Inter- and transgenerational heritability of preconception chronic stress or alcohol exposure: Translational outcomes in brain and behavior.

Chronic stress and alcohol (ethanol) use are highly interrelated and can change an individual's behavior through molecular adaptations that do not change the DNA sequence, but instead change gene expression. A recent wealth of research has found that these nongenomic changes can be transmitted across generations, which could partially account for the "missing heritability" observed in genome-wide association studies of alcohol use disorder and other stress-related neuropsychiatric disorders. In this review, we summarize the molecular and behavioral outcomes of nongenomic inheritance of chronic stress and ethanol exposure and the germline mechanisms that could give rise to this heritability. In doing so, we outline the need for further research to: (1) Investigate individual germline mechanisms of paternal, maternal, and biparental nongenomic chronic stress- and ethanol-related inheritance; (2) Synthesize and dissect cross-generational chronic stress and ethanol exposure; (3) Determine cross-generational molecular outcomes of preconception ethanol exposure that contribute to alcohol-related disease risk, using cancer as an example. A detailed understanding of the cross-generational nongenomic effects of stress and/or ethanol will yield novel insight into the impact of ancestral perturbations on disease risk across generations and uncover actionable targets to improve human health.

Auditory training for tinnitus treatment: a scoping review

Abstract Objectives Our study aimed to verify the evidence of auditory training employed in the audiological treatment of tinnitus in adults and older adults. Methods Scoping review based on a search for articles in journals available in MEDLINE (PubMed), Embase (Elsevier), LILACS (BVS), and Cochrane Library. Titles and abstracts of the retrieved articles were assessed by peers, following the eligibility criteria; they were afterward read in full text, and the references were hand searched in the results found. Studies' level of evidence was classified into very high (Level A+), high (Level A), moderate (Level B), limited (Level C), low (Level D), or very low (Level D−) based on the Critically Appraised Topics. Results 2160 records were identified in the searching stage and 15 studies were eligible for data extraction. Study design, sample characterization, auditory training tasks, sound stimuli, outcome measures, and results were extracted. Frequency discrimination training was the most frequent strategy, followed by auditory attentional skills training and multisensory training. Almost all studies with daily auditory training sessions reported significant benefits demonstrated in at least one outcome measure. Studies that used auditory discrimination training and attentional auditory skill stimulation to treat tinnitus obtained quality evidence levels ranging from limited to high (C‒A) and studies that applied multisensory training or attentional training combined with counseling and passive listening in tinnitus patients reached a high-quality evidence level (A). Conclusion Recent studies had higher levels of evidence and considered attentional factors and multisensory pathways in auditory training strategies.

Benefits of intervention in the Central Auditory Nervous System in individuals with Neurofibromatosis Type 1.

OBJECTIVE: To verify the effectiveness of acoustically controlled auditory training in individuals with Neurofibromatosis Type 1. METHODS: The sample consisted of individuals with Neurofibromatosis Type 1, randomly distributed into two groups, making up the intervention group: individuals undergoing formal auditory training; and the comparison group: individuals who were not submitted to the intervention. Behavioral assessment of central auditory processing and electrophysiological evaluation, composed by Brainstem Auditory Evoked Potential and Long Latency-P300 Auditory Evoked Potential, were evaluated in three moments of evaluations: initial evaluation, reevaluation and after four months of reevaluation and comparing the performance between the groups. RESULTS: Better performances in central auditory processing were observed after the formal auditory training in the intervention group with significant differences between the evaluations and performance maintenance four months after the end of the training. Significant differences were observed between the groups in the evaluations after the intervention. The electrophysiological evaluation shows unsystematic variation in the short latency potentials and changes in the long latency potentials with the appearance of the P3 wave after the intervention. The behavioral and electrophysiological evaluation in group that was not submitted to the intervention demonstrated that there is no improvement without the intervention, with deterioration of performance. Significant differences were observed in the behavioral and electrophysiological evaluations, in favor of the group submitted to formal auditory training. CONCLUSIONS: Formal auditory training is effective in rehabilitation in individuals with Neurofibromatosis Type 1. DESCRIPTORS/KEYWORDS: Neurofibromatosis 1; Hearing Disorders; Auditory Perceptual Disorders; Acoustic Stimulation; Evoked Potentials, Auditory.

Limiar Diferencial de mascaramento e potencial evocado auditivo de tronco encefálico em adultos normo-ouvintes com zumbido / Masking Level Difference and Auditory Brainstem ResponseIn Normal Hearing Adults With Tinnitus / Umbral de enmascaramiento diferencial y potencial evocado auditivo del tronco encefálico en adultos con audición normal y tinnitus

Introdução: O zumbido é uma ilusão auditiva consciente, uma sensação sonora não relacionada com uma fonte externa de estimulação. Objetivos: Caracterizar a Acufenometria, Limiar Diferencial de Mascaramento, o questionário de qualidade de vida Inventário de Desvantagem do Zumbido e Potencial Auditivo de Tronco Encefálico em adultos normo-ouvintes com zumbido, com a finalidade de comparar seus achados. Método: Vinte indivíduos do sexo feminino e masculino, entre 20 e 60 anos de idade, normo-ouvintes com queixa de zumbido, foram submetidos ao Acufenometria, Limiar Diferencial de Mascaramento, Inventário de Desvantagem do Zumbido e Potencial Evocado Auditivo de Tronco Encefálico. Resultados: AAcufenometriarevelou que o pitch médio foi de 4,3 KHz à orelha direita e 4,6 KHz à orelha esquerda. O loudness médio foi de 21,7 dBNS à orelha direita e 23,5 dBNS à orelha esquerda. O Limiar Diferencial de Mascaramento médio mostrou-se alterado. O Inventário de Desvantagem do Zumbido médio correspondeu à classificação de grau leve. O Potencial Evocado Auditivo de Tronco Encefálico apresentou parâmetros dentro da normalidade bilateralmente. Conclusão: Constatou-se que adultos normo-ouvintes com queixa de zumbido apresentam zumbido de pitch agudo bilateral com discreto impacto na qualidade de vida, condução adequada das vias auditivas até o tronco encefálico e comprometimento na identificação de sons na presença de ruído, demonstrando que o zumbido pode ter repercussões nas habilidades auditivas centrais. (AU)

