Maria Francisca Colella-Santos

Triagem auditiva em escolares de 5 a 10 anos

OBJETIVO: analisar o desempenho de escolares na triagem auditiva, considerando-se o sexo masculino e feminino e a faixa etaria-grupos I, II e III. METODOS: foram avaliados 287 escolares de cinco a dez anos, do sexo feminino e masculino, que frequentavam o PRODECAD (Programa de Desenvolvimento e Integracao da Crianca e do Adolescente) da UNICAMP. A triagem auditiva foi constituida pela meatoscopia, imitanciometria - timpanometria e pesquisa do reflexo acustico, alem dos testes que compoem a avaliacao simplificada do processamento auditivo. RESULTADOS: na imitanciometria, 60,6% (N=174/287) dos escolares passaram. Constatou-se que houve diferenca estatisticamente significante entre a curva timpanometrica e os grupos estudados. A curva do tipo A foi mais frequente nas criancas maiores, do grupo III. Alem disso, o Grupo III apresentou maior numero de resposta presente para o reflexo acustico, sendo a diferenca entre os grupos estudados estatisticamente significantes. Observa-se que os escolares desse estudo apresentaram mais dificuldade em memorizar sequencia de sons ou ordenacao temporal do que localizar a fonte sonora. CONCLUSAO: com base na analise dos resultados obtidos neste estudo foi possivel concluir que na imitanciometria, 60,6% dos escolares passaram, ou seja, apresentaram condicoes de orelha media normais, alem de integridade de vias auditivas ate o tronco encefalico. Passaram na triagem do processamento auditivo, 56% dos escolares. Com relacao aos grupos estudados, os grupos I e II apresentaram um numero maior de criancas que falharam na triagem auditiva, considerando-se tanto a imitanciometria, como os testes de processamento auditivo.

Resolução temporal: desempenho de escolares no teste GIN - Gaps-in-noise

UNLABELLED Time resolution hearing skill is the minimum time necessary to solve acoustic events, which is fundamental for speech understanding, and which may be assessed by gap-detection tests, such as the Gaps-in-noise test (GIN). AIM the purpose of this study was to verify the performance of time processing ability in children with no hearing and/or education difficulties by applying the GIN test in both genders and ages from 8 to 10 years. STUDY DESIGN a prospective cross-sectional contemporary cohort. MATERIAL AND METHOD The GIN test was applied to 75 school-aged children separated into three groups by age. RESULTS The findings showed no statistical differences among age groups or ears. Males had slightly better responses than females on the percentage of correct responses only. CONCLUSION The gap threshold and percentage of correct responses were calculated regardless of the ear, gender or age, and were respectively 4.7ms and 73.6%. Based on a 95% confidence interval, the cut-off criterion for normal and abnormal performance was 6.1ms for the mean gap detection threshold and 60% for the percentage of correct responses.A habilidade auditiva denominada resolucao temporal consiste no tempo minimo necessario para resolver eventos acusticos, sendo fundamental para a compreensao de fala, e pode ser avaliada por testes de deteccao de gaps, dentre eles o teste GIN - Gaps In Noise. OBJETIVO: Verificar o desempenho da resolucao temporal em criancas sem queixas auditivas e/ou dificuldades escolares, no teste GIN, considerando-se o genero masculino e feminino e a faixa etaria de 8, 9 e 10 anos. FORMA DO ESTUDO: Coorte contemporânea com corte transversal prospectivo. MATERIAL E METODO: O teste GIN foi aplicado em 75 escolares, reunidos em tres grupos por faixa etaria. RESULTADOS: Nao foram encontradas diferencas significantes em relacao as variaveis orelha e faixa etaria. O genero masculino obteve desempenho levemente melhor do que o feminino em relacao apenas a porcentagem de acertos. CONCLUSAO: A media do limiar de deteccao de gaps e porcentagem de acertos foram calculados independente das variaveis orelha, genero e faixa etaria, sendo encontrados os valores de 4,7ms e 73,6%. Baseado no criterio de intervalo de confianca 95% como corte para normalidade, os valores do limiar de deteccao de gap e porcentagem de acertos foram 6,1ms e 60%, respectivamente.

