Indiana University-Purdue University Indianapolis (IUPUI) / Testicular cancer is the most common solid tumor among young men. Although testicular cancer survivors (TCS) are expected to live for over 40 years after cancer diagnosis, they are at risk for chemotherapy adverse effects such as hearing loss (HL), tinnitus, and psychosocial effects. The aim of this study was to investigate factors associated with discrepancies between subjective and objective HL, factors associated with HL, and factors associated with the use of medications for anxiety/depression. TCS were enrolled in the Platinum Study. Sociodemographic characteristics, health behaviors, morbidities, and prescription medications were assessed though self-reporting using validated questionnaires. Bilateral pure-tone air conduction thresholds were collected at frequencies 0.25-12 kHz. To assess HL severity, hearing thresholds were classified according to American Speech-Language-Hearing Association criteria. Multivariable multinomial, ordinal, and binomial logistic regressions were used to test factors for association with discrepancy between subjective and objective HL, cisplatin-induced HL, and use of medications for anxiety/depression, respectively. Patients with HL at only extended high frequencies (10-12 kHz) could perceive hearing deficits; thus, it would be preferable for these frequencies to be included in audiometric assessments of cisplatin-treated adult-onset cancer survivors. Age, no noise exposure, and mixed/conductive HL were significantly associated with more underestimation of HL severity. Hearing aid use and education were significantly associated with less underestimation of HL severity. Having tinnitus was associated with more overestimation of HL severity. Age, cumulative cisplatin dose, and hypertension showed significant association with greater HL severity, whereas post-graduate education was associated with less HL severity. Factors associated with more use of medications for anxiety/depression were tinnitus, and peripheral sensory neuropathy, while being employed and engaging in physical activity were significantly associated with less use of anxiety/depression medications. The sole use of patient-reported measures of HL might not be well-suited to evaluate HL in cancer survivors; thus, the use of audiometry may complement patient-reported HL. In terms of modifiable risk factors of cisplatin-induced HL, healthcare providers should monitor patients’ blood pressure and manage hypertension appropriately. In addition, healthcare providers need to effectively manage tinnitus and peripheral neuropathy to improve treatment outcomes of anxiety and depression. / 2022-05-19

In animals, noise exposure can destroy synapses between inner hair cells and auditory nerve fibres, without widespread loss of hair cells. This 'cochlear synaptopathy' does not permanently elevate cochlear thresholds, but does permanently reduce brainstem-response amplitudes at medium-to-high stimulus levels. If this pathophysiology manifests in humans, it might constitute a 'hidden' hearing loss, leading to auditory deficits despite normal audiometric thresholds. We recruited a cohort of adults with tinnitus and normal audiograms, and compared them with controls matched for age, sex, and audiometric thresholds. We also conducted a parallel study in adults with impaired speech perception in noise (SPiN) and normal audiograms. Measures of synaptopathy in both studies were the auditory brainstem response (ABR) and envelope-following response (EFR). Lifetime noise exposure was estimated using a detailed structured interview, which has since been developed into an instrument for use by other researchers. Neither study revealed any association of auditory deficits with measures of synaptopathy, although tinnitus was associated with greater lifetime noise exposure. Finally, we conducted a study assessing the reliability and interrelations of seven proxy measures of synaptopathy. Raw amplitude and threshold measures were highly reliable, but likely reflect myriad factors besides synaptopathy. Differential ABR and EFR measures were unreliable, and purported measures of synaptopathy did not correlate. Taken together, the results of the project provide no evidence that cochlear synaptopathy is a significant aetiology of tinnitus or impaired SPiN in humans with normal audiograms. However, in light of the uncertain validity of measures of synaptopathy, absence of evidence cannot be taken as evidence of absence.

