POSTER ABSTRACTS

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CONTENTS

1. WELCOME LETTER ................................................................................ 3

2. PRESIDENT’ S MESSAGE - BRAZILIAN ACADEMY OF AUDIOLOGY ................ 5

3. ICA EIA 2010 ORGANIZING COMMITTEE .................................................. 7

4. ISA - INTERNATIONAL SOCIETY OF AUDIOLOGY ...................................... 8

5. ABOUT THE CONGRESS ........................................................................ 8

6. ABA – BRAZILIAN ACADEMY OF AUDIOLOGY ............................................ 9

7. SOCIAL PROGRAMME .......................................................................... 10

8. GENERAL INFORMATION...................................................................... 11

9. CONVENTION CENTER FLOOR PLAN ...................................................... 12

10. PROGRAMME FRAMEWORK ................................................................. 13

11. DETAILED PROGRAMME ..................................................................... 14

12. PRE CONGRESS ABSTRACTS .............................................................. 17

13. KEYNOTE SPEAKERS AND ROUND TABLES ............................................ 19

14. GRAND ROUND ................................................................................ 25

15. CONFERENCES ................................................................................. 30

16. SHORT COURSE ............................................................................... 31

17. FREE PRESENTATION ABSTRACTS ....................................................... 33

18. POSTER AWARD NOMINEES ............................................................... 63

19. POSTER SESSION ABSTRACTS ............................................................ 71

20. ExHIBITORS LIST ............................................................................141

21. AUTHOR INDEx ...............................................................................143

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1. WELCOME LETTER

Dear Colleagues,

OnbehalfoftheOrganizingandScientificCommittee,IampleasedtowelcometotheXXX International Congress of Audiology (ICA)jointmeetingwiththeXXVInternationalMeetingofAudiology(EIA),organizedbythe International Society of Audiology (ISA) and the Brazilian Academy of Audiology (ABA).

DuringtheCongress,thelatestadvancesinresearchandclinicalapplicationintheaudiologicalfieldwillbereviewed.Greatcarewastakentoelaborateaprogramwithaselectionofhighstandardoralandposterpresentations.

TheXXXInternationalCongressofAudiologywillexplorethethemesofHearing Health Care and Latest Technologies, Globalization of Standards and Education in Audiology and Hearing Loss Prevention, through researchpresentations, invited lectures, interactiveworkshops, clinicalroundsandpaneldiscussionsledbypre-eminentspeakers.

Since1960,BrazilhasstartedthefirsttrainingprogramincommunicationdisordersattheUniversityof São Paulo, but only ten years later, the first graduate course in Audiologywas launched. Theavailabilityofgraduatetrainingnotonlyraisedthestandardofprofessionalcare,butalsoexpandedjob opportunities and the scope of practice for audiologists. The progress achieved places Brazilina leadershipposition inLatinAmericaandotherPortuguesespeakingcountrieswith regards toprevention,diagnosis,treatment,andrehabilitationofhearingloss.

The ICA2010will be an excellent opportunity for you to update your knowledge and share yourfindings.

The scientific program is combinedwith an exciting social event.Among thedifferent activitiesa concert, a sightseeing excursion and a carnival gala dinnerareplanned.

Finally,Iwouldliketoleaveapieceofadvice:workhard,divulgethelatestadvancesinresearchandclinicalapplicationintheaudiologicalfield,buttakeyourtimetoenjoySãoPaulocity,thelargestmetropolisinSouthAmericaandsharetheBrazilianhospitality,tasteournationaldrink“caipirinha”,ourfamousblackbeans“feijoada”,tryoursamba music,wellknownallovertheworldandfeelfreetocomebackwheneveryoufeellike.

Iêda Chaves Pacheco Russo, Ph.D.

ISA President .

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2. PRESIDENT’ S MESSAGE - BRAZILIAN ACADEMY OF AUDIOLOGY

OEncontroInternacionaldeAudiologia(EIA)éumaconquistadosprofissionaisbrasileirosnestaárea.

Criado em 1985, para arrecadar fundos para acampanha do SOS pela reconstrução do TeatroUniversitário (TUCA) da Pontifícia UniversidadeCatólica de São Paulo, que teve fundamentalimportância na luta dos direitos humanos edemocráticosaolongodahistóriadoBrasil.

A partir daí a evolução foi constante. No anopassado conseguimos fazer no24°EIAdeBauruapesquisacomosparticipantesquenosauxiliouaconhecê-loseapontounovosdesafiostaiscomo:anecessidadededescentralizaçãodasaçõesdaABA;aparticipaçãodaABAnascapacitaçõesprofissionaisemdiferentesregiõesdopaísetambémutilizandoplataformasonline;atuaçãodaABAnaformulaçãoderegulamentações;comitês;gruposdetrabalhoerepresentações regionais visando, principalmente,segundo os participantes que a ABA promova oavanço do ensino e da pesquisa em Audiologia:procurandoservirnaorientaçãodesuaconsolidaçãoe aperfeiçoamento, promovendo o intercâmbiode estudos científicos na área da Audiologia eelaborando recomendações e pareceres no quese refereaatuaçãoprofissionalemaudiologianoBrasil.

E assim tem sido oEIA, hoje o evento oficial daAcademiaBrasileiradeAudiologia,quetemauxiliadonaconsolidaçãodaspesquisasnaárea,umavezqueofereceaospesquisadoresosresultadospréviosdeseustrabalhosantesdesuaspublicações.Tambémvem cumprindo com a tarefa de formação derecursoshumanos,quandoofereceespaçoparaosnovostalentosdaáreaapresentaremsuaspesquisaseexperiênciasclinicas.

Neste EIA em especial estamos recebendo osparticipantes internacionais da International Society of Audiology organizando conjuntamente o Congresso Mundial desta associação que é o International Congress of Audiology (ICA). Estaconquistapermeouanosdepreparoefoiumtrabalhocontinuo das últimas diretorias da ABA. Coube aatualdiretoriadaABAaoperacionalizaçãodoeventoe a responsabilidade civil. É com tranqüilidadee orgulho que podemos dizer, cumprimos ocombinado,estamoshonrandoonomedaABAcomaadesãode todososnossosassociadoseoutrosmembros da comunidade cientifica brasileira.Comonúmerodebrasileiros inscritosnoevento,atéomomento,maisde700participantes,e405trabalhosnacionais inscritos,temosoorgulhodedizerqueoBrasilestámostrandoasuaAudiologiaebuscandoainternacionalizaçãodoconhecimentocomaparceriacomaISA,aspectotãoimportantenomundoglobalizadodehoje.

Éimportantecitarqueestaéa25ªediçãodoEIAeestamoscomemorandonossas“bodasdeprata”.Istodemonstraoresultadodeumdesafioqueseapresentouem1985ehojerepresentaumevento

The International Meeting of Audiology (EIA) isanachievementofBrazilianprofessionalsinthisarea.

Created in 1985 to raise funds for the SOScampaignforthereconstructionofUniversityTheater (TUCA) of Catholic Universityof Sao Paulo, which had fundamentalimportanceinthefightforhumanrightsanddemocracy throughout thehistoryofBrazil . Sincethenthetrendhasbeenconstant.Lastyearwewereabletoconductaresearchatthe24thEIAinBauru/SP/Brazilwithparticipantswhohelpedustoknowandpointedoutnewchallengessuchastheneedfordecentralizationof the ABA and using online platforms.They agree with the ABA goals and actionsaiming the formulationof rules,committees,working groups and regional offices for theadvancement of teaching and research inAudiology, the way for its consolidation andimprovement.

AndsoithasbeentheEIA,todaytheofficialcongressoftheBrazilianAcademyofAudiology,whichhashelpedtoconsolidatetheresearchintheareasincetheresearcherscandiscussthepreviousresultsoftheirworkbeforetheywere published. It also comes with fulfillingthetaskoftraininghumanresources,itoffersspace for new talent in the area to presenttheirresearchandclinicalexperience.

In this EIA, we are receiving internationalparticipants from the International Congressof Audiology (ICA), which was a joint effortof the International Society of Audiology (ISA).Thisachievementpermeatedyearsofpreparationandwasacontinuousworkofthelastdirectorsof theABA. It fellon theABAboardtobringthiseventtoreality.Itiswitheaseandpridewecansay,thetaskhasbeenmet, we are honoring the name of the ABAwiththesupportofallourmembersandothermembersoftheBrazilianscientificcommunity.WiththenumberofBraziliansenteredintheeventsofar,around800participantsand405national papers, we are proud to say thatBrazil is showing its Audiology and seekingthe internationalization of knowledge inpartnershipwithISA,whichissoimportantintoday’sglobalizedworld.

Itisimportanttomentionthatthisisthe25theditionoftheEIAandwearecelebratingour“silveranniversary”.Thisshowstheresultofachallengethatpresenteditselfin1985andtodayrepresentsaconsolidatedevent.Andaswe celebrate, we can not forget the peoplewho were instrumental in this achievement.The proposal came fromDr. Robert Keith oftheUSA,PauloPizarrofromPortugalandourinspiring José Barajas Pratt that encouragedusand inspiredustoassumethischallenge.

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2. PRESIDENT’ S MESSAGE - BRAZILIAN ACADEMY OF AUDIOLOGY

consolidado. E, ao comemoramos, não podemosesqueceraspessoasqueforamfundamentaisparaestaconquista.ApropostasurgiudoDr.RobertKeithdosUSA,PauloPizarrodePortugaleonossoinspiradorDr. JoséBarajasdePratquenos incentivouenosanimouemassumirmosessedesafio.PublicamenteagradecemosavocêJosé.NosprimeiroscincoanosveioaparticipaçãodaProfa.Dra.LuizaFickerqueexerceu a função de secretária geral e a equipede docentes da área da Audiologia da PontifíciaUniversidadeCatólicadeSãoPaulo.DepoisveioaeradeBaurucomaProfa.Dra.AdrianeMortariMoretti,Profa.Dra.KatiaAlvarengaeaDra.ReginaBorlettoAmantini, além dos docentes do Departamentode Fonoaudiologia e profissionais do Centro dePesquisas Audiológicas doHospital deReabilitaçãodeAnomaliasCraniofaciaisdaUniversidadedeSãoPaulo,CampusBauru.DaíoEIAcomeçouaviajarparaoutrasregiõesdopaíscomoapoioincondicionaldoDr.ArnaldoMárcioCostanoRiodeJaneiroeDra.SôniaBortoluzzinoRioGrandedoSuljuntocomocorpodocenteediscentedaUniversidadeFederaldeSantaMaria,dandoaconotaçãoqueoEIApertenciaao Brasil e não apenas a um grupo universitário.Assim,surgiuanecessidadedafundaçãodaABAeoEIAcomoseueventoanual.

ParabénsAudiologiaBrasileira.

Obrigada Internacional Society of Audiologypelooreconhecimentodanossacompetência.

Obrigadaparticipantesnacionaiseinternacionaispelapresença.Vocêssãoaspessoasque enriquecemestaárea.

SejambemvindosaSãoPauloeumótimoICA/EIA.

Profa. Dra. Maria Cecilia Bevilacqua PresidentedaAcademiaBrasileiradeAudiologia Presidentedo25ºEIA

Publicly,thankyoutoJose.

During the first five years the EIA hadthe participation of Dr Luiza Ficker whoservedassecretarygeneralwiththestaffof Audiology department of the CatholicUniversity of São Paulo. Then came theBauruErawithDr.AdrianeMortariMoretti,Dr.KatiaAlvarengaandDr.ReginaBorletoAmantine in addition to the DepartmentofSpeechPathologyandAudiologyoftheUniversityofSaoPaulo,BauruCampus.

EIAbegantotraveltootherpartsofthecountry with the backing of Dr. ArnaldoMarcio Costa in Rio de Janeiro and Dr.SoniaBortoluzziinRioGrandedoSulwiththesupportoftheUniversidadeFederaldeSantaMaria,giving theconnotation thatthe EIA belonged to Brazil and not justauniversitygroup.Thus,thefoundingoftheABAandtheEIAasitsannualeventwasthenaturalresultofallthoseyears.

CongratulationsBrazilianAudiology.

We are grateful to the International Society of Audiology by the recognition of ABA.

Weare grateful to the participants fornational and international presence. Youarethepeoplewhoenrichthisarea.

Welcome to Sao Paulo and a greatICA/EIA 2010.

