Keywords child - cleft palate - hearing - auditory perception
Palavras-chave criança - fissura palatina - audição - percepção auditiva
Introduction
Great similarity between the behavior of patients with cleft lip and palate and those
with auditory processing disorders have been reported by researchers investigating
the hearing abilities through the application of a questionnaire[1 ] and behavioral tests[2 ].
Auditory processing disorder refers to difficulties in perceptual processing of auditory
information in the central nervous system. The problem may be exacerbated in unfavorable
acoustic environments[3 ]
[4 ]. Thus, children with this disorder are described by their parents and teachers as
having difficulty listening in noise background, to follow oral instructions, as well
as having difficulty understanding the distorted speech, speech in the presence of
two speakers, for example, in situations of group discussion[3 ]. This disorder is cited as a factor of 50% of Brazilian children, according to the
Ministry of Education (MEC), which reach the end of high school with serious reading
and writing[5 ]. Thus, currently, the association between learning difficulties and changes in the
development of listening skills has been emphasized in studies of auditory processing
tests[6 ]. Researchers[7 ] reported that children with dyslexia show changes of central neurological processing
that can be detected by specific tests of auditory processing, as in functional imaging
exam, such as SPECT (Single Photon Emission Computed Tomography).
A variety of behavioral informal procedures, designed for parents or teachers, has
been developed to systematically investigate conduct that may be useful in determining
whether a child should be referred for an evaluation of auditory processing[3 ]
[8 ].
Literature[9 ] has shown that much information from parents and / or teachers to help identify
changes found in their children.
This study aims to determine the hearing of children with cleft lip and palate, through
the trial of the teacher observing the characteristics of their students with this
type of craniofacial malformation in silence, in ideal listening situation, in the
presence of multiple stimuli, noise when asked to recall information and heard in
a long period of listening.
Method
In order to compose the sample size of this cohort study with cross-section was selected
patients with cleft type most frequently found in a hospital specializing in this
craniofacial malformation. Therefore, to the universe of 800 children with cleft lip
and palate involving the left, operated, of both genders, who were aged 7-11 years,
regularly enrolled in the Hospital, and, attending class regularly, level from 1st
to 4th grade was sent by mail a questionnaire to be delivered to her teachers, aiming
at the objective proposed in this study. The same teacher may have worked with more
than one child in different classrooms.
Guidelines for the purpose of the study, the completion of the questionnaire was provided
in writing to teachers. Responded to 224 questionnaires returned, along with the completion
of informed consent signed. Thus, teachers participated in this prospective study
of 141 children was male and 83 female mean age of 9 years.
[Table 1 ] shows the distribution of children according to age and gender.
Table 1.
Distribution of children according to age and gender.
Gender
Age (years)
7
8
9
10
11
Total
Male
17
29
46
38
11
141
Female
18
17
27
16
5
83
Total
35
46
73
54
16
224
The questionnaire was answered and the CHAPPS - Children's Auditory Processing Performance Scale
[8 ] ([Figure 1a ] and [1b ]) that was developed to systematically collect and quantify the characteristics of
listening to children. It is a type questionnaire scale characteristics of listening
to children. Its objective is to verify the trial of the characteristics of the teacher
listens to students in six conditions / functions listening is in a quiet environment,
noise, when the information is required remember hearing (auditory memory / sequence),
and long periods of listening (auditory attention).
Figure 1a. CHAPPS Questionnaire - Children's Auditory Processing Performance Scale[8 ].
Figure 1b. CHAPPS Questionnaire - Children's Auditory Processing Performance Scale[8 ].
This instrument was chosen for these listening conditions are the most frequent complaints
cited in the literature[8 ]
[9 ]
[10 ], parents and teachers of students who have auditory processing disorder.
Each of these six conditions / functions listening has different numbers of items,
comprising 36 items in total.
Each item was asked to judge a teacher by degree of difficulty experienced only school
with cleft lip and palate, comparing this child with the knowledge that the teacher
has other children from school, the same age and similar condition, but without this
craniofacial malformation. For each degree of difficulty was given a score corresponding
to: (+1) less difficulty (0) same difficulty, and (-1) more difficulty, in which the
teacher should mark the answer chosen.
