The Effect of Simultaneous Contralateral White Noise Masking on Cortical Auditory Evoked Potentials Elicited by Speech Stimuli.

Introduction Noise obscures speech signal, causing auditory masking. The effects of this masking can be observed through the cortical auditory evoked potentials (CAEPs). White noise, in turn, has an effect on the auditory cortex, interfering, for example, with lexical decision making. Objective To analyze the effect of simultaneous masking by contralateral white noise on CAEPs elicited by speech stimuli. Methods Cross-sectional observational analytical study carried out with 15 participants of both sexes, who were submitted to CAEPs in two conditions: 1) without noise; 2) with white noise at 100 dBSPL intensity, contralaterally and simultaneously. To compare these conditions, the Student t test or the Wilcoxon test were used, depending on the sample normality. Differences with p values < 0.05 were considered significant. Results : When white noise was presented contralaterally and simultaneously to the CAEPs with speech stimulus, an increase in P1, N1 and P2 wave latencies was observed. P1 and P2 amplitudes and N1-P2 peak to peak amplitude also increased, unlike N1 amplitude, which decreased. The differences were significant for P1 and P2 wave latencies and for P2 wave amplitude. Conclusion The simultaneous masking effect was observed from the morphological alterations of the CAEPs with speech stimulus when white noise was presented in the contralateral ear. There was a significant increase in P1 and P2 wave latencies, as well as in P2 wave amplitude.

The Effect of Simultaneous Contralateral White Noise Masking on Cortical Auditory Evoked Potentials Elicited by Speech Stimuli

Abstract Introduction Noise obscures speech signal, causing auditory masking. The effects of this masking can be observed through the cortical auditory evoked potentials (CAEPs). White noise, in turn, has an effect on the auditory cortex, interfering, for example, with lexical decision making. Objective To analyze the effect of simultaneous masking by contralateral white noise on CAEPs elicited by speech stimuli. Methods Cross-sectional observational analytical study carried out with 15 participants of both sexes, who were submitted to CAEPs in two conditions: 1) without noise; 2) with white noise at 100 dBSPL intensity, contralaterally and simultaneously. To compare these conditions, the Student t test or the Wilcoxon test were used, depending on the sample normality. Differences with p values < 0.05 were considered significant. Results: When white noise was presented contralaterally and simultaneously to the CAEPs with speech stimulus, an increase in P1, N1 and P2 wave latencies was observed. P1 and P2 amplitudes and N1-P2 peak to peak amplitude also increased, unlike N1 amplitude, which decreased. The differences were significant for P1 and P2 wave latencies and for P2 wave amplitude. Conclusion The simultaneous masking effect was observed from the morphological alterations of the CAEPs with speech stimulus when white noise was presented in the contralateral ear. There was a significant increase in P1 and P2 wave latencies, as well as in P2 wave amplitude.

The Effect of Different Stimulation Rates on Brainstem Auditory-Evoked-Potential Responses

Abstract Introduction Auditory-evoked potentials are influenced by several factors, including polarity, filter, stimulus intensity and stimulation rate. The presentation of higher rates of stimuli per second enables the collection of a greater number of responses in a given period of time, promoting a shorter testing time; however, the collected recordings are subject to changes related to wave morphology. Objectives To compare the brainstem auditory-evoked-potential responses with click stimulus with the most commonly used stimulation rates in the clinical practice. Methods The present cross-sectional analytical study was performed with fifteen participants of both genders and normal hearing thresholds. The brainstem auditoryevoked potential was performed at four different stimulation rates (21.1, 26.7, and 27.7 stimuli/s, and a rate determined based on a mathematical calculation using the a measurement of the transmission frequency of the power grid at the time of the examination). Results We observed that the rate of 21.1 stimuli/s showed the highest amplitudes for waves I, III, and V when compared with the other rates. The rate of 26.7 stimuli/s, when compared with 27.7 stimuli/s, showed a higher amplitude for wave V. The latency if wave V was significantly lower with the rate of 21.1 stimuli/s than with 27.7 stimuli/s. Conclusions The stimulation rate interferes with wave latencies and amplitudes; its decrease from 27.7 to 21.1 stimuli/s decreases the latency of wave V and increases the amplitues and improves the morphology of waves I, III and V. In addition, we found evidence that suggests an improvement in the visualization of wave III by adjusting the stimulation rate based on a measurement of the local transmission frequency of the power grid.

The Effect of Different Stimulation Rates on Brainstem Auditory-Evoked-Potential Responses.

