Increased Incidence of Tinnitus Following a Hyperthyroidism Diagnosis: A Population-Based Longitudinal Study.

Background: An association between thyroid disease and tinnitus has been described previously but further longitudinal, population-based studies are limited. Objective: To investigate the incidence of tinnitus in patients with hyperthyroidism in a national sample, and to identify risk level and associated factors for tinnitus in hyperthyroidism patients. Design: Retrospective cohort study. Patient data were collected from the Longitudinal Health Insurance Database (LHID 2000), which includes national claims data of patient expenditures for admissions or ambulatory care from 1996 to 2011. Setting: Taiwan hospitals and clinics providing healthcare nationwide. Participants: Patients aged 20 years and older with newly diagnosed hyperthyroidism (ICD-9-CM code 242) between 2000-2010 were selected as the study cohort. Hyperthyroidism patient cohort were identified from the LHID2000. Those with tinnitus history (ICD-9-CM code 388.3) before the index date (first hyperthyroidism diagnosis), younger than 20 years, and with incomplete demographic data were excluded. The non-hyperthyroidism cohort included patients with no history of hyperthyroidism and no documented tinnitus. Main Outcomes and Measures: Incidence of tinnitus was the primary outcome. Baseline demographic factors and comorbidities possibly associated with tinnitus, including age, sex, and comorbidities of hearing loss, vertigo, insomnia and anxiety, were retrieved from the LHID 2000. Patients were followed until end of 2011. Results: During the study period, 780 (4.9%) hyperthyroidism patients and 2007 (3.2%) non-hyperthyroidism controls developed tinnitus. Incidence rate of tinnitus in the hyperthyroidism cohort was significantly higher in hyperthyroidism cohort (7.86 vs. 5.05 per 1000 person-years) than that in non-hyperthyroidism cohort. A higher proportion of patients with hyperthyroidism had comorbid insomnia (45.1% vs. 30.9%) and anxiety (14.0% vs. 5.73%) than those without hyperthyroidism. After adjusting for age, gender and comorbidities (vertigo, insomnia, anxiety, hearing loss), hyperthyroidism patients had 1.38-fold higher risk of tinnitus (95% CI = 1.27-1.50) than those without hyperthyroidism. Conclusions: This large population-based study suggests patients with diagnosed hyperthyroidism was more prone to develop tinnitus. Our findings suggest evaluation for comorbid vertigo, insomnia, anxiety and/or hearing loss may identify patients who are at high risk of developing tinnitus in patients with hyperthyroidism.

Reliability of the Minimum Masking Level as Outcome Variable in Tinnitus Clinical Research.

Purpose The minimum masking level (MML) is the minimum intensity of a stimulus required to just totally mask the tinnitus. Treatments aimed at reducing the tinnitus itself should attempt to measure the magnitude of the tinnitus. The objective of this study was to evaluate the reliability of the MML. Method Sample consisted of 59 tinnitus patients who reported stable tinnitus. We obtained MML measures on two visits, separated by about 2-3 weeks. We used two noise types: speech-shaped noise and high-frequency emphasis noise. We also investigated the relationship between the MML and tinnitus loudness estimates and the Tinnitus Handicap Questionnaire (THQ). Results There were differences across the different noise types. The within-session standard deviation averaged across subjects varied between 1.3 and 1.8 dB. Across the two sessions, the Pearson correlation coefficients, range was r = .84. There was a weak relationship between the dB SL MML and loudness, and between the MML and the THQ. A moderate correlation (r = .44) was found between the THQ and loudness estimates. Conclusions We conclude that the dB SL MML can be a reliable estimate of tinnitus magnitude, with expected standard deviations in trained subjects of about 1.5 dB. It appears that the dB SL MML and loudness estimates are not closely related.

