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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Obstructive sleep apnea and P300 evoked auditory potential.

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

Síndrome da apneia obstrutiva do sono e o potencial auditivo P300 / Obstructive sleep apnea and P300 evoked auditory potential

A Síndrome da Apneia Obstrutiva do Sono (SAOS) diminui as capacidades da atenção, memória e concentração, fatores relacionados com a cognição. A análise dos parâmetros do P300 auditivo permitiria inferir disfunção cognitiva. OBJETIVO: Comparar os dados da polissonografia e do P300 auditivo em adultos, roncopatas primários com portadores de SAOS. CASUÍSTICA E MÉTODO: Estudo prospectivo em roncopatas primários (N=12) e em portadores de SAOS (N=54), submetidos à polissonografia definidos pelo índice de apneia e hipopneia (IAH). As variáveis da polissonografia e as do P300 foram comparadas, pelos testes "T" de Student, exato de Fisher, regressão logística e análise de correlação com nível de significância de 5 por cento. RESULTADOS: O IAH apresentou correlação inversa com a oximetria em ambos os grupos. A prevalência do P300 foi menor no G.SAOS (teste exato de Fisher, p=0,027). A idade dos pacientes não influenciou a prevalência do P300 (análise de regressão; p=0,232). A amplitude do P300 foi menor do G.SAOS (teste "T" de Student; p=0,003) a latência do P300 foi semelhante em ambos os grupos (teste "T" de Student; p=0,89). CONCLUSÃO: A redução da amplitude do P300 nos portadores de SAOS sugere disfunção cognitiva induzida por diminuição da memória auditiva.

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

Study on suppression of otoacoustic emissions: lateral domain.

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

Study on suppression of otoacoustic emissions: lateral domain / Estudo da supressão da amplitude das emissões otoacústicas: dominância lateral

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

O trato olivococlear medial eferente, ao ser estimulado por ruído contralateral, ipsilateral ou bilateralmente em relação à orelha testada, altera a amplitude da resposta das emissões otoacústicas, reduzindo-a ou suprimindo-a, resultando no efeito de redução/supressão das emissões otoacústicas. Diferenças nos padrões de supressão/redução das emissões otoacústicas entre as orelhas foram documentadas internacionalmente, porém não há trabalhos nacionais que investigaram a dominância lateral do efeito. OBJETIVO: Comparar a presença efeito de supressão/redução das emissões otoacústicas e sua amplitude no que se refere à dominância lateral em indivíduos adultos audiologicamente normais. MATERIAL E MÉTODO: Clínico e experimental. A casuística foi composta por 75 indivíduos. A metodologia foi o modo convencional, com clique linear na intensidade de 60 dB nível de pressão sonora e o ruído branco, como estímulo contralateral, em 60 dB NPS. RESULTADOS: Não foram observadas diferenças estatisticamente significantes entre os resultados da orelha direita comparados à esquerda quanto à assimetria do tamanho da amplitude das emissões otoacústicas e quanto à presença do efeito de supressão/redução. CONCLUSÃO: Não há dominância lateral quanto ao tamanho da amplitude das emissões otoacústicas com presença do efeito de supressão/redução na população.

Auditory neuropathy/auditory dyssynchrony in children with cochlear implants / Neuropatia auditiva/dessincronia auditiva em crianças usuárias de implante coclear

The electrical stimulation generated by the Cochlear Implant (CI) may improve the neural synchrony and hence contribute to the development of auditory skills in patients with Auditory Neuropathy/Auditory Dyssynchrony (AN/AD). AIM: Prospective cohort cross-sectional study to evaluate the auditory performance and the characteristics of the electrically evoked compound action potential (ECAP) in 18 children with AN/AD and cochlear implants. MATERIAL AND METHODS: The auditory perception was evaluated by sound field thresholds and speech perception tests. To evaluate ECAP's characteristics, the threshold and amplitude of neural response were evaluated at 80Hz and 35Hz. RESULTS: No significant statistical difference was found concerning the development of auditory skills. The ECAP's characteristics differences at 80 and 35Hz stimulation rate were also not statistically significant. CONCLUSIONS: The CI was seen as an efficient resource to develop auditory skills in 94 percent of the AN/AD patients studied. The auditory perception benefits and the possibility to measure ECAP showed that the electrical stimulation could compensate for the neural dyssynchrony caused by the AN/AD. However, a unique clinical procedure cannot be proposed at this point. Therefore, a careful and complete evaluation of each AN/AD patient before recommending a Cochlear Implant is advised. Clinical Trials: NCT01023932.

A estimulação elétrica gerada pelo Implante Coclear (IC) pode ser capaz de melhorar a sincronia neural e contribuir para o desenvolvimento das habilidades auditivas de sujeitos portadores de Neuropatia Auditiva/Dessincronia Auditiva (NA/DA). OBJETIVO: Estudo de coorte prospectivo transversal para avaliar o desempenho auditivo e as características do Potencial de Ação Composto Eletricamente Evocado no Nervo Auditivo (ECAP) em 18 crianças portadoras de NA/DA e usuárias de IC. MATERIAL E MÉTODOS: Percepção auditiva e características do ECAP foram avaliadas respectivamente, por meio da determinação dos limiares tonais e testes de percepção de fala e pelas medidas de limiar e amplitude da resposta neural para as frequências de estimulação de 35 e 80Hz. Não foram encontradas diferenças estatisticamente significativas no desenvolvimento das habilidades auditivas entre os sujeitos avaliados. RESULTADOS: Não foram observadas modificações estatisticamente significativas nas características de limiar e amplitude do ECAP para as duas frequências de estimulação testadas. CONCLUSÕES: O IC caracterizou-se como um efetivo recurso para o desenvolvimento das habilidades auditivas em 94 por cento dos sujeitos, sendo a estimulação elétrica capaz de compensar a alteração da sincronia neural decorrente da NA/DA. A avaliação criteriosa de cada caso de maneira específica deve ser realizada no momento anterior à indicação cirúrgica. Clinical Trials: NCT01023932.

