Potenciais evocados auditivos de longa latência com verbais e não verbais.

(1)

© 2015 Associação Brasileira de Otorrinolaringologia e Cirurgia Cérvico-Facial. Publicado por Elsevier Editora Ltda. Este é um artigo Open Access sob a licença CC BY (https://creativecommons.org/licenses/by/4.0/deed.pt).

www.bjorl.org.br

OTORHINOLARYNGOLOGY

Brazilian Journal of

KEYWORDS Audiology; Electrophysiology; Evoked potentials, auditory;

Event-related potentials, P300

Abstract

Introduction: Long-latency auditory evoked potentials represent the cortical activity related to attention, memory, and auditory discrimination skills. Acoustic signal processing occurs

differ-HQWO\EHWZHHQYHUEDODQGQRQYHUEDOVWLPXOLLQÁXHQFLQJWKHODWHQF\DQGDPSOLWXGHSDWWHUQV Objective: To describe the latencies of the cortical potentials P1, N1, P2, N2, and P3, as wellas P3 amplitude, with different speech stimuli and tone bursts, and to classify them in the pres-ence and abspres-ence of these data.

Methods: A total of 30 subjects with normal hearing were assessed, aged 18-32 years old,

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Results: Considering the component N2 for tone burst, the lowest latency found was 217.45 ms

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among them, regardless of the stimuli used.

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☆ ☆_{,QVWLWXLomR8QLYHUVLGDGH)HGHUDOGH6DQWD0DULD8)606DQWD0DULD56%UDVLO}

* Autor para correspondência.

E-mail: she_oppitz@hotmail.com6-2SSLW]

$57,225,,1$/

Long-latency auditory evoked potentials with verbal

and nonverbal stimuli

☆_,☆☆

Sheila Jacques Oppitz

a,

**_{*, Dayane Domeneghini Didoné}**

a

_{, Débora Durigon da Silva}

b

_,

Marjana Gois

b,c

_{, Jordana Folgearini}

b

_{, Geise Corrêa Ferreira}

b

_{, Michele Vargas Garcia}

b,d

a_{Distúrbios da Comunicação Humana, Universidade Federal de Santa Maria (UFSM), Santa Maria, RS, Brasil} b_{Universidade Federal de Santa Maria (UFSM), Santa Maria, RS, Brasil}

c_{Fundo de Incentivo à Pesquisa (FIPE), Santa Maria, RS, Brasil} d_{Universidade Federal de São Paulo (UNIFESP), São Paulo, SP, Brasil}

(2)

PALAVRAS-CHAVE Audiologia;

(OHWURÀVLRORJLD

Potenciais evocados auditivos;

Potencial evocado P300

Conclusion: There was a difference in the latency of potentials N2 and P3 among the stimuli employed but no difference was observed for the P3 amplitude.

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Potenciais evocados auditivos de longa latência com verbais e não verbais

Resumo

Introdução: Os potenciais evocados auditivos de longa latência representam a atividade cortical

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Objetivo: 'HVFUHYHUDVODWrQFLDVGRVSRWHQFLDV3131H3HDDPSOLWXGHGR3FRPRV GLIHUHQWHVHVWtPXORVHFODVVLÀFDUHPSUHVHQoDHDXVrQFLDHVWDVLQIRUPDo}HV

Método: )RUDPDYDOLDGRVLQGLYtGXRVFRPIDL[DHWiULDGHDDQRV(TXLSDUDGRVTXDQWR DRJrQHURHQRUPRRXYLQWHV)RUDPXWLOL]DGRVHVWtPXORVQmRYHUEDLV+=IUHTXHQWHH +]UDURHYHUEDLVEDIUHTXHQWHHJDGDGLUDURV

Resultados: Considerando o componente N2, para o tone burst encontrou-se a menor latên-cia

HPWRUQRGHPVHSDUDRHVWtPXOR%$',DPDLRUODWrQFLDHPWRUQRGHPV1RTXH

diz respeito a componente P3, a latência encontrada com tone burst foi a menor em torno de