To analyze the characteristics of listening in CHAPPS, considered the value obtained in each of the six listening conditions (mean values
scored there), and the value obtained in its totalCHAPPS total (sum of all items marked divided by 36 ). The results were analyzed by checking
the responses separately for gender or grade, in the six listening conditions: noise,
silence, in an ideal situation, the presence of multiple information when required
to recall the information heard (memory / Following hearing) and long periods of listening
(auditory attention).
This study was submitted to the Research Ethics Committee and obtained assent under
the Protocol No 041/2003UEPCEP.
The collected data were entered into a spreadsheet program Excel (Microsoft Corporation), and subsequently imported into the Statistical Programme / Statistica for Window-Stat Soft version 5.1. Inc. Besides descriptive statistics (mean and standard deviation) was used to analyze
differences between gender, grade and condition of listening to analysis of variance
the three criteria and the Tukey test, adopting a significance level of 5% (p <0.05).
Results
Based on the results obtained in CHAPPS questionnaire, drafted to [Table 2 ] and [3 ] showing the distribution of mean values and standard deviations for the children
sampled, according to each grade and gender, according to the hearing condition, respectively.
Table 2.
Mean values (standard deviations) at each hearing condition, according to school grade.
Series
Hearing condition
Noise
Silent
Ideal
Multiple Stimuli
Auditory Memory
Auditory Attention
Chapps total
1a
−,16(0,32)
−,03(0,33)
0,11(0,41)
0,09(0,41)
−,14(0,42)
−,07(0,26)
−,06(0,26)
2a
−,17(0,30)
−,03(0,29)
0,00(0,30)
0,06(0,34)
−,14(0,37)
−,09(0,25)
−,09(0,24)
3a
−,17(0,37)
−,06(0,34)
0,04(0,39)
−0,03(0,42)
−,21(0,39)
−,13(0,34)
−,12(0,30)
4a
−,19(0,37)
−,00(0,29)
0,07(0,34)
−0,00(0,35)
−,06(0,38)
−,04(0,32)
−,06(0,27)
Total
−,17(0,34)
−,03(0,31)
0,05(0,36)
0,03(0,38)
−,14(0,39)
−,09(0,29)
−,08(0,27)
p = 0,555
Table 3.
Mean values and standard deviations at each hearing condition according to gender
(G).
G
Hearing condition
Noise
Silent
Ideal
Multiple Stimuli
Auditory memory
Auditory Attention
Chapps total
Female
−0,13(0,36)
−0,00(0,34)
0,08(0,39)
0,06(0,39)
−0,13(0,38)
−0,06(0,30)
−0,05(0,27)
Male
−0,20(0,32)
−0,06(0,30)
0,03(0,34)
0,08(0,38)
−0,15(0,40)
−0,10(0,29)
−0,10(0,27)
Total
−0,17(0,34)
−0,03(0,31)
0,05(0,36)
0,03(0,38)
−0,14(0,39)
−0,09(0,29)
−0,08(0,27)
p = 0,130
The analysis of variance the three criteria showed no statistically significant difference
between genders (p = 0.130) or between sets (p = 0.555), although only among listening
conditions (p <0.001) ([Table 4 ]).
Table 4.
Comparison between the listening conditions (Tukey test).
Hearing contition
Average
Standard deviation
Noise
−0,17 (a)
0,34
Silent
−0,03 (c)
0,31
Ideal
0,05 (d)
0,36
Multiple Stimuli
0,03 (d)
0,38
Auditory memory
−0,14 (a,b)
0,39
Auditory attention
−0,09 (b,c)
0,29
(Condition with the same letter has no statistically significant difference between
them)
p <0.001
Discussion
The analysis of data from this study suggested that the average characteristics of
the trial listening of the students held by teachers (average value of -0.08, SD = 0.27)
was very close to zero, indicating “same difficulty. Thus, through this instrument,
the teacher did not identify differences between the characteristics of students with
cleft lip and palate with the other without this craniofacial malformation, watching
them in the listening conditions outlined in the questionnaire. This finding is in
agreement with previous studies[11 ] in the trial held by parents of children with cleft lip and palate, using the questionnaire
CHAPPS.
With regard to the outcome of this study, the comparison between the listening conditions
observed, the characteristics of listening to the children sampled in the condition
of listening in noise, was the most difficult.
