A comparison of the human voice (“Baah”) test and the automated auditory brainstem response in detecting neonates with hearing loss in a community setting

Objective@#To assess the usage of the “Baah” Test compared to the AABR (Automated Auditory Brainstem Response) in detecting hearing loss of neonates in the community setting. @*Methods@#This is a retrospective cross-sectional study. The targeted sample population are infants less than a month old who underwent screening at a testing facility in Malolos, Bulacan spanning the years 2011 and 2012. @*Results@#A total of 201 infants were included in the study, with a mean age of 10.77 days with a standard deviation of 7.79. The ratio of males to females was almost equal at 1:1.01. For infants who passed hearing screening on at least one ear, 96% (193 infants) correlated with the results of “Baah” testing. For those with bilateral refer results on AABR, 4 out of the 6 correlated with the “Baah” Test. @*Conclusion@#There is potential in using the “Baah” Test as a tool for hearing loss assessment of infants in situations wherein the usual hearing screening tests are inaccessible. It makes use of little resources, and though it does have its limitations in assessing for unilateral hearing loss (as the test cannot test ears in isolation), it would be able to identify infants likely to have bilateral hearing loss.

Electrococleografía en implante coclear / Electrocochleography in cochlear implant

La electrococleografía es una técnica electrofisiológica desarrollada en modelos animales hace más de 90 años. En la actualidad se utiliza en la práctica clínica en audiolo-gía y otoneurología, ya que permite evaluar la función coclear, a través del registro del potencial microfónico coclear, y la funcionalidad del nervio auditivo por medio del registro del potencial de acción compuesto. Debido al avance de la tecnología de los implantes cocleares, actualmente existe la posibilidad de realizar mediciones clínicas a tiempo real con electrococleografía intraoperatoria, por lo que se puede monitorizar la función auditiva residual durante la inserción de los electrodos del implante coclear. En este artículo se presenta una revisión narrativa del uso y aplicación clínica de la electrococleografía en la evaluación de pacientes con implante coclear para predecir el desempeño auditivo y la percepción del habla. La literatura muestra que la electroco-cleografía es una técnica que se encuentra, plenamente, vigente para evaluar la función auditiva en pacientes usuarios de implantes cocleares. Si bien las respuestas cocleares han demostrado ser un buen predictor de los umbrales perceptuales auditivos y del habla en silencio en adultos, aún es una técnica que requiere más desarrollo para ser una herramienta clínica que permita predecir el habla en ruido y la función auditiva en niños y adultos mayores.

Electrocochleography is an electrophysiological technique developed in animal models more than 90 years ago. It is currently used in clinical practice in audiology and otoneurology, since it allows the evaluation of cochlear function, through the recording of the cochlear microphonic potentials, and the functionality of the auditory nerve by means of compound action potential recordings. Due to the advancement of cochlear implant technology, there is currently the possibility of real-time clinical measurements with intraoperative electrocochleography, so that residual hearing function can be monitored during the insertion of the cochlear implant electrodes. This article presents a narrative review of the use and clinical application of electrocochleography in the evaluation of patients with cochlear implants to predict auditory performance and speech perception. The literature shows that electrocochleography is a technique that is fully in force to assess hearing function in patients who use cochlear implants. Although cochlear responses have been shown to be a good predictor of auditory perceptual thresholds and speech in quiet in adults, it is still a technique that requires further development to become a clinical tool for predicting speech in noise and auditory function in children and older adults.

Resultado do PEATE e Resposta Auditiva de Estado Estável em lactentes com e sem falha na TANU / Results of BAEP and Auditory Steady State Response in infants with and without UNHS failure / Resultados del PEATC e Respuesta Auditiva del Estado Estable en lactantes con y sin falla de CANU

Introdução: A triagem auditiva neonatal universal (TANU) é realizada por meio do exame de potencial evocado auditivo de tronco encefálico (PEATE), na população com indicador de risco para deficiência auditiva. A resposta auditiva de estado estável (RAEE) é uma técnica objetiva e automática de determinação dos limiares auditivos por frequência específica, porém ainda pouco explorada antes da alta hospitalar. Objetivo: analisar os resultados obtidos no exame de PEATE e RAEE em lactentes com indicadores de risco para deficiência auditiva, antes da alta hospitalar, com e sem falha na TANU. Métodos: Estudo observacional analítico prospectivo feito em lactentes com risco para a deficiência auditiva e que realizaram o PEATE e a RAEE na mesma sessão. Resultados: Atenderam ao critério de inclusão 66 lactentes, de ambos os gêneros, idade mediana de 1,2 meses, idade gestacional média de 31 semanas, peso médio ao nascimento 1601 g. Tiveram PEATE normal, 53 (80%) lactentes, denominados de G1 e 13 (20%) tiveram PEATE alterado, denominados de G2. Os limiares eletrofisiológicos da RAEE foram estatisticamente menores nos lactentes de G1. Conclusão: Houve relação entre os achados dos exames de PEATE e RAEE em lactentes de risco para deficiência auditiva, quando realizado antes da alta hospitalar. A mediana dos limiares eletrofisiológicos da RAEE foi menor para os lactentes que tiveram PEATE normal e maior para aqueles que tiveram PEATE alterado na TANU.

Introduction: Universal neonatal hearing screening (UNHS) is performed by examining brainstem auditory evoked potential (BAEP), in the population with a risk indicator for hearing loss. The auditory steady-state response (ASSR) is an objective and automatic technique for determining hearing thresholds by specific frequency, but still little explored before hospital discharge. Objective: to analyze the results obtained in the BAEP and RAEE tests in infants with risk indicators for hearing loss, before hospital discharge, with and without failure in UNHS. Methods: Prospective analytical observational study carried out in infants at risk for hearing loss and who underwent BAEP and ASSR in the same session. Results: 66 infants attempted the inclusion criteria, of both genders, the median age was 1.2 months, the mean gestational age was 31 weeks and the mean weight at birth was 1601 g. 53 (80%) infants, called G1, had normal BAEP, and 13 (20%) had abnormal BAEP, called G2. The electrophysiological thresholds of ASSR were statistically lower in infants of G1. Conclusion: There was a relationship between the findings of the BAEP and ASSR exams in infants at risk for hearing loss, when performed before hospital discharge. The median of the ASSR electrophysiological thresholds was lower for the infants who had normal BAEP and higher for those who had abnormal BAEP in the UNHSque tenían un PEATC normal y mayor para aquellos que tenían un PEATC alterado en CANU.

