Tesis sobre el tema "Objective diagnosis of hearing disorders"

[Truncated abstract] The present study investigated whether any of the characteristics of the compound action potential (CAP) waveform or the spectrum of the neural noise (SNN) recorded from the cochlea, could be used to examine abnormal spike generation in the type I primary afferent neurones, possibly due to pathologies leading to abnormal hearing such as tinnitus or tone decay. It was initially hypothesised that the CAP waveform and SNN contained components produced by the local action currents generated at the peripheral ends of the type I primary afferent neurones, and that changes in these local action currents occurred due to changes in the membrane potential of these neurones. It was further hypothesised that the lateral olivo-cochlear system (LOCS) efferent neurones regulate the membrane potential of the primary afferent dendrites to maintain normal action potential generation, where instability in the membrane potential might lead to abnormal primary afferent firing, and possibly one form of tinnitus. We had hoped that the activity of the LOCS efferent neurones could be observed through secondary changes in the CAP waveform and SNN, resulting from changes in the membrane potential of the primary afferent neurones. The origins of the neural activity generating the CAP waveform and SNN peaks, and the effects of the LOCS on the CAP and SNN were experimentally investigated in guinea pigs using lesions in the auditory system, transient ischemia and asphyxia, focal and systemic temperature changes, and pharmacological manipulations of different regions along the auditory pathway. ... Therefore, the CAP and SNN are altered by changes in the propagation of the action potential along the primary afferent neurones, by changes in the morphology of the tissues surrounding the cochlear nerve, and by changes in the time course of the action currents. If the CAP waveform is not altered, the amplitude of the 1kHz speak in the spontaneous SNN can be used as an objective measure of the spontaneous firing rate of the cochlear neurones. However, because the SNN contains a complex mixture of neural activity from all cochlear neurones, and the amplitude of the spontaneous SNN is variable, it would be difficult to use the spontaneous SNN alone as a differential diagnostic test of cochlear nerve pathologies. To record extratympanic electrocochleography (ET ECochG) from humans, a custom-designed, inexpensive, low-noise, optically isolated biological amplifier was built. Furthermore, a custom-designed extratympanic active electrode and ear canal indifferent electrode were designed, which increased the signal-to-noise ratio of the ECochG recording by a factor of 2, decreasing the overall recording time by 75%. The human and guinea pig CAP waveforms recorded in the present study appeared similar, suggesting that the origins of the human and guinea pig CAP waveforms were the same, and that experimental manipulations of the guinea pig CAP waveform can be used to diagnose the cause of abnormal human ECochG waveforms in cases of cochlear nerve pathologies.

Introduction

Les surdités cochléaires induisent, outre une audibilité réduite, une série de distorsions de la représentation neurale des sons. Deux des mécanismes à la base de ces distorsions sont d’une part une atteinte de la sélectivité fréquentielle et d’autre part des zones neuro-épithéliales non fonctionnelles. Tant le premier que le second mécanisme apparaissent dans une proportion variable et non prédictible d’un sujet à un autre. Deux tests permettent le diagnostic de ces atteintes spécifiques: la Courbe d’Accord (Tuning Curve: TC) et le Threshold Equalising Noise (TEN) test. La TC, mesurée par une technique psychoacoustique chez un adulte collaborant (Psychophysical TC: PTC), consiste en la mesure du niveau de bruit (masqueur) nécessaire pour masquer un son pur (signal) de fréquence et d’intensité fixes. Le TEN test consiste en la mesure des seuils auditifs dans le silence et en présence d’un bruit égalisateur de seuil (TEN). Ces tests qui requièrent des capacités cognitives adultes normales, ne sont pas applicables aux populations pédiatriques prélinguales.

Ce travail de thèse avait pour but le développement d’un équivalent objectif et non invasif des TCs et du TEN test applicable aux populations pédiatriques. La méthode objective choisie fut les potentiels auditifs stationnaires ou ASSEPs (Auditory Steady State Evoked Potentials). Les ASSEPs sont une réponse électrophysiologique cérébrale évoquée par un stimulus acoustique de longue durée modulé en amplitude et/ou en fréquence.

Méthodes & Résultats

Etape 1

Les développements méthodologiques ont été réalisés sur l’espèce canine et humaine adulte. Les ASSEPs n’ayant jamais été préalablement enregistrés chez le chien, une première étape à consister à définir chez cette espèce les paramètres d’enregistrement optimaux (modulation en amplitude optimale) dont on sait qu’ils interagissent avec l’état veille-sommeil, avec la fréquence testée et probablement avec l’espèce animale investiguée.

A cette fin, les seuils auditifs obtenus chez 32 chiens à l’aide des ASSEPs ont été validés à cinq fréquences audiométriques par comparaison aux seuils obtenus avec les potentiels auditifs du tronc cérébral évoqués aux bouffées tonales.

Les seuils obtenus aux ASSEPs avec les paramètres optimaux d’enregistrement (légèrement différents des paramètres optimaux humains) étaient similaires à ceux obtenus aux bouffées tonales.

Ces résultats ont été publiés dans Clinical Neurophysiology (Markessis et al. 2006; 117: 1760-1771).

Etape 2

La possibilité de mesurer des TCs à l’aide des ASSEPs (ASSEP-TCs) a été évaluée sur 10 chiens. Les données canines ont été comparées à des données de la littérature, çàd aux TC enregistrées chez d’autres espèces et avec d’autres méthodes. Des ASSEP-TCs ont également été enregistrées chez 7 humains adultes et confrontées aux PTCs obtenues chez les mêmes sujets. Les PTCs sont typiquement energistrées avec un signal sinusoïdal alors que le stimulus utilisé pour évoquer un ASSEP est une sinusoïde modulée en amplitude. L’effet des sinusoïdes modulées en amplitude sur les paramètres qualitatifs et quantitatifs des TCs a donc été évalué en comparant les PTCs obtenues avec un son pur et avec un son pur modulé en amplitude chez 10 humains adultes.

Les résultats ont révélé que les ASSEP-TCs enregistrées chez le chien et l’humain présentaient des paramètres qualitatifs et quantitatifs similaires respectivement à ceux décrits dans la littérature et aux PTCs. Par ailleurs, auncun effet des stimuli modulés en amplitude sur les paramètres des PTCs n’a été démontré.

Ces données ont été publiées dans Ear & Hearing (Markessis et al. 2009, 30: 43-53).

Etape 3

Les ASSEP-TCs ont été validées chez 10 chiens en comparant les données aux TC enregistrées par électrocochléographie (Compound Action Potential TC: CAP-TC). Le masqueur utilisé pour les CAP-TCs est typiquement une sinusoïde alors que le masqueur utilisé pour les ASSEP-TCs est un bruit à bande étroite. Dès lors, une comparaison du type de masqueur (sinusoïde vs bruit à bande étroite) sur les paramètres des CAP-TCs et ASSEP-TCs a été réalisée chez 10 chiens.

Les ASSEP-TCs chez le chien se sont révélées qualitativement et quantitativement similaires aux CAP-TCs quel que soit le type de masqueur. Elles presentaient par ailleurs l’avantage d’être moins variables, plus précises et non invasives par rapport aux CAP-TCs.

Ces données ont été publiées dans International Journal of Audiology (Markessis et al. 2010, 49 ;455-62).

Etape 4

Afin d’étudier la validité de la procédure à mettre en évidence des changements de sélectivité fréquentielle dus à une atteinte cochléaire, des ASSEP-TCs ont été obtenues chez 10 chiens cochléo-lésés suite à un trauma acoustique. Les Produits de Distorsion Acoustiques, les potentiels évoqués auditifs du tronc cérébral évoqués par un clic et les ASSEPs à cinq fréquences audiométriques ont été enregisrés afin de délimiter l’étendue de la lésion.

