Bakgrund: Tinnitus och ljudkänslighet är symptom som tycks öka bland ungdomar. En förklaring kan vara att ungdomar tillbringar allt mer och längre tid i bullriga miljöer utan att använda hörselskydd. Syfte: Syftet med studien är att jämföra gymnasieungdomars attityder till stark musik i relation till olika självupplevda hörselsymptom samt med avseende på variablerna norm, risktagande och riskmedvetenhet. Metod: Enkätstudie på 281 gymnasieungdomar i åldrarna 15-19 år, om deras attityder till stark musik. Enkäten bygger bl.a. på frågor och påståenden från Youth Attitude to Noise Scale, Health Belief Model och Theory of Planned Behavior. Resultat: Personer med permanent tinnitus hade mer negativa attityder till stark musik än de som inte hade det. Även självupplevda hörselsymptom relaterade till ljudkänslighet hade ett signifikant samband med mer negativa attityder till stark musik. Tillsammans förklarar de oberoende variablerna permanent tinnitus och frågorna om ljudkänslighet 17,4% av variationen i attityder till stark musik. De psykologiska variablerna norm, riskmedvetenhet och risktagande förklarade 40,8% av variationen i attityder till stark musik. Tillsammans med hörselsymptomsvariablerna permanent tinnitus och ljudkänslighet förklarades 48,0% av variationen i attityder. Slutsatser: De psykologiska variablerna i vår undersökning förklarar mer av ungdomarnas attityder till stark musik än vad de självupplevda hörselsymptomen gör.

碩士 / 國立屏東大學 / 特殊教育學系碩士班 / 104 / This retrospective questionnaire study is focused on the relationships between the earphone use, environmental noise and the tinnitus of the young population. We collected 31 patients, among 15 to 40 years old who ever visited the otorhinolaryngologic outpatient clinic in southern Taiwan for the problems of tinnitus and the hearing. All patients ever used the earphone and exposed to the environmental noise. The patients diagnosed to have the pathologies of the external ear, middle ear, inner ear or the central auditory system after the physical examination and a series of hearing tests were excluded from the study. All participants competed the inform consent, the patient assent and the parental permission for the teenagers. The questionnaires including the Tinnitus Handicap Inventory (Huang, 2001), Noise Exposure Rating Scale (Zheng, 2010) and Subjective Tinnitus Analogue Scale (Li, 2005). All analyses were performed using SPSS software (version 17.0). Testing for the association was performed using t test, analysis of variance and Pearson’s correlation coefficient. The main results are: (1)Severe disabilities of tinnitus was associated with the continuous use of earphone for more than 30 minutes in young population. (2)Participants use the portable music player persisted for more than one hour once and more than four times in one week always get the severe disabilities of tinnitus and very loudly subjective tinnitus. (3)Participants will get very loudly subjective tinnitus after using the music instrument for more than one hour. (4)There is a positive correlation between the scale of tinnitus disabilities and the loudness of subjective tinnitus.

