Development and accuracy of a hearing screening application / Desenvolvimento e acurácia de um aplicativo para rastreio auditivo

Abstract Introduction: Hearing impairment, or hearing loss, can be caused by several factors and the implications vary according to the type, degree, cause and age of occurrence. Hearing screening should be a common procedure, allowing the pre-clinical identification and necessary referrals, avoiding the consequences of auditory deprivation. Mobile apps have shown to be a good alternative for hearing assessment. Objective: The objective was to develop an app and assess its performance in identifying hearing loss by comparing it with another validated screening tool. Methods: The application, called Ouviu, was created using audiological knowledge and tools available on the iOS platform. We evaluated 185 people, aged between 6 and 96 years, distributed into 5 age groups, performing audiometry and hearing screening using two tools: HearCheck and the application. Results: The results showed that the sensitivity of the application in identifying hearing loss was approximately 97%, while that of HearCheck was 79%. The positive predictive value of the application showed that the probability of a person being identified with this tool and actually having a hearing loss was 94%, while for HearCheck it was 96%. False negatives, which failed hearing loss identification, were fewer in the app (3%) than in HearCheck (21%). Conclusion: Consequently, the developed application was shown to be effective as a hearing screening tool, surpassing HearCheck in identifying mild hearing loss. In addition to being portable, easy to apply, low cost and rapidly performed, the application has the advantage of assessing environmental noise to perform the exam, as well as the fact that it is not necessary to attach any hardware to the mobile device.

Resumo Introdução: O comprometimento da audição, ou perda auditiva, pode ser ocasionado por diversos fatores e as implicações variam de acordo com o tipo, grau, causa e idade de acometimento. A triagem auditiva deveria ser um procedimento usual que possibilitasse a identificação pré-clínica e os encaminhamentos necessários, evitaria as consequências da privação desse sentido. Aplicativos móveis mostram-se uma boa opção. Objetivo: Desenvolver um aplicativo e verificar seu desempenho na identificação de perda auditiva comparado com outro instrumento de rastreio validado. Método: O aplicativo, chamado Ouviu, foi criado com o conhecimento audiológico e as ferramentas disponíveis na plataforma iOS. Avaliamos 185 pessoas, entre 6 e 96 anos, distribuídas em 5 grupos, fizemos audiometria e rastreio auditivo por meio de dois instrumentos: HearCheck e aplicativo. Resultados: Ficou evidenciado que a sensibilidade do aplicativo para identificar perda auditiva foi aproximadamente 97%, enquanto a do HearCheck foi 79%. O valor preditivo positivo do aplicativo mostrou que a probabilidade de uma pessoa ser identificada com esse instrumento e realmente ter perda auditiva foi 94%, o HearCheck foi de 96%. Os falsos negativos, que deixaram de identificar perda auditiva, foram menores no aplicativo (3%) que no HearCheck (21%). Conclusão: O aplicativo desenvolvido mostrou-se eficaz como uma ferramenta de rastreio auditivo. É melhor do que HearCheck na identificação de perda auditiva leve. Além de ser portátil, de fácil aplicação, baixo custo e rápida execução, o aplicativo tem a vantagem de avaliar o ruído ambiental para fazer o exame e também a não necessidade de quaisquer hardwares para acoplar ao dispositivo móvel.

Profile and prevalence of hearing complaints in the elderly / Perfil e prevalência de queixa auditiva em idosos

Abstract Introduction: Hearing is essential for the processing of acoustic information and the understanding of speech signals. Hearing loss may be associated with cognitive decline, depression and reduced functionality. Objective: To analyze the prevalence of hearing complaints in elderly individuals from Rio Grande do Sul and describe the profile of the study participants with and without hearing complaints. Methods: 7315 elderly individuals interviewed in their homes, in 59 cities in the state of Rio Grande do Sul, Brazil, participated in the study. Inclusion criteria were age 60 years or older and answering the question on auditory self-perception. For statistical purposes, the chi-square test and logistic regression were performed to assess the correlations between variables. Results: 139 elderly individuals who did not answer the question on auditory self-perception and 9 who self-reported hearing loss were excluded, totaling 7167 elderly participants. Hearing loss complaint rate was 28% (2011) among the elderly, showing differences between genders, ethnicity, income, and social participation. The mean age of the elderly without hearing complaints was 69.44 (±6.91) and among those with complaint, 72.8 (±7.75) years. Elderly individuals without hearing complaints had 5.10 (±3.78) years of formal education compared to 4.48 (±3.49) years among those who had complaints. Multiple logistic regression observed that protective factors for hearing complaints were: higher level of schooling, contributing to the family income and having received health care in the last six months. Risk factors for hearing complaints were: older age, male gender, experiencing difficulty in leaving home and carrying out social activities. Conclusions: Among the elderly population of the state of Rio Grande do Sul, the prevalence of hearing complaints reached 28%. The complaint is more often present in elderly men who did not participate in the generation of family income, who did not receive health care, performed social and community activities, had a lower level of schooling and were older.

