Tinnitus Footprints in the Cochlea

The purpose of this paper is to show how temporal bone histopathology has been instrumental in adding knowledge about the origin of tinnitus in the cochlea and how it will still be useful for that purpose in the future. The papers published on this subject will be reviewed, and their contributions will be highlighted. The knowledge that is now part of the subject will be pointed out, and future research on this area will be pointed out.

Hearing of neonates without risk indicators for hearing loss and use of antimalarial drugs during pregnancy: a historical cohort study in the Northern Region of Brazil

INTRODUCTION

Studies have demonstrated the ototoxic effects of antimalarial drugs in individuals who receive these drugs, but little is known regarding the toxicity of these drugs in the newborn auditory system when administered to the mother receive the drug during pregnancy.

OBJECTIVE

To verify the incidence of hearing loss in neonates who have no other associated risk indicators, born to mothers treated for malaria during pregnancy.

METHODS

A retrospective, quantitative cohort study was developed at Hospital de Base Dr. Ary Pinheiro and Clínica Limiar, both located in the municipality of Porto Velho (Rondônia). The sample consisted of 527 newborns divided into two groups: exposed to antimalarials drugs during pregnancy group (n = 32) and non-exposed group (n = 495). Data collection took place from September 2014 to December 2015, through an interview with the mothers and/or guardians of the newborn, through the newborns' and the mothers' records, and the neonatal hearing screening database of the above-mentioned institutions.

RESULTS

All the neonates in the exposed group, assessed through the recording of transient otoacoustic emissions associated with the automated brainstem auditory evoked potential test, underwent neonatal hearing screening in the first examination. Among the newborns in the non-exposed group, 30 showed failure and were retested. Of these, one continued to fail and was referred for diagnosis, in whom the results showed to be within the normal range. Among the neonates of the exposed group, infection with Plasmodium vivax was the most frequent, and was similarly distributed among the gestational trimesters, and chloroquine was the most commonly used antimalarial drug treatment more often given during the third trimester; these findings did not show any influence on the audiological findings of the studied neonates.

CONCLUSION

The present study did not identify any cases of hearing loss in neonates born to mothers who used antimalarial drugs during gestation.

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.

Does ear endoscopy provide advantages in the outpatient management of open mastoidectomy cavities?

Objective

To evaluate the use of ear endoscopy in the postoperative management of open mastoidectomy cavities, and to test whether ear endoscopy improves inspection and cleaning compared with ear microscopy.

Methods

Prospective study. Thirty-two ears were divided into two groups: group 1, examination and cleaning of mastoid cavities under endoscopic visualization after microscopic standard ear cleaning; group 2, examination and cleaning of mastoid cavities under microscopic visualization after endoscope-assisted ear cleaning. We assessed the ability of each method to provide exposure and facilitate cleaning, comparing the benefits of microscopy and endoscopy when used sequentially and vice-versa.

Results

Endoscopy provided additional benefits for exposure in 61.1% of cases and cleaning in 66.7%. Microscopy provided no additional benefits in terms of exposure in any case, and provided added benefit for cleaning in only 21.4% of cases.

Discussion

For outpatient postoperative care of open mastoidectomy cavities, ear endoscopy provides greater benefit over ear microscopy than vice-versa. In over half of all cases, endoscopy was able to expose areas not visualized under the microscope. Furthermore, in two-thirds of cases, endoscopy enabled removal of material that could not be cleared under microscopy. Ear endoscopy was superior to microscopy in terms of enabling exposure and cleaning of hard-to-reach sites, due to its wider field of vision.

Conclusion

Ear endoscopy is a feasible technique for the postoperative management of open mastoidectomy cavities. Ear endoscopy provided superior advantages in terms of exposure and aural cleaning compared with microscopy.

