Avaliação das funções cognitivas em idosos com e sem alterações no processamento auditivo central / Evaluation of cognitive functions in the elderly with and without central auditory processing disorder

RESUMO Objetivo Avaliar e comparar as funções cognitivas entre idosos com e sem alteração do processamento auditivo central. Método Vinte e oito idosos saudáveis (14 do grupo controle e 14 do grupo Transtorno do Processamento Auditivo Central - TPAC) participaram do estudo. Todos os idosos foram submetidos à bateria mínima de avaliação do processamento auditivo central (PAC), ao potencial auditivo cognitivo P300 e a bateria cognitiva breve (BCB). Na comparação entre sujeitos, foi aplicado o teste de Mann-Whitney e na comparação intra-sujeitos, utilizamos o teste de postos sinalizados de Wilcoxon. Para verificar se houve associação entre o desempenho do PAC e das variáveis cognitivas, foi utilizada a correlação de Spearman. Resultados Não houve diferenças estatisticamente significantes entre os grupos 'Controle' e TPAC para a maioria das habilidades cognitivas avaliadas por meio da BCB, bem como para as variáveis do potencial cognitivo P300. Contudo, houve diferença estatisticamente significante entre o desempenho do grupo 'Controle' e TPAC para a prova do desenho do relógio. Além disso, foi possível observar correlação entre o desempenho do teste do relógio e no TPF. Conclusão Idosos com TPAC não apresentaram alteração na maior parte dos testes cognitivos, com exceção da prova do desenho do relógio, cuja tarefa envolve múltiplas funções cognitivas, incluindo processamento visuoespacial, função executiva, memória semântica e planejamento.

ABSTRACT Purpose Evaluate and compare the performance of cognitive functions between elderly with and without auditory processing disorders. Methods Twenty-eight healthy elderly (14 Control group and 14 Auditory Processing Disorder group - APD group) participated in the study. All elderly were submitted to (central) auditory processing evaluation, P300 event-related potential and brief cognitive battery (BCB). In the comparison between subjects, the Mann-Whitney test was applied and in the intra-subjects comparison, the Wilcoxon signed rank test was used. To verify if there was an association between the performance of the PAC and the cognitive variables, Spearman's correlation was used. Results There were no statistically significant differences between the Control and APD groups for the cognitive abilities assessed by BCB, as well as for the P300 cognitive potential variables. Conclusion Elderly with auditory processing disorders do not seem to show greater cognitive difficulties compared to elderly of the same age group without auditory processing disorders, exception of the clock drawing test, whose task involves multiple cognitive functions, including visuospatial processing, executive function, semantic memory, and planning.

ELSA-Brasil: a 4-year incidence of hearing loss in adults with and without hypertension

ABSTRACT OBJECTIVE To compare the incidence of hearing loss among adults stratified by the occurrence of hypertension, and to investigate the association between hypertension and hearing loss. METHODS Longitudinal observational study, part of the Estudo Longitudinal da Saúde do Adulto (ELSA-Brasil, Longitudinal Study on Adult's Health). Data from the first and second waves were analyzed, including information from audiological assessment and general health of the subjects. As outcome, we considered the presence of hearing loss (hearing thresholds above 25 dBHL at frequencies from 500 Hz to 8 kHz) and, as exposure variable, hypertension (report of medical diagnosis of hypertension; and/or use of drugs to treat hypertension; and/or pressure systolic blood pressure ≥ 140 mmHg; or diastolic blood pressure ≥ 90 mmHg). As covariables for adjustment were considered: sex, age, education, race / ethnicity, income, smoking, diabetes, and occupational exposure to noise. Poisson regression analysis was conducted, estimating the crude and adjusted relative risks, with 95% confidence intervals, in order to assess the factors associated with hearing loss. RESULTS In crude analyses, the incidence of hearing loss was higher for subjects with hypertension (9.7% versus 5.4%). The crude relative risks for hearing loss was almost double (1.93; 95%CI: 1.10-3.39) for subjects with hypertension in the right ear. In the adjusted analyses, the relative risks was not significant for the hypertension variable (1.42; 95%CI: 0.75-2.67). Being 60 years or older (RR: 5.41; 95%CI: 2.79-10.50) showed a statistically significant association with hearing loss, indicating that older adults have higher relative risks for hearing loss. CONCLUSION In the adjusted analyses controlled for multiple risk factors there was no association between hypertension and hearing loss. The dichotomous variable age (being 60 years or older), on the other hand, has shown a significant association with hearing loss.

Hearing loss, tinnitus, and hypertension: analysis of the baseline data from the Brazilian Longitudinal Study of Adult Health (ELSA-Brasil)

OBJECTIVES: To investigate the association among hypertension, tinnitus, and sensorineural hearing loss and evaluate the influence of other covariates on this association. METHODS: Baseline data (2008-2010) from the Brazilian Longitudinal Study of Adult Health (ELSA-Brasil) were analyzed. Altogether, 900 participants were evaluated. The baseline assessment consisted of a 7-hour examination to obtain clinical and laboratory variables. Hearing was measured using pure-tone audiometry. RESULTS: Overall, 33.3% of the participants had hypertension. Participants with hypertension were more likely to be older, male, and diabetic compared to those without hypertension. The prevalence of tinnitus was higher among hypertensive participants and the odds ratio for tinnitus was higher in participants with hypertension than in those without hypertension. However, the difference was not significant after adjusting for age. Audiometric results at 250-8,000 Hz were worse in participants with hypertension than in those without hypertension in the crude analysis; however, the differences were not significant after adjustment for age, sex, diagnosis of diabetes, and exposure to noise. No significant difference was observed in hearing thresholds among participants having hypertension for <6 years, those having hypertension for ≥6 years, and individuals without hypertension. CONCLUSION: Hearing thresholds were worse in participants with hypertension. However, after adjusting for age, sex, diagnosis of diabetes, and exposure to noise, no significant differences were observed between participants with and without hypertension. A higher prevalence of tinnitus was observed in participants with hypertension compared to those without hypertension, but without significance after adjusting for age.

