Objetivo: Avaliar tipo e frequência de alteração vestibular por meio de vectoeletronistagmografia em indivíduos com Disfunção Temporomandibular (DTM) de origem muscular. Método: Foram incluídos neste estudo 25 pacientes do gênero feminino, com faixa etária de 18 a 44 anos de idade com DTM muscular, classificada de acordo com os critérios do questionário já validado Research Diagnostic Criteria for Temporomandibular Disorders (RDC). Todos os indivíduos foram submetidos à avaliação otoneurológica, composta por anamnese, meatoscopia e vectoeletronistagmografia computadorizada. Resultados: Foram encontrados apenas três sujeitos com alteração na vectoetronistagmografia (alteração do nistagmo pós-calórico). Houve elevada ocorrência de sintomas otoneurológicos, dentre eles: tontura (96%), intolerância a sons altos, cinetose (76%), insônia (72%), plenitudeaural (64%) e zumbido (52%). Os músculos que apresentaram prevalência de dor à palpação foram: tendão do músculo temporal (96%), pterigóideo lateral (96%), masseter médio (92%) e masseter Inferior (68%). Não houve diferença estaticamente significante entre indivíduos com e sem alteração na vectoeletronistagmografia em relação aos principais sintomas otoneurológicos. Também não foi observada diferença estaticamente significante entre mulheres com e sem vertigem com relação à dor à palpação nos músculos estudados. Conclusão: Indivíduos com DTM do tipo muscular apresentaram baixa taxa de alterações vestibulares evidenciadas pelo exame de vectoeletronistagmografia computadorizada, apesar da elevada ocorrência de sintomatologia otoneurológica. / Objective: To evaluate the type and frequency of vestibular alteration through vectoelectronystagmography in individuals with temporomandibular disorder (TMD) muscle. Method: The study included 25 female patients, aged 18 to 44 years old with muscular TMD, classified according to the criteria of the questionnaire that has been validated by Research Diagnostic Criteria for Temporomandibular Disorders (RDC). All subjects underwent otoneurologicalavaliation consisting of anamnesis, otoscopyand computerized vectoelectronystagmography. Results: There were only three subjects with altered vectoelectronystagmography (modification of post-caloric nystagmus). There was a high occurrence of otoneurological symptoms, including dizziness (96%), intolerance to loud sounds, motion sickness (76%), insomnia (72%), fullness (64%) and tinnitus (52%). The muscles that had a prevalence of pain on palpation were temporal muscle tendon (96%), lateral pterygoid (96%), the middle portion of masseter (92%) and the lower masseter (68%). There was no statistically significant difference between individuals with and without changes in vectonystagmography on the main otoneurological symptoms.There was also no statistically significant difference between women with and without vertigo with respect to pain on palpation in the muscles studied. Conclusion: Individuals with TMD of muscular type showed a low rate of vestibular disorders revealed by the computerized vectoelectronystagmography despite the high occurrence of otoneurological symptoms.

Bakgrund: Befolkningens hälsoutveckling följs ofta genom enkätundersökningar. Dessa har ofta med en generell fråga om självskattad hälsa, vilket har visat sig ha samband med såväl fysiska som psykiska faktorer. För enkätundersökningar riktade till ungdomar används ofta en fråga om självskattat mående. Det är dock inte empiriskt klarlagt vad självskattat mående hos ungdomar egentligen mäter. Syfte: Studien syftar till att undersöka i vilken utsträckning självskattat mående hos ungdomar mäter hälsorelaterad livskvalitet, där både positiva och negativa aspekter av hälsa ingår, positiv hälsa i form av positiv psykisk hälsa, psykisk ohälsa i form av symptom på depression/ångest, fysisk ohälsa gällande symptom på smärta/värk samt medicinska tillstånd i form av astma, födoämnesallergi, allergi, migrän och öronsus/tinnitus. Metod: En kvantitativ metod med tvärsnittsdesign användes med data från enkätundersökningen Liv och Hälsa Ung 2014, där 4047 elever från årskurs nio på högstadiet och årskurs två på gymnasiet i Västmanland inkluderades. Korrelationsanalyser genomfördes. Resultat: Självskattat mående mäter hälsorelaterad livskvalitet, positiv psykisk hälsa och psykisk ohälsa i måttlig utsträckning, smärta/värk i liten utsträckning och medicinska tillstånd i mycket liten utsträckning.  Slutsats: Självskattat mående mäter psykiska faktorer mer än fysiska faktorer. Självskattat mående mäter även hälsorelaterad livskvalitet i måttlig utsträckning, vilket motsvarar ett helhetsperspektiv på hälsa. Självskattat mående bland ungdomar är inte en adekvat indikator för fysisk ohälsa vilket bör tas i beaktande när denna fråga tolkas i befolkningsundersökningar. / Background: The health development of the population is often followed by questionnaires. These often include a general question of self rated health, which has been shown to be associated with both physical and mental factors. For questionnaires aimed at adolescents, a genereal question of self rated well-being is often used. However, it is not empirically clear what that question really measure. Aim: This study aims at investigating to which extent self rated well-being among adolescents measures health related quality of life, including both positive and negative aspects of health, positive health in terms of positive mental health, mental health in terms of symptoms of depression/anxiety, physical health complaints and medical conditions. Method: A quantitative