碩士 / 國立成功大學 / 醫學工程研究所碩博士班 / 93 / Salicylate-induced rat model is one of the animal models for tinnitus study. Since the mechanisms for the tinnitus are varied a lot, there is no break-through progress in related studies. Through the study of the salicylate-induced rat model, the conduction pathway for the auditory neurons in the brain may be activated. These activated neurons may then be fos-labeled for analysis. From the identification and distribution analysis, some mechanism of tinnitus may be revealed from the Salicylate-induced rat model study. In this study, in order to overcome the disadvantages of the manual identification of auditory neurons, a radial basis function neural network for automatic identification is developed due to its features of easy training and learning. From the experimental results, the recognition rate is demonstrated to be as high as 98%. Not only the recognition rate is improved, but also it is very objective in analysis. In addition, a support vector clustering is applied to neurons distribution analysis. Traditionally, the distribution is only characterized in number or density of neurons. Using the support vector machine, the clustering feature may be obtained as another possible parameter for analysis. Base on the clustering analysis, it is found that the cluster number and distribution area for the Salicylated-induced fos-labeled neurons are very different from those of controlled group. However, it needs to be further investigated in physiology.

Abstract Meniere’s disease (MD) is an inner ear disorder characterized by vertigo, tinnitus and sensorineural hearing impairment. An inherited form of the disease is called familial Meniere’s disease (FMD). The aim of this thesis was to describe the clinical and genetic features of Finnish FMD and to study its prevalence in Finland. In addition genetic factors previously associated with MD were studied in Finnish MD patients. A total of 38 Meniere-families were analysed in this study. In most of the families the mode of inheritance was found to be autosomal dominant. Meniere-like symptoms such as tinnitus or vertigo were common in these families even in individuals without a full triad of MD. Familial patients were affected earlier, suffered from longer spells of vertigo and had more autoimmune diseases compared to sporadic MD patients. The prevalence of FMD was studied among the patients treated in the Oulu University Hospital and Kainuu Central Hospital during the years 2005-2010. A family history of MD was probable in 23.4% of the cases, but only 9.3% could be confirmed, as it was not possible to gain information from deceased generations. Six candidate genes previously associated with MD were screened for mutations in Finnish MD patients. Two possibly adverse variations were observed in the KCNE1 gene in two patients but in none of the controls. The role of these variations in MD is still unclear and needs further study. The association of MD to the five other genes could not be confirmed, nor was Finnish FMD linked to a previously suggested locus on chromosome 12. / Tiivistelmä Menieren tauti on sisäkorvan sairaus, jolle on tyypillistä huimaus, korvien soiminen ja kuulon heikkeneminen. Tauti voi esiintyä myös perinnöllisenä. Tutkimustyön tavoitteena oli selvittää perinnöllisyyden osuutta Menieren taudissa, kuvata suomalaisen perinnöllisen Menieren taudin tyypilliset piirteet ja tutkia suomalaisessa aineistossa aikaisemmin tautiin yhdistettyjä perinnöllisiä tekijöitä. Tutkimuksessa analysoitiin 38 sukua, joissa Menieren tautia esiintyi perinnöllisenä. Suurimmassa osassa tapauksista periytyminen tapahtui vallitsevasti. Suvuissa esiintyi paljon Meniere-tyypistä oirehdintaa, kuten tinnitusta ja huimausta, ilman Menieren taudin koko taudinkuvaa. Meniere-suvuissa potilaat sairastuivat keskimääräistä aikaisemmin, kärsivät pidemmistä huimauskohtauksista ja sairastivat enemmän autoimmuunitauteja. Perinnöllisen Menieren taudin yleisyyttä tutkittiin Kainuun keskussairaalassa ja Oulun yliopistollisessa sairaalassa vuosina 2005−2010 hoidettujen potilaiden keskuudessa. Potilaista 23,4 %:lla Menieren taudin sukuhistoria oli positiivinen; kuitenkin vain 9,3 % pystyttiin vahvistamaan, sillä tietojen kerääminen edesmenneiltä sukupolvilta ei ollut mahdollista. Kuuden Menieren tautiin aikaisemmin yhdistetyn geenin merkitystä tutkittiin suomalaisessa aineistossa mutaatio- ja ehdokasgeenianalyysillä. KCNE1-geenistä löydettiin kaksi mahdollisesti proteiinia vaurioittavaa sekvenssinvaihtelua, joita ei havaittu kontrollihenkilöillä. Muutosten merkitys Menieren taudin synnyssä jäi kuitenkin epävarmaksi ja vaatii jatkotutkimuksia. Muiden geenien yhteyttä sairauteen ei pystytty vahvistamaan. Suomalainen Menieren tauti ei myöskään kytkeytynyt aikaisemmin ehdotettuun lokukseen kromosomissa 12.

