Maria Cecília Martinelli Iório

Aclimatização: estudo do reconhecimento de fala em usuários de próteses auditivas

Background: acclimatization is the period that succeeds the fitting of hearing aids, when a progressive improvement of the hearing and speech recognition abilities is observed due to the new speech cues that are available to the hearing aid user. Aim: to verify acclimatization after the fitting of hearing aids through objective (speech tests) and subjective (Questionnaire) evaluations. Method: 16 hearing impaired individuals were evaluated on the first day of hearing aid fitting and were monthly reassessed for three months. In all three months the following speech tests were used: PISR - percentage index of speech recognition through monosyllabic words and SRT - speech recognition threshold through sentences, determining the speech/ noise ratio (S/N). The International Outcome Inventory of Hearing Aid (IOI-HA) was also applied in the first and third months after the hearing aids were fitted. Results: the comparison between the first day, first, second and third months after the hearing aids were fitted revealed a statistically significant improvement (p<0.001) between the results, not only for the PISR but also for the S/N ratio. No statistically significant difference was found for the results obtained through the questionnaire applied in the first and third months. Conclusion: the objective evaluation, using speech recognition tests, presents better results in the months following the hearing aids fitting indicating a progressive improvement in the speech abilities from the first month onwards. The subjective evaluation does not reveal an improvement when comparing the first and third moths after the hearing aids were fitted.

Testes de padrão de freqüência e de duração em idosos com sensibilidade auditiva normal

Current studies indicate the fact that elderly individuals may present a hearing processing disorder even without a structural lesion explaining it directly. AIM: To characterize the performance of elderly people with normal hearing sensitivity in the Frequency Standard and Duration Patterns Tests. STUDY DESIGN: Clinical prospective. METHOD: The sample counted on 25 elderly people with normal hearing and without history of central impairments. The Duration Pattern Test and the Frequency Pattern Test were carried out at 50 dBNS, with the request of answers through indication. RESULTS: The statistical analysis has shown that neither the ear side (right or left). The correct answer percentages found in the Duration Pattern Test was 67.5 and in the Frequency Pattern Test was 49.2. CONCLUSION: Statistic differences between the ears (right or left) were not found. The elderly individuals with normal hearing sensitivity present an average percentage of correct answers of 47.2% in the Frequency Pattern Test and of 67.5% in the Duration Pattern Test. The percentile values 3 and 97 were 23% and 96% for the Duration Pattern Test and of 17% and 98% for the Frequency Pattern Test, respectively.

Treinamento auditivo: avaliação do benefício em idosos usuários de próteses auditivas****

Background: hearing impairment has a negative impact on communication. This impact can be minimized by hearing aids fitting and auditory training. Aim: to verify the effectiveness of auditory training in elderly individuals, new users of hearing aids, regarding the benefit in fitting. Method: forty-two individuals with mild to moderate neurosensorial hearing loss, ranging in age from 60 to 90 years, were selected. Individuals were new users of bilateral hearing aids and were divided in two groups: Experimental Group (EG) and Sham Group (SG). The EG was submitted to training in an acoustic cabin during six sessions. Both groups were assessed through the following tests: Speech in Noise, Dichotic Digits and the Abbreviated Profile of Hearing Aid Benefit Aphab self-assessment questionnaire, without the hearing aids, four and eight weeks after they were fitted. Results: there was a statistically significant difference between the groups in both of the used tests, and for the Abbreviated Profile of Hearing Aid Benefit Aphab in the second and third assessments in the sub-scales of: Communication Easiness, Reverberation and Environmental Noise. Conclusion: auditory training favored the improvement in the auditory processing abilities and benefited the hearing aid fitting process.

Monitoramento da audição de pacientes expostos à cisplatina

Cisplatin is an antineoplasic drug, which has ototoxicity as a side effect. The goals of this paper were to evaluate the audiological behavior in osteosarcoma patients treated with cisplatin and to verify which evaluation method is the best for early detection of drug induced hearing loss. STUDY DESIGN: Clinical prospective. MATERIAL AND METHOD: 13 patients, that received four cisplatin cycles of 120 mg/m2/cycle divided in two days (60 mg/m2/day), were evaluated prior to start of chemotherapy, prior to each scheduled course and at the end of treatment. It was performed the pure tone audiometry (250 to 18000 Hz) and the transitory and distortion product otoacoustic emission (TOAE and DPOAE). RESULTS: In the mean values, it was observed hearing loss, after 480 mg/m2 cumulative cisplatin dosage, beginning at 8 kHz. At the individual values, it was observed that 15,3% had mild to moderate hearing loss beginning at 3kHz, 15,3% beginning at 4 kHz, 15,3% beginning at 6 kHz and 15,3% beginning at 8 kHz. TOAE did not show changes before the audiometry. DPOAE showed smaller amplitude after the cycles of cisplatin, but this change happened together with the audiometry - not prior. CONCLUSION: The high frequency audiometry was more efficient to detect early ototoxicity. TOAE and DPOAE can be used as complement tests. All cisplatin exposed patients showed high frequency hearing loss, 30,6% showed hearing loss in important frequencies (3 and 4 kHz) for speech comprehension.