Ongoing maturation in the time-compressed speech test

OBJECTIVES: To verify the neuromaturational influence in the ability of auditory closure, that is, to verify the performance of children and young adults in the ability of auditory closure, through the time compressed speech test (TCS). METHODS: Thirty children (8 to 10 years old) and 30 young adults (16 to 24 years old) with normal hearing without complaints (neurological, cognitive, auditory processing) who performed TFC (monosyllables and disyllables) with a compression ratio of 60% in both ears. Statistical analysis was performed using analysis of variance (ANOVA) and ANOVA with repeated measures with a significance level of 0.05. The minimum statistical power was 80%. RESULTS: In the comparison between ears, there was no significant difference between groups for the monosyllables. For disyllables, the second ear tested was better in children, and the right ear was better than the left ear for young adults. In the comparison between modalities (monosyllables and disyllables), children did not show significant differences. The performance of the young adults was better in the disyllables in both ears. Comparing the age groups, the young adults were better than the children for both modalities and ears. CONCLUSION: The study has demonstrated the influence and impact of age (maturational factor) on TCS test performance, showing the importance of establishing normality patterns for various age groups to provide a standardized tool for evaluation of auditory closure ability.

Association between language and hearing disorders - risk identification

OBJECTIVE: To identify children at risk for hearing and/or language disorders and to investigate the association between these risks by conducting pre-validated hearing and language screenings. METHODS: The study was conducted during a polio vaccination campaign in August of 2013 in basic health units in western São Paulo. Parents of children between 2 and 5 years of age were asked to complete two screening tools: a hearing questionnaire (regarding hearing development) and a language production and comprehension scale (including the major language development milestones). The screening tools were administered by different researchers. We compared the risk of having language disorders among children at risk for hearing loss versus children not at risk, as well as the attributable risk and odds ratios. Chi-squared tests and logistic regression analyses were used. RESULTS: The study included 479 children with a mean age of three and one-half years, of whom 26.9% were identified as at risk for deficits in language production, 8.6% were at risk for deficits in language comprehension and 14% were at risk for hearing disorders. The children at risk for hearing disorders were twice as likely as those not at risk to exhibit language production and comprehension deficits. CONCLUSION: The results of this study highlight the importance of establishing and adopting low-cost procedures such as screenings to identify children at risk of developing language and/or hearing disorders in early childhood.

Effect of education on listening comprehension of sentences on healthy elderly: analysis of number of correct responses and task execution time / Efeito da escolaridade na compreensão auditiva de sentenças em idosos saudáveis: análise do número de acertos e tempo de execução da tarefa

ABSTRACT Purpose To analyze the effect of education on sentence listening comprehension on cognitively healthy elderly. Methods A total of 111 healthy elderly, aged 60-80 years of both genders were divided into two groups according to educational level: low education (0-8 years of formal education) and high education (≥9 years of formal education). The participants were assessed using the Revised Token Test, an instrument that supports the evaluation of auditory comprehension of orders with different working memory and syntactic complexity demands. The indicators used for performance analysis were the number of correct responses (accuracy analysis) and task execution time (temporal analysis) in the different blocks. Results The low educated group had a lower number of correct responses than the high educated group on all blocks of the test. In the temporal analysis, participants with low education had longer execution time for commands on the first four blocks related to working memory. However, the two groups had similar execution time for blocks more related to syntactic comprehension. Conclusion Education influenced sentence listening comprehension on elderly. Temporal analysis allowed to infer over the relationship between comprehension and other cognitive abilities, and to observe that the low educated elderly did not use effective compensation strategies to improve their performances on the task. Therefore, low educational level, associated with aging, may potentialize the risks for language decline.

RESUMO Objetivo Analisar o efeito da escolaridade na compreensão auditiva de sentenças em idosos cognitivamente saudáveis. Método Foram avaliados 111 idosos normais, com idades entre 60 e 80 anos, de ambos os gêneros, divididos em dois grupos, de acordo com a escolaridade: baixa escolaridade (0 a 8 anos de ensino formal) e alta escolaridade (9 ou mais anos de ensino formal). Os indivíduos foram examinados por meio do Token Test Revisado, que dá suporte para a avaliação da compreensão auditiva de ordens com diferentes demandas de memória operacional e complexidade sintática. Os indicadores utilizados para análise do desempenho foram números de acertos (análise de acurácia) e tempo de execução da tarefa (análise temporal) nos diferentes blocos. Resultados O grupo de baixa escolaridade apresentou menor número de acertos que o grupo de alta escolaridade em todos os blocos do teste. Na análise temporal, os idosos de baixa escolaridade apresentaram maior tempo para execução das ordens nos primeiros quatro blocos, mais relacionados à memória operacional. Porém, os grupos apresentaram tempo de execução semelhante quanto aos blocos mais relacionados à compreensão sintática. Conclusão A escolaridade influenciou a habilidade de compreensão auditiva de sentenças em indivíduos idosos. A análise temporal permitiu inferir sobre a relação da compreensão com outras habilidades cognitivas e observar que os idosos de baixa escolaridade não utilizam estratégias eficazes de compensação para melhorar o desempenho na tarefa. Portanto, o baixo nível educacional, associado ao envelhecimento, pode potencializar os riscos para o declínio da linguagem.

