Doris Ruthi Lewis

Comparing auditory brainstem responses (ABRs) to toneburst and narrow band CE-chirp in young infants.

OBJECTIVE The difference of characteristics (latency and amplitude) between toneburst and narrow CE-chirp stimuli on ABR recording was analyzed in normal hearing infants. METHODS 500, 1000, 2000 and 4000 Hz toneburst and narrow band CE-chirp auditory brainstem responses (ABRs) were recorded in 40 normal-hearing infants. The amplitude and latency parameters of the ABR were collected for each of the four stimulus levels: 80, 60, 40, and 20 dB nHL. Both stimuli started from 80 dB nHL using alternating polarity and the rates were both 27.1/s. RESULTS The toneburst latencies are greater than narrow band CE-chirp latencies for all intensities at 500, 1000 and 2000 Hz (p < 0.001). However, at 4000 Hz this difference was not significant. At 500 Hz, wave V amplitude is larger for toneburst than narrow CE-chirp (p < 0.001) in 80 dB nHL. The difference between the two stimuli in 60 dB nHL was not significant (p = 0.495) and at 40 and 20 dB nHL the wave V narrow band CE-chirp amplitude is greater than toneburst amplitude (p < 0.001). At 1000, 2000 and 4000 Hz there is no difference between the wave V toneburst and narrow band CE-chirp amplitudes at 80 dB nHL (p = 0.940; p = 0.776 and p = 0.217 respectively). On the other hand, in the levels to 60, 40 and 20 dB nHL, narrow band CE-chirp amplitudes are larger than toneburst amplitude (p < 0.001). CONCLUSION Narrow band CE-chirp ABRs generates shorter latencies than the toneburst ABRs, especially to low frequencies. Higher amplitudes were found with narrow band CE-chirp stimuli for all frequencies tested, except to high levels.

Achados timpanométricos em neonatos com emissões otoacústicas presentes: medidas e interpretações

Tympanometry is used in evaluating middle ear functional conditions. Before six months of age its results may be misleading. High frequency studies aim to provide more valid procedures. AIM: To describe and discuss tympanometric measurements and the interpretation in normal hearing neonates at 226, 678 and 1000Hz. METHOD: 110 neonates that were analyzed had normal otoacoustic emissions and no risk for hearing impairment. The age range was 6 to 30 days. Curves were obtained using the GSI-33-II, at the Divisao de Educacao e Reabilitacao dos Disturbios da Comunicacao, Sao Paulo, in 2004. STUDY DESIGN: Clinical prospective. RESULTS: There was a balance between single and double peak curves at 226Hz. Most of the curves were asymmetric at 678Hz, and single-peaked at 1000Hz. quantitative measurements showed a significant gender difference in the Equivalent Ear Canal Volume at 226Hz and on the Peak Compensated Static Acoustic Admittance at 1000Hz. The English protocol showed that almost 100% of ears were normal at 678 and 1000Hz. CONCLUSION: 1000Hz yielded superior results for characterizing normality. The English protocol was efficient to reduce the variability of tympanometric measurements. Data from this study may be used as a guide for diagnosis using tympanometry in neonates.

Emissões Otoacústicas Evocadas por Estímulo Transiente: protocolos de Triagem Auditiva Neonatal

Purpose: to describe the results of three TEOE protocols obtained from automatic equipment used in a Newborn Hearing Screening Program. Method: during two months, TEOEs of 287 neonates in Sao Paulo were studied. To register them, we used a three-protocol, set up with different pass/fail criteria. The following protocols were registered: Protocol A: to pass in four frequency bands, not necessarily consecutive-; Protocol B: to pass in three frequency bands, not necessarily consecutive – and Protocol C: to pass in two frequency bands, not necessarily consecutive, as well. The parameters that we used to consider these answers were: reproducibility above 50%, as well as signal/noise ratio > 3dB at 1.0 and 1.5 kHz and > 6dB at 2.0, 3.0 and 4.0 kHz. Results: TEOEs of 574 ears were analyzed and the 2.0, 3.0 and 4.0 frequencies showed the highest pass percentages (94.1, 95.8 and 92.7% for protocols A, B and C respectively). Protocol C showed the highest pass percentage, achieving 96,9%. Nevertheless, the results obtained in Protocol B, which had the presence of three bands, showed a similar percentage to Protocol C (96,2%). Therefore, there was a not statistically significant difference between Protocols B and C. 1.0 kHz frequency achieved a percentage of only 9.9 in the tested ears. Conclusions: one has to research Protocols A, B and C with gold standard in order to verify which one suits best in terms of sensibility and specificity, even though the three protocols studied showed similar results in pass criteria for two or three frequency bands.

