Reclassification of flat type sudden deafness / 中华耳鼻咽喉头颈外科杂志

Objective: To reclassify the flat type sudden deafness according to the types of audiogram shape, and to explore the correlation between different pattern of hearing loss and prognosis. Methods: All of 1 024 patients with unilateral sudden deafness (492 males and 532 females, aged from 19 to 65 years, with an average age of 41.2 years old) admitted to 33 hospitals nationwide from August 2007 to October 2011 were divided into four types according to Chinese Guideline of Sudden Deafness(2015): low-frequency, high-frequency, flat and total deafness. Then, 402 patients with flat type sudden deafness were further divided into ascending type, descending type and consistent type according to the audiogram shapes. First, we compared the clinical characteristics and prognosis among these three subtypes of flat deafness, then compared the clinical characteristics and prognosis between ascending flat deafness and low-frequency deafness, descending flat deafness and high-frequency deafness, consistent flat deafness and total deafness, explored the factors related to the prognosis of flat deafness. SPSS 21.0 software, ANOVA, χ2 test, t-test and Logistic regression were used to analyze the data. Results: The cure rates of flat ascending, flat descending and flat consistent sudden deafness groups were 70.7%, 17.1% and 34.0% respectively, with a statistically significant difference (χ2=33.984, P<0.001); However, there was no significant difference in age, sex and affected side (all P>0.05). The independent related factors for the recovery of flat type sudden deafness were as follows: whether there was dizziness [OR=0.459; 95% confidence interval (CI): 0.271-0.777], the type of audiogram shape (OR=0.721; 95%CI: 0.530-0.981), and days from onset to therapy (OR=0.903, 95%CI: 0.835-0.978), all of which had P values<0.05. There was no significant difference in the cure rates between ascending flat sudden deafness and low-frequency descending sudden deafness, descending flat sudden deafness and high-frequency descending sudden deafness (all P>0.05). The pure tone average(PTA) of flat consistent sudden deafness and total deafness were (69.1±18.9) and (101.7±17.7) dB HL, respectively, with a statistically significant difference (t=20.890, P<0.001), and the cure rates were 34.0% and 14.5%, respectively, with a statistically significant difference (χ2=29.012, P<0.001). Conclusion: According to the audiogram shape, the flat type sudden deafness can be further divided into ascending flat sudden deafness, descending flat sudden deafness and consistent flat sudden deafness, which can more effectively evaluate the prognosis. The cure rate of ascending flat sudden deafness is similar to that of low-frequency sudden deafness, and the prognosis is well; The cure rate of descending flat sudden deafness is similar to that of high-frequency descending sudden deafness, and the prognosis is poor. The cure rate of consistent flat sudden deafness is higher than that of total deafness. PTA plays an important role in the prognosis of consistent flat sudden deafness and total deafness. Total deafness can be regarded as a single type of sudden deafness.

Aplicabilidade e considerações clínicas do Sistema Contralateral Routing of Signal (CROS): revisão sistemática / Applicability and clinical considerations of the Contralateral Routing of Signal System (CROS): systematic review / Aplicabilidad y consideraciones clínicas del sistema de enrutamiento de señal contralateral (CROS): revisión sistemática

Introdução: O Sistema Contralateral Routing of Signal (CROS) é uma opção de intervenção auditiva com propósito de melhorar a percepção monoaural e minimizar as dificuldades da perda auditiva unilateral. Objetivo: analisar e descrever o público-alvo, o tempo de adaptação, o controle de uso do Sistema CROS, as avaliações utilizadas para medir os seus benefícios, sua efetividade e limitações. Método: Este estudo foi conduzido de acordo com as diretrizes PRISMA. A pesquisa bibliográfica foi realizada através dos bancos de dados científicos online na área da saúde, PubMed e Scopus, foram utilizadas as palavras-chave "Unilateral hearing loss", "Hearing aid", "CROS" e "Contralateral Routing of Signal". Os resultados da pesquisa limitaram-se a artigos científicos experimentais, que abordavam diretamente o sistema CROS, publicados em inglês, português ou espanhol. Resultados: Onze artigos foram selecionados para a revisão do texto completo. Quanto aos usuários do CROS, a faixa etária variou entre nove a 84 anos; prevalência do sexo masculino. Observou-se grande diversidade nas avaliações, sendo realizadas com tempo de uso inferior a 30 dias e superior a seis meses, após adaptação do CROS. Tal avaliação era realizada por meio de questionários não padronizados e avaliações objetivas com estímulos controlados. O uso do CROS proporcionou benefícios na localização sonora, efeito sombra da cabeça e inteligibilidade de fala, porém não mostrou eficácia em situações ruidosas. Conclusão: Por ser um dispositivo, não invasivo, de fácil adaptação e manuseio que traz benefícios imediatos, o CROS deve ser a primeira opção na reabilitação da perda auditiva unilateral.

Introducción: El Sistema Contralateral Routing of Signal (CROS) es una opción de intervención auditiva con el propósito de mejorar la percepción monoaural y minimizar las dificultades de la pérdida auditiva unilateral. Objetivo: analizar y describir el público objetivo, el tiempo de adaptación, el control del uso del Sistema CROS, las evaluaciones utilizadas para medir sus beneficios, su efectividad y limitaciones. Metodo: Este estudio se realizó de acuerdo con las pautas PRISMA. La búsqueda bibliográfica se realizó a través de bases de datos científicas online del área de salud, PubMed y Scopus, utilizando las palabras clave "Unilateral hearing loss", "Hearing aid", "CROS" y "Contralateral Routing of Signal". Los resultados de la investigación se limitaron a artículos científicos experimentales, que abordaron directamente el sistema CROS, publicados en inglés, portugués o español. Resultados: Se seleccionaron once artículos para revisión de texto completo. En cuanto a los usuarios de CROS, la edad osciló entre los nueve y los 84 años; prevalencia masculina. Hub gran diversidad en las evaluaciones, realizadas con tiempos de uso de menos de 30 días y más de seis meses tras la adaptación del CROS. Dicha evaluación se realizó mediante cuestionarios no estandarizados y evaluaciones objetivas con estímulos controlados. El uso de CROS proporcionó beneficios en la localización del sonido, el efecto de sombra de la cabeza y la inteligibilidad del habla, pero no fue efectivo en situaciones ruidosas. Conclusión: Al tratarse de un dispositivo no invasivo, de fácil adaptación y manejo que aporta beneficios inmediatos, CROS debería ser la primera opción en la rehabilitación de la hipoacusia unilateral.

