Algumas teorias propõem que a percepção auditiva para sons complexos, como a fala e sons simples, ocorre de maneira distinta. Teorias sobre a existência de uma rota especial para decodificação da fala, com distinções desde a detecção do espectro acústico, a despolarização não linear das fibras do nervo auditivo, até a localização de neurônios especializados para interpretar sons de fala a nível cortical. Seria possível esta habilidade específica de percepção de fala um fator que modificaria as respostas de crianças entre 6 a 24 meses durante uma avaliação comportamental? Para avaliação audiológica nesta faixa etária, a Audiometria com Reforço Visual (VRA) é o exame indicado para obter níveis mínimos de audição (NMA). Diversos estudos apresentam as indicações da técnica do VRA para obter respostas confiáveis do sistema auditivo. Diante destas perguntas, determinou-se realizar um estudo comparativo do VRA com dois estímulos: warble nas frequências de 0.5, 1, 2 e 4kHz, e estímulos de fala, os seis sons de Ling /a/, /i/, /u/, /s/, /?/, /m/. Os dois exames foram aplicados em crianças com e sem deficiência auditiva, com os objetivos de determinar os NMA, o tempo de teste, número de sessões e os comportamentos observados durante a avaliação. Além da investigação quantitativa, foi elaborado um guia de orientações para realização do VRA. Foram avaliadas 123 crianças, as quais 57 foram inclusas na pesquisa, os principais motivos de exclusão foram: timpanogramas alterados, deficiências múltiplas, atraso motor e desordem do espectro da neuropatia auditiva. Participaram do grupo controle (GC) 33 crianças sem deficiência auditiva, idade média de 12 meses, e 24 com deficiência auditiva do grupo experimental (GE), idade média de 18 meses. No total foram obtidos 718 NMA considerando as 57 crianças e os 10 estímulos avaliados. Para o GC a média do VRA-warble foi de 17,05 dBNA e para o VRA-Ling de 13,60 dBNA; no GE as médias foram respectivamente, 95,51 dBNA e 85,88 dBNA, ou seja, estatisticamente os valores obtidos com os sons de Ling foram menores do que os obtidos com o estímulo warble. Os tempos médios para obtenção de pelo menos um NMA ou todos os NMA com o Ling e warble, não se diferiram na comparação intra grupos, assim como o número de sessões realizadas. No entanto, observou-se na comparação entre grupos, que o número de sessões, o número de NMA obtidos e o tempo de teste na realização do VRA-warble, foram maiores no GE. Outros comportamentos foram observados durante o decorrer do VRA: atenção, reflexo de orientação, imitação do estímulo auditivo, apontar para o fone, olhar para avaliadora/mãe. Considerando os resultados obtidos: o protocolo de teste utilizado mostrou-se eficaz para obtenção dos NMA nos dois grupos estudados; os sons de Ling podem ser utilizados na avaliação audiológica infantil de forma a complementar os achados com os estímulos de frequência específica. Porém, uma vez que os sons de Ling possuem uma ampla faixa de frequência, outros estudos que correlacionem os NMA para os sons de Ling nas diferentes configurações audiométricas são necessários. / Some theories postulate the auditory perception to complex sounds and simple sounds, occur differently. Theories about the existence of a special route for decoding speech, with distinctions from the detection of the acoustic spectrum, nonlinear depolarization of the auditory nerve fibers to the location of specialized neurons to interpret speech sounds at the cortical level. Is it possible this specific skill of speech perception a factor that would change the responses of children aged 6 to 24 months during a behavioral assessment? For audiological evaluation in this age group, with Visual Reinforcement Audiometry (VRA) is the test to obtain minimum response levels (MRL) or thresholds. Faced with these questions, determined to carry out a comparative study of the VRA with two stimuli: warble tones in the frequencies of 0.5, 1, 2 and 4 kHz, and speech stimuli, the six Ling sounds /a/, /i/, /u/, /s/, /?/, /m/. Both tests were applied in children with and without hearing impairment with the objective of determining the NMA, test time, number of sessions and the behavior observed during the assessment. In addition to quantitative research, we designed a guide guidelines for conducting the VRA. 123 children were evaluated, of which 57 were included in the survey, the main reasons for exclusion were changed tympanograms, multiple disabilities, delayed motor and auditory neuropathy spectrum disorder. Participated in the control group (CG) 33 children without hearing impairment, mean age 12 months, and 24 with hearing loss in the experimental group (GE), average age of 18 months. In total 718 were obtained NMA considering the 57 children and 10 evaluated stimuli. For the GC average of VRA-warble was 17.05 dBHL and for VRA-Ling of 13.60 dB HL; GE in the averages were respectively 95.51 and 85.88 dBHL dBNA, ie, statistically the values obtained with the sounds of Ling were lower than those obtained with the warble stimulus. The average time to achieve at least one or all of the NMA NMA with Ling and warble, did not differ compared intra groups, as well as the number of sessions. However, it was noted in comparison between groups, the number of sessions, the number of NMA obtained and the and the test time in achieving VRA-warble were higher in the EG. Other behaviors were observed during the course of the VRA: attention, orientation reflex, imitation of auditory stimuli, point to the phone, look appraiser / mother. Considering the results obtained: the test protocol used was effective for obtaining the NMA in both groups; Ling sounds can be used in the audiological evaluation of children to complement the findings with specific frequency stimuli. However, since Ling sounds have a wide range of frequencies, other studies correlating to NMA Ling sounds in different audiometric configurations are needed.