Les ASSEP-TCs ont été fortement altérées, mais pas comme attendu ni suggéré par les mesures fonctionnelles indiquant que le trauma acoustique a créé une lésion différente de celle espérée.

Cette étude doit être poursuivie, des lésions moins importantes créées et une validation histopathologique réalisée.

Etape 5

Le TEN test a été mesuré à l’aide des ASSEPs (ASSEP-TEN) chez 12 adultes et cinq enfants normo-entendants. Les données adultes ont été confrontées aux données comportementales. L’effet des stimuli ASSEP (son pur modulé en amplitude) sur les TEN test a également été investigué en comparant les données comportementales obtenues avec une sinusoïde et avec une sinusoïde modulée en amplitude chez 24 adultes.

Les seuils masqués enregistrés aux ASSEPs étaient supérieurs à ceux mesurés par une épreuve comportementale. L’élévation des seuils masqués pose un problème potentiel de dynamique.

La procédure doit être testée chez des patients présentant une surdité cochléaire attendu que la différence entre les seuils auditifs mesurés aux ASSEPs et par une épreuve comportementale est moindre dans cette population. Dans la mesure où le problème de dynamique résiduelle persiste chez les patients malentendants, d’autres stimuli ou algorithmes d’enregistrement doivent être utilisés.

Etape 6

Le TEN est un stimulus large bande. Il peut dès lors se révéler intolérable chez des patients présentant une atteinte auditive restreinte à une region fréquentielle. L’effet du filtrage du TEN sur les seuils et la sonie du TEN a été étudié chez 24 sujets normo-entendants et 35 patients présentant une perte cochléaire dans les hautes fréquences.

Le filtrage passe-haut du TEN s’est avéré être une solution satisfaisante.

Ces données ont été publiées dans International Journal of Audiology (Markessis et al. 2006; 45: 91-98).

Etape 7

L’effet de l’intensité du TEN sur le diagnostic des zones neuro-épithéliales non fonctionnelles a été investigué chez 24 patients en mesurant les seuils masqués à quatre intensités de TEN différentes. La fiabilité du TEN test a également été évaluée.

Le TEN est une procédure fiable. L’intensité du TEN a affecté le diagnostic chez cinq patients. Ce résultat est interprété en termes de degré de l’atteinte du complexe neurosensoriel.

Ces données ont été publiées dans International Journal of Audiology (Markessis et al. 2009; 48: 55-62).

Conclusion

Un algorithme permettant la mesure de TC et du TEN test objective à l’aide des ASSEPs a été développé. L’implémentation clinique de l’algorithme appliqué à l’enregistrement des CA paraît envisageable. Une importante étape de la corrélation entre modifications anatomiques (à l’aide de l’histopathologie) et physiologiques (ASSEP-TC et CAP-TC) est maintenant celle qui s’impose. Les données préliminaires obtenues sur le TEN test électrophysiologique chez des sujets normo-entendants suggèrent que son implémentation clinique puisse se heurter à un problème de dynamique si ce dernier est confirmé en présence de surdités cochléaires. Plusieurs pistes potentielles de solutions ont été avancées.

Doctorat en Sciences biomédicales et pharmaceutiques
info:eu-repo/semantics/nonPublished

Among complications associated with non-syndromic cleft lip and/or palate (NSCL/P) in school age children, conductive hearing loss has been thoroughly investigated because the symptoms are noticeable and the treatment is often easy to access. Research on central auditory processing disorder [(C)APD] has been rarely explored in this clinical population. However, children with NSCL/P have been reported to have delayed speech and language development, as well as poor academic performance in general compared to craniofacially normal peers, despite their peripheral hearing problems typically resolving with age. In order to investigate suspected (C)APD in children with NSCL/P, the present research program was initiated. The study aimed to utilize a comprehensive test battery to assess auditory status in children with NSCL/P, and to investigate whether they have a greater frequency of (C)APD compared to craniofacially normal children. 147 children with NSCL/P and 60 normal children were recruited. They were Mandarin speakers and attending regular schools. The children with NSCL/P did not have peripheral hearing problems at time of assessment. There were three types of assessment tools used in the present research program. Firstly, hearing health tests were conducted to evaluate peripheral hearing function. Case history and auditory questionnaire reports were completed by caregivers to obtain basic medical and developmental information (Chapter 3). Secondly, auditory behavioral tests of (C)APD functioning were administered, including a gap detection test and a speech in noise recognition test (Chapter 4). Thirdly, an auditory evoked potential (AEP) assessment was conducted as an objective evaluation of the central auditory nervous system (Chapter 5). Based on the results of this research program, it was concluded that, firstly, children with NSCL/P showed behaviors typically found in children with (C)APD when questionnaire results were considered. Children with cleft palate (CP) showed the most negative outcomes, and cleft lip (CL) group children showed results equivalent to craniofacially normal children. Secondly, behavioral assessment results showed that compared to control group children, maturation for temporal resolution abilities was delayed in children with NSCL/P. Also, the ability to use interaural timing and intensity cues for speech recognition in a noisy environment was poorer in children with CP and CLP. Finally, abnormal AEP findings in children with cleft suggested longer neural transmission times and delayed development of the auditory nervous system may occur in this population. In summary, the research program found that children with NSCL/P are at higher risk of auditory processing difficulties compared to craniofacially normal children. In addition, a comprehensive test battery is more appropriate for making an accurate diagnosis of (C)APD in this population than a single assessment protocol. The present research program has contributed to an enhanced awareness of potential (C)APD in children with NSCL/P, which had not been investigated using a comprehensive test battery for a large sample of children with cleft disorders in any previous studies. Since Chinese language specific assessment tools are limited, further studies to develop an appropriate, comprehensive test battery for the diagnosis of auditory processing disorder in Chinese children with oral cleft and to explore effective management of this disorder are required.
published_or_final_version
Speech and Hearing Sciences
Doctoral
Doctor of Philosophy

The purpose of the study was to evaluate the sensitivity of the CID Everyday sentences, with competing cafeteria noise, as a measure of the real life receptive communication difficulty experienced by subjects with hearing loss limited to frequencies above 2000 Hz. In order to establish normative data the speech discrimination test w~s given to 38 normal hearing subjects (aged 19-46). Second, the discrimination test was given to 12 hearing impaired subjects (29-64), who also completed a self-assessment questionnaire, the Hearing Handicap Inventory for Adults (HHIA). The results were analyzed to determine: (a) if there was a significant difference between the mean scores of the normal hearing and the hearing impaired subjects, and (b) if there was a significant correlation between the hearing impaired subjects' scores on the discrimination test and those obtained on the HHIA. The investigation revealed that a statistically significant difference (p=0.04) existed between the mean scores of the two subject groups on the discrimination test. The hearing impaired subjects averaged about 9% below the normal hearing subjects. Although there was a weak to moderate correlation between the hearing impaired subjects' scores on the discrimination test and their scores on the HHIA, it was not statistically significant. It was concluded that, with further research, the CID Everyday sentences, with competing cafeteria noise, have potential merit as a speech discrimination procedure to quantify the hearing handicap produced by a high frequency hearing loss.

