Tinnitus: una revisión narrativa / Tinnitus: A narrative review / Tinnitus: uma revisão narrativa

El tinnitus o acúfeno es la percepción de sonido en ausencia de un estímulo acústico externo; es uno de los motivos de consulta más comunes en el área de otorrinolaringolo­gía. Se ha asociado a diversas etiologías tales como ototoxicidad, tumores, traumatismo craneoencefálico y trastornos psiquiátricos, siendo también las causas de carácter idio­pático ampliamente conocidas. Las características clínicas de los tinnitus son variables de paciente a paciente, por lo que su diagnóstico, tratamiento y seguimiento son un desafío clínico Si bien recientes estudios han propuesto distintos manejos clínicos y terapéuticos, estos continúan hoy en día en estudio. Esta revisión narrativa pretende realizar una actualización sobre el abordaje diagnóstico, clínico y terapéutico de los tinnitus en la última década.

Tinnitus, the perception of sound in the absence of an external acoustic stimulus, is one of the most common reasons for consultation in the area of otorhinolaryngology. It has been associated with various etiologies such as ototoxicity, tumors, head trauma, and psychiatric disorders; idiopathic causes are also widely known. The clinical characteristics of tinnitus are variable from patient to patient; therefore, its diagnosis, treatment, and follow-up are a clinical challenge. Although recent studies have proposed different clinical and therapeutic approaches, these are still under analysis today. This narrative review aims to update the diagnostic, clinical and therapeutic approach to tinnitus in the last decade.

Tinnitus ou zumbido é a percepção do som na ausência de um estímulo acústico externo; é um dos motivos mais comuns de consulta na área de otorrinolaringologia. Tem sido associada a várias etiologias, como ototoxicidade, tumores, traumatismo craniano e distúrbios psiquiátricos, sendo também amplamente conhecidas causas idiopáticas. As características clínicas do zumbido são variáveis de paciente para paciente, por isso seu diagnóstico, tratamento e acompanhamento são um desafio clínico, embora estudos recentes tenham proposto diferentes abordagens clínicas e terapêuticas, ainda hoje estão em estudo. Esta revisão narrativa visa atualizar a abordagem diagnóstica, clínica e terapêutica do zumbido na última década.

Singing Voice Therapy Revisited / Revisión de la terapia de voz cantada

Introduction. Singing is a type of sportive activity and, like sports medicine, profes-sional voice medicine is interested in the habilitation and rehabilitation of the vocal performer. The vocal needs of the professional vocal performer may not be similar to other professional or non-professional voice users. Like a professional athlete, a vocal performer's ability to perform for many decades at a high level will be enhanced by basing artistic and lifestyle decisions on a scientifically sound foundation. Objective. The aim of this study is to present a multidimensional introduction to the methods of SVT, incorporating the principles of sport and exercise medicine, and physical therapy and rehabilitation.Reflection. Singing voice therapy needs to provide answers to "what", "why", "how", and "when" questions. SVT must first correctly identify the problem, leading to the "how to do" solutions for a wide variety of cases, followed by a schedule of prescribed activities including answers to the "why" question (which exercise relates to which muscle). The periodization and motor learning principles provide a temporal answer to the "when" question when developing habilitation and/or rehabilitative protocols.Conclusion. Singing is not only an artistic expression, but also a sportive performance. The clinical approach to professional voice is a multidimensional and multilayered team effort. All practices are structured by blending scientific and ped-agogical knowledge

Introducción. El canto es una forma de actividad deportiva y, al igual que la medicina deportiva, la medicina vocal profesional se interesa por la habilitación y rehabilitación del intérprete vocal. Las necesidades vocales del intérprete vocal profesional pueden no ser similares a las de otros usuarios de voz profesionales o no profesionales. Al igual que un atleta profesional, la capacidad de un intérprete vocal para desempeñarse durante muchas décadas a un alto nivel se mejorará al basar las decisiones artísticas y de estilo de vida en un fundamento científicamente sólido. Objetivo. El objetivo de este estudio es presentar una introducción multidimensional a los métodos de TSV, incorporando los principios de la medicina del deporte y el ejercicio, y la fisioterapia y rehabilitación. Reflexión. La terapia de la voz cantada debe proporcionar respuestas a preguntas de "qué", "por qué", "cómo" y "cuándo". SVT primero debe identificar correctamente el problema, lo que lleva a las soluciones de "cómo hacer" para una amplia variedad de casos, seguido de un programa de actividades prescritas que incluyen respuestas a la pregunta "por qué" (qué ejercicio se relaciona con qué músculo). Los principios de periodización y aprendizaje motor proporcionan una respuesta temporal a la pregunta de "cuándo", al desarrollar protocolos de habilitación y/o rehabilitación. Conclusión. Cantar no es solo una expresión artística, sino también una actuación deportiva. El enfoque clínico de la voz profesional es un esfuerzo de equipo multidimensional y de múltiples capas. Todas las prácticas están estructuradas, al combinar conocimientos científicos y pedagógicos.

