Audiological Tests Used in the Evaluation of the Effects of Solvents on the Human Auditory System: A Mixed Methods Review.

This study aimed to scope the literature, identify knowledge gaps, appraise results, and synthesize the evidence on the audiological evaluation of workers exposed to solvents. We searched Medline, PubMed, Embase, CINAHL, and NIOSHTIC-2 up to March 22, 2021. Using Covidence, two authors independently assessed study eligibility, risk of bias, and extracted data. National Institute of Health Quality Assessment Tools was used in the quality evaluation of included studies; the Downs and Black checklist was used to assess the risk of bias. Of 454 located references, 37 were included. Twenty-five tests were studied: two tests to measure hearing thresholds, one test to measure word recognition in quiet, six electroacoustic procedures, four electrophysiological tests, and twelve behavioral tests to assess auditory processing skills. Two studies used the Amsterdam Inventory for Auditory Disability and Handicap. The quality of individual studies was mostly considered moderate, but the overall quality of evidence was considered low. The discrepancies between studies and differences in the methodologies/outcomes prevent recommending a specific test battery to assess the auditory effects of occupational solvents. Decisions on audiological tests for patients with a history of solvent exposures require the integration of the most current research evidence with clinical expertise and stakeholder perspectives.

The Promotion of Hearing Health through Wikipedia Campaigns: Article Quality and Reach Assessment.

This case study examined the feasibility, reach, and potential impact of using Wikipedia as a tool for hearing health promotion. Activities involved editing existing Portuguese-language Wikipedia hearing health articles, as well as translating English-language hearing health articles to Portuguese during the Wiki4WorldHearingDay2019 and Wiki4YearOfSound2020 online campaigns. The Wikipedia efforts that took place in Brazil were carried out by 10 volunteer undergraduate students in Speech-Language Pathology and Audiology at the Federal University of Santa Catarina, in Brazil. Among new and existing Wikipedia articles, the group edited 37 articles, which attracted more than 220,000 views during the set tracking period. Students were responsible for 60% of the Portuguese-language edits during the Wiki4WorldHearingDay2019 campaign and more than 90% of the Portuguese-language edits during the first half of the Wiki4YearOfSound2020 campaign. Moreover, the quality indexes for pages either created or edited were improved in all situations by registering an increase rate ranging from 33% to 100%. Wikipedia-centered activities expanded the availability of quality scientific content, written in plain language, to the public. Students worked together in order to select topics, assess existing information, validate it, create new content, and share information-steps that contributed to the mission of health promotion and knowledge dissemination for the benefit of society.

Sintomas auditivos e vocais: uma análise da autopercepção de jogadores de jogos digitais / Auditory and vocal symptoms: an analysis of the self-perception of digital game players

RESUMO Objetivo identificar os fatores associados a zumbido, percepção auditiva e risco de distúrbio vocal entre jogadores de jogos digitais. Métodos estudo transversal realizado com jogadores de jogos digitais por meio de questionários eletrônicos para coletar dados relacionados à saúde auditiva e vocal. Foram analisados três desfechos principais: zumbido, percepção auditiva (sensação da diminuição da audição) e risco de distúrbio de voz, mensurado pela Escala de Sintomas Vocais. As variáveis independentes referiram-se às características sociodemográficas, perfil dos jogadores e sinais e sintomas. Aplicaram-se os testes Qui-quadrado de Pearson e Exato de Fisher. Resultados a amostra foi composta por 59 jogadores, sendo a maioria do gênero masculino (79,7%), com idade entre 18 e 24 anos (69,5%). Com relação aos desfechos, 27,6% dos participantes apresentaram zumbido, 57,6%, risco de distúrbio vocal e 13,6% referiram sensação de diminuição da audição. Observou-se associação entre zumbido e cefaleia (p=0,024), zumbido e uso de smartphone (0,012), sensação de diminuição da audição e presença de ansiedade (p=0,049). O risco de distúrbio de voz associou-se ao maior tempo de horas jogadas por semana (p=0,020). Conclusão a autopercepção de zumbido esteve associada à cefaleia e ao uso de smartphone. Houve, ainda, associação entre ansiedade e sensação de diminuição da audição, além de risco de distúrbio de voz e maior tempo de horas jogadas por semana.

ABSTRACT Purpose to identify factors associated with tinnitus, auditory perception and risk of voice disorders among digital game players. Methods cross-sectional study carried out with digital game players through electronic procedures to collect data related to hearing and vocal health. Three main outcomes were analyzed: tinnitus; auditory perception (sensation of diminished hearing) and risk of voice disorders, measured by the Vocal Symptoms Scale (VSS). The independent variables were related to sociodemographic characteristics, player profile and signs and symptoms. Pearson's chi-square test and Fisher's exact test were applied. Results the sample consisted of 59 players. Most were male (79.7%) and ages between 18 and 24 years (69.5%). Regarding the terms, 27.6% had tinnitus, 57.6% were at risk of vocal disorder and 13.6% reported hearing loss. There was an association between tinnitus and headache (p=0.024), tinnitus and smartphone use (0.012), hearing loss and anxiety (p= 0.049). A risk of voice disorder(s ) was associated with more hours played per week (p=0.020). Conclusion self-perceived tinnitus was associated with headache and smartphone use; there was also an association between anxiety and the feeling of hearing impairment, in addition to the risk of voice disorders and more hours played per week.

