Masking Level Difference em escolares: análises ambientais / Masking Level Difference in schoolchildren: environmental analysis

RESUMO Objetivo Pesquisar a habilidade auditiva de atenção seletiva na população escolar e identificar valores de referência para a faixa etária de sete a dez anos por meio do teste Masking Level Difference, além de identificar se a escolaridade dos pais, bem como a renda familiar, pode influenciar os resultados do teste. Método Participaram do estudo 31 escolares que se encaixaram nos critérios de elegibilidade da pesquisa, sendo 20 do gênero feminino e 11 do gênero masculino. Realizou-se anamnese para questionamento da renda familiar e escolaridade dos pais do escolar, inspeção visual do meato acústico externo, audiometria tonal liminar, logoaudiometria, medidas de imitância acústica, teste Dicótico de Dígitos e teste Masking Level Difference. Resultados A idade média dos indivíduos foi de 8,67 anos. Não foi observada diferença entre os gêneros e entre as idades avaliadas, no desempenho do MLD. Não houve relação entre a escolaridade dos pais e a renda mensal média com o desempenho das crianças no MLD. A média do MLD foi de 7,65 dB, com desvio padrão de 2,51 dB. Conclusão O Masking Level Difference em escolares de sete a dez anos é de 7,65 dB e independe do gênero, do nível de escolaridade dos pais ou da renda mensal média da família do escolar.

ABSTRACT Purpose To investigate the auditory ability of selective attention in the school population and to identify reference values to the age group from seven to ten years old through the Masking Level Difference Test, and to identify if the parents' schooling, as well as the family income can influence the test results. Methods Thirty-one schoolchildren who match the eligibility criteria attended the study, being 20 female and 11 male. An anamnesis was conducted to question the familiar income and the schooling of the children´s parents; we also performed visual inspection of the External Acoustic Meatus, Pure Tone Audiometry, Speech Audiometry, Acoustic Immittance Measures, Dichotic Digits Test and Masking Level Difference test. Results The mean age of the individuals was 8.67 years. There were no observed differences between genders and between the evaluated ages in the MLD performance. There was no relation between the parents' schooling and the average monthly income with the performance of the children in MLD Test. The MLD mean was 7.65 dB and standard deviation of 2.51 dB. Conclusion The Masking Level Difference in schoolchildren from seven to ten years old is 7.65 dB and is independent of the gender, parents' schooling and the average monthly income of the schoolchild.

Enmascaramiento clínico: una revisión de la literatura / Clinical masking: a literature review

Son diversos los métodos planteados para aplicar enmascaramiento, de esta forma es necesario revisar la literatura en búsqueda de consenso. Se revisaron críticamente los métodos utilizados y recomendados por la literatura y sociedades internacionales, en torno a la aplicación de enmascaramiento. Se consultó entre agosto y noviembre de 2015 en PUBMED, SciELO y Google Scholar por estudios acerca de métodos de enmascaramiento utilizados en audiometría. También se revisaron las guías de organizaciones internacionales y lo publicado en libros relacionados con el área de audiología. El método de "La Meseta" es el más referenciado, siendo modificado posteriormente. Existen variaciones en criterios de atenuación interaural, necesidad de enmascaramiento, enmascaramiento inicial, incrementos para obtener la meseta y niveles del efecto de oclusión. Se concluye que la literatura muestra diferencias al momento de decidir cuándo enmascarar y cómo hacerlo. No obstante, se puede establecer criterios comunes en relación a los niveles de atenuación interaural, cuándo enmascarar, valores de efecto de oclusión y metodología. El método de "La Meseta" sigue siendo el más recomendado. La modificación realizada por Yacullo es la más referenciada y recomendada en la literatura actual.

Adequate use of masking is key in the correct diagnosis of hearing loss. Various methods are suggested regarding the application of clinical masking, hence the need to review literature in order to reach a consensus. To critically review the specialized literature and international societies' recommendations regarding clinical masking. From August to November 2015, PUBMED, SciELO and Google Scholar articles on clinical masking methods used in tonal audiometries were consulted, as well as international organization guidelines, and literature in the area of Audiology. Hood's plateau method, later revised, received the most references. The modified versions consider the number of increments needed to determine the true threshold, and the occlusion effect. Optimized methods show the variations regarding interaural attenuation, need for masking, initial masking level, increments to reach "The Plateau", and the occlusion effect. Literature shows differences regarding when and how to use masking; however, common criteria can be established with reference to the levels of interaural attenuation, when to use masking, occlusion effect values and methodology. The plateau method proposed by Hood is still the most recommended. Yacullo's optimization is currently the one with the most references and recommendations in specialized literature.

