The influence of sound generator associated with conventional amplification for tinnitus control: randomized blind clinical trial.

Hearing aids with an integrated sound generator have been used to enhance the treatment of tinnitus. The main aim of this study was to verify whether the combined use of amplification and sound generator is more effective than conventional amplification alone in reducing tinnitus annoyance by means of the use of a new hearing aid with an integrated sound generator. A total of 49 patients underwent a blind randomized clinical trial. Tinnitus annoyance was measured by Tinnitus Handicap Inventory and numerical scales, and psychoacoustic measures of tinnitus were also performed. The sound generator was set at the lowest intensity capable of providing relief from tinnitus. Results showed that 62.5% of the patients presented a reduction in tinnitus annoyance in the combined fitting group and in the group with amplification alone, 78% showed a reduction. This difference between the groups was not statistically significant.

Use of the satisfaction with amplification in daily life questionnaire to assess patient satisfaction following remote hearing aid adjustments (telefitting).

BACKGROUND: Hearing loss can affect approximately 15% of the pediatric population and up to 40% of the adult population. The gold standard of treatment for hearing loss is amplification of hearing thresholds by means of a hearing aid instrument. A hearing aid is an electronic device equipped with a topology of only three major components of aggregate cost. The gold standard of hearing aid fittings is face-to-face appointments in hearing aid centers, clinics, or hospitals. Telefitting encompasses the programming and adjustments of hearing aid settings remotely. Fitting hearing aids remotely is a relatively simple procedure, using minimal computer hardware and Internet access. OBJECTIVE: This project aimed to examine the feasibility and outcomes of remote hearing aid adjustments (telefitting) by assessing patient satisfaction via the Portuguese version of the Satisfaction With Amplification in Daily Life (SADL) questionnaire. METHODS: The Brazilian Portuguese version of the SADL was used in this experimental research design. Participants were randomly selected through the Rehabilitation Clinical (Espaco Reouvir) of the Otorhinolaryngology Department Medical School University of Sao Paulo. Of the 8 participants in the study, 5 were female and 3 were male, with a mean age of 71.5 years. The design consisted of two face-to-face sessions performed within 15 working days of each other. The remote assistance took place 15 days later. RESULTS: The average scores from this study are above the mean scores from the original SADL normative data. These indicate a high level of satisfaction in participants who were fitted remotely. CONCLUSIONS: The use of an evaluation questionnaire is a simple yet effective method to objectively assess the success of a remote fitting. Questionnaire outcomes can help hearing stakeholders improve the National Policy on Hearing Health Care in Brazil. The results of this project indicated that patient satisfaction levels of those fitted remotely were comparable to those fitted in the conventional manner, that is, face-to-face.

Performance analysis of ten brands of batteries for hearing aids

Comparison of the performance of hearing instrument batteries from various manufacturers can enable otologists, audiologists, or final consumers to select the best products, maximizing the use of these materials. AIM: To analyze the performance of ten brands of batteries for hearing aids available in the Brazilian marketplace. METHODS: Hearing aid batteries in four sizes were acquired from ten manufacturers and subjected to the same test conditions in an acoustic laboratory. RESULTS: The results obtained in the laboratory contrasted with the values reported by manufacturers highlighted significant discrepancies, besides the fact that certain brands in certain sizes perform better on some tests, but does not indicate which brand is the best in all sizes. CONCLUSIONS: It was possible to investigate the performance of ten brands of hearing aid batteries and describe the procedures to be followed for leakage, accidental intake, and disposal...

Performance analysis of ten brands of batteries for hearing aids.

INTRODUCTION: Comparison of the performance of hearing instrument batteries from various manufacturers can enable otologists, audiologists, or final consumers to select the best products, maximizing the use of these materials. AIM: To analyze the performance of ten brands of batteries for hearing aids available in the Brazilian marketplace. METHODS: Hearing aid batteries in four sizes were acquired from ten manufacturers and subjected to the same test conditions in an acoustic laboratory. RESULTS: The results obtained in the laboratory contrasted with the values reported by manufacturers highlighted significant discrepancies, besides the fact that certain brands in certain sizes perform better on some tests, but does not indicate which brand is the best in all sizes. CONCLUSIONS: It was possible to investigate the performance of ten brands of hearing aid batteries and describe the procedures to be followed for leakage, accidental intake, and disposal.

