Tecnologia auditiva assistiva em usuários de implante coclear em ambientes reverberantes com múltiplas fontes de ruído / Assistive listening technology in cochlear implant users in reverberant environments with multiple noise sources

RESUMO Objetivo Avaliar a contribuição da tecnologia de escuta assistida em usuários de implante coclear (IC) em situações de reverberação e ruído. Métodos Estudo transversal prospectivo aprovado pelo Comitê de Ética Institucional (CAAE 8 3031418.4.0000.0068). Foram selecionados adolescentes e adultos usuários de IC com surdez pré ou pós-lingual. Para usuários bilaterais, cada orelha foi avaliada separadamente. O reconhecimento de fala foi avaliado por meio de listas gravadas de palavras dissílabas apresentadas a 65 dBA a 0° azimute com e sem o Mini Microfone2 (Cochlear™) conectado ao processador de fala Nucleus®6. A reverberação da sala foi medida como 550 ms. Para avaliar a contribuição do dispositivo de escuta assistida (DEA) em ambiente reverberante, o reconhecimento de fala foi avaliado no silêncio. Para avaliar a contribuição do DEA em reverberação e ruído, o reconhecimento de fala foi apresentado a 0° azimute com o ruído proveniente de 8 alto-falantes dispostos simetricamente a 2 metros de distância do centro com ruído de múltiplos falantes usando relação sinal-ruído de +10dB. Para evitar viés de aprendizado ou fadiga, a ordem dos testes foi randomizada. A comparação das médias foi analisada pelo teste t para amostras pareadas, adotando-se nível de significância de p<0,005. Resultados Dezessete pacientes com idade média de 40 anos foram convidados e concordaram em participar, sendo 2 participantes bilaterais, totalizando 19 orelhas. Houve contribuição positiva significante do Mini Mic2 na reverberação e ruído+reverberação (p<0,001). Conclusão DEA foi capaz de melhorar o reconhecimento de fala de usuários de IC tanto em situações de reverberação quanto ruidosas.

ABSTRACT Purpose This study aimed to evaluate the contribution of assistive listening technology with wireless connectivity in cochlear implant (CI) users in reverberating and noise situations. Methods Prospective cross-sectional study approved by the Institutional Ethics Committee (CAAE 8 3031418.4.0000.0068). Adolescents and adults CI users with pre- or post-lingual deafness were selected. For bilateral users, each ear was assessed separately. Speech recognition was assessed using recorded lists of disyllabic words presented at 65 dBA at 0° azimuth with and without the Wireless Mini Microphone 2 (Cochlear™) connected to the Nucleus®6 speech processor. Room reverberation was measured as 550 ms. To assess the contribution of the assistive listening device (ALD) in a reverberating environment, speech recognition was assessed in quiet. To assess the contribution of the ALD in reverberation and noise, speech recognition was presented at 0° azimuth along with the noise coming from 8 loudspeakers symmetrically arranged 2 meters away from the center with multi-talker babble noise using signal to noise ratio of +10dB. To avoid learning bias or fatigue, the order of the tests was randomized. Comparison of means was analyzed by t test for paired samples, adopting significance level of p <0.005. Results Seventeen patients with a mean age of 40 years were invited and agreed to participate, with 2 bilateral participants, totaling 19 ears assessed. There was a significant positive contribution from the Mini Mic2 in reverberation, and noise+reverberation (p <0.001). Conclusion ALD was able to improve speech recognition of CI users in both reverberation and noisy situations.

Biphasic Cholinergic Modulation of Reverberatory Activity in Neuronal Networks / 神经科学通报·英文版

Acetylcholine (ACh) is an important neuromodulator in various cognitive functions. However, it is unclear how ACh influences neural circuit dynamics by altering cellular properties. Here, we investigated how ACh influences reverberatory activity in cultured neuronal networks. We found that ACh suppressed the occurrence of evoked reverberation at low to moderate doses, but to a much lesser extent at high doses. Moreover, high doses of ACh caused a longer duration of evoked reverberation, and a higher occurrence of spontaneous activity. With whole-cell recording from single neurons, we found that ACh inhibited excitatory postsynaptic currents (EPSCs) while elevating neuronal firing in a dose-dependent manner. Furthermore, all ACh-induced cellular and network changes were blocked by muscarinic, but not nicotinic receptor antagonists. With computational modeling, we found that simulated changes in EPSCs and the excitability of single cells mimicking the effects of ACh indeed modulated the evoked network reverberation similar to experimental observations. Thus, ACh modulates network dynamics in a biphasic fashion, probably by inhibiting excitatory synaptic transmission and facilitating neuronal excitability through muscarinic signaling pathways.