Peripheral and central auditory assessment in among the elderly / Avaliação auditiva periférica e central em idosos

Abstract Introduction: Presbycusis can affect different portions of the auditory system, causing impacts of varying degrees of seriousness on the daily routine of elderly persons. It is essential that the extent of the deficit as well as the degree of handicap is evaluated, so that the hearing of the elderly can be effectively rehabilitated, improving their quality of life. Purpose: To characterize the peripheral and central hearing of elderly individuals and assess their auditory handicaps. Methods: A cross sectional observational study was performed. We evaluated 83 elderly persons (60-85 years; 33 men, 50 women) with normal hearing or sensorineural hearing loss. Individuals were divided into 3 groups according to the 3 to 6kHz hearing thresholds: G1 - mean of 0 to 39 dBHL (80 ears); G2 - mean of 40 to 59 dBHL (48 ears); G3 - mean of 60 to 120dBHL (38 ears). All individuals responded to the Hearing Handicap Inventory for the Elderly (HHIE), and underwent Pure Tone Audiometry, Auditory Brainstem Response (ABR) and Long Latency Response (P300) evaluation. Results: Men had higher auditory thresholds at frequencies from 500 to 12,000Hz (with a statistical difference between 2-8 kHz) and also significantly greater latencies for ABR components. There was no difference between genders for the P300 evaluation. Comparison between groups showed: a statistically significant difference for age; greater ABR wave latencies and interwave intervals; that questionnaire scores worsened as hearing threshold declined; and similar P300 latencies. Conclusions: Elderly people have impairment throughout the auditory pathway (peripheral and central). The P300 was less accurate at identifying the losses that come with age. The HHIE demonstrated negative effects on the social life of elderly people, agreeing with the hearing thresholds found. AU

Resumo Introdução: A presbiacusia pode afetar diferentes porções do sistema auditivo, causando impactos diversos na vida do idoso. É fundamental que a extensão do deficit e o grau do handicap sejam avaliados, visando uma reabilitação auditiva mais específica e eficaz, melhorando a qualidade de vida do idoso. Objetivo: Caracterizar a audição periférica e central de idosos e avaliar o handicap auditivo. Método: estudo transversal observacional. Foram avaliados 83 idosos (60 a 85 anos; 33 homens, 50 mulheres) com audição normal ou perda auditiva neurossensorial, divididos em 3 grupos, de acordo com os limiares de 3 a 6 kHz: G1 - média de 0 a 39 dBNA (80 orelhas); G2 - média de 40 a 59 dBNA (48 orelhas); G3 - média de 60 a 120dBNA (38 orelhas). Realizaram questionário Hearing Handicap Inventory for the Elderly (HHIE), Audiometria Tonal, Potenciais Evocados Auditivos de Tronco Encefálico (PEATE) e de Longa Latência. Resultados: O sexo masculino apresentou limiares auditivos piores nas frequências de 500 a 12000 Hz e latências aumentadas para os componentes do PEATE; não houve diferença entre sexos no P300. Na comparação entre grupos, observou-se diferença significante com relação à idade; aumento das latências e interpicos no PEATE e piora da pontuação do questionário conforme piora do limiar auditivo; semelhança nas latências do P300. Conclusões: Idosos apresentam comprometimento da via auditiva (periférica e central). O P300 mostrou-se menos sensível para as alterações decorrentes da idade; o questionário HHIE demonstrou prejuízo para a vida social dos idosos, mostrando concordância com os limiares auditivos avaliados. AU

Programa de treinamento auditivo em portadores de zumbido / Auditory training program in subjects with tinnitus

RESUMO O zumbido pode ser definido como a percepção consciente de um som, sem a presença de estimulação acústica externa. Considerando o prejuízo causado pelo zumbido e a falta de tratamentos definitivos, fica evidente a necessidade de alternativas para reabilitação de pessoas com zumbido. A hipótese é que o treinamento auditivo pode causar uma reorganização plástica desse sistema, promovendo uma melhora do sintoma. Objetivo: Verificar o efeito de um programa de treinamento auditivo em portadores de zumbido na percepção desse sintoma. Métodos: Participaram 12 indivíduos portadores de zumbido, divididos em dois grupos: Grupo Estudo (GE) e Grupo Controle (GC). Todos os indivíduos realizaram: audiometria; avaliação eletrofisiológica; acufenometria; aplicação do Tinnitus Handicap Inventory (THI) e avaliação do processamento auditivo (GIN - Gaps In Noise , Teste de Padrão de Frequência e Fala com Ruído). Após a avaliação, foram iniciados os treinamentos e o GE foi submetido ao treinamento auditivo formal enquanto o GC ao treinamento visual. Resultados: Na caracterização dos grupos não foram observadas diferenças estatisticamente significantes para as variáveis: idade, pitch e loudness do zumbido, nem para os limiares auditivos na audiometria convencional e altas frequências. Na comparação entre os grupos, pré e pós-treinamento, dos testes eletrofisiológicos, comportamentais e THI não houve diferenças estatisticamente significantes entre eles para nenhuma das avaliações realizadas. Conclusão: Achados não mostraram diferenças estatisticamente significantes entre os grupos na comparação entre pré e pós-treinamento (auditivo ou visual), tanto para os achados eletrofisiológicos quanto para a avaliação comportamental do processamento auditivo e para o THI, embora diferenças pontuais na análise individual tenham ocorrido.