Auditory steady state response in pediatric audiology.

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

Potencial evocado auditivo de estado estável em audiologia pediátrica / Auditory steady state response in pediatric audiology

A principal questão que envolve o diagnóstico audiológico infantil é a determinação de procedimentos que configurem resultados confiáveis e objetivos, que possam ser utilizados na predição dos limiares auditivos por frequência específica. OBJETIVO: Correlacionar os achados do potencial evocado auditivo de estado estável (PEAEE) com outros exames em crianças com perda auditiva neurossensorial. MATERIAL E MÉTODO: Estudo prospectivo de coorte contemporânea com corte transversal. 23 crianças de ambos os gêneros e com idades entre 1 e 7 anos realizaram PEAEE, audiometria de reforço visual, potencial evocado auditivo de tronco encefálico (PEATE) clique e tone burst e medida do reflexo acústico para aplicação da regra de predição do limiar auditivo a partir do reflexo acústico. RESULTADOS: A correlação entre o PEAEE e audiometria variou de 0.70 a 0.93, para o PEATE-clique (2k e 4kHz) variou de 0.83 a 0.89, para o tone burst variou de 0.73 a 0.93. A concordância entre o PEAEE e a regra de predição do limiar auditivo foi considerada moderada. CONCLUSÃO: Houve correlação significativa entre o PEAEE e audiometria, assim como para o PEATE clique (2k e 4kHz) e para o PEATE tone burst. O reflexo acústico pode ser usado para acrescentar informações ao diagnóstico infantil.

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

Protocolo para captação dos potenciais evocados auditivos de longa latência / Protocol to collect late latency auditory evoked potentials

Os potenciais evocados auditivos de longa latência (PEALLs) se referem a uma série de mudanças elétricas, ocorridas no sistema nervoso central, resultante da estimulação da via sensorial auditiva. Muitos estudos abordam o uso destes potenciais, controlando o artefato gerado pelo movimento ocular com a utilização de equipamentos com grande número de canais. Porém, na prática clínica nacional, a realidade é diferente, havendo disponibilidade de equipamentos com número reduzido de canais. Objetivo: Comparar dois métodos de controle do artefato gerado pelo movimento ocular durante a captação dos PEALLs usando dois canais de registro. Material e método: Estudo prospectivo pela aplicação de dois métodos de captação dos PEALLs (subtração do artefato ocular e controle do limite de rejeição) em 10 adultos ouvintes normais. Resultados: Não foi observada diferença estatisticamente significante entre os valores de latência obtidos com o uso dos dois métodos, apenas entre os valores de amplitude. Conclusão: Os dois métodos foram eficientes para a captação dos PEALLs e para o controle do artefato do movimento ocular. O método do controle do limite de rejeição promoveu maiores valores de amplitude.

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

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

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

Central hearing system maturation in normally hearing children.

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

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

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

Maturação do sistema auditivo central em crianças ouvintes normais / Central hearing system maturation in normally hearing children

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

TEMA: os potenciais evocados auditivos de longa latência (PEALLs) fornecem dados objetivos sobre a funcionalidade das estruturas centrais auditivas. OBJETIVO: caracterizar a maturação do sistema auditivo central em crianças com audição normal. MÉTODO: registro dos PEALLs de 56 indivíduos ouvintes normais, de ambos os sexos, sendo 46 crianças e 10 adultos. Com a disponibilidade de dois canais de registro, um foi destinado à captação dos PEALLs e outro, ao registro do artefato gerado pelo movimento ocular, visando ao seu controle. Os potenciais foram registrados com os indivíduos em estado de alerta, por meio de eletrodos posicionados em Cz (ativo) e A2 (referência) e os movimentos oculares, por eletrodos em posição supra e infra-orbital esquerda; o eletrodo terra foi colocado em A1. Foram analisados a morfologia e os valores de latência e amplitude dos componentes P1, N1 e P2, de acordo com a idade. Para verificar a reprodutibilidade dos registros, foi realizado um estudo duplo-cego com a introdução da análise de outra avaliadora. RESULTADOS: o estudo duplo-cego não mostrou diferenças estatisticamente significantes entre as análises. Com o avanço da idade, houve melhora na morfologia e diminuição nos valores de latência dos componentes P1, N1 e P2. O componente P1 teve sua amplitude diminuída e não foi observada variação nos valores de amplitude dos componentes N1 e P2. Não foi observada diferença estatisticamente significante entre os sexos. CONCLUSÃO: o processo maturacional do sistema auditivo central acontece de maneira gradativa, sendo as maiores modificações observadas ao se comparar crianças e adultos.