Audiología pediátrica: el arte de armar rompecabezas / Pediatric Audiology: The Art of Putting Puzzles Together

La audición funcional ­para fines prácticos­ consiste en la posibilidad de despertar sensaciones precisas en regiones específicas del cerebro, a partir del procesamiento y extracción de mensajes ocultos en los cambios en la presión de las moléculas del aire que nos rodea. Medir la funcionalidad de la audición en un ser humano se convierte en un reto titánico que implica que nuestra vida profesional transcurra analizando información tanto subjetiva como objetiva de nuestros pacientes, ambas con un valor diagnóstico innegable. En cuanto a la primera, la historia clínica, las observaciones de la conducta auditiva del paciente, los reportes de la casa, la escuela y la terapia, o de estudios como la audiometría tonal y la logoaudiometría, resultan fundamentales no solo para el diagnóstico, sino para el seguimiento de nuestros pacientes. Sin embargo, en el caso de los pacientes más pequeños, o ante la necesidad de evaluar aspectos como la presión del oído medio, la función de las células ciliadas, o la presencia de microfónica coclear, la utilidad de esas herramientas subjetivas se encuentra limitada y entonces los registros, trazos, curvas y cifras relativas a intensidades, presiones, latencias, frecuencias, amplitudes y demás datos obtenidos a través de estudios objetivos, son los recursos que usamos para diagnosticar e iniciar la habilitación o rehabilitación de nuestros pacientes.

Functional hearing ­ for practical purposes ­ consists of the possibility of awakening precise sensations in specific regions of the brain from the processing and extraction of hidden messages in changes in the pressure of the molecules of the air that surrounds us. Measuring the functionality of hearing in a human being becomes a titanic challenge that implies that our professional life is spent analyzing both subjective and objective information from our patients, both with an undeniable diagnostic value: as for the first, the clinical history, observations of the patient's listening behavior, reports from home, school and therapy, or studies such as pure tone audiometry and speech audiometry, are essential not only for diagnosis but also for the follow-up of our patients. However, in the case of smaller patients, or when faced with the need to evaluate aspects such as middle ear pressure, hair cell function, or the presence of cochlear microphonics; The usefulness of these subjective tools is limited and therefore the records, traces, curves and figures related to intensities, pressures, latencies, frequencies, amplitudes and other data obtained through objective studies are the resources we use to diagnose and start the investigation. rehabilitation or rehabilitation of our patients.

Recomendaciones para la atención fonoaudiológica en las áreas de audiología y otoneurología en contexto COVID-19: una revisión narrativa / Recommendations for audiologist assistance in the areas of audiology and otoneurology in context COVID-19: a narrative review

La pandemia por el virus SARS-CoV-2 causante de la enfermedad COVID-19 se ha expandido rápidamente a nivel mundial. Las autoridades de salud pública han recomendado limitar las prestaciones de salud no esenciales, buscando el equilibrio entre el riesgo del retraso en el tratamiento y la potencial exposición al virus. En la mayoría de las prestaciones en las áreas de audiología y otoneurología no es posible cumplir con el distanciamiento físico recomendado y la duración de la atención puede superar los 45 minutos, factores que aumentan el riesgo de contagio para el profesional. El objetivo de la presente revisión es describir la evidencia actual sobre las recomendaciones de atención para las áreas de audiología y otoneurología en contexto COVID-19. Además de la búsqueda de artículos científicos en diversas bases de datos, se revisaron las recomendaciones emitidas por las principales asociaciones en el área. La información obtenida se organizó considerando cuatro aspectos clínicos relevantes: prestaciones, procedimientos, elementos de protección personal y limpieza de equipamiento e insumos. La evidencia científica y las sugerencias de las asociaciones están en constante actualización y algunos temas se han desarrollado escasamente. Sin embargo, las recomendaciones coinciden en priorizar la atención a distancia, extremar el uso de elementos de protección personal, implementar protocolos de higiene de manos y limpieza de equipos e insumos. También, se sugiere incorporar estrategias de comunicación alternativas al lenguaje oral con las personas con hipoacusia para facilitar la discriminación de la palabra.

