Doris Ruthy Lewis

Multiprofessional committee on auditory health: COMUSA

Created in 2007, COMUSA is a multiprofessional committee comprising speech therapy, otology, otorhinolaryngology and pediatrics with the aim of debating and countersigning auditory health actions for neonatal, lactating, preschool and school children, adolescents, adults and elderly persons. COMUSA includes representatives of the Brazilian Audiology Academy (Academia Brasileira de Audiologia or ABA), the Brazilian Otorhinolaryngology and Cervicofacial Surgery Association (Associação Brasileira de Otorrinolaringologia e Cirurgia Cérvico Facial or ABORL), the Brazilian Phonoaudiology Society (Sociedade Brasileira de Fonoaudiologia or SBFa), the Brazilian Otology Society (Sociedade Brasileira de Otologia or SBO), and the Brazilian Pediatrics Society (Sociedade Brasileira de Pediatria or SBP).

Estudo dos limiares eletrofisiológicos das vias aérea e óssea em crianças com até 2 meses de idade

O diagnostico diferencial de perdas auditivas com potencial evocado auditivo de tronco encefalico por via aerea e por via ossea em criancas pequenas tem sido pouco estudado no Brasil. OBJETIVO: Comparar as respostas do potencial evocado auditivo de tronco encefalico por vias aerea e ossea em criancas de ate 2 meses de idade sem perdas auditivas. FORMA DE ESTUDO: Clinico prospectivo com coorte transversal. MATERIAL E METODO: Foram avaliadas 12 criancas que passaram na triagem auditiva, por meio do potencial evocado auditivo de tronco encefalico por via aerea e via ossea. A via ossea foi realizada sem mascaramento contralateral. As respostas foram comparadas e analisadas por meio do teste de McNemar e pela analise de variância com medidas repetidas. RESULTADOS: Nao houve diferenca estatistica no limiar eletrofisiologico por via aerea e via ossea (p>0,05). O tempo de latencia por via ossea foi estatisticamente maior do que o tempo de latencia por via aerea (p=0,000). CONCLUSAO: Houve concordância no registro do Potencial Evocado Auditivo de Tronco Encefalico captado por vias aerea e ossea nas intensidades proximas ao limiar auditivo; a latencia da onda V registrada por via ossea foi estatisticamente maior que a registrada por via aerea.

AUDITORY STEADY-STATE RESPONSE IN CHILDREN WITH COCHLEAR HEARING LOSS

BACKGROUND auditory steady-state response (ASSR) is indicated as a promising technique in the assessment of the hearing status of children. AIM to investigate the level of agreement between the results of the ASSR and the visual reinforcement audiometry (VRA) in a group of children, thus examining the clinical applicability of this technique in hearing assessment of children. METHOD participants were 14 children with ages between 4 and 36 months (mean 16 months) with the diagnosis of cochlear hearing loss. The ASSR was recorded in the frequencies of 0.5, 1, 2 and 4kHz for multiple simultaneous stimulation and the results were compared with the visual reinforcement audiometry (VRA). RESULTS the intraclass correlation coefficients between ASSR and VRA were 0.90, 0.93, 0.93 and 0.89 respectively for the frequencies of 0.5, 1, 2 and 4kHz, indicating a strong correlation between the techniques. CONCLUSION the ASSR can provide accurate information to support the selection of hearing aids for children when it is not possible to perform the VRA.

