Pricila Sleifer

Prevalência de perda auditiva em recém-nascidos de muito baixo peso

Objectives: to evaluate the prevalence of hearing alterations in very low birth weight patients in the Neonatal Intensive Care Unit of the Hospital de Clinicas de Porto Alegre and to study the variables that can be related to alterations of the hearing acuity.

Auditory hypersensitivity in children and teenagers with autistic spectrum disorder

OBJECTIVE To verify if the clinical behavior of auditory hypersensitivity, reported in interviews with parents/caregivers and therapists/teachers of 46 children and teenagers suffering from autistic spectrum disorder, correspond to audiological findings. METHOD The clinical diagnosis for auditory hypersensitivity was investigated by means of an interview. Subsequently, a test of the acoustic stapedial reflex was conducted, and responses to intense acoustic stimulus in open field were observed. RESULTS Of the 46 subjects, 11 (23.9%) were clinically diagnosed as oversensitive to sound and only 2 showed discomfort when exposed to intense acoustic stimulus in open field. There was no statistically significant difference for the test of the ipsilateral acoustic stapedial reflex between the groups. CONCLUSION Behavioral manifestations to sounds are not associated to hypersensitivity of the auditory pathways, but instead these are associated to difficulties in the upper processing, involving systems that usually are impaired in autistic spectrum patients, such as the limbic system.

The impact of chronic suppurative otitis media on children's and teenagers’ hearing

OBJECTIVE Otitis media is the most common otological condition during childhood which compromises sound conduction in the middle ear. In chronic cases, it is estimated that the degree to which hearing is compromised is directly proportional to the damage caused to the middle ears structures. It means that hearing thresholds may be influenced by factors such as the size and location of the tympanic perforation, the presence of ossicular chain erosion or disarticulation as well as the presence of cholesteatoma and its growth patterns. The goals of this study were to compare air conduction, bone conduction thresholds and air-bone gaps of children and teenagers between those with chronic suppurative otitis media with cholesteatoma and those without cholesteatoma. To compare air-bone gap values for different cholesteatoma growth patterns. To verify the relationship between the number of perforated quadrants and the size of the air-bone gap. To compare air-bone gap values between tympanic perforations in posterior quadrants with those in anterior quadrants. METHODS A transversal study involving 202 children and teenagers (287 ears), aged between 6 and 18, with chronic suppurative otitis media with and without cholesteatoma, submitted to digital videotoscopy and pure tone audiometry (PTA) was conducted. RESULTS AND CONCLUSIONS Air conduction, bone conduction thresholds and air-bone gaps in children and teenagers with CCOM are significantly greater. There were no significative differences between air-bone gaps in epitympanic and posterior mesotympanic cholesteatomas. In NCCOM, the gap value is positively correlated with the number of quadrants with tympanic perforation. There was no significative difference between the air-bone gaps in tympanic perforations affecting the posterior and anterior quadrants.

Achados na triagem imitanciométrica e de processamento auditivo em escolares

PURPOSE: to check acoustic immittance screening findings and results of the simplified evaluation of auditory processing in school children. METHOD: the subjects under this study were students from the 1st to the 4th grade, with ages ranging from seven to ten year-old, from a public school in Porto Alegre. 130 students were evaluated in the immitance screening, which consisted of a tympanometry and an ipsilateral acoustic reflex, and a simplified evaluation of auditory processing. This has also involved the tests of sonorous localization, and verbal and non-verbal sequential memory. RESULTS: in the screening immittance, 43.08% of the students passed and the type A curve was the most frequent. The acoustic reflex at 4000 Hz had a lower percentage of appearance when compared with the others. In the tests for simplified evaluation of auditory processing, 76.15% of the children passed. Moreover, it was observed that the worst performance of the evaluated students was found in the verbal sequential memory test. CONCLUSION: the type A tympanometric curve was the most frequent in this population. In the simplified evaluation of auditory processing, most subjects passed, obtaining higher frequency of correct answers in the sonorous localization test. No statistical association between the results of the immittance screening and the simplified evaluation of auditory processing was found.

