Compare self-perceived discrimination between immigrants and locals in Chile and analyze the relationship between immigration and perceived discrimination and immigration, discrimination and health outcomes, adjusting for sociodemographic characteristics and social capital. Cross-sectional study, using population-based survey (CASEN2017). We selected 2,409 immigrants  and 67,857 locals  over 18 years of age surveyed. We estimated logistic regression models, considering the complex sample, with discrimination, self-rated health, medical treatment, healthcare system membership, complementary health insurance, medical consultation and problems when consulting as dependent variables, immigration and discrimination as main exposure variables, and social capital and sociodemographic variables as covariates of the models. Immigrants were more likely to perceive discrimination in general compared to locals . However, this does not occur for all specific reasons for discrimination; skin color and physical appearance were the most frequent causes of discrimination in immigrants. The interaction between immigration and discrimination was significantly related to worse self-rated health outcomes and treatment for pathologies, disfavoring discrimination against immigrants. In both locals and immigrants, discrimination was not associated with health care access outcomes, except for problems during consultation in locals . In Chile, experiences of discrimination are intertwined with other forms of rejection and social exclusion, so it is urgent to raise awareness among the population to prevent these discriminatory practices, especially in health care and daily use places. It is essential to address discrimination in order to have an impact on intermediate variables and health outcomes. The extension of the results to the entire immigrant population could be very useful to deepen the problem and improve the estimates made. The perception of negative discrimination has effects on the general well-being and physical and mental health of the individual, which has been reported for various types of discrimination3. This can lead to poor access to quality medical care7 and hinder the scope of public health programs3. When differences between social groups are systematic, they produce social inequities in health that must be urgently addressed. In migrant populations this has been documented regardless of the development of the country, migration policy or characteristics of the health care system.Discrimination is defined as different treatment of a person or group with common characteristics9, higher prevalence of chronic diseases, poor general well-being, self-rated health, and adverse pregnancy and childbirth outcomes9. For example, in Moroccan immigrants settled in Spain, it was estimated that up to 40% of cases reported a deterioration in health that could be attributed to discrimination11. In Canada, afrodescendants and indigenous people have been more exposed to discriminatory experiences, exhibiting results suggesting that this is decisive in the presence of chronic diseases and their risk factors12. In some countries where legally guaranteed access to health care is available, barriers such as discriminatory practices, administrative requirements, language, fear of being reported and refusal of care hinder immigrants’ access to health care13.Regarding immigrants, studies based on ethnoracial discrimination have predominated, relating them to the presence of depressive symptoms, distress, low self-esteem14. In addition, acculturative stress12and a constant feeling of “otherness”15 can be triggers of physical-psychological discomfort in immigrants.Discrimination can damage health through multiple mechanisms11. Belonging to social or religious organizations and family, social and emotional support networks are frequently repeated as moderating factors in the discrimination and health-discrimination relationship15. Social and emotional supports show no positive effect on long-term disease management15 and protect against threats to physical-psychological health15, respectively. Variables such as age, sex, marital status, education, socioeconomic level, poverty, race and ethnicity are associated with both discrimination and health outcomes. In addition, time of stay, country of origin, and migratory status and distance are also important in the case of immigrants17.There are individual differences in the perception, coping and reception of discrimination, which can mitigate discrimination and its harmful effectsIn Latin America, studies on discrimination of the immigrant population and its relationship with health outcomes and access to health care are scarce, especially at the population level. Likewise, their understanding of potentially protective social processes, such as social capital, is limited.18. Previous evidence highlighted the heterogeneity of this population, whose demographic and socioeconomic characteristics differ not only from the Chilean population, but also within migrant groups19. Although migrants are a heterogeneous group, seven nationalities accounted for approximately 79% of foreigners in 2020. First, Venezuelans (30.7%), followed by Peruvians (16.3%), Haitians (12.5%), Colombians (11.4%) and Bolivians (8.5%)18.Among the countries in the region, Chile experienced a sustained increase in international migration according to current estimates by the National Institute of Statistics, which reports 1,462,103 immigrants in the country by the end of 2020, reaching 8% of the total population20. Although the country rectifies several international conventions and establishes non-discrimination22in its legislation, the National Institute of Human Rights recorded multiple complaints of discrimination against the immigrant population, in daily interactions or in collective actions by authorities and institutions22.A recent study with the Peruvian and Colombian population residing in three cities in Chile  found a high presence of symptoms associated with mental health problems, mainly depression, anxiety, difficulties in social interaction and social adjustment problems, related to discrimination, high levels of acculturation stress and the use of acculturation strategies linked to assimilation and marginalization19, although regular and irregular migrants guaranteed access to public health care by formal enrollment in a health center close to their place of living in the entire national territory, as stated in Decree 67 of 2016.On the other hand, the Chilean Health System is segmented and fragmented with public and private participation. Subsystems with different financing and provision modalities coexist in it. International migrants showed lower access to this system in contrast to local migrants, an increasing gap, from 9% in 2013 to 18% in 2017Consequently, this study aimed to describe inequality gaps in perceived discrimination between migrants and locals, in a crude form and adjusted for sociodemographic variables and social capital; as well as their possible association with access to the health system and overall health outcomes. The specific objectives of this study were: (i) compare self-perceived discrimination between immigrants and locals in Chile, (ii) explore the association of perceived discrimination with being an international migrant, in a crude manner and adjusted for sociodemographic, economic and social capital covariates, and (iii) analyze the relationship between access to health services and health outcomes (as response variables) and perceived discrimination in international migrants and the local population.This is a cross-sectional analytical study, conducted from the National Socioeconomic Characterization Survey (Casen) of Chile in its 2017 version.23.The Casen 2017 survey is a diagnostic, evaluation and targeting instrument aimed at understanding the socioeconomic conditions of households in Chile, especially in priority groups according to social policies. We collected data by means of structured interviews with qualified informants (heads of household or responsible adults), residents of private homes, excluding areas of difficult access. Casen 2017 uses a probabilistic, stratified and two-stage sampling, with national representativeness, which allows obtaining population sizes from expansion factorsThe 2017 Casen survey collected information from 6,811  international migrants, identified as those who self-reported being born in a country other than Chile, 207,603  locals identified as those who self-reported being born in Chile, and 2,025  who reported not knowing their country of birth .The study included eligible informants who were international migrants  and local migrants , in accordance with the population that effectively responds to the perceived discrimination variable. According to the Casen survey, a suitable informant is defined as any head of household or, alternatively, a member of the household