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Souza DDS, Almeida AA, Andrade SMDS, Machado DGDS, Leitão M, Sanchez TG, Rosa MRDD. Transcranial direct current stimulation improves tinnitus perception and modulates cortical electrical activity in patients with tinnitus: A randomized clinical trial. Neurophysiol Clin 2020; 50:289-300. [PMID: 32863109 DOI: 10.1016/j.neucli.2020.07.002] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2020] [Revised: 07/17/2020] [Accepted: 07/17/2020] [Indexed: 12/19/2022] Open
Abstract
OBJECTIVES This study aims to determine whether transcranial direct current stimulation (tDCS): a) is effective in the treatment of tinnitus by decreasing its annoyance and severity; b) modulates the cortical electrical activity of such individuals. METHODS A double-blind, placebo-controlled clinical trial was conducted with 24 patients with tinnitus, randomized into two groups: Group 1 (n = 12) received anodal tDCS over the left temporoparietal area (LTA) and cathodal tDCS over the right dorsolateral prefrontal cortex (DLPFC) and Group 2 (n = 12) received placebo intervention. Tinnitus perception using a visual analog scale (VAS) and the Tinnitus Handicap Inventory (THI) questionnaire, in addition to electroencephalogram (EEG) was measured with eyes opened and closed at baseline and after the intervention. For the treatment, patients were subjected to five consecutive sessions of tDCS with the anodal electrode over the LTA and cathodal electrode over the right DLPFC (7 × 5 cm, 2 mA for 20 min). tDCS was turned off after 30 s in the sham group. RESULTS Active tDCS significantly improved tinnitus annoyance and severity. It was associated with decreased beta and theta EEG frequency bands with eyes opened and decreased alpha frequency with eyes closed. sLORETA identified changes in frequency bands in the frontal, temporoparietal, and limbic regions. Finally, there were negative correlations between baseline EEG frequency bands and tDCS-induced change in tinnitus annoyance and severity. CONCLUSIONS These results demonstrate that tDCS modulates the EEG activity and alleviates tinnitus perception. This effect may be related to baseline EEG activity.
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Affiliation(s)
- Dayse da Silva Souza
- Graduate Program in Cognitive Neuroscience and Behavior, Federal University of Paraiba, João Pessoa, Brazil.
| | - Alexandre Alex Almeida
- Graduate Program in Cognitive Neuroscience and Behavior, Federal University of Paraiba, João Pessoa, Brazil
| | | | | | - Márcio Leitão
- Department of Classical and Vernacular Letters, Federal University of Paraíba, Brazil
| | - Tanit Ganz Sanchez
- University of São Paulo School of Medicine, São Paulo, Brazil; Ganz Sanches Institute of Integrated Otorhinolaryngology, São Paulo, Brazil
| | - Marine Raquel Diniz da Rosa
- Graduate Program in Cognitive Neuroscience and Behavior, Federal University of Paraiba, João Pessoa, Brazil.
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Abstract
BACKGROUND Clinical observation suggests that total remission of tinnitus may exist, but a systematic analysis of these cases is missing. We aimed to identify subjects with long lasting total remission of tinnitus. METHODS By publishing announcements, we included volunteers of any gender and age who have had daily perception of tinnitus for over 3 months and have been in total remission (lack of tinnitus perception, even in silence and with deliberate attention to it) for over 6 months. We excluded individuals in a state of habituation or masking. We applied a structured interview to standardize information about tinnitus and its remission. Follow-up interviews took place after 6, 12, and 18 months. RESULTS Eighty individuals (56 females; age=54.2±16.8 years) were included. History of bilateral tinnitus accounted for 51.4% of cases. Total remission occurred in subjects whose tinnitus lasted for 49.0±73.5 months. Remission occurred gradually in 78.6% of cases and suddenly in 22%. During the further 18-month follow-up, 7.9% reported recurrence of tinnitus and 92.1% remained symptom free. CONCLUSION Different than the knowledge obtained from clinical trials, this study showed that long-lasting total remission of tinnitus may occur. This status was reached by individuals of any gender and age range, with any location and duration of tinnitus, mostly as a gradual process. Future studies should better clarify how each treatment modality may achieve the best results.
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Affiliation(s)
- Tanit Ganz Sanchez
- Department of Otolaryngology, University of São Paulo School of Medicine, São Paulo, Brazil; Instituto Ganz Sanchez, São Paulo, Brazil.
| | | | - Winfried Schlee
- Department of Psychiatry and Psychotherapy, Bezirksklinikum, University of Regensburg, Regensburg, Germany
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Sanchez TG, Roberts LE. Total remission or persistence of tinnitus and decreased sound level tolerance in adolescents with normal audiograms: A follow-up study. Prog Brain Res 2020; 260:253-268. [PMID: 33637221 DOI: 10.1016/bs.pbr.2020.05.025] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
BACKGROUND Tinnitus may reflect hidden cochlear synaptic injury that does not express in the audiogram, but leads to neuroplastic changes in auditory pathways that, in turn, reduce tolerance to sounds. Such injury may follow the exposure to loud sounds. The aim of this study was to follow-up adolescents enrolled in a private school to evaluate the prevalence of tinnitus and reduced sound level tolerance (SLT) with 1-year interval, as well as to observe rates of tinnitus persistence, remission and incidence of new cases by repeat measurements. METHODS In Study 1 (Sanchez et al., 2016), we evaluated 170 adolescents by a questionnaire about tinnitus and reduced tolerance to ordinary sounds and by measurements in a sound booth: audiometry (0.25-16kHz), Loudness Discomfort Levels (LDL, 0.5-4kHz) and tinnitus pitch/loudness matching (if present). Tinnitus measured in the booth was then called "confirmed tinnitus." In Study 2, we revaluated 54 adolescents who returned voluntarily 1 year later to repeat all measurements. RESULTS From Study 1 to 2, the prevalence of confirmed tinnitus reduced from 28.8% (49/170) to 14.9% (8/54) in retested subjects, which includes the cases of persisting tinnitus (confirmed tinnitus in both studies, n=6/54=11.2%) and the new cases of tinnitus (confirmed tinnitus just at Study 2, n=2/54=3.7%). Among the 15 adolescents with confirmed tinnitus at Study 1 who returned for Study 2, 40% had persistent tinnitus (n=6) and 60% did not (remitted tinnitus, n=9). SLT was reduced by 17.3dB in cases with persistent tinnitus (P<0.0002), similar to the findings of Study 1, and returned to normal levels in subjects with remitted tinnitus. Hearing thresholds averaged 4.37dBHL and were <20dBHL in 97% of ears and all frequencies. At 14 and 16kHz thresholds were bilaterally elevated at Study 1 (5.07dB) and 2 (5.56dB) in adolescents with confirmed tinnitus. CONCLUSIONS Tinnitus and reduced sound tolerance could feature early signals of hidden synaptic injury that is prevalent among adolescents and hidden from the audiogram. The strong relationship between both symptoms, in addition to low-level increases in hearing thresholds at high frequencies in the extended audiogram, poses a challenge for future hearing health and should be further evaluated as a possible intrinsic vulnerability for lesions following exposure to loud sounds. Moreover, the relationship between their spontaneous remissions may signal a possible synaptic repair, which has been reported in animal models.
