INTRODUÇÃO: A síndrome de Down apresenta elevados índices de alteração da função da orelha média, bem como malformações congênitas na orelha externa, média e interna. Tais condições podem interferir na transmissão sonora pelo sistema tímpano-ossicular até a cóclea e vias auditivas centrais, afetando a compreensão da linguagem falada. Uma recente ferramenta de avaliação da orelha média, a reflectância de energia de faixa ampla, pode quantificar a energia sonora refletida ou absorvida no meato acústico externo ao longo de uma ampla faixa de frequências, mais rapidamente do que a timpanometria. OBJETIVO: Comparar as medidas de reflectância de energia de faixa ampla entre crianças com síndrome de Down e um grupo controle pareado por idade, de acordo com os achados timpanométricos. MÉTODOS: Foram analisados os dados de quatro grupos com síndrome de Down, entre 28 e 195 meses, sendo: timpanometria normal (19 orelhas), timpanometria plana (13 orelhas), timpanometria com pressão negativa moderada (6 orelhas), timpanometria com pressão negativa severa (4 orelhas). Todos os achados foram comparados a um grupo controle (21 orelhas). Os participantes foram submetidos aos exames de timpanometria e reflexo acústico ipsilateral com frequência de sonda de 226 Hz., audiometria tonal limiar, limiar de reconhecimento de fala, emissões otoacústicas evocadas por estímulo transiente e reflectância de energia na faixa de 200 a 6000 Hz. com estímulos do tipo chirp e tons puros. RESULTADOS: Os cinco grupos estudados exibiram diferentes padrões de curvas de reflectância de energia, sem diferença significativa em algumas comparações. Houve correlação negativa entre o volume do meato acústico externo e a reflectância com estímulo chirp entre 250 e 1600 Hz. e com o estímulo de tons puros entre 258 e 1500 Hz., e entre o pico de admitância da timpanometria e a reflectância com estímulo chirp em 500 e 1000 Hz. Não houve correlação entre as frequências da reflectância com estímulo chirp em 1000 e 2000 Hz e os resultados das emissões otoacústicas em 1000, 2000 Hz. e Response. A técnica de análise discriminante utilizada para classificar os dados dos participantes com base nos valores da reflectância com estímulo chirp em 1000 e 1600 Hz., alcançou um índice de classificação correta de 60% para os participantes com síndrome de Down. CONCLUSÕES: Foi possível caracterizar a curva de respostas da orelha média, para diferentes timpanogramas, na síndrome de Down, por meio da reflectância de energia de faixa ampla. Crianças com síndrome de Down com timpanograma normal apresentaram curva de reflectância semelhante ao grupo controle. A análise discriminante por meio dos resultados da timpanometria e reflectância com estímulo chirp em 1600 e 1000 Hz. classificou corretamente 60% dos dados pesquisados nas crianças com síndrome de Down / INTRODUCTION: Children with Down syndrome have high incidence of disorders of the middle ear, as well as congenital abnormalities in the external, middle and inner ear. Such conditions may change the sound transmission through the ossicular chain to the cochlea and central auditory pathways, impairing the comprehension of spoken language. An recent assessment tool of the middle ear, the wideband reflectance energy, can measure the sound energy reflected or absorbed in the ear canal over a wide frequency range, faster than tympanometry. OBJECTIVE: To compare the wideband reflectance measurements between children with Down syndrome and a control group matched by age, according to the tympanometric findings. METHODS: This study evaluated four groups with Down syndrome, between 28 and 195 months: normal tympanogram (19 ears), flat tympanogram (13 ears), moderate negative pressure tympanogram (6 ears), severe negative pressure tympanogram (4 ears). All findings were compared to a control group (21 ears). The subjects underwent to tympanometry and acoustic reflex ipsilateral with a 226 Hz probe tone frequency, pure tone audiometry, speech recognition thresholds, transient otoacoustic emissions and wideband reflectance over the 200-6000 Hz range with chirp and tone stimuli. RESULTS: Results revealed that the five groups had different reflectance curves, without significant difference in some comparisons. There was a negative correlation between the volume of the external auditory meatus and the wideband reflectance with the chirp stimulus between 250 and 1600 Hz and with the tone stimulus between 258 and 1500 Hz, and between the static acoustic admittance at the tympanic membrane level and the wideband reflectance with chirp stimulus at 500 and 1000 Hz. There was no correlation between the frequency of the chirp stimulus with reflectance at 1000 and 2000 Hz and the results of the otoacoustic emissions at 1000, 2000 Hz and general response. The discriminant analysis technique used to classify participants\' data based on the values of reflectance with chirp stimulus in 1000 and 1600 Hz, achieved a correct classification rate of 60% for participants with Down syndrome. CONCLUSIONS: The findings showed the responses of the middle ear, for different tympanograms in Down syndrome through the wideband reflectance. In this study, children with Down syndrome and normal tympanogram showed wideband reflectance curve similar to the control group. A discriminant analysis with the tympanometric results and reflectance with chirp stimulus at 1600 and 1000 Hz correctly classified 60% of the data for children with Down syndrome

