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Background Multiple sclerosis (MS) is an inflammatory demyelinating disease. Auditory evoked potential studies have demonstrated conduction and neural processing deficits in adults with MS, but little is known about the electrophysiological responses in children and adolescents.

(1) Background: To assess and compare speech intelligibility with conventional and universal musician-specific hearing protection devices (HPD); (2) Methods: The sample comprised 15 normal-hearing musicians of both sexes who had been professionals for more than 5 years. They underwent thorough audiological assessment and free-field audiometry to measure the attenuation levels of three HPD models (musician-specific, silicone, and foam devices). The sentence recognition thresholds in quiet (SRTQ) and noise (SRTN) were assessed with the Lists of Sentences in Portuguese. User satisfaction with musician HPD was assessed after 2 months; (3) Results: Conventional HPD had higher pure-tone mean attenuation levels than musician HPD. No statistically significant differences were found in SRTQ and SRTN between the three HPD types. However, the musician HPD had higher mean signal-to-noise ratios and percentages of correct words from sentences presented in noise than the other HPD. The answers also indicated a positive trend toward satisfaction with the musician-specific HPD; (4) Conclusions: Despite the lack of significant differences in speech intelligibility while wearing the three HPD models in either quiet or noise, the musician-specific HPD provided greater musical sound quality. This reinforces the possibility of an effective and adequate use of protection to preserve musicians’ hearing.

Objective: to verify the frequency of congenital infections in newborns and their possible associations with the universal-neonatal-hearing-screening (UNHS) results, and evaluate a reference UNHS service in the Unified Health System (Sistema Único de Saúde—SUS), according to quality indicators. Methods: Historical cohort study with data analysis of newborns attending prestigious hearing-health SUS services from January 2017 to December 2021, in Santa Catarina, Brazil. The quality of screening coverage was assessed based on the quality indicators proposed by the Brazilian neonatal-hearing-screening-care guidelines (Diretrizes de Atenção da Triagem Auditiva Neonatal—DATAN). Logistic-regression analysis, crude OR calculations, Cochran–Mantel–Haenszel OR calculation, and chi-square test were performed to estimate the association between risk indicators for hearing loss and UNHS failure. Results: In the last five years, the prestigious services performed UNHS on 34,801 newborns and met the DATAN quality indicators. Congenital syphilis was the most frequent (1.59%) congenital infection in newborns, followed by HIV (0.87%), whereas the least frequent was rubella (0.029%). Conclusion: Prestigious UNHS services reached ≥95% hearing screening coverage. Considering all congenital infections, the prevalence was 2.87%, with congenital syphilis the most frequent. Newborns with congenital syphilis or HIV are more likely to fail UNHS.

RESUMO Objetivo Traduzir e realizar a adaptação transcultural dos instrumentos Noise Exposure Questionnaire (NEQ) e 1-Minute Noise Screen (NEQ-S) para a versão em português brasileiro. Método O processo de tradução e adaptação transcultural seguiu procedimentos amplamente utilizados em pesquisas da área da saúde, compostos pelas seguintes etapas: tradução inicial, síntese das traduções, retrotradução, comitê de especialistas, pré-teste, e validação do conteúdo e aparência. Na etapa de pré-teste, participaram 60 trabalhadores, que responderam aos questionários e, posteriormente, os avaliaram quanto ao: entendimento, aparência, clareza e escrita. Para a verificação da confiabilidade, foi utilizado o teste kappa de Cohen e para a análise da consistência interna foi aplicado o coeficiente alfa de Cronbach. Resultados As versões traduzidas e adaptadas dos questionários NEQ e NEQ-S mostraram-se semelhantes em relação ao significado geral e referencial. Entretanto, algumas modificações e adaptações foram realizadas, para adequação à realidade brasileira. O teste kappa indicou concordância moderada e o coeficiente alfa de Cronbach, consistência interna substancial. Conclusão A tradução e a adaptação transcultural foram realizadas de acordo com a metodologia preconizada na literatura nacional e internacional, incluindo-se as equivalências necessárias para a manutenção da validade de face e conteúdo com o instrumento original. A disponibilização dos questionários NEQ e NEQ-S na versão da língua portuguesa brasileira abre novos campos de pesquisa para aprofundamento da quantificação de exposição anual ao ruído.

ABSTRACT Purpose COVID-19 posed numerous challenges to educational programs that had to quickly adapt to remote online learning (ROL) to ensure the continuity of health professional training over the pandemic. We aimed to assess the students' and professors' perceptions of the teaching-learning process in the Physical Therapy, Speech-Language-Hearing Sciences, and Occupational Therapy undergraduate programs at a Brazilian public university. Methods We used an electronic self-reported questionnaire with multiple-choice questions on a Likert scale ranged 1-5; higher the score, higher the level of agreement/importance/satisfaction. Results Most of undergraduate students and teachers had previous experience using information and communication technologies, and 85% stated their preference for in-person learning. Students expressed their appreciation for more active learning methodologies with clear objectives, accessible content, and visualization of abstract concepts. Regarding benefits and barriers, some similar perceptions were observed between students and teachers with ROL favoring time management, benefits in the teaching-learning process, satisfaction and motivation with the course content, and low attendance rates to general academic activities due to absent or poor access to technological resources. Conclusion ROL is an alternative learning mode when the in-person classes cannot be carried out, as in the case of the COVID-19 pandemic. ROL is believed to be unfit to replace in-person learning, although it can complement the traditional classroom-based education in a hybrid model, respecting the nature of each program in the field of health that requires in-person practical training.

BackgroundSARS-CoV-2 induces a spectrum of clinical conditions ranging from asymptomatic infection to life threatening severe disease. Host microRNAs have been involved in the cytokine storm driven by SARS-CoV-2 infection and proposed as candidate biomarkers for COVID-19.MethodsTo discover signatures of circulating miRNAs associated with COVID-19, disease severity and mortality, small RNA-sequencing was performed on serum samples collected from 89 COVID-19 patients (34 severe, 29 moderate, 26 mild) at hospital admission and from 45 healthy controls (HC). To search for possible sources of miRNAs, investigation of differentially expressed (DE) miRNAs in relevant human cell types in vitro.ResultsCOVID-19 patients showed upregulation of miRNAs associated with lung disease, vascular damage and inflammation and downregulation of miRNAs that inhibit pro-inflammatory cytokines and chemokines, angiogenesis, and stress response. Compared with mild/moderate disease, patients with severe COVID-19 had a miRNA signature indicating a profound impairment of innate and adaptive immune responses, inflammation, lung fibrosis and heart failure. A subset of the DE miRNAs predicted mortality. In particular, a combination of high serum miR-22-3p and miR-21-5p, which target antiviral response genes, and low miR-224-5p and miR-155-5p, targeting pro-inflammatory factors, discriminated severe from mild/moderate COVID-19 (AUROC 0.88, 95% CI 0.80-0.95, p

Abstract Background Patients with type 2 diabetes (T2DM) have a prothrombotic state that needs to be fully clarified; microparticles (MPs) have emerged as mediators and markers of this condition. Thus, we investigate, in vivo, in T2DM either with good (HbA1c ≤ 7.0%; GGC) or poor (HbA1c > 7.0%; PGC) glycemic control, the circulating levels of MPs, and in vitro, the molecular pathways involved in the release of MPs from platelets (PMP) and tested their pro-inflammatory effects on THP-1 transformed macrophages. Methods In 59 T2DM, and 23 control subjects with normal glucose tolerance (NGT), circulating levels of CD62E+, CD62P+, CD142+, CD45+ MPs were determined by flow cytometry, while plasma levels of ICAM-1, VCAM-1, IL-6 by ELISA. In vitro, PMP release and activation of isolated platelets from GGC and PGC were investigated, along with their effect on IL-6 secretion in THP-1 transformed macrophages. Results We found that MPs CD62P+ (PMP) and CD142+ (tissue factor-bearing MP) were significantly higher in PGC T2DM than GGC T2DM and NGT. Among MPs, PMP were also correlated with HbA1c and IL-6. In vitro, we showed that acute thrombin exposure stimulated a significantly higher PMP release in PGC T2DM than GGC T2DM through a more robust activation of PAR-4 receptor than PAR-1 receptor. Treatment with PAR-4 agonist induced an increased release of PMP in PGC with a Ca2+-calpain dependent mechanism since this effect was blunted by calpain inhibitor. Finally, the uptake of PMP derived from PAR-4 treated PGC platelets into THP-1 transformed macrophages promoted a marked increase of IL-6 release compared to PMP derived from GGC through the activation of the NF-kB pathway. Conclusions These results identify PAR-4 as a mediator of platelet activation, microparticle release, and inflammation, in poorly controlled T2DM.