aged 18 years or older.Perceived discrimination:Perceived discrimination (yes/no) based on: (a) socioeconomic status, (b) being a woman or a man, (c) marital status, (d) clothing, (e) skin color, (f) being a foreigner, (g) age, (h) sexual orientation or gender identity, (i) tattoos, piercings, plugs, (j) physical appearance, (k) beliefs or religion, (l) political ideology or opinion, (m) participation or not in unions or associations, (n) place where they live, (o) establishment where they studied, (p) belonging to an indigenous people, (q) health condition or disability, (r) other reasons. Corresponding to 18 independent variables.Perceived discrimination on one or more reasons .Access to the health system and its use:General access, that is, enrollment in the social security health system .Seguro de Salud Complementario) for risk of illness or accident; No: no member covered by SSC).Complementary health coverage .Consultation in case of illness or accident .Health outcomes:Medical treatment in the last year (yes/no).Salud autoevaluada), on a scale of 1 to 7, being 1 very bad and 7 very good.Self-rated health (SAV – Poor SAV (yes/no), based on SAV variable categorized as yes = 1,2 and no = 3,4,5,6,7.Social capital:Participation in organizations or organized groups (yes/no).Social and/or family support networks (yes/no).Sociodemographic variables: Sex, age, ethnicity, educational level, area, household income quintile, occupation. In immigrants: time of residence in Chile and country of origin.We estimated the percentages of the discrimination against immigrant and local population, both in total and according to the reasons for discrimination. Likewise, we analyzed descriptively the variables of health outcomes, access and use of the health system, distinguishing between those who perceived discrimination and those who did not, using frequency measures with their respective confidence intervals. We analyzed the independence between variables using chi-square tests with Rao-Scott correction . On the Logistic regression models were fitted to analyze the effect of social capital and sociodemographic factors on perceived discrimination, using discrimination perception as the dependent variable and social support networks and participation in social organizations as independent variables, for immigrants and locals separately .Subsequently, we added to these models an adjustment for sociodemographic variables (va. SD) .Similarly, we fitted models of the form (models 5-10) to explore the effect of the interaction between immigration and perceived discrimination on the various health outcomes and access to health services:Finally, we explored the relationship between discrimination and health outcomes and access to health in immigrants and locals separately, using form models:In immigrant we additionally adjust for country of origin and length of residence.For all estimated models, the robustness of fit was examined by means of an adjusted F-test of residual means (Archer and Lemeshow).All analyses were performed with Stata 14 software, with significance of 0.05, 95% confidence, considering the complex sample , treating strata with a single cluster as a unit of certainty and Taylor linearization for variance estimation.Of all eligible immigrant informants, 26.92% (95%CI: 21.5–33.2), equivalent to 78,413 people, reported being discriminated against or treated unfairly because they were foreigners. In immigrants, physical appearance and skin color were the most frequently reported reasons for discrimination, differing significantly from the local population. In crude models, immigrants were 8.23 (95%CI: 5.4–12.5) times more likely to be discriminated against because of their skin color compared to locals and 2.82 (95%CI: 1.4–5.8) times more likely to be discriminated against because of their physical appearance. After adjusting for social capital and sociodemographic variables, these magnitudes of association were 5.27 (95%CI: 3.4–8.1) and 1.71 (95%CI: 0.91–3.2), respectively. In contrast, immigrants were significantly less likely to report discrimination based on being male or female , place where they live , age , religion , sexuality or gender identity , establishment where they studied , and tattoos, piercings or plugs , than locals. For all adjusted models, social support networks were statistically significant, generally being protective factors .Thirty-two point ninety-nine percent (95%CI: 28.08–38.31) of immigrants  and 14.46% (95%CI: 13.91–15.02) of locals claimed to experience unfair treatment or discrimination outside their home. After adjusting for sociodemographic variables and social capital, immigrants were 2.3 (95%CI: 1.9–2.9) times more likely to be discriminated against than the local population . In immiDescriptively, in the immigrant and local population, the discrimination against subgroup had a higher percentage of the population with poor health and in medical treatment compared to the non-discriminated against . After aIn immigrants, having support networks reported 88.6% (95%CI: 0.06–0.23) and 67.2% (95%CI: 0.19–0.57) less chance of having poor SAV and being in treatment, respectively, compared to those without networks .Regarding access to health care, the interaction between discrimination and migration was not significant in the lack of consultation in the event of illness or accident . However, in the population that used medical consultations, immigrants  and Chileans  who were not discriminated against were significantly less likely to present problems during the consultation compared to discrimination against immigrants. Whether they perceive discrimination or not, immigrants were more likely to have no health insurance compared to those born in Chile. Specifically, discrimination against Chileans have 0.265 (95%CI: 0.17–0.41) times less chance of not having health insurance compared to discrimination against immigrants, in non- discrimination against Chileans this value was 0.212 (95%CI: 0.14–0.32) times .Regarding sociodemographic factors in relation to access to health care in immigrants, ethnicity was significant in the lack of health insurance (OR = 0.565) and possession of complementary insurance (OR = 5.801). Likewise, the area of residence was significant for lack of healthcare insurance (OR = 1.545), possession of complementary insurance (OR = 2.181), lack of consultation (OR = 0.181) and problems during the consultation process (OR = 0.233). Finally, belonging to the richest quintile compared to the poorest quintile was significant in the lack of complementary insurance (OR = 0.129) and no consultation (OR = 0.124) .In contrast to immigrants, discrimination against locals was significant in presenting problems during the consultation process, to the disadvantage of those discriminated against [OR immigrants = 1.399 (95%CI: 0.60–3.28) versus OR locals = 1.604 (95%CI: 1.41–1.83)] .Finally, in immigrants, a longer time of residence in the country was a significant risk factor for being or having been under medical treatment (OR = 1.067) and a protective factor for not having health insurance, SSC (OR = 0.922) and lack of complementary health insurance (OR = 0.974). In the latter, country of origin also proved to be a significant factor (result not shown in table).12. Regarding the latter, in this study, although discrimination did not show a significant association with non-consultation, in some situations it was related to presenting problems during the consultation, which could have negative repercussions on seeking care in the future.This study aimed to describe inequality gaps in the perception of discrimination between immigrants and locals, from a social inequity approach to health. The results presented suggest that immigrants residing in Chile are more likely to perceive discrimination compared to locals, and that the interaction between immigration and discrimination may be related to worse self-rated health outcomes and medical treatment. According to the evidence, perceived discrimination could trigger a series of mechanisms that intervene in the risk of becoming ill, and can be distinguished between (i) direct, by provoking a response to stress and unhealthy coping with it; and (ii) indirect or structural, by limiting employment, income, general well-being, and access to and perceived treatment in health systems and services, among others17. In Ghanaian immigrants in Europe, higher levels of perceived discrimination were associated with a higher risk of cardiovascular disease24, and in immigrants of different origins using social and health services in Barcelona, approximately 50% of respondents reported feeling discriminated against in such services, worsening in irregular immigrants25.Some international studies showed similar results. For example, in Iraqi refugees and immigrants, the perception of discrimination contributed significantly to the prediction of depression and poor or fair