Adriana Neves de Andrade

A efetividade do treinamento auditivo formal em idosos usuários de próteses auditivas no período de aclimatização

OBJETIVO: Verificar a efetividade de um programa de treinamento auditivo formal em idosos usuarios de proteses auditivas intraaurais no periodo de aclimatizacao. METODOS: A amostra foi composta por 18 idosos (idade media: 71, 38 anos), de ambos os sexos, adaptados ha uma semana com proteses auditivas intra-aurais binaurais. Os participantes foram randomizados em dois grupos: Grupo Experimental (submetidos ao treinamento auditivo) e Grupo Controle (nao submetidos ao treinamento auditivo). O Grupo Experimental participou de sete sessoes de treinamento auditivo em cabina acustica, uma sessao por semana, com duracao de 50 minutos cada. Os procedimentos de avaliacao incluiram testes de reconhecimento de fala e questionario de auto-avaliacao do handicap auditivo. Estes foram aplicados em duas oportunidades, antes (1a avaliacao) e depois (2a avaliacao) do treinamento auditivo no Grupo Experimental e na avaliacao inicial e final do estudo no Grupo Controle. RESULTADOS: No Grupo Experimental, o Indice de Reconhecimento de Fala e Fala com Ruido Branco foram significantemente melhores apos o treinamento auditivo (2a avaliacao). Ja o estudo das relacoes sinal/ruido no teste de reconhecimento de sentencas no ruido revelou uma tendencia (p-valor proximo a 0,05) de melhora na avaliacao pos-treinamento. Observou-se nos idosos do Grupo Experimental que os resultados obtidos na 2a avaliacao nao foram significantemente melhores aos obtidos no Grupo Controle em todos os testes. CONCLUSAO: Pode-se concluir que um programa de reabilitacao aural, incluindo treinamento auditivo formal beneficia os idosos no periodo de adaptacao das proteses auditivas, bem como modifica o comportamento auditivo destes individuos.

Memory Networks in Tinnitus: A Functional Brain Image Study

Tinnitus is characterized by the perception of sound in the absence of an external auditory stimulus. The network connectivity of auditory and non-auditory brain structures associated with emotion, memory and attention are functionally altered in debilitating tinnitus. Current studies suggest that tinnitus results from neuroplastic changes in the frontal and limbic temporal regions. The objective of this study was to use Single-Photon Emission Computed Tomography (SPECT) to evaluate changes in the cerebral blood flow in tinnitus patients with normal hearing compared with healthy controls. Methods: Twenty tinnitus patients with normal hearing and 17 healthy controls, matched for sex, age and years of education, were subjected to Single Photon Emission Computed Tomography using the radiotracer ethylenedicysteine diethyl ester, labeled with Technetium 99 m (99 mTc-ECD SPECT). The severity of tinnitus was assessed using the “Tinnitus Handicap Inventory” (THI). The images were processed and analyzed using “Statistical Parametric Mapping” (SPM8). Results: A significant increase in cerebral perfusion in the left parahippocampal gyrus (pFWE <0.05) was observed in patients with tinnitus compared with healthy controls. The average total THI score was 50.8+18.24, classified as moderate tinnitus. Conclusion: It was possible to identify significant changes in the limbic system of the brain perfusion in tinnitus patients with normal hearing, suggesting that central mechanisms, not specific to the auditory pathway, are involved in the pathophysiology of symptoms, even in the absence of clinically diagnosed peripheral changes.

Avaliação comportamental do processamento auditivo em indivíduos gagos

BACKGROUND: the behavioral auditory processing (AP) evaluation allows the investigation of neuroaudiological processes involved in speech fluency processing. AIM: the purpose of this study was to describe the results obtained in the AP evaluation in stutterers, comparing the type of AP disorder with the severity of stuttering. METHOD: 56 subjects, 49 male and 7 female, ranging in age from 4 to 34 years, were referred from the speech-language clinic of UNIFESP to the AP evaluation. All patients were submitted to the following evaluations: audiological, speech and language. Disfluency was classified according to the protocol proposed by Riley (1994) which includes the following stuttering severity levels: very mild, mild, moderate, severe and very severe. Behavioral AP tests were selected and analyzed according to the patients age and to the proposal of Pereira & Schochat (1997). RESULTS: subjects with ages between 4 to 7 years and between 12 to 34 years presented mostly mild stuttering, subjects between 8 to 11 years presented mostly moderate stuttering. From the total of 56 individuals who were evaluated, 92.85% presented AP disorders. The most common auditory processing disorders were supra-segmental and decoding. No statistical differences were found considering the results of the AP evaluation and the severity of stuttering for none of the age groups. CONCLUSION: the AP evaluation indicated deficits for most of the participants of all age groups, however no correlations were observed with the severity of stuttering.

