Miopatia mitocondrial e deficiência auditiva neurossensorial: estudo de caso / Mitochondrial myopathy and sensorineural hearing loss: case study

Resumo A miopatia mitocondrial é causada pela ausência e/ou insuficiência de uma enzina quaternária, L-carnitina, responsável por transportar ácidos graxos livres para a parte interna da mitocôndria. A função da mitocôndria é produzir energia, contribuindo para o bom funcionamento das células. A Lipidose Muscular é uma doença que provoca anomalias em enzimas que metabolizam gordura e por consequência causa acúmulo de toxinas de subprodutos com gordura nos tecidos. O objetivo deste trabalho é apresentar o estudo de caso da paciente B.D., 37 anos, diagnosticada com Lipidose Muscular aos seis anos, com deficiência de L-Carnitina e relatar o acompanhamento fonoaudiológico realizado em um serviço de saúde auditiva. A abertura de prontuário da paciente foi realizada em 05/03/1989. Foi prescrito pelo neurologista o uso contínuo de 2g/dia de L-carnitina. A mãe relatou que B.D. apresentava dificuldades em ouvir, pois era muito desatenta, o que foi mais evidente quando começou a frequentar a escola. Em 1988, a paciente foi diagnosticada com perda auditiva neurossensorial de grau moderado bilateral e começou a fazer uso de aparelhos de amplificação sonora individual retroauriculares em 1989. O desempenho escolar e comunicação melhoraram. Em 1998, passou a utilizar aparelhos tipo micro canal, o que a favoreceu esteticamente, promoveu melhora da localização sonora e maior ganho em altas frequências. Os limiares de audibilidade apresentaram uma leve piora e a paciente atualmente é pós-graduada e trabalha em uma grande instituição financeira. Conclui-se que o diagnostico neurológico e a intervenção fonoaudiológica precoces possibilitaram o adequado desenvolvimento de linguagem da paciente.

Abstract Mitochondrial myopathy is caused by the absence and/or insufficiency of L-carnitine, a quaternary enzyme responsible for transporting free fatty acids into the mitochondria. The primary function of the mitochondria is to produce energy, contributing to proper cell functioning. Muscular lipidosis causes abnormalities in enzymes that metabolize fat, resulting in the accumulation of harmful amounts of fats in tissues. The aim of this study was to present the case study of patient B.D., a 37-year-old woman diagnosed with muscular lipidosis with L-carnitine deficiency at 6 years old, and describe the speech-language follow-up performed at a hearing care clinic. The first entry in the patient's medical chart was on 03/05/1989, with continuous use of 2g/day of L-carnitine prescribed by a neurologist. The mother reported that B.D. had difficulty hearing and was inattentive, which became more evident when she started school. In 1988 the patient was diagnosed with moderate bilateral sensorineural hearing loss and began using behind-the-ear (BTE) hearing aids in 1989, after which her academic performance and communication improved. In 1998 she switched to Completely in Canal (CIC) hearing aids, which are more discreet, provided better sound localization and greater high frequency gain, although her hearing thresholds worsened slightly. She completed her graduate studies and currently works at a large financial institution. It was concluded that early neurological diagnosis and speech-language intervention enabled adequate language development in the patient.

Speech, Spatial and Qualities of hearing scale na avaliação do benefício em usuários de prótese auditiva / Speech, Spatial and Qualities of Hearing Scale in assessing the benefit in hearing aid users

RESUMO Objetivo foi verificar o grau de confiabilidade do Speech, Spatial and Qualities of Hearing Scale (SSQ), na avaliação do benefício em usuários de próteses auditivas. Método Participaram do estudo 30 adultos deficientes auditivos, candidatos ao uso (novatos) ou usuários em fase de troca de suas próteses auditivas (experientes). Todos os participantes realizaram avaliação audiológica completa, seleção e adaptação das próteses auditivas que incluiu a verificação com medidas com microfone sonda e avaliação do benefício do uso das próteses auditivas utilizando o questionário Speech, Spatial and Qualities of Hearing Scale (SSQ). Inicialmente, foi aplicado o questionário SSQ Base, em forma de entrevista. Após quatro semanas de uso das próteses auditivas novas reaplicou-se o questionário SSQ, em sua versão B (para os novatos) e C (para os experientes). Resultados Foi identificada maior dificuldade no domínio Audição para fala, do que nos outros domínios Audição espacial e Qualidades da audição. Todas as questões foram de fácil compreensão para a maioria dos participantes, que relataram serem compatíveis com as situações do seu cotidiano. A análise estatística revelou alto coeficiente Alpha de Cronbach (>0,9), demonstrando boa consistência interna entre os diversos itens do questionário. Demonstrou ser uma valiosa ferramenta para avaliar subjetivamente o desempenho comunicativo com e sem próteses auditivas. Conclusão O SSQ mostrou ser um instrumento de fácil aplicação e com alta confiabilidade que permite avaliação do benefício em indivíduos que se encontram em processo de reabilitação auditiva e pode ser aplicado a indivíduos que utilizam diferentes tipos de próteses auditivas.

