Andréa Tortosa Marangoni

Influência do tipo de transdutor na deficiência auditiva de grau profundo

TEMA: individuos com deficiencia auditiva de grau profundo podem apresentar respostas por vibracao com os fones supra-aurais devido a grande area do crânio exposta a vibracao nestes transdutores. OBJETIVO: verificar a influencia do tipo de transdutor na obtencao dos limiares auditivos por via aerea em individuos com deficiencia auditiva neurossensorial de grau profundo. METODO: 50 individuos, com idades variando de 16 a 55 anos, foram submetidos a anamnese, meatoscopia, e posteriormente, a audiometria tonal liminar e limiar de deteccao de voz (LDV). As audiometrias tonal e vocal foram realizadas tanto com fones supra-aurais TDH-39 quanto com os fones de insercao ER-3A. RESULTADOS: nas audiometrias tonal e vocal, notamos que, com o fone de insercao, foram obtidos limiares auditivos mais elevados do que os obtidos com o fone supra-aural, com significância estatistica nas frequencias de 250Hz e 1000Hz. Ao observarmos a diferenca entre os resultados obtidos com o transdutor TDH-39 e o ER-3A em cada orelha separadamente, notamos que a diferenca foi maior na orelha direita com significância estatistica somente na frequencia de 250 Hz. Em relacao ao sexo, notamos que as diferencas entre os transdutores foram maiores no sexo masculino com significância estatistica na frequencia de 250 Hz. No entanto, no LDV, a diferenca maior foi encontrada no sexo feminino. CONCLUSAO: deficientes auditivos neurossensorias de grau profundo bilateral apresentam limiares de audibilidade mais elevados (piores) com os fones de insercao do que com os fones supra-aurais nas frequencias baixas, evidenciando a existencia das respostas por vibracao com os fones supra-aurais.

Fones de inserção: aplicação no colabamento de meato acústico externo

ABSTRACT Purpose: To determine the efficacy of insert earphones in cases of collapsed external auditory canals. Methods: Twenty-one elderly individuals with air-bone gaps greater than 10 dBHL at frequencies of 3 kHz and/or 4 kHz underwent anamnesis, pure tone audiome-try, speech audiometry, and immittance test. Pure tone audiometry and speech audiometry were performed with both supra-aural and insert earphones. Results: Air conduction thresholds were lower with insert earphones at all frequencies except 1 kHz. The magnitude of the air-bone gap was also lower with the insert earphones, and there was a air-bone coupling with this transducer. Conclusion: Insert earphones ER-3A allowed significant improvement in air conduction hearing thresholds in elderly individuals, reducing or even eliminating the air-bone gap in cases of collapsed external auditory canals, especially at higher frequencies. Keywords: Hearing; Audiometry; Auditory threshold; Ear canal; Aged REFERENCIAS 1. Bryde RL, Feldman AS. An approach to the management of the collapsing ear canal. Detroit: American Speech-Language-Hearing Association Convention; 1980. 2. Jerger J, Jerger S, Mauldin L. Studies in impedance audiometry. I. Normal and sensorineural ears. Arch Otolaryngol. 1972;96(6):513-23. 3. McCarthy PA. Rehabilitation of the hearing impaired geriatric client. In: Alpiner JG, McCarthy PA. Rehabilitative audiology: children and adults. Baltimore: The Williams & Wilkins; 1987. p.370-409. 4. Clemis JD, Ballad WJ, Killion MC. Clinical use of an insert earphone. Ann Otol Rhinol Laryngol. 1986;95(5 Pt 1):520-4. 5. Killion MC, Villchur E. Coments on “Earphones in Audiometry” [Zwislocki et al., J Acoust Soc Am. 1988;83:1688-9]. J Acoust Soc Am. 1989;85(4):1775-9. 6. Lilly DJ, Purdy JK. On the routine use of tubephone insert earphones. Am J Audiol. 1993;2:17-20. 7. Yantis EA. Pure tone air conduction threshold testing. In: Katz J. Handbook of clinical audiology. 4th ed. Baltimore: The Williams & Wilkins; 1994, p.97-108. 8. Ventry IM, Chaiklin JB, Boyle WF. Collapse of the ear canal during audiometry. Arch Otolaryngol. 1961:73(6):727-31. 9. Creston JE, Tice RE. Collapse of the ear canal during audiometry. Observation in siblings. Arch Otolaryngol. 1964:79:389-92. 10. Ross M, Tucker CA. A case study of collapse of the ear canal during audiometry. Laryngoscope. 1965:75:65-7. 11. Chaiklin JB, McClellan ME. Audiometry management of collapsible ear canals. Arch Otolaryngol. 1971:93(4):397-407. 12. Schow RL, Nerbonne MA. Hearing levels among elderly nursing home residents. J Speech Hear Disord. 1980;45(1):124-32. 13. Marshall L, Gossman MA. Management of ear-canal collapse. Arch Otolaryngol. 1982;108(6):357-61. 14. Gil D, Borges AC. Fones de insercao: um estudo em individuos audiologicamente normais. Rev Bras Otorrinolaringol. 2001;67(4 Pt 1):480-7. 15. Wilber LA, Kruger B, Killion MC. Reference thresholds for the ER-3A insert earphone. J Acoust Soc Am. 1988;83(2):669-76. 16. Clark JL, Roeser RJ. Three studies comparing performance of the ER-3A tubephone with the TDH-50P earphone. Ear Hear. 1988;9(5):268-74. 17. Schmuziger N, Probst R, Smurzynski J. Test-retest reliability of pure-tone thresholds from 0.5 to 16kHz using Sennheiser HDA 200 and Etymotic Research ER-2 earphones. Ear Hear. 2004;25(2):127-32. 18. Stuart A, Stenstrom R, Tompkins C, Vandenhoff S. Test-restest variability in audiometric threshold with supraaural and insert earphones among children and adults. Audiology. 1991;30(2):82-90.

