Musicoterapia en niños con implante coclear / Music therapy program for children with cochlear implants

Introducción: Los usuarios de implante coclear (IC) pasan por procesos de rehabilitación, que incluyen el desarrollo de detección, discriminación, identificación y comprensión sonora. Sin embargo existen pocos programas de tratamiento, en esta área, creados por musicoterapeutas. Objetivo: Describir las características de un programa de tratamiento de musicoterapia, creado para niños entre 8-10 años con IC, para el desarrollo de la detección, discriminación, identificación y comprensión sonora musical. Material y método: Investigación cualitativa de tipo exploratorio, en la que se utilizó una herramienta de evaluación musicoterapéutica que se aplicó antes y después de la intervención. El proceso de tratamiento comprendió 10 sesiones individuales, para niños de 8-10 años usuarios de IC. El programa fue realizado en 4 participantes del Centro de Investigación e Información en Deficiencias Auditivas (CINDA) de Bogotá, Colombia. Resultados: Los participantes mostraron un avance importante en las áreas específicas contempladas: detección, discriminación, identificación y comprensión sonora-musical. Cualitativamente, se observó un entusiasmo particular por asistir a la sesión de musicoterapia, reportado por los padres y por el equipo interdisciplinario a cargo de los casos. Se desarrollaron habilidades musicales básicas y en general un despertar en el interés por la música. Conclusiones: El programa de musicoterapia y la herramienta de evaluación tuvieron un impacto positivo en la rehabilitación de niños con IC, se sugiere implementarlos a gran escala en estos pacientes.

Introduction: Cochlear implant (CI) users pass through rehabilitation processes that include developing detection, discrimination, identification and soundunderstanding. However, there are few treatment programs created by music therapists in this particular area. Aim: To describe the characteristics of a music therapy treatment program, designed for children with CI aged 8-10 years old. The program aimed to the development of detection, discrimination, identification and understanding of musical sounds. Material and method: This is a qualitative research, with an exploratory study in which a music therapy assessment tool was applied before and after the intervention. The treatment process consisted of 10 individual sessions for children with CI, aged 8-10 years. The program was conducted in 4 participants of the Research and Information Center for Hearing Deficiencies (CINDA) at Bogota, Colombia. Results: Participants showed valuable progress in the specific areas covered: detection, discrimination, identification and musical soundunderstanding. Qualitatively, it was observed a particular enthusiasm for attending music therapy sessions, this being reported by parents and by the interdisciplinary team responsible of the cases. Basic musical skills and a general awakening for music exploration was developed. Conclusions: The music therapy program and the assessment tool had a positive impact on the rehabilitation of children with CI, it is suggested to implement both of them in a large scale with these patients.

Sound production and pectoral spine locking in a Neotropical catfish (Iheringichthys labrosus, Pimelodidae)

Catfishes may have two sonic organs: pectoral spines for stridulation and swimbladder drumming muscles. The aim of this study was to characterize the sound production of the catfish Iheringichthys labrosus. The I. labrosus male and female emits two different types of sounds: stridulatory sounds (655.8 + 230 Hz) consisting of a train of pulses, and drumming sounds (220 + 46 Hz), which are composed of single-pulse harmonic signals. Stridulatory sounds are emitted during abduction of the pectoral spine. At the base of the spine there is a dorsal process that bears a series of ridges on its latero-ventral surface, and by pressing the ridges against the groove (with an unspecialized rough surface) during a fin sweep, the animal produce a series of short pulses. Drumming sound is produced by an extrinsic sonic muscle, originated on a flat tendon of the transverse process of the fourth vertebra and inserted on the rostral and ventral surface of the swimbladder. The sounds emitted by both mechanisms are emitted in distress situation. Distress was induced by manipulating fish in a laboratory tank while sounds were recorded. Our results indicate that the catfish initially emits a stridulatory sound, which is followed by a drumming sound. Simultaneous production of stridulatory and drumming sounds was also observed. The catfish drumming sounds were lower in dominant frequency than stridulatory sounds, and also exhibited a small degree of dominant frequency modulation. Another behaviour observed in this catfish was the pectoral spine locking. This reaction was always observed before the distress sound production. Like other authors outline, our results suggest that in the catfish I. labrosus stridulatory and drumming sounds may function primarily as a distress call.