method with a cross-sectional design was used with data from ”Survey of Adolescent Life in Vestmanland” (SALVe), 2014, which included 4047 students in grade 9 in elementary school and grade 2 in high school in Västmanland. Correlation analysis were used. Results: Self rated well-being is measuring health related quality of life, positive mental health and mental health to a moderate extent, physical complaints to a small extent and medical conditions to a very small extent. Conclusion: Self rated well-being measures mental factors more than physical factors. Self rated well-being also measures health-related quality of life to a moderate extent, which corresponds with a holistic perspective of health. Self rated well-being among adolescents is not an adequate indicator of physical complaints and medical conditions, which should be taken into consideration when the result of the question is interpreted in population surveys.

Background information The premise of this study was that hearing deterioration, associated with treatment for head and neck cancer, has a negative impact on patients' quality of life. However, there have been no studies to assess this phenomenon in people receiving current UK treatment, and there is little information on the impact of subsequent hearing deterioration. Objective This study, conducted in one UK hospital, aimed to investigate the incidence and severity of hearing deterioration, and patient experience of it, following treatment for head and neck cancer. Design A sequential mixed methods explanatory design was chosen as it was the most appropriate for addressing the research aims. A critical realist framework underpinned the study. A prospective observational repeated measures design was employed to obtain quantitative data in Phase 1 of the study to assess changes in hearing at the end of treatment, and at 3-month follow-up post-treatment, using pre-treatment test level comparison. The Common Terminology Criteria for Adverse Events (version 4.03) were used to determine the incidence and severity of hearing deterioration. Results from Phase 1 were used to inform selection of participants for Phase 2 of the study. An approach informed by phenomenology using interview methodology, was used to explore patient experience of hearing deterioration. Study sample Fifty adults who had been diagnosed with head and neck cancer were recruited to Phase 1 of the study using a consecutive sampling approach. These participants were due to receive standard UK curative radiotherapy (intensity modulated radiotherapy) or chemoradiotherapy (including the use of cisplatin or carboplatin). From the 50 participants recruited, 13 who had hearing deterioration were selected using purposive sampling for one-to-one interviews to obtain in-depth information on their experience of hearing loss. Results The incidence of hearing deterioration was 57% in the 42 participants who completed testing at the end of treatment, and 50% percent in those who completed 3-month follow-up testing. At 3-month follow-up, 26% of participants had major (Grade 3) hearing deterioration in at least one ear. Patients who had chemoradiotherapy were more likely to experience hearing deterioration compared with those who had had radiotherapy only (p=0.01). Older patients were more at risk of hearing deterioration than younger participants (p=0.03), but if hearing deterioration occurred it appeared that younger patients suffered more severe deterioration than older patients (p=0.02). Aural change (including hyperacusis) experienced by some participants during treatment required a change in treatment regimen for them. Participants reporting either minor (Grade 1) or major hearing deterioration were adversely affected by their aural symptoms that manifested with treatment, and the impact of tinnitus (the incidence of which is not covered by existing studies), was extensive in head and neck cancer survivors. Another emerging finding in this study was that middle ear dysfunction, in the early post treatment phase, had a negative impact on patient experience. A further novel finding was that participants with bilateral mild-moderate or moderate severity, mid-high frequency sudden-onset hearing loss required lip-reading to assist their communication. There was evidence that some participants played down their aural symptoms, yet hearing deterioration had a negative impact on their overall quality of life, including generating a sense of loss (principally in older patients) and isolation (associated with younger patients). Finally, there was varied experience among participants receiving information on their hearing test results and on the process of receiving support for their hearing and tinnitus concerns. Conclusions and recommendations This current study provides evidence that could be used to increase awareness of the potential scale and impact of hearing deterioration following head and neck cancer treatment, in the early post treatment period. A larger multi-centre UK study would test the issues identified in the study to inform national policy, clinical practice and education. The study suggests a number of changes for consideration in improving current clinical practice when designing care provision of patients preparing for and recovering from radiotherapy or chemoradiotherapy for head and neck cancer. One key recommendation is for the adoption of a multidisciplinary approach in developing appropriate protocols to inform and support patients about hearing and tinnitus concerns that may occur with their treatment.

