How should hyperbilirubinemia be considered in the definition of the hearing screening protocol for neonates at risk? / Como a hiperbilirrubinemia deve ser considerada na definição do protocolo da triagem auditiva para neonatos de risco?

PURPOSE: To analyze hyperbilirubinemia as an indicator for the definition of risk protocol in newborn hearing screening (NHS) and in auditory monitoring in full-term and preterm neonates. METHODS: This is an observational, cross-sectional and retrospective study. A total of 554 children born in a public maternity hospital were included and divided into two groups: (G1) with 373 full-terms neonates; (G2) with 181 preterm neonates. Data were collected from the participant's medical records to obtain information regarding the result of the NHS, performed by recording the automated auditory brainstem response (AABR), birth conditions, clinical characteristics, interventions performed, and results of the first test of total bilirubin (TB) and indirect bilirubin (IB) as well as the peak of TB and IB. A descriptive statistical analysis of the results was performed, and the level of significance adopted was 5%. RESULTS: On the NHS test, quotes of retest referral rates were smaller in G1 when compared to G2. There was no significant difference between the groups regarding type of delivery, gender, presence of Rh and ABO incompatibility, G6PD enzyme deficiency, and performance of phototherapy. TB and IB levels at the first exam and at peak time did not differ between neonates with "pass" and "fail" results on the NHS test in both groups. CONCLUSION: Bilirubin levels in the neonatal period below the recommended values for indication of exchange transfusion are not directly related to the "fail" result on the NHS tests in term and preterm neonates.

OBJETIVO: Analisar a hiperbilirrubinemia como indicador para a realização do protocolo de risco na triagem auditiva neonatal (TAN) e no monitoramento auditivo em neonatos a termo e prematuros. MÉTODO: Trata-se de um estudo observacional, transversal e retrospectivo. Foram incluídas 554 crianças nascidas em uma maternidade pública, subdivididas em dois grupos: (G1) com 373 recém-nascidos a termo; (G2) com 181 neonatos prematuros. Os dados foram coletados nos prontuários dos participantes, a fim de se obter informações referentes ao resultado da TAN realizada por meio do registro do Potencial Evocado Auditivo de Tronco Encefálico, às condições de nascimento, características clínicas, intervenções realizadas, resultados do primeiro exame de bilirrubina total (BT) e bilirrubina indireta (BI) e do pico de BT e BI. Realizou-se análise estatística descritiva e inferencial dos dados, com adoção do nível de significância de 5%. RESULTADOS: No teste da TAN, foram observadas taxas de encaminhamento para reteste inferiores no G1 em relação ao G2. Não houve diferença entre os grupos quanto à ocorrência do tipo de parto, sexo, presença de incompatibilidade sanguínea Rh e ABO, deficiência de enzima G6PD e realização de fototerapia. Em relação aos níveis de BT e BI no primeiro exame e no momento do pico, não houve diferenças entre os neonatos com resultado "passa" e "falha" na TAN-teste nos dois grupos. CONCLUSÃO: Os níveis de bilirrubina no período neonatal abaixo dos valores recomendados para indicação de exsanguineotransfusão não estão diretamente relacionados ao resultado "falha" na TAN em neonatos a termo e prematuros.

Como a hiperbilirrubinemia deve ser considerada na definição do protocolo da triagem auditiva para neonatos de risco? / How should hyperbilirubinemia be considered in the definition of the hearing screening protocol for neonates at risk?

RESUMO Objetivo Analisar a hiperbilirrubinemia como indicador para a realização do protocolo de risco na triagem auditiva neonatal (TAN) e no monitoramento auditivo em neonatos a termo e prematuros. Método Trata-se de um estudo observacional, transversal e retrospectivo. Foram incluídas 554 crianças nascidas em uma maternidade pública, subdivididas em dois grupos: (G1) com 373 recém-nascidos a termo; (G2) com 181 neonatos prematuros. Os dados foram coletados nos prontuários dos participantes, a fim de se obter informações referentes ao resultado da TAN realizada por meio do registro do Potencial Evocado Auditivo de Tronco Encefálico, às condições de nascimento, características clínicas, intervenções realizadas, resultados do primeiro exame de bilirrubina total (BT) e bilirrubina indireta (BI) e do pico de BT e BI. Realizou-se análise estatística descritiva e inferencial dos dados, com adoção do nível de significância de 5%. Resultados No teste da TAN, foram observadas taxas de encaminhamento para reteste inferiores no G1 em relação ao G2. Não houve diferença entre os grupos quanto à ocorrência do tipo de parto, sexo, presença de incompatibilidade sanguínea Rh e ABO, deficiência de enzima G6PD e realização de fototerapia. Em relação aos níveis de BT e BI no primeiro exame e no momento do pico, não houve diferenças entre os neonatos com resultado "passa" e "falha" na TAN-teste nos dois grupos. Conclusão Os níveis de bilirrubina no período neonatal abaixo dos valores recomendados para indicação de exsanguineotransfusão não estão diretamente relacionados ao resultado "falha" na TAN em neonatos a termo e prematuros.

ABSTRACT Purpose To analyze hyperbilirubinemia as an indicator for the definition of risk protocol in newborn hearing screening (NHS) and in auditory monitoring in full-term and preterm neonates. Methods This is an observational, cross-sectional and retrospective study. A total of 554 children born in a public maternity hospital were included and divided into two groups: (G1) with 373 full-terms neonates; (G2) with 181 preterm neonates. Data were collected from the participant's medical records to obtain information regarding the result of the NHS, performed by recording the automated auditory brainstem response (AABR), birth conditions, clinical characteristics, interventions performed, and results of the first test of total bilirubin (TB) and indirect bilirubin (IB) as well as the peak of TB and IB. A descriptive statistical analysis of the results was performed, and the level of significance adopted was 5%. Results On the NHS test, quotes of retest referral rates were smaller in G1 when compared to G2. There was no significant difference between the groups regarding type of delivery, gender, presence of Rh and ABO incompatibility, G6PD enzyme deficiency, and performance of phototherapy. TB and IB levels at the first exam and at peak time did not differ between neonates with "pass" and "fail" results on the NHS test in both groups. Conclusion Bilirubin levels in the neonatal period below the recommended values for indication of exchange transfusion are not directly related to the "fail" result on the NHS tests in term and preterm neonates.

