Objetivos: Caracterizar o perfil audiológico dos indivíduos com malformações congênitas de orelha externa e/ou orelha média, na Divisão de Saúde Auditiva (DSA), do Hospital de Reabilitação de Anomalias Craniofaciais (HRAC), da Universidade de São Paulo (USP), campus Bauru e avaliar o benefício e a satisfação dos usuários de aparelhos de amplificação sonora individuais por condução óssea (AASI VO) retroauriculares. Modelo: Análise de prontuários, avaliação do benefício pelo teste de reconhecimento de sentenças com ruído competitivo e pelas medidas do ganho funcional e avaliação da satisfação pelo questionário internacional QI - AASI. Local: DSA, HRAC/USP, Bauru. Participantes: Foram analisados os prontuários de 170 indivíduos e, destes, selecionados 13, com malformações congênitas bilaterais de orelha externa e/ou orelha média, deficiência auditiva condutiva ou mista moderada ou severa e usuários de AASI VO retroauricular. Resultados: O perfil audiológico (n = 170) caracterizou-se pelo predomínio das malformações bilaterais (53%), das malformações no sexo masculino (61%), da deficiência auditiva condutiva moderada ou severa (80%) e da adaptação de AASI VO (56%). A orelha direita foi mais afetada (32%), quando consideradas apenas as malformações unilaterais. Na amostra selecionada (n = 13), o benefício foi comprovado pelo melhor desempenho obtido na avaliação proposta, na condição com AASI, quando comparada à condição sem AASI. A satisfação foi confirmada pelos escores elevados obtidos no QI-AASI. Conclusões: O uso do AASI VO retroauricular trouxe benefícios para o reconhecimento da fala no ruído e para a percepção do sinal acústico, além de satisfação aos indivíduos com malformações congênitas de orelha, portanto, esses dispositivos devem ser considerados como uma opção no tratamento dessa população. / Objectives: To characterize the audiological profile of the individuals with congenital malformations of the external and/or middle ear, in the Divisão de Saúde Auditiva (DSA) of the Hospital de Reabilitação de Anomalias Craniofaciais (HRAC) of Universidade de São Paulo (USP), in Bauru and to evaluate the benefits and satisfaction of patients fitted with bone conduction hearing aid (BCHA). Model: Analysis of files, evaluation of benefits by means of test of recognition of sentences with competitive noise and by the measures of the functional gain, and evaluation of satisfaction by International Outcome Inventory for Hearing Aids (IOI/HA). Participants: 170 patients? files were analyzed, from which 13 were selected with bilateral congenital malformations of the external and/or middle ear, moderate or severe conductive or mixed hearing loss, and patients fitted with BCHA. Results: The audiological profile (n=170) was characterized by the prevalence of bilateral malformations (53%), of malformations in males (61%), of the moderate or severe conductive hearing loss (80%) and of the fitting of BCHA (56%). The right ear was more affected (32%) when considered the unilateral malformations only. In the selected sample (n=13), the benefit was demonstrated by the best performance obtained in the proposed evaluation, in the condition with hearing aid, when compared to the condition without hearing aid. The satisfaction was confirmed by the high scores obtained in the IOI - HA. Conclusions: Fitting BCHA denoted improvement at speech perception in noise and sound detection. Individuals with congenital malformations of the ear were satisfied with this device, so that must be considered as an option to the treatment of this population.

