Professional research project (Au.D.)--University of SouthFlorida, 2002. / Title from PDF of title page. / Document formatted into pages; contains 22 pages. / Includes bibliographical references. / Text (Electronic thesis) in PDF format. / ABSTRACT: The purpose of this study was to determine the prevalence of the binaural interaction component (BIC) in a large sample of normal hearing adults, and to measure the absolute latency and amplitude of the BIC as a function of the click rate of the stimulus and the electrode montage. The BIC is obtained by subtracting the auditory evoked potential waveform obtained with binaural stimulation from the waveform obtained by adding the responses from the left and right monaural stimulation. The tested hypothesis was that the recordings of the BIC vary among normal hearing individuals, and BIC latency and amplitude values change as a function of stimulus rate. Studies of the BIC help to explain the neural correlates of some binaural processes, and to develop an electrophysiological index of binaural processes for objective clinical evaluations.Data was completed and analyzed on 47 adults between the ages of 20 and 41 (mean = 25) with hearing in the normal range (thresholds [ 20 dB HL at 500, 1000, 2000, and 4000 Hz in each ear) and no known neurological disorders. The results revealed a great variability in BIC morphology between subjects. The BIC waveforms were categorized into five distinct groups according to the number of positive and negative peaks present. Chi-square analyses revealed a significant relationship between click rate and BIC category; however, the relationship between recording montage and BIC category was insignificant. An Analysis of Variance (ANOVAs) revealed a significant increase in absolute latency and decrease in absolute amplitude of both negative and positive peaks as click rate increased from 7.7/s to 57.7/s. The results did not reveal a significant change in the type of BIC as an effect of electrode montage.In conclusion, the BIC within the binaural difference waveform may be obtained in the majority of young individuals with normal hearing. Specifically, a slower stimulus rate revealed more components of the waveform, as well as an improvement in the morphology of the BIC compared to a faster stimulus rate. As these findings may aid in the development of an electrophysiological index of binaural neural processes in young individuals with normal hearing, more research should be attempted in the study of BIC in other age groups and patients with different audiograms. / System requirements: World Wide Web browser and PDF reader. / Mode of access: World Wide Web.

Methods for collecting behavioral audiograms are often time consuming and require trained, captive subjects. It is more practical to measure hearing sensitivity using electrophysiological methods, such as auditory evoked potential (AEP) testing, in which electrodes measure action potentials in response to acoustic stimuli. These data can be collected in a matter of hours. However, results should be verified through behavioral testing. Current knowledge of marine turtle auditory abilities is based on a few electrophysiological tests. The purpose of this study was to collect and compare behavioral and auditory evoked potential audiograms in a captive adult loggerhead turtle (Caretta caretta). The behavioral audiogram was collected using a go/no-go modified staircase method utilizing 2-second pure-tone stimuli. AEP thresholds were measured underwater using subdermal electrodes placed beneath the frontoparietal scale, dorsal to the midbrain. Action potentials were measured in response to 50 ms tonal stimuli and averaged over a maximum of 1,000 responses. Evoked potential testing yielded thresholds from 100 - 1131 Hz with peak sensitivity at 200 and 400 Hz (110 dB re 1 µPa). Behavioral testing yielded thresholds from 50 - 800 Hz with peak sensitivity at 100 Hz (98 dB re 1 µPa). Behavioral thresholds averaged 8 dB lower than AEP thresholds from 100 to 400 Hz and 5 dB higher at 800 Hz. Results indicate that behavioral and evoked potential techniques are suitable for determining marine turtle hearing sensitivity. AEP testing is a good alternative when dealing with wild or untrained animals and when time is a critical factor.