Language and Focal Brain Lesion in Childhood

Childhood ischemic strokes can lead to problems like hemiplegias, epilepsies, cognitive changes (memory and mathematical solutions), and language ability (reading, writing, and aphasias). The purpose of this study was to evaluate language and its aspects in children with unilateral ischemic stroke and associate them with the age during the event, injured side, and occurrence of epilepsy. Thirty-two children between 8 months and 19 years of age were evaluated. Among them, 21 (65%) had a change in their language skills, there being a connection between age and the time of injury (P < .05). The most impaired aspects were their phonology, semantics, and syntax. In this sample, there was a persistent change in the semantic aspect, which is an alert for the early detection of learning and future development problems.

Potenciais evocados auditivos corticais em neonatos nascidos a termo e pré-termo

Purpose To measure the exogenous components of the cortical auditory evoked potential (CAEP) in term and preterm newborns and compare them considering the variables latency and amplitude. Methods This is a cross-sectional, prospective, comparative, contemporary study. One hundred twenty-seven newborns were evaluated; 96 of these were included in the study after analysis of the exams by three referees. Participants were divided into two groups: Term Group: 66 infants and Preterm Group: 30 neonates. The recordings of CAEP were performed using surface electrodes with newborns comfortably positioned in the lap of their mothers and/or guardians in natural sleep. To this end, binaural verbal stimuli were presented with /ba/ as the frequent stimulation and /ga/ the rare stimulus, at an intensity of 70 dB HL, through insert earphones. The presence or absence of exogenous components and the latency and amplitude of P1 and N1 were analyzed in both groups. Pertinent tests were used in the statistical analysis of data. Results The latency of the waves P1 and N1 was smaller in participants in the Term Group. However, there were no statistically significant differences in the amplitude of P1 and N1 between the groups. No difference between the groups was found when comparing the presence and absence of the components P2 and N2. Conclusion It is possible to measure the CAEP in term and preterm neonates. There was influence of the maturational process only on the measure of latency of the components P1, binaurally, and N1, in the left ear, which were smaller in participants in the Term Group.

Importance of a multidisciplinary approach and monitoring in fetal warfarin syndrome

Warfarin is a synthetic oral anticoagulant that crosses the placenta and can lead to a number of congenital abnormalities known as fetal warfarin syndrome. Our aim is to report on the follow‐up from birth to age 8 years of a patient with fetal warfarin syndrome. He presented significant respiratory dysfunction, as well as dental and speech and language complications. The patient was the second child of a mother who took warfarin during pregnancy due to a metallic heart valve. The patient had respiratory dysfunction at birth. On physical examination, he had a hypoplastic nose, pectus excavatum, and clubbing of the fingers. Nasal fibrobronchoscopy showed upper airway obstruction due to narrowing of the nasal cavities. He underwent surgical correction with Max Pereira graft, zetaplasty, and osteotomies for the piriform aperture. At dental evaluation, he had caries and delayed eruption of the upper incisors. Speech and language assessment revealed high palate, mouth breathing, little nasal patency, and shortened upper lip. Auditory long latency and cognitive‐related potential to auditory stimuli demonstrated functional changes in the cortical auditory pathways. We believe that the frequency of certain findings observed in our patient may be higher in fetal warfarin syndrome than is appreciated, since a significant number result in abortions, stillbirths, or children evaluated in the first year of life without a follow‐up. Thus, a multidisciplinary approach and long‐term monitoring of these patients may be necessary.

Correlation of the findings of auditory steady-state evoked potential and of behavioral hearing assessment in infants with sensorineural hearing loss

PURPOSE To correlate the findings of an open-field audiometry with the thresholds of steady-state auditory-evoked potentials (SSAEPs) found in infants of up to 6 months of age with sensorineural hearing loss. METHODS This study included 19 infants with sensorineural hearing loss (8 males and 11 females), with minimum age of 2 months and maximum age of 6 months. The SSAEPs were assessed at 500 and 2000 Hz, and the audiometry was performed in open field through observation of behavioral responses to sound stimuli, at the same frequencies. RESULTS We observed a significant correlation between the findings of both tests conducted at 500 and 2000 Hz, with p-values of 0.002 and 0.013, respectively. There was no statistical difference between ears (p=0.532) and genders (p=0.615). CONCLUSION We conclude that there was a significant correlation between the SSAEP thresholds and the findings of the open-field audiometry. Therefore, we can affirm that the SSAEPs are a viable examination, able to predict the degree and configuration of hearing loss in infants of up to 6 months of age, and that they can be included in the clinical routine of hearing assessments conducted in children.