The COVID-19 pandemic caused by the SARS-CoV-2 virus has rapidly spread worldwide. Public health authorities have recommended limiting non-essential healthcare, in search of a balance between the risk of delaying treatment and the potential exposure to the virus. Most services in the audiology and otoneurologyareas can easily exceed 45 minutes and it is not possible to keep the recommended physical distancing. Both factors increase the risk of professionals being infected. Therefore, the purpose of this review is to describe the current evidence about recommendations in audiology and otoneurology care in the context of COVID-19. In addition to the search of scientific articles in various databases, recommendations issued by the mainassociations in the area were consulted. The information was gathered considering four relevant clinical aspects: health careservices, procedures, personal protective equipment and the cleaning of equipment and supplies. Scientific evidence and suggestions made by associations are being constantly updated, and therefore there is limited content on some topics. However, the recommendations agree on prioritizing remote health care, increasing the use of personal protective equipment, implementing protocols for hand hygiene and for the cleaning of equipment and supplies. The incorporation communication strategies other than oral language to interact with people with hearing lossto facilitate speech discrimination is also recommended.

Enmascaramiento clínico: una revisión de la literatura / Clinical masking: a literature review

Son diversos los métodos planteados para aplicar enmascaramiento, de esta forma es necesario revisar la literatura en búsqueda de consenso. Se revisaron críticamente los métodos utilizados y recomendados por la literatura y sociedades internacionales, en torno a la aplicación de enmascaramiento. Se consultó entre agosto y noviembre de 2015 en PUBMED, SciELO y Google Scholar por estudios acerca de métodos de enmascaramiento utilizados en audiometría. También se revisaron las guías de organizaciones internacionales y lo publicado en libros relacionados con el área de audiología. El método de "La Meseta" es el más referenciado, siendo modificado posteriormente. Existen variaciones en criterios de atenuación interaural, necesidad de enmascaramiento, enmascaramiento inicial, incrementos para obtener la meseta y niveles del efecto de oclusión. Se concluye que la literatura muestra diferencias al momento de decidir cuándo enmascarar y cómo hacerlo. No obstante, se puede establecer criterios comunes en relación a los niveles de atenuación interaural, cuándo enmascarar, valores de efecto de oclusión y metodología. El método de "La Meseta" sigue siendo el más recomendado. La modificación realizada por Yacullo es la más referenciada y recomendada en la literatura actual.

Adequate use of masking is key in the correct diagnosis of hearing loss. Various methods are suggested regarding the application of clinical masking, hence the need to review literature in order to reach a consensus. To critically review the specialized literature and international societies' recommendations regarding clinical masking. From August to November 2015, PUBMED, SciELO and Google Scholar articles on clinical masking methods used in tonal audiometries were consulted, as well as international organization guidelines, and literature in the area of Audiology. Hood's plateau method, later revised, received the most references. The modified versions consider the number of increments needed to determine the true threshold, and the occlusion effect. Optimized methods show the variations regarding interaural attenuation, need for masking, initial masking level, increments to reach "The Plateau", and the occlusion effect. Literature shows differences regarding when and how to use masking; however, common criteria can be established with reference to the levels of interaural attenuation, when to use masking, occlusion effect values and methodology. The plateau method proposed by Hood is still the most recommended. Yacullo's optimization is currently the one with the most references and recommendations in specialized literature.

Calidad de vida de la población adulta con acúfenos / Quality of life of the adult population with tinnitus