High-frequency conductive hearing loss as a diagnostic test for incomplete ossicular discontinuity in non-cholesteatomatous chronic suppurative otitis media

Chronic suppurative otitis media, with or without cholesteatoma, may lead to erosion of the ossicles and discontinuity of the ossicular chain. In incomplete ossicular discontinuity (IOD), partial erosion of the ossicles occurs, but some sound transmission is noted throughout the ossicular chain. High-frequency conductive hearing loss (HfCHL) has been considered a hallmark of incomplete ossicular discontinuity. This study aims to evaluate the use of HfCHL as a preoperative predictor of IOD in patients with non-cholesteatomatous chronic suppurative otitis media. The HfCHL test was defined as the preoperative air-bone gap (ABG) at 4 kHz minus the average of the ABG at 0.25 and 0.5 kHz. The test was applied in 328 patients before surgery and compared to intraoperative findings as the gold standard. At surgery, 201 (61.3%) patients had an intact ossicular chain, 44 (13.4%) had a complete ossicular discontinuity, and 83 (25.3%) exhibited an IOD. The best cutoff level was calculated as 10 dB. The HfCHL test to diagnose IOD had a sensitivity of 83% and a specificity of 92% with a post-test probability of 78% and a likelihood ratio of 10.2. We concluded that the HfCHL test is highly effective in predicting IOD in patients with non-cholesteatomatous chronic suppurative otitis media and that it should be used routinely as a screening test prior to surgery.

Analysis of Hearing and Tinnitus in Workers Exposed to Occupational Noise

INTRODUCTION

Noise is one of the harmful agents to health that is present in the various branches of economic activity. Hearing loss and tinnitus are among the most frequently reported complaints by workers exposed to occupational noise.

OBJECTIVE

To analyze the hearing and tinnitus in normal-hearing workers exposed to occupational noise.

METHODS

This is a cross-sectional analytical trial in metallurgical industries, in which we evaluated normal-hearing workers through anamnesis, audiometry and otoacoustic emissions.

RESULTS

It was observed high prevalence of failure of otoacoustic emissions (40%) and tinnitus (66.6%). Both in the amplitude and in the signal-to-noise ratio, the higher is the frequency of the sound, the worse the results. Despite having audiometry within normal limits, the results indicate that workers are suffering the effects of exposure and reveals association between failure of otoacoustic emissions and tinnitus in this population (X² = 6,732).

CONCLUSION

It is concluded that failures in DPOAE and tinnitus are predictors of hearing damage in normal-hearing workers.

Amplified music exposure carries risks to hearing

OBJECTIVE

To investigate the association between changes in the outer hair cells and exposure to amplified music in a group of high-school students.

MATERIALS AND METHODS

In this retrospective, case-control study, 86 subjects underwent audiometry, immittance audiometry, and distortion-product otoacoustic emission tests. The subjects were questioned about their listening habits and divided into 2 groups: exposed and unexposed.

RESULTS

Most of the subjects had reduced function in their outer hair cells, mainly beginning at 8 kHz. Among 60 subjects-30 cases and 30 controls-75% were considered exposed and 25% unexposed. The exposed subjects were 9.33 times more likely to have altered outer hair cells than the unexposed subjects were.

CONCLUSION

Exposure to amplified music is associated with reduced function in the hair cells.

Intratympanic corticosteroid for sudden hearing loss: does it really work?

Introduction

Sudden deafness is characterized by an abrupt hearing loss of at least 30 dB in three sequential frequencies in the standard pure tone audiogram over three days or less. Treatment is based on its etiology, and oral corticosteroids are widely used. Intratympanic corticosteroids are included as primary or secondary treatment when there is no improvement with the use of oral corticosteroids.

Objective

To determine the effectiveness of therapy with intratympanic steroids in sudden deafness.

Methods

A systematic review was performed of publications on the topic in the databases of PubMed/MEDLINE, with the keywords: sudden deafness, sudden hearing loss, and corticosteroids.

Results

Thirty scientific studies were analyzed. As to the objectives of the study analyzed, 76.7% sought to evaluate the use of intratympanic therapy salvage after failure to conventional treatment, and intratympanic therapy was used as the primary treatment 23.3% of the studies.

Conclusion

Intratympanic corticosteroid therapy is prescribed primarily when there is failure of conventional therapy and when it is limited to use systemic corticosteroids, such as the diabetic patient.

