Programa Associado de Pós-Graduação em Fonoaudiologia
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Master Thesis Concordância entre procedimentos de triagem auditiva e o teste de dígitos no ruído (TDR) em estudantes(Universidade Federal do Rio Grande do Norte, 2025-12-01) Oliveira, Ranielly Nóbrega de; Balen, Sheila Andreoli; Araújo, Aryelly Dayane da Silva Nunes; https://orcid.org/0000-0002-3814-2675; http://lattes.cnpq.br/3932225932295114; http://lattes.cnpq.br/3487546022829633; http://lattes.cnpq.br/5116738594130098; Cavalcanti, Hannalice Gottschalck; https://orcid.org/0000-0003-2327-8040; http://lattes.cnpq.br/6975482659120440; Comerlatto Júnior, Ademir Antonio; https://orcid.org/0000-0003-2746-0851; http://lattes.cnpq.br/6132323467519862Introduction: Identifying hearing loss in students is essential to ensure adequate educational and social development. Objective: To assess the agreement between auditory screening procedures and the Hearing-in-Noise Test (HINT) adapted as the Digits-in-Noise Test (DIN) in students. Method: This was a cross-sectional study conducted with 83 students from the Federal Institute of Rio Grande do Norte – Parnamirim Campus (52.2% female; 15 to 45 years old; mean age = 19.79 years), who underwent audiometric screening, transient-evoked otoacoustic emissions (TEOAE) screening, distortion product otoacoustic emissions (DPOAE) screening, tympanometric screening, and the Digits-in-Noise Test (DIN) in diotic and antiphasic modes. The DIN was administered via an online link on a smartphone using headphones, following an automated adaptive procedure, with cut-off points of –6.7 dB SNR (diotic) and –11 dB SNR (antiphasic). Agreement between procedures was analyzed using Fleiss’ Kappa and Cohen’s Kappa indices. Results: The diotic DIN showed the highest pass rate (98.80%), followed by the antiphasic DIN and DPOAEs (91.57%). The highest failure rate occurred in the TEOAEs (42.17%). Overall agreement between procedures was low (Fleiss’ kappa = –0.20), and pairwise agreement ranged from slight to regular agreement among tests, with the highest agreement observed between tympanometry and DPOAEs. Conclusion: The DIN, particularly in the antiphasic mode, shows greater agreement with otoacoustic emissions in failure outcomes. Nevertheless, the sample size and differences in the distribution of outcomes may have limited the results. The DIN is a functional and promising tool for identifying hearing difficulties related to speech-in-noise recognition, although it does not replace traditional methods. The combination of different procedures contributes to a more sensitive hearing screening process among students.Master Thesis Codificação neural de sons de fala em lactentes com citomegalovírus congênito e adultos normo-ouvintes(Universidade Federal do Rio Grande do Norte, 2025-09-23) Câmara, Lara Louise Pinto; Balen, Sheila Andreoli; http://lattes.cnpq.br/3487546022829633; https://orcid.org/0000-0002-2716-7906; http://lattes.cnpq.br/2717831726629612; Carnaúba, Aline Tenório Lins; https://orcid.org/0000-0003-4100-6866; http://lattes.cnpq.br/5017815237151501; Sanfins, Milaine Dominici; https://orcid.org/0000-0002-3647-3999; http://lattes.cnpq.br/5730428419438808Master Thesis Disfunção vestibular e alterações posturais na população pediátrica com citomegalovírus congênito: uma revisão sistemática(Universidade Federal do Rio Grande do Norte, 2025-06-17) Calheiros, Karine Christine Gusmão de Freitas; Mantello, Erika Barioni; Taveira, Karinna Verissimo Meira; http://lattes.cnpq.br/0851971851975853; https://orcid.org/0000-0003-3200-5474; http://lattes.cnpq.br/9843066941267902; http://lattes.cnpq.br/3984816240846247; Anastasio, Adriana Ribeiro Tavares; Balen, Sheila Andreoli; http://lattes.cnpq.br/3487546022829633Congenital cytomegalovirus (CMV) is considered the most common etiology of congenital infection and its main sequela is sensorineural hearing loss. Considering the prevalence of sensorineural hearing loss in this population and the anatomical proximity of the cochlear and vestibular organs in the inner ear, vestibular disorders may also occur in children affected by congenital CMV infection. This study aimed to verify the presence of vestibular alterations and postural balance disorders in the pediatric population with congenital CMV infection. This is a systematic review conducted and reported according to PRISMA and registered in the