Tinnitus and sound intolerance: evidence and experience of a Brazilian group / Zumbido e intolerância a sons: evidência e experiência de um grupo brasileiro

Abstract Introduction Tinnitus and sound intolerance are frequent and subjective complaints that may have an impact on a patient's quality of life. Objective To present a review of the salient points including concepts, pathophysiology, diagnosis and approach of the patient with tinnitus and sensitivity to sounds. Methods Literature review with bibliographic survey in LILACS, SciELO, Pubmed and MEDLINE database. Articles and book chapters on tinnitus and sound sensitivity were selected. The several topics were discussed by a group of Brazilian professionals and the conclusions were described. Results The prevalence of tinnitus has increased over the years, often associated with hearing loss, metabolic factors and inadequate diet. Medical evaluation should be performed carefully to guide the request of subsidiary exams. Currently available treatments range from medications to the use of sounds with specific characteristics and meditation techniques, with variable results. Conclusion A review on tinnitus and auditory sensitivity was presented, allowing the reader a broad view of the approach to these patients, based on scientific evidence and national experience.

Resumo Introdução Zumbido e intolerância a sons são queixas frequentes e subjetivas que podem ter impacto na qualidade de vida do paciente. Objetivo Apresentar uma revisão dos principais pontos, inclusive conceitos, fisiopatologia, diagnóstico e abordagem do paciente com zumbido e sensibilidade a sons. Método Revisão da literatura com levantamento bibliográfico na base de dados da LILACS, SciELO, Pubmed e MEDLINE. Foram selecionados artigos e capítulos de livros sobre zumbido e sensibilidade a sons. Os diversos tópicos foram discutidos por um grupo de profissionais brasileiros e as conclusões, descritas. Resultado A prevalência de zumbido tem aumentado ao longo dos anos, muitas vezes associado a perda auditiva, fatores metabólicos e erros alimentares. A avaliação médica deve ser feita minuciosamente no sentido de orientar a solicitação de exames subsidiários. Os tratamentos disponíveis atualmente variam de medicamentos ao uso de sons com características específicas e técnicas de meditação, com resultados variáveis. Conclusão Foi apresentada uma revisão sobre os temas que permitindo ao leitor uma visão ampla da abordagem dos pacientes com zumbido e sensibilidade auditiva baseada em evidências científicas e experiência nacional.

Tinnitus and sound intolerance: evidence and experience of a Brazilian group.

INTRODUCTION: Tinnitus and sound intolerance are frequent and subjective complaints that may have an impact on a patient's quality of life. OBJECTIVE: To present a review of the salient points including concepts, pathophysiology, diagnosis and approach of the patient with tinnitus and sensitivity to sounds. METHODS: Literature review with bibliographic survey in LILACS, SciELO, Pubmed and MEDLINE database. Articles and book chapters on tinnitus and sound sensitivity were selected. The several topics were discussed by a group of Brazilian professionals and the conclusions were described. RESULTS: The prevalence of tinnitus has increased over the years, often associated with hearing loss, metabolic factors and inadequate diet. Medical evaluation should be performed carefully to guide the request of subsidiary exams. Currently available treatments range from medications to the use of sounds with specific characteristics and meditation techniques, with variable results. CONCLUSION: A review on tinnitus and auditory sensitivity was presented, allowing the reader a broad view of the approach to these patients, based on scientific evidence and national experience.

Multidisciplinary assessment of patients with musical hallucinations, tinnitus and hearing loss.

BACKGROUND: Although auditory hallucinations are considered a psychopathological phenomenon, musical hallucinations have been reported in individuals without psychosis but with auditory symptoms (tinnitus and/or hearing loss). Thus, a possible different cognitive functioning may be involved in musical hallucinations. The aim of the study was to characterize patients with tinnitus and musical hallucinations through a multidisciplinary assessment, allowing a better understanding of these concomitant phenomena. SAMPLING AND METHODS: As this sample is rare to find, all consecutive patients with tinnitus, hearing loss and musical hallucinations were included over a 3-year period, excluding those unable to respond. All subjects underwent the following assessments: (1) otolaryngological and audiological assessment (physical examination and audiometry), (2) neurological assessment (cognition, electroencephalogram and imaging examination) and (3) psychiatric assessment (structured interview). RESULTS: A total of 16 patients were included (87.5% women; mean age 61.43 ± 15.99 years). The otolaryngological examination was normal in all cases, but audiometry revealed that the degree of hearing loss was severe to profound in 68.75% of participants. Neurological assessment showed electroencephalogram changes in only 17.6% of cases, while 25% presented with mild attention deficit and 43.75% had small foci of gliosis or ischemia on the imaging examination. Psychiatric assessment showed that 68.75% of cases had depression, 6.25% had anxiety disorder and 25% had no psychiatric conditions. CONCLUSIONS: Musical hallucinations were strongly associated with female elderly adults and with mood disorders. Thus, in contrast to common auditory hallucinations, patients with musical hallucinations associated with tinnitus and hearing loss should be offered a more multidisciplinary assessment.