Formal auditory training in adult hearing aid users.

INTRODUCTION Individuals with sensorineural hearing loss are often able to regain some lost auditory function with the help of hearing aids. However, hearing aids are not able to overcome auditory distortions such as impaired frequency resolution and speech understanding in noisy environments. The coexistence of peripheral hearing loss and a central auditory deficit may contribute to patient dissatisfaction with amplification, even when audiological tests indicate nearly normal hearing thresholds. OBJECTIVE This study was designed to validate the effects of a formal auditory training program in adult hearing aid users with mild to moderate sensorineural hearing loss. METHODS Fourteen bilateral hearing aid users were divided into two groups: seven who received auditory training and seven who did not. The training program was designed to improve auditory closure, figure-to-ground for verbal and nonverbal sounds and temporal processing (frequency and duration of sounds). Pre- and post-training evaluations included measuring electrophysiological and behavioral auditory processing and administration of the Abbreviated Profile of Hearing Aid Benefit (APHAB) self-report scale. RESULTS The post-training evaluation of the experimental group demonstrated a statistically significant reduction in P3 latency, improved performance in some of the behavioral auditory processing tests and higher hearing aid benefit in noisy situations (p-value < 0,05). No changes were noted for the control group (p-value <0,05). CONCLUSION The results demonstrated that auditory training in adult hearing aid users can lead to a reduction in P3 latency, improvements in sound localization, memory for nonverbal sounds in sequence, auditory closure, figure-to-ground for verbal sounds and greater benefits in reverberant and noisy environments.

A efetividade do treinamento auditivo formal em idosos usuários de próteses auditivas no período de aclimatização

OBJETIVO: Verificar a efetividade de um programa de treinamento auditivo formal em idosos usuarios de proteses auditivas intraaurais no periodo de aclimatizacao. METODOS: A amostra foi composta por 18 idosos (idade media: 71, 38 anos), de ambos os sexos, adaptados ha uma semana com proteses auditivas intra-aurais binaurais. Os participantes foram randomizados em dois grupos: Grupo Experimental (submetidos ao treinamento auditivo) e Grupo Controle (nao submetidos ao treinamento auditivo). O Grupo Experimental participou de sete sessoes de treinamento auditivo em cabina acustica, uma sessao por semana, com duracao de 50 minutos cada. Os procedimentos de avaliacao incluiram testes de reconhecimento de fala e questionario de auto-avaliacao do handicap auditivo. Estes foram aplicados em duas oportunidades, antes (1a avaliacao) e depois (2a avaliacao) do treinamento auditivo no Grupo Experimental e na avaliacao inicial e final do estudo no Grupo Controle. RESULTADOS: No Grupo Experimental, o Indice de Reconhecimento de Fala e Fala com Ruido Branco foram significantemente melhores apos o treinamento auditivo (2a avaliacao). Ja o estudo das relacoes sinal/ruido no teste de reconhecimento de sentencas no ruido revelou uma tendencia (p-valor proximo a 0,05) de melhora na avaliacao pos-treinamento. Observou-se nos idosos do Grupo Experimental que os resultados obtidos na 2a avaliacao nao foram significantemente melhores aos obtidos no Grupo Controle em todos os testes. CONCLUSAO: Pode-se concluir que um programa de reabilitacao aural, incluindo treinamento auditivo formal beneficia os idosos no periodo de adaptacao das proteses auditivas, bem como modifica o comportamento auditivo destes individuos.

Proposta de acompanhamento em grupo para idosos protetizados

Implementing rehabilitation programs to hearing impaired adults is of great importance, mainly in the elderly population, and it is necessary to add them to the routine of outpatient care programs. AIM: to present a group care program for elderly patients who are fitted with hearing aids. MATERIAL AND METHOD: to carry out a pilot study of clinical and experimental type, with the participation of 40 elderly users of hearing aids donated by the government, distributed within six groups, with maximum of eight participants jointly with their respective companions. Program consisted of three meetings every fifteen days, where information and education on the proper use hearing aids was transmitted. RESULTS: Most of the patients participated actively in the meetings spontaneously giving their opinion or answering questions when so requested. All elderly had been informed as to the importance of accepting their auditory deficiency and on the need to be motivated towards using hearing aids. Moreover, listening to depositions of other elderly users seemed to facilitate understanding of their own difficulties and stimulated them in the process of getting used to the sound amplification. CONCLUSION: Groups structure facilitated interaction among aged ones, helping them to clarify communication doubts and strategies and, consequently, it promoted their adaptation.

