Kelly Cristina Lira de Andrade

The importance of acoustic reflex for communication

PURPOSE The purpose of the study was to compare the speech recognition capacity between listeners with and without acoustic reflex using different types of noises and intensities. MATERIALS AND METHODS We studied 18 women allocated to 2 groups: acoustic reflex present (20 ears) and absent (16 ears). They were presented with 180 disyllable words (90 to each ear), emitted randomly at a fixed intensity of 40 dB above the pure tone average hearing level. At the same time, 3 types of noises were presented ipsilaterally (white, pink, and speech), one at a time, at 3 intensities: 40, 50, and 60 dB above the pure tone average hearing level. RESULTS The ages and auditory thresholds were statistically equal between the groups. There was a significant difference in mean number of hits between the 2 groups for the 3 types of noises used. There was also a significant difference in mean number of hits for noise type and intensity when white and pink noise was used at 40 and 50 dB and for all the intensities when speech was used. CONCLUSION Acoustic reflex helps communication in high-noise environments and is more efficient for speech sounds.

A importancia do reflexo estapedico evocado eletricamente no implante coclear

Introduction: The most important stage in fitting a cochlear implant is the identification of its dynamic range. The use of objective measures, in particular the electrically elicited stapedius reflex, may provide suitable assistence for initial fitting of cochlear implant, especially in children or adult with multiple disorders, because they provide specific values that serve as the basis of early cochlear implant programming. Objective: Verify through a review the use of the electrically elicited stapedius reflex threshold during the activation and mapping process of cochlear implant. Methods: Bibliographical search on the Pubmed and Bireme plataforms, and also on Medline, LILACS and SciELO databases, with standard searches until September 2012, using specific keywords. For the selection and evaluation of scientific studies found in the search, criterias have been established, considering the following aspects: author, year/location, grade of recommendation/level of evidence, purpose, sample, age, mean age in years, evaluative testing, results and conclusion. Results: Among 7,304 articles found, 7,080 were excluded from the title, 152 from the abstract, 17 from the article reading, 43 were repeated and 12 were selected for the study. Conclusion: The electrically elicited stapedius reflex may support when programming the cochlear implant, especially in patients with inconsistent responses.INTRODUCTION The most important stage in fitting a cochlear implant is the identification of its dynamic range. The use of objective measures, in particular the electrically elicited stapedius reflex, may provide suitable assistence for initial fitting of cochlear implant, especially in children or adult with multiple disorders, because they provide specific values that serve as the basis of early cochlear implant programming. OBJECTIVE Verify through a review the use of the electrically elicited stapedius reflex threshold during the activation and mapping process of cochlear implant. METHODS Bibliographical search on the Pubmed and Bireme plataforms, and also on Medline, LILACS and SciELO databases, with standard searches until September 2012, using specific keywords. For the selection and evaluation of scientific studies found in the search, criterias have been established, considering the following aspects: author, year/location, grade of recommendation/level of evidence, purpose, sample, age, mean age in years, evaluative testing, results and conclusion. RESULTS Among 7,304 articles found, 7,080 were excluded from the title, 152 from the abstract, 17 from the article reading, 43 were repeated and 12 were selected for the study. CONCLUSION The electrically elicited stapedius reflex may support when programming the cochlear implant, especially in patients with inconsistent responses.

The impact of stimulation rates in vestibular evoked myogenic potential testing

UNLABELLED Vestibular evoked myogenic potentials (VEMP) have been used in complementary otoneurological assessment, but the use of VEMP in clinical settings is limited. VEMPs can be used to assess vestibular function, particularly of the saccule, the inferior vestibular nerve, and/or the vestibular nucleus. OBJECTIVE To verify the highest possible - and reliable - stimulation rate to obtain VEMPs. METHOD The VEMPs of 18 subjects were acquired using stimulation rates ranging between 5.1 and 40.8 stimuli per second. STUDY DESIGN cross-sectional contemporary cohort study. RESULTS Latencies were kept unaltered and amplitudes were progressively reduced as stimulation rates were increased. However, ANOVA and the Kruskal-Wallis test failed to find statistically significant differences between the tested parameters. The study further indicated that when stimulation rates of 5.1 and 10.2 stimuli per second were compared, no statistically significant differences were observed in latency. CONCLUSION The highest reliable stimulation rate observed in the group of young adults with normal hearing included in this study was 10.2 stimuli per second.