Introduction: Tinnitus is a conscious auditory illusion, a sound perception unrelated to any external stimulus source. Objectives: To characterize the Acuphenometry, Masking Level Difference, the quality of life questionnaire Tinnitus Handicap Inventory and Auditory Brainstem Response in normal hearing adults with tinnitus, with the purpose of comparing the findings. Method: Twenty female and male individuals, between 20 and 60 years of age, normal hearing with complaints of tinnitus, underwent Acuphenometry, Masking Level Difference, Tinnitus Handicap Inventory and Auditory Brainstem Response. Results: The Acuphenometry showed the average pitch was 4.3 KHz to the right ear and 4.6 KHz to the left ear. The average loudness was 21.7 dBSL to the right ear and 23.5 dBs to the left ear. The average Masking Level Difference was altered. The average Tinnitus Handicap Inventory corresponded to the classification of mild grade. Auditory Brainstem Response showed parameters within normal range bilaterally. Conclusion: It was found that normal hearing adults with tinnitus complaints have bilateral acute pitch tinnitus with a slight impact on quality of life, appropriate conduction of auditory pathways to the brainstem and impaired identification of sounds in the presence of noise, demonstrating that tinnitus can have repercussions on central auditory skills. (AU)

Introducción: El tinnitus es una ilusión auditiva consciente, una sensación de sonido no relacionada con una fuente externa de estimulación. Objetivos: Caracterizar la coincidencia de tono y volumen, el umbral de enmascaramiento diferencial, el inventario de minusvalía para acúfenos y el potencial auditivo del tronco encefálico en adultos normoyentes con acúfenos, con el fin de comparar sus hallazgos. Método:Veinte sujetos masculinos y femeninos, con edades entre 20 y 60 años, audición normal con tinnitus, fueron sometidos a acúfenos, Umbral de Enmascaramiento Diferencial, Inventario de Desventajas de Tinnitus y Potenciales Evocados Auditivos del Tronco Encefalico. Resultados: La combinación de tono y volumen reveló que el tono promedio era de 4,3 KHz en el oído derecho y de 4,6 KHz en el oído izquierdo. Mientras que el volumen medio fue de 21,7 dBNS para el oído derecho y de 23,5 dBNS para el oído izquierdo. Se modificó el umbral diferencial de enmascaramiento promedio. El Inventario de Desventajas de Tinnitus promedio correspondió a la clasificación de grado leve. El Potenciales Evocados Auditivos del Tronco Encefalico presentó parámetros dentro del rango normal bilateralmente. Conclusión:Se encontró que los adultos normooyentes con quejas de tinnitus presentan tinnitus de tono alto bilateral con leve impacto en la calidad de vida, conducción adecuada de las vías auditivas al tronco encefálico y deterioro en la identificación de sonidos en presencia de ruido, demostrando que Tinnitus puede tener repercusiones en las habilidades auditivas centrales. (AU)

Avaliação comportamental do processamento auditivo central em mulheres no climatério / Behavioral evaluation of central auditory processing in climacteric women

RESUMO Objetivo Comparar as habilidades auditivas centrais de mulheres no climatério, com e sem terapia de reposição hormonal. Métodos Estudo observacional, realizado com mulheres no climatério, divididas em dois grupos, segundo o uso ou não de terapia hormonal. Foram realizados os testes de Localização Sonora em cinco direções; Memória Sequencial para Sons Verbais e Não Verbais; Padrão de Duração; Random Gap Detection Test (RGDT); Masking Level Difference (MLD); Dicótico de Dígitos; Fala Com Ruído Branco, e aplicado o Questionário Avaliação Informal de Fadiga. Resultados Houve diferença tendenciosa de melhor desempenho médio no grupo com terapia hormonal, em comparação ao grupo sem terapia para o teste de Memória para Sons Não Verbais. Nos testes de Localização Sonora, Memória para Sons Verbais, RGDT e MLD, o grupo com terapia hormonal apresentou resultados quantitativamente melhores. O grupo com terapia hormonal demonstrou maior porcentagem de mulheres com alto nível de fadiga. Conclusão Mulheres no climatério, com e sem terapia hormonal, apresentam transtorno de processamento auditivo central envolvendo as habilidades auditivas de localização sonora, ordenação temporal simples e complexa, figura-fundo, resolução temporal e interação binaural. No entanto, as mulheres do grupo com terapia hormonal apresentam melhor desempenho em ordenação temporal simples.

ABSTRACT Purpose To compare the central auditory abilities of climacteric women, with and without hormone replacement therapy. Methods Observational study, performed with climacteric women with and without hormone replacement therapy. Sound localization tests were performed in five directions; Sequential Verbal Memory Test; Sequential Memory Test for Nonverbal Sounds; Duration Pattern Test; Random Gap Detection Test); Masking Level Difference; Dichotic Digit Test and Speech With White Noise Test and the questionnaire "Informal Fatigue Assessment" was applied. Results The differences pointed out revealed the biased difference that occurs due to higher average performance in the group with TH compared to the group without TH for TMSnV. In the TLS, TMSN, RGDT and MLD tests, the group with HT presented quantitatively better results. Conclusion Climacteric women, with and without hormone therapy, have central auditory processing disorder involving the auditory skills of sound localization, simple and complex temporal ordering, background figure, temporal resolution and binaural interaction. However, women in the hormone therapy group performed better in simple temporal ordering.

