Elderly people with hearing loss and cognitive decline: speech perception performance in noise. / Idosos com perda auditiva e declínio cognitivo: desempenho da percepção de fala no ruído.

PURPOSE: To verify the influence of verbal intellectual-cognitive skills on speech perception in noise, in elderly with sensorineural hearing loss, considering education, age, and degree of hearing loss. METHODS: 36 elderly between 60 and 89 years old with bilateral sensorineural hearing loss participated in the study. After psychological assessment using the Wechsler Intelligence Scale for Adults (WAIS-III), they were grouped into (GI) 24 elderly without cognitive alteration and (GII) 12 elderly with risk of cognitive alteration. They underwent otorhinolaryngological assessment, audiological interview, pure tone audiometry, and assessment of speech perception in noise using the Hearing in Noise Test (HINT-Brazil). The Mann-Whitney U statistical test compared the results between the groups, and the Spearman correlation verified the variable's age, degree of hearing loss, and level of education. RESULTS: There was no difference between the groups in the ability to perceive speech in noise, except in the noise on the left condition, in which GII showed better performance in HINT-Brazil. The degree of hearing loss and level of education influenced the perception of speech in noise. The level of education was correlated with the WAIS-III results. CONCLUSION: The decline in verbal intellectual-cognitive skills did not affect speech perception of noise in the elderly with hearing loss. The degree of hearing loss and level of education influenced the performance of the elderly in the speech perception test in noise. Performance in verbal cognitive skills varied according to the level of education.

OBJETIVO: Verificar a influência das habilidades intelectuais-cognitivas verbais na percepção de fala no ruído, em idosos com perda auditiva sensorioneural, considerando a escolaridade, a idade e o grau da perda auditiva. MÉTODO: Participaram 36 idosos entre 60 e 89 anos com perda auditiva sensorioneural bilateral, que após avaliação psicológica por meio do Wechsler Intelligence Scale for Adults (WAIS III), foram divididos em (GI) 24 idosos sem alteração cognitiva e (GII) 12 idosos com risco de alteração cognitiva. Foram submetidos à avaliação otorrinolaringológica, entrevista audiológica, audiometria tonal liminar e a avaliação da percepção de fala no ruído por meio do Hearing in Noise Test (HINT-Brasil). O teste estatístico U de Mann-Whitney comparou os resultados entre os grupos, e a correlação de Spearman verificou as variáveis idade, grau da perda auditiva e nível de escolaridade. RESULTADOS: Não houve diferença entre os grupos na habilidade de percepção de fala no ruído, exceto na condição ruído à esquerda, no qual o GII apresentou melhor desempenho no HINT-Brasil. O grau da perda auditiva e o nível de escolaridade influenciaram na percepção de fala no ruído. O nível de escolaridade teve correlação com os resultados do WAIS III. CONCLUSÃO: O declínio das habilidades intelectuais-cognitivas verbais não interferiu na percepção de fala no ruído nos idosos com perda auditiva. O grau da perda auditiva e o nível de escolaridade influenciaram no desempenho dos idosos no teste de percepção de fala no ruído. O desempenho nas habilidades cognitivas verbais variou com o nível de escolaridade.

Frequency Modulation System and Bone Conduction Hearing Aid: Electroacoustic Verification.

Introduction A protocol has not yet been developed to perform electroacoustic measurements and behavioral tests to fit the frequency modulation (FM) system in bone conduction hearing aid (BCHA) users. Electroacoustic verification, with "FM transparency" achieved, ensures user audibility of FM transmitter and hearing aid signals. Objective To propose and validate a protocol for electroacoustic verification of the FM system coupled to the BCHA. Method Twenty-four sets of FM system and BCHA were submitted to electroacoustic verification, using a receiver and a plastic adapter to connect the BCHA to a 2cc coupler in the hearing instrument analyzer. The measurements were performed in the acoustic box, at 65 dB sound pressure level (SPL), with International Speech Test Signal (ISTS), first to the BCHA microphone and then to the FM system microphone, to determine the transparency, in which equivalent inputs for both microphones result in equivalent outputs. The FM gain or volume has been adjusted to try to gain transparency for the outputs of the two input devices. Results Transparency was achieved for all sets evaluated, but in some combinations, adjustments to the FM receiver gain over the manufacturer's default setting were required. Conclusion The proposed protocol proved to be effective for the electroacoustic verification of the FM system coupled to the BCHA.