ABSTRACT Tinnitus may be defined as the conscious perception of sound or noise, without the presence of external acoustic stimulation. Given the damage caused by tinnitus and the lack of effective treatment, alternatives are necessary to rehabilitate subjects with tinnitus. There is an assumption that auditory training (AT) could lead to a plastic reorganization of this system, thus promoting an improvement of the symptom. Objective: To verify the effect of an AT program in subjects with tinnitus in the perception of this symptom. Methods: Twelve subjects with tinnitus were included in the study and divided into two groups: Study Group (SG) and Control Group (CG). All of them underwent audiometric and electrophysiological assessments; acuphenometry; Tinnitus Handicap Inventory and auditory processing assessment (GIN - Gaps in Noise, Frequency Pattern Test and Speech-in-Noise). Afterward, trainings began and the SG was submitted to the formal AT, and the CG to the visual training. Results: In the characterization of the groups, no statistically significant difference was found for the variables such as age, pitch, and loudness of tinnitus, or for hearing thresholds in conventional audiometry and high frequencies. Comparisons were performed between the groups, before and after the trainings, regarding electrophysiological, behavioral, and Tinnitus Handicap Inventory tests, and no statistically significant differences were found between them for any of the evaluations. Conclusion: Findings showed no statistically significant differences between groups in the comparison between the moments pre- and post-trainings (auditory or visual), nor for the electrophysiological findings or behavioral assessment of the auditory processing and for the Tinnitus Handicap Inventory, although some specific differences in the individual analysis have occurred.

O Potencial Evocado Auditivo com estímulo de fala pode ser uma ferramenta útil na prática clínica? / Can speech-evoked Auditory Brainstem Response become a useful tool in clinical practice?

RESUMO Objetivo: Discutir a aplicabilidade clínica do Potencial Evocado Auditivo com Estímulo de Fala (PEATEf) no auxílio à identificação dos transtornos do processamento auditivo. Métodos : Foram selecionados os prontuários de 27 crianças e adolescentes, com idade entre sete e 15 anos, que apresentaram alteração no PEATEf. Foram levantados os dados referentes à avaliação comportamental do processamento auditivo desses indivíduos. Resultados: Observou-se que das 27 crianças com PEATEf alterado, 23 também apresentaram alteração de processamento auditivo. A partir dessa amostra, foi possível apontar probabilidade de 85,15% em observar avaliação comportamental do processamento auditivo alterada em uma criança que apresentou PEATEf também alterado. Conclusão: Sugere-se que o PEATEf pode ser utilizado na prática clínica como uma ferramenta importante no diagnóstico do Transtorno do Processamento Auditivo, uma vez que neste estudo uma alteração do PEATEf quase sempre representou, também, uma alteração nos resultados da avaliação comportamental do processamento auditivo, portanto pode ser utilizado para obter informações acerca da percepção dos sons da fala em crianças menores de sete anos ou de difícil avaliação comportamental.

ABSTRACT Purpose : To discuss the clinical applicability of the speech-evoked Auditory Brainstem Response (speech-evoked ABR) to help identifying auditory processing disorders. Methods : We analyzed the records of 27 children and adolescents, aged between seven and 15, who presented abnormal speech-evoked ABR. Then, the data from the behavioral auditory processing evaluation of these individuals were surveyed. Results : It was observed that, among the 27 children with abnormal speech-evoked ABR, 23 also had auditory processing disorders. Therefore, from this sample, an 85.15% probability of observing abnormal behavioral assessment of auditory processing in a child who presented abnormal speech-evoked ABR was obtained. Conclusion : It is argued that the speech-evoked ABR can be used in clinical practice as an important aid tool in the diagnosis of auditory processing disorder, because, in this study, an abnormal speech-evoked ABR usually represented a deficit in the results of behavioral assessment of auditory processing. Thus, it can be used to obtain information about the perception of speech sounds in children under seven years or with challenging behavioral assessment.

Interação entre diabetes mellitus e hipertensão arterial sobre a audição de idosos / Interaction between diabetes mellitus and hypertension on hearing of elderly

RESUMO Introdução: Doenças crônicas e alterações metabólicas podem atuar como fator de aceleração na degeneração do sistema auditivo decorrente da idade. No entanto, estudos envolvendo a associação entre a perda auditiva com a diabetes mellitus (DM) e com a hipertensão arterial (AH) em idosos mostraram conclusões controversas. Sendo assim, novos estudos sobre essa temática são necessários, a fim de elucidarmos o efeito dessas doenças crônicas sobre o sistema auditivo. Objetivo: Comparar os limiares auditivos de idosos portadores de DM, de HA e de DM+AH com um grupo controle (GC). Métodos: Estudo retrospectivo realizado por meio de levantamento de prontuários de 80 idosos com avaliação audiológica completa, entre 2008 e 2012. Os idosos foram distribuídos em quatro grupos: portadores de DM, portadores de AH, portadores de DM+AH e sem doenças crônicas conhecidas (GC). Foram utilizados os testes estatísticos ANOVA, Tukey e Mauchly, com nível de significância de 0,05. Resultados: Não houve diferença estatisticamente significante entre as orelhas, sendo esses resultados agrupados. As comparações entre as médias dos limiares auditivos dos grupos GC e DM ou AH não mostraram diferenças estatisticamente significantes, entretanto houve diferença estatisticamente significante na comparação entre esses três grupos e o grupo DM+AH para várias das frequências da audiometria avaliadas. Conclusão: Verificou-se que idosos com DM e AH associados apresentaram maior comprometimento auditivo com relação aos outros grupos, sugerindo um efeito sinérgico das duas doenças crônicas sobre a audição.