Introduction: The system Contralateral Routing of Signal (CROS) is an option of auditory intervention in order to improve the monaural perception and minimize the difficulties of unilateral hearing loss. Objective: to analyze and describe the target users, the adaptation time and the control use of CROS system, the evaluations utilized to measure its benefits, as well as its effectiveness and limitations. Method: This study was conducted according to the PRISMA guidelines. The bibliographic research was through the scientific data online banks in the health area, PubMed and Scopus, using the keywords "Unilateral hearing loss", "Hearing aid", "CROS" and "Contralateral Routing of Signal". The results of the research were limited to experimental scientific articles, which address directly the CROS system, published in English, Portuguese or Spanish. Results: Eleven studies were selected to review. The age of CROS users ranged from nine to 84 years and male sex prevalence. There was great diversity in the evaluations being carried out. The performance's evaluation date varied between less than 30 days and more than six months after the adaptation. Such assessments were performed using non-standardized questionnaires and objective evaluations with controlled stimuli. The use of CROS provides benefits in sound localization, head shadow effect and speech intelligibility, but it is not effective in noisy situations. Conclusion: CROS should be the first option in unilateral hearing loss rehabilitation for being a non-invasive, easy adaption, handling dispositive and with good benefits to the client.

Hipoacusia sensorioneural unilateral: Revisión de los manejos posibles en nuestra realidad nacional / Unilateral sensorineural hearing loss: Review of possible management in our national reality

La hipoacusia unilateral (HUL) definida como la pérdida auditiva de cualquier grado en un solo oído tiene prevalencias en edad escolar de 3% a 6%. La etiología es desconocida en la mayoría de los casos, pero destacan las anormalidades anatómicas severas a diferencia de las hipoacusias bilaterales, lo que le otorga importancia al estudio de imágenes. También se recomienda realizar evaluación oftalmológica. El impacto de la HUL se observa en la localización sonora, reconocimiento del habla, desarrollo del lenguaje, desempeño social y conducta, pero por sobre todo en el rendimiento académico. En este sentido es relevante mencionar que además de existir mayor probabilidad de repitencia de curso, es necesario mayor apoyo educacional individualizado para evitar dicha repitencia o lograr mismo éxito académico que un normoyente. En relación al diagnóstico aún faltan normas o protocolos, siendo éste un desafío en las zonas donde no hay screening universal. Se discute la importancia de las encuestas para realizar evaluaciones y seguimiento en estos casos. Finalmente se abordan las estrategias de intervención disponibles, además de un plan individualizado considerando al niño, su familia y sus expectativas, particularmente se discuten las características o factores a tomar en cuenta en el momento de la adaptación, para así lograr un tratamiento tendiente al éxito.

Unilateral hearing loss (UHL) defined as hearing loss of any degree in only one ear has a school-age prevalence of 3% to 6%. The etiology is unknown in most cases, but severe anatomical abnormalities stand out as opposed to bilateral hearing loss, which gives importance to the study of images. Ophthalmological evaluation is also recommended. The impact of UHL is observed in sound localization, speech recognition, language development, social performance and behavior, but above all in academic performance. In this sense, it is relevant to mention that in addition to having a higher probability of repeating the course, it is necessary to have more individualized educational support to avoid this repetition or achieve the same academic success as a normal listener. Regarding the diagnosis, there are still missing norms or protocols, this being a challenge in areas where there is no universal screening. The importance of surveys to carry out evaluations and follow-up in these cases is discussed. Finally, the available intervention strategies are discussed, in addition to an individualized plan considering the child, his family and his expectations, particularly, the factors to be taken into account at the time of adaptation, in order to achieve a success treatment.

Preliminary audiological evaluation of the SoundBite bone conduction devices in adults with single-sided deafness / 中华耳鼻咽喉头颈外科杂志

Objective: The auditory deficits of single-sided deafness (SSD) can be treated with a novel intra-oral device, SoundBite, which delivers sound by applying vibratory signal to the teeth. The purpose of this study was to evaluate the efficacy and benefit of the bone conduction device for Chinese adults with SSD. Methods: Eighteen patients aged 19-66 yrs with acquired, permanent sensorineural SSD and no current treatment by any other devices for SSD, were recruited in a prospective controlled, nonrandomized, unblinded study. They were requested the continually daily wear of the new device over a 30-day free trial period. The intra-oral hearing device was placed around two maxillary teeth and was similar to a small partial denture or retainer. The audiological tests included pure tone air conduction thresholds, monosyllable word recognition score (WRS) in quiet and sentence reception thresholds in noise (via CMNmatrix test). The benefit was determined with the Abbreviated Profile of Hearing Aid Benefit (APHAB) and the Speech, Spatial and Qualities of Hearing Scale (SSQ) questionnaire. Results: The monosyllable WRS and the 50% threshold of signal-to-noise ratio (SNR50) were significantly better in all aided conditions. The head shadow effect, assessed by the SNR50 via CMNmatrix test improved an average of 2.6 dB after 30 days' wearing compared with unaided condition (P<0.001). The APHAB scores improved (P<0.05) for all subjects for the Global and Ease of Communication, Reverberation, Background Noise subscales. The SSQ scores improved (P<0.05) for all subjects for Speech, Spatial and Qualities of Hearing subscales. Conclusion: The SoundBite is a good alternative to the well-established implantable bone conduction devices in patients with SSD. An improvement in listening ability in noise and quiet as well as a decrease of the head shadow effect is validated as the expected.

