Hearing aid effectiveness on patients with chronic tinnitus and associated hearing loss

Abstract Objective: Our study aimed to measure the effectiveness of using HA in reducing the disturbance caused by tinnitus. Methods: Study was designed as a within-subjects clinical trial. Nineteen patients with chronic tinnitus and untreated sensorineural hearing loss were under counseling, HA fitting and 6 months follow-up. Tinnitus assessment was performed with Tinnitus Handicap Inventory (THI), Visual Analog Scale (VAS), pitch and loudness matching, and Minimum Masking Level measurements (MML). Results: following 6 months of HA use, a reduction in reported tinnitus and hearing handicap scales scores was observed both statistically and clinically. The pitch and loudness matching, as well as MML at the baseline and final evaluation were compared. MML's thresholds reduced significantly after 6 months of HA use. Conclusion: Our study has provided evidence that HA fitting is a valuable treatment strategy for chronic tinnitus relief and associated hearing loss subtype of patient. Level of evidence: 3.

Intervención educativa en adultos mayores hipoacúsicos sobre el uso de audífonos para la rehabilitación auditiva / Educative intervention for hearing impaired older adults on the use of hearing aids for auditory rehabilitation / Intervenção educativa em idosos com deficiência auditiva sobre o uso de aparelhos para reabilitação auditiva

RESUMEN Introducción: La educación de los pacientes adultos mayores hipoacúsicos sobre su enfermedad y el uso de audífonos es una exigencia social. Objetivo: Diseñar e implementar una intervención educativa dirigida a la preparación de los pacientes adultos mayores con hipoacusia neurosensorial respecto al uso de audífonos para la rehabilitación auditiva atendidos en el Centro Auditivo "Dr. Mario Velázquez Leal" de la provincia de Guantánamo en el año 2019. Método: Se realizó un pre experimento en 80 pacientes con hipoacusia neurosensorial que utilizaron audífonos. El estímulo consistió en la implementación de una intervención educativa dirigida a su preparación respecto al tema hipoacusia y el uso de audífonos para la rehabilitación auditiva. Resultados: El 88,7 % de los pacientes consideró que la hipoacusia limitaba la calidad de vida y el 87,5 % reconoció que asumía una actitud inadecuada para el control de la discapacidad, lo que indicó la necesidad de educarlos respecto al tema. El 36,2 % de ellos está adecuadamente preparado sobre el tema, luego de la intervención educativa esta proporción se elevó hasta el 93,7 %. Conclusiones: Se identifica que los pacientes adultos mayores con hipoacusia neurosensorial que utilizan audífonos para la rehabilitación auditiva muestran carencias teóricas sobre el tema hipoacusia y uso de audífonos, que son resueltas con el diseño e implementación de una intervención educativa dirigida a su preparación para esta finalidad.

ABSTRACT Introduction: Educating the older hearing impaired patients about their condition and the use of hearing aids is a social requirement. Objective: To design and implement an educative intervention aimed at preparing older adult patients with presence of sensorineural hearing loss regarding the use of hearing aids for auditory rehabilitation attended at the Centro Auditivo "Dr. Mario Velázquez Leal", Guantánamo, in 2019. Method: A pre-experimental study was conducted on 80 patients with sensorineural hearing loss who used hearing aids. The stimulus consisted on the implementation of an educative intervention aimed at preparing them for appearance hearing loss and the use of hearing aids for auditory rehabilitation. Results: The 88.7% of patients considering that hearing loss is a problem in health and 87.5% recognized that they had an inadequate attitude towards the management of their impairment, which revealed the need to educate them on the subject. The 36.2% of patients were adequately prepared on the subject, but after the educative intervention this proportion rose to 93.7%. Conclusions: It is marked that older adult patients with sensorineural hearing loss, who use hearing aids for auditory rehabilitation, demonstrated theoretical deficiencies on the hearing loss and use of hearing aids subject, which are solved with the design and implementation of an educative intervention aimed at preparing the patients for this purpose.