Prevalência e fatores associados a atividades que levam ao nervosismo no trabalho no Brasil: estudo com dados da Pesquisa Nacional de Saúde, 2013 / Prevalence and factors associated with activities that lead to nervousness at work in Brazil: study with data from the National Health Survey, 2013

Resumo Objetivos: descrever a prevalência de atividades que levam ao nervosismo e analisar os fatores associados a essa condição em trabalhadores brasileiros. Métodos: estudo transversal realizado com dados da Pesquisa Nacional de Saúde (PNS), edição de 2013. A variável dependente foi o envolvimento em atividades que levam ao nervosismo e as independentes foram características sociodemográficas, ocupacionais e situação de saúde. Empregou-se análise de regressão de Poisson com variância robusta. Resultados: participaram deste estudo 36.442 trabalhadores, 53,4% do sexo masculino. A prevalência de atividades que levam ao nervosismo no trabalho foi de 33,8% (Intervalo de Confiança de 95% [IC95%]: 33,2; 34,2). Na análise ajustada, raça/cor da pele preta (Razão de Prevalência [RP]: 0,84; IC95%: 0,77;0,92) e parda (RP:0,86; IC95%: 0,82;0,91), idade maior que 60 anos (RP:0,74; IC95%: 0,64;0,85) e trabalhar em ambientes abertos (RP: 0,82; IC95%: 0,77;0,87) foram significativamente associados a uma menor prevalência de atividades que levam ao nervosismo. Ruído (RP: 1,96; IC95%: 1,86;2,06), material radioativo (RP: 1,28; IC95%: 1,16;1,41), trabalho noturno (RP: 1,31; IC95%: 1,24; 1,38), idade de 30 a 39 anos (RP: 1,10; IC95%: 1,03;1,17) e depressão (RP: 1,36; IC95%: 1,26;1,47) associaram-se a uma maior probabilidade do desfecho. Conclusão: características sociodemográficas, ambientais e aspectos de saúde estão associados a atividades que levam ao nervosismo em trabalhadores brasileiros.

Abstract Objective: to describe the prevalence of activities leading to nervousness and analyze the factors associated with this condition in Brazilian workers. Methods: cross-sectional study using data from the National Health Survey (PNS) - 2013. The dependent variable was involvement in activities leading to nervousness, and the independent variables included sociodemographic, occupational, and health-related characteristics. We calculated the Poisson regression with robust variance. Results: 36,442 workers participated in this study, 53.4% male. The prevalence of activities leading to nervousness at work was 33.8% (95% of Confidence Interval [95%CI]: 33.2; 34.2). In the adjusted analysis, black (Prevalence Ratio [PR]: 0.84; 95%CI: 0.77;0.92) and mixed race (PR: 0.86; 95%CI: 0.82;0.91) individuals, aged over 60 years (PR: 0.74; 95% CI: 0.64;0.85), and those working in open environments (PR: 0.82; 95%CI: 0.77;0.87) were significantly associated with a lower prevalence of activities leading to nervousness. Noise (PR: 1.96; 95%CI: 1.86;2.06), radioactive materials (PR: 1.28; 95% CI: 1.16;1.41), night work (PR: 1.31; 95%CI: 1.24;1.38), age 30 to 39 years (PR: 1.10; 95%CI: 1.03;1.17), and depression (PR: 1.36; 95%CI: 1.26;1.47) were associated with a higher probability of the outcome. Conclusion: sociodemographic, environmental, and health-related characteristics are associated with activities leading to nervousness in Brazilian workers.

Temporary and Permanent Auditory Effects Associated with Occupational Coexposure to Low Levels of Noise and Solvents.

This study aimed to assess temporary and permanent auditory effects associated with occupational coexposure to low levels of noise and solvents. Cross-sectional study with 25 printing industry workers simultaneously exposed to low noise (<80 dBA TWA) and low levels of solvents. The control group consisted of 29 industry workers without the selected exposures. Participants answered a questionnaire and underwent auditory tests. Auditory fatigue was measured by comparing the acoustic reflex threshold before and after the workday. Workers coexposed to solvents and noise showed significantly worse results in auditory tests in comparison with the participants in the control group. Auditory brainstem response results showed differences in III−V interpeak intervals (p = 0.046 in right ear; p = 0.039 in left ear). Mean dichotic digits scores (exposed = 89.5 ± 13.33; controls = 96.40 ± 4.46) were only different in the left ear (p = 0.054). The comparison of pre and postacoustic reflex testing indicated mean differences (p = 0.032) between the exposed (4.58 ± 6.8) and controls (0 ± 4.62) groups. This study provides evidence of a possible temporary effect (hearing fatigue) at the level of the acoustic reflex of the stapedius muscle. The permanent effects were identified mainly at the level of the high brainstem and in the auditory ability of binaural integration.

Dificuldade auditiva autorreferida em trabalhadores expostos à poeira industrial no sul do Brasil / Self-reported hearing difficulty in workers exposed to industrial dust in southern Brazil

RESUMO Objetivo Investigar a associação entre dificuldade auditiva autorreferida e exposição ocupacional à poeira industrial em trabalhadores do sul do Brasil. Método Trata-se de um estudo transversal analítico, realizado com dados do inquérito da Pesquisa Nacional de Saúde (2013). A variável dependente foi a dificuldade auditiva autorreferida e a variável independente principal foi a exposição ocupacional à poeira industrial. As covariáveis foram: sexo, cor da pele, idade em anos completos, exposição a ruído e exposição à substâncias químicas. As variáveis de exposição ocupacional a ruído e substâncias químicas foram utilizadas como variáveis de ajuste (variáveis de confusão) e as análises foram estratificadas por cada estado (Santa Catarina, Paraná e Rio Grande do Sul), com o intuito de verificar a diferença na magnitude dos resultados por região. Tanto para a análise bruta quanto para a ajustada, a razão de chance foi utilizada como medida de associação, estimada por meio da análise de regressão logística. Os dados foram analisados no software Stata, versão 14. Resultados Com relação a exposição principal, 10,1% da amostra (n=490) afirmou estar exposta à poeira industrial em ambiente ocupacional, ao passo que 7,0% afirmou ter dificuldade auditiva. Na análise final, trabalhadores expostos a poeira industrial apresentaram 1,77 vezes mais chance de mencionar dificuldade auditiva, quando comparados a indivíduos não expostos a este agente. Conclusão Houve associação entre dificuldade auditiva e exposição à poeira industrial em trabalhadores da região Sul do Brasil.