P300-long-latency auditory evoked potential in normal hearing subjects: simultaneous recording value in Fz and Cz.

UNLABELLED: The P300 is and auditory Evoked Potential, called endogenous potential because it reflects the functional use the individual makes of the auditory stimulus, being highly dependent on cognitive skills; among them we list attention and auditory discrimination. It is a procedure of objective evaluation; however, one that depends on the examiner's experience to detect wave peaks, and it is important to use recording methods that facilitate the response presence analysis and result interpretation. AIM: To analyze the P300 Long Latency Auditory Evoked Potential obtained through the use of two active electrodes positioned on Fz and Cz. MATERIALS AND METHODS: 330 individuals from both genders and age ranging between 7 and 34 years participated in this study, they all had normal hearing and did not have any risk factor for mental problems. RESULTS: Results show that there was no statistically significant difference for N2 and P3 latency and P3 amplitude as far as gender is concerned, nor correlation with the individual's age. There was a strong correlation of these measures with Fz and Cz electrode positioning. CONCLUSION: Fz and Cz active electrodes positioning can be considered one more resource to help in the P300 clinical analysis.

Idosos com perda auditiva e declínio cognitivo: desempenho da percepção de fala no ruído / Elderly people with hearing loss and cognitive decline: speech perception performance in noise

RESUMO Objetivo Verificar a influência das habilidades intelectuais-cognitivas verbais na percepção de fala no ruído, em idosos com perda auditiva sensorioneural, considerando a escolaridade, a idade e o grau da perda auditiva. Método Participaram 36 idosos entre 60 e 89 anos com perda auditiva sensorioneural bilateral, que após avaliação psicológica por meio do Wechsler Intelligence Scale for Adults (WAIS III), foram divididos em (GI) 24 idosos sem alteração cognitiva e (GII) 12 idosos com risco de alteração cognitiva. Foram submetidos à avaliação otorrinolaringológica, entrevista audiológica, audiometria tonal liminar e a avaliação da percepção de fala no ruído por meio do Hearing in Noise Test (HINT-Brasil). O teste estatístico U de Mann-Whitney comparou os resultados entre os grupos, e a correlação de Spearman verificou as variáveis idade, grau da perda auditiva e nível de escolaridade. Resultados Não houve diferença entre os grupos na habilidade de percepção de fala no ruído, exceto na condição ruído à esquerda, no qual o GII apresentou melhor desempenho no HINT-Brasil. O grau da perda auditiva e o nível de escolaridade influenciaram na percepção de fala no ruído. O nível de escolaridade teve correlação com os resultados do WAIS III. Conclusão O declínio das habilidades intelectuais-cognitivas verbais não interferiu na percepção de fala no ruído nos idosos com perda auditiva. O grau da perda auditiva e o nível de escolaridade influenciaram no desempenho dos idosos no teste de percepção de fala no ruído. O desempenho nas habilidades cognitivas verbais variou com o nível de escolaridade.