Relación de la microaudiometría (audiometría de alta resolución) y el tinnitugrama en los pacientes con tinnitus / The relationship between high resolution audiometry and tinnitugram in tinnitus patients

Introducción: el tinnitus es una condición generalmente idiopática, de alta prevalencia, asociada con una pérdida auditiva que no puede evaluarse completamente en una audiometría convencional. En el presente estudio se propone el uso de métodos innovadores para la medición subjetiva del tinnitus y los umbrales de audición, por medio del tinnitugrama y la microaudiometría. Objetivo: el objetivo de este trabajo es analizar la relación entre los umbrales tonales de la microaudiometría y el tinnitugrama. Metodología: estudio descriptivo retrospectivo en 58 pacientes con tinnitus, que fueron estudiados entre marzo de 2018 y noviembre de 2019, con una microaudiometría de 67 frecuencias (rango de 262-11 840 Hz) y un tinnitugrama de 134 frecuencias. Se utilizó una prueba no paramétrica (Mann-Whitney) para comparar los grupos. Resultados: no encontramos una relación significativa entre la frecuencia del tinnitus y la frecuencia de mayor descenso en la microaudiometría. La frecuencia del mayor punto de descenso de los umbrales tonales fue más alta en los pacientes con tinnitus >8000 Hz (22,4 %) que en aquellos <8000 Hz (p = 0,006). Conclusiones: los umbrales de la microaudiometría no se relacionan con las características subjetivas del tinnitus, excepto en los pacientes con tinnitus en frecuencias >8000 Hz. Las frecuencias altas deberían incluirse en las pruebas audiológicas para el tinnitus.

Introduction: tinnitus is a high prevalence, idiopathic condition, associated with hearing loss, which cannot be completely evaluated in conventional audiometry. The present study proposes the use of innovative methods for the subjective measurement of tinnitus and hearing thresholds with the use of tinnitugram and microaudiometry (automated audiometry). Objective: to analyzes the relationship between the tonal thresholds of microaudiometry and the tinnitugram. Methodology: a Retrospective descriptive study. Fifty-eight patients with tinnitus were studied between March 2018 and November 2019, with 67 frequency microaudiometry (range of 262-11 840 Hz) and the 134 frequency tinnitugram. A non-parametric test (Mann-Whitney) was used to compare the groups. Results: we found no significant relationship between the frecuency of tinnitus and the frequency of greatest decrease in microaudiometry. The frequency of the highest point of decrease in tonal thresholds was higher in patients with tinnitus >8000 Hz (22.4 %) than in those <8000 Hz (p = 0.006). Conclusions: the thresholds of microaudiometry are not associated with the subjective characteristics of tinnitus, except in patients with tinnitus at frequencies >8000 Hz. High frequencies should be included in audiological tests for tinnitus.

Epidemiología digital como herramienta para la evaluación de enfermedades del oído y la vía aérea en Colombia, durante los años 2012-2014: Un estudio ecológico / Digital epidemiology as a tool for the evaluation of ear and airway diseases in Colombia, during the years 2012-2014: An ecological study

Introducción: Las tecnologías de información y la facilidad de acceso a grandes volúmenes de datos "big data" están revolucionando la epidemiología. Objetivo: Analizar datos del sistema integral de Información "SISPRO" del Ministerio de Salud para obtener los motivos más frecuentes de consulta en otorrinolaringología en consulta externa y urgencias. Diseño: Estudio descriptivo ecológico. Metodología: En SISPRO se usaron los códigos CIE-10 para analizar los datos de atención en salud para patologías de oído (H60-H959) y vía aérea superior (J00-J399). Resultados: Los principales motivos de consulta incluyen: infecciones de la vía aérea superior (rinofaringitis, faringitis, amigdalitis, otitis media aguda e infecciones no especificadas) con 14.935.729 atenciones, 7.877.189 personas atendidas y un promedio de 1,9 consultas por persona; Rinitis (1.760.055 atenciones, 899.349 personas y 1,96 consultas/persona); Vértigo (1.632.012 atenciones, 686.470 personas y 2,38 consultas/persona); Cerumen impactado (554.744 atenciones, 296.324 personas y 18,76 consultas/persona); Hipoacusia (853.047 atenciones, 366.037 personas y 2,33 consultas/persona). La relación entre el número de atenciones en consulta externa vs urgencias es de 281,66 (hipoacusia), 126,23 (Rinitis), 37,2 (Cerumen impactado), 10,73 (vértigo) y 6,9 (infecciones). Conclusión: La epidemiología digital es una herramienta útil en la práctica de ORL. Las enfermedades infecciosas son la principal causa de atención en ORL.

