The Best-Matched Pure Tone Average and Speech Recognition Threshold for Different Audiometric Configurations / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: The agreement between pure-tone average (PTA) and speech recognition threshold (SRT) has become more important with the increasing demands for medical certification. The purpose of this study was to explore the relationships between the SRT and several variations of PTA, and to determine which PTA formula would provide the best agreement with SRT for different audiometric configurations. SUBJECTS AND METHOD: Audiological data on 783 ears were retrospectively collected. The air-conduction PTAs were calculated using five different formulas: three-frequency average (3FA), weighted three-frequency average (W3FA), four-frequency average (4FA), weighted four-frequency average (W4FA), and six-frequency average (6FA). The audiometric configuration was classified into five categories. The PTA-SRT relationships were analyzed using correlation and simple linear regression for each audiometric configuration. RESULTS: Highest correlation was observed between the SRT and W3FA for all audiometric configurations with the correlation coefficient of 0.964 as a whole. The SRT and 3FA were best-matched in the linear regression models for overall/flat/high frequency gently sloping/low frequency ascending; the SRT and W3FA were best-matched for high frequency steeply sloping (HFSS); the SRT and 4FA were best-matched for miscellaneous audiograms. CONCLUSION: The most stable PTA variations that make the best-matched pairs with SRT for any audiogram are the conventional 3FA and W3FA doubling 1 kHz threshold. The addition of frequencies higher than 2 kHz to a PTA formula seems to have impeded the PTA-SRT agreement, especially for HFSS audiograms. W3FA should be the method of choice in predicting SRT from PTA for HFSS audiograms.

Dispositivo auditivo totalmente implantable Carina®: revisión sistemática / Fully implantable hearing device Carina®: systematic review / Fully implantable hearing device Carina®: systematic review

Objetivos: Revisar/resumir indicaciones, resultados audiológicos y de calidad de vida del dispositivo totalmente implantable Carina®. Diseño: Revisión sistemática. Métodos: Se realizó una búsqueda sistemática de la literatura entre junio/2011 y enero/2012 en bases de datos: Medline, OVID, Embase, Pro Quest, Biblioteca Cochrane. También se revisó literatura gris (Sigle) en búsqueda de información no publicada. No hubo restricción de lenguaje o límite temporal, y se incluyeron estudios en humanos con mediciones antes/después de la intervención. Se excluyeron reportes de un caso y estudios con pacientes prelinguales. Se evaluó heterogeneidad estadística (prueba Der Simonian-Laird), y la ganancia funcional combinada (GFC) se estimó con un modelo de efectos aleatorios. Se evaluó sesgo de publicación (gráfica de embudo y prueba Eggs). Resultados: Se identificaron 155 publicaciones, 43 enfocadas en el tema de investigación; ocho cumplieron criterios de inclusión/exclusión, que reportan 110 pacientes. La GFC fue 27,24 dB [IC 95% = 21,66-32,83 dB], I2 = 85%. El reconocimiento de palabras (65 dB-SPL) se incrementó con Carina® entre 35 y 70%, y hubo mejoría en calidad de vida (escala Aphab). La complicación más frecuente fue extrusión (2,7%). Se encontró sesgo de publicación (Eggs = 0,0011). Conclusiones: Se encontró heterogeneidad clínica y bajo nivel de evidencia publicada. La GFC fue considerable con el implante…

Objectives: To review and summarize indications, audiological and quality of life (QOL) outcomes of Carina® fully implantable device. Design: Systematic review. Methods: We conducted a systematic search of literature between June/2011 and January/2012 in: Medline, OVID, Embase, ProQuest, Cochrane Library. The unpublished information gray literature databases (Sigle) were also reviewed. No language or time limit restriction. Study eligibility criteria were: human studies with measures before and after the intervention. One patient case report and prelingual patients studies were excluded. Statistical heterogeneity was assessed (Der Simonian- Laird test), random effects model as a method of synthesis of functional gain was used. Publication bias was assessed (funnel plot and Eggs test). Results: 155 publications were identified, 43 of them were focused on the research topic, eight met the inclusion/exclusion criteria and report 110 patients. The pooled functional gain was 27.24 dB [95% CI = 21.66-32.83 dB], I2 = 85%. The word recognition (65 dB-SPL) was increased between 35%-70% with Carina®. A QOL improvement was observed (APHAB scale). The most frequent complication was device extrusion (3.6%). Publication bias was found (Eggs = 0.0011). Conclusions: Clinical heterogeneity and low evidence level were found in the published literature. The pooled functional gain was considerable with the implant. …