RESUMO Introdução: A educação dos pacientes idosos com deficiência auditiva sobre a sua doença eo uso de aparelhos auditivos é uma exigência social. Objetivo: Projetar e implementar uma intervenção educativa destinada a preparar pacientes idosos com perda auditiva neurossensorial em relação ao uso de aparelhos auditivos para reabilitação auditiva atendidos no Centro Auditivo "Dr. Mario Velázquez Leal" da província de Guantánamo durante 2019. Método: Um pré-experimento foi realizado em 80 pacientes com perda auditiva neurossensorial que usou aparelhos auditivos. O estímulo consistiu na implementação de uma intervenção educacional que visa a sua preparação em relação à questão da perda e do uso de aparelhos auditivos para reabilitação auditiva. Resultados: 88,7% dos pacientes consideraram que a perda auditiva limitou sua qualidade de vida e 87,5% reconheceram que assumiram uma atitude inadequada para controlar a deficiência, o que indicou a necessidade de educá-los sobre o assunto. 36,2% deles estão adequadamente preparados sobre o assunto, após a intervenção educativa essa proporção subiu para 93,7%. Conclusões: Identifica-se que pacientes idosos com perda auditiva neurossensorial usuários de aparelhos para reabilitação auditiva apresentam deficiências teóricas sobre o tema perda auditiva e uso aparelhos auditivos, as quais são sanadas com a concepção e implementação de uma intervenção educativa voltada à sua preparação. para este propósito.

Computer-Based Auditory Training Programs for Children with Hearing Impairment - A Scoping Review

Abstract Introduction Communication breakdown, a consequence of hearing impairment (HI), is being fought by fitting amplification devices and providing auditory training since the inception of audiology. The advances in both audiology and rehabilitation programs have led to the advent of computer-based auditory training programs (CBATPs). Objective To review the existing literature documenting the evidence-based CBATPs for children with HIs. Since there was only one such article, we also chose to review the commercially available CBATPs for children with HI. The strengths and weaknesses of the existing literature were reviewed in order to improve further researches. Data Synthesis Google Scholar and PubMed databases were searched using various combinations of keywords. The participant, intervention, control, outcome and study design (PICOS) criteria were used for the inclusion of articles. Out of 124 article abstracts reviewed, 5 studies were shortlisted for detailed reading. One among them satisfied all the criteria, and was taken for review. The commercially available programs were chosen based on an extensive search in Google. The reviewed article was wellstructured, with appropriate outcomes. The commercially available programs cover many aspects of the auditory training through a wide range of stimuli and activities. Conclusions There is a dire need for extensive research to be performed in the field of CBATPs to establish their efficacy, also to establish them as evidence-based practices.

Dynamics of Speech Perception in the Auditory-Visual Mode: An Empirical Evidence for the Management of Auditory Neuropathy Spectrum Disorders

BACKGROUND AND OBJECTIVES: The present study probed into the relative and combined contribution of auditory and visual modalities in the speech perception of individuals with auditory neuropathy spectrum disorders (ANSD). Specifically, the identification scores of consonant-vowel (CV) syllables, visual enhancement (VE), and auditory enhancement in different signal to noise ratios (SNRs) were compared with that of the control group. SUBJECTS AND METHODS: The study used a repeated measure standard group comparison research design. Two groups of individuals in the age range of 16 to 35 years participated in the study. The clinical group included 35 participants diagnosed as ANSD, while the control group had 35 age and gender matched individuals with typical auditory abilities. The participants were assessed for CV syllable identification in auditory only (A), visual only (V), and auditory-visual (AV) modalities. The syllables were presented in quiet and at 0 dB SNR. RESULTS: The speech identification score was maximum in AV condition followed by A-condition and least in V condition. This was true in both the groups. The individuals with ANSD were able to make better use of visual cues than the control group, as evident in the VE score. CONCLUSIONS: The dynamics of speech perception in the AV mode is different between ANSD and control. There is definite benefit of auditory as well as visual cues to individuals with ANSD, suggesting the need to facilitate both the modalities as part of the audiological rehabilitation. Future studies can focus on independently facilitating the two modalities and testing the benefits in the AV mode of speech perception in individuals with ANSD.