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Affiliation(s)
- Tanit Ganz Sanchez
- Department of Otolaryngology, University of São Paulo School of Medicine, São Paulo, Brazil; Instituto Ganz Sanchez, São Paulo, Brazil.
| | - Larry E Roberts
- Department of Psychology Neuroscience and Behaviour, McMaster University, Hamilton, ON, Canada
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Bento RF, Sanchez TG, Miniti A, Tedesco-Marchesi AJ. Continuous, High-frequency Objective Tinnitus Caused by Middle Ear Myoclonus. Ear, Nose & Throat Journal 2019. [DOI: 10.1177/014556139807701007] [Citation(s) in RCA: 30] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Affiliation(s)
- Ricardo Ferreira Bento
- Department of Otolaryngology, Clinics Hospital, University of Sao Paulo, São Paulo, Brazil
| | - Tanit Ganz Sanchez
- Department of Otolaryngology, Clinics Hospital, University of Sao Paulo, São Paulo, Brazil
| | - Aroldo Miniti
- Department of Otolaryngology, Clinics Hospital, University of Sao Paulo, São Paulo, Brazil
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Michiels S, Ganz Sanchez T, Oron Y, Gilles A, Haider HF, Erlandsson S, Bechter K, Vielsmeier V, Biesinger E, Nam EC, Oiticica J, de Medeiros ÍRT, Bezerra Rocha C, Langguth B, Van de Heyning P, De Hertogh W, Hall DA. Diagnostic Criteria for Somatosensory Tinnitus: A Delphi Process and Face-to-Face Meeting to Establish Consensus. Trends Hear 2019; 22:2331216518796403. [PMID: 30213235 PMCID: PMC6144502 DOI: 10.1177/2331216518796403] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Abstract
Since somatic or somatosensory tinnitus (ST) was first described as a subtype of subjective tinnitus, where altered somatosensory afference from the cervical spine or temporomandibular area causes or changes a patient’s tinnitus perception, several studies in humans and animals have provided a neurophysiological explanation for this type of tinnitus. Due to a lack of unambiguous clinical tests, many authors and clinicians use their own criteria for diagnosing ST. This resulted in large differences in prevalence figures in different studies and limits the comparison of clinical trials on ST treatment. This study aimed to reach an international consensus on diagnostic criteria for ST among experts, scientists and clinicians using a Delphi survey and face-to-face consensus meeting strategy. Following recommended procedures to gain expert consensus, a two-round Delphi survey was delivered online, followed by an in-person consensus meeting. Experts agreed upon a set of criteria that strongly suggest ST. These criteria comprise items on somatosensory modulation, specific tinnitus characteristics, and symptoms that can accompany the tinnitus. None of these criteria have to be present in every single patient with ST, but in case they are present, they strongly suggest the presence of ST. Because of the international nature of the survey, we expect these criteria to gain wide acceptance in the research field and to serve as a guideline for clinicians across all disciplines. Criteria developed in this consensus paper should now allow further investigation of the extent of somatosensory influence in individual tinnitus patients and tinnitus populations.
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Affiliation(s)
- Sarah Michiels
- 1 Department of Rehabilitation Sciences and Physiotherapy, Faculty of Medicine and Health Sciences, University of Antwerp, Wilrijk, Belgium.,2 Department of Otorhinolaryngology, Faculty of Medicine and Health Sciences, Antwerp University Hospital, Edegem, Belgium.,3 Department of Translational Neurosciences, Faculty of Medicine and Health Sciences, University of Antwerp, Wilrijk, Belgium
| | - Tanit Ganz Sanchez
- 4 Instituto Ganz Sanchez, São Paulo, Brazil.,5 ENT Department, School of Medicine, University of Sao Paulo, Brazil
| | - Yahav Oron
- 6 Department of Otolaryngology, Head, Neck and Maxillofacial Surgery, Sackler School of Medicine, Tel-Aviv Sourasky Medical Center, Tel Aviv University, Israel
| | - Annick Gilles
- 2 Department of Otorhinolaryngology, Faculty of Medicine and Health Sciences, Antwerp University Hospital, Edegem, Belgium.,3 Department of Translational Neurosciences, Faculty of Medicine and Health Sciences, University of Antwerp, Wilrijk, Belgium.,7 Department of Human and Social Welfare, University College Ghent, Belgium
| | - Haúla F Haider
- 8 ENT Department, Hospital Cuf Infante Santo, NOVA Medical School, Lisbon, Portugal
| | - Soly Erlandsson
- 9 Center for Child and Youth Studies, University West, Trollhättan, Sweden
| | - Karl Bechter
- 10 Clinic for Psychiatry and Psychotherapy II, Bezirkskrankenhaus Günzburg, University of Ulm, Germany
| | | | - Eberhard Biesinger
- 12 ENT-Clinic and Otolaryngology Department, Klinikum Traunstein, Germany
| | - Eui-Cheol Nam
- 13 Department of Otolaryngolgy, School of Medicine, Kangwon National University, Chuncheon-si, Gangwon-do, Republic of Korea
| | - Jeanne Oiticica
- 5 ENT Department, School of Medicine, University of Sao Paulo, Brazil
| | | | | | - Berthold Langguth
- 14 Department of Psychiatry and Psychotherapy, University of Regensburg, Germany
| | - Paul Van de Heyning
- 2 Department of Otorhinolaryngology, Faculty of Medicine and Health Sciences, Antwerp University Hospital, Edegem, Belgium.,3 Department of Translational Neurosciences, Faculty of Medicine and Health Sciences, University of Antwerp, Wilrijk, Belgium.,15 Multidisciplinary Motor Centre Antwerp, University of Antwerp, Wilrijk, Belgium
| | - Willem De Hertogh
- 1 Department of Rehabilitation Sciences and Physiotherapy, Faculty of Medicine and Health Sciences, University of Antwerp, Wilrijk, Belgium
| | - Deborah A Hall
- 16 NIHR Nottingham Biomedical Research Centre, Nottingham, UK.,17 Hearing Sciences, Division of Clinical Neuroscience, School of Medicine, University of Nottingham, UK.,18 Nottingham University Hospitals NHS Trust, Queens Medical Centre, Nottingham, UK.,19 University of Nottingham Malaysia, Semeniyh, Selangor Darul Ehsan, Malaysia
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Onishi ET, Coelho CCDB, Oiticica J, Figueiredo RR, Guimarães RDCC, Sanchez TG, Gürtler AL, Venosa AR, Sampaio ALL, Azevedo AA, Pires APBDÁ, Barros BBDC, Oliveira CACPD, Saba C, Yonamine FK, Medeiros ÍRTD, Rosito LPS, Rates MJA, Kii MA, Fávero ML, Santos MADO, Person OC, Ciminelli P, Marcondes RDA, Moreira RKDP, Torres SDMS. Tinnitus and sound intolerance: evidence and experience of a Brazilian group. Braz J Otorhinolaryngol 2018; 84:135-149. [PMID: 29339026 PMCID: PMC9449167 DOI: 10.1016/j.bjorl.2017.12.002] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2017] [Accepted: 12/07/2017] [Indexed: 12/13/2022] Open
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.
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Sanchez TG, Silva FED. Familial misophonia or selective sound sensitivity syndrome : evidence for autosomal dominant inheritance? Braz J Otorhinolaryngol 2017; 84:553-559. [PMID: 28823694 PMCID: PMC9452240 DOI: 10.1016/j.bjorl.2017.06.014] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2017] [Revised: 06/09/2017] [Accepted: 06/30/2017] [Indexed: 11/29/2022] Open
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.