We conducted a systematic and comprehensive review of the peer-reviewed scientific literature with respect to hearing loss among musicians, exposure to noise, determinants of noise exposure, and methods for controlling those exposures. Details of the literature search are given in an appendix. A one-page summary of this review is available at http://www.cher.ubc.ca/PDFs/reviews/noiseandhearingloss.pdf We found that both classical and rock musicians are at increased risk of developing noise-induced hearing loss and an associated disease, tinnitus, as a result of their exposure to music.

Dissertação (mestrado)—Universidade de Brasília, Faculdade de Ciências da Saúde, Programa de Pós-Graduação em Ciências da Saúde, 2016. / Submitted by Albânia Cézar de Melo (albania@bce.unb.br) on 2017-03-30T16:17:47Z No. of bitstreams: 1 2016_LianeSousaTeixeira.pdf: 1641774 bytes, checksum: 7c83d9b03cf3c760abac26fce6095a0b (MD5) / Approved for entry into archive by Ruthléa Nascimento(ruthleanascimento@bce.unb.br) on 2017-03-31T15:38:50Z (GMT) No. of bitstreams: 1 2016_LianeSousaTeixeira.pdf: 1641774 bytes, checksum: 7c83d9b03cf3c760abac26fce6095a0b (MD5) / Made available in DSpace on 2017-03-31T15:38:50Z (GMT). No. of bitstreams: 1 2016_LianeSousaTeixeira.pdf: 1641774 bytes, checksum: 7c83d9b03cf3c760abac26fce6095a0b (MD5) / Introdução: O zumbido é uma sensação auditiva na ausência de qualquer estímulo externo. Provoca um impacto negativo na qualidade de vida e pode interferir na concentração, no sono, em atividades sociais e, até mesmo, na estabilidade emocional. Os distúrbios do sono são a segunda comorbidade mais frequente entre pacientes com zumbido, apresentando uma prevalência variável, em torno de 25%. Objetivo: Comparar a arquitetura do sono em pacientes com e sem zumbido subjetivo crônico. Métodos: É um estudo do tipo observacional, não intervencionista, prospectivo, que foi realizado no Instituto Brasiliense de Otorrinolaringologia do Distrito Federal (IBORL), com auxílio do Instituto do Sono da Asa Norte (ISAN). A amostra foi composta por 50 indivíduos de ambos os sexos, com idades entre 20 e 60 anos. 25 pacientes com zumbido compuseram o grupo de estudo e, para comparação, foi formado um grupo controle, constituído por 25 pacientes sem queixas de zumbido. Os pacientes realizaram a polissonografia e responderam aos questionários Escala de Sonolência de Epworth, Tinnitus Handicap Inventory e Escala Visual Analógica. Resultados: Em relação aos estágios do sono, comparando-se com o grupo controle, o grupo com zumbido apresentou maiores médias nos estágios 1 e 2, e menores médias nos estágios 3 e sono REM, sendo essa diferença significativa apenas para o sono REM (p = 0,031). Isso demonstra que os pacientes com zumbido permaneceram mais tempo em sono superficial e menos tempo no sono profundo (estágio 3 e REM). Conclusão: O estudo mostrou que os pacientes com zumbido apresentaram alterações significativas na fase REM do sono. / Introduction: Tinnitus is an auditory sensation in the absence of any external stimulus. It has a negative impact on quality of life and interferes with concentration, sleep, social activities and even emotional stability. Sleep disturbances are the second most frequent comorbidity among patients with tinnitus, with a variable prevalence of around 25%. Objective: To compare sleep architecture in patients with and without chronic subjective tinnitus. Methods: This is an observational, non-interventional, prospective study conducted at the Brazilian Institute of Otorhinolaryngology of the Federal District (IBORL), with assistance from the North Asleep Sleep Institute (ISAN). The sample consisted of 50 individuals of both sexes, aged between 20 and 60 years. 25 patients with tinnitus comprised the study group and, for comparison, a control group consisting of 25 patients without tinnitus complaints was formed. The patients performed the polysomnography and answered the questionnaires Epworth Sleepiness Scale, Tinnitus Handicap Inventory and Visual Analog Scale. Results: In relation to the sleep stages, the group with tinnitus presented higher mean values in stages 1 and 2, and lower mean values in stages 3 and REM sleep, compared to the control group, and this difference was significant only for REM sleep P = 0.031). This demonstrates that patients with tinnitus remained longer in shallow sleep and less time in deep sleep (stage 3 and REM). Conclusion: The study showed that patients with tinnitus presented significant changes in REM sleep.