ABSTRACT Purpose To investigate the association between self-reported hearing difficulties and occupational exposure to industrial dust in workers in southern Brazil. Methods This is a cross-sectional analytical study conducted with data from the National Health Survey (Pesquisa Nacional de Saúde, 2013). The dependent variable was self-reported hearing impairment, and the primary independent variable was occupational exposure to industrial dust. The covariables were: sex, skin color, age in complete years, exposure to noise, and exposure to chemical substances. The variables of occupational exposure to noise and chemical substances were used as adjustment variables (confounding variables), and the analyses were stratified per state (Santa Catarina, Paraná, and Rio Grande do Sul) to verify the difference in magnitude results per region. For the crude and adjusted analysis, the odds ratio (OR) was used as a measure of association, estimated through the logistic regression analysis. The data were analyzed through the software Stata, version 14. Results Regarding the main exposure, 10.1% of the sample (n = 490) reported being exposed to industrial dust in an occupational environment, while 7.0% reported hearing impairment. In the final analysis, workers exposed to industrial dust were 1.77 times more likely to report hearing impairment when compared to individuals not exposed to this agent. Conclusion There was an association between hearing impairment and exposure to industrial dust in workers in the southern region of Brazil.

Perda auditiva induzida por ruído no Brasil: descrição de 14 anos de notificação / Noise-induced hearing loss in Brazil: a description of 14 years of notifications

RESUMO Objetivo descrever as notificações de perda auditiva induzida por ruído (PAIR) no Brasil, segundo aspectos sociodemográficos e laborais, no período de 2006 a 2019. Métodos estudo transversal e descritivo, realizado com dados das fichas de notificação de PAIR no Brasil, oriundos do Sistema de Informações de Agravos de Notificação. Os dados foram acessados por meio da página do Centro Colaborador de Vigilância aos Agravos à Saúde do Trabalhador. Foram analisadas as frequências absolutas e relativas de variáveis sociodemográficas e de características do trabalho. Resultados no período, foram notificados 7.819 casos de PAIR no Brasil. O ano de 2016 e o estado de São Paulo registraram o maior número de notificações, com 1.106 e 2.488 casos, respectivamente. Em todo o período, houve maior proporção de casos em indivíduos com carteira assinada (55,0%), gênero masculino (88,2%), cor de pele branca (59,1%) e faixa etária de 50 a 59 (33,7%). O ruído contínuo foi predominante no ambiente de trabalho (41,1%) e 51,1% dos indivíduos faziam uso de medidas de proteção individual, enquanto para 12,6% a proteção foi coletiva. Conclusão foram notificados 7.819 casos de PAIR no Brasil no período analisado, número que pode ser considerado desproporcional, em relação à prevalência desse agravo. A subnotificação observada impacta a compreensão da magnitude do problema e, consequentemente, o desenvolvimento e implementação de ações e programas de saúde pública, voltados para a saúde e segurança do trabalhador.

ABSTRACT Purpose To describe the notifications of NIHL in Brazil, according to sociodemographic and labor aspects, in the period from 2006 to 2019. Methods Cross-sectional and descriptive study carried out with data from notification forms for noise-induced hearing loss in Brazil, from SINAN. The data were accessed through the page of the Collaborating Center for Surveillance of Workers' Health Disorders (ISC-UFBA). Absolute and relative frequencies of sociodemographic variables and work characteristics were analyzed. Results During the period, 7,819 cases of NIHL were reported in Brazil. The year 2016 and the state of São Paulo registered the highest number of notifications, with 1,106 and 2,488 cases, respectively. Throughout the period, there was a higher proportion of cases in: individuals with a formal contract (55.0%), male (88.2%), white (59.1%) and aged between 50 and 59 years (33.7%). Continuous noise was predominant in the work environment (41.1%) and 51.1% of the individuals used individual protection measures, while 12.6% were protected collectively. Conclusion A total of 7,819 cases of NIHL were reported in Brazil in the period analyzed, a number that can be considered disproportionate in relation to the prevalence of this condition. The observed underreporting impacts on the understanding of the magnitude of the problem, and, consequently, on the development and implementation of public health actions and programs, aimed at worker health and safety.

[Self-reported hearing impairment and occupational exposure to hazardous noise and ototoxic agents: a population-based study]. / Dificuldade auditiva autorreferida e exposição ocupacional a agentes otoagressores: um estudo de base populacional.

This study's objective was to estimate the association between self-reported hearing impairment and occupational exposure to hazardous noise and ototoxic agents in Brazilian workers. This was a cross-sectional study with data from the Brazilian National Health Survey (PNS-2013). The dependent variable was self-reported hearing impairment, and three principal exposures were analyzed: noise, industrial dust, and chemical substances. Logistic regression was performed, estimating crude and adjusted odds ratios (OR) with 95% confidence intervals (95%CI). The principal exposure variables were adjusted for each other and by covariables sex, age, workplace, time on the job, and hypertension. 36,442 workers participated in the study. Higher prevalence of hearing impairment was seen in workers exposed to industrial dust (9.9%) (p < 0.001). The older the worker and the longer the time on the job, the higher the prevalence of hearing impairment (p < 0.001). In the adjusted analysis, workers exposed to noise showed 1.65 higher odds of reporting difficulty hearing, when compared to unexposed individuals (p < 0.001). The same was true for workers exposed to industrial dust (OR = 1.36) (p = 0.012). No association was observed between the outcome and exposure to chemical substances (p = 0.120). There was an association between hearing impairment and occupational exposure to noise and industrial dust in Brazilian workers. This emphasizes the importance of strengthening public policies for hearing health and the development of measures for prevention and auditory monitoring in the workplace.

O objetivo deste estudo foi estimar a associação entre dificuldade auditiva autorreferida e exposição ocupacional a agentes otoagressores em trabalhadores brasileiros. Trata-se de um estudo transversal realizado com dados da Pesquisa Nacional de Saúde (PNS-2013). A variável dependente foi a dificuldade auditiva autorreferida, e foram analisadas três exposições principais: ruído, poeira industrial e substâncias químicas. Realizou-se análise de regressão logística, estimando-se as odds ratio (OR) brutas e ajustadas, com intervalos de 95% de confiança (IC95%). As variáveis principais de exposição foram ajustadas entre si e pelas covariáveis sexo, idade, ambiente de trabalho, tempo de trabalho e hipertensão arterial. Participaram deste estudo 36.442 trabalhadores. Maior prevalência de dificuldade auditiva foi observada em indivíduos expostos à poeira industrial (9,9%) (p < 0,001). Além disso, quanto maior a idade do trabalhador e tempo de trabalho, maior foi a prevalência do desfecho (p < 0,001). Na análise ajustada, trabalhadores expostos a ruído apresentaram 1,65 vez mais chance de referir dificuldade auditiva, quando comparados aos indivíduos não expostos (p < 0,001). O mesmo ocorreu com trabalhadores expostos à poeira industrial (OR = 1,36) (p = 0,012). Não foi observada associação entre o desfecho e a variável exposição a substâncias químicas (p = 0,120). Observou-se associação entre dificuldade auditiva e exposição ocupacional a ruído e à poeira industrial em trabalhadores brasileiros. Reforçam-se a importância do aprimoramento de políticas públicas em saúde auditiva e o desenvolvimento de ações voltadas à prevenção e ao monitoramento auditivo em ambiente ocupacional.