Newborn Hearing Screening and Early Diagnostic in the NICU

The aim was to describe the outcome of neonatal hearing screening (NHS) and audiological diagnosis in neonates in the NICU. The sample was divided into Group I: neonates who underwent NHS in one step and Group II: neonates who underwent a test and retest NHS. NHS procedure was automated auditory brainstem response. NHS was performed in 82.1% of surviving neonates. For GI, referral rate was 18.6% and false-positive was 62.2% (normal hearing in the diagnostic stage). In GII, with retest, referral rate dropped to 4.1% and false-positive to 12.5%. Sensorineural hearing loss was found in 13.2% of infants and conductive in 26.4% of cases. There was one case of auditory neuropathy spectrum (1.9%). Dropout rate in whole process was 21.7% for GI and 24.03% for GII. We concluded that it was not possible to perform universal NHS in the studied sample or, in many cases, to apply it within the first month of life. Retest reduced failure and false-positive rate and did not increase evasion, indicating that it is a recommendable step in NHS programs in the NICU. The incidence of hearing loss was 2.9%, considering sensorineural hearing loss (0.91%), conductive (1.83%) and auditory neuropathy spectrum (0.19%).

(Central) Auditory Processing: the impact of otitis media

OBJECTIVE: To analyze auditory processing test results in children suffering from otitis media in their first five years of age, considering their age. Furthermore, to classify central auditory processing test findings regarding the hearing skills evaluated. METHODS: A total of 109 students between 8 and 12 years old were divided into three groups. The control group consisted of 40 students from public school without a history of otitis media. Experimental group I consisted of 39 students from public schools and experimental group II consisted of 30 students from private schools; students in both groups suffered from secretory otitis media in their first five years of age and underwent surgery for placement of bilateral ventilation tubes. The individuals underwent complete audiological evaluation and assessment by Auditory Processing tests. RESULTS: The left ear showed significantly worse performance when compared to the right ear in the dichotic digits test and pitch pattern sequence test. The students from the experimental groups showed worse performance when compared to the control group in the dichotic digits test and gaps-in-noise. Children from experimental group I had significantly lower results on the dichotic digits and gaps-in-noise tests compared with experimental group II. The hearing skills that were altered were temporal resolution and figure-ground perception. CONCLUSION: Children who suffered from secretory otitis media in their first five years and who underwent surgery for placement of bilateral ventilation tubes showed worse performance in auditory abilities, and children from public schools had worse results on auditory processing tests compared with students from private schools.

Serum Metabolic Alterations upon Zika Infection

Zika virus (ZIKV) infection has recently emerged as a major concern worldwide due to its strong association with nervous system malformation (microcephaly) of fetuses in pregnant women infected by the virus. Signs and symptoms of ZIKV infection are often mistaken with other common viral infections. Since transmission may occur through biological fluids exchange and coitus, in addition to mosquito bite, this condition is an important infectious disease. Thus, understanding the mechanism of viral infection has become an important research focus, as well as providing potential targets for assertive clinical diagnosis and quality screening for hemoderivatives. Within this context, the present work analyzed blood plasma from 79 subjects, divided as a control group and a ZIKV-infected group. Samples underwent direct-infusion mass spectrometry and statistical analysis, where eight markers related to the pathophysiological process of ZIKV infection were elected and characterized. Among these, Angiotensin (1-7) and Angiotensin I were upregulated under infection, showing an attempt to induce autophagy of the infected cells. However, this finding is concerning about hypertensive individuals under treatment with inhibitors of the Renin-Angiotensin System (RAS), which could reduce this response against the virus and exacerbate the symptoms of the infection. Moreover, one of the most abundant glycosphingolipids in the nervous tissue, Ganglioside GM2, was also elected in the present study as an infection biomarker. Considered an important pathogen receptor at membranes outer layer, this finding represents the importance of gangliosides for ZIKV infection and its association with brain tropism. Furthermore, a series of phosphatidylinositols were also identified as biomarkers, implying a significant role of the PI3K-AKT-mTOR Pathway in this mechanism. Finally, these pathways may also be understood as potential targets to be considered in pharmacological intervention studies on ZIKV infection management.

