Speech perception and cortical auditory evoked potentials in cochlear implant users with auditory neuropathy spectrum disorders.

OBJECTIVE: To characterize the P(1) component of long latency auditory evoked potentials (LLAEPs) in cochlear implant users with auditory neuropathy spectrum disorder (ANSD) and determine firstly whether they correlate with speech perception performance and secondly whether they correlate with other variables related to cochlear implant use. METHODS: This study was conducted at the Center for Audiological Research at the University of São Paulo. The sample included 14 pediatric (4-11 years of age) cochlear implant users with ANSD, of both sexes, with profound prelingual hearing loss. Patients with hypoplasia or agenesis of the auditory nerve were excluded from the study. LLAEPs produced in response to speech stimuli were recorded using a Smart EP USB Jr. system. The subjects' speech perception was evaluated using tests 5 and 6 of the Glendonald Auditory Screening Procedure (GASP). RESULTS: The P(1) component was detected in 12/14 (85.7%) children with ANSD. Latency of the P(1) component correlated with duration of sensorial hearing deprivation (*p=0.007, r=0.7278), but not with duration of cochlear implant use. An analysis of groups assigned according to GASP performance (k-means clustering) revealed that aspects of prior central auditory system development reflected in the P(1) component are related to behavioral auditory skills. CONCLUSIONS: In children with ANSD using cochlear implants, the P(1) component can serve as a marker of central auditory cortical development and a predictor of the implanted child's speech perception performance.

FM listening evaluation for children: adaptação para a língua portuguesa / FM listening evaluation for children

INTRODUÇÃO: A inclusão do deficiente auditivo na escola é assegurada pelo poder público no Brasil por documentos oficiais e o sistema FM é um instrumento da tecnologia assistiva que o professor deve ter acesso. OBJETIVO: traduzir e adaptar para a Língua Portuguesa o questionário FM Listening Evaluation for children. MÉTODOS: A tradução e adaptação do questionário FM Listening Evaluation incluíram a tradução para o idioma português, adaptação lingüística e revisão das equivalências gramatical e idiomática e adaptação; também foi avaliada a reprodutibilidade intra-pesquisadores. O questionário foi aplicado nos professores e na fonoaudióloga de 12 crianças de sete a treze anos deficientes auditivas, usuárias de Aparelho de Amplificação Sonora Individual e adaptadas com sistema FM. RESULTADOS: A tradução e adaptação do questionário resultaram no novo inventário:AVALIAÇÃO DO SISTEMA FM, apresentando diferença significativa entre os resultados de ruído e: via auditiva e silêncio; - distância e: via auditiva e silêncio; - via auditiva e: ruído, distância e silêncio; - silêncio e: ruído, distância e via auditiva. Houve diferença significativa sem e com o Sistema FM, sendo que neste a pontuação foi sempre maior. Na comparação intrapesquisadores evidenciou-se diferença significativa entre: pontuação total com FM; via auditiva sem FM e ruído com FM. CONCLUSÃO: O questionário Avaliação do Sistema FM foi considerado um instrumento confiável para verificação e acompanhamento dos benefícios do Sistema FM podendo favorecer assim o processo de inclusão escolar do aluno deficiente auditivo.

INTRODUCTION: The inclusion of children with hearing impairments in schools is guaranteed by the Brazilian government by means of official legislation. The FM system is an assistive technology instrument to which regular teachers should have access. OBJECTIVE: To translate and adapt to Portuguese the FM Listening Evaluation questionnaire for children and assess its reliability. METHODS: The translation and adaptation to the FM Listening Evaluation included translation into Portuguese, linguistic adaptation and revision of the grammatical and idiomatic equivalences and adaptation; inter-researcher reproducibility was also evaluated. The questionnaire was administered to the teachers and speech-language pathologists of 12 children aged seven to thirteen years with hearing impairment; the children used hearing aids and had been adapted to the FM system. RESULTS: The translation and adaptation of the questionnaire resulted in new inventory: FM EVALUATION SYSTEM, presenting a significant difference between the results of noise and: hearing pathways and silence; - distance and: hearing pathways and silence; - hearing pathways and: noise, distance and silence; - silence and: noise, distance and hearing pathways. There was significant difference with and without the FM system, in which the score was always higher. Intra-examiner comparison revealed a significant difference between the total score with FM, via FM and hearing no noise with FM. CONCLUSION: The questionnaire Rating System FM was considered a reliable instrument for verifying and monitoring the benefits of FM system, in order to promote the process of educational inclusion for students with hearing impairments.

