Study of aged central auditory function using the auditory middle latency response.

OBJECTIVE: Investigate the auditory function of the elderly using the middle latency potentials. METHODOLOGY: Group 1 (G1): 20 healthy individuals of both genders, older than 60 years, without hearing loss. Group 2 (G2): 20 healthy individuals of both sexes, older than 60 years, with hearing loss in frequencies from 4 to 8 kHz. Potential recording was performed with unilateral and bilateral stimulation and the Binaural Interaction Component was calculated. RESULTS: Na latency in C3A1 was greater in the stimulation of the right ear in G2 and the amplitude of Na-Pa was greater in the stimulation of the right ear and recording in C3A1 in G1. The latency of the Pa component was higher in the stimulation of the right ear recorded in C4A2. The Pb component in G2 by bilateral stimulation and recorded in C4A2 had higher latency. The first and second negative and positive peaks presented greater amplitude in G1. In C3A1, the 1st negative peak was more negative in G1 and the 2nd positive peak showed greater amplitude in C4A2 in both groups. CONCLUSION: The transmission of auditory information to the primary auditory cortex is impaired with aging, especially in unilateral stimulation, reinforced by losses in elderly people with peripheral hearing loss, such as in the binaural interaction at the cortical and subcortical levels. Thus, the AMLR has shown to be a sensitive examination to investigate neuroauditory disorders in the elderly, especially related to high-frequency hearing loss and primary auditory cortex dysfunctions caused by the aging process.

The Effect of Different Stimulation Rates on Brainstem Auditory-Evoked-Potential Responses.

Introduction Auditory-evoked potentials are influenced by several factors, including polarity, filter, stimulus intensity and stimulation rate. The presentation of higher rates of stimuli per second enables the collection of a greater number of responses in a given period of time, promoting a shorter testing time; however, the collected recordings are subject to changes related to wave morphology. Objectives To compare the brainstem auditory-evoked-potential responses with click stimulus with the most commonly used stimulation rates in the clinical practice. Methods The present cross-sectional analytical study was performed with fifteen participants of both genders and normal hearing thresholds. The brainstem auditory-evoked potential was performed at four different stimulation rates (21.1, 26.7, and 27.7 stimuli/s, and a rate determined based on a mathematical calculation using the a measurement of the transmission frequency of the power grid at the time of the examination). Results We observed that the rate of 21.1 stimuli/s showed the highest amplitudes for waves I, III, and V when compared with the other rates. The rate of 26.7 stimuli/s, when compared with 27.7 stimuli/s, showed a higher amplitude for wave V. The latency if wave V was significantly lower with the rate of 21.1 stimuli/s than with 27.7 stimuli/s. Conclusions The stimulation rate interferes with wave latencies and amplitudes; its decrease from 27.7 to 21.1 stimuli/s decreases the latency of wave V and increases the amplitues and improves the morphology of waves I, III and V. In addition, we found evidence that suggests an improvement in the visualization of wave III by adjusting the stimulation rate based on a measurement of the local transmission frequency of the power grid.

Frailty syndrome and risks for falling in the elderly community. / Síndrome da fragilidade e riscos para quedas em idosos da comunidade.

PURPOSE: To identify the prevalence of Frailty Syndrome in the elderly and the relationship with risk of falling. METHODS: Descriptive, cross-sectional, and analytical clinical study. One hundred and one volunteers over 60 years old were submitted to audiological evaluation, Dynamic Gait Index - Brazilian brief (DGI), Timed Up and Go (TUG) and Edmonton Fragility Scale (EFE) that verified, respectively, hearing thresholds, frailty syndrome, functional and dynamic balance, and risk of falling. The simple percentual distribution, the Wilcoxon´s test and the Bivariate Correlation with Pearson's coefficient were used for statistical analysis. Limits equal to or less than 1.0 and 5.0% were adopted. RESULTS: EFE identified 22.8% of volunteers as fragile and 22.8% as vulnerable. DGI and TUG found 34.6% and 84.1% of at risk for falls, respectively. Significant correlations between EFE and DGI (p <0.01), EFE and TUG (p <0.01), and DGI and TUG (p <0.01) were observed. Pearson's coefficient between EFE and DGI, EFE and TUG, and DGI and TUG were -0.26, -0.41, and 0.46, respectively. An association between DGI and TUG and age (p <0.01) was identified. No correlation between EFE and sex or age was found. CONCLUSION: Frailty and pre-frailty were identified in a significant segment of the volunteers, especially in the oldest subjects. Functional and dynamic balance were moderately correlated with frailty, which demonstrated that frailty syndrome increases the risk of falls.