El objetivo de este estudio fue estimar la asociación entre dificultad auditiva autoinformada y la exposición ocupacional a agentes otoagresores en trabajadores brasileños. Se trata de un estudio transversal, realizado con datos de la Encuesta Nacional de Salud (PNS-2013). La variable dependiente fue la dificultad auditiva autoinformada y se analizaron tres exposiciones principales: ruido, polvo industrial y substancias químicas. Se realizó un análisis de regresión logística, estimándose las odds ratio (OR) brutas y ajustadas, con intervalos de un 95% de confianza (IC95%). Las variables principales de exposición fueron ajustadas entre sí y por las covariables: sexo, edad, ambiente de trabajo, tiempo de trabajo e hipertensión arterial. Participaron en este estudio 36.442 trabajadores. La mayor prevalencia de dificultad auditiva se observó en individuos expuestos al polvo industrial (9,9%) (p < 0,001). Asimismo, cuanto mayor era la edad del trabajador y tiempo de trabajo, mayor fue la prevalencia del desenlace (p < 0,001). En el análisis ajustado, los trabajadores expuestos a ruido presentaron 1,65 veces más oportunidad de informar de dificultad auditiva, cuando se comparan con los individuos no expuestos (p < 0,001). Lo mismo sucedió con trabajadores expuestos a polvo industrial (OR = 1,36) (p = 0,012). No se observó una asociación entre el desenlace y la variable exposición a sustancias químicas (p = 0,120). Se observó una asociación entre dificultad auditiva y exposición ocupacional a ruido y polvo industrial en trabajadores brasileños. Se refuerza la importancia del perfeccionamiento de políticas públicas en salud auditiva y desarrollo de acciones dirigidas a la prevención y monitoreo auditivo en el entorno laboral.

Self-reported hearing difficulty in workers exposed to industrial dust in southern Brazil. / Dificuldade auditiva autorreferida em trabalhadores expostos à poeira industrial no sul do Brasil.

PURPOSE: To investigate the association between self-reported hearing difficulties and occupational exposure to industrial dust in workers in southern Brazil. METHODS: This is a cross-sectional analytical study conducted with data from the National Health Survey (Pesquisa Nacional de Saúde, 2013). The dependent variable was self-reported hearing impairment, and the primary independent variable was occupational exposure to industrial dust. The covariables were: sex, skin color, age in complete years, exposure to noise, and exposure to chemical substances. The variables of occupational exposure to noise and chemical substances were used as adjustment variables (confounding variables), and the analyses were stratified per state (Santa Catarina, Paraná, and Rio Grande do Sul) to verify the difference in magnitude results per region. For the crude and adjusted analysis, the odds ratio (OR) was used as a measure of association, estimated through the logistic regression analysis. The data were analyzed through the software Stata, version 14. RESULTS: Regarding the main exposure, 10.1% of the sample (n = 490) reported being exposed to industrial dust in an occupational environment, while 7.0% reported hearing impairment. In the final analysis, workers exposed to industrial dust were 1.77 times more likely to report hearing impairment when compared to individuals not exposed to this agent. CONCLUSION: There was an association between hearing impairment and exposure to industrial dust in workers in the southern region of Brazil.

OBJETIVO: Investigar a associação entre dificuldade auditiva autorreferida e exposição ocupacional à poeira industrial em trabalhadores do sul do Brasil. MÉTODO: Trata-se de um estudo transversal analítico, realizado com dados do inquérito da Pesquisa Nacional de Saúde (2013). A variável dependente foi a dificuldade auditiva autorreferida e a variável independente principal foi a exposição ocupacional à poeira industrial. As covariáveis foram: sexo, cor da pele, idade em anos completos, exposição a ruído e exposição à substâncias químicas. As variáveis de exposição ocupacional a ruído e substâncias químicas foram utilizadas como variáveis de ajuste (variáveis de confusão) e as análises foram estratificadas por cada estado (Santa Catarina, Paraná e Rio Grande do Sul), com o intuito de verificar a diferença na magnitude dos resultados por região. Tanto para a análise bruta quanto para a ajustada, a razão de chance foi utilizada como medida de associação, estimada por meio da análise de regressão logística. Os dados foram analisados no software Stata, versão 14. RESULTADOS: Com relação a exposição principal, 10,1% da amostra (n=490) afirmou estar exposta à poeira industrial em ambiente ocupacional, ao passo que 7,0% afirmou ter dificuldade auditiva. Na análise final, trabalhadores expostos a poeira industrial apresentaram 1,77 vezes mais chance de mencionar dificuldade auditiva, quando comparados a indivíduos não expostos a este agente. CONCLUSÃO: Houve associação entre dificuldade auditiva e exposição à poeira industrial em trabalhadores da região Sul do Brasil.