碩士 / 靜宜大學 / 食品營養研究所 / 98 / Tinnitus is a phantom sensation of sound in the absence of external stimulations while its pathogenesis is unclear and effective treatment has not been developed yet. To approach the phantom sensation, we aimed to develop a SAMP8 mice behavioral model of conscious tinnitus using salicylate, an active component of aspirin known to induce tinnitus. The purpose of this study was to examine the effects of Spirulina and C-phycocyanin on tinnitus in senescence accelerated prone mice (SAMP8). Three-month-old SAMP8 mice were randomly divided into four experimental groups, including (A) normal control, (B) tinnitus group with intraperitoneal injection of salicylate (300 mg/Kg BW), (C) oral Spiulina (1000 mg/Kg BW) with salicylate-induced tinnitus group and (D) oral C-PC (130 mg/Kg BW) with salicylate-induced tinnitus group. Body weight and active avoidance test were performed during nine days of feeding period. The tumor necrosis factor α (TNF-α), interleukin-1β (IL-1β), cycoloxygenase-2 (COX-2) and N-methyl-D-aspartate receptor 2B (NMDA receptor 2B) mRNA expressions of brain stem, hippocampus and inner ear were examined after sacrificed. The results showed that the salicylate-induced tinnitus group led to a decrease in the percentage of correct response (score) and a drastic increase in the number of false positive response (i.e., animals execute the motor task during a silent period), and Spirulina or C-PC with salicylate-induced tinnitus groups had significantly improved, indicated that the Spirulina and C-PC could improve the learning and memory impairment and the conscious tinnitus. Salicylate inhibited the cyclooxygenase-2 (COX-2) mRNA expression in hippocampus and inner ear, and Spirulina and C-PC also decreased the COX-2 mRNA expression. When compared with salicylate-induced tinntus group, both Spirulina and C-PC could lower the TNF-α and IL-1β mRNA over-expression of brain stem, hippocampus and inner ear after salicylate injection. Spirulina and C-PC also could decrease the NMDA receptor 2B mRNA over-expression in hippocampus and inner ear. Furthermore, C-PC treatment should more effective than the Spirulina treatment group. In summary, we conclude that the supplementation of Spirulina and C-PC could improve the salicylate-induced conscious tinnitus in SAMP8 mice. The mechanism maybe related to the over-expression of TNF-α, IL-1β, NMDA receptor 2B. The variation of different tissues maybe related to the part of induced tinnitus after salicylate injection.

碩士 / 國立臺灣大學 / 臨床醫學研究所 / 95 / Background Tinnitus (from Latin tinnire, which means to ring or to tinkle) describes an auditory perception experienced in the absence of any evident external stimulus. Overall, 10-14% of adults have prolonged spontaneous tinnitus or have tinnitus ‘always’ or ‘often’. In 0.5-1%, tinnitus has a severe effect on quality of life or on ability to lead a normal life. Hearing impairment is commonly associated with tinnitus, but it is not exceptional for tinnitus to occur in patients with normal hearing. In a Swedish population study, 19% of subjects with subjective normal hearing said they suffered from tinnitus "always", and the British national study found that 7% of adults were annoyed by prolonged spontaneous tinnitus but did not have difficulty hearing. (Axelsson-1989; Vesterager-1997) The conditions in which tinnitus occurs are legion, but the pathophysiology of tinnitus remains obscure. The source of ‘tinnitogenic’ activity could be any level of the auditory system. Purely subjective tinnitus can be evaluated by psychoacoustic methods. Most of these psychoacoustic features have a high test-retest reliability, which proves that subjective tinnitus is based on some constant pathophysiological process (Hoke-1989). The complexity of the changes in the nervous system associated with tinnitus may explain why it is so resistant to treatment. In view of the great number of individuals (0.5-1%) who are unable to lead a normal life and the ineffectiveness of current tinnitus therapy (Lockwood-2002) it is highly desirable that some method be devised to objectively assess the existence of tinnitus. Møller et al had ever recorded the compound action potentials (CAPs) directly from the exposed intracranial portion of the eighth nerve in 19 patients undergoing microvascular decompression of the eighth nerve for intractable tinnitus. In the study, brainstem auditory evoked responses (BAEPs) in response to click sounds were also recorded during the operation. According the analyses of results, it may be assumed that the abnormalities in the latencies of peak V of BAEPs in the patients with tinnitus are a result of abnormalities in the superior olivary complex (SOC). (Møller-1992) In pervious studies, auditory cortical reorganization was demonstrated in normal hearing tinnitus (Hoke-1989; Mühlnickel-1998; Andersson-2000). Similarities between the data and the previous demonstrations that phantom limb pain is highly correlated with somatosensory cortical reorganization suggest that tinnitus may be an auditory phantom phenomenon (Mühlnickel-1998). The