Non-flat audiograms in sensorineural hearing loss and speech perception

OBJECTIVE: The audibility thresholds for the sound frequency of 137 upward- and downward-sloping audiograms showing sensorineural hearing loss were selected and analyzed in conjunction with speech recognition thresholds obtained from individuals seen at a public otolaryngology clinic to determine which frequencies in slope audiograms best represent speech recognition thresholds. METHOD: The linear regression model and mean square error were used to determine the associations between the threshold values. RESULT: The mean square error identified larger errors when using thresholds of 500, 1000, and 2000 Hz than when using audibility thresholds of 500, 1000, 2000, and 4000 Hz. The linear regression model showed a higher correlation (91%) between the audiogram thresholds for frequencies of 500, 1000, 2000, and 4000 Hz than for the frequencies of 500, 1000, and 2000 Hz (88%). CONCLUSION: Frequencies of 500, 1000, 2000, and 4000 Hz were the most significant in predicting the speech recognition threshold.

Positioning of earphones and variations in auditory thresholds

INTRODUCTION One of the problems observed in pure-tone audiometry tonal has been the variation in test results of a same individual, particularly at frequencies of 4kHz, 6kHz and/or 8kHz. Improper placement of headphones is one of the factors that can cause alterations in results. OBJECTIVE To compare differences in auditory thresholds using earphones positioned by the examiner and by the worker. METHODS Clinical and experimental study conducted in 2009, with 324 workers aged between 19 and 61 years, with a mean of 33.29 years and mean exposure time of 7.67 years. All subjects were familiar with audiometry procedures. Auditory thresholds were obtained at frequencies of 0.25-8kHz, with earphones positioned by the examiners, and at frequencies of 4, 6 and 8kHz, with earphones placed by workers in a comfortable position, following the examiners instructions. The thresholds obtained in these two situations were compared. RESULTS The three frequencies exhibited better responses with earphones placed by the workers themselves (p<0.001). At a frequency of 8kHz a greater difference was found (p<0.001), with a mean of 13.89dB and standard deviation of 6.07dB. CONCLUSION Earphone placement by the workers themselves under supervision of the examiner results in improved mean auditory thresholds at frequencies of 4, 6 and 8kHz, the last one significantly higher than the other two.

Sound localization and occupational noise

OBJECTIVE: The aim of this study was to determine the effects of occupational noise on sound localization in different spatial planes and frequencies among normal hearing firefighters. METHOD: A total of 29 adults with pure-tone hearing thresholds below 25 dB took part in the study. The participants were divided into a group of 19 firefighters exposed to occupational noise and a control group of 10 adults who were not exposed to such noise. All subjects were assigned a sound localization task involving 117 stimuli from 13 sound sources that were spatially distributed in horizontal, vertical, midsagittal and transverse planes. The three stimuli, which were square waves with fundamental frequencies of 500, 2,000 and 4,000 Hz, were presented at a sound level of 70 dB and were randomly repeated three times from each sound source. The angle between the speakers axis in the same plane was 45°, and the distance to the subject was 1 m. RESULT: The results demonstrate that the sound localization ability of the firefighters was significantly lower (p<0.01) than that of the control group. CONCLUSION: Exposure to occupational noise, even when not resulting in hearing loss, may lead to a diminished ability to locate a sound source.

Potencial miogênico evocado vestibular e suas implicações no domínio das frequências

Purpose: Determine whether there is an association between VEMP in the time domain and the frequency domain. Methods: The sample was composed of 18 individuals (36 ears), six men and 12 women. In the VEMP test in the time domain, 200 tone burst stimuli were promediated at a frequency of 500 Hz, with 5.1 stimulations/s at an intensity of 95 dBNAn. This was followed by capture in the frequency domain, where 200 stimuli consisting of 500 Hz (carrier frequency) pure tones were promediated and modulated at a frequency of 40 Hz. Odds ratio was calculated and the chi-squared test was applied to compare the responses of two domains. This is a cross-sectional contemporary cohort study. Results: VEMP in the time domain was recorded by unilateral stimulation and capture, with adequate morphology, in 88.88% of the ears. In the frequency domain test, a steady-state peak was found in 30 of the 36 tests (83.33%). The chi-squared test and odds ratio calculation showed a strong relationship between the two domains. Conclusion: There is a significant association between the VEMP tests in the time and frequency domains, a finding that suppports its use in clinical practice.