Validez y confiabilidad del listado de monosílabos colombianos / Validity and reliability of the Colombian monosyllable word list

El presente estudio tuvo como objeto determinar el nivel de validez y confiabilidad del listado de palabras monosílabas colombianas -LMC – para la evaluación de la discriminación en la población adulta, luego de realizar ajustes a nivel de familiaridad, balance fonético y disimilitud acústica de los estímulos que componen tal instrumento. Se hallo evidencia de consistencia interna y adicionalmente se correlacionaron los datos obtenidos a partir de la aplicación de la escala con el diagnóstico previo de hipoacusia en 150 sujetos. El análisis de consistencia interna el análisis arrojó un coeficiente de correlación alpha de cronbach de 0.96. Se encontró que el nivel de audición está relacionado con el nivel de discriminación identificado en los sujetos a partir de la aplicación del listado de palabras monosílabos -LMC – (p-value= 0.001).

The present study had as aim determine the level of validity and reliability of the list of monosyllabic Colombian words -LMC- in order to evaluate discrimination in the adult population. It was done after adjustments to level of familiarity, phonetic balance and acoustic unlikeness of stimuli composing the above mentioned instrument. Internal consistency was found and data obtained from the application of the scale was correlated with hipoacusia previous diagnosis of 150 subjects. Internal consistency analysis showed 0.96 Cronbach alpha correlation coefficient. It was found that the level of audition is related to discrimination level identified in subjects from application of the list of monosyllabic words -LMC - (p-value = 0.001).

A prevalência de perdas auditivas em crianças e adolescentes com câncer / The prevalence of hearing loss in children and adolescents with cancer

O tratamento do câncer infantil provoca diversos efeitos colaterais, como a ototoxicidade, que é capaz de lesar estruturas da orelha interna e pode levar à perda auditiva. OBJETIVO: Estimar a prevalência de perda auditiva em crianças e adolescentes com câncer, utilizando três classificações: American Speech-Language-Hearing Association (ASHA), Pediatric Oncology Group Toxicity (POGT) e Perda Auditiva Bilateral (PAB). Forma de Estudo: Transversal. MATERIAL E MÉTODO: Analisou-se 94 pacientes atendidos entre 2003 e 2004. Os indivíduos foram submetidos à inspeção visual do meato acústico externo e avaliação audiológica. Para caracterização da amostra utilizou-se a estatística descritiva e para a análise da concordância da perda auditiva nas três classificações foi utilizada a estatística Kappa. RESULTADOS: Houve prevalência de perda auditiva de 42,5 por cento pela ASHA, 40,4 por cento pela POGT e 12,8 por cento pela PAB. A concordância para POGT e PAB, e para PAB e ASHA foi fraca (respectivamente, k=0,36 e k=0,33). A concordância entre ASHA e POGT foi quase perfeita (k=0,96). CONCLUSÕES: A perda de audição é um efeito colateral importante nos pacientes com câncer. A monitorização auditiva é fundamental, pois possibilita detecção precoce e revisão do tratamento. Recomenda-se adotar uma classificação que contemple perdas auditivas leves, como proposta pela ASHA.

