as expected for age in the behavioral assessment, with 20 dB bilaterally for tones calibrated in the field at frequencies of 500 Hz, 1kHz, 2 kHz, 4 kHz, with 2 children being able to perform field audiometry with bilateral earphone insertion. Regarding the transient evoked otoacoustic emissions, all presented responses in both ears, ten children had tympanometry type A and one had type Ar tympanometry. Regarding the auditory evoked potential, 8 children had results within the normal range, with a minimum level of response at 20 dBnHL bilaterally. In the auditory steady-state evoked potential, 6 children had a minimum response level of 500 Hz, 1 kHz, 2 kHz, and 4 kHz, bilaterally, at 20 dBnHL. Conclusion the children did not present sensorineural hearing loss.

Establishing auditory steady-state response thresholds to narrow band CE-chirps(®) in full-term neonates.

UNLABELLED: Narrow band CE-chirps(®) were developed to provide a better synchronization of neural response due to the compensation of the traveling wave delay in the basilar membrane. These stimuli combined with a detection method that includes higher response harmonics on the auditory steady-state response (ASSR) recording was studied in this research. OBJECTIVE: (1) To establish air conduction thresholds for ASSR to narrow band CE-chirp(®) in normal hearing full-term neonates; (2) describe the test time needed for the above in one ear and (3) to compare the results in infants and normally hearing adults. METHOD: ASSR to air-conducted stimuli were obtained in 30 full-term neonates (14 girls and 16 boys) with an average age of 34.3h of life. All neonates were presented presence of transient-evoked otoacoustic emissions (TEOAE) and result "pass" in automatic ABR at 35dB nHL before ASSR test. ASSR thresholds of both ears of 10 normal hearing adults (5 girls and 5 boys) varied in age between 23 and 30 years and with hearing thresholds better than or equal to 15dB HL at all frequencies between 250 and 8000Hz were recorded to compare with the neonate data. RESULTS: The neonate ASSR thresholds estimated from 50% using cumulative distributions were 24.5, 13.5, 7.5 and 10dB nHL at 500, 1000, 2000, and 4000Hz, respectively. For the same frequency order, ASSR thresholds estimated from 90% of the neonates were 34.5, 28, 12.5 and 15dB nHL. It required 21.2 (±5)min on average to obtain threshold in each ear in neonates, with a range of 12-29min. When ASSR thresholds recorded in full-term neonates and adults were directly compared, the differences between these groups were not significant for 1000Hz (p=0.500), 2000Hz (p=0.610) and 4000Hz (p=0.362). However, at 500Hz, ASSR thresholds in neonates tend to be greater than in adults (p=0.001). CONCLUSION: In this study ASSR thresholds estimated from 90% of the neonates were 34.5, 28, 12.5 and 15dB nHL. It required 21.2 (±5)min on average to obtain threshold in each ear and ASSR thresholds to narrow band CE-chirp(®) in neonates are not significant for adults ASSR thresholds, except at 500Hz, when the ASSR thresholds in neonates tend to be greater than in adults.

Características demográficas e audiológicas da população pediátrica de um centro de referência em saúde auditiva de São Paulo / Demographic and audiological characteristics of a pediatric population in a hearing health care center in São Paulo / Características demográficas y audiológicas de la población pediátrica de un centro de referencia en salud auditiva de Sao Paulo

