Hearing Loss and Cognitive Function: Baseline Findings From the Brazilian Longitudinal Study of Adult Health: ELSA-Brasil.

OBJECTIVE: Hearing loss (HL) has been associated with cognitive impairment in high-income countries. However, no study has investigated this association in low- and middle-income countries. Therefore, our aim was to investigate the association between cognitive function and HL in the Brazilian Longitudinal Study of Adult Health. DESIGN: Cross-sectional analysis of Longitudinal Study of Adult Health (ELSA-Brasil) with 802 individuals (35-74 years old). Hearing was measured using pure-tone audiometry. A pure-tone average (s) of thresholds at 500, 1000, 2000, and 4000 Hz was calculated. HL was defined as a PTA above 25 dB in the better ear or either ear, as a categorical variable. Cognitive performance was measured using the Consortium to Establish a Registry for Alzheimer's Disease word list memory test, the semantic and phonemic verbal fluency (VF) tests, and the Trail Making test version B. To investigate the association between cognitive performance and HL, we used linear regression models adjusted for sociodemographic and clinical variables. RESULTS: Of the total of participants, 7.6% had HL. After adjustment for sociodemographic and health confounding variables, only VF was associated with HL; a 10 dB increase in the PTA in the better ear was associated with worse performance in the phonemic VF test (ß = -0.115 [95% CI, -0.203 to -0.027], p = 0.01). We found a significant interaction between HL and age in the VF domain ( p = 0.01). HL was related to poor VF performance among older adults only. CONCLUSION: In a community-dwelling sample of most middle-aged adults, objectively measured HL was associated with lower VF. These results should be evaluated with caution, given the likelihood of residual confounding and the fact that only VF showed an association with HL.

Auditory Event Related Potentials in children with autism spectrum disorder.

OBJECTIVE: To analyze auditory cortical processing in high functioning ASD individuals. METHODS: Thirty individuals were included in the study (15 with Autism Spectrum Disorder and 15 with typical development), and their Auditory Event Related Potentials evaluation, elicited with tone burst and speech stimuli, were analyzed. RESULTS: There were no significant differences between individuals with high-functioning Autism Spectrum Disorder without intellectual disability and those with typical development in the auditory Event-related Potentials elicited with tone bursts or speech stimuli. CONCLUSIONS: The results of Auditory Event Related Potentials did not show any change at the cortical level in individuals with Autism Spectrum Disorder.

Oxidative Stress as a Risk Factor for Hearing Changes in HIV-positive Normal Listeners.

OBJECTIVES: Human immunodeficiency virus-positive (HIV+) individuals can experience a decrease in antioxidants. Such deficiency can make inner ear cells and synapses more vulnerable to oxidative stress, resulting in auditory alterations, even in the presence of normal thresholds. This study aims to compare the audiological findings of HIV+ patients (with and without exposure to anti-retroviral treatment) to those of healthy individuals. METHODS: This was a cross-sectional observational study, comprising 42 normal-hearing adults divided into the Control Group (CG), without HIV; Group I (GI), HIV+, without exposure to the highly active anti-retroviral therapy (HAART); Group II (GII), HIV+, with exposure to HAART. All participants underwent conventional audiometry (0.25-8 kHz), high-frequency audiometry (9-20 kHz), transient evoked otoacoustic emissions (TEOAEs), efferent auditory pathway's inhibitory effect assessment, brainstem auditory evoked potentials (BAEPs), and cognitive potential (P300). RESULTS: In the comparison of the hearing thresholds between the groups, there was a statistically significant difference for most of the frequencies assessed (GII presented hearing thresholds significantly poor when compared with other groups). The presence of TEOAE and the inhibitory effect was also verified in a significantly higher number of individuals in the CG than in the other groups. As for the BAEP, there was a statistically significant difference for the interpeak intervals I-V (GII showed higher values when compared with CG). For P300, there were no statistically significant differences. CONCLUSION: Normal-hearing HIV+ individuals (with and without exposure to HAART) presented with poor performance in the audiological procedures, suggesting the presence of auditory alterations even in the presence of normal-hearing thresholds.