Prof. Dr. Maria Cecilia Bevilacqua

PresidentoftheBrazilianAcademyofAudiology Presidentofthe25thEIA

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3. ICA EIA 2010 ORGANIZING COMMITTEE

Executive Committee Chairman:IêdaChavesPachecoRusso Treasurer:KátiadeAlmeida Secretary:MariaAngelinaNardideSouzaMartinez MariaCeciliaBevilacqua-PresidentABA AnaCláudiaFiorini-FormerPresidentABA ElianeSchochat-FormerPresidentABA AltairCadrobbiPupo-TreasurerABA RenataMottaMamedeCarvallo-ScientificCommittee

ABA Board -MariaCecíliaBevilacqua - Maria Angelina Nardi de Souza Martinez - Sheila Andreoli Balen -AltairCadrobbiPupo -SilvanaMariaMonteCoelhoFrota -AnaClaudiaMirândolaBarbosaReis Scientific Committee -AdrianeLimaMortariMoret -AldaCristinadeCarvalhoBorges -AltairCadrobbiPupo -AnaCláudiaFiorini -AnaCláudiaMirândolaBarbosaReis -BeatrizCavalcantideAlbuquerqueCaiubyNovaes -CarlaMarcondesCésarAffonsoPadovani -DináOlivettideCarvalhoHubig -DórisRuthyLewis - Eliane Schochat -IêdaChavesPachecoRusso -KátiadeAlmeida -KátiadeFreitasAlvarenga -LilianCássiaBórniaJacob -LilianeDesgualdoPereira - Maria Angelina Nardi de Souza Martinez -MariaCecíliaBevilacqua -MariaCecíliaMartinelliIório -RenataMottaMamedeCarvalho - Sheila Andreoli Balen -SilvanaMariaMonteCoelhoFrota -AlessandraGiannellaSamelli -AlessandraSpadaDurante -CarlaGentileMatas - Daniela Gil -MariaFranciscaColelladosSantos

Congress Secretariat R.HamamEventos RuaTácitodeAlmeida,148–Perdizes 01251-010 – São Paulo – SP Tel.:(11)3676-0688/Fax:(11)3676-0689 ica2010@audiologiabrasil.org.br www.rhamam.com.br

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4. ISA - INTERNATIONAL SOCIETY OF AUDIOLOGY

Board IedaPachecoRusso–president JoseJuanBarajasdePrat–president-elect WilliamNoble–lastpresident GeorgeMencher–secretary-general GeorgeA.Tavartkiladze–assistantsecretarygeneral

Members of large:

Kajsa-MiaHolgers–representingaffiliatedSocieties RobertCowan–representinggeneralassembly

Editors

RossRoeser-InternationalJournalofAudiology DennisL.Burrows-AUDINEWS ViktorKoci-Website

5 . ABOUT THE CONGRESS

TheInternationalCongressofAudiology(ICA)isabiennialcongressheldindifferentpartsoftheworldtodiscussimportantissuesregardingaudiology.

ThisyearthemeetingwillbeheldfromMarch28thtoApril1st2010andwilltakeplaceinthecityofSãoPaulo–Brazil,thelargestmetropolisinSouthAmerica,concurrentlywiththeannualBraziliancongress:XXVth EIA – International Meeting of Audiology

TheICA2010isjointlyorganizedbythe International Society of Audiology (ISA) andthe Brazilian Academy ofAudiology (ABA).

Thehistoryoftheeventlasteditionsshowstheimportanceofthemeetings:

»ICA2000–XXVInternationalCongressofAudiology–Hague(NED)»ICA2002–XXVIInternationalCongressofAudiology-Melbourne(AUS)»ICA2004–XXVIIInternationalCongressofAudiology-Phoenix(USA)»ICA2006–XXVIIIInternationalCongressofAudiology-Innsbruck(AUT)»ICA2008–XXIXInternationalCongressofAudiology-HongKong(CHN)Since 2002 the Brazilian Academy of Audiology (ABA) has been responsible to organize. The International Meeting of Audiology ,anannualeventdedicatedtoprofessionals intheareaofAudiology that has started back in 1985. It is themost important scientific event of the area ofAudiology in Brazil.

Last editions:

»24ºEIA-Bauru/SP2009»23ºEIA-Itajaí/SC2008»22ºEIA-Natal/RN2007»21ºEIA-Bauru/SP2006

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6. ABA – BRAZILIAN ACADEMY OF AUDIOLOGY

FoundedinMayof2001,theBrazilianAcademyofAudiology(ABA),aimsatdevelopingaudiologyasasciencewithinthecountryandabroad,througheducationandculture,accordingtotheprinciplesofdemocraticparticipation,freedomandsocialjustice.

ABAisanon-profitcivilsociety,whichcongregatesprofessionals,graduateandundergraduatestudents,andresearcherswithintheaudiologyfield,withcourtinSãoPaulo,SP,forlegalpurposes.

MISSION: “Tocongregatethescientificcommunity,committedtocollectivecompetenceasaguaranteeofinteraction,formation,researchandpublicpolicies,aimingatstrengtheninganddemocratizingthefieldofaudiology”.

GOALS:

I–Topromotetheadvancementofteachingandresearchonaudiology,toservetheguidanceofitsconsolidationandimprovement,aswellastostimulatenewexperiences;

II – To guarantee the exchange and cooperation among institutions, professionals, students andresearchersonaudiology;

III–Tocreatemeansforthediffusionandinterchangeofscientificstudiesinthefieldofaudiology,broadeningthepublicationsinthearea;

IV–Tofightforgreaterparticipationofacademicandscientificcommunitiesintheformulationanddevelopmentofaudiologyinthecountry;

V – To contribute to the professional qualification and improvement of the working conditions ofaudiologyprofessionalsacrossthecountry,particularlyatthegraduatelevel;

VI–Topromotetheinterchangeandcooperationamongassociationsandcongenerentities;

VII–Toperformaptactivitiestokeepitsscientific,technicalandsocialrepresentationgoalsfortheprofessionalcategory,suchaspublications,congresses,seminarsandmeetings;

VIII–Tostimulatethescientificimprovementofthefaculty,researchersandaudiologyprofessionals,(assumindoqueelequisdizer“devidoaoseupapelcomoqualificadoresdeprofissionais)duetotheirinvolvementintheformationandtrainingofprofessionalsinthefield.

IX–Toelaboraterecommendationsandopinions,asfarastheprofessionalperformanceinaudiologyisconcerned

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7. SOCIAL PROGRAMME

28th March 2010 Opening Ceremony 6.00pm–7.00pm

Auditorium Cocktail

7.00pm–9.00pm ExpositionArea

Price:freeofcharge

29th March 2010 Concert 7.30pm Auditorium

Price:freeofcharge

30th March 2010 Sightseeing tour 2.00pm–8:00pm

Price:freeofcharge.Bookthisexcursionatthe registrationdeskonMonday

31st April 2010 Gala Dinner & Carnival Night

7.30pm–11:00pm Price:US$75.Bookthisactivityattheregistrationdesk

1st April 2010 Closing Ceremony 12.45pm–1.30pm Price:freeofcharge

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8. GENERAL INFORMATION

CONGRESS LOCATIONShoppingMall&ConventionCenterFreiCaneca

RuaFreiCaneca,569,5thfloorConsolaçãoSãoPauloSP

CEP 01307-001Tel.:+55(11)34722000/+55(11)34722000

Latitude:23º33’13’’SLongitude:046º39’09’’W

CONGRESS SECRETARIAT

FreiCanecaConventionCenter- 5th Floor

BADGES

Eachparticipantwillreceiveanamebadgeuponregistration.Forsecurityreasonsallparticipantsarerequestedtoweartheirbadgeduringthe

congressactivitiesandsocialevents.

OFFICIAL LANGUAGE

TheofficiallanguageofthecongressisEnglish.

ThesimultaneoustranslationtoPortuguesewillbeavailable.

Thepre-congresswillbejustinPortuguese.

CERTIFICATE OF ATTENDANCE

Allparticipantswillreceiveacertificateofattendanceattheregistration.

SMOKING POLICY

TheFreiCanecaConventionCenterisanon-smokingfacility.

PEOPLE WITH SPECIAL NEEDS

Everyefforthasbeenmadetoensurethatpeoplewithspecialneedshavebeencateredfor.Ifyourequireanyspecificassistance

pleasecontacttheregistrationdesktoenableustomakeyourstayinSãoPauloapleasant

andcomfortableexperience.

TIME DIFFERENCE

GMT – 3

CLIMATE

InMarchthetemperatureinSaoPaulorangeisusuallybetween17oC (60oF) and 30oC (80oF). It’smainlysunnybutafewthunderstormsis

possible.

CURRENCY

Real(R$)istheofficialcurrencyinBrazilwhichispeggedtotheUSdollarat 0,57

BANKS

AutomaticBanksareavailableattheShoppingMall area.

EMERGENCY

PleasecontacttheCongressSecretariatincaseofemergency.Foremergencyoraccident,

pleasecall190.

WiFi ZONE

It´snotfreebutit´savaiabletobuyattheCongressVenue.

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9. CONVENTION CENTER FLOOR PLAN

5th Floor - morning

5th Floor - afternoon

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10. PROGRAMME FRAMEWORK

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11. DETAILED PROGRAMME

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11. DETAILED PROGRAMME

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12. PRE CONGRESS ABSTRACTS**Durimg the pre congress all lectures will be only in Portuguese

Forum: Public Policies 28th, March – Room A - 15:00 to 16:30pm Coordinator: Maria Cecília Bevilacqua Érica Pizaneshi, Carla Daher, Andréia Ribeiro

HEARING HEALTH PUBLIC POLICIES

Bevilacqua MCFull Professor of the Speech Pathology and Audiology Department / FOB/University of São Paulo USP-Campus Bauru, Audiological Research Center /HRAC/USP-Bauru SP - Brazil

WiththepublicationofDecrees2.073/GM,SAS587and589,theassistancetothehearingimpaired,inBrazil,hascometoanewreality,withtheestablishmentofaNationalHearingHealthPolicy.

ThequalitativeleapaccomplishedwiththeDecreesof2004wastheguaranteedassistancenetworktothehearing impaired,atthenational level.Recentdiscussionswithgroupsofprofessionalsandentitiesinvolved,asinForumsofPublicPolicies,heldattheInternationalAudiologyMeetingof2009and, Scientific Seminar of Public Policies, and Hearing Health Services and Systems, held by theSpeechPathologyDepartmentandAudiology/FOB/USP/Bauru,areleadingtheprofessionalsintheareatoareflectiontowardstheidentificationofnewneedsandthesearchofsolutions,soastosettlethisNationalHearingHealthPolicy.

In2009,duringourForumofPublicPolicies,heldattheInternationalAudiologyMeeting,thediscussedandapprovedactions,were:

1-RequestofatechnicalchamberwiththeHealthMinistrytoanalyzetheproposaloftechnologicalupdatingfortypesofHAsA,BandC;

2 - Implementation of basic hearing health actions by high complexity services, emphasizing thetrainingofhealthagents,andfamilyhealthstrategies,aswellas identifyinganddivulgingthehearingrisks;

3 - Actions regarding auditory rehabitation: to operate the concept of follow-up and auditoryrehabitation;expandthespeechtherapyassistancenetwork,qualifyingprofessionalsforsuch,indirection003;requestaworthyvalueforspeechtherapy.

4-Astudyonthenumberofservicesandplacesnecessarytoexpandthecochlearimplantservices.

5-Useoflifequalityindicatorsforimpactassessment

6-Testwith3modelsofHAstobereplacedbysuitableprescriptivemethodsandbyobjectiveelectro-acousticmeasurements:

7-RequestameetingofHealthMinisterywithsupervisorstodeterminetheguidelinesandorganizethenetwork;

8-PublicconsultationbyABAonbasicpriorityactionstobepresentedtothesupervisors.

In2010,duringthe30thInternationalCongressofAudiology/25thInternationalAudiologyMeeting,tobeheldinthecityofSãoPaulo,anewdiscussionwillbeproposedonPublicPoliciesintheareaofthehearingimpaired,withotherneedstobediscussed,aimingatthemaximumqualityassistancetothispopulation.

DuringthisForum,theassessmentofFederalPolicies,proposedinthearea,willbeapproached,notonlyemphasizingthehealtharea,butalsowillanalyzewhat is proposedtothehearing impairedin termsofeducation,owing to theneedof interactionbetweenthe twosectors.Advances in thediscussions, such as the provision of FM systems to the hearing impaired population inserted inschools,willbeaddressedanddiscussedbytheprofessionals.