Tympanometry in neonates with normal otoacoustic emissions: measurements and interpretation

UNLABELLED Tympanometry is used in evaluating middle ear functional conditions. Before six months of age its results may be misleading. High frequency studies aim to provide more valid procedures. AIM To describe and discuss tympanometric measurements and the interpretation in normal hearing neonates at 226, 678 and 1000Hz. METHOD 110 neonates that were analyzed had normal otoacoustic emissions and no risk for hearing impairment. The age range was 6 to 30 days. Curves were obtained using the GSI-33-II, at the Divisão de Educação e Reabilitação dos Distúrbios da Comunicação, São Paulo, in 2004. STUDY DESIGN Clinical prospective. RESULTS There was a balance between single and double peak curves at 226Hz. Most of the curves were asymmetric at 678Hz, and single-peaked at 1000Hz. quantitative measurements showed a significant gender difference in the Equivalent Ear Canal Volume at 226Hz and on the Peak Compensated Static Acoustic Admittance at 1000Hz. The English protocol showed that almost 100% of ears were normal at 678 and 1000Hz. CONCLUSION 1000Hz yielded superior results for characterizing normality. The English protocol was efficient to reduce the variability of tympanometric measurements. Data from this study may be used as a guide for diagnosis using tympanometry in neonates.

Comparação dos estímulos clique e CE-chirp® no registro do Potencial Evocado Auditivo de Tronco Encefálico

PURPOSE: To compare the latencies and amplitudes of wave V on the Brainstem Auditory Evoked Potential (BAEP) recording obtained with click and CE-chirp® stimuli and the presence or absence of waves I, III and V in high intensities. METHODS: Cross-sectional study with 12 adults with audiometric thresholds <15 dBHL (24 ears) and mean age of 27 years. The parameters used for the recording with both stimuli in intensities of 80, 60, 40, 20 dBnHL were alternate polarity and repetition rate of 27.1 Hz. RESULTS: The CE-chirp® latencies for wave V were longer than click latencies at low intensity levels (20 and 40 dBnHL). At high intensity levels (60 and 80 dBnHL), the opposite occurred. Larger wave V amplitudes were observed with CE-chirp® in all intensity levels, except at 80 dBnHL. CONCLUSION: The CE-chirp® showed shorter latencies than those observed with clicks at high intensity levels and larger amplitudes at all intensity levels, except at 80 dBnHL. The waves I and III tended to disappear with CE-chirp® stimulation.

Triagem auditiva neonatal com potencial evocado auditivo de tronco encefálico automático: a utilização de diferentes tecnologias

Objetivo : Analisar os resultados da Triagem Auditiva Neonatal com Potencial Evocado Auditivo de Tronco Encefalico Automatico, com diferentes tecnologias, estudando a sensibilidade, a especificidade e o tempo de exame. Metodos : Foram avaliados 200 neonatos, por meio do Potencial Evocado Auditivo de Tronco Encefalico Automatico utilizando metodo de deteccao no dominio da frequencia e taxa de repeticao do estimulo a 93 Hz. Todos os neonatos foram submetidos ao Potencial Evocado Auditivo de Tronco Encefalico como padrao ouro, para garantir os resultados encontrados. Durante a realizacao da triagem, os neonatos foram classificados de acordo com a Escala Neonatal de Avaliacao Comportamental, conhecida como Escala de Brazelton, como variavel para analise do tempo de exame. Resultados : Dois dos 200 neonatos triados falharam no Potencial Evocado Auditivo de Tronco Encefalico Automatico e no Potencial Evocado Auditivo de Tronco Encefalico Diagnostico e 198 passaram nos dois exames realizados. A sensibilidade encontrada foi de 100% e a especificidade, de 100%. O tempo medio de exame foi de 32,9 segundos. Os neonatos foram dividido em tres grupos, de acordo com o estado de consciencia, segundo a Escala de Brazelton. O Grupo 1 apresentou media de exame de 18,94 segundos, o Grupo 2, de 33,43 segundos e o Grupo 3, de 49,24 segundos. Conclusao : O Potencial Evocado Auditivo de Tronco Encefalico Automatico com diferentes tecnologias apresenta alta sensibilidade e especificidade, com tempo consideravelmente curto para a determinacao da presenca ou ausencia de resposta e o estado de consciencia do neonato influencia no tempo de deteccao da resposta auditiva.