Speech Perception in Ménière Disease

Abstract Introduction Ménière disease (MD) affects the inner ear, comprising the cochlea and semicircular canals. Symptoms include severe incapacitating vertigo, nausea, vomit, aural fullness, and sensorineural hearing loss - in which speech discrimination and intelligibility are impaired and can be quantified with speech audiometry. Objective To investigate the influence of the stimuli presentation level in speech audiometry and the quality of life in adults with and without a diagnosis of MD. Method Two groups were formed with nine individuals each - one with and the other without MD. The Speech Recognition Percentage Index was researched with stimuli presented above the self-reported comfort level or 5 dB below the discomfort level. Dizziness Handicap and Tinnitus Handicap Inventories were administered to individuals with tinnitus and vertigo complaints. Results Speech recognition was better in the study group with higher presentation levels, as 75% of the sample improved their performance. The presence of vertigo significantly impacted the quality of life of individuals in the study group. Conclusion Speech recognition improves with higher presentation levels. Also, MD impacts the quality of life, especially regarding limitations caused by vertigo.

Categorias auditivas e de linguagem em crianças usuárias de Implante / CoclearAuditory and language categories in children with cochlear implant / Categorías auditivas y de lenguaje en niños con implantes cocleares

Introdução: O implante coclear beneficia o indivíduo com perda auditiva tanto no desenvolvimento da linguagem, quanto no aprimoramento da percepção dos sons da fala. A cirurgia do implante coclear bem-sucedida, somada à estimulação adequada e ao monitoramento correto, proporcionam um melhor desenvolvimento das habilidades auditivas e de linguagem das crianças. Nesse sentido, além de controlar as variáveis de idade na cirurgia e acesso à terapia fonoaudiológica para o desenvolvimento das habilidades auditivas e de linguagem, conhecer as famílias e de que maneira ela influencia no desempenho das crianças é extremamente válido, pois pode melhorar o acolhimento e direcionar melhor o aconselhamento. Objetivo: verificar a relação entre as categorias de audição e de linguagem considerando a idade na cirurgia e a relação entre as categorias de audição, linguagem e de envolvimento familiar em crianças usuárias de implante coclear. Método: A amostra estudada foi composta por 15 crianças com idade entre 2,2 e 8,3 anos. Foram utilizados questionários que mensuravam a percepção auditiva, a percepção de fala e o uso da linguagem pelas crianças. Foi aplicada também a escala de avaliação do envolvimento familiar para o auxílio na categorização das crianças a partir da audição e da linguagem. Resultados: Houve relação significante entre categorias de audição e envolvimento familiar e audição e linguagem. Não houve relação entre a idade da criança na cirurgia e as categorias de audição e de linguagem. Também não houve relação entre o envolvimento familiar e linguagem. Conclusão: A idade da criança na implantação do dispositivo não se relacionou com a classificação das categorias de audição e de linguagem. As crianças de famílias mais participativas apresentaram melhores índices de desenvolvimento auditivo.

Introduction: Cochlear implant benefits the individual with hearing loss both in language development and in improving the perception of speech sounds. Successful cochlear implant surgery, coupled with adequate stimulation and correct monitoring, provide a better development of children's hearing and language skills. In this sense, in addition to controlling the variables of age at surgery and access to speech therapy for the development of auditory and language skills, knowing the families and how it influences the children's performance is extremely valid, as it can improve the reception and better target counseling. Objective: To verify the relationship between the categories of hearing and language considering the age at surgery and the relationship between the categories of hearing, language and family involvement in children with cochlear implants. Method: The studied sample consisted of 15 children aged between 2.2 and 8.3 years. Questionnaires were used that measured auditory perception, speech perception and language use by children. The family involvement assessment scale was also applied to help categorize children based on hearing and language. Results: There was a significant relationship between hearing and family involvement and hearing and language categories. There was no relationship between the child's age at surgery and the hearing and language categories. There was also no relationship between family involvement and language. Conclusion: The child's age at device implantation was not related to the classification of hearing and language categories. Children from more participatory families presented better rates of auditory development.

Introducción: El implante coclear beneficia al individuo con pérdida auditiva tanto en el desarrollo del lenguaje como en la mejora de la percepción de los sonidos del habla. La cirugía exitosa de implante coclear, aunada a una estimulación adecuada y un correcto monitoreo, brindan un mejor desarrollo de las habilidades auditivas y del lenguaje de los niños. En este sentido, además de controlar las variables edad de la cirugía y acceso a logopedia para el desarrollo de las habilidades auditivas y del lenguaje, conocer a las familias y cómo influye en el desempeño de los niños es de gran validez, ya que puede mejorar la recepción y mejor asesoramiento de destino. Objetivo: Verificar la relación entre las categorías de audición y lenguaje considerando la edad en la cirugía y la relación entre las categorías de audición, lenguaje y envolvimiento familiar en niños con implante coclear. Método: La muestra estudiada estuvo constituida por 15 niños con edades comprendidas entre 2,2 y 8,3 años. Se utilizaron cuestionarios que midieron la percepción auditiva, la percepción del habla y el uso del lenguaje por parte de los niños. También se aplicó la escala de evaluación de la participación familiar para ayudar a categorizar a los niños en función de la audición y el lenguaje. Resultados: Hubo una relación significativa entre las categorías de audición y participación familiar y audición y lenguaje. No hubo relación entre la edad del niño en el momento de la cirugía y las categorías de audición y lenguaje. Tampoco hubo relación entre la participación familiar y el lenguaje. Conclusión: La edad del niño en el momento de la implantación del dispositivo no se relacionó con la clasificación de las categorías de audición y lenguaje. Los niños de familias más participativas presentaron mejores índices de desarrollo auditivo.

