Audiology in Brazil

The profession of audiology took root in Brazil nearly a half a century ago and has since blossomed into a flourishing, well-developed field. Currently, audiologists in Brazil work at private institutions, including private medical practices and dedicated speech and hearing clinics. They are also employed in a wide array of public institutions, including community clinics, elementary schools, colleges, and universities. In both the private sector and health clinics, audiologists perform diagnostic evaluations of auditory and vestibular disorders, select and fit hearing aids, and provide aural rehabilitation. At the public level, they assist with workers` health programs, dispense hearing aids, and aural rehabilitation. There is always room to grow, however, and the future of audiology in Brazil holds both challenges and opportunity. The following article will sketch the development of audiology training and practice in Brazil, provide a picture of how the field stands today, and summarize the unique challenges which the profession faces in this large and diverse nation.

Auditory steady state response in pediatric audiology

The main issue regarding pediatric audiology diagnosis is determining procedures to configure reliable results which can be used to predict frequency-specific hearing thresholds. Aim: To investigate the correlation between auditory steady-state response (ASSR) with other tests in children with sensorineural hearing loss. Methods: Prospective cross-sectional contemporary cohort study. Twenty-three children (ages 1 to 7; mean, 3 years old) were submitted to ASSR, behavioral audiometry, click audiometry brain stem response (ABR), tone burst ABR, and predicting hearing level from the acoustic reflex. Results: the correlation between behavioral thresholds and ASSR was (0.70- 0.93), for the ABR tone burst it was (0.73 -0.93), for the ABR click it was (0.83-0.89) only at 2k and 4 kHz. The match between the ASSR and the hearing threshold prediction rule was considered moderate. Conclusion: there was a significant correlation between the ASSR and audiometry, as well as between ABR click (2k and 4 kHz) and for the ABR tone burst. The acoustic reflex can be used to add information to diagnosis in children.

Telehealth in audiology: The need and potential to reach underserved communities

Permanent hearing loss is a leading global health care burden, with 1 in 10 people affected to a mild or greater degree. A shortage of trained healthcare professionals and associated infrastructure and resource limitations mean that hearing health services are unavailable to the majority of the world population. Utilizing information and communication technology in hearing health care, or tele-audiology, combined with automation offer unique opportunities for improved clinical care, widespread access to services, and more cost-effective and sustainable hearing health care. Tele-audiology demonstrates significant potential in areas such as education and training of hearing health care professionals, paraprofessionals, parents, and adults with hearing disorders; screening for auditory disorders; diagnosis of hearing loss; and intervention services. Global connectivity is rapidly growing with increasingly widespread distribution into underserved communities where audiological services may be facilitated through telehealth models. Although many questions related to aspects such as quality control, licensure, jurisdictional responsibility, certification and reimbursement still need to be addressed; no alternative strategy can currently offer the same potential reach for impacting the global burden of hearing loss in the near and foreseeable future.

Síndrome do X Frágil com variante de Dandy-Walker: estudo clínico das manifestações comunicativas orais e escritas

A síndrome do X Frágil é a causa mais frequente de deficiência intelectual hereditária. A variante de Dandy-Walker trata-se de uma constelação específica de achados neurorradiológicos. Este estudo relata achados da comunicação oral e escrita de um menino de 15 anos com diagnóstico clínico e molecular da síndrome do X-Frágil e achados de neuroimagem do encéfalo compatíveis com variante de Dandy-Walker. A avaliação fonoaudiológica foi realizada por meio da Observação do Comportamento Comunicativo, aplicação do ABFW - Teste de Linguagem Infantil - Fonologia, Perfil de Habilidades Fonológicas, Teste de Desempenho Escolar, Teste Illinois de Habilidades Psicolinguísticas, avaliação do sistema estomatognático e avaliação audiológica. Observou-se: alteração de linguagem oral quanto às habilidades fonológicas, semânticas, pragmáticas e morfossintáticas; déficits nas habilidades psicolinguísticas (recepção auditiva, expressão verbal, combinação de sons, memória sequencial auditiva e visual, closura auditiva, associação auditiva e visual); e alterações morfológicas e funcionais do sistema estomatognático. Na leitura verificou-se dificuldades na decodificação dos símbolos gráficos e na escrita havia omissões, aglutinações e representações múltiplas com o uso predominante de vogais e dificuldades na organização viso-espacial. Em matemática, apesar do reconhecimento numérico, não realizou operações aritméticas. Não foram observadas alterações na avaliação audiológica periférica. A constelação de sintomas comportamentais, cognitivos, linguísticos e perceptivos, previstos na síndrome do X-Frágil, somada às alterações estruturais do sistema nervoso central, pertencentes à variante de Dandy-Walker, trouxeram interferências marcantes no desenvolvimento das habilidades comunicativas, no aprendizado da leitura e escrita e na integração social do indivíduo.