Dissertação (mestrado)—Universidade de Brasília, Faculdade de ciências da saúde, Programa de Pós-Graduação em Ciências da Saúde, 2014. / Submitted by Alaíde Gonçalves dos Santos (alaide@unb.br) on 2014-05-27T12:31:23Z No. of bitstreams: 1 2014_LucienySilvaMartinsSerra.pdf: 1936016 bytes, checksum: d6747b0bea24a10eea9ad1b55c57c55a (MD5) / Approved for entry into archive by Guimaraes Jacqueline(jacqueline.guimaraes@bce.unb.br) on 2014-05-27T14:19:46Z (GMT) No. of bitstreams: 1 2014_LucienySilvaMartinsSerra.pdf: 1936016 bytes, checksum: d6747b0bea24a10eea9ad1b55c57c55a (MD5) / Made available in DSpace on 2014-05-27T14:19:46Z (GMT). No. of bitstreams: 1 2014_LucienySilvaMartinsSerra.pdf: 1936016 bytes, checksum: d6747b0bea24a10eea9ad1b55c57c55a (MD5) / INTRODUÇÃO: Pacientes com queixa de zumbido apontam o incômodo do sintoma como angustiante. Há relatos descritos de tentativas de suicídio em virtude do desespero e incapacitação causados pelo zumbido. Em alguns casos, ele chega a ser mais debilitante do que a perda auditiva. Cerca de 20% dos portadores de zumbido apresentam incômodo significativo com grande prejuízo na qualidade de vida. Não foi verificado na literatura nenhum estudo que correlacionasse o grau do incômodo referido pelo indivíduo com zumbido com o exame de supressão das EOA. OBJETIVO: Correlacionar o exame de supressão de Emissões Otoacústicas Evocadas com o incômodo do zumbido referido pelo Tinnitus Handicap Inventory (THI) e pela Escala Visual Analógica (EVA). MÉTODO: Caso Controle. A amostra partiu de 80 indivíduos com zumbido e audiometria normal. Desse total, 20 apresentaram audiometria e exames de EOA normais. Esses indivíduos foram agrupados em um grupo denominado Grupo de Estudos (GE). Outro grupo, de indivíduos sem queixas audiológicas e audição normal, denominado Grupo Controle (GC) foi formado por voluntários e serviu para fins de comparação. Os participantes realizaram exames de audiometria, imitanciometria, reflexos acústicos, EOAPD, EOAT e supressão das EOAT. Os exames foram realizados em cabine acusticamente tratada com o ILO USB-V6 Clinical OAE. O estímulo foi do tipo linear na intensidade de 60 dB com apresentação de ruído contralateral na intensidade de 65dB. Foi considerado como efeito de supressão: diferenças iguais ou maiores que 0,5 dB quando comparados os exames sem e com ruído contralateral. RESULTADOS: No GE 52,9% dos exames de supressão de EOA estavam alterados e no GC esse percentual foi de 32,4% (p=0,086). O efeito de supressão das EOAT esteve ausente em 38,5% dos indivíduos com incômodo “Ligeiro” ou “Leve” e em 61,9% dos indivíduos com incômodo “Moderado” ou “Grave” (p=0,183). CONCLUSÃO: Não foi possível associar o incômodo do zumbido com o exame de supressão de EOAT, embora tenha-se observado uma tendência estatística, na qual à medida que aumenta o incômodo do zumbido, os valores do efeito de supressão diminuem. _______________________________________________________________________________________ ABSTRACT / INTRODUCTION: Patients with complaint of tinnitus describe the annoyance of the symptom as anguishing. There are reports of suicide attempts in virtue of the despair and incapacity caused by the tinnitus. In some cases, it comes to be more debiliting than the hearing loss. About 20% of the people who suffer from tinnitus present significative annoyance with great loss on the life quality. It has not been verified in the literature any study that correlates the degree of annoyance refered by the individual with tinnitus and the exam of suppression of the EOA. OBJECTIVE: Correlate the exam of Evoked Otoacustic Emissions with the annoyance of tinnitus refered by the Tinnitus Handicap Inventory (THI) and by the Analogic Visual Scale (EVA). METHOD: Control Case. The sample has begun with 80 individuals with tinnitus and normal audiometry. Of those, 20 presented normal audiometry and exams of EOA. These individuals were grouped under the label of Studies' Group (GE). Another group, of individuals without audiological complaints and normal hearing, named Control Group (GC) was formed by volunteers and served by means of comparing. The participants undergone exams of audiometry, imitanciometry, acoustic reflexes, EOAPD, EOAT and suppression of the EOAT. The exams were