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-o}HVUHIHUHQWHVDRVYDORUHVGDVODWrQFLDVGRVFRPSRQHQWHV3131H3LQGHSHQGHQWH GRHVWtPXORXWLOL]DGRKRXYHSUHVHQoDGRVFRPSRQHQWHVVHPGLIHUHQoDVHVWDWtVWLFDVHQWUHHOHV Conclusão: +RXYHGLIHUHQoDQDODWrQFLDGRSRWHQFLDO1H3HQWUHRVHVWtPXORVPDVQmRIRL REVHUYDGDGLIHUHQoDSDUDDDPSOLWXGHGR3

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Introdução

2VSRWHQFLDLVHYRFDGRVDXGLWLYRVGHORQJDODWrQFLD3($// WrPVLGRXWLOL]DGRVQDSUiWLFDFOtQLFDGHIRUPDFRPSOHPHQWDU jVDYDOLDo}HVFRPSRUWDPHQWDLVGHSURFHVVDPHQWRDXGLWLYR (VWHVVmRGHVFULWRVFRPRSLFRVSRVLWLYRV3HQHJDWLYRV1RV TXDLVUHSUHVHQWDPDDWLYLGDGHFRUWLFDOUHODFLRQDGDjVKDELOL-GDGHVGHDWHQomRGHPHPyULDHGHGLVFULPLQDomRDXGLWLYD

)D]HPSDUWHGRV3($//DVRQGDVSRVLWLYR3QHJDWLYR 1SRVLWLYR3QHJDWLYR1HSRVLWLYR3 VHQGRVXEGLYLGLGDVHPSRWHQFLDLVH[yJHQRV3131 RVTXDLVVmRLQÁXHQFLDGRVSHODVFDUDFWHUtVWLFDVItVLFDVGR HVWtPXORFRPRLQWHQVLGDGHGXUDomRIUHTXrQFLDHSRWHQFLDO HQGyJHQR3LQÁXHQFLDGRSUHGRPLQDQWHPHQWHSRUHYHQWRV relacionados às habilidades cognitivas.1

3DUDREWHQomRGRVSRWHQFLDLVFRUWLFDLVVmRXWLOL]DGRVHVWt-PXORVIUHTXHQWHVHUDURVSDUDGLJPDoddball2VHVWtPXORV

PDLVXWLOL]DGRVQDSUiWLFDFOtQLFDVmRRVGHtone burst, repre-VHQWDGRVSRUXPDIUHTXrQFLDPDLVJUDYHHVWtPXORIUHTXHQWH HXPDIUHTXrQFLDPDLVDJXGDHVWtPXORUDUR&RQWXGRXPD VpULHGHGLIHUHQWHVHVWtPXORVFRPRFRQWUDVWHVGHYRJDLVGH VtODEDVGHSDODYUDVHDWpPHVPRGHVHQWHQoDVSRGHPVHU utilizados para evocar esses potenciais.2,3

Alguns estudos4,5

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GRVSRWHQFLDVFRUWLFDLVFRPHVWtPXORVGHIDODDOJXPDVSHVTXLVDV UHIHUHPTXHHVVHVVHULDPLGHDLVSDUDRHVWXGRGDVEDVHVQHXUDLV GDGHWHFomRHGLVFULPLQDomRGDIDOD3,6_{contribuindo para}

infor-PDo}HVDGLFLRQDLVGRSURFHVVDPHQWRGHVLQDLVFRPSOH[RV Os estímulos de fala têm sido utilizados para fornecer in-IRUPDo}HVGRSURFHVVDPHQWRGRVLQDOGHIDODHPVLWXDo}HV HPTXHDDYDOLDomRFRPSRUWDPHQWDOQmRpXPPpWRGRSUH-FLVRDX[LOLDQGRQDLGHQWLÀFDomRGHDOWHUDo}HVGHGHWHFomR RXGLVFULPLQDomRGHIDOD7

&RPEDVHQRH[SRVWRHSHODQHFHVVLGDGHGHFDUDFWHUL]DomR dos potenciais corticais com diferentes estímulos, o objetivo deste estudo foi comparar a latências dos potencias corticais P1, N1, P2, N2 e P3 e a amplitude do P3 com diferentes es-tímulos de fala e tone burst.