Risk of hearing alterations in newborns of mothers treated for malaria

INTRODUCTION

The antimalarial drugs can cause irreversible sensorineural hearing loss, and chloroquine phosphate use can be ototoxic to the fetus.

OBJECTIVE

To compare the results of hearing screening in newborns of mothers treated for malaria in pregnancy with the results of newborns of mothers untreated and check for increased risk of hearing alterations in the group exposed to treatment.

METHOD

Retrospective cohort study which involved 284 infants, 30 in the exposed group to malaria treatment and 254 in the unexposed group, matched for gestational age, birth weight and risk indicators for hearing. They underwent hearing screening by means of transient evoked otoacoustic emissions and/or auditory brainstem response automatic. The variables were collected in an interview with the parents in the health record and the screening database.

RESULTS

The prevalence of fail in exposed group (6.7%) was significant when compared with the unexposed group (1.2%). The risk of failing in the hearing screening in the exposed group was 5.64 (CI 1.17 to 27.3).

CONCLUSION

Newborns of mothers treated for malaria in pregnancy had a prevalence of fail in hearing screening at 6.7% and 5.64 higher chances to fail than newborns of untreated mothers.

Association between suppression of otoacoustic emissions and annoyance levels in tinnitus patients with normal hearing

OBJECTIVE

To correlate the annoyance of tinnitus assessed by the Tinnitus Handicap Inventory and on a visual analogue scale with the evoked otoacoustic emission test result in tinnitus patients with normal hearing.

STUDY DESIGN

Case-control study.

SETTING

Public tertiary hospital.

SUBJECTS AND METHODS

The sample was initially based on a population of 80 subjects with tinnitus; 20 of them had normal hearing and normal evoked otoacoustic emission test results and comprised the study group. For the purpose of comparison, a control group was formed, which consisted of 17 subjects with no hearing complaints and normal hearing. The participants were submitted to hearing tests, immittance testing and tests for the evaluation of acoustic reflexes, distortion product otoacoustic emissions, transient evoked otoacoustic emissions (TEOAEs), and suppression of TEOAEs. The tests were performed in a sound-treated booth using a linear contralateral noise of 60 dB. The presence of suppression effects was defined when the response amplitude was 0.5 dB or higher.

RESULTS

Abnormal evoked otoacoustic emission suppression test results were observed in 52.9% of tinnitus patients and in 32.4% of control subjects (p = 0.086). Suppression effects of TEOAEs were absent in 38.5% of subjects with minimal or mild discomfort and in 61.9% of subjects with moderate or severe discomfort (p = 0.183).

CONCLUSION

It was not possible to associate the annoyance caused by tinnitus with the TEOAE suppression test results, although suppression effects were found to decrease with increasing annoyance.

Comparative analysis of vocabulary in children with cochlear implants

INTRODUCTION

The use of tests assessing the speech of patients who underwent cochlear implant (CI) surgery is warranted to increase knowledge on the development of these patients' language skills. The ABFW Child Language Test evaluates vocabulary, phonology, fluency, and pragmatics and can be administered to these children.

OBJECTIVE

To evaluate the vocabulary of children using CI.

METHOD

This study included 16 children who underwent CI surgery between 1-4 years and 11 months old. Patients were divided into five groups according to age upon CI activation.

RESULTS

In comparison with the age of brain's auditory development vs. chronological age of hearing children, all children using CI performed better. The comparison between children using unilateral CI and bilateral CI showed that those using bilateral CI had better results. When we compared children's performance considering the chronological age of deaf and hearing children, hearing children performed better. However, there were similar results when patients effectively used their CI and attended auditory rehabilitation sessions.

CONCLUSION

In our study, the vocabulary of children using CI is similar to the vocabulary of hearing children.

Stapedotomy in a residency training program

INTRODUCTION

The major objective of a stapedotomy is the restoration of hearing. In training centers, the hearing results obtained by resident physicians are lower than those achieved by more experienced surgeons. An analysis of the surgical results obtained by resident physicians is essential to identification of the deficiencies in the learning process.

