Eliene Silva Araújo

Triagem auditiva neonatal: motivos da evasão das famílias no processo de detecção precoce

PURPOSE: To analyze the reasons for evasion of the families from the newborn hearing screening program conducted at a public hospital, and to correlate them with the demographic distribution of the families and the characteristics of the program. METHODS: Participants were 132 families, from a total of 739 contacted, whose children had been born in a maternity hospital in the interior of the state of Sao Paulo, Brazil, from October/2003 to December/2005, and who had not showed up for the newborn hearing screening test or retest. A questionnaire regarding the causes for evasion was applied, asking information related to the newborn hearing screening, level of education and occupation of parents, and the childs hearing and language development. RESULTS: The questionnaire was applied to 132 families (17.86%); contact was not possible with the other families. From this total, 82 had not shown up in the first stage of the hearing screening (test), and 50 had not returned for retest. The most frequently provided reasons for the evasion were lack of interest and scheduling conflicts. There was no association between the reasons for the evasion and parents education level and occupation, nor with the professional who provided orientation regarding the newborn hearing screening. Hearing alteration were not referred, as well as significant language development delay. CONCLUSION: The reasons for family evasion are independent from variables related to the family and the dynamics of the hearing screening program.

Monitoramento de crianças com indicadores de risco para a deficiência auditiva

Purpose: to describe the proposal of monitoring children in the first year of life, who were not identified in the newborn hearing screening program but had risk factors for hearing loss. Method: the study included 258 risk children who had obtained the result “pass” in the Universal Newborn Hearing Screening Program of Hospital Santa Isabel – Bauru/SP, from June to November 2008. It was applied by the telephone, a validated questionnaire in a previous study, containing questions about hearing and language. For each question there were two possible answers: “yes” or “no” and we considered “failure” to obtain at least one “no” answer. With such result, the child was scheduled to perform an immediate hearing evaluation. Results: the questionnaire was applied with 169 families; with the others, there was no contact. From the total, 164 (97,04%) obtained “passed” and five (2,96%) “failed”. Between these five children, only three showed up for hearing evaluation and one had no disorders; two presented conductive hearing loss. It was observed distinct prevalence among the risk factors and there was no relation (p>0,05) of the risk factors with the evasion in the monitoring process. Conclusion: the monitoring through a questionnaire applied by telephone proved to be feasible, however, it is necessary to develop strategies to support their execution.

Community health worker training for infant hearing health: Effectiveness of distance learning

Abstract Objective: The purpose of this study was to evaluate the effectiveness of a distance training program in infant hearing health to community health workers (CHWs). Design: Pre- and post- tests were administered to two groups of subjects following the use of an interactive CD-ROM for tele-educational training. Study sample: Two groups of subjects were used: Group I (GI) consisted of 43 CHWs who had previously participated in at least one training activity involving hearing health, and Group II (GII) were 47 CHWs who had received no prior training in hearing health. Results: CHWs retained a significant amount of training content. There was not significant correlation between the global post-training questionnaire score and performance on the simulation activity (GI: r = 0.11, p = 0.698 and GII: r = 0.29, p = 0.074), and the simulation activity performance was significantly better among GI CHWs (p = 0.05). Conclusion: The CHWs’ training in infant hearing health using an interactive tele-educational tool was effective, as the CHW demonstrated significant short-term information retention and applied such data in hypothetical situations representative of their daily activities.