self-rated health, increasing up to twice the risk in the discriminated against population12. Thus, in the immigrant population, social capital can play an ambiguous role in the perception of discrimination by protecting against and coping with discriminatory events, but it can facilitate the perception of subtle aggressions in accordance with the customs of the receiving country and isolation in closed groups.In the current context, discrimination tends to occur as subtle or structural microaggressions, rather than explicit. Hence, perceived discrimination is used worldwide in similar studies, since its subjective nature makes it possible to capture events not defined as discriminatory according to local laws or particular social definitions21. Among the study participants who perceived discrimination, approximately one third said they were discriminated against for multiple reasons. This shows the complexity of these multiple and dynamic social processes, as well as the importance of having coordinated and planned actions to protect the dignity, health and suppress any form of social disadvantage of immigrants. Considering the possible chronic effects of discrimination and the fact that the main reasons for discrimination among immigrants are perceived externally, it is urgent to raise awareness among the local population about its prevention and rejection, especially in health care.In Chile, experiences of discrimination are intertwined with other forms of rejection, social exclusion, classism, racism and contempt for people living in povertyThe strengths of this study are the simultaneous analysis of social and health variables, and the use of a reliable and highly accepted population base in Chile, allowing acceptable overall accuracy. On the other hand, since this is an analysis of secondary data, the exclusion of groups of interest (residents of inaccessible areas and homeless people), the impossibility of analyzing other variables relevant to the problem, and limited sample sizes in the migrant population, which was not the focus of the sample selection, are limitations. Finally, we recognize the cross-sectional nature of the data, which prevents us from inferring causality.The results of this study can support the development of public and health policies in Chile and in other countries that show similar results. There is evidence from Latin America and the Caribbean documenting the relationship between experiences of stigma, discrimination and racism and poorer health outcomes in migrants, refugees and moving people. These social phenomena are complex and dynamic, and relevant when it comes to delving into the social mechanisms of rejection and exclusion that trigger a series of subjective and objective health outcomes. Discrimination has its origin in the formation of social groups that perceive themselves differently from others, thus creating one or multiple “othernesses” of lower rank or caste, loaded with stereotypes and prejudices. Therefore, the greater perception of discrimination among migrants compared to locals in Chile illustrates the existence of patterns of social interaction that differentiate and subjugate migrants based on their status as foreigners, in addition, as suggested by the results of this study, to their skin color and physical appearance. In terms of public policy, this study reinforces the importance of addressing, containing and reversing processes of stigma and discrimination against migrants in Chile, which is also documented in other countries. These public policy recommendations can be organized around different levels of action, for example: (i) the political level, with the development of regulations and mechanisms to reject all forms of discrimination in public contexts, including the health system, (ii) community level, through awareness campaigns that promote respect for social and cultural diversity and the construction of inclusive and respectful communities, (iii) health system, through the development of continuous training mechanisms on migration, discrimination and health, the promotion of teams with intercultural competencies in health, and permanent campaigns for the explicit rejection and auditing of all forms of discrimination and violence in health care.13, (ii) longitudinal life course approach and (iii) analysis of specific health problems. Likewise, an approach to social inequalities integrating the intersection with gender identity is relevant, as these are often derived from the dominant values of the host society and are exacerbated in women4. Therefore, this study covers multiple approaches, but can be further developed, especially in population-based surveys including an adequate representation of migrant groups.Regarding future research, there are three relevant aspects documented in the literature not sufficiently analyzed in this study: (i) migration variables critical to the experience of discrimination as regularity and refuge/asylum 1; y es un factor estructural relevante en el desarrollo de desigualdades en salud, especialmente en grupos sociales minoritarios3. La percepción de discriminación negativa tiene efectos sobre el bienestar general y salud física y mental del individuo, lo que ha sido reportado para diversos tipos de discriminación3. Esta puede llevar a un acceso deficiente a atención médica de calidad7 y obstaculizar el alcance de programas de salud pública3. Cuando las diferencias entre grupos sociales son sistemáticas, producen inequidades sociales en salud que deben ser atendidas con urgencia. En poblaciones migrantes esto ha sido documentado independientemente del desarrollo del país, política migratoria o características del sistema de salud.La discriminación se define como el trato diferente hacia una persona o grupo con características en común9, mayor prevalencia de enfermedades crónicas, escaso bienestar general, salud autoevaluada y resultados adversos de embarazo y parto9. Por ejemplo, en inmigrantes marroquíes asentados en España, se estimó que hasta un 40% de los casos se informó un deterioro en la salud que podía atribuirse a discriminación11. En Canadá, afrodescendientes y aborígenes han sido más expuestos a experiencias discriminatorias, exhibiendo resultados que sugieren que esta es determinante en la presencia de enfermedades crónicas y sus factores de riesgo12. En algunos países donde el acceso a atención medica está garantizado por ley, barreras como prácticas discriminatorias, requisitos administrativos, idioma, miedo a ser denunciados y negativas a ser atendidos obstaculizan el acceso a cuidados en salud en inmigrantes13.En inmigrantes han predominado estudios basados en discriminación etnoracial, relacionándolos con presencia de síntomas depresivos, angustia, baja autoestima14. En inmigrantes adicionalmente, estrés aculturativo12 y sensación constante de “otredad”15 pueden ser factores desencadenantes de malestar físico-psicológico.La discriminación puede dañar la salud mediante múltiples mecanismos11. Particularmente, pertenecer a organizaciones sociales o religiosas y redes de apoyo familiar, social y emocional se repiten frecuentemente como los factores moderadores en la discriminación y relación salud-discriminación15. Los apoyos sociales y emocionales han mostrado afectar positivamente al tratamiento de enfermedades a largo plazo15 y proteger frente a amenazas a la salud físico-psicológica15, respectivamente. Las variables como edad, sexo, estado civil, educación, nivel socioeconómico, pobreza, raza y etnia se han asociado tanto a discriminación como a resultados de salud. En inmigrantes, adicionalmente, son importantes el tiempo de estadía, país de origen y situación y distancia migratoria17.Existen diferencias individuales en la percepción, afrontamiento y recepción de la discriminación, que pueden amortiguar esta y sus efectos nocivosEn Latinoamérica, estudios sobre discriminación en población inmigrante y su relación con resultados de salud y acceso a salud han sido escasos, más aún a niveles poblacionales. Igualmente, es limitada su comprensión con procesos sociales potencialmente protectores, como capital social.18. La evidencia previa ha resaltado la heterogeneidad de esta población, cuyas características demográficas y socioeconómicas no solo difieren de la población chilena, sino también dentro de los grupos migrantes19. Si bien los migrantes son un grupo heterogéneo, en 2020 siete nacionalidades constituían aproximadamente el 79% de los extranjeros. Primeramente, se encuentra los venezolanos , seguido por peruanos , haitianos , colombianos  y bolivianos 18.Entre los países de la región, Chile ha experimentado un aumento sostenido de la migración internacional según las estimaciones actuales del Instituto Nacional de Estadística, que reporta 1.462.103 personas inmigrantes en el país a fines de 2020, alcanzando el 8% de la población total20. Si bien el país rectifica diversas convenciones internacionales y establece en su