Research was conducted on twenty-seven preoperative myringotomy patients to clarify the correlation between tympanometry type and the presence of middle ear effusion. Test results indicate that the relationship between tympanometry and middle ear effusion is dependent on the amount of fluid present. In impacted ears primarily Type B tympanograms were obtained whereas for less than impacted ears all tympanogram types were seen. Also suggested was that a combination of height of the tympanogram and the amount of negative pressure may be diagnostically more important than negative pressure alone as an indicator of effusion. It was recommended that other measures in addition to tympanometry be employed in the diagnosis of middle ear effusion and that further research is needed to achieve optimal use of impedance audiometry.

Com a obrigatoriedade da triagem auditiva neonatal universal a partir do ano de 2010 em todo território brasileiro, maior número de crianças estão sendo submetidas ao diagnóstico audiológico logo nos primeiros meses de idade. O Potencial Evocado Auditivo de Tronco Encefálico e o Potencial Evocado Auditivo de Estado Estável são amplamente utilizados para fechamento do diagnóstico audiológico nesta idade, já que auxiliam na caracterização da perda auditiva quanto ao grau, tipo e configuração. Os estímulos utilizados nestes procedimentos apresentam limitações inerentes às características acústicas de cada um e devem ser consideradas pelo profissional no momento de analisar os resultados obtidos. Diante disso, o objetivo deste trabalho foi analisar comparativamente a aplicabilidade do estímulo Narrow Band CE-Chirp® para predizer os limiares psicoacústicos nas perdas auditivas sensorioneurais de graus severo e profundo. Trata-se de um estudo prospectivo transversal, na qual foram avaliadas 28 crianças com perda auditiva neurossensorial com limiares superiores a 61 dBNA, idade entre 6 e 37 meses, sendo 15 do sexo feminino e 13 do sexo masculino. Os procedimentos utilizados foram: Potencial Evocado Auditivo de Tronco Encefálico com os estímulos tone burst e Narrow Band CE-Chirp®, Potencial Evocado Auditivo de Estado Estável e Audiometria com Reforço Visual ou Audiometria Lúdica Condicionada. Os resultados mostraram que os limiares eletrofisológicos no Potencial Evocado Auditivo de Tronco Encefálico foram mais próximos dos limiares psicoacústicos obtidos na Audiometria com Reforço Visual ou Audiometria Lúdica Condicionada quando utilizado o estímulo Narrow Band CE-Chirp® ao invés do tone burst. Na ausência de resposta no Potencial Evocado Auditivo de Tronco Encefálico com ambos os estímulos, observou-se que o Potencial Evocado Auditivo de Estado Estável realizado em intensidades fortes apresentou boa correlação com os limiares psicoacústicos, contudo, a utilização de forte intensidade deve ser cuidadosa nas frequências de 2000 e 4000 Hz para não se obter limiares eletrofisiológicos que não são reais. Conclui-se então, que, clinicamente, a utilização do PEATE com o estímulo Narrow Band CE-Chirp® mostrou limiares eletrofisiológicos mais próximos dos limiares psicoacústicos da Audiometria com Reforço Visual/ Audiometria Lúdica Condicionada do que quando o estímulo utilizado foi o tone burst. Ainda assim, mais estudos devem ser realizados para verificar os benefícios deste estímulo na população infantil e com alguma alteração auditiva. O Potencial Evocado Auditivo de Estado Estável, por utilizar estímulos em intensidades mais fortes, caracterizou a audição residual com precisão nas frequências de 500 e 1000 Hz. / With the requirement of universal newborn hearing screening from the year 2010, throughout the Brazilian territory, more children are undergoing audiologic diagnosis in their first months. The Brainstem Auditory Evoked Potential and the Steady State Evoked Potential are widely used for closing the audiologic diagnosis at this age, since they assist in the characterization of hearing loss as to the degree, type and configuration. The stimuli used in these procedures pose limitations inherent to the acoustic characteristics of each subject and should be taken into account by the professional analyzing the results. Therefore, this study aimed to compare the applicability of the Narrow Band CE-Chirp® stimulus to predict the psychoacoustic thresholds in severe and profound sensorineural hearing loss. This was a cross-sectional prospective study in which 28 children, being 15 females and 13 males, aged 6 to 37 months, presented with sensorineural hearing loss and with thresholds above 61 dBNA, were assessed. The used procedures were Brainstem Auditory Evoked Potential with tone burst stimuli and Narrow Band CE-Chirp®, Steady-state auditory evoked potential and audiometry with visual reinforcement or conditioned ludic audiometry. The results showed that the electrophysiological thresholds in the Brainstem Auditory Evoked Potential were closer to the psychoacoustic thresholds obtained in the visually reinforced audiometry or conditioned ludic audiometry when using the Narrow Band CE-Chirp® stimulus in lieu of the tone burst. In the absence of response in the Brainstem Auditory Evoked Potential with both stimuli, it was observed that the Steady State Auditory Evoked Potential performed at high intensities presented good correlation with the psychoacoustic thresholds, nevertheless, high intensity should be used with caution in the frequencies 2000 and 4000 Hz, for unreal electrophysiological thresholds not to be obtained. It was concluded that, clinically, the use of Brainstem Auditory Evoked Potential with the Narrow Band CE-Chirp® stimulus showed electrophysiological thresholds closer to psychoacoustic ones of the audiometry with visual reinforcement/conditioned ludic audiometry than when using the tone burst. Nevertheless, further studies should be performed to verify the benefits of this stimulus in children and with some hearing impairment. For using stimuli in higher intensities, the Steady-state auditory evoked potential characterized the residual hearing, accurately, at frequencies of 500 and 1000 Hz.