Trabajo de Investigación Requisito para optar al Título de Cirujano Dentista / El objetivo del presente trabajo de investigación fue realizar una caracterización clínica, epidemiológica y anatómica de los Trastornos Témporo Mandibulares. Este estudio se realizó en pacientes derivados a la Unidad de Cirugía Máxilo Facial del Servicio de Estomatología del Hospital Sótero del Río del Servicio de Salud Metropolitano Sur Oriente. Para realizar nuestra investigación se utilizaron instrumentos de recolección de información ad hoc. Así, se diseñó y usó dos tipos de fichas destinadas a este fin. Recaba información general del paciente y mediante un exámen clínico, información de cada uno de los sistemas anatómicos que componen la Unidad Cráneo Cérvico Facial. Las preguntas fueron abiertas, no dirigidas, ni señalando alternativas a los pacientes y se pretendió obtener la mayor cantidad de información. De una muestra total de 190 pacientes, 38 fueron sometidos a la investigación entre septiembre y noviembre en todas sus etapas. Ellos fueron examinados en un box de la Unidad de Cirugía Máxilo Facial y además de la información recolectada en sus interrogatorios y en su examen clínico, se les solicitó radiografías de perfil para determinar su clase esqueletal. Se determinó que existe una gran variación en la terminología utilizada, entre los diagnósticos realizados en el lugar en que se origina la interconsulta a la Unidad de Máxilo facial. 120 Mediante análisis estadísticos se determinó que los cuadros afectan mas al género femenino. Son crónicos y todos los sistemas anatómicos y funcionales investigados presentan algún grado de compromiso o alguna condición favorable en distintos grados para el desarrollo de los Trastornos Témporo Mandibulares. Además, acostumbran consultar otras disciplinas médicas. En los pacientes sometidos a la investigación se observó bajo compromiso con el cuidado dental y periodontal y con los controles que le indica su Dentista de Consultorio. Tienen mecanismos aprendidos propios para el control del dolor y ciertos aspectos de la calidad de vida se ve alterada en forma crónica. Sobre el sistema dental/periodontal, se encontró en condiciones regulares. Presentó además condiciones favorables para el establecimiento y/o perpetuación de los TTM, como son contactos prematuros , falta de mesa oclusal posterior, etc. El sistema muscular mostró diverso compromiso de sus componentes . Articularmente se presentaron los signos y síntomas que refiere la literatura . Ruidos en alto porcentaje y dolor preauricular. Esqueletalemente, la muestra se presentó con clase II esqueletal . El compromiso neurológico fue principalmente del VIII par., expresado por la presencia de mareos , vértigo y/o tinnitus. 121 Sobre el momento de mayor dolor, el área que en mayor porcentaje se hallaba comprometida era la preauricular , seguida del borde posterior mandibular. En menor porcentaje otras áreas. Respecto de los tratamientos que se realizan en el Servicio, no se determinó la presencia de protocolos de estudio o terapéuticos comunes entre los tratantes.

Introduction. Mobile health (mHealth) integrates mobile devices into healthcare, enabling remote monitoring, data collection, and personalized interventions. Machine Learning (ML), a subfield of Artificial Intelligence (AI), can use mHealth data to confirm or extend domain knowledge by finding associations within the data, i.e., with the goal of improving healthcare decisions. In this work, two data collection techniques were used for mHealth data fed into ML systems: Mobile Crowdsensing (MCS), which is a collaborative data gathering approach, and Ecological Momentary Assessments (EMA), which capture real-time individual experiences within the individual’s common environments using questionnaires and sensors. We collected EMA and MCS data on tinnitus and COVID-19. About 15 % of the world’s population suffers from tinnitus. Materials & Methods. This thesis investigates the challenges of ML systems when using MCS and EMA data. It asks: How can ML confirm or broad domain knowledge? Domain knowledge refers to expertise and understanding in a specific field, gained through experience and education. Are ML systems always superior to simple heuristics and if yes, how can one reach explainable AI (XAI) in the presence of mHealth data? An XAI method enables a human to understand why a model makes certain predictions. Finally, which guidelines can be beneficial for the use of ML within the mHealth domain? In tinnitus research, ML discerns gender, temperature, and season-related variations among patients. In the realm of COVID-19, we collaboratively designed a COVID-19 check app for public education, incorporating EMA data to offer informative feedback on COVID-19-related matters. This thesis uses seven EMA datasets with more than 250,000 assessments. Our analyses revealed a set of challenges: App user over-representation, time gaps, identity ambiguity, and operating system specific rounding errors, among others. Our systematic review of 450 medical studies assessed prior utilization of XAI methods. Results. ML models predict gender and tinnitus perception, validating gender-linked tinnitus disparities. Using season and temperature to predict tinnitus shows the association of these variables with tinnitus. Multiple assessments of one app user can constitute a group. Neglecting these groups in data sets leads to model overfitting. In select instances, heuristics outperform ML models, highlighting the need for domain expert consultation to unveil hidden groups or find simple heuristics. Conclusion. This thesis suggests guidelines for mHealth related data analyses and improves estimates for ML performance. Close communication with medical domain experts to identify latent user subsets and incremental benefits of ML is essential. / Einleitung. Unter Mobile Health (mHealth) versteht man die Nutzung mobiler Geräte wie Handys zur Unterstützung der Gesundheitsversorgung. So können Ärzt:innen z. B. Gesundheitsinformationen sammeln, die Gesundheit aus der Ferne überwachen, sowie personalisierte Behandlungen anbieten. Man kann maschinelles Lernen (ML) als System nutzen, um aus diesen Gesundheitsinformationen zu lernen. Das ML-System versucht, Muster in den mHealth Daten zu finden, um Ärzt:innen zu helfen, bessere Entschei- dungen zu treffen. Zur Datensammlung wurden zwei Methoden verwendet: Einerseits trugen zahlreiche Personen zur Sammlung von umfassenden Informationen mit mo- bilen Geräten bei (sog. Mobile Crowdsensing), zum anderen wurde den Mitwirkenden digitale Fragebögen gesendet und Sensoren wie GPS eingesetzt, um Informationen in einer alltäglichen Umgebung zu erfassen (sog. Ecologcial Momentary Assessments). Diese Arbeit verwendet Daten aus zwei medizinischen Bereichen: Tinnitus und COVID-19. Schätzungen zufolge leidet etwa 15 % der Menschheit an Tinnitus. Materialien & Methoden. Die Arbeit untersucht, wie ML-Systeme mit mHealth Daten umgehen: Wie können diese Systeme robuster werden oder neue Dinge lernen? Funktion- ieren die neuen ML-Systeme immer besser als einfache Daumenregeln, und wenn ja, wie können wir sie dazu bringen, zu erklären, warum sie bestimmte Entscheidungen treffen? Welche speziellen Regeln sollte man außerdem befolgen, wenn man ML-Systeme mit mHealth Daten trainiert? Während der COVID-19-Pandemie entwickelten wir eine App, die den Menschen helfen sollte, sich über das Virus zu informieren. Diese App nutzte Daten der Krankheitssymptome der App Nutzer:innen, um Handlungsempfehlungen für das weitere Vorgehen zu geben. Ergebnisse. ML-Systeme wurden trainiert, um Tinnitus vorherzusagen und wie er mit geschlechtsspezifischen Unterschieden zusammenhängen könnte. Die Verwendung von Faktoren wie Jahreszeit und Temperatur kann helfen, Tinnitus und seine Beziehung zu diesen Faktoren zu verstehen. Wenn wir beim Training nicht berücksichtigen, dass ein App User mehrere Datensätze ausfüllen kann, führt dies zu einer Überanpassung und damit Verschlechterung des ML-Systems. Interessanterweise führen manchmal einfache Regeln zu robusteren und besseren Modellen als komplexe ML-Systeme. Das zeigt, dass es wichtig ist, Experten auf dem Gebiet einzubeziehen, um Überanpassung zu vermeiden oder einfache Regeln zur Vorhersage zu finden. Fazit. Durch die Betrachtung verschiedener Langzeitdaten konnten wir neue Empfehlun- gen zur Analyse von mHealth Daten und der Entwicklung von ML-Systemen ableiten. Dabei ist es wichtig, medizinischen Experten mit einzubeziehen, um Überanpassung zu vermeiden und ML-Systeme schrittweise zu verbessern.