Central auditory processing in children after traumatic brain injury

Abstract Introduction: Traumatic brain injury can impair the central auditory pathways and auditory cortex. Hence, individuals who suffered a traumatic brain injury may be at risk of central auditory processing disorders, which can be identified with behavioral tests that assess central auditory function. Objective: To characterize and compare the performance of children and adolescents with and without a history of traumatic brain injury in behavioral tests that assess central auditory processing. Method: The sample comprised 8- to 18-year-old individuals of both sexes who suffered moderate or severe closed traumatic brain injury 3 to 24 months before their participation in the study and whose hearing thresholds were normal. These individuals were matched for sex and age with other subjects without a history of traumatic brain injury and submitted to behavioral assessment of the central auditory processing with special tests to assess hearing skills (namely, auditory closure, figure-ground, and temporal processing), selected according to their chronological age and response-ability. Results: The study group performed statistically worse than the comparison group in auditory closure, figure-ground in verbal dichotic listening, and temporal ordering. The central auditory processing tests with abnormal results in the comparison group were different from those in the study group. Conclusion: Central auditory processing disorders were identified in all subjects of the study group, especially involving auditory closure and temporal processing skills, in comparison with subjects without a history of traumatic brain injury.

Scale of Auditory Behaviors in the monitoring of acoustically controled auditory training / Escala de Funcionamento Auditivo no monitoramento do treinamento auditivo acusticamente controlado

ABSTRACT Purpose: to identify the Scale of Auditory Behaviors perception after an acoustically controlled auditory training program. Methods: 23 individuals of both genders, aged 6 to 15 years, participated in this study. Inclusion criteria: to present auditory thresholds lower than 20 dBHL between 250 and 8000Hz, type A tympanometry and diagnosis of central auditory processing disorder confirmed by behavioral tests with indication of acoustically controlled auditory training which was performed in ten one-hour sessions. Hearing tests in progressively adverse listening conditions were used. In the first and last session of the acoustically controlled auditory training program, the individuals were submitted to the Scale of Auditory Behaviors. The appropriate statistical tests were applied considering a p-value less than 0.05. Results: questions Q1, Q2, Q4, Q7, Q8 and Q11 showed statistically significant results and improvement in behaviors after the acoustically controlled auditory training. On the other hand, questions Q3 and Q10 showed a tendency towards significance and the total score in the post time period increased in relation to the pre-moment, pointing to a statistically significant difference that represents complaint reductions. Conclusion: the subjective perception of the individuals and their family members could be identified by the application of SAB in the pre and post auditory training, revealing an improvement in auditory and attention behaviors.

RESUMO Objetivo: identificar a percepção subjetiva por meio da Escala de Funcionamento Auditivo após um programa de treinamento auditivo acusticamente controlado. Métodos: participaram deste estudo 23 indivíduos de ambos os sexos, na faixa etária de 6 a 15 anos. Critérios de inclusão: apresentar limiares auditivos menores do que 20 dBNA entre 250 e 8000 Hz, timpanometria com curvas tipo A e diagnóstico de transtorno de processamento auditivo central confirmado por testes comportamentais com indicação de treinamento auditivo acusticamente controlado. O treinamento auditivo acusticamente controlado foi realizado em dez sessões com duração de uma hora cada. Foram utilizados testes auditivos apresentados em condições de escuta progressivamente adversas. Na primeira e na última sessão do treinamento auditivo acusticamente controlado os indivíduos foram submetidos à aplicação da Escala de Funcionamento Auditivo - SAB. Foram aplicados os testes estatísticos apropriados, considerando-se valor de p menor que 0,05. Resultados: as questões Q1, Q2, Q4, Q7, Q8 e Q11 demonstraram resultados estatisticamente significantes, evidenciando melhora dos comportamentos após o treinamento auditivo acusticamente controlado. Já as questões Q3 e Q10 apresentaram tendência á significância e a pontuação total no momento pós aumentou em relação ao momento pré, demonstrando diferença estatisticamente significante representando uma redução nas queixas. Conclusão: a percepção subjetiva do indivíduo e de seus familiares foi passível de ser identificada pela aplicação da Escala de Funcionamento Auditivo no pré e pós Treinamento Auditivo Acusticamente Contolado, revelando melhora dos comportamentos auditivos e de atenção.

Masking Level Difference and Electrophysiological Evaluation in Adults with Normal Hearing

Abstract Introduction The auditory structures of the brainstem are involved in binaural interaction, which contributes to sound location and auditory figure-background perception. Objective To investigate the performance of young adults in the masking level difference (MLD) test, brainstem auditory-evoked potentials (BAEPs) with click stimulus, and frequency-following response (FFR), as well as to verify the correlation between the findings, considering the topographic origin of the components of these procedures. Methods A total of 20 female subjects between 18 and 30 years of age, with normal hearing and no complaints concerning central auditory processing underwent a basic audiological evaluation, as well as the MLD test, BAEP and FFR. Results The mean result on the MLD test was of 10.70 dB. There was a statistically significant difference in the absolute latencies of waves I, III and V in the BAEPs of the ears. A change in the FFR characterized by the absence of the C, E and F waves was noticed. There was a statistically significant difference in the positive correlation of wave V in the BAEPs with the MLD. There was a statistically significant difference in the positive correlation of the mean MLD and the V, A and F components of the FFR. Conclusion The mean MLD was adequate. In the BAEPs, we observed that the click stimulus transmission occurred faster in the right ear. The FFR showed absence of some components. The mean MLD correlated positively with the BAEPs and FFR.