Introdução: A Síndrome da Imunodeficiência Adquirida ocorre devido presença do vírus HIV no organismo afetando o sistema imunológico, podendo deteriorá-lo, permitindo a manifestação de infecções oportunistas. Estas infecções podem acometer o Sistema Auditivo Periférico trazendo prejuízo à audição dos indivíduos infectados. A literatura aponta a avaliação da Audiometria em Altas Frequências como um preditor importante para as alterações deste sistema. Objetivo: Caracterizar as manifestações audiológicas em indivíduos com HIV / AIDS submetidos e não submetidos à terapia antirretroviral. Método: A avaliação audiológica foi realizada em 28 indivíduos do GPI com HIV/AIDS, submetidos à terapia antirretroviral; 24 indivíduos do GPII com HIV/AIDS, não submetidos à terapia antirretroviral e 45 indivíduos saudáveis do GC. Os exames audiológicos que compuseram esta pesquisa foram: Audiometria Tonal Convencional, Logoaudiometria, Audiometria em Altas Frequências, Medidas de Imitância Acústica. Resultado: Para as medidas de Imitância Acústica não houve diferença estatisticamente significante para os resultados obtidos entre os grupos, tanto para a Timpanometria, como para os Reflexos Acústicos. Observou-se também, que para os três grupos, a proporção de resultados normais para a Timpanometria é maior, enquanto para os Reflexos Acústicos, a maior proporção foi de resultados alterados. Os grupos GPI e GPII, compostos por indivíduos com HIV/AIDS apresentam alterações tanto na avaliação audiológica convencional, como em altas frequências. Em relação à Audiometria Tonal Convencional, na comparação entre os grupos, observou-se limiares auditivos mais elevados nas frequências de 250 Hz, 1000 Hz, 2000 Hz, 4000 Hz, 6000 Hz e 8000 Hz para os indivíduos com HIV/AIDS. No que diz respeito à Audiometria em Altas Frequências, os resultados obtidos demonstraram, também, limiares auditivos mais elevados em indivíduos com HIV/AIDS nas frequências de 10 KHz, 11,2 KHz, 12,5 KHz, 14KHz, 18 kHz e 20 KHz. Conclusão: Para as Medidas de Imitância Acústica, não foi observada diferença entre os três grupos. Indivíduos com HIV/AIDS apresentam mais alteração na Audiometria Tonal Convencional e na Audiometria em Altas Frequências quando comparados a indivíduos saudáveis, sugerindo, comprometimento do sistema auditivo periférico. Não houve diferença significativa entre indivíduos com HIV/AIDS submetidos e não submetidos à terapia antirretroviral / Introduction: Acquired Immune Deficiency Syndrome occurs as a result of the presence of the HIV virus in the body affecting the immunological system, potentially making it deteriorate, allowing the manifestation of opportunistic infections. These infections can attack the peripheral hearing system causing hearing damage to the infected individuals. Literature indicates High Frequency Audiometry as an important pointer to the alterations of the peripheral hearing system. Objective: To characterize the audiological manifestations in individuals with HIV/AIDS submitted and not submitted to antiretroviral therapy. Method: The audiological evaluation was carried out in 28 individuals of GPI with HIV/AIDS submitted to antiretroviral therapy; 24 individuals of GPII with HIV/AIDS not submitted to the antiretroviral therapy and 45 healthy individuals of GC. The audiological tests that make up this survey were: Conventional Tonal Audiometry, Speech Audiometry, High Frequency Audiometry and Acoustic Immitance Measures. Result: In the measurement of Acoustic Immitance, there was no statistically significant difference in the results obtained amongst the groups, for Tympanometry Test and for Acoustic Reflexes. It was also observed that for the three groups, the percentage of normal results for Tympanometry Test was higher, whilst for Acoustic Reflexes the higher percentage was of altered results.The groups GPI and GPII, formed by individuals with HIV/AIDS, presented alterations in the conventional audiological evaluation as well as in the high frequency one. With regards to the Conventional Tonal Audiometry, in the comparison amongst the groups, it showed higher audiometrics thresholds in frequencies of 250 Hz, 1000 Hz, 2000 Hz, 4000 Hz, 6000 Hz and 8000 Hz for individuals with HIV/AIDS. Regarding High Frequency Audiometry, the results also showed higher audiometrics thresholds in individuals with HIV/AIDS in frequencies of 10 KHz, 11,2 KHz, 12,5 KHz, 14KHz, 18 kHz and 20 KHz. Conclusion: There was no difference in the Measurements of Acoustic Immitance observed amongst the three groups Individuals with HIV/AIDS present more alterations in Conventional Tonal Audiometry and in High Frequency Audiometry when compared to healthy individuals which indicates a compromise on the peripheral hearing system. There was no significant difference between individuals with HIV/AIDS submitted and not submitted to antiretroviral therapy

