Auditory Brainstem Evoked Response: response patterns of full-term and premature infants

Auditory Brainstem Response (ABR) is important for the early diagnosis of hearing impairment in infants. AIM: To compare ABR responses in full-term and premature infants; gender and ear were taken into account. METHODS: A cross-sectional prospective cohort study was carried out. We evaluated 36 full-term and 30 premature infants that had passed the Transient Otoacoustic Emissions test, had type A tympanometric curves, and had no risk factor for hearing loss besides prematurity. The evaluations were done from the time of hospital discharge to the third month of life, and consisted of a clinical history, acoustic immittance testing and ABR evaluation. RESULTS: The comparison of absolute and interpeak wave I, III and V latencies in right and left ears revealed a statistically significant difference at the interpeak I-III. There was no significant gender differences in the comparison of results. Significant difference in wave I, III and V absolute latencies at 80 dB and in wave V at 60 db and 20 db were observed in a comparison of absolute and interpeak latencies between full-term and premature infants. An inverse correlation was found between age and absolute latencies. CONCLUSIONS: The maturity of the auditory system influences ABR responses in infants. To avoid misinterpretation of results, gestational age must be taken into account in the analysis of ABR in pediatric population.O Potencial Evocado Auditivo de Tronco Encefálico (PEATE) é um teste de grande importância na detecção precoce de alterações auditivas em crianças. OBJETIVOS: Analisar as respostas de neonatos e lactentes termos e prematuros para o PEATE, considerando gênero e orelha. MATERIAL E MÉTODOS: Estudo de coorte transversal e prospectivo. Foram avaliados 36 lactentes termos e 30 prematuros sem indicadores de risco para perda auditiva além da prematuridade,que permaneceram no alojamento conjunto, passaram nas Emissões Otoacústicas Transientes e apresentaram curva timpanométrica tipo A. As avaliações ocorreram entre a alta hospitalar e o terceiro mês de vida, sendo constituídas por anamnese, medidas de imitância acústica e pelo PEATE. RESULTADOS: Na comparação das latências absolutas e interpicos das ondas I, III e V quanto às orelhas direita e esquerda observou-se diferença estatisticamente significante para o interpico I-III. Quanto ao gênero masculino e feminino, não houve diferença significante. Na comparação entre prematuros e termos observou-se diferença significante para as latências absolutas das ondas I, III e V em 80 dB e da onda V em 60 e 20 dB. Verificou-se correlação inversa entre idade gestacional e latências absolutas. CONCLUSÃO: A maturação do sistema auditivo influencia as respostas do PEATE de lactentes. Para evitar a interpretação equivocada dos resultados deve-se considerar a idade gestacional na análise do PEATE nessa população.72973

Otitis Media, Behavioral and Electrophysiological Tests, and Auditory Rehabilitation

For speech and language to develop, an intact and active auditory system is of fundamental importance. The central auditory nervous system (CANS) can be hampered by several occurrences, including otitis media (OM) originating from inflammation in the middle ear and which is often associated with the accumulation of infected (or sometimes noninfected) fluid. OM can have a diffuse effect on cognitive and linguistic abilities, affecting both speech and phoneme perception through a failure to discriminate, store, and reproduce the acoustic contrasts necessary for comprehension. It is especially common in the first years of school. In addition, OM can generate internal noise from the presence of middle ear fluid near the cochlea, which can lead to changes in speech perception, distortion in acoustic images, and a reduction in the speed and accuracy of decoding speech. Evaluating the effectiveness of the CANS is recommended in cases where there have been repeated episodes of OM. Very useful information can be gained from behavioral and electrophysiological tests. The tests allow functional diagnoses to be made and can also reveal clinical and subclinical changes. In this way, they allow information to be collected, which can help in making a prognosis and planning intervention strategies

Speech-Evoked Brainstem Response

The auditory brainstem response (ABR) is a clinical tool to assess the neural functionality of the auditory brainstem. The use of verbal stimuli in ABR protocols has provided important information of how the speech stimuli are processed by the brainstem structure. The perception of speech sounds seems to begin in the brainstem, which has an important role in the reading process and the phonological acquisition speech ABR assessment allows the identification of fine-grained auditory processing deficits, which do not appear in click evoked ABR responses. The syllable /da/ is commonly used by speech ABR assessment due to it being considered a universal syllable and allows it to be applied in different countries with good clinical assertiveness. The speech ABR is a objective, fast procedure that can be applied to very young subjects. It be utilized in different languages and can provide differential diagnoses of diseases with similar symptoms, as an effective biomarker of auditory processing disorders present in various diseases, such as dyslexia, specific language impairment, hearing loss, auditory processing disorders, otitis media, and scholastic difficulties. Speech ABR protocols can assist in the detection, treatment, and monitoring of various types of hearing impairments