legislación la no discriminación22, el Instituto Nacional de Derechos Humanos ha registrado múltiples denuncias de discriminación hacia la población inmigrante, ya sea en interacciones cotidianas o como colectivo por parte de autoridades e instituciones22.Un reciente estudio con la población peruana y colombiana residente en tres ciudades de Chile  reveló alta presencia de síntomas asociados a problemas de salud mental, fundamentalmente depresión, ansiedad, dificultades en interacción social y problemas de ajuste social; relacionándolos a discriminación, altos niveles de estrés por aculturación y utilización de estrategias de aculturación vinculadas a asimilación y marginación19, aun cuando migrantes regulares y en situación irregular tienen garantía de acceso a la salud pública vía inscripción formal en un centro de salud cercano a su lugar de residencia en todo el territorio nacional según lo plantea el Decreto 67 del 2016.Por otra parte, el Sistema de Salud de Chile es segmentado y fragmentado con participación público y privada. En él coexisten subsistemas con distintas modalidades de financiamiento y provisión. Los migrantes internacionales han mostrado sostenidamente un menor acceso a este sistema en contraste con los locales, brecha que estaría aumentando, pasando del 9% en 2013 a un 18% en 2017En consiguiente, este estudio buscó describir brechas de desigualdad en percepción de discriminación entre migrantes y locales, en forma cruda y ajustada por variables sociodemográficas y capital social; así como su posible asociación con acceso al sistema de salud y resultados generales de salud. Los objetivos específicos de este estudio fueron: (i) comparar la autopercepción de discriminación entre inmigrantes y locales en Chile, (ii) explorar la asociación de la discriminación percibida con el ser migrante internacional, de manera cruda y ajustada por covariables sociodemográficas, económicas y capital social, y (iii) analizar la relación entre acceso a servicios de salud y resultados de salud (como variables respuestas) y discriminación percibida en migrantes internacionales y población local.Este es un estudio analítico de corte transversal, realizado a partir de la Encuesta de Caracterización Socioeconómica Nacional (Casen) de Chile en su versión 2017.23.La encuesta Casen 2017 es un instrumento de diagnóstico, evaluación y focalización que busca conocer las condiciones socioeconómicas de los hogares en Chile, especialmente en grupos prioritarios según las políticas sociales. La recolección de datos se realizó mediante entrevistas estructuradas a informantes idóneos (jefes de hogar o adultos responsables), residentes de viviendas particulares, excluyendo áreas de difícil acceso. Casen 2017 utiliza un muestreo probabilístico, estratificado y bietápico, con representatividad a nivel nacional, que permite obtener tamaños poblacionales a partir de factores de expansiónLa encuesta Casen 2017 recolectó la información de 6.811 (representativos de 777.407) migrantes internacionales, identificados como aquellos que autorreportan haber nacido en otro país distinto de Chile, 207.603 (representativos de 16.843.471) locales identificados como aquellos que autorreportaron haber nacido en Chile y 2.025 (representativos de 186.536) que reportaron no saber su país de nacimiento .Se incluyeron en el estudio a informantes idóneos migrantes internacionales (2.409 encuestados representativos de 291.270 personas) y locales , en concordancia con la población que responde efectivamente a la variable de discriminación percibida. Definiéndose, acorde a la encuesta Casen, como informante idóneo todo jefe(a) de hogar o, en su defecto, un integrante del hogar de 18 años o más.Discriminación percibida:I.Discriminación percibida (sí/no) por: (a) nivel socioeconómico, (b) ser mujer u hombre, (c) estado civil, (d) ropa, (e) color de piel, (f) ser extranjero, (g) edad, (h) orientación sexual o identidad de género, (i) tatuajes, piercing, perforaciones o expansiones, (j) apariencia física, (k) creencias o religión, (l) ideología u opinión política, (m) participar o no en sindicatos u organizaciones gremiales, (n) lugar donde vive, (o) establecimiento donde estudió, (p) pertenecer a un pueblo indígena, (q) condición de salud o discapacidad, (r) otros motivos. Correspondiente a 18 variables independientes.II.Discriminación percibida por uno o más motivos .Acceso y uso del sistema de salud:I.Acceso general, esto es, inscripción al sistema previsional de salud .II.Cobertura de salud complementaria  ante riesgo de enfermedad o accidente; No: ningún miembro cubierto por SSC).III.Consulta ante enfermedad o accidente (sí/no).IV.Consulta ante enfermedad o accidente .Resultados de salud:I.Tratamiento médico en el último año (sí/no).II.Salud autoevaluada (SAV), en escala de 1 a 7, donde 1 es muy mal y 7 muy bien.III.Mala SAV (sí/no), a partir de variable SAV categorizada en sí = 1,2 y no = 3,4,5,6,7.Capital social:I.Participación en organizaciones o grupos organizados (sí/no).II.Redes de apoyo social y/o familiar (sí/no).Variables sociodemográficas: Sexo, edad, pertenencia étnica, nivel educacional, zona, quintil de ingreso del hogar, ocupación. En inmigrantes: tiempo de residencia en Chile y país de origen.Se estimaron los porcentajes de población inmigrante y local discriminada total y según motivos de discriminación. Asimismo, se analizaron descriptivamente las variables de resultados de salud, acceso y uso del sistema de salud distinguiendo entre quienes percibieron discriminación y quienes no, utilizando medidas de frecuencia con sus respectivos intervalos de confianza. La independencia entre variables se analizó mediante pruebas chi cuadrado con corrección Rao-Scott . Por otrPara analizar el efecto del capital social y los factores sociodemográficos sobre la discriminación percibida, en primera instancia, se ajustaron modelos de regresión logística utilizando como variable dependiente la percepción de discriminación y como independientes las redes de apoyo social y participación en organizaciones sociales, para inmigrantes y locales por separado .Posteriormente, se adicionó a tales modelos un ajuste por variables sociodemográficas (va. SD) .En la misma línea, para explorar el efecto de la interacción entre inmigración y discriminación percibida sobre los diversos resultados de salud y acceso a servicios de salud, se ajustaron modelos de la forma (modelos 5-10):Finalmente, se exploró la relación entre discriminación y resultados de salud y acceso a salud en inmigrantes y locales por separado, mediante modelos de la forma:En inmigrante se ajustó adicionalmente por país de origen y tiempo de residencia.test F ajustado de medias residuales (Archer y Lemeshow).Para todos los modelos estimados, la bondad de ajuste fue examinada mediante Los análisis se realizaron con el software Stata 14, con significancia de 0,05, confianza del 95%, considerando la muestra compleja , tratando estratos con un único conglomerado como una unidad de certeza y linealización de Taylor para estimación de la varianza.Del total de informantes idóneos inmigrantes, el 26,92% , equivalente a 78.413 personas, indicó haber sido discriminado o tratado injustamente por ser extranjero. En inmigrantes, apariencia física y color de piel fueron los motivos de discriminación reportados con mayor frecuencia, difiriendo significativamente de la población local. En modelos crudos, los inmigrantes tuvieron 8,23  veces más chance de ser discriminados por su color de piel comparado con locales y 2,82  veces más chance de ser discriminados por su apariencia física. Tras ajustar por capital social y variables sociodemográficas, estas magnitudes de asociación fueron 5,27  y 1,71 , respectivamente. Contrariamente, los inmigrantes tuvieron significativamente menos chance de reportar discriminación por ser hombre o mujer , lugar donde vive , edad , religión , sexualidad o identidad de género , establecimiento donde estudió  y tatuajes o perforaciones , que los locales. Para todos los modelos ajustados, las redes de apoyo social fueron estadísticamente significativas, siendo generalmente factores protectores .El 32,99%  de los inmigrantes (n = 96.095) y 14,46%  de los locales afirmaron haber sido tratados injustamente o discriminados fuera del hogar. Tras ajustes por variables sociodemográficas y capital social, los inmigrantes tuvieron 2,3  veces más chance de haber sido discriminados que la población local . En inmiDescriptivamente, en población inmigrante y local, el subgrupo de discriminados tuvo mayor porcentaje de población con mala salud y en tratamiento médico comparado con los no discriminados . Tras ajOR: 0,06–0,23) y 67,2%  menos chance de tener mala SAV y estar en tratamiento, respectivamente, comparados con aquellos sin redes . Sin embargo, en población consultante, inmigrantes  y chilenos  no discriminados tuvieron significativamente menos chance de presentar problemas durante la consulta comparados con inmigrantes