Early Listening Function (ELF): adaptação para a língua portuguesa / Early Listening Function (ELF): adaptation into Brazilian Portuguese

OBJETIVO: Traduzir e adaptar culturalmente para a língua portuguesa o questionário Early Listening Function (ELF), e avaliar a confiabilidade do mesmo. MÉTODOS: Foi realizada a tradução do questionário para o idioma Português, revisão das equivalências gramatical e idiomática (traduções reversas) e adaptações linguística e cultural. Além disso, foi avaliada a reprodutibilidade intra-pesquisadores. Após a tradução, o ELF foi aplicado, em ambiente silencioso e ruidoso, em 30 crianças entre zero e três anos de idade, sem histórico de risco para deficiência auditiva, ausência de queixa familiar quanto ao desenvolvimento global da criança e sem indicadores de perda auditiva incapacitante, em diferentes distâncias, em 12 situações de detecção auditiva. RESULTADOS: Os resultados foram analisados com estudo estatístico descritivo a partir da pontuação obtida no ELF. CONCLUSÃO: O instrumento ELF foi traduzido e adaptado culturalmente para a população estudada. No Português, sua denominação manteve a sigla ELF. O estudo permitiu verificar sua confiabilidade para observação e acompanhamento das etapas iniciais do comportamento auditivo.

PURPOSE: To translate and adapt the Early Listening Function (ELF) questionnaire into the Brazilian Portuguese language, and to evaluate the reliability of the test. METHODS: It was carried out the translation of the ELF questionnaire into Brazilian Portuguese, the review of grammatical and idiomatic equivalents (reversed translations), and linguistic and cultural adaptation. Moreover, the intra-researcher reproducibility was evaluated. After the translation, the ELF was carried out with 30 children between zero and three years old, with no history of hearing loss risk, lack of family complaint regarding the overall development of the child, and no indicators of hearing loss disability. The questionnaire was applied in 12 cases of hearing detection at different distances, in quiet and noisy environments. RESULTS: Results were analyzed using a descriptive statistical study based on the results obtained on the ELF score sheet. CONCLUSION: The ELF questionnaire was translated and culturally adapted for the studied population. In Brazilian Portuguese, its designation maintained the acronym ELF. The study verified the instrument's reliability for observing and monitoring the initial stages of hearing behavior.

Avaliação da percepção da fala no ruído em diferentes posições em adultos com implante coclear / Evaluation of the speech perception in the noise in different positions in adults with cochlear implants

Introdução: A queixa mais frequente dos usuários de implante coclear tem sido reconhecer e compreender o sinal da fala na presença do ruído. Pesquisas investigam a percepção da fala dos usuários de implante coclear, enfocando aspectos como os efeitos da diminuição da relação sinal/ruído na percepção da fala, o reconhecimento da fala no ruído, com diferentes tipos de implante coclear e estratégias de codificação da fala e os efeitos da estimulação biaural na percepção da fala no ruído. Objetivo: 1 - Avaliar a percepção de fala em adultos usuários de implante coclear, em diferentes posições quanto à apresentação do estimulo; 2 - comparar os índices de reconhecimento de fala nas posições frontal, ipsilateral e contralateral e 3 - analisar o efeito da adaptação monoaural na percepção da fala com ruído. Método: Avaliados 22 adultos usuários de implante coclear quanto à percepção da fala. Os indivíduos foram submetidos à avaliação de reconhecimento das sentenças, com ruído competitivo na relação sinal/ruído +10 decibeis em três posições: frontal, ipsilateral e contralateral ao lado implantado. Resultados: Os resultados demonstraram maior índice de reconhecimento da fala na posição ipsilateral (100%) e o menor índice de reconhecimento da fala com sentenças na posição contralateral (5%). Conclusão: O desempenho da percepção da fala em indivíduos implantados é prejudicado quando é introduzido o ruído competitivo, o índice de reconhecimento da fala é melhor quando a fala é apresentada ipsilateralmente, e consequentemente é pior quando é apresentada contralateralmente ao implante coclear, e há maior prejuízo na inteligibilidade da fala quando existe apenas entrada monoaural.

