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Adults may acquire a hearing impairment through natural aging processes (presbycusis), exposure to loud noises, illnesses (e.g., Meniere's disease), and hereditary factors. Because hearing loss affects basic communication processes, couples often have to adjust their ways of interacting when one spouse develops a hearing loss. Extant literature presents relevant information about couple relationships in later life, individual adaptation to a hearing loss, and couple relationships where one spouse has a hearing loss. The current study was conducted to explore couple resilience processes. The family resilience theoretical framework guided this study (Ganong & Coleman, 2002; Walsh, 1996), with an emphasis on meaning that couples give to their experiences. The interaction of belief systems was explored in connection with resilience processes and the development of couple relationships. Qualitative semi-structured interviews with couples was the main method of data collection. Couples were recruited through audiologists and through a snowball sampling method. At least one partner was 60 years of age or older. Audiograms were requested from audiologists, and couples completed a marital satisfaction scale. Themes describing meaning and resilience processes emerged from interviews with eight couples in which one spouse was hearing-impaired. Themes related to meaning included couples' acceptance of the hearing loss, and demonstrations of the beliefs and values regarding their loss such as optimism, humor, gratitude, and pleasure through hearing. Couples reported having confidence in their communication skills. They also said that models of resilience, assistive listening devices, and faith in God, helped them to adapt to hearing loss stressors. Couples demonstrated healthy spousal caregiving relationships during the interviews. A focus group with marriage and family therapists (MFTs) was conducted to obtain clinical interpretations of the themes that emerged from the couple interviews. Clinicians' responses focused on couple relationship dynamics, possible clinical situations with these couples, and the therapist/client relationship. Many couples facing the hearing impairment of one spouse are living resilient lives together. However, there are likely many that are struggling. Implications for audiologists and MFTs are shared. As professionals are informed about the often unspoken and unheard stories relating to hearing loss, they can then serve with greater knowledge, empathy, and hope. / Ph. D.

Yes / Objectives: Listening-related fatigue can be a significant problem for adults who struggle to hear and understand, particularly adults with hearing loss. However, valid, sensitive, and clinically useful measures for listening-related fatigue do not currently exist. The purpose of this study was to develop and validate a brief clinical tool for measuring listening-related fatigue in adults. Design: The clinical scale was derived from the 40-item version of the Vanderbilt Fatigue Scale for Adults (VFS-A-40), an existing, reliable, and valid research tool for measuring listening9 related fatigue. The study consisted of two phases. Phase 1 (N = 580) and Phase 2 (N = 607) participants consisted of convenience samples of adults recruited via online advertisements, clinical records review, and a pool of prior research participants. In Phase 1, results from item response theory (IRT) analyses of VFS-A-40 items were used to identify high quality items for the brief (10-item) clinical scale: the VFS-A-10. In Phase 2, the characteristics and quality of the VFS-A-10 were evaluated in a separate sample of respondents. Dimensionality was evaluated using exploratory factor analyses (EFA) and item quality and characteristics were evaluated using IRT. VFS-A-10 reliability and validity were assessed multiple ways. IRT reliability analysis was used to examine VFS-A-10 measurement fidelity. In addition, test-retest reliability was assessed in a subset of Phase 2 participants (n = 145) who completed the VFS-A-10 a second time approximately one month after their initial measure (range 5-90 days). IRT differential item functioning (DIF) was used to assess item bias across different age, gender, and hearing loss subgroups. Convergent construct validity was evaluated by comparing VFS-A-10 responses to two other generic fatigue scales and a measure of hearing disability. Known-groups validity was assessed by comparing VFS-A-10 scores between adults with and without self reported hearing loss Results: EFA suggested a unidimensional structure for the VFS-A-10. IRT analyses confirmed all test items were high quality. IRT reliability analysis revealed good measurement fidelity over a wide range of fatigue severities. Test-retest reliability was excellent (rs = .88, collapsed across participants). IRT DIF analyses confirmed the VFS-A-10 provided a valid measure of listening29 related fatigue regardless of respondent age, gender, or hearing status. An examination of associations between VFS-A-10 scores and generic fatigue/vigor measures revealed only weak31 to-moderate correlations (Spearman’s correlation coefficient rs = -.36 to .57). Stronger associations were seen between VFS-A-10 scores and a measure of perceived hearing difficulties (rs = .79 to .81) providing evidence of convergent construct validity. In addition, the VFS-A-10 was more sensitive to fatigue associated with self-reported hearing difficulties than generic measures. It was also more sensitive than generic measures to variations in fatigue as a function of degree of hearing impairment. Conclusions: These findings suggest that the VFS-A-10 is a reliable, valid, and sensitive tool for measuring listening-related fatigue in adults. Its brevity, high sensitivity, and good reliability make it appropriate for clinical use. The scale will be useful for identifying those most affected by listening-related fatigue and for assessing benefits of interventions designed to reduce its negative effects. / Starkey Inc, NIH National Institute on Deafness and Other Communication Disorders (NIDCD) Grant #R21DC012865, NICHD Grant P30HD15052 to the Vanderbilt Kennedy Center for Research on Human Development, Vanderbilt Institute for Clinical and Translational Research grant (UL1 TR000445 from NCATS/NIH) / The full-text of this article will be released for public view at the end of the publisher embargo on 1 Sep 2024.

