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

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

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

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

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

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

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

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

Direct and progressive differentiation of human embryonic stem cells into the chondrogenic lineage.

Treatment of common and debilitating degenerative cartilage diseases particularly osteoarthritis is a clinical challenge because of the limited capacity of the tissue for self-repair. Because of their unlimited capacity for self-renewal and ability to differentiate into multiple lineages, human embryonic stem cells (hESCs) are a potentially powerful tool for repair of cartilage defects. The primary objective of the present study was to develop culture systems and conditions that enable hESCs to directly and uniformly differentiate into the chondrogenic lineage without prior embryoid body (EB) formation, since the inherent cellular heterogeneity of EBs hinders obtaining homogeneous populations of chondrogenic cells that can be used for cartilage repair. To this end, we have subjected undifferentiated pluripotent hESCs to the high density micromass culture conditions we have extensively used to direct the differentiation of embryonic limb bud mesenchymal cells into chondrocytes. We report that micromass cultures of pluripotent hESCs undergo direct, rapid, progressive, and substantially uniform chondrogenic differentiation in the presence of BMP2 or a combination of BMP2 and TGF-beta1, signaling molecules that act in concert to regulate chondrogenesis in the developing limb. The gene expression profiles of hESC-derived cultures harvested at various times during the progression of their differentiation has enabled us to identify cultures comprising cells in different phases of the chondrogenic lineage ranging from cultures just entering the lineage to well differentiated chondrocytes. Thus, we are poised to compare the abilities of hESC-derived progenitors in different phases of the chondrogenic lineage for cartilage repair.

Telehealth in audiology: the need and potential to reach underserved communities.

Permanent hearing loss is a leading global health care burden, with 1 in 10 people affected to a mild or greater degree. A shortage of trained healthcare professionals and associated infrastructure and resource limitations mean that hearing health services are unavailable to the majority of the world population. Utilizing information and communication technology in hearing health care, or tele-audiology, combined with automation offer unique opportunities for improved clinical care, widespread access to services, and more cost-effective and sustainable hearing health care. Tele-audiology demonstrates significant potential in areas such as education and training of hearing health care professionals, paraprofessionals, parents, and adults with hearing disorders; screening for auditory disorders; diagnosis of hearing loss; and intervention services. Global connectivity is rapidly growing with increasingly widespread distribution into underserved communities where audiological services may be facilitated through telehealth models. Although many questions related to aspects such as quality control, licensure, jurisdictional responsibility, certification and reimbursement still need to be addressed; no alternative strategy can currently offer the same potential reach for impacting the global burden of hearing loss in the near and foreseeable future.

Toward Better Outcomes in Audiology Distance Education: An Educational Data Mining Approach.

PURPOSE: This article introduces concepts and a general taxonomy used by the educational data mining (EDM) community, as well as examples of their applications, with the aims of providing audiology educators with a referential basis for developing this area. METHOD: A narrative review was carried out to present an overview of EDM and its main methods. Some of these methods were exemplified with analysis of real data from an Internet-based specialization course on pediatric auditory rehabilitation. RESULTS: The review introduced EDM main concepts and applications and described methods from its area. Real data examples illustrated EDM use to predict interpersonal help-seeking, model interpersonal interaction, analyze students' trajectories within a course's module, and understand how students approached group assignments. Some of the insights provided by EDM to support teaching and learning processes were also described. CONCLUSIONS: EDM methods offer new tools to discover knowledge from digital traces (i.e., logs) and support key stakeholders (students, instructors, or course administrators) to raise awareness about course dynamics. This approach has the potential to foster a better understanding and management of educational processes in audiology distance education.

Expression of Dlx5 and Dlx6 during specification of the elbow joint.