Recent studies involving guinea pigs have shown that noise can damage the synapses between the inner hair cells and spiral ganglion neurons, even with normal hearing thresholds—which makes it important to investigate this kind of impairment in humans. The aim was to investigate, with multiple audiological assessments, the auditory function of normal hearing workers exposed to occupational noise. Altogether, 60 workers were assessed (30 in the noise-exposure group [NEG], who were exposed to occupational noise, and 30 in the control group [CG], who were not exposed to occupational noise); the workers were matched according to age. The following procedures were used: complete audiological assessment; speech recognition threshold in noise (SRTN); speech in noise (SN) in an acoustic field; gaps-in-noise (GIN); transient evoked otoacoustic emissions (TEOAE) and inhibitory effect of the efferent auditory pathway; auditory brainstem response (ABR); and long-latency auditory evoked potentials (LLAEP). No significant difference was found between the groups in SRTN. In SN, the NEG performed worse than the CG in signal-to-noise ratio (SNR) 0 (p-value 0.023). In GIN, the NEG had a significantly lower percentage of correct answers (p-value 0.042). In TEOAE, the NEG had smaller amplitude values bilaterally (RE p-value 0.048; LE p-value 0.045) and a smaller inhibitory effect of the efferent pathway (p-value 0.009). In ABR, the NEG had greater latencies of wave V (p-value 0.017) and interpeak intervals III-V and I-V in the LE (respective p-values: 0.005 and 0.04). In LLAEP, the NEG had a smaller P3 amplitude bilaterally (RE p-value 0.001; LE p-value 0.002). The NEG performed worse than the CG in most of the assessments, suggesting that the auditory function in individuals exposed to occupational noise is impaired, even with normal audiometric thresholds.

ABSTRACT OBJECTIVE To compare the incidence of hearing loss among adults stratified by the occurrence of hypertension, and to investigate the association between hypertension and hearing loss. METHODS Longitudinal observational study, part of the Estudo Longitudinal da Saúde do Adulto (ELSA-Brasil, Longitudinal Study on Adult’s Health). Data from the first and second waves were analyzed, including information from audiological assessment and general health of the subjects. As outcome, we considered the presence of hearing loss (hearing thresholds above 25 dBHL at frequencies from 500 Hz to 8 kHz) and, as exposure variable, hypertension (report of medical diagnosis of hypertension; and/or use of drugs to treat hypertension; and/or pressure systolic blood pressure ≥ 140 mmHg; or diastolic blood pressure ≥ 90 mmHg). As covariables for adjustment were considered: sex, age, education, race / ethnicity, income, smoking, diabetes, and occupational exposure to noise. Poisson regression analysis was conducted, estimating the crude and adjusted relative risks, with 95% confidence intervals, in order to assess the factors associated with hearing loss. RESULTS In crude analyses, the incidence of hearing loss was higher for subjects with hypertension (9.7% versus 5.4%). The crude relative risks for hearing loss was almost double (1.93; 95%CI: 1.10–3.39) for subjects with hypertension in the right ear. In the adjusted analyses, the relative risks was not significant for the hypertension variable (1.42; 95%CI: 0.75–2.67). Being 60 years or older (RR: 5.41; 95%CI: 2.79–10.50) showed a statistically significant association with hearing loss, indicating that older adults have higher relative risks for hearing loss. CONCLUSION In the adjusted analyses controlled for multiple risk factors there was no association between hypertension and hearing loss. The dichotomous variable age (being 60 years or older), on the other hand, has shown a significant association with hearing loss.

OBJECTIVES: To investigate the association among hypertension, tinnitus, and sensorineural hearing loss and evaluate the influence of other covariates on this association. METHODS: Baseline data (2008-2010) from the Brazilian Longitudinal Study of Adult Health (ELSA-Brasil) were analyzed. Altogether, 900 participants were evaluated. The baseline assessment consisted of a 7-hour examination to obtain clinical and laboratory variables. Hearing was measured using pure-tone audiometry. RESULTS: Overall, 33.3% of the participants had hypertension. Participants with hypertension were more likely to be older, male, and diabetic compared to those without hypertension. The prevalence of tinnitus was higher among hypertensive participants and the odds ratio for tinnitus was higher in participants with hypertension than in those without hypertension. However, the difference was not significant after adjusting for age. Audiometric results at 250-8,000 Hz were worse in participants with hypertension than in those without hypertension in the crude analysis; however, the differences were not significant after adjustment for age, sex, diagnosis of diabetes, and exposure to noise. No significant difference was observed in hearing thresholds among participants having hypertension for

ABSTRACT Purpose: to monitor, with long-latency auditory evoked potentials, the plasticity of the central auditory pathways in adults and older adults, new users of hearing aids. Methods: a total of 15 adults and older adults, aged 55 to 85 years, participated in the research. They had a symmetric bilateral mild to moderate sensorineural hearing loss, without previous experience with any type of hearing aid. The long-latency auditory evoked potentials were conducted with and without amplification, at 60 and 75 dBnHL, with speech stimulus in a sound field, in two assessment moments: up to one week after fitting the hearing aid and after six months of its use. The Student’s t-test was used for statistical analysis, considering significant the p-value < 0.05. Results: responses with lower latency values were observed for the right ear in the second assessment. Comparing the first with the second assessment, both with and without the hearing aid, an increase in the amplitude of P2-N2 was observed, as well as an increase in the latency of the P2 component at the intensity of 75 dBnHL. No statistically significant differences were observed at the intensity of 60 dBnHL. Conclusion:the use of the hearing aid promoted the plasticity of the central auditory pathways, increasing the number of neurons responsive to the sound stimuli.

ABSTRACT Purpose: to identify and analyze the effects of chemotherapy on the auditory system of children and/or adolescents with cancer treated with cisplatin and carboplatin, assessed through standardized audiological procedures. Methods: studies in Brazilian Portuguese and in English were searched for, as available in the databases Science Direct, PubMed, LILACS, BIREME, Embase, SciELO, Web of Science and Cochrane. The descriptors were: Hearing Loss, Audiology, Child Cancer, Chemotherapy, and Child. Articles with levels 1 and 2 of scientific evidence, published in the last 20 years (1997 to 2017), were considered, of which the audiological results were analyzed, as well as the prevalence of hearing loss in children with cancer undergoing chemotherapy. Results: 3,625 articles were found, of which only 23 were selected for analysis in the present review. Studies have shown a high incidence of sensorineural hearing loss and decrease or even loss of otoacoustic emissions in children and adolescents with cancer, even after the first dose of chemotherapy drugs, with high frequencies being the most affected. Conclusion: there is evidence that both carboplatin and especially cisplatin from the first doses may impair the hearing of children and adolescents, mainly affecting the cochlear function, thus, the importance of long-term audiological monitoring.

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. Objective: To compare the initial audiometry (A1) with a subsequent audiometry (A2) performed after a 3 to 4-year interval in a population of elderly patients with diabetes mellitus and/or systemic arterial hypertension, to verify whether hearing loss in these groups is more accelerated when compared to controls without these clinical conditions. Methods: 100 elderly individuals participated in this study. For the auditory threshold assessment, a previous complete audiological evaluation (A1) and a new audiological evaluation (A2) performed 3–4 years after the first one was utilized. The participants were divided into four groups: 20 individuals in the diabetes mellitus group, 20 individuals in the systemic arterial hypertension group, 20 individuals in the diabetes mellitus/systemic arterial hypertension group and 40 individuals in the control group, matching them with each study group, according to age and gender. ANOVA and Kruskal–Wallis statistical tests were used, with a significance level set at 0.05. Results: When comparing the mean annual increase in the auditory thresholds of the A1 with the A2 assessment, considering each study group and its respective control, it can be observed that there was no statistically significant difference for any of the frequencies for the diabetes mellitus group; for the systemic arterial hypertension group, significant differences were observed after 4 kHz. For the diabetes mellitus and systemic arterial hypertension group, significant differences were observed at the frequencies of 500, 2 kHz, 3 kHz and 8 kHz. Conclusion: It was observed that the systemic arterial hypertension group showed the greatest decrease in auditory thresholds in the studied segment when compared to the other groups, suggesting that among the three studied conditions, hypertension seems to have the greatest influence on hearing. Resumo: Introdução: Doenças crônicas podem atuar como fator de aceleração na degeneração do sistema auditivo. Os estudos sobre a associação da presbiacusia com o diabetes mellitus e com a hipertensão arterial sistêmica mostraram conclusões controversas. Objetivo: Comparar a audiometria inicial (A1) com uma audiometria sequencial (A2) feita com um intervalo de três a quatro anos em uma população de idosos portadores de diabetes mellitus e/ ou hipertensão arterial sistêmica, a fim de saber se a perda de acuidade auditiva nesses grupos é mais acelerada comparada com controles sem essas condições clínicas. Método: Participaram deste estudo 100 idosos. Para a análise dos limiares auditivos, foram usadas: uma avaliação audiológica completa feita anteriormente (A1) e uma nova avaliação audiológica (A2) feita após três a quatro anos da primeira. Os participantes foram distribuídos em quatro grupos: 20 indivíduos no grupo com diabetes mellitus, 20 no grupo hipertensão arterial sistêmica, 20 no grupo diabetes mellitus/hipertensão arterial sistêmica e 40 indivíduos no grupo controle, foram pareados com cada grupo de estudo, de acordo com as características referentes a idade e sexo. Foram usados os testes estatísticos Anova e Kruskal-Wallis, com nível de significância de 0,05. Resultados: Na comparação da média de aumento anual dos limiares auditivos da avaliação A1 com a avaliação A2, considerando cada grupo estudo e seu respectivo controle, pode-se observar que para o grupo diabetes mellitus não houve diferença estatisticamente significante para qualquer das frequências; para o grupo hipertensão arterial sistêmica foram observadas diferenças significantes a partir de 4 kHz. Já para o grupo diabetes mellitus/hipertensão arterial sistêmica foram observadas diferenças significantes nas frequências de 500, 2k, 3k e 8 kHz. Conclusão: Verificou-se que o grupo hipertensão arterial sistêmica foi o que apresentou maior queda dos limiares auditivos no segmento estudado, quando comparado com os outros grupos, sugeriu que entre as três condições estudadas a hipertensão parece ser a que teve maior influência sobre a audição. Keywords: Hearing, Diabetes mellitus, Systemic arterial hypertension, Hearing loss, Elderly, Palavras-chave: Audição, Diabetes mellitus, Hipertensão arterial sistêmica, Perda auditiva, Idoso