Tinnitus in adolescents: the start of the vulnerability of the auditory pathways.

INTRODUCTION: Although tinnitus is an increasingly common symptom, few studies have assessed its prevalence or incidence among adolescents. PURPOSE: To assess whether the presence of tinnitus in adolescents is associated with minimal hearing damage, evaluated through high-frequency audiometry (HFA), otoacoustic emission (OAE), and loudness discomfort level (LDL). METHODS: The sample comprised 168 adolescents of a private school (61.3% boys; mean age 14.1 years old; standard deviation=2). All of them completed a questionnaire about tinnitus and hypersensitivity to sounds (sound intolerance), and then underwent otoscopy, pure-tone audiometry, HFA, LDL, transient and distortion product otoacoustic emissions (TOAE and DPOAE), and tinnitus pitch/loudness matching (the latter only in those with tinnitus). Participants were later divided into three groups: with no tinnitus (n=73, 43.4%), with sporadic tinnitus (n=47, 28%), and with constant tinnitus (n=48, 28.6%). RESULTS: No significant difference was observed between the groups regarding audiometry thresholds in frequencies from 0.25 to 16 kHz, or TOAE and DPOAE. However, the LDL in adolescents with constant tinnitus was significantly lower than that in other groups, suggesting hypersensitivity to sounds. CONCLUSION: There was no evidence of minimal hearing damage in the audiometry and OAE. Nonetheless, the decreased LDL in adolescents with constant tinnitus suggests that their auditory system is more sensitive. Therefore, this may be the first sign of vulnerability to sounds. Future medium- to long-term monitoring of these students may show whether they will begin a process of functional impairment, altering hearing thresholds, and OAE.

Tinnitus in adolescents: the start of the vulnerability of the auditory pathways / Zumbido em adolescentes: o início da vulnerabilidade das vias auditivas

INTRODUCTION: Although tinnitus is an increasingly common symptom, few studies have assessed its prevalence or incidence among adolescents. PURPOSE: To assess whether the presence of tinnitus in adolescents is associated with minimal hearing damage, evaluated through high-frequency audiometry (HFA), otoacoustic emission (OAE), and loudness discomfort level (LDL). METHODS: The sample comprised 168 adolescents of a private school (61.3% boys; mean age 14.1 years old; standard deviation=2). All of them completed a questionnaire about tinnitus and hypersensitivity to sounds (sound intolerance), and then underwent otoscopy, pure-tone audiometry, HFA, LDL, transient and distortion product otoacoustic emissions (TOAE and DPOAE), and tinnitus pitch/loudness matching (the latter only in those with tinnitus). Participants were later divided into three groups: with no tinnitus (n=73, 43.4%), with sporadic tinnitus (n=47, 28%), and with constant tinnitus (n=48, 28.6%). RESULTS: No significant difference was observed between the groups regarding audiometry thresholds in frequencies from 0.25 to 16 kHz, or TOAE and DPOAE. However, the LDL in adolescents with constant tinnitus was significantly lower than that in other groups, suggesting hypersensitivity to sounds. CONCLUSION: There was no evidence of minimal hearing damage in the audiometry and OAE. Nonetheless, the decreased LDL in adolescents with constant tinnitus suggests that their auditory system is more sensitive. Therefore, this may be the first sign of vulnerability to sounds. Future medium- to long-term monitoring of these students may show whether they will begin a process of functional impairment, altering hearing thresholds, and OAE. .

Embora o zumbido seja um sintoma cada vez mais comum, poucos estudos avaliaram sua prevalência ou incidência entre adolescentes. OBJETIVO: Avaliar se a presença de zumbido em adolescentes está associada a lesões auditivas mínimas, avaliadas por audiometria de altas frequências (AAF), emissões otoacústicas (EOA) e limiar de desconforto a sons (LDL). MÉTODOS: Participaram da amostra 168 alunos adolescentes de uma escola particular, sendo 61,3% do gênero masculino e com média de idade de 14,1 anos (desvio padrão=2). Todos responderam a um questionário sobre zumbido e hipersensibilidade auditiva (intolerância a sons) e foram submetidos à otoscopia, audiometria tonal convencional e de frequências acima de 8.000 Hz, LDL, EOA transientes (EOAT) e produto de distorção (EOAPD) e acufenometria (esta apenas naqueles com zumbido). Em seguida, foram divididos em três grupos: Sem Zumbido (n=73; 43,4%), Zumbido Esporádico (n=47; 28%) e Zumbido Constante (n=48; 28,6%). RESULTADOS: Não houve diferença significativa entre os grupos em relação aos limiares da audiometria nas frequências de 250 a 16.000 Hz, nem nas EOAT ou EOAPD. Entretanto, o LDL dos adolescentes com zumbido constante foi significativamente menor do que o dos demais grupos, sugerindo hipersensibilidade auditiva. CONCLUSÃO: Não houve evidência de alterações auditivas mínimas na audiometria e EOA. Entretanto, a diminuição do LDL em jovens com zumbido constante sugere que suas cócleas sejam mais sensíveis. Portanto, esse pode ser o primeiro sinal de vulnerabilidade a sons, mas o acompanhamento desses adolescentes a médio prazo poderá demonstrar se tais regiões entrarão em processo de comprometimento funcional, alterando os limiares audiométricos e as EOA. .