conducted on an acoustically treated cabin with the ILO USBV6 Clinical OAE. The stimulus was a linear type in the intensity of 60 dB with contralateral noise with presenting of contralateral noise on the 65 dB intensity. It was considered as suppression's effect: differences equal to or greater than 0.5 dB when compared the exams without and with contralateral noise. RESULTS: On GE 52,9% of the EOA suppression's exams were altered and on GC this percentage was of 32,4% (p=0.086). The EOAT suppression's effect was absent in 38,5% of the individuals with “Light” annoyance level and in 61,9% of the individuals with “Moderate” or “Severe” annoyance level (p=0.183). CONCLUSION: It has not been possible to associate the tinnitus' annoyance to the exam of EOAT suppression, although it might be possible to observe that as it increases the tinnitus' annoyance, the values of the suppression effect diminish.

Circa 3% der Menschen in einer Bevölkerung ohne Komorbiditäten sind Träger eines unrupturierten intrakraniellen Aneurysmas. Intrakranielle Aneurysmen können dabei inzidentell, also asymptomatisch und damit ein Zufallsbefund sein oder zu Symptomen wie Kopfschmerzen oder Tinnitus führen. Die schwerwiegendste Komplikation ist die Ruptur durch einen Einriss in der Gefäßwand. Die Ruptur eines intrakraniellen Aneurysmas ist die häufigste Ursache für eine nicht-traumatische Subarachnoidalblutung, einem Ereignis, das mit einer hohen Morbidität und Mortalität einhergeht. Jedoch ist das Auftreten einer Subarachnoidalblutung mit einem Risiko von circa 1,5% in 5 Jahren gegenüber der relativen Häufigkeit von intrakraniellen Aneurysmen selten. Die nahezu ubiquitäre Verfügbarkeit von MRT-Bildgebungen des Kopfes ermöglicht zudem eine frühzeitige Detektion inzidenteller Aneurysmen und so die Versorgung vor einer potentiellen Ruptur. Der präventive Verschluss des Aneurysmas geht wiederum mit einem therapie-assoziierten Risiko von circa 4% einher. Es gilt also, zwischen Patienten zu differenzieren, die vom Verschluss profitieren und Patienten, deren Blutungsrisiko kleiner ist als das Verschlussrisiko. Im Umkehrschluss bedeutet das, zwischen rupturgefährdeten und stabilen Aneurysmen zu unterscheiden. Das Ziel der vorliegenden Arbeit war es, ein Risikoprofil der lokalen Leipziger Population zu erstellen, um Patienten am Universitätsklinikum Leipzig optimal in ihrer Rupturgefährdung einschätzen und dann beraten zu können. Die folgenden 7 Faktoren wurden dabei als besonders relevant für das Beratungsgespräch herausgearbeitet: 1. Aneurysmagröße zwischen 2-9 mm, oder zunehmend 2. Anterior-Stromgebiet und A. communicans posterior als Aneurysma-Lokalisation 3. fetaler Versorgungstyp der A. cerebri posterior und Gefäßduplikaturen als ko-existente Variationen des Circulus Willisii 4. irreguläre Form des Aneurysmas 5. Alter des Patienten zwischen 40 und 60 Jahren 6. Nikotinabusus 7. arterieller Hypertonus

This thesis describes the data mining of a large set of patient records from the hearing aid clinic at James Cook University Hospital in Middlesbrough, UK. As typical of medical data in general, these audiology records are heterogeneous, containing the following three different types of data: Audiograms (graphs of hearing ability at different frequencies) Structured tabular data (such as gender, date of birth and diagnosis) Unstructured text (specific observations made about each patient in a free- text or comment field) This audiology data set is unique, as it contains records of patients prescribed with both ITE and BTE hearing aids. ITE hearing aids are not generally available on the British National Health Service in England, as they are more expensive than BTE hearing aids. However, both types of aids are prescribed at James Cook University Hospital in Middlesbrough, UK, which is also an important feature of this data. There are two research questions for this research: Which factors influence the choice of ITE (in the ear) as opposed to BTE (behind the ear) hearing aids? For patients diagnosed with tinnitus (ringing in the ear), which factors influence the decision whether to fit a tinnitus masker (a gentle sound source, worn like a hearing aid, designed to drown out tinnitus)? A number of data mining techniques, such as clustering of