ABSTRACT Introduction: Chronic diseases and metabolic changes may act as accelerating factor in the degeneration of the auditory system due to age. However, studies involving an association between hearing loss and diabetes mellitus (DM) and hypertension (HA) in the elderly have shown controversial conclusions. Thus, further studies on this topic are needed in order to elucidate the effect of these chronic diseases on the auditory system. Aim: To compare the hearing thresholds of elderly patients with DM, HA and DM + HA with a control group (CG). Methods: Retrospective study was conducted through survey charts of 80 elderly people with full hearing assessment, between 2008 and 2012. Subjects were divided into four groups: DM, HA, DM + HA and without chronic diseases known (CG). The ANOVA, Tukey and Mauchly tests, with a significance level of 0.05, were used. Results: There was no statistically significant difference between the ears, which are grouped. Comparisons between the means of hearing thresholds of CG and DM or HA showed no statistically significant differences. However, a statistically significant difference in the comparison between these three groups and DM + HA group for several of the frequencies evaluated was observed. Conclusion: It was found that older adults with DM and hypertension associated showed greater hearing impairment in comparison with the other groups, suggesting a synergistic effect of the two chronic diseases on hearing.

Temporal resolution in individuals with neurological disorders

OBJECTIVE:Temporal processing refers to the ability of the central auditory nervous system to encode and detect subtle changes in acoustic signals. This study aims to investigate the temporal resolution ability of individuals with mesial temporal sclerosis and to determine the sensitivity and specificity of the gaps-in-noise test in identifying this type of lesion.METHOD:This prospective study investigated differences in temporal resolution between 30 individuals with normal hearing and without neurological lesions (G1) and 16 individuals with both normal hearing and mesial temporal sclerosis (G2). Test performances were compared, and the sensitivity and specificity were calculated.RESULTS:There was no difference in gap detection thresholds between the two groups, although G1 revealed better average thresholds than G2 did. The sensitivity and specificity of the gaps-in-noise test for neurological lesions were 68% and 98%, respectively.CONCLUSIONS:Temporal resolution ability is compromised in individuals with neurological lesions caused by mesial temporal sclerosis. The gaps-in-noise test was shown to be a sensitive and specific measure of central auditory dysfunction in these patients.

Cortical inhibition effect in musicians and non-musicians using P300 with and without contralateral stimulation / Efeito da inibição cortical utilizando o P300 em músicos e não músicos com e sem estimulação contralateral

Introduction: Musicians have more robust and efficient neural responses in the cortical and sub-cortical regions, demonstrating that musical experience benefits the processing of both non-linguistic and linguistic stimuli. Objective: This study aimed to verify P300's latency and amplitude behavioral using contralateral stimulation in musicians and non-musicians. Methods: This was a case-control study. Subjects were divided in two groups: musicians, comprising 30 professional musicians, and non-musicians, comprising 25 subjects without musical experience. Results: The present study showed that the musicians had lower latencies and higher amplitudes than the non-musicians in the P300 without contralateral noise. For the P300 amplitude values, the difference between groups persisted, and the musicians presented significantly higher amplitude values compared with the non-musicians; additionally, the analysis of the noise effect on the P300 response showed that the latency values were significantly increased in the musicians. Conclusion: The central auditory nervous system of musicians presents peculiar characteristics of electrophysiological responses probably due to the plasticity imposed by musical practice. .

Introdução: Os músicos possuem respostas neurais mais robustas e eficientes em regiões corticais, mostrando que a experiência musical beneficia o processamento de estímulos linguísticos e não linguísticos. Objetivo: Verificar como a latência e a amplitude do P300 se comporta usando estimulação contralateral, em músicos e não músicos. Método: Estudo de caso-controle. Os indivíduos foram divididos em dois grupos: GM (grupo de músicos) com 30 músicos profissionais e GNM (grupo de não músicos) com 25 indivíduos sem experiência musical. Resultados: Os resultados mostraram que: GM teve latências menores e amplitudes maiores do que a GNM no P300 sem ruído contralateral. Para os valores de amplitude do P300, a diferença entre os grupos se manteve, e o GM apresentou valores de amplitude significativamente maiores em comparação com o GNM; e a análise do efeito do ruído sobre a resposta P300 mostrou que os valores de latência foram significativamente maiores no GM. Conclusão: Concluímos que o sistema nervoso auditivo central de músicos apresenta características peculiares de respostas eletrofisiológicas provavelmente devido à plasticidade imposta pela prática musical. .