Electroacoustic and electrophysiological auditory assessment in aphasic individuals / Avaliação eletroacústica e eletrofisiológica da audição em indivíduos afásicos

ABSTRACT Purpose: to verify the functioning of the outer hair cells and the medial efferent olivocochlear system, and the integrity of the auditory pathways in the brainstem up to the auditory cortex, in aphasic individuals. Methods: the sample comprised 20 individuals - 10 without aphasia and 10 with it, aged from 21 to 58 years. The procedures used were the research of the otoacoustic emissions by a transient stimulus with and without noise, and the cognitive potential (tone-burst and speech stimuli). The findings were analyzed based on descriptive statistics. Results: the suppression effect was more present in individuals without aphasia when compared with the aphasic ones. In the cognitive potential, the mean latency values of P3 was within normality standards, with a higher latency in the individuals presented with aphasia for the tone-burst stimulus in both ears. A statistically significant difference of the P3-N2 amplitude was observed for the tone-burst stimulus, comparing the ears in both groups, and for speech stimulus only to the left ear in both groups. Conclusions: aphasic individuals did not present significant differences regarding suppression of the otoacoustic emissions. As for the cognitive potential, the aphasic individuals presented higher latency values when compared to those with no aphasia.

RESUMO Objetivos: verificar o funcionamento das células ciliadas externas e do sistema olivococlear eferente medial e a integridade das vias auditivas no tronco encefálico até o córtex auditivo, em indivíduos afásicos. Métodos: a amostra foi composta por 20 indivíduos, sendo 10 indivíduos sem afasia e 10 indivíduos afásicos, com idades entre 21 e 58 anos. Os procedimentos utilizados foram: pesquisa das emissões otoacústicas por estímulo transiente sem e com ruído, e potencial cognitivo (estímulo toneburst e de fala). Os achados foram analisados a partir da estatística descritiva. Resultados: o efeito de supressão esteve mais presente nos indivíduos sem afasia quando comparado com os afásicos. No potencial cognitivo, o valor médio das latências P3, mostrou-se dentro dos padrões da normalidade com maior latência nos indivíduos com afasia para o estímulo toneburst em ambas as orelhas. Observou-se diferença estatisticamente significante da amplitude P3-N2 para o estímulo toneburst, comparando as orelhas em ambos os grupos, e para o estímulo de fala apenas à orelha esquerda em ambos os grupos. Conclusões: indivíduos afásicos não apresentaram diferenças significantes quanto à supressão das emissões otoacústicas. Quanto ao potencial cognitivo, os indivíduos afásicos apresentaram maior valor de latência em relação aos indivíduos sem afasia.

Audiological assessment and otoacoustic emissions in patients with head and neck cancer / Avaliação audiológica e emissões otoacústicas em pacientes com câncer de cabeça e pescoço

ABSTRACT Purpose: to describe the audiological and otoacoustic emission findings in patients who had head and neck cancer and compare them with individuals without the disease. Methods: a comparative, cross-sectional, observational study encompassing two groups: Study: individuals with a history of head and neck cancer, submitted to chemotherapy and/or radiotherapy; Control: individuals without the disease. The sample comprised 23 individuals in each group, matched for age and gender. Procedures in which the groups were compared: meatoscopy; pure-tone threshold and high-frequency audiometry; speech audiometry; transient-evoked otoacoustic emissions. Statistical tests: Pearson's chi-square; Fisher's exact; two-proportion Z-test; Wilcoxon; Mann-Whitney; Student's t-test. Results: the comparison between the groups revealed statistically significant differences at the 3, 6, 8, 10, and 12.5 kHz frequencies in the pure-tone threshold audiometry, with better pure-tone auditory thresholds in the control group. No significant differences were observed between the groups in the otoacoustic emissions regarding the general response and frequency band. Conclusion: individuals with a history of head and neck cancer had higher pure-tone auditory thresholds than their controls, especially at the higher frequencies. This evidences the deleterious effect of ototoxicity on the peripheral auditory system of adults. The otoacoustic emissions were similar in the two groups.

RESUMO Objetivo: descrever os achados audiológicos e das emissões otoacústicas em pacientes com câncer de cabeça e pescoço e compará-los com indivíduos sem a doença. Métodos: estudo observacional transversal comparativo realizado em dois grupos: Estudo: indivíduos com histórico de câncer de cabeça e pescoço submetidos à quimioterapia e/ou radioterapia; Controle: indivíduos sem a doença. A amostra foi composta por 23 indivíduos em cada grupo, pareados considerando idade e gênero. Procedimentos: meatoscopia; audiometria tonal liminar e de altas frequências; logoaudiometria e emissões otoacústicas evocadas transientes, comparados entre os grupos. Testes estatísticos: Qui-quadrado de Pearson; exato de Fisher; igualdade de duas proporções; Wilcoxon; Mann-Whitney e t de Student. Resultados: a comparação entre os grupos revelou diferença estatisticamente significante nas frequências de 3, 6, 8, 10 e 12,5kHz na audiometria tonal liminar, com melhores limiares auditivos tonais no grupo controle. Não foram observadas diferenças significantes entre os grupos nas emissões otoacústicas, quanto a resposta geral e banda de frequência. Conclusão: indivíduos com histórico de câncer de cabeça e pescoço apresentam limiares auditivos tonais mais elevados do que seus controles, sobretudo nas frequências altas, evidenciando o efeito deletério da ototoxicidade no sistema auditivo periférico de adultos. As emissões otoacústicas mostraram-se semelhantes nos dois grupos.