audiograms, association analysis of variables (such as, age, gender, diagnosis, masker, mould and free text keywords) using contingency tables and principal component analysis on audiograms were used to find candidate variables to be combined into a decision support system (OSS) where unseen patient records are presented to the system, and the relative likelihood that a patient should be fitted with an ITE as opposed to a BTE aid or a tinnitus with masker as opposed to tinnitus not with masker is returned. The DSS was created using the techniques of logistic regression, Nalve Bayesian analysis and Bayesian network, and these systems were tested using 5 fold cross validations to see which of the techniques produced the better results. The advantage of these techniques for the combination of evidence is that it is easy to see which variables contributed to the final d~~Jpion. The constructed models and the data behind them were validated by"presenting them to the Principal audiologist, Dr. Robertshaw at James Cook University Hospital in Middlesbrough for comments and suggestions for improvements. The techniques developed in this thesis for the construction of prediction models were also used successfully on a different audiology data set from Malaysia. These decisions are typically made by audiology technicians working in the out- patient clinics, on the basis of audiogram results and in consultation with the patients. In many cases, the choice is clear cut, but at other times the technicians might benefit from a second opinion given by an automatic system with an explanation of how that second opinion was arrived at.

Die Inzidenz vestibulocochleärer Symptome bei Patienten mit Morbus Fabry ist hoch. Typischerweise handelt es sich um eine progrediente sensorineurale Hörminderung im Hochtonbereich, welche einseitig beginnt und im Verlauf die Gegenseite betreffen kann. Es wird von einer Läsion auf cochleärer Ebene ausgegangen, Hinweise auf eine retrocochleäre Läsion ergeben sich nicht. Schwindel scheint einem anderen pathophysiologischen Muster zu folgen. Ergebnisse von VNG, VP und VEMP sprechen für eine teils kombinierte peripher-vestibuläre und neurogene Läsion. Histologische Funde scheinen dies zu unterstützen. Die Arbeit bringt neue Erkenntnisse über die Ausprägung vestibulocochleärer Symptome bei fortschreitender Organbeteiligung von Nieren und Herz. Die progrediente Organinsuffizienz geht mit einer signifikant zunehmenden Hörminderung einher. Dies zeigt sich bei Schwindel etwas weniger deutlich. Prognosebestimmende renale, kardiale und neurologische Komplikationen lassen Ohrsymptome, wie Tinnitus, Hörminderung und Schwindel, häufig in den Hintergrund treten, obwohl diese die Lebensqualität maßgeblich beeinflussen können. Eine ausführliche hno-ärztliche Untersuchung und regelmäßige Kontrollen sollten bei Patienten mit Morbus Fabry erfolgen. Hierfür wäre eine optimierte audiologische Diagnostik unter Beachtung der hohen Frequenzen sowie eine detaillierte vestibuläre Diagnostik empfehlenswert. / The incidence of vestibulocochlear symptoms in patients with Fabry disease is high. Typically, a progressive high frequency sensorineural hearing loss is shown, which begins on one side and can affect the opposite side later on. Here, a cochlear lesion is assumed; a retrocochlear lesion could not be revealed. Vertigo seems to follow a different pathophysiological pattern. Results of VNG, VP and VEMP indicate a partially combined peripheral-vestibular and neurogenic lesion. Histological findings seem to support these results. This work provides new insights into the severity of vestibulocochlear symptoms in comparison to the progressive organ involvement of kidneys and heart. Progressive organ failure is associated with a significant increase in hearing loss. This is less evident in vertigo. Due to the severity of the organ involvement of kidneys, heart and brain, symptoms like hearing loss, tinnitus and vertigo often are neglected although they can seriously affect the quality of life. A detailed ENT medical examination and regular check-ups should be carried out on patients with Fabry disease. For this purpose, an optimized audiological assessment considerung high frequencies and a detailed vestibular evaluation is recommended.

