Wave V threshold among children with delayed speech and language, using brainstem evoked response audiometry – A cross-sectional study

Background: Brainstem Evoked Response Audiometry (BERA) is an objective test for audiometric assessment of children. As deprived linguistic skill is often associated with auditory impairment in initial years of life; early diagnosis and interventions are much needed. Aim and Objective: To detect Wave V, in the lowest intensity, as it is a reliable parameter to assess BERA threshold for hearing among different age group of children. Materials and Methods: This cross-sectional study included 250 children (n = 250) with impaired speech and 120 normal children. The case population was divided into four groups according to age – Group 1 (<1 year); Group 2 (1–3 years); Group3 (3–6 years); and Group 4 (6–12 years). Wave V threshold was determined by BERA (measure brainstem auditory evoked potential). Cases were also divided into two categories depending on unilateral or bilateral involvement of ear. Mean threshold of each group was compared with corresponding control group of similar age. The test of significance used was Mann–Whitney U-test. Intragroup comparison was done by Kruskal–Wallis test. Results: In Group 1, 91.7%; Group 2, 100%; Group 3; 88.6%, and Group 4; 85% of children were suffering from bilateral hearing loss. In all the groups, mean threshold was statistically significantly increased in comparison with control group. In intragroup comparison, there was no statistically significant difference of threshold among all the groups of cases in both of the ears. Conclusions: This study identified increased wave V threshold in children with impaired speech of all four groups. Thereby, it indicates the necessity of BERA as screening method.

Limiar Diferencial de mascaramento e potencial evocado auditivo de tronco encefálico em adultos normo-ouvintes com zumbido / Masking Level Difference and Auditory Brainstem ResponseIn Normal Hearing Adults With Tinnitus / Umbral de enmascaramiento diferencial y potencial evocado auditivo del tronco encefálico en adultos con audición normal y tinnitus

Introdução: O zumbido é uma ilusão auditiva consciente, uma sensação sonora não relacionada com uma fonte externa de estimulação. Objetivos: Caracterizar a Acufenometria, Limiar Diferencial de Mascaramento, o questionário de qualidade de vida Inventário de Desvantagem do Zumbido e Potencial Auditivo de Tronco Encefálico em adultos normo-ouvintes com zumbido, com a finalidade de comparar seus achados. Método: Vinte indivíduos do sexo feminino e masculino, entre 20 e 60 anos de idade, normo-ouvintes com queixa de zumbido, foram submetidos ao Acufenometria, Limiar Diferencial de Mascaramento, Inventário de Desvantagem do Zumbido e Potencial Evocado Auditivo de Tronco Encefálico. Resultados: AAcufenometriarevelou que o pitch médio foi de 4,3 KHz à orelha direita e 4,6 KHz à orelha esquerda. O loudness médio foi de 21,7 dBNS à orelha direita e 23,5 dBNS à orelha esquerda. O Limiar Diferencial de Mascaramento médio mostrou-se alterado. O Inventário de Desvantagem do Zumbido médio correspondeu à classificação de grau leve. O Potencial Evocado Auditivo de Tronco Encefálico apresentou parâmetros dentro da normalidade bilateralmente. Conclusão: Constatou-se que adultos normo-ouvintes com queixa de zumbido apresentam zumbido de pitch agudo bilateral com discreto impacto na qualidade de vida, condução adequada das vias auditivas até o tronco encefálico e comprometimento na identificação de sons na presença de ruído, demonstrando que o zumbido pode ter repercussões nas habilidades auditivas centrais. (AU)

Introduction: Tinnitus is a conscious auditory illusion, a sound perception unrelated to any external stimulus source. Objectives: To characterize the Acuphenometry, Masking Level Difference, the quality of life questionnaire Tinnitus Handicap Inventory and Auditory Brainstem Response in normal hearing adults with tinnitus, with the purpose of comparing the findings. Method: Twenty female and male individuals, between 20 and 60 years of age, normal hearing with complaints of tinnitus, underwent Acuphenometry, Masking Level Difference, Tinnitus Handicap Inventory and Auditory Brainstem Response. Results: The Acuphenometry showed the average pitch was 4.3 KHz to the right ear and 4.6 KHz to the left ear. The average loudness was 21.7 dBSL to the right ear and 23.5 dBs to the left ear. The average Masking Level Difference was altered. The average Tinnitus Handicap Inventory corresponded to the classification of mild grade. Auditory Brainstem Response showed parameters within normal range bilaterally. Conclusion: It was found that normal hearing adults with tinnitus complaints have bilateral acute pitch tinnitus with a slight impact on quality of life, appropriate conduction of auditory pathways to the brainstem and impaired identification of sounds in the presence of noise, demonstrating that tinnitus can have repercussions on central auditory skills. (AU)

Introducción: El tinnitus es una ilusión auditiva consciente, una sensación de sonido no relacionada con una fuente externa de estimulación. Objetivos: Caracterizar la coincidencia de tono y volumen, el umbral de enmascaramiento diferencial, el inventario de minusvalía para acúfenos y el potencial auditivo del tronco encefálico en adultos normoyentes con acúfenos, con el fin de comparar sus hallazgos. Método:Veinte sujetos masculinos y femeninos, con edades entre 20 y 60 años, audición normal con tinnitus, fueron sometidos a acúfenos, Umbral de Enmascaramiento Diferencial, Inventario de Desventajas de Tinnitus y Potenciales Evocados Auditivos del Tronco Encefalico. Resultados: La combinación de tono y volumen reveló que el tono promedio era de 4,3 KHz en el oído derecho y de 4,6 KHz en el oído izquierdo. Mientras que el volumen medio fue de 21,7 dBNS para el oído derecho y de 23,5 dBNS para el oído izquierdo. Se modificó el umbral diferencial de enmascaramiento promedio. El Inventario de Desventajas de Tinnitus promedio correspondió a la clasificación de grado leve. El Potenciales Evocados Auditivos del Tronco Encefalico presentó parámetros dentro del rango normal bilateralmente. Conclusión:Se encontró que los adultos normooyentes con quejas de tinnitus presentan tinnitus de tono alto bilateral con leve impacto en la calidad de vida, conducción adecuada de las vías auditivas al tronco encefálico y deterioro en la identificación de sonidos en presencia de ruido, demostrando que Tinnitus puede tener repercusiones en las habilidades auditivas centrales. (AU)

