Overview of newborn hearing screening programs in Brazilian maternity hospitals

IntroductionNewborn hearing screening has as its main objective the early identification of hearing loss in newborns and infants. In order to guarantee good results, quality indicators for newborn hearing screening programs are used as benchmarks.ObjectiveTo observe and describe the reality of national newborn hearing screening programs in Brazil, and to evaluate if they can be referred to as having quality indicators.MethodsIntegrative literature review in databases such as MEDLINE, LILACS, SciELO, and Google.Results22 articles were analyzed in relation to newborn hearing screening coverage, the place and period newborn hearing screening was performed, initial results, referral to diagnostic procedures, loss to follow-up, and occurrence of hearing loss.ConclusionTransient otoacoustic emissions were the most often used screening methodology. Coverage varied widely, and only a few maternity wards achieved 95% of the cases screened. Referral to diagnostic procedures was under 4%, but lack of adherence can be considered a barrier to successful follow-up. The occurrence of hearing loss ranged from 0% to 1.09%. The involvement of government, physicians, and society is necessary, so that the goals of newborn hearing screening can be achieved.     

Effect of hearing aids use on speech stimulus decoding through speech-evoked ABR

Introduction

The electrophysiological responses obtained with the complex auditory brainstem response (cABR) provide objective measures of subcortical processing of speech and other complex stimuli. The cABR has also been used to verify the plasticity in the auditory pathway in the subcortical regions.

Language evaluation in children with pre-lingual hearing loss and cochlear implant

IntroductionThe cochlear implant is an effective device for children with severe and/or profound prelingual hearing loss, since it provides considerable improvement in oral language acquisition through the auditory pathway. The use of a cochlear implant contributes to the development of auditory perception, favoring the acquisition of the linguistic processes related to communication skills, which might have a positive effect on other areas of development.ObjectiveThe aim of this study was to verify the performance of children using cochlear implants for expressive and receptive oral language.MethodsThis was a prospective cross-sectional study that used the following tests: Child language test in the phonology, vocabulary, fluency and pragmatics areas, and the Peabody picture vocabulary test. Thirty children participated in this study, of both genders, aged between 36 and 72 months, with severe and/or profound bilateral sensorineural hearing loss, without other impairments and users of unilateral cochlear implant with full electrode insertion for a minimum of 12 months.ResultsThe longer duration of the cochlear implant use, the younger age at surgery and the better performance in the auditory perception of speech influenced the performance in expressive and receptive oral language. Even though when compared to the normative language acquisition process, the results showed that these children had patterns of linguistic skills that are below their chronological age; the results indicate that these children are developing expressive and receptive oral language skills, and this is the outcome that should be taken into account in this study.ConclusionThe longer duration of the cochlear implant use, the younger age at surgery and the better performance in the auditory perception of speech influenced the performance in expressive and receptive oral language skills, but not in all the studied semantic categories.     

Objective comparison between perforation and hearing loss

IntroductionThere appears to be no relationship between the size of tympanic perforations and hearing loss. Some studies in the literature have assessed this connection, with conflicting data and without proper methodology, especially concerning the measurement of the size of the perforation, which was performed in a subjective manner.ObjectiveTo evaluate the size of tympanic perforations and to relate them to hearing loss in four different sound frequencies through the use of an objective method.MethodsTransversal retrospective study. The present study evaluated 187 perforations through digital imaging, calculated the percentages of the tympanic membrane that was perforated using ImageScope software version 11.1.2.760 and correlated perforations’ size with hearing loss at four frequencies.ResultsData were statistically analyzed using Pearson's correlation test.ConclusionThere was no significant relationship between the size of tympanic perforations and hearing loss in the four analyzed frequencies.     

Auditory and language skills of children using hearing aids

IntroductionHearing loss may impair the development of a child. The rehabilitation process for individuals with hearing loss depends on effective interventions.ObjectiveTo describe the linguistic profile and the hearing skills of children using hearing aids, to characterize the rehabilitation process and to analyze its association with the children's degree of hearing loss.MethodsCross-sectional study with a non-probabilistic sample of 110 children using hearing aids (6–10 years of age) for mild to profound hearing loss. Tests of language, speech perception, phonemic discrimination, and school performance were performed. The associations were verified by the following tests: chi-squared for linear trend and Kruskal–Wallis.ResultsAbout 65% of the children had altered vocabulary, whereas 89% and 94% had altered phonology and inferior school performance, respectively. The degree of hearing loss was associated with differences in the median age of diagnosis; the age at which the hearing aids were adapted and at which speech therapy was started; and the performance on auditory tests and the type of communication used.ConclusionThe diagnosis of hearing loss and the clinical interventions occurred late, contributing to impairments in auditory and language development.     