The treatment of cancer in children has several side effects, including ototoxicity. Inner ear structures may be affected and hearing loss may ensue. AIM: To estimate the prevalence of hearing loss in patients with cancer using the American Speech-Language-Hearing Association (ASHA), the Pediatric Oncology Group Toxicity (POGT), and the Bilateral Hearing Loss (PAB) criteria. Study design: a prospective study. MATERIAL AND METHODS: 94 patients admitted between 2003 and 2004 were analyzed. Visual inspection of the external auditory meatus and an audiologic evaluation were done. Descriptive statistics was used to characterize the sample, and Kappa statistics was used to investigate concordance of hearing loss in the three types of classification. RESULTS: The prevalence of hearing loss was 42.5 percent using ASHA, 40.4 percent using POGT, and 12.8 percent using PAB. The concordance of hearing loss was weak for POGT and PAB (k=0.36) and for PAB and ASHA (k=0.33). The concordance between ASHA and POGT was almost perfect (k=0.96). CONCLUSIONS: Hearing loss is an important side effect of the treatment of cancer in children. Periodic audiology monitoring is recommended to detect early hearing loss and to revise the treatment if necessary. Adoption of a classification system that detects mild hearing loss (ASHA) is recommended.

A Clinical Analysis of Psychogenic Hearing Loss Presenting as Sudden Deafness / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: Sudden deafness results from, in most cases, lack an apparent cause. However viral infection, vascular occlusion, cochlear membrane rupture, and others are known to be associated with this disease. In this study, we observed incidence, etiology, audiologic, psychiatric, and clinical aspect of psychogenic sudden deafness through retrospective chart review and analysis of patients who are thought to have had sudden deafness from psychogenic causes and stressor. SUBJECTS AND METHOD: We reviewed the records of 277 patients who had been admitted to the Department of Otolaryngology, Kangbuk Samsung hospital, from January 1997 to July 2003, under the initial diagnosis of idiopathic sudden hearing loss. RESULTS: In patients' medical history, there were 9 patients who had association between sudden onset of hearing loss and psychogenic causes and stressor. And there were 4 patients who had preexisting psycho-pathologic condition. Among these patients, a joint study with psychiatrist classified 7 psychogenic sudden deafness patients (2.5%) who has been ruled out organic causes and showed discrepancy between pure tone audiometry and ABR. In distribution ratio, there were 2 males and 5 females, 4 patients were in their 10's, 1 in 20's, and 2 in 40's (24 years old in average), 3 bilaterals, and 4 unilaterals. In hearing test, there were 4 patients with severe to profound hearing loss at 71 dB or higher, 2 patients with moderately severe hearing loss ranged from 56 to 70 dB, and 1 patient with moderate hearing loss from 41 to 56 dB. Hearing ability of all these patients were partially or completely recovered by treatment including steroid injection and joint psychotherapy with psychiatrist. CONCLUSION: About 2.5% of sudden deafness patients were psychogenic sudden deafness patients, and the results showed distinctive features for each of audiologic, psychiatric, and clinical characteristics. The recovery rate and prognosis were better in patients who had cure and diagnosis under consult with department of psychiatry and accurate audiometry.

A implementação de programa de triagen auditiva neonatal universal em um hospital universitário brasileiro / Universak newborn hearing screeening program assessment in a Brazilian university

Objetivo: avaliar os resultados de implementação do Programa de Triagem Auditiva Neonatal Universal (PT aNU) no Hospital Universitário da Universidade de São Paulo (HU-USP), São Paulo, SP. Casuística e Métodos: Programaou-se a avaliação universal por triagem auditiva...

Correlación entre el umbral conductual (audiometría) y umbral electrofisiológico: (Peaee amf monoaural) Audix / Correlation between behavioral threshold (audiometry)and electrophysiological threshold: (ASSR amf monaural)audix

