Keywords hearing - hearing loss - auxiliary from hearing - children - questionnaire
Palavras-chave audição - perda auditiva - auxiliares de audição - criança - questionários
Introduction
The hearing loss, independently from degree, can take to a series of perceptual impairments
and changes in the speech, damaging the communication from the individual and can
cause secondary deficiencies involving the cognitive, emotional, social and educational
aspects[1 ].
To minimize these commitments, is necessary the diagnosis and the efficient early
intervention, with the indication and adaptation from the adequate hearing aids, also
as specialized therapeutic accompaniment[2 ].
The benefits and limitations from the abilities of hearing of the children using hearing
aids are evaluated by the phonoaudiologist, in the final stage from the process of
adaptation from the hearing aids. Is verified, though, which are the effects of amplification
in the quality of life from the child[3 ].
To verify these benefits, the phonoaudiologist can use procedures to observe the behavior
of that child in respond to the amplified signal provided by the hearing aid, quantify
the behaviors responses using the amplification by means of functional gain and from
tests of speech perception (direct measures); like also, analyze the indirect measures
from the performances obtained in interviews with parents, caregivers and/or educators
by means of a questionnaire developed for such purpose[3 ].
With the purpose to verify the benefit according to the sound amplification in children
with less than 4 years and from 4 to 7 years, respectively, was developed the Infant-toddler
Meaningful Auditory Integration (IT-MAIS) and the Meaningful Auditory Integration
Scale (MAIS). These scales approach information related to the frequency that the
child shows significant hearing behaviors in the day-to-day.
To research the benefit provided by the amplification in patients with ages between
7 and 14 years, Boscolo et al. (2006) developed a questionnaire of self-evaluation, which contain closed
questions and illustrative engravings, that aim to know the improvement of performance
provided by the amplification in the home environment, at school and in the social
living in children and teenagers[8 ].
Such instruments allow the audiologist to investigate the perception of the patient
and from the family about the difficulties of communication, monitoring its progress
and locate their hearing needs outside from the standard audiometric battery[9 ].
With base in these purposes, the objective of this study was to evaluate the benefit
provided by the use of sound amplification by means of instruments of self-evaluation
in children and teenagers attended by the program of attention to the hearing health
from Universidade Federal de Santa Maria (UFSM).
Methods
The present study was performed at Laboratory of Hearing Aids (LHA) from the Service
of Phonoaudiologic Attendance (SPA) from Universidade Federal de Santa Maria (UFSM),
in the period between April and August of 2009.
This research is linked to the project “Research and Data Basis in Hearing Health”,
registered at the office Projects from the Center of Sciences of Health under the
number: 019731 and approved by the Committee of Ethics in Research (CER) from UFSM
in 12/05/2006, protocol n° 23081.0.016862/2006-09.
Participated from this study, individuals with hearing loss, prothetizades in the
Laboratory of Hearing Aids from UFSM by means of a program of attention to hearing
health of this institution. This program is current since the year 2005 and attend
in the average complexity the municipalities from the Midwest macro-region from the
state of Rio Grande do Sul.
Only were evaluated the individuals which parents or responsible agreed with the performance
from the needed procedures for the execution of the research and signed the Term of
Consent Free and Clarified, after had received the clarification about the objective
and methodology from the proposed study.
To do part of the research, the criteria of inclusion established were: have age between
3 to 14 years and a minimum time of three months of use of the amplification, because
the clinical experience have showed that this is a reasonable time for the adaptation
to hearing aid, being possible verify the real results of the intervention, since
the benefits arising from the use of the amplification do not emerge immediately[10 ].
The individuals were evaluated during a follow-up of the process of adaptation of
hearing aids, where a member of a family or responsible by the child or teenager was
present. This session, was checked the technical conditions of the hearing aids and
a interview was performed containing aspects like effectiveness and the frequency
of use of the hearing aids by the child and teenager; complaints and difficulties
related to the use of the hearing aids; the development and school performance of
the patient; the performance of an phonoaudiologic accompaniment, among others.
The benefit obtained with the use of the sound amplification was researched through
application of questionnaires of self-evaluation compatible with the age of the patients.
For the verification of the benefit regarding the sound amplification in children
until 4 years old, was used the scale of significant hearing integration for small
children, the IT-MAIS – Infant-toddler Meaningful Auditory Integration ([Annex 1 ]). This scale researches spontaneous hearing behaviors of children in situations
of daily life, through examples in three different areas of development from the hearing
abilities. This three areas include changes in the vocalization associate with the
use of the device, alert for environmental sounds and attribution of meaning to the
sound[5 ]
[6 ].
