Factores asociados a un mayor grado de incapacidad por acúfenos en pacientes del servicio de Otorrinolaringología de una Clínica en Lima

Objetivo: Identificar los factores asociados a un mayor grado de incapacidad por acúfenos en pacientes del servicio de Otorrinolaringología en una clínica de Lima-Perú. El estudio: La muestra estuvo conformada por 100 pacientes que manifestaron sufrir de acufenos, a quienes se les aplicó el cuestionario Tinnitus Handicap Inventory (THI). Para el análisis comparativo se usó el test de Chi-Square o Kruskal-Wallis. Para determinar la asociación entre las variables de estudio se usaron modelos de regresión de Poisson, con intervalos de confianza al 95%. Hallazgos: El 94% de los participantes presentaron algún grado de incapacidad por acufenos, 40% de grado severo. Por cada año cumplido aumenta 7% la probabilidad de padecer incapacidad grave por acufenos, mientras que ser hipertenso y tener depresión aumentan esta probabilidad en 8 y 4.8 veces respectivamente. Conclusiones: La edad, la Hipertensión y la depresión son factores asociados a un mayor grado de incapacidad por acúfenos.

Objective: The goal of this investigation was to determine the factors associated with a higher degree of disability due to tinnitus in patients of the otorhinolaryngology service in a clinic in Lima-Peru. The study: The sample consisted of 100 patients who reported suffering from tinnitus, to whom the Tinnitus Handicap Inventory (THI) questionnaire was applied. For the comparative analysis, either the Chi-Square or the Kruskal-Wallis test was used. To determine the association between the study variables, Poisson regression models were used, with 95% confidence intervals. Findings: Of the participants, 94% exhibited some degree of disability due to tinnitus. For 40% of the patients the disability was found to be severe. For every subsequent year of age, the probability of suffering from severe disability due to tinnitus increases by 7%, while being hypertensive and having depression increased this probability by 8 and 4.8 times, respectively. Conclusions: age, hypertension and depression are factors associated with a higher degree of disability due to tinnitus.

Impacto en la calidad de vida por la comprensión del tinnitus / The Quality of Life impaction by Tinnitus Comprehension

El tinnitus es la sensación de sonido en ausencia de cualquier fuente externa. Nuestro objetivo fue evaluar la repercusión del tinnitus en la calidad de vida. Se inscribieron 25 pacientes con tinnitus con una amplia gama de umbrales de pérdida auditiva (HLT) y estado de gravedad de tinnitus. La gravedad, la ansiedad y la depresión del tinnitus se evaluaron mediante el inventario de discapacidades por tinnitus (THI), el índice funcional de tinnitus (TFI) y la escala de ansiedad y depresión hospitalaria (HADS), respectivamente. Se realizó una audiometría de conducción aérea de tono puro. El impacto de la percepción del tinnitus en la calidad de vida se encontró más alto en el grupo de sufrimiento. La escala de ansiedad y depresión figuraba en 40% y 60%, respectivamente. El uso de la mano fue de 20 diestros y 5 zurdos. El tinnitus bilateral se está experimentando en el 76%. El LH se presentó en 17 (68%) de los pacientes con tinnitus. La descripción del sonido del tinnitus como silbido (40%), siseo (24%), pulsante (16%), timbre (8%) y ruidos de tono alto (12%). Con respecto al cuestionario THI, los sujetos con tinnitus se dividen en 60% (leve), 30% (moderado) y 10% (grave). Mientras que el cuestionario TFI, el 50% mostró un (leve), el 25% (moderado) y el 25% mostró (severo). Postulamos una fuerte asociación positiva significativa entre HADS y la gravedad del tinnitus: THI (P = 0,000) y TFI (P = 0,001). Esos datos revelaron que la percepción del tinnitus tiene impactos negativos en la calidad de vida mientras que la gravedad puede verse alterada por la lateralidad