Postlingually deafened cochlear implant (CI) adults have large variability in speech perception abilities. While CIs are one of the most successful neural prosthetic devices, they are not able to adequately provide fine structure cues which results in a degraded signal for the listener to interpret. While behavioral measures remain the gold standard for determining speech perception abilities, an objective measure is needed for patients who are unable to provide reliable behavioral responses. Behavioral, cognitive, and neural measures were collected in this study to identify potential neural biomarkers that correlate with speech perception performance. Behavioral experiments evaluated participants' abilities to identify, discriminate, and recognize words as well as sentences in quiet and in noise. Cognitive measures were assessed to determine the roles of attention, impulse control, memory, and cognitive flexibility on speech recognition. Auditory event-related potentials (ERP) were obtained with a double oddball paradigm to produce the mismatch negativity (MMN) response, which has been shown to have associations with phonetic categorical perception at the group level. The results indicated that executive function is highly predictive of speech performance and that the MMN is associated with categorical perception at the individual level. These findings are clinically relevant to determining appropriate follow-up care post-implantation.

INTRODUÇÃO: A audição é um dos sentidos mais importantes para o ser humano, e seu funcionamento está interligado à sua produtividade, o que não é diferente aos músicos, já que ela é de suma importância para a qualidade de seu trabalho e permanência na carreira. O desenvolvimento de um programa de prevenção de perdas auditivas tem por objetivo modificar o comportamento dos músicos em relação à sua audição, uma vez que, constantemente, estão expostos a níveis de pressão sonora elevados e ao surgimento de lesões irreversíveis. Contudo, se medidas preventivas não forem realizadas corretamente, as exposições dos músicos frente à intensidade sonora elevada podem trazer prejuízos à saúde e alguns destes, irreversíveis como, a Perda Auditiva Induzida por Níveis de Pressão Sonora Elevados (PAINPSE) ou Perda Auditiva Induzida por Música (PAIM). OBJETIVO GERAL: submeter os músicos ao programa de prevenção de perdas auditivas (PPPA) e verificar sua eficácia. MATERIAL E MÉTODOS: Participaram componentes de quatro bandas musicais, correspondendo a um total de 16 participantes. Esses membros foram submetidos ao Programa de Prevenção de Perdas Auditivas (PPPA) que engloba as seguintes etapas: (1) medição do nível de pressão sonora no ensaio e show; (2) entrevista específica, Audiometria Tonal Liminar e de Altas Frequências, Logoaudiometria, Imitanciometria e Emissões Otoacústicas por estímulo Transientes e Produto de Distorção; (3) orientação sobre a utilização do Equipamento de Proteção Individual (EPI); e (4) a realização de medidas educativas por meio de workshops. RESULTADOS: O Nível de Pressão Sonora (NPS) durante os ensaios e apresentações/shows, encontram-se elevados, sintomas não auditivos estão presentes em 68, 75% da população total da amostra, presença de zumbido após o show em 100% da amostra; maiores dificuldades de compreensão de fala no ruído nos músicos que tocam baixo (75%). Ao traçar o perfil audiológico do músico foram encontrados: maiores médias dos limiares audiológicos por frequência das bandas estudadas em 500Hz e 3KHz (B1), 3KHz e 4KHz (B2), 3KHz, 4KHz e 6KHz (B3) e em 3KHz (B4); as maiores médias dos limiares audiológicos por frequência dos instrumentos estudados foram em 3KHz, 4KHz e 6KHz (voz), 3KHz e 4KHz (guitarra), 3KHz, 4KHz e 6KHz (baixo) e 3KHz, 4KHz (bateria); presença de entalhe nas frequências de 2KHz, 4KHz, 6KHz e 8KHz na audiometria tonal liminar; já na audiometria de altas frequências em todas as frequências apareceram ao menos um caso, reflexos ausentes em 4KHz (ipsilateral e contralateral); ausência de resposta em 4KHz para todos os baixistas bilateralmente (100%) quando pesquisado EOE por estímulo transiente e na produto de distorção foram encontradas ausência de respostas em 50% da amostra na frequência de 6KHz, sendo assim pesquisada a curva de crescimento (dp growth rate) aparecendo resposta em 75dB em quase 100% dos casos em que houve necessidade de sua realização. Quanto aos achados obtidos da avaliação realizada pelos participantes (músicos) referente ao website, os resultados mostraram que o mesmo atende às necessidades propostas, ou seja, a promoção da saúde auditiva em músicos. CONCLUSÃO: Existe a necessidade de serem tomadas medidas preventivas e a inserção dos músicos em um Programa de Prevenção de Perdas Auditivas (PPPA) a fim de proporcioná-los maiores condições de qualidade de vida e em seu trabalho, já que necessitam da sua audição para desempenhar com eficácia suas atividades e se manter no mercado de trabalho atuando como músico. / INTRODUCTION: Hearing is one of the most important senses for the human being, and its operation is interconnected to its productivity, which is no different to the musicians, since it is of the utmost importance for the quality of their work The development of a hearing loss prevention program, aims to modify the musicians behavior in relation to their hearing, once, constantly, are exposed to high sound pressure levels and the emergence of permanent injury. However, if preventives measures are not performed correctly, the exposures of the musicians facing the high sound intensity can bring losses to health and some of these, irreversible such as, Hearing Loss Induced by High Sound Pressure Levels (HLIHSPL) or Music-induced hearing loss (MIHL) - Noise-Induced Hearing Loss (NIHL). GENERAL OBJECTIVE: submit the musicians to the Hearing Loss Prevention Program (HLPP) and verify its effectiveness. MATERIAL AND METHODS: participated components from four musical bands, corresponding to a total of 16 participants. These members were submitted to the Hearing Loss Prevention Program (PPPA) that include the following steps: (1) measurement of the sound pressure level at the rehearsal and concert; (2) specific interview, Pure Tone Audiometry and High Frequencies, Logoaudiometry, Imitanciometry and Distortion Product Evoked Otoacoustic Emissions (DPEOE); (3) guidance on the use of Personal Protective Equipment (PPE); and (4) the achievement of educational measures through workshops. RESULTS: The Sound Pressure Level (SPL) during the rehearsals and performances/shows are elevated, symptoms not auditory are presents in 68,75% of the total sample population, presence of tinnitus after the show in 100% of the sample; major difficulties of speech comprehension in the noise of the musicians who playing bass (75%). When plotting the audiological profile of the musician were found: highest averages of audiological thresholds by frequency from the studied bands in 500Hz and 3KHz (B1), 3KHz and 4KHz (B2), 3KHz, 4KHz and 6KHz (B3) and in 3KHz (B4); the major averages of audiological frequency thresholds of the studied instruments were in 3KHz, 4KHz and 6KHz (voice), 3KHz and 4KHz (electric guitar), 3KHz, 4KHz and 6KHz (bass) and 3KHz, 4KHz (drums); presence of notch in the frequencies of 2KHz, 4KHz, 6KHz and 8 kHz in the pure tone audiometry; but in the high audiometry frequencies, in all frequencies appeared at least one case, missing reflexes in 4KHz (ipsilateral and contralateral); missing reply in 4KHz for all bassists bilaterally (100%) when researched EOE by transient stimulus and in the distortion product were found missing responses in 50% of the frequency sample of 6KHz, so researched the growth curve (dp growth rate) showing response in 75dB at almost 100% of cases which there was need for its achievement. CONCLUSION: there is a need to take preventive measures and the insertion of the musicians in the Hearing Loss Prevention Program (HLPP) in order to provide them greater conditions of quality of life and in their work, since they need their hearing to play effectively their activities and stay in the labor market working as a musician.