Tradução e adaptação transcultural do Unilateral Hearing Loss Questionnaire para a língua portuguesa brasileira / Translation and cross-cultural adaptation of the Unilateral Hearing Loss Questionnaire into brazilian portuguese

RESUMO Objetivo Tradução e adaptação transcultural do Unilateral Hearing Loss Questionnaire para a língua portuguesa brasileira, e aplicação do questionário em um grupo de crianças/adolescentes com perda auditiva unilateral, usuárias de aparelho de amplificação sonora individual, e seus respectivos pais/responsáveis. Métodos O trabalho foi dividido em duas partes: tradução e adaptação transcultural do Unilateral Hearing Loss Questionnaire para a língua portuguesa brasileira e aplicação nas crianças/adolescentes e em seus pais/responsáveis, a fim de realizar a comparação entre as respostas do questionário por meio do percentual de concordância. Resultados A análise do trabalho dos tradutores brasileiros considerou a equivalência semântica e houve apenas dois ajustes terminológicos. A retrotradução não apresentou discrepâncias conceituais, apenas problemas linguísticos. Uma comparação entre as respostas dos entrevistados permitiu realizar o percentual de concordância. Conclusão O questionário de perda auditiva unilateral para crianças e pais foi traduzido para o português brasileiro, apresentando equivalência e semântica e idiomática. A análise descritiva do percentual de concordância entre crianças/adolescentes com perda auditiva unilateral e seus pais/responsáveis mostrou ser um preditor na equivalência das repostas.

ABSTRACT Purpose Translate and make the cross-cultural adaptation of the Unilateral Hearing Loss Questionnaire. This questionnaire will be conducted with children / adolescents and also by caregivers into the Brazilian Portuguese language. Methods The work was divided into two parts: translation and cross-cultural adaptation of the Unilateral Hearing Loss Questionnaire into Brazilian Portuguese and application to children/adolescents and caregives through the agreement percentage. Results The analysis of the work of Brazilian translators considered semantic equivalence, and there were only two terminological adjustments. The back-translation did not present conceptual discrepancies, only linguistic problems. A preliminary comparison showed that the agreement percentage between the answers of caregivers and children/teenagers was satisfactory. Conclusion The Unilateral Hearing Loss Questionnaire for children and parents was translated and cross-culturally adapted into the Brazilian Portuguese language showing semantic equivalence and idiomatic. The comparative descriptive analysis of the agreement percentage between children and caregivers showed a predictor in the equivalence of responses.

Hipoacusia unilateral: bases neurobiológicas de la ambliaudia / Unilateral hearing loss: neurobiological basis of amblyaudia

Resumen La hipoacusia unilateral es una alteración prevalente e importante en la población infantil que puede llevar a un deterioro del procesamiento auditivo. Cualquier patología que cause hipoacusia asimétrica (conductiva o sensorioneural) durante ventanas críticas del desarrollo cerebral, puede dar lugar a déficits del procesamiento auditivo que podrían persistir incluso después de la rehabilitación audiológica. Este proceso fisiopatológico se ha denominado "ambliaudia" y los niños que la presentan tienen un mayor riesgo de sufrir retraso en el desarrollo del lenguaje, así como de padecer dificultades académicas, sociales y cognitivas. Por esto, la ambliaudia se presenta como un desafío en audiología, siendo necesario comprender los mecanismos neurobiológicos que la subyacen. Entender de mejor manera cuáles son las consecuencias que tiene la pérdida auditiva asimétrica sobre el desarrollo del sistema nervioso podría ser clave para guiar de mejor forma las intervenciones terapéuticas. En este artículo se revisan trabajos en humanos y en modelos animales que describen las consecuencias neurobiológicas de la deprivación auditiva unilateral durante el desarrollo del sistema nervioso y su posible aplicación a la práctica clínica.

Abstract Unilateral hearing loss is a prevalent and important disorder in children that can lead to an impairment of auditory processing. Any pathology that causes asymmetric (conductive or sensorineural) hearing loss during critical brain development windows can lead to hearing deficits that may persist even after audiological rehabilitation. This pathophysiological process has been referred to as amblyaudia, and children are at greater risk of experiencing language developmental delays as well as academic, social and cognitive impairments. For this reason, amblyaudia presents itself as a challenge in audiology, and it has become necessary to understand its neurobiological mechanisms. A better understanding of the consequences of asymmetric hearing loss on the development of the nervous system may be key to better guiding therapeutic interventions. This article reviews studies performed in humans and animal models that describe the neurobiological consequences of unilateral hearing deprivation during the development of the nervous system and its possible applications to clinical practice.

Unilateral hearing loss: benefit of amplification in sound localization, temporal ordering and resolution / Perda auditiva unilateral: benefício da amplificação na ordenação e resolução temporal e na localização sonora

ABSTRACT Purpose To assess the hearing abilities of temporal ordering, temporal resolution and sound localization before and after the fitting of a hearing aid (HA) in individuals with unilateral hearing loss (UHL). Methods There were evaluated 22 subjects, aged 18 to 60 years, diagnosed with sensorineural or mixed UHL, from mild to severe degrees. The study was divided into two stages: the pre and post-adaptation of HA. In both phases, subjects performed an interview, application of Questionnaire for Disabilities Associated with Impaired Auditory Localization, auditory processing screening protocol (APSP) and Random Gap Detection Test (RGDT). Results This study found no statistically significant difference in sound localization and memory evaluations for verbal sounds in sequence, in RGDT and Questionnaire for Disabilities Associated with Impaired Auditory Localization. Conclusion With the effective use of hearing aids, individuals with UHL showed improvement in the auditory abilities of sound localization, ordering and temporal resolution.

RESUMO Objetivo Verificar as habilidades auditivas de ordenação temporal, resolução temporal e localização sonora, antes e após a adaptação do aparelho de amplificação sonora individual (AASI) em indivíduos com perda auditiva unilateral (PAUn). Método Foram avaliados 22 indivíduos, com idades de 18 a 60 anos, com diagnóstico de PAUn sensorioneural ou mista, de graus leve a severo. O estudo foi dividido em duas etapas: a pré- e a pós-adaptação do AASI. Em ambas as etapas, os indivíduos realizaram anamnese, bem como a aplicação do Questionário de Habilidade Auditiva da Localização da Fonte Sonora (QHALFS), avaliação simplificada do processamento auditivo (ASPA) e Random Gap Detection Test (RGDT). Resultados O presente estudo encontrou diferenças estatisticamente significantes nas avaliações de localização sonora e memória para sons verbais em sequência, no RGDT e no QHALFS. Conclusão Com o uso efetivo do AASI, indivíduos com PAUn apresentaram melhora nas habilidades auditivas de localização sonora, ordenação e resolução temporal.

