Vestibular schwannoma is one of the most common tumors found in a cerebellopontine angle. Despite tumor's benignity, there are many cases that are indicated for a surgical resection. Frequently postoperative symptoms described by patients and also by literature are hearing loss, vertigo, tinnitus and weakness or numbness of face. Our work wants to show also other factors which can be damaging for patient life. We talk about postoperative headache and anxiety or depression disorders. The aim of the study will be describe these symptoms, try to find the corelations between them and determine the impact on quality of life. In our survey, patients one year after vestibular schwannoma resection recieve convenient questionnaires to fill. The questionnaires will be focused on headache disability, anxiety and depression, vestibular dysfunction and perception of quality of life.

Introduktion Menieres sjukdom är en relativt ovanlig åkomma som karakteriseras av symtom som yrsel, hörselnedsättning och tinnitus. Sjukdomen beror på en störning i innerörat som kan påverka både balans och hörsel. Mekanismen bakom Menieres sjukdom är ännu inte klarlagd, men det finns flera teorier som menar att uppkomsten av symtomen beror på ett förhöjt vätsketryck i innerörat. Flera farmakologiska och icke farmakologiska behandlingar har prövats som terapi vid Menieres sjukdom, men det finns ännu inte någon tillräckligt effektiv behandling att tillgå. Syfte Syftet med denna litteraturstudie är att ta reda på vilka farmakologiska alternativ som finns vid behandling av Menieres sjukdom och hur effektiva dessa är vid behandling av yrsel. Metod Större delen av informationssökningen till denna litteraturstudie har gjorts via databasen PubMed med hjälp av MeSH- termer, men sökmotorn Google har också utnyttjats. Information till introduktionen i detta arbete har även inhämtats från hemsidorna; fass.se och internetmedicin.se. Resultat De läkemedel som finns som behandling av yrsel vid Menieres sjukdom idag är Gentamicin, Betahistin, Diuretika och Dexametason. Det finns även teorier om att Latanoprost skulle kunna ha en gynnsam effekt vid sjukdomen. I Resultatet redovisas effekten av dessa fem läkemedel vid yrsel, utifrån studier som är gjorda för att undersöka hur gynnsamma läkemedlen är vid Menieres sjukdom. Resultatet i denna litteraturstudie bygger på fem vetenskapliga artiklar, dvs. en artikel om varje läkemedel. Enligt resultatet från samtliga studier gav alla läkemedel bättre effekt vid yrsel än placebo. Diskussion Jag valde att inrikta mig på den farmakologiska behandlingen av yrsel vid Menieres sjukdom då jag förut inte har stött på några artiklar som endast tar upp och diskuterar detta. Något jag märkte tidigt under arbetet var att det inte har gjorts så mycket forskning inom ämnet, det var därför svårt att hitta lämpliga artiklar att inkludera i mitt arbete. Tanken var från början att jag skulle jämföra effekten av de olika läkemedlen som kan användas som behandling vid Menieres sjukdom för att se vilken behandling som är att föredra. Det var dock inte möjligt att göra denna jämförelse även om jag lyckats hitta studier med samma upplägg och design. Studierna skiljer sig nämligen åt vad det gäller resultatredovisning samt val av symtomskattningsskalor. Slutsats De läkemedel som finns för behandling av yrsel vid Menieres sjukdom idag är Gentamicin, Betahistin, Diuretika och Dexametason. Ett läkemedel som kan komma att användas som ny farmakologisk behandling i framtiden är Latanoprost. Enligt resultaten från de fem olika studierna gav samtliga läkemedel bättre effekt än placebo vid behandling av yrsel hos patienter med Menieres sjukdom. Vilket läkemedel som har bäst effekt vid yrsel går dessvärre inte att avgöra. Det behövs göras fler studier inom området, för att i framtiden kunna erbjuda patienter med Menieres sjukdom en bättre behandling.