P300 em trabalhadores expostos a ruído ocupacional / P300 in workers exposed to occupational noise

O prejuízo do ruído para as vias auditivas centrais em trabalhadores expostos a ruído ocupacional tem sido pouco estudado. OBJETIVO: Avaliar as vias auditivas centrais por meio do potencial evocado auditivo de longa latência (P300), em indivíduos normo-ouvintes expostos a ruído. MÉTODO: Estudo prospectivo em que foram avaliados 25 indivíduos com limiares auditivos dentro da normalidade. Tais indivíduos foram divididos em dois grupos: expostos a ruído ocupacional (13 sujeitos, grupo pesquisa-GP) e não expostos a ruído ocupacional (12 sujeitos, grupo controle-GC). Foi realizado o P300, utilizando estímulos verbais e não verbais. RESULTADOS: Não houve diferença estatisticamente significante entre as orelhas para nenhum dos estímulos, em nenhum dos grupos. Tanto para o estímulo verbal como para o não verbal houve diferença estatisticamente significante entre os grupos, sendo que o GP apresentou latências maiores que o GC. Na análise qualitativa, observou-se maior número de resultados alterados para o P300 com estímulo não verbal e verbal para o GP, apesar de não haver diferença estatisticamente significante entre eles. CONCLUSÃO: Os indivíduos expostos a níveis de pressão sonora elevados apresentaram, tanto para estímulo verbal quanto para estímulo não verbal, médias de latências do P300 maiores quando comparadas com as do grupo controle.

The harm upon the central auditory pathways of workers exposed to occupational noise has been scarcely studied. OBJECTIVE: To assess the central auditory pathways by testing the long latency auditory evoked potentials (P300) of individuals exposed to occupational noise and controls. METHOD: This prospective study enrolled 25 individuals with normal hearing thresholds. The subjects were divided into two groups: individuals exposed to occupational noise (13 subjects; case group) and individuals not exposed to occupational noise (12 subjects; control group). The P300 test was used with verbal and non-verbal stimuli. RESULTS: No statistically significant differences were found between ears for any of the stimuli or between groups. The groups had no statistically significant difference for verbal or non-verbal stimuli. Case group subjects had longer latencies than controls. In qualitative analysis, a greater number of altered P300 test results for verbal and non-verbal stimuli was seen in the case group, despite the absence of statistically significant differences between case and control subjects. CONCLUSION: Individuals exposed to high sound pressure levels had longer P300 latencies in verbal and non-verbal stimuli when compared to controls.

P300 com estímulo verbal e não verbal em adultos normo-ouvintes / P300 with verbal and nonverbal stimuli in normal hearing adults

O P300 é resultado da focalização da atenção a estímulos raros, dentre outros estímulos frequentes, e investiga a atenção e a memória recente, ambos dependentes da discriminação entre os estímulos, quer sejam verbais ou não verbais. OBJETIVO: Comparar o P300 com estímulos verbais e não verbais em indivíduos adultos com audição normal. MATERIAL E MÉTODO: Estudo prospectivo, no qual foram avaliados 15 sujeitos, com idades entre 22 e 55 anos, do gênero masculino, sem queixas auditivas. Foram submetidos aos potenciais evocados auditivos de curta e longa latência (P300) com estímulos verbal e não verbal. RESULTADOS: As médias das latências do P300 com estímulos verbais foram significantemente maiores que para o P300 com estímulos não verbais. Por sua vez, as médias das amplitudes da onda P300 foram significantemente menores para os estímulos verbais, quando comparados aos não verbais. CONCLUSÃO: Não houve diferença entre as orelhas, no que se refere às latências e amplitudes do P300, tanto para estímulos não verbais quanto verbais. As latências apresentaram valores maiores para os estímulos verbais e as amplitudes mostraram valores menores.

The P300 results from focusing attention on rare stimuli in the midst of other frequent stimuli; it tests recent attention and memory, both of which depend on discriminating among verbal or nonverbal stimuli. AIM: To compare the P300 with verbal and nonverbal stimuli in normal-hearing adults. MATERIAL AND METHOD: A prospective study was made of 15 male subjects aged from 22 to 55, with no hearing complaints. The subjects underwent short and long latency (P300) auditory evoked potentials with verbal and non-verbal stimuli. RESULTS: The mean P300 latency with verbal stimuli was significantly higher than the P300 with nonverbal stimuli. The P300 amplitudes were significantly lower for verbal compared with non-verbal stimuli. CONCLUSION: There were no differences between ears with respect to P300 latencies and amplitudes for both non-verbal and verbal stimuli. Latencies were higher with verbal stimuli; amplitudes had lower values.

O teste Gaps-in-Noise: limiares de detecção de gap em crianças de 9 anos com audição normal / Gaps-in-Noise test: gap detection thresholds in 9-year-old normal-hearing children

OBJETIVO: Estabelecer os critérios de normalidade para o teste Gaps-in-Noise (GIN) em crianças de 9 anos de idade com audição normal, obter as médias dos limiares de detecção de intervalos de silêncio no ruído (gap) e verificar a influência das variáveis referentes a gênero e orelha. MÉTODOS: Foram avaliados 40 indivíduos, 20 do gênero masculino e 20 do feminino, com idade entre 9 anos e 9 anos e 11 meses, normo-ouvintes. Os procedimentos realizados foram: anamnese, avaliação audiométrica, imitanciometria (timpanometria e pesquisa dos reflexos acústicos), teste Dicótico de Dígitos (aplicado para determinar a inclusão no estudo) e teste GIN. Os dados obtidos foram analisados estatisticamente. RESULTADOS: Em relação ao desempenho no teste GIN por orelha, o resultado entre as orelhas direita e esquerda foi semelhante na população estudada. Em relação ao gênero, também não houve diferença. Nos indivíduos avaliados, a média dos limiares de detecção de intervalos de silêncio no ruído (gap) foi de 4,4 ms para orelha direita e 4,2 ms para orelha esquerda. CONCLUSÃO: Para crianças de 9 anos, os valores obtidos para a orelha direita e esquerda acrescidos de um desvio padrão podem ser usados como critério de normalidade para a idade independente da orelha ou gênero avaliado.