Introdução: A criação de políticas públicas regulamentando ações na atenção básica de promoção à saúde auditiva, prevenção e identificação de problemas auditivos, garante a reabilitação, dando proteção às pessoas com deficiência. Objetivo: Caracterizar os dados demográficos e audiológicos dos usuários de um centro de referência em saúde auditiva, do município de São Paulo. Método: Trata-se de estudo de caráter descritivo e retrospectivo, desenvolvido no Centro Audição na Criança (CeAC/DERDIC/PUCSP). Foram analisados 857 prontuários de pacientes que compareceram para avaliação audiológica e concluíram o diagnóstico, entre agosto/2010 e junho/2015. Foram extraídos os seguintes dados dos prontuários: sexo, data de nascimento, zona de moradia, realização da triagem auditiva neonatal (TAN), indicadores de risco para deficiência auditiva na história da criança, origem do encaminhamento, idade na primeira consulta, idade na finalização do diagnóstico audiológico e resultado do mesmo. Resultados: 64,2% das crianças atendidas residem na região Sul de São Paulo; 2 meses foi a idade média no início do diagnóstico; 54,8% das queixas foi suspeita de perdas auditivas seguida da necessidade de diagnóstico por falha na TAN (29,6%); 57,8% das crianças realizaram a TAN; 50,2% finalizaram o diagnóstico com idade superior a um ano, seguida pelas crianças de 0 à 3 meses (18,4%); o diagnóstico encontrado nas crianças foi de 22,4% de perdas auditivas sensórioneurais bilateralmente, 17,7% de perdas condutivas. Conclusão: A maioria da população atendida se origina em queixas de perdas auditivas e não pela demanda proveniente das maternidades que realizam a TAN. Nota-se ainda que o referido centro atende a população de sua área de referência.

ntroduction: The creation of public policies regulating actions in primary care to promote hearing health care, prevention and identification of hearing loss, ensures rehabilitation, providing support and protection of persons with disabilities, in addition to health. Objective: To characterize demographic and audiological data of users of a hearing health care center, in São Paulo City. Method: This is a descriptive and retrospective observational study developed at the Hearing in Children Center (CeAC). There were analyzed 857 patients' recordings of those who concluded the audiological assessment, from August 2010 to June 2015. The following data were extracted from the recordings: gender, date of birth, dwelling area, newborn hearing screening (NHS) tests performed, risk indicators for hearing loss in the children's history, origin of the referral, age at the first visit, age at diagnosis, and results for hearing status Results: 64.2% of the children live in the South region of São Paulo city; 2 months old was the mean age at the beginning of the diagnosis; 54,8% of the complaints were of hearing loss followed by refers after NHS (29.6%); 57.8% of the children performed NHS; 50,2% of children completed the diagnosis in the age group over one year old; auditory status was found to be 22,4% for bilaterally sensorial hearing loss, 17,7% for conductive hearing loss. Conclusion: The principal reason for searching diagnosis was hearing loss, and not because of refers after NHS. The center assists specially the children who live in the area for which the center is responsible, according to the hearing health policies.

Introducción: La creación de políticas públicas regulando acciones en la atención básica de promoción a la salud auditiva, prevención e identificación de problemas auditivos, garantiza la rehabilitación, dando amparo a las personas con discapacidad. Objetivo: Caracterizar los datos demográficos y audiológicos de los usuarios de un centro de referencia en salud auditiva. Método: Se trata de un estudio de carácter descriptivo y retrospectivo, desarrollado en el Centro AudicióndelNiño (CeAC/DERDIC/PUCSP). Se analizaron 857 prontuarios de pacientes que comparecieron para evaluación audiológica y concluyeron el diagnóstico, entre agosto/2010 a junio/2015. Se tomaron los siguientes datos: sexo, fecha de nacimiento, zona de vivienda, realización de lo rastreo auditivo neonatal(TAN), indicadores de riesgo para deficiencia auditivaen la historia del niño, origen del encaminamiento, edad en la primera consulta, edad en la finalización del diagnóstico audiológico y su resultado. Resultados: 64,2% de los niños atendidos residen en la región Sur de São Paulo; 2 meses fue el promedio de edad al inicio del diagnóstico; 54,8% de las quejas fue sospecha de pérdida auditiva, seguida de la necesidad de diagnóstico por fallo en el rastreo (29,6%); 57,8% de los niños realizaron rastreo; 50,2% finalizó el diagnóstico con edad superior a un año, seguido por niños de 0 a 3 meses 18,4%; el diagnostico encontrado fue de 22,4% de pérdidas auditivas sensorioneuronales bilaterales, 17,7% de pérdidas conductivas. Conclusión: La mayoría de la población atendida se origina a partir de quejas de pérdidas auditivas y no por demanda proveniente de las maternidades que realizan el rastreo. Se observa además que el referido centro atiende a la población de su área de referencia.