博士 / 高雄醫學院 / 醫學研究所 / 87 / Hearing system is the main route by which the animals perceive message in auditory sense. Apart from ascending and descending pathways, there are two feedback systems in the auditory brain that protect the mammals from excessive noise. The first one is the middle—ear muscle reflex and the other system is the olivocochlear efferent system that is originated from the superior olivary complex and projecting towards the cochlea named olivocochlear bundle (OCB). Most of literatures reported that OCB could inhibit the activities and excitation of outer hair cells and auditory nerve so reduce the overstimulation of inner ear and then protect from hearing damage. Hearing is an important sensory input to an animal, hence a hearing impaired animal would exhibit modified behavior compared with a hearing intact animal. Scarce literatures had been devoted to the study of such modified behavior in hearing impaired animal. Thus, this thesis is aimed to study the changes of the animals whose OCB has been demolished by radiofrequency current after stereostaxis. In the present studies, electrophysiological methods, long-term locomotor activity monitoring and Fos immunohistochemistry (early gene c-Fos) shall be used to examine and to provide evidences of OCB actions in central auditory system during acute, chronic effects and protective role under noise exposure. Brainstem auditory evoked potential (BAEP), as the name implies, records the electrical potentials of the ascending auditory pathway during the first 10ms after external stimulus and it reflects the auditory related neuronal activity in the brainstem. This method was used to record the changes took placed after OCB lesion of rats. The results showed no significant changes in the BAEP peak latencies could be observed but the BAEP amplitudes from waves I to III were increased significantly. It meant that the suppressed effect of OCB was removed from ascending pathway and cochlear nucleus, hence leading to the increase in numbers of neurons that discharge action potentials and the increased BAEP amplitudes reflected such neuronal hyperactivity. Meanwhile, long-term locomotor activity monitoring recorded an increased activity of the OCB-lesion rat especially exploring and stereotype behaviors. We hypothesized that the impaired OCB not long imposed an inhibitory effect on the hearing so the animals perceived more external stimuli than before and this reflected on the increased in exploring and locomotor activities. Apart from the electrophysiological study, tone-evoked expression of early gene c-fos could also provide direct evidence at molecular level of the consequences before and after the OCB was disrupted. The Fos immunohistochemical study showed that tone-evoked Fos-like immunoreactivity was present in auditory neurons of OCB-lesion, sham-operated and normal rats under no noise exposure. After moderate-intensity noise exposure for 5 days, the Fos only appeared in sham-operated and normal groups but not in OCB-lesion group. The hearing threshold levels were all increased in three groups especially the OCB-lesion group. The Fos all disappeared in three groups of rats after continuations of 10-day moderate-level or high-level noise exposure following 10-day moderate-level noise exposure. This signified that while the OCB was lesioned, the auditory system would be more vulnerable and a further increased in hearing thresholds that would cause Fos induction impossible and difficult. Due to the importance of OCB in electrophysiology and locomotor activity, interests were aroused in seeking possible connection between OCB lesion and tinnitus. Tinnitus is a disturbing symptom with poorly understood etiology and mechanism. The majority of literatures suggest that the disinhibition after OCB was damaged would allow the OHC to continue firing hence leading to hyper-responsiveness of auditory afferents and was the possible generation of tinnitus. One aspect in our studies is to compare our OCB lesion animal model with the popular established model that is postulated by aspirin (salicylate) injection. We replicated the aspirin-induced tinnitus animal model, also measured the BAEP and recorded the locomotor activity and then compared with the OCB-lesion rats to find if there were any comparable observations. The results showed that the BAEP latencies were decreased but amplitude was no changes 80 minutes after aspirin injection. In the OCB-lesion model, the BAEP amplitudes were enlarged without latency delay. Locomotor activity monitoring provided other measurement after aspirin injection. The locomotor activity of the rat decreased significantly after aspirin injection but the OCB-lesion rat exhibited increased locomotor activity. All the aforementioned data indicated that aspirin-injection and OCB-lesion groups would produce substantially different results. Hence we proposed that tinnitus would not be produced at all after the OCB was damaged, or at a wilder sense, the two ways of eliciting tinnitus were so radically different that resulted in two distinctive different responses of animals. In conclusion, this thesis confirms that the OCB lesion and the aspirin-induced tinnitus animal models were in fact different models and shall not be replaced.