Introduction: The most frequent complaint of the cochlear implant users has been to recognize and understand the speech signal in the presence of noise. Researches have been developed on the speech perception of users of cochlear implant with focus on aspects such as the effect of the reduction to the signal/noise ratio in the speech perception, the speech recognition in the noise, with different types of cochlear implant and strategies of speech codification and the effects of the binaural stimulation in the speech perception in noise. Objective: 1-To assess the speech perception in cochlear implant adult users in different positions regarding the presentation of the stimulus, 2-to compare the index of speech recognition in the frontal, ipsilateral and contralateral positions and 3-to analyze the effect of monoaural adaptation in the speech perception with noise. Method: 22 cochlear implant adult users were evaluated regarding the speech perception. The individuals were submitted to sentences recognition evaluation, with competitive noise in the signal/noise ratio +10 decibels in three positions: frontal, ipsilateral and contralateral to the cochlear implant side. Results: The results demonstrated the largest index of speech recognition in the ipsilateral position (100%) and the lowest index of speech recognition with sentences in the contralateral position (5%). Conclusion: The performance of speech perception in cochlear implant users is damaged when the competitive noise is introduced, the index of speech recognition is better when the speech is presented ipsilaterally, and it's consequently worse when presented contralaterally to the cochlear implant, and there are more damages in the speech intelligibility when there is only monoaural input.

Condições de saúde auditiva no trabalho: investigação dos efeitos auditivos em trabalhadores expostos ao ruído ocupacional / Conditions of auditory health at work: inquiry of the auditoy effect in workers exposed to the occupationl noise

Introdução: Fisiologicamente, indivíduos expostos ao ruído, podem desenvolver uma patologia muito comum, a perda auditiva induzida por níveis de pressão sonora elevada. Objetivo: Investigar por meio de um estudo transversal, a prevalência de perda auditiva ocupacional em trabalhadores expostos a níveis de pressão sonora acima de 85 dB NPS. Método: Participaram deste estudo 400 prontuários de trabalhadores expostos a níveis de pressão sonora acima de 85 dB NPS, locados em empresas de diferentes segmentos. Resultados: Nesta amostra, foram observadas diferenças estatisticamente significante entre os limiares de baixas e altas frequências e que o tempo de trabalho influenciou na piora dos limiares nas altas frequências bilateralmente. Quanto à lateralidade não foram constatadas diferenças significativas entre as orelhas, assim como a ausência da correlação entre zumbido e perda auditiva. Conclusões: Um trabalho intensivo de promoção da saúde auditiva e/ou prevenção de perdas auditivas, deve ser enfatizado, principalmente para trabalhadores expostos a níveis elevados de ruído ocupacional, além da utilização, de forma adequada, de equipamento de proteção auditiva individual.

Introduction: Physiologically, the individuals exposed to the noise may develop a very common pathology; the occupational noise induced hearing loss. Objective: Research the by means of a cross-sectional study, prevalence of occupational hearing loss in workers exposed to noise pressure levels over 85 dB NPL. Method: 400 records of workers exposed to noise pressure levels above 85 db NPS, working in companies of different segments. Results: In this sample, statistically significant differences were observed between the low and high frequencies thresholds and that the work duration influenced in the worsening of high frequencies thresholds bilaterally. As for the laterality no significant differences were confirmed between the ears, as well as the absence of correlation between tinnitus and hearing loss. Conclusion: An intensive work of auditory health promotion and/or auditory loss prevention must be emphasized, especially for workers exposed to high level occupational noises, as well as the appropriate features of individual auditory protection equipment.

The maturational process of the auditory system in the first year of life characterized by brainstem auditory evoked potentials.