Determination of ambient noise levels in the medical and surgical intensive care units and adult ward of the Makati Medical Center

Objective@#To measure the levels of environmental noise in the medical intensive care unit, surgical intensive care unit, and adult ward of the Makati Medical Center for the morning, afternoon, and evening shifts, on weekdays and weekends, and to compare noise levels across shifts, and between weekdays and weekends. @*Methods@#Design: Environmental Noise Survey. Setting: Tertiary Private Training Hospital. Participants: None. @*Results@#The overall mean environment noise levels in all the areas surveyed (medical intensive care unit, surgical intensive care unit and adult ward) exceeded World Health Organization recommendations by more than 20 dB across different working shifts on both weekdays and weekends. There was no significant difference in noise levels between weekdays and weekends across shifts in all areas, except for the afternoon shift in the Medical ICU. Using Repeated Measures ANOVA, results showed that there is no sufficient evidence to conclude that at least one shift has significantly different mean noise level in any of the 3 areas (MICU: F(2)=4.73, p-value=.1124; SICU: F(2)=7.91, p-value=.0540; WARD: F(2)=2.73, p-value=.1948) @*Conclusion@#The overall environmental noise levels in the different areas of MICU, SICU and Adult ward exceeded the WHO recommendation. It is recommended that a change in strategy is needed for prevention of environmental noise, setting guidelines and policies to assure quality health care and noise control. Further investigations to ascertain exact sources may give rise to feasible solutions.

Applicability of the real ear measurement for audiological intervention of tinnitus / Aplicabilidade das medidas da orelha real na intervenção audiológica do zumbido

Abstract Introduction Tinnitus is present in a large part of chronic health complaints, and it is considered a public health problem injurious to the individual's quality of life. Considering the increase of the world population associated with an increase of life expectancy, tinnitus remains a cause for medical concern, since during aging the occurrence of auditory impairments due to the deterioration of the peripheral auditory structures and central impairs the quality of life. Objective The aim of the present study was to analyze the applicability of real ear measurements for audiological intervention of tinnitus through specific evaluation, selection, verification and validation of the hearing aids combined with the sound generator. Methods Forty individuals of both genders with hearing loss and tinnitus complaints were deemed eligible to compose the sample. They were enrolled according to clinical symptoms and submitted to the following procedures: anamnesis and previous complaint history, high frequency audiometry, immittanciometry and acuphenometry with the research of psychoacoustic thresholds of pitch, loudness and minimum masking threshold, sound generator, in addition to the application of the Tinnitus Handicap Inventory and Visual Analog Scale tools. The entire sample was adapted with Siemens hearing aids and a sound generator, participated in a counseling session with support of digital material and evaluated in two situations: Initial Assessment (before the hearing aids and sound generator adaptation) and Final Assessment (6 months, after adaptation). The statistical analyzes were descriptive and inferential, adopted a significance level of 5% and the T-Paired Test and the Spearman Correlation test were performed. Results The results showed that there was a benefit with the use of hearing aids combined with a sound generator from the statistically significant values and strong correlations between the sound generator verification data regarding acuphenometry and the nuisance/severity questionnaires. Regarding the verification of the sound generator, it is important to highlight that the entire sample selected the effective acoustic stimulation based on the comfort levels, which was proved in the present study to be a sufficient intensity for positive prognosis, whereas the users' noises were found below the psychoacoustic thresholds of acuphenometry. Conclusion The present study concluded that the audiological intervention with any level of sound stimulus is enough to obtain a positive prognosis in the medium term. Data that specifies that the verification of sound generator was effective at the real ear measurements are important in the evaluation and intervention of the complaint. In addition, it points out that the greater the tinnitus perception, the greater its severity, and the greater the nuisance, the higher the psychoacoustics thresholds of frequency and the minimum threshold of masking.