Bagres podem apresentar dois órgãos sonoros: o espinho peitoral para o som peitoral ou estridulatório e o músculo sonoro da bexiga natatória. O objetivo deste trabalho foi caracterizar a produção de som no bagre Iheringichthys labrosus. Essa espécie emite dois sons diferentes, o som peitoral ou estridulatório (655,8 + 230 Hz) que consiste numa série de pulsos, e o som de tamboril (220 + 46 Hz) que é composto por sinais harmônicos de pulso simples. O som peitoral é emitido com o movimento do espinho da nadadeira peitoral. A base do espinho possui um processo dorsal que suporta uma série de cristas na sua superfície lateroventral, e ao pressionar as cristas contra o sulco (com uma superfície rugosa não especializada) durante o movimento de abertura da nadadeira, se produz uma série de pulsos curtos. O som de tamboril é produzido por um músculo sônico extrínseco, originado em um tendão plano preso ao processo transversal da quarta vértebra e inserido nas superfícies rostral e ventral da bexiga natatória. Os sons são emitidos por ambos os mecanismos em situação de estresse, a qual foi induzida através da manipulação dos peixes em um tanque no laboratório, enquanto os sons eram gravados. Nossos resultados indicam que o bagre emite primeiro o som peitoral e em seguida o som de tamboril. Também foi observada a produção simultânea dos sons estridulatório e de tamboril. O som de tamboril mostra uma frequência dominante mais baixa do que o som peitoral, e também apresenta um grau menor de modulação de frequência dominante. Isso pode estar relacionado com um som de cortejo, como verificado em outros peixes teleósteos. Outro comportamento observado nessa espécie de bagre é a capacidade de travar o espinho peitoral. Essa reação foi observada imediatamente antes da produção do som. Como descrevem outros autores, nossos resultados sugerem que em I. labrosus o som de estridulação e de tamboril funcionam como uma chamada de alarme.

Desempenho de adultos jovens normais em dois testes de resolução temporal / Performance of normal young adults in two temporal resolution tests

TEMA: o processamento auditivo temporal se refere a percepção de um evento sonoro ou de uma alteração no mesmo, dentro de um intervalo definido de tempo e é considerado uma habilidade fundamental na percepção auditiva de sons verbais e não verbais, na percepção de música, ritmo e pontuação e na discriminação de pitch, de duração e de fonemas. OBJETIVO: realizar um estudo comparativo do desempenho de adultos jovens normais nos testes de resolução temporal, Random Gap Detection Test (RGDT) e Gaps-in-Noise (GIN) e analisar diferenças entre esses dois métodos de avaliação. MÉTODO: 25 universitários, 11 homens e 14 mulheres, com audição normal e sem histórico de alterações educacionais, neurológicas e/ou linguagem, foram submetidos ao RGDT e ao GIN, a 40dB NS. RESULTADO: observou-se diferença estatisticamente significante entre os sexos sendo que as mulheres apresentaram pior desempenho nos dois testes. No estudo comparativo dos resultados do RGDT e GIN, observaram-se diferenças significativas no desempenho da amostra. De maneira geral, os limiares de detecção de gap no teste GIN foram melhores do que os limiares obtidos no RGDT. CONCLUSÃO: o sexo masculino teve melhor desempenho tanto no teste RGDT quanto no GIN, quando comparado ao feminino. Além disso, não houve diferença significante nas repostas do GIN nas orelhas direita e esquerda. Os sujeitos deste estudo tiveram melhor desempenho no teste GIN, quando comparado ao RGDT, tanto no sexo masculino quanto no feminino. Portanto, o teste GIN apresentou vantagens sobre o RGDT não apenas quanto à sua validade e sensibilidade, mas também com relação a sua aplicação e correção dos resultados.