Potenciais evocados auditivos de tronco encefálico em indivíduos com doença de Parkinson: revisão de literatura / Brainstem auditory evoked potentials in individuals with Parkinson's disease: literature review

Objetivo: investigar a integridade da via auditiva por meio do Potencial Evocado Auditivo de Tronco Encefálico (PEATE) em indivíduos com Doença de Parkinson (DP) por meio de uma revisão integrativa da literatura. Métodos: foram utilizadas as bases de dados Embase, Google acadêmico, Scielo, bem como o portal eletrônico completo da Biblioteca Virtual da Saúde, com os seguintes descritores: DP (Parkinson Disease ou Parkinsonian Disorders) e PEATE (Evoked Potentials, Auditory, Brain Stem ou Evoked Potentials, Auditory). Foram selecionados artigos nacionais e internacionais, sem limitação de ano ou idioma. Os estudos foram descritos e analisados qualitativamente e quantitativamente quanto à latência absoluta e à amplitude das ondas I, III e V, e quanto aos interpicos I-III, III-V e I-V. Resultados: após exclusão dos títulos repetidos, 420 artigos foram encontrados, sendo que 17 atenderam aos critérios de inclusão. Nos resultados do PEATE, estudos descreveram o aumento da latência de todas as ondas, principalmente das ondas III e V e, também, aumento dos interpicos I-V e III-V. Conclusão: indivíduos com DP apresentam neurodegeneração das vias auditivas centrais com diminuição na velocidade de transmissão neural do estímulo acústico.

Purpose: investigate the integrity of the auditory pathway through the Brainstem Auditory Evoked Potential (BAEP) in individuals with Parkinson's Disease (PD) through an integrative literature review. Methods: Embase, Academic Google, Scielo databases were used, as well as the complete electronic portal of the Virtual Health Library, with the following descriptors: PD (Parkinson Disease or Parkinsonian Disorders) and BAEP (Evoked Potentials, Auditory, Brain Stem or Evoked Potentials, Auditory). National and international articles were selected, without limitation of year or language. The studies were described and analyzed qualitatively and quantitatively regarding the absolute latency and amplitude of waves I, III and V, and regarding the interpeaks I-III, III-V and I-V. Results: After excluding repeated titles, 420 articles were found, however only 17 met the inclusion criteria. In the ABR results, studies described the increase in latency of all waves, especially waves III and V, and also an increase in interpeaks I-V and III-V. Conclusion: individuals with PD present neurodegeneration of the central auditory pathways with a decrease in the neural transmission speed of the acoustic stimulus.

The effect of increase in blood glucose level on hearing loss

Abstract Objective: Previous studies have shown that hearing function is also vulnerable to the effects of diabetes mellitus which can be shown by brainstem auditory evoked potential and distortion product otoacoustic emission recordings. This study aimed to investigate the changes of brainstem auditory evoked potential and distortion product otoacoustic emission in hyperglycemia and whether there is a relationship between reactive oxygen substances production and hearing deterioration in the rat model. Methods: 25 streptozotocin induced diabetic rats were divided into three groups: control, high blood glucose, and diabetes mellitus. Brainstem auditory evoked potential and distortion product otoacoustic emission were recorded, and thiobarbituric acid reactive substances levels were measured in the brainstem tissue. Results: At 8 kHz, the latencies of I, II, III, IV, and V brainstem auditory evoked potential waves in high blood glucose and diabetes mellitus groups were elongated, at 16 kHz, only these wave latencies of the diabetes mellitus group were prolonged compared with the control group. A significant decrease was also found in distortion product otoacoustic emission amplitudes at 4, 6, 8, and 10 kHz in the high blood glucose and diabetes mellitus groups compared to the control group. There was a significant increase in thiobarbituric acid reactive substances values due to the increase in blood glucose levels in the high blood glucose and diabetes mellitus groups compared to the control group. Conclusion: These results suggested that high blood glucose levels may cause hearing impairment not only in the diabetic state but also in the period of hyperglycemia before the onset of manifest diabetes mellitus and reactive oxygen substances may play an important role in the pathophysiology of diabetes mellitus. We suggest that regulating high glucose levels even before the onset of manifest diabetes mellitus may prevent hazardous effects on hearing function. Level of evidence: Level 3.

Comparative assessment of brainstem auditory evoked potentials in apparently healthy medical students with a family history of diabetes mellitus type 2