Otherissuesrelatedtothesematterswillbediscussedaswell.

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12. PRE CONGRESS ABSTRACTS

Forum: Hearing Aids 28th , March – Room B - 10:30 to 12:00am Coordinators: Maria Cecília Bevilacqua, Thelma Costa, Sonia Bortoluzzi Deborah Ferrari, Isabela

HEARINGAID,COCHLEARIMPLANTANDSEMI-IMPLANTABLEDEVICES

Bevilacqua; M.C1.;Costa; T.R.S.2; Bortholuzzi; S.M.F.31 Universidade de São Paulo – Campus USP Bauru2 Pontifica Universidade Católica de São Paulo3 Universidade Federal de Santa Maria - RS

TheHearingAidforum,nowtermedHA,CochlearImplant,Semi-implantableDevicesandAcousticSystem/accessibility Forum”, aims, mainly, at discussing, elaborating and establishing norms tostandardizeproceduresintheseareas,asaclinicalroutineofthecountry.TheseForumsareattendedbyspecialistsinthefield,forwidediscussions,elaborationandconclusionoftheseresolutions,whichasnorm,arekeptinthesiteoftheBrazilianAudiologyAcademy(ABA)forpublicconsultationandsuggestions.

TheexpansionofHealthCarePrograms,morespecificallytheactionswhichtheHearingHealthDecreeproposesforroutineassistancetothehearingimpairedpopulation,aswellasthesearchforoptimalquality in theproceduresandtheir results,hasguidedthediscussionsof the last forumstootherthemesofthearea,forthecompilationofprotocolswhichdetermineprocedurestobeutilizedinthefittingofHAsinchildrenandadults.

Takingintoaccountthespecificitiesthatinvolvetheassistancetothepediatricpopulation,thisforumwillapproach,too,proceduresusedwithchildrenpresentedwithminimumhearingloss,solutionsforchildreninthewaitinglist,whoneedasurgicaltreatment,aswellasnewprocedureswhichmustbeincludedinthehearingprogramstobeprovidedbytheGovernment´sHearingHealthprograms,suchas:FM,andotherhearingauxiliarysystems.Alongwiththeelaborationofproceduralnorms,oneofthethemesbroadlydiscussedinrecentforums,tobeaddressed,isthequalityoftheprofessionalsworkinginthisfield,mainly,inthefittingofHAsinchildrenandadults.Theestablishmentofpermanentprofessionaleducationstrategies,aswellasthesolidparticipationofcouncils,theMinistryofHealthintheregulationoftheworkandprofessionalqualification,willbeoneofthegoalsofthisForum.ItwillbeopentootherissuesconcerningHAsandotherselectronicdevicesinthisarea.

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13. KEYNOTE SPEAKERS AND ROUND TABLES

29th March (Monday) - AUDITORIUM - 8:30 - 9:30am Keynote topic: Hearing Health Care and latest technologies Keynote speaker: Maria Cecília Bevilacqua

Resumed CV:

MARIA CECÍLIA BEVILACQUA. Ph.D.

B.A., Speech Pathology and Audiology, 1970; B.A., Psychology, 1977; M.A., Audiology, 1978; Ph.D., in Educational Psychology, 1985; Full Professor, Audiology, 1990 at Pontificia Universidade Católica de São Paulo/Brazil and in 2005 at Department of Audiology and Speech Pathology (FOB) at University of São Paulo, Campus Bauru/BrazilOTHER BIOGRAPHICAL INFORMATION1. Elected President of Brazilian Academy of Audiology from 2009 to 2011;2. Consultant to the National Council for Scientific and Technological Development (CNPq); Coordination for

Refinement of Graduated Students (CAPES) and Foundation for Research Support in the State of São Paulo (FAPESP);

3. A member of WWHearing since the foundation in 2003;4. A nominated member of the Technical Chamber in Hearing Health with the Health Ministry since June 2005;5. Nominated Chairman of the Audiology and Speech Pathology Department at the University of São Paulo, on

April 7th, 2005;6. General Coordinator for the International Audiology Meeting since 1985;7. A founding member of the Brazilian Academy of Audiology, November, 20018. A member of the Commission of Specialists in Audiology and Speech Pathology with MEC, Ministerial Decree

# 972, of 08/11/1997; 9. Publish scientific papers, book chapters and books regularly.

Abstract:

Sincetheendofthelastdecade,theconcerninrelationtohearingaspectsoftheworldpopulationhas grown, worldwide, owing to the increase in the estimates of hearing loss prevalence, in thelastyears.Theimpactofthisincreaseontheeconomyofthecountryishigh,becauseofthehugeexpendituretotreatthehearingimpairedpopulation.Inthisverysameperiod,withtheadventofnewtechnologiessuchasdigitalhearingaids,cochlearimplants,semi-implantableelectronicdevices,andmoreadvancedassistivetechnologiessuchastheFMsystem,were introduced inthemarket,increasing the treatmentcosts.Consequently,anotherconcernhasemerged:createqualitypublicserviceswitharationaluseofpublicresourcesandminimizetheeconomicimpactontheservicesofcomplementaryhealth.Agrowingworldmovementtoassesshealthactionshasbeenseenamongtheinitiativestoplanandmanagethepracticesofthissector,soastoproviderelevantinformationforthedecisionmakingandservicequalityimprovementprocess.Thisassessmentaimsatreorganizingtheperformanceofactionsandservices,expandingthemsoastoencompasstheneedsoftheirpublic,rationalizingtheuseoffinancialresources.InBrazil,theAttentionPolicytotheHearingImpairedwasinstitutedbytheHealthMinistry,in2004,settlingtheassistanceinrelationtotheprovisionofHAs.Sinceuponthecreationact,noinstrumentwasavailabletoguidethesupervisorsintheassessmentoftheseservices,renderingdifficultitsconsolidation.Asforcochlearimplants(CI),throughthePublicHealthSystem(SUS),thewholeprocessfortheCIsurgeryhasbeenfreeofcharge,since1993(HM,Decree#126,1993).Onlyin1996and1999,twodecrees(#211,1996and#1.278/GM,1999)regulated thisprocedure,establishingnorms fora cadastreofCenters/Nuclei toperformCochlearImplantsandthecriteriafortheirindicationandcontraindication.Theactionstoassessthequalityoftheseservicesarenotmuchdiscussedinthisarea,thusadeeperstudyofthisissueisnecessary,giventhehighcostofthisdevice.AnotherissuecurrentlydiscussedinthecountryistheregulationtodispensetheModulatedFrequencySystem(FM).Aspectssuchaswhowouldbeinchargetoelaboratepoliciesfortheprovisionoftheseequipmentsandtoallotresourcestobuythem:HealthMinistryorEducationMinistry,havebeendiscussed,butlittleprogresshasbeenmade.Meanwhile,thepopulationinneedofthesedevicestoimprovetheirschoolachievementistheonemostaffected.

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Round Table Discussion: Hearing Health Care and latest technologiesCoordinator: ANDREW SMITH David McPherson, Bradley McPherson, DeWet Swanepoel, Maria Cecília Bevilacqua

DavidL.McPhersonBrighamYoungUniversity,UtahUSA

Abstract:

Duringthepastdecadetherehavebeenrenewedeffortsandinterestsinthedeliveryofhearinghealthcare throughout theworld. The challenge facing audiology can be approached fromboth a risk/benefitandcost/benefitstandpoint.Thatis,societieswhereaudiologyiswellestablishedandgivengovernmental priorities face rising health care cost issues with advancing technologies; whereas,developing societies and societies where government priorities are not consistent with the risingawarenessofhearinghealthcare issueshavedifficulty implementinghigh-end technologies. Thisdichotomousglobalinequitybringsadimensiontohearinghealthcarethatshouldprovokethoseofusdevotedtothehearingprofessionstodevelopandbringinnovativeandhightechnologicalsolutionstotheglobalcommunityatcoststhatbenefitthecommunityandnottheindustryperse.

Therearesixareasthatneedtobeconsideredaswedeliverhealthcareandtechnologytotheglobalcommunity: Training, community education, identification, diagnosis, intervention, and long-termcare.Therearebothlowandhightechnologicalsolutionsforeachoftheseareasand,withinsocieties,theapplicationoftechnologydoesnot,andgenerallyisnot,uniformacrossthesixareas.ThisKeynoteAddresswilldiscusstheoptionsineachoftheseareasdiscussingimplementationandoutcomeswhichincludecurrenthearinghealthcaremodelsandtheuseoftechnologyacrossthespectrumtoachievespecificgoalsineachoftheareas.

BradleyMcPhersonPhD Head,DivisionofSpeechandHearingSciences,UniversityofHongKong

Abstract:

TheWorld Health Organization (WHO) has commenced a campaign to providemore people withhearinglossindevelopingcountrieswithaccesstoaffordable,appropriatehearingaidsandhearingaidfittingservices.TheWHOhasconsistentlypointedoutthatonlyaverysmallminorityofthoseinneedofamplificationdevicesindevelopingcountriesarefittedwithanytypeofhearingaid.Thispresentationgivesanoverviewofemerginghearinghealthcaretechnologyandsystemsthatmay,inthefuture,betterservetheneedsofindividualswithhearingimpairmentindevelopingcountries.Themajorimplicationsofsuchnewtechnologyandsystemsfortheorganisationsthatsupportthemajorityoftheworld’speoplewithhearinghandicap–thosewholiveindevelopingcountries-areoutlined.

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30th March (Monday) - AUDITORIUM - 8:30 – 9:30am Keynote topic: Globalization of Standards and Education in Audiology Keynote speaker: John Durrant

Resumed CV:

JohnD.Durrant,Ph.D.

BornintheUS,Prof.DurrantisB.F.A.inSpeechandHearingTherapy,MasterinAudiologyandSpeechScienceattheOhioStateUniversity;Ph.DinAudiologyandPhysiologicalAcousticsattheNorthwesternUniversity.Hehas been teaching in thefields of communication disorders,otolaryngologyandhearingscience,workingatdifferentAmericanUniversitiesastheSchoolofMedicine-TempleUniversity,OhioStateUniversityandUniversityofPittsburgh.

HehasalsobeenaVisitingResearcherandInvitedProfessoratClaudeBernardUniversitéinLyon,France. He has published many papers in several international magazines and he is member ofprestigiousscientificandprofessionalassociationsas theAcousticalSocietyofAmerica(ASA), theAmericanAcademyofAudiology(AAA),theAmericanSpeech-Language-HearingAssociation(ASHA)andInternationalSocietyofAudiology(ISA).Atthepresentmoment,Prof.DurrantisAdjunctProfessorofSpeechandHearingScienceandVice-Chairof theDepartmentofCommunicationSciencesandDisordersattheUniversityofPittsburgh.

Abstract:

ChallengesoftheGlobalizationofStandardsandEducationinAudiology

Thename,“InternationalSocietyofAudiology”,rightfullymaybetakentoimplysolidarityofinterestinanacademicandprofessionalareaand,atleastatfacevalue,impliesahomogeneoussectorofhealthcare.Whiletheformerseemsbroadlytrue,thelatter isfar lesscertainonmultipleplanes—background of practitioners, scope of practice, standards of practice, and professional autonomy.Audiology,asaclinicalfield,developedfromarelativelylimitedscopeofpractice,yetrapidlyexpandedandsincehasenjoyedincreasinglyglobalinterestanddevelopmentasafield.Still,furthergrowthisneededtomeetglobalhearinghealthcareneeds,likelyrequiringvariousmodelsofservicedevelopmentanddeliverytomeetsuchneeds.Thissessionisdevotedtotheimperativeissuesofeducationandstandardsinaudiology.Thepointofdeparturewillbeanoverviewoftheoriginsofaudiologyasaclinical science from theperspectiveof a former studentofCarhartwhoworks in the region thatserendipitouslygavebirthtoaudiologyasaprofession.Thepresentationwillproceedwithexplorationofperhapsthemostcontentiousaspectofthefield—inwhosehandsdoesaudiologybelong?Boththerootsoftheprofessionandthecomplexitiesofautonomyinevitably impactthe issuesofwhatareappropriateeducational requirements forpractitionersandeffective standardsofpractice.Currentscopesof practiceunder theaudiologybanner (internationally)will be considered, alongwith thepotentialimpactofthegrowingdiversityofservices.Additionalfactorsforthefutureofglobalizationoftheprofessionincludesocioeconomicbarrierstoadequatetrainingandservicedevelopment,aswellasthepervasiveneedforand/orpotentialbarrier(s)tocommonstandardsofinstrumentationcalibrationandmethodsofpractice.Theseandvariousothertopicswillbehighlightedwiththeintention,aswell,to challengeexpert participants of the subsequent roundtable discussion, as follows (andas timepermits):Howaccessibleareaudiologyservicestodayforindividualsaroundtheglobe,especiallyforthoseoflimitedmeans?Areuniversalhearinghealthcareprioritiesrealistic?Whatisagoodmodelbywhichtoexpandservicesintounderdevelopedregions?Arenationalprofessionalorganizationsahelporbarriertoglobalization?Arenationalstandardorganizationsahelporbarriertoglobalization?Howcantechnologicaladvancesbothempowerandbea liability toglobalization?Whatshouldbetherelativerole(s)ofISAand/orISOinglobalization,versus(perhaps)selectivepartneringoflike-mindedprofessionalsamongsubsetsofcountries?Ultimately,thegoalforthissessionisneithertofind immediate solutionsnor to stirup controversy, rather to stimulateahealthyself-appraisalofaudiologyasaclinicalfield.Itisanticipatedthatonlythroughsuchopennesscanfrankandproductiveinternational communication occur and lead to further development of audiology in a truly globalcommunityeffort.

