RESUMO
As the proportion of older adults in the world's total population continues to grow, the adverse health outcomes of age-related hearing loss are becoming increasingly recognized. While research has shown that age-related hearing loss is the single greatest modifiable risk factor for dementia, use of hearing aids remains low worldwide, even in many middle- and high-income countries. Reasons for poor uptake of hearing aids are likely to involve a combination of factors, ranging from increasing costs of hearing aid technology to a widespread lack of insurance coverage. This article aims to identify the current state of access to hearing aids, focusing on eight middle- and high-income countries. We discuss how to facilitate greater access to hearing aids for patients by addressing changes in how devices are regulated, technological advancements in hearing devices, the need to adjust reimbursement schemes and the importance of adaptation among the community workforce for hearing-care.
Alors que la proportion de personnes âgées au sein de la population mondiale totale continue à croître, les effets néfastes sur la santé de la perte de l'acuité auditive liée à l'âge sont de plus en plus reconnus. Bien que la recherche ait démontré que la perte de l'acuité auditive liée à l'âge est le principal facteur de risque modifiable de la démence, l'utilisation de prothèses auditives reste limitée à l'échelle mondiale, y compris dans de nombreux pays à revenu intermédiaire et élevé. Les raisons de ce recours limité aux prothèses auditives tiennent probablement à une combinaison de facteurs qui vont des coûts croissants de la technologie des appareils auditifs à un manque généralisé de couverture médicale. Cet article vise à déterminer l'état actuel de l'accès aux prothèses auditives en se concentrant sur huit pays à revenu intermédiaire et élevé. Nous étudions comment permettre aux patients d'accéder plus facilement aux prothèses auditives en tenant compte de la réglementation applicable aux appareils, des progrès technologiques relatifs aux appareils auditifs, de la nécessité d'ajuster les systèmes de remboursement et de l'importance de l'adaptation au sein de la main-d'Åuvre locale pour les soins auditifs.
A medida que la proporción de adultos mayores en la población total del mundo continúa creciendo, los resultados adversos para la salud de la pérdida de audición relacionada con la edad son cada vez más reconocidos. Aunque las investigaciones han demostrado que la pérdida de audición relacionada con la edad es el mayor factor de riesgo modificable para la demencia, el uso de audífonos sigue siendo bajo en todo el mundo, incluso en muchos países de ingresos medios y altos. Las causas de la escasa aceptación de los audífonos pueden ser una combinación de factores, que van desde el aumento de los costes de la tecnología de los audífonos hasta la falta generalizada de cobertura de seguro. Este artículo pretende identificar el estado actual del acceso a los audífonos, centrándose en ocho países de ingresos medios y altos. Discutimos cómo facilitar un mayor acceso a los audífonos para los pacientes abordando los cambios en cómo se regulan los dispositivos, los avances tecnológicos en los audífonos, la necesidad de ajustar los esquemas de reembolso y la importancia de la adaptación entre los trabajadores de la comunidad para el cuidado de la audición.
Assuntos
Acessibilidade aos Serviços de Saúde , Auxiliares de Audição , Perda Auditiva/terapia , Cobertura do Seguro , Austrália , Brasil , China , Serviços Comunitários de Saúde Mental , Alemanha , Política de Saúde , Auxiliares de Audição/economia , Auxiliares de Audição/normas , Humanos , Cobertura do Seguro/economia , Japão , Países Baixos , Reino Unido , Estados UnidosRESUMO
OBJECTIVE: To compare hearing performance relating to the peripheral and central auditory system between solvent-exposed and non-exposed workers. METHODS: Forty-eight workers exposed to a mixture of solvents and 48 non-exposed control subjects of matched age, gender and educational level were selected to participate in the study. The evaluation procedures included: pure-tone audiometry (500 - 8,000 Hz), to investigate the peripheral auditory system; the Random Gap Detection test, to assess the central auditory system; and the Amsterdam Inventory for Auditory Disability and Handicap, to investigate subjects' self-reported hearing performance in daily-life activities. A Student t test and analyses of covariance (ANCOVA) were computed to determine possible significant differences between solvent-exposed and non-exposed subjects for the hearing level, Random Gap Detection test and Amsterdam Inventory for Auditory Disability and Handicap. Pearson correlations among the three measures were also calculated. RESULTS: Solvent-exposed subjects exhibited significantly poorer hearing thresholds for the right ear than non-exposed subjects. Also, solvent-exposed subjects exhibited poorer results for the Random Gap Detection test and self-reported poorer listening performance than non-exposed subjects. Results of the Amsterdam Inventory for Auditory Disability and Handicap were significantly correlated with the binaural average of subject pure-tone thresholds and Random Gap Detection test performance. CONCLUSIONS: Solvent exposure is associated with poorer hearing performance in daily life activities that relate to the function of the peripheral and central auditory system.
