Submitted by Setor de Tratamento da Informa??o - BC/PUCRS (tede2@pucrs.br) on 2016-08-29T13:40:30Z No. of bitstreams: 1 TES_CAIO_MARCELO_PANITZ_SELAIMEN_PARCIAL.pdf: 164594 bytes, checksum: 018c15c8423502c0c2b2575d4a609cb2 (MD5) / Made available in DSpace on 2016-08-29T13:40:31Z (GMT). No. of bitstreams: 1 TES_CAIO_MARCELO_PANITZ_SELAIMEN_PARCIAL.pdf: 164594 bytes, checksum: 018c15c8423502c0c2b2575d4a609cb2 (MD5) Previous issue date: 2008-11-19 / Objectives: (1) To verify the prevalence of signs and symptoms of temporomandibular disorders (TMD) in patients with tinnitus and any degree of audiometric loss versus patients with tinnitus and normal audiometry versus a control group with no tinnitus; 2) To establish a possible correlation between signs and symptoms of TMD with established or presumed causes of tinnitus; 3) To verify the correlation between the worse side of tinnitus (predominant side) with the signs and symptoms of TMD according to the RDC/TMD Axis I. Methods and materials: The basic audiological evaluation, including the objective and psychoacoustic evaluation of tinnitus as well as its etiology, were clinically established by means of basic audiologic tests performed by physicians (ENT) and speech pathologists of the Clinical Hospital of Porto Alegre (HCPA). Such methods of assessment follow the Research Diagnostic Criteria for Tinnitus created by the Tinnitus Clinic in the Ear Nose Throat Service of the HCPA. The instrument for evaluation of TMD was the official version of the Research Diagnostic Criteria for Temporomandibular Disorders (RDC/TMD). Three groups were studied: a) patients with tinnitus and any degree of hearing loss confirmed by an ENT doctor; b) patients with tinnitus and normal audiometry confirmed by an ENT doctor; c) patients free of signs and symptoms of tinnitus (control group) without otolaryngological complaints confirmed by a ENT doctor. Results and conclusions: Patients from the group of tinnitus with any hearing loss had a direct association with the diagnosis of myofascial pain, with the diagnosis of disk displacement with reduction, arthralgia, osteoarthrosis and osteoarthritis of the TMJ, and also with the diagnosis of reduced vertical dimension. However, no association was detected between the diagnosis of Axis I and part of tinnitus, neither between the presence of the musculo-articular pain and the side where the tinnitus symptom was more intense, nor between the severity of tinnitus and the level of the musculo-articular pain. Patients from the tinnitus without hearing loss had a direct association with the diagnosis of disk displacement with reduction and arthralgia. A direct association between the tinnitus intensity and the pain level in the left and right posterior temporalis muscles. However, an association neither between the diagnosis and the side of tinnitus or the presence of musculo-articular pain the worst side of tinnitus. Besides that, the patient groups with tinnitus did not different between each other in relation to chronic pain grade, depression and somatization, with and without pain, despite both having superior scores than the control group. Despite not having significantly higher scores in the Axis II of the RDC, patients with tinnitus with hearing loss had worse scores than those with tinnitus with no hearing loss. / Objetivos: (1) Verificar a preval?ncia de sinais e sintomas de disfun??o temporomandibular (DTM) em pacientes com zumbido e qualquer grau de perda auditiva e em pacientes com zumbido e audiometria normal em compara??o com um grupo controle; 2) Estabelecer uma poss?vel concomit?ncia e/ou correla??o dos sinais e sintomas de DTM com as causas estabelecidas ou presum?veis do zumbido presente; 3) Verificar a exist?ncia de rela??o entre o local e o lado onde o sintoma zumbido ? mais intenso (lado predominante) e os sinais e sintomas de DTM, conforme os diagn?sticos de Eixo - I de DTM. Materiais e m?todos: A avalia??o audiol?gica b?sica, avalia??o objetiva e psicoac?stica do zumbido, bem como sua etiologia foram estabelecidas clinicamente e atrav?s de testes auditivos b?sicos executados por m?dicos otorrinolaringologistas e fonoaudi?logos do Hospital de Cl?nicas de Porto Alegre (HCPA). Os referidos m?todos de avalia??o seguiram os Crit?rios de Diagn?stico de Pesquisa para o Zumbido, estabelecidos pelo Ambulat?rio de Zumbido do Servi?o de Otorrinolaringologia do HCPA. O instrumento para avalia??o da DTM foi a vers?o oficial do question?rio e formul?rio de exame dos Crit?rios de Diagn?stico para Pesquisa das Disfun??es Temporomandibulares (RDC/TMD). Foram formados tr?s grupos de estudo: a) pacientes com zumbido e qualquer grau de perda auditiva; b) pacientes com zumbido