Introdução: A Reflectância acústica é um procedimento introduzido mais recentemente na clínica audiológica, cuja abrangência diagnóstica pode ainda ser explorada. Suas medidas têm sido citadas como uma importante ferramenta na avaliação das afecções da orelha média, sendo um método considerado vantajoso em relação à timpanometria. Tem havido crescente interesse no estudo da estimulação acústica contralateral e seu efeito na ativação da via eferente auditiva. Estudos têm demonstrado que a introdução de estímulo simultâneo na orelha contralateral gera mudanças no padrão de respostas auditivas, tanto em medidas de emissões otoacústicas como em imitância acústica. Desta forma, surgiu o interesse em investigar a ocorrência de mudanças no padrão de resposta da curva de reflectância, quando pesquisada com a aplicação de ruído de banda larga na orelha contralateral. Objetivo: Verificar a influência da estimulação contralateral nas medidas de reflectância acústica da orelha média em adultos jovens. Metodologia: A casuística foi composta por 30 participantes de ambos os gêneros, na faixa etária de 18 a 30 anos. Procedimentos: Inspeção do meato acústico externo; Imitanciometria; Audiometria tonal limiar; Pesquisa do limiar de ruído branco; Pesquisa da Reflectância Acústica em dois passos: (a) foi obtida a curva de reflectância no intervalo de frequência de 200 a 6000 Hz na intensidade de 60dB SPL utilizando-se os estímulos chirp e de tons puros, e (b) o procedimento foi repetido com os mesmos parâmetros e estímulos, com a presença de ruído contralateral simultâneo por meio de fones de inserção a 30 dBNS em relação ao limiar de ruído branco. Resultados: Os resultados apontaram que não existem diferenças quando comparados gêneros. Quando a análise foi realizada separadamente por orelha houve diferenças entre estímulos chirp e de tons puros nas frequências de 1,5 e 2 kHz em orelha direita. Entre as condições de teste e reteste as diferenças estatísticas foram nas frequências de 0,25 e 0,5 kHz em orelha direita para estímulo de tons puros. A análise entre as condições de teste, reteste e teste com ruído contralateral apresentou diferença estatística na frequência de 2 kHz (pvalor 0,011 em teste e 0,002 em reteste) para estímulo chirp em orelha direita. A comparação entre orelhas esquerda e direita identificou diferenças estatísticas nas frequências de 3 e 4 kHz para os dois tipos de estímulos utilizados. Conclusão: Este estudo permite concluir que a ativação da via auditiva eferente por meio da estimulação acústica contralateral com ruído branco produz mudanças nos padrões de respostas da reflectância acústica, aumentando suas respostas e modificando a transferência de energia sonora da orelha média / Introduction: The acoustic reflectance is a procedure introduced more recently in audiology, which diagnostic scope can be further explored. Its measurements have been cited as an important instrument in the evaluation of middle ear affections, as a method considered advantageous in relation to tympanometry. There has been growing interest in the study of contralateral acoustic stimulation and its effect on activation of the auditory efferent pathway. Studies have shown that the introduction of simultaneous stimulation in the contralateral ear generates changes in the pattern of auditory responses in both measures of otoacoustic emissions as in acoustic impedance. Therefore, emerged the interest in investigating the occurrence of changes in the response pattern of the reflectance curve when studied with the application of broadband noise in the contralateral ear. Objective: Investigate the influence of contralateral stimulation on acoustic reflectance measurements of the middle ear in young adults. Methods: The sample consisted of 30 participants of both genders, aged 18-30 years. Procedures: Inspection of the external acoustic meatus; imitanciometry; pure tone audiometry threshold; threshold research of White Noise; acoustics reflectance research in two steps: (a) obtaining of reflectance curve in the frequency range 200-6000 Hz in the intensity of 60dB SPL using chirp stimuli and pure tone, and (b) repeating the procedure with the same parameters and stimuli with contralateral noise simultaneously through insert earphones at 30 dBNS over the white noise threshold. Results: The results presented no difference compared genres. The analysis performed separately by ear presented differences between chirp stimuli and pure tone at frequencies of 1.5 and 2 kHz in the right ear. Between test and retest conditions the statistical differences in frequencies were at frequencies of 0.25 and of 0.5 kHz in the right ear for pure tone. Analysis of the conditions of test, retest and test with contralateral noise presented statistical difference at the frequency of 2 kHz (pvalue on test 0.011 and 0.002 on retest) for chirp stimulus in the right ear. The comparison between left and right ears identified statistical differences at the frequencies of 3 and 4 kHz for the two types of stimuli used. Conclusion: This study shows that the activation of the efferent auditory pathway by contralateral acoustic stimulation with white noise produces changes in response patterns of acoustic reflectance, increasing their responses and modifying the transfer of sound energy from the middle ear