Estudios internacionales describen que los músicos pueden presentar pérdida auditiva producto de la exposición a ruido a niveles elevados de presión sonora. En Chile, se desconocen las condiciones que pueden alterar el rendimiento auditivo en los músicos, por lo que actualmente los resultados internacionales no son completamente extrapolables a esta población. Los objetivos de esta investigación son: (1) describir los hallazgos audiológicos, (2) describir los antecedentes y hábitos audiológicos, y (3) explorar la asociación entre los hallazgos audiológicos y los antecedentes y hábitos auditivos de un grupo de músicos chilenos. La muestra se constituyó por 28 músicos chilenos, con trayectoria musical mínima de 4 años ysin uso de ayudas auditiva. Se evaluó mediante cuestionario de antecedentes, otoscopia, audiometría, DPOAEs y dosimetría. Los resultados mostraron que, si bien no existe hipoacusia en el 89,3% de los sujetos, se observa la presencia de escotoma en las frecuencias 3000 a 6000Hz en el audiograma. Las DPOAEs están presentes principalmente en las frecuencias 2000Hz (85,7%) y 1000Hz (63,3%). Dentro de los síntomas presentados destacan tinitus, disminución de la audición y molestia ante ruidos fuertes. El ruido alcanzó una intensidad promedio de 116,4dBLAeq y 110dBLAeq, durante ensayos y presentaciones respectivamente. En conclusión, la prueba de DPOAEs es la más sensible en esta población, evidenciando el inicio de daño coclear. Además los músicos se exponen a altos niveles de ruido sin utilizar protectores auditivos, afectando de manera permanente su audición. / International studies describe that musicians can present product of noise exposure to high sound pressure levels hearing loss. In Chile, conditions that can alter the hearing performance in musicians are unknown, so that international results are currently not fully extrapolated to this population. The objectives of this research are: (1) describe the audiological findings, (2) describe the background and audiological habits, and (3) to explore the association between audiological findings and background and listening habits of a group of Chilean musicians. The sample consisted of 28 Chilean musicians, with a minimal musical career of four years and no use of hearing aids. It was evaluated by background questionnaire, otoscopy, audiometry and DPOAEs dosimetry. The results showed that while there is no hearing loss in 89.3% of subjects, the presence of scotoma is observed at frequencies 3000 to 6000Hz in the audiogram. DPOAEs are mainly present in 2000Hz (85.7%) and 1000 Hz (63.3%) frequencies. Among the presenting symptoms include tinnitus, hearing loss and discomfort to loud noises. The noise reached an average intensity of 110dBLAeq and 116,4dBLAeq during rehearsals and performances respectively. In conclusion, DPOAEs test is the most sensitive in this population, showing us the start of cochlear damage. Besides the musicians are exposed to high noise levels without using ear protection, permanently affecting your hearing.

Submitted in partial fulfilment of the requirements for the degree Masters in Audiology Discipline of Speech Pathology and Audiology School of Human Community Development Faculty of Humanities University of the Witwatersrand Johannesburg March / Auditory disturbances in HIV-positive individuals have been reported in the literature. Although ample research is available regarding hearing impairment in HIV-positive individuals, there is a lack of research on the effects of this virus on the vestibular system. The aim of this study was therefore to describe the audiological and peripheral vestibular characteristics of a group of HIV-positive individuals and to compare these findings with those of a group of HIV-negative individuals. A non-experimental, descriptive, cross-sectional research design was employed for the purpose of this study. Purposive sampling was used to recruit the two participant groups. The first participant group (n1) included 60 HIV-positive individuals (mean age = 41.4 years; ± 5.3; range: 23-50) whilst the second participant group (n2) included 32 HIV-negative individuals (mean age = 32.5 years; ± 9.1; range: 18-50). The clinical test protocol for both groups consisted of: case history, the Activities-specific Balance Confidence (ABC) scale, otoscopy, tympanometry, pure tone audiometry, and the head impulse test paradigm (HIMP). The findings indicate a significantly higher occurrence of tinnitus in the HIV-positive participant group compared to the control group. However, no significant differences were found between the two participant groups in respect of the remainder of the test battery. In conclusion, results from this study suggest that HIV does not seem to affect higher frequencies of the vestibulo-ocular reflex (VOR) pathway. However, as comparable fall risk and audiological results were also found between the two groups, the similar results may be attributed to new ARV guidelines and effective management. A strong agreement was found between the ABC scores and the HIMP in both participant groups. Keywords: Balance, inner ear, semi-circular canals, vestibular function, tinnitus, quality of life (QoL), human immunodeficiency virus (HIV), activities-specific balance confidence (ABC) scale, video head impulse test (vHIT), head impulse test paradigm (HIMP). / E.R. 2019