e audiometria normal; c) pacientes do grupo controle sem queixas otorrinolaringol?gicas. As condi??es nos tr?s casos, foram comprovadas por um m?dico otorrinolaringologista. Resultados e conclus?es: Os pacientes do grupo de zumbido com qualquer grau de perda auditiva apresentaram uma associa??o direta com o diagn?stico de dor miofacial, com o diagn?stico de deslocamento de disco com redu??o, artralgia, osteoartrose, osteoartrite da ATM e tamb?m com o diagn?stico de redu??o da dimens?o vertical. Entretanto, n?o apresentaram associa??o entre o diagn?stico do Eixo I e o lado do zumbido, entre a presen?a de dor m?sculo-articular e o lado no qual o sintoma zumbido era mais intenso, nem entre a gravidade do zumbido e o n?vel de dor m?sculo-articular. Os pacientes do grupo de zumbido sem perda auditiva apresentaram uma associa??o direta com o diagn?stico de deslocamento de disco com redu??o e artralgia. Apresentaram tamb?m uma associa??o direta entre a gravidade do zumbido e o n?vel de dor nos m?sculos temporais posteriores esquerdo e direito. Entretanto, tais indiv?duos n?o apresentaram uma associa??o entre o diagn?stico do Eixo I e o lado do zumbido, nem entre a presen?a de dor m?sculo-articular e o lado no qual o zumbido era mais intenso. Al?m disso, os grupos de pacientes de zumbido n?o diferiram entre si em rela??o aos escores do grau de dor cr?nica, depress?o e somatiza??o, incluindo e excluindo dor, apesar de apresentarem escores superiores aos do grupo controle. Entretanto, embora n?o tenham apresentado escores significativamente mais elevados no Eixo II do RDC, os pacientes do grupo de zumbido com perda auditiva apresentaram valores superiores para a gravidade do zumbido em rela??o ao grupo de pacientes com zumbido sem perda auditiva.

Dissertação (mestrado)—Universidade de Brasília, Faculdade de Medicina, 2009. / Submitted by Jaqueline Ferreira de Souza (jaquefs.braz@gmail.com) on 2011-05-21T22:13:01Z No. of bitstreams: 1 2009_LisianeHoldefer.pdf: 792751 bytes, checksum: 3853e9b0e8efe350b3cf97e237753176 (MD5) / Approved for entry into archive by Jaqueline Ferreira de Souza(jaquefs.braz@gmail.com) on 2011-05-21T22:14:03Z (GMT) No. of bitstreams: 1 2009_LisianeHoldefer.pdf: 792751 bytes, checksum: 3853e9b0e8efe350b3cf97e237753176 (MD5) / Made available in DSpace on 2011-05-21T22:14:03Z (GMT). No. of bitstreams: 1 2009_LisianeHoldefer.pdf: 792751 bytes, checksum: 3853e9b0e8efe350b3cf97e237753176 (MD5) / Embora os tratamentos em grupos para o zumbido sejam uma área bem documentada na literatura internacional, até onde se sabe, nunca foi documentada no Brasil. O objetivo deste estudo é avaliar pacientes com zumbido antes e depois do tratamento em grupo estruturado com base na terapia de retreinamento do zumbido e na terapia cognitivo comportamental. Quanto aos pacientes e métodos, adotou-se o estudo de coorte prospectivo, no qual 56 sujeitos foram recrutados para a pesquisa, respondendo ao Inventário do Handicap do Zumbido (THI) e à escala Hospitalar de Ansiedade e Depressão (HAD), antes e depois do tratamento. Foram realizadas 6 sessões estruturadas segundo os princípios da terapia de retreinamento do zumbido, associada a técnicas cognitivo comportamentais. Os resultados obtidos foram: 56 pacientes iniciaram e 37 terminaram o tratamento (19 foram excluídos); 19 (51,35%) eram homens e 18 (48,65%) e a idade média foi de 48 anos. Os resultados do THI antes e depois do tratamento foram, respectivamente: funcionais 29,4 e 13,3; emocional 23,8 e 9,4; e catastrófico 12,7 e 5,3. Os resultado da escala HAD antes e após o tratamento foram: ansiedade 11,6 e 7,7; depressão 9,4 e 5,6. Conclui-se que o tratamento descrito é efetivo na melhora do zumbido. ________________________________________________________________________________ ABSTRACT / Introduction: Although group treatments is a known research area documented in international literature, as far as we know it has never been done in Brazil. This study is about an experience of a group treatment for tinnitus based on tinnitus retraining therapy allied with cognitive behavioral therapy techniques. We evaluated patients whit tinnitus before and after they had gone through a structures group treatment program using tinnitus retraining therapy, associated with cognitive behavioral techniques. Methods: Cohort prospective study: 56 subjects were included. They answered the Tinnitus Handicap Inventory (THI) and the Hospital Anxiety and Depression (HAD) scale, before and after treatment. Patients went through 6 structured sessions based in the tinnitus retraining therapy associated with techniques of cognitive behavioral therapy. Results: 56 patients initiated and 37 completed the treatment (19 patients were excluded); 51,35% were males and mean age was 48 years old. The THI results before and after treatment, respectively was: functional 29,4 and 13,3; emotional 23,8 and 9,4; catastrophic 12,7 and 5,3 and HAD scale score was 11,6 and 7,7 for anxiety and 9,4 and 5,6 for depression. Conclusion: The results support the efficacy of the group treatment.