Background: Neuronal studies on diabetes mellitus (DM) were previously based on peripheral and autonomic nerves. With the advent of Brainstem Auditory Evoked Potential (BAEPs), studies on sensory pathways in the central nervous system become easier and more productive. BAEPs is a non-invasive electrophysiological tool to detect retro-cochlear lesion. Hence, it is helpful to detect early Impairment of the auditory nerve and brainstem function. Aim and Objective: DM Type 2 (T2DM) is a known cause of neuropathy and in earlier course, it involves sensory nerves. T2DM runs in families and it has a genetic predisposition. BAEP is one of the methods to find out problems related to hearing by analyzing latencies of waveforms and inter-peak latencies. Hence, BAEPs in apparently healthy subjects with and without family history of T2DM is assessed. Materials and methods: This is a cross-sectional, casecontrol study. We have taken 110 volunteers from MBBS students of IMS, BHU of 17–23 years of age. Those with co-morbid conditions (eg. diabetes and hypertension), neurodegenerative diseases, neuropathy, schizophrenia, and those on ototoxic and neurotoxic drugs are excluded from the study. After taking consent and conducting a preliminary physical examination, BAEPs are recorded using a proper BAEP recording device. Statistical analysis is done using SPSS 2016 software trial version with Chi-square test. Results: The subjects with positive family history of T2DM in paternal grandfather showed deviation in latencies of BAEPs wave I (P < 0.001), wave III (P = 0.019), wave V (P = 0.033), and inter-peak latency between wave I and wave V (P = 0.019) from the normal values in the left ear. The subjects with positive family history of T2DM in paternal grandmother showed deviation from the normal in case of V/I % in the right ear (P = 0.016). Conclusion: The presence of T2DM in families can affect the wave latencies and inter-peak latencies of BAEPs.

Audiological profile of individuals with Cornelia de Lange syndrome: an integrative review / Perfil audiológico de indivíduos com síndrome de Cornelia de Lange: revisão integrativa da literatura

ABSTRACT Purpose: to describe the audiological profile of patients with Cornelia de Lange syndrome (CdLS) in an integrative review of the literature. Methods: after developing the research question, articles were searched in six databases (EMBASE, ISI of Knowledge, LILACS, MEDLINE/PubMed, SciELO, and Scopus) and in sources of information (Google Scholar, OpenGrey, and ProQuest), with the following descriptors: audiology, hearing loss, deafness, hearing disorders, and Cornelia de Lange syndrome. This review was registered in Prospero under number CRD42020191481. National and international studies were considered for analysis, using the PECO acronym. The risk of bias in the studies was analyzed with Joanna Briggs Institute protocols. Then, the studies were described and analyzed. Results: of the 1,080 articles found, 12 met the inclusion criteria. Audiological results showed that individuals with CdLS can have hearing loss - conductive hearing losses were the most frequent impairments, corresponding to 49.20% of individuals with CdLS assessed, followed by sensorineural hearing losses (13.49%). The degrees of hearing loss ranged from mild to profound. Conclusion: individuals presented with CdLS often have hearing loss, mainly due to middle ear changes, with degrees ranging from mild to profound.

RESUMO Objetivo: descrever o perfil audiológico de pacientes com Síndrome de Cornelia de Lange (SCdL), por meio de uma revisão integrativa da literatura. Métodos: após formulação da pergunta, realizou-se uma busca em seis bases de dados (Embase, ISI of Knowledge, Lilacs, Medline/PubMed, Scielo e Scopus), e fontes de informação (Google Acadêmico, OpenGrey e Proquest), com os descritores: audiologia, perda auditiva, surdez, transtornos da audição e Síndrome de Cornelia de Lange. Esta revisão foi cadastrada no Próspero, sob número CRD42020191481. Foram considerados para análise, estudos nacionais e internacionais, utilizando o direcionamento do acrônimo PECO. Para análise do risco de viés dos estudos, utilizou-se os protocolos do Instituto Joanna Briggs. Após isso, os estudos foram descritos e analisados. Resultados: dos 1.080 artigos encontrados, 12 atenderam aos critérios de inclusão. Nos resultados audiológicos, constatou-se que indivíduos com SCdL podem apresentar perda auditiva, sendo que o comprometimento pela perda auditiva condutiva foi o mais frequente, correspondendo a 49,20% dos indivíduos com SCdL avaliados, seguido pela perda auditiva neurossensorial (13,49%). O grau de perda auditiva variou de leve à profundo. Conclusão: indivíduos com SCdL frequentemente apresentam perda auditiva, decorrente principalmente de alterações de orelha média, com graus variando de leve a profundo.

Cochleopalpebral reflex: sensitivity and specificity in the auditory screening of newborns discharged from the neonatal intensive care unit / Reflejo cocleopalpebral: sensibilidad y especificidad en el tamiz auditivo de recién nacidos egresados de una unidad de cuidados intensivos neonatales

Abstract Background: The sensitivity and specificity of the clinical audiological evaluation in newborns are debatable compared to neurophysiological methods of a hearing evaluation. This study aimed to determine the sensitivity and specificity of the cochleopalpebral reflex as a clinical test for hearing screening in newborns. Methods: A case-control study was designed. Newborns discharged from a neonatal intensive care unit (NICU) were included. Brainstem evoked auditory potentials were recorded. A wooden rattle was used to explore the cochleopalpebral reflex. The sensitivity and specificity of the cochleopalpebral reflex were calculated. Continuous data were analyzed with Student's t-test, with statistically significant p-values < 0.05. Results: We selected 450 newborns who were divided into two groups: group A, with bilateral sensory neural hearing loss (n = 150), and group B, with normal hearing (n = 300). Group A showed a significantly lower gestation age at birth (p = 0.005) compared to group B (32.5 ± 2.6 vs. 34.4 ± 3.5 weeks). In group A, the cochleopalpebral reflex's sensitivity was 80% using the wooden rattle. In group B, the specificity was 98%. Conclusions: The NICU discharged newborns' clinical hearing evaluation is not enough to exclude hearing loss. Although it may be the only diagnostic tool for hearing loss in some settings, its limitations should be considered.

