Silvio Pires Penteado

Remote hearing aid fitting: Tele-audiology in the context of Brazilian Public Policy.

Summary Introduction: Currently, the Brazilian government has certificated nearly 140 specialized centers in hearing aid fittings through the Brazilian National Health System (SUS). Remote fitting through the Internet can allow a broader and more efficient coverage with a higher likelihood of success for patients covered by the SUS, as they can receive fittings from their own homes instead of going to the few and distant specialized centers. Aim: To describe a case of remote fitting between 2 cities, with revision of the literature. Method: Computer gears, a universal interface, and hearing aids were used. Case study: An audiologist located in a specialized center introduced a new hearing aid and its fitting procedure to a remote center (200 km away). The specialized center helped the remote center in fitting a hearing aid in 2 patients, and performed fitting in one of its own patients. The whole process was done through the Internet with audio and video in real time. Results: Three patients were fitted remotely. Three audiologists were remotely trained on how to fit the hearing aids. Conclusions: Remote fitting of hearing aids is possible through the Internet, as well as further supplying technical training to a remote center about the fitting procedures. Such a technological approach can help the government advance public policies on hearing rehabilitation, as patients can be motivated about maintaining their use of hearing aids with the option to ask for help in the comfort of their own homes.

Designing of a Digital Behind-the-Ear Hearing Aid to Meet the World Health Organization Requirements

Hearing loss is a common health issue that affects nearly 10% of the world population as indicated by many international studies. The hearing impaired typically experience more frustration, anxiety, irritability, depression, and disorientation than those with normal hearing levels. The standard rehabilitation tool for hearing impairment is an electronic hearing aid whose main components are transducers (microphone and receiver) and a digital signal processor. These electronic components are manufactured by supply chain rather than by hearing aid manufacturers. Manufacturers can use custom-designed components or generic off-the-shelf components. These electronic components are available as application-specific or off-the-shelf products, with the former designed for a specific manufacturer and the latter for a generic approach. The choice of custom or generic components will affect the product specifications, pricing, manufacturing, life cycle, and marketing strategies of the product. The World Health Organization is interested in making available to developing countries hearing aids that are inexpensive to purchase and maintain. The hearing aid presented in this article was developed with these specifications in mind together with additional contemporary features such as four channels with wide dynamic range compression, an adjustable compression rate for each channel, four comfort programs, an adaptive feedback manager, and full volume control. This digital hearing aid is fitted using a personal computer with minimal hardware requirements in intuitive three-step fitting software. A trimmer-adjusted version can be developed where human and material resources are scarce.Hearing loss is a common health issue that affects nearly 10% of the world population as indicated by many international studies. The hearing impaired typically experience more frustration, anxiety, irritability, depression, and disorientation than those with normal hearing levels. The standard rehabilitation tool for hearing impairment is an electronic hearing aid whose main components are transducers (microphone and receiver) and a digital signal processor. These electronic components are manufactured by supply chain rather than by hearing aid manufacturers. Manufacturers can use custom-designed components or generic off-the-shelf components. These electronic components are available as application-specific or off-the-shelf products, with the former designed for a specific manufacturer and the latter for a generic approach. The choice of custom or generic components will affect the product specifications, pricing, manufacturing, life cycle, and marketing strategies of the product. The World Health Organization is interested in making available to developing countries hearing aids that are inexpensive to purchase and maintain. The hearing aid presented in this article was developed with these specifications in mind together with additional contemporary features such as four channels with wide dynamic range compression, an adjustable compression rate for each channel, four comfort programs, an adaptive feedback manager, and full volume control. This digital hearing aid is fitted using a personal computer with minimal hardware requirements in intuitive three-step fitting software. A trimmer-adjusted version can be developed where human and material resources are scarce.

Use of the satisfaction with amplification in daily life questionnaire to assess patient satisfaction following remote hearing aid adjustments (telefitting).