Thesis. 1978. M.S.--Massachusetts Institute of Technology. Dept. of Electrical Engineering and Computer Science. / MICROFICHE COPY AVAILABLE IN ARCHIVES AND ENGINEERING. / Bibliography: leaves 185-191. / M.S.

Introdução: O tratamento dos pacientes com fibrose cística envolve o uso de medicamentos ototóxicos, sendo que os mais frequentemente utilizados são os antibióticos aminoglicosídeos. Devido ao uso frequente deste tipo de medicamento, os pacientes com fibrose cística apresentam risco de desenvolver perda auditiva. Objetivo: o objetivo deste estudo foi avaliar a audição dos pacientes com fibrose cística pela audiometria de altas frequências (AAF) e emissões otoacústicas por produto de distorção (EOAPD). Pacientes e métodos: estudo transversal retrospectivo e prospectivo, incluindo 75 indivíduos, sendo 39 do grupo de estudo e 36 do grupo controle. Foram realizados os exames de AAF (de 250 a 16.000 Hz) e EOAPD. Resultados: o grupo de estudo apresentou limiares na AAF significativamente mais elevados em 250, 1.000, 8.000, 9.000, 10.000, 12.500 e 16.000 Hz. (p=0,004) e maior prevalência de alterações nas EOAPD em 1.000 e 6.000 Hz (p=0,001), com amplitudes significativamente mais baixas em 1.000, 1.400 e 6.000 Hz. Houve associação significativa entre as alterações dos limiares auditivos na AAF com o número de cursos de aminoglicosídeos realizados (p=0,005). Oitenta e três por cento dos pacientes que realizaram mais de 10 cursos de aminoglicosídeos apresentaram perda auditiva na AAF. Conclusão: Um número expressivo de pacientes com fibrose cística que receberam repetidos cursos de aminoglicosídeos apresentou alterações na AAF e EOAPD. realização de 10 ou mais cursos de aminoglicosídeos esteve associada às alterações na AAF. / Introduction: the treatment of patients with cystic fibrosis involves the use of ototoxic drugs, and the most frequently used are the aminoglycoside antibiotics. Due to the frequent use of this drug, cystic fibrosis patients are at risk to develop hearing loss. Objective: the aim of this study was to evaluate the hearing of patients with cystic fibrosis by high frequency audiometry (HFA) and distortion product otoacoustic emissions (DPOAE). Patients and methods: retrospective and prospective crosssectional study including 75 individuals, 39 of the study group and 36 in the control group. HFA (250 – 16,000 Hz) and DPOAE tests were conducted. Results: the study group had thresholds significantly higher in the HFA in 250, 1,000, 8,000, 9,000, 10,000, 12,500 and 16,000 Hz (p=0.004) and higher prevalence of abnormal DPOAE at 1,000 and 6,000 Hz (p=0.001), with significantly lower amplitudes of 1,000, 1,400 and 6,000 Hz. There was a significant association between changes in hearing thresholds in HFA with the number of courses of aminoglycosides performed (p=0.005). Eighty-three percent of patients who completed more than 10 courses of aminoglycosides had hearing loss in HFA. Conclusion: a significant number of patients with cystic fibrosis who received repeated courses of aminoglycosides showed alterations in HFA and DPOAE.