Introduction: Cisplatin chemotherapy causes ototoxicity manifested as sensorineural hearing loss and/or tinnitus. Ototoxicity is induced via damage to the inner ear by reactive oxygen species. Dexamethasone reduces reactive species and has a well-documented history of transtympanic clinical use for various cochlear disorders. / Objectives: Determine the effect of transtympanic dexamethasone on cisplatin ototoxicity in a guinea pig animal model. / Material and Methods: Pre- and post-treatment Auditory Brainstem Responses (ABRs) were compared to measure threshold changes in 58 guinea pigs. The optimal ototoxic dose of cisplatin, the safety of dexamethasone and the effect of dexamethasone on cisplatin ototoxicity were examined. / Results: Cisplatin at a dose of 12 mg/kg induces significant hearing loss (p < 0.05) with minimal mortality. Transtympanic dexamethasone in cisplatin-treated guinea pigs showed signs of otoprotection particularly in the lower frequencies. / Conclusion: Transtympanic dexamethasone presents as a simple, safe and potentially effective treatment modality against cisplatin ototoxicity. / Introduction: La chimiotherapie au cisplatin cause une perte auditive ototoxique induite par dommages à l'oreille interne par des espèces réactives. La dexaméthasone réduit les espèces réactives et a déjà fait ses preuves dans des traitements trans-tympaniques (TT) de pathologies cochléaires. / Objectifs: Déterminer l'effet de la dexaméthasone TT sur l'ototoxicité du cisplatin chez le cobaye. / Matériel et méthodes: Les potentiels auditifs évoqués du tronc cérébral (PTE) ont été comparés chez 58 cobayes. La dose ototoxique optimale du cisplatin, la sécurité de la dexaméthasone et l'effet de la dexaméthasone sur l'ototoxicité du cisplatin ont été examinés. / Résultats: 12 mg/kg de cisplatin induit une perte auditive significative (p < 0.05) avec une mortalité minime. La dexaméthasone TT a montré des signes d'otoprotection chez les cobayes traités au cisplatin surtout dans les basses fréquences. / Conclusion: La dexaméthasone TT se présente comme une modalité de traitement simple, sécuritaire et potentiellement efficace contre l'ototoxicité produite par le cisplatin.

Mémoire en recherche-création / la liste de mes jointures récupère certaines paroles reçues, bruits parasitaires qui restent comme les acouphènes. Ils se déclenchent parfois à la suite d’un stress : les sifflements de la narratrice empirent au secondaire. Le trouble alimentaire aussi. Poésie du déséquilibre, la liste de mes jointures recense les chutes, les absences, les jugements, la jumelle qui nous échappe. Chaque section du recueil relie une partie du corps à une pièce de la maison. Et la peur de mourir à celle de vivre. Le regard des autres et de soi-même sont des miroirs impossibles à décrocher. L’alliance entre le corps et la maison se rencontre aussi dans Lecture en vélocipède d’Huguette Gaulin. Difficile à cerner, le quotidien apparaît aussi fragmenté que le sujet poétique : la maison est le lieu où tous deux se reconstruisent. Avec Habiter le corps : mise en scène du quotidien dans Lecture en vélocipède d’Huguette Gaulin, on a accès au dialogue entre l’intérieur et l’extérieur, au dédoublement du manque et à une maternité sans fin. / the list of my knuckles retrieves some words heard, paratic noises who stay like tinnitus. These are often triggered by anxiety : the narrator’s ringing gets worse in high school. The eating disorder too. Poetry of imbalance, the list of my knuckles inventories falls, absences, judgments, the twin sister who gets away from us. Each section of the book connects a part of the body to a room in the house. And a fear of dying to a fear of living. The gaze of others and of oneself are mirrors impossible to take down. Lecture en vélocipède of Huguette Gaulin also joins the body to the house. Everyday life is hard to define and appears as divided as the poetic subject : they both rebuild themselves in the house. Habiter le corps : mise en scène du quotidien dans Lecture en vélocipède d’Huguette Gaulin gives us access to the dialogue between the inside and the outside, the duplication of a lack and to an endless motherhood.