BACKGROUND: temporal auditory processing is defined as the perception of sound or of sound alteration within a restricted time interval and is considered a fundamental ability for the auditory perception of verbal and non verbal sounds, for the perception of music, rhythm, periodicity and in the discrimination of pitch, duration and of phonemes. AIM: to compare the performance of normal Brazilian adults in two temporal resolution tests: the Gaps-in-Noise Test (GIN) and the Random Gap Detection Test (RGDT), and to analyze potential differences of performance in these two tests. METHOD: twenty-five college students with normal hearing (11 males and 14 females) and no history of educational, neurological and/or language problems, underwent the GIN and RGDT at 40dB SL. RESULTS: statistically significant gender effects for both tests were found, with female participants showing poorer performance on both temporal processing tests. In addition, a comparative analysis of the results obtained in the GIN and RGDT revealed significant differences in the threshold measures derived for these two tests. In general, significantly better gap detection thresholds were observed for both male and female participants on the GIN test when compared to the results obtained for the RGDT. CONCLUSION: male participants presented better performances on both RGDT and GIN, when compared to the females. There were no differences in performance between right and left ears on the GIN test. Participants of the present investigation, males and females, performed better on the GIN when compared to the RGDT. The GIN presented advantages over the RGDT, not only in terms of clinical validity and sensibility, but also in terms of application and scoring.

Implicações do efeito Lombard sobre a intensidade, freqüência fundamental e estabilidade da voz de indivíduos com doença de Parkinson / Lombard's effect's implication in intensity, fundamental frequency and stability on the voice of individuals with Parkinson's disease

A Doença de Parkinson afeta o sistema nervoso central resultando em alterações qualitativas da voz que pouco melhoram com o tratamento farmacológico e com a fonoterapia tradicional. Estudos mostram que o mascaramento auditivo leva ao aumento da intensidade da voz em indivíduos normais (Efeito Lombard). OBJETIVO: Avaliar implicações do efeito Lombard sobre a intensidade, freqüência fundamental e estabilidade da voz de indivíduos com doença de Parkinson (N=17). FORMA DE ESTUDO: Estudo clínico e experimental. Material e Métodos: Através de análise acústica, avaliamos as alterações de intensidade e freqüência fundamental, antes e depois da exposição a mascaramento auditivo "white noise", em 40, 70 e 90 dBNS, bem como as variações durante cada emissão e comparamos com um grupo controle (N=16). RESUTADOS: A intensidade de emissão vocal variou de acordo com a intensidade de mascaramento, tendendo a aumento não-linear, ocorrendo também nos grupos Parkinson e controle, não sendo influenciado pelo sexo. A freqüência fundamental da emissão vocal variou, tendendo a aumento não-linear, em ambos os grupos e sexos. Ocorreu melhora da estabilidade, tanto com relação à freqüência quanto à intensidade de emissão vocal. CONCLUSÃO: O Efeito Lombard elevou a intensidade e freqüência fundamental e melhorou a estabilidade da voz desses pacientes.

Parkinson's disease affects the central nervous system resulting in voice quality alterations. It is typically resistant to drug therapy and often persists despite extensive behavioural speech and language therapy. Previous findings show that masking noise will produce a consistent increase in voice intensity in most normal individuals (Lombard's effect). AIM: we evaluated Lombard's effect's implication in intensity, fundamental frequency and stability on the voice of individuals with Parkinson's disease (N=17). MATERIAL AND METHODS: through acoustic analysis, we evaluated intensity alterations and fundamental frequency, before and after white masking noise 40, 70 and 90 dBSL intensities, as well as variations during each vocalization and compared with a control group (N=16). RESULTS: voice intensity varied according to masking intensity, tending to non-linear increases in both groups and gender. Fundamental frequency varied, tending to non-linear increase in both groups and gender. Improvement stability occurred in fundamental frequency and vocal intensity. CONCLUSION: Lombard's effect increased intensity, fundamental frequency and improves voice stability on these patients. Study: clinical and experimental.

