INTRODUÇÃO: O zumbido é um sintoma muito freqüente e de difícil tratamento. Atualmente, algumas evidências mostraram que o zumbido está associado a alterações funcionais do sistema nervoso central. Nos últimos anos, a modulação da atividade cortical relacionada ao zumbido por meio da estimulação magnética transcraniana repetitiva (EMT) tem sido proposta como um tratamento promissor. Entretanto, nenhum estudo avaliou sua eficácia no controle do zumbido em pacientes sem perda auditiva concomitante, nem seu efeito de longa duração. O objetivo do trabalho foi investigar os efeitos imediatos e a longo prazo da estimulação magnética transcraniana repetitiva de baixa freqüência (1 Hz) em pacientes com zumbido e audiometria normal. MÉTODOS: Utilizando um ensaio clínico aleatorizado, duplo cego e paralelo, foram randomizados 20 pacientes para receber a EMT ativa ou placebo. A estimulação foi aplicada no córtex têmporo-parietal esquerdo por cinco dias consecutivos. A avaliação clínica foi feita por meio do Tinnitus Handicap Inventory e da escala análogo-visual. A avaliação por neuroimagem foi feita por meio do SPECT, o qual foi realizado antes e 14 dias após o período de estimulação. RESULTADOS: Clinicamente, o grupo submetido à estimulação magnética transcraniana ativa apresentou uma melhora significativa do zumbido, mantida por até seis meses, quando comparado ao grupo que recebeu a estimulação placebo. A avaliação por SPECT demonstrou redução do fluxo sanguíneo no lobo temporal esquerdo após o período de estimulação ativa. CONCLUSÃO: Os resultados revelam o potencial terapêutico da estimulação magnética transcraniana como nova ferramenta no tratamento do zumbido, proporcionando redução significativa do incômodo provocado pelo zumbido por até seis meses e reduzindo a atividade neuronal no córtex temporal. / INTRODUCTION: Tinnitus is a frequent disorder which is very difficult to treat. There is compelling evidence that tinnitus is associated with functional alterations in the central nervous system. Recently, the targeted modulation of tinnitus-related cortical activity through repetitive transcranial magnetic stimulation (rTMS) has been proposed as a promising new treatment approach. However, its efficacy in patients without hearing loss has never been studied, as well as the long-term duration of its effect. The objective of this study was to investigate both immediate and long-term effect of low frequency (1 Hz) rTMS in patients with tinnitus and normal hearing. METHODS: Using a randomized double-blind and parallel clinical trial, 20 patients were divided to receive either active or placebo transcranial magnetic stimulation over the left temporoparietal cortex for 5 consecutive days. The clinical evaluation was performed by using the Tinnitus Handicap Inventory and the visual analogue scale. The neuroimage evaluation included and ECD-SPECT imaging, which was performed before and 14 days after rTMS. RESULTS: From the clinical point of view, the group submitted to active rTMS presented significant improvement of the tinnitus score, which was sustained up to six months, when compared to the group that received the sham rTMS. SPECT measurements demonstrated a reduction of metabolic activity in the 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 six months and a significant reduction of neural activity in the temporal cortex.