(Central) Auditory Processing: the impact of otitis media

OBJECTIVE: To analyze auditory processing test results in children suffering from otitis media in their first five years of age, considering their age. Furthermore, to classify central auditory processing test findings regarding the hearing skills evaluated. METHODS: A total of 109 students between 8 and 12 years old were divided into three groups. The control group consisted of 40 students from public school without a history of otitis media. Experimental group I consisted of 39 students from public schools and experimental group II consisted of 30 students from private schools; students in both groups suffered from secretory otitis media in their first five years of age and underwent surgery for placement of bilateral ventilation tubes. The individuals underwent complete audiological evaluation and assessment by Auditory Processing tests. RESULTS: The left ear showed significantly worse performance when compared to the right ear in the dichotic digits test and pitch pattern sequence test. The students from the experimental groups showed worse performance when compared to the control group in the dichotic digits test and gaps-in-noise. Children from experimental group I had significantly lower results on the dichotic digits and gaps-in-noise tests compared with experimental group II. The hearing skills that were altered were temporal resolution and figure-ground perception. CONCLUSION: Children who suffered from secretory otitis media in their first five years and who underwent surgery for placement of bilateral ventilation tubes showed worse performance in auditory abilities, and children from public schools had worse results on auditory processing tests compared with students from private schools

Vestibular rehabilitation in a university hospital

A Reabilitação Vestibular visa melhorar o equilíbrio global, a qualidade de vida e orientação espacial dos pacientes com tontura. OBJETIVOS: Traçar o perfil dos pacientes atendidos no Ambulatório de Reabilitação Vestibular do Setor de Otoneurologia de um hospital universitário e verificar os resultados obtidos no período de novembro/2000 a dezembro/2004. MATERIAL E MÉTODO: Levantamento de dados contidos nas fichas dos 93 pacientes submetidos à Reabilitação Vestibular no período. FORMA DE ESTUDO: Clínico retrospectivo. RESULTADOS: A média etária dos pacientes foi de 52,82 anos, 56 do sexo feminino e 37 do sexo masculino. O número médio de atendimentos foi 4,3, sendo maior para os pacientes com distúrbios otoneurológicos centrais (média de 5,9). Dentre os pacientes que concluíram o tratamento proposto, 37 (60,7%) obtiveram melhora significativa, 14 (22,9%) tiveram melhora parcial e 10 (16,4%) não referiram benefícios significativos. Os pacientes que mais se beneficiaram com a Reabilitação Vestibular tinham distúrbios otoneurológicos periféricos. CONCLUSÃO: A maior parte dos pacientes era do sexo feminino, com idade média de 52,8 anos. Cinqüenta e um pacientes (83,6%) tiveram benefício com a terapia confirmando a eficácia do tratamento.The aim of vestibular rehabilitation is to improve total balance, quality of life and spatial orientation of patients with dizziness. AIMS: To determine the characteristics of the patients who underwent the Vestibular Rehabilitation program of the Neurotology Ward of a University Hospital, and to verify the results obtained between November/2000 and December/2004. MATERIALS AND METHODS: analysis of 93 files from patients under Vestibular Rehabilitation during the studied period. STUDY DESIGN: Retrospective clinical. RESULTS: the mean age of patients was 52.82 years, 56 females and 37 males. The average number of therapy sessions was 4.3, higher for patients with central neurotological disorders (average of 5.9). Among the patients who concluded the treatment, 37 (60.7%) had significant improvement, 14 (22.9%) presented partial improvement and 10 (16.4%) did not report significant benefits. Patients with peripheral neurotological disorders were the ones who most benefited from Vestibular Rehabilitation. CONCLUSION: Most of the patients were female, with a mean age of 52.8 years. Fifty one patients (83.6%) benefited from the therapy, confirming treatment efficacy

Wideband Tympanometry

The wideband tympanometry (WBT) assesses the middle ear function with a transient wideband stimulus in order to capture the middle ear behavior at a wide range of frequencies. Data in the literature suggest that the WBT has more sensibility to detect middle ear disorders than the traditional tympanometry. In this context, pathologies, which might be more easily identified/monitored by WBT, include otosclerosis, flaccid eardrums, ossicular chain discontinuity with semicircular canal dehiscence, and negative middle ear pressure with middle ear effusion. The chapter presents information on classical tympanometry, the multifrequency tympanometry equivalent coded as WBT, clarification of terms used in WBT measurements, and a short overview of clinical applications in infants and adults