OBJETIVO: Identificar a prevalência da Síndrome da Fragilidade em idosos e suas relações com o risco para quedas. MÉTODO: Estudo clínico descritivo, transversal e analítico. Cento e um voluntários com mais de 60 anos, foram submetidos à avaliação audiológica, Dynamic Gait Index ­ Brazilian brief (DGI), Timed Up and Go(TUG) e Escala de Fragilidade de Edmonton (EFE) que determinaram, respectivamente, os limiares auditivos, síndrome da fragilidade, equilíbrio funcional e dinâmico e risco para quedas. Utilizou-se a distribuição percentual simples, o teste de Wilcoxon e de Correlação Bivariada com coeficiente de Pearson para a análise estatística. Foram adotados limites iguais inferiores a 1,0 e 5,0%. RESULTADOS: A EFE identificou 22,8% dos voluntários como frágeis e 22,8% como vulneráveis. O DGI e o TUG classificaram 34,6 e 84,1% de riscos para quedas. Ocorreu correlação significativa entre a EFE e o DGI (p<0,01), a EFE e o TUG (p<0,01) e o DGI e TUG (p<0,01). O coeficiente de Pearson entre EFE e o DGI, entre o EFE e o TUG e DGI e TUG foram -0,26, -0,41 e 0,46 respectivamente. Ocorreu associação entre DGI e TUG e idade (p<0,01). Não houve correlação entre a EFE com sexo e idade. CONCLUSÃO: A fragilidade e pré-fragilidade foi identificada em uma parcela expressiva dos voluntários, sobretudo nos mais longevos. O equilíbrio funcional e o dinâmico se correlacionaram moderamente com fragilidade, o que demonstrou que a Síndrome da fragilidade aumenta o risco para quedas.

Masking release in cortical auditory evoked potentials with speech stimulus. / O benefício do mascaramento modulado nos potenciais evocados auditivos corticais com estímulo de fala.

PURPOSE: To analyze the effect of masking on the Cortical Auditory Evoked Potential with speech stimulus in young adults. METHODS: Fourteen individuals aged between 19 and 28 years of both sexes with no hearing loss participated in the study. The Cortical Auditory Evoked Potential examination was performed with synthetic speech stimulus /ba/ simultaneous to Speech Shaped Noise presented under three conditions: steady noise with a 30 dB SPLep intensity (weak steady noise), steady noise with a 65 dB SPLep intensity o (strong steady noise) and modulated noise with 30 dB SPLep and 65 dB SPLep intensities at 25Hz and modulation period of 40 ms. RESULTS: Higher latencies were observed in the cortical components, except P2, in the condition of strong steady noise and more meaningful measures of amplitude of the cortical components P1, N1 and P2 in the condition of modulated noise with statistically significant difference in comparison to the strong steady noise condition. There was worse wave morphology in the condition of strong steady noise, when compared to the other records. The average electrophysiological thresholds for the conditions of strong steady noise and modulated noise were 60 dB SPLep and 49 dB SPLep, respectively, showing a 11.7 dB mean difference. CONCLUSION: We could infer that there was a lower masking effect of modulated noise when compared to the strong steady noise condition, in the amplitude measurements of the cortical components and an average difference of 11.7 dB between the electrophysiological thresholds (interpreted as the measure of the Masking Release).

OBJETIVO: analisar o efeito do mascaramento estável e modulado no Potencial Evocado Auditivo Cortical com estímulo de fala em adultos-jovens. MÉTODO: participaram 14 indivíduos com idades entre 19 e 28 anos de ambos os sexos e sem perda auditiva. O exame de Potencial Evocado Auditivo Cortical foi realizado com estímulo de fala sintética /ba/ simultâneo ao ruído Speech Shaped Noise apresentado em três condições: ruído estável com intensidade de 30 dB NPSpe (ruído estável fraco), ruído estável com intensidade de 65 dB NPSpe (ruído estável forte) e ruído modulado em intensidade de 30 dB NPSpe e 65 dB NPSpe em 25Hz e com período de modulação de 40 ms. RESULTADOS: foram observadas maiores latências nos componentes corticais, exceto P2, na condição de ruído estável forte e medidas mais robustas de amplitude dos componentes corticais P1, N1 e P2 na condição de ruído modulado com diferença estatística significativa na comparação com a condição de ruído estável forte. Houve pior morfologia na condição de ruído estável forte, quando comparado aos demais registros. Os limiares eletrofisiológicos médios para as condições de ruído estável forte e ruído modulado foram 60 dB NPSpe e 49 dB NPSpe, respectivamente, mostrando 11,7 dB de diferença média. CONCLUSÃO: podemos inferir que houve um menor efeito mascarante do ruído modulado, comparado à condição de ruído estável forte, nas medidas de amplitude dos componentes corticais e uma diferença média de 11,7 dB entre os limiares eletrofisiológicos (interpretado como a medida do Benefício do Mascaramento Modulado).

The importance of acoustic reflex for communication.