Dificuldade auditiva autorreferida e exposição ocupacional a agentes otoagressores: um estudo de base populacional / Self-reported hearing impairment and occupational exposure to hazardous noise and ototoxic agents: a population-based study / Dificultad auditiva autoinformada y exposición ocupacional a agentes otoagresores: un estudio de base poblacional

O objetivo deste estudo foi estimar a associação entre dificuldade auditiva autorreferida e exposição ocupacional a agentes otoagressores em trabalhadores brasileiros. Trata-se de um estudo transversal realizado com dados da Pesquisa Nacional de Saúde (PNS-2013). A variável dependente foi a dificuldade auditiva autorreferida, e foram analisadas três exposições principais: ruído, poeira industrial e substâncias químicas. Realizou-se análise de regressão logística, estimando-se as odds ratio (OR) brutas e ajustadas, com intervalos de 95% de confiança (IC95%). As variáveis principais de exposição foram ajustadas entre si e pelas covariáveis sexo, idade, ambiente de trabalho, tempo de trabalho e hipertensão arterial. Participaram deste estudo 36.442 trabalhadores. Maior prevalência de dificuldade auditiva foi observada em indivíduos expostos à poeira industrial (9,9%) (p < 0,001). Além disso, quanto maior a idade do trabalhador e tempo de trabalho, maior foi a prevalência do desfecho (p < 0,001). Na análise ajustada, trabalhadores expostos a ruído apresentaram 1,65 vez mais chance de referir dificuldade auditiva, quando comparados aos indivíduos não expostos (p < 0,001). O mesmo ocorreu com trabalhadores expostos à poeira industrial (OR = 1,36) (p = 0,012). Não foi observada associação entre o desfecho e a variável exposição a substâncias químicas (p = 0,120). Observou-se associação entre dificuldade auditiva e exposição ocupacional a ruído e à poeira industrial em trabalhadores brasileiros. Reforçam-se a importância do aprimoramento de políticas públicas em saúde auditiva e o desenvolvimento de ações voltadas à prevenção e ao monitoramento auditivo em ambiente ocupacional.

This study's objective was to estimate the association between self-reported hearing impairment and occupational exposure to hazardous noise and ototoxic agents in Brazilian workers. This was a cross-sectional study with data from the Brazilian National Health Survey (PNS-2013). The dependent variable was self-reported hearing impairment, and three principal exposures were analyzed: noise, industrial dust, and chemical substances. Logistic regression was performed, estimating crude and adjusted odds ratios (OR) with 95% confidence intervals (95%CI). The principal exposure variables were adjusted for each other and by covariables sex, age, workplace, time on the job, and hypertension. 36,442 workers participated in the study. Higher prevalence of hearing impairment was seen in workers exposed to industrial dust (9.9%) (p < 0.001). The older the worker and the longer the time on the job, the higher the prevalence of hearing impairment (p < 0.001). In the adjusted analysis, workers exposed to noise showed 1.65 higher odds of reporting difficulty hearing, when compared to unexposed individuals (p < 0.001). The same was true for workers exposed to industrial dust (OR = 1.36) (p = 0.012). No association was observed between the outcome and exposure to chemical substances (p = 0.120). There was an association between hearing impairment and occupational exposure to noise and industrial dust in Brazilian workers. This emphasizes the importance of strengthening public policies for hearing health and the development of measures for prevention and auditory monitoring in the workplace.

El objetivo de este estudio fue estimar la asociación entre dificultad auditiva autoinformada y la exposición ocupacional a agentes otoagresores en trabajadores brasileños. Se trata de un estudio transversal, realizado con datos de la Encuesta Nacional de Salud (PNS-2013). La variable dependiente fue la dificultad auditiva autoinformada y se analizaron tres exposiciones principales: ruido, polvo industrial y substancias químicas. Se realizó un análisis de regresión logística, estimándose las odds ratio (OR) brutas y ajustadas, con intervalos de un 95% de confianza (IC95%). Las variables principales de exposición fueron ajustadas entre sí y por las covariables: sexo, edad, ambiente de trabajo, tiempo de trabajo e hipertensión arterial. Participaron en este estudio 36.442 trabajadores. La mayor prevalencia de dificultad auditiva se observó en individuos expuestos al polvo industrial (9,9%) (p < 0,001). Asimismo, cuanto mayor era la edad del trabajador y tiempo de trabajo, mayor fue la prevalencia del desenlace (p < 0,001). En el análisis ajustado, los trabajadores expuestos a ruido presentaron 1,65 veces más oportunidad de informar de dificultad auditiva, cuando se comparan con los individuos no expuestos (p < 0,001). Lo mismo sucedió con trabajadores expuestos a polvo industrial (OR = 1,36) (p = 0,012). No se observó una asociación entre el desenlace y la variable exposición a sustancias químicas (p = 0,120). Se observó una asociación entre dificultad auditiva y exposición ocupacional a ruido y polvo industrial en trabajadores brasileños. Se refuerza la importancia del perfeccionamiento de políticas públicas en salud auditiva y desarrollo de acciones dirigidas a la prevención y monitoreo auditivo en el entorno laboral.

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.

The maturation state of the auditory nerve and brainstem in rats exposed to lead acetate and supplemented with ferrous sulfate / Estado de maturação do nervo auditivo e tronco encefálico em ratos expostos a acetato de chumbo e suplementados com sulfato ferroso

Abstract Introduction The literature has reported the association between lead and auditory effects, based on clinical and experimental studies. However, there is no consensus regarding the effects of lead in the auditory system, or its correlation with the concentration of the metal in the blood. Objective To investigate the maturation state of the auditory system, specifically the auditory nerve and brainstem, in rats exposed to lead acetate and supplemented with ferrous sulfate. Methods 30 weanling male rats (Rattus norvegicus, Wistar) were distributed into six groups of five animals each and exposed to one of two concentrations of lead acetate (100 or 400 mg/L) and supplemented with ferrous sulfate (20 mg/kg). The maturation state of the auditory nerve and brainstem was analyzed using Brainstem Auditory Evoked Potential before and after lead exposure. The concentration of lead in blood and brainstem was analyzed using Inductively Coupled Plasma-Mass Spectrometry. Results We verified that the concentration of Pb in blood and in brainstem presented a high correlation (r = 0.951; p < 0.0001). Both concentrations of lead acetate affected the maturation state of the auditory system, being the maturation slower in the regions corresponding to portion of the auditory nerve (wave I) and cochlear nuclei (wave II). The ferrous sulfate supplementation reduced significantly the concentration of lead in blood and brainstem for the group exposed to the lowest concentration of lead (100 mg/L), but not for the group exposed to the higher concentration (400 mg/L). Conclusion This study indicate that the lead acetate can have deleterious effects on the maturation of the auditory nerve and brainstem (cochlear nucleus region), as detected by the Brainstem Auditory Evoked Potentials, and the ferrous sulphate can partially amend this effect.