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Affiliation(s)
- Tanit Ganz Sanchez
- Instituto Ganz Sanchez, São Paulo, SP, Brazil; Universidade de São Paulo (USP), Faculdade de Medicina, Departamento de Otorrinolaringologia, São Paulo, SP, Brazil.
| | - Fúlvia Eduarda da Silva
- Universidade de São Paulo (USP), Pós-graduação em Ciências da Reabilitação, São Paulo, SP, Brazil
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9
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Affiliation(s)
- Mariana Favero
- Sao Paulo Brazil; Sao Paulo Brazil; Sao Paulo Brazil; Sao Paulo Brazil
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Abstract
Juvenile nasopharyngeal angiofibroma involves a specific age group and changes from vascular tissue to fibrous tissue. The goal of this study was to investigate the correlation among tumor extension, the histologic characteristics of the tumor, and the patient's age. We performed a prospective study of 43 male patients with untreated juvenile nasopharyngeal angiofibroma (average age, 15.42 years). We correlated the patient's age with the extension of the tumor (analyzing the computed tomographic scan) and the immunohistologic characteristics of the tumor (morphological and morphometric analysis of the central portion of the tumor, the sphenopalatine foramen region). We observed that the larger the tumor, the smaller the number of vessels and cells, but the larger the fibrous component and the higher the grade of maturation of the tissue. The patient's age was not correlated with tumor extension or the histologic characteristics of the tumor. However, the grade of maturation of the tissue in the region of the sphenopalatine foramen was higher in larger tumors.
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Affiliation(s)
- Luiz Ubirajara Sennes
- Department of Otolaryngology, University of São Paulo Medical School, São Paulo, Brazil
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Sanchez TG, da Silva Lima A, Brandão AL, Lorenzi MC, Bento RF. Somatic Modulation of Tinnitus: Test Reliability and Results after Repetitive Muscle Contraction Training. Ann Otol Rhinol Laryngol 2016; 116:30-5. [PMID: 17305275 DOI: 10.1177/000348940711600106] [Citation(s) in RCA: 36] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Objectives: We sought to study the reliability of tinnitus modulation by muscle contractions and to observe the effect of their prolonged repetition. Methods: Thirty-eight patients with tinnitus underwent 9 maneuvers of muscle contractions in test and retest situations. After a 2-month training period of repeating the maneuvers, tinnitus modulation and daily perception were evaluated. Results: There was no difference between the occurrence of tinnitus modulation in test (57.9%) and retest (63.2%) situations. After 2 months, the occurrence of modulation during the maneuvers was similar (55.3%), but a new pattern showed an increase in tinnitus improvement and a decrease in tinnitus worsening. The daily perception of tinnitus was unchanged. Conclusions: Maneuvers of head and neck muscle contractions evoked tinnitus modulation in a frequent and reliable manner. Also, the repetition of such maneuvers for 2 months altered the pattern of modulation.
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Affiliation(s)
- Tanit Ganz Sanchez
- Department of Otolaryngology, University of São Paulo Medical School, São Paulo, Brazil
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Sanchez TG, Moraes F, Casseb J, Cota J, Freire K, Roberts LE. Tinnitus is associated with reduced sound level tolerance in adolescents with normal audiograms and otoacoustic emissions. Sci Rep 2016; 6:27109. [PMID: 27265722 PMCID: PMC4893619 DOI: 10.1038/srep27109] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2016] [Accepted: 05/12/2016] [Indexed: 12/26/2022] Open
Abstract
Recent neuroscience research suggests that tinnitus may reflect synaptic loss in the cochlea that does not express in the audiogram but leads to neural changes in auditory pathways that reduce sound level tolerance (SLT). Adolescents (N = 170) completed a questionnaire addressing their prior experience with tinnitus, potentially risky listening habits, and sensitivity to ordinary sounds, followed by psychoacoustic measurements in a sound booth. Among all adolescents 54.7% reported by questionnaire that they had previously experienced tinnitus, while 28.8% heard tinnitus in the booth. Psychoacoustic properties of tinnitus measured in the sound booth corresponded with those of chronic adult tinnitus sufferers. Neither hearing thresholds (≤15 dB HL to 16 kHz) nor otoacoustic emissions discriminated between adolescents reporting or not reporting tinnitus in the sound booth, but loudness discomfort levels (a psychoacoustic measure of SLT) did so, averaging 11.3 dB lower in adolescents experiencing tinnitus in the acoustic chamber. Although risky listening habits were near universal, the teenagers experiencing tinnitus and reduced SLT tended to be more protective of their hearing. Tinnitus and reduced SLT could be early indications of a vulnerability to hidden synaptic injury that is prevalent among adolescents and expressed following exposure to high level environmental sounds.
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Affiliation(s)
- Tanit Ganz Sanchez
- University of São Paulo School of Medicine, São Paulo, Brazil.,Instituto Ganz Sanchez, São Paulo, Brazil.,Association of Interdisciplinary Research and Divulgation of Tinnitus, São Paulo, Brazil
| | | | | | - Jaci Cota
- Instituto Ganz Sanchez, São Paulo, Brazil
| | - Katya Freire
- Association of Interdisciplinary Research and Divulgation of Tinnitus, São Paulo, Brazil
| | - Larry E Roberts
- Department of Psychology Neuroscience and Behaviour, McMaster University, Hamilton, Ontario, Canada
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Sanchez TG, Pereira IM. Management of hyperacusis in children - two case reports. Braz J Otorhinolaryngol 2016; 85:125-128. [PMID: 27133908 PMCID: PMC9442895 DOI: 10.1016/j.bjorl.2016.02.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2015] [Revised: 02/13/2016] [Accepted: 02/16/2016] [Indexed: 11/11/2022] Open
Affiliation(s)
- Tanit Ganz Sanchez
- Universidade de São Paulo (USP), Faculdade de Medicina, Departamento de Otorrinolaringologia, São Paulo, SP, Brazil; Instituto Ganz Sanchez, São Paulo, SP, Brazil.
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Medeiros LN, Sanchez TG. Tinnitus and cell phones: the role of electromagnetic radiofrequency radiation. Braz J Otorhinolaryngol 2016; 82:97-104. [PMID: 26602000 PMCID: PMC9444668 DOI: 10.1016/j.bjorl.2015.04.013] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2014] [Revised: 04/07/2015] [Accepted: 04/17/2015] [Indexed: 10/27/2022] Open
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Sanchez TG, Oliveira JC, Kii MA, Freire K, Cota J, Moraes FVD. Tinnitus in adolescents: the start of the vulnerability of the auditory pathways. Codas 2015; 27:5-12. [PMID: 25885191 DOI: 10.1590/2317-1782/20152013045] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2013] [Accepted: 09/25/2014] [Indexed: 11/21/2022] Open
Abstract
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.
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Affiliation(s)
| | | | | | - Katya Freire
- Associação de Pesquisa Interdisciplinar e Divulgação do Zumbido, São Paulo, SP, Brazil
| | - Jaci Cota
- Instituto Ganz Sanchez, São Paulo, SP, Brazil
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Rocha SCM, Kii MA, Pereira CB, Borelli DT, Forlenza O, Sanchez TG. Multidisciplinary assessment of patients with musical hallucinations, tinnitus and hearing loss. Psychopathology 2015; 48:251-5. [PMID: 26278558 DOI: 10.1159/000435891] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/23/2014] [Accepted: 06/10/2015] [Indexed: 11/19/2022]
Abstract
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.