Submitted by Reginaldo Soares de Freitas (reginaldo.freitas@ufv.br) on 2017-03-27T18:09:52Z No. of bitstreams: 1 texto completo.pdf: 1734929 bytes, checksum: aae34331a26c2426816ff88848309bd7 (MD5) / Made available in DSpace on 2017-03-27T18:09:52Z (GMT). No. of bitstreams: 1 texto completo.pdf: 1734929 bytes, checksum: aae34331a26c2426816ff88848309bd7 (MD5) Previous issue date: 2016-12-06 / A exposição ao ruído ocupacional pode trazer consequências como perda auditiva e, ou, zumbido, além de prejuízos não auditivos como esforço e fadiga para realizar tarefas que impliquem a discriminação auditiva, o estresse, a ansiedade, o isolamento e a autoimagem negativa em relação à deteriorização auditiva. Isso por considerar que a audição é o canal sensorial mais importante, quando se pensa na comunicação por linguagem oral. Este estudo objetivou analisar as consequências da perda auditiva e, ou, zumbido na qualidade de vida (QV) do indivíduo em relação ao trabalho, bem como no meio social. Especificamente, pretenderam-se caracterizar sociodemograficamente os indivíduos e seu perfil audiológico; e avaliar as implicações da perda auditiva e do zumbido na qualidade de vida do indivíduo em relação ao trabalho como também no meio social. Optou-se pela pesquisa quanti-qualitativa e descritiva, feita na Universidade Federal de Viçosa (UFV), com 25 servidores expostos ao ruído, dos setores de pré-moldados e serralheria desta Instituição. Para o alcance dos objetivos propostos, inicialmente, os indivíduos participaram da etapa de caracterização do perfil audiológico, com realização de meatoscopia, audiometrias tonal e vocal, audiometria de altas frequências (AAF) e emissões otoacústicas (EOA). Em seguida, fizeram-se entrevistas fundamentadas em um roteiro estruturado (WHOQOL-Bref), com aplicação de questionários para conhecer os prejuízos sociais da perda auditiva e avaliar a qualidade de vida dos indivíduos no trabalho, tendo o modelo de Walton como referência. Utilizou-se, também, de um roteiro semiestruturado, a fim de conhecer a realidade vivenciada pelos participantes. Os dados quantitativos foram analisados pelo programa estatístico Stata, versão 13, enquanto os qualitativos, pela análise das falas dos participantes. Os resultados indicaram que as alterações auditivas encontradas como entalhe nas frequências agudas na audiometria convencional, o aumento dos limiares em altas frequências e a redução da amplitude das EOA são alterações típicas de exposição ao ruído. No entanto, a ausência de exames audiológicos prévios à exposição, como referência, e a consequente comparação com exames auditivos sequenciais, é indispensável para se afirmar que se trata de perda auditiva induzida por ruído (PAIR). Embora as queixas de dificuldade auditiva e zumbido tenham sido frequentes na análise das falas dos indivíduos avaliados, não foram observadas implicações na QV do indivíduo no trabalho, bem como em suas relações sociais, possivelmente por não ter atingindo, ainda, as frequências relacionadas à fala pela satisfação de pertencer à Instituição, possivelmente amenizou essa dimensão. Esses resultados apontaram para a necessidade de melhorar as condições de trabalho dos indivíduos expostos ao ruído ocupacional, investindo na efetivação do Subsistema Integrado de Atenção à Saúde do Servidor (SIASS). Essa política pública, destinada à promoção, à prevenção e ao acompanhamento da saúde dos servidores públicos federais, se cumprida, evitaria que a saúde auditiva continuasse sendo prejudicada, com consequentes prejuízos para a vida pessoal, laboral e social dos trabalhadores. / The exposure to occupational noise may bring consequences like hearing loss and/or tinnitus, besides not hearing losses, such as effort and tiring when doing tasks that imply in hearing discrimination; stress; anxiety; isolation, negative self image related to hearing deteriorization, for example. That is because the hearing is considered the most important sensorial channel when oral language communication is regarded. Thus, this study aimed to analyze the consequences of hearing loss and/or tinnitus in the individual and work life quality (LQ), as well as in their social relationships. Specifically it was intented to characterize social demografically the individual and their hearing profile, and analyze the implies of the hearing loss and tinnitus in the individual and work life quality, as well as in their social relationships. It was decided to apply a quantitative-qualitative research at UFV with 25 workers exposed to noise in two sectors of the University, pre molded and locksmiths. In order to reach the estabilished goals, initially, the individual participated to a profile audiological characterization based on tonal and vocal meatoanscopy audiometry, high frequency and otoacustics emissions audiometry. Next, interviews were carried out based on a structured script (WHOQOL-Bref), with questionnaire application to recognize social prejudices due to hearing loss and to evaluate the individual and work life quality, modeled by the Walton reference. It was also used a semi- structured script in order to possibilitate to know the participants reality. The quantitative data were analized by the program Stata, version 13, and the qualitative data were analized by the participants speech. The results indicated that the hearing alteration found, such as notch in acute frequency in conventional audiometry, increase in high frequency thresholds and amplitude reduction of EOQ are typical alterations of the noise exposure. However, the absence of previous audiological exams to exposure, as reference, and the consequent comparison with sequential hearing exams, are important to claim a noise inducted hearing loss (NIHL). Although, complains about the hearing difficulty and tinnitus have been frequent in the individual speech analysis, it was not noticed problems in individual and work LQ, as well as the social relationships, possibly because they have not reached yet the frequencies related to the speech. These results point out to the necessity to improve the work conditions for workers exposed to occupational noise, investing on the effectuation of Subsystem Integrated to Attention to Workers Health (SIAWH). This public policy intended to promote, prevent and accompany the federal public workers’ health, if it was done correctly, it would avoid the prejudice of hearing health showing bad consequences for the personal, work and social life of the workers.