The development of the noise sensitivity questionnaire.

The existing questionnaires for determining the noise sensitivity of individuals provide information only about global noise sensitivity, although empirical data suggest that measuring noise sensitivity for different situations in daily life might be more logical. Therefore, the "Noise-Sensitivity-Questionnaire" (NoiSeQ) was developed to measure global noise sensitivity as well as the sensitivity of five domains of daily life, namely, leisure, work, habitation, communication, and sleep. The assessment of the measurement characteristics was based on the Generalizability (G) theory. The results of the G-study (N=66) proved that a single application of the questionnaire is sufficient for determining an individual's noise sensitivity. Furthermore, the ratings are age and gender independent. The subsequently conducted Decision (D)-study (N=288) provides information on the reliability of NoiSeQ. If the questionnaire is used for measuring global noise sensitivity, the reliability (relative and absolute G-coefficient) reaches a value above 0.90. According to ISO 10075-3, the questionnaire satisfies the precision level 1 "accurate measurement" in this case. The G-coefficients for all the subscales exceed the lower limit 0.70, with the exception of subscale leisure, which did not prove satisfactory. However, this subscale can reach a reliability of more than 0.70 if additional items are included. The validity of the instrument was proven for the subscales habitation (N=72) and work (N=72). In both the studies, the participants were asked to rate the annoyance in the presence of several rail and traffic noise scenarios. The subjects were characterized as low and high noise sensitive according to their sensitivity values obtained from NoiSeQ. In conclusion, a significant difference in annoyance rates was observed between the low and high noise sensitive groups for both the subscales habitation and work. This data support the validity of NoiSeQ.

The reliability of the noise sensitivity questionnaire in a cross-national analysis.

Noise sensitivity is regarded as a relevant predictor for annoyance reactions. Since many studies have focused on noise sensitivity at an international level, the present analysis was conducted to detect national peculiarities concerning noise sensitivity. Using the approach of the generalizability theory, reliability of the noise sensitivity questionnaire was analyzed taking into consideration relevant facets assumed to contribute to the measurement error. A total of 126 individuals from seven European countries participated in this study. The reliability coefficients for the global noise sensitivity score ranged from 0.90 to 0.91. It was determined that the translated questionnaires are comparable.

Nível de desconforto para sensação de intensidade em indivíduos com audição normal / Loudness discomfort level in normal hearing individuals

TEMA: o Loudness Discomfort Level (LDL), teste muito utilizado na adaptação de próteses auditivas, teve sua indicação ampliada e passou a ser recomendado para complementar a avaliação de pacientes com zumbido e/ou com suspeita de hiperacusia. OBJETIVO: determinar valores de referência do LDL para normo-ouvintes e sua correlação com o Limiar do Reflexo Acústico (LRA). MÉTODO: o LDL foi aplicado em 64 sujeitos normo-ouvintes de 18 a 25 anos (53,1 por cento do sexo feminino) nas freqüências de 0,5 a 8KHz e para sons da fala encadeada espontânea a viva-voz. Os tons puros pulsáteis foram apresentados por dois segundos, com intervalo de um segundo entre cada apresentação, a partir de 50dB de modo ascendente em passos de 5dB até que o sujeito referisse desconforto inicial com a sensação de intensidade. O procedimento foi realizado nas duas orelhas separadamente e repetido imediatamente (situações de teste e reteste), com alternância da orelha inicial a cada sujeito. O reflexo contralateral foi obtido em seguida. Foi considerado LRA a menor intensidade sonora capaz de provocar uma deflexão visível na agulha do imitanciômetro (maior que 0,05ml). RESULTADOS: a mediana do LDL variou de 86 a 98dBNA, sem diferenças estatisticamente significativas entre homens e mulheres (p > 0,11), entre orelhas (p > 0,36) ou entre as situações de teste e reteste (p > 0,34). Os coeficientes de determinação (r²) do modelo de regressão linear mostraram ausência de correlação entre log(LDL) e log(LRA). CONCLUSAO: normo-ouvintes apresentam LDL de 86 a 98dBNA para todos os estímulos apresentados. Diferenças inter-sujeitos e boa reprodutibilidade sugerem que a interpretação do teste deve ser cuidadosa e aliada à anamnese e que o teste pode ser útil no acompanhamento de pacientes. Não houve correlação entre LDL e LRA.