Acromegalia à uma doenÃa endÃcrina rara. Poucos estudos avaliaram sua associaÃÃo com deficiÃncia auditiva (DA) ou distÃrbios de conduÃÃo do impulso neural auditivo.Osresultados sÃo conflitantes. O objetivo à avaliar a transmissÃo auditiva central e perifÃrica em pacientes com acromegalia. AlÃm disso, avaliar a prevalÃncia e caracterÃsticas da DA em pacientes com acromegalia. Foi feito um estudo transversal com 36 pacientes com acromegalia de um ambulatÃrio especializado em Fortaleza-CearÃ. Foram excluÃdos pacientes com otoscopia anormal ou com histÃria familiar de deficiÃncia auditiva, uso de ototÃxicos ou exposiÃÃo a ruÃdo ocupacional. Inicialmente, o grupo foi avaliado por meio de audiometria tonal limiar. Considerou-se deficiÃncia auditiva (DA) quando a mÃdia dos tons puros foi > 25DbNA para baixas freqÃÃncias (250, 500, 1000 e 2000 Hz) ou altas freqÃÃncias (3000, 4000, 6000 e 8000 Hz).O grupo foi dividido em: acromegalia com DA (Acro DA) e sem DA (Acro NDA) e comparados quanto aos nÃveis hormonais e parÃmetros metabÃlicos. Posteriormente, este grupo de pacientes com acromegalia foi dividido em 2 subgrupos: com (n=16) e sem (n=20) diabetes ou intolerÃncia à glicose de jejum (DM/IGJ). Os resultados foram comparados entre os subgrupos e grupo controle (n=20) quantos aos parÃmetros dos potenciais evocados auditivos de tronco encefÃlico (PEATE). Para avaliar a normalidade da distribuiÃÃo foi utilizado o teste de Kolmogorov-Smirnov quando necessÃrio. Utilizou-se os testes qui-quadrado, t de Student e coeficiente de correlaÃÃo de Pearson. O nÃvel de significÃncia estatÃstica escolhido foi p<0.05 (statistical package for social sciences-SPSS 12.0). Dos 36 pacientes estudados, 14 (38,9%) mostraram DA sensorioneural (Acro DA), sendo em 9 casos bilateral e 5 unilateral. Nenhum apresentou DA mista ou condutiva. A prevalÃncia de DM/IGJ foi similar entre os grupos. As frequÃncias de 250, 3000, 4000, 6000 e 8000 Hz foram as mais afetadas e com padrÃo similar em ambos os lados.O grupo com acromegalia apresentou latÃncia da onda I em orelha direita aumentada em comparaÃÃo ao grupo controle (p=0,007), sem diferenÃa quanto aos intervalos interpicos em nenhum dos lados. Esse padrÃo foi o mesmo quando se comparou o subgrupo com DM/IGJ com o controle.TambÃm houve aumento da latÃncia da onda I na orelha direita em relaÃÃo à orelha esquerda no grupo com acromegalia. Em conclusÃo, mostrou-se uma elevada prevalÃncia de DA sensorioneural em pacientes com acromegalia.No entanto, nÃo se observou relaÃÃo dessa deficiÃncia com caracterÃsticas clÃnicas e metabÃlicas da doenÃa.Pacientes com acromegalia associada DM/IGJ mostraram um retardo no impulso neural no nervo auditivo unilateralmente à direita, evidenciando um efeito neuropÃtico nÃo homogÃneo dos distÃrbios do metabolismo dos carboidratos sobre o nervo auditivo. / Acromegaly is a rare endocrine disease. Few studies have evaluated its association with hearing loss (HL) or disturbance in conduction of the auditory neural impulse. The results are conflicting. The aim is to evaluate central and peripheral auditory transmission in acromegalic patients. Besides, to evaluate the prevalence and characteristics of HL in patients with acromegaly. A cross-sectional study was carried out on 36 patients with acromegaly in a specialized ambulatory in Fortaleza-CearÃ. Patients with abnormal otoscopy, family history of hearing loss, use of ototoxic drugs or occupational noise exposure were excluded. Initially, the group was evaluated by pure tone audiometry. HL was considered when pure tone average was > 25 DBHL for low frequencies (250, 500, 1000 e 2000 Hz) or high frequencies (3000, 4000, 6000 e 8000 Hz). The whole group was divided in: acromegaly with HL (Acro HL) and without HL (AcroNHL) and compared in regards to hormonal levels and metabolic parameters. Additionally that group of patients with acromegaly was divided into 2 subgroups: with (n=16) and without (n=20) diabetes mellitus/impaired glucose tolerance (DM/IGT). The results were compared among these