International prospective register of systematic reviews- PROSPERO, under registration CRD42024549387. Five electronic databases (Embase, LILACS, PubMed/MEDLINE, Scopus and Web of Science) were searched, in addition to the gray literature (Google Scholar and ProQuest Dissertations and Theses). The following inclusion criteria were used: studies conducted in children aged 0 to 12 years, diagnosed with congenital CMV infection, performed through urine or saliva samples in the first 21 days of life, neonatal blood samples, serological tests or molecular tests; articles that addressed the assessment of vestibular function and body balance, and that compared symptomatic groups with asymptomatic groups and/or with healthy children. A metaanalysis was performed to estimate the association between vestibular alterations and cytomegalovirus, as well as the combined proportion of these alterations. A randomeffects model was used and subgroup analyses were performed according to the presence of symptoms. The risk of bias was assessed using the Joanna Briggs Institute Critical Appraisal Checklist, and the certainty of the evidence was assessed using the GRADE tool. Only articles from randomized clinical trials and observational studies were selected. The search in the databases resulted in the identification of 2,840 studies and, subsequently, eight observational articles were considered eligible for qualitative synthesis. All included articles reported vestibular and/or body balance alterations in the group with congenital CMV infection. The meta-analysis indicated an approximately ten-fold higher risk of manifestation of vestibular alterations in this group compared to the control group (95% CI: 2.42–40.29). The analysis of the risk of bias identified that most of the studies were of moderate/high quality. The certainty of the evidence was considered very low according to the GRADE tool. In addition, there was a higher frequency of alterations in children with symptomatic than asymptomatic congenital CMV infection. Among the included studies, 50% were cohort studies and 50% were case-control studies; 100% were published in English; the sample size ranged from 24 to 185 children with congenital CMV infection, aged between zero and 11 years. The most commonly used tests were VEMP and vHIT. It is concluded that there is an approximately ten-fold higher risk of children with congenital CMV infection presenting vestibular alterations, compared to the control group. Furthermore, the estimate of the combined proportion of vestibular alterations was higher in symptomatic individuals. Similarly, children with symptomatic congenital CMV infection showed higher rates of alteration in postural balance tasks, compared to the groups with asymptomatic congenital CMV infection and the control group, in the included studies.Master Thesis Instrumentos de avaliação de leitura de palavras e pseudopalavras: revisão e aplicabilidade(Universidade Federal do Rio Grande do Norte, 2025-03-10) Lima, João Victor Silva de Barros; Azoni, Cintia Alves Salgado; Navas, Ana Luiza Gomes Pinto; http://lattes.cnpq.br/0754347427711718; https://orcid.org/0000-0003-2175-9676; http://lattes.cnpq.br/4935645902363577; https://orcid.org/0000-0002-5071-3645; http://lattes.cnpq.br/5385599236907304; Alves, Luciana Mendonça; https://orcid.org/0000-0002-6403-4117; http://lattes.cnpq.br/6377992247953380; Mousinho, RenataObjective: To analyze the psycholinguistic variables of stimuli derived from a database of words and pseudowords, and to support the validation and development of screening tools and assessment instruments for reading. Method: Study 1 consisted of a scoping review following PRISMA-ScR guidelines, using the PCC (Population, Concept, and Context) strategy. Relevant studies were identified in six international databases. Studies that employed oral reading assessment instruments for schoolchildren aged 6 to 14 years and 11 months were included. Study 2 involved 262 first-, second-, and third-grade elementary school children, individually assessed using the Fluency IDB Portuguese application, which presents stimuli controlled by syllabic complexity. Results: Study 1 analyzed 16 studies and identified 11 assessment instruments with variations in syllabic complexity, regularity, and frequency of words and pseudowords, but found a lack of validation descriptions. Study 2 showed that reading performance was