Deborah Viviane Ferrari

Telehealth in audiology: The need and potential to reach underserved communities

Abstract Permanent hearing loss is a leading global health care burden, with 1 in 10 people affected to a mild or greater degree. A shortage of trained healthcare professionals and associated infrastructure and resource limitations mean that hearing health services are unavailable to the majority of the world population. Utilizing information and communication technology in hearing health care, or tele-audiology, combined with automation offer unique opportunities for improved clinical care, widespread access to services, and more cost-effective and sustainable hearing health care. Tele-audiology demonstrates significant potential in areas such as education and training of hearing health care professionals, paraprofessionals, parents, and adults with hearing disorders; screening for auditory disorders; diagnosis of hearing loss; and intervention services. Global connectivity is rapidly growing with increasingly widespread distribution into underserved communities where audiological services may be facilitated through telehealth models. Although many questions related to aspects such as quality control, licensure, jurisdictional responsibility, certification and reimbursement still need to be addressed; no alternative strategy can currently offer the same potential reach for impacting the global burden of hearing loss in the near and foreseeable future. Sumario La pérdida auditiva permanente es una importante carga para los cuidados de la salud a nivel mundial, con 1 de cada 10 personas afectadas en grado ligero o mayor. La escasez de profesionales entrenados en cuidados de la salud y de infraestructura asociada y la limitación de recursos determina que los servicios de salud auditiva no estén disponibles para la mayoría de la población mundial. La utilización de información y tecnología de la comunicación para los cuidados de la salud auditiva o teleaudiología, combinada con la automatización, ofrece oportunidades únicas para mejorar los cuidados clínicos, ampliar el acceso a los servicios y tener cuidados de salud auditiva costoefectivos y sustentables. La Teleaudiología ha demostrado un potencial significativo en áreas como las de educación y adiestramientio de profesionales de la salud auditiva, profesionales afines, padres y adultos con problemas auditivos; tamiz de problemas auditivos; diagnóstico de pérdidas auditivas y servicios de intervención. La conectividad global está creciendo rápidamente y ha aumentado de manera generalizada su distribución en comunidades con pocos servicios, en donde los servicios audiológicos pueden facilitarse a través de modelos de telesalud. No obstante, existen muchas dudas que deben resolverse y que están relacionadas con aspectos como control de calidad, regulación del ejercicio profesional, responsabilidad jurisdiccional, certificación y reembolso de servicios, pero no existe como alternativa ninguna otra estrategia que pueda ofrecer actualmente el mismo potencial, para impactar el peso global de las pérdidas auditivas en el futuro cercano o previsible.

Validity and reliability of the hearing handicap inventory for adults

UNLABELLED The Hearing Handicap Inventory for Adults (HHIA) translated into Brazilian Portuguese has been used for clinical practice and research purposes; however, information regarding its ease of reading and psychometric properties are still lacking. AIM To evaluate the ease of reading and psychometric properties of the Brazilian translation of this tool, including its validity and reliability. MATERIALS AND METHODS Prospective study. The questionnaire was applied to 30 normal hearing (Group A) and 113 hearing impaired (Group B) persons. Thirty two participants (group B) answered the questionnaire a second time. The Flesch readability index was calculated for each item in the questionnaire. The internal consistency, test-retest reliability and discriminant validity were evaluated. RESULTS Fleschs scores showed that the questionnaire was easy to read. Cronbachs alpha and Pearsons correlation showed high internal consistency. There was no significant difference between test and retest scores. Besides, correlation between these two scores was also high and significant. Student t test indicated significant difference between scores for groups A and B (discriminant validity). CONCLUSIONS The Hearing Handicap Inventory for Adults translated into Brazilian Portuguese maintained the reliability and validity of the English version. Further studies are needed to determine the convergent validity and construct validity for this instrument.