Proposta de estimulação musical para crianças deficientes auditivas: relato de casos / Musical stimulation proposal for hearing impaired children: case reports

RESUMO Objetivo: Desenvolver e aplicar um programa de estimulação musical em crianças usuárias de Implante Coclear. Método: A pesquisa foi realizada no Ambulatório de Audiologia Educacional - UNIFESP e foi realizada em duas etapas - concepção das atividades da estimulação musical e aplicação das mesmas atividades em cinco crianças usuárias de Implante Coclear, com idades entre 2 e 5 anos, que estavam em terapia fonoaudiológica há pelo menos 12 meses. O grupo de estudo foi submetido a seis sessões de estimulação musical. Foram aplicados três instrumentos para quantificar a evolução da criança: Identificação Musical das Crianças, Desenvolvimento das Habilidades Musicais e o Teste de Aptidão Musical - todos elaborados pelas autoras. Resultados: A estimulação musical surtiu efeito positivo, melhorando as habilidades de ritmo e melodia dos participantes, e as crianças apresentaram desempenho superior a 50% nas tarefas realizadas. A estimulação musical surtiu efeito positivo, melhorando as habilidades de ritmo (p = 0,0267) e melodia (p = 0,0445) dos participantes. Conclusão: Foi possível desenvolver um programa de estimulação musical passível de ser aplicado em crianças usuárias de Implante Coclear inseridas em reabilitação aurioral, as quais se beneficiaram de suas atividades.

ABSTRACT Purpose: To develop and to apply a musical stimulation program for children using Cochlear Implant. Method: The research was conducted at the Educational Audiology Outpatient Clinic, UNIFESP, and was carried out in two stages - conception of the musical stimulation activities and its application in five children using Cochlear Implant, aged between 2 and 5 years, who had been under speech therapy for at least 12 months. The study group was submitted to six sessions of musical stimulation. We used three instruments to quantify the evolution of the child: Children's Musical Identification, Musical Skills Development and Musical Aptitude Test - all of them were designed by one of the authors. Results: Musical stimulation had a positive effect, thereby improving the rhythm and the melody skills of the participants. The children showed a performance over 50% in the tasks undertaken. Musical stimulation had a positive effect, thereby improving the rhythm (p=0.0267) and the melody (p=0.0445) skills of the participants. Conclusion: We conclude that it is possible to develop a musical stimulation program that can be applied to children using Cochlear Implant inserted in aurioral rehabilitation, who benefit from the activities.

Mismatch Negativity in Childrenwith Cochlear Implant

Abstract Introduction The mismatch negativity (MMN) is a negative long-latency auditory potential elicited by any discriminable change in a repetitive aspect of auditory stimulation. This evoked potential can provide cortical information about the sound processing, including in children who use cochlear implants. Objective To identify MMN characteristics regarding latency, amplitude, and wave area in cochlear implanted children and to identify associations among language development, speech perception and family involvement. Methods This is a descriptive, observational, cross-sectional study, which compared two groups: study group-children with cochlear implant, and control group-hearing children. The children were submitted to MMN evaluation with non-verbal tone burst stimulus, differing in frequency in sound field at 70 dBHL, with SmartEP equipment (Intelligent Hearing Systems, Miami, FL, USA). Speech perception and language development questionnaires were also applied, and the family participation in the rehabilitation process was classified. Results The occurrence ofMMNwas 73.3% for the control group and 53.3% for the study group. Values of latency, amplitude and area of MMN of children using cochlear implants were similar tothose ofhearingchildren, anddidnot differbetweengroups. The occurrence of MMN was not correlated to the variables of hearing, language and family categories. Conclusion Children with cochlear implants showed similar MMN responses to those of the children in the control group, withmean latency, amplitude andarea of 208.9ms (±12.8), -2.37 μV (±0.38) and 86.5 μVms (±23.4), respectively. There was no correlation between the presence of MMN and children's performance in the auditory and language development tests or family involvement during rehabilitation.

Audiometric evaluation in individuals with mucopolysaccharidosis

OBJECTIVES: To characterize the audiometric evaluation and acoustic immittance measures in different types of mucopolysaccharidosis. METHOD: Fifty-three mucopolysaccharidosis patients were evaluated. The classification consisted of type I (Hurler syndrome, Hurler-Scheie and Scheie syndrome), type II (Hunter syndrome), type III (Sanfilippo syndrome), type IV (Morquio syndrome), and type VI (Maroteaux-Lamy syndrome). Immittance audiometry and play or conventional threshold tone audiometry were used to obtain auditory thresholds and were chosen according to the patient's chronological age and ability to understand/respond to the procedure. The findings were analyzed using descriptive statistics and considering the recommendations for research involving human beings contained in Resolution CNE N° 466/2012. RESULTS: Fifty-one subjects (96.2%) had hearing loss, and the conductive type was the most frequent. Only two (3.8%) patients presented bilateral thresholds within normal limits, one with type IV mucopolysaccharidosis and the other with type VI. There were 11 individuals (20.8%) with mucopolysaccharidosis type I with mixed hearing loss, 9 (16.9%) individuals with type I with conductive hearing loss and 9 (16.9%) with type VI with conductive hearing loss. Mild hearing loss was most common (37.3%), followed by moderately severe hearing loss (36.3%). The type B tympanometric curve (80.4%) was the most frequent. CONCLUSIONS: Most of the individuals with mucopolysaccharidosis types I, II, III, IV and VI presented mixed or conductive hearing losses of mild to moderately severe degree, type B tympanograms and an absence of contralateral acoustic reflexes.

Masking Level Difference em escolares: análises ambientais / Masking Level Difference in schoolchildren: environmental analysis

RESUMO Objetivo Pesquisar a habilidade auditiva de atenção seletiva na população escolar e identificar valores de referência para a faixa etária de sete a dez anos por meio do teste Masking Level Difference, além de identificar se a escolaridade dos pais, bem como a renda familiar, pode influenciar os resultados do teste. Método Participaram do estudo 31 escolares que se encaixaram nos critérios de elegibilidade da pesquisa, sendo 20 do gênero feminino e 11 do gênero masculino. Realizou-se anamnese para questionamento da renda familiar e escolaridade dos pais do escolar, inspeção visual do meato acústico externo, audiometria tonal liminar, logoaudiometria, medidas de imitância acústica, teste Dicótico de Dígitos e teste Masking Level Difference. Resultados A idade média dos indivíduos foi de 8,67 anos. Não foi observada diferença entre os gêneros e entre as idades avaliadas, no desempenho do MLD. Não houve relação entre a escolaridade dos pais e a renda mensal média com o desempenho das crianças no MLD. A média do MLD foi de 7,65 dB, com desvio padrão de 2,51 dB. Conclusão O Masking Level Difference em escolares de sete a dez anos é de 7,65 dB e independe do gênero, do nível de escolaridade dos pais ou da renda mensal média da família do escolar.