Método

(VWDSHVTXLVDIRLDSURYDGDQR&RPLWrGHeWLFDHP3HVTXLVD &(3VRERSURWRFROR

Os indivíduos assinaram o termo de consentimento livre e HVFODUHFLGR7&/(FRQFRUGDQGRFRPRVREMHWLYRVGRHVWXGR HFRPDSDUWLFLSDomRQRPHVPR

(3)

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2SDFLHQWHIRLRULHQWDGRDSUHVWDUDWHQomRDRVHVWtPXORV GLIHUHQWHVHVWtPXORUDURTXHDSDUHFLDPDOHDWRULDPHQWH GHQWURGHXPDVpULHGHHVWtPXORVLJXDLVHVWtPXORIUHTXHQ-WH$SRUFHQWDJHPGHDSUHVHQWDomRGRVHVWtPXORVUDURVIRL GHHQTXDQWRTXHSDUDHVWtPXORVIUHTXHQWHVIRLGH

)RUDPXWLOL]DGRVHVWtPXORVQmRYHUEDLVtone burstQDV IUHTXrQFLDVGH+]HVWtPXORIUHTXHQWHH+] HVWtPXORUDURHYHUEDLVVtODEDVEDHVWtPXORIUHTXHQWH HJDGDHGLHVWtPXORVUDURVDSUHVHQWDGRVGHIRUPD binaural, a uma intensidade de 75 dB NA. Para cada tipo de HVWtPXORYHUEDOQmRYHUEDOIRUDPXWLOL]DGRVHVWtPXORV DSUR[LPDGDPHQWHIUHTXHQWHVHUDURVSDUDDREWHQ-omRGRVSRWHQFLDLV2VWUDoDGRVQmRIRUDPUHSOLFDGRVYLVWR TXHDUHSOLFDomRGRPHVPRSRGHWUDQVIRUPDURHVWtPXORUDUR HPIUHTXHQWHSDUDRSDFLHQWH2VSDUkPHWURVVmRGHVFULWRV na tabela 1.

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A audiometria tonal liminar foi realizada em cabina acus- WLFDPHQWHWUDWDGDFRPRDXGL{PHWUR,WHUD,,GDPDUFD0DG-VHQ)RUDPSHVTXLVDGRVRVOLPLDUHVGHYLDDpUHDQDV IUHTXrQFLDVGHH +]$WpFQLFDXWLOL]DGDIRLGHVFHQGHQWHDVFHQGHQWH )RUDPFRQVLGHUDGRVLQGLYtGXRVQRUPRRXYLQWHVDTXHOHVTXH DSUHVHQWDUDPPpGLDWULWRQDOH+]G% 1$GHFLEHOQtYHOGHDXGLomR8

As medidas de imitância acústica foram realizadas pelo DQDOLVDGRUGHRUHOKDPpGLD$7GDInteracoustics, para SHVTXLVDGDFXUYDWLPSDQRPpWULFDHGRVUHÁH[RVDF~VWLFRV 2VUHIOH[RVIRUDPSHVTXLVDGRVQDVIUHTXrQFLDVGHD +]ELODWHUDOPHQWHQRPRGRFRQWUDODWHUDO)RUDPLQ-cluídos na amostra somente indivíduos com timpanograma WLSR$HUHÁH[RVDF~VWLFRVSUHVHQWHV9

3DUDDSHVTXLVDGRVSRWHQFLDLVHYRFDGRVDXGLWLYRVGHORQJD ODWrQFLDIRLXWLOL]DGRRHTXLSDPHQWRIntelligent Hearing

Sys-Tabela 1 Média e desvio padrão para os componentes P1, N1, P2, N2 e P3 com todos estímulos de fala (BA-GA/BA-DA/ BA-DI) e tone burst_(1.000_⫻_4.000)