ABSTRACT Purpose To check the degree of reliability of the Speech, Spatial and Qualities of Hearing Scale (SSQ), in the assessment of the benefit in hearing aid users. Methods Thirty hearing impaired adults, candidates for use (novice users) or users whose hearing aids (experienced users) were being replaced, participated in the study. All participants underwent complete audiological evaluation, selection and fitting of hearing aids, which included checking measurements with a probe microphone and assessment of the benefit from using hearing aids with the Speech, Spatial and Qualities of Hearing Scale (SSQ) questionnaire. A basic SSQ questionnaire was administered in the form of an interview. Later, four weeks after having started using new hearing aids, the versions B (for novice users) and C (for experienced users) of the SSQ questionnaire were administered. Results Greater difficulty was identified in the Hearing for speech domain than in the other domains, namely Spatial hearing, and Qualities of hearing. Most participants found all questions easy to understand and reported they were compatible with the situations they dealt with in their daily life. Statistical analysis revealed a high Cronbach's alpha coefficient (>0.9), which is indicative of good internal consistency between the various items contained in the questionnaire. It proved to be a valuable tool for subjectively assessing communicative performance with and without the use of hearing aids. Conclusion The SSQ proved to be an instrument that is easy to administer and highly reliable, allowing for the assessment of the benefit in individuals who are undergoing auditory rehabilitation, and which can be administered to individuals using different types of hearing aids.

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.

Sequential bilateral cochlear implant: results in children and adolescents / Implante coclear bilateral sequencial: resultados em crianças e adolescentes

Abstract Introduction: The use of the bilateral cochlear implants can promote the symmetrical development of the central auditory pathways, thus benefiting the development of auditory abilities and improving sound localization and the ability of auditory speech perception in situations of competitive noise. Objective: To evaluate the ability of speech perception in children and adolescents using sequential bilateral cochlear implants, considering the association of these variables: age at surgery, time of device use and interval between surgeries. Methods: A total of 14 individuals between 10 and 16 years of age, who demonstrated surgical indication for the use of sequential bilateral cochlear implants as intervention in the auditory habilitation process, were assessed. The speech perception ability was assessed through sentence lists constructed in the Portuguese language, presented in two situations: in silence, with fixed intensity of 60 dB SPL, and in competitive noise, with a signal-to-noise ratio of +15 dB. The evaluation was performed under the following conditions: unilateral with the first activated cochlear implant, unilateral with the second activated cochlear implant and bilateral with both devices activated. Results: The results of the speech perception tests showed better performance in both silence and in noise for the bilateral cochlear implant condition when compared to the 1st cochlear implant and the 2nd cochlear implant alone. A worse result of speech perception was found using the 2nd cochlear implant alone. No statistically significant correlation was found between age at the surgical procedure, interval between surgeries and the time of use of the 2nd cochlear implant, and the auditory speech perception performance for all assessed conditions. The use of a hearing aid prior to the 2nd cochlear implant resulted in benefits for auditory speech perception with the 2nd cochlear implant, both in silence and in noise. Conclusion: The bilateral cochlear implant provided better speech perception in silence and in noise situations when compared to the unilateral cochlear implant, regardless of the interval between surgeries, age at the surgical procedure and the time of use of the 2nd cochlear implant. Speech perception with the 1st cochlear implant was significantly better than with the 2nd cochlear implant, both in silence and in noise. The use of the hearing aid prior to the 2nd cochlear implant influenced speech perception performance with the 2nd cochlear implant, both in silence and in noise.

Resumo Introdução: A utilização do implante coclear bilateral pode promover o desenvolvimento das vias auditivas centrais de maneira simétrica, beneficiando, assim, o desenvolvimento das habilidades auditivas e melhorando a localização sonora e a habilidade de percepção auditiva da fala em situações de ruído competitivo. Objetivo: Avaliar a habilidade de reconhecimento de fala em crianças e adolescentes usuários do implante coclear bilateral sequencial, considerando a relação das variáveis: idade cirúrgica, tempo de uso do dispositivo e intervalo entre as cirurgias. Método: Foram avaliados 14 indivíduos entre 10 e 16 anos, que receberam indicação cirúrgica para implante coclear bilateral sequencial como forma de intervenção no processo de habilitação auditiva. A habilidade de reconhecimento de fala foi avaliada por meio de listas de sentenças construídas na língua portuguesa, apresentadas em duas situações: no silêncio, com intensidade fixa de 60 dB NPS, e no ruído competitivo, com a relação sinal/ruído de + 15 dB. A avaliação foi feita nas seguintes condições: unilateral com o 1° implante coclear ativado, unilateral com o 2° implante coclear ativado e bilateral com ambos os dispositivos ativados. Resultado: Os resultados dos testes de reconhecimento de fala demonstraram melhor desempenho tanto no silêncio quanto no ruído para a condição implante coclear bilateral, quando comparado ao 1° implante coclear e 2° implante coclear isoladamente. Um pior resultado de reconhecimento de fala foi encontrado com o uso do 2° implante coclear isoladamente. Não foi encontrada correlação estatisticamente significante entre idade cirúrgica, intervalo entre as cirurgias e tempo de uso do 2° implante coclear e o desempenho de percepção auditiva da fala para todas as condições avaliadas. O uso do aparelho de amplificação sonora individual anterior ao 2° implante coclear beneficiou os resultados de percepção auditiva da fala com o 2° implante coclear, tanto no silêncio quanto no ruído. Conclusão: O implante coclear bilateral proporcionou melhor reconhecimento de fala em situações de silêncio e de ruído, quando comparado com o implante coclear unilateral, independentemente do intervalo entre as cirurgias, da idade cirúrgica e do tempo de uso do 2° implante coclear. O reconhecimento de fala com o 1° implante coclear foi significativamente melhor do que com o 2° implante coclear, tanto no silêncio quanto no ruído. O uso do aparelho de amplificação sonora individual anterior ao 2° implante coclear influenciou o desempenho de reconhecimento de fala com o 2° implante coclear, tanto no silêncio quanto no ruído.