Hearing aid handling skills: relationship with satisfaction and benefit

ABSTRACT Purpose: To evaluate hearing aid handling skills for new and experienced users and to assess if such skills influence user’s benefit and satisfaction. Methods: Seventy four participants (mean age of 70.43), experienced (n=37) or new hearing aid users (n=37) performed the tasks of “Practical Hearing Aid Skills Test” (PHAST), which were scored on a five-point Likert scale — higher scores indicate better hearing aid handling skills. Experienced users answered the International Outcome Inventory for Hearing Aids (IOI-HA) and the hearing aid benefit for handicap reduction was calculated by the hearing handicap inventory (HHIA/HHIE). Results: Medians for PHAST total scores of 79 and 71% were obtained for experienced and new users, respectively — there were no significant difference between groups. Lower PHAST scores were observed for the tasks of volume control manipulation and telephone usage. Moderate correlations were obtained between IOI benefit and quality of life items and the PHAST scores. There was no correlation between the results of PHAST and demographic data of the participants.

Remote probe microphone measurement to verify hearing aid performance

We assessed the feasibility of obtaining probe microphone measurements of hearing aids at a distance. Face-to-face and remote probe microphone measurements were carried out in 60 hearing aid users (mean age 67 yrs) with uni- or bilateral hearing losses (105 ears tested). The participant and a facilitator were located in a room equipped with a probe microphone system interfaced to a PC. Desktop videoconferencing and application sharing was used to allow an audiologist in another room to instruct the facilitator and control the equipment via the LAN. There were significant correlations between face-to-face and remote real ear unaided response (REUR), aided response (REAR) and insertion gain (REIG) at seven discrete frequencies from 250 to 6000 Hz. Differences between face-to-face and remote responses were within the reported variability for probe microphone measurements themselves. The results show that remote probe microphone measurements are feasible and might improve the quality of public hearing aid services and professional training in Brazil.

Internet e educação ao paciente

INTRODUCTION: The process of education of a patient aims to improve knowledge and skill of the patient and/or family, in a way to influence attitudes and behaviors needed to maintain or improve health. Must be a integral part of interpersonal communication between health professionals and patients, and this can happen through interpersonal communication and various other means such as pamphlets, manuals and, more recently, computer resources. GOAL: This update article approach the patient education and the internet potential for this process, still presenting some initiatives in the audiology area. DISCUSSION: The informations, related to health are popular in the internet, and include interactive websites, portals, e-mails, telehealth aplications, and others. The education of the patients supported by the internet can help to solve a big ethical, political and economic issue: the problem to conciliate the needs and the expectations of the patients with the characteristics and limitations of the health system. Although the use of internet in the education of the patient is promising, this is not a solution to be used without careful planning, monitoring and evaluation. In audiology there are few initiatives with the use of e-mails and websites for complement of the patient education. FINAL CONSIDERATIONS: The health professionals, including the speech therapists, must check if their patients use internet resources, recognize that behavior change and prepare not only to discuss the information obtained with the patient, but also suggest websites with reliable information and help them to evaluate the quality of the information available online.

A telemetria de respostas neurais no sistema de implante coclear multicanal nucleus 24: revisão da literatura

Neural response telemetry (NRT) is a new technique available on the Nucleus 24 cochlear implant system (Cochlear Corporation) which allows recording electrically evoked compound action potential (ECAP) pre- or postoperatively by using only the equipment necessary for speech processor programming. The aim of this article is to describe the NRT procedure and some of its clinical and research applications. The literature shows that NRT has some advantages over other objective measures and that the ECAP responses may be useful for estimating thresholds and most comfortable levels in electrical hearing. Further research is necessary to verify how such measures may be used to study properties of the remaining structures of the auditory nerve.