Methicillin-resistenta Staphylococcus aureus (MRSA) som bär på genen mecA, har förekommit och spridit sig över hela världen, främst i sjukhusmiljö, och orsakat utbrott av vårdrelaterade (så kallade nosokomiala) infektioner. Dessa infektioner kan inte behandlas med stafylokock-penicilliner och MRSA-bakterierna är ofta resistenta även mot flera andra grupper av antibiotika vilket medför att infektionerna ofta är påtagligt svårbehandlade. Under senare år har emellertid allt fler fall beskrivits av samhällsförvärvad MRSA infektion, det vill säga uppträdande av MRSA hos personer som tidigare ej har haft kontakt med sjukhusvård eller behandlats med antibiotika. Det har länge varit oklart om de samhällsförvärvade MRSA [community-acquired (CA-MRSA)] representerar spridning av bakterier från sjukhusmiljön ut till samhället eller om dessa MRSA är spontant uppträdande. Många av dessa stammar har dessutom visat sig bära på sjukdomsrelaterade gener som vanligen inte återfinns hos S. aureus, t.ex. Panton Valentine leukocidin (PVL) som associeras med hudinfektioner och allvarlig lunginflammation med hög dödlighet hos unga och annars friska individer. Denna avhandling beskriver den molekylära epidemiologin hos MRSA med fokus på samhällsförvärvade MRSA som utgjorde mer än hälften av samtliga fall av MRSA i Örebro län och som dessutom ofta producerade PVL toxinet, vars funktion vidare analyserades i detalj. Undersökning av ursprung och släktskap hos samtliga MRSA som isolerats i Örebro län, samt karaktärisering av det genetiskt element som kallas staphylococcal cassette chromosome mec (SCCmec) vilket innehåller genen mecA och ibland även andra resistensgener, visade att CA-MRSA inte är relaterade till de nosokomiala MRSA, och att dessa har uppstått oberoende av varandra. Flertalet MRSA visade sig dessutom bära på SCCmec, och resistensmekanismer, som tidigare inte beskrivits. Troligen har dessa MRSA uppstått genom ett genetiskt utbyte av SCCmec mellan methicillin-resistenta koagulas-negativa stafylokocker (MR-KNS), som utgör huvudparten av normalfloran på huden, och methicillin-känsliga S. aureus som därvid erhåller genen mecA och resistensmekanismer mot samtliga stafylokockantibiotika. I den här avhandlingen framläggs bevis för att ett sådant genetiskt utbyte har skett på Barnkliniken på Universitetssjukhuset i Örebro i slutet på 1990-talet, vilket resulterade i uppkomsten av en ny klon av MRSA som därefter orsakade ett allvarligt utbrott. Kartläggning av DNA-sekvensen hos flertalet unika SCCmec från svenska MRSA gav dessutom en bättre förståelse för hur resistens uppkommer och sprider sig, samt mekanismerna bakom detta. Dessa nya kunskaper kan bidra till en förbättrad diagnostik av MRSA. Detta är framför allt av stor betydelse eftersom nya effektiva kloner av MRSA verkar kunna uppstå ute i samhället med potential att orsaka svårbehandlade infektioner men även att sprida sig bland den friska befolkningen. / Material and methods - During a period of 14 years, around 2000 patients with head injuries were admitted to the emergency ward at Lindesberg County Hospital and Örebro Medical Centre Hospital. Six hundred subjects suffered from skull fracture and/or brain contusion and diagnosis was established using a computed tomography scan (CT). The degree of initial brain injury was estimated using the Swedish Reaction Level Scale (RLS). Sixty-six subjects were investigated with pure tone audiometry in close proximity to the trauma, and this gave an opportunity to study the issue of progress. The investigation took place two to 14 years after trauma, and the results were compared to matched control groups. A battery of different audiological methods was used to investigate peripheral and central auditory function, and a specially designed acoustic environmental room was also utilized. Cognition was investigated using a computer-based test-battery, text information process system (TIPS). Self-assessed hearing, cognition and quality of life were explored using different questionnaires. Results - A high percentage of peripheral and central auditory impairments and also cognitive shortcomings were demonstrated. Progress of SNHL was a common finding, and fracture, high age at trauma and large initial hearing loss predicted progress. Antibody-mediated autoimmunity as a mechanism behind posttraumatic progress of SNHL or clear evidence for sympathetic cochleolabyrinthitis could not be demonstrated. Binaural auditory deficits could be demonstrated when tested in a realistic acoustic environment. Tinnitus, vertigo and memory shortcomings proved to be common sequelae, even in a long-term perspectiveCognitive shortcomings were found in several of these well-rehabilitated subjects.On a group level, there was a good correlation between self-assessments and audiometric results, even if some individuals had a tendency to over- or underestimate their abilities. Conclusion - Auditory and cognitive long-term sequelae of CHI are a common finding even in well-rehabilitated and socially well-functioning subjects, as are vertigo and tinnitus. Vertigo and tinnitus are also common sequelae after CHI, therefore a basic audiovestibular investigation after CHI is recommended, at least in selected cases.Early awareness of the risk for hearing and cognitive sequelae after CHI could lead to measurements taken to prevent tension-related symptoms.Early detection of HI offers an opportunity to try immunosuppressive treatment in cases with a large initial SNHL.