Orientador: Everardo Andrade da Costa / Dissertação (mestrado) - Universidade Estadual de Campinas, Faculdade de Ciencias Medicas / Made available in DSpace on 2018-08-04T02:20:32Z (GMT). No. of bitstreams: 1 Ogido_Rosalina_M.pdf: 7089279 bytes, checksum: 10c9c3ce4222a8f1f570a917ceaf8f8c (MD5) Previous issue date: 2004 / Resumo: A Perda Auditiva Induzida por Ruído Ocupacional (PAIRO) é a segunda causa de doença de origem ocupacional, nos trabalhadores atendidos pelo Centro de Referência de Saúde do Trabalhador (CRST) de Campinas. Foi realizado um estudo retrospectivo, dos trabalhadores com diagnóstico de PAIRO atendidos no CRST no período de 1997 a agosto de 2003. o objetivo foi avaliar a freqüência dos sintomas de disfunções auditivas e vestibulares como hipoacusia, zumbido e vertigem nestes trabalhadores, descrever a casuística e comparar os tipos de sintomas relatados com as variáveis idade, tempo de exposição ao ruído e limiares auditivos tonais. Foram pesquisados os prontuários médicos de 175 trabalhadores submetidos a avaliação audiológica e ocupacional, do banco de dados do CRST. Para descrever o perfil da amostra segundo as diversas variáveis em estudo, foram feitas tabelas de freqüência das variáveis categóricas e estatísticas descritivas das variáveis contínuas. Para analisar a associação entre os tipos de queixas e as variáveis categóricas de interesse foram utilizados o teste Qui-Quadrado ou o teste exato de Fisher. A amostra foi constituída de 174 homens e 1 mulher, com idade de 21 a 63 anos, média de tempo total de exposição ao ruído de 15,75anos. o principal ramo de atividade foi o da indústria metalúrgica, com 71,26% da amostra. Os sintomas vestibulares (tontura, vertigem), foram relatado em 13,22% dos casos, dos quais 88, 24% com freqüência esporádica. Em 80,81% dos relatos, houve a presença de zumbido. Destes, 54,14% de forma constante. Tanto os sintomas vestibulares quanto o zumbido não tiveram correlação com os limiares auditivos nem com o tempo de serviço. O sintoma hipoacusia foi relatado em 74,12% dos casos e apresentou correlação tanto com o tempo de serviço quanto com a idade e os limiares auditivos. Conclusões: Apesar dos avanços no conhecimento e na legislação sobre PAIR, ainda existem trabalhadores lesionados pelo ruído. Esta doença ocupacional gera inúmeros prejuízos para a sociedade e para o indivíduo acometido, seja dificultando a sua inserção no mercado de trabalho, seja prejudicando sua capacidade de comunicação e qualidade de vida, como demonstrado pela ocorrência de disfunções auditivas. Enfatiza-se a necessidade de prevenção da exposição ao ruído no ambiente de trabalho e fora dele, nos programas de educação, no diagnóstico precoce e no aprimoramento dos métodos de avaliação audiológica para as disfunções auditivas / Abstract: Noise Induced Hearing Loss is the second cause of occupational disease in the workers avaliated at Campinas Centro de Referência de Saúde do Trabalhador (CRST) . A retrospective study was conducted, avaliating the workers with the diagnosis of noise induced hearing loss attended at CRST from1997 to August 2003. The objective was to study the ITequencyof auditive disfunctions symptoms as difficulty to hear, tinnitus and vertigo in these workers, to describe the casuistic and to compare the related symptoms with the variables: duration of exposure to occupational noise, age and auditive thresholds. After audiological and occupational evaluation, the data of 175 workers with noise induced, loss diagnosis were stored at the CRST data bank Epi Info Program, version 6. To describe the sample profile according to the different variables studied, frequency tables of the categoric variables and descriptive statistic from the continuous variables were employed. To analyse the association between the complaints and the categoric variables of interest, the Qui-Square test or the Fisher exact test were employed. The gender distribution was 174 men and 1 woman, age from21 to 63 years old and the mean of occupational noise exposition time was 15.75years. The main function was metallurgical with 71.26% ofthe population. The dizziness symptom was related in 13.22% of the cases, 88,24% sporadically. The tinnitus was referred in 80.81% ofthe cases. In 54.14% the symptom was constant. To the dizziness