A new paradigm for temporal masking assessment: pilot study / Um novo paradigma para a avaliação do mascaramento temporal auditivo: estudo piloto

PURPOSE: To determine the feasibility and applicability of a clinical backward masking test, focusing on the analysis of inter-stimuli interval, and not on the intensity thresholds as it has been traditionally done, thus proposing a new paradigm for temporal masking assessment. METHOD: The test consisted of the presentation of a target tone of 1.000 Hz followed by a broadband masking noise (950-1.050 Hz), with inter-stimuli interval of 0, 10, 20, 50 and 100 ms. The stimuli were presented monaurally to both ears, with intensity ratio between masker and target tone varying between -10, -20, -30 and -40 dB. Twenty undergraduate students, without hearing or auditory processing complaints, participated in this study. RESULTS: Regardless of the signal-to-noise ratio, we observed decrease of average performance according to the decrease of the interval between stimuli. We also observed the indication that little or no masking occurs at the 100 ms interval, suggesting this interval is unsuitable for temporal masking assessment. The average interval threshold was below 27 ms for all investigated intensities, and increased 9 ms with every increase of 10 dB at signal-to-noise ratio. The signal-to-noise ratios of -20 and -30 were the best ratios for the test application. CONCLUSION: The paradigm proposed in this pilot study proved to be feasible, easy to apply, and trustworthy, being compatible with other researches which are the foundation for the study of temporal masking. This theme deserves further studies, continuing the analysis initiated here. .

OBJETIVO: Determinar a viabilidade e aplicabilidade de um teste clínico do mascaramento temporal sucessor, com foco de análise nos intervalos interestímulos e não nos limiares de intensidade, como tradicionalmente realizado, propondo, assim, um novo paradigma para a avaliação do mascaramento temporal. MÉTODO: O teste contou com a apresentação de um tom alvo de 1.000 Hz seguido de um ruído mascarador de banda estreita (950-1.050 Hz), com intervalos entre os estímulos de 0, 10, 20, 50 e 100 ms. Os itens foram apresentados de forma monoaural em ambas as orelhas, com relação de intensidade entre o mascarador e o tom alvo variando entre -10, -20, -30 e -40 dB. Vinte universitários, sem queixas de audição ou de processamento auditivo, participaram deste estudo. RESULTADOS: Foi observada diminuição no desempenho médio de acordo com a diminuição do intervalo, independentemente da relação sinal-ruído. Observou-se também o indício de que pouco ou nenhum mascaramento ocorre para o intervalo de 100 ms, tornando-o inadequado para a avaliação do mascaramento temporal. O limiar de intervalo médio manteve-se abaixo de 27 ms para todas as intensidades avaliadas, e aumentou 9 ms a cada 10 dB de aumento na relação sinal-ruído. As melhores relações sinal-ruído para avaliação são -20 e -30 dB. CONCLUSÃO: O paradigma proposto neste estudo piloto provou-se factível, de fácil aplicação e confiável, mostrando-se compatível com resultados de pesquisas que fundamentam o estudo do mascaramento temporal. O tema merece outros estudos para aprofundar as análises aqui iniciadas. .

Mascaramento clínico: aplicabilidade dos métodos platô e otimizado na pesquisa dos limiares auditivos / Clinical masking: applicability of plateau and optimized methods in hearing thresholds testing

BACKGROUND: many situations may raise difficulties when obtaining hearing thresholds for each ear separately. These situations demand the use of masking. The plateau method has been used for more than four decades. Nevertheless, in 2004 a different masking protocol was suggested, called the optimized method, to replace the plateau method in specific cases. AIM: to evaluate the feasibility of two clinical masking methods, plateau and optimized, in the testing of hearing thresholds. METHOD: participants of this study were 40 individuals aged 15 to 65 years, with either unilateral or bilateral hearing losses. All participants underwent air and bone conduction pure tone audiometry for both ears, with and without the use of the two masking methods, considering unilateral, bilateral, symmetrical and bone-only patterns. RESULTS: there was no statistically significant difference between the two masking methods for obtaining the air conduction hearing thresholds considering the tested situations. However, there was a higher percentage difference for the symmetrical pattern in the air conduction retest situation. There was a statistically significant difference between the plateau and optimized methods regarding the bone conduction thresholds for the symmetrical and bone-only patterns. CONCLUSION: the plateau method can be used for all patterns and the optimized method is the most effective for unilateral and bilateral patterns. Therefore, it is important for the audiologist to have the knowledge about the application of both masking methods in order to obtain more reliable results.