Resumo Introdução: A audição é essencial para o processamento de eventos acústicos e emissão e compreensão dos sinais de fala. A perda auditiva pode estar associada ao declínio cognitivo, à depressão e à redução da funcionalidade. Objetivo: Analisar a prevalência de queixa auditiva em idosos do Rio Grande do Sul e descrever o perfil dos participantes com e sem queixa auditiva. Método: Participaram do estudo 7.315 idosos entrevistados em suas residências, em 59 cidades gaúchas. Os critérios de inclusão adotados foram ter 60 anos ou mais e terem respondido à questão sobre autopercepção auditiva. Para fins estatísticos foi realizado o teste Qui-quadrado e regressão logística para avaliar as correlações entre as variáveis. Resultados: Foram excluídos 139 idosos sem resposta à autopercepção auditiva e nove por autorreferirem surdez (7.167 participantes). A frequência de queixa de perda auditiva foi de 28% (2011) dos idosos, apresentou diferença entre gêneros, etnia, renda, participação social. A média de idade dos idosos sem queixa auditiva foi de 69,44 (± 6,91) e com queixa 72,8 (± 7,75) anos. Os idosos sem queixa auditiva apresentaram 5,10 (± 3,78) anos de estudo comparados com 4,48 (± 3,49) anos dos com queixa. A regressão logística múltipla observou que foram fatores protetores para a queixa auditiva maior escolaridade, contribuir na renda familiar e ter recebido atendimento de saúde nos últimos seis meses. Fatores de risco para a queixa auditiva foram idade mais avançada, sexo masculino, apresentar dificuldade de sair de casa e realizar atividades sociais. Conclusões Na população idosa do Rio Grande do Sul a prevalência de queixa auditiva atingiu 28%. A queixa está mais presente em idosos homens, sem participação na renda familiar, não receberam atendimento de saúde, tinham atividade social e comunitária, com menor escolaridade e maior idade.

Study of the hearing threshold of dance teachers

Introduction High sound pressure levels can cause hearing loss, beginning at high frequencies. Objective To analyze the hearing thresholds of dance teachers. Methods This study had a cross-sectional, observational, prospective, and descriptive design. Conventional and high-frequency hearing evaluations were performed with dance teachers and subjects in the control group. Results In all, 64 individuals were assessed, 32 in the research group and 32 in the control group. Results showed that individuals in the research group had hearing loss at frequencies between 4 and 8 kHz, but no significant difference was found between groups. Frequency analysis showed that individuals in the control group had higher thresholds than individuals in the research group at the frequency of 0.25 kHz. In the control group, men showed higher thresholds than women at the frequency of 9 kHz. Conclusion A low prevalence of hearing loss was found, with no difference between teachers and subjects fromthe control group. No difference was found for hearing thresholds at high frequencies between groups. Results have been partially affected by sex.

Audição em adultos e idosos: associação com sexo, idade e cognição / Hearing in middle aged adults and elderly: association with gender, age and cognitive performance

OBJETIVO: verificar a existência de associação entre a presença e o grau de perda auditiva em adultos e idosos e o desempenho em teste de rastreio cognitivo, o sexo e a idade dos mesmos. MÉTODOS: participaram deste estudo sujeitos com idade entre 52 e 92 anos. Todos responderam a questionário sócio-demográfico, ao teste de Mini Exame do Estado Mental e à audiometria tonal liminar. RESULTADOS: dos 90 indivíduos avaliados, 22 (24,4%) eram do sexo masculino e 68 (75,6%) do sexo feminino. Constatou-se que apenas 11 orelhas direitas e 11 orelhas esquerdas apresentavam limiares auditivos normais. Constatou-se que a idade estava associada com o aumento dos limiares auditivos, evidenciando que os indivíduos mais velhos apresentam maior grau de perda auditiva (p<0,005). Não houve diferença estatística entre os limiares auditivos de homens e mulheres (p=0,1). Observou-se que 80% dos sujeitos cujo resultado do rastreio cognitivo foi normal apresentaram os limiares auditivos menos afetados. Já 60% dos indivíduos cujo resultado do rastreio cognitivo foi alterado apresentaram maior grau de perda auditiva. Pode-se constatar a relação dos achados audiológicos com os resultados do teste de rastreio cognitivo, evidenciando que os sujeitos com o resultado alterado do mini Exame do Estado mental apresentam os maiores graus de perda auditiva (p<0,001). CONCLUSÃO: verificou-se que houve associação entre a presença e grau da perda auditiva com o resultado do Mini Exame do Estado Mental. O aumento da idade mostrou-se proporcional ao aumento dos limiares auditivos. Não foi constatada associação entre gênero e audição na amostra. .