Resumo Introdução O zumbido está presente em grande parte das queixas crônicas de saúde, é considerado um problema de saúde pública, prejudicial à qualidade de vida do indivíduo. Considerando o aumento da população mundial associado ao aumento da expectativa de vida, a tendência é que o zumbido permaneça como um motivo de preocupação, uma vez que com a idade a ocorrência de prejuízos auditivos decorrentes da deterioração das estruturas auditivas periféricas e centrais ocasiona grande impacto negativo na qualidade de vida. Objetivo Analisar a aplicabilidade das medidas da orelha real para a intervenção audiológica do zumbido através de avaliação específica, seleção, verificação e validação do aparelho de amplificação sonora individual combinada ao gerador de som. Método Quarenta indivíduos de ambos os sexos com perda auditiva e queixa de zumbido foram considerados elegíveis para compor a amostra. Eles foram atendidos conforme a demanda clínica e submetidos aos seguintes procedimentos: anamnese e história pregressa da queixa, audiometria de alta frequência, imitanciometria e acufenometria com pesquisa dos limiares psicoacústicos de pitch, loudness e limiar mínimo de mascaramento, gerador de som, além da aplicação das ferramentas tinnitus handicap inventory e escala visual analógica. Toda a amostra recebeu aparelho de amplificação sonora individual e gerador de som, ambos da marca Siemens, participaram de uma sessão de aconselhamento com apoio de material digital e foram avaliados em duas situações: Avaliação inicial (antes da adaptação dos aparelhos de amplificação sonora individual e gerador de som) e Avaliação final (6 meses após a adaptação). As análises estatísticas foram descritivas e inferenciais, adotou-se um nível de significância de 5% com a realização do teste t pareado e o teste de correlação de Spearman. Resultados Os resultados mostraram que houve benefício com o uso de aparelho de amplificação sonora individual combinado ao gerador de som com base nos valores estatisticamente significantes e fortes correlações entre os dados da verificação do gerador de som em relação à acufenometria e os questionários de incômodo/gravidade. Em relação à verificação do gerador de som, é importante destacar que toda a amostra selecionou a estimulação acústica efetiva baseada nos níveis de conforto e no presente estudo demonstraram ser de intensidade suficiente para o prognóstico positivo, enquanto que os ruídos dos usuários estavam abaixo dos limiares psicoacústicos da acufenometria. Conclusão A intervenção audiológica com qualquer nível de estímulo sonoro é suficiente para obter um prognóstico positivo em médio prazo. Os dados que demonstram que a verificação do gerador de som foi efetiva nas medidas da orelha real são importantes na avaliação e intervenção da queixa. Além disso, mostram que quanto maior a percepção do zumbido, maior a sua gravidade; e quanto maior o incômodo, maiores os limiares de frequência psicoacústica e o limiar mínimo de mascaramento.

Parámetros vocales para definir la severidad de una disfonía / Vocal parameters to determine severity of voice disorders

Introducción: la severidad de una disfonía da cuenta del grado de alteración que tiene una voz en relación con todos los procesos fisiológicos involucrados con la producción del sonido. Es importante determinar el nivel de severidad a fin de establecer un programa con el conjunto de ejercicios que permitan una rehabilitación apropiada. Objetivo: comprender si el comportamiento de los diferentes parámetros aerodinámicos, electroglotográficos, acústicos y de autorreporte vocal permite o no determinar la severidad de una disfonía. Método: se evaluaron 55 sujetos con diferentes tipos de disfonía según pará-metros aerodinámicos, electroglotográficos, acústicos y de autorreporte vocal. La muestra fue dividida en 3 grupos de acuerdo con el grado de gravedad de la patología. Se aplicó un análisis de varianza para comparar el comportamiento de las variables dependientes en relación con los niveles de severidad de la disfonía. Con el fin de determinar las diferencias entre estos niveles, se aplicó la prueba Post hoc (Tukey) a las variables significativas. Resultados: es posible determinar el nivel de severidad de una disfonía a partir de parámetros acústicos como el CPP, HNR y el cociente de pendiente espectral 1/5-5/8Khz. También se puede hacer por medio de cuestionarios de autorreporte vocal como el VOISS, el VHI y el VTDS

Introduction: the severity of dysphonia shows the degree of alteration that a voice has in relation to all the physiological processes involved in the production of sound. It is essential to determine the level of severity to establish a program with the set of exercises required for a proper rehabilitation. Objective: to understand if the behavior of the different aerodynamic, electroglot-tographic, acoustic, and vocal self-report parameters allows, or not, to determine the severity of dysphonia. Method: 55 subjects with different types of dysphonia were evaluated according to aerodynamic, electroglottographic, acoustic, and vocal self-report parameters. The sample was divided into three groups in relation to the severity degree of the patho-logy. An analysis of variance was applied to compare the behavior of dependent variables with the severity levels of dysphonia. The Post hoc test (Tukey) was applied to the significant variables to determine the differences between the severity levels. Results: it is possible to determine the level of severity of dysphonia from acoustic parameters such as CPP, HNR, and the ratio of spectral slope 1 / 5-5 / 8Khz. It is also possible to use voice self-report questionnaires such as the VOISS, the VHI, and the VTDS

Temporomandibular joint disorder predisposing factors and clicking

This study includes 450 patients, 271 females and 179 males, ages between 13-65 years. The Helkimo index for temporomandibular disorder (TMD) diagnosis was used to quantitatively evaluate the signs and symptoms of the disorder. Clicking of the joint was diagnosed by using stethoscope. Parafunctional activity, previous trauma, missing teeth, angle's classification, crossbite, overbite and overjet were assessed and considered as variables in this research. SPSS with chi square test and Pearson's coefficient correlation were used for statistical analysis. The results of this study show no association between clicking, parafunctional habits, unilateral chewing, previous trauma, angle's classification, crossbite, overbite and overjet. These result coincide the hypothesis that the exact etiology of TMDs is still obscure and the lack of a clear single cause of TMD, specially clicking, has resulted in the proposal of a multifactorial etiology for TMD.