Musical hallucination associated with hearing loss.

In spite of the fact that musical hallucination have a significant impact on patients' lives, they have received very little attention of experts. Some researchers agree on a combination of peripheral and central dysfunctions as the mechanism that causes hallucination. The most accepted physiopathology of musical hallucination associated to hearing loss (caused by cochlear lesion, cochlear nerve lesion or by interruption of mesencephalon or pontine auditory information) is the disinhibition of auditory memory circuits due to sensory deprivation. Concerning the cortical area involved in musical hallucination, there is evidence that the excitatory mechanism of the superior temporal gyrus, as in epilepsies, is responsible for musical hallucination. In musical release hallucination there is also activation of the auditory association cortex. Finally, considering the laterality, functional studies with musical perception and imagery in normal individuals showed that songs with words cause bilateral temporal activation and melodies activate only the right lobe. The effect of hearing aids on the improvement of musical hallucination as a result of the hearing loss improvement is well documented. It happens because auditory hallucination may be influenced by the external acoustical environment. Neuroleptics, antidepressants and anticonvulsants have been used in the treatment of musical hallucination. Cases of improvement with the administration of carbamazepine, meclobemide and donepezil were reported, but the results obtained were not consistent.

Perfil de auto-anticorpos na surdez súbita, surdez rapidamente progressiva e doença de Ménière / Autoantibody profile in instantaneous hearing loss, rapidly progressive hearing loss and Ménière disease

A surdez neurossensorial (SNS) imunomediada é uma das formas de SNS com possibilidade de reversão. Surdez súbita, surdez rapidamente progressiva e doença de Ménière são relacionadas à etiologia autoimune. O Western blot (WB) com antígeno de tecidos bovinos é usado para detecção do anticorpo anti-68kD (hsp70) em SNS imunomediada. Marcadores específicos são necessários para diagnóstico e prognóstico desta entidade. O objetivo do estudo foi determinar reatividade dos soros de pacientes com SNS contra antígeno de células humanas (HeLa) pelo WB. Observou-se reatividade contra células HeLa, confirmando a presença de autorreatividade e autoanticorpos. O papel destes anticorpos ainda é desconhecido. /Immune-mediated sensorineural hearing loss (SNHL) is one of few forms of reversible SNHL. The rapidly progressive hearing loss, sudden SNHL and Ménière’s disease are often related to autoimmune etiology. Western blot with bovine tissues as target has been used, detecting anti-68kD antibody (hsp70) in immune-mediated SNHL. Other specific markers are necessary to diagnosis and prognosis. The aim of this study was determinate reactivity from SNHL patients’ sera against human cell line antigen (HeLa) by Western blot. Reactivity to HeLa cells was observed reinforcing autoreactivity and autoantibody presence. The role of these autoantibodies is unknown and futher studies are necessary...

Atendimento para retirada de corpos estranhos de ouvido, nariz e faringe em crianças / Ear, nose and throat foreign body removal in children

O atendimento para retirada de corpos estranhos em ouvido, nariz e faringe em crianças, corresponde a uma grande parcela do total de consultas dos serviços de emergência em Otorrinolaringologia. O presente trabalho, teve como objetivo, estudar 100 casos de atendimento para remoçäo de corpos estranhos em crianças de 1 a 12 anos, efetuados pelo Pronto-Socorro de Otorrinolaringologia do Hospital das Clinicas da Faculdade de Medicina da Universidade de Säo Paulo, no periodo de fevereiro a maio de 1997. Foram analisadas sua distribuiçäo por sexo e idade e as caracteristicas de corpos estranhos. Os resultados obtidos mostraram que das 100 crianças atendidas, 45 por cento eram do sexo masculino e 55 por cento do sexo feminino e, 78 por cento tinham menos de 5 anos; 46 por cento apresentavam corpo estranho em fossa nasal, 53 por cento em ouvido e apenas 1 por cento em faringe...