Background Hearing loss can affect approximately 15% of the pediatric population and up to 40% of the adult population. The gold standard of treatment for hearing loss is amplification of hearing thresholds by means of a hearing aid instrument. A hearing aid is an electronic device equipped with a topology of only three major components of aggregate cost. The gold standard of hearing aid fittings is face-to-face appointments in hearing aid centers, clinics, or hospitals. Telefitting encompasses the programming and adjustments of hearing aid settings remotely. Fitting hearing aids remotely is a relatively simple procedure, using minimal computer hardware and Internet access. Objective This project aimed to examine the feasibility and outcomes of remote hearing aid adjustments (telefitting) by assessing patient satisfaction via the Portuguese version of the Satisfaction With Amplification in Daily Life (SADL) questionnaire. Methods The Brazilian Portuguese version of the SADL was used in this experimental research design. Participants were randomly selected through the Rehabilitation Clinical (Espaco Reouvir) of the Otorhinolaryngology Department Medical School University of Sao Paulo. Of the 8 participants in the study, 5 were female and 3 were male, with a mean age of 71.5 years. The design consisted of two face-to-face sessions performed within 15 working days of each other. The remote assistance took place 15 days later. Results The average scores from this study are above the mean scores from the original SADL normative data. These indicate a high level of satisfaction in participants who were fitted remotely. Conclusions The use of an evaluation questionnaire is a simple yet effective method to objectively assess the success of a remote fitting. Questionnaire outcomes can help hearing stakeholders improve the National Policy on Hearing Health Care in Brazil. The results of this project indicated that patient satisfaction levels of those fitted remotely were comparable to those fitted in the conventional manner, that is, face-to-face.

The Influence of Sound Generator Associated With Conventional Amplification for Tinnitus Control: Randomized Blind Clinical Trial

Hearing aids with an integrated sound generator have been used to enhance the treatment of tinnitus. The main aim of this study was to verify whether the combined use of amplification and sound generator is more effective than conventional amplification alone in reducing tinnitus annoyance by means of the use of a new hearing aid with an integrated sound generator. A total of 49 patients underwent a blind randomized clinical trial. Tinnitus annoyance was measured by Tinnitus Handicap Inventory and numerical scales, and psychoacoustic measures of tinnitus were also performed. The sound generator was set at the lowest intensity capable of providing relief from tinnitus. Results showed that 62.5% of the patients presented a reduction in tinnitus annoyance in the combined fitting group and in the group with amplification alone, 78% showed a reduction. This difference between the groups was not statistically significant.

Performance analysis of ten brands of batteries for hearing aids.

Summary Introduction: Comparison of the performance of hearing instrument batteries from various manufacturers can enable otologists, audiologists, or final consumers to select the best products, maximizing the use of these materials. Aim: To analyze the performance of ten brands of batteries for hearing aids available in the Brazilian marketplace. Methods: Hearing aid batteries in four sizes were acquired from ten manufacturers and subjected to the same test conditions in an acoustic laboratory. Results: The results obtained in the laboratory contrasted with the values reported by manufacturers highlighted significant discrepancies, besides the fact that certain brands in certain sizes perform better on some tests, but does not indicate which brand is the best in all sizes. Conclusions: It was possible to investigate the performance of ten brands of hearing aid batteries and describe the procedures to be followed for leakage, accidental intake, and disposal.

Development of a digital hearing aid to meet the Brazilian Government's Ordinance 587 (APAC)