The influence of socio-economic status on adolescent attitude to social noise and hearing protection.

The focus of the present study, of 1285 adolescents, was young people's attitudes towards noise and their use of hearing protection at discos and pop concerts. Comparisons were made between adolescents from different age groups, and with different socio-economic status. Logistic regressions indicated that "worry before attending noisy activities" and "hearing symptoms" such as tinnitus and noise sensitivity could, to some degree, explain the use of hearing protection in noisy environments. Another conclusion to be drawn from this study was that adolescents' attitudes and behaviours regarding hearing protection use differed between levels of socio-economic status. Individuals with high SES expressed more negative attitudes and used ear protection to a greater extent than those with lower SES. This result might indicate differences in the development of future auditory problems among individuals with different levels of socio-economic status. The cause of hearing impairment and tinnitus may not be restricted merely to noise exposure. Psychological aspects, such as attitudes towards noisy environments and the individual's behaviour regarding the use of hearing protection may be considered as important factors in the understanding of why the prevalence of hearing related problems has increased among adolescents.

Self-reported tinnitus and noise sensitivity among adolescents in Sweden.

It seems to be a common opinion among researchers within the field of audiology that the prevalence of tinnitus will increase as a consequence of environmental factors, for example exposure to loud noise. Young people are exposed to loud sounds, more than any other age group, especially during leisure time activities, i.e. at pop concerts, discotheques and gyms. A crucial factor for the prevention of hearing impairments and hearing-related symptoms in the young population is the use of hearing protection. The focus of the present study is use of hearing protection and self-reported hearing-related symptoms, such as tinnitus and noise sensitivity in a young population of high-school students (N=1285), aged 13 to 19 years. The results show that the prevalence of permanent tinnitus and noise sensitivity, reported in the total group, was 8.7% and 17.1% respectively. Permanent tinnitus was not significantly related to level of socio-economic status, but age-related differences in the prevalence rates of experienced tinnitus and noise sensitivity were found to be significant. Older students reported such symptoms to a greater extent than younger students did. Those who reported tinnitus and other hearing-related symptoms protected their hearing to the highest extent and were the ones most worried.

Hearing at low and infrasonic frequencies.

The human perception of sound at frequencies below 200 Hz is reviewed. Knowledge about our perception of this frequency range is important, since much of the sound we are exposed to in our everyday environment contains significant energy in this range. Sound at 20-200 Hz is called low-frequency sound, while for sound below 20 Hz the term infrasound is used. The hearing becomes gradually less sensitive for decreasing frequency, but despite the general understanding that infrasound is inaudible, humans can perceive infrasound, if the level is sufficiently high. The ear is the primary organ for sensing infrasound, but at levels somewhat above the hearing threshold it is possible to feel vibrations in various parts of the body. The threshold of hearing is standardized for frequencies down to 20 Hz, but there is a reasonably good agreement between investigations below this frequency. It is not only the sensitivity but also the perceived character of a sound that changes with decreasing frequency. Pure tones become gradually less continuous, the tonal sensation ceases around 20 Hz, and below 10 Hz it is possible to perceive the single cycles of the sound. A sensation of pressure at the eardrums also occurs. The dynamic range of the auditory system decreases with decreasing frequency. This compression can be seen in the equal-loudness-level contours, and it implies that a slight increase in level can change the perceived loudness from barely audible to loud. Combined with the natural spread in thresholds, it may have the effect that a sound, which is inaudible to some people, may be loud to others. Some investigations give evidence of persons with an extraordinary sensitivity in the low and infrasonic frequency range, but further research is needed in order to confirm and explain this phenomenon.