subgroups and a control group (n=20) regarding the brainstem auditory evoked potentials (BAEP) parameters.Kolmogorov-Smirnov test was used to evaluate the normality of distribution when necessary. Qui-quadrado, Student t test and Pearson correlation coefficient were carried out. The level of statistical significance chosen was at p<0.05 (statistical package for social sciences-SPSS 12.0). Among 36 patients evaluated, 14 (38,9%) showed sensorioneural HL (Acro HL), being 9 bilateral and 5 unilateral cases. No one had mixed or conductive HL. The prevalence of diabetes/impaired glucose tolerance was similar between the groups. The frequencies 250, 3000, 4000, 6000 and 8000 Hz were the most affected and with a similar pattern in both ears. The group with acromegaly showed a prolonged peak I latency in the right ear in comparison to the control group (p=0,007), with no difference regarding the interpeak intervals in any sides. This pattern was the same when comparing the DM/IGT subgroup to controls. Also, we found a prolonged peak I latency in the right ear in relation to the left ear in the group with acromegaly.In conclusion, a high prevalence of sensorineural HL was shown in patients with acromegaly. Nevertheless, no correlation was observed between this dysfunction and clinical or metabolic characteristics of the disease. Patients with acromegaly associated with DM/IGT showed a delayed neural impulse in the auditory nerve unilaterally in the right side, evidencing a non-homogenous neuropathic effect of the carbohydrate metabolism disturbances on the auditory nerve.

Made available in DSpace on 2015-04-22T22:14:16Z (GMT). No. of bitstreams: 1 Adriana Nogueira.pdf: 871584 bytes, checksum: 41fee274b7eea5122b18c42a032a72ed (MD5) Previous issue date: 2011-02-25 / Conselho Nacional de Desenvolvimento Científico e Tecnológico / Health can not be seen as just absence of disease, it should be understood from multiple factors including, among other work conditions. In work environments there are different situations and risks conditions for workers health. Among the occupational risks, we can detach the noise. Occupational exposure to noise has been studied by researchers in the field of occupational health, as one of the most prevalent and the risk that exposes many workers around the world. The best known effect of this exposure is Noise-induced Hearing Loss (NIHL) or High Sound Pressure induced Hearing Loss, considered today as one of the most prevalent disease in work environments and therefore the focus of attention prevention and health promotion. The Hearing Loss Prevention Program (HLPP) plays a key role in activities aimed at protecting workers health against the initiation and aggravation caused by occupational noise that lead to consequences for job performance, the family and participation in society. Accordingly we sought to assess the approach of health professionals, who work in occupational health companies in the Industrial Pole of Manaus, face to Hearing Loss Prevention Program in the workplace. The sample consisted of 20 occupational physicians and 20 audiologists. The technique for the collecting information was the interview with open and closed questions and the method of analysis was the content. Three categories were identified that express the knowledge of professionals about the HLPP: pragmatic, disciplinary and systems view. These categories that reflect the performance professional and detach the limitation and advances of care that companies have in relation to workers health in particular, of the hearing. The HLPP as normative and procedural aspect seeks a set measures that require an integrated work of a team of several professionals from different fields. This study shows, however, that there is still a monumental distance between what is and what is proposed. The reasons that show this scenario indicates the need for further studies in order to insert all the social actors and thus detach the context in several dimensions. / Saúde não pode ser vista apenas como