One of the most common complaints of individuals with auditory processing disorder
is a problem processing under difficult listening conditions. When evaluated, many
of these will do very well in a favorable situation. However, when the signals are
distorted or degraded, often demonstrate significant difficulties due to the withdrawal
of some of the inherent redundancy of the speech signal[12 ].
One method of reducing the redundancy of a speech signal is introducing a background
noise (noise) with this sign. Thus, a listener with auditory processing disorder has
difficulty in recognizing speech in noise[10 ].
In this sense the school is under heavy impact of various noises, which become invisible
opponents to learning, in a location where the viewing situation should be much preferred.
Thus, in an unfavorable situation in which there is competition between the teacher's
speech and other noises, school performance may suffer interference[13 ]. Researchers[14 ] believe the noise level found in schools is above the recommended values, this being
a situation unfavorable listening, taking the child in need of greater attention to
retain the spoken message.
Auditory memory is the ability to store and retain the auditory stimulus. Process
that allows you to archive the information to be able to retrieve them when needed[15 ]. Some auditory processing tasks require the child to retain information to formulate
a response. Thus, auditory memory is essential to enable listening skills[16 ]. The condition of when asked to recall information heard (auditory memory) was the
second most difficult in this study.
The student with auditory processing disorder may demonstrate problems with listening
comprehension, auditory discrimination, and auditory memory, figure-background auditory
and auditory attention, among others[16 ].
Auditory attention is defined as a cognitive process that allows the listener to focus
selectively on the stimulus of interest, while ignoring a competitive stimulus not
relevant, limiting the amount of processed information to the intention[17 ]. Learning depends on the attention that is associated with what is important, the
meaning will influence the degree of attention[18 ].The condition for long periods of listening (auditory attention), this investigation
has been among the more difficulty presented by the student.
When analyzing this work, the significant difference between the results obtained
from the reactive behaviors due to the conditions of listening in noise, when the
information is required remember hearing (auditory memory) and long periods of listening
(auditory attention), in relation to other conditions, studies[19 ] have shown that exposure to loud noise can cause damage, such as decreased attention,
but children can adapt to noise interference during the activities for filtering the
noisy stimulus undesirable. They can use this strategy even when there is no noise,
leading to their poor ability to sustain attention in the classroom, which may over
time continue to affect attention, even in the absence of exposure noisy (Medical Research Council 1997)[20 ] could justify the difficulty of the students also provided when listening in silence.
Several key points were recorded on data obtained using this instrument with respect
to the condition that the student listens with cleft lip and palate, considering that
when compared to other work,[1 ] was applied in specific tests, confirms auditory attention problems, verbal memory,
history of recurrent ear infections, high rates of learning disabilities, repetition
rate and low educational attainment in this population.
The data found in this study support those of researchers[21 ]
[22 ] who concluded that children with cleft lip and palate had difficulties in the auditory
figure-ground and selective attention by means of the tests, suggesting that the assessment
of auditory processing in battery hearing clinic for routine subjects with this malformation.
The trial of the teachers regarding hearing conditions submitted by the student, as
having more problems (noise, memory and auditory attention) suggests that the children
studied have to undergo an expert evaluation of auditory processing, in order that
the alterations are common in children or adults with auditory processing disorders,
the child may not be able to interpret the sound, since that interpretation depends
on auditory skills organized and structured linked to brain functions like memory
and attention.
Thus, the inclusion of procedures, such as questionnaires, checklist in the investigation of changes in processing of auditory information, the battery
of audiological clinic for routine subjects with cleft lip and palate, seems justified
for better orientation in the diagnostic process, treatment and family, aimed not
only improvements in academic performance, but also a better quality of life. Such
procedures may provide valuable information regarding the real impact of hearing loss,
helping in the process of differential diagnosis, but should not be overestimated,
nor used for diagnostic purposes.
Conclusion
In this study the hearing of children with cleft lip and palate, as judged by the
teacher of another child of similar age and hearing condition similar and not as the
bearer of this craniofacial malformation evaluates CHAPPS, was practically similar.
However condition had more difficulty in noise, when asked to recall the information
heard (auditory memory) and for a long period of listening (auditory attention), for
any of the genres and for all grades attended.