Annex 1.
Infant-toddler Meaningful Auditory Interaction Scale (IT- MAIS) (Zimmerman-Phillips,Osberger
& Robbins, 1997 adaptado por Castiquini e Bevilacqua, 2000).
1. The vocal behavior of the child is modified when it is using the hearing aid?
( ) 0 never
( ) 1 rarely (25%)
( ) 2 occasionally (50%)
( ) 3 frequently (75%)
( ) 4 always (100%)
2. The child produces well articulated syllables and syllabic sequences that may be
recognized as speaking?
( ) 0 never
( ) 1 rarely (25%)
( ) 2 occasionally (50%)
( ) 3 frequently (75%)
( ) 4 always (100%)
3. The children respond spontaneously to his name, in a quiet environment, when called
only through hearing via, without visual clues?
( ) 0 never ( )
1 rarely (25%)
( ) 2 occasionally (50%)
( ) 3 frequently (75%)
( ) 4 always (100%)
4. The child respond spontaneously to his name,in the presence of background noise,
when called only through hearing via, without visual clues?
( ) 0 never
( ) 1 rarely (25%)
( ) 2 occasionally (50%)
( ) 3 frequently (75%)
( ) 4 always (100%)
5. The children, spontaneously, is attentive to the environmental sound (dogs,toys)
without being induced or alerted earlier about them?
( ) 0 never
( ) 1 rarely (25%)
( ) 2 occasionally (50%)
( ) 3 frequently (75%)
( ) 4 always (100%)
6. The child is alert, spontaneously, to the hearing signals when in new environments?
( ) 0 never
( ) 1 rarely (25%)
( ) 2 occasionally (50%)
( ) 3 frequently (75%)
( ) 4 always (100%)
7. The child recognizes, spontaneously, the hearing signals that make part of the
daily routine?
( ) 0 never
( ) 1 rarely (25%)
( ) 2 occasionally (50%)
( ) 3 frequently (75%)
( ) 4 always (100%)
8. The child shows abilities to discriminate spontaneously two speakers, using only
the hearing, withou visual clues?
( ) 0 never
( ) 1 rarely (25%)
( ) 2 occasionally (50%)
( ) 3 frequently (75%)
( ) 4 always (100%)
9. The child notice, spontaneously, the diferences between the sounds of speek and
not speek through only the hearing?
( ) 0 never
( ) 1 rarely (25%)
( ) 2 occasionally (50%)
( ) 3 frequently (75%)
( ) 4 always (100%)
10. The child associates, spontaneously, the entonation from the voice (anger, excitement)
and the meaning only through hearing?
( ) 0 never
( ) 1 rarely (25%)
( ) 2 occasionally (50%)
( ) 3 frequently (75%)
( ) 4 always (100%)
Total of points: _____/40 Scale IT-MAIS: _____%
For children aged between 4 and 7 years, was applied the scale of significant hearing
integration, the MAIS – Meaningful Auditory Integration Scale ([Annex 2 ]). This scale contains ten close questions that evaluate the connection of the child
with the hearing aid; the capacity of alert for the sounds and the capacity of extract
the meaning from auditory phenomena[4 ]
[7 ].
Annex 2.
Meaningful Auditory Interaction Scale (MAIS) (Robbins; Renshaw; Berry,1991 adapted
by Castiquini e Bevilacqua, 2000).
1. The child recquires that put his hearing aid or put himself?
( ) 0 never
( ) 1 rarely
( ) 2 occasionaly
( ) 3 frequently
( ) 4 always
2. The child reports and seems to be disturbed when his hearing aid is not working
for some reason?
( ) 0 never
( ) 1 rarely
( ) 2 occasionaly
( ) 3 frequently
( ) 4 always
3. The child answer spontaneously to his name, when is silence when called, without
visual clues?
( ) 0 never
( ) 1 rarely
( ) 2 occasionaly
( ) 3 frequently
( ) 4 always
4. The child answer spontaneously to his name, when in the presence of environmental
noise when called, without visual clues? How many times it anwers in the first try?
( ) 0 never
( ) 1 rarely
( ) 2 occasionaly
( ) 3 frequently
( ) 4 always
5. The child is alert, spontaneously to the hearing signals when in new environments?
( ) 0 never
( ) 1 rarely
( ) 2 occasionaly
( ) 3 frequently
( ) 4 always
6. The child is alert, spontaneously to the hearing signals when in new environments?
( ) 0 never
( ) 1 rarely
( ) 2 occasionaly
( ) 3 frequently
( ) 4 always
7. The child recognizes, spontaneously, the hearing signals that make parto f the
domestic and scholar routine?