Objetivos: Caracterizar o perfil audiológico dos indivíduos com malformações congênitas de orelha externa e/ou orelha média, na Divisão de Saúde Auditiva (DSA), do Hospital de Reabilitação de Anomalias Craniofaciais (HRAC), da Universidade de São Paulo (USP), campus Bauru e avaliar o benefício e a satisfação dos usuários de aparelhos de amplificação sonora individuais por condução óssea (AASI VO) retroauriculares. Modelo: Análise de prontuários, avaliação do benefício pelo teste de reconhecimento de sentenças com ruído competitivo e pelas medidas do ganho funcional e avaliação da satisfação pelo questionário internacional QI - AASI. Local: DSA, HRAC/USP, Bauru. Participantes: Foram analisados os prontuários de 170 indivíduos e, destes, selecionados 13, com malformações congênitas bilaterais de orelha externa e/ou orelha média, deficiência auditiva condutiva ou mista moderada ou severa e usuários de AASI VO retroauricular. Resultados: O perfil audiológico (n = 170) caracterizou-se pelo predomínio das malformações bilaterais (53%), das malformações no sexo masculino (61%), da deficiência auditiva condutiva moderada ou severa (80%) e da adaptação de AASI VO (56%). A orelha direita foi mais afetada (32%), quando consideradas apenas as malformações unilaterais. Na amostra selecionada (n = 13), o benefício foi comprovado pelo melhor desempenho obtido na avaliação proposta, na condição com AASI, quando comparada à condição sem AASI. A satisfação foi confirmada pelos escores elevados obtidos no QI-AASI. Conclusões: O uso do AASI VO retroauricular trouxe benefícios para o reconhecimento da fala no ruído e para a percepção do sinal acústico, além de satisfação aos indivíduos com malformações congênitas de orelha, portanto, esses dispositivos devem ser considerados como uma opção no tratamento dessa população. / Objectives: To characterize the audiological profile of the individuals with congenital malformations of the external and/or middle ear, in the Divisão de Saúde Auditiva (DSA) of the Hospital de Reabilitação de Anomalias Craniofaciais (HRAC) of Universidade de São Paulo (USP), in Bauru and to evaluate the benefits and satisfaction of patients fitted with bone conduction hearing aid (BCHA). Model: Analysis of files, evaluation of benefits by means of test of recognition of sentences with competitive noise and by the measures of the functional gain, and evaluation of satisfaction by International Outcome Inventory for Hearing Aids (IOI/HA). Participants: 170 patients? files were analyzed, from which 13 were selected with bilateral congenital malformations of the external and/or middle ear, moderate or severe conductive or mixed hearing loss, and patients fitted with BCHA. Results: The audiological profile (n=170) was characterized by the prevalence of bilateral malformations (53%), of malformations in males (61%), of the moderate or severe conductive hearing loss (80%) and of the fitting of BCHA (56%). The right ear was more affected (32%) when considered the unilateral malformations only. In the selected sample (n=13), the benefit was demonstrated by the best performance obtained in the proposed evaluation, in the condition with hearing aid, when compared to the condition without hearing aid. The satisfaction was confirmed by the high scores obtained in the IOI - HA. Conclusions: Fitting BCHA denoted improvement at speech perception in noise and sound detection. Individuals with congenital malformations of the ear were satisfied with this device, so that must be considered as an option to the treatment of this population.