discovery of otoacoustic emissions, energy emitted by the outer hair cells (OHCs) in cochlea and recordable as acoustic vibrations in external auditory canal (Kemp-1978), was important for both theoretical and practical reasons. As otoacoustic emissions are invariably associated with functioning outer hair cells, their presence is a reliable indicator of cochlear structural integrity, and their absence may indicate a cochlear lesions. Besides being an expression of the cochlear structural status, otoacoustic emissions may also give an indication of functional integrity of the mechanisms which control the cochlea. The olivocochlear efferent system is a part of that regulatory complex, and its medial division, widely known as the medial olivocochlear (MOC) system, seems to be of particular importance in the modulation of cochlear activity. It has been suggested that tinnitus may be related to cochlear mechanical activity (Kemp-1981; O-Uchi-1988; Plinkert-1990; Norton-1990; Mckee-1992; Chéry-Croze-1994). Less effectiveness of MOC system had been revealed in tinnitus also (Veuillet-1992; Chéry-Croze-1993; Attias-1996; Ceranic-1998). Our proposed hypothesis is that dysfunction of MOC system in tinnitus alters the cochlear mechanical process, cochlear neural output and compound action potential of auditory nerve, and then the consequent cortical reorganization triggers the phantom perception of tinnitus. A better comprehension of the mechanisms underlying a symptom will probably come from exhaustive exploration of simplified cases. A more precise evaluation of the medial olivocochlear efferent activity in tinnitus patients requires a homogenous population. Factors including age, gender, general health, hearing threshold, duration of tinnitus suffering, clearly must be controlled for. Our study tried to explore the dysfunction level of the auditory system in the patients who suffer from annoying tinnitus with normal or nearly normal hearing by assessment with otoacoustic emissions. By this study, we will show the potential value of otoacoustic emissions in the assessment of tinnitus. This information may contribute to a better understanding of the origin and mechanisms underlying tinnitus. Materials and methods We collected patients complain of unilateral or bilateral tinnitus. All patients included in the study should have normal or nearly normal hearing. Normal subjects without auditory complaints were introduced to be the control group. Pitch matching test and loudness-balance test were carried out on tinnitus sufferers for objectifying tinnitus. All subjects underwent a protocol which includes an interview to obtain relevant information, otoscopy, standard pure tone audiometry, tympanometry, static compliance measurement, acoustic reflex test, auditory brainstem response survey, otoacoustic emissions examination (including SOAEs, TEOAEs, DPOAEs), and olivocochlear suppression test. Then we compared the results in tinnitus-disease ears, tinnitus-health ears and control-normal ears. An effort was made to match the age and gender proportion of the tinnitus to those of control subjects. Informed consent was obtained from all subjects. Results and Discussion Although there were no significantly statistical differences in the thresholds of pure tone audiometry, prevalence of SOAEs and TEOAE responses between three ear groups, averaged DPOAE levels of tinnitus-disease and tinnitus-health ears were significantly decreased over limited frequency range in comparison with those of control-normal group. Furthermore, higher percentage in tinnitus-disease and tinnitus-health ears were noted to have significant decreases or increases on DPOAE amplitude over a limited frequency range. But, in the present study, the pitch-matched tinnitus frequency was out of the frequency range in numbers of the cases. It is suggested that changes of cochlear dynamic properties exist in tinnitus, but simplex cochlear mechanism can not explain the tinnitogenesis. Significantly reduction of TEOAE responses under contralateral acoustic stimulation was observed in both tinnitus-health and control-normal groups, but not in tinnitus-disease ears. In comparison with control-normal group, the averaged central efferent suppression on DPOAEs of tinnitus-disease and tinnitus-health ears were significantly decreased over limited frequency range. Deducible connection between dysfunction of descending auditory pathway and tinnitus could be made logically. At last, inspection of the records of ABR showed significant prolonged latencies of peak III and V in the tinnitus-disease group compared with the control-normal group, although the values of IPL III-V were not statistically different from each other. Caudal pontine lesion ipsilateral to tinnitus affected ear was implied and may be the source of tinnitogenic activity. Conclusions This study has shown the potential value of otoacoustic emissions in the assessment of tinnitus. The dysfunction of descending auditory pathway caudal to SOC (medial olivocochlear efferents, MOC system) maybe play the leading role in the tinnitogenesis.