Calidad de vida relacionada con la salud en pacientes con tinnitus. En el servicio de audiología de la Fundación Hospital Universitario Metropolitano / Quality Of Life Related To Health In Patients With Tinnitus. In the audiology service of the Metropolitan University Hospital Foundation

El acúfeno se entiende como "la percepción de sonidos sin que exista fuente sonora externa" (Sáez & Herráiz, 2006 p.190) generando múltiples efectos en la calidad de vida, entre esos, problemas emocionales como la depresión. En este artículo, se identifican los efectos del acúfeno en la calidad de vida, relacionada con la salud en los adultos que consultan al servicio de audiología de la Fundación Hospital Universitario Metropolitano, a través de la aplicación del Tinnitus Handicap Inventory (THI), Hearing Handicap Inventor y for Elderly Screening (Hhie-s) y el World Health Organization Quality of Life (Whoqol Bref), a 23 sujetos identificados previamente; el primero evaluó el grado de discapacidad del tinnitus, el segundo, la autopercepción que cada sujeto tiene de su audición, y el tercero estableció los efectos del tinnitus causados en la condición de salud y las intervenciones en salud recibidas, en la calidad de vida de la persona desde su autopercepción. Los resultados permitieron establecer que la relación dificultad auditiva vs acúfeno es directamente proporcional, siendo el género masculino el mayormente afectado, según referencias, en las edades de 14-25 años. En cuanto a calidad de vida, se concluyó que el tinnitus representa un deterioro general de la salud física, influenciado por factores ambientales y sociales, que a su vez repercuten en el estado emocional/psicológico de los sujetos

Tinnitus is defined as the "perception of sounds without the existence of an external sound source" generating multiple effects on the quality of life, among them, emotional problems such as depression. In this article, the effects of tinnitus on the quality of life are identified, related to health in adults who consult the audiology service of the Metropolitan University Hospital Foundation, through the application of THI, Hhie-s and Whoqol Bref, to 23 previously identified subjects; the first assesses the self-perception that each subject has of their hearing, the second evaluates the degree of severity of tinnitus, and the third affects the effects of tinnitus caused in the health condition and health treatments in the quality of life of the person from their self-perception. The results allowed us to establish that the relationship between auditory difficulty and tinnitus is directly proportional, with the male gender being the most affected, at the ages of 14-25 years. Regarding the quality of life, it was concluded that tinnitus represents a general disorder of physical health, influenced by environmental and social factors, which in turn affected the emotional / psychological state of the subjects.

Revisión de la relación entre estrés y tinnitus / Review of the relationship between stress and tinnitus

El tinnitus es un síntoma común y frecuente definido como una sensación de sonido que se produce en ausencia de cualquier fuente acústica externa. El tinnitus crónico no solo es aversivo, sino que también interfiere con las actividades de la vida diaria de las personas que lo perciben. Se realizó una revisión narrativa utilizando las palabras claves "tinnitus", "estrés", "acúfeno", "estresor" y "fisiología" en las bases de datos Scielo,Medline, Embase, Ovid y PubMed. Los modelos fisiopatológicos actuales relacionan la aparición y el mantenimiento del tinnitus con el estrés; esta activación implica un conjunto de reacciones conductuales y fisiológicas (neuronales, metabólicas y neuroendocrinas) que permiten responder al estresor de la manera más adaptada posible. Esta respuesta depende tanto de la magnitud del estresante que en este caso es el tinnitus como del aprendizaje, autoestima, sentido de dominio y control, apoyo social y emocional de la persona que presenta el síntoma. Dado que los sistemas auditivo y límbico están interconectados, el tinnitus puede afectar las propiedades emocionales y cognitivas y a su vez, el sistema límbico puede desempeñar un papel esencial para la generación o estabilización del tinnitus. Este artículo recoge la evidencia reciente que demuestra la relación fisiológica y psicológica del tinnitus con el estrés para poner de manifiesto la importancia de que sea un factor a tener en cuenta en la evaluación y manejo de esta población

Tinnitus is a common and frequent symptom defined as a sound sensation that occurs in the absence of an external acoustic source. Chronic tinnitus is not only aversive but also interferes with the activities of the daily life of people who perceive it. A narrative review was carried out using the keywords "tinnitus", "stress", "stressor" and "physiology" in the Scielo, Medline, Embase, Ovid, and PubMed databases. Current pathophysiological models relate to the onset and maintenance of tinnitus to stress. This appearance of stress implies a set of behavioral and physiological reactions (neuronal, metabolic, and neuroendocrine) that allow responding to the stressor in the most adapted way possible. This response depends on the magnitude of the stressor that, in this case, it is tinnitus as well as learning, self-esteem, sense of dominance and control, social and emotional support of the person presenting the symptom. Since the auditory and limbic systems are interconnected, tinnitus can affect emotional and cognitive properties. In turn, the limbic system can play an essential role in the generation or stabilization of tinnitus. This article gathers recent evidence that demonstrates the physiological and psychological relationship of tinnitus with stress to highlight the importance of being a factor to consider in the evaluation and management of this population