Introducción: El cribado auditivo neonatal universal (CANU) se realiza examinando el potencial evocado auditivo del tronco cerebral (PEAC), en la población con un indicador de riesgo de hipoacusia. La respuesta auditiva en estado estable (RAEE) es una técnica objetiva y automática para determinar los umbrales de audición por frecuencia específica, pero aún poco explorada antes del alta hospitalaria. Objetivo: analizar los resultados obtenidos en la exploración de PEAC y RAEE en lactantes con indicadores de riesgo de hipoacusia, antes del alta hospitalaria, con y sin fallo en CANU. Metodos: Estudio observacional analítico prospectivo realizado en lactantes con riesgo de hipoacusia a los que se les realizó PEATC y RAEE en una misma sesión. Resultados: Los criterios de inclusión cumplieron con 66 lactantes, de ambos sexos, edad media de 1,2 meses, edad gestacional media de 31 semanas, peso medio al nacer 1601 g. Tenían un PEATC normal, 53 (80%) lactantes, llamados G1 y 13 (20%) tenían un PEATC anormal, llamado G2. Los umbrales electrofisiológicos de RAEE fueron estadísticamente más bajos en lactantes del G1. Conclusión: Hubo una relación entre los hallazgos de los exámenes PEATC y RAEE en lactantes con riesgo de hipoacusia, cuando se realizaron antes del alta hospitalaria. La mediana de los umbrales electrofisiológicos de RAEE fue menor para los lactantes.

Comparison of ASSR, ABR and 40 Hz AERP Response Thresholds at Different Frequencies and Their Forensic Applications / 法医学杂志

OBJECTIVES@#To explore the relationship between the frequency characteristics and response threshold of auditory steady-state response (ASSR), auditory brainstem response (ABR) and 40 Hz auditory event related potential (40 Hz AERP), and their application values in forensic medicine.@*METHODS@#Thirty volunteers with normal hearing (60 ears) were selected to perform pure tone audiometry (PTA) threshold and ASSR, ABR and 40 Hz AERP response threshold tests in the standard sound insulation shielding room, and the results were statistically analyzed by SPSS 22.0 software.@*RESULTS@#At 0.5 kHz and 1.0 kHz frequencies, the correlation between 40 Hz AERP response threshold and PTA threshold was good, which was better than that of ASSR and ABR response threshold. At 2.0 kHz and 4.0 kHz frequencies, the correlation between ASSR and ABR response thresholds and PTA threshold was good, which was better than that of 40 Hz AERP response threshold.@*CONCLUSIONS@#To evaluate the hearing at 0.5 kHz and 1.0 kHz frequencies, it is recommended to use 40 Hz AERP and ASSR to comprehensively assess the PTA threshold of the subjects. To evaluate the hearing at 2.0 kHz and 4.0 kHz frequencies, ABR and ASSR are recommended to assess the PTA threshold of subjects comprehensively. The combination of ASSR, ABR and 40 Hz AERP can improve the accuracy of hearing function evaluation.

Diagnóstico diferencial: perda auditiva ou transtorno do espectro do autismo / Differential diagnosis: hearing loss or autism spectrum disorder / Diagnóstico diferencial: pérdida auditiva o transtorno del espectro autista

Introdução: a perda auditiva (PA) caracteriza-se por uma alteração no sistema auditivo, com diminuição da audição e o Transtorno do Espectro do Autismo (TEA) é definido como uma alteração de desenvolvimento e do comportamento. Muitos sintomas da PA e do TEA se sobrepõem, requerendo um diagnóstico diferencial. Objetivo: determinar as características do atendimento em um Serviço Ambulatorial de Saúde Auditiva (SASA) para diagnóstico diferencial de deficiência auditiva em crianças de zero a 12 anos de idade, com suspeita ou confirmação de TEA. Metodologia: pesquisa quantitativa documental transversal em banco de dados com 94 registros de crianças de zero a 12 anos, com suspeita ou confirmação de TEA. A análise estatística foi descritiva com teste de comparação entre duas proporções (α < 5%). Resultados: dos 94 registros, 36 tinham a confirmação de TEA e 58, a suspeita deste. Houve prevalência do sexo masculino e da faixa etária de três a quatro anos. Observou-se forte tendência de crianças com TEA suspeito apresentarem audição dentro dos padrões da normalidade, enquanto que as com TEA confirmado tiveram forte tendência para ocorrência de PA condutiva. Na avaliação eletrofisiológica foram observadas alterações não compatíveis com PA coclear em alguns casos de TEA confirmado, sendo que nos atrasos de linguagem associados a outras alterações na função comunicativa houve forte tendência para alterações no PEATE não compatíveis com PA coclear. Conclusões: deve-se ter atenção, durante os atendimentos audiológicos infantis, para os resultados da avaliação eletrofisiológica, que associada à história clínica pode despertar a suspeita de TEA.

Introduction: Hearing loss (HL) is characterized by a change in the auditory system, with decreased hearing ability, while the Autism Spectrum Disorder (ASD) is defined as a developmental and behavioral change. However, there are many symptoms of HL and ASD that overlap, requiring a differential diagnosis to be performed by a multidisciplinary team. Objective: To characterize the process of differential diagnosis between HL and ASD and its association in children from zero to twelve years of age, at a Hearing Health Outpatient Clinic (Serviço Ambulatorial de Saúde Auditiva - SASA). Method: This is a cross-sectional and qualitative document-based study in a database of 94 records of children attended by the clinic from 2012 to 2017, with at least one diagnostic hypothesis of ASD. The statistical analysis was descriptive with a comparison test between the two population proportions with a 5% significance level. Results: Of the 94 suspected cases of ASD, 36 were confirmed. There was a prevalence of males and the age group of three to four years at the time of the suspicion or confirmed diagnosis of ASD. Most of the children presented borderline hearing loss within the normal limits, and normal results in the Brainstem Auditory Evoked Potential (BAEP) responses. Although there was a prevalence of language delays in the language assessment, when this was associated with other communicative changes (symbolic function, communicative intention and/or echolalia) there was an increase in the changes in the BAEP. Conclusions: Multidisciplinary care is important for the differential diagnosis of HL, ASD, or the association between them, in order to ensure the most adequate intervention for each case.