PURPOSE: to verify whether the presence and level of hearing loss in adults and elderly as well as their performance in tests are linked to their gender, age and cognitive tracking. METHODS: subjects with ages between 52 and 92 years old took part in this study. They all answered a sociodemographic questionnaire and went through Mini-Mental State Examination as well as pure-tone threshold audiometry. RESULTS: out of the 90 individuals, 22 (24,4%) were male and 68 (75,6%) were female. It was seen that only 11 right ears and 11 left ears presented normal auditory thresholds. It was possible to verify that age was indeed linked to the auditory thresholds increase, making it clear that older individuals present higher levels of hearing loss (p<0,005). There was no statistical difference between the auditory thresholds of male and female (p=0,1). It was observed that 80% of the individuals whose cognitive tracking results were normal presented least affected auditory thresholds, while 60% of those whose cognitive tracking results were altered presented a higher level of hearing loss. It is possible to identify a relation between these audiological findings and the cognitive tracking test results, proving that the individuals with the altered Mini-Mental State Examination results present higher hearing loss (p<0,001). CONCLUSION: there was an association between the presence and degree of hearing loss with the result of the Mini-Mental State Examination. Increasing age was proportional to the increase in hearing thresholds. There was no association between gender and hearing in the sample. .

Sensitivity and Specificity of Portable Hearing Screening in Middle-Aged and Older Adults

Introduction: Hearing screening allows the identification of individuals with hearing loss. Aim: To determine the sensitivity and specificity of a portable hearing screening device in middle-aged and older adults using the manufacturer scoring and a scoring system proposed by the researchers. Methods: In this transversal study, participants underwent anamnesis, otoscopy, and hearing screening using portable equipment. After this, a pure tone audiometry was performed, with participants classified into two groups: with and without hearing loss. The sensitivity and specificity of the hearing screening were calculated for the right and left ears using two methods of interpretation: the original method recommended by the manufacturer (criteria 1) and the method proposed by researchers (criteria 2). Results: The sample consisted of 55 individuals, 83.6% (n = 46) of whom were women. Per criteria 1, the sensitivities were 26.3 (right ear) and 21.4% (left ear). The specificity was 100% for both ears. Using criteria 2, the sensitivity was 94.7 (right ear) and 100% (left ear). The specificity was 74.3 (right ear) and 65.9% (left ear). Conclusion: This study showed that the criteria proposed by the manufacturer presented low sensitivity in the hearing screening. The criteria proposed by the researchers to achieve a more efficient performance reached high and balanced values for sensitivity and specificity...

Exposure to classroom sound pressure level among dance teachers in Porto Alegre (RS)

Introduction: Dance teachers are exposed to high sound intensities. Aim: To verify the sound intensity of music used by dance teachers during classes. Method: This was a transversal and prospective study. Dance teachers were evaluated with a sociodemographic questionnaire, and sound intensity level measurements were taken at the beginning, middle, and end of dance classes. Results: The sample comprised 35 teachers (average age, 31.8 years). The duration of their career as dance teachers was 1-37 years; they worked daily for approximately 1-10 h. Among the classes followed, there were 15 (42.85%) classical ballet classes, 4 (11.42%) tap dancing lessons, 5 (14.28%) jazz dance classes, 2 (5.71) Arab dance lessons, 6 (17.14%) street dance classes, and 3 (8.57%) ballroom dancing lessons. The average values observed at the beginning, middle, and end of the classes were 80.91 dB (A), 83.22 dB (A), and 85.19 dB (A), respectively. The music played in the street dance classes exposed teachers to the highest sound intensity. Conclusion: The average level of sound intensity of the dance classes in this study was either below or equal to the limit considered harmful for hearing health. Analysis of different class types showed that the sound densities of street, ballroom, and tap dance classes were above the recommended limits...

Os efeitos da estimulação sensório motora oral na sucção nutritiva na mamadeira de recém-nascidos pré-termo / The sensory-motor-oral stimulation effects on nutritive sucking of preterm infants during bottle feeding