Introdução: Os benefícios da triagem auditiva neonatal e em escolares têm sido bem demonstrados, porém a disponibilização de programas de triagem auditiva tem sido restrita aos grandes centros, devido à escassez de equipamentos e profissionais especializados na maioria das localidades nos países em desenvolvimento. Para atingir estes objetivos, algumas iniciativas têm utilizado a telemedicina em diferentes soluções. No entanto, não existem relatos na literatura de métodos para avaliação auditiva à distância em que não se utiliza um periférico específico no ponto remoto, nem tampouco sem a necessidade de um profissional especializado de forma presencial ou remotamente. Objetivos: a) Desenvolver um método de triagem à distância para identificação de indivíduos com perda auditiva; b) Testar sua acurácia e compará-lo ao teste de audiometria de triagem (AV) sem cabine acústica. Material e Métodos: o novo método de triagem, denominado telaudiometria (TA), consiste em um software próprio desenvolvido, instalado em um computador com fone TDH 39. Foram selecionadas aleatoriamente entre pacientes e acompanhantes do Hospital das Clínicas, 73 pessoas entre 17 e 50 anos, sendo 42 (57,5%) do sexo feminino. Após serem submetidos a um questionário de sintomas e otoscopia, os indivíduos realizavam os testes de telaudiometria e audiometria de triagem com varredura em 20 dB nas freqüências de 1, 2 e 4 kHz seguindo o protocolo da ASHA (1997) e ao teste padrão-ouro de audiometria de tons puros em cabine acústica em ordem aleatória. Resultados: a TA durou em média 125 ± 11 s e a AV, 65 ± 18 s. Observou-se que 69 pessoas (94,5%) declararam ter achado fácil ou muito fácil realizar a TA e 61 (83,6%) consideraram fácil ou muito fácil a AV. Os resultados da acurácia da TA e AV foram respectivamente: sensibilidade (86,7% / 86,7%), especificidade (75,9% / 72,4%) e valor preditivo negativo (95,7% / 95,5%), valor preditivo positivo (48,1% / 55,2%). Conclusão: A teleaudiometria mostrou-se uma boa opção como método de triagem auditiva, apresentando acurácia próxima da audiometria de triagem. Em comparação a este método, a telaudiometria apresentou sensibilidade semelhante, maiores especificidade, valor preditivo negativo e tempo de duração e menor valor preditivo positivo. / Introduction: Hearing deficiency interferes with the perception and recognition of speech. The benefits of auditory screening in newborns and schoolchildren have been well demonstrated. However, in developing countries, the availability of auditory screening programs has been restricted to larger facilities, due to the scarcity of equipment and specialized professionals in the majority of areas. Objectives: To develop a method of remote screening for the identification of individuals with hearing loss, as well as to determine its accuracy in comparison with that of sweep audiometry without a sound-treated booth. Design: The new screening method, designated teleaudiometry, consists of its own newly developed computer program, installed on a computer with supra-aural headphones attached. The study participants were randomly selected from among patients and their companions at the University of Sao Paulo School of Medicine Hospital das Clínicas, in Sao Paulo, Brazil. We selected 73 individuals between 17 and 50 years of age, 42 (57.5%) of whom were female. After completing a symptoms questionnaire and being submitted to otoscopy, the participants underwent teleaudiometry and sweep audiometry with a sweep of 20 dB at the frequencies of 1, 2 and 4 kHz following the American Speech-Language-Hearing Association protocol, as well as the gold-standard test of pure tone audiometry in sound-treated booth, in random order. Results: The teleaudiometry lasted, on average, 125 ± 11 sec, compared with 65 ± 18 sec for sweep audiometry. Of the 73 participants, 69 (94.5%) found it easy or quite easy to perform the teleaudiometry, compared with 61 (83.6%) for the sweep audiometry. Teleaudiometry and sweep audiometry presented, respectively, the following: sensitivity of 86.7% and 86.7%; specificity of 75.9% and 72.4%; a negative predictive value of 95.7% and 95.5%; and a positive predictive value of 48.1% and 55.2%. Conclusions: Teleaudiometry proved to be a viable option as a method of auditory screening, presenting accuracy similar to that of sweep audiometry. The use of teleaudiometry could increase the number of identified cases of hearing loss, thereby allowing more timely treatment of such cases in underserved populations

Submitted by Fabiana Gonçalves Pinto (benf@ndc.uff.br) on 2015-11-27T17:21:30Z No. of bitstreams: 1 Andrea Maria dos Santos Rodrigues.pdf: 1631844 bytes, checksum: c774a006e60a7f7184ae9622e64078b1 (MD5) / Made available in DSpace on 2015-11-27T17:21:30Z (GMT). No. of bitstreams: 1 Andrea Maria dos Santos Rodrigues.pdf: 1631844 bytes, checksum: c774a006e60a7f7184ae9622e64078b1 (MD5) Previous issue date: 2011 / Mestrado Profissional em Enfermagem Assistencial / Trata-se de uma pesquisa desenvolvida junto ao Mestrado Acadêmico em Ciências do Cuidado em Saúde que tem como objeto de estudo o cuidado com a saúde auditiva em motoristas de ônibus urbanos, considerando que a saúde auditiva é um dos aspectos fundamentais para a comunicação humana. A pesquisa fundamentou-se nos pressupostos teóricos da audição, na área da saúde do trabalhador e na perspectiva do cuidado em saúde, pois cuidar da saúde do trabalhador é buscar espaços e condições de trabalho saudáveis fazendo com que sua atividade diária seja cada vez menos prejudicial, tanto no campo físico quanto no campo psíquico. Os objetivos do estudo foram: identificar a existência de variação nos limiares auditivos dos motoristas de ônibus através das audiometrias ocupacionais ao longo de três anos consecutivos; verificar os saberes dos motoristas de ônibus urbano em relação aos riscos de exposição ao ruído e sobre o cuidado com sua saúde auditiva; descrever o