Introduction: The Human Immunodeficiency Virus (HIV) and infections related to it can affect multiple sites in the hearing system. The use of High Activity Anti-Retroviral Therapy (HAART) can cause side effects such as ototoxicity. Thus, no consistent patterns of hearing impairment in adults with Human Immunodeficiency Virus / Acquired Immune Deficiency Syndrome have been established, and the problems that affect the hearing system of this population warrant further research. Objectives: This study aimed to compare the audiological and electrophysiological data of Human Immunodeficiency Virus-positive patients with and without Acquired Immune Deficiency Syndrome, who were receiving High Activity Anti-Retroviral Therapy, to healthy individuals. Methods: It was a cross-sectional study conducted with 71 subjects (30–48 years old), divided into groups: Research Group I: 16 Human Immunodeficiency Virus-positive individuals without Acquired Immunodeficiency Syndrome (not receiving antiretroviral treatment); Research Group II: 25 Human Immunodeficiency Virus-positive individuals with Acquired Immunodeficiency Syndrome (receiving antiretroviral treatment); Control Group: 30 healthy subjects. All individuals were tested by pure-tone air conduction thresholds at 0.25–8 kHz, extended high frequencies at 9–20 kHz, electrophysiological tests (Auditory Brainstem Response, Middle Latency Responses, Cognitive Potential). Results: Research Group I and Research Group II had higher hearing thresholds in both conventional and high frequency audiometry when compared to the control group, prolonged latency of waves I, III, V and interpeak I–V in Auditory Brainstem Response and prolonged latency of P300 Cognitive Potential. Regarding Middle Latency Responses, there was a decrease in the amplitude of the Pa wave of Research Group II compared to the Research Group I. Conclusions: Both groups with Human Immunodeficiency Virus had higher hearing thresholds when compared to healthy individuals (group exposed to antiretroviral treatment showed the worst hearing threshold) and seemed to have lower neuroelectric transmission speed along the auditory pathway in the brainstem, subcortical and cortical regions. Resumo: Introdução: O HIV e as infecções relacionadas a ele podem afetar vários locais do sistema auditivo. O uso de terapia antirretroviral altamente ativa pode causar efeitos colaterais, como ototoxicidade. Assim, não foram estabelecidos padrões consistentes de deficiência auditiva em adultos com HIV/Aids e os problemas que afetam o sistema auditivo dessa população justificam pesquisas futuras. Objetivos: Este estudo teve como objetivo comparar os dados audiológicos e eletrofisiológicos de pacientes HIV positivos com e sem Aids que recebiam terapia antirretroviral altamente ativa com os de indivíduos saudáveis. Método: Estudo transversal com 71 indivíduos (30-48 anos), dividido em grupos: Grupo de Pesquisa I: 16 indivíduos HIV-positivos sem Aids (não recebendo tratamento antirretroviral); Grupo de Pesquisa II: 25 indivíduos HIV-positivos com Aids (recebiam tratamento antirretroviral); Grupo Controle: 30 indivíduos saudáveis. Todos os indivíduos foram testados para limiares de condução aérea de tons puros a 0,25-8 kHz, altas frequências de 9-20 kHz, testes eletrofisiológicos (potencial evocado auditivo de tronco encefálico, potencial evocado auditivo de média latência, potencial cognitivo). Resultados: Os grupos de pesquisa I e II apresentaram limiares auditivos mais elevados em audiometria convencional e nas frequências altas quando comparados com o grupo controle, latência prolongada das ondas I, III, V e interpico I-V em resposta auditiva de tronco encefálico e latência prolongada de P300. Em relação às respostas de latência média, houve uma diminuição na amplitude da onda Pa do Grupo de pesquisa II em comparação com o grupo de pesquisa I. Conclusões: Ambos os grupos com HIV apresentaram limiares auditivos mais elevados quando comparados aos indivíduos saudáveis (o grupo exposto ao tratamento antirretroviral apresentou o pior limiar auditivo) e parecem ter menor velocidade de transmissão neuroelétrica ao longo da via auditiva nas regiões do tronco encefálico, subcortical e cortical. Keywords: Acquired immunodeficiency syndrome, Adults, Auditory evoked potentials, Hearing loss, HIV, Palavras chave: Síndrome da imunodeficiência adquirida, Adultos, Potenciais auditivos evocados, Perda auditiva, HIV

Abstract Background Microparticles (MPs) are vesicular structures shed from endothelial or circulating blood cells, after activation or apoptosis, and can be considered markers of vascular damage. We aimed to determine the levels of circulating MPs, their content of miRNA-126-3p and 5p, and their relationship with early endothelial activation/damage, in patients with different degree of glucose tolerance. Methods CD62E+, CD62P+, CD142+, CD45+ circulating MPs, their apoptotic (AnnexinV+) fractions, and miRNA-126 expression were determined in 39 prediabetic (PreDM), 68 type 2 diabetic (T2DM), and 53 control (NGT) subjects, along with main anthropometric and biochemical measurements. MPs were analysed by flow cytometry. miRNA-126 was measured by quantitative real-time PCR. Plasma antioxidant capacity was determined by electronic spin resonance; ICAM-1, and VCAM-1 by ELISA. Results Activated endothelial cell-derived MPs (CD62E+) were significantly increased in PreDM and T2DM in comparison to NGT (p

ABSTRACT OBJECTIVES To analyze the health care network for at-risk infants in the western region of the city of São Paulo, with the primary health care as coordinator, and to compare the presence and extension of attributes of primary health care in the services provided, according to the service management model (Family Health Strategy and traditional basic health units). METHODS A survey was conducted with all at-risk infants born in the western region of São Paulo between 2013 and 2014. The children were then actively searched for a later application of the PCATool – child version. The total of 233 children were located in the territory; 113 guardians agreed to participate, and 81 composed the final sample. RESULTS Regarding the results of PCATool for overall and essential scores, the units with Family Health Strategy were better evaluated by users, when compared with traditional basic health units, showing a statistically significant difference. However, these scores were low for both management models. Regarding attributes, the Family Health Strategy presented better performance compared with traditional basic health units for most of them, except for coordination of information systems. Of ten assessed attributes, seven reached values ≥6.6 for Family Health Strategy and two for the traditional basic health unit. CONCLUSIONS Regardless of the type of management model, low overall and essential scores were found, indicating that guardians of at-risk infants rated some attributes as unsatisfactory, with emphasis on accessibility, integrality and family guidance. Such a performance may have negative consequences for the quality and integrality of these infants’ health care.