碩士 / 國立成功大學 / 醫學工程研究所碩博士班 / 94 / There are 17% of the total population suffering from Tinnitus in UK and USA; the prevalence of tinnitus patients has been increasing with the aging. There are approximately 30% of the elderly population suffering from Tinnitus. The noises from tinnitus have influenced seriously on the daily life for tinnitus patients sometimes. Currently, most of tinnitus devices are to provide wide-band noises for therapeutic purpose, and also expensive. The disadvantages of using wide-band therapeutic noises are: (1) tinnitus patients are suffering from noises with varied frequency bands and intensities; (2) more than 70% of patients also suffering from hearing loss usually at high frequency regions. When tinnitus patients have wear the current wide-band noise device for a period of time, they are usually at high risk of hearing loss. This research, based on the Tinnitus Masking and TRT for patient’s specific frequency band and volume, is to design and develop a microprocessor-based platform to provide customized band-pass noise for the tinnitus. This DSP technique would like to improve the shortcoming of current wide-band noise generator and ultimately be beneficial to the tinnitus. 　This system consists of a PC, Dlr169 emulation board with MSP430F169 chip, earphone, FLASH Emulation Tool for software programming and JTAG transmission line. A wide-band white noise, which is generated through random numbers in PC, is input to the Dlr169 for FIR filter processing. Filter parameters and processing programs, which are designed and programmed through FDATooL of MATLAB, are then down-loaded to the Dlir169. The prescribed narrow-band noise with volume are then output from the speaker. 　The prototype of narrow-band noise platform has been completed. The system calibration has been investigated for different stop bandwidths and rank and volume intensities on optimal parameter design in order to provide high quality narrow-band noises. A comparative study is conducted and the results indicate that the microprocessor-based system provides better narrow-band noise quality than the PC-based platform system. 　A clinical investigation on using the system is suggested in the future.

碩士 / 國立臺灣大學 / 醫學工程學研究所 / 93 / Tinnitus is prevalent among 10% of the general population and tends to increase in frequency among older ages. It has been difficult for the physicians to make a clinical evaluation of this annoying symptom since there lacks an objective approach to the diagnosis. To investigate the brain processes underlying tinnitus as well as to evaluate the symptoms objectively, multi-channel EEG recording is applied to investigate the appearance of ERPs (Event-Related Potentials) in tinnitus patients. ERPs were recorded from sixteen tinnitus patients and fifteen normal controls. All subjects have no significant hearing loss. A tone burst of 0.5, 1, 2, and 4 kHz are used as auditory stimuli. The stimuli of each frequency are presented at five different intensities: 50, 56, 62, 68, and 74 dB SBL. The intensity dependences of the N100/P200 amplitude and N100 latency are calculated for each frequency in each group. Aside from the component analysis, the isoelectric topography and current source density topography are developed to observe dipoles and active origins’ distribution of cortical activity respectively. The results show no significant differences in N100/P200 amplitude and N100 latency between the tinnitus and normal groups (two-tailed Student’s t-test, p > 0.05). There is also, no gross difference of isoelectric topography and current density topography between the two groups. Most multi-channel recording systems are very expensive. They are usually constructed by duplicating single-channel hardware into multiple copies. Their size, power consumption, and cost increase rapidly as the number of channels multiply. To resolve this problem, the other part of this thesis is dedicated to developing a time-division-multiplexing (TDM) system for multi-channel recording. By utilizing the TDM method, multiple input signals can be conditioned by using a single amplifier and filter stage. The design considerations of the multiplexing amplifier and filter stages are discussed herein. The phenomena in the filter caused by the TDM architecture are the drop of cutoff frequency and the attenuation of gain. The underlying mechanism of the phenomena is depicted and modeled with mathematics, whereby the responses of several types TDM filter were evaluated for understanding the behavior, including first-order low-pass, first-order high-pass, and second-order low-pass filters. The transfer function of such TDM-type filters are derived and verified, in addition to their design rule.