Round Table Discussion: Globalization of Standards and Education in Audiology Coordinator: JOHN DURRANT George Tavartkiladze, DeWet Swanepoel, Kajsa-Mia Holgers, Angelina Martinez

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31st March (Tuesday) - AUDITORIUM - 8:30 – 9:30am Keynote topic: Hearing Loss Prevention Keynote speaker: Thais Morata

Resumed CV:

Audiologist,withaMaster’sdegreeatPUC-SP,DoctoraldegreeattheUniversityofCincinnatiandpost-docsinoccupationalhealthintheUnitedStatesandSweden.

Workswithhearing losspreventionsince1982.Herstudies focusondifferentapproaches topreventhearinglossandontheeffectsoftheoccupationalexposuretonoiseandchemicalsonhearing,topicofherdoctoraldissertation.Sincethen,shehascoordinatedstudieswithdifferentinstitutionworldwide.CurrentlysheworksattheNationalInstituteforOccupationalSafetyandHealth(NIOSH,USA)andisanAssociateEditorofISA’sInternationalJournalofAudiology.

Abstract:

HearingLossPrevention:howcanwegetthere?

OnSeptember2009,Dr.ThomasFrieden, theDirectorof theUSCenters forDiseaseControlandPrevention, reminded staff at theNational Institute forOccupationalSafetyandHealth thatwhilethegapbetweenwhatweknowandwhatwedonotknowinpublichealthishuge,thegapbetweenwhatwealreadyknowandwhatweactuallydoinpractice(the“know-dogap”)isalsoimmense.Hechallengedustomakeeveryefforttominimizebothgaps.Thischallengeisveryrelevanttohearinglossprevention.While there isstillmuchweneedto learn, there ismuchwealreadyknowaboutpreventinghearinglosswhichisnotbeingeffectivelyimplementedamongthoseatrisk.Thissessionwillhighlightthelatestinformationonhearinglossprevention,includingthewhole-lifeapproachtoprevention,newly-recognizedriskfactors,implementationofnationalpolicies,andtheeffectivenessofpreventioninitiatives.Thepresentationwillalsodiscussmethodsforminimizingthe“know-dogap.”NeilPakenham-Walsh, fromtheInternationalNetwork for theAvailabilityofScientificPublications,notesthataddressingthe“know-dogap”requiresclearlyidentifyingthe“we”inourdiscourse—arewe“afarmerinNepal,doctorinNairobi,healtheducatorinNewYork,theWorldHealthOrganization,thebiomedicalcommunity,theCatholicChurch,orthePresidentofSouthAfrica?”Healsoindicatedthat gaps exist “between what a profession as a whole knows and what individual professionalsknow to be relevant to their practice and between people’s awareness of health risks and theiractualbehaviour”(“Learningfromoneanothertobridgethe‘know-dogap,’”BMJ,2004,329:1189).We, the participants of this conference, healthcare providers, researchers, publishers, informationprofessionals,policy-makers,needtoreachall.Thepromotionofhealthcanonlybeaccomplishedthrough the organized efforts and informed choices of individuals, organizations (both public andprivate),communities,andsocietyasawhole.We,throughourprofessionalsocieties,publicationsandconferenceslikethisone,areconstantlyimprovingthisexchangeofinformationandexpeditingprogress.Inthetraditionalrealmsofinformationexchange,weexcel.Still,weneedtodobetter.Weneedtoexplorenewavenues.Inordertoachievetheultimategoalofhearinglosspreventionaspartofapublichealthmission,allofuswhoare involvedinthecreation,exchange,anduseofhealthknowledge—healthcareproviders,researchers,publishers,policy-makers—needtoexcelinbroadlyinforming,communicating,andeducatingbothourselvesandthoseweserve.Weneedtoexplorethenewcommunicationtoolsandsocialmedia,suchasWikipedia,Facebook,Twitter,Orkut,andwhatever“nextnewthing”comesalong.If“blogging”and“tweeting”arewhatittakestominimizethe“know-dogap,”thenwemustblogandtweettoensurethateveryonehasthesameopportunitytokeepinformed,tobenefitfromcontinuingprofessionaldevelopmentandeducation,andtocommunicatethisinformationtoourtargetpopulations.Weneedtoteach,weneedtolearn,andweneedtoapplywhatwelearntoachievesharedgoalsinhearinglossprevention.

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Round Table Discussion: Hearing loss prevention Coordinator: THAIS MORATA Kathleen Campbell, Peter Thorne, Adrian Davis

PharmacologicProtectiveAgentsforNoise-andDrug-InducedHearingLoss KathleenC.M.Campbell,PhD Professor&DirectorofAudiologyResearchSouthernIll.Univ.SchoolofMedicine

Inthefuture,wemaybeabletopreventorreducepermanentnoise-anddrug-inducedhearinglossbyadministeringprotectiveagents.Currentresearchsuggeststhatavarietyofpharmacologicagentsmaybegivenbeforeorinsomecasesevenafteratoxiccochlearexposureandpreventpermanenthearingloss.Someoftheseprotectiveagentsmaybegivenorallywhileothersneedtobeinjectedoradministeredtotheroundwindow.Someagentshaveonlybeentestedinanimalswhileothersareinorapproachingclinicaltrials.Thereforeinthenottoodistantfuture,audiologistsmaybeinvolvedindeterminingwhenotoprotectiveagentsshouldbeusedintheirpatientpopulations.Consequentlytheyshouldbeawareofthevariousagentsbeingdeveloped.Furthermanyoftheprotectiveagentsarederivedfromorcontained in foodstuffs.Thereforethisresearchsuggestsaroleofnutrition inpreventinghearingloss.

Thispresentationwillreviewcurrentresearchinotoprotectiveagentsfordrug-andnoise-inducedototoxicityincludingDr.Campbell’sownresearchwithD-methionineasanotoprotectiveagent.Howeveranoverviewofthevarioustypesofotoprotectiveagentscurrentlybeingdevelopedwillbeprovided.Dr.Campbellownsseveralpatentsforprotectiveagentswhicharenowinclinicaltrials.HerpatentsareownedbyheremployerandlicensedbyMolecularTherapeutics.Howevershealsocollaboratesandassistsothersdevelopingvarioustypesofotoprotectiveagents.

TowardsaHearingLossPreventionProgrammeinNewZealand PeterRThorne, SectionofAudiology,SchoolofPopulationHealth,UniversityofAuckland,Auckland,NewZealand

Hearingimpairmentaffectsupto15%ofthepopulationinNewZealandand,likeothernationsthereare concerns that the prevalence will rise substantially with the aging population. New Zealandhas challenges with significant prevalence disparities in the population with a greater prevalenceof hearing loss amongMaori and Pacific populations. In addition, because of the publicly-fundedworkplacecompensationand“no-fault”accidentinsuranceschemethereisgovernmentpressuretolimittheincreasingcostofrehabilitationforoccupationalnoise-inducedhearingloss.Thisallsupportstheneedtodevelophearinglosspreventionstrategies,nationally.ThispresentationwilloutlinesomeofthemeasuresbeingundertakenorproposednationallyinanattempttopreventhearinglossinNewZealandaswellasreduceitsimpactthroughthedevelopmentofappropriatehealthservices.Theseefforts involve a number of combined or linked initiatives involving government agencies, privatehealthservicesandNGOs.ThegovernmenthasrecentlyintroducedaNewbornHearingScreeningandEarlyInterventionProgrammewhichisnationallycoordinatedandisnowbeingimplementedacrossthecountry.Thereisconsiderablefocusonreducingtheincidenceofnoise-inducedhearinglosswithanumberofshortandlongterminitiatives.Theseincludeimprovedworkplaceinterventionsthroughgovernmentagenciesandeducationprogrammestargetingthepublicandschool-agedchildrentoraiseawarenessoftheeffectsofnoiseexposureonhearing.ThelatterprogrammesarebeingdevelopedandcoordinatedthroughanumberofNGOs,includingtheNationalFoundationfortheDeaf.ManyoftheseprogrammesarebeinginformedbyseverallargemultidisciplinaryresearchprogrammesbeingundertakenontheepidemiologyofhearinglossinNewZealandandthenatureandefficacyofcurrenthearingconservationprogrammesintheworkplace.Anincreasingfocusonhearinglosspreventionin the community is facilitated by the inclusion of the audiology department at the University ofAucklandwithinaSchoolofPopulationHealth,whichhasgreatlyenabledresearchcollaborationswithepidemiologists,healtheconomistsandMaoriandPacificpopulationhealthspecialists.Animportantfocuswillbetheevaluationofanystrategiesputinplace.

HearingLossPrevention AdrianDavis UniversityofManchester

HearingLossPreventionshouldbealife-longgoal.Toaddressthisvisionandmakeitarealityweneed

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agoodunderstandingofthenaturalhistoryofhearinglossandhowitcanbeprevented.Concentratingonnoiseasanexample,thistalkwillexamineourcurrentunderstandingofitsimpactsothatwecanseewhatisneededtobedonetotransformourunderstandingofHearingLossPreventioninaction!

Noiseisnewsworthy,withmanycommentatorsandindeedprofessionalsindicatingthatthereismorenoise nowadays or that there is about to be an avalanche of hearing loss, due to the very highprevalenceoflisteningtopersonalmusicplayers.Thesedominantmessagesarenotinfactbackedupbytheevidencethathasbeenpublishedaboutnoisedimpactonhearing.

Noise is of course amajor public health challenge and reinforces the inequalities in hearing duetosocioeconomicfactors!Itismajorbecauseitisallpervasiveinoursocietiesatalevelthatcanseriously affect population health.Hearing Loss in adults aged18– 59 is the 7th largest burdenofdiseaseworldwide(HealthisGlobal,DH2007http://www.dh.gov.uk/en/Publicationsandstatistics/Publications/PublicationsPolicyAndGuidance/DH_072697).

TheSCENIHRreportonpersonalmusicplayers(PMP)emphasisedthepotentialrisksofsocialnoisenowthattheaccesstodigitalmusicwasincrediblyhighinthepopulation(http://ec.europa.eu/health/ph_risk/committees/04_scenihr/docs/scenihr_o_017.pdf).

Martin (http://www.ohsu.edu/ohrc/staff/martin/martin.html ;http://www.dangerousdecibels.org/) presentsavisionandimplementationkitforahealthpromotionpackagethatfeaturessomeinterestingandlowcostideas.Thereisaclearneedtoevaluatethisapproachtohearinglosspreventionandtoseewhattheadvantagesandpitfallsmightbetotakingthisapproachforwardonawholepopulationbasis.

Amajorissueforthefieldisthat,inthefaceofthelargeincreasesinrisktohearing(andtinnitus)duetoincreasingPMPuse,thereisalackofdataconcerning:

a)thecurrentPMPusepattern,durationandoutputlevelandexposureofuserstootherhighlevelsoundsources.

b)thecontributionofnoisetohearingdifficultiesandcognitiveandattentiondeficitsinchildrenandyoungpeople.

c)long-termstudiesusingmoresensitivemeasures(e.g.otoacousticemissions)toassesstheimpactofPMPsonhearingandidentifythepotentialsub-groupsmore‘atrisk’(e.g.geneticsub-groupsandenvironmentalsub-groupssuchasthosewhocommutetoworkorschoolinnoisysurroundings).

d) biological basis of individual susceptibility to noise and the benefits from pharmacologicaltreatment.