From research to clinical practice: An analysis of 226 Hz-probe tone tympanometry to identify otitis media with effusion in children.

OBJECTIVES: (1) To calculate the sensitivity and specificity of tympanometry with a 226 Hz probe to identify middle ear condition in children; (2) To propose the intersection range of static compliance and tympanometric peak pressure values obtained in ears with and without middle ear effusion. METHODS: 224 children's ears without middle ear alteration, with a mean age of 1 year and 4 months (GI), and 56 children's ears with middle ear effusion (GII), with a mean age of two years, were analyzed. For analysis, the static compliance and tympanometric peak pressure values obtained in the tympanometry with a 226 Hz probe were considered. RESULTS: In the group with no alteration, the Mann Whitney Test showed no significant difference between the sexes for the static compliance (p = 0.085) and tympanometric peak pressure (p = 0.782). No difference was seen, either, for compliance (p = 0.079) and pressure (p = 0.678) values, according to age. When applying the optimal criterion of the ROC curve, the cutoff value obtained was ≤0.26 ml for static compliance (sensitivity= 83.9 %; specificity= 86.6 %) and ≤-56 daPa for peak pressure (sensitivity= 82.1 %; specificity= 84.8 %). When comparing the values obtained for the two groups, it is noted that the data overlap, that is, they create an inconclusive intersection range between the normal middle ear and the altered one. CONCLUSION: The tympanometry cut-off with greater sensitivity and specificity was, respectively, 83.9 and 86.6 % for static compliance and 82.1 and 84.8 % for tympanometric peak pressure. The ranges from 0.16 to 0.43 ml for static compliance and from -109 to 25 daPa for tympanometric peak pressure do not allow defining the presence or absence of alteration in the middle ear, in children aged 6 to 36 months.

Usability evaluation of the Agente Escuta application: translational research. / Avaliação da usabilidade do aplicativo Agente Escuta: uma pesquisa translacional.

PURPOSE: To evaluate the usability and satisfaction of users with the interface of the 'Agente Escuta' application, in addition to identifying problems and possibilities for improvement. METHODS: Descriptive exploratory translational study, characterized by a usability test with a quantitative and qualitative approach, subdivided into three stages: (I) prior evaluation of usability by 10 judges, including students, primary care professionals, professors and researchers in Information Technology and Speech Therapy; (II) evaluation of the application by the target audience, that is, community health agents from six municipalities in Rio Grande do Norte; (III) evaluation of the satisfaction of the agents who used the application in their work routine. The System Usability Scale and the Net Promoter Score were used, in addition to a qualitative evaluation of the opinions. RESULTS: Usability was rated as excellent by judges, regardless of category. In the evaluation by community health agents, usability was considered good and there was no effect of the city of origin. It was found that the perception of the judges and the target audience were different, with a lower score for the participants in the second stage. However, most would give positive publicity to the product. The heuristic with the highest score was ease of memorization and participants in the third stage were interested in continuing to use the tool in practice, even after the end of the study. CONCLUSION: The Agente Escuta prototype showed good usability and satisfaction and aspects that could be improved in future solutions were identified.

OBJETIVO: Avaliar a usabilidade e satisfação dos usuários com a interface do aplicativo "Agente Escuta", além de identificar problemas e possibilidades de melhorias. MÉTODO: Estudo translacional exploratório descritivo, caracterizado por um teste de usabilidade com abordagem quanti-qualitativa, subdividido em três etapas: (I) avaliação prévia da usabilidade por 10 juízes, incluindo estudantes, profissionais da atenção primária, docentes e pesquisadores em Tecnologia da Informação e Fonoaudiologia; (II) avaliação do aplicativo pelo público-alvo, agentes comunitários de saúde de seis municípios potiguares; (III) Avaliação da satisfação dos agentes que utilizaram o aplicativo na rotina de trabalho. Utilizou-se o System Usability Scale e pelo Net Promoter Score, além de uma avaliação qualitativa das opiniões. RESULTADOS: A usabilidade foi avaliada como excelente pelos juízes, independentemente da categoria. Na avaliação pelos agentes comunitários de saúde, a usabilidade foi considerada boa e não houve efeito do município de origem. Constatou-se que a percepção dos juízes e do público-alvo foram distintas, com menor escore para os participantes da segunda etapa, no entanto, a maioria dariam publicidade positiva ao produto. A heurística com maior pontuação foi a facilidade de memorização e os participantes da terceira etapa mostraram-se interessados em continuar utilizando a ferramenta na prática, mesmo após o término do estudo. CONCLUSÃO: O protótipo do Agente Escuta apresentou boa usabilidade e satisfação e foram identificados aspectos que poderão ser aprimorados em soluções futuras.

Virtual Patients: Impact of Computer Simulation on Audiology Learning and Practice.