discriminados. Ya sea que perciban discriminación o no, los inmigrantes presentaron más chance de no tener previsión de salud en comparación con los nacidos en Chile. Específicamente, los chilenos discriminados tienen 0,265  veces menos chance de no tener previsión de salud en comparación con inmigrantes discriminados, en chilenos no discriminados este valor fue de 0,212  veces  veces .Respecto a los factores sociodemográficos en relación al acceso a atención en salud en inmigrantes, la pertenencia étnica resultó ser significativa en la falta de previsión de salud  y tenencia de seguros complementarios . Asimismo, la zona de residencia fue significativa para la falta de previsión de salud , tenencia de seguros complementarios , falta de consulta  y problemas durante el proceso de consulta . Finalmente, el pertenecer el quintal más rico en comparación al quintil más pobre resultó significativo en la falta de seguros complementarios  y la no consulta  .inmigrantes = 1,399  versus ORlocales = 1,604 ] ] .Finalmente, en inmigrantes un mayor tiempo de residencia en el país fue un factor de riesgo significativo en el estar o haber estado en tratamiento médico  y protector en el no tener previsión de salud, SSC  y falta de seguros de salud complementarios . En este último el país de origen también resultó ser un factor significativo – (resultado no presentado en tabla).12. Respecto a este último, si bien en este estudio la discriminación no mostró una asociación significativa con la no consulta, en algunas situaciones sí se relacionó con el presentar problemas durante la consulta, pudiendo tener repercusiones negativas en la búsqueda de atención en el futuro.Este estudio buscó describir brechas de desigualdad en la percepción de discriminación entre inmigrantes y locales, desde un enfoque de inequidad social en salud. Los resultados presentados sugieren que inmigrantes residentes en Chile tienen mayor chance de percibir discriminación comparado con locales, y que la interacción entre inmigración y discriminación se puede relacionar con peores resultados de salud autoevaluada y tratamiento médico. Acorde a la evidencia, la discriminación percibida podría desencadenar una serie de mecanismos que intervienen en el riesgo de enfermar, pudiendo distinguirse entre (i) directos, provocando una respuesta al estrés y afrontamiento poco saludable de este; e (ii) indirectos o estructurales, al limitar el empleo, ingreso, bienestar general, y acceso y trato percibido en sistemas y servicios de salud, entre otros17. En inmigrantes ghaneses en Europa niveles más altos de discriminación percibida se asociaron con un alto riesgo de enfermedades cardiovasculares24, y en inmigrantes usuarios de diverso origen de servicios sociosanitarios en Barcelona aproximadamente el 50% de los encuestados indicó sentirse discriminado en tales servicios, empeorando en inmigrantes irregulares25.Algunos estudios internacionales han mostrados resultados similares. Por ejemplo, en refugiados e inmigrantes iraquíes la percepción de discriminación contribuyó significativamente a la predicción de depresión y mala o regular salud autoevaluada, aumentando hasta dos veces el riesgo en población discriminada12. En este sentido, en población inmigrante, el capital social puede jugar un rol ambiguo en la percepción de discriminación al proteger frente a eventos discriminatorios y su afrontamiento, pero puede facilitar la percepción de agresiones sutiles acorde a las costumbres del país receptor y el aislamiento en grupos cerrados.En el contexto actual, la discriminación tiende a ocurrir como microagresiones sutiles o estructurales, en vez de explicita y abierta. Así, la discriminación percibida ha sido utilizada mundialmente en estudios similares, ya que su naturaleza subjetiva permite capturar eventos no definidos como discriminatorios según leyes locales o definiciones sociales particulares21. Entre los participantes del estudio que percibieron discriminación aproximadamente un tercio afirmó ser discriminados por múltiples motivos. Esto da cuenta de la complejidad de estos procesos sociales, múltiples y dinámicos, así como la importancia de contar de manera coordinada y planificada con acciones de protección de la dignidad, salud y cualquier forma de desventaja social en inmigrantes. Considerando los posibles efectos crónicos de la discriminación y que los principales motivos de discriminación en inmigrantes se perciben en apariencia externa, es urgente concientizar a la población local acerca de su prevención y rechazo, sobre todo en la atención en salud.En Chile, las experiencias de discriminación se entrelazan con otras formas de rechazo, exclusión social, clasismo, racismo y desprecio a personas en pobrezaLas fortalezas de este estudio consisten en el análisis simultáneo de variables sociales y de salud, y la utilización de una base poblacional confiable y altamente aceptada en Chile, permitiendo aceptable precisión general. Por otra parte, al tratarse de un análisis de datos secundarios, son limitaciones la exclusión de grupos de interés , la imposibilidad de analizar otras variables pertinentes a la problemática y tamaños de muestra limitados en población migrante al no ser foco de selección de la muestra. Finalmente, se reconoce la naturaleza transversal de los datos impidiendo inferir causalidad.Los resultados de este estudio pueden apoyar en el desarrollo de políticas públicas y de salud en Chile y en otros países que muestren resultados similares. Existe evidencia en América Latina y el Caribe que documenta la relación entre experiencias de estigma, discriminación y racismo y peores resultados de salud en migrantes, refugiados y personas en movimiento. Estos fenómenos sociales son complejos y dinámicos, y relevantes a la hora de profundizar en los mecanismos sociales de rechazo y exclusión que desencadenan una serie de resultados de salud subjetivos y objetivos. La discriminación tiene su origen en la formación de grupos sociales que se autoconciben de manera distinta a los demás, creando así una o múltiples “otredades” de menor rango o casta, las cuales están cargadas de estereotipos y prejuicios. En este sentido, la mayor percepción de discriminación en migrantes comparados a locales en Chile ilustra la existencia de patrones de interacción social que va diferenciando, y subyugando, al migrante por su estatus de extranjero, además, como sugieren los resultados de este estudio, de su color de piel y aspecto físico. En materia de política pública, este estudio permite reforzar la importancia de atender, contener y revertir procesos de estigma y discriminación hacia migrantes en Chile, que también se ha documentado en otros países. Dichas recomendaciones de política pública pueden organizarse en torno a niveles diferenciados de acción, por ejemplo: (i) nivel político, con el desarrollo de normativas y mecanismos de rechazo a toda forma de discriminación en contextos públicos, incluyendo en sistema de salud, (ii) nivel comunitario, mediante campañas de sensibilización que promuevan el respeto a la diversidad social y cultural y la construcción de comunidades inclusivas y respetuosas, (iii) sistema de salud, mediante desarrollo de mecanismos de formación continua en la temática de migración, discriminación y salud, la promoción de equipos con competencias interculturales en salud y campañas permanentes de rechazo explícito y auditoría a toda forma de discriminación y violencia en la atención de salud.13, (ii) enfoque longitudinal de curso de vida y (iii) análisis de problemas específicos de salud. Asimismo, un enfoque de desigualdades sociales que integre la intersección con identidad de género es relevante, pues estas suelen derivarse de valores dominantes de la sociedad de acogida y se exacerban en mujeres4. Por tanto, este estudio abarca múltiples enfoques, pero puede seguir profundizándose, especialmente en encuestas poblacionales que incluyan una adecuada representación de colectivos migrantes.Sobre futuras investigaciones, existen tres aspectos relevantes documentados en la literatura que no están suficientemente analizados en este estudio: (i) variables migratorias críticas para la experiencia de discriminación como regularidad y refugio/asilo