Avaliação audiológica em criança com microcefalia pelo zika vírus: estudo de caso / Audiological evaluation in a child with microcephaly zika vírus: case study / Evaluación audiológica en niño con microcefalia por zika virus: estudio de caso

Introdução: A microcefalia caracteriza-se pela medida do perímetro cefálico de um indivíduo com dois desvios-padrões abaixo da média populacional para sexo e idade. Sabe-se que crianças com microcefalia são consideradas de alto risco para perda auditiva. Portanto, é imprescindível a avaliação e monitoramento audiológico até o terceiro ano de vida. Dentro da bateria de exames, há atualmente novos estímulos, como o Ichirp, que se pode utilizar no Potencial Evocado Auditivo de Tronco Encefálico durante a avaliação. Objetivo: Descrever a avaliação audiológica de uma criança com microcefalia pelo Zika vírus. Método: Foi realizada uma bateria de exames audiológicos: meatoscopia, avaliação comportamental, imitânciometria e o Potencial Evocado Auditivo de Tronco Encefálico, com os estímulos clique e Ichirp. Esses exames foram aplicados em uma criança de sete meses, diagnosticada com microcefalia pelo Zika vírus. Resultados: A criança apresentou exames audiológicos dentro dos padrões de normalidade, com exceção da audiometria de reforço visual. Conclusão: A avaliação audiológica foi dentro dos padrões de normalidade. Deve-se monitorar até o terceiro ano de vida, devido ao risco da perda progressiva. Foram observadas, no PEATE, melhor morfologia e maiores latências das ondas no estímulo Ichirp, quando comparadas ao clique.

Introduction: Microcephaly is characterized by measuring the head circumference of an individual with two standard deviations below the population mean for sex and age. It is known that children with microcephaly are considered at high risk for hearing loss. Therefore, it is essential to evaluate and monitor the hearing until the third year of life. Within the battery of exams, there are currently new stimuli, such as Ichirp, that can be used in the Auditory Evoked Brain Stem Potential during the evaluation. Objective: To describe the audiological evaluation of a child with microcephaly by the Zika virus. Method: A battery of audiological exams was performed: meatoscopy, behavioural evaluation, imitanciometry and the Auditory Evoked Potential of Brain Stem, with the click and Ichirp stimuli. These tests were applied on a sevenmonth-old child diagnosed with microcephaly by the Zika virus. Results: The child presented audiological tests within the normal range, with the exception of visual reinforcement audiometry. Conclusion: The audiological evaluation was within the norms of normality. It should be monitored until the third year of life due to the risk of progressive loss. In the BAEP, better morphology and higher wave latencies were observed in the Ichirp stimulus when compared to the click.

Introducción: La microcefalia se caracteriza por la medida del perímetro cefálico de un individuo con dos desviaciones estándar debajo del promedio de la población para sexo y edad. Se sabe que los niños con microcefalia se consideran de alto riesgo para la pérdida auditiva. Por lo tanto, es imprescindible la evaluación y monitoreo audiológico hasta el tercer año de vida. Dentro de la batería de exámenes, hay actualmente nuevos estímulos, como el Ichirp, que se puede utilizar en el Potencial Evocado Auditivo de Tronco Encefálico durante la evaluación. Objetivo: Describir la evaluación audiológica de un niño con microcefalia por el Zika virus. Método: Se realizó una batería de exámenes audiológicos: meatoscopia, evaluación comportamental, imitánciometría y el Potencial Evocado Auditivo de Tronco Encefálico, con los estímulos clic y Ichirp. Estos exámenes se aplicaron en un niño de siete meses, diagnosticado con microcefalia por el Zika virus. Resultados: El niño presentó exámenes audiológicos dentro de los patrones de normalidad, con la excepción de la audiometría de refuerzo visual. Conclusión: La evaluación audiológica fue dentro de los patrones de normalidad. Se debe monitorear hasta el tercer año de vida, debido al riesgo de la pérdida progresiva. Se observaron, en el PEATE, mejor morfología y mayores latencias de las ondas en el estímulo Ichirp, cuando comparadas al clic.