Los acúfenos se definen como aquellos sonidos percibidos por el paciente, de tonalidad e intensidad variable, en ausencia de una fuente externa sonora. Son un síntoma prevalente y afectan aproximadamente entre el 10 y el 15% de la población y en una parte de ellos deteriora significativamente la calidad de vida. Actualmente suponen un síntoma con un alto coste individual, social y económico y resulta imprescindible disponer de valoraciones de la repercusión psicoemocional. Existen muy pocas referencias de medidas genéricas que valoren las dimensiones de la vida diaria que se ven más afectadas en estos pacientes y no existen estudios comparativos entre la evaluación genérica y específica. Ambas visiones son muy útiles y necesarias a la hora de planificar políticas sanitarias y adaptar los recursos a este grupo de pacientes y estudios como el presente pueden reforzar la importancia del tema. Por este motivo planteamos un estudio inédito de tipo descriptivo transversal en pacientes con acúfenos con el objetivo de medir la calidad de vida relacionada con la salud mediante un cuestionario específico para acúfenos validado y ampliamente utilizado en la literatura internacional como el THI (Tinnitus Handicap Inventory) y el cuestionario de calidad de vida SF-36. La muestra fue obtenida a partir de los pacientes con acúfenos subjetivos visitados en las consultas externas del Servicio de Otorrinolaringología del Hospital General Universitario “Vall d’Hebron” de Barcelona. En total, la muestra está compuesta por 203 pacientes que cumplieron con los criterios de inclusión. Se anotaron los datos procedentes del Test de Goldberg, THI y SF36. Además se recogieron los datos procedentes de otras variables como edad, sexo, estado civil, vida laboral, profesión, hábitos, antecedentes otológicos y familiares, tonalidad, localización, factores modificadores, comorbilidad, actividad física y social, grado de estrés e irritabilidad, trastornos del sueño, tratamientos previos, hiperacusia y pérdida auditiva. En nuestro estudio se comprueba que aquellos pacientes con discapacidad producida por acúfenos medida a través del THI obtienen peores resultados en las áreas mentales del SF-36. / Tinnitus is defined as sounds of varying tone and intensity perceived by the patient in the absence of an external sound source. Tinnitus is a highly prevalent symptom, affecting approximately 10 to 15% of the population, and is associated with a significantly impaired quality of life in some patients. As a consequence, tinnitus is a symptom with a high individual, social and economic cost. Therefore, it is essential to assess its psycho-emotional impact in patients’ life in order to better plan and adapt health policies and resources to this group of patients. Several questionnaires have been proposed to measure the psycho-emotional impact of tinnitus, but, so far, little is known about the areas most frequently affected in tinnitus patients when generic quality of life questionnaires are used. Moreover, no direct comparison has been done between generic and tinnitus-specific questionnaires in order to see the areas more altered in this group of patients. Hence, the aims of this thesis were, on the one hand, to carry out a cross-sectional descriptive study in patients with tinnitus with the objective of measuring the quality of life through a validated and widely used specific (Tinnitus Handicap Inventory, THI) and generic (Short Form (36) Health Survey (SF-36) and Goldberg test) quality of life questionnaires, and, on the other hand, to compare the different questionnaires. A total of 203 patients with tinnitus were included in this study. Patients were recruited from a dedicated Tinnitus Unit at the Ear-Nose-Throat Department in Hospital Vall d'Hebron (Barcelona, Spain). All patients completed the Goldberg Test, THI and SF36 test. Data on baseline characteristics (age, sex, marital status, working life, profession, habits, family history, comorbidity, physical and social activity, level of stress and irritability, disturbances about sleep) as well as on previous otologic pathology and tinnitus characteristics (location, modifying factors, previous treatments, hyperacusis and hearing loss) were recorded. Our analysis showed that tinnitus patients with disability as defined by the THI, also get worse results in mental areas of SF-36.