El acúfeno es la percepción de un sonido en ausencia de un estímulo acústico externo. Se estima que comprometen gravemente la calidad de vida de los adultos y se asocia con un deterioro significativo en el desempeño de las actividades cotidianas; a menudo conduce a estados psicopatológicos tales como ansiedad y depresión. El presente trabajo adquiere un particular interés debido al aumento de la población mundial de adultos mayores, que son los que con mayor frecuencia sufren acúfenos. HIPÓTESIS: Los pacientes con acúfenos se ven afectados negativamente en su calidad de vida. OBJETIVOS: Determinar la calidad de vida de una muestra de pacientes con acúfenos. Determinar el nivel y el perfil audiológico mediante la audiometría y la logoaudiometría. Evaluar la funcionalidad del oído medio a través de la impedanciometría. Determinar y analizar las características de los acúfenos y la respuesta en el Test de Inhibición residual del acúfeno. Correlacionar las características del acúfeno con el perfil audiológico. Pacientes y métodos: Estudio observacional, transversal, analítico en el que se incluyeron pacientes adultos con acúfenos uni o bilaterales, normo oyentes o hipoacúsicos. En los mismos se realizó un examen Otorrinolaringológico y los estudios complementarios auditivos (Audiometría, Logoaudiometría, Impedanciometría, Acufenometría y Test de inhibición residual del acúfeno). La calidad de vida se evaluó con el cuestionario Tinnitus Handicap Inventory Questionnaire. Las variables continuas se describieron con sus respectivos valores de posición y dispersión y las variables categóricas con porcentajes. La correlación de las características del acúfeno con el perfil audiológico se realizó con test de Chi cuadrado. Se consideró significativa una p < 0,05. Resultados: El análisis de este estudio incluyó 93 pacientes y 149 acúfenos siendo estos: unilaterales (N=36), bilaterales (N= 111) y de localización cefálica (N=2). No se encontraron diferencias entre ambos géneros: 49 (53%) fueron de sexo masculino, mientras que el 44 (47%) fueron de sexo femenino. Los pacientes tenían una edad media (desviación estándar) de 52.5 (13.1) años. La calidad de vida a partir del THI demostró que 38 (41%) pacientes tenían alteración de la calidad vida leve (grado II), 20 ( 22%) no presentaron alteraciones (grado I) y en 20 (22%) la alteración fue moderada (grado III). Al analizar el perfil y el nivel audiológico, 82/149 (55%) de los acúfenos estudiados presentaron un perfil audiológico de tipo de hipoacusia neurosensorial y 49/149 (33%) eran normo oyentes. Por otro lado, 83/149 (91%) de los oídos estudiados no tenían alteraciones en oído medio. Ante el Test de Inhibición residual del acúfeno, se observó que 68 (46%) tuvieron respuestas parciales, 55 (37%) respuesta completa, 19 (12%) negativa y 7 (5%) tuvieron "efecto rebound". Según el tono, se observó que el perfil predominante era el de hipoacusia neurosensorial, 6 (75%) con acúfenos de banda estrecha y 74 (57%) con acúfenos agudos. Por otro lado, el perfil normo oyente se observó en 8 (67%) acúfenos de tono grave (p= 0.006). Con respecto al ruido del acúfeno, 5 (50%) pacientes presentaron ruidos pulsátiles y 7 (50%) intermitentes, siendo audiológicamente normo oyentes. Setenta y dos (58%) pacientes con hipoacusia neurosensorial presentaron ruidos continuos (p= 0.012). Según la localización, dos pacientes (100%) tenían acúfenos cefálicos y perfil audiológico normo oyente. Por otro lado, 21 (58%) pacientes presentaron acúfenos unilaterales y 61 (55%) bilaterales, ambos asociados en su mayoría a hipoacusia neurosensorial. (p= 0.42). Por último, ante la inhibición residual, 27 acúfenos en oídos con perfil audiológico normal (50%) presentaron respuesta completa. Mientras que oídos con perfil de hipoacusia neurosensorial, 44 (65%) presentaron respuesta parcial, 11 (58%) negativa y 6 (86%) efecto rebound. (p=0,05) Conclusión: Los acúfenos afectan negativamente la calidad de vida de quienes los padecen pero estos no los limitan en sus actividades diarias y pueden ser inhibidos con los estímulos acústicos. La mayoría de los acúfenos estudiados fueron inhibidos ante estímulos sonoros, lo cual nos abre puertas a las futuras conductas terapéuticas a seguir en cada caso. (AU)