PURPOSE: The purpose of the study was to compare the speech recognition capacity between listeners with and without acoustic reflex using different types of noises and intensities. MATERIALS AND METHODS: We studied 18 women allocated to 2 groups: acoustic reflex present (20 ears) and absent (16 ears). They were presented with 180 disyllable words (90 to each ear), emitted randomly at a fixed intensity of 40 dB above the pure tone average hearing level. At the same time, 3 types of noises were presented ipsilaterally (white, pink, and speech), one at a time, at 3 intensities: 40, 50, and 60 dB above the pure tone average hearing level. RESULTS: The ages and auditory thresholds were statistically equal between the groups. There was a significant difference in mean number of hits between the 2 groups for the 3 types of noises used. There was also a significant difference in mean number of hits for noise type and intensity when white and pink noise was used at 40 and 50 dB and for all the intensities when speech was used. CONCLUSION: Acoustic reflex helps communication in high-noise environments and is more efficient for speech sounds.

Cognitive performance and long-latency auditory evoked potentials: a study on aging.

OBJECTIVE: To evaluate the relationship between cognitive performance and long-latency auditory evoked potentials in an elderly population. METHODS: The sample consisted of adults between 20 and 58 years of age and elderly adults between 60 and 70 years of age. The screening procedures adopted were an inspection of the external auditory canal, tonal and vocal audiometry, tympanometry, brain stem auditory evoked potential, the Montreal Cognitive Assessment test, and long-latency auditory evoked potential. RESULTS: The latency and amplitude values of cortical components by age group showed significant differences under the following conditions: (i) signals evoked by the speech stimulus /da/ and by the pure-tone stimulus at 2,000 Hz for the N2 amplitude (p=0.008 and p=0.001, respectively) , which were both higher for adults, and (ii) signals evoked by the speech stimulus /da/ for N1 latency (p=0.018) and by the pure-tone stimulus at 2,000 Hz for P2 latency (p=0.017), which were both higher in the elderly population. The cognitive component (P300) showed a significant difference when evoked by speech stimuli, with higher latency in the elderly population (p=0.013). When correlated with cognitive processes, the latency and amplitude of cortical potentials showed direct and medium-strength correlations between abnormal scores obtained on the Montreal Cognitive Assessment test and P2 amplitude (p<0.001 and r=0.452). CONCLUSION: There is a relationship between long-latency potentials and cognitive performance in the elderly, which was observed by the increase in the P2 amplitude and the impairment of the process of sound decoding.

Vestibular evoked myogenic potentials (VEMP) captured in the forearm flexor muscles: a study of its feasibility and reference ranges.

OBJECTIVE: To determine the central tendency measures and variability of vestibular evoked myogenic potential (VEMP) with regard to the latency and wave amplitude when potentials are captured from the flexor muscles of the forearm. METHODS: Ten adult volunteers with normal hearing underwent examination of their forearm flexor muscles (right and left sides; 20 samples in total) for VEMP acquisition. To this end, 200 tone burst stimuli at a 500 Hz frequency and 95 dBnHL intensity were promediated. RESULTS: No statistical differences were observed in VEMP responses acquired from the right and left forearm flexor muscles concerning P34 and N44 latencies (p=0.32 and 0.90, respectively). The mean latency obtained for the P34 wave component was 34.9 ms (±2.6), with a lower limit equal to 29.3 and an upper limit equal to 40.4 ms. The average latency of the N44 wave component was 43.6 ms (±2.1), with a lower limit of 39.1 ms and an upper limit of 48.1 ms. The results were consistent and had low variability, and showed an average asymmetry index of 15.4 (±10.7). These findings indicate that potentials may be investigated in different age groups and in specific clinical populations, such as pathologies that may alter the neuronal transmission of the inferior vestibular pathway, especially when a longer portion is observed. CONCLUSIONS: VEMP recording from forearm flexors is both feasible and stable, with latency reference ranges between 29.3 and 40.4 ms for P34, and 39.1 and 48.1 ms for N44.

Effect of Forward Masking on Frequency Following Response as a Function of Age.

BACKGROUND: Forward masking occurs when noise is presented before the target signal, making the latter difficult to be perceived. It is related to temporal auditory processing and consequently to speech recognition in noisy environments, which may decline with age. Interest in forward masking has grown in the last years. Studies investigate psychoacoustic and electrophysiological recordings in different age- groups. PURPOSE: The purpose of the study was to investigate the effect of forward masking on frequency following response (FFR) as a function of age. RESEARCH DESIGN: Cross-sectional analytical observational study. STUDY SAMPLE: We assessed 69 normal-hearing participants of both genders assigned to three groups: 40 young individuals (aged 18-25 years, mean age = 22 years 8 months), 21 middle-age individuals (aged 25-55 years, mean age = 37 years 2 months), and 8 seniors (aged <55 years, mean age = 65 years 3 months). INTERVENTION: FFRs were recorded using the /da/ syllable with and without noise. DATA COLLECTION AND ANALYSIS: The /da/ syllable and speech-shaped noise were monaurally presented to the participants' right ears through ER-3a insert earphones. Electrodes were placed in M1 and M2 (-), Fz (+), and Fpz (ground). Acquisition occurred under two conditions: (1) the/da/ syllable presented without the noise and (2) the /da/ syllable presented 4 msec after the noise. RESULTS: Data show that (1) considering the mean values of all participants, there was a significant latency delay of all waves (PV, A, PW, PX, PY, PZ, and O) when the /da/ syllable was presented 4 msec after the masking noise as compared with the condition without noise, that is, forward masking occurred in all components of the FFR responses, and (2) for the youngest group and the middle-age group, forward masking was seen for all waves, except PX in the latter one; for the senior group, an irregular pattern was observed (presence of forward masking in PA, PY, PZ, and O). This pattern may be due to an aging effect on FFR responses even without noise presence, which makes it more difficult to identify forward masking effect in this population. Although it is well documented in the literature that forward masking increases with age, this is less evident on FFR recordings in the senior population. CONCLUSIONS: An aging effect was identified in FFR responses. Forward masking was identified in FFR responses of all groups but less evident in senior population.