Programa de Conservação Auditiva da Empresa de Transporte Coletivo; e discutir ações de cuidado com a saúde auditiva para compor o Programa de Conservação Auditiva. A abordagem metodológica utilizada foi um estudo de caso em uma empresa de transporte coletivo localizada na Cidade do Rio de Janeiro. A caracterização do estudo é observacional, do tipo coorte, que significa a seleção de indivíduos conforme o status de exposição, sendo acompanhados para avaliação da incidência de doença. Para análise dos dados estatísticos foram utilizados como métodos: ANOVA de Friedman para verificar a existência de variação significativa nas audiometrias, ao longo de três anos consecutivos; o teste de comparações múltiplas de Nemenyi, para identificar quais os anos que apresentam diferenças significativas entre si; e o teste dos postos sinalizados de Wilcoxon para verificar a existência de variação na audiometria entre as orelhas, direita e esquerda. Esta pesquisa foi aprovada pelo Comitê de Ética e Pesquisa do Hospital Universitário Antonio Pedro da Universidade Federal Fluminense (HUAP/ UFF) sob CAAE - 6141.0.000.258-10. Os resultados da pesquisa apontam que existem variações nos limiares auditivos dos motoristas de ônibus ao longo de três anos consecutivos, separadamente, por orelha. Comparando-se os limiares da orelha direita e esquerda observou-se que a orelha direita não apresentou diferenças significantes nas frequências analisadas dos exames audiométricos realizados, porém a orelha esquerda apresentou diferenças significativas em três frequências (500 Hz, 1000 Hz e 3000 Hz). De acordo com a Classificação da Portaria 19 (1998), evidenciou-se que houve uma redução do número de motoristas com exame de referência dentro dos limites de normalidade, em relação ao terceiro ano observado (exame sequencial). Cabe ressaltar, que a ocorrência das classificações de agravamento ou desencadeamento de Perda Auditiva Induzida por Ruído (PAIR) não foram identificadas na amostra avaliada. Destaca-se que os motoristas de ônibus em sua maioria não possuem conhecimento sobre os riscos de exposição e cuidados com a saúde auditiva, advindos da falta de informação. Esse estudo aponta que a atuação do fonoaudiólogo através de ações de cuidado inseridas no Programa de Conservação Auditiva é imprescindível para promover a saúde auditiva noambiente de trabalho. / This is a survey developed along the Academic Masters in health care sciences that have as an object of study the hearing health care in urban bus drivers, since the hearing health is one of the fundamental aspects to human communication. The survey was based on theoretical assumptions of the hearing, in the area of workers' health and the prospect of health care because care of workers' health is seeking spaces and healthy working conditions causing their daily activity to become less and less harmful, both in physical and psychic field. The objectives of the study were to: identify the existence of variation in auditory thresholds of bus drivers through the occupational audiometries over three consecutive years; verify the knowledge of urban bus drivers in relation to risks of exposure to noise and about the care of their health hearing; describe the company's Hearing Conservation program of Collective Transport; and discuss actions of hearing health care to compose the Hearing Conservation program. The methodological approach used was a case studied in a public transportation company located in the city of Rio de Janeiro. The characterization of the observational study is of a kind cohort, which means the selection of individuals as the exposure status, being monitored with a view to assessing the incidence of the disease. For analysis of the statistical data were used as methods: Friedman's ANOVA to verify the existence of significant variation in audiometries, over three consecutive years; multiple comparisons testing Nemenyi, to identify which year that have significant differences between themselves; and testing of flagged posts of Wilcoxon to verify the existence of variation in audiometry between the ears, right and left. This research was approved by the Ethics Committee and University Hospital Research Antonio Pedro of the Universidade Federal Fluminense (HUAPUFF) under CAAE-6141.0.000.258-10. Search results show that there are variations in the auditory thresholds of bus drivers over three consecutive years, separately, by ear. Comparing left and right ear thresholds observed that the right ear did not present significant differences in frequencies of audiometric tests conducted, analyzed but the left ear presented significant differences in three frequencies (500 Hz, 1000 Hz and 3000 Hz). According to the classification of the Gatehouse 19, it showed that there was a reduction in the number of drivers with reference examination within the bounds of normality, in relation to the third year observed (sequential examination). Please note that the occurrence of the trigger or worsen ratings for Noise-induced hearing loss (PAIR) were not identified in the sample evaluated. It is noteworthy that the bus drivers mostly do not have knowledge about the risks of exposure and hearing health care, from lack of information. This study points out that the actions of the audiologist through careful actions entered in the Hearing Conservation program is essential to promote hearing health in the working environment.