Introducción: la perdida de audición (PA) se caracteriza por un cambio en el sistema auditivo, con disminución de la audición, y el transtorno del espectro autista (TEA) se define como un cambio en el desarrollo y el comportamento. Muchos sintomas de PA y TEA se superponen, lo que requiere que un equipo multidisciplinario haga un diagnóstico diferencial. Objetivo: caracterizar el proceso de diagnóstico diferencial entre BP, ASD y su asociación en niños de cero a doce años en un Servicio de Salud Auditiva Ambulatoria (SASA). Metodología: investigación documental cuantitativa transversal em una base de datos con 94 registros de niños de 0-12 años tratados de 2012 a 2017, con al menos una hipótesis diagnóstica de TEA. El análisis estadístico fue una prueba descriptiva y comparativa entre dos proporciones a un nível de significación del 5%. Resultados: entre los 94 casos sospechos de TEA, 36 tuvieron confirmación. Hubo una prevalencia de varones y el grupo de edad de tres a cuatro años en el momento de la sospecha o confirmación de TEA. La mayoría de los niños tienen umbrales auditivos normales y resultados normales en los potenciales evocados auditivos del tronco encefálico (BAEP). En la evaluación del lenguaje, hubo una prevalencia de retraso del lenguaje, pero cuando se asoció con otras alteraciones comunicativas (función simbólica, intención comunicativa y / o ecolalia), hubo un aumento em las alteraciones BAEP. Conclusiones: la atención multidisciplinaria es relevante para el diagnóstico diferencial de PA, TEA o su asociación, con el objetivo de la interación más adecuada para cada caso.

The Role of Magnetic Resonance Imaging of the Temporomandibular Joint to Investigate Tinnitus in Adults with Temporomandibular Joint Disorder: A Comparative Study

Abstract Introduction The prevalence of tinnitus is higher in individuals with temporoman- dibular joint disorder (TMD) than in the general population. Magnetic resonance imaging (MRI) of the temporomandibular joint (TMJ) is the method of choice for investigation, and it has been hypothesized that specific MRI findings might be observed in TMD with comorbid tinnitus. Objective To comparatively describe MRI findings in patients with TMD with and without tinnitus, identifying the most common TMJ alterations and determining whether a correlation exists between severity of TMD and tinnitus. Methods A cross-sectional study of 53 adult patients with bilateral or unilateral TMD (30 with and 23 without tinnitus). The association between tinnitus and morphological aspects of TMD (changes in condylar morphology, articular eminence morphology, and disc morphology), disc displacement (with/without reduction), condylar translation, and intra-articular effusion was analyzed on MRI images. Results The mean patient age was 46.12 ± 16.1 years. Disc displacement was the most common finding in both groups (24 patients with tinnitus versus 15 without; p = 0.043). Only the frequency of disc displacement with reduction was significantly different between groups. Conclusion Additional imaging techniques should be explored to detect specific aspects of the relationship between tinnitus and TMD.

Frequency Characteristics of AEPs in Normal Young Adults and Comparison of Their Response Threshold and Pure Tone Audiometry Threshold / 法医学杂志

Objective The tests of three types of auditory evoked potentials （AEPs） were performed on normal young adults, to understand the frequency characteristics of different testing methods and the relationship between response threshold and pure tone audiometry threshold of different methods, and to discuss the forensic value of 3 types of AEPs to evaluate hearing function. Methods Twenty normal young adults were selected, their standard pure tone audiometry threshold, short-term pure tone audiometry threshold and the response threshold of 3 types of AEPs （tone burst-auditory brainstem response, 40 Hz auditory event-related potential and slow vertex response） at 0.5 kHz, 1.0 kHz, 2.0 kHz and 4.0 kHz were recorded. The relationship between the response threshold and standard pure tone audiometry threshold, short-term pure tone audiometry threshold of 3 types of AEPs at different frequencies as well as the differences between different types of AEPs were analyzed. Results The short-term pure tone audiometry threshold was higher than the standard pure tone audiometry threshold at each frequency. The response threshold and standard pure tone audiometry threshold of the 3 types of AEPs all had a certain correlation, and the response threshold of the 3 types of AEPs was higher than short-term pure tone audiometry threshold and standard pure tone audiometry threshold at each frequency. The differences in the differences between the response threshold and standard pure tone audiometry threshold of the 3 types of AEPs at different frequencies had statistical significance. Linear regression mathematical models were established to infer the standard pure tone audiometry threshold （hearing level） from response threshold （sound pressure level） of 3 types of AEPs of normal young adults. Conclusion When using response threshold of different types of AEPs to estimate pure tone audiometry threshold, conversion and correction are needed. Combined use of different types of AEPs could improve the accuracy of hearing function evaluation.

Comparison between chloral hydrate and propofol-ketamine as sedation regimens for pediatric auditory brainstem response testing / Comparação entre o uso de hidrato de cloral e propofol-quetamina como formas de sedação para exames de potenciais evocados auditivos de tronco encefálico

Abstract Introduction: The use of diagnostic auditory brainstem response testing under sedation is currently the "gold standard" in infants and young children who are not developmentally capable of completing the test. Objective: The aim of the study is to compare a propofol-ketamine regimen to an oral chloral hydrate regimen for sedating children undergoing auditory brainstem response testing. Methods: Patients between 4 months and 6 years who required sedation for auditory brainstem response testing were included in this retrospective study. Drugs doses, adverse effects, sedation times, and the effectiveness of the sedative regimens were reviewed. Results: 73 patients underwent oral chloral hydrate sedation, while 117 received propofol-ketamine sedation. 12% of the patients in the chloral hydrate group failed to achieve desired sedation level. The average procedure, recovery and total nursing times were significantly lower in the propofol-ketamine group. Propofol-ketamine group experienced higher incidence of transient hypoxemia. Conclusion: Both sedation regimens can be successfully used for sedating children undergoing auditory brainstem response testing. While deep sedation using propofol-ketamine regimen offers more efficiency than moderate sedation using chloral hydrate, it does carry a higher incidence of transient hypoxemia, which warrants the use of a highly skilled team trained in pediatric cardio-respiratory monitoring and airway management.

