Emisiones otoacústicas como analizador de la función coclear en niños con problemas de lenguaje / Otoacoustic emissions as cochlear function analyser in children with language disorders

Introducción y objetivos: La percepción del sonido que se lleva a cabo en la cóclea está involucrada en el lenguaje. El objetivo fue describir los hallazgos encontrados en las emisiones otoacústicas transitorias (EOT) en niños con problemas de lenguaje antes y después de 6 meses de terapia. Métodos: A 17 niños diagnosticados como anártricos, se les realizó historia clínica, escala de inteligencia, prueba de lenguaje inicial y estudios audiológicos. Resultados: Al hacer la comparación del inicio y después de 6 meses de terapia, encontramos, en el análisis frecuencial de las EOT una p ≤ 0,05 en 1 kHz en el oído derecho, en la audiometría; se encontró una p ≤ 0,05 en las frecuencias de 0,5, 1,5, 2, 3, 4 y 8 kHz en el oído derecho y en las frecuencias de 2, 3, 4 y 8 kHz en el oído izquierdo. Conclusiones: El análisis del sonido a través de la cóclea está involucrado en el proceso de adquisición del lenguaje. Un mal procesamiento de los sonidos del lenguaje en el sistema periférico podría dar como resultado un mal procesamiento a nivel central. Por esto, es importante tener nuestros resultados en consideración al realizar el diagnóstico y el tratamiento rehabilitador en los niños con trastornos de lenguaje (AU)

Introduction and objectives: Speech perception that takes place in the cochlea is involved in the process of language. The objective was to describe the findings in transient otoacoustic emissions in children with language problems before and after 6 months of speech therapy. Methods: There were 17 children with language problems between 3 and 6 years of age diagnosed with anarthric language delay (expressive and mixed language disorder). They underwent medical history, otoscopy, intelligence level testing, initial language test, tympanometry of 226 Hz, audiometry and transient otoacoustic emission test. Results: We evaluated the 17 patients again after 6 months of attending speech therapy. The percentage of overall reproducibility of transient otoacoustic emissions in both ears was adequate to perform frequency analysis. We found a statistically significant difference (P≤0.01) in the frequency of 1 kHz reproducibility when comparing results before and after therapy in the right ear. There was a significant difference (P≤0.05) when comparing the results of audiometry at frequencies of 0.5, 1.5, 2, 4 and 8 kHz in the right ear and a highly significant difference (P = 0.001) in the frequency of 3 kHz in the left ear. Conclusions: The analysis of sound through the cochlea is involved in the process of language acquisition. A poor processing of speech sounds in the peripheral system could result in poor processing at the central level. Consequently, it is important to consider our results when making a diagnosis and carrying out rehabilitation treatment in children with language disorders (AU)

[Otoacoustic emissions as cochlear function analyser in children with language disorders]. / Emisiones otoacústicas como analizador de la función coclear en niños con problemas de lenguaje.

INTRODUCTION AND OBJECTIVES: Speech perception that takes place in the cochlea is involved in the process of language. The objective was to describe the findings in transient otoacoustic emissions in children with language problems before and after 6 months of speech therapy. METHODS: There were 17 children with language problems between 3 and 6 years of age diagnosed with anarthric language delay (expressive and mixed language disorder). They underwent medical history, otoscopy, intelligence level testing, initial language test, tympanometry of 226Hz, audiometry and transient otoacoustic emission test. RESULTS: We evaluated the 17 patients again after 6 months of attending speech therapy. The percentage of overall reproducibility of transient otoacoustic emissions in both ears was adequate to perform frequency analysis. We found a statistically significant difference (P≤0.01) in the frequency of 1kHz reproducibility when comparing results before and after therapy in the right ear. There was a significant difference (P≤0.05) when comparing the results of audiometry at frequencies of 0.5, 1.5, 2, 4 and 8kHz in the right ear and a highly significant difference (P=0.001) in the frequency of 3kHz in the left ear. CONCLUSIONS: The analysis of sound through the cochlea is involved in the process of language acquisition. A poor processing of speech sounds in the peripheral system could result in poor processing at the central level. Consequently, it is important to consider our results when making a diagnosis and carrying out rehabilitation treatment in children with language disorders.