Coordenação de Aperfeiçoamento de Pessoal de Nível Superior / Purpose: to evaluate and compare the performance of elderly people with descending hearing loss, still considering the presence or absence of dead regions in cochlea (DRs), in speech recognition tests, in silence and in noise, using auditory prostheses with and without the activation of the nonlinear frequency compression (NLFC). Materials and Methods: the study presents quantitative, observational, descriptive, and transversal traits. 48 subjects were evaluated: 33 men and 15 women, aged between 61 and 84 years, with mild to moderate hearing loss and descending configuration. In order to collect the data the Lists of Sentences in Portuguese test was used (LSP), seeking the Sentence Recognition Thresholds in Silence (LRSS), the Sentences Recognition Threshold in Noise (LRSR) expressed by the signal/noise relationship (S/R) and Percentage Index Sentence Recognition of Threshold in Silence (IPRSS) and in noise (IPRSR). The subjects were evaluated using binaural auditory prostheses, which had their adjustments verified through measurements with a probe microphone. All measurements were obtained using auditory prostheses both without the activation of the NLFC (SC) and with the activation of the NLFC (CC). For the analysis of collected data, the subjects were distributed in two formats; in one study the 48 subjects comprised a sample, in the other, considering the results obtained in the DRs identification test, the subjects distributed themselves in Group A (24 elderly people without evidence of DRs) and Group B (14 elderly people with evidence of DRs). Results: in the first study, a statistically significant difference between LRSS and IPRSS obtained using auditory prostheses SC and CC was observed, the latter being those that provided the better results. In the S/R relationship and in the IPRSR there was no statistically significant difference observed between the use of auditory prostheses SC and CC. In the second study analyzing the results of group A and B separately, in both a statistically significant difference in performance between the IPRSS obtained using auditory prostheses SC and CC, the latter being those that provided the better results. There was no difference observed in IPRSR. Comparing the groups, one verifies that there was no statistically significant difference in performance in IPRSS SC, IPRSS CC, and in IPRSR CC. Yet, the IPRSR SC presented statistically significant difference between the groups, the best being the performance of Group B. Conclusion: in the first study, the general sample presented statistically significant improvement in the measurements obtained in silence using auditory prostheses with CNLF if compared to the auditory prostheses without NLFC. In noise, no difference in performance was verified with or without NLFC. In the second study, both the group of subjects without and the group with DRs obtained statistically significant improvement in performance, in silence, using auditory prostheses with NLFC, in noise, however, there was no difference. Comparing the groups with and without DRs, the only measure that presented a significant difference was that obtained in noise with auditory prostheses without NLFC, in which the group with DRs obtained better performance than the group without DRs. / Objetivo: avaliar e comparar o desempenho de idosos com perda auditiva de configuração descendente, considerando ainda a presença ou não de zonas mortas na cóclea (ZMC) em testes de reconhecimento de fala, no silêncio e no ruído, usando próteses auditivas sem e com a ativação do algoritmo de compressão não linear de frequências (CNLF). Material e método: o estudo apresenta caráter quantitativo, observacional, descritivo e transversal. Foram avaliados 48 sujeitos, sendo 33 homens e 15 mulheres, com idade entre 61 e 84 anos, perda auditiva de grau leve a moderado e configuração descendente, sem experiência com o uso de próteses auditivas. Para coleta dos dados, foi utilizado o teste Listas de Sentenças em Português (LSP), sendo pesquisados os Limiares de Reconhecimento de Sentenças no Silêncio (LRSS), relações sinal/ruído (S/R) e Índices Percentuais de Reconhecimento de Sentenças no Silêncio (IPRSS) e no ruído (IPRSR). Os sujeitos foram avaliados usando próteses auditivas de forma binaural, as quais tiveram seus ajustes verificados por meio de mensurações com microfone sonda. Todas as medidas foram obtidas com o uso de próteses auditivas sem a ativação da CNLF (SC) e com próteses auditivas com a CNLF ativada (CC). Para análise dos dados, os sujeitos foram distribuídos de duas formas: em um estudo os 48 sujeitos compuseram a amostra; em outro, considerando os resultados obtidos no teste para identificação de ZMC, distribuíram-se os sujeitos em Grupo A (24 idosos sem indícios de ZMC) e Grupo B (14 idosos com indícios de ZMC). Resultados: considerando a amostra geral, foi observada diferença estatisticamente significante entre os LRSS e IPRSS obtidos usando próteses auditivas SC e CC, sendo as últimas as que proporcionaram melhores resultados. Na relação S/R e IPRSR, não foi observada diferença estatisticamente significante entre o uso de próteses auditivas SC e CC. Analisando-se separadamente os resultados do grupo A e B, em ambos observou-se diferença estatisticamente significante de desempenho entre os IPRSS obtidos usando próteses auditivas SC e CC, sendo as últimas as que proporcionaram melhores resultados. Não foi observada diferença no IPRSR. Comparando-se os grupos A e B, verificou-se que não houve diferença estatisticamente significante de desempenho no IPRSS SC, no IPRSS CC e no IPRSR CC. Já o IPRSR SC apresentou diferença estatisticamente significante entre os grupos, sendo o melhor o desempenho do grupo B. Conclusão: Considerando-se a amostra geral, no silêncio, as próteses auditivas CC proporcionaram maiores benefícios do que as SC. No ruído, o reconhecimento de fala foi semelhante com o uso de próteses auditivas SC e CC. Considerando-se a presença de ZMC, no silêncio, tanto no grupo de idosos sem quanto no com ZMC, o uso de próteses auditivas CC apresentou tendência a proporcionar maiores benefícios do que as SC. No ruído, os resultados foram semelhantes nas condições SC e CC em ambos os grupos. Comparando-se os grupos sem e com ZMC, a única medida que apresentou diferença significante foi a obtida no ruído com próteses auditivas CC, na qual o grupo com ZMC obteve desempenho melhor do que o sem ZMC.