ABSTRACT Purpose To investigate the auditory ability of selective attention in the school population and to identify reference values to the age group from seven to ten years old through the Masking Level Difference Test, and to identify if the parents' schooling, as well as the family income can influence the test results. Methods Thirty-one schoolchildren who match the eligibility criteria attended the study, being 20 female and 11 male. An anamnesis was conducted to question the familiar income and the schooling of the children´s parents; we also performed visual inspection of the External Acoustic Meatus, Pure Tone Audiometry, Speech Audiometry, Acoustic Immittance Measures, Dichotic Digits Test and Masking Level Difference test. Results The mean age of the individuals was 8.67 years. There were no observed differences between genders and between the evaluated ages in the MLD performance. There was no relation between the parents' schooling and the average monthly income with the performance of the children in MLD Test. The MLD mean was 7.65 dB and standard deviation of 2.51 dB. Conclusion The Masking Level Difference in schoolchildren from seven to ten years old is 7.65 dB and is independent of the gender, parents' schooling and the average monthly income of the schoolchild.

A influência da idade, escolaridade e gênero na ocorrência de pausas do teste DSI / Influence of the age, level of schooling and gender on the occurrence of the DSI test pauses

RESUMO Objetivo Avaliar a influência das variáveis idade, escolaridade e gênero na ocorrência de pausas após o tempo padrão no teste de identificação de sentenças dicóticas. Método A amostra foi constituída por 200 indivíduos destros distribuídos em quatro grupos segundo a faixa etária: grupo I - 13 a 19 anos de idade, grupo II - 20 a 29 anos de idade, grupo III - 30 a 39 anos de idade e o grupo IV - 40 a 49 anos de idade. Cada grupo continha 50 sujeitos (25 homens e 25 mulheres) pareados por escolaridade. Foram adotados os seguintes critérios de elegibilidade: língua materna português brasileiro, normouvinte, leitura fluente independentemente do grau de escolaridade. O teste de identificação de sentenças dicóticas foi aplicado nas etapas de integração binaural e escuta direcionada e a necessidade de pausas no teste após o tempo padrão foi anotada. Foram realizadas estatísticas descritivas e inferenciais. Resultados Para as etapas de integração binaural, houve associação positiva entre idade e ocorrência de pausas. A variável escolaridade apresentou associação negativa com a ocorrência de pausas em todas as etapas do teste. A variável gênero não apresentou nenhuma associação com a ocorrência de pausa em nenhuma das etapas do teste. Conclusão Com o aumento da idade, há um aumento na incidência de pausas na etapa de integração binaural do teste. Quanto mais anos de estudo menor a chance de o indivíduo necessitar de pausas para realizar o teste em todas as etapas de apresentação. A variável gênero não influenciou na ocorrência de pausas.

ABSTRACT Purpose To evaluate the influence of variables age, educational status and sex in the occurrence of pauses after the standard time in the dichotic sentence identification test. Methods This investigation included 200 right-handed subjects divided into four groups according to age: group I - from 13 to 19 years old, group II - from 20 to 29 years old, group III - from 30 to 39 years old and group IV - from 40 to 49 years old. Each group contained 50 subjects (25 men and 25 women) matched by educational level. The following eligibility criteria was adopted: Brazilian Portuguese mother language, listeners, and fluent readers independent of the educational level. It was applied the dichotic sentence identification test in the steps of binaural integration, directed listening, and it was noted the need for pauses in the test after the standard time. The descriptive and inferential statistics were performed. Results For the binaural integration stages there was a positive association between age and pause occurrence. The educational variable presented a negative association with the occurrence of pauses in all stages of the DSI test. The gender variable showed no association with the occurrence of pause in any of the test steps. Conclusion With increasing age, there is an increase in the incidence of pauses in the binaural integration stages of the test. The more years of study the less chance that the individual will need breaks to perform the test at all stages of presentation. The variable gender did not influence the occurrence of pauses.

Cortical Auditory Evoked Potentials with Simple (Tone Burst) and Complex (Speech) Stimuli in Children with Cochlear Implant

Abstract Introduction The registry of the component P1 of the cortical auditory evoked potential has been widely used to analyze the behavior of auditory pathways in response to cochlear implant stimulation. Objective To determine the influence of aural rehabilitation in the parameters of latency and amplitude of the P1 cortical auditory evoked potential component elicited by simple auditory stimuli (tone burst) and complex stimuli (speech) in children with cochlear implants. Method The study included six individuals of both genders aged 5 to 10 years old who have been cochlear implant users for at least 12 months, and who attended auditory rehabilitation with an aural rehabilitation therapy approach. Participants were submitted to research of the cortical auditory evoked potential at the beginning of the study and after 3 months of aural rehabilitation. To elicit the responses, simple stimuli (tone burst) and complex stimuli (speech) were used and presented in free field at 70 dB HL. The results were statistically analyzed, and both evaluations were compared. Results There was no significant difference between the type of eliciting stimulus of the cortical auditory evoked potential for the latency and the amplitude of P1. There was a statistically significant difference in the P1 latency between the evaluations for both stimuli, with reduction of the latency in the second evaluation after 3 months of auditory rehabilitation. There was no statistically significant difference regarding the amplitude of P1 under the two types of stimuli or in the two evaluations. Conclusion A decrease in latency of the P1 component elicited by both simple and complex stimuli was observed within a three-month interval in children with cochlear implant undergoing aural rehabilitation.