9DULiYHLV Estímulos p*

BA ⫻ GA BA ⫻ DA BA ⫻ DI 1.000 ⫻ 4.000 Hz

n 0pGLD '3 n 0pGLD '3 n 0pGLD '3 n 0pGLD '3

P1

2' 26 62,2 8,1 27 59,8 8,1 25 65,5 18,3 22 62,2 11,9 0,393

OE 25 62,6 10,9 25 60,4 7,0 25 67,2 17,5 21 64,1 13,3 0,382

p-valor* 0,909 0,944 0,057 0,557

N1

2' 30 103,8ab _10,4 ₃₀ _103,3ab _11,9 ₃₀ _107,8ª _18,2 ₃₀ _99,3b _14,7 _0,038 OE 30 108,3 10,5 30 103,7 10,9 30 109,3 17,9 30 101,9 16,2 0,067

p-valor < 0,001 0,726 0,178 0,135

P2

2' 30 173,2ab _19,9 ₃₀ _175,7ab _20,4 ₃₀ _182,7ª _26,2 ₃₀ _171,5b _26,7 _0,026 OE 30 176,9b _17,0 ₃₀ _175,5b _24,5 ₃₀ _187,1ª _24,1 ₃₀ _175,5b _28,6 _0,017

p-valor 0,140 0,945 0,016 0,153

N2

2' 23 245,7ab _37,0 ₁₆ _237,1b _43,4 ₁₄ _251,6ª _37,7 ₁₀ _216,4c _34,8 _0,006 OE 22 255,3ab _29,6 ₁₄ _232,6b _38,7 ₁₃ _261,4ª _33,2 ₁₃ _218,5c _39,2 _0,003

p-valor 0,188 0,526 0,720 0,517

P3

2' 26 341,7a _44,2 ₂₆ _301,5c _47,5 ₂₅ _324,2b _59,2 ₂₅ _297,0b _27,3 _0,005 OE 26 344,4a _46,5 ₂₈ _303,4c _46,3 ₂₁ _329,9ab _63,4 ₂₄ _300,4b _36,4 _0,002

p-valor 0,171 0,325 0,619 0,163

Amplitude do P3

2' 27 6,2 2,2 30 6,9 5,3 24 6,3 2,8 26 5,8 2,1 0,208

OE 26 6,6b _2,1 ₂₈ _7,8ª _5,4 ₂₁ _6,7b _2,5 ₂₄ _6,1c _2,3 _0,027

p-valor 0,700 0,095 0,999 0,737

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&RQVLGHUDQGRRFRPSRQHQWH1IRLREVHUYDGDGLIHUHQoD VLJQLÀFDQWHSYDORUHSDUD2'H2(UHVSHFWLYD- PHQWHHQWUHDODWrQFLDHQFRQWUDGDHPUHODomRDRVGLIHUHQ-WHVHVWtPXORVVHQGRTXHSDUDRtone burst encontrou-se a PHQRUODWrQFLDHSDUDRHVWtPXOR%$',DPDLRUODWrQFLDQR componente.

1RTXHGL]UHVSHLWRDRFRPSRQHQWH3KRXYHGLIHUHQoD FRPVLJQLÀFkQFLDSYDORUHSDUD2'H2(UHV- SHFWLYDPHQWHHQWUHRVHVWtPXORVXWLOL]DGRVHDODWrQFLDHQ-contrada. Com tone burst foi encontrada a menor latência e FRPRHVWtPXOR%$*$DPDLRUODWrQFLD

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,QGHSHQGHQWHPHQWHGRHVWtPXORXWLOL]DGRKRXYHSUHVHQoD GRVFRPSRQHQWHVVHPGLIHUHQoDVHVWDWtVWLFDVHQWUHHOHV1D tabelaVmRDSUHVHQWDGDVDVHVWLPDWLYDVSDUDDVGLVWULEXLo}HV absoluta e relativa.