influenced by school year, stimulus type, and syllabic complexity, demonstrating that simpler structures were read more easily. Conclusion: Study 1 highlighted that the lack of validation information on assessment instruments may compromise the accuracy of reading evaluations. Study 2 reinforced the impact of syllabic complexity on reading fluency and emphasized the importance of validated instruments for effective assessment of reading difficulties, enabling more precise interventions in both clinical and educational contexts.Master Thesis Conhecimento e atitudes sobre saúde auditiva infantil de gestantes e puérperas: uma intervenção guiada por vídeo educativo(Universidade Federal do Rio Grande do Norte, 2025-03-07) Mariz, Ana Clara Lopes; Araújo, Eliene Silva; https://orcid.org/0000-0002-3675-4651; http://lattes.cnpq.br/5637269791915082; https://orcid.org/0000-0003-2987-1590; http://lattes.cnpq.br/7400334901157699; Cavalcanti, Hannalice Gottschalck; https://orcid.org/0000-0003-2327-8040; http://lattes.cnpq.br/6975482659120440; Dutra, Monique Ramos Paschoal; https://orcid.org/0000-0002-3973-5704; http://lattes.cnpq.br/7236165628224190Introduction: Parents' knowledge about neonatal hearing screening (NHS), risk indicators for hearing impairment, and attitudes towards hearing loss directly influences child care. Educational videos have been effective in promoting hearing health. Objective: To validate an educational video on child hearing health and assess its impact on the knowledge and attitudes of pregnant women and puerperal woman. Method: The dissertation is structured into two articles. The first is a descriptive study aimed at validating a video as a tool for education in child hearing health. Initially, the video validation was conducted with five specialists, and in the second stage, 50 mothers evaluated their satisfaction with the video using a standardized questionnaire and the Net Promoter Score (NPS). The second study consists of a triple-blind randomized clinical trial, seeking to compare the impact of the educational intervention on child hearing health on the level of knowledge and information retention during pregnancy and the postpartum period. The study involved 60 pregnant women and 80 puerperal woman, with each population divided into two randomized groups: 30 pregnant women and 40 puerperal woman in the intervention group (IG) and the same number from each population in the comparison group (CG). Participants were subjected to a questionnaire on knowledge and attitudes regarding child hearing health, both before and immediately after exposure to the educational video (targeted for IG or about breastfeeding for CG). To assess medium-term information retention, puerperal woman in the IG were re-evaluated with the questionnaire three months after the intervention. Results: In the first study, it was observed that the video was well evaluated from both the specialists' and the target population's perspectives, showing a tendency towards satisfaction with the educational tool used. Specific suggestions for video improvement were noted by the specialists, and 84.0% of the mothers would give positive feedback (promoters), while 14.0% were indifferent. In the second study, an increase in knowledge was observed for both pregnant women (p<0.001) and puerperal woman (p<0.001) when comparing pre- and post-intervention moments in the IG. The comparison between IG and CG post-intervention demonstrated greater knowledge for the groups subjected to the intervention in both populations (p<0.001). On the other hand, when comparing the amount of information assimilated between pregnant women and puerperal woman, no difference was found (p=0.686), indicating that mothers were able to assimilate the knowledge conveyed at both moments of motherhood. Furthermore, for the IG of puerperal woman, there was no difference between knowledge immediately post-intervention and three months after the intervention (p=0.090). Conclusion: The educational video "Hearing Pills" was validated as an effective tool for education in child hearing health. In the first study, specialists and the target population positively evaluated the material, highlighting its appropriateness and relevance. In the second study, it was found that the video significantly increased knowledge on the topic among pregnant women and puerperal woman, with medium-term information retention. The