Tablet-based tele-audiometry: Automated hearing screening for schoolchildren.

Introduction: To assess the performance of a tablet-based tele-audiometry method for automated hearing screening of schoolchildren through a comparison of the results of various hearing screening approaches. Methods: A total of 244 children were evaluated. Tablet-based screening results were compared with gold-standard pure-tone audiometry. Acoustic immittance measurements were also conducted. To pass the tablet-based screening, the children were required to respond to at least two out of three sounds for all the frequencies in each ear. Several hearing screening methods were analysed: exclusively tablet-based (with and without 500 Hz checked) and combined tests (series and parallel). The sensitivity, specificity, positive and negative predictive values and accuracy were calculated. Results: A total of 9.43% of children presented with mild to moderate conductive hearing loss (unilateral or bilateral). Diagnostic values varied among the different hearing screening approaches that were evaluated: sensitivities ranged from 60 to 95%, specificities ranged from 44 to 91%, positive predictive values ranged from 15 to 44%, negative predictive values ranged from 95 to 99%, accuracy values ranged from 49 to 88%, and area under curve values ranged from 0.690 to 0.883. Regarding diagnostic values, the highest results were found for the tablet-based screening method and for the series approach. Discussion: Compared with the results obtained by conventional audiometry and considering the diagnostic values of the different hearing screening approaches, the highest diagnostic values were generally obtained using the automated hearing screening method (including 500 Hz). Thus, this application, which was developed for the tablet computer, was shown to be a valuable hearing screening tool for use with schoolchildren. Therefore, we suggest that this hearing screening protocol has the potential to improve asynchronous tele-audiology service delivery.

Oxidative stress as a risk factor for haring changes in HIV-positive normal listeners

OBJECTIVES: Human immunodeficiency virus-positive (HIV+) individuals can experience a decrease in antioxidants. Such deficiency can make inner ear cells and synapses more vulnerable to oxidative stress, resulting in auditory alterations, even in the presence of normal thresholds. This study aims to compare the audiological findings of HIV+ patients (with and without exposure to anti-retroviral treatment) to those of healthy individuals. METHODS: This was a cross-sectional observational study, comprising 42 normal-hearing adults divided into the Control Group (CG), without HIV; Group I (GI), HIV+, without exposure to the highly active anti-retroviral therapy (HAART); Group II (GII), HIV+, with exposure to HAART. All participants underwent conventional audiometry (0.25-8 kHz), high-frequency audiometry (9-20 kHz), transient evoked otoacoustic emissions (TEOAEs), efferent auditory pathway's inhibitory effect assessment, brainstem auditory evoked potentials (BAEPs), and cognitive potential (P300). RESULTS: In the comparison of the hearing thresholds between the groups, there was a statistically significant difference for most of the frequencies assessed (GII presented hearing thresholds significantly poor when compared with other groups). The presence of TEOAE and the inhibitory effect was also verified in a significantly higher number of individuals in the CG than in the other groups. As for the BAEP, there was a statistically significant difference for the interpeak intervals I-V (GII showed higher values when compared with CG). For P300, there were no statistically significant differences. CONCLUSION: Normal-hearing HIV+ individuals (with and without exposure to HAART) presented with poor performance in the audiological procedures, suggesting the presence of auditory alterations even in the presence of normal-hearing thresholds.

Severe obstructive sleep apnea is associated with cochlear function impairment.