El presente trabajo describe la correlación que existe entre el umbral conductual (UC) tomados de la audiometría tonal y el umbral electrofisiológico UE basado en el registro de Potenciales Evocados Auditivos de Estado Estable (PEAee) a múltiples frecuencias (MF) Monoaural. Se estudio un grupo de 30 niños (60 oídos) de 3 a 10 años de edad, 22 con audición normal y 8 con hipoacusia neurosensorial; se tomaron los datos de la historia clínica de cada uno de los sujetos (Audiometría Tonal en 500, 100, 2000 y 4000 Hz y PEAee a MF Monoaural en 500, 100, 200 y 4000 Hz en dB SPL, dB nHL y dB HL utilizando tonos modulados en amplitud entre 80 y 110 Hz). En términos generales entre el PEAee a MF Monoaural y la audiometría tonal se encontraron coeficientes de correlación altos mayores de 0.7; y entre las escalas SPL, nHL y HL del PEAee a MF fueron mayores de 0.9. Se encontraron diferencias entre UC y UE en cada una de las escalas dB SPL (de 41 a 56 dB), dB nHL (de 3 a 14 dB) y dB HL (33 a 48 dB). Se concluye que la técnica de PEAee a MF Monoaural presenta una correlación significativa con la audiometría tonal, demostrando que reduce considerablemente el tiempo de exploración manteniendo la confiabilidad con respecto a la predicción del umbral conductual.

Avaliaçäo da autopercepçäo do handicap auditivo em idosos / Evaluation of self-perception of hearing handcap among the elderly

Estudo que analisa a autopercepçäo do handicap auditivo em idosos de um Centro de Convivência do Idoso. Foram avaliados 40 idosos na faixa de 60 a 79 anos por meio do questionário de auto-avaliaçäo Hearing Handicap Inventory for the Elderly

Baixa discriminação auditiva em ambiente competitivo de pacientes jovens com audiograma normal / Low Intelligibility in Noisy Environment in Young People with Normal Audiometry

Foram estudados seis pacientes com queixa de dificuldade auditiva, entre 14 e 35 anos de idade (média de 27,8), mas que apresentavam avaliação audiométrica convencional normal, inclusive discriminação de 100%. Material e métodos: Utilizamos uma metodologia desenvolvida para avaliação do índice de reconhecimento da fala no silêncio e perante um ruído competitivo (ruído branco) em uma cabina audiométrica, sem fone de ouvido, onde observamos o comportamento da dificuldade crescente em discriminar monossílabos de acordo com o aumento do ruído branco dentro da cabina. Resultados: Comparamos o resultado encontrado com 14 pacientes jovens normais e sem queixas, tendo sido mostrado que os seis pacientes estudados realmente apresentavam uma compreensão das palavras muito aquém da revelada pelos pacientes normais em ambiente competitivo, mesmo apresentando uma discriminação de 100% no silêncio. Conclusão: O presente estudo demonstra que o resultado normal de um audiograma convencional nem sempre traduz a realidade, sendo que devemos lançar mão deste tipo de avaliação para uma definição mais precisa das condições auditivas de um indivíduo.

Six patients between 14 and 35 years old (on avarage of 27,8) with normal audiologic level were studied. They declared that their quality in audition was not good, even though their conventional audiological level was a normal and the intelligibility 100%. Material and methods: We used a methodology developed to evaluate the audiologic level in silence and in the presence of a competitive noise (white noise) in an audiometric cabin without earphone where we could observe the increasing difficulty in discriminating monosyllables according to the rise of white noise into the cabin. Results: It has been showed, comparing the results found in the study with 14 normal patients with any complaint, that the six studied patients in fact, have a comprehension of the words far short of the normal ones in a competitive environment although they showed a 100% of discrimination in silence. Conclusion: The current study proves that a normal result of a conventional audiogram not always shows the reality so that we should use this kind of evaluation to a more accurate definition of an individual's audition condition.

Caracterizaçäo do zumbido em trabalhadores atendidos no CERESTSP / Caracterization of tinnitus in workers evaluated at CEREST/SP-Brazil

O zumbido pode ser encontrado em associaçäo com diversas patologias, no entanto, muitos revelam uma íntima relaçäo com exposiçäo ao ruído e PAIR. Nesta pesquisa procurou-se verificar a prevalência do zumbido e suas características em indivíduos atendidos no CEREST/SP no período de out. 97 a fev. 98. Foram estudados neste período 121 trabalhadores, dos quais 57 por cento apresentaram PAIR e 81 por cento referiram zumbido, na mior parte dos casos de frequência aguda. Entre aqueles com PAIR observou-se prevalência de 82,6 por cento com zumbido. Mais uma vez fica comprovada a necessidade de uma açäo intensiva no combate aos níveis elevados de ruído no sentido de garantir aos trabalhadores uma boa qualidade de vida