Coordenação de Aperfeiçoamento de Pessoal de Nível Superior / The organophosphate pesticides are widely used in agriculture, and the widespread application of these agents, without the appropriate use of bio-security measures, has contributed to environmental degradation and the increased incidence of occupational poisoning, becoming one of the main public health problems in rural areas. Studies show that the ototoxic agents, in addition to the peripheral vestibular and auditory systems compromise, also impair central auditory pathways. Among the major toxic agents that can lead to hearing loss are the solvents, metals, suffocating and organophosphate pesticides. This study examined the acute ototoxic action of a pesticide on the peripheral auditory system. This is a prospective experimental study. We used male albino guinea pigs, divided into three groups, which was administered distilled water (group 1 - control), pesticide - 0.3 mg/Kg/day (group 2), pesticide - 3 mg/Kg/day (group 3), for seven consecutive days. The pesticide used was Tamaron® (methamidophos). The auditory functional evaluation was performed using the Distortion Product Otoacoustic Emissions (DPOAE) and Auditory Brainstem Response (ABR), both performed before and immediately after the application of the pesticide. The anatomical assessment was performed with scanning electron microscopy. The guinea pigs subjected to pesticide had cochlear morphological changes, with lesions in three turns examined in electron microscopy, which was increased according to the dosage received from the agent. In all animals the DPOAE was present, but it was verified that the signal/noise ratio of the frequencies of 1.500 and 6.000 Hz in DPOAE of groups 2 and 3 showed statistically significant difference when compared to control group, indicating possible cell impairment. There were no statistically significant changes in functional assessment of VIII nerve when evaluated by wave I of ABR. It is concluded that the organophosphorous can be considered as a harmful acute agent of outer hair cells, seen the correlation between the dose applied and the amount of changes observed by electron microscopy, however, the acute exposure to Tamaron® did not cause functional alteration of the peripheral auditory system. / Os agrotóxicos organofosforados são amplamente utilizados na agricultura, e a elevada aplicação desses agentes, sem o emprego das devidas medidas de biossegurança, vem contribuindo para a degradação ambiental e para o aumento da incidência de intoxicação ocupacional, tornando-se um dos principais problemas de saúde pública no meio rural. Pesquisas demonstram que os agentes ototóxicos, além de comprometer os sistemas auditivo e vestibular periféricos, provocam ainda alterações nas vias auditivas centrais. Dentre os principais agentes químicos que podem levar à perda auditiva incluem-se os solventes, os metais, os asfixiantes e os agrotóxicos organofosforados. O objetivo deste estudo foi analisar a ação ototóxica aguda de um agrotóxico do grupo dos organofosforados no sistema auditivo periférico. Trata-se de um estudo experimental prospectivo, realizado em cobaias albinas machos, divididas em três grupos, nos quais se administrou água destilada (grupo 1 - controle), agrotóxico - 0,3mg/Kg/dia (grupo 2), agrotóxico 3 mg/Kg/dia (grupo 3), durante sete dias consecutivos. O agrotóxico utilizado foi Tamaron® (metamidofós). A avaliação auditiva funcional foi realizada utilizando-se Emissões Otoacústicas Produto de Distorção (EOAPD) e Potencial Evocado Auditivo de Tronco Encefálico (PEATE), ambos realizados antes e imediatamente após o período de aplicação do agrotóxico. A avaliação anatômica foi realizada com Microscopia Eletrônica de Varredura. As cobaias submetidas ao agrotóxico apresentaram alterações morfológicas cocleares, com lesões nas três espiras analisadas na microscopia eletrônica, intensificadas de acordo com a dosagem recebida do agente. Na avaliação auditiva funcional, todas as cobaias apresentaram EOAPD presentes, no entanto verificou-se significância estatística nos valores da relação sinal/ruído das frequências de 1.500 e 6.000 Hz das EOAPD das cobaias dos grupos 2 e 3 quando confrontados com os achados dos animais do grupo controle, indicando um possível sofrimento celular. Não foram encontradas alterações estatisticamente significantes na avaliação do VIII par craniano por meio da análise da onda I do PEATE. Concluiu-se que o organofosforado pode ser considerado um agente lesivo agudo das células ciliadas externas visto a correlação entre a dosagem aplicada e a quantidade de alterações observadas à microscopia eletrônica, entretanto a exposição aguda ao Tamaron® não causou alteração funcional do sistema auditivo periférico.