PURPOSE: The purpose of this study is to investigate the association between obstructive sleep apnea (OSA) with middle ear acoustic transference and cochlear function. METHODS: Male individuals with and without mild, moderate, and severe OSA according to standard criteria of full polysomnography and no co-morbidities were studied. Subjects with BMI ≥40 kg/m2, present or past treatment for OSA, with heart failure, diabetes, hypertension, dyslipidemia, stroke, use of chronic medications, and previous history of risk for hearing loss were excluded. All subjects were submitted to full polysomnography, evaluation of wideband acoustic immittance by energy of absorbance (EA), and distortion product otoacoustic emissions (DPOAE). RESULTS: We studied 38 subjects (age 35.8 ± 7.2 years, BMI 28.8 ± 3.8 kg/m2) divided into no OSA (n = 10, age 33.6 ± 6.4 years, BMI 26.9 ± 4.1 kg/m2), mild (n = 11, age 32.8 ± 2.9 years, BMI 28.5 ± 3.5 kg/m2), moderate (n = 8, age 34.1 ± 6.8 years, BMI 29.6 ± 3.3 kg/m2), and severe OSA (n = 9, age 41.2 ± 9.2 years, BMI 30.5 ± 3.8 kg/m2). EA was similar between groups. In contrast, patients with severe OSA presented significantly lower DPOAE amplitudes when compared to the control, mild, and moderate OSA groups (p ≤ 0.03, for all comparisons). CONCLUSIONS: Acoustic transference function of middle ear is similar in adults with and without OSA. Severe OSA is independently associated with cochlear function impairment in patients with no significant co-morbidities.

Language and central temporal auditory processing in childhood epilepsies.

Because of the relationship between rolandic, temporoparietal, and centrotemporal areas and language and auditory processing, the aim of this study was to investigate language and central temporal auditory processing of children with epilepsy (rolandic epilepsy and temporal lobe epilepsy) and compare these with those of children without epilepsy. Thirty-five children aged between eight and 14 years old were studied. Two groups of children participated in this study: a group with childhood epilepsy (n=19), and a control group without epilepsy or linguistic changes (n=16). There was a significant difference between the two groups, with the worst performance in children with epilepsy for the gaps-in-noise test, right ear (p<0.001) and left ear (p<0.001) tests, and duration pattern test--naming (p=0.002) and humming (p=0.002). In auditory P300, there was no significant difference in latency (p=0.343) and amplitude (p=0.194) between the groups. There was a significant difference between the groups, with the worst performance in children with epilepsy, for the auditory-receptive vocabulary (PPVT) (p<0.001) and phonological working memory (nonwords repetition task) tasks (p=0.001). We conclude that the impairment of central temporal auditory processing and language skills may be comorbidities in children with rolandic epilepsy and temporal lobe epilepsy.

Audiological and electrophysiological assessment of professional pop/rock musicians.

In the present study, we evaluated peripheral and central auditory pathways in professional musicians (with and without hearing loss) compared to non-musicians. The goal was to verify if music exposure could affect auditory pathways as a whole. This is a prospective study that compared the results obtained between three groups (musicians with and without hearing loss and non-musicians). Thirty-two male individuals participated and they were assessed by: Immittance measurements, pure-tone air conduction thresholds at all frequencies from 0.25 to 20 kHz, Transient Evoked Otoacoustic Emissions, Auditory Brainstem Response (ABR), and Cognitive Potential. The musicians showed worse hearing thresholds in both conventional and high frequency audiometry when compared to the non-musicians; the mean amplitude of Transient Evoked Otoacoustic Emissions was smaller in the musicians group, but the mean latencies of Auditory Brainstem Response and Cognitive Potential were diminished in the musicians when compared to the non-musicians. Our findings suggest that the population of musicians is at risk for developing music-induced hearing loss. However, the electrophysiological evaluation showed that latency waves of ABR and P300 were diminished in musicians, which may suggest that the auditory training to which these musicians are exposed acts as a facilitator of the acoustic signal transmission to the cortex.

Central auditory evaluation in multiple sclerosis: case report.