Resumen Introducción: La sensibilidad y la especificidad de la evaluación audiológica clínica en recién nacidos son cuestionables en comparación con los métodos neurofisiológicos de evaluación auditiva. El objetivo de este estudio fue determinar la sensibilidad y la especificidad del reflejo cocleopalpebral como prueba clínica de tamizaje auditivo en recién nacidos. Métodos: Se diseñó un estudio de casos y controles en el que se incluyeron recién nacidos egresados de una unidad de cuidados intensivos neonatales (UCIN). Se les efectuaron potenciales auditivos evocados de tallo cerebral. Para la exploración del reflejo cocleopalpebral se utilizó una matraca de madera. Se calcularon la sensibilidad y la especificidad del reflejo cocleopalpebral. Los datos continuos se analizaron con la prueba t de Student y se consideraron estadísticamente significativos los valores de p < 0.05. Resultados: Se seleccionaron 450 recién nacidos y se dividieron en dos grupos: el grupo A (n = 150) con hipoacusia sensorineural y el grupo B (n = 300) con audición normal. El grupo A mostró una diferencia significativa (p = 0.005) en cuanto a la edad de gestación al nacer en comparación con el grupo B (32.5 ± 2.6 vs. 34.4 ± 3.5 semanas). En el grupo A, la sensibilidad del reflejo cocleopalpebral fue del 80% utilizando la matraca de madera. En el grupo B se encontró una especificidad del 98%. Conclusiones: La evaluación del reflejo cocleopalpebral como prueba clínica de tamizaje auditivo en una población de recién nacidos egresados de una UCIN no es suficiente para descartar la pérdida de la audición. Aunque puede ser la única herramienta de diagnóstico para evaluar la pérdida de la audición en algunos casos, es importante considerar sus limitaciones.

Padronização dos parâmetros latência e amplitude no registro dos potenciais evocados auditivos de tronco encefálico com o estímulo Ichirp de banda estreita em adultos audiologicamente normais / Standardization of latency and amplitude parameters on brainstem auditory evoked potential recording with narrow band Ichirp stimulus in normal hearing adults

RESUMO Objetivo Padronizar os parâmetros de latência e amplitude obtidos com o estímulo Ichirp de banda estreita, na pesquisa dos potenciais evocados auditivos de tronco encefálico nas frequências de 500 Hz, 1 kHz, 2 kHz e 4 kHz. Métodos O estudo foi realizado na Divisão de Saúde Auditiva do Hospital de Reabilitação de Anomalias Craniofaciais, da Universidade de São Paulo. Participaram 20 adultos ouvintes normais, na faixa etária de 18 a 35 anos. Todos os participantes foram submetidos à audiometria tonal limiar, logoaudiometria, imitanciometria e aos potenciais evocados auditivos de tronco encefálico, pesquisados com o estímulo Ichirp de banda estreita, nas frequências de 500 Hz, 1 kHz, 2 kHz e 4 kHz. Resultados Em todas as frequências avaliadas foi observada a função latência-intensidade, ou seja, o aumento na latência da onda V, na medida em que a intensidade do estímulo foi diminuída, bem como a diminuição na latência da onda V com o aumento da frequência avaliada. Além disso, verificou-se a redução na amplitude da onda V com a diminuição da intensidade do estímulo. Constatou-se o nível mínimo de resposta, em todas as frequências, em níveis inferiores aos valores sugeridos pela literatura como critério de normalidade no registro dos potenciais evocados auditivos de tronco encefálico de frequência específica, sendo os maiores valores nas frequências de 500 Hz e 1 kHz. Conclusão Foram obtidos os valores de referência de normalidade para os potenciais evocados auditivos de tronco encefálico em adultos ouvintes normais com o estímulo Ichirp, valores estes que podem contribuir para o aprimoramento do exame, na prática clínica.

ABSTRACT Purpose Standardize the latency and amplitude parameters using the narrow band Ichirp stimulus on Brainstem Auditory Evoked Potential (BAEP) at frequencies of 500 Hz, 1 kHz, 2 kHz and 4 kHz. Methods The study was performed at the Hospital for Rehabilitation of Craniofacial Anomalies (HRAC), Auditory Health Division, University of São Paulo (USP). Twenty normal hearing adults, aged between 18 and 35 years, were submitted to pure tone audiometry, speech audiometry, immittance and to BAEP with narrow band Ichirp stimulus at 500 Hz, 1 kHz, 2 kHz and 4 kHz frequencies. Results In all frequencies evaluated, the latency-intensity function was observed, that is, the increase in the latency of the V wave as the stimulus intensity was decreased, as well as the decrease in the latency of the V wave with the increase of the frequency. In addition, the reduction in the amplitude of the wave V was verified with the decrease of the intensity of the stimulus. The minimum response level, in all frequencies, was found to be lower than the values suggested in the literature as a criterion of normality in frequency - specific BAEP, with the highest values at frequencies of 500 Hz and 1 kHz. Conclusion Normal reference values to BAEP were obtained in normal hearing adults with the narrow band Ichirp stimulus, which may contribute to its improvement in clinical practice.

Influência do sexo nas respostas do potencial evocado auditivo de tronco encefálico com diferentes estímulos em neonatos / The influence of gender on brainstem auditory evoked potentials responses to different stimuli in newborns

RESUMO Objetivo avaliar a influência da variável sexo nos valores da latência e amplitude da onda V do potencial evocado auditivo de tronco encefálico, com diferentes estímulos em neonatos. Métodos participaram deste estudo 62 neonatos nascidos a termo (29 do sexo feminino e 33 do sexo masculino). Realizou-se a pesquisa de limiar eletrofisiológico do potencial evocado auditivo de tronco encefálico com quatro estímulos diferentes (clique, Ichirp banda larga-BL, tone burst e Ichirp-frequência específica-FE), nas intensidades de 60, 40 e 20 dBnNA. A variável sexo foi comparada para cada estímulo e intensidade. Resultados os resultados obtidos demonstraram menor latência e maior amplitude no sexo feminino para o estímulo clique. Entretanto, para o estímulo tone burst, o sexo feminino apresentou maior latência e maior amplitude. Quando utilizados os estímulos Ichirp-BL e Ichirp-FE, a variável sexo não apresentou diferença estatisticamente significativa para os valores de latência e amplitude. Conclusão a onda V do PEATE de neonatos sofre influência da variável sexo, quando utilizados os estímulos clique e tone burst. Entretanto, não houve tal influência quando utilizado o estímulo Ichirp banda larga-BL e o estímulo Ichirp frequência específica-FE.