Introduction Auditory-evoked potentials are influenced by several factors, including polarity, filter, stimulus intensity and stimulation rate. The presentation of higher rates of stimuli per second enables the collection of a greater number of responses in a given period of time, promoting a shorter testing time; however, the collected recordings are subject to changes related to wave morphology. Objectives To compare the brainstem auditory-evoked-potential responses with click stimulus with the most commonly used stimulation rates in the clinical practice. Methods The present cross-sectional analytical study was performed with fifteen participants of both genders and normal hearing thresholds. The brainstem auditory-evoked potential was performed at four different stimulation rates (21.1, 26.7, and 27.7 stimuli/s, and a rate determined based on a mathematical calculation using the a measurement of the transmission frequency of the power grid at the time of the examination). Results We observed that the rate of 21.1 stimuli/s showed the highest amplitudes for waves I, III, and V when compared with the other rates. The rate of 26.7 stimuli/s, when compared with 27.7 stimuli/s, showed a higher amplitude for wave V. The latency if wave V was significantly lower with the rate of 21.1 stimuli/s than with 27.7 stimuli/s. Conclusions The stimulation rate interferes with wave latencies and amplitudes; its decrease from 27.7 to 21.1 stimuli/s decreases the latency of wave V and increases the amplitues and improves the morphology of waves I, III and V. In addition, we found evidence that suggests an improvement in the visualization of wave III by adjusting the stimulation rate based on a measurement of the local transmission frequency of the power grid.

Changes in cortical auditory evoked potentials in response to auditory training in elderly hearing aid users: A pilot study.

OBJECTIVE: To compare the cortical auditory evoked potential responses pre-and post-Auditory Musical Training associated with hearing aid adaptation in elderly people with presbycusis. DESIGN: This is a pilot, prospective, randomized, single-blind study. STUDY SAMPLE: Eight presbiacusis elderly people between 65 and 80 years, new hearing aid users, divided into two groups participated in the study: Hearing Aid Group: use of hearing aid; and Auditory Training Group: use of hearing aid in addition to musical auditory training for 16 sessions. All participants were submitted to cortical auditory evoked potential tests with verbal stimulation in two different moments: Initial assessment, carried out before hearing aid adaptation and auditory training, and after three months, final assessment at the end of the auditory training sessions. All participants were adapted bilaterally with digital mini hearing aids. RESULTS: There was a decrease in the P3a latency component for the Auditory Training Group when initial and final assessment were compared. CONCLUSION: There was a change in the cortical auditory evoked potential in elderly people with presbycusis in response to the Musical Auditory Training associated with the use of hearing aids in elderly people with presbycusis.

Aspectos cognitivos e auditivos: o efeito do envelhecimento no declínio do reconhecimento de fala / Cognitive and auditory aspects: the effect of aging on the decline of speech recognition / Aspectos cognitivos y auditivos: el efecto del envejecimiento sobre la disminución del reconocimiento de voz

Introdução: Dificuldades de desempenho comunicativo e de reconhecimento de fala em ambientes ruidosos são associadas ao envelhecimento. O declínio do reconhecimento da fala com ruído competitivo é devido a uma combinação de fatores auditivos e não-auditivos que acentuam ao longo do tempo e com o avanço da idade. Objetivo: Identificar os aspectos cognitivos e auditivos que contribuem para o declínio do reconhecimento de fala no ruído em idosos. Método: Trata-se de um estudo prospectivo, analítico, observacional e transversal. A amostra foi composta por dois grupos: um de adultos e outro de idosos, selecionados conforme os seguintes critérios de inclusão: ouvintes normais; idade entre 18 e 70 anos, de ambos os sexos. Os aspectos cognitivos foram analisados pelo Montreal Cognitive Assessment e, nos processos auditivos, foram aplicados testes de audiometria tonal limiar, psicofísicos de reconhecimento de fala em escuta difícil e de resolução temporal. Resultados: Quando comparados por grupo etário, os testes psicoacústicos apresentaram diferenças significativas nas condições: 1) SSI / OD - S/R 0 (p=0,001), 2) SSI / OD - S/R -15 (p=0,000), 3) HINT / OE S/R -10 (p=0,03), 5) HINT / OE S/R -15 (p= 0,02) quando aplicado o teste Mann Whitney U. Quando comparados por grupo etário, os testes GIN e TDD não apresentaram diferenças significativas. Já quando os testes psicoacústicos foram comparados independentes do grupo etário, os sujeitos com MoCA normal e alterados não apresentaram diferenças significativas (p=0,280). Conclusão: A partir da amostra estudada, observou-se que os aspectos cognitivos não contribuíram no desempenho da percepção de fala com estímulos competitivos quando comparados os grupos de adultos e idosos. Por outro lado, os aspectos auditivos avaliados mostraram que os idosos apresentam maiores dificuldades de compreensão da fala no ruído quando comparados aos indivíduos mais jovens.

Introduction: Difficulties in communicative performance and speech recognition in noise are associated with aging. The decline in speech recognition with competitive noise is due to a combination of auditory and non-auditory factors that worsens over time and with aging. Objective: To identify the cognitive and auditory aspects that contribute to the decline of speech recognition in noise in the elderly. Method: This is a prospective, analytical, observational and cross-sectional study. The sample consisted of two groups: one of adults and one of elderly, selected according to the following inclusion criteria: normal listeners; between 18 and 70 years old, of both sexes. The cognitive aspects were analyzed with the Montreal Cognitive Assessment and, in the auditory processes, pure-tone audiometry threshold tests, psychophysical speech recognition in difficult listening and temporal resolution were applied. Results: When compared by age group, psychoacoustic tests showed significant differences in conditions: 1) SSI / RE - SNR 0 (p = 0.001), 2) SSI / RE - SNR -15 (p = 0.000), 3) HINT / LE SNR -10 (p = 0.03), 5) HINT / LE SNR -15 (p = 0.02) when the Mann Whitney U test was applied. GIN and DDT tests did not show significant differences. When the psychoacoustic tests were compared regardless of the age group, the subjects with normal and changed MoCA did not present significant differences (p = 0.280). Conclusion: From the studied sample, cognitive aspects did not contribute to the performance of speech perception with competitive stimuli when comparing the adults and the elderly. On the other hand, the assessed auditory aspects showed that the elderly have greater difficulties in understanding speech in noise when compared to younger individuals.