Remote hearing aid fitting: Tele-audiology in the context of Brazilian Public Policy

Introduction: Currently, the Brazilian government has certificated nearly 140 specialized centers in hearing aid fittings through the Brazilian National Health System (SUS). Remote fitting through the Internet can allow a broader and more efficient coverage with a higher likelihood of success for patients covered by the SUS, as they can receive fittings from their own homes instead of going to the few and distant specialized centers. Aim: To describe a case of remote fitting between 2 cities, with revision of the literature. Method: Computer gears, a universal interface, and hearing aids were used. Case study: An audiologist located in a specialized center introduced a new hearing aid and its fitting procedure to a remote center (200 km away). The specialized center helped the remote center in fitting a hearing aid in 2 patients, and performed fitting in one of its own patients. The whole process was done through the Internet with audio and video in real time. Results: Three patients were fitted remotely. Three audiologists were remotely trained on how to fit the hearing aids. Conclusions: Remote fitting of hearing aids is possible through the Internet, as well as further supplying technical training to a remote center about the fitting procedures. Such a technological approach can help the government advance public policies on hearing rehabilitation, as patients can be motivated about maintaining their use of hearing aids with the option to ask for help in the comfort of their own homes...

Remote hearing aid fitting: Tele-audiology in the context of Brazilian Public Policy.

INTRODUCTION: Currently, the Brazilian government has certificated nearly 140 specialized centers in hearing aid fittings through the Brazilian National Health System (SUS). Remote fitting through the Internet can allow a broader and more efficient coverage with a higher likelihood of success for patients covered by the SUS, as they can receive fittings from their own homes instead of going to the few and distant specialized centers. AIM: To describe a case of remote fitting between 2 cities, with revision of the literature. METHOD: Computer gears, a universal interface, and hearing aids were used. CASE STUDY: An audiologist located in a specialized center introduced a new hearing aid and its fitting procedure to a remote center (200 km away). The specialized center helped the remote center in fitting a hearing aid in 2 patients, and performed fitting in one of its own patients. The whole process was done through the Internet with audio and video in real time. RESULTS: Three patients were fitted remotely. Three audiologists were remotely trained on how to fit the hearing aids. CONCLUSIONS: Remote fitting of hearing aids is possible through the Internet, as well as further supplying technical training to a remote center about the fitting procedures. Such a technological approach can help the government advance public policies on hearing rehabilitation, as patients can be motivated about maintaining their use of hearing aids with the option to ask for help in the comfort of their own homes.

Reabilitação auditiva por meio da Telemedicina para a melhoria das políticas públicas no Brasil / Hearing rehabilitation through telemedicine to enhance public policies in Brazil

Since 2004, the Brazilian government has run one of the most all-inclusive hearing rehabilitation program based on hearing aids worldwide. In 2007 this investment in hearing aids topped U$ 68 million, apart from covering the cost of physicians and audiologists. Nearly 140 centers are certified by the government to dispense fitted hearing aids, figures which are still low when one considers the size of the country. Telemedicine can represent a of knowledge which broadens hearing rehabilitations services in Brazil, for it may help increase the number of hearing rehabilitation centers, enable remote training and provide for an "online second opinion". As far as public administration is concerned, it may enable process standardization and the very control over this hugely complex operation. The present article aimed to consider Telemedicine a powerful ally to improve hearing health care policies in Brazil.

O governo brasileiro possui um dos mais abrangentes programas de reabilitação auditiva com base em próteses auditivas acústicas de todo o mundo, que foi iniciado em 2004. Em 2007, foi realizado um investimento social de cerca de R$ 146 milhões somente nessas próteses, além dos investimentos nos atendimentos médico e fonoaudiológico. São cerca de 140 centros credenciados pelo Sistema Único de Saúde - número que pode ser considerado modesto considerando as extensões territoriais do país. A Telemedicina pode emergir como área do conhecimento que amplia os serviços de reabilitação auditiva no Brasil, por permitir, entre outros, que seja aumentado o número de centros credenciados, além de disponibilizar treinamentos à distância e obter a segunda opinião formativa online. No âmbito da administração pública, pode permitir a padronização dos processos e o controle de toda essa complexa operação. Este trabalho teve como objetivo inscrever a Telemedicina como poderoso aliado na melhoria das políticas públicas da saúde auditiva no Brasil.

Hearing rehabilitation through telemedicine to enhance public policies in Brazil.