$SHVTXLVDLQLFLRXFRPRVSDUHVEDHJDVHJXLGRGH EDHGLEDHGDHtone burst

VHQGRTXHDQWHULRU-PHQWHjREWHQomRGRVWUDoDGRVIRUDPDSUHVHQWDGRVWRGRV os estímulos de fala e tone burst

SDUDTXHRSDFLHQWHSX-GHVVHVHIDPLOLDUL]DUFRPRVGLIHUHQWHVHVWtPXORV$SyVD SHVTXLVDGRVGRLVSULPHLURVHVWtPXORVGHIDODRSDFLHQWHIRL RULHQWDGRDUHSRXVDUSDUDTXHRFDQVDoRQmRLQWHUYLHVVHQDV UHVSRVWDVGDVGXDV~OWLPDVVHTXrQFLDVGHHVWtPXORV

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Os dados foram tabelados e analisados estatisticamente, tendo sido comparadas as latências dos componentes P1, N1, P2, N2 e P3 entre os estímulos de fala e tone burst.

Resultados

Os resultados apresentados referem-se a uma amostra de LQYHVWLJDGRVFRPPpGLDGHLGDGHGHDQRV VHQGRDPtQLPDGHHDPi[LPDGHDQRV(PUHODomRDR JrQHURDGLVWULEXLomRVHPRVWURXLJXDOFRPQ de homens e mulheres.

Tabela 2 Distribuição absoluta e relativa a presença e ausência de informação sobre os dados para os componentes P1, N1, P2, N2 com todos estímulos de fala (BA-GA/BA-DA/BA-DI) e tone burst_(1.000_⫻_4.000)

9DULiYHLV Estímulos

BA ⫻ GA BA ⫻ DA BA ⫻ DI 1.000 ⫻ 4.000 Hz

6LP 1mR 6LP 1mR 6LP 1mR 6LP 1mR

n % n % n % n % n % n % n % n %

P1

2' 26 86,7 4 13,3 27 90,0 3 10,0 25 83,3 5 16,7 22 73,3 8 26,7

OE 25 83,3 5 16,7 25 83,3 5 16,7 25 83,3 5 16,7 21 70,0 9 30,0

N1

2' 30 100,0 0 0,0 30 100,0 0 0,0 30 100,0 0 0,0 30 100,0 0 0,0 OE 30 100,0 0 0,0 30 100,0 0 0,0 30 100,0 0 0,0 30 100,0 0 0,0

P2

2' 30 100,0 0 0,0 30 100,0 0 0,0 30 100,0 0 0,0 30 100,0 0 0,0 OE 30 100,0 0 0,0 30 100,0 0 0,0 30 100,0 0 0,0 30 100,0 0 0,0

N2

2' 23 76,7 7 23,3 16 53,3 14 46,7 14 46,7 16 53,3 10 33,3 20 66,7

OE 22 73,3 8 26,7 14 46,7 16 53,3 13 43,3 17 56,7 13 43,3 17 56,7

P3

2' 26 86,7 4 13,3 26 86,7 4 13,3 25 83,3 5 16,7 25 83,3 5 16,7

OE 26 86,7 4 13,3 28 93,3 2 6,7 21 70,0 9 30,0 24 80,0 6 20,0

Amp P3

(5)

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&RQWXGRVDEHPRVTXHRSRWHQFLDOHYRFDGRDXGLWLYRFRJ-nitivo P3 gerado por estímulo de fala pode ser utilizado, WDPEpPSDUDIRUQHFHULQIRUPDo}HVGRSURFHVVDPHQWRGR sinal de fala, e, segundo o autor,11HVWHHVWtPXORDX[LOLDQD

LGHQWLÀFDomRGHDOWHUDo}HVQDGHWHFomRRXGLVFULPLQDomR LQIRUPDomRHVWDTXHSRGHGLUHFLRQDUDUHDELOLWDomRWHUDSrX-tica de um indivíduo.

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Conclusão

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Con

Á

itos de interesse

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Referências

1. 'XDUWH-/$OYDUHQJD.)%DQKDUD050HOOR$'36iV50)LOKR

OAC. Potencial evocado auditivo de longa latência-P300 em

in-GLYtGXRVQRUPDLVYDORUGRUHJLVWURVLPXOWkQHRHP)]H&] %UD]-2WRUKLQRODU\QJRO

2. *URHQHQ3$3%H\QRQ$-6QLN$)09DQ%36SHHFKHYRNHGFRU

-tical potentials and speech recognition in cochlear implant

us-HUV6FDQG$XGLRO

3. .RUF]DN3$.XUW]EHUJ'6WDSHOOV'5(IIHFWVRIVHQVRULQHXUDO

hearing loss and personal hearing aids on cortical event-relat-ed potential and behavioral measures of speech-sound