Questionário Hearing Handicap Inventory for the Elderly - Screening version (HHIE-S): estudo da sensibilidade e especificidade

PURPOSE: To investigate the sensitivity and specificity of the questionnaire Hearing Handicap Inventory for the Elderly - Screening version (HHIE-S) in the hearing screening of elderly people who seek for different health care services (audiological clinic and other clinics). METHODS: The hearing of 78 elderly - 23 attended at the Discipline of Geriatrics and Gerontology of the institution who did not, necessarily, have complaints regarding their hearing, and 55 attended at the Audiology Clinic of the same institution with complaints related to the auditory and/or vestibular systems - was assessed. The HHIE-S questionnaire was applied, and its total score was divided into three categories, according to the handicap perception. RESULTS: A statistically significant relationship was found between handicap and degree of hearing loss in both patients from the Audiology Clinic (p=0.009*) and from the Geriatrics Clinic (p=0.002). In the first group, the HHIE-S questionnaire showed low sensitivity (23.5%) and high specificity (73.7%). In the group of patients from the Geriatrics Clinic, the values of sensitivity (94.7%) and specificity (75%) were both high. CONCLUSIONS: There was positive association between the degree of hearing loss and the handicap referred by both groups of subjects. The HHIE-S questionnaire is a hearing screening instrument with high sensitivity and specificity in identifying hearing loss in elderly people that seek health care services that are not specific for attention related to hearing disorders.

Avaliação da restrição de participação e de processos cognitivos em idosos antes e após intervenção fonoaudiológica

PURPOSE To evaluate the restriction of participation in activities of daily living and cognitive processes in older adults, according to gender and age, before and after rehabilitation. METHODS The study included 50 individuals, 23 females and 27 males. The elderly were divided into two groups: Group 1 to 24 individuals aged between 60 and 74 years (11 females and 13 males), Group 2 - 26 elderly aged above 75 years (12 of female and 14 male). The elderly were evaluated before one year after the adaptation of hearing aids through the HHIE test and MMSE. Bimonthly follow-ups were conducted a total of seven meetings, to ensure the effective use of the prosthesis. As for the statistical analysis were performed descriptive and statistical analysis. RESULTS There was a reduction of the restriction of participation in social and emotional scales HHIE post-intervention in both groups, individuals of both genders. The MMSE test results were better in the post-intervention, regardless of gender and age of the participant. CONCLUSION There is little perception of the restrictions on participation in activities of daily living after rehabilitation. Moreover, the elderly of different ages and both genders decreased cognitive constraints refer after hearing aid fitting.

P300 em sujeitos com perda auditiva

BACKGROUND: behavioral and electrophysiological evaluations contribute to the understanding of the hearing system and to the intervention process. AIM: to investigate the occurrence of P300 in subjects with congenital severe to profound hearing loss, according to the variables of gender, age and hearing loss level. METHOD: the design of this research is a descriptive transversal study. Twenty-nine subjects, 15 male and 14 female, ranging in age from 11 to 42 years, were evaluated. Inclusion criteria were: to have at least 11 years of age and no more than 45 years; to have the diagnosis of congenital severe to profound sensorineural hearing loss; to have no other disorder; and absence of central hearing loss or any other auditory conductive disorder. The first stage consisted of an auditory behavioral and physiological evaluation, including: pure tone audiometry (air and bone conduction measures), speech audiometry, SDT (Speech Detection Threshold) and functional gain measures for the subjects using hearing aids, and immittance measures - tympanometry and acoustic reflexes thresholds; transient evoked otoacoustic emissions (TEOAE); distortion product otoacoustic emissions (DPOAE). The electrophysiological evaluation was the fourth stage of the study and included: auditory brainstem response (ABR) and late latency response (P300). RESULTS: P300 was obtained for 17 out of the 29 subjects. Mean latency and amplitude were 326.97 ms and 3.76 V, respectively. A statistical significant difference was observed for latency when considering the variable age (electrode CzA2 p < 0.003 and CzA1 p < 0.02) and for amplitude when considering the variable hearing loss level (p < 0.0015). CONCLUSION: P300 can be recorded in subjects with hearing loss.