Influence of speech-language therapy on P300 outcome in patients with language disorders: a meta-analysis.

INTRODUCTION: The patient's evolution in the audiology and speech-language clinic acts as a motivator of the therapeutic process, contributing to patient adherence to the treatment and allowing the therapist to review and/or maintain their clinical therapeutic conducts. Electrophysiological measures, such as the P300 evoked potential, help in the evaluation, understanding and monitoring of human communication disorders, thus facilitating the prognosis definition in each case. OBJECTIVE: To determine whether the audiology and speech-language therapy influences the variation of P300 latency and amplitude in patients with speech disorders undergoing speech therapy. METHODS: This is a systematic review with meta-analysis, in which the following databases were searched: Pubmed, ScienceDirect, SCOPUS, Web of Science, SciELO and LILACS, in addition to the gray literature bases: OpenGrey.eu and DissOnline. The inclusion criteria were randomized or non-randomized clinical trials, without language or date restriction, which evaluated children with language disorders undergoing speech therapy, monitored by P300, compared to children without intervention. RESULTS: The mean difference between the latencies in the group submitted to therapy and the control group was -20.12ms with a 95% confidence interval of -43.98 to 3.74ms (p=0.08, I2=25% and p value=0.26). The mean difference between the amplitudes of the group submitted to therapy and the control group was 0.73uV with a 95% confidence interval of -1.77 to 3.23uV (p=0.57, I2=0% and p value=0.47). CONCLUSION: The present meta-analysis demonstrates that speech therapy does not influence the latency and amplitude results of the P300 evoked potential in children undergoing speech therapy intervention.

Effect of caffeine on vestibular evoked myogenic potential: a systematic review with meta-analysis.

INTRODUCTION: Caffeine can be considered the most consumed drug by adults worldwide, and can be found in several foods, such as chocolate, coffee, tea, soda and others. Overall, caffeine in moderate doses, results in increased physical and intellectual productivity, increases the capacity of concentration and reduces the time of reaction to sensory stimuli. On the other hand, high doses can cause noticeable signs of mental confusion and error induction in intellectual tasks, anxiety, restlessness, muscle tremors, tachycardia, labyrinthine changes, and tinnitus. OBJECTIVE: Considering that the vestibular evoked myogenic potential is a clinical test that evaluates the muscular response of high intensity auditory stimulation, the present systematic review aimed to analyze the effects of caffeine on vestibular evoked myogenic potential. METHODS: This study consisted of the search of the following databases: MEDLINE, CENTRAL, ScienceDirect, Scopus, Web of Science, LILACS, SciELO and ClinicalTrials.gov. Additionally, the gray literature was also searched. The search strategy included terms related to intervention (caffeine or coffee consumption) and the primary outcome (vestibular evoked myogenic potential). RESULTS: Based on the 253 potentially relevant articles identified through the database search, only two full-text publications were retrieved for further evaluation, which were maintained for qualitative analysis. CONCLUSION: Analyzing the articles found, caffeine has no effect on vestibular evoked myogenic potential in normal individuals.

Effect of antioxidant supplementation on the auditory threshold in sensorineural hearing loss: a meta-analysis.