Diese Dissertation stellt das Verfahren des Brain Electrical Activity Mappings der späten Vestibulär Evozierten Potentiale (BEAM-VestEP) bei Tinnituspatienten vor im Hinblick auf die therapeutische Wirksamkeit der kompetitiv-kinästhetischen-Interaktionstherapie auf der Basis der Brügger Therapie im „Murnauer Konzept“ und überprüft ihre Evidenz. / This dissertation introduces the procedure of Brain Electrical Activity Mapping of the Late Vestibular Evoked Potentials (BEAM-VestEP) among patients with Tinnitus in view of the therapeutic efficacy of the competitive kinesthetic therapy as explained by Brügger based on the "Murnauer concept" and examines its evidence.

Introdução: Entre as queixas mais comuns dentro dos consultórios de otorrinolaringologia e fonoaudiologia, o zumbido destaca-se como uma das que geram mais incômodo ao indivíduo. Existem várias modalidades para o tratamento do zumbido, com destaque para a terapia farmacêutica, fisioterapia, psicoterapia, cirurgia, e dentre as possibilidades de intervenção, vem crescendo o interesse no uso do laser de baixa intensidade. No entanto, apesar de existir na literatura internacional artigos sobre este assunto, há inúmeras divergências quanto ao protocolo de aplicação e a eficácia desse tratamento. Proposição: Verificar o efeito da fotobiomodulação em indivíduos com sintoma de zumbido crônico sem perda auditiva. Casuística e Métodos: O estudo foi desenvolvido no Centro Auditivo Ouvir Bauru, com a aprovação do Comitê de Ética em Pesquisa e aquiescência do paciente confirmada mediante a assinatura do Termo de Consentimento Livre e Esclarecido. Os pacientes que se enquadravam nos critérios de inclusão foram divididos aleatoriamente em Grupo 1: uso do laser de baixa intensidade e Grupo 2: uso do placebo. Foi realizado anamnese com os indivíduos antes da realização da bateria de testes e os dados coletados foram anotados no prontuário do mesmo. Após entrevista, iniciou-se a bateria de exames audiológicos que incluiu: audiometria tonal, audiometria de altas frequências, imitanciometria e acufenometria para descarte de perda auditiva, questionário Tinnitus Handicap Inventory para mensurar o nível de incomodo com o zumbido pré e pós tratamento e escala visual analógica para mensurar o nível de incômodo pré e pós aplicação do laser. O protocolo de fotobiomodulação incluiu 12 sessões de laser de baixa intensidade para o Grupo 1 e placebo para o Grupo 2, utilizando 4J na veia lingual no comprimento de onda vermelho, 4J na membrana timpânica direita e esquerda, no comprimento de onda vermelho e 9J na mastoide direita e esquerda, no comprimento de onda infra-vermelho. Resultados: a amostra foi composta por 20 pacientes, sendo oito do sexo feminino e 12 do sexo masculino com média de idade de 54 anos. Não houve diferença estatística em função do grupo de intervenção e do momento de avaliação para os desfechos audiometria de altas frequências e acufenometria. A desvantagem dos indivíduos com zumbido crônico reduziu significativamente após a intervenção, independentemente da intervenção. Pode-se averiguar que a insatisfação dos indivíduos com zumbido crônico diminuiu significativamente com diferença entre as sessões iniciais e finais, independentemente do grupo de intervenção, porém, o Grupo 1 apresentou redução significativamente maior que o Grupo 2, independentemente do momento de avaliação e do número da sessão. Conclusão: Conclui-se que indivíduos com zumbido crônico reduziram a desvantagem independentemente do grupo de intervenção, e o nível de insatisfação com o zumbido nas sessões iniciais em relação as finais independentemente do momento de avaliação e do grupo de intervenção. O grupo que recebeu a fotobiomodulação melhorou mais o nível de insatisfação com o zumbido, independentemente do momento de avaliação e do número da sessão. / Introduction: Among the most common complaints within otorhinolaryngology and audiology clinics, tinnitus stands out as one of the most uncomfortable for the subject. There are several modalities for the treatment of tinnitus, with emphasis on pharmaceutical therapy, physiotherapy, psychotherapy, surgery, and among the possibilities of intervention, there is growing significance in the use of low level laser. Nevertheless, despite many articles in the international literature about this theme, there are several disagreements regarding the protocol of application and the efficacy of this treatment. Proposition: To verify the effect of laser therapy in individuals with chronic tinnitus