O tratamento das disacusias sensorio-neurais esta balizado no uso de proteses auditivas, conhecidas como aparelhos auditivos ou aparelhos de amplificacao sonora individuais. As proteses auditivas adquiridas pelo Governo Brasileiro para a conducao de politicas publicas tem como uma de suas caracteristicas a utilizacao de componentes dedicados, o que traz beneficios, mas que encarece a aquisicao e pode inviabilizar os servicos de reparo apos o termino da garantia do fabricante. OBJETIVO: Desenvolver proteses auditivas digitais no desenho retroauricular, construidas a partir de componentes padronizados oriundos da propria cadeia de suprimentos dos fabricantes de proteses auditivas. FORMA DE ESTUDO: Experimental. MATERIAL E METODO: Identificar a cadeia de suprimentos destes fabricantes, solicitar amostras e montar proteses auditivas em laboratorio. RESULTADOS: As proteses auditivas desenvolvidas apresentaram recursos eletroacusticos nao inferiores aquelas adquiridas pelo Governo, sendo adicionalmente atestadas pela mesma norma tecnica internacional de referencia. CONCLUSAO: E possivel desenvolver proteses auditivas digitais no desenho retroauricular montados a partir de componentes padronizados da cadeia de suprimentos dos fabricantes de proteses auditivas. Suas vantagens residem no baixo custo operacional - aquisicao (com vantagens para o Governo) e de manutencao (com vantagens para o paciente).

Desenvolvimento de prótese auditiva digital para atendimento da Portaria nº 587 (APAC) do Ministério da Saúde: Health Department

O tratamento das disacusias sensorio-neurais esta balizado no uso de proteses auditivas, conhecidas como aparelhos auditivos ou aparelhos de amplificacao sonora individuais. As proteses auditivas adquiridas pelo Governo Brasileiro para a conducao de politicas publicas tem como uma de suas caracteristicas a utilizacao de componentes dedicados, o que traz beneficios, mas que encarece a aquisicao e pode inviabilizar os servicos de reparo apos o termino da garantia do fabricante. OBJETIVO: Desenvolver proteses auditivas digitais no desenho retroauricular, construidas a partir de componentes padronizados oriundos da propria cadeia de suprimentos dos fabricantes de proteses auditivas. FORMA DE ESTUDO: Experimental. MATERIAL E METODO: Identificar a cadeia de suprimentos destes fabricantes, solicitar amostras e montar proteses auditivas em laboratorio. RESULTADOS: As proteses auditivas desenvolvidas apresentaram recursos eletroacusticos nao inferiores aquelas adquiridas pelo Governo, sendo adicionalmente atestadas pela mesma norma tecnica internacional de referencia. CONCLUSAO: E possivel desenvolver proteses auditivas digitais no desenho retroauricular montados a partir de componentes padronizados da cadeia de suprimentos dos fabricantes de proteses auditivas. Suas vantagens residem no baixo custo operacional - aquisicao (com vantagens para o Governo) e de manutencao (com vantagens para o paciente).

Development of a digital hearing aid to meet the Brazilian Government's Ordinance 587 (APAC) - Health Department

O tratamento das disacusias sensorio-neurais esta balizado no uso de proteses auditivas, conhecidas como aparelhos auditivos ou aparelhos de amplificacao sonora individuais. As proteses auditivas adquiridas pelo Governo Brasileiro para a conducao de politicas publicas tem como uma de suas caracteristicas a utilizacao de componentes dedicados, o que traz beneficios, mas que encarece a aquisicao e pode inviabilizar os servicos de reparo apos o termino da garantia do fabricante. OBJETIVO: Desenvolver proteses auditivas digitais no desenho retroauricular, construidas a partir de componentes padronizados oriundos da propria cadeia de suprimentos dos fabricantes de proteses auditivas. FORMA DE ESTUDO: Experimental. MATERIAL E METODO: Identificar a cadeia de suprimentos destes fabricantes, solicitar amostras e montar proteses auditivas em laboratorio. RESULTADOS: As proteses auditivas desenvolvidas apresentaram recursos eletroacusticos nao inferiores aquelas adquiridas pelo Governo, sendo adicionalmente atestadas pela mesma norma tecnica internacional de referencia. CONCLUSAO: E possivel desenvolver proteses auditivas digitais no desenho retroauricular montados a partir de componentes padronizados da cadeia de suprimentos dos fabricantes de proteses auditivas. Suas vantagens residem no baixo custo operacional - aquisicao (com vantagens para o Governo) e de manutencao (com vantagens para o paciente).