Made available in DSpace on 2015-07-22T20:50:45Z (GMT). No. of bitstreams: 0 Previous issue date: 2009-10-28 / INTRODUÇÃO: O zumbido é a percepção de um som quando não existe nenhuma fonte sonora externa emitindo sinais acústicos. Como conseqüência do zumbido, alguns indivíduos apresentam déficit na atenção. Um bom desempenho do processamento auditivo também se associa à integridade funcional de diversos fatores cognitivos tais como memória, aprendizado e atenção. Considerando-se que o zumbido afeta a atenção, acredita-se na possibilidade de que indivíduos com este tipo de queixa possam apresentar o zumbido em co-ocorrência a uma alteração do processamento auditivo. OBJETIVO: Avaliar e comparar o comportamento auditivo de resolução temporal e de atenção seletiva de indivíduos adultos com audiometria normal, com e sem zumbido e verificar se existe relação com o grau de incômodo e a sensação de freqüência e de intensidade do zumbido. MÉTODO: Foram selecionados entre estudantes da Universidade Federal de São Paulo aqueles que voluntariamente concordaram em participar do estudo. Os mesmos foram divididos em dois grupos: estudo e comparação. Os critérios de inclusão para ambos os grupos foram: faixa etária entre 19 e 44 anos de idade, dos sexos masculino e feminino, com limiares de audibilidade normais. Para o grupo estudo, os indivíduos deveriam apresentar queixa de zumbido uni ou bilateral. Ambos os grupos passaram por testes para avaliar a audição e o processamento auditivo. Após as avaliações, os dados foram analisados e comparados entre os grupos por meio de métodos estatísticos que foram realizados de forma descritiva, análises inferenciais por meio de testes não paramétricos quando a distribuição não era normal e testes paramétricos quando havia distribuição estatística normal dos resultados. RESULTADOS: No teste de fala com ruído branco o valor médio da porcentagem de acertos para o grupo sem zumbido foi de 96,5% na orelha direita e 96,4% na esquerda, para o grupo com zumbido foi de 98,3% na direita e 97,1% na esquerda. Em relação ao teste dicótico de dígitos, o grupo sem zumbido apresentou média de 99,5% de acertos na direita e 99,4% na esquerda e o grupo com zumbido obteve média de 99,3% de acertos tanto na orelha direita quanto na esquerda. Quanto ao teste Gaps In Noise, a média do limiar de detecção de gap foi de 4,7 ms na direita e 5,1 ms na esquerda para o grupo sem zumbido e para o grupo com zumbido a média foi de 4,7 ms na direita e 4,8 ms na esquerda. Em todos os testes não houve diferença estatisticamente significante entre os grupos. CONCLUSÃO: O desempenho dos indivíduos com zumbido foi semelhante ao dos indivíduos sem zumbido nos testes de processamento auditivo que avaliaram as habilidades auditivas de atenção seletiva e resolução temporal. / INTRODUCTION: Tinnitus is an individual’s auditory perception when there is no external sound source. Some individuals have attention deficits as a result of tinnitus. A good auditory processing performance depends on cognitive factors such as memory, learning and attention integrity. Considering that tinnitus affects attention, it is possible that individuals with tinnitus could have also auditory processing disorder. OBJECTIVE: Evaluate and compare the auditory abilities of temporal resolution and selective attention of adults with normal audiometry, with and without tinnitus and verify if it’s correlated with the tinnitus handicap, pitch and loudness. METHOD: Students of Federal University of Sao Paulo where selected and divided in two groups: study and comparison. The inclusion criteria for both groups where: age between 19 and 44 years old, male or female with normal hearing. For the study group, the individuals should have tinnitus complain in one or both ears. Both groups had their audition and auditory processing assessed. After the assessments, the data were analyzed and compared between groups by descriptive statistics, parametric tests when there was a normal distribution and not parametric when the distribution was normal. RESULTS: In the Speech in noise test, the mean value of correct answers for the group without tinnitus was 96.5% on the right ear and 96.4% on the left, and for the tinnitus group was 98.3% on the right and 97.1% on the left. In the Dichotic digits test, the mean value of correct answers for the group without tinnitus was 99.5% on the right ear and 99.4% on the left, and for the tinnitus group was 99.3% on the right and left ears. The mean gap detection threshold for the without tinnitus group in the assessment of the Gaps in noise test was 4.7 msec for the right ear and 5.1 msec for the left and for the tinnitus group was 4.7 msec for the right and 4.8 msec for the left. There were no statistical significant differences between groups when comparing all the tests results. CONCLUSIONS: The individuals with and without tinnitus had the same performance on the assessment of auditory processing tests that evaluate selective attention and temporal resolution auditory abilities / TEDE / BV UNIFESP: Teses e dissertações