To compare the air-conduction hearing thresholds obtained with different acoustic transducers and verify the users’ preferences regarding them.This is a cross-sectional, analytical, observational study with 26 participants aged 18 to 30 years, with normal hearing and no history of exposure to high sound pressure levels or complaints of tinnitus at the time of the assessment. We surveyed their medical history and performed meatoscopy, pure-tone threshold audiometry, speech audiometry, and acoustic immittance. The auditory thresholds were surveyed twice, each time with a different type of acoustic transducer: insert (E-A-RTONE) and circumaural earphones (HDA200). The assessments were performed in a random order, with 5-minute intervals. In the end, we asked the participants which earphones they found more comfortable in the tests. The data were submitted to nonparametric statistical analysis.Assessing the medians in the auditory threshold survey, the circumaural earphones obtained better results at 250, 500, 2000, and 6000 Hz, while the insert earphones were better at 3000 and 4000 Hz; there were no statistical differences at 1000 and 8000 Hz. The circumaural was elected the most comfortable earphone.The circumaural earphones had better auditory thresholds at 250, 500, 2000, and 6000 Hz than the insert earphones and were reported by the patients as the most comfortable type of transducer. It assesses both air-conduction (with earphones) and bone-conduction (with a bone vibrator) thresholds in both ears.Three types of phones are used to obtain air-conduction hearing thresholds for both pure tones and speech stimuli: supra-aural, circumaural, or insert earphones, but its disadvantages are the possibility of coupling between the earphone and the ear and the little reliability at low frequencies due to possible air leak.Supra-aural earphones are the ones most used in audiology clinical practice. It is fitted by pressing the earpad onto the auricle. Its advantages are the lower risk of collapse and greater interaural attenuation, besides being the earphone with the lowest variability caused by ear leakage, tending to minimize physiological noise in the ear, in contrast with the other types of earphones. However, it is subject to variations in the geometry of the external ear canal and difficulties controlling the precise insertion depth.Insert earphones are inserted into the external ear canal with a disposable foam earplug. It ensures minimum contact with the skin and diminishes the area of the head in contact with the sound stimulus, differing from the others,4. In general terms, they have greater interaural attenuation than supra-aural earphones, especially at low frequencies. Moreover, given their physical characteristics, they are the ones indicated for pure-tone audiometry at high frequencies (9 to 16 kHz). Various studies address the difference in hearing thresholds obtained with acoustic transducers and in different populations. They mostly compare the thresholds obtained with supra-aural and insert earphones – with better results with the insert ones, especially at low frequencies, although the supra-aural earphones sometimes have better results at high frequencies-6,8-12. One study has researched the difference between the hearing thresholds obtained with supra-aural and circumaural earphones, showing that the circumaural earphones had better thresholds even at low frequencies.Circumaural earphones, when fitted to the patient, are placed around the auricle. They provide greater comfort because their earpads do not pressure the ear, they considerably reduce the variability in ear leakage and physiological noise in the ear and better attenuates environmental noiseSince the circumaural earphones are used less often in clinical practice, particularly in Brazil, evidently few papers have compared the hearing thresholds obtained with them and the other acoustic transducers. However, audiometers currently enable the use of different types of earphones, which has stimulated their use in clinical practice. This justifies research to provide better knowledge of their performance.Hence, the objective of this study was to compare the air-conduction hearing thresholds obtained with different acoustic transducers – insert (E-A-RTONE) and circumaural (HDA200) earphones – and verify the users’ preference regarding them.This is a cross-sectional, analytical, observational study conducted between March and September 2018. We selected for this research people of both genders from a nonprobabilistic convenience sample, employing personal contact and announcement on social media.This study was analyzed and approved by the Human Research Ethics Committee, under CAAE protocol: 79890817.6.0000.0121, and evaluation report number: 2.537.085. The procedures were explained to all participants, who signed the informed consent form..The eligibility criteria were as follows: individuals 18 to 30 years old of both genders, without hearing complaints, with hearing thresholds of 25 dBHL or less at 250 to 8000 Hz, speech recognition index (SRI) of at least 88%, and with acoustic reflexesSubjects with a history of exposure to frequent high occupational and/or recreational sound pressure levels, complaints of tinnitus at the time of the assessment, and any type of obstruction in the external ear canal that might interfere with the assessments were excluded.All the participants were submitted to the following procedures: medical history survey, meatoscopy, PTA, speech audiometry, and acoustic immittance measures..In PTA, the air-conduction threshold was surveyed at 250, 500, 1000, 2000, 3000, 4000, 6000, and 8000 Hz, bilaterally, with the descending method. Every time they detected the sound, its intensity was decreased by 10 dB until they stopped responding to the sound. If there was no response, the sound intensity was increased by 5 dB until they detected it again. The hearing threshold was established as the lowest sound intensity they had heard in 50% of the presentations at each frequency tested.To confirm the air-conduction thresholds, we researched the speech recognition threshold (SRT) – i.e., the lowest intensity at which the person recognized at least 50% of the words presented. Then, we surveyed the SRI, presenting in a live voice a list with 25 monosyllables at 40 dBSL, with the three-frequency mean between 500, 1000, and 2000 Hz.We measured the acoustic immittance (tympanometry and acoustic reflex) with an AT235 device (Interacoustics) to exclude the possibility of middle ear changesThe hearing thresholds and SRT were surveyed with two different types of earphones  to assess the influence of the type of air-conduction acoustic transducer on the audiological assessment.The PTA was surveyed with an Astera II audiometer (Otometrics) using circumaural (HDA-200) and insert earphones . The earphones were calibrated according to ISO 389 norms , IEC 60645 , and ISO 8253 .We defined the order with which each acoustic transducer and ear was assessed in a draw to avoid order effect bias. There were 5-minute intervals in between the collections. Once they were finished, we asked the subjects which earphones they preferred regarding comfort, to classify them as the most and least comfortable ones.We tabulated the data in an Excel spreadsheet  and submitted them to descriptive and inferential statistical analyses.Initially, the Kolmogorov-Smirnov test was applied to test the normality of the numerical variables. Since the data did not have a normal distribution (p < 0.0001), we used nonparametric tests. The Mann-Whitney test was used to compare the hearing thresholds between the ears; the Wilcoxon test, to compare the hearing thresholds between the transducers; and the chi-squared test, to analyze the association regarding the comfort in wearing the earphones. The significance level was set at p < 0.05, which is indicated with an asterisk. We used the MedCalc software for data analysis.Of the 30 people who agreed to participate in the study, 26 met the eligibility criteria – 16 females and 10 males, aged 18 to 30 years .Firstly, we compared the hearing thresholds between the ears, for each transducer, and verified no difference between the ears (Mann-Whitney test). Hence, the research data were analyzed considering the total number of ears (n=52).The median hearing threshold results at 250 to 8000 Hz obtained with the two acoustic transducers – circumaural (HDA-200) and insert (E-A-RTONE) – revealed better results with the circumaural earphone at 250, 500, 2000, 6000, and 8000 Hz, while the result at 1000 Hz was the same for both types of transducers .In the comparison between hearing thresholds obtained with each transducer at each frequency tested, the Wilcoxon test revealed better air-conduction hearing thresholds with the circumaural earphone, with a significant difference at all the frequencies, except for 1000 and 8000 Hz .Regarding the patients’ answers about the physical comfort with the two types of transducers, the chi-squared test showed an association between the type of transducer and their preference – i.e., the HDA transducer was reported by 65.4% of the research participants as the most comfortable one. This preference was statistically significant (p < 0.0001) .Choosing the type of transducer to assess hearing in PTA requires knowledge based on their advantages and disadvantages from both the acoustic and the patient’s perspective. The choice must consider that it is used with different age groups, in different degrees of impairment, aiming to obtain hearing thresholds at different frequencies.,6,8-12, whereas comparisons with circumaural earphones are still scarce,17.Given the possibility