ABSTRACT Purpose To verify the influence of verbal intellectual-cognitive skills on speech perception in noise, in elderly with sensorineural hearing loss, considering education, age, and degree of hearing loss. Methods 36 elderly between 60 and 89 years old with bilateral sensorineural hearing loss participated in the study. After psychological assessment using the Wechsler Intelligence Scale for Adults (WAIS-III), they were grouped into (GI) 24 elderly without cognitive alteration and (GII) 12 elderly with risk of cognitive alteration. They underwent otorhinolaryngological assessment, audiological interview, pure tone audiometry, and assessment of speech perception in noise using the Hearing in Noise Test (HINT-Brazil). The Mann-Whitney U statistical test compared the results between the groups, and the Spearman correlation verified the variable's age, degree of hearing loss, and level of education. Results There was no difference between the groups in the ability to perceive speech in noise, except in the noise on the left condition, in which GII showed better performance in HINT-Brazil. The degree of hearing loss and level of education influenced the perception of speech in noise. The level of education was correlated with the WAIS-III results. Conclusion The decline in verbal intellectual-cognitive skills did not affect speech perception of noise in the elderly with hearing loss. The degree of hearing loss and level of education influenced the performance of the elderly in the speech perception test in noise. Performance in verbal cognitive skills varied according to the level of education.

Extratympanic electrocochleography in the diagnosis of auditory neuropathy/auditory dyssynchrony.

UNLABELLED: The brainstem auditory evoked potential (BAEP) is being extensively used as a method for the evaluation of cochlear function in individuals with diagnosis of auditory neuropathy/auditory dyssynchrony (AN/AD). In the absence of otoacoustic emissions, many cases of AN/AD have been diagnosed by the presence of CM identified in the BAEP. AIM: to demonstrate the clinical applicability of extratympanic electrocochleography (ET-Ecochg) in the differential diagnosis of AN/AD compared to the BAEP. METHOD: a 4-year-old child with a diagnosis of AN/AD seen at the Audiological Research Center was submitted to ET-Ecochg with a 2000 Hz tone burst in rarefaction and condensation polarities. RESULTS: the ET-Ecochg exam was illustrated. Using an appropriate protocol, it was possible to demonstrate CM and to confirm it in the Ecochg, with a recording quality superior to that obtained in the BAEP. CONCLUSION: ET-Ecochg permitted a more detailed analysis of CM compared to the BAEP, thus showing clinical applicability for the investigation of cochlear function in AN/AD.

Cochlear implant and large vestibular aqueduct syndrome in children.

UNLABELLED: Children with LVAS can develop a severe sensorineural hearing loss early in childhood, but they can be rehabilitated with hearing aids to continue their regular studies and to have a normal life. The problem is that they can deteriorate their hearing capacity, and at this point a cochlear implant can be used to preserve their hearing skills and vocalization. AIM: to evaluate the hearing skills of 3 children with LVAS referred to cochlear implants. MATERIAL: retrospective study based on medical charts' review. RESULTS: Speech recognition in open field: patient 1, 80%; patient 2, 87.5%; patient 3, 4 %. CONCLUSION: Children with LVAS are considered good candidates for Cochlear implant surgery by the most important centers of the world because most of them can develop good speech recognition, providing them a good social life.

Vestibular function in cochlear implant users.

UNLABELLED: Balance alterations in the postoperative of cochlear implant surgeries varies from 31 to 75%. AIM: to analyze vestibular function in the pre and postoperative periods of cochlear implanted individuals. MATERIALS AND METHODS: the vestibular function was assessed, through electronystagmography, in 38 patients, in the pre and postoperative of cochlear implant procedures. RESULTS: The main complaint of unbalance reported by patients was dizziness, followed by postural vertigo and non-postural vertigo. Results: 13% of the patients did not show any balance disorder following cochlear implant surgery and just 5% showed symptoms worsening. 13 % of the patients showed an improvement, and this could be related to the vestibular compensation phenomenon and to electric stimulation. However, it was observed, in the caloric responses, a worsening in the vestibular system function, for both implanted and non-implanted ears. Thus, there is no evidence of more damage to the implanted ear. CONCLUSION: the study showed that cochlear implant surgeries could injure the vestibular system in both ears. However, the vestibular symptoms take place in a smaller proportion, and can improve after cochlear implant surgery.