OBJECTIVE

To analyze the postoperative hearing results obtained by otosclerosis patients who underwent stapedotomy performed by surgeons in a residency program.

METHODS

The pre- and postoperative audiometric results were evaluated in a retrospective study of 98 otosclerosis patients who underwent stapedotomy from January 2000 to December 2010.

RESULTS

The distribution of patients according to the postoperative results was as follows: 68.4% of the patients achieved a postoperative gap of less than or equal to 10 dB, and 91.8% of the patients achieved a postoperative gap of less than or equal to 20 dB. Three (3.1%) patients had profound sensorineural hearing loss after the procedure.

CONCLUSIONS

An improvement in surgical outcomes of doctors in training is essential for the continuation of training for stapes surgery during medical residency.

Eagle's Syndrome

Introduction: Eagle's syndrome is characterized by cervicopharyngeal signs and symptoms associated with elongation of the styloid apophysis. This elongation may occur through ossification of the stylohyoid ligament, or through growth of the apophysis due to osteogenesis triggered by a factor such as trauma. Elongation of the styloid apophysis may give rise to intense facial pain, headache, dysphagia, otalgia, buzzing sensations, and trismus. Precise diagnosis of the syndrome is difficult, and it is generally confounded by other manifestations of cervicopharyngeal pain.

Objective: To describe a case of Eagle's syndrome.

Case Report: A 53-year-old man reported lateral pain in his neck that had been present for 30 years. Computed tomography (CT) of the neck showed elongation and ossification of the styloid processes of the temporal bone, which was compatible with Eagle's syndrome. Surgery was performed for bilateral resection of the stylohyoid ligament by using a transoral and endoscopic access route. The patient continued to present pain laterally in the neck, predominantly on his left side. CT was performed again, which showed elongation of the styloid processes. The patient then underwent lateral cervicotomy with resection of the stylohyoid process, which partially resolved his painful condition.

Final Comments: Patients with Eagle's syndrome generally have a history of chronic pain. Appropriate knowledge of this disease is necessary for adequate treatment to be provided. The importance of diagnosing this uncommon and often unsuspected disease should be emphasized, given that correct clinical-surgical treatment is frequently delayed. The diagnosis of Eagle's syndrome is clinical and radiographic, and the definitive treatment in cases of difficult-to-control pain is surgical.

Is the Degree of Discomfort Caused by Tinnitus in Normal-Hearing Individuals Correlated with Psychiatric Disorders?

Objective

To evaluate the annoyance of tinnitus in normal-hearing patients and to correlate it with outer hair cell function and with anxiety and depression disorders.

Study design

Case-control study.

Setting

Tertiary care medical center.

Subjects and Methods

Sixty-eight patients with tinnitus (study group) and a control group consisting of 46 subjects without tinnitus were studied. The subjects ranged in age from 20 to 45 years and had a hearing threshold of up to 25 dB in the frequency range of 500 to 8000 Hz. The subjects were submitted to otoacoustic emission (OAE) tests. Tinnitus annoyance was evaluated using the Tinnitus Handicap Inventory, and anxiety and depression were measured using the Beck Anxiety and Depression Inventories.

Results

In the study group, 67% of the transient-evoked OAE tests were altered, with the observation of significant differences for all frequencies tested. In addition, 65.2% of the distortion product–evoked OAE tests were altered at 3000, 6000, and 8000 Hz, and this difference was significant when compared with control. Anxiety (44.1%) and depression (33.3%) were significantly more frequent among patients with tinnitus. Tinnitus annoyance was not correlated with the OAE results or tinnitus duration but showed a correlation with the presence of anxiety and depression. In the study group, no difference in tinnitus annoyance, anxiety, or depression was observed between patients with normal and altered OAE tests.

Conclusion

This study showed altered OAE in patients with tinnitus and normal hearing. It also demonstrated a positive correlation between the annoyance of tinnitus and anxiety and depression in normal-hearing patients.