Tinnitus evaluation: relationship between pitch matching and loudness, visual analog scale and tinnitus handicap inventory / Análise da relação entre tinnitus handicap inventory, acufenometria e escala visualanalógica na avaliação do zumbido

Abstract Introduction: Tinnitus is a subjective auditory symptom usually associated with a sound, even in the absence of external sound sources. Its diagnosis is complex, and some of the forms of measurement alone or in combination, include self-assessment questionnaires, such as the tinnitus handicap inventory, the visual analog scale and/or pitch and loudness matching. Objective: To analyze the correlation among three tinnitus measurement methods: tinnitus handicap inventory, visual analog scale and pitch and loudness matching. Methods: The study consisted of 148 patients complaining of chronic tinnitus. An otorhinolaryngological evaluation, anamnesis directed to tinnitus, audiometry (pure tone and speech), imitanciometry, tinnitus handicap inventory, visual analog scale, and pitch and loudness matching were performed. The study was registered in the Ethics Committee of the Institution with no. 0129/12. Results: Regarding the frequency of tinnitus handicap inventory responses, a higher occurrence of the mild degree was observed. An average of 6 points was observed on the visual analog scale. The mean loudness matching in the right ear was 20 dBNS, and in the left ear was 17 dBNS. As for the type of stimulus, the most found was continuous pure tone. The frequency of the pitch sensation was 6000 Hz in the largest number of cases. Regarding the measures of tinnitus handicap inventory and the visual analogical scale, a significant correlation was observed, and as one value increases the other also increases. Pitch and loudness matching and the visual analogical scale results are also significant. Conclusion: There was a significant correlation between the values measured by the tinnitus handicap inventory, visual analogical scale (annoyance) and loudness matching in the evaluation of tinnitus. The selection of any one of the three evaluative methods for tinnitus investigation provides different dimensions of the tinnitus and complements the others.

Resumo Introdução: O zumbido é um sintoma auditivo de natureza subjetivo, normalmente associado a um som, mesmo na ausência de fontes sonoras externas. Apresenta diagnóstico complexo. Uma das formas de mensuração é o uso, isolado ou em conjunto, de questionários de autoavaliação, como o Tinnitus Handicap Inventory, a escala visual analógica e o exame de acufenometria. Objetivo: Analisar a correlação entre os métodos de mensuração do zumbido: Tinnitus Handicap Inventory, escala visual analógica e acufenometria. Método: Participaram do estudo 148 pacientes com queixa de zumbido crônico. Realizou-se avaliação otorrinolaringológica, anamnese direcionada ao zumbido, audiometria (tonal e vocal), imitanciometria, Tinnitus Handicap Inventory, escala visual analógica e acufenometria. O estudo foi registrado no comitê de ética da instituição, com nº 0129/12. Resultados: Em relação à frequência das respostas do Tinnitus Handicap Inventory, foi observada maior ocorrência do grau leve. Observou-se uma média de 6 pontos na escala visual analógica. A média da sensação de intensidade medida na acufenometria na orelha direita foi de 20 dBNS e na orelha esquerda foi de 17 dBNS. Quanto ao tipo de estímulo, o mais encontrado foi o tom puro contínuo. A sensação de frequência, no maior número de casos, foi de 6.000 Hz Entre as medidas do Tinnitus Handicap Inventory e da escala visual analógica, observou-se correlação significante. À medida que um valor aumenta o outro também aumenta. Os resultados da acufenometria e da escala visual analógica também apresentam significância. Conclusão: Houve correlação significante entre os valores medidos pelo Tinnitus Handicap Inventory, escala visual analógica (incômodo) e acufenometria (loudness) na avaliação do zumbido. A escolha de um dos três métodos avaliativos para pesquisa do zumbido fornece dimensões diferentes do zumbido e se complementam.

Sound Localization Test in Presence of Noise (Sound Localization Test) in Adults without Hearing Alteration

Abstract Introduction Even people with normal hearing may have difficulties locating a sound source in unfavorable sound environments where competitive noise is intense. Objective To develop, describe, validate and establish the normality curve of the sound localization test. Method The sample consisted of 100 healthy subjects with normal hearing, > 18 years old,who agreed to participate in the study. The sound localization testwas applied after the subjects underwent a tonal audiometry exam. For this purpose, a calibrated free field test environment was set up. Then, 30 randompure tones were presented in 2 speakers placed at 45° (on the right and on the left sides of the subject), and the noise was presented froma 3rd speaker, placed at 180°. The noise was presented in 3 hearing situations: optimal listening condition (no noise), noise in relation to 0 dB, and noise in relation to - 10 dB. The subject was asked to point out the side where the pure tone was being perceived, even in the presence of noise. Results All of the 100 participants performed the test in an average time of 99 seconds. The average score was 21, the medium score was 23, and the standard deviation was 3.05. Conclusion The sound localization test proved to be easy to set-up and to apply. The results obtained in the validation of the test suggest that individuals with normal hearing should locate 70% of the presented stimuli. The test can constitute an important instrument in the measurement of noise interference in the ability to locate the sound.

Speech Perception and Gap Detection Performance of Single-Sided Deafness under Noisy Conditions

BACKGROUND AND OBJECTIVES: Many studies have reported no benefit of sound localization, but improved speech understanding in noise after treating patients with single-sided deafness (SSD). Furthermore, their performances provided a large individual difference. The present study aimed to measure the ability of speech perception and gap detection in noise for the SSD patients to better understand their hearing nature.