UNLABELLED: The study of brainstem auditory evoked potentials (BAEP) allows obtaining the electrophysiological activity generated in the cochlear nerve to the inferior colliculus. In the first months of life, a period of greater neuronal plasticity, important changes are observed in the absolute latency and inter-peak intervals of BAEP, which occur up to the completion of the maturational process, around 18 months of life in full-term newborns, when the response is similar to that of adults. OBJECTIVE: The goal of this study was to establish normal values of absolute latencies for waves I, III and V and inter-peak intervals I-III, III-V and I-V of the BAEP performed in full-term infants attending the Infant Hearing Health Program of the Speech-Language Pathology and Audiology Course at Bauru School of Dentistry, Brazil, with no risk history for hearing impairment. MATERIAL AND METHODS: The stimulation parameters were: rarefaction click stimulus presented by the 3ª insertion phone, intensity of 80 dBnHL and a rate of 21.1 c/s, band-pass filter of 30 and 3,000 Hz and average of 2,000 stimuli. A sample of 86 infants was first divided according to their gestational age in preterm (n=12) and full-term (n=74), and then according to their chronological age in three periods: P1: 0 to 29 days (n=46), P2: 30 days to 5 months 29 days (n=28) and P3: above 6 months (n= 12). RESULTS: The absolute latency of wave I was similar to that of adults, generally in the 1st month of life, demonstrating a complete process maturity of the auditory nerve. For waves III and V, there was a gradual decrease of absolute latencies with age, characterizing the maturation of axons and synaptic mechanisms in the brainstem level. CONCLUSION: Age proved to be a determining factor in the absolute latency of the BAEP components, especially those generated in the brainstem, in the first year of life.

The maturational process of the auditory system in the first year of life characterized by brainstem auditory evoked potentials

The study of brainstem auditory evoked potentials (BAEP) allows obtaining the electrophysiological activity generated in the cochlear nerve to the inferior colliculus. In the first months of life, a period of greater neuronal plasticity, important changes are observed in the absolute latency and inter-peak intervals of BAEP, which occur up to the completion of the maturational process, around 18 months of life in full-term newborns, when the response is similar to that of adults. OBJECTIVE: The goal of this study was to establish normal values of absolute latencies for waves I, III and V and inter-peak intervals I-III, III-V and I-V of the BAEP performed in full-term infants attending the Infant Hearing Health Program of the Speech-Language Pathology and Audiology Course at Bauru School of Dentistry, Brazil, with no risk history for hearing impairment. MATERIAL AND METHODS: The stimulation parameters were: rarefaction click stimulus presented by the 3ª insertion phone, intensity of 80 dBnHL and a rate of 21.1 c/s, band-pass filter of 30 and 3,000 Hz and average of 2,000 stimuli. A sample of 86 infants was first divided according to their gestational age in preterm (n=12) and full-term (n=74), and then according to their chronological age in three periods: P1: 0 to 29 days (n=46), P2: 30 days to 5 months 29 days (n=28) and P3: above 6 months (n= 12). RESULTS: The absolute latency of wave I was similar to that of adults, generally in the 1st month of life, demonstrating a complete process maturity of the auditory nerve. For waves III and V, there was a gradual decrease of absolute latencies with age, characterizing the maturation of axons and synaptic mechanisms in the brainstem level. CONCLUSION: Age proved to be a determining factor in the absolute latency of the BAEP components, especially those generated in the brainstem, in the first year of life.

Atitudes frente às próteses auditivas / Attitudes towards hearing aids

OBJETIVOS: avaliar as atitudes frente à deficiência auditiva e o aparelho de amplificação sonora individual (AASI) em candidatos e usuários destes dispositivos. Verificar se existe relação entre tais atitudes e os dados demográficos, audiométricos e características do AASI. MÉTODOS: 63 indivíduos (35 homens e 28 mulheres, idade média de 64,3 anos) com deficiência auditiva neurossensorial bilateral de diferentes graus, candidatos e usuários de AASI responderam o "Questionário de Atitudes Frente à Deficiência Auditiva" (ALHQ v3.0). Foi analisada a distribuição da pontuação das subescalas do ALHQ e realizada a correlação entre estas e os dados demográficos, audiológicos e da adaptação do AASI dos participantes. Foram também realizadas comparações da pontuação do ALHQ entre os grupos de candidatos e usuários, entre homens e mulheres. RESULTADOS: não houve distribuição normal das respostas nas subescalas do ALHQ. Não houve correlações entre a pontuação do ALHQ com os dados demográficos e audiológicos. Foram verificadas correlações fracas e significativas entre as subescalas do questionário: "estratégias negativas" e "estima" (rho=-0,39), "negação" e "estima" (rho=-0,27), "estratégias negativas" e "associações negativas" (rho=0,25) e "negação" e "estratégias negativas" (rho=-0,30). Houve diferença significativa nas subescalas estratégias negativas (p=0,02) e associações negativas (p=0,00) entre o grupo de candidatos e usuários. Não houve diferença na pontuação entre homens e mulheres. CONCLUSÃO: a existência de atitudes negativas frente à deficiência auditiva e ao uso do AASI reforça a necessidade do aconselhamento de ajuste pessoal incluído no processo de adaptação do AASI em adultos e idosos. É necessário validar o questionário traduzido para o português brasileiro.