Assuntos
Perda Auditiva/induzido quimicamente , Doenças Profissionais/induzido quimicamente , Exposição Ocupacional/efeitos adversos , Solventes/toxicidade , Adulto , Audiometria , Percepção Auditiva , Limiar Auditivo , Testes Auditivos , Humanos , Masculino , Pessoa de Meia-Idade , Adulto JovemRESUMO
OBJECTIVES: Animal data indicate that xylene induces cochlear dysfunction, characterized by the loss of outer hair cells. There is little evidence regarding xylene-induced ototoxicity in humans. The aim of the study was to investigate the possible adverse effects of xylene on the peripheral and central auditory system in humans. DESIGN: A total of 30 medical laboratory workers who had been exposed to a mixture of xylene isomers, together with 30 nonexposed control participants matched for gender, age, and educational level were selected. Participants of both groups were not exposed to noise levels above 85 dBA time-weighted average. All participants were evaluated with a comprehensive audiological test battery, which included measures of peripheral and central auditory function. Peripheral auditory measures included pure-tone audiometry and distortion product otoacoustic emissions. Behavioral measures of central auditory function included a pitch pattern sequence test, an adaptive test of temporal resolution, a dichotic digit test, and a masking level difference test. The auditory brainstem response was used to objectively evaluate the function of the auditory pathways at the brainstem level. Speech perception in quiet and in noise was evaluated using the Hearing In Noise Test (HINT). The xylene-exposed participants were extensively evaluated with regard to their exposure to both noise and xylene. Noise dosimetry was conducted over an 8-hr work shift to obtain noise-exposure levels for each xylene-exposed worker. Airborne xylene concentrations were obtained at 11 different workstations throughout the medical laboratories, and methyl hippuric acid levels per gram of creatinine in urine were obtained for each xylene-exposed subject. Finally, a detailed interview exploring current and past solvent and noise exposure was conducted. RESULTS: The xylene-exposed participants showed significantly worse pure-tone thresholds in comparison with the nonexposed participants. The xylene-exposed participants demonstrated significantly worse results than the control group participants for the pitch pattern sequence test, dichotic digit test, HINT, and the auditory brainstem response (absolute and interpeak latencies). No significant differences between the xylene-exposed and nonexposed participants were observed for distortion product otoacoustic emissions, adaptive test of temporal resolution, or the masking level difference test. A significant correlation between the concentrations of methyl hippuric acid in urine and pure-tone thresholds (2 to 8 kHz) was found in xylene-exposed workers. Also, participants with high cumulative dose of xylene exposure presented with poorer test results than participants with low cumulative dose of xylene exposure. CONCLUSIONS: The results of the present research suggest that xylene is associated with adverse central auditory effects and poorer sound detection abilities in humans. A major limitation of the study is that the results found among xylene-exposed participants cannot be proved to be permanent, and thus further research should be conducted to clarify this limitation. Workers exposed to this chemical should be routinely evaluated with a comprehensive audiological test battery, to detect early signs of auditory dysfunction.
Assuntos
Doenças Auditivas Centrais/induzido quimicamente , Doenças Auditivas Centrais/fisiopatologia , Exposição Ocupacional/efeitos adversos , Percepção da Altura Sonora/efeitos dos fármacos , Percepção da Fala/efeitos dos fármacos , Xilenos/efeitos adversos , Adulto , Audiometria de Tons Puros , Doenças Auditivas Centrais/diagnóstico , Limiar Auditivo/efeitos dos fármacos , Limiar Auditivo/fisiologia , Testes com Listas de Dissílabos , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Ruído Ocupacional/efeitos adversos , Emissões Otoacústicas Espontâneas/efeitos dos fármacos , Emissões Otoacústicas Espontâneas/fisiologia , Percepção da Altura Sonora/fisiologia , Solventes/efeitos adversos , Localização de Som/efeitos dos fármacos , Localização de Som/fisiologia , Percepção da Fala/fisiologia , Adulto JovemRESUMO
BACKGROUND: Xylene is an organic solvent, widely used in histology laboratories and other occupational settings. Research in animals has demonstrated that xylene induces outer hair cell damage. Evidence regarding the effects of xylene in humans is only available from studies investigating workers exposed to mixtures of solvents containing xylene. These data indicate that mixtures of solvents containing xylene may induce hearing loss and central auditory dysfunction. PURPOSE: To comprehensively evaluate the peripheral and central auditory system of a histology laboratory worker exposed to xylene, who had presented with bilateral mild sensorineural hearing loss at an initial assessment. RESEARCH DESIGN: A case report of a male histology laboratory worker who has been exposed to xylene for over 20 yr. RESULTS: A diagnosis of bilateral mild sensorineural hearing loss of cochlear origin was made on the basis of otological, neuroimaging, and audiological examinations. Results indicating the absence of transient-evoked otoacoustic emissions, and auditory brainstem responses as expected for a mild cochlear hearing loss, were obtained. CONCLUSIONS: The observed bilateral mild sensorineural hearing loss was considered to have been induced by xylene exposure, due to the absence of any other etiological factors related to the onset of hearing loss. The results found in this patient are in agreement with animal data indicating xylene-induced ototoxicity. Xylene-exposed individuals should be audiologically monitored on a regular basis.