PURPOSE: To establish the standard criteria for the Gaps-in-Noise (GIN) test in 9-year-old normal-hearing children; to obtain the mean gap detection thresholds; and to verify the influence of the variables gender and ear on the gap detection thresholds. METHODS: Forty normal-hearing individuals, 20 male and 20 female, with ages ranging from 9 years to 9 years and 11 months, were evaluated. The procedures performed were: anamnesis, audiological evaluation, acoustic immittance measures (tympanometry and acoustic reflex), Dichotic Digits Test, and GIN test. The results obtained were statistically analyzed. RESULTS: The results revealed similar performance of right and left ears in the population studied. There was also no difference regarding the variable gender. In the subjects evaluated, the mean gap detection thresholds were 4.4 ms for the right ear, and 4.2 ms for the left ear. CONCLUSION: The values obtained for right and left ear, as well as their standard deviations, can be used as standard criteria for 9-year-old children, regardless of ear or gender.

Sensitivity and specificity of auditory steady-state response testing

INTRODUCTION: The ASSR test is an electrophysiological test that evaluates, among other aspects, neural synchrony, based on the frequency or amplitude modulation of tones. OBJECTIVE: The aim of this study was to determine the sensitivity and specificity of auditory steady-state response testing in detecting lesions and dysfunctions of the central auditory nervous system. METHODS: Seventy volunteers were divided into three groups: those with normal hearing; those with mesial temporal sclerosis; and those with central auditory processing disorder. All subjects underwent auditory steady-state response testing of both ears at 500 Hz and 2000 Hz (frequency modulation, 46 Hz). The difference between auditory steady-state response-estimated thresholds and behavioral thresholds (audiometric evaluation) was calculated. RESULTS: Estimated thresholds were significantly higher in the mesial temporal sclerosis group than in the normal and central auditory processing disorder groups. In addition, the difference between auditory steady-state response-estimated and behavioral thresholds was greatest in the mesial temporal sclerosis group when compared to the normal group than in the central auditory processing disorder group compared to the normal group. DISCUSSION: Research focusing on central auditory nervous system (CANS) lesions has shown that individuals with CANS lesions present a greater difference between ASSR-estimated thresholds and actual behavioral thresholds; ASSR-estimated thresholds being significantly worse than behavioral thresholds in subjects with CANS insults. This is most likely because the disorder prevents the transmission of the sound stimulus from being in phase with the received stimulus, resulting in asynchronous transmitter release. Another possible cause of the greater difference between the ASSR-estimated thresholds and the behavioral thresholds is impaired temporal resolution. CONCLUSIONS: The overall sensitivity of auditory steady-state response testing was lower than its overall specificity. Although the overall specificity was high, it was lower in the central auditory processing disorder group than in the mesial temporal sclerosis group. Overall sensitivity was also lower in the central auditory processing disorder group than in the mesial temporal sclerosis group.

Development and analysis of a low-cost screening tool to identify and classify hearing loss in children: a proposal for developing countries

OBJECTIVE: A lack of attention has been given to hearing health in primary care in developing countries. A strategy involving low-cost screening tools may fill the current gap in hearing health care provided to children. Therefore, it is necessary to establish and adopt lower-cost procedures that are accessible to underserved areas that lack other physical or human resources that would enable the identification of groups at risk for hearing loss. The aim of this study was to develop and analyze the efficacy of a low-cost screening tool to identify and classify hearing loss in children. METHODS: A total of 214 2-to-10 year-old children participated in this study. The study was conducted by providing a questionnaire to the parents and comparing the answers with the results of a complete audiological assessment. Receiver operating characteristic (ROC) curves were constructed, and discriminant analysis techniques were used to classify each child based on the total score. RESULTS: We found conductive hearing loss in 39.3 percent of children, sensorineural hearing loss in 7.4 percent and normal hearing in 53.3 percent. The discriminant analysis technique provided the following classification rule for the total score on the questionnaire: 0 to 4 points - normal hearing; 5 to 7 points - conductive hearing loss; over 7 points - sensorineural hearing loss. CONCLUSION: Our results suggest that the questionnaire could be used as a screening tool to classify children with normal hearing or hearing loss and according to the type of hearing loss based on the total questionnaire score.

Avaliação eletrofisiológica e comportamental do processamento temporal / Electrophysiological and behavioral assessment of temporal processing