Health effects of noise exposure levels among instrumentalists in pentecostal churches in port harcourt city, Nigeria

BACKGROUND: Noise is everywhere in our daily lives and becomes very important as it affects our health. Religion is anintegr al part of daily lives and the use of acoustic and electronic instruments in worship. With the increase in sophistry of these instruments come their attendant untoward effects on the auditory organs of the body. This study was to assess noise exposure levels amongst instrumentalists in Pentecostal churches in Port Harcourt City, Nigeria.MATERIALS & METHODS: Following ethical consideration, 216 consenting respondents from 30 churches in Port Harcourt were recruited by table of random numbers. Structured close ended interviewer administered questionnaire incorporating the Hearing Health Quick Test (HHQT) was used to access demographic data. Hearing assessments were also performed using tonal audiometry. The data were entered and analyzed using SPSS version 20.0 and presented using descriptive and inferential statistics.RESULTS: Most 90.28% and 37.96% of respondents were male and within the 39-45 year-old age range respectively. Also, 80.56% of respondents were aware that loud music can cause permanent hearing loss. The prevalence of NIHL andTinnitus was 39% and 38% respectively; and only 19% used Hearing Protection Devices (HPD). Statistically significant risk of NIHL was observed in musicians who had experienced tinnitus, played only amplified instruments and Music experience greater or equal to 10 years (p=0.001).CONCLUSION: Gospel instrumentalists are exposed to noise in the course of their duties which have significant effect on their hearing. Use of Hearing Protection Devices (HPD) as a personal protective equipment is encouraged just as health education of this group of workers is necessary

Bowel Sound Signal Identifcation of Whole Abdomen Based on Voice Endpoint Detection / 中国医疗器械杂志

Bowel sounds are one of the important physiological signals of the body,and different bowel sounds can reflect different gastrointestinal states.In this paper,long time bowel sound data is obtained with wearable full belly bowel sound recorder which is independent designed.After adaptive noise cancellation and wavelet threshold denoising,voice endpoint detection method based on short-time energy is used to identify effective bowel sounds.Experiments and results show that the sound recorder is simple and reliable.Through processing,analysis and endpoint detection algorithm,the recognition accuracy of effective bowel sounds is high,which has certain clinical practicality and research significance.

Familial misophonia or selective sound sensitivity syndrome: evidence for autosomal dominant inheritance? / Misofonia familiar ou síndrome da sensibilidade seletiva a sons: evidência de herança autossômica dominante?

Abstract Introduction: Misophonia is a recently described, poorly understood and neglected condition. It is characterized by strong negative reactions of hatred, anger or fear when subjects have to face some selective and low level repetitive sounds. The most common ones that trigger such aversive reactions are those elicited by the mouth (chewing gum or food, popping lips) or the nose (breathing, sniffing, and blowing) or by the fingers (typing, kneading paper, clicking pen, drumming on the table). Previous articles have cited that such individuals usually know at least one close relative with similar symptoms, suggesting a possible hereditary component. Objective: We found and described a family with 15 members having misophonia, detailing their common characteristics and the pattern of sounds that trigger such strong discomfort. Methods: All 15 members agreed to give us their epidemiological data, and 12 agreed to answer a specific questionnaire which investigated the symptoms, specific trigger sounds, main feelings evoked and attitudes adopted by each participant. Results: The 15 members belong to three generations of the family. Their age ranged from 9 to 73 years (mean 38.3 years; median 41 years) and 10 were females. Analysis of the 12 questionnaires showed that 10 subjects (83.3%) developed the first symptoms during childhood or adolescence. The mean annoyance score on the Visual Analog Scale from 0 to 10 was 7.3 (median 7.5). Individuals reported hatred/anger, irritability and anxiety in response to sounds, and faced the situation asking to stop the sound, leaving/avoiding the place and even fighting. The self-reported associated symptoms were anxiety (91.3%), tinnitus (50%), obsessive-compulsive disorder (41.6%), depression (33.3%), and hypersensitivity to sounds (25%). Conclusion: The high incidence of misophonia in this particular familial distribution suggests that it might be more common than expected and raises the possibility of having a hereditary etiology.