INTRODUCTION: Confidence in the reliability and validity of a diagnosis of APD is currently low among clinical and professional groups, principally due to the lack of a gold standard test sensitive to APD, differences in accepted diagnostic criteria and considerable variability in clinical test batteries implemented. Listening difficulties associated with APD are also not exclusive to the disorder, and are frequently observed in individuals with alternative disorders such as specific language impairment, specific reading impairment, and attention deficit disorder. The research undertaken in this thesis attempts to identify subjective and objective measures that differentiate adults diagnosed with clinical-APD from oto-neurologically normal adults with no perceived hearing difficulties using a popular hearing inventory, three speech in-noise tests and the speech-evoked auditory brainstem response test. The Speech, Spatial and Qualities of Hearing Scale (SSQ), presents a rich array of communication environments that reflect the three-dimensional dynamic auditory world humans live in. It comprises three hearing subscales - speech intelligibility, spatial awareness and other qualities of hearing. The three speech-in-noise tests - Who Is Right, the Children’s Coordinate Response Measure with competing male-talker (CCRM1) and the Children’s Coordinate Response Measure with competing speech-shaped noise (CCRM2) assess different aspects of auditory cognition, (i.e., low level auditory processing and auditory attention). In all three speech tests the target signal and competing noise were presented simultaneously and dichotically via headphones, and an automatic adaptive approach was used to adjust the signal-to-noise ratio. The speech-ABR was elicited under monaural and binaural stimulation, with a 40ms /da/ consonantvowel syllable. Several measures can be used to characterise the speech-ABR onset response and frequency following response (FFR) including response timings, responses amplitudes, and stimulus versus response waveform correlation coefficients. METHODOLOGY: Normative data were derived for all three subscales of the SSQ Hearing Scale, for the three behavioural speech tests, and the speech-ABR, following the collection and analysis of data obtained from 52 adults with normal hearing and no reported listening difficulties. Research data for the same outcome measures were obtained from a clinical-APD group (n=21) and two smaller APD subgroups (a developmental-APD group comprising 10 subjects and an acquired- APD group consisting of 8 subjects). SUMMARY OF RESEARCH FINDINGS: SSQ self-reported hearing ability scores were significantly worse for the clinical-APD group (n=21) compared with the normal hearing control group (n=52) for the ‘speech intelligibility’ and ‘other qualities of hearing’ subscales at the 0.01 alpha level. Statistically significant group differences were also observed for CCRM1 and Who Is Right tasks - poorer scores were apparent for the clinical-APD group for both tests, providing some evidence for deficits in auditory attention and auditory processing in these subjects. No statistically significant group differences were observed for all speech-ABR response timings or key features of the FFR. Independent Sample T-tests did suggest that statistically significant group differences were apparent for V-A amplitude, V-A slope and V-A area; however these differences may be attributed to age and gender distribution differences between the two groups. 75% of the acquired-APD subjects failed the CCRM1 task (a test of auditory attention), compared with 30% of the developmental-APD group. 50% of the acquired-APD subjects failed the Who Is Right task (a test of auditory processing) compared with 10% of the developmental- APD group; and 50% of the acquired -APD group failed the CCRM2 task (a test of attentional allocation and/or auditory processing) compared with 10% of the developmental-APD group. Findings for the speech-ABR also revealed evidence for low level central auditory nervous system anomalies for both APD subgroups. Abnormalities in the speech-ABR FFR were observed in 30% of developmental-APD subjects compared with 62.5% of acquired-APD subjects; whilst mild anomalies were present in 20% of developmental-APD subjects compared with 37.5% of acquired-APD subjects for the onset response. Altogether these results provide evidence for the deficits in auditory cognition for both APD-groups. Although this test battery demonstrates low sensitivity overall for the developmental-APD group, it does show better sensitivity for the acquired-APD subjects who exhibit more severe deficits in auditory cognition.

This study assessed the effective use of pure-tone testing versus speech testing as used to predict the degree of hearing handicap experienced by an individual. Twenty-one subjects over the age of 65 were tested. Each subject was administered the following test battery: spondee threshold; a pure-tone evaluation, including air and bone conduction; Speech Perception in Noise (SPIN) test; Synthetic Sentence Identification (SSI) test; NU-6 for speech discrimination; establishment of most comfortable listening level (MCL) and loudness discomfort listening level (LDL); immittance testing including tympanograms, acoustic reflex thresholds, and reflex decay.

The purpose of this study was to determine if an association exists among the diagnosis of speech-language impairments (SLI) and the diagnoses of learning disabilities (LD) and/or attention deficit hyperactivity disorder (ADHD) in a school-aged population of children referred to a Learning Disorders Clinic (LDC) because of academic underachievement and/or behavior problems. The two research questions asked in this study are: (a) What percentage of students diagnosed with SLI have a concomitant diagnosis of LD and/or ADHD? and (b) Is there an association among the diagnosis of SLI and the diagnoses of LD and/or ADHD? A sample of 94 subjects was obtained from review of 291 LDC records of children ref erred and diagnosed during the years 1989-1992. The subjects were grouped into eight categories by diagnosis, that is, (a) SLI, (b) SLI/LD, (c) SLI/ADHO, (d) SLI/LO/ADHD, (e) no diagnosis of SLI/LO/AOHD, (f) LO, (g) ADHD, and (h) LD/ADHD. The obtained Chi square value was not statistically significant at a .OS alpha level. Thus, the null hypothesis: there will be no association among the diagnosis of SLI and the diagnoses of LO and/or ADHD, could not be rejected. In this sample, however, 85% of the children diagnosed with SLI had a concomitant diagnosis of LD and/or ADHD, and 70% with no SLI diagnosis were diagnosed with LD and/or ADHD. The overlapping nature of the disorders of SLI, LD, and ADHD is noted. The definitions of SLI and LO demonstrate how enmeshed language and learning problems are. One inference from this study is that as children grow older, their language deficits are recognized in the context of a learning disorder.

Thesis (M.S.)--Worcester Polytechnic Institute.
Keywords: tympanic membrane; optoelectronic holography; otoscope; stroboscopic holography; interferometry. Includes bibliographical references (leaves 62-68).

The purpose of this study was to determine if single-word elicitation procedures used in the assessment of phonological processes would have highly similar results to those obtained through connected speech. Connected speech sampling provides a medium for natural production with coarticulatory influence, but can be time-consuming and impractical for clinicians maintaining heavy caseloads or working with highly unintelligible children. Elicitation through single words requires less time than a connected-speech sample and may be more effective with highly unintelligible children because the context is known, but it lacks the influence of surrounding words. Given the inherent differences between these two methods of elicitation, knowledge of the relative effectiveness of single-word and connected-speech sampling may become an issue for clinicians operating under severe time constraints and requiring an efficient and effective means of assessing phonological processes.