Resumo Introdução: O uso de testes diagnósticos de potencial evocado auditivo de tronco encefálico sob sedação é atualmente o padrão-ouro em lactentes e crianças pequenas que não têm desenvolvimento suficiente para realizar o exame. Objetivo: O objetivo do estudo foi comparar a sedação de crianças submetidas a testes de potencial evocado auditivo de tronco encefálico com propofol-quetamina e com hidrato de cloral por via oral. Método: Pacientes entre 4 meses e 6 anos de idade que necessitaram de sedação para a realização do potencial evocado auditivo de tronco encefálico foram incluídos nesse estudo retrospectivo. Foram revisadas as doses dos medicamentos, os efeitos adversos, os tempos de sedação e a eficácia das formas de sedação. Resultados: 73 pacientes foram submetidos à sedação oral com hidrato de cloral, enquanto 117 receberam sedação com propofol-quetamina; 12% dos pacientes do grupo hidrato de cloral não alcançaram o nível desejado de sedação. Os tempos médios de procedimento, recuperação e o tempo total de cuidados de enfermagem foram significativamente menores no grupo propofol-quetamina, entretanto este grupo experimentou maior incidência de hipoxemia transitória. Conclusão: Ambos os regimes de sedação podem ser utilizados com sucesso para sedar crianças para realização do exame de potencial evocado de tronco encefálico. Embora a sedação profunda com propofol e quetamina ofereça mais eficiência do que a sedação moderada com hidrato de cloral, ela apresenta maior incidência de hipoxemia transitória, o que requer uma equipe altamente qualificada, treinada em monitoramento cardiorrespiratório pediátrico e manejo de vias aéreas.

Asymptomatic Hearing Impairment Frequently Occurs in Early-Onset Parkinson's Disease

OBJECTIVE: Recent reports of hearing impairment in Parkinson's disease (PD) have suggested that auditory dysfunction could be a non-motor manifestation of PD. These reports were based on observations of elderly patients for whom presbycusis may, to some extent, have contributed to hearing dysfunction. Therefore, we aimed to explore the auditory functions in younger patients with PD. METHODS: We conducted a case-control study in a relatively younger (< 55 years of age at study time) population of PD patients and healthy volunteers to test whether auditory dysfunction is a significant non-motor dysfunction in PD. Pure tone audiometry (PTA) and brainstem evoked response audiometry (BERA) were performed in all participants. RESULTS: None of the patients or controls reported hearing deficits. Fifty-one patients with PD and 50 healthy volunteers who were age- and gender-matched to the patients participated. PTA-detected hearing impairment was found in 64.7% of patients and 28% of controls (p < 0.001) for both low-mid and/or high frequencies. Hearing impairment was more frequent in the younger subgroups of patients than age-matched controls, while the frequency of hearing impairment was similar in older groups of subjects. BERA was not different between patients and controls. CONCLUSION: Asymptomatic auditory dysfunction is a common non-motor manifestation of early-onset PD and more frequent in younger patients, indicating that it may be independent of aging. The mechanism underlying this dysfunction appears to be peripheral, although a central dysfunction cannot be ruled out based on the findings of this study.

The Effect of Methylphenidate on the Hearing of Children with Attention Deficit Hyperactivity Disorder

Abstract Introduction There has been a sudden idiopathic hearing loss case presented after methylphenidate treatment in a child with attention deficit hyperactivity disorder (ADHD). Objective This study was performed to reveal the probable ototoxic side effects of methylphenidate use in patients with ADHD. Methods Thirty pediatric patients with ADHD were included in the study. Pure tone audiometry, speech discrimination scores, waves I, III, V absolute latencies and waves IIII, I-V, III-V interpeak latencies at the 80 dB nHL intensity after click stimulus auditory brainstem response (ABR) results were compared before and 3 months after methylphenidate treatment. Results There were no statistically significant difference between pretreatment and posttreatment pure tone and speech audiometry findings and ABR results (p > 0.05 for all parameters). Conclusion Methylphenidate can be regarded as a safe drug regarding ototoxic side effects. Additional studies with a larger sample size and longer follow-up may be needed.

Análise da diferença entre os limiares auditivos comportamentais e os resultados obtidos através do exame potencial evocado auditivo de estado estável (PEAEE) em adultos jovens / Analysis of difference between the behavioral hearing thresholds and the results obtained through the auditory steady state response (ASSR) in young adults / Análisis de la diferencia entre los umbrales auditivos comportamentales y los resultados obtenidos a través del examen potencial evocado auditivo de estado estable (PEAEE) en adultos jóvenes

Introdução: A audição, sentido que nos permite receber a informação sonora, se apresenta como um dos facilitadores para uma interação social eficaz. Um déficit nessa função acarreta prejuízo no processo comunicativo, devendo ser diagnosticado e tratado precocemente. Atualmente dispomos de meios subjetivos e objetivos para avaliar o sistema auditivo. A audiometria tonal é a forma subjetiva mais aplicada para medir esse sentido. Entretanto, em populações impossibilitadas de responder subjetivamente, aplicam-se técnicas objetivas, como o Potencial Evocado Auditivo de Estado Estável. Ambos pesquisam respostas auditivas do sujeito sob teste, utilizando técnicas distintas. Objetivo: Avaliar adultos jovens, sem queixas auditivas, pesquisando a sensibilidade auditiva e, a partir de indicadores estatísticos, calcular as médias das diferenças das respostas obtidas nesses procedimentos, verificando se há correlação entre eles. Método: Pesquisa de respostas auditivas via Audiometria Tonal e Potencial Evocado Auditivo de Estado Estável, nas frequências de 500, 1000, 2000 e 4000 Hz, em 30 sujeitos normo-ouvintes. Resultados: Ao calcularmos a média das diferenças entre as frequências testadas nos dois procedimentos, elas variaram de 10,47 a 18,22, não havendo forte correlação em nenhuma delas, deixando dúvidas na frequência de 1000 Hz. Conclusão: Podemos dizer que as médias das diferenças entre os valores obtidos nos dois procedimentos foram razoavelmente elevadas, principalmente em 500 Hz e, em menor proporção, para 4 kHz. Os valores obtidos nos dois exames, embora não tenham apresentado forte correlação, apresentaram-se discretamente melhores para 500 Hz. Resultados de 1000 Hz não nos permitem afirmar, inclusive, se existe alguma correlação entre os testes.

