Condições de orelha média em lactentes: potencial evocado auditivo de estado estável e variáveis ambientais
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Data
2011
Autores
Garcia, Michele Vargas [UNIFESP]
Orientadores
Azevedo, Marisa Frasson de [UNIFESP]
Tipo
Tese de doutorado
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Objetivo: Verificar os níveis mínimos de resposta no potencial evocado auditivo de estado estável por via aérea e via óssea em crianças com e sem comprometimento condutivo, bem como identificar a influência de variáveis ambientais nas condições de orelha média. Método: Foram avaliadas 120 crianças de seis a doze meses, destas 60 com comprometimento condutivo e 60 sem o comprometimento, que foram distribuídas em grupos controle e grupos estudo. A avaliação foi composto por: medidas de imitância acústica, avaliação otorrinolaringológica, potencial evocado auditivo de estado estável por via aérea e via óssea, audiometria de reforço visual nas crianças de seis a doze meses por via aérea e via óssea e ainda aplicação de questionários para verificar a exposição das crianças a variáveis ambientais. Resultados: Nos grupos controle, houve predominância estatística de curva timpanométrica do tipo “A”. Nos grupos estudo, houve predominância de curvas timpanométricas tipo “B” e curvas tipo “C” de modo estatisticamente significante. Quanto à avaliação otorrinolaringológica dos grupos controle foi encontrada normalidade, de modo estatisticamente significante. Nos grupos estudo, na avaliação otorrinolaringológica foi encontrado opacidade e retração com dados estatisticamente significantes. No PEAEE dos grupos controle por via aérea houve respostas em torno de 17,2; 26,2; 22, 7 e 19,8 dBNA para as freqüências 500, 1, 2 e 4KHz e para via óssea em torno de 18,8 a 20 dBNA para as mesmas freqüências, sendo estas estatisticamente menores que as respostas dos grupos estudo. No PEAEE dos grupos estudo por via aérea as respostas foram em torno de 53; 56; 50,2 e 48 dBNA para as freqüências de 500, 1, 2 e 4KHz e por via óssea 25; 25; 20 e 20 dBNA para as mesmas freqüências. Nos grupos controle foi encontrado mais crianças com amamentação natural e que recebiam o aleitamento em posição correta, sendo estatisticamente significante. Também foi encontrado mais crianças não expostas ao tabagismo passivo de modo estatisticamente significante. No grupo estudo, houve predomínio de crianças recebendo aleitamento artificial e de crianças expostas ao tabagismo passivo. A audiometria de reforço visual das crianças de seis a 12 meses apresentou níveis mínimos em torno de 30dBNA para a via aérea no grupo controle e 60dBNA para o grupo estudo para as 4 freqüências avaliadas. Por via óssea as respostas foram cerca de 20dBNA para ambos os grupos. Conclusão: Foi possível realizar o PEAEE por via aérea e via óssea em todas as crianças da amostra, bem como foi possível realizar VRA nas crianças de seis a 12 meses. No grupo controle foi encontrado maior numero de crianças expostas a amamentação natural e no grupo estudo mais crianças expostas ao tabagismo passivo. Houve uma boa concordância para o diagnóstico entre PEAEE e VRA nas crianças de seis a 12 meses, porém a correlação para os níveis mínimos de resposta entre os exames foi baixa.