INTRODUCTION: Hearing loss is conceptualized as any impairment of the ability to hear and/or detect speech or environment sounds, regardless of cause, type, or degree. It may occur at different stages of life; during pregnancy or childbirth, in childhood, adulthood or old age. It should be noted that aging is the most common cause of sensorineural hearing loss followed by noise-induced hearing loss, and both are closely related to the formation of reactive oxygen species. Dietary antioxidant supplementation has been employed as a therapeutic strategy to prevent and/or delay the risks of major human diseases. OBJECTIVE: To assess randomized clinical trials to determine the effect of antioxidant supplementation on the auditory thresholds in patients of different age groups with sensorineural hearing loss. METHODS: This systematic review consisted of a search in the following databases: MEDLINE, CENTRAL, ScienceDirect, Scopus, Web of Science, LILACS, SciELO and ClinicalTrials.gov. Additionally, the gray literature was also searched. The search strategy included terms related to the intervention (antioxidant supplementation), primary outcome (sensorineural hearing loss), as well as terms related to randomized clinical trials to improve search sensitivity. RESULTS: Based on 977 potentially relevant records identified through the search in the databases, ten full-text publications were retrieved for further evaluation. The increase in threshold at the 4kHz frequency was statistically higher in the control group (1.89 [1.01-2.78], p<0.0001) when compared to the NAC group and the ginseng group, whereas at 6kHz, the threshold increase was higher in the control group (1.42 [-1.14-3.97], p=0.28), but no statistically significant differences were found between groups. CONCLUSION: Ginseng was the antioxidant agent that showed the best effect in preventing auditory threshold worsening at the frequency of 4kHz, but not at 6kHz in patients with sensorineural hearing loss caused by exposure to high sound pressure levels. There was no improvement in the thresholds with vitamin E supplementation.

The Value of Electrically Evoked Stapedius Reflex in Determining the Maximum Comfort Level of a Cochlear Implant.

BACKGROUND: One of the most important steps for good user performance with a cochlear implant (CI) is activation and programming, aimed at determining the dynamic range. In adults, current levels are determined by psychophysical measures. In babies, small children, or individuals with multiple disorders, this procedure requires techniques that may provide inconsistent responses because of auditory inexperience or the age of the child, making it a very difficult process that demands the collaboration of both the patient and the family. PURPOSE: To study the relationship between the electrically evoked stapedius reflex threshold (ESRT) and maximum comfort level for stimulating electrodes (C-level) in postoperative CI users. RESEARCH DESIGN: Cross-sectional analytical observational case series study. STUDY SAMPLE: We assessed 24 patients of both sexes, aged between 18 and 68 yr, submitted to CI surgery. INTERVENTION: Otoscopy and immittance. Next, an implant speech processor connected to an Itautec® computer containing the manufacturer's software (custom sound Ep 3-2) was used, as well as an AT 235h probe inserted into the ear contralateral to the CI to capture the stapedius reflex, obtaining electrically evoked stapedius reflex thresholds. DATA COLLECTION AND ANALYSIS: Data from the last programming, defining C-levels for each electrode studied, were extracted from the databank of each patient. The manual decay function of the AT 235h middle ear analyzer was used to observe ESRT response in a same window for a longer response capture time. Electrodes 22, 16, 11, 6, and 1 were tested when active, with the aim of using electrodes over the entire length of the CI, and ESRT was considered present when compliance was ≥0.05 ml. Stimuli, in current units, were always initiated at 20 cu above the C-level. The analysis of variance parametric test, Tukey's honest significant difference test, the t-test, Wilcoxon nonparametric test, and the Kolmogorov-Smirnov test examined whether significant relationships existed between these other factors. RESULTS: The results demonstrate that all the electrodes selected for the study exhibited higher mean reflex threshold values than their mean C-level counterparts. However, there was no significant difference between them, for electrodes 1, 6, 11, and 16. The data provided allow the use of ESRT to define C-level values and make it possible to stipulate a correction factor ranging between 6 and 25.6 electrical units. CONCLUSION: The use of electrically evoked stapedius reflex thresholds can help the team in charge of programming CIs, making the process faster and safer, mainly for infants, small children, or individuals with multiple disorders.

O benefício do mascaramento modulado nos potenciais evocados auditivos corticais com estímulo de fala / Masking release in cortical auditory evoked potentials with speech stimulus

RESUMO Objetivo analisar o efeito do mascaramento estável e modulado no Potencial Evocado Auditivo Cortical com estímulo de fala em adultos-jovens. Método participaram 14 indivíduos com idades entre 19 e 28 anos de ambos os sexos e sem perda auditiva. O exame de Potencial Evocado Auditivo Cortical foi realizado com estímulo de fala sintética /ba/ simultâneo ao ruído Speech Shaped Noise apresentado em três condições: ruído estável com intensidade de 30 dB NPSpe (ruído estável fraco), ruído estável com intensidade de 65 dB NPSpe (ruído estável forte) e ruído modulado em intensidade de 30 dB NPSpe e 65 dB NPSpe em 25Hz e com período de modulação de 40 ms. Resultados foram observadas maiores latências nos componentes corticais, exceto P2, na condição de ruído estável forte e medidas mais robustas de amplitude dos componentes corticais P1, N1 e P2 na condição de ruído modulado com diferença estatística significativa na comparação com a condição de ruído estável forte. Houve pior morfologia na condição de ruído estável forte, quando comparado aos demais registros. Os limiares eletrofisiológicos médios para as condições de ruído estável forte e ruído modulado foram 60 dB NPSpe e 49 dB NPSpe, respectivamente, mostrando 11,7 dB de diferença média. Conclusão podemos inferir que houve um menor efeito mascarante do ruído modulado, comparado à condição de ruído estável forte, nas medidas de amplitude dos componentes corticais e uma diferença média de 11,7 dB entre os limiares eletrofisiológicos (interpretado como a medida do Benefício do Mascaramento Modulado).