of using supra-aural, insert, or circumaural earphones to obtain air-conduction hearing thresholds at 250 to 8000 Hz, we must compare them and verify the users’ satisfaction with them. We commonly find studies reporting the difference in hearing thresholds obtained with supra-aural and insert earphones in different populations. On the other hand, the present study compared the performance of insert and circumaural earphones and observed that the insert ones were better than the others only at 3000 and 4000 Hz , without audiological changes, found better hearing thresholds with insert than supra-aural earphones, at 250, 500, 1000, 2000, 3000, and 4000 Hz 4000 Hz . The cir 4000 Hz . We founThe results show the relevance of choosing circumaural earphones to obtain air-conduction thresholds at 250 to 8000 Hz, as they help improve the values obtained with this examination . than supra-aural earphones. The authors explained it with the fact that circumaural earphones reduce possible air leakage between the earphone and the ear. Hence, they are considerably more reliable at low frequencies, provide greater attenuation of external noise than the supra-aural earphones, diminish the physiological noise in the ear, and are more comfortable,7. The greater attenuation of environmental noise provided by the circumaural earphone also qualifies it as the most indicated earphone when the pure-tone audiometry cannot be performed in an acoustically treated setting.A study conducted in adults showed better thresholds with circumaural. Thus, we believe that the difference in thresholds found in the present research does not result from the test-retest variable, but from the difference between the transducers. The researchers took precautions to avoid variables that might interfere with the result analysis. For instance, we randomized the procedures by drawing lots to define which transducer and ear would be assessed first.Due to the time available to carry out this study, we could not assess whether the differences between the hearing thresholds obtained with the two transducers were actually due to the earphone variable or some variation between test and retest. Nonetheless, a study assessed hearing threshold variations in test and retest with different transducers and verified no difference in hearing thresholds between the assessments, particularly at 500 to 6000 Hz, in comparison with the range from 8000 to 14000 Hz. A previous study also highlighted the comfort in audiological assessments as an advantage of circumaural earphones.Another rather important aspect in this study was the subjects’ earphone preference regarding comfort in the assessments. The circumaural earphone was elected the most comfortable . This fiHence, based on these research findings, we emphasize how important it is for audiologists to know the particularities of the different types of earphones. Thus, they will make better choices not only when providing attention but also when choosing transducers to equip the healthcare service, considering the setting where attention will be provided, the population they will possibly attend, and the type of assessment they will make. Moreover, we believe these research results are relevant to speech-language-hearing clinical practice, as they showed the advantages of using circumaural earphones both for acoustic reasons and the users’ comfort. Some other characteristics of this earphone, already listed in the literature and mentioned in this study, corroborate its use to obtain air-conduction hearing thresholds.Further research on this topic is warranted, given the scarcity of recent studies comparing the three types of acoustic transducers, particularly in people with unilateral profound hearing loss, to better characterize the interaural attenuation provided by different transducers, especially with circumaural earphones.The circumaural earphones obtained better hearing thresholds at 250, 500, 2000, and 6000 Hz than the insert ones, besides being the most comfortable transducer as reported by the patients. .A Audiometria Tonal Liminar (ATL) é o exame padrão-ouro para avaliar a audição e tem como objetivo pesquisar o limiar de intensidade sonora em que o indivíduo detecta a presença do som em diversas frequências. Por meio desse exame é possível avaliar tanto a audição por via aérea, por meio de fones, quanto por via óssea, por meio de vibrador ósseo, em ambas as orelhas.Para obtenção dos limiares auditivos por via aérea, tanto para tons puros, como para estímulos de fala, é possível utilizar três tipos de fones: supra-aural, circum-aural ou de inserção, como desvantagem há a possibilidade de acoplamento entre o fone de ouvido e a orelha, além disso há confiabilidade reduzida em frequências baixas, devido ao possível vazamento de ar.O fone supra-aural é o mais utilizado na prática da audiologia clínica, seu ajuste consiste em pressionar o coxim contra o pavilhão auricular. Suas vantagens consistem na redução do risco de colabamento, aumento da atenuação interaural e também, é o fone que mais reduz a variabilidade causada por vazamentos de ar e tende a minimizar o ruído fisiológico no ouvido em relação aos demais tipos de fone. No entanto, está sujeito a variabilidade da geometria do meato acústico externo e dificuldades de controlar a profundidade exata de inserção.O fone de inserção fica inserido dentro do meato acústico externo, por meio de plugue de espuma descartável, o que proporciona mínimo contato com a pele e diminui a área da cabeça em contato com o estímulo sonoro, o diferenciando dos demais,4.De forma geral, apresenta atenuação interaural maior em comparação ao fone supra-aural, principalmente em frequências baixas. Além disso, por conta de suas características físicas, também é o indicado para a realização da audiometria tonal para as altas frequências (9 a 16kHz). Diversos estudos discutem sobre a diferença dos limiares auditivos obtidos entre os transdutores acústicos em diferentes populações. Em sua maioria, são comparados os limiares obtidos com os fones supra-aural e de inserção, no qual é possível observar que o de inserção obtém melhores resultados, principalmente em frequências baixas, enquanto o supra-aural, algumas vezes, apresenta melhores resultados para frequências altas-6,8-12. Já um estudo que pesquisou a diferença dos limiares auditivos obtidos entre os fones supra-aural e circum-aural, foi possível evidenciar que o circum-aural apresentou melhores limiares inclusive para frequências baixas.O fone circum-aural, quando adaptado no paciente, encontra-se instalado ao redor do pavilhão auricular, o que causa mais conforto ao indivíduo, pois o coxim do fone não gera pressão e reduz consideravelmente a variabilidade do vazamento de ar e o ruído fisiológico no ouvido, além de proporcionar maior atenuação do ruído ambientalComo o fone circum-aural é menos utilizado na prática clínica, principalmente na realidade brasileira, fica evidente a escassez de trabalhos que comparam os limiares auditivos obtidos com este fone em relação aos demais transdutores acústicos. Entretanto, atualmente os audiômetros disponibilizam o uso dos diferentes tipos de fones, o que estimulou o seu uso na prática clínica, justificando o melhor conhecimento do seu desempenho por meio de pesquisas.Desta forma, o objetivo deste estudo foi comparar os limiares auditivos por via aérea obtidos em diferentes transdutores acústicos, de inserção (E-A-RTone) e circum-aural (HDA200), e verificar a preferência do usuário.Tratou-se de um estudo observacional, analítico de delineamento transversal realizado no período de março a setembro de 2018. Para esta pesquisa foram selecionados indivíduos de ambos os sexos, a partir de uma amostra não probabilística por conveniência, por meio de contato pessoal e divulgação da pesquisa em redes sociais.O presente estudo foi analisado e aprovado pelo Comitê de Ética em Pesquisa com Seres Humanos, sob protocolo CAAE: 79890817.6.0000.0121, parecer número: 2.537.085. Todos os participantes receberam esclarecimentos sobre os procedimentos a serem executados e assinaram o Termo de Consentimento Livre e Esclarecido..Os critérios de elegibilidade estabelecidos foram: indivíduos de 18 a 30 anos de ambos os sexos, sem queixas auditivas, com limiares auditivos menores ou iguais a 25 dBNA de 250 a 8000 Hz, Índice de Reconhecimento de Fala (IRF) de no mínimo 88% e reflexos acústicos presentesForam excluídos os indivíduos com histórico de exposição a níveis de pressão sonora elevados de origem ocupacional e/ou recreacional frequentes, queixa de zumbido no momento da avaliação e algum tipo de obstrução do meato acústico externo que pudesse comprometer as avaliações.Todos os participantes foram submetidos aos seguintes procedimentos: anamnese, meatoscopia, ATL, logoaudiometria e medidas de imitância acústica..Na ATL, a pesquisa por via aérea foi realizada nas frequências de 250, 500, 1000, 2000, 3000, 4000, 6000 e 8000 Hz, bilateralmente