INTRODUÇÃO: Os resultados da triagem auditiva neonatal podem ser afetados por condições transientes no meato acústico externo e na orelha média. A reflectância de banda larga (RBL) surge como um instrumento de diagnóstico que fornece medidas objetivas do estado da orelha média e pode explicar variações na forma de como a orelha média recebe, absorve e transmite a energia sonora. Dessa forma, a RBL apresenta um grande potencial para a detecção de alterações de orelha média em recém-nascidos. OBJETIVO: Verificar a correlação entre as medidas de reflectância da energia de banda larga com as medidas das emissões otoacústicas e as imitanciométricas em recém-nascidos. MÉTODO: Estudo de casos. Para este estudo foram avaliados 77 recém-nascidos (40 do sexo masculino e 37 do feminino) de idades entre 27 e 78h sem riscos para perda auditiva segundo o JCHI (2007), e com emissões otoacústicas presentes por estímulo transiente (EOAT). Foram submetidos ao teste das mediadas de EOAT, da reflectância da energia com os estímulos chirp e tom puro numa faixa de 0.2 a 6 kHz, e da timpanometria e reflexo acústico ipsilateral com as frequências da sonda de 226 e 1000 Hz. Os estímulos ativadores de 1000 e 2000 Hz e ruído de banda larga foram usados no reflexo acústico. RESULTADOS: Os resultados apontaram que os recém-nascidos com EAOT presentes revelaram uma configuração de curva da reflectância com característica peculiar da idade, ou seja, baixa reflectância na frequência de 6000 Hz. O timpanograma de curva do tipo A foi obtido em 90,2% das orelhas com a sonda de 1000 Hz, e com a sonda de 226 Hz a maioria (89%) das orelhas apresentaram curva do tipo pico duplo. A configuração da curva 3B/3G foi apresentada em 69,8% das orelhas na sonda de 226 Hz, e as configurações 1B/1G (43%) e 1B/1G S (27%) juntas foram obtidas em 70% das orelhas. Na sonda de 1000 Hz os recém-nascidos avaliados apresentaram 100% de presença dos reflexos acústicos ipsilaterais para estímulos ativadores de 2000 Hz e ruído branco. Não houve diferença significativa entre os resultados do sexo masculino e do feminino. CONCLUSÃO: Este estudo demonstrou que a inter-relação entre o nível de amplitude das EOAT, a configuração timpanométrica B/G e a reflectância apresentou diferenças no comportamento por orelha. Algumas frequências e configurações B/G indicaram uma tendência da diminuição de EOAT com o aumento da reflectância. Dada a equivalência entre os estímulos chirp e tom puro, qualquer um pode ser usado para avaliação da orelha média em recém-nascidos / INTRODUCTION: Newborn hearing screening test outcomes can be influenced by transient conditions in the ear canal and middle ear. Wideband reflectance (WBR) emerges as a diagnostic tool that provides objective measures of the status of the middle ear and can explain variations in how the middle ear receives, absorbs and transmits sound energy. Thus, the WRL has a great potential for the detection of middle ear disorders in newborns. OBJECTIVE: To verify the correlation between wideband reflectance power measurement with otoacoustic emissions and immittance measurement in newborns. METHOD: Case studies. This study evaluated 77 newborns (40 males and 37 females) aged from 27 to 78 hours without risk of hearing loss according to JCHI (2007), and transient evoked otoacoustic emissions present (TEOAE). The newborns underwent the test of TEOAE measurement, the power reflectance using both tone and chirp stimuli from 0.2 to 6 kHz, and 226 and 1000 Hz admittance probe-tone tympanometry and ipsilateral acoustic reflex. The stimuli triggers 1000 and 2000 Hz and broadband noise were used in the acoustic reflex. RESULTS: Results showed that newborns with EAOT present revealed a configuration of the reflectance curve, peculiar feature of the age, i.e., low reflectance in the frequency of 6000 Hz. Single-peaked tympanogram was obtained in 90.2% of ears using a 1000 Hz probe tone, and double-peaked tympanogram was found in 89% of the ears using a 226 Hz probe tone. The 3B/3G tympanograms were found in 69.8% of the ears at 226 Hz probe tone, and the tympanograms 1B/1G (43%) and 1B/1G S (27%) together were obtained in 70% of the ears. In the 1000 Hz probe tone newborns evaluated showed 100% presence of ipsilateral acoustic reflexes to activating stimuli of 2000 Hz and white noise. No significant differences were obtained across gender considering the results of all test evaluated in newborns. CONCLUSION: This study demonstrated that the inter-relationship between the level of TEOAE amplitude, tympanometric configuration B/G and reflectance showed differences according in the ear. Some frequencies and configurations B/G indicated a trend of TEOAE decreasing of TEOAE with reflectance increasing. Given the equivalence between the tone and chirp stimuli, any of them can be used to evaluate the middle ear in newborns

Objetivos: Verificar a aplicabilidade de um procedimento de avaliação comportamental da audição em crianças com fissura labiopalatina, no que se refere ao tempo de duração da avaliação; ao número total de estímulos; ao número de estímulo controle e ao número de interrupções e, verificar os níveis mínimos de resposta auditiva destas crianças. Modelo: Estudo transverso Local de execução: Setor de Fonoaudiologia, Hospital de Reabilitação de Anomalias Craniofaciais, USP, Bauru. Participantes: Oitenta pacientes com fissura labiopalatina ou palatina, de ambos os gêneros, idade entre seis e vinte quatro meses, subdivididos em grupos etários: Grupo I 7 meses a 11 meses 29 dias (n= 12); Grupo II 12 meses a 17 meses 29 dias (n= 31); Grupo III 18 meses a 24 meses (n= 37). Intervenções: Entrevista audiológica, inspeção visual do meato acústico externo, avaliação eletroacústica (timpanometria nas