Resumo Introdução: A misofonia é uma condição recentemente descrita, mal compreendida e negligenciada. É caracterizada por fortes reações negativas de ódio, raiva ou medo quando os indivíduos precisam enfrentar alguns sons repetitivos seletivos e de baixa intensidade. Os mais comuns que desencadeiam tais reações aversivas são aqueles provocados pela boca (mascar goma ou mastigar comida, estalar os lábios) ou nariz (respirando, cheirando e soprando) ou pelos dedos (digitando, amassando papel, clicando a caneta, tamborilando na mesa). Artigos anteriores citam que esses indivíduos geralmente conhecem pelo menos um parente próximo com sintomas semelhantes, sugerindo um possível componente hereditário. Objetivo: Encontramos e descrevemos uma família com 15 membros com misofonia, detalhando suas características comuns e o padrão de sons que desencadeiam um desconforto tão forte. Método: Todos os 15 membros concordaram em nos fornecer seus dados epidemiológicos e 12 concordaram em responder a um questionário específico que investigou os sintomas, sons de gatilho específicos, principais sentimentos evocados e atitudes adotadas por cada participante. Resultados: Os 15 membros pertencem a três gerações da família. A idade variou de 9 a 73 anos (média de 38,3 anos, mediana de 41 anos) e 10 eram mulheres. A análise dos 12 questionários mostrou que 10 indivíduos (83,3%) desenvolveram os primeiros sintomas durante a infância ou a adolescência. A média do escore de irritação na Escala Visual Analógica de 0 a 10 foi de 7,3 (mediana 7,5). Os indivíduos relataram sentimentos de ódio/raiva, irritabilidade e ansiedade em resposta a sons, e enfrentaram a situação pedindo para interromper o som, deixando/evitando o lugar e até mesmo discutindo. Os sintomas associados auto-relatados foram ansiedade (91,3%), zumbido (50%), transtorno obsessivo-compulsivo (41,6%), depressão (33,3%) e hipersensibilidade aos sons (25%). Conclusão: A alta incidência de misofonia nessa distribuição familiar em particular sugere que possa ser mais comum do que o esperado e suscita a possibilidade de haver uma etiologia hereditária.

Diagnostic validity of methods for assessment of swallowing sounds: a systematic review / Validade diagnóstica dos métodos de avaliação dos sons de deglutição: uma revisão sistemática

Abstract Introduction: Oropharyngeal dysphagia is a highly prevalent comorbidity in neurological patients and presents a serious health threat, which may lead to outcomes of aspiration pneumonia, ranging from hospitalization to death. This assessment proposes a non-invasive, acoustic-based method to differentiate between individuals with and without signals of penetration and aspiration. Objective: This systematic review evaluated the diagnostic validity of different methods for assessment of swallowing sounds, when compared to videofluroscopy swallowing study to detect oropharyngeal dysphagia. Methods: Articles in which the primary objective was to evaluate the accuracy of swallowing sounds were searched in five electronic databases with no language or time limitations. Accuracy measurements described in the studies were transformed to construct receiver operating characteristic curves and forest plots with the aid of Review Manager v. 5.2 (The Nordic Cochrane Centre, Copenhagen, Denmark). The methodology of the selected studies was evaluated using the Quality Assessment Tool for Diagnostic Accuracy Studies-2. Results: The final electronic search revealed 554 records, however only 3 studies met the inclusion criteria. The accuracy values (area under the curve) were 0.94 for microphone, 0.80 for doppler, and 0.60 for stethoscope. Conclusion: Based on limited evidence and low methodological quality because few studies were included, with a small sample size, from all index testes found for this systematic review, doppler showed excellent diagnostic accuracy for the discrimination of swallowing sounds, whereas microphone-reported good accuracy discrimination of swallowing sounds of dysphagic patients and stethoscope showed best screening test.

Resumo Introdução: A disfagia orofaríngea é uma comorbidade altamente prevalente em pacientes neurológicos e representa uma séria ameaça à saúde, pode levar a desfechos como pneumonia por aspiração, hospitalização e até morte. A avaliação propõe um método não invasivo, acústico, para diferenciar entre indivíduos com e sem sinais de penetração e aspiração. Objetivo: Esta revisão sistemática analisou a validade diagnóstica de diferentes métodos para avaliação dos sons de deglutição, quando comparados com a videofluoroscopia da deglutição para detectar disfagia orofaríngea. Método: Artigos nos quais o objetivo principal era avaliar a acurácia dos sons de deglutição foram pesquisados em cinco bancos de dados eletrônicos sem limitações de idioma ou tempo de publicação. As medidas de acurácia descritas nos estudos foram transformadas para construir curvas ROC (Receptor Operating Characteristic) e gráfico em floresta (forest plot) com o auxílio do software Review Manager v. 5.2 (The Nordic Cochrane Centre, Copenhagen, Dinamarca). A metodologia dos estudos selecionados foi avaliada com a ferramenta Avaliação da Qualidade de Estudos de Acurácia de Testes Diagnósticos-2. Resultados: A busca eletrônica final resultou na identificação de 554 artigos; no entanto, apenas três estudos preencheram os critérios de inclusão. Os valores de acurácia (área abaixo da curva) foram 0,94 para microfone, 0,80 para doppler e 0,60 para estetoscópio. Conclusão: Baseado nas evidências limitadas e da baixa qualidade metodológica, pois foram poucos os estudos incluídos, e com pequeno tamanho amostral, de todos os testes diagnósticos (index testes) encontrados para essa revisão sistemática o doppler mostrou excelente acurácia diagnóstica na discriminação dos sons de deglutição, o microfone demonstrou uma boa acurácia na discriminação dos sons de pacientes disfágicos e o estetoscópio revelou o melhor teste de triagem.