Introducción: Las dificultades en el desempeño comunicativo y el reconocimiento del habla en entornos ruidosos están asociadas con el envejecimiento. La disminución del reconocimiento de voz con ruido competitivo se debe a una combinación de factores auditivos y no auditivos que se acentúan con el tiempo y con la edad. Objetivo: Identificar los aspectos cognitivos y auditivos que contribuyen al declive del reconocimiento del habla en ruido en las personas mayores. Método: Se trata de un estudio prospectivo, analítico, observacional y transversal. La muestra estuvo conformada por dos grupos: uno para adultos y otro para ancianos, seleccionados según los siguientes criterios de inclusión: oyentes normales; entre 18 y 70 años, de ambos los sexos. Los aspectos cognitivos fueron analizados por la Evaluación Cognitiva de Montreal y, en los procesos auditivos, se aplicaron pruebas de audiometría tonal umbral, reconocimiento psicofísico del habla en audiencias difíciles y resolución temporal. Resultados: Cuando se compararon por grupo de edad, las pruebas psicoacústicas mostraron diferencias significativas en las condiciones: 1) SSI / OD - S / R 0 (p = 0,001), 2) SSI / OD - S / R -15 (p = 0,000), 3 ) HINT/ OE S / R -10 (p = 0.03), 5) HINT / OE S / R -15 (p = 0.02) cuando se aplicó la prueba Mann Whitney U. Las pruebas GIN y TDD no mostraron diferencias significativas. Cuando se compararon las pruebas psicoacústicas independientemente del grupo de edad, los sujetos con MoCA normal y alterado no presentaron diferencias significativas (p = 0,280). Conclusión: De la muestra estudiada, se observó que los aspectos cognitivos no contribuyeron al desempeño de la percepción del habla con estímulos competitivos al comparar los grupos de adultos y ancianos. Por otro lado, los aspectos auditivos evaluados mostraron que los ancianos tienen mayores dificultades para comprender el habla en ruido en comparación con los más jóvenes.

Cognitive performance and long-latency auditory evoked potentials: a study on aging.

OBJECTIVE: To evaluate the relationship between cognitive performance and long-latency auditory evoked potentials in an elderly population. METHODS: The sample consisted of adults between 20 and 58 years of age and elderly adults between 60 and 70 years of age. The screening procedures adopted were an inspection of the external auditory canal, tonal and vocal audiometry, tympanometry, brain stem auditory evoked potential, the Montreal Cognitive Assessment test, and long-latency auditory evoked potential. RESULTS: The latency and amplitude values of cortical components by age group showed significant differences under the following conditions: (i) signals evoked by the speech stimulus /da/ and by the pure-tone stimulus at 2,000 Hz for the N2 amplitude (p=0.008 and p=0.001, respectively) , which were both higher for adults, and (ii) signals evoked by the speech stimulus /da/ for N1 latency (p=0.018) and by the pure-tone stimulus at 2,000 Hz for P2 latency (p=0.017), which were both higher in the elderly population. The cognitive component (P300) showed a significant difference when evoked by speech stimuli, with higher latency in the elderly population (p=0.013). When correlated with cognitive processes, the latency and amplitude of cortical potentials showed direct and medium-strength correlations between abnormal scores obtained on the Montreal Cognitive Assessment test and P2 amplitude (p<0.001 and r=0.452). CONCLUSION: There is a relationship between long-latency potentials and cognitive performance in the elderly, which was observed by the increase in the P2 amplitude and the impairment of the process of sound decoding.

Satisfação de usuários de aparelho de amplificação sonora individual após utilização de um site responsivo no processo de adaptação / Satisfaction of users of hearing aids after using a responsive website in the adaptation process

RESUMO Objetivo O aparelho de amplificação sonora individual propicia benefícios para indivíduos com deficiência auditiva. No entanto, ainda são observados baixos níveis de adesão ao tratamento, devido às dificuldades no processo de adaptação. Neste sentido, destaca-se o uso de sites ou aplicativos com os objetivos de auxiliar no processo de orientação aos usuários e de avaliar a satisfação de usuários de aparelho de amplificação sonora individual, após a utilização de um site responsivo desenvolvido para auxiliar no processo de adaptação. Métodos Estudo quantitativo analítico experimental, ensaio clínico não randomizado, com 20 participantes, divididos em dois grupos. O grupo estudo fez uso do site responsivo como ferramenta de auxílio na adaptação, além de receber as orientações em seu formato tradicional. O grupo controle foi orientado somente pelo formato tradicional já existente no serviço. Após um mês, os participantes responderam a um questionário de avaliação de satisfação e também foi realizada a análise da ferramenta datalogging. Resultados O site responsivo contou com orientações sobre manutenção e dicas de uso do aparelho de amplificação sonora individual, permitindo fácil acesso às principais orientações ao usuário inexperiente. A análise dos dados demonstrou respostas mais positivas ao questionário pelo grupo estudo, bem como maior tempo de uso diário dos aparelhos de amplificação sonora individuais. Conclusão o grupo que utilizou o site responsivo como ferramenta complementar ao processo de adaptação do aparelho de amplificação sonora individual mostrou, a partir da avaliação da satisfação e dos dados da ferramenta datalogging, maior satisfação e maior tempo de uso diário do aparelho.