RESUMO Introdução Poucos estudos realizaram, concomitantemente, o potencial evocado auditivo de tronco encefálico (PEATE) e o P300 na Síndrome de Down (SD), em indivíduos audiologicamente normais, para a avaliação da via auditiva central, principalmente pela dificuldade de realizar estes procedimentos nesta população. Estudos anteriores sugeriram que indivíduos com SD podem apresentar padrões de respostas diferentes das encontradas em indivíduos com desenvolvimento típico, sendo que a identificação destes seria fundamental para o estabelecimento de um diagnóstico audiológico preciso. Objetivo Caracterizar o PEATE e o P300 em indivíduos com SD audiologicamente normais. Método Foram analisados o PEATE e o P300 de 17 indivíduos com SD e 21 com desenvolvimento típico de sete a 15 anos. A análise foi quantitativa e qualitativa, utilizando medidas descritivas e os testes de hipótese. Resultados Os valores de latência foram menores no PEATE para o grupo SD, com diferença estatisticamente significante para a onda V, interpicos III-V e I-V; não foram encontradas diferenças significantes nos valores de latência do P300. Observou-se maior número de indivíduos com valores precoces para as latências do PEATE e com latências atrasadas para o P300 no grupo SD; ambas as comparações mostraram diferenças significantes. Conclusão Crianças e adolescentes com SD podem apresentar respostas precoces para os componentes do PEATE, sugerindo que a via auditiva destes necessita de menor tempo para a transmissão neural do estímulo acústico até o tronco encefálico. Quanto ao P300, indivíduos com SD podem apresentar latências aumentadas, sugerindo comprometimento na via auditiva central quanto ao processamento cortical da informação auditiva.

OBJECTIVE: To determine whether there is any influence of systemic arterial hypertension on the peripheral auditory system. METHODS: This was a cross-sectional study that investigated 40 individuals between 30 and 50 years old, who were divided into groups with and without systemic arterial hypertension, using data from high-frequency audiometry, transient-evoked otoacoustic emissions and distortion-product otoacoustic emissions. The results were compared with those from groups of normal-hearing individuals, with and without systemic arterial hypertension, who underwent the pure-tone audiometry test. All individuals also underwent the following procedures: otoscopy, acoustic immittance measures, pure-tone audiometry at frequencies from 250 to 16000 Hz, transient-evoked otoacoustic emissions test and distortion-product otoacoustic emissions test. RESULTS: No statistically significant difference was observed between the groups with and without systemic arterial hypertension in either conventional or high-frequency audiometry. Regarding transient-evoked otoacoustic emissions, there was a trend toward statistical significance whereby the systemic arterial hypertension group showed lower results. Regarding distortion-product otoacoustic emissions, the systemic arterial hypertension group showed significantly lower results at the following frequencies: 1501, 2002, and 3003 Hz. A discriminant analysis indicated that the distortion-product otoacoustic emissions variables best distinguished individuals with and without systemic arterial hypertension. CONCLUSION: Data from this study suggest cochlear dysfunction in individuals with systemic arterial hypertension because their otoacoustic emission results were lower than those in the systemic arterial hypertension group.

RESUMO Objetivo Caracterizar bebês de risco quanto ao perfil sociodemográfico e de saúde e descrever o acompanhamento de parte destes nas Unidades Básicas de Saúde (UBS), segundo diferentes modelos de gestão. Método Levantamento de dados de prontuários dos bebês de risco nascidos na região Oeste da cidade de São Paulo entre agosto de 2013 e fevereiro de 2014 em duas etapas (1 – caracterização; 2 – acompanhamento do desenvolvimento). Resultados Dos 225 indivíduos incluídos na primeira etapa, 51,1% eram do gênero feminino e 7,11% eram gemelares. Predominaram mães adolescentes (45,2%), pardas (50,56%), com ensino fundamental completo (47,60%) e solteiras (46,09%). A média de consultas pré-natais foi de 7,12. A maioria teve parto vaginal (62,21%) com idade gestacional média de 37,05 semanas. A média do Apgar foi de 7,13 no 1º minuto e 8,80 no 5º minuto. O peso médio ao nascimento foi de 2597,21 g, com 50,22% apresentando peso ≤2500g. Na segunda etapa, descreveu-se e comparou-se o acompanhamento do desenvolvimento de 55 bebês, segundo o modelo de gestão das UBS (28 em UBS/Estratégia Saúde da Família [ESF] e 27 em UBS tradicional). As UBS/ESF apresentaram maior média de consultas (p=0,006). Houve maior intervalo entre consultas nas UBS tradicionais. Da amostra, 56% não apresentaram registros referentes aos marcos de desenvolvimento. As medidas de crescimento foram registradas em maior número nas UBS/ESF. Para ambos, o número de consultas e o intervalo entre estas foram menores que o preconizado pelo Ministério da Saúde. Conclusão Ainda existem lacunas no acompanhamento ao bebê de risco, segundo as diretrizes preconizadas na Rede Cegonha.

OBJECTIVE: To compare the efficacy and feasibility of teleaudiometry with that of sweep audiometry in elementary school children, using pure-tone audiometry as the gold standard. METHODS: A total of 243 students with a mean age of 8.3 years participated in the study. Of these, 118 were boys, and 125 were girls. The following procedures were performed: teleaudiometry screening with software that evaluates hearing at frequencies of 1,000, 2000 and 4000 Hz at 25 dBHL; sweep audiometry screening in an acoustic booth (20 dBHL at the same frequencies); pure-tone audiometry thresholds in an acoustic booth (frequencies of 500, 1000, 2000 and 4000 Hz); and acoustic immittance measurements. RESULTS: The diagnostic capacities of the teleaudiometry/sweep audiometry screening methods were as follows: sensitivity ϝ 58%/65%; specificity ϝ 86%/99%; positive predictive value ϝ 51%/91%; negative predictive value ϝ 89%/92%; and accuracy ϝ 81%/92%. Teleaudiometry and sweep audiometry showed moderate agreement. Furthermore, the use of these methods in series with immittance testing improved the specificity, whereas parallel testing improved the sensitivity. CONCLUSION: Teleaudiometry was found to be reliable and feasible for screening hearing in school children. Moreover, teleaudiometry is the preferred method for remote areas where specialized personnel and specific equipment are not available, and its use may reduce the costs of hearing screening programs.

ABSTRACT OBJECTIVE To measure the risk of dysphonia in teachers, as well as investigate whether the perceptual-auditory and acoustic aspects of the voice of teachers in situations of silence and noise, the signal-to-noise ratio, and the noise levels in the classroom are associated with the presence of dysphonia. METHODS This is an observational cross-sectional research with 23 primary and secondary school teachers from a private school in the municipality of São Paulo, Brazil, divided into the groups without dysphonia and with dysphonia. We performed the following procedures: general Dysphonia Risk Screening Protocol (General-DRSP) and complementary to speaking voice - teacher (Specific-DRSP), voice recording during class and in an individual situation in a silent room, and measurement of the signal-to-noise ratio and noise levels of classrooms. RESULTS We have found differences between groups regarding physical activity (General-DRSP) and particularities of the profession (Specific-DRSP), as well as in all aspects of the perceptual-auditory vocal analysis. We have found signs of voice wear in the group without dysphonia. Regarding the vocal resources in the situations of noise and silence, we have identified a difference for the production of abrupt vocal attack and the tendency of a more precise speech in the situation of noise. Both the signal-to-noise ratio and the room noise levels during class were high in both groups. CONCLUSIONS Teachers in both groups are at high risk for developing dysphonia and have negative vocal signals to a greater or lesser extent. Signal-to-noise ratio was inadequate in most classrooms, considering the standards for both children with normal hearing and with hearing loss, as well as equivalent noise levels.

OBJECTIVES:We evaluated the central auditory pathways in workers with noise-induced tinnitus with normal hearing thresholds, compared the auditory brainstem response results in groups with and without tinnitus and correlated the tinnitus location to the auditory brainstem response findings in individuals with a history of occupational noise exposure.METHOD:Sixty individuals participated in the study and the following procedures were performed: anamnesis, immittance measures, pure-tone air conduction thresholds at all frequencies between 0.25-8 kHz and auditory brainstem response.RESULTS:The mean auditory brainstem response latencies were lower in the Control group than in the Tinnitus group, but no significant differences between the groups were observed. Qualitative analysis showed more alterations in the lower brainstem in the Tinnitus group. The strongest relationship between tinnitus location and auditory brainstem response alterations was detected in individuals with bilateral tinnitus and bilateral auditory brainstem response alterations compared with patients with unilateral alterations.CONCLUSION:Our findings suggest the occurrence of a possible dysfunction in the central auditory nervous system (brainstem) in individuals with noise-induced tinnitus and a normal hearing threshold.

OBJECTIVE:The aim of this study was to characterize the epidemiological profile of the population attending primary health care units in the western region of the city of São Paulo, Brazil, highlighting referred speech-language and hearing complaints.METHOD:This investigation was a cross-sectional observational study conducted in primary health care units. Household surveys were conducted and information was obtained from approximately 2602 individuals, including (but not limited to) data related to education, family income, health issues, access to public services and access to health services. The speech-language and hearing complaints were identified from specific questions.RESULTS:Our results revealed that the populations participating in the survey were heterogeneous in terms of their demographic and economic characteristics. The prevalence of referred speech-language and hearing complaints in this population was 10%, and only half the users of the public health system in the studied region who had complaints were monitored or received specific treatment.CONCLUSIONS:The results demonstrate the importance of using population surveys to identify speech-language and hearing complaints at the level of primary health care. Moreover, these findings highlight the need to reorganize the speech-language pathology and audiology service in the western region of São Paulo, as well as the need to improve the Family Health Strategy in areas that do not have a complete coverage, in order to expand and improve the territorial diagnostics and the speech-language pathology and audiology actions related to the prevention, identification, and rehabilitation of human communication disorders.