Uso do metrônomo na ressuscitação cardiopulmonar em uma unidade de terapia intensiva / Uso del metrónomo en la resucitación cardiopulmonar en unidad de terapia intensiva / Use of a metronome in cardiopulmonary resuscitation in an intensive care unit

Objetivo relatar a vivência de três enfermeiras assistenciais na utilização do metrônomo durante manobras de ressuscitação cardiopulmonar em unidade de terapia intensiva. Método trata-se de um relato de experiência que reflete a troca de informações, no cotidiano de trabalho, de três enfermeiras que atuam na unidade de terapia intensiva de um hospital de grande porte em Salvador, Bahia, Brasil. Resultados o uso continuado do equipamento na ressuscitação cardiopulmonar tem sido indicado para auxiliar na realização das compressões torácicas. O som emitido pelo dispositivo não indica o término de cada ciclo na reanimação e/ou assegura a adequação da profundidade das compressões. Acrescenta ruídos ao ambiente, dificulta a comunicação da equipe multiprofissional e é mais um aparelho a ser configurado no momento da ressuscitação cardiopulmonar, impactando de forma negativa. Conclusão o metrônomo, nessa experiência, não assegurou a qualidade na ressuscitação cardiopulmonar.

Objetivo relatar la vivencia de tres enfermeras asistenciales en la utilización del metrónomo durante maniobras de resucitación cardiopulmonar en unidad de terapia intensiva. Método relato de experiencia que refleja el intercambio de informaciones, en el cotidiano de trabajo, de tres enfermeras que actúan en unidad de terapia intensiva de hospital de gran porte en Salvador, Bahía, Brasil. Resultados el uso continuado del equipo en la resucitación cardiopulmonar ha sido indicado para auxiliar en la realización de las compresiones torácicas. El sonido emitido por el dispositivo no indica el final de cada ciclo en la reanimación y/o asegura la adecuación de la profundidad de las compresiones. Añade ruidos al ambiente, dificulta la comunicación del equipo multiprofesional y es más un aparato a ser configurado en el momento de la resucitación cardiopulmonar, impactando negativamente. Conclusión el metrónomo, en esa experiencia, no aseguró calidad en la resucitación cardiopulmonar.

Objective to report the experience of three nurses with the use of a metronome during cardiopulmonary resuscitation maneuvers in an intensive care unit. Method this is an experience report which reflects the exchange of information in the work routine of three nurses who work in the intensive care unit of a large hospital in Salvador, Bahia, Brazil. Results continued use of the device in cardiopulmonary resuscitation is indicated to help in chest compressions. The sound emitted by the device does not indicate the end of each cycle in reanimation and does not ensure an adequate depth of compressions. It makes the environment noisier, hampers communication within the multiprofessional staff and is an additional device to be set up at the moment of cardiopulmonary resuscitation, all of which are negative effects. Conclusion in this experiment, the metronome did not ensure quality in cardiopulmonary resuscitation.

Utilização de estéreos pessoais por alunos do ensino médio: mensuração da intensidade utilizada e hábitos de uso / Use of digital audio players by high school students: measurement of use intensity and usage habits

RESUMO Objetivo Esta pesquisa teve como objetivo mensurar em um ambiente ruidoso o nível de pressão sonora dos estéreos pessoais de jovens do ensino médio, levantar suas queixas auditivas e extra-auditivas e seus hábitos de uso. Considerando-se ainda a preocupação com a saúde auditiva e as fontes utilizadas pelos jovens para obtenção de informações sobre o assunto. Método Trata-se de um estudo observacional, descritivo, quantitativo, de delineamento transversal, do qual participaram jovens do ensino médio. Inicialmente foi realizado o exame de emissões otoacústicas evocadas por estímulos transientes, seguido da resolução de um questionário e a mensuração do nível de pressão sonora dos reprodutores de música utilizados em situação ruidosa simulada. Resultados A partir da mensuração dos estéreos pessoais, foram encontradas as intensidades mínima, de 69 dB(A), e máxima, de 93 dB(A). Os resultados mostraram hábitos nocivos à saúde auditiva sendo realizados pelos jovens, tais como tempo de uso (horas, dias e anos) e intensidade utilizada nos estéreos pessoais, assim como sintomas que podem indicar suscetibilidade a perdas auditivas. Observou-se que os jovens, em sua maioria, afirmam preocupar-se com sua audição, no entanto não há mudança de atitude diante dessas situações. Conclusão O hábito do uso do estéreo pessoal é iniciado muito cedo dentro da população escolar e, em muitos casos, esse costume é praticado com o equipamento em intensidades elevadas, o que pode acarretar diversos prejuízos a esses alunos.