Sequential bilateral cochlear implant: results in children and adolescents

IntroductionThe use of the bilateral cochlear implants can promote the symmetrical development of the central auditory pathways, thus benefiting the development of auditory abilities and improving sound localization and the ability of auditory speech perception in situations of competitive noise.ObjectiveTo evaluate the ability of speech perception in children and adolescents using sequential bilateral cochlear implants, considering the association of these variables: age at surgery, time of device use and interval between surgeries.MethodsA total of 14 individuals between 10 and 16 years of age, who demonstrated surgical indication for the use of sequential bilateral cochlear implants as intervention in the auditory habilitation process, were assessed. The speech perception ability was assessed through sentence lists constructed in the Portuguese language, presented in two situations: in silence, with fixed intensity of 60 dB SPL, and in competitive noise, with a signal-to-noise ratio of +15 dB. The evaluation was performed under the following conditions: unilateral with the first activated cochlear implant, unilateral with the second activated cochlear implant and bilateral with both devices activated.ResultsThe results of the speech perception tests showed better performance in both silence and in noise for the bilateral cochlear implant condition when compared to the 1st cochlear implant and the 2nd cochlear implant alone. A worse result of speech perception was found using the 2nd cochlear implant alone. No statistically significant correlation was found between age at the surgical procedure, interval between surgeries and the time of use of the 2nd cochlear implant, and the auditory speech perception performance for all assessed conditions. The use of a hearing aid prior to the 2nd cochlear implant resulted in benefits for auditory speech perception with the 2nd cochlear implant, both in silence and in noise.ConclusionThe bilateral cochlear implant provided better speech perception in silence and in noise situations when compared to the unilateral cochlear implant, regardless of the interval between surgeries, age at the surgical procedure and the time of use of the 2nd cochlear implant. Speech perception with the 1st cochlear implant was significantly better than with the 2nd cochlear implant, both in silence and in noise. The use of the hearing aid prior to the 2nd cochlear implant influenced speech perception performance with the 2nd cochlear implant, both in silence and in noise.     

Cortical inhibition effect in musicians and non-musicians using P300 with and without contralateral stimulation

IntroductionMusicians have more robust and efficient neural responses in the cortical and sub-cortical regions, demonstrating that musical experience benefits the processing of both non-linguistic and linguistic stimuli.ObjectiveThis study aimed to verify P300's latency and amplitude behavioral using contralateral stimulation in musicians and non-musicians.MethodsThis was a case–control study. Subjects were divided in two groups: musicians, comprising 30 professional musicians, and non-musicians, comprising 25 subjects without musical experience.ResultsThe present study showed that the musicians had lower latencies and higher amplitudes than the non-musicians in the P300 without contralateral noise. For the P300 amplitude values, the difference between groups persisted, and the musicians presented significantly higher amplitude values compared with the non-musicians; additionally, the analysis of the noise effect on the P300 response showed that the latency values were significantly increased in the musicians.ConclusionThe central auditory nervous system of musicians presents peculiar characteristics of electrophysiological responses probably due to the plasticity imposed by musical practice.     

Auditory attention in individuals with tinnitus

IntroductionTinnitus is characterized by the presence of a sound in the absence of external sound stimulus. In individuals with normal audiometry, it may be associated with auditory attention difficulty, especially in those who report high tinnitus annoyance.ObjectiveTo investigate auditory attention ability in individuals with tinnitus complaint.MethodsCross-sectional analytical observational study. We evaluated 30 volunteers with normal hearing (up to 25 dBHL): 15 with tinnitus (test group) and 15 with no complaints (control group), aged between 18-40 years. The volunteers answered the tinnitus handicap inventory questionnaire and a visual analogue scale. Subsequently, a basic audiological evaluation (meatoscopy, tonal and vocal audiometry, and imittanciometry) and psychoacoustic measures of tinnitus (loudness and pitch) were performed. To evaluate auditory attention, the following tests were performed: auditory cognitive evoked potential (P300), central auditory processing tests (dichotic digits test and speech-in-noise test) and sustained auditory attention ability test.ResultsIn the tinnitus handicap inventory, individuals with tinnitus had a mean score of 37.78 (±27.05), characterized as moderate degree. In the dichotic digits test (binaural separation), a difference was observed between the groups in both ears. Moreover, there was a difference in the speech-in-noise test in both ears (RE: p = 0.044; LE: p = 0.019), in P300 (p = 0.049) and in total sustained auditory attention ability test (p = 0.032). Also, there is a negative correlation between sustained auditory attention ability test, decrease in attentiveness and binaural integration (RE: p = 0.044; LE: p = 0.048).ConclusionsIndividuals with tinnitus had a poorer performance compared to the control group regarding auditory attention ability. Therefore, it is inferred that tinnitus is associated with poor performance in selective and sustained auditory attention in the assessed volunteers. These aspects should be considered for the management of patients with tinnitus.     