Tinnitus is the perception of a sound in the absence of an external acoustic stimulus. They are estimated to severely compromise the quality of life of adults and is associated with a significant deterioration in the performance of daily activities; Often leads to psychopathological states such as anxiety and depression. The present work acquires a particular interest due to the increase of the world-wide population of older adults, who are the most frequent sufferers of tinnitus. HYPHOTESIS: Patients with tinnitus are negatively affected in their quality of life. Objectives: To determine the quality of life of a sample of patients with tinnitus. To determine the level and the audiological profile through audiometry and logoaudiometry. To evaluate the functionality of the middle ear through the impedanciometry. To determine and analyze the characteristics of tinnitus and the response in the residual inhibition test of tinnitus. Correlate the characteristics of the tinnitus with the audiological profile. Patients and methods: An observational, crosssectional, analytical study in which adult patients with uni or bilateral tinnitus, normo hearing or hypoacusic tinnitus were included. An otorhinolaryngological examination and complementary auditory studies (Audiometry, audiometry, impedance measurement, acuphenometry and residual inhibition of tinnitus) were performed. Quality of life was assessed using the Tinnitus Handicap Inventory Questionnaire. Continuous variables were described with their respective position and dispersion values and categorical variables with percentages. The correlation of the characteristics of the tinnitus with the audiological profile was performed with Chi square test. A p <0.05 was considered significant. RESULTS: The analysis of the study included 93 patients and 149 tinnitus. These were: unilateral (N = 36), bilateral (N = 111) and cephalic (N = 2). No differences were found between the two genders: 49 (53%) were male, while 44 (47%) were female. Patients had a mean age (standard deviation) of 52.5 (13.1) years. Quality of life from THI showed that 38 (41%) patients had altered quality of life (grade II), 20 (22%) Did not present alterations (grade I) and in 20 (22%) the alteration was moderate (grade III). When analyzing the profile and the audiological level, 82/149 (55%) of the tinnitus studied presented an audiological profile of type of sensorineural hearing loss and 49/149 (33%) were normal hearing. On the other hand, 83/149 (91%) of the ears studied had no alterations in the middle ear. Before the residual inhibition test of tinnitus, 68 (46%) had partial responses, 55 (37%) complete response, 19 (12%) negative and 7 (5%) had a "rebound effect". According to the tone, the predominant profile was sensorineural hypoacusis, 6 (75%) with narrow-band tinnitus and 74 (57%) with acute tinnitus. On the other hand, the normal hearing profile was observed in 8 (67%) severe tinnitus tinnitus (p = 0.006). Concerning tinnitus noise, 5 (50%) patients presented intermittent pulsing and 7 (50%) noises, being audiologically normal hearing. Seventy-two (58%) patients with neurosensory hearing loss had continuous noises (p = 0.012). According to the location, two patients (100%) had cephalic tinnitus and a normal hearing profile. On the other hand, 21 (58%) patients presented unilateral and 61 (55%) bilateral tinnitus, both of which were associated with sensorineural hearing loss. (P = 0.42). Finally, due to residual inhibition, 27 tinnitus in ears with normal audiological profile (50%) presented complete response. While ears with a sensorineural hearing loss profile, 44 (65%) presented partial response, 11 (58%) negative and 6 (86%) rebound effect. (P = 0.05). CONCLUSION: Tinnitus adversely affects the quality of life of those who suffer from them but these do not limit them in their daily activities and can be inhibited by acoustic stimuli. Most of the tinnitus studied were inhibited by sound stimuli, which opens the door to future therapeutic behaviors to be followed in each case. (AU)

A systematic review of the use of telehealth in speech, language and hearing sciences.

INTRODUCTION: We conducted a systematic literature review to investigate the domain of speech-language and hearing sciences (SLHS) in telehealth. METHODS: The databases used for the literature search were Web of Knowledge, Pubmed, Scopus, Embase and Scielo. The inclusion criteria consisted of papers published up to August 2014. Papers without peer-review evaluation, and those without abstracts or available full texts were excluded. RESULTS: A total of 103 papers were selected. The selected studies have focused primarily on hearing (32.1%), followed by speech (19.4%), language (16.5%), voice (8.7%), swallowing (5.8%), multiple areas (13.6%) and others (3.9%). The majority of the studies focused on assessment (36.9%) or intervention (36.9%). The use of telehealth in SLHS has been increasing in many countries, especially in the last 5 years. The country with the largest number of published studies was the United States of America (32.03%), followed by Australia (29.12%). The remaining studies were distributed in lower numbers among other countries. DISCUSSION: The advancement of information and communication technologies provides more favourable conditions for providing distance care in several areas. Most of studies concluded that the telehealth procedure had advantages over the non-telehealth alternative approach (85.5%); however, 13.6% reported that it was unclear whether the telehealth procedure had advantages. Some barriers still need to be overcome, such as technology, training, regulation, acceptance and recognition of the benefits of this practice by the public and professionals. The need for speech-language pathologists and audiologists to adapt to this new health care modality is evident.