[Auditory steady-state response in the auditory evaluation: clinical application]. / A resposta auditiva de estado estável na avaliação auditiva: aplicação clínica.

BACKGROUND: the auditory steady state response (ASSR) is an electrophysiological procedure that evaluates, at the same time, the hearing thresholds of both ears at various frequencies. This procedure reduces the time of testing and enables the stimulation of levels close to 125dB HL, characterizing residual hearing. AIM: to verify the applicability of the ASSR to determine the hearing thresholds in different levels of sensorineural hearing loss. METHOD: 48 individuals aged 7-30 years, with different levels of hearing loss were assessed. The Pure tone Audiometry (PTA) and the ASSR were carried out in following carrier frequencies 0.5; 1; 2 and 4k Hz. The carrier frequencies in the ASSR were modulated in amplitude and frequency, with multiple dicotic stimulation for mild and moderate hearing loss. Simple stimulation was used to test the other hearing deficit levels. RESULTS: there was a significant association (p<0.01) between the thresholds obtained in the PTA and in the ASSR for all of the tested frequencies, especially for the severe levels. However, for some patients, the hearing loss level was overestimated in the ASSR. CONCLUSION: the ASSR can be used to estimate the PTA threshold; nevertheless, it should not be analyzed in an isolated way, but seen as a complementary procedure to the behavioral auditory assessment.

[Electrophysiological study of the central and peripheral hearing system of aphasic individuals]. / Estudo eletrofisiológico do sistema auditivo periférico e central em indivíduos afásicos.

SUBJECT: Electrophysiology of the auditory system. OBJECTIVE: Electrophysiological evaluation of the peripheral and central auditory system of brain injured patients. METHOD: Experimental group: eleven brain injured and aphasic subjects, both genders and with ages ranging from 43 to 75; control group: eleven individuals without hearing complaints, equalized as to gender and age. The subjects were evaluated through auditory brainstem response (ABR); auditory middle latency response (AMLR) and auditory P300 response. RESULTS: An increase in the V wave latency and I-V interpeak in both groups, due to the age factor. The presence of statistically significant hemispheric differences when compared to the Pa component in MLAEP research, registered in the C3 (left hemisphere) and the C4 (right hemisphere). In researching the P300 Cognitive Potential, there was an absence or increase in P300 latency and a decrease in P300 amplitude in the presence of the N2 component. CONCLUSION: The AMLR and auditory P300 response have proven to be effective instruments for evaluating aphasic individuals.

Hearing aid fitting at SUS (Brazilian Public Health Care System) compared with a compact fitting model.

UNLABELLED: In the present days it is critical to identify the factors that contribute to the quality of the audiologic care provided. The hearing aid fitting model proposed by the Brazilian Unified Health System (SUS) implies multidisciplinary care. This leads to some relevant and current questions. OBJECTIVE: To evaluate and compare the results of the hearing aid fitting model proposed by the SUS with a more compact and streamlined care. METHOD: We conducted a prospective longitudinal study with 174 participants randomly assigned to two groups: SUS Group and Streamline Group. For both groups we assessed key areas related to hearing aid fitting through the International Outcome Inventory for Hearing Aids (IOI-HA) questionnaire, in addition to evaluating the results of Speech Recognition Index (SRI) 3 and 9 months after fitting. RESULTS: Both groups had the same improvement related to the speech recognition after nine months of AASI use, and the IOI-HA didn't show any statically significant difference on three and nine months. CONCLUSION: The two strategies of care did not differ, from the clinical point of view, as regards the hearing aid fitting results obtained upon the evaluation of patients in the short and medium term, thus changes in the current model of care should be considered.

Study on suppression of otoacoustic emissions: lateral domain.