The Value of Electrically Evoked Stapedius Reflex in Determining the Maximum Comfort Level of a Cochlear Implant

BACKGROUND One of the most important steps for good user performance with a cochlear implant (CI) is activation and programming, aimed at determining the dynamic range. In adults, current levels are determined by psychophysical measures. In babies, small children, or individuals with multiple disorders, this procedure requires techniques that may provide inconsistent responses because of auditory inexperience or the age of the child, making it a very difficult process that demands the collaboration of both the patient and the family. PURPOSE To study the relationship between the electrically evoked stapedius reflex threshold (ESRT) and maximum comfort level for stimulating electrodes (C-level) in postoperative CI users. RESEARCH DESIGN Cross-sectional analytical observational case series study. STUDY SAMPLE We assessed 24 patients of both sexes, aged between 18 and 68 yr, submitted to CI surgery. INTERVENTION Otoscopy and immittance. Next, an implant speech processor connected to an Itautec® computer containing the manufacturers software (custom sound Ep 3-2) was used, as well as an AT 235h probe inserted into the ear contralateral to the CI to capture the stapedius reflex, obtaining electrically evoked stapedius reflex thresholds. DATA COLLECTION AND ANALYSIS Data from the last programming, defining C-levels for each electrode studied, were extracted from the databank of each patient. The manual decay function of the AT 235h middle ear analyzer was used to observe ESRT response in a same window for a longer response capture time. Electrodes 22, 16, 11, 6, and 1 were tested when active, with the aim of using electrodes over the entire length of the CI, and ESRT was considered present when compliance was ≥0.05 ml. Stimuli, in current units, were always initiated at 20 cu above the C-level. The analysis of variance parametric test, Tukeys honest significant difference test, the t-test, Wilcoxon nonparametric test, and the Kolmogorov-Smirnov test examined whether significant relationships existed between these other factors. RESULTS The results demonstrate that all the electrodes selected for the study exhibited higher mean reflex threshold values than their mean C-level counterparts. However, there was no significant difference between them, for electrodes 1, 6, 11, and 16. The data provided allow the use of ESRT to define C-level values and make it possible to stipulate a correction factor ranging between 6 and 25.6 electrical units. CONCLUSION The use of electrically evoked stapedius reflex thresholds can help the team in charge of programming CIs, making the process faster and safer, mainly for infants, small children, or individuals with multiple disorders.

Implante coclear em indivíduos com mais de 65 anos de idade: Qualidade de vida e resultados audiológicos

Claudia Aimoni, Andrea Ciorba, Stravos Hatzopoulos, Giulia Ramacciotti, Manuela Mazzoli, Chiara Bianchini, Monica Rosignoli, Henryk Henryk Skarzynski e Pitor H. Skarzynski.

Potencial evocado auditivo de estado estável em frequências portadoras acima de 4000 Hz

Introdução: O potencial evocado auditivo de estado estável (PEAEE) tem sido apontado como uma técnica promissora para avaliar a audição de pacientes que não cooperam espontaneamente na determinação dos limiares auditivo. Embora estudos relatem desempenho diminuído nas frequências portadoras acima de 4000 Hz, são necessários avanços técnicos para determinar a sua utilidade clínica, pois o uso dessas frequências pode contribuir para um melhor diagnóstico audiológico. Objetivo: Analisar os potenciais evocados auditivos de estado estável, em frequências portadoras acima de 4000 Hz. Métodos: A avaliação dos PEAEE foi realizada de forma isolada e combinada, nas intensidades de 50 dBNPSpe e 80 dBNPSpe, nas frequências portadoras de 6000 e 8000 Hz, com o sistema de aquisição e análise MASTER. Resultados: Foi realizada análise de variância (ANOVA two-way), em que se encontrou diminuição das amplitudes, quando relacionadas às intensidades e às condições do estímulo. Conclusão: Foi possível avaliar as frequências portadoras de 6000 e 8000 Hz, tanto de forma isolada, quanto combinada. Não houve interações entre as frequências portadoras de 6000 Hz e 8000 Hz, quanto à forma de apresentação (combinada e isolada) e intensidade, para a amostra estudada.