Introduction: Information technologies and the ease of access to large volumes of data "big data" are revolutionizing epidemiology. Objective: Analyze data from the Comprehensive Information System "SISPRO" of the Ministry of Health, to obtain the most frequent reasons for consultation in otorhinolaryngology in outpatient and emergency departments. Design: ecological descriptive study. Methods: In SISPRO, ICD-10 codes were used to analyze health care data for ear (H60-H959) and upper airway (J00-J399) pathologies. Results: The main reasons for consultation included: upper airway infections (rhinopharyngitis, pharyngitis, tonsillitis, acute otitis media and unspecified infections) with 14,935,729 attentions, 7,877,189 people attended and an average of 1.9 consultations per person; Rhinitis (1,760,055 attentions, 899,349 people and 1.96 consultations / person); Vertigo (1,632,012 attentions, 686,470 people and 2,38 consultations / person; Cerumen impacted (554,744 attentions, 296,324 people and 18,76 consultations / person); Hearing loss (853,047 attentions, 366,037 people and 2,33 consultations / person). The ratio between the number of visits in the outpatient clinic vs. emergencies is 281.66 (hearing loss), 126.23 (rhinitis), 37.2 (impacted earwax), 10.73 (vertigo) and 6.9 (infections). Conclusion: Digital epidemiology is an useful tool in ENT. Infectious diseases are the main cause of consultation in ENT.

Papiloma nasal escamoso bilateral Reporte de un caso / Bilateral sinonasal squamous papilloma Case report

El papiloma escamoso sinunasal es un tumor de baja prevalencia, benigno y de presentación clínica usualmente unilateral. El manejo del papiloma escamoso sinunasal es la resección quirúrgica del tumor, a pesar de lo cual existe una alta tasa de recurrencia. Se presenta el caso de un paciente con papilomatosis escamosa sinunasal bilateral con varios episodios de recurrencia, a pesar de su resección quirúrgica. Aunque existe una alta recurrencia luego del manejo quirúrgico del papiloma escamoso sinunasal, la cirugía sigue siendo la primera opción de tratamiento, especialmente en casos de tumores invasivos

The sinonasal squamous papilloma is a benign tumor of low prevalence, and usually unilateral. Management of sinonasal squamous papilloma includes surgical resection, although its recurrence is common. We report a case of bilateral sinonasal squamous papilloma with several episodes of recurrence, despite surgical resection. Although there is a high recurrence rate after surgical management, the surgical management of sinunasal squamous papilloma remains the first line of treatment, especially in cases of invasive tumors.

Survey on the Effectiveness of Dietary Supplements to Treat Tinnitus.

PURPOSE: We surveyed the benefit of dietary supplements to treat tinnitus and reported adverse effects. METHOD: A website was created for people with tinnitus to complete a variety of questions. RESULTS: The 1,788 subjects who responded to questionnaires came from 53 different countries; 413 (23.1%) reported taking supplements. No effect on tinnitus was reported in 70.7%, improvement in 19.0%, and worsening in 10.3%. Adverse effects were reported in 6% (n = 36), including bleeding, diarrhea, headache, and others. Supplements were reported to be helpful for sleep: melatonin (effect size, d = 1.228) and lipoflavonoid (d = 0.5244); emotional reactions: melatonin (d = 0.6138) and lipoflavonoid (d = 0.457); hearing: Ginkgo biloba (d = 0.3758); and concentration Ginkgo biloba (d = 0.3611). The positive, subjective reports should be interpreted cautiously; many might have reported a positive effect because they were committed to treatment and expected a benefit. Users of supplements were more likely to have loudness hyperacusis and to have a louder tinnitus. CONCLUSIONS: The use of dietary supplements to treat tinnitus is common, particularly with Ginkgo biloba, lipoflavonoids, magnesium, melatonin, vitamin B12, and zinc. It is likely that some supplements will help with sleep for some patients. However, they are generally not effective, and many produced adverse effects. We concluded that dietary supplements should not be recommended to treat tinnitus but could have a positive outcome on tinnitus reactions in some people.