Summary Introduction: Few population-based studies have quantified hearing levels in Brazil; additional studies on this subject are needed. Purpose: The purpose of this study was to characterize hearing complaints and the audiological profile of the population served by the Clinical Audiology Service of an Academic Health Center in the western region of São Paulo, Brazil, between 2003 and 2008. An additional aim was to check whether there is a positive association between the signs/symptoms and type of hearing loss. Methods: This was a retrospective study of the records of 2,145 patients. The health history, tonal and vocal audiometry, and imitanciometry findings were analyzed. Results: The mean age of the patients was 20.6 years. The majority of the subjects had normal hearing thresholds, and the prevalence of hearing loss was approximately 35%. As the patient's age increased, the frequency of conductive hearing loss decreased and that of sensorineural hearing loss increased. There was a tendency toward hearing loss worsening with age. Conclusion: Hearing complaints can predict the type of hearing loss; therefore, they should always be valued because they can be used as a form of screening and thus help to determine the diagnostic hypothesis. This could help to reduce the gap between the patient's perception of the complaints and the audiological assessment and thus improve the prognosis.

O prejuízo do ruído para as vias auditivas centrais em trabalhadores expostos a ruído ocupacional tem sido pouco estudado. OBJETIVO: Avaliar as vias auditivas centrais por meio do potencial evocado auditivo de longa latência (P300), em indivíduos normo-ouvintes expostos a ruído. MÉTODO: Estudo prospectivo em que foram avaliados 25 indivíduos com limiares auditivos dentro da normalidade. Tais indivíduos foram divididos em dois grupos: expostos a ruído ocupacional (13 sujeitos, grupo pesquisa-GP) e não expostos a ruído ocupacional (12 sujeitos, grupo controle-GC). Foi realizado o P300, utilizando estímulos verbais e não verbais. RESULTADOS: Não houve diferença estatisticamente significante entre as orelhas para nenhum dos estímulos, em nenhum dos grupos. Tanto para o estímulo verbal como para o não verbal houve diferença estatisticamente significante entre os grupos, sendo que o GP apresentou latências maiores que o GC. Na análise qualitativa, observou-se maior número de resultados alterados para o P300 com estímulo não verbal e verbal para o GP, apesar de não haver diferença estatisticamente significante entre eles. CONCLUSÃO: Os indivíduos expostos a níveis de pressão sonora elevados apresentaram, tanto para estímulo verbal quanto para estímulo não verbal, médias de latências do P300 maiores quando comparadas com as do grupo controle.The harm upon the central auditory pathways of workers exposed to occupational noise has been scarcely studied. OBJECTIVE: To assess the central auditory pathways by testing the long latency auditory evoked potentials (P300) of individuals exposed to occupational noise and controls. METHOD: This prospective study enrolled 25 individuals with normal hearing thresholds. The subjects were divided into two groups: individuals exposed to occupational noise (13 subjects; case group) and individuals not exposed to occupational noise (12 subjects; control group). The P300 test was used with verbal and non-verbal stimuli. RESULTS: No statistically significant differences were found between ears for any of the stimuli or between groups. The groups had no statistically significant difference for verbal or non-verbal stimuli. Case group subjects had longer latencies than controls. In qualitative analysis, a greater number of altered P300 test results for verbal and non-verbal stimuli was seen in the case group, despite the absence of statistically significant differences between case and control subjects. CONCLUSION: Individuals exposed to high sound pressure levels had longer P300 latencies in verbal and non-verbal stimuli when compared to controls.

O P300 é resultado da focalização da atenção a estímulos raros, dentre outros estímulos frequentes, e investiga a atenção e a memória recente, ambos dependentes da discriminação entre os estímulos, quer sejam verbais ou não verbais. OBJETIVO: Comparar o P300 com estímulos verbais e não verbais em indivíduos adultos com audição normal. MATERIAL E MÉTODO: Estudo prospectivo, no qual foram avaliados 15 sujeitos, com idades entre 22 e 55 anos, do gênero masculino, sem queixas auditivas. Foram submetidos aos potenciais evocados auditivos de curta e longa latência (P300) com estímulos verbal e não verbal. RESULTADOS: As médias das latências do P300 com estímulos verbais foram significantemente maiores que para o P300 com estímulos não verbais. Por sua vez, as médias das amplitudes da onda P300 foram significantemente menores para os estímulos verbais, quando comparados aos não verbais. CONCLUSÃO: Não houve diferença entre as orelhas, no que se refere às latências e amplitudes do P300, tanto para estímulos não verbais quanto verbais. As latências apresentaram valores maiores para os estímulos verbais e as amplitudes mostraram valores menores.The P300 results from focusing attention on rare stimuli in the midst of other frequent stimuli; it tests recent attention and memory, both of which depend on discriminating among verbal or nonverbal stimuli. AIM: To compare the P300 with verbal and nonverbal stimuli in normal-hearing adults. MATERIAL AND METHOD: A prospective study was made of 15 male subjects aged from 22 to 55, with no hearing complaints. The subjects underwent short and long latency (P300) auditory evoked potentials with verbal and non-verbal stimuli. RESULTS: The mean P300 latency with verbal stimuli was significantly higher than the P300 with nonverbal stimuli. The P300 amplitudes were significantly lower for verbal compared with non-verbal stimuli. CONCLUSION: There were no differences between ears with respect to P300 latencies and amplitudes for both non-verbal and verbal stimuli. Latencies were higher with verbal stimuli; amplitudes had lower values.

OBJETIVO: Investigar o desempenho de escolares de 7 a 12 anos de idade, sem queixas auditivas, no teste Gaps-in-Noise (GIN). MÉTODOS: Todas as crianças foram submetidas à otoscopia, audiometria tonal, logoaudiometria, medidas de imitância acústica e teste dicótico de dígitos. Somente realizaram o teste GIN os escolares com resultados dentro do esperado nos referidos testes (37 crianças, sendo 20 de escola particular e 17 de escola pública). Uma vez que não houve diferença entre o desempenho das crianças de escola pública e escola particular, o grupo foi tratado como único. RESULTADOS: Foram encontrados os seguintes valores médios no GIN por faixa etária: 7 anos (5,65 ms); 8 anos (5,12 ms); 9 anos (4,87 ms); 10 anos (5,1 ms) e acima de 11 anos (4,75 ms). CONCLUSÃO: O limiar médio de detecção de gap na orelha direita foi de 5 ms e na orelha esquerda foi de 5,19 ms. Não houve diferença entre as diversas faixas-etárias, orelhas e gêneros, no que se refere aos limiares de detecção de gap avaliados pelo GIN.PURPOSE: To investigate the performance of children with no hearing complaints with ages between 7 and 12 years on the Gaps-in-Noise (GIN) test. METHODS: All children were submitted to otoscopy, pure tone audiometry, speech audiometry, acoustic immittance measures, and dichotic digits test. Only children who passed the previous audiological assessment carried out the GIN test (37 children - 20 who were enrolled in private schools, and 17 from public schools). As there was no difference between the performance of children from public and private schools, both groups were combined for the analysis. RESULTS: The following average values were found for performance on the GIN test: 7-year-olds (5.65 ms), 8-year-olds (5.12 ms), 9-year-olds (4.87 ms), 10-year-olds (5.1 ms), and children over 11 years old (4.75 ms). CONCLUSION: The mean gap detection threshold in the right ear was 5 ms and in the left ear, 5.19 ms. No age, gender, or ear effects were found for gap detection thresholds assessed by the GIN test.