Submitted by Daniella Santos (daniella.santos@ufma.br) on 2017-08-16T11:54:15Z No. of bitstreams: 1 Mariana de Oliveira Sanchez.pdf: 1926503 bytes, checksum: d73b97b83fdb0cbabcd732772b5d3c10 (MD5) / Made available in DSpace on 2017-08-16T11:54:15Z (GMT). No. of bitstreams: 1 Mariana de Oliveira Sanchez.pdf: 1926503 bytes, checksum: d73b97b83fdb0cbabcd732772b5d3c10 (MD5) Previous issue date: 2017-02-23 / FAPEMA / Background: Temporomandibular disorder (TMD) is a group of clinical signs and symptoms that may affect the orofacial musculature and the temporomandibular joint. Its etiology is multifactorial, however, depression has been indicated in the literature as one of the risk factors, and there is a need for studies to elucidate the performance of depression in the development of TMD. Objectives: To study the association of depression and the presence of temporomandibular disorder in students. Methods: Cross-sectional study of TMD prevalence, involving 763 students, from a simple random sample. For the description of the TMD symptoms, the Fonseca’s Anamnesic Index (FAI) and the Research Diagnostic Criteria for Temporomandibular Disorders (RDC/TMD) axis II were used. After, 168 subjects diagnosed with severe depression were submitted to the RDC/TMD axis I to diagnose TMD and the axis II of the same questionnaire for questions about parafunctional habits, tinnitus, perception of occlusion and headache. Results: The prevalence of TMD was 63.8% and that of signs and symptoms of depression was 47.6%. Carriers of severe depressive symptoms had a risk 12.51 times higher of developing TMD signs and symptoms when compared to the students with no signs and symptoms of TMD and depression (p <0.01). Among the college students with severe depression symptons (p<0.05) a significant association was observed between the diagnosis of TMD and reports of diurnal (95.2%) and nocturnal (91.9%) parafunctional habits, report of tired jaw (93.8%), presence of tinnitus (91.9%), feeling that the teeth do not articulate well (90.3%) and headache (89.7%). Creaking or clenching teeth (OR = 7.61, CI = 1.51-38.26), presence of tinnitus (OR = 3.83, CI = 1.34-10.95) and presence of headache (OR = 6.80; CI = 2.67-17.28) were indicators of increased risks of developing TMD among college students with severe depressive symptomatology. Conclusions: There was a statistically significant association between the presence of signs and symptoms of TMD and depression. As greater the severity of the symptoms of depression, higher the risk to develop TMD signs and symptoms. There was a high prevalence of TMD in college students with severe signs and symptoms of depression, highlighting an increased risk of developing TMD among those who self-perceived diurnal parafunctional habits, tinnitus and headache. / Introdução: A disfunção temporomandibular (DTM) é um conjunto de sinais e sintomas clínicos que podem acometer a musculatura orofacial e a articulação temporomandibular. Sua etiologia é multifatorial, entretanto, a depressão tem sido apontada na literatura como um dos fatores de risco, havendo a necessidade de elucidar a atuação da depressão no desenvolvimento da DTM. Objetivos: Estudar a associação da depressão e presença de disfunção temporomandibular em estudantes. Métodos: Estudo transversal de prevalência de DTM, envolvendo 763 estudantes de uma faculdade de um município da região nordeste do Brasil, a partir de uma amostra aleatória simples, no período de agosto de 2015 a fevereiro de 2017. Para a descrição da sintomatologia da DTM foi utilizado o Índice Anamnésico de Fonseca (IAF) e para a identificação de sinais e sintomas de depressão foi aplicado o Research Diagnostic Criteria for Temporomandibular Disorders (RDC/TMD) eixo II. Posteriormente, 168 sujeitos com diagnóstico de depressão