Utilidad diagnóstica del reflejo acústico para predecir audición en población pediátrica / Diagnostic utility of the acoustic reflex in predicting hearing in paediatric populations

Introducción y objetivos: La sensibilidad de predicción del reflejo acústico determina el nivel de pérdida auditiva, útil sobre todo en población pediátrica. Se basa en la diferencia entre el umbral del reflejo estapedial con tono puro y con ruido blanco contralateral. El umbral con ruido blanco es de 60 dB y con tono puro de 80 dB. El objetivo de este estudio fue determinar la utilidad diagnóstica de la sensibilidad de predicción del reflejo acústico. Métodos: Previo consentimiento informado, se estudió a niños menores de 10 años, de octubre del 2011 a mayo del 2012, midiendo el reflejo estapedial con ruido blanco y tono puro. Se realizaron pruebas de contraste con χ2 y t de Student. La concordancia se midió con kappa. Se consideró significativo un valor de p ≤ 0,05. El proyecto fue aprobado por el Comité de Ética. En todos los casos se obtuvo el consentimiento informado de los padres. Resultados: Predicción de audición normal: 0,84 para el oído derecho y 0,78 en el oído izquierdo y para hipoacusia sin especificar el grado: 0,98 para el oído derecho y 0,96 en el oído izquierdo. Valor de kappa de 0,7 para el oído derecho y 0,6 para el oído izquierdo. Conclusiones: La utilidad diagnóstica del reflejo acústico tiene muy poco valor para predecir el grado de pérdida auditiva, pero predice en más del 80% la audición normal. Por lo que se sugiere utilizar como una prueba objetiva obligada como parte del Cribado auditivo (AU)

Introduction and objectives: The sensitivity of prediction of acoustic reflex, in determining the level of hearing loss, is especially useful in paediatric populations. It is based on the difference between the pure tone stapedius reflex threshold and contralateral white noise. The white noise threshold was 60 dB and that of pure tone was 80 dB. Our objective was to determine the diagnostic sensitivity of the prediction of the acoustic reflex. Methods: We studied children aged <10 years, from October 2011 to May 2012, by measuring the acoustic reflex with white noise and pure tone. We used contrast tests, with X2 and student t-test. Concordance was measured with Kappa. Results were considered significant at P≤.05. Our protocol was approved by Institutional Ethics Committee. Informed consent was obtained from the parents in all cases. Results: Prediction of normal hearing was 0.84 for the right ear and 0.78 in left ear, while for hearing loss of an unspecified grade, it was 0.98 for the right ear and 0.96 in the left ear. Kappa value was 0.7 to 0.6 for the right ear and left ear. Conclusions: The acoustic reflex is of little diagnostic utility in predicting the degree of hearing loss, but it predicts more than 80% of normal hearing. The clinical utility of the reflex is indisputable, as it is an objective method, simple and rapid to use, that can be performed from birth and whose results are independent of the cooperation and willingness of the subject. It is proposed as an obligatory part of hearing screening (AU)

Audiometric evaluation short and medium term in cochlear implants.