Perda auditiva unilateral e assimétrica na infância / Unilateral and asymmetric hearing loss in childhood

RESUMO Objetivo Descrever a perda auditiva sensorioneural unilateral e bilateral assimétrica em crianças quanto às características etiológicas, audiológicas e demográficas. Método Estudo retrospectivo transversal, desenvolvido na Seção de Implante Coclear do Hospital de Reabilitação de Anomalias Craniofaciais, por meio da análise de prontuários. Resultados Foram analisados os dados de 1152 pacientes, sendo 424 (37%) adolescentes, adultos ou idosos e 728 (63%) crianças, dentre as quais, 691 (95%) apresentavam perda auditiva bilateral simétrica e 37 (5%) perda auditiva sensorioneural unilateral (n=10) ou bilateral assimétrica (n=27). A idade média ao diagnóstico na perda auditiva sensorioneural unilateral foi de 33,58±21,69 meses e na bilateral assimétrica de 33,12±21,69 meses, com prevalência de 1,4% e 3,7%, respectivamente. O indicador de risco para a deficiência auditiva de maior ocorrência para ambos os grupos foi o de antecedente familiar. A maioria dos familiares das crianças com perda auditiva sensorioneural unilateral apresentaram a classificação socioeconômica baixa superior (50%), enquanto que as crianças com perda auditiva sensorioneural bilateral assimétrica se subdividiram igualmente em baixa superior (37%) e média inferior (37%). Conclusão Houve uma maior prevalência da perda auditiva sensorioneural bilateral assimétrica em relação à unilateral, bem como do indicador de risco de hereditariedade, com predomínio do grau profundo na pior orelha e preponderância do sexo feminino, em ambos os grupos. Apesar de a triagem auditiva neonatal propiciar a identificação precoce da perda auditiva sensorioneural unilateral, a idade no diagnóstico audiológico ainda se encontra acima do recomendado. Adicionalmente, a maioria dos familiares das crianças apresentou nível de rendimento baixo.

ABSTRACT Purpose To describe unilateral and bilateral asymmetric sensorineural hearing loss in children and its etiological, audiological and demographic characteristics. Methods Retrospective cross-sectional study developed in the Seção de Implante Coclear of Hospital de Reabilitação de Anomalias Craniofaciais, through the analysis of medical records. Results Data from 1152 patients were analyzed: 424 (37%) adolescents, adults or elderly, and 728 (63%) children, of whom 691 (95%) had bilateral symmetrical hearing loss, and 37 (5%) had unilateral hearing loss (n=10) or bilateral asymmetric (n=27) sensorineural hearing loss. The mean age at diagnosis of unilateral sensorineural hearing loss was 33.58±21.69 months, and for asymmetric bilateral it was 33.12±21.69 months, with a prevalence of 1.4% and 3.7%, respectively. The highest risk indicator for hearing loss for both groups was the family history of permanent deafness, which began in childhood. The majority of the relatives of children with unilateral sensorineural hearing loss presented the highest low socioeconomic classification (50%), while children with bilateral asymmetric sensorineural hearing loss were also be subdivided into upper (37%) and lower (37%). Conclusion We observed a greater occurrence of asymmetric bilateral sensorineural hearing loss compared to unilateral hearing loss, as well as the hereditary risk indicator, with a predominance of the deep ear and female preponderance in both groups. Although neonatal hearing screening provides early identification of unilateral sensorineural hearing loss, the age at the audiological diagnosis is still above the recommended level. In addition, the majority of the children's family members presented a low level of income.

Análise da percepção da fala com uso de dispositivos de amplificação em indivíduos com malformação de orelha e perda auditiva unilateral / Analysis of speech perception with amplification devices in subjects with ear malformation and unilateral hearing loss

RESUMO Objetivo: Verificar a percepção da fala de indivíduos com malformação de orelha e perda auditiva unilateral utilizando dois tipos de amplificação: amplificação sonora individual (AASI) convencional e softband (faixa com vibrador ósseo). Método: Foram selecionados 15 indivíduos, de ambos os sexos, com malformação congênita de orelha externa e/ou orelha média, diagnóstico de perda auditiva unilateral do tipo condutiva ou mista de grau moderado a severo, idade entre 15 e 25 anos, e encaminhamento para amplificação realizado pelo médico otorrinolaringologista. Após a adaptação com AASI e softband, foi realizada avaliação da percepção da fala sem uso da amplificação, com AASI acoplado ao arco e vibrador ósseo (convencional) e com uso do softband (faixa com vibrador). Os indivíduos foram avaliados por meio do Hearing in Noise Test (HINT) nas condições de silêncio e de ruído. Resultados: Foram avaliados sete indivíduos com malformação de orelha unilateral, sendo 57,1% na orelha direita e 42,9% na orelha esquerda. Quanto ao tipo e grau da perda, 71, 4% da amostra possuía perda auditiva condutiva moderada. No teste de percepção de fala na condição de silêncio, ruído frontal e ruído lateral, em três situações: sem amplificação, com o uso do AASI convencional e com o uso do softband, os resultados com uso de dispositivos de amplificação apresentaram-se melhores em todas as condições. Conclusão: Os indivíduos apresentaram melhora sutil, porém não significativa, na percepção de fala tanto em situações de silêncio, ruído frontal e lateral independentemente do tipo de amplificação.