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Abstract
Chronic pain in areas surrounding the ear may influence tinnitus. Objective To investigate the efficacy of myofascial trigger point deactivation for the relief of tinnitus. Method A double-blind randomized clinical trial enrolled 71 patients with tinnitus and myofascial pain syndrome. The experimental group (n = 37) underwent 10 sessions of myofascial trigger point deactivation and the control group (n = 34), 10 sessions with sham deactivation. Results Treatment of the experimental group was effective for tinnitus relief (p < 0.001). Pain and tinnitus relieves were associated (p = 0.013), so were the ear with worst tinnitus and the side of the body with more pain (p < 0.001). The presence of temporary tinnitus modulation (increase or decrease) upon initial muscle palpation was frequent in both groups, but its temporary decrease was related to the persistent relief at the end of treatment (p = 0.002). Conclusion Besides medical and audiological investigation, patients with tinnitus should also be checked for: 1) presence of myofascial pain surrounding the ear; 2) laterality between both symptoms; 3) initial decrease of tinnitus during muscle palpation. Treating this specific subgroup of tinnitus patients with myofascial trigger point release may provide better results than others described so far.
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Affiliation(s)
- Carina Bezerra Rocha
- Department of Otorhinolaryngology, Medical School of the University of São Paulo, Rua Mato Grosso no. 306, São Paulo, SP, Brazil
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Santos RMRD, Sanchez TG, Bento RF, Lucia MCSD. Auditory hallucinations in tinnitus patients: Emotional relationships and depression. Int Arch Otorhinolaryngol 2012; 16:322-7. [PMID: 25991952 PMCID: PMC4399702 DOI: 10.7162/s1809-97772012000300004] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2011] [Accepted: 01/09/2012] [Indexed: 11/04/2022] Open
Abstract
INTRODUCTION Over the last few years, our Tinnitus Research Group has identified an increasing number of patients with tinnitus who also complained of repeated perception of complex sounds, such as music and voices. Such hallucinatory phenomena motivated us to study their possible relation to the patients' psyches. AIMS To assess whether hallucinatory phenomena were related to the patients' psychosis and/or depression, and clarify their content and function in the patients' psyches. METHOD Ten subjects (8 women; mean age = 65.7 years) were selected by otolaryngologists and evaluated by the same psychologists through semi-structured interviews, the Hamilton Depression Rating Scale, and psychoanalysis interviews. RESULTS We found no association between auditory hallucinations and psychosis; instead, this phenomenon was associated with depressive aspects. The patients' discourse revealed that hallucinatory phenomena played unconscious roles in their emotional life. In all cases, there was a remarkable and strong tendency to recall/repeat unpleasant facts/situations, which tended to exacerbate the distress caused by the tinnitus and hallucinatory phenomena and worsen depressive aspects. CONCLUSIONS There is an important relationship between tinnitus, hallucinatory phenomena, and depression based on persistent recall of facts/situations leading to psychic distress. The knowledge of such findings represents a further step towards the need to adapt the treatment of this particular subgroup of tinnitus patients through interdisciplinary teamwork. Prospective.
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Sanchez TG, Rocha SCM, Knobel KAB, Kii MA, Santos RMRD, Pereira CB. Musical hallucination associated with hearing loss. Arq Neuropsiquiatr 2011; 69:395-400. [PMID: 21625772 DOI: 10.1590/s0004-282x2011000300024] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/01/2010] [Accepted: 12/06/2010] [Indexed: 11/22/2022]
Abstract
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.
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Affiliation(s)
- Tanit Ganz Sanchez
- Tinnitus Research Group, Medical School, São Paulo University, São Paulo, SP, Brazil.
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Hall DA, Láinez MJA, Newman CW, Sanchez TG, Egler M, Tennigkeit F, Koch M, Langguth B. Treatment options for subjective tinnitus: self reports from a sample of general practitioners and ENT physicians within Europe and the USA. BMC Health Serv Res 2011; 11:302. [PMID: 22053947 PMCID: PMC3227628 DOI: 10.1186/1472-6963-11-302] [Citation(s) in RCA: 77] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2011] [Accepted: 11/04/2011] [Indexed: 11/17/2022] Open
Abstract
Background Tinnitus affects about 10-15% of the general population and risks for developing tinnitus are rising through increased exposure to leisure noise through listening to personal music players at high volume. The disorder has a considerable heterogeneity and so no single mechanism is likely to explain the presence of tinnitus in all those affected. As such there is no standardized management pathway nor singly effective treatment for the condition. Choice of clinical intervention is a multi-factorial decision based on many factors, including assessment of patient needs and the healthcare context. The present research surveyed clinicians working in six Westernized countries with the aims: a) to establish the range of referral pathways, b) to evaluate the typical treatment options for categories of subjective tinnitus defined as acute or chronic, and c) to seek clinical opinion about levels of satisfaction with current standards of practice. Methods A structured online questionnaire was conducted with 712 physicians who reported seeing at least one tinnitus patients in the previous three months. They were 370 general practitioners (GPs) and 365 ear-nose-throat specialists (ENTs) from the US, Germany, UK, France, Italy and Spain. Results Our international comparison of health systems for tinnitus revealed that although the characteristics of tinnitus appeared broadly similar across countries, the patient's experience of clinical services differed widely. GPs and ENTs were always involved in referral and management to some degree, but multi-disciplinary teams engaged either neurology (Germany, Italy and Spain) or audiology (UK and US) professionals. For acute subjective tinnitus, pharmacological prescriptions were common, while audiological and psychological approaches were more typical for chronic subjective tinnitus; with several specific treatment options being highly country specific. All therapy options were associated with low levels of satisfaction. Conclusions Despite a large variety of treatment options, the low success rates of tinnitus therapy lead to frustration of physicians and patients alike. For subjective tinnitus in particular, effective therapeutic options with guidelines about key diagnostic criteria are urgently needed.
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Affiliation(s)
- Deborah A Hall
- NIHR National Biomedical Research Unit in Hearing, Nottingham, UK.
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Abstract
Tinnitus is the perception of sound in the absence of an acoustic external stimulus. It affects 10-17% of the world's population and it a complex symptom with multiple causes, which is influenced by pathways other than the auditory one. Recently, it has been observed that tinnitus may be provoked or modulated by stimulation arising from the somatosensorial system, as well as from the somatomotor and visual-motor systems. This specific subgroup -somatosensory tinnitus - is present in 65% of cases, even though it tends to be underdiagnosed. As a consequence, it is necessary to establish evaluation protocols and specific treatments focusing on both the auditory pathway and the musculoskeletal system.
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Affiliation(s)
- Tanit Ganz Sanchez
- Department of Otolaryngology, Faculdade de Medicina, Universidade de São Paulo, São Paulo, SP, Brazil.