The onset of elbow joint formation in the developing limb is characterized morphologically by the conversion of differentiated chondrocytes at the site of incipient joint formation into the densely packed flattened cells of the joint interzone. However, experimental studies have indicated that the elbow joint is specified well before joint interzone formation by a distinctive population of precursor cells located at the site in the developing limb bud at which the elbow joint will subsequently form. Here we show that during specification of the elbow joint in the chick limb bud, the homeodomain transcription factors Dlx5 and Dlx6 are highly expressed by a discrete group of cells that encompass the prospective elbow joint. The Dlx5- and Dlx6-expressing cells at the prospective elbow joint are located where the differentiating humerus branches into the radius and ulna. Thus, Dlx5 and Dlx6 are the earliest molecular markers of the presumptive elbow joint yet described. The onset of Dlx5 expression in the region of the presumptive elbow joint is shortly followed by the initiation of expression amongst the Dlx5-expressing cells of Gdf5, which encodes a secreted signaling molecule that is involved in regulating the onset of joint formation. These results suggest that Dlx genes may be involved in specification of the elbow joint and/or in providing positional information that specifies the site at which the elbow joint will form.

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

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

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

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

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

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

Social skills training in Speech-Language Pathology and Audiology: students' perception / Treinamento de habilidades sociais em Fonoaudiologia: percepção dos estudantes

ABSTRACT Purpose: to investigate the perception of Speech-Language Pathology and Audiology (SLPA) students, submitted to a Social Skills Training (SST) program, regarding potentialities, difficulties and perceived gains in their social skills (SS) repertoire. Methods: this qualitative study included 22 students (between 19 and 21 years old), enrolled in the 2nd year of the undergraduate SLPA course. The SST structure was based on theoretical-informative and practical-experiential methodology, developed over 15 meetings, using different teaching strategies. Content analysis was applied to assess the responses to a questionnaire with five open ended questions about the SS and the program itself, administered at the beginning, middle and end of the training. Results: greater difficulty was observed for students in relation to public speaking as well as empathetic and assertive skills toward their peers and professors. The participants highlighted the importance of the SST for the professional-patient relationship and for their professional training, as the training expands skills and competences beyond technical knowledge, with self-knowledge having a central role in this process. Conclusion: in preparation for clinical practice the SST can be used as a promising teaching-learning methodology in the curricula of SLPA courses.

RESUMO Objetivo: investigar a percepção de estudantes de Fonoaudiologia submetidos ao programa de Treinamento de Habilidades Sociais (THS) no que tange às potencialidades, dificuldades e ganhos percebidos no repertório de habilidades sociais (HS). Métodos: este estudo qualitativo incluiu 22 estudantes (idades entre 19 e 21 anos), matriculados no 2º ano do curso de graduação em Fonoaudiologia. A estrutura do THS baseou-se na metodologia teórico-informativa e prático-vivencial, desenvolvidas ao longo de 15 encontros, empregando-se distintas estratégias de ensino. A análise de conteúdo foi utilizada para avaliar as respostas a um questionário com cinco perguntas abertas a respeito das HS e do próprio programa, aplicado no início, meio e final do treinamento. Resultados: observou-se maior dificuldade dos participantes em falar em público e nas habilidades empáticas e assertivas com os colegas e professores. Os participantes destacaram a importância das HS na relação profissional-paciente e da inserção do programa para a formação profissional, por ampliar as habilidades e competências para além do saber técnico, tendo o autoconhecimento papel central neste processo. Conclusão: na preparação para a atividade clínica, o THS pode ser utilizado como uma metodologia de ensino-aprendizagem promissora nos currículos dos cursos de Fonoaudiologia.

Development and Technical Validation of the Mobile Based Assistive Listening System: A Smartphone-Based Remote Microphone.

PURPOSE: The purpose of this research note is to describe the development and technical validation of the Mobile Based Assistive Listening System (MoBALS), a free-of-charge smartphone-based remote microphone application. METHOD: MoBALS Version 1.0 was developed for Android (Version 2.1 or higher) and was coded with Java using Eclipse Indigo with the Android Software Development Kit. A Wi-Fi router with background traffic and 2 affordable smartphones were used for debugging and technical validation comprising, among other things, multicasting capability, data packet loss, and battery consumption. RESULTS: MoBALS requires at least 2 smartphones connected to the same Wi-Fi router for signal transmission and reception. Subscriber identity module cards or Internet connections are not needed. MoBALS can be used alone or connected to a hearing aid or cochlear implant via direct audio input. Maximum data packet loss was 99.28%, and minimum battery life was 5 hr. Other relevant design specifications and their implementation are described. CONCLUSIONS: MoBALS performed as a remote microphone with enhanced accessibility features and avoids overhead expenses by using already-available and affordable technology. The further development and technical revalidation of MoBALS will be followed by clinical evaluation with persons with hearing impairment.