grave foram submetidos ao RDC/TMD eixo I para diagnosticar DTM e o eixo II do mesmo questionário para as questões sobre hábitos parafuncionais, zumbido, percepção da oclusão e dor de cabeça. Resultados: A prevalência de DTM foi de 63,8% e de sinais e sintomas de depressão foi de 47,6%. Portadores de sintomas depressivos graves apresentaram uma prevalência de 26,2% e um risco 12,51 maior de desenvolver sinais e sintomas de DTM quando comparados a estudantes sem sinais e sintomas de DTM e depressão (p<0,01). Entre os universitários com sintomas grave de depressão, observou-se uma associação significativa (p<0,05) entre o diagnóstico de DTM e relatos de hábitos parafuncionais diurno (95,2%) e noturno (91,9%), relato de mandíbula cansada (93,8%), presença de zumbido (91,9%), sensação de que os dentes não se articulam bem (90,3%) e dor de cabeça (89,7%). As variáveis de ranger ou apertar os dentes acordado (OR= 7,61; IC=1,51-38,26), a presença de zumbido (OR=3,83; IC=1,34-10,95) e a presença de dor de cabeça (OR= 6,80; IC=2,67-17,28) foram indicadores de maiores chances de desenvolver DTM entre os universitários com sintomatologia depressiva grave. Conclusões: Houve associação estatisticamente significante entre a presença de sinais e sintomas da DTM e da depressão. Quanto maior a gravidade da sintomatologia da depressão maior o risco de desenvolver sinais e sintomas da DTM. Houve elevada prevalência de DTM em universitários com sinais e sintomas graves de depressão, destacando-se_aumento de DTM entre os que autoperceberam hábitos parafuncionais diurno, zumbido e dor de cabeça.

In der vorliegenden Arbeit erfolgte ein Vergleich von 203 Patienten, die sich mit dem Symptom Schwindel in der neurootologischen Abteilung der HNO-Klinik der Universität Würzburg zwischen Januar 2002 und Dezember 2004 vorgestellt haben und zum Zeitpunkt der Untersuchung mindestens 60 Jahre alt waren. Die Patienten wurden im Gesamtkollektiv und auf geschlechts- sowie altersspezifische Unterschiede untersucht. Die meisten Patienten litten seit Jahren an Schwindelanfällen, die Sekunden dauern. Über 80% gaben eine Hörminderung und über 60% ein Ohrgeräusch an. Ca. 60% hatten einen Spontannystagmus nach rechts oder links. Im Geschlechtervergleich zeigte sich, dass Frauen vor allem unter Drehschwindel und Unsicherheit litten, wogegen Männer vermehrt über Schwankschwindel berichteten. Mit zunehmendem Alter gaben mehr Patienten Schwankschwindel und Fallneigung an und weniger Patienten berichteten über Drehschwindel. Zudem sank das Vorkommen von vegetativen Symptomen. Audiologisch wurde einen zunehmende Hörminderung vor allem im hohen Frequenzbereich erfasst. In der neurootologischen Untersuchung zeigten sich ein Rückgang der Spontannystagmusfrequenz mit steigendem Lebensalter sowie eine Abnahme der durchschnittlichen Perrotatoriusschlagzahl bei Links- und Rechtsdrehung. Auch in dieser Arbeit konnte aufgezeigt werden, dass Schwindel mit steigendem Lebensalter häufiger auftritt und Symptom vieler Erkrankungen sein kann. / Vertigo is a common complaint in older patients. This thesis analysed 203 patients 60 years and older with the symptom of vertigo. All patients came to the ENT Department of the University Hospital in Würzburg (Germany) between January 2002 and December 2004. Most patients suffered for several years from vertigo that lasted for seconds. Over 80 % complained about reduced hearing ability and over 60 % about tinnitus. Approximately 60 % had a spontaneous nystagmus to the left or to the right side.With increasing age more patients suffered from dizziness and drop attack and less patients from vertigo.In addition the incidence of vegetative symptoms was reduced. The thesis proved again that vertigo occurs more often in elderly people and that it can be a symptom of different diseases.