ABSTRACT Purpose To analyze the effect of masking on the Cortical Auditory Evoked Potential with speech stimulus in young adults. Methods Fourteen individuals aged between 19 and 28 years of both sexes with no hearing loss participated in the study. The Cortical Auditory Evoked Potential examination was performed with synthetic speech stimulus /ba/ simultaneous to Speech Shaped Noise presented under three conditions: steady noise with a 30 dB SPLep intensity (weak steady noise), steady noise with a 65 dB SPLep intensity o (strong steady noise) and modulated noise with 30 dB SPLep and 65 dB SPLep intensities at 25Hz and modulation period of 40 ms. Results Higher latencies were observed in the cortical components, except P2, in the condition of strong steady noise and more meaningful measures of amplitude of the cortical components P1, N1 and P2 in the condition of modulated noise with statistically significant difference in comparison to the strong steady noise condition. There was worse wave morphology in the condition of strong steady noise, when compared to the other records. The average electrophysiological thresholds for the conditions of strong steady noise and modulated noise were 60 dB SPLep and 49 dB SPLep, respectively, showing a 11.7 dB mean difference. Conclusion We could infer that there was a lower masking effect of modulated noise when compared to the strong steady noise condition, in the amplitude measurements of the cortical components and an average difference of 11.7 dB between the electrophysiological thresholds (interpreted as the measure of the Masking Release).

Study of aged central auditory function using the auditory middle latency response

Abstract Objective Investigate the auditory function of the elderly using the middle latency potentials. Methodology Group 1 (G1): 20 healthy individuals of both genders, older than 60 years, without hearing loss. Group 2 (G2): 20 healthy individuals of both sexes, older than 60 years, with hearing loss in frequencies from 4 to 8 kHz. Potential recording was performed with unilateral and bilateral stimulation and the Binaural Interaction Component was calculated. Results Na latency in C3A1 was greater in the stimulation of the right ear in G2 and the amplitude of Na-Pa was greater in the stimulation of the right ear and recording in C3A1 in G1. The latency of the Pa component was higher in the stimulation of the right ear recorded in C4A2. The Pb component in G2 by bilateral stimulation and recorded in C4A2 had higher latency. The first and second negative and positive peaks presented greater amplitude in G1. In C3A1, the 1st negative peak was more negative in G1 and the 2nd positive peak showed greater amplitude in C4A2 in both groups. Conclusion The transmission of auditory information to the primary auditory cortex is impaired with aging, especially in unilateral stimulation, reinforced by losses in elderly people with peripheral hearing loss, such as in the binaural interaction at the cortical and subcortical levels. Thus, the AMLR has shown to be a sensitive examination to investigate neuroauditory disorders in the elderly, especially related to high-frequency hearing loss and primary auditory cortex dysfunctions caused by the aging process.

The Effect of Different Stimulation Rates on Brainstem Auditory-Evoked-Potential Responses

Abstract Introduction Auditory-evoked potentials are influenced by several factors, including polarity, filter, stimulus intensity and stimulation rate. The presentation of higher rates of stimuli per second enables the collection of a greater number of responses in a given period of time, promoting a shorter testing time; however, the collected recordings are subject to changes related to wave morphology. Objectives To compare the brainstem auditory-evoked-potential responses with click stimulus with the most commonly used stimulation rates in the clinical practice. Methods The present cross-sectional analytical study was performed with fifteen participants of both genders and normal hearing thresholds. The brainstem auditoryevoked potential was performed at four different stimulation rates (21.1, 26.7, and 27.7 stimuli/s, and a rate determined based on a mathematical calculation using the a measurement of the transmission frequency of the power grid at the time of the examination). Results We observed that the rate of 21.1 stimuli/s showed the highest amplitudes for waves I, III, and V when compared with the other rates. The rate of 26.7 stimuli/s, when compared with 27.7 stimuli/s, showed a higher amplitude for wave V. The latency if wave V was significantly lower with the rate of 21.1 stimuli/s than with 27.7 stimuli/s. Conclusions The stimulation rate interferes with wave latencies and amplitudes; its decrease from 27.7 to 21.1 stimuli/s decreases the latency of wave V and increases the amplitues and improves the morphology of waves I, III and V. In addition, we found evidence that suggests an improvement in the visualization of wave III by adjusting the stimulation rate based on a measurement of the local transmission frequency of the power grid.

[Indicative factors of early facial aging in mouth breathing adults]. / Aspectos indicativos de envelhecimento facial precoce em respiradores orais adultos.