Avaliação do Naída CI Q70 e estratégia UltraZoom para o reconhecimento de fala em situações reverberantes e com ruído competitivo / Assessment of the benefits of the Naída CI Q70 and its Ultrazoom strategy for speech recognition in reverberating and noisy listening conditions

RESUMO Objetivo identificar a contribuição do microfone omnidirecional (T-Mic) e microfone direcional adaptativo (UltraZoom) do processador de som Naída CIQ70 para o reconhecimento da fala no ruído e em ambiente reverberante. Identificar a contribuição do processador de som Naída CIQ70 para usuários do processador Harmony. Métodos participaram do estudo sete adultos com implante coclear unilateral, usuários do processador de som Harmony. O reconhecimento de sentenças foi avaliado em silêncio, em sala reverberante (RT60 de 553 ms) e ruído de 42,7 dBA (Leq), com os processadores Harmony e Naída CIQ70. A contribuição do microfone direcional UltraZoom foi avaliada no ruído. As sentenças gravadas foram apresentadas a 0° azimute. O ruído (babble noise) foi apresentado a + 5 dB SNR, a 90° azimute. Os participantes avaliaram subjetivamente a clareza do som e a dificuldade de escutar nas várias condições do teste. Resultados a média do reconhecimento de sentenças no silêncio com reverberação foi de 38,5% com o Harmony e 66,5% com o Naída CIQ70. A pontuação média de reconhecimento de sentenças no ruído foi de 40,5% com o Naída CIQ70, sem UltraZoom, e de 64,5% com UltraZoom. Nas classificações subjetivas de clareza do som e facilidade de escuta no ruído, nenhuma diferença foi identificada entre as condições de teste. Conclusão para usuários experientes do processador de som Harmony, a compreensão da fala em silêncio em uma sala reverbente foi significativamente melhor com o Naída CIQ70. O uso de uma tecnologia de microfone direcional adaptativa (UltraZoom) contribuiu para o reconhecimento de fala no ruído.

Abstract Purpose 1) To measure speech understanding in noise with the Naída Q70 in the omnidirectional microphone mode (T-Mic) and adaptive directional microphone mode (UltraZoom) in reverberating acoustics and noisy conditions. 2) To measure improvement in speech understanding with use of the Advanced Bionics (AB) Naída Q70 sound processor for existing Harmony users. Methods Seven adult unilateral cochlear implant (CI) recipients, who were experienced users of the Harmony sound processor, participated in the study. Sentence recognition was evaluated in quiet in a reverberating room, with Harmony and Naída CI Q70 processors. Effectiveness of Naída CI Q70's UltraZoom directional microphone was evaluated in noise. Target stimuli were recorded Portuguese sentences presented from 0° azimuth. Twenty-talker babble was presented at +5dB SNR from ±90° azimuth. In addition to sentence recognition, the participants also rated the clarity of sound and difficulty of listening in the various test conditions. In order to evaluate the outcomes under more realistic acoustic conditions, tests were conducted in a non-sound treated reverberant room (RT60 of 553 ms and noise floor of 42.7 dBA (Leq). Results The average sentence recognition in quiet in the reverberant non-sound treated room was 38.5% with the Harmony and 66.5% with Naída CI Q70. The average sentence recognition score in noise was 40.5% with Naída CI Q70 without UltraZoom and 64.5% with UltraZoom. For subjective ratings of sound clarity and listening ease in noise no difference were identified between the test conditions. Conclusion For experienced users of the Harmony sound processor, speech understanding in quiet in a reverberating room was significantly improved with the Naída CI Q70. The use of an adaptive directional microphone technology (UltraZoom) enhanced speech perception in noise.