Introduction: Hearing is the sense which allows us to receive auditory information; therefore it facilitates efficient social interaction. Any loss in this function damages the communicative process, so it must be diagnosed and treated as soon as possible. Nowadays, both objective and subjective hearing tests are available. Pure Tone Audiometry is the most widely used subjective way to evaluate this sense. However, for those who are unable to respond subjectively, we can try objective techniques like the Auditory Steady State Response. Both will search for patients' minimum hearing responses, applying different approaches. Objective: To evaluate normal-hearing young adults with no hearing complaints by analyzing their hearing sensibility and, based on statistical indicators, calculate the average of the differences between the results obtained in both procedures in order to verify the existence of correlation between them. Method: We studied the hearing responses from 30 normal-hearing subjects through Pure Tone Audiometry and Auditory Steady State Response at 500, 1000, 2000 and 4000 Hz. Results: When we calculated the average of the differences between the tested frequencies, they ranged from 10,47 to 18,22 with no strong correlation, except at 1000 Hz whose results were uncertain. Conclusion: We concluded that the average of the differences of hearing values obtained in Pure Tone Audiometry and Auditory Steady State Response were reasonably elevated mainly at 500 Hz, and at a lower level at 4000 Hz. Although the scores obtained in both tests had not shown strong correlation, they were slightly better at 500 Hz. The results for 1000 Hz are inconclusive regarding any existing correlation between these two tests.

Introducción: La audición, sentido que nos permite recibir la información sonora, se presenta como uno de los facilitadores para una interacción social eficaz. Un déficit en esta función acarrea perjuicio en el proceso comunicativo, lo que debe ser diagnosticado y tratado lo antes posible. Actualmente disponemos de medios subjetivos y objetivos para evaluar el sistema auditivo. La audiometría tonal es la forma subjetiva más aplicada para medir ese sentido. Sin embargo, en poblaciones imposibilitadas de responder subjetivamente, se aplican técnicas subjetivas como el Potencial Evocado Auditivo de Estado Estable. Ambas investigan las respuestas auditivas del sujeto bajo test, utilizando técnicas distintas. Objetivo: Evaluar a adultos jóvenes, sin quejas auditivas, investigando la sensibilidad auditiva y, a partir de los indicadores estadísticos, calcular los promedios de la diferencias de las respuestas obtenidas en esos procedimientos, y comprobar si existe correlación entre ellos. Método: Pesquisa de respuestas auditivas vía Audiometría Tonal y Potencial Evocado Auditivo de Estado Estable en las frecuencias de 500,1000, 2000 y 4000 Hz, en 30 sujetos oyentes normales. Resultados: Tras el cálculo del promedio de las diferencias entre las frecuencias testadas en los dos procedimientos, se pudo verificar una variación de 10,47 a 18,22, donde no se ha registrado fuerte correlación en ninguna de ellas, dejando duda en la frecuencia de 1000 Hz. Conclusión: Podemos decir que los promedios de las diferencias entre los valores obtenidos en los dos procedimientos fueron razonablemente elevados, sobre todo en 500 Hz y, en menor proporción, para 4kHz. Los valores que se obtuvieron en los dos exámenes, aunque no hayan presentado fuerte correlación, se presentaron discretamente mejores para 500 Hz. Resultados de 1000 Hz no nos permiten afirmar, incluso, si hay alguna correlación entre los testes.

Resposta auditiva de estado estável e avaliação comportamental em crianças de 6 a 48 meses / Auditory steady-state response and behavioral avaluation in children between 6 to 48 monhts of age

RESUMO Objetivo Verificar como os limiares obtidos pelas respostas auditivas de estado estável (RAEE) podem estimar os limiares obtidos pela audiometria com reforço visual (VRA), em crianças com audição normal e perda auditiva de diversos graus. Métodos Foram avaliadas 41 crianças de ambos os sexos (28 crianças do sexo masculino e 13 do sexo feminino), com faixa etária de 18 a 48 meses. Foram pesquisadas as frequências de 500, 1000, 2000 e 4000 Hz, em ambos os métodos de avaliação, e avaliadas as orelhas separadamente, totalizando 82 orelhas, sendo 20 com audição normal e 62 com perda auditiva. Os limiares foram analisados para calcular suas correlações e outras variáveis. Resultados Os limiares não variaram significativamente, nem com a idade, nem com o sexo. Em média, foram observados limiares eletrofisiológicos maiores que os limiares comportamentais. Conclusão A técnica da RAEE possibilita a determinação dos limiares auditivos objetivamente, com uma considerável correlação com os limiares psicoacústicos, concordando com a literatura. Recomenda-se, entretanto, a realização de novos estudos brasileiros, que visem ao estabelecimento de critérios mínimos necessários para o planejamento e aplicação de protocolos, com fins de padronização, contribuindo com a validação diagnóstica.

ABSTRACT Purpose The objective of the following study was to verify how the thresholds obtained by ASSR can estimate the thresholds obtained by the VRA in children with normal hearing and hearing loss of different degrees. Methods Were evaluated 41 children of both sex (28 boys and 13 girls), on ages between 18 and 48 months. The thresholds were obtained with ASSR with multiple and simultaneous stimulation on frequencies of 500, 1000, 2000 and 4000Hz. The thresholds were obtained with VRA on each ear separately on frequencies of 500, 1000, 2000 and 4000Hz. Were evaluated 82 ears, 20 with normal hearing and 62 with hearing loss. The correlation between the thresholds was calculated. Results The findings of this study demonstrate that the thresholds didn't have a statistic relevant relation with variables of age and sex. Considering the mean, the eletrophysiological thresholds were higher than the behavioral. These findings suggest ASSR can determinate hearing thresholds objectively and with a high correlation with psychoacoustic thresholds obtained by the behavioral method. Conclusion We recommend, however that another Brazilian studies be made, so it can be established a minimum criteria necessary for the planning and application of pattern protocols, contributing with diagnostic validation of ASSR technique.