Auditory Localization Performances in Subjects with Simulated Unilateral Conductive Hearing Loss

No abstract available.

Influência da musicalização infantil nas habilidades auditivas de pré-escolares / Influence of children's music learning on preschoolers' listening skills

RESUMO Objetivo Verificar a associação entre musicalização infantil e habilidades auditivas de ordenação temporal e localização sonora em pré-escolares de 5 e 6 anos. Métodos Participaram do estudo 60 crianças de ambos os sexos, de 5 anos a 6 anos e 11 meses, sendo 30 do grupo com treinamento musical e 30 do grupo sem treinamento musical. Os participantes de ambos os grupos foram submetidos à triagem auditiva, avaliação simplificada do processamento auditivo e ao teste Padrão de Frequência, em campo livre. Os desempenhos de cada um dos procedimentos foram tabulados, analisando-se as possíveis correlações e associações entre eles, como variáveis dependentes e variáveis independentes, como grupo, sexo e idade. Resultados O grupo com treinamento musical apresentou média de acertos superior ao grupo sem treinamento musical, nos testes de memória sequencial não verbal e verbal, teste Padrão de Frequência não verbal e verbal. Sujeitos de 5 anos do grupo com treinamento musical obtiveram melhor desempenho, em relação aos sujeitos de 5 anos do grupo sem treinamento musical, acertando mais sequências. No teste de localização sonora, não houve diferença entre a idade e o grupo. Conclusão Pré-escolares de 5 e 6 anos que participavam de musicalização infantil apresentaram melhor desempenho nos testes que avaliaram as habilidades de memória sequencial não verbal e verbal e de ordenação temporal de três sons, quando comparados aos pré-escolares que não participavam de musicalização. Portanto, a musicalização infantil influenciou positivamente as habilidades auditivas de pré-escolares de 5 e 6 anos.

ABSTRACT Purpose Verify the association between children's music learning and listening skills of temporal ordering and sound localization in preschoolers from 5 to 6 years old. Methods 60 children of both genders, from 5 to 6 years and 11 months, participated in the study, 30 of the group with music training and the other 30 of the group with no music training. The participants of both groups were submitted to hearing screening, simplified auditory processing assessment and to the Pitch Pattern Sequence. The performance of each of the procedures was tabulated, being analyzed the possible correlations and associations between them, as, for example, dependent and independent variables such as group, gender and age. Results The group with music training presented higher mean of scores than the one with no music training in the verbal and nonverbal sequential memory tests and on the verbal and nonverbal Pitch Pattern Sequence. The 5-year-old children of the group with music training got better results than the 5-year-old ones with no music training, getting right in more sequences. In the sound localization test, there was no difference between ages and groups. Conclusion Preschoolers from 5 to 6 years old who participated in children's music learning presented better performance in the tests that evaluate the abilities of the verbal and non-verbal sequential memory and of the temporal ordering of three sounds when compared to the preschoolers who did not participate in the music learning. Therefore, the children's music learning positively influenced the listening skills of preschoolers from 5 to 6 years old.

Hearing in Noise Test, HINT-Brazil, in normal-hearing children / Teste de Reconhecimento de Fala no Ruído, HINT-Brasil, em crianças normo-ouvintes

Abstract Introduction: The auditory processing is related to certain skills such as speech recognition in noise. The HINT-Brazil test allows the measurement of the Speech/Noise ratio however there are no studies in the national literature that establish parameters for the child population. Objective: To analyze the performance of normal-hearing subjects aged 8-10 years old in tasks for speech recognition in noise using HINT test. Methods: Sixty schoolchildren were evaluated. They were between 8 and 10 years of age, of both genders, and had no auditory and school complaints, with results ranking within normality for the Basic Audiological Assessment and the Dichotic Digits Test. HINT-Brazil test was applied with headphones, with the Speech/Noise ratio in conditions of frontal noise, noise to the right, and noise to the left being investigated. The software calculated the Composite Noise, which corresponds to the weighted mean of the tested conditions. Results: There was no statistically significant difference between the ears, nor between the genders. There was a statistically significant difference for age ranges of 8 and 10 years, in situations with noise, and for Composite Noise. The age group of 10 years showed better performance than the age group of 8; the age group of 9 years did not show statistically significant difference regarding the other age ranges. We suggest the values of mean and standard deviation of the Speech/Noise ratio, considering the age ranges of: 8 years - Frontal Noise: −2.09 (±1.09); Right Noise: −7.64 (±1.72); Left Noise: −7.53 (±2.80); Composite Noise: −4.86 (±1.31); 9 years - Frontal Noise: −2.82 (±0.74); Right Noise: −8.49 (±2.24); Left Noise: −8.41 (±1.75); Composite Noise: −5.63 (±1.02); 10 years - Frontal Noise: −3.01 (±0.95); Right Noise: −9.47 (±1.43); Left Noise: −9.16 (±1.65); Composite Noise: −6.16 (±0.91). Conclusion: HINT-Brazil test is a simple and fast test, and is not difficult to performed with normal-hearing children. The results confirm that it is an efficient test to be used with the age range evaluated.