findings indicate that both moments are opportune for educational intervention, enabling mothers to take an active role in their children's hearing health.Master Thesis Análise da aplicabilidade de um protocolo de avaliação da linguagem via teleconsulta para crianças com risco e com diagnóstico de deficiência auditiva(Universidade Federal do Rio Grande do Norte, 2025-03-28) Pereira, Rhadimylla Nágila; Brazorotto, Joseli Soares; https://orcid.org/0000-0002-3891-9819; http://lattes.cnpq.br/8038447445698925; http://lattes.cnpq.br/0879414917473239; Assenco, Ana Manhani Caceres; Moret, Adriane Lima MortariIntroduction: The unequal distribution of specialized professionals has spurred research in digital health to address the needs of oral language care in childhood, given that language delays are common complaints during this period. In this sense, this dissertation, composed of two research articles presented below, aimed to contribute to the field. Article 1: A scoping review investigated: “Which instruments are applicable for screening and assessing oral language in early childhood using digital health?” Studies were included if they utilized screening and assessment tests for oral language via teleconsultation, applications, and web-based tools, without restrictions on time, language, or ethnicity, in clinical, educational, and non-clinical settings. The databases consulted were PubMed, Web of Science, LILACS, Embase, and Scopus, in addition to gray literature via Google Scholar and ProQuest Dissertations and Theses. Out of 2,435 studies identified, 20 comprised the final sample. Eleven studies evaluated language skills screening and nine investigated digital language assessment. Fourteen studies adapted previously validated in-person tests to an online format; four developed specific teleconsultation tools, and two conducted synchronous or asynchronous observations without defined protocols. Most research was conducted in clinical settings with speech-language pathologists, although community health workers also participated in some studies. Videoconferencing was the most frequently used digital modality. The findings of this review reinforce the feasibility of telehealth for screening and assessing oral language, highlighting the need for further research to consolidate evidence-based practice in teleaudiology Article 2: This prospective clinical study, approved by an Institutional Ethics Committee (protocol no. 6.754.773), involved 12 children of both sexes, aged between 21 and 74 months. Of these, seven had bilateral sensorineural hearing loss ranging from moderate to profound, and five exhibited language alterations without confirmed hearing loss. All were evaluated using the Behavioral Observation Protocol (PROC), administered both remotely and in person by trained, blinded researchers. Agreement between scores obtained in each session was assessed using the intraclass correlation coefficient (ICC) and the Kappa index, comparing in-person and remote evaluations. Results: In the hearing-impaired group, the ICC for the overall score was 0.964 (p ≤ 0.05), and in the at-risk group, it was 0.888 (p ≤ 0.05), with a Kappa of 1.0 (p ≤ 0.05) for both groups. In the at-risk group, variable ICCs were observed when analyzing the individual sections of the PROC separately. Conclusion: Language assessment via synchronous teleconsultation using the PROC demonstrated clinical applicability in the studied population.Master Thesis Práticas de leitura familiar nos pré-escolares(Universidade Federal do Rio Grande do Norte, 2025-03-28) Ferreira, Mirelly Danglês de Oliveira; Azoni, Cintia Alves Salgado; https://orcid.org/0000-0003-2175-9676; http://lattes.cnpq.br/4935645902363577; http://lattes.cnpq.br/5847388240781179; Silva, Júlia Beatriz Lopes; Reis, Vanessa de Oliveira MartinsIntroduction: Family literacy is a construct of practices that includes all the resources, experiences and supports related to skills that promote children's development at home, including the ways in which they engage in literacy activities with other family members. When thinking about the importance for learning, family literacy practices can shape learning development, including in the areas of vocabulary, letter knowledge and reading comprehension. Objective: To analyze family literacy practices in preschool children and their impact on children with developmental risks. Methods: This is a two-part