Dissertação (mestrado)—Universidade de Brasília, Faculdade de Ciências da Saúde, Programa de Pós-Graduação em Ciências da Saúde, 2014. / Submitted by Ana Cristina Barbosa da Silva (annabds@hotmail.com) on 2014-11-21T16:45:18Z No. of bitstreams: 1 2014_CarolinaCostaCardoso.pdf: 1194529 bytes, checksum: dc7cea8a26e81fada00b763a83606a56 (MD5) / Approved for entry into archive by Patrícia Nunes da Silva(patricia@bce.unb.br) on 2014-11-24T15:09:55Z (GMT) No. of bitstreams: 1 2014_CarolinaCostaCardoso.pdf: 1194529 bytes, checksum: dc7cea8a26e81fada00b763a83606a56 (MD5) / Made available in DSpace on 2014-11-24T15:09:55Z (GMT). No. of bitstreams: 1 2014_CarolinaCostaCardoso.pdf: 1194529 bytes, checksum: dc7cea8a26e81fada00b763a83606a56 (MD5) / Introdução: O Bone Anchored Hearing Aid (BAHA) é um sistema de condução óssea que propaga o som diretamente à orelha interna, transpondo a impedância da pele e do tecido subcutâneo. A indicação acontece para pacientes com perda auditiva mista, condutiva e neurossensorial unilateral que não se beneficiaram com o uso do Aparelho de Amplificação Sonora Individual convencional (AASI). Apesar dos benefícios do BAHA serem bem documentados internacionalmente, no Brasil ainda há escassez de estudos sobre o tema. Objetivo: Avaliar o processo de reabilitação auditiva de usuários do implante BAHA quanto aos seguintes aspectos: ganho audiológico, testes de percepção de fala e zumbido. Metodologia: Indivíduos de ambos os gêneros, portadores de perda auditiva usuários do sistema BAHA. A coleta de dados foi realizada da seguinte forma: carta convite para participação da pesquisa, termo de consentimento, audiometria tonal limiar em campo livre, audiometria de ganho funcional, testes de percepção de fala, Inventário de Handicap do Zumbido (THI) em formato aberto e Escala Visual Análoga (EVA).Todos realizados antes e após utilização do BAHA. Resultados: Foi constatado que os sujeitos obtiveram benefícios com o uso do BAHA. Em relação à acuidade auditiva, a diferença antes e depois do BAHA foi significativa. Nos testes de percepção de fala, não ocorreu diferença estatisticamente significativa. Em relação ao zumbido, no THI, 80% dos sujeitos apresentaram zumbido classificado como ligeiro após o uso do BAHA. Na Escala Visual Analóga, após o BAHA, 80% mudaram para categoria leve sendo significativo.Conclusão: Baseados nos resultados do presente estudo, podemos concluir que, nos sujeitos avaliados, houve melhora tanto com relação à percepção auditiva quanto ao zumbido. Assim, salientamos que aparelhos auditivos ancorados ao osso, com base no conceito de osteointegração, e o uso da audição por condução óssea podem beneficiar pacientes adultos e crianças, com perda auditiva condutiva, mista e neurossensorial. Também ressaltamos que a técnica cirúrgica é simples e os resultados são consistentes e favoráveis à melhora auditiva, bem como à qualidade de vida. ______________________________________________________________________________ ABSTRACT / Introduction: The Bone Anchored Hearing Aid (BAHA) is a bone conduction system that transmits the sound directly to the inner ear, surpassing the skin impedance and subcutaneous tissue. It is indicated for patients with mixed, conductive and unilateral sensorioneural hearing loss, who did not have benefits with conventional hearing aids (HA). Although the benefits of BAHA are well demonstrated internationally, in Brazil there is still a lack of studies on this area. Objective: To evaluate the auditory rehabilitation process in BAHA users in audiological, speech perception and tinnitus aspects. Methods: Individuals with hearing loss were evaluated before and after BAHA implantation. Participants were submitted to: pure tone audiometry in free field, functional gain audiometry, speech perception tests, Tinnitus Handicap Inventory (THI) in open format and Visual Analog Scale (VAS). Results: It was found that participants obtained benefits from the use of BAHA. The difference in participants’ performance before and after BAHA surgery was significant in terms of