INTRODUÇÃO: O Transtorno Fonológico (TF) é uma alteração de fala, de causa indefinida e de manifestações heterogêneas. OBJETIVO: Caracterizar crianças com TF, quanto à: habilidade fonológica (porcentagem de consoantes corretas - PCC; porcentagem de consoantes corretas revisada - PCC-R; densidade de processos fonológicos- PDI; tipos de processos fonológicos; número de diferentes tipos de processos fonológicos; número de sons ausentes), estimulabilidade, inconsistência de fala, habilidades metafonológicas, habilidades de discriminação auditiva e potenciais evocados e auditivos de curta (PEATE) e longa latências (PEALL). MÉTODO: Participaram 29 crianças, com idades entre 5;0 anos e 7;11 anos com TF e submetidas a avaliação do PEATE e PEALL com diferentes estímulos. Dois diferentes estudos foram realizados. As crianças foram agrupadas de acordo com a gravidade do TF GL (9 crianças), GM (10 crianças) e GL (10 crianças) e faixa-etária GL1(3), GL2(3), GL3(3), GM1(3), GM2(6), GM3(1), GG1(4), GG2(3), GG3 (3). No estudo 1 foi realizada a descrição das características fonológicas das crianças. No estudo 2 foi realizada a descrição e a caracterização dos PEATE e PEALL das crianças com TF. RESULTADOS: O estudo 1 mostrou que o sexo masculino foi o que predominou na amostra, sendo que o valor médio do índice PCC-R foi maior que o do PCC. A média dos diferentes tipos de processos fonológicos empregados pelas crianças foi 4,1 e o processo fonológico de maior ocorrência foi o SEC. As crianças com TF não apresentaram dificuldade na prova de discriminação auditiva, independentemente da idade e da gravidade. A habilidade metafonológica de rima foi a que as crianças demonstraram maior dificuldade. Em média as crianças tiveram cinco sons ausentes sendo três estimuláveis. No estudo 2 os resultados indicaram que no PEATE-fala não houve interação entre a amplitude do complexo V-A e a gravidade do TF. Em contrapartida encontrou que as crianças mais velhas e com TF mais grave apresentaram maior latência da onda V. Não foi encontrada interferência da faixa-etária na latência das ondas A, C, D, E, F e O. No PEATE-click as crianças com TF apresentaram normalidade na latência das ondas I, III e V e interpicos I-III, III-V e I-V. No PEALL-fala as crianças mais velhas e com TF grave tiveram as menores médias de latência da onda P2 e para a onda N2 as crianças mais velhas do Grupo Leve e do Grupo Grave mostraram latências menores para este potencial. Todas as crianças deste estudo atingiram valores normais para a latência de P3. Na análise dos PEALL-click os resultados indicaram que este potencial foi o com mais respostas ausentes. As crianças mais velhas demonstraram as menores latências para a onda P1. CONCLUSÃO: Neste estudo as crianças com TF mostraram valores dentro da normalidade para os potenciais de curta latência com o estimulo click. Além disso, no geral as crianças com TF mais grave evidenciaram latências aumentadas em todos os potenciais. Conclui-se que o PEATE-fala demostrou ser o potencial que melhor identificou as dificuldades de percepção auditiva de crianças com TF
INTRODUCTION: Speech Sound Disorder (SSD) is a speech disorder of unknown origin in which children are heterogeneous. AIM: To characterize children with SSD, according to phonological ability (Percentage of Consonants Correct (PCC), Percentage of Consonants Correct - Revised (PCC-R), density of phonological processes (PDI), type of phonological processes, number of different types of phonological processes; number of absent sounds), stimulability, speech inconsistency, metaphonological skills, auditory discrimination abilities, Auditory Brainstem Response (ABR) and Long Latency Auditory Potentials (LLAP). METHODS: Participants were 29 male and female children with SSD between 5:0 and 7:11 years old, submitted to the ABR and LLAP assessment by different stimuli: speech and click. Two different studies were performed. The children were grouped according to severity of the SSD, Mild Group (9 children), Moderate Group (10 children) and Severe Group (10 children) and, according to age, Mild Group 1 (3), Mild Group 2 (3), Mild Group 3 (3), Moderate Group 1 (3), Moderate Group 2 (6), Moderate Group 3 (1), Severe Group 1 (4), Severe Group 2 (3), Severe Group 3 (3). In study 1 the aim was to describe the phonological characteristics of children with SSD. In study 2, the aim was to describe and to characterize the ABR and LLAP of the children with SSD. RESULTS: Study 1 showed that males predominated, and the mean value of PCC-R index was higher than PCC. The mean of the different types of phonological processes used by the children was 4.1 and the most frequent phonological process was the cluster reduction. Children with SSD had no difficulty in hearing discrimination, regardless age and severity. Rhyme was the metaphonological ability that children demonstrated greater difficulty. Children had an average of five absent sounds and three of them were stimulable. In study 2 results indicated that in ABR-speech there was no interaction between the amplitude of V-A complex and severity of the SSD. In contrast, older children with severe SSD had higher latency of wave V. No age interference was found in latency of wave A, C, D, E, F, and O. In ABR-click the children with SSD presented normality in the latency of waves I, III and V and interpeaks I-III, III-V and I-V. In LLAP- speech, older children with severe SSD had the lowest mean of P2 wave latency and for N2 wave the older children of LG and SG showed lower latencies for the wave N2. All children in this study reached normal values for P3 latency. In the analysis of the LLAP-click the results indicated that this potential was the one with the most absent answers. Older children showed lower latencies for P1 wave. CONCLUSION: In this study children with SSD showed values within normality for the potentials of short latency with the stimulus click. In addition, in general, children with severe SSD showed increased latencies at all potentials. Final conclusion was that ABR-speech was the potential that best identified the difficulties of auditory perception in children with SSD

INTRODUÇÃO: O Transtorno Fonológico (TF) é uma alteração de fala, de causa indefinida e de manifestações heterogêneas. OBJETIVO: Verificar o desempenho de crianças com TF em medidas fonológicas, inconsistência de fala (IF) e habilidades metafonológicas em função da presença do histórico de otite media e da alteração de Processamento Auditivo Central (PAC). MÉTODO: Fizeram parte desta pesquisa 21 sujeitos, com idades entre 7:0 anos e 9:11 anos com diagnóstico de TF, Fizeram parte desta pesquisa 21 sujeitos, com idades entre 7:0 anos e 9:11 anos com diagnóstico de TF. Três diferentes análises foram realizadas de acordo com: 1) as medidas fonológicas (21 - sujeitos); 2) com a ausência (GSHO - 16 sujeitos) ou presença (GHO- cinco sujeitos) do histórico de otite média e 3) com a ausência (G1 - 10 sujeitos) ou presença (G2 - 11 sujeitos) da desordem do Processamento Auditivo Central. RESULTADOS: quando agrupados por meio das medidas fonológicas, mostraram que quanto maior a gravidade do TF, pior o desempenho na IF e nas habilidades metafonológicas. Quando foram agrupados de acordo com o histórico de otite média, os resultados demostraram não haver diferença para nenhuma das variáveis estudadas, com exceção do subteste do Teste de Sensibilidade Fonológica (TSF) de aliteração diferente na versão visual, sendo que os sujeitos com o histórico de otite foram piores neste subteste. Quando os sujeitos foram agrupados de acordo com a alteração do PAC, os resultados mostraram não haver diferença entre os grupos em função da idade, histórico de otite média, IF e para o número de diferentes tipos de processos fonológicos. Os sujeitos com alteração de PAC apresentaram maior ocorrência do processo fonológico de Simplificação do Encontro Consonantal (SEC), somente na prova de Imitação de palavras, menores valores de Porcentagem de Consoantes Corretas (PCC), Porcentagem de Consoantes Corretas - Revisado (PCC-R) e maiores de Process Density Index (PDI). A construção da curva ROC para o PDI indicou poder discriminatório para a composição dos dois grupos (área=0,79), sendo o valor de corte estabelecido 0,54 com sensibilidade (0,73) e especificidade (0,90). Este resultado sugere que crianças com TF e valores de PDI acima desse valor podem apresentar alteração no PAC. Os sujeitos com alteração do PAC apresentam maior dificuldade no TSF em todos os subtestes, tanto na versão auditiva como na visual. CONCLUSÃO: Foi possível verificar com as análises realizadas, evidências de que o maior comprometimento da representação fonológica indica também maior comprometimento do PAC. O histórico de otite não mostrou evidências de sua influência no TF. A análise dos sujeitos com TF em função da presença de alteração do PAC sugeriu maior comprometimento dessas crianças nas medidas de fonologia e das habilidades de rima e aliteração envolvidas no TSF, porém isso não ocorreu para IF. Assim a aplicação de provas complementares forneceu informações relevantes para o diagnóstico do TF
INTRODUCION: The Speech Sound Disorder (SSD) is a speech disorder of unknown origin and heterogeneous manifestations. AIM: To verify the performance of children with SSD in different phonological measures, in speech inconsistency (SI) and in metaphonological abilities according to the presence of otitis media history and Central Auditory Processing disorder. METHOD: The study participants included 21 male and female children with SSD between 7 and 9:11 years old. Three different analysis were conducted according to: 1) the phonological measures; 2) the absence (GSHO-16 subjects) or presence (GHO-five subjects) of OMH and 3) the absence (G1-10 subjects) or presence (11 subjects) of central auditory processing disorder. RESULTS: First analysis indicated that the greater the severity, the worst were both the SI and metaphonological performance at the tests. When subjects were grouped according to the otitis media history no difference was observed among the different variables except for the alliteration subtest of the phonological awareness in visual version indicating that children with otitis media history performed worse at this subtest. No difference was observed at the analysis of age interference, otitis media history, SI and different types of phonological processes when children were grouped according to the presence/absence of central auditory processing disorder. Subjects with central auditory processing disorder presented more gliding simplification at the picture naming task and lower values at the indexes of Percentage of Consonants Correct (PCC) and Percentage of Consonants Correct - Revised (PCC-R). The ROC curve for the index PDI indicated discriminatory power to the composition of two diferente groups (area = 0.79) according to the cutoff value of 0.54 with sensitivity of 0.73 and specificity of 0,90. This result suggests that children with SSD and PDI values above this cutoff value may present a disorder at the central auditory processing evaluation. Subjects with central auditory processing disorder had more difficulty at the phonological awareness test (in all subtests) of both visual and auditory versions. CONCLUSION: It was possible to identify evidences that the greater the involvement at the phonological representation, the greater is the disorder at the central auditory processing evaluation. No influence of the otitis media history was observed at the present study. The analysis of children with SSD according to the central auditory processing disorder suggested greater involvement of these children on the phonological measures and on the metaphonological abilities (rhyme and alliteration) but it did not occur at the SI analysis. Thus the use of complementary tests provided relevant information to the diagnosis of SSD