(http://ec.europa.eu/health/ph_risk/committees/04_scenihr/docs/scenihr_o_017.pdf)

Clearlyas thesenew issuesemerge there isaneed forearly identificationof risk,whetheratanenvironmentalorindividuallevel.Butoverallthereisarealneedtothinkabouthowwecanbringaboutanewandmoresuccessfulparadigmforhearinglosspreventionthanwecurrentlyhave.Thetalkwillchallengeprofessionalstothinkcreativelyabouthowhearinglosspreventioncansucceedandwhatisneededtoputtheseideasintopractice!

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14. GRAND ROUND

Grand Round: The Central Auditory Nervous System in 3D 29th , March – Auditorium - 11:15am to 12:15pm Coordinator: Eliane Schochat Frank Musiek, Nora Neustadt

A3-DTouroftheCentralAuditoryNervousSystem FrankE.Musiek,UniversityofConnecticut

ThispresentationwillshowthefunctionalneuroanatomyoftheCentralAuditoryNervousSystemin3-D. Startingatthebrainstemlevel,thevascularanatomywillbeprofiledalongwiththecranialnervesastheyexitthebrainstem.Alsoincludedwillbetheauditoryanatomyofthepons,midbrainandthalamus.Auditorypathwaysprojectingfromthethalamustothecortexwillbehighlightedaswellaskeycorticalandinterhemisphericstructures.Saggittal,coronalandtransverseviewswillbeshownofauditorystructures.This3-Dpresentationwillofferviewsintothecentralauditorynervoussystemthatareseldomseenandwillprovideauniqueperspectiveonclinicalcorrelatestotheneuroanatomyofhearing.

Grand Round: Hearing Aids Outcomes 29th , March – Auditorium – 1:45pm to 3:00pm Coordinator: Kátia de Almeida Cecília Martinelli, Lena Wong, Raymond Hull

AssessmentofoutcomesinthedevelopingWorldLena L N Wong HKU,UniversityofHongKong

Becauseoflinguisticandculturaldifferences,manyissueshavetobeconsideredwhenadaptingself-reportedassessmenttoolsforuseinthedevelopingWorld.Thispresentationwilldiscusssomeoftheseissues,provideexamplesthatarebasedonresearchintheChineseandillustratehowtheyshouldbehandled.ItemselectionandfactorstructureBecauseofculturaldifferences,itemsshouldbecarefullyselectedtoensurerelevancetotheculture.Whilemanyliveinthecities,themajorityislivinginruralareas.Anexamplewouldbeanitemonwhetheranindividualisabletohearwellatthedrive-throughwindow,asmeasuredontheProfileofHearingAidPerformanceanddrive-throughwindowsarenotcommoninmanysocieties.Theseitemsshouldbedeleted.Ontheotherhand,conversationonpublictransport,whichisnotincludedinmeasurementtoolsdesignedintheUnitedStates,shouldbeadded.Dailyactivitiesmaydifferacrosscultures,andtherefore,anindividual’sneedsandimportanceofcommunication.WhilefindingsinpreviousresearchwouldallowresearchersinWesternsocietiestoassignitemstoscalesapriori,factoranalysisshouldbeusedwhenadaptingaself-reportmeasure,inordertoensurethattheitemsarecategorizedintorelevantscales.Forexample,someitemsonoriginalPHAPwereassignedtootherscalesinHongKongusers,probablybecauseofthecrowdedlivingenvironmentandsmalllivingspace.ItemwordingandtestadministrationTestitemsshouldbewordedtosuitethereadinglevelofaspecificpopulation.Reversescoringmaynotbeappropriatebecausetheseitemsmaybeconfusingtoindividualswithloweducationlevelandtheymayevendistractedfromrespondingtotheitems.Culturealsoaffectsour concept of agingand treatment efficacy. For example, hearing impairmentmaybe regardedbyChineseelderlypeopleaspartoftheirelderlycharacter,andtheresponsibilityofsuccessfulconversationmaybepassedfromtheelderlywithahearingimpairmenttohis/hercommunicationpartner.Basedonourresearchexperience,itemsthatfocusonseverityofhearinglossdidnotyieldresultsthatreflectactualhearingdifficulty;instead,frequencyofdifficultyshouldbemeasured.SubjectsamplingLow-costandinappropriatelyfittedhearingaidsmayprovideinsufficientorsometimesevendistortedamplification,adverselyaffectingoutcomes.However,withimprovedlivingstandardovertheyearsandthereductioninthecostofadvancedtechnology,“better”hearingaidsarefitted.Inorderforoutcomestobecomparedacrossstudies,subjectcharacteristicsshouldbedescribedcarefully.LowliteracylevelinthedevelopingWorldmaydeterindividualsfromparticipationinaresearchthatwouldrequireresponsesinapaper-pencilformat,ortraveltoalaboratoryawayfromhome.Differentmodesoftestadministrationshouldbeconsideredandevaluatedforconsistencyinoutcomes.

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14. GRAND ROUND

Grand Round: Teleaudiology 30th , March – Auditorium - 11:15am to 12:15pm Coordinator: Deborah Ferrari DeWet Swanopoel, Sergio Daré Junior, Wanderleia Blasca

DeWetSwanopoel UniversityofPretoria,SouthAfrica

Permanenthearinglossisaleadingglobalhealthcareburden,with1in10peopleaffectedtoamildorgreaterdegree.Ashortageoftrainedhealthcareprofessionalsandassociatedinfrastructureandresourcelimitationsmeanthathearinghealthservicesareunavailabletothemajorityoftheworldpopulation.Utilizinginformationandcommunicationtechnologyinhearinghealthcare,ortele-audiology,combinedwithautomationofferuniqueopportunities for improvedclinicalcare,widespreadaccess toservices,andmorecost-effectiveandsustainablehearinghealth care.Tele-audiologydemonstrates significantpotentialinareassuchaseducationandtrainingofhearinghealthcareprofessionals,paraprofessionals,parents,andadultswithhearingdisorders;screeningforauditorydisorders;diagnosisofhearingloss;andinterventionservices.Globalconnectivityisrapidlygrowingwithincreasinglywidespreaddistributionintounderservedcommunitieswhereaudiologicalservicesmaybefacilitatedthroughtelehealthmodels.Althoughmanyquestionsrelatedtoaspectssuchasqualitycontrol,licensure,jurisdictionalresponsibility,certificationandreimbursementstillneedtobeaddressed;noalternativestrategycancurrentlyofferthesamepotentialreachforimpactingtheglobalburdenofhearinglossinthenearandforeseeablefuture.Thispresentationwillprovideasystematicoverviewofcurrentempiricalevidenceonaudiologyrelatedtelehealthservicesandthescopeoffuturepossibilities.

BrazilianNationalTelehealthProgram DaréJunior,S MedicineSchoolofUniversityofSãoPaulo

BrazilianNationalTelehealthProgramwaslaunchedin2007asapilotproject,andsinceFebruary24th,2010ithasbeenofficiallyconsideredasaProgrambytheBrazilianMinistryofHealth.TheProgramwillbecomposedbyanetworkofpartners Institutionscalled theBrazilianTelehealthNetwork.ThepilotprojectbeganwithninestatesofBrazil(Amazonas,Ceara,Goias,MinasGerais,Pernambuco,RiodeJaneiro,SantaCatarina,RioGrandedoSul,andSaoPaulo)underthecoordinationoftheOfficeofLabourandEducationManagementintheHealthSystem(SGTES),fromtheMinistryofHealth.OneachstateaUniversityCenterisresponsibleforimplementingatleastonehundredconnectionstoreachFamilyHealthTeams.TheSaoPauloTelehealthNucleusisunderthecoordinationoftheFacultyofMedicineoftheUniversityofSaoPaulo.TheaimsoftheBrazilianNationalTelehealthProgramaretoimprovethequalityofthehealthcareprofessionalsoftheFamilyHealthProgram,broadentheresolvabilityoftheclinicalcases,andstrengthentheFamilyHealthStrategy.Toaccomplishtheseobjectivessomeactionswereput inoperation, forexample,theFormativeSecondOpinion.TheFormativeSecondOpinion isconsidereda structured response to thequestionsaskedby thehealth careprofessionals located intheBasicHealthUnitsinBrazil.Theresponsesarebaseduponthebestclinicalandscientificevidenceavailable,andtheaccessisthroughthewebsitewww.telessaude.org.br.Anotheractionistheproductionandavailabilityofqualitymaterialwiththepurposeofpermanenteducation.In2008amultiprofessionalgroupfromtheUniversityofSaoPaulometinordertoproducesomematerialandpromotepermanentdistanceeducationconcerningbreastfeeding.Telebreastfeedingwasborn,andthroughasystemcalledCybertutordevelopedbytheDisciplineofTelemedicineoftheFacultyofMedicineoftheUniversityofSaoPauloweareabletogiveaccesstotexts,imagesandvideosaboutbreastfeeding.TelebreastfeedingwasmadeavailabletothehealthcareprofessionalsoftheFamilyHealthTeamsthroughthesiteofSaoPauloTelehealthNucleus.

TelebreastfeedingisapartofBrazilianNationalTelehealthProgram,anditrepresentsamultiprofessionalteameffortofpediatricians,speechlanguagepathologists/audiologists,dentists,nurses,nutritionistsandjournalists,whichbroughttheirinvaluablecontributiontothissubject.

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14 GRAND ROUND

Round Table: Audiology in Latin America 31st , March – Auditorium - 11:15am to 12:15pm Coordinator: Beatriz Novaes Diana Laurnagaray, Pedro Berruecos, Adrian Fuente

Diana Laurnagaray Researchassociate,NationalCenterforAudiology,Canada,Argentina

ThemissionofEarlyHearingDetectionandInterventionProgramsistominimizeoreliminatecommunicationdisordersresultingfromhearingloss.

Thegoalofprogramsistoidentifycongenitalhearinglossinchildrenbeforethreemonthsofageandtoassureenrollmentinappropriateearlyinterventionservicesbeforesixmonthsofageaswelltofollowupallthechildrenthatareonriskofacquiringhearinglosswithlateonset.

InArgentinathe25.415lawstatedearlydetectionandinterventionforallinfantssince2001.

Thishaschangedpositivelythesituationinthecountryandpermitaudiologistsandalltheprofessionalswhoarerelatedtoinfancyhearingproblemshavemoreaccessibilitytowork.

ItwillbedescribedthesituationinpublichealthandprivateenvironmentsinaudiologyinArgentinaandtheurgentneed todevelop the implementationofcompleteprograms forUniversalScreening,EarlyDetectionandInterventioninsteadofIndividualefforts,implementingscreeningathospitals,clinicsalloverthecountrytryingtoachievethegoals.

Anoverviewoftheevidencebasedprotocolsusedwillbeexplained:screening,diagnosis,intervention,habilitation,rehabilitation,followup,informationforfamilies,includingtrainingofprofessionals,qualitymanagementandprogrameffectiveness

ThebigchallengeforArgentinaandLatinAmericancountriesistheimplementationoffamilycenteredevidencebasedscientificprogramswhereaudiologistscanpromotehighstandardsofqualityservices,givingthebestopportunitiesforthechildrenandtheirfamilies.

PedroBerruecos CoordinatoroftheNationalProgramofHearingHealth,Mexico

Thispaper iscentered intheeffortstoaccomplishaLatinAmericanConsensusonNewbornHearingScreeningintheregion.Sincethemiddleof2007,agroupwasintegratedwithexpertsrepresentingthethreemainLatinAmericanareas-SouthAmerica,CentralAmerica/CaribbeanandNorthAmerica-,workinginPuertoRico,Guatemala,Panamá,Argentina,Brazil,ColombiaandMexico.

After a careful analysis of different International consensus criteria, an adaptation to the specificpeculiaritiesof theLatinAmericanareawasmade,adding the featuresconsideredasneeded in theregion.Afterthat,50statementsweregroupedbythemesinthefollowingmanner:1)Basicprinciples;2)Justification;3)Objectives,parametersandgoals;4)Methodologyandassessmentofoutcomes;5)Monitoringandtrackingand6)Professional,Ethicalandinstitutionalcommitments.