The Auditory Brainstem Respose signals are characteristic of the combination of neural activity responses in presence of sound stimuli, detected by the cortex and characterized by peaks and valleys. They are named by roman numerals (I, II, III, IV, V, VI and VII). The identification of these peaks is made by the classic manual process of analysis, which is based on the visualization of the signal generated by the sum of each sample. In the sum the morphological characteristics of the signal and the temporal aspects relevant waves made by Jewett are identified. However, in this visual process some difficulties may occur, regarding the recognition of patterns present, which may vary according to local, individual equipment and settings in the selected protocol. Making the analysis of ABR subject to the influence of many variables and a constant source of doubt about the reliability and agreement between examiners. In order to create a system to automatic detection of these peaks and self-learning, that takes into account the profile for evaluate from examiners this work was developed. The continuous wavelet transforms an innovative technique for the detection of peaks was used associate with a probabilistic model for classification based on the histograms with information provide by examiners. In evaluating of the system, based on the swat rate between the system and a manual technique an accuracy ranging for 74.3% to 99.7%, according to each waves. Thus the proposed technique is proved to be accurate especially in ABR that is a sign of low amplitude. / Os PEATE são sinais resultantes da combinação de respostas de atividades neurais a estímulos sonoros, detectados sobre o córtex, que se caracterizam por vales e picos, sendo nomeados por algarismos romanos (I, II, III, IV, V, VI e VII). O processo clássico de identificação desses picos é baseado na visualização do sinal gerado pela somatória de cada uma de suas componentes. Nele são identificadas as características morfológicas do sinal e os aspectos temporais relevantes constituídos pelas ondas de Jewett. No entanto, neste processo de identificação visual surgem dificuldades que tornam a análise visual dos PEATE uma fonte constante de dúvidas em relação à fidedignidade e concordância entre os examinadores. Com o objetivo de melhorar o processo de avaliação dos PEATE, foi desenvolvido um sistema de detecção automática para os picos, com capacidade de aprendizado que leva em consideração o perfil de marcação realizado por examinadores. Para a detecção de picos foi utilizada a Transformada Wavelet Contínua associado a mesma foi desenvolvido um classificador probabilístico baseado nos histogramas gerados a partir de marcações realizadas pelos profissionais. Na avaliação do sistema proposto, com base na taxa de acerto entre o sistema e a marcação manual, o mesmo apresentou uma acurácia variando de 74,3% a 99,7%, dependendo do tipo de onda analisada. Assim a técnica proposta se revela precisa, principalmente na presença de ruído característico de sinais biológicos, especialmente no PEATE, que é um sinal de amplitude baixa. / Doutor em Ciências

Introdução: O Acidente Vascular Cerebral do tipo isquêmico é um quadro clínico que afeta milhares de pessoas no mundo. Como resultado dessa injúria observamos morte neuronal, e no decorrer natural de recuperação, o indivíduo pode desenvolver a sepse. A sepse é uma resposta inflamatória sistêmica que pode levar o indivíduo a morte. No seu desenvolvimento há a produção de diversas citocinas que caracterizam o processo inflamatório no organismo. Para avaliar as condições clínicas de um paciente com esse quadro o Potencial Evocado Auditivo de Tronco Encefálico (PEATE) pode ser útil,uma vez que ele não é um procedimento invasivo, sua técnica é rápida e pode ser feita à beira do leito. Porém, por outro lado, o PEATE pode ser sensível ao uso de alguns anestésicos. Objetivos: Fazer análise das citocinas IL-6, IL-10 e TNF- no decorrer da sepse; verificar os valores de latência do PEATE em gerbils submetidos à isquemia e sepse; e verificar a influência do anestésico ketamina associado à xilazina nos valores do PEATE desses animais. Método: Foram coletados os PEATEs de 72 gerbils machos adultos que foram divididos em 6 grupos, a saber: controle, sepse, isquemia, sham, isquemia com sepse e sham com sepse. Para a indução de sepse foi aplicado Lipopolissacarídeo (LPS) intraperitoneal nos gerbils. Os animais foram anestesiados antes das coletas com ketamina associada à xilazina, seus PEATEs foram coletados antes de qualquer procedimento (coleta base), após isquemia e 2, 4, 8 e 24 horas após a aplicação de LPS. Foi avaliada a latência absoluta da onda V, e os valores foram comparados intra e