Introdução: Os benefícios da triagem auditiva neonatal e em escolares têm sido bem demonstrados, porém a disponibilização de programas de triagem auditiva tem sido restrita aos grandes centros, devido à escassez de equipamentos e profissionais especializados na maioria das localidades nos países em desenvolvimento. Para atingir estes objetivos, algumas iniciativas têm utilizado a telemedicina em diferentes soluções. No entanto, não existem relatos na literatura de métodos para avaliação auditiva à distância em que não se utiliza um periférico específico no ponto remoto, nem tampouco sem a necessidade de um profissional especializado de forma presencial ou remotamente. Objetivos: a) Desenvolver um método de triagem à distância para identificação de indivíduos com perda auditiva; b) Testar sua acurácia e compará-lo ao teste de audiometria de triagem (AV) sem cabine acústica. Material e Métodos: o novo método de triagem, denominado telaudiometria (TA), consiste em um software próprio desenvolvido, instalado em um computador com fone TDH 39. Foram selecionadas aleatoriamente entre pacientes e acompanhantes do Hospital das Clínicas, 73 pessoas entre 17 e 50 anos, sendo 42 (57,5%) do sexo feminino. Após serem submetidos a um questionário de sintomas e otoscopia, os indivíduos realizavam os testes de telaudiometria e audiometria de triagem com varredura em 20 dB nas freqüências de 1, 2 e 4 kHz seguindo o protocolo da ASHA (1997) e ao teste padrão-ouro de audiometria de tons puros em cabine acústica em ordem aleatória. Resultados: a TA durou em média 125 ± 11 s e a AV, 65 ± 18 s. Observou-se que 69 pessoas (94,5%) declararam ter achado fácil ou muito fácil realizar a TA e 61 (83,6%) consideraram fácil ou muito fácil a AV. Os resultados da acurácia da TA e AV foram respectivamente: sensibilidade (86,7% / 86,7%), especificidade (75,9% / 72,4%) e valor preditivo negativo (95,7% / 95,5%), valor preditivo positivo (48,1% / 55,2%). Conclusão: A teleaudiometria mostrou-se uma boa opção como método de triagem auditiva, apresentando acurácia próxima da audiometria de triagem. Em comparação a este método, a telaudiometria apresentou sensibilidade semelhante, maiores especificidade, valor preditivo negativo e tempo de duração e menor valor preditivo positivo.
Introduction: Hearing deficiency interferes with the perception and recognition of speech. The benefits of auditory screening in newborns and schoolchildren have been well demonstrated. However, in developing countries, the availability of auditory screening programs has been restricted to larger facilities, due to the scarcity of equipment and specialized professionals in the majority of areas. Objectives: To develop a method of remote screening for the identification of individuals with hearing loss, as well as to determine its accuracy in comparison with that of sweep audiometry without a sound-treated booth. Design: The new screening method, designated teleaudiometry, consists of its own newly developed computer program, installed on a computer with supra-aural headphones attached. The study participants were randomly selected from among patients and their companions at the University of Sao Paulo School of Medicine Hospital das Clínicas, in Sao Paulo, Brazil. We selected 73 individuals between 17 and 50 years of age, 42 (57.5%) of whom were female. After completing a symptoms questionnaire and being submitted to otoscopy, the participants underwent teleaudiometry and sweep audiometry with a sweep of 20 dB at the frequencies of 1, 2 and 4 kHz following the American Speech-Language-Hearing Association protocol, as well as the gold-standard test of pure tone audiometry in sound-treated booth, in random order. Results: The teleaudiometry lasted, on average, 125 ± 11 sec, compared with 65 ± 18 sec for sweep audiometry. Of the 73 participants, 69 (94.5%) found it easy or quite easy to perform the teleaudiometry, compared with 61 (83.6%) for the sweep audiometry. Teleaudiometry and sweep audiometry presented, respectively, the following: sensitivity of 86.7% and 86.7%; specificity of 75.9% and 72.4%; a negative predictive value of 95.7% and 95.5%; and a positive predictive value of 48.1% and 55.2%. Conclusions: Teleaudiometry proved to be a viable option as a method of auditory screening, presenting accuracy similar to that of sweep audiometry. The use of teleaudiometry could increase the number of identified cases of hearing loss, thereby allowing more timely treatment of such cases in underserved populations

The difference in otoacoustic emission (OAE) hearing screening failure rates as a function of ethnic category was investigated in a population of newborns at Tampa General Hospital, Tampa, Florida. Clinical observation led to a concern that due to a higher incidence of outer and middle ear dysfunction in Hispanic newborns and children, screening could result in disparate failure rates, with a larger number of these infants requiring further testing. This result would warrant changes in current protocols, as well as screener training,and parent counseling practices. Between January and July of 2000, 1407 newborns were tested utilizing distortion product otoacoustic emission screening protocols. Of those infants,only 68 failed, yielding a higher than average overall program referral rate of 5%. It is hypothesized that since later reported referral rates for this program fall below 1%, the individuals performing the screenings had not yet become experienced enough to yield low refer rates. In addition, initial screens are not repeated in this program due to staffing and funding issues, which may contribute to higher than average fail rates. More important, however, results indicated that there is indeed a difference in failure rates as a function of ethnicity, with a greater proportion of Hispanic and African-American and "Other" newborn referrals that Caucasian or Asian newborns. This difference, however, was not significantly reliable. It is hypothesized that this difference may be the result of a generally lower socioeconomic status and access to medical care within urban minority populations in Hillsborough County, Florida. Implications are discussed.