Magister Public Health - MPH / Ototoxic induced hearing loss is a common adverse event related to aminoglycosides used in Multi Drug Resistant -Tuberculosis treatment. Exposure to ototoxic drugs damages the structures of the inner ear. Symptomatic hearing loss presents as tinnitus, decreased hearing, a blocked sensation, difficulty understanding speech, and perception of fluctuating hearing, dizziness and hyperacusis/recruitment. The World Health Organization (1995) indicated that most cases of ototoxic hearing loss globally could be attributed to treatment with aminoglycosides. The aim of the study was to determine the proportion of DR-TB patients initiated on treatment at three decentralized sites during a defined period (1st October to 31st December 2015) who developed ototoxic induced hearing loss and the corresponding risk factors, whilst receiving audiological monitoring with an extended high frequency audiometer (KUDUwave). A retrospective cross-sectional study was conducted. Cumulatively across the three decentralized sites, 69 patient records were reviewed that met the inclusion criteria of the study. The mean age of the patients was 36.1, with a standard deviation (SD) of 10.7 years; more than half (37) were female. Ototoxicity , a threshold shift, placing patients at risk of developing a hearing loss was detected in 56.5% (n=39)of patients and not detected in 30.4%(n=21).The remaining 13,1% (n=9)is missing data. As a result, the regimen was adjusted in 36.2% of patients. . From the 53 patients who were tested for hearing loss post completion of the injectable phase of treatment, 22.6% (n=12) had normal hearing, 17.0 % (n=9) had unilateral hearing loss, and 60.4% (n=32) had bilateral hearing loss. Therefore, a total of 41 patients had a degree of hearing loss: over 30% (n=22)had mild to moderate hearing loss, and only about 15% (n=11)had severe to profound hearing loss. Analysis of risk factors showed that having ototoxicity detected and not adjusting regimen significantly increases the risk of patients developing a hearing loss. The key findings of the study have shown that a significant proportion of DR-TB patients receiving an aminoglycoside based regimen are at risk of developing ototoxic induced hearing loss, despite receiving audiological monitoring with an extended high frequency audiometer that allows for early detection of ototoxicity (threshold shift).