Noise and Room Acoustic Conditions in a Tertiary Referral Hospital, Seoul National University Hospital

BACKGROUND AND OBJECTIVES: Noise levels and room acoustic parameters at a tertiary referral hospital, Seoul National University Hospital (SNUH) in Korea, are investigated. MATERIALS AND METHODS: Through a questionnaire, acoustically problematic rooms are identified. Noise levels in emergency rooms (ERs) and intensive care units (ICUs) are measured over about three days. Acoustically critical and problematic rooms in the otolaryngology department are measured including examination rooms, operating rooms, nurse stations, receptions, and patient rooms. RESULTS: The A-weighted equivalent noise level, L(Aeq), ranges from 54 to 56 dBA, which is at least 10 dB lower than the noise levels of 65 to 73 dBA measured in American ERs. In an ICU, the noise level for the first night was 66 dBA, which came down to 56 dBA for the next day. The noise levels during three different ear surgeries vary from 57 to 62 dBA, depending on the use of surgical drills and suctions. The noise levels in a patient room is found to be 47 dBA, while the nurse stations and the receptions have high noise levels up to 64 dBA. The reverberation times in an operation room, examination room, and single patient room are found to be below 0.6 s. CONCLUSIONS: At SNUH, the nurse stations and receptions were found to be quite noisy. The ERs were quieter than in the previous studies. The measured reverberation times seemed low enough but some other nurse stations and examination rooms were not satisfactory according to the questionnaire.

Effects of classroom-acoustic change on the attention level of university students

Diversas investigaciones han señalado la necesidad de modificar los espacios de aprendizaje para favorecer las condiciones de salud-trabajo-vida de los docentes y para mejorar las condiciones de aprendizaje de los estudiantes. Dichas modificaciones implican cambios arquitecturales, ya sea a través de amplificadores de sonido o deflectores, que permiten variar los niveles de reverberación del sonido y que por tanto modifican las necesidades de modular la voz y el desgaste asociado en el docente. El objetivo de la investigación realizada fue indagar el efecto del nivel de ruido, de la reverberación y de barreras acústicas, en el nivel atencional de 141 estudiantes de una universidad privada de la ciudad de Bogotá (Colombia). Se utilizaron dos estrategias de medición de la atención. La primera de ellas contó con la medición del nivel atencional a través de un cuestionario con palabras pertenecientes a la clase y no pertenecientes a la misma, pero que tuvieran relación con la asignatura. La segunda estrategia midió el Índice de Atención (IA), el cual estuvo conformado por el promedio de las desviaciones de la mirada a un punto, calculado sobre una cuadrícula. Los resultados señalan diferencias significativas entre los grupos intervenidos y no intervenidos. Esta diferencia es significativa tanto para la estrategia de medición tradicional de la atención, a través del cuestionario con la lista de palabras, como para la estrategia alternativa de medición del Índice de Atención, a través de la cuadrícula. Este estudio señala que cambios específicos dirigidos a disminuir los valores de reverberación en los salones de clase, afectan positivamente los niveles de atención y el desempeño de estudiantes. Lo que indica la necesidad de mejorar las condiciones acústicas de los sitios de aprendizaje para así lograr tanto mejores comprensiones de los contenidos por parte de los estudiantes como menor desgaste en la voz de los docentes.

Noise in learning environments has proven to be a big source of health problems not only for teachers, but also for students. Noise is considered as every type of sound that we are not interested in hearing, whereas a useful sound is the one we want to perceive. Studies that analyze the relationship between the effects of noise and attention processes are developed within the idea that sound stimulation acts intermittently as an activator and therefore it can generate an over-activation in the individual due to the distortion caused by this diffused stimulation on the attention process. Furthermore, researches also show that the presence of noise affects performance by making subjects focus their attention upon aspects of the task defined as relevant. Researchers have stated the importance of changing learning spaces in order to favor the health- work-life conditions of teachers and to improve the students’ learning conditions. These alterations include architectural changes, using sound-field amplification, or ceiling baffles and reflect ors that allow changing the reverberation levels of sound in order to modify the need teachers have to modulate their voice and avoid wearing it out. Is common that regulations on the acoustic characteristics of many places set general requisites that are minimal and insufficient to control noise and reverberation, and that are not in line with the guidelines on intermittent sounds. The objective of this research was to examine the effect of noise, reverberation, and acoustical barriers on the level of attention of 141 students from a private university in . Modular panels with acoustic properties were used for an acoustic intervention in some classrooms, intending to reduce the noise levels. Then, all the students of four courses of Mathematics and Statistics were considered. At least two courses had classes in the class rooms that had the acoustic intervention at the beginning of the semester, and the same teacher should be teaching those courses (in both altered and unaltered classrooms) in order to exclude differences associated with the teacher. Since the investigation aimed to measure the level of attention of the students that were in both classrooms. We designed two measurement strategies that correspond to the two types of researches that study the relationship between noise and attention. However, this study presents important differences regarding the strategies that are traditionally associated with embedded figures tests, tests regarding global shape processing and details, or surveillance tasks, because these situations were not controlled within a lab but real noise situations in a classroom. Two strategies of attention measurement were used. The first strategy measured the level of attention through a questionnaire with words belonging and not belonging to the class, but related to the subject. The second strategy allows calculating the Attention Index (AI), which would be measured by the average of the times students look away to a specific point, this is indicated in a grid. The results point towards significant differences between the acoustically intervened and non-intervened groups. That difference is significant both for the traditional attention measurement strategy through a questionnaire with word list and for the alternate Attention Index (AI) measurement strategy using a grid. This study shows that noise levels have an important effect on the students’ attention processes, and that specific changes, aimed at decreasing reverberation values in classrooms affect positively the levels of attention and student performance. They also indicate the need to improve the acoustic conditions of learning sites in order to allow students to achieve a better understanding of contents and to lessen the fatigue of the teachers’ voices.

