Liliane Desgualdo Pereira

Processamento auditivo em idosos: estudo da interação por meio de testes com estímulos verbais e não-verbais

Presbyacusis is a hearing loss combined with functional auditory decline due to the aging process. AIM: The aim of this study is to characterize verbal and nonverbal sound interaction aspects in elderly individuals with and without hearing loss by means of Binaural Fusion Test, Sound Localization Test at five directions and Pediatric Sentence Identification (PSI), taking into consideration each procedure and hearing loss magnitude. STUDY DESIGN: Clinical study with transversal cohort. MATERIAL AND METHOD: A number of 110 elderly individuals, aged between 60 to 85 years, with normal hearing and with symmetric neurossensorial hearing loss up to moderately severe hearing impairment participated in this study. The common auditory behavior for all the selected tests was nominated as interaction. The analysis was performed by means of a single procedure and also based on audiometric magnitude. RESULTS: There were more individuals that failed the Binaural Fusion Test. The procedures that showed significant statistical dependency on the audiometric magnitude groups were Sound Localization Test, Temporal Lateralization Test and PSI-MCI (-10) Test. CONCLUSION: Elderly individuals present difficulty in the binaural interaction process when the auditory information is not complete. The magnitude of the hearing loss interfered specially in the localization auditory behavior.

Processamento auditivo e SPECT em crianças com dislexia

Dichotic listening (DL) was evaluated in 36 children with: verbal dichotic listening test, alternating dissilable dichotic test and non-verbal dichotic listening test. Children were separated into two groups: experimental group with 18 dyslexic children and control group with 18 normal children. Both groups were comparable in gender, laterality and social-economic level. All dyslexic children underwent neuroimaging exam (SPECT). Our data showed that there was a statistical difference between both groups in all DL tests. Abnormal SPECT findings were seen in 50% of the dyslexic children, hypoperfusion of the left temporal lobe being the most frequent abnormality. We conclude that dyslexic children present an impairment of central neurologic processing that may be detected by DL tests, and by functional imaging exam, such as SPECT, as well.

Resolução temporal: análise em pré-escolares nascidos a termo e pré-termo

BACKGROUND: auditory processing. AIM: to verify the hearing behavior of temporal resolution in children with ages from five to six years, who were born preterm, with no evidence of neurological alterations and to compare this behavior to that observed in children of the same age, who were born at term, with low risk for developmental disorders, taking into consideration the variables of: threshold detection gaps through pre-established frequency, binaural and monaural presentation, order of stimuli presentation and gender. METHOD: 70 children divided in two groups: Group 1 with 44 children who were born at term (20 female and 24 male) and Group 2 with 26 preterm children (12 female and 14 male). Children were submitted to audiologic evaluation composed of audiometry, speech response threshold, acoustic impedance test and the Random Gap Detection Test (RGDT). RESULTS: children who were born at term presented lower threshold detection gaps in the RGDT, for both monaural and binaural stimuli presentation, in all of the pre-established frequencies when compared to preterm children. This difference between the groups was statistically significant. The average threshold detection gaps of Group 1 rose according to the increase of frequency. For Group 2 statistically significant differences were not found regarding the average of threshold detection gaps, for both monaural and binaural stimuli presentation. CONCLUSION: preterm children differ from those born at term regarding the hearing behavior of temporal resolution. The RGDT can be used as a tool to evaluate the hearing process, once the early detection of alterations in temporal processes indicates the need for intervention in order to minimize or avoid future language impairments.