Artéria esfenopalatina: desafio cirúrgico na epistaxe

Knowledge on the anatomy of the sphenopalatine artery (SPA) and its branches is fundamental for the success of the endoscopic treatment of posterior epistaxis. However, the complex anatomical variations seen in the irrigation of the nasal cavity poses a significant surgical challenge.

Objective: This paper aims to describe the endoscopic anatomy of the SPA in human cadavers.

Materials and Methods: This is a contemporary cross-sectional cohort study carried out between April 2010 and August 2011. The presence of the ethmoidal crest on the lamina perpendicular to the palatine bone and the location of the principal sphenopalatine foramen (PSF) and the accessory sphenopalatine foramen (ASF) were analyzed in 28 cadavers, and the branches emerging from the foramens were counted.

Results: Fifty-six nasal fossae were analyzed. The ethmoidal crest was present in 96% of the cases and was located anteriorly to the PSF in most cases. The PSF was located in the transition area between the middle and the superior meatus in all cases. The ASF was seen in 12 cases. Most nasal fossae (n = 12) presented a single bilateral arterial trunk emerging from the PSF. In other cases, three (n = 8) or two (n = 5) arterial trunks emerged bilaterally from the PSF. In most cases, the SPA emerged as a single trunk from the ASP.

Conclusions: The anatomy of the SPA is highly variable. The success of the treatment for severe epistaxis relies heavily on adequate knowledge of the possible anatomical variations of the sphenopalatine artery.

Prevalência de alterações das células ciliadas externas em estudantes de uma escola do Distrito Federal

Exposure to loud music is increasing among young people, and so could be the number of hearing impairment cases in this population. Otoacoustic emission tests are sensitive in capturing the effects of exposure to noise, and allow the detection of early cochlear disorders.

Objective: This study aims to look into the prevalence rates of injuries to outer hair cells in a population of students through otoacoustic emission testing.

Materials and Method: One-hundred and thirty-four subjects were submitted to transient evoked and distortion product otoacoustic emission tests. Subjects were assessed on a “pass/fail” scale. This is a cross-sectional descriptive study on prevalence rates.

Results: More than four fifths (80.6%) of the 134 subjects had altered transient otoacoustic emissions, most of whom were males; 97.8% had altered distortion product otoacoustic emissions and 79.9% had altered test results in both transient evoked and distortion product OAEs; most were males; 94.0% reported they used earphones; and 82.8% stated they frequented places where loud music was played.

Conclusion: The high prevalence rates of altered test results seem to indicate the presence of early cochlear disorders in the studied subjects. A significant number of subjects reported exposure to loud music, a habit that may be conducive to the onset of cochlear disorders.

DATASUS as a instrument for developing otologic public health policies

Ear diseases are illnesses which represent a relevant group of morbidity. Otitis media, for instance, still is a public health problem today.

Objective

To correlate hospital morbidity of ear diseases according to data from the Information Technology Department of the Public Health Care System -SUS (DATASUS), through the Hospital Information System (SIH) with the Human Development Index (IDH) from each unit of the federation. To assess the use of this official data in the creation of otologic public health care policies.

Materials and Methods

Brazilian states were classified according to their respective IDH values. The percentage population from each state was calculated in relation to the entire population of the country, as well as the percentage of hospital admission caused by ear diseases (SIH) for each state in relation to their total number. The hospital admissions from each state were correlated with their respective IDH values.

Results

The state of São Paulo, the third largest IDH was responsible for 38.82% of hospital admissions caused by ear diseases, although its population represents 21.64% of the national population. States with lower IDH had lower hospital admission rates for ear diseases.

Conclusion

SIH, a DATASUS tool, even with limitations, can be an instrument used to create public policies concerning ear diseases.

Auditory neuropathy spectrum: the importance of adequate diagnosis

OBJECTIVE

To evaluate the prevalence of misdiagnosis of the hearing impaired children, in order to investigate the existence of Auditory Neuropathy Spectrum Disorder.