Communicative and psycholinguistic abilities in children with phenylketonuria and congenital hypothyroidism

The Neonatal Screening for Inborn Errors of Metabolism of the Association of Parents and Friends of Special Needs Individuals (APAE) - Bauru, Brazil, was implanted and accredited by the Brazilian Ministry of Health in 1998. It covers about 286 cities of the Bauru region and 420 collection spots. Their activities include screening, diagnosis, treatment and assistance to congenital hypothyroidism (CH) and phenylketonuria (PKU), among others. In 2005, a partnership was established with the Department of Speech-Language Pathology and Audiology, Bauru School of Dentistry, University of São Paulo, Bauru, seeking to characterize and to follow, by means of research studies, the development of the communicative abilities of children with CH and PKU. OBJECTIVE: The aim of this study was to describe communicative and psycholinguistic abilities in children with CH and PKU. MATERIALS AND METHODS: Sixty-eight children (25 children aged 1 to 120 months with PKU and 43 children aged 1 to 60 months with CH) participated in the study. The handbooks were analyzed and different instruments were applied (Observation of Communication Behavior, Early Language Milestone Scale, Peabody Picture Vocabulary Test, Gesell & Amatruda's Behavioral Development Scale, Portage Operation Inventory, Language Development Evaluation Scale, Denver Developmental Screening Test, ABFW Child Language Test-phonology and Illinois Test of Psycholinguistic Abilities), according to the children's age group and developmental level. RESULTS: It was observed that the children with PKU and CH at risk for alterations in their developmental abilities (motor, cognitive, linguistic, adaptive and personal-social), mainly in the first years of life. Alterations in the psycholinguistic abilities were also found, mainly after the preschool age. Attention deficits, language and cognitive alterations were more often observed in children with CH, while attention deficits with hyperactivity and alterations in the personal-social, language and motor adaptive abilities were more frequent in children with PKU. CONCLUSION: CH and PKU can cause communicative and psycholinguistic alterations that compromise the communication and affect the social integration and learning of these individuals, proving the need of having these abilities assisted by a speech and language pathologist.

Contribuições para análise da política de saúde auditiva no Brasil

OBJETIVO: Realizar o levantamento do quantitativo dos procedimentos relacionados à adaptação de aparelho de amplificação sonora individual (AASI) incluídos na Tabela do Sistema Único de Saúde (Tabela SUS). MÉTODOS: Os dados sobre os procedimentos relacionados à adaptação de AASI incluídos na Tabela SUS foram levantados no site www.datasus.gov.br. Após o levantamento desses dados, foi realizada a organização e a análise descritiva da produção dos atendimentos ambulatoriais registrados pelos serviços de saúde auditiva do Brasil, durante o período de novembro de 2004 a julho de 2010. Os dados foram analisados estatisticamente. RESULTADOS: Quanto aos procedimentos relacionados à dispensação de AASI no território nacional no âmbito da saúde auditiva, em 2006, a terapia fonoaudiológica ultrapassou o quantitativo obtido pela adaptação de AASI e, o acompanhamento fonoaudiológico, por sua vez, foi pouco realizado no país. Os AASI com tecnologias B e C vem sendo mais adaptados do que os AASI de tecnologia A e a realização de medida com microfone sonda ou acoplador de 2cc na adaptação dos AASI é pouco realizada em comparação ao ganho funcional. CONCLUSÃO: Houve grandes avanços na atenção ao deficiente auditivo no país, mas é necessário aprimorar o acompanhamento dos usuários de AASI, e revisar procedimentos como medidas com microfone sonda e tecnologias dos AASI.