Tinnitus is the sensation of sound in the absence of any external source, and the aim is to assess the impaction of tinnitus on QoL. 25-tinnitus sufferers were enrolled with a wide range of hearing loss thresholds (HLT) and tinnitus severity status. Tinnitus severity, anxiety and depression were assessed using tinnitus handicap inventory (THI), tinnitus functional index (TFI), and the hospital anxiety and depression scale (HADS), respectively. Pure tone air conduction audiometry was performed. The impaction of tinnitus perception on QoL was found higher in suffering group. The anxiety and depression scale figured in 40%, and 60%, respectively. The handed use was 20 rights handed and 5 left-handed. Bilateral tinnitus is experiencing in 76%. The HL occurred in 17(68%) of tinnitus patients. The description of tinnitus sound as whistling (40%), hissing (24%), pulsating (16%), ringing (8%), and high pitch noises (12%). Regarding THI questionnaire, tinnitus subjects are divided to 60% (mild), 30% (moderate), and 10% (severe). While TFI questionnaire, 50% showed a (mild), 25% (moderate), and 25% showed (severe). We postulated a strong significant positive association between HADS and tinnitus severity: THI (P=0.000) and TFI (P= 0.001). Those data revealed that tinnitus perception has negative impacts on QoL, and the severity may be altered by laterality.

Genetic effect of season on the preweaning growth of beef cattle: A first approach on Retinta calves / Efecto genético de la estación climática sobre el crecimiento predestete del ganado de carne: Un primer estudio en terneros de raza Retinta / Efeito genético de estações climáticas no crescimento pré-desmame de bovinos de corte: uma primeira abordagem para os bezerros Retinta

Abstract Background: Heat stress derived from global warming is causing major economic losses in the livestock industry. Objective: To develop a novel methodological approach for determining the influence of climatic factors on the estimation of genetic parameters for growth traits in Retinta cattle breed by using reaction-norm models. Methods: Live weight records (n=7,753) from 3,162 Retinta calves born from 1,249 dams and 85 sires and raised in the Andalusian region (Spain) were analyzed. The effect of heat stress was measured using the temperature-humidity index, calculated with climatological data obtained from four weather stations. A bivariate-random-regression reaction-norm model was used to estimate the (co)variance components of weight until weaning in two different climatic seasons corresponding to warm and cold months. Results: The heritability pattern of individuals reared under diverse environments during the first 90 days of age was different. However, differences were not significant at the end of the growing period. Weaned calves reared during the cold season showed greater growth from 70 to 160 days in comparison with those reared during the warm season. Conclusions: Overall, this assessment did not show significant effects of the genotype-environment interaction. However, highly significant evidence of genotype-climatic condition interaction was found during the calf´s first three months of age.

Resumen Antecedentes: El estrés térmico derivado del calentamiento global está causando pérdidas económicas en la industria ganadera. Objetivo: Desarrollar un enfoque metodológico para estimar la influencia de algunos factores climáticos sobre la estimación de parámetros genéticos en las variables de crecimiento de la raza bovina Retinta. Métodos: Se analizaron registros de peso vivo (n=7.753) de 3.162 terneros hijos de 1.249 vacas y 85 toros, criados en la región de Andalucía (España). El efecto del estrés térmico se midió mediante un índice de temperatura-humedad obtenido a partir de los datos de cuatro estaciones meteorológicas. Se usó un modelo bivariado de regresión aleatoria de "norma-reacción" para estimar la (co)varianza del peso hasta el destete en dos diferentes épocas climáticas correspondientes a los meses cálidos y fríos. Resultados: Se encontraron diferencias en el patrón de heredabilidad de individuos criados en diferentes ambientes durante los primeros 90 días de vida. Sin embargo, tales diferencias no fueron significativas al final del periodo de crecimiento. Los terneros destetados en la época fría mostraron un mayor crecimiento entre 70 y 160 días en comparación con los criados en la temporada cálida. Conclusiones: Se encontró una evidencia altamente significativa de la interacción genotipo-condición climática durante los primeros tres meses de crecimiento del ternero.