Resumo Introdução A literatura relatou a associação entre o chumbo e os efeitos auditivos, com base em estudos clínicos e experimentais. No entanto, não há consenso em relação aos efeitos do chumbo no sistema auditivo, ou sua correlação com a concentração do metal no sangue. Objetivo Investigar o estado de maturação do sistema auditivo, especificamente do nervo auditivo e do tronco encefálico, em ratos expostos ao acetato de chumbo e suplementados com sulfato ferroso. Método 30 ratos machos desmamados (Rattus norvegicus, Wistar) foram distribuídos em seis grupos de cinco animais e expostos a uma de duas concentrações de acetato de chumbo (100 ou 400 mg/L) e suplementados com sulfato ferroso (20 mg/kg). O estado de maturação do nervo auditivo e do tronco encefálico foi analisado pelo Potencial Evocado Auditivo do Tronco Encefálico antes e após a exposição ao chumbo. A concentração de chumbo no sangue e tronco encefálico foi analisada utilizando-se Espectrometria de Massa com Plasma Indutivamente Acoplado. Resultados Verificamos que as concentrações de Pb no sangue e no tronco encefálico apresentaram alta correlação (r = 0,951, p < 0,0001). Ambas as concentrações de acetato de chumbo afetaram o estado de maturação do sistema auditivo, a maturação foi mais lenta nas regiões correspondentes à porção do nervo auditivo (onda I) e dos núcleos cocleares (onda II). A suplementação com sulfato ferroso reduziu significativamente a concentração de chumbo no sangue e no tronco encefálico no grupo exposto à menor concentração de chumbo (100 mg/L), mas não para o grupo exposto à maior concentração (400 mg/L). Conclusão Esse estudo indica que o acetato de chumbo pode ter efeitos deletérios na maturação do nervo auditivo e do tronco encefálico (região do núcleo coclear), como detectado pelos potenciais evocados auditivos do tronco encefálico, e que o sulfato ferroso pode diminuir parcialmente esse efeito.

The maturation state of the auditory nerve and brainstem in rats exposed to lead acetate and supplemented with ferrous sulfate.

INTRODUCTION: The literature has reported the association between lead and auditory effects, based on clinical and experimental studies. However, there is no consensus regarding the effects of lead in the auditory system, or its correlation with the concentration of the metal in the blood. OBJECTIVE: To investigate the maturation state of the auditory system, specifically the auditory nerve and brainstem, in rats exposed to lead acetate and supplemented with ferrous sulfate. METHODS: 30 weanling male rats (Rattus norvegicus, Wistar) were distributed into six groups of five animals each and exposed to one of two concentrations of lead acetate (100 or 400mg/L) and supplemented with ferrous sulfate (20mg/kg). The maturation state of the auditory nerve and brainstem was analyzed using Brainstem Auditory Evoked Potential before and after lead exposure. The concentration of lead in blood and brainstem was analyzed using Inductively Coupled Plasma-Mass Spectrometry. RESULTS: We verified that the concentration of Pb in blood and in brainstem presented a high correlation (r=0.951; p<0.0001). Both concentrations of lead acetate affected the maturation state of the auditory system, being the maturation slower in the regions corresponding to portion of the auditory nerve (wave I) and cochlear nuclei (wave II). The ferrous sulfate supplementation reduced significantly the concentration of lead in blood and brainstem for the group exposed to the lowest concentration of lead (100mg/L), but not for the group exposed to the higher concentration (400mg/L). CONCLUSION: This study indicate that the lead acetate can have deleterious effects on the maturation of the auditory nerve and brainstem (cochlear nucleus region), as detected by the Brainstem Auditory Evoked Potentials, and the ferrous sulphate can partially amend this effect.

Influence of iron on modulation of the antioxidant system in rat brains exposed to lead.

The objective of this study was to evaluate markers of oxidative stress in the brains of rats exposed to lead acetate (Pb(C2 H3 O2 )2 ), either associated or not associated with ferrous sulfate (FeSO4 ). A total of 36 weaning rats (Rattus norvegicus) were divided into 6 groups of six animals and exposed to lead acetate for six weeks. In the control group (control), the animals received deionized water. The Pb260 and Pb260 + Fe received 260 µM lead acetate, and the Pb1050 and Pb1050 + Fe received 1050 µM lead acetate. The Pb260 + Fe and Pb1050 + Fe were supplemented with 20 mg of ferrous sulfate/Kg body weight every 2 days. Group Fe received deionized water and ferrous sulfate. The rat brains were collected to analyze the enzymatic activity of catalase (CAT), superoxide dismutase (SOD), glutathione peroxidase (GPx), and the concentration of reduced glutathione (GSH), lipid peroxidation (TBARS), and total antioxidant substance (TAS) (DPPH• technique). The activity of SOD and GPx in the experimental groups decreased compared to the control, together with the concentration of GSH (p < 0.05). For CAT analysis, SOD tended to increase in concentration in the experimental groups without a concomitant exposure to FeSO4 , whereas GPx showed a slight tendency to increase in activity compared to the control. For TAS-DPPH• , there was a decrease in the experimental groups (p < 0.05). According to the results, SOD, GPx, and GSH were affected by lead acetate and exposure to ferrous sulfate changed this dynamic. However, further studies are needed to verify whether ferrous sulfate acts as a protectant against the toxic effects of lead. © 2016 Wiley Periodicals, Inc. Environ Toxicol 32: 813-822, 2017.

Caracterização do perfil auditivo de frentistas de postos de combustível / Characterization of hearing profile of gas station attendants

RESUMO Introdução Pesquisas voltadas para as populações com baixas exposições a solventes, ou exposições dentro dos níveis de tolerância permitidos em âmbito ocupacional ainda são restritas. Objetivo Caracterizar o perfil auditivo de frentistas de postos de combustíveis. Métodos Estudo transversal, constituído por dois grupos, pareados por gênero e idade: Grupo Controle - 23 indivíduos sem exposição a ruído ou agentes químicos; Grupo Experimental - 21 frentistas de postos de combustíveis. Foi realizada avaliação audiológica, composta por audiometria tonal liminar, logoaudiometria e medidas de imitância acústica. A análise estatística utilizou cálculo de média, desvio padrão, valor mínimo e máximo, teste Qui-quadrado e coeficiente de correlação de Pearson. O nível de significância adotado foi de 5%. Resultados Foram verificadas alterações auditivas nos frentistas, caracterizadas por comprometimento no sistema auditivo periférico, sugerindo ação tóxica da exposição a combustíveis. Houve correlação entre idade e tempo de exposição a solvente. Na comparação entre os grupos, o reflexo acústico demonstrou maior número de alterações no grupo experimental, com diferença para os reflexos acústicos ipsilaterais da orelha direita e contralaterais da orelha esquerda. Conclusão Não houve diferença entre os grupos para os limiares auditivos, porém, a diferença verificada nos reflexos acústicos ipsilaterais e contralaterais no grupo experimental sugere comprometimento retrococlear. Diante das evidências observadas neste estudo, considera-se relevante incluir a pesquisa do reflexo acústico na avaliação auditiva dos frentistas, bem como a integração desta categoria profissional aos programas de prevenção de perda auditiva.