The work and results presented in this dissertation concern two complimentary studies that are rooted in surface acoustic waves and transducer study. Surface acoustic wave devices are utilized in a variety of fields that span biomedical applications to radio wave transmitters and receivers. Of interest in this dissertation is the study of surface acoustic wave interaction with polydimethylsiloxane. This material, commonly known as PDMS, is widely used in the microfluidic field applications in order to create channels for fluid flow on the surface of a piezoelectric substrate. The size, and type of PDMS that is created and ultimately etched on the surface of the substrate, plays a significant role in its operation, chiefly in the insertion loss levels experienced. Here, through finite element analysis, via ANSYS® 15 Finite Element Modeling software, the insertion loss levels of varying PDMS sidewall channel dimensions, from two to eight millimeters is investigated. The simulation is modeled after previously published experimental data, and the results demonstrate a clear increase in insertion loss levels with an increase in channel sidewall dimensions. Analysis of the results further show that due to the viscoelastic nature of PDMS, there is a non -linear increase of insertion loss as the sidewall dimensions thicken. There is a calculated variation of 8.31 decibels between the insertion loss created in a microfluidic device with a PDMS channel sidewall thickness of eight millimeters verse a thickness of two millimeters. Finally, examination of the results show that insertion loss levels in a device are optimized when the PDMS sidewall channels are between two and four millimeters. The second portion of this dissertation concerns the calibration of an ultrasonic transducer. This work is inspired by the need to properly quantify the signal generated by an ultrasonic transducer, placed under a static loading condition, that will be used in measuring ultrasonic bone conducted frequency perception of human subjects. Ultrasonic perception, classified as perception beyond the typical hearing limit of approximately 20 kHz, is a subject of great interest in audiology. Among other reasons, ultrasonic signal perception in humans is of interest because the mechanism by which either the brain or the ear interprets these signals is not entirely understood. Previous studies have utilized ultrasonic transducers in order to study this ultrasonic perception; however, the calibration methods taken, were either incomplete or did not properly account for the operation conditions of the transducers. A novel transducer calibration method is detailed in this dissertation that resolves this issue and provides a reliable means by which the signal that is being created can be compared to the perception of human subjects.

Made available in DSpace on 2016-04-27T18:12:34Z (GMT). No. of bitstreams: 1 Tatiana Fernandes Cili.pdf: 1959713 bytes, checksum: 95c16fc57e6e2cf785b81f8534de86bf (MD5) Previous issue date: 2008-05-14 / Coordenação de Aperfeiçoamento de Pessoal de Nível Superior / Clinical audiology literature and practice raise questions about bone conduction assessment results. The most common questions are related to the reliability of bone conduction thresholds as they suffer a lot of artifacts that may mislead the results obtained. Silman & Silverman (1997) describe two important factors that could interfere in such measurement: acoustic radiation (escaping acoustic energy that can be heard by air conduction, mainly in the high frequencies) and bone vibrator positioning in the mastoid. In order to obtain bone conduction thresholds in 2 kHz, or at higher frequencies, researchers suggest the insertion of earplugs in either the tested ear or in both ears to prevent acoustic radiation. In order to increase reliability on bone conduction evaluation researchers suggest that the patient must position the bone vibrator at the point on mastoid that he has the biggest sensation of sound stimuli. Objectives: 1. to investigate the bone vibrator s positioning influence in bone conduction thresholds evaluation for 500, 1k, 2k, 3k, and 4 kHz in normal hearing subjects. 2. to investigate the influence of insert earplugs on bone conduction thresholds measurement for 2000, 3000 and 4000 Hz in normal hearing subjects. Specific Objectives: 1- to determine the bone conduction sensitivity due to the influence of the bone vibrator s positioning in the mastoid to obtain bone conduction thresholds at 500, 1k, 2k, 3k, and 4 kHz in normal hearing subjects. 