Since 2004, the Brazilian government has run one of the most all-inclusive hearing rehabilitation program based on hearing aids worldwide. In 2007 this investment in hearing aids topped U$ 68 million, apart from covering the cost of physicians and audiologists. Nearly 140 centers are certified by the government to dispense fitted hearing aids, figures which are still low when one considers the size of the country. Telemedicine can represent a field of knowledge which broadens hearing rehabilitations services in Brazil, for it may help increase the number of hearing rehabilitation centers, enable remote training and provide for an "online second opinion". As far as public administration is concerned, it may enable process standardization and the very control over this hugely complex operation. The present article aimed to consider Telemedicine a powerful ally to improve hearing health care policies in Brazil.

Avaliação de desempenho do aparelho de amplificação sonora individual modelo retroauricular, digital e de especificações mínimas / Performance evaluation of the digital retroauricular model sonar amplifying device of minimal specifications

O tratamento das disacusias neurosensoriais baseia-se no uso de aparelho de amplificação sonora individual, conhecido como prótese auditiva acústica. Em 2004, o Governo Brasileiro implementou um programa nacional de saúde auditiva, distribuindo próteses auditivas gratuitamente do Sistema Único de Saúde (SUS). Tais produtos são importados, primariamente projetados para atender pacientes de varejo, os quais contam com recursos financeiros distintos dos pacientes que procuram receber as doações governamentais. Terminada a garantia de suas próteses, os pacientes que receberam as doações se vêem com dificuldades financeiras para mantê-las em funcionamento e, habitualmente, as abandonam. Contatou-se a cadeia de suprimentos dos fabricantes internacionais de próteses auditivas e, por meio de ensaios, obteve-se um modelo retroauricular digital, desenvolvido a partir de componentes padronizados, apresentando baixo custo de montagem. Várias unidades foram montadas e testadas em pacientes usuários de próteses auditivas doadas pelo Governo. Os pacientes registraram níveis de satisfação próximos dos observados nos produtos importados, mas com um menor consumo de bateria. Concluiu-se que é possível desenvolver próteses auditivas digitais no desenho retroauricular, montados a partir de componentes padronizados com vantagens no baixo custo de aquisição (vantagens para o Governo) e de manutenção (vantagens para o paciente).

Designing of a digital behind-the-ear hearing aid to meet the World Health Organization requirements.

Hearing loss is a common health issue that affects nearly 10% of the world population as indicated by many international studies. The hearing impaired typically experience more frustration, anxiety, irritability, depression, and disorientation than those with normal hearing levels. The standard rehabilitation tool for hearing impairment is an electronic hearing aid whose main components are transducers (microphone and receiver) and a digital signal processor. These electronic components are manufactured by supply chain rather than by hearing aid manufacturers. Manufacturers can use custom-designed components or generic off-the-shelf components. These electronic components are available as application-specific or off-the-shelf products, with the former designed for a specific manufacturer and the latter for a generic approach. The choice of custom or generic components will affect the product specifications, pricing, manufacturing, life cycle, and marketing strategies of the product. The World Health Organization is interested in making available to developing countries hearing aids that are inexpensive to purchase and maintain. The hearing aid presented in this article was developed with these specifications in mind together with additional contemporary features such as four channels with wide dynamic range compression, an adjustable compression rate for each channel, four comfort programs, an adaptive feedback manager, and full volume control. This digital hearing aid is fitted using a personal computer with minimal hardware requirements in intuitive three-step fitting software. A trimmer-adjusted version can be developed where human and material resources are scarce.

Development of a digital hearing aid to meet the Brazilian Government's Ordinance 587 (APAC).

UNLABELLED: The treatment of sensorineural hearing loss is based on hearing aids, also known as individual sound amplification devices. The hearing aids purchased by the Brazilian Government, aiming at fulfilling public policies, are based on dedicated components, which bring about benefits, but also render them expensive and may impair repair services after manufacture's warranty expires. AIM: to design digital behind-the-ear hearing aids built from standardized components coming from the very supply chain of these manufacturers. STUDY DESIGN: experimental. MATERIALS AND METHODS: to identify the supply chain of these manufacturers, request samples and set up hearing aids in the laboratory. RESULTS: The developed hearing aids did not show lesser electroacoustic characteristics when compared to those acquired by the Government, also being tested by the same reference international technical standard. CONCLUSION: It is possible to develop digital behind-the-ear hearing aids based on off-the-shelf components from hearing aid manufacturers' supply chain. Their advantages include low operational costs - for acquisition (with clear advantages for the Government) and service (advantage for the patient).