Pilot study of a high-frequency school-based hearing screen to detect adolescent hearing loss.

OBJECTIVE: Like most of the United States, school-based hearing screening in Pennsylvania focuses on low-frequency, conductive hearing losses typical for young children, rather than the high-frequency, noise-induced hearing loss more prevalent among adolescents. The objective of this study was to compare the sensitivity and specificity of current school hearing screening in Pennsylvania with hearing screening including high frequencies, designed to detect adolescent hearing loss. SETTING: A single public high school. METHODS: In the Autumn of 2011 the high-frequency screen was delivered alongside the Pennsylvania school screen for students in the 11(th) grade. Screening referrals and a subset of passes returned for "gold standard" testing with audiology in a sound treated booth, in order to determine the sensitivity and specificity of the screening tests. RESULTS: Of 282 participants, five (2%) were referred on the Pennsylvania school screen, and 85 (30%) were referred on the high-frequency screen. Of the 48 who returned for gold standard testing with audiology, hearing loss was diagnosed in 9/48 (19%). Sensitivity of the Pennsylvania and high-frequency screens were 13% (95% confidence interval [CI] 0-53%) and 100% (95% CI 66-100%) respectively. Specificity of the Pennsylvania and high-frequency screens were 97% (95% CI 87-100%) and 49% (95% CI 32-65%) respectively. CONCLUSIONS: Current school hearing screens have low sensitivity for detection of adolescent hearing loss. Modifying school-based protocols may be warranted to best screen adolescents, and make optimal use of school nurse time and effort.

Evaluation of ototoxicity in children treated for retinoblastoma: preliminary results of a systematic audiological evaluation.

BACKGROUND: The objective of this study was to identify the ocurrence of hearing loss in children treated for retinoblastoma using a multidisciplinary approach. PATIENTS AND METHODS: Thirty-two children were evaluated pre- and post-treatment. Eleven children were treated exclusively with enucleation, fifteen with carboplatin and six with cisplatin. Otoacoustic emissions were performed with the ILO 88, before and after the treatment. RESULTS: In our study we found 5 children (24%) with hearing loss among the 21 evaluated. However in the group of children treated with carboplatin (N=15), 1 case (6.6%) presented hearing loss, while among those treated with cisplatin (N=6) we found 4 cases (66.6%) with hearing loss (p=0.0114). CONCLUSION: We concluded that patients who are treated with cisplatin are at risk for developing hearing loss.

Audiology and aging: literature review and current horizons.

AIM: to review the literature on aging-related hearing loss and its current impacts. LITERATURE REVIEW: In studies carried out in Brazil, presbycusis has been blamed for being the most frequent cause of hearing loss in the elderly, causing verbal communication impairment. International studies also show the high prevalence of hearing loss in the elderly. DISCUSSION: According to recent investigations, as the number of elderly people increase, the prevalence of presbycusis interfering in the life quality of this population also increases. Even among health care professionals, there is a huge lack of knowledge about the advantages and gains a specific hearing reeducation can bring about for the elderly with hearing impairment. CONCLUSIONS: the papers hereby analyzed showed that the public health care centers with physicians and speech and hearing therapists, should establish the guidelines for the development of diagnostic programs, purchase of hearing aids and, most specially, hearing reeducation for the elderly with presbycusis, so that they may enjoy their social relations, and thus enhance their life quality. However, in Brazil, studies and research in this area only beginning.