Ordenação e resolução temporal em cantores profissionais e amadores afinados e desafinados

BACKGROUND: temporal ordering and temporal resolution. AIM: to compare the performance of professional singers with that of well tuned and out of tune amateur singers in the pitch pattern test (PPT) and in the Random Gap Detection Test (RGDT). METHOD: participants were 78 individuals, male and female, with ages ranging from 18 to 55 years. All of the participants were singers with normal hearing - previously assessed using pure tone and speech audiometry - and had no language, speech, voice or hearing complaints. Each individual answered a questionnaire concerning, among other subjects, perception about own voice when singing, number of years of professional singing, difficulties when singing new songs and number of years of music study. For the objective assessment the PPT and the RGDT were used in order to investigate temporal ordering and temporal resolution respectively. RESULTS: regarding the RGDT, there was no statistically significant difference between the groups and variables. As for the PPT, it was observed that professional singers presented a better performance, with statistic significance, when compared to well tuned amateur singers and these a better performance when compared to out of tune amateur singers. The performance in the PPT was related to specialized training and study of music theory. CONCLUSION: the RGDT did not prove to be a sensitive test to distinguish professional and amateur singers. On the other hand, the PPT did. The performance in the PPT reflects the number of years of specialized auditory training and music theory study.

Processamento auditivo e audiometria de altas freqüências em escolares de São Paulo

TEMA: processamento auditivo e sensibilidade auditiva para altas frequencias. OBJETIVO: caracterizar os processos de localizacao, ordenacao temporal, padroes auditivos e deteccao de tons de altas frequencias, procurando relacoes entre elas. METODO: 32 ouvintes, paulistanos, escolares (quarta serie), submetidos a avaliacao simplificada do processamento auditivo, teste de padrao de duracao, audiometria de alta frequencia. RESULTADOS: tres (9,4%) individuos mostraram transtorno do processamento auditivo (TPA), e em um coexistiu o rebaixamento auditivo em altas frequencias. CONCLUSAO: TPA associado a perda da sensibilidade auditiva em altas frequencias deve ser esclarecido em novas pesquisas.

Processamento auditivo em indivíduos com epilepsia de lobo temporal

Temporal epilepsy, one of the most common presentation of this pathology, causes excessive electrical discharges in the area where we have the final station of the auditory pathway. Both the anatomical and functional integrity of the auditory pathway structures are essential for the correct processing of auditory stimuli. AIM: to check the Auditory Processing in patients with temporal lobe epilepsy regarding the auditory mechanisms of discrimination from sequential sounds and tone patterns, discrimination of the sound source direction and selective attention to verbal and nonverbal sounds. METHOD: eight individuals with temporal lobe epilepsy were assessed, after excluding those with non-confirmed diagnosis or with the focus of discharges not limited to this lobe. The evaluation was carried out through special auditory tests: Sound Localization Test, Duration Pattern Test, Digits Dichotic Test and Non-Verbal Dichotic Test. Their performances were compared to the performances of individuals without neurological diseases (case-control study). RESULTS: similar performances were observed between patients with temporal lobe epilepsy and the control group regarding the auditory mechanism of sound source direction discrimination. Comparing the other auditory mechanisms assessed, the patients with temporal lobe epilepsy presented worse results. CONCLUSION: individuals with temporal lobe epilepsy had more deficits in auditory processing than those without cortical damage.

Atenção seletiva: PSI em crianças com distúrbio de aprendizagem

Selective attention is essential for learning how to write and read. AIM: The objective of this study was to examine the process of selective auditory attention in children with learning disabilities. MATERIAL AND METHOD: Group I included forty subjects aged between 9 years and six months and 10 years and eleven months, who had a low risk of altered hearing, language and learning development. Group II included 20 subjects aged between 9 years and five months and 11 years and ten months, who presented learning disabilities. A prospective study was done using the Pediatric Speech Intelligibility Test (PSI). RESULT: Right ear PSI with an ipsilateral competing message at speech/noise ratios of 0 and -10 was sufficient to differentiate Group I and Group II. Special attention should be given to the performance of Group II on the first tested ear, which may substantiate important signs of improvements in performance and rehabilitation. CONCLUSION: The PSI - MCI of the right ear at speech/noise ratios of 0 and -10 was appropriate to differentiate Groups I and II. There was an association with the group that presented learning disabilities: this group showed problems in selective attention.