study: (1) a scoping review reported according to the Preferred Reporting Items for Systematic reviews and Meta-Analyses extension for Scoping Reviews (PRISMA-ScR); (2) a longitudinal, prospective and qualitative study that will be carried out between August 2024 and January 2025. The study population consisted of 8 children of both genders, aged between 15 months and 2 years and 6 months. Results: (1) 29 studies were included in the final synthesis of the scoping review, which revealed a predominance of informal practices. Among the activities carried out, the most cited was reading books, followed by shared reading. (2) When it came to analyzing the effectiveness of family literacy practices, the results showed that in communication skills, the children performed below expectations in the pre-intervention assessment and post-intervention improvements. Conclusion: Based on the findings, it was observed that the literacy practices of the Conta pra Mim Program were beneficial for the oral language development of children at risk of development.Master Thesis Sinaptopatia coclear relacionada à idade em ratos: o uso do potencial evocado auditivo de tronco encefálico(Universidade Federal do Rio Grande do Norte, 2025-03-06) Silva, Maria Gabriela Paz da; Araújo, Eliene Silva; https://orcid.org/0000-0002-3675-4651; http://lattes.cnpq.br/5637269791915082; https://orcid.org/0000-0003-4938-3949; http://lattes.cnpq.br/1738023168769094; Andrade, Kelly Cristina Lira de; Alvarenga, Kátia de FreitasIn the natural aging process, there is a reduction in synapses between the inner hair cells of the organ of Corti and the neurons of the spiral ganglion in the auditory nerve, a phenomenon known as cochlear synaptopathy (CS). Studies suggest that shortlatency auditory evoked potentials (AEPs) can identify CS, but there are still gaps in the protocols and parameters used for its identification in clinical settings. Objective: To evaluate the use of short-latency AEPs in identifying age-related CS in rodents. Method: Two studies were conducted. The first was a systematic review with a metaanalysis, registered in PROSPERO (CRD42025615318), aiming to synthesize data on the accuracy of short-latency AEPs in identifying CS in aging rodents. The review followed the Preferred Reporting Items for a Systematic Review and Meta-analysis of Diagnostic Test Accuracy Studies (PRISMA-DTA) guidelines, searching the PUBMED/MEDLINE, Cochrane Library, Scopus, Embase, Web of Science, Scielo, LILACS databases, and gray literature. Article selection was performed independently and blindly by two reviewers, using the Rayyan and EndNote tools. No restrictions were applied regarding publication period or language. The second study was a crosssectional observational study, approved by the Animal Use Ethics Committee (2024- 02-ISD). Ten healthy Wistar rats of both sexes, with no prior noise exposure, were divided into age groups: G1 (3–4 months), G2 (10 months), G3 (14–15 months), and G4 (24 months). The animals underwent Auditory Brainstem Response (ABR) recording with click stimuli, alternating polarity at 90, 85, and 80 dBnHL, and stimulation rates of 33.1, 15.1, and 7.1 clicks/s. The amplitudes of waves I and IV were blindly analyzed by two specialists. Data were subjected to descriptive and inferential statistical analysis using IBM Statistical Package for the Social Sciences (SPSS), with a significance level of p<0.05. Results: In Study 1, 2,821 articles were identified, of which 15 were included in the systematic review, and seven were suitable for metaanalysis. All studies used the ABR to identify CS, with wave I amplitude being the most frequently reported biomarker. In Study 2, inter-examiner agreement was excellent (>90%). The mean amplitude was 1.33±0.69μV for wave I and 0.75±0.62μV for wave IV. There was an influence of sex, age, and stimulation rate, with wave I showing greater amplitude at 7.1 clicks/s compared to 33.1 clicks/s. Conclusion: The ABR demonstrated diagnostic performance in identifying SC in rodents, with the amplitude of wave I as a relevant biomarker and a clear effect of the stimulation rate. The findings reinforce the use of click-evoked ABR in SC investigation and provide support for future studies.Master Thesis Obtenção de evidências de validade com base no conteúdo e nos processos de resposta do DEGLUTO: Instrumento de Avaliação Clínica da Deglutição(Universidade