Resumo Introdução: O processamento auditivo está relacionado a determinadas habilidades, como o reconhecimento de fala no ruído. O teste HINT-Brasil permite a mensuração da relação Fala/Ruído, porém, não há na literatura nacional estudos que estabeleçam parâmetros para a população infantil. Objetivo: Analisar o desempenho de normo-ouvintes, de 8 a 10 anos, nas tarefas de reconhecimento de fala no ruído, por meio do teste HINT. Método: Avaliados 60 escolares, entre 8 e 10 anos, de ambos os gêneros, sem queixas auditivas e escolares, e com resultados dentro da normalidade para a Avaliação Audiológica Básica e o Teste Dicótico de Dígitos. O teste HINT-Brasil foi aplicado com fones de ouvido, sendo pesquisada a relação Fala/Ruído nas condições Ruído Frontal, Ruído à Direita e Ruído à Esquerda. O software calculou o Ruído Composto, que corresponde à média ponderada das condições testadas. Resultados: Não houve diferença estatisticamente significante entre as orelhas, nem entre os gêneros. Houve diferença estatisticamente significante para as faixas de 8 e 10 anos, nas situações com ruído e para o Ruído Composto. A faixa etária de 10 anos apresentou desempenho melhor do que a faixa etária de 8; a faixa etária de 9 anos não apresentou diferença estatisticamente significante com relação as outras faixas etárias. Sugerimos os valores de Média e Desvio Padrão da relação F/R, considerando as faixas: 8 anos - RF: -2,09 (± 1,09); RD: -7,64 (± 1,72); RE: -7,53 (± 2,80); RC: -4,86 (± 1,31); 9 anos - RF: -2,82 (± 0,74); RD: -8,49 (± 2,24); RE: -8,41 (± 1,75); RC: -5,63 (± 1,02); 10 anos - RF: -3,01 (± 0,95); RD: -9,47 (± 1,43); RE: -9,16 (± 1,65); RC: -6,16 (± 0,91). Conclusão: O teste HINT-Brasil é um teste simples e rápido e não oferece dificuldades em seu uso com crianças normo-ouvintes; os resultados mostram se tratar de um teste eficaz para ser utilizado com a faixa etária avaliada.

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.

Encoding of speech sounds at auditory brainstem level in good and poor hearing aid performers / Codificação dos sons da fala no nível do tronco encefálico auditivo em bons e maususuários de aparelhos auditivos

Abstract Introduction: Hearing aids are prescribed to alleviate loss of audibility. It has been reported that about 31% of hearing aid users reject their own hearing aid because of annoyance towards background noise. The reason for dissatisfaction can be located anywhere from the hearing aid microphone till the integrity of neurons along the auditory pathway. Objectives: To measure spectra from the output of hearing aid at the ear canal level and frequency following response recorded at the auditory brainstem from individuals with hearing impairment. Methods: A total of sixty participants having moderate sensorineural hearing impairment with age range from 15 to 65 years were involved. Each participant was classified as either Good or Poor Hearing aid Performers based on acceptable noise level measure. Stimuli /da/ and /si/ were presented through loudspeaker at 65 dB SPL. At the ear canal, the spectra were measured in the unaided and aided conditions. At auditory brainstem, frequency following response were recorded to the same stimuli from the participants. Results: Spectrum measured in each condition at ear canal was same in good hearing aid performers and poor hearing aid performers. At brainstem level, better F0 encoding; F0 and F1 energies were significantly higher in good hearing aid performers than in poor hearing aid performers. Though the hearing aid spectra were almost same between good hearing aid performers and poor hearing aid performers, subtle physiological variations exist at the auditory brainstem. Conclusion: The result of the present study suggests that neural encoding of speech sound at the brainstem level might be mediated distinctly in good hearing aid performers from that of poor hearing aid performers. Thus, it can be inferred that subtle physiological changes are evident at the auditory brainstem in a person who is willing to accept noise from those who are not willing to accept noise.

Resumo Introdução: Os aparelhos auditivos são prescritos para aliviar a perda de audibilidade. Tem sido relatado que 31% dos usuários rejeitam seu aparelho auditivo devido ao desconforto com o ruído de fundo. A razão para a insatisfação pode estar situada em qualquer local desde o microfone do aparelho auditivo até a integridade de neurônios ao longo da via auditiva. Objetivos: Medir espectros desde a saída do aparelho auditivo no nível do meato acústico externo e frequência de resposta (FFR) registrada no tronco encefálico de indivíduos com deficiência auditiva. Método: Foram selecionados 60 participantes com deficiência auditiva neurossensorial moderada, de 15 a 65 anos. Cada participante foi classificado como usuário bom ou mau de prótese auditiva (GHP ou PHP) com base na medida de nível de ruído aceitável (ANL). Estímulos/da/e/si/foram apresentados em alto-falante a 65 dB SPL. No meato acústico externo, os espectros foram medidos nas condições sem aparelho e com aparelho. No tronco encefálico auditivo, FFR foram registradas para os mesmos estímulos dos participantes. Resultados: Os espectros medidos em cada condição no meato acústico externo foram os mesmos em GHP e PHP. No nível do tronco cerebral, melhor codificação F0; energias de F0 e F1 foram significativamente maiores em GHP do que em PHP. Embora os espectros do aparelho auditivo fossem quase os mesmos entre GHP e PHP, existem variações fisiológicas sutis no tronco encefálico auditivo. Conclusão: O resultado do presente estudo sugere que a codificação neural do som da fala no nível do tronco encefálico pode ser mediada distintamente em GHP em comparação com PHP. Assim, pode-se inferir que mudanças fisiológicas sutis são evidentes no tronco encefálico em uma pessoa que está disposta a aceitar o ruído em comparação com aqueles que não estão dispostos a aceitar o ruído.