Triagem auditiva de crianças com síndrome congênita pelo vírus Zika atendidas em Fortaleza, Ceará, 2016 / Triagem auditiva de niños con síndrome de Zika Virus Congénita en Fortaleza, Ceará, Brasil, 2016 / Hearing Screening in children with Congenital Zika Virus Syndrome in Fortaleza, Ceará, Brazil, 2016

Objetivo: descrever resultados da triagem auditiva em crianças com síndrome congênita pelo vírus Zika (SCZ) atendidas em Fortaleza, Ceará, Brasil. Métodos: estudo transversal descritivo envolvendo crianças com SCZ atendidas durante o II Mutirão de Zika, em Fortaleza, em dezembro de 2016; os exames realizados na triagem auditiva foram imitanciometria, emissões otoacústicas transientes (EOAT), reflexos acústicos e reflexo cócleo-palpebral (RCP). Resultados: foram incluídas 45 crianças com idade média de 10 meses. Destas, 44 realizaram triagem timpanométrica, das quais 16 se apresentaram dentro da normalidade na orelha direita e 22 na orelha esquerda. Entre as 43 crianças avaliadas pelas EOAT, 30 "passaram" nas duas orelhas, nove "falharam" nas duas orelhas e quatro "falharam" em uma orelha; 13/43 falharam, sendo necessário repetir a triagem. Das 43 crianças avaliadas pelo RCP, 37 apresentaram respostas presentes. Conclusão: a maioria das crianças apresentou função coclear íntegra e alterações de orelha média compatíveis com a faixa etária.

Objetivo: describir los resultados de un cribado auditiva en niños con síndrome congénito del virus Zika (SCZ) en Fortaleza, Ceará, Brasil. Métodos: estudio transversal donde participaron niños con SCZ atendidos en Fortaleza, 2016; fueron evaluados mediante immittanciometría, emisiones otoacústicas transitorias (TEOAE), reflejos acústicos y reflejo cocleo-párpado. Resultados: 45 niños con una edad media de 10 meses; entre las 44 orejas del lado derecho, 16 niños se encontraban normal y 28 fallaron a la detección timpanométrica; para el oído izquierda, 22 niños estaban dentro del rango normal y 22 presentaban fallas; entre los 43 niños evaluados por TEOAE, 30 "pasaron" en ambas orejas, nueve "fallaron" en ambas y cuatro "fallaron" en una; 13/43 fallaron, necesitando repetir la clasificación; de los 43 niños evaluados mediante RCP, 37 presentaron las respuestas actuales. Conclusión: la mayoría de los niños tenían una función coclear completa y cambios en el oído medio compatibles con el grupo de edad.

Objective: to describe the results of hearing screening performed in children with Congenital Zika Virus Syndrome (CZS) in Fortaleza, Ceará, Brazil. Methods: this was a descriptive cross-sectional study involving children with CZS receiving health care in Fortaleza, 2016; the hearing screening tests performed were immittance audiometry, transient otoacoustic emissions (TOAE), acoustic reflexes, and cochleopalpebral reflex (CPR). Results: The study included 45 children with an average age of 10 months. 44 of them underwent tympanometric screening, with 16 of these having the right ear within the normal range and 22 having the left ear within the normal range. Among the 43 children evaluated by TOAE, 30 "passed" in both ears, nine "refered" in both ears and four "refered" just in ear; 13/43 "refered" and needed to repeat screening. 43 children evaluated by CPR, 37 showed responses. Conclusion: most of the children evaluated had completed cochlear function and middle ear results refer in compatible with their age range.

Auditory steady-state response in children with cochlear hearing loss.