and tinnitus, there was no correlation between the symptom with the auditory thresholds, nor the occupation noise exposure time. The hearing loss complaint was referred in 74.12% of the cases, and presents correlation with both the occupation noise exposure time, the age and the auditory thresholds, in the mean thresholds of 500, 1000 and 2000 Hz and 3000, 4000 and 6000 Hz, bilaterally. Conclusions: Despite of advances in the knowledge and in the legislation about noise induced hearing loss, there are still many workers impaired by noise exposure.This occupational disease causes losses to the society and to the injured worker: difficulty in the insertion at a newjob, difficulty in the communication ability and a worse quality of life as demonstrated by the occurrence of the auditive disfunctions. It needs to emphasize the noise exposure prevention at the work environnent and outside it, in the information, instruction and training programes, in the early diagnosis and in extending the audiologic evaluation methods for these disfunctions / Mestrado / Saude Coletiva / Mestre em Saude Coletiva

碩士 / 國立高雄師範大學 / 教育學類研究所 / 86 / Abstract The pruposes of the study were to investigate hearing and communication problems of workers with Noise Induced Hearing Loss(NIHL), to discover the effect of a self-designed Hearing Conservation Program(HCP)and to draw administrative and educational personnels'' attention to the issue of hearing conservation for workers. Subjects were 69 workers who had typical NIHL(V-typed)and 85 workers who had precipitous-typed hearing loss. They worked in a steel company in Kaohsiung cith. Workers hearing threshold levels and their answers to questionnaire of communicative problems were analyzed and the effect of HCP was examed on 43 NIHL workers. The results were as follows. I. For workers with V-typed audiograms: 1.The hearing level at 4kHz in the better ear of those who drank alcohol were worse than those who didn''t drink. The predictability of the hearing level at 4kHz in the better ear based on alcohol drinking was 6.56%. 2.Those who self-evaluated their hearing as poor, felt their hearing was getting worse, had tinnitus, wore ear-plugs more often, worked in noisy areas for less years, had more serious communicative problems. The predictability of communicative problems based on these five items were 43.53%. 3.The greater the loss of threshold at 1kHz in the left ear and at 0.5kHz in the right ear were, the more serious were the communicative problems. The predictability of the communicative problems with these three items were 10.46%. II. For wirkers with precipitous-typed audiograms: 1.Those wiho self-evealuated their hearing as poor, had a low level of education, felt their hearing was getting worse, the predictability of the threshold at 4kHz with these three items were 11.47%. 2.those who wore ear-plugs less, were older, drank alcohol, had passive attitudes toward ear-plugs wearing, smoked, the average of thresholds at 0.5kHz, 1kHz and 2kHz were worse. The predictability of the average of thresholds at 0.5kHz 1kHz and 2kHz with these five items were 31.65%. 3.Those who self-evaluated their hearing as poor, felt their hearing was getting worse, had tinnitus, self-evaluated their communicative ability as poor, had more serious communicative problems. The predictability of the communicative problems based on these four items were 44.1% 4.The greater the loss of threshold at 4kHz in the right ear and at 4kHz, 8kHz in the left ear, the more serious were the communicative problems. The predictability of the communicative problems with these three items were 10.46%. III.About half of NIHL workers had moderate to severe degree of difficulty in hearing comprehension. About 10% of NIHL workers had moderate to severe degree of troblesome in communication. About 15% of NIHL workers had moderate to severe degree problems in communication. IV.Workers with NIHL needed to improve their knowledge in HCP. V. The HCP was effective. The self-designed HCP was effective both in improving workers'' knowledge and in their attitudes toward HCP. They were satisfied with HCP program and appreciated the value of the HCP, realized that workers who worked in noisy areas needed to participate in HCP, and they wore ear-plugs more willingly.

