BrazJOtorhinolaryngol.2015;81(2):222---223
www.bjorl.org
Brazilian
Journal
of
OTORHINOLARYNGOLOGY
CASE
REPORT
Unilateral
malformation:
adaptation
of
the
frequency
modulation
system
夽,夽夽
Malformac
¸ão
unilateral:
adaptac
¸ão
do
sistema
de
frequência
modulada
Maria
Fernanda
Capoani
Garcia
Mondelli
a,∗,
Regina
Tangerino
de
Souza
Jacob
a,
Larissa
Germiniani
dos
Santos
b,
Vanessa
Luiza
Destro
Fidêncio
baFaculdadedeOdontologiadeBauru,UniversidadedeSãoPaulo(USP),Bauru,SP,Brazil
bPost-GraduatePrograminSpeechTherapy,FaculdadedeOdontologiadeBauru,UniversidadedeSãoPaulo(USP),Bauru,SP,
Brazil
Received16September2014;accepted23November2014 Availableonline14January2015
Introduction
Sensorydeprivation due toa unilateral ear malformation can result in a delay in the acquisition and development oflanguage,affectingtheindividual’ssocial,psychological, andeducationaldevelopment.1
Earmalformations are abnormalities that occur during
the embryonic development period and may affect the
external,middle,and/orinternalear.Hearinglossisoneof
themostcommonclinicalfindingsinthesepatients,which
mayvaryin typeand degree,depending onthedegree of
involvement.1
Among the most commoncomplaints reportedby
indi-viduals with unilateral hearing loss are the difficulty in
understanding speech in noisy environments and,
conse-quently,agreatereffortintheschoolenvironment.2
In these cases, the intervention consists of providing
sound amplification to favor auditory stimulation; thus,
夽 Pleasecitethisarticleas:MondelliMF,JacobRT,dosSantosLG, FidêncioVL.Unilateralmalformation:adaptationofthefrequency modulationsystem.BrazJOtorhinolaryngol.2015;81:222---3.
夽夽
Institution:FaculdadedeOdontologiadeBauru,Universidade deSãoPaulo,Bauru,SP,Brazil.
∗Correspondingauthor.
E-mail:[email protected](M.F.C.G.Mondelli).
there are new alternatives such as the bone conduction
hearingaid,theboneanchoredhearingaid(baha),andthe
frequencymodulationsystem(FM).
The FM system allows sending wireless sound
infor-mation, causing the signal received by the transmitter
microphonetobesentdirectlytotheindividual,eliminating
thelossofauditoryinformationcausedbythedistancefrom
thesoundsourceandbackgroundnoise.
ThisclinicalstudyevaluatedtheeffectivenessoftheFM
systeminacaseofunilateralmalformation.
Case
presentation
K.A.S.,born on08/16/2002,has severemalformationand
hearingloss ontheright. In2013, shesought help dueto
thedifficultyinunderstandingspeechintheclassroom.She
underwent FMsystem adaptation (PHONAK) withISenseTM
receiverandInspiroTMtransmitteronthe leftear(normal
hearing).
Systemcheckwascarriedoutusingthefollowing
proce-dures:
1. Hearing in noise test (HINT): adaptive speech
percep-tiontest,whichrequirestheindividualtorecognizeand
repeat simple sentences in silence and in noise,
per-formedaccordingwiththerecommendationoftheAAA
(AmericanAcademyofAudiology)guide3at180◦.
http://dx.doi.org/10.1016/j.bjorl.2015.01.002
Unilateralmalformation:adaptationofthefrequencymodulationsystem 223
Table1 Resultsofthehearinginnoisetest.
HINT180◦ Silence Noise
WithoutFM 42.1dBA −4.7S/NdB
WithFM 39.8dBA −15.7S/NdB
HINT,hearinginnoisetest;FM,frequencymodulationsystem; dB,decibel;dBA,A-weighteddecibel;S/N,signal/noiseratio.
2. Classroom participation questionnaire (CPQ): subjec-tive evaluation of student participation in the class,4
completed by the students themselves. The
question-nairecontains28 listeningsituations, dividedintofour
subscales,whicharescoredas1(almostnever);2
(some-times);3(normal);and4(almostalways).
The results indicated thatafter theuse of theFM
sys-tem for a period of three months, the score regarding
‘‘teacherunderstanding’’increasedfrom16to24,‘‘student
understanding’’increasedfrom8to13,‘‘positiveaspects’’
increasedfrom9to15,and‘‘negativeaspects’’decreased
from 16 to 12, indicating the patient’s participation
improvementinclass(Table1).
Discussion
The patient had learning difficulties as a result of
hear-inglosssecondarytoherearmalformation.Environmental
noisehindersoral communicationandcangenerate
physi-cal,emotional,andeducationallosses,inadditiontolosses
in learning,asthestudentmay misssome of thecontent
thatistaught,orevenreceiveadistortedmessage.
ThegreatestbenefitsoftheFMsystemcanbeobserved
intheacademicenvironment,asitensuresthebestaccess
toinformationandknowledgethatistransmitteddirectlyto
theauditorysensorydevice.
Based onthe results, itwas observedthat the patient
showedsatisfactoryperformanceattheHINT,confirmingthe
FMsystem’sproposaltoimprovethesignal-noiseratio,
cor-roboratingdatafromastudyperformed withapopulation
aged7---13years.5
The CPQ score indicated benefits in the classroom,
ashigher scores are desirable, except for the ‘‘negative
aspects’’scale,inwhichaninvertedscoreisexpected.
Individualswithunilateralhearinglosshavehearing
dif-ficultiesandcanbenefitfromamplification6and,amongthe
possibilities,fromtheFMsystem.
Final
comments
TheFMsystemfacilitatedtheperceptionofspeechand
par-ticipationinclass.
Conflicts
of
interest
Theauthorsdeclarenoconflictsofinterest.
References
1.Dell’Aringa AHB, Castiquini EAT. Adaptac¸ão do aparelho de amplificac¸ãosonora individual porviaóssea em crianc¸as por-tadoras de malformac¸ão de orelha externa e média. Arq Int Otorrinolaringol.2005;9:310---6.
2.Hicks CB, Tharpe AM. Listening effort and fatigue in school-agechildrenwithandwithouthearingloss.JSpeechHearRes. 2002;45:5.
3.American Academy of Audiology Clinical Practice Guidelines: Remotemicrophonehearingassistancetechnologiesforchildren andyouthfrombirthto21years,2008.Availablefrom:http:// www.audiology.org/resources/documentlibrary/documents/ hatguideline.pdf
4.Jacob RTS, Alves TKM, Moret ALM, Morettin M, Santos LG, Mondelli MFCG. Participation in regular classroom of student with hearing loss: frequency modulation system use. CoDAS. 2014;26:308---14.
5.Jacob RTS, Bevilacqua MC, Molina SV, Queiroz M, Hoshii LA, LaurisJR,etal.Sistema defrequência moduladaemcrianc¸as comdeficiênciaauditiva:avaliac¸ãoderesultados.RevSocBras Fonoaudiol.2012;17:417---21.