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Sanches SGG, Samelli AG, Nishiyama AK, Sanchez TG, Carvallo RMM. Teste GIN (Gaps-in-Noise) em ouvintes normais com e sem zumbido. ACTA ACUST UNITED AC 2010; 22:257-62. [DOI: 10.1590/s0104-56872010000300017] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2009] [Accepted: 08/18/2010] [Indexed: 11/22/2022]
Abstract
TEMA: o teste Gaps-in-Noise (GIN) avalia a habilidade auditiva de resolução temporal. Estudos têm mostrado o teste GIN como um instrumento de fácil aplicação, com boa sensibilidade e especificidade. OBJETIVO: comparar os resultados do teste GIN em ouvintes normais com e sem zumbido e fazer a correlação entre os resultados deste, os limiares tonais e idade. MÉTODO: foram avaliados 44 adultos (limiares tonais 25 dBNA nas freqüências de 0,25 a 8 kHz), formando 2 grupos: Grupo Controle composto por 23 sujeitos, 8 homens e 15 mulheres, sem queixa de zumbido, idade entre 22 e 40 anos (média 29,7); Grupo Pesquisa formado por 18 indivíduos, 3 homens e 15 mulheres, com queixa de zumbido, idade entre 21 e 45 anos (média 31,3). Os sujeitos foram submetidos à audiometria tonal e vocal, imitanciometria e ao teste GIN. Para a análise estatística foi adotado nível de significância de 0.05. RESULTADOS: na audiometria tonal, a média global dos limiares tonais foi mais elevada para o Grupo Pesquisa, comparado ao Grupo Controle (p = 0,001). A comparação do desempenho no teste GIN mostrou que o Grupo Controle detectou intervalos de silêncio em média com intervalo de tempo menor que o Grupo Pesquisa (p < 0,001). Não houve correlação entre a idade dos sujeitos e o limiar do GIN. CONCLUSÃO: o teste GIN identificou prejuízo na habilidade auditiva de resolução temporal nos indivíduos com zumbido. Na faixa etária pesquisada (entre 21 e 45 anos) não houve correlação entre a idade e os resultados do teste GIN.
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Abstract
Tinnitus is a symptom present in approximately 15% of the world population. Most patients are between 40 and 80 years of age; the prevalence above 60 reaches 33%. About 20% have moderate to severe impact in the quality of life but the factors associated with the tinnitus annoyance are not completely known. Aim The objective of this study is to evaluate the relationship between age, gender and hearing loss on tinnitus annoyance. Materials and methods 68 patients were evaluated at the tinnitus center at our hospital, from March 2007 to march 2008, with a detailed interview, complete otolaryngological examination, the Portuguese version of the Tinnitus Handicap Inventory and pure tone audiometry. Results Age varied from 24 to 83 (mean=59); the mean THI value was 39 (females: 36; males: 44). THI grades were: slight: 32.3%; mild: 19.1%; moderate: 20.6%; severe: 13.2% and catastrophic: 14.7%. No significant correlation was found between gender (p=0.30), age (p=0.77) hearing loss (p>0.05 for all averages analyzed) and tinnitus severity. Conclusion Gender, age and hearing loss do not influence tinnitus annoyance, using the THI.
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Sanches SGG, Sanchez TG, Carvallo RMM. Influence of Cochlear Function on Auditory Temporal Resolution in Tinnitus Patients. ACTA ACUST UNITED AC 2010; 15:273-81. [DOI: 10.1159/000272939] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2008] [Accepted: 09/16/2009] [Indexed: 11/19/2022]
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Marcondes RA, Sanchez TG, Kii MA, Ono CR, Buchpiguel CA, Langguth B, Marcolin MA. Repetitive transcranial magnetic stimulation improve tinnitus in normal hearing patients: a double-blind controlled, clinical and neuroimaging outcome study. Eur J Neurol 2009; 17:38-44. [PMID: 19614962 DOI: 10.1111/j.1468-1331.2009.02730.x] [Citation(s) in RCA: 87] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
BACKGROUND AND PURPOSE Tinnitus is a frequent disorder which is very difficult to treat and there is compelling evidence that tinnitus is associated with functional alterations in the central nervous system. Targeted modulation of tinnitus-related cortical activity has been proposed as a promising new treatment approach. We aimed to investigate both immediate and long-term effects of low frequency (1 Hz) repetitive transcranial magnetic stimulation (rTMS) in patients with tinnitus and normal hearing. METHODS Using a parallel design, 20 patients were randomized to receive either active or placebo stimulation over the left temporoparietal cortex for five consecutive days. Treatment results were assessed by using the Tinnitus Handicap Inventory. Ethyl cysteinate dimmer-single photon emission computed tomography (SPECT) imaging was performed before and 14 days after rTMS. RESULTS After active rTMS there was significant improvement of the tinnitus score as compared to sham rTMS for up to 6 months after stimulation. SPECT measurements demonstrated a reduction of metabolic activity in the inferior left temporal lobe after active rTMS. CONCLUSION These results support the potential of rTMS as a new therapeutic tool for the treatment of chronic tinnitus, by demonstrating a significant reduction of tinnitus complaints over a period of at least 6 months and significant reduction of neural activity in the inferior temporal cortex, despite the stimulation applied on the superior temporal cortex.
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Affiliation(s)
- R A Marcondes
- Department of Otolaryngology, University of São Paulo School of Medicine, São Paulo, Brazil
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Abstract
INTRODUCTION Several investigations have shown that the occurrence of auditory hallucinations (AH) is not restricted to neuropsychiatric patients. The aim of this study is to analyse the effect of attention and sustained silence on the emergence of AH in a nonclinical sample. METHODS Sitting in a silent sound booth, 66 adults were studied under different attention demands and then where asked about their auditory perception. RESULTS While performing a Hanoi Tower in silence, 10.6% of the individuals had hallucination-like perceptions (music, voices, and others). This rate decreased to 6.0% during a visual attention task, but highly increased to 36.4% during auditory attention. CONCLUSIONS Auditory hallucinations may occur in a nonclinical population in a silent environment. Concomitant auditory attention increases both the quantity and the quality of those perceptions.
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Knobel KAB, Sanchez TG. Influence of silence and attention on tinnitus perception. Otolaryngol Head Neck Surg 2008; 138:18-22. [DOI: 10.1016/j.otohns.2007.09.023] [Citation(s) in RCA: 37] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2007] [Revised: 09/10/2007] [Accepted: 09/26/2007] [Indexed: 11/17/2022]
Abstract
Objective The purpose of this study was to study the effect of attention and sustained silence on the emergence of auditory phantom perception in normal-hearing adults. Study Design Cross-sectional survey. Subjects and Methods While sitting in a sound booth, 66 volunteers (age range, 18–65; mean age, 37.3) performed 3 experiments of 5 minutes each, consecutively and randomly presented. Two deviated attention from auditory system (Hanoi and visual attention experiments), and 1 drove attention to the auditory system (auditory attention). After each experiment, participants were asked about their auditory and visual perception. No sound or light change was given at any moment. Results Of the participants, 19.7% experienced tinnitus during Hanoi, 45.5% during visual attention, and 68.2% during auditory attention experiment, with no significant differences for studied variables. Conclusion Tinnitus-like perceptions may occur in a non-clinical population in a silent environment. Concomitant auditory attention plays an important role on the emergence of tinnitus.