Teleaudiology: efficacy assessment of an online social network as a support tool for parents of children candidates for cochlear implant.

PURPOSE: To assess the efficacy of an online social network as a support for parents of children with hearing impairment. METHODS: Twenty-two mothers, randomly divided into experimental (n=11) and control (n=11) groups, filled in an online form containing the Parental Stress Index - Short Form (PSI-SF). Only the experimental group had access to the "Babies' Portal" social network. Both groups filled in the online form once again 3 months after the first assessment, for evaluating the use and participation in the social network. The posts on the social network were rated by two independent raters regarding themes and mechanisms of self-help. RESULTS: No difference was observed in mean PSI-SF scores between the groups for both assessments. Intragroup analysis showed no difference for total and subscale results of PSI-SF between the two data collected for both groups except for the "Defensive Response" subscale, in which a decrease was observed in the score for the control group. The most frequent posting themes were related to personal information and expressions of religious beliefs. Regarding self-help mechanisms, a higher frequency of exchanging experiences and gratitude expressions was observed. Participants in the experimental group stated they would have liked to participate more frequently in the social network as they considered this tool important because of the exchange of information and experience with other mothers and hearing health-care professionals. CONCLUSION: The posts and the assessment of participants indicated the potential of this network to support parents of children with hearing impairment.

Overexpression of Dlx5 in chicken calvarial cells accelerates osteoblastic differentiation.

Our laboratory and others have shown that a homeodomain protein binding site plays an important role in transcription of the Collal gene in osteoblasts. This suggests that homeodomain proteins have an important role in osteoblast differentiation. We have investigated the role of Dlx5 in osteoblastic differentiation. In situ hybridization studies indicated that Dlx5 is expressed in chick calvarial osteoblasts (cCOB) in vivo. Northern blot analysis indicated that Dlx5 expression in cultured cCOBs is induced concurrently with osteoblastic markers. To study the effect of overexpression of Dlx5 on osteoblast differentiation, we infected primary osteoblast cultures from 15-day-old embryonal chicken calvaria with replication competent retroviral vectors [RCASBP(A)] expressing Dlx5 or control replication competent avian splice acceptor brianhightiter polymerase subtype A [RCASBP(A)]. Expression of Collal, osteopontin, alkaline phosphatase, and osteocalcin messenger RNA (mRNA) occurred sooner and at higher levels in cultures infected with RCASBP(A)DLX5 than in RCASBP(A)-infected cultures. Mineralization of Dlx5-expressing cultures was evident by days 12-14, and RCAS-infected control osteoblasts did not begin to mineralize until day 17. Dlx5 also stimulated osteoblastic differentiation of calvarial cells that do not normally undergo osteoblastic differentiation in vitro. Our results suggest that Dlx5 plays an important role in inducing calvarial osteoblast differentiation.

Babies' portal website hearing aid section: assessment by audiologists.

Introduction The family has ultimate responsibility for decisions about the use and care during the daily routine and problem solving in the manipulation of hearing aids (HA) in infants and children. Objective The purpose of the study was to assess technical and content quality of Babies' Portal website Hearing Aid section by audiologists. Methods Letters and e-mails were sent inviting professionals to surf the website and anonymously fill out an online form with 58 questions covering demographic data as well as the website's technical (Emory questionnaire with the subscales of accuracy, authorship, updates, public, navigation, links, and structure) and content quality. Results A total of 109 professionals (tree men and 106 women) with mean age of 31.6 years participated in the study. Emory percentage scores ranged from 90.1 to 96.7%. The Hearing Aid section contents were considered good or very good. Conclusion The website was deemed to have good technical and content quality, being suitable to supplement informational counseling to parents of hearing-impaired children fitted with hearing aids.

Hearing aid handling skills: relationship with satisfaction and benefit.