ABSTRACT Purpose: To verify the speech perception in subjects with ear malformation and unilateral hearing loss, fitted with two types of amplification as follows: conventional hearing aids and softband (band with vibrator bone). Method: The study included fifteen subjects of both sexes who presented congenital malformation of the middle or outer ear, diagnosed with unilateral conductive or mixed hearing loss, moderate to severe hearing loss, age range between 15 to 25 years and, prescription from a specialist doctor for hearing device fitting. We performed the speech perception assessment without amplification after the hearing aid and softband fitting, with the hearing aid linked to the bone vibrator (conventional) and the softband (band with the bone vibrator). The subjects were evaluated using the Hearing in Noise Test (HINT), in silence and in noise. Results: Seven subjects with unilateral ear malformation were evaluated, 57.1 % had impairment in the right ear and 42.9 % in the left ear. Regarding the type and the level of hearing loss, 71 % of all subjects included in the sample presented moderate conductive hearing loss. The assessment of speech perception was performed during silence, frontal noise, lateral noise and, during three specifics situations: no amplification, with conventional hearing aid and with the softband. The results with the amplification devices were positive in all evaluated conditions. Conclusion: Evaluated subjects presented improvement in speech perception, in silence, frontal noise and lateral noise situations, regardless of the type of amplification; however, the difference was not statistically significant.

Treinamento auditivo acusticamente controlado como opção de intervenção em transtorno do processamento auditivo central em perda auditiva unilateral severa/profunda / Acoustically controlled auditory training as an intervention option in central auditory processing disorder in severe/profound unilateral hearing loss

RESUMO Objetivo Verificar a efetividade do treinamento auditivo acusticamente controlado em pessoas com distúrbio do processamento auditivo central e perda auditiva unilateral de grau severo a profundo. Métodos Participaram do estudo 16 indivíduos, de 13 a 21 anos de idade, diagnosticados com perda auditiva unilateral de grau severo a profundo e transtorno do processamento auditivo central, divididos em dois grupos, com oito indivíduos cada, pareados por idade, sexo e escolaridade: grupo estudo, submetido ao programa de treinamento auditivo acusticamente controlado, em oito sessões, realizadas uma vez por semana; grupo comparação, que não foi submetido a nenhum tipo de intervenção. Ao final de oito semanas, os grupos foram reavaliados quanto ao potencial evocado auditivo de longa latência (P300) e quanto às habilidades auditivas alteradas, observadas nos testes Localização Sonora, Identificação de Sentenças Sintéticas, Fala no Ruído e Randon Gap Detection Test. Resultados Não houve influências do lado da perda auditiva na avaliação inicial, para nenhum dos grupos. Na avaliação final, verificou-se, somente no grupo estudo, aprimoramento de todas as habilidades auditivas, diminuição da latência e aumento da amplitude no P300. Indivíduos com perda auditiva à direita apresentaram maior aumento da amplitude do P300. Não foram observadas modificações no grupo comparação. Conclusão O treinamento auditivo acusticamente controlado foi eficaz, pois possibilitou o aprimoramento das habilidades auditivas e a modificação na atividade neurobiológica quanto à velocidade de processamento auditivo. Sugere-se essa opção de intervenção em pessoas com transtorno do processamento auditivo central e perda auditiva unilateral.

ABSTRACT Purpose To verify the effectiveness of the auditory training acoustically controlled in people with central auditory processing disorders and unilateral hearing loss from severe to profound. Methods 16 individuals between the age of 13 to 21 diagnosed with unilateral hearing loss from severe to profound and central auditory process disorder has participated in this study, individuals were divided into two groups, consisting of eight individuals each, paired by age, sex and education. Eight of them - Experimental Group - underwent an individual Acoustically Controlled Auditory Training program consisting of eight sessions accomplished once a week. The remaining individuals - Control Group - there were no intervention. At the end of eight weeks, both groups were reassessed for Long Latency Auditory Evoked Potential (P300), and altered hearing abilities on the Sound Localization test, Synthetic Sentence Identification, Speech in Noise and Random Gap Detection Test. Results There were no influences of the hearing loss side in the initial assessment for any of the groups. In the final assessment there was an improvement in all abilities, decreased latency and increased amplitude in P300 only Experimental Group. Individuals with hearing loss on the right showed a greater increase in P300 amplitude. There were no changes in the Control Group. Conclusion The acoustically controlled auditory training was effective because it allowed an improvement of the auditory abilities and a modification in the neurobiological activity in relation to the auditory processing speed. This option it is suggested for intervention in people with a central auditory processing disorder and hearing loss.

Reabilitação com prótese auditiva em indivíduos com perda auditiva unilateral: revisão sistemática / Rehabilitation with hearing aids for individuals with unilateral hearing loss: a systematic review / Rehabilitación con prótesis auditiva en indivíduos con pérdida auditiva unilateral: revisión sistemática

Determinar, por meio de uma revisão sistemática, os resultados auditivos da reabilitação por meio de prótese auditiva em indivíduos com Perda Auditiva Unilateral (PAUn), no que se refere às habilidades de reconhecimento de fala na presença de ruído competitivo, localização da fonte sonora, satisfação e tempo de uso da prótese auditiva. Método: O levantamento bibliográfico foi realizado nas bases de dados Cochrane, Lilacs, Medline, Pubmed e Scielo, buscando triar estudos publicados entre 1997 e 2017, com os seguintes descritores em português: perda auditiva unilateral e auxiliares de audição; e em inglês: unilateral hearing loss e hearing aid. Os critérios de seleção dos estudos foram, amostra de indivíduos com PAUn, com idade mínima de 18 anos, que tivessem sido submetidos a avaliações de resultados voltados para a investigação do reconhecimento de fala na presença de ruído e/ou localização da fonte sonora e/ou satisfação e/ou tempo de uso da prótese auditiva, pré e pós-adaptação de prótese auditiva. Resultados: Após o levantamento bibliográfico, seis artigos foram analisados. Conclusão: Observou-se escassez de estudos voltados para a investigação da reabilitação por meio de prótese auditiva em indivíduos com PAUn. Apesar da maioria dos estudos demonstrarem benefício e satisfação com a adaptação de prótese auditiva, parte desta população não faz uso da mesma. A adaptação de prótese auditiva nesta população deve ser incentivada, levando em consideração a avaliação da demanda comunicativa de cada indivíduo, sua restrição de participação, principais queixas auditivas deste indivíduo pré e pós-adaptação e do ajuste de programação da prótese auditiva.