Analysis of sound pressure levels emitted by children's toys

OBJECTIVE To verify the levels of sound pressure emitted by non-certified childrens toys. METHODS Cross-sectional study of sound toys available at popular retail stores of the so-called informal sector. Electronic, mechanical, and musical toys were analyzed. The measurement of each product was carried out by an acoustic engineer in an acoustically isolated booth, by a decibel meter. To obtain the sound parameters of intensity and frequency, the toys were set to produce sounds at a distance of 10 and 50cm from the researchers ear. The intensity of sound pressure [dB(A)] and the frequency in hertz (Hz) were measured. RESULTS 48 toys were evaluated. The mean sound pressure 10cm from the ear was 102±10 dB(A), and at 50cm, 94±8 dB(A), with p<0.05. The level of sound pressure emitted by the majority of toys was above 85dB(A). The frequency ranged from 413 to 6,635Hz, with 56.3% of toys emitting frequency higher than 2,000Hz. CONCLUSIONS The majority of toys assessed in this research emitted a high level of sound pressure.OBJECTIVE:To verify the levels of sound pressure emitted by non-certified childrens toys. METHODS: Cross-sectional study of sound toys available at popular retail stores of the so-called informal sector. Electronic, mechanical, and musical toys were analyzed. The measurement of each product was carried out by an acoustic engineer in an acoustically isolated booth, by a decibel meter. To obtain the sound parameters of intensity and frequency, the toys were set to produce sounds at a distance of 10 and 50cm from the researchers ear. The intensity of sound pressure [dB(A)] and the frequency in hertz (Hz) were measured. RESULTS:48 toys were evaluated. The mean sound pressure 10cm from the ear was 102±10 dB(A), and at 50cm, 94±8 dB(A), with p<0.05. The level of sound pressure emitted by the majority of toys was above 85dB(A). The frequency ranged from 413 to 6,635Hz, with 56.3% of toys emitting frequency higher than 2,000Hz. CONCLUSIONS: The majority of toys assessed in this research emitted a high level of sound pressure.

Estudo das medidas de imitância acústica com tom sonda de 226 e 1000 Hz em neonatos

PURPOSE: Study the measures of volume, peak pressure and complacency in tympanometric curves of neonates with gender, ears and tone probe of 226 and 1000 Hz and analyze the responses obtained in the survey of the acoustic reflections with the two tone probe tested. METHODS: transversal study, observational and contemporary. We evaluated 73 neonatal with integrity of outer hair cells observed by transient evoked otoacoustic emissions. The children performed the evaluation of measures of acoustic immittance clinical outcome, observation of the answers obtained in tympanometries and research of acoustic reflexes with tone probe 226 and 1000 Hz. RESULTS: We observed statistically significant difference between the curves of single and double peak, with a higher occurrence of single peak with tone probe of 1000 Hz. There was statistically significant difference between the genders as complacency in 226 Hz and between the ears in compliance measures and peak pressure in 226 and 1000 Hz, respectively. In addition, we found statistically significant difference in the average of the ipsilateral and contralateral acoustic reflexes with tone probe of 1000 Hz against the variable gender and ipsilateral and contralateral reflexes between the frequencies of 1000 and 2000 Hz with tone probe of 226 and 1000 Hz. CONCLUSION: The results obtained in this study showed statistically significant difference between analyzed variables with tone probe of 226 and 1000 Hz tone. The compliance values and reflexes were higher in females. All neonates had acoustic reflexes, and reflexes contralateral higher than the ipsilateral.