Professional research project (Au.D.)--University of South Florida, 2000.
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ABSTRACT: The primary objective of the project was to survey recognized "experts" in the field of neurodiagnostic audiology and practicing audiologists regarding their referral criteria and referral patterns for administering an auditory brainstem response test (ABR). For purposes of this study, "expert" was defined as any recognized audiologist with at least two or more publications and/or seminarsin the field of auditory evoked potentials.
Responses of experts and practicing audiologists were compared and contrasted to establish: a) if there was a standard referral pattern; b) what, if any, were the apparent critical components of referral patterns; and, c) whether or not current practice reflected the utilization of such critical components. The survey was designed to establish whether the respondent was practicing, in what type of practice setting, and how often ABRs were performed. Specificity and sensitivity of ABR outcomes was also requested.
The survey was administered verbally, via telephone, to 3 experts and was sent via e-mail to 178 randomly selected audiologists in the United States. Of the latter 53 returned, 38 reported conducting ABRs. Thus, data analysis was reported on 38 respondents. The survey results did not reveal a consistent standard referral pattern. Critical components for referral were hypothesized based on the "expert" majority response. These include ABR referral based on the presence of: (1) asymmetric sensorineural hearing loss; (2) unilateral tinnitus; (3) positive reflex decay; and, (4) word recognition rollover. The majority of "non-expert" practitioners surveyed reported that these symptoms warranted consideration for referral, thus reflecting utilization of apparent critical components.
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One of the more widely-used methods for pinpointing children in need of more in-depth language evaluation is screening. One language screening instrument designed to accomplish this in an effective and efficient way was the Clinical Evaluation of Language Functions Elementary Screening Test (CELF-S) (Semel & Wiig, 1980). The purpose of this study was to determine the effectiveness of the CELF-S in identifying those children in a second grade setting, who were in need of more thorough evaluation. This study sought to answer the following questions: 1) What is the percentage of false negatives produced by the CELF-S?, and 2) What is the percentage of false positives produced by the CELF-S?

Com o objetivo de analisar o efeito de supressão das emissões otoacústicas transientes com a apresentação de ruído branco contralateral, foram avaliadas 51 crianças de 7 a 11 anos, sendo 15 sem queixas auditivas (grupo controle) e 36 com distúrbio de processamento auditivo (divididas em dois grupos experimentais). Foram determinados, para cada grupo, a média e o desvio padrão dos valores de supressão em cada condição de estímulo: clique linear e clique não linear. Verificou-se que a proporção de ausência do efeito de supressão foi significativamente maior nos grupos de crianças com distúrbio de processamento auditivo, comparados ao grupo controle
This study concerns the suppression of transient evoked otoacoustic emissions by contralateral white noise in children with auditory processing disorder. Fifty-one children between 7 and 11 years old were assessed, being 15 children without auditory complaints (control group) and 36 with auditory processing disorder (divided in two experimental groups). The mean suppression of otoacoustic emissions and standard deviation were determined for each group, both in linear and nonlinear acquisition mode. The results provided evidence that proportion of absence of otoacoustic emissions suppression was significantly higher in auditory processing disorder groups, when compared to control group

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Child development disorders summon people from different fields of knowledge to reflect on their roles. Within this context, the practice of speech therapy causes continuous reflections based on the singularity of treated cases and their riddles. As a path, the possibility of a dialogue with other areas can respond to important concerns along the career of a professional inSpeech-language Therapy. The experience with children and clinical intervention issues demand from professionals to refer to other disciplines of knowledge as a means to proceed with the interlocution process and understanding of patients as well their clinical condition. The process purpose is to think about the direction of treatment. Objective: This study aims to find evidence of an interdisciplinary practice, focusing on diagnosis and treatment, from case records of children and adolescents with language disorders, shared by phoniatrics and speech-language therapy clinics. Method: This research conducted a descriptive analysis based on Prof. Dr. Mauro Spinelli s clinical collection, whose database included records of children and adolescents attended by him and by the researcher, between the years 1990-2005. The collection is stored in the Interdisciplinary Clinical Unit Professor Dr. Mauro Spinelli, in São Paulo, where the survey took place. Results: In this study, the male gender was prevalent (64.5%) and the language disorder of multifactorial etiology was the most frequent (44%). The treatment commonly adopted was speech-language therapy. Interdisciplinary work was present at the discussion of diagnosis and treatment, at the data presentation, and at the clinical reflections/interlocutions and diagnostic therapy approach. Conclusion: The perspective of professionals involved in the cases reviewed here was guided by the principles of listening and dialogue/interlocution between clinician and patient, and between clinicians, in a process that brought understanding of the child resources and skills, acknowledging that the patient was a subject in a process of constitution. The professionals involved shared the same notion on the subject/child about whom the interlocution was being carried out. These considerations point out the possibility of diagnostic therapy combined with interdisciplinary approach without separating diagnosis and treatment, since this process is continuous
Os distúrbios do desenvolvimento infantil convocam profissionais de diferentes campos de conhecimento a refletirem sobre seus papéis. Neste contexto, o exercício da clínica fonoaudiológica provoca continuas reflexões a partir da singularidade dos casos atendidos e seus enigmas. Como caminho, a possibilidade de diálogo com outras áreas pode responder a algumas inquietações durante o percurso profissional na Fonoaudiologia. A experiência com crianças e as questões acerca das intervenções clínicas apontam uma demanda para que o profissional recorra a outras áreas de conhecimento como forma de avançar no processo de interlocução e compreensão dos pacientes e de seus quadros clínicos, cuja a finalidade é pensar a direção do tratamento. Objetivo: Este trabalho tem como objetivo buscar evidências de uma prática interdisciplinar, particularizando diagnóstico e conduta, a partir de registros de casos de crianças e adolescentes com dificuldades na linguagem, compartilhados pelas clínicas foniátrica e fonoaudiológica. Método: Esta pesquisa realizou uma análise descritiva baseada no acervo clínico do Prof. Dr. Mauro Spinelli, cujo banco de dados incluia prontuários de crianças e adolescentes atendidos por ele e pela pesquisadora, entre os anos de 1990 a 2005. O acervo clínico encontra-se guardado na Clínica Interdisciplinar Prof. Dr. Mauro Spinelli, na cidade de São Paulo, onde foi realizada a pesquisa. Resultados: Neste estudo, o gênero masculino foi prevalente (64,5%), e o distúrbio de linguagem de etiologia multifatorial foi o mais frequente (44%). A conduta comumente adotada foi a terapia fonoaudiológica e o trabalho interdisciplinar esteve presente na discussão sobre diagnóstico e conduta, na apresentação dos dados, nas reflexões/interlocuções clínicas e na abordagem de terapia diagnóstica. Conclusão: A perspectiva dos profissionais envolvidos nos casos aqui analisados foi norteada pelos princípios da escuta e do diálogo/interlocução entre clínico e paciente, e entre clínicos, num processo em que se foi entendendo os recursos e habilidades da criança, compreendendo tratar-se de um sujeito em constituição. Os profissionais envolvidos compartilhavam da mesma concepção sujeito/criança que ali estava sendo falada. Essas considerações apontam para a possibilidade da terapia diagnóstica aliada a abordagem interdisciplinar, não separando necessariamente diagnóstico e conduta, pois trata-se de processo contínuo

A student manual of audiological procedures with accompanying laboratory assignments does not presently exist at the University of South Florida (USF). In the first year of the four year Au.D. program at USF, students are enrolled in Audiology Laboratory Clinic I, II, and III, in consecutive semesters. Groups of four to six students meet weekly for a 3-1/2 hour clinical laboratory session to receive training in test instruction, test procedures, test application, and test interpretation. The purpose of the first year Audiology laboratory clinic sessions is to prepare the student for clinical experience in year two of the Au.D program at USF. In preparation for these laboratory sessions, it was discovered that materials related to test procedures are currently scattered throughout a variety of texts, journals, manuals, educational software, videos, and web sites. No one source contains all the needed information on any given test procedure. In addition, specific procedures outlined in documents [American Standards Institute (ANSI) and the American Speech-Language-Hearing Association (ASHA)] are not consistently used by the different sources. Thus, there is no standard procedural manual containing laboratory assignments that lead to the development of appropriate clinical testing skills by a first year Au.D student. A standard test procedural manual for pure tone audiometry, speech audiometry, and immittance testing, with assignments, was developed to assist in the cultivation of the students testing skills. The manual contains test history, purposes, procedures, scoring guidelines, interpretations, and limitations for each test. Laboratory assignments include practice exercises using a computer simulator, classmates, and volunteers. Each assignment is accompanied by discussion questions to enhance and augment student understanding. A reference list is available to obtain further information on each topic area. This manual will be made available to the first year Au.D student as well as to the advanced Au.D student who would benefit from an all-inclusive, updateable source providing the best possible clinical procedures. The final product will be available for a fee in a notebook type format to allow for the inclusion of additional topics and updates as the standards of practice in Audiology change.