To determine, using a systematic review, the auditory rehabilitation results through hearing aids in individuals with Unilateral Hearing Loss (UHL), in terms of speech recognition skills in competitive noise, location of the sound source, satisfaction and usage time of the hearing aid. Methods: The literature review was performed in the databases Cochrane, Lilacs, Medline, Pubmed and Scielo, searching for published studies between 1997 and 2017, with the following descriptors in Portuguese: perda auditiva unilateral e auxiliares de audição; and in English: unilateral hearing loss and hearing aids. The selection criteria of the studies were, sample of individuals presenting UHL, aged at least 18, who had been submitted to results evaluations for speech recognition research recognition in the presence of noise and/or location of the sound source and/or satisfaction and/or usage time of hearing aid, pre and post-adaptation of hearing aid. Results: After the bibliographical survey, six articles were analyzed. Conclusion: There was a shortage of studies aimed at the investigation of the rehabilitation by hearing aids in individuals presenting UHL. Although most studies show benefit and satisfaction with hearing aid adaptation, part of this population does not use it. The adaptation of hearing aids in this population should be encouraged, taking into account the evaluation of the communicative demand of each individual, their participation restriction, the main auditory complaints of this individual before and after adaptation and the programming adjustment of the hearing aid.

Determinar, a través de una revisión sistemática, los resultados auditivos de la rehabilitación por medio de prótesis auditivas en individuos con Pérdida Auditiva Unilateral (PAUn), en lo que se refiere a las habilidades de reconocimiento de habla en la presencia de ruido competitivo, localización de la fuente sonora, satisfacción y tiempo de uso de la prótesis auditiva. Metodos: El estudio de la literatura se realizó en las bases de datos Cochrane, Lilacs, Medline, Pubmed e Scielo buscando clasificar estudios publicados entre 1997 y 2017, con los siguientes descriptores en portugués: perda auditiva unilateral y auxiliares de audição; y en inglés: unilateral hearing loss e hearing aid. Los criterios de selección de los estudios fueron, muestras de individuos con PAUn, con edad mínima de 18 años, que hubieran sido sometidos a evaluaciones de resultados dirigidos a la investigación del reconocimiento de habla en la presencia de ruido y / o localización de la fuente sonora y / o satisfacción y / o tiempo de uso de la prótesis auditiva, pre y post-adaptación de prótesis auditiva. Resultados: Después de los estudios bibliográficos, seis artículos fueron analizados. Conclusión: Se observó escasez de estudios orientados a la investigación de la rehabilitación por medio de prótesis auditiva en individuos con PAUn. Aunque la mayoría de los estudios demuestran beneficio y satisfacción con la adaptación de la prótesis auditiva, parte de esta población no hace uso de la misma. La adaptación de prótesis auditiva en esta población debe ser incentivada, teniendo en cuenta la evaluación de la demanda comunicativa de cada individuo, su restricción de participación, principales quejas auditivas de este individuo pre y post-adaptación y del ajuste de programación de la prótesis auditiva.

O uso do mascaramento contralateral na pesquisa do potencial evocado auditivo de tronco encefálico por condução aérea: revisão sistemática / Use of contralateral masking in air-conduction auditory brainstem response: systematic review

RESUMO Objetivos analisar criticamente a necessidade do uso do mascaramento contralateral na pesquisa do potencial evocado auditivo de tronco encefálico (PEATE) por condução aérea, na perda auditiva sensorioneural unilateral ou bilateral assimétrica, por meio de uma revisão sistemática da literatura. Estratégia de pesquisa foram consultadas as bases de dados eletrônicas PubMed/MEDLINE, LILACS, ADOLEC, IBECS, SciELO, Web of Science, Scopus e Embase, bem como os anais do Encontro Internacional de Audiologia e do Congresso Brasileiro de Fonoaudiologia, além das bases de instituições com pós-graduação em Fonoaudiologia, utilizando os descritores Evoked Potentials, Auditory, Brain Stem, Perceptual Masking e Hearing Loss, Sensorineural. Critérios de seleção foram selecionados os estudos com níveis de evidência de 1 a 5, publicados em português, inglês ou espanhol, até janeiro de 2018. Os artigos deveriam abordar a necessidade do uso do mascaramento contralateral na pesquisa do PEATE por condução aérea, em indivíduos com perda auditiva sensorioneural unilateral ou bilateral assimétrica. Resultados foram encontrados 334 estudos, sendo que oito artigos contemplaram os critérios preestabelecidos. Os estudos incluídos foram controversos quanto ao uso do mascaramento contralateral. Conclusão não existe um consenso quanto à necessidade do uso do mascaramento contralateral no PEATE por condução aérea, em indivíduos com perda auditiva sensorioneural unilateral. No entanto, a maioria dos estudos direcionou para a sua utilização na pesquisa do PEATE com estímulo clique em indivíduos com perda auditiva sensorioneural unilateral de graus severo e profundo.

ABSTRACT Purpose Critically analyze the need to use contralateral masking in the measurement of Auditory Brainstem Response (ABR) by air conduction on unilateral or bilateral asymmetric sensorineural hearing loss by means of a systematic literature review. Research strategies A search was conducted at the PubMed/MEDLINE, LILACS, ADOLEC, IBECS, SciELO, Web of Science, Scopus and Embase electronic databases, proceedings of the International Meeting of Audiology and the Brazilian Congress of Speech-language Pathology and Audiology, and bases of institutions with Graduate Studies Programs in Speech-language Pathology and Audiology, using the following descriptors: Evoked Potentials, Auditory, Brainstem, Perceptual Masking, Hearing Loss, and Sensorineural. Selection criteria Studies with levels of evidence from 1 to 5 published in Portuguese, English or Spanish until January 2018 were selected. The articles should address the need to use contralateral masking in the measurement of air-conduction ABR in individuals with unilateral or bilateral asymmetric sensorineural hearing loss. Results A total of 334 studies were found, and eight of them met the pre-established criteria. The studies included in the review were controversial as to the need for contralateral masking. Conclusion There is no consensus on the need to use contralateral masking in the measurement of ABR by air conduction in individuals with unilateral sensorineural hearing loss; however, most studies report the use of contralateral masking in the measurement of ABR with click stimulus in individuals with severe and profound unilateral sensorineural hearing loss.