BACKGROUND: auditory steady-state response (ASSR) is indicated as a promising technique in the assessment of the hearing status of children. AIM: to investigate the level of agreement between the results of the ASSR and the visual reinforcement audiometry (VRA) in a group of children, thus examining the clinical applicability of this technique in hearing assessment of children. METHOD: participants were 14 children with ages between 4 and 36 months (mean 16 months) with the diagnosis of cochlear hearing loss. The ASSR was recorded in the frequencies of 0.5, 1, 2 and 4kHz for multiple simultaneous stimulation and the results were compared with the visual reinforcement audiometry (VRA). RESULTS: the intraclass correlation coefficients between ASSR and VRA were 0.90, 0.93, 0.93 and 0.89 respectively for the frequencies of 0.5, 1, 2 and 4kHz, indicating a strong correlation between the techniques. CONCLUSION: the ASSR can provide accurate information to support the selection of hearing aids for children when it is not possible to perform the VRA.

Potencial evocado auditivo de longa latência em crianças com deficiência auditiva sensorioneural e usuárias de aparelho de amplificação sonora individual / Long latency auditory evoked potential in children with sensorineural hearing impairment and hearing aids users / Potencial evocado auditivo de larga latencia en niños con deficiencia auditivaneurosensorial y los usuarios de equipos de amplificacións de escucha individual

Objetivo: Descrever os resultados dos potenciais evocados auditivos de longa latência (complexo P1-N1-P2) em crianças com deficiência auditiva sensorioneural e usuárias de aparelho de amplificação sonora individual (AASI). Método: Participaram da pesquisa 10 crianças com perda auditiva sensorioneural congênita, com graus de moderado a profundo, idades entre dois e oito anos, que estavam em acompanhamento num centro de referência em audiologia de São Paulo.Foram coletados dados sobre as características audiológicas e sobre a terapia fonoaudiológica. Os potenciais evocados auditivos de longa latência (PEALL) foram registrados nos testes sem AASI,utilizando fones de inserção na intensidade de 85dBNPS,e com AASI por meio de um alto-falante na intensidade de 100dBNPS. Resultados:As crianças com ausência dos PEALL no teste sem AASI tinham grau de perda auditiva severa e profunda. No teste com AASI, em toda a amostra foram identificados os PEALL. Houve uma correlação sugestiva de significância entre a idade auditiva e o tempo de latência de P1-N1. Na análise entre idade de início do uso do AASI, horas semanais de terapia, abordagem terapêutica e uso sistemático do AASI, não houve associação com a latência de P1-N1. Conclusão: As crianças com o grau de perda auditiva moderada apresentaram presença dos PEALL nos testes sem e com AASI.As crianças que tinham o grau de perda auditiva severa e profunda apresentaram ausência dos PEALL nos testes sem AASI. Todos os voluntários tiveram presença dos PEALL no teste com AASI. O valor de latência de P1 foi aumentado, independenteda idade auditiva.

Objective: To describe the results of auditory evoked potentials of long latency (complex P1-N1-P2) in children with sensorineural hearing loss and individual hearing aid users (hearing aid). Method: There were 10 children with congenital sensorineural hearing loss, with degrees from mild to profound, aged two to eight years, who were followed at a referral center for Audiology of São Paulo. Data were collected about the audiological features and the speech therapy. The auditory evoked potentials of long latency (LLR) were recorded without HA tests using insert earphones in the intensity of 85 dB SPL, and hearing aids through a speaker on the intensity of 100 dB SPL.Results: Children with lack of LLAEP without HA test had grade severe and profound hearing loss. In the test with hearing aids in the whole sample LLEAP were identified. There was a significant suggestive correlation between age and hearing P1-N1 latency time. In the analysis between age of onset of use of hearing aids, weekly hours of therapy, therapeutic approach and systematic use of hearing aids, there was no association with the latency of P1-N1. Conclusion: Children with moderate degree of hearing loss showed presence of LLAEP in the tests with and without hearing aids. Children who had the degree of severe and profound hearing loss had no LLAEP without HA tests. All volunteers had LLAEP presence of the test with hearing aids. The value of P1 latency was increased, regardless of hearing age.