PURPOSE: The purpose of this study was to verify users' satisfaction with the interface of an audiometric simulator and self-perception of the computer simulation impact on practical acting in audiology, allowing the identification of problems and possibilities for improvement. METHOD: A prospective, observational study was divided into two phases: The first is evaluating the student's satisfaction, using the simulator in the theoretical and practical learning of audiology, and the second one is assessing the self-perception of the simulator's impact on the practical performance of audiology. The sample comprised 35 students from two Speech-Language Pathology and Audiology courses, in Brazil, selected by convenience, who answered the questionnaire after completing the theoretical module, using Google Forms, without any identification. RESULTS: In the first phase of the study, students positively evaluated the use of the simulator as an auxiliary tool for audiology learning, and in the second one, they also positively assessed the impact of training with the simulator in audiological practice. CONCLUSION: The analyzed audiometric simulator proved to be an interactive system with high acceptability, level of satisfaction, and potential impact on practical performance in audiology. SUPPLEMENTAL MATERIAL: https://doi.org/10.23641/asha.23876325.

Effectiveness of an online continuing education course in infant hearing health for primary care professionals.

OBJECTIVE: To evaluate the effectiveness of an online continuing education course on infant hearing health for primary care professionals. DESIGN: A prospective longitudinal study with interrupted time series pre-test/post-test design. The effectiveness of the online course was assessed by comparing pre- vs. post-training performance and analysing responses to evaluations of the quality of the course. STUDY SAMPLE: The sample comprised individuals enrolled between September 2018 and August 2019 in a Ministry of Health course, "Actions in primary care for the early identification of hearing impairment" offered on the AVASUS platform. RESULTS: Of the 2908 individuals registered, 1842 (63.3%) completed the course. Their ages ranged from 18 to 77 years, and 67.4% of them were females. Students and doctors were overrepresented among the enrollees. All Brazilian states were included in the sample. Comparisons of pre- and post-training performances showed a significant improvement in knowledge, and 99.3% of the participants provided positive comments regarding the quality of the course. CONCLUSIONS: The course is an effective distance learning tool on infant hearing health for primary care professionals. The online course circumvents the limitations posed by geographical barriers and also facilitates decentralisation.

Avaliação da usabilidade do aplicativo Agente Escuta: uma pesquisa translacional / Usability evaluation of the Agente Escuta application: translational research

RESUMO Objetivo Avaliar a usabilidade e satisfação dos usuários com a interface do aplicativo "Agente Escuta", além de identificar problemas e possibilidades de melhorias. Método Estudo translacional exploratório descritivo, caracterizado por um teste de usabilidade com abordagem quanti-qualitativa, subdividido em três etapas: (I) avaliação prévia da usabilidade por 10 juízes, incluindo estudantes, profissionais da atenção primária, docentes e pesquisadores em Tecnologia da Informação e Fonoaudiologia; (II) avaliação do aplicativo pelo público-alvo, agentes comunitários de saúde de seis municípios potiguares; (III) Avaliação da satisfação dos agentes que utilizaram o aplicativo na rotina de trabalho. Utilizou-se o System Usability Scale e pelo Net Promoter Score, além de uma avaliação qualitativa das opiniões. Resultados A usabilidade foi avaliada como excelente pelos juízes, independentemente da categoria. Na avaliação pelos agentes comunitários de saúde, a usabilidade foi considerada boa e não houve efeito do município de origem. Constatou-se que a percepção dos juízes e do público-alvo foram distintas, com menor escore para os participantes da segunda etapa, no entanto, a maioria dariam publicidade positiva ao produto. A heurística com maior pontuação foi a facilidade de memorização e os participantes da terceira etapa mostraram-se interessados em continuar utilizando a ferramenta na prática, mesmo após o término do estudo. Conclusão O protótipo do Agente Escuta apresentou boa usabilidade e satisfação e foram identificados aspectos que poderão ser aprimorados em soluções futuras.

ABSTRACT Purpose To evaluate the usability and satisfaction of users with the interface of the 'Agente Escuta' application, in addition to identifying problems and possibilities for improvement. Methods Descriptive exploratory translational study, characterized by a usability test with a quantitative and qualitative approach, subdivided into three stages: (I) prior evaluation of usability by 10 judges, including students, primary care professionals, professors and researchers in Information Technology and Speech Therapy; (II) evaluation of the application by the target audience, that is, community health agents from six municipalities in Rio Grande do Norte; (III) evaluation of the satisfaction of the agents who used the application in their work routine. The System Usability Scale and the Net Promoter Score were used, in addition to a qualitative evaluation of the opinions. Results Usability was rated as excellent by judges, regardless of category. In the evaluation by community health agents, usability was considered good and there was no effect of the city of origin. It was found that the perception of the judges and the target audience were different, with a lower score for the participants in the second stage. However, most would give positive publicity to the product. The heuristic with the highest score was ease of memorization and participants in the third stage were interested in continuing to use the tool in practice, even after the end of the study. Conclusion The Agente Escuta prototype showed good usability and satisfaction and aspects that could be improved in future solutions were identified.

Analysis of a hearing loss identification and intervention program in the first years of life in primary care / Análise de um programa de identificação e intervenção da perda auditiva nos primeiros anos de vida na atenção primária

ABSTRACT Purpose: to analyze the implementation and effectiveness of a hearing loss identification and intervention program in the first years of life in primary care. Methods: an experimental study carried out in two Basic Health Units. Twenty-three Community Health Workers participated, trained through an online self-instructional course from the Ministry of Health. Subsequently, they followed the hearing and language of children from zero to two years old, referring them, if necessary, to audiological evaluation. For the analysis of pre and post online course knowledge, the Wilcoxon test was applied, and to compare the performance between the participants of the two Basic Health Units, the Mann Whitney test was used, adopting p<0.05. Additionally, the qualitative perception of participating community workers, the referrals, and the result of the audiological evaluation were analyzed. Results: the online course was effective in improving the knowledge of the participants. A total of 102 children were monitored, 15 of them were referred for evaluation. From these, four underwent hearing screening and 11 underwent a complete hearing assessment, a case of conductive hearing loss being identified. Conclusion: the implementation of a program for the identification and intervention of hearing loss, in the first years of life, in primary care, permeated by community health workers, is feasible.