The use of remote microphone systems in unilateral hearing loss: a preliminary study among Brazilian children and teenagers

Abstract Due to the large number of individuals with Unilateral Hearing Loss (UHL) and the recommendation to use hearing assistive devices, studies are required to define possibilities of intervention for this population. Objective: To evaluate the performance of the Remote Microphone System (RMS) in children with UHL. Methodology: Prospective clinical study with a convenience sample. Eleven children (mean age of 9.2 years) with severe and profound sensorineural UHL, hearing aid users and enrolled in regular schools participated in the study. They were evaluated using the Hearing in Noise Test (HINT), the Classroom Participation Questionnaire (CPQ), and the Sustained Auditory Attention Ability Test (SAAAT) with RMS. Results: HINT results were analyzed using variance to three criteria of repeated measures, which revealed differences between intervention, position, and time factors and significant interaction between these three factors. The comparative analysis of the results from CPQ showed significant differences in the statistical t-test (p=<0.001) for all subscales. The analysis of variance at two repeated measures criteria used in the study of SAAAT revealed a difference between intervention and time, and both interacted significantly. Conclusion: The RMS associated with a hearing aid was effective for individuals with UHL.

A Case of Middle Ear Neuroendocrine Adenoma in a Patient with Hearing Loss and Facial Palsy / 대한이비인후과학회지

Middle ear adenoma is a very rare disease which is benign and originates from the middle ear mucosa. Patients of middle ear adenoma usually come to the clinic for unilateral hearing loss or tinnitus, but rarely for accompanied facial palsy. It is non-gender specific and occurs over a wide range of ages. The recurrence rate is known to be very low, but few authors argue that neuroendocrine adenoma should be considered as a low grade carcinoma due to some cases of recurrence. A 18 years-old male who had a left side facial palsy about 3 years ago but has currently improved as compared with the initial onset, visited our clinic for the left side hearing loss. Pure tone audiogram showed about 30 dB of conductive hearing loss and a pinkish polypoid mass involving the left tympanic membrane. We removed a tumor via transmastoid approach. The final diagnosis was middle ear adenoma with neuroendocrine differentiation. Neither signs of complication nor recurrence were observed after six months of the surgery.

A Comparison of the Operative Techniques and the Postoperative Complications for Bone-Anchored Hearing Aid Implantation

Abstract Introduction Bone anchored hearing aids (BAHA) represent a useful surgical option for patients with single sided deafness. Objectives To compare multiple techniques for BAHA implantation regarding postoperative complications, operative time, and duration between the surgery and the first use of the BAHA. Methods A retrospective study was conducted of all patients receiving implantation of a BAHA from August of 2008 to October of 2014. Data collected included: patient age, gender, side operated, abutment length, operative time, duration until first use of the BAHA, operative technique, and postoperative complications. The statistical analysis was performed using analysis of variance (ANOVA), Tukey pairwise comparison, chi-square, and paired t-test. Statistical significance was determined using a level of p< 0.05. Results A total of 88 patients (43 female and 45 male) were included in the data analysis. A total of 80 complications were documented, and these complications were classified according to the Holgers criteria. A significant difference in the total postoperative complications existed between the six techniques used (ANOVA; p< 0.01). In addition, there was also a significant difference among the six techniques employed regarding the operative time (ANOVA; p< 0.01). The average time duration until fitting of the BAHA processor among the various techniques trended toward but did not reach statistical significance (ANOVA; p= 0.16). Conclusions Significant differences in the operative outcomes exist among the various techniques for BAHA implantation. Based on the statistical analysis of our data, the BAHA Attract system (Cochlear Ltd., Sidney, Australia) requires greater operative time, but it is associated with less postoperative complications than percutaneous techniques and its processor may be fitted significantly sooner.

Horizontal Localization in Simulated Unilateral Hearing Loss

BACKGROUND AND OBJECTIVES: The ability to localize a sound source is one of the binaural hearing benefits in a horizontal plane based on interaural time difference and interaural intensity difference. Unilateral or bilateral asymmetric hearing loss will affect binaural hearing and lead to sound locating errors. In this cross sectional analytical descriptive study, the localization error was investigated when participants turned their heads to the sound source with closed eyes and after simulating unilateral hearing loss by placing earplugs inside the right ear canal. SUBJECTS AND METHODS: This cross sectional analytical descriptive study was carried out on 30 right-handed adults, 22 female and 8 male (average: 25 years, standard deviation: 3.16). They were selected with the available random access method. Horizontal localization was evaluated with five speakers located at 0, ±30, and ±60 degree azimuths at a 1-meter distance from the examinee. Narrow-band noise signals were delivered at 35 dB SL in two “without earplug” and “with earplug” situations and the results were compared. The study was performed between September and December 2016 in Tehran, Iran. RESULTS: Significant differences were observed in localization errors between the “with earplug” and “without earplug” situations. The localization differences were greater for left-side speakers (-30 and -60 degrees) compared with right-side speakers (+30 and +60 degrees). The differences were more apparent at 4,000 and 6,000 Hz, which confirmed the effect of unilateral simulated hearing loss on interaural latency differences. CONCLUSIONS: Simulating hearing loss by using an earplug in one ear (right) increased localization errors at all frequencies. The errors increased at higher frequencies.

Current Developments and Challenge of Implantable Bone Conduction Hearing Aids / 대한이비인후과학회지

It is acknowledged that implantable bone conduction hearing aids such as a bone anchored hearing aid provide benefit and satisfaction to patients with unilateral hearing loss in terms of sound localization and speech perception under noise circumstances. This review paper introduces current models of the implantable bone conduction hearing aids, their candidacy, brief surgical procedures, and general audiological examinations. A table summary was used for nine published research papers which have very similar results by three points, i.e., no change in ability of sound localization, better performance of Hearing-In-Noise Test, and improved satisfaction of sound quality using questionnaires after the implantation. Unfortunately, systematic fitting strategy for users of the implantable bone conduction hearing aids has not been either studied or developed yet. Futhermore, there is no scientific based approach of reason why the implantation has no benefit in sound localization but still provides better performance for speech perception in noise. In conclusion, specific and effective fitting strategy of the current implantable bone conduction hearing aids should be developed and also support effect of the implantation with sensitivity and specificity for both clinicians and patients while accompanying their advanced technology.