intergrupos. As citocinas IL-6, IL-10 e TNF- foram analisadas e comparadas em cada grupo estudado. Resultados: Foi observado aumento das citocinas IL-6, IL-10 e TNF- no decorrer da sepse. Houve diferença estatisticamente significante nos grupos submetidos à sepse no valor da latência da onda V em relação aos demais grupos. Observou-se, também, aumento da latência da onda V após a aplicação sucessiva do anestésico ketamina/xilazina em todos os grupos estudados. Conclusão: Houve aumento dos níveis das citocinas IL-6, IL-10 e TNF- nos animais que sofreram aplicação de LPS, revelando uma alteração de expressão gênica de moléculas pró (IL-6 e TNF-) e anti-inflamatória (IL-10) no decorrer da sepse.O PEATE se mostrou sensível a sepse com aumento de latência da onda V no desenvolver da doença no modelo experimental utilizado. O uso de Ketamina associada à xilazina influenciou o resultado do PEATE, aumentando o valor de latência absoluta da onda V do PEATE / Introduction: The Cerebrovascular Accident of ischemic type is a clinical condition affecting thousands of people around the world. As a result of this injury we observe neuronal death, and along the natural course of recovery individuals may develop sepsis. Sepsis is a systemic inflammatory response that may lead to death. Along its development, several cytokines are produced that characterize the inflammatory process on the body. To assess the clinical conditions of a patient with this condition the Auditory Brainstem Response (ABR) may be useful, as it is not an invasive procedure, it is fast to perform, and may be done at the patients bedside. On the other hand, the ABR may be sensitive to the use of some anesthetics. Objectives: To perform an analysis of the IL-6, IL-10 and TNF- cytokines in the course of sepsis; to verify the ABR latency values in gerbils submitted to ischemia and sepsis; and to verify the influence of the ketamine/xylazine anesthetic on the ABR values in these animals. Method: ABRs were collected for 72 adult male gerbils divided into 6 groups, namely: control, sepsis, ischemia, sham, ischemia with sepsis and sham with sepsis. For induction of sepsis, intraperitoneal lipopolysaccharide (LPS) was injected into the gerbils. The animals were anesthetized prior to the collections with ketamine/xylazine, theirs ABRs were collected before any procedure (base collection), after ischemia and 2, 4, 8 and 24 hours after the LPS injection. The absolute latency of the V wave was assessed, and values were compared within and among groups. The IL-6, IL-10 and TNF- cytokines were analyzed and compared in each study group. Results: An increase was observed in IL-6, IL-10 and TNF- cytokines in the course of sepsis. There was a statistically significant difference in the groups submitted to sepsis in the value of the V wave latency compared to the other groups. An increase in the V wave latency was also observed after successive injection of the ketamine/xylazine anesthetic in all study groups. Conclusion: There was an increase in the levels of IL-6, IL-10 and TNF- cytokines in the animals injected with LPS, revealing a change of the gene expression of the pro- (IL-6 and TNF-) and anti-inflammatory (IL-10) molecules in the course of sepsis. The ABR proved to be sensitive to sepsis with an increase of the V wave latency in the course of the disease on the experimental model used. The use of ketamine/xylazine influenced the results of the ABR, increasing the absolute latency value for the V wave of the ABR

A pesquisa dos potenciais evocados auditivos de tronco encefálico (PEATE) foi indicada para os casos onde há suspeita ou presença de síndromes genéticas pelo Joint Committee on Infant Hearing em 2007. O comitê fornece as diretrizes para a detecção das perdas auditivas na infância, para as quais as síndromes são fator de risco. A alta prevalência da SD e de alterações auditivas nesta população reforça a importância da identificação das perdas auditivas até os três meses de idade, como forma de minimizar os decorrentes prejuízos na comunicação. Este estudo, aprovado pela Comissão de Ética para análise de projetos de pesquisa do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo (HCFMUSP), teve como objetivo descrever as avaliações da audição de 30 crianças com SD, sem queixas otológicas, das quais 25 bebês (idade média de 2,47 meses) compuseram a amostra. Método: Foram pesquisados os PEATE durante o sono natural. A amostra foi analisada por bebês e por orelhas. Os bebês e as orelhas foram agrupados por intensidade de limiar eletrofisiológico: G1 (<= 30 dBNA), G2 (30 | 40 dBNA), G3 (> 40 dBNA) e registradas as latências absolutas I, III e V e as inter-latências I-III, III-V e I-V. Resultado: Dos 25 bebês, 3 apresentaram