TEMA: na audiometria tonal liminar (ATL) algumas situações dificultam a obtenção dos limiares auditivos para cada orelha separadamente, havendo a necessidade do mascaramento. O método Platô, é o mais utilizado há mais de quatro décadas. Em 2004, foi sugerido um protocolo de mascaramento em que o método Otimizado substituiria o Platô, em casos específicos. OBJETIVO: analisar a aplicabilidade dos métodos Platô e Otimizado, na pesquisa dos limiares auditivos. MÉTODO: participaram deste estudo 40 indivíduos, de 15 a 65 anos, com perda auditiva unilateral ou bilateral. Foi realizada a ATL por via aérea (VA) e via óssea (VO), para ambas as orelhas, sem e com a utilização do mascaramento, segundo os padrões unilateral, bilateral, simétrico e somente-ósseo. RESULTADOS: não houve diferença estatisticamente significante entre os dois métodos para a obtenção dos limiares por VA, para os padrões avaliados. Contudo, houve um maior percentual de diferença para o padrão simétrico, durante reteste de VA. Houve diferença estatisticamente significante entre os métodos Platô e Otimizado, para a obtenção dos limiares por VO, para os padrões: simétrico e somente-ósseo. CONCLUSÃO: o Método Platô pode ser utilizado para todos os padrões e o Otimizado é mais eficaz para os padrões unilateral e bilateral. Desta forma, é necessário que o audiologista saiba diferenciar os melhores casos para a aplicação de um dos dois métodos e assim, obter resultados fidedignos.

Identificação de zonas mortas da cóclea por meio do teste TEN / Identifying dead regions in the cochlea through the TEN test

O audiograma ou o relato do paciente não é suficiente para determinar a presença ou não de zonas mortas na cóclea (ZMC), nem identificar sua extensão. OBJETIVO: Investigar, utilizando o teste TEN, ZMC de indivíduos com perda auditiva neurossensorial (PANS). CEDALVI/ HRAC-USP-Bauru, de agosto de 2003 a fevereiro de 2004. TIPO DE ESTUDO: Estudo de coorte contemporânea com corte transversal. Casuística e Métodos: O TEN foi aplicado nos grupos G1 (5 mulheres com limiares tonais aéreos dentro do padrão de normalidade); G2 (4 mulheres e 5 homens com PANS moderada plana); G3 (19 mulheres e 24 homens com PANS com o grau variando entre leve a profundo). RESULTADOS: Para G1, o valor de TEN para eliminar o tom de teste foi, em média, próximo ao limiar absoluto para todas as freqüências. Não foi observada ZMC em nenhuma das orelhas testadas do G2. Para as 76 orelhas do G3, 6 não apresentaram indício de ZM. CONCLUSÕES: O TEN é efetivo para indicar ZMC em indivíduos com PANS descendente. Há evidência de diferença na detecção do tom puro na presença de ruído entre indivíduos com PANS em altas freqüências e com PANS plana, pois se observou diferença significativa entre o limiar mascarado e absoluto apenas para PANS descendentes e não para as planas.

An audiogram is not sufficient to indicate cochlear dead regions. AIM: To investigate cochlear dead regions in sensorineural hearing loss subjects using the TEN test. Site: CEDALVI/ HRAC-USP-Bauru/Sao Paulo/Brazil, August 2003 to February 2004. STUDY DESING: A contemporary cross-sectional cohort study. Material and Methods: The TEN test was applied in three groups: G1(5 women with pure-tone thresholds within normal limits); G2(4 women and 5 men with moderate sensorineural flat hearing loss); G3(19 women and 24 men with mild to severe sloping sensorineural hearing loss). RESULTS: In the G1 group the TEN value required to eliminate the test tone was, on average, close to the absolute threshold for all frequencies. No dead regions were found in the ears tested in group G2. 76 ears were tested in group G3, and six showed no evidence of dead regions in the cochlea. CONCLUSIONS:The TEN test was an effective test to indicate a dead region in the cochlea of subjects with sloping sensorineural hearing loss. There is evidence that pure-tone detection is different for subjects with high frequency sensorineural hearing loss and flat hearing loss; we observed a significant difference between the masked threshold and the absolute threshold only in sloping hearing loss and not for flat hearing loss.