UNLABELLED: A pon stimulation by contralateral, ipsilateral or bilateral noise, the medial olivocochlear efferent tract changes the amplitude of otoacoustic emissions relative to the tested ear, reducing or removing it; this resulted in a reduction/suppression effect of otoacoustic emissions. Differences in patterns of elimination/reduction of otoacoustic emissions between ears have been documented worldwide; there are, however, no Brazilian studies investigating the effect of lateral dominance. AIMS: To compare the effect of the presence of deletion/reduction of otoacoustic emissions and their amplitude relative to lateral dominance in normal hearing adults. METHODS: A clinical and experimental study. The sample comprised 75 individuals. The methodology was conventional - linear click intensity of 60 dB SPL; white noise was contralateral stimulation at 60 dB SPL. DESCRIPTION OF RESULTS: There were no statistically significant differences between right and left ear results, in terms of asymmetry of the degree of otoacoustic emissions and the presence of suppression/reduction. CONCLUSION: There is no lateral dominance in the degree of otoacoustic emissions in the presence of suppression/reduction in the study population.

Obstructive sleep apnea and P300 evoked auditory potential.

UNLABELLED: The obstructive sleep apnea syndrome (OSAS) reduces attention span, memory and concentration capacities, all associated with cognition. The analysis of the auditory P300 parameters could help infer cognitive dysfunction. OBJECTIVE: To compare the data from polysomnography and the auditory P300 in adults, primary snorers with OSAS patients. MATERIALS AND METHODS: Prospective study with primary snorers (N=12) and in OSAS patients (N=54), submitted to polysomnography, defined by the apnea-hypopnea index (AHI). The polysomnography and P300 variables were compared by the t-Student test, the Exact Fisher's Test, logistic regression and analysis of correlation with a significance level of 5%. RESULTS: AIH had an inverse correlation with the oximetry in both groups. The P300 prevalence was lower in the OSAS group (Fisher's Exact Test, p=0.027). Patient age did not influence the P300 prevalence (regression analysis; p=0.232). The P300 amplitude was lower in the OSAS group (t-Student test; p=0.003) and the P300 latency was similar in both groups (t-Student test; p=0.89). CONCLUSION: The reduction in the P300 amplitude in patients with OSAS suggests cognitive dysfunction induced by a reduction in auditory memory.

Auditory steady state response in pediatric audiology.

UNLABELLED: The main issue regarding pediatric audiology diagnosis is determining procedures to configure reliable results which can be used to predict frequency-specific hearing thresholds. AIM: To investigate the correlation between auditory steady-state response (ASSR) with other tests in children with sensorineural hearing loss. METHODS: Prospective cross-sectional contemporary cohort study. Twenty-three children (ages 1 to 7; mean, 3 years old) were submitted to ASSR, behavioral audiometry, click audiometry brain stem response (ABR), tone burst ABR, and predicting hearing level from the acoustic reflex. RESULTS: the correlation between behavioral thresholds and ASSR was (0.70- 0.93), for the ABR tone burst it was (0.73 -0.93), for the ABR click it was (0.83-0.89) only at 2k and 4 kHz. The match between the ASSR and the hearing threshold prediction rule was considered moderate. CONCLUSION: there was a significant correlation between the ASSR and audiometry, as well as between ABR click (2k and 4 kHz) and for the ABR tone burst. The acoustic reflex can be used to add information to diagnosis in children.

Medidas de imitância acústica de banda larga com estímulo chirp e tom puro em lactentes com normalidade de orelha média / Wideband acoustic immittance measures using chirp and pure tone stimuli in infants with middle ear integrity

