Reabilitação da perda auditiva em pacientes oncológicos: fatores de influência na adesão ao uso do aparelho de amplificação / Rehabilitation of hearing loss in cancer patients: influencing factors in adherence to the use of hearing aids

RESUMO

INTRODUÇÃO: O tratamento do câncer pode desencadear perda auditiva, exigindo a monitorização e a adaptação de aparelho de amplificação sonora individual (AASI) para auxiliar na reabilitação auditiva quando necessário. OBJETIVO: analisar quais fatores podem influenciar na adesão ao uso do AASI em pacientes que passaram por tratamento oncológico. MATERIAL E MÉTODO: Estudo prospectivo observacional de corte transversal aprovado pelo Comitê de Ética em Pesquisa da Universidade do Vale do Itajaí, sob parecer consubstanciado nº 2.777.076. Foram selecionados indivíduos participantes do acompanhamento de rotina do Serviço Ambulatorial de Saúde Auditiva (SASA/UNIVALI) com registro de diagnóstico e tratamento de câncer e pareados por idade e grau de perda auditiva com participantes sem histórico de tratamento de câncer. Dados quanto ao histórico do câncer, resultados da aplicação dos questionários de levantamento de dificuldades auditivas e uso do AASI (IOI-HA) foram coletados em prontuário. Foram aplicados o teste de zonas mortas da cóclea (teste TEN), índice de inteligibilidade de fala (SII) e realizada a leitura do datalogging na visita de rotina para acompanhamento anual no serviço. As perdas auditivas foram classificadas tanto pelo Common Terminology Criteria for Adverse Events (CTCAE ­NCI) como pela classificação do Sistema de Conselhos de Fonoaudiologia. Os dados foram analisados pelos testes T de Student e correlação de Spearman. RESULTADOS: A amostra contou com 30 participantes, sendo 15 participantes alocados no grupo estudo (GE) composto por usuários de AASI com registro de diagnóstico e tratamento de câncer e um grupo controle (GC) composto por 15 usuários de AASI, sem histórico de câncer, com idade média de 62,4.

ABSTRACT

INTRODUCTION: Cancer treatment can induce hearing loss, requiring monitoring and adaptation of an hearing aids to assist in auditory rehabilitation when necessary. OBJECTIVE: to analyze which factors can influence the adherence to the use of hearing aids in patients who underwent cancer treatment. MATERIAL AND METHODS: Prospective observational cross-sectional study approved by the Research Ethics Committee of University of Vale do Itajaí, under protocol number 2,777,076. Individuals participating in the routine follow-up of the Hearing Health Outpatient Service (SASA/UNIVALI) with a record of cancer diagnosis and treatment were selected and matched by age and degree of hearing loss with those without a history of cancer treatment. Data regarding cancer history, results of questionnaires for surveying hearing difficulties and hearing aid use (IOI-HA) were collected from medical records. Cochlear dead regions test (TEN test) and speech intelligibility index (SII) were applied, and the datalogging was taken during the routine visit for annual follow-up at the service. Hearing losses were classified both by the Common Terminology Criteria for Adverse Events (CTCAE ­NCI) and by the classification of the Speech Therapy Council System. Data were analyzed by Student's t-test and Spearman's correlation. RESULTS: Thirty participants were selected, with 15 participants allocated to the study group (SG) composed of hearing aid users with a record of cancer diagnosis and treatment, and 15 hearing aid users allocated to a control group (CG), with no history of cancer, with a mean age of 62.4 years (EG) and 61.4 years in the (CG) respectively, and similar distribution of sex. In both groups, moderate high frequency sensorineural hearing loss prevailed, with the use of binaural hearing aids for more than five years. Cochlear unresponsive (dead) regions were found at all frequencies from 50010 to 4000Hz, in both ears and in both groups. There was no statistical difference between the groups in the SII values. Even participants with unresponsive zones showed hearing aid use for more than 7 hours/day, although the control group showed hearing aid use for more hours. There was also no statistical difference in the IOI-HA, with a positive perception of benefit and satisfaction with the hearing aid in both groups. There was no correlation between datalogging and SII in both groups. In the SII and in the IOI-HA, participants with no unresponsive zones presented higher scores than those with unresponsive zones. CONCLUSION: Both groups were similar in audiological findings and presence of cochlear dead (unresponsive) regions, however, participants without a history of cancer showed greater adherence to hearing devices. Adherence to use was not influenced by the SII score or to the presence of unresponsive regions in the cochlea. The presence of unresponsive regions in the cochlea influenced the speech intelligibility index and user satisfaction with their hearing aid. Participants who use the hearing aid for a longer time judge their emotional and social aspects better.