Entrevista al audiólogo Gean Paolo Mazzoni sobre Potenciales Evocados y Emisiones Otoacústicas

Prof. Mazzoni, ¿qué son las emisiones otoacústicas?

El avance de la tecnología ha permitido desarrollar software y hardware de alta complejidad que permite nuevos exámenes auditivos. Las emisiones otoacústicas se iniciaron en Inglaterra en los años 1980, por el profesor Dr. Kemp y estos exámenes permiten una detección precoz de la sordera. La literatura médica informa que cuando los niños son diagnosticados en forma temprana esto permite a los médicos actuar con mejores resultados clínicos. Esto es particularmente importante en los recién nacidos porque entre el momento de nacer y los 18 meses es cuando  el sistema neuro sensorial auditivo tiene el mas rápido crecimiento y es entre este tiempo que el sistema necesita estimulación para desarrollarse.

 

¿Qué tipos de emisiones otoacústicas hay?

Las emisiones otoacústicas es energía generada por la cóclea cuando es estimulada por un sonido.  Esta energía, que es generada por las Células Ciliadas Externas las cuales residen en la cóclea,  es detectada por un micrófono y es elaborada mediante programas computacionales.

Hay emisiones otoacústicas transitorias que responden a un clic auditivo breve (OAE). El otro tipo de emisiones otoacústicas son de producto de distorsión (DPOAE) y corresponden a dos estímulos simultáneos presentados en el conducto auditivo del paciente. Ambos exámenes son útiles para hacer un screening rápido en recién nacidos.  Estas emisiones, sea Transientes que DPOAE, se encuentran en el 100% de los pacientes con audición normal.

 

¿Cuál es la situación en Europa y Estados Unidos en relación a las emisiones otoacústicas?

Un buen ejemplo es el Canadá. En algunos estados de Canadá, específicamente Ontario y BC, han implementado el Universal Neonatal Auditory Screening. Este obliga que a todos los recién nacidos se le haga esto examen de OEA antes de salir desde el hospital. El examen es hecho por el audiólogo en cooperación del pediatra y la enfermera de pediatría.

Creemos que un avance en este sentido en Chile puede ser una importante contribución para disminuir los niveles de sordera en Chile.

 

¿Qué son los potenciales evocados?

Hay varios tipos de potenciales evocados. En los exámenes de Potenciales Evocados Acústicos (PEA) son actividades neuro sensoriales de la vía auditiva a un estimulo acústico. Los potenciales evocados de tronco cerebral (PEATC) son exámenes de la vía auditiva hasta las estructuras en el tronco cefálico. Miden la funcionalidad del  sistema neuro sensorial auditivo, hasta el Tálamo. Mientra los Potenciales Evocados de Latencia Media miden la vía auditiva hasta la Corteza cerebral y los tardíos miden toda la vía auditiva. El problema con los potenciales de latencia media y tardía es que nos son confiables, dependen demasiado desde el estado del paciente, mientras los PEATC son muy estables y no importa si el paciente es cooperante o no. Además de los potenciales auditivos hay potenciales somatosensoriales, con estimulación eléctrica y visual con estimulación visiva.

El desarrollo de la tecnología ha permitido importantes avances en diversos tipos de potenciales evocados, permitiendo efectuar exámenes ambulatorios en forma fluida. Entre los exámenes más comunes en la clínica audiológica están:

  • Potenciales evocados auditivos desde el tronco cefálico PEATC
  • Potenciales evocados miogenicos VEMPS
  • Electrococleografía no invasiva
  • Estimulación del nervio facial.

 

¿Quiénes son los profesionales que trabajan con estos equipos?

En el caso de las OEA en algunos hospitales los exámenes son efectuados por enfermeras no especialistas. Para que estos exámenes tengan confiabilidad deben ser efectuados o por lo meno interpretados por audiólogos capacitados. En los exámenes de PEA estos son efectuados por audiólogos el que permite detectar precozmente las patologías asociadas a la audición. Son un importante aporte a pesquisar problemas que no son detectados con otros exámenes.

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