ABSTRACT Purpose The hearing aid provides benefits for individuals with hearing impairment. However, low levels of treatment adherence are still observed due to difficulties in the adaptation process. In this sense, the use of websites or applications stands out in order to assist in the process of orienting users. To evaluate the satisfaction of users of hearing aids after using a responsive website designed to assist in the adaptation process. Methods Quantitative analytical experimental study non-randomized clinical trial whit 20 participants, divided into two groups. The study group made use of the responsive website as an aid tool in adapting, in addition to also receiving the guidelines in their traditional format. The control group was guided only with the traditional format already existing in the service. After one month, the participants answered a satisfaction assessment questionnaire, as well as an analysis of the datalogging. Results The responsive website had guidance on maintenance and tips on using the individual hearing aid, allowing easy access to the main guidelines for inexperienced users. The analysis of the data showed more positive responses to the questionnaire by the study group, as well as a longer time of daily use of hearing aids. Conclusion The group that used the responsive website as a complementary tool to the adaptation process of the hearing aid showed, from the assessment of satisfaction and data from the datalogging tool, greater satisfaction and a longer time of daily use of the hearing aid.

Cognitive performance and long-latency auditory evoked potentials: a study on aging

OBJECTIVE: To evaluate the relationship between cognitive performance and long-latency auditory evoked potentials in an elderly population. METHODS: The sample consisted of adults between 20 and 58 years of age and elderly adults between 60 and 70 years of age. The screening procedures adopted were an inspection of the external auditory canal, tonal and vocal audiometry, tympanometry, brain stem auditory evoked potential, the Montreal Cognitive Assessment test, and long-latency auditory evoked potential. RESULTS: The latency and amplitude values of cortical components by age group showed significant differences under the following conditions: (i) signals evoked by the speech stimulus /da/ and by the pure-tone stimulus at 2,000 Hz for the N2 amplitude (p=0.008 and p=0.001, respectively) , which were both higher for adults, and (ii) signals evoked by the speech stimulus /da/ for N1 latency (p=0.018) and by the pure-tone stimulus at 2,000 Hz for P2 latency (p=0.017), which were both higher in the elderly population. The cognitive component (P300) showed a significant difference when evoked by speech stimuli, with higher latency in the elderly population (p=0.013). When correlated with cognitive processes, the latency and amplitude of cortical potentials showed direct and medium-strength correlations between abnormal scores obtained on the Montreal Cognitive Assessment test and P2 amplitude (p<0.001 and r=0.452). CONCLUSION: There is a relationship between long-latency potentials and cognitive performance in the elderly, which was observed by the increase in the P2 amplitude and the impairment of the process of sound decoding.

Olfactory and taste disorders in COVID-19: a systematic review / Desordens olfativas e gustativas na COVID-19: uma revisão sistemática

Abstract Introduction: The SARS-CoV-2 virus causes COVID-19, and it is responsible for the largest pandemic since the 1918 H1N1 influenza outbreak. The classic symptoms of the disease have been well defined by the World Health Organization; however, olfactory/gustatory disorders have been reported in some studies, but there are still several missing points in the understanding and in the consensus about the clinical management of these cases. Objective: To identify evidence in the scientific literature about olfactory/gustatory disorders, their clinical presentation, prevalence and possible specific treatments associated with COVID-19. Methods: A systematic review of articles published up to April 25, 2020 was performed in Medline, Cochrane Clinical Trials, ScienceDirect, Lilacs, Scopus and Google Schoolar, OpenGrey.eu, DissOnline, The New York Academy of Medicine and Reasearch Gate. Inclusion criteria: (1) Studies on patients with COVID-19; (2) Records of COVID-19 signs/symptoms, and olfactory/gustatory functions. Exclusion criteria: (1) Studies on non-human coronavirus; (2) Review articles; (3) Experimental studies (in animals or in vitro); (4) Olfactory/gustatory disorders initiated prior to SARS-CoV-2 infection. The risk assessment of bias of the selected studies was performed using the Newcastle-Ottawa scale. Results: Six articles from the 1788 records met the inclusion criteria and were analyzed. A total of 1457 patients of different ethnicities were assessed; of them, 885 (60.7%) and 822 (56.4%) had smell and taste disorders, respectively, with women being most often affected. There were olfactory/gustatory disorders even without nasal obstruction/rhinorrhea and beginning even before the signs/symptoms of COVID-19; the recovery of smell/taste, when it occurs, usually happened in the first two weeks after COVID-19 resolution. There is evidence that olfactory/gustatory disorders are strong predictors of infection by SARS-CoV-2, and it is possible to recommend patient isolation, as early as of the medical consultation, preventing the spread of the virus. No scientific evidence has been identified for effective treatments for any of the disorders. Conclusion: Olfactory/gustatory disorders may occur at varying intensities and prior to the general symptoms of COVID-19 and should be considered as part of the clinical features of COVID-19, even in mild cases. There is still no scientific evidence of specific treatments for such disorders in COVID-19 disease.