Evaluation of vestibular evoked myogenic potentials (VEMP) and electrocochleography for the diagnosis of Ménière's disease / Avaliação dos potenciais evocados miogênicos vestibulares (VEMP) e eletrococleografia no diagnóstico da doença de Ménière

Abstract Introduction: Ménière's disease (MD) is an inner ear disorder characterized by episodic vertigo, tinnitus, ear fullness, and fluctuating hearing. Its diagnosis can be especially difficult in cases where vestibular symptoms are present in isolation (vestibular MD). The definitive diagnosis is made histologically and can only be performed post-mortem, after analysis of the temporal bone. Endolymphatic hydrops is a histopathological finding of the disease and occurs more often in the cochlea and saccule, followed by the utricle and semicircular canals. Vestibular evoked myogenic potentials (VEMP) emerged as the method of assessment of vestibular function in 1994. Until then, there was no unique way of assessing saccular function and the inferior vestibular nerve. Given that the saccule is responsible for most cases of severe hydrops, VEMP appears as a new tool to assist in the diagnosis of MD. Objective: To evaluate the sensitivity and specificity of VEMP and electrocochleography (EcochG) in the diagnosis of definite MD compared with clinical diagnosis. Methods: The study includes 12 patients (24 ears) diagnosed with definite MD defined according to the clinical criteria proposed by the American Academy of Otolaryngology - Head and Neck Surgery (AAO-HNS) in 1995, as well as 12 healthy volunteers allocated to the control group (24 ears). A clinical diagnosis by the AAO-HNS criteria was considered as the gold standard. All patients underwent an otoneurological examination, including pure tone and speech audiometry, VEMP, and extratympanic EcochG. The sensitivity and specificity to detect the presence or absence of disease were calculated, as well as their 95% confidence intervals. The reliability of VEMP and EcochG in both ears was assessed using the kappa index. Results: In both tests and in both ears, the ability to diagnose healthy cases was high, with specificity ranging from 84.6% to 100%. Moreover, the ability of the tests to diagnose the disease varied from low to moderate sensitivity, with values ranging from 37.5% to 63.6%. The agreement of both tests in the right ear, measured by the kappa coefficient, was equal to 0.54 (95% CI: 0.20-0.89), indicating a moderate agreement. In the left ear, that agreement was equal to 0.07 (95% CI: −0.33 to 0.46), indicating a weak correlation between the tests. The sensitivity of the VEMP for the right ear was 63.6% and for the left ear, 62.5%. The sensitivity of EcochG for the right ear was 63.6% and 37.5% for the left ear. Conclusion: The specificity of both tests was high, and the sensitivity of VEMP was higher than that of EcochG.

Resumo Introdução: A doença de Ménière (DM) é uma doença da orelha interna caracterizada por vertigem episódica, zumbido, plenitude aural e audição flutuante. Seu diagnóstico pode ser especialmente difícil nos casos em que os sintomas vestibulares estão presentes isoladamente (DM vestibular). O diagnóstico de certeza é histológico e somente pode ser feito no post mortem, após análise do osso temporal. A hidropisia endolinfática é um achado histopatológico da doença e ocorre mais frequentemente na cóclea e sáculo, seguidos pelo utrículo e canais semicirculares. Os potenciais evocados miogênicos vestibulares (VEMP) surgiram como método de avaliação da função vestibular em 1994. Até então não havia uma maneira exclusiva de avaliação da função sacular e do nervo vestibular inferior e como o sáculo era responsável por grande parte dos casos de hidropisia severa, o VEMP apareceu como uma nova ferramenta para auxiliar no diagnóstico da DM. Objetivo: Avaliar a sensibilidade e especificidade do VEMP e da eletrococleografia (ECochG) no diagnóstico da DM em comparação com o diagnóstico clínico. Método: Foram selecionados 12 pacientes (24 orelhas) com diagnóstico de DM definida de acordo com os critérios clínicos propostos pela American Academy of Otolaryngology-Head and Neck Surgery 1995 (AAO-HNS) e 12 voluntários saudáveis alocados no grupo controle (24 orelhas). Considerou-se o diagnóstico clínico pela AAO-HNS como padrão ouro. Todos os pacientes foram submetidos a exame otoneurológico, incluindo audiometria tonal e vocal, VEMP e eletrococleografia extratimpânica. A sensibilidade e especificidade para detectar a presença ou ausência de doença foram calculadas e os respectivos intervalos de confiança de 95% obtidos. A confiabilidade dos testes de diagnóstico VEMP e eletrococleografia em ambas as orelhas foi avaliada pelo índice kappa. Resultados: Em ambos os testes e em ambas as orelhas, a capacidade para diagnosticar os casos saudáveis é alta, a especificidade varia de 84,6%-100%. Além disso, a capacidade dos testes para o diagnóstico da doença varia de baixa a moderada sensibilidade, com valores de 37,5%-63,6%. A concordância dos dois testes na orelha direita, medida pelo coeficiente de kappa, foi igual a 0,54; 95% IC (0,20-0,89) indicaram uma concordância moderada. Para a orelha esquerda essa concordância foi igual a 0,07 com 95% IC (-0,33-0,46), o que indicou uma concordância fraca entre os testes. A sensibilidade do VEMP para a orelha direita foi de 63,6% e para a orelha esquerda, de 62,5%. A sensibilidade da ECochG para a orelha direita foi de 63,6% e 37,5% para a orelha esquerda. Conclusão: A especificidade de ambos os testes foi alta e a sensibilidade do VEMP foi maior do que a da eletrococleografia.

Alterações retrococleares na esclerose sistêmica: relato de casos / Retrocochlear impairments in systemic sclerosis: a case report study

RESUMO Objetivo Relatar três casos de pacientes portadores de Esclerose Sistêmica e que apresentaram alterações retrococleares. Método Trata-se de um estudo de relato de casos de três indivíduos com esclerose sistêmica e alteração retrococlear, acompanhados em um serviço de reumatologia. Todos os pacientes realizaram o Potencial Evocado Auditivo de Tronco Encefálico e, quando necessário, nova audiometria. Resultados Todos os indivíduos apresentaram perda auditiva do tipo sensorioneural. Não foi identificado na avaliação audiológica básica qualquer resultado que sugerisse alteração retrococlear, porém o PEATE apresentou-se alterado. Conclusão Pode-se concluir que o estudo revela alterações retrococleares nesta população, ocorrendo tanto nas latências absolutas quanto no intervalo interpico. E, neste contexto, reumatologistas e fonoaudiólogos, ao acompanharem pacientes com esclerose sistêmica, devem estar atentos para a possibilidade da ocorrência dessa alteração nessa população. Revela também, a necessidade de estudos epidemiológicos sobre o tema.

