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.

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.

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.

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.

Audiologists are reliant on objective audiometric procedures to predict auditory sensitivity in difficult-to-test populations. A technique to estimate frequency-specific hearing thresholds in a time-efficient way for difficult-to-test populations, who are unable to provide behavioural responses, has long been the hope of audiologists. The auditory brainstem response (ABR) has dominated the field of objective electrophysiological audiometry for the past three decades. Although it provides a useful method of estimating auditory sensitivity, it presents with its own set of limitations. Recently the auditory steady state response (ASSR) has demonstrated promise of addressing the limitations of the ABR as it is an evoked response uniquely suited to frequency-specific measurement. An optimised version of the ASSR, the dichotic multiple frequency (MF) ASSR, has been proposed as a time-efficient way of evaluating different frequencies simultaneously in both ears. The aim of this study was to evaluate the clinical usefulness of the dichotic MF ASSR technique for estimating pure tone behavioural thresholds at 0.5, 1, 2, and 4 kHz, compared to a 0.5 kHz tone burst and broadband click ABR protocol in a sample of normal hearing adults (56 ears). A comparative experimental research design was selected in order to compare thresholds obtained with the different procedures. The results indicated that both the dichotic MF ASSR and a 0.5 kHz tone burst and broadband click ABR protocol provided a reasonable estimation of PT behavioural thresholds in a time-efficient manner for a group of normal hearing subjects. The click ABR did, however, present with 1, 2, and 4 kHz PT threshold estimations that were almost 50 % closer than that of the dichotic MF ASSR according to the mean and normal deviation. This increased accuracy and reliability of the click ABR is however compromised by its lack of frequency-specificity. In the low frequency region of 0.5 kHz, the tone burst ABR and dichotic MF ASSR evidenced estimations of the pure tone threshold that were, on average, very similar. The tone burst ABR, however, presented with a mean threshold slightly (3 dB) closer to the pure tone threshold than the dichotic MF ASSR. The 0.5 kHz dichotic MF ASSR presented with a smaller range of normal deviation in the estimation of pure tone thresholds which suggested a more reliable measure than the 0.5 kHz tone burst ABR. The dichotic MF ASSR evaluation provided eight thresholds (4/ear) in 23 minutes on average compared to 25 minutes on average required by the ABR protocol to evaluate 4 thresholds (2/ear). This research concluded that the dichotic MF ASSR is useful for estimating frequency-specific pure tone thresholds reasonably well in a time-efficient manner but that this technique should be used in a test-battery alongside the ABR. Both the dichotic MF ASSR and the ABR comprise unique qualities that can be combined in a cross-check principle approach in order to provide complementary information that will verify results obtained with each procedure. / Dissertation (MA (Communication Pathology))--University of Pretoria, 2006. / Speech-Language Pathology and Audiology / Unrestricted

This project describes the implementation of computer audiometry for subjective hearing tests. The paper describes the implementation of the audiometer in C + + Borland Builder. Designed audiometer consists of a standard PC with operating system Windows, a sound card and headphones. The work also includes analysis of the problems of hearing loss and its examinations, that were used in the implementation of audiometry.

See Afrikaans / Dissertation (M(Communication Pathology))--University of Pretoria, 2005. / Speech-Language Pathology and Audiology / unrestricted

This article summarizes the significant contributions of Fred H. Bess to the early detection of hearing loss in infants and children. Based on public health and educational policy, Bess challenged audiologists to view hearing screening as a responsibility that brought with it the need to develop screening tools that are effective in identifying hearing loss - whether for use with infants, preschoolers, or school-age children - and that adhere to important screening principles. A review of his influence on pertinent guidelines, position statements, and recommendations highlights his belief that early identification of hearing loss is critical if children are to overcome the significant obstacles presented by even mild and unilateral hearing losses. This section is followed by a review of seminal papers that stimulated research in universal newborn hearing screening programs and the detection of unilateral and minimal hearing loss. We conclude with a review of selected studies that build on Bess's earlier work and strive to drive our field forward to practices that are both evidence-based and effective in detecting hearing loss in children.

The purpose of this study was to investigate the effects of increased intensity on the bone conducted speech discrimination ability of normal listeners utilizing standard audiological equipment. The NU-6 word lists were utilized to test the bone conducted speech discrimination skills of ten normal hearing subjects, 21 to 30 years of age, on standard clinical equipment. Both the hearing levels (dB HL) and the sensation levels (dB SL) of the test administration were considered. In general, it was recommended that 100 dB Hl is the most appropriate dial setting for the administration of bone conducted speech discrimination tests even though comparable speech discrimination scores may be obtained with a 95 dB HL dial setting. This study indicates that the most appropriate sensation levels for the administration of bone conducted speech discrimination tests are 55 and 60 dB SL. Most normal listeners can be expected to achieve a 55 dB sensation level at the limits of the speech audiometer (100 dB HL). Additionally, it was found that when bone conducted speech discrimination tests are administered at levels of less than 55 dB SL, the results may be compromised by variances that occurred in this normal hearing sample. Therefore, the clinical audiologist should accept bone conducted speech discrimination results as valid only when the scores obtained at 40, 45 and 50 dB sensation levels are within the limits of clinical normality (90% or better). Recommendations for further research are discussed.

The purpose of this study was to establish a normal, bone conducted intensity level for the speech reception threshold (SRT) and obtain a normal performance intensity function by bone conduction from 0 dB SL (threshold) through the maximum output level of the standard audiometer. All bone conducted speech test materials consisted of pre-recorded W-2 spondiac words and NU-6 monosyllabic speech discrimination word lists.