Em virtude da alta prevalência da presbiacusia e dos prejuízos por ela trazidos, uma triagem pode ser útil na identificação da perda auditiva em atenção primária. OBJETIVOS: Estimar a prevalência da perda auditiva em uma população de idosos residentes no Butantã utilizando o método de screening audiológico (questionário) e a avaliação audiológica básica; comparar os resultados do screening audiológico e da avaliação audiológica básica, verificando a validade deste instrumento como forma de triagem auditiva. FORMA DE ESTUDO: Do tipo transversal, descritivo. MATERIAL E MÉTODO: Foram selecionados randomicamente 200 sujeitos de ambos os sexos, com faixa etária a partir de 60 anos, para aplicação do screening audiológico (questionário) e, destes, 100 indivíduos realizaram a avaliação audiológica completa. Em seguida, os resultados dos dois métodos de avaliação foram comparados. RESULTADOS: Verificou-se que não existe associação estatisticamente significante entre a queixa, obtida pelo questionário e o grau de perda auditiva. CONCLUSÕES: A prevalência de perda auditiva encontrada para esta população foi de aproximadamente 56% pelo screening e de 95% pela avaliação audiológica básica. Desta forma, o screening não se mostrou como instrumento válido para uso em triagem auditiva, quando comparado à avaliação audiológica básica.Given the high prevalence of presbycusis and the damage it brings about, a screening test can be useful in the identification of hearing loss in primary care. AIM: To estimate the prevalence of hearing loss in a representative sample of elderly people living at Butantan using an audiological screening method (questionnaire) and a basic audiological evaluation; to compare the results of the two kinds of evaluations, checking the validity of this tool for hearing loss screening. DESIGN: Cross sectional descriptive study. MATERIALS AND METHODS: 200 individuals (above 60 years old, both genders) were randomly selected to undergo audiological screening (questionnaire). Another randomly selected group encompassed 100 individuals who were submitted to a set of audiological tests. Then, we compared the results from the two methods. RESULTS: There were no statistically significant associations between the questionnaire and the degree of hearing loss of the patients. CONCLUSION: The prevalence of hearing loss in our sample was of 56% in the screening and of 95% when checked by the audiological evaluation. Therefore, screening was not proven valid to assess hearing when compared to audiological evaluation.

OBJECTIVE: To determine whether neurophysiological auditory brainstem responses to clicks and repeated speech stimuli differ between typically developing children and children with phonological disorders. INTRODUCTION: Phonological disorders are language impairments resulting from inadequate use of adult phonological language rules and are among the most common speech and language disorders in children (prevalence: 8 - 9%). Our hypothesis is that children with phonological disorders have basic differences in the way that their brains encode acoustic signals at brainstem level when compared to normal counterparts. METHODS: We recorded click and speech evoked auditory brainstem responses in 18 typically developing children (control group) and in 18 children who were clinically diagnosed with phonological disorders (research group). The age range of the children was from 7-11 years. RESULTS: The research group exhibited significantly longer latency responses to click stimuli (waves I, III and V) and speech stimuli (waves V and A) when compared to the control group. DISCUSSION: These results suggest that the abnormal encoding of speech sounds may be a biological marker of phonological disorders. However, these results cannot define the biological origins of phonological problems. We also observed that speech-evoked auditory brainstem responses had a higher specificity/sensitivity for identifying phonological disorders than click-evoked auditory brainstem responses. CONCLUSIONS: Early stages of the auditory pathway processing of an acoustic stimulus are not similar in typically developing children and those with phonological disorders. These findings suggest that there are brainstem auditory pathway abnormalities in children with phonological disorders.

OBJECTIVE: A lack of attention has been given to hearing health in primary care in developing countries. A strategy involving low-cost screening tools may fill the current gap in hearing health care provided to children. Therefore, it is necessary to establish and adopt lower-cost procedures that are accessible to underserved areas that lack other physical or human resources that would enable the identification of groups at risk for hearing loss. The aim of this study was to develop and analyze the efficacy of a low-cost screening tool to identify and classify hearing loss in children. METHODS: A total of 214 2-to-10 year-old children participated in this study. The study was conducted by providing a questionnaire to the parents and comparing the answers with the results of a complete audiological assessment. Receiver operating characteristic (ROC) curves were constructed, and discriminant analysis techniques were used to classify each child based on the total score. RESULTS: We found conductive hearing loss in 39.3% of children, sensorineural hearing loss in 7.4% and normal hearing in 53.3%. The discriminant analysis technique provided the following classification rule for the total score on the questionnaire: 0 to 4 points - normal hearing; 5 to 7 points - conductive hearing loss; over 7 points - sensorineural hearing loss. CONCLUSION: Our results suggest that the questionnaire could be used as a screening tool to classify children with normal hearing or hearing loss and according to the type of hearing loss based on the total questionnaire score

OBJETIVO: verificar a eficácia de um programa informal de treinamento auditivo específico para transtornos do Processamento Auditivo, em um grupo de pacientes com esta alteração, por meio da comparação de pré e pós-testes. MÉTODOS: participaram deste estudo 10 indivíduos de ambos os sexos, da faixa etária entre sete e 20 anos. Todos realizaram avaliação audiológica completa e do processamento auditivo (testes: Fala com Ruído, Sttagered Spondaic Word - SSW, Dicótico de Dígitos, Padrão de Frequência). Após 10 sessões individuais de treinamento auditivo, nas quais foram trabalhadas diretamente as habilidades auditivas alteradas, a avaliação do processamento auditivo foi refeita. RESULTADOS: as porcentagens médias de acertos nas situações pré e pós-treinamento auditivo demonstraram diferenças estatisticamente significantes em todos os testes realizados. CONCLUSÃO: o programa de treinamento auditivo informal empregado mostrou-se eficaz em um grupo de pacientes com transtorno do processamento auditivo, uma vez que determinou diferença estatisticamente significante entre o desempenho pré e pós-testes na avaliação do processamento auditivo, indicando melhora das habilidades auditivas alteradas.PURPOSE: to check the auditory training efficacy in patients with (central) auditory processing disorder, by comparing pre and post results. METHODS: ten male and female subjects, from 7 to 20-year old, took part in this study. All participants were submitted to audiological and (central) auditory processing evaluations, which included Speech Recognition under in Noise, Staggered Spondaic Word, Dichotic Digits and Frequency Pattern Discrimination tests. Evaluation was carried out after 10 auditory training sessions. RESULTS: statistical differences were verified comparing pre and post results concerning the mean percentage for all tests. CONCLUSION: the informal auditory training program used showed to be efficient for patients with (central) auditory processing disorder considering the patients significant improvement in all post test results.

OBJETIVO: Investigar a presença de possíveis perdas auditivas em ritmistas de uma escola de samba de São Paulo. MÉTODOS: O presente estudo foi prospectivo. Participaram dez ritmistas da bateria da escola de samba, de faixa etária entre 20 e 31 anos de idade. Foram realizadas medição dos níveis de pressão sonora dentro da quadra e avaliações audiológicas dos participantes. RESULTADOS: A média dos níveis de pressão sonora na quadra da escola de samba durante os ensaios foi de 111,42 dBA. Seis indivíduos apresentaram limiares auditivos dentro dos limites da normalidade em ambas as orelhas (sendo que as frequências altas apresentaram-se elevadas quando comparadas às frequências médias e baixas); três apresentaram perdas auditivas leves unilaterais; um apresentou perda auditiva neurossensorial leve em ambas as orelhas. CONCLUSÃO: Quatro ritmistas da escola de samba apresentaram algum grau de perda auditiva.PURPOSE: To investigate possible hearing loss in percussionists of a samba school from São Paulo. METHODS: Ten percussionists of a samba school from São Paulo, with ages between 20 and 31 years, participated in this prospective study. Sound pressure levels were measured during a rehearsal and auditory evaluations of the participants were carried out. RESULTS: Mean sound pressure level during rehearsals at the samba school was 111.42 dBA. Six subjects showed normal hearing thresholds in both ears (high frequencies more elevated than medium and low frequencies); three showed unilateral hearing loss; one had bilateral sensorineural hearing loss. CONCLUSION: Four percussionists of the samba school had some degree of hearing loss.

OBJETIVO: Analisar os potenciais evocados auditivos de tronco encefálico em usuários de crack e múltiplas drogas, bem como levantar as possíveis queixas auditivas e de equilíbrio nesta população. MÉTODOS: Foram avaliados 40 usuários de drogas (20 com uso há mais de cinco anos e 20 há menos de cinco anos) e 20 não usuários, do sexo masculino, com idades entre 19 e 46 anos, com limiares auditivos dentro da normalidade. RESULTADOS: Não houve diferenças significativas dos potenciais evocados auditivos de tronco encefálico dos usuários de drogas quando comparados ao grupo controle. CONCLUSÃO: Os potenciais evocados auditivos de tronco encefálico dos usuários de drogas não diferiram significantemente do grupo controle. As queixas apresentadas pelos usuários de drogas foram hiperacusia, alucinação auditiva, zumbido e alteração de equilíbrio.PURPOSE: To study the findings of auditory brainstem evoked potentials in crack and multiple drugs users, as well as to raise possible auditory and balance complaints in this population. METHODS: A total of 40 drugs addicts (20 who had been using drugs for over five years and 20 for less than five years) and 20 non-users were evaluated. Subjects were all male, with ages ranging from 19 to 46 years, and had auditory thresholds within normal. RESULTS: No significant statistical differences were found regarding the auditory brainstem evoked potentials findings of the addicts group, when compared to the non-users. CONCLUSION: Auditory brainstem evoked potentials in crack and multiple drugs users did not differ significantly from the control group. Complaints presented by drugs addicts were hyperacusis, auditory hallucination, tinnitus and altered balance.