Avaliação da capacitação de profissionais de saúde na área de reabilitação auditiva via teleducação: ênfase em crianças de zero a três anos de idade / Assessment of a distance learning course on auditory rehabilitation: emphasis on children from birth up to three years old

O ritmo da evolução do conhecimento e tecnologias aplicadas na área reabilitação das deficiências auditivas torna necessária a constante atualização profissional. O ensino à distância (EaD) caracteriza uma importante estratégia para a educação permanente em saúde. O Curso de Especialização à Distância Habilitação e Reabilitação Auditiva em Crianças (CEDHRAC) teve como objetivo a capacitação de fonoaudiólogos e otorrinolaringologistas atuantes nos serviços de reabilitação auditiva que compõe a rede de cuidados à pessoa com deficiência. O presente este estudo teve como objetivo avaliar o CEDHRAC no que tange à reação dos estudantes frente ao curso e estratégias de aprendizagem utilizadas pelos mesmos, assim como o suporte recebido para transferência do treinamento no ambiente de trabalho e o impacto do curso no trabalho. Além disto foram verificadas as relações entre estes diferentes níveis de avaliação. Para responder a estes objetivos são apresentados dois manuscritos. Manuscrito 01: Estudo longitudinal, quali-quantitativo. Dos 105 alunos regularmente matriculados no CEDHRAC, 90 preencheram instrumentos de avaliação de reação aos diferentes núcleos temáticos quanto aos aspectos de conteúdos e atividades, tutores, professores, comunicação visual nos materiais didáticos, e habilidades técnicas e de navegação, além do instrumento de autoavaliação (assiduidade, pontualidade, autonomia, envolvimento, colaboração e desempenho geral). As respostas foram dadas em uma escala Likert de 5 pontos, sendo que pontuações maiores estavam associadas a melhores resultados. A análise temática dos comentários dos participantes também foi realizada. A taxa de evasão do curso foi de 9,5%. Em ambos questionários as pontuações médias obtidas estavam próximas de cinco e foram significativamente maiores (p=0,00) do que o ponto médio da escala, demonstrando que a a percepção do aluno frente ao próprio desempenho e quanto aos atributos do CEDHRAC foram positivas. A análise qualitativa confirmou tais achados e também os complementou, na medida em que foram apontadas algumas necessidades de melhorias, em particular na carga horária, construção de materiais didáticos e usabilidade do ambiente virtual de aprendizagem. Manuscrito 02: Estudo quantitativo. Foram avaliados 116 indivíduos, sendo 85 alunos do CEDHRAC e 31 gestores dos serviços onde o participante tinha vínculo empregatício. Imediatamente ao término do curso foram avaliados os componentes: reação ao curso, suporte à transferência de treinamento e estratégias de aprendizagem. A escala de reação ao curso é composta por 24 itens que se agrupam em dois fatores: REARES (reações aos resultados, aplicabilidade e expectativas de suporte) e REAPRO (reação à programação e ao apoio). A escala de suporte à transferência de treinamento composta de 22 afirmativas, contendo as dimensões do suporte psicossocial (fatores situacionais de apoio e as consequências associadas ao uso das novas habilidades) e o suporte material à transferência de treinamento. A escala estratégias de aprendizagem composta por 28 itens divididos em sete fatores: controle da emoção, busca de ajuda interpessoal, repetição e organização, controle da motivação, elaboração, busca de ajuda ao material didático, monitoramento da compreensão. Seis meses após o término do CEDHRAC o questionário com 12 itens relacionado ao impacto do treinamento no trabalho foi preenchido por egressos (autoavaliação) e gestores (heteroavaliação). As respostas foram dadas em uma escala Likert de cinco (reação, transferência e impacto) ou 10 pontos (estratégias de aprendizagem), com pontuações maiores associadas a resultados mais favoráveis. A reação dos egressos foi positiva em todos os aspectos avaliados, porém, com pontuação menor quanto ao suporte no trabalho. No suporte à transferência de treinamento a frequência dos fatores situacionais de apoio foi maior do que a das consequências associadas ao uso de novas habilidades (ANOVA, F=6,79; p=0,00; Teste de Tukey, p=0,001). Observaram-se altas pontuações quanto ao impacto do curso no trabalho, não havendo diferença significativa entre a auto e heteroavaliação (t=-0,039670; p=0,968). Verificou-se correlação (Pearson) fraca a moderada, significativa, entre os resultados de reação, suporte à transferência de treinamento e impacto. Diferentes estratégias de aprendizagem foram utilizadas pelos estudantes sendo que as estratégias de "elaboração" e "monitoramento da compreensão", foram utilizadas com maior e menor frequência, respectivamente (ANOVA, F=42,89; p=0,00; Teste de Tukey, p=0,000). Em conclusão, os participantes indicaram satisfação com o curso. O CEDHRAC possibilitou o aprimoramento profissional e reflexões sobre a prática profissional, impelindo o egresso à realização de mudanças no trabalho. Essas avaliações também forneceram aos desenvolvedores do curso informações para melhoria do treinamento e sobre alguns obstáculos que impediam a aplicação das novas habilidades adquiridas no ambiente de trabalho.(AU)

The pace of evolution of knowledge and technologies applied for the rehabilitation of hearing impairments request continuing professional education. Distance learning features an important strategy for health permanent education. The online course on Auditory Rehabilitation in Children (ARC) aimed to capacitate audiologists and ENT physicians working in public hearing healthcare services. The aim of this study was to evaluate the ARC regarding students' reaction towards the course and learning strategies used by them, as well as workplace support for training transfer and the impact of the course in workplace. In addition, the relationship between these different evaluation levels were verified. To meet these objectives two manuscripts are presented. Manuscript 01: Longitudinal qualitative and quantitative. From 105 ARC's students, 90 filled the assessments instruments available in each of the course's module concerning reaction to content and activities, tutors, teachers, didactic materials and navigation in the virtual learning system (VLS) as well as the self-assessment of performance (assiduity, punctuality, autonomy, involvement, collaboration and overall performance). The participants answers were given in a 5-point Likert scale, with higher scores associated with better results. The thematic analysis of participants' comments was also made. The course's dropout rate was 9.5%. In both instruments the average scores were close to five points and were significantly higher (p=0.00) than the scale´s midpoint, demonstrating students' perception of self-performance and ARC's attributes were positive. The qualitative analysis confirmed and complemented those findings, as they identified some need for improvement in workload, didactic materials and usability of the VLS. Manuscript 02: Quantitative study. Participated in the study 116 individuals - 85 ARC's students and 31 managers at the services where students were employed. Reaction to ARC's course, support for training transfer at work and learning strategies used, were assessed at course completion. The reaction scale consists of 24 items grouped into two factors: REARES (results reactions, applicability and support expectations) and REAPRO (reaction to programming and support). The training transfer support scale is comprised of 22 items divided in dimensions of psychosocial support (situational factors support and consequences associated with new skills use) and material support for training transfer. The learning strategies scale consists of 28 items divided into seven factors: control of emotion, interpersonal help, repetition and organization, control of motivation, elaboration, courseware help, comprehension monitoring. Impact of training on workplace questionnaire, consisting of 12 statements, was administered six month after course completion, to former ARC's students (self-assessment) and managers (assessment of others). Responses were given on 5-points (reaction, transfer and impact) or 10-points (learning strategies) Likert scale, with higher scores associated with more favorable results. Students' reaction to ARC were positive for all aspects evaluated, however lower scores were given to workplace support. Situational factors support was higher than consequences associated with new skills (ANOVA, F=6.79, p=0.00. Tukey Test p=0,001). Impact of ARC inn workplace was considered high and no difference was found between self and others assessments (t=-0.039670; p=0.968). Weak to moderate significant correlation (Pearson) were found between reaction, training transfer support and training impact. Different learning strategies were used by the students, with "elaboration" and "comprehension monitoring" being more and less used, respectively (ANOVA, F=42.89, p=0.00; Tukey test, p=0.000). In conclusion, participants indicated satisfaction with the course. The ARC enabled the professional development and reflection about professional practice, impelling changes at the workplace. These assessments also provided course developers with information for the course improvement as well as regarding some obstacles that prevented the application of acquired skills in the students' workplace.(AU)