PURPOSE: To evaluate hearing aid handling skills for new and experienced users and to assess if such skills influence user's benefit and satisfaction. METHODS: Seventy four participants (mean age of 70.43), experienced (n=37) or new hearing aid users (n=37) performed the tasks of "Practical Hearing Aid Skills Test" (PHAST), which were scored on a five-point Likert scale - higher scores indicate better hearing aid handling skills. Experienced users answered the International Outcome Inventory for Hearing Aids (IOI-HA) and the hearing aid benefit for handicap reduction was calculated by the hearing handicap inventory (HHIA/HHIE). RESULTS: Medians for PHAST total scores of 79 and 71% were obtained for experienced and new users, respectively - there were no significant difference between groups. Lower PHAST scores were observed for the tasks of volume control manipulation and telephone usage. Moderate correlations were obtained between IOI benefit and quality of life items and the PHAST scores. There was no correlation between the results of PHAST and demographic data of the participants. CONCLUSION: There was no difference in handling skills between new and experienced hearing aid users. Handling skills affected hearing aid benefit.

Quality, range, and legibility in web sites related to orofacial functions.

Introduction Plenty of information about health is available on the Internet; however, quality and legibility are not always evaluated. Knowledge regarding orofacial functions can be considered important for the population because it allows proper stimulus, early diagnosis, and prevention of the oral myofunctional alterations during early infancy. Objective The aim was evaluate the quality, legibility, and range of Web sites available in Brazilian Portuguese regarding the orofacial functions. Methods Selected Web sites with information directed to parents/caregivers of babies regarding breast-feeding, feeding after 6 months, deleterious oral habits, and breathing and speech were studied. The Web sites were evaluated through the application of Flesch Reading Ease Test and aspects of the Health on the Net (HON) modified code (HONCode); the range of the subjects addressed was compared with other aspects of infant development. Results From the access of 350 pages of the Internet, 35 Web sites were selected and 315 excluded because they did not meet the inclusion criteria. In relation to legibility, Web sites scored an average of 61.23% in the Flesch Test, and the application of the modified HONCode showed an average of 6.43 points; an average of 2.49 subjects were found per Web site evaluated, with information on breast-feeding being more frequent and subjects such as breathing and speech less frequent. Conclusions Web sites that deal with orofacial functions presented standard legibility classification. Only half of the ethical principles were considered by the modified HONCode in their majority, and most addressed subjects after "breast-feeding" were presented with restricted range.

Results obtained with a low cost software-based audiometer for hearing screening.

INTRODUCTION: The implementation of hearing screening programs can be facilitated by reducing operating costs, including the cost of equipment. The Telessaúde (TS) audiometer is a low-cost, software-based, and easy-to-use piece of equipment for conducting audiometric screening. AIM: To evaluate the TS audiometer for conducting audiometric screening. METHODS: A prospective randomized study was performed. Sixty subjects, divided into those who did not have (group A, n = 30) and those who had otologic complaints (group B, n = 30), underwent audiometric screening with conventional and TS audiometers in a randomized order. Pure tones at 25 dB HL were presented at frequencies of 500, 1000, 2000, and 4000 Hz. A "fail" result was considered when the individual failed to respond to at least one of the stimuli. Pure-tone audiometry was also performed on all participants. The concordance of the results of screening with both audiometers was evaluated. The sensitivity, specificity, and positive and negative predictive values of screening with the TS audiometer were calculated. RESULTS: For group A, 100% of the ears tested passed the screening. For group B, "pass" results were obtained in 34.2% (TS) and 38.3% (conventional) of the ears tested. The agreement between procedures (TS vs. conventional) ranged from 93% to 98%. For group B, screening with the TS audiometer showed 95.5% sensitivity, 90.4% sensitivity, and positive and negative predictive values equal to 94.9% and 91.5%, respectively. CONCLUSIONS: The results of the TS audiometer were similar to those obtained with the conventional audiometer, indicating that the TS audiometer can be used for audiometric screening.

Website Babies Portal: development and evaluation of the contents regarding orofacial functions.