Resumo Introdução: O vírus SARS-CoV-2 causa a COVID-19 e é responsável pela maior pandemia desde o surto de influenza H1N1 de 1918. Os sintomas clássicos da doença já foram bem definidos pela Organização Mundial da Saúde; entretanto, distúrbios olfativo-gustativos têm sido relatados em alguns estudos, mas ainda com várias lacunas no entendimento e no consenso sobre a condução clínica desses casos. Objetivo: Identificar evidências na literatura científica sobre os distúrbios olfativo-gustativos acerca da apresentação clínica, prevalência e possíveis tratamentos específicos associados à COVID-19. Método: Revisão sistemática de artigos publicados até 25 de abril de 2020 nas bases de dados: Medline, Cochrane Clinical Trials, ScienceDirect, Lilacs, Scopus e Google Schoolar, OpenGrey.eu, DissOnline, The New York Academy of Medicine e Research Gate. Foram critérios de inclusão: 1) Estudos com indivíduos com COVID-19; 2) Registro dos sinais/sintomas da COVID-19 e das funções olfativo-gustativa. Foram critérios de exclusão: 1) Estudos sobre coronavírus não humano; 2) Artigos de revisão; 3) Estudos experimentais (em animais ou in vitro); 4) Distúrbios olfativos-gustativos iniciados previamente à infecção pelo SARS-CoV-2. A avaliação de risco de viés dos estudos selecionados foi feita por meio da escala de Newcastle-Ottawa. Resultados: Seis artigos dos 1.788 registros foram selecionados. Um total de 1.457 pacientes de diversas etnias foi avaliado; desses, 885 (60,7%) apresentaram perda do olfato e 822 (56,4%) perda do paladar, sendo as mulheres as mais afetadas. Os distúrbios olfativo-gustativos estiveram presentes mesmo sem obstrução nasal/rinorreia e com início mesmo antes dos sinais/sintomas clínicos da COVID-19; a recuperação do olfato/paladar, quando ocorre, geralmente se dá nas duas primeiras semanas após a resolução da doença. Há evidências de que os distúrbios olfativo-gustativos sejam fortes preditores de infecção pelo SARS-CoV-2, podendo-se recomendar o isolamento do paciente, já a partir da consulta médica, para evitar a disseminação do vírus. Não foram identificadas evidências científicas para tratamentos eficazes para qualquer dos distúrbios. Conclusão: Podem ocorrer distúrbios olfativo-gustativos em intensidades variáveis e prévios aos sintomas gerais da COVID-19, devem ser considerados como parte dos sintomas da doença, mesmo em quadros leves. Não há ainda evidências científicas de tratamentos específicos para tais distúrbios na COVID-19.

Vestibular evoked myogenic potentials (VEMP) captured in the forearm flexor muscles: a study of its feasibility and reference ranges.

OBJECTIVE: To determine the central tendency measures and variability of vestibular evoked myogenic potential (VEMP) with regard to the latency and wave amplitude when potentials are captured from the flexor muscles of the forearm. METHODS: Ten adult volunteers with normal hearing underwent examination of their forearm flexor muscles (right and left sides; 20 samples in total) for VEMP acquisition. To this end, 200 tone burst stimuli at a 500 Hz frequency and 95 dBnHL intensity were promediated. RESULTS: No statistical differences were observed in VEMP responses acquired from the right and left forearm flexor muscles concerning P34 and N44 latencies (p=0.32 and 0.90, respectively). The mean latency obtained for the P34 wave component was 34.9 ms (±2.6), with a lower limit equal to 29.3 and an upper limit equal to 40.4 ms. The average latency of the N44 wave component was 43.6 ms (±2.1), with a lower limit of 39.1 ms and an upper limit of 48.1 ms. The results were consistent and had low variability, and showed an average asymmetry index of 15.4 (±10.7). These findings indicate that potentials may be investigated in different age groups and in specific clinical populations, such as pathologies that may alter the neuronal transmission of the inferior vestibular pathway, especially when a longer portion is observed. CONCLUSIONS: VEMP recording from forearm flexors is both feasible and stable, with latency reference ranges between 29.3 and 40.4 ms for P34, and 39.1 and 48.1 ms for N44.

Olfactory and taste disorders in COVID-19: a systematic review.