Effect of conductive hearing loss on central auditory function / Efeito da perda auditiva condutiva na função auditiva central

Abstract Introduction: It has been demonstrated that long-term Conductive Hearing Loss (CHL) may influence the precise detection of the temporal features of acoustic signals or Auditory Temporal Processing (ATP). It can be argued that ATP may be the underlying component of many central auditory processing capabilities such as speech comprehension or sound localization. Little is known about the consequences of CHL on temporal aspects of central auditory processing. Objective: This study was designed to assess auditory temporal processing ability in individuals with chronic CHL. Methods: During this analytical cross-sectional study, 52 patients with mild to moderate chronic CHL and 52 normal-hearing listeners (control), aged between 18 and 45 year-old, were recruited. In order to evaluate auditory temporal processing, the Gaps-in-Noise (GIN) test was used. The results obtained for each ear were analyzed based on the gap perception threshold and the percentage of correct responses. Results: The average of GIN thresholds was significantly smaller for the control group than for the CHL group for both ears (right: p = 0.004; left: p < 0.001). Individuals with CHL had significantly lower correct responses than individuals with normal hearing for both sides (p < 0.001). No correlation was found between GIN performance and degree of hearing loss in either group (p > 0.05). Conclusion: The results suggest reduced auditory temporal processing ability in adults with CHL compared to normal hearing subjects. Therefore, developing a clinical protocol to evaluate auditory temporal processing in this population is recommended.

Resumo Introdução: Já foi demonstrado que a perda auditiva condutiva (PAC), em longo prazo, pode influenciar na detecção precisa das características temporais dos sinais acústicos ou do processamento auditivo temporal (PAT). Pode-se argumentar que o PAT pode ser o componente subjacente de muitos recursos do processamento auditivo central, como a compreensão da fala ou localização do som. Pouco se sabe sobre as consequências da PAC nos aspectos temporais do processamento auditivo central. Objetivo: Este estudo foi projetado para avaliar a capacidade de processamento auditivo temporal em indivíduos com PAC crônica. Método: Durante este estudo transversal analítico, 52 pacientes com PAC crônica leve a moderada e 52 indivíduos com audição normal (controle), entre 18 e 45 anos, foram recrutados. Para avaliar o processamento auditivo temporal, foi usado o teste de resolução temporal Gaps-in-Noise (GIN). Os resultados obtidos para cada orelha foram analisados com base no limiar de percepção da quebra de continuidade (gap) e na porcentagem de respostas corretas. Resultados: A média dos limiares no GIN foi significativamente menor para o grupo controle do que para o grupo PAC em ambas as orelhas (direita: p = 0,004; esquerda: p < 0,001). Os indivíduos com PAC apresentaram respostas corretas significativamente mais baixas do que os indivíduos com audição normal em ambas as orelhas (p < 0,001). Não houve correlação entre o desempenho no GIN e o grau de perda auditiva em ambos os grupos (p > 0,05). Conclusão: Os resultados sugerem uma redução da capacidade de processamento auditivo temporal em adultos com PAC comparados com indivíduos que apresentam audição normal. Portanto, o desenvolvimento de um protocolo clínico para avaliar o processamento auditivo temporal nessa população é recomendado.

A wearable system for adaptation to left–right reversed audition tested in combination with magnetoencephalography

Exposure of humans to unusual spaces is effective to observe the adaptive strategy for an environment. Though adaptation to such spaces has been typically tested with vision, little has been examined about adaptation to left–right reversed audition, partially due to the apparatus for adaptation. Thus, it is unclear if the adaptive effects reach early auditory processing. Here, we constructed a left–right reversed stereophonic system using only wearable devices and asked two participants to wear it for 4 weeks. Every week, the magnetoencephalographic responses were measured under the selective reaction time task, where they immediately distinguished between sounds delivered to either the left or the right ear with the index finger on the compatible or incompatible side. The constructed system showed high performance in sound localization and achieved gradual reduction of a feeling of strangeness. The N1m intensities for the response-compatible sounds tended to be larger than those for the response-incompatible sounds until the third week but decreased on the fourth week, which correlated with the initially shorter and longer reaction times for the compatible and incompatible conditions, respectively. In the second week, disruption of the auditory-motor connectivity was observed with the largest N1m intensities and the longest reaction times, irrespective of compatibility. In conclusion, we successfully produced a high-quality space of left–right reversed audition using our system. The results suggest that a 4-week exposure to the reversed audition causes optimization of the auditory-motor coordination according to the new rule, which eventually results in the modulation of early auditory processing.

Validation of the Korean Version of the Spatial Hearing Questionnaire for Assessing the Severity and Symmetry of Hearing Impairment

PURPOSE: Spatial hearing refers to the ability to understand speech and identify sounds in various environments. We assessed the validity of the Korean version of the Spatial Hearing Questionnaire (K-SHQ). MATERIALS AND METHODS: We performed forward translation of the original English SHQ to Korean and backward translation from the Korean to English. Forty-eight patients who were able to read and understand Korean and received a score of 24 or higher on the Mini-Mental Status Examination were included in the study. Patients underwent pure tone audiometry (PTA) using a standard protocol and completed the K-SHQ. Internal consistency was evaluated using Cronbach's alpha, and factor analysis was performed to prove reliability. Construct validity was tested by comparing K-SHQ scores from patients with normal hearing to those with hearing impairment. Scores were compared between subjects with unilateral or bilateral hearing loss and between symmetrical and asymmetrical hearing impairment. RESULTS: Cronbach's alpha showed good internal consistency (0.982). Two factors were identified by factor analysis: There was a significant difference in K-SHQ scores for patients with normal hearing compared to those with hearing impairment. Patients with asymmetric hearing impairment had higher K-SHQ scores than those with symmetric hearing impairment. This is related to a lower threshold of PTA in the better ear of subjects. The hearing ability of the better ear is correlated with K-SHQ score. CONCLUSION: The K-SHQ is a reliable and valid tool with which to assess spatial hearing in patients who speak and read Korean. K-SHQ score reflects the severity and symmetry of hearing impairment.