2 - to determine bone conduction threshold with and without insert earplug in order to investigate the presence of the acoustic radiation phenomenon during the bone conduction assessment at 2k, 3k, and 4 kHz in normal hearing subjects. Methods: Thirty six ears from 18 subjects were examined. Both ears were tested for air and bone conduction in a sound booth. The RADIOEAR B71 bone vibrator was used to assess bone conduction at 500, 1k, 2k, 3k, and 4 kHz. Two audiometers were used: Interacoustics AC40 and Betamedical Beta 6000. To evaluate the effect of the bone vibrator positioning, bone conduction thresholds were obtained using narrow band noise, at the opposite ear, at 30 dB HL in 1 dB steps (Ritcher; Brinkman; 1981); and to assess the effects of the acoustic radiation the examiner positioned the bone vibrator and inserted a foam earplug in the tested ear (Robinson; Shipton; 1982). Results: Bone vibrator s positioning influence was present in bone conduction thresholds evaluation at 500, 1000 e 3000 Hz, in more than 20% of the cases. This study proved that, when assessing bone conduction, the acoustic radiation phenomenon was present at 2k, 3k, and 4 kHz in 70% of the cases, mainly at 3 kHz. Conclusion: The acoustic radiation phenomenon was present mainly at 3 kHz, besides being present at 2k and 4 kHz. This could lead to an inaccurate interpretation of test results, which depend on reliable air and bone conduction values / A literatura e a prática na área da audiologia clínica, nos fazem questionar até que ponto o resultado da avaliação da via óssea de um sujeito é verdadeira ou é produto da interferência de atos ou fatos que ocorrem durante a audiometria. Silman e Silverman (1997) pontuam dois importantes fatores que podem interferir nessa medida: a radiação acústica (fuga de energia sonora do vibrador ósseo que poderia ser ouvida pela via aérea, principalmente em freqüências altas) e o posicionamento do vibrador ósseo na mastóide. Para obtenção dos limiares por via óssea em 2 kHz ou em freqüências mais altas, autores sugerem a inserção de plugs na orelha sob teste ou nas duas orelhas, para prevenir a radiação acústica. Para evitar o efeito do posicionamento do vibrador ósseo, os autores sugerem que o paciente posicione o vibrador ósseo no local onde sente o estímulo acústico mais intenso. Objetivos: 1. investigar a influência do posicionamento do vibrador ósseo na mastóide na obtenção do limiar tonal por via óssea para as freqüências de 500, 1k, 2k, 3k e 4k Hz, em sujeitos sem queixa auditiva; 2. investigar a influência do plug auricular na medida dos limiares ósseos de 2000, 3000 e 4000 Hz. Objetivos específicos: 1 - determinar os valores de sensibilidade da via óssea devido à influência do posicionamento do vibrador ósseo na mastóide para a obtenção do limiar tonal por via óssea para as freqüências de 500, 1k, 2k, 3k e 4k Hz, em sujeitos sem queixa auditiva. 2 - determinar os valores de sensibilidade da via óssea com e sem e com plug auditivo, para as freqüências de 2k, 3k e 4k Hz, em sujeitos sem queixa auditiva, para determinar a existência do fenômeno da radiação acústica na obtenção do limiar tonal por via óssea. Método: Foram examinadas 36 orelhas de 18 indivíduos; audiometria tonal por via aérea e óssea em ambas as orelhas, em cabine acústica. O modelo do vibrador ósseo foi RADIOEAR B71 para avaliar as freqüências 500, 1k, 2k, 3k, 4k Hz (via óssea). Audiômetro da Marca Interacoustics, modelo AC40 e da Marca Betamedical, modelo Beta 6000. Para avaliar o efeito do posicionamento do vibrador ósseo foi realizada a pesquisa do limiar de sensibilidade auditiva da via óssea, em degraus de 1 dB, com ruído de banda estreita de 30 dBNA, na orelha oposta (Richter; Brinkmann; 1981); para avaliar o efeito da radiação acústica foi realizada a medida da via óssea, com o vibrador ósseo posicionado pelo examinador e inserção de um plug automoldável na orelha examinada, (Robinson; Shipton; 1982). Resultados: Em 500, 1 e 3 kHz mais de 20% das pessoas tiveram seus limiares por via óssea alterados em mais de 6 dB, devido ao efeito do posicionamento do vibrador ósseo. Este estudo comprovou o fenômeno da radiação acústica nas freqüências de 2, 3 e 4 kHz quando a via óssea foi avaliada, principalmente em 3 kHz, em 70% dos casos. Conclusão: O fenômeno da radiação acústica estava presente principalmente em 3 kHz, além de estar presente em 2 e 4 kHz. O que pode levar a interpretação errônea dos resultados audiométricos que dependem da exatidão dos valores aéreos e ósseos

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Bone conduction transmission and head‐shadow effects were determined with transcranial completely‐in‐the‐canal (TCCIC) CROS hearing aids. Five subjects with documented profound unilateral hearing loss and experience with traditional CROS/BICROS fittings (TCROS) were tested with a CIC hearing aid placed in their poorer ear. Peak SPL was measured at the tympanic membrane and ranged from 105–115 dB SPL at 2000 Hz. Pure‐tone crossover thresholds and functional gain tested at frequencies from 250–8000 Hz varied considerably more than the SPL measures. The pure‐tone results indicated that sensitivity in the better ear was moderately associated with functional gain across frequency. Speech recognition was then tested in the sound field in two conditions: direct (noise in the poorer ear, speech in the better ear) and indirect (noise in the better ear, speech in the poorer ear) at S/Ns of −6, 0, +6, +12, and quiet. The TCCIC fittings were more effective than TCROS aids across S/Ns, particularly in the direct condition. In the indirect condition, the two fittings performed similarly. When data were pooled across conditions, the TCCIC aids provided better word recognition than the TCROS aids, particularly for those subjects with greater sensitivity in the better ear.