RESUMO Objetivo: Caracterizar os valores de reflectância e absorvância de banda larga em lactentes com integridade de orelha média. Métodos: Foram analisados os valores de reflectância e absorvância de banda larga, para os estímulos chirp e tom puro, de 31 orelhas de 18 lactentes, na faixa etária de 10 dias a cinco meses de idade. Considerou-se como critérios de inclusão: ausência de fator de risco para deficiência auditiva, timpanometria com sonda de 1000 Hz, sugerindo normalidade de orelha média e presença de emissões otoacústicas evocadas por estímulo transiente, na triagem auditiva neonatal. Resultados: Os valores de reflectância mostraram-se maiores para as baixas frequências, reduzindo para as médias e aumentando, novamente, para as frequências altas, enquanto para os valores de absorvância, o comportamento foi o oposto. Não existiu diferença significativa entre os estímulos chirp e tom puro. Conclusão: Observou-se um comportamento típico das medidas estudadas, caracterizado por maior reflectância nas frequências graves e maior absorvância para as frequências médias.

ABSTRACT Purpose: To characterize the wideband reflectance and absorbance values in infants with middle ear integrity. Methods: The wideband reflectance and absorbance values for chirp and pure tone stimuli of 31 ears of infants aged 10 days to five months were analyzed. Inclusion criteria considered: 1000 Hz tympanometry. suggesting normal middle ear and the presence of transient evoked otoacoustic emission. Results: The reflectance values were shown to be greater for low frequencies, reducing to medium ones and increasing once again to high frequencies, while the absorbance values displayed an opposite behavior. No significant difference was verified between chirp and pure tone stimuli. Conclusion: A typical behavior of the measures, characterized by a higher reflectance at low frequencies and higher absorbance at medium frequencies was observed in the population studied.

Protocol to collect late latency auditory evoked potentials.

UNLABELLED: Long Latency Auditory Evoked Potentials (LLAEP) represents a number of electrical changes occurring in the central nervous system, resulting from stimulation of the auditory sensorial pathways. Many studies approach the use of these potentials controlling the artifact created by eye movement with the use of equipment with a large number of channels. However, what happens is very different in Brazilian clinical practice, where the equipment used has a very limited number of channels. AIM: to compare the two methods used to control the artifacts created by eye movements during LLAEP capture using two recording channels. MATERIALS AND METHODS: this is a prospective study with the application of two LLAEP capturing methods (eye artifact subtraction and rejection limit control) in 10 normal hearing individuals. RESULTS: we did not observe statistically significant differences concerning the latency values obtained with the use of both methods, only concerning amplitude values. CONCLUSION: both methods were efficient to capture the LLAEP and to control the eye movement artifact. The rejection limit control method produced greater amplitude values.

Age impact on the efferent system activities in cochlear mechanical properties in normal hearing individuals.

UNLABELLED: The medial olivocochlear tract has efferent control over the outer hair cells, regulating the slow contractions and damping the fast ones. Using ipsilateral, contralateral or bilateral otoacoustic emissions amplitude studies, it is possible to estimate the conditions of this tract, since the effect resulting from the reduction/suppression of these emissions indicate the tract's functioning. Aging implies an activity reduction in the central auditory system, because of the degeneration of the structures involved in hearing skills. AIM: our goal was to investigate the effects of age on the activities of this tract on the cochlea, through the analysis of the emissions' amplitude with contralateral acoustic stimulation. MATERIALS AND METHODS: Our series was made up of 75 individuals grouped according to age. The methodology was conventional, with a linear click and a white noise. CASE STUDY: the analysis considered the response from both ears and the comparison between the groups. RESULTS: the results show a statistically significant difference between the emissions' response with and without contralateral acoustic stimulation in the individuals between 20 and 39 years of age. The emissions reduction/suppression effect reduced with age (fourth decade). CONCLUSION: aging impairs the tract effectiveness.

Central hearing system maturation in normally hearing children.