Purpose: To investigate the occurrence of binaural interference. To investigate the mono or binaural use of hearing aids and the complaints of speech comprehension in silence and noise.To evaluate the speech recognition with and without the use of mono and binaural hearing aids and the auditory processing skills.To correlate the obtained results in different tests. To evaluate the recognition of sentences in silence and noise by elderly individuals with symmetrical hearing loss, users of hearing aids with mono and binaural adaptation, and to investigate in which of both situations it may be verified the best performance in conditions that simulate daily communication situations. Material and Method: The evaluated subjects were 25 men and 13 women, with ages between 60 and 89 years old, with sensorineural hearing loss from mild to moderate severe level, symmetrical configuration, users of hearing aids with binaural indication. It was researched the Percentage Index of Speech Recognition (PISR) in both ears (BE) and it was performed the Dichotic Digits Test (DDT) of divided and directed attention, and the Portuguese Sentence List test (PSL). It was also studied the sentence recognition threshold in quiet (SRTQ) and in noise (SRTN) and the percentual indexes of sentence recognition in quiet environment and under noise (PISRQ and PISRN), with binaural adaptation (BA) and monaural in the right ear (RE) and in the left ear (LE). Results: Among the evaluated individuals, 31 (81.58%) referred that they use binaural hearing aids, 19 subjects (50%) reported they have never had difficulties to understand speech in silent places and 17 (44.75%) answered sometimes. 22 (57.89%) referred difficulties to recognize speech in noisy places, sometimes and 15 (39.47%) said it always happened. The obtained average values for the PISR were 72.95% in BE, 59.26% in the RE and 60.53% in the LE, respectively. The obtained averages in the DDT were 54.58% in BE, 65.16% in the RE and 71.95% in the LE. Regarding the PISRQ data, they were 79.63% in BE, 74.79% in the RE and 72.40% in the LE. The correlation of the PISR, DDT and PISRQ, the PISR and the PSL tend to present similar values. About analyzes into silence and into noise with binaural and monaural adaptation, the average values for PISRQ were 80.89% in BE, 76.33% in the RE and 71.16% in the LE, respectively. The obtained averages for PISRN were 62.05% in BE, 60.52% in the RE and 60.33% in the LE. Conclusion: It was found in an individual, the presence of binaural interference. Most elderly people used binaural hearing aids; only one individual did not present complaints of speech comprehension into noise. The PISR showed better performance in binaural condition; the DDT may not be the most proper option to be used in elderly patients with hearing loss; the PISR and the PSL tend to present similar values. The sentence recognition by the evaluated subjects presented better performance with the binaural adaptation, as into silence as into noise. However, that difference was not statistically significant. / Objetivo:Investigar a ocorrência da interferência binaural. Investigar o uso mono ou binaural das próteses auditivas e as queixas de compreensão de fala no silêncio e no ruído. Avaliar o reconhecimento de fala com e sem uso de próteses auditivas mono e binaural e habilidades do processamento auditivo. Correlacionar os resultados obtidos nos diferentes testes. Avaliar o reconhecimento de sentenças no silêncio e no ruído, de indivíduos idosos com perdas auditivas simétricas, usuários de próteses auditivas com adaptação mono e binaural, investigando em qual das duas situações pode ser verificado o melhor desempenho em condições que simulam situações de comunicação do diaadia. Material e método: Foram avaliados 38 sujeitos, sendo 25 homens e 13 mulheres, com idade entre 60 e 89 anos, perda auditiva neurossensorial de grau leve a moderadamente severo, de configuração simétrica, usuários de próteses auditivascom indicação binaural. Foi pesquisado o Índice Percentual de Reconhecimento de Fala (IPRF) em ambas as orelhas (AO) e realizados dois testes: oTeste Dicótico de Dígitos (TDD) atenção dividida e direcionada e o teste Listas de Sentenças em Português (LSP). Pesquisou-se aindaos Limiares de Reconhecimento de Sentenças no Silêncio e no Ruído (LRSS e LRSR) e Índice Percentual de Reconhecimento de Sentenças no Silêncio e no ruído (IPRSS e IPRSR), com adaptação binaural (AO) e monoaural orelha direita (OD) e orelha esquerda (OE). Resultados:Entre os indivíduos avaliados, 31(81,58%) relataram fazer uso binaural das próteses auditivas, 19 (50%) relataram nunca ter dificuldade de compreender a fala no silêncio e 17(44,75%) às vezes. 22 (57,89%) referiram dificuldade para reconhecer a fala no ruído, às vezes e 15 (39,47%) sempre. Os valores médios obtidos para os IPRF foram de 72,95% em AO, 59,26% na OD e 60,53% na OE, respectivamente. As médias obtidas do TDD foram 54,58% em AO, 65,16% na OD e 71,95% OE. Quanto aos dados do IPRSS, foram de 79,63% em AO, 74,79% na OD e 72,40% na OE. A correlação das variáveis IPRF, TDD e IPRSS, o IPRF e o LSP tendem a apresentar resultados semelhantes. Em relação às análises no silêncio e no ruído com adaptação binaural e monoaural, os valores médios obtidos para os IPRSS foram de 80,89% em AO, 76,33% na OD e 71,16% na OE, respectivamente. Já as médias obtidas do IPRSR foram 62,05 % em AO, 60,52% na OD e 60,33%OE. Conclusão:Foi encontrado em um indivíduo indícios da presença de interferência binaural. A grande maioria dos idosos fazia uso binaural das próteses auditivas.Somente um indivíduo não apresentou queixa de compreensão de fala no ruído. O IPRF demonstrou melhor desempenho na condição binaural. O TDD evidenciou pior desempenho na tarefa de integração binaural. Já no LSP não foi encontrada diferença estatisticamente significante entre o desempenho mono e binaural. O teste TDD pode não ser a opção mais adequada para ser utilizado em pacientes idosos com perda auditiva; já o IPRF e o LSP tendem a apresentar resultados semelhantes. O reconhecimento de sentenças dos sujeitos avaliados mostrou melhor desempenho com a adaptação binaural, tanto no silêncio como no ruído. Entretanto, essa diferença não foi estatisticamente significante.