PURPOSE: to evaluate the attitudes towards hearing loss and hearing aids in a group of hearing aid candidates and users. To verify if attitudes are related to demographical and audiometric data as well as hearing aid characteristics. METHODS: 63 participants (35 men and 28 women, mean age 64.3 years) with bilateral sensorineural hearing losses of different degrees, hearing aid candidates or users answered the "Attitudes Towards Hearing Loss Questionnaire" (ALHQ v3.0). The ALHQ scores distribution was analyzed. The correlation between ALHQ scores and demographical and audiological data as well as the hearing aid fitting characteristics were obtained. The ALHQ scores were also compared between groups of hearing aid candidates and users as well as among men and women. RESULTS: ALHQ subscale responses did not follow normal distribution. No correlation was found among demographical data, mean hearing thresholds and ALHQ scores. There were weak but significant correlations between the subscales: "negative coping strategies" and "hearing-related esteem" (rho =-0.39), "denial" and "hearing related esteem" (rho =-0.27), "negative coping strategies" and "negative associations" (rho = 0.25) and "denial" and "negative coping strategies" (rho =-0.30). A statistical difference was found for "negative coping strategies" and "negative associations" subscales between hearing aid candidates and users. No statistical difference was found for ALHQ scores among men and women. CONCLUSION: the existence of negative attitudes towards hearing loss and hearing aids reinforces the need for personal adjustment counseling. It is necessary to validate the ALHQ questionnaire translated into Brazilian Portuguese.

Alterações auditivas da exposição ocupacional em músicos / Auditory alterations for occupational exposition in musicians

Introdução: A exposição à música tornou-se interesse entre os especialistas em audição e acústica, uma vez que está relacionada à atividade profissional e social e à alta prevalência da Perda Auditiva. Objetivo: Investigar a saúde auditiva de músicos. Método: Fizeram parte do estudo 30 músicos, os quais foram submetidos à entrevista específica, audiometria tonal convencional e de altas freqüências, timpanometria e emissões otoacústicas evocadas transiente e por produto de distorção. Resultado: 17% dos sujeitos apresentaram audiograma sugestivo de Perda Auditiva Induzida por Ruído, 7% normal com entalhe e 7% com outras configurações. A média dos limiares das freqüências de 3, 4 e 6kHz mostraram-se com maior nível de intensidade quando comparada com a de 500, 1 e 2kHz; assim como a média dos limiares da audiometria de altas freqüências quando comparada com a audiometria convencional. Houve correlação positiva dos limiares com idade e com tempo de profissão. Encontrado ausência de emissões otoacústicas evocadas transiente em 26,7% (orelha direita) e 23,3% (orelha esquerda) e ausência de emissões em freqüências isoladas nas emissões otoacústicas evocadas por produto de distorção. Conclusão: Foram observadas alterações nos testes realizados na ausência de queixa de dificuldade auditiva; o teste das emissões otoacústicas mostrou-se com maior sensibilidade na detecção precoce de alterações auditivas; músicos apresentam risco significativo de desenvolverem perda auditiva.

Introduction: Exposure to music has become an interest among experts in hearing and acoustics, once it's related to the professional and social activity and to the high prevalence of Hearing Loss. Objective: To investigate musicians auditory health. Method: 30 musicians participated in the study and were submitted to specific interview, conventional and highfrequency tonal audiometry, tympanometry and transient-evoked and distortion-produced otoacoustic emissions. Results: 17% of the participants presented an audiogram that suggested Noise-Induced Hearing Loss, 7% normal with notch and 7% with other characteristics. The frequency thresholds average of 3, 4 and 6kHz presented a more intense level when compared to the one of 500, 1 and 2kHz; as well as the high frequency audiometry thresholds average when compared to the conventional audiometry. There was a threshold positive correlation with the age and time of profession. There hasn't been found transiently evoked otoacoustic emissions in 26,7% (right ear) and 23,3% (left ear), as well as in isolated frequencies in distortion-produced evoked otoacoustic emissions. Conclusion: Alterations were observed in tests with no complaints of hearing difficulties; the otoacoustic emissions test presented more sensitivity in the early detection of hearing alterations; musicians present a significant risk of developing hearing loss.