P300 auditory cognitive evoked potential as an indicator of therapeutical evolution in students with developmental dyslexia

PURPOSE To verify the effectiveness of the Cognitive Auditory Evoked Potential-P300 (CAEP-P300) for monitoring the therapeutical evolution of students with developmental dyslexia. METHODS Twenty students diagnosed with developmental dyslexia, of both genders, aged between 8 and 14 years, divided into two randomized groups, one of them submitted to a phonological remediation program associated with reading and writing (GI), and the other one representing the control group (GII), participated in the study. The groups were paired up, and the individuals were submitted to two evaluations of the CAEP-P300 and the same interval was kept for both. Paired Students t-test, ANOVA test, and Pearsons correlation coefficient were used, adopting 5% significance level. RESULTS The statistical comparison of the pre and post evaluations of each group demonstrated difference in the Phonological Awareness Test (p=0.000) and in the P300 latency (p=0.005) only for GI. CONCLUSION CAEP-P300 use for monitoring the therapeutical evolution of children with developmental dyslexia is possible and represents a viable option for intervention programs.PURPOSE To evaluate the cochlear function of parents of individuals with autosomal recessive gene Gap Junction Protein Beta-2 hearing loss by ultra-high frequencies distortion-product otoacoustic emissions (DPOAEs), compared with responses of a control group matched for age and gender. METHODS We studied 56 subjects aged from 20 to 58 years, divided into two groups. The study group comprised 28 parents of hearing-impaired patients due to autosomal recessive inheritance, 14 females aged 20.0-55.0 years (mean 32.8 years) and 14 males aged 20.0-58.0 years (mean 35.2 years). Control group was composed of normal hearing individuals, 14 males and 14 females age-matched to the study group. The subjects underwent tests for audiometry, tympanometry, and DPOAE in the frequency range of 9.000-16.000 Hz. RESULTS We found 64.3% of normal results of DPOAE in the study group compared to 91.1% in the control. There were significant differences between groups in the ears and DPOAE responses, and the mean level of response was in 10 dBNPS in study group and 14 dBNPS in the control. The Pearsons correlation between age and DPOAE in ultra-high frequencies showed no statistical significance. CONCLUSION DPOAE at ultra-high frequencies were able to identify individuals from both groups, suggesting that heterozygous individuals for the Gap Junction Protein Beta-2 gene mutation may have damage to the cochlear function before clinical manifestation in audiometry.

CAPACITAÇÃO DE AGENTES COMUNITÁRIOS DE SAÚDE NA ÁREA DE SAÚDE AUDITIVA INFANTIL: RETENÇÃO DA INFORMAÇÃO RECEBIDA

PURPOSE:to investigate the information retention provided to Community Health Workers on infant hearing health training.METHODS:the sample was composed of 24 Community Health Workers prior trained through a cybertutor, a based web education system. The content was ranging from prevention to rehabilitation of hearing impairment. Immediately after training, the Community Health Workers answered a multiple choice questionnaire with 20 questions, divided into domains (1: general concepts; 2: type, prevention and causes of hearing impairment; 3: Techniques of identification and diagnosis of the hearing impairment; 4: general aspects of hearing impairment). The same questionnaire was applied one more time after 15 months. The information retention level was analyzed comparing performance in the evaluations by the Wilcoxon test and the significance level adopted was 5%.RESULTS:it was verified a significant decrease (p = 0.03) in percentage, of the Community Health Workers general knowledge on infant hearing health (73,5±8,4/66,7±12,5). In the analysis by domains it was possible to see a worsening in 1(76,4±14,7/58,3±22,5), 2 (72,9±30,3/64,6±19,4) and 3 (69,4±14,5/68,8±17,2) domains, it was significant in 1 domain (p = 0.012). Regarding to 4 domain, there was a slight improvement (76,0±11,6/78,1±11,2).CONCLUSION:it was observed significant decrease of the Community Health Workers knowledge on infant hearing health, which demonstrates that the community health workers training should occur continuously.