INTRODUCTION: The SARS-CoV-2 virus causes COVID-19, and it is responsible for the largest pandemic since the 1918 H1N1 influenza outbreak. The classic symptoms of the disease have been well defined by the World Health Organization; however, olfactory/gustatory disorders have been reported in some studies, but there are still several missing points in the understanding and in the consensus about the clinical management of these cases. OBJECTIVE: To identify evidence in the scientific literature about olfactory/gustatory disorders, their clinical presentation, prevalence and possible specific treatments associated with COVID-19. METHODS: A systematic review of articles published up to April 25, 2020 was performed in Medline, Cochrane Clinical Trials, ScienceDirect, Lilacs, Scopus and Google Schoolar, OpenGrey.eu, DissOnline, The New York Academy of Medicine and Reasearch Gate. INCLUSION CRITERIA: (1) Studies on patients with COVID-19; (2) Records of COVID-19 signs/symptoms, and olfactory/gustatory functions. EXCLUSION CRITERIA: (1) Studies on non-human coronavirus; (2) Review articles; (3) Experimental studies (in animals or in vitro); (4) Olfactory/gustatory disorders initiated prior to SARS-CoV-2 infection. The risk assessment of bias of the selected studies was performed using the Newcastle-Ottawa scale. RESULTS: Six articles from the 1788 records met the inclusion criteria and were analyzed. A total of 1457 patients of different ethnicities were assessed; of them, 885 (60.7%) and 822 (56.4%) had smell and taste disorders, respectively, with women being most often affected. There were olfactory/gustatory disorders even without nasal obstruction/rhinorrhea and beginning even before the signs/symptoms of COVID-19; the recovery of smell/taste, when it occurs, usually happened in the first two weeks after COVID-19 resolution. There is evidence that olfactory/gustatory disorders are strong predictors of infection by SARS-CoV-2, and it is possible to recommend patient isolation, as early as of the medical consultation, preventing the spread of the virus. No scientific evidence has been identified for effective treatments for any of the disorders. CONCLUSION: Olfactory/gustatory disorders may occur at varying intensities and prior to the general symptoms of COVID-19 and should be considered as part of the clinical features of COVID-19, even in mild cases. There is still no scientific evidence of specific treatments for such disorders in COVID-19 disease.

Vestibular evoked myogenic potentials (VEMP) captured in the forearm flexor muscles: a study of its feasibility and reference ranges

OBJECTIVE: To determine the central tendency measures and variability of vestibular evoked myogenic potential (VEMP) with regard to the latency and wave amplitude when potentials are captured from the flexor muscles of the forearm. METHODS: Ten adult volunteers with normal hearing underwent examination of their forearm flexor muscles (right and left sides; 20 samples in total) for VEMP acquisition. To this end, 200 tone burst stimuli at a 500 Hz frequency and 95 dBnHL intensity were promediated. RESULTS: No statistical differences were observed in VEMP responses acquired from the right and left forearm flexor muscles concerning P34 and N44 latencies (p=0.32 and 0.90, respectively). The mean latency obtained for the P34 wave component was 34.9 ms (±2.6), with a lower limit equal to 29.3 and an upper limit equal to 40.4 ms. The average latency of the N44 wave component was 43.6 ms (±2.1), with a lower limit of 39.1 ms and an upper limit of 48.1 ms. The results were consistent and had low variability, and showed an average asymmetry index of 15.4 (±10.7). These findings indicate that potentials may be investigated in different age groups and in specific clinical populations, such as pathologies that may alter the neuronal transmission of the inferior vestibular pathway, especially when a longer portion is observed. CONCLUSIONS: VEMP recording from forearm flexors is both feasible and stable, with latency reference ranges between 29.3 and 40.4 ms for P34, and 39.1 and 48.1 ms for N44.

Influence of speech-language therapy on P300 outcome in patients with language disorders: a meta-analysis / Influência da terapia fonoaudiológica no resultado do P300 em pacientes distúrbio de linguagem: uma metanálise

Abstract Introduction: The patient's evolution in the audiology and speech-language clinic acts as a motivator of the therapeutic process, contributing to patient adherence to the treatment and allowing the therapist to review and/or maintain their clinical therapeutic conducts. Electrophysiological measures, such as the P300 evoked potential, help in the evaluation, understanding and monitoring of human communication disorders, thus facilitating the prognosis definition in each case. Objective: To determine whether the audiology and speech-language therapy influences the variation of P300 latency and amplitude in patients with speech disorders undergoing speech therapy. Methods: This is a systematic review with meta-analysis, in which the following databases were searched: Pubmed, ScienceDirect, SCOPUS, Web of Science, SciELO and LILACS, in addition to the gray literature bases: OpenGrey.eu and DissOnline. The inclusion criteria were randomized or non-randomized clinical trials, without language or date restriction, which evaluated children with language disorders undergoing speech therapy, monitored by P300, compared to children without intervention. Results: The mean difference between the latencies in the group submitted to therapy and the control group was −20.12 ms with a 95% confidence interval of −43.98 to 3.74 ms (p = 0.08, I 2 = 25% and p value = 0.26). The mean difference between the amplitudes of the group submitted to therapy and the control group was 0.73 uV with a 95% confidence interval of −1.77 to 3.23 uV (p = 0.57, I 2 = 0% and p value = 0.47). Conclusion: The present meta-analysis demonstrates that speech therapy does not influence the latency and amplitude results of the P300 evoked potential in children undergoing speech therapy intervention.