OBJETIVO: verificar o desempenho da sucção nutritiva, na mamadeira, em recém-nascidos pré-termo submetidos à estimulação sensório-motora-oral. MÉTODOS: pesquisa do tipo ensaio clínico controlado de intervenção. 20 recém-nascidos pré-termo foram distribuídos em grupo estimulado e grupo controle. Estes grupos foram submetidos à avaliação fonoaudiológica em dois diferentes momentos: na liberação da alimentação por via oral; e quando atingiam alimentação plena por via oral num período de 24 horas. As avaliações foram filmadas, e os resultados foram analisados pela pesquisadora. Para análise dos dados utilizou-se o Teste exato de Fishe r e o Teste "T" de Studen t do software estatístico STATA 10.0. Considerou-se p < 0,05. RESULTADOS: recém-nascidos do grupo estimulado, na segunda avaliação, apresentaram resultados com diferença estatística significante quanto a força de sucção forte (p=0,003), presença dos três reflexos adaptativos (p=0,001), coordenação da sucção/deglutição/respiração (p=0,003), no tempo total de sucções (p=0,01) e na frequência de sucção (p<0,01). O número total de sucções apresentou diferença estatística significante (p<0,05) entre as avaliações do grupo controle. Quanto ao ritmo e a relação entre o volume de leite prescrito e ingerido não apresentou resultados com diferença estatística significante. CONCLUSÃO: a estimulação sensório-motora oral parece favorecer o desempenho nas funções de sucção nutritiva de recém-nascidos pré-termo.

PURPOSE: to check the nutritive sucking performance in preterm infants that underwent sensory-motororal stimulation. METHODS: a controlled clinical trial of intervention was performed in 20 preterm infants divided into experimental and control group. The infants received a speech therapist evaluation in two different times: at the beginning of the oral feeding (first speech therapist evaluation) and when they reached full oral feeding (second evaluation). Statistical data analyses used STATA 10 package and they were analyzed for treatment group differences with Fisher's exact Test and Student's unpaired t-test (p<0.05). RESULTS: infants in the experimental group, in the second evaluation, differed statistically in the pressure of strong sucking (p=0.003), presence of the three adaptive reflexes (p=0.001), coordination among sucking, swallowing and breathing (p=0.003), the total time for sucking (p=0.01) and of number of sucking/time (p<0.01). The total number of sucks showed a statistically significant difference (p<0.05) among the evaluations of the control group. No differences were observed among the groups as for sucking rhythm, and prescribed and ingested milk volume. CONCLUSION: in this study, sensory-motor-oral stimulation contributed for a better sucking performance, during bottle feeding, in preterm infants.

Avaliação da estimulação sensório-motora-oral na transição da alimentação enteral para a via oral plena em recém-nascidos pré-termo / Evaluation of sensory-motor-oral stimulation in the transition from gastric tube to full oral feeding in preterm newborns

OBJETIVOS: avaliar a influência da estimulação sensório-motora-oral (SMO) sobre o ganho de peso, tempo para realizar a transição da sonda para a via oral e, indiretamente, sobre a alta hospitalar de pré-termos. MÉTODOS: estudo de intervenção, do tipo ensaio clínico controlado, que incluiu 24 pré-termos, internados na UTI Neonatal do Hospital Universitário de Santa Maria, Rio Grande do Sul, Brasil, entre maio de 2007 e março de 2008, alocados, por sorteio, em grupo estimulado (GE) e controle (GC). A análise das diferenças entre os grupos foi testada utilizando o teste t-Student independente e exato de Fisher (valor de p<0,05). RESULTADOS: não houve diferença estatística para as medidas antropométricas, embora o incremento diário de peso tenha sido maior no GE (p=0,16). O GE realizou a transição completa da sonda para a via oral em média 1,6 dias antes que o GC, sendo que 83,3 por cento das crianças do GE fizeram essa transição em até sete dias, enquanto apenas 38,9 por cento do GC alcançaram esse prazo. Não houve diferença no tempo de permanência hospitalar entre os grupos (p=0,48). CONCLUSÕES: a estimulação SMO favoreceu uma transição mais rápida da sonda para a via oral, não comprometendo o ganho de peso de recém-nascidos pré-termo. Não foi possível observar sua influência sobre o tempo de permanência hospitalar.

OBJECTIVES: to evaluate the influence of sensory-motor-oral (SMO) stimulation on weight gain, the time taken to make the transition from tube-to oral feeding and, indirectly, on the duration of hospitalization of preterm infants. METHODS: a controlled clinical intervention study was carried out with 24 preterm infants hospitalized in the Neonatal ICU of the Santa Maria University Hospital in the State of Rio Grande do Sul, Brazil, between May 2007 and March 2008, divided randomly into a treatment (TG) and control group (CG). The analysis of the differences between the groups was tested using Student's independent t-test and Fisher's exact test (with a p value <0.05). RESULTS: there was no statistical difference in terms of anthropometrical measurements, although the daily weight gain was higher in the TG (p=0.16). The TG group made a full transition from tube-to oral feeding on average 1.6 days earlier than the CG, 83.3 percent of the children in the TG making the transition within seven days, compared to only 38.9 percent of the control group. There was no difference in terms of the length of stay in hospital between the two groups (p=0.48). CONCLUSIONS: SMO stimulation was likely to lead to a swifter transition from tube-to oral feeding, without any adverse effect on weight gain in preterm newborns. No influence on the length of stay in hospital was observed.