alteração neurossensorial ao menos unilateral (12%), 5 alteração condutiva (20%) e 17 (68%) indicaram resultados normais ao PEATE. Limiares eletrofisiológicos foram encontrados em 76% (n=38) das orelhas estavam abaixo, e em 24% (n=12), acima de 40 dBNA. Os grupos G1 e G2 apresentaram respostas equivalentes exceto para a latência absoluta da onda V e inter-latência III-V, que estiveram encurtadas no G2 em relação ao G1 (p<0,02;p=0,04) Discussão: Vários autores sugerem maior ocorrência de alterações condutivas entre portadores de SD. A prevalência de alterações auditivas condutivas e neurossensoriais encontradas nos bebês neste estudo apontam para a importância da investigação da via auditiva até os três meses de idade. Conclusão: A perda auditiva é uma alteração frequente em bebês com SD. Ocorreram alterações tanto condutivas quanto neurossensoriais nas orelhas com limiar alterado. As alterações neurossensoriais encontradas neste estudo reforçam a importância da adoção de procedimentos preventivos de avaliação da audição em bebês com SD e consequente intervenção / Introduction: The study of evoked auditory brainstem response (ABR) was indicated for cases of genetic syndromes by the Joint Committee on Infant Hearing in 2007. These guidelines indicate the detection of hearing loss in the childhood, for which genetic syndromes are a risk factor. The high prevalence of DS and of hearing disorders in this population reinforces the importance of identifying hearing loss by 3 months of age, to minimize the losses arising in communication. The main objective of this study, approved by the Ethics Committee of University of São Paulo, School of Medicine, Clinical Hospital (HCFMUSP) was to characterize the hearing ability of 30 children with Down syndrome, of which 25 babies (mean age 2.47 months), with no history of ear disease, comprised the sample. Method: ABR test has been performed during natural sleep. The babies and the ears were put together in groups by threshold level: G1 (<= 30 dB HL), G2 (30 |40 dB HL), G3 (over 40 dB HL). Results: Out of 25 babies, 3 (12%) had sensory neural hearing disorder in at least one ear; 5 (20%) had conductive hearing disorder in at least one ear and 17 (68%) had normal results on the ABR. Electrophysiological thresholds under 40 dB HL have been obtained in 76% (n = 38) of tested ears under, and in 24% (n = 12) over 40 dB HL. Groups G1 and G2 have had similar response, except for III-V interval shortened in G2 when compared to G1. Discussion: Many authors suggest conductive losses are more frequent than sensory neural losses in this population. The prevalence of sensory neural hearing disorder found in these babies point to the importance of investigating the auditory pathway. The group with thresholds between 30 and 40 dB HL was similar to the normal group, except for shortening of interval III-V. Statistically significant differences were found between normal and abnormal in the ABR. Conclusion: Sensory neural losses found in this study reinforce the importance of adopting preventive procedures for evaluating the hearing and subsequent intervention

The field of early detection and intervention of hearing loss in neonates and infants has been marked by a growing international body of research investigating hearing screening programmes, protocols and outcomes of early detection for hearing loss. In South Africa, screening for neonates and infants in general and particularly for hearing loss is not common practice and is not meeting the needs of the South African population, with very few infants identified with hearing loss early in life. The Year 2002 Hearing Screening Position Statement recommends an intermediate step toward universal screening in the form of Targeted Newborn Hearing Screening (TNHS) as an option for developing countries with limited resources. The Neonatal Intensive Care Unit (NICU) provides a starting point for TNHS because it encompasses a number of risk factors for hearing loss. A combined descriptive and exploratory research methodology was followed to provide a comprehensive perspective on longitudinal hearing screening for NICU neonates and infants at a provincial hospital in South Africa. The quantitative methods included a structured interview to compile risk factor information. Immittance measurements used included acoustic reflex measurements, 226 Hz and 1000 Hz tympanometry. Automated Otoacoustic Emission (AOAE) as well as Automated Auditory Brainstem Response (AABR) screening was conducted. Routine follow-up visits at three month intervals were booked if a subject passed the screen and a follow-up screening for further testing was booked if a subject referred the screening. A total of 49 neonates and