UNLABELLED: Education mediated by technology facilitates the access to information and can reach more people, including a broader range of socio-economic groups and ages, and at a low-cost. The website "Babies Portal - Speech-Language Pathology/Audiology and Dentistry" (http://portaldosbebes.fob.usp.br) was developed to provide parents with information on communication procedure disorders and oral health, enabling them to prevent and identify any changes in development early while looking for the best treatment. OBJECTIVE: The objective is to describe the development and evaluation of the content pertaining to the oral functions featured in the "Babies Portal". METHODS: The first stage consisted of a literature review, development/selection of illustrations and an evaluation of the possible external links that could be available. In the second stage, 10 speech-language and hearing pathologists (group A) and five parents of babies (group B) evaluated the website via an online form, which included ethical and personal information and questions about the quality, technical information and comparative prior knowledge acquired after the access. In the first stage, there was the construction of five sections ("The Oral Functions", "Breastfeeding", "Food", "Pacifier, baby bottle and finger sucking" and "Breath") based on scientific studies, presenting objective information, content links prepared by the Ministry of Health and a Dentistry section in the "Babies Portal" website. Videos, static and dynamic images were also distributed throughout the sections. RESULTS: Regarding the second stage, 90% of all speech-language and hearing pathologists judged a good/excellent quality for all sections and classified the technical quality as very good. By their turn, 88% of the parents (group B) reported that the website helped or helped very much in understanding the contents, and 80% rated the quality as good or excellent. CONCLUSIONS: Five sections concerning the oral functions were structured, and the results collected from groups A and B suggest that the content provided is adequate and reliable.

Teleaudiology: evaluation of teleconsultation efficacy for hearing aid fitting.

PURPOSE: To evaluate teleconsultation's efficacy for hearing aid fitting. METHODS: Fifty hearing impaired individuals with ages ranging from 39 to 88 years and mean audiometric thresholds between 30 and 68.75 dBHL participated in this study. Participants were divided into two groups (stratified randomization): control group (n=25), submitted to face-to-face procedures, and experimental group (n=25), submitted to synchronous teleconsultation with interactive video and remote applicative control. The hearing aids were programmed and verified (with microphone probe), and the subjects received instructions regarding use and care for the device. Time taken for the procedures was measured. Following the consultations, an evaluator (blind to the groups) applied the Hearing in Noise Test (HINT-Brazil). Approximately one month after consultations, the daily time of hearing aid use was verified, and the International Outcome Inventory for Hearing Aids (IOI-HA) was administered. RESULTS: A greater time for programming and verification and a smaller time for orientation were observed for the experimental group. No difference was found between groups for the total consultation time. The real ear measures' matching to their respective targets was similar for both groups. No difference was observed between groups for the HINT results (silence and noise), the daily amount of use of hearing aids in hours, and the IOI-HA scores. CONCLUSION: Teleconsultation is an efficient procedure for hearing aid programming, verification and fitting when face-to-face services are not available.

Real ear unaided gain and its relation with the equivalent volume of the external and middle ear.

INTRODUCTION: Old age is associated with changes in the characteristics of the middle ear transmission system and in external ear resonance, and these carry implications for the hearing aid (HA) verification process for which targets and measures of the real ear insertion gain (REIG) are used. AIM: To compare the real ear unaided gain (REUG) and the equivalent volumes of the external ear (VeqEE) and the middle ear (VeqME) between elderly and adult patients. METHODS: This is a retrospective study in which the medical records of 28 elderly patients (aged between 61 and 102 years, average hearing thresholds between 38.75 and 85 dB HL) and 23 adult patients (aged 20-59, mean hearing thresholds between 31.25 and 116.25 dB HL) with bilateral sensorineural hearing loss and no history of middle ear abnormalities were analyzed. Immittance measurements (VeqEE, VeqME, and pressure of the peak of maximum compliance) and the REUG (frequency and amplitude of the primary peak) were recovered for a total of 40 ears. These data were compared between elderly and adults as well as between men and women, using Student's t test. Correlations (Pearson) between immittance and REUG data were also verified. RESULTS: No statistically significant differences (p < 0.01) were found for immittance and REUG data between elderly and adults, or between men and women. A negative and weak but significant correlation was observed between the REUG primary peak and VeqEE. CONCLUSION: Hearing aid verification can be performed with target and measures of the REIG in the elderly population.