symptom without hearing loss. Methods: The study was developed at the Centro Auditivo Ouvir - Bauru, with the acceptance of the Research Ethics Committee and patient acquiescence confirmed by signing the Informed Consent Term. Patients who suited the inclusion criteria were randomly set to Group 1: treated with low level laser and Group 2: treated with placebo laser. Anamnesis was applied with the individuals before the battery of tests and the data collected were registered in the individuals folder. after the interview, the audiological exams started, which included: tonal audiometry, high frequency audiometry, immittanciometry and acufenometry for hearing loss disposal, Tinnitus Handicap Inventory to measure the level of discomfort with tinnitus pre and post treatment and visual analogue scale to measure the level of discomfort with tinnitus pre and post laser application. The Laser Therapy protocol included 12 laser therapy sessions for Group 1 and placebo laser for Group 2, using 4J in the lingual vein in the red wavelength, 4J in the right and left tympanic membrane, in the red wavelength, and 9J in the right and left mastoid, at the infra-red wavelength. Results: the sample consisted of 20 patients, eight females and 12 males with the average of 54 years-old. There was no statistical difference in function of the intervention group and the moment of evaluation for the high frequency audiometry and acuphenometry outcomes. The disadvantage of individuals with chronic tinnitus reduced significantly after the intervention, regardless of the intervention. It can be verified that the annoyance of individuals with chronic tinnitus decreased significantly with difference between the initial and final sessions, independently of the intervention group, but Group 1 presented a greater reduction than Group 2, independently of the moment of evaluation and the number of the session. Conclusion: It was concluded that individuals with chronic tinnitus reduced the disadvantage independently of the intervention group, and the level of discontentment with tinnitus in the initial sessions according to the final ones independently of the moment of evaluation and the intervention group. The group receiving laser therapy further improved the level of tinnitus dissatisfaction, regardless of timing and session number.

INTRODUÇÃO: As terapias mais eficazes para zumbido são baseadas nos modelos psicológico e neurofisiológico, que teorizam que o incômodo existente é resultado da interação dinâmica dos centros auditivos, sistemas límbico e nervoso autônomo. Embora sejam amplamente aceitos na prática clínica, ainda necessitam validação científica. A ressonância magnética funcional (RMf) é um método objetivo capaz de identificar as áreas cerebrais descritas pelos modelos, como também a rede neural relacionada à percepção de estímulos emocionais, que ainda não foi investigada em estudos de zumbido. OBJETIVOS: 1) Baseado nos modelos que explicam o incômodo do zumbido, analisar as áreas corticais auditivas e não-auditivas em adultos normo-ouvintes com e sem zumbido, ativadas durante estimulação auditiva desagradável; 2) de acordo com a teoria da percepção de um estímulo emocional, avaliar se os pacientes com zumbido recrutavam a mesma rede neural para a percepção de sons desagradáveis que os indivíduos sem zumbido. MÉTODOS: Quinze pacientes com zumbido subjetivo crônico não-pulsátil (grupo zumbido, GZ) e 20 voluntários sem zumbido (grupo controle, GC), pareados por sexo e idade, foram submetidos à RMf (1.5 T). Os critérios de inclusão foram: indivíduos destros, audiometria normal, inventário de depressão de Beck < 20 pontos e escolaridade equivalente ao segundo grau completo. O paradigma incluiu sons do catálogo IADS (International Affective Digitized Sounds), validados para valência emocional e grau de estímulo, associado à escala análogo-visual SAM (Self Assessment Manikin), modificada para RMf. O paradigma foi praticado previamente em um simulador de RMf. A aquisição de imagens e a apresentação de estímulos foram realizadas através da técnica de seqüência de pulso com ruído acústico minimizado (SPRAM). RESULTADOS: O hipocampo esquerdo foi a área mais ativada no GC e não demonstrou atividade neural no GZ, no qual a maior ativação foi localizada na ínsula esquerda. Áreas auditivas (giro temporal superior e região ínfero-posterior do lobo temporal) e límbicas (ínsula) foram ativadas pelos sons desagradáveis em ambos os grupos. Na análise comparativa, a maior ativação no GZ ocorreu no cerebelo direito (p < 0,05) e, no GC, no giro temporal superior esquerdo e giro frontal inferior esquerdo (p < 0,05). CONCLUSÕES: A ativação paralela dos sistemas auditivo e límbico aos sons desagradáveis foi demonstrada nos pacientes com e sem zumbido. Entretanto, na comparação entre grupos, áreas límbicas e préfrontais não foram significantemente mais ativadas em pacientes com zumbido. Sugere-se que o cerebelo direito, recentemente relacionado à função cognitiva, pode ser a área não-auditiva envolvida no incômodo do zumbido. Especula-se que o incômodo do sintoma esteja relacionado a anormalidades na percepção emocional, seja pela identificação exacerbada (via ínsula) de sons desagradáveis ou pela ausência de regulação da resposta afetiva (via hipocampo) a este estímulo / INTRODUCTION: The most successful tinnitus therapies are based on the psychological and the neurophysiological models, which suggest that tinnitus-related annoyance results from the dynamic interaction of auditory brain centers, limbic and autonomic nervous systems. Although these models have been largely accepted in clinical practice, they lack experimental support and validation. Functional magnetic resonance imaging (fMRI) offers the opportunity to identify those brain regions pertinent to each model, and studies the neural network involved in the theory of emotion perception of stimuli. The latter has not been thoroughly investigated in tinnitus. OBJECTIVES: 1) Based on the models of developing tinnitus-related annoyance, analyze the cortical areas (auditory and non-auditory) in normal hearing individuals with and without tinnitus, activated by unpleasant auditory stimulation; and 2) according to the theory of emotion perception of acoustic stimulus, evaluate whether the patients with tinnitus were using the same neural network for perception of unpleasant sounds than the subjects without tinnitus. METHODS: Fifteen subjects with chronic subjective non-pulsatile tinnitus (tinnitus group, TG), and 20 healthy volunteers (control group, CG), matched for gender and age, were submitted to 1.5 T fMRI. Inclusion criteria consisted of normal pure-tone audiogram, righthandedness, Beck depression inventory < 20 points, and formal education level > 11 years. The paradigm comprised sounds from IADS (International Affective Digitized Sounds) with validated emotional valence and arousal, and a modified visual-analog Self Assessment Manikin (SAM) scale. All individuals previously practiced the task in a mock scanner. Image acquisition and stimuli presentation were designed using the silent event-related method, in which the scanner acoustic noise effects were minimized during brain activation detection. RESULTS: The left insula presented the highest neuronal activity in the TG, which showed no activity in the hippocampus. In the CG, the activation was markedly present in the left hippocampus, and was barely found in the insula. Unpleasant sounds activated auditory areas (superior temporal gyrus, inferior-posterior temporal lobe) and the limbic system (insula) in both groups. When the groups were compared, the right cerebellum was the most activated brain area in the TG (p < 0.05), and CG showed the highest activation in the left superior temporal gyrus and the left inferior frontal gyrus (p < 0.05). CONCLUSIONS: Parallel activation of auditory and limbic systems was demonstrated in both tinnitus and control patients. However, limbic and prefrontal areas were not significantly more activated in patients with tinnitus. The right cerebellum, recently described to have cognitive function, may be responsible for integrating the brain centers involved in the annoyance of tinnitus. In addition, we suggested that tinnitus-related annoyance may be secondary to emotion perception abnormalities, either a higher identification of emotional significance of the unpleasant sounds (via insula), or a lack of regulation of individual affective reaction (via hippocampus)