infants as well as mothers were enrolled in the first year and followed up for the second year of data collection period. The results indicated that the NICU had potential as platform for TNHS in South Africa. The high incidence of risk factors reported is more when compared with developed countries and highlights the importance of hearing screening in the at risk population for a developing country. The results confirmed reports that 226 Hz probe tone tympanometry produces erroneous responses in young infants. A high correspondence between high frequency tympanometry and AOAE results was found and underlines the need for differential diagnosis to accurately detect middle ear effusion and/or sensorineural hearing loss in neonates and infants. The unilateral AOAE refer rate (7%) was within range of the reported values for initial screening at discharge from the NICU. AABR results indicated a relatively high unilateral refer result (24%) and may be attributed to irritability and restlessness. The highest referral rates in the current study were recorded during the second and third visit and may be attributed to the presence of middle-ear pathology in older infants. The perceptions of mothers emphasized the lack of awareness regarding hearing and hearing loss in South Africa. Lack of knowledge may be a contributing actor to poor compliance with screening follow-up. Despite prevailing challenges, such as a low follow-up return rate, lack of awareness regarding the benefits of early detection of hearing loss, the effect of middle ear effusion on screening results, the cost of hearing screening and different priorities of the national healthcare system, such as Human Immunodeficiency Virus, demonstrated the NICU promise as platform for TNHS in South Africa. TNHS programmes may serve as starting point to direct universal neonatal hearing screening programmes in South Africa. / Dissertation (MCommunication Pathology)--University of Pretoria, 2008. / Speech-Language Pathology and Audiology / MComm Path / unrestricted

Determining auditory functioning in difficult-to-test populations such as cerebral palsy (CP) remains a challenge in paediatric audiology. The auditory brainstem response (ABR) is favoured as the procedure to assess auditory functioning in difficult-to-test populations such as CP. The CP population, however, offers unique challenges for the ABR procedure due to the presence of involuntary muscular movements that may compromise the signal-to-noise ratio (SNR) of the ABR. Conventional ABR technology attempts to improve the SNR by the modification of acquisition parameters e.g. adjusting the low cut filter or implementing stricter artifact rejection criteria. However, such modifications may compromise the waveform morphology of the ABR. Furthermore, sedation or general anesthesia can also be used to improve the SNR by reducing excessive muscular movements. The CP population, however, displays a high risk for developing upper airway obstruction when being sedated or anesthetized. Thus, the feasibility and reliability of the conventional ABR may be compromised when being employed in the CP population. In recent years a novel ABR system, the Vivosonic Integrity (VS) ABR has become clinically available. The device incorporates features such as pre-amplification of the ABR signal, Kalman filtering and wireless recording. These features promise to address the limitations of conventional ABR technology to obtain a reliable recording in the midst of excessive myogenic artifact. The aim of this study was therefore to evaluate the clinical utility of the VS system when assessing a sample of children with CP without the use of sedation. The clinical utility of the VS ABR system was determined by comparing its success rates, the threshold correspondence to behavioural pure tone (PT) thresholds and recording time to a conventional ABR system when using click and 0.5 kHz TB stimuli. A cross-sectional within-subject comparison research design was selected in order to compare thresholds obtained with different procedures. The experimental part of this study was represented by the within-subject control condition where the VS ABR system and the conventional ABR system were simultaneously conducted in each subject. This unique setup was important in the research as equivalent test conditions in terms of EEG and environmental conditions had to be ensured for both ABR systems. 