Programa de acompanhamento fonoaudiológico de professores de alunos deficientes auditivos que utilizam a comunicação oral / Phonoaudiological follow-up program for teachers of hearing impaired students who use oral communication

Introdução: A atuação uníssona entre professor e fonoaudiólogo poderá contribuir para que ocorram adequações no contexto escolar, possibilitando a aprendizagem de alunos deficientes auditivos, usuários de aparelho de amplificação sonora individual ou implante coclear que se comunicam oralmente (Delgado-Pinheiro, 2003). Objetivo: Caracterizar o conhecimento dos professores em relação à deficiência auditiva, analisar a interação comunicativa desses professores com o aluno com perda auditiva e realizar um programa de acompanhamento fonoaudiológico. Metodologia: Participaram deste estudo dez professores de alunos deficientes auditivos, que frequentam o ensino regular. Foram realizadas entrevistas e filmagens antes e após o programa de acompanhamento fonoaudiológico. O programa de acompanhamento realizado consistiu de reuniões mensais, com todos os participantes, durante o ano letivo. Os temas das reuniões foram apresentados por meio de debates, diálogos, recursos audiovisuais e discussões das filmagens das interações professor e aluno. Resultados: Todos os participantes, antes do programa de acompanhamento fonoaudiológico, não apresentavam conhecimentos específicos necessários para atuação com o aluno deficiente auditivo. Entretanto, após o programa a totalidade dos participantes, apresentou conhecimentos sobre perda auditiva, recursos tecnológicos, estratégias de comunicação e fatores ambientais que interferem na comunicação do professor com o aluno deficiente auditivo. Para análise das filmagens, foram organizados 19 itens que compunham as estratégias de comunicação utilizadas pelo professor. Após o programa proposto, 11 itens foram classificados como "observados". Conclusão: O acompanhamento fonoaudiológico propiciou aos professores, tanto conhecimentos específicos sobre a deficiência auditiva, quanto à utilização de estratégias de comunicação que facilitam o diálogo com o aluno deficiente auditivo.|

The cooperation between teachers and therapists may contribute to the adjustment of the school context, allowing the learning of hearing impaired students, who use personal sound amplifi cation device (hearing aids) (Delgado-Pinheiro, 2003). This work aimed at characterizing the knowledge of teachers concerning hearing impairment, analyzing the communicative interaction of these teachers with the hearing impaired students and carrying out a program of speech and language therapeutical accompaniment. Ten teachers of hearing impaired students who attend regular school participated in this study. Interviews and video recordings were carried out before and after the accompaniment program, which included monthly meetings with the participants throughout the school year. The topics of the meetings were presented using debates, dialogues, audiovisual resources and discussing the video recordings of interactions between teacher and student. Initially, the participants did not have the necessary specifi c knowledge to act with the hearing impaired students. However, after the program, all the participants showed to know about hearing loss, technological resources, communication strategies and environmental factors infl uencing the communication with the hearing impaired student. The accompaniment provided the teachers with both specifi c knowledge about hearing impairment and the use of communication strategies which make easier the dialogue with the hearing impaired students.