INTRODUÇÃO: O termo memória operacional (MO) refere-se a um constructo cognitivo capaz de armazenar e manter a informação acessível para uso determinado por um tempo limitado, possibilitando a manipulação de diversas informações simultâneas e sequenciais como operações matemáticas longas ou complexas, compreensão de palavras pouco frequentes, extensas ou frases complexas. A linguagem está entre as funções cognitivas que dependem do funcionamento da memória operacional e pode estar comprometida em várias condições patológicas, dentre elas o traumatismo cranioencefálico (TCE). Dados da literatura referentes a essa população ainda são restritos ou pouco consistentes. OBJETIVOS: investigar se o teste n-back é uma medida válida para identificar o déficit de memória em pacientes com TCE, estabelecer nota de corte e curva ROC do teste n-back, comparar o desempenho entre os indivíduos saudáveis e aqueles que sofreram TCE, comparar o teste n-back com os testes de linguagem e aspectos da lesão neurológica, tais como gravidade e tempo, tempo de coma e localização hemisférica da lesão nos resultados para verificar o desempenho e a relevância na separação dos casos em pacientes e controles.MÉTODOS: 53 indivíduos brasileiros (26 adultos com TCE e 30 adultos saudáveis) foram avaliados por bateria de estímulos verbais auditivos para verificar diferenças inter-grupos na capacidade de processamento da memória operacional, quanto ao numero de respostas corretas (acurácia), capacidade máxima de processamento na memória operacional (span) e também verificar a relação da memória operacional com habilidades linguísticas, através da comparação de testes. RESULTADOS: na comparação entre os pacientes e os indivíduos do grupo controle observou-se diferença estatisticamente significante entre os grupos tanto para os testes de base quanto para os resultados do n-back. Os grupos foram estatisticamente pareados em relação às variáveis sócio-demográficas (idade, escolaridade e gênero). O modelo estatístico com as variáveis do teste n-back demonstrou ótima separação dos casos em pacientes/ controle com a área sob a curva ROC de 89%. O modelo também mostrou convergência com os testes de linguagem para compreensão auditiva de sentenças, fluência verbal e aspectos discursivos-pragmáticos e com o nível cognitivo. O lado da lesão foi estatisticamente significante para o n-back, fluência verbal e discurso conversacional. CONCLUSÃO: Os resultados mostram que o n-back na maneira como foi desenhado é capaz de diferenciar os indivíduos alterados e os normais na habilidade de memória operacional. No estudo foi possível discriminar o comportamento de indivíduos com lesão encefálica adquirida e indivíduos saudáveis quanto à medida de acurácia e capacidade máxima de manipulação da informação na memória operacional. Esse comportamento reflete o funcionamento linguístico e cognitivo que se correlaciona com o mecanismo de memória operacional
INTRODUCTION: The term working memory (WM) refers to a construct cognitive capability of storing and keeping information on line to a determined use for a limited time, enabling the manipulation of diverse simultaneous and sequential information such as long or complex mathematical operations, comprehension of less frequent words, extensive or complex sentences. The language is among the cognitive functions which depends on the operational memory behavior and may be engaged in many pathological conditions, among them the TBI (traumatic brain injury). Literature dada relative to such population are still restrict or weak. AIM: investigate whether the n -back task is a valid measure for identifying memory deficits in patients with TBI; establish cutoff and ROC curve of n-back task; to compare performance between normals individuals and those who have suffered TBI; to compare n-back task with tests of language and aspects of neurological injury, such as severity, coma and hemispheric laterality of the lesion to verify the performance and relevance in the separation of cases. METHODOS: 53 individuals Brazilians (26 adults with TBI and 30 healthy adults) were assessed by a battery of auditory verbal stimuli for detecting differences between groups in the processing capacity of working memory, as the accuracy and span also check the relationship of working memory to language skills, through the comparison tests. RESULTS: in the comparison between patients and control subjects was observed statistically significant differences between groups thus to the tests as the basis tests as to results of the n -back. The groups were statistically matched in relation to socio-demographic variables (age, education and gender). The statistical model with variables of the n -back test showed good separation of cases where patients / control with the area under the ROC curve of 89 % . The model also showed convergence with language tests for auditory comprehension of sentences, verbal fluency and pragmatic - discursive aspects and the cognitive level. The side of the lesion was statistically significant for the n -back, verbal fluency and conversational discourse. CONCLUSION: the results demonstrated that the n-back on the way it was designed is able to distinguish the changed individuals and the normal on the working memory ability. On the study it was possible to discriminate the behaviors of individuals with acquired brain injury and healthy individuals regarding the accuracy and maximum capacity of manipulating information on the working memory. Such behavior reflects the linguistic and cognitive function which correlates with the working memory mechanism