Avaliação audiológica pré-cirurgia otológica de indivíduos com fissura labiopalatina operada

OBJETIVO: descrever as características audiológicas de indivíduos com fissura labiopalatina operada (FLP) e indicação de cirurgia otológica, comparando os grupos quanto ao tipo e grau da perda auditiva, bem como a curva timpanométrica. MÉTODOS: análise de 150 prontuários, ambos os gêneros, idade igual ou superior a 4 anos, FLP e indicação de cirurgia otológica, divididos em 3 grupos: I - Tubo de ventilação (TV), II - Timpanoplastia e III - Timpanomastoidectomia, analisando aspectos quanto a entrevista audiológica, audiometria tonal limiar e imitanciometria. RESULTADOS: o grupo I apresentou porcentagem maior de cirurgia bilateral (86%), o que não ocorreu nos demais grupos. Na entrevista audiológica, 83% apresentou algum tipo de queixa auditiva, sendo a mais frequente a perda auditiva (64%) com p<0,05 entre os grupos I e II; I e III. O tipo de perda auditiva de maior ocorrência foi condutivo bilateral (56%) seguido de unilateral (35%), com p<0,05 entre os grupos I e II; I e III. A perda de grau leve unilateral foi a de maior ocorrência (41%), seguida de grau leve a moderada bilateral (20%), com p<0,05 entre os três grupos. A curva timpanométrica mais frequente foi a do tipo B bilateral (39%) com p<0,05 entre os três grupos. CONCLUSÃO: a maioria dos indivíduos apresentou algum tipo de queixa na entrevista audiológica e alterações na audiometria tonal limiar e imitanciometria. A maioria dessas alterações foi compatível com problemas de orelha média, com perda auditiva do tipo condutiva, de grau leve e bilateral, independentemente da indicação cirúrgica.

Emerging Issues Concerning the Education of Speech and Language Pathologists and Audiologists in Brazil and South America

Diversity is one of the major characteristics of Brazil and all South America. This paper presents an overview of the current situation of the education of speech and language pathologists (SLP) and audiologists in Brazil and in several other countries of South America. This paper also discusses the main challenges shared by these countries. The discussion is focused on the mutual interferences between education and the areas of professional practice, cultural diversity and continued education. There are many emerging issues about the education of SLP and audiologists in South America. The suggested conclusion is that, despite the many differences, the South American SLP and audiologists` education would benefit from joint efforts and collaborative experiences. Copyright (C) 2010 S. Karger AG, Basel

Influence of Cochlear Function on Auditory Temporal Resolution in Tinnitus Patients

Our aim was to analyze the influence of subtle cochlear damage on temporal auditory resolution in tinnitus patients. Forty-eight subjects (hearing threshold <= 25 dB HL) were assigned to one of two experimental groups: 28 without auditory complaints (mean age, 28.8 years) and 20 with tinnitus (mean age, 33.5 years). We analyzed distortion product otoacoustic emission growth functions (by threshold, slope, and estimated amplitude), extended high-frequency thresholds, and the Gaps-in-Noise test. There were differences between the groups, principally in the extended high-frequency thresholds and the Gaps-in-Noise test results. Our findings suggest that subtle peripheral hearing impairment affects temporal resolution in tinnitus, even when pure-tone thresholds as conventionally measured appear normal. Copyright (C) 2010 S. Karger AG, Basel

The gaps-in-noise test: Gap detection thresholds in normal-hearing young adults

The aim of this study was to establish parameters for the gaps-in-noise test in normal-hearing young adults. One hundred subjects (50 males and 50 females) received an audiological evaluation to rule out hearing loss and auditory processing disorder. The gaps-in-noise test was then conducted on all subjects. The mean gap detection threshold was 4.19 ms. A psychometric function by gap duration was constructed, revealing that the percentage of correct responses was less than or equal to 5% for a gap duration of 2 ms, 10-30% for a gap duration of 3 ms, 60-70% for a gap duration of 4 ms, and over 96% for gap durations of 5 ms or longer. The results suggest that the data obtained can be applied as reference values for future testing. In the subjects evaluated, the gaps-in-noise test proved to be consistent with low variability.