Performance of hearing skills in children with auditory neuropathy spectrum disorder using cochlear implant: a systematic review

IntroductionCurrently, there are no doubts about the benefits of cochlear implants for the development of children with severe or profound hearing loss. However, there is still no consensus among researchers and professionals regarding the benefits for the improvement of hearing skills in children with auditory neuropathy spectrum disorder using cochlear implants.ObjectiveReview the available evidence in the literature to answer the following: “What is the performance of hearing skills in children with auditory neuropathy spectrum disorder using cochlear implants?”MethodsSystematic review of the literature through electronic database consultation, considering publications in the period 2002–2013.ResultsTwenty-two studies met the criteria and were included in the systematic review.ConclusionThe analyzed studies demonstrated that after cochlear implant surgery, individuals with auditory neuropathy spectrum disorder improved their performance of hearing skills and had similar performance to that of children with sensorineural hearing loss using cochlear implant.     

Variables with prognostic value in the onset of idiopathic sudden sensorineural hearing loss

IntroductionThe establishment of an individualized prognostic evaluation in patients with a diagnosis of idiopathic sudden sensorineural hearing loss (ISSHL) remains a difficult and imprecise task, due mostly to the variety of etiologies. Determining which variables have prognostic value in the initial assessment of the patient would be extremely useful in clinical practice.ObjectiveTo establish which variables identifiable at the onset of idiopathic sudden sensorineural hearing loss have prognostic value in the final hearing recovery.MethodsProspective, longitudinal cohort study. Patients with ISSHL followed by the Department of Otology-Neurotology of a quaternary hospital were included. The following variables were evaluated and correlated with final hearing recovery: age, gender, vertigo, tinnitus, initial degree of hearing loss, contralateral ear hearing, and elapsed time to treatment.Results127 patients with ISSHL were evaluated. Rates of absolute and relative recovery were 23.6 dB and 37.2% respectively. Complete hearing improvement was observed in 15.7% patients; 27.6% demonstrated significant improvement and improvement was noted in 57.5%.ConclusionDuring the onset of ISSHL, the following variables were correlated with a worse prognosis: dizziness, profound hearing loss, impaired hearing in the contralateral ear, and delay to start treatment. Tinnitus at the onset of ISSHL correlated with a better prognosis.     

Effects of diabetes mellitus and systemic arterial hypertension on elderly patients’ hearing

Introduction

Chronic diseases can act as an accelerating factor in the auditory system degeneration. Studies on the association between presbycusis and diabetes mellitus and systemic arterial hypertension have shown controversial conclusions.

Tinnitus and sound intolerance: evidence and experience of a Brazilian group

Introduction

Tinnitus and sound intolerance are frequent and subjective complaints that may have an impact on a patient's quality of life.

Hearing in Noise Test Brazil: standardization for young adults with normal hearing

IntroductionIndividuals with the same ability of speech recognition in quiet can have extremely different results in noisy environments.ObjectiveTo standardize speech perception in adults with normal hearing in the free field using the Brazilian Hearing in Noise Test.MethodsContemporary, cross-sectional cohort study. 79 adults with normal hearing and without cognitive impairment participated in the study. Lists of Hearing in Noise Test sentences were randomly in quiet, noise front, noise right, and noise left.ResultsThere were no significant differences between right and left ears at all frequencies tested (paired t − 1 test). Nor were significant differences observed when comparing gender and interaction between these conditions. A difference was observed among the free field positions tested, except in the situations of noise right and noise left.ConclusionResults of speech perception in adults with normal hearing in the free field during different listening situations in noise indicated poorer performance during the condition with noise and speech in front, i.e., 0°/0°. The values found in the standardization of the Hearing in Noise Test free field can be used as a reference in the development of protocols for tests of speech perception in noise, and for monitoring individuals with hearing impairment.     

The importance of retesting the hearing screening as an indicator of the real early hearing disorder

IntroductionEarly diagnosis of hearing loss minimizes its impact on child development. We studied factors that influence the effectiveness of screening programs.ObjectiveTo investigate the relationship between gender, weight at birth, gestational age, risk factors for hearing loss, venue for newborn hearing screening and “pass” and “fail” results in the retest.MethodsProspective cohort study was carried out in a tertiary referral hospital. The screening was performed in 565 newborns through transient evoked otoacoustic emissions in three admission units before hospital discharge and retest in the outpatient clinic. Gender, weight at birth, gestational age, presence of risk indicators for hearing loss and venue for newborn hearing screening were considered.ResultsFull-term infants comprised 86% of the cases, preterm 14%, and risk factors for hearing loss were identified in 11%. Considering the 165 newborns retested, only the venue for screening, Intermediate Care Unit, was related to “fail” result in the retest.ConclusionsGender, weight at birth, gestational age and presence of risk factors for hearing loss were not related to “pass” and/or “fail” results in the retest. The screening performed in intermediate care units increases the chance of continued “fail” result in the Transient Otoacoustic Evoked Emissions test.     