ABSTRACT Purpose To evaluate the influence of gender on the brainstem auditory evoked potentials V-wave latency and amplitude values in newborns, with different stimuli. Methods 62 full-term newborns (29 females and 33 males) participated in this study. The electrophysiological threshold of the brainstem auditory evoked potential was investigated with four different stimuli - click, broadband (BB) Ichirp, tone-burst, and specific-frequency (SF) Ichirp -, in intensities of 60, 40 and 20 dBnHL. The genders were compared in each stimulus and intensity. Results The results obtained showed lower latency and greater amplitude in females for the click stimulus. However, for tone-burst, the females presented higher latency and greater amplitude. When the BB-Ichirp and SF-Ichirp stimuli were used, the gender did not present a statistically significant difference in the latency and amplitude values. Conclusion The BAEP V-wave in newborns is influenced by gender when the click and tone-burst stimuli are used. However, such influence was not noted when the BB-Ichirp and SF-Ichirp stimuli were used.

Frequency-following response (FFR) com estímulo de fala em jovens adultos normo-ouvintes / Frequency-following response (FFR) with speech stimulus in normal-hearing young adults

RESUMO Objetivo: Analisar o slope e as latências e amplitudes das ondas V, A, C, D, E, F e da Frequency-Following Response, com estímulo de fala, em adultos com audição normal, tendo como base referência internacional. Método: Onze adultos normo- ouvintes com idade entre 18 e 30 anos, sem queixas auditivas, foram avaliados na pesquisa. O equipamento utilizado foi o Intelligent Hearing System. O estímulo de fala /da/ foi apresentado por meio de fone de inserção na orelha direita e a resposta foi captada por meio de eletrodos posicionados no vértex, na mastoide direita e eletrodo terra na fronte. Resultados: Os valores descritivos de latência dos componentes foram: V 6,50, A 7,87, C 17,74, D 22,77, E 32,07, F 40,03 e O 48,07 ms. As médias de amplitude foram V 0,17, A -0,12, C -0,14, D -0,14, E -0,20, F -0,22 e O -0,14 µV. A média do valor do slope encontrada foi 0,23. Na comparação com estudo de referência internacional, Krizman et al. (2012) mostraram que a maioria dos resultados se encontra dentro de um desvio padrão positivo e negativo para a faixa etária estudada tanto para o slope quanto para as latências e amplitudes. Conclusão: A resposta eletrofisiológica da Frequency Following Response, utilizando o estímulo de fala /da/, em adultos com audição normal e sem queixas auditivas, apresentou valores de slope e de latência e amplitude de todos os componentes dentro do padrão de normalidade apresentado pela literatura internacional.

ABSTRACT Purpose: Analyze the slope, latency and amplitude values of the waveforms V, A, C, D, E, F and O from Frequency-following Response (FFR) with speech stimulus in normal-hearing adults based on a recent international reference study. Method: Eleven normal-hearing adults aged 18-30 years, without hearing complaints, were evaluated in this study using an Intelligent Hearing Systems device. The speech stimulus /da/ was presented to the right ear via insertion phone and the responses were captured by electrodes placed on the vertex, right mastoid bone, and forehead (ground). Results: The descriptive latency values of the components were V 6.50, A 7.87, C 17.74, D 22.77, E 32.07, F 40.03 and O 48.07 ms. The mean amplitude measures of the waves were V 0.17, A -0.12, C -0.14, D -0.14, E -0.20, F -0.22 and O -0.14 µV. The mean slope value was 0.23. Comparison with an international study, Krizman et al. (2012), showed that most of the results are within positive and negative standard deviation values for the assessed age group for slope, latency and amplitude. Conclusion: The electrophysiological measures obtained from Frequency-following Response using the speech stimulus / da/ in normal-hearing adults without hearing complaints showed slope, latency and amplitude values of all FFR components within the normality standard described in the international literature.

Respuestas evocadas auditivas obtenidas mediante un estímulo chirp de banda ancha / Auditory evoked responses obtained by a broad-band chirp stimulus

Introducción: La estimación de la audición con Potenciales Evocados Auditivos de Tallo Cerebral obtenidos mediante estímulos tipo chirp constituye una alternativa de reciente aplicación. Varios autores han demostrado que, este tipo de estimulación compensa el retardo de la onda sonora en la codificación de frecuencias, generándose Potenciales Evocados Auditivos de Tallo Cerebral con componentes de amplitudes mayores. Objetivos: Diseñar y generar un estímulo chirp (banda ancha) para implementar en el sistema AUDIX (La Habana, Neuronic SA) y, realizar una serie de controles para evaluar su viabilidad en el registro de Potenciales Evocados Auditivos de Tallo Cerebral en sujetos con audición normal. Métodos: Las formulaciones que se utilizaron en la generación del estímulo fueron implementadas como una función en Matlab®, y luego, insertada en el sistema AUDIX con las siguientes especificaciones técnicas, frecuencia de muestreo: 48 kHz, composición de frecuencias (ascendente): 350-11300 Hz, y duración total: 4,95 ms. Se obtuvieron registros de PEATC mediante estímulos chirp y click a un nivel de intensidad fija (60 dB nHL) en 9 sujetos adultos (18 oídos) con audición normal. Resultados: El estímulo chirp diseñado tuvo un comportamiento funcional similar a lo reportado en la literatura. Cuando se compara con los Potenciales Evocados Auditivos de Tallo Cerebral -click, la onda V de Potenciales Evocados Auditivos de Tallo Cerebral -chirp mostró valores de amplitud significativamente mayores (relación de amplitud chirp/click: 1,62), con una ganancia promedio de 54 por ciento (p< 0,001, n= 18, prueba de rangos de Wilcoxon). Conclusiones: El estímulo chirp (banda ancha) diseñado resulta más eficiente que el estímulo click para obtener registros de Potenciales Evocados Auditivos de Tallo Cerebral. Con respecto a la amplitud de la onda V, el sistema muestra un funcionamiento lineal (mejor sincronía neural). Este tipo de estimulación pudiera resultar de mucha utilidad en programas de pesquisa auditiva neonatal pues la obtención de una onda V de mayor amplitud permitiría su fácil y rápida detección, y posible automatización(AU)