frequências 226 Hz e 1000 Hz, emissões otoacústicas transientes) e audiometria de reforço visual informatizada em campo livre. Resultados: A média do nível mínimo de audição foi de 36 dB em todas as frequências para o Grupo I, 32 dB para o Grupo II e 31 dB para o Grupo III. Observou-se que os Grupos I e II tiveram maiores níveis mínimos de audição que o Grupo III. O Grupo I necessitou de maior número de estímulos totais, apresentando cansaço, agitação e tempo de atenção reduzido sendo necessário maior número de interrupções no exame, um tempo de duração do exame maior e uma menor porcentagem de controles corretos. Conclusão: A avaliação realizada por meio do ARVI permite estimar a audição de crianças na faixa etária de 7 a 24 meses em uma única sessão, em curto período de tempo, sem a necessidade de um segundo examinador durante a realização do exame. / Aim: Verify the applicability of a procedure for behavioral auditory of hearing in children with cleft lip and palate, with regard to the duration of the evaluation; the total number of stimuli; the number of stimulus control and the number of interruptions and verify the minimum levels of auditory response of these children. Model: Cross-sectional Location: Department of Speech Pathology and Audiology, Hospital for Rehabilitation of Craniofacial Anomalies, USP, Bauru. Participants: Eighty subjects with cleft lip and palate or palate, both genders, aged between seven and twenty-four. Interventions: anamneses, otoscopy, multifrequency tympanometry, evoked otoacustic emissions and intelligent visual reinforcement audiometry. Results: The mean of the minimum hearing level was 36 dB at all frequencies for Group I, 32 dB to Group II and 31 dB to Group III. We observed that Groups I and II had higher \"minimum levels\" of hearing that the Group III. Group I needed a greater number of total trials, showing tiredness, restlessness and short attention span and need more breaks in the examination, duration of greater examination and a lower percentage of correct controls. Conclusion: The assessment carried out by the IVRA allows estimating the hearing of children aged 7-24 months in a single session, in short time, without the need of a second examiner during the examination.

Objetivos: O objetivo deste trabalho é descrever, comparar e analisar as características dos achados timpanométricos com sonda de tom prova nas frequências de 226 Hz, 678 Hz e 1000 Hz. Modelo: Estudo transverso Local de execução: Setor de Fonoaudiologia, Hospital de Reabilitação de Anomalias Craniofaciais, USP, Bauru. Participantes: Sessenta e oito pacientes com fissura labiopalatina, sem cirurgia prévia, de ambos os sexos, idade entre três e doze meses. Intervenções: anamnese, otoscopia e timpanometria de multifrequência. Resultados: Devido ao efeito de oclusão foi obtido 136 timpanogramas para a sonda de 226 Hz, 94 timpanogramas para a sonda de 678Hz e 135 timpanogramas para a sonda de 1000 Hz, em um total de 365 timpanogramas. A curva que demonstra maior ocorrência é a de Pico Único, isto nas três frequências de sonda: 79,41% em 226 Hz, 40,42% em 678 Hz e 37,04% em 1000 Hz. A curva de PD foi encontrada apenas nas frequências de 678 Hz e 1000 Hz com ocorrência de 5,32% e 1,48% respectivamente. O mesmo aconteceu com as curvas ASS e INV, sendo visualizadas 7,45% em 678 Hz; 8,89% em 1000 Hz para a curva ASS e 21,28% em 678 Hz, 24,44% em 1000 Hz para curva INV. A curva PL ocorreu em todas as freqüências de tom de sonda com porcentagem de 20,59%, 25,53%, 28,15% para as sonda de 226 Hz, 678 Hz e 1000 Hz, respectivamente. Conclusão: Nos achados timpanométricos dos lactententes deste estudo foram encontrados diferentes tipos de curvas, que incluíram os tipos Pico Duplo (PD), Assimétrica (ASS), Invertida (INV) e Plana (PL). Os resultados mostraram maior ocorrência de curvas do tipo Pico Único (PU) na sonda de 1000 Hz, para sonda de 226 Hz a prevalência foi de curvas do tipo PU apresentando também curva Plana (P). A sonda de 678 Hz apresentou todos os tipos de curvas, com uma maior ocorrência da curva do tipo PU. / Aim: This study aimed to describe, compare and analyze the characteristics of tympanometric findings with 226 Hz, 678 Hz and 1000 Hz tone probes. Model: Cross-sectional Location: Department of Speech Pathology and Audiology, Hospital for Rehabilitation of Craniofacial Anomalies, USP, Bauru. Participants: Sixty eight subjects with cleft lip and palate, non-operated, both genders, aged between three and twelve months. Interventions: anamneses, otoscopy and multifrequency tympanometry. Results: Given the occlusion effect, of 365 tympanograms, 136 were obtained for the 226 Hz probe, 94 for 678Hz and 135 for 1000 Hz probe. Single-peak curve was the most prevalent at the three probe frequencies: 79.41% at 226 Hz, 40.42% at 678 Hz and 37,04% at 1000 Hz. PD curve was found at 678 Hz and 1000 Hz occurring 5.32% and 1.48% respectively. ASS and INV curves were visualized 7, 45% at 678 Hz; 8,89% at 1000 Hz for ASS and 21,28% at 678 Hz, 24,44% at 1000 Hz for a INV curve. PL curve occurred in all frequencies at 20.59%, 25.53%, and 28.15% for the 226 Hz, 678 Hz and 1000 Hz probes, respectively. Conclusion: Different kinds of curves were found including: Double peak(DP), asymmetric (AS), inverted (INV) and plan (PL). Results indicated most prevalence of single-peak curves for 1000 Hz probe. The 226 Hz probe showed single-peak and plan curves as well. The 678 Hz probe showed all kinds of curves being the single-peak the most prevalent.