Study of hearing in children with visual deficiency

PURPOSE: analyze the hearing of students presenting with visual deficiency (low vision and blindness). METHOD: evaluation of 30 (100%) children, divided into two groups: Group I comprised 15 (50%) children with visual deficiency; and Group II comprised 15 (50%) children with normal vision, without hearing and/or education complaints. The patients underwent meatoscopy, liminal tonal audiometry, logoaudiometry and immitanciometry; in addition to sound location tests in five directions, verbal and non-verbal sequential memory, speech-in-noise tests, dichotic digit tests, duration standard behavior and random gap detection test (RGDT). RESULTS: concerning the basic auditory evaluation in Group I, four (26.6%) students showed results altered - two (13, 3%) with conductive hearing loss, one (6, 8%) with mixed and one (6, 8%) with neurosensorial hearing loss. Conversely, all participants in Group II showed normal results. In the sequence of auditory processing tests, 10 (66.6%) students in Group I showed results altered and four (26.6%) showed normal results. CONCLUSION: Group I demonstrated unfavorable performance in comparison with Group II, either in the basic auditory evaluation or in the sequence of auditory processing tests.OBJETIVO: analisar a audição de escolares portadores de deficiência visual (baixa visão e cegueira) e caracterizá-los quanto ao desempenho escolar. MÉTODO: anamnese e avaliação audiológica de 30 (100%) crianças de 8 a 12 anos, sendo 15 (50%) do Grupo I, constituído por portadores de deficiência visual e 15 (50%) do Grupo II formado por crianças com visão normal, sem queixas auditivas e/ou escolares. Foram realizadas meatoscopia, audiometria tonal liminar, logoaudiometria e imitanciometria; além dos testes de Localização Sonora em Cinco Direções, Memória Sequencial para Sons Verbais e Não-Verbais, Fala com Ruído, Dicótico de Dígitos, Padrão de Duração e Detecção de Intervalos Aleatórios (RGDT). Os pais e/ou responsáveis responderam questões sobre o histórico escolar. RESULTADOS: na avaliação audiológica básica, no Grupo I, 04 (26,6%) escolares obtiveram resultados alterados, sendo 02 (13,3%) com perda auditiva do tipo condutiva, 01 (6,8%) com perda auditiva sensórioneural e 01 (6,8%) com perda mista. No Grupo II, todos os escolares apresentaram resultados normais. Nos testes do Processamento Auditivo, verificou-se que o Grupo I obteve resultados semelhantes ao Grupo II nos testes de Localização Sonora, Memória Seqüencial para Sons Não-Verbais e Fala com Ruído. Nos demais testes, O Grupo I mostrou desempenho inferior ao Grupo II. CONCLUSÃO: o Grupo I mostrou-se com desempenho desfavorável em relação ao Grupo II tanto na avaliação audiológica básica, como na bateria de testes do Processamento Auditivo. O mesmo foi observado para o desempenho escolar, havendo no Grupo I maior número de repetências e dificuldades no aprendizado da leitura e escrita.46047

Newborn Hearing Screening And Early Diagnostic In The Nicu.

The aim was to describe the outcome of neonatal hearing screening (NHS) and audiological diagnosis in neonates in the NICU. The sample was divided into Group I: neonates who underwent NHS in one step and Group II: neonates who underwent a test and retest NHS. NHS procedure was automated auditory brainstem response. NHS was performed in 82.1% of surviving neonates. For GI, referral rate was 18.6% and false-positive was 62.2% (normal hearing in the diagnostic stage). In GII, with retest, referral rate dropped to 4.1% and false-positive to 12.5%. Sensorineural hearing loss was found in 13.2% of infants and conductive in 26.4% of cases. There was one case of auditory neuropathy spectrum (1.9%). Dropout rate in whole process was 21.7% for GI and 24.03% for GII. We concluded that it was not possible to perform universal NHS in the studied sample or, in many cases, to apply it within the first month of life. Retest reduced failure and false-positive rate and did not increase evasion, indicating that it is a recommendable step in NHS programs in the NICU. The incidence of hearing loss was 2.9%, considering sensorineural hearing loss (0.91%), conductive (1.83%) and auditory neuropathy spectrum (0.19%).201484530