( ) 0 never
( ) 1 rarely
( ) 2 occasionaly
( ) 3 frequently
( ) 4 always
8. The child shows abilities to discriminate spontaneously two speakers, using only
the hearing?
( ) 0 never
( ) 1 rarely
( ) 2 occasionaly
( ) 3 frequently
( ) 4 always
9. The child notice, spontaneously, the difference betweem the sounds of speech and
enviromental only hearing?
( ) 0 never
( ) 1 rarely
( ) 2 occasionaly
( ) 3 frequently
( ) 4 always
10. The child associates, spontaneously, the entonation of voice and the meaning only
through hearing?
( ) 0 never
( ) 1 rarely
( ) 2 occasionaly
( ) 3 frequently
( ) 4 always
Total of points: ____/40 Scale MAIS: ____%
These scales were developed to evaluate children with hearing loss of profound degree
and are scored trough information from the family or responsible by the children.
For each question, there was the possibility of 5 answers, and each question was scored
by the frequency of occurrence from the behavior that varies from 0 (“never showed
such behavior”) to 4 (“always showed such behavior”). The total possibility of score
in the scales MAIS and IT-MAIS is 40[4 ]
[5 ]
[6 ]
[7 ].
For each patient aged between 8 and 14 years, the provided benefit was amplified through
the questionnaire of self-evaluation elaborated by Boscolo et al. (2006) ([Annex 3 ]). This instrument contain closed questions, which are accompanied of illustrative
engravings referring to the benefit provided by the hearing aids in the residential
environment, at school and social living. This questionnaire was responded by the
patient itself, but in a few cases, like when the patient did not understood the engraving,
or was necessary to pass some complementary information by means of Sign Language
or indicative gestures, the help from the family or responsible was allowed[8 ].
Annex 3.
Questionnaire of Evaluation from Benefit of HA in Children and Teenagers (Boscolo et al., 2006).
Based on the stablished criteria, were evaluated 63 children and teenagers, and the
IT-MAIS scale was applied in 1 individual, the scale MAIS in 10 individuals and the
questionnaire of evaluation from the benefit in children and teenagers was applied
in 52 individuals. All individuals were submitted to the application of the IT-MAIS
and MAIS scales, had neurosensory hearing loss of a bilateral profound degree, with
exception of one individual, which had neurosensory hearing loss of severe degree
in the right ear and of profound degree in the left ear. But the individuals which
were applied the questionnaire of evaluation of benefit in children and teenagers,
had others types and degrees of hearing losses, since that the authors from the questionnaire
did not make references to the limitation of its application in many configurations
of hearing losses. To facilitate the visualization from the data, in [Image 1 ], are exposed the types and degrees of hearing losses, from the 52 individuals that
responded to the questionnaire of evaluation from the benefit in children and teenagers[8 ].
Image 1. Distribution from the individuals according to the type and degree from the hearing
loss by ear (n = 52).
The obtained data from the evaluations were analyzed and presented descriptively.
Results
Only in 1 (1,6%) individual was applied the scale of Infant-toddler Meaningful Auditory
Integration (IT-MAIS), because this was the only patient that fit the age group of
application of the instrument of self-evaluation. The score found in this case was
equal to zero.
Regarding the Meaningful Auditory Integration Scale (MAIS), this could be applied
in 10 (15,9%) individuals, all carriers of neurosensory hearing loss of profound bilateral
degree, with exception of one individual, which had hearing loss of severe degree
in the right ear and profound degree in the left ear.
In [Table 1 ] were found the score and the rates reached for each individual, in the MAIS scale.
Still in this table, are found data referring to the regular use and the time of adaptation
of the hearing aid.
Table 1.
Score and individuals rates found in the MAIS scale, regularity from use and time
of adaptation from the hearing aids in the evaluated individuals (n = 10).
Individuals
Score
Rate (%)
Regular use
Time of adaptation
1
4
10
Yes
6 months
2
3
7,5
No
10 months
3
15
37,5
Yes
11 months
4
33
85
Yes
1 year and 6 months
5
8
20
No
8 months
6
18
42,5
Yes
2 years and 3 months
7
37
82,5
Yes
1 year and 9 months
8
23
57,5
Yes
4 years and 2 months
9
34
80
Yes
1 year and 2 months
10
24
60
Yes
1 year and 6 months
Average
19,9
48,2
−
18,3 months
Regarding the time of adaptation to the hearing aids in these individuals, were found
very different values and a few reliable, because the family did not know refer exactly
how long the child used the hearing aid, in patients with fitting was not performed
in our service. The minimum and maximum time approximated to the adaptation found
in three months, and from 10 years, respectively.