O objetivo deste estudo foi avaliar o efeito de placas oclusais com guias anteriores de desoclusão e placas oclusais com contatos bilaterais e anteriores simultâneos durante os movimentos excursivos da mandíbula em pacientes com disfunção temporomandibular (DTM) e zumbido subjetivo. Foram avaliados 264 pacientes encaminhados para tratamento da DTM na FORP/USP e selecionados 32 mulheres com DTM muscular, associada ou não a DTM articular, e zumbido subjetivo que preencheram os critérios de inclusão. O diagnóstico da DTM foi realizado com o Research Diagnostic Criteria for Temporomadibular Disorders (RDC/TMD). As pacientes foram divididas randomicamente em dois grupos para utilizarem um dos dois tipos de placas. As avaliações incluíram dor à palpação, limiar de dor a pressão com algômetro, medidas da amplitude dos movimentos mandibulares, eletromiografia de superfície, relato da intensidade da dor e da loudness do zumbido em escala visual analógica (EVA) e das características do zumbido. Os pacientes também responderam a um questionário para quantificação da frequência e severidade dos sinais e sintomas de DTM (ProDTMMulti) e para a avaliação do impacto do zumbido no dia-a-dia (Tinnitus Handicap Inventory - THI). A avaliação eletromiográfica foi realizada em várias atividades com e sem placa oclusal (apertamento máximo voluntário, movimentos excursivos mandibulares, repouso e mastigação habitual) e comparada com um grupo de 13 mulheres assintomáticas. As avaliações foram realizadas inicialmente (A1), no dia de instalação das placas oclusais, após 60 dias da avaliação inicial (A2) e após 90 dias de uso da placa oclusal (A3). O período entre as avaliações A1 e A2 foi considerado um período controle. Os resultados mostraram uma significante melhora da dor relatada pelo pacientes e aumento da amplitude da abertura bucal sem dor nos dois grupos, sem diferença entre eles. A atividade eletromiográfica foi significativamente reduzida durante apertamento máximo voluntário com a placa oclusal em comparação com o apertamento em máxima intercuspidação habitual, para as demais atividades realizadas durante o exame não houve diferença significante. A avaliação do zumbido mostrou que em muitos pacientes houve remissão do sintoma após o tratamento com placa oclusal. Não houve diferença entre os grupos para todas as avaliações realizadas. Baseados nesses achados, pode-se concluir que o tratamento com ambas as placas promoveu melhora na sintomatologia dos pacientes, sem diferenças entre elas, e houve em muitos pacientes uma remissão do zumbido relatado durante o tratamento. / The aim of this study was to assess the effect of anterior guidance and bilateral balanced splints in patients with temporomandibular disorders (TMD) and subjective tinnitus. A total of 264 subjects referred for treatment of TMD in FORP/USP were evaluated and 32 women with muscular TMD with or without the diagnosis of articular TMD, who met the inclusion criteria, were selected. TMD diagnosis was performed according to Research Diagnostic Criteria for Temporomadibular Disorders (RDC/TMD). The patients were randomly divided into two groups: anterior guidance splint group and bilateral balanced splints group. The assessments included pain to palpation, pressure pain threshold with algometer, measurement of amplitude of mandibular movements, surface electromyography, pain intensity and loudness of tinnitus reports in visual analogue scale (VAS) and characteristics of tinnitus. The patients also answered a questionnaire to quantify the frequency and severity of signs and symptoms of TMD (ProDTMMulti) and to assess the impact of tinnitus on a day-to-day (Tinnitus Handicap Inventory - THI). The electromyography evaluation was performed in different activities with and without occlusal splint (maximum voluntary clenching, excursive jaw movements, resting and habitual chewing) and compared to a group of 13 asymptomatic women. The assessments were performed initially (A1), at the day of installation of the occlusal splints, after 60 days of the initial assessment (A2) and after 90 days of occlusal splint therapy (A3). The period between A1 and A2 assessments was considered a control period. The results showed a significant improvement in pain reported by patients and an increase in the amplitude of mouth opening without pain in both groups, without difference between them. The electromyographic activity was significantly reduced during maximum voluntary clenching with occlusal splint compared to clenching in maximal habitual intercuspation, to the other activities performed during the examination there was no significant difference. The tinnitus evaluation showed that in many patients there was remission of symptom after treatment with occlusal splint. There was no difference among groups for all assessments. Based on these findings it is possible to conclude that treatment with both splints promoted improvement in symptoms of patients, without differences among them, and many patients had a remission of reported tinnitus during the treatment.