Processamento auditivo: comparação entre potenciais evocados auditivos de média latência e testes de padrões temporais

PURPOSE: to check the concordance between the Middle Latency Response and temporal processing tests. METHODS: 155 normal hearing subjects of both genders (age group range between 7 to 16 years) were evaluated with the Pitch and Duration Pattern Tests (behavioral) and Middle Latency Response (electrophysiologic) and divided into two groups: normal and abnormal, according to their test results. RESULTS: among all subjects, 30% showed abnormality in the tests, except for the Middle Latency Response that was under 17.4%. The pitch and duration patterns (right and left ears) agreed until 12 years of age. From 13 years, there was a greater number of alteration in the pitch patterns than in the duration patterns. The pitch and duration patterns (right and left ears) and MLR did not show concordance. For the 7 and 8-year-old group, the combination pitch and duration patterns normal/abnormal Middle Latency Response had greater occurrence than the combination pitch and duration patterns abnormal / normal Middle Latency Response. For the other groups the opposite occurred. There was not statistical difference among the age groups regarding normal and abnormal results for the pitch patterns (right and left ears) and Middle Latency Response, the duration patterns showed more abnormal results for the 9, 10 years old group. CONCLUSION: it was not possible to verify concordance between the Middle Latency Response and behavioral evaluation of Frequency and Duration Patterns Test.

A eficácia do treinamento auditivo formal em adultos com distúrbio do processamento auditivo (central)

OBJETIVO: comparar o desempenho de adultos com disturbio do processamento auditivo em testes comportamentais pre e pos-treinamento auditivo formal, visando verificar a eficacia desse treinamento. METODOS: trata-se de um estudo retrospectivo quantitativo com 18 individuos com disturbio do processamento auditivo comprovado pela avaliacao comportamental, idade entre 16 e 38 anos. Todos os individuos foram submetidos a um programa de treinamento auditivo formal realizado em oito sessoes de 45 minutos cada, duas vezes por semana, cujas sessoes foram organizadas em ordem crescente de complexidade visando o treinamento das habilidades auditivas de fechamento auditivo, figura-fundo para frases, palavras, silabas e sons nao verbais e de processamento temporal dos sons (analise da intensidade, duracao e frequencia dos sons). Foram comparados os resultados dos testes SSW em Portugues, SSI (MCI) e Reconhecimento de Padrao de Duracao e de Frequencia obtidos no pre e pos - treinamento auditivo, envolvendo as variaveis: orelha e sexo. RESULTADOS: nao foram observadas diferencas estatisticamente significantes entre as orelhas. Tanto homens quanto mulheres quando analisados separadamente demonstraram resultados melhores no pos-treinamento. Estas diferencas foram estatisticamente significantes nos testes de padrao de duracao e frequencia, para homens e mulheres. No SSW melhora no sexo masculino e no SSI R/S -15 no sexo feminino, respectivamente. Alem disso, todos os individuos relataram melhor desempenho comunicativo e de atencao no pos-treinamento. CONCLUSAO: o treinamento auditivo formal melhora as habilidades auditivas de figura - fundo para sons verbais e de processamento temporal medidas por testes comportamentais em adultos diagnosticados com disturbio de processamento auditivo.

Elaboração da versão em Português Brasileiro do teste de identificação de sentenças dicóticas (DSI)

PURPOSE: To develop the Brazilian Portuguese version of the dichotic sentence idenfication test (DSI). METHODS: The sentences used in the Portuguese version of DSI test were extracted from the Synthetic Sentece Identification (SSI) test in Portuguese. A method of combination was used in order to create 45 pairs of sentences, each pair corresponding to a test item. The items were divided into five groups, each group corresponding to a specific test condition. For this purpose, a computer program was designed in the Matlab 7.0 computing platform, using the Monte Carlo method, or the brute force method, for the distribution of items in each group. The sentences were edited, recorded and finalized; for manipulation of data it was used the CaKewalk Sonar 2.2 program. Finally, the Sound Forge program was used for finalization and standardization of the recording. RESULTS: As a result, a compact disc with six tracks was obtained to be used as part of the behavioral assessment of auditory processing, including the following tracks: calibration, practice, binaural integration, directed attention to the right and to the left ears. The use of the calibration and auditory training tracks is recommended for use in the rehabilitation of auditory processing disorders. CONCLUSION: The compact disc with the Brazilian Portuguese version of the DSI test consisted of six tracks: calibration, practice, binaural integration, directed attention to the right and to the left ears and auditory training.