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Affiliation(s)
- Keila Alessandra Baraldi Knobel
- ENT Department, University of São Paulo Medical School. Presented at The American Academy of Audiology, Denver, CO, April 18–21, 2007, São Paulo, Brazil
| | - Tanit Ganz Sanchez
- ENT Department, University of São Paulo Medical School. Presented at The American Academy of Audiology, Denver, CO, April 18–21, 2007, São Paulo, Brazil
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Bezerra Rocha CAC, Sanchez TG, Tesseroli de Siqueira JT. Myofascial trigger point:a possible way of modulating tinnitus. Audiol Neurootol 2007; 13:153-60. [PMID: 18075244 DOI: 10.1159/000112423] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2006] [Accepted: 08/22/2007] [Indexed: 11/19/2022] Open
Abstract
In order to investigate whether myofascial trigger points can modulate tinnitus, as well as the association between tinnitus and myofascial trigger points, 94 individuals with and 94 without tinnitus, matched by age and gender, were analyzed by means of bilateral digital pressure of 9 muscles. Temporary modulation of tinnitus was frequently observed (55.9%) during digital pressure, mainly in the masseter. The rate of tinnitus modulation was significantly higher on the same side of the myofascial trigger point subject to examination in 6 out of 9 muscles. An association between tinnitus and the presence of myofascial trigger points was observed (p < 0.001), as well as a laterality association between the ear with the worst tinnitus and the side of the body with more myofascial trigger points (p < 0.001). Thus, this relationship could be explained not only by somatosensory-auditory system interactions but also by the influence of the sympathetic system.
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Knobel KB, Sanchez TG. R086: Attention and Silence Elicit Phantom Auditory Perceptions. Otolaryngol Head Neck Surg 2007. [DOI: 10.1016/j.otohns.2007.06.421] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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Lima ADS, Sanchez TG, Moraes MFB, Alves SCB, Bento RF. Efeito da timpanoplastia no zumbido de pacientes com hipoacusia condutiva: seguimento de seis meses. ACTA ACUST UNITED AC 2007. [DOI: 10.1590/s0034-72992007000300014] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
O timpanoplastia tem como objetivos erradicar a doença da orelha média e restaurar os mecanismos de condução sonora. Contudo, alguns pacientes apresentam incômodo com o zumbido e muitas vezes questionam o médico sobre os resultados da cirurgia em relação ao zumbido. OBJETIVO: Avaliar a evolução do zumbido em pacientes com hipoacusia condutiva após timpanoplastia. Forma de Estudo: Coorte prospectiva. CASUÍSTICA E MÉTODO: Foram avaliados 23 pacientes com queixa de zumbido e diagnóstico de otite média crônica simples com indicação cirúrgica. Os pacientes foram submetidos a um protocolo de investigação médica e audiológica do zumbido antes, 30 e 180 dias após a timpanoplastia. RESULTADOS: 82,6% dos pacientes apresentaram melhora ou abolição do zumbido. Melhora significante do incômodo do zumbido no pré-operatório (5,26) em relação ao pós-operatório (1,91 com 30 e 180 dias), assim como entre o incômodo da perda auditiva pré-operatória (6,56) e pós-operatória (3,65 e 2,91). A audiometria revelou melhora do limiar tonal em todas as freqüências, com exceção de 8KHz, havendo fechamento ou gap máximo de 10dB NA em 61% dos casos. Pega total do enxerto em 78% dos casos. CONCLUSÃO: Além da melhora da perda auditiva, a timpanoplastia também proporciona bons resultados sobre o controle do zumbido.
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Munhoes dos Santos Ferrari G, Sanchez TG, Bovino Pedalini ME. The efficacy of open molds in controlling tinnitus. Braz J Otorhinolaryngol 2007; 73:370-7. [PMID: 17684658 PMCID: PMC9445727 DOI: 10.1016/s1808-8694(15)30081-1] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2006] [Accepted: 06/15/2006] [Indexed: 11/22/2022] Open
Abstract
Hearing aids may be a option to improve tinnitus and hearing loss. Aim: to evaluate tinnitus after one month use of BTE hearing aids with open molds and pressure vent molds in patients with symmetric sensorineural hearing loss. Methods: 50 patients seen at our Tinnitus Clinic who presented bilateral tinnitus and hearing loss underwent a randomized blind crossover clinical trial: 26 first used BTE hearing aids with open molds, and the remaining 24 first used pressure vent molds. After 30 days using the first mold and a wash-out period, the type of earmold was changed and was applied for another 30-day-period. Tinnitus evaluation was done qualitatively (improved, unchanged and worsened) and quantitatively (variation on a numeric scale from 0 to 10). Results: 82% of the cases reported improvement of tinnitus with at least one type of earmold; there was no significant difference in the reduction of discomfort due to tinnitus in the quantitative and qualitative evaluations. Although similar tinnitus control was obtained with both methods, 66% of the patients preferred the open mold. Conclusion: In a short-term evaluation improvement of tinnitus by the use of hearing aids does not depend on earmold ventilation.
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Lima ADS, Sanchez TG, Bonadia Moraes MF, Batezati Alves SC, Bento RF. The effect of timpanoplasty on tinnitus in patients with conductive hearing loss: a six month follow-up. Braz J Otorhinolaryngol 2007; 73:384-9. [PMID: 17684660 PMCID: PMC9445756 DOI: 10.1016/s1808-8694(15)30083-5] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2006] [Accepted: 03/13/2007] [Indexed: 11/22/2022] Open
Abstract
UNLABELLED Tympanoplasty is done to eradicate ear pathology and to restore the conductive hearing mechanism (eardrum and ossicles). Some patients, however, do not tolerate tinnitus and question physicians about the results of surgery when tinnitus persists. AIM to evaluate the progression of tinnitus in patients with conductive hearing loss after tympanoplasty. STUDY DESIGN a prospective cohort study. MATERIAL AND METHODS 23 consecutive patients with tinnitus due to chronic otitis media underwent tympanoplasty. The patients underwent a medical and audiological protocol for tinnitus before and after tympanoplasty. RESULTS 82.6% of patients had improvement or elimination of tinnitus after tympanoplasty The mean score of postoperative intolerance to tinnitus (1.91 for 30 and 180 days) was significantly different from preoperative scores (5.26). As to hearing loss, patients improved medically 30 and 180 days after surgery (3.65 and 2.91) compared to the preoperative condition (6.56). Audiometry revealed improvement at all frequencies from 0.25 to 6KHz, except at 8KHz. The air-bone gap was closed or was within 10dB in 14 cases (61%). An intact tympanic membrane was achieved in 78% of the cases. CONCLUSION Aside from the classical improvement of hearing loss, tympanoplasty also offers good control of tinnitus.
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Rocha CAB, Sanchez TG. Myofascial trigger points: another way of modulating tinnitus. Tinnitus: Pathophysiology and Treatment 2007; 166:209-14. [DOI: 10.1016/s0079-6123(07)66018-x] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/16/2023]
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Coelho CB, Sanchez TG, Tyler RS. Hyperacusis, sound annoyance, and loudness hypersensitivity in children. Tinnitus: Pathophysiology and Treatment 2007; 166:169-78. [DOI: 10.1016/s0079-6123(07)66015-4] [Citation(s) in RCA: 53] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/03/2022]
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Coelho CB, Sanchez TG, Tyler RS. Tinnitus in children and associated risk factors. Tinnitus: Pathophysiology and Treatment 2007; 166:179-91. [DOI: 10.1016/s0079-6123(07)66016-6] [Citation(s) in RCA: 59] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
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Fregni F, Marcondes R, Boggio PS, Marcolin MA, Rigonatti SP, Sanchez TG, Nitsche MA, Pascual-Leone A. Transient tinnitus suppression induced by repetitive transcranial magnetic stimulation and transcranial direct current stimulation. Eur J Neurol 2006; 13:996-1001. [PMID: 16930367 DOI: 10.1111/j.1468-1331.2006.01414.x] [Citation(s) in RCA: 147] [Impact Index Per Article: 8.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
Modulation of activity in the left temporoparietal area (LTA) by 10 Hz repetitive transcranial magnetic stimulation (rTMS) results in a transient reduction of tinnitus. We aimed to replicate these results and test whether transcranial direct current stimulation (tDCS) of LTA could yield similar effect. Patients with tinnitus underwent six different types of stimulation in a random order: 10-Hz rTMS of LTA, 10-Hz rTMS of mesial parietal cortex, sham rTMS, anodal tDCS of LTA, cathodal tDCS of LTA and sham tDCS. A non-parametric analysis of variance showed a significant main effect of type of stimulation (P = 0.002) and post hoc tests showed that 10-Hz rTMS and anodal tDCS of LTA resulted in a significant reduction of tinnitus. These effects were short lasting. These results replicate the findings of the previous study and, in addition, show preliminary evidence that anodal tDCS of LTA induces a similar transient tinnitus reduction as high-frequency rTMS.