ABSTRACT Purpose To report three cases of patients with Systemic Sclerosis (SSc) and retrocochlear impairments. Methods This is a case report of three individuals with SSc and retrocochlear impairments assisted at a rheumatology outpatient clinic. All individuals underwent Brainstem Auditory Evoked Potential (BAEP) and, when necessary, audiometry. Results All three individuals presented sensorineural hearing loss. Although no retrocochlear impairment was identified in the basic audiologic evaluation, the BAEP results were altered. Conclusion Retrocochlear impairments were present in the individuals under study, both in the absolute latencies and interpeak interval, thereby demanding the attention of rheumatologists and speech-language pathologists to such changes during the monitoring of SSc patients. The results also show a need for epidemiological studies on the theme.

Usefulness Assessment of Cochlear Hydrops Analysis Masking Procedure Test in Progress of Ménière's Disease / 대한평형의학회지

OBJECTIVE: There were few recent study concern about usefulness of cochlear hydrops analysis masking procedure (CHAMP) in progression of Ménière's disease. The purpose of this study is to analyze changes in the CHAMP as advancement of Ménière's disease. METHODS: We studied 19 cases of ‘ Definite’ group of Ménière's disease. We assumed progression of Ménière's disease would be checked by pure tone threshold by four tone average (4PTA), low tone average (LPTA). We also compared electrocochleography (ECoG), dizziness handicap inventory (DHI), tinnitus handicap inventory (THI) as parameters for progression of Ménière's disease to CHAMP latency delay and amplitude ratio. Chi-square test was used as a statistical method. RESULTS: In the group of patients had abnormal amplitude ratio, ECoG value were not improved, but there was not statistically significant (odds ratio [OR]=5.727, p>0.05). Better DHI and THI score were not necessarily construed as the improvement value in the CHAMP (p>0.05). In amplitude ratio abnormal group, 4PTA was aggravated, but not statistically significant (OR=1.5, p>0.05). In the group of patient had abnormality in both latency delay and amplitude ratio, LPTA was relatively aggravated (OR in latency delay: 2, OR in amplitude ratio: 10); however, reveals no statistically significance between them (p>0.05). Change of ECoG, hearing threshold including 4PTA and LPTA with progression of Ménière's disease were not correlated significantly with latency delay or amplitude ratio of CHAMP. CONCLUSION: We conclude that CHAMP does not reflect clinical features with progression of Ménière's disease.

Is Electrocochleography Still Helpful in Early Diagnosis of Meniere Disease?

BACKGROUND AND OBJECTIVES: Despite the extensive research for the Meniere's disease (MD), it's pathophysiology still remains uncertain and questionable among scientists. Clinical symptoms and audiometric tests form the basis for the diagnosis. Nevertheless the differential diagnosis can be extremely challenging, due to subjective and not specific results. Incorrect diagnosis is most likely and for this reason there is a great demand for objective and reliable tests. SUBJECTS AND METHODS: The presence of endolymphatic hydrops is necessary condition but non enough for the diagnosis. In this study we analyze retrospectively the summating potentials (SP)/action protentials (AP) ratio from peritympanic electrocochleography in 34 patients,divided in two groups (13 patients classified as defined MD and 21 patients classified as probable MD). The purpose was to identify the utility of the exam so to be able to achieve an early defined diagnosis. Furthermore our intention was to obtain an objective test, besides the clinical criteria currently in use for the diagnosis and the classification of the MD. RESULTS: The analysis of the SP/AP results shows high predictability for the MD (positive in six out of seven cases with a sensitivity greater than 80%). CONCLUSIONS: Our study demonstrates a satisfactory sensibility percentage in recurrent defined MD presentation (>80%). Early identification of MD can lead to an early treatment and control of the progression of the disease. Furthermore it could be a valuable instrument for the follow up and evaluation of the patients classified as probable MD in accordance with the criteria of the American Academy of Otolaryngology-Head and Neck Surgery (1995).

Evaluation of central vestibular syndrome in dogs using brainstem auditory evoked responses recorded with surface electrodes / Avaliação da síndrome vestibular central em cães usando respostas evocadas auditivas do tronco cerebral gravadas com eletrodos de superfície

The present study aimed to analyse the wave morphology, amplitude, latency, and intervals of the brainstem auditory evoked responses (BAERs) in dogs with central vestibular syndrome (CVS) recorded with surface electrodes. Ten dogs with CVS were examined by mono- and binaural stimulation, using the Neuropack electrodiagnostic system, with stimulus intensities of 90 dBSPL. BAERs examinations revealed morphological changes of waves I, II, III, and V and decreased amplitudes of all waves in 7/10 dogs. P values obtained were = 0.014 for wave I amplitude, 0.031 for II, and III and 0.032 for V. Comparing the latencies of waves I, II, III, and V generated by right and left monoaural stimulation in dogs with CVS, we did not observe significant differences (P > 0.05). No statistical differences were observed for BAERs latencies of the waves recorded after binaural and monaural stimulation (left or right). As far as we know, this is the first study of BAERs using surface electrodes, obtained from dogs with CVS.(AU)

Este estudo destina-se à análise da morfologia, da amplitude, da latência e do intervalo das ondas das respostas evocadas auditivas no tronco cerebral (BAERs) em cães com síndrome vestibular central (CVS) registrados com eletrodos de superfície. Dez cães com CVS foram examinados por estimulação mono e binaural usando um sistema de eletrodiagnóstico Neuropack, com intensidade do estímulo de 90 dBSPL. Os exames BAERs relevaram alterações morfológicas das ondas I, II, III e V, bem como baixas amplitudes para todas as ondas no caso dos 7/10 cães. Os valores de P obtidos foram = 0.014 para ampitude da onda I, 0.031 para a II e 0.032 para a V. Compararam-se as latências das ondas I, II, III e V geradas pelo estímulo monoaural direito e esquerdo em cães com CVS e não foram constatadas diferenças significativas (P > 0.05). Igualmente não foram observadas diferenças estatísticas no caso das latências BAERs no que diz respeito às ondas gravadas depois de estímulos binaural e monoaural (esquerdo ou direito). Pelo que é de conhecimento dos autores da presente pesquisa, este é o primeiro estudo sobre BAERs usando eletrodos de superfície obtidos em cães com CVS.(AU)

