
The application of 60 questionnaires was planned, each consisting of 15 questions, including: workplace; conditions to acquire knowledge on congenital hearing loss; knowledge of high-risk factors for hearing loss; conduct when treating a child at high risk for hearing loss; minimum age possible for hearing assessment; hearing assessment in children as a routine; specific tests used in hearing assessment in childhood; degrees and types of hearing loss, including age for referral to the otorhinolaryngologist; appropriate age for hearing aid use; age at which the child can undergo speech therapy; and the physician's responsibility in relation to the child's communication capacity. There were also questions aimed to identify the respondent, such as age, year of graduation, and medical specialty (pediatrics, neonatology, pediatric residency).
This study was approved by the Research Ethics Committee of the Institution under protocol N • 146/2011. Statistical analysis was conducted by the statistician in charge of the Support Center for Research and Teaching (Núcleo de Apoio à Pesquisa e à Docência ---NAPED) of the Institution.

Results
A total of 47 questionnaires were completed of 60 planned; 13 physicians refused to participate.
The mean age of respondents was 40.58 years and the mean time after graduation was 15.06 years.
As for the medical specialty of respondents, 26 (55.3%) were pediatricians, 14 (29.8%) were neonatologists, five (10.6%) were residents in pediatrics, and two (4.3%) did not reply to this field. Of the participants, 19 (40.5%) worked in public and private hospitals, 11 (23.4%) only in private hospitals, eight (17%) only in public hospitals, five (10.7%) in private hospitals and other public places (offices and Basic Health Units [BHUs]), two (4.2%) in private hospitals and other places (offices and BHUs), one (2.1%) in a public hospital and elsewhere, and one (2.1%) only elsewhere (Table 1). Thirty-nine (83%) respondents said they acquired knowledge on congenital hearing loss during the undergraduate course, five (10.6%) said they had taken a specific course, seven (14.9%) had taken other courses, and one (2.7%) did not answer the question, surpassing the total of 100%, considering that three answered ''undergraduate course'' and ''specific course'' and two answered ''undergraduate course'' and ''others''. Regarding those who answered ''others'', they had to specify their answers and thus, two answered ''during residency'', two reported having acquired knowledge through medical literature, and three did not answer.
Professionals were asked to define at what age hearing could be evaluated in children, and 47 (100%) physicians responded that it is possible to do it within the first six months of a child's life.
Fifteen (31.9%) reported having knowledge about specific tests to assess hearing in children, and 32 (68.1%) answered no to that question (Fig. 3). Of the affirmative cases, five physicians (33.3%) said they knew of the OAE test, five (33.3%) reported having knowledge of OAE and ABR, two (13.3%) only of ABR, and three (20.1%) did not answer the question.
Twenty-four physicians (51.1%) confirmed that they routinely check hearing in their patients, while 23 (48.9%) said they did not check (Fig. 4). Of the 24 who stated that they assess hearing, 22 (91.7%) do so in the first six months of life,  Using an open question, respondents were asked which hearing test is applied in the routine care; the responses were diverse. Te n (41.6%) answered that they applied coarse examinations (such as sound stimuli, clapping, rattles, buzzers), eight (33.3%) applied the OAE test, two (8.3%) referred the patients to the audiologist, one (4.1%) performed the ABR (auditory brainstem response) test, one (4.1%) performed the OAE and ABR tests, one (4.1%) performed audiometry, and one (4.1%) did not respond.
Regarding the knowledge of a classification for different degrees of hearing loss, only nine (19.1%) reported having this knowledge, while 38 (80.9%) said they did not know about it (Fig. 5). Of the affirmative responses, three respondents (33.3%) classified hearing loss as mild, moderate, and severe, one (11.1%) classified it as mild, moderate, severe, and profound, and one (11.1%) classified it as congenital or acquired. Four (44.4%) did not answer the question.
Respondents were asked a multiple-choice question with four alternatives, regarding the situation in which the respondent would send a child to a hearing specialist. In descending order, the answers were when you notice something during your assessment, 34 (72.3%); when the mother has a complaint, 29 (61.7%); when the child is at high risk for hearing loss, 28 (59.6%); and as a routine, 15 (31.9%). Seven respondents (14.9%) gave two answers, 20 (42.5%) gave three answers, and four (8.5%) gave four answers.
Regarding the age at which the child should be referred to a specialist, the responses were: 39 (83%) in the first 6 months of age, four (8.5%) at the end of the first year, two (4.2%) in the second year of life and two (4.3%) in the third year of life.
Regarding the age at which the child can wear a hearing aid, 18 (38.3%) said it was possible to use them within the first six months of life, 13 (27.6%) at the end of the first year, eight (17%) in the second year of life, two (4.2%) after 3 years of age, and three (4.2%) in the third year of life. Four respondents (8.5%) did not answer this question.
Regarding the question, ''at what age the respondent considers that the child can undergo speech therapy for deafness?'', 18 (38.2%) said at the end of the first year of life, 13 (27.7%) in second year, 10 (21.2%) answered within the first six months, four (8.5%) after 3 years of age, and two respondents (4.2%) did not answer this question (Fig. 7).
All participants believe that physicians have the responsibility to assess the child's communication capacity.

Discussion
The mean age and the time since graduation of the physicians who participated in this study were high, in agreement with the literature, 3,11 but different from the study by Colozza and Anastasio, 10 in which most of the participants were residents, with a mean age of 34.4 years and time since graduation of 9.9 years. In that study, it can be considered that at the time of graduation and residence of respondents, de Campos AC et al. the UNHS and hearing loss had their dissemination restricted to otorhinolaryngologists and audiologists.
Most participants in the present study were pediatricians (55.3%), whereas the others were neonatologists and medical residents in pediatrics. Colozza and Anastasio 10 showed that most respondents were residents (61.1%); two other studies 8,12 included pediatricians only, and one study assessed only neonatologists. 3 The study sample population represented approximately 15% of pediatricians in the city of Jundiaí, and it was verified that some participants worked in more than one of the selected hospitals, resulting in a more restricted sample.
This study showed a predominance of participants that worked in both private and public hospitals (40.4%). Regarding those working in only one type of hospital, private hospitals predominated. A previously published study 10 did not specify the type of hospital where the respondents worked, but most worked in hospitals, and a minority in private clinics and other places.
It can be observed that most of the respondents (83%) reported having obtained information about hearing impairment during medical school, similar to the results found by other studies. 3,8,10 In this study, the majority (68.1%) of respondents said they had no knowledge of techniques to assess children's hearing, a finding similar to that in literature. 3,8,10 This result may demonstrate that the federal requirement of performing the OAE test did not lead these experts to seek further information on the subject and/or there were no programs that reported the importance of the UNHS, which hampers early diagnosis and treatment.
The present study included 10 risk factors for deafness, considering that the respondents had the possibility of multiple-choice answers for these factors, with 71% positive responses, indicating good knowledge of pediatric and neonatal clinical practice on the subject ( Table 2). This result was similar to that found in the literature. 3,8,10 The seven criteria of high-risk factors for hearing loss from the Joint Committee on Infant Hearing were mentioned in the literature: family history, intrauterine or perinatal infections, malformations involving the head and neck, neonates weighing less than 1500 g at birth, severe neonatal hyperbilirubinemia, bacterial meningitis, and severe hypoxia at birth. Three additional risk factors were included in this study: ototoxic medications, mechanical ventilation, and neonatal septicemia, following the example of another study in the literature. 10 All physicians in this study agreed that it is possible to evaluate the child's hearing within the first six months of life, which is in agreement with the literature. 10