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Affiliation(s)
- F Fregni
- Harvard Center for Noninvasive Brain Stimulation, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA.
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Chien HF, Sanchez TG, Sennes LU, Barbosa ER. Endonasal approach of salpingopharyngeus muscle for the treatment of ear click related to palatal tremor. Parkinsonism Relat Disord 2006; 13:254-6. [PMID: 16828572 DOI: 10.1016/j.parkreldis.2006.05.004] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/26/2006] [Revised: 05/02/2006] [Accepted: 05/03/2006] [Indexed: 10/24/2022]
Abstract
Palatal tremor (PT) is a rare disease associated with rhythmic movements of the soft palate. It can be separated into two distinct clinical entities: symptomatic and essential. Most patients with essential PT complain of the rhythmic ear clicks and in some cases tinnitus, but usually have an uneventful medical history. Symptomatic PT patients are often unaware of the palatal movements and have symptoms and signs of brainstem or cerebellar dysfunction. We describe the case of a 25-year-old patient who developed severe essential PT, with very distressing bilateral objective tinnitus, constantly perceived as ear clicks. Several oral medications were prescribed with poor results. No significant improvement was obtained with repetitive injections of botulinum toxin type A (BTX A) distributed in soft palate muscles. Because of the continuous tinnitus and its impact on the patient's quality of life, chemical denervation of the salpingopharyngeus muscles, which is involved in the production of tinnitus, with BTX A was performed endonasally under endoscopic guidance. The result was very satisfactory. Tinnitus due to essential PT may be satisfactorily treated by endonasal injection of BTX into the salpingopharyngeus and palatopharyngeus muscles.
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Affiliation(s)
- Hsin Fen Chien
- Movement Disorders Clinic, Department of Neurology, University of São Paulo Medical School, São Paulo, Brazil.
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Fávero ML, Sanchez TG, Bento RF, Nascimento AF. Contralateral suppression of otoacoustic emission in patients with tinnitus. Braz J Otorhinolaryngol 2006; 72:223-6. [PMID: 16951856 PMCID: PMC9445734 DOI: 10.1016/s1808-8694(15)30059-8] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2005] [Accepted: 02/20/2006] [Indexed: 11/23/2022] Open
Abstract
Introduction: The medial olivocochlear bundle effect is studied through the suppression of otoacoustic emissions and seems to be influenced by the laterality of the central nervous system, presenting no symmetry between right and left ear. A dysfunction of this bundle may be involved in the generation of tinnitus, although this fact was not confirmed. Objectives: Study the suppression of distortion product otoacoustic emissions in tinnitus patients. Material and Method: A case-controlled study involving 44 tinnitus patients from the Tinnitus Group of the ENT Department of the University of São Paulo Medical School and 44 controls who underwent distortion product otoacoustic emissions testing with and without contralateral noise. Only the results from the right ears from both groups were compared. Results: There was a relationship between the presence of tinnitus and the absence of suppression at all frequencies studied (OR>2.1). Conclusion: There was a correlation between diminished effectiveness of the medial olivocochlear bundle and the presence of tinnitus.
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Murao MS, Bento RF, Sanchez TG, Ribas GC. Transient evoked otoacoustic emissions after vestibular nerve section in chinchillas. Hear Res 2006; 213:43-8. [PMID: 16497453 DOI: 10.1016/j.heares.2005.12.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/23/2005] [Accepted: 12/15/2005] [Indexed: 10/25/2022]
Abstract
Transient evoked otoacoustic emissions are believed to be sensitive to the effects of the cochlear efferent system. The most well-known function of this system is inhibitory on cochlear response. It has been demonstrated that crossed medial efferent system section produces inhibitory control of the outer hair cells mechanisms responsible for non-linear transient evoked otoacoustic emissions generation. However, we suppose that the uncrossed medial efferent system plays a role in outer hair cell function too. We recorded the non-linear part of transient evoked otoacoustic emissions in 17 chinchillas before and after section of the vestibular nerve (crossed and uncrossed fibers). Responses at frequencies bands centered on 0.8, 1.6, 2.4, 3.2 and 4.0 kHz, as well as total emission responses, were analyzed. After vestibular nerve section, there were significant increases in the amplitudes of the 2.4- and 4.0 kHz responses and of the total response. These results indicate that the medial efferent system is important to maintain normal cochlear mechanics. Uncrossed medial efferent system and lateral efferent system seem to be not important in maintaining normal cochlear mechanics.
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Affiliation(s)
- Marcia Sayuri Murao
- Otorhinolaryngology Science Laboratory, University of Sao Paulo School of Medicine, Av. Dr. Arnaldo, 455, LIM 32, CEP 01246-903, Sao Paulo, SP, Brazil.
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Abstract
TEMA: o Loudness Discomfort Level (LDL), teste muito utilizado na adaptação de próteses auditivas, teve sua indicação ampliada e passou a ser recomendado para complementar a avaliação de pacientes com zumbido e/ou com suspeita de hiperacusia. OBJETIVO: determinar valores de referência do LDL para normo-ouvintes e sua correlação com o Limiar do Reflexo Acústico (LRA). MÉTODO: o LDL foi aplicado em 64 sujeitos normo-ouvintes de 18 a 25 anos (53,1% do sexo feminino) nas freqüências de 0,5 a 8KHz e para sons da fala encadeada espontânea a viva-voz. Os tons puros pulsáteis foram apresentados por dois segundos, com intervalo de um segundo entre cada apresentação, a partir de 50dB de modo ascendente em passos de 5dB até que o sujeito referisse desconforto inicial com a sensação de intensidade. O procedimento foi realizado nas duas orelhas separadamente e repetido imediatamente (situações de teste e reteste), com alternância da orelha inicial a cada sujeito. O reflexo contralateral foi obtido em seguida. Foi considerado LRA a menor intensidade sonora capaz de provocar uma deflexão visível na agulha do imitanciômetro (maior que 0,05ml). RESULTADOS: a mediana do LDL variou de 86 a 98dBNA, sem diferenças estatisticamente significativas entre homens e mulheres (p > 0,11), entre orelhas (p > 0,36) ou entre as situações de teste e reteste (p > 0,34). Os coeficientes de determinação (r²) do modelo de regressão linear mostraram ausência de correlação entre log(LDL) e log(LRA). CONCLUSÃO: normo-ouvintes apresentam LDL de 86 a 98dBNA para todos os estímulos apresentados. Diferenças inter-sujeitos e boa reprodutibilidade sugerem que a interpretação do teste deve ser cuidadosa e aliada à anamnese e que o teste pode ser útil no acompanhamento de pacientes. Não houve correlação entre LDL e LRA.