INTRODUÇÃO: O processamento temporal pode ser definido como a percepção das características temporais do som, ou a percepção na mudança da duração dessas características, dentro de um intervalo de tempo restrito. Para que essas sutis mudanças possam ser percebidas, o sistema nervoso auditivo central necessita de um processamento preciso da estrutura de tempo do sinal acústico recebido. Nesse estudo, os objetivos foram: avaliar a resolução temporal, por meio de dois diferentes testes, o GIN (gap-in-noise), um teste comportamental, e o Potencial evocado auditivo de estado estável, um teste eletrofisiológico, em indivíduos normais, com lesão neurológica, e com transtorno de processamento auditivo (central); e verificar a sensibilidade e a especificidade, de ambos os testes. MÉTODOS: Foram avaliados 70 indivíduos voluntários, de ambos os gêneros, com idade entre 16 e 50 anos, divididos em três grupos: G1(grupo normal), G2 (grupo com lesão de lobo temporal, causada por Esclerose mesial temporal), e G3 ( indivíduos com transtorno do processamento auditivo (central)). Todos os indivíduos realizaram ambos os testes. No teste GIN foram utilizadas as listas um e dois. Os limiares de detecção de gap e a porcentagem de acertos foram calculados para todos os indivíduos. O potencial evocado auditivo de estado estável foi realizado com modulação de freqüência de 46 Hz, nas intensidades de 500 e 2000 Hz, em ambas as orelhas. Foram calculados os limiares eletrofisiológicos, os limiares estimados, e a diferença entre o limiar tonal comportamental e o eletrofisiológico, para todos os indivíduos. RESULTADOS: Os resultados do teste GIN mostraram que os indivíduos do G2 apresentam limiares de detecção de gap significantemente piores que os indivíduos do G1 e do G3. O mesmo ocorreu para a porcentagem de acertos, o G2 apresentou uma porcentagem de acertos pior que os grupos G1 e G3. Os indivíduos do G3 apresentaram limiares de detecção de gap aumentados em relação ao G1...

INTRODUCTION: Temporal processing can be defined as a perception of temporal characteristics of the sound, or as a perception of the change in the duration of these characteristics, in a restrict period of time. For these subtle changes to be noticed, the central nervous system needs an accurate processing of the structure of the acoustic stimulus received. The aims of this study were: to assess the temporal resolution using two different tests - the gaps-in-noise test (a behavioral test) and the Auditory steady-state response (an electrophysiological test) in three groups of subjects: normal group; neurological group and (central) auditory processing disorder group. It also aimed to verify the sensitivity and specificity of the two tests. METHODS: Seventy volunteers of both genders were evaluated. Subjects ranged in age from 16 to 50 years, and were divided in three groups: G1 (normal group); G2 (subjects with temporal lobe insult caused by temporal mesial sclerosis) and G3 (subjects with (central) auditory processing disorder). Both tests were conducted on all subjects. The lists 1 and 2 of the gap-in-noise test were applied in all subjects. Gap detection threshold and the percentage of correct responses were calculated for all participants. Auditory steady-state response with 46 Hz of frequency modulation was applied for the frequencies of 500 Hz and 2000 Hz in both ears. Electrophysiological and estimated thresholds were calculated, and the difference between estimated and behavioral tonal thresholds was also obtained for the subjects. RESULTS: results of the gaps-in-noise test showed that the G2 gap detection thresholds were significantly worse than the G1 and G3 thresholds. The same result was observed for the percentage of correct responses, G2 showed a worse percentage of correct responses than those verified for the G1 and the G3 groups. Individuals of the G3 showed increased gap detection threshold compared with the G1, although this difference...

Time-compressed speech test in Brazilian Portuguese

INTRODUCTION: The time-compressed speech test has existed since the 1970s. It is sensitive for evaluating auditory closure. However, it is not used in Brazil because until recently, it had not been developed in Portuguese. PURPOSE: To develop a compressed speech test in Portuguese, to apply it to normal-hearing adults, and to verify which of the compressed lists (50 percent, 60 percent, or 70 percent) is the most appropriate to be part of a set of auditory processing tests. METHODS: 144 normal-hearing adults, distributed homogeneously between both genders, were assessed. The compressed speech tests were applied using monosyllables and disyllables according to 8 previously established sequences, and the results were compared with respect to the initial ear, to the order of presentation, and to the kind of test. RESULTS: There were no significant differences between ears. The 50 percent, 60 percent and 70 percent presentation order produced a better average of correct responses than the 70 percent, 60 percent and 50 percent one. There was a significant difference (P <.001) between the results of the tests comprising lists of monosyllables compared to those comprising disyllables. In both tests (with monosyllables and disyllables) the average of correct responses decreased as the compression increased. CONCLUSION: The monosyllabic and disyllabic lists with 60 percent compression appeared to be more stable than the others, with the average of correct responses around 90 percent.

INTRODUÇÃO: O teste de fala comprimida existe há mais de 30 anos, é sensível para avaliar o fechamento auditivo, porém não é usado no Brasil, já que, até os dias de hoje, ainda não havia sido desenvolvido para o português do Brasil. OBJETIVOS: Elaborar um teste de fala comprimida em português e aplicá-lo em adultos normo-ouvintes, verificar qual das listas comprimidas (50, 60 e 70 por cento) é a mais apropriada para integrar o grupo de testes de Processamento Auditivo. MÉTODOS: Foram avaliados 144 indivíduos adultos, distribuídos homogeneamente entre os gêneros masculino e feminino. Foram aplicados os testes de fala comprimida com monossílabos e dissílabos, de acordo com oito seqüências previamente estabelecidas para em seguida comparar os resultados de acordo com a orelha inicial, ordem de apresentação e tipo de teste. RESULTADOS: Não houve diferença estatisticamente significante entre as orelhas, a ordem crescente de apresentação mostrou uma média de acertos melhor que a decrescente, os testes com monossílabos apresentaram maior média de acertos que os dissílabos e em ambos os testes (com monossílabos e com dissílabos) a média de acertos diminui com o aumento da compressão. CONCLUSÃO: As listas de monossílabos e dissílabos com compressão de 60 por cento mostraram-se mais estáveis que as outras, com média de acerto em torno de 90 por cento.