Processamento auditivo em gagos: análise do desempenho das orelhas direita e esquerda

OBJETIVO: Comparar a diferenca entre as orelhas nos testes comportamentais do processamento auditivo e os resultados de sujeitos com diferentes graus de gravidade de gagueira em cada teste do processamento auditivo. METODOS: Cinquenta e seis individuos, com idades entre quatro e 34 anos, foram encaminhados pelo Ambulatorio de Avaliacao Fonoaudiologica da UNIFESP para avaliacao comportamental do processamento auditivo. Todos os pacientes foram submetidos a avaliacao de audicao, fala e linguagem. A disfluencia foi classificada segundo o protocolo de Riley (1994), o qual preve os seguintes graus de gravidade da gagueira: muito leve, leve, moderado, severo e muito severo. Os testes para avaliacao do processamento auditivo foram selecionados e analisados de acordo com a idade do paciente e a proposta de Pereira & Schochat (1997). RESULTADOS: Observamos prevalencia da gagueira de grau leve nas faixas etarias de quatro a sete anos e de 12 a 34 anos de idade, e de grau moderado nos individuos de oito a 11 anos de idade. Dos 56 individuos avaliados 92,85% apresentaram alteracao do processamento auditivo. Houve diferenca estatisticamente significante entre as orelhas direita e esquerda na etapa de atencao direcionada do teste dicotico nao verbal, em todas as faixas etarias estudadas. Nao foram encontradas diferencas significativas entre os graus de gravidade da gagueira em nenhum dos testes de processamento auditivo. CONCLUSOES: A orelha direita apresentou melhor desempenho do que a esquerda nos diferentes testes comportamentais. O grau de gravidade da gagueira nao interferiu no resultado de cada teste.

Avaliação comportamental do processamento auditivo em indivíduos pós - traumatismo cranioencefálico: estudo piloto

PURPOSE: to characterize the performance of individuals after traumatic brain injury in behavioral tests to evaluate auditory processing. METHOD: the participants of this research were 10 individuals with normal hearing with traumatic brain injury. They were submitted to: pure tone audiometry, speech audiometry, acoustic immittance measures (tympanometry and acoustic reflex) and behavioral evaluation of auditory processing (Sound Location Test, Verbal Sequential Memory, Non Verbal Sequential Memory, Duration Pattern Sequence Test, Dichotic Consonant-vowel, Staggered Spondaic Word (Portuguese version), Identification of synthetic sentences with competitive message, Random Gap Detection Test, Percentage Index of Speech Recognition with recording, speech test). RESULTS: the test of Duration Pattern indicated the test with the largest number of alteration (60%). The test with the most satisfactory average was the Percentage Index of Speech Recognition with recording (93%) and the less satisfactory average test was related to dichotic consonant-vowel (40,56%). The reversals (70%) represented the tendency of more frequent errors in the SSW. The damage of decoding was the most prevalent (100%), followed by the organization (90%), supra-segmental (60%) and encoding-gradual loss of memory (20%). There was no damage of encoding-integration. CONCLUSIONS: the patients after traumatic brain injury present auditory processing disorders of varying degrees, involving the processes of decoding and organization.

Temporal processing and long-latency auditory evoked potential in stutterers

INTRODUCTION Stuttering is a speech fluency disorder, and may be associated with neuroaudiological factors linked to central auditory processing, including changes in auditory processing skills and temporal resolution. OBJECTIVE To characterize the temporal processing and long-latency auditory evoked potential in stutterers and to compare them with non-stutterers. METHODS The study included 41 right-handed subjects, aged 18-46 years, divided into two groups: stutterers (n=20) and non-stutters (n=21), compared according to age, education, and sex. All subjects were submitted to the duration pattern tests, random gap detection test, and long-latency auditory evoked potential. RESULTS Individuals who stutter showed poorer performance on Duration Pattern and Random Gap Detection tests when compared with fluent individuals. In the long-latency auditory evoked potential, there was a difference in the latency of N2 and P3 components; stutterers had higher latency values. CONCLUSION Stutterers have poor performance in temporal processing and higher latency values for N2 and P3 components.

Effects of auditory training in individuals with high-frequency hearing loss

OBJECTIVE: To determine the effects of a formal auditory training program on the behavioral, electrophysiological and subjective aspects of auditory function in individuals with bilateral high-frequency hearing loss. METHOD: A prospective study of seven individuals aged 46 to 57 years with symmetric, moderate high-frequency hearing loss ranging from 3 to 8 kHz was conducted. Evaluations of auditory processing (sound location, verbal and non-verbal sequential memory tests, the speech-in-noise test, the staggered spondaic word test, synthetic sentence identification with competitive ipsilateral and contralateral competitive messages, random gap detection and the standard duration test), auditory brainstem response and long-latency potentials and the administration of the Abbreviated Profile of Hearing Aid Benefit questionnaire were performed in a sound booth before and immediately after formal auditory training. RESULTS: All of the participants demonstrated abnormal pre-training long-latency characteristics (abnormal latency or absence of the P3 component) and these abnormal characteristics were maintained in six of the seven individuals at the post-training evaluation. No significant differences were found between ears in the quantitative analysis of auditory brainstem responses or long-latency potentials. However, the subjects demonstrated improvements on all behavioral tests. For the questionnaire, the difference on the background noise subscale achieved statistical significance. CONCLUSION: Auditory training in adults with high-frequency hearing loss led to improvements in figure-background hearing skills for verbal sounds, temporal ordination and resolution, and communication in noisy environments. Electrophysiological changes were also observed because, after the training, some long latency components that were absent pre-training were observed during the re-evaluation.