Resumo Antecedentes: O estresse térmico devido ao aumento da temperatura média está produzindo grandes perdas econômicas na indústria pecuária. Objetivo: Realizar uma nova abordagem metodológica para estimar a importância dos fatores climáticos em parâmetros genéticos em variáveis de crescimento da população da raça Retinta. Métodos: Foram analisados registros de peso vivo (n=7.753) de 3.162 Retinta bezerros, nascidos de 1.249 vacas e 85 touros criados na região da Andaluzia (Espanha). O efeito do estresse térmico foi medido utilizando o índice de temperatura-umidade obtido com dados climatológicos de quatro estações meteorológicas. Um modelo de regressão aleatória bivariado de norma-reação foi usado para estimar os componentes da (co)variância do peso à desmama em duas estações climáticas com correspondência aos meses quentes e fríos. Resultados: Diferenças foram encontradas no padrão de herdabilidade de indivíduos criados em diferentes ambientes nos primeiros 90 dias de idade. No entanto, essas diferenças não foram significativas no final do período de crescimento. Os bezerros desmamados globalmente na estação fria apresentaram um crescimento maior dos 70 aos 160 dias em comparação com os indivíduos criados na estação quente. Conclusões: Uma evidência altamente significativa da interação genótipo-ambiente foi encontrada durante os primeiros três meses de crescimento do bezerro.

Effect of Fractal Tones on the Improvement of Tinnitus Handicap Inventory Functional Scores among Chronic Tinnitus Patients: An Open-label Pilot Study

Abstract Introduction Music-based sound therapies become recently a trend in the treatment of tinnitus. Few publications have studied the therapeutic use of fractal tones to treat chronic tinnitus. Objective The aim of this study was to determine the benefits of using fractal tones as a unique sound therapy for chronic tinnitus sufferers. Methods Twelve participants were recruited; however, six could not be assigned. At baseline and at 1, 3 and 6 months, the participants were provided with the Tinnitus Handicap Inventory (THI) and Hearing Handicap Inventory for Adults (HHIA) questionnaires, and their visual analog scale score was recorded. Tinnitus pitch and loudness matching was performed before fitting and after 6 months of use. Results The visual analog scale (VAS) score, pitch and loudness matching and minimal masking levels did not result in significant improvement at the end of the treatment. The mean THI measured at baseline was 45, and the final one was 25. A paired sample t-test showed that this 20-point difference was statistically significant. Conclusions We measured the benefits of using fractal tone therapy for the treatment of chronic tinnitus and found that most of the benefits were in the THI functional domain, which includes concentration, reading, attention, consciousness, sleep, social activities, and household tasks. For all patients with bothersome chronic tinnitus and high scores on the THI functional scale, fractal tones should be considered a promising initial sound therapy strategy. The findings from this open-label pilot study are preliminary, and further trials are needed before these results can be generalized to a larger tinnitus population.

Efeito do estresse térmico calórico agudo e crônico sobre a qualidade oocitária de bovinos de raças adaptadas / Effect of acute and chronic caloric heat stress on oocyte quality of adapted breeds cattle

Nos trópicos, o uso de raças adaptadas tem sido uma estratégia para minimizar o efeito do estresse térmico calórico (ETC). No entanto, faltam informações que quantifiquem o estresse e o seu efeito sobre a reprodução dessas raças. O objetivo deste estudo foi avaliar a qualidade do oócito recuperado e alguns parâmetros fisiológicos indicadores de ETC em bovinos de raças adaptadas. Animais Bos taurus x Bos indicus (n=6) e Bos taurus (raça Pantaneira; n=12), localizados na região de transição entre o Cerrado e o Pantanal brasileiro, foram submetidos à aspiração folicular guiada por ultrassonografia (OPU) em diferentes condições climáticas. Foram realizadas oito sessões de OPU, com intervalo mínimo de sete dias e máximo de 54 dias entre as coletas. Para caracterização climática, foi realizado o cálculo do índice de temperatura e umidade (ITU). Foram quantificados os ITUs do dia da OPU, sete dias antes e 60 dias antes de cada sessão. Os parâmetros fisiológicos e a viabilidade oocitária de fêmeas das raças Girolando e Pantaneira não foram afetados negativamente por ITUs entre 72 e 78. O ETC crônico (60 dias) parece afetar a viabilidade oocitária de doadoras na raça Pantaneira quando ITU é superior a 75.(AU)