Objetivo: Describir los resultados de los potenciales evocados auditivos de larga latencia (complejo P1-N1-P2) en niños con deficiencia auditiva neurosensorial y usuarios de audífonos individuales. Método: Participan en el estudio 10 niños con deficiencia auditiva congénita neurosensorial, de grado moderado a profundo, de 2 a 8 años de edad, que fueron acompañados en un centro de referencia de San Pablo. Fueron colectados datos sobre la pérdida auditiva y la terapia fonoaudiológica. Los potenciales evocados auditivos de larga latencia (PEALL) fueron registrados en los testes sin audífonos individuales(AASI), utilizando auriculares de inserción en intensidad 85dBNPS y con audífonos individuales por medio de un parlante en intensidad 100dBNPS. Resultados: Los niños con ausencia de PEALL en los testes sin audífonos individuales tuvieron grado de pérdida auditiva grave y profunda. En los testescon audífonos individuales en toda la muestra fueron identificados los PEALL. Hubo una correlación sugestiva de significancia entre la edad auditiva y el tiempo de latencia P1-N1. En el análisis entre edad de inicio de uso de los audífonos individuales, horas semanales de terapia, acercamiento terapéutico y uso sistemático de audífonos individuales, no hubo asociación con la latencia de P1-N1. Conclusión: Los niños con grado de pérdida auditiva moderada presentaron presencia de PEALL en los testes sin y con audífonos individuales. Los niños con pérdida auditiva grave y profunda presentan ausencia de PEALL en los testes sin audífonos individuales. Todos los voluntarios tuvieron presencia de PEALL en los testes con audífonos individuales. El valor de latencia de P1 fue aumentado, independiente de la edad auditiva.

Multiprofessional committee on auditory health: COMUSA.

Created in 2007, COMUSA is a multiprofessional committee comprising speech therapy, otology, otorhinolaryngology and pediatrics with the aim of debating and countersigning auditory health actions for neonatal, lactating, preschool and school children, adolescents, adults and elderly persons. COMUSA includes representatives of the Brazilian Audiology Academy (Academia Brasileira de Audiologia or ABA), the Brazilian Otorhinolaryngology and Cervicofacial Surgery Association (Associação Brasileira de Otorrinolaringologia e Cirurgia Cérvico Facial or ABORL), the Brazilian Phonoaudiology Society (Sociedade Brasileira de Fonoaudiologia or SBFa), the Brazilian Otology Society (Sociedade Brasileira de Otologia or SBO), and the Brazilian Pediatrics Society (Sociedade Brasileira de Pediatria or SBP).

Triagem auditiva neonatal com emissão otoacústica transiente utilizando estímulo de banda estreita / Neonatal hearing screening with transient evoked otoacoustic emissions using narrow band stimulus

OBJETIVO: avaliar a sensibilidade e a especificidade de um equipamento automático de Emissão Otoacustica Evocada Transiente que utiliza um estímulo de banda estreita, Narrow. MÉTODOS: foi analisado o resultado da Triagem Auditiva Neonatal de 300 neonatos. A Emissão Otoacústica Evocada Transiente foi realizada com um equipamento portátil automático, com o estímulo de banda estreita - Narrow. Todos os neonatos foram submetidos ao Potencial Evocado Auditivo de Tronco Encefálico com o estímulo clique, duração 100μs como padrão-ouro. RESULTADOS: o percentual de "passa" na Triagem Auditiva Neonatal foi de 90,7%. Considerando os resultados do padrão-ouro, foi observado uma taxa de falso-positivo de 9%. A sensibilidade e especificidade encontradas foram de 100% e 92%, respectivamente. CONCLUSÃO: o estímulo de banda estreita - Narrow mostrou-se eficaz para ser utilizado nos programa de Triagem Auditiva Neonatal Universal. .

PURPOSE: to assess the sensitivity and specificity of an automated Transient Evoked Otoacoustic Emissions equipment using narrow band stimulus. METHODS: the hearing screening results of 300 newborns were analyzed. A portable automated equipment was used with narrow band stimulus to conduct the Transient Evoked Otoacoustic Emissions. All newborns were also submitted to the Brainstem Auditory Evoked Potentials using 100μs-duration click stimuli, which was considered the gold standard test. RESULTS: the proportion of "pass" results in the neonatal hearing screening was 90.7%. Considering the gold standard results, it was observed a false-positive rate of 9%. The Transient Evoked Otoacoustic Emissions with narrow band stimulus presented sensitivity of 100% and specificity of 92%. CONCLUSION: the narrow band stimulus was efficient enough to be used in neonatal hearing screening programs. .