TheLickertScalewasusedaskingthesevenparticipantstoqualifyeachoneofthe50statementsfrom0-10,being“0”atotaldisagreementand“10”atotalagreement.Astatementwith70points(100%)wasconsideredas“totally”agreedbyconsensus;with63-69(>90%),asa“tacit”consensusandwith53-62(>75%),asa“simple”consensus.Statementswithlessof52pointsweresubjectedtoaseconddiscussionstage.94%ofthestatementsweretextsagreebymoreof75%ofconsensusandinathirdstep,onlythreerequiredanadditionaldiscussion.Thethreeweresubsequentlyagreedbyconsensus,aftermakingthenecessarychangesinthephrasingofthestatement.

ThefinaldocumentcanbethebasisforarealdevelopmentofNHSinLatinAmerica.Ifthesimple,tacitortotalconsensuscorrespondedto94%ofthestatements,someminordisagreementsordoubtscannotstopthedisseminationofthefinaltextbutbeeventuallythereasontoamoredetaileddiscussion.Itispossiblealsothatconsideringthedifferentspecialprofessional,social,economicorpoliticscharacteristicsofourcountries,someofourcolleagueswillbeobliged,basedinthiswork,tomadesomeadjustmentsconsideredasappropriate.Nevertheless,wefeel,finally,thatthedocumentalreadycalled“LatinAmericanConsensusonNHS”isalreadyofaparticularimportanceinthecontextoftheAuditoryHealthprogramsin our region.

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Adrian Fuente UQpostdoctoralfellow,UniversityofQueensland,Australia

OccupationhearinglossinLatinAmerica

OccupationalhearinglossstillremainsasoneofthemostpreventablehearinghealthconditionsinLatinAmericaandtherestoftheworld.Overall,morethanfourmilliondisability-adjustedlifeyears(DALYs)havebeenlosttoNoise-inducedhearingloss.However,thetermoccupationalhearinglosscomprisesnotonlyNIHL,butalsohearinglossesinducedbyotherwork-relatedototoxicagentssuchsolventsandmetals.LatinAmericarepresentsavastterritoryandindeedtherealityofoccupationalhearinglossisdifferentfromcountrytocountry.Hearingconservationprograms(HCP)havebeensuccessfullyruninsomecountries.ArethecitizensofLatinAmericancountriesawareofthedeleteriouseffectsofnoiseandotherototoxicagentsatwork?,arethelocalgovernmentsmakingeffortstopreventoccupationalhearingloss?,areworkerswhohaveacquiredSIHLeligibleforcompensation?,isresearchonoccupationalhearinglosstakingplaceinLatinAmericancountries?.Thesequestionsandthechallengesforaudiologistsandlocalgovernmentswillbeaddressed.

Round Table: Auditory Neuropathy 31st , March– Room A - 13:15pm to 14:45pm Coordinator: Dóris Lewis Linda Hood, Osmar Mesquita Neto

AuditoryNeuropathy/Dys-synchrony:PatientVariationandIssuesforManagement LindaJ.Hood,Ph.D. VanderbiltUniversity,USA

Patientswithauditoryneuropathy/dys-synchrony(AN/AD)presentclinicalchallengesrelatedtoaccurateevaluation andmanagement. Otoacoustic emissions, auditory brainstem responses, andmiddle-earmuscle reflexesarevaluable tools in clinical differentiation. Patientsdemonstratebroadvariation inauditoryandothercharacteristics,thoughpatientsconsistentlyhavedifficultyinunderstandingspeech,particularlyinnoise.VariousmechanismsunderlieAN/ADanddiscoveriesrelatedtothegeneticsareproviding one form of insight into the observed variation. Management strategies should considerindividualvariationandthepossibilityforchangeovertime.Inchildren,languagedevelopmentisakeyfactorandcallsforpartneringofseveralprofessionstofullyunderstandapatient’sneedsandassurecomprehensivemanagement.Manypatientsaresuccessfulcochlearimplantuserswhilesuccesswithamplificationismorevariable.Patientvariationinthecontextofevaluationandmanagementstrategieswillbediscussed.

Round Table: Global Burden Disease 1st , April – Room A - 9:00 to 10:30am Coordinator: Maria Cecília Bevilacqua Andrew Smith, Adrian Davis

ProfessorAndrewSmith LondonSchoolofHygieneandTropicalMedicine

TheGBD2005projectaimstoestimatethediseaseburdenassociatedwithmorethan200diseasesandtheirdisablingsequelaeaswellasthesizeofdiseaseburdenthatcanbeattributedtomajorriskfactors.Expertgroupsarecurrentlycollectingasmuchinformationaspossibleon:(a)theoccurrenceofdiseasesand sequelae (prevalence and incidence) and other epidemiological disease parameters (remission,mortalityrisk,averageduration,severitydistribution);(b)prevalenceofexposuretoriskfactors;and(c)theriskofdiseasebylevelofexposure.

Fromthe‘raw’datacollectedduringthesystematicreviews,estimateswillbederivedfor21Worldregionsbyageandsexwithuncertaintyintervals.Thisrequiresanumberofimputationstodealwithmissingvaluesand to checkavailable estimates, especially for diseases, for internal consistency. Dedicatedsoftware is used to: (a) determine commonagepatterns; and (b) impute regional estimates fromthedatasuppliedby theExpertGroups from their systematic reviews. Itwillproducean internallyconsistentsetofepidemiologicalparametersdescribingadiseaseanditsdisablingsequelae.ThereisalsoaComparativeRiskAssessmentwhichusessimilartechniquestoderiveregionalestimatesofriskfactorexposure.

Forthefirsttime,throughthisnewinitiative,theworkonGlobalBurdenofDiseasewillincludeanexpertgrouponhearingloss.Thegroupwasformedin2008andconsistsof2sub-groups,oneworkingonsequelaeanddefinitionsandtheotherworkingonsystematicreview.Thispresentationwillbrieflydescribe

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14. ROUND TABLE

theoverallpurpose,valueandprocessesoftheGBDinitiative;thiswillbefollowedbyadescriptionofthedevelopmentandgeneralfunctioningoftheHearingLossExpertGroupanditsimportancetoaudiologistsandtohealthprogrammeplannersingovernmentsandelsewhere.

ProfessorAdrianDavis UniversityofManchester

TheGBDprojectstartedtolookathearingimpairmentfromacommonperspectiveforallagegroups.ItaimedtoestimatetheprevalenceandincidenceofsubstantivehearingimpairmentacrossallWHOregionsasafunctionofage.Inordertodothisfromacommonbasethecurrentschemesfordescribinghearingimpairmentwerereviewed.Thegroupfinallydecidedonametricthatdescribedhearingimpairment,forbothadultsandchildren,fromthebasisoftheaveragedthresholdacrossthefrequencies0.5,1,2&4kHzonthebetterear,butforthefirsttimeallowingunilateralhearingimpairmentasahearingproblem.Startingfromverygoodhearingat-10dBHLto+4.9dBHLaveragethresholdinthebetterear,thedivisionsthathavebeenusedwerein15dBHLbandsupto95dBHL+.Thismildhearingimpairmentisat20–34.9dBHLandmoderatestartinginthecategory35–49.9dBHL,withmoderatetoseverebeingat50–64.9dBHL.Generally,themodelindicatesthathearingimpairmentwasgreateramongmenthanwomen,low-incomecountriesthanhigh-incomecountries,Sub-SaharanAfricaandLatinAmericathanotherregionsandgreaterin1990thanin2005.Theoverallprevalenceofmoderateorworsehearingimpairment in theworldwasestimatedpreliminarily in the range7–8%decreasing to3–4%formoderatetoseverehearingimpairment.Aseparatesurveyisbeingconductedthataskspopulationstocomparedifferentproblemsthatpeoplehaveegmildhearingimpairmentvsmildmemorylossvsmildproblemsinwalking.Thiswilleventuallyhelpdeterminetheestimatedglobaldisabilitypriorities.Aclearpictureemergesthataudiologicaldataarescarceandthatthereisaneedformoreconsistentlongtermdatacollectioninrespectofprevalenceandincidence.

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15. CONFERENCE

Conference: Updating of the electrophysiological response in the newborns 29th March – Room B – 13:45 - 15:00pm José Juan Barajas de Prat.

Dr.JoséJuanBarajasdePrat. FundaciónDr.Barajas.Tenerife.UniversidaddeLaLagunaCanaryIslands.Spain.

Theelectrophysiologicaltechniqueshasbeenuseformanyyearsinordertoestablishauditorypathwaysintegrityandindirectlythehearingstatusofthesubject.

TheAuditoryBrainStemEvokedPotentials(ABRs)isthemostrobustelectrophysiologicaltestinordertoasseshearingsensitivity.Ingeneraltheseresponsesareobtainedbyaclickasstimulusandtheresponsecome from thewhole part of the cochlear partition. This lack of frequency selectivity is a seriouslylimitationforclinicalapplicationsuchahearingaidfittings.TheAuditorySteady-StateResponses(ASSR)isaprocedurethatmayprovideaquickandobjectiveelectrophysiologicalhearingthresholdsatdifferentfrequencies.InthispresentationwewillreviewthecharacteristicsofASSRinthenewbornsandinfantsanditsclinicalapplications.Auditorylonglatencyresponses(ALR)canbeelicitedinthenewborns.Theseresponsesareelicitedwithanstimulus longenoughthatadmitcertain frequencyselectivityandcanprovidesomeinterestedclinicalinformationfromHearingaidusersandCochlearimplantpatients

Conference: BrainStem Implant in Argentina 29th March – Room D – 16:45 - 18:00pm Norma Pallares Garcia

NormaPallares(MA). UniversidaddelSalvador.CentrodeImplantesCocleares“Prof.Diamante”.BuenosAires.Argentina.

TheareasofexpansionornewtrendsinrelationwithCochlearImplants(CI)arespeciallyrelatedtotheageatimplantationandchangesintheaudiologicalcriteria.

1-CIinchildrenunder12monthsofage.ResearchshowsCIcanbeperformedsafelyinthesechildren,but it is necessary appropriate diagnostic, surgery, programming and intervention.Receptive andexpressivelanguageinthesechildrengrowsatratessimilartonormalhearingchildren(Miyamotoetal,2003,2005,Dettmanetal,2007,HoltandSvirsky,2008)butasadditionaldisabilitiescanbepresent,acautiousprognosticisnecessary.

2-Adolescentsandadultswithprelingualdeafness,results inthesepatientsareactuallybetter thanbefore, due to new technology, new surgical approaches, new strategies and new rehabilitationtechniques. Counselling is critical for outcomes and device usage (Waltzman, 2008).We studiedspeechperceptionresults in35adultsprelinguallydeafpatientswithCI includingthe incidenceofsomatosensorialstimulationwithCIactivation.

3-GeriatricPopulation.ThesepatientsobtainsignificantbenefitfromCIbutresearchshowatrendtoworseperformance innoisecomparedwithyoungerpatients.(Waltzmanetal,2008).Westudiedspeechperceptionresultsin23patientsofthisgroupafterCItuneup.

4- Auditory Neuropathy/Spectrum Disorder (ANSD). CI is a viable option. Research show differentresultsfromgoodperformancetopoorrealization.(Shallopetal,2001,GibsonandHalit,2007).Ourexperienceshowvariableresultsin12ANSDCIpatients.Comparingperformanceofthisgroupwithacontrolgroupweobservedthatinbothgroupsspeechperceptionwasimprovingalongdifferenttime’sevaluatedalthoughthecontrolgroupwasbetter.

5-BilateralCI.SimultaneousorSequential inadultsandchildren.Resultsshowbetterperformanceinquietandnoise,better localization, improvedeaseof listeningandqualityof life. (Dunnetal,2008,Zeitleretal,2008).Ourexperienceconsistsof35bilateralCIpatients,adultsandchildren,simultaneousorsequential.

6-Multiply-handicappedpatients.Inourexperiencewith106multihandicappedCIchildren(outof422paediatricpatients),thedisabilitiesobservedwerecerebralpalsy(25%),developmentaldelay(13%),motordisorders(15%),cognitivedisorders(9%),severevisualdisorders(5%),andotherdeficitslikelanguagedisorders,epilepsyandattentiondeficits.OurresultssuggestthatallthesechildrenobtaindifferentdegreesofbenefitfromCIdependingontypeandextentofassociateddisability.Therateofprogressisslowerthanindeafchildrenwithoutotherdisabilities(HaltandKirk,2005,Wileyetal,2005).Currentlyallofthemusefullythedeviceandparents´reportsshowbetterqualityoflife.Inrelationwithspeechperceptionaftermorethan12monthsofCIuse,someofthem(N=32)areinSpeechPerception(CID,1994)category1and37hadaccesstocategory6.