RESUMO Objetivo: analisar a implantação e a eficácia de um programa de identificação e intervenção da perda auditiva nos primeiros anos de vida na atenção primária. Métodos: estudo experimental realizado em duas Unidades Básicas de Saúde. Participaram 23 agentes comunitários de saúde, capacitados por meio de um curso autoinstrucional online do Ministério da Saúde. Posteriormente, acompanharam a audição e a linguagem das crianças de zero a dois anos, encaminhando-as, se necessário, para avaliação audiológica. Para análise do conhecimento pré e pós curso online foi aplicado o teste de Wilcoxon e para comparação do desempenho entre os participantes das duas Unidades Básicas de Saúde empregou-se o teste de Mann Whitney, com adoção de p<0,05. Adicionalmente, avaliou-se a percepção qualitativa dos agentes comunitários participantes, os encaminhamentos realizados e o resultado da avaliação audiológica. Resultados: o curso online foi eficaz na melhoria do conhecimento dos participantes. Totalizaram-se 102 crianças acompanhadas, 15 delas encaminhadas para avaliação. Destas, quatro realizaram triagem auditiva e 11 realizaram a avaliação auditiva completa, sendo identificado um caso de perda auditiva condutiva. Conclusão: a implantação de um programa de identificação e intervenção da perda auditiva nos primeiros anos de vida na atenção primária, permeada por agentes comunitários de saúde, mostrou-se viável.

Wideband absorbance for the assessment of pressure equalizing tubes patency in children.

OBJECTIVES: To analyze the feasibility of using wideband absorbance to verify the patency of pressure equalizing tubes (PETs) in clinical practice and to present the response pattern of this measure for ears with patent PET. METHODS: This observational case-control type study evaluated 48 ears of 30 children with severe or profound hearing loss, aged 10-44 months, of both sexes. The subjects were subdivided into two groups: 24 ears with Sheppard type PET (experimental group - EG) and 24 ears with normal middle ear (control group - CG), paired with the EG, according to age, sex, and ear evaluated. To obtain the wideband absorbance, a Middle-Ear Power Analyzer, version 5.0 (Mimosa Acoustics), was used, and absorbance values for pure tone and chirp stimuli were analyzed. RESULTS: There was no influence of ear (right or left) on the measurements obtained. The EG showed higher absorbance values at low frequencies. Although the two stimuli made it possible to identify the difference in acoustic transfer function between the groups studied, compared to pure tone, the chirp stimulus allowed identification of differences in a higher number of frequencies. CONCLUSIONS: Ears with a patent PET present an acoustic transfer pattern that differs from that obtained for normal middle ears, with a higher absorbance at low frequencies. Both pure tone and chirp stimuli can be used to identify such differences, nevertheless, the use of chirp stimulus is recommended, since it allows differentiation over a wider frequency range.

Percepção dos pais sobre hipersensibilidade auditiva de crianças com sinais clínicos de risco para o Transtorno do Espectro do Autismo / Parents' perception of auditory hypersensitivity in children with clinical signs of risk for Autism Spectrum Disorder

Resumo Objetivo Averiguar a ocorrência e o tipo de hipersensibilidade auditiva em crianças com sinais clínicos de Transtorno do Espectro do Autismo por meio do relato dos pais no contexto da pandemia da COVID-19. Método Trata-se de um estudo transversal e descritivo, composto por pais de 11 crianças com sinais clínicos de risco para Transtorno do Espectro do Autismo. As crianças eram de ambos os sexos, com média de 44,8 meses de idade. Os pais responderam, por meio de contato telefônico, a um questionário, previamente validado, sobre comportamentos de hipersensibilidade auditiva de seus filhos. Foi considerado como sinalizador de hipersensibilidade a pontuação igual ou superior a oito pontos no escore geral. Resultados 63,6% das crianças apresentaram resultado indicativo de hipersensibilidade e 54,5% obtiveram pontuação máxima nas questões relacionadas à irritabilidade a sons específicos. Os sons citados como geradores de irritabilidade foram: palmas, fogos, gritos, ferramentas de construção, canto e toque de celular. Conclusão Constatou-se ocorrência de hipersensibilidade auditiva, especialmente relacionada à irritabilidade, o que sugere relação com o sistema límbico e, portanto, pode remeter à misofonia. Assim, torna-se importante a equipe multidisciplinar atentar-se à ocorrência e a características de hipersensibilidade dessa população, a fim de maximizar condições favoráveis à reabilitação.

Abstract Objective To investigate the occurrence and type of auditory hypersensitivity in children with clinical signs of Autism Spectrum Disorder through parents' reports in the context of the COVID-19 pandemic. Method This is a cross-sectional and descriptive study, composed of parents of 11 children with clinical signs of risk for Autism Spectrum Disorder. The children were of both sexes, with a mean age of 44.8 months. Parents answered a previously validated questionnaire about their children's auditory hypersensitivity behaviors by telephone. A score equal to or greater than eight points in the general score was considered as a sign of hypersensitivity. Results 63.6% of the children presented results indicative of hypersensitivity and 54.5% obtained maximum scores on questions related to irritability to specific sounds. The sounds cited as generating irritability were: clapping, fireworks, shouting, construction tools, singing and cell phone ringtones. Conclusion Auditory hypersensitivity was observed, especially related to irritability, which suggests a relationship with the limbic system and, therefore, may refer to misophonia. Thus, it is important for the multidisciplinary team to pay attention to the occurrence and characteristics of hypersensitivity in this population, in order to maximize favorable conditions for rehabilitation.

Virtual audiometer: technology integrated to teaching. / Audiômetro virtual: tecnologia integrada ao ensino.

