Proposta de protocolo para avaliação e monitoramento da função auditiva na Síndrome de Down

Abstract

Objectives: I – To conduct an integrative review of the scientific literature on hearing assessment procedures and auditory monitoring protocols for children with Down syndrome (DS). II – To develop a proposed clinical care protocol for the assessment and monitoring of auditory function in children with DS. Methods: I – An integrative review of observational studies was conducted in the PubMed, Web of Science, Scopus, Embase, and Google Scholar databases, using the descriptors Down Syndrome, Trisomy 21, Audiological Assessment, Hearing Monitoring, Hearing Disorders, Hearing Loss, without time or language restrictions, from January to April 2025. Observational studies were included, with a sample composed of individuals diagnosed with DS and aged 12 years or younger, regardless of sex and ethnicity, that descriptively addressed the methods and protocols used in the assessment and monitoring of auditory function in children with DS. Methodological quality was assessed using the Joanna Briggs Institute's Critical Appraisal tool for Analytical Cross-Sectional Studies. II – The clinical care protocol was developed in three stages: (1) integrative review of the scientific literature; (2) development of the protocol in the form of a registration sheet; and (3) construction of a flowchart. The review identified scientific evidence on auditory assessment and monitoring in children with Down syndrome, which guided the choice of validated and appropriate objective procedures for the specificities of this population. The protocol includes the collection of identification and clinical history data, inspection of the external auditory canal, tympanometry, Auditory Brainstem Response (ABR), and Evoked Otacoustic Emissions (OAEs), and enables the diagnosis and monitoring of auditory function in children from zero to 12 years of age, regardless of active participation in the assessment. Results: I – The exploratory search in the databases resulted in 1,493 studies. After reading the titles and abstracts, 1,474 were excluded for not meeting the eligibility criteria. The 19 potentially relevant articles were evaluated in full, and eight were included in this review. The most frequently used tests were ABR and tympanometry, followed by behavioral audiometry and OAEs. The analysis revealed a lack of standardization and a shortage of specific hearing assessment and monitoring protocols for this population. II – A clinical care protocol was developed for the assessment and monitoring of auditory function in children with Down syndrome, with a graphical flowchart representation and registration sheet, which includes fields for patient identification, inspection of the external auditory canal, acoustic immittance measurements and investigation of acoustic reflex thresholds, in addition to electrophysiological evaluation through ABR and the performance of OAEs. The protocol allows for standardized recording of findings, diagnosis of the type and degree of hearing loss, and longitudinal monitoring of auditory function. Conclusion: I – The integrative review revealed the lack of standardized protocols for the assessment and monitoring of hearing in children with Down syndrome and highlighted the need for objective methods that consider their cognitive particularities, with ABR and tympanometry being the most frequently mentioned methods. II – The developed protocol presents an innovative character by establishing standardized guidelines for the evaluation and monitoring of auditory function in children with Down syndrome. It favors early diagnosis, reduces delays in intervention, and improves the quality of hearing health care by using tympanometry, ABR, and OAEs as diagnostic methods appropriate to the specificities of this population.