In tropical regions, the use of adapted breeds has been a strategy to minimize the effect of heat stress (HS) in cattle. However, information quantifying stress and its effect on reproduction of these breeds is lacking. The aim of this study was to evaluate the quality of the recovered oocyte and some physiological parameters that indicate HS in adapted breed. Bos taurus x Bos indicus (n=6) and Pantaneira (n=12) cows, located in the transition region between Cerrado and Brazilian Pantanal, underwent follicular aspiration guided by ultrasound (OPU) in different weather conditions. Eight sessions of OPU were carried out, with a minimum interval of 7 days and maximum 54 days between sessions. For weather characterization, the temperature and humidity index (THI) was calculated. THI of the day of OPU, 7 days before and 60 days before each session were calculated. The physiological parameters and oocyte viability of Girolando and Pantaneira cows were not negatively influenced under ITU between 72 and 78. The chronic HS (60 days)may affect the oocyte viability of Pantaneira donors when ITU is over 75.(AU)

Effectiveness of sound therapy in patients with tinnitus resistant to previous treatments: importance of adjustments / Eficácia da terapia sonora em pacientes com zumbido resistente a tratamentos anteriores: importância dos ajustes

ABSTRACT INTRODUCTION: The difficulty in choosing the appropriate therapy for chronic tinnitus relates to the variable impact on the quality of life of affected patients and, thus, requires individualization of treatment. OBJECTIVE: To evaluate the effectiveness of using sound generators with individual adjustments to relieve tinnitus in patients unresponsive to previous treatments. METHODS: A prospective study of 10 patients with chronic tinnitus who were unresponsive to previous drug treatments, five males and five females, with ages ranging from 41 to 78 years. Bilateral sound generators (Reach 62 or Mind 9 models) were used daily for at least 6 h during 18 months. The patients were evaluated at the beginning, after 1 month and at each 3 months until 18 months through acuphenometry, minimum masking level, the Tinnitus Handicap Inventory, visual analog scale, and the Hospital Anxiety and Depression Scale. The sound generators were adjusted at each visit. RESULTS: There was a reduction of Tinnitus Handicap Inventory in nine patients using a protocol with a customized approach, independent of psychoacoustic characteristics of tinnitus. The best response to treatment occurred in those with whistle-type tinnitus. A correlation among the adjustments and tinnitus loudness and minimum masking level was found. Only one patient, who had indication of depression by Hospital Anxiety and Depression Scale, did not respond to sound therapy. CONCLUSION: There was improvement in quality of life (Tinnitus Handicap Inventory), with good response to sound therapy using customized settings in patients who did not respond to previous treatments for tinnitus.

Resumo Introdução: A dificuldade em escolher a terapia apropriada para zumbido crônico encontra-se nas suas diversas formas de impacto sobre a qualidade de vida dos pacientes e requer a sua individualização. Objetivo: Avaliar a eficácia do uso do gerador de som com ajustes individuais para aliviar o zumbido em pacientes sem resposta aos tratamentos anteriores. Método: Um estudo prospectivo em 10 pacientes, 5 homens e 5 mulheres, na faixa etária de 41 a 78 anos com zumbido crônico e resistente a tratamentos medicamentosos. Foram utilizados geradores de som bilaterais nos modelos Reach 62 ou Mind 9 por no mínimo 6 horas diárias durante 18 meses. Os pacientes foram avaliados no início, depois de 1 mês e a cada 3 meses até 18 meses através da acufenometria, Minimum Masking Level (MML), Tinnitus Handicap Inventory (THI), Escala Visual Analógica (EVA) e Hospital Anxiety and Depression Scale (HADS). Os geradores de som foram ajustados em cada visita. Resultado: Houve uma redução do THI em 9 pacientes usando-se um protocolo com uma abordagem personalizada, independente das características psicoacústicas do zumbido. A melhor resposta ao tratamento ocorreu naqueles pacientes com zumbido do tipo apito. Encontramos uma correlação entre os ajustes e a intensidade do zumbido e o MML. Apenas um paciente com indicação de depressão HADS não respondeu à terapia sonora. Conclusão: Houve uma melhora na qualidade de vida (THI) com boa resposta a terapia sonora com ajustes personalizados em pacientes resistentes a tratamentos anteriores para o zumbido.