Auditory assessment in the school-age children

PURPOSE: to analyze schoolchildren's performance in hearing screening, considering male and female genders and ages in groups I, II and III. METHODS: two-hundred and eighty-seven male and female schoolchildren, 5 to 10-year old, who attended the Child and Adolescent Program - University of Campinas (Prodecad/Unicamp), were evaluated. Hearing screening was constituted by meatoscopy, imitanciometry - tympanometry, and acoustic reflex research, in addition to tests which comprise the simplified evaluation of hearing process. RESULTS: considering imitanciometry, 60.6% of schoolchildren presented normal median ear conditions, in addition to integrity of hearing tracts up to encephalic trunk. Fifty-six percent of schoolchildren presented good results in the hearing screening process. Groups I and II presented a larger number of children who failed in hearing screening, considering either imitanciometry or hearing processing tests. CONCLUSION: hearing screening is an effective way to determine the adequate conduct to be adopted with schoolchildren regarding peripheral hearing loss and/or hearing abilities.OBJETIVO: analisar o desempenho de escolares na triagem auditiva, considerando-se o sexo masculino e feminino e a faixa etária-grupos I, II e III. MÉTODOS: foram avaliados 287 escolares de cinco a dez anos, do sexo feminino e masculino, que frequentavam o PRODECAD (Programa de Desenvolvimento e Integração da Criança e do Adolescente) da UNICAMP. A triagem auditiva foi constituída pela meatoscopia, imitanciometria - timpanometria e pesquisa do reflexo acústico, além dos testes que compõem a avaliação simplificada do processamento auditivo. RESULTADOS: na imitanciometria, 60,6% (N=174/287) dos escolares passaram. Constatou-se que houve diferença estatisticamente significante entre a curva timpanométrica e os grupos estudados. A curva do tipo A foi mais frequente nas crianças maiores, do grupo III. Além disso, o Grupo III apresentou maior número de resposta presente para o reflexo acústico, sendo a diferença entre os grupos estudados estatisticamente significantes. Observa-se que os escolares desse estudo apresentaram mais dificuldade em memorizar sequência de sons ou ordenação temporal do que localizar a fonte sonora. CONCLUSÃO: com base na análise dos resultados obtidos neste estudo foi possível concluir que na imitanciometria, 60,6% dos escolares passaram, ou seja, apresentaram condições de orelha média normais, além de integridade de vias auditivas até o tronco encefálico. Passaram na triagem do processamento auditivo, 56% dos escolares. Com relação aos grupos estudados, os grupos I e II apresentaram um número maior de crianças que falharam na triagem auditiva, considerando-se tanto a imitanciometria, como os testes de processamento auditivo.644653Conselho Nacional de Desenvolvimento Científico e Tecnológico (CNPq

Adherence to a Neonatal Hearing Screening Program

Neonatal hearing screening programs have been developed worldwide. Since 2002, the newborns from the Center for Integral Assistance to Women's Health at UNICAMP have been referred to hearing screening at the Center for Studies and Research on Rehabilitation Prof. Dr. Gabriel Porto. Nevertheless, not all newborns come to the screening and others drop out before the procedures are completed. The goal of this research was to characterize the newborns' adherence rates to the Neonatal Hearing Screening Program. A retrospective investigation was carried out, collecting data on the records of all cases screened from February to November of 2007. A total of 2107 infants were referred to hearing screening and 1310 actually came. Among those who failed the test (92 infants), 73 returned for the retest with the use of BAEP. The adherence rate in the first stage of the screening was 62.17% and, in the second, 79.34%. These rates are bellow the ones recommended by the JCIH as well as bellow those reached by hearing screening programs of some developed countries. However, they are similar to other Brazilian experiences of neonatal hearing screening programs. A close follow up of the families of those infants who failed the first stage of the screening, as well as the orientation given to them about early detection of hearing loss and its consequences, may have contributed to the increase in the adherence rate in the second stage of the screening.A Triagem Auditiva Neonatal tem se efetivado mundialmente como meio para detecção precoce da surdez. Na Unicamp, desde 2002, os recém-nascidos na maternidade do Centro de Atenção Integral à Saúde da Mulher são agendados para a triagem auditiva no Centro de Estudos e Pesquisas em Reabilitação Prof. Dr. Gabriel Porto. No entanto, nem todos vêm para a triagem e alguns abandonam o processo de avaliação antes do diagnóstico. O objetivo desta pesquisa foi caracterizar as taxas de adesão de lactentes ao Programa de Triagem Auditiva Neonatal. Tratou-se de pesquisa que utilizou dados contidos nos prontuários dos lactentes que efetuaram a triagem no período de fevereiro a novembro de 2007. Permaneceram no alojamento conjunto do CAISM 2107 lactentes e vieram para a triagem 1310. Dentre aqueles que não passaram na triagem (92 lactentes), realizaram o exame de PEATE-A 73 lactentes. A adesão na primeira etapa da triagem foi de 62,17%, e na segunda, 79,34%. As taxas de adesão são inferiores às preconizadas pelo Joint Comittee on Infant Hearing e encontradas em alguns países desenvolvidos. No entanto, aproximam-se de outras experiências brasileiras de programas de triagem auditiva neonatal. O acompanhamento sistemático às famílias dos lactentes que não passaram na primeira avaliação e a conscientização destas sobre a detecção precoce da perda auditiva e suas consequências podem ter contribuído para o aumento da taxa de adesão na segunda etapa da triagem.Fundação do Desenvolvimento Administrativo (FUNDAP)Unicamp Faculdade de Ciências MédicasUniversidade Estadual Paulista Júlio de Mesquita FilhoUnicamp Faculdade de Ciências Médicas Centro de Estudos e Pesquisas em Reabilitação Prof. Dr. Gabriel PortoUNIFESPUNIFESPSciEL