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Abstract
Pacientes com zumbido e audiometria normal constituem um grupo importante, pois seus achados não sofrem influência da perda auditiva. Apesar disso, este grupo é pouco estudado e não sabemos se suas características clínicas e repercussões são semelhantes às dos indivíduos com perda auditiva. OBJETIVOS: Comparar as características clínicas do zumbido e sua interferência nas atividades diárias em pacientes com e sem perda auditiva. FORMA DE ESTUDO: coorte histórica. MATERIAL E MÉTODO: Entre 744 pacientes atendidos no Grupo de Pesquisa em Zumbido do HCFMUSP, avaliou-se retrospectivamente com um corte transversal os 55 indivíduos com audiometria tonal normal. O grupo controle correspondeu a 198 pacientes com zumbido e perda auditiva atendidos sob o mesmo protocolo. Analisou-se os dados dos pacientes, as características clínicas do zumbido e sua repercussão na vida do paciente. RESULTADOS: A idade média no grupo de estudo (43,1 ± 13,4 anos) foi significantemente menor do que a do grupo controle (49,9 ± 14,5 anos). Em ambos os grupos houve predomínio do sexo feminino e o zumbido foi predominantemente bilateral, único e constante, porém sem diferença entre os grupos. A interferência na concentração e no equilíbrio emocional foi significantemente menor no grupo de estudo (25,5% e 36,4%) do que no controle (46% e 61,6%), porém sem diferença quanto à interferência no sono e na atividade social. CONCLUSÕES: O grupo de pacientes com zumbido e audição normal apresentou características clínicas semelhantes em relação ao grupo com perda auditiva. Entretanto, a faixa etária acometida e a interferência sobre a concentração e o equilíbrio emocional foram significantemente menores nestes.
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Lima ADS, Sanchez TG, Marcondes R, Bento RF. The effect of stapedotomy on tinnitus in patients with otospongiosis. Ear Nose Throat J 2005; 84:412-4. [PMID: 16813029] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/10/2023] Open
Abstract
Stapedotomy is primarily performed to treat hearing loss secondary to otospongiosis, although some patients find that the accompanying tinnitus is more bothersome than the hearing loss. We prospectively studied 23 consecutive patients with tinnitus secondary to otospongiosis who had undergone stapedotomy, and we compared their pre- and postoperative medical and audiologic findings. Patients' annoyance with their tinnitus was quantified by means of a visual analog scale, and their air-conduction thresholds were determined by measurements of a 4-frequency pure-tone average (0.5, 1, 2, and 4 kHz). Statistical analysis was performed using the paired Student's t test and Fisher's exact test. In the group as a whole, the mean tinnitus annoyance visual analog scores were 8.34 preoperatively and 1.56 postoperatively, a highly significant difference. Clinically, 22 of the 23 patients (95.7%) achieved satisfactory control of their tinnitus (improvement or complete resolution) following stapedotomy. With respect to hearing loss, all patients clinically improved postoperatively, and audiometry confirmed improvement at all 4 frequencies between 0.5 and 4 kHz. An air-bone gap of less than 10 dB was noted in 17 patients (73.9%). We conclude that in addition to improving hearing, stapedotomy also provides good control of tinnitus.
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Abstract
Patients with tinnitus and normal hearing constitute an important group, given that findings do not suffer influence of the hearing loss. However, this group is rarely studied, so we do not know whether its clinical characteristics and interference in daily life are the same of those of the patients with tinnitus and hearing loss. Aim: To compare tinnitus characteristics and interference in daily life among patients with and without hearing loss. Study design: historic cohort. Material and Method: Among 744 tinnitus patients seen at a Tinnitus Clinic, 55 with normal audiometry were retrospectively evaluated. The control group consisted of 198 patients with tinnitus and hearing loss, following the same protocol. We analyzed the patients’ data as well as the tinnitus characteristics and interference in daily life. Results: The mean age of the studied group (43.1 ± 13.4 years) was significantly lower than that of the control group (49.9 ± 14.5 years). In both groups, tinnitus was predominant in women, bilateral, single tone and constant, but there were no differences between both groups. The interference in concentration and emotional status (25.5% and 36.4%) was significantly lower in the studied group than that of the control group (46% and 61.6%), but it did not happen in regard to interference over sleep and social life. Conclusions: Patients with tinnitus and normal hearing showed similar characteristics when compared to those with hearing loss. However, the age of the patients and the interference over concentration and emotional status were significantly lower in this group.
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Abstract
Stapedotomy is primarily performed to treat hearing loss secondary to otospongiosis, although some patients find that the accompanying tinnitus is more bothersome than the hearing loss. We prospectively studied 23 consecutive patients with tinnitus secondary to otospongiosis who had undergone stapedotomy, and we compared their pre- and postoperative medical and audiologic findings. Patients annoyance with their tinnitus was quantified by means of a visual analog scale, and their air-conduction thresholds were determined by measurements of a 4-frequency pure-tone average (0.5, 1, 2, and 4 kHz). Statistical analysis was performed using the paired Student's t test and Fisher's exact test. In the group as a whole, the mean tinnitus annoyance visual analog scores were 8.34 preoperatively and 1.56 postoperatively, a highly significant difference. Clinically, 22 of the 23 patients (95.7%) achieved satisfactory control of their tinnitus (improvement or complete resolution) following stapedotomy. With respect to hearing loss, all patients clinically improved postoperatively, and audiometry confirmed improvement at all 4 frequencies between 0.5 and 4 kHz. An air-bone gap of less than 10 dB was noted in 17 patients (73.9%). We conclude that in addition to improving hearing, stapedotomy also provides good control of tinnitus.
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Affiliation(s)
- Adriana da Silva Lima
- Department of Otorhinolaryngology, University Hospital, University of São Paulo Medical School
| | - Tanit Ganz Sanchez
- Department of Otorhinolaryngology, University Hospital, University of São Paulo Medical School
| | - Renata Marcondes
- Department of Otorhinolaryngology, University Hospital, University of São Paulo Medical School
| | - Ricardo Ferreira Bento
- Department of Otorhinolaryngology, University Hospital, University of São Paulo Medical School
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Murao MS, Sanchez TG, Bento RF. An Approach to the Vestibular Nerve in Chinchillas. Otolaryngol Head Neck Surg 2004. [DOI: 10.1016/j.otohns.2004.06.275] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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Murao MS, Sanchez TG, Bento RF. Transient Evoked Otoacoustic Emissions after Vestibular Nerve Section in Chinchillas. Otolaryngol Head Neck Surg 2004. [DOI: 10.1016/j.otohns.2004.06.276] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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Sennes LU, Butugan O, Sanchez TG, Bernardi FDC, Nascimento PHS. P072: Juvenile Nasopharyngeal Angiofibroma: Tissue Maturation during Its Growth. Otolaryngol Head Neck Surg 2003. [DOI: 10.1016/s0194-59980300930-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
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Lima AS, Sanchez TG, Marcondes R, Bento RF. P041: Tinnitus Evolution after Stapedotomy. Otolaryngol Head Neck Surg 2003. [DOI: 10.1016/s0194-59980300836-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
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