Resumo Introdução: A evolução do paciente na clínica fonoaudiológica atua como fator motivador do processo terapêutico, contribui para a sua adesão ao tratamento e possibilita ao terapeuta a revisão e/ou a manutenção de suas condutas. As medidas eletrofisiológicas, como o potencial evocado P300, auxiliam na avaliação, na compreensão e no monitoramento dos distúrbios da comunicação humana, facilitam, dessa forma, a definição do prognóstico de cada caso. Objetivo: Determinar se a terapia fonoaudiológica influencia na variação da latência e da amplitude do P300 em pacientes com distúrbio de linguagem submetidos à terapia fonoaudiológica. Método: Revisão sistemática com metanálise, na qual foram feitas buscas nas seguintes bases de dados: Pubmed, ScienceDirect, Scopus, Web of Science, SciELO e Lilacs, além das bases de literatura cinzenta: OpenGrey.eu e DissOnline. Foram considerados critérios de inclusão: ensaios clínicos aleatórios ou não, sem restrição de idiomas ou data, que submeteram crianças com distúrbio de linguagem à terapia fonoaudiológica, monitoradas pelo P300, comparadas a crianças sem intervenção. Resultados: A diferença média entre as latências do grupo submetido à terapia e do grupo controle foi de -20,12 ms com intervalo de confiança 95% entre -43,98 e 3,74 ms (p = 0,08; I2 = 25% e o valor de p = 0,26). A diferença média entre as amplitudes do grupo submetido à terapia e do grupo controle foi de 0,73 uV com intervalo de confiança de 95% entre -1,77 e 3,23 uV (p = 0,57; I2 = 0% e o valor de p = 0,47). Conclusão: A terapia fonoaudiológica não influencia nos resultados de latência e amplitude do potencial evocado P300 em crianças submetidas à intervenção fonoaudiológica.

Influence of speech-language therapy on P300 outcome in patients with language disorders: a meta-analysis.

INTRODUCTION: The patient's evolution in the audiology and speech-language clinic acts as a motivator of the therapeutic process, contributing to patient adherence to the treatment and allowing the therapist to review and/or maintain their clinical therapeutic conducts. Electrophysiological measures, such as the P300 evoked potential, help in the evaluation, understanding and monitoring of human communication disorders, thus facilitating the prognosis definition in each case. OBJECTIVE: To determine whether the audiology and speech-language therapy influences the variation of P300 latency and amplitude in patients with speech disorders undergoing speech therapy. METHODS: This is a systematic review with meta-analysis, in which the following databases were searched: Pubmed, ScienceDirect, SCOPUS, Web of Science, SciELO and LILACS, in addition to the gray literature bases: OpenGrey.eu and DissOnline. The inclusion criteria were randomized or non-randomized clinical trials, without language or date restriction, which evaluated children with language disorders undergoing speech therapy, monitored by P300, compared to children without intervention. RESULTS: The mean difference between the latencies in the group submitted to therapy and the control group was -20.12ms with a 95% confidence interval of -43.98 to 3.74ms (p=0.08, I2=25% and p value=0.26). The mean difference between the amplitudes of the group submitted to therapy and the control group was 0.73uV with a 95% confidence interval of -1.77 to 3.23uV (p=0.57, I2=0% and p value=0.47). CONCLUSION: The present meta-analysis demonstrates that speech therapy does not influence the latency and amplitude results of the P300 evoked potential in children undergoing speech therapy intervention.

The Value of Electrically Evoked Stapedius Reflex in Determining the Maximum Comfort Level of a Cochlear Implant.

BACKGROUND: One of the most important steps for good user performance with a cochlear implant (CI) is activation and programming, aimed at determining the dynamic range. In adults, current levels are determined by psychophysical measures. In babies, small children, or individuals with multiple disorders, this procedure requires techniques that may provide inconsistent responses because of auditory inexperience or the age of the child, making it a very difficult process that demands the collaboration of both the patient and the family. PURPOSE: To study the relationship between the electrically evoked stapedius reflex threshold (ESRT) and maximum comfort level for stimulating electrodes (C-level) in postoperative CI users. RESEARCH DESIGN: Cross-sectional analytical observational case series study. STUDY SAMPLE: We assessed 24 patients of both sexes, aged between 18 and 68 yr, submitted to CI surgery. INTERVENTION: Otoscopy and immittance. Next, an implant speech processor connected to an Itautec® computer containing the manufacturer's software (custom sound Ep 3-2) was used, as well as an AT 235h probe inserted into the ear contralateral to the CI to capture the stapedius reflex, obtaining electrically evoked stapedius reflex thresholds. DATA COLLECTION AND ANALYSIS: Data from the last programming, defining C-levels for each electrode studied, were extracted from the databank of each patient. The manual decay function of the AT 235h middle ear analyzer was used to observe ESRT response in a same window for a longer response capture time. Electrodes 22, 16, 11, 6, and 1 were tested when active, with the aim of using electrodes over the entire length of the CI, and ESRT was considered present when compliance was ≥0.05 ml. Stimuli, in current units, were always initiated at 20 cu above the C-level. The analysis of variance parametric test, Tukey's honest significant difference test, the t-test, Wilcoxon nonparametric test, and the Kolmogorov-Smirnov test examined whether significant relationships existed between these other factors. RESULTS: The results demonstrate that all the electrodes selected for the study exhibited higher mean reflex threshold values than their mean C-level counterparts. However, there was no significant difference between them, for electrodes 1, 6, 11, and 16. The data provided allow the use of ESRT to define C-level values and make it possible to stipulate a correction factor ranging between 6 and 25.6 electrical units. CONCLUSION: The use of electrically evoked stapedius reflex thresholds can help the team in charge of programming CIs, making the process faster and safer, mainly for infants, small children, or individuals with multiple disorders.