Objective: Verify minimum response level in the auditory steady state response, via air and bone, as well, envolving children with and without conductive imperfection, and identify the environmental variables in the condition of the mid ear. Method: 120 children aging six to 12 months were evaluated, being 60 presenting conductive imperfections and 60 flawless (perfect). They were distributed in control groups and evaluation (study) groups. The evaluation comprised: acoustic immittance, otorhinolaryngologic assessment, auditory steady state response via air and via bone, audiometry of visual reinforcement involving children aging 6 to 12 months both air and bone via and use of questionnaires aiming at verifying the exposition of the children to environmental variables. Results: Within the control groups statistical predominancy of tympanometric curve of “A“ type. Within the study groups, prevailed the tympanometric curve “B “ type and “C“ type statistically significant. As to the otorhinolaryngologic evaluation within the control groups a normal condition was revealed, statistically significant. Within the study groups in the otorhinolaryngologic, opacity and retraction were presented, on a statistically significant manner. In the PEAEE of the control groups, via air , there were results around 17,2; 26,2; 22,7 and 19,8 dBNA for the frequencies of 500, 1, 2 and 4 KHz and, for via bone around 18,8 to 20 dBNA for same frequencies, being these statistically lesser than the results of the study groups. In the PEAEE of the study groups via air, results were around 53; 56; 50,2 and 48 dBNA for frequencies of 500, 1,2 and 4 KHz and bone via 25; 25; 20 and 20 dBNA for same frequencies. Within the control groups were found more children with natural breast-feeding which were being fed in correct position, being statistically significant. Also, were found more children not exposed to passive smoking, statistically significant. Within the study group, prevailed children being artificially fed and children exposed to passive smoking. The audiometry of visual reinforcement involving children aging 6 to 12 months presented minimum levels, around,30dBNA for the via air of control group and 60 dBNA for the study group in the 4 frequencies analysed. In the bone via the results were around 20dBNA for both groups. It was possible to proceed the PEAEE via air as well as bone via comprising all children of the sample, and it was possible proceed the VRA in the children aging 6 to 12 months. In the control group a larger number of children naturally fed was found. Within the study group a larger number of children exposed to passive smoking was found. There was an appreciable concordance for the diagnosis between PEAEE and VRA within the children aging 6 to 12 months, however the correlation for the minimum response (result) levels in the examination was low.
Objective: Verify minimum response level in the auditory steady state response, via air and bone, as well, envolving children with and without conductive imperfection, and identify the environmental variables in the condition of the mid ear. Method: 120 children aging six to 12 months were evaluated, being 60 presenting conductive imperfections and 60 flawless (perfect). They were distributed in control groups and evaluation (study) groups. The evaluation comprised: acoustic immittance, otorhinolaryngologic assessment, auditory steady state response via air and via bone, audiometry of visual reinforcement involving children aging 6 to 12 months both air and bone via and use of questionnaires aiming at verifying the exposition of the children to environmental variables. Results: Within the control groups statistical predominancy of tympanometric curve of “A“ type. Within the study groups, prevailed the tympanometric curve “B “ type and “C“ type statistically significant. As to the otorhinolaryngologic evaluation within the control groups a normal condition was revealed, statistically significant. Within the study groups in the otorhinolaryngologic, opacity and retraction were presented, on a statistically significant manner. In the PEAEE of the control groups, via air , there were results around 17,2; 26,2; 22,7 and 19,8 dBNA for the frequencies of 500, 1, 2 and 4 KHz and, for via bone around 18,8 to 20 dBNA for same frequencies, being these statistically lesser than the results of the study groups. In the PEAEE of the study groups via air, results were around 53; 56; 50,2 and 48 dBNA for frequencies of 500, 1,2 and 4 KHz and bone via 25; 25; 20 and 20 dBNA for same frequencies. Within the control groups were found more children with natural breast-feeding which were being fed in correct position, being statistically significant. Also, were found more children not exposed to passive smoking, statistically significant. Within the study group, prevailed children being artificially fed and children exposed to passive smoking. The audiometry of visual reinforcement involving children aging 6 to 12 months presented minimum levels, around,30dBNA for the via air of control group and 60 dBNA for the study group in the 4 frequencies analysed. In the bone via the results were around 20dBNA for both groups. It was possible to proceed the PEAEE via air as well as bone via comprising all children of the sample, and it was possible proceed the VRA in the children aging 6 to 12 months. In the control group a larger number of children naturally fed was found. Within the study group a larger number of children exposed to passive smoking was found. There was an appreciable concordance for the diagnosis between PEAEE and VRA within the children aging 6 to 12 months, however the correlation for the minimum response (result) levels in the examination was low.
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Citação
GARCIA, Michele Vargas. Condições de orelha média em lactentes: potencial evocado auditivo de estado estável e variáveis ambientais. Tese (Doutorado em Ciências) - Escola Paulista de Medicina, Universidade Federal de São Paulo (UNIFESP), São Paulo, 2011.