Surgical management of congenital aural atresia

A prospective study was done on 11 pediatric patients with congenital aural atresia [CAA] with or without macrotia of the ear. The use of early audiological evaluation [using auditory brain stem response [ABR] and pure tone audiometry] and strict radiologic and clinical criteria for surgical candidates was necessary. The surgical reconstruction of their congenital aural atresia was reviewed for hearing improvement, cosmetic improvement, safe ear and complications. The aim of the surgery was to create a patent skin lined external auditory canal and improvement of hearing threshold. Functional hearing was obtained in 54% of cases with safe ear. Congenital cholesteatoma was found in two ears. The split thickness skin graft was associated with minimal complications. The main complications were recurrent infection [45%], stenosis of the canal [36%], failed graft [27%] and keloid of the wound [18%]. Though, the improvement of postoperative results for CAA requires an experienced otologic surgeon, long-term follow up together with control of infection through strict asepsis. Also, improved personal hygiene is mandatory

Psychometric evaluation of hearing impaired children

Hearing Loss [HL] is often associated with a defective communication and delayed development of social cognitive and intellectual skills. The aim of the present survey was to study the relations between hearing loss and development of intellectual skills in children. The survey included 303 children with hearing loss ranging in age between 1 and 14 years. They were evaluated using a standard audiologic procedure and psychometric evaluation using the suitable technique for the child's age. The study showed that nearly half of the children with H.L. [46.9%] had below average intellectual abilities

Morbilidad de los defectos auditivos en comunidades rurales de ocho estados de la República Mexicana / Morbidity of hearing impairment in rural communities of eight states of Mexico

Se efectuó in estudio transversal, descriptivo y observacional en muestreo de defectos auditivos en comunidades rurales de 8 Estados de la República Mexicana. Se encontró un incidencia global de 21.07 por ciento, con una alta incidencia de hipoacusias profundas (10.31 por ciento) y severas (6.39 por ciento). Se hizo en análisis de los defectos auditivos según la edad, el tipo de hipoacusia y la patología.

Afasia de conduçäo: contribuiçäo para as hipóteses do prejuízo da memória auditiva imediata e de seu acesso / Conduction aphasia: contribution to the hypothesis of auditive short-term memory loose and its access

A partir do relato de dois casos de afasia de conduçäo clássica, os autores abordam este polêmico e interessante problema, relatando algumas posiçöes a respeito. Usam o "Token test", repetiçäo de dígitos, de palavras com e sem significado e frases, reconhecimento de figuras, provas rítmicas e testes ambientais para memória auditiva e visual, imediata, recente e tardia. Nossos casos apontam para um defeito na memória auditiva imediata e da transcodificaçäo verbal destes dados, mais intenso para o exercício da metalinguagem (evocaçäo de nomes, números e repetiçäo de frases sem conexäo funcional com o contexto)

Perda auditiva näo-orgânica em crianças / Non-organic hearing loss in children

Discutimos aqui as diversas causas de perda auditiva funcional ou näo-orgânica, incluindo neste conceito crianças com limiar audiométrico normal mas que näo ouvem bem em determinadas situaçöes näo-teste. Apresentamos nossa experiência e uma revisäo da literatura sobre o assunto. A hipoacusia näo-orgânica é na verdade uma abstraçäo que engloba diagnósticos como perda auditiva psicogênica, histeria, autismo, êrro de técnica, instruçöes inadequadas para o paciente sobre a audiometria, simulaçäo e falta de motivaçäo em responder ao teste. A surdes psicogênica é a típica perda auditiva näo-orgânica de causa inconsciente. Como a influência do psiquismo sobre o sistema auditivo central pode variar em situaçöes ambientais diferentes, o conceito de audiçäo passa ser mais amplo do que os resultados obtidos numa cabine audiométrica