Speech perception in noise in unilateral hearing loss / Percepção da fala no ruído em perda auditiva unilateral

ABSTRACT INTRODUCTION: Unilateral hearing loss is characterized by a decrease of hearing in one ear only. In the presence of ambient noise, individuals with unilateral hearing loss are faced with greater difficulties understanding speech than normal listeners. OBJECTIVE: To evaluate the speech perception of individuals with unilateral hearing loss in speech perception with and without competitive noise, before and after the hearing aid fitting process. METHODS: The study included 30 adults of both genders diagnosed with moderate or severe sensorineural unilateral hearing loss using the Hearing In Noise Test - Hearing In Noise Test-Brazil, in the following scenarios: silence, frontal noise, noise to the right, and noise to the left, before and after the hearing aid fitting process. RESULTS: The study participants had a mean age of 41.9 years and most of them presented right unilateral hearing loss. In all cases evaluated with Hearing In Noise Test, a better performance in speech perception was observed with the use of hearing aids. CONCLUSION: Using the Hearing In Noise Test-Brazil test evaluation, individuals with unilateral hearing loss demonstrated better performance in speech perception when using hearing aids, both in silence and in situations with a competing noise, with use of hearing aids.

Resumo Introdução: A perda auditiva unilateral (PAUn) é caracterizada pela diminuição da audição em apenas uma orelha. Em presença de ruído ambiental, indivíduos com PAUn encontram maiores dificuldades que os ouvintes normais para compreender a fala. Objetivo: Avaliar o desempenho de indivíduos com perda auditiva unilateral, na percepção da fala sem e com ruído competidor, antes a após adaptação do AASI. Método: Estudo com 30 adultos, e de ambos os sexos, com diagnóstico de perda auditiva unilateral sensorioneural, de graus moderado e severo, utilizando o Hearing In Noise Test - HINT - Brasil, nas seguintes situações: silêncio, ruído à frente, ruído a direita e ruído a esquerda. Antes e após adaptação do AASI. Resultados: Os participantes da pesquisa apresentavam média de idade de 41,9 anos e PAUn predominante à direita. Em todas as situações propostas pelo HINT foi constatado melhor desempenho na percepção da fala com o uso do AASI. Conclusão: No teste HINT - Brasil, indivíduos com PAUn demonstraram melhor desempenho napercepção da fala, em tanto no silêncio quanto nas situações com ruído competidor, com usodo AASI.

Speech recognition in individuals with sensorineural hearing loss / Reconhecimento de fala em indivíduos com perda auditiva neurossensorial

ABSTRACT INTRODUCTION: Hearing loss can negatively influence the communication performance of individuals, who should be evaluated with suitable material and in situations of listening close to those found in everyday life. OBJECTIVE: To analyze and compare the performance of patients with mild-to-moderate sensorineural hearing loss in speech recognition tests carried out in silence and with noise, according to the variables ear (right and left) and type of stimulus presentation. METHODS: The study included 19 right-handed individuals with mild-to-moderate symmetrical bilateral sensorineural hearing loss, submitted to the speech recognition test with words in different modalities and speech test with white noise and pictures. RESULTS: There was no significant difference between right and left ears in any of the tests. The mean number of correct responses in the speech recognition test with pictures, live voice, and recorded monosyllables was 97.1%, 85.9%, and 76.1%, respectively, whereas after the introduction of noise, the performance decreased to 72.6% accuracy. CONCLUSIONS: The best performances in the Speech Recognition Percentage Index were obtained using monosyllabic stimuli, represented by pictures presented in silence, with no significant differences between the right and left ears. After the introduction of competitive noise, there was a decrease in individuals' performance.

Resumo Introdução: A perda auditiva pode influenciar negativamente o desempenho comunicativo e estes indivíduos devem ser avaliados com material adequado e em situações de escuta próximas às observadas no cotidiano. Objetivo: Analisar e comparar o desempenho de indivíduos com perda auditiva neurossensorial de grau leve a moderado em testes de reconhecimento de fala apresentados no silêncio e no ruído segundo as variáveis orelha e tipos de apresentação do estímulo. Método: Participaram do estudo 19 indivíduos destros com perda auditiva neurossensorial bilateral simétrica de grau leve a moderado, submetidos ao teste de reconhecimento de fala com palavras em diferentes modalidades e ao teste de fala com ruído branco com figuras. Resultados: Não houve diferença significante entre as orelhas direita e esquerda para nenhum dos testes realizados. A média de acertos no teste de reconhecimento de fala com figuras, viva voz e monossílabos gravados foi 97,1%; 85,9% e 76,1%, respectivamente, e 72,6% de acertos no teste com ruído. Conclusões: O melhor desempenho no Índice Percentual de Reconhecimento de Fala foi obtido utilizando como estímulos monossílabos representados por figuras apresentados no silêncio, sem diferenças significantes entre as orelhas direita e esquerda. Com a introdução do ruído competitivo, houve descréscimo no desempenho dos indivíduos.