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.

FONES DE INSERÇÃO E FONES SUPRA-AURAIS: AVALIAÇÃO AUDIOLÓGICA EM IDOSOS

Purpose: to investigate the influence of transducers type in pure-tone and speech audiometry of elderly in different decades of life. Methods: 39 individuals participated in this study of both sexes, aged between 60 and 89 years, selected from the Ambulatorio de Audiologia Clinica do Departamento de Fonoaudiologia - UNIFESP, were divided into three groups considering the decade of life (60-69 (G1), 70-79 (G2), 80-89 years old (G3 ). All individuals have undergone clinical history, pure-tone and speech audiometries which were performed with both supra-aural TDH-39 and ER-3A insert earphones. The results were statistically analyzed with the ANOVA and T-Student Pareado tests in order to compare the performance of the subjects with different transducers in groups and between age groups. Results: statistical analysis performed by ear and by group revealed lower hearing thresholds with ER-3A earphones with statistical significance in the frequencies of 4 and 6 kHz. Comparing age groups, poorer thresholds were obtained in the oldest subjects independent of the transducer. The older the subject, the poorer the thresholds independent of the transducer. Word recognition score showed better results with insert earphones and worsened with increasing age. Conclusion: insert earphones (ER-3A) provide better hearing thresholds compared to supra-aural headphones (TDH-39) at regardless of age. A progressive decrease in hearing and also in word recognition score result from increasing age.

Avaliação eletrofisiológica da audição em indivíduos após traumatismo cranioencefálico

OBJETIVO: caracterizar o potencial evocado auditivo de tronco encefalico e de longa latencia em pacientes pos traumatismo cranioencefalico, comparando-os com individuos normais. METODO: estudo clinico transversal realizado com 20 individuos audiologicamente normais divididos em dois grupos pareados por idade e sexo: a) 10 individuos que sofreram traumatismo cranioencefalico (grupo pesquisa); b) 10 individuos sem qualquer tipo de alteracao neurologica (grupo controle). Foram submetidos a avaliacao audiologica basica, ao potencial evocado auditivo de tronco encefalico e ao potencial evocado auditivo de longa latencia (P300). RESULTADOS: observou-se no potencial evocado auditivo de tronco encefalico, latencias absolutas das ondas I, III e V e intervalo interpico I-III mais prolongados no grupo pesquisa do que no grupo controle, sendo estatisticamente significante para as latencias absolutas das ondas I e III a direita e para a onda III e intervalo interpico I-III a esquerda. A amplitude das ondas I, III e V na orelha direita e das ondas III e V na orelha esquerda foram maiores no grupo controle. Em relacao ao P300, o grupo pesquisa apresentou maior latencia e menor amplitude em ambas as orelhas, sem significância estatistica, quando comparado ao grupo controle. CONCLUSAO: individuos que sofreram traumatismo cranioencefalico apresentam alteracoes no potencial evocado auditivo de tronco encefalico e nao apresentam diferencas significantes no potencial evocado auditivo de longa latencia (P300) quando comparados a individuos sem lesoes cerebrais.