ABSTRACT Introduction Researches into populations with low solvent exposures, or exposures within tolerance levels allowed in the occupational field are still restricted. Purpose To characterize the hearing profile of gas station attendants. Methods Cross-sectional study, constituted of two groups, matched by gender and age: Control Group - 23 subjects without exposure to noise or chemicals; Experimental Group - 21 gas station attendants. An audiological evaluation was performed, composed by pure tone audiometry, speech audiometry and acoustic impedance tests. The statistical analysis used average calculation, standard deviation, minimum and maximum value; Chi-square Test and Pearson’s correlation coefficient. The significance level was 5%. Results Hearing loss was verified in gas station attendants characterized by impairment of the peripheral auditory system, suggesting toxic effects of exposure to fuels. There was a correlation between age and solvent exposure time. Comparing the groups, the acoustic reflex showed more alterations in the experimental group, with a difference for the ipsilateral acoustic reflexes of the right ear and contralateral ones of the left ear. Conclusion There was no difference between the groups for the hearing thresholds; however, the difference observed in the ipsilateral and contralateral acoustic reflexes in the experimental group suggests retrocochlear impairment. Due to the evidence observed in this study, it is considered relevant to include the acoustic reflex research in the auditory evaluation of the gas station attendants, as well as the integration of this professional category into hearing loss prevention programs.

Training of Community Health Agents in health hearing children: current perspectives.

PURPOSE: To characterize the training of Community Health Workers in the field of child hearing health. RESEARCH STRATEGY: A systematic literature review on Biblioteca Virtual em Saúde (BVS) and Biblioteca Digital de Teses e Dissertações of USP databases was performed. SELECTION CRITERIA: The search strategy was oriented by the specific question: "How have the Community Health Workers been trained to work in the field of child hearing health?" The study selection criteria involved consistency with the proposed theme, belonging to the category of scientific papers, dissertation or thesis, and publication in Brazilian Portuguese. DATA ANALYSIS: A total of 2,687 studies were found. After analyzing the title and abstract, eight studies were chosen for full reading, however, only four of them met the proposed criteria and were included in the review. RESULTS: The studies indicated live and virtual classes with the use of video conferencing or CD-ROM as training strategies for Community Health Workers. Trainings were effective. Only one questionnaire about hearing and language monitoring was described. Different possibilities for the activities of Community Health Workers were identified. CONCLUSION: Different learning methodologies have been used for training the Community Health Worker in the field of child hearing health, and all of have proven effective for knowledge acquisition. Community Health Workers play an important role in promoting and monitoring child hearing health.

Capacitação do Agente Comunitário de Saúde na saúde auditiva infantil: perspectivas atuais / Training of Community Health Agents in health hearing children: current perspectives

RESUMO Objetivo: Caracterizar a capacitação dos Agentes Comunitários de Saúde (ACS) na área da saúde auditiva infantil. Estratégia de pesquisa Foi realizada uma revisão sistemática da literatura no Portal de Pesquisa da Biblioteca Virtual em Saúde (BVS) e na Biblioteca Digital de Teses e Dissertações da USP. Critérios de seleção: A estratégia de busca foi direcionada por uma questão específica "Como tem sido realizada a capacitação do Agente Comunitário de Saúde na área de saúde auditiva infantil?". Os critérios de seleção dos estudos envolveram a coerência com o tema proposto, pertencer à categoria artigo, dissertação ou tese e ser publicado na língua portuguesa. Análise dos dados: Foram localizados 2.687 estudos. Após análise do título e resumo, 8 estudos foram selecionados para leitura completa. Destes, apenas 4 atenderam aos critérios propostos e foram incluídos na revisão. Resultados: Os estudos apontaram como estratégias de capacitação dos ACS a aula presencial e as aulas a distância com o uso de videoconferência ou de CD-ROM. As capacitações foram consideradas efetivas. Foi apontado apenas um questionário de monitoramento sobre a audição e linguagem. Distintas possibilidades de atuação dos ACS foram identificadas. Conclusão: Atualmente, diferentes modalidades de ensino têm sido utilizadas para a capacitação do ACS na área de saúde auditiva infantil, todas se mostrando efetivas quanto à retenção do conhecimento. O ACS desempenha um papel importante na promoção e vigilância da saúde auditiva infantil.

ABSTRACT Purpose To characterize the training of Community Health Workers in the field of child hearing health. Research strategy A systematic literature review on Biblioteca Virtual em Saúde (BVS) and Biblioteca Digital de Teses e Dissertações of USP databases was performed. Selection criteria The search strategy was oriented by the specific question: "How have the Community Health Workers been trained to work in the field of child hearing health?" The study selection criteria involved consistency with the proposed theme, belonging to the category of scientific papers, dissertation or thesis, and publication in Brazilian Portuguese. Data analysis : A total of 2,687 studies were found. After analyzing the title and abstract, eight studies were chosen for full reading, however, only four of them met the proposed criteria and were included in the review. Results The studies indicated live and virtual classes with the use of video conferencing or CD-ROM as training strategies for Community Health Workers. Trainings were effective. Only one questionnaire about hearing and language monitoring was described. Different possibilities for the activities of Community Health Workers were identified. Conclusion Different learning methodologies have been used for training the Community Health Worker in the field of child hearing health, and all of have proven effective for knowledge acquisition. Community Health Workers play an important role in promoting and monitoring child hearing health.