Submitted by Filipe dos Santos (fsantos@pucsp.br) on 2018-06-15T12:32:33Z No. of bitstreams: 1 Jéssica Raignieri.pdf: 1240538 bytes, checksum: 94c6dfb67614061048d3c5cfdd8ce0c9 (MD5) / Made available in DSpace on 2018-06-15T12:32:34Z (GMT). No. of bitstreams: 1 Jéssica Raignieri.pdf: 1240538 bytes, checksum: 94c6dfb67614061048d3c5cfdd8ce0c9 (MD5) Previous issue date: 2018-03-14 / Coordenação de Aperfeiçoamento de Pessoal de Nível Superior - CAPES / Introduction: Audiological monitoring is aimed at monitoring children from six months to three years old, due to the risk of late or progressive hearing loss. Objective: To study the results of the Wideband Tympanometry in acoustic absorbance measurements and the Transient Evoked Otoacoustic Emissions and Distortion Product record in children with risk indicators for hearing loss during audiological monitoring. Method: Fifty-eight children with risk indicators for hearing loss were evaluated in the audiological monitoring process, with a mean age of 16.7 months. In order to contact the families of the children, phone calls were made, with information obtained from a database of four public maternity hospitals in São Paulo. Subjects were characterized in normal auditory status and conductive altered auditory status, in the groups with and without risk indicators for auditory deficiency, and according to the audiological results of auditory monitoring. Transient Otoacoustic Emissions and Distortion Product tests were performed, in addition to the Wideband Tympanometry. For the analysis of the absorbance in the Wideband Tympanometry, seven frequency bands were selected from 1 kHz to 8 kHz, similar to the Otoacoustic Emission Frequency bands. Results: In this study, the absorbance curves presented similar results for the right and left ears, both for children with normal hearing, and for those with conductive hearing loss, as well as for females and males. It was observed that in the frequencies between 1500 Hz and 6000 Hz, the subjects with normal hearing status, the absorbance was between 0.92 and 0.98, and the best results obtained for this age group being in this frequency range. Absorbance is higher in the group of children without risk indicators for hearing loss (RIHL) when compared to the group of children with (RIHL). The recording of Transient Otoacoustic Emissions (TOAE) and Distortion Product Otoacoustic Emissions (DPOAE) showed a strong agreement with the measured absorbance in all frequency bands in both ears. Conclusion: Absorbance values are higher in males, and for children with normal hearing status. 13 There was an agreement for the results of Evoked Otoacoustic Emissions level and absorbance measurements, and the higher the absorbance, the higher the TOAE and DPOAE levels / Introdução: o monitoramento audiológico visa ao acompanhamento de crianças de seis meses até três anos de idade, devido ao risco de perdas auditivas de início tardio ou progressivo. Objetivo: estudar os resultados da Timpanometria de Banda Larga nas medidas de absorvância acústica e do registro das Emissões Otoacústicas Evocadas Transiente e Produto de Distorção, em crianças com indicadores de risco para a deficiência auditiva durante o monitoramento audiológico. Método: foram avaliadas 58 crianças com indicadores de risco para a deficiência auditiva no processo de monitoramento audiológico, com idade média de 16,7 meses de vida. Para contato com as famílias das crianças, ligações telefônicas foram realizadas, com informações obtidas de um banco de dados de quatro maternidades públicas de São Paulo. Os sujeitos foram caracterizados em status auditivo normal e status auditivo alterado condutivo nos grupos com e sem indicadores de risco para a deficiência auditiva e de acordo com os resultados audiológicos do monitoramento auditivo. Foram realizados testes de Emissões Otoacústicas Transientes e Produto de Distorção, além da Timpanometria de Banda Larga. Para análise da absorvância na Timpanometria de Banda Larga, foram selecionadas sete bandas de frequências que variam de 1 kHz a 8 kHz similares às bandas de frequências. Resultados: neste estudo, as curvas de absorvância apresentaram-se de forma similar para as orelhas direita e esquerda, tanto para as crianças com audição dentro da normalidade, como para aquelas com perdas auditivas condutivas e, também, no sexo feminino e masculino. Observou-se que, na frequência de 1500 Hz a 6000 Hz, nos sujeitos com status auditivos normal, a absorvância estava entre 0,92 a 0,98, podendo estar, nessa faixa de frequência, os melhores resultados obtidos para essa faixa etária estudada. A absorvância foi maior no grupo de crianças sem 11 indicadores de risco para a deficiência auditiva (IRDA) quando comparado com o grupo de crianças com IRDA. O registro das Emissões Otoacústicas Transientes (EOAT) e Emissões Otoacústicas Produto de Distorção (EOAPD) apresentou uma forte concordância com a medida de absorvância registrada, em todas as bandas de frequências, em ambas as orelhas. Conclusão: os valores de absorvância são maiores no sexo masculino e em crianças com status auditivo normal. Houve concordância para os resultados de nível de Emissões Otoacústicas Evocadas e medidas de absorvância, sendo que, quanto maior a absorvância, maior o nível de EOAT e EOPD

