Marisa Frasson de Azevedo

Programa de triagem auditiva neonatal: associação entre perda auditiva e fatores de risco

BACKGROUND: hearing loss in newborns. Aim: to verify the prevalence of auditory alterations in newborns of Hospital Sao Paulo (hospital), observing if there are any correlations with the following variables: birth weight, gestational age, relation weight/gestational age and risk factors for hearing loss. METHOD: A retrospective analysis of the hospital records of 1696 newborns; 648 records of preterm infants and 1048 records of infants born at term. All of the infants had been submitted to an auditory evaluation consisting of: Transient Otoacoustic Emissions, investigation of the cochleal-palpebral reflexes and acoustic imittance tests, identifying the type and level of hearing loss. RESULTS: sensorineural hearing loss was identified in .82% of the infants who were born at term and in 3.1% of the preterm infants - with a statistically significant difference. Conductive hearing loss was the most frequent type of hearing loss in both groups, occurring in 14.6% of the term infants and in 16.3% of the preterm infants. Alteration of the central auditory system was considered as a possible diagnosis for 5.8% of the preterm infants and for 3.3% of the term infants. For the group of infants who were born at term, a significant correlation was observed between failure in the hearing screening test and the presence of risk factors such as family history and presence of a syndrome - the child who presented a syndrome had 37 times more chances of failing in the hearing screening test and seven times more chances of failing in the right ear when there was a family history for hearing loss. The lower the gestational age (< 30 weeks) and birth weight (< 1500g), the higher the chances of failing in the hearing screening test (3 times more). CONCLUSION: hearing loss had a higher occurrence in preterm infants who remained in the ICU. Gestational age and birth weight were important variables related to the possibility of failure in the hearing screening test. A correlation was observed between the presence of a syndrome and sensorineural hearing loss in infants who were born at term.

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.

Triagem auditiva neonatal: ocorrência de falhas, perdas auditivas e indicadores de riscos

UNLABELLED To check the rate of failure, hearing loss and its association with demographic variables and risk indicators for hearing loss in newborns submitted to the Newborn Hearing Screening in a secondary hospital. MATERIALS AND METHODS Cross-sectional and retrospective study, involving 1,570 newborns submitted to the different stages of the Newborn Hearing Screening Program. Initially, we carried out otoacoustic emission tests (ILO Echocheck) and the cochlear-eyelid reflex. Afterwards, we analyzed the demographic and clinical characteristics of the newborns, screening rate of failure, hearing loss and its association with demographic variables and risk indicators. RESULTS Twenty-six newborns had failures in the first stages of the Program (1.7%), who were then referred to diagnostic evaluation. Of these, 16 (61.5%) did not come, two (7.7%) had normal results and eight (30.8%) were diagnosed with hearing disorders. The screening failure rate was 1.7% and the frequency of hearing disorders was 0.5%. CONCLUSIONS Pre-term newborns of very low birth weights had higher rates of screening failures and a greater occurrence of hearing changes. The factors associated with screening failure and hearing changes were similar to the ones described in the literature.

Linguagem expressiva de crianças nascidas pré-termo e termo aos dois anos de idade

BACKGROUND expressive language of pre-term children. AIM to compare the expressive vocabulary of two year-old children born prematurely, to that of those born at term. METHODS the study sample was composed by 118 speech-language assessment protocols, divided in two groups: the pre-term group (PTG) composed by 58 underweight premature children followed by a multi-professional team at the Casa do Prematuro (House of Premature Children) at Unifesp, and the full-term group (FTG) composed by 60 full-term born children. In order to evaluate the expressive language of these children, the Lave - Lista de Avaliação do Vocabulário Expressivo (Assessment List of the Expressive Vocabulary) was used. The Lave is an adaptation of the LDS - Language Development Survey - for the Brazilian Portuguese Language. The Lave investigates the expressive language and detects delays in oral language. RESULTS children born underweight and prematurely present a greater occurrence of expressive language delay, 27.6%. These pre-term children present significantly lower expressive vocabulary and phrasal extension than children of the same age born at full-term in all semantic categories. Family income proved to be positively associated to phrasal extension, as well as to gestational age and weight at birth; thus indicating the effect of these adverse conditions still during the third year of age. The audiological status was associated to word utterances in the PTG. CONCLUSION children born prematurely and underweight are at risk in terms of vocabulary development; this determines the need for speech-therapy intervention programs.BACKGROUND: expressive language of pre-term children. AIM: to compare the expressive vocabulary of two year-old children born prematurely, to that of those born at term. METHODS: the study sample was composed by 118 speech-language assessment protocols, divided in two groups: the pre-term group (PTG) composed by 58 underweight premature children followed by a multi-professional team at the Casa do Prematuro (House of Premature Children) at Unifesp, and the full-term group (FTG) composed by 60 full-term born children. In order to evaluate the expressive language of these children, the Lave - Lista de Avaliacao do Vocabulario Expressivo (Assessment List of the Expressive Vocabulary) was used. The Lave is an adaptation of the LDS - Language Development Survey - for the Brazilian Portuguese Language. The Lave investigates the expressive language and detects delays in oral language. RESULTS: children born underweight and prematurely present a greater occurrence of expressive language delay, 27.6%. These pre-term children present significantly lower expressive vocabulary and phrasal extension than children of the same age born at full-term in all semantic categories. Family income proved to be positively associated to phrasal extension, as well as to gestational age and weight at birth; thus indicating the effect of these adverse conditions still during the third year of age. The audiological status was associated to word utterances in the PTG. CONCLUSION: children born prematurely and underweight are at risk in terms of vocabulary development; this determines the need for speech-therapy intervention programs.