Achados otológicos em pacientes pós-infecção pelo zika vírus: estudos de caso / Otological findings in patients following infection with Zika virus: case report

RESUMO O Zika vírus em humanos é transmitido pelo mosquito Aedes aegypti e se tornou uma emergência de saúde pública, conforme declaração da Organização Mundial de Saúde. Estudos relataram a associação do vírus com alterações auditivas em pacientes, pós-infecção. Este estudo foi concebido em função da importância da audição para a comunicação, associado aos poucos relatos sobre o impacto que o Zika vírus pode causar no sistema auditivo de indivíduos adultos. O objetivo do estudo foi caracterizar os achados otológicos em dois pacientes adultos, pós-infecção pelo Zika vírus. Foram descritos os achados otológicos de pacientes de um ambulatório de otorrinolaringologia, que apresentaram queixas auditivas logo após os sintomas clínicos de infecção pelo Zika vírus. Os dois pacientes adultos relataram os seguintes sintomas: mal-estar, erupção cutânea, artralgia, plenitude auricular e perda auditiva. Exame sorológico reagente para Zika vírus (IgG). Os achados audiológicos foram: perda auditiva periférica unilateral em um paciente, alterações de reflexos contralaterais em ambos e do potencial evocado de tronco encefálico em um paciente. Os achados audiológicos demonstram possível envolvimento neuronal nas queixas apresentadas, associado, ou não, ao componente periférico, nos pacientes infectados pelo Zika vírus.

ABSTRACT The Zika virus is transmitted between humans by the Aedes aegypti mosquito and has become a public health emergency, as declared by the World Health Organization. Studies have reported the virus to be associated with hearing alterations in patients, following infection. This study was conceived in view of the importance of hearing for communication, associated with the limited number of reports on the impact of Zika virus on the hearing system of adults. The aim of the study was to characterize the otological findings in two adult patients, following infection with the Zika virus. The otological findings observed in two outpatients of an otorhinolaryngology service were described, both of whom reported hearing complaints immediately following the clinical symptoms of Zika virus infection. Both adult patients reported the following symptoms: discomfort, skin rash, joint pain, auricular fullness, and hearing loss. Serologic testing (IgG) for Zika virus was performed. The audiological findings were unilateral peripheral hearing loss in one of the patients, alterations in contralateral acoustic reflexes in both patients, and alteration in the brainstem auditory-evoked potential in one patient. The audiological findings demonstrate possible neuronal involvement in the manifested complaints, whether or not associated with the peripheral component, in patients infected with Zika virus.

Reabilitação de perdas auditivas unilaterais por próteses auditivas implantáveis: revisão sistemática / Rehabilitation of unilateral hearing loss by implantable hearing aids: systematic review

RESUMO Introdução A audição binaural é a condição adequada que permite ao ouvinte a dimensão de profundidade e sonoridade necessárias à percepção do mundo sonoro. Objetivo Determinar, por meio de uma revisão sistemática, quais os benefícios que as próteses auditivas implantáveis trazem para indivíduos adultos que possuem perda auditiva unilateral, no que se refere às habilidades de localização da fonte sonora e do reconhecimento de fala na presença do ruído. Estratégia de pesquisa Foram utilizadas combinações de sete descritores em português, indexados no Descritores em Ciências da Saúde (DeCS), e em inglês, indexados no Medical Subject Headings (MeSH), sendo eles: Adulto, Perda Auditiva Unilateral, Auxiliares de Audição, Condução Óssea, Implante Coclear, Idoso, Reabilitação Adult, Hearing Loss Unilateral, Bone Conduction, Cochlear Implantation, Rehabilitation, Elderly e Hearing Aid . Foi realizada uma pesquisa nas bases de dados PubMed , Cochrane , LILACS e Science Direct de artigos publicados entre janeiro de 2005 e setembro de 2015. Critérios de seleção Participantes da pesquisa com mais de 18 anos de idade, com perda auditiva unilateral, que utilizavam prótese auditiva implantável (prótese auditiva ancorada no osso ou implante coclear) e que tivessem sido submetidos à avaliação de localização da fonte sonora ou desempenho de reconhecimento de fala na presença de ruído, antes e depois da implantação. Resultados Dos 21 artigos analisados, sete foram experimentais, seis prospectivos, três descritivos, quatro séries de casos e um estudo de caso. Conclusão Apesar da grande heterogeneidade clínica observada entre os estudos que avaliaram a reabilitação auditiva de pacientes com perda auditiva unilateral, é possível concluir que o implante coclear fornece melhores resultados, tanto para a habilidade de localização da fonte sonora, como do reconhecimento de fala na presença de ruído.

ABSTRACT Introduction The binaural hearing is the proper condition that allows the listener the depth dimension and sonority necessary to the perception of the soundworld. Objective To determine, through a systematic review, the benefits that implantable hearing aids bring to adult individuals who have unilateral hearing loss in terms of localization of sound source and speech recognition in the presence of noise. Research strategy Were used combinations of seven Portuguese descriptors indexed in Health Sciences (DeCS), and in English indexed in the Medical Subject Headings (MeSH), being: Adult, Unilateral Hearing Loss, Hearing Aids, Bone Conduction, Cochlear Implant We conducted a survey of the PubMed, Cochrane, LILACS, and Science Direct databases of articles published between January 2005 and September 2015. Selection criteria Survey participants over 18 years old with unilateral hearing loss, who used implantable hearing aid bone anchored hearing aids or cochlear implantation) and who had been submitted to the evaluation of the location of the sound source or performance of speech recognition in the presence of noise before and After implantation. Results Of the 21 articles analyzed, seven were experimental; six were prospective, three descriptive, four case series and one case study. Conclusion Despite the great clinical heterogeneity observed among the studies that evaluated the auditory rehabilitation of patients with unilateral hearing loss, it is possible to conclude that the cochlear implant provides better results both for the localization of the sound source and for speech recognition in the presence of noise.