Potencial evocado auditivo de tronco encefálico por frequência específica por via aérea e via óssea em neonatos ouvintes normais / Air and bone-conduction frequency-specific auditory brainstem response in neonates with normal hearing

Objetivo determinar os níveis mínimos de resposta (NMR) e a latência da onda V do Potencial Evocado Auditivo de Tronco encefálico por Frequência específica (PEATE-FE) em neonatos ouvintes normais nas frequências de 0.5, 1, 2 e 4 kHz por via aérea e via óssea e determinar valores normativos. Métodos foram avaliados neonatos com audição normal, sendo realizado o PEATE-FE nas frequências de 0.5, 1, 2 e 4 kHz, tanto por via aérea (VA) quanto por via óssea (VO). Para cada frequência, foram avaliadas 12 orelhas em um total de 18 neonatos. A análise dos resultados avaliou o tempo de latência e a presença da onda V até a intensidade de 20 dBnNA para quatro intensidades e para os dois tipos de condução (aérea e óssea). Resultados observou-se aumento da latência da onda V com a diminuição da intensidade e maiores latências nas frequências mais baixas, tanto na VA quanto na VO. Porém, em fortes intensidades, em ambas condições, não houve diferença entre as latências de 0.5 e 1 kHz, contrariando os achados da literatura. Para VA, na frequência de 500 Hz, houve presença da onda V até 30 dBnNA em todas as orelhas, e em 1000 Hz, 11 orelhas (91,66 %) apresentaram resposta em 20 dBnNA; nas demais frequências, 100% das orelhas avaliadas apresentaram resposta em 20 dBnNA. Na VO, a presença da onda V em 20 dBnNA foi observada em todas as frequências estudadas. Conclusão os valores descritos podem ser considerados normativos e utilizados na clinica como padrão de normalidade, auxiliando no diagnóstico diferencial da perda auditiva ao nascimento. .

Purpose to determine the minimum response and the latency of V wave in the Frequency-specific auditory brainstem responses (FS-ABR) in normal hearing neonates at the frequencies: 0.5, 1, 2 and 4 kHz by air and bone conduction and to determine normative values. Methods normal hearing neonates were assessed with FS-ABR at 0.5, 1, 2 and 4 kHz, air and bone conduction. Twelve ears were assessed in each frequency, totalizing 18 neonates. Results analysis considered the latency and the presence of wave V until 20 dB nHL in air and bone conduction, for four intensities. Results it was observed an increase of wave V latency with the decrease of intensity, and greater latencies at lower frequencies in both air and bone conduction. Nevertheless, there was no difference between the latencies at 0.5 and 1 kHz with strong intensity stimuli in both conditions, contrasting to literature findings. Considering air conduction, wave V was present at 0,5 kHz at 30 dB nHL in all ears and at 1 kHz 11 ears (91,66%) presented it at 20 dB nHL. All subjects (100%) presented responses to the other frequencies at 20 dBn HL. Considering bone conduction, all subjects presented wave V at 20 dB nHL in all frequencies. Conclusion the found values can be used in clinical practice in order to guide the differential diagnosis of hearing loss, complementing the evaluation as for hearing neonates. .