TEMA: processamento auditivo temporal e resolução temporal. OBJETIVO: realizar revisão teórica sobre processamento auditivo e resolução temporal, bem como sobre os diferentes parâmetros de marcadores utilizados em testes de detecção de gap e como eles podem interferir na determinação dos limiares. CONCLUSÃO: o processamento auditivo e a resolução temporal são fundamentais para o desenvolvimento da linguagem. Em virtude dos diferentes parâmetros que podem ser utilizados no teste em questão, os limiares de detecção de gap podem variar consideravelmente.BACKGROUND: temporal auditory processing and temporal resolution. PURPOSE: promote a theoretical approach on auditory processing, temporal resolution, and different parameters of markers used at various gap detection tests and how they can interfere in threshold determination. CONCLUSION: auditory processing and temporal resolution are key-factors for language development. The diverse parameters that can be used in the study of gap detection thresholds can result in quite discrepant thresholds.

OBJETIVO: comparar o equilíbrio estático, dinâmico e recuperado de crianças surdas e ouvintes. MÉTODOS: foram avaliadas 9 crianças surdas e 18 crianças ouvintes, de 9 a 12 anos, de ambos os sexos. Foram utilizados os seguintes testes: teste "do quatro" e de Romberg (equilíbrio estático), teste "passeio na trave" e de Unterberger (equilíbrio dinâmico), e giro de 180º (equilíbrio recuperado). RESULTADOS: em todos os testes, a maioria dos ouvintes apresentou equilíbrio estável, enquanto a maioria dos surdos apresentou equilíbrio instável recuperado. CONCLUSÃO: a análise dos resultados apontou para um desempenho melhor das crianças ouvintes, em relação às surdas, no que se refere ao equilíbrio estático, dinâmico e recuperado.PURPOSE: to compare the static, dynamic and recovered balance of deaf and hearing children. METHODS: nine deaf children and eighteen hearing children were evaluated (age nine to twelve, both sexes). To evaluate the static, dynamic and recovered balance, we used the "four" test, Romberg test, the "spend on the bridge" test, Unterberger test and 180º test, respectively. RESULTS: in all tests, most of hearing children showed steady balance and most of deaf children showed unstable recovered balance. CONCLUSION: the analysis of results led to a conclusion that hearing children have best performance than deaf children, regarding static, dynamic and recovered balance.

Purpose: The aims of this study were to characterize hearing symptoms, habits, and sound pressure levels (SPLs) of personal audio system (PAS) used by young adults; estimate the risk of developing hearing loss and assess whether instructions given to users led to behavioral changes; and propose recommendations for PAS users. Method: A cross-sectional study was performed in 50 subjects with normal hearing. Procedures included questionnaire and measurement of PAS SPLs (real ear and manikin) through the users' own headphones and devices while they listened to four songs. After 1 year, 30 subjects answered questions about their usage habits. For the statistical analysis, one-way analysis of variance, Tukey's post hoc test, Lin and Spearman coefficients, the chi-square test, and logistic regression were used. Results: Most subjects listened to music every day, usually in noisy environments. Sixty percent of the subjects reported hearing symptoms after using a PAS. Substantial variability in the equivalent music listening level (Leq) was noted (M = 84.7 dBA; min = 65.1 dBA, max = 97.5 dBA). A significant difference was found only in the 4-kHz band when comparing the real-ear and manikin techniques. Based on the Leq, 38% of the individuals exceeded the maximum daily time allowance. Comparison of the subjects according to the maximum allowed daily exposure time revealed a higher number of hearing complaints from people with greater exposure. After 1 year, 43% of the subjects reduced their usage time, and 70% reduced the volume. A volume not exceeding 80% was recommended, and at this volume, the maximum usage time should be 160 min. Conclusions: The habit of listening to music at high intensities on a daily basis seems to cause hearing symptoms, even in individuals with normal hearing. The real-ear and manikin techniques produced similar results. Providing instructions on this topic combined with measuring PAS SPLs may be an appropriate strategy for raising the awareness of people who are at risk.

RESUMO Objetivo Avaliar a eficácia da atenuação de um protetor auditivo em uma situação real de trabalho utilizando o método f-Microphone-in-real-ear (f-MIRE). Métodos Participaram 18 indivíduos, de ambos os gêneros (média de idade 47,17±8 anos). No local de trabalho, foi realizada a avaliação do nível pessoal de atenuação do Protetor Auditivo (PA) pelo método Field Microphone-in-Real-Ear (f-MIRE), seguido por orientações sobre a importância do uso do PA, higienização, armazenamento e treinamento para sua colocação efetiva. Resultados As análises mostraram que houve atenuação estatisticamente significante para todos os dados coletados (ruído total, por banda de frequência e dose) quando comparados os níveis de ruído no microfone lapela e no microfone sonda. Na comparação entre os valores de atenuação fornecidos pelo fabricante e os encontrados neste estudo, observou-se valores maiores para o fabricante em todas as bandas de frequência. Não houve diferença para os níveis de ruído nas diferentes atividades e horários avaliados. Conclusão Os achados do presente estudo possibilitaram conhecer o nível pessoal de atenuação do protetor auditivo durante uma situação real de trabalho, que estava dentro dos limites de tolerância. Também foi possível coletar informações sobre o ruído do ambiente em que esses trabalhadores estão expostos, onde observamos situações nas quais esse nível ultrapassava os valores de segurança, sendo assim recomendável o uso do PA. É importante que mais estudos sejam realizados utilizando o método f-MIRE, pois pode ser um aliado para avaliar a eficácia da atenuação do PA no local de trabalho.

OBJETIVO: Construir indicadores de qualidade para Audiologia Clínica, sob a ótica do usuário. MÉTODOS: Trata-se de um estudo transversal, realizado por meio de pesquisa de satisfação, aplicada por meio de 13 perguntas (sendo apenas uma aberta). Foi solicitado ao participante que opinasse sobre o último atendimento na unidade, com relação aos seguintes aspectos: acesso ao atendimento; tempo de espera; cordialidade; atenção dada às queixas; impressão sobre o procedimento; confiança; explicações (queixa e seguimento); satisfação; avaliação geral. As respostas foram dadas por meio de uma escala visual-analógica, representada por cinco ícones, que deveriam expressar a opinião dos participantes. Os resultados foram analisados considerando-se a pontuação de cada questão (mínima de 1 e máxima de 5 pontos) e a pontuação total do questionário. Os dados foram submetidos à análise estatística para a construção dos indicadores de qualidade. RESULTADOS: A pontuação dos questionários atingiu um escore médio de 55,5 pontos. Os dados levantados foram homogêneos, configurando material adequado para a construção de indicadores de qualidade. CONCLUSÃO: Os indicadores construídos para o serviço foram: acesso ao atendimento, tempo em sala de espera, acolhimento, atuação profissional, agendamento e avaliação do atendimento.

ABSTRACT Purpose: To determine the efficacy of hearing protector insertion by comparing attenuation values measured by objective (MIRE) and subjective (REAT) methods in groups with and without training. Methods: The study included 80 male subjects assigned to experimental (with training) and control (without training) groups. The following procedures were performed: occupational history, objective and subjective assessment of hearing protectors. Only subjects in the experimental group received training and guidance on proper hearing protector insertion. Results: Attenuation values were significantly higher in the experimental group than in the control group at all frequencies (500, 1000, 2000, and 4000 Hz) investigated through the objective (MIRE) and subjective (REAT) methods. In addition, attenuation values in the control group were lower than those provided by the hearing protector manufacturer. Conclusion: Both objective and subjective attenuation tests demonstrated the efficacy of training on insertion of hearing protectors because the group that received training on proper hearing protection insertion exhibited higher attenuation values than the untrained group.

ABSTRACT Objective: to verify the effect of a vestibular rehabilitation program on workers with dizziness from the Division of Nutrition and Dietetics at a University Hospital. Methods: a total of 13 employees between 42 and 65 years of age participated, of whom, 1 was male, and 12, females. They were evaluated before and after the vestibular rehabilitation program using the Dizziness Handicap Inventory, Work Ability Index and Visual Analog Scale. The program was conducted in groups at the workplace. Statistical analysis was performed using the analysis of variance test for paired factors and the chi-square test. Results: in the pre- and post-vestibular rehabilitation comparison, significant differences were found in the Dizziness Handicap Inventory and Visual Analogue Scale scores. In the qualitative analysis of the Work Ability Index, an increase was observed in the number of workers who considered their ability to work to have improved. Conclusion: vestibular rehabilitation conducted in groups and in the working environment was effective in improving dizziness complaint in workers at the Division of Nutrition and Dietetics. It is believed that the positive experience of this program may be extended to other areas.