Tese (doutorado)—Universidade de Brasília, Faculdade de Ciências da Saúde, Programa de Pós-Graduação em Ciências da Saúde, 2016. / Submitted by Fernanda Percia França (fernandafranca@bce.unb.br) on 2016-09-09T20:06:36Z No. of bitstreams: 1 2016_MoniqueAntunesdeSouzaChelminskiBarretto.pdf: 13848185 bytes, checksum: 1577fbb6997711c38574b6b4ff83b210 (MD5) / Approved for entry into archive by Ruthléa Nascimento(ruthleanascimento@bce.unb.br) on 2016-10-04T17:06:29Z (GMT) No. of bitstreams: 1 2016_MoniqueAntunesdeSouzaChelminskiBarretto.pdf: 13848185 bytes, checksum: 1577fbb6997711c38574b6b4ff83b210 (MD5) / Made available in DSpace on 2016-10-04T17:06:29Z (GMT). No. of bitstreams: 1 2016_MoniqueAntunesdeSouzaChelminskiBarretto.pdf: 13848185 bytes, checksum: 1577fbb6997711c38574b6b4ff83b210 (MD5) / Introdução: O zumbido é um distúrbio complexo de audição e está presente em até 80% dos pacientes portadores de perda auditiva neurossensorial súbita, tornando-se inclusive, sua principal queixa. Objetivo: Analisar o zumbido e a audição em portadores de perda auditiva neurossensorial súbita idiopática submetidos à corticoterapia. Método: Estudo analítico, observacional, prospectivo e longitudinal com 23 sujeitos (Grupo Via Oral e Grupo Resgate – corticoide intratimpânico), avaliados pelo Tinnitus Handicap Inventory (THI), Escala Analógico-Visual (EAV), Audiometria Tonal Limiar e Emissões Otoacústicas Evocadas por Produto de Distorção, antes e após três meses de tratamento. Resultados: O incômodo com o zumbido medido por meio da EAV, no Grupo Via Oral foi de 7,69 no pré tratamento e 5,30 no pós tratamento. Para o Grupo Resgate, estes valores foram de 8,30 (pré) e 5,81 (pós). No THI, a nota da gravidade do zumbido no pré tratamento para o Grupo Via Oral foi 64,77 (pré) e 45,90 (pós) e para o Grupo Resgate foi 72, 20 (pré) e 47,73 (pós). Na Audiometria, no Grupo Via Oral a média tetratonal era 74,23dB e reduziu para 59,69dB. No Grupo Resgate era 86,50dB e reduziu para 51,91dB. Ocorreu melhora tanto na amplitude quanto na relação sinal/ruído das Emissões Otoacústicas Evocadas por Produto de Distorção nas quatro frequências avaliadas (2KHz, 3KHz, 4KHz e 5KHz). Os resultados mostraram uma diminuição no incômodo, na gravidade do zumbido, diminuição dos limiares auditivos e melhora na amplitude e relação sinal/ruído das emissões otoacústicas evocadas em ambos os grupos, com diferenças significativas ao comparar pré e pós tratamento, mas não diferença estatisticamente significante entre os grupos. Conclusão: Ocorreu melhora significativa do zumbido e da audição em ambos os grupos, demonstrando a eficácia de ambos tratamentos para portadores de perda auditiva neurossensorial súbita idiopática e zumbido. O tratamento com corticoide por via intratimpânica demonstrou ser uma alternativa eficaz. ________________________________________________________________________________________________ ABSTRACT / Introduction: Tinnitus is a hearing complex disorder and is present in up to 80% of patients with sudden sensorineural hearing loss, becoming even their main complaint. Objective: To analyse the tinnitus and hearing in patients with idiopathic sudden sensorineural hearing loss treated with steroids. Method: analytical, observational, prospective, longitudinal