Noise exposure is one of the most prevalent causes of irreversible occupational disease in Sweden and in many other countries. In hearing conservation programs, aimed at preventing noise-induced hearing loss, audiometry is an important instrument to highlight the risks and to assess the effectiveness of the program. A hazardous working environment and persons affected by it can be identified by monitoring the hearing thresholds of individual employees or groups of employees over time. However, in order to evaluate the prevalence of occupational noise-induced hearing loss, relevant reference data of unexposed subjects is needed. The first part of this dissertation concerns the changes in hearing thresholds over three decades in two occupational environments with high noise levels in the province of Östergötland, Sweden: the mechanical and the wood processing industries. The results show a positive trend, with improving median hearing thresholds from the 1970s into the 1990s. However, the hearing loss present also in the best period, during the 1990s, was probably greater than if the occupational noise exposure had not occurred. This study made clear the need for a valid reference data base, representing the statistical distribution of hearing threshold levels in a population not exposed to occupational noise but otherwise comparable to the group under study. In the second part of the dissertation, reference data for hearing threshold levels in women and men aged from 20 to 79 years are presented, based on measurements of 603 randomly selected individuals in Östergötland. A mathematical model is introduced, based on the hyperbolic tangent function, describing the hearing threshold levels as functions of age. The results show an age-related gender difference, with poorer hearing for men in age groups above 50 years. The prevalence of different degree of hearing loss and tinnitus is described for the same population in the third part of the dissertation. The overall prevalence of mild, moderate, severe or profound hearing loss was 20.9% collectively for women and 25.0% collectively for men. Tinnitus was reported by 8.9% of the women and 17.6% of the men. Approximately 2.4% of the subjects under study had been provided with hearing aids. However, about 7.7% were estimated to potentially benefit from hearing aids as estimated from their degree of hearing loss. Noise-induced hearing loss primarily causes damage to the outer hair cells of the inner ear. The fourth and last part of the dissertation evaluates the outer hair cell function, using otoacoustic emission measurements (OAE). Prevalence results from three different measuring techniques are presented: spontaneous otoacoustic emissions (SOAE), transient evoked otoacoustic emissions (TEOAE) and distortion product otoacoustic emissions (DPOAE). Gender and age effects on the recorded emission levels were also investigated. Women showed higher emission levels compared to men and for both women and men the emission levels decreased with increasing age. The results from the OAE recordings were shown to be somewhat affected by the state of the middle ear. The study included tympanometry, and the relation of the outcome ofthis test to the otoacoustic emissions is described, where high middle ear compliance resulted in low emission level. Reference data for the tympanometric measurements are also presented. The results of this project form an essential part of the important work against noiseinduced hearing loss, which needs continuous monitoring. The reference data presented here will provide a valid and reliable data base for the future assessment of hearing tests performed by occupational health centres in Sweden. This data base will in turn prove useful for comparison studies for Sweden as a responsible fellow EU member country setting high standards for work force safety. The statistical distribution of hearing threshold levels as a function of age for men and women in tabulated form is available on the Swedish Work Environment Authority (Arbetsmiljöverket) web site: http://www.av.se/publikationer/bocker/fysiskt/h293.shtm.

Cartilage Tissue Engineering. Joint pain and functional impairment due to cartilage damage from osteoarthritis and other means is a major source of disability for adults the world over. Cartilage is an avascular tissue with a very limited capacity for self repair. Current medical and surgical approaches to cartilage repair also have limited efficacy, and in all cases fail to completely restore a normal, healthy cartilage phenotype. Tissue engineering is a relatively new approach to cartilage repair that seeks to fabricate a replacement tissue, indistinguishable from healthy, native tissue. The basic idea of the tissue engineering approach is to seed tissue synthesizing cells into a shapeable, biocompatible/bioabsorbable scaffold that serves as a temporary extracellular matrix with a localized source of bioactive molecules to direct the development of new tissue. The challenge of tissue engineering is to identify cells, scaffolds, and growth conditions that will be optimal for tissue regeneration. The goal of the current studies was to evaluate one aspect of all three of the major components of cartilage tissue engineering: cell source, scaffolding material and preparation, and controlled growth factor delivery. We evaluated the chondrogenic potential of human nasal chondrocytes grown in calcium alginate in an in vivo culture system, the potential of computer-aided design and injection molding with calcium alginate to reliably reproduce complex geometries with high dimensional tolerances, and the potential for the controlled release of TGF-β1 from calcium alginate modified by the covalent addition of a recently discovered TGF-β binding peptide. We found that adult human nasal chondrocytes show significant chondrogenic potential when grown within an alginate scaffold. We also found that alginate is readily amenable to an injection molding process that