RESUMO O zumbido pode ser definido como a percepção consciente de um som, sem a presença de estimulação acústica externa. Considerando o prejuízo causado pelo zumbido e a falta de tratamentos definitivos, fica evidente a necessidade de alternativas para reabilitação de pessoas com zumbido. A hipótese é que o treinamento auditivo pode causar uma reorganização plástica desse sistema, promovendo uma melhora do sintoma. Objetivo: Verificar o efeito de um programa de treinamento auditivo em portadores de zumbido na percepção desse sintoma. Métodos: Participaram 12 indivíduos portadores de zumbido, divididos em dois grupos: Grupo Estudo (GE) e Grupo Controle (GC). Todos os indivíduos realizaram: audiometria; avaliação eletrofisiológica; acufenometria; aplicação do Tinnitus Handicap Inventory (THI) e avaliação do processamento auditivo (GIN - Gaps In Noise , Teste de Padrão de Frequência e Fala com Ruído). Após a avaliação, foram iniciados os treinamentos e o GE foi submetido ao treinamento auditivo formal enquanto o GC ao treinamento visual. Resultados: Na caracterização dos grupos não foram observadas diferenças estatisticamente significantes para as variáveis: idade, pitch e loudness do zumbido, nem para os limiares auditivos na audiometria convencional e altas frequências. Na comparação entre os grupos, pré e pós-treinamento, dos testes eletrofisiológicos, comportamentais e THI não houve diferenças estatisticamente significantes entre eles para nenhuma das avaliações realizadas. Conclusão: Achados não mostraram diferenças estatisticamente significantes entre os grupos na comparação entre pré e pós-treinamento (auditivo ou visual), tanto para os achados eletrofisiológicos quanto para a avaliação comportamental do processamento auditivo e para o THI, embora diferenças pontuais na análise individual tenham ocorrido.

Abstract Introduction: Presbycusis can affect different portions of the auditory system, causing impacts of varying degrees of seriousness on the daily routine of elderly persons. It is essential that the extent of the deficit as well as the degree of handicap is evaluated, so that the hearing of the elderly can be effectively rehabilitated, improving their quality of life. Purpose: To characterize the peripheral and central hearing of elderly individuals and assess their auditory handicaps. Methods: A cross sectional observational study was performed. We evaluated 83 elderly persons (60-85 years; 33 men, 50 women) with normal hearing or sensorineural hearing loss. Individuals were divided into 3 groups according to the 3 to 6kHz hearing thresholds: G1 - mean of 0 to 39 dBHL (80 ears); G2 - mean of 40 to 59 dBHL (48 ears); G3 - mean of 60 to 120dBHL (38 ears). All individuals responded to the Hearing Handicap Inventory for the Elderly (HHIE), and underwent Pure Tone Audiometry, Auditory Brainstem Response (ABR) and Long Latency Response (P300) evaluation. Results: Men had higher auditory thresholds at frequencies from 500 to 12,000Hz (with a statistical difference between 2-8 kHz) and also significantly greater latencies for ABR components. There was no difference between genders for the P300 evaluation. Comparison between groups showed: a statistically significant difference for age; greater ABR wave latencies and interwave intervals; that questionnaire scores worsened as hearing threshold declined; and similar P300 latencies. Conclusions: Elderly people have impairment throughout the auditory pathway (peripheral and central). The P300 was less accurate at identifying the losses that come with age. The HHIE demonstrated negative effects on the social life of elderly people, agreeing with the hearing thresholds found.

OBJECTIVE: To identify children at risk for hearing and/or language disorders and to investigate the association between these risks by conducting pre-validated hearing and language screenings. METHODS: The study was conducted during a polio vaccination campaign in August of 2013 in basic health units in western São Paulo. Parents of children between 2 and 5 years of age were asked to complete two screening tools: a hearing questionnaire (regarding hearing development) and a language production and comprehension scale (including the major language development milestones). The screening tools were administered by different researchers. We compared the risk of having language disorders among children at risk for hearing loss versus children not at risk, as well as the attributable risk and odds ratios. Chi-squared tests and logistic regression analyses were used. RESULTS: The study included 479 children with a mean age of three and one-half years, of whom 26.9% were identified as at risk for deficits in language production, 8.6% were at risk for deficits in language comprehension and 14% were at risk for hearing disorders. The children at risk for hearing disorders were twice as likely as those not at risk to exhibit language production and comprehension deficits. CONCLUSION: The results of this study highlight the importance of establishing and adopting low-cost procedures such as screenings to identify children at risk of developing language and/or hearing disorders in early childhood.

RESUMO Introdução: Doenças crônicas e alterações metabólicas podem atuar como fator de aceleração na degeneração do sistema auditivo decorrente da idade. No entanto, estudos envolvendo a associação entre a perda auditiva com a diabetes mellitus (DM) e com a hipertensão arterial (AH) em idosos mostraram conclusões controversas. Sendo assim, novos estudos sobre essa temática são necessários, a fim de elucidarmos o efeito dessas doenças crônicas sobre o sistema auditivo. Objetivo: Comparar os limiares auditivos de idosos portadores de DM, de HA e de DM+AH com um grupo controle (GC). Métodos: Estudo retrospectivo realizado por meio de levantamento de prontuários de 80 idosos com avaliação audiológica completa, entre 2008 e 2012. Os idosos foram distribuídos em quatro grupos: portadores de DM, portadores de AH, portadores de DM+AH e sem doenças crônicas conhecidas (GC). Foram utilizados os testes estatísticos ANOVA, Tukey e Mauchly, com nível de significância de 0,05. Resultados: Não houve diferença estatisticamente significante entre as orelhas, sendo esses resultados agrupados. As comparações entre as médias dos limiares auditivos dos grupos GC e DM ou AH não mostraram diferenças estatisticamente significantes, entretanto houve diferença estatisticamente significante na comparação entre esses três grupos e o grupo DM+AH para várias das frequências da audiometria avaliadas. Conclusão: Verificou-se que idosos com DM e AH associados apresentaram maior comprometimento auditivo com relação aos outros grupos, sugerindo um efeito sinérgico das duas doenças crônicas sobre a audição.

PURPOSE: To analyze the structure of the Centers for Supporting the Family Health (NASF), in 2010, identify the satisfaction degree of speech language pathologists who work in this area and compare the model proposed by the Brazilian Ministry of Health with practice. METHODS: Prospective and descriptive study, with 40 speech language pathologists inserted in NASF type one, from all Brazilian regions, in 2010. It was used a questionnaire with nine questions related to different topics (work infrastructure, NASF team, actions developed by these professionals and satisfaction about the work), sent by electronic mail to the speech language pathologists. Descriptive statistics, χ2, ANOVA and Pearson coefficient of variation were used to analyze variables. Significance level of 5% was adopted. RESULTS: The speech language pathologists reported that, in their working places (NASF), there was an average of 12.2 Health Family Teams, with 8.9 professionals and 1.6 speech language pathologists. Most of them work 40 hours per week. Routine activities cited by speech language pathologists were: promotion and health prevention actions, matricial, therapies, support to health community workers, referrals, home visits, intersectoral actions and administrative tasks. There was variability in the satisfaction score: the majority of interviewees indicated the degree "Somewhat satisfied" for work infrastructure and referrals, as well as reported "Very satisfied" degree for home visits and support for health community workers. Comparing the model proposed by the Ministry of Health with the speech language pathologists' practices, there was no significant difference. The results show that 40% of speech language pathologists consider that the NASF actions are below the proposed model. CONCLUSION: The NASF structure varied in terms of the number of Family Health Teams, professionals involved and actions performed. There was also significant variability in the satisfaction degree among the subjects studied.

Objetivo Caracterizar o sistema auditivo periférico de indivíduos com síndrome de Down, por meio da audiometria convencional e de altas frequências. Métodos Estudo do tipo transversal e observacional. Participaram 15 indivíduos com síndrome de Down, de ambos os gêneros, entre 7 e 15 anos de idade. Foram realizados os seguintes procedimentos: Meatoscopia, Timpanometria com pesquisa do reflexo acústico ipsilateral e contralateral, Audiometria Tonal, Audiometria Vocal e Audiometria de Altas Frequências. Resultados Houve predomínio de perda auditiva condutiva de grau leve, em uma ou ambas as orelhas. As médias dos limiares auditivos para a audiometria convencional ficaram abaixo de 20 dBNA e, para a audiometria de altas frequências, ficaram entre 20 e 40 dBNA. O coeficiente de correlação de Pearson revelou correlação moderada positiva, entre os limiares de 9 a 14 kHz e a idade. Conclusão De forma geral, não foram observadas diferenças significativas, quando comparadas as orelhas direita e esquerda de indivíduos com síndrome de Down, na audiometria tonal, imitanciometria e logoaudiometria. A maioria das crianças apresentou alteração de orelha média e perda auditiva condutiva. A audiometria de altas frequências sugere o início de prejuízo da função coclear, que pode estar associado às otites médias frequentes e/ou à degeneração coclear precoce.