Sound localization and word discrimination in reverberant environment in children with developmental dyslexia / Localización sonora y discriminación de palabras en ambientes reverberantes en niños con dislexia del desarrollo

Objective Compare if localization of sounds and words discrimination in reverberant environment is different between children with dyslexia and controls. Method We studied 30 children with dyslexia and 30 controls. Sound and word localization and discrimination was studied in five angles from left to right auditory fields (-90o, -45o, 0o, +45o, +90o), under reverberant and no-reverberant conditions; correct answers were compared. Results Spatial location of words in no-reverberant test was deficient in children with dyslexia at 0º and +90o. Spatial location for reverberant test was altered in children with dyslexia at all angles, except –-90o. Word discrimination in no-reverberant test in children with dyslexia had a poor performance at left angles. In reverberant test, children with dyslexia exhibited deficiencies at -45o, -90o, and +45o angles. Conclusion Children with dyslexia could had problems when have to locate sound, and discriminate words in extreme locations of the horizontal plane in classrooms with reverberation. .

Objetivo Comparar localización de sonidos y localización-discriminación de palabras bajo reverberación y sin reverberación en niños disléxicos y controles. Método Estudiamos 30 niños disléxicos y 30 controles, pareados por edad. La localización sonora y discriminación a palabras fue estudiada en cinco ángulos horizontales en los campos izquierdo y derecho (-90o, -45o, 0o, +45o, +90o), bajo reverberación y sin reverberación; las respuestas correctas fueron comparadas Resultados: La localización sonora sin reverberación fue deficiente en niños disléxicos a 0º y +90º. La localización bajo reverberación falló en niños disléxicos en todos los ángulos, excepto –-90o. Durante la discriminación a palabras, sin reverberación, los niños disléxicos fallaron en ángulos izquierdos. En la prueba reverberante, los niños disléxicos fallaron a -–45o, -90o y +45o. Conclusion Los niños con dislexia pueden tener problemas cuando tienen que localizar sonidos y discriminar palabras en las localizaciones extremas del plano horizontal en salones de clases típicos con reverberación. .

Negativo e contratransferência / Negativo y contratransferencia / Negative and countertransference

Embora André Green nunca tenha duvidado de ser a contratransferência uma via de abordagem essencial nas formas extremas de negatividade, ele não dedicou nenhum texto completo a este tema. A razão disto está provavelmente no fato de ele ter sido absorvido pela discussão das formas tênues atribuídas à noção de contratransferência na psicanálise de língua inglesa. As noções de dupla referência, de dupla significância e de dupla representância, bem como aquela de tempo fragmentado, nos fornecem, contudo, um conceito útil para continuar o estudo sobre o negativo e a contratransferência.

Although André Green never doubted that countertransference was an essential tool for approaching the extreme forms of negativity, he did not dedicate any full text to this topic. The reason for this lays probably in the fact that he was absorbed by the discussion about the subtle forms attributed to the notion of countertransference in English speaking psychoanalysis. The notions of double reference, double significance, and double representation, as well as on fragmented time provide us, nevertheless, with a useful concept to continue the study on the negative and countertransference.

Aunque André Green nunca haya dudado de que la contratransferencia sea una vía de abordaje esencial en las formas extremas de negatividad, no dedicó ningún texto completo a este tema. La razón para esto está probablemente en el hecho de haber sido absorbido por la discusión de las formas tenues atribuidas a la noción de contratransferencia en psicoanálisis de lengua inglesa. Las nociones de doble referencia, de doble significación y de doble representación, bien como aquella de tiempo fragmentado, nos ofrecen, sin embargo, un concepto útil para continuar el estudio sobre lo negativo y la contratransferencia.