PURPOSE: To elaborate a virtual tool, with didactic purposes, that allows the integration of technology to the teaching of Pure Tone Audiometry (PTA) and speech audiometry. METHODS: The Interacoustics AD229b audiometer was used as a physical model to achieve the virtual tool. The Visual Basic 6 programming language was used, so that the colors, characters, and functions were similar to the real audiometer. In addition, the possibility of simulating the patient's response was added, as well as of recording the hearing thresholds in a virtual audiogram. For speech audiometry, the possibility of adjusting the VU meter and recording the number of correct and incorrect answers were implemented. RESULTS: The developed tool was able to reproduce frequencies from 125 Hz to 8000 Hz, in intensities ranging from -10 to 110 dB, being possible to use different stimulus, as well as clinical masking by air and bone conduction. The microphone button can be used to facilitate the teaching of speech audiometry. CONCLUSION: The virtual version of the audiometer is similar to the model equipment, making the integration of technology into teaching feasible, with exemplify the PTA and speech audiometry.

OBJETIVO: Elaborar uma ferramenta virtual, com fins didáticos, que possibilite a integração da tecnologia ao ensino da Audiometria Tonal Limiar (ATL) e logoaudiometria. MÉTODO: O audiômetro da marca Interacoustics AD229b foi utilizado como modelo físico para a consecução da ferramenta virtual. Utilizou-se a linguagem de programação Visual Basic 6, de modo que as cores, os caracteres e as funções fossem similares ao audiômetro real. Além disso, acrescentou-se a possibilidade de simular a resposta do paciente, como também de registrar os limiares auditivos em um audiograma virtualizado. Para a logoaudiometria, implementou-se a possibilidade de ajuste do "VU meter" e o registro da quantidade de acertos e erros no exame. RESULTADOS: A ferramenta desenvolvida mostrou-se capaz de reproduzir as frequências de 125 a 8000 Hz, em intensidades que variam de -10 a 110 dB, sendo possível empregar diferentes formas de apresentação do estímulo, assim como o mascaramento clínico por condução aérea e óssea. A ativação da função "microfone" pode ser aplicada para facilitar o ensino da logoaudiometria. CONCLUSÃO: A versão virtualizada do audiômetro mostrou-se semelhante ao equipamento modelo, tornando factível a integração da tecnologia ao ensino, com exemplificação da ATL e da logoaudiometria.

Contralateral Masking in the Measurement of Auditory Brainstem Responses with Air-Conducted Tone Burst Stimuli in Individuals with Unilateral Hearing Loss.

BACKGROUND: Contralateral noise masking is an important aspect of auditory brainstem response (ABR) measurements. PURPOSE: The primary aim of this study is to determine how contralateral white noise (WN) masking influences the amplitude and the latency of V wave generated during ABR measurements, using tone burst (TB), in adult ears with normal hearing (NH). The secondary aim of this study is to ascertain the need of contralateral masking in ABR measurements with the TB stimuli using a 3A insertion earphone, and to propose the applicability of WN masking in unilateral sensorineural hearing loss (USNHL). RESEARCH DESIGN: It is a cross-sectional observational and descriptive study. STUDY SAMPLE: Experiment 1: Thirty individuals, without any otologic, psychological, or neurological dysfunction, were selected. Experiment 2: Fifteen individuals with previous audiological diagnoses of severe and profound USNHL were considered. INTERVENTION: The study involves ABR TB at specific frequencies of 0.5, 1, 2, and 4 kHz. DATA COLLECTION AND ANALYSIS: Experiment 1: The evaluation was performed at the fixed intensity of 80 dB nHL (decibel normalized hearing level) on the tested ear, followed by the application of simultaneous masking to the nontested ear, intensity ranged from 0 to 80 dB. Experiment 2: ABR threshold measurements were first performed on the ear with hearing loss (HL) at the frequencies of 1, 2, and 4 kHz. The results were subsequently confirmed using contralateral masking. RESULTS: Experiment 1: At any given frequency, there were no statistically significant differences in the amplitude and latency of V wave with increase in the intensities of WN masking. Experiment 2: Cross-hearing was observed at least once in all frequencies analyzed through the occurrence of V wave. CONCLUSION: In conclusion, the contralateral WN masking at the maximum intensity of 80 dB does not affect the amplitude and latency of V wave of the ABR TB at 1, 2, and 4 kHz. Contralateral masking for the ABR TB presented using 3A insertion earphones is necessary at 1, 2, and 4 kHz in individuals with severe or profound degrees of USNHL and at intensities of 15, 20, and 10 dB above the ABR threshold of the nontested ear.

Audiômetro virtual: tecnologia integrada ao ensino / Virtual audiometer: technology integrated to teaching

RESUMO Objetivo Elaborar uma ferramenta virtual, com fins didáticos, que possibilite a integração da tecnologia ao ensino da Audiometria Tonal Limiar (ATL) e logoaudiometria. Método O audiômetro da marca Interacoustics AD229b foi utilizado como modelo físico para a consecução da ferramenta virtual. Utilizou-se a linguagem de programação Visual Basic 6, de modo que as cores, os caracteres e as funções fossem similares ao audiômetro real. Além disso, acrescentou-se a possibilidade de simular a resposta do paciente, como também de registrar os limiares auditivos em um audiograma virtualizado. Para a logoaudiometria, implementou-se a possibilidade de ajuste do "VU meter" e o registro da quantidade de acertos e erros no exame. Resultados A ferramenta desenvolvida mostrou-se capaz de reproduzir as frequências de 125 a 8000 Hz, em intensidades que variam de -10 a 110 dB, sendo possível empregar diferentes formas de apresentação do estímulo, assim como o mascaramento clínico por condução aérea e óssea. A ativação da função "microfone" pode ser aplicada para facilitar o ensino da logoaudiometria. Conclusão A versão virtualizada do audiômetro mostrou-se semelhante ao equipamento modelo, tornando factível a integração da tecnologia ao ensino, com exemplificação da ATL e da logoaudiometria.