Control of attention by a peripheral visual cue depends on whether the target is difficult to discriminate

The influence of a peripheral cue represented by a gray ring on responsivity to a subsequent target varies. When a vertical line inside a ring was a go target and a white small ring inside a ring was a no-go target, reaction time was shorter at the same location relative to a different location. However, no reaction time difference between the two locations occurred when a white cross inside the ring, instead of the white vertical line inside the ring, was the go target. We investigated whether this last finding was due to a forward masking influence of the cue, a requirement of low attention for the discrimination or a lack of attention mobilization by the cue. In Experiment 1, the intensity of the cue was reduced in an attempt to reduce forward masking. In Experiment 2, the vertical line and the cross were presented in the same block of trials so as to be dealt with a common attentional strategy. In Experiments 3 and 4, the no-go target was a 45° rotated cross inside a ring to increase the difficulty of the discrimination. No evidence was obtained that the cross was forward masked by the cue nor that it demanded less attention to be discriminated from the small ring. There was a facilitation of responsivity by the cue when the small ring was replaced by the rotated cross. The results suggest that when the discrimination to be performed is too easy the cue does not mobilize attention.

The benefit method: fitting hearing aids in noise.

The most common complaint among individuals with hearing impairment is the inability to follow a conversation when several people are talking simultaneously, a noisy listening situation which is completely different from the quiet surrounding of the conventional pure tone audiometry used as basis for the hearing aid settings. The purpose of this report was to present important characteristics of the BeneFit Method (BFM), a procedure that fits the hearing aid under simulated conditions of competing speech and also a clinical pilot evaluation study comparing the BFM to the NAL-R recommendations and also to the Logic procedure, a GN resound proprietary fitting algorithm representing a modern digital hearing aid fitting procedure. Speech recognition scores in noise (SRSN) using monosyllabic words presented under different background noise levels were evaluated on 21 randomly selected subjects with hearing impairment. The subjects were fitted with the same type of hearing aid Danalogic 163D according to the BFM procedure as well as the logic procedure, the latter developed and recommended by the manufacturer. A comparison of the SRSN when using the subjects' current hearing aid fitted according to the NAL-R procedure was also made. Only the BFM procedure provided a significant SRSN improvement compared to the unaided condition (P< 0.01) in a signal/speech-noise level of 75/65 dB corresponding to a normal cocktail party condition. Moreover, patients performed significantly higher SRSN when fitted according to the BFM, than when fitted according the Logic or NAL-R procedures. The BFM procedure, which is based on individual and functional detection of hearing thresholds in noise levels corresponding to a cocktail party condition, can improve SRSN significantly. Hearing aids should be fitted under conditions similar to those when the hearing disability is perceived the most, i.e, in an environment with background noise.

Testes de fala: aplicação em portadores de perda auditiva induzida por ruído / Speech tests: application in individuals with noise induced hearing loss

Tema: inteligibilidade de fala. Objetivo: avaliar o reconhecimento de fala de portadores de Perda Auditiva Induzida por Ruído (PAIR). Método: participaram deste estudo 79 indivíduos adultos divididos em dois grupos: o grupo-controle, composto por 39 pessoas com limiares auditivos até 25dB, e o grupo-pesquisa com 40 portadores de traçado audiométrico e história ocupacional de PAIR. Em todos, foram aplicados os testes: Índice Percentual de Reconhecimento de Fala (IPRF), teste de tarefa dicótica Staggered Spondaic Word (SSW) e Teste de Fala com Ruído (nas relações sinal/ruído +5 e -5dB, com ruído branco ipsilateral). Resultados: o IPRF e o SSW são nada ou pouco úteis para discriminar portadores de PAIR de normo-ouvintes. Conclusão: o Teste de Fala com Ruído pode ser sensível na identificação de alterações auditivas em portadores de PAIR.

Colesteatoma de conduto auditivo externo / Cholesteatoma of external auditory canal

O colesteatoma de conduto auditivo externo (CCAE) é uma doença rara, mais comum em idosos. Os autores apresentam o caso de um jovem com otorréia unilateral à direita, estenose de conduto auditivo externo; à tomografia computadorizada, com hipótese diagnóstica de otomastoidite crônica. No ato cirúrgico verificou-se erosäo do conduto auditivo externo, com membra na timpânica intacta