Cisplatin is a potent chemotherapeutic agent that is commonly used to treat a wide variety of tumours. Although highly effective, its administration is complicated by its ototoxic effect, a well known side effect that occurs in a significant number of patients. The hearing loss observed is typically irreversible, progressive, bilateral, high-frequency sensorineural hearing loss associated with tinnitus. At present there is no approved method for protecting or remedying against deterioration of hearing status, therefore, the detection and appropriate management of cisplatin-induced ototoxicity is reliant on effective audiological monitoring. The present study aimed to investigate the prevalence of ototoxicity in head and neck oncology patients who received cisplatin in combination with cranial irradiation. In addition, the study also aimed to examine the current state of audiological monitoring for this population at Christchurch Hospital. Post-treatment diagnostic audiological assessments were performed for 23 participants. The post-treatment assessment battery included case history, standard pure-tone audiometry (0.25 – 8 kHz), extended high-frequency audiometry (9 – 16 kHz), speech audiometry, tympanometry, acoustic reflexes and distortion product otoacoustic emissions. Prior to the assessments, a search of the Christchurch Audiology and Ear, Nose and Throat (ENT) Department oncology audiogram files was undertaken to match any previous audiograms to participating individuals. The results showed that pre-treatment assessment had been performed for 16 of the 23 participants. Of those 16, 15 participants experienced a significant cochleotoxic change in their hearing thresholds according to the ASHA criteria. One participant only received one dose of cisplatin due to deteriorating hearing, while one other participant elected to stop cisplatin treatment after the first dose due to a significant increase in tinnitus severity. Ototoxicity resulting from cisplatin chemotherapy constitutes a significant clinical problem that may have serious vocational, educational, and social consequences. Findings from this study highlight the importance of effective audiological monitoring for the timely detection and appropriate management of cisplatin-induced ototoxicity.

Ménière’s disease (MD) is an inner ear condition characterised by progressive hearing loss, tinnitus, aural fullness, and vertigo. Migraine is a common, chronic neurovascular disorder characterised by attacks of severe headaches, autonomic nervous system dysfunction, and, in some patients, visual disturbances. Patients with certain subclasses of migraine may also present with symptoms typically experienced by MD sufferers, such as vertigo, hearing loss, and tinnitus. Currently most MD cases are diagnosed through subjective criteria such as the guidelines provided by the American Academy of Otolaryngology-Head and Neck Surgery Committee on Hearing Equilibrium (AAO-HNS CHE) and the Gibson score. Migraine is diagnosed subjectively according to the International Headache Society (IHS). The purpose of this study was to investigate whether tone burst Electrocochleography (ECochG) measures, which have been found to be effective in assisting with the diagnosis of MD, may be sensitive in differentiating between suspected MD patients with and without a history of migraine. A database of 395 patients, whose medical files included ECochG records, was analysed. The ECochG data and other patient characteristics were compared between three groups, including patients who had a history of migraine and attacks of vertigo (“Migraine”), patients who had no history of migraine but reported having had headaches and attacks of vertigo (“No migraine-with headache”), and patients who reported having had attacks of vertigo but neither a history of migraine nor headaches (“No migraine-without headache”). The “Migraine” group was found to have a significantly higher proportion of “negative” ECochG cases compared to the other two groups. The “Migraine” group also had the lowest occurrence of hearing loss and lowest mean Gibson scores amongst the three groups. These findings suggest that some patients who are subjectively diagnosed with MD may have vestibular migraine instead of MD. It is, therefore, concluded that utilisation of physiological test such as ECochG may improve the differential diagnosis of MD and vestibular migraine.

Acoustic over exposure (AOE) triggers hearing loss and tinnitus but cellular mechanisms underlying those auditory defects are still poorly understood. This thesis explores the changes of excitability produced by AOE in identified cells of the rat dorsal cochlear nucleus (DCN) within the auditory brainstem. A development of a method combining Golgi silver impregnation with Nissl staining allowed study of the morphology and the distribution of the main DCN neuronal subtypes within slices containing the DCN. Whole cell patch clamp recordings allowed characterisation of the distinctive electrophysiological properties of the main DCN neuronal subtypes. In vitro stimulations of auditory or multisensory synaptic inputs showed fundamental differences in terms of the principal neurones firing pattern and the role of inhibitory synaptic transmission on firing pattern. Wistar rats were exposed to loud (110 dB SPL) single tones (15 kHz) for a period of 4 hours (protocol of AOE). Non invasive auditory brainstem response recordings were performed after 3 to 4 days and showed a significant increase of the rat’s hearing threshold for frequencies above 8 kHz. Whole cell recordings performed at a similar time (3 to 4 days) after AOE, showed that AOE led to a change of the passive and the active properties of DCN interneurones and principal cells. AOE also decreased the general excitability of the cellular network and affected differently excitatory and inhibitory synaptic transmission onto principal neurones depending on whether multisensory or auditory synaptic inputs were stimulated. Computational modelling allowed simulation of the effects of AOE on principal cell firing patterns and elaboration of a general theory whereby AOE triggers shifts of hearing thresholds concomitant with plastic adjustments in the DCN network. In conclusion, an elevation of the hearing threshold accompanied by significant excitability changes within the central auditory system could represent fundamental steps towards the development of tinnitus.