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It is estimated that 10% of the global population is impaired to a significant degree by a decrease in hearing sensitivity. With the greatest proportion of these persons residing in developing countries where communities are grossly underserved, it is incumbent on hearing healthcare professionals to seek means of offering equitable hearing health care services to these communities. The delivery of conventional diagnostic hearing services to these population groups is challenged by limitations in human resources, financial constraints and by the dearth of audiometric testing facilities that are compliant with permissible ambient noise levels for reliable testing. Valid diagnostic hearing assessment without an audiometric test booth will allow greater mobility of services and could extend hearing healthcare service delivery in underserved areas. The purpose of this study was to investigate the validity of diagnostic pure tone audiometry in a natural environment, outside a sound treated room, using a computer-operated audiometer with insert earphones covered by circumaural earcups incorporating real-time monitoring of environmental noise. A within-subject repeated measures research design was employed to assess elderly adults with diagnostic air (250 to 8000 Hz) and bone (250 to 4000 Hz) conduction pure tone audiometry. The study was of a quantitative nature and the required data was collected by testing subjects initially in a natural environment and subsequently in a sound booth environment to compare the threshold measurements. One experienced audiologist used audiometric KUDUwave test equipment to evaluate subjects in both environments. A total of 147 adults with an average age of 76 (± 5.7) years were tested. Ears had pure tone averages (500, 1000, 2000 and 4000 Hz) of ≥ 25 dB in 59%, >40 dB in 23% and ˃ 55 dB in 6% of cases. Analysis of collected data showed air conduction thresholds (n = 2259) corresponding within 0 to 5 dB in 95% of all comparisons between testing in the natural and sound booth environments. Bone conduction thresholds (n = 1669) corresponded within 0 to 5 dB in 86% of comparisons and within 10 dB or less in 97% of cases. Average threshold differences (–0.6 to 1.1) and standard deviations (3.3 to 5.9) were within typical test-retest reliability limits. Recorded thresholds showed no statistically significant differences with a paired samples t-test (p ˃ 0.01) except at 8000 Hz in the left ear. Overall the correlation between the air-conduction thresholds recorded in the sound booth environment and the natural environment was very high (˃ 0.92) across all frequencies while for bone conduction threshold correlation for the two environments fell between 0.63 and 0.97. This study demonstrates that valid diagnostic pure tone audiometry in an elderly population can be performed in a natural environment using an audiometer employing insert earphones covered by circumaural earcups with real-time monitoring of ambient noise levels. Mobile diagnostic audiometry performed outside of an audiometric sound booth may extend current hearing healthcare services to remote underserved communities where booths are scarce or inaccessible. In combination with Telehealth applications this technology could offer a powerful and viable alternate diagnostic service to persons unable to attend conventional testing facilities for whatever reasons. / Dissertation (MCommunication Pathology)--University of Pretoria, 2013. / gm2014 / Speech-Language Pathology and Audiology / Unrestricted