ABSTRACT Purpose To elaborate a virtual tool, with didactic purposes, that allows the integration of technology to the teaching of Pure Tone Audiometry (PTA) and speech audiometry. Methods The Interacoustics AD229b audiometer was used as a physical model to achieve the virtual tool. The Visual Basic 6 programming language was used, so that the colors, characters, and functions were similar to the real audiometer. In addition, the possibility of simulating the patient's response was added, as well as of recording the hearing thresholds in a virtual audiogram. For speech audiometry, the possibility of adjusting the VU meter and recording the number of correct and incorrect answers were implemented. Results The developed tool was able to reproduce frequencies from 125 Hz to 8000 Hz, in intensities ranging from -10 to 110 dB, being possible to use different stimulus, as well as clinical masking by air and bone conduction. The microphone button can be used to facilitate the teaching of speech audiometry. Conclusion The virtual version of the audiometer is similar to the model equipment, making the integration of technology into teaching feasible, with exemplify the PTA and speech audiometry.

Nursing training program in children's hearing health: a proposal for interactive tele-education.

OBJECTIVE: To verify the effectiveness of a nursing training program in the area of children's hearing health using interactive tele-education. METHODS: Interrupted time series with non-random control group pre-test/ post-test. A cohort of 41 nurses, with no previous formal training in hearing health. A "Children's Hearing Health" Cybertutor was employed. The effectiveness of the nursing training was verified by comparing pre- versus post-training performance and by analyzing responses to an evaluation questionnaire. RESULTS: Following training, the performance was significantly better in all domains assessed and in the total score. The evaluation questionnaire demonstrated that the Cybertutor was well accepted and the performance revealed in the pre-training phase demonstrated the need for children´s hearing health training. CONCLUSION: The effectiveness of the nursing training program in the area of Children's Hearing Health using interactive tele-education could be proven, since there was an improvement in performance in all domains evaluated.

Unilateral and asymmetric hearing loss in childhood. / Perda auditiva unilateral e assimétrica na infância.

PURPOSE: To describe unilateral and bilateral asymmetric sensorineural hearing loss in children and its etiological, audiological and demographic characteristics. METHODS: Retrospective cross-sectional study developed in the Seção de Implante Coclear of Hospital de Reabilitação de Anomalias Craniofaciais, through the analysis of medical records. RESULTS: Data from 1152 patients were analyzed: 424 (37%) adolescents, adults or elderly, and 728 (63%) children, of whom 691 (95%) had bilateral symmetrical hearing loss, and 37 (5%) had unilateral hearing loss (n=10) or bilateral asymmetric (n=27) sensorineural hearing loss. The mean age at diagnosis of unilateral sensorineural hearing loss was 33.58±21.69 months, and for asymmetric bilateral it was 33.12±21.69 months, with a prevalence of 1.4% and 3.7%, respectively. The highest risk indicator for hearing loss for both groups was the family history of permanent deafness, which began in childhood. The majority of the relatives of children with unilateral sensorineural hearing loss presented the highest low socioeconomic classification (50%), while children with bilateral asymmetric sensorineural hearing loss were also be subdivided into upper (37%) and lower (37%). CONCLUSION: We observed a greater occurrence of asymmetric bilateral sensorineural hearing loss compared to unilateral hearing loss, as well as the hereditary risk indicator, with a predominance of the deep ear and female preponderance in both groups. Although neonatal hearing screening provides early identification of unilateral sensorineural hearing loss, the age at the audiological diagnosis is still above the recommended level. In addition, the majority of the children's family members presented a low level of income.

OBJETIVO: Descrever a perda auditiva sensorioneural unilateral e bilateral assimétrica em crianças quanto às características etiológicas, audiológicas e demográficas. MÉTODO: Estudo retrospectivo transversal, desenvolvido na Seção de Implante Coclear do Hospital de Reabilitação de Anomalias Craniofaciais, por meio da análise de prontuários. RESULTADOS: Foram analisados os dados de 1152 pacientes, sendo 424 (37%) adolescentes, adultos ou idosos e 728 (63%) crianças, dentre as quais, 691 (95%) apresentavam perda auditiva bilateral simétrica e 37 (5%) perda auditiva sensorioneural unilateral (n=10) ou bilateral assimétrica (n=27). A idade média ao diagnóstico na perda auditiva sensorioneural unilateral foi de 33,58±21,69 meses e na bilateral assimétrica de 33,12±21,69 meses, com prevalência de 1,4% e 3,7%, respectivamente. O indicador de risco para a deficiência auditiva de maior ocorrência para ambos os grupos foi o de antecedente familiar. A maioria dos familiares das crianças com perda auditiva sensorioneural unilateral apresentaram a classificação socioeconômica baixa superior (50%), enquanto que as crianças com perda auditiva sensorioneural bilateral assimétrica se subdividiram igualmente em baixa superior (37%) e média inferior (37%). CONCLUSÃO: Houve uma maior prevalência da perda auditiva sensorioneural bilateral assimétrica em relação à unilateral, bem como do indicador de risco de hereditariedade, com predomínio do grau profundo na pior orelha e preponderância do sexo feminino, em ambos os grupos. Apesar de a triagem auditiva neonatal propiciar a identificação precoce da perda auditiva sensorioneural unilateral, a idade no diagnóstico audiológico ainda se encontra acima do recomendado. Adicionalmente, a maioria dos familiares das crianças apresentou nível de rendimento baixo.