utilizes precision made molds from computer-aided design and solid free form fabrication, allowing for the fabrication of tissue engineered constructs with very precise shape fidelity. Additionally, we found that calcium alginate could be reliably modified by the covalent addition of peptides, and that the addition of a newly discovered TGF-β binding peptide delayed the release of pre-loaded TGF-β1. Together these results show some of the encouraging prospects for cartilage tissue engineering. `Menière’s Syndrome.Menière’s syndrome is an inner ear disorder characterized by idiopathic endolymphatic hydrops with associated periodic tinnitus, vertigo, and progressive sensorineural hearing loss. It affects approximately 0.2% of the population, for whom it can be quite devastating. In addition to progressive hearing loss people with Menière’s syndrome are prone to sudden attacks of vertigo and tinnitus that are severe enough that they can lead to falls and potentially serious injury. People subject to frequent attacks are unable to drive, with obvious consequences on standard of living. In the current studies we evaluated the standard animal model of Menière’s syndrome by comparing cochlear turn specific hearing thresholds and the degree of hydrops in that turn. A positive correlation between these had previously been established in the study of human temporal bones from people with Menière’s syndrome, but had not been reported in the animal model. We also evaluated the potential of aminoguanidine, a relatively specific inhibitor of the inducible isoform of nitric oxide synthase, as a neuroprotective therapeutic agent for preservation of hearing in animals with surgically induced endolymphatic hydrops. We found, for the first time, a partial correlation between cochlear turn specific hydrops and hearing thresholds in the most commonly used animal model of Menière’s syndrome, helping to validate the utility of this animal model for future studies. We also found that aminoguanidine did indeed partially preserve hearing in animals with surgically induced Menière’s syndrome. This encouraging result appears to be the first report of a medical intervention protective against hearing loss in an animal model of Menière’s syndrome, and may help us to understand the etiology pathology seen in Menière’s syndrome.

Introduction: Systemic arterial hypertension is a highly prevalent disease in our society afflicting around 15% to 20% of the adult population aged 18 years and over. Symptoms as headache, dizziness, tinnitus, and weakness are usually regarded as effects of high blood pressure. Aim: This research aims at verifying existence alterations of the vestibulocochlear system in individuals suffering from systemic arterial hypertension. Methodology: The study group consisted of 19 systemic arterial hypertension patients, 7 men and 12 women, with ages ranging from 38 to 59. The control group consisted of 19 matched healthy individuals. They were submitted to anamnesis, basic hearing evaluation, and computerized vectoelectronystagmography (VENG). Results: the complaint about tinnitus was presented in 63,16% of the suffering HAS patients and in 42,10% in the group control individuals. In the hypertension patients group, 52,63 % have presented complaints about dizziness and 31, 58% in the group control patients. The hearing evaluation has presented alteration in 42,11% of the suffering HAS patients. None individual in the group control has presented alteration in the hearing evaluation. In VENG s conclusion, 57, 89% of the suffering HAS patients presented vestibular exam with no alteration, 26, 32% presented some alteration as the peripheral vestibular hyperfunction syndrome and 15, 79% of the patients presented peripheral vestibular hypofunction syndrome. In the group upon control, 84, 21% of the patients presented vestibular exams with no alteration, 10,53% presented alteration as the peripheral vestibular hyperfunction syndrome and only 5,26% presented alterations as the peripheral vestibular hypofunction syndrome. Conclusion: hypertension individuals presented major incidence in the hearing alteration in the vestibularcochlear system than non-hypertension individuals. / Introdução: A hipertensão arterial sistêmica (HAS) é uma doença altamente prevalente em nosso meio, atingindo cerca de 15 a 20% da população adulta com mais de 18 anos. Os sintomas, como cefáleia, tonturas, zumbido, fraqueza, costumam aparecer somente quando esta se eleva. Objetivo: Verificar a existência de alterações no aparelho vestíbulo-coclear em indivíduos portadores de HAS. Metodologia: Foram avaliados 19 pacientes, sendo 7 homens e 12 mulheres, com idade entre 38 e 59 anos, portadores de HAS e 19 pacientes sem queixa de HAS a fim de formar o grupo controle pareado. Realizou-se anamnese, avaliação audiológica básica e vectoeletronistagmografia computadorizada (VENG). Resultados: A queixa de zumbido esteve presente em 63,16% dos pacientes portadores de HAS e em 42,10% dos indivíduos do grupo controle. No grupo dos pacientes hipertensos, 52,63% apresentaram queixa de tontura e 31,58% dos pacientes do grupo controle. A avaliação audiológica apresentou-se alterada em 42,11% dos pacientes portadores de HAS. Nenhum indivíduo do grupo controle apresentou a avaliação audiológica alterada. Na conclusão da VENG, 57,89% dos pacientes portadores de HAS apresentaram exame vestibular sem alteração, 26,32% apresentaram alteração do tipo síndrome vestibular periférica irritativa e 15,79% dos pacientes apresentaram síndrome vestibular periférica deficitária. No grupo controle, 84,21% dos pacientes apresentaram exame vestibular sem alterações, 10,53% apresentaram alterações do tipo síndrome vestibular periférica irritativa e apenas 5,26% apresentaram alterações do tipo síndrome vestibular periférica deficitária. Conclusão: Indivíduos hipertensos apresentam maior incidência de alterações auditivas no aparelho vestíbulo-coclear, quando comparados à indivíduos não hipertensos.