Conference: Central Auditory Processing Disorders 1st April – Room B – 11:00am -12:30pm David McPherson

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Evaluating Auditory Function Using Physiologic Methods 1st Part - 31st March (Wednesday) - Room D - 14:45 - 16:15pm 2nd Part - 1st April (Thursday) - Room D - 9:00 - 10:30am Coordinator: Dóris Lewis Linda J. Hood, Thierry Morlet LindaJ.Hood,Ph.D.,VanderbiltUniversity,USAandThierryMorlet,Ph.D.,AssociateResearchScientist,A.I.duPontHospitalforChildren,USA

Physiologicalmeasuresofauditoryfunctionarepowerfulobjectivemethodsthatcanbeusedtoobtaininformationaboutneuralintegrityandperipheralauditorysensitivity.Theyareparticularlyimportantinidentifying,quantifyingandmanaginghearinglossesininfantsandchildren.Aclinicalteststrategythatincludesmiddle-earmeasuresandotoacousticemissions(OAE)providesinformationaboutmiddle-ear,cochlearouterhaircell,andreflexarcintegrity.Auditoryevokedpotentialsthatassessneuralactivityatthelevelofthebrainstemarevaluableasindirectmethodsofquantifyinghearingsensitivityinpediatricpatients.Quantifyingthedegreeandconfigurationofhearinglossshouldincludetheabilitytodeterminesensitivityforeachearindividuallyandforindividualfrequencyregions.Appropriateapproachesincludefrequency-specific auditory brainstem responses (ABR) and auditory steady state responses (ASSR).Theseobjectivemethodsaresuitableforinfantsandyoungchildrenaswellasotherpatientswhocannotprovideappropriatebehavioral responses. Touse theseapproachesappropriately, it is important tounderstand maturational characteristics, relationships to behavioral thresholds, and strengths andlimitationsofeachtechnique.Thesefactorswillbediscussedinthispresentation.

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SESSION: FP1 - 1 DATE: 29/3/2010 TIME: 13H45 - 15H00HEARING IN NOISE TEST(HINT BRAZIL)IN WORKERS EXPOSED TO NOISE WITH SENSORINEURAL HEARING LOSSAuthorsALINEDEMORAESARIETA,EVERARDOANDRADEDACOSTAInstitution1.UNICAMP,UNIVERSIDADEESTADUALDECAMPINASAbstractIntroduction:thehint-brazil(hearinginnoisetest,versioninportugueseofbrazil)isatestofrecognitionofspeechinnoise,whichsimulatesresembledauditivesituationstothedailyones.Addedtothenationalaudiologicroutine,itconstitutesanimportantdiagnostictooltoevaluatetheauditiveincapacities,particularlyforpatientsofsensorioneuralsdisacusiasinhighfrequencies,whichpredominatesinourway.objective:evaluatetheresultsofthehintinworkerswithsensorioneuralsauditivelossesexposedtothenoiseandcomparethemwiththeresultsofworkersnotexposed.Method:thehintcontains240representativesentencesofthedailyspeech,short,phoneticbalanced,ofeasyunderstandingandwiththesamedegreeofdifficulty.Theyaredistributedin12listsof20sentenceseach,presentedwithearphones,infoursituations:withsoundfrontalandwithoutnoise;withsoundfrontalandnoisefrontal,noisetotherightandnoisetotheleft.Fourteenexamedworkershadbeenexposedtotheoccupationalnoiseformorethanoneyear,withaverageauditivethresholdsin3,4and6khzgreaterthan25dbhl,withanaverageageof39,5years(standarddeviation9,5).Theseresultshadbeencomparedtotheonesof25workerswithauditivethresholdswithinthelimitsacceptableandnotexposedtothenoiseoccupational,withaverageageof27,6years(standarddeviation5,5).Results:thefoundaveragevaluesintheworkerswithhearingslosseshadbeen:36,2dbwithsoundfrontal(srt);signaltonoiseratio(s/r)of-3,5dbwithnoisefrontal,-9,8dbwithnoisetotheright;-9,6dbwithnoisetotheleft.Theobtainedaveragevaluesinexposedworkershadnotbeen:27,9dbwithsoundfrontal(srt);relationssignal/noise(s/r)of-5,0dbwithnoisefrontal,-12,2dbwithnoisetotheright;-12,5dbwithnoisetotheleft.Conclusion:comparativilytherehadbeensignificantdifferencebetweenexposedandnotexposedworkers.

SESSION: FP1 - 2 DATE: 29/3/2010 TIME: 13H45 - 15H00HEARING SCREENING IN SCHOOL AGE CHILDREN IN POLAND - RESULTS FROM 2008 AND 2009AuthorsSKARZYNSKI HENRYK1,KOCHANEKKRZYSZTOF1,SKARZYNSKIPIOTR,HENRYK2,1,SENDERSKIANDRZEJ1,2,BRUSKI£UKASZ2Institution1.IFPS,InstituteofPhysiologyandPathologyofHearing,Poland2.ISO,InstituteofSenseOrgansKajetany,PolandAbstractItisrecommendedtoconducthearingscreeninginschoolagechildrenespeciallyinareaswithnonwelldevelopedhealthcaresystemhoweverthereisstilldebateconcerningmethodsandorganizationofsuchascreening.Thehearingscreeningprogramconductedlast2yearsinWarsaw-capitalofPolandandinruralareasofeasternPolandwasaimedtodetectchildrenwithconductiveorsensoryhearinglossinchildrenfromfirstgradeofelementaryschoolsandtoraisetheawarenessoftheparentsandteachersabouttheconsequencesofdelayeddetectionofhearingdisordersandaboutthepossibilitiesofearlytherapeuticintervention.ThehearingscreeningwasconductedbymeansoftheSensesExaminationPlatformandscreeningdeviceAudiometerSusingairconductionpuretoneaudiometryforfrequenciesrangingfrom250Hzto8kHz.Additionally,toassesshigherauditoryfunctionsthePolishDichoticDigitstestwasused.Parentsfilledoutaudiologicalquestionnaireandadditionallyduringthetestingchildrenwereaskedfewquestions.EasternPolandresults:Intheperiodofthreemonths95320childrenfrom50541elementaryschoolsin6ruralareasofeasternPolandwerescreened.13,1%ofchildrendidnotpassthepuretoneaudiometryscreeningtest,15%ofchildrendidnotpassthespeechinnoisetestanddichoticdigitstest.Aftercarefulanalysisoftheresultsofindividualtestsforfurtherdiagnosticevaluationwereferred8432children.Wewillpresentresultsofthedetailedanalysisofallaudiometrictestsandaudiologicalquestionnaireandwewilldiscusstheorganizationandcosteffectivenessofthehearingscreeningprograminschoolagechildren.WealsopresentthesensitivityandspecificityofthescreeningprogrambasedonfollowupdatafromWarsawregion.

SESSION: FP1 - 3 DATE: 29/3/2010 TIME: 13H45 - 15H00THE RELATION BETWEEN HIGH FAIL RATES IN HEARING SCREENING AND SOCIOECONOMIC/DEMOGRAPHIC CHARACTERISTICS OF A POPULATION ATTENDED IN A NEWBORN HEARING SCREENING (NHS) PROGRAMAuthorsSILVANAMARIASOBRALGRIZ,NATHÁLIARAPHAELAPESSOAVAZCURADO,DENISECOSTAMENEZES,ADRIANARIBEIRODEALMEIDAESILVA,CAMILAPADILHABARBOSA,EMANUELLEQUEIROZDOSSANTOSTENÓRIO,ANAKAROLLINADASILVEIRA,DENISEALMEIDAInstitution1.UFPE,UNIVERSIDADEFEDERALDEPERNAMBUCOAbstractIntroduction:Ahearingimpairmentmaycauseproblemsinlanguagedevelopment.However,whenahearinglossisearlydetectedandappropriateinterventionisoffered,chancesforimprovementinlanguagearegreater.ThisiswhyEarlyHearingDetectionandIntervention(EHDI)programshavebeenwidelyimplementedinhospitals.Inordertosuchprogramstobeeffectivesomeaspectsmaybeconsidered.Socioeconomicanddemographiccharacteristicsofthepopulationattendedinthehospitalareprobablyrelatedtothemotherandhernewborn.MainPurpose:ThepresentstudyaimedtoidentifysocioeconomicanddemographiccharacteristicsofthepopulationattendedintheNewbornHearingScreening(NHS)programintheFederalUniversityofPernambucoHospitalandcorrelatethosecharacteristicswithscreeningresults.Method:atotalof847mothersofnewbornssubmittedtotheNHSprogramhaveparticipatedinthestudy.Theyallansweredtoaninterviewbeforetheirnewborns’hearinghadbeentested.Socioeconomicanddemographicaspectsas:ageofthemothers,maritalstatus,degreeofeducation,occupation,personalandfamilyincome,residencelocationandconditions,familyimmovable,andpregnancyfollow-upwereanalyzedaccordingtohearingtestsresults.Results:Statisticanalyseshaveshownasignificantrelationbetweenthreevariables(familyincome,mothers’degreeofeducationandresidencelocation)andfailresultinhearingscreening. Itseemsthat the family income interferes in livingconditions,alimentation, leisureandhealth,and lackofeducationmaybeassociatedtolackofinformationabouthealthcare.Accordingtoresidencelocation,itcanbeobservedinthisstudythatitmayberelatedtohealthassistancebecausethefamilieswholiveintheurbanareahaveeasieraccesstomorecomplexhospitalsthanthosefamilieswholiveintheinteriorofthestate.Othersocioeconomicanddemographicvariablesarealsodiscussedinthestudy,eventhoughtheirrelationwithhearingtestingresultswasnotstatisticallysignificant.Conclusions:Resultsshowtheneedofhealthpromotioninthestudiedpopulation,oncehighleveloffailresultsinhearingscreeningarerelatedtoaspectsofpublichealth.Key-words:hearingscreening,publichealth,neonate

SESSION: FP1 - 4 DATE: 29/3/2010 TIME: 13H45 - 15H00KNOWLEDGE OF THE PEDIATRICIAN ABOUT THE HEARING NEONATAL SCREENING: ANALYSIS OF THE INFLUENCE OF TRAINING AND EXPERTISE PROFILE.AuthorsLUDMILATEIXEIRAFAZITO,JOELALVESLAMOUNIER,RICARDONEVESGODINHO,MARIADOCARMOBARROSDEMELO,JOãONEVESMEDEIROSInstitution1.UFMG,UniversidadeFederaldeMinasGeraisAbstractTo identify thepossible factorsrelatedtotheknowledgeof thepediatriciansabout theneonatalhearingscreening isextremelynecessarytoestablishabetterdivulgationof theadequateprocedures to theearlydetectionanddiagnosisofhearingproblems innewborns.Objective:Compare theknowledgeofadequateproceduresandconductstotherealizationoftheneonatalhearingscreenginrelatingtotheaverageofgraduationtime,natureofthegraduationinstitution,kindofspecialization,andnatureofworkingenvironment.MethodsandMaterials:cross-sectionstudyrealizedthroughinquirywith127pediatricians.47(37%)ofthemareknowersand80(63%)areunknowers.Results:Therewerenostatisticsdifferencesbetweenpediatriciansknowersandunknowersrelatedtotheaverageofgraduationtime(p=0,52),natureofthegraduationinstitution(p=0,06),periodofresidencyconclusion(p=0,17),kindofpediatricspecialization(p=0,76),natureofworkenvironment(p=0,10),knowledgeofwhichageispossibletoevaluatebaby’shearing(p=0,18)andknowledgethatallofthechildrenmustpassthroughthehearingscreening(p=0,07).Theothervariablesresearcheddemonstratesignificantstatisticaldifferencebetweenknowersandunknowers.Conclusion:Therewerenotspecificcharacteristicsinthepediatricians’profilefoundedthatcouldimprovethefactofbeingknowerorunknower.Informationsabouttheimportanceofthehearingscreeningtothedevelopmentoftheorallanguageofthechildandthenecessityofallchildrenmustpassthroughthescreengintendtobecommonknowledgeamongpediatricians.