Manganese and Lipoflavonoid Plus(®) to Treat Tinnitus: A Randomized Controlled Trial.

BACKGROUND: Several tinnitus sufferers suggest that manganese has been helpful with their tinnitus. PURPOSE: We tested this in a controlled experiment where participants were committed to taking manganese and Lipoflavonoid Plus(®) to treat their tinnitus. RESEARCH DESIGN: Randomized controlled trial. STUDY SAMPLE: 40 participants were randomized to receive both manganese and Lipoflavonoid Plus(®) for 6 months, or Lipoflavonoid Plus(®) only (as the control). DATA COLLECTION AND ANALYSIS: Pre- and postmeasures were obtained with the Tinnitus Handicap Questionnaire, Tinnitus Primary Functions Questionnaire, and tinnitus loudness and annoyance ratings. An audiologist performed the audiogram, the tinnitus loudness match, and minimal masking level. RESULTS: Twelve participants were dropped out of the study because of the side effects or were lost to follow-up. In the manganese group, 1 participant (out of 12) showed a decrease in the questionnaires, and another showed a decrease in the loudness and annoyance ratings. No participants from the control group (total 16) showed a decrease in the questionnaires ratings. Two participants in the control group reported a loudness decrement and one reported an annoyance decrement. CONCLUSIONS: We were not able to conclude that either manganese or Lipoflavonoid Plus(®) is an effective treatment for tinnitus.

Diagnostic test validation: cochlear hydrops analysis masking procedure in Ménière's disease.

OBJECTIVE: To determine the diagnostic value of the cochlear hydrops analysis masking procedure (CHAMP) in patients with definite Ménière's disease. STUDY DESIGN: Prospective validation study for a diagnostic test, study phase 2. SETTING: Tertiary referral centers. PATIENTS: Subjects with definite Ménière's disease (Group 1), differential diagnosis (Group 2: another audiovestibular diseases or neurologic disorders), and normal hearing (Group 3) were included. Sample sizes were calculated. INTERVENTIONS: Study test (CHAMP) was compared with the current clinical criterion standard described by the guidelines of the American Academy of Otolaryngology-Head and Neck Surgery. MAIN OUTCOME MEASURE: Sensitivity, specificity, and other indicators of diagnostic validation. RESULTS: One hundred ten cases completed the follow-up, and their results are presented. Sensitivity at 31.3% and specificity at 100% were found in subjects with definite Ménière's disease, features that are more helpful in confirming the diagnosis than in rejecting it. Group 1 showed significantly shorter latency delays than Groups 2 and 3 (p < 0.001). CONCLUSION: If definite Ménière's disease is suspected, an abnormal result confirms the diagnosis; however, a normal result does not rule out the Ménière's disease diagnosis.

Base alar: analisis estetico y nueva tecnica quirurgica / Alar base: aesthetic analysis and new surgical technique

La nariz es una estructura facial de importancia central desde el punto de vista estético, pequeños cambios en la nariz pueden modificar la apariencia facial completa. La base alar se expande después de corregir una punta sobreproyectada o se presenta cuando hay expansión alar, bulbosidad o anchura excesiva de la base nasal; en estos casos hay indicación de modificar la base alar para lo cual se han utilizado técnicas quirúrgicas abiertas. Presentamos el caso de un paciente a quien se le realizó una septorrinoplastia funcional y una reducción de base alar con un punto entre el ala y piso nasal de cada fosa nasal sin utilizar una incisión adicional, y con el cual se obtuvo una disminución del ancho alar de 3.5 mm.