Made available in DSpace on 2015-07-22T20:50:17Z (GMT). No. of bitstreams: 0 Previous issue date: 2011-02-22 / Música é uma forma de arte que é apreciada pelas pessoas desde a Antiguidade. O avanço tecnológico permitiu que a música pudesse ser ouvida em qualquer local, por longos períodos e no volume desejado. Os objetivos deste estudo foram caracterizar os hábitos auditivos e relacioná-los aos achados audiológicos de adultos sem queixas auditivas, usuários de estéreos pessoais. Métodos: Foram avaliados 85 indivíduos, com idades entre 18 e 34 anos, com audição normal, sem exposição a ruído ocupacional. Foi solicitado para que eles respondessem a um questionário de hábitos auditivos, disponibilizado na Internet e convocados para a avaliação audiológica: Audiometria Altas Freqüências, Emissões Otoacústicas Evocadas por Estímulo Transiente (EOAT) e Emissões Otoacústicas Evocadas por Produto de Distorção (EOAPD). A mensuração do nível de pressão sonora do estéreo pessoal, no silêncio e no ruído também foi realizada. Resultados: Os participantes do estudo ficam expostos há mais de duas horas diárias à música apresentada por meio de fones de ouvidos, por mais de quatro anos, normalmente em meios de transporte. A dificuldade para entender o interlocutor em ambiente ruidoso aumenta proporcionalmente ao ruído ambiental e vinte e um indivíduos referiram ter zumbido. A maioria se preocupa com a saúde auditiva e acredita que os maus hábitos podem causar danos à audição. Observou-se um entalhe em 6 kHz no delineamento da configuração audiométrica a partir das médias dos limiares auditivos de via aérea, característico de PAIR. A maioria dos indivíduos que afirmaram ter zumbido utilizam fones de ouvido há mais de 5,1 anos. Houve uma maior porcentagem de indivíduos que usam fones de ouvido dentro do meato acústico e que apresentaram limiares de 12 kHz acima de 25 dB. Conclusões: Os resultados do presente estudo mostraram que, embora os indivíduos não apresentassem queixas auditivas, aspectos relacionados à exposição ao ruído foram evidenciados, tais como zumbido e estresse, bem como a queixa de maior dificuldade de inteligibilidade de fala à medida que o ruído ambiental era maior. A abordagem de campanhas de prevenção a danos auditivos, a partir de conseqüências psicológicas e sociais pode ser uma medida importante para a conscientização da população, principalmente dos mais jovens, cada vez mais atualizados e “equipados” com as novas tecnologias, além de mais precoces com relação a hábitos auditivos como ir a concertos, shows e baladas. / Music is a form of art which has been enjoyed by many people since Antiquity. Technological progress has enabled us to hear our favorite songs wherever, whenever and at whatever level we want through portable personal stereos for long periods of time. The aims of this study were to characterize the hearing habits of personal stereo users, without hearing complaints and to correlate the hearing habits and the audiological findings of these adults. Methods: 85 adults (54 females and 31 males), ages between 18 and 34 years, without occupational noise exposure, and personal stereo users participated in this study. They answered a questionnaire about hearing habits and had their hearing evaluations performed at the Federal University of São Paulo. The procedures included: Pure Tone Audiometry; High-frequency Audiometry; Immitance measures; Transient Evoked Otoacoustic Emissions (TEOAE) and Distortion Product Otoacoustic Emissions (DPOAE). Results: Study participants are exposed for more than two hours daily to music presented through headphones for more than four years, usually by transport. The trouble understanding the speaker in a noisy environment increases proportionally to the increase of environment noise and twenty-one subjects reported having tinnitus. The majority is worried about hearing health and believes that bad habits can damage their hearing. There was a 6 kHz notch in the delineation of audiometric configuration from the average hearing thresholds which is characteristic of Noise Induced Hearing Loss (NIHL). Most individuals who claimed to have tinnitus use headphones for over 5.1 years. There was a higher percentage of individuals who use headphones in the ear canal and the thresholds of 12 kHz above 25 dB. Conclusions: The results of this study showed that, although individuals did not show hearing complaints, issues related to noise exposure were observed, such as tinnitus and stress, reflecting the difficulty in understanding speech in noisy environments. Campaigns to prevent hearing damage that focus psychological and social consequences it can cause had an important role in increasing public awareness, especially in younger population / TEDE / BV UNIFESP: Teses e dissertações