Este trabalho objetivou avaliar a prevalência de subgrupos da Disfunção Temporomandibular (DTM) e hábitos parafuncionais orais em indivíduos portadores de zumbido subjetivo, sendo comparados com indivíduos sem zumbido. Duzentos indivíduos, de ambos os gêneros, com idade entre 18 a 60 anos, participaram do estudo. Inicialmente, foram subdivididos, com auxílio do exame otorrinolaringológico, em grupo experimental (n=100), indivíduos portadores de zumbido subjetivo, e grupo controle (n=100), voluntários sem qualquer queixa de zumbido. A análise da prevalência de DTM, bem como o estudo dos seus sinais e sintomas, foi feita segundo os critérios de diagnóstico Research Diagnostic Criteria for Temporomandibular Disorders (RDC/TMD). O Limiar de Dor à Pressão (LDP) dos músculos masseter e temporais (anterior, médio e posterior) foram medidos bilateralmente, por meio de um algômetro KRATOS®, e a dor subjetiva pela Escala de Análise Visual (EAV). O estudo da presença dos hábitos parafuncionais orais, apertamento dentário diurno e bruxismo do sono, foi feito através do auto-relato e da aplicação de exame clínico de bruxismo, respectivamente. Os dados obtidos foram submetidos à análise estatística (Testes Qui-Quadrado, t de Student e Mann-Whitney e Coeficiente de Correlação de Spearman), em um nível de significância de 5%. Foi encontrada uma maior prevalência de DTM no grupo experimental quando comparado ao grupo controle (p<0,05). De uma maneira geral, os sinais e sintomas de DTM avaliados foram mais prevalentes no grupo experimental em comparação ao grupo controle, como a presença de dor à palpação na ATM e de ruídos articulares na abertura bucal, maior tempo de dor e maior grau de severidade de dor crônica. O resultado médio da EAV encontrado foi estatisticamente maior no grupo experimental (p<0,05), contudo os LDPs não apresentaram diferença significativa entre os grupos. A análise dos hábitos parafuncionais mostrou diferença estatisticamentente significativa da presença de bruxismo noturno entre os grupos, sendo mais prevalente no grupo experimental (p<0,05). Houve uma correlação positiva estatisticamente significativa entre a severidade do zumbido e a severidade da dor crônica (p<0,05) e entre o tempo de zumbido e o tempo de dor (p<0,05). Conclui-se que parece existir uma forte correlação entre os sinais e sintomas da DTM e o zumbido de caráter subjetivo. / The aim of this study was to study the prevalence of Temporomandibular Disorders (TMD) subgroups and oral parafunctional habits, daytime clenching and sleep bruxism, in patients with subjective tinnitus when compared to a group of asymptomatic volunteers. Two hundred patients (ages between 18-60 years-old) participated in this study, divided into two groups, according to the presence (experimental) or not (comparison) of subjective tinnitus. According to the RDC/TMD criteria, the subgroups were determined. The Pain Pressure Threshold (PPT) values of masseter and temporalis (anterior, middle, and posterior regions) muscles were recorded bilaterally with an algometer and a visual analog scale (VAS) was used to address subjective pain. The severity of the TMD was determined by using an anamnestic questionnaire while a self-reported questionnaire detected parafuncional habits. Data were submitted to statistical analysis (Chi-square, t Student, Mann-Whitney and Spearmans Correlation), at a 5% significance level. The prevalence of signs and symptoms of TMD was significantly associated with the presence of tinnitus (p.001). The three most prevalent TMD subgroups in tinnitus patients (p<.05) were myofascial pain with temporomandibular joint (TMJ) internal derangement (39%), disc displacement with reduction (44,33%) and arthralgy (53,54%). The PPT values were lower (p>.05) while VAS was statistically higher (p<.05) for tinnitus patients. The severity of TMD was associated with tinnitus (p0.001). Both, the report of sleep bruxism (58%), as well as of daytime clenching (60%) were found more frequently in tinnitus patients. Significant difference, however, was detected only for the report of bruxism (p<.05). These results suggest that an association exists between TMD and subjective tinnitus.