BACKGROUND: the long latency auditory evoked potentials (LLAEP) provide objective data about the function of hearing cortical structures. AIM: to characterize the maturation of the central hearing system in normally hearing children. METHOD: record of LLAEP of fifty-six subjects with hearing tresholds within normal limits, of both genders, being 46 children and 10 adults. With the availability of two recording channels, one was directed to register the LLAEP and the other, to record the artifact generated by ocular movement, aiming at its control. The potentials were recorded with subjects in an alert state, through electrodes positioned in Cz (active) and A2 (reference), and the ocular movements, through electrodes in the left supra and infra-orbital positions; the ground electrode was placed in A1. The morphology and the values of latency and of amplitude for components P1, N1 and P2, according to age, were analyzed. In order to verify the reproducibility of the recorded potentials, a double blind study was carried out, by introducing the analysis of another evaluator. RESULTS: the double blind study did not present statistically significant differences between the analyses. With the increase in age there was an improvement in the morphology and a decrease in the latency values of components P1, N1 and P2. Also there was a decrease in the amplitude of component P1 and no variation in the amplitude values was observed for components N1 and P2. No statistically significant difference was observed between genders. CONCLUSION: the maturational process of the central hearing system occurs gradually, being the greatest changes observed when comparing children and adults.

The relationship between the speech perception and the degree of satisfaction among adult users of cochlear implants

INTRODUCTION: In recent years, the benefits associated with the use of cochlear implants (CIs), especially with regard to speech perception, have proven to surpass those produced by the use of hearing aids, making CIs a highly efficient resource for patients with severe/profound hearing loss. However, few studies so far have assessed the satisfaction of adult users of CIs. OBJECTIVE: To analyze the relationship between the level of speech perception and degree of satisfaction of adult users of CI. METHODS: This was a prospective cross-sectional study conducted in the Audiological Research Center (CPA) of the Hospital of Craniofacial Anomalies, University of São Paulo (HRAC/USP), in Bauru, São Paulo, Brazil. A total of 12 users of CIs with pre-lingual or post-lingual hearing loss participated in this study. The following tools were used in the assessment: a questionnaire, "Satisfaction with Amplification in Daily Life" (SADL), culturally adapted to Brazilian Portuguese, as well as its relationship with the speech perception results; a speech perception test under quiet conditions; and the Hearing in Noise Test (HINT)Brazil under free field conditions. RESULTS: The participants in the study were on the whole satisfied with their devices, and the degree of satisfaction correlated positively with the ability to perceive monosyllabic words under quiet conditions. The satisfaction did not correlate with the level of speech perception in noisy environments. CONCLUSION: Assessments of satisfaction may help professionals to predict what other factors, in addition to speech perception, may contribute to the satisfaction of CI users in order to reorganize the intervention process to improve the users' quality of life.

Adaptação do aparelho de amplificação sonora no SUS comparado com um modelo de adaptação compacto / Hearing aid fitting at SUS (Brazilian Public Health Care System) compared with a compact fitting model

Nos dias atuais é imprescindível identificar fatores que contribuem para a qualidade do atendimento audiológico prestado. O modelo de adaptação do AASI proposto pelo SUS implica no atendimento de multiprofissional para essa prática. Isto provoca alguns questionamentos necessários e atuais. OBJETIVO: Avaliar e comparar os resultados da adaptação do AASI do modelo de prestação de serviço proposto pelo SUS, com um modelo mais compacto e enxuto de atendimento. MÉTODO: Foi realizado um estudo prospectivo longitudinal, com 174 participantes distribuídos aleatoriamente em: grupo SUS e grupo Streamline. Para ambos os grupos, foi aplicado o questionário International Outcome Inventory for Hearing Aids (IOI-HA), além da avaliação do Índice de Reconhecimento de Fala (IRF) após 3 e 9 meses de adaptação. RESULTADOS: Os dois grupos tiveram a mesma melhora em relação ao reconhecimento de fala após 9 meses de uso dos AASI e, no questionário IOI-HA, não foi encontrada diferença estatisticamente significante aos três e nove meses. CONCLUSÃO: As duas estratégias de atendimento não tiveram diferença do ponto de vista clínico, no que diz respeito aos resultados obtidos na avaliação dos pacientes quanto à adaptação dos AASI obtidos a curto e médio prazo, devendo ser consideradas modificações no modelo atual de atendimento.