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This thesis was formulated around oodles of issues that have been the subject of research in speech therapy clinic structure which were gathered in a challenge to unravel: what are the epistemological and praxis conditions to empower the symptomatology and the speech diagnostic and thus reinvent its method of treatment? To care about these questions, it was decided to return to Demosthenes and establish the formalization of different logical, ethical and rhetorical functions that were assumed in overcoming its history of his stuttering, the invention of his healing and discursive strategies applied on public speaking. Define the specific characteristics of the position occupied by Demosthenes as stuttering, as a clinician and after as a speaker, represents a strategy for research on the place of capture of the speech therapist, the subject and the social in the field of speech and language. The construction of the clinical case had as support the version told by Plutarch and the speech by Demosthenes: Prayer of the Crown (BC), which enshrines the last as the great orator of antiquity. It was necessary to return to Demosthenes because it represented the possibility of making visible the mechanisms of their treatment method for the emergence of the speech therapy clinic as we know it today, in which it follows the practical experience and the limits of clinical strategy. After followed in the case of Demosthenes and in the history of the main movements of similarities and differences of speech therapy clinic to medical clinic, to the psychological and to the psychoanalytic clinic, we proposed a model of understanding of the subject articulation and language in determining speech therapy symptoms. With this subsidy, we made up an integrative way to meet the different requirements necessary to rethink the diagnostic and the speech therapy clinic intervention in relation to other clinical cases described in the literature. To verify etiological hypotheses, diagnostic and therapeutic, was used as the basis of linguistic reasons the structural analysis of language developed by Saussure, improved by Jakobson and inserted in the design of language acquisition proposed by De Lemos, and still the theory of the subject in Lacan. Finally, we discuss the process of autonomy of the symptoms language model, and we indicate the possible directions of reinvention of diagnostic reasoning and clinical method on the relationship between subject and language
Esta tese foi formulada em torno a uma série de questões que têm sido objeto de investigação da estrutura clínica fonoaudiológica, reunidas em uma espécie de desafio a desvendar: quais são as condições epistemológicas e práxicas para autonomizar a semiologia e a diagnóstica fonoaudiológica e, consequentemente, reinventar o seu método de tratamento? Para lidar com essas questões, optou-se por retornar a Demóstenes e estabelecer a formalização das diferentes funções lógicas, éticas e retóricas assumidas na história de superação da sua gagueira, na invenção de sua cura e nas estratégias discursivas empregadas diante do falar em público. Delimitar as características específicas da posição ocupada por Demóstenes como gago, como clínico e depois como orador representa uma estratégia de investigação sobre o lugar de captura do fonoaudiológo, do sujeito e do social, no campo da fala e da linguagem. A construção do caso clínico teve como suporte a versão contada por Plutarco e alguns discursos proferidos por Demóstenes, entre eles: Oração da Coroa (IV a.C.), que o consagra como grande orador da Antiguidade. Retornar a Demóstenes representou a possibilidade de tornar visíveis os mecanismos do seu método de tratamento para a emergência da clínica fonoaudiológica tal como a conhecemos hoje, pela qual se deduz a experiência prática e os limites da estratégia clínica. Acompanhamos, no caso de Demóstenes e na história dos principais movimentos de aproximações e distanciamentos da clínica fonoaudiológica à clínica médica, à psicológica e à psicanalítica e propusemos um modelo de entendimento da articulação sujeito e linguagem na determinação de sintomas fonoaudiológicos. Tendo isso em vista, formulamos um modo integrativo de reunir as diferentes exigências necessárias para repensar a diagnóstica e a intervenção clínica fonoaudiológicas, em relação a outros casos clínicos descritos na literatura. Para verificar hipóteses etiológicas, diagnósticas e terapêuticas, utilizamos como base de fundamentação linguística a análise estrutural da linguagem desenvolvida por Saussure, aprimorada por Jakobson e a inserida pela concepção de aquisição de linguagem proposta por De Lemos e, ainda, a teoria do sujeito em Lacan. Para finalizar, discutimos a autonomização do modelo de sintomas de linguagem e indicamos direções possíveis de reinvenção do raciocínio diagnóstico e método clínico, na articulação entre sujeito e linguagem

A research thesis submitted for the degree of Doctor of Philosophy in Audiology in the Faculty of Humanities the University of the Witwatersrand March 2016.
Purpose: The main objective of the current study was to explore risk-based new-born hearing screening within a developing country by conducting early hearing detection in high-risk neonates within an academic hospital complex in Gauteng, South Africa. Specific objectives describing the case history factors and audio logical function in a group of high-risk determining the relationship between the case history factors and audio logical establishing the true-positive (TP) and true-negative (TN) results with different combinations of screening measures; establishing the percentage of TP and NT screening results in the total sample; and exploring the factors associated with follow-up return rate for hearing screening and diagnostic audio logical assessment.
GR2017

Please read the abstract in the section 00front of this document
Dissertation (MA (Communication Pathology))--University of Pretoria, 2006.
Speech-Language Pathology and Audiology
unrestricted

In the evaluation of special populations, such as neonates, infants and malingerers, audiologists have to rely heavily on objective measurements to assess hearing ability. Current objective audiological procedures such as tympanometry, the acoustic reflex, auditory brainstem response and transient evoked otoacoustic emissions, however, have certain limitations, contributing to the need of an objective, non-invasive, rapid, economic test of hearing that evaluate hearing ability in a wide range of frequencies. The purpose of this study was to investigate distortion product otoacoustic emissions (DPOAEs) as an objective test of hearing. The main aim was to improve prediction of pure tone thresholds at 500 Hz, 1000 Hz, 2000 Hz and 4000 Hz with DPOAEs and artificial neural networks (ANNs) in normal and hearing-impaired ears. Other studies that attempted to predict hearing ability with DPOAEs and conventional statistical methods were only able to distinguish between normal and impaired hearing. Back propagation neural networks were trained with the pattern of all present and absent DPOAE responses of 11 DPOAE frequencies of eight DP Grams and pure tone thresholds at 500 Hz, 1000 Hz, 2000 Hz and 4000 Hz. The neural network used the learned correlation between these two data sets to predict hearing ability at 500 Hz, 1000 Hz, 2000 Hz and 4000 Hz. Hearing ability was not predicted as a decibel value, but into one of several categories spanning 1 OdB. Results for prediction accuracy of normal hearing improved from 92% to 94% at 500 Hz, 87% to 88% at 1000 Hz, 84% to 88% at 2000 Hz and 91% to 93% at 4000 Hz from the De Waal (1998) study to the present study. The improvement of prediction of normal hearing can be attributed to extensive experimentation with neural network topology and manipulation of input data to present information to the network optimally. The prediction of hearing-impaired categories was less satisfactory, due to insufficient data for the ANNs to train on. A prediction versus ear count correlation strongly suggested that the inaccurate predictions of hearing-impaired categories is not a result of an inability of DPOAEs to predict pure tone thresholds in hearing impaired ears, but a result of insufficient data for the neural network to train on. This research concluded that DPOAEs and ANNs can be used to accurately predict hearing ability within 10dB in normal and hearing-impaired ears from 500 Hz to 4000 Hz for hearing losses of up to 65dB HL.
Thesis (DPhil (Communication Pathology))--University of Pretoria, 2007.
Speech-Language Pathology and Audiology
unrestricted

Lee Yuet-sheung.
"May 2003."
Thesis (Ph.D.)--Chinese University of Hong Kong, 2003.
Includes bibliographical references (p. 352-361).
Electronic reproduction. Hong Kong : Chinese University of Hong Kong, [2012] System requirements: Adobe Acrobat Reader. Available via World Wide Web.
Mode of access: World Wide Web.
Abstracts in English and Chinese.

There has always been a need for objective tests that assess auditory function in infants, young children, and/or any patient whose development level precludes the use of behavioral audiometric techniques. Although the Auditory Brainstem Response (ABR) is seen as the ‘gold standard’ in the field of objective audiometry, it presents with its own set of limitations. The Auditory Steady State Response (ASSR) has gained considerable attention and is seen as a promising addition to the AEP ‘family’ to address some of the limitations of the ABR. The ASSR promises to estimate all categories of hearing loss (mild to profound) in a frequency specific manner. It also indicates to the possibility to validate hearing aid fittings by determining functional gain of hearing aids by determining unaided and aided ASSR thresholds. An exploratory research design was selected in order to compare unaided thresholds, obtained through the use of three different procedures – ABR, ASSR and behavioral thresholds. Aided thresholds were also obtained and compared with two procedures – the aided ASSR (measured and predicted) and aided behavioral threshold. The results indicated that both the ABR (tone burst and click) and ASSR provided a reasonable estimation of the subsequently obtained behavioral audiograms. The ASSR, however, approximated the behavioral thresholds closer than the ABR and were furthermore able to quantify hearing thresholds accurately for subjects with severe and profound hearing losses. The result indicated further that the ASSR can be instrumental in the validation process of hearing aid fittings in infants. These results demonstrated however, that the ASSR measured thresholds underestimate the aided behavioral thresholds and the aided ASSR predicted thresholds overestimate the aided behavioral thresholds. The research concluded that the ASSR is useful in estimating frequency-specific behavioral thresholds accurately in infants and validating hearing aid fittings. Until evidence is sufficient to recommend the ASSR as primary electrophysiological measure of hearing in infants, the ASSR should be used in conjunction with the ABR – following a test battery approach in the diagnostic process of hearing loss in infants. The ASSR further shows great promise in validating hearing aid fittings, but this specific application of the ASSR needs further research evidence on large groups to validate the procedure.
Dissertation (Master of Communication Pathology)--University of Pretoria, 2007.
Speech-Language Pathology and Audiology
unrestricted