Potencial evocado auditivo de média latência em populações infantis / Middle latency auditory evoked potential in child population

INTRODUCTION: The middle-latency auditory evoked potential is used to evaluate any abnormality that might impair the central auditory pathways, which are situated between the brain stem and the primary auditory cortex OBJECTIVE: To analyse the middle-latency auditory evoked potentials in children Methods : This is a descriptive and cross-sectional study. Pure-tone audiometry was performed, and if no change was detected, Biologic's portable Evoked Potential System (EP) was used to measure auditory evoked potentials. The identification of the responses was performed using electrodes positioned at C3 and C4 (left and right hemispheres) in reference to ears A1 and A2 (left and right earlobe). These were ipsilaterally and contralaterally paired and landed at Fpz (forehead), in two steps, with alternating stimulation of the right and left ears. RESULTS: In this study, there was 100% detectability of the Na, Pa, and Nb components and interamplitude Na-Pa. This study compared different electrode leads, and there was no significant difference between the different electrode positions studied for the right and left ears in the studied population CONCLUSION: It was concluded that the examination of middle-latency evoked potential is steady and feasible for the studied age group regardless of electrode position

INTRODUÇÃO: O potencial evocado auditivo de média latência é utilizado na avaliação de qualquer anomalia que possa comprometer as vias auditivas centrais, situadas entre o tronco encefálico e córtex auditivo primário OBJETIVO: Analisar os potenciais evocados auditivos de média latência em escolares MÉTODO: Esse estudo é descritivo transversal. Como procedimento foi realizado a audiometria tonal, e caso não fosse detectada nenhuma alteração, foi utilizado o equipamento portátil de potencial evocado auditivo Biologic's Evoked Potencial System (EP). O registro das respostas foi efetuado com eletrodos posicionados em C3 e C4 (hemisfério esquerdo e direito, respectivamente) em referência às orelhas A1 (lóbulo da orelha esquerda) e A2 (lóbulo da orelha direita), pareados ipsilateralmente e contralateralmente e terra em Fp (fronte), em duas etapas, alternando as estimulações das orelhas direita e esquerda RESULTADOS: Neste estudo houve 100% de detectabilidade dos componentes Na, Pa, Nb e interamplitude Na-Pa. Foram comparadas diferentes derivações de eletrodo e não foi observada diferença significativa entre diferentes posições de eletrodos pesquisadas tanto para orelha direita quanto para orelha esquerda nesta população de estudo CONCLUSÃO: O exame de potencial evocado auditivo de média latência é estável e viável para faixa etária estudada independente da posição dos eletrodos

Analysis of Electrocochleography: According to the Position of Summating Potential Peak / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: The aim of this study was to analyze the summating potential (SP)/action potential (AP) ratio of electrocochleography (ECoG) recorded from the position of SP peak. We compared the SP/AP ratios of negative polarity and positive polarity graphs from the same ECoG of each patient by assuming different the position of SP peak. In addition, we attempted to evaluate the utility of two different manners of recording the ECoG graph in the diagnosis of Meniere's disease. SUBJECTS AND METHOD: Retrospectively, we analyzed the results of ECoG in 67 patients with unilateral definite Meniere's disease. ECoG was analyzed in two different manners. From the AP peak, the SP peak was determined close when positioned in the negative polarity; on the other hand, SP peak was considered distant when positioned in the positive polarity. The SP/AP ratio was interpreted with reference to the base line value. The ratio of two different ECoG values from each patient of Meniere's disease was calculated. RESULTS: In the abnormal side, the negative polarity ECoG showed significantly greater value of SP/AP ratio (mean: 0.334±0.10) than the positive polarity ECoG (mean: 0.283±0.09) (p<0.001). In the normal side, the negative polarity ECoG, showed significantly greater value of SP/AP ratio (mean: 0.250±0.09) than the positive polarity ECoG (mean: 0.204±0.06), as well as in the abnormal cases (p<0.001). CONCLUSION: The standard SP/AP ratio for the diagnosis of Meniere's disease can be variable according to the manner of determining the SP peak.

The Effect of Garlic Derivatives (S-Allylmercaptocysteine, Diallyl Disulfide, and S-Allylcysteine) on Gentamicin Induced Ototoxicity: An Experimental Study

OBJECTIVES: Gentamicin is a potent aminoglycoside antibiotic. Ototoxicity and nephrotoxicity are the main side effects which restrict the use of gentamicin. Garlic with its intrinsic antioxidant activity may prove beneficial in prevention from ototoxicity. S-allylmercaptocysteine (SAMC), diallyl disulfide (DD), and S-allylcysteine (SAC) are three active compounds found in garlic. In this study, we investigated the effect of SAMC, DD, and SAC on the ototoxicity induced by gentamicin in rats, by using brainstem evoked response audiometry (BERA). METHODS: Thirty male Wistar rats with intact Preyer’s reflex initially weighing 220–260 g were randomly assigned to either the gentamicin injection with SAMC treatment group (Genta-w SAMC), DD treatment group (Genta-w DD), SAC treatment group (Genta-w SAC), gentamicin injection without any active compounds (AC) treatment groups (Genta-w/o AC), or control group (n=6 rats each group). Gentamicin was given 120-mg/kg body weight, intraperitoneally once daily for 25 days to subjects in all groups except the control group. SAMC 100-mg/kg, and DD 50-mg/kg body weight were given intragastrically, and SAC 250-mg/kg body weight was given intraperitoneally once daily to subjects in Genta-w SAMC, and Genta-w DD, and Genta-w SAC groups, respectively during the study. After 25 days hearing thresholds were evaluated by using BERA test. RESULTS: The mean amplitude of auditory thresholds (sensation level [SL]) measured by using BERA for the Genta-w SAMC, Genta-w DD, Genta-w SAC, Genta-w/o AC, and control groups were 22±8, 25±5, 30±9, 54±11, and 10±7 dB SL, respectively (mean±SD). The differences between every active compound group (Genta-w SAMC, Genta-w DD, and Genta-w SAC) and Genta-w/o AC were statistically significant (P<0.016). CONCLUSION: SAMC, DD, and SAC are derivative of garlic seems to attenuate aminoglycoside-induced hearing loss. The effect of SAMC and DD seems to be more prominent than that of SAC.