Submitted by Marlene Aparecida de Souza Cardozo (mcardozo@pucsp.br) on 2016-08-27T15:05:09Z No. of bitstreams: 1 Mary Ellen dos Santos.pdf: 862232 bytes, checksum: 49c986c29cce37665eec385fa318b02b (MD5) / Made available in DSpace on 2016-08-27T15:05:09Z (GMT). No. of bitstreams: 1 Mary Ellen dos Santos.pdf: 862232 bytes, checksum: 49c986c29cce37665eec385fa318b02b (MD5) Previous issue date: 2016-05-10 / Conselho Nacional de Desenvolvimento Científico e Tecnológico / Introduction: The Wideband Tympanometry (WBT), with acoustic absorbance measures, is a recently introduced procedure in audiology, and its diagnostic comprehensiveness is still little explored. This is a technique that provides dynamic measurements of acoustic absorbance of the middle ear (ME), which increases the possibilities of studying anatomical and functional variables of this structure in children. It also measures all tympanograms from 226 Hz to 8000 Hz and identifies the resonance frequency of ME in an only and fast stimulus, using the same classical tympanometry procedure. Objective: To evaluate the Wideband Tympanometry with acoustic absorbance measures associated with the hearing status in children up to 3 years of age. Method: This is a descriptive, observational, retrospective and quantitative approach, accomplished through the use of WBT, with acoustic absorbance measurements and chirp stimuli in children up to 3 years old. We studied 81 medical records of patients of both sexes, of which only twenty-four completed the diagnosis, with normal tests, slight conductive alterations, or conductive hearing loss. Results: The results show important statistics differences of the broaband absorbance between the ears of same hearing status groups. Statistical analysis showed that the group with normal hearing tends to have higher means and medians of acoustic resonance and absorbance than the groups with slight conductive alterations and conductive hearing loss. However, it was observed that at frequencies below 0.5 kHz was not practically significant difference in the average absorbance between the acoustic group with normal hearing and the other groups aged ≥ 7 months. The group's results with normal hearing showed further that the means and medians absorbance changed systematically till the frequency of 6168.84 Hz. Conclusions: This study demonstrated, in general, the values of absorbance of broadband energy group with normal hearing were higher than the group with mild conductive hearing disorders and hearing loss, regardless of age. However, for it’s clinical practice becomes effective, it is recommended to establish normality patterns / Introdução: A Timpanometria de Banda Larga (TBL) com medidas de absorvância acústica é um procedimento introduzido recentemente na clínica audiológica, tendo sua abrangência diagnóstica ainda pouco explorada. Trata-se de uma técnica que oferece medidas dinâmicas de absorvância acústica da orelha média (OM), o que aumenta as possibilidades de estudo das variáveis anatômicas e funcionais dessa estrutura no público infantil. Além disso, também mensura todos os timpanogramas de 226 Hz a 8000 Hz e identifica a frequência de ressonância da OM em um único e rápido estímulo, utilizando o mesmo procedimento da timpanometria clássica. Objetivo: Estudar a Timpanometria de Banda Larga com medidas de absorvância acústica em crianças de até 3 anos de idade. Método: Trata-se de um estudo descritivo, observacional, retrospectivo e de caráter quantitativo, realizado por meio da utilização da TBL, com medidas de absorvância acústica e estímulos chirp, em crianças até 3 anos de idade. Foram estudados 81 prontuários de pacientes de ambos os sexos, dos quais apenas vinte e quatro concluíram o diagnóstico, apresentando exames normais, alterações condutivas leves, ou perda auditiva condutiva. Resultados: Os resultados evidenciaram diferenças estatísticas importantes da absorvância de banda larga entre as orelhas dos grupos de mesmo status auditivo. A análise estatística apontou que o grupo com audição normal tende a apresentar maiores médias e medianas de ressonância e absorvância acústica do que os grupos com alterações condutivas leves e perda auditiva condutiva. Porém, dessa comparação, observou-se que nas frequências abaixo de 0,5 kHz não houve, praticamente, diferença significativa na média da absorvância acústica entre o grupo com audição normal e os demais grupos na faixa etária ≥ 7 meses. Os resultados do grupo com audição normal demonstraram, ainda, que as médias e medianas de absorvância mudaram de forma sistemática até a frequência de 6168,84 Hz. Conclusões: Este estudo demonstrou, de forma geral, que os valores da absorvância da energia de banda larga dos grupos com audição normal foram mais altos do que os dos grupos com alterações condutivas leves e perda auditiva condutiva, independentemente da faixa etária. No entanto, para que sua prática clínica se torne efetiva, recomenda-se o estabelecimento de padrões de normalidades

Comparisons were made between changes in the audibility of bone-conduction stimuli to differences in the sound pressure present in the external auditory canal when ears were occluded. Fifteen listeners with normal middle ear function were tested using pure tones of 250, 500, and 1000 Hz, delivered via a bone-conduction oscillator placed on the mastoid process and the frontal bone. At all three frequencies, and both sites of stimulation, ear canal sound pressures were greater in the occluded than in the unoccluded conditions. Concurrently, the test signals were detected at lower intensities, although the changes in audibility and external canal sound pressure levels were not unity. The occlusion effect was attenuated slightly when the skull was vibrated from the frontal bone.