Nos últimos vinte anos, os estudos sobre os efeitos do ruído na audição e conseqüente qualidade de vida do ser humano ganharam grande impulso, evidenciando sua importância. O propósito do presente estudo foi verificar o efeito do ruído persistente, decorrente das condições de trabalho, sobre a qualidade de vida, relativamente às repercussões sobre a audição e a qualidade do sono. Neste sentido visou contribuir para a valorização dos prejuízos do ruído excessivo e sistemático sobre a saúde. Foram estudados 20 trabalhadores do sexo masculino, da Seção de Engenharia do Hospital das Clínicas da Faculdade de Medicina de Ribeirão Preto (HCFMRP-USP), com idade entre 33 e 50 anos, expostos a ruído ambiental maior ou igual a 85 dB, em jornada de oito horas de trabalho diário, há pelo menos oito anos; sem alterações anatômicas de orelha externa/média e de vias aéreas superiores. Outros 20 trabalhadores da Seção de Atividades Complementares do mesmo hospital na mesma faixa etária e mesmas características físicas, sócio-econômico-culturais, expostos ao ruído ambiental habitual inferior a 85 dB na jornada de trabalho de 8 horas diárias, compuseram um grupo controle. Os dados de audiometria tonal limiar e imitanciometria foram correlacionados com a qualidade do sono observada através da polissonografia e com parâmetros clínicos gerais de saúde. Com os resultados dos testes de comparação aplicados a idade, estatura, peso, índice de massa corporal, circunferência do pescoço, cintura e quadril e indicadores do estado sócio-econômico-cultural obtidos em entrevista, verificamos que as amostras foram semelhantes nestes aspectos. A análise estatística da audiometria e imitanciometria, nos dois grupos, feita pelo teste exato de Fischer revelou perda auditiva leve e moderada, do tipo PAIR, significante (p < 0,001) no G1. O sono dos indivíduos dos dois grupos apresentou anormalidades nas medidas de continuidade do sono revelando sono de má qualidade. Dos 40 indivíduos, treze (32,5 %) apresentaram distúrbio respiratório do sono, dez dos quais tinham sonolência pela Escala de Epworth; doze outros (30 %) tinham sonolência sem distúrbio respiratório do sono. Os indicadores da quantidade de sono revelaram-se normais. As comparações mostraram que o sono dos dois grupos é igual, quando analisado pelo teste de Mann – Whitney para dados independentes. Análise de contingência entre sono alterado e perda auditiva revelou ausência de interrelação (p = 0,4316). Concluimos que a permanência prolongada sob ruído ambiental superior aos níveis considerados seguros foi suficiente para produzir danos auditivos detectáveis laboratorialmente através dos testes usuais e que não há razão para crer que a má qualidade do sono do cidadão comum guarde relação com a convivência diurna em ambientes ruidosos. / In the last twenty years, the studies on the effect of noise in the hearing and consequently in the quality of life of the human have earned great impulse, evidencing its importance. The purpose of the present study was to verify the effect of persistent noise, occasioned by work conditions, on the quality of life, concerned to the repercussions on the hearing and on the quality of sleep. In this direction, this study aimed at contributing to the awareness of damages caused by extreme and systematic noise on health. Twenty male workers, from the Engineering Section of the Hospital of Clinics of the Faculty of Medicine of Ribeirão Preto (HCFMRP-USP), with ages between 33 and 50 years old, exposed to environmental noise louder or equal 85 dB, on a daily eight-hour working week, for at least eight years, with no anatomical alterations of the extern/medium ear and upper airways; were studied. Other twenty workers from the Complementary Activities Section of the same hospital, in the same age range and equal physical, social-economical-cultural characteristics, exposed to usual environmental noise (lower than 85 dB), on a daily eight-hour working week, composed a control group. The data from the pure tone audiometry and the impedance measurements were correlated with the quality of sleep observed through the polysomnography and with the general clinical health parameters. The results showed that two groups had similar physical social-economic and cultural aspects, when comparison tests where applied to age, height, weight, body mass index, size of the neck, wrist and hips and socio-economic and cultural markers obtained by clinical interview. Statistical analysis of audiometria e imitanciometria by Fischer’s test has shown significant (p = 0,001) mild and moderate hearing loss in G1. The majority of the subjects had bad sleep quality as shown by analysis of sleep disruption markers. The 40 subjects, thirteen (32,5 %) have had sleep disordered breathing ten of whom had day-time sleepiness as measured by Epworth scale; twelve other subjects (30 %) had day-time sleepiness without sleep disordered breathing. The sleep amount markers where normal. At statistical analysis by Mann-Whitney test the sleep of the two groups was equal. Analysis of contingency between altered sleep and hearing loss has shown no correlation (p = 0,4316). Conclusion long stay under noisy condition was enough to produce hearing loss detectable through usual laboratorial tests the there is no reason to believe that sleep of bad quality of ordinary people keep relation with diurnal stay under noisy condition.

The middle ear system is a vital component in the propagation mechanism of otoacoustic emissions. As such, investigation of the effect of variation in middle ear impedance on the measurement of emissions is warranted. Distortion product otoacoustic emissions (DPOAEs) have gained recognition as a means of gaining frequency specific information on auditory function. As the effects of changes in middle ear impedance will vary as a function of frequency, a clear definition of the relationship between middle ear impedance and DPOAE amplitude across the frequency spectrum is needed. Twenty adults (ages 20-37) with normal hearing and normal middle ear function were selected as subjects. Commercially available equipment (Virtual 330) was used to measure the DPOAEs on all subjects. The unit was modified to change canal pressure by coupling the probe to the pressure pump of a clinical acoustic immittance system. One ear from each subject was randomly selected for measurement and each subject was tested under five pressure conditions: +200, O, -200, -300, -400 daPa. The mean frequency of the fl/f2 tone pairs swept from 500 to 8000 Hz. Results indicate that changes in ear canal pressure can effect the amplitude of DPOAEs. Alteration of ear canal pressure resulted in decreased emission amplitude. This effect was found to differ as a function of eliciting frequency with the greatest reduction in amplitude with the mean of the primaries at 500 Hz. Less variation was noted across the ear canal pressures with the higher frequency stimuli. These results are consistent with previous findings reported regarding the effects of impedance changes on spontaneous and transiently evoked otoacoustic emissions.