15 CP subjects between the ages of 12 and 18 years were included in the project. A diagnostic audiological test battery including immittance, distortion product otoacoustic emissions and behavioural audiometry was conducted on each subject prior the administration of the ABR procedures. The variability of the audiological test battery results – between the subjects and when compared to previous research – emphasized the heterogeneity of the CP population. Furthermore, more than half of the research sample (53%; n=15) responded inconsistently to behavioural pure tone (PT) stimuli. It was suggested that the severity of physical impairments as well as additional impairments such as mental retardation might have influenced the consistency of the subjects’ responses during behavioural PT audiometry. The ABR results indicated that there were no significant differences with regards to threshold correspondence and recording time between the two ABR systems when using click and 0.5 kHz TB stimuli (p>0.05). With regards to the success rates, the VS system was successful in more cases than the conventional ABR system using click and 0.5 kHz TB stimuli. Although results also showed no statistically significant value for click p=.1121) and 0.5 kHz TB stimuli p=.1648), there was a tendency towards the 95% confidence level in both cases suggesting that the VS ABR system may produce a statistically significant success rate for click as well as for 0.5 kHz TB stimuli, provided a larger sample is tested. The research indicated that, since the VS ABR system was more successful across a wider range of subjects during click-evoked and 0.5 kHz TB recordings, it may increase the clinical usefulness of the ABR especially in terms of hearing screening in the CP population. The research suggested that excessive muscular movements during the recordings influenced not only the VS ABR’s, but also the conventional ABR’s threshold correspondences to PT thresholds as well as the recording time of the measurements. Therefore it may still be necessary to use a light sedative in some CP patients to reduce excessive myogenic interference despite the possible advantages of the VS ABR system. / Dissertation (MCommunication Pathology)--University of Pretoria, 2010. / Speech-Language Pathology and Audiology / unrestricted

No description available.

Background Due to small iron stores and rapid growth during the first months of life, infants with low birth weight (LBW) are at risk of iron deficiency (ID). ID in infancy is associated with irreversible impaired neurodevelopment. Preventive iron supplementation may reduce the risk of ID and benefit neurodevelopment, but there is also a possible risk of adverse effects. More than 50% of all LBW infants are born with marginally LBW (MLBW, 2000-2500g), and it is not known if they benefit from iron supplementation. Methods We randomized 285 healthy, Swedish, MLBW infants to receive 3 different doses of oral iron supplements; 0 (Placebo), 1, and 2 mg/kg/day from six weeks to six months of age. Iron status, during and after the intervention was assessed and so was the prevalence of ID and ID anemia (IDA), growth, morbidity and the interplay with iron and the erythropoetic hormones hepcidin and erythropoietin (EPO). As a proxy for conduction speed in the developing brain, auditory brainstem response (ABR) was analyzed at six months. In a follow up at 3.5 years of age, the children were assessed with a cognitive test (WPPSI-III) and a validated parental checklist of behavioral problems (CBCL), and compared to a matched reference group of 95 children born with normal birth weight. Results At six months of age, the prevalence of ID and IDA was significantly higher in the placebo group compared to the iron supplemented infants. 36% had ID in the placebo group, compared to 8% and 4 % in the 1 and 2mg/kg/day-groups, respectively. The prevalence of IDA was 10%, 3% and 0%, respectively. ABR-latencies did not correlate with the iron intake and was not increased in infants with ID or IDA. ABR wave V latencies were similar in all three groups. Hepcidin correlated to ferritin and increased in supplemented infants while EPO, which was negatively correlated to iron status indicators, decreased. At follow up there were no differences in cognitive scores between the groups but the prevalence of behavioral problems was significantly higher in the placebo group compared to those supplemented and to controls. The relative risk increase of CBCL-scores above a validated cutoff was 4.5 (1.4 – 14.2) in the placebo-group compared to supplemented children. There was no detected difference in growth or morbidity at any age. Conclusion MLBW infants are at risk of ID in infancy and behavioral problems at 3 years of age. Iron supplementation at a dose of 1-2 mg/kg/day from six weeks to six months of age reduces the risks with no adverse effects, suggesting both short and long term benefit. MLBW infants should be included in general iron supplementation programs during their first six months of life.