Cochlear Implantation and Single-sided Deafness: A Systematic Review of the Literature

Introduction Current data show that binaural hearing is superior to unilateral hearing, specifically in the understanding of speech in noisy environments. Furthermore, unilateral hearing reduce oné s ability to localize sound. Objectives This study provides a systematic review of recent studies to evaluate the outcomes of cochlear implantation in patients with single-sided deafness (SSD) with regards to speech discrimination, sound localization and tinnitus suppression. Data Synthesis We performed a search in the PubMed, Cochrane Library and Lilacs databases to assess studies related to cochlear implantation in patients with unilateral deafness. After critical appraisal, eleven studies were selected for data extraction and analysis of demographic, study design and outcome data. Conclusion Although some studies have shown encouraging results on cochlear implantation and SSD, all fail to provide a high level of evidence. Larger studies are necessary to define the tangible benefits of cochlear implantation in patients with SSD.

Management of Pediatric Unilateral Sensorineural Hearing Loss / 대한이비인후과학회지

Every one of a thousand of neonates is born with unilateral sensorineural hearing loss (UHL) and the prevalence of UHL increases in school aged children due to delayed-onset or acquired HL. Some studies showed that UHL impacted on speech-language development and school performance adversely. Therefore, appropriate intervention for UHL children may be needed. Treatment approach for UHL children can be chosen depending on the degree of HL. Cochlear implantation (CI) provides benefits of binaural hearing including better speech perception in noise and sound localization to children with acquired severe-to-profound UHL. However, children with congenital severe-to-profound UHL and long duration of HL gain the unfavorable benefit from CI. Contralateral routing of signal hearing aid and bone anchored hearing device should not be recommended for young children with UHL because these devices can introduce noise to normal hearing ear and young children are not able to competently monitor their listening environment and to make judgments about when these devices may be appropriate. Conventional hearing aid (HA) has the potential of providing binaural hearing for UHL children with amplifiable hearing and the studies realized the binaural hearing when UHL children wore HA. However adherence to HA is poor because of some reasons including parents' reluctance to fit a HA in the presence of a normal-hearing ear and stigma effect. Long term follow up data of these interventions for UHL children are lacking. So fully informed consent is required during decision making process for UHL children until the concrete guideline of intervention for UHL children is established.

Behavioral and electrophysiological auditory processing measures in traumatic brain injury after acoustically controlled auditory training: a long-term study / Medidas comportamentais e eletrofisiológicas do processamento auditivo em traumatismo craniencefálico após treinamento auditivo acusticamente controlado: estudo de longo prazo

ABSTRACT Objective To investigate the long-term efficacy of acoustically controlled auditory training in adults after tarumatic brain injury. Methods A total of six audioogically normal individuals aged between 20 and 37 years were studied. They suffered severe traumatic brain injury with diffuse axional lesion and underwent an acoustically controlled auditory training program approximately one year before. The results obtained in the behavioral and electrophysiological evaluation of auditory processing immediately after acoustically controlled auditory training were compared to reassessment findings, one year later. Results Quantitative analysis of auditory brainsteim response showed increased absolute latency of all waves and interpeak intervals, bilaterraly, when comparing both evaluations. Moreover, increased amplitude of all waves, and the wave V amplitude was statistically significant for the right ear, and wave III for the left ear. As to P3, decreased latency and increased amplitude were found for both ears in reassessment. The previous and current behavioral assessment showed similar results, except for the staggered spondaic words in the left ear and the amount of errors on the dichotic consonant-vowel test. Conclusion The acoustically controlled auditory training was effective in the long run, since better latency and amplitude results were observed in the electrophysiological evaluation, in addition to stability of behavioral measures after one-year training.

RESUMO Objetivo Investigar a eficácia de longo prazo do treinamento auditivo acusticamente controlado em indivíduos adultos após traumatismo craniencefálico. Métodos Foram estudados seis indivíduos audiologicamente normais com idades entre 20 e 37 anos, que sofreram traumatismo craniencefálico grave com lesão axional difusa, submetidos a um programa de treinamento auditivo acusticamente controlado aproximadamente um ano antes. Foram comparados os resultados obtidos nas avaliações comportamental e eletrofisiológica do processamento auditivo imediatamente após o treinamento auditivo acusticamente controlado e a reavaliação, um ano após. Resultados Quanto ao potencial de tronco encefálico, observou-se aumento da latência absoluta de todas as ondas e os intervalos interpicos, na comparação entre as avaliações, bilateralmente, bem como aumento da amplitude de todas as ondas, sendo a onda V estatisticamente significativa, para a orelha direita e a onda III para a orelha esquerda. Quanto ao P3, observaram-se diminuição da latência e aumento da amplitude do P3 na avaliação atual em ambas as orelhas. A avaliação comportamental atual evidenciou desempenho semelhante nas duas avaliações, exceto no teste dicótico de dissílabos alternados na orelha esquerda e a quantidade de erros no teste dicótico consoante-vogal. Conclusão O treinamento auditivo acusticamente controlado mostrou-se eficaz em longo prazo, uma vez que foram observados resultados melhores de latência e amplitude na avaliação eletrofisiológica, bem como estabilidade das medidas comportamentais após um ano de treinamento.