Federal do Rio Grande do Norte, 2025-03-10) Alves, Jadson Stheferson Dutra; Magalhães Júnior, Hipólito Virgílio; Pernambuco, Leandro de Araújo; https://orcid.org/0000-0002-8469-9570; http://lattes.cnpq.br/6690138144458483; http://lattes.cnpq.br/1697939517271283; Almeida, Anna Alice Figueirêdo de; Sugueno, Lica ArakawaOropharyngeal dysphagia is a prevalent condition in various clinical populations and can lead to complications such as malnutrition, dehydration, and aspiration pneumonia. Structured clinical assessment is essential for the proper management of dysphagia, requiring reliable and validated instruments. Given the need for a protocol adapted to the Brazilian reality, the DEGLUTO: Swallowing Assessment Instrument at the Bedside was developed, and its validation process is the focus of this dissertation. This is a methodological study divided into two phases. The first phase involved obtaining evidence of validity based on content, conducted through the Delphi method, with the participation of 13 dysphagia expert judges. The instrument's items were analyzed for relevance, clarity, and alignment with the evaluated construct. Seven items were removed, and twenty-one. was reformulated, resulting in a preliminary version with 21 items. The second phase consisted of obtaining evidence of validity based on response processes through the application of the instrument by eight speech-language pathologists in hospital and outpatient settings. The professionals assessed the clarity and applicability of the items, as well as patients' understanding during the evaluation. Statistical analysis included the Content Validity Index (CVI), the Content Validity Coefficient (CVC), and the Kappa coefficient to assess agreement among raters. The results demonstrated high agreement for most items, except for one, which was removed, leading to the preliminary final version of DEGLUTO with 20 items. The study provided evidence that the instrument has clarity, relevance, and clinical applicability, contributing to the qualification of oropharyngeal dysphagia assessment. The findings support the continuation of the validation process.Master Thesis Identificação precoce para dificuldades na aprendizagem da leitura(Universidade Federal do Rio Grande do Norte, 2025-04-02) França, Beatriz de Souza dos Reis; Azoni, Cintia Alves Salgado; https://orcid.org/0000-0003-2175-9676; http://lattes.cnpq.br/4935645902363577; http://lattes.cnpq.br/1965416061361892; Taveira, Karinna Verissimo Meira; Crenitte, Patricia Abreu PinheiroObjective: To analyze the strengths and limitations of studies available in the literature on screening instruments used to identify risks of reading difficulties and disorders in preschool and school children, in clinical and educational contexts (article 1) and to investigate initial evidence of validity of the Brazilian version of the SPRouT instrument for screening phonological processing in preschool and school-aged children. Method: Scoping review conducted according to the PRISMA-ScR guidelines. The search was carried out in the SciELO, PubMed, LILACS, ERIC, Google Scholar and Web of Science databases, including studies on the construction, validation and practical application of the instruments (article 1). The second study included a pilot validation stage, descriptive and analytical, carried out in a private school in Brazil with children between 4 and 8 years old, including participants with and without oral and written language complaints (article 2). Results: Initial screening of 1,173 articles identified 40 relevant studies and 32 screening instruments. The review pointed out gaps in the psychometric validation and accessibility of the instruments, which limits their application (article 1). Article 2, in turn, revealed significant negative correlations between the SPRouT and other instruments for assessing phonological processing. Conclusion: Although there are a variety of instruments for screening for reading difficulties, significant challenges, such as accessibility and psychometric validity, restrict their application in different contexts (article 1). The SPRouT, in turn, proved to be particularly effective in predicting performance in tasks associated with phonological processing, providing preliminary evidence of validity and highlighting its potential as a promising tool for the early identification of risk for reading difficulties (article 2).