Introduction: Estimation of audition through brainstem auditory evoked potentials obtained by chirp stimuli is an alternative of recent application. It has been shown by several authors that this type of stimulation compensates for retardation of the sound wave in the coding of frequencies, generating auditory evoked responses with components of higher amplitudes. Objectives: Design and develop a broad-band chirp stimulus to be implemented in the AUDIX system and conduct a control series evaluation of its viability to register brainstem auditory evoked potentials in normal-hearing subjects. Methods: The formulations used to generate the stimulus were implemented as a function on Matlab® and then incorporated into the AUDIX system with the following technical specifications: sampling frequency: 48 kHz, frequency composition (rising): 350-11 300 Hz, and total duration: 4.95 ms. BAEP registries were obtained with chirp and click stimuli at a fixed intensity level (60 dB nHL) in nine normal-hearing adult subjects (18 ears). Results: The chirp stimulus designed had a functional behavior similar to the one reported in the literature. When compared with the click-BAEP, the V wave of chirp-BAEP displayed significantly higher amplitude values (chirp/click amplitude ratio: 1.62), with an average gain of 54 percent (p< 0.001, n= 18, Wilcoxon rank test). Conclusions: The broad band chirp stimulus designed proved to be more efficient than the click stimulus to obtain registries of Brainstem Auditory Evoked Potentials. Regarding V wave amplitude, the system was found to function linearly (better neural synchrony). This type of stimulation could be very useful in neonatal hearing screening programs, since a higher amplitude V wave could facilitate its fast and easy detection and possible automation(AU)

Auditory training in autism spectrum disorder: a case report / Treinamento auditivo no transtorno do espectro autista: relato de caso

ABSTRACT This study aimed to measure the effects of a Computer-based Auditory Training Program (CBATP) on an adolescent diagnosed with Autism Spectrum Disorder (ASD) and Central Auditory Processing Disorder (CAPD). This is the case report of a male, 14-year-old adolescent diagnosed with ASD. The individual was submitted to basic audiological evaluation, central auditory processing assessment and hearing electrophysiology (EP), pre- and post-therapeutic intervention. Central auditory processing (CAP) was assessed by means of the following instruments: Time-compressed Speech Test (TCST), Random Gap Detection Test (RGDT), Staggered Spondaic Word Test (SSWT), Frequency (Pitch) Pattern Sequence Test (FPST), and Duration Pattern Test (DPT). The P300 component of the Event-related Potential (ERP) was used in the hearing EP. Pre-intervention assessment of CAP showed changes in the auditory skills of closure, figure-ground and temporal ordering, but normal temporal resolution ability. Post-intervention evaluation of CAP showed improvement in all previously mentioned auditory skills, except for the figure-ground ability, which remained unchanged. Regarding the findings of the hearing EP, a decrease in the latency of the P300 component was observed pre- and post-intervention. This study demonstrated that the use of a CBATP resulted in improvement in the hearing abilities assessed in an adolescent diagnosed with ASD.

RESUMO O objetivo deste estudo foi mensurar o efeito do treinamento auditivo computadorizado em um adolescente diagnosticado com Transtorno do Espectro Autista e Transtorno do Processamento Auditivo. Participou do estudo um adolescente de 14 anos, do sexo masculino, diagnosticado com Transtorno do Espectro Autista. O sujeito foi submetido à avaliação audiológica básica, avaliação do processamento auditivo central e avaliação eletrofisiológica da audição pré e pós-intervenção. A avaliação do processamento auditivo foi composta do Teste de Fala Comprimida (FC), Randon Gap Detection Test (RGDT), Staggered Spondaic Words (SSW), Teste de Padrão de Frequência (TPF) e Teste de Padrão de Duração (TPD). Na avaliação eletrofisiológica, utilizou-se o Potencial Evocado Auditivo Cognitivo (P300). Na avaliação do processamento auditivo central pré-intervenção terapêutica, observou-se alteração nas habilidades de fechamento auditivo, figura-fundo e ordenação temporal. Na habilidade auditiva de resolução temporal, o sujeito da pesquisa demonstrou desempenho dentro dos padrões de normalidade. Na realização do processamento auditivo central, foi possível observar melhora nos resultados de todas as habilidades auditivas citadas anteriormente, exceto na habilidade de figura-fundo, que permaneceu alterada. Quantos aos achados da avaliação eletrofisiológica da audição, verificou-se diminuição da latência do componente P300 na comparação dos resultados pré e pós-treinamento auditivo. Este estudo demonstrou que a utilização de treinamento auditivo trouxe como efeito uma melhora das habilidades auditivas avaliadas de um adolescente diagnosticado com Transtorno do Espectro Autista.