METHODS

Analytical, prospective study conducted with 15 participants (30 ears) aged 10-12 years, with bilateral sensorineural hearing loss, attending a Hearing Rehabilitation Center, accompanied by a multidisciplinary team with otolaryngologist, audiologist, psychologist, teacher and social worker. The participants underwent ENT examination and audiological assessment: tympanometry, acoustic reflexes, otoacoustic emissions test and Auditory Evoked response.

RESULTS

From the total sample (30 ears), 8 ears (26.7%) presented absent responses in the Auditory Evoked response with the presence of cochlear microphonism. Within the selected eight ears, six (75%) showed presence of otoacoustic emissions test in isolated frequencies and two (25%) ears had otoacoustic emissions test even in the presence of the isolated frequencies. It was found that 26.7% of the ears tested presented results that are compatible with Auditory Neuropathy Spectrum Disorder.

CONCLUSION

The results of this study have identified characteristics related to ANSD in 26.7% of ears tested, 6 participants with age over 10 years old, showing that misdiagnosis in hearing loss patients is still very frequent.

Otoacoustic emissions in normal-hearing workers exposed to different noise doses

INTRODUCTION

The otoacoustic emission test is useful in monitoring hearing changes not yet detectable in pure-tone audiometry, as well as in monitoring cochlear damage caused by exposure to noise.

OBJECTIVE

To evaluate distortion product otoacoustic emissions in normal-hearing workers exposed to different occupational noise doses.

MATERIALS AND METHOD

This is a cohort prospective study performed in metalworking industries, in which normal-hearing workers were assessed by being divided into three different groups: GI not exposed, GII sporadically exposed and GIII often exposed to occupational noise.

RESULTS

Otoacoustic emission alterations were found in groups II and III bilaterally. Both in the amplitude and in the signal/noise ratio it was observed that as higher was the frequency, worse were the results of GII and GIII (p > 0.001), and the greater the exposure dose is, the lower the averages found in otoacoustic emission.

CONCLUSION

The otoacoustic emissions are worse in the exposed groups compared to the unexposed group and the greater are the noise dose, worse are the results.

Intratympanic corticotherapy and tinnitus control after sudden hearing loss

INTRODUCTION

Sudden deafness is characterized by an abrupt onset, often idiopathic and tinnitus is present, and becomes the main complaint in up to 80% of patients.

OBJECTIVE

To review carefully all studies of the past 10 years on sudden deafness and tinnitus and analyze the effectiveness of oral and intratympanic steroids for tinnitus control in eight patients with sudden deafness and severe disabling tinnitus.

METHOD

An analytical prospective in which 64 patients after sudden deafness with tinnitus were monitored and 08 of these suffering with severe disabling tinnitus underwent hearing evaluation and application of the Tinnitus Handicap Inventory and Visual Analogue Scale before, during and after sudden deafness treated with oral and intratympanic steroids. It was made a systematic review of publications on the topic in the library of PubMed/MedLine, keywords: Sudden deafness and tinnitus.

RESULTS

Eleven scientific studies were analyzed. Eight patients treated with intratympanic and oral corticosteroids were selected, just two patients showed improvement over the hearing but seven of them showed big improvement in their tinnitus, which was demonstrated by an improvement in the values of the degrees of severity of tinnitus.

CONCLUSION

Patients with sudden deafness and severe disabling tinnitus, and underwent intratympanic and oral corticosteroids showed, in this study, significant reduction and/or remission of tinnitus.

Benign paroxysmal positional vertigo: diagnosis and treatment

Benign paroxysmal positional vertigo is a common disorder in Neurotology. This vestibular syndrome is characterized by transient attacks of vertigo, caused by change in head position, and associated with paroxysmal characteristic nystagmus. The symptoms result from movement of the free floating otoconia particles in the endolymph or their attachment to the cupulae of the semicircular canal. The diagnosis is essentially clinical and should be confirmed by performing diagnostic maneuvers. Treatment is based on the identification of the affected semicircular canal and performance of liberatory maneuvers or repositioning of free floating particles of otoliths. The effectiveness varies from 70 to 100%.