study with 23 subjects (Oral Group and Rescue Group - corticosteroids via intratympanic), evaluated by the Tinnitus Handicap Inventory (THI), Visual Analogic Scale (VAS), pure tone audiometry and evoked otoacoustic emissions distortion product, before and after three months of treatment. Results: The annoyance caused by tinnitus, measured by VAS, in Oral Group was 7.69 at pre-treatment and 5.30 at post treatment. To the Rescue group, these values were 8.30 (pre) and 5.81 (post). At THI, the score for the Oral Group was 64.77 (pre) and 45.90 (post) and for the Rescue Group was 72.20 (pre) and 47.73 (post).At pure tone audiometry, for Oral Group, the tetratonal average was reduced from 74,23dB to 59,69dB. For Rescue Group it was reduced from 86,50dB to 51,91dB. There was an improvement in both the amplitude and the signal/noise ratio of Evoked Otoacoustic Emissions Distortion Product in the four evaluated frequencies ( 2KHz , 3KHz , 4KHz and 5KHz ). The results showed a decrease in tinnitus severety and annoyance, decreased hearing thresholds and improved amplitude and signal/noise ratio of Evoked Otoacoustic Emissions in both groups, with significant differences when comparing pre and post treatment, but no statistically significant difference between groups. Conclusion: There was a significant improvement of tinnitus and hearing in both groups , demonstrating the efficacy of corticosteroids for idiopathic sudden sensorineural hearing loss and tinnitus. Treatment with corticosteroids via intratympanic shown to be an effective alternative.

碩士 / 國立中央大學 / 電機工程研究所 / 97 / Steady-state auditory evoked field (SSAEF) is a technique which utilizes magnetoencephalography (MEG) to measure the magneto-physiological responses evoked by repetitive auditory stimuli. SSAEFs have been widely used in clinical application and suggested as a clinical idex for diagnosing the function of auditory cortex in human brain. Nevertheless, the SSVEP is susceptible to be affected by task-irrelevant noise and may sometimes deteriorate the correctness in clinical diagnoses. Accordingly, this study aims to develop an empirical mode decomposition (EMD) – based technique to extract SSAEPs so that the signal-to-noise ratio (SNR) of SSAEP can be greatly improved. The efficacy of the proposed method has been applied to study clinical tinnitus patients. The genesis of tinnitus is still unclear and lacks of a reliably objective procedure for diagnosis in clinics. Recent studies have shown the auditory evoked potential / field (AEP/AEF) in patients with tinnitus are deviant from normal subjects. These evidences imply the pathogenesis of tinnitus might be associated with the central auditory plasticity, i.e., the functional reorganization of the auditory cortex, rather than the dysfunction of peripheral auditory sensory networks. In this study, we apply the concurrent measurements of auditory steady-state fields (SSAEFs) to investigate the profound signal processing of the interhemispheric inhibition and binaural interaction. With the localization of auditory-related neural sources by applying electric current dipole (ECD), the proposed EMD-based method may be a powerful tool to shed light on studying the development of tinnitus.