Monitoramento auditivo em adultos submetidos à quimioterapia com carboplatina / Auditory monitoring in adults undergoing chemotherapy with carboplatin / Monitoreo del oído en adultos sometidos a quimioterapia con carboplatino

Objetivo: Caracterizar a audição de pacientes adultos submetidos à quimioterapia com carboplatina por meio de exames audiológicos em dois momentos durante o tratamento quimioterápico. Métodos: Prospectivo e observacional. Participaram da pesquisa seis sujeitos adultos entre 53 e 59 anos e 11 meses, em tratamento quimioterápico com carboplatina submetidos a uma bateria de exames audiológicos. Os dados foram analisados por meio do teste ANOVA, teste z para proporções e Teste de Wilcoxon. O valor de significância adotado foi de 5% (p≤0,05). Resultados: Um aumento nos limiares auditivos foi observado, sobretudo nas frequências mais altas, porém não houve significância. Também foi observado aumento na relação sinal/ruído das emissões otoacústicas evocadas transientes e por produto de distorção, porém sem significância estatística. Conclusão: Não foram observadas mudanças estatisticamente significantes quanto aos limiares auditivos e as respostas das emissões otoacústicas, no entanto pode-se notar um aumento nos limiares audíveis, especialmente nas altas frequências, bem como aumento da amplitude de respostas nas emissões otoacústicas.

Purpose: To characterize the hearing of adult patients undergoing chemotherapy with carboplatin using two sequential audiological tests during chemotherapy treatment. Methods: Prospective and observational. The participants were six adult subjects between 53 and 59 years and 11 months, undergoing chemotherapy treatment with carboplatin subjected to a battery of audiological exams. Data were analyzed using the ANOVA test, z test for proportions and Wilcoxon signed-ranks test. The adopted significance was 5% (p ≤ 0.05). Results: An increase in hearing thresholds was observed, particularly in the higher frequencies, but there was no significance. It was also observed an increase in the signal / noise ratio of transient evoked otoacoustic emissions and for distortion product, but without statistical significance. Conclusion: No statistically significant changes regarding the hearing thresholds and responses of otoacoustic emissions were observed, however it could be noted an increase in hearing thresholds, especially at high frequencies, as well as the increased amplitude on the responses in otoacoustic emissions.

Objetivo: Caracterizar la audición de pacientes adultos sometidos a quimioterapia con carboplatino a través de pruebas audiológicas dos veces durante la quimioterapia. Métodos: Estudio prospectivo observacional. Los participantes fueron seis sujetos adultos de entre 53 y 59 años y 11 meses, sometidos a quimioterapia con carboplatino sometido a una batería de pruebas audiológicas. Los datos se analizaron mediante la prueba de ANOVA, prueba z para proporciones y prueba de los rangos con signo de Wilcoxon. La significancia fue del 5% (p ≤ 0,05). Resultados: fueron observados un aumento de los umbrales de audición, en particular en las frecuencias más altas, pero no identificaron significación. También se observó un aumento de la relación señal / ruido de emisiones otoacústicas evocadas transitorias y productos de distorsión, pero sin significación estadística. Conclusión: Los cambios estadísticamente significativos con respecto a los umbrales de audición y las respuestas de las emisiones otoacústicas, fueron observadas sin embargo es posible que observe un aumento de los umbrales audibles, especialmente a altas frecuencias, así como una mayor gama de respuestas de las emisiones otoacústicas.

Temporal processing and long-latency auditory evoked potential in stutterers / Processamento temporal e potencial evocado auditivo de longa latência em indivíduos gagos

Abstract Introduction: Stuttering is a speech fluency disorder, and may be associated with neuroaudiological factors linked to central auditory processing, including changes in auditory processing skills and temporal resolution. Objective: To characterize the temporal processing and long-latency auditory evoked potential in stutterers and to compare them with non-stutterers. Methods: The study included 41 right-handed subjects, aged 18-46 years, divided into two groups: stutterers (n = 20) and non-stutters (n = 21), compared according to age, education, and sex. All subjects were submitted to the duration pattern tests, random gap detection test, and long-latency auditory evoked potential. Results: Individuals who stutter showed poorer performance on Duration Pattern and Random Gap Detection tests when compared with fluent individuals. In the long-latency auditory evoked potential, there was a difference in the latency of N2 and P3 components; stutterers had higher latency values. Conclusion: Stutterers have poor performance in temporal processing and higher latency values for N2 and P3 components.

Resumo Introdução: A gagueira é um distúrbio da fluência da fala e pode estar associada a fatores neuroaudiológicos ligados ao processamento auditivo central, entre eles as alterações das habilidades auditivas de processamento e resolução temporal. Objetivo: Caracterizar o processamento temporal e o potencial evocado auditivo de longa latência em indivíduos gagos e compará-los com indivíduos sem gagueira. Método: Participaram do estudo 41 indivíduos destros, de 18 a 46 anos, distribuídos em dois grupos: 20 com gagueira e 21 sem gagueira, comparados segundo idade, escolaridade e gênero. Todos os indivíduos foram submetidos aos testes de padrão de duração, teste de identificação de intervalos aleatórios e o potencial evocado auditivo de longa latência. Resultados: Indivíduos com gagueira apresentaram pior desempenho nos testes de padrão de duração e Random Gap Detection, quando comparados com os indivíduos fluentes. No potencial evocado auditivo de longa latência, houve diferença na latência dos componentes N2 e P3, os indivíduos gagos apresentaram maiores valores de latência. Conclusão: Os indivíduos com gagueira apresentaram processamento temporal com desempenho abaixo do esperado e um maior valor de latência para os componentes N2 e P3.