Medidas de imitância acústica de banda larga com estímulo chirp e tom puro em lactentes com normalidade de orelha média

Objetivo: Caracterizar os valores de reflectância e absorvância de banda larga em lactentes com integridade de orelha media. Metodos: Foram analisados os valores de reflectância e absorvância de banda larga, para os estimulos chirp e tom puro, de 31 orelhas de 18 lactentes, na faixa etaria de 10 dias a cinco meses de idade. Considerou-se como criterios de inclusao: ausencia de fator de risco para deficiencia auditiva, timpanometria com sonda de 1000 Hz, sugerindo normalidade de orelha media e presenca de emissoes otoacusticas evocadas por estimulo transiente, na triagem auditiva neonatal. Resultados: Os valores de reflectância mostraram-se maiores para as baixas frequencias, reduzindo para as medias e aumentando, novamente, para as frequencias altas, enquanto para os valores de absorvância, o comportamento foi o oposto. Nao existiu diferenca significativa entre os estimulos chirp e tom puro. Conclusao: Observou-se um comportamento tipico das medidas estudadas, caracterizado por maior reflectância nas frequencias graves e maior absorvância para as frequencias medias.

Auditory Steady-State Response in the First Six Months of Life

Objective: To characterize the thresholds of the auditory steady-state response that relates to term newborns and infants. Design: The study was cross-sectional using auditory steady-state response assessment, and the real-ear-to-dial difference was measured in the external auditory canal. Study Sample: The study group included 60 newborns and infants between the age of 0 and 6 months. Results: A statistically significant difference was found in the carrier frequency variable for auditory steady-state response thresholds but not in comparison to ages. Furthermore, there is an association between auditory steady-state response thresholds and the real-ear-to-dial difference. Conclusion: The same threshold can be used as a normality reference for this age range, with distinct values for the different carrier frequencies. The influence of external auditory canal amplification should be taken into account.

Potencial Cognitivo Auditivo - P300 como indicador de evolução terapêutica em escolares com Dislexia do Desenvolvimento

PURPOSE To verify the effectiveness of the Cognitive Auditory Evoked Potential-P300 (CAEP-P300) for monitoring the therapeutical evolution of students with developmental dyslexia. METHODS Twenty students diagnosed with developmental dyslexia, of both genders, aged between 8 and 14 years, divided into two randomized groups, one of them submitted to a phonological remediation program associated with reading and writing (GI), and the other one representing the control group (GII), participated in the study. The groups were paired up, and the individuals were submitted to two evaluations of the CAEP-P300 and the same interval was kept for both. Paired Students t-test, ANOVA test, and Pearsons correlation coefficient were used, adopting 5% significance level. RESULTS The statistical comparison of the pre and post evaluations of each group demonstrated difference in the Phonological Awareness Test (p=0.000) and in the P300 latency (p=0.005) only for GI. CONCLUSION CAEP-P300 use for monitoring the therapeutical evolution of children with developmental dyslexia is possible and represents a viable option for intervention programs.PURPOSE To evaluate the cochlear function of parents of individuals with autosomal recessive gene Gap Junction Protein Beta-2 hearing loss by ultra-high frequencies distortion-product otoacoustic emissions (DPOAEs), compared with responses of a control group matched for age and gender. METHODS We studied 56 subjects aged from 20 to 58 years, divided into two groups. The study group comprised 28 parents of hearing-impaired patients due to autosomal recessive inheritance, 14 females aged 20.0-55.0 years (mean 32.8 years) and 14 males aged 20.0-58.0 years (mean 35.2 years). Control group was composed of normal hearing individuals, 14 males and 14 females age-matched to the study group. The subjects underwent tests for audiometry, tympanometry, and DPOAE in the frequency range of 9.000-16.000 Hz. RESULTS We found 64.3% of normal results of DPOAE in the study group compared to 91.1% in the control. There were significant differences between groups in the ears and DPOAE responses, and the mean level of response was in 10 dBNPS in study group and 14 dBNPS in the control. The Pearsons correlation between age and DPOAE in ultra-high frequencies showed no statistical significance. CONCLUSION DPOAE at ultra-high frequencies were able to identify individuals from both groups, suggesting that heterozygous individuals for the Gap Junction Protein Beta-2 gene mutation may have damage to the cochlear function before clinical manifestation in audiometry.