Perda auditiva unilateral e assimétrica na infância / Unilateral and asymmetric hearing loss in childhood

RESUMO Objetivo Descrever a perda auditiva sensorioneural unilateral e bilateral assimétrica em crianças quanto às características etiológicas, audiológicas e demográficas. Método Estudo retrospectivo transversal, desenvolvido na Seção de Implante Coclear do Hospital de Reabilitação de Anomalias Craniofaciais, por meio da análise de prontuários. Resultados Foram analisados os dados de 1152 pacientes, sendo 424 (37%) adolescentes, adultos ou idosos e 728 (63%) crianças, dentre as quais, 691 (95%) apresentavam perda auditiva bilateral simétrica e 37 (5%) perda auditiva sensorioneural unilateral (n=10) ou bilateral assimétrica (n=27). A idade média ao diagnóstico na perda auditiva sensorioneural unilateral foi de 33,58±21,69 meses e na bilateral assimétrica de 33,12±21,69 meses, com prevalência de 1,4% e 3,7%, respectivamente. O indicador de risco para a deficiência auditiva de maior ocorrência para ambos os grupos foi o de antecedente familiar. A maioria dos familiares das crianças com perda auditiva sensorioneural unilateral apresentaram a classificação socioeconômica baixa superior (50%), enquanto que as crianças com perda auditiva sensorioneural bilateral assimétrica se subdividiram igualmente em baixa superior (37%) e média inferior (37%). Conclusão Houve uma maior prevalência da perda auditiva sensorioneural bilateral assimétrica em relação à unilateral, bem como do indicador de risco de hereditariedade, com predomínio do grau profundo na pior orelha e preponderância do sexo feminino, em ambos os grupos. Apesar de a triagem auditiva neonatal propiciar a identificação precoce da perda auditiva sensorioneural unilateral, a idade no diagnóstico audiológico ainda se encontra acima do recomendado. Adicionalmente, a maioria dos familiares das crianças apresentou nível de rendimento baixo.

ABSTRACT Purpose To describe unilateral and bilateral asymmetric sensorineural hearing loss in children and its etiological, audiological and demographic characteristics. Methods Retrospective cross-sectional study developed in the Seção de Implante Coclear of Hospital de Reabilitação de Anomalias Craniofaciais, through the analysis of medical records. Results Data from 1152 patients were analyzed: 424 (37%) adolescents, adults or elderly, and 728 (63%) children, of whom 691 (95%) had bilateral symmetrical hearing loss, and 37 (5%) had unilateral hearing loss (n=10) or bilateral asymmetric (n=27) sensorineural hearing loss. The mean age at diagnosis of unilateral sensorineural hearing loss was 33.58±21.69 months, and for asymmetric bilateral it was 33.12±21.69 months, with a prevalence of 1.4% and 3.7%, respectively. The highest risk indicator for hearing loss for both groups was the family history of permanent deafness, which began in childhood. The majority of the relatives of children with unilateral sensorineural hearing loss presented the highest low socioeconomic classification (50%), while children with bilateral asymmetric sensorineural hearing loss were also be subdivided into upper (37%) and lower (37%). Conclusion We observed a greater occurrence of asymmetric bilateral sensorineural hearing loss compared to unilateral hearing loss, as well as the hereditary risk indicator, with a predominance of the deep ear and female preponderance in both groups. Although neonatal hearing screening provides early identification of unilateral sensorineural hearing loss, the age at the audiological diagnosis is still above the recommended level. In addition, the majority of the children's family members presented a low level of income.

Nursing training program in childrens hearing health: a proposal for interactive tele-education / Capacitación de enfermeros en salud auditiva infantil: una propuesta de teleducación interactiva / Capacitação dos enfermeiros em saúde auditiva infantil: uma proposta de teleducação interativa

ABSTRACT Objective: To verify the effectiveness of a nursing training program in the area of children's hearing health using interactive tele-education. Methods: Interrupted time series with non-random control group pre-test/ post-test. A cohort of 41 nurses, with no previous formal training in hearing health. A "Children's Hearing Health" Cybertutor was employed. The effectiveness of the nursing training was verified by comparing pre- versus post-training performance and by analyzing responses to an evaluation questionnaire. Results: Following training, the performance was significantly better in all domains assessed and in the total score. The evaluation questionnaire demonstrated that the Cybertutor was well accepted and the performance revealed in the pre-training phase demonstrated the need for children´s hearing health training. Conclusion: The effectiveness of the nursing training program in the area of Children's Hearing Health using interactive tele-education could be proven, since there was an improvement in performance in all domains evaluated.

RESUMEN Objetivo: verificar la eficacia de un tutor electrónico - cybertutor en la formación de enfermeros en el área de salud auditiva infantil. Métodos: series temporales interrumpidas con grupo control pretest/posttest no aleatorio. Participaron 41 enfermeros, que fueron capacitados a través de un Cybertutor denomidado "Salud auditiva infantil". La eficacia de la capacitación se verificó comparando el desempeño de los enfermeros en los cuestionarios pre y post capacitación, y la evaluación del Cybertutor se investigó a través de un formulario con preguntas cerradas y abiertas. Resultados: El desempeño en el cuestionario precapacitación demostró la necesidad de capacitación en salud auditiva infantil. Hubo una diferencia en el desempeño después del entrenamiento en todos los dominios evaluados y en el puntaje total. Conclusión: La efectividad del cybertutor en la capacitación de enfermeras en el área de Salud Auditiva Infantil podría demostrarse, ya que hubo una mejora en el rendimiento en todos los dominios evaluados.