Regarding the data referring to the responses found in the application of the questionnaire
of evaluation from the benefits from HA in children and teenagers[8 ], is observed in [Image 2 ], the analysis of the frequency of use from the hearing aids by the children and
teenagers considering different environment.
Image 2. Distribution from the individuals according the frequency of use of the hearing aids
considering diferentes environments (n = 52).
In [Image 3 ] is checked the distribution from the individuals regarding the responses about the
benefit provided by the hearing aids referred by the children and teenagers in situations
lived in the domestic environment; in [Image 4 ], the ones lived in the school environment and in [Image 5 ], the ones lived in a social environment.
Image 3. Distribution from the individuals regarding the responses about the benefits provided
by the hearing aids in the domestic environment (n = 52).
Image 4. Distribution from the individuals regarding the responses about the benefits provided
by the hearing aids in a scholar environment (n = 52).
Image 5. Distribution from the individuals regarding the responses about the benefits provided
by the hearing aids in a social environment (n = 52).
Discussion
Regarding the results found in the application of the IT-MAIS scale, only 1 (1,6%)
individual could be evaluated, because it was the only patient that fit in the age
group of application from this instrument of self-evaluation. The score found in this
case was equal to 0 (zero), in other words, the family referred that the child did
not presented, in any moment, none of the behaviors evaluated in the scale, even using
the hearing aid. But, this patient besides of hearing impairment of a profound degree,
a chart of many neuropsychomotor limitations resulting from cerebral paralysis, not
presenting the head control, which compromised the analysis from the development from
the hearing aids.
As the results found in the application of the scale MAIS have showed very different,
and the minimum rate found was of 7,5% and the maximum 85%, obtaining an average rate
of 48,2% in the group of individuals evaluated.
In literature are found values varied in the application of this scale. Were found
approximated values, and the results of this study were better than the ones reported
by other studies that obtained average rates of 25,42% and 22,6% when evaluating 12
individuals carriers from hearing impairment from severe and profound degree, users
from hearing aids[3 ]
[11 ]. Also, were found in the literature values lower than the one found in this study[4 ]
[12 ], such researches refer to an average rate of 70% when applied the scale with the
family of 10 children carriers from neurosensory hearing loss of profound bilateral
degree, users of hearing aids and, rates above 82,5% in 20 children carriers of malformation
from the external and middle ear, carriers of conductive hearing loss of a moderate
degree and users of devices of hearing aids by bone conducting.
From the group of 10 children analyzed, could be observed that all the researched
individuals had neurosensory hearing loss of bilateral profound degree, with exception
of the individual number 7, which had hearing loss of a severe degree in the right
ear and profound degree in the left ear, and this was the one that had the second
best performance among the evaluated individuals (82,5%). Is referred by other authors,
that the found rate in the scale increases proportionally, according to the hearing
capacity of the child, and so the amount of residual hearing influences directly on
the result found[7 ].
The patients 5 and 9, besides the hearing impairment, had neuropsychomotor limitations
resulting from cerebral paralysis. Besides, is observed that the individual number
5 did not make effective use of the hearing aid, which can justify the poor performance
found (20%). In other hand, the individual number 9, even having limitations resulting
from cerebral paralysis, obtained a performance extremely satisfactory in the evaluated
behaviors (80%).
Analyzing the [Table 1 ], is observed that the individuals 1,3 and 6 had a satisfactory performance, in other
words, a rate lower than 50%[7 ], even using regularly the hearing aid and did not having changes that would influence
directly in the hearing capacity. However, must take to account that the scale is
scored from information provided by the family of the child, in this way, the feelings
regarding the hearing impairment and the use of the hearing aid can have certain influence
in the obtained answers[13 ].
The result obtained by means of application from the MAIS scale to the family provided
important information regarding the hearing spontaneous behavior of the children in
situations of daily life. Such information could not be obtained by standard battery
of tests, once that these behaviors tend to occur at home and not in testing environment,
which have control from the environment sound[14 ]. Therefore, the results obtained in the MAIS scale serve to contribute for the evaluation
of perception of speech, complementing the objective procedures[7 ].
And so the obtained results with the MAIS scale, the results obtained through the
application of the questionnaire of evaluation from the benefits in children and teenagers[8 ] were very important, most of all because evaluated the benefit provided by the sound
amplification through information from the patient itself.
Because it is a questionnaire with questions of easy access and for having the help
of illustrative engravings, itself was responded without difficulties by most of the
patients.