Encaminhamentos sobre a classificação do grau de perda auditiva em nossa realidade

Rev Soc Bras Fonoaudiol. 2009;14(2):287-8 (1) Professora Titular do Programa de Pós-Graduação em Fonoaudiologia da Pontifícia Universidade Católica de São Paulo – PUCSP – São Paulo (SP), Brasil; Professora Adjunto do Curso de Graduação em Fonoaudiologia da Faculdade de Ciências Médicas da Santa Casa de São Paulo – FCMSCSP – São Paulo (SP), Brasil. (2) Livre-docente, Professora Associada do Curso de Fonoaudiologia e do Programa de Pós-Graduação em Distúrbios da Comunicação Humana da Universidade Federal de São Paulo – UNIFESP – São Paulo (SP), Brasil. (3) Livre-docente, Professora Associada do Departamento de Fisioterapia, Fonoaudiologia e Terapia Ocupacional da Faculdade de Medicina da Universidade de São Paulo – USP – São Paulo (SP), Brasil. (4) Doutora, Professora do Curso de Fonoaudiologia da Faculdade de Medicina de Ribeirão Preto da Universidade de São Paulo – USP – Ribeirão Preto (SP), Brasil. Endereço para correspondência: Ieda Chaves Pacheco Russo. R. Teixeira da Silva, 487/64, Paraíso, São Paulo – SP, CEP: 04002-032. E-mail: irusso@ terra.com.br Encaminhamentos sobre a classificação do grau de perda auditiva em nossa realidade

O Teste Gap in Noise em crianças de 11 e 12 anos

BACKGROUND: gap detection in 11 and 12-year-old children. AIM: to investigate temporal resolution through the Gap in Noise test in children of 11 and 12 years in order to establish criteria of normal development. METHOD: participants were 92 children, with ages of 11 and 12 years, enrolled in elementary school, with no evidences of otologic, and/or neurologic, and/or cognitive disorders, as well as with no history of learning difficulties or school failure. Participants Besides that, their hearing thresholds were within normal limits and their verbal recognition in the dichotic test of digits was equal or superior to 95% of hits. All were submitted to the Gap in Noise test. The statistical analysis was performed by non-parametric tests with significance level of 0.05 (5%). RESULTS: the average of the gap thresholds was 5.05ms, and the average percentage of correct answers was 71.70%. There was no significant statistical difference between the responses by age (eleven and twelve years), by ear (right and left), by gender (male and female). However, when comparing the tests, it was observed that the 1st test showed a higher percentage of identifications of gap, statistically significant than the 2nd test. CONCLUSION: in 78.27% of the population of this study, the gap thresholds were up to 5ms, response recommended as normality reference for the age group searched.

Ocorrência de reflexo acústico alterado em desordens do processamento auditivo

Introduction: The acoustic reflex threshold is defined as the lowest sound intensity capable of starting the middle ear protection mechanism due to intense sounds (Metz, 1952; Jerger, 1970), being necessary the structural and functional integrity of the periferic and central auditory system. These structures are also responsable for the central processing of auditory information. Aim: We intend to verify whether acoustic reflex abnormalities can also appear in auditory processing (AP) disorders, resulting in symptoms related to speech and language disorders. Study design: Prospective randomized. Material and method: Data were analyzed from one hundred AP assessments, using Pereira (1997) method. Patients, male and female, with ages ranging from 07 to 18 years, had normal hearing thresholds and normal tympanograms patterns. The difference between the acoustic reflex and hearing thresholds defined the acoustic reflex level (ARL), considered normal between 70-90dB and altered when above of this range or when absent in one or more frequencies (Carvallo, 1996; 1997; Metz, 1952). Results: Disorders of AP were found in 97% of the patients. In this group, 62% showed ARL abnormalities, being statistically significant. Furthermore, patients with AP disorders showed ARL alterations, more frequently on severe degree disorders, on patients with combined auditory gnosis impairments and on patients with more than one auditory ability altered. Conclusion: Patients with acoustic reflex alterations and normal audiometry should perform the AP assessment, as these symptoms could unmask pathologies of the central nervous system.