Clinical applications of auditory evoked potentials in ICU / 中国小儿急救医学

In critically ill patients,evoked potential(EP) testing is an important tool for measuring neurologic function,signal transmission,and secondary processing of sensory information in real time.EP potential measures conduction along the peripheral and central sensory pathways with longer-latency potentials representing more complex thalamocortical and intracortical processing.In critically ill patients with limited neurologic exams,EP provides a window into brain function and the potential for recovery of consciousness.Brainstem auditory EP and cortical event-related potentials are most commonly used in ICU.The primary indications for EP in critically ill patients are prognostication in anoxic-ischemic or traumatic coma,monitoring for neurologic improvement or decline,and confirmation of brain death.Historically,EP has been regarded as a negative prognostic test,that is,the absence of cortical potentials are associated with poor outcomes while the presence cortical potentials are prognostically indeterminate.In recent studies,the presence of middle-latency and long-latency potentials as well as the amplitude of cortical potentials is more specific for good outcomes.Event-related potentials,particularly mismatch negativity of complex auditory patterns,is emerging as an important positive prognostic test in patients under comatose.In infants,other than anoxic-ischemic or traumatic brain injury,brainstem auditory is also widely used in premature baby,bilirubin encephalopathy and detection of possible hearing loss.

Brainstem auditory evoked potentials in children with lead exposure / Potencial evocado auditivo de tronco encefálico em crianças com exposição ao chumbo

Introduction: Earlier studies have demonstrated an auditory effect of lead exposure in children, but information on the effects of low chronic exposures needs to be further elucidated. Objective: To investigate the effect of low chronic exposures of the auditory system in children with a history of low blood lead levels, using an auditory electrophysiological test. Methods: Contemporary cross-sectional cohort. Study participants underwent tympanometry, pure tone and speech audiometry, transient evoked otoacoustic emissions, and brainstem auditory evoked potentials, with blood lead monitoring over a period of 35.5 months. The study included 130 children, with ages ranging from 18 months to 14 years, 5 months (mean age 6 years, 8 months ± 3 years, 2 months). Results: The mean time-integrated cumulative blood lead index was 12 µg/dL (SD ± 5.7, range:2.433). All participants had hearing thresholds equal to or below 20 dBHL and normal amplitudes of transient evoked otoacoustic emissions. No association was found between the absolute latencies of waves I, III, and V, the interpeak latencies I-III, III-V, and I-V, and the cumulative lead values. Conclusion: No evidence of toxic effects from chronic low lead exposures was observed on the auditory function of children living in a lead contaminated area. .

Introdução: Estudos anteriores têm demonstrado efeitos da exposição ao chumbo no sistema auditivo em crianças, porém a exposição deste metal em níveis baixos ainda precisa ser investigada. Objetivo: Investigar os efeitos da exposição crônica ao chumbo no sistema auditivo de crianças com histórico de baixo nível sanguíneo de chumbo por meio de um teste eletrofisiológico. Método: Estudo de coorte transversal contemporânea. Foram realizados imitanciometria, audiometria tonal liminar e vocal, emissões otoacústicas evocadas transientes e potenciais evocados auditivos de tronco encefálico, com o monitoramento sanguíneo de chumbo durante um período de 35,5 meses. Participaram 130 crianças na faixa etária de 18 meses a 14 anos e 5 meses (6a8 m ± 3a2 m). Resultados: A média estimada do índice de pumblemia foi 12 mg/dL (DP ± 5,7). Todos os participantes apresentaram limiares auditivos iguais ou inferiores a 20 dBNA e amplitude normal das emissões otoacústicas evocadas transientes. Não foi encontrada associação entre as latências absolutas das ondas I, III e V e interpicos I-III, III-V e I-V e os valores cumulativos de chumbo. Conclusão: Não foi observada evidência de efeitos tóxicos em baixas exposições crônicas ao chumbo sobre a função auditiva de crianças que vivem em uma área contaminada por este metal. .

Early Detection Tools for Cerebral Palsy (review) / 中国康复理论与实践

@#The studies on early detection of cerebral palsy(CP) showed that neurological examinations(Vojta Posture Reflex, Infant Movement Milestone, Neonatal Behavioral Neurological Assessment, General Movement Assessment), imaging examinations (cranial B-ultrasonography, CT, MRI) and electrophysiologic examinations (Brainstem auditory evoked potentials, electroencephalogram, somatosensory evoked potentials) are in common use. General Movement Assessment was used in China three years ago, showing high sensitivity and specificity in predicting CP. Imaging examinations and electrophysiologic examinations can find organic diseases and other dysfunctions.

The Hearing Status and the Functions of Efferent System in Autistic Children / 听力学及言语疾病杂志

Objective To assess hearing and efferent system functions of autistic children.Methods Tests were performed on 30 Autistic children and 15 normal children to evaluate hearing objectively by using otoacoustic emission (OAE) and auditory brainstem response (ABR).The efferent system functions were analyzed through contralateral suppression in OAE.Results The mean ABR Ⅰ-Ⅴ interpeak latencies (IPLs) in children with Autism were significantly reduced than that in the control group.The amplitudes of OAE at 1 kHz and 2 kHz in autistic children were significantly different in two groups.There were no significant differences in contralateral suppressions between the Autistic children and the control.Conclusion Hearing impairment may be more common in children with Autism than in normal children,while for a few Autistic children,their efferent system functions are affected.