Tinnitus is the experience of sounds without an appropriate external auditory source. These auditory sensations are intertwined with emotional and attentional processing. Drawing on theories of mental control, we predicted that suppressing an affectively negative sound mimicking the psychoacoustic features of tinnitus would result in decreased persistence in a mentally challenging task (mental arithmetic) that required participants to ignore the same sound, but that receiving a mindfulness exercise would reduce this effect. Normal hearing participants (N = 119) were instructed to suppress an affectively negative sound under cognitive load or were given no such instructions. Next, participants received either a mindfulness induction or an attention control task. Finally, all participants worked with mental arithmetic while exposed to the same sound. The length of time participants could persist in the second task served as the dependent variable. As hypothesized, results indicated that an auditory suppression rationale reduced time of persistence relative to no such rationale, and that a mindfulness induction counteracted this detrimental effect. The study may offer new insights into the mechanisms involved in the development of tinnitus interference. Implications are also discussed in the broader context of attention control strategies and the effects of emotional sound on task performance. The ironic processes of mental control may have an analog in the experience of sounds. / <p>On the day of the defence date the status of this article was <em>Manuscript</em>.</p>

Diss. Linköping : Univ., 2003.

The ability of neurons to regulate their activity (homeostatic plasticity) is thought to be responsible for changes in neural responsiveness/gain induced by sensory deprivation, or augmented stimulation. For example, following auditory deprivation, excitatory and inhibitory synaptic transmission is strengthened and weakened, respectively. Abnormally high neural gain results in an 'over amplification' of spontaneous and stimulus-evoked firing rates, and may result in aberrant auditory perceptions including tinnitus and/or hyperacusis, respectively. The first manuscript in the thesis 'Pump up the Volume' (Chapter Three) provides a summary of the neural gain mechanism in the adult auditory system. Aspects of neural gain, including temporal characteristics and frequency specificity, had not been systematically investigated. Therefore, the aim of this thesis was to investigate characteristics of the neural gain mechanism. The thesis comprises three related studies involving normal hearing adult listeners: two studies involved short term sensory deprivation and one study involved short term augmented stimulation. The main outcome measures were the acoustic reflex threshold (ART), auditory brainstem response (ABR) and loudness. In Study One, the time course, frequency specificity and anatomical location of changes in the ART, following 6 days of unilateral earplug use (ca 30 dB attenuation at 2-4 kHz), were investigated. The reduction in ART in the treatment ear was greatest at day 4 and at frequencies most attenuated by the earplug. Ipsilateral and contralateral ARTs were similar when stimuli were presented to the treatment ear. ARTs were not statistically significant from baseline when measured 4 and 24 hours after earplug removal. In Study Two, the ART and ABR were measured at baseline and after 7 days of unilateral and bilateral hearing aid use (13-17 dB real ear insertion gain), to compare the effect of symmetrical and asymmetrical inputs. There was no change in ART and ABR after treatment, suggesting that the augmented stimulation was insufficient to modify neural gain. In Study Three, ARTs, ABRs and loudness were investigated after 4 days of unilateral earplug use (30 dB attenuation at 2-4 kHz). There was a significant reduction in ART (ca 6 dB) in the treatment ear, which returned to baseline within 1-2 hours of earplug removal. There was an unexpected but significant 35 nV decrease in the ABR wave V peak-to-trough amplitude in the treatment ear, and a 12 nV increase in the control ear. The change in ABR was opposite in direction to the change in ART. There was no change in loudness. The thesis has provided information on the threshold of deprivation/stimulation required to elicit a change in neural gain, along with the frequency specificity and temporal characteristics of the gain control mechanism. The anatomical location for changes in neural gain is around the level of the cochlear nucleus. The change in ABR was in the opposite direction to those predicted, but could be due a difference in the compensatory changes of contralateral and ipsilateral inputs at the level of the inferior colliculus.