Introducción: La actuación coordinada entre profesor y fonoaudiólogo podrá contribuir para que ocurran adecuaciones en el contexto escolar, posibilitando el aprendizaje de alumnos defi cientes auditivos, usuarios de audífonos o implante coclear que se comunican oralmente (Delgado-Pinheiro, 2003). Objetivo: Caracterizar el conocimiento de los profesores con respecto a la defi ciencia auditiva, analizar la interacción comunicativa de esos profesores con los alumnos que presenten pérdida auditiva y realizar un programa de seguimiento por un fonoaudiólogo. Metodología: Participaron de ese estudio diez profesores de alumnos defi cientes auditivos, que frecuentan la enseñanza regular. Se realizaron entrevistas y grabación de vídeos antes y después del programa de seguimiento fonoaudiológico. El programa de seguimiento realizado consistió en reuniones mensuales, con todos los participantes, durante el año lectivo. Los temas de las reuniones han sido presentados por medio de debates, diálogos, recursos audiovisuales y discusiones de los vídeos de las interacciones entre profesor y alumno. Resultados: Todos los participantes, antes del programa de seguimiento fonoaudiológico no presentaban conocimientos específi cos necesarios para lidear con el alumno defi ciente auditivo. Sin embargo, después del programa,la totalidad de los participantes presentó conocimientos sobre pérdida auditiva, recursos tecnológicos, estrategias de comunicación y factores ambientales que interfi eren en la comunicación entre profesor y alumno defi ciente auditivo. Para analizar las escenas grabadas, se organizaron 19 aspectos que componían las estrategias de comunicación utilizadas por el profesor. Después del programa propuesto, se observó la presencia de 11 aspectos. Conclusión: El seguimiento por el fonoaudiólogo propició a los profesores adquirir conocimientos específi cos sobre la defi ciencia auditiva y utilizar estrategias de comunicación que facilitan el dialogo con el alumno defi ciente auditivo.

Canal wall-down tympanoplasty and simultaneous auditory rehabilitation / 中国基层医药

Objective To explore the therapeutic effects of canal wall-down tympanoplasty(CWdT)on chronic otitis media and evaluate the effects of simultaneous auditory rehabilitation.Methods 13 cases on chronic otitis media with cholesteatoma and/or granulation tissue were treated by CWdT,the effects were contrast with radi- cal mastoidectomy.Results After 6 months to 6 years of follow-up,all the cases by CWdT had dry ear without re- currence.The rate of hearing restoration and improvement was 84.6% from the cases.In same times,the rate of re- currence,hearing restoration and improvement was 52.6%,31.0% from the mastoidectomies.Conclusion The CWdT has advantage in indication,removal of lesions and the operation could be adjusted appropriately for simulta- neously auditory rehabilitation.

Aural Rehabilitation and Development of Speech Perception Skills in Young Children with Profoundly Hearing Impairment

Rehabilitation of young children with hearing impairment can be defined as a teaching/learning process where the role of the clinician is to facilitate the acquisition of listening, speech and language in a normal developmental order. The young children with hearing impairment are helped by hearing aids and cochlear implants to learn language. Auditory (re)habilitation in young children with hearing impairment is to acquire auditory skills at four stages : sound detection, sound identification through imitation, sound discrimination, and comprehension. Without appropriate auditory training and early intervention, children with hearing impairment cannot develop spoken language. Speech acquisition is a perceptual as well as an oral process. To maximize the speech acquisition in children with hearing impairment, indepth understanding of the characteristics of the children, the parents' motivation and cooperation, a well-designed educational program, and the high competence of the health care professionals are important. Therefore, listening is not an isolated skill, and the auditory development in children with hearing impairment should be achieved in a comprehensive approach. Young children with hearing impairment need supports and guidance from health care professionals whose holistic approach balances auditory learning with the parallel development of the children's other learning processes.