Perfil audiológico de motoristas agrícolas expostos: ruído e hidrocarbonetos / Audiological profile of agricultural drivers exposed to noise and hydrocarbons

RESUMO Objetivo: Estabelecer o perfil audiológico de motoristas agrícolas expostos, simultaneamente, a ruído e hidrocarbonetos. Métodos: Foram analisados os prontuários de motoristas com queixas auditivas de uma empresa do ramo agrícola do município de Lençóis Paulista (SP), dentro do Programa de Prevenção de Riscos Ambientais (PPRA). As informações analisadas foram: idade, tempo de exposição combinada a ruído e hidrocarbonetos e exames de audiometria tonal liminar de referência. Para a análise da influência da idade e do tempo de exposição sobre os limiares auditivos, ajustaram-se modelos de sobrevivência para dados grupados (riscos proporcionais e logísticos). Resultados: Verificou-se que os efeitos da idade e do tempo de exposição combinada a ruído e hidrocarbonetos foram significativos na perda de audição, nos modelos de riscos proporcionais e logísticos. Conclusão: É fundamental o desenvolvimento de ações voltadas para a prevenção de perdas auditivas em motoristas agrícolas expostos aos agentes ruído e hidrocarbonetos.

ABSTRACT Purpose: To establish the audiological profile of agricultural drivers simultaneously exposed to noise and hydrocarbons. Methods: The study comprised analysis of the medical records of agricultural drivers with hearing complaints, from an agricultural company of Lençóis Paulista (SP), Brazil, within the Environmental Risk Prevention Program. The information analyzed included age, period of simultaneous exposure to noise and hydrocarbons and testing of reference pure tone audiometry. Survival models for grouped data (proportional risk and logistic) were adjusted to analyze the influence of age and period of exposure of hearing thresholds. Results: It was observed that the effects of age and period of simultaneous exposure to noise and hydrocarbons were significant for hearing loss in proportional risk and logistic models. Conclusion: It is fundamental to develop actions for the prevention of hearing loss in agricultural drivers exposed to the agents noise and hydrocarbons.

Acoustic reflex on newborns: the influence of the 226 and 1,000 Hz probes.

PURPOSE: To analyze the occurrence of acoustic reflex and its threshold on newborns using the 226 and 1,000 Hz probes. METHODS: Thirty-six newborns with "PASS" results in newborn hearing screening and tympanogram with one or two peaks for both probe tones were included. Group I comprised 20 full-term newborns without risk indicator for hearing loss, and Group II comprised 16 newborns with at least one risk indicator. The study about ipsilateral acoustic reflex thresholds was conducted in 500, 1,000, 2,000, and 4,000 Hz. RESULTS: The groups presented the acoustic reflex thresholds between 50 and 100 dB for both probe tones. In the comparison between the probes, there were differences in all frequencies evaluated in Group I, with the lowest threshold mean for the 1,000 Hz probe. In Group II, differences were detected at 2,000 Hz. The mean acoustic reflex thresholds were similar in both groups for the 226 Hz probe. There was a difference for the 1,000 Hz probe in all tested frequencies. The percentage of response was higher in both groups for the 1,000 Hz probe. The kappa test showed extremely poor agreement in the comparison of results between both probes. CONCLUSION: The occurrence of acoustic reflex was higher in newborns and its thresholds were lower with the 1,000 Hz probe both for healthy newborns and for newborns at risk.

Acoustic reflex on newborns: the influence of the 226 and 1,000 Hz probes / A influência da sonda de 226 e 1.000 Hz no registro do reflexo acústico em neonatos

PURPOSE: To analyze the occurrence of acoustic reflex and its threshold on newborns using the 226 and 1,000 Hz probes. METHODS: Thirty-six newborns with "PASS" results in newborn hearing screening and tympanogram with one or two peaks for both probe tones were included. Group I comprised 20 full-term newborns without risk indicator for hearing loss, and Group II comprised 16 newborns with at least one risk indicator. The study about ipsilateral acoustic reflex thresholds was conducted in 500, 1,000, 2,000, and 4,000 Hz. RESULTS: The groups presented the acoustic reflex thresholds between 50 and 100 dB for both probe tones. In the comparison between the probes, there were differences in all frequencies evaluated in Group I, with the lowest threshold mean for the 1,000 Hz probe. In Group II, differences were detected at 2,000 Hz. The mean acoustic reflex thresholds were similar in both groups for the 226 Hz probe. There was a difference for the 1,000 Hz probe in all tested frequencies. The percentage of response was higher in both groups for the 1,000 Hz probe. The kappa test showed extremely poor agreement in the comparison of results between both probes. CONCLUSION: The occurrence of acoustic reflex was higher in newborns and its thresholds were lower with the 1,000 Hz probe both for healthy newborns and for newborns at risk. .

OBJETIVO: Verificar a ocorrência e o limiar do reflexo acústico em neonatos utilizando a sonda de 226 e 1.000 Hz. MÉTODOS: Trinta e seis neonatos com resultado "PASS" na triagem auditiva neonatal e timpanogramas com um ou dois picos para os dois tons de sonda. O Grupo I foi composto por 20 neonatos a termo sem indicador de risco para deficiência auditiva e o Grupo II, por 16 neonatos com pelo menos um indicador de risco. A pesquisa dos limiares do reflexo acústico ipsilateral foi realizada em 500, 1.000, 2.000 e 4.000 Hz. RESULTADOS: Os grupos apresentaram limiar do reflexo acústico entre 50 e 100 dB para ambos os tons de sonda. Na comparação entre as sondas, houve diferença em todas as frequências avaliadas no Grupo I, com a média de limiares menor com a sonda de 1.000 Hz. No Grupo II, foi detectada diferença em 2.000 Hz. Com a sonda de 226 Hz, os limiares médios do reflexo acústico foram semelhantes nos dois grupos. Com a sonda de 1.000 Hz, houve diferença em todas as frequências avaliadas. A porcentagem de presença de resposta foi maior para ambos os grupos para a sonda de 1.000 Hz. O teste kappa revelou concordância extremamente pobre na comparação dos resultados entre as duas sondas. CONCLUSÃO: A ocorrência de reflexo acústico em neonatos foi maior e os limiares menores com a utilização da sonda de 1.000 Hz, tanto para neonatos saudáveis como para os neonatos de risco. .