Musicians are a unique population in the world of audiology. It has been reported that on average, they exceed the recommended daily dose of noise exposure before the middle of their day. This significantly increases the risk of a permanent noise- or music- induced hearing loss. Such a hearing loss may influence their perception of timbre, pitch, and loudness thereby affecting their ability to play and enjoy music. Therefore, early identification of hearing problems is critical to this population. Twelve subjects with a variety of musical backgrounds and experiences were recruited for the study that had three primary purposes. The first was to design and implement a sensitive hearing assessment protocol to identify early signs of hearing loss in young musicians. The second was to determine the presence and significance of hearing loss, tinnitus (perception of sound when no actual external signal is present, commonly referred to as “ringing in the ears”), and hyperacusis (experience of everyday life sounds being perceived as intrusively loud, uncomfortable, or even painful) among musicians. The third was to determine if and when hearing protection devices were used in this population. All subjects completed a thorough case history that included history of noise exposure, musical background, habits and preferences for hearing protection device use, as well as screening for mental and physical health concerns. When indicated by patient responses to the case history, questionnaires about tinnitus, vertigo, hyperacusis, and hearing were administered and scored. The test battery included an evaluation of middle-ear function (otoscopy, tympanometry, and acoustic reflex), cochlear function based on distortion product otoacoustic emissions (DPOAEs), audiometry using conventional test frequencies (0.25-8 kHz) and extended high-frequencies (8-16 kHz), and the Words in Noise (WIN) test which uses monosyllabic words to quantify the loss of speech understanding in adverse listening situations. Results revealed that six subjects experience bothersome tinnitus (four, of whom had WIN scores in the mild range and three of whom reported hyperacusis). One of these seven also had absent DPOAES, absent acoustic reflexes, and a mild to moderate hearing loss from 6 – 16kHz. Case history indicated that the majority of subjects were not using hearing protection devices, suggesting a need for further education and preventative efforts. It also revealed a positive trend between anxiety/depression and tinnitus, hyperacusis, and dizziness severity. In our test protocol the WIN test was the most effective tool for identifying difficulty in adverse listening situations but asking subjects about experiencing tinnitus was a more reliable predictor of functional change to the auditory system (even in patients with thresholdsfrequencies). Together, these assessments could provide clinicians, musicians, and school administrators the value of music students using hearing protection when practicing, performing, or attending live shows.

Background: Patients often report that living with a condition such as tinnitus can be debilitating, worrying, and frustrating. Efficient ways to foster management strategies for individuals with tinnitus and promoting tinnitus self-efficacy are needed. Internet-based cognitive behavioral therapy (ICBT) for tinnitus shows promise as an evidence-based intervention in Europe, but is not available in the United States. The aim of this pilot study was to evaluate the feasibility of an ICBT intervention for tinnitus in the United States. Method: This study reports the Phase 1 trial intended to support implementation of a larger randomized clinical trial (RCT) comparing ICBT to a weekly monitoring group. As a pilot study, a single-group pretest–posttest design was used to determine outcome potential, recruitment strategy, retention, and adherence rates of ICBT for tinnitus. The primary outcome was a change in tinnitus distress. Secondary outcome measures included measures of anxiety, depression, insomnia, tinnitus cognitions, hearing-related difficulties, and quality of life. Results: Of the 42 screened participants, nine did not meet the inclusion criteria and six withdrew. There were 27 participants who completed the intervention, with a mean age of 55.48 (± 9.9) years. Feasibility was established, as a large pretest–posttest effect size of d = 1.6 was found for tinnitus severity. Large pretest–posttest effect sizes were also found for tinnitus cognitions and hearing-related effects, and a medium effect was found for insomnia and quality of life. Treatment adherence varied with a retention rate of 85% (n = 23) at post-intervention assessment and 67% (n = 18) for the follow-up assessment. Conclusions: This pilot study supported the feasibility of ICBT for tinnitus in the United States. Ways of improving intervention retention and recruitment rates need to be explored in future ICBT studies. Protocol refinements that were identified will be implemented prior to further RCTs to investigate the efficacy of ICBT for tinnitus in the United States.

Denna, både kvantitativa och kvalitativa, studie har till syfte att undersöka hur hörselkvalitén är hos musiklärare och deras elever på gymnasiet och i folkhögskola, hur musiklärarna och deras elever hanterar och upplever ljudnivåer både i musikundervisningen och privat samt huruvida hörselvård som ämne anammas i musikundervisningen. Studien baseras på en anonym enkätundersökning som utförts på två gymnasieskolor och en folkhögskola om sammanlagt 78 elever och 7 musiklärare. Resultatet redovisar statistik baserad på svarsfrekvens från enkäterna, ger svar på att musiklärarnas och elevernas hörselkvalité är till stor del lägre och flertalet hörselskador i olika former, såsom tinnitus, ljudkänslighet och hörselnedsättning upplevs. Resultatet visar också att hörselvård tas upp till stor grad i musikundervisningen.