Both audiologists and hearing instrument specialists (HIS) can assess hearing loss and fit hearing aids; consumers interested in purchasing hearing aids can choose the type of hearing professional they see. However, there are vast differences in required training and scope of practice for each professional and advanced test batteries, such as those associated with vestibular assessment and tinnitus management, may distinguish the two professional groups more thoroughly than standard hearing testing and hearing aid fitting. This study aimed to determine the knowledge and opinions the average individual possesses regarding differences between these two types of hearing professionals in order to identify areas in which audiologists can more effectively differentiate themselves from hearing instrument specialists. A one-time survey was administered at 3 locations to a total of 47 English-speaking participants over the age of 18. Locations included the 2018 Remote Area Medical event in Gray, TN; the Johnson City Senior Center, and the Bristol Public Library. The survey consisted of 8 demographic questions with 3 additional questions if the participant wore hearing aids, followed by 18 questions that covered “Diagnostics,” “Intervention,” and “Interpersonal Patient Interactions.” Responses were analyzed for trends in overall data as well as in sub-categories for gender, household income, education level, age, and hearing aid use. Overall, participants tended to believe audiologists were most likely to perform tasks in the “Diagnostic” category, while a majority of participants believed both professionals could perform tasks in the “Intervention” category. There was no clear trend within the “Interpersonal Patient Interactions” category. Most participants believed that either both professional groups, or only audiologists, could perform most tasks adequately, indicating subjects likely do understand differences between the two professionals. In analyzing results, two issues emerged. The first was that the majority of participants believed that they would not be likely to pay a reasonable price for hearing aids when visiting either professional. One reason may be that only a few hearing aid companies produce most of the world’s hearing aids, leaving little room for low-cost competition. The “bundled” method which most hearing healthcare providers use for selling hearing aids along with services might also exert an influence on the perception of hearing aid pricing and may not be clear to patients who try to understand the actual cost of devices and services. Another issue identified in this survey was access. A significant number of respondents believed it was difficult to make and attend appointments with either professional, signifying a possible deficit in this area in access to hearing healthcare. The barriers to access included income, availability of transportation, inconvenient provider hours, and lack of insurance coverage. The results suggested that audiologists and HISs face challenges when recommending personal hearing devices to support rehabilitative efforts. Additionally, the provision of services that utilize advanced diagnostic batteries, such as balance assessment and tinnitus services, may offer audiologists an opportunity to distinguish their practices from those managed by HISs.