BACKGROUND: Early facial aging in mouth breathing adults. AIM: To verify the presence of indicative factors of early facial aging and to characterize the measurements of the projection of the nasogeniane fold to the tragus and of the face width in mouth and nose breathing adults. METHOD: Aspects of early facial aging were observed in 60 individuals (presence of dark circles and wrinkles under the eyes, mentual wrinkles and mentual ridges). Measurements of the projection of the nasogeniane fold to the tragus and of the face width (distance between the buccinators) were taken using a digital caliper. Later, the volunteers were submitted to speech-language evaluations (anamneses and orofacial myofuntional assessment) and to an otolaryngology inspection in order to establish the diagnosis of mouth breathing (anamneses, clinical evaluation and video laryngoscopy). The obtained data were analyzed according to descriptive statistics and to the following statistic tests: Kolmogorov-Smirnov, Shapiro-Wilk, Qui-square, Mann-Withney and the T-Student test for independent variables. Differences were considered significant when the p value was inferior to .05 and the accepted beta error was of .1. RESULTS: The research sample consisted only of female volunteers. For the research group (mouth breathers) the age average was of 22.04 +/- 2.25 years and, for the control group (nose breathers) the age average was of 21.94 +/- 2.03 years. The presence of a high percentage of indicative factors of early facial aging was observed for the group of mouth breathers when compared to the group of nose breathers. Greater differences between the projections of the nasogenianos ridges in right and left side of the face was also observed for the group of mouth breathers. However, higher values of face widths were observed for the nose breathing individuals, configuring a discreetly more widened face in the cheek region. CONCLUSIONS: In the present study there was a higher indication of early facial aging for the group of mouth breathers.

Hearing handicap in patients with chronic kidney disease: a study of the different classifications of the degree of hearing loss.

INTRODUCTION: The association between hearing loss and chronic kidney disease and hemodialysis has been well documented. However, the classification used for the degree of loss may underestimate the actual diagnosis due to specific characteristics related to the most affected auditory frequencies. Furthermore, correlations of hearing loss and hemodialysis time with hearing handicap remain unknown in this population. OBJECTIVE: To compare the results of Lloyd's and Kaplan's and The Bureau Internacional d'Audiophonologie classifications in chronic kidney disease patients, and to correlate the averages calculated by their formulas with hemodialysis time and the hearing handicap. METHODS: This is an analytical, observational and cross-sectional study with 80 patients on hemodialysis. Tympanometry, speech audiometry, pure tone audiometry and interview of patients with hearing loss through Hearing Handicap Inventory for Adults. Cases were classified according to the degree of loss. The correlations of tone averages with hemodialysis time and the total scores of Hearing Handicap Inventory for Adults and its domains were verified. RESULTS: 86 ears (53.75%) had hearing loss in at least one of the tonal averages in 48 patients who responded to Hearing Handicap Inventory for Adults. The Bureau Internacional d'Audiophonologie classification identified a greater number of cases (n=52) with some degree of disability compared to Lloyd and Kaplan (n=16). In the group with hemodialysis time of at least 2 years, there was weak but statistically significant correlation of The Bureau Internacional d'Audiophonologie classification average with hemodialysis time (r=0.363). There were moderate correlations of average The Bureau Internacional d'Audiophonologie classification (r=0.510) and tritone 2 (r=0.470) with the total scores of Hearing Handicap Inventory for Adults and with its social domain. CONCLUSION: The Bureau Internacional d'Audiophonologie classification seems to be more appropriate than Lloyd's and Kaplan's for use in this population; its average showed correlations with hearing loss in patients with hemodialysis time≥2 years and it exhibited moderate levels of correlation with the total score of Hearing Handicap Inventory for Adults and its social domain (r=0.557 and r=0.512).

Aging and wave-component latency delays in oVEMP and cVEMP: a systematic review with meta-analysis.

INTRODUCTION: The natural aging process may result in morphological changes in the vestibular system and in the afferent neural pathway, including loss of hair cells, decreased numbers of vestibular nerve cells, and loss of neurons in the vestibular nucleus. Thus, with advancing age, there should be a decrease in amplitudes and an increase in latencies of the vestibular evoked myogenic potentials, especially the prolongation of p13 latency. Moreover, many investigations have found no significant differences in latencies with advancing age. OBJECTIVE: To determine if there are significant differences in the latencies of cervical and ocular evoked myogenic potentials between elderly and adult patients. METHODS: This is a systematic review with meta-analysis of observational studies, comparing the differences of these parameters between elderly and young adults, without language or date restrictions, in the following databases: Pubmed, ScienceDirect, SCOPUS, Web of Science, SciELO and LILACS, in addition to the gray literature databases: OpenGrey.eu and DissOnline, as well as Research Gate. RESULTS: The n1 oVEMP latencies had a mean delay in the elderly of 2.32ms with 95% CI of 0.55-4.10ms. The overall effect test showed p=0.01, disclosing that such difference was significant. The heterogeneity found was I2=96% (p<0.001). Evaluation of p1 latency was not possible due to the low number of articles selected for this condition. cVEMP analysis was performed in 13 articles. For the p13 component, the mean latency delay in the elderly was 1.34ms with 95% CI of 0.56-2.11ms. The overall effect test showed a p<0.001, with heterogeneity value I2=92% (p<0.001). For the n23 component, the mean latency delay for the elderly was 2.82ms with 95% CI of 0.33-5.30ms. The overall effect test showed p=0.03. The heterogeneity found was I2=99% (p<0.001). CONCLUSION: The latency of oVEMP n1 wave component and latencies of cVEMP p13 and n23 wave components are longer in the elderly aged >60 years than in young adults.