Desenvolvimento de prótese auditiva digital para atendimento da Portaria nº 587 (APAC) do Ministério da Saúde / Development of a digital hearing aid to meet the Brazilian Government's Ordinance 587 (APAC): Health Department

The treatment of sensorineural hearing loss is based on hearing aids, also known as individual sound amplification devices. The hearing aids purchased by the Brazilian Government, aiming at fulfilling public policies, are based on dedicated components, which bring about benefits, but also render them expensive and may impair repair services after manufacture's warranty expires. AIM: to design digital behind-the-ear hearing aids built from standardized components coming from the very supply chain of these manufacturers. STUDY DESIGN: experimental. MATERIALS AND METHODS: to identify the supply chain of these manufacturers, request samples and set up hearing aids in the laboratory. RESULTS: The developed hearing aids did not show lesser electroacoustic characteristics when compared to those acquired by the Government, also being tested by the same reference international technical standard. CONCLUSION: It is possible to develop digital behind-the-ear hearing aids based on off-the-shelf components from hearing aid manufacturers' supply chain. Their advantages include low operational costs - for acquisition (with clear advantages for the Government) and service (advantage for the patient).

O tratamento das disacusias sensório-neurais está balizado no uso de próteses auditivas, conhecidas como aparelhos auditivos ou aparelhos de amplificação sonora individuais. As próteses auditivas adquiridas pelo Governo Brasileiro para a condução de políticas públicas têm como uma de suas características a utilização de componentes dedicados, o que traz benefícios, mas que encarece a aquisição e pode inviabilizar os serviços de reparo após o término da garantia do fabricante. OBJETIVO: Desenvolver próteses auditivas digitais no desenho retroauricular, construídas a partir de componentes padronizados oriundos da própria cadeia de suprimentos dos fabricantes de próteses auditivas. FORMA DE ESTUDO: Experimental. MATERIAL E MÉTODO: Identificar a cadeia de suprimentos destes fabricantes, solicitar amostras e montar próteses auditivas em laboratório. RESULTADOS: As próteses auditivas desenvolvidas apresentaram recursos eletroacústicos não inferiores àquelas adquiridas pelo Governo, sendo adicionalmente atestadas pela mesma norma técnica internacional de referência. CONCLUSÃO: É possível desenvolver próteses auditivas digitais no desenho retroauricular montados a partir de componentes padronizados da cadeia de suprimentos dos fabricantes de próteses auditivas. Suas vantagens residem no baixo custo operacional - aquisição (com vantagens para o Governo) e de manutenção (com vantagens para o paciente).

Projeto e desenvolvimento do aparelho auditivo digital de baixo custo: Manaus / Project and development of the low-cost digital hearing aid: Manaus

Introdução: Todo portador de deficiência auditiva é um candidato ao uso de aparelho de amplificação sonora individual (AASI). Indústrias internacionais dominam o mercado mundial a oferecer produtos cujos valores agregados são incompatíveis com a realidade econômico-financeira das populações de países com economias em desenvolvimento. Objetivo: Projetar e desenvolver AASIs digitais e de baixo custo no desenho BTE, construídos sob um circuito eletrônico genérico e com recursos eletroacústicos não inferiores aos AASIs hoje comercializados no mercado brasileiro. Método: Desenvolver um vínculo de relacionamento com os principais fornecedores de partes e peças para a indústria de AASIs e projetar AASIs no desenho BTE. Os testes de desempenho acústico dos AASIs montados foram realizados em laboratório independente com a utilização de equipamentos de investigação acústica. Conclusão: É possível o desenvolvimento de AASIs digitais no desenho BTE com características de desempenho não inferiores aos comercializados por indústrias internacionais, mas a baixo custo operacional.

Introduction: Any hearing impaired person is an applicant of being a hearing aid wearer. International companies rule the market with a range of products those value added are inconsistent with the income of the population in developing countries. Objective: Design and development of digital low-cost hearing aid, BTE design, in a generic electronic configuration with electroacoustics features not lesser than those traded in the Brazilian marketplace. Method: Establish a strictly professional relationship with the predominant hearing aid suppliers in the hearing aid industry and develop BTE hearing aid. The electroacoustics outcomes of these hearing aids were performed at an independent acoustic investigation lab. Conclusion: It is possible the development of digital low-cost BTE hearing aid with performance features not lesser than those traded in the Brazilian marketplace but at low-cost operational costs.