Tone-evoked ABR in full-term and preterm neonates with normal hearing

This study was designed to investigate the feasibility of applying tone-ABRs in the nursery and neonatal intensive care unit (NICU), and to provide normative tone-ABR data from neonates. Normative tone-ABR latency data were determined. The study obtained intensity series of tone-ABRs from thirty preterm neonates and twenty fullterm neonates who had confirmed normal peripheral auditory function after passing both an OAE and ABR screening examination. ABRs were collected in response to 500, 1500, and 4000 Hz tone bursts at 70, 50, 30, and 20 dB nHL. Mean wave V latencies were compared between groups, ears, and by gender. Responses to tone bursts of 20 and 30 dB nHL were detected in 97% and 100% of all ears respectively, in addition to responses to the higher-intensity stimuli. Preterm neonates` ABRs showed significantly longer latencies than those of the full-term infants. Tone-ABR evaluation was found to be both feasible and reliable as a measure of auditory function in neonates.

Alpha-Tricalcium Phosphate Bone Cement in the Surgical Treatment of Open Mastoid Cavity

Hypothesis: This study aimed to evaluate the biocompatibility of alpha-tricalcium phosphate bone cement in the obliteration of the mastoid cavity in guinea pigs. Background: Treatment with open cavity mastoidectomy can present poor functional results in chronic otitis media with cholesteatoma, especially if the cavity is large. Partial or total obliteration of the cavity can overcome these problems. Alpha-tricalcium phosphate bone cement has physicochemical characteristics that suggest its potential in mastoid cavity obliteration. Materials and Methods: Twenty guinea pigs were studied. All animals underwent surgery involving the dorsal tympanic bulla. In the study group animals (n = 10), mastoid cavity obliteration was performed with alpha-tricalcium phosphate bone cement. In the control group animals (n = 10), the cavity was left unfilled. On postoperative day 60, the animals were sacrificed and studied for signs of rejection of the material and other complications. Temporal bones were removed for histopathological study, in which the type and degree of inflammatory response, as well as the degree of ossification, were analyzed. Results: The mortality rate was the same in both groups. Deaths were attributed to anesthetic complications in the initial postoperative period. In the animals that survived, there were no complications, and there was good healing of the incision in both groups. There were no clinical signs of rejection of the material, and the histopathological analysis of the cement group revealed no signs of foreign body reaction (inflammatory response). Conclusion: Alpha-tricalcium phosphate bone cement is biocompatible in the mastoid cavity of guinea pigs.

Myofascial trigger point: A possible way of modulating tinnitus

In order to investigate whether myofascial trigger points can modulate tinnitus, as well as the association between tinnitus and myofascial trigger points, 94 individuals with and 94 without tinnitus, matched by age and gender, were analyzed by means of bilateral digital pressure of 9 muscles. Temporary modulation of tinnitus was frequently observed (55.9%) during digital pressure, mainly in the masseter. The rate of tinnitus modulation was significantly higher on the same side of the myofascial trigger point subject to examination in 6 out of 9 muscles. An association between tinnitus and the presence of myofascial trigger points was observed (p < 0.001), as well as a laterality association between the ear with the worst tinnitus and the side of the body with more myofascial trigger points (p < 0.001). Thus, this relationship could be explained not only by somatosensory-auditory system interactions but also by the influence of the sympathetic system. Copyright (c) 2007 S. Karger AG, Basel.

Zinc Supplement Modifies Auditory Brainstem Responses in Patients with Tinnitus

Introduction: Zinc is an essential element for human homeostasis being clearly related to almost all metabolic pathways. It is found in some neural circuitries, probably acting as a modulator of glutamatergic excitatory synapsis. In the auditory system its presence has been demonstrated within the cochlea and cochlear nuclei. Tinnitus symptoms are correlated to zinc physiology, and it has been postulated that the oligoelement could be used as an alternative treatment for this clinical situation. Aim: This study has evaluated the brainstem responses (ABR) in patients who suffer from chronic idiophatic tinnitus, before and after being treated with zinc. Neural transmissions in the brainstem auditory structures were also compared in both conditions. Materials and Methods: Forty-one patients (22 with tinnitus and 19 controls, groups I and II, respectively) were included in the study and submitted to anamnesis, otorhinolaryngologic examinations, biochemical evaluation and audiological tests. Group I patients received an specific zinc formulation for 90 days. ABR tests were performed at the beginning of the study and at the end of the zinc treatment. Results: First ABR tests showed no differences between the groups, but on the second evaluation there was a significant prolongation of the wave V latency and an enlargement of wave V amplitude shown in group I. Conclusion: Treatment with systemic zinc could change some aspects of auditory neurotransmission in the brainstem.