Effects of acupuncture on tinnitus:A case series / 全日本鍼灸学会雑誌

[Purpose]Various factors may affect tinnitus, but the effects of acupuncture on tinnitus have not been evaluated. Therefore, we accumulated cases, and evaluated the characteristic effects of acupuncture on tinnitus.<BR>[Methods]Of 46 patients with tinnitus who visited the Acupuncture Clinic, Meiji School of Oriental Medicine between April 2004 and March 2014, 31 who underwent acupuncture therapy consecutively 5 times or more were included as the subjects for analysis. The median age of the subjects was 60 years old (range: 26-88 years old), and the duration of tinnitus was 1 month or more in 81%of the cases. A total of 29 patients had visited otolaryngological clinics, and hearing loss had been detected in 23patients. Tinnitus loudness was assessed with the Visual Analogue Scale (VAS), handicap due to tinnitus in daily life with the Japanese version of the Tinnitus Handicap Inventory (THI), and tinnitus persistence and annoyance with the subjective expression of the Standard Tinnitus Test (1993). In situ acupuncture was performed once per week at acupoints around the mastoid process, such as at GB 12 (Wangu), and at points in the head and neck area that changed the tinnitus when compressed.<BR>[Results]At the completion of acupuncture therapy, the tinnitus loudness evaluated by VAS was significantly decreased. THI scores and annoyance also significantly decreased, but tinnitus persistence did not change. Tinnitus change was observed in 6 patients during the compression of points in the head and neck, and for all of them tinnitus reduction was observed at the completion of acupuncture therapy. Of the other 21 patients, who showed no change during the compression of points in the head and neck, tinnitus reduction was observed in 57%, no change in 14%, and aggravation in 29%.<BR>[Discussion and Conclusion]Acupuncture might reduce tinnitus loudness, annoyance, and handicap caused by it in daily life. Acupuncture therapy may be effective for patients in whom tinnitus changes during the compression of points in the head and neck area, suggesting the involvement of somatosensory stimulation in its development.

Adequacy of the Simplified Version of the Tinnitus Handicap Inventory (THI-S) to Measure Tinnitus Handicap and Relevant Distress

BACKGROUND AND OBJECTIVES: The Tinnitus Handicap Inventory (THI) often requires patients to devote their time to complete the questionnaire than they expect. Given that it limits the effectiveness of THI in a busy clinical practice that desires a quick and easy assessment of tinnitus handicap, this study evaluated clinical usefulness of a Simplified version of Tinnitus Handicap Inventory (THI-S) in measuring the severity of tinnitus handicap as well as predicting the psychological distress associated with tinnitus. SUBJECTS AND METHODS: A total of 129 outpatients suffering from tinnitus (61 with normal hearing and 68 with hearing loss) participated in this study. The responses of THI-S (10 items) and THI (25 items) were evaluated to quantify the subjective handicap of tinnitus. The self-perceived level of stress, anxiety, and depression of all participants was measured with a series of self-report questionnaires such as Korean version of Brief Encounter Psychosocial Instrument (BEPSI), State Trait Anxiety Inventory (STAI), and Beck Depression Inventory (BDI), respectively. All the questionnaire responses were analyzed using non-parametric analyses to examine the convergence, comparability, internal consistency reliability and validity of THI-S. RESULTS: The severity of tinnitus handicap and the relevant psychological distress greatly varied across individuals. The THI-S responses were comparable to original THI responses, regardless of hearing status of patients. The internal consistency of THI-S responses was found to be good for total score (Cronbach's alpha=0.83-0.91), with moderately high consistency for the emotional, functional, and catastrophic subscales. Significant (p<0.01) correlations of the THI-S with the THI (r(s)=0.95) as well as with the BEPSI, STAI, BDI questionnaires (r(s)=0.40-0.45) suggest that the THI-S questionnaire appeared to be useful to provide objective data of subjective tinnitus handicap as well as predict psychological distress. Three factors were extracted through factor analysis, which explained 73% of the total variance. CONCLUSIONS: Despite reducing the length of 25 items of THI to 10 items, the THI-S can be used as s a simple but reliable and valid tool for evaluating severity of tinnitus handicap as well as detecting its negative impact on psychological functioning.