Aging and wave-component latency delays in oVEMP and cVEMP: a systematic review with meta-analysis / Envelhecimento e os atrasos nas latências das componentes de onda no oVEMP e no cVEMP: uma revisão sistemática com metanálise

Abstract Introduction: The natural aging process may result in morphological changes in the vestibular system and in the afferent neural pathway, including loss of hair cells, decreased numbers of vestibular nerve cells, and loss of neurons in the vestibular nucleus. Thus, with advancing age, there should be a decrease in amplitudes and an increase in latencies of the vestibular evoked myogenic potentials, especially the prolongation of p13 latency. Moreover, many investigations have found no significant differences in latencies with advancing age. Objective: To determine if there are significant differences in the latencies of cervical and ocular evoked myogenic potentials between elderly and adult patients. Methods: This is a systematic review with meta-analysis of observational studies, comparing the differences of these parameters between elderly and young adults, without language or date restrictions, in the following databases: Pubmed, ScienceDirect, SCOPUS, Web of Science, SciELO and LILACS, in addition to the gray literature databases: OpenGrey.eu and DissOnline, as well as Research Gate. Results: The n1 oVEMP latencies had a mean delay in the elderly of 2.32 ms with 95% CI of 0.55-4.10 ms. The overall effect test showed p = 0.01, disclosing that such difference was significant. The heterogeneity found was I 2 = 96% (p < 0.001). Evaluation of p1 latency was not possible due to the low number of articles selected for this condition. cVEMP analysis was performed in 13 articles. For the p13 component, the mean latency delay in the elderly was 1.34 ms with 95% CI of 0.56-2.11 ms. The overall effect test showed a p < 0.001, with heterogeneity value I 2 = 92% (p < 0.001). For the n23 component, the mean latency delay for the elderly was 2.82 ms with 95% CI of 0.33-5.30 ms. The overall effect test showed p = 0.03. The heterogeneity found was I 2 = 99% (p < 0.001). Conclusion: The latency of oVEMP n1 wave component and latencies of cVEMP p13 and n23 wave components are longer in the elderly aged >60 years than in young adults.

Resumo Introdução: O processo natural de envelhecimento pode resultar em mudanças morfológicas no sistema vestibular e na via neural aferente, inclusive perda de células ciliadas, diminuição do número de células do nervo vestibular e perda de neurônios no núcleo vestibular. Dessa forma, com o avanço da idade, deveria ocorrer diminuição nas amplitudes e aumento nas latências dos potenciais evocados miogênicos vestibulares (VEMP), principalmente o prolongamento da latência p13. Além disso, muitos artigos não encontraram diferenças significativas nas latências do VEMP com o avanço da idade. Objetivo: Analisar se existem diferenças significativas para as latências do VEMP cervical (cVEMP) e do VEMP ocular (oVEMP) entre idosos e adultos. Método: Revisão sistemática com metanálise de estudos observacionais que comparam diferenças desses parâmetros entre idosos e adultos jovens, sem restrições de idiomas ou datas, nas seguintes bases de dados: Pubmed, ScienceDirect, Scopus, Web of Science, SciELO e Lilacs. Além das bases de literatura cinzenta OpenGrey.eu e DissOnline e ainda no Research Gate. Resultados: As latências n1 do oVEMP tiveram um atraso médio nos idosos de 2,32 ms com IC 95% 0,55-4,10 ms. O teste para o efeito geral obteve p = 0,01 e revelou que tal diferença foi significativa. A heterogeneidade encontrada foi I2 = 96% (p < 0,001). Avaliação da latência de p1 não foi possível devido ao baixo número de artigos selecionados para essa condição. A análise do cVEMP foi feita com 13 artigos. Para o componente p13, o atraso médio para as latências dos idosos foi de 1,34 ms com IC 95% 0,56-2,11 ms. O teste para o efeito geral obteve p < 0,001; com valor da heterogeneidade I2 = 92% (p < 0,001). Para o componente n23, o atraso médio para as latências dos idosos foi de 2,82 ms com IC 95% 0,33-5,30 ms. O teste para o efeito geral obteve p = 0,03. A heterogeneidade encontrada foi I2 = 99% (p < 0,001). Conclusão: A latência do componente de onda n1 do oVEMP e as latências dos componentes de onda p13 e n23 do cVEMP são mais prolongadas em idosos com idade > 60 anos do que em adultos jovens.