Cortical auditory evoked potentials using the speech stimulus /ma/

ABSTRACT Purpose: to compare cortical auditory evoked responses using two speech stimuli, /ma/ and /da/, in normally hearing young adults. Methods: a cross-sectional, observational and analytical study, with a sample composed of nineteen normally hearing young adults, recruited by convenience, ages between 18 and 25 years old, from both genders, participated in the study. Cortical auditory evoked potentials (CAEP) were monaurally recorded in two conditions: 1) with a pair of speech stimuli /ba/ and /da/, and 2), with a pair of speech stimuli /ba/ and /ma/. The order of the experiments was randomized in a proportion of 50% for each of the two stimuli, totaling 100 stimuli for each experiment. Speech sounds were presented at 70 dB SPL. Descriptive and analytical statistical tests were performed. Results: mean latency values of the complex P1, N1, P2, N2 and P3 were lower for the /ma/ when compared to those of /da/ (p <0,05). There was no difference in amplitude values between responses evoked using /ma/ and /da/. Conclusion: cortical auditory evoked potentials, elicited by the speech stimulus /ma/ had, on average, lower latency peaks of P1-N1-P2-N2 and P3, when compared to those of speech stimulus /da/.

Síndrome da fragilidade e riscos para quedas em idosos da comunidade / Frailty syndrome and risks for falling in the elderly community

RESUMO Objetivo Identificar a prevalência da Síndrome da Fragilidade em idosos e suas relações com o risco para quedas. Método Estudo clínico descritivo, transversal e analítico. Cento e um voluntários com mais de 60 anos, foram submetidos à avaliação audiológica, Dynamic Gait Index - Brazilian brief (DGI), Timed Up and Go(TUG) e Escala de Fragilidade de Edmonton (EFE) que determinaram, respectivamente, os limiares auditivos, síndrome da fragilidade, equilíbrio funcional e dinâmico e risco para quedas. Utilizou-se a distribuição percentual simples, o teste de Wilcoxon e de Correlação Bivariada com coeficiente de Pearson para a análise estatística. Foram adotados limites iguais inferiores a 1,0 e 5,0%. Resultados A EFE identificou 22,8% dos voluntários como frágeis e 22,8% como vulneráveis. O DGI e o TUG classificaram 34,6 e 84,1% de riscos para quedas. Ocorreu correlação significativa entre a EFE e o DGI (p<0,01), a EFE e o TUG (p<0,01) e o DGI e TUG (p<0,01). O coeficiente de Pearson entre EFE e o DGI, entre o EFE e o TUG e DGI e TUG foram -0,26, -0,41 e 0,46 respectivamente. Ocorreu associação entre DGI e TUG e idade (p<0,01). Não houve correlação entre a EFE com sexo e idade. Conclusão A fragilidade e pré-fragilidade foi identificada em uma parcela expressiva dos voluntários, sobretudo nos mais longevos. O equilíbrio funcional e o dinâmico se correlacionaram moderamente com fragilidade, o que demonstrou que a Síndrome da fragilidade aumenta o risco para quedas.

ABSTRACT Purpose To identify the prevalence of Frailty Syndrome in the elderly and the relationship with risk of falling. Methods Descriptive, cross-sectional, and analytical clinical study. One hundred and one volunteers over 60 years old were submitted to audiological evaluation, Dynamic Gait Index - Brazilian brief (DGI), Timed Up and Go (TUG) and Edmonton Fragility Scale (EFE) that verified, respectively, hearing thresholds, frailty syndrome, functional and dynamic balance, and risk of falling. The simple percentual distribution, the Wilcoxon´s test and the Bivariate Correlation with Pearson's coefficient were used for statistical analysis. Limits equal to or less than 1.0 and 5.0% were adopted. Results EFE identified 22.8% of volunteers as fragile and 22.8% as vulnerable. DGI and TUG found 34.6% and 84.1% of at risk for falls, respectively. Significant correlations between EFE and DGI (p <0.01), EFE and TUG (p <0.01), and DGI and TUG (p <0.01) were observed. Pearson's coefficient between EFE and DGI, EFE and TUG, and DGI and TUG were -0.26, -0.41, and 0.46, respectively. An association between DGI and TUG and age (p <0.01) was identified. No correlation between EFE and sex or age was found. Conclusion Frailty and pre-frailty were identified in a significant segment of the volunteers, especially in the oldest subjects. Functional and dynamic balance were moderately correlated with frailty, which demonstrated that frailty syndrome increases the risk of falls.