SESSION: FP1 - 5 DATE: 29/3/2010 TIME: 13H45 - 15H00THE KNOWLEDGE OF PEDIATRICIANS IN EARLY INTERVENTION OF HEARING LOSS AuthorsPRISCILAFELICIANODEOLIVEIRA,LARYSSAGUIMARAESRAIMUNDO,ANNYCAROLINEARAGãODOSSANTOS,CAMILAARAUJO,GREICEMARIASAMPAIOROCHA,LARISSACOSTAMACEDO,LUANAARAUJODOSSANTOS,RAFAELLAMARIABARROSOCARDOSO,RAQUELASSUNçãORIBEIROInstitution1.UFS,UniversidadeFederaldeSergipeAbstractIntroduction:Hearingtakesanimportantrole inhumancommunication.Ahearingimpairmentthat isnottreatedearlycanleadtoanirreversiblehandicap,sodiagnosisofhearingimpairmentinchildrenhelpsinachildglobaldevelopment.Technologicalprogressasotoemissionacusticandcochlearimplantsprovidesanearlierdiagnoseandrehabilitation.Howeversomeprofessionalsdonotrealizehowmuchtheymaycontributetomitigatethesequelcausedbyhearingimpairment.Pediatriciansasamemberofthisprocessplayafundamentalroleinachildhealthpromotion.Aim:Investigatepediatriciansknowledgeabouthearingimpairmentandmethodsofdiagnosisofhearingloss.Methods:14pediatriciansofSergipefulfilledastandardizedquestionnaireproposedbyBarros,GalindoandJacob(2002).Theinstrumentwassentto30physiciansofthestate.Results:100%ofthepopulationonthestudyworkinhospital,85,7%inpublicserviceand42,9%inprivateservice.Mostof them(78,6%)hadknowledgeabouthearing impairment incollegegraduation.71,4%affirmedtosearch forhearing impairment in thefirst6monthsoflife.Onlyninepediatricians(64,3%)hadknowledgeaboutdiagnostictechniques.7,2%hadknowledgeabouthearinglossgradeandtypes.Conclusion:Thepediatricianshavelimitedknowledgeaboutconductsfacetochildrenhearingimpairment.

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SESSION: FP1 - 6 DATE: 29/3/2010 TIME: 13H45 - 15H00CHARACTERIZATION OF ACOUSTIC IMITTANCE FINDINGS ON A PRESCHOOL CHILDREN’S GROUP.AuthorsANAMARCELALOBO,ANACLÁUDIAVIEIRACARDOSOInstitution1.UNESP,UniversidadeEstadualPaulista“JúliodeMesquitaFilho”AbstractTheyoungpopulation,mainlypreschoolandschoolchildren,presentsgreaterriskformiddleeardisorders.Theacousticimittanceisarecommendablemethodtoidentifysuchdisorders,dueitsefficiency,objectivityandfastexecution.Thesensibleuseoftheacousticimittancecanbeavaluableandtrustfulwaytodeterminewhichchildrenmustbedirectedforcompleteclinicevaluationandtreatment.Theaimofthisworkwastocharacterizetheacousticimittancefindingsonapreschoolchildren’sgroup.Seventypreschoolchildrenwereevaluated;theywereofbothgendersandtheiragevariedfrom3yearsto6yearsand7months.TheywereregisteredonaMunicipalSchoolofChildrenEducationinMarília.Aftervisualinspectionoftheear,wereperformedtheacousticimittanceevaluation.TheequipmentusedwastheGSI-38,witha226Hzprobetoneandairpressurevariationfrom+200daPa-to400daPa.Theresultshadbeenclassifiedinaccordancetothefollowingmeasurements:StaticAdmittance(PeakY),TympanometricWidth(TW),EquivalentEarCanalVolume(Vea)and,TympanometricPeakPressure(TPP).ThepreschoolerspresentedStaticAdmittancevaluesonameanaverageof0,5ccforbothears,withdeviationpatternof0,3cc;theirTympanometricWidthmeanaveragewasof92daPaforbothears,withdeviationpatternof32daPafortherightearand29daPafortheleftear;theEquivalentEarCanalVolumemeanaveragewas0,8ccfortherightearand0,7ccfortheleftear,withdeviationpatternof0,3ccforbothearsand;fortheTympanometricPeakPressurethemeanaveragewas-86daPa,withdeviationpatternof82daPafortherightearand,meanaverageof-89daPa,withdeviationpatternof65daPafortheleftear.Aimingabettercharacterizationofthestudiedgroupwasanalyzedthevaluesthathadoccurredmorefrequently,forStaticAdmittancewasobservedthevalueof0,3ccforboththeears,fortheTympanometricWidth90daPafortherightearand85daPafortheleftear,forEquivalentEarCanalVolume0,6ccbilaterallyand,fortheTympanometricPeakPressure-70daPafortherightearand-60daPafortheleftear.Analyzingthegottendataitcanbeconcludedthatthestudiedgrouppresentsalowincidenceofmiddleeardisorders.

SESSION: FP3 - 1 DATE: 29/3/2010 TIME: 15H00 - 16H15PREVALENCE OF AUDITORY NEUROPATHY SPECTRUM DISORDERS IN SCHOOLS FOR THE DEAF AND THE HARD OF HEARING IN BELGIUMAuthorsMELINA WILLEMSInstitution1.UCAHS,UniversityCollegeofArteveldehogeschoolAbstractTheobjectiveofthepresentstudywastoinvestigatetheprevalenceofauditoryneuropathyspectrumdisorders(ANSD)inschoolsforthedeafandthehardofhearinginBelgium.Atthetimeoftheinvestigation,atotalof436individualswithpermanentchildhoodhearingloss(>40dBHLatthebetterear),aged2y6m–21y11m,attendedoneofthe8specialschoolsforthedeafandthehardofhearinginBelgium(FlandersorBrusselsHeadCapitalRegion).Inordertocollectepidemiologicaldata,filestudywasdoneoneverychildaccordingtoastricttestprotocol.Audiologicalassessmentwasconductedafterwards,includingtympanometry,acousticreflex testing,pure toneaudiometry, speechaudiometry,otoacousticemissions (OAE)andauditorybrainstemresponses (ABR).Minimumrequirements tobeincludedinthisstudywerenormalmiddleearfunction,dataonotoacousticemissions,andauditorybrainstemresponses.Ofallindividuals,34.9%(N=152)wasnotacknowledgedwithinthefinalresultsduetoeitheralackofessentialinformation,oradeliberateexclusionfromparticipation.Theresultsobtainedfromtheassessmentindicatedhow10outof284individualspresentedahearinglossofthetypeANSD,whichinturnsuggestedanincidenceof3.52%.NotonesinglefilementionedtheexistenceofANSDpriortothepresentassessment.Suchanoutcomeshouldpromptcaregiverstoacknowledgethisparticulartypeofsensorineuralhearingloss.Itshouldfurthermoreresultinrecommendationsforamorespecifictestprotocol,anadaptedrehabilitationprogram,morecarefulselectionofhearingaidsorcochlearimplants,and/orextraoralternativedevices.Allepidemiologicaldataregardingtheparticulartypeofhearinglossdetectedintheindividualswillbepresented,includingneonatalhearingscreeningresults,ageatdetectionanddiagnosis,startofinterventionand/orrehabilitation,typeanddegreeofhearingloss,etiology,typeofamplification,typeofeducation,other(related)problems,multipledisabilities,speechandlanguagedevelopment,communicationmode,andresultsonthedifferentaudiometrictests.

SESSION: FP3 - 2 DATE: 29/3/2010 TIME: 15H00 - 16H15ELECTROPHYSIOLOGICAL EVALUATION OF HEARING IN CHILDREN WITH DOWN SYNDROME: ANALYSIS OF RESPONSES OF AUDITORY EVOKED POTENTIAL OF BRAINSTEM - ABR RESPONSESAuthors MARIA PAULA ROBERTOInstitution1.USP,UniversidadedesãoPaulo2.PMSP,PrefeituradoMunicipiodeSãoPauloAbstractINTRODUCTION:Syndromesareconsideredariskfactorforhearingloss.ThehighprevalenceofDownsyndromeinrelationtoothersyndromesemphasizethatthecommitteesofthearearecommendationsareappliedinthediagnosisofhearingdisorders,Asawaytominimizethedamageinoralandwrittencommunicationduetoalatediagnosis,anearlyhearingassesmentisindicated.Theassesmentoftheauditorybrainstemresponse–ABRhasbeenthemostcommoninstrumentofaudiologicalevaluationinchildrenwiththesyndrome.OBJECTIVE:ThisstudyaimstocharacterizethefindingsofelectrophysiologicalevaluationofhearinginindividualswithDownsyndrome,METHOD:Auditorybrainstemresponse-ABRbyairconduction(clickstimulusfrom2000to4000Hz)wasusedasawaytoaccesstheintegrityoftheaudi-torypathwaytothebrainstem.All29childrenwithclinicaldiagnosisofDownsyndrom(DS)deliveredbyaspecialistinpediatricgeneticsfortheAudiologydepartmentofaclinic,locatedinthecityofSãoPaulo,from1997to2002wereincluded..RESULTS:Thesamplewasequallydistributedbygender(51.7%fem,and48.3%male)andagesbetween22daysand3yearsand11months(meanageof5.54m).82.76%ofthesamplewereunder6monthsofage.Amongthe29childrenassessed,20wereidentifiedwithnormalresultsofABR(68.97%),andtheremaining9withalteredresults(31.03%).Thenormalaccountedfor55%ofgirlsand45%ofboysevaluated.Thus,theremaining45%ofgirlshadabnormalresults,aswellas56%ofboys.Regardingtheelectrophysiologicalthresholdsintherightear62.07%werelessthanorequalto30dBHL,20.69%from35dBHLto45dBHL.Theremaining17.24%representedindividualswiththresholdsabove50dBHL,associatedtothepresenceofhearingloss.Intheleftearthepercentageswererespectively58.62%,17.24%and24.14%.23children(79.31%)showednodifferenceinthethresholdvalueobtainedbetweentheears.CONCLUSION:Theresultsofthisstudyshowedthattherewasnodifferencebetweennormalandabnormalaccordingtogender.Thedifferenceinthresholdvaluesobtainedbetweentheearswasnotstatisticallysignificant.Inviewof20.69%ofchildrenwiththresholdsbetween35dBHLand45dBHL,andconsideringtheimportanceofearlyaudiologicaldiagnosisconfirmationwesuggestthatthedetectionofevokedauditorybrainstemresponsebyairconduction,issupplementedbyboneconductionresearch.Thiswouldprovideconclusionabouttheinfluenceoftheconductivecomponentinthispopulation.Keywords:AuditoryBrainstemResponse,ABR,DownSyndrome,Hearing.SãoPaulo:Master’sThesis-DepartmentofPreventiveMedicine-FacultyofMedicine,UniversityofSãoPaulo

SESSION: FP3 - 3 DATE: 29/3/2010 TIME: 15H00 - 16H15TEST-RETEST RELIABILITY OF THE MULTIFREqUENCY AND MULTICOMPONENT TYMPANOMETRYAuthorsKAUSHLENDRAKUMAR,ASHWINIGUTTEDAR,CHRISTINAJEANVIVARTHINI,DR.JAYASHREEBHAT,PEARLD’COSTAInstitution2.manipaluniversity,kasturbamedicalcollegeAbstractTympanometryisthemeasurementoftheacousticimmittanceoftheearasafunctionofearcanalairpressure.MultifrequencyandMulticomponenttympanogramshavebeenshowntoprovideclinicallyusefulinformationinavarietyofpatientpopulations.However,foratesttobewidelyacceptedasaclinicaltool,theresultsshouldberepeatableorvaryslightlywithin limitsofmeasurementalerror.Todate,therearenopublishedstudies investigatingthetest-retestreliabilityofthemulticomponentandmultifrequency tympanometryon largenumberofpopulation.Theaimof thecurrentstudy is toexamine the test-retest reliabilityof themulticomponentandmultifrequencytympanometryinagroupnormaladult.Thepresentstudyincluded50normalhearingadultsubjects(50ears)intheagegroupof18to35yearsofagewithnormalimmittancefindingsandnootologicalorneurologicalhistorywithtwomonthsgapbetweenthetestandtheretestsessions.Pure toneaudiometrywas followedby immittance,firstwithmulticomponent tympanometry for226,678and1000Hzprobe tonesand thenwithmultihertztympanometryusingsweepfrequencyandsweeppressuremethods.Fourcomparisonmethodsforresonantfrequencywasusedwhichwerepositivetailmethod,negativetailmethod,ƒ´Bandƒ´ƒámethod.Theresultsrevealedsignificantdifferencebetweentwotestretestsessionsforƒ´Bandnosignificantdifferencesforothermeasures.Thedataalsoshowshighcorrelationandtestretestreliabilitybetweenthetwosessionsforpositivetailmeasurementmethodandlowcorrelationandt