Fatores na infância e adolescência que podem influenciar o processamento auditivo: revisão sistemática

Ha consenso na literatura da importância do sistema auditivo para o desenvolvimento da linguagem oral e escrita. O Disturbio do Processamento Auditivo refere-se a dificuldade no processamento de informacoes auditivas, nao sendo devido a perda auditiva, nem ao deficit intelectual. O objetivo desta revisao sistematica da literatura foi analisar quais fatores ocorridos na infância e adolescencia podem influenciar no processamento auditivo, nao necessariamente sendo a causa ou consequencia do disturbio. Foram utilizadas as bases SciELO e PUBMed por duas pesquisadoras de forma independente. Os descritores utilizados foram: processamento auditivo; percepcao auditiva; criancas; adolescentes, em combinacoes variadas. Dentre os 205 artigos identificados, 30 artigos corresponderam aos criterios de inclusao, sendo analisados. Apenas dois estudos demonstraram fatores positivos influenciando a habilidade do processamento auditivo: a influencia da estimulacao musical na infância e o uso de Metilfenidato, como tratamento doTranstorno de Deficit de Atencao e Hiperatividade. As influencias sao, em sua maioria, negativas ao processamento auditivo, destacando-se a relacao do disturbio com a dislexia, dificuldades escolares, disturbio especifico de linguagem, nivel socioeconomico baixo, Transtorno de Deficit de Atencao e Hiperatividade, nascimento pre-termo, desvio fonologico, deficiencia visual, respiracao oral, gagueira, otite media, fissura labiopalatina, anemia, exposicao ao mercurio metalico, sindrome da apneia/hipopneiaobstrutiva do sono, acidente vascular cerebral, criancas em vulnerabilidade social e criancas disfonicas. O Processamento Auditivo mostra-se sensivel as influencias negativas de fatores ambientais, quimicos, condicoes socioeconomicas, alteracoes de linguagem, auditivas, e neurologicas. A exposicao a musica e o uso de Metilfenidato foram os unicos fatores, com influencia positiva nas habilidades do processamento auditivo.

Temporal Auditory Processing and Phonological Awareness in Children with Benign Epilepsy with Centrotemporal Spikes

The aim of this research was to analyze temporal auditory processing and phonological awareness in school-age children with benign childhood epilepsy with centrotemporal spikes (BECTS). Patient group (GI) consisted of 13 children diagnosed with BECTS. Control group (GII) consisted of 17 healthy children. After neurological and peripheral audiological assessment, children underwent a behavioral auditory evaluation and phonological awareness assessment. The procedures applied were: Gaps-in-Noise test (GIN), Duration Pattern test, and Phonological Awareness test (PCF). Results were compared between the groups and a correlation analysis was performed between temporal tasks and phonological awareness performance. GII performed significantly better than the children with BECTS (GI) in both GIN and Duration Pattern test (P < 0.001). GI performed significantly worse in all of the 4 categories of phonological awareness assessed: syllabic (P = 0.001), phonemic (P = 0.006), rhyme (P = 0.015) and alliteration (P = 0.010). Statistical analysis showed a significant positive correlation between the phonological awareness assessment and Duration Pattern test (P < 0.001). From the analysis of the results, it was concluded that children with BECTS may have difficulties in temporal resolution, temporal ordering, and phonological awareness skills. A correlation was observed between auditory temporal processing and phonological awareness in the suited sample.