Respostas falso-positivas na triagem auditiva neonatal universal: possíveis causas

OBJETIVO: avaliar a ocorrencia de respostas falso-positivas na Triagem Auditiva dentro de uma maternidade particular, suas possiveis causas e solucoes. METODOS: foram avaliados 1.110 recem-nascidos eutroficos entre 6 e 48 horas de vida no bercario, com o analisador de Emissoes Otoacusticas Evocadas Transientes (EOATE) modelo Echochek da Ilodynamics Ltd. Na ausencia de resposta, foi realizada a manipulacao do meato acustico externo (Manobra Facilitadora) e colhido novo resultado. Os que falharam foram retestados em 15 dias. RESULTADOS: 50,09% dos RN falhou na primeira tentativa. Apos a manobra facilitadora, 24,41% continuou falhando, mas demonstraram EOATE presentes no reteste. O tempo medio de internacao foi de 42,27 h, sendo 93,42% oriundos de cesareana. Pertenciam a convenios particulares padrao enfermaria 98% e 2% quarto individual. A idade media do grupo que passou foi de 24,14 h (± 10,21) e a do grupo que falhou 19,19 horas (±8,43). Possuiam menos de 24 horas de vida no momento do teste 66,12% dos RN, foi constatado vernix obliterante em 4.9%. CONLUSAO: face a alta precoce hospitalar, e necessario que o Fonoaudiologo realize o teste antes das 48 horas de vida do RN. Desta forma, alem das causas biologicas inerentes a faixa etaria, detectou-se um problema estrutural de administracao hospitalar, que independe da habilidade ou experiencia do Fonoaudiologo. A Manobra Facilitadora e altamente recomendada.

O cigarro como um fator de risco para alterações auditivas

O tabagismo e um problema de saude publica e ainda nao se sabe ao certo sua relacao com problemas auditivos. OBJETIVO:Verificar o efeito do cigarro nos limiares audiometricos, na ocorrencia das emissoes otoacusticas e na inibicao das mesmas pelo sistema eferente olivococlear medial. MATERIAL E METODO: 144 adultos de ambos os sexos, entre 20 a 31 anos, fumantes e nao fumantes, foram submetidos a audiometria convencional e de alta frequencia, emissoes otoacusticas por estimulo transiente e a pesquisa do efeito de supressao. RESULTADOS: O grupo de fumantes apresentou limiares auditivos piores nas frequencias 12500Hz na orelha direita e 14000Hz em ambas orelhas. Nas emissoes otoacusticas apresentou nivel de resposta menor nas frequencias de 1000Hz em ambas orelhas e 4000Hz na orelha esquerda. O grupo de fumantes tambem apresentou maior numero de casos com disfuncao coclear e queixa de zumbido. CONCLUSAO: Os resultados do estudo sugerem que o cigarro tem um efeito nocivo no sistema auditivo.