Tympanometry and acoustic stapedial reflex (ASR) are routinely used in audiology clinics to assess the functional integrity of the eardrum and middle ear system in humans. Conventional tympanometry (which delivers a probe tone of 226 Hz into the ear canal and measures the mobility of the eardrum as the air pressure in the ear canal is varied) and acoustic reflex testing are effective in detecting middle ear pathologies in children and adults. However, the clinical application of these two tests to infants younger than 7 months has major limitations. In recent years, high frequency tympanometry (HFT) with a probe tone of 1000 Hz has been trialled successfully in young infants (< 7 months) and research on ASRs as they apply to this age group is continuing. Although preliminary HFT data for this population are emerging, there has been no detailed study that describes the effect of age on HFT and ASR results, no clear guideline on ways to interpret the HFT results, and no investigation to measure the feasibility and reliability of the ASR findings. For these reasons, systematic investigation into the use of HFT and ASR measures for evaluating the middle ear function of young infants is warranted. This thesis aimed to: (i) investigate the feasibility of obtaining HFT and ASR findings from newborn and 6-week-old infants, and study the characteristics of the immittance findings in these two age groups; (ii) investigate methods within HFT to measure the middle ear admittance of newborn babies; (iii) establish normative HFT data from healthy newborn babies using the new component compensation method; (iv) examine the test-retest reliability of the ASR test in healthy neonates; and (v) investigate the test-retest reliability of the ASR test in 6-week-old infants. The aims of the thesis were met through five studies. In study one (Chapter 2), a pilot study was conducted to examine the feasibility of performing HFT and ASR in 42 healthy infants and study the characteristics of the immittance findings obtained from these infants using a longitudinal study design. In this pilot study, all infants were tested at birth and then re-tested approximately 6 weeks after the first test. This study confirmed the feasibility of obtaining valid immittance findings from healthy young infants. Most importantly, the findings of this pilot study revealed that the mean values of the majority of HFT parameters and acoustic stapedial reflex threshold (ASRT) obtained at 6 weeks were significantly greater than those obtained at birth, indicating the need to have separate sets of normative data for both tests for newborn and 6-week-old infants. In study 2 (Chapter 3), three different methods to measure middle ear admittance (often described as peak compensated static admittance) in 36 healthy neonates were compared. The three methods were the traditional baseline compensation method (compensated for the susceptance component at 200 daPa pressure) and two new component compensated methods (compensated for both the susceptance and conductance components at 200 daPa and -400 daPa). The results showed that the mean middle ear admittances obtained by compensating for the two components of admittance at a pressure of 200 daPa (YCC200) and -400 daPa (YCC-400) were significantly greater than that using the traditional baseline compensation method (YBC). The higher mean admittance results obtained using the new component compensated methods suggests that the two new methods have the potential to better separate normal from abnormal admittance results. The test-retest reliability of YBC, YCC200 and YCC-400 was investigated, with the result that a lower test-retest reliability was obtained for YCC-400 than for the other two measures. It was, therefore, concluded that the component compensation method compensated at 200 daPa may serve as an alternative method for estimating middle ear admittance, especially in the context of assessing neonates using HFT. In study 3 (Chapter 4), normative data were gathered using the new component compensation method (compensated at 200 daPa) on a group of 157 healthy newborn babies. In addition to the component compensated static admittance (YCC), normative data showing the 90 % ranges for tympanometric peak pressure, admittance at 200 daPa, uncompensated peak admittance, and traditional baseline compensated static admittance (YBC) were established in this study. No gender effect was found on any of the tympanometric measures. In study 4 (Chapter 5), the use of ASR to evaluate middle ear function in neonates was studied. The