The need for hearing health care services across the world far outweighs the capacity to deliver these services with the present shortage of hearing health care personnel. Automated test procedures coupled with telemedicine may assist in extending services. Automated threshold audiometry has existed for many decades; however, there has been a lack of systematic evidence supporting its clinical use. The aim of this study was to systematically review the current body of peer-reviewed publications on the validity (test-retest reliability and accuracy) of automated threshold audiometry. A meta-analysis was thereafter conducted to combine and quantify the results of individual reports so that an overall assessment of validity based on existing evidence could be made for automated threshold audiometry. A systematic literature review and meta-analysis was conducted using peerreviewed publications. A multifaceted approach, covering several databases and employing different search strategies, was utilized to ensure comprehensive coverage and crosschecking of search findings. Publications were obtained using the following three databases: Medline, SCOPUS and PubMed, and by inspecting the reference list of relevant reports. Reports were selected based according to inclusion and an exclusion criterion, thereafter data extraction was conducted. Subsequently, the meta-analysis combined and quantified data to determine the validity of automated threshold audiometry. In total, 29 articles met the inclusion criteria. The outcomes from these studies indicated that two types of automated threshold testing procedures have been utilized, the ‘method of limits’ and ‘method of adjustments’. Reported findings suggest accurate and reliable thresholds when utilizing automated audiometry. Most of the reports included data on adult populations using air conduction testing, limited data on children, bone conduction testing and the effects of hearing status on automated threshold testing were however reported. The meta-analysis revealed that test-retest reliability for automated threshold audiometry was within typical testretest reliability for manual audiometry. Furthermore, the meta-analysis showed comparable overall average differences between manual and automated air conduction audiometry (0.4 dB, 6.1 SD) compared to test-retest differences for manual (1.3 dB, 6.1 SD) and automated (0.3 dB, 6.9 SD) air conduction audiometry. Overall, no significant differences (p>0.01; Summarized Data ANOVA) were obtained in any of the comparisons between test-retest reliability (manual and automated) and accuracy. Current evidence demonstrates that automated threshold audiometry can produce an accurate measure of hearing threshold. The differences between automated and manual audiometry fall within typical test-retest and inter-tester variability. Despite its long history however, validation is still limited for (i) automated bone conduction audiometry; (ii) automated audiometry in children and difficult-to-test populations and; (iii) automated audiometry with different types and degrees of hearing loss. / Dissertation (MCommunication Pathology)--University of Pretoria, 2013. / gm2014 / Speech-Language Pathology and Audiology / unrestricted

Preliminary studies have stirred the hope that sound-field stimulation through auditory steady state evoked potentials can be used to assess aided thresholds in the difficult-to-test population. Before the introduction of ASSEP into the clinical field, as a technique for the prediction of aided thresholds in the difficult-to-test population, a question arises concerning its clinical validation. The application of ASSEP through sound field stimulation, in the determination of aided thresholds and for the evaluation of amplification fittings, is dependent on the determination of unaided responses. Subsequently the estimation of unaided thresholds in the hearing impaired population is dependent on the establishment of normative data from the normal hearing population. The aim of this study was to determine the influence of insert earphones and sound field speaker presentation on threshold estimations using monotic auditory steady state evoked potentials, in a group of normal hearing adults. To achieve the aim of the study, a comparative, within-group experimental design was selected. The results of the current study indicated that the monotic single ASSEP technique under both insert earphone- and sound field conditions provided a reasonable estimation (25-35 dB HL for inset earphones; 20-33 dB HL for sound field speaker presentation) of the behavioural pure tone thresholds. The minimum response levels obtained under insert earphone conditions differed significantly from those obtained under sound field conditions for all the frequencies tested except 2 kHz (p < 0.01). Subsequently, the current study indicates that minimum response levels obtained using a specific transducer should serve as the basis of comparison with behavioural thresholds obtained under the same transducer. Therefore, behavioural pure tone thresholds obtained under insert earphone conditions will not suffice as a basis of comparison for minimum response levels obtained for the ASSEP technique under sound field conditions, and vice versa. This research endeavour concluded that the monotic ASSEP technique under both insert earphone and sound field conditions provide useful information for the estimation of frequency specific thresholds, but that the results are transducer specific and that comparison across transducers should be avoided. / Dissertation (M (Communication Pathology))--University of Pretoria, 2006. / Speech-Language Pathology and Audiology / Unrestricted