Processo de triagem auditiva neonatal e o impacto dos resultados / Newborn hearing screening and the impact of the results / Proceso del tamizaje auditiva neonatal y el impacto de los resultados

Introdução: O grande desafio na realização da triagem auditiva neonatal (TAN) é a utilização de técnicas que identifiquem crianças deficientes auditivas, com números baixos de falsos-positivos e falsos-negativos. O número de falsos-positivos e a falha na TAN podem gerar stress/impacto negativo aos pais. Método: A pesquisa foi realizada em uma maternidade pública de São Paulo, entre maio e outubro de 2008. Na primeira etapa foram entrevistados 64 responsáveis, cujos neonatos passaram, ou não, na TAN. Na segunda etapa foram entrevistadas oito mães que compareceram ao retorno. Resultados e Discussão: Dos entrevistados, 18,7% tinham entendimento prévio da TAN. O desconhecimento pode gerar mais stress e impacto negativo em relação à TAN. Outros 54,6% dos responsáveis estavam preocupados na realização do teste. A preocupação não teve relação direta com o resultado do teste. Quanto ao grau de preocupação após a informação do resultado, 31,2% citaram ter um nível de preocupação relacionado à falha da TAN. Na segunda etapa, das oito mães que retornaram para um novo teste, uma mãe estava muito preocupada: aquela cujo filho continuou mantendo a resposta inadequada após o teste. Conclusões: A TAN gera uma preocupação durante e após a sua realização, independentemente de os resultados serem satisfatórios ou não. As mães cujos neonatos não passaram na TAN mostraram uma maior preocupação com os resultados, necessitando assim assistência, apoio e informações antes da alta hospitalar. As informações devem ser realizadas oralmente e por meio de folhetos ilustrados, desde a gestação, para maior compreensão do processo de TAN.

Introduction: The major challenge in newborn hearing screening (NHS) is the right techniques that identify hearing impaired children with low numbers of false-positives and false-negatives. However, the number of false-positive and the fault in the NHS could be stressful and create a negative impact on their parents. Method: The study was conducted in a public hospital in São Paulo, between May and October 2008. In the first stage 64 volunteers were interviewed whose neonates passed or not the NHS. In the second stage, eight mothers who attended in return, were interviewed. Results and Discussion: The volunteers, 18.7% had a prior understanding of the NHS, the ignorance can cause more stress andnegative impact. 54.6% of parents were concerned for testing. The concern has no direct relationship with the results. The degree of concern after the information of income, 31.2% cited having a level of concernrelated to TAN failure. In the second stage, eight mothers were interviewed. A mother was very worried, one whose son continued keeping inadequate response after the test. Conclusions: The NHS generates a concern during and after the NHS process, regardless of the results satisfactory or not. Mothers whose infants failed the NHS showed a greater concern with the results, thus requiring assistance, support andinformation before discharge from hospital. The information must be made orally and through illustrated leaflets, from gestation to greater understanding of the NHS process.

Introducción: El grande desafío en Tamizaje Auditiva Neonatal (TAN) es el uso de técnicas para identificar los niños sordos, con bajos números de falsos-positivos y falsos-negativos. El fallo en la TAN y el número de falsos-positivos, pueden generar estrés e impacto negativo en los padres. Método: El estudio fue realizado en una maternidad pública de São Paulo, entre mayo y octubre 2008. En la primera fase 64 responsables fueron entrevistados, cuyos recién nacidos fallaron o no en la TAN. En la segunda fase se entrevistó a ocho madres que acordaron volver. Resultados y Discusión: De los entrevistados el 18.7% tenían un conocimiento previo de la TAN. La falta de conocimientos puede generar más estrés y impacto negativo en relación a la TAN. Otro 54,6% de los entrevistados estaban preocupados por el examen. La preocupación no tubo relación directa con el resultado. En lo que respeta al grado de preocupación después de la información de los resultados, el 31,2% refirió tenerla con relación a falla en la TAN. En la segunda fase, de las ocho madres que volvieron para nueva prueba, una estaba muy preocupada: aquella cuyo hijo siguió manteniendo la respuesta inadecuada después de la prueba. Conclusiones: El TAN genera una preocupación durante y después de su realización, independientemente de resultados satisfactorios o no. Las madres cuyos hijos fallaron en la TAN mostraron mayor preocupación con los resultados, necesitando de asistencia, apoyó e informaciones antes del alta hospitalar. Las informaciones deben ser realizadas en charlas y por medio de folletos ilustrados, desde de la gestación, para mayorcomprensión del proceso de TAN.