Herein, we report a case of multiple sclerosis in which peripheral and central hearing, were evaluated through early (brainstem), middle and late auditory evoked potentials before and after corticosteroid therapy. Auditory evaluation revealed better performance on all post-treatment tests. In this case, central auditory function tests (behavioral and electrophysiological) identified the location of the impairment (brainstem), which was in agreement with the patient complaint. The speech in noise test and brainstem auditory evoked potentials are definitely appropriate in confirming brainstem lesions.

Central auditory evaluation in multiple sclerosis: case report / Avaliação auditiva central na esclerose múltipla: relato de caso

Herein, we report a case of multiple sclerosis in which peripheral and central hearing, were evaluated through early (brainstem), middle and late auditory evoked potentials before and after corticosteroid therapy. Auditory evaluation revealed better performance on all post-treatment tests. In this case, central auditory function tests (behavioral and electrophysiological) identified the location of the impairment (brainstem), which was in agreement with the patient complaint. The speech in noise test and brainstem auditory evoked potentials are definitely appropriate in confirming brainstem lesions.

Relatamos caso de esclerose múltipla em que foi feita avaliação da audição periférica e central utilizando os potenciais evocados auditivos de curta, média e longa latência antes e depois da terapia com corticosteróides. A avaliação auditiva revelou melhor desempenho em todos os testes após o tratamento. Neste caso, os testes que avaliam a função central da audição (comportamental e eletrofisiológico) foram capazes de identificar o local da lesão (tronco encefálico), o que estava de acordo com as queixas do paciente. Os testes de fala com ruído e os potenciais evocados auditivos de curta latência são apropriados para revelar lesões de tronco encefálico.

Audiometria de tronco encefálico (abr): o uso do mascaramento na avaliação de indivíduos portadores de perda auditiva unilateral / Auditory brainstem response (abr): use of masking in unilateral hearing loss patients

A necessidade do mascaramento na avaliaçäo da audiçäo por meio da ABR ainda é um assunto consideravelmente debatido (Durrant & Ferraro, 2001). OBJETIVO: O presente estudo propôs investigar a necessidade do mascaramento contralateral, empregado na orelha normal, ao realizar a ABR em indivíduos portadores de perda auditiva neurossensorial unilateral. FORMA DE ESTUDO: Clínico prospectivo. MATERIAL E MÉTODO: A amostra constituiu-se de 22 indivíduos portadores de perda auditiva neurossensorial unilateral de grau profundo, sendo 10 do sexo feminino e 12 do sexo masculino, com idades variando entre 9 e 44 anos. Todos os indivíduos foram submetidos a: audiometria tonal liminar, logoaudiometria (SRT, IPRF e SDT), medidas de imitância acústica (incluindo a pesquisa dos reflexos acústicos - modo ipsilateral e contralateral) e audiometria de tronco encefálico na ausência e na presença do mascaramento. RESULTADOS: Todos os indivíduos apresentaram perda auditiva neurossensorial unilateral de grau profundo e curvas timpanométricas do tipo A bilateralmente. Na avaliaçäo da ABR, 100 por cento da amostra apresentou presença da Onda V na orelha comprometida, sendo que ao introduzir o mascaramento contralateral tais respostas näo foram observadas. CONCLUSÖES: O mascaramento é um procedimento necessário para a avaliaçäo da audiçäo por meio da ABR em indivíduos portadores de perdas auditivas unilaterais, visando a obtençäo de resultados fidedignos. Na ABR, a atenuaçäo interaural para clicks foi maior (65 dB) do que a observada na audiometria tonal liminar, sendo necessário, portanto, uma menor intensidade de mascaramento para eliminar a resposta da via auditiva contralateral