ausência de doença, ela deve ser entendida a partir de múltiplos fatores incluindo entre outros, as condições de trabalho. Nos ambientes laborais existem diversas situações e condições de risco para a saúde dos trabalhadores. Entre os riscos ocupacionais, podemos destacar o ruído. A exposição ocupacional ao ruído é objeto de estudo de pesquisadores da área de saúde do trabalhador, por ser um dos riscos mais prevalentes e o que expõe inúmeros trabalhadores em todo o mundo. O efeito mais conhecido desta exposição é a Perda Auditiva Induzida por Ruído (PAIR) ou Perda Auditiva Induzida por Níveis de Pressão Sonora Elevados (PAINPSE), considerada hoje como uma das doenças profissionais mais prevalentes nos ambientes de trabalho e, portanto, foco de atenção de prevenção e promoção da saúde. O Programa de Prevenção de Perda Auditiva (PPPA) desempenha um papel fundamental nas atividades destinadas à proteção da saúde do trabalhador contra o desencadeamento e agravos provocados pelo ruído ocupacional que levam a consequências no desempenho profissional, na convivência familiar e participação na sociedade. Nesse sentido, pretendeu-se avaliar a abordagem dos profissionais de saúde, que atuam na saúde do trabalhador em empresas do Pólo Industrial de Manaus, frente ao Programa de Prevenção de Perda Auditiva no trabalho. A amostra foi de 20 médicos do trabalho e 20 fonoaudiólogos. A técnica para a coleta de informações foi a de entrevista com questões abertas e fechadas e o método de análise foi o de conteúdo. Foram identificadas três categorias que expressam o conhecimento dos profissionais sobre o PPPA: visão pragmática, visão disciplinar e visão sistêmica. Categorias estas que retratam a atuação profissional e evidenciam limitações e avanços de cuidado que as empresas têm em relação à saúde do trabalhador em particular, da audição. O PPPA como aspecto normativo e processual, busca um conjunto de medidas que exige um trabalho integrado de uma equipe com diversos profissionais de diferentes áreas. Este estudo mostra, no entanto, que ainda há uma distância monumental entre o que é proposto e o que se faz. Os motivos que retratam esse cenário indicam a necessidade de estudos mais aprofundados, de modo a inserir todos os atores sociais e assim evidenciar o contexto nas mais diversas dimensões.

A hearing impairment is primarily diagnosed by measuring the hearing thresholds at a range of auditory frequencies (air-conduction audiometry). Although this clinical procedure is simple, affordable, reliable and fast, it does not offer differential information about origins of the hearing impairment. The main goal of this thesis is to quantitatively link specific cochlear pathologies to certain changes in the spectral and temporal characteristics of the auditory system. This can help better understand the underlying mechanisms associated with sensorineural hearing impairments, beyond what is shown in the audiogram. Here, an electromechanical signal-transmission model is devised in MATLAB where the parameters of the model convey biological interpretations of mammalian cochlear structures. The model is exploited to simulate the cell-level cochlear pathologies associated with two common types of sensorineural hearing impairments, 1: presbyacusis (age-related hearing impairment) and, 2: noise-induced hearing impairment. Furthermore, a clinical study, consisting of different psychoacoustic and physiological tests, was performed to trace and validate the model predictions in human. The results of the clinical tests were collated and compared with the model predictions, showing a reasonable agreement. In summary, the present model provides a biophysical foundation for simulating the effect of specific cellular lesions, due to different inner-ear diseases and external insults, on the entire cochlear mechanism and thereby on the whole auditory system. This is a multidisciplinary work in the sense that it connects the ‘biological processes’ with ‘acoustic modelling’ and ‘clinical audiology’ in a translational context.