feasibility of obtaining ipsilateral ASR from neonates by stimulating their ears with a 2 kHz tone and broadband noise (BBN) was demonstrated. ASRs were elicited from 91.3% of 219 full-term normal neonates, while the remaining 8.7% of neonates who had flat tympanograms and no transient evoked otoacoustic emissions did not exhibit ASRs. Good test-retest reliability was demonstrated in the ASRT obtained using both the 2 kHz and BBN stimulus; there was no significant difference between test and retest conditions and intra-correlation coefficients of 0.83 for the 2 kHz tone and 0.76 for the BBN stimulus. In the last study (Chapter 6), the test-retest reliability of ASRT obtained from 70 6-week-old infants was investigated. The methodology described in Chapter 5 was followed. No significant difference in ASRT between test and retest conditions was found for the 2 kHz tone (mean ASRT = 67.3 dB HL versus 67.1 dB HL) and BBN stimulus (mean ASRT = 80.9 dB HL versus 81.6 dB HL). Good test-retest reliability of ASRT with intra-correlation coefficients of 0.78 was found for both the 2 kHz tone and the BBN stimulus. In essence, through achieving the aforementioned aims, the current research program was able to enhance the minimal literature available concerning the use of HFT and ASR testing in young infants. Ultimately, the findings presented in this thesis will inform clinicians of the recent developments in HFT and ASR testing, and assist them in evaluating the middle ear function of young infants with accuracy and confidence.

Ο σκοπός της διδακτορικής διατριβής ήταν η μελέτη και η ανάπτυξη προσομοιωτή λειτουργίας του μέσου ωτός με σκοπό την υποστήριξη στη διάγνωση. Ο βασικός τρόπος διάγνωσης των παθολογιών του μέσου ωτός βασίζεται στην τυμπανομετρία. Εξέλιξη της τυμπανομετρίας είναι η τυμπανομετρία πολλαπλών συχνοτήτων, η οποία χρησιμοποιήθηκε για το σκοπό της διατριβής. Στις περισσότερες παθολογικές καταστάσεις, η διάγνωση βασίζεται εν μέρει σε αντικειμενικά κριτήρια. Το πρόβλημα έγκειται στη μετάφραση της κωδωνοειδούς καμπύλης του τυμπανογράμματος. Σε πολλές περιπτώσεις αυτό είναι αναποτελεσματικό για δύο λόγους. Πρώτον γιατί η καμπύλη ενδέχεται να συμπίπτει σε περισσότερες από μία παθολογικές καταστασεις και δεύτερον γιατί μπορεί να λειτουργούν στοιχεία του συστήματος κατά τέτοιο τρόπο ώστε να αλληλοεξουδετερώνονται τα αποτελέσματά τους. Η λειτουργία του προσομοιωτή βασίζεται στην αντιστοίχιση του βιολογικού συστήματος του μέσου ωτός (από τον τυμπανικό υμένα ως την ωοειδή και στρογγυλή θυρίδα) σε μηχανολογικό σύστημα και εν συνεχεία στην αντιστοίχιση του σε ισοδύναμο ηλεκτρικό κύκλωμα. Στο πλαίσιο της μελέτης εκφράστηκε η συνάρτηση μεταφοράς του ισοδύναμου κυκλώματος, αναπτύχθηκε η αρχιτεκτονική λειτουργίας του προσομοιωτή, διερευνήθηκαν αλγόριθμοι επεξεργασίας των μετρήσεων, λήφθηκαν κλινικές μετρήσεις φυσιολογικών και παθολογικών δειγμάτων και αξιολογήθηκαν τα αποτελέσματά τους. Εν τέλει αποδείχθηκε η ορθή λειτουργία του προσομοιωτή για φυσιολογική λειτουργία του μέσου ωτός και για την παθολογική λειτουργία του στις νόσους της ωτοσκλήρυνσης και της μέσης εκκριτικής ωτίτιδας. / The purpose of this doctoral dissertation was the study and development of a simulator of the function of middle-ear in order to support the diagnostic procedure. The basic diagnostic procedure for middle ear pathologies is based on tympanometry. The evolution of classic tympanometry is multi-frequency tympanometry, which was used for the purpose of this study. In most pathological situations, diagnosis is based partly on objective criteria. The problem lies with the translation of the bell-like curve of the tympanogram. In most cases this is not effective for two reasons. Firstly, because the curve may concur in more than one pathological situations and secondly, because elements of the system may function in such a way as to cancel each other out in their depiction. The operation of the simulator is based on the correlation of the biological system of the middle ear (tympanic membrane to round and oval windows) to the mechanical system and eventually to the equivalent electrical circuit. During thiw study, the transfer function of the system was generated, the architecture of the simulator was created, algorithms of manipulation of the measurements were investigated, clinical measurements were taken for both normal and pathological ears and their results were evaluated. Finally, the correct operation of the simulator was proven for normal operation of the middle ear and pathological operation in the cases of otosclerosis and secretory otitis media.