RESUMO Objetivo: verificar a eficácia de um tutor eletrônico - cybertutor na capacitação de enfermeiros na área de saúde auditiva infantil. Métodos: séries temporais interrompidas com grupo controle pré-teste/pós-teste não randomizado. Participaram 41 enfermeiros que foram capacitados por meio de um Cybertutor denominado "Saúde Auditiva Infantil". A eficácia da capacitação foi verificada a partir da comparação do desempenho dos enfermeiros, nos questionários pré e pós-capacitação, e a avaliação do Cybertutor foi investigada por meio de um formulário com perguntas fechadas e abertas. Resultados: O desempenho no questionário pré-capacitação demonstrou a necessidade da capacitação em saúde auditiva infantil. Houve diferença no desempenho após a capacitação em todos os domínios avaliados e no escore total. Conclusão: A eficácia do cybertutor na capacitação de enfermeiros na área de Saúde Auditiva Infantil pôde ser comprovada, uma vez que houve melhora no desempenho em todos os domínios avaliados.

O uso do mascaramento contralateral na pesquisa do potencial evocado auditivo de tronco encefálico por condução aérea: revisão sistemática / Use of contralateral masking in air-conduction auditory brainstem response: systematic review

RESUMO Objetivos analisar criticamente a necessidade do uso do mascaramento contralateral na pesquisa do potencial evocado auditivo de tronco encefálico (PEATE) por condução aérea, na perda auditiva sensorioneural unilateral ou bilateral assimétrica, por meio de uma revisão sistemática da literatura. Estratégia de pesquisa foram consultadas as bases de dados eletrônicas PubMed/MEDLINE, LILACS, ADOLEC, IBECS, SciELO, Web of Science, Scopus e Embase, bem como os anais do Encontro Internacional de Audiologia e do Congresso Brasileiro de Fonoaudiologia, além das bases de instituições com pós-graduação em Fonoaudiologia, utilizando os descritores Evoked Potentials, Auditory, Brain Stem, Perceptual Masking e Hearing Loss, Sensorineural. Critérios de seleção foram selecionados os estudos com níveis de evidência de 1 a 5, publicados em português, inglês ou espanhol, até janeiro de 2018. Os artigos deveriam abordar a necessidade do uso do mascaramento contralateral na pesquisa do PEATE por condução aérea, em indivíduos com perda auditiva sensorioneural unilateral ou bilateral assimétrica. Resultados foram encontrados 334 estudos, sendo que oito artigos contemplaram os critérios preestabelecidos. Os estudos incluídos foram controversos quanto ao uso do mascaramento contralateral. Conclusão não existe um consenso quanto à necessidade do uso do mascaramento contralateral no PEATE por condução aérea, em indivíduos com perda auditiva sensorioneural unilateral. No entanto, a maioria dos estudos direcionou para a sua utilização na pesquisa do PEATE com estímulo clique em indivíduos com perda auditiva sensorioneural unilateral de graus severo e profundo.

ABSTRACT Purpose Critically analyze the need to use contralateral masking in the measurement of Auditory Brainstem Response (ABR) by air conduction on unilateral or bilateral asymmetric sensorineural hearing loss by means of a systematic literature review. Research strategies A search was conducted at the PubMed/MEDLINE, LILACS, ADOLEC, IBECS, SciELO, Web of Science, Scopus and Embase electronic databases, proceedings of the International Meeting of Audiology and the Brazilian Congress of Speech-language Pathology and Audiology, and bases of institutions with Graduate Studies Programs in Speech-language Pathology and Audiology, using the following descriptors: Evoked Potentials, Auditory, Brainstem, Perceptual Masking, Hearing Loss, and Sensorineural. Selection criteria Studies with levels of evidence from 1 to 5 published in Portuguese, English or Spanish until January 2018 were selected. The articles should address the need to use contralateral masking in the measurement of air-conduction ABR in individuals with unilateral or bilateral asymmetric sensorineural hearing loss. Results A total of 334 studies were found, and eight of them met the pre-established criteria. The studies included in the review were controversial as to the need for contralateral masking. Conclusion There is no consensus on the need to use contralateral masking in the measurement of ABR by air conduction in individuals with unilateral sensorineural hearing loss; however, most studies report the use of contralateral masking in the measurement of ABR with click stimulus in individuals with severe and profound unilateral sensorineural hearing loss.

Acoustic Reflex Testing in Neonatal Hearing Screening and Subsequent Audiological Evaluation.

Purpose: The aims of the study were to examine the acoustic reflex screening and threshold in healthy neonates and those at risk of hearing loss and to determine the effect of birth weight and gestational age on acoustic stapedial reflex (ASR). Method: We assessed 18 healthy neonates (Group I) and 16 with at least 1 risk factor for hearing loss (Group II); all of them passed the transient evoked otoacoustic emission test that assessed neonatal hearing. The test battery included an acoustic reflex screening with activators of 0.5, 1, 2, and 4 kHz and broadband noise and an acoustic reflex threshold test with all of them, except for the broadband noise activator. Results: In the evaluated neonates, the main risk factors were the gestational age at birth and a low birth weight; hence, these were further analyzed. The lower the gestational age at birth and birth weight, the less likely that an acoustic reflex would be elicited by pure-tone activators. This effect was significant at the frequencies of 0.5, 1, and 2 kHz for gestational age at birth and at the frequencies of 1 and 2 kHz for birth weight. When the broadband noise stimulus was used, a response was elicited in all neonates in both groups. When the pure-tone stimulus was used, the Group II showed the highest acoustic reflex thresholds and the highest percentage of cases with an absent ASR. The ASR threshold varied from 50 to 100 dB HL in both groups. Group II presented higher mean ASR thresholds than Group I, this difference being significant at frequencies of 1, 2, and 4 kHz. Conclusions: Birth weight and gestational age at birth were related to the elicitation of the acoustic reflex. Neonates with these risk factors for hearing impairment were less likely to exhibit the acoustic reflex and had higher thresholds.

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.