Submitted by Isaac Francisco de Souza Dias (isaac.souzadias@ufpe.br) on 2016-02-16T16:40:00Z No. of bitstreams: 2 license_rdf: 1232 bytes, checksum: 66e71c371cc565284e70f40736c94386 (MD5) Mestrado para CCS UFPE.pdf: 3248604 bytes, checksum: 70c1dc47150b4a28d4ec56047b8ad4db (MD5) / Made available in DSpace on 2016-02-16T16:40:00Z (GMT). No. of bitstreams: 2 license_rdf: 1232 bytes, checksum: 66e71c371cc565284e70f40736c94386 (MD5) Mestrado para CCS UFPE.pdf: 3248604 bytes, checksum: 70c1dc47150b4a28d4ec56047b8ad4db (MD5) Previous issue date: 2015-05-28 / Esse estudo teve como objetivo avaliar a prevalência de DTM e de sintomas otológicos, assim como a associação entre esses fatores. Para isso, 676 voluntários com idade igual ou superior a 15 anos foram aleatoriamente selecionados dentre aqueles que buscavam atendimento médico/odontológico ou seus acompanhantes nas Unidades de Saúde da Família na cidade do Recife-PE. Características pessoais como gênero, idade e escolaridade foram coletadas durante entrevista. O perfil econômico foi analisado por meio dos Critérios de Classificação Econômica Brasil. A condição psicológica dos indivíduos, dada pela presença ou não de depressão, foi avaliada utilizando-se os Critérios de Diagnóstico em Pesquisa para DTM (RDC/TMD-Eixo II). As presenças de DTM e zumbido foram analisadas por meio do RDC/TMD-Eixos I e II, respectivamente. Já as características do zumbido, além da presença dos outros sintomas otológicos: otalgia, plenitude auricular, tontura e hipoacusia foram obtidas por meio de entrevista. A análise estatística foi realizada usando-se o teste Quiquadrado de Pearson e regressão logística (p≤0,05). Houve maior prevalência de DTM no gênero feminino (89,75%) e na faixa etária de 25-44 anos (46,8%). Nos indivíduos com DTM, foi detectada prevalência de 60,5% de zumbido, 35,2% de tontura, 27,5% de plenitude auricular, 22,7% de otalgia e 22,7% de hipoacusia. Todos os sintomas otológicos, assim como o número desses sintomas acumulados no mesmo indivíduo foram associados à DTM quando analisados isoladamente. Após a utilização do modelo de regressão logística ajustado para gênero, idade e depressão, apenas a plenitude auricular manteve a associação com a DTM. Concluiu-se que DTM e sintomas otológicos apresentaram alta prevalência na população estudada e todos esses sintomas, individualmente ou em conjunto no mesmo indivíduo, assim como gênero feminino, idade e depressão foram associados à disfunção. / The aim of this study was to evaluate the prevalence of TMD and otologic symptoms, as well as the association between these factors In this regard, 676 volunteers aged 15 years old or over were randomly selected from those who sought medical / dental care or their companions in the Family Health Units in the city of Recife. Personal characteristics such as gender, age and educational level were assessed by interview. Economic status was analyzed by means of the Brazilian Economic Classification Criteria. The psychological condition of individuals, assessed by presence or absence of depression, was evaluated using the Research Diagnostic Criteria for TMD (RDC/TMD-Axis II). Presence of TMD and tinnitus was analyzed using the RDC/TMD-Axis I and II, respectively. Tinnitus characteristics and the presence of other otologic symptoms: otalgia, ear fullness, dizziness and hearing loss were analyzed by interview. Statistical analysis was performed using Pearson Chi-square test and logistic regression (p≤0.05). There was a higher prevalence of TMD in females (89.75%) and in the age group of 25-44 years (46.8%). Depression was also associated with the presence of TMD (p≤0.05). In TMD subjects, it was observed a prevalence of 60.5% of tinnitus, 35.2% of dizziness, 27.5% of ear fullness, 22.7% of ear pain and 22.7% of hearing loss. All otologic symptoms, as well as the number of these symptoms accumulated in the same individual were associated with TMD when analyzed separately. After using the logistic regression model adjusted for gender, age and depression, just ear fullness maintained the association with TMD. It was concluded that TMD and otologic symptoms showed high prevalence in the studied population and all these symptoms, individually or together in the same individual, as well as female gender, age and depression were associated with the dysfunction.