Development of Simplified Version of Korean-Type Tinnitus Handicap Inventory / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: The Tinnitus Handicap Inventory (THI) is a useful measure to evaluate the tinnitus and to quantify the functional and psychosocial consequences of tinnitus. However, it can be difficult for patients to understand the items of questionnaire and may take 10 to 15 minutes for them to complete the questionnaire, which can be problematic. The objective of this study is to develop a simplified version of the Korean type Tinnitus Handicap Inventory (THIS). SUBJECTS AND METHOD: A retrospective clinical study was conducted to analyze the THI-S cutoff score used for referral purpose and the level of predictability between the THI and the THIS. 100 patients participated. The subject samples were drawn from outpatients who reported tinnitus as their primary complaints at the time of the initial audiology and otolaryngology evaluations. The 10-item THI-S, selected by using Cronbach's alpha coefficient, showed a high correlation with the scores of the THI. Based on their clinical experiences, the four otologists developed their own screening versions of THI, which were designated as THI-A, B, C and D. The Pearson product-moment correlation was used to assess the comparability of the scores between the THI and the THI-S, A, B, C and D. RESULTS: The results showed that there is a higher correlation between the THIS and the THI-S. A high comparability was shown in the comparison between the THI and the THI-S. CONCLUSION: Further studies will be needed if the THI-S can be applied for clinical use.

The Characterisitics of Tinnitus and Its Relationship to Depression from Tinnitus Acquired from Military Service / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: This study aimed to investigate the characteristics of tinnitus in patients who acquired the condition during military service. We also investigated the discomfort patients felt due to tinnitus and its relationship to depression. SUBJECTS AND METHOD: Research participants included 295 victims of tinnitus, who acquired it during military service. The subjects completed a structured questionnaire designed to investigate socio-demographic characteristics, tinnitus characteristics, and health effects of the condition. The Tinnitus Handicap Inventory (THI) was used to evaluate the social and psychological discomfort caused by tinnitus. When the center for epidemiological studies-depression scale score was 25 or higher, the subjects were considered positive for depression. RESULTS: Severe tinnitus affected 76.6% of subjects, with THI scores of at least 58 indicating effects on everyday life, and 35.6% of subjects showing depression. Depression showed a significant relationship with past history of ear diseases, hearing loss, loudness of tinnitus, tinnitus handicap, and effects on health due to tinnitus. In the multiple logistic regression analysis, hearing loss, loudness of tinnitus, and tinnitus handicap significantly affected the occurrence of depression. The adjusted odds ratios were as follows: 2.39 (95% CI, 1.36-4.21) with hearing loss, 2.51 (95% CI, 1.14-5.54) for high loudness of tinnitus, and 5.04 (95% CI, 1.98-12.79) for high tinnitus handicap. CONCLUSION: Relevant countermeasures are needed due to the high risk of depression observed among patients with high tinnitus handicap with hearing loss that affect everyday life.

Clinical Application of Medical Ultrasonic Technique / 医疗卫生装备

The clinic main application of medical ultrasonic techniques are introduced,including ophthalmology,neurology,angiology,cardiopathy,digestive system,urology,gynaecology and obstetrics,and surgery. Four kinds of medical ultrasonic techniques in the value on the clinic diagnosis are important,namely transcranial color -coded duplex sonography(TCCD),tissue harmonic imaging(THI),three dimensional imaging(3D),and extended field Of view(EFV).