ABSTRACT Purpose The main goal of this study was to measure the sound pressure level of digital audio players of high school students and investigate their auditory and non-auditory complaints, and their hearing habits. Another goal was to consider the concern with hearing health and the knowledge sources used by young people to gather information about the subject. Methods This is an observational, descriptive, quantitative, and cross-sectional study, which had the participation of high school students. The first step was an examination of transient-evoked optoacoustic emissions, followed by the application of a questionnaire and the measurement of the volume of audio players. Results The results showed harmful habits of young people regarding hearing health, such as an excessive time of use (hours, days and years) and high volume levels of digital audio players (DAPs), as well as symptoms that may point to hearing loss. It was found that most young people seem to be concerned about their hearing; however, there is no change of attitude to such situations. Conclusion The students develop the habit of using DAPs at very early ages and, in many cases, this habit is practiced with the equipment operating at high intensities, which can cause several hearing losses in these students.

Effects of Infrasound on Gastric Motility, Gastric Morphology and Expression of Nitric Oxide Synthase in Rat / 生物医学与环境科学（英文）

Infrasound widely exists in nature, our living condition, productive and traffic environment. Gastrointestinal tract is relatively sensitive to infrasound. However, the effect of infrasound on gastrointestinal function is unclear. Therefore, the purpose of our study was to observe the effects of infrasound on gastric motility and gastric morphology and to assess the expression of nitric oxide synthase (NOS) in gastric antrum after exposure to infrasound of 8 Hz - 130 dB for 2 hours per day for 14 consecutive days. Gastric motility was assessed by gastric fluid-emptying rate. Gastric morphology was evaluated by HE. The expression of NOS was measured by tissue microarray technology. The results would contribute to understand the role of infrasound in gastroenterology, and help to explain the mechanism of infrasound on gastroenterology.

Las agnosias auditivas: una revisión teórica / Auditory agnosias: a theoretical review

Las agnosias auditivas son consideradas un déficit en la percepción y/o en el reconocimiento de los sonidos, en ausencia de pérdida auditiva, manteniendo indemnes las habilidades cognitivas y lingüísticas. Si bien la mayoría de las agnosias auditivas se deben a lesiones orgánicas, principalmente accidentes cerebrovasculares, también existen casos en donde los déficits son congénitos. La presente revisión teórica esquematiza los principales tópicos concernientes a esta patología, presentando además un modelo neuropsicológico del procesamiento auditivo de los objetos y sus trastornos. Se realizó un estudio teórico de tipo clásico, en donde se seleccionan de manera direccionada los artículos pertinentes a la temática, utilizando como base de datos primaria a Medline. Por otra parte, se complementa la búsqueda con investigaciones afines y capítulos de libros que no fueron considerados en la búsqueda principal. Se concluyó que, si bien existe un amplio conocimiento en torno a este tema, principalmente en idioma inglés, éste aún es insuficiente. Por tanto, es necesario seguir realizando investigaciones, de modo que se pueda obtener mayor cantidad de artículos con la mayor evidencia disponible, es decir, del tipo meta-análisis, ensayos clínicos aleatorizados y revisiones sistemáticas de la literatura.

Auditory agnosias are considered as a deficit in the perception and/or recognition of sounds, in the absence of hearing loss, and with cognitive and linguistic skills indemnity. Although most auditory agnosias are due to organic lesions, mainly strokes, nontheless there are also cases where the deficits are congenital. A theoretical study of classic type was realized, in which the articles pertinent were selected using as main database Medline. On the other hand, the serach was complemented with related stuides, and book chapters that were not considered in the main search. It was concluded that, although there is extensive knowledge on this subject, mainly in English, it is still insufficient. Therefore, further research is necessary to obtain higher quality articles, like meta-analysis, randomized clinical trials and systematic reviews.

Damage to Hippocampus of Rats after Being Exposed to Infrasound / 生物医学与环境科学（英文）

<p><b>OBJECTIVE</b>The objective was to observe damage of hippocampus in rats after exposure to infrasound, and to assess HSP70 expression in hippocampus.</p><p><b>METHODS</b>SD rats in the experimental group were exposed to 140 dB (8 Hz) infrasound for 2 h per day for 3 days. The morphology of the hippocampus was examined by transmission electronic microscopic (TEM). Cell apoptosis was observed by TUNEL staining at 0 h, 24 h, 48 h, and 2 w after exposure. HSP70 expression was detected by immunohistochemistry (IHC) and Western blotting (WB).</p><p><b>RESULTS</b>TEM showed that hippocampus was significantly damaged by exposure, and exhibited recovery 1 week after exposure. The TUNEL data showed that neuronal apoptosis after exposure was significantly higher than in the control rats at 24 h and 48 h, and the apoptotic cells decreased one week after exposure. IHC and WB showed HSP70 expression was significantly higher in the exposed rats, peaked at 24 h.</p><p><b>CONCLUSION</b>Exposure to 140 dB (8 Hz) infrasound for 2 h per day for 3 days appeared to induce damage to the hippocampus of rats, based on changes in ultrastructure and increased cell apoptosis. However, recovery from the damage occurred overtime. HSP70 expression also increased after the exposure and decreased by 48.</p>