Emissões otoacústicas: produto de distorção em lactentes até dois meses de idade

BACKGROUND There is a need to determine parameters for the analyses of the distortion product otoacoustic emissions (DPOAE) of infants so that it can be used as a clinical criterion in auditory assessment. AIM To describe the DPOAE records of infants from birth to two months, considering the response level, noise level and the signal to noise ratio in all frequencies; the analysis of response level according to the variables of gender, timpanometry pressure peak, state of infant during the test and distribution of the response percentile level. METHOD 138 infants were evaluated, all of which presented no risk indicators for hearing loss and passed the hearing screening test. The parameters used were: L1=65 dB SPL and L2=50 dB SPL in the equipment ILO292-Otodynamics. RESULTS 70 male and 68 female were evaluated, with ages between 6 to 65 days. The medians for DPOAE level for each frequency (f2) varied between 6.0 dB SPL and 16.3 dB SPL. The medians for the noise level for each frequency (f2) varied between -12.5 dB SPL and -2.1 dB SPL. The medians for the signal to noise ratio for each frequency (f2) varied between 10.5 dB SPL and 25.5 dB SPL. CONCLUSIONS There was no statistically significant difference between genders and between ears for the response level. The timpanometry pression peak determined by three groups (between -50 and +50 daPa; <-50 daPa and >+50 daPa) indicated no influence on records of the response level. For clinical interpretation, percentile 5 can suggest hearing loss and percentile 95 can suggest normal hearing. Studies with infants who present hearing loss are considered important in order to complement the clinical criterion in case of presence of DPOAE and hearing loss.

Efeito de supressão das emissões otoacústicas evocadas por estímulo transiente em lactentes de risco para perda auditiva nascidos pré-termo

PURPOSE: to study the occurrence and magnitude of the transient otoacoustic emissions suppression in pre-term infants with high risk for hearing loss. METHODS: the study was carried out in 15 pre-term infants. The used equipment was ILO USB II V6 Clinical OAE Software from Ododynamics. The used stimulation was linear clicks displayed at the intensity of 60 dB pe SPL (± 5). The contralateral noise (white noise) was set at 60 dB SPL (± 5). RESULTS: From 15 infants, only one did not show bilateral suppression. Suppression effect was shown on 93.3% of the subjects, being 71.4% for both ears and 28.6% for only one ear. The results showed that there was a significant statistical difference between the right and left ears. We could not observe significant differences when actual and gestational age were analyzed. The baby boys showed higher responses when compared to baby girls. CONCLUSIONS: most of the studied population showed OAE suppression effect. White noise was found in the contralateral ear, and reduced the response level of the transient otoacoustic emissions, demonstrating the participation of the efferent system. The responses were different considering the side of the ear, being higher on the right ear and for boys.

Electrophysiologic threshold study in air and bone conduction in children with 2 months or less age

UNLABELLED The differential diagnosis of hearing loss with air and bone Auditory Brainstem Response in small children has not been enough studied in Brazil. AIM To compare air and bone Auditory Brainstem Response results in children under 2 months of age with normal hearing. STUDY DESIGN clinical with transversal cohort. MATERIALS AND METHODS 12 children who passed the hearing screening were evaluated using air and bone Auditory Brainstem Response. No contralateral masking was used in the bone conduction test. The responses were compared and analyzed by the McNemar test and repetitive measurements of the variance test. RESULTS There were no statistic differences between air and bone conduction Auditory Brainstem Response thresholds (p>0.05). The bone conduction latency for wave V was statistically higher than air conduction latency (p=0.000). CONCLUSION There was agreement on the results recorded for air and bone conduction Auditory Brainstem Response for threshold intensities; latency for bone conduction wave V was statistically higher than the air conduction latency.

CORRELAÇÃO DOS ACHADOS DO PEATE-FE E DA AVALIAÇÃO COMPORTAMENTAL EM CRIANÇAS COM DEFICIÊNCIA AUDITIVA

PURPOSE: analyze and correlate the findings of the frequency specific auditory brainstem response and behavioral assessment by air and bone conduction in children with sensorineural hearing loss or mixed hearing loss. METHOD: the sample was composed of ten children up to three years old, diagnosed with sensorineural hearing loss. We conducted the FS-ABR in the frequencies of 0.5, 1, 2 and 4 kHz and behavioral audiometry in the same frequencies, by air and bone conduction. The results of both procedures were correlated in order to verify if the FS-ABR is able to predict auditory status of children with hearing impairment. RESULTS: it was observed a strong correlation between the two procedures in the four frequencies studied by air conduction; for bone conduction, found a strong correlation was found in the frequencies of 0.5, 1 and 2 kHz and a moderate correlation at 4 kHz. CONCLUSION: FS-ABR estimated the hearing with strong accuracy when compared to behavioral audiometry. Thus, the application of FS-ABR enables the estimation of hearing status until they can be determined by behavioral hearing tests in the population studied.