This thesis is based on noise recordings and health evaluations carried out at preschools in the northern part of Sweden. Sound level recordings were made on individuals and by use of stationary devices in dining rooms and play halls. Health evaluations were based on ratings by use of questionnaires and by analyses of cortisol. The average equivalent individual noise exposure was 71 dB(A). The average equivalent noise levels in the dining room and playing halls were 64 dB(A). The hearing loss of the employees was significantly higher for the frequencies tested than in an unexposed control group. Symptoms of tinnitus were reported among 31% of the employees. Noise annoyance was rated as somewhat to very annoying, and the voices of the children were the most annoying noise source. The dB(A) level and fluctuations of the noise exposure were significantly correlated with the number of children per department. Stress and energy output were pronounced among the employees. About 30% of the staff experienced strong burnout syndromes. Mental recovery was low as indicated by noise fatigue and high levels of stress after work. Increased cortisol levels during work were associated with higher number of children present at the department. An essential finding of the thesis was that noise and noise sources may impair the pedagogic work, thereby increasing the work load of employees. It is concluded that noise exposure in the preschool, isolated or in combination with other stressors, plays a fundamental role in the building up of acute as well as long term stress. An intervention study implementing six acoustical and seven organizational measures was tested, aimed to improve the noise situation in the departments. Acoustical measures improved the noise situation as well as the rated noise experiences better than the organizational measures. / Avhandlingen baseras på ett samarbete med förskoleverksamheten inom Umeå kommun och har innefattat medverkan från 101 pedagoger i delstudie 1 och 24 pedagoger i en delstudie 2. Studie 1 som redovisas i tre delarbeten, I, II och III, har innefattat personburna och stationära bullermätningar i lekhallar och i matsalar. Påverkan på upplevelser samt hälsoeffekter av ljudmiljön har analyserats via frågeformulär och analyser av kortisol. Kontroll av hörselstatus har genomförts via audiometrisk screening. Studie 1 innefattar analys av bullrets effekter på såväl hörselrelaterad (Delarbete I) som stressrelaterad ohälsa (Delarbete II). Olika typer av åtgärder för att förbättra ljudmiljön och minska den bullerrelaterade ohälsan redovisas i delarbete III. Delarbete IV fokuserar på hur samverkan mellan buller och arbetsorganisation kan påverka den stressrelaterade ohälsan. Genomförda analyser av buller visar på förhållandevis likvärdiga bullerexponeringsnivåer förskolor och avdelningar emellan. Skillnaderna i exponeringsnivåer veckodagar emellan var små, skillnader mellan individer var däremot stora. Påtagliga skillnader i exponeringsnivåer förelåg som väntat under arbetsdagen. I synnerhet den personburna bulleranalysen pekade på en bullerexponering med påtagliga inslag av variation och transienter i exponeringen. Ljudmiljön karaktäriserades av medverkande pedagoger som den enskilt mest besvärande arbetsmiljöfaktorn. Barnens röster och ljud från deras aktiviteter klassificerades som de mest besvärande bullerkällorna. Personalen uppvisade sämre hörtrösklar för samtliga testade frekvenser jämfört med svensk ej bullerexponerad referenspopulation. De försämrade hörtrösklarna var relativt låga och föranledde inte i något fall remittering till hörselklinik. Prevalensen för tinnitus var 31 %, vilket motsvarar en överfrekvens på 15-20 %, jämfört med svenskt normalvärde. Ljudtrötthet efter arbetsdagens slut utgjorde ett uttalat symptom bland pedagogerna liksom försämrad sömnkvalitet och förhöjd sömnighet vid uppvaknande. Analyser av arbetsbelastning baserat på skattning och kortisolmätningar, indikerade höga energiuttag under arbete och inslag av utpräglad stress, och i flera fall utbrändhet. Signifikanta samband mellan upplevd dålig ljudmiljö, maskering av tal, försämrade förutsättningar för det pedagogiska arbetet och därmed ökad ohälsa kunde påvisas. Ljudmiljön, såväl nivåer som fluktuationer påverkades på ett uttalat sätt av antalet barn på avdelningen. Detta utgjorde också den enskilt viktigaste faktorn för att förbättra såväl ljudmiljön som den till ljudmiljön relaterade hälsan. Akustiska åtgärder visade sig genomgående mer framgångsrika för att förbättra ljudklimatet än organisatoriska åtgärder.