Emissões otoacústicas e medidas de imitância acústica com tons de sonda de 226 e 1000 hz em lactentes

PURPOSE: to assess the results found in Immittance measurements using 226 Hz and 1000 Hz in neonates without Hearing Loss Risks Indicators (HLRI) and to correlate them to Transient Evoked Otoacoustic Emissions (TOAEs) and also to study Acoustic Reflex using 226 Hz probe tones. METHODS: assessments of 52 full - term neonates, being 26 males and 26 females on an age group from 11 to 51 days of life. Anamnesis, Meatoscopy, EOAT, Tympanometry using 226 and 1000 probe tones and Ipsilateral Acoustic Reflex Research were performed. For statistical analysis of the data the following tests were applied: Wilcoxon Test and McNemar, Mann-Whitney Test, Test Qui-Square and Kruskal-Wallis ANOVA. RESULTS: data were analyzed regardless gender and ears. In relation to TOAEs, (78.8%) were found. The found tympanometric curves using 226 Hz probe tone were: A (55.8%), D (40.4%) and Ar (1%), B (2.9%); and the found ones using 1000 Hz probe tone were: A (74%), D (1%), B (14,4%) and Blocked (10.6%). According to p - value, there was a relation between Tympanometric and general reproductivity. On the sample, 81.7% of the ears indicated presence of Acoustic Reflex. CONCLUSION: tympanometric curve using 1000 Hz probe tone showed to be more adequate for detecting changes in the middle ear than 226 Hz probe tone, changes in the middle ear had influence on amplitude by frequency band and general reproductivity of TOAEs. Acoustic Reflex using 226 Hz probe tone was present in most of the neonates without HLRI.

Resolução temporal: procedimentos e parâmetros de avaliação em escolares

UNLABELLED Temporal resolution enables the identification of fine differences in speech segmental aspects. Random Gap Detection Test (RGDT) and Gaps-In-Noise Test (GIN) evaluate such skills, by using different acoustic parameters. OBJECTIVE To compare the performance of normal school aged children without learning disabilities and/or hearing complaints in the GIN and RGDT, and analyze potential performance differences in these two procedures. METHOD Cross sectional contemporary cohort study. 28 children, aged 8-10 years were evaluated. After peripheral audiological evaluation, RGDT and GIN were performed. RESULTS There were no statistical differences in performance between gender and age on the RGDT and GIN tests, between the right and left ears on the GIN test, and between frequencies on the RGDT test. The mean detection threshold gap for RGDT was 9.25 ± 3.67 ms, and for GIN was 4.32 ± 0.61 ms (right ear) and 4.43 ± 0.79 ms (left ear). The results of the GIN Test were statistically lower than those from the RGDT (p < 0.001). CONCLUSION Both tests indicated normal temporal resolution for all 28 children. GIN test presents advantages regarding the ease of application, task variable, stimuli and presentations form. However, the RGDT has advantages concerning the time required for administration and scoring.

Audiological and genetics studies in high-risk infants

UNLABELLED Hearing is one of the main ways with which one person can contact the external world; it plays a key role in their integration with society. AIM The objective of this study was to analyze the results of the hearing, medical and genetic evaluation of high-risk infants who failed the newborn hearing screening. MATERIALS AND METHODS Clinical and experimental study. We assessed thirty-eight neonates, with ages between one and six months. The infants underwent the following procedures: medical interview; immittance testing; Brainstem Auditory Evoked Potential; Transient Evoked Otoacoustic Emission and otorhinolaryngological evaluation. DNA extraction from the oral mucosa was performed for genetic studies using the protocol method adapted from the Human Genetics Lab of the CBMEG/UNICAMP. RESULTS Regarding gender and presence of risk factors, significant statistically differences were not found in normal hearing infants and in those with hearing loss. Concerning gestational age, term infants were more affected by hearing loss. Hearing loss was identified in 58% of the sample, conduction hearing loss represented 31.5% (12/38) and neurossensory 28.9% of cases. There were none of the genetic mutations most commonly seen in cases with a genetic etiology. CONCLUSION Hearing loss was identified in the majority of High-risk infants.