Potencial evocado auditivo de tronco encefálico por frequência específica por via aérea e via óssea em neonatos ouvintes normais

ABSTRACT Purpose: to determine the minimum response and the latency of V wave in the Frequency-specific auditory brainstem responses (FS-ABR) in normal hearing neonates at the frequencies: 0.5, 1, 2 and 4 kHz by air and bone conduction and to determine normative values. Methods: normal hearing neonates were assessed with FS-ABR at 0.5, 1, 2 and 4 kHz, air and bone conduction. Twelve ears were assessed in each frequency, totalizing 18 neonates. Results analysis considered the latency and the presence of wave V until 20 dB nHL in air and bone conduction, for four intensities. Results: it was observed an increase of wave V latency with the decrease of intensity, and greater latencies at lower frequencies in both air and bone conduction. Nevertheless, there was no difference between the latencies at 0.5 and 1 kHz with strong intensity stimuli in both conditions, contrasting to literature findings. Considering air conduction, wave V was present at 0,5 kHz at 30 dB nHL in all ears and at 1 kHz 11 ears (91,66%) presented it at 20 dB nHL. All subjects (100%) presented responses to the other frequencies at 20 dBn HL. Considering bone conduction, all subjects presented wave V at 20 dB nHL in all frequencies.

Timpanometria com tons teste de 226 Hz e 1 kHz em um grupo de lactentes com indicadores de risco para deficiência auditiva

ABSTRACT Purpose: To analyze the results of 226 Hz and 1 kHz tympanometry in infants under six months of age, and to relate these results with age and with the results of Transient Evoked Otoacoustic Emissions (TOAE). Methods: The sample consisted of 142 infants with risk indicators for hearing loss, who had passed the Automated Brainstem Auditory Evoked Potential (A-BAEP). Subjects were submitted to 226 Hz and 1 kHz tympanometry and also to hearing screening with TOAE and A-BAEP. Infants were divided into age groups (0-90 days old and 91-180 days old), and into groups 1 and 2, according to the presence or absence of TOAE, respectively. The tympanometric curves were classified into types A, Flat, C, Double Peak (DP), Asymmetrical (ASS) and Inverted (I), and also as normal or altered. Results: It was analyzed 245 ears. Type A tympanograms were predominant in both probe tones and in both groups. When tympanometric curves were analyzed according to age, it was verified that type A presented higher occurrence, follo-wed by the type DP in infants younger than 90 days, and by the type Flat in infants older than 90 days. The 1 kHz tympanometry presented sensitivity of 74.01%, and specificity of 83.94%; the 226 Hz tympanometry presented sensitivity of 24.00% and specificity of 90.80%.

Triagem auditiva neonatal com emissão otoacústica transiente utilizando estímulo de banda estreita

ABSTRACT Purpose: to assess the sensitivity and specificity of an automated Transient Evoked Otoacoustic Emissions equipment using narrow band stimulus. Methods: the hearing screening results of 300 newborns were analyzed. A portable automated equipment was used with narrow band stimulus to conduct the Transient Evoked Otoacoustic Emissions. All newborns were also submitted to the Brainstem Auditory Evoked Potentials using 100μs-duration click stimuli, which was considered the gold standard test. Results: the proportion of “pass” results in the neonatal hearing screening was 90.7%. Considering the gold standard results, it was observed a false-positive rate of 9%. The Transient Evoked Otoacoustic Emissions with narrow band stimulus presented sensitivity of 100% and specificity of 92%. Conclusion: the narrow band stimulus was efficient enough to be used in neonatal hearing screening programs. KEYWORDS: Infant, Newborn; Hearing Tests; Otoacoustic Emissions, Spontaneous; Evoked Potentials, Auditory; Hearing Loss