Open fitting: performance verification of receiver in the ear and receiver in the aid

ObjectiveTo verify the receiver in the ear and receiver in the aid adaptations by measuring in situ the speech perception and users’ level of satisfaction.MethodsThe study was approved by the research ethics committee (Process: 027/2011). Twenty subjects older than 18 years with audiological diagnosis of mild and moderate bilateral descending sensorineural hearing loss were evaluated. The subjects were divided into two groups, where G1 (group 1) was fitted with open-fit hearing aids with the built-in receiver unit (receiver in the ear) and G2 (group 2) was fitted with open-fit hearing aids with RITE. A probe microphone measurement was performed to check the gain and output provided by the amplification and for assessment of speech perception with Hearing in Noise Test with and without hearing aids. After a period of six weeks of use without interruption, the subjects returned for follow-up and answered the Satisfaction with Amplification in Daily Life questionnaire, and were again subjected to Hearing in Noise Test.ResultsBoth groups presented better test results for speech recognition in the presence of noise.ConclusionGroups 1 and 2 were satisfied with the use of hearing aids and improved speech recognition in silent and noisy situations with hearing aids.     

Glucocorticoid influence on prognosis of idiopathic sudden sensorineural hearing loss

IntroductionIdiopathic Sudden Sensorineural Hearing Loss (ISSHL) is defined when a loss of at least 30 dB occurs in over 3 continuous frequencies, in up to 72 hours, of which etiology is not established, despite adequate investigation. Different types of treatment regimens have been proposed, but only glucocorticoids have shown some evidence of benefit in the literature.ObjectiveTo analyze whether the type of treatment or time of treatment with glucocorticoids have any influence on hearing recovery in ISSHL.MethodsObservational retrospective cohort study. One hundred twenty-seven patients with ISSHL, treated at outpatient clinics between the years 2000 and 2010, were studied. We evaluated the prognostic correlation of the type of treatment and time to treatment with glucocorticoids and ISSHL.ResultsThe absolute hearing gain and the relative hearing gain was as follows: 23.6 dB and 37.2%. Complete recovery was observed in 15.7% of patients, significant recovery in 27.6% and recovery in 57.5%.ConclusionIn this study, there was no difference between the use and nonuse of glucocorticoids in hearing improvement. However, when started within seven days after onset, the use of glucocorticoids was a factor of better prognosis.     

Development and validation of the protocol for the evaluation of voice in patients with hearing impairment (PEV-SHI)

IntroductionThe voice of individuals with hearing impairment has been widely described, and can be compromised in all levels of the phonatory system.ObjectiveTo develop and validate an instrument for evaluating the voice of this population.MethodsThe instrument underwent the validation steps suggested by the Scientific Advisory Committee of the Medical Outcomes Trust. The study sample consisted of seventy-eight Brazilian people with cochlear implants (experimental group) and 78 individuals with normal hearing (control group), divided in groups by age range — children from 3 to 5 years; children from 6 to 10 years and adults from 18 to 46 years. The study sample participated in a voice recording of the sustained vowel /a/, connected speech and spontaneous conversation, in which three voice specialists rated using the proposed instrument. It consists of visual-analog scales of suprasegmental aspects, respiratory-phonatory coordination, resonance, phonation, additional parameters and general vocal perception.ResultsEvaluation by an expert committee and a pilot test established content validity. Reliability measures showed excellent test-retest reproducibility for the majority of the parameters. Analysis with the ROC curve showed that perceptual evaluation with the sustained vowel did not strongly differentiate individuals with cochlear implants from those with normal hearing, and the parameter “speech rate” did not differentiate the groups at all. For the connected speech and spontaneous conversation, the majority of the parameters differentiated the experimental group from the control group with an area under the curve ≥0.7. The cutoff values with maximum specificity and sensitivity were 30.5 for mild, 49.0 for moderate and 69.5 for intense deviation.ConclusionsThe protocol for the evaluation of voice in subjects with hearing impairment, PEV-SHI, is a reliable and useful tool for assessing the particularities of the voice of individuals with hearing impairment treated with cochlear implants and can be used in research and clinical settings to standardize evaluation and facilitate information exchange among services.