Les dérivés de platine (cisplatine, oxaliplatine et carboplatine) et les taxanes (paclitaxel et docétaxel) font partie des grandes familles d’agents anticancéreux couramment utilisés en chimiothérapie. Ils permettent de traiter les tumeurs solides telles que les cancers de l’ovaire, du poumon, de la prostate, du sein, tête et cou. Cependant, ils sont à l’origine d’importantes neuropathies périphériques qui peuvent devenir irréversibles et laisser les patients avec des séquelles importantes. Il s'agit de vertiges, acouphènes, engourdissements, pertes de sensibilité, allodynies au toucher ou aux variations de température. Ces effets secondaires sont fortement contraignants et réduisent considérablement la qualité de vie de 30 à 50% des patients. L'importance clinique est considérable, puisque cela conduit environ 1/3 des patients atteints à l’arrêt et/ou au changement des traitements, bien que ceux-ci soient efficaces sur les tumeurs.Les dérivés de platine sont des agents pontants : leurs interactions avec les bases purines de l’ADN forment des adduits, qui vont être reconnus par des protéines de dommage à l’ADN, conduisant à la mort cellulaire. Les taxanes bloquent la dépolymérisation des microtubules, ce qui induit la mort des cellules en divisions. Le fait que deux mécanismes d’action antitumorale très différents provoquent, à court ou à moyen terme, les mêmes neuropathies périphériques, est paradoxal et n’a pas d’explication.Le but de mon projet de thèse était d’étudier le ou les mécanismes à l’origine de ces neuropathies et de développer une formulation visant à les réduire. Pour cela, j’ai étudié les effets des taxanes et dérivés de platine sur les canaux ioniques, impliqués dans la nociception. Ces canaux ioniques, appelés nocicepteurs, sont transcrits dans les corps cellulaires des ganglions spinaux (DRG), avant d’être principalement adressés à l’extrémité des nerfs périphériques. Ils détectent les stimuli mécaniques, thermiques et chimiques et génèrent ou transmettent les potentiels d’action correspondants. Le fait de perturber l’expression génique et/ou l’activité de ces nocicepteurs, aura donc pour conséquence de modifier les seuils de sensibilité et la transmission de différents stimuli.Mes résultats ont permis de quantifier dans des cultures primaires de DRG et in vivo chez la souris, le remodelage génique de nocicepteurs induit par les traitements de chimiothérapie, en corrélation avec l’apparition de neuropathies périphériques que j'ai mesurées par des tests comportementaux. Cela nous a permis d'identifier une famille de molécules candidates, qui pourraient potentiellement contrer le mécanisme identifié dans ces travaux. L'une de ces molécules permet de rétablir l’expression génique de nocicepteurs et aussi de supprimer les neuropathies périphériques chez la souris. Ce travail devrait se poursuivre dans le cadre d'un processus de valorisation, ayant pour objectif d'aboutir à un traitement préventif et/ou curatif, de ces neuropathies chez les patients. / Platinum-based drugs (cisplatin, oxaliplatin and carboplatin) and taxanes (paclitaxel and docetaxel) are among the most common drugs families used in chemotherapy. They are used for treatment of numerous human cancers including bladder, breast, head and neck, lung, ovarian, prostate and testicular cancers. However, these anticancer drugs cause significant peripheral neuropathies, that can become irreversible and leave serious clinical sequelae in patients. These include tinnitus, dizziness, tingling, numbness, loss of sensitivity, allodynia to touch or temperature changes and hyperalgesia. These side effects are highly restrictive and significantly reduce the quality of life of 30-50% of patients. The clinical significance is considerable, since it leads to about one-third of patients with stopping and/or changing treatments, although these are effective on tumors.Platinum-based drugs are DNA binding agents: they generate DNA lesions on the purine bases of DNA, that will be recognized by DNA damage response proteins, leading to cell death. Taxanes block the cell cycle in mitosis, by stabilizing the microtubule cytoskeleton against depolymerization. The fact that these two completely different antitumor mechanisms of action, induce the same peripheral neuropathies in the short to medium term, is paradoxical and has no explanation.The aim of my PhD research project was to study the mechanism(s) behind these neuropathies and to develop a new formulation to prevent and/or reduce them. Therefore, I studied the effects of taxanes and platinum-based drugs on several ion channels, involved in nociception. These ion channels, called nociceptors, are transcribed into the cell bodies of dorsal root ganglia (DRGs) and located to the peripheral nerve endings. They detect mechanical, thermal and chemical stimuli and generate or transmit the corresponding action potentials. Changes in gene expression and/or activity of nociceptors, will therefore modify the nociceptive thresholds and the transmission of different stimuli.My results allowed me to quantify, in primary cell culture of mouse DRGs and in vivo, the remodeling of ion channel expression induced by chemotherapy, in correlation with the development of peripheral neuropathies, that I measured by behavioral assessment. These results allowed us to identify a family of candidate molecules, that could potentially counteract the mechanism identified in this work. I showed that one of these molecules, can restore the gene expression of nociceptors and suppress peripheral neuropathies in mice. This work should continue as part of a valorization process, aiming to lead to a preventive and/or curative treatment, of these neuropathies in patients.