OBJECTIVE: Our purpose is report the results of cochlear implant program in this Institute, since our first surgery from November 2007, until December 2012. MATERIAL AND METHODS: A cross-sectional study, observational, descriptive, analyzing the information about thresholds before and after implantation, using patients files (diagnosis, onset of hearing loss, brainstem auditory evoked potential (BAEP), computed tomography (CT), magnetic resonance imaging (MRI), implanted ear, brand and model of cochlear implants (CI) and audiometric studies before and after the CI. RESULTS: We report the evolution of 68 patients, age ranged 1 year 8 months to 39 years 3 months old. 94% patients (n = 64) had pre-lingual hearing loss being hereditary non-syndromic hearing loss the most common etiology (29.4%). 100% patients had auditory brainstem responses showing bilateral profound hearing loss, in the 77.9% type A tympanograms were obtained (Jerger's classification), and 100% had absence of stapedial reflexes and otoacoustic emissions with low reproducibility. CT reported as normal in 85.2% of patients, the findings: 5.8% had chronic mastoiditis changes, other findings reported in 1.4% of patients were: digastric right facial nerve, facial nerve canal dehiscence, enlarged vestibular aqueduct, occupation and poor pneumatization of mastoid air cells, lateral semicircular canals agenesis, incomplete partition of the cochlea with wide vestibular and vestibular aqueduct dilatation. Most frequent MR findings of skull with cerebellopontine angle approach were vascular loops of internal auditory canals unilaterally. In 10.2%, 55.8% of patients (n = 38) were implanted in the right ear, 56 (82.3%) with a CI from Advanced Bionics, HiRes 90K model, the remaining with Cochlear, Freedom and Nucleus 5 models. Developments in CI results by audiometric tests: prior to placement was 106.2 dB averages at frequencies assessed, one month later 62.4 dB, at 6 months 44 dB, and with satisfactory threshold 32.9 dB. 55.8% of patients (n = 38) with P + HiRes Fidelity 120 strategy, the remaining with Hires S + Fidelity 120, Hires S and ACE RE. DISCUSSION: Audiology service proposed to place the CI in the worst ear by threshold in audiometric tests, the otolaryngology service proposed the best ear from anatomical point view. Implanted in the INR more Advanced Bionics CI faq frequently due to the donation by the insurance for a new generation. Hearing thresholds using CI have improved since activation.

Valoración de la audición residual en pacientes postimplante coclear mediante audiometría y potenciales evocados auditivos de estado estable / Residual hearing evaluated by audiometry and steady-state auditory evoked potentials in cochlear implant patients

Introducción y objetivos. La audición residual se considera uno de los factores pronósticos para la evolución de pacientes con implante coclear, y su determinación de manera objetiva a través de potenciales evocados auditivos de estado estable (PEAee) es de suma importancia. Los objetivos en este estudio fueron cuantificar la audición residual y evaluar la utilidad de los PEAee en su medición en pacientes implantados. Métodos. A 12 pacientes con implante coclear se les aplicó audiometría tonal liminar (ATL) pre y postimplantación, así como PEAee postimplante. Se realizó estadística descriptiva, correlaciones de Pearson y tablas de contingencia. Resultados. Se conservó la audición residual en el 37,5% de los pacientes para la frecuencia de 125 Hz; para 250 y 500 Hz, la conservaron el 45,45% de los pacientes; en 1.000 Hz, el 27,27%; en 2.000 Hz, el 28,85% conservó la audición posterior al implante coclear; en 4.000 Hz, el 16%, y el 0% en el caso de 8.000 Hz. Al realizar PEAee postimplante se observa que no hay respuesta en el oído implantado, en comparación con el oído no implantado, donde encontramos respuesta en las frecuencias de 500 y 1.000 Hz, dado que los pacientes eran portadores de hipoacusia bilateral profunda, lo que podría evidenciar destrucción parcial del tejido neural en el oído implantado. Conclusiones. La audición residual en frecuencias graves se conservó en la mayor parte de los pacientes. Los resultados en PEAee sugieren que es un estudio útil para evaluar la audición residual(AU)

Background and objectives. Residual hearing is considered a prognostic factor in patients with cochlear implants. Objective determination of residual hearing by steady-state evoked potential (SSEP) is of the utmost importance. The aims of this study were to quantify residual hearing and evaluate the usefulness of SSEP measurement in patients with cochlear implants. Methods. Liminal pure-tone audiometry was applied in 12 patients before and after cochlear implantation. SSEP were evaluated post-implantation. Descriptive statistics and Pearson correlations were carried out and contingency tables were constructed. Results. Residual hearing at a frequency of 125 Hz was preserved in 37.5% of the patients, at 250 and 500 Hz in 45.45%, and at 1000 Hz in 27.27%. After implantation, residual hearing at 2000 Hz was retained in 28.85%, at 4000 Hz in 16%, and at 8000 Hz in 0%. Post-implantation SSEP showed no response in the implanted ear as compared with the non-implanted ear at frequencies of 500 and 1000 Hz. Because the patients had bilateral profound hearing loss, this finding suggested partial destruction of the neural tissue in the implanted ear. Conclusions. Residual low frequency hearing was preserved in most patients. Our results suggest that SSEP is useful in the assessment of residual hearing(AU)