Avaliação do ruído e seus efeitos em professores e alunos de academias de ginástica / Evaluation of noise and its effects on gym teachers and students

O ruído encontra-se cada vez mais relacionado à atividade de lazer no Brasil, inclusive em academias de ginástica, onde milhares de professores e alunos estão expostos a elevados níveis de pressão sonora durante várias horas por dia, sem qualquer tipo de proteção, sendo necessária a preocupação com a saúde mental e corporal desta população. Esta pesquisa teve como objetivo avaliar os níveis de ruído em academias de ginástica nas cidades de Curitiba-PR e Irati-PR, através das medições dos níveis de pressão sonora - nível sonoro equivalente (Leq), níveis mínimos (Lmin) e máximos (Lmax), simulações dos parâmetros acústicos (tempo de reverberação - TR e índice de transmissão da fala - STI) e identificação dos efeitos causados pelo ruído nos professores e alunos. Para a coleta de dados, foi utilizado um medidor sonoro classe I da marca Brüel & Kjær, modelo 2238, as simulações computacionais foram realizadas com o software Odeon Combined versão 9.2 e para a identificação dos efeitos, foram aplicados questionários nos alunos e professores. Na análise estatística foi utilizado o software R versão 2.11.1, considerado o nível de significância igual a 5% (p ? 0,05). Os resultados mostraram que os níveis de pressão sonora (Leq) variaram entre 80,1 e 100,1 dB(A), atingindo o valor máximo (Lmax) 117,2 dB(A), ultrapassando os valores limites estabelecidos pela legislação. Verificou-se que as modificações realizadas nas academias de ginástica reduziram o tempo de reverberação e alteraram a classificação do índice de transmissão da fala de pobre para satisfatório, melhorando assim as condições acústicas das academias de ginásticas. Os efeitos mais relatados pelos alunos e professores foram cansaço e fadiga vocal. Diversas alterações vocais foram apontadas pelos professores no final se sua jornada de trabalho, sendo que a mais relatada foi rouquidão. Conclui-se que o ambiente da academia de ginástica onde as pessoas buscam a promoção da saúde e lazer apresentou, incoerentemente, altos níveis de pressão sonora que são encontrados em ambientes industriais, gerando assim extrema preocupação com relação à saúde de seus alunos e, especialmente, dos professores atuantes. Diante dos resultados encontrados neste estudo, fica evidente a necessidade de ações que minimizem e controlem a ação prejudicial do ruído nas academias de ginástica, podendo ser realizadas através de medidas de controle da exposição do ruído na fonte, na trajetória e no indivíduo.

Noise is increasingly related to leisure activities in Brazil, including those carried out in fitness gyms where thousands of instructors and users are exposed to high sound pressure levels during several hours a day without any kind of protection, a situation in which it becomes necessary the concern about the mental and physical health of this population. The objective of this research was to evaluate the noise levels in fitness gyms in the cities of Curitiba and Irati in the State of Paraná through the measurements of sound pressure levels - equivalent continuous sound pressure level (Leq), minimum (Lmin) and maximum (Lmax) levels, simulations of the acoustic standards (reverberation time - RT and speech transmission index - STI) and the identification of effects caused by noise in instructors and users. A sound meter class I, model 2238 from the make Brüel e Kjær was used to collect the data and the software Odeon Combined version 9.2 was used for the computational simulations. In addition, a questionnaire was submitted to instructors and users aiming at identifying the effects of the high sound pressure levels on them. The software R version 2.11.1 was employed for the statistical analysis considering the significance level as 5% (p ? .05). The results showed that the sound pressure levels (Leq) varied between 80.1 and 100.1 dB(A), reaching the maximum value (Lmax) at 117.2 dB(A), surpassing the limits established by law. It was verified that the modifications made in the fitness gyms reduced the reverberation time and changed the speech transmission index classification from poor to fair improving the acoustic conditions of the gyms. The most reported effects by users and instructors were tiredness, and vocal fatigue. Several vocal alterations were pointed out by instructors in the end of their workday, being hoarseness the most reported one. The conclusion is that the fitness gym environment, despite being a place where people seek health improvement and leisure time, shows high sound pressure levels similar to the ones found in industrial environments, which creates an extreme concern in relation to the health of its users, and especially its instructors. In face of the results found in this research it seems unmistakable the need of efforts which minimize and control the hazardous action of noise in fitness gyms, which can be done through control measures of the noise exposure in the source, in the trajectory and in the individual.