碩士 / 國立交通大學 / 分子醫學與生物工程研究所 / 102 / Tinnitus is a phantom perception of sound in the absence of external sound stimulation. It is the most prevalent disorder of hearing. Unfortunately, no effective cure is currently available because of its diverse causes and clinical presentations and its underlying neural mechanisms are still poorly understood. SS-induced rat is one of widely used tinnitus animal models. The SS-induced tinnitus was associated with over-activity in the central auditory pathways, e.g., auditory cortex. Whether the lower efferent relays (e.g. lateral superior olivary complex, LSO) are involved remains unclear. In this study, we used Fos-immunohistochemistry to map the over-active neurons at the auditory pathways following a single dose of SS injection. Specifically, we examined the cochlear nucleus (CN), superior olivary complex (SOC), inferior colliculus (IC), medial geniculate body (MGB) and auditory cortex (AC). Experimental rats (n = 12) received single of SS (250 mg/kg, i.p.). Rats were sacrificed at 2 hours after the injection. Standard Fos-immunohistochemical staining procedures were used for processing frozen sections (40 µm in thickness). Control rats received saline injections. Results showed that following the SS injection there was a significant increase (p < 0.05) in the number of Fos-stains at the LSO and AC. In contrast, only small number of IC neurons expressed Fos after SS injections. MGB neurons no expressed Fos after SS injections. Results of an increase of Fos-immunoreactivity at LSO and AC suggested that the pathogenesis of SS-induced tinnitus involves an alteration in the efferent mediated feedback systems such as AC and LSO. However, how AC and LSO neurons may change their activity in a temporal manner and the details of regulation mechanisms during the pathogenesis of SS-induced tinnitus would obviously require a time-lapse study in the future.

Tinnitus aurium ist eine Hörempfindung, der kein äußeres Schallereignis zu Grunde liegt, die aber vom Betroffenen als reales, oft störendes Geräusch wahrgenommen wird. Untersuchungen am Tiermodell zeigen, dass die Tinnitusaktivität nicht wie ursprünglich angenommen im Innenohr entsteht, sondern innerhalb des zentralen auditorischen Systems generiert wird. Ein Tinnitus der für einen längeren Zeitraum bestehen bleibt ist meist nicht mehr reversibel. Man nimmt daher an, dass anhaltende molekulare Veränderungen in den Neuronen des zentralen Nervensystems zu einer Stabilisierung der Tinnitusaktivität führen. Solche anhaltenden Veränderungen gehen mit der Bildung bestimmter plastizitätsrelevanter Proteine einher. In der vorliegenden Arbeit wurde die die Bildung der Plastizitätsmarker Arg3.1 und c-Fos im auditorischen und limbischen System der Mongolischen Wüstenrennmaus (Meriones unguiculatus) nach experimenteller Tinnitusauslösung durch Salicylat untersucht und mit der Bildung dieser Proteine nach akustischer Stimulation und Salinebehandlung verglichen. Es zeigte sich, dass Arg3.1 im auditorischen Cortex (AC) vermehrt in Regionen gebildet wird in denen Neurone lokalisiert sind, die in Einklang mit der Tonotopie am besten auf die Stimulationsfrequenz antworten. Nach Salicylatinjektion liegen Arg3.1-Neurone vermehrt im hochfrequenten Bereich des AC vor. Dagegen führen Salineinjektionen zu einer uneinheitlichen Verteilung und einer schwächeren Arg3.1-Markierung. C-Fos-Neurone werden nach allen Behandlungen wesentlich häufiger gefunden und zeigen eine breitere Verteilung. In subcorticalen auditorischen Gebieten liegen im Vergleich zu den anderen Behandlungen nach Salicylatinjektion wesentlich weniger c-Fos-Neurone vor, ein Befund, der auf die salicylatbedingte Reduktion des Hörvermögens zurück geführt werden kann. In der zentralen (CeA) und lateralen Amygdala führen nur Salicylatinjektionen zu einer deutlichen Arg3.1 und c-Fos Markierung. In situ-Hybridisierungs Experimenten zeigen, dass auch die arg3.1-mRNA nur nach Salicylatinjektion in CeA erhöht ist. Die simultane Gabe von Salicylat zusammen mit dem muscarinergen Acetylcholinrezeptor-Antagonisten Scopolamin führt im Vergleich zu einer reinen Salicylatgabe zu einer Unterdrückung der Arg3.1- und c-Fos- Bildung im AC, während die Anzahl der markierten Neurone in CeA vergleichbar ist. Eine nähere Charakterisierung der Arg3.1-Neurone über Fluoreszenz-Doppelmarkierungen ergab, dass Arg3.1 in einer Untergruppe von c-Fos-Neuronen gebildet wird. Zudem liegt Arg3.1 im AC nur in exzitatorischen Pyramidenzellen vor. Die Ergebnisse der vorliegenden Arbeit zeigen, dass es nach experimenteller Tinnitusauslösung zu plastischen Veränderungen im AC und der Amygdala kommt. Dabei wird die Aktivierung des AC vermutlich über verstärkte Rückkopplungmechanismen innerhalb des auditorischen Systems, als Reaktion auf den durch salicylatbedingten Hörschaden generiert, während die plastischen Veränderungen im AC über die Aktivierung der Amygdala und ihre Projektionen in den Nucleus basalis moduliert werden. Zudem verändern sich im AC ausschließlich die exzitatorischen Pyramidenzellen.