hearing acuity. There was no statistically significant difference in speech perception tests. Tinnitus evaluation showed that 80% of participants scored slight tinnitus severity in THI after using the BAHA. Eighty percent of participants classified their tinnitus as absent to mild in visual analog scale (VAS) after the BAHA surgery. Conclusion: Based on the results of this study, we can conclude that participants improved both the auditory perception and the tinnitus handicap. Bone anchored hearing aid, based on the concept of osseointegration, and the use of hearing through bone conduction can benefit children and adults with conductive, mixed and sensorioneural hearing loss. We emphasize that the BAHA system is implanted with a simple surgical technique and that the benefits are consistent and favorable to an improvement in hearing and in quality of life.

Dissertação (mestrado)—Universidade de Brasília, Faculdade de Ciências da Saúde, 2007. / Submitted by Kathryn Cardim Araujo (kathryn.cardim@gmail.com) on 2009-12-15T16:31:17Z No. of bitstreams: 1 Dissert_Marlene Escher Boger.pdf: 376459 bytes, checksum: 9e4e878c13c9cc2df54a1d206c9603fa (MD5) / Approved for entry into archive by Lucila Saraiva(lucilasaraiva1@gmail.com) on 2009-12-22T00:04:51Z (GMT) No. of bitstreams: 1 Dissert_Marlene Escher Boger.pdf: 376459 bytes, checksum: 9e4e878c13c9cc2df54a1d206c9603fa (MD5) / Made available in DSpace on 2009-12-22T00:04:51Z (GMT). No. of bitstreams: 1 Dissert_Marlene Escher Boger.pdf: 376459 bytes, checksum: 9e4e878c13c9cc2df54a1d206c9603fa (MD5) Previous issue date: 2007-07-03 / Introdução: O ruído é um dos agentes nocivos à saúde que está presente nos mais diversos ramos de atividade econômica. Entre as queixas mais relatadas por trabalhadores expostos ao ruído ocupacional, encontram-se a perda auditiva e o zumbido. Objetivo: Avaliar a influência do espectro de ruído na prevalência de Perda Auditiva Induzida por Ruído e zumbido em trabalhadores. Método: Trata-se de um estudo analítico transversal realizado em indústrias metalúrgicas, madeireiras e marmorarias, com níveis de ruído acima de 85 dB, nas quais avaliou-se o nível mínimo de respostas para as freqüências de 250Hz a 16.000Hz, e por meio de anamnese ocupacional foram identificados aspectos relacionados à morbidade. A avaliação ambiental foi realizada em 2 momentos, sendo que no primeiro verificou-se o som geral de todo o ambiente industrial, no intuito de verificar a distribuição da intensidade sonora em filtro de freqüência de oitava. No segundo momento foi realizada a avaliação da exposição individual de cada trabalhador durante sua jornada de trabalho. Resultados: Foram realizadas 192 avaliações do limiar auditivo precedidas de anamnese ocupacional. Ao avaliar a prevalência de zumbido nos trabalhadores, observou-se que 45,8% referem apresentar esta sensação, sendo que 34,1% afirmam sentir freqüentemente e 65,9% percebem o zumbido raramente. Em relação à PAIR observou-se que 49,0% dos resultados audiométricos apresentam entalhe em freqüências agudas no audiograma convencional. Destes, 13,8% em orelha direita, 23,4% em orelha esquerda e 62,8% em ambas as orelhas. Foram verificadas as médias e o desvio padrão das freqüências a partir de 3.000 Hz em todos os trabalhadores, nas quais se observa que as maiores médias encontram- se na freqüência de 6.000Hz, quando analisada a audiometria convencional. Ao avaliar as médias das altas freqüências (a partir de 8.000Hz) observa-se que as maiores médias ocorreram em 16.000Hz em orelha esquerda. A ocorrência de zumbido entre os trabalhadores com PAIR mostrou prevalência de 56,4%. As médias audiométricas dos trabalhadores com zumbido freqüente apresentaram-se piores quando comparadas às medias audiométricas dos trabalhadores com zumbido raramente. Não foi observada associação entre as bandas de freqüência com níveis intensos de ruído e a freqüência da lesão auditiva. Segundo a avaliação da dose de ruído, observa-se que em cada um dos ramos avaliados a intensidade do ruído ultrapassa 100 dB, com percentuais de dose