These two joint-studies used recorded versions of the Northwestern University Auditory Test Number 6 (NU-6) and the California Consonant Test (CCT) in the hearing aid evaluations (HAEs) of 12 male and one female subjects, aged 41 to 87 years. They exhibited precipitous high frequency losses beyond 1 kHz in at least one ear. All subjects were evaluated without amplification and while monaurally aided with two conventional high pass hearing aids. Ten of the subjects were evaluated in multi-talker noise and 11 were tested in quiet. Since the CCT was more heavily weighted than the NU-6 with target phonemes sensitive to high frequency losses, it was hypothesized that the CCT might be more sensitive than the NU-6 to significant differences between aided and/or unaided performances of these particularly high frequency impaired subjects. The data collected in noise and in quiet was analyzed separately with the one-way analysis of variance (ANOVA) for repeated measures. No significant differences were found in noise or quiet between the aided performances on either the CCT or the NU-6. The NU-6 in noise, however, revealed significant degrees of aided improvement at the .01 level of confidence that the CCT did not. The addition of noise seemed to make the CCT too difficult for these subjects. In quiet, both tests seemed to be as equally sensitive in revealing significant aided improvement at the .01 level of confidence. The lower mean CCT scores in quiet, however, seemed to indicate that if unaided NU-6 performances are too high to allow for significant aided improvement or significant differences between aids, the more time consuming CCT might be appropriate.

Speech reception threshold testing by bone conduction is very useful in diagnostic audiometry. However, there are little data regarding the CID W-1 spondee word lists used with the Radioear B-71 and B-72 and Pracitronic KH 70 bone conduction vibrators at higher presentation levels for testing hearing impaired clients. Data are needed in order that results of speech reception thresholds using the CID W-1 word lists via these three bone conduction vibrators at higher intensity levels can be used confidently in the clinic. More data are available for speech reception thresholds using the CID W-1 word lists via earphones. This study compared speech intelligibility presented via bone conduction at higher intensity levels to that presented via earphone at higher intensity levels. Twelve normal hearing adults, with thresholds artificially elevated by binaural speech noise masking to simulate a hearing impairment, were used as subjects. Recorded CID W-1 spondee word lists were presented via four transducers: Radioear B-71, Radioear B-72, and Pracitronic KR 70 bone vibrators, and a TDH-39 earphone. Investigation of each bone conduction vibrator was accomplished by using forehead placement and using binaural speech noise masking via earphones. Investigation of the earphone was accomplished by simultaneously presenting binaural speech stimuli and speech noise masking. Spondees from the CID W-1 word lists were presented to the subject via a transducer. A bracketing technique was used to estimate the speech reception threshold. Using the intensity level of the predetermined SRT as 0 dB, each list was presented at one of the following levels: +4, +2, O, -2, -4, and -6. Performance-intensity functions, the percentage of correctly identified spondees as a function of presentation level, were obtained for each transducer. The percentage of spondees correctly identified increased with the stimulus level for all transducers. Using linear regression, the line of best fit was calculated for each subject's data under each transducer condition. A one way analysis of variance indicated that there was a significant difference in the slopes of the performance-intensity functions of the transducers. A follow-up test for the one way analysis of variance indicated that there was a signficant difference between the TDH-39 earphone and each of the bone conduction vibrators. There were no significant differences among the bone conduction vibrators. Results of the study suggested that CID W-1 word lists and the 50 percent criterion may be inappropriate for use with these bone conduction vibrators at higher intensity levels. Given that there was a preponderance of data points below 50 percent for the bone vibrators, a criterion of less than 50 percent might be more appropriate. Because presentation levels might be elevated for sensorineural hearing impaired listeners, their SRT performances could be affected. Consequently, the results of speech reception threshold testing via bone conduction at higher intensity levels should be interpreted with caution in clinics.

The purpose of this study was to determine whether the compression circuit of a hearing aid could be activated by a high frequency biasing tone such that its output for a transient stimulus could be made to approximate that of a continuous tone alone. Sufficient compression activation by a transient stimulus would mean that this type of hearing aid could be used in obtaining aided ABR measurements, since transient stimuli are commonly used for this procedure. Four hearing aids were used, and transient or continuous stimuli were introduced either alone or in combination with an 8 or 10 kHz biasing tone. The biasing tone was either held at one constant level or varied in intensity along with the transient or continuous signal.