Speech audiometry is considered an essential tool in the assessment of hearing, not only to validate pure tone measurements, but also to indicate speech perception as a critical communicative function. The use of sentence material in the assessment of speech perception has great value as it simulates – more closely than single words – the type of speech stimuli that listeners are confronted with on a daily basis. In South Africa, speech recognition (reception and discrimination) abilities are most commonly assessed through the use of single words, presented by monitored live voice, a practice sternly criticized in the literature. Furthermore, speech recognition is commonly evaluated in an ideal (quiet) listening environment. This method gives an incomplete impression of a patient’s auditory performance, since everyday listening situations are often characterised by the presence of background noise that influences comprehension of speech. The present study was therefore launched with the aim to develop a reliable measure of speech recognition in noise using Afrikaans sentence material. The development of the test was conducted in three phases. The first phase entailed the compilation of culturally valid, pre-recorded Afrikaans sentence material. During the second phase the uniformity of the recorded sentence collection was improved by determining the intelligibility of each sentence in the presence of noise and eliminating sentences that were not of equivalent difficulty in this regard. The objective of the third phase was to arrange the sentence material into lists using two different methods of list compilation. The first method involved grouping sentences together based solely on their intelligibility in noise (as assessed in the previous phase). The second method was the well-documented method of compiling phonetically balanced lists. The inter-list reliability of both sets of lists was evaluated in both normal hearing listeners and listeners with a simulated high frequency hearing loss. The results provided valuable information on the process of developing a test of speech recognition in noise, especially in terms of options for list compilation. Findings indicated that lists compiled according to intelligibility in noise showed a higher degree of equivalence than phonetically balanced lists when applied to normally hearing listeners. However, when applied to listeners with a simulated loss, phonetically balanced lists displayed greater equivalence. The developed test provides a means of assessing speech recognition in noise in Afrikaans, and shows potential for application in the assessment of hearing impaired populations, individuals with auditory processing difficulties, and the paediatric population. In addition, the methodology described for the development of the test could provide a valuable guideline for future researchers looking to develop similar tests in other languages. / Dissertation (MCommunication Pathology)--University of Pretoria, 2008. / Speech-Language Pathology and Audiology / MCommunication Pathology / Unrestricted

With the worldwide increase in numbers of individuals infected with the human-immune deficiency virus (HIV) and acquired immune deficiency syndrome (AIDS), the need for more information became essential. The devastating influences and fatal outcome of this disease is inevitable. These individuals are confronted with mortality and various disabling conditions. One of these disabling conditions is the possible development of a hearing loss. Loss of hearing sensitivity related to HIV/AIDS is only one of numerous effects the virus may have on humans and their quality of life. Therefore increased awareness of HIV/AIDS and the influences of this disease is inevitable for the modern audiologist. The precise nature and the extent of the influence that HIV/AIDS and antiretroviral therapy (ART) has on the hearing ability of a person are unknown to date. Even though a relationship between hearing loss, HIV/AIDS and the administration of relevant medication is expected, no clear explanation is available to provide the public or clinicians with the necessary information on assessments, interventions and aural rehabilitation techniques. Without being able to identify the specific cause, symptoms and place of lesion of the hearing loss, it will be difficult to ensure appropriate monitoring and treatment. Information regarding the influences of HIV/AIDS and ART on hearing sensitivity had to be established to ensure appropriate intervention and rehabilitation options. The first part of this research project reviews the evidence available regarding the possible influences of HIV/AIDS on hearing. Throughout the research a cross-sectional design with quantitative and qualitative approaches were followed comprising of a structured interview, basic and specialized audiometric battery to obtain the necessary case history, as well as results for these different audiological tests that were conducted. The specialised tests included immittance measurements, distortion-product otoacoustic emission (DPOAE) and auditory brainstem response (ABR). The results of this study were discussed in terms of the three sub aims in accordance with the different audiological tests that were conducted. The results indicated that those participants with ART exposure had a significantly higher incidence of hearing loss. The pure tone averages were mainly found within normal limits but decreased with the progression of the final stages of HIV/AIDS. The high and low frequencies of the audiogram were often affected with loss of hearing sensitivity suggesting the presence of a high and low frequency slope. The final three stages of HIV/AIDS had a significantly higher incidence of bilateral hearing loss. ART exposure were associated with more severe degrees of hearing loss. The DPOAE and ABR indicated that cochlear and retro-cochlear damage existed often among these participants. Only 20% participants had abnormal tympanograms suggestive of conductive pathology. The results revealed that the type of pathology varied across the stages of HIV/AIDS. The conclusions and implications of this study are discussed. Recommendations incorporate the development of HIV/AIDS awareness campaigns that includes audiological information on the possible influences, where to refer or where to seek assistance; issues regarding the improvement of the modern audiologists’ knowledge in terms of the management of the audiological needs of individuals with HIV/AIDS and the application of these results in the industrial setting to utilize when they consider granting compensation claims. / Dissertation (MCommunication Pathology)--University of Pretoria, 2008. / Speech-Language Pathology and Audiology / unrestricted