elevados e tempo de tolerância, para permanência do trabalhador sem o uso de EPI auricular, baixíssimo. Conclusão: os resultados revelam que os trabalhadores estão expostos a níveis de ruído elevados, assim como o nível de exposição diária. O limite máximo para a dose percentual, que deveria ser 100%, é ultrapassado em todos os ramos. A ocorrência de zumbido entre os trabalhadores com PAIR apresentou forte associação neste estudo. Em relação ao espectro de ruído, conclui-se que a intensidade do ruído parece ser o principal fator de risco tanto para perda auditiva quanto para o zumbido, independentemente da banda de freqüência. Observou- se que apesar dos três ramos avaliados apresentarem espectros de ruído diferentes, as perdas auditivas encontram-se semelhantes entre os ramos. __________________________________________________________________________________________ ABSTRACT / Introduction: The noise is one of the harmful agents to the health that is present in the most different economic activity branches. Among the complaints related by workers exposed to occupational noise, there are the loss hearing and the tinnitus. Objective: To evaluate the noise spectrum influence of Noise-Induced Hearing Loss and Tinnitus prevalence in workers. Method: It is a transverse analytical study accomplished in steel mill industries, lumbers and marble shops, with noise levels above 85 dB, in which were evaluated the minimum answers level for frequencies from 250 Hz to 16.000 Hz, and by means of occupational anamnesis there were identified features related to morbidity. The ambient evaluation was accomplished in 2 moments; in the first one it was observed the whole industrial ambient sound, aiming to verify the sonorous intensity dispensation in frequency filter eighth. In the second moment, It was accomplished the individual exposed evaluation of each worker during its work journey. Results: It has been accomplished 192 hearing thresholds evaluations preceded of occupational anamnesis. When evaluating the tinnitus prevalence in workers, it was observed that 45,8% present that sensation, 34,1% affirmed the sensation frequently happens and 65,9% noticed the tinnitus rarely. Concerning to Noise- Induced Hearing Loss, it was observed that 49,0% of the audiometries results presents degradation in acute frequencies in the conventional audiogram. Among these, 13,8% in the right ear, 23,4% in the left ear and 62,8% in both ears. There were verified the average and the standard deviation for frequencies over 3.000 Hz, in all workers, in which it is observed that the biggest averages are in 6.000 Hz frequency, as for conventional audiometria. When evaluating the high frequencies average (over 8.000 Hz) it reveals that the biggest averages occurred in 16.000 Hz in the left ear. The Tinnitus occurrence among Noise-Induced Hearing Loss workers revealed 56,4% prevalence. The audiometries averages for workers presenting frequent tinnitus, revealed to be worse than audiometries averages for workers presenting rare tinnitus. It was not observed any association between the range of frequencies with intense noise levels and the damage hearing frequency. According to the noise potion evaluation, it was observed that in each branch evaluated the noise intensity exceed 100 dB, with potion percentage elevated and tolerance time, for worker continuance without using the hearing protection equipment, very low. Conclusion: The results reveal that workers are exposed to high noise levels, as or the daily exposition level. The maximum limit for percentage potion, which should be 100%, is exceeded in all branches. The Tinnitus occurrence among the Noise-Induced Hearing Loss workers revealed a strong association in this study. Concerning to noise spectrum, it is concluded that the noise intensity seems to be he main risk factor as much for loss hearing as for tinnitus, independently from the range of frequency. It was observed that despite the three evaluated branches revealed different noise spectrums, the loss hearing are similar among the branches.