Effects of Electric Stimulation on Mastoidea on Ischemic Stroke using TCD and BAEP / 中国康复理论与实践

@# Objective To observe the effects of electric stimulation on mastoidea in the patients with ischemic stroke by transcranial Doppler sonography (TCD) and brainstem auditory evoked potentials (BAEP).Methods 40 patients with ischemic stroke were equally divided into two groups, i.e., observation group (20 cases) and control group(20 cases). The two groups received routine treatment, while the observation group added electrical stimulation on mastoidea. The blood flow vecolity of anterior cerebral artery (ACA), middle cerebral artery (MCA), posterior cerebral artery (PCA), vetebral artery (VA) and basilar artery (BA), and the peak latency(PL) of wavesⅠ, Ⅲ and Ⅴ, and inter-peak latency(IPL) of Ⅰ-Ⅲ and III-V were examined by TCD and BAEP before and 2 weeks after treatment.Results The blood flow velocity in the observation group accelerated after treatment compared to pre-treatment(P<0.05). Compared with the control group, the blood flow velocity in the observation group accelerated more markedly(P<0.001). The nerve conduction in both groups improved after treatment. After treatment, PL of waves I, Ⅲ and V, and IPL of I-Ⅲ, III-V and III-V/I-Ⅲ in the observation group improved more significantly than the control group(P<0.05). Conclusion Electric stimulation on mastoidea can enhance the blood flow velocity of brain and the function of brainstem nerve conduction in patients with ischemic stroke.

ESTIMACIÓN DE POTENCIALES EVOCADOS AUDITIVOS DEL TRONCO CEREBRAL MEDIANTE DESCOMPOSICIÓN MODAL EMPÍRICA

Los potenciales evocados auditivos del tronco cerebral (PEATC) son frecuentemente usados para fines diagnósticos; sin embargo, su procesamiento se hace difícil porque están inmersos en una gran cantidad de ruido proveniente no solo de fuentes externas sino también fisiológicas. Hasta ahora el método más utilizado y aceptado para obtener un registro confiable es la promediación coherente, aunque presenta algunos inconvenientes. La descomposición modal empírica (EMD) es una técnica relativamente nueva que se usa para el procesamiento de señales no estacionarias como la mayoría de señales fisiológicas. Este método separa una señal, extrayendo la energía asociada a diferentes escalas de tiempo intrínsecas, en una suma finita de modos oscilatorios. El propósito de este trabajo fue evaluar la EMD como una herramienta para mejorar el desempeño de la promediación coherente de PEATC buscando reducir la cantidad de épocas necesarias para obtener un registro confiable. Para tal fin se analizó la reconstrucción de ocho registros usando solamente los modos 2, 3 y 4 resultantes de la EMD, los estudios determinaron que una reconstrucción de 800 épocas es aceptable.

The brainstem auditory evoked potentials (BAEPs) are commonly used for diagnostic purposes; however, processing becomes difficult because they are immersed in a large amount of noise coming not only from external sources but also from other physiological sources. So far the most widely used and accepted method to obtain reliable recording is the coherent averaging, but this type of processing presents some drawbacks. The empirical mode decomposition (EMD) is a relatively new technique which is used for processing of non-stationary signal like almost physiological signals. This method separates a signal, xextracting the energy associated with various intrinsic time scales, into a finite set of oscillatory modes. The purpose of the study was to asssess the EMD as a tool for improving the performance of the averaging coherent BAEPs seeking to reduce the amount of epochs needed to obtain a reliable register. To this end, we have analyzed the reconstruction of eight registers using only modes 2, 3 and 4 resulting from the EMD, the studies found that a reconstruction of 800 epochs is acceptable.

Auditory Nerve Way Injury of Children with Cerebral Palsy:A 963-case Report / 中国康复理论与实践

@#Objective To investigate the incidence rate of auditory nerve way injury in children with cerebral palsy (CP) and the relationship with sexes, CP types and risk factors.MethodsThe clinic data of 963 children with CP were reviewed to find out the incidence rate of auditory nerve way injury in CP children and the relationship with sexes, CP types and risk factors.ResultsIn 963 CP children, the incidence rate of auditory nerve way injury was 24.5% (236/963), there was no sexes difference ( P>0.05), but there was a significant difference among different CP types ( P<0.05), athetosis and mixed CP had higher incidence rate ( P<0.01). Furthermore, pathological jaundice was high risk factor ( OR=2.0279, 95%CI:1.483～2.774).ConclusionCP children are often complicated with auditory nerve way injury, it not relate with sexes, but with CP type, athetosis and mixed CP have a higher incidence rate of auditory nerve way injury, and the pathological jaundice is a high risk factors.

The primary application of intra-operative evoked potentials monitoring in microsurgery of intracranial aneurysms / 中国神经精神疾病杂志

Background Although remarkable progress has been made in microsurgery, surgery of intracranial aneurysm still encounters various complications. Cerebral ischemia and postoperative disorders of nervous system could be induced by various specific operation procedures. To improve the outcomes in intracranial aneurysm surgery and to minimize the occurrence of postoperative ischemic complications, it is necessary to perform real-time monitoring on ischemic damages for the corresponding functional areas. To elevate the sensitivity of Eps changes for the detection of cerebral ischemia induced by operation, we monitored Motion Evoked Potential ( MEPs), Somatosensory Evoked Potential (SSEPs)and Brainstem Auditory Evoked Potential (BAEPs) in microsurgical operations of intracranial aneurysms. And then the correlation between Eps changes and clinical outcome was investigated.Methods MEPs, SSEPs, and BAEPs were recorded intra-operatively for 25 cases in intracranial aneurysms. Monitored results and clinical outcome were analyzed in a prospective observational design.Results The MEPs in 5 of 21 cases, the SSEPs in 5 of 25 cases and the BAEPs in 1 of 3 cases showed inadequate temporary clipping, inadvertent occlusion, inadequate retraction, vasospasm, or compromise to perforating vessels. 3 patients developed advanced weakness, which showed abnormal SSEPs in only one patient while showed abnormal MEPs in all 3 cases.Conclusions The MEPs is more sensitive than SSEPs in monitoring the motor ischemic impairments. The monitoring results were correlated to the clinical outcome closely. Monitoring Eps in keyhole microsurgery of intracranial aneurysms could improve the sensitivity in detecting insufficient distal collateral flow. And then successful completion of potentially hazardous maneuvers would be attained.