Estudo de caso: neuropatia auditiva / Auditory neuropathy: a study case

Atualmente, podemos complementar os resultados encontrados na audiometria convencional com os obtidos nos exames eletrofisiológicos, o que nos permite diagnosticar näo apenas uma perda auditiva periférica, mas também diferenciar uma perda auditiva coclear da neural, ou central. Isto nos conduziu a um grupo novo de pacientes que apresentava alteraçäo na sincronia neural com funçäo normal das células ciliadas externas. Esta patologia é conhecida como Neuropatia Auditiva. O objetivo deste estudo é descrever as características audiológicas de um paciente com Neuropatia Auditiva atendido no Centro de Docência e Pesquisa em Fonoaudiologia da Faculdade de Medicina da Universidade de Säo Paulo (FMUSP), correlacionando os achados com os encontrados na literatura. O caso descrito é de um indivíduo de 24 anos de idade, com o diagnóstico de Neuropatia Auditiva, atendido no ano de 2001 no Centro de Docência e Pesquisa em Fonoaudiologia da FMUSP. Foram realizados anamnese, audiometria tonal e vocal, medidas de imitância acústica, Emissöes Otoacústicas (EOAs) e Audiometria de Tronco Encefálico (ABR). Observamos no caso estudado a incompatibilidade de resultados entre audiometria tonal e testes de inteligibilidade de fala, com os exames objetivos, EOAs e ABR, onde observou-se perda auditiva com importante alteraçäo nos testes de inteligibilidade de fala, EOAs presentes e ABR anormal. Estes dados sugerem funçäo coclear normal e alteraçäo da sincronia neural

Avaliação audiológica em crianças nascidas de mães soropositivas para o vírus da imunodeficiência humana / Audiological Evaluation in Children Born to HIV Positive Mothers

Presente trabalho teve como objetivo avaliar audiologicamente crianças nascidas de mães soropositivas para o HIV, verificando a ocorrência de alterações auditivas. Material e método: A população estudada constou de 143 crianças, 82 do sexo masculino e 61 do sexo feminino, na faixa etária entre um mês a dois anos e seis meses de idade. As crianças foram divididas em três grupos, de acordo com o Sistema de Classificação Revisado 16 para a infecção pelo HIV em crianças menores de 13 anos de idade, sendo estes denominados: infectado (I), sororrevertido (SR) e exposto (E). Os procedimentos empregados na avaliação audiológica foram a audiometria de observação comportamental, audiometria com reforço visual e medidas de imitância acústica. Analisando a amostra avaliada segundo as variáveis duração da gestação e peso ao nascimento, pôde ser observado um número maior de crianças nascidas a termo e com peso adequado para a idade gestacional. No estudo da ocorrência de alterações auditivas, foram utilizados os resultados da última avaliação audiológica obtidos nas 143 crianças da amostra. Resultados: A análise estatística revelou presença de alterações auditivas significantemente maior nas crianças infectadas. Nos grupos sororrevertido e exposto ocorreu exatamente o oposto, ou seja, houve predominância de ausência de alterações auditivas. Conclusão: O tipo de alteração auditiva mais freqüentemente encontrado no grupo infectado foi a sugestiva de alteração auditiva central, e nos demais grupos ocorreu similaridade entre as alterações de orelha média e as sugestivas de alterações auditivas centrais.

The aim of the present study was the audiological evaluation of children born to mothers serologically positive for HIV, in order to verify the occurrence of auditory disorders. Material and method: The population studied included 143 children - 82 males and 61 females - ranging in age from one month to two years and six months. The children were divided into three groups, following the revised classification systemt1 for human immunodeficiency virus infection in children less than 13 years of age, as infected (1), seroreverter (SR) or exposed (E). The audiological evaluation procedures employed were behavioral observation audiometry, visual reinforcement audiometry and acoustic immittance measurements. Analysis of the sample population for duration of gestation and birth weight showed that the majority of the children were born at term with a suitable weight for gestational age. For studying the incidence of auditory disorders, the results of the latest audiological examinations on the 143 children were used. Results: Statistical analysis showed a significantly higher incidence of auditory disorder in the infected children. Among the seroreverter and exposed children the inverse was the case, with the majority of the children showing no auditory disorder. Conclusion: Results suggesting central auditory disorders were predominant in the infected group, whereas the incidences of central and middle ear disorders were similar in the other two groups.