Orientação ao usuário de prótese auditiva: retenção da informação

1) Especialista em Audiologia Clinica e Educacional - HRAC/USP. Fonoaudiologa. Politec Saude.2) Doutorado. Professor Doutor.3) Fonoaudiologa. Discente do Programa de Mestrado em Fonoaudiologia da Faculdade de Odontologia de Bauru - Universidade de Sao Paulo.Instituicao: Centro de Pesquisas Audiologicas. Hospital de Reabilitacao das Anomalias Craniofaciais - Universidade de Sao Paulo. Campus Bauru.Bauru / SP - Brasil.Endereco para correspondencia: Departamento de Fonoaudiologia. - Al. Octavio Pinheiro Brizolla 9-75 - Vila Universitaria - Baur u / SP - Brasil - CEP: 17012-901 - Telefone:(+55 14) 3235-8332 - E-mail: deborahferrari@usp.brArtigo recebido em 14 de Fevereiro de 2011. Artigo aprovado em 18 de Agosto de 2011.

Direcionalidade e redução de ruído em AASI: percepção de fala e benefício

UNLABELLED Hearing aid. AIM To compare the performance, benefit and satisfaction of users of ITE, CIC and BTE digital hearing aid with noise reduction and omnidirectional and directional microphones. METHOD 34 users of hearing aid were evaluated by means of speech perception in noise tests and APHAB and IOI self assessment questionnaires. Prospective study. RESULTS Better results were obtained by users of ITE, CIC and directional hearing aids, however, no statistical significance was found between the groups. CONCLUSION Directivity improved speech perception in noise and benefit in daily life situations.

Relação entre limiares audiométricos, handicap e tempo para procura de tratamento da deficiência auditiva

PURPOSE: To investigate the relationship between audiometric thresholds, self-perception of handicap, and time taken to seek treatment in patients treated at a public health care service. METHODS: This retrospective study analyzed the records of 152 elderly and 48 adult patients with hearing impairment. The mean ISO audiometric thresholds (500 Hz to 4 kHz) and the mean high frequencies thresholds (2 to 6 kHz), the speech recognition thresholds, and the total, social and emotional scores from the Hearing Handicap Inventory for the Adults (HHIA) and Elderly (HHIE) were compared with the time elapsed from the onset of hearing complaints and the treatment seeking. RESULTS: The mean time for seeking treatment was 7.6 years. No difference was found between adults and elderly for ISO and high frequency mean thresholds, HHIA/E scores, and time for treatment seeking. Weak but significant negative correlations were observed between auditory thresholds and time taken for treatment seeking. No relationship was found between the time taken for treatment seeking and the variables related to educational and socioeconomic levels and perception of handicap. CONCLUSION: Search for treatment seems to be influenced by auditory thresholds. Despite technological advances and changes in the access to information and treatment, the time taken for treatment seeking was similar to that reported 30 years ago.

Sistema de freqüência modulada no transtorno do processamento auditivo: prática baseada em evidências?

TEMA: uso do sistema de frequencia modulada (FM) no transtorno do processamento auditivo. OBJETIVO: verificar a existencia de evidencia cientifica que comprove a efetividade do sistema FM para tratamento do transtorno do processamento auditivo (TPA) por meio de revisao sistematica da literatura pertinente encontrada em bases de dados eletronicas (Medline, Lilacs e registro de ensaios clinicos da biblioteca Cochrane) e buscadores da internet, sendo os artigos recuperados analisados com base na declaracao CONSORT e classificados quanto ao nivel de evidencia. CONCLUSAO: a busca resultou em 1589 referencias, das quais somente 19 enquadraram-se nos criterios de inclusao. Todos os artigos analisados foram classificados com baixo nivel de evidencia (opinao de especialista ou estudo de casos). Nao foi encontrada forte evidencia cientifica que comprove a efetividade do uso do sistema FM na intervencao de individuos com TPA. Uma vez que este equipamento e frequentemente recomendado para a intervencao nos casos do TPA, se torna imprescindivel a realizacao de estudos com alta evidencia cientifica que possam guiar seguramente as tomadas de decisoes clinicas a este respeito.