In the present days it is critical to identify the factors that contribute to the quality of the audiologic care provided. The hearing aid fitting model proposed by the Brazilian Unified Health System (SUS) implies multidisciplinary care. This leads to some relevant and current questions. OBJECTIVE: To evaluate and compare the results of the hearing aid fitting model proposed by the SUS with a more compact and streamlined care. METHOD: We conducted a prospective longitudinal study with 174 participants randomly assigned to two groups: SUS Group and Streamline Group. For both groups we assessed key areas related to hearing aid fitting through the International Outcome Inventory for Hearing Aids (IOI-HA) questionnaire, in addition to evaluating the results of Speech Recognition Index (SRI) 3 and 9 months after fitting. RESULTS: Both groups had the same improvement related to the speech recognition after nine months of AASI use, and the IOI-HA didn't show any statically significant difference on three and nine months. CONCLUSION: The two strategies of care did not differ, from the clinical point of view, as regards the hearing aid fitting results obtained upon the evaluation of patients in the short and medium term, thus changes in the current model of care should be considered.

Radiografia do implante coclear: técnica adaptada para aparelho portátil / Cochlear implant radiography: technique adapted into a portable apparatus

Considerando a indisponibilidade de equipamentos avançados de aquisição de imagens nos centros cirúrgicos da maioria dos centros hospitalares e a importância fundamental que têm para o cirurgião uma visualização imediata do implante coclear logo após sua inserção, uma boa opção é a utilização da radiografia convencional. OBJETIVO: Descrever um método radiográfico rápido prático e de baixo custo, que permita avaliar não só a posição, mas também a integridade dos eletrodos, na instalação do implante coclear. MATERIAL E MÉTODO: Foram analisadas radiografias de 262 pacientes submetidos à cirurgia de implante coclear entre Março/2005 e Outubro/2008, com radiografia transoperatória, logo após a inserção dos eletrodos. As radiografias foram analisadas pelo cirurgião no transoperatório e, posteriormente, pelo médico radiologista. RESULTADOS: Foram analisadas 524 radiografias das quais, 95,61 por cento apresentavam técnica adequada, com posicionamento do paciente dentro da técnica descrita neste estudo e boa visualização dos eletrodos, sendo consideradas satisfatórias e 4,39 por cento apresentavam técnica inadequada e/ou visualização insatisfatória dos eletrodos, sendo consideradas insatisfatórias. CONCLUSÃO: Apesar dos aparelhos de Raios X portáteis possuírem limitações, utilizando técnicas e acessórios adequados, é possível conseguir radiografias com resultados satisfatórios para visualização dos implantes cocleares.

The unavailability of advanced imaging equipment in the operating rooms of most hospitals - as well as the fundamental importance for surgeons of immediate observation of the cochlear implants soon after their insertion - makes conventional radiography a good option. OBJECTIVE: To describe a practical, fast and low-cost radiographic method, allowing for evaluation of the electrodes regarding their position and integrity, during the insertion of cochlear implants. MATERIALS AND METHODS: Radiographies from 262 cochlear implant patients were analyzed, from March 2005 to October 2008, by means of intraoperative radiography, soon after electrode insertion. All radiographies were analyzed by the surgeon in the intraoperative period and, afterwards, by the radiologist. RESULTS: A total of 524 radiographies were analyzed, and 95.61 percent presented adequate technique - with the patient being positioned into the technique proposed in this study - as well as a clear visualization of the electrodes, regarded as satisfactory. On the other hand, 4.39 percent presented inadequate technique and/or unsatisfactory visualization of the electrodes, regarded as unsatisfactory. CONCLUSION: Although the portable X-ray apparatus presents limitations, the employment of proper techniques and accessories makes possible the obtainment of satisfactory radiographies to observe cochlear implants.