por meio da técnica descendente. A cada resposta de detecção do som, a intensidade sonora foi reduzida em intervalos de 10 dB até que o indivíduo não respondesse mais ao som. Na ausência de resposta, a intensidade sonora foi elevada com intervalos de 5 dB até que o indivíduo detectasse a resposta. O limiar auditivo correspondeu à menor intensidade sonora ouvida, em 50% das apresentações, para cada frequência testada.Na intenção de confirmar os limiares aéreos, foi pesquisado o Limiar de Reconhecimento de Fala (LRF), ou seja, a menor intensidade na qual o indivíduo reconhece pelo menos 50% das palavras apresentadas. Em seguida, foi realizada a pesquisa do índice de reconhecimento de fala, no qual foi apresentada uma lista de 25 palavras monossílabas a 40 dBNS, da média tritonal de 500, 1000 e 2000 Hz, à viva voz.Para se excluir qualquer alteração de orelha média, foram realizadas as medidas de imitância acústica (timpanometria e a pesquisa do reflexo acústico), por meio do equipamento AT235 (Interacoustics)Para avaliar a influência do tipo de transdutor acústico de via aérea na avaliação audiológica, os limiares auditivos e o LRF foram realizados com dois diferentes tipos de fones, o circum-aural e o de inserção.A ATL foi realizada por meio do audiômetro Astera II (Otometrics) com uso do fone circum-aural (HDA-200) e com o fone de inserção (modelo E-A-R TONE da 3M). Os fones foram calibrados de acordo com as Normas ISO 389 Partes 1, 3, 4, 5 e 8 IEC 60645 partes 1, 2, 4 e ISSO 8253 Partes 1, 2, 3.A ordem de avaliação para cada transdutor acústico e orelha foram feitos a partir de um sorteio, no intuito de não se ter prejuízo devido ao efeito de ordem e foram realizados intervalos de cinco minutos entre as coletas. Ao término os indivíduos foram questionados quanto à preferência em relação ao conforto, podendo classificar como o mais confortável e o menos confortável.Os dados foram tabulados em uma planilha do Excel  e submetidos à análise estatística descritiva e inferencial.software MedCalc foi utilizado para a análise dos dados.Inicialmente aplicou-se o teste Kolmogorov-Smirnov para testar a normalidade das variáveis numéricas. Uma vez que os dados não mostraram distribuição normal , foram utilizados testes não paramétricos. O teste de Mann-Whitney foi utilizado para a comparação dos limiares auditivos entre as orelhas, o Teste de Wilcoxon na comparação dos limiares auditivos entre os transdutores e o Teste de Qui Quadrado nas análises de associação quanto ao conforto do uso dos fones. Foi estabelecido como nível de significância quando p < 0,05, sendo estes marcados com um asterisco. O Dos 30 indivíduos que aceitaram participar do estudo, 26 atenderam os critérios de elegibilidade, sendo 16 do sexo feminino e dez do sexo masculino, com idade entre 18 e 30 anos .Inicialmente, os limiares auditivos foram comparados entre as orelhas, para cada transdutor e verificou-se que não houve diferença entre as orelhas (Teste de Mann-Whitney). Sendo assim, os dados desta pesquisa foram analisados considerando o número total de orelhas (n=52).Os resultados dos limiares auditivos medianos de 250 a 8000Hz obtidos com os diferentes transdutores acústicos, circum-aural (HDA-200) e de inserção (E-A-R TONE) demonstraram que o fone circum-aural apresentou melhores resultados para as frequências de 250, 500, 2000, 6000 e 8000 Hz, sendo que 1000 Hz permaneceu igual para os dois tipos de transdutores .Na comparação dos limiares audiométricos obtidos para cada transdutor em cada frequência sonora testada, o teste de Wilcoxon evidenciou melhores limiares auditivos por via aérea para o fone circum-aural, com diferença significativa em todas as frequências testadas, com exceção de 1000 e 8000Hz .Quanto às respostas ao conforto físico de cada paciente em relação aos diferentes tipos de transdutores, o teste Qui quadrado mostrou associação entre o tipo de transdutor e a preferência, ou seja, o transdutor HDA foi relatado por 65,4% dos participantes da pesquisa como sendo o mais confortável, sendo esta preferência estatisticamente significante  .Na ATL, a escolha do tipo de transdutor na avaliação da audição do paciente requer o conhecimento baseado nas vantagens e desvantagens tanto do ponto de vista acústico como do próprio paciente, já que é utilizado em diferentes faixas etárias, em diferentes graus de comprometimento e para a obtenção dos limiares auditivos em diferentes frequências.,6,8-12, enquanto que a comparação com o fone circum-aural ainda é escassa,17.Diante da possibilidade da utilização dos fones supra-aural, de inserção e circum-aural, na obtenção dos limiares auditivos por via aérea na faixa de 250 a 8000Hz, a comparação entre eles, bem como a satisfação do usuário se fazem necessárias. Comumente encontramos estudos que relatam a diferença dos limiares auditivos obtidos entre os fones supra-aural e de inserção em diferentes populações. Por outro lado, no presente estudo, ao comparar o desempenho do fone de inserção com o fone circum-aural observou-se que o primeiro (fone de inserção) foi melhor que o circum-aural apenas para as frequências de 3000 e 4000 Hz , sem alterações audiológicas, encontrou limiares auditivos obtidos com fone de inserção melhores quando comparados com os obtidos com o fone supra-aural, nas frequências de 250, 500, 1000, 2000, 3000 e 4000 Hz 4000 Hz . Já o ci 4000 Hz . Na liteOs resultados mostram a relevância da escolha do fone circum-aural na obtenção dos limiares de via aérea de 250 a 8000Hz, já que auxilia na melhora dos valores na obtenção de limiares aéreos . em comparação ao fone supra-aural e a explicação dada pelos autores se deve ao fato do fone circum-aural reduzir o possível vazamento de ar entre o fone e a orelha, sendo consideravelmente mais confiável em frequências baixas, além de oferecer uma maior atenuação do ruído externo quando comparado ao fone supra-aural, diminuir o ruído fisiológico no ouvido do indivíduo e ser mais confortável,7. A maior atenuação do ruído ambiental proporcionada pelo fone circum-aural o elege também como fone mais indicado em situações nas quais a audiometria tonal não pode ser realizada em um ambiente acusticamente tratado.Um estudo realizado com indivíduos adultos mostrou melhores limiares para o fone circum-aural. Desta forma, acredita-se que a diferença de limiares encontrada na presente pesquisa não é decorrente da variável teste e reteste e sim da diferença entre os transdutores. Com o intuito de evitar variáveis que pudessem interferir na análise dos resultados, os pesquisadores tomaram alguns cuidados como, por exemplo, aleatorizar os procedimentos, realizando-se sorteio para definir qual seriam o transdutor e a orelha na primeira avaliação.Em virtude do tempo necessário para a realização do presente estudo, não foi possível avaliar se as diferenças dos limiares auditivos, obtidas entre os transdutores, foram realmente pela variável “fone de ouvido” ou por uma variação entre teste e reteste. Entretanto, em um estudo realizado com o intuito de avaliar a variação dos limiares auditivos em situações de teste e reteste para diferentes transdutores, verificou-se que não houve diferença dos limiares auditivos entre as avaliações, principalmente na faixa de frequência de 500 a 6000Hz quando comparado à faixa de 8000 a 14000Hz. Estudo anterior também ressaltou como vantagem do fone circum-aural o seu conforto durante a avaliação audiológica.Outro aspecto muito importante, realizado neste estudo, foi a preferência dos indivíduos em relação ao conforto de cada fone, durante as avaliações. O fone circum-aural foi eleito o mais confortável . Este acDesta forma, a partir dos achados desta pesquisa ressalta-se a importância do conhecimento do audiologista sobre as particularidades dos diferentes tipos de fones para se ter uma melhor escolha, seja no momento dos seus atendimentos, como no momento de escolha do transdutor para equipar seu serviço, pensando no local em que eles serão realizados, a população que possivelmente atenderá e o tipo de avaliação que realizará. Ademais, acredita-se que os resultados desta pesquisa são de relevância para a clínica fonoaudiológica, pois mostrou as vantagens do uso fone circum-aural tanto para os aspectos acústicos como para o conforto do usuário. Além disso, outras características deste fone, já elencadas na literatura e citadas neste estudo, corroboram para que este seja um fone utilizado para a obtenção dos limiares auditivos por via aérea.Sugerem-se pesquisas com este tema, visto a escassez de estudos recentes e que comparem os três tipos de transdutores acústicos, principalmente em indivíduos com perda auditiva profunda unilateral, a fim de caracterizar melhor a atenuação interaural gerada por diferentes transdutores, especialmente com o fone circum-aural.O fone circum-aural apresentou melhores limiares auditivos em 250, 500, 2000, 6000Hz quando comparado ao fone de inserção, além de ser o tipo de transdutor mais confortável relatado pelos pacientes.