Ljudmiljön är något som ofta blir problematiserat i dagens förskola av pedagogerna. Storleken på barngrupperna ökar i takt med att världens befolkning ökar, vilket leder till att den allmänna ljudnivån höjs i förskolan. En hög ljudmiljö påverkar inte bara pedagogerna, utan även barnen. Syftet med studien är att undersöka hur ljudmiljön i förskolan upplevs av både barn och pedagoger. För att samla in material som besvarar våra frågeställningar, har vi gjort kvalitativa undersökningar i form av decibelmätningar, observationer och intervjuer. Teorier vi använt oss av för att tolka resultatet av vårt insamlade material är barns perspektiv (barnens egna tankar), barnperspektivet (pedagogers uppfattning av barns tankar) och ramfaktorteorin (yttre faktorer som kan ha inverkan i verksamheten).  Resultatet av studien visade att barnen och pedagogerna tycker att det är hög ljudnivå på förskolan och att de ville ha lugn och ro i sin vardag. Leksakerna var en stor bidragande faktor till ljud och oljud i förskolan. Utformningen av lärmiljöerna och en närvarande pedagog var viktiga faktorer för att hålla ljudnivåerna nere. Den ständiga utsattheten av höga ljudnivåer på förskolan har lett till ohälsa hos pedagogerna med ökad stress, någon form av hörselskada och tinnitus.

No description available.

Tese (doutorado)—Universidade de Brasília, Faculdade de Ciências da Saúde, Programa de Pós-Graduação em Ciências da Saúde, 2011 / Submitted by Alaíde Gonçalves dos Santos (alaide@unb.br) on 2012-05-04T15:15:37Z No. of bitstreams: 1 2011_RonaldoCamposGranjeiro.pdf: 1157736 bytes, checksum: 7836e27f2b502e0e780e6070ab729057 (MD5) / Approved for entry into archive by Marília Freitas(marilia@bce.unb.br) on 2012-05-11T14:43:45Z (GMT) No. of bitstreams: 1 2011_RonaldoCamposGranjeiro.pdf: 1157736 bytes, checksum: 7836e27f2b502e0e780e6070ab729057 (MD5) / Made available in DSpace on 2012-05-11T14:43:45Z (GMT). No. of bitstreams: 1 2011_RonaldoCamposGranjeiro.pdf: 1157736 bytes, checksum: 7836e27f2b502e0e780e6070ab729057 (MD5) / O zumbido é mais comum em pacientes com perda auditiva, porém em torno de 10 a 20% dos casos ocorrem em pacientes com o limiar auditivo normal. Existem várias teorias responsáveis pela geração do zumbido, e é consenso que o zumbido é resultado de atividade neural anormal na via auditiva, interpretada erroneamente nos centros auditivos cerebrais.Dados da história clínica, fatores etiológicos, grau da perda auditiva e medidas psicoacústicas não têm sido relacionados ao incômodo e à intensidade do zumbido. No entanto, o incômodo do zumbido tem sido associado a transtornos de ansiedade e depressão, com ênfase no papel das disfunções cognitivas para sua percepção e interpretação. A ativação de diferentes regiões corticais e subcorticais envolvidas no mecanismo central do processamento dos sinais auditivos, da emoção, da memória e da atenção em pacientes com zumbido sugerem que essas áreas são ligadas à percepção do zumbido. Os estudos relacionados ao incômodo do zumbido têm sido realizados em pacientes com diferentes graus de perda auditiva. A proposta desta pesquisa é avaliar o incômodo do zumbido em pacientes com limiar auditivo normal e correlacionar os achados com as funções das células ciliadas externas (CCE) e os transtornos de ansiedade e depressão. O presente estudo foi realizado em 68 pacientes com zumbido (Grupo Estudo) e em 46 pacientes sem zumbido (Grupo Controle), com idade entre 20 e 45 anos e com o limiar auditivo menor ou igual 25 dB nas frequências de 500 a 8000 Hz. Foi realizado o teste das Emissões Otoacústicas com o aparelho AuDX Plus da Biologic, a avaliação do incômodo zumbido com o Tinnitus Handicap Inventory (THI) e dos níveis de ansiedade e depressão com as Escalas de Beck. No Grupo Estudo, 67% das EOAT foram alteradas, com diferença estatística significante para todas as frequências testadas. Nas EOAPD, 65,2% dos exames foram alterados, sendo frequências de 3000 Hz, 6000 Hz e 8000 Hz com diferença estatística. Ainda