Comparação do tempo de dois procedimentos com novas tecnologias de Potencial Evocado Auditivo de Tronco Encefálico Automático (PEATE-A)

PURPOSE: To compare the testing time of two Automated Auditory Brainstem Response (AABR) procedures using different repetition rates and detection modes. METHODS: A hearing screening using AABR was performed in 30 newborns with mean age of 21 days. Each newborn was submitted to two hearing screening procedures using different AABR equipments (Procedure 1 and Procedure 2). Procedure 1 used a repetition rate of 53 Hz and the one-sample test for response detection; Procedure 2 used a repetition rate of 90 Hz, and the q-sample test for response detection. The ABR with click stimulus was then registered as gold standard test, and the responses were analyzed by a trained audiologist. RESULTS: The mean time observed for Procedure 1 considering both ears was 84.8 (±53.5) seconds; for Procedure 2 the mean time was 27.9 (±20.0) seconds. The testing time of the first procedure was three times longer than the second one. Statistical analysis showed significant difference between the testing times of the procedures. CONCLUSION: The q-sample test and the repetition rate of 90 Hz used in the AABR equipment showed earlier response detection.

Potencial evocado auditivo de tronco encefálico automático com o estímulo CE-Chirp® em diferentes intensidades

Purpose: To study the results from the Automated Auditory Brainstem Response (AABR) using the CE-chirp ® stimulus at 30 and 35 dBHL. Methods: The AABR was conducted in 40 newborns with and without risk indicators for hearing loss using both clicks and CE-chirp ® stimuli at 30 and 35 dBHL. The diagnostic ABR was also performed, as goldstandard procedure. “Pass/refer” results were analyzed, and validation values and response detection times were determined. Results: The “pass” results were more frequent with the CE-chirp ® AABR, at both intensities tested. However, this difference was significant only for the left ear, at 30 dBHL. There was no significant difference between the two intensities for the “pass/fail” results obtained with CE-Chirp ® and click stimuli. The mean response detection time was lower for the CE-chirp ® stimulus at both intensities. This finding was significant at 35 dBHL for both ears, and at 30 dBHL for the right ear. Significant differences were found between intensities for the right ear. Conclusion: The CE-Chirp

Maturação auditiva central e desenvolvimento do balbucio em crianças usuárias de implante coclear

Crianca” da Divisao de Educacao e Reabilitacao dos Dis-turbios da Comunicacao da Pontificia Universidade Cato-lica de Sao Paulo, CeAC/DERDIC/PUCSP, Sao Paulo, SP, Brasil; Mestre em Fonoaudiologia pela Pontificia Universi-dade Catolica de Sao Paulo; Doutoranda do Programa de Estudos Pos-Graduados em Fonoaudiologia da Pontificia Universidade Catolica de Sao Paulo.

Auditory and communicative abilities in the auditory neuropathy spectrum disorder and mutation in the Otoferlin gene: clinical cases study

This study had the aim to investigate the auditory and communicative abilities of children diagnosed with Auditory Neuropathy Spectrum Disorder due to mutation in the Otoferlin gene. It is a descriptive and qualitative study in which two siblings with this diagnosis were assessed. The procedures conducted were: speech perception tests for children with profound hearing loss, and assessment of communication abilities using the Behavioral Observation Protocol. Because they were siblings, the subjects in the study shared family and communicative context. However, they developed different communication abilities, especially regarding the use of oral language. The study showed that the Auditory Neuropathy Spectrum Disorder is a heterogeneous condition in all its aspects, and it is not possible to make generalizations or assume that cases with similar clinical features will develop similar auditory and communicative abilities, even when they are siblings. It is concluded that the acquisition of communicative abilities involves subjective factors, which should be investigated based on the uniqueness of each case.