Emissões otoacústicas e sistema olivococlear medial: pacientes com zumbido sem perda auditiva

BACKGROUND: tinnitus. AIM: to compare the results of otoacoustic emissions for transitory stimulus (TEOAE) and the functioning of the olivocochlear medial system, in individuals with normal hearing sensibility, with and without tinnitus. METHOD: participants of this study were 60 subjects, with tonal thresholds and acoustic imitance measurements within normal standards, distributed in two groups: group one - 30 subjects with tinnitus and group two - 30 subjects without tinnitus, paired up by gender and age. Both groups were submitted to the TEOAE test, with and without the presence of white contralateral white noise at 60dB NPS. For the 19 subjects who presented unilateral tinnitus, TEOAE and suppression results were compared regarding the variables of side, taking in consideration the presence of tinnitus. RESULTS: in the group comparison, with and without tinnitus, there was no significant statistical difference for the incidence of TEOAE, response levels, and incidence of the suppression effect. Significant statistical difference was not observed between the right and left ears in the group with tinnitus. For the 19 subjects with unilateral tinnitus, a higher amplitude of the responses and a higher suppression incidence were observed for the right ear, as well as a higher incidence of tinnitus and a lower incidence of suppression for the left ear. CONCLUSION: there was no significant statistical difference for both TEOAE incidence and response levels, as well as for the functioning of the olivocochlear medial system between the subjects, with normal hearing sensibility, with and without tinnitus. For the subjects who presented unilateral tinnitus, the overall TEOAE reponse levels was significantly higher in the ear with no tinnitus and the olivocochlear medial system was significantly less efficient in the ear with tinnitus.

Auditory evoked potentials in premature and full-term infants

UNLABELLED Accurate information about type, degree, and configuration of hearing loss are necessary for successful audiological early interventions. Auditory brainstem response with tone burst stimuli (TB ABR) and auditory steady-state response (ASSR) exams provide this information. AIM To analyze the clinical applicability of TB ABR and ASSR at 2 kHz in infants, comparing responses in full-term and premature neonates. MATERIAL AND METHOD The study was cross-sectional, clinical and experimental. Subjects consisted of 17 premature infants and 19 full-term infants. TB ABR and ASSR exams at 2000 Hz were done during natural sleep. RESULTS The electrophysiological minimum response obtained with TB ABR was 32.4 dBnHL (52.4 dBSPL); the ASSR minimum was 13.8 dBHL (26.4 dBSPL). The exams required 21.1 min and 22 min, respectively. Premature and full-term infant responses showed no statistically significant differences, except for auditory steady-state response duration. CONCLUSIONS Both exams have clinical applicability at 2 kHz in infants, with 20 min of duration, on average. In general, there are no differences between premature and full-term individuals.

Medidas de imitância acústica em lactentes com 226hz e 1000hz: correlação com as emissões otoacústicas e o exame otoscópico

A avaliacao audiologica do lactente deve ser composta pela verificacao das condicoes de orelha media (medidas de imitância acustica e otoscopia) e pela avaliacao coclear (Emissoes Otoacusticas). OBJETIVO: Verificar qual tom teste da timpanometria (226Hz ou 1000Hz) tem maior correlacao com o exame otoscopico e com o resultado das Emissoes Otoacusticas por estimulo transiente. METODO: Realizou-se emissoes otoacusticas nos 60 lactentes da amostra, com idade entre de zero e quatro meses. Foram distribuidos em dois grupos, sendo o grupo I 30 lactentes com EOA presente e o grupo II 30 lactentes com EOA ausente. Foram submetidos a timpanometria de multiplas frequencias, com tom teste de 226Hz e 1000Hz e avaliacao otoscopica. RESULTADOS: Na timpanometria, o tom teste de 1000Hz apresentou mais sensibilidade para identificar as alteracoes de orelha media. Nas criancas com curva timpanometrica dentro da normalidade, ambos os tons-teste (226 e 1000Hz) apresentaram alta especificidade. Todas as correlacoes foram significantes com o tom teste de 1000Hz. CONCLUSAO: O tom teste de 1000Hz apresentou maior correlacao estatisticamente significante com as EOA e com a avaliacao otoscopica para lactentes de zero a quatro meses.

Cigarette smoking as a risk factor for auditory problems

UNLABELLED Smoking is a public health concern and we are still unsure of its relation with auditory problems. AIM To study the effects of cigarette smoking in auditory thresholds, in otoacoustic emissions and in their inhibition by the efferent olivocochlear medial system. MATERIALS AND METHODS 144 adults from both genders, between 20 and 31 years of age, smoking and non-smoking individuals were submitted to conventional and high-frequency audiometry, transient stimuli otoacoustic emissions and suppression effect investigation. RESULTS smokers presented worse auditory thresholds in the frequencies of 12.500Hz in the right ear and 14,000 kHz in both ears. Regarding the otoacoustic emissions, smokers group presented a lower response level in the frequencies of 1,000Hz in both ears and 4,000Hz in the left ear. Among smokers there were more cases of cochlear dysfunction and tinnitus. CONCLUSION Our results suggest that cigarette smoking has an adverse effect on the auditory system.