verificou-se que 44,1% dos pacientes possuem ansiedade e 33,3% possuem depressão, com diferença estatística significante do Grupo Controle. O incômodo do zumbido não mostrou correlação com os resultados das EOA e com o tempo de zumbido, mas com a presença de ansiedade e depressão. Em outras palavras, quanto maior o escore para ansiedade e depressão, maior o incômodo do zumbido. Ainda observou-se que, quando comparados, dentro do Grupo Estudo, os pacientes com EOA normais e alteradas, não houve diferença entre os grupos para a ansiedade e a depressão, concluindo-se que as EOA não exercem influência na presença ou na ausência de ansiedade e depressão. Por fim, parece que o incômodo do zumbido pode ser desencadeado e interpretado por áreas corticais e subcorticais de forma semelhante entre pacientes com e sem perda auditiva, o que reforça a ideia de que o gatilho periférico do zumbido não possui correlação com o seu incômodo. _______________________________________________________________________________________ ABSTRACT / Tinnitus is more common in patients with hearing loss however; in about 10 to 20 percent of cases, tinnitus occurs in patients who have a normal hearing threshold. There are several theories about what is responsible for the generation of tinnitus. The consensus is that tinnitus is a result of abnormal neural activity in the auditory pathway, which is being misinterpreted in the auditory brain centers. Factors such as clinical history, etiologic considerations, the degree of hearing loss and psychoacoustic measurements have not been linked to discomfort and the intensity of tinnitus. Pervasive, tinnitus has been associated with anxiety disorders and depression, highlighting its role in cognitive dysfunction effecting sufferer’s perception and interpretation. The activation of different cortical and subcortical regions involved in the mechanisms of the central processing of auditory signals such as emotion, memory and attention in patients with tinnitus suggests that these areas are involved in the pathology of tinnitus. This study examines the effects of tinnitus and has been conducted with patients who have different degrees of hearing loss. The purpose of this study is to evaluate the level of annoyance of tinnitus in patients with a normal auditory threshold correlating with the functions of outer hair cells (OHC) and anxiety disorders and depression. This study was conducted in 68 tinnitus patients (study group) and 46 patients without tinnitus (control group), aged between 20 and 45 with the hearing threshold of 25 dB or less at 500 to 8000 Hz. Otoacoustic Emissions tests were performed with AuUDX Plus Biologic equipment, assessing annoyance with the Tinnitus Handicap Inventory (THI) and levels of anxiety and depression with the Beck scale. In the study group, 67% of the TEOAE was altered, with a statistically significant differences for all frequencies tested. DPOAE, 65.2% of exams were altered, showing a significant statistical difference to frequencies of 3000 Hz, 6000 Hz and 8000 Hz. It was found that 44.1% had anxiety and 33.3% had depression in the study group which is statistically significantly different from the control group. The annoyance level of tinnitus showed no correlation with the results of OAE and tinnitus duration, but instead with the presence of anxiety and depression. That is, the higher the score for anxiety and depression, the greater the annoyance of tinnitus. It was found that when normal and altered OAE was compared within the study group that there was no difference between groups for anxiety and depression, concluding that the OAE has no influence on the presence or absence of anxiety and depression. Finally, it seems that the discomfort caused by tinnitus can be triggered and interpreted by cortical and subcortical areas which are similar between patients with and without hearing loss. This reinforces that the triggering of peripheral tinnitus, has no correlation with their discomfort.