Audiologia do envelhecimento: revisão da literatura e perspectivas atuais / Audiology and aging: literature review and current horizons

OBJETIVO: Revisar a literatura sobre a perda auditiva associada ao envelhecimento e suas implicações, numa perspectiva atual. REVISÃO DA LITERATURA: Nos estudos realizados no Brasil, a presbiacusia vem sendo apontada como causa mais freqüente da deficiência auditiva em pessoas idosas, implicando em uma dificuldade de compreensão durante a comunicação verbal. Estudos internacionais também mostram alta prevalência da perda auditiva em pessoas idosas. DISCUSSÃO: Segundo pesquisas recentes, à medida que o quantitativo da população idosa vem aumentando, também aumenta a prevalência da presbiacusia que interfere na qualidade de vida do idoso. Mesmo entre os profissionais de saúde, ainda é grande o desconhecimento em relação às vantagens e ganhos que a reeducação auditiva específica para idosos com perda auditiva pode oferecer. CONCLUSÃO: Os artigos aqui analisados mostraram que os serviços de saúde da rede pública, que envolvem médicos e fonoaudiólogos, devem estabelecer diretrizes para o desenvolvimento de programas de diagnóstico, aquisição de aparelhos de amplificação sonora individual e, principalmente, de reeducação auditiva para os idosos portadores de presbiacusia, para que eles possam participar e desfrutar das relações sociais, mantendo uma boa qualidade de vida. Entretanto, no Brasil, os estudos e pesquisas nesta área estão apenas começando.

AIM: to review the literature on aging-related hearing loss and its current impacts. LITERATURE REVIEW: In studies carried out in Brazil, presbycusis has been blamed for being the most frequent cause of hearing loss in the elderly, causing verbal communication impairment. International studies also show the high prevalence of hearing loss in the elderly. DISCUSSION: According to recent investigations, as the number of elderly people increase, the prevalence of presbycusis interfering in the life quality of this population also increases. Even among health care professionals, there is a huge lack of knowledge about the advantages and gains a specific hearing reeducation can bring about for the elderly with hearing impairment. CONCLUSIONS: the papers hereby analyzed showed that the public health care centers with physicians and speech and hearing therapists, should establish the guidelines for the development of diagnostic programs, purchase of hearing aids and, most specially, hearing reeducation for the elderly with presbycusis, so that they may enjoy their social relations, and thus enhance their life quality. However, in Brazil, studies and research in this area only beginning.

Intervenção fonoaudiológica no tratamento do zumbido: uma estratégia de promoção em saúde coletiva / Phomiatric intervention in the treatment of the ear buzzing a strategy in promoting community health

O presente estudo tem como objetivo aumentar os conhecimentos sobre o Trabalho Fonoaudiológico em Saúde Pública, especialmente no caso de pacientes portadores de zumbido. A escolha deste tema tem origem em questionamentos feitos por profissionais da saúde referentes ao papel do Fonoaudiológo, principalmente em Programas de Saúde Coletiva. E na demanda de casos de pacientes portadores de zumbido verificada junto ao atendimento em uma Unidade Básica de Saúde. Demanda esta comprovada na revisão de algumas publicações sobre o tema. Este trabalho consiste em uma pesquisa bibliográfica, de publicações recentes, em que temas como: histórico da fonoaudilogia, anátomo-fisiologia da audição, etiologia do zumbido, zumbidos de origem auditiva e para-auditiva, tratamento, terapias cognitivas e comportamentais, proposta para uma alternativa de atendimento em grupo...

Corriente prevaleciente de educación para niños y jóvenes hipoacúsicos y sordos / Mainstream education for hearing impaired children and youth

Corriente prevaleciente: Aspectos auditivo-perceptuales y psicosociales de los estudiantes deficientes auditivos evaluados; Problemas y prácticas; aspectos administrativos.- Programas y materiales ejemplares

Corriente prevaleciente de educación para niños y jóvenes hipoacúsicos y sordos / Mainstream education for hearing impaired children and youth

Corriente prevaleciente: Aspectos auditivo-perceptuales y psicosociales de los estudiantes deficientes auditivos evaluados; Problemas y prácticas; aspectos administrativos.- Programas y materiales ejemplares