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Discussão

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entre os estímulos de fala e tone burstTXDQWRjODWrQFLDGRV FRPSRQHQWHVH[yJHQRVHDODWrQFLDHDDPSOLWXGHGRFRP-SRQHQWHHQGyJHQR3 1RSUHVHQWHHVWXGRTXDQGRFRPSDUDGDVjVODWrQFLDVGRV FRPSRQHQWHVSDUD313QmRKRXYHGLIHUHQoDHQWUHRV TXDWURHVWtPXORVXWLOL]DGRVtabela'HQWUHRVSULQFLSDLV FRPSRQHQWHVHQGyJHQRVHQFRQWUDPVHDVRQGDV1HR3RV TXDLVHYLGHQFLDUDPGLIHUHQoDVQDVODWrQFLDVTXDQGRFRPSDUD- GRVRVTXDWURHVWtPXORVVHQGRPHQRUSDUDDPERVRVFRPSR-nentes com o tone burstPDLRUSDUDR3FRPHVWtPXOR%$

*$HDLQGDPDLRUSDUD1FRPHVWtPXOR%$',tabela (VVHDFKDGRpFRQVRDQWHFRPRHVWXGR10_{TXHUHIHUHTXHR}

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TXHUHIHUHTXHRWLSRGHHV-WtPXORXWLOL]DGRpXPDYDULiYHOLPSRUWDQWHQDREWHQomRGRV componentes N2 e P3. Os estímulos verbais constituem tare-IDGHGLÀFXOGDGHGHHVFXWDPDLRUTXDQGRFRPSDUDGDFRPD GLVFULPLQDomRGHHVWtPXORVQmRYHUEDLV$OJXQVDXWRUHV15,16 REVHUYDUDPTXHDODWrQFLDGR3DXPHQWDTXDQGRRV´DOYRVµ SDUDGLVFULPLQDomRVmRPDLV´GLItFHLVµGRTXHRSDGUmRRX VHMDDODWrQFLDpVHQVtYHOjGHPDQGDGRSURFHVVDPHQWRGD tarefa. 1RSUHVHQWHHVWXGRKRXYHLQÁXrQFLDGRHVWtPXORGHIDOD QRFRPSRQHQWH1HHVVHIDWRMiIRLREVHUYDGRSRUDXWRUHV17 TXHFLWDPRUHJLVWURGRFRPSRQHQWH1FRPRHVWDQGRUHOD-FLRQDGRFRPRSURFHVVDPHQWRGHLGHQWLÀFDomRHDWHQomRDR HVWtPXORUDURFRPFRUUHODomRSRVLWLYDHQWUHRYDORUGHVXD ODWrQFLDHRQtYHOGHGLÀFXOGDGHGDWDUHIDGHGLVFULPLQDomR Em outro estudo,10_{o mesmo fato foi observado, onde o N2}

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$DPSOLWXGHGRSRWHQFLDO3pGHVFULWDFRPJUDQGHYD-riabilidade na literatura,19-21_{HVWDQGRDIDL[DGHQRUPDOLGDGH}

para amplitude do P300 entre 1,7 μV a 19,0 μV.

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17. 1RYDN*35LWWHU:9DXJKDQ+*-U:L]QLW]HU0/'LIIHUHQWLD -tion of negative event-related potentials in an auditory dis-crimination task. Electroencephalogr Clin Neurophysiol.

18. *HDO'RU0.DPHQLU<%DENRII+(YHQWUHODWHGSRWHQWLDOV (53VDQGEHKDYLRUDOUHVSRQVHVFRPSDULVRQRIWRQDOVWLPXOLWR

speech stimuli in phonological and semantic tasks. J Basic Clin

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cortical auditory evoked potentials. Braz J Otorhinolaryngol.

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with verbal and nonverbal stimuli in normal hearing adults.

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dos potenciais evocados auditivos de longa latência. Braz J

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and perception of speech signals in informational masking. Ear

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