Assuntos
Perda Auditiva Bilateral/induzido quimicamente , Perda Auditiva Neurossensorial/induzido quimicamente , Exposição Ocupacional/efeitos adversos , Patologia Clínica , Xilenos/toxicidade , Perda Auditiva Bilateral/diagnóstico , Perda Auditiva Neurossensorial/diagnóstico , Humanos , Laboratórios Hospitalares , Masculino , Pessoa de Meia-Idade , Solventes/toxicidadeRESUMO
OBJECTIVES: Various studies have demonstrated that organic solvent exposure may induce auditory damage. Studies conducted in workers occupationally exposed to solvents suggest, on the one hand, poorer hearing thresholds than in matched non-exposed workers, and on the other hand, central auditory damage due to solvent exposure. Taking into account the potential auditory damage induced by solvent exposure due to the neurotoxic properties of such substances, the present research aimed at studying the possible auditory processing disorder (APD), and possible hearing difficulties in daily life listening situations that solvent-exposed workers may acquire. MATERIALS AND METHODS: Fifty workers exposed to a mixture of organic solvents (xylene, toluene, methyl ethyl ketone) and 50 non-exposed workers matched by age, gender and education were assessed. Only subjects with no history of ear infections, high blood pressure, kidney failure, metabolic and neurological diseases, or alcoholism were selected. The subjects had either normal hearing or sensorineural hearing loss, and normal tympanometric results. Hearing-in-noise (HINT), dichotic digit (DD), filtered speech (FS), pitch pattern sequence (PPS), and random gap detection (RGD) tests were carried out in the exposed and non-exposed groups. A self-report inventory of each subject's performance in daily life listening situations, the Amsterdam Inventory for Auditory Disability and Handicap, was also administered. RESULTS: Significant threshold differences between exposed and non-exposed workers were found at some of the hearing test frequencies, for both ears. However, exposed workers still presented normal hearing thresholds as a group (equal or better than 20 dB HL). Also, for the HINT, DD, PPS, FS and RGD tests, non-exposed workers obtained better results than exposed workers. Finally, solvent-exposed workers reported significantly more hearing complaints in daily life listening situations than non-exposed workers. CONCLUSIONS: It is concluded that subjects exposed to solvents may acquire an APD and thus the sole use of pure-tone audiometry is insufficient to assess hearing in solvent-exposed populations.
Assuntos
Transtornos do Desenvolvimento da Linguagem/induzido quimicamente , Solventes/efeitos adversos , Adolescente , Adulto , Chile , Hong Kong , Humanos , Masculino , Pessoa de Meia-Idade , Exposição Ocupacional , Solventes/intoxicação , Testes de Discriminação da Fala/métodosRESUMO
Se ha propuesto que la evaluación de la resolución temporal debe ser uno de los aspectos a incluir en la evaluación comportamental del procesamiento auditivo central. Algunos estudios han demostrado que este aspectos está alterado en sujetos con trastornos de lenguaje. Keith (2000) desarrolló un nuevo instrumento para evaluar la resolución temporal, la prueba de Random Gap Detection. Normas para esta prueba han sido reportadas para sujetos angloparlantes. Hasta ahora no existen normas para los hispanoparlantes, limitando su uso en esta población. El objetivo del estudio fue obtener normas de esta prueba para una población nativa hispanoparlantes. Fueron evaluados 40 sujetos auditivamente normales y hablantes nativos de español de Chile. Se encontraron correlaciones entre algunas subpruebas. Se definieron percentiles 90 como criterios de corte entre las categorías de puntaje normal y anormal. Se aborda una discusión de los hallazgos y la necesidad de futuras investigaciones.
Assuntos
Humanos , Adolescente , Adulto , Pessoa de Meia-Idade , Estimulação Acústica/métodos , Percepção Auditiva/fisiologia , Testes Auditivos/métodos , Distribuição por Idade , Audiometria de Tons Puros , Limiar Auditivo , Chile , Fatores Culturais , Percepção da Fala/fisiologia , Percepção do Timbre/fisiologia , Distribuição por Sexo , Fatores de Tempo , Testes de Impedância AcústicaRESUMO
La habilidad de comprender el habla bajo la presencia de varios sonidos enmascarantes es un fenómeno complejo que ya ha sido estudiado por varios autores. El fenómeno de cocktail party propuesto por Cherry (1953) fue el primer intento de dar a entender cómo los oyentes son capaces de utilizar claves monoaurales y biaurales cuando discriminan el habla bajo la presencia de sonidos enmascarantes. El presente artículo pretente discutir el fenómeno de percepción del habla bajo la presencia de sonidos enmascarantes, el rol de la atención y la memoria de trabajo como "importantes procesos cognitivos" que los oyentes utilizan al percibir un sonido verbal bajo la presencia de enmascaradores de información. Finalmente, en la última parte del artículo se abordan algunas pruebas de procesamiento auditivo central y las habilidades auditivas involucradas en cada prueba. Esto, tomando en consideración que las habilidades auditivas están directamente relacionadas con distintos mecanismos de la percepción del habla, especialmente bajo la presencia de sonidos enmascarantes.