As well as the one found by the author of the questionnaire[8 ], the individuals presented bigger difficulties from utterance interpretation of
the questions by the children and teenagers with hearing loss of profound degree.
Because the absence of oral/auditory experiences, this individuals have difficulties
in the access of the written language and favor more than one system of visual-spatial
language[15 ]
[16 ]. So, with the help of the engravings and of signs language or indicative gestures,
the meaning from the wording of the questions was easily reached[17 ].
Regarding the use of the hearing aid could be observed that 34 (65,4%) individuals
said to use the prosthesis everywhere they go, taking off only to shower or to sleep.
This data reveals the interest and commitment with the use of the hearing aid, because
of the benefits that it has to offer to those individuals[8 ].
But other individuals, said to use the prosthesis in more specifically environments,
in other words, 3 (5,7%) only at home, 6 (11,5%) only at school, 1 only in therapy
(1,9%), 2 at home and in therapy (3,8%) and 4 (7,6%) at home and at school. It is
observed that certain patients choose to use the hearing aid only in situations which
the communicative demands increase, being that it some cases, the restrict use of
the hearing aid was usually related to resistance from the patient and not from a
bad adequation to the standards of amplification from the prostheses. In these cases
it becomes necessary to guide the responsible and the hearing impaired itself about
the benefits that the hearing aid can provide[8 ].
It is known that the benefits from the hearing aids it is related to the improvement
from communication in daily life, including the reduction from the inability and from
hearing disadvantage[18 ]. In this context, is included the domestic environment, because it is in this environment
that occurs great part of the daily events, besides being the environment that has
all the family living. And so, regarding the benefit provided by the hearing aids
in the situation of routine, lived in a domestic environment, was checked that 40
(76,9%) patients said that the hearing aid helps to hear better the television, 35
(67,3%) to hear better the phone ringing or the bell and 37 (71,1%) to hear the parents
calling their names, agreeing with the results founds for other studies[8 ].
Regarding the benefit provided by the hearing aids in a school environment, was said
by 36 (69,2%) children and teenagers that the hearing aid helps to hear the professor
better, 33 (63,5%) said that helps to hear their classmates better. The biggest difficulty
found was to listen the teacher when he is far 22 (42,3%). This reinforces the need
to be guided as the positioning from the student next to the teacher, because it favors
the perception from the signal of the speech and reduces the interference from the
environmental noise[19 ].
When analyzing the benefit provided by the hearing aids in situations of routine lived
in a social environment, we found satisfactory results. Was observed that 35 children
and teenagers (67,3%) reported that with the hearing aid they play better with their
friends, 33 (63,4%), listen to the friends talking, 38 (73,1%), are able to hear cars
passing through the street, and 24 (46,1%) said that they can hear a person talking
in a very noisy local. It is observed that by means of the results, the use of the
hearing aid is indispensable for the maintenance of the social living from children
and teenagers that were evaluated, helping in the improvement of life for them[20 ].
Was observed that only 24 individuals (46,1%) said to hear better when a person is
talking in a noisy local. Authors referred that in an noisy environment, the individual
can present numerous difficulties in the intelligibility of speech, because the number
of lanes falls significantly, taking them to use only available lanes on the situation.
In those environments, is necessary that the standards of amplification from the hearing
aid are well adjusted to do not cause any hearing discomfort, which can lead the user
to a withdrawal from the use of the prostheses in these situations[8 ]
[21 ].
The success of adaptation from the hearing aids depends from the analysis of the benefit
that the prostheses provides for each user and this measures are each time more importante
in any program of adaptation of hearing aids[22 ].
The execution of this study allow us to suggest the use of the questionnaire of evaluation
from the benefit in children and teenagers[8 ], with the purpose of evaluate the benefit provided by the amplification about the
point of view from the patient, since this instrument has showed to be effective into
providing information about the benefit that the hearing aid provides in situations
of domestic routine, scholar and social for children and teenagers evaluated.
Conclusion
From the analysis and discussion from the obtained results, was verified that in the
application of the MAIS scale were found satisfactory rates (above 50%) and 5 (50%)
from the tem evaluated individuals.
In the application of the questionnaire of evaluation from the benefit in children
and teenagers[8 ], was checked that all items evaluated the most of the children and teenagers said
to be having an improvement in the performance because of the use of the hearing aid.
So, was checked benefit provided by the sound amplification, in different situations
of the daily life, as for the view of the patient as for his family view. In a few
cases, where it was found a little or none benefit with the use from the amplification,
there was influence from clinical alterations, besides the hearing losses, influencing
in the effective use from the hearing aids.
